Health and Aging: Unifying Concepts, Scores, Biomarkers and Pathways
Georg Fuellen1,*, Ludger Jansen2,*, Alan A Cohen3, Walter Luyten4, Manfred Gogol5, Andreas Simm6, Nadine Saul7, Francesca Cirulli8, Alessandra Berry8, Peter Antal9,10, Rüdiger Köhling11, Brecht Wouters12, Steffen Möller1
1Rostock University Medical Center, Institute for Biostatistics and Informatics in Medicine and Aging Research (IBIMA), Rostock, Germany. 2Institute of Philosophy, University of Rostock, Germany. 3Department of Family Medicine, University of Sherbrooke, Sherbrooke, Canada. 4KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium. 5Institute of Gerontology, University Heidelberg, Germany. 6Department of Cardiac Surgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. 7Humboldt-University of Berlin, Institute of Biology, Berlin, Germany. 8Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Italy. 9Budapest University of Technology and Economics, Budapest, Hungary. 10Abiomics Europe Ltd., Hungary. 11Rostock University Medical Center, Institute for Physiology, Rostock, Germany. 12KU Leuven, Department of Biology, Leuven, Belgium
Despite increasing research efforts, there is a lack of consensus on defining aging or health. To understand the underlying processes, and to foster the development of targeted interventions towards increasing one’s health, there is an urgent need to find a broadly acceptable and useful definition of health, based on a list of (molecular) features; to operationalize features of health so that it can be measured; to identify predictive biomarkers and (molecular) pathways of health; and to suggest interventions, such as nutrition and exercise, targeted at putative causal pathways and processes. Based on a survey of the literature, we propose to define health as a state of an individual characterized by the core features of physiological, cognitive, physical and reproductive function, and a lack of disease. We further define aging as the aggregate of all processes in an individual that reduce its wellbeing, that is, its health or survival or both. We define biomarkers of health by their attribute of predicting future health better than chronological age. We define healthspan pathways as molecular features of health that relate to each other by belonging to the same molecular pathway. Our conceptual framework may integrate diverse operationalizations of health and guide precision prevention efforts.
physical & cognitive function (=strength and cognition)
(motor) balance, dexterity
physical function (=strength)
cf. [18, 20, 42, 43]
cf. [20, 44, 45]
[18, 22, 46, 47]
gait speed, chair rising
cf. [20, 48, 49]
cognitive function (=cognition)
cf. [20, 50-52]
(short-term) memory, processing speed
sleep, cardiac rhythm
cf. [20, 57]
number of offspring
lack of frailty, Healthy Aging Index (and similar), allostatic load; lack of physiological dysregulation, self-reported health, quality of life
(prodromal) organ/physiological function (heart/cardiovascular, neurological, etc.) (prodromal) paralysis, protein aggregation/plaques
cf. [20, 75, 76]
lack of disease and medications
e.g., [77, 78]
Table 2 Features contributing to a definition of health.
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