Waist circumference as a predictor of disability among older adults

The association between body mass index, waist circumference and waist-to-hip-ratio with all-cause mortality in older adults: A systematic review

BACKGROUND & AIMS

The association between anthropometric obesity parameters and all-cause mortality in older adults is of significant interest due to the implications for public health and clinical practice. This systematic review aims to assess and synthesize the literature on the relationship between anthropometric obesity parameters, such as the body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), with all-cause mortality in older adults.

METHODS

This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO - CRD42024521886). A systematic search was conducted across five databases: PubMed, EMBASE, Web of Science, SCOPUS, and LILACS. The study included: (1) older adults (≥60 years); (2) an observational-longitudinal study design (prospective and retrospective cohorts); (3) different anthropometric methods for the diagnosis of obesity; and (4) all-cause mortality as an outcome. The National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies was employed to assess the methodological quality of the included studies.

RESULTS

A total of 38 studies were included. Most studies have investigated associations between BMI and all-cause mortality. Among them, 9 studies found no significant association, 25 reported a protective effect, 1 identified BMI as a risk factor, and 4 observed a U-shaped relationship. Regarding WC, the results were conflicting: 15 studies found no association with mortality, 8 identified WC as a risk factor, and 6 suggested a protective effect. As for WHR, although it was the least frequently assessed measure, 8 studies identified it as a risk factor for mortality in older adults, 4 found no significant association, and 1 reported an inverse relationship. These findings highlight discrepancies in the associations between obesity measures and mortality.

CONCLUSION

BMI appears to be inversely associated with mortality in older adults, while findings for WC remain controversial. WHR demonstrates a positive association with mortality, but further research is needed to confirm these findings. Clinicians should ensure that older patients do not remain at lower BMI thresholds, as higher BMI values appear protective, particularly in the presence of diseases. This recommendation should be made on an individualized basis, considering the individual's health status. Recommendations at the individual level should also consider functional status and body composition measurements. Moreover, WHR may provide additional insights into mortality risk beyond BMI, highlighting its importance for clinical practice. These findings support an integrative approach to monitoring both metrics to better inform preventative strategies and resource allocation for aging populations. Cut-off points for anthropometric measures of obesity should be reassessed and standardized for older adults.

Weight-adjusted waist index and disability: a cohort study from CHARLS

BACKGROUND

The association between weight-adjusted waist index (WWI) and disability is unclear. This study aimed to assess the relationship between WWI and disability in middle-aged and elderly Chinese individuals and provide more predictive indicators for disability prevention.

METHODS

In this study, 13,015 middle-aged and older adults aged 45 years and above who were surveyed in 2011 by the China Health and Aging Tracking Survey (CHARLS) database were selected, and 8344 respondents with complete data were included for cohort analysis after seven years of follow-up. Information on clinical demographic characteristics, anthropometric indices, assessment of disability, and related covariates were collected, and the presence or absence of disability was assessed by the disability scale. WWI was calculated by dividing the waist circumference (cm) by the square root of the body weight (kg). Cox proportional hazards model was used to analyze the association between WWI and disability after follow-up.

RESULTS

Our study found that 2912 of 8344 participants had disability after seven years of follow-up, and disability incidence was approximately 34.9%. Age, sex, place of residence, chronic disease, depression, waist circumference, and WWI were significantly associated with disability in univariate analysis. Among them, there was a positive association between WWI as a continuous variable and incidence of disability (hazard ratio (HR) = 1.26, 95% CI: 1.22-1.31, p < 0.001). WWI was transformed into categorical variables using quartiles as cutoffs for disability regression analysis. After adjusting covariates, HR values in the 2nd, 3rd and 4th quantile showed an increasing trend compared with the 1st quantile, and the risk of disability among WWI subjects in the 4th quantile increased by 43% (95% CI: 1.24-1.64). P values for the trend test in the model were all < 0.001. In subgroup analyses, the positive association between WWI and risk of disability remained robust for sex, age, alcohol consumption, smoking status, education level, marital status, and place of residence after adjusting for all covariates considered in this study.

CONCLUSIONS

WWI is a new and reliable obesity-related indicator that can be used for disability prevention. WWI can be detected and controlled for reducing the risk of disability.

Muscle Mass Adjusted by Body Height is not Correlated with Mobility of Middle-Aged and Older Adults

Background

Low muscle mass and obesity are associated with mobility disability, cardiometabolic diseases, and loss of independence. Three skeletal muscle indices (SMIs) are proposed to adjust the body size of individuals. However, it is unknown which index is better correlated with mobility. Additionally, it remains unclear whether low muscle mass or abdominal obesity has a greater impact on the mobility and cardiometabolic health of older adults.

Objectives

This study explored the association between different SMIs {appendicular skeletal muscle mass [ASM] adjusted by body height [Ht], body weight [Wt], or body mass index [BMI (kg/m2)]} and mobility/cardiometabolic health. The roles of low muscle mass and abdominal obesity in the mobility and cardiometabolic health of individuals were also identified.

Methods

Four-hundred and twenty-seven community-dwelling middle-aged and older adults underwent body composition assessments [dual-energy x-ray absorptiometry and waist circumference (WC)], grip strength, and mobility (timed up-and-go test and chair stand test). Spearman's rank correlation coefficient and regression models were used to examine research questions. This study was registered in the Thai Clinical Trials Registry (registration number: TCTR20210521007).

Results

All SMIs were positively correlated with the grip strength (ASM/Ht2: r = 0.392; ASM/Wt: r = 0.439; ASM/BMI: r = 0.569). Regarding mobility, only ASM/Ht2 wasn't relevant. After adjusting for age, sex, and WC, ASM/BMI was the only SMI associated with grip strength (β = 0.274). When age and sex were controlled, WC, but not SMI, was associated with mobility and cardiometabolic health.

Conclusions

ASM/Ht2 did not correlate with mobility in middle-aged and older adults, whereas ASM/Wt and ASM/BMI did. Abdominal obesity has a greater impact on mobility and cardiometabolic health than low muscle mass in middle-aged and older adults. We recommend using ASM/BMI to identify the low muscle mass of individuals. In addition, clinicians should note the important role of abdominal obesity when considering mobility in middle-aged and older adults.

Less Favorable Nutri-Score Consumption Ratings Are Prospectively Associated with Abdominal Obesity in Older Adults

Nutri-Score is a front-of-package (FOP) labeling designed to assist consumers in selecting healthier options at the point of purchase and ultimately enhance their health. This study aims to evaluate the association between the Nutri-Score system and incident abdominal obesity (AO) in community-dwelling older adults. A prospective cohort of 628 individuals aged ≥ 60 were recruited in Spain between 2008-2010 and were reexamined between 2015-2017. Dietary intake was evaluated utilizing a validated computerized dietary history. Food was categorized based on the Nutri-Score system into five levels from A (green, representing the best quality) to E (red, representing the poorest quality). A five-color Nutri-Score dietary index (5-CNS DI) in g/day/kg was calculated for each participant. AO was determined by a waist circumference (WC) of ≥102 cm for men and ≥88 cm for women. Logistic regression models were adjusted for the main potential confounders. During a mean six-year follow-up, 184 incident cases of AO occurred. The odds ratio (OR) and 95% confidence interval (CI) for AO, when comparing the highest and lowest quartiles of the 5-CNS DI, were 2.45 (1.17-5.14), with a p-value for trend of 0.035. In sensitivity analyses, the OR was 2.59 (1.22-5.52, p-trend: 0.032) after adjustment for WC at baseline, and 1.75 (0.74-4.18, p-trend: 0.316) after adjustment for ultra-processed food consumption. In conclusion, less favorable food-consumption ratings in the Nutri-Score are associated with incident AO in the elderly. These findings support the use of this FOP system to potentially improve metabolic health.

Gender and physical frailty modify the association between abdominal obesity and functional disability in older adults

BACKGROUND

Abdominal obesity is associated with functional disability in older adults.

AIM

We evaluated whether this association was modified by gender and/or physical frailty.

METHODS

We used cross-sectional data from 12,583 participants in the third follow-up of the population-based Singapore Chinese Health Study, when participants had mean age of 74 years (range 63-97). Abdominal obesity was defined using waist circumference, physical frailty was established using the modified Cardiovascular Health Study phenotype, and functional disability was determined by the Lawton Instrumental Activities of Daily Living Scale. We used logistic regression models to compute odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between abdominal obesity and disability.

RESULTS

Abdominal obesity was associated with increased likelihood of functional disability, and this association was stronger in women than in men [OR (95% CI): 1.27 (1.11-1.46) vs. 1.08 (0.93-1.25); P for interaction < 0.001]. Furthermore, there was a significantly stronger association between abdominal obesity and functional disability in participants who were physically frail compared to those who were not [OR (95% CI): 1.57 (1.19-2.08) vs. 1.11 (0.99-1.23); P for interaction = 0.003], and this phenomenon was observed in both genders. When compared to participants who were neither abdominally obese nor physically frail, participants who were both abdominally obese and physically frail had a synergistically increased risk of functional disability [OR (95% CI): 3.61 (3.03-4.30)].

CONCLUSIONS

Women with abdominal obesity had higher risk of functional disability compared to men, and older adults who were both abdominally obese and physically frail had a synergistically increased risk of disability.

Visceral fat area is the measure of obesity best associated with mobility disability in community dwelling oldest-old Chinese adults

Background

Although obesity can be clinically defined by body mass index (BMI), waist circumference, percent body fat, or visceral fat area, it is unclear which specific measure is best associated with mobility disability in oldest-old adults.

Methods

Among 589 Chinese participants aged 85 years and older in a population-based cohort in Singapore, we measured waist circumference, computed BMI, estimated appendicular skeletal muscle mass, percent body fat, and visceral fat area using bioelectrical impedance analysis, and evaluated mobility disability using the Loco-Check questionnaire. We computed areas under the receiver operating characteristic curves (AUC_ROC) to compare how well these measures discriminated between those with and without mobility disability. Logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (CI) for the associations between obesity defined by these measures and mobility disability.

Results

Compared to BMI, which had an AUC_ROC (95% CI) of 0.68 (0.64–0.72) for the discrimination of mobility disability, only visceral fat area had a significantly higher discriminative performance [AUC_ROC (95% CI) of 0.71 (0.67–0.75) (P_adjusted = 0.002)]. The optimal cut-offs of visceral fat area for the discrimination of mobility disability were ≥ 104 cm² in men and ≥ 137 cm² in women. In fully adjusted models, only obesity defined by visceral fat area was significantly associated with mobility disability [OR (95% CI) of 2.04 (1.10–3.77)]; obesity defined by the other measures were not associated with mobility disability after adjusting for visceral fat.

Conclusion

In oldest-old adults, visceral fat area was the best discriminator for obesity associated with mobility disability.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02226-6.

Sex-specific typologies of older adults' sedentary behaviors and their associations with health-related and socio-demographic factors: a latent profile analysis

BACKGROUND

Some types of sedentary behaviors tend to cluster in individuals or groups of older adults. Insight into how these different types of sedentary behavior cluster is needed, as recent research suggests that not all types of sedentary behavior may have the same negative effects on physical and mental health. Therefore, the aim of this study was to identify sex-specific typologies of older adults' sedentary behavior, and to examine their associations with health-related and socio-demographic factors.

METHODS

Cross-sectional data were collected as part of the BEPAS Seniors, and the Busschaert study among 696 Flemish older adults (60+). Typologies of self-reported sedentary behavior were identified using latent profile analysis, and associations with health-related and sociodemographic factors were examined using analyses of variances.

RESULTS

Five distinct typologies were identified from seven sedentary behaviors (television time, computer time, transport-related sitting time, sitting for reading, sitting for hobbies, sitting for socializing and sitting for meals) in men, and three typologies were identified from six sedentary behaviors (television time, transport-related sitting time, sitting for reading, sitting for hobbies, sitting for socializing and sitting for meals) in women. Typologies that are characterized by high television time seem to be related to more negative health outcomes, like a higher BMI, less grip strength, and a lower physical and mental health-related quality-of-life. Typologies that are represented by high computer time and motorized transport seem to be related to more positive health outcomes, such as a lower body mass index, more grip strength and a higher physical and mental health-related quality-of-life.

CONCLUSIONS

Although causal direction between identified typologies and health outcomes remains uncertain, our results suggests that future interventions should better focus on specific types of sedentary behavior (e.g. television time), or patterns of sedentary behavior, rather than on total sedentary behavior.

Ultra-Processed Food Consumption Is Associated with Abdominal Obesity: A Prospective Cohort Study in Older Adults

INTRODUCTION AND OBJECTIVES

Ultra-processed food (UPF) consumption has been associated with increased incidence of cardiovascular disease and its risk factors. The aim of this study was to assess, for the first time in the literature, the prospective association between UPF consumption and the incidence of abdominal obesity (AO) in older adults.

METHODS

The study sample consists of 652 participants in the Seniors Study on Nutrition and Cardiovascular Risk in Spain: Seniors-ENRICA-1 study, (mean age 67, 44% women). At baseline, standardized anthropometric measurements were collected (including abdominal circumference). After a median follow-up of six years, the abdominal circumference was measured again, and the incidence of abdominal obesity (AO) was calculated, defined as an abdominal perimeter ≥102 cm in men and ≥88 cm in women. At baseline, dietary information was collected using a computerized and validated dietary history. Information was obtained on the usual diet in the previous year. A total number of 880 foods were classified according to their degree of processing following the NOVA classification. Foods or drinks formulated mostly or entirely from substances derived from foods, with little or no presence of the unaltered original food were classified as UPF. For each participant, the percentage of energy from UPF was derived and sex-specific tertiles were calculated. Logistic regression models were built and adjusted for sociodemographic, lifestyle, morbidity, and drug treatment variables.

RESULTS

Among those participants without AO at baseline, 177 developed AO during follow-up. The average consumption of UPF was 17% of total energy (7% in the first tertile; 29% in the third tertile). The odds ratio (95% confidence interval) for incident AO risk when compared to the lowest tertile was: 1.55 (0.99-2.44) for the second tertile of UPF consumption and 1.62 (1.04-2.54) for the third tertile; p for linear trend: 0.037. Results remained statistically significant after adjusting for potential dietary confounding factors such as fiber consumption, the intake of very long chain omega-3 fatty acids and adherence to the Mediterranean diet.

CONCLUSIONS

A higher UPF consumption is positively associated with incident AO in older adults in Spain. These findings extend the current evidence of the detrimental effect of UPF consumption on cardiometabolic health.

Does self-report of multimorbidity in later life predict impaired physical functioning, and might this be useful in clinical practice?

Background

Multimorbidity has been shown in several studies to relate to impaired physical function in later life.

Aims

To examine if self-report of multimorbidity predicts impaired physical functioning, as assessed by formal physical function testing, in community-dwelling older adults.

Methods

Non-communicable diseases (NCDs) were self-reported by 443 older community-dwelling UK adults via questionnaire, asking the question: ‘Have you been told by a doctor that you have any of the following conditions?’ Assessments of walking speed, chair stands and balance allowed us to create a composite score (0–12) on which impaired physical functioning was defined as ≤ 9.

Results

The mean age of participants was 75.5 ± 2.5 years for men and 75.8 ± 2.6 for women. The proportion of individuals with impaired physical functioning was 71.2% in women and 56.9% in men. Having four or more NCDs was associated with an increased risk of poor physical function in men and women (p < 0.05). The number of medications and medicated systems was associated with gait speed (p < 0.03 and < 0.02, respectively) and timed up-and-go tests (p < 0.03 and < 0.02, respectively) in women but not men.

Discussion and conclusion

Self-report of 4 or more NCDs was associated with an increased risk of poor physical function, an outcome which has previously been associated with adverse clinical sequelae. This observation may inform development of a simple screening tool to look for poor physical function in older adults.

Electronic supplementary material

The online version of this article (10.1007/s40520-020-01500-8) contains supplementary material, which is available to authorized users.

Distribution of daily protein intake across meals and lower extremity functioning in community-dwelling Spanish older adults: a prospective cohort study

PURPOSE

Total dietary protein intake has been associated with better physical function in older adults. However, it is unclear whether an even mealtime distribution of protein intake also has an impact on physical functioning. The aim of this study was to examine the prospective association between distribution of daily protein intake across meals and the risk of impaired lower extremity function (ILEF).

METHODS

We used information of 2975 individuals ≥ 60 years from the Seniors-ENRICA cohort. Habitual dietary protein intake was assessed in 2008-2010 with a validated diet history. For each participant, dietary protein intake across meals was determined using the coefficient of variation (CV) of the distribution. Study participants were followed up until 2017 to identify incident ILEF, assessed with the short physical performance battery (SPPB).

RESULTS

Over a median follow-up of 6.3 years, we identified 521 participants with ILEF (SPPB ≤ 6). After adjusting for potential confounders including total protein intake/kg/day, a higher CV (less even distribution) of protein intake did not show an association with the risk of ILEF [hazard ratios (HR) and 95% confidence intervals (CI) for second and third vs. the first tertile: 1.08 (0.87-1.34), and 1.06 (0.85-1.32), respectively; p trend = 0.60]. When assessing each component of the SPPB, a higher CV of protein intake was associated with higher risk of impaired standing balance (HR for tertile 3 vs. tertile 1: 1.26 (1.03-1.54); p trend = 0.02).

CONCLUSION

The mealtime distribution of protein intake was not associated with ILEF. The possibility of a detrimental effect of uneven distribution of protein on standing balance needs to be further investigated.

Dynapenic Abdominal Obesity as a Risk Factor for Worse Trajectories of ADL Disability Among Older Adults: The ELSA Cohort Study

Background

There is little epidemiological evidence demonstrating that dynapenic abdominal obese individuals have worse trajectories of disability than those with dynapenia and abdominal obesity alone. Our aim was to investigate whether dynapenic abdominal obesity can result in worse trajectories of activities of daily living (ADL) over 8 years of follow-up.

Methods

We used longitudinal data from 3,723 participants free from ADL disability at baseline from the English Longitudinal Study of Ageing. Using measures of handgrip strength (<26 kg for men; <16 kg for women) and waist circumference (>102 cm for men; >88 cm for women), participants were classified into four groups: nondynapenic/nonabdominal obese (reference group), abdominal obese only, dynapenic only, and dynapenic abdominal obese. We used generalized linear mixed models with ADL as the outcome and the four groups according to dynapenia and abdominal obesity status as the main exposure controlled by sociodemographic, behavioral, and clinical characteristics.

Results

The estimated change over time in ADL disability was significantly higher for participants with dynapenic abdominal obesity compared with those with neither condition (+0.018, 95% CI: 0.008 to 0.027). Compared with the results of our main analysis (which took into account the combination of dynapenia and abdominal obesity on the rate of change in ADL), the results of our sensitivity analysis—which examined dynapenia and abdominal obesity only as independent conditions—showed an overestimation of the associations of dynapenia only and of abdominal obesity only on the ADL disability trajectories.

Conclusions

Dynapenic abdominal obesity is an important risk factor for functional decline in older adults.

Prevalence, Incidence, and Risk Factors for Overall, Physical, and Cognitive Independence Among Those From Exceptionally Long-Lived Families: The Long Life Family Study

BACKGROUND

The Long Life Family Study (LLFS) enrolled families exhibiting exceptional longevity. The goal of this article was to determine the prevalence and predictors of remaining independent after 7 years in the oldest generation.

METHODS

We examined 7-year change in physical (free of activities of daily living difficulty), cognitive (Mini-Mental State Examination score ≥ 24), and overall independence (physically/cognitively independent) in adults aged 90.3 ± 6.3 from LLFS's oldest generation. Potential predictors (n = 28) of remaining independent included demographics, diseases, biomarkers, anthropometrics, and physical and cognitive performance tasks and were determined using generalized estimating equations (α: p < .05). This was a discovery/exploratory analysis, so no multiple testing correction was employed and the results require independent replication.

RESULTS

At baseline (n = 1442), 67.3%, 83.8%, and 79.7% were overall, physically, and cognitively independent, respectively. After 7 years, 66% died, 7.5% were lost to follow-up, and the prevalence of overall independence decreased to 59.1% in survivors (-8.2%, 95% confidence interval: -14.1%, 2.2%). Of those with baseline independence, 156/226 (69.0%) remained independent. Predictors of remaining physically independent included younger age, better Short Physical Performance Battery score and lung function, smaller waist circumference, and lower soluble receptor for advanced glycation end-product levels (p < .05). Predictors of remaining cognitively independent included no cancer history, better Digit Symbol Substitution Test performance, and higher body weight (p < .05).

CONCLUSIONS

The prevalence of independence decreased by only 8.2% after 7 years, demonstrating the close correspondence between disability and mortality. Further, despite a mean baseline age of 90 years, a large proportion of survivors remained independent, suggesting this exceptional subgroup may harbor protective mechanisms.

Malnutrition is associated with increased risk of hospital admission and death in the first 18 months of institutionalization

OBJECTIVES

This study aimed to investigate the association between different nutritional and anthropometric parameters with the risk of hospitalizations and death within 18 months from nursing home admission. Our hypothesis was that measures of malnutrition could be more strongly associated with worse clinical outcomes than measures of overweight/obesity.

METHODS

This prospective study involved 144 older adults newly admitted in nursing home and followed up over 18 months. A multidimensional assessment focusing on clinical, functional and cognitive status was performed at baseline. Assessment also included body mass index (BMI), waist circumference, calf circumference, MNA Short-Form (MNA-SF), and serum albumin and lymphocytes levels. Anthropometric measurements were repeated at 6 months. Data on hospitalizations and mortality over the study period, with their respective causes, were obtained from administrative data. The associations between baseline nutritional parameters and the risk of hospitalizations or death were analyzed through multinomial logistic regressions and Cox regressions, respectively.

RESULTS

During the follow-up, 64 individuals (44.4%) were hospitalized, and 52 (36.1%) died. Residents who reported low MNA-SF and calf circumference at nursing home admission had more than threefold-increased odds of hospitalizations compared with their healthier counterparts. Adults with low calf circumference also had the highest mortality (HR = 3.39, 95%CI:1.80-6.39), while more attenuated results were observed for low serum albumin, MNA-SF, and BMI (either when considering cut-offs of excess weight or malnutrition). When assessing the associations between 0 and 6 month changes in calf circumference and mortality in the following 12 months, we found that each 1 cm decrease in calf circumference increased the one-year mortality by 29% (95%CI 1.04-1.60).

CONCLUSIONS

Malnutrition, but not overweight/obesity, seems associated with a higher risk of hospitalization and mortality after nursing home admission. Monitoring calf circumference, in particular, may help in the early detection of individuals who are potentially vulnerable to adverse health-related outcomes after institutionalization.

Worsening Disability and Hospitalization Risk in Sarcopenic Obese and Dynapenic Abdominal Obese: A 5.5 Years Follow-Up Study in Elderly Men and Women

Background/Objectives: A general lack of studies comparing the effect of both dynapenic abdominal obesity and sarcopenic obesity on worsening disability and hospitalization risk should be recognized. The aim of the current study was to evaluate, with a 5.5-year follow-up, the prognostic value of sarcopenic obesity and dynapenic abdominal obesity definitions on worsening disability and hospitalization risk in a sample of older adults. Subjects/Methods: In 177 women and 97 men aged 68-78 years, the following outcomes were evaluated at baseline: appendicular skeletal muscle mass (ASMM), percent fat mass (FM%), leg isometric strength, body mass index (BMI), lipid profile, vitamin D3, albumin, fibrinogen, glycemia, physical activity level, income, smoking status, and comorbidities. The rate of reported disabilities and hospitalization were also assessed at baseline, 1, 2, 3, and 5.5-years follow-up. The study population was classified into: (i) non-sarcopenic/obese (NS/O), sarcopenic/non-obese (S/NO), sarcopenic/obese (S/O), non-sarcopenic/non-obese (NS/NO, reference category) according to relative ASMM/FM% tertiles; (ii) non-dynapenic/abdominal obese (ND/AO), dynapenic/non-abdominal obese (D/NAO), dynapenic/abdominal obese (D/AO), non-dynapenic/non-abdominal obese (ND/NAO, reference category) according to muscle strength/waist circumference tertiles. Results: The prevalence of D/AO and S/O was 12.0 and 8.0%, respectively. Only 2 subjects were both D/NAO and S/O (0.8%). D/NAO subjects showed a worsening disability risk of 1.69 times (95% CI: 1.11-2.57), ND/AO subjects showed a 2-fold increased risk (95% CI: 1.34-2.98), while being D/AO more than trebled the risk, even after adjustment for confounding factors (HR: 3.39, 95%; CI: 1.91-6.02). By dividing the study population according to the relative ASMM/FM% tertiles, no groups showed an increased risk of worsening disability. The hospitalization risk, even after adjustment for potential confounders, was 1.84 (95% CI: 1.06-3.19) for D/AO. Dividing the study population according to the relative ASMM/FM% tertiles, no groups showed increased risk of hospitalization. Conclusions: Our results showed that dynapenic abdominal obesity and sarcopenic obesity seem to indicate two distinct phenotypes associated with different health risk profiles. The distribution of participants in waist circumference and muscle strength tertiles allowed for a more accurate risk stratification for worsening disability and hospitalization.

Association between changes in waist circumferences and disability among older adults: WHO-INDEPTH study on global ageing and adult health (SAGE) in Indonesia

BACKGROUND

There is a lack of evidence regarding the impact of changes in waist circumference on disability among older populations in low- and middle-income countries (LMICs). This research examines the association between changes in waist circumference with disability in the older populations of Indonesia, and whether the associations are dependent on wealth or baseline abdominal obesity levels.

METHODS

In 2007 the INDEPTH-WHO Study on global AGEing and adult health (SAGE) was conducted among 11,753 individuals aged 50 years and older in Purworejo District, Central Java Province, Indonesia. Of these, a total of 8,089 were followed up in 2010. On both occasions, individuals' waist circumferences were measured and the 12-item version of the WHO Disability Assessment Schedule version 2 (WHODAS-II) was implemented to measure disability.

RESULTS

A significant positive association was observed between waist circumference and disability at the baseline (β=0.066; p<0.001), and between the increase in waist circumference and the level of disability during the three-year follow-up period (β=0.094; p<0.001) after adjusting for baseline variables. This association was also significant among the poor, non-obese men, as well as poor and rich obese women. Among the non-obese women, a decrease in waist circumference was associated with more disabilities.

CONCLUSIONS

An increase in waist circumference is associated with increased disability among older people in Purworejo, Indonesia. Health promotion programmes aiming to prevent obesity could have positive effects in preventing and reducing disability among older adults.

Physical Activity Attenuates Total and Cardiovascular Mortality Associated With Physical Disability: A National Cohort of Older Adults

Background

Regular physical activity (PA) has been shown to protect against disability onset but, once the disability is present, it is unclear if PA might attenuate its harmful health consequences. Thus, we examined if mortality risk associated with physical disability can be offset by PA among older adults.

Methods

We used data from a cohort of 3,752 individuals representative of the noninstitutionalized population aged 60 years and older in Spain. In 2000-2001, participants self-reported both PA levels (inactive, occasionally, monthly, weekly) and five physical disabilities (agility, mobility, global daily activities, instrumental activities of daily living, and self-care). Individuals were prospectively followed through 2014 to assess incident deaths.

Results

The mean follow-up was 10.8 years, with a total of 1,727 deaths, 638 of them due to cardiovascular disease (CVD). All disability types were associated with higher total and CVD mortality. Being physically active (ie, doing any PA) was associated with a statistically significant 26%-37% and 35%-50% lower risk of total and CVD death, respectively, across types of disability. As compared with those being physically active and without disability, those who were inactive and had a disability showed the highest mortality risk from total (hazard ratios from 1.52 to 1.90 across disabilities, all p < .05) and from CVD (hazard ratios from 1.99 to 2.24 across disabilities, all p < .05). Total and CVD mortality risk was similar in physically active participants with disabilities and in inactive individuals without disability.

Conclusions

In older adults, PA could attenuate the increased risk of mortality associated with physical disability.

Mediterranean Dietary Patterns and Impaired Physical Function in Older Adults

Background

Information about nutritional risk factors of functional limitation is scarce. The aim of this study was to examine the association between the Mediterranean diet and risk of physical function impairment in older adults.

Methods

We used data from 1,630 participants in the Seniors-ENRICA cohort aged ≥60 years. In 2008-2010, adherence to the Mediterranean diet pattern was measured with the Mediterranean Diet Score (MDS) and the Mediterranean Diet Adherence Screener (MEDAS). Study participants were followed up through 2012 to assess incident impairment in agility and mobility as well as impairment in overall physical functioning, defined as a ≥5-point decrease from baseline to follow-up in the physical component summary of the 12-Item Short-Form Health Survey.

Results

Over a median follow-up of 3.5 years, we identified 343 individuals with agility limitation, 212 with mobility limitation, and 457 with decreased overall physical functioning. No association was found between the MDS score and the likelihood of impaired agility or mobility, although a 2-point increment in the MDS score was marginally associated with lower likelihood for decreased overall physical function. Compared to individuals in the lowest tertile of the MEDAS score, those in the highest tertile showed a lower odds of agility limitation (odds ratio: 0.67, 95% confidence interval: 0.48; 0.94, p trend = .02), mobility limitation (odds ratio: 0.69, 95% confidence interval: 0.40; 0.88, p trend = .01), and decreased overall physical functioning (odds ratio: 0.60, 95% confidence interval: 0.45; 0.79, p trend < .001).

Conclusions

In this prospective cohort study, a Mediterranean-style dietary pattern, especially when measured with the MEDAS, was associated with a lower likelihood of physical function impairment in older adults.

Gender differences in four-year incidence of self-reported and performance-based functional disability: The International Mobility in Aging Study

OBJECTIVES

To examine differences in incidence of functional disability between older women and men.

METHODS

2002 participants (65-74 years) were recruited in 2012 from Canada, Brazil, Colombia, and Albania, and re-assessed in 2016. Three measures of functional disability were used (1) Difficulty in any of five mobility-related Activities of Daily Living (ADL disability); (2) Self-reported difficulty climbing a flight of stairs or walking 400 m (mobility disability); and (3) Poor physical performance. We estimated the adjusted gender-specific incidence risk ratios (IRR) for each outcome in 2016.

RESULTS

In 2016, 1506 participants (52% women) were re-examined, 80% of the surviving cohort. Among those not disabled in 2012, seventy-four (12.9%) men developed ADL disability, while 105 (19.2%) developed mobility disability, and 97 (16.1%) developed poor physical performance. For women, numbers were higher 120 (21.4%) developed ADL disability, 117 (26.5%) developed mobility disability, and 140 (23.0%) developed poor physical performance. Compared to men, women had a higher adjusted incidence of self-reported ADL disability (IRR 1.4; 95% CI 1.04-1.88) and mobility disability (IRR 1.4; 95% CI 1.06-1.77), but not of poor physical performance (IRR 1.03; 95% CI 0.88-1.32).

CONCLUSIONS

Although women have a higher self-reported incidence of ADL and mobility disability than men, there was no significant difference in poor physical performance. Reasons for this discrepancy between self-reported and performance-based measures require further investigation. Understanding gender differences in functional disabilities can provide the basis for interventions to prevent mobility loss and minimize any gender gap.

Aging and Imaging Assessment of Body Composition: From Fat to Facts

The aging process is characterized by the chronic inflammatory status called "inflammaging", which shares major molecular and cellular features with the metabolism-induced inflammation called "metaflammation." Metaflammation is mainly driven by overnutrition and nutrient excess, but other contributing factors are metabolic modifications related to the specific body composition (BC) changes occurring with age. The aging process is indeed characterized by an increase in body total fat mass and a concomitant decrease in lean mass and bone density, that are independent from general and physiological fluctuations in weight and body mass index (BMI). Body adiposity is also re-distributed with age, resulting in a general increase in trunk fat (mainly abdominal fat) and a reduction in appendicular fat (mainly subcutaneous fat). Moreover, the accumulation of fat infiltration in organs such as liver and muscles also increases in elderly, while subcutaneous fat mass tends to decrease. These specific variations in BC are considered risk factors for the major age-related diseases, such as cardiovascular diseases, type 2 diabetes, sarcopenia and osteoporosis, and can predispose to disabilities. Thus, the maintenance of a balance rate of fat, muscle and bone is crucial to preserve metabolic homeostasis and a health status, positively contributing to a successful aging. For this reason, a detailed assessment of BC in elderly is critical and could be an additional preventive personalized strategy for age-related diseases. Despite BMI and other clinical measures, such as waist circumference measurement, waist-hip ratio, underwater weighing and bioelectrical impedance, are widely used as a surrogate measure for body adiposity, they barely reflect the distribution of body fat. Because of the great advantages offered by imaging tools in research and clinics, the attention of clinicians is now moving to powerful imaging techniques such as computed tomography, magnetic resonance imaging, dual-energy X-ray absorptiometry and ultrasound to obtain a more accurate estimation of BC. The aim of this review is to present the state of the art of the imaging techniques that are currently available to measure BC and that can be applied to the study of BC changes in the elderly, outlining advantages and disadvantages of each technique.

Recent Progress in Sarcopenia Research: a Focus on Operationalizing a Definition of Sarcopenia

PURPOSE OF REVIEW

To discuss recent progress in sarcopenia research and to highlight controversies in the field particularly around reaching consensus on a definition of sarcopenia.

RECENT FINDINGS

Accordingly, this review begins with a discussion of the increasing awareness of this condition; briefly describes evolving definitions of sarcopenia; suggests a framework for consistent terminology for sarcopenia; discusses outstanding issues in the definition of sarcopenia; and reviews the association between sarcopenia and adverse outcome in older adults. In addition, the role of sarcopenia in other diseases is discussed. The field of sarcopenia continues to hold considerable promise and work continues to resolve outstanding concerns in this field with a unifying consensus definition on the horizon.

Severe central obesity or diabetes can replace weight loss in the detection of frailty in obese younger elderly - a preliminary study

Purpose

Unwanted weight loss is one of the established criteria for the diagnosis of frailty. However, the relevance of this criterion to detect frailty in obese older adults has not been assessed. In particular, with the exception of malignancy, unwanted weight loss is not commonly seen in older obese subjects. Therefore, we tested the possibility that some obesity phenotypes and/or diabetes might be more useful in the detection of frailty in this setting.

Patients and methods

A preliminary cross-sectional study of 50 consecutive subjects was conducted at The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center. Inclusion criteria were: young elderly (aged 65–75 years), with general and/or abdominal obesity, without cancer. Frailty was assessed directly using the Fried model, the five-item fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale. Eventually, in the assessment of frailty, the weight loss criterion was replaced by one or several of obesity/diabetes-related variables each time: severity of obesity by body mass index, waist circumference (and their interaction), body fat, and diabetes. The receiver operating characteristic curves for functional impairment indices were plotted to compare the usefulness of the frailty accepted and adjusted models.

Results

The prevalence of frailty and pre-frailty in this cohort were 7/50 (14%) and 27/50 (54%), respectively, but unwanted weight loss was seen in three subjects (6%) only. The level of abdominal obesity had the strongest correlation with functional score (r=0.292, P<0.05). Frailty models which included either severe abdominal obesity or diabetes in lieu of unwanted weight loss had good sensitivity rates per each frailty score as compared with the original Fried model.

Conclusion

For detecting and/or screening for the frailty syndrome in obese young elderly, the level of abdominal obesity or diabetes may provide a useful marker.

General and Abdominal Obesity as Risk Factors for Late-Life Mobility Limitation After Total Knee or Hip Replacement for Osteoarthritis Among Women

OBJECTIVE

To investigate associations of body mass index (BMI), waist circumference (WC), and waist/hip ratio (WHR) with survival to age 85 years with mobility limitation or death before age 85 years among older women with total knee replacement (TKR) or total hip replacement (THR) for osteoarthritis (OA).

METHODS

This was a prospective study of women (ages 65-79 years at baseline) from the Women's Health Initiative, recruited during 1993-1998 and followed through 2012. Women's Health Initiative data were linked to Medicare claims data to determine TKR (n = 1,867) and THR (n = 944) for OA. Women were followed for up to 18 years after undergoing THR or TKR to determine mobility status at age 85 years.

RESULTS

Compared with normal-weight women, overweight, obese I, and obese II women with THR had significantly increased risk of survival to age 85 years with mobility limitation (P < 0.001 for linear trend), with the strongest risk among obese II women (odds ratio [OR] 4.37 [95% confidence interval (95% CI) 1.96-9.74]). Obese II women with THR also had increased risk of death before age 85 years. Women with THR and WC >88 cm relative to ≤88 cm had increased risk of survival to age 85 years with mobility limitation (OR 1.65 [95% CI 1.17-2.33]) but not death before age 85 years. High BMI, WC, and WHR were associated with significantly increased risk of late-life mobility limitation and death among women with TKR for OA.

CONCLUSION

Among older women who underwent THR or TKR for OA, baseline general and abdominal obesity were associated with increased risk of late-life mobility limitation.

Cognitive impairment and the association between frailty and functional deficits are linked to abdominal obesity in the elderly

OBJECTIVE

To evaluate whether specific obesity phenotypes in community-dwelling elderly: (a) affect differently the relationship between frailty and functional impairment and (b) are related to cognitive impairment.

STUDY DESIGN

A post-hoc cross-sectional analysis of the last Israeli national health and nutrition survey of the elderly (≥ 65 yrs.; n = 1619).

MAIN OUTCOME MEASURES

We implemented a previously validated frailty model based on frailty-related variables that were obtained in the survey. Mild cognitive impairment was defined using the Mini-Mental State Examination (a score <24 and >17). The Katz's scale of activities of daily living was used for functional assessment. Data were clustered according to different obesity phenotypes using measured body mass index (BMI) and waist circumference (WC).

RESULTS

The link between frailty and disability was most prominent in subjects with abdominal obesity who were non-obese by BMI: compared with non-obese subjects as defined by WC and BMI, the odds ratio (OR) for functional limitations in this phenotype was 8.34 (95 % CI, 2.14-32.48) for pre-frail subjects and 69.26 (10.58-453.55) for frail subjects. The rate of cognitive impairment was 3.3 times higher (p = .023) in women who were obese by WC but not by BMI.

CONCLUSIONS

In elderly people with a large WC and BMI < 30 kg/m², disability is more tightly linked to frailty than for any other form of obesity. Cognitive impairment was more prominent in women with central obesity and BMI < 30 kg/m² than in the other anthropometric phenotypes. WC should be used for early detection of individuals at risk of progression of frailty to functional incapacity.

Consumption of meat in relation to physical functioning in the Seniors-ENRICA cohort

BACKGROUND

Meat is an important source of high-quality protein and vitamin B but also has a relatively high content of saturated and trans fatty acids. Although protein and vitamin B intake seems to protect people from functional limitations, little is known about the effect of habitual meat consumption on physical function. The objective of this study was to examine the prospective association between the intake of meat (processed meat, red meat, and poultry) and physical function impairment in older adults.

METHODS

Data were collected for 2982 participants in the Seniors-ENRICA cohort, who were aged ≥60 years and free of physical function impairment. In 2008-2010, their habitual diet was assessed through a validated computer-assisted face-to-face diet history. Study participants were followed up through 2015 to assess self-reported incident impairment in agility, mobility, and performance-based lower-extremity function.

RESULTS

Over a median follow-up of 5.2 years, we identified 625 participants with impaired agility, 455 with impaired mobility, and 446 with impaired lower-extremity function. After adjustment for potential confounders, processed meat intake was associated with a higher risk of impaired agility (hazard ratio [HR] for highest vs. lowest tertile: 1.33; 95% confidence interval [CI]: 1.08-1.64; p trend = 0.01) and of impaired lower-extremity function (HR for highest vs. lowest tertile: 1.31; 95% CI: 1.02-1.68; p trend = 0.04). No significant associations were found for red meat and poultry. Replacing one serving per day of processed meat with one serving per day of red meat, poultry, or with other important protein sources (fish, legumes, dairy, and nuts) was associated with lower risk of impaired agility and lower-extremity function.

CONCLUSIONS

A higher consumption of processed meat was associated with a higher risk of impairment in agility and lower-extremity function. Replacing processed meat by other protein sources may slow the decline in physical functioning in older adults.

Lower body functioning and correlates among older American Indians: The Cerebrovascular Disease and Its Consequences in American Indians Study

BACKGROUND

More than six million American Indians live in the United States, and an estimated 1.6 million will be aged ≥65 years old by 2050 tripling in numbers since 2012. Physical functioning and related factors in this population are poorly understood. Our study aimed to assess lower body functioning and identify the prevalence and correlates of "good" functioning in a multi-tribe, community-based sample of older American Indians.

METHODS

Assessments used the Short Physical Performance Battery (SPPB). "Good" lower body functioning was defined as a total SPPB score of ≥10. Potential correlates included demographic characteristics, study site, anthropometrics, cognitive functioning, depressive symptomatology, grip strength, hypertension, diabetes mellitus, heart disease, prior stroke, smoking, alcohol use, and over-the-counter medication use for arthritis or pain. Data were collected between 2010 and 2013 by the Cerebrovascular Disease and Its Consequences in American Indians Study from community-dwelling adults aged ≥60 years (n = 818).

RESULTS

The sample's mean age was 73 ± 5.9 years. After adjustment for age and study site, average SPPB scores were 7.0 (95% CI, 6.8, 7.3) in women and 7.8 (95% CI, 7.5, 8.2) in men. Only 25% of the sample were classified with "good" lower body functioning. When treating lower body functioning as a continuous measure and adjusting for age, gender, and study site, the correlates of better functioning that we identified were younger age, male gender, married status, higher levels of education, higher annual household income, Southern Plains study site, lower waist-hip ratio, better cognitive functioning, stronger grip strength, lower levels of depressive symptomatology, alcohol consumption, and the absence of hypertension, diabetes mellitus, and heart disease. In our fully adjusted models, correlates of "good" lower body functioning were younger age, higher annual household income, better cognitive functioning, stronger grip, and the absence of diabetes mellitus and heart disease.

CONCLUSIONS

These results suggest that "good" lower body functioning is uncommon in this population, whereas its correlates are similar to those found in studies of other older adult populations. Future efforts should include the development or cultural tailoring of interventions to improve lower body functioning in older American Indians.

Abdominal Obesity and Mobility Disability in Older Adults: A 4-Year Follow-Up the International Mobility in Aging Study

BACKGROUND

Abdominal obesity is related to the disability process in older adults, however, little is known about this relationship when adjusted for important confounders such as depression and physical performance measures in a diverse international aged population.

OBJECTIVES

To explore the longitudinal relationship between abdominal obesity and mobility disability controlling for physical performance and depression.

DESIGN AND SETTING

Longitudinal observational study using data from the International Mobility in Aging Study (IMIAS) Study.

PARTICIPANTS

1104 out of 2002 older adults aged 64-74 years old free of mobility disability at baseline (2012) and then reassessed in 2016.

MEASUREMENTS

Mobility disability was defined as reporting difficulty in walking 400 m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. Abdominal obesity was defined as waist circumference ≥ 88cm for women or ≥ 102 cm for men. Four meters gait speed, handgrip strength and depressive symptoms (CES-D) were assessed. Generalized Estimating Equations (GEE) and multinomial regressions were used to estimate associations between disability and abdominal obesity.

RESULTS

1104 free of disability participants were followed over 4 years, the mean age was 68.9 (±2.9) years among men and 68.7 (±2.6) years among women. Prevalence and incidence rates of mobility disability varied widely across research site and sex. The longitudinal associations between mobility disability and abdominal obesity remained significant even when adjusted by depressive symptoms, handgrip strength, gait speed, age, sex, education and research site. Participants with abdominal obesity had higher mobility disability (OR=1.68, 95% CI 1.23-1.76, p-value=0.01) and also increased risk for ADL disability (OR: 1.47, 95% CI 1.23-1.76, p-value=0.01). Abdominal obesity in baseline was also predictor of mobility disability in 2016 (OR: 1.93, 95% CI 1.17-3.17, p-value <0.01) but not for ADL disability (OR: 1.59, 95% CI 0.93-2.71, p-value =0.09) with accounting mortality.

CONCLUSION

Abdominal obesity is associated longitudinally and predicts mobility disability, even over a short period (4 years) in community-dwelling older adults from different epidemiological contexts.

Association between disability and social capital among community-dwelling elderly

Objective

To assess the prevalence of disability and its association with social capital among community-dwelling elderly.

Methods

The study was based on 2nd Health Survey of Belo Horizonte Metropolitan Region - 2010, that included 1,995 community-dwelling elderly, randomly sampled. The exposure of interest was social capital, measured by confidence in neighborhood, perception of the physical environment, sense of cohesion in housing, and neighborhood perception of help. Socio-demographic variables, health conditions and use of health services were considered in the analysis with the purpose of adjustment.

Results

Approximately one third of participants (32.6%) were unable to at least one instrumental activity of daily living (IADL) and/or basic activity of daily living (ADL); the prevalence of disability in ADL/IADL was 18.1%, and only in IADL was 14.6%. Elderly with functional disabilities had higher odds of poor social capital, but only the sense of cohesion in housing neighborhood showed to be independently associated with functional disability (OR = 1.80; 95%CI 1.12 - 2.88).

Conclusions

Our results show the importance of social capital in research on associated factors of functional disability and indicate the need to implement public policies for social and environmental areas, since the needs of the elderly require measures beyond those typical of the health sector.

The combination of dynapenia and abdominal obesity as a risk factor for worse trajectories of IADL disability among older adults

Background/Objectives

The concept of dynapenic obesity has been gaining great attention recently. However, there is little epidemiological evidence demonstrating that dynapenic abdominal obese individuals have worse trajectories of disability than those with dynapenia and abdominal obesity alone. Our aim was to investigate whether dynapenia combined with abdominal obesity can result in worse trajectories of instrumental activities of daily living (IADL) among English and Brazilian older adults over eight and ten years of follow-up, respectively.

Methods

We used longitudinal data from 3374 participants from the English Longitudinal Study of Ageing (ELSA) and 1040 participants from the Brazilian Health, Well-being and Aging Study (SABE) who were free from disability as assessed by IADL at baseline. IADL disability was defined herein as a difficulty to perform the following: preparing meals, managing money, using transportation, shopping, using the telephone, house cleaning, washing clothes, and taking medications according to the Lawton IADL modified scale. The study population in each country was categorized into non-dynapenic/non-abdominal obese (reference group), abdominal obese, dynapenic and dynapenic abdominal obese according to their handgrip strength (<26 kg for men and <16 kg for women) and waist circumference (>102 cm for men and >88 cm for women). We used generalized linear mixed models with IADL as the outcome.

Results

The estimated change over time in IADL disability was significantly higher for participants with dynapenic abdominal obesity compared to those with neither condition in both cohorts (ELSA: 0.023, 95% CI = 0.012–0.034, p < 0.001; SABE: +0.065, 95% CI = 0.038–0.091, p < 0.001). Abdominal+obesity was also associated with changes over time in IADL disability (ELSA: +0.009, 95% CI = 0.002–0.015, p < 0.05; SABE: +0.021, 95% CI = 0.002–0.041, p < 0.05), which was not observed for dynapenia.

Conclusions

Abdominal obesity is an important risk factor for IADL decline but participants with dynapenic abdominal obesity had the highest rates of IADL decline over time among English and Brazilian older adults.

Sex and Race/Ethnic Disparities in Food Security and Chronic Diseases in U.S. Older Adults

Objective: The purpose of this study was to determine the relationships among sex, race/ethnicity, and food security with the likelihood of cancer, diabetes, cardiovascular disease, and lung disease for older adults. Method: Complex sample analysis by logistic regression models for chronic diseases were conducted from National Health and Nutrition Examination Surveys, 2011 to 2012 and 2013 to 2014, for N = 3,871 adults aged ≥55 years. Results: Being female with low food security was associated with lung disease and diabetes. Poverty, rather than low food security, was associated with cardiovascular diseases. Minority status was independently associated with low food security and diabetes. Discussion: Food insecurity, sex, and race/ethnicity were associated with chronic diseases in a representative sample of U.S. older adults.

Body composition and frailty profiles in Brazilian older people: Frailty in Brazilian Older People Study-FIBRA-BR

OBJECTIVE

To determine the association between body composition and frailty in older Brazilian subjects.

MATERIAL AND METHODS

This is a Cross-sectional study called FIBRA-BR and developed in community Brazilian aged ≥65 (n=5638). Frailty was assessed according to Fried et al. definition and body composition was determined by BMI, waist circumference and waist-hip ratio.

RESULTS

The lowest prevalence of frailty was observed in subjects with BMI between 25.0 and 29.9kg/m². Subjects with a BMI <18.5 and those with elevated WC presented a higher risk of frailty compared to eutrophic subjects (odds ratio (OR)=3.10; 95% CI: 2.06-4.67) and (OR=1.15; 95% CI: 1.03-1.27), respectively. Being overweight was protective for pre-frailty (OR=0.48; 95% CI: 0.4-0.58) and frailty (OR=0.77; 95% CI: 0.67-0.9). Obese older people presented a higher risk of pre-frailty only (OR=1.29; 95% CI: 1.09-1.51). Older people with high WC showed a greater proportion of frailty regardless of the BMI range.

CONCLUSION

Undernutrition is associated with pre-frailty and frailty in Brazilian elderly subjects, whereas obesity is associated only with pre-frailty. Overweight seems to have a protective effect against the syndrome. The excess of abdominal fat is associated with both profiles independent of the BMI.

Abdominal obesity as a risk factor for disability in Brazilian older adults

OBJECTIVE

To assess the role of abdominal obesity in the incidence of disability in older adults living in São Paulo, Brazil, in a 5-year period.

DESIGN

Longitudinal study, part of the SABE Study (Health, Wellbeing and Aging). We assessed the disability incidence in the period (reported difficulty in at least one activity of daily living (ADL) in 2010) in relation to abdominal obesity in 2006 (waist circumference ≥102 cm in men and ≥88 cm in women). We used Poisson regression to evaluate the association between obesity and disability incidence, adjusting for sociodemographic and clinical factors including BMI.

SETTING

São Paulo, Brazil.

SUBJECTS

Older adults (n 1109) who were independent in ADL in 2006. In 2010, 789 of these were located and re-interviewed.

RESULTS

The crude disability incidence (at least one ADL) was 27·1/1000 person-years in the period. The incidence rate was two times higher in participants with abdominal obesity compared with those without (39·1/1000 and 19·4/1000 person-years, respectively; P<0·001). This pattern was observed in all BMI levels. In regression models, abdominal obesity remained associated with disability incidence (incidence rate ratio=1·90; P<0·03), even after controlling for BMI, gender, age, low grip strength, cognitive impairment, physical inactivity and chronic diseases.

CONCLUSIONS

Abdominal obesity was strong risk factor for disability, showing a more significant effect than BMI, and thus should be an intervention target for older adults. Waist measure is simple, cost-effective and easily interpreted, and therefore can be used in several settings to identify individuals at higher risk of disability.

Joint Association of Obesity and Hypertension with Disability in the Elderly-- A Community-Based Study of Residents in Shanghai, China

BACKGROUND

Although both obesity and hypertension are known risk factors for disability, the joint association of obesity and hypertension with risk of disability is unknown. This paper is aim to examine the joint association of obesity and hypertension with risk of disability.

METHODS

Cross-sectional study with 8060 elderly community-dwelling individuals participating in the survey initiated by Shanghai Health and Family Planning Commission from March to September 2013. Obesity was measured using the body mass index (BMI) in World Health Organization (WHO) Asia criteria. Hypertension, based on the doctor's diagnosis, was obtained through face-to-face interview. Disability was measured using the self-reported physical self-maintenance scale (PSMS) and the instrumental activities of daily living (IADL) scale developed by Lawton and Brody.

RESULTS

A total of 8.97% of participants reported ADL disability, and 15.18% for IADL disability. After adjusting social demographics and chronic conditions, the risk of ADL disability was progressively greater in obese persons with hypertension (OR=1.40, 95% CI=1.05-1.89), underweight persons without hypertension (OR=2.05, 95% CI=1.29-3.25), and underweight persons with hypertension (OR=2.14, 95% CI=1.36-3.36). For IADL disability, only underweight persons with hypertension were significantly associated (OR=1.65, 95% CI=1.23-2.21).

CONCLUSIONS

Low or extremely high BMI, independent of its metabolic consequences, is a risk factor for disability among the elderly. Simple hypertension wasn't significantly associated with disability. In addition, having hypertension significantly increased the risk of ADL disability in obese individuals and IADL disability in underweight individuals.

Plasma zinc alpha2-glycoprotein levels correlate positively with frailty severity in female elders

Frailty is a geriatric syndrome associated with adiposity. Zinc alpha2-glycoprotein (ZAG), a novel adipokine, is a modulator of body fat mass and positively correlates with age. This observational study aims to investigate the relationship between plasma ZAG levels and frailty in the elderly.We enrolled 189 elder participants from a hospital-based comprehensive geriatric assessment program in Taiwan from January 2007 to June 2008. The demographic data, body weight, body mass index, appendicular skeletal muscle mass index (ASMI), body fat mass percentage, metabolic and inflammatory parameters including plasma tumor-necrosis factor alpha, C-reactive protein and ZAG levels, were assessed. The frailty score was assessed by Fried Frailty Index.The mean age of all participants (91 [48.1%] men and 98 [51.9%] women) was 77.19 ± 6.12 years. Judged by the FFI score, 46 (24.34%) elders were robust, 106 (56.08%) were pre-frail, and 37 (19.58%) were frail. Older men showed greater ASMI and lower fat mass percentage in comparison to older women (P < 0.0001). The log-transformed mean plasma ZAG (μg/mL) level of overall was 1.82 ± 0.11, and it was higher in men than in women (1.85 ± 0.12 vs 1.79 ± 0.1, P = 0.0006). Plasma ZAG levels were different among the robust, pre-frail and frail subgroups (1.78 ± 0.09, 1.83 ± 0.12, 1.83 ± 1.10, respectively, P = 0.028), and the differences were more significant in woman elders (P = 0.005). Further multiple linear regression analysis showed plasma ZAG levels positively correlated with frailty severity in women (P for trend = 0.0435).Plasma ZAG levels positively correlated with frailty severity in woman elders. The difference between sexes suggests certain sex-specific mechanisms may exist to affect the association between plasma ZAG levels and frailty.

Gender Roles and Physical Function in Older Adults: Cross-Sectional Analysis of the International Mobility in Aging Study (IMIAS)

OBJECTIVES

To examine the relationships between physical function and gender-stereotyped traits and whether these relationships are modified by sex or social context.

METHODS

A total of 1995 community-dwelling older adults from the International Mobility in Aging Study (IMIAS) aged 65 to 74 years were recruited in Natal (Brazil), Manizales (Colombia), Tirana (Albania), Kingston (Ontario, Canada), and Saint-Hyacinthe (Quebec, Canada). We performed a cross-sectional analysis. Study outcomes were mobility disability, defined as having difficulty in walking 400 meters without assistance or climbing a flight of stairs without resting, and low physical performance, defined as a score < 8 on the Short Physical Performance Battery. The 12-item Bem Sex Role Inventory (BSRI) was used to classify participants into four gender roles (Masculine, Feminine, Androgynous, and Undifferentiated) using site-specific medians of femininity and masculinity as cut-off points. Poisson regression models were used to estimate prevalence rate ratios (PRR) of mobility disability and poor physical performance according to gender roles.

RESULTS

In models adjusted for sex, marital status, education, income, and research site, when comparing to the androgynous role, we found higher prevalence of mobility disability and poor physical performance among participants endorsing the feminine role (PRR = 1.20, 95% confidence interval (CI) 1.03-1.39 and PRR = 1.37, CI 1.01-1.88, respectively) or the undifferentiated role (PRR = 1.23, 95% CI 1.07-1.42 and PRR = 1.58, CI 1.18-2.12, respectively). Participants classified as masculine did not differ from androgynous participants in prevalence rates of mobility disability or low physical performance. None of the multiplicative interactions by sex and research site were significant.

CONCLUSION

Feminine and undifferentiated gender roles are independent risk factors for mobility disability and low physical performance in older adults. Longitudinal research is needed to assess the mediation pathways through which gender-stereotyped traits influence functional limitations and to investigate the longitudinal nature of these relationships.

Alcohol drinking patterns and risk of functional limitations in two cohorts of older adults

BACKGROUND & AIMS

Several studies have found that moderate alcohol intake is associated with lower risk of functional limitations in older adults. However, no previous investigation has assessed this association in older adults from Mediterranean countries, who show characteristic drinking patterns.

METHODS

Data were taken from the UAM and the Seniors-ENRICA cohorts in Spain, comprising community-dwelling people aged ≥60 years. At baseline, participants in both cohorts were classified as non-drinkers, ex-drinkers, moderate drinkers and heavy drinkers (the threshold between moderate and heavy intake was ≥40 g/day in men and ≥24 g/day in women). The Seniors-ENRICA cohort allowed assessment of a Mediterranean Drinking Pattern (MDP), defined as moderate alcohol intake, with wine preference (≥80% of alcohol consumed as wine) and drinking only with meals. The incidence of limitation in mobility, agility, and instrumental activities of daily living (IADL) was ascertained in each cohort at the end of a 3.5-year follow-up. Analyses were adjusted for sex, age, education, lifestyle, BMI, chronic conditions, and functional limitations at baseline others than the studied limitation.

RESULTS

Compared with non-drinkers, ex-drinkers showed a higher risk of IADL limitation (pooled adjusted odds ratio [paOR]: 1.63; 95% confidence interval [CI]: 1.04-2.21). By contrast, moderate drinkers had a lower risk of limitations in mobility (paOR: 0.80; 95% CI: 0.63-0.97), agility (paOR: 0.82; 95% CI: 0.65-0.99) and IADL (paOR: 0.54; 95% CI: 0.39-0.69). Among individuals reporting poor or fair health, the MDP was associated with lower risk of mobility limitation (aOR: 0.51; 95% CI: 0.27-0.97).

CONCLUSION

In older adults, moderate alcohol consumption, as well as the MDP in specific subgroups, is associated with lower risk of functional limitation. These results should not serve to promote alcohol intake, because older adults are particularly vulnerable to its harmful effects.

Factors associated with ADL/IADL disability in community dwelling older adults in the Irish longitudinal study on ageing (TILDA)

PURPOSE

To identify the factors associated with disability across many domains using a large powered sample in the activities of daily living (ADL) and instrumental activities of daily living (IADL).

METHODS

Those aged ≥65 years from the Irish longitudinal study on ageing (TILDA) were included in this cross sectional analysis. Three logistic regression models were used to examine the relationships between 25 health, psychological and sociodemographic variables and difficulties in ADL, IADL and ADL/IADL combined.

RESULTS

The proportion of those reporting combined ADL/IADL difficulties was 18%. More individuals reported difficulty with ADLs (13%) than IADLS (11%). The main model showed that after age, the top three factors associated with difficulty in ADL/IADL combined were pain, taking five or more medications and depression. After age, the factors with the highest impact on ADL disability were pain, taking five or more medications and body mass index (BMI); the factors with the highest impact on IADL were being separated or divorced, living with others (non-spouse) and self-rated memory.

CONCLUSIONS

Awareness of sociodemographics and early interventions for pain and cognitive deficits could reduce ADL/IADL disability and promote successful ageing. Identification of variables that influence ADL/IADLs can be used to inform policy and practice. Implications for rehabilitation After age, pain and taking five or more medications were the strongest factors associated with difficulty in ADL/IADL combined and ADL alone. Practice therefore needs to be cognizant that it is not the disease label but the symptoms of a disease that affect ADL and IADL activities. Given the strong influence of pain on difficulties with ADL and IADL, there is a need for early interventions from a multidisciplinary perspective for pain reduction, control, and self-management. These interventions should include development of pain-coping strategies and exercises to maintain mobility. After age, being separated/divorced or living with non-spouse others are the strongest factors associated with IADL difficulties. Awareness of these social factors can be used to inform support mechanisms, such as development of community services and suitable housing for those with these changing sociodemographics. Unsurprisingly, cognitive impairments were strongly associated with IADL difficulties. Simple cognitive screening assessments could be used for early detection of cognitive changes. In order to maintain optimal cognitive functioning, rehabilitation professionals should facilitate older adults' engagement in activities that are cognitively demanding and socially interactive.

Nutritional status and eating habits of the institutionalised elderly in Turkey: a follow-up study

BACKGROUND

As the elderly population increases in Turkey, so do the associated health and nutritional problems. The main purpose of the present study was to determine the nutritional status of elderly individuals who live in institutions.

METHODS

A total of 102 elderly volunteers was recruited from seven residential homes of the Ministry of Family and Social Policies in Ankara. In the consecutive years of 2007, 2008 and 2009, dietary intake was assessed using a 24-h food recall. Nutritional status was screened using a questionnaire from the Mini-Nutritional Assessment, basic characteristics were determined and anthropometric measurements were assessed.

RESULTS

The percentage of elderly participants who were malnourished or at risk for malnutrition increased by the completion of the follow-up (P < 0.05). It was found that energy, total protein, animal proteins, carbohydrates, niacin, vitamin C, vitamin E and zinc intake of men decreased significantly over the years studied (P < 0.05). A significant decrease occurred among women in animal protein, vitamin B1 , niacin and the percentage of energy from proteins (P < 0.05); however, an increase in energy from fat (P < 0.05) was determined. Within the years studied, the percentage of nutrients meeting the Turkish recommended daily allowances decreased from 2007 to 2009 both in men and women. During the years 2007 to 2009, the percentage of waist circumferences >102 cm for men was 46.4%, 45.6% and 48.1%, respectively, and the percentage of waist circumferences for women >88 cm was 75.6%, 75.6% and 81.8%, respectively.

CONCLUSIONS

During the follow-up, significant nutritional changes were determined. To prevent malnutrition, periodical screening of nutritional status should be a priority and a standard policy for elderly people, especially for those institutionalised.

Obese very old women have low relative hangrip strength, poor physical function, and difficulties in daily living

OBJECTIVES

To investigate whether anthropometric and body composition variables and handgrip strength (HS) were associated with physical function and independent daily living in 88-year-old Swedish women.

PARTICIPANTS

A cross-sectional analysis of 83 community-dwelling women aged 88 years who were of normal weight (n=30), overweight (n=29), and obese (n=24) was performed.

MEASUREMENTS

Body weight (Wt), height, waist circumference (WC), and arm circumference were assessed using an electronic scale and a measuring tape. Tricep skinfold thickness was measured using a skinfold calliper. Fat mass (FM) and fat-free mass (FFM) were measured using bioelectrical impedance analysis, and HS was recorded with an electronic grip force instrument. Linear regression was used to determine the contributions of parameters as a single predictor or as a ratio of HS to physical function (Short Form-36, SF-36PF) and instrumental activities of daily living (IADL).

RESULTS

Obese women had greater absolute FM and FFM and lower HS corrected for FFM and HS-based ratios (i.e., HS/Wt, HS/body mass index [BMI]) than their normal weight and overweight counterparts. After adjusting for physical activity levels and the number of chronic diseases, HS-based ratios explained more variance in SF-36PF scoring (R2, 0.52-0.54) than single anthropometric and body composition variables (R2, 0.45-0.51). WC, HS, and HS-based ratios (HS/Wt and HS/FFM) were also associated with independence in IADL.

CONCLUSION

Obese very old women have a high WC but their HS is relatively low in relation to their Wt and FFM. These parameters are better than BMI for predicting physical function and independent daily living.

The effect of obesity on incidence of disability and mortality in Mexicans aged 50 years and older

OBJECTIVE

To examine the effect of obesity on incidence of disability and mortality among non-disabled older Mexicans at baseline.

MATERIALS AND METHODS

The sample included 8 415 Mexicans aged ≥ 50 years from the Mexican Health and Aging Study (2001 -2012), who reported no limitations in activities of daily living (ADLs) at baseline and have complete data on all covariates. Sociodemographics, smoking status, comorbidities, ADL activities, and body mass index (BMI) were collected.

RESULTS

The lowest hazard ratio (HR) for disability was at BMI of 25 to < 30 (HR = 0.97;95% confidence interval [CI], 0.85-1.12).The lowest HR for mortality were seen among participants with BMIs 25 to < 30 (HR = 0.85; 95%CI, 075-0.97), 30 to < 35 (HR = 0.86; 95 %CI, 0.72-1.02), and > 35 (HR = 0.92; 95 %CI, 0.70-1.22).

CONCLUSION

Mexican older adults with a BMI of 25 to < 30 were at less risk for both disability and mortality.

Association between waist circumference and self-reported disability among Chinese adults aged 90 years and older

AIM

To investigate the relationship between waist circumference (WC) and activities of daily living (ADL)/instrumental activities of daily living (IADL) disability among nonagenarians and centenarians.

METHODS

We analyzed data obtained from a cross-sectional study carried out in 870 older Chinese adults aged 90 years and older in Dujiangyan, a town in West China. The participants were divided into four groups according to their sex and WC quartile. The ADL and IADL disabilities were measured using the physical self-maintenance scale and Lawton and Brody's IADL scale, respectively.

RESULTS

We included 233 men and 505 women in this statistical analysis. The prevalence of ADL or IADL disability was 53.6% in men and 71.3% in women. Participants in the highest WC quartile group (WC ≥83.0 cm for men or WC ≥82.0 cm for women) had higher prevalence of ADL or IADL disability compared with those in the lowest WC quartile group (WC <73.0 cm for men or WC <70.5 cm for women). Adjusting for relevant confounders, the highest quartile group showed significantly increased odds ratios for either ADL (1.7 for men and 2.1 for women) or IADL disability (odds ratios 3.3 for men and 2.0 for women) compared with the lowest quartile group.

CONCLUSION

Among Chinese older adults aged 90 years and older, both men and women in the highest quartile of WC were at higher risk of ADL or IADL disability compared with those in the lowest quartile of WC. Geriatr Gerontol Int 2015; 15: 1249-1257.

Association of Body Mass Index and Waist Circumference With Physical Functioning: The Vitality 90+ Study

BACKGROUND

Both obesity and underweight are associated with impaired physical functioning, but related information on the oldest old population is scarce. Our purpose was to examine whether body mass index, waist circumference (WC), and their combination are associated with physical performance and activities of daily living (ADL) disability in 90-year-old women and men.

METHODS

Data are from the Vitality 90+ Study, which is a population-based study of persons with age ≥90 years living in the area of Tampere, Finland. Altogether 416 women and 153 men, aged 90-91 years, provided data on body mass index, WC, chair stand, and Barthel Index. Comorbidity, physical exercise, smoking history, living residence, and sample year were used as covariates in multinomial logistic and logistic regression models.

RESULTS

Women in the highest WC tertile had lower physical performance and were more likely unable to perform the chair stand than women in the lowest WC tertile. Women in the highest WC tertile were also more likely to have ADL disability, compared to the lowest WC tertile. In women, overweight and obesity were associated with ADL disability, but not when WC was included in the model. Men with body mass index ≥25 kg/m(2) and WC < sex-specific median were less likely to have ADL disability. Similarly classified women were less likely to have low performance or unable to perform chair stand (marginally significant).

CONCLUSIONS

High WC in the oldest old women, but not in men, is associated with both poor physical performance and ADL disability.

Patterns of alcohol consumption in the older population of Spain, 2008-2010

BACKGROUND

Older adults are a growing segment of the European population and alcohol is an important cause of disease burden; thus, it is noteworthy that little information is available on alcohol intake among older adults in Europe.

OBJECTIVE

The aim of this study was to examine alcohol consumption patterns and their association with demographic and clinical variables in the older population of Spain.

DESIGN

This was a cross-sectional study.

PARTICIPANTS/SETTING

The sample included 3,058 individuals, representative of the Spanish population aged ≥60 years during 2008-2010.

MAIN OUTCOME MEASURE

Regular alcohol consumption was measured with a validated diet history questionnaire. The threshold between moderate and heavy drinking was ≥40 g alcohol/day in men (≥24 g in women). Binge drinking was defined as intake of ≥80 g alcohol in men (≥60 g in women) during any drinking occasion in the previous month, and problem drinking by a CAGE score ≥2.

STATISTICAL ANALYSIS PERFORMED

The prevalence and 95% CI of the drinking patterns were calculated after accounting for sampling design.

RESULTS

The prevalence of moderate drinking was 44.3% (95% CI 42.0% to 46.6%) and of heavy drinking was 7.8% (95% CI 6.7% to 8.9%). In total, 68.4% (95% CI 65.7% to 71.2%) of individuals obtained >80% of alcohol from wine and 61.8% (95% CI 58.9% to 64.6%) drank only with meals. Furthermore, 1% (95% CI 0.6% to 1.4%) showed binge drinking and 3.1% (95% CI 2.3% to 3.8%) showed problem drinking. Heavy alcohol consumption was significantly more frequent in men. Moderate alcohol consumption was significantly less frequent among women, persons who were not married, living alone, with a diagnosis of diabetes, receiving treatment for diabetes, and with suboptimal self-rated health. About 5% to 10% of individuals with diagnosed hypertension, diabetes, or cardiovascular disease showed heavy drinking. Among those taking sleeping pills or antidiabetes or antithrombotic treatment, 37% to 46% had moderate alcohol intake and 5% to 8% had heavy intake.

CONCLUSIONS

Alcohol consumption among older adults in Spain is frequent and mostly consistent with the traditional Mediterranean drinking pattern. However, a proportion of individuals were heavy drinkers and used medication that may interact with alcohol.

The impact of waist circumference on function and physical activity in older adults: longitudinal observational data from the osteoarthritis initiative

Background

We previously demonstrated that BMI is associated with functional decline and reduced quality of life. While BMI in older adults is fraught with challenges, waist circumference (WC) is a marker of visceral adiposity that can also predict mortality. However, its association with function and quality of life in older adults is not well understood and hence we sought to examine the impact of WC on six-year outcomes.

Methods

We identified adults aged ≥60 years from the longitudinal Osteoarthritis Initiative and stratified the cohort into quartiles based on WC. Our primary outcome measures of function at six year follow-up included: self-reported quality of life [Short Form-12 (SF-12)], physical function [Physical Activity Scale for the Elderly (PASE)] and disability [Late-life Disability Index (LLDI)]. Linear regression analyses predicted 6-year outcomes based on WC quartile category (lowest = referent), adjusted for age, sex, race, education, knee pain, smoking status, a modified Charlson co-morbidity index and baseline scores, where available.

Results

We identified 2,182 subjects meeting our inclusion criteria and stratified the study cohort by quartiles of WC. Mean age ranged from 67.5-68.7 years, 60-71% were female and 80-86% were white. The highest WC quartile compared to 50-75th, 25-50th or lowest quartile, was associated with a greater number of medications (4.3, 4.0, 3.6 and 3.4 [p < 0.001]), lower gait speeds (1.23, 1.27, 1.32, and 1.34 m/s[p < 0.001]), higher rates of knee osteoarthritis (70.2, 62.2, 60.2, 48.6;p < 0.001), higher Charlson co-morbidity scores and greater knee pain (WOMAC scores) (all p < 0.001). At follow-up, adjusted SF-12 physical function subscale and PASE scores, were lowest in the highest WC quartile as compared to the 50-75%, 25-50%, and lowest quartiles [(SF-12 scores: 45.5, 46.7, 47.6, and 47.9), and (PASE scores: 109.6, 128.7, 126.6, and 131.0). The LLDI limitation subscale for disability demonstrated lower scores in the high WC quartile as opposed to the referent group.

Conclusions

Elevated WC is associated with lower quality of life, a decline in physical function, and a slightly higher risk of disability over time. Intervention studies are needed to prevent functional decline in this high-risk population.

Gender-dependent association of body mass index and waist circumference with disability in the Chinese oldest old

OBJECTIVES

To explore associations of BMI and waist circumference (WC) with disability among the Chinese oldest old.

METHODS

The 5,495 oldest old in the sixth wave of Chinese Longitudinal Healthy Longevity Study conducted in 2011 were included in this study. Disability was assessed by activities of daily living (ADL); height and weight for BMI and WC were measured; information including socio-demographics, lifestyles, and health status was collected.

RESULTS

Generalized additive models analysis showed that the association of BMI/WC with ADL disability was nonlinear. Among the males, logistic regression results supported a "J" shape association between ADL disability with BMI/WC-the highest tertile group in BMI or WC was significantly associated with an increased risk of ADL disability: odds ratio 1.78 (95% confidence interval (CI): 1.26-2.52) for BMI and 2.01 (95% CI: 1.44-2.82) for WC. Among females, an inverse "J" shape association was found, only the lowest tertile group before the cutoff point had an increased risk of ADL disability: odds ratio 1.42 (95%CI: 1.02-1.97) for BMI and 1.47 (95% CI:1.06-2.04) for WC.

CONCLUSIONS

Associations of BMI and WC with ADL disability are significant even in the oldest old, but differ between the genders.

Continued sedentariness, change in sitting time, and mortality in older adults

PURPOSE

Prolonged sitting time (ST) is associated with higher mortality. However, previous studies used only a single measure of ST at baseline, so they could not directly assess the effect of continued exposure to high ST, or of changes in ST, on mortality. We prospectively assessed the association of continued sedentariness and of changes in ST for 2 yr with subsequent long-term all-cause mortality.

METHODS

This study was based on a prospective cohort of 2635 persons representative of the Spanish population 60 yr and older. ST was self-reported in 2001 and 2003. The median of ST was used as the cutoff to define excessive ST. Individuals were classified as consistently sedentary (> median in 2001 and 2003), newly sedentary (≤ median in 2001 and > median in 2003), formerly sedentary (> median in 2001 and ≤ median in 2003), and consistently nonsedentary (≤ median in 2001 and 2003). The association of ST in the period 2001-2003 with all-cause mortality from 2003 through 2011 was assessed with Cox regression and adjusted for the main confounders, including physical activity.

RESULTS

Among the study participants, 846 died between 2003 and 2011. Compared with persons who were consistently sedentary, the hazard ratios (95% confidence interval) for mortality were 0.91 (0.76-1.10) in those who were newly sedentary, 0.86 (0.70-1.05) in formerly sedentary individuals, and 0.75 (0.62-0.90) in those who remained consistently nonsedentary. The results were similar across strata defined according to obesity, morbidity, functional limitations, or meeting recommendations for physical activity.

CONCLUSION

Compared with older adults who were consistently sedentary during 2 yr, consistently nonsedentary individuals showed reduced all-cause mortality. Individuals who changed ST experienced an intermediate reduction in mortality.

Nutritional risk, nutritional status and incident disability in older adults. The FRADEA study

OBJECTIVES

To analyze if body mass index (BMI) and waist circumference (WC) as measures of nutritional status, and the Mini Nutritional Assessment Short Form (MNA-SF) as a nutritional risk measure are associated with increased risk of incident disability in basic activities of daily living (BADL) in a population based cohort of Spanish older adults.

DESIGN

Concurrent cohort study.

SETTING

Albacete City, Spain.

PARTICIPANTS

678 subjects over age 70 from the FRADEA Study (Frailty and Dependence in Albacete).

MEASUREMENTS

BMI, WC and MNA-SF were recorded at the basal visit of the FRADEA Study. Incident disability in BADL was defined as loss of the ability to perform bathing, grooming, dressing, toilet use, or feeding from basal to follow-up visit, using the Barthel index. The association between nutritional status and nutritional risk with incident BADL disability was determined by Kaplan-Meier analysis and logistic regression adjusted for age, sex, basal function, comorbidity, cognitive decline, depression risk and frailty status.

RESULTS

Each point less of MNA-SF (OR 1.17, 95%CI 1.04-1.31) and MNA-SF<14 (OR 2.33, 95%CI 1.39-3.89), but not MNA-SF<12 (OR 1.47, 95%CI 0.89-2.42) had a greater adjusted risk of incident disability in BADL. Neither BMI (OR 1.02, 95%CI 0.97-1.06) nor WC (OR 1.01, 95%CI 0.99-1.03) were associated. Weight loss (OR 1.75, 95%CI 1.08-2.83) and mobility impairment (OR 3.35, 95%CI 1.67-6.73) remained as adjusted predictors of incident BADL disability, while anorexia almost reached the significance (OR 1.65, 95%CI 0.94-2.87).

CONCLUSION

Nutritional risk measured with the MNA-SF is associated with incident disability in BADL in older adults, while nutritional status measured with BMI or WC is not.