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.
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References
Alberti KGMM, Zimmet P, Shaw J (2006) Metabolic syndrome--a new world-wide definition. A consensus statement from the international diabetes federation. Diabet Med 23:469–480. doi:10.1111/j.1464-5491.2006.01858.x
Alexander CM, Landsman PB, Teutsch SM, Haffner SM (2003) NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older. Diabetes 52:1210–1214. doi:10.2337/diabetes.52.5.1210
Avila-Funes J, Medina-Campos R, Tamez-Rivera O et al (2014) Frailty is associated with disability and recent hospitalization in community-dwelling elderly: the Coyoacan Cohort. J Frailty Aging 3:206–210
Barzilay JI, Blaum C, Moore T et al (2007) Insulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study. Arch Intern Med 167:635–641. doi:10.1001/archinte.167.7.635
Blodgett J, Theou O, Kirkland S et al (2015) Frailty in NHANES: comparing the frailty index and phenotype. Arch Gerontol Geriatr 60:464–470. doi:10.1016/j.archger.2015.01.016
Blom JW, de Ruijter W, Witteman JCM et al (2013) Changing prediction of mortality by systolic blood pressure with increasing age: the Rotterdam study. Age (Dordr) 35:431–438. doi:10.1007/s11357-011-9349-7
Case A, Paxson C (2005) Sex differences in morbidity and mortality. Demography 42:189–214. doi:10.2307/4147343
Cesari M, Leeuwenburgh C, Lauretani F et al (2006) Frailty syndrome and skeletal muscle: results from the Invecchiare in Chianti study. Am J Clin Nutr 83:1142–1148. doi:10.1037/1528-3542.8.3.425.Beyond
Clegg A, Young J, Iliffe S et al (2013) Frailty in elderly people. Lancet 381:752–762. doi:10.1016/S0140-6736(12)62167-9
Collard RM, Boter H, Schoevers RA, Oude Voshaar RC (2012) Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 60:1487–1492. doi:10.1111/j.1532-5415.2012.04054.x
Collerton J, Martin-Ruiz C, Davies K et al (2012) Frailty and the role of inflammation, immunosenescence and cellular ageing in the very old: cross-sectional findings from the Newcastle 85+ study. Mech Ageing Dev 133:456–466. doi:10.1016/j.mad.2012.05.005
Hao Q, Song X, Yang M et al (2016) Understanding risk in the oldest old: frailty and the metabolic syndrome in a Chinese community sample aged 90+ years. J Nutr Heal Aging 20:82–88. doi:10.1007/s12603-016-0680-7
Howlett SE, Rockwood MRH, Mitnitski A, Rockwood K (2014) Standard laboratory tests to identify older adults at increased risk of death. BMC Med 12:171. doi:10.1186/s12916-014-0171-9
Hu G, Qiao Q, Tuomilehto J et al (2004) Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women. Arch Intern Med 164:1066–1076. doi:10.1001/archinte.164.10.1066
Hubbard RE, Theou O (2012) Frailty: enhancing the known knowns. Age Ageing 41:574–575. doi:10.1093/ageing/afs093
Hubbard RE, Woodhouse KW (2010) Frailty, inflammation and the elderly. Biogerontology 11:635–641. doi:10.1007/s10522-010-9292-5
Kulminski A, Ukraintseva S, Kulminskaya I et al (2008a) Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. J Am Geriatr Soc 56:898–903. doi:10.1111/j.1532-5415.2008.01656.x.Cumulative
Kulminski AM, Culminskaya IV, Ukraintseva SV et al (2008b) Sex-specific health deterioration and mortality: the morbidity-mortality paradox over age and time. Exp Gerontol 43:1052–1057. doi:10.1016/j.exger.2008.09.007
Lafortune L, Martin S, Kelly S et al (2016) Behavioural risk factors in mid-life associated with successful ageing, disability, dementia and frailty in later life: a rapid systematic review. PLoS One 11:1–34. doi:10.1371/journal.pone.0144405
Lakka HM, Laaksonen DE, Lakka TA et al (2002) The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 288:2709–2716
Le Couteur DG, Simpson SJ (2011) Adaptive senectitude: the prolongevity effects of aging. Journals Gerontol - Ser A Biol Sci Med Sci 66(A):179–182. doi:10.1093/gerona/glq171
Lee WY, Jung CH, Park JS et al (2005) Effects of smoking, alcohol, exercise, education, and family history on the metabolic syndrome as defined by the ATP III. Diabetes Res Clin Pract 67:70–77. doi:10.1016/j.diabres.2004.05.006
Lin F, Roiland R, Chen D, Qiu C (2015) Linking cognition and frailty in middle and old age: metabolic syndrome matters. Int J Geriatr Psychiatry 30:64–71. doi:10.1126/scisignal.2001449.Engineering
Maggi S, Noale M, Gallina P et al (2006) Metabolic syndrome, diabetes, and cardiovascular disease in an elderly Caucasian cohort: the Italian Longitudinal Study on Aging. Journals Gerontol Ser A Biol Sci Med Sci 61:505–510. doi:10.1093/gerona/61.5.505
McNeill AM, Rosamond WD, Girman CJ et al (2005) The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study. Diabetes Care 28:385–390. doi:10.2337/diacare.28.2.385
Meigs JB, Wilson PWF, Nathan DM et al (2003) Prevalence and characteristics of the metabolic syndrome in the San Antonio Heart and Framingham Offspring Studies. Diabetes 52:2160–2167. doi:10.2337/diabetes.52.8.2160
Mitnitski AB, Mogilner AJ, MacKnight C, Rockwood K (2002) The mortality rate as a function of accumulated deficits in a frailty index. Mech Ageing Dev 123:1457–1460
Mitnitski A, Song X, Rockwood K (2013) Assessing biological aging: the origin of deficit accumulation. Biogerontology 14:709–717. doi:10.1007/s10522-013-9446-3
Mohler MJ, Fain MJ, Wertheimer AM et al (2014) The frailty syndrome: clinical measurements and basic underpinnings in humans and animals. Exp Gerontol 54:6–13. doi:10.1016/j.exger.2014.01.024
Park Y, Zhu S, Palaniappan L et al (2003) The metabolic syndrome. Arch Intern Med 163:427–436. doi:10.1007/978-3-7091-1331-8
Price GM, Uauy R, Breeze E et al (2006) Weight, shape, and mortality risk in older persons: elevated waist- hip ratio, not high body mass index, is associated with a greater risk of death. Am J Clin Nutr 84:449–460
Rockwood K, Mitnitski A (2007) Frailty in relation to the accumulation of deficits. Journals Gerontol Biol Sci Med Sci 62:722–727. doi:10.1093/gerona/62.7.722
Rockwood K, Song X, Mitnitski AB (2011) Changes in relative fitness and frailty across the adult lifespan: evidence from the Canadian National Population Health Survey. Can Med Assoc J 138:487–494. doi:10.1503/cmaj.110626
Sattar N, McConnachie A, Shaper AG et al (2008) Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies. Lancet 371:1927–1935. doi:10.1016/S0140-6736(08)60602-9
Scuteri A, Najjar SS, Morrell C, Lakatta E (2005) The metabolic syndrome in older individuals: prevalence and prediction. Diabetes Care 28:882–887
Singh GM, Danaei G, Farzadfar F et al (2013) The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis. PLoS One 8:e65174. doi:10.1371/journal.pone.0065174
Song X, Mitnitski A, Rockwood K (2011) Nontraditional risk factors combine to predict Alzheimer disease and dementia. Neurology 77:227–234. doi:10.1212/WNL.0b013e318225c6bc
Tang Z, Wang C, Song X et al (2013) Co-occurrence of cardiometabolic diseases and frailty in older Chinese adults in the Beijing longitudinal study of ageing. Age Ageing 42:346–351. doi:10.1093/ageing/aft004
Vaupel JW, Manton KG, Stallard E (1979) The impact of heterogeneity in individual frailty on the dynamics of mortality. Demography 16:439–454. doi:10.2307/2061224
Viscogliosi G (2016) The metabolic syndrome: a risk factor for the frailty syndrome? J Am Med Dir Assoc 17:364–366. doi:10.1016/j.jamda.2016.01.005
Visscher TL, Seidell JC, Molarius A et al (2001) A comparison of body mass index, waist-hip ratio and waist circumference as predictors of all-cause mortality among the elderly: the Rotterdam study. Int J Obes Relat Metab Disord 25:1730–1735. doi:10.1038/sj.ijo.0801787
Wang J, Ruotsalainen S, Moilanen L et al (2007) The metabolic syndrome predicts cardiovascular mortality: a 13-year follow-up study in elderly non-diabetic Finns. Eur Heart J 28:857–864. doi:10.1093/eurheartj/ehl524
Wang J, Ruotsalainen S, Moilanen L et al (2008) The metabolic syndrome predicts incident stroke: a 14-year follow-up study in elderly people in Finland. Stroke 39:1078–1083. doi:10.1161/STROKEAHA.107.499830
Zipf G, Chiappa M, Porter KS et al (2013) National health and nutrition examination survey: plan and operations, 1999-2010. Vital Health Stat 1:1–37
Acknowledgments
This study was supported by grants from the Canadian Institutes of Health Research (MOP 126018, MOP 97973 and MOP 209888) and the Fountain Innovation Fund of the Queen Elizabeth II Health Sciences Foundation.
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Kane, A.E., Gregson, E., Theou, O. et al. The association between frailty, the metabolic syndrome, and mortality over the lifespan. GeroScience 39, 221–229 (2017). https://doi.org/10.1007/s11357-017-9967-9
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DOI: https://doi.org/10.1007/s11357-017-9967-9