Skip to main content
SpringerLink
Log in

Nutritional Status and Renal Function in Relation to Frailty among the Community-Dwelling Elderly Taiwanese Population

  • Original Research
  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

Frailty is a significant public health and clinical issue among the elder population. This study aimed to evaluate the nutritional status and renal function in relation to frailty among elderly Taiwanese.

Design

We administered community-based health surveys to the elder population in Chiayi County, Taiwan, from 2017 to 2019.

Measurements

We measured nutritional status (including serum albumin and total protein levels), renal function (including serum blood urea nitrogen, creatinine, urine protein, and urine creatinine levels), hand grip strength (GS) and calculated appendicular muscle mass (AMM).

Results

The study recruited 3739 participants (2139 women). Participants of both sexes with normal GS had higher serum albumin levels and lower urine protein/creatinine ratios (UPCRs). For the men with normal and weak GS, serum albumin levels were 4.15 ± 0.2 and 4.10 ± 0.2 g/dL (p < 0.01), and UPCRs were 123.1 ± 219.6 and 188.7 ± 366.2 (p < 0.001), respectively. GS was positively correlated with serum albumin and urine creatinine levels (r = 0.136 and 0.177, both p < 0.001). AMM was also positively correlated with serum albumin and urine creatinine levels (r = 0.078 and 0.091, both p < 0.001). In the multivariate regression model, for every 1 g/dL increase in serum albumin level, there was a 1.9 and 1.7-kg increase in GS for men and women (p < 0.05 and p < 0.01), respectively. The final model for predicting GS included age, albumin, BUN, and UPCR (urine creatinine for women) which presented a variance of 22.1% and 13.8%, respectively.

Conclusion

Proper dietary nutritional intake and maintaining renal function are key elements for preventing frailty among elder population in Taiwan.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Yu R, Wong M, Chong KC, et al. Trajectories of frailty among Chinese older people in Hong Kong between 2001 and 2012: an age-period-cohort analysis. Age and Ageing. 2018;47(2):254–261. doi:https://doi.org/10.1093/ageing/afx170

    Article  Google Scholar 

  2. Dent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston JD. Management of frailty: opportunities, challenges, and future directions. The Lancet. 2019;394(10206):1376–1386. doi:https://doi.org/10.1016/S0140-6736(19)31785-4

    Article  Google Scholar 

  3. 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(3):M146–M157. doi:https://doi.org/10.1093/gerona/56.3.M146

    Article  CAS  Google Scholar 

  4. Campbell AJ, Buchner DM. Unstable disability and the fluctuations of frailty. Age Ageing. 1997;26(4):315–318. doi:https://doi.org/10.1093/ageing/26.4.315

    Article  CAS  Google Scholar 

  5. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. The Lancet. 2013;381(9868):752–762. doi:https://doi.org/10.1016/S0140-6736(12)62167-9

    Article  Google Scholar 

  6. Vermeiren S, Vella-Azzopardi R, Beckwée D, et al. Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis. Journal of the American Medical Directors Association. 2016;17(12):1163.e1–1163.e17. doi:https://doi.org/10.1016/j.jamda.2016.09.010

    Article  Google Scholar 

  7. Rosenberg IH. Sarcopenia: Origins and Clinical Relevance. The Journal of Nutrition. 1997;127(5):990S–991S. doi:https://doi.org/10.1093/jn/127.5.990S

    Article  CAS  Google Scholar 

  8. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16–31. doi:https://doi.org/10.1093/ageing/afy169

    Article  Google Scholar 

  9. Manini TM, Clark BC. Dynapenia and Aging: An Update. The Journals of Gerontology: Series A. 2012;67A(1):28–40. doi:https://doi.org/10.1093/gerona/glr010

    Article  Google Scholar 

  10. Syddall H, Cooper C, Martin F, Briggs R, Aihie Sayer A. Is grip strength a useful single marker of frailty? Age and Ageing. 2003;32(6):650–656. doi:https://doi.org/10.1093/ageing/afg111

    Article  Google Scholar 

  11. Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. The Lancet. 2015;386(9990):266–273. doi:https://doi.org/10.1016/S0140-6736(14)62000-6

    Article  Google Scholar 

  12. Buckinx F, Landi F, Cesari M, et al. Pitfalls in the measurement of muscle mass: a need for a reference standard: Measurement of muscle mass. Journal of Cachexia, Sarcopenia and Muscle. 2018;9(2):269–278. doi:https://doi.org/10.1002/jcsm.12268

    Article  Google Scholar 

  13. Bahat G, Tufan A, Tufan F, et al. Cut-off points to identify sarcopenia according to European Working Group on Sarcopenia in Older People (EWGSOP) definition. Clinical Nutrition. 2016;35(6):1557–1563. doi:https://doi.org/10.1016/j.clnu.2016.02.002

    Article  Google Scholar 

  14. Hsiao M-Y, Chang K-V, Wu W-T, Huang K-C, Han D-S. Grip Strength and Demographic Variables Estimate Appendicular Muscle Mass Better Than Bioelectrical Impedance in Taiwanese Older Persons. Journal of the American Medical Directors Association. 2021;22(4):760–765. doi:https://doi.org/10.1016/j.jamda.2020.08.003

    Article  Google Scholar 

  15. Sullivan DH. What do the serum proteins tell us about our elderly patients? J Gerontol A Biol Sci Med Sci. 2001;56(2):M71–74. doi:https://doi.org/10.1093/gerona/56.2.m71

    Article  CAS  Google Scholar 

  16. Reuben DB, Cheh AI, Harris TB, et al. Peripheral blood markers of inflammation predict mortality and functional decline in high-functioning community-dwelling older persons. J Am Geriatr Soc. 2002;50(4):638–644. doi:https://doi.org/10.1046/j.1532-5415.2002.50157.x

    Article  Google Scholar 

  17. Schalk BWM, Deeg DJH, Penninx BWJH, Bouter LM, Visser M. Serum albumin and muscle strength: a longitudinal study in older men and women. J Am Geriatr Soc. 2005;53(8):1331–1338. doi:https://doi.org/10.1111/j.1532-5415.2005.53417.x

    Article  Google Scholar 

  18. Snyder CK, Lapidus JA, Cawthon PM, et al. Serum albumin in relation to change in muscle mass, muscle strength, and muscle power in older men. J Am Geriatr Soc. 2012;60(9):1663–1672. doi:https://doi.org/10.1111/j.1532-5415.2012.04115.x

    Article  Google Scholar 

  19. Reijnierse EM, Trappenburg MC, Leter MJ, et al. Serum albumin and muscle measures in a cohort of healthy young and old participants. Age (Dordr). 2015;37(5):88. doi:https://doi.org/10.1007/s11357-015-9825-6

    Article  CAS  Google Scholar 

  20. Foley RN, Wang C, Ishani A, Collins AJ, Murray AM. Kidney function and sarcopenia in the United States general population: NHANES III. Am J Nephrol. 2007;27(3):279–286. doi:https://doi.org/10.1159/000101827

    Article  Google Scholar 

  21. Sabatino A, Cuppari L, Stenvinkel P, Lindholm B, Avesani CM. Sarcopenia in chronic kidney disease: what have we learned so far? J Nephrol. Published online September 2, 2020. doi:https://doi.org/10.1007/s40620-020-00840-y

  22. Toyama T, van den Broek-Best O, Ohkuma T, et al. Associations of Impaired Renal Function With Declines in Muscle Strength and Muscle Function in Older Men: Findings From the CHAMP Study. Newman A, ed. The Journals of Gerontology: Series A. 2019;74(11):1812–1820. doi:https://doi.org/10.1093/gerona/glz100

    Article  CAS  Google Scholar 

  23. Cadenas-Sanchez C, Sanchez-Delgado G, Martinez-Tellez B, et al. Reliability and Validity of Different Models of TKK Hand Dynamometers. Am J Occup Ther. 2016;70(4):7004300010p1. doi:https://doi.org/10.5014/ajot.2016.019117

    Article  Google Scholar 

  24. España-Romero V, Ortega FB, Vicente-Rodríguez G, Artero EG, Rey JP, Ruiz JR. Elbow Position Affects Handgrip Strength in Adolescents: Validity and Reliability of Jamar, DynEx, and TKK Dynamometers. Journal of Strength and Conditioning Research. 2010;24(1):272–277. doi:https://doi.org/10.1519/JSC.0b013e3181b296a5

    Article  Google Scholar 

  25. Oxford KL. Elbow positioning for maximum grip performance. J Hand Ther. 2000;13(1):33–36. doi:https://doi.org/10.1016/s0894-1130(00)80050-2

    Article  CAS  Google Scholar 

  26. Gürlek Demirci B, Sezer S, Tutal E, Çolak T, Uyanik S, Haberal M. Hand-Grip Strength Is Associated With Serum Testosterone and Albumin Levels in Male Kidney Transplant Recipients. Exp Clin Transplant. 2018;16 Suppl 1(Suppl 1):75–79. doi:https://doi.org/10.6002/ect.TOND-TDTD2017.O31

    Google Scholar 

  27. Baumgartner RN, Koehler KM, Romero L, Garry PJ. Serum albumin is associated with skeletal muscle in elderly men and women. The American Journal of Clinical Nutrition. 1996;64(4):552–558. doi:https://doi.org/10.1093/ajcn/64.4.552

    Article  CAS  Google Scholar 

  28. Visser M, Kritchevsky SB, Newman AB, et al. Lower serum albumin concentration and change in muscle mass: the Health, Aging and Body Composition Study. Am J Clin Nutr. 2005;82(3):531–537. doi:https://doi.org/10.1093/ajcn.82.3.531

    Article  CAS  Google Scholar 

  29. Smith G, Avenell A, Band MM, et al. Associations between frailty, physical performance, and renal biomarkers in older people with advanced chronic kidney disease. Eur Geriatr Med. Published online March 17, 2021. doi:https://doi.org/10.1007/s41999-021-00478-4

  30. Kabasawa K, Nakamura K, Ito Y, Tanaka J, Narita I. Association Between Estimated Glomerular Filtration Rate Based on Cystatin C and Grip Strength in Community-Dwelling Japanese Older Adults. Magaziner J, ed. The Journals of Gerontology: Series A. Published online October 30, 2020:glaa240. doi:https://doi.org/10.1093/gerona/glaa240

  31. Bůžková P, Barzilay JI, Fink HA, et al. Higher albumin:creatinine ratio and lower estimated glomerular filtration rate are potential risk factors for decline of physical performance in the elderly: the Cardiovascular Health Study. Clinical Kidney Journal. 2019;12(6):788–794. doi:https://doi.org/10.1093/ckj/sfz024

    Article  CAS  Google Scholar 

  32. Dodds RM, Syddall HE, Cooper R, et al. Grip strength across the life course: normative data from twelve British studies. PLoS One. 2014;9(12):e113637. doi:https://doi.org/10.1371/journal.pone.0113637

    Article  CAS  Google Scholar 

Download references

Acknowledgement

The authors thank Ms. Winnie Chu for her English writing and correction.

Funding

Funding: This research received no external funding.

Author information

Author notes

  1. These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, ROC

    C.-Y. Chang & M.-K. Tsai

  2. Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC

    C.-Y. Chang, M.-H. Lin, C.-C. Kuo, C.-H. Lu &  Nain-Feng Chu

  3. School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC

    D.-M. Wu &  Nain-Feng Chu

  4. PO Box 90048-509, Nei-Hu, Taipei, Taiwan, ROC

    Nain-Feng Chu

Authors
  1. C.-Y. Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M.-H. Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C.-C. Kuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C.-H. Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D.-M. Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M.-K. Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nain-Feng Chu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Author contributions: Dr. Chang CY: data analysis, manuscript writing and discussion. Dr. Lin MS: data analysis, manuscript processing and discussion. Dr. Kuo CC: data discussion and manuscript formatting. Dr. Lu CH: supervision and discussion. Prof. Wu DM: data processing and analysis, manuscript formatting. Dr. Tsai MK: instruction and supervision. Prof. Chu NF: study design, data discussion, manuscript formatting and supervision

Corresponding author

Correspondence to Nain-Feng Chu.

Ethics declarations

Conflict of interest: No potential conflict of interest relevant to this article was reported.

Ethical standard: The authors declare that the study procedures comply with current ethical standards for research involving human participants in Taiwan.

Additional information

Institutional Review Board Statement: The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of Tri-service General Hospital approved this study (Approval No.: TSGHIRB-1-108-05-073).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chang, CY., Lin, MH., Kuo, CC. et al. Nutritional Status and Renal Function in Relation to Frailty among the Community-Dwelling Elderly Taiwanese Population. J Nutr Health Aging 26, 6–12 (2022). https://doi.org/10.1007/s12603-021-1714-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-021-1714-3

Key words

Search

Navigation