Brown J C, Harhay M O, Harhay M N
Justin C. Brown, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 423 Guardian Drive, 8th Floor, Blockley Hall, Philadelphia, PA 19104, Phone: 215-573-6490, Fax: 251-573-5311, Email:
J Nutr Health Aging. 2017;21(3):342-345. doi: 10.1007/s12603-016-0753-7.
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.
This was a population-based cohort study.
The Third National Health and Nutrition Survey (NHANES III; 1988-1994).
Older adults (age ≥65 years) with pre-frailty or frailty defined using the Fried criteria.
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.
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.
ALM distinguishes the risk of mortality among prefrail and frail older adults. Additional research examining ALM as a therapeutic target is warranted.
衰弱前期和衰弱的老年人是一个异质性群体。测量四肢瘦体重（ALM）可能有助于区分预后较差风险较高和较低的人群。我们研究了衰弱前期和衰弱老年人中ALM与死亡率之间的关系。
这是一项基于人群的队列研究。
第三次全国健康与营养调查（NHANES III；1988 - 1994年）。
根据弗里德标准定义为衰弱前期或衰弱的老年人（年龄≥65岁）。
使用生物电阻抗分析对ALM进行量化。多变量调整的Cox回归分析研究了ALM与死亡率之间的关系。逻辑回归分析用于确定将ALM纳入年龄和性别因素后是否能提高对五年和十年死亡率的预测辨别力。
在基线时，平均年龄为74.9岁，66.7%为女性，分别有86.3%和13.7%为衰弱前期和衰弱状态。平均ALM为18.9千克[标准差（SD）：5.5]。在中位8.9年的随访期间，1487名研究参与者中有1307人死亡（87.9%）。较高的ALM与较低的死亡风险相关。在一个考虑了人口统计学、行为、临床、身体功能和衰弱特征的多变量调整回归模型中，ALM每增加一个标准差，死亡风险降低50%[风险比：0.50（95%置信区间：0.27 - 0.92）；P = 0.026]。将ALM纳入年龄和性别因素后，提高了对五年（P = 0.027）和十年（P = 0.016）死亡率的预测辨别力。
ALM可区分衰弱前期和衰弱老年人的死亡风险。有必要进一步研究将ALM作为治疗靶点。
