Malnutrition Risk, Physical Function Decline and Disability in Middle-Aged and Older Adults Followed Up in the Singapore Longitudinal Ageing Study

Figures & data

Figure 1 Flow chart of study participants recruitment and assessment.

Table 1 Baseline Characteristics of Study Participants in Total (Combined SLAS-1 and SLAS-2) Cohort and SLAS-2 Cohort

	Total Cohort			SLAS-2 Cohort
	Total	N	%	Total	N	%
	(N=5358)	Mean	± SD	N=2880	Mean	± SD
Sex: female		3377	63.0		1813	63.0
Age, years		66.6	± 7.6		66.3	± 7.7
Ethnicity: Chinese		5006	93.4		2528	87.8
Malay		212	4.0		212	7.4
Indian		140	2.6		140	4.9
Education: ≤6 years		1857	34.7		564	19.6
7–10 years		2001	37.3		1218	42.3
≥11 years		1500	28.0		1098	38.1
Housing: 1–2 room public		764	14.3		610	21.2
3 room public		1404	26.3		817	28.4
≥4 room and private		3190	59.6		1453	50.4
Single/divorced/widowed		1625	30.3		996	34.6
Live alone		625	11.7		450	15.6
Physical activity score		4.5	± 2.5		6.2	1.5
≥5 medical illnesses		706	13.2		523	18.2
MMSE score		27.4	± 3.2		27.8	2.8
GDS score		1.27	± 2.2		0.73	1.47
ENIGMA7 score		1.17	± 1.31		1.30	± 1.43
0 (no MR)		2035	38.0		1092	37.9
1–2 (low-medium MR)		2525	47.1		1254	43.5
3+ (high MR)		798	14.9		534	18.5
Eating difficulty (chewing and swallowing)		353	6.6		225	7.8
Take 5 or more drugs		808	15.1		544	18.9
Few fruits or vegetables		498	9.3		295	10.2
Low total cholesterol		609	11.4		418	14.5
Low albumin		1341	25.0		614	21.3
Low haemoglobin		927	17.3		588	20.4
Low lymphocyte counts		351	6.6		204	7.1
Baseline prevalent IADL-BADL disability		897	16.7		293	10.2

Abbreviation: NA, not analysed (data not available in SLAS-1 cohort).

Table 2 Risks of Prevalent and Incident Disability and Functional Decline Associated with ENIGMA Malnutrition Risk in the Total (Combined SLAS-1 and SLAS-2) Cohort (N=5358)

		Prevalent Disability					Incident Disability					Functional Decline
		At Risk	%	(N)	OR	(95% CI)	At Risk^¥	%	(N)	OR	(95% CI)	At Risk	%	(N)	OR	(95% CI)
Total		5358	16.7	(897)			2480	8.9	(220)			2988	7.9	(237)
Malnutrition risk score	0	2035	11.6	(236)	1	Ref	1048	5.9	(62)	1		1195	5.3	(63)	1	Ref
	1–2	2525	18.2	(460)	1.23	(1.02, 1.48)**	1150	10.1	(116)	1.43	(1.06, 2.07)*	1427	8.3	(119)	1.26	(0.90, 1.76)
	3+	798	25.2	(201)***	1.26	(0.98, 1.62)	282	14.9	(42)***	1.86	(1.18, 2.95)**	366	14.8	(54)***	1.65	(1.08, 2.53)*
Eating difficulty	No	5005	15.6	(781)	1		2361	8.5	(200)			2819	7.4	(209)
	Yes	353	32.9	(116)***	1.79	(1.36, 2.37)***	119	16.8	(20)**	1.88	(1.09, 3.23)*	169	16.0	(27)***	1.63	(1.01, 2.64)*
Taking 5 or more drugs	No	4550	15.0	(684)			2212	8.5	(187)			2611	7.1	(185)
	Yes	808	26.4	(213)***	1.33	(1.05, 1.69)*	268	12.3	(33)*	0.87	(0.53, 1.41)	377	13.5	(51)***	1.07	(0.71, 1.62)
Few fruits orvegetables	No	4860	16.2	(786)			2291	8.6	(198)			2748	7.7	(211)
	Yes	498	22.3	(111)**	0.97	(0.75, 1.27)	189	11.6	(22)	1.13	(0.69, 1.11)	240	10.4	(25)	0.98	(0.61, 1.57)
Low cholesterol	No	4749	16.2	(767)			2231	8.6	(192)			2677	7.4	(198)
	Yes	609	21.3	(130)**	1.13	(1.10, 1.16)	249	11.2	(28)	1.01	(0.63, 1.61)	309	12.6	(39)**	1.11	(0.73, 1.67)
Low albumin	No	4017	15.3	(615)			1908	7.7	(147)			2257	7.0	(159)
	Yes	1341	21.0	(282)***	0.97	(0.80, 1.16)**	572	12.8	(73)***	1.30	(0.95, 1.80)	731	10.5	(77)**	1.12	(0.82, 1.54)
Low haemoglobin	No	4431	16.1	(713)			2128	8.4	(178)			2553	7.4	(189)
	Yes	927	19.8	(184)**	0.94	(0.76, 1.17)	352	11.9	(42)*	1.23	(0.84, 1.81)	435	10.8	(47)*	1.16	(0.81, 1.68)
Low lymphocyte	No	5007	16.5	(827)			2334	8.6	(200)			2812	7.5	(210)
	Yes	351	19.9	(70)	1.04	(0.76, 1.42)	146	13.7	(20)*	1.58	(0.92, 2.73)	176	14.8	(26)***	2.14	(1.33, 3.44)***

Notes:^¥Disability-free at baseline; *P<0.05, **p<0.01, ***p<0.001. Adjusted for socio-demographic + lifestyle behaviour (single/widowed/divorced status, living alone, physical activity) + health (multi-morbidity, MMSE, GDS).

Table 3 Adjusted Estimates of Between-Nutritional Group Differences in Decline in Physical Performance Among Disability-Free SLAS2 Participants

		Decline from Baseline		Between Group Differences
		Adjusted Mean (95% CI)		Adjusted Mean (95% CI)		%
KES, kg
Malnutrition risk score	0	−2.63	(−3.44, −1.82)	0	Reference	0
	1–2	−2.65	(−3.44, −1.86)	−0.02	(−0.55, 0.51)	0.8
	3+	−2.46	(−3.38, −1.53)	0.17	(−0.67, 1.01)	6.5
Eating difficulty due to oral problems	No	−2.58	(−3.31, −1.85)	0
	Yes	−2.33	(−3.54, −1.13)	0.24	(−0.75, 1.24)	9.3
Taking 5 or more drugs	No	−2.65	(−3.38, −0.19)	0
	Yes	−2.52	(−0.35, −0.59)	0.13	(−0.64, 0.89)	4.9
Few fruits or vegetables	No	−2.70	(−3.44, −1.96)***	0
	Yes	−1.76	(−2.81, −0.71)**	0.94	(0.07, 1.82)*	34.8
Low cholesterol	No	−2.58	(−3.33, −1.82)	0
	Yes	−2.73	(−3.65, −1.81)	−0.16	(−0.89, 0.57)	6.2
Low albumin	No	−2.50	(−3.25, −1.74)	0
	Yes	−2.81	(−3.68, −1.93)	−0.31	(−0.93, 0.31)	11.3
Low haemoglobin	No	−2.55	(−3.31, −1.80)	0
	Yes	−2.79	(−3.68, −1.90)	−0.23	(−0.87, 0.41)	9.0
Low lymphocyte count	No	−2.60	(−3.34, −1.86)	0
	Yes	−2.66	(−3.87, −1.45)	−0.06	(−1.04, 0.91)	2.3
GV, m/s
Malnutrition risk score	0	−0.14	(−0.20, −0.09)	0	Reference	0
	1–2	−0.17	(−0.23, −0.12)*	−0.03	(−0.07, −0.01)*	21.4
	3+	−0.21	(−0.28, −0.15)*	−0.07	(−0.13, −0.001)*	50.0
Eating difficulty due to oral problems	No	−0.16	(−0.21, −0.11)	0
	Yes	−0.20	(−0.28, −0.12)	−0.04	(−0.11, 0.03)	25.0
Taking 5 or more drugs	No	−0.16	(−0.22, −0.11)	0
	Yes	−0.22	(−0.27, −0.15)	−0.05	(−0.10, 0.01)	31.2
Few fruits or vegetables	No	−0.16	(−0.21, −0.11)	0
	Yes	−0.20	(−0.27, −0.12)	−0.04	(−0.10, 0.03)	25.0
Low cholesterol	No	−0.16	(−0.21, −0.11)	0
	Yes	−0.20	(−0.27, −0.13)	−0.04	(−0.09, 0.01)	25.0
Low albumin	No	−0.16	(−0.21, −0.10)	0
	Yes	−0.22	(−0.28, −0.15)**	−0.06	(−0.10, −0.02)**	37.5
Low haemoglobin	No	−0.17	(−0.22, −0.12)	0
	Yes	−0.18	(−0.24, −0.12)	−0.01	(−0.06, 0.03)	5.9
Low lymphocyte count	No	−0.17	(−0.22, −0.12)	0
	Yes	−0.20	(−0.28, −0.11)	−0.03	(−0.09, 0.04)	17.6
TUG, sec
Malnutrition risk score	0	0.61	(0.10, 1.12)	0	Reference	0
	1–2	0.96	(0.46, 1.46)	0.34	(−0.03, 0.72)	55.7
	3+	1.38	(0.79, 1.97)**	0.77	(0.17, 1.37)**	126.2
Eating difficulty due to oral problems	No	1.01	(0.54, 1.48)	0
	Yes	1.59	(0.83, 2.35)	0.58	(−0.05, 1.21)	57.4
Taking 5 or more drugs	No	1.05	(0.59, 1.52)	0
	Yes	1.65	(1.04, 2.26)*	0.59	(0.10, 1.09)*	56.2
Few fruits or vegetables	No	1.04	(0.57, 1.52)	0
	Yes	1.03	(0.35, 1.72)	−0.007	(−0.580, 0.565)	0.7
Low cholesterol	No	0.85	(0.367, 1.33)	0
	Yes	1.14	(0.55, 1.74)	0.29	(−0.18, 0.76)	34.1
Low albumin	No	0.77	(0.29, 1.24)	0
	Yes	1.46	(0.90, 2.02)***	0.70	(0.30, 1.08)***	90.9
Low haemoglobin	No	0.91	(0.43, 1.39)	0
	Yes	0.99	(0.43, 1.56)	0.09	(−0.32, 0.49)	9.9
Low lymphocyte count	No	0.91	(0.44, 1.38)	0
	Yes	1.40	(0.65, 2.16)	0.49	(−0.12, 1.11)	53.8

Notes: Ref: Reference; *p<0.05, **p<0.01, ***p<0.001 (Bonferroni-adjusted). Adjusted for age, sex, ethnicity, education, housing type, marital status, living arrangement, hours of moderate to high physical activity, number of comorbidities, GDS, MMSE and baseline KES (or GV or TUG). Deterioration from baseline is measured with appropriate reverse signs for changes from baseline of KES, GV and TUG.

Figure 2 Significant estimates of GV and TUG declines at follow-up associated with ENIGMA7 malnutrition risk, low albumin and consumption of ≥5 drugs among disability-free SLAS-2 participants.