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

Autoři: Andres Gil-Salcedo aff001;  Aline Dugravot aff001;  Aurore Fayosse aff001;  Julien Dumurgier aff001;  Kim Bouillon aff002;  Alexis Schnitzler aff001;  Mika Kivimäki aff003;  Archana Singh-Manoux aff001;  Séverine Sabia aff001
Působiště autorů: Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, France aff001;  Département d’Information Médicale, Centre Hospitalier de Saint-Brieuc, Saint-Brieuc, France aff002;  Department of Epidemiology and Public Health, University College London, London, United Kingdom aff003;  Helsinki Institute of Life Sciences, University of Helsinki, Helsinki, Finland aff004
Vyšlo v časopise: 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. PLoS Med 17(7): e1003147. doi:10.1371/journal.pmed.1003147
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003147



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.

Methods and findings

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.

Klíčová slova:

Alcohol consumption – Behavior – Behavioral and social aspects of health – Ethnic epidemiology – Frailty – Morbidity – Physical activity – Socioeconomic aspects of health


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