Height and body weight in the elderly. I. A 25-year longitudinal study of a population aged 70 to 95 years

Association between physical activity, growth differentiation factor 15 and bodyweight in older adults: A longitudinal mediation analysis

BACKGROUND

Late-life aging is often associated with appetite reduction and weight loss. Physical activity (PA) may prevent these processes, but the molecular mechanisms involved remain elusive. The present study investigated the putative mediating aspect of growth differentiation factor 15 (GDF-15), a stress signalling protein involved in aging, exercise and appetite control, on the association between PA and late-life-associated weight loss.

METHODS

One thousand eighty-three healthy adults (63.8% women) aged 70 years and over who participated in the Multidomain Alzheimer Preventive Trial were included. Bodyweight (kg) and PA levels (square root of metabolic equivalent of task-min/week) were assessed repeatedly from baseline to the 3-year visit, whereas plasma GDF-15 (pg/mL) was measured at the 1-year visit. Multiple linear regressions were performed to test the association between first-year mean PA level, 1-year visit GDF-15 concentration and subsequent bodyweight changes. Mediation analyses were used to investigate whether GDF-15 mediated the association between first-year mean PA levels and consecutive bodyweight changes.

RESULTS

Multiple regression analyses demonstrated that higher first-year mean PA levels significantly predicted lower GDF-15 and bodyweight at 1 year (B = -2.22; SE = 0.79; P = 0.005). In addition, higher 1-year visit GDF-15 levels were associated with faster subsequent bodyweight loss (Time × GDF-15 interaction B = -0.0004; SE = 0.0001; P = 0.003). Mediation analyses confirmed that GDF-15 mediated the association between first-year mean PA levels and subsequent bodyweight changes (mediated effect ab = 0.0018; bootstrap SE = 0.001; P < 0.05) and revealed that mean PA had no direct effect on subsequent bodyweight changes (c' = 0.006; SE = 0.008; P > 0.05).

CONCLUSIONS

This study suggests that GDF-15 may be one of the molecules mediating the link between PA and late-life weight loss, but mechanistic studies are necessary to further support the present findings.

Do brachycephaly and nose size predict the severity of obstructive sleep apnea (OSA)? A sample-based geometric morphometric analysis of craniofacial variation in relation to OSA syndrome and the role of confounding factors

Obstructive sleep apnea is a common disorder that leads to sleep fragmentation and is potentially bidirectionally related to a variety of comorbidities, including an increased risk of heart failure and stroke. It is often considered a consequence of anatomical abnormalities, especially in the head and neck, but its pathophysiology is likely to be multifactorial in origin. With geometric morphometrics, and a large sample of adults from the Study for Health in Pomerania, we explore the association of craniofacial morphology to the apnea-hypopnea index used as an estimate of obstructive sleep apnea severity. We show that craniofacial size and asymmetry, an aspect of morphological variation seldom analysed in obstructive sleep apnea research, are both uncorrelated to apnea-hypopnea index. In contrast, as in previous analyses, we find evidence that brachycephaly and larger nasal proportions might be associated to obstructive sleep apnea severity. However, this correlational signal is weak and completely disappears when age-related shape variation is statistically controlled for. Our findings suggest that previous work might need to be re-evaluated, and urge researchers to take into account the role of confounders to avoid potentially spurious findings in association studies.

Comparison of body fat percentage assessments by bioelectrical impedance analysis, anthropometrical prediction equations, and dual-energy X-ray absorptiometry in older women

Background

Individuals with high body fat have a higher risk of mortality. Numerous anthropometric-based predictive equations are available for body composition assessments; furthermore, bioelectrical impedance analysis (BIA) estimates are available. However, in older adults, the validity of body fat estimates requires further investigation.

Objective

To assess the agreement between percentage body fat (BF%) estimates by BIA and five predictive equations based on anthropometric characteristics using dual X-ray absorptiometry (DXA) as reference method. A secondary objective was to identify whether excluding short-stature women improves the agreement of BF% estimates in a group of community-dwelling, older Mexican women.

Methods

A concordance analysis of BF% was performed. A total of 121 older women participated in the study. Anthropometric information, BIA, and DXA body composition estimates were obtained. Five equations using anthropometric data were evaluated in order to determine body fat percentage (BF%) using DXA as reference method. Paired t-test comparisons and standard error of estimates (SEE) were obtained. The Bland-Altman plot with 95% limits of agreement and the concordance correlation coefficient (CCC) were used to evaluate the BF% prediction equations and BIA estimates.

Results

The mean age of the study participants was 73.7 (±5.8) years old. BIA and the anthropometric based equations examined showed mean significant differences when tested in the entire sample. For the taller women (height > 145 cm), no significant difference in the paired comparison was found between DXA and BIA of BF% estimates. The mean BF% was 40.3 (±4.8) and 40.7 (±6.2) for DXA and BIA, respectively. The concordance between methods was good (CCC 0.814), (SEE 2.62). Also, in the taller women subset, the Woolcott equation using waist-to-height ratio presented no significant difference in the paired comparison; however, the error of the estimates was high (SEE 3.37) and the concordance was moderate (CCC 0.693).

Conclusion

This study found that BIA yielded good results in the estimation of BF% among women with heights over 145 cm. Also, in this group, the Woolcott predictive equation based on waist circumference and height ratio showed no significant differences compared to DXA in the paired comparison; however, the large error of estimates observed may limit its application. In older women, short stature may impact the validity of the body fat percentage estimates of anthropometric-based predictive equations.

Relationship Between Handgrip Strength and Age in the Body Composition Variables Among People Living with HIV

BACKGROUND

The study of aging and handgrip strength (HGS) is important to gain knowledge regarding health care and quality of life in people living with HIV (PLHIV).

OBJECTIVE

The aim of the study is to analyze the relationship between HGS and age in the body composition variables of PLHIV.

METHODS

The sample consisted of 77 PLHIV, divided into three groups: G40 - PLHIV aged 40-49 years (n=39); G50 - PLHIV aged 50-59 years (n=26); and G60 - PLHIV aged 60-69 years (n=12). Data collection included anamnesis (sociodemographic, clinical, and laboratory information), physical assessment (body composition and HGS), and physical activity level. Data were analyzed by descriptive and inferential statistics.

RESULTS

It was noted that men, compared to women, are 5.85 times more likely to present adequate HGS (p<0.001). In addition, adequate HGS was associated with adequate values of body mass index (p<0.001), waist circumference (p<0.001), and fat percentage (p<0.001). The G40 and G50 groups, in relation to the G60, were associated with adequate abdominal circumference (p=0.04).

CONCLUSION

Monitoring the evolution of HGS in PLHIV, over time, makes it possible to infer about body fat and muscle mass, in order to propose prevention actions and guidelines to prevent early muscle loss, the development of overweight/obesity, and abdominal obesity.

Growing taller unequally? Adult height and socioeconomic status in Spain (Cohorts 1940–1994)

Socioeconomic inequalities and their evolution in different historical contexts have been widely studied. However, some of their dimensions remain relatively unexplored, such as the role played by socioeconomic status in the trajectory of biological living standards, especially net nutritional status. The main objective of this article is to analyze whether the power of socioeconomic status (SES) to explain differences in the biological dimensions of human well-being (in this case, adult height, a reliable metric for health and nutritional status) has increased or diminished over time. Educational attainment and occupational category have been used as two different proxies for the SES of Spanish men and women born between 1940 and 1994, thus covering a historical period in Spain characterized by remarkable socioeconomic development and a marked increase in mean adult height. Our data is drawn from nine waves of the Spanish National Health Survey and the Spanish sample of two waves of the European Health Interview Survey (ENSE) for the period 1987 to 2017 (N = 73,699 citizens aged 23–47). A multivariate regression analysis has been conducted, showing that, as a whole, height differentials by educational attainment have diminished over time, whereas differences by occupational category of household heads have largely persisted. These results indicate the need for further qualification when describing the process of convergence in biological well-being indicators across social groups. For instance, the progressive enrollment of a greater proportion of the population into higher educational levels may lead us to underestimate the real differences between socioeconomic groups, while other proxies of SES still point to the persistence of such differences.

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Different SES impact on nutritional status according to SES operationalization.

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Significant reduction in height differentials by educational attainment over time.

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Height differentials largely persist by social class over time.

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Evidence is provided on recent halt of upward intergenerational growth in Spain.

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Mean cohort height stagnation not due to increases in social groups' differentials.

Anthropometric Equations to Determine Maximum Height in Adults ≥ 60 Years: A Systematic Review

Although it is common to measure bone lengths for study, methodological errors in data measurement and processing often invalidate their clinical and scientific usefulness. This manuscript reviews the validity of several published equations used to determine the maximum height in older adults, since height is an anthropometric parameter widely employed in health sciences. A systematic review of original articles published in the English, Spanish, or Portuguese languages was performed in PubMed, ScienceDirect, EBSCO, Springer Link, and two institutional publisher integrators (UACJ and CONRICYT). The search terms were included in the metasearch engines in a combined way and text form using the Boolean connectors AND and OR {(Determination OR Estimation OR Equation) AND Height AND (Elderly OR "Older adults")}. Eleven manuscripts were selected from 1935 records identified through database searching after applying the following criteria: (1) original articles that designed and validated equations for the determination of height by anthropometric methods in adults 60 years of age and older and (2) manuscripts that presented robust evidence of validation of the proposed regression models. The validity of the reported linear regression models was assessed throughout a manuscript review process called multi-objective optimization that considered the collection of the models, the prediction errors, and the adjustment values (i.e., R², standard error of estimation, and pure error). A total of 64 equations were designed and validated in 45,449 participants (57.1% women) from four continents: America (85.3%, with 46 equations), Asia (8.1%, with 10), Europe (4.6%, with 7), and Africa (2.0%, with 1); the Hispanic American ethnic group was the most numerous in participants and equations (69.0%, with 28). Due to various omissions and methodological errors, this study did not find any valid and reliable equations to assess the maximum height in older adults by anthropometric methods. It is proposed to adjust allometric mathematical models that can be interpreted in the light of ontogenetic processes.

Evaluation of an alternative skeletal muscle index for skeletal muscle mass assessment in a group of Australian women

Background

Sarcopenia is assessed by several methods, including dual energy X-ray absorptiometry (DEXA), which provide a height-adjusted skeletal muscle index (H-SMI). A SMI 2 standard deviation below the young adult reference [1] combined with low muscle strength or performance is used to identify sarcopenia. As height declines with age, H-SMI may underestimate low skeletal muscle mass in the older population. Our study aims to evaluate an alternative SMI and to examine its relationship to grip strength in a group of Australian women.

Methods

Women from two cohorts were analysed. 2041 women had body composition data (112 had calf circumference, 137 had leg length measurements) without grip strength, and 49 women had grip strength measured (40 had body composition data).The relationship between leg length-adjusted SMI (LL-SMI) to grip strength and anthropometric variables to skeletal muscle mass by DEXA were examined by linear regression analysis.

Results

Cohort 1: Older women were compared to younger women. Older women were shorter but leg length did not differ between different age groups. H-SMI was not different between groups (P = 0.528). LL-SMI was lower in older women (P = 0.002). Cohort 2: LL-SMI was significantly associated with grip strength (P = 0.048) after adjustment for age.

Conclusion

Older women were shorter, while leg length did not differ from the younger group. H-SMI may obscure and may underestimate low muscle mass in older individuals. LL-SMI may be a better measure of skeletal muscle mass in older individuals. These alternate SMI would benefit from further exploration in older individuals.

Preferences of seniors living in selected Baltic Sea region countries towards the use of indoor public space furniture

Demographic changes can be observed all over the world. The number of seniors located in the societies of well-developed countries continues to rise. Both enterprises and governments need to be prepared for such changes. Consequently, public spaces need to evolve to reduce problems related to ageism and be friendly to all. Much attention is currently being paid to finding solutions for redesigning public spaces and adjusting them to the needs and requirements of senior citizens. To identify the preferences of seniors in relation to the characteristics of furniture in indoor public spaces, a survey study with 1539 respondents aged 60+ was conducted in Denmark, Finland, Latvia, Poland, Russia and Sweden. The gathered data were coded and implemented to the unified database. The statistical grouping method was used to recognize the characteristics of the needs and attitudes of seniors related to the use of public space furniture. The main variables taken into consideration in the analysis were the age and gender of respondents and their country of living. Among the most important findings are those indicating the necessity to provide the increased number of furniture for sitting in the public spaces and making sure they are not located too far away from each other. As the main disadvantages of public space furniture respondents indicated the lack of armrests or other solutions to facilitate getting up and/or sitting down, as well as profiled backrests that constitute solid support for the spine. The implementation of these data in the process of rethinking and redesigning public spaces may support the adaptation of indoor public furniture according to the requirements of a very large group of customers, namely, seniors.

Anthropometry as a readily accessible health assessment of older adults

Anthropometry (derived from the Greek Anthropos: human, and metron: measure) refers to the systematic collection, and measurement of the physical characteristics of the human body, primarily body weight, body size, and shape. Anthropometric values are closely related to genetic factors, environmental characteristics, social, and cultural conditions, lifestyle, functional status, and health. Anthropometric measurements can be used to assess risk of malnutrition, obesity, muscle wasting, increased fat mass, and maldistribution of adipose tissue. Potential modifiable factors include circumferences, skinfolds, and body weight. While are height, and the bone diameters are non-modifiable. Kinanthropometry is the study of size, shape, proportionality, composition, biological maturation, and body function, in order to understand the process of growth, exercise, sports performance, and nutrition. Aging of the population, which is associated with increased risk of chronic disease, and disability, is one of the most important demographic changes facing many countries. Anthropometric indicators are simple, portable, non-invasive, inexpensive, and easily applied measurements that can be readily applied in geriatric populations to guide preventative measures, and medical interventions in older adults.

A review of foot finite element modelling for pressure ulcer prevention in bedrest: Current perspectives and future recommendations

Pressure ulcers (PUs) are a major public health challenge, having a significant impact on healthcare service and patient quality of life. Computational biomechanical modelling has enhanced PU research by facilitating the investigation of pressure responses in subcutaneous tissue and skeletal muscle. Extensive work has been undertaken on PUs on patients in the seated posture, but research into heel ulcers has been relatively neglected. The aim of this review was to address the key challenges that exist in developing an effective FE foot model for PU prevention and the confusion surrounding the wide range of outputs reported. Nine FE foot studies investigating heel ulcers in bedrest were identified and reviewed. Six studies modelled the posterior part of the heel, two included the calf and foot, and one modelled the whole body. Due to the complexity of the foot anatomy, all studies involved simplification or assumptions regarding parts of the foot structure, boundary conditions and material parameters. Simulations aimed to understand better the stresses and strains exhibited in the heel soft tissues of the healthy foot. The biomechanical properties of soft tissue derived from experimental measurements are critical for developing a realistic model and consequently guiding clinical decisions. Yet, little to no validation was reported in each of the studies. If FE models are to address future research questions and clinical applications, then sound verification and validation of these models is required to ensure accurate conclusions and prediction of patient outcomes. Recommendations and considerations for future FE studies are therefore proposed.

Prediction equations for estimating body weight in older adults

BACKGROUND

Assessing body weight in older adults may be challenging. Hence, the present study aimed to develop and cross-validate updated and reproducible equations to estimate body weight in a large sample of older adults, namely among the older-old.

METHODS

In total, 1456 individuals aged ≥ 65 years, from the Nutrition UP 65 study, were included in the present analysis. The participants were randomly assigned to one of two sub-samples: development (n = 991) and validation samples (n = 465). Prediction equations using height, mid-upper arm circumference (MUAC), waist circumference (WC), calf circumference (CC) and triceps skinfold thickness (TST) were generated for the development sample using multiple regression analysis and then validated using the validation sample.

RESULTS

The model with five predictor variables generated the following equations: females 65-79 years: -114.682 + 0.522 × height (cm) + 0.620 × MUAC (cm) + 0.517 × WC (cm) + 0.893 × CC (cm) + 0.111 × TST (mm) (adjusted r²  = 0.883, standard error of the estimate (SEE) = 4.4); females ≥ 80 years: -110.806 + 0.494 × height (cm) + 0.637 × MUAC (cm) + 0.500 × WC (cm) + 0.986 × CC (cm) + 0.021 × TST (mm) (adjusted r²  = 0.890, SEE = 3.9); males 65-79 years: -114.875 + 0.558 × height (cm) + 0.073 × MUAC (cm) + 0.671 × WC (cm) + 0.717 × CC (cm) + 0.182 × TST(mm) (adjusted r²  = 0.820, SEE=5.0); and males ≥ 80 years: -128.789 + 0.546 × height (cm) + 0.202 × MUAC (cm) + 0.612 × WC (cm) + 1.236 × CC (cm) + 0.093 × TST (mm) (adjusted r²  = 0.906, SEE = 3.5).

CONCLUSIONS

Body weight can be estimated with good accuracy in older adults using these sex- and age-specific equations generated from regression models using three to five anthropometric predictor variables.

Moderating effect of age on the relationships between pre-frailty and body measures

This study aims to investigate the relationship between body measures and the presence of two frailty-related phenotypes, and the moderating effect of age on this relationship. This is a secondary data analysis of the baseline data of an interventional study. The participants were residents of seven districts in Hong Kong, aged 55 or older, able to ambulate independently and to function well cognitively. Pre-frailty refers to the presence of two frailty-related phenotypes: low physical activity or poor handgrip strength or both. Included in the study were 199 individuals with a mean age of 73.43 (SD 7.54). Regression models showed that body weight (OR = 0.95, 95% CI 0.92-0.99, p < .05) was significantly associated with pre-frailty, as was body height (OR = 0.88, 95% CI 0.83-0.94, p < .001). Age is a significant moderator of the relationship between pre-frailty and body weight and body height. The effect of body weight (beta = -0.044, p < .05) and height (beta = -0.16, p < .001) on pre-frailty was significant and negative in the younger age groups. The findings indicate that raw body measures (i.e. body weight, body height) are more predictive of pre-frailty than BMI in older Chinese people. However, in the old-old group, these measures are not significant predictors of pre-frailty in Chinese community-dwelling adults. Practitioners should consider adopting body measures as predictors of pre-frailty in the younger-old population.

Trajectories of Body Composition during Advanced Aging in Consideration of Diet and Physical Activity: A 20-Year Longitudinal Study

This prospective study investigates age-dependent changes in anthropometric data and body composition over a period of two decades in consideration of physical activity and diet in community-dwelling subjects ≥60 years. Overall, 401 subjects with median follow-up time of 12 years were examined. Fat-free mass (FFM) and fat mass (FM) were analyzed using bioelectrical impedance analysis. Physical activity was assessed via a self-administered questionnaire. Dietary intake was examined by 3-day dietary records. Linear mixed-effects models were used to analyze the influence of age, sex, physical activity and energy/protein intake on anthropometric data and body composition by considering year of entry, use of diuretics and diagnosis of selected diseases. At baseline, median values for daily energy and protein intakes were 8.5 megajoule and 81 g and physical activity index was 1.7. After adjusting for covariates, advancing age was associated with parabolic changes indicating overall changes from age 60 to 90 years in women and men in body mass: −4.7 kg, −5.0 kg; body mass index: +0.04 kg/m², −0.33 kg/m²; absolute FFM: −2.8 kg, −3.5 kg; absolute FM: −1.8 kg, −1.2 kg and waist circumference: +16 cm, +12 cm, respectively. No age-dependent changes were found for upper arm circumference and relative (%) FFM. Dietary and lifestyle factors were not associated with changes in anthropometric or body composition parameters. In summary, the results indicate non-linear age-dependent changes in anthropometric data and body composition, which are largely unaffected by the degree of habitual physical activity and dietary protein intake in well-nourished community-dwelling subjects.

Association between obesity and education level among the elderly in Taipei, Taiwan between 2013 and 2015: a cross-sectional study

The inverse association between obesity and education level has been demonstrated in many developed countries; however, few studies have investigated obesity in geriatric populations. This cross-sectional analysis explored the association between geriatric obesity and education level, along with other demographic characteristics in Taipei, Taiwan between 2013 and 2015. Taipei citizens ≥ 65 years (aborigines ≥ 55 years) were recruited to participate in the elderly health examination programme. Logistic regression was applied to analyse the relationship between obesity (defined as body mass index ≥ 27 kg/m² in Taiwan) and education level among men and women after controlling for age, race, income status, and smoking status. A total of 28,092 men and 31,835 women were included in the final analysis. Compared to those with education years ≥ 16, older men and women with education years ≤ 12 had higher odds of being obese. The odds ratios increase as years of education decrease, and the trend is more pronounced among women. Aborigines had much higher chances of being obese among men and women, while there were no differences by income status. The results clarified the factors related to obesity in the elderly, and will be useful for authorities working to improve health outcomes among this population.

Evidence of Bidirectional Associations Between Depressive Symptoms and Body Mass Among Older Adults

OBJECTIVES

Body fat, measured with body mass index (BMI), and obesity are associated with depressive symptoms. Among younger adults there is stronger evidence of obesity leading to depressive symptoms than of depressive symptoms leading to obesity, but the temporal relationship is unknown among older adults. This study utilized dual-change-score models (DCSMs) to determine the directional relationship between body mass and depressive symptoms among older adults.

METHOD

Participants (n = 1,743) from the Swedish Twin Registry (baseline age range 50-96 years) completed at least one assessment of BMI (nurse measurement of height and weight) and the Center for Epidemiologic Studies-Depression scale (CESD). More than half the sample completed 3 or more assessments, scheduled at intervals of 2-4 years. DCSMs modeled the relationship of BMI and CESD across age, both independently and as part of bivariate relationships.

RESULTS

Depressive symptoms contributed to subsequent changes in BMI after age 70, while BMI contributed to subsequent changes in depressive symptoms after age 82. Thus, there is a reciprocal relationship that may change with age. The effect was more pronounced for women.

DISCUSSION

The association of BMI and depressive symptoms is bidirectional among older adults, and it appears to be affected by both age and sex.

Repository Describing an Aging Population to Inform Physiologically Based Pharmacokinetic Models Considering Anatomical, Physiological, and Biological Age-Dependent Changes

BACKGROUND

Aging is characterized by anatomical, physiological, and biological changes that can impact drug kinetics. The elderly are often excluded from clinical trials and knowledge about drug kinetics and drug-drug interaction magnitudes is sparse. Physiologically based pharmacokinetic modeling can overcome this clinical limitation but detailed descriptions of the population characteristics are essential to adequately inform models.

OBJECTIVE

The objective of this study was to develop and verify a population database for aging Caucasians considering anatomical, physiological, and biological system parameters required to inform a physiologically based pharmacokinetic model that included population variability.

METHODS

A structured literature search was performed to analyze age-dependent changes of system parameters. All collated data were carefully analyzed, and descriptive mathematical equations were derived.

RESULTS

A total of 362 studies were found of which 318 studies were included in the analysis as they reported rich data for anthropometric parameters and specific organs (e.g., liver). Continuous functions could be derived for most system parameters describing a Caucasian population from 20 to 99 years of age with variability. Areas with sparse data were identified such as tissue composition, but knowledge gaps were filled with plausible qualified assumptions. The developed population was implemented in Matlab^® and estimated system parameters from 1000 virtual individuals were in accordance with independent observed data showing the robustness of the developed population.

CONCLUSIONS

The developed repository for aging subjects provides a singular specific source for key system parameters needed for physiologically based pharmacokinetic modeling and can in turn be used to investigate drug kinetics and drug-drug interaction magnitudes in the elderly.

Senescence and Longevity of Sea Urchins

Sea urchins are a minor class of marine invertebrates that share genetic similarities with humans. For example, the sea urchin species Strongylocentrotus purpuratus is estimated to have 23,300 genes in which the majority of vertebrate gene families are enveloped. Some of the sea urchin species can demonstrate extreme longevity, such as Mesocentrotus franciscanus, living for well over 100 years. Comparing human to sea urchin aging suggests that the latter do not fit within the classic understanding of biological aging, as both long- and short-lived sea urchin species demonstrate negligible senescence. Sea urchins are highly regenerative organisms. Adults can regenerate external appendages and can maintain their regenerative abilities throughout life. They grow indeterminately and reproduce throughout their entire adult life. Both long- and short-lived species do not exhibit age-associated telomere shortening and display telomerase activity in somatic tissues regardless of age. Aging S. purpuratus urchins show changes in expression patterns of protein coding genes that are involved in several fundamental cellular functions such as the ubiquitin-proteasome system, signaling pathways, translational regulation, and electron transport chain. Sea urchin longevity and senescence research is a new and promising field that holds promise for the understanding of aging in vertebrates and can increase our understanding of human longevity and of healthy aging.

Anthropometric heritability and child growth in a Caribbean village: A quantitative genetic analysis of longitudinal height, weight, and body mass index in Bwa Mawego, Dominica

OBJECTIVES

Body size and composition vary widely among individuals and populations, and long-term research in diverse contexts informs our understanding of genetic, cultural, and environmental impacts on this variation. We analyze longitudinal measures of height, weight, and body mass index (BMI) from a Caribbean village, estimating the extent to which these anthropometrics are shaped by genetic variance in a small-scale population of mixed ancestry.

MATERIALS AND METHODS

Longitudinal data from a traditionally horticultural village in Dominica document height and weight in a non-Western population that is transitioning to increasingly Westernized lifestyles, and an 11-generation pedigree enables us to estimate the proportions of phenotypic variation in height, weight, and BMI attributed to genetic variation. We assess within-individual variation across growth curves as well as heritabilities of these traits for 260 individuals using Bayesian variance component estimation.

RESULTS

Age, sex, and secular trends account for the majority of anthropometric variation in these longitudinal data. Independent of age, sex, and secular trends, our analyses show high repeatabilities for the remaining variation in height, weight, and BMI growth curves (>0.75), and moderate heritabilities (h² _height = 0.68, h² _weight = 0.64, h² _BMI = 0.49) reveal clear genetic signals that account for large proportions of the variation in body size observed between families. Secular trends show increases of 6.5% in height and 16.0% in weight from 1997 to 2017.

DISCUSSION

This horticultural Caribbean population has transitioned to include more Westernized foods and technologies over the decades captured in this analysis. BMI varies widely between individuals and is significantly shaped by genetic variation, warranting future exploration with other physiological correlates and associated genetic variants.

＜Editors' Choice＞ Ultrasound measurement of thigh muscle thickness for assessment of sarcopenia

Our aim of this study is to compare the thigh muscle thickness measurements obtained using ultrasound and bioelectrical impedance analysis (BIA) methods, and to investigate the validity and cutoff value of the ultrasonography. We analyzed a total of 201 participants (99 male and 102 female participants, mean age, 66.2 years) participated in the annual health checkup in the Yakumo Study, 2014. Thigh muscle thickness (TMT, sum of the rectus femoris and vastus intermedius muscle thickness) was measured using ultrasound at mid-thigh in the sitting position. Appendicular skeletal muscle mass (aSMI) was measured using BIA. Cutoff value of TMT was determined through the receiver operating characteristic analysis. We defined sarcopenia with the diagnostic algorithm of Asian Working Group for Sarcopenia. TMT was significantly reduced in subject with sarcopenia than in those without sarcopenia in both gender. Muscle measurements obtained using the BIA methods (aSMI) and ultrasound methods (TMT) showed a significant correlation, with a correlation coefficient of 0.38 (P < 0.001). Cutoff value, sensitivity, and specificity of TMT in diagnosis of muscle loss were 36 mm, 72.0%, and 73.9%, respectively, for the male participants, and 34 mm, 72.2%, and 72.4%, respectively, for the female participants. In conclusion, the ultrasonography for thigh muscle might be a simple diagnostic method for sarcopenia.

Residential relocation and obesity after a natural disaster: A natural experiment from the 2011 Japan Earthquake and Tsunami

Natural disasters are often associated with forced residential relocation, thereby affected people experience a change of food environment that results in the increased body mass index. However, there are a few studies that examined whether a change in food environment caused risk of obesity after a natural disaster. To address this question, we leveraged a natural experiment of residential relocation in the aftermath of the 2011 Japan Earthquake and Tsunami. Our baseline data came from a nationwide cohort study of older community-dwelling adults conducted 7 months prior to the disaster. By chance, one of the field sites (Iwanuma City, Miyagi Prefecture) was directly in the line of the tsunami. Approximately 2.5 years after the disaster, we ascertained the residential addresses and health status of 3,594 survivors aged 65 years or older (82.1% follow-up rate). Fixed effects multinomial logistic regression showed that shortened distances to food outlets/bars increased the risks of transitioning from BMI in the normal range (18.5–22.9) to obesity (≥25.0) (Odds ratios: 1.46 for supermarkets; 1.43 for bars; 1.44 times for fast food outlets). Radically changed food access after a natural disaster may raise the risk of obesity among older survivors.

Nutritional Status and Cognitive Impairment among the Very Old in a Community Sample from Southern Brazil

OBJECTIVE

To determine which factors, especially those related to nutrition, are associated with cognitive function in the oldest old, here considered those at least 80 years of age.

DESIGN

A cross-sectional, population-based study.

SETTING

Veranópolis, Rio Grande do Sul, Brazil, and surrounding rural areas.

PARTICIPANTS

Individuals aged 80 years and older.

MEASUREMENTS

The Mini Nutritional Assessment, anthropometric measurements, and serum levels of albumin and vitamin B12 were associated with cognitive function according to the Mini Mental State Examination (MMSE) and the Clock Drawing Test (CDT). Socio-demographic data were obtained through a structured questionnaire. Multivariate analysis was used to determine the associations.

RESULTS

According to the MMSE and the CDT, the prevalence of cognitive impairment was 47.7% [95%CI 39.7-55.7] and 58.2% [95%CI 50.3-66.1], respectively. In the adjusted analysis, the only positive linear association with MMSE scores indicating cognitive impairment was age. However, CDT scores indicating cognitive impairment were five times higher among those with low serum vitamin B12 concentrations. For the other variables, there was a positive association between age, being widowed, a low educational level and central nervous system drugs. Being single, living with children and living alone were protective factors for cognitive impairment.

CONCLUSIONS

Although cognitive impairment was positively associated with old age, being widowed and low educational level in this population, the only nutritional variable positively associated with cognitive impairment was a low vitamin B12 concentration.

Mid-upper arm circumference, calf circumference and mortality in Chinese long-term care facility residents: a prospective cohort study

OBJECTIVE

To investigate the association between mid-upper arm circumference (MUAC), calf circumference (CC) and all-cause mortality in a Chinese population.

DESIGN

Prospective cohort study.

SETTING

Eight long-term care facilities in central Taiwan.

PARTICIPANTS

A total of 329 residents age 60 years and older (median 79.0 years, range 60-101; 139 men, 190 women) were enrolled.

METHODS

Anthropometrics and metabolic parameters were measured at the time of enrolment to the study. Mean MUAC and CC were 24.2±3.4 cm and 27.5±4.3 cm, respectively. Mortality data were obtained from the Department of Health in Taiwan.

MAIN OUTCOME MEASURE

To identify the association between all-cause mortality and MUAC or CC.

RESULTS

There were 255 deaths during the 7-year follow-up period. After adjusting for age, sex, cigarette smoking, betel nut chewing, alcohol use, Karnofsky Performance Status Scale score, serum albumin level, hypertension and diabetes mellitus, subjects in the highest tertile of MUAC (27.8±2.2 cm) and CC (32.1±2.6 cm) had a significantly lower mortality rate than did subjects in the lowest tertile (MUAC 20.6±1.7 cm; CC 22.8±1.9 cm). The adjusted HR for all-cause mortality in the highest versus lowest MUAC tertile was 0.64 (95% CI 0.45 to 0.90). The adjusted HR for all-cause mortality in the highest versus lowest CC tertile was 0.51 (95% CI 0.35 to 0.74).

CONCLUSIONS

MUAC and CC are negative predictors for all-cause mortality in older Chinese adults living in long-term care facilities. Participants with higher MUAC and CC had lower all-cause mortality.

Obesity is not associated with recurrent venous thromboembolism in elderly patients: Results from the prospective SWITCO65+ cohort study

Background

Whether obesity is associated with recurrent venous thromboembolism (VTE) in elderly patients is unknown.

Objectives

To examine the association between two obesity measures, the body mass index (BMI) and the waist circumference (WC), and recurrent VTE in elderly patients.

Patients/Methods

We studied 986 patients aged ≥65 years with an acute VTE from a prospective multicenter cohort study (09/2009-12/2013). The BMI was determined and categorized as <25, 25 to <30, or ≥30 kg/m². The WC was categorized as <80 cm in women (w)/<94 cm in men (m), 80 to <88 cm (w)/94 to <102 cm (m), or ≥88 cm (w)/≥102 cm (m). We examined the association between the BMI and the WC and the time to a first symptomatic recurrent VTE using competing risk regression, adjusting for known risk factors of VTE recurrence and periods of anticoagulation.

Results

The mean follow-up was 28 months. The 3-year cumulative incidence of recurrent VTE did not vary by BMI and was 17.6% for a BMI <25 kg/m², 11.5% for a BMI 25 to <30 kg/m², and 16.9% for a BMI ≥30 kg/m² (P = 0.09). The 3-year cumulative incidence of recurrent VTE did not vary by WC. After adjustment, neither the BMI (sub-hazard ratio [SHR] 1.02, 95% confidence interval [CI 0.98–1.05]) nor the WC (SHR 1.01, 95% CI 0.99–1.02) was associated with recurrent VTE.

Conclusions

Measures of body weight were not associated with recurrent VTE in our cohort. Obesity does not appear to be a predictor of recurrent VTE in the elderly.

Anthropometric parameters and the incidence of atrial fibrillation in older people: the PRO.V.A study

BACKGROUND

Atrial fibrillation (AF) has been associated with body size and central obesity, but the impact of different anthropometric measures in this relationship has been inadequately investigated.

HYPOTHESIS

In this study, we examined the association between baseline anthropometric parameters with the incidence of AF in older people, hypothesizing that body size could impact the onset of AF more than fat distribution.

METHODS

Our study included 1764 participants with a mean age of 74.3 ± 6.9 years and no AF at baseline. Body mass index (BMI), body height, body surface area (BSA), waist and hip circumference, waist-to-stature ratio, waist-to-hip ratio, and mid-upper arm circumference (MUAC) were measured by trained physicians. AF was assessed after a 4.4-year follow-up.

RESULTS

There were 115 new cases of AF observed after the follow-up. Taking lower values of these measures for reference, the adjusted AF risk was 2.42 (95% confidence interval [CI]:1.88-3.12) for the highest stature quartile, 1.36 (95% CI:1.15-1.62) for BMI ≥30 kg/m2 , 2.12 (95% CI:1.73-2.59) for the highest BSA quartile, 1.38 (95% CI: 1.21-1.56) for higher MUAC, and 1.39 (95% CI: 1.23-1.58, P < 0.0001) for higher hip circumference values. Central obesity did not seem to relevantly predict the onset of AF in our sample. Stature revealed the strongest impact on the onset of AF (5% higher risk of developing AF per 1 cm increase in height).

CONCLUSIONS

Body size, particularly tall stature and obesity, but not fat distribution, seems to be associated with the risk of AF in the elderly.

Do sociodemographic, behavioral or health status variables affect longitudinal anthropometric changes in older adults? Population-based cohort study in Southern Brazil

AIM

To assess the influence of sociodemographic, behavioral and health status variables on longitudinal changes in height, weight, and waist circumference in older adults.

METHODS

This is a population-based cohort study in Southern Brazil (EpiFloripa Study) investigating 1702 individuals aged 70.6 ± 8.0 years (62.5% women). Height, weight and waist circumference were measured in 2009/10 and 2013/14 (n = 1197). Linear mixed regression models were used to estimate age-related changes in anthropometric measurements according to the explanatory variables.

RESULTS

Unmarried individuals, with higher education level or household income, with excessive alcohol consumption, former smokers and positives for some chronic disease were heavier than their counterparts. Similar associations were observed for waist circumference in terms of marital status, smoking and the presence of chronic diseases. Height was higher among the wealthiest, in former smokers and those physically active. Only in men were a lower education level and being unmarried associated with higher weight loss after the age of 75 years, but not with waist circumference reduction.

CONCLUSIONS

Despite their association with current height, weight and waist circumference, neither behavioral variables nor the presence of chronic diseases influenced the anthropometric changes. Less educated and unmarried men lose weight at a higher rate, showing a higher risk of sarcopenia. Geriatr Gerontol Int 2017; 17: 2074-2082.

Bioimpedance to screen for abdominal fat in patients with breast cancer treatment-related lymphedema

BACKGROUND

One of the dreaded complications after the treatment of breast cancer is lymphedema. Therapies used in the treatment of breast cancer such as surgery, radiotherapy, hormone therapy and chemotherapy may be adversely affected by obesity.

AIM

The objective of this study was to use bioimpedance to assess abdominal fat in women with breast cancer treatment-related lymphedema and suggest this as a screening method.

METHODS

Forty-five female patients with clinical diagnosis of breast cancer treatment-related lymphedema were evaluated in this quantitative cross-sectional study. A control group, composed of 38 patients with varicose veins and women attending a social support group, was matched for age and body mass index (BMI). All participants were submitted to a bioimpedance evaluation (In Body S 10), with particular attention being paid to abdominal fat and their BMI. The unpaired t -test, Fisher Exact test and Mann-Whitney test were used for statistical analysis and an alpha error of 5%.

RESULTS

There was no significant difference (p -value = 0.23) in the mean BMI between the study group (27.79 kg∕m2) and the control group (28.80 kg∕m2). The mean abdominal circumference, a measure of abdominal fat, of the women in the study group was 130.54 cm2 and for the control group it was 102.24 cm2 (p -value = 0.0037). Thus the study group had more abdominal fat (p -value = 0.0003). Moreover, on comparing obese patients in the two groups, the study group had more abdominal fat (p -value = 0.02). However, no significant difference was observed comparing non-obese patients (p -value = 0.6). The comparison of obese patients with non-obese patients in the control group identifies an association between obesity and abdominal fat (p -value < 0.04).

CONCLUSION

Overweight and obese women with breast cancer treatment-related lymphedema are more likely to have increased abdominal fat than the general population with bioimpedance.

Defining malnutrition: A plea to rethink

In a recent consensus report in Clinical Nutrition the undernourished category of malnutrition was proposed to be defined and diagnosed on the basis of a low BMI or unintentional weight loss combined with low BMI or FFMI with certain cut off points. The definition was endorsed by ESPEN despite recent endorsement of a very different definition. The approach aims to assess whether nutritional intake is sufficient but is imprecise because a low BMI does not always indicate malnutrition and individuals with increasing BMI's may have decreasing FFM's. The pathophysiology of individuals, considered to be malnourished in rich countries and in areas with endemic malnutrition, results predominantly from deficient nutrition combined with infection/inflammation. Both elements jointly determine body composition and function and consequently outcome of disease, trauma or treatment. When following the consensus statement only an imprecise estimate is acquired of nutritional intake without knowing the impact of inflammation. Most importantly, functional abilities are not assessed. Consequently it will remain uncertain how well the individual can overcome stressful events, what the causes are of dysfunction, how to set priorities for treatment and how to predict the effect of nutritional support. We therefore advise to consider the pathophysiology of malnourished individuals leading to inclusion of the following elements in the definition of malnutrition: a disordered nutritional state resulting from a combination of inflammation and a negative nutrient balance, leading to changes in body composition, function and outcome. A precise diagnosis of malnutrition should be based on assessment of these elements.

Body mass index, waist-hip ratio and risk of chronic medical condition in the elderly population: results from the Well-being of the Singapore Elderly (WiSE) Study

BACKGROUND

The aim of the current study was to establish the prevalence and relationship of Body Mass Index (BMI) and Waist-Hip Ratio (WHR) with chronic health conditions and their associated socio-demographic correlates in the elderly population of Singapore.

METHODS

The data was extracted from the Well-being of the Singapore Elderly (WiSE) study, a comprehensive single phase, cross-sectional, population-based, epidemiological study conducted in 2013 among Singaporean residents (n = 2565) aged 60 years and above with a mean age of 72.7 years (range 60 to 105, SD = 9.53). The respondents were assessed with anthropometric measurements including height, weight, BMI, waist circumference, hip circumference and WHR. Participants provided information on their socio-demographic details and chronic health conditions.

RESULTS

Prevalence of those who were obese, overweight, normal and underweight based on BMI was 8.7 %, 33.4 %, 52.5 % and 5.5 % respectively. Malays were more likely to be overweight compared to Chinese and Indians, while Malays and Indians were more likely to be obese compared to Chinese. Participants who were never married were less likely to be overweight compared to married. Participants aged 85 years and above were more likely to be underweight compared to those aged 60-75 years. Prevalence of high WHR (above 0.90 for men and 0.80 for women) was 79.8 % and this was more pervasive amongst Indians. Participants who were homemakers were more likely to have high WHR while those with tertiary education tended to have low WHR. Being overweight was associated with hypertension and heart problems, while obesity was associated with hypertension and diabetes, and a high WHR was associated with hypertension and diabetes. There were no significant differences in the other chronic conditions in this elderly population.

CONCLUSIONS

This study demonstrates the importance of anthropometric measurements in the elderly and its association with certain chronic physical conditions, indicating their utility in the clinical management of these conditions in the elderly.

Increased 1-year survival and discharge to independent living in overweight hip fracture patients: A prospective study of 843 patients

BACKGROUND AND PURPOSE

Hip fracture patients usually have low body mass index (BMI), and suffer further postoperative catabolism. How BMI relates to outcome in relatively healthy hip fracture patients is not well investigated. We investigated the association between BMI, survival, and independent living 1 year postoperatively.

PATIENTS AND METHODS

This prospective multicenter study involved 843 patients with a hip fracture (mean age 82 (SD 7) years, 73% women), without severe cognitive impairment and living independently before admission. We investigated the relationship between BMI and both 1-year mortality and ability to return to independent living.

RESULTS

Patients with BMI > 26 had a lower mortality rate than those with BMI < 22 and those with BMI 22-26 (6%, 16%, and 18% respectively; p = 0.006). The odds ratio (OR) for 1-year survival in the group with BMI > 26 was 2.6 (95% CI: 1.2-5.5) after adjustment for age, sex, and physical status. Patients with BMI > 26 were also more likely to return to independent living after the hip fracture (OR = 2.6, 95% CI: 1.4-5.0). Patients with BMI < 22 had similar mortality and a similar likelihood of independent living to those with BMI 22-26.

INTERPRETATION

In this selected group of patients with hip fracture, the overweight and obese patients (BMI > 26) had a higher survival rate at 1 year, and returned to independent living to a higher degree than those of normal (healthy) weight. The obesity paradox and the recommendations for optimal BMI need further consideration in patients with hip fracture.

Anthropometric reference data for elderly Swedes and its disease-related pattern

Background/Objectives:

Anthropometric measurement is a noninvasive and cost-efficient method for nutritional assessment. The study aims to present age- and gender-specific anthropometric reference data for Swedish elderly in relation to common medical conditions, and also formulate prediction equations for such anthropometric measurements.

Subjects/Methods:

A cross-sectional study among random heterogeneous sample of 3360 subjects, aged 60–99 years, from a population study ‘Good Aging in Scania. Means (±s.d.) and percentiles for height, weight, waist-, hip-, arm-, calf circumferences, triceps- (TST) and subscapular skinfold thickness (SST), body mass index (BMI), waist-hip ratio (WHR) and arm muscle circumference (AMC) were presented. The values were estimated based on the prevalence of myocardial infarction (MI), cardiac failure (CHF), stroke, cognitive impairment, dementia and dependence in daily living activities (ADL). Linear regression analysis was used to formulate the prediction equations.

Results:

Mean BMI was 27.5±5.8 kg/m² (men) and 27.2±8.1 kg/m² (women). WHR was higher among men (Men: 0.98±0.3, women: 0.87±0.2), except at age 85+ (women: 0.91±0.6). TST was 6.7±0.4 mm higher among women. Men with MI had BMI: 28.6±4.8 kg/m² and SST: 21±9.2 mm, whereas subjects with dementia had lower weight (by 9.5±2.9 kg) compared with the non-demented. ADL-dependent women had BMI= 29.0±3.9 kg/m², TST=19.2±1.3 mm.

Conclusion:

New normative data on gender- and age-specific anthropometrics on the general elderly population are presented. Cardiovascular diseases are associated with subcutaneous and central adiposity opposed to fat loss with dementia. ADL dependence indicates inadequate physical activity. The prediction models could be used as possible indicators monitoring physical activity and adiposity among the general elderly population hence potential health indicators in health promotion.

On the Mathematical Relationship Between Latent Change Score and Autoregressive Cross-Lagged Factor Approaches: Cautions for Inferring Causal Relationship Between Variables

The present paper focuses on the relationship between latent change score (LCS) and autoregressive cross-lagged (ARCL) factor models in longitudinal designs. These models originated from different theoretical traditions for different analytic purposes, yet they share similar mathematical forms. In this paper, we elucidate the mathematical relationship between these models and show that the LCS model is reduced to the ARCL model when fixed effects are assumed in the slope factor scores. Additionally, we provide an applied example using height and weight data from a gerontological study. Throughout the example, we emphasize caution in choosing which model (ARCL or LCS) to apply due to the risk of obtaining misleading results concerning the presence and direction of causal precedence between two variables. We suggest approaching model specification not only by comparing estimates and fit indices between the LCS and ARCL models (as well as other models) but also by giving appropriate weight to substantive and theoretical considerations, such as assessing the justifiability of the assumption of random effects in the slope factor scores.

Body composition and morphological assessment of nutritional status in adults: a review of anthropometric variables

Evaluation of body composition is an important part of assessing nutritional status and provides prognostically useful data and an opportunity to monitor the effects of nutrition-related disease progression and nutritional intervention. The aim of this narrative review is to critically evaluate body composition methodology in adults, focusing on anthropometric variables. The variables considered include height, weight, body mass index and alternative indices, trunk measurements (waist and hip circumferences and sagittal abdominal diameter) and limb measurements (mid-upper arm and calf circumferences) and skinfold thickness. The importance of adhering to a defined measurement protocol, checking measurement error and the need to interpret measurements using appropriate population-specific cut-off values to identify health risks were highlighted. Selecting the optimum method for assessing body composition using anthropometry depends on the purpose (i.e. evaluating obesity or undernutrition) and requires practitioners to have a good understanding of both practical and theoretical limitations and to be able to interpret the results wisely.

Association between fixation technique and revision risk in total hip arthroplasty patients younger than 55 years of age. Results from the Nordic Arthroplasty Register Association

OBJECTIVES

To evaluate implant survival following primary total hip replacement (THR) in younger patients. To describe the diversity in use of cup-stem implant combinations.

DESIGN

29,558 primary THRs osteoarthritis (OA) patients younger than 55 years of age performed from 1995 through 2011 were identified using the Nordic Arthroplasty Registry Association database. We estimated adjusted relative risk (aRR) of revision with 95% confidence interval (CI) using Cox regression.

RESULTS

In general, no difference was observed between uncemented and cemented implants in terms of risk of any revision. Hybrid implants were associated with higher risk of any revision (aRR = 1.3, CI: 1.1-1.5). Uncemented implants led to a reduced risk of revision due to aseptic loosening (aRR = 0.5, CI: 0.5-0.6), whereas the risk was similar for hybrid and cemented implants. Compared with cemented implants, both uncemented and hybrid implants led to elevated risk of revision due to other causes, as well as elevated risk of revision due to any reason within 2 years. 183 different uncemented cup-stem implant combinations were registered in Denmark, of these, 172 were used in less than 100 operations which is similar to Norway, Sweden and Finland.

CONCLUSIONS

Uncemented implants perform better in relation to long-term risk of aseptic loosening, whereas both uncemented and hybrid rather than cemented implants in patients younger than 55 years had more short-term revisions because problems due to dislocation, periprosthetic fracture and infection has not yet been completely solved. The vast majority of cup-stem combinations were used in very few operations.

Epicardial fat: definition, measurements and systematic review of main outcomes

Epicardial fat (EF) is a visceral fat deposit, located between the heart and the pericardium, which shares many of the pathophysiological properties of other visceral fat deposits, It also potentially causes local inflammation and likely has direct effects on coronary atherosclerosis. Echocardiography, computed tomography and magnetic resonance imaging have been used to evaluate EF, but variations between methodologies limit the comparability between these modalities.

We performed a systematic review of the literature finding associations of EF with metabolic syndrome and coronary artery disease. The summarization of these associations is limited by the heterogeneity of the methods used and the populations studied, where most of the subjects were at high cardiovascular disease risk.

EF is also associated with other known factors, such as obesity, diabetes mellitus, age and hypertension, which makes the interpretation of its role as an independent risk marker intricate. Based on these data, we conclude that EF is a visceral fat deposit with potential implications in coronary artery disease. We describe the reference values of EF for the different imaging modalities, even though these have not yet been validated for clinical use. It is still necessary to better define normal reference values and the risk associated with EF to further evaluate its role in cardiovascular and metabolic risk assessment in relation to other criteria currently used.

Multifactorial analysis of changes in body mass index across the adult life course: a study with 65 years of follow-up

Background

Although the negative consequences on health of being obese are well known, most adults gain weight across the life span. The general increase in body mass index (BMI) is mainly considered to originate from behavioral and environmental changes, but few studies have evaluated the influence of these factors on change in BMI in the presence of genetic risk. We aimed to study the influence of multifactorial causes of change in BMI, over 65 years.

Methods and Findings

Totally, 6,130 participants from TwinGene, who had up to 5 assessments, and 536 from the Swedish Adoption/Twin Study of Aging, who had up to 12 assessments, ranging over 65 years were included. The influence of lifestyle factors, birth cohort, cardiometabolic diseases, and an individual obesity genetic risk score based on 32 single nucleotide polymorphisms on change in BMI was evaluated with a growth model. For both sexes, BMI increased from early adulthood to age 65 years, after which the increase leveled off; BMI declined after age 80 years. A higher obesity genetic risk score, birth after 1925, and cardiometabolic diseases were associated with higher average BMI and a steeper increase in BMI prior to age 65 years. Among men, few factors were identified that influence BMI trajectories in late life, while for women, type 2 diabetes mellitus and dementia were associated with a steeper decrease in BMI after the age of 65 years.

Conclusions

There are two turning points in BMI in late adulthood, one at age 65 years and one at age 80 years. Factors associated with an increase in BMI in midlife, were not associated with an increase in BMI after the age of 65 years. These findings indicate that the causes and consequences of change in BMI differ across the life span. Current health recommendations need to be adjusted accordingly.

Body mass index, lifestyles, physical performance and cognitive decline: the "Treviso Longeva (TRELONG)" study

OBJECTIVES

The relative contributions of risk factors, as body mass index (BMI), depression, chronic diseases, smoking, and lifestyles (as physical and performance activity, social contacts and reading habit) to cognitive decline in the elderly are unclear. We explored these variables in relation to 7-year cognitive decline in long-lived Italian elderly.

DESIGN

Secondary data analysis of a longitudinal study of a representative, age-stratified, population sample.

SETTING

The TREVISO LONGEVA (TRELONG) Study, in Treviso, Italy.

PARTICIPANTS

120 men and 189 women, age 77 years and older (mean age 80.2 ± 6.9 years) survivors after seven years of follow up.

MEASUREMENTS

Cognitive decline measured as difference between Mini-Mental State Examination (MMSE) score in 2003 and in 2010; Body mass index (BMI), handgrip, Short Physical Performance Battery (SPPB) score, social contacts, reading habit, sight, hearing, schooling, mediterranean diet and multiple clinical and survey data recorded at baseline in 2003.

RESULTS

In separate univariate analyses, age, SPPB score < 5, depressive symptoms (GDS) and more comorbidities (CCI) were associated with greater cognitive decline. Otherwise higher BMI, higher handgrip, reading habit, non-deteriorated sight and hearing, and schooling were protective. In a final multivariate model, age and higher BMI were associated with greater cognitive decline while reading habits was protective. SPPB score < 5 tends, though weakly, to be associated with greater cognitive decline. These associations remained with multivariate adjustment for gender, schooling, Charlson co-morbidity index (CCI) and baseline MMSE.

CONCLUSION

Age and higher baseline BMI, independent of gender, and other confounding factors, are risk factors for cognitive decline. Reading habit plays a protective role seven years later among northern Italian adults aged 70 years or older. Low physical performance tends, though weakly, to be associated with greater cognitive decline.

Latent heterogeneity in long-term trajectories of body mass index in older adults

OBJECTIVE

To evaluate latent heterogeneity in long-term trajectories of body weight in older adults.

METHODS

We analyzed 14-year longitudinal data on 10,314 older adults from the Health and Retirement Study. Semiparametric mixture models identified latent subgroups of similar trajectories of body mass index (BMI).

RESULTS

Five distinct trajectory subgroups emerged: normal starting-BMI with accelerated increase over time (trajectory #1), overweight and increasing (trajectory #2), borderline-obese and increasing (trajectory #3), obese and increasing (trajectory #4), and morbidly obese with decelerating gain (trajectory #5). Blacks and Hispanics had greater risk of membership in ascending high-BMI trajectory groups. Females had approximately half the risk of following overweight and obese increasing BMI trajectories compared with males.

DISCUSSION

Distinct latent subgroups of BMI trajectories and significant racial/ethnic and gender trajectory heterogeneity exist in the older adult population. The propensity of men and minorities to experience high-risk BMI trajectories may exacerbate existing disparities in morbidity/ mortality in older age.

Perfil antropométrico dos idosos residentes em Campina Grande-PB

O objetivo deste estudo foi descrever o perfil antropométrico dos idosos residentes em Campina Grande - PB. Este estudo é populacional, transversal e domiciliar. Os dados são apresentados sob a forma de média, desvio-padrão e percentil (P5, P10, P25, P50, P75, P90 e P95) do peso, estatura, índice de massa corporal (IMC), perímetro do braço (PB), dobra cutânea tricipital (DCT), circunferência muscular do braço (CMB), perímetro da panturrilha (PP) e perímetro da cintura (PC). Foi realizado o teste t Student para verificar a diferença dos valores médios das variáveis entre os sexos. Foi realizada a análise de variância (ANOVA) para verificar o efeito da idade nas variáveis. Foram avaliados 806 idosos (60 anos ou mais). Os valores médios de todas as variáveis apresentaram diferença estatisticamente significativa entre os sexos. As médias das variáveis peso, estatura, CMB, PP e PC foram significativamente maiores entre os homens, enquanto que as médias de IMC, PB e DCT foram significativamente maiores entre as mulheres. Todas as variáveis apresentaram tendência de declínio entre os grupos etários mais avançados. Os resultados mostram que o padrão antropométrico dos idosos deste estudo segue a tendência de outros estudos, no entanto, os valores diferem. Dessa forma, sugere-se que estes possam ser usados para auxiliar na avaliação antropométrica de idosos.

Anthropometric changes in the Brazilian cohort of older adults: SABE survey (health, well-being, and aging)

The aim of the present study was to analyze the anthropometric changes in a home-based cohort of Brazilian older adults who participated in the SABE Survey, conducted in 2000 and 2006. A total of 1030 men and women were examined by age group: 60-69, 70-79, and ≥80 years. This representative sample consists of the survivors of the 2000 cohort. The following anthropometric variables were assessed: body mass, arm muscle, waist and calf circumferences, triceps skinfold thickness, body mass index, waist-hip ratio, and arm muscle area according to mean values and percentile distribution. Except for body mass and body mass index, a significant difference (P < 0.05) was observed among the assessed anthropometric variables during the follow-up period. The older adults ≥80 years presented the lowest values. The reduction in the mean values of triceps skinfold thickness was greater (30%) than that of waist circumference (9%) and was more pronounced in women (21%) than in men (9%). Arm muscle circumference and area reduced by 8% and 19%, respectively, in men and 1% and 3%, correspondingly, in women. Our findings revealed reductions in the mean values for all anthropometric variables in the follow-up period from 2000 to 2006 among older adults.

Relationship of BMI, Waist Circumference, and Weight Change with Use of Health Services by Older Adults

OBJECTIVE

To examine the relationship of BMI, waist circumference (WC), and weight change with use of health care services by older adults.

RESEARCH METHODS AND PROCEDURES

This was a prospective cohort study conducted from 2001 to 2003 among 2919 persons representative of the non-institutionalized Spanish population > or =60 years of age. Analyses were performed using logistic regression, with adjustment for age, educational level, size of place of residence, tobacco use, alcohol consumption, and presence of chronic disease.

RESULTS

Obesity (BMI > or = 30 kg/m(2)) and abdominal obesity (WC >102 cm in men and >88 cm in women) in 2001 were associated with greater use of certain health care services among men and women in the period 2001-2003. Compared with women with WC < or = 88 cm, women with abdominal obesity were more likely to visit primary care physicians [odds ratio (OR): 1.36; 95% confidence limit (CL): 1.06-1.73] and receive influenza vaccination (OR: 1.30; 95% CL: 1.03-1.63). Weight gain was not associated with greater health service use by either sex, regardless of baseline BMI. Weight loss was associated with greater health service use by obese and non-obese subjects of both sexes. In comparison with those who reported no important weight change, non-obese women who lost weight were more likely to visit hospital specialists (OR: 1.45; 95% CL: 1.02-2.06), receive home medical visits (OR: 1.61; 95% CL: 1.06-2.45), be hospitalized (OR: 1.88; 95% CL: 1.29-2.74), and have more than one hospital admission (OR: 2.31; 95% CL: 1.19-4.47).

DISCUSSION

Obesity and weight loss are associated with greater health service use among the elderly.