LAUSR

Frailty, a syndrome whose prevalence increases with age, is an important health problem and the parameters that affect this syndrome should be studied. The article published by Liao et al. [1] concerning the relationship between waist circumference and frailty risk is quite interesting. There are, however, some problems with the methodology. It is well known that there is a significant overlap between sarcopenia and frailty [2]. Thus, it is crucial to assess sarcopenia in detail to clearly define other factors contributing to frailty. Loss of muscle strength, muscle mass and physical function are the main components of sarcopenia that can be objectively evaluated using several methods [3]. The present study only used Tinetti POMA for physical performance without including other methods such as handgrip strength or walking speed. Thus, the sarcopenia status of patients with higher and normal waist circumferences has not been sufficiently conducted to conclude that waist circumference per se can predict frailty risk, since sarcopenic obesity may also be a contributor. As decreased 25(OH) vitamin D levels are involved in the pathophysiology of frailty, it should be included in the frailty index. Additionally, as lower vitamin D levels were found to be associated with frailty, obesity and also higher waist circumference [4], the interrelationship between these variables should be clarified by statistical analysis. The results concerning the significance of the relationship between some of the variables, for which the odds ratios were adjusted in model two, and frailty are not discussed in the article. As mentioned in the article, there are numerous studies which have reported an association between frailty and increased body fat mass. On the other hand, other studies have focused on the obesity paradox phenomenon [5]. In our view, further longitudinal studies examining body weights could help us to understand the nature of the relationship between body composition and poor clinical outcomes such as frailty and mortality.