The association between frailty, the metabolic syndrome, and mortality over the lifespan

Abstract

Frailty and the metabolic syndrome are each associated with poor outcomes, but in very old people (90+ years) only frailty was associated with an increased mortality risk. We investigated the relationship between frailty, metabolic syndrome, and mortality risk, in younger (20-65 years) and older (65+ years) people. This is a secondary analysis of the US National Health and Nutrition Examination Survey (NHANES) datasets for 2003-2004 and 2005-2006, linked with mortality data up to 2011. The metabolic syndrome was defined using the International Diabetes Federation criteria. Frailty was operationalized using a 41-item frailty index (FI). Compared to the younger group (n = 6403), older adults (n = 2152) had both a higher FI (0.10 ± 0.00 vs. 0.22 ± 0.00, p < 0.001) and a greater prevalence of the metabolic syndrome (24.1 vs. 45.5%, p < 0.001). The metabolic syndrome and FI were correlated in younger people (r = 0.25, p < 0.001) but not in older people (r = 0.08, p < 0.1). In bivariate analyses, the FI predicted mortality risk in both age groups whereas the metabolic syndrome did so only in the younger group. In Cox models, adjusted for age, sex, race, education, and each other, the FI was associated with increased mortality risk at both ages (younger HR 1.05 (1.04-1.06); older HR 1.04 (1.03-1.04) whereas the metabolic syndrome did not contribute to mortality risk. The FI better predicted mortality than did the metabolic syndrome, regardless of age.

How healthy is the healthspan concept?

“…The health trajectory will be different in different individuals, but will generally trend downward with age. In principle, a Bhealthspan indexŵ hich quantifies overall health could be developed, perhaps akin to established frailty indices (Kane et al 2017;Kim et al 2017;Mitnitski et al 2017) or geropathology platforms (Snider et al 2018), but more inclusive of other aspects of health (e.g. emotional, psychological, etc.).…”

Hypertension impairs neurovascular coupling and promotes microvascular injury: role in exacerbation of Alzheimer’s disease

“…Hypertension in the elderly substantially increases the risk of Alzheimer's disease (AD); however, the underlying mechanisms are not completely understood (Forette et al 1998;Launer et al 2000;Israeli-Korn et al 2010;Guo et al 2001;Marr and Hafez 2014;Petrovitch et al 2000;van Dijk et al 2004;Joas et al 2012). In this review (published as part of the BTranslational Geroscience^initiative of the journal (Callisaya et al 2017;Kane et al 2017;Kim et al 2017;Liu et al 2017;Meschiari et al 2017;Perrott et al 2017;Shobin et al 2017;Ashpole et al 2017;Bennis et al 2017;Deepa et al 2017;Grimmig et al 2017;Hancock et al 2017;Konopka et al 2017;Podlutsky et al 2017;Sierra and Kohanski 2017;Tenk et al 2017;Ungvari et al 2017a;Urfer et al 2017a, b)), the effects of hypertension on structural and functional integrity of the cerebral microcirculation are considered, with a primary focus on cellular and molecular mechanisms involved in microvascular damage (capillary rarefaction, BBB disruption), neurovascular uncoupling, and the genesis of cerebral microhemorrhages and their potential role in exacerbation of cognitive decline associated with AD.…”

Evaluation of the pharmacokinetics of metformin and acarbose in the common marmoset

“…Certainly, studies testing the effects of compounds like acarbose and metformin on marmoset lifespan would be informative, but such long-term studies should also include more inclusive assessments of health or healthspan [33]. That is, it will be important to test whether acarbose or metformin (or even combination) will slow the physiological, functional and molecular changes associated with aging in mammalian species [34][35][36][37][38][39][40]…”