The "obesity paradox," frailty, disability, and mortality in older men: a prospective, longitudinal cohort study

Social isolation in relation to the incidence and dynamic progression of frailty in the oldest old: a trajectory analysis of a nationwide cohort

BACKGROUND

There is still a lack of evidence examining the association of behavioral and social factors with frailty transitions and mortality. We investigated whether social isolation is associated with different progressions and outcomes of frailty among community-dwelling older adults.

METHODS

This community-based cohort study assessed the frailty index and objective social isolation of 31,168 participants (58.3% female; average age: 88.1 ± 11.1 years) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018. Four Markov state-transition models were constructed to examine the associations between social isolation and the seven transitions of the frailty trajectory.

RESULTS

According to the Markov state-transition model, for every one-point increase in the social isolation score of non-frail participants, the risk of developing prefrailty increased by 4.2% [hazard ratio (HR) = 1.042, 95% confidence interval (CI): 1.007-1.079], whereas for prefrail participants, the risk of developing frailty and death increased by 3.9% (HR = 1.039, 95% CI: 1.007-1.073) and 16.1% (HR = 1.161, 95% CI: 1.099-1.226), respectively. For each increase in the social isolation score in the frail population, the risk of death increased by 2.9% (HR = 1.029, 95% CI: 1.004-1.054). Socially isolated persons had a greater cumulative transition probability to prefrailty and frailty. Socially isolated women were more likely to experience prefrailty and frailty than socially isolated men, whereas the latter were more likely to die from prefrailty and frailty than the former.

CONCLUSIONS

This study indicates that social isolation may contribute to an increased risk of both the incidence and progression of frailty, elevating deterioration risks in initially non-frail and prefrail populations, while primarily exacerbating mortality risks in those already experiencing prefrailty or frailty.

Is a higher body mass index associated with longer duration of survival with disability in frail than in non-frail older adults?

BACKGROUND/OBJECTIVES

This study investigated the hitherto unclear association of body mass index (BMI) with age at overall, disability, and disability-free survival in older adults with and without frailty.

METHODS

This prospective cohort study enroled 10232 Japanese adults aged ≥65 years, who underwent follow-up for adverse events, from the Kyoto-Kameoka Study conducted from 2011-2016. BMI, calculated based on self-reported height and body weight, was classified into five categories: <18.5, 18.5-21.4, 21.5-24.9, 25.0-27.4, and ≥27.5 kg/m2. Frailty was assessed using the validated Kihon Checklist. The relationships between BMI and disability and mortality were analysed using multivariate Cox proportional hazards models and Laplace regression.

RESULTS

During the 5.3-year median follow-up period (45472 person-years), 2348 (22.9%) incidences of disabilities occurred. After adjusting for confounders, including medical history and lifestyle, individuals in the lowest and highest BMI categories had a higher hazard ratio (HR) of disability [<18.5 kg/m2: HR: 1.31, confidence interval (CI): 1.16-1.49; ≥27.5 kg/m2: HR: 1.27, 95% CI: 1.08-1.49, p for non-linearity <0.001] compared with that of those with BMI = 21.5-24.9 kg/m2. In the 50th percentile differences in age at overall and disability-free survival, participants with BMI < 18.5 kg/m2 were more likely to die before disability incidence [survival with disability (overall survival - disability-free survival): -10.2 months]; those with BMI ≥ 27.5 kg/m2 had longer survival with disability (12.5 months). These relationships were more marked in the frailty-stratified model, where in the BMI ≥ 27.5 kg/m2 group, individuals with frailty survived longer with disability (27.2 months) than did individuals without frailty (6.2 months).

CONCLUSION

Higher BMI is associated with a longer duration of survival with disability among older adults, especially in those with frailty. Therefore, reversing frailty should be prioritised because individuals with frailty have a shorter probability of disability-free survival than do individuals without frailty, regardless of BMI.

Longitudinal association between Body mass index (BMI), BMI trajectories and the risk of frailty among older adults: A systematic review and meta-analysis of prospective cohort studies

OBJECTIVE

We aimed to determine whether BMI categories and BMI trajectories were longitudinally associated with frailty in older adults via systematic review and meta-analysis of prospective cohort studies.

METHOD

3 databases (PubMed/MEDLINE, EMBASE and Web of Science) were systematically searched from inception to 8 September 2023. Two independent reviewers extracted data and appraised study quality. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Data were pooled using random-effects models.

RESULTS

7 prospective cohort studies with 23043 participants were included in final BMI categories analyses, and 3 studies included BMI trajectory(23725 individuals). Compared with normal weight, we found a positive association between obesity (odds ratios(OR) = 1.74, 95 % confidence interval (CI): 1.21-2.51, P = 0.003), underweight (OR = 1.70, 95 % CI: 1.13-2.57, P = 0.011) and frailty in older adults. In middle age subgroup, compared with normal weight, OR of 2.21 (95 % CI: 1.44-3.38;I2 = 0 %) for overweight and OR of 5.20 (95 % CI: 2.56-10.55; I2 = 0 %) for obesity were significantly associated with frailty. In old age subgroup, compared with normal weight, only OR of 1.41 (95 % CI: 1.13-1.77; I2 = 65 %) for obesity was significantly associated with frailty. The results of BMI trajectories found that decreasing BMI (OR = 3.25, 95 % CI: 2.20-4.79, P < 0.0001) and consistently high BMI (OR = 3.66, 95 % CI: 2.03-6.61, P < 0.0001) increase the risk of frailty compared to consistently normal or overweight.

CONCLUSION

Overweight and obesity in middle age were associated with significantly higher frailty in older adults, while obesity and underweight in old age were associated with relatively higher frailty in older adults. Early weight control may be beneficial for old age.

Impact of REM Sleep Behavior and Sleep Talking on Mortality in Parkinson's Disease

Background REM sleep behavior disorder (RBD) is a prodromal marker for Parkinson's disease (PD) and other alpha-synucleinopathies. Sleep talking (ST) is an isolated symptom and is frequent in PD and RBD. Here, we investigate the associations of ST and RBD with the mortality of PD patients. Patients and methods A total of 1,500 PD patients were randomly selected from the registry of the Finnish Parkinson's Association. Of the 855 that participated at baseline, 645 gave permission for follow-up studies. We gathered a completely filled sleep questionnaire and mortality information from 384 subjects. The Nelson-Aalen test and Cox hazard ratios (HR) were used for mortality analyses. Results The mean follow-up time was 4.3 years (0.3-7.0). PD patients with RBD or frequent ST had more non-motor symptoms. Depression, hallucinations, constipation, and excessive daytime sleepiness were more prevalent among subjects with RBD. Subjects with RBD and frequent ST (talking in their sleep ≥ once per week) had increased mortality (HR: 1.90, 95% CI: 1.18-3.06). RBD without frequent ST was not associated with mortality (HR: 0.77, 95% CI: 0.4-1.5). Frequent ST was associated with increased mortality when adjusted for age, PD duration, depression, gender, RBD, BMI, and hallucinations (HR: 2.22, 95% CI: 1.10-4.51). Additionally, age, duration of PD, arterial hypertension, and lower BMI were associated with increased mortality. Male gender, dopaminergic medication, depression, and hallucinations were not significantly associated with mortality. Conclusions RBD with frequent ST and ST alone appear to be risk factors for mortality in PD. Frequent ST may be a sign representing wider neurodegeneration. RBD subjects and frequent sleep talkers demonstrated more non-motor symptoms compared to PD without RBD or ST. Our findings have clinical implications. It remains to be seen if frequent ST indicates a poorer prognosis. Prospective studies are needed to find whether frequent ST is also a risk factor for developing PD.

A comprehensive analysis of the triad of frailty, aging, and obesity in spine surgery: the risk analysis index predicted 30-day mortality with superior discrimination

BACKGROUND CONTEXT

The United States has experienced substantial shifts in its population dynamics due to an aging population and increasing obesity rates. Nonetheless, there is limited data about the interplay between the triad of frailty, aging, and obesity.

PURPOSE

To investigate discriminative thresholds and independent associations of the Risk Analysis Index (RAI), Modified Frailty Index-5 (mFI-5), and greater patient age.

STUDY DESIGN

An observational retrospective cohort study.

PATIENT SAMPLE

We analyzed 49,754 spine surgery patients from the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2020.

OUTCOME MEASURE

A total of 30-day postoperative mortality.

METHODS

Using receiver operating characteristic (ROC) and multivariable (odds ratios [OR] and 95% confidence intervals [CI]) analyses, we compared the discriminative thresholds and independent associations of RAI, mFI-5, and greater patient age in elderly obese patients who underwent spine surgery.

RESULTS

There were 49,754 spine surgery patients, with a median age of 71 years (IQR: 68-75), largely white (82.6%) and male (51.9%). The ROC analysis for 30-day postoperative mortality demonstrated superior discrimination for RAI (C-statistic 0.779, 95%CI 0.54-0.805) compared to mFI-5 (C-statistic 0.623, 95% CI 0.594-0.651) and greater patient age (C-statistic 0.627, 95% CI 0.598-0.656). Multivariable analyses revealed a dose-dependent association and a larger effect magnitude for RAI: frail patients OR: 19.52 (95% CI 18.29-20.82) and very frail patients OR: 65.81 (95% CI 62.32-69.50). A similar trend was observed in the interaction evaluating RAI-age-obesity (p<.001).

CONCLUSION

Our study highlights a strong association between frailty and 30-day postoperative mortality in elderly obese spine patients, revealing a dose-dependent relationship. The RAI has superior discrimination than the mFI-5 and greater patient age in predicting 30-day postoperative mortality after spine surgery. Using the RAI in preoperative assessments may improve outcomes and help healthcare providers effectively communicate accurate surgical risks and potential benefits, set realistic recovery expectations, and enhances patient satisfaction.

Lower Body Mass Index at Baseline Is Related to Steeper Cognitive Decline in the Alzheimer's Disease Neuroimaging Initiative Cohort

OBJECTIVE

Midlife obesity is a risk factor for dementia, whereas obesity in older age may be protective of cognition, a phenomenon known as the "obesity paradox." The mechanisms underlying this phenomenon and the relationship between body mass index (BMI) and cognitive function over time remain unclear.

METHODS

In 1399 adults with and without mild cognitive impairment (median age 73.6 years) from the Alzheimer's Disease Neuroimaging Initiative, we modeled the effects of baseline BMI on within-person trajectories of cognitive decline using Latent Growth Curve Modeling. We also tested if the effects of BMI on cognitive decline are global or specific to memory, executive function, or language.

RESULTS

Higher baseline BMI was associated with better memory ( βBMI = 0.06, p < .05) and worse executive function ( βBMI = -0.05, p < .05) and not associated with language. Independent of baseline diagnosis, higher baseline BMI was associated with slower rate of decline in executive function, memory, and language ( βBMI = 0.13, 0.12, and 0.12, respectively; p < .01). Higher BMI was not associated with the intercept ( βBMI = 0.04, p = .059) or change ( βBMI = 0.04, p = .415) in a global cognitive factor.

CONCLUSIONS

We found that higher baseline BMI was associated with slower cognitive decline in participants with and without mild cognitive impairment diagnosis. Higher BMI in this context seems to be protective of cognitive function for people at risk for dementia. Our findings also support domain-specific effects of obesity on various cognitive functions rather than a final common pathway.

Development and validation of a preliminary clinical support system for measuring the probability of incident 2-year (pre)frailty among community-dwelling older adults: A prospective cohort study

OBJECTIVE

To develop the wed-based system for predicting risk of (pre)frailty among community-dwelling older adults.

MATERIALS AND METHODS

(Pre)frailty was determined by physical frailty phenotype scale. A total of 2802 robust older adults aged ≥60 years from the China Health and Retirement Longitudinal Study (CHARLS) 2013-2015 survey were randomly assigned to derivation or internal validation cohort at a ratio of 8:2. Logistic regression, Random Forest, Support Vector Machine and eXtreme Gradient Boosting (XGBoost) were used to construct (pre)frailty prediction models. The Grid search and 5-fold cross validation were combined to find the optimal parameters. All models were evaluated externally using the temporal validation method via the CHARLS 2011-2013 survey. The (pre)frailty predictive system was web-based and built upon representational state transfer application program interfaces.

RESULTS

The incidence of (pre)frailty was 34.2 % in derivation cohort, 34.8 % in internal validation cohort, and 32.4 % in external validation cohort. The XGBoost model achieved better prediction performance in derivation and internal validation cohorts, and all models had similar performance in external validation cohort. For internal validation cohort, XGBoost model showed acceptable discrimination (AUC: 0.701, 95 % CI: [0.655-0.746]), calibration (p-value of Hosmer-Lemeshow test > 0.05; good agreement on calibration plot), overall performance (Brier score: 0.200), and clinical usefulness (decision curve analysis: more net benefit than default strategies within the threshold of 0.15-0.80). The top 3 of 14 important predictors generally available in community were age, waist circumference and cognitive function. We embedded XGBoost model into the server and this (pre)frailty predictive system is accessible at http://www.frailtyprediction.com.cn. A nomogram was also conducted to enhance the practical use.

CONCLUSIONS

A user-friendly web-based system was developed with good performance to assist healthcare providers to measure the probability of being (pre)frail among community-dwelling older adults in the next two years, facilitating the early identification of high-risk population of (pre)frailty. Further research is needed to validate this preliminary system across more controlled cohorts.

Weight loss severity and functional decline among the oldest old in a middle-income country: The FIBRA study longitudinal findings

BACKGROUND AND AIMS

Nutritional status is a key modifiable risk factor associated with disability, and further evidence suggests that weight change is also linked to this adverse outcome. Thus, this study aims to evaluate weight loss severity and functional decline in instrumental activities of daily living (IADL) in a seven-year period among a sample of Brazilian oldest-old adults.

METHODS

Longitudinal prospective study using data from the FIBRA study (Frailty in Older Brazilians), a population-based investigation carried out in 2008/2009, with follow-up data collected in 2016/2017 from participants who were 80 years and older in the follow-up in Campinas, Brazil. Of the 167 participants with complete data in 2016-2017, 16 had improved their functional status and were excluded, so the final sample was restricted to 151 participants who maintained or declined functional status. We considered functional decline when a subject had greater IADL dependencies at follow-up than baseline. Logistic regression was performed to assess the effect of weight loss, according to severity (moderate weight loss: 5-10% of body weight; severe weight loss >10%) in increasing the number of disabilities than the group with stable weight, controlling for covariates (gender, age, education, and morbidity). An alpha level of <5% was adopted.

RESULTS

During the follow-up period, 60.3% of the participants kept stable weight, 21.8% had moderate weight loss, and 17.9% had severe weight loss. During the follow-up, only severe weight loss was associated with a higher risk of functional decline (OR = 2.74; p = 0.032).

CONCLUSIONS

Severe weight loss was associated with functional decline. This finding reinforces the importance of early identification of weight loss among older adults.

Weight loss, visit-to-visit body weight variability and cognitive function in older individuals

OBJECTIVE

to investigate the association between variability and loss of body weight with subsequent cognitive performance and activities of daily living in older individuals.

DESIGN

cross-sectional cohort study.

SETTING

PROspective Study of Pravastatin in the Elderly at Risk, multicentre trial with participants from Scotland, Ireland and the Netherlands.

SUBJECTS

4,309 participants without severe cognitive dysfunction (mean age 75.1 years, standard deviation (SD) = 3.3), at higher risk for cardiovascular disease (CVD).

METHODS

body weight was measured every 3 months for 2.5 years. Weight loss was defined as an average slope across all weight measurements and as ≥5% decrease in baseline body weight during follow-up. Visit-to-visit variability was defined as the SD of weight measurements (kg) between visits. Four tests of cognitive function were examined: Stroop test, letter-digit coding test (LDCT), immediate and delayed picture-word learning tests. Two measures of daily living activities: Barthel Index (BI) and instrumental activities of daily living (IADL). All tests were examined at month 30.

RESULTS

both larger body weight variability and loss of ≥5% of baseline weight were independently associated with worse scores on all cognitive tests, but minimally with BI and IADL. Compared with participants with stable weight, participants with significant weight loss performed 5.83 seconds (95% CI 3.74; 7.92) slower on the Stroop test, coded 1.72 digits less (95% CI -2.21; -1.13) on the LDCT and remembered 0.71 pictures less (95% CI -0.93; -0.48) on the delayed picture-word learning test.

CONCLUSION

in older people at higher risk for CVD, weight loss and variability are independent risk-factors for worse cognitive function.

Stability in BMI over time is associated with a better cognitive trajectory in older adults

OBJECTIVE

Evidence on simultaneous changes in body mass index (BMI) and cognitive decline, which better reflect the natural course of both health phenomena, is limited.

METHODS

We capitalized on longitudinal data from 15,977 initially non-demented elderly from the Alzheimer's Disease Centers followed for 5 years on average. Changes in BMI were defined as (1) last minus first BMI, (2) mean of all follow-up BMIs minus first BMI, and (3) standard deviation of BMI change from baseline and all follow-up visits (representing variability).

RESULTS

Participants with significant changes in BMI (increase or decrease of ≥5%), or who had greater variability in BMI, had faster cognitive decline. This pattern was consistent irrespective of normal (BMI < 25; N = 5747), overweight (25 ≤ BMI < 30; N = 6302), or obese (BMI ≥ 30; N = 3928) BMI at baseline.

CONCLUSIONS

Stability in BMI predicts better cognitive trajectories suggesting clinical value in tracking BMI change, which is simple to measure, and may point to individuals whose cognition is declining.

Prevalence of Undernutrition and Risk of Undernutrition in Overweight and Obese Older People

Older people with excess body weight are not spared from undernutrition. They may face appetite decline which may lead to insufficient nutrient intake. They also have a higher risk of developing chronic diseases which may have a negative impact on protein-anabolic pathways. The present study aimed to determine the prevalence of undernutrition in overweight and obese older people from a secondary analysis on data collected through two French surveys among people aged 65 or over (n = 782; 31% men; 65–103 years old). Undernutrition was assessed using the MNA screening tool (Mini-Nutritional Assessment). Results showed that 2% of the respondents with a BMI over 25 were undernourished (MNA score below 17/30) and 23% were at risk of undernutrition (MNA score of 17–23.5). Specifically, 18% of overweight and 29% of obese respondents were at risk of undernutrition. Taking into account the most recent French census data, it can be estimated that in France, around 1,7 million people aged over 65 with a BMI over 25 are undernourished or at risk of undernutrition. Given the worldwide increase in the number of overweight/obese individuals in the last few decades, further research will be needed to develop strategies to tackle nutritional risk in overweight/obese older adults.

Interactive effects of exercise and sleep on frailty severity in community-dwelling older adults: a cross-sectional study

Objectives: This study examined the effects of the interaction between exercise and sleep on frailty severity in community-dwelling older adults.

Materials and Methods: This was a cross-sectional study. Data were collected in July 2019. In total, 2021 adults participated who responded to a questionnaire. Among them, 672 participants (317 men and 355 women) with valid responses were included in the analysis. Ordinal logistic regression analysis was performed to examine the association between frailty severity and the interaction between exercise and sleep. The dependent variable represents three different levels of frailty. The independent variables included basic information and interaction between exercise and sleep.

Results: The results of ordinal logistic regression analysis (odds ratio [OR]) showed that the period from the start of exercise (OR=0.96), age (OR=1.00 for participants in their 60 s, OR=1.65 for those in their 70s, and OR=3.13 for those aged >80 years), poor subjective health perception (OR=2.12), poor quality of sleep (OR=1.88), stress (OR=1.62), and exercise–sleep interaction (OR=1.00 based on good-exercise–good-sleep interaction, OR=3.09 poor-exercise–good-sleep interaction, and OR=3.50 poor-exercise–poor-sleep interaction) significantly contributed to the model. The Nagelkerke coefficient of determination adjusted for degrees-of-freedom (R²), which represents the contribution rate of the regression equation, was 0.334.

Conclusions: Our results suggest that a combination of good exercise and good sleep is needed to prevent frailty progression in community-dwelling older adults.

Falls may trigger body weight decline in nursing home residents

OBJECTIVES

The effect of falls on changes in body weight is still unknown. This study investigated the extent to which falls can modify the course of body weight in nursing home residents, and aimed to identify the factors that might modulate this effect.

METHODS

The sample included 132 residents aged ≥60 y who had experienced at least one fall after nursing home admission. Body weight was measured monthly in the 6 mo after the fall in the entire sample, and also in the 6 mo prefall in a subsample (n = 111). Sociodemographic and health data were obtained from medical records. Linear mixed models were used to estimate the average monthly changes in body weight after the fall in the total sample, and as a function of the sociodemographic and medical factors.

RESULTS

Falls modified the course of body weight in the total sample (β = -0.28, 95% confidence interval, -0.44 to -0.12, for the change in slope before and after fall) in all age classes and especially in individuals with severe cognitive impairment who received less-frequent informal visits (β = -0.55, 95% confidence interval, -0.87 to -0.22). Individuals aged ≥90 y and those with severe cognitive impairment had a steeper monthly weight decline in the 6 mo postfall, of 0.23 and 0.35 kg greater, respectively, than their younger and cognitively healthier counterparts.

CONCLUSIONS

Falls may trigger a body weight loss in nursing home residents, especially in the oldest old people and those with severe cognitive impairment who receive little support from informal caregivers. These findings highlight the importance of monitoring nutritional status of people who live in institutions after falls.

Association of BMI, comorbidities and all-cause mortality by using a baseline mortality risk model

Objective

The association of body mass index (BMI) and all-cause mortality is controversial, frequently referred to as a paradox. Whether the cause is metabolic factors or statistical biases is still controversial. We assessed the association of BMI and all-cause mortality considering a wide range of comorbidities and baseline mortality risk.

Methods

Retrospective cohort study of Olmsted County residents with at least one BMI measurement between 2000–2005, clinical data in the electronic health record and minimum 8 year follow-up or death within this time. The cohort was categorized based on baseline mortality risk: Low, Medium, Medium-high, High and Very-high. All-cause mortality was assessed for BMI intervals of 5 and 0.5 Kg/m².

Results

Of 39,739 subjects (average age 52.6, range 18–89; 38.1% male) 11.86% died during 8-year follow-up. The 8-year all-cause mortality risk had a “U” shape with a flat nadir in all the risk groups. Extreme BMI showed higher risk (BMI <15 = 36.4%, 15 to <20 = 15.4% and ≥45 = 13.7%), while intermediate BMI categories showed a plateau between 10.6 and 12.5%. The increased risk attributed to baseline risk and comorbidities was more obvious than the risk based on BMI increase within the same risk groups.

Conclusions

There is a complex association between BMI and all-cause mortality when evaluated including comorbidities and baseline mortality risk. In general, comorbidities are better predictors of mortality risk except at extreme BMIs. In patients with no or few comorbidities, BMI seems to better define mortality risk. Aggressive management of comorbidities may provide better survival outcome for patients with body mass between normal and moderate obesity.

Drivers of Frailty from Adulthood into Old Age: Results from a 27-Year Longitudinal Population-Based Study in Sweden

BACKGROUND

Frailty is a strong predictor of adverse outcomes. However, longitudinal drivers of frailty are not well understood. This study aimed at investigating the longitudinal trajectories of a frailty index (FI) from adulthood to late life and identifying the factors associated with the level and rate of change in FI.

METHODS

An age-based latent growth curve analysis was performed in the Swedish Adoption/Twin Study of Aging (N = 1,842; aged 29-102 years) using data from up to 15 measurement waves across 27 years. A 42-item FI was used to measure frailty at each wave.

RESULTS

A bilinear, two-slope model with a turning point at age 65 best described the age-related change in FI, showing that the increase in frailty was more than twice as fast after age 65. Underweight, obesity, female sex, overweight, being separated from one's co-twin during childhood, smoking, poor social support, and low physical activity were associated with a higher FI at age 65, with underweight having the largest effect size. When tested as time-varying covariates, underweight and higher social support were associated with a steeper increase in FI before age 65, whereas overweight and obesity were associated with less steep increase in FI after age 65.

CONCLUSIONS

Factors associated with the level and rate of change in frailty are largely actionable and could provide targets for intervention. As deviations from normal weight showed the strongest associations with frailty, future public health programs could benefit from monitoring of individuals with abnormal BMI, especially those who are underweight.

Effects of body mass index on kidney transplant outcomes are significantly modified by patient characteristics

Body mass index (BMI) is a known risk factor associated with kidney transplant outcomes and is incorporated for determining transplant candidate eligibility. However, BMI is a coarse health measure and risks associated with BMI may vary by patient characteristics. We evaluated 296 807 adult (age > 17) solitary kidney transplant recipients from the Scientific Registry of Transplant Recipients (2000-2019). We examined effects of BMI using survival models and tested interactions with recipient characteristics. Overall, BMI demonstrated a "J-Shaped" risk profile with elevated risks for overall graft loss with low BMI and obesity. However, multivariable models indicated interactions between BMI with recipient age, diagnosis, gender, and race/ethnicity. Low BMI was relatively higher risk for older recipients (>60 years), people with type I diabetes, and males and demonstrated no additional risk among younger (18-39) and Hispanic recipients. High BMI was associated with elevated risk for Caucasians and attenuated risk among African Americans and people with type II diabetes. Effects of BMI had variable risks for mortality vs graft loss by recipient characteristics in competing risks models. The association of BMI with posttransplant outcomes is highly variable among kidney transplant recipients. Results are important considerations for personalized care and risk stratification. Findings suggest that transplant contraindications should not be based on absolute BMI thresholds but modified based on patient characteristics.

Building research in diet and cognition (BRIDGE): Baseline characteristics of older obese African American adults in a randomized controlled trial to examine the effect of the Mediterranean diet with and without weight loss on cognitive functioning

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The MedDiet is correlated with slower cognitive decline in longitudinal studies.

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Self-reported MedDiet adherence positively associated with select cognitive domains.

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Women outperformed men across verbal tasks, including learning and memory.

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Younger participants outperformed older participants on cognitive assessments.

In the United States, >5.4 million people age 65 and older are affected by cognitive impairment and dementia, including Alzheimer’s disease. African Americans are more likely than non-Hispanic whites to suffer from these disorders. Obesity is linked to accelerated age-related cognitive decline, and weight loss through caloric restriction is a potential strategy to prevent this cognitive impairment. Adherence to a healthful dietary pattern, such as the Mediterranean Diet (MedDiet), has also shown positive effects on reducing risk for dementia. African Americans are disproportionately affected by obesity and have less healthful diets than non-Hispanic whites. We present baseline characteristics from a three-arm randomized controlled trial that randomized 185 obese (BMI ≥ 30 kg/m² and ≤ 50 kg/m²) healthy older adults (55–85 years of age) to: 1) Typical Diet Control (TDC); 2) MedDiet alone (MedDiet-A) intervention; or 3) MedDiet caloric restricted intervention to promote weight loss (MedDiet-WL). The majority of the sample was African American (91.4%) and female (85.9%). The two active interventions (MedDiet-A and MedDiet-WL) met once weekly for 8 months, and the TDC received weekly general health newsletters. Baseline data were collected between January 2017 and July 2019 in Chicago, IL. In our sample, closer adherence to a MedDiet pattern was associated with higher attention and information processing (AIP) and higher executive functioning (EF). Consistent with the literature, we saw that older participants performed more poorly on the cognitive assessments than younger participants, and women outperformed men across verbally mediated tasks, especially ones related to learning and memory.

BMI, functional and cognitive status in a cohort of nonagenarians: results from the Mugello study

Aim

Our aim was to investigate the association of body mass index (BMI) with functional and cognitive status in a group of nonagenarians.

Findings

By grouping the participants according to BMI categories, overweight and obese participants showed lower functional capability, higher risk of falling but better Mini-Mental State Examination (MMSE) performance than participants with normal weight or underweight.

Message

This cross-sectional survey supports the hypothesis that adiposity could affect the cognitive state of people reaching the old age.

Purpose

The study of the relationship between body weight and health in old age has attracted increasing interest. The aim of the present study is to investigate the association of body mass index (BMI) with functional and cognitive status in a group of nonagenarians.

Methods

We analyzed 475 participants (348 women, 127 men; median age 92 years) from the Mugello study. Participants were evaluated through laboratory, instrumental examinations and questionnaires.

Results

By grouping the participants according to BMI categories, a better perception of health and nutritional status and a lower prevalence of sarcopenia (p < 0.05) were observed in participants with overweight and obesity compared to participants with normal weight or underweight. Concerning functional and cognitive measures, overweight and obese participants showed significantly worse performance on short physical performance battery and timed up and go tests and better performance on the mini-mental state examination (MMSE). As regards the other tests performed, no statistically significant differences were observed. In a multivariate logistic regression analysis adjusted for possible confounding factors, participants with BMI ≥ 30 kg/m² showed lower probability to achieve poor performance on the MMSE (OR 0.42; 95% CI 0.19–0.94; p = 0.035).

Conclusion

Our results support the hypothesis that in nonagenarians, a higher BMI is associated with better cognitive ability. Further studies are needed to explore the mechanisms underlying this association.

Weight Fluctuation and the Risk of Cardiovascular Events in Patients with Rheumatoid Arthritis

PURPOSE

Fluctuations in weight have been linked to cardiovascular (CV) outcomes in the general population. We evaluated whether weight fluctuation was independently predictive of CV events in patients with rheumatoid arthritis (RA).

METHODS

We studied patients with RA from the Corrona registry. Weight change was categorized as loss of ≥10%, loss of 5-10%, stable, gain of 5-10%, and gain of ≥10%. We also categorized patients by quintile of variability in weight in prior observation periods. Cox proportional hazard models explored independent associations between time-varying weight change and weight variability and risk of CV events before and after adjusting for CV risk factors, RA disease features, and disability.

RESULTS

Among 31,381 participants, those that lost or gained 10% of their weight had greater disease activity, worse physical function, and were more likely to smoke, have diabetes, use corticosteroids, and be disabled. In adjusted models, a greater risk of CV events was observed in those that experienced 10% weight loss [HR: 1.18 (1.03,1.36) p=0.02] or weight gain [HR 1.20 (1.04,1.38) p=0.01]. The association between weight change and CV events was stronger among participants with BMI <25 kg/m² for 10% weight loss [HR: 1.34 (1.08,1.66) p=0.001] and 10% weight gain [1.74 (1.41,2.24) p<0.001]. Patients with greater variability in weight had a higher risk of CV events.

CONCLUSIONS

Recent changes and high variability in weight predict CV events in RA, particularly among thin patients. Further study is necessary to determine if weight fluctuation has adverse cardiometabolic consequences that are independent of other risk factors.

Comparing Analytical Methods for the Gut Microbiome and Aging: Gut Microbial Communities and Body Weight in the Osteoporotic Fractures in Men (MrOS) Study

Determining the role of gut microbial communities in aging-related phenotypes, including weight loss, is an emerging gerontology research priority. Gut microbiome datasets comprise relative abundances of microbial taxa that necessarily sum to 1; analysis ignoring this feature may produce misleading results. Using data from the Osteoporotic Fractures in Men (MrOS) study (n = 530; mean [SD] age = 84.3 [4.1] years), we assessed 163 genera from stool samples and body weight. We compared conventional analysis, which does not address the sum-to-1 constraint, to compositional analysis, which does. Specifically, we compared elastic net regression (for variable selection) and conventional Bayesian linear regression (BLR) and network analysis to compositional BLR and network analysis; adjusting for past weight, height, and other covariates. Conventional BLR identified Roseburia and Dialister (higher weight) and Coprococcus-1 (lower weight) after multiple comparisons adjustment (p < .0125); plus Sutterella and Ruminococcus-1 (p < .05). No conventional network module was associated with weight. Using compositional BLR, Coprococcus-2 and Acidaminococcus were most strongly associated with higher adjusted weight; Coprococcus-1 and Ruminococcus-1 were most strongly associated with lower adjusted weight (p < .05), but nonsignificant after multiple comparisons adjustment. Two compositional network modules with respective hub taxa Blautia and Faecalibacterium were associated with adjusted weight (p < .01). Findings depended on analytical workflow. Compositional analysis is advocated to appropriately handle the sum-to-1 constraint.

Obesity, Weight Loss, and Progression of Disability in Rheumatoid Arthritis

OBJECTIVE

Cross-sectional studies have demonstrated that obese patients with rheumatoid arthritis (RA) often report greater disability. The longitudinal effects of obesity, however, are not well-characterized. We evaluated associations between obesity, weight loss, and worsening of disability in patients of 2 large registry studies, which included patients who were followed for longer periods of time.

METHODS

This study included patients with RA from the National Data Bank for Rheumatic Diseases (FORWARD) (n = 23,323) and the Veterans Affairs RA (VARA) registry study (n = 1,697). Results of the Health Assessment Questionnaire (HAQ) or Multidimensional HAQ (MD-HAQ) were recorded through follow-up. Significant worsening of disability was defined as an increase of >0.2 in HAQ or MD-HAQ scores. The Cox proportional hazards model was used to evaluate the risk of worsening of disability from baseline and to adjust for demographics, baseline disability, comorbidity, disease duration, and other disease features.

RESULTS

At enrollment, disability scores were higher among severely obese patients compared to those who were overweight both in FORWARD (β = 0.17 [95% confidence interval (95% CI) 0.14, 0.20]; P < 0.001) and in the VARA registry (β = 0.17 [95% CI 0.074, 0.27]; P = 0.001). In multivariable models, patients who were severely obese at enrollment had a greater risk of progressive disability compared to overweight patients in FORWARD (HR 1.25 [95% CI 1.18, 1.33] P < 0.001) and in the VARA registry (HR 1.33 [95% CI 1.07, 1.66]; P = 0.01). Weight loss following enrollment was also associated with a greater risk in both cohorts. In the VARA registry, associations were independent of other clinical factors, including time-varying C-reactive protein and swollen joint count.

CONCLUSION

Severe obesity is associated with a more rapid progression of disability in RA. Weight loss is also associated with worsening disability, possibly due to it being an indication of chronic illness and the development of age-related or disease-related frailty.

Body Weight Variation Patterns as Predictors of Cognitive Decline over a 5 Year Follow-Up among Community-Dwelling Elderly (MAPT Study)

This study aimed to analyze associations between weight variation patterns and changes in cognitive function and hippocampal volume among non-demented, community-dwelling elderly. Sample was formed of 1394 adults >70 years (63.9% female), all volunteers from the Multidomain Alzheimer Preventive Trial (MAPT). Weight loss was defined as ≥5% of body weight decrease in the first year of follow-up; weight gain as ≥5% of weight increase; and stability if <5% weight variation. Cognition was examined by a Z-score combining four tests. Measures were assessed at baseline, 6, 12, 24, 36, 48, and 60 months of follow-up. Hippocampal volume was evaluated with magnetic resonance imaging in 349 subjects in the first year and at 36 months. Mixed models were performed. From the 1394 participants, 5.5% (n = 76) presented weight loss, and 9.0% (n = 125) presented weight gain. Cognitive Z-score decreased among all groups after 5 years, but decline was more pronounced among those who presented weight loss (adjusted between-group mean difference vs. stable: -0.24, 95%CI: -0.41 to -0.07; p = 0.006). After 3 years, hippocampal atrophy was observed among all groups, but no between-group differences were found. In conclusion, weight loss ≥5% in the first year predicted higher cognitive decline over a 5 year follow-up among community-dwelling elderly, independently of body mass index.

Obesity, Dietary inflammation, and Frailty among Older Adults: Evidence from the National Health and Nutrition Examination Survey

Knowledge related to the relationship between obesity and frailty is limited. This study aimed to investigate associations between obesity, dietary inflammation, and frailty among older adults. Study data came from National Health and Nutrition Examination Survey (2007-2014) examinations of adults age ≥60 years (n = 7182). Dietary inflammatory potential was determined using the Dietary Inflammatory Index (DII^®) derived from 24-h dietary recall. We analyzed independent and joint associations of obesity and DII with frailty to evaluate interaction. Multivariable logistic regression revealed that both obesity (Odds Ratio [OR] = 2.24, 95% CI: 1.68, 2.99) and moderately pro-inflammatory DII (OR = 1.68, 95% CI: 1.10, 2.58) were independently associated with greater frailty prevalence. A negative multiplicative interaction between obesity and highest pro-inflammatory diet also was found (adjusted odds in non-obese and obese were 2.07 and 2.37, respectively; p = 0.046). Results indicate the importance of considering obesity and dietary inflammatory potential when screening for frailty or developing treatments.

Associations of the metabolic syndrome and its components with cognitive impairment in older adults

Background

The metabolic syndrome (MetS) is an established cardiovascular risk factor. Here, we investigated its role in cognitive impairment.

Methods

Baseline data from 202 participants (aged 65 to 87 years) of the BioCog study were used. All were free of clinical dementia (MMSE≥24/30). Cognitive impairment was defined as the lowest tertile of a cognitive summary score. Multiple logistic regression analyses examined associations of body mass index (BMI), triglycerides (TG), high-density lipoprotein (HDL-C), glucose and glycated hemoglobin A1c (HbA1c) levels with the odds of cognitive impairment. MetS was defined as ≥3 of its 5 components obesity (BMI ≥ 30 kg/m²), elevated TG (TG ≥1.7 mmol/L), reduced HDL-C (males: < 1.0 mmol/L; females: < 1.3 mmol/L), elevated glucose (glucose ≥5.5 mmol/L and/or diagnosed diabetes) and elevated blood pressure (history of hypertension). Analyses controlled for age, sex and smoking history.

Results

Lower HDL-C was significantly associated with a higher odds of cognitive impairment (OR 2.70 per 1 mmol/L reduction; 95% CI 1.25, 5.56; p = 0.011), whereas BMI, TG, glucose and HbA1c were not (all p > 0.05). Results for HDL-C were similar when HDL-C, glucose, BMI and TG were entered into a single model (OR 2.56 per 1 mmol/L reduction, 95% CI 1.09, 5.88, p = 0.031) and when cerebrovascular disease and coronary heart disease were additionally controlled for (OR 2.56 per 1 mmol/L reduction, 95% CI 1.06, 6.25, p = 0.036). Among the 5 MetS components, participants with elevated TG were at 2-fold increased odds of impairment (OR 2.09, 95% CI 1.08, 4.05, p = 0.028) including when the remaining 4 MetS components were entered (OR 2.23, 95% CI 1.07, 4.65, p = 0.033), but the finding was no longer statistically significant when cerebrovascular disease and coronary heart disease were additionally controlled for (p = 0.11). Presence of MetS and of obesity, reduced HDL-C, elevated glucose or elevated blood pressure were not significantly associated with impairment (all p > 0.05).

Conclusion

Our findings support low HDL-C as an independent risk marker of cognitive impairment in older age. The need for research into mediatory and confounding factors, and re-evaluation of traditional cut-off points is highlighted.

Trial registration

The study was registered on 15th October 2014 at clinicaltrials.gov (NCT02265263).

The effect of early cardiopulmonary rehabilitation on the outcomes of intensive care unit survivors

This study aims to compare the impact of early and late post-discharge cardiopulmonary rehabilitation on the outcomes of intensive care unit (ICU) survivors.The retrospective, cohort study used a sub-database of the Taiwan National Health Insurance Research Database (NHIRD) that contained information of all patients had ICU admission between 2000 and 2012. Early group was defined if patients had received cardiopulmonary rehabilitation within 30 days after ICU discharge, and late group was define as if patients had received cardiopulmonary rehabilitation between 30 days and 1 year after ICU discharge. The end points were mortality and re-admission during the 3-year follow-up.Among 2136 patients received cardiopulmonary rehabilitation after ICU discharge, 994 was classified early group and other 1142 patients were classified as late group. Overall, early group had a lower mortality rate (6.64% vs. 10.86%, P = .0006), and a lower ICU readmission rate (47.8% vs. 57.97%, P < 0.0001) than late group after 3-year follow-up. Kaplan-Meier analysis showed that early group had significantly lower mortality (P = .0009) and readmission rate (P < .0001) than late group. In multivariate analysis, the risk of ICU readmission was found to be independently associated with late group (hazard ratio, [HR], 1.28; 95% confidence intervals, [CI], 1.13-1.47).Early post-discharge cardiopulmonary rehabilitation among ICU survivors has the long-term survival benefit and significantly decreases the readmission rate.

Midlife Body Mass Index Trajectory and Risk of Frailty 8 Years Later in Taiwan

OBJECTIVES

Few studies have focused on weight change and frailty, especially in Asia. This research aimed to evaluate midlife body mass index (BMI) trajectory and assess its relationship with frailty 8 years later in Taiwan.

DESIGN

A prospective cohort study.

SETTING AND PARTICIPANTS

Data were retrieved from the Taiwan Longitudinal Study on Aging conducted from 1999 to 2007. The analysis was restricted to respondents aged between 50 to 69 years old, who were not frail in 1999 and were alive in 2007 (n=1609).

MEASUREMENTS

Frailty was defined using the Fried criteria. The group-based model of trajectory was used to estimate BMI trajectories among elderly participants. Logistic regression analysis was used to examine the association between BMI change and frailty.

RESULTS

Four trajectory classes were identified and each remained stable during the 8-year follow-up. There were 316 participants (20.3%) in the low-normal weight group (baseline BMI=20.38 kg/m2), 737 participants (44.7%) in the high-normal weight group (baseline BMI=23.22 kg/m2), 449 participants (28.4%) in the overweight group (baseline BMI=26.24 kg/m2), and 107 participants (6.6%) in the obesity group (baseline BMI=30.65 kg/m2). After adjustment for confounding factors, the low-normal weight group and obesity group were associated with increased frailty compared with the high-normal weight group.

CONCLUSION

Our results showed that the BMI trajectories of midlife individuals tended to be constant and those in both the low-normal weight group and obesity group had an increased risk of developing frailty in later life. Therefore, an optimal weight-targeting strategy should be considered for Asian elderly individuals.

Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management

OBJECTIVE

The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults.

METHODS

These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.

The association of under-weight and obesity with mortality after hip arthroplasty

Background

although many studies have demonstrated the association between body mass index (BMI) and many diseases, there is little evidence of postoperative mortality after hip arthroplasty. The aim of this study was to evaluate the association between BMI and mortality after hip arthroplasty in the older population.

Methods

a total of 3,627 older patients who underwent hip arthroplasty from 2010 to 2013 were included. We used Cox regression analysis to evaluate the association between BMI and mortality after hip arthroplasty. The hazard ratios (HRs) was calculated from 30 days, 31-365 days, and from the first day of surgery to the day of death during the study.

Results

under-weight (BMI under 18.5 kg/m2) is significantly associated with increased mortality (HR:1.423; 95% Confidence Interval (CI): 1.023-1.981) after hip arthroplasty compared to the normal range. However, in the short-term mortality within 30 days after surgery, both under-weight (HR: 2.368; 95%CI: 1.130-4.960) and obesity (25-29.9 kg/m2, HR: 2.023; 95%CI: 1.008-4.059) are associated with increased mortality.

Conclusion

our study suggested that under-weight is associated with increased risk of mortality after hip arthroplasty. Further, in a short-term outcome, obesity appear to be associated with increased mortality after hip arthroplasty within 30 days.

The role of nutrition in ageing: A narrative review from the perspective of the European joint action on frailty - ADVANTAGE JA

BACKGROUND AND PURPOSE

There is sufficient evidence that nutrition and frailty status are related. In order to deliver quality management of frail and pre-frail patients, clinicians and dieticians should understand the role of nutrition in the concept of frailty. This study examines the role of nutrition in ageing in general, malnutrition and the risk of frailty, individual nutritional factors as the risk factors of frailty and lastly nutritional interventions that have a significant role in frailty.

METHODS

A literature search was conducted in the following databases: PubMed, Cochrane, Embase, Cinahl and UpToDate. The criterion in selecting the literature was that articles were published between 2002 and 2017. From 39,885 initial hits, 28 publications were selected.

RESULTS

Malnutrition or being at risk of malnutrition increases the risk of frailty and its consequences. With regard to the importance of recognizing malnutrition and the risk of malnutrition, the Mini Nutritional Assessment is a validated tool with acceptable sensitivity/specificity to be used for screening and assessment. Frail patients who are at an elevated risk of falls and fractures need Vitamin D supplementation. The promotion of a Mediterranean diet and a protein intake of at least 1-1.2 g per kilogram of body weight per day is beneficial.

CONCLUSIONS

One of the main variable risk factors for the development of frailty can be unsuitable nourishment and there is evidence that nutrition and frailty status are related. Successful comprehensive management of frailty requires a balanced healthy nutrition at all ages, preferably in combination with physical activity.

Association of body mass index with mortality in cardiovascular disease: New insights into the obesity paradox from multiple perspectives

Over the past 4 decades, prevalence of obesity has increased rapidly at both the national and global level and presents a major public health challenge. Obesity is associated with increased risk of morbidity from cardiovascular diseases. Data suggesting that the presence of obesity may be protective in individuals with clinically manifest cardiovascular disease have led to discussion of an "obesity paradox", stirring controversy and leading to unclear messaging regarding the true health risks of excess weight. This review explores the relationship between obesity and fatal and non-fatal outcomes in patients with prevalent cardiovascular disease and offers novel insights into the obesity paradox.

Association between frailty and its individual components with the risk of falls in patients with schizophrenia spectrum disorders

Frailty is common among older people who carry an increased risk for poor outcomes, including falls, physical disabilities, infections, and mortality. However, the prevalence of frailty and the prognostic influence of frailty status are poorly understood in adults with schizophrenia. The present study aimed to assess the predictive ability of frailty and its individual components for the risk of falls in patients with chronic schizophrenia. Frailty status was assessed at baseline by using Fried frailty criteria after the enrollment of 561 patients with chronic schizophrenia. The patients were followed up for 18 months, and the outcome of the study was the incidence of falls. The mean age of the patients was 53.8 years, and a total of 35.3% were females. One-quarter (25.3%) of patients received typical antipsychotics. The prevalence of frailty was 10.2% at baseline. During follow-up, 40 patients (7.1%) experienced falls. Frailty status was associated with increased susceptibility to falling with an unadjusted hazard ratio of 5.27 (95% confidence interval: 2.75-10.10) and a hazard ratio of 4.65 (95% confidence interval: 1.88-11.54) after multivariate adjustment. Among the components of frailty, the most significant association was observed between low physical activity and falls (p < 0.05). In conclusion, frailty is highly prevalent in patients with chronic schizophrenia and is associated with the risk of adverse clinical events. Further studies are needed to explore the mechanisms underlying the relationship between schizophrenia and frailty in an attempt to develop an appropriate treatment plan for improving clinical outcomes for these patients.

Change in body size and mortality: a systematic review and meta-analysis

Background

: Observational studies have reported that weight loss in later life is associated with an increased risk of mortality. However, the association with weight gain is unclear. We conducted a systematic review and meta-analysis of prospective studies assessing the association of weight gain and loss, and mortality.

Methods

: We searched PubMed, Scopus and Web of Science for articles published before 5 September 2015. We included prospective studies that reported enough information to extract hazard ratios (HRs) with the corresponding 95% confidence intervals (CIs) for the association between weight gain and/or weight loss, and all-cause and cause-specific mortality. The estimates were pooled using a random-effects model. Meta-regression models were fitted to explore sources of potential between-study heterogeneity.

Results

: A total of 25 (providing data from 437 772 participants with 34 038 deaths from all causes) and 24 studies (434 694 participants with 31 978 deaths) presented results for the exposures, weight loss and weight gain. Weight loss compared with a stable weight was associated with an increased risk of all-cause (pooled HR: 1.45; 95% CI: 1.34, 1.58), and cardiovascular disease (CVD) mortality (1.50; 1.32, 1.70) and a slightly increased risk of cancer mortality (1.19; 0.97, 1.46). Weight gain was associated with an increased risk of CVD mortality (1.21; 1.07, 1.36) and a slightly increased risk of all-cause mortality (1.07; 1.01, 1.13) and cancer mortality (1.04; 0.96, 1.13). Considerable heterogeneity was observed; the method used to ascertain body size and the proportion of the baseline sample included in the final analysis explained most of the heterogeneity.

Conclusion

: Weight loss and weight gain in midlife are associated with increased risk of all-cause and CVD mortality.

Nutrition, Daily Walking and Resilience Are Associated with Physical Function in the Oldest Old Men

BACKGROUND

Maintaining good physical functioning in old age is of utmost importance for healthy and active aging. We examined physical function and associated factors in the oldest-old men.

SUBJECTS AND METHODS

The participants of this cross sectional analysis of a longitudinal study were the oldest old men( n=394, mean age 88 years, range 82-97 years) from the Helsinki Business Men cohort who responded to a postal health and nutrition survey in 2016. Physical function was defined using the respective subscale (Physical Function, PF) in the RAND-36 health-related quality of life (HRQoL) instrument. Resilience was measured with validated Finnish version of Resilience scale. Diet quality was assessed using Mediterranean diet adherence score (MeDi) and Diet quality index (DQI) which is designed to show adherence to Finnish dietary recommendations. Food and dietary intakes were retrieved using 3-day food records (obtained from a sub-group of the respondents). The participants were divided into quartiles corresponding to their PF scores and health and nutrition indicators were calculated into these PF quartiles. Furthermore, a linear regression model was used to determine factors associated with PF.

RESULTS

PF quartiles were positively associated with lower age, daily walking habit, cognition, diet quality, resilience, alcohol use and negatively associated with blood glucose levels, weight loss, body weight (BW) and falls. Polyunsaturated to saturated fat ratio and berry intake were also associated with PF. In a linear regression model PF was positively associated (p < .001, adjusted R2 = .560) with MeDi, cognition, resilience, vitality (RAND-36), and negatively with age and BW.

CONCLUSION

MeDi, exercise, resilience, cognition, use of alcohol, fat quality and lower age were positively associated with PF in the oldest-old men. Weight loss, falls and interestingly BW were negatively associated with PF.

Exploring the "Obesity Paradox" as a Correlate of Cognitive and Physical Function in Community-dwelling Black and White Older Adults

Objective

The obesity paradox has been documented in aged populations, yet it remains unclear if this paradox persists for physical and cognitive outcomes in community-dwelling older adult populations. Our study examines associations between body mass index (BMI) classification, cognitive function, and physical function. We also investigate whether these associations are modified by race or age.

Design

Cross-sectional study.

Setting

Senior residential sites and community centers in Saint Louis, Missouri.

Participants

Study participants included 331 adults, aged >55 years. Age was stratified into young-old (aged 55-74 years) and older (aged ≥75 years).

Outcome Measures

Physical function was measured using the mini-Physical Performance Test (mini-PPT) and grip strength. Cognitive function was assessed with the Short Blessed Test (SBT) and the Trail Making Tests (TMT-A and TMT-B) performance.

Results

Older adults who were obese had significantly better cognitive flexibility (TMT-B) performance than normal weight older adults (P=.02), and this association was not influenced by age or race. Adiposity was not associated with psychomotor speed (TMT-A), general cognition (SBT), or measures of physical function (Ps>.05).

Conclusion

In a diverse sample of community-dwelling older adults, we found partial support for the controversial obesity paradox. Our results suggest excess adiposity may be protective for executive function processes. Future research is needed to examine the underlying physiological processes linking adiposity to executive function in older adults.

Changes in disability, self-rated health, comorbidities and psychological wellbeing in community-dwelling 75-95-year-old cohorts over two decades in Helsinki

OBJECTIVE

To explore changes in self-reported disabilities, health, comorbidities and psychological wellbeing (PWB) in aged cohorts over two decades.

DESIGN, SETTING AND SUBJECTS

Cross-sectional cohort studies with postal surveys were conducted among community-dwelling people aged 75, 80, 85, 90 and 95 years in 1989 (n = 660), 1999 (n = 2598) and 2009 (n = 1637) in Helsinki, Finland.

MAIN OUTCOME MEASURES

Self-reported items on disability, self-rated health (SRH), diagnoses and PWB were compared between cohorts of the same age. Standardized mortality ratios (SMRs) were calculated for each study year to explore the representativeness of the samples compared to general population of same age.

RESULTS

A significantly lower proportion of the 75-85-year-olds of the later study years reported going outdoors daily, although this group had improvements in both SRH and PWB scores. The number of comorbidities increased over time among 75-85-year-olds. The only significant change that could be verified among 90- and 95-year-olds between 1999 and 2009, was the lower proportion of participants going outdoors daily. The trend of leveling-off in disabilities was not explained by the SMRs (0.90, 0.71 and 0.60 for 1989, 1999 and 2009).

CONCLUSIONS

The latest older people's cohorts showed an end to previously reported improvements in disabilities, despite having favorable trends in SRH and PWB. Primary care may be faced with increasing need of appropriate services for their senior members.

The Importance of Mid-to-Late-Life Body Mass Index Trajectories on Late-Life Gait Speed

BACKGROUND

Prior studies suggest being overweight may be protective against poor functional outcomes in older adults.

METHODS

Body mass index (BMI, kg/m2) was measured over 25 years across five visits (1987-2011) among Atherosclerosis Risk in Communities Study participants (baseline Visit 1 n = 15,720, aged 45-64 years). Gait speed was measured at Visit 5 ("late-life", aged ≥65 years, n = 6,229). BMI trajectories were examined using clinical cutpoints and continuous mixed models to estimate effects of patterns of BMI change on gait speed, adjusting for demographics and comorbidities.

RESULTS

Mid-life BMI (baseline visit; 55% women; 27% black) was associated with late-life gait speed 25 years later; gait speeds were 94.3, 89.6, and 82.1 cm/s for participants with baseline normal BMI (<25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30) (p < .001). In longitudinal analyses, late-life gait speeds were 96.9, 88.8, and 81.3 cm/s for participants who maintained normal, overweight, and obese weight status, respectively, across 25 years (p < .01). Increasing BMI over 25 years was associated with poorer late-life gait speeds; a 1%/year BMI increase for a participant with a baseline BMI of 22.5 (final BMI 28.5) was associated with a 4.6-cm/s (95% confidence interval: -7.0, -1.8) slower late-life gait speed than a participant who maintained a baseline BMI of 22.5.

CONCLUSION

Being overweight in older age was not protective of mobility function. Maintaining a normal BMI in mid- and late-life may help preserve late-life mobility.

High Intake of Nonmilk Extrinsic Sugars Is Associated With Protein and Micronutrient Dilution in Home-Dwelling and Institutionalized Older People

BACKGROUND

High dietary sugar intake may compromise protein and micronutrient intakes in people with low energy intakes. The results of micronutrient dilution studies in older people have been few and conflicting. We examined the nutritional status and nutrient intakes associated with nonmilk extrinsic sugars (NMES) intakes in older people representing a broad spectrum of both healthy and vulnerable older populations.

DESIGN AND PARTICIPANTS

This cross-sectional study combined five Finnish data sets covering home-dwelling (n = 526) and institutionalized (n = 374) older people. Their nutritional status was assessed using Mini Nutritional Assessment (MNA) and nutrient intakes retrieved from 1- to 3-day food records. The participants were divided into quartiles corresponding to the proportions of energy received from NMES. Energy, nutrient, and fiber intakes were classified according to the NMES quartiles, and the participants were divided according to their places of residence (home, institution).

RESULTS

High NMES intakes were associated with older age, female sex, poor cognition, low MNA scores, immobility, and institutionalization. In all, 90% of the participants in the highest NMES quartile (Q4) were institutionalized. In the institutionalized individuals, low protein and micronutrient intakes were observed in both those with low energy intake (Q1) and in those with very high NMES intakes (Q4). In home-dwelling individuals, the nutrient intakes tended to decline linearly with increasing NMES intakes in protein and most micronutrients.

CONCLUSIONS

Institutionalized older people consumed diets high in NMES, compared with those living at home, and their low energy and high NMES intakes were associated with low protein and micronutrient intakes.

Body weight and body composition in old age and their relationship with frailty

PURPOSE OF REVIEW

Aging is associated with various changes in body composition, including changes in weight, loss of muscle mass, and increase in fat mass. This article describes the role of body weight and body composition, and their changes, in the risk of frailty in old age.

RECENT FINDINGS

Based on current literature, observational studies on obesity and high waist circumference show most convincing results for an association with frailty. The independent role of muscle mass and muscle fat infiltration remains unclear, mainly due to a lack of studies and a lack of accurate measurement of body composition by computed tomography or MRI. Weight loss and exercise training intervention studies can be of benefit to frail older adults.

SUMMARY

Obesity and high waist circumference may be important determinants of frailty in old age, whereas the role of muscle mass and muscle fat infiltration is still unclear. More prospective studies that will specifically focus on frailty as an outcome measure are needed to identify specific body composition components as potential targets for the prevention of frailty in old age.

[Obesity in old age and its importance for functionality and frailty]

In later life a high body mass index (BMI) is associated with the lowest age-related mortality rate. The BMI range used by the World Health Organization (WHO) to classify overweight, a BMI of 25-30 kg/m², can be regarded as normal weight in old age; nevertheless, obesity is associated with an increased risk of disability and of a deterioration in physical functionality, particularly among older age groups. This relationship to obesity has also been established for frailty. For this reason, a reduction in weight may be appropriate under functional aspects if BMI values exceed 30 kg/m²; however, such a decision cannot be made on the basis of an individual BMI alone. The functional status, body composition, comorbidities and, in particular the life perspectives of the patient should also be taken into consideration. If weight loss is intended, it must always be performed under strict medical supervision involving optimized protein intake, a carefully calculated moderate reduction in calories and adequate physical training. In the case of chronically ill elderly patients, weight reduction is not usually appropriate. Restrictive diets of any kind should principally be critically viewed in old age because even temporary inadequate energy intake may lead to accelerated deterioration of muscle and bone structure.

Trajectories of body mass indices and development of frailty: Evidence from the health and retirement study

OBJECTIVE

To estimate trajectories of body mass index (BMI) and determine their association with incident frailty in later life.

METHODS

Data come from the 2004 to 2012 waves of the Health and Retirement Study, a longitudinal survey of older adults. Analysis was restricted to respondents who were not frail at baseline (n = 10,827). BMI (kg/m(2) ) was calculated from self-reported weight and height. Incident frailty was assessed using the Frailty Index. Longitudinal growth mixture modeling was used to estimate the relationship between BMI trajectories and incident frailty over a 10-year period.

RESULTS

Four trajectory classes were identified: weight gain (n = 162 [1.4%], mean final BMI = 42 kg/m(2) ), weight loss (n = 171 [1.7%], mean final BMI = 25.0 kg/m(2) ), consistent obesity (n = 640 [6.8%], mean final BMI = 34.7 kg/m(2) ), and consistent overweight (n = 9,864 [90.1%] mean final BMI = 26.0 kg/m(2) ). Cumulative incidence of frailty was 19.9%. Relative to the consistent overweight class, the weight gain class had the highest likelihood of incident frailty (odds ratio, OR: 3.61, 95% confidence interval, CI: 2.39-5.46). The consistent obesity (OR: 2.72, 95% CI: 2.06-3.58) and weight loss (OR: 2.81, 95% CI: 1.84-4.30) classes had similarly elevated risk of frailty.

CONCLUSIONS

Weight change and obesity are associated with risk of frailty.

High proportions of older people with normal nutritional status have poor protein intake and low diet quality

INTRODUCTION

The Mini Nutritional Assessment (MNA) is a well-validated instrument examining the nutritional status of older people. The aim of this study was to examine how older people's energy and nutrient intakes are associated with the MNA and to determine how sensitive and specific MNA is in identifying those having low energy and protein intakes.

MATERIALS AND METHODS

This cross-sectional study combined data from five nutritional studies (N=900): both home-dwelling and institutionalized older people without and with disabilities. Their nutritional status was assessed with MNA, and nutrient intakes were retrieved from 1 to 3day food diaries. Nutrient intakes were divided according to MNA status (normal nutritional status, at-risk of malnutrition, malnourished). Sensitivity, specificity, and likelihood ratios of MNA of various cut-off points were tested with recommended protein and energy intakes. ROC curves was constructed.

RESULTS

Energy, protein and most nutrient intakes showed logical linear trends according to MNA classes. However, more than three-fourths of the participants with MNA>23.5 had lower than recommended protein intakes. Sensitivity of MNA ranged from 0.32 to 0.82 for recommended energy (F:1570kcal/d/M:2070kcal/d) and protein intakes (1.0g/kg BW or 1.2g/kgBW) cut-off points, and specificity from 0.75 to 0.25, respectively. AUC values were low (0.52-0.53).

CONCLUSIONS

MNA status was consistently associated with nutrient intakes and diet quality. However, a high proportion of older people even with normal nutritional status had poor energy and protein intakes. Thus, MNA does not identify all those with poor nutrient intakes who may be at risk of developing malnutrition.

Survival and its predictors from age 75 to 85 in men and women belonging to cohorts with marked survival differences to age 75: a comparative study in three Nordic populations

BACKGROUND AND AIMS

While predictors of survival in older people have been examined in depth in a large number of studies, a literature search revealed no cross-national comparative prospective cohort studies on this issue. This study investigated survival and its predictors from age 75 to 85 among three local Nordic populations using survival data on national cohorts as background information.

METHODS

The data were derived from national registers and from samples of 75-year old living in Denmark, Sweden, and Finland. The subjects were invited to take part in interviews and examinations focusing on different domains of health, functional capacity, and physical and social activities.

RESULTS

The proportion of survivors to age 75 was markedly smaller among the Finnish men and women than Danish or Swedish subjects. In the local population no marked differences in survival from age 75 to 85 were observed between the groups of men, while women survived longer than men and longer in Göteborg than in Glostrup or Jyväskylä. Univariate models revealed 12 predictors of survival. In the multivariate models, the significant predictors among men related to physical fitness, whereas among women they pertained to social activities and morbidity.

CONCLUSIONS

Despite great differences in the proportions of survivors to age 75, and excepting the survival advantage of women, only minor differences were present in the subjects' further survival to age 85. In the univariate analyses, many of the factors predictive of survival from age 75 to 85 were the same in the examined populations, whereas in the multivariate analyses differences between the sexes emerged.

Obesity and Structural Brain Integrity in Older Women: The Women's Health Initiative Magnetic Resonance Imaging Study

BACKGROUND

Midlife obesity has been linked to age-related brain atrophy and risk of dementia, but the relationships are less clear for older individuals. These associations may be explained by changes in appetite or metabolism in the dementia prodrome; thus, prospective studies with adequate follow-up are needed. We examined the associations that obesity (body mass index, BMI) and change in BMI over an average of 6.6 (1.0-9.1) years have with global and regional brain and white matter lesion volumes in a sample of 1,366 women aged 65-80.

METHODS

Least square means for regional brain volumes and white matter lesion loads for women grouped by BMI and changes in BMI were generated from multivariable linear models with and without adjustment for demographic and health covariates.

RESULTS

Both global obesity and increase in BMI were associated with lower cerebrospinal fluid and higher specific brain volumes (ps < .05), after controlling for diabetes and other cerebrovascular disease risk factors. Obesity, but not change in BMI, predicted lower lesion loads for the total, parietal, and occipital white matter (ps < .05).

CONCLUSIONS

Obesity in this cohort is associated with less brain atrophy and lower ischemic lesion loads. The findings are consistent with our previous report of worse cognitive performance in association with weight loss (probably not due to frailty) in this cohort and in line with the idea of the "obesity paradox" as differences in dementia risk vary across time, whereby midlife obesity seems to be a predictor of dementia, whereas weight loss seems to be a better predictor at older ages.

Life History and Risk of Death after 50: A Survival Analysis for Europe

Dans notre étude nous avons examiné l’influence des événements du passé des individus sur le risque de décès des Européens âgés de plus de 50 ans, en contrôlant autres variables pertinentes. Notre analyse était basée sur les données d’entretiens biographiques rétrospectifs, les données d’entretiens réguliers au suivi longitudinal et celles d’entretiens de fin de vie de l’Enquête européenne SHARE sur la santé, le vieillissement et la retraite en Europe. En particulier, nous relevons l’état de santé auto-déclaré pendant l’enfance; les périodes de pauvreté, de faim et de mauvaise santé éprouvées dans le passé; et aussi l’histoire des soins de santé, y compris les soins dentaires, les analyses de sang et les mesures de pression artérielle. Ces informations, avec l’age, le sexe, l’état de santé subjectif et objectif, et d’autres facteurs socio-démographiques, permettent d’expliquer le risque de décès. L’analyse de survie, en contrôlant des variables pertinentes, montre que les événements du passé ont un impact significatif sur le risque de décès des Européens âgés de plus de 50 ans.

Association of Frailty and Cardiometabolic Risk Among Community-Dwelling Middle-Aged and Older People: Results from the I-Lan Longitudinal Aging Study

The aim of this study was to evaluate the association of cardiometabolic risk and frailty through a community-based aging cohort in Taiwan In total, 1839 participants (men, 47.5%; mean age 63.9 ± 9.3 years) from the first wave of the I-Lan longitudinal cohort study, recruited between August of 2011 and August of 2013, were retrieved for the analysis of this cross-sectional study. Frailty was defined by Cardiovascular Health Study (CHS) criteria, encompassing un-intentional weight loss, slow walk speed, poor grip strength, exhaustion, and low activity. Comparisons between cardiometabolic risk and frailty status were performed after adjustment for age, hormone parameters, functional measurements, and skeletal muscle mass. Independent association of cardiometabolic risk and frailty status was identified through the multivariate logistic regression model. We found that the prevalence of frailty and pre-frial were 6.8% and 40.5%, respectively. Adjustments for age, blood pressure, low-density lipoprotein cholesterol (LDL-C), uric acid, creatinine, and carotid intima media thickness were not significantly associated with frailty. However, lower total cholesterol and high-density lipoprotein cholesterol (HDL-C), higher high-sensitivity C-reactive protein (hsCRP) and glycemia profiles were significantly associated with frailty. For hormone parameters, dehydroepiandrosterone sulfate (DHEA-S), insulin-like growth factor-1 (IGF-1), and free androgen index were not significantly associated with frailty after age adjustment. In a multivariate logistic regression model, abdominal obesity, homeostasis model assessment of insulin resistance (HOMA-IR), and hsCRP were significantly associated with frailty. The odds ratio (OR) for frailty was 3.57 (95% confidence interval [CI] 1.88-6.78, p < 0.001), 1.30 (95% CI 1.02-1.66, p = 0.032), and 1.66 (95% CI 1.10-2.49, p = 0.016), respectively, in a fully adjusted model. Conversely, higher total cholesterol was associated with a lower prevalence of frailty (OR = 0.44, 95% CI 0.22-0.89, p = 0.023) in the final model. In this study, abdominal obesity, insulin resistance, and inflammation were significantly associated with frailty, and the effect was independent of functional measurement and decline of skeletal muscle mass. An integrated approach targeted at cardiometabolic aging and frailty is needed in clinical practice.