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Research article
Low serum albumin, aspartate aminotransferase, and body mass are risk factors for frailty in elderly people with diabetes–a cross-sectional study
Toshihiko Yanase
Muta Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2971-9943
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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.
Keywords
frailty, albumin, transaminase, DHEA-S, Type 2 diabetes
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Received 10 Apr, 2020
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Received 10 Apr, 2020
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On 08 Apr, 2020
Editor assigned
On 07 Apr, 2020
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Review #1 received
Received 03 Mar, 2020
Review #2 received
Received 03 Mar, 2020
Editorial decision: Major revision
On 03 Mar, 2020
Reviewer #2 agreed
On 19 Feb, 2020
Reviewer #1 agreed
On 17 Feb, 2020
Reviewers invited
Invitations sent on 17 Feb, 2020
Editor assigned
On 13 Feb, 2020
Submission checks complete
On 04 Feb, 2020
Editor invited
On 04 Feb, 2020
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This preprint is under consideration at BMC Geriatrics. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Low serum albumin, aspartate aminotransferase, and body mass are risk factors for frailty in elderly people with diabetes–a cross-sectional study
Toshihiko Yanase
Muta Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2971-9943
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 4
Posted 08 Jun, 2020
No community comments so far
Submission checks complete
On 03 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 21 May, 2020
Editor assigned
On 05 May, 2020
Editor invited
On 04 May, 2020
Submission checks complete
On 03 Feb, 2020
No comments provided
Editorial decision: Major revision
On 28 Apr, 2020
Reviewer #2 agreed
On 10 Apr, 2020
Review #1 received
Received 10 Apr, 2020
Review #2 received
Received 10 Apr, 2020
Reviewers invited
Invitations sent on 08 Apr, 2020
Reviewer #1 agreed
On 08 Apr, 2020
Editor assigned
On 07 Apr, 2020
Editor invited
On 06 Apr, 2020
Submission checks complete
On 05 Apr, 2020
No comments provided
Review #1 received
Received 03 Mar, 2020
Review #2 received
Received 03 Mar, 2020
Editorial decision: Major revision
On 03 Mar, 2020
Reviewer #2 agreed
On 19 Feb, 2020
Reviewer #1 agreed
On 17 Feb, 2020
Reviewers invited
Invitations sent on 17 Feb, 2020
Editor assigned
On 13 Feb, 2020
Submission checks complete
On 04 Feb, 2020
Editor invited
On 04 Feb, 2020
First submitted
On 02 Feb, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Geriatrics & Gerontology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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.
Figure 1
Figure 2