Decreased muscle mass and increased central adiposity are independently related to mortality in older men

Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, United Kingdom.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 11/2007; 86(5):1339-46.
Source: PubMed


Aging is associated with significant changes in body composition. Body mass index (BMI; in kg/m(2)) is not an accurate indicator of overweight and obesity in the elderly.
We examined the relation between other anthropometric indexes of body composition (both muscle mass and body fat) and all-cause mortality in men aged 60-79 y.
The study was a prospective study of 4107 men aged 60-79 y with no diagnosis of heart failure and who were followed for a mean period of 6 y, during which time there were 713 deaths.
Underweight men (BMI < 18.5) had exceptionally high mortality rates. After the exclusion of these men, increased adiposity [BMI, waist circumference (WC), and waist-to-hip ratio] showed little relation with mortality after adjustment for lifestyle characteristics. Muscle mass [indicated by midarm muscle circumference (MAMC)] was significantly and inversely associated with mortality. After adjustment for MAMC, obesity markers, particularly high WC (>102 cm) and waist-to-hip ratio (top quartile), were associated with increased mortality. A composite measure of MAMC and WC most effectively predicted mortality. Men with low WC (</=102 cm) and above-median muscle mass showed the lowest mortality risk. Men with WC > 102 cm and above-median muscle mass showed significantly increased mortality [age-adjusted relative risk: 1.36; 95% CI: 1.07, 1.74), and this increased to 1.55 (95% CI: 1.01, 2.39) in those with WC > 102 and low MAMC.
The findings suggest that the combined use of both WC and MAMC provides simple measures of body composition to assess mortality risk in older men.

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    • "Conversely, physical inactivity leads to decreased skeletal muscle mass [20]. Decreased skeletal muscle mass and strength is associated with increased morality [21,22]. Sarcopenic obesity is also associated with hypertension, independent of abdominal obesity [23]. "
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    Diabetology and Metabolic Syndrome 02/2014; 6(1):27. DOI:10.1186/1758-5996-6-27 · 2.17 Impact Factor
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    • "However few population studies to date have examined the possible role of lean muscle mass, adipokines (leptin , adiponectin) and NT-proBNP in explaining the obesity paradox, although previous studies suggest that NT-proBNP and adiponectin may explain the obesity paradox in HF [18,21]. In a previous report, we observed a positive association between BMI and mortality in older adults without HF once muscle mass had been taken into account [13]. However , the association of BMI and mortality in men with CHD or HF has not been specifically examined. "
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    ABSTRACT: We have investigated the role of muscle mass, natriuretic peptides and adipokines in explaining the obesity paradox. The obesity paradox relates to the association between obesity and increased survival in patients with coronary heart disease (CHD) or heart failure (HF). Prospective study of 4046 men aged 60-79years followed up for a mean period of 11years, during which 1340 deaths occurred. The men were divided according to the presence of doctor diagnosed CHD and HF: (i) no CHD or HF ii), with CHD (no HF) and (iii) with HF. Overweight (BMI 25-9.9kg/m(2)) and obesity (BMI≥30kg/m(2)) were associated with lower mortality risk compared to men with normal weight (BMI 18.5-24.9kg/m(2)) in those with CHD [hazards ratio (HR) 0.71 (0.56,0.91) and 0.77 (0.57,1.04); p=0.04 for trend] and in those with HF [HR 0.57 (0.28,1.16) and 0.41 (0.16,1.09; p=0.04 for trend). Adjustment for muscle mass and NT-proBNP attenuated the inverse association in those with CHD (no HF) [HR 0.78 (0.61,1.01) and 0.96 (0.68,1.36) p=0.60 for trend) but made minor differences to those with HF [p=0.05]. Leptin related positively to mortality in men without HF but inversely to mortality in those with HF; adjustment for leptin abolished the BMI mortality association in men with HF [HR 0.82 (0.31,2.20) and 0.99 (0.27,3.71); p=0.98 for trend]. The lower mortality risk associated with excess weight in men with CHD without HF may be due to higher muscle mass. In men with HF, leptin (possibly reflecting cachexia) explain the inverse association.
    International journal of cardiology 11/2013; 171(1). DOI:10.1016/j.ijcard.2013.11.043 · 4.04 Impact Factor
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    • "However, in other studies, the r2 values between BMI and muscle mass were not so high (r2 = 0.22 to 0.40) [10,12,13]. The reasons for these lower r2 values are unknown, but it might be due to the fact that the previous studies used muscle girth or area estimated from the anthropometric data of the upper arm [10,13] or the upper arm and calf [12]. "
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    ABSTRACT: Body mass index (BMI), expressed as the ratio of body mass to height squared (kg/m2), involves not only fat but also lean mass. The present study aimed to clarify how BMI is associated with total muscle mass (TMM) in older Japanese women and men. Using a B-mode ultrasound apparatus, muscle thickness was measured at nine sites (forearm, upper arm anterior and posterior, thigh anterior and posterior, lower leg anterior and posterior, abdomen, and subscapular) for 346 women (BMI 16.40 to 33.11 kg/m2) and 286 men (BMI 16.86 to 31.18 kg/m2) aged 60.0 to 79.5 yrs. TMM was estimated using the product of the sum of the muscle thicknesses at the nine sites with height as an independent variable. For both sexes, the estimated TMM relative to height squared was significantly correlated with BMI (r = 0.688, P<0.0001 for women; r = 0.696, P<0.0001 for men), but the percentage of the estimated TMM in body mass was not. These results indicate that, for older Japanese women and men, BMI is a simple and convenient index for assessing total muscularity.
    Journal of PHYSIOLOGICAL ANTHROPOLOGY 03/2013; 32(1):4. DOI:10.1186/1880-6805-32-4 · 1.27 Impact Factor
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