Association Between Sarcopenic Obesity and Falls in a Multiethnic Cohort of Postmenopausal Women

Abstract

OBJECTIVES: To prospectively investigate associations of sarcopenia, obesity, and sarcopenic obesity with the incidence of falls in a racially and ethnically diverse cohort of healthy postmenopausal women from the Women’s Health Initiative (WHI). DESIGN: Prospective cohort study. SETTING: Three WHI clinical centers (Tucson-Phoenix, AZ; Pittsburgh, PA; Birmingham, AL). PARTICIPANTS: Postmenopausal women aged 50–79 years enrolled in the WHI who received bone and body composition scans by Dual-Energy X-ray Absorptiometry (DXA) at baseline (n=11,020). MEASUREMENTS: Sarcopenia was defined as the lowest 20th percentile of appendicular lean mass, correcting for height and body fat. Obesity was defined as a body fat percentage above 42%. Sarcopenic obesity was defined as the co-occurrence of sarcopenia and obesity. Fall outcome was defined as participants who reported falling 2 or more times in any year during 7 years of follow-up. The relative risk (RR) and 95% confidence interval (95% CI) for falls associated with sarcopenic obesity status were analyzed with log binomial regression models stratified by age and race/ethnicity. RESULTS: Sarcopenic obesity was associated with an increased risk of falls among women aged 50 – 64 years (RR=1.35, 95% CI: 1.17, 1.56), and those aged 65–79 years (RR=1.21, 95% CI: 1.05, 1.39). Sarcopenic obesity related fall risk among Hispanic/Latina women was higher than Non-Hispanic White women (RR=2.40, 95% CI: 1.56, 3.67 and RR=1.24, 95% CI: 1.11, 1.39, respectively). CONCLUSION: In a multiethnic cohort of postmenopausal women, sarcopenic obesity related fall risk was elevated among women aged less than 65 years and women 65 years and over. Sarcopenic obesity posed the highest risk for falls in Hispanic/Latina women. The findings support identification of causal factors and health disparities in sarcopenic obesity to better tailor fall prevention strategies and ameliorate this significant public health burden.

Factors Associated with history of Fall among Elderly people in Southern West Bank

“…Sarcopenia is gradual decrease in muscle strength and function. Declined muscle mass is replaced by fat tissue with consequent increase in obesity (Follis, Cook, Bea, Going, & Laddu, 2018). Sarcopenic individuals have 60% increases in the odds of falling in meta-analysis of studies on elderly ≥ 65 (Yeung et al, 2019).…”

Effects of Hormone Replacement Therapy on Sarcopenia: Is It Real?

“…

We read the article by Follis and colleagues examining the relationship between sarcopenic obesity and falls in a multiethnic cohort of postmenopausal women. 1 We found this article interesting; however, we want to address some points.Although the anabolic effects of androgens are well known, the results of studies examining the effect of estrogen on skeletal muscle are conflicting. Previous studies have shown that hormone replacement therapy (HRT) increased muscle mass and strength in postmenopausal women.

…”

Reply to Effects of Hormone Replacement Therapy on Sarcopenia: Is It Real?

“…Accordingly, we controlled for HRT as a confounder in the association between sarcopenic obesity and falls. 2 To further address this point, we conducted a sensitivity analysis excluding HRT users. The results for risk of falls yielded similar findings to the total sample (data not shown), in agreement with prior research in the Women's Health Initiative (WHI) cohort.…”

“…As the authors indicate, there is some evidence that hormone replacement therapy (HRT) may play an important role in sarcopenia. Accordingly, we controlled for HRT as a confounder in the association between sarcopenic obesity and falls . To further address this point, we conducted a sensitivity analysis excluding HRT users.…”