Association Between Life‐Course Obesity and Frailty in Older Adults: Findings in the GAZEL Cohort

Abstract

► Frailty is a predictor of poor health outcomes among older adults. ► Although weight loss is part of frailty, previous studies demonstrated that aged individuals with obesity are more likely to be frail compared with aged individuals without obesity. ► The impact of life-course obesity on the risk of frailty in old age remains poorly described.What does this study add?► In a cohort of older adults followed for 26 years, we showed that the duration of obesity influences the risk of frailty: the longer the period of obesity, the higher the risk of frailty. ► We also identified a persisting effect of obesity on the risk of frailty among individuals who previously had obesity.Objective: This study aimed to assess the relationship between weight history during adulthood and frailty in late life in men and women participating in the GAZEL (GAZ and ELectricité) cohort.Methods: This cohort study included 8,751 men and 3,033 women (aged 61 to 76 years) followed up since 1989. Modified Fried's frailty criteria (weakness, fatigue, unintentional weight loss, low physical activity, and impaired mobility) were assessed in 2015. Reported BMI was determined each year to characterize: obesity status in 2015, obesity duration over the 1990 to 2015 period, and trajectories of BMI. Associations between frailty and weight history were assessed using multinomial regression.Results: In 2015, 12% of men had obesity, 1.8% severe obesity, and 0.4% morbid obesity; for women, these percentages were 11%, 2.2%, and 0.8%, respectively. Individuals with obesity were more likely to be frail than those with normal BMI and the risk of frailty increased with each additional year of obesity (adjusted odds ratio 1.04 [1.00-1.08] for men and 1.07 [1.02-1.13] for women). Trajectories of BMI revealed that both long-term obesity and onset of obesity in late adulthood were associated with frailty.Conclusions: Current and past obesity appear to be important determinants of frailty. Early weight management may be beneficial in old age.

Nutritional Status and Risk Factors for Frailty in Community-Dwelling Older People: A Cross-Sectional Study

“…Our sample presented a status of overnutrition according to different nutritional markers, including obesity according to BMI, waist circumference, body fat percentage, and biochemical markers. While BMI alone does not seem to be a suitable measure for assessing the risk of frailty [38], in populations with high caloric intake there is evidence of an association between obesity and frailty [39], and BMI trajectories have revealed that both long-term obesity and onset of obesity in late adulthood were associated with frailty [40]. Central obesity, as assessed by waist circumference, was high in both groups, although the body fat percentage was slightly lower in the prefrail/frail group.…”

Nutrition and Frailty: Opportunities for Prevention and Treatment

“…A high proportion of undernourished people are frail, and undernutrition leads to weight loss, which can contribute to the frailty syndrome [ 18 ]. At the other end of the spectrum is overnutrition; obesity increases frailty risk [ 19 ], with evidence that the risk of frailty increases with longer duration of obesity [ 20 ]. In terms of body composition, frailty has been associated with higher body fat mass and fat percentage, with low muscle mass and often no association with body mass index (BMI) [ 21 , 22 , 23 , 24 ].…”

Body mass index and physical frailty among older Mexican Americans: Findings from an 18-year follow up

“…Longitudinal studies have also found that obesity predicts the development of frailty [18][19][20][21][22][23][24][25]. For example, a study by Stenholm et al [24] concluded that midlife obesity led to a fivefold increase in the risk of frailty over a 22-year follow up compared to those of normal weight among participants in the Mini-Finland Health Examination Survey.…”