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Hwang AC, Chen LY, Tang TC, Peng LN, Lin MH, Chou YJ, Hsiao FY, Chen LK. Transitions in Frailty and 4-Year Mortality Risk in Taiwan Longitudinal Study on Aging. J Am Med Dir Assoc 2023; 24:48-56.e5. [PMID: 36370752 DOI: 10.1016/j.jamda.2022.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To explore the associations of (1) the frailty phenotype or frailty index transition with cause-specific mortality, and (2) different combinations of transition in frailty phenotype and frailty index with all-cause mortality. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Data from 3529 respondents aged >50 years who completed the 1999 and 2003 surveys of the Taiwan Longitudinal Study on Aging were analyzed. METHODS Cox regression and subdistribution hazard models were constructed to investigate frailty phenotype or frailty index transitions (by categories of frailty phenotype, absolute and percentage changes in frailty index, and combined categories of the 2 measurements) and subsequent 4-year all-cause and cause-specific mortality, respectively. RESULTS Among the frailty phenotype transition groups, the improved frailty group had overall mortality risk comparable to that of the maintained robustness/prefrailty group [hazard ratio (HR): 0.9; 95% CI: 0.7-1.2] and lower risk of mortality due to organ failure (HR: 0.4; 95% CI: 0.2-0.8; P = .015), whereas the worsened frailty group had the highest risk of all-cause mortality and death from infection, malignancy, cardiometabolic/cerebrovascular diseases, and other causes (HR: 1.8-3.7; all P < .03). The rapidly increased frailty index group had significantly higher all-cause and every cause-specific mortality than the decreased frailty index group (HR: 1.8-7.7; all P < .05). When frailty phenotype and frailty index transition groups were combined, participants with worsened frailty/rapidly increased frailty index had increased risk under the same frailty index/frailty phenotype transition condition, particularly for large changes in each factor (HR: 1.5-2.2; P < .01 for worsened frailty; 1.7-4.5, P < .03 for rapidly increased frailty index). CONCLUSIONS AND IMPLICATIONS We found that considering both frailty phenotype and frailty index provided best mortality prediction. These associations were independent of baseline frailty status and comorbidities. Nevertheless, even capturing transitions in frailty phenotype or frailty index only can provide good mortality prediction, which supported adopting these approaches in different clinical settings.
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Affiliation(s)
- An-Chun Hwang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Liang-Yu Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ting-Ching Tang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Hsien Lin
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Yilan County, Taiwan.
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan.
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Hwang AC, Lee WJ, Huang N, Chen LY, Peng LN, Lin MH, Chou YJ, Chen LK. Longitudinal changes of frailty in 8 years: comparisons between physical frailty and frailty index. BMC Geriatr 2021; 21:726. [PMID: 34922488 PMCID: PMC8684153 DOI: 10.1186/s12877-021-02665-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
Background Few studies have made longitudinal comparisons between frailty phenotype (FP) and frailty index (FI) changes. We aimed to investigate frailty status changes defined by FP and FI concurrently, and to compare the associated factors and incident disability among different combination of FI and FP trajectory groups. Methods Data on respondents aged over 50 who completed the 1999, 2003 and 2007 Taiwan Longitudinal Study on Aging (TLSA) surveys (n = 2807) were excerpted. Changes of FI, FP and major time-dependent variables were constructed by group-based trajectory modeling. Logistic regression was used to investigate the associated factors and relationships with incident disability among different frailty trajectories. Results We identified four FP trajectories – stably robust, worsened frailty, improved frailty, and stably frail and three FI trajectories – stable FI, moderate increase FI and rapid increase FI. Lower self-rated health, mobility impairment, and depressed mood were associated with unfavorable FP and FI changes (all p < 0.001). Regardless of FP trajectory groups, the moderate and rapid increase FI group had significantly more comorbidities than the stable FI group, and more visual, hearing, oral intake impairment, more difficulty in meeting living expenses, and poorer cognitive function in ≥65-year-olds (all p < 0.05). In addition, the worsened frailty, improved frailty, and stably frail groups had ORs for incident disability of 10.5, 3.0, and 13.4, respectively, compared with the stably robust group (all p < 0.01); the moderate and rapid increase FI groups had 8.4-fold and 77.5-fold higher risk than the stable FI group (both p < 0.001). When combining FI and FP trajectories, risk increased with FI trajectory steepness, independent of FP change (all p < 0.01 in rapid increase FI vs stable FI). Conclusions Four FP trajectories (stably robust, worsened frailty, improved frailty, and stably frail) and three FI trajectories (stable FI, moderate increase FI and rapid increase FI) were identified. Lower self-rated health, mobility impairment, and depressed mood were associated with both unfavorable FP and FI trajectories. Nevertheless, even for individuals in stably robust or improved frailty FP groups, moderate or rapid increase in FI, either due to comorbidities, sensory impairment, cognitive deficits, or financial challenges, may still increase the risk of incident disability. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02665-1.
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Affiliation(s)
- An-Chun Hwang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Public Health, National Yang Ming Chiao Tung University, No.115, Sec. 2, Li-Nong Street, Taipei, 112, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Ju Lee
- Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Family Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan County, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Liang-Yu Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Hsien Lin
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, National Yang Ming Chiao Tung University, No.115, Sec. 2, Li-Nong Street, Taipei, 112, Taiwan. .,Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Yilan County, Taiwan.
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan. .,Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
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Chen LY, Hwang AC, Huang CY, Chen LK, Wang FD, Chan YJ. CMV infection, CD19 + B cell depletion, and Lymphopenia as predictors for unexpected admission in the institutionalized elderly. Immun Ageing 2021; 18:21. [PMID: 33947427 PMCID: PMC8094471 DOI: 10.1186/s12979-021-00233-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/13/2021] [Indexed: 11/27/2022]
Abstract
Background Chronic infections played a detrimental role on health outcomes in the aged population, and had complex associations with lymphocyte subsets distribution. Our study aimed to explore the predictive roles of chronic infections, lymphopenia, and lymphocyte subsets on unexpected admission and mortality in the institutionalized oldest-old during 3 year follow-up period. Results There were 163 participants enrolled prospectively with median age of 87.3 years (IQR: 83.1–90.2), male of 88.3%, and being followed for 156.4 weeks (IQR: 136.9–156.4 weeks). The unexpected admission and mortality rates were 55.2 and 24.5% respectively. The Cox proportional hazards models demonstrated the 3rd quartile of cytomegalovirus IgG (OR: 3.26, 95% CI: 1.55–6.84), lymphopenia (OR: 2.85, 95% CI: 1.2–6.74), and 1st quartile of CD19+ B cell count (OR: 2.84, 95% CI: 1.29–6.25) predicted elevated risks of unexpected admission after adjusting for potential confounders; while the 3rd quartile of CD3+ T cell indicated a reduced risk of mortality (OR: 0.19, 95% CI: 0.05–0.71). Negative association between CMV IgG and CD19+ B cell count suggested that CMV infection might lead to B cell depletion via decreasing memory B cells repertoire. Conclusions CMV infection, lymphopenia, and CD19+ B cell depletion might predict greater risk of unexpected admission, while more CD3+ T cell would suggest a reduced risk of mortality among the oldest-old population. A non-linear or U-shaped relationship was supposed between health outcomes and CMV infection, CD3+ T cell, or CD19+ B cell counts. Further prospective studies with more participants included would be needed to elucidate above findings.
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Affiliation(s)
- Liang-Yu Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St, Taipei, 11221, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St, Taipei, 11221, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd, Taipei, 11217, Taiwan
| | - An-Chun Hwang
- Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St, Taipei, 11221, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St, Taipei, 11221, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd, Taipei, 11217, Taiwan
| | - Chung-Yu Huang
- Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St, Taipei, 11221, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St, Taipei, 11221, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd, Taipei, 11217, Taiwan
| | - Liang-Kung Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St, Taipei, 11221, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St, Taipei, 11221, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd, Taipei, 11217, Taiwan
| | - Fu-Der Wang
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St, Taipei, 11221, Taiwan.,Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd, Taipei, 11217, Taiwan
| | - Yu-Jiun Chan
- Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St, Taipei, 11221, Taiwan. .,Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd, Taipei, 11217, Taiwan. .,Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd, Taipei, 11217, Taiwan.
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Hwang AC, Lee WJ, Peng LN, Liu LK, Lin MH, Loh CH, Chen LK. Unfavorable body composition and quality of life among community-dwelling middle-aged and older adults: What really matters? Maturitas 2020; 140:34-40. [DOI: 10.1016/j.maturitas.2020.05.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/19/2020] [Accepted: 05/29/2020] [Indexed: 12/25/2022]
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Chen LK, Hwang AC, Lee WJ, Peng LN, Lin MH, Neil DL, Shih SF, Loh CH, Chiou ST. Efficacy of multidomain interventions to improve physical frailty, depression and cognition: data from cluster-randomized controlled trials. J Cachexia Sarcopenia Muscle 2020; 11:650-662. [PMID: 32134208 PMCID: PMC7296266 DOI: 10.1002/jcsm.12534] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/01/2019] [Accepted: 12/05/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Frailty is the pre-eminent exigency of aging. Although frailty-related impairments are preventable, and multidomain interventions appear more effective than unimodal ones, the optimal components remain uncertain. METHODS We devised multidomain interventions against physical and cognitive decline among prefrail/frail community-dwelling ≥65-year-olds and evaluated these in complementary cluster-randomized trials of efficacy and participant empowerment. The Efficacy Study compared ~3-monthly telephone consultations vs. 16, 2 h sessions/year comprising communally partaken physical and cognitive training plus nutrition and disease education; the Empowerment Study compared the standard Efficacy Study multidomain intervention (Sessions 1-10) vs. an enhanced version redesigned to empower and motivate individual participants. Changes from baseline in physical, functional, and cognitive performance were measured after 6 and 12 months in the Efficacy Study and after 6 months in the Empowerment Study, with post-intervention follow-up at 9 months. Primary outcomes are as follows: Cardiovascular Health Study frailty score; gait speed; handgrip strength; and Montreal Cognitive Assessment (MoCA). Secondary outcomes are as follows: instrumental activities of daily living; metabolic equivalent of task (MET); depressed mood (Geriatric Depression Scale-5 ≥2); and malnutrition (Mini-Nutritional Assessment short-form ≤11). Intervention effects were analyzed using a generalized linear mixed model. RESULTS Efficacy Study participants (n = 1082, 40 clusters) were 75.1 ± 6.3 years old, 68.7% women, and 64.7% prefrail/frail; analytic clusters: 19 intervention (410/549 completed) vs. 21 control (375/533 completed). Empowerment Study participants (n = 440, 14 clusters) were 75.9 ± 7.1 years old, 83.6% women, and 56.7% prefrail/frail; analytic clusters: seven intervention (209/230 completed) vs. seven control (189/210 completed). The standard and enhanced multidomain interventions both reduced frailty and significantly improved aspects of physical, functional, and cognitive performance, especially among ≥75-year-olds. Standard multidomain intervention decreased depression [odds ratio 0.56, 95% confidence interval (CI) 0.32, 0.99] and malnutrition (odds ratio 0.45, 95% CI 0.26, 0.78) by 12 months and improved concentration at Months 6 (0.23, 95% CI 0.04, 0.42) and 12 (0.46, 95% CI 0.22, 0.70). Participant empowerment augmented activity (4.67 MET/h, 95% CI 1.64, 7.69) and gait speed (0.06 m/s, 95% CI 0.00, 0.11) at 6 months, with sustained improvements in delayed recall (0.63, 95% CI 0.20, 1.06) and MoCA performance (1.29, 95% CI 0.54, 2.03), and less prevalent malnutrition (odds ratio 0.39, 95% CI 0.18, 0.84), 3 months after the intervention ceased. CONCLUSIONS Pragmatic multidomain intervention can diminish physical frailty, malnutrition, and depression and enhance cognitive performance among community-dwelling elders, especially ≥75-year-olds; this might supplement healthy aging policies, probably more effectively if participants are empowered.
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Affiliation(s)
- Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - An-Chun Hwang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Wei-Ju Lee
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yilan, Taiwan
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Ming-Hsien Lin
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - David L Neil
- Full Universe Integrated Marketing, Taipei, Taiwan
| | - Shu-Fang Shih
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Ching-Hui Loh
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Shu-Ti Chiou
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan.,Cheng-Hsin General Hospital, Taipei, Taiwan
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Chuang SY, Cheng HM, Mitchell GF, Sung SH, Chen CH, Pan WH, Hwang AC, Chen LK, Wang PN. Carotid Flow Velocities and Blood Pressures Are Independently Associated With Cognitive Function. Am J Hypertens 2019; 32:289-297. [PMID: 30388195 DOI: 10.1093/ajh/hpy165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/01/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Few studies simultaneously addressed associations between carotid flow velocities, blood pressure (BP), and cognitive function. MATERIALS AND METHODS Subject without dementia (N = 1,684) underwent measurements of BP and biochemical markers. Mini-Mental State Examination (MMSE) and comprehensive neuropsychological tests were used to evaluate cognitive function. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured in common and internal carotid artery. Subjects with MMSE score of ≤24 (25th percentile) was defined as low MMSE. Multivariable linear and logistic regression were used to evaluate the relationship of cognitive function with carotid flow velocities and BP. RESULTS Carotid flow velocities (PSV: standardized β = 0.067, P = 0.0009; and EDV: standardized β = 0.067, P = 0.0021) and systolic blood pressure (standardized β = -0.061, P = 0.005) were positively and negatively associated with MMSE, respectively, in the model with adjustments for age, sex, educational attainment, nutritional status, and smoking. Similar trends were noted for the associations between flow velocities and different neuropsychological tests. By multivariable logistic regression, the group with the lowest quartile (<25th percentile) of flow velocities had increased probability of low MMSE (odds ratio: 1.538; 95% confidence intervals: 1.142 to 2.071, P = 0.0046 for PSV; and odds ratio: 1.699; 95% confidence intervals: 1.233 to 2.341; P = 0.0012 for EDV), compared to those with the highest quartile (≥75th) flow velocities. CONCLUSION Both low carotid flow velocity and high BP were independently and comparably associated with cognitive dysfunction.
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Affiliation(s)
- Shao-Yuan Chuang
- Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C
| | - Hao-Min Cheng
- Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Gary F Mitchell
- Cardiovascular Engineering, Inc., Norwood, Massachusetts, USA
| | - Shih-Hsien Sung
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Chen-Huan Chen
- Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Wen-Harn Pan
- Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C
- Institute of BioMedical Science, Academia Sincia, Taipei, Taiwan, R.O.C
| | - An-Chun Hwang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Liang-Kung Chen
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Pei-Ning Wang
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
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Liu LK, Chen CH, Lee WJ, Wu YH, Hwang AC, Lin MH, Shimada H, Peng LN, Loh CH, Arai H, Chen LK. Cognitive Frailty and Its Association with All-Cause Mortality Among Community-Dwelling Older Adults in Taiwan: Results from I-Lan Longitudinal Aging Study. Rejuvenation Res 2019; 21:510-517. [PMID: 29644921 DOI: 10.1089/rej.2017.2038] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The definition of cognitive frailty and its prediction for adverse outcome of community-living older adults remains controversial. This study aims to evaluate the association between cognitive frailty and all-cause mortality among community-living older adults. Data of the I-Lan Longitudinal Aging Study (ILAS) were retrieved for study. Frailty was defined by Fried's criteria, and a series of neuropsychological assessments, including the Mini-Mental State Examination, Center for Epidemiology Studies-Depression, the delayed free recall in the Chinese Version Verbal Learning Test, the Boston Naming Test, the category (animal) Verbal Fluency Test, the Taylor Complex Figure Test, the digital backward, and the Clock Drawing Test were performed. All participants received blood sampling after 10-hour overnight fast for various biochemical markers. Cognitive frailty was defined as the concomitant presence of dynapenia and cognitive declines in any domains. Overall, data of 678 participants aged 65 years and older (mean age: 73.3 ± 5.3 years) were obtained for the study. The prevalence of cognitive frailty in this study was 13.3%. People with cognitive frailty were significantly older, having higher multimorbidity burden, more likely to be women, and had less skeletal muscle mass. Adjusted for age and gender, both dynapenia without cognitive impairment (hazard ratio [HR]: 5.402; 95% confidence interval [CI]: 1.463-19.954; p = 0.011) and cognitive frailty (HR: 6.682; 95% CI: 1.803-26.116; p = 0.005) were significantly associated with all-cause mortality. The prevalence of cognitive frailty was 13.3% in Taiwan and was predictive for all-cause mortality. Further study is needed to explore the pathophysiology and reversibility of cognitive frailty.
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Affiliation(s)
- Li-Kuo Liu
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,2 Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,3 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Hung Chen
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,4 Department of Family Medicine, Taipei City Hospital Hoping Branch, Taipei, Taiwan
| | - Wei-Ju Lee
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,2 Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,5 Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yilan, Taiwan
| | - Yi-Hui Wu
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,2 Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,3 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - An-Chun Hwang
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,2 Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,3 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Hsien Lin
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,2 Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,3 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Li-Ning Peng
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,2 Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,3 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Hui Loh
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,7 Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Hidenori Arai
- 6 National Center for Geriatrics and Gerontology, Obu, Japan
| | - Liang-Kung Chen
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,2 Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,3 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
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8
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Chen LY, Wu YH, Liu LK, Lee WJ, Hwang AC, Peng LN, Lin MH, Chen LK. Association Among Serum Insulin-Like Growth Factor-1, Frailty, Muscle Mass, Bone Mineral Density, and Physical Performance Among Community-Dwelling Middle-Aged and Older Adults in Taiwan. Rejuvenation Res 2018; 21:270-277. [DOI: 10.1089/rej.2016.1882] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Liang-Yu Chen
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Hui Wu
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Kuo Liu
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Ju Lee
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yilan City, Taiwan
| | - An-Chun Hwang
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Hsien Lin
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
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9
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Chen LY, Wu YH, Huang CY, Liu LK, Hwang AC, Peng LN, Lin MH, Chen LK. Predictive factors for dementia and cognitive impairment among residents living in the veterans' retirement communities in Taiwan: Implications for cognitive health promotion activities. Geriatr Gerontol Int 2018; 17 Suppl 1:7-13. [PMID: 28436185 DOI: 10.1111/ggi.13039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 12/13/2022]
Abstract
AIM To identify potentially modifiable risk factors for cognitive decline among veterans' home residents in Taiwan METHODS: The present retrospective cohort study was part of the Veteran Affairs-Comprehensive Geriatric Assessment study that retrieved data of the comprehensive geriatric assessment for 946 residents living at four veterans' homes in Taiwan. The study participants were interviewed every 3-6 months from January 2012 and December 2014. Demographic characteristics,multimorbidity by Charlson's Comorbidities Index, physical function by the Barthel Index, cognition by the Mini-Mental State Examination (MMSE), depression by the five-item Geriatric Depression Scale and nutritional status by the Mini-Nutrition Assessment-Short Form were collected for analysis. A generalized estimating equation model was used after it was adjusted for age, educational level, five-item Geriatric Depression Scale, and problem of communication difficulty to identify potential modifiable risk factors for cognitive decline. RESULTS The mean age of the participants was 85.7 ± 5.2 years, with a mean follow-up period of 41 ± 21.6 weeks. The prevalence of cognitive impairment (defined by MMSE <24) was 65.6%, whereas 34% of the study participants were positive for depressive symptoms. Approximately one-fifth of the study participants were using psychotropic agents, which was higher among participants with cognitive impairment (23.6% vs 15.6%, P < 0.05) than those without. In the generalized estimating equation model, physical function, nutritional status, depressive symptoms, ex-drinker, multimorbidity and stool incontinence were positively correlated with MMSE score; whereas advanced age, low educational level (<6 years), presence of communication difficulty and use of psychotropic agents were inversely associated with the MMSE score. CONCLUSIONS Physical function and nutritional status were positively associated with the MMSE score, and use of psychotropic agents was negatively correlated with cognitive function. Further intervention study is required to improve the cognitive health of older adults living in the veterans' retirement communities. Geriatr Gerontol Int 2017: 17 (Suppl. 1): 7-13.
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Affiliation(s)
- Liang-Yu Chen
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Hui Wu
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Yu Huang
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Kuo Liu
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Biomedical informatics, National Yang-Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - An-Chun Hwang
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Hsieh Lin
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
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10
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Hwang AC, Liu LK, Lee WJ, Peng LN, Chen LK. Calf Circumference as a Screening Instrument for Appendicular Muscle Mass Measurement. J Am Med Dir Assoc 2018; 19:182-184. [DOI: 10.1016/j.jamda.2017.11.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 01/06/2023]
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11
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Marzetti E, Hwang AC, Tosato M, Peng LN, Calvani R, Picca A, Chen LK, Landi F. Age-related changes of skeletal muscle mass and strength among Italian and Taiwanese older people: Results from the Milan EXPO 2015 survey and the I-Lan Longitudinal Aging Study. Exp Gerontol 2018; 102:76-80. [DOI: 10.1016/j.exger.2017.12.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/09/2017] [Accepted: 12/11/2017] [Indexed: 12/31/2022]
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12
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Tang TC, Hwang AC, Liu LK, Lee WJ, Chen LY, Wu YH, Huang CY, Hung CH, Wang CJ, Lin MH, Peng LN, Chen LK. FNIH-defined Sarcopenia Predicts Adverse Outcomes Among Community-Dwelling Older People in Taiwan: Results From I-Lan Longitudinal Aging Study. J Gerontol A Biol Sci Med Sci 2017; 73:828-834. [DOI: 10.1093/gerona/glx148] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 07/19/2017] [Indexed: 01/06/2023] Open
Affiliation(s)
- Ting-Ching Tang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taiwan
- Aging and Health Research Center, Taipei, Taiwan
| | - An-Chun Hwang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taiwan
- Aging and Health Research Center, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
| | - Li-Kuo Liu
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taiwan
- Aging and Health Research Center, Taipei, Taiwan
| | - Wei-Ju Lee
- Aging and Health Research Center, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Taiwan
| | - Liang-Yu Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taiwan
- Aging and Health Research Center, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
| | - Yi-Hui Wu
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taiwan
- Aging and Health Research Center, Taipei, Taiwan
| | - Chung-Yu Huang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taiwan
- Aging and Health Research Center, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
| | - Cheng-Hao Hung
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taiwan
- Aging and Health Research Center, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
| | - Chih-Jen Wang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taiwan
- Aging and Health Research Center, Taipei, Taiwan
- Department of Medicine, Changhua Christian Hospital, Taiwan
| | - Ming-Hsien Lin
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taiwan
- Aging and Health Research Center, Taipei, Taiwan
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taiwan
- Aging and Health Research Center, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taiwan
- Aging and Health Research Center, Taipei, Taiwan
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13
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Hsu TJ, Tsai HT, Hwang AC, Chen LY, Chen LK. Predictors of non-pharmacological intervention effect on cognitive function and behavioral and psychological symptoms of older people with dementia. Geriatr Gerontol Int 2017; 17 Suppl 1:28-35. [DOI: 10.1111/ggi.13037] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Ting-Jung Hsu
- Center for Geriatrics and Gerontology; Taipei Veterans General Hospital; Taipei Taiwan
| | - Hui-Te Tsai
- Center for Geriatrics and Gerontology; Taipei Veterans General Hospital; Taipei Taiwan
| | - An-Chun Hwang
- Center for Geriatrics and Gerontology; Taipei Veterans General Hospital; Taipei Taiwan
- Aging and Health Research Center; National Yang Ming University; Taipei Taiwan
- Institute of Public Health; National Yang Ming University; Taipei Taiwan
| | - Liang-Yu Chen
- Center for Geriatrics and Gerontology; Taipei Veterans General Hospital; Taipei Taiwan
- Aging and Health Research Center; National Yang Ming University; Taipei Taiwan
- Institute of Public Health; National Yang Ming University; Taipei Taiwan
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology; Taipei Veterans General Hospital; Taipei Taiwan
- Aging and Health Research Center; National Yang Ming University; Taipei Taiwan
- Institute of Public Health; National Yang Ming University; Taipei Taiwan
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14
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Liu LK, Guo CY, Lee WJ, Chen LY, Hwang AC, Lin MH, Peng LN, Chen LK, Liang KY. Subtypes of physical frailty: Latent class analysis and associations with clinical characteristics and outcomes. Sci Rep 2017; 7:46417. [PMID: 28397814 PMCID: PMC5387710 DOI: 10.1038/srep46417] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/15/2017] [Indexed: 12/23/2022] Open
Abstract
Frailty is a well-recognized geriatric syndrome with various definitions and conceptual frameworks. This study aimed to use latent class analysis to discover potential subtypes of pre-frail and frail older people. Data from the I-Lan Longitudinal Aging Study (ILAS), a community-based cohort study was used for analysis. Latent class analysis was applied to characterize classes or subgroups with different frailty phenotypes among ILAS participants targeting older adults aged 65 and above, capable of completing a 6-meter walk, without severe major or life threatening diseases, and not institutionalized. Latent class analysis identified three distinct subgroups with different frailty phenotypes: non-mobility-type (weight loss and exhaustion), mobility-type frailty (slowness and weakness), and low physical activity. Comparing these groups with the robust group, people with mobility-type frailty had poorer body composition, worse bone health, poorer cognitive function, lower survival (hazard ratio: 6.82, p = 0.019), and poorer overall health outcomes (hazard ratio: 1.67, p = 0.040). People in the non-mobility-type group had poorer bone health and more metabolic serum abnormalities. In conclusion, mobility-type frailty was a better predictor of adverse outcomes. However, further investigation is needed to evaluate how these phenotypic subgroups may help in predicting prognosis or in developing interventions.
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Affiliation(s)
- Li-Kuo Liu
- Aging and Health Research Center, National Yang Ming University, No. 155, Sec. 2, Linong St., Taipei City 11221, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd., Taipei 11217, Taiwan
| | - Chao-Yu Guo
- Aging and Health Research Center, National Yang Ming University, No. 155, Sec. 2, Linong St., Taipei City 11221, Taiwan.,Institute of Public Health, National Yang Ming University, No. 155, Sec. 2, Linong St., Taipei City 11221, Taiwan
| | - Wei-Ju Lee
- Aging and Health Research Center, National Yang Ming University, No. 155, Sec. 2, Linong St., Taipei City 11221, Taiwan.,Department of Family Medicine, Taipei Veterans General Hospital, Yuanshan Branch, No. 386 Rongguang Rd., Yuanshan Township, Yilan County 264, Taiwan
| | - Liang-Yu Chen
- Aging and Health Research Center, National Yang Ming University, No. 155, Sec. 2, Linong St., Taipei City 11221, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd., Taipei 11217, Taiwan.,Institute of Public Health, National Yang Ming University, No. 155, Sec. 2, Linong St., Taipei City 11221, Taiwan
| | - An-Chun Hwang
- Aging and Health Research Center, National Yang Ming University, No. 155, Sec. 2, Linong St., Taipei City 11221, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd., Taipei 11217, Taiwan.,Institute of Public Health, National Yang Ming University, No. 155, Sec. 2, Linong St., Taipei City 11221, Taiwan
| | - Ming-Hsien Lin
- Aging and Health Research Center, National Yang Ming University, No. 155, Sec. 2, Linong St., Taipei City 11221, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd., Taipei 11217, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, No. 155, Sec. 2, Linong St., Taipei City 11221, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd., Taipei 11217, Taiwan.,Institute of Public Health, National Yang Ming University, No. 155, Sec. 2, Linong St., Taipei City 11221, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, No. 155, Sec. 2, Linong St., Taipei City 11221, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd., Taipei 11217, Taiwan
| | - Kung-Yee Liang
- Aging and Health Research Center, National Yang Ming University, No. 155, Sec. 2, Linong St., Taipei City 11221, Taiwan.,Institute of Public Health, National Yang Ming University, No. 155, Sec. 2, Linong St., Taipei City 11221, Taiwan
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15
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Wu YH, Hwang AC, Liu LK, Peng LN, Chen LK. Sex differences of sarcopenia in Asian populations: The implications in diagnosis and management. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jcgg.2016.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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16
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Hwang AC, Zhan YR, Lee WJ, Peng LN, Chen LY, Lin MH, Liu LK, Chen LK. Higher Daily Physical Activities Continue to Preserve Muscle Strength After Mid-Life, But Not Muscle Mass After Age of 75. Medicine (Baltimore) 2016; 95:e3809. [PMID: 27258519 PMCID: PMC4900727 DOI: 10.1097/md.0000000000003809] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The objective of this study is to explore the impact of aging and daily physical activities (PA) on muscle mass and muscle strength among community-dwelling people in Taiwan.The design is a cross-sectional study. Setting is a population-based community study.One thousand eight hundred thirty-nine community-dwelling people aged 50 years and older in Taiwan participated in the study.Measurements include demographic characteristics, Charlson Comorbidity Index (CCI) for multimorbidity, mini-nutritional assessment (MNA) for nutritional evaluation, functional autonomy measurement system (SMAF) for functional capacity, Chinese version mini mental state examination (MMSE), 5-item Taiwan Geriatric Depression Scale (TGDS-5), Chinese version of International Physical Activity Questionnaire (IPAQ), height-adjusted skeletal muscle index (SMI) by dual-energy X-ray absorptiometry, handgrip strength, timed 6-m walking test for usual gait speed. Laboratory measurements include testosterone, sex-hormone binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEA-S), insulin-like growth factor-1 (IGF-1), high-sensitivity C-reactive protein (hsCRP), 25-OH vitamin D, and insulin resistance.After adjusted for age, the lowest PA tertile was associated with multimorbidity, poorer functional capacity and nutritional status, more depressive symptoms, lower SMI and lower handgrip strength, and lower free androgen index (FAI) in men. The negative association between PA and low SMI was more significant among subjects aged younger than 65 and the association decreased with older age. For subjects aged younger than 65, moderate daily PA (Q2) group had lower risk of low SMI compared with Q1 participants (OR: 0.62, 95% CI = 0.39-0.98, P = 0.040). For muscle strength, higher daily PA was associated with lower risk of low handgrip strength after age of 65 and the effect was dose-dependent. The effect was attenuated by potential confounders during age 65 to 74, while after age 75, the result was almost unchanged in fully adjusted model (OR = 0.37, 95% CI = 0.18-0.79, P = 0.010).Older age may attenuate the protective effects of higher daily PA on preventing muscle loss, but higher daily PA continues to preserve muscle strength at different age groups, even after the age of 75. The prognostic role of daily PA may be mediated by muscle strength instead of muscle mass among people aged 75 years and older.
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Affiliation(s)
- An-Chun Hwang
- From the Center for Geriatrics and Gerontology (A-cH, Y-RZ, L-NP, L-YC, M-HL, L-KL, L-KC), Taipei Veterans General Hospital; Department of Rehabilitation Medicine (Y-RZ), Taipei City Hospital Hoping Fuyou Branch; Department of Family Medicine (W-JL), Taipei Veterans General Hospital Yuanshan Branch; Aging and Health Research Center (A-cH, W-JL, L-NP, L-YC, M-HL, L-KL, L-KC); and Institute of Public Health (A-cH, W-JL, L-NP, L-YC, L-KC), National Yang Ming University, Taipei, Taiwan
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17
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Huang XM, Hwang AC, Sharma-Walia N. ID: 51: CHEMOTHERAPEUTIC POTENTIAL OF LIPOXINS IN KAPOSI'S SARCOMA AND PRIMARY EFFUSION LYMPHOMA. J Investig Med 2016. [DOI: 10.1136/jim-2016-000120.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Current treatments for Kaposi's Sarcoma (KS) and Primary Effusion Lymphoma (PEL) rely on systemic chemotherapeutics developed for non-virus-associated cancers that target DNA replication of all dividing cells. Other treatment methods aim at keeping immune system healthy and infection under control through surgery. All of the above approaches have low efficacy, high cost, and high risk of secondary malignancies especially in immuno-compromised patients. Hence, there is an emerging need to look for alternative treatment focused on KS or PEL host molecules, such as Lipoxins. Lipoxins are anti-inflammatory molecules that can target a variety of pro-inflammatory pathways of KS and PEL. Previous results from our lab have shown that level of ALX receptor (ALXR) does not change after Kaposi's Sarcoma Herpes Virus (KSHV) infection, leading to the potential use of Lipoxins to trigger anti-inflammatory and pro-apoptotic pathways as treatment of KS and PEL.In this study, we investigated downstream signaling in KSHV harboring body cavity B cell lymphoma (BCBL-1) cells induced by Lipoxin treatment to assess its pro-apoptotic effect. We treated 5–10×106 BCBL-1 cells with solvent control (EtOH), Lipoxin (100 mM), or Epilipoxin (100 mM) for 48 and 72 hrs. Downstream phosphorylation of Akt, NF-kB p65, and ERK were assessed using Western blotting and pro-apoptotic gene changes were detected using Real-Time PCR. Cell survival and cell cycle progression was assessed using BrdU FACS analysis. We found that Lipoxin and Epilipoxin treatment downregulated NF-kB and ERK activation via ALXR binding while Akt signaling was not affected. We also found that Lipoxin successfully upregulated pro-apoptotic genes such as BIM-1, BAX, BCL-10, and p53 compared to control. Lipoxin treatment also led to decreased S-phase progression and induction of apoptosis. In conclusion, our study suggests that Lipoxins have therapeutic potential for PEL and should be explored in KS and other PEL cell types.
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Huang CY, Hwang AC, Liu LK, Lee WJ, Chen LY, Peng LN, Lin MH, Chen LK. Association of Dynapenia, Sarcopenia, and Cognitive Impairment Among Community-Dwelling Older Taiwanese. Rejuvenation Res 2016; 19:71-8. [DOI: 10.1089/rej.2015.1710] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chung-Yu Huang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | - An-Chun Hwang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | - Li-Kuo Liu
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | - Wei-Ju Lee
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yuanshan Township, Yilan County, Taiwan
| | - Liang-Yu Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | - Ming-Hsien Lin
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
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19
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Hwang AC, Liu LK, Lee WJ, Chen LY, Peng LN, Lin MH, Chen LK. Association of Frailty and Cardiometabolic Risk Among Community-Dwelling Middle-Aged and Older People: Results from the I-Lan Longitudinal Aging Study. Rejuvenation Res 2015; 18:564-72. [PMID: 26556635 DOI: 10.1089/rej.2015.1699] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The aim of this study was to evaluate the association of cardiometabolic risk and frailty through a community-based aging cohort in Taiwan In total, 1839 participants (men, 47.5%; mean age 63.9 ± 9.3 years) from the first wave of the I-Lan longitudinal cohort study, recruited between August of 2011 and August of 2013, were retrieved for the analysis of this cross-sectional study. Frailty was defined by Cardiovascular Health Study (CHS) criteria, encompassing un-intentional weight loss, slow walk speed, poor grip strength, exhaustion, and low activity. Comparisons between cardiometabolic risk and frailty status were performed after adjustment for age, hormone parameters, functional measurements, and skeletal muscle mass. Independent association of cardiometabolic risk and frailty status was identified through the multivariate logistic regression model. We found that the prevalence of frailty and pre-frial were 6.8% and 40.5%, respectively. Adjustments for age, blood pressure, low-density lipoprotein cholesterol (LDL-C), uric acid, creatinine, and carotid intima media thickness were not significantly associated with frailty. However, lower total cholesterol and high-density lipoprotein cholesterol (HDL-C), higher high-sensitivity C-reactive protein (hsCRP) and glycemia profiles were significantly associated with frailty. For hormone parameters, dehydroepiandrosterone sulfate (DHEA-S), insulin-like growth factor-1 (IGF-1), and free androgen index were not significantly associated with frailty after age adjustment. In a multivariate logistic regression model, abdominal obesity, homeostasis model assessment of insulin resistance (HOMA-IR), and hsCRP were significantly associated with frailty. The odds ratio (OR) for frailty was 3.57 (95% confidence interval [CI] 1.88-6.78, p < 0.001), 1.30 (95% CI 1.02-1.66, p = 0.032), and 1.66 (95% CI 1.10-2.49, p = 0.016), respectively, in a fully adjusted model. Conversely, higher total cholesterol was associated with a lower prevalence of frailty (OR = 0.44, 95% CI 0.22-0.89, p = 0.023) in the final model. In this study, abdominal obesity, insulin resistance, and inflammation were significantly associated with frailty, and the effect was independent of functional measurement and decline of skeletal muscle mass. An integrated approach targeted at cardiometabolic aging and frailty is needed in clinical practice.
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Affiliation(s)
- An-Chun Hwang
- 1 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital , Taipei, Taiwan .,2 Aging and Health Research Center, National Yang Ming University , Taipei, Taiwan .,3 Institute of Public Health, National Yang Ming University , Taipei, Taiwan
| | - Li-Kuo Liu
- 1 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital , Taipei, Taiwan .,2 Aging and Health Research Center, National Yang Ming University , Taipei, Taiwan
| | - Wei-Ju Lee
- 1 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital , Taipei, Taiwan .,2 Aging and Health Research Center, National Yang Ming University , Taipei, Taiwan .,4 Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch , I-Lan, Taiwan
| | - Liang-Yu Chen
- 1 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital , Taipei, Taiwan .,2 Aging and Health Research Center, National Yang Ming University , Taipei, Taiwan
| | - Li-Ning Peng
- 1 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital , Taipei, Taiwan .,2 Aging and Health Research Center, National Yang Ming University , Taipei, Taiwan
| | - Ming-Hsien Lin
- 1 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital , Taipei, Taiwan .,2 Aging and Health Research Center, National Yang Ming University , Taipei, Taiwan
| | - Liang-Kung Chen
- 1 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital , Taipei, Taiwan .,2 Aging and Health Research Center, National Yang Ming University , Taipei, Taiwan
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Liu LK, Lee WJ, Chen LY, Hwang AC, Lin MH, Peng LN, Chen LK. Association between Frailty, Osteoporosis, Falls and Hip Fractures among Community-Dwelling People Aged 50 Years and Older in Taiwan: Results from I-Lan Longitudinal Aging Study. PLoS One 2015; 10:e0136968. [PMID: 26348034 PMCID: PMC4562637 DOI: 10.1371/journal.pone.0136968] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 08/11/2015] [Indexed: 12/25/2022] Open
Abstract
Background Association of frailty with adverse clinical outcomes has been reported in Western countries, but data from the Asian population are scarce. This study aimed to evaluate the epidemiology of frailty among community-dwelling middle-aged and elderly population and to explore its association with musculoskeletal health in Taiwan. Methods I-Lan Longitudinal Aging Study (ILAS) data were retrieved for this study. Frailty was defined by the Fried’s criteria; a comparison of demographic characteristics, physical performance, and body composition, including skeletal muscle mass and bone mineral density (BMD), as well as recent falls, history of hip fractures and the functional status of subjects with different frailty statuses were accomplished. Results Overall, the data of 1,839 participants (mean age: 63.9±9.3 years, male 47.5%) were obtained for analysis. The prevalence of pre-frailty was 42.3% in men and 38.8% in women, whereas the prevalence of frailty was 6.9% and 6.7% in men and women, respectively. Frailty was significantly associated with older age, the male gender, larger waist circumference, lower skeletal muscle index, lower hip BMD, poorer physical function, poorer nutritional status, and poorer cognitive function. Also, frailty was significantly associated with osteoporosis (OR: 7.73, 95% CI: 5.01–11.90, p<0.001), history of hip fractures (OR: 8.66, 95% CI: 2.47–30.40, p = 0.001), and recent falls (O.R: 2.53, 95% CI: 1.35–4.76, p = 0.004). Conclusions Frailty and pre-frailty, in Taiwan, was closely associated with recent falls, history of hip fractures and osteoporosis among community-dwelling people 50 years of age and older. Furthermore, frailty intervention programs should take an integrated approach towards strengthening both and muscle mass, as well as prevention of falls.
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Affiliation(s)
- Li-Kuo Liu
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Ju Lee
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, I-Lan County, Taiwan
| | - Liang-Yu Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - An-Chun Hwang
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Hsien Lin
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail:
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Liu LK, Lee WJ, Chen LY, Hwang AC, Lin MH, Peng LN, Chen LK. Sarcopenia, and its association with cardiometabolic and functional characteristics in Taiwan: results from I-Lan Longitudinal Aging Study. Geriatr Gerontol Int 2014; 14 Suppl 1:36-45. [PMID: 24450559 DOI: 10.1111/ggi.12208] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2013] [Indexed: 12/25/2022]
Abstract
AIM Sarcopenia is a well-recognized geriatric syndrome, which is associated with a variety of adverse outcomes. The present study aimed to evaluate the prevalence of sarcopenia and its associative clinical characteristics in Taiwan. METHODS Data of the I-Lan Longitudinal Aging Study (ILAS) were retrieved for this study. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People criteria, and comparisons of demographic characteristics, physical performance, body composition, cardiometabolic profiles and functionality indicators were carried out. RESULTS Overall, data of 1008 participants (mean age 65.2 ± 9.3 years, male 50.6%) were retrieved for analysis. The cut-off value of relative appendicular skeletal muscle was 7.0 kg/m(2) for men and 5.9 kg/m(2) for women. Sarcopenia was significantly related to low body mass index, smaller waist circumference, poor nutrition and poor cognition. The mean carotid intima-media thickness and cardiometabolic parameters showed no statistically significant findings. CONCLUSIONS The present paper showed the epidemiology of sarcopenia, and the strong connection to functionality indicators. However, sarcopenia was not associated with cardiometabolic risk or carotid intima media thickness in the present study.
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Affiliation(s)
- Li-Kuo Liu
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
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Liu LK, Chen LY, Yeh KP, Lin MH, Hwang AC, Peng LN, Chen LK. Sarcopenia, but not sarcopenic obesity, predicts mortality for older old men: A 3-year prospective cohort study. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.jcgg.2014.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hwang AC, Peng LN, Wen YW, Tsai YW, Chang LC, Chiou ST, Chen LK. Predicting all-cause and cause-specific mortality by static and dynamic measurements of allostatic load: a 10-year population-based cohort study in Taiwan. J Am Med Dir Assoc 2014; 15:490-496. [PMID: 24631353 DOI: 10.1016/j.jamda.2014.02.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/31/2014] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the role of allostatic load (AL), either static or dynamic measurements, in predicting all-cause and cause-specific mortality of older people in Taiwan. DESIGN A prospective cohort study. SETTING Population-based community study. PARTICIPANTS One thousand twenty-three community-dwelling older people. MEASUREMENTS Allostatic load (calculated by systolic blood pressure, diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, triglyceride, glycosylated hemoglobin, fasting glucose, waist-to-hip ratio, body mass index, dehydroepiandrosterone sulfate, insulin-like growth factor-1, 12-hour urine cortisol, 12-hour urine epinephrine, 12-hour urine norepinephrine, 12-hour urine dopamine, white blood cell count, neutrophils, interleukin-6, albumin, creatinine) and all-cause and cause-specific mortality from national death registry. INTERVENTION None. RESULTS Adjusted for age and sex, each 1-point increase in AL score was associated with 20% incremental risk of mortality [hazard ratio 1.20, 95% confidence interval (CI) 1.09-1.31]. This association can be extended to cause-specific mortality in both sexes in general. In addition, the higher AL score quintile was significantly associated with higher risk of 10-year all-cause mortality (P < .0001). This association was consistent across different cause-specific mortality (ie, malignant neoplasm (P = .008), cardiometabolic diseases (P < .0001), infectious diseases (P < .0001), respiratory diseases (P < .0001), and others (P = .0002), respectively. Compared with AL score decliners, adjusted for age, sex, and baseline AL score in 2000, participants with fast increase had significantly higher mortality (HR 2.68, 95% CI 1.23-5.84, P = .01). The effect was stronger in men (HR 2.83, 95% CI 1.1-7.29, P = .03 in slow increase; HR 4.06, 95% CI 1.56-10.6, P = .001 in fast increase group), but it was insignificant in female participants. CONCLUSIONS Higher AL score or rapid increase of AL score significantly increased subsequent mortality risk in older adults, either measured statically or dynamically. AL is predictive of 10-year mortality regardless of cause of death, and rapid increase in AL score is associated with higher subsequent mortality.
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Affiliation(s)
- An-Chun Hwang
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Institute of Public Health, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Institute of Public Health, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Wen Wen
- Clinical Informatics and Medical Statistics Research Center, Chang-Gung University, Taoyuan, Taiwan
| | - Yi-Wen Tsai
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Institute of Health Welfare and Policy, National Yang Ming University, Taipei, Taiwan
| | - Li-Chuan Chang
- Institute of Health Welfare and Policy, National Yang Ming University, Taipei, Taiwan
| | - Shu-Ti Chiou
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan; Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Clinical Informatics and Medical Statistics Research Center, Chang-Gung University, Taoyuan, Taiwan.
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Hwang AC, Liu LK, Lee WJ, Chen LY, Lin MH, Peng LN, Won CW, Chen LK. Association of Androgen with Skeletal Muscle Mass and Muscle Function Among Men and Women Aged 50 Years and Older in Taiwan: Results from the I-Lan Longitudinal Aging Study. Rejuvenation Res 2013; 16:453-9. [DOI: 10.1089/rej.2013.1442] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- An-Chun Hwang
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Kuo Liu
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Ju Lee
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, I-Lan, Taiwan
| | - Liang-Yu Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Hsien Lin
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chang Won Won
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, South Korea
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Liu PT, Hwang AC, Chen JD. Combined effects of hepatitis B virus infection and elevated alanine aminotransferase levels on dyslipidemia. Metabolism 2013; 62:220-5. [PMID: 22938729 DOI: 10.1016/j.metabol.2012.07.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 07/27/2012] [Accepted: 07/27/2012] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Although elevated alanine aminotransferase (ALT) levels are associated with lipid profiles, most studies do not consider the role of hepatitis B virus (HBV) infection. This study investigated the combined effects of HBV infection and elevated ALT levels on the lipid profiles of Taiwanese adults. MATERIALS/METHODS A total of 7695 subjects were enrolled after an annual health examination. Dyslipidemia was defined as serum total cholesterol≥200 mg/dL, serum triglyceride≥150 mg/dL, high-density lipoprotein cholesterol<40 mg/dL in men or <50 mg/dL in women, or low-density lipoprotein cholesterol≥130 mg/dL. Multiple logistic regression analysis was performed to assess the associations between dyslipidemia, HBV infection, and elevated ALT levels. RESULTS Hepatitis B surface antigen positivity (HBV[+]) and elevated ALT levels (ALT[+], ≥50 U/L) were observed in 13.5% and 12.2% of the subjects, respectively. Multiple logistic analysis revealed that the HBV(+) group had a significantly lower odds ratios (ORs) for hypercholesterolemia (OR, 0.8), hypertriglyceridemia (OR, 0.7), and high low-density lipoprotein cholesterol levels (OR, 0.8); whereas, the subjects with elevated ALT levels had significantly higher ORs for all of the dyslipidemia criteria. The interaction between HBV(+) and ALT(+) had a significantly lower OR for hypertriglyceridemia (OR, 0.7). The subjects with HBV infections had a significantly lower OR for hypertriglyceridemia regardless of the ALT levels. CONCLUSIONS HBV infection and elevated ALT levels have opposite effects on dyslipidemia, whereas their combined effects result in a significantly lower OR for hypertriglyceridemia.
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Affiliation(s)
- Peng-Tzu Liu
- Department of Family Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Hwang AC, Lin YC, Liu PT, Kao YM, Chen JD. Synergistic effect of gamma glutamyltransferase and obesity on metabolic syndrome, independent of hepatic steatosis. Ann Epidemiol 2012; 22:876-80. [PMID: 23110960 DOI: 10.1016/j.annepidem.2012.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 09/24/2012] [Accepted: 09/27/2012] [Indexed: 12/21/2022]
Abstract
PURPOSE Both obesity and gamma glutamyltransferase (GGT) are individually considered to be closely associated with metabolic syndrome (MetS). Whether the 2 factors synergistically associate with MetS is not yet confirmed. The purpose of this study was to investigate whether obesity and GGT are interactively associated with MetS. METHODS A cross-sectional study of 7390 adults (age 32-62 years old) was conducted from 2009 to 2010. RESULTS Our results showed that greater serum GGT quartiles were positively associated with all MetS components and fatty liver (P < .001). The odds ratio of MetS increased significantly along with quartiles of GGT and obesity. In comparison with subjects with normal body mass index and first quartile GGT, the odds ratio of MetS in obese groups with 1st, 2nd, 3rd, and 4th quartile GGT were 6.8, 14.5, 20.3, and 45.2, respectively, and it remained tenable after adjustment for fatty liver. The synergy index of GGT and obesity on MetS is 2.2 (95% confidence interval, 1.9-2.6). CONCLUSIONS Serum GGT level in combination with obesity can be a simple but useful tool for risk stratification of developing MetS. Obese individuals with high-normal GGT levels require close monitoring for high risk of MetS.
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Affiliation(s)
- An-Chun Hwang
- Department of Family Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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