John A Batsis

Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States

Are you John A Batsis?

Claim your profile

Publications (65)216.36 Total impact

  • Lydia E. Gill · Stephen J. Bartels · John A. Batsis
    [Show abstract] [Hide abstract]
    ABSTRACT: As the number of older adults increases rapidly, the national epidemic of obesity is also affecting our aging population. This is particularly concerning given the numerous health risks and increased costs associated with this condition. Weight management is extremely important for older adults given the risks associated with abdominal adiposity, which is a typical fat redistribution during aging, and the prevalence of comorbid conditions in this age group. However, approaches to weight loss must be considered critically given the dangers of sarcopenia (a condition that occurs when muscle mass and quality are lost), the increased risk of hip fracture with weight loss, and the association between reduced mortality and increased BMI in older adults. This overview highlights the challenges and implications of measuring adiposity in older adults and the dangers and benefits of weight loss in this population and provides an overview of the new Medicare Obesity Benefit. In addition, we provide a summary of outcomes from successful weight loss interventions for older adults and discuss implications for advancing clinical practice.
    09/2015; 4(3). DOI:10.1007/s13679-015-0161-z
  • [Show abstract] [Hide abstract]
    ABSTRACT: To identify the risks of the combination of normal body mass index (BMI) and central obesity (normal weight and central obesity (NWCO)) on physical activity and function. Longitudinal Osteoarthritis Initiative Study. Community based. Adults aged 60 and older at risk of osteoarthritis (N = 2,210; mean age 68, range 67.1-69.0) were grouped according to BMI (normal 18.5-24.9 kg/m(2) , overweight 25.0-29.9 kg/m(2) , obese ≥30.0 kg/m(2) ). High waist circumference (WC) was defined as greater than 88 cm for women and greater than 102 cm for men. Subjects were subcategorized according to WC (five categories). Subjects with normal BMI and a large WC were considered to have NWCO (n = 280, 12.7%). Six-year changes in the Physical Component Summary of the Medical Outcomes Study 12-item Short Form Survey (PCS), Physical Activity Scale for the Elderly (PASE), and Late-Life Function and Disability Index (LL-FDI) were examined. The association between BMI and WC over 6 years was assessed (reference normal BMI, normal WC). Stratified analyses were performed according to age (60-69; ≥70). Physical component scores, PASE, and LL-FDI declined with time. Mean PASE scores at 6 years differed between the NWCO group and the group with normal BMI and WC (117.7 vs 141.5), but rate of change from baseline to 6 years was not significantly different (P = .35). In adjusted models, those with NWCO had greater decline in PCS over time, particularly those aged 70 and older than those with normal BMI and WC (time interaction β = -0.37, 95% confidence interval = -0.68 to -0.06). Normal weight and central obesity in older adults at risk of osteoarthritis may be a risk factor for declining function and physical activity, particularly in those aged 70 and older, suggesting the value of targeting those with NWCO who would otherwise be labeled as low risk. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.
    Journal of the American Geriatrics Society 07/2015; 63(8). DOI:10.1111/jgs.13542 · 4.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Older adults with obesity are at risk for osteoarthritis (OA) and are predisposed to functional decline and disability. We examined the association between obesity and disability, physical activity, and quality of life at 6 years. Using data from the longitudinal Osteoarthritis Initiative (OAI), we analysed older adults (age ≥ 60 years) with a body mass index (BMI) at baseline ≥ 18.5 kg/m(2) (n = 2378) using standard BMI categories. Outcomes were assessed at the 6-year follow-up and included: the Late-Life Function and Disability Index (LLDI), the 12-item Short Form Health Survey (SF-12), and the Physical Activity Scale for the Elderly (PASE). Linear regression predicted outcomes based on BMI category, adjusting for age, sex, race, education, smoking, cohort status, radiographic knee OA, co-morbidity scores, and baseline scores when available. Follow-up data were available for 1727 (71.9%) participants (mean age 67.9 ± 5.3 years; 61.6% female). At baseline, obese subjects compared to overweight and normal were on a greater number of medications (4.28 vs. 3.63 vs. 3.32), had lower gait speeds (1.22 vs. 1.32 vs. 1.36 m/s), higher Charlson scores (0.59 vs. 0.37 vs. 0.30), and higher Western Ontario and McMaster University OA Index (WOMAC) scores (right: 14.8 vs. 10.3 vs. 7.5; left: 14.4 vs. 9.9 vs. 7.5). SF-12 scores at 6 years were lower in obese patients than in overweight or normal [99.5 (95% CI 98.7-100.4) vs. 101.1 (95% CI 100.4-101.8) vs. 102.8 (95% CI 101.8-103.8)], as were PASE scores [115.1 (95% CI 110.3-119.8) vs. 126.2 (95% CI 122.2-130.2) vs. 131.4 (95% CI 125.8-137.0)]. The LLDI limitation component demonstrated differences in obese compared to overweight or normal [78.6 (95% CI 77.4-79.9) vs. 81.2 (95% CI 80.2-82.3) vs. 82.5 (95% CI 81.1-84.0)]. Obesity was associated with worse physical activity scores, lower quality of life, and higher risk of 6-year disability.
    Scandinavian journal of rheumatology 06/2015; DOI:10.3109/03009742.2015.1021376 · 2.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: AimObesity is a major cardiovascular (CV) risk factor. Bariatric surgery (BSx) is an approved therapeutic alternative for class II–III obesity, but little evidence focuses on older adults. We assessed the effect of BSx on cardiometabolic variables and long-term CV risk in older adults.Methods We carried out a population-based, observational study from 1990–2009, of 40 consecutive elderly (age ≥60 years) residents of Olmsted County, MN, USA, with class II–III obesity treated with BSx at a University-based, academic health center. Data were obtained from the Rochester Epidemiology Project. Metabolic syndrome (MetS) was defined using American Heart Association/National Heart, Lung, Blood Institute (AHA/NHLBI) criteria (increased triglycerides, low high-density lipoprotein, increased blood pressure, increased glucose and body mass index as a modified measure of obesity instead of waist circumference). Change in CV risk factors, MetS prevalence, and impact on predicted CV risk using the Framingham risk score was ascertained at 1 year postoperatively and assessed statistically.ResultsMean age and body mass index were 64.4 ± 3.7 and 45.0 ± 6.3 kg/m2, respectively, and 28 out of 40 (70%) were women. One participant died during the 11-month study period after BSx from respiratory complications related to BSx, and one participant died at 2 years. Percentage of excess weight loss decreased by 57.5% at 1 year. Prevalence 1 year after BSx decreased for diabetes (57.5% to 22.5%; P < 0.03), hypertension 87.5% to 73.7% (P = 0.003), dyslipidemia (80% to 42.5%; P < 0.001) and sleep apnea (62.5% to 23.7%; P < 0.001).MetS prevalence decreased from 80% to 45% (P < 0.002). Baseline risk was 14.1%, which changed at follow up at 8.2%.Conclusions In older adults, BSx induces considerable weight loss, improves CV risk factors, decreases MetS prevalence and is an effective treatment in this population. Geriatr Gerontol Int 2015; ●●: ●●–●●.
    Geriatrics & Gerontology International 06/2015; DOI:10.1111/ggi.12527 · 2.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine whether leptin is related to all-cause and cardiovascular (CV) mortality in older adults. Participants 60 years and older with plasma leptin level measurements from the National Health and Nutrition Examination Survey III (1988-1994) and mortality data linked to the National Death Index were included. We created sex-specific tertiles of leptin (men: 4.2-7.7 μg/L; women: 11.5-21.4 μg/L) to identify the effect of leptin on all-cause and CV mortality. We also determined whether leptin predicted mortality in patients with obesity. We classified obesity using 4 possible definitions: body mass index 30 kg/m(2) or greater; body fat 25% or more in men and 35% or more in women; waist circumference 102 cm or greater in men and 88 cm or greater in women; and waist-hip ratio 0.85 or higher in women and 0.95 or higher in men. Sex-specific proportional hazard models were used to assess the effect of leptin on all-cause and CV mortality. Of 1794 participants, 51.6% were women; the mean age was 70.3±0.4 years, and the follow-up period was 12.5 years with 994 deaths (469 were CV deaths). All-cause mortality in the highest leptin tertile was significant neither in men (hazard ratio [HR], 1.23; 95% CI, 0.93-1.63) nor in women (HR, 0.97; 95% CI, 0.68-1.40). CV mortality was the highest in the highest leptin tertile in men (HR, 1.69; 95% CI, 1.06-2.70) but not in women (HR, 1.21; 95% CI, 0.73-1.98). Evaluating the effect of leptin in subgroups of different obesity definitions, we found that high leptin levels as predict CV mortality in men as measured by waist circumference or body fat. Elevated leptin level is predictive of CV mortality only in men. Leptin may provide additional mortality discrimination in obese men. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
    Mayo Clinic Proceedings 04/2015; 90(4):481-491. DOI:10.1016/j.mayocp.2015.01.023 · 6.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Physical activity reduces mobility impairments in elders. We examined the association of physical activity on risk of subjective and objective physical function in adults with and at risk for osteoarthritis (OA). Adults aged≥60years from the longitudinal Osteoarthritis Initiative (OAI), a prospective observational study of knee OA, were classified by sex-specific quartiles of Physical Activity Score for the Elderly (PASE) scores. Using linear mixed models, we assessed 6-year data on self-reported health, gait speed, Late-Life Disability Index (LLDI) and chair stand. Of 2,252 subjects, mean age ranged from 66-70 years. Within each quartile, physical component (PCS) of the Short Form-12 and gait speed decreased from baseline to follow-up in both sexes (all p<0.001), yet the overall changes across PASE quartiles between these two time points were no different(p=0.40 and 0.69, males and females, respectively).Decline in PCS occurred in the younger age group, but rates of change between quartiles over time were no different in any outcomes in either sex. LLDI scores declined in the 70+ age group. Adjusting for knee extensor strength reduced the strength of association. Higher physical activity is associated with maintained physical function, and is mediated by muscle strength highlighting the importance of encouraging physical activity in older adults with and at risk for osteoarthritis.
    Journal of Physical Activity and Health 04/2015; DOI:10.1123/jpah.2014-0531 · 1.95 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Obesity and physical inactivity are independently associated with declines in physical and functional limitations in older adults. The current study examines the impact of physical activity on odds of physical and functional limitations in older adults with central and general obesity. Data from 6279 community-dwelling adults aged 60 years or more from the Health and Retirement Study 2006 and 2008 waves were used to calculate prevalence and odds of physical and functional limitation among obese older adults with high waist circumference (waist circumference ≥88 cm in females and ≥102 cm in males) who were physically active versus inactive (engaging in moderate/vigorous activity less than once per week). Logistic regression models were adjusted for age, sex, race/ethnicity, education, smoking status, body mass index, and number of comorbidities. Physical activity was associated with lower odds of physical and functional limitations among older adults with high waist circumference (odds ratio [OR], 0.59; confidence interval [CI], 0.52-0.68, for physical limitations; OR, 0.52; CI, 0.44-0.62, for activities of daily living; and OR, 0.44; CI, 0.39-0.50, for instrumental activities of daily living). Physical activity is associated with significantly lower odds of physical and functional limitations in obese older adults regardless of how obesity is classified. Additional research is needed to determine whether physical activity moderates long-term physical and functional limitations.
    03/2015; DOI:10.1519/JPT.0000000000000051
  • John A. Batsis · Kenneth M. Dolkart
    [Show abstract] [Hide abstract]
    ABSTRACT: The prevalence of obesity in the general population is increasing worldwide, and those surviving are at an increased risk for developing comorbidity and physical limitations. With aging, obesity places this high-risk population at an increased risk for future morbidity, institutionalization, and functional decline. Traditional weight loss programs lead to inconsistent improvements in comorbidity, function, and quality of life. Bariatric surgery may offer a reasonable alternative in selected patients to achieve improvements in these outcomes. We present our approach in assessing the physiologic age of older candidates for bariatric surgery from a geriatrician's perspective that may be useful for general internists, bariatricians, and general surgeons alike. We present how a focus on function and physiological parameters of aging provides more predictive power than that on chronological age alone.
    Journal of Clinical Gerontology and Geriatrics 02/2015; 6(2). DOI:10.1016/j.jcgg.2015.01.001
  • John A Batsis
    The American Journal of Medicine 12/2014; 127(12):e13. DOI:10.1016/j.amjmed.2014.07.013 · 5.00 Impact Factor
  • John A Batsis · Karen L Huyck · Stephen J Bartels
    [Show abstract] [Hide abstract]
    ABSTRACT: Obesity and the growing population of older adults are significant public health concerns in the United States. In 2011, the Centers for Medicare and Medicaid Services introduced a Medicare benefit for obesity counselling using Intensive Behavioral Therapy that would reimburse structured visits over a 12-month period. Although we applaud this new benefit that addresses the obesity epidemic in older adults, three major shortcomings limit its utility and potential effectiveness: 1) weight loss interventions differ in older and younger adults, yet the benefit relies predominantly on data from interventions studied in younger populations; 2) body mass index is not an accurate measure for identifying obesity; and 3) tying reimbursement to clinician visits may hamper the integration of this benefit into practice. To overcome these shortcomings, we propose: 1) obesity treatment should focus on improving quality of life and physical function and on mitigating muscle and bone loss rather than focusing solely on weight loss; 2) waist circumference or waist-hip ratio should be considered as additional anthropometric measures in ascertaining obesity; and 3) allied health professionals should be reimbursed for providing this benefit. Incorporating these suggestions will improve its usability in clinical practice and increase the chances that this well-meaning benefit will improve patient outcomes.
    Journal of General Internal Medicine 09/2014; 30(1). DOI:10.1007/s11606-014-3031-6 · 3.45 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background We previously demonstrated that BMI is associated with functional decline and reduced quality of life. While BMI in older adults is fraught with challenges, waist circumference (WC) is a marker of visceral adiposity that can also predict mortality. However, its association with function and quality of life in older adults is not well understood and hence we sought to examine the impact of WC on six-year outcomes. Methods We identified adults aged ≥60 years from the longitudinal Osteoarthritis Initiative and stratified the cohort into quartiles based on WC. Our primary outcome measures of function at six year follow-up included: self-reported quality of life [Short Form-12 (SF-12)], physical function [Physical Activity Scale for the Elderly (PASE)] and disability [Late-life Disability Index (LLDI)]. Linear regression analyses predicted 6-year outcomes based on WC quartile category (lowest = referent), adjusted for age, sex, race, education, knee pain, smoking status, a modified Charlson co-morbidity index and baseline scores, where available. Results We identified 2,182 subjects meeting our inclusion criteria and stratified the study cohort by quartiles of WC. Mean age ranged from 67.5-68.7 years, 60-71% were female and 80-86% were white. The highest WC quartile compared to 50-75th, 25-50th or lowest quartile, was associated with a greater number of medications (4.3, 4.0, 3.6 and 3.4 [p < 0.001]), lower gait speeds (1.23, 1.27, 1.32, and 1.34 m/s[p < 0.001]), higher rates of knee osteoarthritis (70.2, 62.2, 60.2, 48.6;p < 0.001), higher Charlson co-morbidity scores and greater knee pain (WOMAC scores) (all p < 0.001). At follow-up, adjusted SF-12 physical function subscale and PASE scores, were lowest in the highest WC quartile as compared to the 50-75%, 25-50%, and lowest quartiles [(SF-12 scores: 45.5, 46.7, 47.6, and 47.9), and (PASE scores: 109.6, 128.7, 126.6, and 131.0). The LLDI limitation subscale for disability demonstrated lower scores in the high WC quartile as opposed to the referent group. Conclusions Elevated WC is associated with lower quality of life, a decline in physical function, and a slightly higher risk of disability over time. Intervention studies are needed to prevent functional decline in this high-risk population.
    Nutrition Journal 08/2014; 13(1):81. DOI:10.1186/1475-2891-13-81 · 2.60 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Physical activity (PA) improves function in older obese adults. However, body mass index is an unreliable adiposity indicator better reflected by waist circumference (WC). The impact of PA on physical impairment and mobility with high WC is unclear. We performed a secondary data analysis of 4,976 adults ≥60 years using National Health and Nutrition Examination Surveys (NHANES) 2005-2010. Physical limitations (PL), activities of daily living (ADL) impairments, and PA (low(<1day/week) or high (>1day/week) were self-reported. Waist circumference (WC) was dichotomized (females: 88cm; males: 102cm). Mean age was 70.1years, 55.1% were female. Prevalence of PL and ADL impairment in the high WC group were 57.7% and 18.8%, respectively, and high PA was present in 53.9%. Among high WC, high PA vs. low PA were at lower risk of PL (OR 0.58[0.48-0.70]) and ADL impairment (OR 0.46 [0.32-0.65]). High WC had higher odds of PL irrespective of PA (high PA: OR 1.57 [1.30-1.88]; low PA: OR 1.52[1.29-1.79]) and ADL impairment (high PA:OR 1.27 [1.02-1.57] and low PA:OR 1.24 [0.99-1.54]). High PA in viscerally obese individuals is associated with impairments.
    Journal of aging and physical activity 08/2014; 23(3). DOI:10.1123/japa.2014-0007 · 1.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Sarcopenia is defined as the loss of skeletal muscle mass and quality, which accelerates with aging and is associated with functional decline. Rising obesity prevalence has led to a high-risk group with both disorders. We assessed mortality risk associated with sarcopenia and sarcopenic obesity in elders. Methods: A subsample of 4652 subjects ≥60 years of age was identified from the National Health and Nutrition Examination Survey III (1988-1994), a cross-sectional survey of non-institutionalized adults. National Death Index data were linked to this data set. Sarcopenia was defined using a bioelectrical impedance formula validated using magnetic resonance imaging-measured skeletal mass by Janssen et al. Cutoffs for total skeletal muscle mass adjusted for height(2) were sex-specific (men: ≤5.75 kg/m(2); females ≤10.75 kg/m(2)). Obesity was based on % body fat (males: ≥27%, females: ≥38%). Modeling assessed mortality adjusting for age, sex, ethnicity (model 1), comorbidities (hypertension, diabetes, congestive heart failure, osteoporosis, cancer, coronary artery disease and arthritis), smoking, physical activity, self-reported health (model 2) and mobility limitations (model 3). Results: Mean age was 70.6±0.2 years and 57.2% were female. Median follow-up was 14.3 years (interquartile range: 12.5-16.1). Overall prevalence of sarcopenia was 35.4% in women and 75.5% in men, which increased with age. Prevalence of obesity was 60.8% in women and 54.4% in men. Sarcopenic obesity prevalence was 18.1% in women and 42.9% in men. There were 2782 (61.7%) deaths, of which 39.0% were cardiovascular. Women with sarcopenia and sarcopenic obesity had a higher mortality risk than those without sarcopenia or obesity after adjustment (model 2, hazard ratio (HR): 1.35 (1.05-1.74) and 1.29 (1.03-1.60)). After adjusting for mobility limitations (model 3), sarcopenia alone (HR: 1.32 ((1.04-1.69) but not sarcopenia with obesity (HR: 1.25 (0.99-1.58)) was associated with mortality. For men, the risk of death with sarcopenia and sarcopenic obesity was nonsignificant in both model-2 (HR: 0.98 (0.77-1.25), and HR: 0.99 (0.79-1.23)) and model 3 (HR: 0.98 (0.77-1.24) and HR: 0.98 (0.79-1.22)). Conclusions: Older women with sarcopenia have an increased all-cause mortality risk independent of obesity.
    European Journal of Clinical Nutrition 06/2014; 68(9). DOI:10.1038/ejcn.2014.117 · 2.71 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The objective of this study was to (a) to examine whether the association between obesity and physical functioning among older adults is moderated by physical activity (PA) and (b) to test whether this moderating effect varies by gender. Method: Data from adults (aged >60 years) who participated in the National Health and Nutrition Examination Surveys (2005-2010) were analyzed. Using multivariate logistic regression, we estimated the prevalence ratio (PR) of functional limitations and impairment in activities of daily living and instrumental activities of daily living, by body mass index and PA, while adjusting for age, educational level, and a comorbidity index. Results: The sample included 5,304 subjects (mean age = 70.4 years), and 50.5% were female. Overweight and obesity were associated with higher levels of functional limitations when compared with normal weight individuals regardless of the PA status (PR = 1.47, 95% confidence interval [CI] [1.17, 1.85], and PR = 2.71, 95% CI [2.00, 3.67], respectively) even after adjustment for confounders. Discussion: Overweight and obesity are associated with impairment in functional outcomes irrespective of PA.
    Journal of Aging and Health 06/2014; 26(6). DOI:10.1177/0898264314535635 · 1.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Obesity defined by body mass index (BMI) is associated with higher levels of functional impairment. However, BMI strata misrepresent true adiposity, particularly in those with a normal BMI but elevated body fat (BF%) (normal weight obesity [NWO]) whom are at higher metabolic and mortality risk. Whether this subset of patients is associated with worsening functional outcomes is unclear. Methods: Subjects aged ≥60 years with a BMI ≥18.5 kg/m(2) from NHANES III (1988-1994) were included. We created sex-specific tertiles of BF%. Data on physical limitations (PL), instrumental (IADL) and basic activities of daily living (BADL) were obtained. The analysis focused on the association between NWO and these outcomes. Comparative rates among each tertile using logistic regression (referent=lowest tertile) were assessed, incrementally adding co-variates. Results: Of the 4484 subjects aged ≥60 years, 1528 had a normal BMI, and the range of the mean age of tertiles was 69.9-71.2 years. Lean mass was lowest in the elevated BF% group than in the middle or low tertiles (42.6 vs 44.9 vs 45.8; p<0.001). Those with NWO had higher PL risk than the referent in females only in our adjusted model (males OR 1.18 [0.63-2.21]; females OR 1.90 [1.04-3.48]) but not after incorporating lean mass (males OR 1.11[0.56-2.20]; females (1.73 [0.92-3.25]). Neither sex with high BF% had higher IADL risk than the corresponding tertiles (males OR 0.67 [0.35-1.33]; females OR 1.20 [0.74-1.93]). NWO was protective in males only (OR 0.28 [0.10-0.83]) but not in females (OR 0.64 [0.40-1.03]). Conclusions: NWO is associated with increased physical impairment in older adults in females only, highlighting the importance of recognizing the association of obesity with disability in elders.
    European Journal of Internal Medicine 06/2014; 25(6). DOI:10.1016/j.ejim.2014.05.008 · 2.89 Impact Factor
  • Source
    Journal of the American College of Cardiology 04/2014; 63(12):A1281. DOI:10.1016/S0735-1097(14)61281-X · 16.50 Impact Factor
  • John A. Batsis · S Singh · F Lopez-Jimenez
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: The impact of adiposity on mortality in older adults remains controversial. Some reports suggest that measures of general adiposity such as body mass index (BMI) predict better survival. We assessed the relationship between measures of adiposity and mortality in older adults. Design: Cross-sectional analysis of a population-based sample. Setting: Non-institutionalized persons in the United States participating in the National Health and Nutrition Examination Surveys III and its linked mortality dataset. Participants: A subsample of 4,489 non-institutionalized survey participants aged >60 years with measures of body composition using bioimpedance. To account for possible residual confounding, smokers, subjects with heart failure, respiratory disease, kidney disease and cancer were excluded (n=2,920). Data from 1569 subjects were analysed. Measurements: BMI, waist circumference (WC), waist-hip ratio (WHR), lean mass (LM) and % Body Fat (BF) were classified by tertiles (lowest=referent). Proportional-hazard models evaluated the association of anthropometric indices with overall and cardiovascular mortality. Results: Mean age was 69.4years, and 265(16.9%) were >80 years. There were 717(47.6%) women and 792 deaths of which 284 [35.9%] were cardiovascular related. Elevated BMI was associated with reduced cardiovascular mortality (HR 0.53 [0.30-0.84]), and remained significant after adjusting for LM (HR 0.54 [0.31-0.93]). Elevated %BF was associated with reduced mortality from cardiovascular causes (HR 0.52 [0.29-0.91]). Low BMI was associated with higher risk of cardiovascular (HR 3.66 [1.25-10.69]) and overall death (HR 2.44 [1.22-4.90]). Conclusion: Measures of adiposity in older participants are associated with lower mortality from cardiovascular causes that cannot be explained by major known confounders between obesity and mortality. Further studies need to elucidate a possible protective role and interplay between adiposity and skeletal muscle in older adults.
    The Journal of Nutrition Health and Aging 02/2014; 18(2):123-30. DOI:10.1007/s12603-013-0366-3 · 3.00 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Obesity is a multifactorial syndrome and the likelihood of success of a medical nutritional treatment (MNT) over the long term is low. As psychological and behavioural factors have an important role in both pathogenesis and the treatment of obesity, these issues were investigated in individuals with obesity who reported a long-term success or a failure in terms of weight loss following a MNT. Eighty-eight individuals of an original cohort of 251 subjects were re-evaluated 10 years after a MNT with cognitive-behavioural approach for uncomplicated obesity. Fifty-three participants were classified as failure (body weight change ≥0.5 kg) and 35 as a success (10-year body weight change <0.5 kg) of the MNT. Prior to the beginning of the weight-management program, both the Dieting Readiness Test (DRT) and the Hospital Anxiety and Depression Scale (HADS) were administered. At a 10-year follow-up after the MNT, self-reported questionnaires were administered: quality of life was assessed by the Obesity Related Well-Being (ORWELL 97) questionnaire, eating attitudes and behaviours by the Eating Disorder Examination Questionnaire (EDE-Q), the Binge Eating Scale (BES) investigated the presence and severity of binge eating and the Symptom Checklist (SCL 90-R) was used to identify the psychopathological distress. The scores of the ORWELL 97 items concerning symptoms (P = 0.005), discomfort (P = 0.03) and the total score (P = 0.02) were significantly lower in the success group. The depression score of the HADS was positively correlated with the percentage of body weight change observed 10 years after the MNT (r = 0.22; P = 0.045). The scores of the shape concern (EDE-Q) (r = 0.35; P = 0.013) and of the discomfort (ORWELL 97) (r = 0.36; P = 0.012) were significantly correlated with the percentage of body weight change 10 years after the MNT. In conclusion, this study is in agreement with the possibility that the psychological quality of life is associated even with modest amounts of weight loss in the long run. Further research should support identifying successful predictors of weight loss.
    Eating and weight disorders: EWD 09/2013; 18(4). DOI:10.1007/s40519-013-0059-2 · 0.79 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Current body mass index (BMI) strata likely misrepresent the accuracy of true adiposity in older adults. Subjects with normal BMI with elevated body fat may metabolically have higher cardiovascular and overall mortality than previously suspected. We identified 4,489 subjects aged ≥60 years (BMI = 18.5 to 25 kg/m(2)) with anthropometric and bioelectrical impedance measurements from the National Health and Nutrition Examination Surveys III (1988 to 1994) and mortality data linked to the National Death Index. Normal weight obesity (NWO) was classified in 2 ways: creation of tertiles with highest percentage of body fat and body fat percent cutoffs (men >25% and women >35%). We compared overall and cardiovascular mortality rates, models adjusted for age, gender, smoking, race, diabetes, and BMI. The final sample included 1,528 subjects, mean age was 70 years, median (interquartile range) follow-up was 12.9 years (range 7.5 to 15.3) with 902 deaths (46.5% cardiovascular). Prevalence of NWO was 27.9% and 21.4% in men and 20.4% and 31.3% in women using tertiles and cutoffs, respectively. Subjects with NWO had higher rates of abnormal cardiovascular risk factors. Lean mass decreased, whereas leptin increased with increasing tertile. There were no gender-specific differences in overall mortality. Short-term mortality (<140 person-months) was higher in women, whereas long-term mortality (>140 person-months) was higher in men. We highlight the importance of considering body fat in gender-specific risk stratification in older adults with normal weight. In conclusion, NWO in older adults is associated with cardiometabolic dysregulation and is a risk for cardiovascular mortality independent of BMI and central fat distribution.
    The American journal of cardiology 08/2013; 112(10). DOI:10.1016/j.amjcard.2013.07.014 · 3.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the prevalence range for sarcopenic obesity and its relationship with sex, age, and ethnicity. Cross-sectional analysis of a population-based sample. Noninstitutionalized persons in the United States participating in the National Health and Nutrition Examination Surveys 1999–2004. Subsample of 4,984 subjects aged 60 and older with dual-energy X-ray absorptiometry body composition data. Eight definitions of sarcopenic obesity identified from six studies found using a systematic literature review (Baumgartner, Bouchard, Davison, Zoico, Levine, Kim-1,2,3) were applied to the sample. Results were stratified according to sex, age, and ethnicity. Prevalence of sarcopenic obesity ranged from 4.4% to 84.0% in men and from 3.6% to 94.0% in women. Prevalence was higher in men using definitions from Baumgartner (17.9% vs 13.3%, P < .001), Levine (14.2% vs 6.6%, P < .001), and Kim-1 (30.0% vs 9.3%, P < .001); lower for men using the Davison (4.4% vs 11.1%, P < .001) and Kim-2 (83.7% vs 94.0%) definitions; and the same for men and women using the Bouchard (45.3% vs 44.3%, P = .32) and Kim-3 (75.6% vs 77.0%, P = .51) definitions. For all but one definition, sarcopenic obesity increased with each decade and was lower in non-Hispanic blacks than whites. Prevalence of sarcopenic obesity in older adults varies up to 26-fold depending on current research definitions. Such a high degree of variability suggests the need to establish consensus criteria that can be reliably applied across clinical and research settings.
    Journal of the American Geriatrics Society 05/2013; 61(6). DOI:10.1111/jgs.12260 · 4.57 Impact Factor

Publication Stats

1k Citations
216.36 Total Impact Points


  • 2013–2015
    • Geisel School of Medicine at Dartmouth
      Hanover, New Hampshire, United States
  • 2009–2015
    • Dartmouth–Hitchcock Medical Center
      LEB, New Hampshire, United States
  • 2010
    • Università degli Studi di Palermo
      • Department of internal medicine and medical specialties (DIMIS)
      Palermo, Sicily, Italy
  • 2005–2008
    • Mayo Clinic - Rochester
      • • Department of Primary Care Internal Medicine
      • • Department of Internal Medicine
      Rochester, Minnesota, United States