卫生研究

目的 了解城市社区老年人认知衰弱发生的影响因素。方法 采用方便抽样的方法，于2022年7月—2023年6月在山东东营和重庆江北区选取两个调查点，1086名65岁及以上的老年人为研究对象，开展一般情况、膳食频率调查，结合Fried衰弱量表与中文版简易精神状况检测量表对认知衰弱进行判定，并进行身体测量、血液样本检测。采用Lasso回归对变量进行筛选，Logistic回归分析城市社区老年人认知衰弱发生的影响因素。结果 1086例老年人中，认知衰弱270例(24.9%),非认知衰弱816例(75.1%)。两组老年人在养老金收入及患病种类差异有统计学意义(P<0.05),认知衰弱的发生率随着养老金收入的增加而降低，随着患病种类的增加而降低(趋势性检验P<0.05);与非认知衰弱老年人相比，认知衰弱老年人的谷薯类、鱼虾等水产品类、蛋类、新鲜蔬菜类、水果类的每周摄入频次较低(P<0.05);舒张压、6米步速、甘油三酯、白介素-6、白蛋白及维生素B₁₂均较高(P<0.05);小腿围、握力的异常率较高(P<0.05)。基于Lasso回归筛选出文化程度、居住状况、养老金、小腿围、谷薯类摄入频次、鱼虾等水产品摄入频次、奶制品摄入频次、蔬菜摄入频次、水果摄入频次、收缩压、舒张压、甘油三酯、总胆固醇和维生素B₁₂等14个变量。多因素Logistic回归结果显示，在校正年龄、性别和文化程度后，养老金在4001～6000元/月(OR=0.356, 95%CI 0.218～0.583)、>6000元/月(OR=0.542,95%CI 0.302～0.971)、鱼虾等水产品(OR=0.815, 95%CI 0.682～0.973)、水果的摄入频次增加(OR=0.955,95%CI 0.914～0.998)是影响认知衰弱的保护因素，共同居住(OR=2.038, 95%CI 1.065～3.903)及小腿围异常(OR=2.196,95%CI 1.591～3.031)是影响认知衰弱的危险因素。结论 城市社区老年人认知衰弱发生率较高，影响因素多元化。

OBJECTIVE To analyze the influencing factors of cognitive frailty in urban community elderly.METHODS Using convenience sampling, we recruited 1086 elderly aged ≥65 years from two study sites(Dongying City, Shandong Province and Jiangbei District, Chongqing Municipality) between July 2022 and June 2023. Data collection included general demographic characteristics and dietary assessment using food frequency questionnaires. The assessment of cognitive frailty was conducted using the Fried frailty phenotype criteria combined with the Chinese version of the mini-mental state examination. Physical measurements and blood sample collection were performed. Variable selection was performed using Lasso regression, followed by Logistic regression analysis to identify factors associated with cognitive frailty among urban community elderly.RESULTS Among the 1086 elderly, a total of 270 cases(24.9%) had cognitive frailty. Significant differences were observed between the two groups regarding pension income and number of chronic conditions(P<0.05). The cognitive frailty rates decreased with the pension income and the number of chronic, the trend were statistically significant(P<0.05). Compared to non-cognitively frail elderly, those with cognitive frailty had significantly lower weekly intake frequencies of grains & tubers, fish/shellfish, eggs, fresh vegetables, and fruits(P<0.05), diastolic blood pressure, 6-meter walking speed, triglycerides, interleukin-6, albumin, vitamin B₁₂, the abnormal rates of calf circumference and handgrip strength were significantly higher(P<0.05). Based on Lasso regression, 14 variables were selected: level of education, living arrangement, pension income, calf circumference, intake frequency of grains/tubers, fish/shellfish, dairy products, vegetables, and fruits, systolic blood pressure, diastolic blood pressure, triglycerides, total cholesterol, and vitamin B₁₂ levels. Multivariable Logistic regression analysis result showed that: adjusted for age, sex and level of education, revealed the following protective factors against cognitive frailty: a monthly pension of 4001-6000 RMB/month(OR=0.356, 95%CI 0.218-0.583),>6000 RMB/month(OR=0.542,95%CI 0.302-0.971), fish/shellfish consumption(OR=0.815, 95%CI 0.682-0.973) and fruit intake(OR=0.955, 95%CI 0.914-0.998).The risk factors for cognitive frailty were co-residence(OR=2.038, 95%CI 1.065-3.903) and abnormal calf circumference(OR=2.196, 95%CI 1.591-3.031).CONCLUSION The prevalence of cognitive frailty among urban community elderly is high with multifactorial determinants.