Physiological reserve and cardiometabolic burden in relation to functional decline in older adults: a multicohort study
- 1Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong China
- 2Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
Abstract
Purpose: Activities of daily living (ADL) disability is a clinically important manifestation of functional decline in later life. It remains unclear whether peak expiratory flow (PEF), a simple marker of respiratory physiological reserve, and cardiometabolic burden provide complementary information for identifying older adults at higher risk. We examined their separate and joint associations with incident ADL disability across three ageing cohorts.
Methods: We conducted harmonized prospective analyses of adults aged > 60 years who were free of ADL disability at baseline in CHARLS, HRS, and SHARE. Low PEF was defined using cohort- and sex-specific lowest-quartile thresholds, and high cardiometabolic burden as two or more of hypertension, diabetes, lipid disorder, and obesity. We fitted cohort-specific Cox models and pooled estimates by random-effects meta-analysis. We evaluated multiplicative and additive interaction, between-cohort heterogeneity, multiple imputation, and proportional hazards assumptions.
Results: Among 43,285 participants, 11,315 developed incident ADL disability. Higher PEF was associated with a lower risk, whereas greater cardiometabolic burden was associated with a higher risk. Participants with both low PEF and high cardiometabolic burden had the highest relative hazard (pooled HR 1.73, 95% CI 1.54, 1.95). The multiplicative interaction estimate was statistically significant but small in the complete-case analysis (HR 1.09, 95% CI 1.01, 1.19; P = 0.029). It was similar in the multiple-imputation analysis (HR 1.10, 95% CI 1.02, 1.17; P = 0.008) and heterogeneous across cohorts. Pooled additive interaction estimates were close to the null.
Conclusion: The combination of low PEF and high cardiometabolic burden identified an older subgroup at elevated risk of incident ADL disability. However, the small and heterogeneous multiplicative interaction and near-null additive interaction estimates did not support a consistent interaction beyond the separate associations.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12877-026-08436-0.
Related
- Ultra-processed food indices and component food groups in relation to incident type 2 diabetes and cardiometabolic multimorbidity: a prospective cohort study
- Beyond Anatomy in Uncomplicated Type B Aortic Dissection: Hypoxia, Physiological Reserve, and the Next Generation of Intelligent Endovascular Devices
- Reduced physiological reserve and a blunted response to acute exercise in adults with cerebral palsy
- Anaerobic Speed Reserve and Critical Speed as Predictors of 200 m Front Crawl Performance: A Practical Alternative to Physiological Testing in Trained Swimmers.
- Physiological reserve and early recovery across oncologic and non-oncologic abdominal surgery: a prospective multicenter interaction analysis
BibTeX
@article{chen2026physiological,
title = {{Physiological reserve and cardiometabolic burden in relation to functional decline in older adults: a multicohort study}},
author = {Weimin Chen and Zelin Pan and Song Yang and Weizhong Zhuang and Luoming Hu and Jimei Chen},
journal = {BMC Geriatrics},
year = {2026},
month = oct,
doi = {10.1186/s12877-026-08436-0},
url = {https://doi.org/10.1186/s12877-026-08436-0},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Physiological reserve and cardiometabolic burden in relation to functional decline in older adults: a multicohort study
AU - Weimin Chen
AU - Zelin Pan
AU - Song Yang
AU - Weizhong Zhuang
AU - Luoming Hu
AU - Jimei Chen
PY - 2026
DA - 2026/10/09
JO - BMC Geriatrics
DO - 10.1186/s12877-026-08436-0
UR - https://doi.org/10.1186/s12877-026-08436-0
AB - Purpose: Activities of daily living (ADL) disability is a clinically important manifestation of functional decline in later life. It remains unclear whether peak expiratory flow (PEF), a simple marker of respiratory physiological reserve, and cardiometabolic burden provide complementary information for identifying older adults at higher risk. We examined their separate and joint associations with incident ADL disability across three ageing cohorts. Methods: We conducted harmonized prospective analyses of adults aged > 60 years who were free of ADL disability at baseline in CHARLS, HRS, and SHARE. Low PEF was defined using cohort- and sex-specific lowest-quartile thresholds, and high cardiometabolic burden as two or more of hypertension, diabetes, lipid disorder, and obesity. We fitted cohort-specific Cox models and pooled estimates by random-effects meta-analysis. We evaluated multiplicative and additive interaction, between-cohort heterogeneity, multiple imputation, and proportional hazards assumptions. Results: Among 43,285 participants, 11,315 developed incident ADL disability. Higher PEF was associated with a lower risk, whereas greater cardiometabolic burden was associated with a higher risk. Participants with both low PEF and high cardiometabolic burden had the highest relative hazard (pooled HR 1.73, 95% CI 1.54, 1.95). The multiplicative interaction estimate was statistically significant but small in the complete-case analysis (HR 1.09, 95% CI 1.01, 1.19; P = 0.029). It was similar in the multiple-imputation analysis (HR 1.10, 95% CI 1.02, 1.17; P = 0.008) and heterogeneous across cohorts. Pooled additive interaction estimates were close to the null. Conclusion: The combination of low PEF and high cardiometabolic burden identified an older subgroup at elevated risk of incident ADL disability. However, the small and heterogeneous multiplicative interaction and near-null additive interaction estimates did not support a consistent interaction beyond the separate associations. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12877-026-08436-0.
SN - 1471-2318
ER -