Body Composition in Late Midlife as a Predictor of Accelerated Age-associated Deficit-accumulation From Late Midlife into Old Age: A Longitudinal Birth Cohort Study

The influence of HIV on body composition and its relationship with physical function in mid-life women: a cross-sectional study from Zimbabwe

OBJECTIVE

Menopause-related changes in body composition and physical function are unclear in Southern Africa, particularly in the context of a generalized HIV epidemic with high antiretroviral therapy (ART) coverage.

METHOD

A total of 263 Zimbabwean women (53% women living with HIV [WLH]) aged 40-60 years provided data on menopause, ART use, anthropometry, body composition (appendicular lean mass [ALM], muscle area, fat mass), handgrip strength (HGS) and gait speed. Linear regression determined relationships between body composition and physical function, unadjusted and age-menopause-adjusted, stratified by HIV status. Univariate logistic regression investigated associations between body composition and self-reported falls.

RESULTS

WLH (96% ART established) were a median (interquartile range) 10.4 (6.4-14.5) years since diagnosis, with lower weight, body mass index, ALM, fat mass and HGS than women living without HIV (WLWOH). With menopause transition, WLH lost weight, ALM, gynoid mass and muscle area (all p-trend <0.05); however, WLWOH did not. Both WLH and WLWOH lost HGS (p-trend <0.05). ALM was positively associated with HGS in all women. In WLH, greater percentage body fat, particularly gynoid fat, was associated with increased odds of falls (1.69 [1.00-2.89], p = 0.049 and 1.72 [1.08-2.75], p = 0.023, respectively).

CONCLUSION

Women living with HIV were more likely to experience adverse changes in body composition through menopause; fat mass gains were associated with risk of falls.

Association Between Healthful Plant-Based Dietary Pattern and Obesity Trajectories and Future Cardiovascular Diseases in Middle-Aged and Elderly: A Prospective and Longitudinal Cohort Study

We aimed to explore the association between plant-based dietary (PBD) patterns and obesity trajectories in middle-aged and elderly, as well as obesity trajectories linked to cardiovascular disease (CVD) risk. A total of 7108 middle-aged and elderly UK Biobank participants with at least three physical measurements were included. Dietary information collected at enrolment was used to calculate the healthful plant-based diet index (hPDI). Group-based trajectory modeling identified two trajectories for each adiposity measure: BMI Low-Smooth and High-Growth-Decline; FMI Low-Smooth and High-Growth-Decline; WHR Low-Growth and High-Growth. Logistic regression showed that participants in the medium and high hPDI groups were less likely to follow the BMI High-Growth-Decline (OR = 0.72, 95% CI: 0.60-0.87; OR = 0.49, 95% CI: 0.39-0.61), FMI High-Growth-Decline (OR = 0.71, 95% CI: 0.60-0.84; OR = 0.55, 95% CI: 0.46-0.66), and WHR High-Growth (OR = 0.73, 95% CI: 0.61-0.87; OR = 0.52, 95% CI: 0.43-0.63) trajectories. After a median follow-up time of 3.88 years, Cox regression showed higher CVD risk for participants in these trajectories (HR = 1.70, 95% CI: 1.37-2.11; HR = 1.68, 95% CI: 1.37-2.06; HR = 1.30, 95% CI: 1.04-1.63). A healthy PBD pattern was associated with the maintenance of a healthy BMI classification. Furthermore, the long-term stabilization of a healthy BMI classification may be linked to a reduced risk of CVD.

The relationship between thigh circumference and sarcopenia in Chinese community-dwelling elderly aged ≥60 years

Background

There has been a growing body of research demonstrating that thigh circumference is closely associated with the development of various chronic disease. However, limited evidence has been obtained regarding the relationship between thigh circumference and sarcopenia.

Objective

The aim of this study was to investigate the relationship between thigh circumference and sarcopenia, and explore the potential role of thigh circumference for sarcopenia screening among community-dwelling older adults.

Methods

The investigation was carried out in six rural communities located in northwestern China with participants aged ≥60 years old. We collected variables related to sarcopenia, including function, muscle mass, and strength. The thigh circumference was categorized into four groups based on quartiles, with the first quartile (≤46.65 cm); the second quartile (46.66-48.50 cm); the third quartile (48.51-50.55 cm); and the fourth quartile (>50.55 cm). The associations and screening effect were estimated with multivariate logistics regression and ROC curves.

Results

Of the 1000 participants aged 70.72 ± 4.68 years. Compared with the first quartile (≤46.65 cm), the odds ratios for the second, third, and fourth quartiles of thigh circumference were 0.465 (95%CI: 0.281-0.770, p = 0.003), 0.199 (95%CI: 0.097-0.407, p < 0.001), and 0.059 (95%CI: 0.016-0.220, p < 0.001), respectively. The regression results were consistent across different sexes. The AUC and cutoff values of thigh circumference for sarcopenia were 0.873 (95 % CI 0.836-0.909, p < 0.001) and 48.83 cm for men and 0.861 (95 % CI 0.822-0.900, p < 0.001) and 46.78 cm for women. There was a positive correlation between thigh circumference and skeletal muscle mass (r = 0.747, p < 0.001), hand grip strength (r = 0.337, p < 0.001), and gait speed (r = 0.142, p < 0.001), while a negative correlation was observed with five-times-sit-to-stand test (r = -0.073, p = 0.021).

Conclusion

There was a negative correlation between thigh circumference and sarcopenia, suggesting that thigh circumference may serve as a potential useful indicator for sarcopenia screening in the elderly.

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.

Association Between Sarcopenic Obesity and Frailty Risk in Community-Dwelling Older Women With Locomotive Syndrome: A Cross-Sectional Survey

Background Concurrent sarcopenia and obesity in locomotive syndrome (LS) impair activities of daily living and decrease extremity muscle strength and motor function. However, the increased risk of frailty posed by sarcopenic obesity compared to either sarcopenia or obesity alone remains unclear. Objective To examine the association between sarcopenic obesity and frailty risk in community-dwelling older adult women with LS. Methods This cross-sectional study included 158 women aged ≥65 years with LS stage 1 (age, 74.0 yrs, body mass index, 22.7 kg/m2) according to the Japanese Orthopaedic Association criteria. Bioelectrical impedance analysis was used to measure the skeletal muscle mass index (SMI) and percent body fat (PBF). Participants were classified into four subtypes: normal (non-obesity, non-sarcopenia), sarcopenia (SMI < 5.7 kg/m2), obesity (PBF > 35%), and sarcopenic obesity (SMI < 5.7 kg/m2 and PBF > 35%). Logistic regression analysis was used to adjust for age, body mass index, back pain, knee pain, history of falls, and physical function. Results Among the participants, 52 individuals (32.9%) were classified as frailty risk. The percentage of body phenotypes was 30.4% normal, 32.9% were sarcopenia, 22.8% had obesity (RT1), and 13.9% had sarcopenic obesity. The odds ratios for frailty risk compared to normal were 3.97 (95% confidence interval (CI): 1.51 to 10.4), 1.71 (95% CI: 0.55 to 5.39), and 4.25 (95% CI: 1.34 to 13.5) for sarcopenia (RT2), obesity, and sarcopenic obesity subtypes, respectively, sarcopenia and sarcopenic obesity were significantly associated with frailty risk. Conclusion In older adult women with LS, the presence of sarcopenia or sarcopenic obesity may increase the risk of frailty; however, the addition of obesity does not always further increase this risk. Further investigation of the association between increased body fat and frailty in older adult women is warranted.

Neuro-Adipokine Crosstalk in Alzheimer's Disease

The connection between body weight alterations and Alzheimer's disease highlights the intricate relationship between the brain and adipose tissue in the context of neurological disorders. During midlife, weight gain increases the risk of cognitive decline and dementia, whereas in late life, weight gain becomes a protective factor. Despite their substantial impact on metabolism, the role of adipokines in the transition from healthy aging to neurological disorders remains largely unexplored. We aim to investigate how the adipose tissue milieu and the secreted adipokines are involved in the transition between biological and pathological aging, highlighting the bidirectional relationship between the brain and systemic metabolism. Understanding the function of these adipokines will allow us to identify biomarkers for early detection of Alzheimer's disease and uncover novel therapeutic options.

Frailty in Midlife as a Predictor of Changes in Body Composition from Midlife into Old Age: A Longitudinal Birth Cohort Study

INTRODUCTION

Few studies have investigated the association between frailty and subsequent body composition.

METHODS

We performed separate linear mixed model analyses to study the associations between changes in the participant frailty status assessed by a frailty index (FI) and subsequent body mass index (BMI), lean mass index (LMI), fat mass index (FMI), and FMI to LMI ratio values assessed on three occasions over 17 years. The analyses were carried out among 996 participants spanning from age 57 to 84 years.

RESULTS

With advancing age, LMI and BMI decreased, whereas FMI and FMI to LMI ratio increased. Participants with "stable frailty," followed by those with "increasing frailty" experienced faster decreases in LMI and faster increases in FMI and FMI to LMI ratio values from midlife into old age relative to those in the group "stable not frail." Contrastingly, those in the highest third of absolute annual increase in FMI and FMI to LMI ratio became more frail faster from midlife into old age relative to those in the lowest third.

CONCLUSIONS

We found evidence of an adverse health outcome of frailty where lean indices declined faster and fat indices and fat-to-lean ratios increased faster from midlife into old age. The changes resembled those that occurred with aging, but at a faster pace. The relationship between body composition and frailty is likely bidirectional, where high or increasing levels of fat are associated with the risk of becoming more frail earlier, but where a longer duration of frailty may increase the risk of faster age-related changes to body composition.

Associations between body mass index, biological age and frailty in the critically ill

BACKGROUND

The relationship between body mass index (BMI) and outcomes in the acute care setting is controversial, with evidence suggesting that obesity is either protective - which is also called obesity paradox - or associated with worse outcomes. The purpose of this study was to assess whether BMI was related to frailty and biological age, and whether BMI remained predictive of mortality after adjusting for frailty and biological age.

SUBJECTS

Of the 2950 patients who had a biological age estimated on admission to the intensive care unit, 877 (30 %) also had BMI and frailty data available for further analysis in this retrospective cohort study.

METHODS

Biological age of each patient was estimated using the Levine PhenoAge model based on results of nine blood tests that were reflective of DNA methylation. Biological age in excess of chronological age was then indexed to the local study context by a linear regression to generate the residuals. The associations between BMI, clinical frailty scale, and the residuals were first analyzed using univariable analyses. Their associations with mortality were then assessed by multivariable analysis, including the use of a 3-knot restricted cubic spline function to allow non-linearity.

RESULTS

Both frailty (p = 0.003) and the residuals of the biological age (p = 0.001) were related to BMI in a U-shaped fashion. BMI was not related to hospital mortality, but both frailty (p = 0.015) and the residuals of biological age (OR per decade older than chronological age 1.50, 95 % confidence interval [CI] 1.04-2.18; p = 0.031) were predictive of mortality after adjusting for chronological age, diabetes mellitus and severity of acute illness.

CONCLUSIONS

BMI was significantly associated with both frailty and biological age in a U-shaped fashion but only the latter two were related to mortality. These results may, in part, explain why obesity paradox could be observed in some studies.

The brain insulin receptor gene network and associations with frailty index

OBJECTIVE

To investigate longitudinal associations between variations in the co-expression-based brain insulin receptor polygenic risk score and frailty, as well as change in frailty across follow-up.

METHODS

This longitudinal study included 1605 participants from the Helsinki Birth Cohort Study. Biologically informed expression-based polygenic risk scores for the insulin receptor gene network, which measure genetic variation in the function of the insulin receptor, were calculated for the hippocampal (hePRS-IR) and the mesocorticolimbic (mePRS-IR) regions. Frailty was assessed in at baseline in 2001-2004, 2011-2013 and 2017-2018 by applying a deficit accumulation-based frailty index. Analyses were carried out by applying linear mixed models and logistical regression models adjusted for adult socioeconomic status, birthweight, smoking and their interactions with age.

RESULTS

The FI levels of women were 1.19%-points (95% CI 0.12-2.26, P = 0.029) higher than in men. Both categorical and continuous hePRS-IR in women were associated with higher FI levels than in men at baseline (P < 0.05). In women with high hePRS-IR, the rate of change was steeper with increasing age compared to those with low or moderate hePRS-IR (P < 0.05). No associations were detected between mePRS-IR and frailty at baseline, nor between mePRS-IR and the increase in mean FI levels per year in either sex (P > 0.43).

CONCLUSIONS

Higher variation in the function of the insulin receptor gene network in the hippocampus is associated with increasing frailty in women. This could potentially offer novel targets for future drug development aimed at frailty and ageing.

Lifestyle-related factors in late midlife as predictors of frailty from late midlife into old age: a longitudinal birth cohort study

BACKGROUND

Few studies have examined longitudinal changes in lifestyle-related factors and frailty.

METHODS

We examined the association between individual lifestyle factors (exercise, diet, sleep, alcohol, smoking and body composition), their sum at baseline, their change over the 17-year follow-up and the rate of change in frailty index values using linear mixed models in a cohort of 2,000 participants aged 57-69 years at baseline.

RESULTS

A higher number of healthy lifestyle-related factors at baseline was associated with lower levels of frailty but not with its rate of change from late midlife into old age. Participants who stopped exercising regularly (adjusted β × Time = 0.19, 95%CI = 0.10, 0.27) and who began experiencing sleeping difficulties (adjusted β × Time = 0.20, 95%CI = 0.10, 0.31) experienced more rapid increases in frailty from late midlife into old age. Conversely, those whose sleep improved (adjusted β × Time = -0.10, 95%CI = -0.23, -0.01) showed a slower increase in frailty from late midlife onwards. Participants letting go of lifestyle-related factors (decline by 3+ factors vs. no change) became more frail faster from late midlife into old age (adjusted β × Time = 0.16, 95% CI = 0.01, 0.30).

CONCLUSIONS

Lifestyle-related differences in frailty were already evident in late midlife and persisted into old age. Adopting one new healthy lifestyle-related factor had a small impact on a slightly less steeply increasing level of frailty. Maintaining regular exercise and sleeping habits may help prevent more rapid increases in frailty.

The Influence of Obesity on Bone Health in Post-COVID-19 Recovery- Single-Center Experience

Introduction

The ongoing repercussions of the COVID-19 pandemic include potentially deleterious impacts on bone health.

Aim

This research aimed to ascertain the effects of COVID-19 on the bone health of obese and non-obese Indian individuals.

Methods

We executed a case-control study enrolling individuals who recovered from COVID-19. Participants were stratified into obese and non-obese groups based on their BMI. Comprehensive assessments encompassed anthropometric evaluations, laboratory tests, and bone mineral density (BMD) measurements using dual-energy X-ray absorptiometry (DEXA).

Results

From April to July 2022, we enrolled obese (n = 27, mean BMI = 30.54 ± 4.51 kg/m 2) and non-obese (n = 23, mean BMI = 21.97 ± 2.20 kg/m 2) individuals. The cohort's average age was 36.08 ± 15.81 years, with a male-to-female ratio of 1.6:1. There was a difference in BMD, especially at the total hip, between the two groups. BMD at the spine (L1-L4), the neck of the femur, and ultra-distal radius were consistent across both groups. Weight exhibited a significant positive correlation with BMD at L1-L4 (r = 0.40, p = 0.003) and the left femur total (r = 0.27, p = 0.001). Haemoglobin levels were lower in the obese group compared to their non-obese counterparts (12.3 ± 2.0 vs 13.6 ± 1.9, p = 0.01). Multivariate analysis underscored weight as a crucial predictor for BMD at the spine (L1-L4, p = 0.003) and total hip (p = 0.001).

Conclusion

Even with advanced age, obese post-COVID-19 individuals demonstrate a higher bone mineral density (BMD) at the hip than non-obese subjects.

Frailty in Late Midlife to Old Age and Its Relationship to Medical Imaging Use and Imaging-related Costs: A Longitudinal Study

Background Frailty, defined as an increased vulnerability to and impaired recovery from stressors, is common in individuals in late midlife to old age. While frailty predisposes individuals to adverse health outcomes and increased health care utilization, how it impacts imaging service use and related costs remains unclear. Purpose To determine whether frailty is associated with greater use of imaging services and higher imaging-related costs. Materials and Methods This longitudinal study included a subset of participants from the Helsinki Birth Cohort Study who were clinically assessed up to three times from late midlife to old age between August 2001 and September 2018. A frailty index (FI) based on 41 variables was calculated, and an FI of 0.25 or more indicated frailty. Associations of baseline frailty and its rate of change during the study with medical imaging service use and imaging-related costs were assessed using covariate-adjusted negative binomial and other generalized linear models. Results Of the 1995 participants (mean age, 61.5 years ± 2.9 [SD]; 1074 female participants) included in this study, 569 (28.5%) were identified as frail at baseline, and these participants underwent 10 677 (42.4%) of the 25 172 medical imaging examinations among the participants. Compared to participants who were not frail at baseline, participants who were frail at baseline showed increased use of all imaging modalities (incidence rate ratio [IRR], 2.28 [95% CI: 1.97, 2.64]; P < .001) and higher imaging costs (log annual cost, 3.26 [95% CI: 2.36, 4.50]; P < .001). Compared to participants with stable or slow change in frailty (<0.0010 FI units per year), participants with a rapid increase in frailty (>0.0064 FI units per year) from late midlife to old age showed greater use of all medical imaging services, independent of FI at baseline (IRR, 1.82 [95% CI: 1.53, 2.17]; P < .001) and had higher imaging costs (log annual cost, 1.62 [95% CI: 1.30, 2.01)]; P < .001). Conclusion The presence of frailty and its progression rate are associated with increased use of imaging services and higher imaging-related costs. © RSNA, 2023 Supplemental material is available for this article.

Analysis of the relationship between body habitus and frailty of community adults in Chongqing: a cross-sectional survey study

Objective

Currently, a multitude of studies are underway to investigate the factors affecting the degree of frailty, with a significant focus on the critical role of body mass index (BMI). This study aims to conduct a cross-sectional survey to investigate the multifaceted relationship between multiple body habitus and the factors that influence the degree of frailty.

Methods

A questionnaire survey was conducted among 840 adult residents in Chongqing communities. A total of 723 participants were included in the data analysis, with an effective response rate of 92.0%. Fried's frailty scale was used to classify individuals into fit, pre-frail, or frail. Non-parametric tests and chi-square tests were employed to evaluate the inter-group differences in frailty levels under different influencing factors. Multivariate logistic regression analysis was performed to select the independent variables associated with frailty statistics. According to the results of the parallel line test, ordered or disordered multivariate logistic regression was used to evaluate the impact of a single independent variable on frailty for different variables.

Results

Adult community residents in Chongqing accounted for 29.18 and 5.67% in pre-frailty and frailty, respectively. In multivariate logistic regression analysis, high BMI, and high waist-hip ratio (WHR) were identified as major risk factors for frailty. Furthermore, the process of aging, coupled with moderate to heavy alcohol consumption, active weight loss behavior in the past year, and the presence of comorbidities, emerged as significant contributors to frailty. Conversely, factors such as a positive inclination toward taste, consistent meal timing, habitual breakfast consumption, sound nutritional intake, and the cultivation of healthy dietary practices were recognized as pivotal elements that act as protective factors against frailty.

Conclusion

The integration of both BMI and WHR provides a more comprehensive perspective, effectively capturing the intertwined influence of obesity and sarcopenia on the extent of frailty. To mitigate the risk of community-wide frailty, a multipronged approach is essential, involving the promotion of favorable dietary practices and achieving nutritional equilibrium, diligent management of coexisting medical conditions, moderation in alcohol consumption, and the enhancement of physical functionality.