Journal of Gerontology: MEDICAL SCIENCES
Cite journal as: J Gerontol A Biol Sci Med Sci
2009. Vol. 64A, No. 1, 96 – 102
Metabolic Syndrome and Physical Decline in Older
Persons: Results from the Health, Aging and Body
© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America.
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Advance Access publication on January 20, 2009
Mobility limitation is of particular interest because it is com-
mon, strongly related to health outcomes including major
disability or mortality, and represents a stage early enough in
the disablement process to be amenable to intervention ( 1 ).
Better characterization of the relationship between common,
preventable conditions and incident mobility limitations is
critical to efforts aimed at preventing disability.
The metabolic syndrome, a clustering of traditional cere-
brovascular disease (CVD) risk factors, is an example of a
prevalent and treatable condition in older people. According
to the adult treatment panel (ATP) III ( 2 ), the metabolic syn-
drome is most commonly defi ned as the presence of three or
more of the following fi ve conditions: abdominal obesity,
AINTENANCE of physical function is a critical fac-
tor in the ability of older adults to remain independent.
hypertriglyceridemia, low high-density lipoprotein (HDL)
cholesterol, hyper tension, and hyperglycemia. Using these
criteria, the national health and nutrition examination survey
study estimated a prevalence of 42% among U.S. adults aged
70+ years ( 3 ). Even though there is ongoing dispute about its
defi nition and concept ( 4 ), the metabolic syndrome does in-
crease the risk of diabetes and cardiovascular morbidity and
mortality ( 5 – 7 ). Unfortunately, there are scant data demon-
strating the health consequences of the metabolic syndrome
beyond cardiovascular and diabetes outcomes.
Systematic evaluation of the consequences of the meta-
bolic syndrome, and its individual components, on aging-re-
lated physical function decline is scarce. To prevent
or slow the decline in physical function with aging, it is
important to know whether, and which, metabolic syndrome
Brenda W. J. H. Penninx , 1 Barbara J. Nicklas , 2 Anne B. Newman , 3 Tamara B. Harris , 4
Bret H. Goodpaster , 3 Suzanne Satterfi eld , 5 Nathalie de Rekeneire , 6 Kristine Yaffe , 7 Marco Pahor , 8 and
Stephen B. Kritchevsky , 2 for the Health ABC Study
1 EMGO Institute/Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands .
2 The Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, North Carolina .
3 University of Pittsburgh, Pennsylvania.
4 National Institute on Aging, Bethesda, Maryland .
5 University of Tennessee, Memphis .
6 Center for Disease Control, Atlanta, Georgia .
7 University of California, San Francisco .
8 University of Florida, Gainesville .
Background. The metabolic syndrome includes dyslipidemia, abdominal obesity, insulin resistance, and hypertension
and is associated with an increased risk of diabetes and cerebrovascular disease (CVD) , but consequences beyond these
outcomes have not been examined extensively. We investigated whether metabolic abnormalities have independent con-
sequences on loss of mobility function of older persons.
Methods. Data are from 2,920 men and women, 70 – 79 years, participating in the Health ABC study without mobility
limitations at baseline. Metabolic syndrome was defi ned as ≥ 3 of the following: (a) waist circumference >102 (men) or
>88 cm (women); (b) triglycerides ≥ 150 mg/dL; (c) high-density lipoprotein cholesterol <40 mg/dL (men) or <50 mg/dL
(women); (d) blood pressure ≥ 130/85 mm Hg or antihypertensive medication; and (d) fasting glucose ≥ 110 mg/dL or
antidiabetic medication. Mobility limitation was defi ned as diffi culty or inability walking ¼ mile or climbing 10 steps
during two consecutive semiannual assessments over 4.5 years.
Results. The prevalence of metabolic syndrome was 38.6%. The metabolic syndrome was associated with an adjusted
relative risk (RR) of 1.46 (95% confi dence interval [CI] = 1.30 – 1.63) for developing mobility limitations. The risk in-
creased when more metabolic syndrome components were present ( p trend >.001). All metabolic syndrome components
were signifi cantly associated with incident mobility limitations with the highest RRs for abdominal obesity (RR = 1.54,
95% CI = 1.35 – 1.75) and hyperglycemia (RR = 1.44, 95% CI = 1.27 – 1.63). Findings were unchanged when persons with
baseline, or incident, CVD, stroke, or diabetes were excluded.
Conclusions. Metabolic syndrome abnormalities, especially abdominal obesity and hyperglycemia, are predictive of
mobility limitations in the elderly, independent of CVD or diabetes.
Key Words: Metabolic syndrome — Obesity — Glucose — Mobility limitation — Older — Diabetes — Cerebrovascular disease .
PENNINX ET AL.
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Received July 24, 2007
Accepted April 24 , 2008
Decision Editor: Luigi Ferrucci, MD, PhD