Jason Leung

Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation.

To compare three simple bedside tools based on frailty phenotypes with a Frailty Index using the multiple deficit approach in the prediction of mortality and physical limitation after 4 years.

A Meta‐Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX

Trabecular bone score (TBS) is a gray‐level textural index of bone microarchitecture derived from lumbar spine dual‐energy X‐ray absorptiometry (DXA) images. TBS is a bone mineral density (BMD)‐independent predictor of fracture risk. The objective of this meta‐analysis was to determine whether TBS predicted fracture risk independently of FRAX probability and to examine their combined performance by adjusting the FRAX probability for TBS. We utilized individual‐level data from 17,809 men and women in 14 prospective population‐based cohorts. Baseline evaluation included TBS and the FRAX risk variables, and outcomes during follow‐up (mean 6.7 years) comprised major osteoporotic fractures. The association between TBS, FRAX probabilities, and the risk of fracture was examined using an extension of the Poisson regression model in each cohort and for each sex and expressed as the gradient of risk (GR; hazard ratio per 1 SD change in risk variable in direction of increased risk). FRAX probabilities were adjusted for TBS using an adjustment factor derived from an independent cohort (the Manitoba Bone Density Cohort). Overall, the GR of TBS for major osteoporotic fracture was 1.44 (95% confidence interval [CI] 1.35–1.53) when adjusted for age and time since baseline and was similar in men and women (p > 0.10). When additionally adjusted for FRAX 10‐year probability of major osteoporotic fracture, TBS remained a significant, independent predictor for fracture (GR = 1.32, 95% CI 1.24–1.41). The adjustment of FRAX probability for TBS resulted in a small increase in the GR (1.76, 95% CI 1.65–1.87 versus 1.70, 95% CI 1.60–1.81). A smaller change in GR for hip fracture was observed (FRAX hip fracture probability GR 2.25 vs. 2.22). TBS is a significant predictor of fracture risk independently of FRAX. The findings support the use of TBS as a potential adjustment for FRAX probability, though the impact of the adjustment remains to be determined in the context of clinical assessment guidelines.

Functional Decline in Cognitive Impairment - The Relationship between Physical and Cognitive Function

Background: Physical function decline is associated with dementia, which might either be mediated by the coexisting sarcopenia or directly related to the impaired cognition. Our objectives are to examine the relationship between cognitive function and performance-based physical function and to test the hypothesis that cognitive function is related to poor physical function independent of muscle mass. Methods: We measured muscle strength, performance-based physical function and muscle mass using dual-energy X-ray absorptiometry and cognitive function using the cognitive part of the Community Screening Instrument of Dementia (CSI-D) in 4,000 community-dwelling Chinese elderly aged >65 years. A CSI-D cognitive score of >28.40 was considered as cognitively impaired. The effect of cognitive impairment on muscle strength and physical function was analyzed by multivariate analysis with adjustment for age, appendicular skeletal mass (ASM), the Physical Activity Scale for the Elderly (PASE) and other comorbidities. Results: In both genders, the cognitively impaired (CSI-D cognitive score >28.40) group had a weaker grip strength (–5.10 kg, p < 0.001 in men; –1.08 kg in women, p < 0.001) and performed worse in the two physical function tests (in men, 6-meter walk speed, –0.13 m/s, p < 0.001, chair stand test, 1.42 s, p < 0.001; in women, 6-meter walk speed, –0.08 m/s, p < 0.001, chair stand test, 1.48 s, p < 0.001). After adjustment for age, ASM, PASE and other comorbidities, significant differences in grip strength (–2.60 kg, p < 0.001 in men; –0.49 kg, p = 0.011 in women) and the two physical function tests persisted between the cognitively impaired and nonimpaired group (in men, 6-meter walk speed, –0.072 m/s, p < 0.001, chair stand test, 0.80 s, p = 0.045; in women, 6-meter walk speed, –0.049 m/s, p < 0.001, chair stand test, 0.98 s, p < 0.001). Conclusions: Poor physical function and muscle strength coexisted with cognitive impairment. This relationship was independent of muscle mass. It is likely therefore that the functional decline in dementia might be related directly to factors resulting in cognitive impairment independently of the coexisting sarcopenia.

Validating the SARC-F: a suitable community screening tool for sarcopenia?

OBJECTIVES Using data from the Hong Kong Mr and Ms Os study, we validated the SARC-F against 3 consensus definitions of sarcopenia from Europe, Asia, and an international group, and compared the ability of all 4 measures to predict 4-year physical limitation, walking speed, and repeated chair stands. DESIGN Prospective cohort study. SETTING Hong Kong community. PARTICIPANTS Four thousand men and women living in the community. MEASUREMENTS A questionnaire regarding ability to carry a heavy load, walking, rising from a chair, climbing stairs, and falls frequency was administered. These questions were used to calculate the SARC-F score. Measurements, including appendicular muscle mass, were taken using dual-energy X-ray, grip strength using a dynamometer, 6-m gait speed, and time taken for repeated chair stand. Classification using the SARC-F score was compared using consensus panel criteria from international, European, and Asian sarcopenia working groups. The performance of all 4 methods was compared by examining the predictive ability for 4-year outcomes using ROC curve. RESULTS The SARC-F has excellent specificity but poor sensitivity for sarcopenia classification; however, all 4 methods have comparable but modest predictive power for 4-year physical limitation. CONCLUSION The SARC-F may be considered a suitable tool for community screening for sarcopenia.

BMI, Body Composition, and Physical Functioning in Older Adults

Objective: Recent studies have emphasized the importance of muscle and fat mass in relation to age‐related decline in physical function. Our objective was to determine whether BMI, as a surrogate measurement of fat mass, may be used as a measure of risk factor for physical functioning in older adults and whether body composition measurements confer any advantage over BMI.

Transitions in Frailty States Among Community-Living Older Adults and Their Associated Factors

BACKGROUND Frailty renders older individuals more prone to adverse health outcomes. Little has been reported about the transitions between the different frailty states. We attempted to examine the rate of these transitions and their associated factors. METHODS We recruited 3018 Chinese community-living adults 65 years or older. Frailty status was classified according to the Fried criteria in 2 visits 2 years apart. Demographic data, medical conditions, hospitalizations, and cognition were recorded. Rates of transitions and associated factors were studied. RESULTS At baseline, 850 (48.7%) men and 884 (52.6%) women were prefrail. Among these, 23.4% men and 26.6% women improved after 2 years; 11.1% of men and 6.6% of women worsened. More men than women (P < .001) deteriorated into frailty. Hospitalizations, older age, previous stroke, lower cognition, and osteoarthritis were risk factors for decline among prefrail participants. Having diabetes was associated with 50% lower chance of improvement in women. Among the robust, older age and previous cancer, hospitalizations, chronic lung diseases, and stroke were risk factors for worsening. Higher socioeconomic status was protective. Previous stroke reduced the chance of improvement by 78% in frail men. Only younger age was associated with improvement in frail women. CONCLUSION Women were less likely to decline in frailty status than men. Hospitalizations, older age, previous stroke, lower cognitive function, diabetes, and osteoarthritis were associated with worsening or less improvement. Older age, previous cancer, hospitalizations, lung diseases, and stroke were risk factors for worsening in the robust and higher socioeconomic status was protective.

Survival in Older Men May Benefit From Being Slightly Overweight and Centrally Obese—A 5-Year Follow-up Study in 4,000 Older Adults Using DXA

BACKGROUND Whether overweight in old age is hazardous remains controversial. Body mass index (BMI) overestimates adiposity and fails to measure central adiposity. We used dual-energy x-ray absorptiometry (DXA) to measure adiposity and hypothesized that overall adiposity, distribution of adiposity, and muscle mass might individually affect survival. METHODS We recruited 2000 men and 2000 women aged 65 years or older. Baseline BMI, waist-hip ratio (WHR), body fat index (BFI = total body fat/height square), relative truncal fat (RTF = trunk fat/total body fat), and body muscle mass index (BMMI = total body muscle mass/height square) were measured. Mortality was ascertained by death registry after 63.3 (median) months. RESULTS Two hundred and forty-two men and 78 women died. In men, mortality hazard ratio (HR) decreased consistently by 0.85 (p < .005), 0.86 (p < .005), and 0.86 (p < .005) per every quintile increase in BMI, BFI, and BMMI, respectively. A J-shaped relationship was observed in central adiposity (RTF and WHR) quintiles; the minimum values were at the 3rd WHR quintile (0.92-0.94) and 4th RTF quintile (mean WHR, 0.94). When RTF was tested with BFI, both high and low central adiposity were unfavorable while general adiposity became marginally insignificant (p = 0.062). When BFI and BMMI were tested together, increasing adiposity rather than muscle mass favored survival (BFI quintile, HR 0.97, p .015; BMMI quintile, HR 1.00, p .997). CONCLUSIONS Older men were resistive to hazards of overweight and adiposity; and mild-grade overweight, obesity, and even central obesity might be protective. This may bear significant implication on the recommended cutoff values for BMI and WHR in the older population.

Defining sarcopenia in terms of incident adverse outcomes.

OBJECTIVES The objectives of this study were to compare the performance of different diagnoses of sarcopenia using European Working Group on Sarcopenia in Older People, International Working Group on Sarcopenia, and the US Foundation of National Institutes of Health (FNIH) criteria, and the screening tool SARC-F, against the Asian Working Group for Sarcopenia consensus panel definitions, in predicting physical limitation, slow walking speed, and repeated chair stand performance, days of hospital stay and mortality at follow up. DESIGN Longitudinal study. SETTING Community survey in Hong Kong. PARTICIPANTS Participants were 4000 men and women 65 years and older living in the community. MEASUREMENTS Information from questionnaire regarding activities of daily living, physical functioning limitations, and constituent questions of SARC-F; body mass index (BMI), grip strength (GS), walking speed, and appendicular muscle mass (ASM). RESULTS FNIH, consensus panel definitions, and the screening tool SARC-F all have similar AUC values in predicting incident physical limitation and physical performance measures at 4 years, walking speed at 7 years, days of hospital stay at 7 years, and mortality at 10 years. None of the definitions predicted increase in physical limitation at 4 years or mortality at 10 years in women, and none predicted all the adverse outcomes. The highest AUC values were observed for walking speed at 4 and 7 years. CONCLUSION When applied to a Chinese elderly population, criteria used for diagnosis of sarcopenia derived from European, Asian, and international consensus panels, from US cutoff values defined from incident physical limitation, and the SARC-F screening tool, all have similar performance in predicting incident physical limitation and mortality.

Bone marrow fat content in the elderly: A reversal of sex difference seen in younger subjects

To investigate vertebral bone marrow fat content in elderly subjects related to sex, age, and bone mineral density (BMD) and relate these findings to published data in younger subjects.

Defining sarcopenia in terms of risk of physical limitations: a 5-year follow-up study of 3,153 chinese men and women.

OBJECTIVES: To examine the definition of sarcopenia in Chinese subjects by relating the value of appendicular skeletal muscle mass (ASM) divided by height squared to physical functional outcomes after 4 years.