High body fatness, but not low fat-free mass, predicts disability in older men and women: the Cardiovascular Health Study

Obesity as a confounding health factor among women with mobility impairment

PURPOSE

To examine the relationships between self-reported height and weight and factors associated with disabilities that impair mobility among adult women.

DATA SOURCES

Survey data were gathered from a convenience sample of 83 women with disabilities at community events targeting the disabled population. Height, weight, and factors associated with their disabilities were reported on a demographic questionnaire. Body mass index (BMI) was estimated using a conversion table and the self-reported height and weight of each participant.

CONCLUSIONS

The average self-reported weight was 168.3 lb. Only 38% of the women fell into the normal range on estimated BMI, but 62% of the women fell into the categories of overweight or obese. The incidence of overweight and obesity exceeded that reported for the general population of women in a national sample X2 = 6.48, p = 03, 2 df). Self-reported weight was positively correlated with the number of comorbidities reported by the women (r = .419, p < .0001).

IMPLICATIONS

The issue of obesity is an important problem facing women with disabilities. Women who have mobility limitations need to be weighed periodically, and strategies should be devised for weight management, including both dietary plans and appropriate exercise regimens given their limitations.

Benefits of exercise and dietary measures to optimize shifts in body composition with age

Ageing is associated with changes in body composition, including an increase and redistribution of adipose tissue and a decrease in muscle and bone mass, beginning as early as the fourth decade of life. These changes have significant implications for the health and functioning of the individual because of their associations with chronic disease expression and severity, as well as geriatric syndromes such as mobility impairment, falls, frailty and functional decline. Therefore, understanding the preventive and therapeutic options for optimizing body composition in old age is central to the care of patients in mid-life and beyond. Pharmacological interventions are currently available for maintaining or improving bone mass, and much current interest is focused on anabolic agents that will preserve or restore muscle mass, as well as those that can potentially limit adipose tissue deposition. However, in this brief review, non-pharmacological modulation of body composition through appropriate dietary intake and physical activity patterns, will be discussed. There is sufficient evidence currently to suggest that a substantial portion of what have been considered 'age-related' changes in muscle, fat and bone are in fact related either to excess energy consumption, decreased energy expenditure in physical activity, or both factors in combination. In addition, selective underconsumption of certain macro- or micronutrients contributes to losses of muscle and bone mass. Each of the three compartments will be considered in turn, with recommendations for optimizing the size of these body tissue stores in early adulthood, and minimizing undesirable changes typically seen in middle and old age.

Strength and muscle quality in a well-functioning cohort of older adults: the Health, Aging and Body Composition Study

OBJECTIVES

To determine whether lower lean mass and higher fat mass have independent effects on the loss of strength and muscle quality in older adults and might explain part of the effect of age.

DESIGN

Single-episode, cross-sectional analyses of a cohort of subjects in the Health, Aging and Body Composition (Health ABC) Study.

SETTING

Ambulatory clinic and research laboratory.

PARTICIPANTS

Two thousand six hundred twenty-three men and women aged 70 to 79 from the Health ABC Study.

MEASUREMENTS

Upper and lower extremity strength was measured using isokinetic (knee extension) and isometric (grip strength) dynamometers. Body composition (lean mass and fat mass) was determined by measuring lean mass of upper and lower extremities and the total body by dual-energy x-ray absorptiometry. Muscle quality was ascertained by taking the ratio of strength to muscle mass for both upper and lower extremities.

RESULTS

Upper and lower extremity strength and muscle quality decreased as age increased. Most of the explained variance in strength was due to differences in muscle mass, but, in those at the extremes of body fat and lower leg muscle quality, the association with body fat was independent of the effect of age. Although blacks had greater muscle strength and mass than whites, leg muscle quality tended to be lower in blacks than in whites. Upper extremity strength adjusted for lean mass and muscle quality were also associated inversely and independently with age, body fat, and black race.

CONCLUSION

In this older cohort, lower strength with older age was predominantly due to a lower muscle mass. Age and body fat also had significant inverse associations with strength and muscle quality. Both preservation of lean mass and prevention of gain in fat may be important in maintaining strength and muscle quality in old age.

A adiposidade corporal e a idade prejudicam a capacidade funcional para realizar as atividades da vida diária de mulheres acima de 47 anos

Este estudo teve como objetivo verificar o efeito da idade, peso, altura, índice de massa corporal e adiposidade corporal na capacidade funcional de mulheres acima de 47 anos para realizar as atividades da vida diária. Para tanto, a amostra foi constituída por 129 mulheres na faixa etária de 47 a 77 anos de idade. A adiposidade total (Adp T) foi considerada por meio do somatório das dobras cutâneas bíceps (BI), tríceps (TRI), subescapular (SB), axilar média (AM), supra-ilíaca (SI), abdominal (ABD), coxa anterior (CA) e panturrilha medial (PM). A adiposidade central (Adp C) representou o somatório de SB, AM, SI e ABD, e a adiposidade periférica (Adp P), o somatório de BI, TRI, CA e PM. A capacidade funcional para realizar as atividades da vida diária foi predita mediante os testes: velocidade para se levantar de uma posição sentada (VLPS) e para se levantar de uma posição deitada (VLPD), velocidade para calçar e amarrar o tênis (VCAT) e velocidade para subir escada (VSE). Foi calculado o quartil (Q) para todas as variáveis independentes (idade, peso, altura, índice de massa corporal e adiposidade corporal [total, central e periférica]). A análise estatística utilizada foi a ANOVA one way e os coeficientes de correlação linear de Pearson e Spearman rank-order. As diferenças estatisticamente significativas ocorreram principalmente entre os quartis das extremidades (Q1 x Q4) para VLPS e VLPD (exceção para peso e IMC), enquanto para VSE foi entre Q2 x Q4 (idade). As variáveis independentes exerceram efeito nulo sobre VCAT. A magnitude de variação percentual ocorreu entre a amplitude de 14,1% (idade [VLPD: Q3 x Q4]) e 36,1% (Adp T [VLPS: Q2 x Q4]). Em ordem, as variáveis independentes que exerceram maior repercussão negativa sobre a performance nos testes de capacidade funcional (VLPS, VLPD, VSE) para realizar as atividades da vida diária foram Adp C, idade, Adp T, Adp P, IMC e peso.

Undernutrition in the European SENECA studies

The SENECA study, which sampled a cohort of community-dwelling persons born between 1913 and 1918 in 12 European countries in baseline (1988), follow up (1993), and final (1999) surveys, found a relatively high risk of malnutrition despite a low prevalence of actual malnourishment. The results point out the importance of monitoring nutritional status in healthy elderly adults.

Percentage of body fat and body mass index are associated with mobility limitations in people aged 70 and older from NHANES III

OBJECTIVES

To assess the association between functional limitations and body composition indices, including percentage of body fat, muscle mass, and body mass index (BMI).

DESIGN

A cross-sectional, population-representative sample.

SETTING

All noninstitutionalized people living in the United States (National Health and Nutrition Examination Survey). Data were collected between 1988 and 1994.

PARTICIPANTS

One thousand five hundred twenty-six women and 1,391 men aged 70 and older.

MEASUREMENTS

Independent variables included BMI, muscle mass, and percentage of body fat; the latter two were assessed using predictive equations. The dependent variable, functional limitations, was defined as difficulty in performing at least three of five functional living tasks, such as carrying a 10-pound bag of groceries.

RESULTS

Women in the highest quintile for percentage of body fat and women with a BMI of 30 or greater were two times more likely to report functional limitations than women in the comparison groups. Similar, but weaker, relationships were found among men; men in the highest quintile for body fat and men with a BMI of 35 or greater were 1.5 times more likely to report limitations. Low muscle mass (sarcopenia) and sarcopenia in combination with high percentage of body fat (sarcopenic obesity) were not associated with a greater likelihood of reporting functional limitations.

CONCLUSIONS

Prevention of excessive accumulation of body fat and maintenance of a BMI in the normal range may reduce the likelihood of functional limitations in old age.

Obesity is associated with functional decline in community-dwelling rural older persons

OBJECTIVES

This investigation sought to examine potential gender differences in the relationship between body mass index (BMI) and functional decline.

DESIGN

Cohort study.

SETTING

Rural Pennsylvania.

PARTICIPANTS

Medicare managed-risk program participants (aged > or =65) in the Geisinger Health Plan. Mean age at study baseline was 71. Final analyzable sample was 2,634 participants.

MEASUREMENTS

Self-reported weight, weight change, living and eating habits, alcohol and medication use, depression, dentition, and functional status were obtained upon enrollment and again between 3 and 4 years later. Measured height and weight were also recorded at enrollment. Functional decline was defined as any increase in reported limitations in activities of daily living or instrumental activities of daily living over the study period. Logistic regression was used to evaluate the relationship between BMI, as defined by current National Institutes of Health categories, and risk of functional decline while controlling for age, depression, and polypharmacy. The referent category was BMI 18.5 to 24.9.

RESULTS

Women had a higher prevalence of reported functional decline than men at the upper range of BMI categories (31.4% vs 14.3% for BMI > or =40). Women (odds ratio (OR) = 2.61, 95% confidence interval (CI) = 1.39-4.95) and men (OR = 3.32, 95% CI = 1.29-8.46) exhibited increased risk for any functional decline at BMI of 35 or greater. Weight loss of 10 pounds and weight gain of 20 pounds were also risk factors for any functional decline.

CONCLUSIONS

Obesity was a risk factor for functional decline in older persons of either gender. Change in body weight did not benefit function for many older persons.

Anthropometric measurements in the elderly: age and gender differences

In clinical practice and epidemiological surveys, anthropometric measurements represent an important component of nutritional assessment in the elderly. The anthropometric standards derived from adult populations may not be appropriate for the elderly because of body composition changes occurring during ageing. Specific anthropometric reference data for the elderly are necessary. In the present study we investigated anthropometric characteristics and their relationship to gender and age in a cross-sectional sample of 3,356 subjects, randomly selected from an elderly Italian population. In both sexes, weight and height significantly decreased with age while knee height did not. The BMI was significantly higher in women than in men (27.6 SD 5.7 v. 26.4 SD 3.7; P<0.001) and it was lower in the oldest than in the youngest subjects (P<0.05) of both genders. The 75th year of age was a turning point for BMI as for other anthropometric measurements. According to BMI values, the prevalence of malnutrition was lower than 5 % in both genders, whereas obesity was shown to have a higher prevalence in women than in men (28% v. 16%; P<0.001). Waist circumference and waist: hip ratio values were higher for the youngest men than for the oldest men (P<0.05), whereas in women the waist: hip ratio values were higher in the oldest women, suggesting that visceral redistribution in old age predominantly affects females. In conclusion, in the elderly the oldest subjects showed a thinner body frame than the youngest of both genders, and there was a more marked fat redistribution in women.

Waist circumference and weight change are associated with disability among elderly Hispanics

BACKGROUND

Studies have suggested that both high and low body mass index (BMI) and weight change are related to functional disability in elderly populations. Elderly Hispanics have a high prevalence of both obesity and disability, yet few studies have examined their interrelationship in this population. Therefore, we examined these relationships in a mostly Puerto Rican group of Hispanic elders.

METHODS

We investigated associations between a three-level disability score created from responses to a questionnaire on activities of daily living and BMI, waist circumference (WC), and weight change since age 50, using the proportional odds model in a cross-sectional study of 763 elderly Hispanics, aged 60 to 92 years, residing in Massachusetts.

RESULTS

After adjusting for potential confounders, men with a WC > or =109.3 cm (vs <90 cm), or with a reported weight loss of -0.32 to -0.01 kg/year, or a weight gain > or =0.55 kg/year since age 50 (vs relatively stable weight, -0.01 to +0.21 kg/year [y]) were each significantly associated with an approximately threefold higher risk for greater disability. Women with a BMI > or =35 kg/m(2) were almost four times as likely to have higher disability as those with a BMI of 20 to 25 kg/m(2). Compared with women with a WC < or =85.2 cm, those with a WC of 91.5 to 106.6 cm were two times more likely, and those with a WC > or =106.6 cm were five times more likely, to have higher disability scores. Compared with relatively stable weight (-0.05 to +0.23 kg/y), weight gain > or =0.23 kg/year was associated with a twofold higher risk of greater disability among women. When BMI and WC were included in the same model, WC, but not BMI, remained significantly associated with disability.

CONCLUSIONS

Abdominal obesity (WC > or =109.3 cm for men, or WC > or =91.5 cm for women) and weight gain > or =0.55 kg/year after age 50 in men or > or =0.23 kg/year in women may increase the risk of disability among elderly Hispanics.

Determinants of disability in older coronary patients

BACKGROUND

Patient-reported physical function is a major component of disability determinations and an important contributor to health-related quality of life. Prior studies of coronary disability have shown a surprisingly poor correlation between real-life activity profile and exercise capacity measured on the treadmill. The goal of the current investigation was to evaluate the relative importance of medical factors, sex, fitness-related measures, and psychologic factors as determinants of patient-reported physical function score in older persons with established coronary heart disease (CHD).

METHODS

Determinants of disability were studied in 51 community-dwelling patients >65 years old (71 +/- 5 years, range 65-83 years) with established chronic CHD. Patient-reported physical function score (scaled 0-100) was measured by the Medical Outcomes Study Short Form physical function section. Independent variables included clinical and demographic data, treadmill testing, rest and exercise echocardiography, measures of body composition, strength, aerobic fitness, and a depression score.

RESULTS

Patients with a diagnosis of myocardial infarction had a lower physical function score than did patients with other CHD diagnoses (68 +/- 19 vs 82 +/- 22, P <.05). Univariate predictors of patient-reported physical function score included peak aerobic capacity (R = 0.62), treadmill test duration (R = 0.61), depression score (R = -0.60), handgrip strength (R = 0.42), and comorbidity score (R = -0.39). Peak aerobic capacity (R2 = 0.38) and depression score (cumulative R2 = 0.60) were the best independent predictors of physical function. Women had lower physical function scores than men (64 +/- 22 vs 78 +/- 20, P <.05) despite a similar age, diagnostic distribution, depression score, and comorbidity score. Resting left ventricular ejection fraction was not a predictor of physical function score.

CONCLUSIONS

Peak aerobic capacity and depression score were the best independent predictors of patient-reported physical function score in older coronary patients. These data focus on the potential for exercise training and treatment of mental depression to prevent and treat coronary disability in older coronary patients.

Recreational physical activity levels in healthy older women: the importance of fear of falling

OBJECTIVES

To examine whether fear of falling is a probable cause of reduced recreational physical activity levels in healthy older women.

DESIGN

Cross-sectional analysis of baseline data from a longitudinal study.

PARTICIPANTS

One thousand five hundred older, ambulatory women (aged 70-85), selected at random from the electoral roll.

MEASUREMENTS

Self-reported recreational physical activity levels and fear of falling, demographic variables, anthropometric variables and measures of disability, and physical and cognitive function.

RESULTS

The study subjects had low levels of physical and cognitive impairments; 24.1% of the group was obese (body mass index> 30). Twenty-six percent of the women did not participate in recreational physical activity; 39% participated in sufficient activity to gain probable health benefits. Although the women who did not participate in recreational activities were most likely to report fear of falling (45.2%), it was common in the group as a whole (33.9%), including the most active women (27.0%). Independent risk factors for nonparticipation in physical activity were fear of falling (odds ratio (OR)=0.70, 95% confidence interval (CI)=0.54-0.90, P=.006), obesity (OR=0.50, 95% CI=0.38-0.66, P=.001), and slower times on the timed up-and-go test (OR=0.88, 95% CI=0.84-0.92, P=.001). Fear of falling was also independently associated with lower recreational physical activity levels in women who were active (beta=-0.09, P=.003). Subgroup analysis suggested that fear of falls affected activity levels at a predisability stage in women with mildly impaired mobility.

CONCLUSIONS

Fear of falling is common in healthy, high-functioning older women and is independently associated with reduced levels of participation in recreational physical activity. Fear of falling is an important psychological barrier that may need to be overcome in programs attempting to improve activity levels in older women.

Obesity in the elderly

In developed countries, there is a general increase in body weight and body mass index (BMI) with age, until approximately 60 years of age, when body weight and BMI begin to decline. The proportion of intra-abdominal fat, which is related to increased morbidity and mortality, progressively increases with age. There is also a progressive decline in energy intake and daily total energy expenditure (165 kcal/decade in men and 103 kcal/decade in women in developed countries), which is primarily due to a decrease in physical activity, and to a lesser extent, a decrease in basal metabolic rate. The decrease in physical activity is more pronounced in those with chronic disabilities and diseases. The BMI-mortality curves have been reported to move upward (greater overall mortality), become flatter (less effect of BMI on mortality), and in some cases shift to the right (minimum mortality occurs at a higher BMI), for a variety of possible reasons. Weight loss in the elderly has been reported to increase, decrease, or not alter mortality, but the studies are confounded by numerous methodological problems. It has been argued that there may be little benefit in encouraging weight loss in extreme old age (short life expectancy), especially when there are no obesity-related complications or biochemical risk factors and when strong resistance and distress arise from changes in lifelong habits of eating and exercise. In contrast, weight loss in the elderly can reduce morbidity from arthritis, diabetes and other conditions, reduce cardiovascular risk factors, and improve well-being. BMI also predicts morbidity in those without disease. Furthermore, increased physical activity in the elderly, which is an important component of weight management, can produce beneficial effects on muscle strength, endurance, and well-being.

Weight change in old age and its association with mortality

OBJECTIVES

Previous studies of weight change and mortality in older adults have relied on self-reported weight loss, have not evaluated weight gain, or have had limited information on health status. Our objective was to determine whether 5% weight gain or loss in 3 years was predictive of mortality in a large sample of older adults.

DESIGN

Longitudinal observational cohort study.

SETTING

Four U.S. communities.

PARTICIPANTS

Four thousand seven hundred fourteen community-dwelling older adults, age 65 and older.

MEASUREMENTS

Weight gain or loss of 5% in a 3-year period was examined in relationship to baseline health status and interim health events. Risk for subsequent mortality was estimated in those with weight loss or weight gain compared with the group whose weight was stable.

RESULTS

Weight changes occurred in 34.6% of women and 27.3% of men, with weight loss being more frequent than gain. Weight loss was associated with older age, black race, higher weight, lower waist circumference, current smoking, stroke, any hospitalization, death of a spouse, activities of daily living disability, lower grip strength, and slower gait speed. Weight loss but not weight gain of 5% or more was associated with an increased risk of mortality that persisted after multivariate adjustment (Hazard ratio (HR) = 1.67, 95% CI = 1.29-2.15) and was similar in those with no serious illness in the period of weight change. Those with weight loss and low baseline weight had the highest crude mortality rate, although the HR for weight loss was similar for all tertiles of baseline weight and for those with or without a special diet, compared with those whose weight was stable.

CONCLUSIONS

This study confirms that even modest decline in body weight is an important and independent marker of risk of mortality in older adults.

Effects of GH and/or sex steroid administration on abdominal subcutaneous and visceral fat in healthy aged women and men

Aging is associated with reduced GH, IGF-I, and sex steroid axis activity and with increased abdominal fat. We employed a randomized, double-masked, placebo-controlled, noncross-over design to study the effects of 6 months of administration of GH alone (20 microg/kg BW), sex hormone alone (hormone replacement therapy in women, testosterone enanthate in men), or GH + sex hormone on total abdominal area, abdominal sc fat, and visceral fat in 110 healthy women (n = 46) and men (n = 64), 65-88 yr old (mean, 72 yr). GH administration increased IGF-I levels in women (P = 0.05) and men (P = 0.0001), with the increment in IGF-I levels being higher in men (P = 0.05). Sex steroid administration increased levels of estrogen and testosterone in women and men, respectively (P = 0.05). In women, neither GH, hormone replacement therapy, nor GH + hormone replacement therapy altered total abdominal area, sc fat, or visceral fat significantly. In contrast, in men, administration of GH and GH + testosterone enanthate decreased total abdominal area by 3.9% and 3.8%, respectively, within group and vs. placebo (P = 0.05). Within-group comparisons revealed that sc fat decreased by 10% (P = 0.01) after GH, and by 14% (P = 0.0005) after GH + testosterone enanthate. Compared with placebo, sc fat decreased by 14% (P = 0.05) after GH, by 7% (P = 0.05) after testosterone enanthate, and by 16% (P = 0.0005) after GH + testosterone enanthate. Compared with placebo, visceral fat did not decrease significantly after administration of GH, testosterone enanthate, or GH + testosterone enanthate. These data suggest that in healthy older individuals, GH and/or sex hormone administration elicits a sexually dimorphic response on sc abdominal fat. The generally proportionate reductions we observed in sc and visceral fat, after 6 months of GH administration in healthy aged men, contrast with the disproportionate reduction of visceral fat reported after a similar period of GH treatment of nonelderly GH deficient men and women. Whether longer term administration of GH or testosterone enanthate, alone or in combination, will reduce abdominal fat distribution-related cardiovascular risk in healthy older men remains to be elucidated.

Obesity in the elderly--a future matter of concern?

In most studies mean body weight increases with age up to about age 60 and then levels off, but information about the association between body weight and mortality at higher ages is sparse, since most studies published are cross-sectional, thus introducing a bias in selectivity. Some studies actually suggest a protective effect of overweight in the oldest age groups. Indices of visceral obesity may be better indicators of risk than body mass index (BMI) in these age groups. Not only actual weight, but also weight development over the last decades may predict outcome. Most clinical trials exclude older patients and little is known about benefits of diets or drugs inducing weight loss in these age groups. More information is available suggesting multiple benefits of physical activity. Mechanical complications of obesity, such as osteoarthritis and static respiratory complications seem to improve with weight loss even at higher ages. For health economic reasons it will become important to address treatment strategies in the elderly in the future, since they will constitute a large segment of the population. Recent studies suggest that bariatric surgery, previously considered contraindicated in obese patients above age 60 can be safely performed even in patients above age 70 and with the same benefits as for younger subjects.

[Validation of the OMRON BF 300 monitor for measuring body fat by bioelectric impedance]

OBJECTIVES

To assess the accuracy of the OMRON BF 300 body fat monitor using bioelectric impedance and to validate its measurement of body fat percentage (BF%) against the Siri equation.

DESIGN

Cross-sectional descriptive study.

SETTING

Primary care. Coronel de Palma and San Fernando Health Centres, Móstoles.

PARTICIPANTS

88 people took part in the assessment of the accuracy of the monitor, and 91 in the validation.

MEASUREMENTS AND MAIN RESULTS

The BF% were recorded in triplicate, with the mean being the figure noted. Precision was evaluated through the intra-class correlation coefficient (ICC) and the coefficient of variation (CV); validity, through technical error, the ICC and the Bland-Altman method. In the Siri equation, body density was calculated through the Durnin-Womersley equation. Precision: ICC was 0.999 and CV 0.4 +/- 0.03.

VALIDATION

the difference between the BF% monitor (26.6 +/- 9.1%) and the Siri equation (27.8 +/- 8.2%) was -1.27% (p < 0.01; 95% CI -1.97 to -0.57); the technical error of the monitor was 2.2% and of the ICC 0.956 (95% CI, 0.9335-0.9710). Thus, 80.2% of the monitor-equation differences were below 5%, with a concordance interval under the Bland-Altman method of +5.45 to -7.99%.

CONCLUSIONS

The OMRON BF 300 monitor satisfies the precision criteria (ICC > 0.95 and low CV) and validation (excellent technical error, ICC > 0.75 and clinically acceptable differences) and is a valid alternative to cutaneous folds as a method of assessing nutrition of the patient.

Instrumental activities of daily living as a potential marker of frailty: a study of 7364 community-dwelling elderly women (the EPIDOS study)

BACKGROUND

A number of clinical conditions have been shown to be associated with frailty in elderly people. We hypothesized that incapacities on the Instrumental Activities of Daily Living (IADLs) scale could make it possible to identify this population. We investigated the associations between IADL incapacities and the various known correlates of frailty in a cohort of community-dwelling elderly women.

METHODS

Cross-sectional analysis was carried out on the data from 7364 women aged over 75 years (EPIDOS Study). The IADL was the dependent variable. Sociodemographic, medical, and psychological performance measures were obtained during an assessment visit. Falls in the previous 6 months and fear of falling were also ascertained. Body composition was measured by dual-energy x-ray absorptiometry. The factors associated with disability in at least one IADL were included in a logistic regression model.

RESULTS

Thirty-two percent of the population studied had disability in at least one IADL item. This group was significantly older (81.7 +/- 4.1 yr vs 79.8 +/- 3.4 yr), had more frequent histories of heart disease, stroke, depression or diabetes, and was socially less active (p =.001). These associations persisted after multivariate analysis. Cognitive impairment as assessed by the Pfeiffer test (Pfeiffer score <8) was closely associated with disabilities on the IADL (OR 3.101, 95% confidence interval [CI] 2.19-4.38). Falls and fear of falling were also more frequent in the group of women with an abnormal IADL (p =.001) but only fear of falling remained significantly associated with incapacities on at least one IADL item after logistic regression (OR 1.47, 95% CI 1.28-1.69). Women with disability on at least one IADL item also had lower bone mineral density, this was independent of the other factors.

CONCLUSION

Our results confirmed that women with disability on at least one IADL item are frailer because they had more associated disorders, poorer cognitive function and more frequent falls. Disabilities on this scale could be a good tool for identifying individuals at risk of frailty among elderly persons living at home and in apparent good health. This finding requires confirmation by longitudinal studies.

Longitudinal changes in body mass index and body composition over 3 years and relationship to health outcomes in Hong Kong Chinese age 70 and older

OBJECTIVES

To determine longitudinal changes in body mass index (BMI) and body composition with age and the relationship between these changes with mortality, morbidity, functional capacity, and other health outcome measures.

DESIGN

A 3-year longitudinal study of a random sample of community-living subjects.

SETTING

Older Chinese in the Hong Kong Special Administrative Region of China.

PARTICIPANTS

Two thousand and thirty-two Chinese subjects age 70 and older recruited territory-wide by proportional random sampling.

MEASUREMENTS

Baseline information collected included medical history, self-perceived health, Barthel Index, Geriatric Depression Score, time taken to complete a 16-foot walk, height, weight, mid-arm circumference, arm skin-fold thickness, and waist/hip ratio. Body composition was calculated from prediction equation. Outcome measures included mortality, development of new diseases, Barthel Index, time taken for 16-foot walk, self-perceived health, and Geriatric Depression Score.

RESULTS

All parameters, with the exception of triceps skin-fold thickness in men, decreased, regardless of presence or absence of disease. The decrease in arm circumference, triceps skin-fold thickness, and total body fat (TBF) was greater in women than in men, whereas men had a greater decrease in fat-free mass (FFM). Even in the absence of disease, three times as many subjects lost > or =5kg in weight as gained > or =5kg (15% vs. 5%), and only age could be identified as a contributing factor to this weight loss. In the absence of disease, lower anthropometric indices were associated with greater mortality, development of new disease (in women only), dependency, and poor performance measure. Waist-hip ratio was not associated with mortality or any other health outcomes. Decrease in both FFM and TBF were associated with worse outcomes, the effect being more marked in women.

CONCLUSION

In the older population, changes in weight and body composition occur even in the absence of disease and are associated with mortality and physical functioning level. Weight loss rather than weight gain appears to be more important in this population, and promotion of life-style interventions targeted at weight maintenance would be important.

The relationship between body mass index and self-reported functional limitation among older adults: a gender difference

OBJECTIVES

To determine whether there is a gender difference in how body mass index (BMI) relates to self-reported functional limitation. Also, to evaluate whether the method of categorizing BMI changes the observed results.

DESIGN

Cross-sectional cohort study.

SETTING

Rural Pennsylvania.

PARTICIPANTS

A total of 7,120 male (n = 3,312) and female (n = 3,808) community-dwelling older adults enrolled in a Medicare managed-risk contract.

MEASUREMENTS

All subjects completed a modified Level II Nutrition Risk Screen upon enrollment in the health plan. Height and weight were obtained by nursing personnel during an enrollment clinic visit. Subjects who reported 10 or more pounds weight loss in the previous 6 months were excluded. Logistic regression was used to evaluate the relationship between BMI and self-reported functional limitation separately for each sex, adjusting for age, depression, and polypharmacy. Two schemes were used to categorize BMI: equally distributed sex-specific quintiles and arbitrary division based on National Institutes of Health (NIH) Obesity Guidelines.

RESULTS

How BMI relates to functional limitation depends upon both sex and method of categorizing BMI. When BMI was considered in gender-specific quintiles, women in the highest quintile of BMI had increased risk of functional impairment; there was no relationship between BMI and functional limitation for men. When BMI was categorized by the NIH obesity guidelines, both men and women with BMI >40 had significantly increased risk of functional limitation.

CONCLUSIONS

The mechanisms behind gender discrepancy in self-reported functional limitation remain unclear. Studies may need to consider men and women separately, because how BMI relates to function depends on gender. Further research is needed to evaluate how changes in weight and body composition during middle and old age affect functional status.

The relationship between body composition and physical performance in older women

BACKGROUND

The relationship between age-associated change in body composition and physical disability is still unknown. Skeletal muscle mass declines with age in both sexes; however, since women have less muscle mass per unit of weight than men, these changes may be more debilitating in women.

OBJECTIVE

To evaluate the relationship between body composition and physical performance.

DESIGN

A cross-sectional study.

PARTICIPANTS

144 women aged 68 to 75 were selected randomly from the general population of Verona.

MEASUREMENTS

Body composition was evaluated using dual energy X-ray absorptiometry and bioimpedance. Physical performance was evaluated using a modified version of the Activities of Daily Living scale. Distance walked in 6 minutes was calculated, and isometric knee strength was tested.

RESULTS

Normal women had a significantly lower body mass index (BMI) and percent body fat. These women also had a higher ratio of body cell mass (BCM) and total fat free mass (FFM) than women with physical impairments. After adjusting for BMI, women in the lowest tertile of muscle strength had significantly lower BCM than those in the highest tertile.

CONCLUSIONS

These cross-sectional data show that although muscle strength is related to fat-free mass, disability in older women is associated with heavier BMI and with a higher percentage of body fat.