Dietary patterns and intrinsic capacity among community-dwelling older adults: a 3-year prospective cohort study.

PURPOSE: The WHO has proposed a novel model of healthy aging called intrinsic capacity (IC). However, the association between dietary patterns and IC is unclear. We aimed to investigate the prospective associations between dietary patterns and IC trajectories over a 3-year period in community-dwelling Japanese adults aged ≥ 60 years. METHODS: A prospective cohort study which contained nutritional status, mental status, and physical function was used. A validated 34-item food frequency questionnaire was used to determine dietary intake and to derive five dietary patterns ("fruits and vegetables", "sugar and fat", "salt and pickles", "noodle and alcohol", and "protein-rich") using principal component analysis. The composite IC score was calculated as the mean of the locomotion Z-score, cognition Z-score, psychological Z-score, vitality Z-score, and sensory regression score. A generalized estimating equation was applied for longitudinal analysis. RESULTS: A total of 666 enrollees were included in the analysis. The mean baseline IC was 0.07 ± 0.47. The "fruits and vegetables" dietary pattern was positively associated with composite IC score changes after adjusting for confounders (Q4 vs. Q1: mean difference [0.069], P = 0.019). Similarly, a positive correlation was observed for the "protein-rich" dietary pattern with the composite IC score changes (Q4 vs. Q1: mean difference [0.092], Q3 vs. Q1: mean difference [0.101], Q2 vs. Q1: mean difference [0.083]; all P < 0.01). However, adherence to the "sugar and fat" dietary pattern was negatively associated with composite IC score changes (Q4 vs. Q1: mean difference [- 0.072], P = 0.026). Furthermore, the percentage of animal protein to total protein intake showed a significant incremental trend in the "protein-rich" dietary pattern (P for trend < 0.001). CONCLUSION: The "fruits and vegetables" and "protein-rich" (animal-based protein in particular) dietary patterns were positively associated with IC changes, whereas the "sugar and fat" dietary pattern was negatively associated with IC changes. Identification and promotion of healthy dietary patterns in older adults may inform future health policies and research.

The association of social frailty with intrinsic capacity in community-dwelling older adults: a prospective cohort study.

BACKGROUND: Social frailty is associated with poor health outcomes; however, its effects on healthy aging indicators have not been adequately investigated. This study assessed the longitudinal association between social frailty and the intrinsic capacity of community-dwelling older adults. METHODS: A total of 663 participants (56.7% women) aged ≥60 years from in Nagoya, Japan, were included in the study. The first measurement occurred in 2014, and annual follow-ups occurred until 2017. Social frailty was determined based on four items: financial difficulty, household status, social activity, and regular contact with others. A deficit score of 0 represented social robustness, 1 represented social prefrailty, and ≥ 2 represented social frailty. Intrinsic capacity was evaluated by the locomotion, cognition, psychological function, vitality, and sensory function domains. The longitudinal association was analyzed using generalized estimating equations. RESULTS: The prevalence of social prefrailty and social frailty at baseline was 31.2 and 6.3%, respectively. The social prefrailty group (ß = - 0.132, P < 0.001) and social frailty group (ß = - 0.258, P < 0.001) were associated with a greater reduction in the composite intrinsic capacity scores than the social robustness group, especially in the cognition, psychological function, and vitality domains. Men with social prefrailty/social frailty demonstrated a greater decrease in the psychological function domain score (- 0.512 vs. - 0.278) than women. Additionally, the cognition domain score only decreased in men in the social prefrailty/social frailty group (ß = - 0.122, P = 0.016). CONCLUSIONS: Social frailty was associated with intrinsic capacity and its subdomains longitudinally. Men with social frailty were more vulnerable than women to a decline in their psychological function and cognition domains. Therefore, the advanced management of social frailty is necessary to facilitate healthy aging.

Association between Japanese Diet Adherence and Muscle Weakness in Japanese Adults Aged ≥50 Years: Findings from the JSTAR Cohort Study.

Japanese diet adherence has been inversely correlated with muscle weakness. In this study, we aimed to validate that association. Longitudinal data from 1699 individuals aged ≥50 years (mean age 62.5 ± 6.9 years, 50.4% female) at two time points (2007 and 2011) were used. Participants without muscle weakness from several regions in Japan were included. The 12-component revised Japanese Diet Index (rJDI12) classified by tertiles assessed adherence to the Japanese dietary pattern. Muscle weakness was defined as a handgrip strength of ˂18 kg for females and ˂28 kg for males based on the Asian Working Group for Sarcopenia criteria 2019. A multivariate logistic approach was used to determine the relationship between rJDI12 tertile and the occurrence of muscle weakness by calculating the odds ratio (OR) and its 95% confidence interval (95% CI) throughout the observation period. Muscle weakness was negatively correlated with the highest rJDI12 tertile (OR [95% CI] 0.891 [0.814, 0.973] for T3). This association was consistent in sensitivity analyses with multiple imputations of missing values. Closely following the Japanese dietary pattern appears to reduce the occurrence of muscle weakness among the aging population in this study, suggesting it may prevent frailty and sarcopenia in the aging population.

Association of Japanese and Mediterranean Dietary Patterns with Muscle Weakness in Japanese Community-Dwelling Middle-Aged and Older Adults: Post Hoc Cross-Sectional Analysis.

The association of Japanese and Mediterranean dietary patterns with muscle weakness in middle-aged and older Japanese individuals is unclear. This cross-sectional study investigated the association between Japanese and Mediterranean dietary patterns and muscle weakness in community-dwelling, middle-aged, and older Japanese individuals (enrolled from 2007 to 2011). Based on the dietary consumption information obtained from the brief self-administered diet history questionnaire, we assessed adherence to the Japanese (12-component revised Japanese diet index (rJDI12)) and Mediterranean (alternate Mediterranean diet (aMed) score) dietary patterns. Muscle weakness was defined as handgrip strength <28 and <18 kg for men and women, respectively. Logistic regression was used to ascertain the relationship between dietary pattern and muscle weakness. In our study, with 6031 participants, the Japanese, but not Mediterranean, dietary pattern was inversely associated with muscle weakness (p for trend = 0.031 and 0.242, respectively). In the model adjusted for confounders, including energy intake, the highest quartile of rJDI12 scores (9-12 points), and the rJDI12 scores, entered as continuous variables, showed an independent association (odds ratio (95% CI), 0.703 (0.507-0.974), and 0.933 (0.891-0.977), respectively). Our findings showed that adherence to the Japanese dietary pattern is associated with a low prevalence of muscle weakness.

Hospital Frailty Risk Score predicts adverse events in older patients with vertebral compression fractures: Analysis of data in a nationwide in-patient database in Japan.

AIMS: This study investigated the usefulness of frailty for predicting adverse events in patients with vertebral compression fractures (VCFs) during hospitalization using data obtained from the Japanese health insurance system. METHODS: This retrospective cohort study of patients with VCFs aged ≥65 years was conducted using a nationwide database in Japan. We examined the relationships between frailty risk, classified using the Hospital Frailty Risk Score (HFRS), in-hospital mortality, and complications such as pressure ulcers and pneumonia. Multivariate logistic regression analysis was used to estimate the association between the HFRS and the outcomes of patients with VCFs. RESULTS: In this study, the data of 30 980 in-patients with VCFs were analyzed. Of these patients, 76.8%, 21.3%, and 1.9% had low, intermediate, and high risks of frailty, respectively. The higher the risk of frailty, the higher the rate of in-hospital mortality and the occurrence of all complications (P < 0.001 for trend). An intermediate risk of frailty was independently associated with in-hospital mortality (odds ratio [OR], 1.421; P < 0.001), whereas a high risk of frailty did not show statistical significance (OR, 1.385; P = 0.150). Each frailty risk was independently associated with the occurrence of all complications during hospitalization. CONCLUSIONS: The HFRS, which can assess the risk of frailty based on routinely collected medical records, was predictive of adverse events in older patients with VCFs based on a nationwide database in Japan. Future studies need to assess approaches to preventing adverse events in frail VCF patients. Geriatr Gerontol Int 2022; 22: 233-239.

Hospital Frailty Risk Score predicts adverse events in older patients with hip fractures after surgery: Analysis of a nationwide inpatient database in Japan.

BACKGROUND: Frailty may predict adverse events in patients with hip fractures. This study aimed to investigate the association between frailty and adverse events in patients with hip fractures after surgery using information from Japanese health insurance. METHODS: This retrospective cohort study included patients with hip fractures aged ≥ 65 years using a nationwide database in Japan. We examined the relationship of the frailty risk, which was defined using the Hospital Frailty Risk Score (HFRS), with in-hospital mortality, complications such as delirium and pneumonia, and functional outcomes. We used descriptive analysis, logistic regression, and linear regression analysis to estimate the association between the HFRS and outcomes in patients with hip fracture. RESULTS: We analysed data from 36,192 patients with hip fractures after surgery (mean age: 83.6 ± 6.7 years, female: 79.5%). The proportions of low, intermediate, and high risk of frailty were 68.4%, 28.1%, and 3.5%, respectively. The frailty risk was independently associated with in-hospital mortality (intermediate risk: odds ratio [OR] 1.385, P < 0.001; high risk: OR 1.572; P < 0.001) and the occurrence of complications. Furthermore, each frailty risk was negatively associated with the Barthel Index score at discharge (intermediate risk: coefficient -11.919, P < 0.001; high risk: coefficient -18.044; P < 0.001). CONCLUSIONS: The HFRS could predict adverse events, including in-hospital mortality, in Japanese older patients with hip fractures. This finding supports the validity of using the HFRS in clinical practice for patients with hip fractures.

Friendship-related social isolation is a potential risk factor for the transition from robust to prefrailty among healthy older adults: a 1-year follow-up study.

PURPOSE: Social factors are often overlooked when considering physical frailty. The purpose of this study was to determine whether social isolation is associated with new onset of physical frailty among healthy Japanese older adults. METHODS: This was a 1-year prospective cohort study conducted in Japan from August 2014 to August 2015. The participants were 229 Japanese older people (106 men, 123 women, mean age = 69.3 ± 4.2 years) who did not have prefrailty or frailty at baseline and who were current students or graduates of a community college for older people in Japan. Social isolation was assessed using the Lubben Social Network Scale-6 in terms of overall social isolation, family-related social isolation, and friendship-related social isolation. Frailty was categorized using the Fried frailty criteria. The association between new onset of physical frailty and baseline characteristics, including social isolation, was investigated. RESULTS: At 1-year follow-up, 180 (78.6%) of the participants remained robust, while 49 (21.4%) were identified as prefrail; no participants were identified as frail. Prefrailty was only associated with friendship-related social isolation (odds ratio: 4.58, 95% confidence interval 2.11-9.92, P < 0.001) at baseline. No significant associations were observed for any other baseline characteristics, including overall social isolation, family-related social isolation, comorbidities, body composition, and physical function. CONCLUSION: Older adults with friendship-related social isolation are four times more likely to develop prefrailty from robust during the 1-year follow-up. The results suggest that friendship-related social isolation increases the risk of healthy older adults transitioning from robust to prefrail.

A 3-year prospective cohort study of dietary patterns and frailty risk among community-dwelling older adults.

BACKGROUND & AIMS: The association between dietary patterns and frailty is less investigated in Asia. We aimed to investigate the prospective associations between dietary patterns and frailty index (FI) in community-dwelling Japanese older adults aged 60 years or older. METHODS: A 3-year cohort collected the data on sociodemographic information, lifestyle behaviors, comorbidities, medication history, depression status, nutrition, and physical function from 2014 to 2017. Five dietary patterns including "Mediterranean-style," "sugar and fat," "salt and pickles," "noodle and alcohol," and "protein-rich" dietary patterns were identified using principal component analysis from 20 food groups obtained using a validated food frequency questionnaire. A 54-item FI was constructed on the basis of a deficit accumulation model. This project aimed to investigate the longitudinal association between dietary pattern and frailty trajectories with annual measurements over a 3-year period using a generalized estimating equation. RESULT: After excluding 108 participants with incomplete data at baseline, 666 participants (56.5% female, 69.4 ± 4.4 years) were included for longitudinal analysis. Our results demonstrated that adherence score to "sugar and fat" dietary pattern" (Q4 vs. Q1: mean difference [0.017], 95% CI [0.006 to 0.029]) and "salt and pickles" dietary pattern (Q3 vs. Q1: mean difference [0.010], 95% CI [0.001 to 0.020]; Q4 vs. Q1: mean difference [0.014], 95% CI [0.003 to 0.025]) were positively associated with change in FI. Adherence score to a "protein-rich" dietary pattern was negatively associated with change in FI (Q4 vs. Q1: mean difference [-0.013], 95% CI [-0.025 to -0.002]). CONCLUSIONS: "Salt and pickles" dietary pattern and "sugar and fat" dietary pattern were positively associated with frailty. In contrast, "protein-rich" dietary pattern was negatively associated with frailty.

Built Environment and Frailty: Neighborhood Perceptions and Associations With Frailty, Experience From the Nagoya Longitudinal Study.

Neighborhood physical characteristics have been consistently associated with the health of older adults. This article investigates links between frailty and perceptions of the neighborhood environment. Using a cross-sectional analysis of 370 community-dwelling older adults from Nagoya, Japan, neighborhood perceptions were assessed using the Neighborhood Environmental Walkability Scale (NEWS) in addition to frailty, using a frailty index. Frailty was associated with the NEWS composite index, land use mix diversity, land use mix access, street connectivity, walking infrastructure, aesthetics, and crime safety, after adjustment for covariates. Older adults with increasing frailty have poorer perceptions of their neighborhoods, which could lead to further constriction of the life-space, less social and physical engagement, and worsening of frailty status.

Sex-Specific Association between Social Frailty and Diet Quality, Diet Quantity, and Nutrition in Community-Dwelling Elderly.

The effects of social frailty on diet and nutrition are under-investigated. Our study aimed to assess the association between social frailty and diet quality, diet quantity, and nutrition over a 3-year period in community-dwelling older Japanese adults. This prospective cohort study recruited individuals aged ≥60 years from a community college and followed up 666 participants annually. Social frailty was determined using a 4-item questionnaire. Diet quantity (energy and macronutrient intake) and diet quality (dietary diversity score and Diet Quality Index-International) were assessed using a food frequency questionnaire. Nutrition was evaluated using the Mini-Nutritional Assessment (MNA). Out of the 666 participants (56.5% women), 250 (37.5%) were categorized as having social prefrailty or frailty. Regarding diet quantity, energy intake (ß = -1.59kcal/kg/day, p < 0.01) and nutrient intake (protein intake, ß = -0.08g/kg/day; fat intake, ß = -0.06g/kg/day; carbohydrate intake, ß = -0.18g/kg/day; fiber intake, ß = -0.01g/kg/day; all p < 0.05) were lower in men with social prefrailty or frailty than in men with social robustness. Dietary diversity score (ß = -0.25, p = 0.01) and MNA score (ß = -0.32, p = 0.04) decreased in men with social prefrailty or frailty. However, these associations were not observed in women. Social frailty is associated with lower dietary intake, poor diet quality, and poor nutrition among community-dwelling older men. Future studies are required to determine the benefits of sex-specific interventions targeting social frailty on nutritional outcomes.

Frailty prevalence using Frailty Index, associated factors and level of agreement among frailty tools in a cohort of Japanese older adults.

Frailty prevalence defined by the deficit accumulation model (Frailty Index) has limited exploration in a Japanese population. The objective of this paper is to investigate the prevalence of frailty by Frailty Index among a cohort of healthy Japanese older adults, define risk factors associated with pre-frailty and frailty status and evaluate Frailty Index's agreement with Frailty Phenotype and Kihon checklist. METHODS: Data from 673 participants of the 2014 wave of the Nagoya Longitudinal Study - Healthy Elderly were used. Annual assessments include investigation of mood, memory, health status, nutrition, physical performance and oral health. The Frailty Index was compared to Frailty Phenotype and Kihon Checklist, and factors associated to Frailty Index were investigated through univariate and multivariate logistic regression. RESULTS: Frailty prevalence was 13.5% (n = 91) by Frailty Index, 1.5% (n = 10) by Frailty Phenotype and 4% (n = 27) by Kihon Checklist. Although the correlations between the three scales were moderate to high, the agreement between the scales was poor. In terms of risk factors, age, polypharmacy and physical activity level were associated with being pre-frail and frail. Having a higher waist circumference was associated with being pre-frail, and lower handgrip strength and lower walking speed were associated with being frail. CONCLUSIONS: The Frailty Index showed similar metrics and agreement comparable to findings of previous studies, and was able to identify a higher number of individuals who were pre-frail and frail. Age, polypharmacy, physical activity, waking speed and waist circumference were associated with pre-frailty and frailty by frailty index.

Is serum albumin a good marker for malnutrition in the physically impaired elderly?

BACKGROUND AND AIMS: Although serum albumin is well known as a marker of nutritional status, it has remained unclear whether impaired physical function affects serum albumin concentrations in older people. We examined whether hypoalbuminemia can be used as a marker of malnutrition in elderly subjects with various levels of physical impairment. METHODS: A total of 262 elderly subjects without acute illness were enrolled from various geriatric settings. For the nutritional assessment, serum albumin, total cholesterol, anthropometric measurements, and subjective global assessment (SGA) were determined. Physical function was evaluated by rating score of activity of daily living (ADL). RESULTS: As a whole, participants' serum albumin levels correlated with various nutritional parameters including anthropometric measurements and levels of serum total cholesterol as well as the SGA evaluation. However, after adjusting for age and gender, serum albumin levels in participants with a low ADL function did not correlate with nutritional parameters. Approximately 80% participants with low ADL function who were evaluated as being well nourished according to SGA evaluation had serum albumin levels lower than 35 g/l. CONCLUSIONS: The utility of serum albumin and the traditional cutoff (35 g/l) in older people with low ADL function is questionable even among those without inflammation.

Characteristics of physical prefrailty among Japanese healthy older adults.

AIM: The purpose of the present study was to clarify the characteristics of frailty at an early stage (prefrailty) in a healthy elderly Japanese population. METHODS: The participants were 620 healthy older adults (age range 60-89 years) who were current students or graduates of a community college for older adults in Japan. All participants were evaluated using the Kihon Checklist, a tool developed to screen for frailty in Japan. The participants were categorized by the Fried criteria (lost weight, handgrip strength, walking speed, exhaustion, physical activity) into either a prefrailty (1-2 criteria) or a non-frailty (0 criterion) group. RESULTS: In the logistic regression model for the prevalence of prefrailty, significant and independent determinants were chronic constipation (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.15-3.90, P = 0.016), occurrence of incontinence (OR 2.0, 95% CI 1.39-2.82, P < 0.001), unable to climb stairs (OR 3.0, 95% CI 1.26-7.02, P = 0.013), dry mouth (OR 1.5, 95% CI 1.04-2.22, P = 0.029), a lack of fulfillment (OR 3.2, 95% CI 1.26-7.93, P = 0.015), found easy tasks difficult (OR 2.8, 95% CI 1.30-5.85, P = 0.008) and felt helpless (OR 2.1, 95% CI 1.02-4.39, P = 0.044). CONCLUSIONS: These results suggest that the appearance of autonomic failure, oral malfunction and some psychological factors in relation to depressed mood, but not anthropometric measurements, are characteristic of prefrailty. Geriatr Gerontol Int 2017; 17: 1568-1574.

The nutritional status of frail elderly with care needs according to the mini-nutritional assessment.

BACKGROUND AND AIMS: Although malnutrition is common in the geriatric population, the relationship between frail elderly with various care needs and nutritional status remains unknown. The purpose of this study was to analyze the association between subjects with higher care needs and poorer nutritional status in the Japanese community-dwelling frail elderly. METHODS: A total of 281 community-dwelling elderly subjects from day-care centers (81.9+/-7.2yr of age mean+/-SD; 72 men and 209 women) who were eligible for Long-Term Care Insurance were enrolled in this study to evaluate their nutritional status using the mini-nutritional assessment. The levels of care needs of participants were classified into six levels according to the Long-Term Care Insurance program. RESULTS: According to the mini-nutritional assessment classification, 39.9%, 51.2%, and 8.9% of the participants were assessed as well-nourished, at-risk of malnutrition, and malnourished, respectively. There were significant differences among the six groups with regard to the nutritional status; subjects with higher care needs were associated with poorer nutritional status. In the higher care needs group, more than half of the subjects did not know their weight change during 3-month intervals. CONCLUSIONS: The population of elderly with higher care needs in the community is associated with a higher prevalence of malnutrition.

Association between masticatory performance and anthropometric measurements and nutritional status in the elderly.

AIM: The association between chewing ability and physical constitution and nutritional status remains uncertain in the elderly. We examined the relationships between chewing ability and anthropometric measurements or nutritional status in the elderly. METHODS: A total of 200 subjects (78 men and 122 women; mean age +/- standard deviation, 76.6 +/- 7.1) were enrolled from geriatric clinical settings. Chewing ability was evaluated by color-changeable chewing gum. Bodyweight, body mass index, mid-upper-arm circumference (MAC), and triceps skinfold, grip strength, serum albumin, physical and cognitive functions, depressive status, and dental status were determined. RESULTS: Correlations were found between chewing ability and bodyweight, MAC, dental status, physical and cognitive functions, and depressive status after adjusting for age and sex. The concentrations of serum albumin were well-correlated with chewing ability and anthropometric measurements. Stepwise linear regression analyses revealed that the masticatory cycle, dental status, bodyweight and MAC are predictors of chewing ability, and that age, chewing ability, grip strength and sex are predictors of serum albumin concentrations. CONCLUSION: Chewing ability is associated with not only oral health status but also the physical constitution of the elderly. In addition, chewing ability may add to the regulation of the nutritional status in the elderly.

Raised homocysteine and low folate and vitamin B-12 concentrations predict cognitive decline in community-dwelling older Japanese adults.

BACKGROUND & AIMS: Recently, poor cognition and dementia have been associated with elevated homocysteine and low B vitamin concentrations. The aim of this study is to examine the association in community-dwelling older Japanese adults. METHODS: Ninety-nine subjects (71 women and 28 men; mean age 75 years) were eligible for analysis after exclusion of subjects with high serum creatinine concentrations (1.3mg/dl and over) and those taking vitamin supplements. Fasting blood samples were analyzed for plasma total homocysteine, serum folate, and serum vitamin B-12. Global cognitive function was assessed using the Mini-Mental State Examination (MMSE). RESULTS: Multiple regression analysis revealed that homocysteine concentrations were predicted by concentrations of vitamin B-12 (p<0.001), folate (p<0.005), and creatinine (p<0.001) and age (p<0.005). Scores on the MMSE were associated with concentrations of homocysteine, vitamin B-12, and folate. The association between folate or vitamin B-12 concentrations and MMSE scores remained significant after adjusting for homocysteine concentrations. Folate concentrations, but neither homocysteine nor vitamin B-12 concentrations, were significantly associated with serum albumin concentrations. CONCLUSIONS: Reduced folate and vitamin B-12 concentrations were independently associated with cognitive decline. The correlation between folate and albumin concentrations may imply that the reduction of folate in the Japanese older population is due to nutritional deficiency.