nu ien s
A icle
Nu i ional S a us and Risk Fac o s o F ail y
in Communi y-Dwelling Olde People:
A C oss-Sec ional S udy
Pila Pé ez-Ros 1,*, Ra ael Vila-Candel 1,2,3 , Lou des López-He nández 1and
F ancisco Miguel Ma ínez-A nau 4,5
1Depa men o Nu sing, Uni e sidad Ca ólica de Valencia San Vicen e Má i , 46007 Valencia, Spain;
a ael. ila@uc .es (R.V.-C.); lou des.lopez@uc .es (L.L.-H.)
2Depa men o Obs e ics and Gynaecology, Hospi al Uni e si a io de la Ribe a,
FISABIO. C a. Co be a km 1, 46600 Valencia, Spain
3Depa men o Nu sing, Facul y o Nu sing and Podia y, Uni e si a de València. Jaume Roig, s/n,
46010 Valencia, Spain
4Depa men o Physio he apy, Uni e si a de València. 46010 Valencia, Spain; ancisco.m.ma inez@u .es
5F ail y and Cogni i e Impai men Resea ch G oup (FROG), Uni e si y o Valencia, 46010 Valencia, Spain
*Co espondence: pila .pe ez@uc .es
Recei ed: 27 Feb ua y 2020; Accep ed: 9 Ap il 2020; Published: 10 Ap il 2020
Abs ac :
Objec i e: This s udy aims o assess he ela ionship ha ail y has wi h nu i ional s a us
and unc ional isk ac o s in communi y-dwelling olde adul s. Me hods: C oss-sec ional s udy in
communi y-dwelling olde people, independen o walking and wi hou impai ed cogni ion. F ail y
was assessed by F ied c i e ia. Nu i ional s a us was analyzed by he Mini Nu i ional Assessmen
Sho Fo m (MNA-SF), biochemical ma ke s (albumin, o al p o eins, choles e ol, lymphocy es,
and hemoglobin); and an h opome ic pa ame e s (body mass index [BMI], body a pe cen age,
handg ip, and pe ime e s). A comp ehensi e ge ia ic assessmen analyzed o he isk ac o s:
unc ionali y, cogni ion, alls, como bidi y, polypha macy, physical ac i i y, and quali y o li e (QoL).
Resul s: We included 564 elde ly people wi h a mean age o 76.05 (s anda d de ia ion 3.97) yea s;
63.1% (n=356) we e women, and 83.9% (n=473) we e p e ail, and ail. The sample p esen ed
high unc ionali y and a nu i ional s a us wi h a p edominance o o e weigh and obesi y. Fac o s
associa ed wi h ail y (R
2
=0.43) we e age o e 75 yea s (odds a io [OR] 3.31, 95% con idence
in e al [CI] 1.76, 6.21; p<0.001), emale gende (OR 2.37, 95% CI 1.24, 4.52; p=0.009), anemia
(OR 2.45, 95% CI 1.19, 5.02; p=0.015), alls (OR 1.94, 95% CI 1.12, 3.25; p=0.016) and he ea o alling
(OR 4.01: 95% CI 1.76, 9.16; p=0.001). Pe o ming mo e han 3 weekly hou s o physical ac i i y was
ound o be a p o ec i e ac o (OR 0.23, 95% CI 0.15, 0.35; p<0.001). Conclusions: The ela ionship
be ween ail y and malnu i ion in unc ionally independen communi y-dwelling olde people is
unclea . Mo e s udies a e needed o know wha nu i ional ma ke s a e ela ed o ail y, cogni ion,
and unc ionali y in o de o disc imina e he isk ac o s o communi y-dwelling olde people a
isk o malnu i ion and dependency.
Keywo ds: ail y; nu i ional s a us; independen li ing; isk ac o s; li es yle; ageing; heal h
1. In oduc ion
Li e expec ancy is inc easing in mos coun ies globally. Cu en ly, 9% o he wo ld’s popula ion
is o e 65 yea s old, and his igu e is expec ed o inc ease o 16% by 2050 [
1
]. Popula ion ageing
is accompanied by inc eased como bidi y, unc ional decline, and inc eased p e alence o ge ia ic
Nu ien s 2020,12, 1041; doi:10.3390/nu12041041 www.mdpi.com/jou nal/nu ien s
Nu ien s 2020,12, 1041 2 o 14
synd omes—complex heal h condi ions ha a e no amed in speci ic mo bidi y pa hologies bu a he
mani es h ough phenomena like ail y, alls, immobili y, incon inence, and deli ium [2].
F ail y is a synd ome cha ac e ized by diminished physiological ese es, and i s p e alence is
agg a a ed by age [
3
]. While he e a e se e al de ini ions o he synd ome, Rockwood e al. a o
a mul idimensional concep ha encompasses he physical, psychological and social componen and
i s como bidi y [
4
]. In con as , he model p oposed by F ied [
5
]— he mos widely used wo ldwide
—de ines ail y as he p esence o a leas h ee o i e physical indica o s: weakness ( educed g ip
s eng h), slowness ( educed gai speed), weigh loss, low physical ac i i y, and exhaus ion. People
wi h one o wo indica o s a e classi ied as p e ail. P e alence o ail y a a communi y le el is
es ima ed a 3.9% o 51.4%, and p e alence o p e ail y anges om 13.4% o 71.6%, depending on he
geog aphical egion and he sc eening ools used [6].
In clinical p ac ice, people o e 80 yea s o age wi h high como bidi y o disabili y ha e o en
been misiden i ied as ail [
7
]. Al hough hey can o e lap, como bidi y, loss o unc ionali y and ail y
a e independen en i ies. A he same ime, hey all ha e nega i e e ec s on heal h and a e associa ed
wi h disabili y, hospi aliza ion and dea h [
8
,
9
]. Func ionali y is de ined as a se o physical and men al
skills necessa y o he main enance o independence in he pe o mance o basic and ins umen al
ac i i ies o daily li ing as well as in social and cogni i e aspec s [
10
]. P e ail y and ail y a e isk
ac o s o loss o unc ion, al hough his ela ionship is close in people aged o e 75 yea s [11,12].
The pheno ype p oposed by F ied [
5
] (Figu e 1) ames sa copenia seconda y o malnu i ion
as con ibu ing o low physical ac i i y and inc eased dependence. Bo h en i ies, obesi y and
unde nu i ion, a e ela ed o sa copenia and ail y al hough hese condi ions a e mo e p e alen
in esiden ial and hospi al se ings han in he communi y [
13
,
14
]. Bo h he quan i a i e assessmen
(ene gy in ake) and he quali a i e assessmen (nu ien quali y) a e impo an because he lack o
mic onu ien s (Vi amin D o leucine) and mac onu ien s (p o eins) a e conside ed isk ac o s o
ail y, while he ype o die (Medi e anean die ) can p e en o e e se ail y [
15
]. In addi ion,
nu i ional sc eening using he Mini Nu i ional Assessmen (MNA) o Sho Fo m MNA (MNA-SF) is
ecommended o he de ec ion o malnu i ion [
16
,
17
]. On he o he hand, some s udies epo ha
unde nu i ion is no he only nu i ional s a e ela ed o ail y; some pa ame e s o o e nu i ion,
such as ele a ed BMI, high body a pe cen age and cen al obesi y in adul hood could also inc ease
isk in aging [18,19].
In e na ional guidelines ag ee on he need o ca y ou a co ec nu i ional assessmen , al hough
he subsequen in e en ion s a egies a e no eally de ined due o di icul ies in implemen a ion [
20
–
22
].
The lack o global consensus on anges and pa ame e s o no mali y, he di e si y o assessmen ools
in each pa ame e o nu i ional assessmen [
23
], and he di e si y in he assessmen o ail y [
24
]
all pose challenges o p e en ion s a egies. In addi ion, a comple e nu i ional assessmen includes
die a y, clinical and an h opome ic assessmen s; sc eening ools; and analyses o biochemical ma ke s,
equi ing a conside able in es men o ime and esou ces, as well as in e disciplina y wo k [
25
].
Compa isons be ween some nu i ional pa ame e s a e p oblema ic, as body a pe cen age inc eases
wi h age, aennd body dis ibu ion di e s by sex and could modi y he wais ci cum e ence. Loss o
heigh wi h age could also modi y BMI. Taken oge he , hese aspec s complica e eaching a consensus
on wha is “no mal” and iden i ying clea isk ac o s linked o ail y. The inc ease in body a and
loss o lean mass is ela ed o he ageing p ocess [
19
]. So, he e is a dea h o longi udinal s udies ha
could elucida e he ole o nu i ion in e e sing ail y o ha analyze he nu i ional s a us o o he
popula ions [14,16].
A ecen sys ema ic e iew [
20
] epo ed a p e alence o ail y o 13.6% and o p e ail y, 30.9% in
p e iously obus elde ly, concluding ha communi y-dwelling olde adul s a e p one o de eloping
ail y. Inc eased awa eness o he ac o s ha con e high isk o ail y in his popula ion subg oup is
i al o in o ming he design o in e en ions o p e en ail y and minimize i s consequences.
Nu ien s 2020,12, 1041 3 o 14
The aim o he s udy was o de e mine he ac o s associa ed wi h ail y in communi y-dwelling
olde people wi h unc ional independence and no cogni i e impai men , and o analyze hei
ela ionship wi h nu i ional s a us.
Figu e 1. F ail y de elopmen cycle, adap ed om F ied e al. [5].
2. Ma e ials and Me hods
2.1. S udy Design and Pa icipan s
A c oss-sec ional s udy was ca ied ou om 1 Decembe 2014 o 31 May 2015. The inclusion
c i e ia we e as ollows: pa icipan s aged 70 yea s o olde ; independen o walking (wi h possible
echnical aids, bu no assis ed by ano he pe son); and li ing wi hin he ca chmen a ea o La
Ribe a Heal h Depa men (Valencia, Spain). Exclusion c i e ia we e: e usal o pa icipa e in he
s udy, he exis ence o associa ed disease condi ions esul ing in a li e expec ancy o unde 6 mon hs,
blindness and dea ness, se ious psychia ic p oblems (se e e dep ession subjec ed o ea men o
acu e psychosis), o mode a e o se e e cogni i e impai men (diagnosed p e iously by a physician)
and/o a e cogni i e e alua ion wi h he Mini Men al S a e Examina ion (MMSE) wi h C onbach’s
alpha 0.90 and a sco e o 24 poin s o less, indica ing cogni i e impai men [
26
]. Loss o unc ion is
inc eased in bo h ail and p e ail olde adul s [
12
], so we dicho omized pa icipan s in o a obus
g oup and a p e ail/ ail g oup, acco ding o F ied’s pheno ype o ail y [
5
]. Rec ui men co e ed he
pe iod om Decembe 2014 o May 2015. I was ca ied ou in he heal h cen e s and social cen e s o
olde adul s in he egion o La Ribe a.
Nu ien s 2020,12, 1041 4 o 14
2.2. Sample Size Desc ip ion
The sample size was calcula ed based on he popula ion census o 2013. The egion o La Ribe a
(Valencia, Spain) has a popula ion o abou 253,330 inhabi an s (15.8% o e 70 yea s o age). A sample
o 401 pa icipan s was equi ed o es ima e a 12% incidence o olde adul s wi h ail y, wi h an alpha
e o o 5% and a s a is ical powe o 95%. In o de o con ol o d opou s, o e sampling o 15% was
pe o med, esul ing in a inal minimum sample o 471 pa icipan s.
In o de o use an adequa e sampling ame, we decided o ec ui pa icipan s du ing he mon hs
o highes a endance a p ima y ca e cen e s and con ac all he cen e s o La Ribe a Heal h Depa men .
Mee ings we e held wi h he nu ses and doc o s o explain he s udy objec i e, as hey a e he e e ence
p o essionals o communi y-dwelling olde adul s and could in o m po en ial pa icipan s o ake pa
in he s udy. In addi ion, pos e s we e made and placed in he wai ing ooms o he p ima y heal h
ca e cen e s and communi y social cen e s, o in o m bo h he olde adul s who a ended he cen e
and hei ela i es abou he s udy objec i es. Volun ee s signed up on a lis in each heal h cen e ,
and hei da a we e eco ded using alphanume ic codes iden i ying he cen e and he indi idual.
Open g oup discussions we e scheduled a he di e en heal h cen e s so ha po en ial pa icipan s
could ask ques ions abou he s udy; hese in o ma ion sessions we e held in he mo ning and in he
a e noon o acili a e access o all hose in e es ed. Finally, all people who showed hei willingness o
pa icipa e and who me he inclusion c i e ia we e included.
2.3. Da a Collec ion
I was necessa y o e iew he pa icipan s’ elec onic medical eco ds and conduc pe sonalized
in e iews wi h each o ob ain hei comp ehensi e ge ia ic assessmen s along wi h unc ional and
an h opome ic a iables. This ask was pe o med by ou nu ses wi h a leas 10 yea s o expe ience
in p ima y heal h ca e cen e s.
The a iables collec ed om he clinical his o y we e as ollows: age; sex; diagnosed como bidi y
(hype ension, diabe es melli us, hype lipidemia and me abolic synd ome); numbe o daily ac i e
ing edien s p esc ibed; and numbe o alls eco ded in he las 12 mon hs. O he a iables we e
biochemical alues wi hin he mon h p eceding he comp ehensi e ge ia ic assessmen : c ea inine
(mg/dL), hemoglobin (g/dL), o al lymphocy es (
×
10
3
/mm
3
), o al choles e ol (mg/dL), o al p o eins
(mg/dL) and albumin (mg/dL). Pa icipan s sel - epo ed hei home li ing si ua ion.
The ollowing i e ail y c i e ia we e assessed by nu ses in he p ima y heal h ca e cen e s [
5
]:
weakness ( educed g ip s eng h), slowness ( educed gai speed), weigh loss, low physical ac i i y,
and exhaus ion. Weakness was assessed ollowing s anda dized p ocedu es and using a Ke nMap-40
kg dynamome e wi h a cu -o poin g ip s eng h (GS) adjus ed o gende and body mass index (BMI).
In men, hese alues we e: BMI
≤
24 kg/m
2
: GS
≤
29 kg; BMI 24.1–28 kg/m
2
: GS
≤
30 kg; BMI >28 kg/m
2
:
GS
≤
3 2 kg. Fo women, hey we e as ollows: BMI
≤
23 kg/m
2
: GS
≤
17 kg; BMI 23.1–29 kg/m
2
:
GS
≤
18 kg; BMI >29 kg/m
2
: GS
≤
21 kg). Slowness was assessed based on he ime aken o walk
4.5 m wi h a cu -o alue o <0.8 m/s. Unin en ional weigh loss was de ined as a loss o 4.5 kg o 5%
o body weigh in he las yea (de e mined by di ec measu emen o weigh ). Low physical ac i i y
was de ined based on he weigh ed sco e o kilocalo ies expended pe week (males: 383 kcal/week
and emales 270 kcal/week). Las ly, poo endu ance and ene gy we e documen ed om sel - epo ed
exhaus ion: (a) “I el ha e e y hing I did was an e o ”; (b) “I could no ge going”. The p esence
o one o wo c i e ia was conside ed o indica e p e ail y, and h ee o mo e, ail y. The absence
o all c i e ia was conside ed o indica e obus ness. Func ional pa ame e s we e assessed based on
he Ba hel index wi h C onbach’s alpha 0.70 [
27
], he Law on index wi h C onbach’s alpha 0.94 [
28
],
and he Tine i index wi h C onbach’s alpha 0.95 [29].
Fo he nu i ional assessmen , an h opome ic da a comp ised BMI, hand g ip s eng h de e mined
using a Ke nMap-40 kg (KERN & SOHN GmbH, Balingen, Ge many) dynamome e , body a pe cen age
de e mined by bioelec ical impedance analysis (Tani a BC-601, Tani a Eu ope BV, Ams e dam,
The Ne he lands), and he MNA-SF (Soci
é
é
des P odui s Nes l
é
S.A, Ve ey, Swi ze land) wi h
Nu ien s 2020,12, 1041 5 o 14
C onbach’s alpha 0.670 [
30
]. Abdominal, b achial and high pe ime e s we e collec ed. In addi ion,
we eco ded ea o alls (modi ied Falls E icacy Scale In e na ional, FES-I,
α
=0.96) [
31
]. Heal h- ela ed
QoL was measu ed using he EQ-5D Index and EQ-5D VAS, acco ding o he pa ame e s o he Spanish
popula ion [
32
]. Las ly, he weekly hou s o exe cise in he p e ious 12 mon hs we e ob ained om
e bal epo ing by he pa icipan s and ca ego ized as: less han 3 h pe week, 3 o 6 h pe week,
and mo e han 6 h pe week.
2.4. E hics
All pa icipan s ga e hei in o med consen o inclusion be o e hey pa icipa ed in he s udy.
The s udy was conduc ed in acco dance wi h he Decla a ion o Helsinki, and he p o ocol was
app o ed by he Clinical Resea ch E hics Commi ee o Hospi al Uni e si a io de la Ribe a (Valencia,
Spain), (P ojec iden i ica ion cod HULR_2013/45).
2.5. S a is ical Analysis
The a iables we e epo ed as p opo ions and/o means and s anda d de ia ions (SD).
The Kolmogo o -Smi no es was used o assess no mali y, and he Le ene es was applied o
explo e homogenei y o a iances o con inuous a iables (age, daily numbe o d ugs p esc ibed,
numbe o alls in he las 12 mon hs, c ea inine, hemoglobin, lymphocy es, choles e ol, p o ein,
albumin, Ba hel Index, Law on Index, Tine i Index, MMSE, MNA-SF scale, BMI, a mass, handg ip,
abdominal, b achial and high pe ime e s, and he EQ-5D isual analog scale [VAS] and EQ-5D Index).
The e we e no signi ican ou lie s. The da a me he main assump ions o no mali y, so he - es
o independen samples was used o compa e means. The chi-squa ed es was used o compa e
ca ego ical a iables (gende , como bidi y, home cohabi a ion, and physical ac i i y).
We analyzed he associa ion be ween ail y and di e en isk ac o s, exp essing esul s as odds
a ios (ORs) wi h hei 95% con idence in e als (CIs). Risk ac o s conside ed we e gende , age >75
yea s, li ing a home alone, a e ial hype ension, diabe es melli us, hype lipidemia and me abolic
synd ome, como bidi y (
≥
h ee diseases), his o y o alls, polypha macy (
≥
5 d ugs pe day), cen al
obesi y (wais ci cum e ence o women
≥
88 cm and o men
≥
102 cm), dependence in he basic
ac i i ies o daily li ing (Ba hel <90 poin s), he ins umen al ac i i ies o daily li ing (Law on
≤
4)
and walking (Tinne i <25), obesi y (BMI ≥30 kg/m2), and ea o alling synd ome (FES-I ≥20).
A bina y logis ic eg ession model was i ed o explo e he impo ance o he isk ac o s, de ined
acco ding o ail y g oup. Fi s ly, he comple e model, wi h all he a iables in he bi a ia e analysis,
was ound o be signi ican ly associa ed wi h ail y synd ome. We hen used backwa d s epwise
selec ion o exclude he a iables whose elimina ion om he model ailed o p oduce a signi ican
change (de ined as he absence o an adjus ed e ec o >10%), including hose which did no esul in
an imp o ed s anda d e o when omi ed. In cases whe e wo o mo e subse s o a iables wi h he
same deg ee o i we e ob ained, consensus was sough among he in es iga o s. In o de o in oduce
con inuous a iables in he eg ession model, hese we e ca ego ized acco ding o he cu -o s admi ed
in he li e a u e. The alues we e: o hemoglobin, low <13.5 g/dL in men and <12.5 g/dL in women,
no mal
≥
13.5 g/dL in men and
≥
12.5 g/dL in women; o o al lymphocy es coun ,
low <1×103/mm3
,
no mal 1–4.8
×
10
3
/mm
3
, high >4.8
×
10
3
/mm
3
; o choles e ol, no mal <200 mg/dL,
high ≥200 mg/dL
;
o c ea inine, low <0.7 mL/min, no mal 0.7–1.3 mL/min, high >1.3 mL/min; o p o eins, low <
6 mg/dL, no mal 6–8.3 mg/dL, high >8.3 mg/dL; o albumin, low <3.4 mg/dL, no mal 3.4–5.4 mg/dL,
high >5.4 mg/dL; o cen al obesi y, wais ci cum e ence in women
≥
88 cm and in men
≥
102 cm;
o handg ip ollowing F ied c i e ia, as abo e; o BMI, no mal <30 kg/m
2
, high
≥
30 kg/m
2
; o body
a pe cen age, high in women
≥
42% and in men
≥
30%, no mal sco es below by gende , and o he
MNA-SF, low ≤11, no mal ≥12 poin s.
Nu ien s 2020,12, 1041 6 o 14
3. Resul s
O he 732 people ini ially e alua ed o eligibili y, 22.9% (n=168) we e excluded: 95.6% (n=162)
declined o pa icipa e, and 3.5%, (n=6) did no mee he selec ion c i e ia. The inal s udy sample hus
comp ised 564 pa icipan s (77.1%). Acco ding o he F ied F ail y Pheno ype c i e ia, he p e alence
o ail y was 10.99% (n=62), and he p e alence o p e ail y was 72.89% (n=411), so al oge he
83.86% (n=473) o he pa icipan s we e assigned o he p e ail/ ail g oup (1 o 5 ail y c i e ia),
and 16.13% (n=91) o he obus g oup (no ail y c i e ia).
The e we e mo e women in he p e ail/ ail g oup. Mos pa icipan s li ed wi h hei pa ne ,
al hough he e was a highe pe cen age o elde ly people li ing a home alone in he p e ail/ ail
g oup. The obus g oup pe o med a highe le el o weekly exe cise. The e we e no di e ences in he
p e alence o como bidi y (Table 1).
Table 1.
Pa icipan cha ac e is ics: sociodemog aphics, cohabi a ion, mo bidi y, and physical ac i i y.
Robus G oup
(n=91)
P e ail/F ail G oup
(n=473) p-Value *
Gende Women 31 (34.1) 325 (68.7) <0.001
Men 60 (65.9) 148 (31.3)
Cohabi a ion
Pa ne 70 (76.9) 288 (60.9)
<0.001
Alone 15 (16.5) 141 (29.8)
Child en o o he ela i es 6 (6.6) 44 (9.3)
Physical ac i i y
<3 h/week 0 (0) 228 (48.2)
<0.001
3–6 h/week 41 (45.1) 141 (29.8)
>6 h/week 50 (54.9) 104 (22)
Como bidi y
Hype ension 60 (65.9) 310 (65.5) 0.942
Diabe es melli us 20 (22) 142 (30) 0.120
Hype lipidemia 36 (36.9) 207 (43.8) 0.458
Me abolic synd ome 14 (15.4) 89 (18.8) 0.438
*p- alue: ob ained om Chi-squa e es .
Age was highe in he p e ail/ ail g oup (p<0.001). In he unc ional assessmen , he Ba hel
and Law on indices showed no di e ences in he pe o mance o basic and ins umen al ac i i ies o
daily li ing, espec i ely, no we e he e any di e ences in walking (assessed by Tine i) o in cogni i e
abili y (assessed using he MMSE). On he o he hand, he p e ail/ ail g oup did p esen a signi ican ly
highe numbe o alls in he p e ious 12 mon hs and a signi ican ly highe ea o alling, as assessed
by he FES-I (p<0.001). Quali y o li e was compa ably good in bo h g oups (Table 2).
In he subjec i e nu i ional assessmen , bo h g oups p esen ed a mean sco e g ea e han 11,
indica ing good nu i ional s a us; howe e , he p e ail/ ail g oup s ill had a signi ican ly lowe sco e
han he obus g oup (p=0.019). In he biochemical ma ke s, only hemoglobin di e ed be ween
g oups, wi h he p e ail/ ail g oup showing lowe alues (p<0.001). Fo an h opome ic a iables,
he p e ail/ ail g oup showed a signi ican ly highe BMI and body a pe cen age, and a signi ican ly
weake handg ip (Table 3).
Nu ien s 2020,12, 1041 7 o 14
Table 2. Age, unc ional, and cogni i e cha ac e is ics in obus e sus p e ail/ ail pa icipan s.
Va iable
Robus
N=91
P e ail/F ail
N=473
Mean (SD) Mean (SD) Mean Di e ence 95% CI p-Value *
Age, yea s 74.37 (3.23) 76.37 (4.02) −1.99 −2.76, −1.23 <0.001
Daily p esc ibed d ugs, n3.91 (2.61) 4.86 (3.09) −0.95 −1.63, −0.27 0.006
Ba hel, poin s 194.89 (7.96) 93.45 (9.87) 1.44 −0.71, 3.60 0.189
Law on, poin s 27.46 (0.95) 7.30 (1.17) 0.17 −0.06, 0.39 0.145
Tine i, poin s 325.96 (3.23) 25.75 (3.36) 0.20 −0.55, 0.95 0.595
MMSE, poin s 427.45 (1.50) 27.87 (1.69) −0.42 −1.14, 0.31 0.261
Falls o e p e ious 12 mon hs, n0.23 (0.67) 0.79 (1.41) −0.56 −0.75, −0.37 <0.001
FES-I, poin s 510.90 (11.78) 20.27 (17.07) −9.37 −12.26, −6.48 <0.001
EQ-5D Index, poin s 60.80 (0.22) 0.79 (0.22) 0.01 −0.43, 0.06 0.787
EQ-5D VAS, poin s 775.82 (20.29) 74.94 (20.77) 0.89 −3.77, 5.55 0.708
CI: con idence in e al; SD: s anda d de ia ion.
1
The Ba hel Index assesses unc ion e e ed o basic ac i i ies o
daily li ing based on a sco e o 0 o 100.
2
The Law on Index assesses unc ion e e ed o ins umen al ac i i ies o
daily li ing based on a sco e o 0 o 8.
3
The Tine i Scale e alua es gai and balance based on a sco e o 0 o 28.
4
The Mini Men al S a e Examina ion (MMSE) assesses cogni i e unc ion based on a sco e o 0 o 30.
5
The Falls
E icacy Scale In e na ional assesses ea o alling on a sco e o 0 o 28.
6
Eu oQoL 5 dimensions (EQ-5D) Index
assesses objec i e heal h quali y o li e on a sco e o 0 o 1
7
Eu oQoL 5 dimensions (EQ-5D) isual analog scale
(VAS) assesses subjec i e heal h quali y o li e on a sco e o 0 o 100. * p- alue: ob ained by - es .
Table 3. Di e ences be ween g oups in nu i ional s a us.
Va iable
Robus G oup P e ail/F ail G oup Mean
Di e ence 95% CI p-Value *
NMean (SD) nMean (SD)
MNA-SF, poin s 191 13.69 (0.49) 473 13.55 (0.73) 0.14 0.02, 0.27 0.019
Hemoglobin, g/dL 79 14.69 (1.38) 413 13.63 (1.42) 1.06 0.71, 1.40 <0.001
To al lymphocy e coun ,
×103/mm379 2.26 (0.84) 407 2.32(2.43) −0.05 −0.60, 0.49 0.850
To al choles e ol, mg/dL 78 194.95 (35.21) 400 192.15 (36.94) 2.80 −6.12, 11.72 0.537
To al p o eins, mg/dL 64 7.06 (0.34) 345 7.32 (5.05) −0.25 −1.50, 0.99 0.690
Albumin, mg/dL 34 4.56 (0.45) 196 4.37 (0.83) 0.18 −0.11, 0.47 0.220
C ea inine, mg/dL 82 1.00 (0.25) 423 0.95 (0.38) 0.05 −0.04, 0.13 0.261
BMI, kg/m291 29.08 (3.45) 473 30.25 (4.61) −1.16 −1.99, −0.34 0.006
Wais ci cum e ence, cm 91 103.76 (9.37) 473 104.18 (11.66) −0.42 −2.63, 1.79 0.709
B achial ci cum e ence, cm 91 30.12 (3.15) 473 30.60 (3.78) −0.48 −1.22, 0.25 0.197
Thigh ci cum e ence, cm 91 46.63 (4.93) 473 47.23 (6.68) −0.60 −2.05, 0.84 0.411
Handg ip s eng h, kg 91 31.17 (6.85) 473 18.29 (7.57) 12.88 11.20, 14.55 <0.001
Body a % 91 34.64 (6.49) 471 39.40 (7.07) −4.77 −6.34, −3.20 <0.001
BMI: Body Mass Index; CI: con idence in e al; SD: s anda d de ia ion.
1
The MNA-SF Mini Nu i ional Assessmen
Sho Fo m e alua es unde nu i ion based on a sco e o 0–14. * p- alue: ob ained by - es .
Fo he nu i ional assessmen , we compa ed pa icipan s based on BMI (Figu e 2). Lymphocy e
and p o ein alues we e mos ly in he no mal ange. The pe cen age o pa icipan s wi h anemia was
highe in he p e ail/ ail g oup (13.73% s. 42.62% p<0.001). Albumin alues we e no mal in mos
o he sample. In bo h g oups, he e was a high pe cen age wi h hype choles e olemia ( obus 55.1%
s. ail 59.2%), cen al obesi y ( obus 75.8% s. ail 83.3%) and obesi y ( obus 60.4% s. ail 50.1%).
Howe e , he pe cen age o pa icipan s wi h high body a was lowe in he p e ail/ ail g oup (60.4%
s. 35%), and he pe cen age wi h low palm g ip s eng h was highe (7.7% s. 88.6%). Nu i ional
s a us, as assessed by he MNA-SF, was adequa e in 2.7% o he ail elde ly.
Nu ien s 2020,12, 1041 8 o 14
Figu e 2.
Nu i ional assessmen in obus s. p e ail/ ail g oups, acco ding o es ablished cu o s o no mali y. *p<0.05; **p<0.001. Cu o alues we e: o
hemoglobin, low <13.5 g/dL in men and <12.5 g/dL in woman, no mal
≥
13.5 g/dL in men and
≥
12.5 g/dL in women; o o al lymphocy es coun , low <1
×
103/mm
3
,
no mal 1–4.8
×
103/mm
3
, high >4.8
×
10
3
/mm
3
; o choles e ol, no mal <200 mg/dL, high
≥
200 mg/dL; o c ea inine, low <0.7 mL/min, no mal 0.7–1.3 mL/min,
high >1.3 mL/min
; o p o eins, low <6 mg/dL, no mal 6–8.3 mg/dL, high >8.3 mg/dL; o albumin, low <3.4 mg/dL, no mal 3.4–5.4 mg/dL, high >5.4 mg/dL;
o cen al obesi y, wais ci cum e ence in women
≥
88 cm and in men
≥
102 cm; o handg ip ollowing F ied c i e ia; o BMI, no mal <30 kg/m
2
, high
≥
30 kg/m
2
;
o body a pe cen age, high in women ≥42% and in men ≥30%, no mal sco es below by gende , and o he MNA-SF, low ≤11, no mal ≥12 poin s.
Nu ien s 2020,12, 1041 9 o 14
Compa ing isk ac o s be ween g oups, he p e ail/ ail pa icipan s showed highe odds o
p esen ing, in o de o magni ude: a ea o alling, a ecen his o y o alls, anemia (hemoglobin
<13.5 g/dL in men and <12.5 g/dL in women), age o e 75, li ing a home alone, polypha macy,
and emale gende (Table 4).
Table 4.
Odds a ios and 95% con idence in e als om bi a ia e analysis and mul i a ia e logis ic
eg ession analysis o isk ac o s ela ed o ail y.
Fac o C ude OR
(95% CI) pValue * Adjus ed OR
(95% CI) pValue **
Female gende 1.25 (2.64, 6.83) <0.001 2.37 (1.24, 4.53) 0.009
Age >75 2.33 (1.46, 3.71) <0.001 3.31 (1.76, 6.21) <0.001
Li ing a home alone 2.15(1.19, 3.87) 0.007 ns
Hype ension 0.98 (0.61, 1.57) ns
Diabe es melli us 1.52 (0.89, 2.59) ns
Hype lipidemia 1.19 (0.75, 1.88) ns
Me abolic synd ome 1.27 (0.69, 2.35) ns
≥3 como bidi ies 1.27 (0.69, 2.35) ns
Polypha macy (≥5 d ugs pe day) 1.65 (1.03, 2.62) 0.032 ns
Ac i i ies o Daily Li ing, Ba hel <90 poin s 1.71 (0.23, 3.56) ns
Ins umen al. Ac i i ies o Daily Li ing
Law on ≤4 poin s 0.96 (0.11, 8.33) ns
Gai and speed, Tine i <25 poin s 1.24 (0.77, 2.08) ns
P e ious all in he las 12 mon hs 3.89 (2.1, 7.19) <0.001 1.91 (1.13, 3.25) 0.016
Fea o alling, FES-I ≥20 poin s 4.88 (2.53, 9.14) <0.001 4.01 (1.76, 9.16) 0.001
Hemoglobin, low 3.45 (1.87, 6.34) <0.001 2.45 (1.19, 5.03) 0.015
Cen al obesi y 1.59 (0.93, 2.72) ns ns
Obesi y (BMI ≥30 kg/m2)1.52 (0.96, 2.40) ns ns
Body a pe cen age, high 1.21 (0.76, 1.92) ns
Physical ac i i y (≥3 h/week) 0.31 (0.12, 0.38) <0.001 0.23 (0.15, 0.35) <0.001
BMI: body mass index; CI: con idence in e al; OR: odds a io. FES-I Falls E icacy Scale In e na ional; hemoglobin
low <13.5 g/dL in men and <12.5 g/dL in women; cen al obesi y: women wais ci cum e ence
≥
88 cm and men
≥
102 cm; high body a pe cen age: women
≥
42% and men
≥
30%; ns: non s a is ic signi ica i ely. * p- alue:
OR was ob ained by bina y eg ession model be ween ail y and o he s udy a iables. ** p- alue: adjus ed OR
was ob ained by mul i a iable eg ession model be ween ail y and s a is ic signi icance a iables.
A bina y logis ic eg ession was pe o med o iden i y p edic o s o ail y. The ollowing a iables
we e en e ed in o he model: age g oup, emale gende , li ing a home alone, diabe es melli us,
polypha macy, Ba hel <90, p e ious alls, FES-I
≥
20, anemia (hemoglobin <13.5 g/dL in men and
<12.5 g/dL in women), cen al obesi y, obesi y, and physical ac i i y. Handg ip was no in oduced
because i is a c i e ion o he ail y pheno ype. The model was s a is ically signi ican (p<0.001;
R2=0.43), co ec ly classi ying 83.9% o cases, wi h a sensi i i y o 94.4% and a speci ici y o 39.2%.
The a iables included in he inal model we e emale gende , age o e 75 yea s, anemia, his o y
o alling, and ea o alling. The s onges p edic o o ail y was ea o alling. Physical ac i i y was
a de e mining ac o o p e en ing ail y synd ome (Table 4).
4. Discussion
Ou esul s indica e ha ail y in unc ionally independen olde people is associa ed wi h being
a woman, age o 75 yea s o olde , anemia, a ecen his o y o alling, ea o alling, and lack o
physical ac i i y. As a ge ia ic synd ome, ail y is associa ed wi h inc easing age, bu malnu i ion
and dec eased unc ionali y a e also ela ed. E oneously, many clinicians conside any adul o e 80
yea s o age who p esen s dependence, malnu i ion, and como bidi y o be ail, bu hese may be isk
ac o s o consequences [
7
]. Mos s udies ha analyze malnu i ion and i s ela ionship wi h ail y a e
conduc ed in olde people in ins i u ions o hospi als, bu unc ionally independen communi y elde s
a e also a isk o ail y and o he ge ia ic synd omes [
8
,
9
]. The aim o his s udy was o de e mine
