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Abstract：
BACKGROUND: Malnutrition, sarcopenia, and frailty are age-related conditions that are associated with multiple health-related negative outcomes. However, the complex associations between them remain to be elucidated. The aims of the study were to explore: (1) whether the risk of sarcopenia has a mediator effect on the association between risks of malnutrition and frailty; and (2) whether physical activity (PA) level modulates this mediator effect in community-dwelling older adults.
METHODS: This cross-sectional study involved 593 older adults (62.73% female; mean age = 71.35 ± 5.86 years). The Mini Nutritional Assessment-Short Form (MNA-SF), the SARC-F Questionnaire, and the FRAIL Questionnaire were used to assess the risks of malnutrition, sarcopenia, and frailty, respectively. The International Physical Activity Questionnaire Short Form (IPAQ-SF) was employed to assess PA level. Using the Hayes PROCESS macro (Models 4 and 7), mediation and moderated mediation analyses were performed.
RESULTS: The mediation analysis demonstrated that the MNA-SF had a significant effect on the SARC-F (B=-0.325; p < 0.001) and the SARC-F, in turn, had a significant effect on the FRAIL (B = 0.341; p < 0.001). The total (B=-0.171; p < 0.001), direct (B=-0.061; p = 0.001), and indirect (B=-0.111; bootstrap CI did not include zero, which indicates a significant effect) effects of MNA-SF on FRAIL were significant, showing that 65% of the association between the MNA-SF and FRAIL was explained by the SARC-F acting as a mediator. The moderated mediation analysis demonstrated that the association between MNA and SARC-F was moderated by the PA level (B = 0.253; p = 0.016). The SARC-F mediated and relatively enhanced the association between MNA-SF and FRAIL only in older adults with a moderate PA level (B=-0.120; CI: -0.154 to -0.085).
CONCLUSIONS: The SARC-F partially mediates the association between the MNA-SF and the FRAIL, indicating that malnutrition affects frailty through an indirect path via sarcopenia. Furthermore, the PA level moderates this mediator effect, with sarcopenia serving as a mediator in older adults with moderate a PA level but not in those with a low PA level. These findings reveal that it may be beneficial to consider PA level in combination with malnutrition and sarcopenia in the management and prevention of frailty in community-dwelling older adults.
METHODS: This cross-sectional study involved 593 older adults (62.73% female; mean age = 71.35 ± 5.86 years). The Mini Nutritional Assessment-Short Form (MNA-SF), the SARC-F Questionnaire, and the FRAIL Questionnaire were used to assess the risks of malnutrition, sarcopenia, and frailty, respectively. The International Physical Activity Questionnaire Short Form (IPAQ-SF) was employed to assess PA level. Using the Hayes PROCESS macro (Models 4 and 7), mediation and moderated mediation analyses were performed.
RESULTS: The mediation analysis demonstrated that the MNA-SF had a significant effect on the SARC-F (B=-0.325; p < 0.001) and the SARC-F, in turn, had a significant effect on the FRAIL (B = 0.341; p < 0.001). The total (B=-0.171; p < 0.001), direct (B=-0.061; p = 0.001), and indirect (B=-0.111; bootstrap CI did not include zero, which indicates a significant effect) effects of MNA-SF on FRAIL were significant, showing that 65% of the association between the MNA-SF and FRAIL was explained by the SARC-F acting as a mediator. The moderated mediation analysis demonstrated that the association between MNA and SARC-F was moderated by the PA level (B = 0.253; p = 0.016). The SARC-F mediated and relatively enhanced the association between MNA-SF and FRAIL only in older adults with a moderate PA level (B=-0.120; CI: -0.154 to -0.085).
CONCLUSIONS: The SARC-F partially mediates the association between the MNA-SF and the FRAIL, indicating that malnutrition affects frailty through an indirect path via sarcopenia. Furthermore, the PA level moderates this mediator effect, with sarcopenia serving as a mediator in older adults with moderate a PA level but not in those with a low PA level. These findings reveal that it may be beneficial to consider PA level in combination with malnutrition and sarcopenia in the management and prevention of frailty in community-dwelling older adults.
摘要：
背景：营养不良，少肌症,和虚弱是与多种健康相关负面结果相关的年龄相关疾病。然而,它们之间的复杂关联仍有待阐明。该研究的目的是探索：（1）肌肉减少症的风险是否对营养不良和虚弱风险之间的关联具有中介作用；（2）在社区居住的老年人中，身体活动（PA）水平是否调节了这种中介作用。
方法：这项横断面研究涉及593名老年人（62.73%为女性；平均年龄=71.35±5.86岁）。迷你营养评估简表（MNA-SF），SARC-F问卷，使用FRAIL问卷来评估营养不良的风险，少肌症,和脆弱，分别。采用国际身体活动问卷简表（IPAQ-SF）评估PA水平。使用Hayes过程宏(模型4和7)，进行了调解和适度调解分析。
结果：中介分析表明，MNA-SF对SARC-F（B=-0.325；p<0.001）和SARC-F具有显着影响，反过来,对FRAIL有显著影响(B=0.341；p<0.001)。总数（B=-0.171；p<0.001），直接(B=-0.061；p=0.001)，和间接(B=-0.111；bootstrapCI不包括零，这表明显著)MNA-SF对FRAIL的影响显著，显示MNA-SF和FRAIL之间65%的关联是由SARC-F作为介质解释的。调节介导分析表明，PA水平调节了MNA和SARC-F之间的关联（B=0.253；p=0.016）。SARC-F仅在PA水平中等的老年人中介导并相对增强了MNA-SF和FRAIL之间的关联（B=-0.120；CI：-0.154至-0.085）。
结论：SARC-F部分介导了MNA-SF和FRAIL之间的关联，表明营养不良通过肌少症的间接途径影响衰弱。此外，PA水平缓和了这种中介效应，在PA水平中等的老年人中，肌少症可作为介质，而在PA水平低的老年人中则没有。这些发现表明，在社区居住的老年人中，将PA水平与营养不良和肌少症结合起来考虑可能是有益的。
方法：这项横断面研究涉及593名老年人（62.73%为女性；平均年龄=71.35±5.86岁）。迷你营养评估简表（MNA-SF），SARC-F问卷，使用FRAIL问卷来评估营养不良的风险，少肌症,和脆弱，分别。采用国际身体活动问卷简表（IPAQ-SF）评估PA水平。使用Hayes过程宏(模型4和7)，进行了调解和适度调解分析。
结果：中介分析表明，MNA-SF对SARC-F（B=-0.325；p<0.001）和SARC-F具有显着影响，反过来,对FRAIL有显著影响(B=0.341；p<0.001)。总数（B=-0.171；p<0.001），直接(B=-0.061；p=0.001)，和间接(B=-0.111；bootstrapCI不包括零，这表明显著)MNA-SF对FRAIL的影响显著，显示MNA-SF和FRAIL之间65%的关联是由SARC-F作为介质解释的。调节介导分析表明，PA水平调节了MNA和SARC-F之间的关联（B=0.253；p=0.016）。SARC-F仅在PA水平中等的老年人中介导并相对增强了MNA-SF和FRAIL之间的关联（B=-0.120；CI：-0.154至-0.085）。
结论：SARC-F部分介导了MNA-SF和FRAIL之间的关联，表明营养不良通过肌少症的间接途径影响衰弱。此外，PA水平缓和了这种中介效应，在PA水平中等的老年人中，肌少症可作为介质，而在PA水平低的老年人中则没有。这些发现表明，在社区居住的老年人中，将PA水平与营养不良和肌少症结合起来考虑可能是有益的。
