Health of frail people without chronic diseases: an overlooked health state
Happy to share two recently published papers from a collaboration with Paula Stürmer from the University of Kiel, during her postdoctoral fellowship in EpiAgeing lab.
Both studies look at a rather overlooked group: people who are frail (or prefrail), but do not have any diagnosed chronic diseases.
Frailty is usually considered in the context of ageing, multimorbidity and chronic disease. But frailty can also be found in middle-aged people who appear to be healthy. These individuals may be particularly easy to overlook: without a diagnosed disease, there may be little reason for them to interact with the healthcare system.
So we asked a simple question: who are these people? Is frailty (or prefrailty) in the absence of chronic disease merely a measurement artefact, or does it reflect a genuinely different state of health?
🧬 In the first paper, we looked at their physiological profile. Among more than 117,000 disease-free middle-aged adults in the UK Biobank, frailty (or prefrailty) were associated with alterations across multiple physiological systems, including adiposity, glucose metabolism, inflammation, and hepatic and renal function. Interestingly, the overall pattern resembled the physiological dysregulation observed in older and multimorbid populations, suggesting that frailty status may reflect early multisystem physiological dysregulation, even before clinically manifest chronic disease.
⏳ In the second paper, we asked what happens to these people over time. Among more than 183,000 disease-free middle-aged adults followed for a median of 13.8 years, frail (or prefrail) participants had substantially higher risks of both developing chronic conditions and dying. Frailty was also associated with a higher risk of mortality after disease onset. Importantly, these associations remained when events occurring during the first 10 years of follow-up were excluded.
What should we do about these individuals? Our studies do not provide the answer. But they point to a potential blind spot in population health: people who are already frail, but who may remain largely invisible to healthcare systems because they do not yet have a diagnosed disease.
Many thanks to Paula Stürmer and to everyone involved in these studies, and to IReSP – Institut pour la Recherche en Santé Publique, Caisse nationale de solidarité pour l’autonomie, ANR (Agence nationale de la recherche), Programme prioritaire de recherche (PPR) Autonomie, Models of Autonomy, DAAD Deutscher Akademischer Austauschdienst for supporting this work.
By Benjamin Landré
