Lower levels of serum albumin and total cholesterol and future decline in functional performance in older persons: the Longitudinal Aging Study Amsterdam

BACKGROUND: Both serum albumin and total cholesterol are potential markers of frailty. A decline in functional status is one of the key components of frailty. OBJECTIVE: The aim of this study was to investigate the association of serum albumin and total cholesterol, separately and combined, with future decline in functional performance. DESIGN: The Longitudinal Aging Study Amsterdam, an ongoing population-based longitudinal study, started in 1992/1993 with a follow-up every 3 years. PARTICIPANTS: 1,064 men and women aged 55-85 years with complete data on serum albumin and total cholesterol at baseline, and functional performance at baseline and 3-year follow-up. MEASUREMENTS: At baseline, serum albumin and total cholesterol were measured. At baseline and 3 years later, decline in functional status was measured with three performance tests (chair stand, 3-metre walk, putting on and taking off a cardigan). Associations were adjusted for age, life-style and health-related factors. RESULTS: Albumin concentration was not associated with decline in functional performance in men and women. Women with lower serum total cholesterol concentration (</=5.2 mmol/l) were more likely to decline in functional status compared to women with higher serum total cholesterol concentration (reference; OR = 2.50; 95% CI 1.07-5.84). Men with lower serum albumin (</=43 g/l) and lower serum total cholesterol concentration were three times more likely to decline in functional performance compared to men with higher levels (OR = 3.00; 95% CI 1.00-8.97). In women, a similar trend was found (OR = 1.73; 95% CI 0.34-8.94), although not statistically significant. CONCLUSIONS: A combination of low albumin and low cholesterol levels may increase the risk of future functional decline.