Steps in the right direction for physical frailty research.
Steps in the right direction for physical frailty research.
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身体虚弱研究朝着正确的方向迈进。
DOI：
10.1016/s2589-7500(23)00066-3
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Welstead,Miles
中科院分区：
文献类型：
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作者：
Cox,SimonR;Welstead,Miles
在这一期的《柳叶刀数字健康》中，蒋荣涛及其同事1对英国生物库中近50万中老年人的身体虚弱的相关性进行了广泛而有力的观察性研究。通过修改油炸脆弱表型2(基于虚弱、步行速度、不活动、疲惫和体重减轻)，参与者主要自我报告的脆弱状态的最强相关性是自我报告的健康和幸福感的其他方面，以及神经质、焦虑和抑郁。重要的是，报告的许多关联的影响规模相对较小。这些结果在性别之间和大部分年龄范围内都是相似的，除了心理健康指标，中年时与虚弱的联系比老年人更强。在纵向分析中，发现基线健康(特别是精神健康)和9年后测量的脆弱之间存在更强的关联，而不是相反的规范。研究结果还显示，身体脆弱与前十种与脆弱相关的表型之间的关联不到2%，而大脑结构与脆弱之间的关联广泛但很小。这项研究对英国中老年人的身体虚弱及其与健康的其他方面的关系进行了有价值和明确的表征。其优势包括大样本量、广泛的多模式分析、后续信息和整体分析方法--尤其是因为小样本量和脆弱性、暴露和相关性的测量的异质性使当前文献的合成具有挑战性。在这种情况下利用特殊的统计能力在很大程度上否定了多重测试问题，因为即使在进行数百次测试和校正之后，也可以可靠地检测到极小的影响。这种能力允许关注相对效应大小，使那些与身体虚弱关系最密切的因素得到更清晰的关注。英国生物库众所周知是一个范围受限的样本，3，4，但相对于总体人口，可能更有可能低估了关联的严重性和大小。4、5这个队列中的范围限制也可能在一定程度上支持在关联模式中没有与年龄相关的差异
In this issue of The Lancet Digital Health, Rongtao Jiang and colleagues1 present a broad and well powered observational study of the correlates of physical frailty among nearly half a million middle-aged and older adults in the UK Biobank. Using a modification of the Fried frailty phenotype2 (based on weakness, walking speed, inactivity, exhaustion, and weight loss), the strongest correlates of participants’ mainly self-reported frailty status were other aspects of self-reported health and wellbeing, as well as neuroticism, anxiety, and depression. Importantly, many of the associations reported were of relatively small effect size. These results were similar between the sexes and across much of the age range, with the exception of mental health measures, which were more strongly associated with frailty in middle age than in older adults. In longitudinal analyses, stronger associations were found between baseline health (particularly mental health) and frailty measured 9 years later than for the converse specification. The results also show widespread but small brain structural correlates of frailty, which mediated less than 2% of the association between physical frailty and the top ten frailty-related phenotypes. This study is a valuable and definitive characterisation of physical frailty and its relation to other aspects of health in UK-based middle-aged and older adults. The strengths include the large sample size, extensive multimodal analyses, follow-up information, and overall analytical approach—not least because small sample sizes and heterogeneity in the measurement of frailty, exposures, and correlates has made synthesis of the current literature challenging. Exploiting the exceptional statistical power in this setting has largely negated multiple testing concerns as extremely small effects can be reliably detected, even when hundreds of tests are conducted and after correction. This power allows focus on relative effect sizes, bringing into sharper focus those factors that are most closely associated with physical frailty.The UK Biobank is well known to be a range restricted sample, 3, 4 but it might be more likely that the severity and magnitude of associations are underestimated relative to the overall population. 4, 5 The range restriction in this cohort could also partly underpin the absence of age-related differences in the patterning of association