The bidirectional association between body weight and mobility disability: A population-based cohort

Health-related factors leading to disabilities in Korea: Survival analysis

The purpose of this study is to analyze (a) population and socioeconomic factors affecting disability, excluding the occurrence of disability due to accidents and congenital diseases, and (b) health-related behavioral factors and factors that can prevent and reduce the cause of disability due to disease in Korea. This study was a longitudinal research. Data were obtained from The 2018 Korean Health Panel (KHP) is a survey jointly conducted by the Korea Institute of Health and Social Affairs and the National Health Insurance Service. A total of 7, 372 (Mage = 52.14, SD = 21.39; Male = 47.52%) were analyzed in this study. People with Higher education attainments and more income levels were associated with lower hazard of developing new disabilities (all p < 0.05). In this study, the health factors that could be related to the occurrence of new disabilities were smoking, alcohol consumption, physical activity, and stress (all p < 0.0001). However, physical activity was negatively associated with the risk of developing a disability at all follow-ups (p < 0.05). Higher scores on the number of chronic diseases (valid scores = 0, 1, 2, 3, or more) represented a greater level of newly developing disability present at all follow-ups (all p < 0.0001). This longitudinal study confirmed the relationship between health-related factors and specific chronic diseases. Its findings can be used as a crucial foundation for establishing healthcare policies and services that can lower and prevent disability by preventing and reducing specific negative health behaviors and unhealthy behavioral factors, and alleviating chronic diseases in Korea.

Combined effect of obesity and low physical performance on the incidence of hypertension in Chinese community-dwelling older population

The combination of having a low physical performance and obesity results in a vicious cycle, but the effect of this combination on the incidence of hypertension is still unknown. This article aims to examine the effect of obesity and low physical performance on the incidence of hypertension in older adults. The sample was comprised of 349 Chinese community-dwelling participants (199 women; mean age 66.30 ± 5.78 years) without hypertension at baseline. Obesity was defined as having a body mass index (BMI) greater than or equal to 28 kg/m². Participants scoring in the top 20% on the Timed Up and Go Test (TUGT) or in the slowest 20% of the 4-m walking test were defined as having a low physical performance. The outcome was new onset hypertension at the 1-year follow-up. We found that 89 (25.5%) of the 349 participants without hypertension at baseline had developed hypertension at their 1-year follow-up. After multivariate adjustments, it was found that the incidence of hypertension was associated with the combination of obesity and having a low physical performance (OR = 7.30, 95% CI = 1.36-39.11), but not solely with obesity (OR = 1.40, 95% CI = 0.68-2.88) or solely with low physical performance (OR = 0.98, 95% CI = 0.29-3.27). Hence, although obesity and low physical performance did not independently affect the incidence of hypertension after one year, the combination of the two can significantly increase the incidence of hypertension in Chinese community-dwelling older adults.

Differences in Dietary Habits, Physical Exercise, and Quality of Life between Male and Female Patients with Overweight

Overweight can be an additional problem in patients admitted to hospital. Objective: To analyze gender differences in pre-admission dietary habits and physical exercise and in HRQoL at hospital discharge among hospitalized adults with overweight. Methods: Cross-sectional study in non-diabetic patients enrolled in a clinical trial with body mass index (BMI) ≥ 25 Kg/m² at admission. Bivariate analyses used Pearson’s chi-square test and Fisher’s exact test for qualitative variables and the Mann–Whitney test for numerical variables. Results: The study included 148 males and 127 females. At admission, women had higher BMI (p = 0.016) than men and a larger percentage consumed drugs for depression (p = 0.030) and anxiety (p = 0.049), and followed a religion-based diet (p = 0.022). Pre-admission, women had healthier habits related to dietary caloric intake (p = 0.009) and greater adherence to recommendations for a healthy diet (p = 0.001). At discharge, women described worse self-perceived health (p = 0.044) and greater pain/discomfort (p = 0.004) in comparison to men. Conclusions: Pre-admission, women had better habits related to a healthy diet and did not differ from men in habits related to physical exercise but had a higher BMI. At discharge, women reported worse self-perceived health and greater pain/discomfort. These differences should be considered for the adequate clinical management of patients with overweight.

Latent class growth modelling for the evaluation of intervention outcomes: example from a physical activity intervention

Intervention studies often assume that changes in an outcome are homogenous across the population, however this assumption might not always hold. This article describes how latent class growth modelling (LCGM) can be performed in intervention studies, using an empirical example, and discusses the challenges and potential implications of this method. The analysis included 110 young adults with mobility disability that had participated in a parallel randomized controlled trial and received either a mobile app program (n = 55) or a supervised health program (n = 55) for 12 weeks. The primary outcome was accelerometer measured moderate to vigorous physical activity (MVPA) levels in min/day assessed at baseline, 6 weeks, 12 weeks, and 1-year post intervention. The mean change of MVPA from baseline to 1-year was estimated using paired t-test. LCGM was performed to determine the trajectories of MVPA. Logistic regression models were used to identify potential predictors of trajectories. There was no significant difference between baseline and 1-year MVPA levels (4.8 min/day, 95% CI: -1.4, 10.9). Four MVPA trajectories, 'Normal/Decrease', 'Normal/Increase', 'Normal/Rapid increase', and 'High/Increase', were identified through LCGM. Individuals with younger age and higher baseline MVPA were more likely to have increasing trajectories of MVPA. LCGM uncovered hidden trajectories of physical activity that were not represented by the average pattern. This approach could provide significant insights when included in intervention studies. For higher accuracy it is recommended to include larger sample sizes.

Differences in Dietary Habits, Physical Exercise, and Quality of Life between Patients with Obesity and Overweight

BACKGROUND

Overweight and obesity differ in their repercussions on the health and health-related quality of life (HRQoL) of patients. The objective of this study was to compare physical activity levels and dietary habits before admission and HRQoL at discharge between patients with obesity and overweight.

METHODS

A cross-sectional study was undertaken among participants in a clinical trial on education for healthy eating and physical activity, enrolling non-diabetic patients admitted to Internal Medicine Departments. These were classified by body mass index (BMI) as having overweight (25-29.9 Kg/m²) or obesity (≥30 kg/m²). Data were gathered on sociodemographic characteristics, clinical variables (medication for anxiety/depression, Charlson Comorbidity Index, length of hospital stay), physical exercise and diet (International Physical Activity and Pardo Questionnaires), and HRQoL (EQ-5D-5L). The study included 98 patients with overweight (58.2% males) and 177 with obesity (52% males).

RESULTS

In comparison to patients with obesity, those with overweight obtained better results for regular physical exercise (p = 0.007), healthy diet (p = 0.004), and "emotional eating" (p = 0.017). No between-group difference was found in HqoL scores.

CONCLUSION

Patients with overweight and obesity differ in healthy dietary and physical exercise behaviors. Greater efforts are warranted to prevent an increase in the BMI of patients, paying special attention to their state of mind.

Impact of sofosbuvir and daclastavir on health-related quality of life in patients co-infected with hepatitis C and human immunodeficiency virus

BACKGROUND

We conducted a real-life study of health-related quality of life (HRQoL) transformation before and 12 weeks after sofosbuvir and daclatasvir therapy in HCV/HIV co-infected patients. Factors related to the significant changes of each HRQoL domain/item were also evaluated.

METHODS

A prospective study was performed in the HIV integrated clinic at Cipto Mangunkusumo Hospital, Jakarta. HCV/HIV co-infected patients who started sofosbuvir and daclatasvir from government free DAA program in 2017-2019. WHOQoL-HIV BREF and RAND SF-36 questionnaires were recorded at baseline and post-treatment week 12.

RESULTS

145 patients with mean age of 37.8 years (SD = 4.2) were included in the analysis. Most of patients were male (89%), previous IVDU (89%), active smoker (50.4%) and non-cirrhosis (80%). SVR12 was achieved in 95.5% of patients. Sofosbuvir and daclatasvir treatments showed positive impacts on 2 domains and 2 other items of WHOQoL-HIV BREF and 2 domains and 1 item of SF-36. Predicting factors of significant increase in each domain/item were: male and normal body mass index (BMI) for level of independence (RR 4.01,95% CI 1.09-14.74 and 4.80,95% CI 1.79-12.81); higher HCV-RNA for overall perception of QoL (RR 0.42,95% CI 0.18-0.94); non-smoking status for overall perception of health (RR 0.32,95% CI 0.15-0.66); male and fibrosis stage 0-1 for general health (RR 6.21,95% CI 1.69-22.88 and 2.86,95% CI 1.16-7.00); and the use of NNRTI-based ART (RR 5.23, 95% CI 1.16-23.65). Spiritual/personal belief decline was predicted by non-smoking status (RR 0.46, 95% CI 0.23-0.95). Treatment success was not associated with any changes of HR-QoL domain/item.

CONCLUSIONS

HCV/HIV co-infected patients were successfully treated with sofosbuvir and daclatasvir and experienced improvement of HRQoL 12 weeks after treatment completion.

Weight Gain After 20 Years of Age is Associated with Unfavorable Lifestyle and Increased Prevalence of Metabolic Disorders

PURPOSE

It is unclear what kind of modifiable lifestyle factors are associated with long-time weight gain in adulthood. To clarify the lifestyle behavior related to body weight gain since the age of 20 years, we explored the lifestyle risk factor, independently associated with excessive weight gain after 20 years of age as compared to those in subjects with a stable weight, with matching of age, gender, and the current body mass index (BMI).

PATIENTS AND METHODS

From baseline data of a general population-based cohort study, we designed a cross-sectional analysis collecting individual data of medical health check-ups and a questionnaire related to lifestyle, including amount of sleep, frequency of eating breakfast, average times per day engaged in walking and sitting in the prior year, and smoking habits. These data were compared between the subjects with weight gain ≥10kg (n=3601) and <10kg (n=3601) after age 20, matched by a propensity score model which included current BMI, age and gender. We used multivariable logistic regressions to assess the lifestyle factor's association with high weight gain.

RESULTS

Participants who gained ≥10 kg were significantly more likely to sleep <5 hours or ≥9 hours per night, skip breakfast, engage in walking <1 hour per day, and sit ≥5 hours per day than those who gained <10kg. Multivariable logistic regressions analyses showed that, with adjusting for potential confounder, the lifestyles with the positive association with high weight gain were skipping breakfast (OR 1.252; 95% CI 1.053-1.489, vs regularly), long sleeping duration (9 hours/day≤ OR 1.613; 95% CI 1.018-2.557 vs 5≤-<7 hours/day), and former smoker (OR 1.163; 95% CI 1.008-1.343 vs never smoker), while walking duration was negatively associated with high weight gain. Furthermore, despite similar current BMI, participants with weight gain ≥10kg had significantly higher values for waist circumference, blood pressure, HbA1c, LDL-C, triglycerides, and hepatic enzyme levels than those with weight gain <10kg. Similarly, the prevalence rates of hypertension, dyslipidemia, metabolic syndrome (MetS), and former smoker were higher in the participants with weight gain ≥10kg.

CONCLUSION

Major weight gain after 20 years of age was associated with unfavorable lifestyle factors and greater waist circumference, possibly leading to elevated risk for MetS and other non-communicable diseases. These findings highlight the importance of maintaining both weight at age 20 and a favorable lifestyle throughout adulthood.

Association of changes in cardiorespiratory fitness with health-related quality of life in young adults with mobility disability: secondary analysis of a randomized controlled trial of mobile app versus supervised training

Background

Young adults with mobility disability report lower health-related quality of life (HRQoL) than their able-bodied peers. This study aims to examine potential differences between the effects of mobile app versus supervised training and the association of cardiorespiratory fitness change with HRQoL in young adults with mobility disability.

Methods

This is a secondary analysis of a parallel randomized controlled trial of a mobile app (n = 55) and a supervised health program (n = 55) that was provided for 12 weeks to 110 adults (18–45 years) with self-perceived mobility disability. Recruitment took place at rehabilitation centers in Stockholm, Sweden. Cardiorespiratory fitness was estimated from the results of a submaximal cycle ergometer test and HRQoL was assessed with the SF-36 questionnaire. Follow up was at 6 weeks, 12 weeks, and 1-year and all examinations were performed by blinded investigators. Between group differences of changes in HRQoL at follow up were estimated in intention-to-treat analysis using linear regression models. Crude and adjusted mixed-effects models estimated the associations between cardiorespiratory fitness change and HRQoL. Stratified analysis by intervention group was also performed.

Results

In total, 40/55 from the mobile app group and 49/55 from the supervised training group were included in the intention to treat analysis. No significant differences were observed between the effects of the two interventions on HRQoL. In both crude and adjusted models, cardiorespiratory fitness change was associated with the general health (adjusted β = 1.30, 95% CI: 0.48, 2.13) and emotional role functioning (adjusted β = 1.18, 95% CI: 0.11, 2.25) domains of SF-36. After stratification, the associations with general health (adjusted β = 1.88, 95% CI: 0.87, 2.90) and emotional role functioning (adjusted β = 1.37, 95% CI: 0.18, 2.57) were present only in the supervised group.

Conclusion

This study found positive associations between cardiorespiratory fitness change and HRQoL in young adults with mobility disability who received supervised training. The effects of mobile app versus supervised training on HRQoL remain unclear.

Trial registration

International Standard Randomized Controlled Trial Number (ISRCTN) registryISRCTN22387524; Prospectively registered on February 4th, 2018.

Disability assessment in an Italian cohort of patients with obesity using an International Classification of Functioning, Disability and Health (ICF)-derived questionnaire

BACKGROUND

Obesity is a clinical condition that contributes to the development of related disability in different areas (physical, psychological and social). Multidisciplinary treatment calls for specific instruments able to evaluate all related functional problems. We have developed a tool (an ICF-based assessment instrument, the ICF-OB schedule) to evaluate obesity-related disability, composed of an inventory of 71-items from the WHO International Classification of Functioning, Disability and Health (ICF).

AIM

The aim of the present study was to validate this new tool for the definition of obesity-related disability. We also sought to examine the relationship between obesity disability, an index of multimorbidity (Cumulative Illness Rating Scale [CIRS]) and a well-validated score of perceived obesity-related disability (Italian Obesity Society Test for Obesity-Related Disability [TSD-OC]).

DESIGN

Process validation of the ICF-OB schedule.

SETTING

Baseline conditions of out- and in-patients.

POPULATION

A large cohort of obese patients recruited from 9 multidisciplinary centers belonging to the Italian Obesity Society (SIO) network, which provide specialized obesity care.

METHODS

A total of 353 patients (F: 70%, age: 50.2±12.7yrs, BMI: 41.4±8.3kg/m²) were enrolled between January 2017 and June 2018. The ICF-OB was used to define patients' functioning and disability profiles in order to set and appraise rehabilitation goals.

RESULTS

We described the distribution of body functions (BF), body structures (BS) and activities and participations (A&P) categories and the agreement rates were significant for the majority of these. The ICF-OB was more often significantly associated, and with stronger coefficients, with patients' comorbidities as described by the CIRS rather than with Body Mass Index (BMI). The TSD-OC also presented a strong association with A&P indexes.

CONCLUSIONS

The complexity of clinical condition, that generates disability in obesity might be well identified with the use of this new instrument that appear significant related to the perceived disability for each patients and also with their multimorbidity.

CLINICAL REHABILITATION IMPACT

The ICF-OB shows great promise as a tool for goal setting in the rehabilitation of obese patients.

The Effect of Smartphone Apps Versus Supervised Exercise on Physical Activity, Cardiorespiratory Fitness, and Body Composition Among Individuals With Mild-to-Moderate Mobility Disability: Randomized Controlled Trial

Background

Adequate levels of physical activity (PA) and good cardiorespiratory fitness (CRF) are associated with profound health benefits for individuals with mobility disability (MD). Despite the vast amount of research published in the field of PA interventions, little attention has been given to individuals with MD.

Objective

The aim of this study was to examine the efficacy of an app-based versus a supervised exercise and health coaching program to support adults with MD to increase levels of PA, CRF, and improve body composition.

Methods

Participants with self-perceived MD, aged 18 to 45 years, were included in this 12-week parallel-group randomized controlled trial and allocated at random to an app-based intervention, using commercially available apps—the Swedish Military training app (FMTK), the Acupedo walking app, and the LogMyFood food photography app—or a supervised exercise and health coaching intervention, including 1 weekly supervised exercise session and healthy lifestyle coaching. The primary outcome was the level of moderate-to-vigorous PA (MVPA) measured with accelerometers. Secondary outcomes included CRF measured by a submaximal test performed on a stationary bicycle and body composition measured by bioelectrical impedance. All outcomes were measured at baseline, 6 weeks, and 12 weeks. Linear mixed-effect models were used to assess the between-group differences, as well as the within-group changes through time, in each intervention group.

Results

A total of 110 participants with MD were randomized to an app-based intervention (n=55) or a supervised exercise and health intervention (n=55). The mean age of participants was 34.9 years (SD 6.1), and 81.8% (90/110) of the participants were women. CRF showed a moderate increase in both groups after 12 weeks—1.07 (95% CI –0.14 to 2.27) mL/kg/min increase in the app-based group and 1.76 (95% CI 0.70 to 2.83) mLkg/min increase in the supervised exercise group. However, the intention-to-treat analysis showed no significant differences between the groups in MVPA or CRF after 12 weeks. Waist circumference was significantly lower in the app-based intervention group.

Conclusions

Commercially available apps increased levels of CRF and improved body composition over 12 weeks to the same extent as supervised exercise sessions, showing that both are equally effective. However, neither the app-based intervention nor the supervised exercise intervention increased MVPA.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 22387524; http://isrctn.com/ISRCTN22387524.

Influence of excess weight on lower-extremity vertical stiffness and metabolic cost of walking

The purpose was to test whether lower-extremity vertical stiffness and gait mechanics explain differences in energy cost of walking (Cw) between individuals with normal weight (NW) and obesity (OB). Ten OB (33.1 ± 2.0 kg m^-2) and 10 NW (24.2 ± 1.3 kg m^-2) walked for six minutes on an instrumented treadmill at 1.25 m s^-1 while Cw, lower-extremity kinematics, and vertical stiffness (K _vert) were measured. NW completed another trial with a loaded vest (NWL) to simulate the BMI of the obese group. Cw was 24% greater in OB (277.5 ± 45.3 J m^-1) and 23% greater in NWL (272.7 ± 35.7 J m^-1) than NW (211.0 ± 27.0 J m^-1, P < 0.005). Mass-specific Cw (Cw_kg) wasn't different between conditions (P = 0.085). Lower-extremity K _vert was 40% higher in OB (32.7 ± 5.2 kN m^-1) than NW (23.3 ± 4.7 kN m^-1, P < 0.001), but neither was different from NWL (27.5 ± 3.4 kN m^-1, P > 0.05). Mass-specific K _vert (P = 0.081) was similar across conditions. K _vert was related to Cw (r = 0.55, P = 0.001). Cw_kg wasn't different between NW or OB, but there was a negative correlation between BMI and Cw_kg driven by lower Cw_kg in NWL. Cw and K _vert covaried in proportion to body mass, but mass-specific K _vert was unrelated to Cw_kg. Mass-specific K _vert was lower in NWL than OB due to NWL's greater angle of attack, center of mass displacement, and joint range of motion.

The association of mobility disability and obesity with risk of unemployment in two cohorts from Sweden

Background

People with mobility disability (MD) or obesity often have more health problems and are less able to participate in work than individuals without these conditions. This study investigated whether people burdened with MD and obesity have a greater risk of unemployment than people with either one (MD only or obesity only) or none of these conditions.

Methods

The study included two Swedish population-based cohorts, a national cohort (n = 39,947) and a regional cohort (n = 40,088). Six exposure groups were created using baseline self-reported data on MD and body mass index from participants aged 19 to 64 years. The MD definition differed between the cohorts. Various sources of socio-demographic factors were used to address confounding. Participants’ risks of unemployment were assessed longitudinally in a nationwide register with objective data and with almost no loss of follow-up (< 1%). Cox regression was used to analyse associations of MD and/or obesity (BMI ≥ 30) with risk of any (≥1 day) and long-term unemployment (≥90 days during two consecutive years). Quantile regression was used to estimate participants’ unemployment risks as average days of unemployment. Normal-weight people without MD were used as a reference group. The Wald test was applied for specific group comparisons other than to the reference group.

Results

In summary, the groups with MD and the obese group without MD had a higher risk of becoming unemployed than the reference group (regional survey adjusted hazard ratio range: 1.30–1.59; 95% CI range: 1.06–1.90, national survey adjusted hazard ratio range: 1.11–1.34; 95% CI range: 0.88–1.81). The obese group with MD did not differ from the groups with MD only or obesity only in terms of unemployment risk.

Conclusions

People with MD and/or obesity are vulnerable groups at risk of prolonged unemployment during their working life in a country with a highly developed welfare system.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6627-2) contains supplementary material, which is available to authorized users.

Effects of upper-body resistance exercise training on serum nesfatin-1 level, insulin resistance, and body composition in obese paraplegic men

BACKGROUND

As a recently discovered adipokine, nesfatin-1 is conducive to insulin sensitivity, lipid profile, energy balance, and probably obesity.

OBJECTIVE

The aim of the present study was to investigate the effect of upper-body resistance exercise training (RET) on nesfatin-1 levels, insulin resistance, lipid profile, and body composition in obese paraplegic men.

METHODS

Twenty obese paraplegic men were randomly assigned into control and upper-body RET groups. Upper-body RET was performed for 8 weeks, 3 sessions per week at an intensity corresponding to 60-80% maximum amount of force that can be generated in one maximal contraction in 5 stations (bench press, seated rows, sitting lat pulldown, arm extension, and arm curls). Body fat percentage was determined according to 4-sites skinfold protocol of Durnin and Womersley and Siri equation. Obesity for spinal cord injury patients in the current study was set at BMI >22 kg/m². Data were statistically analyzed by paired and independent t-test (P < 0.05).

RESULTS

We found significant improvements in serum levels of nesfatin-1 (21.13%), insulin sensitivity (8.95%), and high-density lipoprotein (10.87%). Other lipid profile markers, i.e. low-density lipoprotein (4.32%), cholesterol (8.20%), and triglyceride (15.10%) reduced significantly after upper-body RET. Moreover, upper-body RET led to a significant reduction in body mass index (2.36%), body fat percentage (2.79%), and waist-to-hip ratio (2.40%).

CONCLUSION

Upper-body RET improved insulin sensitivity, lipid profile, and body composition in paraplegic men. Serum nefastin-1 may be a potential marker of success in weight management in this population.

Is Obesity More Than a Double Burden among People with Mobility Disability? The Effect of Obesity on HRQoL and Participation in Society

Obesity is more common in individuals with mobility disability than in those without this condition. Individuals with mobility disability also have lower health-related quality of life (HRQoL) and are limited in their participation in society. Therefore, this study aimed to investigate the body mass index (BMI) status and the association of overweight or obesity on HRQoL and participation in society among those with mobility disability in comparison to those without mobility disability. This cross-sectional study was based on a health survey conducted in Sweden in 2012 (n = 18,322; age, 18–64 years). Logistic regression with and without interaction analysis was applied. Effect modification by overweight status was significant for, moderate pain. For obesity, effect modification was seen for low general health, pain (moderate and severe), and not participating in work. BMI was higher among those with mobility disability, but no associations between overweight or obesity and HRQoL or participation in society were observed for those with mobility disability. Overweight and obesity did not add an additional burden to mobility disability, probably because mobility disability is associated with low HRQoL and low participation in society. Despite these results, population obesity prevention strategies are still needed.

The association of mobility disability and weight status with risk of disability pension: A prospective cohort study

BACKGROUND/AIMS

Mobility disability (MD) and obesity are conditions which have been associated with weaker labour market attachment. This study investigates whether the combined burden of MD and obesity increase the risk of disability pension compared with having only one of these conditions (the reference group).

METHODS

A nationwide cohort study, based on national surveys made between 1996 and 2011, was conducted including 50,015 individuals aged 19-64 years who were followed-up in a large database in terms of attainment of disability pension until 31 December 2012 (at the latest). Proportional hazards regression models were used to analyse the risk of all-cause and diagnosis-specific disability pension with six exposure groups, established by mobility and weight status (BMI) obtained through self-reports.

RESULTS

A total of 2296 participants had received disability pension after a mean follow-up period of 7.2 years (SD 4.6). People with MD, regardless of weight, had 4-8 times higher risk of disability pension (for any reason) compared with the reference group (individuals with normal weight and no MD).

CONCLUSIONS

No evidence of a double burden of MD and obesity with disability pension was observed in this study. MD seemed to contribute more to the risk of disability pension than weight status. In a long-term perspective, society and also people at risk of these disabling conditions would benefit from reallocation of resources from disability pensions to health-promoting and preventive policies, not least targeting MD.

Combined Effect of Obesity and Mobility Limitation with Incidence of Type 2 Diabetes and Mortality in Chinese Elderly

This article aims to examine the effect of mobility limitation and obesity on the risk of new incidence of type 2 diabetes mellitus (T2DM) and mortality. The design was a cohort study (n = 1075) among adults aged 60 years and older. Obesity was defined as body-mass index greater than or equal to 28 kg/m². Mobility limitation was defined as participants scoring in the top 20% on the timed up and go test or in the slowest 20% for the 4-m walking test. The mean age of the study population was 67.4 ± 5.4 years (age range: 60-86 years), and 57.4% were women. Overall, 5.1% of women and 1.9% of men had both obesity and mobility limitations. During 3-year follow-up, the new incidence of T2DM was 2.98% and the adjusted risk of the new incidence of T2DM was progressively greater in obese subjects without mobility limitation, but not greater in the single mobility limitation subjects. The combination of mobility limitation and obesity (odds ratio = 10.3, 95% confidence interval = 2.25-70.13) has a significantly higher risk than obesity only or mobility limitation only. What is more, obesity with mobility limitation could be an independent predictor of 3-year mortality compared with the other subjects. We demonstrated the associations between obesity and mobility limitation and thus the increased risk of developing, with the combination over time, T2DM and mortality.