Association between a lifestyle-based healthy heart score and risk of frailty in older women: a cohort study

Exercise for frailty research frontiers: a bibliometric analysis and systematic review

Background

Exercise intervention is a method of improving and preventing frailty in old age through physical exercise and physical activity. It has a positive impact on many chronic diseases and health risk factors, in particular cardiovascular disease, metabolic disease, osteoporosis, mental health problems and cancer prevention, and exercise therapies can also fight inflammation, increase muscle strength and flexibility, improve immune function, and enhance overall health. This study was aimed to analyze research hotspots and frontiers in exercise therapies for frailty through bibliometric methods.

Methods

In this study, data of publications from 1st January 2003 to 31st August 2023 were gathered from the Web of Science Core Collection and analyzed the hotspots and frontiers of frailty research in terms of remarkable countries/regions, institutions, cited references, authors, cited journals, burst keywords, and high-frequency keywords using CiteSpace 6.2.R3 software. The PRISMA reporting guidelines were used for this study.

Results

A collection of 7,093 publications was obtained, showing an increasing trend each year. BMC Geriatrics led in publications, while Journals of Gerontology Series A-Biological Sciences and Medical Sciences dominated in citations. The United States led in centrality and publications, with the University of Pittsburgh as the most productive institution. Leocadio R had the highest publication ranking, while Fried Lp ranked first among cited authors. Keywords in the domain of exercise therapies for frailty are "frailty," "older adult," "physical activity," "exercise," and "mortality," with "sarcopenia" exhibiting the greatest centrality. The keywords formed 19 clusters, namely "#0 older persons," "#1 mortality," "#2 muscle strength," "#3 bone mineral density," "#4 muscle mass," "#5 older adults," "#6 older people," "#7 women's health," "#8 frail elderly," "#9 heart failure," "#10 geriatric assessment," "#11 comprehensive geriatric assessment," "#12 outcm," "#13 alzheimers disease," "#14 quality of life," "#15 health care," "#16 oxidative stress," "#17 physical activity," and "#18 protein."

Conclusion

This study presents the latest developments and trends in research on frailty exercise intervention treatments over the past 20 years using CiteSpace visualization software. Through systematic analyses, partners, research hotspots and cutting-edge directions were revealed, providing a guiding basis for future research.

Lifestyle-related factors in late midlife as predictors of frailty from late midlife into old age: a longitudinal birth cohort study

BACKGROUND

Few studies have examined longitudinal changes in lifestyle-related factors and frailty.

METHODS

We examined the association between individual lifestyle factors (exercise, diet, sleep, alcohol, smoking and body composition), their sum at baseline, their change over the 17-year follow-up and the rate of change in frailty index values using linear mixed models in a cohort of 2,000 participants aged 57-69 years at baseline.

RESULTS

A higher number of healthy lifestyle-related factors at baseline was associated with lower levels of frailty but not with its rate of change from late midlife into old age. Participants who stopped exercising regularly (adjusted β × Time = 0.19, 95%CI = 0.10, 0.27) and who began experiencing sleeping difficulties (adjusted β × Time = 0.20, 95%CI = 0.10, 0.31) experienced more rapid increases in frailty from late midlife into old age. Conversely, those whose sleep improved (adjusted β × Time = -0.10, 95%CI = -0.23, -0.01) showed a slower increase in frailty from late midlife onwards. Participants letting go of lifestyle-related factors (decline by 3+ factors vs. no change) became more frail faster from late midlife into old age (adjusted β × Time = 0.16, 95% CI = 0.01, 0.30).

CONCLUSIONS

Lifestyle-related differences in frailty were already evident in late midlife and persisted into old age. Adopting one new healthy lifestyle-related factor had a small impact on a slightly less steeply increasing level of frailty. Maintaining regular exercise and sleeping habits may help prevent more rapid increases in frailty.

Diet strategies for promoting healthy aging and longevity: An epidemiological perspective

In recent decades, global life expectancies have risen significantly, accompanied by a marked increase in chronic diseases and population aging. This narrative review aims to summarize recent findings on the dietary factors influencing chronic diseases and longevity, primarily from large cohort studies. First, maintaining a healthy weight throughout life is pivotal for healthy aging and longevity, mirroring the benefits of lifelong, moderate calorie restriction in today's obesogenic food environment. Second, the specific types or food sources of dietary fat, protein, and carbohydrates are more important in influencing chronic disease risk and mortality than their quantity. Third, some traditional diets (e.g., the Mediterranean, Nordic, and Okinawa) and contemporary dietary patterns, such as healthy plant-based diet index, the DASH (dietary approaches to stop hypertension) diet, and alternate healthy eating index, have been associated with lower mortality and healthy longevity. These patterns share many common components (e.g., a predominance of nutrient-rich plant foods; limited red and processed meats; culinary herbs and spices prevalent in global cuisines) while embracing distinct elements from different cultures. Fourth, combining a healthy diet with other lifestyle factors could extend disease-free life expectancies by 8-10 years. While adhering to core principles of healthy diets, it is crucial to adapt dietary recommendations to individual preferences and cultures as well as nutritional needs of aging populations. Public health strategies should aim to create a healthier food environment where nutritious options are readily accessible, especially in public institutions and care facilities for the elderly. Although further mechanistic studies and human trials are needed to better understand molecular effects of diet on aging, there is a pressing need to establish and maintain long-term cohorts studying diet and aging in culturally diverse populations.

Understanding the Causes of Frailty Using a Life-Course Perspective: A Systematic Review

(1) Background: Few studies have examined risk factors of frailty during early life and mid-adulthood, which may be critical to prevent frailty and/or postpone it. The aim was to identify early life and adulthood risk factors associated with frailty. (2) Methods: A systematic review of cohort studies (of at least 10 years of follow-up), using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). A risk of confounding score was created by the authors for risk of bias assessment. Three databases were searched from inception until 1 January 2023 (Web of Science, Embase, PubMed). Inclusion criteria were any cohort study that evaluated associations between any risk factor and frailty. (3) Results: Overall, a total of 5765 articles were identified, with 33 meeting the inclusion criteria. Of the included studies, only 16 were categorized as having a low risk of confounding due to pre-existing diseases. The long-term risk of frailty was lower among individuals who were normal weight, physically active, consumed fruits and vegetables regularly, and refrained from tobacco smoking, excessive alcohol intake, and regular consumption of sugar or artificially sweetened drinks. (4) Conclusions: Frailty in older adults might be prevented or postponed with behaviors related to ideal cardiovascular health.

Performance and validation of the Healthy Heart Score model for predicting 12-year cardiovascular mortality in a nationwide Mediterranean population

INTRODUCTION AND OBJECTIVES

The Healthy Heart Score (HHS) is a lifestyle-based equation for predicting cardiovascular disease (CVD) risk and may serve as a tool in primordial prevention. However, its performance outside North American populations is unknown. This study assessed the performance of the HHS for estimating CVD mortality in the adult population of Spain.

METHODS

We analyzed data from the ENRICA cohort, comprising 10 228 participants free of chronic disease and representative of the Spanish population aged ≥ 18-years, who were recruited from 2008 to 2010 and were followed up to 2020. The HHS includes body mass index, alcohol, physical activity, smoking, and a 5-component dietary score. The HHS was calculated at baseline using the sex-specific beta coefficients from the original development cohorts. Model discrimination was assessed using the Harrell c-statistic and Gonen-Heller c-statistic for survival data, and calibration was evaluated through calibration plots.

RESULTS

After a median follow-up of 11.8 years, 110 CVD deaths were ascertained. The discrimination of the HHS was similar for women (Harrell c, 0.91; 95%CI, 0.87-0.95; Gonen-Heller-c, 0.85; 95%CI, 0.83-0.88) and men (Harrell c, 0.91; 95%CI, 0.88-0.94; Gonen-Heller c: 0.85; 95%CI, 0.83-0.88). After recalibration by the sex-specific baseline survival function, the calibration became optimal for: a) all deciles of predicted CVD risk except the highest decile, where HHS underestimated the risk, and b) all age groups except 70 years and older, where there was an underestimation.

CONCLUSIONS

In this Spanish cohort, the HHS showed good discrimination and calibration for predicting CVD death. The performance of HHS in other European populations and its implementation in the clinical setting warrants further investigation.