Strong Relationship between Malnutrition and Cognitive Frailty in the Singapore Longitudinal Ageing Studies (SLAS-1 and SLAS-2)
Physical frailty is well known to be strongly associated with malnutrition, but the combined impact of physical frailty and cognitive impairment among non-demented older persons (cognitive frailty) on malnutrition prevalence is not well documented.
Cross-sectional cohort study.
Setting and Participants
Community-dwelling older Singaporeans aged ≥55y (n=5414) without dementia in the Singapore Longitudinal Ageing Study (SLAS-1 and SLAS-2).
The Mini Nutritional Assessment–short form (MNA-SF) and Nutrition Screening Initiative (NSI) Determine Checklist were used to determine their nutritional status. Participants were categorized as cognitive normal (CN) or cognitive impaired (CI) by Mini Mental State Examination (MMSE<=23), as pre-frail (PF) (score=1-2) or frail (F) (score=3-5) using Fried’s criteria, and as cognitive pre-frail (PF+CI) or cognitive frail (F+CI).
The prevalence of cognitive frailty was 1.6%, and cognitive pre-frailty was 5.5% (total, 7.1%). The prevalence of MNA malnutrition was 2.4%, and NSI high nutritional risk was 6.3%. The prevalence of MNA malnutrition was lowest among Robust-CN and highest among Frail-CI (0.5% in Robust- CN, 0.6% in Robust-CI, 2.8% in Pre-frail-CN, 7.3% in Prefrail- CI, 15.4% in Frail-CN, and 23.1% in Frail-CI). Similarly, the prevalence of NSI high nutritional risk was lowest in Robust-CN (3.7%) and highest in Frail-CI (13.6%). Adjusted for sociodemographic and health status, pre-frailty/frailty-CI versus Robust-CN was associated with the highest odds ratio of association with MNA malnutrition (OR=8.16, p<0.001), although not the highest with NSI high nutritional risk (OR=1.48, p=0.017).
An extraordinary high prevalence of malnutrition was observed among older adults with cognitive frailty who should be specially targeted for active intervention.
Key wordsCognitive Frailty Malnutrition Nutritional Risk
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- 4.Gillette Guyonnet S, Abellan Van Kan G, Andrieu S, Barberger Gateau P, Berr C, Bonnefoy M, Dartigues JF, de Groot L, Ferry M, Galan P, Hercberg S, Jeandel C, Morris MC, Nourhashemi F, Payette H, Poulain JP, Portet F, Roussel AM, Ritz P, Rolland Y, Vellas B. IANA task force on nutrition and cognitive decline with aging. J Nutr Health Aging. 2007 Mar-Apr;11(2):132–52.PubMedGoogle Scholar
- 7.Feng L, Nyunt MS, Gao Q, Feng L, Lee TS, Tsoi T, Chong MS, Lim WS, Collinson S, Yap P, Yap KB, Ng TP. Physical Frailty, Cognitive Impairment, and the Risk of Neurocognitive Disorder in the Singapore Longitudinal Ageing Studies. J Gerontol A Biol Sci Med Sci. 2017 Mar 1;72(3):369–375.PubMedGoogle Scholar
- 10.Fávaro-Moreira NC, Krausch-Hofmann S, Matthys C, Vereecken C, Vanhauwaert E, Declercq A, Bekkering GE, Duyck J. Risk Factors for Malnutrition in Older Adults: A Systematic Review of the Literature Based on Longitudinal Data. Adv Nutr. 2016 May 16;7(3):507–22.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Buys DR, Roth DL, Ritchie CS, Sawyer P, Allman RM, Funkhouser EM, Hovater M, Locher JL. Nutritional Risk and Body Mass Index Predict Hospitalization, Nursing Home Admissions, and Mortality in Community-Dwelling Older Adults: Results From the UAB Study of Aging With 8.5 Years of Follow-Up Gerontol A Biol Sci Med Sci 2014 September;69(9):1146–1153.Google Scholar
- 24.Fried, L.P., C.M. Tangen, J. Walston, et al., Frailty in older adults: Evidence for a phenotype. Journal of Gerontology: Medical Sciences, 2001. 56A(3): p. M146–M156.Google Scholar
- 28.Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, Woo J, Dong B, de la Vega S, Hua Poi PJ, Kamaruzzaman SBB, Won C, Chen LK, Rockwood K, Arai H, Rodriguez-Mañas L, Cao L, Cesari M, Chan P, Leung E, Landi F, Fried LP, Morley JE, Vellas B, Flicker L. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. J Am Med Dir Assoc. 2017 Jul 1;18(7):564–575.CrossRefPubMedGoogle Scholar
- 29.Salva A, Coll-Planas L, Bruce S, De Groot L, Andrieu S, Abellan G, Vellas B; Task Force on Nutrition and Ageing of the IAGG and the IANA, Andrieu S, Bartorelli L, Berner YN, Bruce S, Corman B, Domingo A, Egger TP, de Groot L,Guigoz Y, Imedio A, Planas M, Porras C, Rovira JC, Salvà A, Serra JA, Vellas B.Nutritional assessment of residents in long-term care facilities (LTCFs): recommendations of the task force on nutrition and ageing of the IAGG European region and the IANA. J Nutr Health Aging. 2009 Jun;13(6):475–83.CrossRefPubMedGoogle Scholar
- 32.Bollwein, J., D. Volkert, R. Diekmann, et al., Nutritional status according to the Mini Nutritional Assessment (MNA®) and frailty in community dwelling older persons: A close relationship. The Journal of Nutrition, Health & Aging, 2013: p. 1–6Google Scholar