AIM:Dynapenia-loss of muscle strength despite preserved muscle mass-is a clinical concern linked to functional decline in older adults. Diabetes may contribute to dynapenia; however, few studies have examined whether this association varies by sex and age. Clarifying these differences may help inform targeted prevention strategies. This study investigated the association between diabetes and dynapenia in community-dwelling older adults in Japan, focusing on sex- and age-specific differences. METHODS:We conducted a cross-sectional analysis using pooled data from four geriatric cohorts in Japan. Participants were classified into three groups: (1) established diabetes (treatment or HbA1c ≥ 6.5%), (2) prediabetes (HbA1c 5.7%-6.4%, no treatment), and (3) non-diabetes (HbA1c < 5.7%, no treatment). Dynapenia was defined per Asian Working Group for Sarcopenia 2019 cutoffs as low grip strength with preserved muscle mass. Sex-stratified logistic regression examined the association between diabetes status and dynapenia, adjusting for age, body fat, comorbidities, lifestyle factors, and cohort. Analyses were also stratified by age group (65-74 and ≥ 75 years). RESULTS:Among 3085 participants (34.8% men; median age: 70 years), the prevalence of dynapenia was 13.0% in both sexes. In women, dynapenia prevalence increased with glycemic status; adjusted ORs were 1.32 (95% CI: 0.97-1.78) for prediabetes and 1.86 (1.27-2.71) for established diabetes. Stratified analyses showed significant associations in men aged 65-74 and women aged ≥ 75. CONCLUSIONS:Diabetes was associated with dynapenia, with distinct patterns by sex and age. Targeted strategies may be needed for younger-old men and older-old women with diabetes.

Background:Older adults often access traditional media, such as newspapers, magazines, television, and radio, for health information. However, compared with older adults without frailty, older adults with frailty experience greater declines in physical functions and mental health (including depressive symptoms), as well as social functioning, due to reduced interaction with others, which limits their access to these sources of information. Objective:This study aimed to identify the health information sources that are less accessible to participants with frailty than to those without frailty. Methods:A cross-sectional web-based survey was conducted among independent Japanese adults aged ≥75 years. We assessed frailty using the Questionnaire of Medical Checkup for Old-Old, with a score of ≥4 indicating frailty. Participants were asked whether they had accessed any health information source in the past year, including medical institutions, family members, friends or acquaintances, neighbors, government agencies, long-term care or welfare services, television, radio, the internet, magazines, newspapers, or books. The primary explanatory variable was frailty status. Covariates included age, sex, income, education, living arrangements, and health literacy, measured using the eHealth Literacy Scale. Results:In total, 1032 participants (n=518, 50.2% male; median age: 77 y) were analyzed. Multivariable logistic regression analysis revealed that participants with frailty had significantly less access to the following sources of information compared to individuals without frailty: family (odds ratio [OR] 0.69, 95% CI 0.50-0.95), friends/acquaintances (OR 0.70, 95% CI 0.51-0.98), radio (OR 0.50, 95% CI 0.31-0.79), and newspapers (OR 0.66, 95% CI 0.50-0.88). Sex-based subgroup analyses revealed no significant interaction effects, indicating no heterogeneity in the findings. Conclusions:Older adults with frailty were less likely to obtain health information from interpersonal and traditional media sources than did individuals without frailty. Health information providers need to devise strategies for delivering accurate information and improving usability to enable older adults with frailty to proactively access diverse health information.

INTRODUCTION:Sleep quality critically influences amyloid beta (Aβ) clearance, yet the specific role of morning wake transition duration remains unexplored. METHODS:This hypothesis-driven secondary analysis examined 97 cognitively unimpaired older adults (mean age ± SD: 74.4 ± 5.8 years) who underwent 14-day actigraphy and 18F-florbetapir positron emission tomography (PET). Cognitive function was evaluated using the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT). Time to wake up (TWU) was calculated as the midpoint between initial wake and final rise times. RESULTS:Binomial logistic regression models adjusted for age, depression, and sleep duration showed that extended TWU (>6.23 min) associated with higher Aβ positivity (27.1% vs 10.2%, odds ratio [OR] = 1.85, 95% confidence interval [CI]: 1.11-3.07, p = 0.019) and impaired word memory (OR = 2.17, 95% CI: 1.11-4.24, p = 0.023). Exploratory analyses of additional cognitive domains showed no significant associations. DISCUSSION:Prolonged morning wake transitions may represent a behavioral marker associated with Aβ accumulation and memory impairment. The cross-sectional design and modest sample size warrant cautious interpretation and replication in larger longitudinal cohorts.

AIM:Growth differentiation factor-15 (GDF-15) is a biomarker reflecting aging and cellular stress, associated with physical frailty and cognitive decline. We cross-sectionally examined whether physical frailty is involved in the association between GDF-15 and cognitive decline. Understanding this association may help to consider frailty-related cognitive decline and potential preventive approaches. METHODS:This cross-sectional study included 134 participants aged 65 years or older, excluding those with severe renal dysfunction, immune-related diseases, and those with dementia or suspected dementia (Mini-Mental State Examination [MMSE] score ≤ 23). Serum GDF-15 levels were measured, and cognitive decline was assessed using the MMSE with a cutoff score of 27 or lower. Physical frailty was evaluated using the revised Japanese Cardiovascular Health Study criteria comprising five components: shrinking, exhaustion, weakness, slowness, and low activity. RESULTS:A mediation analysis adjusted for age, sex, and education showed a significant indirect effect of GDF-15 on cognitive decline through physical frailty (β = 0.921, 95% confidence interval [CI]: 0.279-1.560). The total effect was also significant (β = 1.020, 95% CI: 0.030-2.010), whereas the direct effect was not significant (β = 0.100, 95% CI: -0.991 to 1.190). CONCLUSIONS:This study suggests a potential involvement of physical frailty in the relationship between serum GDF-15 levels and cognitive decline. Serum GDF-15 levels may have potential as a clinical indicator for frailty-related cognitive decline in the future. Further longitudinal studies are needed to explore this relationship and clarify the role of GDF-15.

To examine the association between meal irregularity and serum GDF-15 levels—a potential biomarker of biological aging—and to determine whether dietary quality mediates this association in community-dwelling older adults. Participants with irregular mealtimes were significantly younger than those with regular mealtimes, yet they exhibited higher serum GDF-15 levels and lower dietary quality. Mediation analysis indicated that poor dietary quality partially accounted for the association between mealtime irregularity and elevated GDF-15 levels. Improving dietary quality may be an important consideration for older adults with irregular mealtimes. This study examined the association between mealtime irregularity and Growth Differentiation Factor-15 (GDF-15)—a potential biomarker of biological aging—and evaluated whether this association could be explained by poor dietary quality among community-dwelling older adults. This cross-sectional study analyzed data from 378 disability-free adults aged ≥ 65 years from the Higashiura Study. Eating habits (regular vs. irregular) were assessed during the interviews. Dietary quality was evaluated using nutrient density scores from the Nutrient-Rich Food Index, calculated from 3-day dietary records. The association among mealtime irregularity, dietary quality, and serum GDF-15 levels was examined using mediation analysis after adjusting for age, sex, comorbidities, sleep duration, physical activity, smoking status, employment status, and total energy intake. Participants with irregular mealtimes were significantly younger than those with regular mealtimes (mean ± standard deviation: 73.3 ± 4.6 vs. 75.1 ± 5.6 years, p = 0.014) and had higher serum GDF-15 levels (least-squares means, 95

PURPOSE:Although the "weekend warrior (WW)" physical activity (PA) pattern has known health benefits, its association with sarcopenia is unclear. This study examined whether the WW PA pattern is associated with a lower likelihood of sarcopenia compared with the inactive and regularly active (RA) PA patterns. METHODS:This cross-sectional study included 28,918 participants. Individuals reporting ≥150 minutes per week of moderate PA, ≥75 minutes per week of vigorous PA, or ≥ 150 minutes per week of moderate to vigorous leisure-time PA were classified as "active." Within the active group, those exercising 1 to 2 days per week were categorized as WWs, and those exercising on ≥3 days per week were categorized as RA. Sarcopenia was defined as a sarcopenia index >2 SD below the sex-specific reference. RESULTS:In a logistic regression adjusted for all covariates, WWs had significantly lower odds of sarcopenia compared with both inactive (OR 0.16; 95% CI, 0.07-0.35) and RA individuals (OR 0.25; 95% CI, 0.11-0.56). RA participants also showed reduced odds compared with the inactive group (OR 0.64; 95% CI, 0.52-0.79). Regarding PA volume, the Kruskal-Wallis test indicated that RA participants participate in more moderate-intensity PA (RA 159.3 vs WW 125.3 min/wk), whereas WWs engaged in more vigorous-intensity PA (RA 32.4 vs WW 47.1 min/wk). CONCLUSIONS:The WW PA pattern was associated with a lower prevalence of sarcopenia compared with both inactive and RA individuals, suggesting that concentrated, infrequent but high-intensity activity may help reduce sarcopenia risk-particularly for those with limited time.

Introduction Although several systematic reviews and meta-analyses have demonstrated the benefits of exercise interventions in older adults with frailty, the potential harm associated with these interventions has not been systematically synthesised. This systematic review aims to examine the adverse events reported in exercise intervention trials involving older adults with frailty and to compare the risk of adverse events between the intervention and control groups.Methods and analysis Searches will be performed in four electronic databases (PubMed, Cochrane Library, Web of Science and SPORTDiscus) for published trials. Eligible studies will be randomised controlled trials of exercise interventions, including older adults with frailty aged ≥60 years, with frailty identified using a validated method. Five reviewers and three referees, all with expertise in exercise interventions, will be assigned to three independent review teams to ensure efficient screening. Reviewers will independently screen titles, abstracts and full texts using Rayyan, and then extract trial and adverse event data into an Excel spreadsheet. The risk of bias in eligible trials will be assessed using the Cochrane Risk of Bias 2 (RoB-2) tool. The referees will resolve any disagreements between the two reviewers throughout the screening, data extraction and risk-of-bias assessment processes. The primary outcome is adverse events, defined as any unfavourable, unintended signs, symptoms or disease that occurred during the study period. An independent biostatistician will perform a random-effects meta-analysis using a generalised linear mixed model with a binomial likelihood and a logit link to estimate the pooled risk ratios (RRs) for adverse events in the intervention group relative to the control group. Publication bias will be evaluated using funnel plots and Egger’s regression test. Depending on the number of available studies, subgroup analyses will be conducted to examine differences in RRs according to the study quality, duration of intervention, exercise frequency, setting and supervision.Ethics and dissemination Ethical approval was not required because we did not use specific patient data. The findings of the systematic review and meta-analysis will be disseminated through publication in a peer-reviewed journal and presentation at appropriate conferences.PROSPERO registration number CRD420251180645.

PURPOSE:Deficient muscle-specific strength has been recognized as a key component of sarcopenia. However, the impact of various interventions on muscle-specific strength has not been systematically reviewed. This study aims to provide a systematic summary of research examining the effects of exercise, nutrition, and other interventions on muscle-specific strength in older adults. METHODS:Randomized controlled trials (RCTs) were identified through comprehensive searches of major databases. Eligible studies included adults aged 60 years or older, with interventions lasting at least 8 weeks. Studies were required to assess muscle strength normalized by muscle mass. Standardized mean differences (SMDs) were calculated using random-effects meta-analyses, and heterogeneity was evaluated using I² statistics. RESULTS:A total of 41 RCTs with 3,141 participants were included in the analysis. Interventions included resistance exercise, nutritional supplementation, aerobic exercise, concurrent training, combined exercise and nutrition, caloric restriction, and other therapies. Resistance exercise significantly improved muscle-specific strength (SMD = 0.61, 95% confidence interval: 0.27 to 0.94), although heterogeneity was observed (I² = 81%). In contrast, interventions such as aerobic exercise, concurrent training, combined exercise and nutrition, and nutritional supplementation did not lead to significant improvements in muscle-specific strength. High heterogeneity was observed across all included studies. CONCLUSIONS:Resistance exercise is the most effective intervention for improving muscle-specific strength in older adults. The effects of other interventions, such as nutritional supplementation and aerobic exercise, remain inconclusive. Further well-designed RCTs exploring diverse exercise regimens and nutritional interventions are needed to confirm these findings and identify the most effective strategies for enhancing muscle-specific strength in older populations.

This preliminary study evaluated effect sizes of differences in circulating cell-free DNA (cfDNA) levels in blood and urine between older adults with and without sarcopenia. This was a subanalysis of the 2021 Itabashi Longitudinal Study on Aging. Twenty-four participants were selected conveniently and classified using the Asian Working Group for Sarcopenia (AWGS) 2019 criteria (sarcopenia, N = 12; non-sarcopenia, N = 10). Plasma and urinary cfDNA were quantified by real-time quantitative polymerase chain reaction (qPCR). cfDNA measures showed substantial inter-individual variability, and no clear between-group differences were observed. Plasma cfDNA demonstrated a moderate positive correlation with skeletal muscle mass index (r = 0.43, p = 0.03), but the clinical relevance remains uncertain given the small sample size. Larger, well-powered longitudinal studies are needed to clarify whether cfDNA, including mitochondrial and nuclear components, can serve as a biomarker of muscle health and sarcopenia risk in older adults.

ABSTRACT Aim Geriatric experts have long debated the inclusion of appendicular lean soft tissue mass (ALSTM) in the diagnostic criteria for sarcopenia. This study examined whether a diagnostic model for sarcopenia that excludes appendicular lean soft tissue mass (ALSTM) is equivalent to one that includes ALSTM in discriminating health‐related outcomes. Methods Community‐dwelling older adults from the Itabashi Longitudinal Study on Aging in Tokyo, Japan, were included. Based on the AWGS2019 criteria, we developed two diagnostic models: Model 1, including low handgrip strength/gait speed and low ALSTM assessed by bioelectrical impedance analysis, and Model 2, excluding low ALSTM. Health‐related outcomes were self‐reported falls and hospitalization in the past year. Differences in area under the receiver operating characteristic curve (AUC) and 95% confidence intervals (CI) between the two models were estimated using 1000 bootstrap samples. Results In total, 2432 participants (median age: 76 years; 53.2% men) without missing data were analyzed. Falls and hospitalization were reported by 17.8% and 15.3% of participants, respectively. The AUCs [95% CIs] of Models 1 and 2 were 0.61 [0.59, 0.64] and 0.61 [0.58, 0.64] for falls and 0.65 [0.62, 0.68] and 0.64 [0.61, 0.67] for hospitalization, respectively. The differences (Model 2—Model 1) in AUCs [95% CI] between the two models were −0.004 [−0.015, 0.006] for falls and −0.004 [−0.014, 0.004] for hospitalization, with the CIs within the pre‐specified equivalence margin (±0.05). Conclusions Diagnostic models excluding ALSTM demonstrated equivalent discrimination ability to those including ALSTM, raising questions about the necessity of ALSTM assessment for sarcopenia diagnosis.

AIM:The social isolation of older Japanese adults with infrequent contact with others diminishes appetite, reduces food intake, and worsens their nutritional status. However, there is insufficient evidence regarding the association between social isolation and nutritional status, with studies primarily confined to rural and suburban areas. This cross-sectional study aimed to investigate the association between social isolation and nutritional status among older adults residing in urban areas. METHODS:This cross-sectional analysis included 1,052 adults (mean age, 78 years). Nutritional status was assessed using the Mini Nutritional Assessment® Short Form, with a score of 11 or below indicating malnutrition. Applying the abbreviated Lubben Social Network Scale, a score < 12 was considered indicative of social isolation. Logistic regression was applied to the entire population, then the population was separated by sex, with social isolation as the independent variable and malnutrition as the dependent variable. The covariates included age, living alone, economic status, health, daily activities, smoking habits, drinking habits, and years of education. RESULTS:Social isolation was observed in 41.7% (n = 439) of the total population, while malnutrition was observed in 27.4% (n = 288). Social isolation was significantly associated with malnutrition (odds ratio: 1.41, 95% confidence interval: 1.06-1.88). Sex subgroup analyses revealed that a significant association was retained only among female participants. CONCLUSIONS:Social isolation has been associated with malnutrition among older urban adults in Japan. Future longitudinal studies of the nutritional status of socially isolated individuals are essential.

Background Physical activity (PA) has long been considered a key strategy in the management of sarcopenia. To our knowledge, this is the first study to examine domain-specific physical activity, including leisure-time and occupational activities, in relation to possible sarcopenia (PS) among middle-aged and older adults. Methods We analyzed a total of 15,819 adults aged ≥40 years. PS was defined on the basis of handgrip strength (males <28 kg and females <18 kg) according to the Asian Working Group for Sarcopenia. The Global Physical Activity Questionnaire was used to evaluate domain-specific PA, including weekly leisure-time or occupational moderate-to-vigorous PA (MVPA). MVPA was classified into three categories: no activity, 1–149 min/week, and ≥150 min/week. Parameters potentially related to PS or PA were included as covariates: age, sex, household income, education, medication, alcohol and smoking habits, nutritional status, and body weight. Results Compared with participants with no leisure-time MVPA, those with 1–149 min/week and ≥150 min/week of leisure-time MVPA had odds ratios (95% confidence intervals) of 0.64 (0.54, 0.74) and 0.60 (0.52, 0.68) for PS, respectively (p<0.001 for both). However, occupational MVPA was not significantly related to PS. Subgroup analyses stratified by sex, age, and sedentary time revealed no significant heterogeneity (all p-values for interactions >0.05). Conclusion These findings demonstrate that PS is inversely related to leisure-time PA but not to occupational PA among middle-aged and older adults, suggesting that PA programs that focus specifically on leisure-time activities may be necessary to prevent and manage possible sarcopenia.

Background Digital gait biomarkers (DGBs) from wrist-worn devices may offer a simple, convenient method for assessing frailty; however, their clinical validity has not been sufficiently verified. This study aimed to determine whether frailty assessed using DGBs is not inferior to the Fried frailty phenotype for predicting hospitalisation and mortality.Methods This longitudinal study included 10 156 adults (aged 43-81 years) with complete Fried frailty phenotype and DGB data from the UK Biobank. DGBs were extracted using validated algorithms on raw data from wrist-worn accelerometers over 7 days. DGB frailty was derived from DGBs and the Fried frailty phenotype.Results First hospitalisations and deaths were followed for 4.4 +/- 2.7 and 7.2 +/- 0.7 years, respectively. In these periods, 6148 (60.5%) were hospitalised (44 277 person-years follow-up) and 270 (2.7%) died (73 312 person-years follow-up). Cox proportional hazards models, adjusting for confounders, showed that both Fried and DGB frailties were predictive of hospitalisation (hazard ratios and 95% confidence intervals [CIs]: 1.29 [1.13-1.47] versus 1.33 [1.17-1.52]) and mortality (1.63 [1.01-2.62] versus 1.77 [1.14-2.74]). The mean differences (DGB frailty-Fried frailty) and 95% CIs in Harrell's C-index for hospitalisation and mortality were 0.000 [-0.002 to 0.001] and 0.002 [-0.004 to 0.009], respectively, with the lower limit of the 95% CIs exceeding the prespecified noninferiority margin (-0.1).Conclusion DGB-derived frailty predicted hospitalisation and mortality and was not inferior to the Fried frailty phenotype. These findings support the clinical validity and potential utility of wearable devices in the assessment of frailty in clinical practice.

AIM:Recently, some researchers have questioned the inclusion of muscle mass as a diagnostic criterion for sarcopenia. We examined the longitudinal association between the presence or absence of muscle mass assessment in sarcopenia diagnosis and the incidence of poor health outcomes. METHODS:This 1-year follow-up study included 730 Japanese outpatients aged ≥65 years without disabilities who visited the frailty clinic. The participants were classified into four groups: robust; low muscle mass only; low grip strength and/or physical function only; and low muscle mass with low grip strength and/or low physical function (sarcopenia) based on the Asian Working Group for Sarcopenia 2019 definition. Muscle mass was assessed using dual-energy X-ray absorptiometry and a bioelectrical impedance analysis. The outcome measure was poor health status, defined as experiencing one or more falls, nursing home admissions or hospitalizations. RESULTS:The multiple logistic regression analysis, adjusted for sex, age, body mass index, cognitive impairment, depressive symptoms, polypharmacy, multimorbidity, pre-orthopedic surgery, undergoing cancer treatment and stroke history, determined the odds ratios (95% confidence intervals) for outcomes with robust used as the reference group were: low muscle mass only 0.84 (0.52-1.35); low grip strength or physical function only 1.04 (0.71-1.53); and sarcopenia 2.00 (1.39-2.87). CONCLUSION:Only participants who had muscle weakness and/or reduced physical function in addition to muscle mass loss were associated with poor health outcome incidence. Excluding muscle mass assessment from the sarcopenia diagnosis might lead to missing a population that requires attention. Geriatr Gerontol Int 2025; 25: 553-559.

OBJECTIVES:To evaluate the response of skeletal muscle architecture (fascicle length and pennation angle) and composition (echo intensity) markers assessed by ultrasonography to intervention in older adults. DESIGN:This is a subsection of a more comprehensive systematic review of clinical trials focusing on changes in muscle quality, registered in PROSPERO (registration number: CRD42022357116). SETTING AND PARTICIPANTS:Randomized controlled trials evaluating the effectiveness of interventions lasting ≥8 weeks in adults aged ≥60 years on fascicle length, pennation angle, and echo intensity. METHODS:After the literature search, 6 peer reviewers and 1 decider conducted a 2-stage screening process, including studies that met the eligibility criteria. Random-effects modeling for Hedges' g was applied to a meta-analysis of studies with sufficient data. The risk of bias in the included studies was assessed using version 2 of the Cochrane Risk-of-Bias tool for randomized trials. RESULTS:In total, 4832 studies were initially searched, and 28 trials involving 1101 participants were included. Six trials were analyzed for fascicle length, 8 for pennation angle, and 8 for echo intensity. The standardized mean differences with 95% CIs, where a positive direction indicates improvement due to treatment, were fascicle length, -0.04 (-0.27 to 0.19); pennation angle, 0.08 (-0.02 to 0.18); and echo intensity, 0.00 (-0.02 to 0.02). No heterogeneity was observed for the outcomes (I2 = 0%). The Cochrane Risk-of-Bias tool showed that 78.6% of the trials had a high risk of bias. CONCLUSIONS AND IMPLICATIONS:Muscle architecture and composition markers assessed via ultrasound did not respond to the intervention. Further well-designed clinical trials are necessary to confirm the clinical validity of these markers.

BACKGROUND & AIMS:The appropriateness of metabolomics for identifying predictive markers preceding sarcopenia diagnosis remains unknown. We conducted a metabolomic analysis comparing older women who developed sarcopenia over a 5-year period with those who did not, with the aim of identifying serum metabolites associated with the development of sarcopenia. METHODS:This longitudinal nested case-control study comprised an independent cohort sample based on data collected as a baseline survey in 2017 and follow-up survey in 2022 in the Itabashi Ward of Tokyo, Japan. This study included 37 women without sarcopenia during the 2017 survey, who were diagnosed with sarcopenia in the 2022 survey, and 37 control participants without sarcopenia throughout both survey periods. Non-targeted metabolomics using gas chromatography-mass spectrometry (GC-MS) was performed on serum samples from all participants as of 2017. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria, which include low muscle mass and either low muscle strength or low physical function. RESULTS:GC-MS analysis showed that 2-aminoadipic acid, alanine, and leucine were significantly associated with sarcopenia development. Binomial logistic regression analysis showed that baseline 2-aminoadipic acid levels were significantly associated with the risk of reduced grip strength after 5 years, with a halving of its concentration increasing this risk by 1.6 times. There were no significant associations between other metabolites (alanine and leucine) and the skeletal muscle index, grip strength, or gait speed. CONCLUSION:Measuring 2-aminoadipic acid, alanine, and leucine levels may provide new insights into the pathophysiology of sarcopenia, and enhance early detection and prevention strategies.

Background: Metabolic acidosis caused by acidogenic diets increases muscle catabolism. High acidogenic diets can increase muscle loss in older adults; however, their association with functional outcomes remains unclear. Objectives: To investigate whether high acidogenic diets increase the incidence of disability. Design:Longitudinal study. Setting: Community-based. Participants: We included 1,704 community-dwelling Japanese individuals aged >= 75 years without disabilities at baseline (52.2 % females). Measurements: Baseline dietary acid load was assessed using potential renal acid load (PRAL) values, which reflect urinary acidity -with higher values indicating more acidogenic diets. The outcome measure was the one-year incidence of disability, defined as needing for long-term care or support based on certification by the Japanese long-term care insurance system. As the effects of PRAL are reportedly sex-specific, separate analyses were conducted for males and females. The participants were categorized into tertiles (T1-T3, with T1 as the reference) based on their PRAL values. Odds ratios (ORs) and 95 % confidence intervals (CIs) for outcome were calculated using multiple logistic regression analysis after adjusting for age, body mass index, living status, smoking status, hypertension, diabetes, dyslipidemia, energy intake, and alcohol intake. Results: The PRAL ranges in groups T1, T2, and T3 were: -64.51 to 0.21, 0.27 to 11.34, and 11.41 to 61.00, respectively, in males, and -61.22 to -3.84, -3.75 to 5.89, and 5.90 to 38.68, respectively, in females. Disabilities occurred in 44 (5.7 %) males and 71 (8.7 %) females. ORs (95 % CIs) for disability in T2 and T3 were 0.79 (0.35- 1.76) and 0.81 (0.37-1.79), respectively, in males and 1.10 (0.57-2.13) and 1.96 (1.06-3.61), respectively, in females. Conclusions: A high dietary acid load increased the incidence of disability in older females. Therefore, managing an acidogenic diet may help maintain daily living functions in older females. Future studies should investigate whether sex is an effect modifier.