Center of Gerontology and Geriatrics and National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, China.
Department of Laboratory Medicine, West China Hospital, Sichuan University, China.
J Nutr Health Aging. 2024 Nov;28(11):100367. doi: 10.1016/j.jnha.2024.100367. Epub 2024 Sep 27.
Allostatic load (AL) is an index that manifests as cumulative wear and tear on multiple physiological systems resulting from repeated adaptation to stressors throughout the life course. Higher AL was found to be associated with increased risk of adverse health outcomes, but studies on functional disability among large Chinese older population were limited. We aimed to investigate the associations of AL with functional disability among Chinese older adults.
This prospective cohort study included 5880 older adults who were at least 50 years old and participated in the CHARLS at baseline (2011 wave), with 3 follow-ups (2013, 2015 and 2018 waves). We selected 11 biomarkers from 4 physiological systems to construct AL. AL score was classified into three categories based on tertiles: 0-1 (low burden), 2-3 (medium burden) and 4-11 (high burden). Functional disability was assessed by activities of daily living (ADL) and instrumental activities of daily living (IADL). Multivariable logistic regression models examined the association between baseline AL, transitions of AL burden and incidence of functional disability.
In cross-sectional analyses, medium and high AL burden were associated with an increased prevalence of ADL disability, while association was only significant between high AL burden and IADL disability. During the 7-year follow-up, 1102 and 1777 participants incident ADL disability and IADL disability, respectively. Those with medium and high AL burden had an increased risk of new-onset ADL disability than those with low AL burden ("medium": OR = 1.25, 95%CI = 1.01, 1.55; "high": OR = 1.69, 95%CI = 1.32, 2.18). As for IADL disability, association was only significant in "high" group (OR = 1.50, 95% CI = 1.24, 1.83). We also found keep medium/high AL burden in 2011 and 2015 was associated with new-onset ADL (OR = 2.27, 95%CI = 1.50, 3.44) and IADL disability (OR = 1.51, 95%CI = 1.11, 2.05) in 2018.
These results show that higher AL predicts functional disability among Chinese older adults. Monitoring AL and paying close attention to those with medium/high AL burden may aid prevention of adverse health outcomes, thus giving a healthier ageing experience to a large proportion of the population.
适应负荷（AL）是一种指标，表现为一生中多次适应压力源导致的多个生理系统的累积磨损和撕裂。较高的 AL 与不良健康结果的风险增加有关，但针对大型中国老年人群的功能障碍研究有限。我们旨在研究 AL 与中国老年人功能障碍之间的关联。
这项前瞻性队列研究包括 5880 名年龄至少 50 岁的老年人，他们在基线（2011 波）参加了 CHARLS，并进行了 3 次随访（2013、2015 和 2018 波）。我们从 4 个生理系统中选择了 11 种生物标志物来构建 AL。根据三分位数，将 AL 评分分为 3 类：0-1（低负担）、2-3（中负担）和 4-11（高负担）。通过日常生活活动（ADL）和工具性日常生活活动（IADL）评估功能障碍。多变量逻辑回归模型检查了基线 AL、AL 负担的变化与功能障碍发生之间的关联。
在横断面分析中，中、高 AL 负担与 ADL 残疾的患病率增加有关，而仅在高 AL 负担与 IADL 残疾之间存在显著关联。在 7 年的随访期间，分别有 1102 名和 1777 名参与者发生新的 ADL 残疾和 IADL 残疾。与低 AL 负担者相比，中、高 AL 负担者发生新的 ADL 残疾的风险增加（“中”：OR=1.25，95%CI=1.01，1.55；“高”：OR=1.69，95%CI=1.32，2.18）。对于 IADL 残疾，仅在“高”组中存在显著关联（OR=1.50，95%CI=1.24，1.83）。我们还发现，2011 年和 2015 年保持中/高 AL 负担与 2018 年新发生的 ADL（OR=2.27，95%CI=1.50，3.44）和 IADL 残疾（OR=1.51，95%CI=1.11，2.05）有关。
这些结果表明，较高的 AL 可预测中国老年人的功能障碍。监测 AL 并密切关注中/高 AL 负担者可能有助于预防不良健康结果，从而为大部分人口提供更健康的老龄化体验。
