Obesity in the elderly

Anti-obesity and immunomodulatory effects of oil and fermented extract dried from Tenebrio molitor larvae on aged obese mice

Preventing disease and maintaining the health of the elderly are crucial goals for an aging population, with obesity and immune function restoration being of paramount importance. Obesity, particularly visceral obesity characterized by excessive fat accumulation around the abdominal organs, is linked to chronic conditions such as diabetes, hypertension, cardiovascular diseases, and immune dysfunction. Globally, obesity is considered a disease, prompting significant research interest in its treatment. Therefore, it is essential to explore potential therapeutic and preventive strategies to address obesity and the decline in immune function brought about by aging. Tenebrio molitor larvae (TML), commonly known as 'mealworms,' are rich in unsaturated fatty acids, including oleic and linoleic acids, and essential amino acids, such as isoleucine and tyrosine. In this study, we aimed to investigate the effects of the consumption of TML oil and mealworm fermented extract (MWF-1) on obesity and immunological changes in aged obese mice. Our data showed reduced body fat in 23-week-old C57BL/6 mice fed processed TML products for 6 weeks. Additionally, the characteristically high levels of serum triglycerides decreased by treating with TML oil. The immune responsiveness results confirmed an increase in B cells by treating with MWF-1, while cytokine levels (interferon-gamma, tumor necrosis factor-alpha, interleukin-2, and -6) were restored to levels similar to young mice. These results suggest that TML oil and MWF-1 are promising dietary supplements for addressing obesity and restoring immune function.

County-level socio-environmental factors and obesity prevalence in the United States

AIMS

To investigate high-risk sociodemographic and environmental determinants of health (SEDH) potentially associated with adult obesity in counties in the United States using machine-learning techniques.

MATERIALS AND METHODS

We performed a cross-sectional analysis of county-level adult obesity prevalence (body mass index ≥30 kg/m2) in the United States using data from the Diabetes Surveillance System 2017. We harvested 49 county-level SEDH factors that were used in a classification and regression trees (CART) model to identify county-level clusters. The CART model was validated using a 'hold-out' set of counties and variable importance was evaluated using Random Forest.

RESULTS

Overall, we analysed 2752 counties in the United States, identifying a national median (interquartile range) obesity prevalence of 34.1% (30.2%, 37.7%). The CART method identified 11 clusters with a 60.8% relative increase in prevalence across the spectrum. Additionally, seven key SEDH variables were identified by CART to guide the categorization of clusters, including Physically Inactive (%), Diabetes (%), Severe Housing Problems (%), Food Insecurity (%), Uninsured (%), Population over 65 years (%) and Non-Hispanic Black (%).

CONCLUSION

There is significant county-level geographical variation in obesity prevalence in the United States, which can in part be explained by complex SEDH factors. The use of machine-learning techniques to analyse these factors can provide valuable insights into the importance of these upstream determinants of obesity and, therefore, aid in the development of geo-specific strategic interventions and optimize resource allocation to help battle the obesity pandemic.

Deep learning-based BMI inference from structural brain MRI reflects brain alterations following lifestyle intervention

Obesity is associated with negative effects on the brain. We exploit Artificial Intelligence (AI) tools to explore whether differences in clinical measurements following lifestyle interventions in overweight population could be reflected in brain morphology. In the DIRECT-PLUS clinical trial, participants with criterion for metabolic syndrome underwent an 18-month lifestyle intervention. Structural brain MRIs were acquired before and after the intervention. We utilized an ensemble learning framework to predict Body-Mass Index (BMI) scores, which correspond to adiposity-related clinical measurements from brain MRIs. We revealed that patient-specific reduction in BMI predictions was associated with actual weight loss and was significantly higher in active diet groups compared to a control group. Moreover, explainable AI (XAI) maps highlighted brain regions contributing to BMI predictions that were distinct from regions associated with age prediction. Our DIRECT-PLUS analysis results imply that predicted BMI and its reduction are unique neural biomarkers for obesity-related brain modifications and weight loss.

Visually assessed body condition shows high heritability in a pedigreed great ape population

Body condition, a measure for relative fat mass, is associated with primate health, fitness, and overall welfare. Body condition is often influenced by dietary factors, age, and/or sex, but several body condition measures (body weight, weight-to-height ratios, and so on) also show high heritability across primate species, indicating a role of genetic effects. Although different measures for body condition exist, many require direct handling of animals, which is invasive, time-consuming, and expensive, making them impractical in wild and captive settings. Therefore, noninvasive visual body condition score (BCS) systems were developed for various animal species, including macaques and chimpanzees, to visually assess relative fat mass. Here we evaluate the utility of a visual BCS system in bonobos by assessing (1) inter-rater reliability, (2) links with body mass, a traditional hands-on measure of condition, and (3) the factors driving individual variation in BCS. We adapted the chimpanzee BCS system to rate 76 bonobos in 11 European zoos (92% of the adult population). Inter-rater reliability was high (s* = 0.948), BCSs were positively associated with body mass (β = 0.075) and not predicted by diet, sex, or age, nor were they associated with a higher abundance of obesity-related diseases. Instead, BCSs showed high levels of heritability (h2  = 0.637), indicating that a majority of body condition variation in bonobos is attributable to genetic similarity of the individuals. This is in line with reported h2 -values for traditional body condition measures in primates and provides support for the reliability of visual BCS systems in great apes. The results of this study emphasize an often unanticipated role of genetics in determining primate body fat and health that has implications for the management of captive primates. Application of this tool in wild populations would aid to unravel environmental from genetic drivers of body condition variation in primates.

Longitudinal transition of body mass index status and its associated factors among Chinese middle-aged and older adults in Markov model

Introduction

Body mass index (BMI) has a strong correlation with chronic diseases and all-cause mortality. However, few studies have previously reported the longitudinal transition of BMI status and its influential factors, especially among Chinese middle-aged and older adults.

Methods

This population-based cohort study involved 6,507 participants derived from the China Health and Retirement Longitudinal Study from 2011 to 2015, including objectively measured BMI recorded in 26,028 person-year of all observations followed up. Multistate Markov model was performed to estimate the BMI state transition intensity and hazard ratios of each potential exposure risk.

Results

The mean intensity of the population that shifted from normal to overweight was more than twice than shifted to underweight. Besides, a predicted probability was up to 16.16% that the population with overweight would suffer from obesity and more than half of the population with underweight would return to normal weight over a 6-year interval. The study also implied significant effects of baseline age, gender, marital status, education level, alcohol consumption, smoking, depression symptoms, and activities of daily living impairment on BMI status transition to varying degrees.

Conclusions

Findings of this study indicated that the mean transition probability between different BMI statuses varied, specific exposure factors serving as barriers or motivators to future transitions based on current BMI status was clarified for the health promotion strategies.

Transitioning to an obese India: Demographic and structural determinants of the rapid rise in overweight incidence

India, which has long suffered from undernutrition, has seen a rapid rise in overweight incidence in the last decade and a half. These changes are characterized by significant within-country differences in overweight incidence that vary by gender and regional development levels. In this paper, we provide an integrative framework, linking the income-gradient hypothesis of obesity with biological, obesogenic, and environmental factors to provide an explanation on the emergence of within-country differences in overweight patterns. We utilize measured body mass index (BMI), along with individual- and household-level data of over 800,000 men and women surveyed in the National Family Health Surveys of 2005-06 and 2015-16 to identify correlates of within-country differences in overweight incidence. A decomposition analysis reveals that among women, in addition to increasing access to obesogenic technologies, biological factors are associated with overweight incidence. Among men, obesogenic factors related to technology use and health behaviors are associated with the rise in overweight incidence, but biological factors are not. At lower levels of regional development, overweight incidence is associated with greater access to obesogenic technology such as motorized transport, which reduces physical activity among men at higher rates than women. At higher levels of economic development, obesogenic behaviors, such as watching more television and reducing smoking, are associated with overweight incidence. Our results corroborate the call by public health experts for group-specific policies to stem the rise of overweight incidence in developing countries.

Ageing and Obesity Shared Patterns: From Molecular Pathogenesis to Epigenetics

In modern societies, ageing and obesity represent medical challenges for healthcare professionals and caregivers. Obesity and ageing share common features including the related cellular and molecular pathways as well as the impacts they have as risk factors for a variety of diseases and health problems. Both of these health problems also share exercise and a healthy lifestyle as the best therapeutic options. Importantly, ageing and obesity also have common epigenetic changes (histone modification, DNA methylation, noncoding RNAs, and chromatin remodeling) that are also impacted by exercise. This suggests that epigenetic pathways are among the mechanisms via which exercise induces its benefits, including ageing and obesity improvements. Exploring these interrelations and based on the fact that both ageing and obesity represent risk factors for each other, would lead to optimizing the available therapeutic approaches towards improved obesity management and healthy ageing.

Sarcopenia, Obesity, and Sarcopenic Obesity: Relationship with Skeletal Muscle Phenotypes and Single Nucleotide Polymorphisms

Obesity may aggravate the effects of sarcopenia on skeletal muscle structure and function in the elderly, but no study has attempted to identify the gene variants associated with sarcopenia in obese women. Therefore, the aims of the present study were to: (1) describe neuromuscular function in sarcopenic and non-sarcopenic women with or without obesity; (2) identify gene variants associated with sarcopenia in older obese women. In 307 Caucasian women (71 ± 6 years, 66.3 ± 11.3 kg), skeletal muscle mass was estimated using bioelectric impedance, and function was tested with a 30 s one-leg standing-balance test. Biceps brachii thickness and vastus lateralis cross-sectional area (VL_ACSA) were measured with B-mode ultrasonography. Handgrip strength, maximum voluntary contraction elbow flexion (MVC_EF), and knee extension torque (MVC_KE) were measured by dynamometry, and MVC_KE/VL_ACSA was calculated. Genotyping was performed for 24 single-nucleotide polymorphisms (SNPs), selected based on their previous associations with muscle-related phenotypes. Based on sarcopenia and obesity thresholds, groups were classified as sarcopenic obese, non-sarcopenic obese, sarcopenic non-obese, or non-sarcopenic non-obese. A two-way analysis of covariance was used to assess the main effects of sarcopenia and obesity on muscle-related phenotypes and binary logistic regression was performed for each SNP to investigate associations with sarcopenia in obesity. There were no significant obesity * sarcopenic status interactions for any of the investigated muscle-related phenotypic parameters. Neither sarcopenia nor obesity had a significant effect on biceps brachii thickness, but sarcopenia was associated with lower VL_ACSA (p = 0.003). Obesity was associated with lower MVC_EF (p = 0.032), MVC_KE (p = 0.047), and MVC_KE/VL_ACSA (p = 0.012) with no significant effect of sarcopenia. Adjusted for age and height, three SNPs (ACTN3 rs1815739, MTHFR rs1801131, and MTHFR rs1537516) were associated with sarcopenia in obese participants. Sarcopenia was associated with a smaller muscle size, while obesity resulted in a lower muscle quality irrespective of sarcopenia. Three gene variants (ACTN3 rs1815739, MTHFR rs1801131, and MTHFR rs1537516) suspected to affect muscle function, homocysteine metabolism, or DNA methylation, respectively, were associated with sarcopenia in obese elderly women. Understanding the skeletal muscle features affected by sarcopenia and obesity, and identification of genes related to sarcopenia in obese women, may facilitate early detection of individuals at particular risk of sarcopenic obesity.

Educational attainment of offspring and obesity among older adults in China

The study focuses on the role of adult offspring's educational attainment in obesity among older adults in China and investigates age and birth cohort heterogeneities in the educational effect. Using the longitudinal data from the 1993-2015 China Health and Nutrition Survey (CHNS), we employed three-level mixed-effects models and conducted sex-stratified analyses to examine the effects of co-resident offspring's education on body mass index (BMI), overweight, waist circumference (WC), and abdominal obesity among older people born before 1956. After controlling for confounding factors, the overall results showed inverted U-shaped educational gradients in BMI-based outcomes for males and positive gradients for females. The effect of education on WC exhibited an inverted U-shaped pattern for both sexes, but no significant effect on abdominal obesity was found among the overall population. However, further analyses of interaction effects indicated considerable age and cohort variations in the educational effects on obesity outcomes. Offspring's schooling was positively associated with obesity among earlier birth cohorts; Among more recent birth cohorts, especially among females, the educational effects were reversed, and disparities in obesity outcomes across education categories strengthened with age. These findings imply that offspring's education appears to gradually exert a protective role against obesity among Chinese older adults in successive cohorts.

Change in BMI affects the risk of falling in postmenopausal osteopenic and osteoporotic women

Objectives:

To investigate the impact of the body mass index (BMI) change on risk of falling in postmenopausal women with osteopenia or osteoporosis. Also, we aimed to evaluate and associate the individuals’ functionality, mobility and balance with the risk of falling.

Methods:

This one-year prospective observational study assessed 498 postmenopausal Greek women over the 50^th year of age suffering from either osteoporosis or osteopenia. Parameters such as the height, weight and BMI were documented. Furthermore, the subjects were asked whether they experienced a fall the preceding year. Balance was evaluated using the Berg Balance Scale, the Timed-Up-And-Go test, and the 30 Seconds Sit-to-Stand test. Hand-grip strength was assessed with the Jamar Hydraulic Hand Dynamometer.

Results:

The observed one-year BMI change was associated with falls in postmenopausal osteopenic and osteoporotic women over the age of 70. Additionally, there were statistically significant changes in the BBS, TUG, 30CST and the hand-grip strength on both hands at the one-year follow-up but there were not associated with an increased fall risk.

Conclusion:

The one-year change in BMI was associated with the risk of falling in postmenopausal osteopenic and osteoporotic women over the 70^th year of age. Whereas, the one-year change in balance, mobility and grip strength were not linked to an increased risk of falling.

Effect of Aerobic or Resistance Exercise, or Both, on Intermuscular and Visceral Fat and Physical and Metabolic Function in Older Adults with Obesity While Dieting

BACKGROUND

Obesity exacerbates age-related effects on body composition, physical and metabolic function. Which exercise mode is most effective in mitigating these deleterious changes in dieting obese older adults is unknown.

METHODS

In a randomized controlled trial, we performed a head-to-head comparison of aerobic (AEX), resistance (REX), or combination (COMB) exercise during matched weight loss in 160 obese older adults. Prespecified analyses compared 6-month changes in intermuscular adipose tissue (IMAT) and visceral adipose tissue (VAT) assessed using MRI, insulin sensitivity index (ISI) by oral glucose tolerance test, physical function using Modified Physical Performance Test (PPT), VO2peak, gait-speed, and knee strength by dynamometry.

RESULTS

IMAT and VAT decreased more in COMB than AEX and REX groups (IMAT; -41% vs. -28% and -23% and VAT: -36% vs. -19% and -21%; p=.003 to .01); IMAT and VAT decreased in all groups more than control (CON) (between-group p<.001). ISI increased more in COMB than AEX and REX groups (86% vs. 50% and 39%; p=.005 to .03). PPT improved more in COMB than AEX and REX groups, while VO2peak improved more in COMB and AEX than REX group (all p<.05). Knee strength improved more in COMB and REX than AEX group (all p<.05). Changes in IMAT and VAT correlated with PPT (r=-.28 and -.39), VO2peak (r=-.49 and -.52), gait-speed (r=-.25 and -.36), and ISI (r=-.49 and -.52) (all p<.05).

CONCLUSIONS

Weight loss plus combination aerobic and resistance exercise was most effective in improving ectopic fat deposition and physical and metabolic function in older adults with obesity.

Does inequality have a silver lining? Municipal income inequality and obesity in Mexico

Income inequality and obesity are both widespread socioeconomic issues, particularly salient in middle-income countries. This article seeks to detect the relationship between local income inequality and excess weight in Mexico, using robust municipal income inequality measures generated through small area estimation method and instrumental variable multilevel estimations. Our results emphasize a negative impact of municipal income inequality on individual bodyweight, especially for women. We also explore the potential channels through which income inequality may decrease bodyweight. Three-stage least squares estimations highlight that the social capital pathway, the public policy pathway and the psychological pathway help to explain the negative effect of inequality on excess weight. Our results are fairly robust to alternative inequality measures and nutritional indicators.

Unexpectedly High Prevalence of Breakfast Skipping in Low Body-Weight Middle-Aged Men: Results of the Kanagawa Investigation of Total Checkup Data from the National Data Base-7 (KITCHEN-7)

Breakfast skipping (BS) has been considered to be associated with obesity, particularly among younger generations. However, few studies have addressed this issue in a middle-aged population considering sex and the conditions prior to breakfast. Therefore, we investigated clinical parameters, self-reported BS, late-night dinner (LND) eating, and late-night snacking (LNS) in ten body mass index (BMI) categories in a cross-sectional study of 892,578 non-diabetic people aged 40-74 years old who underwent a checkup. BS and LND were more prevalent in men (20.7% and 40.5%, respectively) than women (10.9% and 17.4%), whereas LNS was more prevalent in women (15.0%) than men (12.2%; all p < 0.0001). The overall prevalence of BS increased linearly with increasing BMI. However, when subjects were divided into men and women, the prevalence of BS showed a U-shaped relationship with BMI in men (n = 479,203). When male subjects were restricted to those in their 40s or those reporting LND, the prevalence of BS further increased, maintaining a U-shaped form. Logistic regression analysis also showed a U-shaped relationship in the adjusted odds ratios of BMI categories for BS in men and a J-shaped curve in women. In conclusion, our study revealed an unexpectedly high prevalence of BS in middle-aged low-body-weight men.

High Serum Aspartate Aminotransferase, Underweight, and Weight Loss in Older People: Results of the KITCHEN-4

Background: Reduced muscle mass is frequently observed in older people and can lead to being underweight and/or weight loss (WL), but prediction and screening systems utilizing hematological biochemical parameters are limited. High serum aspartatSe aminotransferase in conjunction with normal serum alanine aminotransferase (HASNAL) can reflect systemic muscle damage. HASNAL and the incidence of being underweight concomitant with WL (UWWL) were investigated in the present 6-year community-based cohort study. Methods: Clinical parameters, lifestyle, the incidence of being underweight, ≥ 5% WL, and UWWL were investigated in 238,536 Japanese people aged 40-68 years who had normal serum alanine aminotransferase. HASNAL was defined as serum aspartate aminotransferase ≥ 30 U/L and serum alanine aminotransferase < 30 U/L. The subjects were divided into a younger group (< 55 years) and an older group (≥ 55 years). Results: After 6 years, overall body weight had increased by 0.4% in the younger group and decreased by 0.4% in the older group. In logistic regression analysis, in the younger group ≥ 5% WL was significantly associated with baseline HASNAL compared to baseline low serum aspartate aminotransferase (< 20 U/L). In the older group, baseline HASNAL was significantly associated with being underweight, ≥ 5% WL, and UWWL, even after adjustment for potential confounders, and UWWL was inversely associated with regular exercise and daily alcohol consumption-both of which modified the aforementioned associations. Conclusions: Older subjects with HASNAL were at an increased risk of UWWL, possibly via skeletal muscle damage, which may be affected by common lifestyles.

Association of Anthropometric and Nutrition Status Indicators with Hand Grip Strength and Gait Speed in Older Adults

BACKGROUND

How nutrition status indicators relate to function in older adults is an issue that needs to be explored. This study aimed to quantify the associations of anthropometric parameters and nutrition status indicators with hand grip strength (HGS) and gait speed (GS) in older adults.

METHODS

A cross-sectional observational study was conducted in a population-based sample of 1500 older adults ≥65 years old. Logistic regression models were used to explore the associations between anthropometric, nutrition, and functional measures.

RESULTS

Lower values of height, mid-arm muscle circumference, and calf circumference, as well as higher values of waist circumference, were associated with both low GS and HGS. The adjusted odds ratio (OR) for low GS was around 2-fold higher in participants presenting risk for undernutrition or undernutrition. The adjusted OR (95% confidence interval) for low HGS was 1.54 (1.01-2.36) in women and 1.57 (0.91-2.72) in men at risk for undernutrition/undernutrition.

CONCLUSIONS

In older adults, lower values of height and calf circumference, as well as higher waist circumference, were associated with both low GS and HGS. Lower values of mid-arm muscle circumference were also associated with low values of both functional parameters only in men. The risk for undernutrition/undernutrition was more strongly associated with low GS than with low HGS in both women and men.

Supporting Transitions in Care for Older Adults With Type 2 Diabetes Mellitus and Obesity

The aim of the current study was to compare outcomes for older adults with type 2 diabetes mellitus and obesity following participation in a transitional care intervention that included diabetes self-management education (DSME) and homecare. The three groups analyzed comprised an inpatient DSME plus homecare group (n = 35); an inpatient DSME only group (n = 100); and a group who received usual care (n = 45). Outcomes of interest included rehospitalization rates and hemoglobin A1C (A1C) for up to 1-year post hospital discharge. Rates of rehospitalization and A1C improved for older adults who received nurse-led inpatient DSME and homecare during transitions of care from hospital to home. Rehospitalization rates up to 90 days were decreased for the DSME plus homecare group (10%) compared to DSME only (20%) and usual care groups (26.7%) (p < 0.05). A decrease of -0.4 and -2.3 A1C units was observed for the DSME group and DSME plus homecare group, respectively, at 90 days. These results support a transitional care educational intervention for older adults with type 2 diabetes mellitus and obesity.

TARGETS

Older adults with type 2 diabetes mellitus and obesity.

INTERVENTION DESCRIPTION

Transitional care intervention including diabetes self-management education and homecare.

MECHANISMS OF ACTION

Inpatient diabetes education and homecare helps improve rates of rehospitalization and hemoglobin A1C during care transitions from hospital to home.

OUTCOMES

Rehospitalization rates, glycemic control (i.e., A1C level). [Res Gerontol Nurs. 2018; 11(2):71-81.].

Dynapenic Abdominal Obesity Increases Mortality Risk among English and Brazilian Older Adults: A 10-Year Follow-Up of the ELSA and SABE Studies

BACKGROUND/OBJECTIVE

There is little epidemiological evidence demonstrating that dynapenic abdominal obesity has higher mortality risk than dynapenia and abdominal obesity alone. Our main aim was to investigate whether dynapenia combined with abdominal obesity increases mortality risk among English and Brazilian older adults over ten-year follow-up.

DESIGN

Cohort study.

SETTING

United Kingdom and Brazil.

PARTICIPANTS

Data came from 4,683 individuals from the English Longitudinal Study of Ageing (ELSA) and 1,490 from the Brazilian Health, Well-being and Aging study (SABE), hence the final sample of this study was 6,173 older adults.

MEASUREMENTS

The study population was categorized into the following groups: non-dynapenic/non-abdominal obese, abdominal obese, dynapenic, and dynapenic abdominal obese according to their handgrip strength (< 26 kg for men and < 16 kg for women) and waist circumference (> 102 cm for men and > 88 cm for women). The outcome was all-cause mortality over a ten-year follow-up. Adjusted hazard ratios by sociodemographic, behavioural and clinical characteristics were estimated using Cox proportional hazards models.

RESULTS

The fully adjusted model showed that dynapenic abdominal obesity has a higher mortality risk among the groups. The hazard ratios (HR) were 1.37 for dynapenic abdominal obesity (95% CI = 1.12 - 1.68), 1.15 for abdominal obesity (95% CI = 0.98 - 1.35), and 1.23 for dynapenia (95% CI = 1.04 - 1.45).

CONCLUSIONS

Dynapenia is an important risk factor for mortality but dynapenic abdominal obesity has the highest mortality risk among English and Brazilian older adults.

The effect of blood glucose regulation on sarcopenia parameters in obese and diabetic patients

Objectives

This study aims to evaluate the effect of blood glucose regulation on sarcopenia parameters in sarcopenic, obese, and poorly- regulated diabetic patients.

Patients and methods

Between June 2013 and December 2013, a total of 147 patients (64 males, 83 females; mean age 70.3±6.3 years; range, 60 to 90 years) who were diagnosed with sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria were included in the study. All patients were obese with a body mass index (BMI) of >30 kg/m2 and their glycated hemoglobin (HbA1c) levels were above 8%. Sarcopenia parameters including the gait speed, muscle strength, muscle mass, and handgrip strength were assessed. After a six-month treatment period, the patients were divided into two groups according to their HbA1c levels as having <8% or >8%. Sarcopenia parameters were evaluated before and after receiving treatment.

Results

The mean disease duration was 16±6.2 years. Sixty patients were found to have a HbA1c level of <8% and 45 patients with a HbA1c level of ≥8% at sixth months of follow-up. In better regulated group, sarcopenia parameters such as gait speed, muscle mass, and handgrip strength improved; however, only the change in the muscle mass was found to be statistically significant (p=0.041). There was no significant change in the parameters of sarcopenia in the patient group with a HbA1c level ≥8%. A negative correlation was found between the muscle mass and HbA1c levels in good- and poorly-regulated groups (p=0.039 r:-0.327 and p=0.044 r:-0.183, respectively).

Conclusion

Our study demonstrates that lowering HbA1c levels may have positive effects on the muscle mass even in diabetic and sarcopenic obese elderly individuals.

Social disparities in body mass index (BMI) trajectories among Chinese adults in 1991-2011

Background

Obesity is a serious public health problem in China. The relationship between obesity and socio-economic status (SES) is changing and affected by uncertainty, particularly, in developing countries. The sex-related differences in body mass index (BMI) trajectories are controversial and require substantial empirical data for updating and enriching.

Methods

This study examined the relationship between SES and BMI in Chinese adults from a dynamic perspective using longitudinal data (1991–2011) from the China Health and Nutrition Survey (CHNS). Then, sex-related differences were determined. A hierarchical linear model was used.

Results

SES positively affected the male BMI changes, with faster BMI growth rates in the high-SES males over the past 20 years. By contrast, female BMI was only affected by BMI baseline and residential area. Specifically, greater BMI baseline led to greater BMI growth rate and earlier BMI decline. In the past 20 years, the BMI growth rate has been greater in the urban females than in the rural females.

Conclusions

The relationship between SES and obesity is complex in China, and a substantial sex-related difference exists. We argue that this large sex-related difference is due to the rapid economic and social changes that have affected national health and increased the gender inequality and social role restrictions in females. We provide insights for further research and policy recommendations.

Prevalence of obesity and overweight and its associated factors among registered pensioners in Ghana; a cross sectional studies

Background

The elderly are faced with health problems such as cardiovascular diseases, type II diabetes mellitus, kidney disease, arthritis and other musculoskeletal problems, which can be linked to obesity and overweight. The aim of this study was to determine the prevalence of obesity and overweight and its associated factors amongst registered pensioners in Ghana.

Methods

A cross-sectional study was conducted among members of the national pensioners association of Ghana. 4813 pensioners took part in the study. Thirteen study centers were used in the study with at least one center per regional capital. Questionnaires, physical examinations, blood and urine sample examinations were carried out.

Results

Overall, 16.3% of the pensioners were obese while 30.0% were overweight. Prevalence of obesity among males and females were 8.0% and 34.5% respectively. Pensioners who were hypertensive had 1.8 times the odds (95% CI = 1.5–2.0) of being obese/overweight. Serum triglycerides levels of 2.26 mmol/L (200 mg/dL) or more, were associated with 80% chance of obesity and overweight (OR = 1.8, 95% CI = 1.3 - 2.5). There was 30% increase in arthritis among obese/overweight pensioners compared to normal/underweight pensioners. Obesity and overweight pensioners were more likely to be using eyeglass (OR = 1.7, 95% CI = 1.3–2.2) and less likely to report hearing loss (OR = 0.7, 95% CI =0.5–1.0).

Conclusion

The prevalence of obesity among the elderly in Ghana is high. Age had an inverse linear relationship with BMI among pensioners. Hypertension, arthritis and dyslipidemia were associated with obesity among registered pensioners.

Predictors of BMI Vary along the BMI Range of German Adults - Results of the German National Nutrition Survey II

OBJECTIVE

The objective of the study was to identify predictors of BMI in German adults by considering the BMI distribution and to determine whether the association between BMI and its predictors varies along the BMI distribution.

METHODS

The sample included 9,214 adults aged 18-80 years from the German National Nutrition Survey II (NVS II). Quantile regression analyses were conducted to examine the association between BMI and the following predictors: age, sports activities, socio-economic status (SES), healthy eating index-NVS II (HEI-NVS II), dietary knowledge, sleeping duration and energy intake as well as status of smoking, partner relationship and self-reported health.

RESULTS

Age, SES, self-reported health status, sports activities and energy intake were the strongest predictors of BMI. The important outcome of this study is that the association between BMI and its predictors varies along the BMI distribution. Especially, energy intake, health status and SES were marginally associated with BMI in normal-weight subjects; this relationships became stronger in the range of overweight, and were strongest in the range of obesity.

CONCLUSIONS

Predictors of BMI and the strength of these associations vary across the BMI distribution in German adults. Consequently, to identify predictors of BMI, the entire BMI distribution should be considered.

Body mass index and all-cause mortality among older adults

OBJECTIVE

To examine the association between baseline body mass index (BMI, kg/m(2) ) and all-cause mortality in a well-characterized cohort of older persons.

METHODS

The association between BMI (both as a categorical and continuous variable) and all-cause mortality was investigated using 4,565 Geisinger Rural Aging Study participants with baseline age 74.0 ± 4.7 years (mean ± SD) and BMI 29.5 ± 5.3 kg/m(2) over a mean of 10.9 ± 3.8 years of follow-up.

RESULTS

The relationship between BMI (as a continuous variable) and all-cause mortality was found to be U-shaped (P nonlinearity <0.001). Controlling for age, sex, smoking, alcohol, laboratory values, medications, and comorbidity status, underweight (BMI <18.5 kg/m(2) ) individuals had significantly greater adjusted risk of all-cause mortality than persons of BMI 18.5 to 24.9 kg/m(2) (reference range). Participants with overweight (BMI 25.0-29.9 kg/m(2) ) and class I obesity (BMI 30.0-34.9 kg/m(2) ) had significantly lower adjusted-risk of all-cause mortality. Those with classes II/III obesity (BMI ≥ 35.0 kg/m(2) ) did not have significantly greater adjusted-risk of all-cause mortality. Findings were consistent using propensity score weights and among never-smokers with 2- and 5-year lag analysis and among those with no identified chronic disease.

CONCLUSIONS

A U-shaped association was observed between BMI and all-cause mortality with lower risk among older persons with overweight and class I obesity in comparison with those with BMI 18.5 to 24.9 kg/m(2) .

Body Mass, Smoking, and Overall and Cause-Specific Mortality Among Older U.S. Adults

The authors examine the relationships between body mass, smoking, and overall and cause-specific mortality among U.S. adults aged 60 and older, using data from the National Health Interview Survey linked to the Multiple Cause of Death file and Cox proportional hazard models. The authors find that, compared to those who are normal weight, obese individuals have higher risks of overall, circulatory disease, and diabetes mortality. Furthermore, smoking status suppresses the relationships between obesity and overall, circulatory disease, and cancer mortality, and interacts with lowbody weight to increase mortality risks. Finally, underweight individuals initially face increased risks of death over the follow-up period, although over time their mortality risks diminish to those of normal-weight individuals, likely due to the presence of unobserved illness. Researchers and health practitioners must account for smoking status, body mass, and specific causes of death to understand and improve the health of our increasingly obese elderly population.

Joint effects of age and body mass index on the incidence of hypertension subtypes in the China Health and Nutrition Survey: A cohort study over 22years

OBJECTIVES

We seek to investigate the joint effects of age and body mass index (BMI) on the incident hypertension subtypes among Chinese adults during 1989-2011.

METHODS

We investigated the Incidence rates (IRs, per 100person-years) of hypertension subtypes, adjusted relative risks (RRs) and population attributable risk percent (PAR%) of BMI for hypertension, and clarified the age-specific effect of BMI on incident hypertension utilizing a dynamic cohort study from the China Health and Nutrition Survey (CHNS) 1989-2011.

RESULTS

Normotensive participants (n=53,028) at baseline were included, with mean age was 41.7 (95% CI, 41.6-41.7)years old. During a total of 118,694person years (average was 6.38years) of follow-up, a total of 5208 incident cases of hypertension were documented. The IRs of hypertension were 4.4 (95% CI, 4.3-4.5), which increased gradually by age and BMI (Ptrend<0.001). Compared with those with BMI<22kg/m(2), the RR of hypertension was 3.13 (95% CI, 2.84-3.45) in the group with BMI≥28kg/m(2). The PAR% (BMI>22 vs. BMI<22) for hypertension in Chinese population was 32% (95% CI, 29-34%). Similar trends were observed in all age and BMI groups for both isolated systolic hypertension and systolic-diastolic hypertension, which were mainly affected by age. In contrast, the peak IR of isolated diastolic hypertension was observed in participants aged 30-49years with higher BMIs.

CONCLUSIONS

The PAR% (IR of BP≥140/90 or treatment for BMI>22 vs. IR for BMI<22) of elevated body weight for hypertension was 32% in Chinese population.

Relation between Lifestyle and Socio-Demographic Factors and Body Composition among the Elderly

Background:

Aging is accompanied by various changes that can cause changes in diet and body composition resulting sometimes in malnutrition and disability in the elderly. Changes in body composition among the elderly are mainly the result of physical inactivity and nutrition. This study was designed to examine the relationship between lifestyle and socio-demographic factors and body composition.

Method:

A cross-sectional study was carried out with 380 elderly people aged 60 and over in district 5 of Tehran, Iran. Their body composition was measured by Bioelectrical Impedance Analysis and the Actigraph device was used for assessing physical activity patterns. A three-day food recall was conducted to measure their intake of energy and macronutrients. Lifestyle and socio-demographic information were collected by interview using a pretested questionnaire.

Results:

Overweight, obesity and central obesity were more prevalent in women than in men (p<0.001). Moreover, 57.1% and 18.7% of participants had high and very high fat mass index, respectively. High fat mass index was seen in 47% of men and 37.5% of women who had normal body mass index (BMI). Meanwhile, age, gender, physical activity, energy intake, the percentage of energy from fat and protein, educational level, job, television watching time, smoking, chronic diseases, and taking medicine were significantly associated with anthropometric measurements (p<0.05).

Conclusion:

Overweight, obesity and high body fat percentage were common among the aged. Considering the factors that are significantly associated with body composition, programs that can increase their awareness about the dietary balance and suitable physical activity should be organized to address these problems.

Comparison of different measures of obesity in their association with health-related quality of life in older adults - results from the KORA-Age study

OBJECTIVE

As ageing is associated with changes in body composition, BMI may not be the appropriate obesity measure for older adults. To date, little is known about associations between obesity measures and health-related quality of life (HRQoL). Thus, we aimed to compare different obesity measures in their association with HRQoL and self-rated physical constitution (SRPC) in older adults.

DESIGN

Seven obesity measures (BMI, waist circumference (WC), waist-to-hip ratio, waist-to-height ratio, fat mass percentage based on bioelectrical impedance analysis, hypertriglyceridaemic waist (HTGW) and sarcopenic obesity) were assessed at baseline in 2009. HRQoL, using the EQ-5D questionnaire, and SRPC, using one single question, were collected at baseline and at the 3-year follow-up in 2012. Linear and logistic regression analyses were used to examine the associations between the obesity measures and both outcomes. Model comparisons were conducted by area under the receiver-operating characteristic curve, R 2, Akaike and Schwarz Bayesian information criteria.

SETTING

KORA-Age study in Southern Germany (2009-2012).

SUBJECTS

Older adults (n 883; aged ≥65 years).

RESULTS

Nearly all obesity measures were significantly inversely associated with both outcomes in cross-sectional analyses. Concerning HRQoL, the WC model explained most of the variance and had the best model adaption, followed by the BMI model. Regarding SRPC, the HTGW and BMI models were best as rated by model quality criteria, followed closely by the WC model. Longitudinal analyses showed no significant associations.

CONCLUSIONS

These results suggest that, with regard to HRQoL/SRPC, simple anthropometric measures are sufficient to determine obesity in older adults in medical practice.

BMI and healthy life expectancy in old and very old women

There is conflicting evidence for the effect of BMI on mortality at older ages, and little information on its effect on healthy life expectancy (HLE). Longitudinal data were from the 1921–1926 cohort of the Australian Longitudinal Study on Women’s Health (n 11 119), over 18 years of follow-up. Self-rated health status was measured at each survey, and BMI was measured at baseline. Multi-state models were fitted to estimate the effect of BMI on total life expectancy (TLE) and HLE. Compared with women of normal weight, overweight women at the age of 75 years had similar TLE but fewer years healthy (−0·79; 95 % CI −1·21, −0·37) and more years unhealthy (0·99; 95 % CI 0·56, 1·42). Obese women at the age of 75 years lived fewer years in total than normal-weight women (−1·09; 95 % CI −1·77, −0·41), and had more unhealthy years (1·46; 95 % CI 0·97, 1·95 years). Underweight women had the lowest TLE and the fewest years of healthy life. Women should aim to enter old age at a normal weight and in good health, as the slight benefit on mortality of being overweight is offset by spending fewer years healthy. All outcomes were better for those who began in good health. The relationship between weight and HLE has important implications for nutrition for older people, particularly maintenance of lean body mass and prevention of obesity. The benefit of weight loss in obese older women remains unclear, but we support the recommendation that weight-loss advice be individualised, as any benefits may not outweigh the risks in healthy obese older adults.

The Changing Body Mass-Mortality Association in the United States: Evidence of Sex-Specific Cohort Trends from Three National Health and Nutrition Examination Surveys

The association between body mass index (BMI) categories and mortality remains uncertain. Using three National Health and Nutrition Examination Surveys covering the 1971-2006 period for cohorts born between 1896 and 1968, this study estimates separately for men and women models for year-of-birth (cohort) and year-of-observation (period) trends in how age-specific mortality rates differ across BMI categories. Among women, relative to the normal weight (BMI 18.5-24.9 kg/m(2)), there are increasing trends in mortality rates for the overweight (BMI 25-29.9) or obese (BMI ≥ 30). Among men, mortality rates relative to the normal weight decrease for the overweight, do not change for the moderately obese (BMI 30-34.9), and increase for the severely obese (BMI ≥ 35). Period and cohort trends are similar, but the cohort trends are more consistent. In the latest cohorts, compared with the normal weight, mortality rates are 50 percent lower for overweight men, not different for moderately obese men, and 100-200 percent higher for severely obese men and for overweight or obese women. For U.S. cohorts born after the 1920s, a lower overweight than normal weight mortality is confined to men. I speculate on possible reasons why the mortality association with overweight and obesity varies by sex and cohort.

Health benefits of endurance training alone or combined with diet for obese patients over 60: a review

BACKGROUND

The prevalence of obesity is rapidly increasing in older patients and it is ubiquitous in many developed countries. Obesity is related to various negative health outcomes, making it a major public health target for intervention.

PURPOSE

The aim of this study was to explore and summarise the literature that addresses endurance training alone or combined with nutrition interventions to combat obesity in obese patients over age 60.

METHODS

We searched online electronic databases up to September 2014 for original observational and intervention studies published between 1995 and 2014 on the relationship between endurance training alone or combined with a diet in obese patients over 60 regarding health outcomes.

RESULTS

Twenty-six studies examined interventions aimed specifically at promoting endurance training alone or combined with diet for older obese patients over 60. These studies demonstrated a positive effect of this intervention on the primary prevention of cardiovascular disease, and a significant beneficial effect on the lipid profile. Improvement of body composition and insulin sensitivity, and a reduction in blood pressure were also well established.

CONCLUSIONS

Overall, this review demonstrates a positive effect of endurance training alone or combined with diet on health outcomes and metabolic benefits in older adults. Clinicians can now use this evidence to formulate actions to encourage the older obese to profit from the health benefits of endurance training and diet. This will not only help reduce the dramatic increase in the number of older obese but also help prevent sarcopenic obesity, which is a complex challenge for healthcare professionals.

BMI, overweight status and obesity adjusted by various factors in all age groups in the population of a city in Northeastern Brazil

OBJECTIVE

In Brazil, demographic, socioeconomic and epidemiological changes over time have led to a transition in nutritional standards, resulting in a gradual reduction of malnutrition and an increased prevalence of overweight and obese individuals, similar to the situation in developed countries in previous decades. This study assessed the body mass index (BMI) and the prevalence of an overweight status and obesity, adjusted for various factors, in a population in northeastern Brazil including all age groups.

METHODS

This is a cross-sectional population-based epidemiological study using single sampling procedure composed of levels. Given the heterogeneity of the variable "income" and the relationship between income, prevalence of diseases and nutrition, a stratified sampling on blocks in the first level was used. In this, city districts were classified by income into 10 strata, according to information obtained from IBGE. A systematic sampling was applied on randomly selected blocks in order to choose the residences that would be part of the sample (second level), including 1165 participants from all age groups.

RESULTS AND DISCUSSION

The prevalence of an overweight status or obesity was adjusted for demographic, socioeconomic and lifestyle variables. When the Chi-square test was applied, a relationship was observed between the prevalence of an overweight status or obesity and the age group, gender, educational level and income of the participants. Regarding lifestyle parameters, only smoking was associated with the prevalence of an overweight status or obesity, in both adults and in the total sample. The results for the following groups were significant (p < 0.05): the age group from 20 to 59 years, when the individual presented an educational level greater than or equal to high school; and the age group ≥ 60 years, when the individual was female. It is noteworthy that educational level and being female were significant in adjusting for the total population as major factors influencing an increased BMI, followed by the variables physical activity and family income.

CONCLUSIONS

The adjusted results justify the adoption of intervention and prevention policies to combat these clinical conditions for the study population as a whole, particularly directed toward adults with higher education level as well as elderly females.

Associations between obesity and overweight and fall risk, health status and quality of life in older people

OBJECTIVES

To determine whether overweight and obese individuals have higher reported fall and fall injury risk than individuals of healthy weight, and to examine the influence of BMI on health, quality of life and lifestyle characteristics of fallers.

METHODS

A representative sample of community-based individuals aged 65 years and older in New South Wales was surveyed regarding their history of falls, height, weight, lifestyle and general health within a 12-month period.

RESULTS

Obese individuals had a 31% higher risk of having fallen, but no higher risk of a fall-related injury compared to healthy-weight individuals. Obese fallers also had a 57% higher risk of believing nothing could be done to prevent falls; a 41% higher risk of using four or more medications; a 30% higher risk of experiencing moderate or extreme pain or discomfort; were 26% less likely have walked for two or more hours in the last week; and were less likely to think they were doing enough physical activity.

CONCLUSIONS

Older obese individuals have an increased risk of falls and obese fallers have a higher prevalence of pain and inactivity than fallers of a healthy weight.

IMPLICATIONS

A decrease in sedentary lifestyle and regular weight-bearing exercise may reduce fall risk in older obese individuals.

The association of nutritional profile and prognosis of degenerative diseases associated with carbohydrate and lipid metabolism at high altitude of district Ziarat, Pakistan

OBJECTIVE

In the present study the physiological parameters, their comparative analysis with carbohydrate and lipid metabolism were studied. This study suggests life style, environmental and genetic adaptations in the studied population.

METHOD

One hundred and ninety eight subjects were selected from different towns of District Ziarat. General characteristics of the population according to their nutritional habits including, age, body mass index(BMI), systolic blood pressure, diastolic blood pressure, glycemia, triglycerides, serum low density lipoprotein (LDL), high density lipoprotein (HDL), very low density lipoprotein (VLDL), triglycerides (TG) were measured.

RESULTS

Mean cholesterol, LDL, VLDL and triglyceride values were significantly higher in men than women and the values increased with increasing age in both men and women. HDL and glucose values were significantly higher in females than males. In men with various nutritional groups such as A, B and C, the mean cholesterol (P < 0.001), LDL (P < 0.014), VLDL (P < 0.031) and triglyceride (P < 0.025) levels were significantly observed among comparable groups. However, in women with various nutritional groups such as A, B and C, the mean age (P < 0.047) and triglyceride values (P < 0.033) display statistically significant results.

Obesity and falls in older people: mediating effects of disease, sedentary behavior, mood, pain and medication use

Obesity has been associated with an increased risk of falls among older people. However, it is not certain whether factors commonly associated with falls and/or obesity mediate this risk. This research examines whether specific diseases, sedentary behavior, mood, pain, and medication use mediate the association between obesity and falls. A representative sample of community-living individuals aged 65+ years in New South Wales (NSW), Australia were surveyed regarding their experience of falls, height, weight, lifestyle and general health within a 12 month period. Intervening variable effects were examined using Freedman and Schatzkin's difference in coefficients tests and regression analyses were used to estimate relative risks. Obesity was associated with a 25% higher risk (95%confidence interval (CI) 1.11-1.41; p<0.0003) of having fallen in the previous 12 months compared to non-obese individuals. The strongest mediators of the association between obesity and falls were sleeping tablets (t=-5.452; p<0.0001), sitting for more than 8h per day on weekdays (t=5.178; p<0.0001), heart disease/angina (t=3.526; p<0.0001), anti-depressant use (t=3.102; p=0.002), moderate/extreme anxiety or depression (t=3.038; p=0.002), and diabetes (t=3.032; p=0.002). Sedentary behavior, chronic health conditions and medication use were identified as mediators for the association between obesity and falls in community living older people. Interventions aimed at weight reduction and increased activity may have benefits not only for fall prevention, but also for the mediating health, mood and lifestyle factors identified here.

A new predictive equation for evaluating women body fat percentage and obesity-related cardiovascular disease risk

BACKGROUND

Obesity represents a global public health problem due to its association with cardiovascular diseases and reduced lifespan. The most widely used classification of obesity is expressed as Body Mass Index (BMI); however, this formula is an imprecise adiposity measurement that ignores several important factors involved. Body Adiposity Index (BAI) was more recently proposed as an indirect evaluation of percentage body fat (PBF). PBF is a direct measure of person's relative body fat and a better predictor of obesity-related risk diseases than BMI and BAI. Since obesity and consequent diseases are considered epidemic, new accurate formulas for epidemiological studies are of interest to the scientific community. Because direct measurement of body composition could be quite expensive, the aims of our work were to analyse the distributions of PBF by Dual X-ray absorptiometry, and the creation of new predictive equation using only anthropometric measures that could be helpful to clinicians to assess easily body fat of female patients.

METHODS/RESULTS

A sample of 1,031 Caucasian Italian women was recruited and BMI, BAI and PBF were evaluated. With the aim of developing a predictive model of PBF a multivariate regression model was fitted to observed data.

CONCLUSIONS

The definition of universally recognized PBF by gender and age could have public health implications. In this study, we developed a new predictive PBF equation that does not require the use of medical instruments or skilled measurement techniques and that may be easily applicable to Italian women.

Accuracy of self-reported and measured anthropometric data in the inpatient population

Self-reported body mass index (BMI) is commonly used to assess nutritional status. The aim of the study was to assess the accuracy of self-reported and measured data obtained from the inpatient population. A total of 296 individuals admitted to five hospital wards were included in the study. Patients provided details of their height and weight, and measurements of height and weight were subsequently taken. BMI measurements were calculated from both the self-reported and the measured data. In general, the study participants overestimated their height and underestimated their weight. Older people and women were significantly more likely to overestimate their height, whereas better educated people were more likely to underestimate their weight. Inaccurate height and weight reporting led to BMI values being underestimated. The findings of this study support previously published research questioning the accuracy of self-reported height and weight measurements.

BMI and all-cause mortality in older adults: a meta-analysis

BACKGROUND

Whether the association between body mass index (BMI) and all-cause mortality for older adults is the same as for younger adults is unclear.

OBJECTIVE

The objective was to determine the association between BMI and all-cause mortality risk in adults ≥65 y of age.

DESIGN

A 2-stage random-effects meta-analysis was performed of studies published from 1990 to 2013 that reported the RRs of all-cause mortality for community-based adults aged ≥65 y.

RESULTS

Thirty-two studies met the inclusion criteria; these studies included 197,940 individuals with an average follow-up of 12 y. With the use of a BMI (in kg/m2) of 23.0-23.9 as the reference, there was a 12% greater risk of mortality for a BMI range of 21.0-21.9 and a 19% greater risk for a range of 20.0-20.9 [BMI of 21.0-21.9; HR (95% CI): 1.12 (1.10, 1.13); BMI of 20.0-20.9; HR (95% CI): 1.19 (1.17, 1.22)]. Mortality risk began to increase for BMI >33.0 [BMI of 33.0-33.9; HR (95% CI): 1.08 (1.00, 1.15)]. Self-reported anthropometric measurements, adjustment for intermediary factors, and exclusion of early deaths or preexisting disease did not markedly alter the associations, although there was a slight attenuation of the association in never-smokers.

CONCLUSIONS

For older populations, being overweight was not found to be associated with an increased risk of mortality; however, there was an increased risk for those at the lower end of the recommended BMI range for adults. Because the risk of mortality increased in older people with a BMI <23.0, it would seem appropriate to monitor weight status in this group to address any modifiable causes of weight loss promptly with due consideration of individual comorbidities.