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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    • "They suggested MUAC as an important measurement to evaluate health status of oldest old[47]. In another study, Wannamethee et al. showed a positive relationship between MUAMC and survival in elderly[41]. MAMA was especially used for children and overestimation was noted as much as 25% when applied to adults[29]. "
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    • "Iwao et al. [35] observed that WC only modestly added to BMI in the prediction of cardiovascular disease risk factors in younger subjects and added little predictive value in older subjects (n = 1941). A prospective study of 4107 men aged 60–79 [36] suggested that the combination of WC and midarm muscle circumference provided the best estimation of the total mortality risk in the elderly. Importantly, a significant synergistic effect between NC and visceral adipose tissue on cardiometabolic risk factors was noted in the Framingham Heart Study [37]. "
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    • "We adjusted for body mass index (BMI, kg m À 2 in quintiles) to assess whether it mediates the association of interest. As BMI is not an accurate indicator of overweight and obesity in the elderly (Wannamethee et al, 2007), we conducted sensitivity analysis adjusting for waist circumference, a measure of abdominal obesity and a potential independent risk factor for colorectal cancer (Wang et al, 2008), among a subsample of men who reported their waist information in 1987 and 1996. We examined if the association between TV watching and risk of adenoma differed by age, family history of colorectal cancer (yes/no), BMI (o25, 25–29.9, and 30 þ kg m À 2 ) and employment status (yes/no). "
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