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Yanagita I, Fujihara Y, Iwaya C, Kitajima Y, Tajima M, Honda M, Teruya Y, Asakawa H, Ito T, Eda T, Yamaguchi N, Kayashima Y, Yoshimoto M, Harada M, Yoshimoto S, Aida E, Yanase T, Nawata H, Muta K. Low serum albumin, aspartate aminotransferase, and body mass are risk factors for frailty in elderly people with diabetes-a cross-sectional study. BMC Geriatr 2020; 20:200. [PMID: 32517659 PMCID: PMC7285748 DOI: 10.1186/s12877-020-01601-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 02/02/2020] [Accepted: 06/04/2020] [Indexed: 01/04/2023] Open
Abstract
Background Frailty is broadly characterized by vulnerability and decline in physical, mental and social activities and is more common in elderly patients with type 2 diabetes mellitus (T2DM). Frailty is closely associated with nutrition, muscle strength, inflammation, and hormones etc. In hormones, dehydroepiandrosterone sulfate (DHEA-S) and cortisol are suggested to be such candidates affecting frailty. Little investigation has been performed using a wider range of measures of frailty to clarify risk factors for frailty including the above two hormones. Methods We performed a cross-sectional study to investigate the risk factors for frailty in elderly T2DM patients (n = 148; ≥65 years), using a broad assessment, the clinical frailty scale. We compared parameters between the non-frail and frail groups using the unpaired t and Mann-Whitney U tests. The Jonckheere-Therpstra test was used to identify relationships with the severity of frailty, and risk factors were identified using binary regression analysis. Results Simple regression analysis identified a number of significant risk factors for frailty, including DHEAS < 70 μg/dL and cortisol/DHEA-S ratio ≥ 0.2. Multiple regression analysis showed that low albumin (< 4.0 g/dl) (odds ratio [OR] = 5.79, p < 0.001), low aspartate aminotransferase (AST) activity (< 25 IU/L) (OR = 4.34, p = 0.009), and low body mass (BM) (< 53 kg) (OR = 3.85, p = 0.012) were independent risk factors for frailty. A significant decrease in DHEA-S and a significant increase in the cortisol/DHEA-S ratio occurred alongside increases in the severity of frailty. DHEA-S concentration positively correlated with both serum albumin and BM. Conclusions Hypoalbuminemia, low AST, and low BM are independent risk factors for frailty in elderly T2DM patients, strongly implying relative malnutrition in these frail patients. DHEA-S may be important for the maintenance of liver function and BM. A decrease in DHEA-S and an increase in the cortisol/DHEAS ratio may be involved in the mechanism of the effect of malnutrition in elderly T2DM patients.
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Affiliation(s)
- Ikumi Yanagita
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Yuya Fujihara
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Chikayo Iwaya
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Yuichi Kitajima
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Misuzu Tajima
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Masanao Honda
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Yuji Teruya
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Hideko Asakawa
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Tomoko Ito
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Terumi Eda
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Noriko Yamaguchi
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Yumi Kayashima
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Mihoko Yoshimoto
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Mayumi Harada
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Shoji Yoshimoto
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Eiji Aida
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Toshihiko Yanase
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan. .,Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Hajime Nawata
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
| | - Kazuo Muta
- Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, 814-0163, Japan
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