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Appendicular lean mass and mortality among prefrail and frail older adults

  • Published:
The journal of nutrition, health & aging

Abstract

Objective

Prefrail and frail older adults are a heterogeneous population. The measurement of appendicular lean mass (ALM) may distinguish those at higher versus lower risk of poor outcomes. We examined the relationship between ALM and mortality among prefrail and frail older adults.

Design

This was a population-based cohort study.

Setting

The Third National Health and Nutrition Survey (NHANES III; 1988-1994).

Participants

Older adults (age ≥65 years) with pre-frailty or frailty defined using the Fried criteria.

Measurements

ALM was quantified using bioimpedance analysis. Multivariable-adjusted Cox regression analysis examined the relationship between ALM and mortality. Logistic regression analysis was used to determine if ALM added to age and sex improved the predictive discrimination of five-year and ten-year mortality.

Results

At baseline, the average age was 74.9 years, 66.7% were female, 86.3% and 13.7% were prefrail and frail, respectively. The mean ALM was 18.9 kg [standard deviation (SD): 5.5]. During a median 8.9 years of follow-up, 1,307 of 1,487 study participants died (87.9%). Higher ALM was associated with a lower risk of mortality. In a multivariable-adjusted regression model that accounted for demographic, behavioral, clinical, physical function, and frailty characteristics, each SD increase in ALM was associated with an 50% lower risk of mortality [Hazard Ratio: 0.50 (95% CI: 0.27-0.92); P=0.026]. The addition of ALM to age and sex improved the predictive discrimination of five-year (P=0.027) and ten-year (P=0.016) mortality.

Conclusion

ALM distinguishes the risk of mortality among prefrail and frail older adults. Additional research examining ALM as a therapeutic target is warranted.

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References

  1. Gallagher D, Visser M, De Meersman RE, et al. Appendicular skeletal muscle mass: effects of age, gender, and ethnicity. J Appl Physiol (1985). 1997;83:229–239.

    CAS  Google Scholar 

  2. Auyeung TW, Lee SWJ, Leung J, Kwok T, Woo J. Age-associated decline of muscle mass, grip strength and gait speed: A 4-year longitudinal study of 3018 communitydwelling older Chinese. Geriatrics & gerontology international. 2014;14:76–84.

    Article  Google Scholar 

  3. Kitamura I, Koda M, Otsuka R, Ando F, Shimokata H. Six-year longitudinal changes in body composition of middle-aged and elderly Japanese: Age and sex differences in appendicular skeletal muscle mass. Geriatrics & gerontology international. 2014;14:354–361.

    Article  Google Scholar 

  4. Marzetti E, Leeuwenburgh C. Skeletal muscle apoptosis, sarcopenia and frailty at old age. Exp Gerontol. 2006;41:1234–1238.

    Article  CAS  PubMed  Google Scholar 

  5. Idoate F, Cadore EL, Casas-Herrero A, et al. Adipose tissue compartments, muscle mass, muscle fat infiltration, and coronary calcium in institutionalized frail nonagenarians. Eur Radiol. 2014:1–13.

    Google Scholar 

  6. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2001;56:M146–M157.

    Article  CAS  Google Scholar 

  7. Montero-Odasso M, Bergman H, Béland F, Sourial N, Fletcher JD, Dallaire L. Identifying mobility heterogeneity in very frail older adults. Are frail people all the same? Arch Gerontol Geriatr. 2009;49:272–277.

    Article  PubMed  Google Scholar 

  8. Plan and operation of the Third National Health and Nutrition Examination Survey, 1988-94. Series 1: programs and collection procedures. Vital Health Stat 1. 1994;(32):1–407.

    Google Scholar 

  9. Brown JC, Harhay MO, Harhay MN. The Prognostic Importance of Frailty in Cancer Survivors. J Am Geriatr Soc. 2015;2015;63:2538–2543.

    Article  Google Scholar 

  10. Janssen I, Heymsfield SB, Baumgartner RN, Ross R. Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol (1985). 2000;89:465–471.

    CAS  Google Scholar 

  11. Lukaski HC, Johnson PE, Bolonchuk WW, Lykken GI. Assessment of fat-free mass using bioelectrical impedance measurements of the human body. Am J Clin Nutr. 1985;41:810–817.

    CAS  PubMed  Google Scholar 

  12. Baar Hv, Hulshof P, Tieland M, de Groot C. Bio-impedance analysis for appendicular skeletal muscle mass assessment in (pre-) frail elderly people. Clinical Nutrition ESPEN. 2015.

    Google Scholar 

  13. Rogot E, Sorlie P, Johnson NJ. Probabilistic methods in matching census samples to the National Death Index. J Chronic Dis. 1986;39:719–734.

    Article  CAS  PubMed  Google Scholar 

  14. National Center for Health Statistics. NHANES III Questionnaires, Datasets and Related Documentation. Available at: http://www.cdc.gov/nchs/nhanes/nh3data.htm.

  15. Obisesan TO, Obisesan OA, Martins S, et al. High blood pressure, hypertension, and high pulse pressure are associated with poorer cognitive function in persons aged 60 and older: the Third National Health and Nutrition Examination Survey. J Am Geriatr Soc. 2008;56:501–509.

    Article  PubMed  PubMed Central  Google Scholar 

  16. National Center for Health Statistics. Laboratory Procedures Used for the Third National Health and Nutrition Exam Survey (NHANES III), 1988-1994. Available at: http://wonder.cdc.gov/wonder/sci_data/surveys/hanes/hanes3/type_txt/lab.asp.

  17. Lacher DA, Hughes JP, Carroll MD. Estimate of biological variation of laboratory analytes based on the third national health and nutrition examination survey. Clin Chem. 2005;51:450–452.

    Article  CAS  PubMed  Google Scholar 

  18. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49:M85–94.

    Article  CAS  PubMed  Google Scholar 

  19. Korn EL, Graubard BI. Epidemiologic studies utilizing surveys: accounting for the sampling design. Am J Public Health. 1991;81:1166–1173.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Villareal DT, Smith GI, Sinacore DR, Shah K, Mittendorfer B. Regular multicomponent exercise increases physical fitness and muscle protein anabolism in frail, obese, older adults. Obesity. 2011;19:312–318.

    Article  CAS  PubMed  Google Scholar 

  21. Bibas L, Levi M, Bendayan M, Mullie L, Forman DE, Afilalo J. Therapeutic interventions for frail elderly patients: part I. Published randomized trials. Prog Cardiovasc Dis. 2014;57:134–143.

    Article  PubMed  Google Scholar 

  22. Cesari M, Vellas B, Hsu FC, et al. A Physical Activity Intervention to Treat the Frailty Syndrome in Older Persons-Results From the LIFE-P Study. J Gerontol A Biol Sci Med Sci. 2014.

    Google Scholar 

  23. Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB, Walston JD. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc. 2004;52:625–634.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania School of Medicine, 423 Guardian Drive, 8th Floor, Blockley Hall, Philadelphia, Pennsylvania, 19104, USA

    Justin C. Brown & M. O. Harhay

  2. Division of Nephrology, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA

    M. N. Harhay

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  1. Justin C. Brown
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  2. M. O. Harhay
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Correspondence to Justin C. Brown.

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Brown, J.C., Harhay, M.O. & Harhay, M.N. Appendicular lean mass and mortality among prefrail and frail older adults. J Nutr Health Aging 21, 342–345 (2017). https://doi.org/10.1007/s12603-016-0753-7

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  • DOI: https://doi.org/10.1007/s12603-016-0753-7

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