Healthy behaviors at age 50 years and frailty at older ages in a 20-year follow-up of the UK Whitehall II cohort: A longitudinal study
Frailty is associated with increased risk of various health conditions, disability, and death. Health behaviors are thought to be a potential target for frailty prevention, but the evidence from previous studies is based on older populations with short follow-ups, making results susceptible to rever...
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| creator | Gil-Salcedo, Andres Dugravot, Aline Fayosse, Aurore Dumurgier, Julien Bouillon, Kim Schnitzler, Alexis Kivimäki, Mika Singh-Manoux, Archana Sabia, Séverine |
| description | Frailty is associated with increased risk of various health conditions, disability, and death. Health behaviors are thought to be a potential target for frailty prevention, but the evidence from previous studies is based on older populations with short follow-ups, making results susceptible to reverse causation bias. We examined the associations of healthy behaviors at age 50, singly and in combination, as well as 10-year change in the number of healthy behaviors over midlife with future risk of frailty.
In this prospective cohort study of 6,357 (29.2% women; 91.7% white) participants from the British Whitehall II cohort, healthy behaviors-nonsmoking, moderate alcohol consumption, ≥2.5 hours per week of moderate to vigorous physical activity, and consumption of fruits or vegetables at least twice a day-were measured at age 50, and change in behaviors was measured between 1985 (mean age = 44.4) and 1997 (mean age = 54.8). Fried's frailty phenotype was assessed in clinical examinations in 2002, 2007, 2012, and 2015. Participants were classified as frail if they had ≥3 of the following criteria: slow walking speed, low grip strength, weight loss, exhaustion, and low physical activity. An illness-death model accounting for both competing risk of death and interval censoring was used to examine the association between healthy behaviors and risk of frailty. Over an average follow-up of 20.4 years (standard deviation, 5.9), 445 participants developed frailty. Each healthy behavior at age 50 was associated with lower risk of incident frailty: hazard ratio (HR) after adjustment for other health behaviors and baseline characteristics 0.56 (95% confidence interval [CI] 0.44-0.71; p < 0.001) in nonsmokers, 0.73 (95% CI 0.61-0.88; p < 0.001) for moderate alcohol consumption, 0.66 (95% CI 0.54-0.81; p < 0.001) for ≥2.5 hours of physical activity per week, and 0.76 (95% CI 0.59-0.98; p = 0.03) for consumption of fruits or vegetables at least twice a day. A greater number of healthy behaviors was associated with reduced risk of frailty, with the HR for each additional healthy behavior being 0.69 (95% CI 0.62-0.76; p < 0.001) and the HR for having all versus no healthy behaviors at age 50 being 0.28 (95% CI 0.15-0.52; p < 0.001). Among participants with no or 1 healthy behavior in 1985, those who increased the number of healthy behaviors by 1997 were at a lower risk of frailty (mean follow-up = 16 years) compared with those with no such increase: the HR was 0.64 (95% CI 0. |
| doi_str_mv | 10.1371/journal.pmed.1003147 |
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In this prospective cohort study of 6,357 (29.2% women; 91.7% white) participants from the British Whitehall II cohort, healthy behaviors-nonsmoking, moderate alcohol consumption, ≥2.5 hours per week of moderate to vigorous physical activity, and consumption of fruits or vegetables at least twice a day-were measured at age 50, and change in behaviors was measured between 1985 (mean age = 44.4) and 1997 (mean age = 54.8). Fried's frailty phenotype was assessed in clinical examinations in 2002, 2007, 2012, and 2015. Participants were classified as frail if they had ≥3 of the following criteria: slow walking speed, low grip strength, weight loss, exhaustion, and low physical activity. An illness-death model accounting for both competing risk of death and interval censoring was used to examine the association between healthy behaviors and risk of frailty. Over an average follow-up of 20.4 years (standard deviation, 5.9), 445 participants developed frailty. Each healthy behavior at age 50 was associated with lower risk of incident frailty: hazard ratio (HR) after adjustment for other health behaviors and baseline characteristics 0.56 (95% confidence interval [CI] 0.44-0.71; p < 0.001) in nonsmokers, 0.73 (95% CI 0.61-0.88; p < 0.001) for moderate alcohol consumption, 0.66 (95% CI 0.54-0.81; p < 0.001) for ≥2.5 hours of physical activity per week, and 0.76 (95% CI 0.59-0.98; p = 0.03) for consumption of fruits or vegetables at least twice a day. A greater number of healthy behaviors was associated with reduced risk of frailty, with the HR for each additional healthy behavior being 0.69 (95% CI 0.62-0.76; p < 0.001) and the HR for having all versus no healthy behaviors at age 50 being 0.28 (95% CI 0.15-0.52; p < 0.001). Among participants with no or 1 healthy behavior in 1985, those who increased the number of healthy behaviors by 1997 were at a lower risk of frailty (mean follow-up = 16 years) compared with those with no such increase: the HR was 0.64 (95% CI 0.44-0.94; p = 0.02) for change to 2 healthy behaviors and 0.57 (95% CI 0.38-0.87; p < 0.001) for change to 3-4 healthy behaviors in 1997. The primary limitation of this study is potential selection bias during the follow-up due to missing data on frailty components.
Our findings suggest that healthy behaviors at age 50, as well as improvements in behaviors over midlife, are associated with a lower risk of frailty later in life. Their benefit accumulates so that risk of frailty decreases with greater number of healthy behaviors. These results suggest that healthy behaviors in midlife are a good target for frailty prevention.]]></description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1003147</identifier><identifier>PMID: 32628661</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Age ; Aged ; Aging ; Alcohol ; Alcohol use ; Analysis ; Biology and Life Sciences ; Body mass index ; Body weight loss ; Chronic illnesses ; Data collection ; Death ; Diet ; Epidemiology ; Exercise ; Female ; Frail Elderly - statistics & numerical data ; Frailty ; Frailty - mortality ; Frailty - prevention & control ; Fruit ; Fruits ; Fruits (Food) ; Geriatry and gerontology ; Health aspects ; Health Behavior ; Health care ; Human health and pathology ; Humans ; Life Sciences ; Longitudinal Studies ; Male ; Medical examination ; Medicine and Health Sciences ; Middle Aged ; Mortality ; Phenotypes ; Physical activity ; Physical fitness ; Public health ; Questionnaires ; Risk Factors ; Santé publique et épidémiologie ; Smoking ; Social Sciences ; Studies ; Vegetables ; Weight Loss ; Womens health</subject><ispartof>PLoS medicine, 2020-07, Vol.17 (7), p.e1003147-e1003147</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Gil-Salcedo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Attribution</rights><rights>2020 Gil-Salcedo et al 2020 Gil-Salcedo et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c801t-bfffbab242320a70bca51c53b238258bf237ef4c39117db74104a92c645654d13</citedby><cites>FETCH-LOGICAL-c801t-bfffbab242320a70bca51c53b238258bf237ef4c39117db74104a92c645654d13</cites><orcidid>0000-0002-4546-0970 ; 0000-0003-2646-9408 ; 0000-0002-8086-7987 ; 0000-0002-1244-5037 ; 0000-0002-4699-5627 ; 0000-0003-2070-9706 ; 0000-0003-3109-9720 ; 0000-0001-7838-8752</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337284/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337284/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23847,27903,27904,53769,53771,79346,79347</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32628661$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://inserm.hal.science/inserm-02909367$$DView record in HAL$$Hfree_for_read</backlink></links><search><contributor>Basu, Sanjay</contributor><creatorcontrib>Gil-Salcedo, Andres</creatorcontrib><creatorcontrib>Dugravot, Aline</creatorcontrib><creatorcontrib>Fayosse, Aurore</creatorcontrib><creatorcontrib>Dumurgier, Julien</creatorcontrib><creatorcontrib>Bouillon, Kim</creatorcontrib><creatorcontrib>Schnitzler, Alexis</creatorcontrib><creatorcontrib>Kivimäki, Mika</creatorcontrib><creatorcontrib>Singh-Manoux, Archana</creatorcontrib><creatorcontrib>Sabia, Séverine</creatorcontrib><title>Healthy behaviors at age 50 years and frailty at older ages in a 20-year follow-up of the UK Whitehall II cohort: A longitudinal study</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description><![CDATA[Frailty is associated with increased risk of various health conditions, disability, and death. Health behaviors are thought to be a potential target for frailty prevention, but the evidence from previous studies is based on older populations with short follow-ups, making results susceptible to reverse causation bias. We examined the associations of healthy behaviors at age 50, singly and in combination, as well as 10-year change in the number of healthy behaviors over midlife with future risk of frailty.
In this prospective cohort study of 6,357 (29.2% women; 91.7% white) participants from the British Whitehall II cohort, healthy behaviors-nonsmoking, moderate alcohol consumption, ≥2.5 hours per week of moderate to vigorous physical activity, and consumption of fruits or vegetables at least twice a day-were measured at age 50, and change in behaviors was measured between 1985 (mean age = 44.4) and 1997 (mean age = 54.8). Fried's frailty phenotype was assessed in clinical examinations in 2002, 2007, 2012, and 2015. Participants were classified as frail if they had ≥3 of the following criteria: slow walking speed, low grip strength, weight loss, exhaustion, and low physical activity. An illness-death model accounting for both competing risk of death and interval censoring was used to examine the association between healthy behaviors and risk of frailty. Over an average follow-up of 20.4 years (standard deviation, 5.9), 445 participants developed frailty. Each healthy behavior at age 50 was associated with lower risk of incident frailty: hazard ratio (HR) after adjustment for other health behaviors and baseline characteristics 0.56 (95% confidence interval [CI] 0.44-0.71; p < 0.001) in nonsmokers, 0.73 (95% CI 0.61-0.88; p < 0.001) for moderate alcohol consumption, 0.66 (95% CI 0.54-0.81; p < 0.001) for ≥2.5 hours of physical activity per week, and 0.76 (95% CI 0.59-0.98; p = 0.03) for consumption of fruits or vegetables at least twice a day. A greater number of healthy behaviors was associated with reduced risk of frailty, with the HR for each additional healthy behavior being 0.69 (95% CI 0.62-0.76; p < 0.001) and the HR for having all versus no healthy behaviors at age 50 being 0.28 (95% CI 0.15-0.52; p < 0.001). Among participants with no or 1 healthy behavior in 1985, those who increased the number of healthy behaviors by 1997 were at a lower risk of frailty (mean follow-up = 16 years) compared with those with no such increase: the HR was 0.64 (95% CI 0.44-0.94; p = 0.02) for change to 2 healthy behaviors and 0.57 (95% CI 0.38-0.87; p < 0.001) for change to 3-4 healthy behaviors in 1997. The primary limitation of this study is potential selection bias during the follow-up due to missing data on frailty components.
Our findings suggest that healthy behaviors at age 50, as well as improvements in behaviors over midlife, are associated with a lower risk of frailty later in life. Their benefit accumulates so that risk of frailty decreases with greater number of healthy behaviors. These results suggest that healthy behaviors in midlife are a good target for frailty prevention.]]></description><subject>Age</subject><subject>Aged</subject><subject>Aging</subject><subject>Alcohol</subject><subject>Alcohol use</subject><subject>Analysis</subject><subject>Biology and Life Sciences</subject><subject>Body mass index</subject><subject>Body weight loss</subject><subject>Chronic illnesses</subject><subject>Data collection</subject><subject>Death</subject><subject>Diet</subject><subject>Epidemiology</subject><subject>Exercise</subject><subject>Female</subject><subject>Frail Elderly - statistics & numerical data</subject><subject>Frailty</subject><subject>Frailty - mortality</subject><subject>Frailty - prevention & control</subject><subject>Fruit</subject><subject>Fruits</subject><subject>Fruits (Food)</subject><subject>Geriatry and gerontology</subject><subject>Health aspects</subject><subject>Health Behavior</subject><subject>Health care</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Life Sciences</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical examination</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Phenotypes</subject><subject>Physical activity</subject><subject>Physical fitness</subject><subject>Public health</subject><subject>Questionnaires</subject><subject>Risk Factors</subject><subject>Santé publique et épidémiologie</subject><subject>Smoking</subject><subject>Social Sciences</subject><subject>Studies</subject><subject>Vegetables</subject><subject>Weight Loss</subject><subject>Womens 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behaviors at age 50 years and frailty at older ages in a 20-year follow-up of the UK Whitehall II cohort: A longitudinal study</title><author>Gil-Salcedo, Andres ; Dugravot, Aline ; Fayosse, Aurore ; Dumurgier, Julien ; Bouillon, Kim ; Schnitzler, Alexis ; Kivimäki, Mika ; Singh-Manoux, Archana ; Sabia, Séverine</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c801t-bfffbab242320a70bca51c53b238258bf237ef4c39117db74104a92c645654d13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Age</topic><topic>Aged</topic><topic>Aging</topic><topic>Alcohol</topic><topic>Alcohol use</topic><topic>Analysis</topic><topic>Biology and Life Sciences</topic><topic>Body mass index</topic><topic>Body weight loss</topic><topic>Chronic illnesses</topic><topic>Data collection</topic><topic>Death</topic><topic>Diet</topic><topic>Epidemiology</topic><topic>Exercise</topic><topic>Female</topic><topic>Frail Elderly - statistics & numerical data</topic><topic>Frailty</topic><topic>Frailty - mortality</topic><topic>Frailty - prevention & control</topic><topic>Fruit</topic><topic>Fruits</topic><topic>Fruits (Food)</topic><topic>Geriatry and gerontology</topic><topic>Health aspects</topic><topic>Health Behavior</topic><topic>Health care</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Life Sciences</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical examination</topic><topic>Medicine and Health Sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Phenotypes</topic><topic>Physical activity</topic><topic>Physical fitness</topic><topic>Public health</topic><topic>Questionnaires</topic><topic>Risk Factors</topic><topic>Santé publique et 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(Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gil-Salcedo, Andres</au><au>Dugravot, Aline</au><au>Fayosse, Aurore</au><au>Dumurgier, Julien</au><au>Bouillon, Kim</au><au>Schnitzler, Alexis</au><au>Kivimäki, Mika</au><au>Singh-Manoux, Archana</au><au>Sabia, Séverine</au><au>Basu, Sanjay</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Healthy behaviors at age 50 years and frailty at older ages in a 20-year follow-up of the UK Whitehall II cohort: A longitudinal study</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2020-07-06</date><risdate>2020</risdate><volume>17</volume><issue>7</issue><spage>e1003147</spage><epage>e1003147</epage><pages>e1003147-e1003147</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract><![CDATA[Frailty is associated with increased risk of various health conditions, disability, and death. Health behaviors are thought to be a potential target for frailty prevention, but the evidence from previous studies is based on older populations with short follow-ups, making results susceptible to reverse causation bias. We examined the associations of healthy behaviors at age 50, singly and in combination, as well as 10-year change in the number of healthy behaviors over midlife with future risk of frailty.
In this prospective cohort study of 6,357 (29.2% women; 91.7% white) participants from the British Whitehall II cohort, healthy behaviors-nonsmoking, moderate alcohol consumption, ≥2.5 hours per week of moderate to vigorous physical activity, and consumption of fruits or vegetables at least twice a day-were measured at age 50, and change in behaviors was measured between 1985 (mean age = 44.4) and 1997 (mean age = 54.8). Fried's frailty phenotype was assessed in clinical examinations in 2002, 2007, 2012, and 2015. Participants were classified as frail if they had ≥3 of the following criteria: slow walking speed, low grip strength, weight loss, exhaustion, and low physical activity. An illness-death model accounting for both competing risk of death and interval censoring was used to examine the association between healthy behaviors and risk of frailty. Over an average follow-up of 20.4 years (standard deviation, 5.9), 445 participants developed frailty. Each healthy behavior at age 50 was associated with lower risk of incident frailty: hazard ratio (HR) after adjustment for other health behaviors and baseline characteristics 0.56 (95% confidence interval [CI] 0.44-0.71; p < 0.001) in nonsmokers, 0.73 (95% CI 0.61-0.88; p < 0.001) for moderate alcohol consumption, 0.66 (95% CI 0.54-0.81; p < 0.001) for ≥2.5 hours of physical activity per week, and 0.76 (95% CI 0.59-0.98; p = 0.03) for consumption of fruits or vegetables at least twice a day. A greater number of healthy behaviors was associated with reduced risk of frailty, with the HR for each additional healthy behavior being 0.69 (95% CI 0.62-0.76; p < 0.001) and the HR for having all versus no healthy behaviors at age 50 being 0.28 (95% CI 0.15-0.52; p < 0.001). Among participants with no or 1 healthy behavior in 1985, those who increased the number of healthy behaviors by 1997 were at a lower risk of frailty (mean follow-up = 16 years) compared with those with no such increase: the HR was 0.64 (95% CI 0.44-0.94; p = 0.02) for change to 2 healthy behaviors and 0.57 (95% CI 0.38-0.87; p < 0.001) for change to 3-4 healthy behaviors in 1997. The primary limitation of this study is potential selection bias during the follow-up due to missing data on frailty components.
Our findings suggest that healthy behaviors at age 50, as well as improvements in behaviors over midlife, are associated with a lower risk of frailty later in life. Their benefit accumulates so that risk of frailty decreases with greater number of healthy behaviors. These results suggest that healthy behaviors in midlife are a good target for frailty prevention.]]></abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32628661</pmid><doi>10.1371/journal.pmed.1003147</doi><orcidid>https://orcid.org/0000-0002-4546-0970</orcidid><orcidid>https://orcid.org/0000-0003-2646-9408</orcidid><orcidid>https://orcid.org/0000-0002-8086-7987</orcidid><orcidid>https://orcid.org/0000-0002-1244-5037</orcidid><orcidid>https://orcid.org/0000-0002-4699-5627</orcidid><orcidid>https://orcid.org/0000-0003-2070-9706</orcidid><orcidid>https://orcid.org/0000-0003-3109-9720</orcidid><orcidid>https://orcid.org/0000-0001-7838-8752</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1549-1676 |
| ispartof | PLoS medicine, 2020-07, Vol.17 (7), p.e1003147-e1003147 |
| issn | 1549-1676 1549-1277 1549-1676 |
| language | eng |
| recordid | cdi_plos_journals_2434497567 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Public Library of Science (PLoS) |
| subjects | Age Aged Aging Alcohol Alcohol use Analysis Biology and Life Sciences Body mass index Body weight loss Chronic illnesses Data collection Death Diet Epidemiology Exercise Female Frail Elderly - statistics & numerical data Frailty Frailty - mortality Frailty - prevention & control Fruit Fruits Fruits (Food) Geriatry and gerontology Health aspects Health Behavior Health care Human health and pathology Humans Life Sciences Longitudinal Studies Male Medical examination Medicine and Health Sciences Middle Aged Mortality Phenotypes Physical activity Physical fitness Public health Questionnaires Risk Factors Santé publique et épidémiologie Smoking Social Sciences Studies Vegetables Weight Loss Womens health |
| title | Healthy behaviors at age 50 years and frailty at older ages in a 20-year follow-up of the UK Whitehall II cohort: A longitudinal study |
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