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Kalu ME, Dal Bello-Haas V, Griffin M, Boamah SA, Harris J, Zaide M, Rayner D, Khattab N, Bhatt V, Goodin C, Song JW(B, Smal J, Budd N. Physical mobility determinants among older adults: a scoping review of self-reported and performance-based measures. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2022. [DOI: 10.1080/21679169.2022.2153303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Michael E. Kalu
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Meridith Griffin
- Department of Health, Aging & Society, Faculty of Social Science, McMaster University, Hamilton, Canada
| | - Sheila A. Boamah
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Jocelyn Harris
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mashal Zaide
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Daniel Rayner
- Department of Health Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Nura Khattab
- Department of Kinesiology, Faculty of Sciences, McMaster University, Hamilton, Canada
| | - Vidhi Bhatt
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | | | | | - Justin Smal
- Manitoulin Physio Centre, M'Chigeeng, Canada
| | - Natalie Budd
- The Arthtitis and Sports Medicine Centre, Ancaster, Canada
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2
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Nicolson PJA, Sanchez-Santos MT, Bruce J, Kirtley S, Ward L, Williamson E, Lamb SE. Risk Factors for Mobility Decline in Community-Dwelling Older Adults: A Systematic Literature Review. J Aging Phys Act 2021; 29:1053-1066. [PMID: 34348224 DOI: 10.1123/japa.2020-0482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/18/2022]
Abstract
Mobility is essential to maintaining independence for older adults. This systematic review aimed to summarize evidence about self-reported risk factors for self-reported mobility decline; and to provide an overview of published prognostic models for self-reported mobility decline among community-dwelling older adults. Databases were searched from inception to June 2, 2020. Studies were screened by two independent reviewers who extracted data and assessed study quality. Sixty-one studies (45,187 participants) were included, providing information on 107 risk factors. High-quality evidence and moderate/large effect sizes for the association with mobility decline were found for older age beyond 75 years, the presence of widespread pain, and mobility modifications. Moderate-high quality evidence and small effect sizes were found for a further 21 factors. Three model development studies demonstrated acceptable model performance, limited by high risk of bias. These findings should be considered in intervention development, and in developing a prediction instrument for practical application.
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3
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Jayabalan P, Kocherginsky M, Chang AH, Rouleau GW, Koloms KL, Lee J, Dunlop D, Chang RW, Sharma L. Physical Activity and Worsening of Radiographic Findings in Persons With or at Higher Risk of Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2019; 71:198-206. [PMID: 30238649 DOI: 10.1002/acr.23756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 09/11/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The benefits of physical activity among persons with or at higher risk for knee osteoarthritis are well established. However, activity levels in this population are low, in part due to concern that activity will damage the knee joint. We hypothesized that sedentary and moderate-vigorous physical activity are each associated with greater risk of radiographic worsening of knee OA. METHODS In Osteoarthritis Initiative participants with or at higher risk for knee OA enrolled in an accelerometer substudy at 48 months (study baseline), physical activity was measured by a uniaxial accelerometer (ActiGraph GT1M). Radiographic progression was defined as any 48 month to 96 month worsening of Kellgren/Lawrence (K/L) grade scores. All analyses were knee-level; we used multivariable logistic regression with generalized estimating equations, adjusting for key covariates. RESULTS Of the 1,206 participants, 631 (52%) were female, the mean ± SD age was 64 ± 9 years, and mean ± SD body mass index (BMI) was 28 ± 5. The mean ± SD average daily sedentary activity was 602 ± 86 minutes, average daily light activity was 284 ± 75 minutes, and average daily moderate-vigorous activity was 20 ± 20 minutes. In 1,978 knees, 267 (14%) had worsening of K/L grade scores. In the multivariable model, age, sex, BMI, and pain, were associated with K/L grade worsening, but neither sedentary activity (adjusted odds ratio [OR] 0.99 [95% confidence interval (95% CI) 0.97-1.01]) nor moderate-vigorous activity (adjusted OR 1.00 [95% CI 0.91-1.09]) were associated with K/L grade worsening. CONCLUSION In persons with or at higher risk for knee OA, age, sex, BMI, and pain, but not objectively measured average daily minutes of sedentary or moderate-vigorous activity, were associated with subsequent worsening of K/L grade. Whether findings differ in persons with more severe knee OA and/or engaged more frequently in moderate-vigorous activity should be examined in future studies.
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Affiliation(s)
- Prakash Jayabalan
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Alison H Chang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gerald W Rouleau
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kimberly L Koloms
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jungwha Lee
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dorothy Dunlop
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rowland W Chang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leena Sharma
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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4
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Scott D, Seibel MJ, Cumming R, Naganathan V, Blyth F, Le Couteur DG, Handelsman DJ, Hsu B, Waite LM, Hirani V. Associations of Body Composition Trajectories with Bone Mineral Density, Muscle Function, Falls, and Fractures in Older Men: The Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci 2019; 75:939-945. [DOI: 10.1093/gerona/glz184] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Indexed: 12/17/2022] Open
Abstract
Abstract
Background
Weight loss increases fracture risk in older adults. We aimed to determine associations of 2-year body composition trajectories with subsequent falls and fractures in older men.
Methods
We measured appendicular lean mass (ALM) and total fat mass (FM) by dual-energy X-ray absorptiometry at baseline and Year 2 in 1,326 community-dwelling men aged ≥70 and older. Body composition trajectories were determined from residuals of a linear regression of change in ALM on change in FM (higher values indicate maintenance of ALM over FM), and a categorical variable for change in ALM and FM (did not lose [≥−5% change] versus lost [<−5% change]). Bone mineral density (BMD), hand grip strength, and gait speed were assessed at Years 2 and 5. After Year 2, incident fractures (confirmed by radiographical reports) and falls were recorded for 6.8 years.
Results
Compared with men who did not lose ALM or FM, men who did not lose ALM but lost FM, and men who lost both ALM and FM, had reduced falls (−24% and −34%, respectively; both p < .05). Men who lost ALM but did not lose FM had increased falls (incidence rate ratio = 1.73; 95% CI 1.37–2.18). ALM/FM change residuals were associated with improved lumbar spine BMD (B = 0.007; 95% CI 0.002–0.012 g/cm2 per SD increase) and gait speed (0.015; 0.001–0.029 m/s), and reduced hip fractures (hazard ratio = 0.68; 95% CI 0.47–0.99).
Conclusions
Fracture risk may be increased in older men who lose higher ALM relative to FM. Weight loss interventions for obese older men should target maintenance of lean mass.
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Affiliation(s)
- David Scott
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Department of Medicine and Australian Institute of Musculoskeletal Science, Melbourne Medical School – Western Campus, The University of Melbourne, St Albans, Victoria, Australia
| | - Markus J Seibel
- Bone Research Program, ANZAC Research Institute, and Department of Endocrinology & Metabolism, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Robert Cumming
- School of Public Health, University of Sydney, New South Wales, Australia
- Centre for Education and Research on Ageing and Alzheimer’s Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia
- The ARC Centre of Excellence in Population Ageing Research, University of Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing and Alzheimer’s Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Fiona Blyth
- Centre for Education and Research on Ageing and Alzheimer’s Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing and Alzheimer’s Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia
- ANZAC Research Institute & Charles Perkins Centre, University of Sydney, New South Wales, Australia
| | - David J Handelsman
- Department of Andrology, Concord Hospital & ANZAC Research Institute, University of Sydney, New South Wales, Australia
| | - Benjumin Hsu
- Department of Andrology, Concord Hospital & ANZAC Research Institute, University of Sydney, New South Wales, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing and Alzheimer’s Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Vasant Hirani
- Centre for Education and Research on Ageing and Alzheimer’s Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia
- School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, New South Wales, Australia
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5
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Baker JF, England BR, Mikuls TR, Sayles H, Cannon GW, Sauer BC, George MD, Caplan L, Michaud K. Obesity, Weight Loss, and Progression of Disability in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2019; 70:1740-1747. [PMID: 29707921 DOI: 10.1002/acr.23579] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/10/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Cross-sectional studies have demonstrated that obese patients with rheumatoid arthritis (RA) often report greater disability. The longitudinal effects of obesity, however, are not well-characterized. We evaluated associations between obesity, weight loss, and worsening of disability in patients of 2 large registry studies, which included patients who were followed for longer periods of time. METHODS This study included patients with RA from the National Data Bank for Rheumatic Diseases (FORWARD) (n = 23,323) and the Veterans Affairs RA (VARA) registry study (n = 1,697). Results of the Health Assessment Questionnaire (HAQ) or Multidimensional HAQ (MD-HAQ) were recorded through follow-up. Significant worsening of disability was defined as an increase of >0.2 in HAQ or MD-HAQ scores. The Cox proportional hazards model was used to evaluate the risk of worsening of disability from baseline and to adjust for demographics, baseline disability, comorbidity, disease duration, and other disease features. RESULTS At enrollment, disability scores were higher among severely obese patients compared to those who were overweight both in FORWARD (β = 0.17 [95% confidence interval (95% CI) 0.14, 0.20]; P < 0.001) and in the VARA registry (β = 0.17 [95% CI 0.074, 0.27]; P = 0.001). In multivariable models, patients who were severely obese at enrollment had a greater risk of progressive disability compared to overweight patients in FORWARD (HR 1.25 [95% CI 1.18, 1.33] P < 0.001) and in the VARA registry (HR 1.33 [95% CI 1.07, 1.66]; P = 0.01). Weight loss following enrollment was also associated with a greater risk in both cohorts. In the VARA registry, associations were independent of other clinical factors, including time-varying C-reactive protein and swollen joint count. CONCLUSION Severe obesity is associated with a more rapid progression of disability in RA. Weight loss is also associated with worsening disability, possibly due to it being an indication of chronic illness and the development of age-related or disease-related frailty.
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Affiliation(s)
- Joshua F Baker
- Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, and University of Pennsylvania, Philadelphia
| | - Bryant R England
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska
| | - Ted R Mikuls
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska, University of Nebraska Medical Center, Omaha
| | | | - Grant W Cannon
- Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, and University of Utah, Salt Lake City
| | - Brian C Sauer
- Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, and University of Utah, Salt Lake City
| | | | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and the National Data Bank for Rheumatic Diseases, Wichita, Kansas
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Carbone JW, Pasiakos SM. Dietary Protein and Muscle Mass: Translating Science to Application and Health Benefit. Nutrients 2019; 11:nu11051136. [PMID: 31121843 PMCID: PMC6566799 DOI: 10.3390/nu11051136] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/08/2019] [Accepted: 05/20/2019] [Indexed: 12/14/2022] Open
Abstract
Adequate consumption of dietary protein is critical for the maintenance of optimal health during normal growth and aging. The current Recommended Dietary Allowance (RDA) for protein is defined as the minimum amount required to prevent lean body mass loss, but is often misrepresented and misinterpreted as a recommended optimal intake. Over the past two decades, the potential muscle-related benefits achieved by consuming higher-protein diets have become increasingly clear. Despite greater awareness of how higher-protein diets might be advantageous for muscle mass, actual dietary patterns, particularly as they pertain to protein, have remained relatively unchanged in American adults. This lack of change may, in part, result from confusion over the purported detrimental effects of higher-protein diets. This manuscript will highlight common perceptions and benefits of dietary protein on muscle mass, address misperceptions related to higher-protein diets, and comment on the translation of academic advances to real-life application and health benefit. Given the vast research evidence supporting the positive effects of dietary protein intake on optimal health, we encourage critical evaluation of current protein intake recommendations and responsible representation and application of the RDA as a minimum protein requirement rather than one determined to optimally meet the needs of the population.
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Affiliation(s)
- John W Carbone
- School of Health Sciences, Eastern Michigan University, Ypsilanti, MI 48197, USA.
| | - Stefan M Pasiakos
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine (USARIEM), Natick, MA 01760, USA.
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7
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Ponti F, Santoro A, Mercatelli D, Gasperini C, Conte M, Martucci M, Sangiorgi L, Franceschi C, Bazzocchi A. Aging and Imaging Assessment of Body Composition: From Fat to Facts. Front Endocrinol (Lausanne) 2019; 10:861. [PMID: 31993018 PMCID: PMC6970947 DOI: 10.3389/fendo.2019.00861] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/25/2019] [Indexed: 01/10/2023] Open
Abstract
The aging process is characterized by the chronic inflammatory status called "inflammaging", which shares major molecular and cellular features with the metabolism-induced inflammation called "metaflammation." Metaflammation is mainly driven by overnutrition and nutrient excess, but other contributing factors are metabolic modifications related to the specific body composition (BC) changes occurring with age. The aging process is indeed characterized by an increase in body total fat mass and a concomitant decrease in lean mass and bone density, that are independent from general and physiological fluctuations in weight and body mass index (BMI). Body adiposity is also re-distributed with age, resulting in a general increase in trunk fat (mainly abdominal fat) and a reduction in appendicular fat (mainly subcutaneous fat). Moreover, the accumulation of fat infiltration in organs such as liver and muscles also increases in elderly, while subcutaneous fat mass tends to decrease. These specific variations in BC are considered risk factors for the major age-related diseases, such as cardiovascular diseases, type 2 diabetes, sarcopenia and osteoporosis, and can predispose to disabilities. Thus, the maintenance of a balance rate of fat, muscle and bone is crucial to preserve metabolic homeostasis and a health status, positively contributing to a successful aging. For this reason, a detailed assessment of BC in elderly is critical and could be an additional preventive personalized strategy for age-related diseases. Despite BMI and other clinical measures, such as waist circumference measurement, waist-hip ratio, underwater weighing and bioelectrical impedance, are widely used as a surrogate measure for body adiposity, they barely reflect the distribution of body fat. Because of the great advantages offered by imaging tools in research and clinics, the attention of clinicians is now moving to powerful imaging techniques such as computed tomography, magnetic resonance imaging, dual-energy X-ray absorptiometry and ultrasound to obtain a more accurate estimation of BC. The aim of this review is to present the state of the art of the imaging techniques that are currently available to measure BC and that can be applied to the study of BC changes in the elderly, outlining advantages and disadvantages of each technique.
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Affiliation(s)
- Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Aurelia Santoro
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- C.I.G. Interdepartmental Centre “L. Galvani”, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- *Correspondence: Aurelia Santoro
| | - Daniele Mercatelli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Chiara Gasperini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Conte
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- C.I.G. Interdepartmental Centre “L. Galvani”, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Morena Martucci
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Luca Sangiorgi
- Department of Medical Genetics and Rare Orthopedic Disease & CLIBI Laboratory, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Franceschi
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Department of Applied Mathematics, Institute of Information Technology, Mathematics and Mechanics (ITMM), Lobachevsky State University of Nizhny Novgorod-National Research University (UNN), Nizhny Novgorod, Russia
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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8
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So ES. The Impacts of Weight Change and Weight Change Intention on Health-Related Quality of Life in the Korean Elderly. J Aging Health 2018; 31:1106-1120. [PMID: 29504447 DOI: 10.1177/0898264318761908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: This study aimed to identify the impacts of weight change and weight change intention on health-related quality of life (HRQL) among community-dwelling Korean elderly individuals. Method: Data on those aged 75 years and above from the Korean National Health and Nutrition Examination Survey were analyzed using multiple regression analysis. Results: Compared with no weight change, unintentional weight loss was associated with significantly lower adjusted overall HRQL and lower scores in the subdimensions of mobility, pain/discomfort, usual activities, and self-care (in order), whereas intentional weight loss was associated with significantly poorer scores for anxiety/depression. Weight gain showed no statistically significant differences in comparison with no weight change. Discussion: These findings suggest that weight maintenance or weight gain should be recommended rather than weight loss, whether unintentional or intentional, regardless of weight status, to improve HRQL among the elderly.
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Affiliation(s)
- Eun Sun So
- 1 Chonbuk National University, Jeonju-si, Republic of Korea
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9
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Kim SK, Kwon YH, Cho JH, Lee DY, Park SE, Oh HG, Park CY, Lee WY, Oh KW, Park SW, Rhee EJ. Changes in Body Composition According to Age and Sex among Young Non-Diabetic Korean Adults: The Kangbuk Samsung Health Study. Endocrinol Metab (Seoul) 2017; 32:442-450. [PMID: 29199402 PMCID: PMC5744730 DOI: 10.3803/enm.2017.32.4.442] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/14/2017] [Accepted: 09/26/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Age-related decreases in lean mass represent a serious health problem. We aimed to analyze the risks of rapid decreases in lean mass by age and sex in relatively young Korean adults during a 4-year follow-up study. METHODS A total of 65,856 non-diabetic participants (59.5% men, mean age 39.1 years) in a health screening program were subjected to bioimpedance body composition analyses and metabolic parameter analyses at baseline and after 4 years. The participants were sub-divided according to age, and additionally to six groups by age and the degree of body weight change over the 4-year period. The actual changes in body weight, lean mass, and fat mass and the percent changes over the 4-year period were assessed. RESULTS The percent change in lean mass decreased and the percent change of fat mass increased with increasing age in every age and sex group. However, the annual percent decrease in lean mass and percent increase in fat mass were significantly higher among women than among men (-0.26% vs. -0.15% and 0.34% vs. 0.42%, respectively; P<0.01). Participants who were older than 50 years and had a weight loss <-5% during the 4 years had significantly greater decreases in lean mass and smaller decreases in fat mass, compared to those who were younger than 50 years. An odds ratio analysis to determine the lowest quartile of the percent change in lean mass according to age group revealed that participants older than 60 years had a significantly increased risk of a rapid decrease in the lean mass percentage (2.081; 95% confidence interval, 1.678 to 2.581). CONCLUSION Even in this relatively young study population, the lean mass decreased significantly with age, and the risk of a rapid decrease in lean mass was higher among women than among men. Furthermore, the elderly exhibited a significantly more rapid decrease in lean mass, compared with younger participants.
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Affiliation(s)
- Seul Ki Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yu Hyun Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hwan Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Da Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Se Eun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Geun Oh
- Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Cheol Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Won Oh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Woo Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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10
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Shlisky J, Bloom DE, Beaudreault AR, Tucker KL, Keller HH, Freund-Levi Y, Fielding RA, Cheng FW, Jensen GL, Wu D, Meydani SN. Nutritional Considerations for Healthy Aging and Reduction in Age-Related Chronic Disease. Adv Nutr 2017; 8:17-26. [PMID: 28096124 PMCID: PMC5227979 DOI: 10.3945/an.116.013474] [Citation(s) in RCA: 229] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A projected doubling in the global population of people aged ≥60 y by the year 2050 has major health and economic implications, especially in developing regions. Burdens of unhealthy aging associated with chronic noncommunicable and other age-related diseases may be largely preventable with lifestyle modification, including diet. However, as adults age they become at risk of "nutritional frailty," which can compromise their ability to meet nutritional requirements at a time when specific nutrient needs may be high. This review highlights the role of nutrition science in promoting healthy aging and in improving the prognosis in cases of age-related diseases. It serves to identify key knowledge gaps and implementation challenges to support adequate nutrition for healthy aging, including applicability of metrics used in body-composition and diet adequacy for older adults and mechanisms to reduce nutritional frailty and to promote diet resilience. This review also discusses management recommendations for several leading chronic conditions common in aging populations, including cognitive decline and dementia, sarcopenia, and compromised immunity to infectious disease. The role of health systems in incorporating nutrition care routinely for those aged ≥60 y and living independently and current actions to address nutritional status before hospitalization and the development of disease are discussed.
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Affiliation(s)
- Julie Shlisky
- The Sackler Institute for Nutrition Science at the New York Academy of Sciences, New York, NY;
| | - David E Bloom
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA
| | | | - Katherine L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Heather H Keller
- Schlegel-UW Research Institute for Aging, Applied Health Sciences, University of Waterloo, Ontario, Canada
| | - Yvonne Freund-Levi
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
- Department of Geriatrics, Karolinska University Hospital, Huddinge, Sweden
- Department of Psychiatry, Tiohundra Hospital, Stockholm, Sweden
| | | | - Feon W Cheng
- The Pennsylvania State University, University Park, PA; and
| | | | - Dayong Wu
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
| | - Simin N Meydani
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
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11
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Hajek A, König HH. The Curvilinear Effect of BMI on Functional Health - Evidence of the Long-Running German Ageing Survey. Obes Facts 2017; 10:252-260. [PMID: 28601863 PMCID: PMC5644952 DOI: 10.1159/000471486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 03/09/2017] [Indexed: 11/19/2022] Open
Abstract
AIMS We aimed at determining the effect of BMI on functional health among older Germans longitudinally. METHODS Data from four waves (2002-2014) of the German Ageing Survey ('Deutscher Alterssurvey'; DEAS), a representative sample of community-dwelling individuals aged 40 years and above, were used. Functional health was quantified by the subscale 'physical functioning' of the 36-Item Short Form Health Survey (SF-36). Fixed effects regressions were used to estimate the predictors of functional health. Linear, quadratic, and cubic terms were included for BMI (self-reported). RESULTS Fixed effects regressions showed significant linear, quadratic, and cubic effects of BMI on functional health in the total sample and in both sexes. Furthermore, regressions revealed that functional health decreased with increasing age in the total sample and in both sexes. In addition, changes in marital and employment status were significantly associated with changes in functional health in men, but not in women. CONCLUSION Our data indicate that the greater the extreme of BMI (either higher or lower), the greater the risk for functional decline. Nutrition programs aimed at preventing changes to extreme BMI might be productive.
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Affiliation(s)
- André Hajek
- *Dr. André Hajek, Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany,
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Magnani JW, Wang N, Benjamin EJ, Garcia ME, Bauer DC, Butler J, Ellinor PT, Kritchevsky S, Marcus GM, Newman A, Phillips CL, Sasai H, Satterfield S, Sullivan LM, Harris TB. Atrial Fibrillation and Declining Physical Performance in Older Adults: The Health, Aging, and Body Composition Study. Circ Arrhythm Electrophysiol 2016; 9:e003525. [PMID: 27052031 DOI: 10.1161/circep.115.003525] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/18/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Age is the foremost risk factor for atrial fibrillation (AF), and AF has a rising prevalence in older adults. How AF may contribute to decline in physical performance in older adults has had limited investigation. We examined the associations of incident AF and 4-year interval declines in physical performance at ages 70, 74, 78, and 82 years in the Health, Aging, and Body Composition (Health ABC) Study. METHODS AND RESULTS Health ABC is a prospective cohort of community-dwelling older adults (n=3075). The study conducted serial assessments of physical performance with the Health ABC physical performance battery (scored 0-4), grip strength, 2-minute walk distance, and 400-m walking time. Incident AF was identified from the Center for Medicare and Medicaid Services and related to 4-year interval decline in physical performance. After exclusions, the analysis included 2753 Health ABC participants (52% women, 41% black race). Participants with AF had a significantly greater 4-year physical performance battery decline than those without AF at age 70, 74, 78, and 82, with mean estimated decline ranging from -0.08 to -0.10 U (95% confidence interval, -0.18 to -0.01; P<0.05 for all estimates) after multivariable adjustment. Grip strength, walk distance, and walk time similarly showed significantly greater declines at each 4-year age interval in participants with AF. CONCLUSIONS In community-based cohort older adults, incident AF was associated with increased risk of decline in physical performance. Further research is essential to identify mechanisms and preventive strategies for how AF may contribute toward declining physical performance in older adults.
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Affiliation(s)
- Jared W Magnani
- From the Section of Cardiovascular Medicine, Boston University School of Medicine & National Heart, Lung and Blood Institute and Boston University's Framingham Heart Study, MA (J.W.M., E.J.B.); Department of Biostatistics, Boston University School of Public Health, MA (N.W., L.M.S.); Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (M.E.G., C.L.P.); Division of General Internal Medicine, University of California, San Francisco (D.C.B.); Stony Brook University, NY (J.B.); Cardiovascular Research Center, Massachusetts General Hospital, Charlestown & Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (P.T.E.); Program in Population and Medical Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC (S.K.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.); Department of Epidemiology, University of Pittsburgh, PA (A.N.); University of Tsukuba Faculty of Medicine, Tsukuba, Japan (H.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); and Geriatric Epidemiology Section, National Institute on Aging, Bethesda, MD (T.B.H.).
| | - Na Wang
- From the Section of Cardiovascular Medicine, Boston University School of Medicine & National Heart, Lung and Blood Institute and Boston University's Framingham Heart Study, MA (J.W.M., E.J.B.); Department of Biostatistics, Boston University School of Public Health, MA (N.W., L.M.S.); Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (M.E.G., C.L.P.); Division of General Internal Medicine, University of California, San Francisco (D.C.B.); Stony Brook University, NY (J.B.); Cardiovascular Research Center, Massachusetts General Hospital, Charlestown & Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (P.T.E.); Program in Population and Medical Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC (S.K.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.); Department of Epidemiology, University of Pittsburgh, PA (A.N.); University of Tsukuba Faculty of Medicine, Tsukuba, Japan (H.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); and Geriatric Epidemiology Section, National Institute on Aging, Bethesda, MD (T.B.H.)
| | - Emelia J Benjamin
- From the Section of Cardiovascular Medicine, Boston University School of Medicine & National Heart, Lung and Blood Institute and Boston University's Framingham Heart Study, MA (J.W.M., E.J.B.); Department of Biostatistics, Boston University School of Public Health, MA (N.W., L.M.S.); Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (M.E.G., C.L.P.); Division of General Internal Medicine, University of California, San Francisco (D.C.B.); Stony Brook University, NY (J.B.); Cardiovascular Research Center, Massachusetts General Hospital, Charlestown & Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (P.T.E.); Program in Population and Medical Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC (S.K.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.); Department of Epidemiology, University of Pittsburgh, PA (A.N.); University of Tsukuba Faculty of Medicine, Tsukuba, Japan (H.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); and Geriatric Epidemiology Section, National Institute on Aging, Bethesda, MD (T.B.H.)
| | - Melissa E Garcia
- From the Section of Cardiovascular Medicine, Boston University School of Medicine & National Heart, Lung and Blood Institute and Boston University's Framingham Heart Study, MA (J.W.M., E.J.B.); Department of Biostatistics, Boston University School of Public Health, MA (N.W., L.M.S.); Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (M.E.G., C.L.P.); Division of General Internal Medicine, University of California, San Francisco (D.C.B.); Stony Brook University, NY (J.B.); Cardiovascular Research Center, Massachusetts General Hospital, Charlestown & Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (P.T.E.); Program in Population and Medical Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC (S.K.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.); Department of Epidemiology, University of Pittsburgh, PA (A.N.); University of Tsukuba Faculty of Medicine, Tsukuba, Japan (H.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); and Geriatric Epidemiology Section, National Institute on Aging, Bethesda, MD (T.B.H.)
| | - Douglas C Bauer
- From the Section of Cardiovascular Medicine, Boston University School of Medicine & National Heart, Lung and Blood Institute and Boston University's Framingham Heart Study, MA (J.W.M., E.J.B.); Department of Biostatistics, Boston University School of Public Health, MA (N.W., L.M.S.); Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (M.E.G., C.L.P.); Division of General Internal Medicine, University of California, San Francisco (D.C.B.); Stony Brook University, NY (J.B.); Cardiovascular Research Center, Massachusetts General Hospital, Charlestown & Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (P.T.E.); Program in Population and Medical Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC (S.K.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.); Department of Epidemiology, University of Pittsburgh, PA (A.N.); University of Tsukuba Faculty of Medicine, Tsukuba, Japan (H.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); and Geriatric Epidemiology Section, National Institute on Aging, Bethesda, MD (T.B.H.)
| | - Javed Butler
- From the Section of Cardiovascular Medicine, Boston University School of Medicine & National Heart, Lung and Blood Institute and Boston University's Framingham Heart Study, MA (J.W.M., E.J.B.); Department of Biostatistics, Boston University School of Public Health, MA (N.W., L.M.S.); Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (M.E.G., C.L.P.); Division of General Internal Medicine, University of California, San Francisco (D.C.B.); Stony Brook University, NY (J.B.); Cardiovascular Research Center, Massachusetts General Hospital, Charlestown & Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (P.T.E.); Program in Population and Medical Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC (S.K.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.); Department of Epidemiology, University of Pittsburgh, PA (A.N.); University of Tsukuba Faculty of Medicine, Tsukuba, Japan (H.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); and Geriatric Epidemiology Section, National Institute on Aging, Bethesda, MD (T.B.H.)
| | - Patrick T Ellinor
- From the Section of Cardiovascular Medicine, Boston University School of Medicine & National Heart, Lung and Blood Institute and Boston University's Framingham Heart Study, MA (J.W.M., E.J.B.); Department of Biostatistics, Boston University School of Public Health, MA (N.W., L.M.S.); Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (M.E.G., C.L.P.); Division of General Internal Medicine, University of California, San Francisco (D.C.B.); Stony Brook University, NY (J.B.); Cardiovascular Research Center, Massachusetts General Hospital, Charlestown & Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (P.T.E.); Program in Population and Medical Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC (S.K.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.); Department of Epidemiology, University of Pittsburgh, PA (A.N.); University of Tsukuba Faculty of Medicine, Tsukuba, Japan (H.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); and Geriatric Epidemiology Section, National Institute on Aging, Bethesda, MD (T.B.H.)
| | - Stephen Kritchevsky
- From the Section of Cardiovascular Medicine, Boston University School of Medicine & National Heart, Lung and Blood Institute and Boston University's Framingham Heart Study, MA (J.W.M., E.J.B.); Department of Biostatistics, Boston University School of Public Health, MA (N.W., L.M.S.); Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (M.E.G., C.L.P.); Division of General Internal Medicine, University of California, San Francisco (D.C.B.); Stony Brook University, NY (J.B.); Cardiovascular Research Center, Massachusetts General Hospital, Charlestown & Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (P.T.E.); Program in Population and Medical Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC (S.K.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.); Department of Epidemiology, University of Pittsburgh, PA (A.N.); University of Tsukuba Faculty of Medicine, Tsukuba, Japan (H.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); and Geriatric Epidemiology Section, National Institute on Aging, Bethesda, MD (T.B.H.)
| | - Gregory M Marcus
- From the Section of Cardiovascular Medicine, Boston University School of Medicine & National Heart, Lung and Blood Institute and Boston University's Framingham Heart Study, MA (J.W.M., E.J.B.); Department of Biostatistics, Boston University School of Public Health, MA (N.W., L.M.S.); Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (M.E.G., C.L.P.); Division of General Internal Medicine, University of California, San Francisco (D.C.B.); Stony Brook University, NY (J.B.); Cardiovascular Research Center, Massachusetts General Hospital, Charlestown & Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (P.T.E.); Program in Population and Medical Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC (S.K.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.); Department of Epidemiology, University of Pittsburgh, PA (A.N.); University of Tsukuba Faculty of Medicine, Tsukuba, Japan (H.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); and Geriatric Epidemiology Section, National Institute on Aging, Bethesda, MD (T.B.H.)
| | - Anne Newman
- From the Section of Cardiovascular Medicine, Boston University School of Medicine & National Heart, Lung and Blood Institute and Boston University's Framingham Heart Study, MA (J.W.M., E.J.B.); Department of Biostatistics, Boston University School of Public Health, MA (N.W., L.M.S.); Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (M.E.G., C.L.P.); Division of General Internal Medicine, University of California, San Francisco (D.C.B.); Stony Brook University, NY (J.B.); Cardiovascular Research Center, Massachusetts General Hospital, Charlestown & Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (P.T.E.); Program in Population and Medical Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC (S.K.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.); Department of Epidemiology, University of Pittsburgh, PA (A.N.); University of Tsukuba Faculty of Medicine, Tsukuba, Japan (H.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); and Geriatric Epidemiology Section, National Institute on Aging, Bethesda, MD (T.B.H.)
| | - Caroline L Phillips
- From the Section of Cardiovascular Medicine, Boston University School of Medicine & National Heart, Lung and Blood Institute and Boston University's Framingham Heart Study, MA (J.W.M., E.J.B.); Department of Biostatistics, Boston University School of Public Health, MA (N.W., L.M.S.); Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (M.E.G., C.L.P.); Division of General Internal Medicine, University of California, San Francisco (D.C.B.); Stony Brook University, NY (J.B.); Cardiovascular Research Center, Massachusetts General Hospital, Charlestown & Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (P.T.E.); Program in Population and Medical Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC (S.K.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.); Department of Epidemiology, University of Pittsburgh, PA (A.N.); University of Tsukuba Faculty of Medicine, Tsukuba, Japan (H.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); and Geriatric Epidemiology Section, National Institute on Aging, Bethesda, MD (T.B.H.)
| | - Hiroyuki Sasai
- From the Section of Cardiovascular Medicine, Boston University School of Medicine & National Heart, Lung and Blood Institute and Boston University's Framingham Heart Study, MA (J.W.M., E.J.B.); Department of Biostatistics, Boston University School of Public Health, MA (N.W., L.M.S.); Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (M.E.G., C.L.P.); Division of General Internal Medicine, University of California, San Francisco (D.C.B.); Stony Brook University, NY (J.B.); Cardiovascular Research Center, Massachusetts General Hospital, Charlestown & Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (P.T.E.); Program in Population and Medical Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC (S.K.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.); Department of Epidemiology, University of Pittsburgh, PA (A.N.); University of Tsukuba Faculty of Medicine, Tsukuba, Japan (H.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); and Geriatric Epidemiology Section, National Institute on Aging, Bethesda, MD (T.B.H.)
| | - Suzanne Satterfield
- From the Section of Cardiovascular Medicine, Boston University School of Medicine & National Heart, Lung and Blood Institute and Boston University's Framingham Heart Study, MA (J.W.M., E.J.B.); Department of Biostatistics, Boston University School of Public Health, MA (N.W., L.M.S.); Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (M.E.G., C.L.P.); Division of General Internal Medicine, University of California, San Francisco (D.C.B.); Stony Brook University, NY (J.B.); Cardiovascular Research Center, Massachusetts General Hospital, Charlestown & Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (P.T.E.); Program in Population and Medical Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC (S.K.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.); Department of Epidemiology, University of Pittsburgh, PA (A.N.); University of Tsukuba Faculty of Medicine, Tsukuba, Japan (H.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); and Geriatric Epidemiology Section, National Institute on Aging, Bethesda, MD (T.B.H.)
| | - Lisa M Sullivan
- From the Section of Cardiovascular Medicine, Boston University School of Medicine & National Heart, Lung and Blood Institute and Boston University's Framingham Heart Study, MA (J.W.M., E.J.B.); Department of Biostatistics, Boston University School of Public Health, MA (N.W., L.M.S.); Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (M.E.G., C.L.P.); Division of General Internal Medicine, University of California, San Francisco (D.C.B.); Stony Brook University, NY (J.B.); Cardiovascular Research Center, Massachusetts General Hospital, Charlestown & Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (P.T.E.); Program in Population and Medical Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC (S.K.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.); Department of Epidemiology, University of Pittsburgh, PA (A.N.); University of Tsukuba Faculty of Medicine, Tsukuba, Japan (H.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); and Geriatric Epidemiology Section, National Institute on Aging, Bethesda, MD (T.B.H.)
| | - Tamara B Harris
- From the Section of Cardiovascular Medicine, Boston University School of Medicine & National Heart, Lung and Blood Institute and Boston University's Framingham Heart Study, MA (J.W.M., E.J.B.); Department of Biostatistics, Boston University School of Public Health, MA (N.W., L.M.S.); Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (M.E.G., C.L.P.); Division of General Internal Medicine, University of California, San Francisco (D.C.B.); Stony Brook University, NY (J.B.); Cardiovascular Research Center, Massachusetts General Hospital, Charlestown & Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston (P.T.E.); Program in Population and Medical Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (P.T.E.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC (S.K.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.); Department of Epidemiology, University of Pittsburgh, PA (A.N.); University of Tsukuba Faculty of Medicine, Tsukuba, Japan (H.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); and Geriatric Epidemiology Section, National Institute on Aging, Bethesda, MD (T.B.H.)
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Factors associated with (risk of) undernutrition in
community-dwelling older adults receiving home care: a cross-sectional study in
the Netherlands. Public Health Nutr 2016; 19:2278-89. [DOI: 10.1017/s1368980016000288] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AbstractObjectiveIt is generally thought that causes of undernutrition are multifactorial, but
there are limited quantitative studies performed. We therefore examined a
wide range of potential factors associated with undernutrition in
community-dwelling older adults.DesignCross-sectional study.SettingCommunity-dwelling older adults (≥65 years) receiving home care in the
Netherlands.SubjectsData on potential factors associated with (risk of) undernutrition were
collected among 300 older adults. Nutritional status was assessed by the
SNAQ65+ instrument. Undernutrition was defined as
mid-upper arm circumference <25 cm or unintentional weight loss of
≥4 kg in 6 months. Being at risk of undernutrition was defined as
having poor appetite and inability to walk up and down stairs of fifteen
steps, without resting.ResultsOf all participants, ninety-two (31·7 %) were undernourished
and twenty-four (8·0 %) were at risk of undernutrition. Based
on multivariate logistic regression analyses, the statistically significant
factors associated with (risk of) undernutrition
(P<0·05) were: unable to go outside
(OR=5·39), intestinal problems (OR=2·88),
smoking (OR=2·56), osteoporosis (OR=2·46),
eating fewer than three snacks daily (OR=2·61), dependency in
activities of daily living (OR=1·21), physical inactivity
(OR=2·01), nausea (OR=2·50) and cancer
(OR=2·84); a borderline significant factor was depression
symptoms (OR=1·83,
P=0·053).ConclusionsThe study suggests that (risk of) undernutrition is a multifactorial problem
and that associated factors can be found in several domains. These findings
may support the development of intervention trials for the prevention and
treatment of undernutrition in community-dwelling older adults.
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Should significant weight loss mandated to be “unintentional” for resulting in and regarded as malnutrition? Clin Nutr 2016; 35:234. [DOI: 10.1016/j.clnu.2015.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/24/2015] [Indexed: 11/22/2022]
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Beavers KM, Neiberg RH, Houston DK, Bray GA, Hill JO, Jakicic JM, Johnson KC, Kritchevsky SB. Body Weight Dynamics Following Intentional Weight Loss and Physical Performance: The Look AHEAD Movement and Memory Study. Obes Sci Pract 2015; 1:12-22. [PMID: 27453790 PMCID: PMC4950993 DOI: 10.1002/osp4.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective The aim of this study was to explore the impact of body weight change following intentional weight loss on measures of physical performance in adults with diabetes. Design and methods Four hundred fifty individuals with type 2 diabetes (age, 59.0 ± 6.9 years; body mass index, 35.5 ± 5.9 kg/m2) who participated in the Look AHEAD Movement and Memory Study and lost weight 1 year after being randomized to an intensive lifestyle intervention were assessed. Body weight was measured annually, and participants were categorized as continued losers/maintainers, regainers, or cyclers based on a ±5% annual change in weight. Objective measures of physical performance were measured at the year 8/9 visit. Results Forty‐four percent, 38% and 18% of participants were classified as regainers, cyclers, and continued losers/maintainers, respectively. In women, weight cycling and regain were associated with worse follow‐up expanded physical performance battery score (1.46 ± 0.07 and 1.48 ± 0.07 vs. 1.63 ± 0.07, both p ≤ 0.02) and slower 20‐m walking speed (1.10 ± 0.04 and 1.08 ± 0.04 vs. 1.17 ± 0.04 m/s, both p < 0.05) compared with continued or maintained weight loss. Male cyclers presented with weaker grip strength compared with regainers or continued losers/maintainers (30.12 ± 2.21 vs. 34.46 ± 2.04 and 37.39 ± 2.26 kg; both p < 0.01). Conclusions Weight cycling and regain following intentional weight loss in older adults with diabetes were associated with worse physical function in women and grip strength in men.
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Affiliation(s)
- Kristen M Beavers
- Department of Health and Exercise Science, Wake Forest School of Medicine, Winston-Salem, NC 27157; Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Rebecca H Neiberg
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Denise K Houston
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - George A Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, 70808
| | - James O Hill
- University of Colorado Denver School of Medicine, Aurora, CO 80010
| | | | - Karen C Johnson
- University of Tennessee Health Science Center, Memphis, TN 38105
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157
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Energy and protein intakes and their association with a decline in functional capacity among diabetic older adults from the NuAge cohort. Eur J Nutr 2015; 55:1729-39. [DOI: 10.1007/s00394-015-0991-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 07/03/2015] [Indexed: 12/25/2022]
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García-Esquinas E, Graciani A, Guallar-Castillón P, López-García E, Rodríguez-Mañas L, Rodríguez-Artalejo F. Diabetes and risk of frailty and its potential mechanisms: a prospective cohort study of older adults. J Am Med Dir Assoc 2015; 16:748-54. [PMID: 25986874 DOI: 10.1016/j.jamda.2015.04.008] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/09/2015] [Accepted: 04/13/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is emerging evidence of the role of diabetes as a risk factor for frailty. However, the mechanisms of this association are uncertain. METHODS Prospective cohort study of 1750 noninstitutionalized individuals aged 60 years or older recruited in 2008-2010. At baseline, information was obtained on health behaviors, morbidity, cardiometabolic biomarkers, and antidiabetic treatments. Individuals were considered diabetic if they reported a physician diagnosis or had fasting serum glucose of 126 mg/dL or higher. Study participants were followed through 2012 to assess incident frailty, defined as at least 3 of the 5 Fried criteria. RESULTS At baseline, the cohort included 346 individuals with diabetes and 1404 without diabetes. Over a mean 3.5-year follow-up, 115 cases of incident frailty were ascertained. After adjustment for age, sex, and education, participants with diabetes showed an increased risk of frailty (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.42-3.37). Additional adjustment for health behaviors and abdominal obesity yielded a 29.7% reduction in the OR (OR 1.83, 95% CI 1.16-2.90). Subsequent adjustment for morbidity produced an additional 8.4% reduction (OR 1.76, 95% CI 1.10-2.82), and for cardiometabolic biomarkers, a further 44% reduction (OR 1.32, 95% CI 0.70-2.49). In particular, adjustment for HbA1c, lipoproteins, and triglycerides accounted for the greatest reductions. Finally, additional adjustment for oral antidiabetic medication reduced the OR to 1.01 (95% CI 0.46-2.20), whereas adjustment for nutritional therapy increased the OR to 1.64 (95% CI 0.77-3.49). CONCLUSIONS Diabetes mellitus is associated with higher risk of frailty; this association is partly explained by unhealthy behaviors and obesity and, to a greater extent, by poor glucose control and altered serum lipid profile among diabetic individuals. Conversely, diabetes nutritional therapy reduces the risk of frailty.
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Affiliation(s)
- Esther García-Esquinas
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid / IdiPaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Auxiliadora Graciani
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid / IdiPaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Pilar Guallar-Castillón
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid / IdiPaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Esther López-García
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid / IdiPaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Fernando Rodríguez-Artalejo
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid / IdiPaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Artaud F, Singh-Manoux A, Dugravot A, Tavernier B, Tzourio C, Elbaz A. Body mass index trajectories and functional decline in older adults: Three-City Dijon cohort study. Eur J Epidemiol 2015; 31:73-83. [DOI: 10.1007/s10654-015-0027-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 03/27/2015] [Indexed: 10/23/2022]
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Rossi AP, Harris TB, Fantin F, Armellini F, Zamboni M. The multidomain mobility lab in older persons: from bench to bedside. The assessment of body composition in older persons at risk of mobility limitations. Curr Pharm Des 2015; 20:3245-55. [PMID: 24050162 DOI: 10.2174/13816128113196660694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 08/27/2013] [Indexed: 12/25/2022]
Abstract
With body composition it is possible to divide human body in compartments on the basis of different physical properties. The two level body composition model subdividing the whole body in fat mass and fat free mass is the most used in epidemiological and clinical studies in the elderly. Body composition techniques may be used to study ageing process. Changes in body composition occur as part of the normal ageing process and are associated with important effects on health and function. It has been shown that body composition changes with aging, with an increase in fat mass and a decrease in muscle mass, have important consequences on health and physical disability. Moreover body fat distribution changes with adverse metabolic profiles and increased cardiovascular risk. The purpose of this review is to describe the basic principles and techniques for fat free mass and fat mass evaluation, highlighting the advantages and limitations of different available body composition methods.
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Affiliation(s)
| | | | | | | | - Mauro Zamboni
- Cattedra di Geriatria, Università di Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126 Verona, Italy.
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van der Pols-Vijlbrief R, Wijnhoven HAH, Schaap LA, Terwee CB, Visser M. Determinants of protein-energy malnutrition in community-dwelling older adults: a systematic review of observational studies. Ageing Res Rev 2014; 18:112-31. [PMID: 25257179 DOI: 10.1016/j.arr.2014.09.001] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 09/05/2014] [Accepted: 09/15/2014] [Indexed: 01/17/2023]
Abstract
Protein-energy malnutrition is associated with numerous poor health outcomes, including high health care costs, mortality rates and poor physical functioning in older adults. This systematic literature review aims to identify and provide an evidence based overview of potential determinants of protein-energy malnutrition in community-dwelling older adults. A systematic search was conducted in PUBMED, EMBASE, CINAHL and COCHRANE from the earliest possible date through January 2013. Observational studies that examined determinants of protein-energy malnutrition were selected and a best evidence synthesis was performed to summarize the results. In total 28 studies were included in this review from which 122 unique potential determinants were derived. Thirty-seven determinants were examined in sufficient number of studies and were included in a best evidence synthesis. The best evidence score comprised design (cross-sectional, longitudinal) and quality of the study (high, moderate) to grade the evidence level. Strong evidence for an association with protein-energy malnutrition was found for poor appetite, and moderate evidence for edentulousness, having no diabetes, hospitalization and poor self-reported health. Strong evidence for no association was found for anxiety, chewing difficulty, few friends, living alone, feeling lonely, death of spouse, high number of diseases, heart failure and coronary failure, stroke (CVA) and the use of anti-inflammatory medications. This review shows that protein-energy malnutrition is a multifactorial problem and that different domains likely play a role in the pathway of developing protein-energy malnutrition. These results provide important knowledge for the development of targeted, multifactorial interventions that aim to prevent the development of protein-energy malnutrition in community-dwelling older adults.
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Affiliation(s)
- Rachel van der Pols-Vijlbrief
- Department of Health Sciences, EMGO(+) Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, EMGO(+) Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - Laura A Schaap
- Department of Epidemiology and Biostatistics, EMGO(+) Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, EMGO(+) Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, EMGO(+) Institute for Health and Care Research, VU University, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, EMGO(+) Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Roy M, Shatenstein B, Gaudreau P, Morais JA, Payette H. Seniors’ Body Weight Dissatisfaction and Longitudinal Associations With Weight Changes, Anorexia of Aging, and Obesity. J Aging Health 2014; 27:220-38. [PMID: 25117180 DOI: 10.1177/0898264314546715] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: We examined longitudinal associations between weight dissatisfaction, weight changes, anorexia of aging, and obesity among 1,793 seniors followed over 4 years between 2003 and 2009. Method: Obesity prevalence (body mass index [BMI] ≥ 30) and prevalence/incidence of weight dissatisfaction, anorexia of aging (self-reported appetite loss), and weight changes ≥5% were assessed. Predictors of weight loss ≥5%, anorexia of aging, and weight dissatisfaction were examined using logistic regressions. Results: Half of seniors experienced weight dissatisfaction (50.6%, 95% confidence interval [CI] = [48.1, 53.1]). Anorexia of aging and obesity prevalence was 7.0% (95% CI = [5.7, 8.3]) and 25.1% (95% CI = [22.9, 27.3]), whereas incidence of weight gain/loss ≥5% was 6.6% (95% CI = [1.3, 11.9]) and 8.8% (95% CI = [3.3, 14.3]). Weight gain ≥5% predicts men’s subsequent weight dissatisfaction (odds ratio [OR] = 6.66, 95% CI = [2.06, 21.60]). No other association was observed. Discussion: Weight dissatisfaction is frequent but not associated with subsequent eating disorders. In men, weight gain predicted weight dissatisfaction. Seniors’ weight dissatisfaction does not necessarily equate weight changes. Due to its high prevalence, it is of public health interest to understand how seniors’ weight dissatisfaction may impact health.
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Affiliation(s)
- Mathieu Roy
- Health & Social Services Center-University Institute of Geriatrics of Sherbrooke, Quebec, Canada
| | - Bryna Shatenstein
- Institut universitaire de gériatrie de Montréal, Quebec, Canada
- Université de Montréal, Quebec, Canada
| | - Pierrette Gaudreau
- Université de Montréal, Quebec, Canada
- Centre Hospitalier de l’Université de Montréal Research Center, Quebec, Canada
| | - José A. Morais
- McGill University Health Centre, Montréal, Quebec, Canada
| | - Hélène Payette
- Health & Social Services Center-University Institute of Geriatrics of Sherbrooke, Quebec, Canada
- Université de Sherbrooke, Quebec, Canada
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DiMaria-Ghalili RA. Integrating Nutrition in the Comprehensive Geriatric Assessment. Nutr Clin Pract 2014; 29:420-427. [DOI: 10.1177/0884533614537076] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Topsakal S, Akin F, Yerlikaya E, Erurker T, Dogu H. Dehydroepiandrosterone sulfate levels in Turkish obese patients. Eat Weight Disord 2014; 19:261-5. [PMID: 24715632 DOI: 10.1007/s40519-014-0120-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 03/20/2014] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Obesity is well known to be linked to higher morbidity and mortality. Elevated plasma levels of free dehydroepiandrosterone (DHEA) are associated with reduced obesity and more limited accumulation of abdominal body fat. In contrast, the relationship between the DHEA sulfate ester (DHEAS) and adiposity is inconsistent and contradictory. METHODS The aim of this study was to compare DHEAS levels in obese Turkish individuals, 37 men and 246 women. A variety of fatness, hormone, and blood parameters were measured. RESULTS Statistically significant differences were found between male and female individuals with respect to weight, waist circumference, fat %, insulin, and DHEAS levels. CONCLUSIONS We found that in the Turkish population, while a correlation between obesity parameters and DHEAS levels exists in both female and male individuals, DHEAS levels are significantly higher in obese male individuals than in obese female individuals.
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Affiliation(s)
- Senay Topsakal
- Department of Endocrinology and Metabolism, Burdur State Hospital, Yeni Mahalle, Burdur, 15030, Turkey,
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Gray-Donald K, St-Arnaud-McKenzie D, Gaudreau P, Morais JA, Shatenstein B, Payette H. Protein intake protects against weight loss in healthy community-dwelling older adults. J Nutr 2014; 144:321-6. [PMID: 24357473 DOI: 10.3945/jn.113.184705] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Weight loss is prevalent in the elderly population, with deleterious health consequences, notably loss of lean body mass and subsequent functional decline. Protein intake below the current RDA [0.8 g/(kg · d)] is also common in older adults; however, the link between the 2 has received little attention. Our objective was to assess the relation between protein intake and incident 1-y weight loss ≥5% in community-dwelling older adults. We conducted a nested, prospective, case-control study in 1793 community-living elderly participants of the Quebec Longitudinal Study of Nutrition as a Determinant of Successful Aging (NuAge). We studied 211 incident cases of 1-y weight loss (≥5%) and 211 weight-stable controls (±2%) matched by sex and age category (70 ± 2, 75 ± 2, and 80 ± 2 y). Diet was measured by 3 nonconsecutive 24-h recalls. ORs (95% CIs) for the association between protein intake and weight loss were computed by using conditional logistic regression. After adjustment for body mass index, energy intake, appetite, smoking status, physical activity level, physical function, chronic diseases and medications, depressive symptoms, and serum albumin and ultrasensitive C-reactive protein, the ORs of weight loss in participants with low protein intakes [<0.8 g/(kg · d)] were 2.56 (95% CI: 1.01, 6.50) compared with participants with very high protein intakes [≥1.2 g/(kg · d)]. Corresponding numbers were 2.15 (95% CI: 1.02, 4.56) in participants with moderate protein intakes [0.8-<1.0 g/(kg · d)] and 1.33 (95% CI: 0.77, 2.28) in participants with high protein intakes [1.0-1.2 g/(kg · d)]. Our results suggest that protein intakes >1.0 g/(kg · d) are protective against weight loss in healthy older adults. These findings add epidemiologic evidence in support of higher optimal protein intakes than the current guidelines for healthy older adults.
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Williams ED, Eastwood SV, Tillin T, Hughes AD, Chaturvedi N. The effects of weight and physical activity change over 20 years on later-life objective and self-reported disability. Int J Epidemiol 2014; 43:856-65. [PMID: 24562419 PMCID: PMC4052138 DOI: 10.1093/ije/dyu013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Weight and health behaviours are known to affect physical disability; however the evidence exploring the impact of changes to these lifestyle factors over the life course on disability is inconsistent. We aimed to explore the roles of weight and activity change between mid and later life on physical disability. Methods: Baseline and 20-year clinical follow-up data were collected from1418 men and women, aged 58–88 years at follow-up, as part of a population-based observational study based in north-west London. At clinic, behavioural data were collected by questionnaire and anthropometry measured. Disability was assessed using a performance-based locomotor function test and self-reported questionnaires on functional limitation and basic activities of daily living (ADLs). Results: At follow-up, 39% experienced a locomotor dysfunction, 24% a functional limitation and 17% an impairment of ADLs. Weight gain of 10–20% or >20% of baseline, but not weight loss, were associated with increased odds of a functional limitation [odds ratio (OR) 1.69, 95% confidence interval (CI) 1.14-2.49 and OR 2.74, 1.55-4.83, respectively], after full adjustment for covariates. The same patterns were seen for the other disability outcomes. Increased physical activity reduced, and decreased physical activity enhanced the likelihood of disability, independent of baseline behaviours and adiposity. The adverse effects of weight gain appeared to be lessened in the presence of increased later-life physical activity. Conclusion: Weight and activity changes between mid and later life have strong implications for physical functioning in older groups. These findings reinforce the importance of the maintenance of healthy weight and behaviour throughout the life course, and the need to promote healthy lifestyles across population groups.
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Affiliation(s)
- Emily D Williams
- International Centre for Circulatory Health, Imperial College London, London, UK
| | - Sophie V Eastwood
- International Centre for Circulatory Health, Imperial College London, London, UK
| | - Therese Tillin
- International Centre for Circulatory Health, Imperial College London, London, UK
| | - Alun D Hughes
- International Centre for Circulatory Health, Imperial College London, London, UK
| | - Nishi Chaturvedi
- International Centre for Circulatory Health, Imperial College London, London, UK
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Abstract
Nutrition and hydration are vital components of critical care nursing. However, meeting the nutrition and hydration needs of the critically ill older adult is often complex, because of preexisting risk factors (malnutrition, unintentional weight loss, frailty, and dehydration); as well as intensive care unit-related challenges (catabolism, eating and feeding, end-of-life care). This article highlights the challenges of managing nutrition and hydration in the critically ill older adult, reviews assessment principles, and offers strategies for optimizing nutrition and hydration.
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Fowler-Brown A, Wee CC, Marcantonio E, Ngo L, Leveille S. The mediating effect of chronic pain on the relationship between obesity and physical function and disability in older adults. J Am Geriatr Soc 2013; 61:2079-2086. [PMID: 24329819 DOI: 10.1111/jgs.12512] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine the extent to which bodily pain mediates the effect of obesity on disability and physical function. DESIGN Cross-sectional analysis. SETTING Population-based sample of residents in the greater Boston area. PARTICIPANTS Community-dwelling adults aged 70 and older (N=736). MEASUREMENTS Body mass index (BMI), obtained from measured height and weight, was categorized as normal weight (19.0-24.9 kg/m2), overweight (25.0-29.9 kg/m2), or obese (≥30.0 kg/m2). Main outcome measures were the Physical Component Summary of the Medical Outcomes Study 12-item Short-Form Survey (PCS), activity of daily living (ADL) disability, and Short Physical Performance Battery (SPPB) score. Chronic pain was assessed according to the number of weight-bearing joint sites that had pain (hips, knees, feet and pain all over). RESULTS Older obese adults had greater ADL disability and lower SPPB and PCS scores than their nonobese counterparts, although in sex-stratified adjusted analyses, obesity was adversely associated with outcomes only in women. Obesity was associated with greater number of pain sites; and more pain sites were associated with greater odds of disability. Mediation analysis suggests that pain is a significant mediator (22-44%) of the adverse effect of obesity on disability and physical function in women. CONCLUSION Bodily pain may be an important treatable mediator of the adverse effect of obesity on disability and physical function in women.
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Affiliation(s)
- Angela Fowler-Brown
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christina C Wee
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Edward Marcantonio
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Long Ngo
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Suzanne Leveille
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts, Boston, Massachusetts
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DiMaria-Ghalili RA, Sullivan-Marx EM, Compher C. Inflammation, Functional Status, and Weight Loss During Recovery From Cardiac Surgery in Older Adults. Biol Res Nurs 2013; 16:344-52. [DOI: 10.1177/1099800413503489] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To determine the nutritional, inflammatory, and functional aspects of unintentional weight loss after cardiac surgery that warrant further investigation. Research Methods and Procedures: Twenty community-dwelling adults > 65 years old undergoing cardiac surgery (coronary artery bypass graft [CABG] or CABG + valve) were recruited for this prospective longitudinal (preoperative and 4–6 weeks postdischarge) pilot study. Anthropometrics (weight, standing height, and mid-arm and calf circumference), nutritional status (Mini-Nutritional Assessment™ [MNA]), appetite, physical performance (timed chair stand), muscle strength (hand grip) and functional status (basic and instrumental activities of daily living), and inflammatory markers (plasma leptin, ghrelin, interleukin [IL]-6, high-sensitivity[hs] C-reactive protein, and serum albumin and prealbumin) were measured. Results: Participants who completed the study ( n = 11 males, n = 3 females) had a mean age 70.21 ± 4.02 years. Of these, 12 lost 3.66 ± 1.44 kg over the study period. Weight, BMI, activities of daily living, and leptin decreased over time ( p < .05). IL-6 increased over time ( p < .05). Ghrelin, hs-CRP, and timed chair stand increased over time in those who underwent combined procedures ( p < .05). Grip strength decreased in those who developed complications ( p = .004). Complications, readmission status, and lowered grip strength were found in those with low preoperative MNA scores ( p < .05). Conclusion: After cardiac surgery, postdischarge weight loss occurs during a continued inflammatory response accompanied by decreased physical functioning and may not be a positive outcome. The impacts of weight loss, functional impairment, and inflammation during recovery on disability and frailty warrant further study.
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Affiliation(s)
- Rose Ann DiMaria-Ghalili
- Doctoral Nursing Department and Nutrition Sciences Department, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | | | - Charlene Compher
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Riddle DL, Singh JA, Harmsen WS, Schleck CD, Lewallen DG. Clinically important body weight gain following knee arthroplasty: a five-year comparative cohort study. Arthritis Care Res (Hoboken) 2013. [PMID: 23203539 DOI: 10.1002/acr.21880] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The impact of knee arthroplasty on body weight has not been fully explored. Clinically important weight gain following knee arthroplasty would pose potentially important health risks. METHODS We used one of the largest US-based knee arthroplasty registries and a population-based control sample from the same geographic region to determine whether knee arthroplasty increases the risk of clinically important weight gain of ≥5% of baseline body weight over a 5-year postoperative period. RESULTS Of the persons in the knee arthroplasty sample, 30.0% gained ≥5% of baseline body weight 5 years following surgery as compared to 19.7% of the control sample. The multivariable-adjusted (age, sex, body mass index, education, comorbidity, and presurgical weight change) odds ratio (OR) was 1.6 (95% confidence interval [95% CI] 1.2-2.2) in persons with knee arthroplasty as compared to the control sample. Additional arthroplasty procedures during followup further increased the risk for weight gain (OR 2.1, 95% CI 1.4-3.1) relative to the control sample. Specifically, among patients with knee arthroplasty, younger patients and those who lost greater amounts of weight in the 5-year preoperative period were at greater risk for clinically important weight gain. CONCLUSION Patients who undergo knee arthroplasty are at an increased risk of clinically important weight gain following surgery. The findings potentially have broad implications to multiple members of the health care team. Future research should develop weight loss/maintenance interventions particularly for younger patients who have lost a substantial amount of weight prior to surgery, as they are most at risk for substantial postsurgical weight gain.
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Affiliation(s)
- Daniel L Riddle
- Virginia Commonwealth University, Departments of Physical Therapy and Orthopaedic Surgery, PO Box 980224, Richmond, VA 23298-0224, USA.
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Clinically important body weight gain following total hip arthroplasty: a cohort study with 5-year follow-up. Osteoarthritis Cartilage 2013; 21:35-43. [PMID: 23047011 PMCID: PMC4169300 DOI: 10.1016/j.joca.2012.09.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 08/09/2012] [Accepted: 09/11/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Literature examining the effects of total hip arthroplasty (THA) on subsequent body weight gain is inconclusive. Determining the extent to which clinically relevant weight gain occurs following THA has important public health implications. DESIGN We used multi-variable logistic regression to compare data from one of the largest US-based THA registries to a population-based control sample from the same geographic region. We also identified factors that increased risk of clinically important weight gain specifically among persons undergoing THA. The outcome measure of interest was weight gain of ≥5% of body weight up to 5 years following surgery. RESULTS The multi-variable adjusted [age, sex, body mass index (BMI), education, comorbidity and pre-surgical weight change] odds ratio for important weight gain was 1.7 [95% confidence interval (CI), 1.06, 2.6] for a person with THA as compared to the control sample. Additional arthroplasty procedures during the 5-year follow-up further increased odds for important weight gain (OR = 2.0, 95% CI, 1.4, 2.7) relative to the control sample. A patient with THA had increased risk of important post-surgical weight gain of 12% (OR = 1.12, 95% CI, 1.08, 1.16) for every kilogram of pre-operative weight loss. CONCLUSIONS While findings should be interpreted with caution because of missing follow-up weight data, patients with THA appear to be at increased risk of clinically important weight gain following surgery as compared to peers. Patients less than 60 years and who have lost a substantial amount of weight prior to surgery appear to be at particularly high risk of important post-surgical weight gain.
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Corona LP, Nunes DP, Alexandre TDS, Santos JLF, Duarte YADO, Lebrão ML. Weight gain among elderly women as risk factor for disability: Health, Well-being and Aging Study (SABE Study). J Aging Health 2012; 25:119-35. [PMID: 23277332 DOI: 10.1177/0898264312466261] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the association between weight change and the incidence of disability in activities of daily living (ADL) among elderly women. METHOD In 2006, 227 women aged ≥75 years and independent in ADL were selected from SABE Study (Health, Well-being, and Aging) in Sao Paulo, Brazil. The dependent variable was the report of difficulty on ≥1 ADL in 2009. Differences in weight were calculated between baseline and second interview, and converted to percentage change in relation to initial weight. A change (gain or loss) ≥5% was considered significant. A logistic regression analysis was performed including sociodemographic and health-related variables. RESULTS After adjusting, weight gain remained associated to disability (OR = 2.42; p = .027), whereas weigh loss lost significance (OR = 1.66; p = .384). DISCUSSION Weight loss is generally considered more worrisome than weight gain in elderly. However, weight loss alone was not a risk factor for disability in our study.
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Affiliation(s)
- Ligiana Pires Corona
- Department of Epidemiology, Faculty of Public Health, University of Sao Paulo, São Paulo, SP, Brazil.
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Schaap LA, Koster A, Visser M. Adiposity, Muscle Mass, and Muscle Strength in Relation to Functional Decline in Older Persons. Epidemiol Rev 2012; 35:51-65. [DOI: 10.1093/epirev/mxs006] [Citation(s) in RCA: 228] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 12/13/2022] Open
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Endevelt R, Lemberger J, Bregman J, Kowen G, Berger-Fecht I, Lander H, Karpati T, Shahar DR. Intensive dietary intervention by a dietitian as a case manager among community dwelling older adults: the EDIT study. J Nutr Health Aging 2011; 15:624-30. [PMID: 21968856 DOI: 10.1007/s12603-011-0074-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Clinical trials that have assessed the best approach for treating under-nutrition in old age are scarce. OBJECTIVE To determine the impact of an intensive nutritional intervention program led by a dietitian on the health and nutritional status of malnourished community dwelling older adults. METHODS Sixty-eight eligible participants (age<75) were randomly assigned to a Dietetic Intervention Treatment (DIT), an intensive nutritional intervention led by a dietitian, or a Medical Treatment (MT), a physician-led standard care group, with an educational booklet regarding dietary requirements and recommendations for older adults. An additional 59 eligible participants who were unable to participate in the randomization were included as a non-randomized "untreated nutrition" group (UNG). RESULTS Over the 6-month follow-up, the DIT group showed significant improvement in cognitive function (from 25.8±4.5 to 26.8±4, p=0.04), and depression score (from 7.3±3.9 to 5.4±3.9, p=0.04) compared with the change in the other 2 groups. The DIT group showed a significant improvement in intake of carbohydrates (+15% vs. +1% in the MT and +3% in the UNG), protein (+8% vs. +2% in the MT and -3% in the UNG), vitamin B6 (+20% vs. +7% in the MT and +8% in the UNG), and vitamin B1 (+22% vs. +11% in the MT and 0% in the UNG). The DIT group had a significantly lower cost of physician visits than the other 2 groups ($172.1±232.0 vs. $417.2±368.0 in the MT and $428.1±382.3 in the UNG, p=0.005). CONCLUSION Intensive dietary intervention was moderately effective in lowering cost of services used and improving medical and nutritional status among community dwelling older adults.
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Affiliation(s)
- R Endevelt
- Department of Public Health, University of Haifa, Haifa, Israel.
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Trends in the quality of care for elderly people with type 2 diabetes: The need for improvements in safety and quality (the 2001 and 2007 ENTRED Surveys). DIABETES & METABOLISM 2011; 37:152-61. [PMID: 21435929 DOI: 10.1016/j.diabet.2011.02.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 02/12/2011] [Indexed: 11/22/2022]
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Abstract
There is emerging evidence that weight change during older adulthood is associated with decreased physical function; however, less is known about the association between weight change during middle to older adulthood and physical function. This study assessed the association of weight change between middle and older adulthood and functional limitations among 2,531 older African-American and white participants, ages 65 and older at baseline (1987), from the Piedmont Health Survey of the Elderly. Weight gainers had ≥8% increase in weight, weight losers had >8% decrease in weight, and weight maintainers had <8% increase or decrease between age 50 and baseline. Functional limitations were categorized as none (0), mild (1-3), or severe (4 or more) using items from the activities of daily living scale by Katz and the extremity function scale by Nagi. Modified Poisson regression was used to assess these associations in crude and adjusted analyses. Weight gain and weight loss between age 50 and baseline were associated with severe functional limitations (prevalence ratio (PR) = 1.19, 95% CI: 1.04, 1.36 and PR = 1.58, 95% CI: 1.41, 1.78, respectively) compared to weight maintainers after adjustment for age, race, and gender. These associations were attenuated after additional adjustment for health characteristics, while weaker associations were noted for mild functional limitations. In summary, weight gain and weight loss between middle and older adulthood were associated with severe functional limitations among older adults in North Carolina. Additional research is needed to explore weight change across the life course and its possible effects on physical function later in life.
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Shahar DR, Yu B, Houston DK, Kritchevsky SB, Newman AB, Sellmeyer DE, Tylavsky FA, Lee JS, Harris TB. Misreporting of energy intake in the elderly using doubly labeled water to measure total energy expenditure and weight change. J Am Coll Nutr 2010; 29:14-24. [PMID: 20595641 DOI: 10.1080/07315724.2010.10719812] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND One of the major problems in dietary assessment is inaccuracy in reporting diet. OBJECTIVE To examine the association between self-reported energy intake (EI) by food frequency questionnaire (FFQ) and energy expenditure (EE), measured by doubly labeled water (DLW), among older persons. DESIGN EE was assessed in 298 high-functioning, community-dwelling older adults (70-79 years of age) over a 2-week period using DLW. Dietary intake was assessed using a Block FFQ. The ratio between reported EI and total energy expenditure (TEE) was calculated. Misreporting was defined as follows: participants with an EI/TEE ratio of <0.77 were categorized as low energy reporters, while participants with an EI/TEE ratio >1.28 were categorized as high energy reporters. Participants with an EI/TEE ratio of 0.77-1.28 were categorized as "true" energy reporters. One-year percent weight change prior to EE visit was used as another validation indicator. Participants who were low energy reporters but lost >2% of their body weight were categorized as undereaters. RESULTS Two hundred ninety-six participants provided both FFQ and DLW measurements. Forty-three percent of participants were low energy reporters; among them, almost 30% lost weight and, therefore, were categorized as undereaters. The undereaters consumed significantly fewer calories. No difference in the frequency of low energy reporting was detected between genders or racial groups. Underreporters had significantly higher body weight than "true" or high reporters. Undereaters tended to have higher body mass index than the underreporters. CONCLUSIONS Undereating is prevalent in the elderly and may be falsely perceived as underreporting. It should be further addressed and characterized in future studies.
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Affiliation(s)
- Danit R Shahar
- The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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St-Arnaud-McKenzie D, Payette H, Gray-Donald K. Low physical function predicts either 2-year weight loss or weight gain in healthy community-dwelling older adults. the NuAge Longitudinal Study. J Gerontol A Biol Sci Med Sci 2010; 65:1362-8. [PMID: 20813794 DOI: 10.1093/gerona/glq150] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Weight change in older adults affects physical function (PF). However, data suggest that, conversely, PF may be a determinant of weight change. Our objective was to assess the role of baseline PF as a predictor of 2-year weight loss (WL) and weight gain (WG) ≥ 5% among healthy well-functioning community-dwelling older adults. METHODS The NuAge cohort (67-84 years) was classified into three groups according to the percent weight change over a 2-year follow-up: weight stable (weight change ≤ 2%; n = 629), WL ≥ 5% (n = 189), and WG ≥ 5% (n = 111). A summary measure of baseline PF was computed (sum of biceps, quadriceps, and grip strength, timed up and go, chair stand, normal and maximal gait speed, and balance performance scores [individual test score range = 0-4]; PF score range = 0-32). Multivariable logistic regression models separately assessed the relationships between baseline PF and 2-year WL and WG ≥ 5%. RESULTS Baseline PF was worse in both the WL (p < .001) and the WG (p = .001) groups compared with the weight stable group. In models adjusting for sex, age, body mass index, energy intake, depressive symptoms, and other significantly associated covariates, each 1-unit increase in standard deviation of PF was associated with decreased risk of either 2-year WL (odds ratio = 0.79, 95% CI = 0.63-0.99, p = .043) or WG (odds ratio = 0.74, 95% CI = 0.55-0.99, p = .041). CONCLUSIONS Low baseline PF was an independent common predictor of 2-year WL and WG ≥ 5% in the healthy well-functioning community-dwelling elderly population. Whether PF is an early cause or marker of weight change in this population remains to be determined.
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Affiliation(s)
- Danielle St-Arnaud-McKenzie
- Faculty of Medicine and Health Sciences, University of Sherbrooke and Research Centre on Aging, Health and Social Services Centre, University Institute of Geriatrics of Sherbrooke, 1036 rue Belvédère Sud, Sherbrooke, Québec, Canada
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Delmonico MJ, Harris TB, Visser M, Park SW, Conroy MB, Velasquez-Mieyer P, Boudreau R, Manini TM, Nevitt M, Newman AB, Goodpaster BH. Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr 2009; 90:1579-85. [PMID: 19864405 PMCID: PMC2777469 DOI: 10.3945/ajcn.2009.28047] [Citation(s) in RCA: 935] [Impact Index Per Article: 62.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Sarcopenia is thought to be accompanied by increased muscle fat infiltration. However, no longitudinal studies have examined concomitant changes in muscle mass, strength, or fat infiltration in older adults. OBJECTIVE We present longitudinal data on age-related changes in leg composition, strength, and muscle quality (MQ) in ambulatory, well-functioning men and women. We hypothesized that muscle cross-sectional area (CSA) and strength would decrease and muscular fat infiltration would increase over 5 y. DESIGN Midthigh muscle, subcutaneous fat (SF), and intermuscular fat (IMF) CSAs and isokinetic leg muscle torque (MT) and MQ (MT/quadriceps CSA) were examined over 5 y in the Health, Aging, and Body Composition study cohort (n = 1678). RESULTS Men experienced a 16.1% loss of MT, whereas women experienced a 13.4% loss. Adjusted annualized decreases in MT were 2-5 times greater than the loss of muscle CSA in those who lost weight and in those who remained weight-stable. Weight gain did not prevent the loss of MT, despite a small increase in muscle CSA. Only those who gained weight had an increase in SF (P < 0.001), whereas those who lost weight also lost SF (P < 0.001). There was an age-related increase in IMF in men and women (P < 0.001), and IMF increased in those who lost weight, gained weight, or remained weight-stable (all P < 0.001). CONCLUSIONS Loss of leg MT in older adults is greater than muscle CSA loss, which suggests a decrease in MQ. Additionally, aging is associated with an increase in IMF regardless of changes in weight or SF.
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Affiliation(s)
- Matthew J Delmonico
- Department of Epidemiology and Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Davidson J, Randall GK, Getz MA. Self-Reported Height, Calculated Height, and Derived Body Mass Index in Assessment of Older Adults. ACTA ACUST UNITED AC 2009; 28:359-71. [DOI: 10.1080/01639360903393507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Voznesensky M, Walsh S, Dauser D, Brindisi J, Kenny AM. The association between dehydroepiandosterone and frailty in older men and women. Age Ageing 2009; 38:401-6. [PMID: 19276095 DOI: 10.1093/ageing/afp015] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES to evaluate the association between dehydroepiandosterone (DHEA) and physical frailty in older adults. DESIGN cross-sectional analysis of baseline information from three separate studies in healthy older men, women and residents of assisted living. SETTING academic health centre in greater Hartford, CT, USA. PARTICIPANTS eight hundred and ninety-eight adults residing in the community or assisted living facility. MEASUREMENTS participants had measurement of frailty (weight loss, grip strength, sense of exhaustion, walking speed and physical activity) and serum DHEAS levels. RESULTS overall, 6% of the individuals in the study were classified as frail, 58% intermediate frail and 35% were not frail. In the bivariate analysis, there were differences between categories of frailty across age, gender and by DHEAS levels. In an ordinal logistic regression model, with frailty as a dependent measure, we found that age, DHEAS and interactions of age and BMI and DHEAS and BMI were predictive of more frailty characteristics. CONCLUSION we found an association between frailty and DHEAS levels. Whether the association is due to similar conditions resulting in lower DHEA levels and more susceptibility to frailty or whether lower DHEA levels have an impact on increasing frailty cannot be addressed by cross-sectional analysis. Gender did not impact the association between DHEAS and frailty, but obesity (BMI > 30 kg/m(2)) attenuated the association between higher DHEA levels and lower frailty status.
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Affiliation(s)
- M Voznesensky
- University of Connecticut Health Center, Farmington, CT 06030, USA
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Arnold AM, Newman AB, Cushman M, Ding J, Kritchevsky S. Body weight dynamics and their association with physical function and mortality in older adults: the Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2009; 65:63-70. [PMID: 19386574 DOI: 10.1093/gerona/glp050] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To estimate the associations of weight dynamics with physical functioning and mortality in older adults. METHODS Longitudinal cohort study using prospectively collected data on weight, physical function, and health status in four U.S. Communities in the Cardiovascular Health Study. Included were 3,278 participants (2,013 women and 541 African Americans), aged 65 or older at enrollment, who had at least five weight measurements. Weight was measured at annual clinic visits between 1992 and 1999, and summary measures of mean weight, coefficient of variation, average annual weight change, and episodes of loss and gain (cycling) were calculated. Participants were followed from 1999 to 2006 for activities of daily living (ADL) difficulty, incident mobility limitations, and mortality. RESULTS Higher mean weight, weight variability, and weight cycling increased the risk of new onset of ADL difficulties and mobility limitations. After adjustment for risk factors, the hazard ratio (95% confidence interval) for weight cycling for incident ADL impairment was 1.28 (1.12, 1.47), similar to that for several comorbidities in our model, including cancer and diabetes. Lower weight, weight loss, higher variability, and weight cycling were all risk factors for mortality, after adjustment for demographic risk factors, height, self-report health status, and comorbidities. CONCLUSIONS Variations in weight are important indicators of future physical limitations and mortality in the elderly and may reflect difficulties in maintaining homeostasis throughout older ages. Monitoring the weight of an older person for fluctuations or episodes of both loss and gain is an important aspect of geriatric care.
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Affiliation(s)
- Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle, WA, USA.
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Stenholm S, Alley D, Bandinelli S, Griswold ME, Koskinen S, Rantanen T, Guralnik JM, Ferrucci L. The effect of obesity combined with low muscle strength on decline in mobility in older persons: results from the InCHIANTI study. Int J Obes (Lond) 2009; 33:635-44. [PMID: 19381155 DOI: 10.1038/ijo.2009.62] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Both obesity and muscle impairment are increasingly prevalent among older persons and negatively affect health and physical functioning. However, the combined effect of coexisting obesity and muscle impairment on physical function decline has been little studied. We examined whether obese persons with low muscle strength experience significantly greater declines in walking speed and mobility than persons with only obesity or low muscle strength. DESIGN Community-dwelling adults aged > or = 65 years (n = 930) living in the Chianti geographic area (Tuscany, Italy) were followed for 6 years in the population-based InCHIANTI study. MEASUREMENTS On the basis of baseline measurements (1998-2000), obesity was defined as body mass index (BMI) > or = 30 kg/m(2) and low muscle strength as lowest sex-specific tertile of knee extensor strength. Walking speed and self-reported mobility disability (ability to walk 400 m or climb one flight of stairs) were assessed at baseline and at 3- and 6-year follow-up. RESULTS At baseline, obese persons with low muscle strength had significantly lower walking speed compared with all other groups (P < or = 0.05). In longitudinal analyses, obese participants with low muscle strength had steeper decline in walking speed and high risk of developing new mobility disability over the 6-year follow-up compared with those without obesity or low muscle strength. After the age of 80, the differences between groups were substantially attenuated. The differences seen in walking speed across combination of low muscle strength and obesity groups were partly explained by 6-year changes in muscle strength, BMI and waist circumference. CONCLUSIONS Obesity combined with low muscle strength increases the risk of decline in walking speed and developing mobility disability, especially among persons < 80 years old.
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Affiliation(s)
- S Stenholm
- Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, MD 21225, USA.
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Affiliation(s)
- Carlos Lorenzo
- Department of Medicine, Division of Clinical Epidemiology, University of Texas Heath Science Center, San Antonio, Texas, USA.
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Zettel-Watson L, Britton M. The impact of obesity on the social participation of older adults. The Journal of General Psychology 2008; 135:409-23. [PMID: 18959230 DOI: 10.3200/genp.135.4.409-424] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Previous research (e.g., R. Puhl & K. P. Brownell, 2001) has indicated that stigma associated with obesity contributes to diminished social engagement for the obese, but there is evidence that this stigma is more pronounced in younger age groups. The present authors investigated whether the negative association between obesity and social participation that is apparent in younger age groups continues in older adulthood. The authors analyzed interview data from 1,439 participants aged 60-93 years (M age = 71 years, SD = 5.7 years) from the Changing Lives of Older Couples Study (D. Carr, R. Nesse, & C. Wortman, 2005). Regression results indicated that hypothesized interactions between age and body mass index (BMI) in predicting social participation were not significant after controlling for demographic variables, health status, depression, and self-esteem. In fact, higher BMI was associated with greater overall and formal social participation (i.e., organizations, volunteer work, church), suggesting not only that stigmatization against the obese appears to decrease with age but also that additional factors play a role.
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Affiliation(s)
- Laura Zettel-Watson
- Department of Psychology, California State University, Fullerton, PO Box 6846, Fullerton, CA 92834-6846, USA.
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Kennedy RL, Malabu U, Kazi M, Shahsidhar V. Management of obesity in the elderly: too much and too late? J Nutr Health Aging 2008; 12:608-21. [PMID: 18953458 DOI: 10.1007/bf03008271] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- R L Kennedy
- James Cook University School of Medicine, Queensland, Australia.
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Gordon MM, Bopp MJ, Easter L, Miller GD, Lyles MF, Houston DK, Nicklas BJ, Kritchevsky SB. Effects of dietary protein on the composition of weight loss in post-menopausal women. J Nutr Health Aging 2008; 12:505-9. [PMID: 18810296 PMCID: PMC3629809 DOI: 10.1007/bf02983202] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether a hypocaloric diet higher in protein can prevent the loss of lean mass that is commonly associated with weight loss. DESIGN An intervention study comparing a hypocaloric diet moderately high in protein to one lower in protein. SETTING Study measurements were taken at the Wake Forest University General Clinical Research Center (GCRC) and Geriatric Research Center (GRC). PARTICIPANTS Twenty-four post-menopausal, obese women (mean age = 58 +/- 6.6 yrs; mean BMI = 33.0 +/- 3.6 kg/m2). INTERVENTION Two 20-week hypocaloric diets (both reduced by 2800 kcal/wk) were compared: one maintaining dietary protein intake at 30% of total energy intake (1.2-1.5 g/kg/d; HI PROT), and the other maintaining dietary protein intake at 15% of total energy (0.5-0.7 g/kg/d; LO PROT). The GCRC metabolic kitchen provided lunch and dinner meals which the women picked up 3 days per week and ate outside of the clinic. MEASUREMENTS Body composition, including total body mass, total lean mass, total fat mass, and appendicular lean mass, assessed by dual energy x-ray absorptiometry, was measured before and after the diet interventions. RESULTS The HI PROT group lost 8.4 +/- 4.5 kg and the LO PROT group lost 11.4 +/- 3.8 kg of body weight (p = 0.11). The mean percentage of total mass lost as lean mass was 17.3% +/- 27.8% and 37.5% +/- 14.6%, respectively (p = 0.03). CONCLUSION Maintaining adequate protein intake may reduce lean mass losses associated with voluntary weight loss in older women.
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Affiliation(s)
- M M Gordon
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University Health Sciences, Winston-Salem, NC, USA
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Simonsen MK, Hundrup YA, Grønbaek M, Heitmann BL. A prospective study of the association between weight changes and self-rated health. BMC WOMENS HEALTH 2008; 8:13. [PMID: 18691402 PMCID: PMC2532681 DOI: 10.1186/1472-6874-8-13] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Accepted: 08/08/2008] [Indexed: 12/02/2022]
Abstract
Background Obesity and self-rated health (SRH) are strong predictors of morbidity and mortality but their interrelation is sparsely studied. The aim of this study was to analyse the association between weight changes and changes in SRH among women. We also examined if poor SRH at baseline was associated with later weight gain. Methods The Danish Nurse Cohort Study is a prospective population study (1993–1999) and comprises 13,684 female nurses aged 44 to 69 years. Logistic regression analyses were used to examine the association between weight changes and changes in SRH. Results Women who gained weight during the study period had higher odds of reporting poorer self-rated health (Odds Ratio (OR): 1.18, 95% CI: 1.04–1.35). Weight loss among overweight women, did not result in an increase in self-rated health ratings, in fully adjusted analyses (0.96 (95% CI: 0.76–1.23). Poor self-rated health combined with normal weight at first examination was associated with higher odds of later weight gain (OR: 1.29, 95% CI: 1.10–1.51). Conclusion Weight changes may result in lower SRH. Further, poor self-rated health at baseline seems to predict an increase in weight, among women without any longstanding chronic diseases. Future obesity prevention may focus on normal weight individuals with poor SRH.
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Affiliation(s)
- Mette K Simonsen
- Research Unit for Dietary Studies, Institute of Preventive Medicine, Centre for Health and Society, Copenhagen, Denmark.
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Water consumption reduces energy intake at a breakfast meal in obese older adults. ACTA ACUST UNITED AC 2008; 108:1236-9. [PMID: 18589036 DOI: 10.1016/j.jada.2008.04.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Accepted: 10/15/2007] [Indexed: 11/24/2022]
Abstract
Water consumed before a meal has been found to reduce energy intake among nonobese older adults. However, it is unknown whether this effect is evident among overweight and obese older adults, a population who would benefit from strategies to improve energy intake regulation. Our purpose was to determine whether premeal water consumption reduces meal energy intake in overweight and obese older adults. Twenty-four overweight and obese adults (body mass index=34.3+/-1.2), mean age 61.3+/-1.1 years, were given an ad libitum standardized breakfast meal on two randomly assigned occasions. Thirty minutes before the meal, subjects were given either a 500-mL water preload or no preload. Energy intake at each meal was covertly measured. Meal energy intake was significantly less in the water preload condition as compared with the no-preload condition (500+/-32 vs 574+/-38, respectively; P=0.004), representing an approximate 13% reduction in meal energy intake. The percentage reduction in meal energy intake following the water preload was not related to sex, age, body mass index, or habitual daily water consumption (all P>0.05). Given the high prevalence of overweight and obesity among older adults, future studies should determine whether premeal water consumption is an effective long-term weight control strategy for older adults.
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Stenholm S, Sainio P, Rantanen T, Alanen E, Koskinen S. Effect of co-morbidity on the association of high body mass index with walking limitation among men and women aged 55 years and older. Aging Clin Exp Res 2007; 19:277-83. [PMID: 17726357 DOI: 10.1007/bf03324702] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Obesity among older persons is rapidly increasing, thus affecting their mobility negatively. The aim of this study was to examine the association of high body mass index (BMI) with walking limitation, and the effect of obesity-related diseases on this association. METHODS In a representative sample of the Finnish population of 55 years and older (2055 women and 1337 men), maximal walking speed, chronic diseases, and BMI were ascertained in a health examination. Walking limitation was defined as maximal walking speed of less than 1.2 m/s or difficulty in walking 500 meters. To analyze the effects of chronic conditions, smoking, marital status, and education on BMI class differences in walking limitation, covariates were sequentially adjusted in logistic regression analyses. RESULTS In women, an increasing gradient in the age-adjusted risk of walking limitation was observed with higher BMI: overweight (OR 1.47, 95% CI 1.10-1.96), obese (OR 2.77, 95% CI 2.01-3.82), and severely obese (OR 5.80, 95% CI 3.52-9.54). In men, the risk was significantly increased among the obese (OR 1.63, 95% CI 1.04-2.55) and severely obese (OR 4.33, 95% CI 2.20- 8.53). After adjustment of multiple covariates, the association remained significant among the obese (OR 1.99, 95% CI 1.38-2.86) and severely obese women (OR 3.64, 95% CI 2.12-6.26), as well as severely obese men (OR 2.78, 95% CI 1.30-5.95). Knee osteoarthritis in women and diabetes in men contributed most to the excess risk of walking limitation among obese persons, 18 and 32% respectively. CONCLUSIONS Obesity increases the risk of walking limitation, independent of obesity-related diseases, smoking, marital status, and education, especially in older women. The results of this study emphasize the importance of maintaining normal body weight, in order to prevent obesity-related health risks and loss of functioning in older age.
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Affiliation(s)
- Sari Stenholm
- National Public Health Institute, Department of Health and Functional Capacity, FI-20720 Turku, Finland.
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