Physical function mitigates the adverse effects of being thin on mortality in a free-living older Taiwanese cohort

Body Mass Index Combined With Possible Sarcopenia Status Is Better Than BMI or Possible Sarcopenia Status Alone for Predicting All-Cause Mortality Among Asian Community-Dwelling Older Adults

Background

Body mass index (BMI) and sarcopenia are common indicators of nutritional status. Possible sarcopenia, defined as low muscle strength or performance, was recently introduced by the Asian Working Group for Sarcopenia (AWGS) in 2019. We investigated for association between all-cause mortality and BMI combined with possible sarcopenia severity in Asian older adults.

Methods

This study included a subpopulation (8,195 participants aged ≥60 years; male gender: 49.4%; mean age: 69.2 ± 6.8 years) from the Fourth Thai National Health Examination Survey (NHES-IV). BMI was classified using Asia-Pacific cut-offs. Possible sarcopenia was defined using quadriceps strength based on AWGS 2019 criteria, and possible sarcopenia severity was determined using study population quartile cut-offs. All-cause mortality data was derived from the national vital registry in 2020.

Results

The prevalence of underweight status and possible sarcopenia was 11.8 and 38.9%, respectively. Multivariate analysis showed underweight individuals with severe possible sarcopenia to be at highest risk for increased mortality [adjusted hazard ratio (aHR): 3.98, 95% confidence interval (CI): 2.89-5.48], and higher risk was found in men compared to women (aHR: 5.35, 95% CI: 1.19-8.97). Obese status without possible sarcopenia was an independent protective factor (aHR: 0.61, 95% CI: 0.38-0.97).

Conclusion

BMI combined with possible sarcopenia severity is a better predictor of mortality risk than either parameter alone.

Association of body mass index with all-cause mortality in the elderly population of Taiwan: A prospective cohort study

BACKGROUND AND AIMS

The nutritional status of the elderly is different from that of young people. Body composition changes as people age, for example, fat mass increases, muscle mass decreases, and body fat distribution is changed. We aimed to investigate the association of body mass index (BMI) with cause-specific mortality in the elderly population.

METHODS AND RESULTS

The data of annual health examination for the older citizens (≥65 years old) from 2006 to 2011 in Taipei City Hospital were used. Information on baseline demographics, lifestyle behaviors, medical, and drug usage were collected by a self-administered questionnaire. Cause-specific mortality was ascertained from the National Registration of Death. Individuals were followed up until death or December 31, 2012, whichever was earlier. Univariable and multivariable Cox proportional hazard analyses were applied to investigate the association between BMI and all-cause mortality. Among 81,221 older people included in the analysis, 42,602 (52.45%) were men. The mean age was 73.85 ± 6.32 years. Among the 81,221 participants, 3398 (4.18%) were underweight, 36,476 (44.91%) were normal weight, 25,708 (31.65%) were overweight, and 15,639 (19.25%) were obese. Those in the BMI category 27 ≤ BMI<28 kg/m² had the lowest all-cause mortality risk. The BMI of lowest cause-specific mortality was between 27 kg/m² and 28 kg/m² in infection mortality, between 28 kg/m² and 29 kg/m² in circulation mortality, between 29 kg/m² and 30 kg/m² in respiratory mortality, and between 31 kg/m² and 32 kg/m² in cancer mortality.

CONCLUSIONS

The current study found a J-shaped relation between BMI and cause-specific mortality in the elderly population of Taiwan.

Quality of life and mortality in the general population: a systematic review and meta-analysis

BACKGROUND

Quality of life (QoL) is multi-dimensional concept of an individual' general well-being status in relation to their value, environment, cultural and social context in which they live. This study aimed to quantitatively synthesise available evidence on the association between QoL and mortality in the general population.

METHODS

An electronic search was conducted using three bibliographic databases, MEDLINE, EMBASE and PsycINFO. Inclusion criteria were studies that assessed QoL using standardized tools and examined mortality risk in a non-patient population. Qualitative data synthesis and meta-analyses using a random-effects model were performed.

RESULTS

Of 4184 articles identified, 47 were eligible for inclusion, involving approximately 1,200,000 participants. Studies were highly heterogeneous in terms of QoL measures, population characteristics and data analysis. In total, 43 studies (91.5%) reported that better QoL was associated with lower mortality risk. The results of four meta-analyses indicated that higher health-related QoL (HRQoL) is associated with lower mortality risk, which was consistent for overall HRQoL (HR 0.633, 95% CI: 0.514 to 0.780), physical function (HR 0.987, 95% CI: 0.982 to 0.992), physical component score (OR 0.950, 95% CI: 0.935 to 0.965), and mental component score (OR 0.980, 95% CI: 0.969 to 0.992).

CONCLUSION

These findings provide evidence that better QoL/HRQoL was associated with lower mortality risk. The utility of these measures in predicting mortality risk indicates that they should be considered further as potential screening tools in general clinical practice, beyond the traditional objective measures such as body mass index and the results of laboratory tests.

Fatigue-Related Factors for Community-Dwelling Older Adults with Diabetes: A Theory-Guided Multi-Dimensional Approach Using the Dynamic Biopsychosocial Model

Older adults with diabetes appear more susceptible to fatigue compared to younger adults with diabetes or healthy older adults, since aging and diabetes independently and synergistically influence fatigue. Few studies have investigated fatigue in older adults with diabetes using a multidimensional approach. This study explored the influences of physical, psychological, interpersonal, and contextual factors on diabetes fatigue using a dynamic biopsychosocial model. Face-to-face surveys were administered to community-dwelling older adults with diabetes and included variables across four domains (i.e., physical, psychological, interpersonal, and contextual factors). Univariate analyses and multiple linear regression were used. The mean fatigue score was 3.94 (standard deviation (SD) = 1.81) out of 7, and the prevalence of fatigue was 48.8%. Significant differences in fatigue severity by psychological, interpersonal, and contextual factors were found. Comorbidity and psychological factors were significant predictors of fatigue in the model, explaining 31.9% of the variance. As nearly half the sample experienced moderate or severe fatigue, which was significantly influenced by both comorbidity and psychological factors, including depression, sleep quality, and diet-related psychological characteristics, assessing patients' psychological status may be important. Awareness of fatigue could be incorporated into dietary interventions for older adults with diabetes.

Association between body mass index and mortality in the Korean elderly: A nationwide cohort study

The objective of this study was to investigate the relationship between body mass index (BMI) and mortality in the elderly. This study was a nation-wide population-based retrospective cohort study of the National Health Insurance System-Senior Database (NHIS-SD). In this study, a total of 75,856 subjects were identified and selected from among 251,593 individuals aged ≥ 65 years who underwent health screening at least once between 2009 and 2012 and who had no history of diabetes, cardiovascular disease, stroke, cancer, or chronic obstructive pulmonary disease (COPD). The subjects of this study were followed-up until 2013 to identify the total mortality and the cause-specific mortality of 6 groups divided according to BMI. The hazard ratio (HR) by reference group (23 ≤ BMI < 25 kg/m²) of each group was calculated. A significant increase in the HR with a decreased BMI was observed in the group with a BMI < 23 kg/m², whereas the HR in the group with a BMI ≥ 25 kg/m² was not significantly different than that of the reference group (23 ≤ BMI < 25 kg/m²). This pattern was also seen in the subgroup analyses in relation to age, smoking history, alcohol use, exercise level, and socioeconomic status. In this study, we found that a low BMI was a risk factor for death in the elderly and that no significant difference in mortality was seen in the elderly with a BMI of 25 or over. In terms of an optimal BMI in the elderly, it is important to maintain an appropriately healthy range of BMI with the aim of preventing weight loss.

A non-invasive modifiable Healthy Ageing Nutrition Index (HANI) predicts longevity in free-living older Taiwanese

Nutritional factors contributing to disability and mortality are modifiable in later life. Indices would add utility. We developed a gender-specific Healthy Ageing Nutrition Index (HANI) for all-cause mortality in free-living elderly. We stratified 1898 participants aged ≥65 y from the 1999–2000 Nutrition and Health Survey in Taiwan by region and randomly allocated them into development and validation sets. Linkage to the National Death Registry database until December 31, 2008 enabled mortality prediction using Cox proportional-hazards models. Four factors (appetite, eating with others, dietary diversity score, and BMI) with best total of 25 HANI points for men; and 3 factors (cooking frequency, dietary diversity score, and BMI) with best total of 27 HANI points for women, were developed. In the validation set, the highest HANI group exhibited a greater intake of plant-derived food and associated nutrients, a favourable quality of life, and more muscle mass, compared with the lowest group. The highest HANI group predicts mortality risk lower by 44 percent in men and 61 percent in women. Adjusted mortality HRs were comparable between sets. HANI is a simple, non-invasive, inexpensive, and potentially modifiable tool for nutrition monitoring and survival prediction for older adults, superior to its individual components.

Soy-Based Foods Are Negatively Associated with Cognitive Decline in Taiwan's Elderly

Cognitive impairment is a common neurodegenerative disease in the elderly. Dietary factors have an important role in cognitive dysfunction. Soy has many benefits, and consumption of soy-based foods is general in East Asian countries. In this study, we want to investigate the association between cognitive function decline and soy-based food intake among the elderly in Taiwan. This cross-sectional study was based on data obtained from the 2005-2008 Nutrition and Health Survey in Taiwan (NAHSIT). Subjects aged less than 65 y or with missing data were excluded. There was a total of 1,105 participants aged 65 and over who completed Short Portable Mental Status Questionnaire (SPMSQ). Eighty-five-point-six percent of participants consumed soy-based foods every day. After adjustment for potential variables, the logistic regression model showed significant associations for age, gender, education, soy-based foods intake and physical component summary (PCS). Age and female gender were both positively correlated with cognitive impairment (odds ratios: 1.1 and 4.43, respectively). Furthermore, there were negative correlations for education, soy-based foods intake and PCS (odds ratios: 0.25, 0.45 and 0.97, respectively). In this study, we found that soy-based foods were negatively associated with cognitive function decline among Taiwanese elderly. This result may be used as a reference for dietary advice for the elderly.

Gender differences in longevity in free-living older adults who eat-with-others: a prospective study in Taiwan

OBJECTIVES

Social activities such as 'eating-with-others' can positively affect the ageing process. We investigated the gender-specific association between eating arrangements and risk of all-cause mortality among free-living older adults.

SETTING

A representative sample from the Elderly Nutrition and Health Survey in Taiwan during 1999-2000.

PARTICIPANTS

Some 1894 participants (955 men and 939 women) who aged ≥65 and completed eating arrangement question as well as confirmed survivorship information.

PRIMARY AND SECONDARY OUTCOME MEASURES

Eating arrangements, health condition and 24-hour dietary recall information were collected at baseline. We classified eating arrangements as the daily frequency of eating-with-others (0-3). Survivorship was determined by the National Death Registry until the end of 2008. Cox proportional-hazards regression was used to assess the association between eating-with-others and mortality risk.

RESULTS

Overall, 63.1% of men and 56.4% of women ate with others three times a day. Both men and women who ate with others were more likely to have higher meat and vegetable intakes and greater dietary quality than those who ate alone. The HRs (95% CI) for all-cause mortality when eating-with-others two and three times per day were 0.42 (0.28 to 0.61), 0.67 (0.52 to 0.88) in men and 0.68 (0.42 to 1.11), 0.86 (0.64 to 1.16) in women, compared with those who ate alone. Multivariable HRs (95% CI) adjusted for sociodemographic, nutritional and 'activities of daily living' covariates were 0.43 (0.25 to 0.73), 0.63 (0.41 to 0.98) in men and 0.68 (0.35 to 1.30), 0.69 (0.39 to 1.21) in women. With further adjustment for financial status, HR was reduced by 54% in men who ate with others two times a day. Pathway analysis shows this to be dependent on improved dietary quality by eating-with-others.

CONCLUSIONS

Eating-with-others is an independent survival factor in older men. Providing a social environment which encourages eating-with-others may benefit survival of older people, especially for men.

Optimal Dietary and Plasma Magnesium Statuses Depend on Dietary Quality for a Reduction in the Risk of All-Cause Mortality in Older Adults

The association between dietary or plasma magnesium (Mg) with diabetes incidence and with mortality in free-living elderly was investigated. A total of 1400 participants from the Taiwanese Nutrition Survey, aged ≥ 65 years, and diabetes-free from the 1999–2000 were assessed. The dietary intake and plasma Mg concentration were obtained through 24h dietary recall and health examination at baseline. Participants were classified by quartiles (Q) of dietary Mg or by the plasma Mg normal range (0.75–0.95 mmol/L). Dietary diversity score (DDS, range 1–6) represented the dietary quality. During 8 and 10 years, 231 incident diabetes cases and 475 deaths were identified. Cox’s proportional-hazards regression was used to evaluate the association between Mg and health outcomes. The hazard ratios (95% confidence interval) for death in Q2 and Q3 of Mg intakes with DDS > 4 were 0.57 (0.44–0.74) and 0.59 (0.39–0.88), respectively, compared with the lowest intake and DDS ≤ 4 participants. Participants with normal and high plasma Mg in conjunction with high DDS had relative risks of 0.58 (0.37–0.89) and 0.46 (0.25–0.85) in mortality compared with low plasma Mg and lower DDS. Optimal dietary Mg intake and plasma Mg depend on dietary quality to reduce the mortality risk in older adults.

Sarcopenia: a predictor of mortality and the need for early diagnosis and intervention

The term sarcopenia refers to the loss of muscle mass that occurs with aging. Sarcopenia is defined by the European Working Group on Sarcopenia in Older People (EWGSOP) as low muscle mass and low muscle function (strength and performance). Its prevalence varies depending on the definition used for it, but estimates propose a loss of approximately 8 % per decade until the age of 70 years; afterwards, the loss increases and ranges from 13 to 24 % per decade. Irrespective of how sarcopenia is defined, both low muscle mass and poor muscle strength are highly prevalent and important risk factors for disability and increased mortality in individuals as they age. In this review, we address age-related muscle loss and the risk factors of mortality, emphasizing the need for early diagnosis and intervention.

Sleep quality in the survival of elderly taiwanese: roles for dietary diversity and pyridoxine in men and women

OBJECTIVES

The purpose of this study was to investigate dietary contributors to relationships between sleep and all-cause mortality among elderly men and women using a prospective cohort study.

SETTING

The representative Nutrition and Health Survey in Taiwan (NAHSIT) for elders during 1999-2000.

SUBJECTS

One thousand eight hundred sixty-five individuals aged ≥ 65 years from NAHSIT (942 men and 923 women).

MEASURES OF OUTCOME

Dietary diversity scores (DDS) were from 24-hour dietary recalls. Participants were examined and fasting blood was taken. Sleep quality was assessed by questionnaire and classified as poor, fair, or good. Death registry linkage was made until December 31, 2008.

RESULTS

For women, poor sleepers had significantly lower vegetable and vitamin B-6 intakes compared to good sleepers (p < 0.05). For men, good and fair sleepers had a lower risk of death compared to poor sleepers after adjustment with hazards ratios (HRs) and 95% confidence intervals (CIs) of 0.60 (0.42-0.87) and 0.55 (0.36-0.86). The joint HRs for "DDS > 4 and good sleep" were 0.38 (0.22-0.66) for men and 0.52 (0.30-0.88) for women compared to "DDS ≤ 4 and poor sleep." The joint HRs for "plasma pyridoxal phosphate (PLP) adequate and fair sleep" were 0.27 (0.11-0.65) and 0.49 (0.23-1.07) compared to "insufficient and poor sleep" for men and women; for women, PLP adequacy provided significantly reduced HRs for good and poor sleep.

CONCLUSIONS

Sleep quality played a more important role in mortality for men than for women. Sufficient dietary diversity in men could offset the adverse effect on mortality of poor sleep. In women, PLP predicts mortality more than sleep does.

Appetite predicts mortality in free-living older adults in association with dietary diversity. A NAHSIT cohort study

This study aimed to assess the predictive ability of appetite for mortality among representative free-living Taiwanese older adults. A total of 1856 participants aged 65 years or over from the Elderly Nutrition and Health Survey during 1999-2000 completed an appetite question in a larger questionnaire. Personal information was obtained by face-to-face interview at baseline, together with a 24-hour dietary recall and simplified food frequency questionnaire which provided a dietary diversity score and food intake frequency. Survivorship was ascertained from the Death Registry until December 31, 2008. Participants with a poor appetite had lower dietary diversity scores (DDS) and intake frequencies of meat, fish and sea food, egg, vegetable and fruit intake, along with lower energy, protein, vitamin B-1, niacin, iron and phosphate intakes. Those who had fair and poor appetites had a higher risk of all-cause mortality compared to those with good appetite, with hazard ratios (HR) (95% confidence interval, CI) of 1.28 (1.03-1.58) and 2.27 (1.71-3.02), respectively. After adjustment for confounders, the HRs (95% CI) were 1.05 (0.83-1.33) and 1.50 (1.03-2.18), respectively. With further adjustment for DDS or general health these HRs became non-significant. The joint HR (95% CI) for "DDS ≤ 4 and poor appetite" was 1.77 (1.04-3.00) compared to "DDS > 4 and good appetite" as referent. Poor appetite is associated with lower food and nutrient intakes and an independent risk for mortality in older Taiwanese. In conclusion, appetite is separate, mediated by general health and modulated by dietary quality in its predictive capacity for mortality.

Optimal dairy intake is predicated on total, cardiovascular, and stroke mortalities in a Taiwanese cohort

OBJECTIVE

Dairy foods help achieve essential nutrient adequacy. This role may be conflicted where so-called chronic diseases prevail. We have examined associations between dairy intake and mortality where dairy foods have not been traditional.

METHODS

A representative Taiwanese cohort of 3810 subjects, aged 19-64 years, derived from the Nutrition and Health Survey in Taiwan (NAHSIT, 1993-1996) was linked to death registration (1993-2008). Participants were categorized by 4 dairy weekly intake frequencies from 0 to >7 times. Mortality hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional-hazards models.

RESULTS

Nonconsumers of dairy products included 30.7% of the men and 22.1% of the women. Adverse sociodemographic and personal behaviors were generally significantly associated with lower dairy consumption. After adjustment for covariates, together with body mass index (BMI) and supplement use, those with 3-7 times/week intakes had an HR (95% CI) for all-cause mortality of 0.61 (0.39-0.96) with a significant dose-response trend (p = 0.043). Similarly, the HR for cardiovascular disease (CVD) mortality with dairy weekly intake frequency >7 was 0.14 (0.02-0.97) with a significant linear trend (p = 0.007). For stroke, the corresponding HR (95% CI) was 0.03 (0.00-0.28) with a linear trend. By age and with adjustment for dietary quality, food, and calcium or vitamin D intake, significance and dose-response relationships remained. Dairy intake and cancer mortality were not associated.

CONCLUSION

In a Chinese food culture, a dairy foods intake in adults up to 7 times a week does not increase mortality and may have favorable effects on stroke.

Cardiometabolic risk in overweight subjects with or without relative fat-free mass deficiency: the Strong Heart Study

BACKGROUND AND AIM

Sarcopenia is a condition mainly due to loss of fat-free mass (FFM) in elderly individuals. RFFMD, however, is also frequent in obese subjects due to abnormal body composition. Objective of this study was to evaluate the impact of relative fat-free mass deficiency (RFFMD) on cardiometabolic (CM) risk in obese normoglycemic individuals.

METHODS AND RESULTS

Overweight/obese American Indians from the Strong Heart Study population, without diabetes and with FBG ≤ 110 mg/dL and with GFR >60 mg/mL/1.73 m(2) were selected for this analysis (n = 742). RFFMD was defined on the basis of a multivariable equation previously reported. Fasting glucose and 2 h-OGTT were measured together with urine albumin/creatinine excretion, laboratory and anthropometric parameters. In addition to lower FFM and greater adipose mass, participants with RFFMD had higher body mass index, waist circumference, C-reactive protein, fibrinogen, insulin resistance and urinary albumin/creatinine than participants with normal FFM (all p < 0.001); they also had a greater prevalence of hypertension, impaired glucose tolerance (IGT) or OGTT-diabetes than participants with normal FFM (all p < 0.003) and a near 2-fold greater probability of significant proteinuria (p < 0.01). RFFMD was more frequent in women than in men: significant sex-RFFMD interactions were found for BMI and waist circumference (both p < 0.0001).

CONCLUSIONS

RFFMD in overweight/obese normoglycemic individuals is associated with greater probability of hypertension, abnormalities of glucose tolerance and proteinuria. Assessment of RFFRMD might, therefore, help stratifying cardiometabolic risk among normoglycemic individuals with overweight/obesity.