Possible sarcopenia and risk of hip fracture in older adults in China

Association between estimated pulse wave velocity and hip fracture in middle-aged and older adults: A prospective cohort study in China

BACKGROUND

Hip fractures represent a significant public health challenge among middle-aged and older adults, with substantial implications for health and quality of life. This study aimed to investigate the association between estimated pulse wave velocity (ePWV) and hip fracture risk, with a comprehensive analysis of both overall and female population cohorts.

METHODS

Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS), this prospective cohort study included 11,024 participants aged 45 and older, with a 9-year follow-up period (2011-2020). The research employed Cox proportional hazards models to analyze the overall population and a specific female subgroup. The female subgroup analysis uniquely adjusted for menopausal status to provide a nuanced assessment of ePWV's relationship with hip fracture risk. Restricted cubic spline (RCS) analysis and threshold analysis were conducted to explore nonlinear associations between ePWV and hip fracture risk.

RESULTS

During the follow-up period, 471 hip fractures were documented. In the overall population, each increment in ePWV quartile was associated with a significant 32 % increase in hip fracture risk (Hazard Ratio [HR]: 1.32, 95 % Confidence Interval [CI]: 1.18-1.49, p < 0.001). The female subgroup analysis, after adjusting for menopausal status, revealed a 29 % increased hip fracture risk per ePWV quartile increment (HR: 1.29, 95 % CI: 1.09-1.53, p < 0.05). Nonlinear analysis identified a critical threshold at 11.18 m/s, beyond which hip fracture risk significantly increased [HR (95%CI): 1.28 (1.12-1.47)].

CONCLUSIONS

The ePWV significantly correlates with hip fracture risk in middle-aged and older Chinese adults, offering novel insights into the relationship between arterial stiffness and fracture vulnerability. Future research should validate these findings and explore vascular health-based strategies for hip fracture prevention.

The Current Status of Frailty and Influencing Factors in Elderly Patients With Hip Fractures: A Meta-Analysis

Background: Hip fractures have emerged as a significant health risk, posing a substantial threat to the well-being and longevity of the elderly population. The occurrence of postoperative complications and frailty profoundly impacts the quality of life in these individuals. This meta-analysis is aimed at elucidating the present scenario and clarifying the current status and influencing factors of frailty in elderly hip fracture patients. The findings will serve as a solid evidence for formulating effective and scientific strategies to prevent frailty in this vulnerable patient group. Methods: The databases, including PubMed, Cochrane Library, and Embase, were utilized from February 2003 to February 2023, using the keywords frailty, elderly, and hip fractures to identify systematic reviews or meta-analyses. The primary randomized clinical trials included in systematic reviews or meta-analyses were identified. Two independent authors assessed the quality of all eligible studies. Statistical analyses were evaluated using Review Manager (RevMan) Version 5.3. Results: Of the 15 studies out of 352 identified studies, 12 cross-sectional research studies, 2 case-control studies, and 1 cohort study were confirmed. There were 3475 hip fracture patients, 1209 of them showed frailty, with a 41% incidence of frailty, and 18 influence factors were determined. A marked between-study heterogeneity (I 2 = 95%, p < 0.00001) was examined. Factors influencing frailty in elderly hip fracture patients were identified including age (odds ratio (OR) = 2.73, 95% confidence interval (CI): 2.12~3.53), comorbidity (OR = 4.20, 95% CI: 2.31~7.62), duration of bed rest (OR = 2.22, 95% CI: 1.54~3.18), nutritional status (OR = 1.62, 95% CI: 1.21~2.17), and self-perceived health status (OR = 3.53, 95% CI: 2.09~5.94). There was no publication bias, and the pooled results were stable basing on sensitivity analysis. Conclusion: Frailty in elderly hip fracture patients is associated with a variety of factors consisting of age, comorbidity conditions, extended periods of bed rest, nutritional status, high comorbid conditions, poor self-perceived health status, advanced age, and poor nutritional status.

Association between possible sarcopenia, all-cause mortality, and adverse health outcomes in community-dwelling older adults in China

The relationship between possible sarcopenia and mortality remains ambiguous within Asian populations. To clarify this, we investigated the association in older adults residing in Chinese communities. Utilizing data from the China Health and Retirement Longitudinal Study, this population-based cohort study included individuals aged ≥ 60 years, followed from 2011 to 2012 through 2020. Possible sarcopenia was defined in accordance with the Asian Working Group on Sarcopenia 2019 criteria, and Cox proportional hazards regression was used to analyze its impact on mortality, while exploratory analyses were conducted to investigate the associations of possible sarcopenia with chronic diseases, functional independence, and hospitalization frequency. The study encompassed 5,160 participants (median age: 66 years), nearly half of whom (48.8%) were identified with possible sarcopenia. Over a 9-year follow-up period, there were 1216 recorded deaths. Analysis indicated that individuals with possible sarcopenia faced a significantly elevated mortality risk compared to their counterparts (HR: 1.79, 95% CI: 1.58-2.03; P < 0.001). Further, subgroup analyses confirmed a strong association between possible sarcopenia and all-cause mortality across various subgroups, including those related to sex, obesity status, and living environment. Additionally, exploratory analyses revealed that possible sarcopenia was significantly associated with an increased likelihood of heart disease (OR = 1.18, 95% CI: 1.03-1.34, P = 0.014) and stroke (OR = 1.41, 95% CI: 1.19-1.68, P < 0.001), as well as reduced functional independence (β = -0.17, 95% CI: -0.24--0.10, P < 0.001). Possible sarcopenia was also associated with a higher frequency of hospitalizations at baseline (Exp(β) = 1.50, 95% CI: 1.25-1.81, P < 0.001), although this association was no longer significant during the follow-up period. In conclusion, in Chinese community-dwelling older adults, possible sarcopenia was associated with an increased risk of all-cause mortality, several chronic diseases, and functional dependence. Thus, alleviating or preventing possible sarcopenia may improve health outcomes and extend the lifespan of these individuals.

Plant proteins: are they a good alternative to animal proteins in older people?

PURPOSE OF REVIEW

This review provides the latest insight into the impact of consuming plant-based protein for older people.

RECENT FINDINGS

According to the latest data, a healthy diet rich in plant-based-protein-rich-food could promote healthy aging. This health effect is partly because of the amino acid composition of proteins, as well as to the important constituents such as fiber and bioactive compounds found in the matrix. Furthermore, even though animal protein is more effective at stimulating muscle protein synthesis, a high consumption of plant protein (beyond 31 g/day) appears to enhance physical performance and reduce the risk of frailty in older individuals.

SUMMARY

Recent literature highlights numerous health benefits for older people associated with a substantial intake of plant-based vs. animal-based protein, both in preventing and mitigating chronic age-related diseases and reducing the risk of all-cause mortality. However, a high intake of plant-based protein-rich products could pose risks of malnutrition and fiber-related intestinal intolerances. Further research is needed to assess the risk-benefit ratio of a high consumption of plant proteins in older individuals before we can make robust recommendations on how far animal proteins can be healthfully replaced with plant proteins.