Wang Huai-Yu, Zhang Mufan, Sun Xiaojing
National Institute of Health Data Science, Peking University, Beijing, China.
School of Public Health, Peking University, Beijing, China.
Front Med (Lausanne). 2021 Nov 18;8:775518. doi: 10.3389/fmed.2021.775518. eCollection 2021.
Lifestyle contributors to frailty among the elderly were previously reported in the developed Western countries, while evidence from the less developed East Asian regions was still lacking. Due to the well-acknowledged sex-based disparity of frailty and sex-difference of socioeconomic status and lifestyle, it is worth investigating the sex-specific association between the social and behavioral contributors and the risk of frailty among the East Asian longevous population. The present study was an observational study based on the four waves of interviews of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. The participants aged ≥65 years and without frailty at baseline were included. Fried criteria (exhaustion, shrink, weakness, low mobility, and inactivity) were adopted to identify the incidence of frailty (≥3 domains) and pre-frailty (1-2 domains) during the follow-up. The sex-specific association between lifestyle (smoke status, drinking status, food intake, sleep, exercise, and physical activity) and the risk of incident pre-frailty and frailty was analyzed using the multinomial logistic regression models. Altogether, 3,327 participants aged 81.2 ± 10.3 (range 65-116) years were included. In total, 964 (29.0%) and 1,249 (37.5%) participants were recognized as having incident pre-frailty and frailty, respectively. Older women were disproportionately uneducated, frequently did housework and labor work, but seldom did exercise. Men had diverse dietary and recreational activities but were frequently exposed to tobacco and alcohol. The protective effects of higher income, exercise, doing housework, and daily intake of fresh fruits/vegetables were found in both the sexes ( < 0.05). Sleep disorders (odds ratio [] = 2.16, 95% : 1.28-3.62) and labor work ( = 2.18, 95% : 1.42-3.33) were associated with the increased risk of frailty among women. For men, diverse dietary (four types of food added: = 0.21, 95% : 0.09-0.50) showed a protective effect on the risk of frailty, but daily intake of pickled vegetables showed the opposite effect ( = 1.86, 95% : 1.12-3.07). Socioeconomic status, lifestyle, and the association with the risk of frailty showed substantial difference between the sexes among the longevous population in China. To establish the individualized strategy of behavioral improvement for the frailty prevention should consider the sex disparity.
此前在西方发达国家报道过老年人衰弱的生活方式影响因素，而欠发达的东亚地区仍缺乏相关证据。鉴于衰弱存在公认的性别差异以及社会经济地位和生活方式的性别差异，因此有必要调查东亚长寿人群中社会和行为影响因素与衰弱风险之间的性别特异性关联。本研究是一项基于2008年至2018年中国老年健康长寿跟踪调查（CLHLS）四轮访谈的观察性研究。纳入了基线时年龄≥65岁且无衰弱的参与者。采用弗里德标准（疲惫、消瘦、虚弱、行动不便和不活动）来确定随访期间衰弱（≥3个领域）和衰弱前期（1 - 2个领域）的发生率。使用多项逻辑回归模型分析生活方式（吸烟状况、饮酒状况、食物摄入、睡眠、运动和身体活动）与衰弱前期和衰弱发生风险之间的性别特异性关联。总共纳入了3327名年龄为81.2±10.3（范围65 - 116）岁的参与者。总共有964名（29.0%）和1249名（37.5%）参与者分别被认定为发生了衰弱前期和衰弱。老年女性受教育程度低的比例过高，经常做家务和体力劳动，但很少运动。男性有多样化的饮食和娱乐活动，但经常接触烟草和酒精。较高收入、运动、做家务以及每天摄入新鲜水果/蔬菜对两性均有保护作用（<0.05）。睡眠障碍（优势比[] = 2.16，95%可信区间：1.28 - 3.62）和体力劳动（= 2.18，95%可信区间：1.42 - 3.33）与女性衰弱风险增加相关。对于男性，多样化饮食（增加四种食物类型：= 0.21，95%可信区间：0.09 - 0.50）对衰弱风险有保护作用，但每天摄入腌制蔬菜则显示出相反的效果（= 1.86，95%可信区间：1.12 - 3.07）。在中国长寿人群中，社会经济地位、生活方式以及与衰弱风险的关联在两性之间存在显著差异。为制定预防衰弱的个性化行为改善策略，应考虑性别差异。
