The impact of Upper Gastrointestinal Disorders on Frailty: Insights from the Baltimore Longitudinal Study of Aging

BACKGROUND: Upper gastrointestinal (GI) disorders-including gastroesophageal reflux disorder, peptic ulcer disease, and gastritis-are common with aging, yet their contribution to frailty burden and progression is poorly understood. This study investigated whether upper GI disorders are independently associated with frailty in the Baltimore Longitudinal Study of Aging. METHODS: We analyzed data from 1,353 participants (mean age 65.6 years; 47.7% men) with documented upper GI disorder status and frailty index (FI). Cross-sectional associations were examined using linear regression adjusted for age, sex, race, education, body mass index, and smoking. Longitudinal trajectories of FI were analyzed in a subset with ≥3 follow-up visits (n = 749) using linear mixed-effects models. Sensitivity analyses were conducted after excluding participants whose diagnosis occurred more than one year before FI assessment and for older adults. RESULTS: Upper GI disorders were significantly associated with higher frailty burden in cross-sectional analyses(β = 0.0303, p = 1.13 × 10-11). Older age, higher body mass index, and lower educational attainment were also associated with higher FI. Longitudinal analyses further demonstrated that upper GI disorders were a significant predictor of FI throughout the follow-up period(β = 0.018, p = 4.3 × 10-9). However, the rate of frailty progression did not differ significantly between participants with and without GI disorders. Associations remained robust in all sensitivity analyses. CONCLUSIONS: Upper GI disorders were associated with higher frailty burden and greater degree of frailty that persisted over time, independent of covariates. Further research may be needed to explore the specific mechanisms through which upper GI disorders influence frailty.