The relationship between body composition and physical performance in older women

The risks and benefits of managing obesity in older adults

PURPOSE

This review discusses weight loss considerations in overweight and obese older adults.

SUMMARY

Current US guidelines do not address weight loss in older adults. Waist circumference rather than body mass index (BMI) may be a more accurate assessment tool for obesity in older adults. Weight loss interventions are not recommended in overweight older adults due to the decreased mortality in this population (known as the "obesity paradox"). While weight loss in obese older adults may be beneficial, it is not without risks. The greatest risks include loss of muscle mass, decline in bone mineral density, and development of sarcopenic obesity. Weight loss interventions may be considered in older adults with a BMI of greater than 30 kg/m2 who have metabolic derangements, cardiovascular disease, and/or functional impairments after carefully weighing the risks against the benefits of weight loss and the impact of interventions on the patient's quality of life. Medicare provides limited benefits for weight loss interventions. In older adults, there is no consensus on which lifestyle interventions are best for weight loss and there is a paucity of data on the use of weight loss medications. Careful consideration should be given before utilizing medications for weight loss in older adults given the enhanced adverse effect profiles, interactions, contraindications, and costs.

CONCLUSION

Weight loss in older adults should be approached differently from that in the general adult population. More data are needed on the efficacy and safety of weight loss medications in older adults.

Obesity paradox in older sarcopenic adults - a delay in aging: A systematic review and meta-analysis

The prognostic significance of obesity in sarcopenic adults is controversial. This systematic review and meta-analysis aimed to investigate the effect of additional obesity on health outcomes in sarcopenia. MEDLINE, EMBASE, Scopus and CENTRAL were systematically searched for studies to compare health outcomes of adults with sarcopenic obesity (SO) to those of sarcopenic non-obese (SNO) adults. We also considered the methods of assessing obesity. Of 15060 records screened, 65 papers were included (100612 participants). Older community-dwelling SO adults had 15% lower mortality risk than the SNO group (hazard ratio, HR: 0.85, 95% confidence interval 0.76, 0.94) even when obesity was assessed by measurement of body composition. Additionally, meta-regression analysis revealed a significant negative linear correlation between the age and the HR of all-cause mortality in SO vs. SNO community-dwelling adults, but not in severely ill patients. Compared with SNO, SO patients presented lower physical performance, higher risk for metabolic syndrome, but similar cognitive function, risk of falls and cardiovascular diseases. Age-related obesity, SO and later fat loss leading to SNO represent consecutive phases of biological aging. Additional obesity could worsen the health state in sarcopenia, but above 65 years SO represents a biologically earlier phase with longer life expectancy than SNO.

Longitudinal patterns of abdominal visceral and subcutaneous adipose tissue, total body composition, and anthropometric measures in postmenopausal women: Results from the Women's Health Initiative

BACKGROUND

Abdominal adiposity, including visceral and subcutaneous abdominal adipose tissue (VAT and SAT), is recognized as a strong risk factor for cardiometabolic disease, cancer, and mortality.

OBJECTIVE

The primary aim of this analysis is to describe longitudinal patterns of change in abdominal adipose tissue in postmenopausal women, overall and stratified by age, race/ethnicity, and years since menopause.

METHODS

The data are from six years of follow up on 10,184 postmenopausal women (7828 non-Hispanic White women, 1423 non-Hispanic Black women, and 703 Hispanic women) who participated in the Women's Health Initiative (WHI). The WHI is a large prospective cohort study of postmenopausal women across the United States. All participants in this analysis had DXA scans in the 1990s as part of the WHI protocol. Hologic APEX software was used to re-analyze archived DXA scans and obtain measures of abdominal adipose tissue. Analyses examined differences in abdominal adipose tissue, overall adiposity, and anthropometric variables.

RESULTS

There were important differences in VAT and SAT by age and race/ethnicity. In women <60 years, VAT increased over the follow-up period, while in women ≥70 years, VAT decreased. Non-Hispanic Black women had the highest levels of SAT. Hispanic women had the highest VAT levels. Women more than ten years since menopause had less SAT and more VAT than women less than ten years since menopause, resulting in a higher VAT/SAT ratio. There was a moderate to strong correlation between measures of abdominal adipose tissue and anthropometric measurements of body size. Still, there were substantial differences in the quantity of VAT and SAT within BMI and waist circumference categories.

CONCLUSIONS

These results demonstrate differences in VAT and SAT according to age, race/ethnicity, time since menopause, and compared to standard measures of body composition in a large and diverse cohort of postmenopausal women.

Diagnostic significance of calf circumference in sarcopenia of healthy korean adult males

This study aimed to determine the relationship between sarcopenia and physical function, and the best method of diagnosing sarcopenia in healthy adults. Early prevention of sarcopenia is important; however, no studies have been conducted in healthy and relatively young adults. In addition, it remains unclear whether calf circumference is associated with sarcopenia-defined variables. A total of 85 healthy male participants were enrolled, and the mean standard deviation age of the participants was 59.76 (8.12) years. Abdominal computed tomography (CT) was performed to measure muscle areas. All subjects were divided into sarcopenia and non-sarcopenia groups based on skeletal muscle mass index using computed tomography. Sarcopenia showed a tendency to be related to lower grip strength, five times sit-to-stand and timed up and go tests for physical function. This result shows that overweight and obesity in the sarcopenia group had fully adjusted odds ratios of 0.026 (95% CI: 0.002–0.317) and 0.008 (95% CI: 0.001–0.096), respectively. Calf circumference was higher specificity (71.43 and 64.86) better than bioelectrical impedance analysis-based skeletal mass index and had a similar sensitivity (72.09 and 82.35). In conclusion, calf circumference suggests the need to consider its use as a tool for assessing muscle mass in the diagnosis of sarcopenia.

Reduced body weight or increased muscle quality: Which is more important for improving physical function following exercise and weight loss in overweight and obese older women?

The purpose of this study was to examine the relative contributions of changes in muscle quality and body composition to changes in lower-extremity physical function (LEPF) following a 6-month exercise and weight loss intervention in overweight and obese older women. Thirty-eight overweight and obese (BMI = 30.0 ± 4.4 kg/m²) older (age = 69.3 ± 4.1 y) women completed 6 months of multicomponent exercise (cardiorespiratory, resistance, balance and flexibility training) and weight loss (hypocaloric diet that reduced energy intake by ~500 kcal/d). Body composition was measured via dual-energy X-ray absorptiometry and muscle quality (N-m/kg) was defined as maximal concentric isokinetic knee torque divided by upper-leg lean mass. The standardized scores of four objective measures of physical function were summed to yield a composite LEPF Z-score. At 6 months, there were significant reductions in body weight (-9.6 ± 3.5%, p < 0.01), absolute fat mass (-6.8 ± 2.4 kg, p < 0.01) and relative adiposity (-4.9 ± 2.1%, p < 0.01). There were also improvements in both muscle quality (+1.6 ± 1.8 N-m/kg, p < 0.01) and individual measures of LEPF (11-57%, p < 0.01). Multivariate linear regression indicated that increased muscle quality was the strongest independent predictor of an improvement in LEPF Z-score (standardized β = 0.64, p < 0.01) and explained 34% of the variance. A reduction in body weight also predicted an improvement in LEPF, independent of the change in muscle quality. In conclusion, muscle quality can be increased in the presence of clinically meaningful weight loss, and is the primary determinant of improved physical function in overweight/obese older women.

Association between obesity with low muscle mass and dialysis mortality

BACKGROUND/AIM

To examine the association between body composition and dialysis mortality.

METHODS

Adult patients who underwent haemodialysis in Taoyuan General Hospital from 2012 to 2016 were enrolled. We reviewed their baseline characteristics and followed up their treatment over 5 years after dialysis. Patients with body mass index >25 kg/m² were defined as obese. High or low muscle mass were classified by skeletal muscle mass index (SMMI) based on consensus from Chinese population. All age-matched subjects were classified into four groups: (A) optimal; (B) obesity; (C) low muscle mass; and (D) obesity with low muscle mass. Adjusted hazard ratios for mortality and cumulative survival curves were evaluated by Cox proportional hazard model and Kaplan-Meier method. The discriminative power of SMMI was calculated according to the area under the curve and the receiver operating characteristic curve.

RESULTS

From a total of 176 age-matched patients, the incidence rates of mortality for different groups were 3.7, 7.8, 10.3 and 16.5 per 1000 person-months. After adjusting for continuous variables, SMMI was independently associated with mortality. The difference between groups A and D was more significant in women than in men after multivariate adjustment (adjusted hazard ratios: 7.465 vs 1.682) (P = 0.035 and 0.553). The discriminative power of SMMI to predict 5-year mortality was 0.700 for men and 0.750 for women, and the best cut-off values were 11.1 and 8.4 kg/m² CONCLUSIONS: Low muscle mass was associated with dialysis mortality. Obesity with low muscle mass was a predictor for dialysis mortality in women.

Causes and consequences of fatigue in rheumatoid arthritis

PURPOSE OF REVIEW

To review current information on the causes, treatments, and consequences of fatigue in rheumatoid arthritis.

RECENT FINDINGS

Disease activity (inflammation, pain, joint symptoms) is associated with greater fatigue. However, disease activity per se accounts for only a small portion of fatigue, and rheumatoid arthritis medications that reduce disease activity have small effects on fatigue. Instead, factors outside the direct effects of rheumatoid arthritis, such as obesity, physical inactivity, sleep disturbance, and depression, explain the majority of variation in fatigue. Some of these factors may be indirect effects of disease (e.g. pain can lead to sleep disturbance). Rheumatoid arthritis has significant effects on the quality of life of individuals with rheumatoid arthritis. The most effective approaches to reducing rheumatoid arthritis fatigue appear to be behavioral, such as increasing physical activity, or cognitive, such as cognitive behavioral interventions.

SUMMARY

Fatigue in rheumatoid arthritis appears to be largely because of factors outside the direct effects of the disease, such as behavioral and psychological factors. In spite of the tremendous impact of fatigue on patient health and quality of life, effective treatments remain elusive, but existing data show that behavioral and cognitive approaches may be most effective.

Assessing the Risk of Sarcopenia in the Elderly: The Mini Sarcopenia Risk Assessment (MSRA) Questionnaire

OBJECTIVES

to validate the MSRA questionnaire proposed as prescreening tool for sarcopenia, in a population of community-dwelling elderly subjects.

DESIGN

observational study.

SETTING

community dwelling elderly subjects.

PARTICIPANTS

274 community dwelling elderly subjects, 177 women and 97 men, aged 66-78 years.

MEASUREMENTS

Based on EWGSOP diagnostic criteria subjects were classified as sarcopenic and non-sarcopenic. The Mini Sarcopenia Risk Assessment (MSRA) questionnaire, is composed of seven questions and investigates anamnestic and nutritional characteristics related to risk of sarcopenia onset (age, protein and dairy products consumption, number of meals per day, physical activity level, number of hospitalizations and weight loss in the last year).

RESULTS

33.5% of the study population, were classified as sarcopenic. With the 7-item MSRA score, subjects with a score of 30 or less, had a 4-fold greater risk of being sarcopenic than subjects with a score higher than 30 (OR:4.20;95% CI:2.26-8.06); area under the ROC curve was 0.786 (95% CI:0.725-0.847). In a logistic regression, considering as dependent variable the probability of being sarcopenic, and as independent variables the 7 items of the questionnaire, two items (number of meals and milk and dairy products consumption) showed non-significant diagnostic power. A 5-item score was then derived and the area under the ROC curve was 0.789 (95% IC:0.728-0.851). Taking into account the cost of false positive and false negative costs and the prevalence of sarcopenia, the "optimal" threshold of the original MSRA score (based on 7 items) is 30, with a sensitivity of 0.804 and a specificity of 0.505, while the "optimal" threshold of the MSRA score based on 5 items, is 45, with a sensitivity of 0.804 and a specificity of 0.604.

CONCLUSION

this preliminary study shows that the MSRA questionnaire is predictive of sarcopenia and can be suggested as prescreening instrument to detect this condition. The use of a short form of the MSRA questionnaire improves the capacity to identify sarcopenic subjects.

Sex-specific relationships of physical activity, body composition, and muscle quality with lower-extremity physical function in older men and women

OBJECTIVE

This study aims to determine the sex-specific relationships of physical activity, body composition, and muscle quality with lower-extremity physical function in older men and women.

METHODS

Seventy-nine community-dwelling men (n = 39; mean [SD] age, 76.1 [6.2] y; mean [SD] body mass index, 27.3 [3.8] kg/m(2)) and women (n = 40; mean [SD] age, 75.8 [5.5] y; mean [SD] body mass index, 27.0 [3.8] kg/m(2)) were assessed for physical activity via questionnaire, body composition via dual-energy x-ray absorptiometry scanning, leg extension power using the Nottingham power rig, and muscle quality (W/kg; the ratio of leg extension power [W] to lower-body mineral-free lean mass [kg]). A composite measure of physical function was obtained by summing Z scores from the 6-minute walk, 8-ft up-and-go test, and 30-second chair-stand test.

RESULTS

As expected, men had significantly greater levels of physical activity, lower adiposity, greater lean mass, higher leg extension power, and greater muscle quality compared with women (all P < 0.05). In linear regression analyses, muscle quality and physical activity were the strongest predictors of lower-extremity physical function in men and independently explained 42% and 29% of the variance, respectively. In women, muscle quality (16%) and percent body fat (12%) were independent predictors after adjustment for covariates.

CONCLUSIONS

Muscle quality is the strongest predictor of lower-extremity physical function in men and women, but sex impacts the importance of physical activity and adiposity. These findings suggest that older men and women may benefit from different intervention strategies for preventing physical disability and also highlight the importance of weight management for older women to preserve physical function.

Association of adiposity and muscle quality with physical function differs in young and old women

OBJECTIVE

This study aims were to investigate whether age differentially impacts the relationships between adiposity, muscle quality (MQ), and lower-extremity physical function in young and older women.

METHODS

Women aged 20 to 30 years (YOUNG group; n = 37) and women aged 64 to 80 years (OLD group; n = 39) were assessed for body composition via dual-energy X-ray absorptiometry. Isokinetic strength at 60 deg/second was assessed on a dynamometer. MQ was calculated as Nm / mineral-free lean mass (kg). Lower-extremity physical function was determined by an up-and-go (UPGO) challenge.

RESULTS

YOUNG women had lower relative adiposity (%Fat), greater leg lean mass, greater MQ, and faster UPGO time compared with OLD women (all P < 0.01). On linear regression analyses, mineral-free upper leg lean mass was the strongest predictor of UPGO performance in YOUNG women and independently explained 36% of the variance; in OLD women, age and adiposity were the strongest predictors and explained 57% and 40% of the variance, respectively.

CONCLUSIONS

Predictors of lower-extremity physical function differ between young and old women. These findings suggest that body composition and muscle capacity factors associated with function might change across the age span.

Obesity, Muscular Strength, Muscle Composition and Physical Performance in an Elderly Population

OBJECTIVE

To evaluate the association between BMI levels, muscular strength, muscle composition and physical performance in the elderly.

DESIGN

Italians subjects from the Progetto Veneto Anziani (ProVA) study were analyzed.

SETTING

The ProVa was a population study focused on chronic diseases and functional limitations in Italian subjects aged ≥65 years living in two Northeast Italian cities.

PARTICIPANTS

The ProVa study included 3099 subjects. ProVa participants with unknown information on BMI or disability status were excluded. The final sample was thus represented by 1.188 men, and 1.723 women.

MEASUREMENTS

Physical performance was measured with the Short Physical Performance Battery (SPPB) and leg muscular strength with dynamometry. Fat distribution and skeletal muscle composition were measured in an abdominal single-scan magnetic resonance (MRI) in a randomly selected sample of 348 subjects. Study population was stratified by BMI classes.

RESULTS

An association between BMI levels and SPPB was observed. Normal weight subjects showed the best SPPB scores (8.29±0.03), with significant differences compared to underweight (7.50±0.15; p<0.001), overweight (8.12±0.02; p<0.001), class I (7.72±0.04; p<0.001), class II (6.67±0.09; p<0.001) and class III obesity (5.88±0.24; p<0.001). This pattern was not modified by adjustment for possible confounders. Compared to normal weight subjects (22.9±0.1 kg), leg muscular strength was higher in overweight (23.8±0.1; p<0.001) and in class I obesity (24.5±0.1; p<0.001), but it was reduced in class II (21.4±0.3; p<0.001) and class III (19.8±0.9; p<0.001). The association between BMI and impaired physical performance was not affected by adjustment for muscular strength. An inverse association between SPPB scores and fat infiltration in skeletal muscle was observed in patients with abdominal MRI.

CONCLUSION

A poor physical performance was observed in overweight and obese elderly subjects. Leg strength was reduced only in subjects with severe obesity. Physical performance was negatively influenced by the degree of fat infiltration in skeletal muscle.

Body composition markers in older persons with COPD

BACKGROUND

Body composition has been shown to be correlated with physical performance, but data in older persons with diverse chronic diseases are lacking.

OBJECTIVE

We aimed at investigating the associations of body composition to gait speed and nutritional status of older people in different stages of chronic obstructive pulmonary disease (COPD).

DESIGN, SETTING AND SUBJECTS

Cross-sectional analysis of data from Pulmonary Rehabilitation Geriatric Unit at INRCA in Casatenovo, Italy including 132 consecutively admitted COPD patients (mean age: 75 years) with data on body composition, walking speed and respiratory parameters.

METHODS

Body mass parameters were assessed using bioelectrical impedance analysis. Pulmonary function tests included spirometry and arterial blood gases. Differences among body composition markers were compared according to gender. Separate multivariate linear regression models with gait speed as the dependent variable were used to test for independent associations with body composition markers after adjusting for multiple confounders.

RESULTS

Walking speed deteriorated with increasing severity of COPD. Men were heavier and had more lean mass than women. Participants in the fastest gait tertile were younger, had lower body mass index and fat mass (FM); higher lean-to-fat ratio and albumin levels and better respiratory function (FEV1, FVC) compared with those in the slower tertiles. Total body FM was an independent determinant of walking speed, while fat-free mass and lean-to-fat ratio were not.

CONCLUSIONS

Excess body fat may be harmful for physical functioning among elders with COPD.

Functional Fitness and Physical Activity of Portuguese Community-Residing Older Adults

The purposes of this study were to generate functional-fitness norms for Portuguese older adults, to determine age and sex differences, and to analyze the physical activity–associated variation in functional fitness. The sample was composed of 802 older adults, 401 men and 401 women, age 60–79 yr. Functional fitness was assessed using the Senior Fitness Test. Physical activity level was estimated via the Baecke questionnaire. The P50 values decreased from 60 to 64 to 75 to 79 yr of age. A significant main effect for age group was found in all functional-fitness tests. Men scored significantly better than women in the chair stand, 8-ft up-and-go, and 6-min walk. Women scored significantly better than men in chair sit-and-reach and back scratch. Active participants scored better in functional-fitness tests than their average and nonactive peers. This study showed a decline in functional fitness with age, better performance of men, and increased proficiency in active participants.

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.

A new frailty syndrome: central obesity and frailty in older adults with the human immunodeficiency virus

OBJECTIVES

To evaluate the relationships between body composition and physical frailty in community-dwelling older adults with the human immunodeficiency virus (HIV) (HOA).

DESIGN

Cross-sectional.

SETTING

Academic hospital-based infectious disease clinic in Rochester, New York.

PARTICIPANTS

Forty community-dwelling HOA aged 50 and older undergoing antiretroviral therapy who were able to ambulate without assistive devices with a mean age of 58, a mean BMI of 29.0 kg/m(2), mean CD4 count of 569 cells/mL, and a mean duration since HIV diagnosis of 17 years; 28% were female and 57% Caucasian.

MEASUREMENTS

Subjective and objective measures of functional status were evaluated using the Physical Performance Test (PPT), the graded treadmill test, knee strength, gait speed, balance, and the Functional Status Questionnaire (FSQ). Body composition was evaluated using dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI).

RESULTS

Sixty percent (25/40) of the participants met standard criteria for physical frailty. Frail (FR) and nonfrail (NF) participants were comparable in age, sex, CD4 count, and viral load. FR HOA had greater impairments in PPT, peak oxygen uptake, FSQ, walking speed, balance, and muscle quality than NF HOA. FR HOA had a greater body mass index (BMI), fat mass, and truncal fat with lipodystrophy. Moreover, PPT score was inversely related to trunk fat (correlation coefficient (r) = -0.34; P = .04) and ratio of intermuscular fat to total fat (r = -0.60; P = .02) after adjusting for covariates.

CONCLUSION

HOA represent an emerging cohort of older adults who frequently experience frailty at a much younger age than the general older population. Central obesity and fat redistribution are important predictors of frailty in community-dwelling HOA. These findings suggest that physical frailty in HOA may be amenable to lifestyle interventions, especially exercise and diet therapy.

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.

Impact of obesity on functioning among women with systemic lupus erythematosus

OBJECTIVE

Obesity is associated with high rates of disability in the general population. The nature of the relationship between obesity and disability in systemic lupus erythematosus (SLE), a condition with a high background rate of disability, is unknown.

METHODS

Data were from 2 interviews, 4 years apart, of a longitudinal cohort of individuals with SLE (n = 716 women). Body mass index (BMI) was calculated from self-reported height and weight; obesity was classified by usual (BMI ≥30) and revised (BMI ≥26.8) definitions. Three measures of functioning were examined: the Short Form 36 (SF-36) Health Survey physical function (PF) subscale, Valued Life Activities (VLA) Disability Questionnaire, and employment. Multivariate analyses controlled for demographics, SLE duration and disease activity, glucocorticoid use, depression, and comorbidities. Prospective analyses also controlled for baseline function.

RESULTS

At a BMI of ≥30, 27.8% of the subjects were obese; at a BMI of ≥26.8, 40.6% of the subjects were obese. Regardless of obesity definition, obese women exhibited poorer baseline function, with decrements ranging from 20-33% depending on the functional measure and obesity definition. With a BMI of ≥26.8, the adjusted SF-36 PF scores were 4.3 points lower for obese women (P < 0.0001), VLA difficulty was 0.09 higher (P = 0.01), and odds of employment were 80% of nonobese women (odds ratio 0.8, 95% confidence interval 0.5-1.1). At the 4-year followup, women who were obese at baseline had poorer function and experienced greater functional declines.

CONCLUSION

Obesity was associated with clinically significant negative effects on function, both concurrently and prospectively. This negative impact occurred at a lower BMI than is often considered problematic clinically. Because of the high rate of SLE-related disability, addressing preventable risk factors such as obesity may improve long-term SLE outcomes.

Effect of fast dietary proteins on muscle protein synthesis rate and muscle strength in ad libitum-fed and energy-restricted old rats

Sarcopenia is defined as age-related loss of muscle mass and strength. Energy restriction (ER) delays fibre loss by limiting the accumulated deleterious effects of reactive oxygen species on muscle. However, insufficient protein intake during ER might affect muscle mass and function. We hypothesised that ingestion of fast-digested proteins such as whey protein (WP) improves muscle protein synthesis and muscle strength in aged ER rats. The effect of WP or casein (CAS, slow protein) on muscle mass, protein synthesis and strength was evaluated in 21-month-old rats fed for 5 months either ad libitum (AL) or a 40 % protein and energy-restricted (PER) or 40 % AL-isonitrogenous ER diet. The nitrogen balance was reduced in PER-CAS rats only ( - 48 % v. AL-CAS). WP stimulated muscle protein synthesis rates compared with CAS in all groups (+21,+37 and +34 % in AL, PER and ER conditions, respectively). Muscle strength was higher in ER rats than in AL rats (+23 and +12 % for WP or CAS, respectively). Muscle performance tended to be greater in ER rats fed WP than in ER-CAS rats (P < 0·09). In conclusion, we observed that long-term ER combined with maintained protein intake had a beneficial impact on muscle protein synthesis rate and function during ageing.

Race/Ethnicity differences in the relationship between obesity and gait speed among older Americans

Projections indicate that the older American population will become more racially diverse in the future. Therefore, eliminating health disparities among older adults should be a public health priority. Using data from the 1999-2002 National Health and Nutrition Examination Survey, we examined the relationship between obesity, measured by BMI and waist circumference, and gait speed, a performance-based measure of physical function, in 2,285 older adults (≥60 y) in order to determine whether this relationship varies by race/ethnicity. Overweight and obesity, indicated by a BMI ≥ 25 kg/m(2) and a waist circumference in quartiles 3 (male: 102.4-109.9 cm; female: 97.3-106.3 cm) and 4 (male: 110.2-156.6 cm; female: 106.4-147.5 cm), were associated with slower gait speed in non-Hispanic Whites. Among non-Hispanic Blacks, only extreme obesity, indicated by a BMI ≥ 35 kg/m(2) and a waist circumference in quartile 4 (male: 110.2-149.6 cm; female: 106.4-137.7 cm), was associated with a slower gait speed. Among Mexican Americans, only extreme obesity, indicated by a BMI ≥ 35 kg/m(2), was associated with a slower gait speed. Thus we found the relationship between obesity and gait speed differed by race/ethnicity. The goal of eliminating health disparities in access to and quality of health care is only possible when differences in the associations between possible risk factors and physical function are identified.

Improved nutrient intake in older obese adults undergoing a structured diet and exercise intentional weight loss program

OBJECTIVES

Physicians are often reluctant to advise older obese patients to lose weight for fear of compromised nutrition and excessive loss of muscle mass and strength, all of which may lead to a loss of independence and accelerate disability. Therefore, the purpose of this study was to examine nutrient intake in older obese adults undergoing a weight loss intervention.

SETTING

The study setting was at a university research facility.

PARTICIPANTS

A total of 71 participants (age, 69.5 (SD = 5.8) yrs; 62% female; BMI, 34.6 (4.4) kg/m2) were recruited.

DESIGN

Individuals were randomized into either a weight stable (WS) control group or an intensive weight loss (WL) group.

INTERVENTION

The WL intervention was for 6 months and utilized partial meal replacements (PMR) and a facility-based 3 d/wk, 60 min/session exercise training program encompassing both aerobic and strength exercises. Weight loss goal for WL was 10% from baseline at 6-months.

MEASUREMENTS

Variables were obtained at baseline and 6-months and included 3 day dietary records along with daily step counts for 7 days. Total energy, macronutrients (g and % of energy), micronutrients (vitamins and minerals), as well as use of PMR were assessed from the diet records. Body mass and body fat (g and % of body mass) were determined at the 2 time points.

RESULTS

Estimated marginal means (SEM) for weight loss at 6-months was -8.8 (0.7)% for WL and -0.1 (0.7)% for WS. Daily energy intake at 6-months was lower for WL (1396 (64) kcals) compared to WS (1817 (71) kcals). Additionally, those in the WL group (compared to WS) had lower intakes of total fat (27.5 (1.2)%, WL vs. 36.1 (4.6)%, WS) and saturated fatty acids (8.5 (0.4)% vs. 10.8 (0.5)%), and had higher levels of carbohydrates (57.6 (1.5)% vs. 49.0 (1.7)%), protein (18.4 (0.5% vs. 16.2 (0.6)%), and dietary fiber (21.0 (0.9) g vs. 17.4 (1.0) g) at 6-months. Even with reduced total calorie intake, key micronutrients (calcium, iron, vitamin D, vitamin E, vitamin C) were higher for WL vs. WS at 6-months. Total daily step counts were higher for WL vs. WS at 6-months.

CONCLUSION

A nutrition intervention to promote weight loss in older obese adults was achieved using PMR as a primary strategy. Diet quality was improved for WL vs. WS in using the nutrient fortified product, even with a reduction in total energy intake.

Relative strength as a determinant of mobility in elders 67-84 years of age. a nuage study: nutrition as a determinant of successful aging

This cross-sectional study proposes two relative strength indexes in order to evaluate the risks of lower mobility in healthy older adults: 1) handgrip strength on body mass index and 2) quadriceps strength on body weight. Nine hundred and four men and women aged between 67-84 years old were tested for body composition, muscle strength and mobility function. Individuals in the lowest and middle tertiles of relative handgrip strength were respectively 2.2 (1.3-3.7) and 4.4 (2.6-7.6) more likely to have a lower mobility score. As for relative quadriceps strength, odd ratios for lowest and middle tertiles were respectively 2.8 (1.6-4.9) and 6.9 (3.9-12.1). Relative strength indexes, either using handgrip strength or quadriceps strength, are convenient to use in large scale studies and clinical practice.

Obesity in older adults: relationship to functional limitation

PURPOSE OF REVIEW

The present review is intended to provide a critical overview of recent investigations of obesity among older persons with emphasis upon associated functional limitations, potential for intervention, and a future research agenda.

RECENT FINDINGS

Obesity is growing in prevalence among older persons. The association between obesity and functional decline is well documented. Recent findings suggest possible contributions of obesity-associated inflammatory milieu, sarcopenia, and impairment of muscle function/strength to adverse functional outcomes. A growing body of literature supports consideration of moderate weight reduction to secure improved metabolic and functional parameters for obese older persons.

SUMMARY

Obesity is associated with an unfortunate burden of chronic disease, functional limitation, and poor life quality. In view of the growing numbers of afflicted older individuals, there must be research priority to discern how obesity impacts function so that appropriate prevention and treatment strategies may be adopted.

Regional muscle and whole-body composition factors related to mobility in older individuals: a review

PURPOSE

To describe previously reported locomotor muscle and whole-body composition factors related to mobility in older individuals.

METHODS

A narrative review of the literature, including a combination of search terms related to muscle and whole-body composition factors and to mobility in older individuals, was carried out. Statistical measures of association and risk were consolidated to summarize the common effects between studies.

RESULTS

Fifty-three studies were reviewed. Muscle and whole-body factors accounted for a substantial amount of the variability in walking speed, with coefficients of determination ranging from 0.30 to 0.47. Muscle power consistently accounted for a greater percentage of the variance in mobility than did strength. Risks associated with high fat mass presented a minimum odds ratio (OR) of 0.70 and a maximum OR of 4.07, while the minimum and maximum ORs associated with low lean mass were 0.87 and 2.30 respectively. Whole-body and regional fat deposits accounted for significant amounts of the variance in mobility.

CONCLUSION

Muscle power accounts for a greater amount of the variance in the level of mobility in older individuals than does muscle strength. Whole-body fat accounts for a greater amount of the variance in level of mobility than does whole-body lean tissue. Fat stored within muscle also appears to increase the risk of a mobility limitation in older individuals.

Type 2 diabetes mellitus and other cardiovascular risk factors are no more common during menopause: longitudinal study

OBJECTIVE

The aim of this study was to undertake a prospective study of the changes in certain risk factors for cardiovascular disease occurring during menopause.

METHODS

A longitudinal cohort study of 475 women was followed up for 6 years (Pizarra Study). The final menstrual period was defined after at least 6 months of amenorrhea. The women were classified into three groups: group 1, no menopause at either the first or second study; group 2, no menopause at the first study but menopause at the second study (6 y later); and group 3, menopause at the first study (and also at the second). The following are the main outcome measures used: age; body mass index; waist circumference; waist-to-hip ratio; skinfold thickness; arm circumference; intake of macronutrients (quantitative questionnaire); systolic and diastolic blood pressures; cholesterol, triglycerides; high-density lipoprotein cholesterol; uric acid; homeostasis model assessment of insulin resistance; and the prevalence of obesity, hypertension, type 2 diabetes mellitus, impaired glucose tolerance, and impaired fasting glucose.

RESULTS

None of the cardiovascular risk factors studied changed during the passage from premenopause to postmenopause, independently of age or physical activity.

CONCLUSIONS

Menopause is a biological condition of the human species, for which has recently received attempts at medicalization that were not always justified. If menopause is not accompanied by any other cardiovascular risk factor independently of age, the stigma of menopause being considered a risk factor should cease. Although the results have the strength of a prospective study, the sample size forced us to consider these findings as preliminary.

Sex impacts the relation between body composition and physical function in older adults

OBJECTIVE

To determine the sex-specific relationships between physical activity, aerobic fitness, adiposity (%Fat), mineral-free lean mass (MFLM), and balance and gait performance in older adults.

METHODS

Eighty-five female and 49 male sedentary, healthy, community-dwelling older adults (mean [SD] age, 69.6 [5.4] and 70.3 [4.7] years, respectively) were evaluated on habitual physical activity via questionnaire, aerobic fitness by a maximal oxygen consumption treadmill test, whole and regional body composition by dual-energy x-ray absorptiometry, and lower extremity physical function using gait tasks and computerized dynamic posturography.

RESULTS

As expected, men had less body fat, more lean mass, and higher aerobic fitness than did women and tended to perform better on all lower extremity physical function tasks (all P <or= 0.1). Physical activity was not related to gait; however, fitness was related to gait in both sexes (r > 0.50, all P < 0.05). Body fat was related to gait in women (r = -0.38, P < 0.05) but not in men. Neither fitness nor body composition was related to balance in men, whereas in women, leg MFLM was positively associated (r = 0.27, P < 0.05). Women, but not men, with a greater ratio of body weight to leg MFLM performed worse on gait tasks (P < 0.001). There was an interaction with sex for %Fat on gait (P = 0.05) and for leg MFLM on balance (P < 0.05).

CONCLUSIONS

In sedentary healthy older adults, the relation between body composition, aerobic fitness, and balance and gait differs between sexes such that women are more strongly affected by alterations in body composition. Lower %Fat and preservation of lower body lean mass have important implications for reducing the risk of physical disability, especially in older women.

Sex differences in the relationship between obesity, C-reactive protein, physical activity, depression, sleep quality and fatigue in older adults

Fatigue is a serious health concern in the elderly. Sex differences exist in adiposity, systemic inflammation, physical activity/fitness and fatigue; however, the relations among these variables remain inadequately characterized impeding the development of fatigue prevention strategies. Measures of adiposity, C-reactive protein, physical activity, aerobic fitness, fatigue, sleep quality and depression were obtained from 127 community-dwelling older adults. Although similar in age (70 y) and BMI (28.0kg/m(2)) women (n=80) reported 63% greater fatigue than men (p=0.04). Adiposity (r=0.44), CRP (r=0.29), physical activity (r=-0.26) and fitness (r=-0.41) were related to fatigue in women (all p<0.05), but not in men. Depression was also related to fatigue in women (r=0.37), and was the only variable related to fatigue in men (r=0.42). In women, fatigue was independently explained (all p<0.05) by CRP (6.6%), depression (6.3%), physical activity (5.8%), and adiposity (3.9%); however, in men, only depression explained variance in fatigue (12.0%). CRP was 40% higher and adiposity 12% higher in women reporting fatigue compared to those with no fatigue; no such differences existed in men. Obese women perceived a greater degree of fatigue than non-obese women, but this was not the case in men. Women report more fatigue than men which was independently associated with inflammation, depression, physical activity and adiposity, whereas in men the only independent predictor was depression. Strategies to prevent fatigue may differ in older women and men, especially with regard to inflammation, physical activity and adiposity.

Difficulties with physical function associated with obesity, sarcopenia, and sarcopenic-obesity in community-dwelling elderly women: the EPIDOS (EPIDemiologie de l'OSteoporose) Study

BACKGROUND

In elders, decreased muscle mass (sarcopenia) and increased fat mass (obesity) may contribute to difficulties with physical function.

OBJECTIVE

The objective was to examine the association of obesity, sarcopenia, and their combination (sarcopenic-obesity) with self-reported difficulties performing physical function in a cohort of community-dwelling elderly women.

DESIGN

We assessed muscle and fat mass by dual-energy X-ray absorptiometry and self-reported difficulties with physical function in 1308 healthy women aged > or =75 y. Sarcopenia was defined as an appendicular skeletal muscle mass < or =2 SD below the mean in a young female reference group. Obesity was defined as a percentage body fat above the 60th percentile. Thirty-six sarcopenic-obese, 90 purely sarcopenic, 435 purely obese, and 747 women with a healthy body composition were studied. Anthropometric measures, health status, lifestyle habits, and self-reported difficulties with 6 different physical functions were obtained.

RESULTS

Compared with women with a healthy body composition and after adjustment for confounders, purely sarcopenic women had no increased odds of having difficulties for all of the physical functions assessed, purely obese women had a 44-79% higher odds of having difficulties with most of the physical functions assessed (P < 0.05), and sarcopenic-obese women had a 2.60 higher odds of having difficulty climbing stairs and a 2.35 higher odds of having difficulty going down stairs (all P < 0.05).

CONCLUSIONS

Sarcopenia is not associated with physical difficulties in the absence of obesity. However, in the presence of obesity, sarcopenia tends to add difficulty for some physical functions.

Blood pressure around the menopause: a population study

BACKGROUND

Hypertension is a major cardiovascular risk factor possibly explaining the excessive cardiovascular morbidity and mortality in postmenopausal women. Cross-sectional and longitudinal studies have explored this issue with diverging results. Our study sought to elucidate the impact of the menopause on blood pressure in a representative population sample.

METHODS

The study involved randomly selected 908 female residents of a Prague district, aged 45-54 years (respondence rate, 63.9%). Three definitions of the menopause were used: self-reported menstrual characteristics (premenopausal with the final menstrual period less than 60 days; late menopausal transition, with final menstrual period 60-365 days; and postmenopausal, final menstrual period more than 365 days before the examination), levels of follicle-stimulating hormone (< or = 40 IU/l for premenopausal and more than 40 IU/l for postmenopausal women), and both.

RESULTS

Age-adjusted and BMI-adjusted systolic blood pressure and diastolic blood pressure did not differ among the groups regardless of the definition of menopause. There was also no difference in the prevalence of hypertension and in the age-adjusted and BMI-adjusted odds ratio for hypertension. Multiple regression analysis testing the association between systolic blood pressure and diastolic blood pressure, and age, BMI, heart rate, smoking, and antihypertensive medication explained a rather small proportion of the BP variation. No correlation was found between BP and age in either subgroup; the closest correlation was always found between BP and BMI.

CONCLUSION

In our rather homogeneous representative population random sample of women around the menopause, the rise in blood pressure after the menopause appeared to be due to increased BMI rather than to ovarian failure per se.

The physical functional capacity of frail elderly persons undergoing ambulatory rehabilitation is related to their nutritional status

OBJECTIVES

To estimate the prevalence of malnutrition in frail elders undergoing rehabilitation and the association between their nutritional status and physical function.

DESIGN

Observational study of new participants undergoing ambulatory rehabilitation.

SETTING

Two Geriatric Day Hospitals (GDH) in Montreal, Quebec.

PARTICIPANTS

121 women and 61 men.

INTERVENTION

Evaluation of nutritional status, body composition and physical function.

MEASUREMENTS

The nutritional status was assessed with a composite index based on anthropometric measurements and serum albumin, as well as using the Mini Nutritional Assessment (MNA) questionnaire. Patients were classified as well-nourished, having mild/at risk of malnutrition or malnourished. Body composition was estimated by bioimpedance and handgrip strength and gait speed by standard methods.

RESULTS

13% of patients were found to be mildly malnourished, whereas 6% were malnourished. Malnourished patients were older and had worse cognition, lower BMI, and % body fat (all p<0.05). Malnourished patients and those with mild malnutrition had lower weight, triceps skinfold thickness, muscle and fat mass (all, p<0.003). Handgrip strength was different according to the nutritional status (p=0.034) and correlated with muscle mass (r=0.65, p<0.001). MNA classified 53% of patients as being at risk whereas 3% were malnourished and it correlated with gait speed (r=0.26, p=0.001).

CONCLUSION

There is a high prevalence of patients in GDH at risk or with mild malnutrition. Being malnourished was associated with worse physical performance, which suggests that a nutritional intervention may be of benefit in improving their physical function.

Is bioelectrical impedance accurate for use in large epidemiological studies?

Percentage of body fat is strongly associated with the risk of several chronic diseases but its accurate measurement is difficult. Bioelectrical impedance analysis (BIA) is a relatively simple, quick and non-invasive technique, to measure body composition. It measures body fat accurately in controlled clinical conditions but its performance in the field is inconsistent. In large epidemiologic studies simpler surrogate techniques such as body mass index (BMI), waist circumference, and waist-hip ratio are frequently used instead of BIA to measure body fatness. We reviewed the rationale, theory, and technique of recently developed systems such as foot (or hand)-to-foot BIA measurement, and the elements that could influence its results in large epidemiologic studies. BIA results are influenced by factors such as the environment, ethnicity, phase of menstrual cycle, and underlying medical conditions. We concluded that BIA measurements validated for specific ethnic groups, populations and conditions can accurately measure body fat in those populations, but not others and suggest that for large epdiemiological studies with diverse populations BIA may not be the appropriate choice for body composition measurement unless specific calibration equations are developed for different groups participating in the study.

Sarcopenia: its assessment, etiology, pathogenesis, consequences and future perspectives

Sarcopenia is a loss of muscle protein mass and loss of muscle function. It occurs with increasing age, being a major component in the development of frailty. Current knowledge on its assessment, etiology, pathogenesis, consequences and future perspectives are reported in the present review. On-going and future clinical trials on sarcopenia may radically change our preventive and therapeutic approaches of mobility disability in older people.

[Prevalence of geriatric syndrome and risk factors associated with obesity in community-dwelling elderly women]

AIM

To evaluate the prevalence of geriatric syndrome and risk factors associated with obesity in community-dwelling elderly women.

METHODS

The baseline survey was conducted in November 2006. Subjects were 925 women aged 70 years and older who participated in a comprehensive health examination which included a face-to-face interview, body composition, and physical fitness tests. The participants were classified, the based on percentage of body fat, as normal (<30.0), mild obesity (30.0 to 34.9), and obesity (>or=35.0) groups. To evaluate the differences among the groups with regard to the physical fitness and the interview data, one-way analysis of variance performed for continuous variables and the chi-square test for categorical variables. Multivariate logistic regression models were used to assess the factors associated with obesity in elderly women.

RESULTS

Although obese women had a higher prevalence of urinary incontinence than the normal and mild obese women, there were no significant differences in history of falls during the last year, or fear of falling. A high percentage of body fat was significantly associated with a higher level of instrumental activities of daily living (IADL) and intellectual activity disability, use of 3 or more medications, pain, and circumference (abdominal, hip, calf), and was associated with a lower level of balance and walking ability. According to the logistic model, history of hypertension (odds ratio (OR)=1.70, 95%confidence intervals (CI)=1.25-2.32), pain (OR=1.46, 95%CI=1.07-2.01), urinary incontinence (OR=1.44, 95%CI=1.08-1.92), SBP (OR=1.02, 95%CI=1.01-1.03), and usual walking speed (OR=0.43, 95%CI=0.24-0.75) were independent variables significantly associated with obesity.

CONCLUSIONS

These cross-sectional data show that a higher percentage of body fat is associated with high prevalence of urinary incontinence, IADL and intellectual activity disability, and is related to lower level of walking ability and balance. The present study suggests that regular physical activity and weight control may contribute to the prevention of IADL disability and improvement of physical fitness in obese elderly women.

Sarcopenic obesity: a new category of obesity in the elderly

BACKGROUND AND AIM

In elderly patients, age-related changes in body composition, as well as the increased prevalence of obesity, determine a combination of excess weight and reduced muscle mass or strength, recently defined as sarcopenic obesity (SO). This review examines the main studies regarding sarcopenic obesity in the elderly.

DATA SYNTHESIS

Definition of SO necessarily combines those of sarcopenia and obesity. The prevalence of sarcopenia and SO increases with age. Muscle and fat mass are strongly interconnected from a pathogenetic point of view. A better understanding of the mechanisms which lead from loss of muscle mass to fat gain or vice versa from fat gain to muscle loss seems to be crucial. Recent data suggest that peptides produced by adipose tissue may play an important role in the pathophysiology of SO, thus more research is needed to better characterize this new area. Obesity and sarcopenia in the elderly may potentiate each other maximizing their effects on disability, morbidity and mortality. Identifying elderly subjects with SO should be mandatory; effective treatment of sarcopenia and SO may attenuate its clinical impact.

CONCLUSION

The concept of SO may help to clarify the relationship between obesity, morbidity and mortality in the elderly.

Impact of Functional Limitations and Medical Comorbidity on Subsequent Weight Changes and Increased Depressive Symptoms in Older Adults

Objectives: The primary goal of this study was to determine the effect of the onset of major medical comorbidity and functional decline on subsequent weight change and increased depressive symptoms. Methods: The sample included a prospective cohort of 53 to 63 year olds ( n = 10,150) enrolled in the Health and Retirement Study. Separate lagged covariate models for men and women were used to study the impact of functional decline and medical comorbidity on subsequent increases in depressive symptoms and weight change 2 years later. Results: Functional decline and medical comorbidity were individual predictors of subsequent weight changes but not increased depressive symptoms. Most specific incident medical comorbidities or subtypes of functional decline predicted weight changes in both directions. Discussion: The elevated risk of weight gain subsequent to functional decline or onset of medical comorbidities may require the receipt of preventive measures to reduce further weight-related complications.

Longitudinal body composition changes in old men and women: interrelationships with worsening disability

BACKGROUND

Few studies have evaluated prospectively age-related body composition changes and their relationships with worsening disability in the elderly population.

METHODS

Ninety-seven women and 62 men aged 71.4+/-2.2 and 71.6+/-2.2 years, respectively, at baseline underwent dual-energy x-ray absorptiometry determinations at baseline and at 2- and 5.5-year follow-up intervals to measure total body and leg fat (FM) and total, appendicular, and leg fat-free mass (FFM). Height, weight, body mass index (BMI), and waist circumference (as well as reported disabilities using a four-level scale) were evaluated at baseline and at 2- and 5.5-year follow-up.

RESULTS

In both sexes, total FM did not change significantly, while total, appendicular, and leg FFM significantly decreased over the study follow-up. In men and women losing weight, BMI, total and leg FM, and total, appendicular, and leg FFM significantly decreased. In weight-stable men and women, appendicular and leg FFM significantly decreased and BMI, waist circumference, and total FM significantly increased. Men lost significantly more total, appendicular, and leg FFM than did women, irrespective of whether they maintained or lost weight. Over the follow-up period, 43.3% of women and 43.5% of men declined in one or more levels of reported disability. We evaluated the effect of age, baseline BMI, FM, FFM, number of diseases, baseline 6-minute walking test, categories of weight change, total, appendicular, or leg FFM changes, total FM and waist changes on the probability of a decline in one or more levels of reported disability score over the follow-up period, taking into account sex. Patients losing appendicular and leg FFM were 2.15 and 2.53 times, respectively, more likely to report increased disability than were patients without FFM loss.

CONCLUSIONS

Reduction in appendicular or leg FFM was the main predictor of decline in one or more levels of reported disability in older men and women, and accounted for about a 2-fold increase in risk.

Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women

OBJECTIVES

To compare two methods for classifying an individual as sarcopenic for predicting decline in physical function in the Health, Aging and Body Composition Study.

DESIGN

Observational cohort study with 5 years of follow-up.

SETTING

Communities in Memphis, Tennessee, and Pittsburgh, Pennsylvania.

PARTICIPANTS

Men and women aged 70 to 79 (N=2,976, 52% women, 41% black).

MEASUREMENTS

Appendicular lean mass (aLM) was measured using dual energy x-ray absorptiometry, and participants were classified as sarcopenic first using aLM divided by height squared and then using aLM adjusted for height and body fat mass (residuals). Incidence of persistent lower extremity limitation (PLL) was measured according to self-report, and change in objective lower extremity performance (LEP) measures were observed using the Short Physical Performance Battery.

RESULTS

There was a greater risk of incident PLL in women who were sarcopenic using the residuals sarcopenia method than in women who were not sarcopenic (hazard ratio (HR)=1.34, 95% confidence interval (CI)=1.11-1.61) but not in men. Those defined as sarcopenic using the aLM/ht(2) method had lower incident PLL than nonsarcopenic men (HR=0.76, 95% CI=0.60-0.96) and women (HR=0.75, 95% CI=0.60-0.93), but these were no longer significant with adjustment for body fat mass. Using the residuals method, there were significantly poorer LEP scores in sarcopenic men and women at baseline and Year 6 and greater 5-year decline, whereas sarcopenic men defined using the aLM/ht(2) method had lower 5-year decline. Additional adjustment for fat mass attenuated this protective effect.

CONCLUSION

These findings suggest that sarcopenia defined using the residuals method, a method that considers height and fat mass together, is better for predicting disability in an individual than the aLM/ht(2) method, because it considers fat as part of the definition.

High baseline values of fat mass, independently of appendicular skeletal mass, predict 2-year onset of disability in elderly subjects at the high end of the functional spectrum

BACKGROUND AND AIMS

To evaluate the relation between baseline body composition and 2- year onset of functional limitation in elderly subjects at the high end of the functional spectrum.

METHODS

Anthropometric measurements, physical functioning as measured by a modified version of the Activities of Daily Living Scale, and baseline albumin, were evaluated in 145 men and women aged 66-78 years, free of functional limitations, selected from the general population of Verona. In each subject, total body fat mass (FM) and appendicular FFM (ASMM) were measured by dual-energy X-ray absorptiometry; the FM (FMI) and ASMM indexes (ASMMI) were also calculated by dividing each body composition variable by height squared.

RESULTS

After 2 years of follow-up, 48.2% of women and 40% of men had developed mild levels of disability, with limitations in kneeling, bending and climbing stairs. In women, but not in men, a BMI higher than 25 Kg/m2 or values of FMI higher than the 50th percentile, were significantly associated with a 3 to 5 times increased risk of limitations in climbing stairs and lower body performance. In men, a trend was found between low values of ASMMI and an increased risk of limitations in kneeling and bending. After cross-tabulating categories based on the 50th percentile of ASMMI and FMI, high values of FMI, independently of ASMMI, were significantly related with higher incidence of limitation in climbing stairs in women. In women, the highest 2-year incidence of limitation in climbing stairs was found in the group of obese subjects.

CONCLUSIONS

High body fat and high BMI values were associated with a greater probability of developing functional limitations 2 years later in a population of elderly subjects at the high end of the functional spectrum. Moreover, in women, high baseline values of fat mass, independently of appendicular fat-free mass, were more likely to predict the future onset of functional limitations.

Weight and depressive symptoms in older adults: direction of influence?

OBJECTIVE

. The purpose of this study was to clarify the direction of the relationship between changes in depressive symptoms and changes in weight in older adults. Methods. The sample included a prospective cohort of individuals aged 53-63 (n = 9,130) enrolled in the Health and Retirement Study. We used separate cross-lagged models for men and women in order to study the impact of weight change on subsequent increases in depressive symptoms 2 years later and vice versa.

RESULT

. Weight gain did not lead to increased depressive symptoms, and weight loss preceded increased depressive symptoms only in unadjusted models among men (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.04-1.53). Increased depressive symptoms were not predictive of subsequent weight loss, but they were predictive of subsequent weight gain in unadjusted models only (men: OR = 1.24, 95% CI = 1.00-1.54; women: OR = 1.12, 95% CI = 1.00-1.26). In adjusted models, baseline depressive symptoms predicted both weight loss and weight gain among both men and women. Increase in functional limitations and medical conditions were significant predictors of both weight loss and weight gain. Baseline functional limitations also predicted increased depressive symptoms. Discussion. Based on our findings, it is apparent that researchers need to examine the pathways between changes in weight and increases in depressive symptoms in the context of functional limitations and medical comorbidity.

Body composition and functional limitation in COPD

Background

Low body mass index has been associated with increased mortality in severe COPD. The impact of body composition earlier in the disease remains unclear. We studied the impact of body composition on the risk of functional limitation in COPD.

Methods

We used bioelectrical impedance to estimate body composition in a cohort of 355 younger adults with COPD who had a broad spectrum of severity.

Results

Among women, a higher lean-to-fat ratio was associated with a lower risk of self-reported functional limitation after controlling for age, height, pulmonary function impairment, race, education, and smoking history (OR 0.45 per 0.50 increment in lean-to-fat ratio; 95% CI 0.28 to 0.74). Among men, a higher lean-to-fat ratio was associated with a greater distance walked in 6 minutes (mean difference 40 meters per 0.50 ratio increment; 95% CI 9 to 71 meters). In women, the lean-to-fat ratio was associated with an even greater distance walked (mean difference 162 meters per 0.50 increment; 95% CI 97 to 228 meters). In women, higher lean-to-fat ratio was also associated with better Short Physical Performance Battery Scores. In further analysis, the accumulation of greater fat mass, and not the loss of lean mass, was most strongly associated with functional limitation among both sexes.

Conclusion

Body composition is an important non-pulmonary impairment that modulates the risk of functional limitation in COPD, even after taking pulmonary function into account. Body composition abnormalities may represent an important area for screening and preventive intervention in COPD.

The relations of body composition and adiposity measures to ill health and physical disability in elderly men

Although body build is related to disability and mortality in older people, the independent contributions of adiposity and lean mass are not fully defined. The authors examined the relations of body composition (fat mass index, fat-free mass index) and adiposity (body mass index, waist circumference) to ill health and physical disability in a cross-sectional study of 4,252 British men aged 60-79 years in 1998-2000. Increased body mass index, waist circumference, and fat mass index were associated with increased prevalence of cardiovascular disease, overall ill health, and disability. Adjusted odds ratios of cardiovascular disease (top vs. bottom fifth) were 1.58 (95% confidence interval (CI): 1.23, 2.03) for fat mass index, 1.45 (95% CI: 1.14, 1.86) for body mass index, and 1.27 (95% CI: 0.99, 1.62) for waist circumference. For overall "poor/fair" health, the corresponding odds ratios were 1.71 (95% CI: 1.33, 2.21), 1.49 (95% CI: 1.17, 1.90), and 1.64 (95% CI: 1.28, 2.09) and, for mobility limitation, they were 1.56 (95% CI: 1.17, 2.06), 1.96 (95% CI: 1.48, 2.56), and 1.88 (95% CI: 1.42, 2.49). A high fat-free mass index was associated with only a decreased prevalence of respiratory problems and cancer (odds ratios=0.45 (95% CI: 0.33, 0.62) and 0.62 (95% CI: 0.42, 0.94), respectively). Body fatness, not fat-free mass, is associated with cardiovascular disease and disability in older men. Simple measures of overweight, such as body mass index and waist circumference, are good indicators of the likelihood of morbidity in older men. Prevention of weight gain with increasing age is likely to reduce morbidity and disability among older men.

Age-associated decrease of type IIA/B human skeletal muscle fibers

Elderly individuals often fall because of poor muscle strength and reduced balancing ability related to muscle aging. However, it is unclear whether changes in muscle fiber types contribute to poor strength or imbalance. We studied age- associated changes in human skeletal muscle fibers using muscle biopsy specimens taken from 65 male and female Chinese patients aged 17-96 years. The muscle specimens were cryosectioned with alkaline triphosphatase staining at pH 4.4, followed by image analysis. We analyzed morphologic observations and performed quantitative analyses of the number, size, and area percentage of different types of skeletal muscle fibers and connective tissues. Types IIA and IIB muscle fibers decreased with age in the area percentage, fiber number percentage, and mean fiber area, whereas Type I fibers increased in area and number but not in size. Morphologically, Type II fibers appeared smaller and flatter. Our findings suggest deterioration in muscle quality and balancing coordination in elderly patients. We provide data to help determine treatments for reversing muscle fiber changes and reducing the number of falls and related fractures in patients.

Fat mass rather than muscle strength is the major determinant of physical function and disability in postmenopausal women younger than 75 years of age

OBJECTIVE

Few studies have investigated the relationships between body composition, functional ability, and age-related disability in postmenopausal women. We investigated the relative role of fat mass, lean mass, and muscle strength in the development of disability in a group of healthy postmenopausal women younger than 75 years.

DESIGN

We performed a cross-sectional study among 396 independently living women aged 56-73 years, randomly selected between 8 and 30 years after menopause. Lean mass and fat mass were assessed by dual-energy x-ray absorptiometry. Muscle strength (grip and leg extensors) was assessed using dynamometry. Functional ability was estimated by Physical Performance Score, physical activity during the preceding year, and impairment in activities of daily living.

RESULTS

Of the participants, 43.7 % were overweight (25 > or = BMI < 30 kg/m2), and 17.7% were obese (BM I > or = 30 kg/m2). Higher muscle strength was observed with increasing lean body mass, and participants with higher muscle strength scored better in the physical performance score and activities of daily living. Higher fat mass was significantly associated with a lower physical performance score, lower physical activity, and a higher frequency of disability. Increasing fat mass was associated with increasing lean mass and decreasing lean/fat ratio. The increase in lean mass and muscle strength associated with higher fat mass was mainly localized in the legs.

CONCLUSIONS

Our results support the role of fat mass as the primary risk marker for disability, which might later accelerate by the age-related decrease in lean mass and the development of sarcopenia after the age of 75 years.