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J Am Geriatr Soc. 2019 Jan 10. doi: 10.1111/jgs.15733. [Epub ahead of print]

Triglycerides Paradox Among the Oldest Old: "The Lower the Better?"

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National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Division of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China.
Nutritional Epidemiology Lab, Pennsylvania State University, Philadelphia, Pennsylvania.
Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Duke Molecular Physiology Institute and Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Division of Epidemiology, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
School of Public Health, Peking Union Medical College/Chinese Academy of Medical Sciences, Beijing, China.
Center for the Study of Aging and Human Development and the Geriatric Division of School of Medicine, Duke University, Durham, North Carolina.
Center for Study of Healthy Aging and Development Studies, Peking University, Beijing, China.



Currently, most treatment guidelines suggest lowering hypertriglyceridemia of any severity, even in elderly individuals. However associations of serum triglycerides (TGs) with adverse health and mortality risk decrease with age, it remains unclear among the oldest old (aged 80 years and older). The study was to investigate the relationship of serum TG concentrations with cognitive function, activities of daily living (ADLs), frailty, and mortality among the oldest old in a prospective cohort study.


Longitudinal prospective cohort study.


Community-based setting in longevity areas in China.


A total of 930 (mean age = 94.0 years) Chinese oldest old.


The TG concentrations were measured at baseline survey in 2009. Cognitive function, ADLs, frailty, and mortality were determined over 5 years of follow-up. Cox proportional hazards models and competing risk models were performed to explore the association, adjusting for potential confounders.


Each 1-mmol/L increase in TGs was associated with a nearly 20% lower risk of cognitive decline, ADL decline, and frailty aggravation during the 5 years of follow-up. Consistently, higher TGs (each 1 mmol/L) was associated with lower 5-year all-cause mortality after fully adjustment (hazard ratio [HR] = 0.79; 95% confidence interval [CI] = 0.69-0.89). Nonelevated TG concentrations (less than 2.26 mmol/L) were associated with higher mortality risk (HR = 1.72; 95% CI = 1.22-2.44), relative to TGs of 2.26 mmol/L or more. We observed similar results regarding TG concentrations and mortality in 1-year lag analysis and when excluding participants with identified chronic disease.


In the oldest old, a higher concentration of TGs was associated with a lower risk of cognitive decline, ADL decline, frailty aggravation, and mortality. This paradox suggests the clinical importance of revisiting the concept of "the lower the better" for the oldest old. J Am Geriatr Soc 00:1-8, 2019.


activities of daily living; cognitive function; frailty; mortality; triglycerides


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