Association of central obesity and high body mass index with function and cognition in older adults

Merchant, Reshma Aziz; Kit, Michael Wong Wai; Lim, Jia Yi; Morley, John E.

doi:10.1530/ec-21-0223

Cited by 7 publications

(6 citation statements)

References 52 publications

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“…This is termed the "obesity paradox" and most studies used BMI to define obesity which may not differentiate between fat mass and fat free mass (49). A recently published study on BMI and waist circumference showed that high BMI was associated with better functional and cognitive status especially in males (15). Males in our study had significantly higher FFMI and highest tertile of FFMI group had significantly higher MoCA scores.…”

Section: Discussionmentioning

confidence: 55%

“…BMI need to be interpreted with caution in older adults as loss of physiological height may lead to over-interpretation and lack of correlation with percentage body fat, distribution, or body composition (8)(9)(10)(11). Unlike younger adults, high BMI in older adults is associated with better function, cognition, and survival (12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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Relationship of Fat Mass Index and Fat Free Mass Index With Body Mass Index and Association With Function, Cognition and Sarcopenia in Pre-Frail Older Adults

Merchant

Seetharaman

et al. 2021

Front. Endocrinol.

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BackgroundBody mass index (BMI) is an inadequate marker of obesity, and cannot distinguish between fat mass, fat free mass and distribution of adipose tissue. The purpose of this study was twofold. First, to assess cross-sectional relationship of BMI with fat mass index (FMI), fat free mass index (FFMI) and ratio of fat mass to fat free mass (FM/FFM). Second, to study the association of FMI, FFMI and FM/FFM with physical function including sarcopenia, and cognition in pre-frail older adults.MethodsCross-sectional study of 191 pre-frail participants ≥ 65 years, 57.1% females. Data was collected on demographics, cognition [Montreal Cognitive Assessment (MoCA)], function, frailty, calf circumference, handgrip strength (HGS), short physical performance battery (SPPB) and gait speed. Body composition was measured using InBody S10. FMI, FFMI and FM/FFM were classified into tertiles (T1, T2, T3) with T1 classified as lowest and T3 highest tertile respectively and stratified by BMI.ResultsHigher FFMI and lower FM/FFM in the high BMI group were associated with better functional outcomes. Prevalence of low muscle mass was higher in the normal BMI group. FMI and FM/FFM were significantly higher in females and FFMI in males with significant gender differences except for FFMI in ≥ 80 years old. Small calf circumference was significantly less prevalent in the highest tertile of FMI, FM/FMI and FFMI. Prevalence of sarcopenic obesity and low physical function (HGS, gait speed and SPPB scores) were significantly higher in the highest FMI and FM/FFM tertile. Highest FFMI tertile group had higher physical function, higher MoCA scores, lower prevalence of sarcopenic obesity and sarcopenia, After adjustment, highest tertile of FFMI was associated with lower odds of sarcopenia especially in the high BMI group. Highest tertile of FM/FFM was associated with higher odds of sarcopenia. Higher BMI was associated with lower odds of sarcopenia.ConclusionFFMI and FM/FFM may be a better predictor of functional outcomes in pre-frail older adults than BMI. Cut-off values for healthy BMI values and role of calf circumference as a screening tool for sarcopenia need to be validated in larger population. Health promotion intervention should focus on FFMI increment.

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Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Relationship of Fat Mass Index and Fat Free Mass Index With Body Mass Index and Association With Function, Cognition and Sarcopenia in Pre-Frail Older Adults

Merchant

Seetharaman

et al. 2021

Front. Endocrinol.

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“…Clinically, BMI is often used as an anthropometric indicator to measure nutritional status (Lai et al., 2020), and researchers (Merchant, Kit, et al., 2021;Merchant, Seetharaman, et al., 2021) believe that low BMI (BMI < 18.5 kg/m 2 ) is more correlated with increased mortality in the older adults. This study found that 55.5% of participants had a BMI in the normal range (18.5–23.9 kg/m 2 ), 36.4% of older adults were overweight or obese and only 8.1% were underweight, with a BMI of less than 18.5, reflecting malnutrition.…”

Section: Discussionmentioning

confidence: 99%

Nutritional status of the older adults in nursing homes: A cross‐sectional study

Chen,

Shen,

Gao

et al. 2024

Journal of Clinical Nursing

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Aim and objectivesTo investigate the nutritional status of older adults in nursing homes in Chongqing, China, compare and analyse the differences in the physical condition, cognitive function and social‐related factors of older adults with different nutritional statuses.BackgroundMalnurtition in the older people has become a priority concer, and the incidence and factors associated with malnutrition vary somewhat by healthcare setting. In Chongqing ,China, there is lack of research on malnutrition of the older people in nursing homes. Here, we investigated the incidence of malnutrition and analysed the associated factors.DesignA cross‐sectional study.MethodsFrom January to April 2023, a cross‐sectional survey was conducted in three nursing homes in Chongqing, China. Participants completed a series of questionnaires, including the Demographic Information Questionnaire which included age, gender, education level, previous occupation, marital status and other information. The survey also included validated non‐demographic instruments [Short‐Form Mini‐Nutritional Assessment (MNA‐SF), Barthel Index (BI) and Mini‐mental State Examination (MMSE)] to identify related impact factors. The Guidelines for cross‐sectional studies were used in this study (Data S1).Results209 older adults aged 60 and over participated in this study, of whom 121 were women and 88 were men. The average (SD) age of the participants was 84.7 (6.3) years. Of the participants, 46.4% were classified as well nourished. About 39.2% were at risk of malnutrition and 14.4% were malnourished. Compared to those who were well nourished, those who were malnourished or at risk of becoming malnourished were more likely to suffer from comorbidities, polypharmacy, a higher risk of falling, ADL dependence and to receive more nutritional interventions. However, there are no significant differences after adjustment for age, education level, previous occupation, marital status, length of stay, and type of health care payment.ConclusionMalnutrition is a common problem among older adults innursing homes in Chongqing, China. There are certain differences in physical conditions and nutritional interventions among older adults withdifferent nutritional status.Public ContributionThis study suggests that the problem of malnutrition is very prominent in nursing homes in Chongqing, China. Cognitive impairment, impaired activities of daily living, fall risk and nutritional intervention need to be prevalent in older adults with (risk of) malnutrition.

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“…High BMI may be a protective factor in older adults especially those at risk of declining functional status and indeed has been associated with improved survivability in older adults ( 54 ). Body composition is also an important factor, as men in the high BMI group but without central obesity performed better on the functional and cognitive tests ( 55 ).…”

Section: Discussionmentioning

confidence: 99%

Patterns of improvement in functional ability and predictors of responders to dual-task exercise: A latent class analysis

Chan

Merchant

2023

Front. Public Health

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BackgroundExercise is the pillar for healthy aging. “Non-responders” may be due to a mismatch in exercise prescription. A latent cluster analysis (LCA) profile can be useful to uncover subpopulations sharing similar profiles or outcomes. We aim to use the LCA to develop a response prediction model for older adults who would benefit from The Healthy Aging Promotion Program for You, a community-embedded dual-task exercise program.MethodsA total of 197 participants completed the 3-month follow-up, and the complete data were available for 136 community-dwelling older adults. Inclusion criteria were age ≥60 years, pre-frail or frail and ambulant, mild cognitive impairment, and ability to provide consent. Data collected include demographics, education, falls, physical function (Katz ADL scale and Lawton's IADL scale), physical activity (rapid assessment of physical activity), cognition (Montreal Cognitive Assessment; MoCA), frailty (FRAIL scale), and perceived health, pain, anxiety/depression, fear of falling, and social isolation (Lubben Social Network Scale). The body mass index (BMI), handgrip strength, and short physical performance battery (SPPB) were measured. Those who improved in frailty, anxiety/depression, pain, Lubben, MoCA, SPPB, fear-of-falling, physical activity, falls, and HGS were classified as responders.ResultsThe mean age was 74.7 years, BMI 23.5 kg/m2, 23.5% were male, 96.3% were of Chinese ethnicity, 61% were pre-frail, education level of 4.3 years, and the MoCA score of 23.3 ± 4.8. Two clusters were identified: non-responders (61.8%) and responders (38.2%). Responders had significant improvement in cognition (44.2% vs. 0, p < 0.001) and SPPB (gait:28.8% vs. 0, p < 0.001; balance:42.3% vs. 15.5%, p = 0.001; chair-stand:65.4% vs. 4.8%, p < 0.001). Responders were significantly older (76.9 vs. 73.3 years, p = 0.005), had higher BMI (24.8 vs. 22.8 kg/m2, p = 0.007), lower education (3.4 vs. 4.9 years, p = 0.021), lower MoCA scores (21.8 vs. 24.3, p = 0.002), and lower SPPB scores (8.7 vs. 10.6, p < 0.001). The predictive variables for the responder cluster were age ≥75 years, BMI ≥23 kg/m2, robust, no anxiety, pain, fear of falling, MoCA ≤22, Lubben ≤12, SPPB score: chair-stand ≤2, balance ≤2, gait >2, handgrip strength <20 kg, no falls and RAPA >3. With an optimal cut-off of ≥12, this prediction model had sensitivity of 76.9%, specificity of 70.2%, positive predictive value 61.5%, and negative predictive value of 83.1%.ConclusionResponse to dual-task exercise was influenced by age, SPPB, BMI, and cognition. Prospective longitudinal studies are needed to validate this LCA model and guide the development of public health strategies.

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Association of central obesity and high body mass index with function and cognition in older adults

Cited by 7 publications

References 52 publications

Relationship of Fat Mass Index and Fat Free Mass Index With Body Mass Index and Association With Function, Cognition and Sarcopenia in Pre-Frail Older Adults

Relationship of Fat Mass Index and Fat Free Mass Index With Body Mass Index and Association With Function, Cognition and Sarcopenia in Pre-Frail Older Adults

Nutritional status of the older adults in nursing homes: A cross‐sectional study

Patterns of improvement in functional ability and predictors of responders to dual-task exercise: A latent class analysis

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