Relationships between physical activity, obesity and diabetes mellitus in a French elderly population: the POLA study. Pathologies Oculaires lieés á l' Age

Spatiotemporal characteristics of lower back muscle fatigue during a ten minutes endurance test at 50% upper body weight in healthy inactive, endurance, and strength trained subjects

In modern developed societies, heavy physical demands are decreasing and getting replaced by longer periods of static, low-exertion activities such as sitting or standing. To counteract this lack of physical activity, more and more people are engaging in physical activity through exercise and training. Virtually opposite training modalities are endurance and strength. We asked if back muscle endurance capacity is influenced by training mode. 38 healthy male subjects (age range 19–31 years, mean age 22.6 years) were investigated: sedentary (Control, n = 12), endurance trained (ET, n = 13), and strength trained participants (ST, n = 13). They underwent a ten-minutes isometric extension task at 50% of their upper body weight. Surface EMG was measured in the low-back region utilizing quadratic 4*4 monopolar electrode montages per side. Relative amplitude and mean frequency changes were analysed with respect to electrode position and group during the endurance task. Eight ST subjects failed to complete the endurance task. Relative amplitude and frequency changes were largest in the ST group, followed by Control and ET groups (amplitude: F 6.389, p 0.004, frequency: F 11.741, p<0.001). Further, independent of group largest amplitude increase was observed for the most upper and laterally positioned electrodes. Mean frequency changes showed no systematic spatial distribution pattern. Although, in the light of an aging population, strength training has its merits our results question the functional suitability of frequent and isolated high-impact strength training for everyday endurance requirements like doing the dishes. Fatigue related amplitude elevations are systematically distributed in the back region, showing least fatigue signs for the most caudal and medial, i.e. the lumbar paravertebral region.

Interaction of physical activity on the association of obesity-related measures with multimorbidity among older adults: a population-based cross-sectional study in India

OBJECTIVE

To explore the associations between obesity-related measures and multimorbidity among older Indian adults and the interactive effects of physical activity in those associations.

DESIGN

A cross-sectional study was conducted using large representative survey data.

SETTING AND PARTICIPANTS

The present study used data from the Longitudinal Aging Study in India (LASI) conducted during 2017-2018. Participants included 15 098 male and 16 366 female older adults aged 60 years and above in India.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome variable was multimorbidity among older adults coded as no and yes. Descriptive statistics along with bivariate analysis are presented in the paper. Additionally, binary logistic regression analysis was used to fulfil the study objectives.

RESULTS

About 24% of older adults in the LASI cohort suffered from multimorbidity. Older adults who were overweight/obese (adjusted OR (AOR): 1.61, CI 1.48 to 1.74), had high-risk waist circumference (AOR: 1.66, CI 1.52 to 1.80) and had high-risk waist to hip ratio (AOR: 1.45, CI 1.33 to 1.59) were significantly more likely to suffer from multimorbidity compared with their counterparts. Older adults who were obese and physically inactive had significantly increased odds of suffering from multimorbidity compared with older adults who were obese and physically active. Similarly, older adults with high-risk waist circumference (AOR: 1.30, CI 1.11 to 1.53) and high-risk waist to hip ratio (AOR: 1.32, CI 1.20 to 1.46) along with being physically inactive had significantly higher odds of suffering from multimorbidity in comparison with older adults with high-risk waist circumference and waist to hip ratio along with being physically active.

CONCLUSION

While developing health strategies for older adults, physical activity needs to be recognised as a way of minimising comorbidities. Further, the study highlights the importance of using multiple obesity-related measures to predict chronic conditions in the older population.

The Prevalence and Risk Factors of Type 2 Diabetes Mellitus (DMT2) in a Semi-Urban Saudi Population

(1) Background: Diabetes mellitus is a common health problem in Saudi Arabia, causing a huge burden for individuals, families, and communities. The objectives of the current study were to determine the prevalence and risk factors of type 2 diabetes mellitus among a semi-urban population of Saudi Arabia. (2) Research methods: The research design was cross-sectional, and the research was conducted in five primary health care centers (PHCC) in Majmaah, Saudi Arabia. The sample size was calculated as 353. A pre-tested questionnaire was used to collect data after obtaining ethical approval. Blood samples were taken to assess glucose levels and other variables. SPSS version 21 was used to analyze data. (3) Results: The prevalence of type 2 diabetes mellitus was 34.6%. The disease was more prevalent among the older respondents compared with the younger age groups (44.6% versus 15.6%). We found that females acquire the disease at a slightly higher rate than males (34.9% versus 34.2%), but this difference is not statistically significant. The sociodemographic risk factors of the disease were as follows: old age (44%), business and private occupation (38.5%), divorced or widowed (56.3%), and low income (42.4%). The health behaviors factors were as follows: overweight or obese status (42.3%), high triglycerides (TG) (43.4%), low high-density lipoprotein (HDL) (37.3%), and high total cholesterol (23.7%). There was a statistically significant difference in these risk factors between patients with and without diabetes. (4) Conclusion: The prevalence of type 2 diabetes mellitus among the semi-urban population of Saudi Arabia is high. The disease is more prevalent among elderly respondents and is associated with obesity, high TG, low HDL, and high total cholesterol.

Prevalence and risk factors of underweight, overweight and obesity among a geriatric population living in a high-altitude region of rural Uttarakhand, India

OBJECTIVE

To assess the prevalence and risk factors of underweight, overweight and obesity among a geriatric population living in a high-altitude region of India.

DESIGN

Community-based cross-sectional study. Data were collected on sociodemographic profile and anthropometric parameters. Weight and height measurements were utilized for calculation of BMI. Nutrient intake data were collected using 24 h dietary recall.

SETTING

High-altitude region of Nainital District, Uttarakhand State, North India.

SUBJECTS

Community-dwelling geriatric subjects (n 981) aged 60 years or above.

RESULTS

We found that 26·6 % of the elderly subjects were underweight (BMI<18·5 kg/m2). Overweight (BMI 25·0-29·9 kg/m2) and obesity (BMI≥30·0 kg/m2) was seen among 18·0 % and 4·6 %, respectively. After controlling for potential cofounders, risk factors such as low level of education and income, chewing problems and lower number of daily meals were found to be associated with underweight. On the other hand, risk factors for overweight/obesity were lower age, high income and unskilled work.

CONCLUSIONS

There is a need to develop and implement intervention strategies to prevent underweight, overweight and obesity among the geriatric population of India.

Physical mobility, physical activity, and obesity among elderly: findings from a large population-based Swedish survey

OBJECTIVE

To examine how physical activity and physical mobility are related to obesity in the elderly.

STUDY DESIGN

A cross-sectional study of 2558 men and women aged 65 years and older who participated in a population survey in 2012 was conducted in mid-Sweden with an overall response rate of 67%.

METHODS

Obesity (body mass index ≥30 kg/m²) was based on self-reported weight and height, and physical activity and physical mobility on questionnaire data. Chi-squared test and multiple logistic regressions were used as statistical analyses.

RESULTS

The overall prevalence of obesity was 19% in women and 15% in men and decreased after the age of 75 years. A strong association between both physical activity and obesity, and physical mobility and obesity was found. The odds for obesity were higher for impaired physical mobility (odds ratio [OR] 2.83, 95% confidence interval [CI] 2.14-3.75) than for physical inactivity (OR 1.63, 95% CI 1.28-2.08) when adjusted for gender, age, socio-economic status and fruit and vegetable intake. However, physical activity was associated with obesity only among elderly with physical mobility but not among those with impaired physical mobility.

CONCLUSION

It is important to focus on making it easier for elderly with physical mobility to become or stay physically active, whereas elderly with impaired physical mobility have a higher prevalence of obesity irrespective of physical activity.

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.

Relationship between nutritional profile, measures of adiposity, and bone mineral density in postmenopausal Saudi women

BACKGROUND

Osteoporosis remains a major health problem in all developed countries and is a condition in which several dietary factors have been implicated.

OBJECTIVE

To assess the nutritional status and levels of adiposity of postmenopausal women in relation to bone mineral density.

DESIGN

A cross-sectional study in which dietary intake was estimated by a food frequency questionnaire in 300 Saudi postmenopausal women aged 46-88 years. Bone profile biochemistry (serum calcium, phosphate, parathyroid hormone [PTH], vitamin D) and bone mineral density (BMD) in 3 skeletal sites were determined for all participants.

RESULTS

Overweight and obesity were highly prevalent among the study population. No significant correlation was found between dietary calcium and vitamin D and bone mass at any site. Dietary intake of calcium and vitamin D was significantly less than the recommended levels for a large proportion of the cohort. Energy-adjusted intakes of carbohydrates, fat, protein, and unsaturated fatty acids were associated with BMD in the postmenopausal women. Age, body weight, and residency type were predictors of BMD at all sites. Serum-intact PTH was a predictor of BMD at lumbar spine and femoral neck. Waist : hip ratio (WHR) was a predictor for BMD at femoral neck.

CONCLUSIONS

These results suggest that BMD is influenced by dietary factors other than calcium and vitamin D. However, nondietary factors such as age, WHR, PTH, and body weight may be important determinants of BMD in postmenopausal women.

Relationship between anthropometric variables and nutrient intake in apparently healthy male elderly individuals: a study from Pakistan

BACKGROUND

The elderly population is increasing worldwide, which warrants their nutritional status assessment more important. The present study was undertaken to establish the nutritional status of the least-studied elderly population in Pakistan.

METHODS

This was a cross-sectional study with a sample of 526 generally healthy free-living elderly men (mean age: 68.9 yr; range: 50-98 yr) from Peshawar, Pakistan. Anthropometric measurements (weight, height, WC) were measured and BMI and WHR were calculated from these measurements following WHO standard procedures. Dietary intake was assessed by 24-hr dietary recall. Nutrients were calculated from the information on food intake. Nutrients in terms of % of RNI were calculated using WHO data on recommended intakes.

RESULTS

Based on BMI, the numbers of obese, overweight and underweight elderly were 13.1, 3.1 and 10.8%, respectively. Age was negatively and significantly correlated with BMI (p = 0.0028). Energy (p = 0.0564) and protein intake (p = 0.0776) tended to decrease with age. There was a significant increase in % BF with age (p = <0.0001). The normal weight elderly had significantly (p < 0.05) higher intake of all nutrients studied, except energy which was significantly (p < 0.05) higher in obese and overweight elderly. Overall, however, the majority of subjects had lower than adequate nutrient intake (67.3 - 100% of recommendation).

CONCLUSIONS

Malnutrition is common in apparently healthy elderly Pakistani men. Very few elderly have adequate nutrient intake. Obese and overweight had higher % BF as compared to normal weight elderly. Older age is associated with changes not only in anthropometrics and body composition but also in intake of key nutrients like energy and protein.

Eating habits, obesity related behaviors, and effects of Danhak exercise in elderly Koreans

The aims of this study were to evaluate obesity-related dietary behaviors and to determine long-term exercise effects on obesity and blood lipid profiles in elderly Korean subjects. A total of 120 subjects, aged 60-75 yr, were recruited, and obesity-related dietary behaviors were determined. An exercise intervention was conducted with 35 qualified elderly females for 6 months, and body composition and blood lipids were measured 6 times at 4 week intervals. At baseline, mean BMI (kg/m²) was 24.8 for males and 23.1 for females. The females had better eating habits than the males and were more concerned with reading nutrition labels on food products (P < 0.001); they also preferred convenience foods less than the male subjects (P < 0.05). Obese individuals were more likely than overweight or normal weight individuals to misperceive their weight (P < 0.001). Those with a high BMI responded feeling more depressed (P < 0.01), lacking self-confidence (P < 0.01), and feeling isolated (P < 0.01), as well as having more difficulty doing outdoor activities (P < 0.01). After exercise, body fat (%) and WHR were significantly reduced (P < 0.05), while body weight and BMI were also decreased without statistical significance. Total cholesterol and blood HDL were significantly improved (207.1 mg/dl vs. 182.6 mg/dl, HDL: 45.6 mg/dl vs. 50.6 mg/dl, P < 0.05). Other benefits obtained from exercise were improvements in self-confidence (26.4%), movement (22.6%), stress-relief (18.9%), and depression (13.2%). In conclusion, elderly females had better eating habits and were more concerned with nutrition information and healthy diets compared to elderly males. However, misperceptions of weight and obesity-related stress tended to be very high in females who were overweight and obese, which can be a barrier to maintain normal weight. Long-term Danhak practice, a traditional Korean exercise, was effective at reducing body fat (%) and abdominal obesity, and improved lipid profiles, self-confidence, and stress.

Risk factors for age-related maculopathy

Age-related maculopathy (ARM) is the leading cause of blindness in the elderly. Although beneficial therapeutic strategies have recently begun to emerge, much remains unclear regarding the etiopathogenesis of this disorder. Epidemiologic studies have enhanced our understanding of ARM, but the data, often conflicting, has led to difficulties with drawing firm conclusions with respect to risk for this condition. As a consequence, we saw a need to assimilate the published findings with respect to risk factors for ARM, through a review of the literature appraising results from published cross-sectional studies, prospective cohort studies, case series, and case control studies investigating risk for this condition. Our review shows that, to date, and across a spectrum of epidemiologic study designs, only age, cigarette smoking, and family history of ARM have been consistently demonstrated to represent risk for this condition. In addition, genetic studies have recently implicated many genes in the pathogenesis of age-related maculopathy, including Complement Factor H, PLEKHA 1, and LOC387715/HTRA1, demonstrating that environmental and genetic factors are important for the development of ARM suggesting that gene-environment interaction plays an important role in the pathogenesis of this condition.

Factors Associated with the Prevalence of Diabetes Mellitus Among Elderly Men and Women Living in Mediterranean Islands: The MEDIS Study

BACKGROUND

The aim of the present work was to evaluate the relationships between socio-demographic, clinical, lifestyle and psychological characteristics and the presence of diabetes mellitus, among elderly individuals without known cardiovascular disease.

METHODS

During 2005-2007, 1190 elderly (aged 65 to 100 years) men and women (from Cyprus, Mitilini, Samothraki, Cephalonia, Crete, Lemnos, Corfu and Zakynthos) were enrolled. Socio-demographic, clinical and lifestyle factors were assessed using standard procedures. Diabetes mellitus was defined as fasting blood glucose >125 mg/dl or use of special medication.

RESULTS

21% of males and 23% of females had diabetes. Only 70% of diabetic participants were on a special diet and 76% were receiving pharmaceutical treatment. Diabetic individuals had higher prevalence of hypertension (80% vs. 64%, p < 0.001) and hypercholesterolemia (63% vs. 51%, p < 0.001) and reported lower physical activity status (p < 0.001), compared with non-diabetic participants. After adjusting for various confounders, hypertension and hypercholesterolemia were associated with a 144% (95% CI, 1.37-4.35) and 83% (95% CI, 1.13-2.94) higher likelihood of having diabetes, while moderate and vigorous exercise correlated with a 82% (95% CI, 0.09-0.81) and 67% (95% CI, 0.11-0.97) lower likelihood of diabetes.

CONCLUSIONS

A considerable proportion of our elderly sample had diabetes and other metabolic disorders, almost 25% of which were untreated. Promotion of physical activities, even in the elderly, may contribute to reducing their burden of diabetes and provide them with a better quality of living.

Prevalence of Type 2 Diabetes and Physical Activity Status in Elderly Men and Women from Cyprus (the MEDIS STUDY)

Our aim is to investigate the association of being physically active on the prevalence of Type 2 diabetes mellitus among elderly people. We enrolled 53 men and 97 women, aged 65 to 100, from various areas of Cyprus. Physical activity was evaluated through a validated questionnaire (the short International Physical Activity Questionnaire, IPAQ). Prevalence of diabetes was 26% in men and 18% in women, while 55% of men and 50% of women were reported as being moderately or vigorously active. Furthermore, 5% of the participants reported that they smoked, 4% had stopped smoking, and 8% reported alcohol consumption. People in the upper tertile of the IPAQ score were 0.26 times less likely to have diabetes (p < 0.05); on the other hand people in the lower tertile of the score were 1.7 times more likely to have diabetes (p < 0.05). Our findings support the notion of a beneficial effect of physical activity on the burden of diabetes in the elderly. Asia Pac J Public Health 2007; 19(3): 22-28.

Waist Circumference Adds to the Variance in Plasma C-Reactive Protein Levels in Elderly Patients with Metabolic Syndrome

BACKGROUND

C-reactive protein (CRP), a nonspecific marker of the inflammatory status, is associated with cardiovascular disease risk factors and may be an important feature of the metabolic syndrome (MSX) in middle-aged subjects.

OBJECTIVES

We assessed the relationship of CRP levels to specific components of MSX and other potential determinants in apparently healthy elderly subjects living in the South of France.

METHODS

In the framework of the population-based POLA (Pathologies Oculaires Liées à l'Age) Study, performed in 2,404 subjects aged 60 years or more, we measured the plasma CRP levels. All subjects with known systemic inflammatory diseases, such as chronic bronchitis, cardiovascular disease, and diabetes, and those who were on systemic steroid therapy as well as subjects with CRP levels >10 mg/l were excluded from the study, leaving 1,709 subjects for the statistical analyses. MSX was defined according to NCEP (National Cholesterol Education Program) criteria. Other potential determinants were assessed through interviewer-based questionnaire.

RESULTS

We grouped the subjects into three categories based on the 75th and 25th percentiles, corresponding to 3.05 and 0.82, respectively. We compared subjects in the highest quartile, i.e., with CRP >/=3.05 mg/l, with those in the two intermediate quartiles, i.e., with 0.82 < CRP < 3.05, and those in the lowest quartile, i.e., with CRP <0.82 mg/l according to gender. MSX, which had a prevalence of 31%, was significantly associated with elevated CRP levels. Among MSX components, the strongest positive association with the highest quartile of CRP was with waist circumference in males as well as in females (age-adjusted odds ratio OR 3.06 and 95% confidence interval CI 1.82-5.14; OR 7.04 and 95% CI 4.79-10.34, respectively). Each component of the MSX, such as abnormal fasting plasma glucose (OR 2.90, 95% CI 1.69-4.99), triglycerides (OR 1.96, 95% CI 1.30-2.96), high-density lipoprotein cholesterol (OR 2.31, 95% CI 1.61-3.30), and blood pressure (OR 1.66, 95% CI 1.12-2.45), was significantly associated with high CRP values in elderly women only. In men, only current smoking was significantly associated with high CRP levels (OR 1.52, 95% CI 1.04-2.2). In multivariate analysis, the waist circumference remained significantly associated with high CRP levels, with a graded effect of CRP quartile whatever the gender. In men, current and former smoking remained significantly associated with the CRP levels. In women, the association observed in univariate analysis with fasting glucose or hypertension did not reach statistical significance in the multivariate analysis, while only a weak association could be observed with lipid parameters such as triglycerides and high-density lipoprotein cholesterol.

CONCLUSIONS

Abdominal adiposity adds to the variance in plasma CRP levels in elderly patients with MSX. This suggests that weight loss or other interventions targeted at adipocyte-related inflammation may represent an important means to prevent subclinical inflammation in the elderly, bearing a high risk of cardiovascular disease.

Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review

OBJECTIVE

To systematically evaluate the evidence for an association between physical activity of moderate intensity and risk of type 2 diabetes.

RESEARCH DESIGN AND METHODS

We searched EMBASE and Medline through March 2006 and examined reference lists of retrieved articles. We excluded studies that did not assess physical activity of moderate intensity independent of activities of vigorous intensity (more than six times the resting metabolic rate). Information on study design, participant characteristics, assessment of physical activity, and outcomes and estimates of associations were extracted independently by two investigators. We calculated summary relative risks (RRs) using a random-effects model for the highest versus the lowest reported duration of activities.

RESULTS

We identified 10 prospective cohort studies of physical activity of moderate intensity and type 2 diabetes, including a total of 301,221 participants and 9,367 incident cases. Five of these studies specifically investigated the role of walking. The summary RR of type 2 diabetes was 0.69 (95% CI 0.58-0.83) for regular participation in physical activity of moderate intensity as compared with being sedentary. Similarly, the RR was 0.70 (0.58-0.84) for regular walking (typically > or = 2.5 h/week brisk walking) as compared with almost no walking. The associations remained significant after adjustment for BMI. Similar associations were observed in men and women and in the U.S. and Europe.

CONCLUSIONS

These findings indicate that adherence to recommendations to participate in physical activities of moderate intensity such as brisk walking can substantially reduce the risk of type 2 diabetes.

Obesity in the elderly and its relationship with cardiovascular risk factors in Taiwan

OBJECTIVES

The obese elderly are at increased risk of mortality, morbidity, and functional disability. In this study, we examined the prevalence of obesity and relationship between various anthropometric indices (AI) and cardiovascular disease (CVD) risk factors in the elderly.

RESEARCH METHODS AND PROCEDURES

A stratified multistage clustered sampling scheme was used in the Elderly Nutrition and Health Survey in Taiwan during 1999 to 2000. 2432 non-institutionalized subjects (age, 72.8+/-9.4 years; BMI, 23.6+/-6.4 kg/m2) were recruited. The receiver operating characteristic analysis was used to compare predictive validity of CVD risk factors among various AI, including BMI, waist circumference (WC), and waist-to-hip ratio (WHR).

RESULTS

The prevalence of obesity was 29.0% in men and 36.8% in women by obesity criteria for Asians (BMI>or=25 kg/m2) and 13.3% in men and 21.0% in women by the Taiwanese definition (BMI>or=27 kg/m2). Odds ratios of acquiring various CVD risk factors increased significantly with increment of WC, WHR, and BMI. The areas under the curve predicting metabolic syndrome were all <0.8. The cut-off values of WC corresponding to the highest sensitivity and the highest specificity in predicting various CVD risk factors were 86.2-88.0 cm in men and 82.0-84.0 cm in women, respectively.

DISCUSSION

Obesity was prevalent in the Taiwanese elderly. WC was related to CVD risk factors to a greater extent than BMI and WHR. However, none of them alone was a good screening tool for CVD risk factors. Therefore, how to apply AI prudently to screen elderly for CVD risk factors needs further research.

Anthropometric parameters and type 2 diabetes: a case-control study in a Guadeloupean population

OBJECTIVE

The aim of this study was to quantify the association between three anthropometric parameters and type 2 diabetes in an adult population in Guadeloupe and to evaluate the effect of age on these associations.

DESIGNS AND METHODS

We conducted a case-control study in a population recruited in an Health Center of Guadeloupe in Year 2000. A total of 309 subjects with documented type 2 diabetes were matched on sex and age (+/- 2 Years) with controls free of any glycemic abnormality. Student t-test was used and conditional logistic regressions were performed separately for men and women to quantify the association between type 2 diabetes and the explanatory variables, body mass index (BMI), waist to hip ratio (WHR) and waist circumference (WC).

RESULTS

Mean (SD) WC was 89.0 cm (0.9) in non diabetics men and 97.3 cm (1.1) in diabetics ones, p<10-4. In women, it was 87.7 (0.8) cm for non diabetics and 96.3 cm (0.9) for diabetics. This difference was persistent for any tertile of age in each sex. It was discordant for BMI and WHR at higher tertile for men and women. In the multivariate analysis, Odds ratio[CI95%] for WC was 9.67 [2.32-40.20] in men and 2.97 [1.70-5.19] in women. It was 2.94 [0.99-8.74] in men and 6.15 [3.11-12.17] in women for WHR. Results for BMI were non significant in both sex.

CONCLUSION

Differences between WC and WHR over age groups and sex in predicting type 2 diabetes should be taken into account when using these parameters routinely in medical practice.

Obesity in the elderly: who should we be treating, and why, and how?

PURPOSE OF REVIEW

To investigate emerging data on the relationship between obesity, increased morbidity and mortality, and decreased function in the elderly. To examine what is known about the effectiveness of interventions, and how treatment might be improved.

RECENT FINDINGS

Obesity is a common problem in the elderly, although its prevalence decreases in extreme old age. Decreased physical activity and decreased energy expenditure with ageing predispose to fat accumulation and fat redistribution. Reduction in muscle mass (sarcopenic obesity) is an important determinant of physical function and metabolic rate. Chronic inflammation and endocrine changes contribute to the changes in metabolism and body composition that accompany ageing, and are potential therapeutic targets. Body weight and body mass index are imperfect indicators of risk from obesity. The focus of treatment should be on reduction of intra-abdominal fat and preservation of muscle mass and strength. A number of recent studies have confirmed the effectiveness of exercise interventions in the elderly. Progressive resistance training, rather than endurance exercise, may be more effective in many cases. Reduced function and decreased quality of life accompany development of the complications of obesity such as diabetes and vascular disorders. There is considerable scope to impede the development of these complications in the elderly with lifestyle interventions.

SUMMARY

Sarcopenic obesity, with accumulation of intra-abdominal fat, is a major determinant of health status in the elderly. As in the younger population, prevention and treatment programmes have the potential to decrease the impact of diabetes, vascular disease, and other complications of obesity.

Prevention of type 2 diabetes: data from recent trials

All four main studies of lifestyle intervention on diabetes incidence found a clear benefit for diet and exercise intervention compared with usual care. Although the study populations differed by race and ethnicity, the mean BMI, and the intensity of the lifestyle intervention provided, all investigators found substantial diabetes risk reduction with modest weight loss and increased physical activity. Results of these trials give health care providers useful and heartening information to share with patients at risk for diabetes. The challenge remains to find feasible and cost-efficient methods to identify people at risk and to deliver effective lifestyle interventions. Findings from trials of pharmacologic agents such as metformin, acarbose, and troglitazone are encouraging; however, the ADA recommends that drug therapy should not be used routinely to prevent diabetes until more information regarding the cost-effectiveness of such intervention is known [20]. Results from trials that found a lower incidence of diabetes among those randomly assigned to angiotensin-converting enzyme inhibitors, statins, or hormone therapy are intriguing but must be viewed with caution because they are based on post hoc analyses. Because it is difficult to conduct randomized controlled trials of major operative procedures such as bariatric surgery, observational studies that compare surgical interventions for weight loss with traditional weight-loss management may be the best evidence available. These studies have the potential for healthy-person bias in that people who choose bariatric surgery may have other healthy behaviors that are often difficult to measure and control for; such behaviors could account for their lower incidence of diabetes. Undeniably, the best test to diagnose those at high risk for diabetes is not yet known. New strategies that identify those with pre-diabetes and that overcome the limitations of the current tests, particularly the 2-hour post-challenge glucose test, are needed.

Can obesity be a risk factor in elderly people?

Obesity is increasing in middle-aged adults and in elderly subjects (over 65 years), owing to the concurrence of different factors: inactivity, wrong nutritional habits, and basal metabolism and nutritional need reduction. This condition is becoming a serious problem because of the increasing numbers of the aged population all over the world. In the past, obesity was considered as a 'secondary' pathology of no medical importance in old age; but nowadays, obesity is increasingly being studied in Geriatrics too, because it causes disability and because of its quality-of-life impairment consequences. The Euronut-Seneca study has confirmed the presence of obesity in both men and women in Europe. The definition of obesity, the reference values of body mass index and obesity as a mortality factor in elderly persons are still under discussion. Even when overweight does not represent a serious problem in old age, obese elderly people are certainly at risk of disability, morbidity and mortality. This review focuses on the potential risks of overweight and obesity in the aged population.