Associations between physical frailty and dementia incidence: a prospective study from UK Biobank

Background Dementia is associated with a high burden of dependency and disability. Physical frailty (hereafter referred to as frailty) is a multisystem dysregulation that has been identified as a risk factor for dementia. The aim of this study was to examine the association of frailty and its individual components with all-cause dementia incidence in a cohort of UK adults. Methods Participants in UK Biobank with data available for dementia incidence and without any form of dementia at baseline were included in this prospective study. Frailty was defined using a modified version of the frailty phenotype based on five individual components (weight loss, tiredness, physical activity, gait speed, and grip strength), with participants classified as pre-frail if they fulfilled one or two criteria or frail if they fulfilled three or more. Associations between frailty and dementia incidence were investigated using Cox proportional hazard models adjusted for sociodemographic factors, lifestyle factors, and morbidity count. The population attributable fraction was also estimated. Findings Of 502535 participants in UK Biobank, 143 215 met the inclusion criteria and were included in our analyses. 68 500 (47·8%) of the participants were pre-frail and 5565 (3·9%) were frail. During a median follow-up period of 5·4 years, 726 individuals developed dementia. Compared with non-frail individuals, the risk of dementia incidence was increased for individuals with pre-frailty (hazard ratio 1·21 [95% CI 1·04–1·42]) and frailty (1·98 [1·47–2·67]) in the fully adjusted model. Of the five components used to define frailty, weight loss (1·31 [1·09–1·58]), tiredness (1·48 [1·18–1·86]), low grip strength (1·38 [1·17–1·63]), and slow gait speed (1·55 [1·22–1·96]) were independently associated with incident dementia. Based on population attributable fraction analyses, in the study sample, pre-frailty and frailty accounted for 9·9% and 8·6% of dementia cases, respectively. Interpretation Individuals with pre-frailty and frailty were at a higher risk of dementia incidence even after adjusting for a wide range of confounding factors. Early detection and interventions for frailty could translate into prevention or delayed onset of dementia

Understanding the link between physical capability markers, sarcopenia and frailty and adverse health outcomes

Although chronological age is the main determinant of ageing, physical and social environment factors play a crucial role in healthy ageing, even in earlier stages of life. Physical and biological limitations are not, necessarily, restricted to older ages. Therefore, considering the predicted rapid increase in the number of older people worldwide along with its individual and societal burden, research into healthy ageing – including middle-aged and older individuals – is a priority. Physical capability is the ability to perform the basic and instrumental activities of daily living. As the decline in physical function occurs progressively with age, the study of this process should start earlier in life and not only during older age. Low levels of physical capability markers (such as grip strength, muscle mass and physical performance [gait speed]) are strong predictors of future health, including premature mortality, cardiovascular and neurodegenerative diseases in middle-aged and old-aged populations. With age, the decline in physical function could occur in more than one marker. Consequently, the study of combined physical capability markers and their clinical combinations ‘sarcopenia’ and ‘frailty’ needs to be further explored using prospective data with common and non-common adverse health outcomes. Considering the associations of physical capability, sarcopenia, and frailty with adverse health outcomes are not fully understood (both investigated in isolation and as the combined effect), the main aim of this thesis was to determine the associations between measures of physical capability, sarcopenia, and frailty and a range of health outcomes, including mortality, cardiovascular (CVD) and respiratory diseases. To achieve this general aim, seven papers were completed and included in this thesis. Since the overall prevalence of frailty was already estimated using different classifications, the first paper included in this thesis systematically reports and summarises the overall prevalence of sarcopenia (and severe sarcopenia) using different global classifications. Using 6 main classifications, I estimated that the overall prevalence of sarcopenia ranges from 10% to 27% according to the classification used while the prevalence of severe sarcopenia ranges to 2 to 9%. Then, data from the UK Biobank study was used to investigate the association between the exposures and health outcomes. UK Biobank is a general cohort study that recruited over 500,000 participants between 2006 and 2010. Participants aged 37-73 years attended one of the 22 assessment research centres across Scotland, England and Wales at baseline. Using the UK Biobank data, the other six studies were carried out. Across these manuscripts, the associations between different exposures - combinations of sarcopenia, frailty, and individual physical capabilities – and adverse outcomes were determined in each manuscript included: incident and mortality for CVD, respiratory diseases, osteoporosis, cancer, COVID-19, dementia as well as all-cause mortality. In terms of individuals physical capability markers, the strongest association was identified between slow gait speed and incident COPD and respiratory disease as well as all-cause, respiratory and CVD. For incident osteoporosis instead, low muscle mass, followed by slow gait speed, were associated with a higher risk in both sexes. Regarding combinations of physical capability markers, slow gait speed plus low muscle mass, followed for severe sarcopenia, demonstrated the strongest association with incident respiratory disease and all-cause mortality. In terms of osteoporosis, pre-sarcopenic men and sarcopenic women showed a stronger association with incident osteoporosis. The study of the combination between frailty and sarcopenia categories identified that the highest CVD and respiratory risk was identified among frail and sarcopenic individuals. In addition, individuals with more than one clinical condition (frailty, sarcopenia, cachexia, and malnutrition) had almost five times higher risk of dying than those with none (hazard ratio (HR): 4.96 [95% CI: 2.73 to 9.01]). Finally, when frailty was investigated in isolation, I demonstrated that, independently of the frailty classification used, those with pre-frail or frail had a higher risk of severe covid-19. Moreover, pre-frail and frail individuals had an increased risk of all-cause dementia independently of confounder factors such as morbidity (HR pre-frail: 1.21 [95% CI: 1.04 to 1.42] and HR frail: 1.98 [95% CI: 1.47 to 2.67]). Therefore, this thesis demonstrated that individuals with lower physical capability, sarcopenia and/or frailty had a higher risk of adverse health outcomes, including: incidence and mortality for osteoporosis, CVD, respiratory disease, cancer, COVID-19, dementia, and all-cause mortality. These associations remained even after adjustment for a large range of potential confounders and existed both in middle-aged and older adult sub-groups. Considering that the age-related decline in physical capability markers, and therefore sarcopenia and frailty, could be delay and prevented, health interventions to improve physical capability that may reduce the risk of these outcomes are more urgent than ever

Reflexiones sobre la tuberculosis en Chile: avances y compromisos futuros

Carta al editor, no posee resumen

Parental support for physical activity in schoolchildren and its influence on nutritional status and fitness = Apoyo parental para realizar actividad física en escolares de 6 años de edad: influencia sobre el estado nutricional y fitness

Introduction: Parents are key models for transmitting and teaching healthy lifestyle habits to their children. Our objective was to determine the influence of the economic and motivational support, and parental involvement in their children physical activity (PA) and its relationship with nutritio nal status and cardiorespiratory fitness. Subjects and Method: Cross-sectional study which included 70 six-year-old schoolchildren. Parents completed the “The Parental Influence on Physical Activity Scale” questionnaire. Anthropometric variables were measured according to the Chilean Ministerial Technical Standard for the supervision of children from 0 to 9 years old; PA intensity was measured with triaxial accelerometers GT3X and the VO2max estimation was performed using the Navette Course test. Results: The average body mass index was 17.9 ± 2.9 kg/m2, the obesity prevalence and VO2max were 57.1%, and 38.05 ± 16.9 ml/kg/min, respectively. Moderate PA during the physical education (PE) class was significantly higher in boys compared to girls (p < 0.006). The economic and motivational support of the parents did not significantly influence the body weight of the children, BMI, waist circumference, PA intensity, and VO2max. Children supported by their parent showed significant differences with moderate PA performed in PE compared to those who were not suppor ted by parents (p = 0.023). Conclusions: Parental support of their children in performing physical activity influences the levels of moderate PA that they do during PE classes. This type of study should be continued and the PA should be measured daily

Efecto de una consulta nutricional protocolizada sobre el estado nutricional y hábitos alimentarios de adultos con sobrepeso y obesidad = Effect of a structured nutritional consultation on weight loss and eating habits in overweight and obese adults

Overweight and obesity affect 67% of population in Chile. Different strategies have been developed to reverse and improve this situation, nutritional consultation is one such strategy. However, consultation has not been structured and it is unknown whether this procedure has a positive effect for weight loss. The objective of this study was to assess the effectiveness of a structured nutritional consultation on weight loss and eating habits in overweight and obese adults in a family health center. A pre-post intervention study was performed with 30 participants over 3 months. Anthropometric measures (weight, body mass index (BMI) and waist circumference (WC) and % body fat), dietary intake and eating habits were the main outcomes of the study. A structured nutritional consultation was significantly associated with decreased weight, BMI, WC and % body fat. There were improvements in dietary intake habits. A 92% of the participants incorporated a snack mid-morning and a daily serving of low-fat dairy. Despite benefits observed after a structured nutritional consultation, larger studies with longer duration are warranted

Perceptual blindless in nutrition: We are in a critical time to be connected

Our health and well-being are affected by our food systems. The new nutrition reality has been linked to complex food systems, interrelated with several pathways and determinants, including physical, socioeconomic, environmental, and ecological, and lately, has been strongly associated with population health, the increase in chronic diseases, and climate change. We briefly comment on four pillars, namely food environments, food security, food supply, and safety and nutritional epidemiology, all of which are key determinants of food systems. We overview some highlights, challenges, and methodologies with a view to advancing food and nutrition science as an integrated field of research. By modifying food systems, we are able to improve the aging and well-being of populations and the health of the planet. Trusted science, nutritional education, new scientific-public communication, integrated policy, investment, food availability, and cultural strategies are all essential for creating better food systems. Perceptual blindness in nutrition must be transformed

Predictive ability of both the healthy aging index and the frailty index for all-cause mortality

Aim: We aimed to develop and assess a modified healthy aging index (HAI) among Chileans aged 60 years and older and compare its predictive ability for all-cause mortality risk with the frailty index (FI). Methods: This prospective study analyzed data from the Chilean National Health Survey (CNHS) conducted in 2009–2010. We included 847 adults with complete data to construct the HAI and FI. The HAI comprised five indicators (lung function, systolic blood pressure, fasting glucose, cognitive status, and glomerular filtration rate), while the FI assessed frailty using a 36-item scale. HAI scores were calculated by summing the indicator scores, ranging from 0 to 10, with higher scores indicating poorer health. Receiver operating curves (ROC) and area under the curve (AUC) were used to assess predictive validity. Associations with all-cause mortality were assessed using Cox proportional hazard models adjusted by confounders. Results: The mean HAI score was 4.06, while the FI score was 0.24. The AUC for mortality was higher for the HAI than the FI (0.640, 95% confidence interval (CI) 0.601 to 0.679 vs. 0.586, 95% CI 0.545 to 0.627). After adjusting for confounders, the FI showed a higher mortality risk compared to the HAI (2.63, 95% CI 1.76 to 3.51 vs. 1.16, 95% CI 1.08 to 1.26). Conclusion: The FI and HAI were valid predictors for all-cause mortality in the Chilean population. Integrating these indices into research and clinical practice can significantly enhance our capacity to identify at-risk individuals

Comparison of Diagnostic Models to Estimate the Risk of Metabolic Syndrome in a Chilean Pediatric Population: A Cross-Sectional Study

The pediatric population has various criteria for measuring metabolic syndrome (MetS). The diversity of consensus for diagnosis has led to different non-comparable reported prevalence. Given the increase in its prevalence in pediatric ages, it is necessary to develop efficient methods to encourage early detection. Consequently, early screening for the risk of MetS could favor timely action in preventing associated comorbidities in adulthood. This study aimed to establish the diagnostic capacity of models that use non-invasive (anthropometric) and invasive (serum biomarkers) variables for the early detection of MetS in Chilean children. A cross-sectional study was carried out on 220 children aged 6 to 11. Multivariate logistic regressions and discriminant analyses were applied to determine the diagnostic capacity of invasive and non-invasive variables. Based on these results, four diagnostic models were created and compared: (i) anthropometric, (ii) hormonal (insulin, leptin, and adiponectin), (iii) Lipid A (high-density cholesterol lipoprotein [HDL-c] and triglycerides [TG]) and (iv) Lipid B (TG/HDL-c). The prevalence of MetS was 26.8%. Lipid biomarkers (HDL-c and TG) and their ratio (TG/HDL-c) presented higher diagnostic capacity, above 80%, followed by body mass index (BMI, 0.71–0.88) and waist-to-height ratio (WHtR, 0.70–0.87). The lipid model A was the most accurate (sensitivity [S] = 62.7%, specificity [E] = 96.9%, validity index 87.7%), followed by the anthropometric model (S = 69.5%, E = 88.8% and validity index = 83.6%). In conclusion, detecting MetS was possible through invasive and non-invasive methods tested in overweight and obese children. The proposed models based on anthropometric variables, or serum biomarkers of the lipid model A, presented acceptable validity indices. Moreover, they were higher than those that measured adipokines, leptin, and adiponectin. The anthropometric model was the most cost-effective and easy to apply in different environments

Optimal cut-off points for waist circumference in the definition of metabolic syndrome in Chile

Objective: To identify sex-specific cut-off points for waist circumference (WC) in the definition of metabolic syndrome (MetS) for the Chilean adult population. Design: MetS was defined as the presence of at least two out of four of the following criteria: TAG ≥1·7 mmol/l; HDL-cholesterol: <1·3 mmol/l in women and <1·0 mmol/l in men; systolic blood pressure ≥130 mmHg and/or diastolic blood pressure ≥85 mmHg; and fasting glucose ≥ 5·6 mmol/l or current treatment for diabetes. The receiver operating characteristics curve and the AUC were computed to derive the specificity and sensitivity using bootstrapping (10 000 iterations restricted to have at least between 40 and 60 % of the original population). The optimal cut-off point for the Chilean population was computed by sex. Setting: A representative sample of the Chilean population aged ≥15 years. Participants: 8182 participants (60 % women) from the three available Chilean National Health Surveys conducted in 2003, 2009–2010 and 2016–2017. Results: WC had a good predictive ability for MetS (AUC for men 0·74 (95 % CI 0·72, 0·76); AUC for women 0·71 (95 % CI 0·68, 0·73)). The optimal cut-off points for WC, in the definition of MetS, were 92·3 cm (95 % CI 90·5, 94·4) and 87·6 cm (95 % CI 85·8, 92·1) for men and women, respectively. Conclusions: The mentioned cut-off points should be used for WC in the definition of MetS in Chile. As a result, the current recommendation (WHO/International Diabetes Federation) for WC, in the identification of MetS, is not supported by these findings in a representative sample of the Chilean adult population

Weight velocity in addition to latest weight does not improve the identification of wasting, or the prediction of stunting and mortality: a longitudinal analysis using data from Malawi, South Africa, and Pakistan

Background In low/middle-income countries, most nutritional assessments use the latest weights, without reference to growth trajectory. Objective This study explores whether velocity, in addition to the latest weight, improves the prediction of wasting, stunting or mortality in the first two years of life. Methods We analysed a combined data set with weight and height data collected monthly in the first year of 3447 children from Pakistan, Malawi, South Africa, with height and survival recorded till 24 months. The main exposures were weight-for-age z-score (WAZ) at the end of each 2-month period and weight velocity-for-age z-score (WVZ2) across that period. The outcomes were wasting, stunting or all-cause mortality in the next 1-2 months. As a sensitivity analysis, we also used WVZ over 6 months (WVZ6), with matching WAZ. Cox proportional hazard models with repeated growth measures were used to study the association between exposures and mortality. Mixed Poisson models were used for stunting and wasting. Results Children who were already stunted or wasted were most likely to remain so. WVZ2 was associated with a lower risk of subsequent stunting (RR 0.95; 95% CI 0.93-0.96), but added minimal prediction (difference in AUC = 0.004) compared to a model including only WAZ. Similarly, WVZ2 was associated with wasting (RR 0.74; 95% CI 0.72-0.76) but the prediction was only marginally greater than for WAZ (difference in AUC = 0.015). Compared to WAZ, WVZ6 was less predictive for both wasting and stunting. Low WVZ6 (but not WVZ2) was associated with increased mortality (HR 0.75, 95% CI 0.67-0.85), but added marginal only prediction to a model including WAZ alone (difference in C = 0.015). Conclusions The key anthropometric determinant of impending wasting, stunting, and mortality appears to be how far below the normal range the child’s weight is, rather than how they reached that position