The Impact of Metabolic Syndrome Severity on Frailty Progression among Chinese middle and old-aged adults: A Longitudinal Study

Abstract Background The binary diagnosis of Metabolic Syndrome (MetS) fails to accurately evaluate its severity, and the association between MetS severity and frailty progression remains inadequately elucidated. This study aims to clarify the relationship between the severity of MetS and the progression of frailty among the middle-aged and elderly population in China. Method Participants from the 2011–2018 China Health and Retirement Longitudinal Study (CHARLS) were included for a longitudinal analysis. The study employs a frailty index (FI) based on 32 health deficits to diagnose frailty and to assess FI trajectories. The association between MetS, Cumulative MetS, and the risk and trajectory of frailty were evaluated using Cox regression/logistic regression, and linear mixed models. Restricted Cubic Splines (RCS) models were utilized to detect potential non-linear associations. Results A higher MetS score was significantly associated with an increased risk of frailty (HR per 1 SD increase = 1.205; 95% CI: 1.14 to 1.273) and an accelerated FI trajectory (β per year per 1 SD increase = 0.113; 95% CI: 0.075 to 0.15). Evaluating changes in MetS score using a cumulative MetS score indicated that each 1 SD increase in the cumulative MetS score increased the risk of frailty by 22% (OR = 1.222; 95% CI: 1.133 to 1.319) and accelerated the rate of increase in FI (β = 0.098 per year; 95% CI: 0.058 to 0.138). RCS model results demonstrated a dose-response curve relationship between MetS score and cumulative MetS score with frailty risk. Stratified analysis showed consistency across subgroups. The interaction results indicate that in males and individuals under 60, MetS score may accelerate the increase in FI, a finding consistent across both models. Conclusions Our findings underscore the positive correlation between the severity of MetS and frailty progression in the elderly, highlighting the urgent need for early identification of MetS and targeted interventions to reduce the risk of frailty.