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Table 5 Characteristics of studies worked on the relationship between anemia, cognitive and physical function

From: Association between anemia, physical performance and cognitive function in Iranian elderly people: evidence from Bushehr Elderly Health (BEH) program

Author Population baseline numbers
descriptive Length of follow up
Type of study main outcome Measurements Of cognition or hand grip Measurements Of anemia Adjusted for: Relationship between anemia and cognitive Statistics
Trevisa-n et al 2016 [53] e Progetto Veneto Anziani project on, Italian population, 1227 participants older than 65 years old, without cognitive impairment mean follow up 4.4 (1.2SD) years Cohort the onset of the cognitive impairment the 30-item Mini-Mental State Examination (MMSE) Based on WHO criteria
Samples were Divided into the gender-specific Hb tertiles using the following cut-offs: 13.9 and 14.9 g/dL for men; and 12.8 and 13.7 g/dL for women.
Age, sex, education, smoking, alcohol, monthly income, living alone, physical activity, BMI, hearing loss, vision loss, hypertension, CVD, COPD, OAD, diabetes, cancer Low hg concentration Increases the risk of cognitive impairment in the elderly, apparently with a stronger association in men than in women. Participants with the lowest Hb concentrations had a significant 37% higher risk (95% confidence interval [CI]: 1.08–1.75; p = 0.01) of being diagnosed with cognitive impairment.
Considering the gender separately, the risk of cognitive impairment only increased significantly, by 60%, for men in the lowest Hb tertile (95% CI: 1.06–2.41; p = 0.02), but not for women (hazard ratio = 1.32; 95% CI: 0.97–1.79; p = 0.08).
Dlugaja et al 2015 [69] 4033 participants from mandatory city registries in the Ruhr area in Germany, participant 45 to 75 years of age
Five years follow up
Anemia and mild cognitive impairment
verbal memory measured by a word list consisting of eight words from the Nuremberg Geriatric Inventory
Speed of processing/executive functioning was measured using the labyrinth test, a paper-pencil test from the NAI
For mild cognitive impairment diagnosis: Participants were asked if their cognitive performance changed during the past two years, then statistical manual of mental disorders,
WHO criteria hemoglobin level < 13 g/dl in men and < 12 g/dl in women Age, gender, BMI, education, diabetes, blood pressure hypertension, stroke, cancer, depression scale, smoking status, total cholesterol Anemic participants showed lower performances in verbal memory and executive functions Adjusted Odds ratios (OR) for mild cognitive impairment (MCI), amnestic- MCI, and non-amnestic-MCI in anemic versus non-anemic participants were 1.92 (95%-CI, 1.09–3.39), 1.96 (1.00–3.87), and 1.88 (0.91–3.87).
Payne et al 2018 [13] 4499 men and women aged 40 and over cross-sectional data from a population-based study of rural South African men and women physical and cognitive performance Grip strength was measured twice in both hands, using a Smedley digital dynamometer (12–0286).
Walk speed was measured by asking participants to walk a 2.5 m course twice, with the time taken timed to the nearest 0.1 s.
Cognitive performance was assessed with a cognitive battery adapted for language, cultural, and educational appropriateness from validated measures used in the U.S. Health and Retirement Study.
Hg concentration < 12 g/dL for women and < 13 g/dL for men Age, sex, education, Median C reactive protein concentration, HIV, hypertension, diabetes mellitus, mean body mass index, and self-reported angina, chronic bronchitis, and stroke There was no association between hemoglobin levels and walk speed or cognitive score
Hemoglobin concentration Was independently associated With grip strength
Hemoglobin concentration Was independently associated With grip strength in women when covariates were included in the model (B = 0.391; 95% CI 0.177 to 0.605), but this association was not statistically significant in men (B = 0.266; 95% CI − 0.019 to 0.552
Qin et al 2019 [75] 9324 adults aged 45 years or older from the China Health and Retirement Longitudinal Study Cohort
Association between Anemia and cognitive decline among Chinese middle-aged and elderly
Cognitive performance assessed by memory recall (episodic memory), mental status (TICS), and global cognitive function at baseline survey WHO criteria hemoglobin level < 13 g/dl in men and < 12 g/dl in women Age, gender, education, marital status, cigarette, smoking, body mass index, hypertension, diabetes, abdominal adiposity, chronic pain, dyslipidemia, CRP, HDL, and cholesterol This study found a cross-sectional and longitudinal association between Anemia and accelerated decline in cognitive functions in Chinese middle-aged and elderly
The hemoglobin concentration Was associated with global cognitive function global -cognitive function and episodic- memory was associated with anemia independent of covariates
After adjusting for socio-demographic and health-related covariates, the cross-sectional association between anemia and global cognitive function [β (95%CI) = − 0.49(− 0.69 ~ − 0.29)], episodic memory [β (95%CI) = − 0.14(− 0.23 ~ − 0.05)], and TICS [β (95%CI) = − 0.23(− 0.38 ~ − 0.08)] were significant and did not differ by gender.
Joosten Et al 2016 [38] 220 patients aged 70 years and older Prospective study
The relationship Between Anemia and handgrip and walking speed
Handgrip strength was assessed with a hydraulic hand dynamometer. Gait speed (in meters per second) was calculated after a 4.5 m walk ADL score WHO criteria hemoglobin level < 13 g/dl in men and < 12 g/dl in women Sex, age, BMI, ADL, CRP, GFR, MMSE mean, cancer, gastrointestinal diseases, −Neuropsychiatric diseases, Falls-fractures-osteoporosis Handgrip, ADL score, and gait speed were not significantly different in anemic and non-anemic person No significant correlation was found between the hemoglobin values and the hand-grip strength (Spearman’s rho 0.112, p = 0.1) and walking speed (Spearman’s rho 0.04, p = 0.69)
Hong- bae et al 2019 [70]. 16 observational studies, including eight case-control studies and eight cohort studies, were included in the final analysis In total, 16,765 cognitive impairment cases were surveyed in the meta-analysis. Meta-Analyzed Studies reporting a relationship between Anemia and cognitive impairment from 1964 to July 10, 2019 cognitive impairment in four articles was diagnosed using a cut-off score of 24 on the MMSE, and one article used the International Working Group (IWS) criteria anemia was defined according to the WHO criteria of hemoglobin level < 13 g/dl in men and < 12 g/dl in women gender, mean age, duration of follow-up in cohort studies, number of participants, methodological quality, and studies that adjusted for education, cardiovascular risks, smoking status, apolipoprotein E carrier status, alcohol consumption, and physical activity were used in Sub-group meta-analyses According to this meta-analyzed, There is a relationship between Anemia and cognitive impairment Anemia was significantly linked to cognitive impairment (OR or RR 1.51; 95% CI: 1.32–1.73) in a random-effects meta-analysis
Valladã-o Júnior
et al 2020 [72]
13,624 participants (mean ages = 51.6 years±9) Cross-sectional study base on ELSA-Brazil Cohort scores for verbal learning, late recall, word recognition, a semantic verbal fluency test, and the Trail-Making Test, Part B (TMT-B) WHO criteria hemoglobin level < 13 g/dl in men and < 12 g/dl in women Education, race, monthly family income, excessive alcohol use, thyroid function, smoking status, hypertension, diabetes, dyslipidemia, body mass index, Antipsychotic, antiparkinsonian, or anticonvulsant drug use Hemoglobin levels were not associated with global cognitive scores, Global cognitive scores were similar between participants with and without anemia in adjusted models for the entire sample (b = − 0.004; 95% CI = –0.052, 0.044) or separately, for men (b = 0.047; 95% CI = –0.053, 0.146) and women (b = − 0.015; 95% CI = –0.070, 0.040)
Jiang et al 2020 [71] 4838 participants 65 years old and over Cross-sectional CognitivefunctionwasevaluatedusingtheMini-MentalStateExamination (MMSE) and neuropsychological test battery WHO criteria hemoglobin level < 13 g/dl in men and < 12 g/dl in women Demographic factors, lifestyle, and clinical condition Anemia was associated with cognitive performance There was no relationship between Anemia and dementia Anemia was associated with a multiple-adjusted odds ratio of 1.28 (95%CI:1.041.57) for MCI and 1.27 (95% CI: 0.87–1.85) for dementia, and a multiple-adjusted β coefficient of − 0.60 (95% CI: − 0.94 to − 0.27) for MMSE score
Brenda et al 2004 [37] 1156 participants aged 65 and older from CHIANTI Study (Italy) Used data from the Italian National Research Council of Aging ADL (6 item questioner)
IADL (8 items)
Walking speed: was defined as the best performance (time in seconds) of two 4-m walks.
Standing balance: participants were asked to stand with the feet side by side, a semi tandem position, and a full-tandem position.
Chair stand test: participants were asked to stand up from and sit down in a chair five times without using hands
World Health Organization (WHO) criteria hemoglobin level < 13 g/dl in men and < 12 g/dl in women Age, sex, BMI, smoke, MMSE, diabetes mellitus, myocardial infection, Angina pectoris, Peripheral artery disease, Congestive heart failure, stroke, cancer, lung disease, Gastric ulcer, Hospitalization in the past year, Creatinine, mg/dL Anemia is associated with disability, poorer physical performance, and lower muscle strength anemic persons had more disabilities (1.71 vs 1.04, P = 0.002) and poorer performance (8.8 vs 9.6, P = 0.003), than persons without Anemia.
Anemic persons also had significantly lower knee extensor strength (14.1vs 15.2 kg, P = 0.02) and lower handgrip strength (25.3vs27.1 kg, P = 0.04) than persons without Anemia
Hirani et al 2016 [39] 1705 Australian men aged 70 years old and over from the Concord Health and Ageing in Men Project
Five years follow up
Cross-sectional study, The relationship between HG levels, and sarcopenia, low muscle strength, functional and activities of daily living (ADL), and instrumental ADL (IADL) disabilities in older muscle strength was assessed by handgrip and participate divided in
grip strength less than 26.0 kg versus grip strength 26.0 kg and more.
Walking speed: was measure 4 mm speed. Participants with a walking speed of 0.8 m/s or less were classified as having low walking speed.
ADL: was assessed by seven items from a modified version of the Katz ADL scale
IADL: asks participants how much help they need to perform ten tasks considered necessary for independent living
World Health Organization (WHO) criteria Hb level less than 13 g/dL in men age, income, body mass index, measures of health, estimated glomerular function, inflammatory markers, and medication use Low hemoglobin concentration over time is associated with poor functional performance
for every 1 g/dL increase in Hb, there was a significant reduction in risk of sarcopenia, slow walking speed, poor grip strength, inability to perform chair stands, and ADL and IADL disabilities
there was a association between Hb and grip strength
β coefficient = 1.52, 95% CI = 1.27, 1.78 for unadjusted
β coefficient = 1.05, 95% CI = 0.80, 1.30 for age-adjusted
and β coefficient = 0.82; 95% CI = 0.55, 1.08, for multivariate-adjusted
for walking speed:
β coefficient = 0.03, 95% CI = 0.02, 0.03; for unadjusted
β coefficient = 0.01, 95% CI = 0.01, 0.02; for age-adjusted
and β coefficient = 0.01, 95% CI = 0.004, 0.02,, for multivariate-adjusted.
Thein et al 2009 [45] 328 participants 65 years and older Cross-sectional study
To determine the relationship between HG concentration and functional status, depression, disability, and physical strength, independent of chronic disease
IADL (consists of 13 questions)
Handgrip strength: with a handheld dynamometer (in kg), using the mean value after performing the task three times
WHO criteria hemoglobin level < 13 g/dl in men and < 12 g/dl in women Age, sex, diabetes, hypertension, chronic inflammation, or rheumatoid arthritis There was a significant association of Anemia with declines in health-related quality of life, functional status, and physical strength Anemia was associated with greater fatigue (P < 0.001), lower handgrip strength (P = 0.014), and increased number of disabilities (P = 0.005)