title: Physical frailty in older adults is associated with metabolic and atherosclerotic risk factors and cognitive impairment independent of muscle mass.
abstract: OBJECTIVE
  Metabolic and atherosclerotic diseases are known risk factors for disability in old age, and can result in sarcopenia as well as cognitive impairment, which are both components of frailty syndrome. As muscle loss increases with ageing, it is unclear whether muscle loss per se, or the diseases themselves, are the underlying cause of physical frailty in those suffering from these diseases. We tested the hypothesis that metabolic and atherosclerotic diseases and cognitive impairment are associated with physical frailty independent of muscle loss in old age, and further examined their impact on the relationship between physical frailty and mortality.
  
  
  METHODS
  Prospective.
  
  
  METHODS
  Community.
  
  
  METHODS
  4000 community dwelling Chinese elderly ≥65 years.
  
  
  METHODS
  Diabetes, hypertension, stroke, heart disease, cognitive impairment, smoking, physical activity, waist hip ratio (WHR) and ankle-brachial index (ABI)) were recorded. Physical frailty measurements (grip-strength, chair-stands, stride length and 6-metre walks) were summarized into a composite frailty score (0-20), 0 being the most frail) according to quartiles of performance. Appendicular muscle mass (ASM) was measured using dual X-ray absorptiometry. Relationships between the score and covariates were analyzed. Cox regression was used to study the impact of metabolic and atnerosclerotic risk factors on the relationship between physical frailty and 6-year mortality.
  
  
  RESULTS
  After adjustment for ASM, all metabolic diseases and indexes, and cognitive impairment were significantly associated with the composite physical frailty score in univariate analysis. In multivariate analysis, cognitive impairment, high WHR, diabetes, stroke and heart disease were all independently associated with higher physical frailty with adjustment for age, physical activity level and ASM. Hypertension was associated with physical frailty in men but not in women. In Cox regression, increased physical frailty was associated with higher 6-year mortality. The impact of metabolic and atherosclerotic risk factors was however only modest after adjustment for age and cognitive function.
  
  
  CONCLUSIONS
  Metabolic and atherosclerotic diseases and high WHR, was associated with physical frailty, independent of their adverse effect on cognitive function and muscle mass.
authors.affiliation: Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
authors.forename: J S W
authors.initials: JS
authors.lastname: Lee
authors.forename: T-W
authors.initials: TW
authors.lastname: Auyeung
authors.forename: J
authors.initials: J
authors.lastname: Leung
authors.forename: T
authors.initials: T
authors.lastname: Kwok
authors.forename: P-C
authors.initials: PC
authors.lastname: Leung
authors.forename: J
authors.initials: J
authors.lastname: Woo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications; D001823:Body Composition; D002318:Cardiovascular Diseases / Q000150:complications*; D002681:China; D003072:Cognition Disorders / Q000150:complications*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000150:complications*; D009026:Mortality; D015999:Multivariate Analysis; D053580:Muscle Strength; D018908:Muscle Weakness / Q000209:etiology*; D010809:Physical Fitness; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D055948:Sarcopenia; D012737:Sex Factors; D049629:Waist-Hip Ratio