Effect of weight loss on mortality in overweight and obese nursing home residents during a 5-year follow-up

Pizzato, S.; Sergi, Giuseppe; Bolzetta, Francesco; Rui, Marina De; Ronch, Irene De; Carraro, Samuela; Berton, Linda; Orr, Esther H.; Imoscopi, Alessandra; Perissinotto, Egle; Coin, Alessandra; Manzato, Enzo; Veronese, Nicola

doi:10.1038/ejcn.2015.19

Cited by 25 publications

(11 citation statements)

References 47 publications

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“…If present, weight loss should be viewed as an important factor, even in the obese as it is clearly associated with increased mortality risk in frail, nursing home residents. 48 On the other hand, as obesity becomes a more prevalent phenomenon, obesity-related features should not be overlooked in the context of frailty detection and classification.…”

Section: Discussionmentioning

confidence: 99%

Severe central obesity or diabetes can replace weight loss in the detection of frailty in obese younger elderly – a preliminary study

Buch

Boker

Kis

et al. 2018

CIA

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PurposeUnwanted weight loss is one of the established criteria for the diagnosis of frailty. However, the relevance of this criterion to detect frailty in obese older adults has not been assessed. In particular, with the exception of malignancy, unwanted weight loss is not commonly seen in older obese subjects. Therefore, we tested the possibility that some obesity phenotypes and/or diabetes might be more useful in the detection of frailty in this setting.Patients and methodsA preliminary cross-sectional study of 50 consecutive subjects was conducted at The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center. Inclusion criteria were: young elderly (aged 65–75 years), with general and/or abdominal obesity, without cancer. Frailty was assessed directly using the Fried model, the five-item fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale. Eventually, in the assessment of frailty, the weight loss criterion was replaced by one or several of obesity/diabetes-related variables each time: severity of obesity by body mass index, waist circumference (and their interaction), body fat, and diabetes. The receiver operating characteristic curves for functional impairment indices were plotted to compare the usefulness of the frailty accepted and adjusted models.ResultsThe prevalence of frailty and pre-frailty in this cohort were 7/50 (14%) and 27/50 (54%), respectively, but unwanted weight loss was seen in three subjects (6%) only. The level of abdominal obesity had the strongest correlation with functional score (r=0.292, P<0.05). Frailty models which included either severe abdominal obesity or diabetes in lieu of unwanted weight loss had good sensitivity rates per each frailty score as compared with the original Fried model.ConclusionFor detecting and/or screening for the frailty syndrome in obese young elderly, the level of abdominal obesity or diabetes may provide a useful marker.

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Section: Discussionmentioning

confidence: 99%

Severe central obesity or diabetes can replace weight loss in the detection of frailty in obese younger elderly – a preliminary study

Buch

Boker

Kis

et al. 2018

CIA

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“…The index has been further validated for all-cause mortality in hospitalized patients with specific acute and chronic diseases [ 11 – 15 ], and in outpatients with cognitive impairment [ 16 ]. It has also been associated with mortality in nursing home residents [ 17 ]. The MPI has been found to have high predictive validity across these settings, and it has been shown to have high adherence to clinimetric properties, including accuracy, calibration and feasibility.…”

Section: Introductionmentioning

confidence: 99%

Multidimensional Prognostic Index in Association with Future Mortality and Number of Hospital Days in a Population-Based Sample of Older Adults: Results of the EU Funded MPI_AGE Project

et al. 2015

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BackgroundThe Multidimensional Prognostic Index (MPI) has been found to predict mortality in patients with a variety of clinical conditions. We aimed to assess the association of the MPI with future mortality and number of in-hospital days for the first time in a population-based cohort.MethodsThe study population consisted of 2472 persons, aged 66–99 years, from the Swedish National Study on Aging and Care in Kungsholmen, Sweden, who underwent the baseline visit 2001–4, and were followed up >10 years for in-hospital days and >12 years for mortality. The MPI was a modified version of the original and aggregated seven domains (personal and instrumental activities of daily living, cognitive function, illness severity and comorbidity, number of medications, co-habitation status, and nutritional status). The MPI score was divided into risk groups: low, medium and high. Number of in-hospital days (within 1, 3 and 10 years) and mortality data were derived from official registries. All analyses were age-stratified (sexagenarians, septuagenarians, octogenarians, nonagenarians).ResultsDuring the follow-up 1331 persons (53.8%) died. Laplace regression models, suggested that median survival in medium risk groups varied by age from 2.2–3.6 years earlier than for those in the corresponding low risk groups (p = 0.002-p<0.001), and median survival in high risk groups varied by age from 3.8–9.0 years earlier than for corresponding low risk groups (p<0.001). For nonagenarians, the median age at death was 3.8 years earlier in the high risk group than for the low risk group (p<0.001). The mean number of in-hospital days increased significantly with higher MPI risk score within 1 and 3 years for people of each age group.ConclusionFor the first time, the effectiveness of MPI has been verified in a population-based cohort. Higher MPI risk scores associated with more days in hospital and with fewer years of survival, across a broad and stratified age range.

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“…On the other hand, weight loss results in loss of both fat and lean mass, and can reduce muscular strength and increase functional impairment even among obese individuals25; these changes may be particularly detrimental among very old adults who already have experienced significant age‐related loss of muscle mass,26 resulting in further functional decline27 and incident frailty 28. Therefore, the risks versus benefit of recommendations to lose weight need to be carefully considered in older men on a case‐by‐case basis.…”

Section: Discussionmentioning

confidence: 99%

Central Obesity and Visceral Adipose Tissue Are Not Associated With Incident Atherosclerotic Cardiovascular Disease Events in Older Men

Schousboe

Kats

Langsetmo

et al. 2018

JAHA

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BackgroundVisceral adipose tissue (VAT) and other measures of central obesity predict incident atherosclerotic cardiovascular disease (ASCVD) events in middle‐aged individuals, but these associations are less certain in older individuals age 70 years and older. Our objective was to estimate the associations of VAT and the android–gynoid fat mass ratio, another measure of central obesity, with incident ASCVD events among a large cohort of older men.Methods and ResultsTwo thousand eight hundred ninety‐nine men (mean [SD] age 76.3 [5.5] years) enrolled in the Outcomes of Sleep Disorders in Older Men study had rigorous adjudication of incident ASCVD events (myocardial infarction, coronary heart disease death, or fatal or nonfatal stroke). We used proportional hazards models to estimate the hazard ratios for incident ASCVD per SD increase of VAT or android–gynoid fat mass ratio (measured at baseline with dual‐energy absorptiometry), adjusted for age, race, education, systolic blood pressure, smoking status, oxidized low‐density lipoprotein level, treatment for hypertension, statin use, aspirin use, presence of diabetes mellitus, and study enrollment site. Over a mean (SD) follow‐up period of 7.9 (3.4) years, 424 men (14.6%) had an incident ASCVD event. Neither VAT nor android–gynoid fat mass ratio were associated with incident ASCVD events, either unadjusted or after multivariable‐adjustment (hazard ratios [95% confidence interval ] per SD increase 1.02 [0.92–1.13] and 1.05 [0.95–1.17], respectively).ConclusionsCentral adipose tissue, as measured by VAT or android–gynoid fat mass ratio, was not associated with incident ASCVD events in this study of older men.

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Effect of weight loss on mortality in overweight and obese nursing home residents during a 5-year follow-up

Abstract: In conclusion, weight loss increases the mortality risk in frail, disabled NH residents, even if they are overweight or obese.

Cited by 25 publications

References 47 publications

Severe central obesity or diabetes can replace weight loss in the detection of frailty in obese younger elderly – a preliminary study

Severe central obesity or diabetes can replace weight loss in the detection of frailty in obese younger elderly – a preliminary study

Multidimensional Prognostic Index in Association with Future Mortality and Number of Hospital Days in a Population-Based Sample of Older Adults: Results of the EU Funded MPI_AGE Project

Central Obesity and Visceral Adipose Tissue Are Not Associated With Incident Atherosclerotic Cardiovascular Disease Events in Older Men

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Effect of weight loss on mortality in overweight and obese nursing home residents during a 5-year follow-up

Abstract: In conclusion, weight loss increases the mortality risk in frail, disabled NH residents, even if they are overweight or obese.

Cited by 25 publications

References 47 publications

Severe central obesity or diabetes can replace weight loss in the detection of frailty in obese younger elderly &ndash; a preliminary study

Severe central obesity or diabetes can replace weight loss in the detection of frailty in obese younger elderly &ndash; a preliminary study

Multidimensional Prognostic Index in Association with Future Mortality and Number of Hospital Days in a Population-Based Sample of Older Adults: Results of the EU Funded MPI_AGE Project

Central Obesity and Visceral Adipose Tissue Are Not Associated With Incident Atherosclerotic Cardiovascular Disease Events in Older Men

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Severe central obesity or diabetes can replace weight loss in the detection of frailty in obese younger elderly – a preliminary study

Severe central obesity or diabetes can replace weight loss in the detection of frailty in obese younger elderly – a preliminary study