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Background: To explore activity behaviors at school entry, we describe temporal/demographic associations with accelerometer-measured physical activity in a population-based sample of British 6-year-olds, and examine change from ages 4 to 6. Methods: A total of 712 six-year-olds (308 at both ages) wore Actiheart accelerometers for ≥3 (mean 6.0) days. We derived minutes per day sedentary (<20 cpm) and moderate to vigorous physical activity (MVPA, ≥460 cpm), also segmented across mornings (06:00 AM to 09:00 AM), school (09:00 AM to 3:00 PM), and evenings (3:00 PM to 11:00 PM). Using mixed effects linear regression, we analyzed associations between temporal/demographic factors and children's activity intensities at age 6, and change between ages 4 and 6. Results: Six-year-old children engaged in MVPA (mean [SD]): 64.9 (25.7) minutes per day (53% met UK guidelines). Girls did less MVPA than boys, particularly during school hours. Children were less active on weekends (vs weekdays) and more active on spring/summer evenings (vs winter). Longitudinally, 6-year-old children did less light physical activity (−43.0; 95% confidence interval, −47.5 to −38.4 min/d) but were more sedentary (29.4; 24.6 to 34.2), and engaged in greater MVPA (7.1; 5.2 to 9.1) compared to when they were aged 4. Conclusion: Half of 6-year-old children met current activity guidelines; MVPA levels were lower in girls and at weekends. UK children became more sedentary but did more MVPA as they entered formal schooling. Physical activity promotion efforts should capitalize on these changes in MVPA, to maintain positive habits. [ABSTRACT FROM AUTHOR]

There is increasing interest in modelling longitudinal dietary data and classifying individuals into subgroups (latent classes) who follow similar trajectories over time. These trajectories could identify population groups and time points amenable to dietary interventions. This paper aimed to provide a comparison and overview of two latent class methods: group-based trajectory modelling (GBTM) and growth mixture modelling (GMM). Data from 2963 mother–child dyads from the longitudinal Southampton Women's Survey were analysed. Continuous diet quality indices (DQI) were derived using principal component analysis from interviewer-administered FFQ collected in mothers pre-pregnancy, at 11- and 34-week gestation, and in offspring at 6 and 12 months and 3, 6–7 and 8–9 years. A forward modelling approach from 1 to 6 classes was used to identify the optimal number of DQI latent classes. Models were assessed using the Akaike and Bayesian information criteria, probability of class assignment, ratio of the odds of correct classification, group membership and entropy. Both methods suggested that five classes were optimal, with a strong correlation (Spearman's = 0·98) between class assignment for the two methods. The dietary trajectories were categorised as stable with horizontal lines and were defined as poor (GMM = 4 % and GBTM = 5 %), poor-medium (23 %, 23 %), medium (39 %, 39 %), medium-better (27 %, 28 %) and best (7 %, 6 %). Both GBTM and GMM are suitable for identifying dietary trajectories. GBTM is recommended as it is computationally less intensive, but results could be confirmed using GMM. The stability of the diet quality trajectories from pre-pregnancy underlines the importance of promotion of dietary improvements from preconception onwards. [ABSTRACT FROM AUTHOR]

In the Maternal Vitamin D Osteoporosis Study (MAVIDOS) randomized trial, vitamin D supplementation in pregnancy did not lead to greater neonatal bone mass across the trial as a whole, but, in a prespecified secondary analysis by season of birth, led to greater neonatal bone mass among winter‐born babies. Demonstrating persistence of this effect into childhood would increase confidence in a long‐term benefit of this intervention. We investigated whether antenatal vitamin D supplementation increases offspring bone mineralization in early childhood in a prespecified, single‐center follow‐up of a double‐blinded, multicenter, randomized controlled clinical trial based in the UK (MAVIDOS). A total of 1123 women in early pregnancy with a baseline 25‐hydroxyvitamin D level 25–100 nmol/L from three research centers (2008–2014) were randomized to 1000 IU/d cholecalciferol or matched placebo from 14 weeks of gestation to delivery. Offspring born at the Southampton, UK research center were assessed at age 4 years (2013–2018). Anthropometry and dual‐energy X‐ray absorptiometry (DXA) were performed (yielding whole body less head [WBLH] bone mineral content [BMC], areal bone mineral density [aBMD], bone area [BA], and body composition). Of 723 children, 564 (78.0%) children attended the 4‐year visit, 452 of whom had a useable DXA. Maternal vitamin D supplementation led to greater WBLH aBMD in the children compared with placebo (mean [95% confidence interval {CI}]: supplemented group: 0.477 (95% CI, 0.472–0.481) g/cm2; placebo group: 0.470 (95% CI, 0.466–0.475) g/cm2, p = 0.048). Associations were consistent for BMC and lean mass, and in age‐ and sex‐adjusted models. Effects were observed across the whole cohort irrespective of season of birth. Maternal‐child interactions were observed, with a greater effect size among children with low milk intake and low levels of physical activity. Child weight, height, and body mass index (BMI) were similar by maternal randomization group. These findings suggest a sustained beneficial effect of maternal vitamin D supplementation in pregnancy on offspring aBMD at age 4 years, but will require replication in other trials. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research. [ABSTRACT FROM AUTHOR]

Background: Choline status has been positively associated with weight and fat mass in animal and human studies. As evidence examining maternal circulating choline concentrations and offspring body composition in human infants/children is lacking, we investigated this in two cohorts.Methods: Maternal choline concentrations were measured in the UK Southampton Women's Survey (SWS; serum, n = 985, 11 weeks' gestation) and Singapore Growing Up Towards healthy Outcomes (GUSTO); n = 955, 26-28 weeks' gestation) mother-offspring cohorts. Offspring anthropometry was measured at birth and up to age 5 years. Body fat mass was determined using dual-energy x-ray absorptiometry at birth and age 4 years for SWS; and using air-displacement plethysmography at birth and age 5 years for GUSTO. Linear-regression analyses were performed, adjusting for confounders.Results: In SWS, higher maternal choline concentrations were associated with higher neonatal total body fat mass {β = 0.60 standard deviation [SD]/5 µmol/L maternal choline [95% confidence interval (CI) 0.04-1.16]} and higher subscapular skinfold thickness [β = 0.55 mm/5 µmol/L (95% CI, 0.12-1.00)] at birth. In GUSTO, higher maternal choline concentrations were associated with higher neonatal body mass index-for-age z-score [β = 0.31 SD/5 µmol/L (0.10-0.51)] and higher triceps [β = 0.38 mm/5 µmol/L (95% CI, 0.11-0.65)] and subscapular skinfold thicknesses [β = 0.26 mm/5 µmol/L (95% CI, 0.01-0.50)] at birth. No consistent trends were observed between maternal choline and offspring gain in body mass index, skinfold thicknesses, abdominal circumference, weight, length/height and adiposity measures in later infancy and early childhood.Conclusion: Our study provides evidence that maternal circulating choline concentrations during pregnancy are positively associated with offspring BMI, skinfold thicknesses and adiposity at birth, but not with growth and adiposity through infancy and early childhood to the age of 5 years. [ABSTRACT FROM AUTHOR]

Background: The role of maternal 25-hydroxyvitamin D [25(OH)D] in fetal development is uncertain, and findings of observational studies have been inconsistent. Most studies have assessed 25(OH)D only one time during pregnancy, but to our knowledge, the tracking of an individual's 25(OH)D during pregnancy has not been assessed previously. Objective: We determined the tracking of serum 25(OH)D from early to late pregnancy and factors that influence this. Design: The Southampton Women's Survey is a prospective mother-offspring birth-cohort study. Lifestyle, diet, and 25(OH)D status were assessed at 11 and 34 wk of gestation. A Fourier transformation was used to model the seasonal variation in 25(OH)D for early and late pregnancy separately, and the difference between the measured and seasonally modeled 25(OH)D was calculated to generate a season-corrected 25(OH)D. Tracking was assessed with the use of the Pearson correlation coefficient, and multivariate linear regression was used to determine factors associated with the change in season-corrected 25(OH)D. Results: A total of 1753 women had 25(OH)D measured in both early and late pregnancy. There was a moderate correlation between season-corrected 25(OH)D measurements at 11 and 34 wk of gestation (r = 0.53, P, 0.0001; n = 1753). Vitamin D supplementation was the strongest predictor of tracking; in comparison with women who never used supplements, the discontinuation of supplementation after 11 wk was associated with a reduction in season-corrected 25(OH)D (β = 27.3 nmol/L; P, 0.001), whereas the commencement (β = 12.6 nmol/L; P, 0.001) or continuation (β = 6.6 nmol/L; P, 0.001) of supplementation was associated with increases in season-corrected 25(OH)D. Higher pregnancy weight gain was associated with a reduction in season-corrected 25(OH)D (β = 20.4 nmol µ L-1 µ kg-1; P = 0.015), whereas greater physical activity (β = 0.4 nmol/L per h/wk; P = 0.011) was associated with increases. Conclusions: There is a moderate tracking of 25(OH)D status through pregnancy; factors such as vitamin D supplementation, weight gain, and physical activity are associated with changes in season-corrected 25(OH)D from early to late gestation. These findings have implications for study designs and analyses and approaches to intervention studies and clinical care. [ABSTRACT FROM AUTHOR]

Background: Early life may be a "critical period" when appetite and regulation of energy balance are programmed, with lifelong consequences for obesity risk. Insight into the potential impact of modifying early-life risk factors on later obesity can be gained by evaluating their combined effects. Objective: The objective was to examine the relation between the number of early-life risk factors and obesity outcomes among children in a prospective birth cohort (Southampton Women's Survey). Design: Five risk factors were defined: maternal obesity [prepregnant body mass index (BMI; in kg/m²) .30], excess gestational weight gain (Institute of Medicine, 2009), smoking during pregnancy, low maternal vitamin D status (<64 nmol/L), and short duration of breastfeeding (none or <1 mo). Obesity outcomes examined when the children were aged 4 and 6 y were BMI, dual-energy X-ray absorptiometry-assessed fat mass, overweight, or obesity (International Obesity Task Force). Data were available for 991 mother-child pairs, with children born between 1998 and 2003. Results: Of the children, 148 (15%) had no early-life risk factors, 330 (33%) had 1, 296 (30%) had 2, 160 (16%) had 3, and 57 (6%) had 4 or 5. At both 4 and 6 y, there were positive graded associations between number of early-life risk factors and each obesity outcome (all P < 0.001). After taking account of confounders, the relative risk P of being overweight or obese for children who had 4 or 5 risk factors was 3.99 (95% CI: 1.83, 8.67) at 4 y and 4.65 (95% CI: 2.29, 9.43) at 6 y compared with children who had none (both P < 0.001). P Conclusions: Having a greater number of early-life risk factors was associated with large differences in adiposity and risk of overweight and obesity in later childhood. These findings suggest that early intervention to change these modifiable risk factors could make a significant contribution to the prevention of childhood obesity. [ABSTRACT FROM AUTHOR]

Background: Maternal hyperglycemia in pregnancy is associated with greater adiposity in offspring. The glycemic index (GI) and glycemic load (GL) describe the glycemic response to carbohydrate ingestion. However, the influence of maternal dietary GI and GL in pregnancy on childhood adiposity is unknown. Objective: We examined relations of maternal dietary GI and GL in early and late pregnancy with offspring body composition. Design: A total of 906 mother-child pairs from the prospective cohort the Southampton Women's Survey were included. Children underwent dual-energy X-ray absorptiometry measurements of body composition at birth and 4 and 6 y of age. Log-transformed fat mass and lean mass were standardized with a mean (±SD) of 0 ± 1. Maternal dietary GI and GL were assessed at 11 and 34 wk of gestation by using an administered food-frequency questionnaire. Results: After control for potential confounders, both maternal dietary GI and GL in early pregnancy were positively associated with fat mass at 4 and 6 y of age [fat mass SDs per 10-unit GI increase: β = 0.43 (95% CI: 0.06, 0.80), P = 0.02 at 4 y of age; β = 0.40 (95% CI: 0.10, 0.70), P = 0.01 at 6 y of age; fat mass SDs per 50-unit GL increase: β = 0.43 (95% CI: 0.19, 0.67), P < 0.001 at 4 y of age; β = 0.27 (95% CI: 0.07, 0.47), P = 0.007 at 6 y of age]. In contrast, there were no associations between maternal dietary GI or GL in late pregnancy and offspring fat mass at these ages. Maternal dietary GI and GL were not associated with fat mass at birth or offspring lean mass at any of the ages studied. Conclusion: Higher maternal dietary GI and GL in early pregnancy are associated with greater adiposity in childhood. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate the use of an administered eighty-item FFQ to assess nutrient intake and diet quality in 3-year-old children.DesignFrequency of consumption and portion size of the foods listed on the FFQ during the 3 months preceding the interview were reported by the child's main caregiver; after the interview a 2 d prospective food diary (FD) was completed on behalf of the child. Nutrient intakes from the FFQ and FD were estimated using UK food composition data. Diet quality was assessed from the FFQ and FD according to the child's scores for a principal component analysis-defined dietary pattern (‘prudent’ pattern), characterised by high consumption of fruit, vegetables, water and wholemeal cereals.SettingSouthampton, UK.SubjectsChildren (n 892) aged 3 years in the Southampton Women's Survey.ResultsIntakes of all nutrients assessed by the FFQ were higher than FD estimates, but there was reasonable agreement in terms of ranking of children (range of Spearman rank correlations for energy-adjusted nutrient intakes, rs = 0·41 to 0·59). Prudent diet scores estimated from the FFQ and FD were highly correlated (r = 0·72). Some family and child characteristics appeared to influence the ability of the FFQ to rank children, most notably the number of child's meals eaten away from home.ConclusionsThe FFQ provides useful information to allow ranking of children at this age with respect to nutrient intake and quality of diet, but may overestimate absolute intakes. Dietary studies of young children need to consider family and child characteristics that may impact on reporting error associated with an FFQ. [ABSTRACT FROM PUBLISHER]

Background Little is known about preschool-aged children's levels of physical activity (PA) over the course of the day. Using time-stamped data, we describe the levels and patterns of PA in a population-based sample of four-year-old British children. Methods Within the Southampton Women's Survey the PA levels of 593 4-year-old children (51% female) were measured using (Actiheart) accelerometry for up to 7 days. Three outcome measures: minutes spent sedentary (<20 cpm); in light (LPA:≥20 - 399 cpm) and in moderate-to-vigorous activity (MVPA:≥400 cpm) were derived. Average daily activity levels were calculated and then segmented across the day (morning, afternoon and evening). MVPA was log-transformed. Two-level random intercept models were used to analyse associations between activity level and temporal and demographic factors. Results Children were active for 67% (mean 568.5 SD 79.5 minutes) of their daily registered time on average, with 88% of active time spent in LPA. All children met current UK guidelines of 180 minutes of daily activity. There were no differences in children's average daily levels of sedentary activity and LPA by temporal and demographic factors: differences did emerge when activity was segmented across the day. Sex differences were largest in the morning, with girls being more sedentary, spending fewer minutes in LPA and 18% less time in MVPA than boys. Children were more sedentary and less active (LPA and MVPA) in the morning if they attended childcare full-time compared to part-time, and on weekend mornings compared to weekdays. The reverse was true for weekend afternoons and evenings. Children with more educated mothers were less active in the evenings. Children were less sedentary and did more MVPA on summer evenings compared to winter evenings. Conclusions Preschool-aged children meet current physical activity guidelines, but with the majority of their active time spent in LPA, investigation of the importance of activity intensity in younger children is needed. Activity levels over the day differed by demographic and temporal factors, highlighting the need to consider temporality in future interventions. Increasing girls' morning activity and providing opportunities for daytime activity in winter months may be worthwhile. [ABSTRACT FROM AUTHOR]

Background: Detailed associations between physical activity (PA) subcomponents, sedentary time, and body composition in preschoolers remain unclear. Objective: We examined the magnitude of associations between objectively measured PA subcomponents and sedentary time with body composition in 4-y-old children. Design: We conducted a cross-sectional study in 398 preschool children recruited from the Southampton Women's Survey. PA was measured by using accelerometry, and body composition was measured by using dual-energy X-ray absorptiometry. Associations between light physical activity, moderate physical activity (MPA), vigorous physical activity (VPA), and moderate-to-vigorous physical activity (MVPA) intensity; sedentary time; and body composition were analyzed by using repeated-measures linear regression with adjustment for age, sex, birth weight, maternal education, maternal BMI, smoking during pregnancy, and sleep duration. Sedentary time and PA were also mutually adjusted for one another to determine whether they were independently related to adiposity. Results: VPA was the only intensity of PA to exhibit strong inverse associations with both total adiposity [P < 0.001 for percentage of body fat and fat mass index (FMI)] and abdominal adiposity (P = 0.002 for trunk FMI). MVPA was inversely associated with total adiposity (P = 0.018 for percentage of body fat; P = 0.022 for FMI) but only because of the contribution of VPA, because MPA was unrelated to fatness (P ≥ 0.077). No associations were shown between-the lime spent sedentary and body composition (P ≥ 0.11). Conclusions: In preschoolers, the time spent in VPA is strongly and independently associated with lower adiposity. In contrast, the time spent sedentary and in low-to-moderate-intensity PA was unrelated to adiposity. These results indicate that efforts to challenge pediatric obesity may benefit from prioritizing VPA. [ABSTRACT FROM AUTHOR]

Background: Low vitamin D status has been linked to adiposity, but little is known of the effects of low status in pregnancy on offspring body composition. Objective: The objective was to determine how maternal vitamin D status relates to lean and fat mass of the offspring. Design: The offspring of 977 pregnant women, who had serum 25-hydroxyvitamin D [25(OH)D] measured at 34 wk gestation, were followed up within 3 wk of birth and at 4 and 6 y of age for dual- energy X-ray absorptiometry assessment of lean and fat mass. Results: The median maternal serum 25(OH)D concentration was 62 nmol/L (IQR: 43-89 nmol/L); 35% of the women studied had values <50 nmol/L. Lower vitamin D status was associated with lower fat mass in the offspring at birth but with greater fat mass at ages 4 and 6 y. It was not associated with lean mass at any of the ages studied. The opposing associations seen between maternal 25(OH)D (SDs) and fat mass (SDs) in the offspring at birth and at age 6 y were robust to adjustment for a range of confounding factors, including maternal BMI and weight gain in pregnancy [ß (95% CI): 0.08 (0.02, 0.15) and -0.10 (-0.17, -0.02), respectively]. The key independent predictors of higher maternal vitamin D status were season of assessment and use of vitamin D supplements. Conclusions: Lower maternal vitamin D status may be linked to programmed differences in offspring fat mass. The findings require replication but add to a growing evidence base for a role of vitamin D in the origins of adiposity. Am J Clin Nutr 2012;96:57-63. [ABSTRACT FROM AUTHOR]

A number of studies in developed countries suggest that breastfeeding protects against infections in infancy. However, the choice to breastfeed is often related to maternal characteristics, and many of these studies are limited in the extent to which they can take account of confounding influences. In a prospective birth cohort study, we assessed the relationship between the duration of breastfeeding and the prevalence of lower respiratory tract infections, ear infections and gastrointestinal morbidity during the first year of life in 1764 infants. We considered the duration of all breastfeeding, including mixed feeding. Eighty-one per cent of the infants were breastfed initially, and 25% were breastfed up to 6 months. There were graded decreases in the prevalence of respiratory and gastrointestinal symptoms between birth and 6 months as breastfeeding duration increased; these were robust to adjustment for a number of confounding factors. The adjusted relative risks (95% confidence interval) for infants breastfed for six or more months compared with infants who were never breastfed were 0.72 (0.58-0.89), 0.43 (0.30-0.61) and 0.60 (0.39-0.92) for general respiratory morbidity, diarrhoea and vomiting, respectively. Duration of breastfeeding in the second half of infancy was less strongly related to diagnosed respiratory tract infections and gastrointestinal morbidity, although important benefits of breastfeeding were still seen. Our data provide strong support for a protective role of breastfeeding against respiratory and gastrointestinal infections in infancy. The graded inverse associations with breastfeeding duration suggest that current efforts to promote breastfeeding and increase duration will have important effects in reducing morbidity in infancy. [ABSTRACT FROM AUTHOR]

Medical research has a long history in the United Kingdom and has generally enjoyed good public support. Researchers take confidentiality seriously and few breaches have been recorded. Concerns over research practices at Alder Hey hospital related to consent rather than confidentiality,1 but they tarnished the overall reputation of research. At much the same time, the Data Protection Act 1998 defined stricter criteria for handling personal data,2 supplementing the provisions in the UK common law of confidentiality. There is thus a legal and a moral impetus to ensure that research is conducted with the maximum respect for participants and their privacy, even if the research is not linked to clinical care. Many questions can be answered without the active participation of individuals, but researchers must strike a careful balance between their pursuit of health improvements for all and their obligation to maintain the privacy of individuals participating in research. [ABSTRACT FROM AUTHOR]

Experiences of nausea and/or vomiting in pregnancy (NVP) vary greatly, but the paucity of studies with pre-pregnancy dietary data mean that little is known about the effects of NVP on diet. Using an administered food frequency questionnaire, diet was assessed before pregnancy and at 11 and 34 weeks' gestation in 2270 participants in a UK birth cohort study (Southampton Women's Survey). Experience of NVP in early pregnancy was graded as none, mild, moderate, or severe. Participants reported their level of food consumption as more, the same, or less than before pregnancy. 'Prudent' diet scores (derived using principal component analysis) were used to describe participants' diet quality before, in early and late pregnancy. In early pregnancy, 89% of women were nauseous, although most commonly, the NVP experienced was mild (48%) or moderate (30%); 11% had severe NVP. A total of 39% of women reported an increase in their level of food intake in early pregnancy; 34% reported a reduction. Increasing severity of nausea was associated with changes in intake of a range of foods, most notably reduced consumption of vegetables, tea/coffee, rice/pasta, breakfast cereals, beans/pulses and citrus fruits/fruit juices and increased consumption of white bread, and soft drinks. Increasing severity of nausea was also associated with decreasing prudent diet score from before to early pregnancy, such that women with severe nausea had prudent diet scores 0.29 SDs lower than those with no nausea ( P < 0.001). However, this was transient as NVP was not related to change in diet quality from before to late pregnancy. [ABSTRACT FROM AUTHOR]

Optimum nutrition and weight before and during pregnancy are associated with a lower risk of conditions such as pre-eclampsia and gestational diabetes. There is a lack of user-friendly tools in most clinical settings to support healthcare practitioners (HCPs) in implementing them. This study aimed to evaluate the acceptability of (1) using a nutrition checklist designed by the International Federation of Gynecology and Obstetrics (FIGO) for nutritional screening of women in the preconception and early pregnancy period and (2) routine discussion of nutrition and weight in clinical care. An online cross-sectional survey was conducted with women (aged 18-45) and HCPs (e.g., general practitioners, obstetricians, and midwives). Quantitative statistical analysis and qualitative content analysis were performed. The concept and content of the checklist were acceptable to women ( n = 251) and HCPs ( n = 47) (over 80% in both groups). Several barriers exist to implementation such as lack of time, training for HCPs, and the need for sensitive and non-stigmatizing communication. Routine discussion of nutrition was considered important by both groups; however, results suggest that nutrition is not regularly discussed in perinatal visits in the UK. The FIGO nutrition checklist presents a valuable resource for use in clinical practice, offering long-term and intergenerational benefits for both mother and baby.

Introduction: Epidemiological studies have shown that weaker grip strength in later life is associated with disability, morbidity, and mortality. Grip strength is a key component of the sarcopenia and frailty phenotypes and yet it is unclear how individual measurements should be interpreted. Our objective was to produce cross-sectional centile values for grip strength across the life course. A secondary objective was to examine the impact of different aspects of measurement protocol., Methods: We combined 60,803 observations from 49,964 participants (26,687 female) of 12 general population studies in Great Britain. We produced centile curves for ages 4 to 90 and investigated the prevalence of weak grip, defined as strength at least 2.5 SDs below the gender-specific peak mean. We carried out a series of sensitivity analyses to assess the impact of dynamometer type and measurement position (seated or standing)., Results: Our results suggested three overall periods: an increase to peak in early adult life, maintenance through to midlife, and decline from midlife onwards. Males were on average stronger than females from adolescence onwards: males' peak median grip was 51 kg between ages 29 and 39, compared to 31 kg in females between ages 26 and 42. Weak grip strength, defined as strength at least 2.5 SDs below the gender-specific peak mean, increased sharply with age, reaching a prevalence of 23% in males and 27% in females by age 80. Sensitivity analyses suggested our findings were robust to differences in dynamometer type and measurement position., Conclusion: This is the first study to provide normative data for grip strength across the life course. These centile values have the potential to inform the clinical assessment of grip strength which is recognised as an important part of the identification of people with sarcopenia and frailty.