Joint association of obesity and metabolic syndrome with incident mobility limitation in older men and women--results from the Health, Aging, and Body Composition Study

Association of metabolic syndrome and sarcopenia with all-cause and cardiovascular mortality: a prospective cohort study based on the NHANES

Background

Metabolic syndrome (MetS) and sarcopenia (SP) have emerged as significant public health concerns in contemporary societies, characterized by shared pathophysiological mechanisms and interrelatedness, leading to profound health implications. In this prospective cohort study conducted within a US population, we aimed to examine the influence of MetS and SP on all-cause and cardiovascular mortality.

Methods

This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) III for the years 1999-2006 and 2011-2018, and death outcomes were ascertained by linkage to National Death Index (NDI) records through December 31, 2019. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause and cardiovascular mortality. In addition, subgroup and sensitivity analyses were conducted to test the robustness of the results.

Results

Over a median follow-up period of 13.3 years (95% CI: 12.8-13.8), 1714 deaths were observed. The groups characterized by MetS-/SP+, MetS+/SP-, and MetS+/SP+ exhibited higher all-cause mortality rates in comparison to the MetS-/SP- group, with the MetS+/SP+ group (HR 1.76, 95% CI: 1.37-2.25) displaying the highest all-cause mortality. Increased cardiovascular mortality was observed in the MetS+/SP- (HR 1.84, 95% CI: 1.24-2.72), and MetS+/SP+ groups (HR 2.39, 95% CI: 1.32-4.35) compared to the MetS-/SP- group, whereas it was not statistically significant in the MetS-/SP+ group. However, among males and individuals aged < 60, the presence of both MetS and SP (MetS+/SP+ group) was found to be significantly associated with a higher risk of all-cause and cardiovascular mortality.

Conclusion

The coexistence of MetS and SP increased the risk of all-cause and cardiovascular mortality, particularly in males and in nonelderly populations. Individuals with either MetS or SP may require more careful management to prevent the development of other diseases and thereby reduce mortality.

Assessing the efficacy of duration and intensity prescription for physical activity in mitigating cardiometabolic risk after spinal cord injury

PURPOSE OF REVIEW

Spinal cord injury (SCI) heightens susceptibility to cardiometabolic risk (CMR), predisposing individuals to cardiovascular disease. This monograph aims to assess the optimal duration and intensity of physical activity (PA) for managing CMR factors, particularly obesity, after SCI and provide modality-specific PA durations for optimal energy expenditure.

RECENT FINDINGS

PA guidelines recommend at least 150 min/week of moderate-intensity activity. However, non-SCI literature supports the effectiveness of engaging in vigorous-intensity PA (≥6 METs) and dedicating 250-300 min/week (≈2000 kcal/week) to reduce CMR factors. Engaging in this volume of PA has shown a dose-response relationship, wherein increased activity results in decreased obesity and other CMR factors in persons without SCI.

SUMMARY

To optimize cardiometabolic health, individuals with SCI require a longer duration and higher intensity of PA to achieve energy expenditures comparable to individuals without SCI. Therefore, individuals with SCI who can engage in or approach vigorous-intensity PA should prioritize doing so for at least 150 min/wk. At the same time, those unable to reach such intensities should engage in at least 250-300 min/week of PA at a challenging yet comfortable intensity, aiming to achieve an optimal intensity level based on their abilities. Given the potential to decrease CMR after SCI, increasing PA duration and intensity merits careful consideration in future SCI PA directives.

The Health, Aging, and Body Composition (Health ABC) Study-Ground-Breaking Science for 25 Years and Counting

BACKGROUND

The Health, Aging, and Body Composition Study is a longitudinal cohort study that started just over 25 years ago. This ground-breaking study tested specific hypotheses about the importance of weight, body composition, and weight-related health conditions for incident functional limitation in older adults.

METHODS

Narrative review with analysis of ancillary studies, career awards, publications, and citations.

RESULTS

Key findings of the study demonstrated the importance of body composition as a whole, both fat and lean mass, in the disablement pathway. The quality of the muscle in terms of its strength and its composition was found to be a critical feature in defining sarcopenia. Dietary patterns and especially protein intake, social factors, and cognition were found to be critical elements for functional limitation and disability. The study is highly cited and its assessments have been widely adopted in both observational studies and clinical trials. Its impact continues as a platform for collaboration and career development.

CONCLUSIONS

The Health ABC provides a knowledge base for the prevention of disability and promotion of mobility in older adults.

Hand Grip Strength Relative to Waist Circumference as a Means to Identify Men and Women Possessing Intact Mobility in a Cohort of Older Adults with Type 2 Diabetes

Possessing intact mobility in older adults assures their continued independence. The early identification of reduced mobility in older adults with type 2 diabetes (T2DM) is paramount for preventing their future physical deterioration. Hand grip strength (HGS), relative to body size, is associated with mobility in older T2DM patients. This study aims to identify an HGS index that best identifies mobilityintact older T2DM patients, along with its optimal cut-off point. The baseline data are from a cohort of 122 older T2DM patients (59% women) (mean age of 70.2 ± 4.4 years). Three mobility tests encompassing three main mobility domains were measured, including usual gait speed (UGS), timed up and go (TUG), and a two-minute walk test (2MWT). Passing scores were defined as those either above the established cut-off points or above the 25th percentile of population norms. Passing all three tests was considered as possessing intact mobility. Receiver operating characteristic (ROC) curves of the most relevant HGS indices were constructed to determine the area under the curve (AUC) that best identifies patients with intact mobility. In a sample of 122 older adults with T2DM, 63.9% of women and 60% of men were found to possess intact mobility. HGS relative to waist circumference (WC) was found to have the strongest association with intact mobility, presenting the highest AUC in both men (0.78) and women (0.72) for discriminating mobility status, with an optimal cut-off of 0.355 (kg/cm) and 0.245 (kg/cm) in men and women, respectively. HGS relative to WC best differentiated between mobility-intact older adults with T2DM and those with mobility limitations, especially in men. Using HGS/WC as a simple and safe screening mode for mobility in a clinical setting could potentially identify older patients with T2DM that require therapeutic interventions.

Changes in the Oswestry Disability Index after a 3-Week In-Patient Multidisciplinary Body Weight Reduction Program in Adults with Obesity

The aim of this study was to examine the short-term changes in disability after an inpatient, multidisciplinary body weight reduction program (BWRP) in adults with obesity. A total of 160 individuals (males: 52, females: 108, BMI > 35 kg/m2) hospitalized for a 3-week multidisciplinary BWRP were recruited into the study. Body composition, lower limb muscle power, fatigue severity, and disability were measured at the beginning and end of the intervention by means of bioimpedance analysis, a stair climbing test (SCT), the Fatigue Severity Scale (FSS), and the Oswestry disability index (ODI), respectively. At the end of the 3-week BWRP, an average body weight reduction of 5.0 kg (CI 95% −5.3; −4.6, p < 0.001) was determined, as well as an improvement in all parameters measured. Clinically meaningful reductions in disability were observed in the moderate disability (Δ = −11.8% CI 95% −14.3; −9.3, p < 0.001) and severe disability (Δ = −15.9% CI 95% −19.6; −12.2, p < 0.001) groups. Reductions in disability were explained only by improvements in the SCT (Δ = −2.7 CI 95% −4.1; −1.4, p < 0.001) and the FSS (Δ = −0.3% CI 95% −0.4; −0.1, p < 0.001). These findings demonstrate the importance of incorporating approaches into a BWRP that increase lower limb muscle power and decrease fatigue severity and thus reduce disability in adults with obesity.

Obesity and Work-Related Injuries Among Farmers in Kentucky, Tennessee, and West Virginia

BACKGROUND

Obesity is a recognized risk factor for work-related injuries (WRI). Despite the inherent safety hazards associated with farm work, research on obesity among farmers is limited giving little guidance to occupational health providers on obesity as a risk factor in farm WRI. This study evaluated the association between obesity and farm WRI.

METHODS

Cross-sectional data were collected from farmers (n = 100) in Kentucky, Tennessee, and West Virginia. Data included a survey (demographic data, farm factors, health indicators, occurrences of work-related injuries consistent with the definition of Occupational Safety and Health Administration [OSHA] recordable injuries) and direct anthropometric measures (height, weight, and waist circumference). Logistic regression was used to model any work-related injury, injuries consistent with the definition of OSHA recordables (herein called OSHA-recordable injuries), and recurrent injuries occurring during farm work performance on body mass index (BMI) and waist circumference.

FINDINGS

Twenty-five percent of the participants reported any injuries, and 18% reported OSHA-recordable injuries. Farmers with a BMI ≥30 kg/m² had 3 times the risk for OSHA-recordable injuries and 5 times the risk for recurrent injuries. No significant relationship was identified between waist circumference and farm WRI.

CONCLUSION

This study provides evidence that increased BMI is a safety risk for farmers. Prospective studies with a larger sample are needed. Occupational health nurses and providers should educate farmers on the potential safety risk of obesity and implement weight management programs addressing obesity in farmers.

Group Lifestyle Phone Maintenance for Weight, Health, and Physical Function in Adults Aged 65-80 Years: A Randomized Clinical Trial

BACKGROUND

Group lifestyle sessions with phone maintenance could improve weight, health, and function in vulnerable older adults.

METHODS

Community-dwelling adults (N = 322) with body mass index (BMI, kg/m2) ≥27 and additional risk factors received 12 one-hour in-person behavioral weight management group sessions then were randomized to 8 half-hour telephone sessions (n = 162) or newsletter control (n = 160) from 4 to 12 months with no treatment contact thereafter. Primary outcome was 0- to 12-month weight change. Cardiometabolic, short physical performance battery (SPPB), and self-reported activity changes were assessed at 12 and 24 months.

RESULTS

At baseline, the mean (SD) age was 71.2 (4.3) and BMI was 33.8 (5.1). Participants were 77% women, 13% Black, 85% retired, averaging 4 medical conditions, and taking blood pressure (67.4%) and lipid-lowering (51.6%) medications. At 12 months, a greater proportion of the phone group (66.0%) achieved ≥5% weight loss compared with newsletter control (53.2%; p = .02). Mean (95% CI) weight loss was greater for phone (-6.6 kg [-7.5, -5.8]) than newsletter (-5.1 kg [-7.2, -3.0]); p = .01. Modest lipid, glucose, and blood pressure improvements were found, but did not differ significantly between groups. Small SPPB and activity improvements were maintained at 12 and 24 months in both groups.

CONCLUSIONS

Brief phone contacts compared to newsletters enhanced weight loss maintenance among older high-risk adults at 1 year, but not cardiometabolic outcomes. Modest functional improvements were observed in both. Lower-intensity maintenance contacts (phone or newsletter) for weight, health, and physical function in older adults warrant further study.

CLINICAL TRIALS REGISTRATION NUMBER

NCT03192475.

Association of lung function with functional limitation in older adults: A cross-sectional study

INTRODUCTION

Impaired lung function is independently associated with higher rates of disability, however, few studies have examined the association between lung function and functional limitation. This study aimed to assess this association and dose-response relationship in older adults.

METHODS

Data from the National Health and Nutrition Examination Survey (2007-2012) was used as a cross-sectional study. Lung function was determined by Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). Functional limitation in older adults was identified by six self-reported questions on physical function. 3070 adults aged 60 and over were enrolled in our study. Logistic regression models and restricted cubic spline models were applied to examine the association between lung function and the risk of functional limitation.

RESULTS

FEV1 and FVC were inversely associated with the risk of functional limitation. In the full adjusted model, compared with the lowest tertile of FEV1, the odds ratios (95% confidence intervals) of functional limitation for tertile 2 and tertile 3 were 0.5422 (0.3848-0.7639) and 0.4403 (0.2685-0.7220), and the odds ratios (95% confidence intervals) of functional limitation for tertile 2 and tertile 3 of FVC were 0.5243 (0.3503-0.7848) and 0.3726 (0.2072-0.6698). Furthermore, an inverse association persisted after stratified analysis by gender and sensitivity analysis. Dose-response analyses showed that the odds of functional limitation declined with increase in FEV1 and FVC in a nonlinear manner.

CONCLUSIONS

Lung function was inversely associated with functional limitation among older adults.

Obesity, Even in the Metabolically Healthy, Increases the Risk of Poor Physical Performance: A Cross-Sectional Study of Older People in a Chinese Community

Objective

We examined the association between obesity and physical performance under different metabolic status.

Methods

The sample included 1395 Chinese community-dwelling participants (mean age, 71.88 ± 5.87 years; 40.9% men). Being metabolically healthy was defined as having the presence of < 3 of 5 components of metabolic syndrome (MetS); obesity was defined as having a BMI > 28 kg/m². Participants were divided into four groups based on BMI (non-obese/obese) and metabolic health (healthy/unhealthy). Physical performance was measured by grip strength, 4-m walking speed, and the timed up and go test (TUGT).

Results

After multiple adjustments, compared with metabolically healthy non-obese group, the metabolically unhealthy obese group showed lower relative grip strength, lower 4-m walking speed, and higher TUGT (P all < 0.05), and only relative grip strength of the metabolically healthy obese group was significantly lower than that of metabolically healthy non-obese (P < 0.01). Relative grip strength was negatively associated with impaired fasting glucose (β = −0.071), elevated triglycerides (β = −0.062), abdominal obesity (β = −0.230) and general obesity (β = −0.225) (P all < 0.01). Walking speed and TUGT were only associated with general obesity, rather than other metabolic components. The associations of MetS with physical performance were mainly driven by abdominal obesity.

Conclusion

Even in those who are metabolically healthy, obesity (especially general obesity) increases the risk of poor physical performance. Elderly people with general obesity and MetS, whether in combination or alone, have an increased risk of muscle dysfunction, and that combination produces a higher risk of impaired mobility.

Healthy obesity and risk of accelerated functional decline and disability

BACKGROUND/OBJECTIVES

Some obese adults have a normal metabolic profile and are considered 'healthy', but whether they experience faster ageing than healthy normal-weight adults is unknown. We compared decline in physical function, worsening of bodily pain and likelihood of future mobility limitation and disability between these groups.

SUBJECTS/METHODS

This was a population-based observational study using repeated measures over 2 decades (Whitehall II cohort data). Normal-weight (body mass index (BMI) 18.5-24.9 kg m-2), overweight (25.0-29.9 kg m-2) and obese (⩾30.0 kg m-2) adults were considered metabolically healthy if they had 0 or 1 of 5 risk factors (hypertension, low high-density lipoprotein cholesterol, high triacylglycerol, high blood glucose and insulin resistance) in 1991/1994. Decline in physical function and worsening of bodily pain based on change in Short Form Health Survey items using eight repeated measures over 18.8 years (1991/1994-2012/2013) were compared between metabolic-BMI groups using linear mixed models. Odds of mobility limitation based on objective walking speed (slowest tertile) and of disability based on limitations in ⩾1 of 6 basic activities of daily living, each using three repeated measures over 8.3 years (2002/2004-2012/2013), were compared using logistic mixed models.

RESULTS

In multivariable-adjusted mixed models on up to 6635 adults (initial mean age 50 years; 70% male), healthy normal-weight adults experienced a decline in physical function of -3.68 (95% CI=-4.19, -3.16) score units per decade; healthy obese adults showed an additional -3.48 (-4.88, -2.08) units decline. Healthy normal-weight adults experienced a -0.49 (-1.11, 0.12) score unit worsening of bodily pain per decade; healthy obese adults had an additional -2.23 (-3.78, -0.69) units worsening. Healthy obesity versus healthy normal-weight conferred 3.39 (2.29, 5.02) times higher odds of mobility limitation and 3.75 (1.94, 7.24) times higher odds of disability.

CONCLUSIONS

Our results suggest that obesity, even if metabolically healthy, accelerates age-related declines in functional ability and poses a threat to independence in older age.

Effect of Metabolic Syndrome on the Mobility Benefit of a Structured Physical Activity Intervention-The Lifestyle Interventions and Independence for Elders Randomized Clinical Trial

OBJECTIVES

To test whether structured physical activity (PA) is associated with a greater reduction in major mobility disability (MMD) in older persons with metabolic syndrome (MetS) than in those without.

DESIGN

Data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter randomized trial of 1,635 persons with assessments every 6 months (average 2.7 years).

SETTING

Eight U.S. centers.

PARTICIPANTS

Sedentary men and women aged 70 to 89 with functional limitations (N = 1,535); 100 participants were excluded because of missing MetS data.

INTERVENTION

Participants were randomized to a moderate-intensity PA program (n = 766) or a health education program (n = 769).

MEASUREMENTS

MetS was defined according to the 2009 multiagency harmonized criteria. Outcomes included incident MMD (loss of ability to walk 400 m) and persistent MMD (two consecutive MMD diagnoses or one MMD diagnosis followed by death).

RESULTS

Seven hundred sixty-three (49.7%) participants met criteria for MetS. PA reduced incident MMD more than health education did in participants with MetS (hazard ratio (HR) = 0.72, 95% confidence interval (CI) = 0.57-0.91, P = .007) but not in those without MetS (HR = 0.96, 95% CI = 0.73-1.25, P = .75); the test for statistical interaction was not significant (P = .13). PA reduced the risk of persistent MMD in participants with MetS (HR = 0.57, 95% CI = 0.41-0.79, P < .001) but not in those without MetS (HR = 0.97, 95% CI = 0.67-1.41, P = .87). The test for statistical interaction was significant (P = .04).

CONCLUSION

Moderate-intensity PA substantially reduces the risk of persistent MMD in older persons with functional limitations with MetS but not in those without MetS. Comparable results were observed for incident MMD. The LIFE PA program may be an effective strategy for reducing mobility disability in vulnerable older persons with MetS.

The metabolic syndrome and 10-year cognitive and functional decline in very old men. A population-based study

OBJECTIVES

To describe longitudinal relationships of metabolic syndrome (MetS) to cognitive decline and functional disability in a sample of older non-institutionalized men.

METHODS

data from 1991 to 2000 of the Italian cohorts of the Finland, Italy, the Netherlands, Elderly (FINE) study, were used. Global cognitive function and functional disability, defined as limitations in mobility, basic (ADLs) and instrumental activities of daily living (IADLs) were screened in 1991 and 2000. MetS was defined according to the NCEP ATP-III criteria.

RESULTS

The study sample consisted of 195 men, baseline age 76.1±3.1years. Baseline MetS was prospectively associated with greater 10-year cognitive and functional decline in ADLs and IADLs. After multiple adjustment including age, education, marital status, ApoE ε4 allele, cerebrovascular disease and initial cognitive and depressive status, MetS predicted cognitive decline (B=-1.684, 95%CI=-2.202 to -1.167, p<0.001) and risk of IADLs (OR=1.09, 95% CI=1.01-1.20, p=0.048) and ADLs disability (OR=1.35, 95%CI=1.12-1.62, p<0.001). Interestingly, such associations were not attributable to individual altered components of MetS nor to their sum. Incident disability in ADLs and IADLs were not explained by parallel decline in cognitive function.

CONCLUSIONS

MetS as an entity was associated with accelerated cognitive and functional decline in a population-based sample of very old men.

Joint Association of Obesity and Hypertension with Disability in the Elderly-- A Community-Based Study of Residents in Shanghai, China

BACKGROUND

Although both obesity and hypertension are known risk factors for disability, the joint association of obesity and hypertension with risk of disability is unknown. This paper is aim to examine the joint association of obesity and hypertension with risk of disability.

METHODS

Cross-sectional study with 8060 elderly community-dwelling individuals participating in the survey initiated by Shanghai Health and Family Planning Commission from March to September 2013. Obesity was measured using the body mass index (BMI) in World Health Organization (WHO) Asia criteria. Hypertension, based on the doctor's diagnosis, was obtained through face-to-face interview. Disability was measured using the self-reported physical self-maintenance scale (PSMS) and the instrumental activities of daily living (IADL) scale developed by Lawton and Brody.

RESULTS

A total of 8.97% of participants reported ADL disability, and 15.18% for IADL disability. After adjusting social demographics and chronic conditions, the risk of ADL disability was progressively greater in obese persons with hypertension (OR=1.40, 95% CI=1.05-1.89), underweight persons without hypertension (OR=2.05, 95% CI=1.29-3.25), and underweight persons with hypertension (OR=2.14, 95% CI=1.36-3.36). For IADL disability, only underweight persons with hypertension were significantly associated (OR=1.65, 95% CI=1.23-2.21).

CONCLUSIONS

Low or extremely high BMI, independent of its metabolic consequences, is a risk factor for disability among the elderly. Simple hypertension wasn't significantly associated with disability. In addition, having hypertension significantly increased the risk of ADL disability in obese individuals and IADL disability in underweight individuals.

Impaired autophagy activity is linked to elevated ER-stress and inflammation in aging adipose tissue

Adipose tissue dysfunction in aging is associated with inflammation, metabolic syndrome and other diseases. We propose that impaired protein homeostasis due to compromised lysosomal degradation (micro-autophagy) might promote aberrant ER stress response and inflammation in aging adipose tissue. Using C57BL/6 mouse model, we demonstrate that adipose tissue-derived stromal vascular fraction (SVF) cells from old (18-20 months) mice have reduced expression of autophagy markers as compared to the younger (4-6 months) cohort. Elevated expressions of ER-stress marker CHOP and autophagy substrate SQSTM1/p62 are observed in old SVFs compared to young, when treated with either vehicle or with thapsigargin (Tg), an ER stress inducer. Treatment with bafilomycin A1 (Baf), a vacuolar-type H (+)-ATPase, or Tg elevated expressions of CHOP, and SQSTM1/p62 and LC-3-II, in 3T3-L1-preadipocytes. We also demonstrate impaired autophagy activity in old SVFs by analyzing increased accumulation of autophagy substrates LC3-II and p62. Compromised autophagy activity in old SVFs is correlated with enhanced release of pro-inflammatory cytokines IL-6 and MCP-1. Finally, SVFs from calorie restricted old mice (CR-O) have shown enhanced autophagy activity compared to ad libitum fed old mice (AL-O). Our results support the notion that diminished autophagy activity with aging contributes to increased adipose tissue ER stress and inflammation.

Obesity in Older People With and Without Conditions Associated With Weight Loss: Follow-up of 955,000 Primary Care Patients

Background:

Moderate obesity in later life may improve survival, prompting calls to revise obesity control policies. However, this obesity paradox may be due to confounding from smoking, diseases causing weight-loss, plus varying follow-up periods. We aimed to estimate body mass index (BMI) associations with mortality, incident type 2 diabetes, and coronary heart disease in older people with and without the above confounders.

Methods:

Cohort analysis in Clinical Practice Research Datalink primary care, hospital and death certificate electronic medical records in England for ages 60 to more than 85 years. Models were adjusted for age, gender, alcohol use, smoking, calendar year, and socioeconomic status.

Results:

Overall, BMI 30–34.9 (obesity class 1) was associated with lower overall death rates in all age groups. However, after excluding the specific confounders and follow-up less than 4 years, BMI mortality risk curves at age 65–69 were U-shaped, with raised risks at lower BMIs, a nadir between 23 and 26.9 and steeply rising risks above. In older age groups, mortality nadirs were at modestly higher BMIs (all <30) and risk slopes at higher BMIs were less marked, becoming nonsignificant at age 85 and older. Incidence of diabetes was raised for obesity-1 at all ages and for coronary heart disease to age 84.

Conclusions:

Obesity is associated with shorter survival plus higher incidence of coronary heart disease and type 2 diabetes in older populations after accounting for the studied confounders, at least to age 84. These results cast doubt on calls to revise obesity control policies based on the claimed risk paradox at older ages.

Physical impairment and body weight history in postmenopausal women: the Women's Health Initiative

OBJECTIVE

To examine whether weight history and weight transitions over adult lifespan contribute to physical impairment among postmenopausal women.

DESIGN

BMI categories were calculated among postmenopausal women who reported their weight and height at age 18 years. Multiple-variable logistic regression was used to determine the association between BMI at age 18 years and BMI transitions over adulthood on severe physical impairment (SPI), defined as scoring <60 on the Physical Functioning subscale of the Rand thirty-six-item Short-Form Health Survey.

SETTING

Participants were part of the Women's Health Initiative Observational Study (WHI OS), where participants' health was followed over time via questionnaires and clinical assessments.

SUBJECTS

Postmenopausal women (n 76 016; mean age 63·5 (sd 7·3) years).

RESULTS

Women with overweight (BMI=25·0-29·9 kg/m2) or obesity (BMI≥30·0 kg/m2) at 18 years had greater odds (OR (95 % CI)) of SPI (1·51 (1·35, 1·69) and 2·14 (1·72, 2·65), respectively) than normal-weight (BMI=18·5-24·9 kg/m2) counterparts. Transitions from normal weight to overweight/obese or to underweight (BMI<18·5 kg/m2) were associated with greater odds of SPI (1·97 (1·84, 2·11) and 1·35 (1·06, 1·71), respectively) compared with weight stability. Shifting from underweight to overweight/obese also had increased odds of SPI (1·52 (1·11, 2·09)). Overweight/obese to normal BMI transitions resulted in a reduced SPI odds (0·52 (0·39, 0·71)).

CONCLUSIONS

Higher weight history and transitions into higher weight classes were associated with higher likelihood of SPI, while transitioning into lower weight classes for those with overweight/obesity was protective among postmenopausal women.

[Abdominal obesity mediates the association between a low physical activity and a decline in gait speed in community-dwelling elderly people: A cross-sectional study]

AIM

A low physical activity leads to obesity and a decline in the physical function. The aim of this cross-sectional study was to examine whether the association between a low physical activity and low physical function was mediated by obesity.

METHODS

A total of 73 community-dwelling elderly people participated in this study. The analysis included 56 participants without knee and hip osteoarthritis, low cognitive function (the Mini Mental State Examination score <24) and rheumatoid arthritis (mean age±SD: 73.3±4.1, female: 50%). The daily step count was collected as a measure of physical activity by a single axial accelerometer. The physical function was measured by the gait speed. Obesity was measured by the body mass index and waist circumference. To assess whether the association between the physical activity and physical function was mediated by obesity, linear regression models were fitted according to Baron and Kenny procedures for a mediation analysis. A p value <0.05 was considered to be statistically significant.

RESULTS

The body mass index did not act as a mediator in the association between the physical activity and gait speed, whereas the waist circumference acted as a full mediator in the association between the physical activity and gait speed.

CONCLUSION

An increased waist circumference mediates the association between a low physical activity and a low physical function in community-dwelling elderly people.

Cardiometabolic and Inflammatory Biomarkers as Mediators Between Educational Attainment and Functioning at the Age of 90 Years

BACKGROUND

Low socioeconomic status is associated both with poorer functioning and elevated levels of inflammatory and cardiometabolic biomarkers; however, knowledge of such relations for the oldest old is limited. Our aim was to study whether education is associated with cardiometabolic (cholesterol levels, body mass index, and leptin) and inflammatory (C-reactive protein, interleukin-6, interleukin-1Ra) biomarkers for the 90-year-olds who participated in the Vitality 90+ study. In addition, we investigated whether these biomarkers explain educational inequalities in functioning.

METHODS

All persons in Tampere, Finland, who were born in 1909 or 1910, were invited to participate, irrespective of their health status or dwelling place. The sample consisted of 262 participants who went through the home interview and blood tests. The socioeconomic status indicator used was the highest education, and physical functioning was assessed using the Barthel index. The association of education with individual and combined biomarker scores, and with functioning, was analyzed cross-sectionally applying generalized linear models.

RESULTS

The low- and mid-level-educated participants had greater odds of belonging to the high risk group in cardiometabolic biomarkers than did the high-educated. Differences were statistically significant in three individual biomarkers (high-density lipoprotein-cholesterol, leptin, and body mass index) and in a cardiometabolic score. There were no educational differences in inflammatory biomarkers. When all biomarkers were combined, they mediated educational differences in functioning on an average of 23%. After controlling for smoking, alcohol use and diseases, biomarkers mediated part of the differences between the mid-level- and high-educated.

CONCLUSIONS

High education was associated with better cardiometabolic biomarkers and functioning among the 90-year-olds. In part, educational inequalities in functioning were explained by cardiometabolic biomarkers.

Metabolic syndrome, sarcopenia and role of sex and age: cross-sectional analysis of Kashiwa cohort study

Recent epidemiological evidence suggests that effects of cardiovascular risk factors may vary depending on sex and age. In this study, we assessed the associations of metabolic syndrome (MetS) with sarcopenia and its components in older adults, and examined whether the associations vary by sex and age. We also tested if any one of the MetS components could explain the associations. We conducted a cross-sectional analysis of the baseline data from the cohort study conducted in Kashiwa city, Chiba, Japan in 2012 which included 1971 functionally-independent, community-dwelling Japanese adults aged 65 years or older (977 men, 994 women). Sarcopenia was defined based on appendicular skeletal muscle mass, grip strength and usual gait speed. MetS was defined based on the National Cholesterol Education Program’s Adult Treatment Panel-III criteria. The prevalence of sarcopenia was 14.2% in men and 22.1% in women, while the prevalence of MetS was 43.6% in men and 28.9% in women. After adjustment for potential confounders, MetS was positively associated with sarcopenia in men aged 65 to 74 years (odds ratio 5.5; 95% confidence interval 1.9–15.9) but not in older men or women. Among the sarcopenia components, MetS was associated with lower muscle mass and grip strength, particularly in men aged 65 to 74 years. The associations of MetS with sarcopenia and its components were mainly driven by abdominal obesity regardless of sex or age. In conclusion, MetS is positively associated with sarcopenia in older men. The association is modified by sex and age, but abdominal obesity is the main contributor to the association across sex and age.

Impact of obesity and physical activity on functional outcomes in the elderly: data from NHANES 2005-2010

OBJECTIVE

The objective of this study was to (a) to examine whether the association between obesity and physical functioning among older adults is moderated by physical activity (PA) and (b) to test whether this moderating effect varies by gender.

METHOD

Data from adults (aged >60 years) who participated in the National Health and Nutrition Examination Surveys (2005-2010) were analyzed. Using multivariate logistic regression, we estimated the prevalence ratio (PR) of functional limitations and impairment in activities of daily living and instrumental activities of daily living, by body mass index and PA, while adjusting for age, educational level, and a comorbidity index.

RESULTS

The sample included 5,304 subjects (mean age = 70.4 years), and 50.5% were female. Overweight and obesity were associated with higher levels of functional limitations when compared with normal weight individuals regardless of the PA status (PR = 1.47, 95% confidence interval [CI] [1.17, 1.85], and PR = 2.71, 95% CI [2.00, 3.67], respectively) even after adjustment for confounders.

DISCUSSION

Overweight and obesity are associated with impairment in functional outcomes irrespective of PA.

[Diabetes and osteoporosis: pathophysiological interactions and clinical importance for geriatric patients]

Osteoporosis is an age-associated disease, resulting in impaired bone quality and increased risk for bone fractures. Patients with type 2 diabetes mellitus have--despite a normal or even increased bone mineral density--an increased risk for fractures, which is related to an imbalance between osteoblastic bone formation and osteoclastic resorption. Complex pathophysiological mechanisms associated with insulin resistance and hyperglycemia are involved in the deleterious effects on osteoblast function and bone formation. The quality and regimen of antidiabetic therapy are discussed as modulators of bone metabolism. Of great clinical importance is an assessment of the fall risk especially for diabetic patients, because late complications, such as neuropathy, but also side effects of medication can result in a significantly increased risk for falls. Lifestyle intervention is of advantage with respect to diabetes and osteoporosis prevention and therapy. Vitamin D supplementation results in favorable effects with a reduced risk for falls and also improvements of insulin sensitivity. According to published data, the safety and efficacy of specific medication for the treatment of osteoporosis (bisphosphonates, denosumab, selective estrogen receptor modulators) reveal no difference between patients with and without diabetes mellitus.

Obesity and physical frailty in older adults: a scoping review of lifestyle intervention trials

Many frail older adults are thin, weak, and undernourished; this component of frailty remains a critical concern in the geriatric field. However, there is also strong evidence that excessive adiposity contributes to frailty by reducing the ability of older adults to perform physical activities and increasing metabolic instability. Our scoping review explores the impact of being obese on physical frailty in older adults by summarizing the state of the science for both clinical markers of physical function and biomarkers for potential underlying causes of obesity-related decline. We used the 5-stage methodological framework of Arksey and O'Malley to conduct a scoping review of randomized trials of weight loss and/or exercise interventions for obesity (body mass index ≥ 30 kg/m(2)) in older adults (aged >60 years), examining the outcomes of inflammation, oxidative stress, and lipid accumulation in muscle, as well as direct measures of physical function. Our initial search yielded 212 articles; exclusion of cross-sectional and observational studies, cell culture and animal studies, disease-specific interventions, and articles published before 2001 led to a final result of 21 articles. Findings of these trials included the following major points. The literature consistently confirmed benefits of lifestyle interventions to physical function assessed at the clinical level. Generally speaking, weight loss alone produced a greater effect than exercise alone, and the best outcomes were achieved with a combination of weight loss and exercise, especially exercise programs that combined aerobic, resistance, and flexibility training. Weight loss interventions tended to reduce markers of inflammation and/or oxidative damage when more robust weight reduction was achieved and maintained over time, whereas exercise did not change markers of inflammation. However, participation in a chronic exercise program did reduce the oxidative stress induced by an acute bout of exercise. Weight loss interventions consistently reduced lipid accumulation in the muscle; however, in response to exercise, 3 studies showed an increase and 2 a decrease in muscle lipid infiltration. In summary, this scoping review identified strong clinical evidence that weight reduction and/or exercise interventions can improve physical function and biomarkers of physical dysfunction among overweight/obese older adults, supporting the suggestion that excessive adiposity contributes to physical frailty. However, the evidence also suggests a complexity of metabolic influences, both systemically and within muscle, which has not been elucidated to date. Considerable further study is needed to examine the mechanisms by which lifestyle interventions influence physical frailty before the net impact of such interventions can be fully understood.

Decreased functional capacity and muscle strength in elderly women with metabolic syndrome

Purpose

To compare the metabolic parameters, flexibility, muscle strength, functional capacity, and lower limb muscle power of elderly women with and without the metabolic syndrome (MetS).

Methods

This cross-sectional study included 28 older women divided into two groups: with the MetS (n = 14; 67.3 ± 5.5 years; 67.5 ± 16.7 kg; 1.45 ± 0.35 m; 28.0 ± 7.6 kg/m²), and without the MetS (n = 14; 68.7 ± 5.3 years; 58.2 ± 9.9 kg; 1.55 ± 0.10 m; 24.3 ± 3.8 kg/m²). Body composition was evaluated by dual-energy X-ray absorptiometry and dynamic muscle strength was assessed by one-maximum repetition (1RM) tests in leg press, bench press and biceps curl exercises. Six-minute walk test, Timed Up and Go (TUG); 30-second sitting-rising; arm curl using a 2-kg dumbbell, sit-and-reach (flexibility), and vertical jump tests were performed.

Results

There was no difference between groups regarding age (P = 0.49), height (P = 0.46), body fat (%) (P = 0.19), systolic (P = 0.64), diastolic (P = 0.41) and mean blood pressure (P = 0.86), 30-second sitting-rising (P = 0.57), 30-s arm curl (P = 0.73), leg press 1RM (P = 0.51), bench press 1RM (P = 0.77), and biceps curl 1RM (P = 0.85). However, women without the MetS presented lower body mass (P = 0.001), body mass index (BMI) (P = 0.0001), waist circumference (P = 0.02), waist-to-height ratio (P = 0.02), fat body mass (kg) (P = 0.05), lean body mass (kg) (P = 0.02), blood glucose (P = 0.05), triglycerides (P = 0.03), Z-score for the MetS (P = 0.05), higher high-density lipoprotein-cholesterol (HDL-C) (P = 0.002), better performance on TUG (P = 0.01), flexibility (P = 0.03), six-minute walk test (P = 0.04), vertical jump (P = 0.05) and relative muscle strength for leg press (P = 0.03), bench press (P = 0.04) and biceps curl (P = 0.002) exercises as compared to women with the MetS.

Conclusion

Elderly women with the MetS have higher metabolic risk profile and lower functional capacity, muscle strength, lower limb power and flexibility as compared to women without the MetS. The evaluation of functional capacity may help to determine the degree of physical decline in older persons with the MetS, while exercise interventions should be encouraged.

Metabolic syndrome and disability: findings from the prospective three-city study

BACKGROUND

Metabolic syndrome (MetS) is a potentially reversible cause of disability in the elderly people. The published literature suggests that the MetS-disability association is likely to be complex, depending on co-existing risk factors and with possible variation for each of the specific MetS components. Further evidence is needed to understand the specific consequences of the MetS as a whole and as a function of its components.

METHODS

Prospective analyses included data from 6,141 participants (60.9% women) aged 65 and older from the Three-City cohort. Mixed logistic models were used to determine associations between MetS (National Cholesterol Education Program Adult Treatment Panel III criteria) and 7-year incident disability measured as social restriction, mobility limitations (Rosow and Breslau scale), and limitations in instrumental and basic activities of daily living.

RESULTS

MetS was associated with incident social restriction (odds ratio = 1.55, 95% CI: 1.14-2.09), limited mobility (odds ratio = 1.52, 95% CI: 1.21-1.90), and instrumental activities of daily living limitations (odds ratio = 1.62, 95% CI: 1.24-2.10) after adjustment for a range of potential sociodemographic, health behavior, and health status confounders at baseline. These associations were independent of chronic conditions, including cardiovascular disease and dementia. There was evidence of associations between MetS components: central obesity, high triglycerides, and elevated fasting glucose and incidence of limitations in mobility and instrumental activities of daily living.

CONCLUSIONS

Our results suggest that the increased risk of mobility and instrumental activities of daily living limitations in the elderly people associated with MetS is over and above that associated with its components.

Accuracy of recalled body weight--a study with 20-years of follow-up

OBJECTIVE

Weight changes may be an important indicator of an ongoing pathological process. Retrospective self-report might be the only possibility to capture prior weight. The objective of the study was to evaluate the accuracy of retrospective recall of body weight in old age and factors that might predict accuracy.

DESIGN AND METHODS

In 2007, 646 participants (mean age, 71.6 years) of the Swedish Adoption/Twin Study of Aging (SATSA) answered questions about their present weight and how much they weighed 20-years ago. Of these, 436 had self-reported their weight twenty years earlier and among these 134 had also had their weight assessed at this time point.

RESULTS

Twenty year retrospectively recalled weight underestimated the prior assessed weight by -1.89 ± 5.9 kg and underestimated prior self-reported weight by -0.55 ± 5.2 kg. Moreover, 82.4% of the sample were accurate within 10%, and 45.8% were accurate within 5% of their prior assessed weights; similarly, 84.2% and 58.0% were accurate within 10% and 5% respectively, for prior self-reported weight. Current higher body mass index and preferences of reporting weights ending with zero or five was associated with an underestimation of prior weight, while greater weight change over 20 years, and low Mini-Mental State Scores (MMSE) (<25) led to an overestimation of prior weight.

CONCLUSIONS

Recalled weight comes close to the assessed population mean, but at the individual level there is a large variation. The accuracy is affected by current BMI, changes in weight, end-digit preferences, and current cognitive ability. Recalled weight should be used with caution.

Association of cardiovascular burden with mobility limitation among elderly people: a population-based study

Background

Cardiovascular risk factors (CRFs) such as smoking and diabetes have been associated with mobility limitations among older adults. We seek to examine to what extent individual and aggregated CRFs and cardiovascular diseases (CVDs) are associated with mobility limitation.

Methods

The study sample included 2725 participants (age ≥60 years, mean age 72.7 years, 62% women) in the Swedish National Study on Aging and Care in the Kungsholmen district of central Stockholm, Sweden, who were living either at their own home or in institutions. Data on demographic features, CRFs, and CVDs were collected through interview, clinical examination, self-reported history, laboratory tests, and inpatient register. Mobility limitation was defined as walking speed <0.8 m/s. Data were analyzed using multiple logistic models controlling for potential confounders.

Results

Of the 2725 participants, 581 (21.3%) had mobility limitation. The likelihood of mobility limitation increased linearly with the increasing number of CRFs (i.e., hypertension, high C-reactive protein, obesity, diabetes and smoking) (p for linear trend<0.010) and of CVDs (i.e., ischemic heart disease, atrial fibrillation, heart failure and stroke) (p for linear trend<0.001). There were statistical interactions of aggregated CRFs with age and APOE ε4 allele on mobility limitation (p_interaction<0.05), such that the association of mobility limitation with aggregated CRFs was statistically evident only among people aged <80 years and among carriers of the APOE ε4 allele.

Conclusion

Aggregations of multiple CRFs and CVDs are associated with an increased likelihood of mobility limitation among older adults; however the associations of CRFs with mobility limitation vary by age and genetic susceptibility.

The role of metabolic syndrome, adiposity, and inflammation in physical performance in the Health ABC Study

BACKGROUND

Metabolic syndrome (MetS) and functional limitation have been linked, but whether and how specific components of MetS and associated factors, such as inflammation, drive this relationship is unknown.

METHODS

Data are from 2,822 men and women, aged 70-79 years, participating in the Health, Aging, and Body Composition (Health ABC) study and followed for 5 years. Presence of MetS at baseline was defined according to the National Cholesterol Education Program Adult Treatment Panel III guidelines. Interleukin-6, C-reactive protein, and body fat mass were measured at baseline. Measures of physical performance, including 400-m walk time, 20-m walking speed, and the Health ABC physical performance battery (PPB) were obtained at baseline and examination years 2, 4, and 6.

RESULTS

A total of 1,036 (37%) individuals met criteria for MetS. MetS was associated with poorer physical performance at baseline. Effect estimates between MetS and gait speed, and components of the Health ABC PPB (standing balance and repeated sit-to-stand performance) were modestly attenuated after adjustment for inflammation. All associations were attenuated to nonsignificance after adding total body fat mass to the model. Longitudinal analyses yielded similar results. Individual MetS component analysis revealed that abdominal obesity explained the largest fraction of the variation in physical performance.

CONCLUSIONS

Although inflammatory biomarkers partially accounted for the relationship between MetS and aspects of physical performance, overall findings implicate adiposity as the primary factor explaining poorer physical performance in older adults with MetS.

Fat mass loss predicts gain in physical function with intentional weight loss in older adults

BACKGROUND

Clinical recommendation of weight loss (WL) in older adults remains controversial, partially due to concerns regarding lean mass loss and potential loss of physical function. The purpose of this study is to determine the independent associations between changes in fat and lean mass and changes in physical function in older, overweight, and obese adults undergoing intentional WL.

METHODS

Data from three randomized-controlled trials of intentional WL in older adults with similar functional outcomes (short physical performance battery and Pepper assessment tool for disability) were combined. Analyses of covariance models were used to investigate relationships between changes in weight, fat, and lean mass (acquired using dual-energy x-ray absorptiometry) and changes in physical function.

RESULTS

Overall loss of body weight was -7.8 ± 6.1 kg (-5.6 ± 4.1 kg and -2.7 ± 2.4 kg of fat and lean mass, respectively). In all studies combined, after adjustment for age, sex, and height, overall WL was associated with significant improvements in self-reported mobility disability (p < .01) and walking speed (p < .01). Models including change in both fat and lean mass as independent variables found only the change in fat mass to significantly predict change in mobility disability (β[fat] = 0.04; p < .01) and walking speed (β[fat] = -0.01; p < .01).

CONCLUSIONS

Results from this study demonstrate that loss of body weight, following intentional WL, is associated with significant improvement in self-reported mobility disability and walking speed in overweight and obese older adults. Importantly, fat mass loss was found to be a more significant predictor of change in physical function than lean mass loss.

Survival benefits of metabolic syndrome among older men aged 75 years and over in Taiwan

BACKGROUND

Metabolic syndrome (MetS) was common in the elderly, but its prognostic significance in older old population remained unclear. The main purpose of this study was to evaluate the survival impact of MetS among older men aged 75 and over in Taiwan.

METHODS

From 2008, residents aged 75 years and older of Banciao Veterans Home were invited for study and were followed for 3 years. All participants received history taking, physical examinations, and laboratory tests. Mortality was determined by Veteran Affairs Death Registry, which was linked to the National Death Registry.

RESULTS

Overall, 680 men (mean age: 82.5±4.7 years) were enrolled for study and the prevalence of MetS was 31.6%. During the follow-up period, 140 (20.6%) participants died, and the causes of death included infectious diseases (62, 9.1%), cardiovascular disease (37, 5.4%), cancer (20, 2.9%), and others (21, 3.1%). MetS subjects had a significantly higher prevalence of hypertension, diabetes mellitus, and having higher body mass index, waist circumferences, systolic blood pressure, fasting blood glucose, serum triglyceride and lower HDL-C level than non-MetS subjects. However, MetS subjects were less likely to die during study period (16.3% vs. 22.6%, P=0.059). Multivariate logistic regression showed that older age (OR:1.04, 95% C.I.: 1.00-1.08, P=0.04), diabetes mellitus (OR: 2.10, 95% CI: 1.34-3.30, P=0.001) were independent risk factors for mortality; and serum total cholesterol and triglyceride were protective factors (OR: 0.99, 95% CI: 0.99-1.00, P=0.037 for cholesterol; OR: 0.99, 95% CI: 0.99-1.00, P=0.013 for triglyceride). Adjusted for age, diabetes mellitus, serum levels of total cholesterol, and triglyceride, MetS played a potential trend of survival benefits among study subjects (HR: 0.71, 95% CI: 0.45-1.12, P=0.144).

CONCLUSIONS

The prevalence of MetS among men aged 75 years and over was 31.6%, and the 3-year mortality rate was 20.6%. Older age, diabetes mellitus, lower serum cholesterol and lower serum triglyceride were independent risk factors for mortality. Further investigation is needed to clarify the prognostic impact of MetS in older adults.

Meaningful improvement in gait speed in hip fracture recovery

OBJECTIVES

To estimate meaningful improvements in gait speed observed during recovery from hip fracture and to evaluate the sensitivity and specificity of gait speed changes in detecting change in self-reported mobility.

DESIGN

Secondary longitudinal data analysis from two randomized controlled trials

SETTING

Twelve hospitals in the Baltimore, Maryland, area.

PARTICIPANTS

Two hundred seventeen women admitted with hip fracture.

MEASUREMENTS

Usual gait speed and self-reported mobility (ability to walk 1 block and climb 1 flight of stairs) measured 2 and 12 months after fracture.

RESULTS

Effect size-based estimates of meaningful differences were 0.03 for small differences and 0.09 for substantial differences. Depending on the anchor (stairs vs walking) and method (mean difference vs regression), anchor-based estimates ranged from 0.10 to 0.17 m/s for small meaningful improvements and 0.17 to 0.26 m/s for substantial meaningful improvement. Optimal gait speed cutpoints yielded low sensitivity (0.39-0.62) and specificity (0.57-0.76) for improvements in self-reported mobility.

CONCLUSION

Results from this sample of women recovering from hip fracture provide only limited support for the 0.10-m/s cut point for substantial meaningful change previously identified in community-dwelling older adults experiencing declines in walking abilities. Anchor-based estimates and cut points derived from receiver operating characteristic curve analysis suggest that greater improvements in gait speed may be required for substantial perceived mobility improvement in female hip fracture patients. Furthermore, gait speed change performed poorly in discriminating change in self-reported mobility. Estimates of meaningful change in gait speed may differ based on the direction of change (improvement vs decline) or between patient populations.

Metabolic syndrome and physical performance in elderly men: the osteoporotic fractures in men study

OBJECTIVES

To examine the association between metabolic syndrome (MetS) and objective measures of physical performance.

DESIGN

Cross-sectional analysis of the cohort study, the Osteoporotic Fractures in Men Study.

SETTING

Six clinical sites in the United States.

PARTICIPANTS

Five thousand four hundred fifty-seven ambulatory men (mean age 73.6 ± 5.9).

MEASUREMENTS

Physical performance assessed according to grip strength, narrow walk speed, walking speed, and time to complete five repeated chair stands. Individual scores were converted to quintiles (worst=1 to best=5; unable to complete=0) and summed for an overall score (mean 11.6 ± 4.3, range, 1-20). MetS was defined according to World Health Organization criteria that include evidence of glucose dysregulation (insulin resistance, diabetes mellitus, or hyperinsulinemia) and at least two additional characteristics: high blood pressure, low high-density lipoprotein cholesterol, high triglycerides, obesity.

RESULTS

More than one-quarter (26.3%) of participants met criteria for MetS. In separate linear regression models, four of five MetS components were related to performance (P<.001); only high blood pressure was unrelated. Men with MetS had a 1.1-point lower performance score (mean 10.8, 95% confidence interval (CI)=10.6-11.0) than men without MetS (mean 11.9, 95% CI=11.8-12.0) (P<.001), adjusting for age, race, education, and site. With further covariate adjustment, this difference was reduced but remained significant (β=-0.78, P<.001). A graded association was observed between number of MetS components (0, 1, 2, or ≥3) and performance (P for trend <.001). Findings were similar excluding men with diabetes mellitus or obese men.

CONCLUSION

Metabolic dysregulation is related to objectively assessed poorer physical performance in relatively healthy older men.

Weight loss and low-intensity exercise for the treatment of metabolic syndrome in obese postmenopausal women

BACKGROUND

The prevalence of the metabolic syndrome (MetSyn) approaches 50% in postmenopausal women. This study examines the efficacy of lifestyle modification for the treatment of MetSyn and its associated risk for cardiovascular disease and diabetes in this population.

METHODS

This prospective controlled study examines the effects of a 6-month weight loss and low-intensity exercise program (WL+LEX) on body composition (dual-energy X-ray absorptiometry and abdominal computed tomography scans), fasting glucose and lipid levels, cytokines, and blood pressure in postmenopausal women with and without MetSyn.

RESULTS

WL+LEX reduced body weight (MetSyn: -5% vs non-MetSyn: -7%) and fat mass (-11% vs -15%) and increased VO(2max) (+2% vs +3%) in both MetSyn (N = 35) and non-MetSyn (N = 41) groups. Constituents of MetSyn decreased comparably in both groups. Fifteen (45%) MetSyn participants responded (R) by converting to non-MetSyn, 18 remained MetSyn (NR), and 2 had missing data. Reduction in fat mass (-15% vs -8%, p = .02) was greater in R than NR, but there were no between-group differences in changes in VO(2max), cytokines, or other variables. The decrease in the number of MetSyn criteria was greater in R than in NR (-27 vs -13, p < .0001) due to decreases in blood pressure (p < .01), glucose (p = .02), and with a trend for triglyceride (p = .07). Reductions in fat mass best predicted resolution of MetSyn (p = .04).

CONCLUSIONS

Women who lose more fat are more likely to lower blood pressure, glucose, and triglyceride levels to resolve MetSyn. Thus, a WL+LEX program effectively treats postmenopausal women with MetSyn.

Metabolically healthy obese women and functional capacity

BACKGROUND

Obesity and the metabolic syndrome are significant determinants of functional capacity in women. In the past decade, the term "metabolically healthy obese" (MHO) emerged in the literature to identify a distinct category of obese individuals presenting less metabolic impairment than expected. However, MHO women might have similar risk than non-MHO women for nonmetabolic weight-related co-morbidities, including altered functional capacity.

METHODS

Eighty six obese women aged from 28 to 74 years old were studied. MHO was defined as a body mass index (BMI) ≥30.0 kg/m(2) with less than one metabolic syndrome criteria based on the Adult Treatment Panel III (ATP III) definition. Walking distance (m) and walking speed (m/sec), evaluated by the 6-min walk test, were used as indicators of functional capacity.

RESULTS

Twenty one percent of the sample was considered MHO. Age, BMI, physical activity level, and diastolic blood pressure were not significantly different between MHO and non-MHO women. MHO women performed better on the 6-min walk test (519.8 m±68.2 vs. 448.4 m±67.1; P≤0.01) compared to non-MHO women. Moreover, in multiple regression analyses, MHO status and BMI were significantly associated with walking speed after adjustment for age, physical activity level, the total number of chronic conditions, and arthritis/osteoarthritis.

CONCLUSIONS

Our results show that MHO women have a better functional capacity than non-MHO women, and therefore could be at lower risk for future disability. However, weight management remains important because BMI was also an independent predictor of functional capacity regardless of metabolic profile.

Adipocytokines and the metabolic syndrome among older persons with and without obesity: the InCHIANTI study

OBJECTIVES

Adipose tissue-derived inflammation may contribute to metabolic alterations and eventually to the metabolic syndrome (MetS). The purpose of this study was to: (1) examine the role of adipocytokines in the association between obesity and the MetS and (2) to determine whether the association is different in obese and non-obese persons.

DESIGN

Cross-sectional population-based InCHIANTI study.

SUBJECTS

A total of 944 community-dwelling adults aged 65 years and older living in Tuscany, Italy.

MEASUREMENTS

Obesity was defined as body mass index > or =30 kg/m2 and MetS as > or =3 of the ATP-III criteria. Circulating levels of C-reactive protein, interleukin (IL)-6, IL-1 receptor antagonist (IL-1ra), IL-18, tumour necrosis factor (TNF)-alpha R1, adiponectin, resistin and leptin were measured. Additionally, insulin resistance was determined using the homeostasis model assessment (HOMA-IR).

RESULTS

The prevalence of the MetS was 32%. Both overall and abdominal obesity were significantly associated with the MetS after adjusting for inflammatory cytokines, adipokines and lifestyle factors. After adjusting for multiple confounders and HOMA-IR, IL-1ra, TNF-alpha R1 and adiponectin (P < 0.05) remained significantly associated with the MetS. Having multiple cytokines in the highest tertile increased the likelihood of having the MetS in both obese (P for trend 0.002) and non-obese persons (P for trend 0.001) independent of insulin resistance.

CONCLUSIONS

Non-obese and obese individuals who develop an intense pro-inflammatory state may be more prone to develop the MetS than those with lower levels of inflammation.