Nutrition and function: is there a relationship between body mass index and the functional capabilities of community-dwelling elderly?

Relationships between anthropometric and body composition characteristics and age in Polish women over 60 as affected by their socioeconomic and health status and physical activity levels

Background: Little is known about changes in anthropometric and body composition (A&BC) characteristics during the aging process. Research indicates that body composition can be linked with socioeconomic status (SES), health status (HS), and physical activity (PA) levels. Aim: The aim of this study was to evaluate age-related changes in A&BC characteristics in female seniors aged 60+ in view of their SES, HS, and PA levels. Methods: The survey was conducted in November and December 2022 on a total of 661 female seniors. A questionnaire survey was conducted to obtain information about the participants' socioeconomic status (chronic diseases, health status, marital status, membership in social organizations, financial status, place of residence, education). The respondents' PA levels were assessed with the International Physical Activity Questionnaire (IPAQ), and their A&BC characteristics were determined in a bioelectrical impedance analysis with the InBody 270 body composition analyzer. The relationships between A&BC characteristics and age were evaluated based on the values of the Pearson correlation coefficient (r). Results: The mean values of Percent Body Fat (PBF), Body Mass Index (BMI), and the waist-hip ratio (WHR) were relatively high (37.2%, 28.5 kg/m², and 0.8, respectively) and indicative of overweight and gynoid obesity. A higher number of significant negative correlations between A&BC characteristics and age were observed in seniors with lower values of SES, HS, and PA, which points to more rapid involutional changes in this group of respondents. A segmental analysis also revealed significantly lower values of fat-free mass (FFM) and body fat mass (BFM) (both indicators were calculated in percentage and kg), in particular in the upper limbs, in women with lower SES, HS, and PA levels. Conclusion: Environmental factors, including biological, physiological, environmental, psychological, behavioral, and social factors, are significantly associated with aging in women. Age-related changes in A&BC characteristics tend to proceed more rapidly in female seniors with low values of SES and HE and insufficient PA levels.

Effect of low body mass index on clinical recovery after fusion surgery for osteoporotic vertebral fracture: A retrospective, multicenter study of 237 cases

A retrospective multicenter study. Body mass index (BMI) is recognized as an important determinant of osteoporosis and spinal postoperative outcomes; however, the specific impact of BMI on surgery for osteoporotic vertebral fractures (OVFs) remains inconclusive. This retrospective multicenter study investigated the impact of BMI on clinical outcomes following fusion surgery for OVFs. 237 OVF patients (mean age, 74.3 years; 48 men and 189 women) with neurological symptoms who underwent spinal fusion were included in this study. Patients were grouped by World Health Organization BMI categories: low BMI (<18.5 kg/m2), normal BMI (≥18.5 and <25 kg/m2), and high BMI (≥25 kg/m2). Patients' backgrounds, surgical method, radiological findings, pain measurements, activities of daily living (ADL), and postoperative complications were compared after a mean follow-up period of 4 years. As results, the proportion of patients able to walk independently was significantly smaller in the low BMI group (75.0%) compared with the normal BMI group (89.9%; P = .01) and the high BMI group (94.3%; P = .04). Improvement in the visual analogue scale for leg pain was significantly less in the low BMI group than the high BMI group (26.7 vs 42.8 mm; P = .046). Radiological evaluation, the Frankel classification, and postoperative complications were not significantly different among all 3 groups. Improvement of pain intensity and ADL in the high BMI group was equivalent or non-significantly better for some outcome measures compared with the normal BMI group. Leg pain and independent walking ability after fusion surgery for patients with OVFs improved less in the low versus the high BMI group. Surgeons may want to carefully evaluate at risk low BMI patients before fusion surgery for OVF because poor clinical results may occur.

Relationship of body mass index with frailty and all-cause mortality among middle-aged and older adults

BACKGROUND

Parallel to growth of aging and obese populations, the prevalence of metabolic diseases is rising. How body mass index (BMI) relates to frailty and mortality across frailty levels is controversial. We examined the associations of high BMI with frailty and mortality and explored the effects of percent body fat on these associations.

METHODS

We included 29,937 participants aged ≥50 years from the 2001-2006 National Health and Nutrition Examination Survey (NHANES) cohorts (N=6062; 53.7% females) and from wave 1 (2004) of Survey of Health, Ageing and Retirement in Europe (SHARE) (N=23,875; 54% females). BMI levels were categorized as: normal: 18.5-24.9 kg/m², overweight: 25.0-29.9, obese grade 1: 30.0-34.9, and obese grade 2 or 3: >35.0. A frailty index (FI) was constructed excluding nutrition-related items: 36 items for NHANES and 57 items for SHARE. We categorized the FI using 0.1-point increments: FI ≤ 0.1 (non-frail), 0.1 < FI ≤ 0.2 (very mildly frail), 0.2 < FI ≤ 0.3 (mildly frail), and FI > 0.3 (moderately/severely frail). Percent body fat was measured using DXA for NHANES participants. All-cause mortality data were obtained until 2015 for NHANES and 2017 for SHARE to estimate 10-year mortality risk. All analyses were adjusted for age, sex, educational, marital, employment, and smoking statuses.

RESULTS

Mean age of participants was 63.3±10.2 years for NHANES and 65.0±10.0 years for SHARE. In both cohorts, BMI levels ≥25 kg/m² were associated with higher frailty, compared to normal BMI. In SHARE, having a BMI level greater than 35 kg/m² increased mortality risk in participants with FI≤0.1 (HR 1.31, 95%CI 1.02-1.69). Overweight participants with FI scores >0.3 were at lower risk for mortality compared to normal BMI [NHANES (0.79, 0.64-0.96); SHARE (0.71, 0.63-0.80)]. Higher percent body fat was associated with higher frailty. Percent body fat significantly mediated the relationship between BMI levels and frailty but did not mediate the relationship between BMI levels and mortality risk.

CONCLUSIONS

Being overweight or obese is associated with higher frailty levels. In this study, we found that being overweight is a protective factor of mortality in moderately/severely frail people and obesity grade 1 may be protective for mortality for people with at least a mild level of frailty. In contrast, obesity grades 2 and 3 may be associated with higher mortality risk in non-frail people. The relationship between BMI and frailty is partially explained by body fat.

Relationship of body mass index on activities of daily living in hospitalized patients with chronic obstructive pulmonary disease

BACKGROUND

Weight loss and low lean body mass in patients with chronic obstructive pulmonary disease (COPD) are associated with increased mortality; however, the association between body mass index (BMI) and physical ability remains undetermined. We aimed to investigate the effect of BMI on activities of daily living (ADL) in hospitalized patients with COPD.

METHODS

We used the Japan Medical Data Center's hospital-based database to extract data on hospitalized patients aged ≥ 20 years admitted for COPD between April 2014 and December 2018. The primary outcome was the presence or absence of deterioration in the Barthel Index score for ADLs at discharge compared with that at admission. Secondary outcomes were the length of hospital stay, readmission within 30 days, and the number of drugs administered on admission.

RESULTS

We identified 6529 patients with COPD from the Diagnosis Procedure Combination database, of which 3476 were analyzed (excluded: n = 5, ages < 20 years; n = 3048, missing entries). Barthel Index scores tended to decline in patients with BMI < 18.5 kg/m² (odds ratio, OR: 2.030, p < 0.001) and Hugh-Jones grade 4 (OR: 1.79, p = 0.05) and grade 5 (OR: 2.15, p = 0.01), but not in the obese group (p = 0.598). The low-weight group had a significantly longer hospital stay (p < 0.001) at 14 (8-25) days with greater readmissions within 30 days (6.3%, p < 0.001).

CONCLUSION

Low BMI is associated with lower Barthel Index scores, longer hospital stays, requiring readmissions within 30 days of discharge.

What is the Optimal Body Mass Index Range for Older Adults?

Background

Obesity is pathophysiologically complex in older adults compared to that in young and middle-aged adults. The aim of the present study was to determine the appropriate body mass index (BMI) range based on geriatric evaluation parameters in which complications can be minimized in older adults.

Methods

A total of 1,051 older adult patients who underwent comprehensive geriatric assessment were included. The patients’ demographic characteristics, comorbid diseases, number of drugs, BMI, basic and instrumental activities of daily living (BADL and IADL), Tinetti balance and walking scale, Mini Nutritional Assessment, Geriatric Depression Scale-15, Mini-Mental State Examination, Time Up and Go test, and handgrip strength measurement were extracted from patient records.

Results

Of the patients who took part, 73% were female, and the mean age was 77.22±7.10 years. The most negative results were observed in those with a BMI <25 kg/m² and in those with a BMI >35 kg/m². Receiver operating characteristic (ROC) analysis of the optimum BMI cutoff levels to detect the desirable values of geriatric assessment parameters was found to be 31–32 and 27–28 kg/m² for female and male, respectively.

Conclusion

Older adults with BMI <25 and >35 kg/m² were at a higher risk of a decrease in functional capacity, and experienced gait and balance problems, fall risk, decrease in muscle strength, and malnutrition. Data from this study suggest that the optimum range of BMI levels for older adults is 31–32 and 27–28 kg/m² for female and male, respectively.

Unmet Healthcare Needs Among Elderly Malaysians

Purpose

Older people often have chronic diseases which require a continuity of care over the long term. Countries undergoing population aging need to ensure that older people are receiving the care they need. This study assesses the prevalence of, reasons for, and factors associated with unmet healthcare needs among older people individuals in Malaysia.

Patients and Methods

This cross-sectional study used data collected during 2018–2020 from 1204 older adults aged 60 and older selected from Selangor state, Malaysia. A comprehensive face-to-face interview based on the Bahasa Malaysia version of the Japan Gerontological Evaluation Study (JAGES-BM) questionnaire was administered to gain information on unmet healthcare needs, socioeconomic factors, health-related factors, and measures of function (activities of daily living, depression, visual impairment, hearing impairment, memory impairment, and walking impairment). Multivariate logistic regression was used to analyze factors associated with their unmet healthcare needs.

Results

Overall, the percentage of older people respondents with unmet healthcare needs is 6.6%. The most reported reasons for forgoing or delaying healthcare were lack of knowledge about healthcare and financial barriers to care. The inability to travel alone (adjusted odds ratio [aOR] 2.51), being overweight (aOR 1.88), and having self-reported depression (aOR 2.23) were each associated with a higher likelihood of having unmet healthcare needs in their daily life.

Conclusion

The prevalence of unmet healthcare needs among older people in this part of Malaysia is lower than that reported in some other countries. However, it is possible to further reduce unmet healthcare needs by improving people’s knowledge and attitudes about appropriate healthcare utilization, strengthening financial protection measures and providing support to people at high risk of having unmet healthcare needs.

Minority Women

Perceptions of illness, pain, and death are not static. They vary among populations according to their cultural and biological characteristics. Older black and Hispanic/Latinx women are unique in their approach to health care with respect to mentation, mobility, medication adherence, and what matters to them. It is the complexity of these components, which affect the ability of these women to age gracefully.

Adherence to Healthy Lifestyle and the Risk of Function Limitations in Late Life: The Atherosclerosis Risk in Communities Study

Background: Physiological function impairment is the main precursor of assisted living, movement disorder, and disability in the elderly. The relationship between a combination of healthy lifestyle factors and functional limitations is unclear. We investigated the association between healthy lifestyle scores and the risk of functional impairment in community residents.

Methods: A total of 10,602 participants (aged 40–64 years) of the Atherosclerosis Risk in Communities (ARIC) study with no history of cardiovascular events and tumors and who came for their fourth visit (1997–1999) were included in the final analysis. Primary outcomes were recorded during the fourth visit; these included impaired lower extremity function, activities of daily living, and instrumental activities of daily living. A logistic regression model was used to test the associations between healthy lifestyle scores and functional impairment. The lifestyle score comprised six factors: healthy diet, moderate alcohol consumption, coffee consumption, physical activity, normal body weight, and no smoking.

Results: Among the 10,602 participants with a median follow-up of 9 years, the prevalence rates of impaired lower extremity function, activities of daily living, and instrumental activities of daily living were 50.6%, 14.7%, and 21.6%, respectively. In the adjusted Cox regression model, participants with a healthy lifestyle score of 5 plus 6 had a significant lower risk of impaired lower extremity function (odds ratio = 0.252, 95% confidence interval: 0.184–0.344, P < 0.001), activities of daily living (odds ratio = 0.201, 95% confidence interval: 0.106–0.380, P < 0.001), and instrumental activities of daily living (odds ratio = 0.274, 95% confidence interval: 0.168–0.449, P < 0.001) than did participants with a score of 0. The association of healthy lifestyle scores with impaired activities of daily living and instrumental activities of daily living was stronger for individuals without diabetes than for those with it (P for interaction < 0.05). This can be partly explained by the fact that the lowest risk of functional impairment among the participants with diabetes was associated with being overweight.

Conclusion: Adherence to an overall healthy lifestyle was associated with a lower risk of physiological function limitation. This study highlights the importance of behavioral interventions in the prevention of disabilities.

Clinical Trial Registration: www.ClinicalTrials.gov; Unique identifier: NCT00005131.

Fat percentage cutoff values to define obesity and prevalence of sarcopenic obesity in community-dwelling older adults in Turkey

PURPOSE

Sarcopenic-obesity (SO) is associated with low-functional-status and mortality. Few studies evaluated the definition and prevalence of SO. We aimed to investigate the fat-percentage cut-off values for obesity and prevalences of obesity, SO in community-dwelling older adults in Turkey.

METHODS

Body-composition was measured using bioimpedance-analysis. Sarcopenia was defined by European-Working-Group-on-Sarcopenia-in-Older-People criteria. Obesity was defined by two different methods, a fat-percentile above 60th percentile (Zoico-method) or a BMI of ≥30 kg/m² (WHO-definition).

RESULTS

We enrolled 992 subjects (308 men, 684 women). Body fat-percentage thresholds for obesity were 27.3% for men and 40.7% for women according to Zoico-method. The rates of obesity were about 40% in both genders by Zoico-method; 29.2% versus 53.7% for men and women by WHO definition. Prevalences-of-sarcopenia was 3.1% versus 0.4%; SO was 0.3% versus 0.1% when obesity was assessed with Zoico-method in men and women, respectively. No case of SO was defined when obesity was assessed using WHO-definition.

CONCLUSION

The threshold for obesity definition according to Zoico-method was similar to other European-populations. While obesity-prevalences were considerably high, SO prevalences were low but comparable to other populations. This low-prevalence seems to be due to underestimation of sarcopenia in obese subjects when skeletal-muscle-mass was adjusted by height² to recognize low-muscle-mass.

An Assistive Technology Solution for User Activity Monitoring Exploiting Passive RFID

Population ageing is having a direct influence on serious health issues, including hampered mobility and physical decline. Good habits in performing physical activities, in addition to eating and drinking, are essential to improve the life quality of the elderly population. Technological solutions, aiming at increasing awareness or providing reminders to eat/drink regularly, can have a significant impact in this scenario. These solutions enable the possibility to constantly monitor deviations from users' normal behavior, thus allowing reminders to be provided to users/caregivers. In this context, this paper presents a radio-frequency identification (RFID) system to monitor user's habits, such as the use of food, beverages, and/or drugs. The device was optimized to fulfill specifications imposed by the addressed application. The approach could be extended for the monitoring of home appliances, environment exploitation, and activity rate. Advantages of the approach compared to other solutions, e.g., based on cameras, are related to the low level of invasiveness and flexibility of the adopted technology. A major contribution of this paper is related to the wide investigation of system behavior, which is aimed to define the optimal working conditions of the system, with regards to the power budget, user (antenna)-tag reading range, and the optimal inter-tag distance. To investigate the performance of the system in tag detection, experiments were performed in a scenario replicating a home environment. To achieve this aim, specificity and sensitivity indexes were computed to provide an objective evaluation of the system performance. For the case considered, if proper conditions are meet, a specificity value of 0.9 and a sensitivity value of 1 were estimated.

Comparison of body mass index range criteria and their association with cognition, functioning and depression: a cross-sectional study in Mexican older adults

BACKGROUND

World population is living longer, demanding adjustments in public health policies. Body mass index (BMI) is widely known and used as a parameter and predictor of health status although an adapted criterion for older adults is usually overlooked. BMI has been extensively analysed in relation to mortality but fewer studies address its association with cognition, functioning and depression in older adults. The present study aimed at 1) comparing BMI distribution according to the ranges proposed by the World Health Organization (WHO) and the United States National Research Council Committee on Diet and Health (CDH), 2) analysing their association with cognitive functioning, physical functioning and depression and 3) analysing a possible, interaction of BMI criteria with sex on the outcome measures.

METHODS

This cross-sectional study included 395 participants recruited by convenience sampling; 283 (71.6%) women and 112 (24.58%) men. Mean age was 74.68 (SD = 8.50, range: 60-98). Outcome measures included the Short Portable Mental State Questionnaire for cognitive status, the Barthel's Index of Activities of Daily Living for physical functioning, and the Geriatric Depression Scale.

RESULTS

WHO criterion classified most cases (65.3%) as overweight, followed by normal weight (32.2%) and underweight (2.5%) whereas CDH criterion considered most (48.1%) as normal weight, and followed by overweight (31.4%) and underweight (20.5%). Analysing cognitive status, independent physical functioning and depression mean scores, significant differences (p ≤ .001) were found when comparing the three weight groups (underweight, normal weight and overweight) using either the WHO- or the CDH criterion. Post-hoc tests revealed that in all comparisons the underweight group scored the lowest in all three outcome measures. According to the CDH criterion, overweight was favourable for females but unfavourable for males regarding cognitive status (interaction F(2,389) = 4.52, p ≤ .01) and independent functioning (interaction F(2,389) = 3.86, p ≤ .05).

CONCLUSIONS

BMI and its associations to relevant outcome measures in the older adults must rely on criteria that take into account the particular features of this population, such as the CDH criterion. Underweight was associated with decremented cognition, less independent physical functioning and more depression. Overweight seemed favourable for women but unfavourable for men.

Pharmacy Technician Review of Oral Nutritional Supplements (ONS) within Care Homes

Up to 42% of patients admitted to care homes are at risk of malnutrition. Oral nutritional supplements (ONS) can be prescribed to increase nutritional intake when diet alone is insufficient to meet daily nutritional requirements. Where ONS are inappropriately initiated or continued beyond treatment goals this can contribute to significant waste and unnecessary costs. This study reviewed whether pharmacy technicians working in care home settings can support the cost-effective use of ONS. A quality improvement project using Plan-Do-Study-Act (PDSA) methodology was undertaken by pharmacy technicians working in care homes to review the prescribing and monitoring of ONS. A sample of 330 residents were reviewed across 5 care homes. 45 residents were prescribed ONS, 16 of whom were unknown to dietitians. In collaboration with the dietetic service an oral nutritional support flow chart was developed and tested. Thirteen of the 16 residents unknown to the dietetic team did not require ONS and could be considered for alternative dietary options. Through collaborative working with dietetic services, pharmacy technicians can support effective use and review of ONS for care home residents, reduce unnecessary prescribing, and ensure appropriate referral to dietitians where indicated.

Effect of an Inpatient Rehabilitation Program for Recovery of Deconditioning in Hematologic Cancer Patients After Chemotherapy

OBJECTIVE

To investigate the effect of a rehabilitation program in terms of De Morton Mobility Index (DEMMI) score, in hematologic cancer patients after chemotherapy.

METHODS

Hematologic cancer patients admitted for chemotherapy were reviewed. They received a rehabilitation program during their hospital stay. DEMMI score measurement was performed, before and after rehabilitation. Demographics, diagnosis, chemotherapy information, rehabilitation program duration, mortality, body mass index (BMI), and laboratory test results were collected. For analysis, patients were classified according to diagnosis (multiple myeloma, leukemia, and others), mortality, and additional chemotherapy.

RESULTS

There was statistically significant improvement in DEMMI score of 10.1 points (95% confidence interval, 5.9-14.3) after rehabilitation. It was more evident in the multiple myeloma group, and they revealed less mortality. When patients were divided according to mortality, survivors received the program earlier, and in a shorter period than in mortality cases. Although survivors revealed higher initial DEMMI score, improvement after rehabilitation did not differ significantly.

CONCLUSION

In hematologic cancer patients, rehabilitation program was effective for recovery from deconditioning, revealing significant increase in DEMMI score. Multiple myeloma patients may be good candidates for rehabilitation. Rehabilitation could be sustained during chemotherapy and for high-risk patients.

The joint associations of weight status and physical activity with mobility disability: The NIH-AARP Diet and Health Study

BACKGROUND/OBJECTIVES

The purpose of this study was to determine the joint associations of weight status and physical activity with mobility disability in older men and women.

SUBJECTS/METHODS

We analyzed prospective data from 135,220 participants in the NIH-AARP Diet and Health Study between 1995-1996 and 2004-2005.

METHODS

Height and weight, as well as light- and moderate-to-vigorous-intensity physical activity typical of the past 10 years (h/week) were self-reported at baseline, and body mass index (BMI: kg/m²) was categorized into normal weight (BMI 18 to <25 kg/m²); overweight (BMI 25 to <30 kg/m²); and obese (BMI ≥ 30 kg/m²). Mobility was assessed by self-report at follow-up and mobility disability was defined as reporting "unable to walk" or an "easy usual walking pace (<2 mph)". Multivariable logistic regression determined the independent and joint associations of weight status and total physical activity with the odds of mobility disability.

RESULTS

Twenty-one percent of men and 37% of women reported a mobility disability at follow-up. We observed a curvilinear dose-response association between increasing categories of weight status and mobility disability within each tertile of physical activity, with the highest odds experienced by men and women with overweight (OR = 2.45; 95%CI: 2.25, 2.67 for men and OR = 2.99; 95%CI: 2.78, 3.22 for women) and obesity (OR = 3.93; 95%CI: 3.58, 4.32 for men and OR = 5.08; 95% CI: 4.65, 5.54 for women) in combination with low physical activity. Moreover, among those reporting 7 or fewer hours/week of total physical activity, being of normal body weight did not eliminate the excess odds of mobility disability.

CONCLUSIONS

These findings highlight the combined importance of obesity prevention and physical activity promotion to mobility in older age. Given aging demographics and the global economic burden associated with aging- and disuse-related disability, there is tremendous public health benefit to understanding how various modifiable determinants of mobility disability can interact in older age.

Obesity and the burden of health risks among the elderly in Ghana: A population study

BACKGROUND

The causes and health risks associated with obesity in young people have been extensively documented, but elderly obesity is less well understood, especially in sub-Saharan Africa. This study examines the relationship between obesity and the risk of chronic diseases, cognitive impairment, and functional disability among the elderly in Ghana. It highlights the social and cultural dimensions of elderly obesity and discusses the implications of related health risks using a socio-ecological model.

METHODOLOGY

We used data from wave 1 of the Ghana Study on Global Ageing and Adult Health (SAGE) survey-2007/8, with a restricted sample of 2,091 for those 65 years and older. Using random effects multinomial, ordered, and binary logit models, we examined the relationship between obesity and the risk of stage 1 and stage 2 hypertension, arthritis, difficulties with recall and learning new tasks, and deficiencies with activities of daily living and instrumental activities of daily living.

FINDINGS

Elderly Ghanaians who were overweight and obese had a higher risk of stage 1 and stage 2 hypertension, and were more likely to be diagnosed with arthritis and report severe deficiencies with instrumental activities of daily living. Those who were underweight were 1.71 times more likely to report severe difficulties with activities of daily living. A sub analysis using waist circumference as a measure of body fat showed elderly females with abdominal adiposity were relatively more likely to have stage 2 hypertension.

CONCLUSIONS

These findings call for urgent policy initiatives geared towards reducing obesity among working adults given the potentially detrimental consequences in late adulthood. Future research should explore the gendered pathways leading to health disadvantages among Ghanaian women in late adulthood.

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

OBJECTIVE

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

DESIGN

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

SETTING

São Paulo, Brazil.

SUBJECTS

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

RESULTS

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

CONCLUSIONS

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

Alcohol Energy Intake Is Related to Low Body Mass Index in Japanese Older Adults: Data from the 2010-2011 National Health and Nutrition Survey

OBJECTIVE

The objective of this study was to identify lifestyle and nutritional factors associated with low BMI in Japanese older adults, with a focus on alcohol energy intake.

DESIGN

Cross-sectional study.

PARTICIPANTS

Data from 1,093 respondents (711 men and 382 women) to the National Health and Nutrition Survey aged 65 years and older were included in this study.

MEASUREMENTS

Data were analyzed for associations between BMI and lifestyle, energy, and nutrient intake. Alcohol energy intake was calculated from total energy and participants were categorized into BMI quartiles. Energy-adjusted nutrient intakes were calculated as residuals from a regression model, with BMI as the independent variable and lifestyle factors and nutrient intake as dependent variables. Between-BMI quartile differences were assessed for each sex using multivariate logistic regression analysis. In addition, the nutrient intakes of men consuming more than 280 kcal and less than 280 kcal of alcohol energy per day were compared.

RESULTS

Men and women in the lowest BMI quartile had lower total energy intake but higher alcohol energy intake than men in the other BMI quartiles. In multivariate logistic regression analysis, the lowest BMI quartile was associated with total energy (OR: 0.81, p = 0.0310) and alcohol energy intake (OR: 1.22, p = 0.0472) in men. In men, protein, carbohydrate, fat, calcium, iron, and vitamin intakes were less in those that consumed ≥ 280 kcal than in those that consumed < 280 kcal of alcohol per day.

CONCLUSION

Our results demonstrate an association between alcohol energy intake and low BMI in older Japanese individuals.

Increasing oral intake in dementia patients by altering food texture

Dementia patients lose the ability to tolerate texture in their diets which can result in a refusal to eat and subsequent weight loss. By observing for aversive eating behaviors and manipulating the diet texture, oral intake and weight can be maintained.

Relationship between obesity, hypertension and diabetes, and health-related quality of life among the elderly

BACKGROUND

The purpose of this study was to study the cumulative effects of cardiovascular risk factors on all the health-related quality of life dimensions among the elderly in this era of epidemic obesity and diabetes.

DESIGN AND METHODS

The population-based study covered 3567 participants, representative of the Spanish non-institutionalized population aged 60 years and above. Data were gathered from home-based interviews and from the measurements of blood pressure and other anthropometric variables. Multiple linear regression was used to examine the relationships between health-related quality of life, on each scale of the SF-36 questionnaire, and obesity (waist circumference >102 cm in men and >88 cm in women), hypertension (blood pressure >/=140/90 mmHg), and known diabetes, after adjusting for sociodemographic and lifestyle factors.

RESULTS

Patients with obesity, hypertension, and diabetes, or a combination of these factors were, in general, associated with a worse health-related quality of life, on both the physical and the mental scales, than those without these factors, though statistical significance (P<0.05) was only attained for some relationships. Obesity in women (-2.9 to -6.7 points, according to the scale) and diabetes in men (-6.1 to -16.4 points, according to the scale) were the factors most closely and significantly associated with diminished health-related quality of life. Women who had all three factors showed the maximum decline in health-related quality of life (-10.2 to -17.7 points, according to the scale).

CONCLUSIONS

Obesity in old women and diabetes in old men are the most decisive factors adversely affecting the health-related quality of life. The association with worse health-related quality of life is especially marked (greater than additive) in women with all three factors, thereby rendering them a group that calls for special study and attention.

Relationship of Body Mass and Net Worth for Retirement-Aged Men and Women

This article examines linkages between body weight and socioeconomic status (SES) among Americans at or near retirement age. The authors hypothesize that (a) body weight relates negatively to SES, (b) this relationship is greater for women than men, and (c) the relationship attenuates when health, employment, and marital status are controlled. We use the 1992 Health and Retirement Study for this examination. SES is measured as net worth. Body weight is measured as body mass index and categorized as normal weight, overweight, and obese. Results indicate that, for women, overweight and obesity relate to lower logged networth. This relationship attenuates once covariates are considered. For men, overweight and obesity relate to higher logged net worth, even when covariates are considered. The findings suggest that greater weight has different meanings for men and women in this cohort; it might be related to success for men but a sociocultural detriment for women.

Translating a Food and Food Service Satisfaction Measure Into Spanish

By 2030, at least 4.5 million U.S. Hispanics will require nursing home care due to dementia and chronic disease. Despite the significance of nutrition's role in elder health, malnutrition has not been studied in controlled empirical investigations of such residents. A valid instrument for measuring food and food service satisfaction for Spanish-speaking nursing home residents is urgently needed. This article is to report on pilot testing of such an instrument with the ultimate aim of generating theory-based nursing interventions to increase resident food satisfaction, food intake, and subsequent nutrition status.

Use of Telephone-Administered Survey for Identifying Nutritional Risk Indicators Among Community-Living Older Adults in Rural Areas

The ability of Elderly Nutrition Programs, especially in rural areas, to address increasing needs for disparate program services is linked to determining which older people are most likely to be at nutritional risk and what constitutes the potential risk. The purpose of this study is to characterize nutritional risk factors in a probability sample of rural elders (n = 152) through telephone interviews using a 67-question modified version of the Nutrition Screening Initiative's Level I and II screens. Participants reported high levels of unintentional weight loss, medication use, multiple health conditions, and depression. This study demonstrates that comprehensive information on general health, eating habits, living environment, and functional status can be collected from rural elders by telephone. Because much of the reported nutritional risk in this sample occurs in residents living in areas not receiving nutrition services, expanded nutritional risk data can be used to anticipate need for programs and services in areas not presently served.

Associations Between Asthma Control and Airway Obstruction and Performance of Activities of Daily Living in Older Adults with Asthma

OBJECTIVES

To determine the effect of asthma on functional limitations of older adults in the United States.

DESIGN

Analyses were conducted with data from the Asthma Beliefs and Literacy in the Elderly study, a prospective cohort study of people aged 60 and older with asthma.

SETTING

Participants were recruited from urban primary care and pulmonary specialty practices in New York City and Chicago between 2010 and 2012.

PARTICIPANTS

Individuals aged 60 and older with asthma (380 women, 72 men, mean age 67.5 ± 6.8 (range 60-98), 40% Latino, 30% black).

MEASUREMENTS

Characteristics of participants with and without activity of daily living (ADL) limitations were compared using the chi-square test. Generalized estimating equations were used to model the relationships between poor asthma control (Asthma Control Questionnaire (ACQ) score >1.5) and severity of airway obstruction (forced expiratory volume in 1-second (FEV1 )) and number of ADL limitations.

RESULTS

Participants with one or more ADL limitations were more likely to be female (90% vs 81%, P = .02) and Latino (58% vs 32%, P < .001), have less than a high school education (53% vs 27%, P < .001) and an income of $1,350 per month or less (79% vs 46%, P < .001), and be unmarried (78% vs 64%, P = .003). In the adjusted analysis, poorer ACQ scores (odds ratio (OR) = 1.6, 95% confidence interval (CI) = 1.0-2.4; P = .05) but not severity of airway obstruction (OR = 1.1, 95% CI = 0.6-1.9) was associated with greater ADL limitations.

CONCLUSION

Older adults reporting poor asthma control are more likely to have ADL limitations than those with controlled asthma, although one-time spirometry may not adequately identify those at risk of physical impairment from asthma.

Group trajectory analysis helps to identify older cancer survivors who benefit from distance-based lifestyle interventions

BACKGROUND

The number of older cancer survivors is increasing as more adults survive to older ages. The objectives of this study were to examine trajectories of physical activity (PA) and physical function (PF) over a 2-year lifestyle counseling study and to identify characteristics of the trajectory groups.

METHODS

This was a secondary analysis of Reach Out to Enhance Wellness, a randomized controlled trial of home-based lifestyle counseling. The 641 participants were older (≥65 years), overweight (body mass index [BMI], 25 to <40 kg/m(2)), long-term community-dwelling survivors (>5 years) of breast, prostate, and colorectal cancer from Canada, the United Kingdom, and the United States (21 states) who had been randomly assigned to an immediate intervention or a 12-month-wait-listed control arm. The main outcome measures were PA and PF trajectory group membership.

RESULTS

Three PA groups and 5 PF trajectory groups were observed. The baseline BMI (P < .001) and self-efficacy for performing strength (P < .0001) and endurance exercises (P < .0002) were the strongest predictors of achieving the highest amount of PA and the most favorable functional trajectory over 2 years. Individuals with low baseline self-efficacy, no PA, and a Short Form 36 PF subscale score < 65 did not benefit from the intervention.

CONCLUSIONS

This study identified characteristics of survivors who benefited from home-based interventions and suggested alternative approaches for survivors requiring more structured and intensive interventions to promote behavioral changes.

Comprehensive assessment of physical functioning in bariatric surgery candidates compared with subjects without obesity

BACKGROUND

Obesity appears to be associated with reduced physical performance, but comprehensive assessments of physical functioning are lacking in subjects with severe obesity, in particular in comparison with subjects without obesity. This precludes an objective assessment of the degree of impairment.

OBJECTIVE

To compare motor skills and cardiopulmonary fitness between subjects with severe obesity (OB) (i.e., candidates for bariatric surgery) and control subjects without obesity (non-OB).

SETTING

Cantonal Hospital, Switzerland.

METHODS

Flexibility, movement speed, balance, maximal isometric strength, and cardiopulmonary fitness were tested in 45 OB (body mass index: 42.6±.9 kg/m(2); age: 35±1.7 years; 33 women) and 32 non-OB (body mass index: 23±.4 kg/m(2); age: 38.5±2.1 years; 25 women) subjects.

RESULTS

In comparison with the non-OB group, the OB group showed reduced shoulder flexibility (P<.001) but comparable hamstrings flexibility (P = .3). Speed-related tasks (i.e., timed up-and-go test and timed lying-to-standing test) indicated that the OB group was slower than the non-OB group (all P<.007). Strength-related tasks indicated a greater absolute back muscle and knee-extensor strength (all P<.002) in the OB group with no difference in knee-flexor strength (both P>.8). However, when related to weight, the OB group showed reduced maximal strength (all P<.002). Bicycle spiroergometry indicated that absolute oxygen consumption at peak exercise and at the anaerobic threshold did not differ between groups (both P>.06). Related to weight, however, values were lower in the OB than in the non-OB group (both P< .001).

CONCLUSION

Data indicate a differential pattern of functional impairment in bariatric surgery candidates compared with subjects without obesity. These findings might help to establish tailored intervention protocols to improve physical performance in such subjects.

The relationship of body mass index and the functional status of community-dwelling female older people admitting to a geriatric outpatient clinic

OBJECTIVES

The relationship of body mass index (BMI) with functional status differs in diversified geriatric population and various settings. In this study, we aimed to investigate whether BMI is related to functional status independent of age, nutritional status, multimorbidity, and polypharmacy in a group of Turkish community-dwelling female elderly.

DESIGN

This study was conducted using a cross-sectional study design.

SETTING

Geriatric outpatient clinic of a university hospital.

PARTICIPANTS

There were 438 female patients aged 60 years or older included in the analysis.

MEASUREMENTS

Body mass indexes were calculated from weight (kg) divided by the square of height (m). Functional status was assessed with the evaluation of activities of daily living (ADL) and instrumental activities of daily living (IADL) scales. Diseases and drugs were determined after the evaluation of the patients with comprehensive geriatric assessment, physical examination, first-line biochemical tests, and using the patients' self-report and current medication lists.

RESULTS

In total, 438 subjects comprised our study cohort. Mean age was 73.3 ± 6.9 years. Mean BMI was 27.8 ± 5.2 kg/m(2). Linear regression analysis revealed significant and independent association of lower BMI with higher ADL and IADL scores (p = 0.02, B = -0.10; p < 0.001, B = -0.17, respectively). ADL and IADL were significantly negatively correlated with BMI in subjects with normal nutrition (p = 0.03, r = -0.122; p = 0.001, r = -0.183) but not in subjects with malnutrition risk or malnutrition. We suggest that lower BMI is associated with better functional status in Turkish community-dwelling female older people. This association is prominent in the subjects with normal nutritional status.

CONCLUSIONS

Our study recommends the need for further studies accounting for the nutritional status on the relationship between BMI and functionality in different populations and in different settings. It represents an important example for diversity in BMI-functionality relationship.

Monitoring 6-month trajectory of grip strength improves the prediction of long-term change in grip strength in disabled older women

BACKGROUND

This study aims to assess the degree and heterogeneity of decline in grip strength in the short term (6 months) and the clinical relevance of short-term decline to long-term decline (2.5 years) in grip strength in disabled older women.

METHODS

Eighty-four community-dwelling disabled women aged 65 years or older were evaluated on a weekly basis over 6 months, followed by an additional five semi-annual visits for a total follow-up of 3 years. The study outcome is maximum isometric handgrip strength in the nondominant hand. Linear random effects models were used to characterize population- as well as individual-level change in grip strength over time.

RESULTS

In the weekly assessments over the initial 6 months, individual-level short-term change in grip strength was detectable (mean = -0.12 kg/month; p = .06), heterogeneous (range: -2.03 ± 0.95 kg/month), and independent of absolute grip strength at baseline (mean = 18.4 kg). Additionally, among women with grip strength greater than 16.7 kg at baseline, the long-term rate of decline in grip strength was accelerated by 0.15 kg/year (p = .014) for every 0.5 standard deviation (0.25 kg/month) increase in the short-term rate of decline. The baseline absolute grip strength, however, was not significantly associated with the long-term rate of decline (correlation = -0.36, p = .105).

CONCLUSIONS

Our findings suggest that short-term change in grip strength is detectable and meaningful for disabled older women and it is the individual's past trajectory of grip strength relative to her current strength level, not her current absolute strength per se, that is important for predicting future strength decline.

Body mass index and functional status in community dwelling older Turkish males

Disability is utmost important on an aging population's health. Obesity is associated with increased risk for disability. On-the-other-hand, higher-BMI is reported as associated with better functionality in older people in some reports defined as "obesity paradox". There is some evidence on differential relationship between body weight status and functionality by living setting gender, and different populations. We studied the relation between body mass index and functionality in Turkish community dwelling older males accounting for the most confounding factors: age, multimorbidity, polypharmacy and nutritional status. This is a cross-sectional study in a geriatric outpatient clinic of a university hospital. Functionality was assessed with evaluation of activities of daily living (ADL) and instrumental activities of daily living (IADL) scales. Nutrition was assessed by mini-nutritional assessment test. Two hundred seventy-four subjects comprised our study cohort. Mean age was 74.4 ± 7.1 years, BMI was 25.8 ± 4.4 kg/m(2). Linear regression analysis revealed significant and independent association of lower BMI with higher ADL and IADL scores (B = 0.047 and B = 0.128, respectively) (p < 0.05) and better nutritional status (B = 1.94 and B = 3.05, respectively) (p < 0.001) but not with the total number of medications. Higher IADL score was associated with younger age and lower total number of diseases (B = 0.121, B = 0.595, respectively) (p < 0.05) while ADL was not. We suggest that lower BMI is associated with better functional status in Turkish community-dwelling male older people. Our study recommends longitudinal studies with higher participants from different populations, genders and living settings are needed to comment more.

Obesity and physical frailty in older adults: a scoping review of lifestyle intervention trials

Many frail older adults are thin, weak, and undernourished; this component of frailty remains a critical concern in the geriatric field. However, there is also strong evidence that excessive adiposity contributes to frailty by reducing the ability of older adults to perform physical activities and increasing metabolic instability. Our scoping review explores the impact of being obese on physical frailty in older adults by summarizing the state of the science for both clinical markers of physical function and biomarkers for potential underlying causes of obesity-related decline. We used the 5-stage methodological framework of Arksey and O'Malley to conduct a scoping review of randomized trials of weight loss and/or exercise interventions for obesity (body mass index ≥ 30 kg/m(2)) in older adults (aged >60 years), examining the outcomes of inflammation, oxidative stress, and lipid accumulation in muscle, as well as direct measures of physical function. Our initial search yielded 212 articles; exclusion of cross-sectional and observational studies, cell culture and animal studies, disease-specific interventions, and articles published before 2001 led to a final result of 21 articles. Findings of these trials included the following major points. The literature consistently confirmed benefits of lifestyle interventions to physical function assessed at the clinical level. Generally speaking, weight loss alone produced a greater effect than exercise alone, and the best outcomes were achieved with a combination of weight loss and exercise, especially exercise programs that combined aerobic, resistance, and flexibility training. Weight loss interventions tended to reduce markers of inflammation and/or oxidative damage when more robust weight reduction was achieved and maintained over time, whereas exercise did not change markers of inflammation. However, participation in a chronic exercise program did reduce the oxidative stress induced by an acute bout of exercise. Weight loss interventions consistently reduced lipid accumulation in the muscle; however, in response to exercise, 3 studies showed an increase and 2 a decrease in muscle lipid infiltration. In summary, this scoping review identified strong clinical evidence that weight reduction and/or exercise interventions can improve physical function and biomarkers of physical dysfunction among overweight/obese older adults, supporting the suggestion that excessive adiposity contributes to physical frailty. However, the evidence also suggests a complexity of metabolic influences, both systemically and within muscle, which has not been elucidated to date. Considerable further study is needed to examine the mechanisms by which lifestyle interventions influence physical frailty before the net impact of such interventions can be fully understood.

Nutritional status and functional capacity of community-dwelling elderly in Southern Laos

OBJECTIVES

The aim of this study was to assess the nutritional status and functional capacity of 144 community-dwelling elderly in three rural ethnic groups, namely, the Oy, the Brau and the Lao, of southern Laos.

METHODS

The Mini nutritional assessment (MNA) questionnaire and Determine Your Nutritional Health checklist were used to assess nutritional status. The Barthel Activities of Daily Living questionnaire and Lawton and Brody's Instrumental Activities of Daily Living questionnaire were used to assess the functional capacity of the respondents.

RESULTS

The MNA score results indicated that 92.5 % of Oy respondents, 85.4 % of Brau respondents and 60 % of Lao respondents were malnourished. Analysis of variance tests showed that the MNA scores of the Oy and Lao ethnic groups and of the Brau and Lao ethnic groups were significantly different ( both p < 0.01), but that there was no significant difference between the MNA scores of the Oy and Brau ethnic groups (p > 0.05). In terms of functional capacity, 47.2 % of Oy respondents, 43.9 % of Brau respondents and 20 % of Lao respondents had limitations in their activities of daily living, whereas 98.1 % of Oy respondents, 97.6 % of Brau respondents and 86 % of Lao respondents had limitations in their instrumental activities of daily living. Body mass index, reduced appetite, number of meals consumed daily and presence of common diseases predicted nutritional status in all three ethnic groups; the remaining factors differed by ethnicity. This result implies that ethnic differences and other factors, such as location of the village, services, resources within the village and respondents' lifestyles, can affect nutritional status.

CONCLUSIONS

Because predictors of nutritional status varied by ethnicity, there is a need for area-specific interventions aimed at improving the quality of life of the elderly in these areas.

Osteoporosis in chronic inflammatory disease: the role of malnutrition

Osteoporosis is a metabolic bone disorder affecting million of people worldwide. Increased understanding of bone disease has led to a greater recognition of factors affecting bones, and consequently many secondary causes of osteoporosis were demonstrated. In this study, we aim to explore possible causes of bone loss and fractures in subjects affected by chronic inflammatory disease and to suggest new targets for intervention. In fact several studies, evaluated to perform this study, suggest that the patients with chronic inflammatory disease could be at high risk for fractures due to bone loss as consequence of malnutrition, caused by inflammation and hormonal change. Consequently, some actions could derive from the considerations of these mechanisms: a change in actual approach of chronic patients, that may include the investigation on the possible presence of osteoporosis, as well as further research on this topic to find a better therapy to prevent osteoporosis considering all the mechanisms described.

Weight gain among elderly women as risk factor for disability: Health, Well-being and Aging Study (SABE Study)

OBJECTIVE

To examine the association between weight change and the incidence of disability in activities of daily living (ADL) among elderly women.

METHOD

In 2006, 227 women aged ≥75 years and independent in ADL were selected from SABE Study (Health, Well-being, and Aging) in Sao Paulo, Brazil. The dependent variable was the report of difficulty on ≥1 ADL in 2009. Differences in weight were calculated between baseline and second interview, and converted to percentage change in relation to initial weight. A change (gain or loss) ≥5% was considered significant. A logistic regression analysis was performed including sociodemographic and health-related variables.

RESULTS

After adjusting, weight gain remained associated to disability (OR = 2.42; p = .027), whereas weigh loss lost significance (OR = 1.66; p = .384).

DISCUSSION

Weight loss is generally considered more worrisome than weight gain in elderly. However, weight loss alone was not a risk factor for disability in our study.

Gender differences in anthropometric predictors of physical performance in older adults

BACKGROUND

Both high body fat and low muscle mass have been associated with physical disability in older adults. However, men and women differ markedly in body composition; men generally have more absolute and relative lean muscle mass and less fat mass than women. It is not known how these anthropometric differences differentially affect physical ability in men and women.

OBJECTIVES

This study examines differences in anthropometric predictors of physical performance in older women and men.

METHODS

Participants were 470 older women and men 72.9 (7.9) years of age. Body composition was measured using dual-energy x-ray absorptiometry. Maximum leg strength and power were measured using a leg press. Muscle quality (MQ) was calculated as relative strength (leg press strength per kilogram of leg muscle mass). Gait speed and chair rise were used to assess mobility performance and functional strength.

RESULTS

Body mass index (BMI), age, and MQ emerged as predictors (P < 0.05) of functional strength and mobility in men and women somewhat differently. After accounting for age and sample, leg MQ was related to chair rise time and gait speed in men but not women. BMI was related to gait speed in both men and women, but BMI was related to chair rise time only in women.

CONCLUSION

Results implicate the prioritized importance of healthy weight and muscle maintenance in older women and men for maintained physical functioning with aging.

Body composition and its association with cardiometabolic risk factors in the elderly: a focus on sarcopenic obesity

Important changes in body composition with aging are a progressive loss of muscle mass and increase of fat mass. Despite their enormous clinical importance, body composition changes such as sarcopenic obesity in the elderly are under-recognized. This study aimed to examine the relationship of body composition with a wide variety of cardiometabolic risk factors among 2943 subjects (1250 men and 1693 women) aged 60 years or older from Korean National Health Examination and Nutrition Survey (KNHANES). Sarcopenia was defined as an appendicular skeletal muscle mass (ASM) divided by weight (%) of < 1 SD below the sex-specific mean for young adults. Obesity was defined as a body mass index (BMI) ≥ 25 kg/m(2). Body composition was categorized into four non-overlapping groups: the sarcopenic obese, sarcopenic nonobese, nonsarcopenic obese, and nonsarcopenic nonobese groups. A wide variety of cardiometabolic risk factors, including blood pressure (BP), glucose tolerance indices, lipid profiles, inflammatory markers, and vitamin D level, were compared according to body composition group. The prevalence of sarcopenic obesity was 18.4% in men and 25.8% in women. In both sexes, the prevalence of vitamin D deficiency and metabolic syndrome was highly prevalent in the sarcopenic obese group. Serum insulin level, homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride levels, and ferritin levels were the highest in the sarcopenic obese group in both men and women, whereas HDL-cholesterol and 25-hydroxyvitamin D (25(OH)D) levels were the lowest in the sarcopenic obese group. The sarcopenic obese group was more closely associated with insulin resistance, metabolic syndrome, and cardiovascular disease (CVD) risk factors than any other group in this elderly population.

Does inflammation determine whether obesity is metabolically healthy or unhealthy? The aging perspective

Obesity is a major health issue in developed as well as developing countries. While obesity is associated with relatively good health status in some individuals, it may become a health issue for others. Obesity in the context of inflammation has been studied extensively. However, whether obesity in its various forms has the same adverse effects is a matter of debate and requires further research. During its natural history, metabolically healthy obesity (MHO) converts into metabolically unhealthy obesity (MUHO). What causes this transition to occur and what is the role of obesity-related mediators of inflammation during this transition is discussed in this paper.

Obesity in Older Adults: Technical Review and Position Statement of the American Society for Nutrition and NAASO, The Obesity Society

Obesity causes serious medical complications and impairs quality of life. Moreover, in older persons, obesity can exacerbate the age-related decline in physical function and lead to frailty. However, appropriate treatment for obesity in older persons is controversial because of the reduction in relative health risks associated with increasing body mass index and the concern that weight loss could have potential harmful effects in the older population. This joint position statement from the American Society for Nutrition and NAASO, The Obesity Society reviews the clinical issues related to obesity in older persons and provides health professionals with appropriate weight-management guidelines for obese older patients. The current data show that weight-loss therapy improves physical function, quality of life, and the medical complications associated with obesity in older persons. Therefore, weight-loss therapy that minimizes muscle and bone losses is recommended for older persons who are obese and who have functional impairments or medical complications that can benefit from weight loss.

Risk factors for onset of disability among older persons newly diagnosed with heart failure: the Cardiovascular Health Study

BACKGROUND

As the heart failure population continues to age, disability is becoming an increasingly important issue. Our objective was to identify risk factors for the onset of disability in activities of daily living among older persons with heart failure.

METHODS

The study population included participants with newly diagnosed heart failure from the Cardiovascular Health Study, a longitudinal study of community-living, older persons. Data were collected through annual examinations. Cox regression modeling was used to examine associations between time-dependent predictors and onset of disability.

RESULTS

Of 461 participants newly diagnosed with heart failure (mean age 78.7 [SD 5.89]), 23% subsequently developed disability. The first year after heart failure diagnosis was the period of greatest risk for onset of disability (chi-square P value <.001). Factors that were independently associated with disability included: impaired gait speed (HR 2.29, 95% CI 1.34-3.90); impaired cognition (HR 1.87, 95% CI 1.14-3.05); and depressive symptoms (HR 1.72, 95% CI 1.04-2.83).

CONCLUSIONS

Onset of disability is a common occurrence among older persons newly diagnosed with heart failure. Risk factors for onset of disability in this population are potentially modifiable, and should be routinely assessed in an effort to reduce disability in this growing population.

Acute confusional States in the elderly--diagnosis and treatment

BACKGROUND

Delirium is common, has multiple causes and causes distress to numerous patients and their relatives.

METHOD

Selective review of the literature in PubMed and PsycINFO, with reference to selected national and international guidelines.

RESULTS

The hypoactive subtype of delirium is commoner than the hyperactive type, and often overlooked. Delirium in an elderly individual is associated with an additional burden, a possible loss of potential for rehabilitation, and a marked increase in mortality. The diagnosis of delirium is primarily clinical. All professionals involved in patient care must be able to recognize the features of delirium. Dementia, dehydration and polypharmacy are particularly strongly associated, in the elderly. A careful history and examination with appropriate investigation allows underlying causes to be detected and treated. Rehabilitation strategies should be initiated without delay. Neuroleptics and benzodiazepines have an established role in the pharmacological treatment even of the hyperactive subtype. Non-pharmacological treatments include the creation of a calm and patient centred environment, and the involvement of relatives.

CONCLUSION

In many cases, delirium can be diagnosed and treated in good time. Prevention is preferable to treatment.

A systematic review of the literature concerning the relationship between obesity and mortality in the elderly

INTRODUCTION

Obesity is a risk factor for chronic diseases and premature mortality, but the extent of these associations among the elderly is under debate. The aim of this systematic literature review (SR) is to collate and critically assess the available information of the impact of obesity on mortality in the elderly.

METHODS

In PubMed, there are three-hundred twelve papers on the relationship between obesity and mortality among older adults. These papers were analysed on the basis of their abstracts, and sixteen studies were considered suitable for the purpose of the study. It was possible to perform a pooled estimate for aggregated data in three different studies.

CONCLUSION

The results of this SR document that an increased mortality in obese older adults. The limitation of BMI to index obesity and the noted protective action of a moderate increase in BMI on mortality are highlighted. Waist circumference is an indicator of central adiposity and potentially as good a risk factor for mortality as BMI in obese elderly adults.

Muscle strength and BMI as predictors of major mobility disability in the Lifestyle Interventions and Independence for Elders pilot (LIFE-P)

BACKGROUND

Muscle weakness and obesity are two significant threats to mobility facing the increasing number of older adults. To date, there are no studies that have examined the association of strength and body mass index (BMI) on event rates on a widely used performance measure of major mobility disability.

METHODS

This study was a secondary analysis of a randomized controlled trial in which sedentary functionally limited participants (70-89 years, Short Physical Performance Battery ≤ 9) who were able to complete a 400-m walk test at baseline were randomized to a physical activity or health education intervention and reassessed for major mobility disability every 6 months for up to 18 months. We evaluated whether baseline grip strength and BMI predicted failure to complete the 400-m walk test in 15 minutes or less (major mobility disability).

RESULTS

Among N = 406 participants with baseline measures, lower grip strength was associated with an increased risk for developing major mobility disability, with and without covariate adjustment (p < .01): The hazard ratio (95% confidence interval) for the lowest versus high sex-specific quartile of grip strength was 6.11 (2.24-16.66). We observed a U-shaped relationship between baseline BMI and the risk of developing major mobility disability, such that the risk for participants with a BMI of 25-29 kg/m(2) was approximately half that of participants with BMI less than 25 or 30 kg/m(2) or more (p = .04 in fully adjusted analyses).

CONCLUSIONS

Our data highlight the importance of muscle weakness, low BMI, and obesity as risk factors for major mobility disability in older adults. Being overweight may be protective for major mobility disability.

Association of body mass index with self-report and performance-based measures of balance and mobility

BACKGROUND

The incidence of obesity is increasing in older adults, with associated worsening in the burden of disability. Little is known about the impact of body mass index (BMI) on self-report and performance-based balance and mobility measures in older adults.

OBJECTIVE

The purposes of this study were (1) to examine the association of BMI with measures of balance and mobility and (2) to explore potential explanatory factors.

DESIGN

This was a cross-sectional, observational study.

METHODS

Older adults (mean age=77.6 years) who participated in an ongoing observational study (N=120) were classified as normal weight (BMI=18.5-24.9 kg/m(2)), overweight (BMI=25.0-29.9 kg/m(2)), moderately obese (BMI=30.0-34.9 kg/m(2)), or severely obese (BMI ≥ 35 kg/m(2)). Body mass index data were missing for one individual; thus, data for 119 participants were included in the analysis. Mobility and balance were assessed using self-report and performance-based measures and were compared among weight groups using analysis of variance and chi-square analysis for categorical data. Multiple linear regression analysis was used to examine the association among BMI, mobility, and balance after controlling for potential confounding variables.

RESULTS

Compared with participants who were of normal weight or overweight, those with moderate or severe obesity were less likely to report their mobility as very good or excellent (52%, 55%, 39%, and 6%, respectively); however, there was no difference in self-report of balance among weight groups. Participants with severe obesity (n=17) had the lowest levels of mobility on the performance-based measures, followed by those who were moderately obese (n=31), overweight (n=42), and of normal weight (n=29). There were no differences on performance-based balance measures among weight groups. After controlling for age, sex, minority status, physical activity level, education level, and comorbid conditions, BMI still significantly contributed to mobility (β=-.02, adjusted R(2)=.41).

CONCLUSIONS

Although older adults with severe obesity were most impaired, those with less severe obesity also demonstrated significant decrements in mobility.

Effect of a medical food on body mass index and activities of daily living in patients with Alzheimer's disease: secondary analyses from a randomized, controlled trial

OBJECTIVES

To investigate the effect of a medical food (Souvenaid) on body mass index (BMI) and functional abilities in patients with mild Alzheimer's disease (AD). DESIGN/SETTING/PARTICIPANTS/INTERVENTION /MEASUREMENTS: These analyses were performed on data from a 12-week, double-blind, randomized, controlled, multicenter, proof-of-concept study with a similarly designed and exploratory 12-week extension period. Patients with mild AD (Mini-Mental State Examination score of 20-26) were randomized to receive either the active product or an iso-caloric control product. While primary outcomes included measures of cognition, the 23-item Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) scale was included as a secondary outcome. Both ADCS-ADL and BMI were assessed at baseline and Weeks 6, 12 and 24. Data were analyzed using a repeated-measures mixed model.

RESULTS

Overall, data suggested an increased BMI in the active versus the control group at Week 24 (ITT: p = 0.07; PP: p = 0.03), but no treatment effect on ADCS-ADL was observed. However, baseline BMI was found to be a significant treatment effect modifier (ITT: p = 0.04; PP: p = 0.05), and an increase in ADCS-ADL was observed at Week 12 in patients with a 'low' baseline BMI (ITT: p = 0.02; PP: p = 0.04).

CONCLUSIONS

These data indicate that baseline BMI significantly impacts the effect of Souvenaid on functional abilities. In addition, there was a suggestion that Souvenaid increased BMI.

Which body mass index (BMI) is better in the elderly for functional status?

BMI is commonly used indicator of malnutrition and 18.5-24.9 kg/m(2) is generally regarded optimal. However, there is an ongoing debate on ideal range for elderly. BMI cut-off values vary also between ethnic groups. We aimed to investigate relationships between BMI, functional status and malnutrition in elderly living in a nursing home in Turkey. BMIs of 254 residents were calculated. Chronic diseases and currently used drugs were noted. Functional status was evaluated with Katz-activities-of-daily-living (ADL) and Lawton-instrumental-activities-of-daily-living (IADL). Nutritional assessment was performed by Mini-Nutritional-Assessment (MNA) test. Mean age was 75.2 ± 8.2 years. Subjects were classified into 4 groups as BMI <18.5, 18.5-24.9, 25-29.9, and ≥ 30.0 kg/m(2). ADL scores and IADL scores were higher in higher BMI groups. There were no differences in terms of age-number of chronic diseases. Even in BMI ≥ 35 kg/m(2) residents, ADL was significantly higher than 25-34.9 kg/m(2) residents. BMI was significantly correlated with ADL and IADL scores. In Groups 3 and 4, there were 22.2% and 9.1% residents without normal nutrition, respectively. Better functional status was associated with higher BMI values even in BMIs ≥ 30 kg/m(2). In elderly, relative high rates of undernutrition may be present in BMIs regarded as overweight or obese.