A Study of the Association between Dehydroepiandrosterone and Frailty in Elderly

Abstract

The biological basis for Frailty remains unclear. It is hypothesized that loss of bone mass, decline in protein synthesis, sarcopenia and immune dysfunction influence the onset of frailty. Studies show that low serum DHEA levels are associated with increased rates of morbidity and mortality. Serum levels of DHEA decline with age, and this decline is paralleled by a decrease in muscle and bone mass. Hence we take up this study to test the hypothesis that declining serum DHEA is associated with the frailty phenotype. AIMS & OBJECTIVES: To evaluate the association between Dehydroepiandrosterone (DHEA) and Frailty in the elder population. METHODS: The study group includes elderly subjects > 65 yrs, in the Geriatric ward of Rajiv Gandhi Govt. General Hospital, Chennai, who complied with the inclusion and exclusion criteria. Anthropometric evaluation was done. Fried’s criteria was employed to assess the frailty phenotype. Patients were categorized into 3 groups based on the number of frailty components - FRAIL (≥ 3 characteristics); INTERMEDIATE FRAIL (1-2 characteristics); NON-FRAIL (no characteristic). Blood samples of patients from each group were collected for estimating serum DHEA-s level (using CLIA method) and analysis was performed by appropriate statistical methods. RESULTS: In a study conducted in 100 participants, a significant association between Frailty phenotype and DHEA level was observed (p < 0.0004). Ordinal logistic regression was used to model the relationship between frailty and DHEA, adjusting for age, gender and BMI. A significant DHEA–BMI interaction (OR=1.09; 95% CI; p = 0.0001) suggested that, in general, the relationship between higher levels of frailty decreased relative to higher levels of DHEA, but the magnitude of decrease was larger at lower BMI values and smaller at higher BMI values. A BMI >29 kg/m² attenuated the association between DHEA levels and frailty. CONCLUSION: This study found an inverse association between frailty and DHEA-s levels, similar to other studies that have found associations between DHEA-s and physical function. Whether the inverse association is due to similar conditions resulting in lower DHEA levels and more susceptibility to frailty or whether lower DHEA levels have an impact on increasing frailty cannot be addressed by this cross-sectional