Data Sheet 1_The problem of frailty caused by acute infection and future health management strategies to improve frailty.docx

BackgroundWe aimed to analyze changes in frailty associated with long-COVID, while providing effective health management measures to improve frailty.
MethodsWe conducted a 4-month follow-up cohort study involving 2,471 participants to analyze changes in body frailty after the prevalence of COVID-19 in China. We performed interrupted time series analysis to estimate the impact of acute infection on the changes in frailty. The time-dependent COX model was considered to assess the association between frailty status and infection, and sensitivity analysis was performed to verify the stability of the results. In addition, we established a traditional Cox model to analyze the relationship between healthy behaviors and infections, aiming to improve health management and reduce frailty.
ResultsThere were significantly elevated trend changes in the frailty index compared to the prepandemic period in the total population (+0.029[0.016, 0.041], p < 0.001), and the frailty index was found to be higher in female individuals and people aged over 65 years. Participants with moderate frailty (HR = 1.19, 95% CI: 1.04–1.35, p < 0.001) and severe frailty (HR = 1.34, 95%CI: 1.15–1.56, p < 0.001) had a significantly higher hazard of infection than those with mild frailty. Long-term health monitoring indicated that positive mood, appropriate physical activities, sufficient intake of grains and vegetables, and reduced intake of sugary drinks can improve frailty and ultimately reduce the risk of infection.
ConclusionIn this study, it was found that the population generally became more frail after the pandemic, and frailty increases the risk of acute reinfection. Therefore, it is necessary to carry out health management strategies to improve frailty.

背景：本研究旨在分析与长期新冠（long-COVID）相关的衰弱变化，并提出可改善衰弱状态的有效健康管理措施。
方法：本研究针对中国新型冠状病毒肺炎（COVID-19）流行后的人群开展了一项纳入2471名受试者的4个月随访队列研究，以分析躯体衰弱的变化情况。本研究采用间断时间序列分析（interrupted time series analysis）评估急性感染对衰弱变化的影响；采用时变Cox模型（time-dependent COX model）评估衰弱状态与感染的关联，并通过敏感性分析（sensitivity analysis）验证结果的稳定性。此外，本研究构建传统Cox模型分析健康行为与感染的关联，以期优化健康管理、降低衰弱发生风险。
结果：与大流行前相比，总人群的衰弱指数（frailty index）呈现显著升高的趋势变化（+0.029[0.016, 0.041]，p<0.001）；且女性及65岁以上人群的衰弱指数更高。中度衰弱（风险比（hazard ratio, HR）=1.19，95%置信区间（95% confidence interval, 95%CI）：1.04~1.35，p<0.001）与重度衰弱（HR=1.34，95%CI：1.15~1.56，p<0.001）受试者的感染风险显著高于轻度衰弱受试者。长期健康监测结果显示，积极情绪、适度体力活动、足量谷物与蔬菜摄入以及减少含糖饮料摄入，可改善衰弱状况并最终降低感染风险。
结论：本研究发现，新型冠状病毒肺炎大流行后人群整体衰弱程度普遍升高，且衰弱会增加急性再感染风险。因此，有必要制定健康管理策略以改善衰弱状况。