Detection and significance of Vitamin D and Insulin-like growth factor-1 in elderly patients with frailty

doi:10.21203/rs.3.rs-4146496/v1

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Research Article

Detection and significance of Vitamin D and Insulin-like growth factor-1 in elderly patients with frailty

https://doi.org/10.21203/rs.3.rs-4146496/v1

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Background:With the increase of the elderly population, the problem of senile frailty is becoming more and more serious. The research on frailty is still in the initial stage, and the diagnosis and intervention mechanism of frailty are still unclear. This study investigated the effects of Vitamin D and Insulin-like growth factor-1 on frailty, in order to further provide more accurate interventions for improving frailty.

Purpose:To investigate the frailty characteristics of elderly residents in Mengyang community, Chengdu City, Sichuan Province. To explore the correlation between serological index and human body composition test index; correlation between body composition test index and frailty; to explore the effects of both on frailty.

Method:From July to August 2023, 433 residents in Mengyang community of Chengdu City, Sichuan Province were selected. According to the diagnostic criteria of Fried Evaluation Form, they were divided into non-frailty, pre-frailty and frailty stages. For elderly comprehensive evaluation, including the human body composition test index and physical function test project, and blood tests for Vitamin D and Insulin-like growth factor-1.

Result: Among the 433 elderly patients, 201 were males and 232 were females, aged 60 to 99 years. The median age was 69.27±4.23 in the non- frailty group (99 cases), 71.07±4.687 in the pre-frailty group (173 cases) and 75.4±7.407 in the frailty group (161 cases). The muscle content and physical function indexes of each part of the body composition decreased gradually with the increase of the degree of weakness, and P<0.05. Vitamin D and insulin-like growth factor-1 decreased gradually with the increase of frailty degree, but P > 0.05. Vitamin D and insulin-like growth factor-1 had a certain correlation with the muscle content in all parts of the body, and the muscle content in all parts of the body had a certain correlation with the indexes of body function (P<0.05).

Conclusion: Vitamin D and Insulin-like growth factor-1 are significantly positively correlated with the muscle content of each part of the body, and there is a significant correlation between the muscle content of each part and the body function. With the increase of frailty, the functional indicators of the elderly(including muscle content in various parts、Vitamin D and Insulin-like growth factor-1 levels) decreased, while the physical functional indicators also decreased with the increase of frailty.

Aging

Frail elderly

Vitamin D

Insulin-like growth factor 1

According to the study, the total number of elderly people in the world has reached 629 million, with an average annual growth rate of 1.9% in developed countries and more than 3.0% in developing countries. This data is only a few years ago, now an aging population is gradually accelerated. As the global population ages, the issue of frailty in old age is attracting international attention[1]. Nowadays, the global population is aging, and this demographic phenomenon is an important reason for the frailty in our society[2]. In 1978, the United States Federal Conference on Aging proposed the concept of "Frail elderly"[3]. Senile Frailty is a multi-dimensional and multi-system aging syndrome in which the physiological reserves of various physiological systems are reduced and even the imbalance leads to increased vulnerability to stressful event[4, 5]. When exposed to endogenous or exogenous stressors, elderly patients with frailty are more likely to experience negative effects such as disability、hospitalization and even death, while healthy elderly people recover quickly and fully or have only minor consequence[6]. Studies show that frailty occurs in about 10% of older adults and puts people at serious risk of adverse outcomes, including falls、hospitalization and death[7]. Although the relationship between certain serological indicators and frailty has been preliminarily demonstrated[8], the relevant mechanisms by which serological indicators affect frailty are still not well described.

Vitamin D (Vit D) exerts its biological role by binding to the Vitamin D nuclear receptor (VDR)[9]. Studies have shown that Vit D deficiency is associated with oxidative stress in skeletal muscles, which can lead to muscle atrophy and affect muscle function[10]. Insulin-like growth factor-1 (IGF-1) can also promote the growth of bone and other tissues, is an important regulator of bone formation, and is closely related to muscle[11, 12]. Many studies have shown that there is a mutually reinforcing and synergistic relationship between Vit D and IGF-1[13–16]. Vitamin D is positively correlated with IGF-I concentration, and the two complement each other and promote together. Physical function is the core observation index of frailty. Currently, the commonly used frailty assessment scale such as Fried Evaluation Form is designed with the decline of physical function as the core[17]. A study has shown that functional measures of elderly people in communities, such as grip strength、walking speed、chair sitting and balanced standing are correlated with death[18].

Therefore, objective indicators of physical function measurement are effective indicators to assess the health status of elderly people and predict adverse outcomes and are important biomarkers for frailty assessment at present. Healthy physical function depends on good skeletal muscle function. The purpose of this study was to explore the relationship between Vit D and IGF-1 and muscle content in different parts, and to explore the correlation between muscle content in different parts and physical function in the elderly.

2.1 Research object

From July 2023 to August 2023, 433 elderly people with frailty in Mengyang community of Chengdu City, Sichuan Province were selected as the research objects. The study has been approved by the Research Ethics Committee of the Chinese People's Liberation Army General Hospital (S2019-140-03) and the First Affiliated Hospital of Chengdu Medical College (2020CYFYIRB-BA-116). The project has obtained informed consent from all study participants.

2.2 Research Methods

2.2.1 Basic evaluation

Use Body Composition Analyzer (Inbody Co., Ltd.) to measure body composition indicators (include Soft Lean Mass (SLM)、Skeletal Muscle Mass (SMM)、Percent body fat (PBF)、Body mass index (BMI)、Segmental lean analysis (include Right arm (RA)、Left arm (LA)、Trunk (TR)、Right leg (RL)、Left leg (LL))、Skeletal muscle Mass index (SMI). Measuring physical function index (maximum grip strength、6 m walking time、five times to sit、to stand up to walk time、6 minutes exercise testing、simple physical ability test SPPB scores), Serological specimens were examined

2.2.2 Frailty assessment

Fried Evaluation Form was used as the diagnostic criteria, including 5 items: involuntary weight loss、walking time、decreased grip strength、decreased physical activity and fatigue[19]. The subjects were divided into non-frailty, pre-frailty, and frailty according to the scoring criteria.

2.3 Statistical Methods

The measurement data of normal distribution were represented by X ± S and Single factor analysis was used for comparison between groups; pearson correlation analysis was conducted on Vitamin D, Insulin-like growth factor-1 and body composition test indicators. Pearson correlation analysis was conducted on body composition test indicators including hand strength、6m walking time、5 times of sitting up and walking time、6-minute exercise test and SPPB scores. The missing values were replaced by serial average values. P < 0.05 was considered statistically significant.

3.1 Basic information of the study subjects

Among the 433 elderly patients, 201 were males and 232 were females, ranging in age from 60 to 99 years old. According to Fried Evaluation Form, all study subjects were divided into 99 (22.9%) non-frailty group, 173 (39.9%) pre-frailty group, and 161 (37.2%) frailty group. The number and frailty distribution by age group are shown in Table 1.

Table 1

Distribution of frailty by age group
Age segment	Total number [cases%]^*	Male [cases%]^##	Female [cases%]^##	Non-frailty [cases%]^##	Pre-frailty [cases%]^##	frailty [cases%]^##
60–70 year	198(45.7%)	95(47.3%)	103(44.4%)	64(64.7%)	82(47.4%)	52(32.3%)
71–80 year	191(44.1%)	89(44.3%)	102(44.0%)	34(34.3%)	85(49.1%)	72(44.7%)
81–90 year	38(8.8%)	14(6.9%)	24(10.3%)	1(1.0%)	6(3.5%)	31(19.3%)
≥ 91 year	6(1.4%)	3(1.5%)	3(1.3%)	0	0	6(3.7%)
(Note: * The ratio of the number of persons in each category to the total number (433 persons). ^## Ratio of the number of men, women, non-frailty, pre-frailty and frailty to the total number of people in each age group at different ages.)

3.2 Comparison of body composition test indicators of the study subjects

The median ages of the non-frailty group, the pre-frailty group and the frailty group were 69.27 ± 4.23, 71.07 ± 4.687 and 75.4 ± 7.407, respectively. The frailty degree gradually increased with the increase of age, and the difference between the three groups was statistically significant (P < 0.001). Soft Lean Mass (SLM)、Skeletal Muscle Mass (SMM)、Segmental lean Right arm (RA)、Left arm (LA)、Trunk muscle content (TR)、Right leg (RL)、Left leg (LL))、Skeletal muscle Mass index (SMI) decreased gradually with the increase of frailty degree in non-frailty group, pre-frailty group and frailty group. The difference between the three groups was statistically significant (P < 0.001). Percent body fat (PBF) increased with the increase of frailty degree, but there was no statistically significant difference among the 3 groups (P > 0.05). However, Body mass index (BMI) decreased with the increase of frailty degree, and the difference among the three groups was statistically significant (P = 0.005). With the increase of frailty degree, although the appearance of BMI decreased, the PBF gradually increased, so the core of BMI decrease was caused by muscle loss (Table 2).

Table 2

Comparison of body composition test indexes
Project	Non-frailty (n = 99)	Pre-frailty (n = 173)	Frailty (n = 161)	F value	P value
Age(x ± s)	69.27 ± 4.23	71.07 ± 4.687	75.4 ± 7.407	40.859	< 0.001**
SLM(x ± s)	41.87 ± 7.521	39.86 ± 6.87	35.43 ± 7.572	27.756	< 0.001^**
SMM(x ± s)	24.31 ± 4.709	23.01 ± 4.328	20.04 ± 4.813	30.852	< 0.001^**
Percent body fat(x ± s,%)	26.09 ± 7.561	26.45 ± 8.957	27.94 ± 11.039	1.517	0.221
BMI (x ± s,kg/m2)	24.75 ± 2.719	24.27 ± 3.55	23.35 ± 4.034	5.328	0.005^*
RA(x ± s)	2.10 ± 0.533	1.96 ± 0.526	1.71 ± 0.516	19.357	< 0.001^**
LA(x ± s)	2.09 ± 0.533	1.95 ± 0.517	1.71 ± 0.541	16.914	< 0.001^**
TR(x ± s)	18.41 ± 3.277	17.56 ± 3.22	15.76 ± 3.297	23.307	< 0.001^**
RL(x ± s)	7.49 ± 1.927	7.07 ± 1.677	6.06 ± 1.918	21.926	< 0.001^**
LL(x ± s)	7.31 ± 1.779	6.86 ± 1.545	5.97 ± 1.903	22.660	< 0.001^**
SMI (x ± s,kg/m2)	7.75 ± 1.135	7.43 ± 1.103	6.78 ± 1.427	21.583	< 0.001^**
(Note: The measurement data of normal distribution were expressed as X ± S, and one-way analysis of variance was used for comparison between groups. * means P value < 0.05, ** means P value < 0.001.)

3.3 Comparison of serological indexes of the study subjects

Vitamin D (Vit D) and Insulin-like growth factor-1 (IGF-1) contents gradually decreased with the increase of frailty degree, but there was no significant difference among the three groups (P > 0.05) (Table 3).

Table 3

Comparison of serological indexes
Project	Non-frailty (n = 99)	Pre-frailty (n = 173)	Frailty (n = 161)	F value	P value
IGF-1 (x ± s, ng/mL)	77.98 ± 25.192	75.6 ± 28.853	71.51 ± 31.918	1.505	0.223
Vitamin D (x ± s, ng/mL)	26.25 ± 8.742	25.28 ± 9.73	23.99 ± 9.073	1.605	0.202
(Note: The measurement data of normal distribution were expressed as X ± S, and one-way analysis of variance was used for comparison between groups.)

3.4 Physical function of the study subjects

The 6m-walk time、up and go time、6-minute walk test and 5 times stand up time increased gradually with the increase of frailty degree, and the differences among the three groups were statistically significant (P < 0.001). Maximum grip strength、6-minute exercise test and SPPB scores gradually decreased with the increase of frailty degree, the difference among the three groups was statistically significant (P < 0.001). Because some of the frail group were bedridden elderly people who could not walk, the missing values were replaced by serial mean, so the actual physical function index data of the frail group were worse than the obtained data (Table 4).

Table 4

Comparison of body function
Project	Non-frailty (n = 99)	Pre-frailty (n = 173)	Frailty (n = 161)	F value	P value
6m walking time (x ± s, s)	5.00 ± 0.837	5.64 ± 1.452	8.4 ± 2.011	92.025	< 0.001^**
Maximum grip strength (x ± s, kg)	30.44 ± 8.689	20.26 ± 7.376	15.37 ± 7.507	111.732	< 0.001^**
up and go time (x ± s, s)	4.37 ± 0.943	4.93 ± 1.35	5.47 ± 1.818	11.649	< 0.001^**
6 minute walk test(x ± s, m)	385.95 ± 62.113	366.44 ± 57.264	339.3 ± 54.122	13.022	< 0.001^**
5 times stand up time (x ± s, s)	12.01 ± 2.677	13.12 ± 3.137	14.18 ± 3.69	8.864	< 0.001^**
SPPB(x ± s, score)	10.95 ± 1.014	10.48 ± 1.154	9.82 ± 1.58	15.272	< 0.001^**
(Note: The measurement data of normal distribution were expressed as X ± S, and one-way analysis of variance was used for comparison between groups. ** indicates P value < 0.001.)

3.5 Correlation between Vitamin D and IGF-1 and body composition test indicators

Pearson correlation analysis showed that: Serum Vitamin D was positively correlated with SLM、SMM、RA、LA、TR、RL、LL and SMI (r = 0.341, 0.346, 0.359, 0.315, 0.343, 0.259, 0.262, 0.243, P < 0.001), there was a negative correlation with PBF (r=-0.297, P < 0.001), but no correlation with BMI. At the same time, IGF-1 level was also significantly positively correlated with SLM、SMM、RA、LA、TR、RL、LL and SMI (r = 0.288, 0.289, 0.265, 0.272, 0.278, 0.261, 0.238, 0.257, P < 0.001), there was a positive correlation with BMI (r = 0.235, P < 0.001), but no correlation with PBF (Table 5).

Table 5

Pearson correlation analysis of Vit D, IGF-1 and multiple body composition test indexes
Indicator	Pearson relevant	Vit D	IGF-1
SLM	r value	0.341**	0.288**
SLM	p value	<0.001	<0.001
SMM	r value	0.346**	0.289**
SMM	p value	<0.001	<0.001
PBF	r value	-0.297**	0.025
PBF	p value	<0.001	0.600
BMI	r value	-0.050	0.235**
BMI	p value	0.295	<0.001
RA	r value	0.359**	0.265**
RA	p value	<0.001	<0.001
LA	r value	0.315**	0.272**
LA	p value	<0.001	<0.001
TR	r value	0.343**	0.278**
TR	p value	<0.001	<0.001
RL	r value	0.259**	0.261**
RL	p value	<0.001	<0.001
LL	r value	0.262**	0.238**
LL	p value	<0.001	<0.001
SMI	r value	0.243**	0.257**
SMI	p value	<0.001	<0.001
(Note: ** indicates P value < 0.001.)

3.7 Correlation between body function and body composition test indicators

Pearson correlation analysis showed that: Maximum grip strength was positively correlated with SLM、SMM、BMI、RA、LA、TR、RL、LL and SMI (r = 0.580, 0.589, 0.156, 0.593, 0.547, 0.593, 0.460, 0.449, 0.44) 0, P ≤ 0.001);negatively correlated with PBF (r=-233, P < 0.001). 6m-walking time was positively correlated with PBF (r = 0.121, P = 0.012); negatively correlated with SLM、SMM、RA、LA、TR、RL、LL and SMI (r=-207, -0.218, -0.153, -0.141, -0.160, -0.219, -0.214, -0.206, P ≤ 0.003). The 5 times stand up time was positively correlated with PBF (r = 0.158, P < 0.001); negatively correlated with SLM、SMM、RL、LL and SMI (r=-143, -0.141, -0.175, -0.165, -0.167, P ≤ 0.003). The up and go time was positively correlated with PBF (r = 0.116, P = 0.016), negatively correlated with SLM、SMM、RA、LA、TR、RL、LL and SMI (r=-197, -0.205, -0.183, -0.175, -0.204, -0.169, -0.170, -0.138, P ≤ 0.004). The 6 minute walk test was positively correlated with SLM、SMM、RA、LA、TR、RL、LL and SMI (r = 0.233, 0.239, 0.198, 0.197, 0.216, 0.217, 0.215, 0.184, P < 0.001), negatively correlated with PBF (r=-147, P = 0.002). SPPB scores was positively correlated with SLM、SMM、LA、TR、RL、LL and SMI (r = 0.119, 0.113, 0.095, 0.094, 0.107, 0.116, 0.130, P ≤ 0.05). There is no correlation between the other indicators (Table 6).

Table 6

Correlation between body composition test indicators and physical function
Indicator	Pearson relevant	Maximum grip strength (kg)	6 m walking time (s)	5 times stand up time (s)	up and go time (s)	6 minute walk test (m)	SPPB scores
SLM	r value	0.580**	-0.207*	-0.143**	-0.197**	0.233**	0.119*
SLM	p value	<0.001	<0.001	0.003	<0.001	<0.001	0.014
SMM	r value	0.589**	-0.218**	-0.141**	-0.205**	0.239**	0.113*
SMM	p value	<0.001	<0.001	0.003	< 0.001	<0.001	0.019
PBF	r value	-0.233**	0.121*	0.158**	0.116*	-0.147**	-0.092
PBF	p value	<0.001	0.012	<0.001	0.016	0.002	0.055
BMI	r value	0.156**	-0.027	0.063	0.037	-0.027	-0.006
BMI	p value	0.001	0.580	0.194	0.441	0.575	0.894
RA	r value	0.593**	-0.153**	-0.068	-0.183**	0.198**	0.087
RA	p value	<0.001	0.001	0.157	<0.001	<0.001	0.070
LA	r value	0.547**	-0.141**	-0.062	-0.175**	0.197**	0.095*
LA	p value	<0.001	0.003	0.199	<0.001	<0.001	0.049
TR	r value	0.593**	-0.160**	-0.078	-0.204**	0.216**	0.094*
TR	p value	<0.001	<0.001	0.105	<0.001	<0.001	0.050
RL	r value	0.460**	-0.219**	-0.175**	-0.169**	0.217**	0.107*
RL	p value	<0.001	<0.001	<0.001	<0.001	<0.001	0.025
LL	r value	0.449**	-0.214**	-0.165**	-0.170**	0.215**	0.116*
LL	p value	<0.001	<0.001	<0.001	<0.001	<0.001	0.016
SMI	r value	0.440**	-0.206**	-0.167**	-0.138**	0.184**	0.130**
SMI	p value	<0.001	<0.001	<0.001	0.004	<0.001	0.007
(Note: * means P value < 0.05, ** means P value < 0.001)

3.8 Value analysis of serum Vitamin D and IGF-1 levels in diagnosis of asthenia

There is a causal relationship between IGF-1 and Vitamin D[20], IGF-1 stimulates the production of 1-alpha-hydroxylase, which promotes Vitamin D production in the kidneys, causing Vitamin D levels to increase as IGF-1 concentrations increase[21]. In addition, IGF-1 levels were reduced by knocking out the Vitamin D receptor (VDR)[22], which regulates insulin release either directly or through vitamin D receptors[23–25]. The data of non-fissile and fissile subjects were imported into SPSS and ROC curve was drawn, it was found that the AUC of vitamin D and IGF-1 levels in the non-fissile and fissile groups was greater than 0.40, and the IGF-1 level was of diagnostic value (P = 0.05) (Table 7, Fig. 1).

Table 7

Value analysis of serum vitamin D and IGF-1 levels in diagnosis of frailty
index	AUC	cut-off value	95%CI	P value	specificity	sensitivity	Youden index
Vitamin D	0.429	39.965	0.359,0.500	0.056	0.939	0.062	0.002
IGF-1	0.413	138.5	0.344,0.483	0.019	1	0.05	0.05
(Note: AUC refers to the area, cut-off value refers to the critical value at the maximum Youden index, 95%CI refers to 95% reliability.)

Frailty is a kind of clinical syndrome in which individual strength and endurance decline, multi-system physiological reserve decrease and internal environment disorder, and individual susceptibility to disability, death and other adverse health outcomes increase[26]. It is a common problem and precursor of disability in the elderly, and it is an intermediate stage between self-care and death[27]. Studies have shown that frailty can lead to falls、cognitive impairment、dementia and other events in the elderly, compared with non-frailty elderly people, the average risk of death increased by 15–50%[28, 29]. Our country has entered a period of rapid development of population aging, elderly frailty has become one of the problems that our country must understand and solve[30]. Therefore, timely screening, prevention and intervention of frailty are of great significance to improve the overall quality of life of the elderly.

Older people have reduced muscle mass and physical activity, leading to a series of changes in muscle indicators[31]. Compared with the muscular strength and flexible contraction and relaxation ability of healthy elderly people, frailty elderly people are accompanied by a decrease in muscle mass and a lack of physical activity[32]. Sarcopenia, malnutrition, coexistence of multiple diseases, anxiety and depression are the main risk factors for frailty, especially sarcopenia is considered to be the core elements of frailty, there is a correlation between patients with sarcopenia and elderly patients with frailty[33], and changes in muscle-related indicators are the pathophysiological manifestations of frailty development[34, 35]. In this study, with the continuous growth of age, the degree of frailty of the elderly also increased, while various functional indicators in the body decreased, including the loss of muscle content in various parts.

The active form of Vitamin D (Vit D) in the serological indicators exerts its biological effects by binding to the Vitamin D nuclear receptor (VDR), which is present in human skeletal muscle cells[9]. Studies have shown that Vit D deficiency is related to oxidative stress in skeletal muscle, which affects mitochondrial function and eventually leads to skeletal muscle atrophy[36], Vit D deficiency will lead to muscle atrophy and affect muscle function[10]. At the same time, Insulin-like growth factor-1 (IGF-1) levels are strongly correlated with muscle, increasing the rate of protein synthesis in muscle, fat tissue, liver and other tissues, and decreasing the rate of protein degradation in muscle[11, 12]. In this study, Vit D and IGF-1 content were significantly positively correlated with muscle content indexes related to skeletal muscle and limb muscle content.

At the same time, there is an obvious correlation between the muscle-related content index and the physical function index, and the loss of muscle content and the reduction of muscle strength will lead to the reduction of physical function. Reduced physical function, in turn, leads to reduced physical activity in debilitated elderly people, which leads to muscle loss, and the two affect each other. Therefore, in the frailty population, maintaining muscle mass, regulating muscle strength and physical function are the key indicators of frailty intervention research. In addition, muscle loss is one of the characteristics of frailty, and the levels of Vit D and IGF-1 in frailty elderly people are related to muscle content. In this study, IGF-1 can be used as an auxiliary indicator for frailty diagnosis, but its diagnostic value is not high.

In conclusion, Vit D and IGF-1 are positively correlated with muscle related content indicators, and there is a significant correlation between muscle related content indicators and various indicators of physical function. Vit D and IGF-1 are expected to be one of the auxiliary indicators for the diagnosis of frailty in the future. However, there are some regional limitations in this study. The research object is the elderly residents in a certain area, which cannot represent the elderly group in China.

Vitamin D and Insulin-like growth factor-1 are significantly positively correlated with muscle content in all parts of the body, and there is a significant correlation between muscle content and body function.

Author Contributions

This research protocol was completed by the collaboration of all authors. NP came up with the idea for the project and is the leader of the multicenter study. The research content was further refined by YL (Yilun Liu) as grant holder and XH、YS、and MC as principal investigators. All authors were involved in the design of the study protocol. XH、YS、YD、YL(Yi Li)、CL and HS for project implementation. XH and YL (Yilun Liu) wrote the first draft of the manuscript. XL、JT、YS、XH and YD calculate the sample size according to the data analysis plan and write the statistical section. NP、YL (Yilun Liu)、XH、YS、MC、YD、YL(Yi Li)、CL、HS、XL、JT and FD participated in the drafting and revision of this manuscript and approved the final manuscript.

Authors’ information

Not applicable.

Funding statement

Funding This work was supported by the National Key Research and Development Program of China (No: 2018YFC2002004, 2018YFC2002000). And Chengdu Medical College graduate innovative research fund project (No: YCX2023-01-08).

Availability of data and materials

Data can be obtained from the corresponding author upon reasonable request.

Ethics approval and consent to participate

This study has been approved by the Research Ethics Committee of the Chinese People's Liberation Army General Hospital (S2019-140-03) and the First Affiliated Hospital of Chengdu Medical College (2020CYFYIRB-BA-116). Informed consent has been obtained from all study participants for this project. All participants' information and data will be securely stored and identified by an encoded ID number for the sole purpose of maintaining the confidentiality of the participants.

Consent for publication

Personal information about the study participants will not be published.

Competing interests

All authors declare that they have no conflict of interest.

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No competing interests reported.

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Detection and significance of Vitamin D and Insulin-like growth factor-1 in elderly patients with frailty

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Abstract

Figures

1. Introduction

2. Research Objects and methods

2.1 Research object

2.2 Research Methods

2.2.1 Basic evaluation

2.2.2 Frailty assessment

2.3 Statistical Methods

3. Results

3.1 Basic information of the study subjects

3.2 Comparison of body composition test indicators of the study subjects

3.3 Comparison of serological indexes of the study subjects

3.4 Physical function of the study subjects

3.5 Correlation between Vitamin D and IGF-1 and body composition test indicators

3.7 Correlation between body function and body composition test indicators

3.8 Value analysis of serum Vitamin D and IGF-1 levels in diagnosis of asthenia

4. Discussion

5. Conclusion

Declarations

References

Additional Declarations

Supplementary Files

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