{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T09:54:48Z","timestamp":1789638888736,"version":"4.0.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T00:00:00Z","timestamp":1707350400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Although previous studies found that frailty is prevalent in NAFLD patients with advanced liver fibrosis and cirrhosis, studies examining the relationship are spare.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>Our study aspires to investigate the potential correlation between the Frailty Index (FI) and hepatic fibrosis among middle-aged and older adults with NAFLD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from the 2017\u20132020.03 National Health and Nutrition Examination Survey (NHANES) were utilized for this study, with a final of 2,383 participants aged 50\u2009years and older included. The quantification of frailty was executed employing a 49-item frailty index. The recognition of hepatic steatosis and fibrosis was accomplished through the utilization of the controlling attenuation parameter (CAP) and transient elastography (TE). The relationship between the FI and hepatic fibrosis were investigated employing univariable and multivariable-adjusted logistic regression analyses. A subgroup analysis was conducted, dividing the subjects based on gender, Body Mass Index (BMI), and the presence of hyperlipidemia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The findings demonstrated a positive correlation between the FI and significant hepatic fibrosis in NAFLD, even after using multivariate logistic regression models adjusting for potential confounding factors (OR\u2009=\u20091.022, 95% CI, 1.004\u20131.041) and in tertiles (Q3vs Q1: OR\u2009=\u20092.004, 95% CI, 1.162\u20133.455). In the subgroup analysis, the correlation was more statistically significant in male (OR\u2009=\u20091.046, 95% CI, 1.022\u20131.071), under\/normal weight (OR\u2009=\u20091.077, 95% CI, 1.009\u20131.150), overweight (OR\u2009=\u20091.040, 95% CI, 1.010\u20131.071), and subjects without hyperlipidemia (OR\u2009=\u20091.054, 95% CI, 1.012\u20131.097). The area under the Receiver Operating Characteristic (ROC) curve for the FI in assessing the existence of substantial fibrosis in NAFLD was 0.612 (95% CI, 0.596\u20130.628).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study demonstrated a positive correlation between significant hepatic fibrosis and frailty, particularly among males aged 50\u2009years and older, who were non-obese and did not have hyperlipidemia with NAFLD. Additional studies are required to further validate these findings.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1330221","type":"journal-article","created":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T15:52:17Z","timestamp":1707407537000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Association between frailty and hepatic fibrosis in NAFLD among middle-aged and older adults: results from NHANES 2017\u20132020"],"prefix":"10.3389","volume":"12","author":[{"given":"Falide","family":"Atabieke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiu-Juan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ailikamu","family":"Aierken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yierzhati","family":"Aizezi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-Liang","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi-Qiang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,2,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1053\/j.gastro.2010.09.038","article-title":"Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study","volume":"140","author":"Williams","year":"2011","journal-title":"Gastroenterology"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"15489","DOI":"10.3390\/ijms232415489","article-title":"Non-alcoholic fatty liver disease (NAFLD) pathogenesis and natural products for prevention and treatment","volume":"23","author":"Guo","year":"2022","journal-title":"Int J Mol Sci"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1111\/j.1365-2036.2011.04724.x","article-title":"Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults","volume":"34","author":"Vernon","year":"2011","journal-title":"Aliment Pharmacol Ther"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"9880","DOI":"10.3748\/wjg.v22.i45.9880","article-title":"Hepatic steatosis and fibrosis: non-invasive assessment","volume":"22","author":"Karanjia","year":"2016","journal-title":"World J Gastroenterol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e021787","DOI":"10.1136\/bmjopen-2018-021787","article-title":"Diagnostic accuracy of point shear wave elastography and transient elastography for staging hepatic fibrosis in patients with non-alcoholic fatty liver disease: a meta-analysis","volume":"8","author":"Jiang","year":"2018","journal-title":"BMJ Open"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1022","DOI":"10.1016\/j.jhep.2016.12.022","article-title":"Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis","volume":"66","author":"Karlas","year":"2017","journal-title":"J Hepatol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"433","DOI":"10.2147\/CIA.S45300","article-title":"Frailty syndrome: an overview","volume":"9","author":"Chen","year":"2014","journal-title":"Clin Interv Aging"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2229","DOI":"10.1111\/j.1532-5415.2005.00510.x","article-title":"Just what defines frailty?","volume":"53","author":"Fisher","year":"2005","journal-title":"J Am Geriatr Soc"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1016\/j.jacc.2022.06.037","article-title":"Sacubitril\/valsartan and frailty in patients with heart failure and preserved ejection fraction","volume":"80","author":"Butt","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2021\/5576531","article-title":"Frailty in nonalcoholic fatty liver cirrhosis: a comparison with alcoholic cirrhosis, risk patterns, and impact on prognosis","volume":"2021","author":"Skladany","year":"2021","journal-title":"Can J Gastroenterol Hepatol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1018267","DOI":"10.3389\/fendo.2022.1018267","article-title":"Association between Helicobacter pylori infection and serum thyroid stimulating hormone in the National Health and nutrition examination survey 1999\u20132000","volume":"13","author":"Wang","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"ref12","first-page":"1","article-title":"National Health and nutrition examination survey, 2015\u20132018: sample design and estimation procedures","volume":"184","author":"Chen","year":"2020","journal-title":"Vital Health Stat 2"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1053\/j.gastro.2008.01.034","article-title":"Performance of transient elastography for the staging of liver fibrosis: a meta-analysis","volume":"134","author":"Friedrich-Rust","year":"2008","journal-title":"Gastroenterology"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1016\/j.jhep.2007.11.020","article-title":"Liver stiffness values in apparently healthy subjects: influence of gender and metabolic syndrome","volume":"48","author":"Roulot","year":"2008","journal-title":"J Hepatol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1148\/radiol.2020192437","article-title":"Update to the Society of Radiologists in ultrasound liver Elastography consensus statement","volume":"296","author":"Barr","year":"2020","journal-title":"Radiology"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1016\/j.jamda.2020.07.023","article-title":"Association between Oral health and frailty among American older adults","volume":"22","author":"Hakeem","year":"2021","journal-title":"J Am Med Dir Assoc"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1093\/gerona\/62.7.722","article-title":"Frailty in relation to the accumulation of deficits","volume":"62","author":"Rockwood","year":"2007","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/1471-2318-8-24","article-title":"A standard procedure for creating a frailty index","volume":"8","author":"Searle","year":"2008","journal-title":"BMC Geriatr"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1603966","DOI":"10.3389\/ijph.2021.1603966","article-title":"Associations between lifestyle factors and reduced kidney function in US older adults: NHANES 1999\u20132016","volume":"66","author":"Chang","year":"2021","journal-title":"Int J Public Health"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"968073","DOI":"10.3389\/fnut.2022.968073","article-title":"The association of healthy eating index with periodontitis in NHANES 2013\u20132014","volume":"9","author":"Li","year":"2022","journal-title":"Front Nutr"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"3143","DOI":"10.1161\/circ.106.25.3143","article-title":"Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report","volume":"106","year":"2002","journal-title":"Circulation"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1007\/s11357-021-00434-x","article-title":"Liver frailty and all-cause mortality in the older participants of the Salus in Apulia study","volume":"44","author":"Zupo","year":"2022","journal-title":"Geroscience"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"104612","DOI":"10.1016\/j.archger.2021.104612","article-title":"Frailty assessment using routine clinical data: an integrative review","volume":"99","author":"Lim","year":"2022","journal-title":"Arch Gerontol Geriatr"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/j.ijcard.2017.01.153","article-title":"The prevalence of frailty in heart failure: a systematic review and meta-analysis","volume":"236","author":"Denfeld","year":"2017","journal-title":"Int J Cardiol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"afac064","DOI":"10.1093\/ageing\/afac064","article-title":"Prevalence and implications of frailty in acute stroke: systematic review & meta-analysis","volume":"51","author":"Burton","year":"2022","journal-title":"Age Ageing"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"103952","DOI":"10.1016\/j.ijnurstu.2021.103952","article-title":"The prevalence of frailty among community-dwelling older adults with diabetes: a meta-analysis","volume":"119","author":"Kong","year":"2021","journal-title":"Int J Nurs Stud"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1007\/s12603-019-1258-y","article-title":"Cognitive frailty and its association with nutrition and depression in community-dwelling older people","volume":"23","author":"Kwan","year":"2019","journal-title":"J Nutr Health Aging"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"234","DOI":"10.20524\/aog.2022.0705","article-title":"Frailty in metabolic syndrome, focusing on nonalcoholic fatty liver disease","volume":"35","author":"Karakousis","year":"2022","journal-title":"Ann Gastroenterol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.14218\/JCTH.2020.00065","article-title":"Skeletal muscle dysfunction in the development and progression of nonalcoholic fatty liver disease","volume":"8","author":"Altajar","year":"2020","journal-title":"J Clin Transl Hepatol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1186\/s12876-018-0776-0","article-title":"Relationship of sarcopenia with steatohepatitis and advanced liver fibrosis in non-alcoholic fatty liver disease: a meta-analysis","volume":"18","author":"Yu","year":"2018","journal-title":"BMC Gastroenterol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/j.jhep.2016.08.019","article-title":"Sarcopenia is an independent risk factor for non-alcoholic steatohepatitis and significant fibrosis","volume":"66","author":"Koo","year":"2017","journal-title":"J Hepatol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.1002\/hep.1840080509","article-title":"Free amino acids in plasma and skeletal muscle of patients with liver cirrhosis","volume":"8","author":"Montanari","year":"1988","journal-title":"Hepatology"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e23","DOI":"10.1097\/CCM.0000000000002013","article-title":"Evaluating muscle mass by using markers of kidney function: development of the sarcopenia index","volume":"45","author":"Kashani","year":"2017","journal-title":"Crit Care Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1260","DOI":"10.1038\/s41598-020-58304-z","article-title":"Sarcopenia index based on serum creatinine and cystatin C is associated with 3-year mortality in hospitalized older patients","volume":"10","author":"Tang","year":"2020","journal-title":"Sci Rep"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1530","DOI":"10.1016\/j.amjmed.2021.07.012","article-title":"Cognitive function, sarcopenia, and inflammation are strongly associated with frailty: a Framingham cohort study","volume":"134","author":"Mehta","year":"2021","journal-title":"Am J Med"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1046\/j.1532-5415.2002.50315.x","article-title":"Serum interleukin-6 and hemoglobin as physiological correlates in the geriatric syndrome of frailty: a pilot study","volume":"50","author":"Leng","year":"2002","journal-title":"J Am Geriatr Soc"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jnutbio.2017.11.003","article-title":"Food components with antifibrotic activity and implications in prevention of liver disease","volume":"55","author":"Bae","year":"2018","journal-title":"J Nutr Biochem"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1016\/j.cld.2008.07.005","article-title":"Oxidative and nitrosative stress and fibrogenic response","volume":"12","author":"Urtasun","year":"2008","journal-title":"Clin Liver Dis"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1016\/j.jchf.2021.12.004","article-title":"Frailty, guideline-directed medical therapy, and outcomes in HFrEF: from the GUIDE-IT trial","volume":"10","author":"Khan","year":"2022","journal-title":"JACC Heart Fail"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1459","DOI":"10.1007\/s40520-018-0964-3","article-title":"Comparison of procalcitonin, a potentially new inflammatory biomarker of frailty, to interleukin-6 and C-reactive protein among older Chinese hospitalized patients","volume":"30","author":"Yang","year":"2018","journal-title":"Aging Clin Exp Res"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1713","DOI":"10.1111\/liv.14161","article-title":"Non-alcoholic fatty liver disease, liver fibrosis score and cognitive function in middle-aged adults: the Framingham study","volume":"39","author":"Weinstein","year":"2019","journal-title":"Liver Int"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"248","DOI":"10.3389\/fphys.2012.00248","article-title":"Liver fibrogenesis in non-alcoholic steatohepatitis","volume":"3","author":"Bian","year":"2012","journal-title":"Front Physiol"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1108902","DOI":"10.3389\/fpsyt.2023.1108902","article-title":"Frailty is associated with worse cognitive functioning in older adults","volume":"14","author":"Li","year":"2023","journal-title":"Front Psych"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1007\/s11357-017-9967-9","article-title":"The association between frailty, the metabolic syndrome, and mortality over the lifespan","volume":"39","author":"Kane","year":"2017","journal-title":"Geroscience"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1330221\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T15:53:02Z","timestamp":1707407582000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1330221\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,8]]},"references-count":44,"alternative-id":["10.3389\/fpubh.2024.1330221"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1330221","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,8]]},"article-number":"1330221"}}