ArticleLiterature Review

Villareal DT, Apovian CM, Kushner RF, Klein S. Obesity in older adults: technical review and position statement of the American College for Nutrition and NAASO, The Obesity Society. Am J Clin Nutr 82, 923-934

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Abstract

Obesity causes serious medical complications and impairs quality of life. Moreover, in older persons, obesity can exacerbate the age-related decline in physical function and lead to frailty. However, appropriate treatment for obesity in older persons is controversial because of the reduction in relative health risks associated with increasing body mass index and the concern that weight loss could have potential harmful effects in the older population. This joint position statement from the American Society for Nutrition and NAASO, The Obesity Society reviews the clinical issues related to obesity in older persons and provides health professionals with appropriate weight-management guidelines for obese older patients. The current data show that weight-loss therapy improves physical function, quality of life, and the medical complications associated with obesity in older persons. Therefore, weight-loss therapy that minimizes muscle and bone losses is recommended for older persons who are obese and who have functional impairments or medical complications that can benefit from weight loss.

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... Studies have revealed a significant association between overweight/obesity and age [14,19,20]. Studies have shown the likelihood of obesity and overweight to be high among older women and the possible reason for this finding maybe that old age is likely to be characterised by high physical inactivity as well as the consumption of more energy-dense foods, which may result in overweight and obesity [14]. ...
... Studies have shown the likelihood of obesity and overweight to be high among older women and the possible reason for this finding maybe that old age is likely to be characterised by high physical inactivity as well as the consumption of more energy-dense foods, which may result in overweight and obesity [14]. Another possible explanation for this could be that, as people grow, the composition of their body changes, which results in an increase in fat mass and a decline in fatfree mass [19,20]. Overweight and obesity vary greatly between men and women, with women across the globe disproportionately affected [21]. ...
... With increasing age, women tend to be at higher odds ratios of becoming overweight and obese. Elsewhere in similar settings, the prevalence of overweight and obesity was also reported to be higher among older women [14,19,20]. Other studies associate obesity in old age to be characterised by high physical inactivity as well as the consumption of more energy-dense foods, which may result in overweight and obesity [14]. ...
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Overweight and obesity have increasingly become a health concern globally and, in particular, developing countries such as Zimbabwe. Obesity is associated with an increased risk of non-communicable diseases such as diabetes and cardiovascular diseases. Previous studies in the country have controlled for other factors, but none have examined the relationship between household assets ownership and body mass index. This study examines the association between demographic, socioeconomic factors and household assets ownership and obesity among Zimbabwean women of reproductive age over the 10-year period from 2005 to 2015 based on three Demographic and Health Surveys. The analytical sample consisted of non-pregnant women aged 15–49 years who were dejure household residents. Logistic regression models were used to examine the association between background variables and Body Mass Index. Women in urban areas, with higher education, working and from richer households are more likely to be at risk of overweight and obesity. However, possession of household assets such as television, radio and telephone were not associated with overweight/obesity, except for the television in 2010/11. Thus, there is need for constant awareness programmes on healthy eating food, and physical activity especially among older women and those working.
... Primary OA is an age-related disorder characterized by degradation of the articular cartilage and the substantial loss of matrix [12]. The symptoms and signs gradually develop after the fifth decade [13], and approximately 68% of females and 58% of males older than 65 years of age have OA [14]. There are several contributing factors to the development of OA, such as cartilage matrix degradation and intraarticular cell senescence [15,16], extraarticular loss of SMM [17], and deterioration of proprioception [18]. ...
... There are several contributing factors to the development of OA, such as cartilage matrix degradation and intraarticular cell senescence [15,16], extraarticular loss of SMM [17], and deterioration of proprioception [18]. In addition to age, obesity is associated with an increased risk of knee OA, especially in older subjects [14,19]. The American College of Rheumatology (ACR) criteria for OA of the knee consists of age, joint symptoms, the lack of inflammatory conditions, and positive radiography of the knee [20]. ...
... BMI, the ratio between weight and height, representing body fat, is the most commonly used measure of obesity, and in cross-sectional studies in large populations, BMI values have indicated that the incidence of obesity is increasing in older people. However, after reaching its peak at 50 to 60 years of age, it tends to decline in both sexes [14,29]. ...
Article
Background: This study was conducted to analyze the effects of low skeletal muscle mass index (SMI) and obesity on aging-related osteoarthritis (OA) in the Korean population. Methods: A total of 16,601 participants who underwent a dual-energy X-ray absorptiometry and 3,976 subjects with knee X-rays according to the modified Kellgren-Lawrence (KL) system were enrolled. Knees of ≥KL grade 2 were classified as radiologic OA. The severity of joint space narrowing (JSN) was classified by X-rays as normal, mild-to-moderate, and severe JSN in radiologic OA. The subjects were grouped as normal SMI (SMI of ≥-1 standard deviation [SD] of the mean), low SMI class I (SMI of ≥-2 SDs and <-1 SD), and low SMI class II (SMI of <-2 SDs). Obesity was defined as a body mass index (BMI) of ≥27.5 kg/m2. Results: The modified KL grade and JSN severity were negatively correlated with the SMI and positively correlated with BMI and age. The SMI was negatively correlated with age. JSN severity was significantly associated with a low SMI class compared to a normal SMI, which was more prominent in low SMI class II than class I. Obesity was significantly associated with more severe JSN, only for obesity with a low SMI class. Furthermore, patients with a low SMI class, regardless of obesity, were prone to having more severe JSN. Conclusion: This study suggested that a low SMI class was associated with aging and that an age-related low SMI was more critically related to the severity of JSN in OA.
... Lifestyle weight management programmes consisting of reduced energy intake via calorie-restriction strategies and increased energy expenditure through increased physical activity are recommended with the support of a multidisciplinary team of health care professionals [6]. Calorie-restriction strategies such as low-calorie diets (LCD; 800-1600 kcal daily) may not be nutritionally complete and have long-term low compliance, and very low-calorie diets (VLCD < 800 kcal daily) require medical supervision due to the increased risk of medical complications [8]. For sustainable weight reduction the National Institute for Health and Care Excellence (NICE) recommend dietary approaches that reduce calories by 600 kcal/day, i.e., 600 kcal less than the individual requires to remain the same weight [9]. ...
... For sustainable weight reduction the National Institute for Health and Care Excellence (NICE) recommend dietary approaches that reduce calories by 600 kcal/day, i.e., 600 kcal less than the individual requires to remain the same weight [9]. Similarly, a modest reduction in energy intake (500-750 kcal/day) is recommended for older adults by The American Society for Nutrition, the North American Association for the Study of Obesity (NAASO) and The Obesity Society [8]. In order to determine individual energy requirements, an assessment of resting metabolic rate (RMR) is recommended [10]. ...
... A gradual decline in RMR and TDEE is associated with advancing age, diminished lean mass, energy restriction and weight loss [8,[31][32][33]. Age-induced declines in RMR may be attributed to alterations of organ and tissue masses and diminished fat free mass (FFM) which accounts for the magnitude of resting metabolism [3,34]. ...
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The primary objective of this study was to compare weight changes in two groups of ageing Irish adults with overweight and adiposity-based chronic disease: participants who had dietary energy requirements prescribed on the base of measured RMR and participants whose RMR was estimated by a prediction equation. Fifty-four Caucasian adults (male n = 25; female n = 29, age 57.5 ± 6.3 years, weight 90.3 ± 15.1 kg, height 171.5 ± 9.5 cm, BMI 30.7 ± 4.6 kg/m2) were randomly assigned to a dietary intervention with energy prescription based on either measured RMR or estimated RMR. RMR was measured by indirect calorimetry after an overnight fast and predicted values were determined by the Mifflin et al. (1990) prediction equation. All participants received individual nutritional counselling, motivational interviewing and educational material. Anthropometric variables, blood pressure, blood glucose and blood lipid profile were assessed over 12 weeks. Body weight at week 12 was significantly lower (p < 0.05) for both groups following dietary interventions, mRMR: −4.2%; eRMR: −3.2% of initial body weight. There was no significant difference in weight loss between groups. Overall, 20.8% mRMR and 17.4% of eRMR participants experienced clinically meaningful (i.e., ≥5% of initial weight) weight reduction. Weight reduction in adults aged ≥50 years over the short term (12 weeks) favoured a reduction in blood pressure, triglycerides and glucose, thus reducing cardiovascular disease risk factors. This research indicates that employing a reduced-calorie diet using indirect calorimetry to determine energy needs when improving weight outcomes in adults (>50 years) with overweight and adiposity-based chronic disease is equal to employing a reduced-calorie diet based on the Mifflin et al. (1990) prediction equation. A reduced-energy diet based on mRMR or eRMR facilitates clinically meaningful weight reduction in adults (≥50 years) over the short term (12 weeks) and favours a reduction in blood pressure, triglycerides and glucose, thus reducing cardiovascular disease risk factors. Moreover, the addition of motivational interviewing and behaviour change techniques that support and encourage small behaviour changes is effective in short-term weight management.
... This increase in absolute muscle force-generating capacity has been attributed to increased loading of the musculoskeletal system as a result of supporting and ambulating a greater load [27]. Other studies, however, show that in older adults there is no such obesity-related increase in absolute force-generating capacity [31,33,100,105,106] and in some cases, obesity has even been reported to result in a reduced absolute force-producing capacity of the musculature of older adults [36,105]. The disparity in response between young and old obese groups may in part be explained by an age-induced reduction in myogenesis [107], limiting the adaptations that may occur through elevated loading. ...
... In vivo studies examining obesity effects of muscle quality have resulted in ambiguous findings [28,30] and studies specifically examining the additive effects of obesity and ageing are sparse. There is some evidence to indicate that muscle performance normalised to whole-body or regional lean mass is significantly reduced in old obese adults [33,106]. Using a biopsy of the vastus lateralis, Choi et al. [34] demonstrated that power normalised to fibre CSA was significantly reduced in type I fibres of obese older adults when compared to normal-weight controls. ...
Article
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Obesity is a global epidemic and coupled with the unprecedented growth of the world’s older adult population, a growing number of individuals are both old and obese. Whilst both ageing and obesity are associated with an increased prevalence of chronic health conditions and a substantial economic burden, evidence suggests that the coincident effects exacerbate negative health outcomes. A significant contributor to such detrimental effects may be the reduction in the contractile performance of skeletal muscle, given that poor muscle function is related to chronic disease, poor quality of life and all-cause mortality. Whilst the effects of ageing and obesity independently on skeletal muscle function have been investigated, the combined effects are yet to be thoroughly explored. Given the importance of skeletal muscle to whole-body health and physical function, the present study sought to provide a review of the literature to: (1) summarise the effect of obesity on the age-induced reduction in skeletal muscle contractile function; (2) understand whether obesity effects on skeletal muscle are similar in young and old muscle; (3) consider the consequences of these changes to whole-body functional performance; (4) outline important future work along with the potential for targeted intervention strategies to mitigate potential detrimental effects.
... Obesity is linked to a host of complications and comorbidities that include metabolic syndrome (43% of people aged ≥ 60 years) (22), type 2 diabetes mellitus (T2DM), dyslipidemia, heart failure, atherosclerotic cardiovascular disease, atrial fibrillation, stroke, cognitive decline, many types of cancer, nonalcoholic fatty liver disease, arthritis, thromboembolic events, pulmonary abnormalities, sleep apnea, urinary incontinence, decreased quality of life, frailty, impaired motility, and disability (9). ...
... Caloric restriction in older people requires careful tailoring with attention to nutrients supply. To achieve a weight loss of 0.5 to 1 kg per week or 8% to 10% over 6 months, energy intake should be reduced by 500 to 1000 kcal/d (9,74). ...
Article
Until recently, weight loss in the elderly obese was feared due to ensuing muscle loss and frailty. Facing overall increasing longevity, high rates of obesity in older subjects (≥65 years) and a growing recognition of the health and functional cost of the number of obesity years, abetted by evidence that intentional weight loss in older obese subjects is safe, this approach is gradually, but not unanimously, being replaced by more active principles. Lifestyle interventions that include reduced but sufficient energy intake, age-adequate protein and micronutrient intake, coupled with aerobic and resistance exercise tailored to personal limitations can induce weight loss with improvement in frailty indices. Sustained weight loss in this age can prevent/ameliorate diabetes. More active steps are controversial. The use of weight loss medications, particularly GLP-1 analogs (liraglutide as the first example), provides an additional treatment tier. Its safety and cardiovascular health benefits have been convincingly shown in elderly obese subjects with type 2 diabetes. In our opinion, this option should not be denied to obese subjects with prediabetes or other obesity-related comorbidities based on age. Finally, many reports now provide evidence that bariatric surgery can be safely performed in older subjects as the last treatment tier. Risk-benefit issues should be considered with extreme care and disclosed to candidates. The selection process requires good presurgical functional status, individualized consideration of the sequels of obesity and reliance on centers which are highly experienced in the surgical procedure as well as short and long term subsequent comprehensive care and support.
... BMR is measured shortly after participants wake up, succeeding an overnight stay in a research facility Predictive equations for resting metabolic rate | 75 or metabolic chamber, while RMR is obtained when participants arrive at the research facility in the morning (Miller et al., 2013). Thus, successful interventions designed for weight loss or to prevent weight gain must focus on the accurate determination of the total contribution of individual REE to TEE (Sabounchi et al., 2013;Villareal et al., 2005). ...
... Obese women (1 600.1 ± 425.6 kcal/day) had a significantly higher RMR than their normal weight (1 377.0 ± 313.7 kcal/day) and overweight (1 391.4 ± 268.9 kcal/day) counterparts. 6 ‡ 0.001 * Significant differences between normal weight and overweight women; † significant differences between overweight and obese women; ‡ significant differences between obese and normal-weight women. Table 3 shows the results of the comparison between measured and estimated RMR in normal-weight women. ...
Article
Obesity represents a public health challenge, and dietary interventions to prevent or treat Obesity rely on the ability to accurately determine daily energy requirements - which are based on measures of total energy expenditure. Several prediction equations to estimate resting metabolic rate (RMR) have been developed, however, the validity of these equations is uncertain. The present study aims to determine the accuracy of four commonly used RMR prediction equations in normal weight, overweight and obese Portuguese women aged 18 to 64 years. RMR was measured in 156 women (age: 40.3 ± 10.2 years; Body Mass Index (BMI): 20.6 ± 6.8 kg/m²) using indirect calorimetry. The resulting values were compared with the predictive values from the Harris-Benedict, FAO/WHO/UNU, Schofield and Mifflin-St. Jeor equations across BMI categories. At an individual level, the equations with the highest percentage of accurate predictions were the Mifflin-St. Jeor equation in normal-weight women (41.9%) and the Harris-Benedict equation in overweight (55.4%) and obese (50.9%) women. The accuracy of the RMR prediction equations studied varied by weight status, and due to the low levels of accuracy reported, the present equations might have limited applicability for Portuguese women at an individual level.
... Obesity is linked to a host of complications and comorbidities that include metabolic syndrome (43% of people aged ≥ 60 years) (22), type 2 diabetes mellitus (T2DM), dyslipidemia, heart failure, atherosclerotic cardiovascular disease, atrial fibrillation, stroke, cognitive decline, many types of cancer, nonalcoholic fatty liver disease, arthritis, thromboembolic events, pulmonary abnormalities, sleep apnea, urinary incontinence, decreased quality of life, frailty, impaired motility, and disability (9). ...
... Caloric restriction in older people requires careful tailoring with attention to nutrients supply. To achieve a weight loss of 0.5 to 1 kg per week or 8% to 10% over 6 months, energy intake should be reduced by 500 to 1000 kcal/d (9,74). ...
Article
Until recently, weight loss in the elderly obese was feared due to ensuing muscle loss and frailty. Facing overall increasing longevity, high rates of obesity in older subjects (≥65 years) and a growing recognition of the health and functional cost of the number of obesity years, abetted by evidence that intentional weight loss in older obese subjects is safe, this approach is gradually, but not unanimously, being replaced by more active principles. Lifestyle interventions that include reduced but sufficient energy intake, age-adequate protein and micronutrient intake, coupled with aerobic and resistance exercise tailored to personal limitations can induce weight loss with improvement in frailty indices. Sustained weight loss in this age can prevent/ameliorate diabetes. More active steps are controversial. The use of weight loss medications, particularly GLP-1 analogs (liraglutide as the first example), provides an additional treatment tier. Its safety and cardiovascular health benefits have been convincingly shown in elderly obese subjects with type 2 diabetes. In our opinion, this option should not be denied to obese subjects with prediabetes or other obesity-related comorbidities based on age. Finally, many reports now provide evidence that bariatric surgery can be safely performed in older subjects as the last treatment tier. Risk-benefit issues should be considered with extreme care and disclosed to candidates. The selection process requires good presurgical functional status, individualized consideration of the sequels of obesity and reliance on centers which are highly experienced in the surgical procedure as well as short and long term subsequent comprehensive care and support.
... Aging is the leading risk factor for most chronic diseases, many of which are associated with declines in metabolic homeostasis (Ló pez-Otín et al., 2013). Metabolic detriments associated with advancing age are further exacerbated by obesity (Villareal et al., 2005;Waters et al., 2013), which has risen substantially in the older population (>65 years) over the past several decades (Flegal et al., 2010;Flegal et al., 2016). Moreover, obesity in mid-life has been shown to accelerate aging mechanisms and induce phenotypes more commonly observed in older mammals (Bischof and Park, 2015;Horvath et al., 2014;Nevalainen et al., 2017;Yang et al., 2009;Whitmer et al., 2005a;Whitmer et al., 2005b;Dye et al., 2017). ...
... These observations have led many to postulate that obesity may represent a mild progeria syndrome (Salvestrini et al., 2019;Tzanetakou et al., 2012;Pérez et al., 2016;Tchkonia et al., 2010;Stout et al., 2017a). Although it is well established that dietary interventions, including calorie restriction, can reverse obesity-related metabolic sequelae, many of these strategies are not well tolerated in older patients due to concomitant comorbidities (Villareal et al., 2005;Jensen et al., 2014). Compliance issues across all age groups also remain a paramount hurdle due to calorie restriction adversely affecting mood, thermoregulation, and musculoskeletal mass (Dirks and Leeuwenburgh, 2006). ...
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Metabolic dysfunction underlies several chronic diseases, many of which are exacerbated by obesity. Dietary interventions can reverse metabolic declines and slow aging, although compliance issues remain paramount. 17α-estradiol treatment improves metabolic parameters and slows aging in male mice. The mechanisms by which 17α-estradiol elicits these benefits remain unresolved. Herein, we show that 17α-estradiol elicits similar genomic binding and transcriptional activation through estrogen receptor α (ERα) to that of 17β-estradiol. In addition, we show that the ablation of ERα completely attenuates the beneficial metabolic effects of 17α-E2 in male mice. Our findings suggest that 17α-E2 may act through the liver and hypothalamus to improve metabolic parameters in male mice. Lastly, we also determined that 17α-E2 improves metabolic parameters in male rats, thereby proving that the beneficial effects of 17α-E2 are not limited to mice. Collectively, these studies suggest ERα may be a drug target for mitigating chronic diseases in male mammals.
... De cette façon, les personnes dont le calcul de l'IMC est égal ou supérieure à 30 kg/m 2 sont considérées comme atteintes d'obésité (Table 1). (Villareal, Apovian, Kushner, & Klein, 2005). Selon les multiples panels de santé, l'obésité a été stratifiée selon les seuils d'IMC suivants. ...
... C'est une technique simple, facile à faire et peu couteuse. Bien qu'il s'agisse de la mesure la plus couramment utilisée dans la littérature, elle ne permet pas de faire la distinction entre la masse maigre et la masse grasse et ne fournit aucune indication sur la répartition de la graisse corporelle (Villareal et al., 2005). Il serait donc important de mesurer la graisse corporelle à l'aide d'autres mesures plus acceptables et fiables telles que la DEXA qui est considérée comme l'un des tests de composition corporelle les plus précis et complets puisque la DEXA estime la masse graisseuse totale et la masse graisseuse régionale dans le tronc, les bras, et les jambes, ainsi que la masse maigre et la teneur en minéraux osseux (Adab et al., 2018). ...
... Worldwide, obesity is a leading risk factor for morbidity and mortality [7]. Thus, it is worth exploring genetic factors correlated with obesity to develop an intervention for this condition. ...
Article
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This study investigated the associations between relative telomere length (RTL) and resting metabolic rate (RMR), resting fat oxidation (RFO), and aerobic capacity and whether oxidative stress and inflammation are the underlying mechanisms in sedentary women. We also aimed to determine whether the correlations depend on age and obesity. Sixty-eight normal weight and 66 obese women participated in this study. After adjustment for age, energy expenditure, energy intake, and education level, the RTL of all participants was negatively correlated with absolute RMR (RMRAB) and serum high-sensitivity C-reactive protein (hsCRP) concentration, and positively correlated with maximum oxygen consumption (V˙O2max) (all p < 0.05). After additional adjustment for adiposity indices and fat-free mass (FFM), RTL was positively correlated with plasma vitamin C concentration (p < 0.05). Furthermore, after adjustment for fasting blood glucose concentration, RTL was negatively correlated with age and positively correlated with V˙O2max (mL/kg FFM/min). We found that normal weight women had longer RTL than obese women (p < 0.001). We suggest that RTL is negatively correlated with RMRAB and positively correlated with aerobic capacity, possibly via antioxidant and anti-inflammatory mechanisms. Furthermore, age and obesity influenced the associations. We provide useful information for the management of promotion strategies for health-related physical fitness in women.
... In obese subjects, tendons frequently undergo functional impairment and degeneration caused by the increased load and the presence of systemic dysmetabolic factors, as non-load-bearing tendons resulted affected, especially in male subjects [5,6]. Multiple risk factors are directly or indirectly associated with obesity; among them, environmental factors [7,8], genetics [9], gender [10], aging [11], gut microbiota [12], and diets [13,14] are prominent. For such a reason, in the scientific community, the association between obesity and comorbidities has been widely studied, highlighting insulin resistance (defined as reducing glucose uptake in response to the effects of insulin) as the main link between obesity and the onset of pathological processes. ...
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Obesity is a chronic, complex pathology associated with a risk of developing secondary pathologies, including cardiovascular diseases, cancer, type 2 diabetes (T2DM) and musculoskeletal disorders. Since skeletal muscle accounts for more than 70% of total glucose disposal, metabolic alterations are strictly associated with the onset of insulin resistance and T2DM. The present study relies on the proteomic analysis of gastrocnemius muscle from 15 male and 15 female C56BL/J mice fed for 14 weeks with standard, 45% or 60% high-fat diets (HFD) adopting a label-free LC–MS/MS approach followed by bioinformatic pathway analysis. Results indicate changes in males due to HFD, with increased muscular stiffness (Col1a1, Col1a2, Actb), fiber-type switch from slow/oxidative to fast/glycolytic (decreased Myh7, Myl2, Myl3 and increased Myh2, Mylpf, Mybpc2, Myl1), increased oxidative stress and mitochondrial dysfunction (decreased respiratory chain complex I and V and increased complex III subunits). At variance, females show few alterations and activation of compensatory mechanisms to counteract the increase of fatty acids. Bioinformatics analysis allows identifying upstream molecules involved in regulating pathways identified at variance in our analysis (Ppargc1a, Pparg, Cpt1b, Clpp, Tp53, Kdm5a, Hif1a). These findings underline the presence of a gender-specific response to be considered when approaching obesity and related comorbidities.
... Weight loss in older adults is associated with loss of muscle and bone mass [20]. Therefore, attempts to lose weight should incorporate exercise and optimal protein intake in order to prevent older adults from losing muscle and bone mass [90]. Any unintentional weight loss should lead to further nutritional and physical assessment, no matter the BMI. ...
... Some awareness was already apparent, as evidenced by various strategies for weight management and weight loss for obese older adults [45,46]. Nevertheless, the appropriateness and effectiveness of overweight/obesity treatment for older adults remain questionable because weight loss may lead detrimental to muscle strength and bone mass and bone mineral density [47]. Therefore, safe and effective weight loss strategies for overweight/obese older adults should be exercised with care [4]. ...
... The higher prevalence of overweight and obesity among women who were married or living with a partner could also be linked with the weight gain due to the use of hormonal contraceptives [57]. Another plausible explanation could be the changes in body composition with increased age, particularly those associated with decline in fat-free mass and subsequent rise in fat mass which begins to occur when an individual crosses 30 years of age [55,58]. Moreover, increase in age has been identified as an essential risk factor for both overweight or obesity and other NCDs [53]. ...
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This study aimed to examine the trends in the prevalence of overweight and obesity and to determine the associated socioeconomic and household environmental factors among women in Nepal. Using nationally representative data from the 1996, 2001, 2006, 2011 and 2016 cross-sectional Nepal Demographic and Health Surveys (NDHSs) (n = 33,507), the prevalence of overweight–obesity (body mass index (BMI) ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) among women aged 15–49 years were examined. From the latest NDHS 2016, non-pregnant women with recorded anthropometric measurements (n = 6165) were included in the final analyses. Multivariate logistic regression models were used to determine the socioeconomic and household environmental factors associated with BMI ≥ 25 and BMI ≥ 30. Between 1996 and 2016, the prevalence of overweight–obesity increased from 1.8% to 19.7%, while the prevalence of obesity increased from 0.2% to 4.1%. Age, marital status, wealth index, province of residence, cooking fuel, refrigerator, and bicycle were significantly associated with having both overweight–obesity and obesity. Similarly, educational status, religion, type of toilet facility, television, and mobile phone were significantly associated with having overweight–obesity. Given the alarming increase in the prevalence of overweight and obesity among Nepalese women, there is an urgent need of interventions addressing these critical socioeconomic and household environmental factors.
... Some awareness was already apparent, as evidenced by various strategies for weight management and weight loss for obese older adults [45,46]. Nevertheless, the appropriateness and effectiveness of overweight/obesity treatment for older adults remain questionable because weight loss may lead detrimental to muscle strength and bone mass and bone mineral density [47]. Therefore, safe and effective weight loss strategies for overweight/obese older adults should be exercised with care [4]. ...
Article
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Overweight/obesity and underweight among older adults remain major public health concerns in the United States. This study aims to assess cohort differences in transition among BMI (body mass index) statuses (underweight, normal weight, overweight, and obese) by various cohort and race/ethnicity–gender groups. The empirical work of this study was based on the 1992–2014 Health and Retirement Study (HRS). Multistate life tables (MSLT) were used to assess transitions among different BMI statuses. Results from multistate life tables suggested that the impact of cumulative advantage (disadvantage), persistent inequality, and aging-as-leveler on transition among BMI statuses was shaped along race/ethnicity–gender and cohort lines. Weight management and weight loss strategies should focus on ethnic minorities (i.e., Black and Hispanic populations) and White participants from recent cohorts. Programs aimed at minimizing the negative consequences associated with underweight and weight loss should focus on individuals from earlier cohorts and Black populations.
... Demographic trends indicate a steadily rising prevalence of obesity in older adults, ie another risk factor for health loss in this population group, especially for chronic diseases, directly associated with an increased risk of death. [1][2][3][4][5] Obesity is defined as an excessive and health-threatening accumulation of body fat (BF). According to the World Health Organization (WHO), prevalence of obesity in a global population boasts an epidemic character, accounting for more deaths than an underweight status. ...
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Background: Loss of fat-free mass (FFM) and gain in body fat (BF) are the key disability risk factors, also instrumental in perpetuating already existing functional disorders. Obesity construed in terms of body mass index (BMI) values, in view of undesirable gain in BF, is a risk factor for cardio-metabolic disorders. Both detrimental processes clearly evidence a scope of involutionary changes characteristic of an aging population, also standing for one of its greatest burdens. Purpose: The present study aimed to assess the changes in body composition (BC), in conjunction with the relationship between BF% and BMI, for defining overweight and obesity status in middle-aged and older adults, against the select indicator variables under study. Materials and methods: The study involved 4799 individuals (33.7% men), PONS Project participants, aged 43-64 years. BF% was measured with the aid of bioelectrical impedance analysis (BIA) method. Age-induced changes in BC were determined against BF%, fat mass (FM), FFM, BMI, fat mass index (FMI), and fat-free mass index (FFMI). The relationship between BF% and BMI was established with the aid of Bayesian regression models, adjusted for gender and age. Results: In both genders, BF% increased with age at a similar annual rate. The reduction of FFM was noted mainly in men, which in conjunction with BF% gain ensured BMI stability. The increase in BF% in women with stable FFM affected an increase in BMI. Regardless of the BMI threshold, the anticipated (predicted) BF% increased with age in both genders. Conclusion: Monitoring of BC is of particular importance in older adults, in view of appreciably better characteristics of both the short- and long-term health predictors, as well as overall potential for developing specifically targeted, effective health interventions.
... Accordingly, current geriatric obesity treatment guidelines encourage weight loss therapies that minimize lean, while maximizing fat, mass loss for older adults with obesity [10]. Change in body composition with caloric restriction-induced weight loss appears modifiable through diet, with the amount of dietary protein consumed during caloric restriction identified as a key determinant in lean mass preservation [11]. ...
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Inter-individual response to dietary interventions remains a major challenge to successful weight loss among older adults. This study applied metabolomics technology to identify small molecule signatures associated with a loss of fat mass and overall weight in a cohort of older adults on a nutritionally complete, high-protein diet. A total of 102 unique metabolites were measured using liquid chromatography-mass spectrometry (LC-MS) for 38 adults aged 65–80 years randomized to dietary intervention and 36 controls. Metabolite values were analyzed in both baseline plasma samples and samples collected following the six-month dietary intervention to consider both metabolites that could predict the response to diet and those that changed in response to diet or weight loss.Eight metabolites changed over the intervention at a nominally significant level: D-pantothenic acid, L-methionine, nicotinate, aniline, melatonin, deoxycarnitine, 6-deoxy-L-galactose, and 10-hydroxydecanoate. Within the intervention group, there was broad variation in the achieved weight-loss and dual-energy x-ray absorptiometry (DXA)-defined changes in total fat and visceral adipose tissue (VAT) mass. Change in the VAT mass was significantly associated with the baseline abundance of α-aminoadipate (p = 0.0007) and an additional mass spectrometry peak that may represent D-fructose, myo-inositol, mannose, α-D-glucose, allose, D-galactose, D-tagatose, or L-sorbose (p = 0.0001). This hypothesis-generating study reflects the potential of metabolomic biomarkers for the development of personalized dietary interventions.
... Current recommendations suggest that low functioning obese older adults should receive weight loss treatments that minimizes muscle and bone loss. [9] This recommendation has been empirically supported as obese older adults who follow diet and exercise therapy are able to lose weight while maintaining their muscle mass and improving their physical function. [10] However, systematic reviews of randomized controlled trials (RCTs) indicate that exercise therapy reduces pain and patient-reported disability in patients with knee osteoarthritis (OA), but to date, the optimal exercise regimen has not been identified [11,12]) The effects of exercise programs in clinical trials are likely to vary, since the interventions differ substantially in type of exercise (aerobic, strengthening, etc.), intensity of exercise, duration of intervention, and number of sessions per week. ...
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Obesity is associated with a range of disabling musculoskeletal conditions in adults as knee and hip pain which account for a great deal of activity limitation. The purpose of this study was to investigate the effect of exercise program on balance, gait speed, and knee pain among obese people. A quasi-experimental trial with two groups, experimental and control groups post-test. A total of 40 adult obese patients with knee pain were randomly assigned to the control group (n=20) or experimental group (n=20). Participants in the experimental group received exercise program. A total of 40 patients were enrolled. There were significant differences between the experimental and control group regarding balance, speed gait, and knee pain (P< 0.005) with favor to experimental group. The study confirmed the effect of exercise on decrease knee pain, improved balance, and increase speed gait
... A disadvantage of most weight loss interventions, however, is a decline in muscle mass, which comprises up to one third of total weight lost [2]. Preserving muscle mass during weight loss in this population is highly important, because skeletal muscle is strongly associated with physical performance outcomes in older adults [3], and is responsible for more than 75% of insulin-mediated glucose uptake [4]. ...
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Background: Weight loss is key to treatment of older adults with obesity and type 2 diabetes, but also a risk for muscle mass loss. This study investigated whether a whey protein drink enriched with leucine and vitamin D could preserve muscle mass and improve glycemic control during combined lifestyle intervention in this population. Methods: 123 older adults with obesity and type 2 diabetes were randomized into a 13-week lifestyle intervention with dietary advice and exercise, receiving either the enriched protein drink (test) or an isocaloric control (control). Muscle mass was assessed with dual-energy X-ray absorptiometry and glycemic control by oral glucose tolerance test. Statistical analyses were performed using a linear mixed model. Results: There was a nonsignificant increase in leg muscle mass (+0.28 kg; 95% CI, -0.01 to 0.56) and a significant increase in appendicular muscle mass (+0.36 kg; 95% CI, 0.005 to 0.71) and total lean mass (+0.92 kg; 95% CI, 0.19 to 1.65) in test vs. control. Insulin sensitivity (Matsuda index) also increased in test vs. control (+0.52; 95% CI, 0.07 to 0.97). Conclusions: Use of an enriched protein drink during combined lifestyle intervention shows beneficial effects on muscle mass and glycemic control in older adults with obesity and type 2 diabetes.
... Obesity is accurately described as the presence of unhealthily excessive fat, increasing the risk of disease and death. 1 Simple commonly used assessment methods include body mass index (BMI) and waist circumference measurement; more accurate methods for assessing fat require the use of dual-energy X-ray absorptiometry (DXA), computerised tomography (CT), or magnetic resonance imaging (MRI). The accuracy of BMI and waist circumference in assessing fat volumes is poor, 2 and the accuracy is further reduced as patient age increases. ...
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Objective: The present study aimed to explore the relationships between the distribution of abdominal fat and muscle and age and gender in a middle-aged and elderly population. Methods: The levels of abdominal (visceral and subcutaneous) fat, pericardial fat, and psoas major muscle were measured in subjects who had physical examinations at the Health and Medical Department of Peking Union Medical College Hospital from July 2019 to June 2020. The relationship between fat in different areas (ie, different types of fat) and the relationship between different types of fat and the psoas major muscle were investigated in the context of different genders and ages. Results: The distribution of fat and muscle differed between males and females of the middle-aged and elderly study sample. Volumes of pericardial fat, total abdominal fat, and visceral fat were significantly lower in females than in males, and the area of the psoas major muscle was also significantly lower in females than in males. Levels of subcutaneous fat and total abdominal fat showed no significant correlation with age. The level of muscle showed a significant negative correlation with age. Conclusion: 1) Within the middle-aged and elderly sample, male subjects had higher levels than females of all types of fat except for abdominal subcutaneous fat, and had higher levels of psoas muscle than females. 2) Pericardial fat increased with age, whereas levels of abdominal fat did not change significantly with age. 3) The area of psoas major muscle appears to be positively correlated with volumes of all types of fat: subjects with more fat tended to have higher levels of psoas major muscle.
... Indeed, CR induced significant muscle wasting when initiated at old age in mice (Kvedaras et al., 2020). Nevertheless, weight-loss interventions that minimize muscle and bone losses are recommended for older persons who are obese because obesity has profound negative effects on health and quality of life (Villareal et al., 2005). This warrants search for CR strategies with minimal negative impact on skeletal muscles. ...
Article
Fasting improves metabolic health, but is also associated with loss of lean body mass. We investigated if old mice are less resistant to fasting-induce muscle wasting than adult mice. We compared changes in skeletal muscles and fat distribution in C57BL/6J mice subjected to 48-hour fasting at adult (6-month old) or old (24-month old) age. Old mice lost less weight (11.9 ± 1.5 vs 16.9 ± 2.8%, p < 0.001) and showed less (p < 0.01) pronounced muscle wasting than adult mice. Extensor digitorum longus (EDL) muscle force decreased only in adult mice after fasting. Serum IGF-1 levels were higher (p < 0.01) and showed greater (p < 0.01) decline in adult mice compared to old mice. Phosphorylation of 4EBP1 was reduced in the gastrocnemius muscles of adult mice only. Energy expenditure was slower in old mice and showed smaller fasting-induced decline than in adult mice when adjusted for variations in physical activity. There was a loss of fat mass in both age groups, but it was more pronounced in adult mice than old mice. Our results suggest that ageing-related decrease in metabolic rate protects old mice from skeletal muscle wasting during fasting.
... Values presented are mean change ± SD and % change ± SD. for our study. Taken together, our findings prompt important considerations for promoting weight loss alone in obese older adults and suggest that exercise should be a vital component of weight loss interventions for older obese adults to preserve and/or improve fitness, muscle strength, and physical function, all factors important for maintaining functional independence and reducing risk for morbidity and mortality (31). We investigated the effects of weight loss and exercise on ectopic fat as a potential link to improved insulin sensitivity and physical function. ...
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Background Aging-related disease risk is exacerbated by obesity and physical inactivity. It is unclear how weight loss and increased activity improve risk in older adults. We aimed to determine the effects of diet-induced weight loss with and without exercise on insulin sensitivity, VO2peak, body composition, and physical function in older obese adults. Methods Physically inactive older (68.6 ± 4.5 years) obese (BMI 37.4 ± 4.9 kg/m 2) adults were randomized to: Health education control (HEC; n=25); Diet-induced weight loss (WL; n=31); or Weight loss and exercise (WLEX; n=28) for 6 months. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp, body composition by DXA and MRI, strength by isokinetic dynamometry, and VO2peak by graded exercise test. Results WLEX improved (p<0.05) peripheral insulin sensitivity (+75 ± 103%) vs. HEC (+12 ± 67%); WL (+36 ± 47%) vs. HEC did not reach statistical significance. WLEX increased VO2peak (+7 ± 12%) vs. WL (-2 ± 24%), and prevented reductions in strength and lean mass induced by WL (p<0.05). WLEX decreased abdominal adipose tissue (-16 ± 9%) vs. HEC (-3 ± 8%) and intermuscular adipose tissue (-15 ± 13 %) vs. both HEC (+9 ± 15%) and WL (+2 ± 11%) (p<0.01). Conclusions Exercise with weight loss improved insulin sensitivity and VO2peak, decreased ectopic fat, and preserved lean mass and strength. Weight loss alone decreased lean mass and strength. Older adults intending to lose weight should perform regular exercise to promote cardiometabolic and functional benefits, which may not occur with calorie restriction-induced weight loss alone.
... The increased prevalence of obesity is a major health concern. Aging significantly increases the risks of obesity and obesity-induced co-morbidities such as type-2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease/steatohepatitis (NAFLD/NASH), cardiovascular disease and certain types of cancer [1][2][3][4]. Excess fat accumulation exacerbates frailty in older persons. Conversely, metabolic dysfunction accelerates aging, as young people with obesity and T2DM often exhibit features of accelerated aging [5]. ...
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(1) Background: We previously demonstrated that disruption of IP6K1 improves metabolism, protecting mice from high-fat diet-induced obesity, insulin resistance, and non-alcoholic fatty liver disease and steatohepatitis. Age-induced metabolic dysfunction is a major risk factor for metabolic diseases. The involvement of IP6K1 in this process is unknown. (2) Methods: Here, we compared body and fat mass, insulin sensitivity, energy expenditure and serum-, adipose tissue- and liver-metabolic parameters of chow-fed, aged, wild type (aWT) and whole body Ip6k1 knockout (aKO) mice. (3) Results: IP6K1 was upregulated in the adipose tissue and liver of aWT mice compared to young WT mice. Moreover, Ip6k1 deletion blocked age-induced increase in body- and fat-weight and insulin resistance in mice. aKO mice oxidized carbohydrates more efficiently. The knockouts displayed reduced levels of serum insulin, triglycerides, and non-esterified fatty acids. Ip6k1 deletion partly protected age-induced decline of the thermogenic uncoupling protein UCP1 in inguinal white adipose tissue. Targets inhibited by IP6K1 activity such as the insulin sensitivity- and energy expenditure-inducing protein kinases, protein kinase B (PKB/Akt) and AMP-activated protein kinase (AMPK), were activated in the adipose tissue and liver of aKO mice. (4) Conclusions: Ip6k1 deletion maintains healthy metabolism in aging and thus, targeting this kinase may delay the development of age-induced metabolic dysfunction.
... [17][18][19] Obesity is a well-known risk factor for metabolic and cardiovascular diseases, pulmonary abnormalities and certain types of cancer in older age. 20 Furthermore, obesity is associated with the onset of osteoarthritis in older adults, 21 one of the most disabling medical conditions, severely affecting one's QoL. 22 A meta-analysis of 26 prospective studies in older adults revealed obesity as risk factor for functional decline 23 which is of utmost importance for independent living. ...
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Introduction Obesity is highly prevalent in older adults aged 65 years or older. Different lifestyle interventions (diet, exercise, self-management) are available but benefits and harms have not been fully quantified comparing all available health promotion interventions. Special consideration must be given to functional outcomes and possible adverse effects (loss of muscle and bone mass, hypoglycaemia) of weight loss interventions in this age group. The objective of this study is to synthesise the evidence regarding the effects of different types and modalities of lifestyle interventions, or their combinations, on physical function and obesity-related outcomes such as body composition in older adults with obesity. Methods and analyses Six databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Psychinfo and Web of Science) and two trial registries (Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform) will be searched for randomised controlled trials of lifestyle interventions in older adults with obesity. Screening (title/abstract and full-text) and data extraction of references as well as assessment of risk of bias and rating of the certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluation for network meta-analyses) will be performed by two reviewers independently. Frequentist random-effects network meta-analyses will be conducted to determine the pooled effects from each intervention. Ethics and dissemination We will submit our findings to peer-reviewed journals and present at national and international conferences as well as in scientific medical societies. Patient-targeted dissemination will involve local and national advocate groups. PROSPERO registration number CRD42019147286.
... Furthermore, an excess fat mass is associated with a deterioration in the quality of both muscles and joints, inducing a decrease in the efficiency of the proprioceptive system [68]. This deterioration induced by excess fat mass could be partially compensated in nonsedentary participants by stimuli implied by physical activity [69]. ...
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The aim of this study was to analyze the influence of physical activity level on posturalcontrol in obese and overweight Spanish adult males. Forty-three males aged between 25 and 60 years old were included. Anthropometric, body composition, and physical activity variables wereassessed, and postural control was evaluated using the Sensory Organization Test. No correlationwas found between the level of physical activity and postural control, assessed by the Sensory Organization Test within the whole sample. However, within the group with a higher total fat mass percentage, non-sedentary individuals presented improved scores on the somatosensory organization test when compared to sedentary individuals (96.9±1.8 vs. 95.4±1.2;p< 0.05) and poorer scoreson the composite equilibrium score (73.4±7.2 vs. 79.2±6.9;p< 0.05). The altered integration of somatosensory inputs most likely affects the tuning, sequencing, and execution of balance strategies in sedentary men with a high total fat mass percentage
... Walking <5 k/steps a day is defined physiologically as sedentariness, bringing a correlated surge of non-communicable diseases, ranging from type two diabetes to major depressive disorder (Tremblay et al., 2010;Tudor-Locke et al., 2013). The World Health Organisation and other agencies have repeatedly concluded rising physical inactivity levels (Peçanha et al., 2020), diseases of aging, and, of metabolism, are a major problem in many societies, all of which are exacerbated as the world's population ages (Villareal et al., 2005;Jin et al., 2015). Many diseases of aging are preventable through prophylactic measures (Booth et al., 2011;Reynolds et al., 2019), especially regular exercise: active lifestyles are universally recommended for their health-promoting properties and for preventing non-communicable diseases (even major depressive disorder; Harvey et al., 2018) and diseases of ageing (Goryakin et al., 2019;Savikangas et al., 2020). ...
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Human walking is a socially embedded and shaped biological adaptation: it frees our hands, makes our minds mobile, and is deeply health promoting. Yet, today, physical inactivity is an unsolved, major public health problem. However, globally, tens of millions of people annually undertake ancient, significant and enduring traditions of physiologically and psychologically arduous walks (pilgrimages) of days-to-weeks extent. Pilgrim walking is a significant human activity requiring weighty commitments of time, action and belief, as well as community support. Paradoxically, human walking is most studied on treadmills, not ‘ in the wild’ , while mechanistically vital, treadmill studies of walking cannot, in principle, address why humans walk extraordinary distances together to demonstrate their adherence to a behaviourally demanding belief system. Pilgrim walkers provide a rich ‘living laboratory’ bridging humanistic inquiries, to progressive theoretical and empirical investigations of human walking arising from a behaviourally demanding belief system. Pilgrims vary demographically and undertake arduous journeys on precisely mapped routes of tracked, titrated doses and durations on terrain of varying difficulty, allowing investigations from molecular to cultural levels of analysis. Using the reciprocal perspectives of ‘ inside→out ’ (where processes within brain and body initiate, support and entrain movement) and ‘ outside→in ’ (where processes in the world beyond brain and body drive activity within brain and body), we examine how pilgrim walking might shape personal, social and transcendental processes, revealing potential mechanisms supporting the body and brain in motion, to how pilgrim walking might offer policy solutions for physical inactivity.
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Background Obesity is becoming more prevalent in older people. A management strategy in obese, young adults is to increase dietary protein relative to other macronutrients. It is not clear if this is effective in obese, older individuals. Obesity may be associated with diminished sensitivity to nutrients. We have reported that a 30-g whey protein drink slows gastric emptying more, and suppresses energy intake less, in older, than younger, non-obese men. The aim of this study was to determine the effect of a 30 g whey protein drink on energy intake, GE and glycaemia in obese, older and younger men. Methods In randomized, double-blind order, 10 younger (age: 27 ± 2 years; BMI: 36 ± 2 kg/m²), and 10 older (72 ± 1 years; 33 ± 1 kg/m²), obese men were studied twice. After an overnight fast, subjects ingested a test drink containing 30 g whey protein (120 kcal) or control (2 kcal). Postprandial gastric emptying (antral area, 2D Ultrasound) and blood glucose concentrations were measured for 180 min. At t = 180 min subjects were given a buffet meal and ad libitum energy intake was assessed. Results Older subjects ate non-significantly less (~20%) that the younger subjects (effect of age, P = 0.16). Whey protein had no effect on subsequent energy intake (kcal) compared to control in either the younger (decrease 3 ± 8%) or older (decrease 2 ± 8%) obese men (age effect P > 0.05, protein effect P = 0.46, age × protein interaction effect P = 0.84). Whey protein slowed gastric emptying, to a similar degree in both age groups (50% emptying time: control vs. protein young men: 255 ± 5 min vs. 40 ± 7 min; older men: 16 ± 5 min vs. 50 ± 8 min; protein effect P = 0.001, age effect P = 0.93, age × protein interaction effect P = 0.13). Conclusions Our data suggest that obesity may blunt/abolish the age-related effect of whey protein on suppression of energy intake.
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The measurement of anthropometric indices can be used to promote early prevention of Diabetes mellitus (DM) in the Filipino population. This study aims to compare the recommended anthropometric measurements namely body mass index (BMI), waist circumference, waist-to-height ratio (WHR), skin fold thickness, and mid-upper arm circumference (MUAC) of two groups, those with diabetes and those without (control), to predict the health risk status of the Filipino adult population. The results suggest that the parameters such as BMI, waist circumference, and WHR in females proved to be the most accurate to predict the diabetes risk among Filipino females. On the other hand, using the logistic regression model, the BMI, MUAC, and waist circumference indices collectively were found to have significant bearings with regard to the risk of acquiring DM. The Asian cutoff values of 18.5-24.9 kg/m2 for BMI, and < 90cm and < 80cm for waist circumference of male and female respectively, as recommended according to Taiwanese standards, are also said to apply to the Filipino population. This study is perhaps the first study in the Philippines that has relied on actual data gathering instead of using meta-analysis as done in earlier studies. In the wake of higher mortality in the diabetic COVID 19 positive patients, the gathering of baseline data of potential DM patients will help the government/stakeholders to efficiently strategize public health policies related to future preparedness for such pandemics.
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Background and aims Obesity significantly impacts older adults. Intensive nutrition counseling can aid in weight reduction and improve diet quality, but data are sparse in this population. The objective of this intervention is to determine how intensive nutrition counseling affects diet quality and anthropometric measures during a multi-component weight loss intervention in rural older adults with obesity. Methods A series of 12-week, single-arm feasibility pilots were conducted in fall 2017 and winter/spring 2018 in a community aging center in rural Northern New England. Adults were eligible if ≥ 65 years old with a Body Mass Index (BMI) ≥30 kg/m ². Exclusion criteria included dementia/cognitive impairment, uncontrolled psychiatric illness, weight-loss surgery, weight loss >5% in previous 6-months, life-threatening illness, palliative/hospice services, current participation in another weight-loss study/program, obesogenic medications, or presence of major chronic conditions. Participants received once-weekly nutrition counseling by a registered dietitian nutritionist (RDN), and twice-weekly exercise sessions by a physical therapist (PT). Primary outcomes were diet quality changes measured by total Rapid Eating and Activity Assessment for Patients-Short Version (REAP-S) and Automated Self-Administered 24-h dietary recall (ASA-24). Secondary outcome measures were changes in weight (kilograms) and waist circumference (centimeters). McNemar test was conducted for all paired categorical data while paired t-tests were conducted for all paired continuous data. All analyses were conducted in R; p-value<0.05 was significant. Results Total n = 23. Mean age was 72.2 (5.8) years (73.9% female); mean BMI was 35.9 ± 5.0 kg/m ². At 12 weeks, diet quality significantly improved. REAP-S scores increased by 3.53 ± 3.13 points (p < 0.001). Kilocalories, grams fat, grams saturated fat, milligrams sodium, grams added sugar, and grams alcohol via ASA-24 significantly decreased (all p < 0.05). Significant reductions in weight (−5.22 ± 3.13 kg) and waist circumference (−6.88 ± 5.67 cm) were observed (both p < 0.001). Conclusion Intensive nutrition counseling significantly enhances diet quality and reduces weight and waist circumference in rural older adults with obesity.
Article
Objectives: To determine the effect of diet, exercise, and diet-exercise in combination on measures of biological age. Design: Secondary analysis of a 1-year randomized, controlled trial. Setting: University-based Medical Center. Participants: One-hundred-seven older (age≥65 yrs.) adults with obesity (BMI≥30 kg/m2) were randomized and 93 completed the study. Analyses used intention-to-treat. Interventions: Participants were randomized to a control group, a weight-management (diet) group, an exercise group, or a weight-management-plus-exercise (diet-exercise) group. Main outcome measures: We calculated Klemera-Doubal Method (KDM) biological age, Homeostatic Dysregulation (HD) score, and Health Aging Index (HAI) score at baseline, and changes at 6- and 12-months. Results: Diet and diet-exercise decreased KDM biological age more than exercise and control (-2.4±0.4, -2.2±0.3, -0.2±0.4, and 0.2±0.5, respectively, P<0.05 for the between group-differences). Diet and diet-exercise also decreased HD score more than exercise and control (-1.0±0.3, -1.1±0.3, 0.1±0.3, and 0.3±0.3 respectively, P<0.05). Moreover, diet-exercise decreased HAI score more than exercise, diet, or control (-1.1±0.2, -0.5±0.2, -0.5±0.2, and 0.0±0.2, respectively, P<0.05). Conclusions: These findings suggest that diet and diet-exercise are both effective methods of improving biological age, and that biological age may be a valuable method of assessing geroprotective interventions in older humans.
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Background Existing evidence suggests that there has been a surge of overweight and obesity in low- and middle-income countries around the world. In this study we investigated the prevalence and factors associated with overweight and obesity among women in Mali. Methods We conducted the study among 5198 women using the 2018 Mali Demographic and Health Survey data. We used binary logistic regression for the analysis and pegged statistical significance at p<0.05. Results The prevalence of overweight and obesity was 26.9%. The likelihood of overweight and obesity was high among women 40–44 y of age (adjusted odds ratio [AOR] 5.94 [confidence interval {CI} 4.10 to 8.60]), those who were widowed/divorced/separated (AOR 1.59 [CI 1.04 to 2.43]), those with secondary education (AOR 1.41 [CI 1.13 to 1.75]), richest women (AOR 3.61 [CI 2.63 to 4.95]), those who watched television at least once a week (AOR 1.28 [CI 1.07 to 1.52]) and those who lived in the Kidal region (AOR 10.71 [CI 7.05 to 16.25]). Conversely, the likelihood of overweight and obesity was low among women who belonged to other religions compared with Muslims (AOR 0.63 [CI 0.43 to 0.92]). Conclusions This study found a predominance of overweight and obesity among women in Mali. The study showed that age, marital status, education, religion, region of residence, wealth status and frequency of watching television are associated with overweight and obesity among women in Mali. It is therefore critical for public health promotion programs in Mali to sensitize people to the negative effects associated with overweight and obesity. This implies that policies aimed at controlling overweight and obesity in Mali must take these factors into consideration.
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The association between the pathogenesis and natural course of nonalcoholic fatty liver disease (NAFLD) and skeletal muscle dysfunction is increasingly recognized. These obesity-associated disorders originate primarily from sustained caloric excess, gradually disrupting cellular and molecular mechanisms of the adipose-muscle-liver axis resulting in end-stage tissue injury exemplified by cirrhosis and sarcopenia. These major clinical phenotypes develop through complex organ-tissue interactions from the earliest stages of NAFLD. While the role of adipose tissue expansion and remodeling is well established in the development of NAFLD, less is known about the specific interplay between skeletal muscle and the liver in this process. Here, the relationship between skeletal muscle and liver in various stages of NAFLD progression is reviewed. Current knowledge of the pathophysiology is summarized with the goal of better understanding the natural history, risk stratification, and management of NAFLD.
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Background: Some investigations show that obesity is associated with increase in bone mass due to excessive mechanical exertion. However, these data are contradictory as loss of mineral density of bone tissue and, respectively, the risk of fractures in this population group is higher. The aim of the research was to investigate impact of drug therapy with zoledronic acid on nanostructure of bones in rats with limited mobility and high-calorie diet. Methods: Rats (n = 56) were distributed into three groups: control (n = 18) – standard vivarium conditions, І experimental group (n = 18) – rats, which were on a high-calorie diet with limited mobility (HCD+LM), ІІ experimental group (n = 18) – HCD+LM+zoledronic acid. Zoledronic acid was injected at the dose 0.025 mg/kg intramuscularly every four weeks for six months. X-ray structure analysis, scanning electron microscopy and atomic absorption spectrometry were used for investigation of ultrastructure and quantitative assessment of mineral component loss in the femoral neck. Results: Obesity and limited mobility reduced the level of the mineral component in the femoral neck (−31.5%) compared with control. It is significant that zoledronic acid did not permit decrease in mineral component of the bone throughout the entire experiment compared with group I (+41.8%), and all parameters were higher than in control group (+15%). Conclusions: Obesity and limited mobility negatively affect mineral bone mass. Zoledronic acid induces increase in the mineral component as a result of remodeling inhibition under conditions of obesity and limited mobility modeling.
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Studies in ethnic minority communities with social isolation have low genetic variability. Furthermore, assuming that any attempt to determine ageing by chronological cuts is misleading, it is recommended that functional capacity assessments be performed especially during and at the end of adulthood. Specifically, muscle strength performance is an interesting screening measure of functional capacity because of its association with functional level. However, the behaviour of the muscle strength manifestation between sexes and its association with body composition (BC) parameters in a low genetic variability community are unknown. Therefore, the objective of this study was to verify the influence of BC and sex on the handgrip strength of mature remaining Quilombolas. Seventy Quilombola volunteers of both sexes (♀ = 39; ♂ = 31) were recruited. BC and muscle strength were tested by dual‐energy X‐ray absorptiometry (DEXA) and handgrip equipment (Jamar), respectively. Correlations between muscle strength and age and BC parameters were determined by Spearman equation. In addition, it has executed comparisons of BC and age between strongest and weakest men and women from the interquartile analysis by Mann–Whitney U test. The significance level was adopted: P ≤ 0.05. Of the 70 remaining Quilombolas, with a mean age 64.6 ± 7.07 years, 55.7% were women with a mean age of 63.77 ± 7.56 years and 44.3% men with 65.65 ± 7.87 years. Statistical differences were identified for all parameters of BC and performance evaluated between men and women, except for the ratio of appendicular and axial fat‐free mass (P = 0.183). The evaluation of the influence of BC on strength identified that Quilombola men and women have different processes in the decline of strength, considering both the correlation's tests and the comparisons between groups of different degrees of strength. For Quilombola individuals, strength is a variable that can be modulated due to the influence of gender and BC.
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Der Umgang mit Adipositas im Alter gewinnt aufgrund steigender Prävalenzzahlen, weitreichender Folgen und damit verbundenen Gesundheitskosten zunehmend an Bedeutung. Da biologische Alterungsprozesse individuell sehr unterschiedlich verlaufen, ist die Gruppe älterer Menschen (mit Adipositas) hinsichtlich Gesundheit und Leistungsfähigkeit sehr heterogen, was bei Therapieentscheidungen zu berücksichtigen ist.
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Background Studies have shown neighborhood walkability is associated with obesity. To advance this research, study designs involving longer follow-up, broader geographic regions, appropriate neighborhood characterization, assessment of exposure length and severity, and consideration of stayers and movers are needed. Using a cohort spanning the conterminous United States, this study examines the longitudinal relationship between a network buffer-derived, duration-weighted neighborhood walkability measure and two adiposity-related outcomes. Methods This study included 12,846 Black/African American and White adults in the REasons for Geographic And Racial Differences in Stroke study. Body mass index (BMI) and waist circumference (WC) were assessed at baseline and up to 13.3 years later (M (SD) = 9.4 (1.0) years). BMI and WC were dichotomized. Walk Score® was duration-weighted based on time at each address and categorized as Very Car-Dependent, Car-Dependent, Somewhat Walkable, Very Walkable, and Walker’s Paradise. Unadjusted and adjusted logistic regression models tested each neighborhood walkability-adiposity association. Adjusted models controlled for demographics, health factors, neighborhood socioeconomic status, follow-up time, and either baseline BMI or baseline WC. Adjusted models also tested for interactions. Post-estimation Wald tests examined whether categorical variables had coefficients jointly equal to zero. Orthogonal polynomial contrasts tested for a linear trend in the neighborhood walkability-adiposity relationships. Results The odds of being overweight/obese at follow-up were lower for residents with duration-weighted Walk Score® values in the Walker’s Paradise range and residents with values in the Very Walkable range compared to residents with values in the Very Car-Dependent range. Residents with duration-weighted Walk Score® values classified as Very Walkable had significantly lower odds of having a moderate-to-high risk WC at follow-up relative to those in the Very Car-Dependent range. For both outcomes, the effects were small but meaningful. The negative linear trend was significant for BMI but not WC. Conclusion People with cumulative neighborhood walkability scores in the Walker’s Paradise range were less likely to be overweight/obese independent of other factors, while people with scores in the Very Walkable range were less likely to be overweight/obese and less likely to have a moderate-to-high risk WC. Addressing neighborhood walkability is one approach to combating obesity.
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Clinical studies show that hypogonadism in the aging male is associated with obesity and osteoporosis. Experimental studies are mostly conducted on relatively young adult animals and the induced hypogonadism lasts for a relatively short time. The present study aimed to describe the effect of long-term hypogonadism beginning in puberty on body composition, morphometry, and bone mineral density in aged male rats. Morphometric measurements and dual-energy X-ray absorptiometry were conducted at the age of 30 months on control and gonadectomized males. Long-term hypogonadism did not affect body weight, but led to a higher fat mass (by 26 %), lower lean mass (by 44 %), shorter body length (by 9 %), and anogenital distance (by 26 %), as well as to lower tail circumference (by 15 %) in comparison to control males. Lower bone mineral density (by 13 %) and bone mineral content (by 15 %) were observed in gonadectomized males. Results showing sarcopenic obesity and osteoporosis in this model of long-term hypogonadism might mimic the situation in aging males better than the widely used short-term hypogonadism induced in young animals. The morphometric analysis could potentially be a useful tool to study normal weight obesity without the need for specific equipment.
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High-fat diets(HFD)are defined as lipids accounting for exceeded 30% of total energy in-take, and current research is mostly 45% and 60%. With a view of the tendency that patients who served with HFD are more susceptible to various kinds of diseases, and are involved in osteoporosis, metabolic syndrome, coronary heart disease, and cancer. Thus, there have been hypotheses that HFD may serve as a significant risk factor for bone loss and osteoporosis. A plethora of studies have suggested that the relationship between HFD and bone. Moreover, high fat imparts a vital impact on bone structural and bone health, intestinal flora imbalance and intestine barrier deterioration, inflammation, oxidative stress, adipokine changes, and BMFT (bone marrow fat tissue) accumulation are thought as potential mechanisms. Most re-searches have demonstrated that a high-fat diet diminished bone mineral density and bone microstructure. Some studies, however, showed that a high-fat diet contributes to achieving peak bone mass, associated with weight gain. Diet being modifiable, lifestyle changing, and medication can help bone improvement as well as alleviate bone loss associated with a high-fat diet. This review aims to give a comprehensive understanding of the regulation between HFD and bone health, which might provide strategies to improve bone health by varying dai-ly dietary components and building a healthy lifestyle. We also hope more treatment on diet-related bone loss could be put forward.
Chapter
Nutritional problems are common in older people. In particular, malnutrition is very frequent and associated with several negative health outcomes. Therefore, the screening of malnutrition through validated tools is mandatory in this population. Weight loss is another common condition in older people and may indicate reversible or not reversible causes: the early diagnosis of weight loss is mandatory for starting the correct diagnostic pathways. The first treatment of weight loss is to treat the cause, if possible. Then, the use of dietary recommendations and nutritional supplementations is of importance. In this chapter, we will discuss how nutritional status should be assessed in older adults, the management of malnutrition, the most common treatments of weight loss, obesity in older individuals, and the role of general practitioners (GPs) in nutritional issues affecting older people.
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The number of older obese adults is increasing worldwide. Whether obese adults show similar health benefits in response to lifestyle interventions at different ages is unknown. The study enrolled 25 obese men (BMI 31-39 kg/m2) in two arms according to age (30-40 and 60-70 years old). Participants underwent an 8-week intervention with moderate calorie restriction (~20% below individual energy requirements) and supervised endurance training resulting in ~5% weight loss. Body composition was measured using dual energy X-Ray absorptiometry. Insulin sensitivity was assessed during a hypersinsulinemic euglycemic clamp. Cardiometabolic profile was derived from blood parameters. Subcutaneous fat and vastus lateralis muscle biopsies were used for ex vivo analyses. Two-way repeated-measure ANOVA and linear mixed models were used to evaluate the response to lifestyle intervention and comparison between the two groups. Fat mass was decreased and bone mass was preserved in the two groups after intervention. Muscle mass decreased significantly in older obese men. Cardiovascular risk (Framingham risk score, plasma triglyceride and cholesterol) and insulin sensitivity were greatly improved to a similar extent in the two age groups after intervention. Changes in adipose tissue and skeletal muscle transcriptomes were marginal. Analysis of the differential response to the lifestyle intervention showed tenuous differences between age groups. These data suggest that lifestyle intervention combining calorie restriction and exercise shows similar beneficial effects on cardiometabolic risk and insulin sensitivity in younger and older obese men. However, attention must be paid to potential loss of muscle mass in response to weight loss in older obese men.
Aims Many pharmacutical plants belonged to this region are used as the traditional drug by traditional physicians of the Urmia city in order to treat signs of disorders and cardiovescular system diseases. Background The Ghasemloo valley located in the Urmia city is one of the typical areas in the northwestern Iran and includes many pharmacutical and plant species. Objective Many pharmacutical plants belonged to this region are used as the traditional drug by traditional physicians of the Urmia city in order to treat signs of disorders and cardiovescular system diseases. Method Study was performed among 35 grocers in the Urmia city to identify effective and famous pharmacutical plants in treatment of cardiovescular and related diseases. Firstly a complete list of Urmia grocers was prepared from the Food and Drug Administrator of the Urmia University of Medical Sciences. The direct observation and interview alongside collecting herbarium samples of usual and effective indigenous medicinal plants were used to identify disorders and different signs of cardiovascular diseases. Questionnaires included personal information of grocers and they completed indigenous plants list containing information including the plant local name, the used organ, method of use, and the traditional therapeutic effect. Herbarium samples mentioned in the questionnaire were collected from the region and sent to the Jahad-e-Keshavarzi Research Centers and the Agriculture Faculty of Urmia university to determine the genus and species. After identifying and confirming the plant species, data related to the plant and results of cardiovascular research conducted on them were collected and recorded with reference to valid scientific sites. Data were enterred into the Excel 2010 program and then analyzed. Results 60 medicinal plants of 26 families in Urmia were identified as effective in treatment of cardiovascular diseases from interviews and questionnaires; some plants mentioned in this study had known traditional therapeutic effects on cardiovascular disorders in the literature and some were identified with new effects. Results showed that the most therapeutic effects in cardiovascular diseases belonged to families Rosaceae (15%), Fabaceae (13%), Asteraceae (13%), and Apiaceae (10%). The most used organs of plants were the leave (23%) and fruit (19%). Plants were used mainly as infusion (68%) in the traditional method. Most plants of this study were used to treat the blood cholesterol (29%), hypertension (9%), the blood coagulation, prevention of bleeding (9%), and decrease in the abdominal fat (9%). Conclusion Some herbs introduced in this study have new therapeutic effects introduced for the first time. It is necessary to study therapeutic effects of indigenous plants presented in this research in order to prove studied and mentioned therapeutic effects and to provide study field for researchers in relation to identifying effective substances and studying claimed clinical effects of these plants on different cardiovascular diseases.
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Clinical guidelines have long been one of the working tools of the modern doctor, helping him quickly navigate the most effective proven methods of treatment and prevention of various diseases, and also to adapt these methods to the specific tasks of their patients and to achieve maximum personalization of treatment. Clinical practice guidelines are drawn up by professional non-profit associations and are approved by the Scientific Council of the Ministry of Health of the Russian Federation, while often one recommendation is prepared by two or even three associations. The peculiarity of the recommendations offered to your attention is that not only endocrinologists, but also therapists, cardiologists, gynecologists, gastroenterologists, and experts of many other specialties are involved in the prevention and treatment of obesity. The Multidisciplinary Working Group presents this a project in a multidisciplinary journal to bring together the efforts of several professional associations that associated with the need to pay attention not only to obesity itself but also to comorbid conditions. We are looking forward to constructive criticism and a comprehensive discussion of the problem on the pages of our journal. © 2021 Russian Association of Endocrinologists. All rights reserved.
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: The picture of chronic liver diseases (CLDs) has changed considerably in recent years. One of them is the increase of non-alcoholic fatty liver disease. More and more CLD patients, even those with liver cirrhosis (LC), tend to be presenting with obesity these days. The annual rate of muscle loss increases with worsening liver reserve, and thus LC patients are more likely to complicate with sarcopenia. LC is also characterized by protein-energy malnutrition (PEM). Since the PEM in LC can be invariable, the patients probably present with sarcopenic obesity (Sa-O), which involves both sarcopenia and obesity. Currently, there is no mention of Sa-O in the guidelines; however, the rapidly increasing prevalence and poorer clinical consequences of Sa-O are recognized as an important public health problem, and the diagnostic value of Sa-O is expected to increase in the future. Sa-O involves a complex interplay of physiological mechanisms, including increased inflammatory cytokines, oxidative stress, insulin resistance, hormonal disorders, and decline of physical activity. The pathogenesis of Sa-O in LC is diverse, with a lot of perturbations in the muscle–liver–adipose tissue axis. Here, we overview the current knowledge of Sa-O, especially focusing on LC.
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A key public health issue is the health of the increasing global ageing population. Such a population shift will necessitate changes and improvements to healthcare systems and individual lifestyle behaviours to ensure that adults who are living longer are doing so in good health. Just as in any other age group, adequate nutrition is paramount to ensure optimal physical and mental functioning for older adults. However, the ability to achieve adequate nutritional status will be affected by a range of factors; for example chronic illnesses can have a direct impact on nutritional status, while suffering from poor mental health can affect appetite. This chapter aims to describe the ageing population and nutritional requirements of older adults, present the evidence linking nutrition and chronic disease risk and then summarise the factors that affect dietary intake, nutritional status and malnutrition risk of older adults, including medical, physical, psychological, social and economic factors, which can have both direct and indirect impact on dietary intake.
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Obesity is a global problem across all age groups in the USA during the past 30 years; the proportion of older adults who are obese has doubled. As in the younger age group, genetic, environmental, social, as well as several other factors, are the etiological factors. In the USA, according to the National Institute of Health (NIH), poverty and lower levels of education are linked to obesity because it is cheaper to consume tons of high-calorie, processed food than fresh fruits and vegetables. According to the World Health Organization (WHO), a BMI of >30 is a marker of obesity. BMI above 25 is considered overweight, whereas a BMI over 30 is considered obese. Morbid obesity is defined as a BMI above 35 with comorbidity (diabetes, hypertension, or obstructive sleep apnea) or over 40 without comorbidity. The body composition of an obese older individual is different from their younger counterparts. Hormonal regulatory alterations predispose the old to increases in fat mass. There is redistribution of adipose tissue throughout the body with an increase in intra-abdominal fat with less subcutaneous fat. Aging results in decline in the growth hormone (GH), insulin-like growth factor 1 (IGF-1), testosterone, and estrogen. The decrease in GH results in a decline in lean muscle mass. Sarcopenia may coexist with obesity and may cause frailty and associated complications. Obesity is a risk factor for type 2 DM, coronary artery disease, respiratory problems, dermatological problems, osteoarthritis, and above all many forms of cancer (pancreas, breast, colon, esophageal, endometrial, kidney, thyroid, liver, and gallbladder cancer). Management of obesity in older adults is a complex one and has to be done with the help of a qualified geriatrician, nutritionist, and physical therapist. Surgical procedures are options for a few selected older adults.
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PurposeTo investigate the longitudinal associations between body mass index (BMI) categories and falls risk in men and women.Methods Prospective cohort study using data from 50,041 community-dwelling adults aged ≥ 50 years assessed in Wave 6 and 7 in the cross-national Survey of Health, Ageing and Retirement in Europe (SHARE). Socio-demographic and clinical factors were assessed at baseline (Wave 6). Functional impairment was defined by any limitations in activities of daily living (ADL) or instrumental ADL (IADL). Participants were classified as underweight, normal weight, overweight or obese at baseline. At 2-year follow-up (Wave 7), falls in the previous six months were recorded. The longitudinal associations between BMI categories and falls were analysed by binary logistic regression models; odds ratios (OR) and 95% confidence intervals (CI) were calculated. All analyses were adjusted for socio-demographic and clinical factors. Furthermore, analyses were stratified by sex, age and functional impairment.ResultsMean age was 67.0 years (range 50–102); 28,132 participants were women; 4057 (8.1%) participants reported falls at follow-up. Participants had an increased falls risk [OR (95% CI)] if they were underweight [1.41 (1.06–1.88), p = 0.017] or obese [1.20 (1.09–1.32), p < 0.001] compared to those with normal weight. The association of underweight and obesity with increased falls risk was consistent in participants aged ≥ 65 years. In participants with functional impairment, underweight was associated with higher falls risk [1.61 (1.09–2.40), p = 0.018], while obesity was not.ConclusionA U-shaped relationship between BMI and falls risk was found in community-dwelling adults.
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Background: Older adults living in nursing homes have an increased risk of adverse outcomes. However, the role of body composition in vital health and quality of life parameters such as functional capacity and cognitive function is less studied in this group of older adults compared to community-dwelling counterparts. Objective: The aim of the present study was to examine the association of body composition with functional capacity and cognitive function in nursing home residents. Methods: Fifty-three older adults (82.8±7.3 years) were enrolled in this study and they underwent body composition evaluation, functional capacity and cognitive function measurements. Results: The results showed a high prevalence of obesity accompanied by functional capacity limitations and cognitive impairment in older adults living in nursing homes. Partial correlations, controlling for age, showed that body fat percentage was positively correlated with sit-to-stand-5 (r=0.310, p=0.025) and timed-up-and-go (r=0.331, p=0.017), and negatively correlated with handgrip strength test results (r=-0.431, p<0.001), whereas greater lean body mass was associated with better sit-to-stand-5 (r=-0.410, p=0.003), handgrip strength (r=0.624, p<0.001) and cognitive function performance (r=0.302, p=0.037). Conclusions: These important associations reinforce the need to develop effective healthy lifestyle interventions targeting both lean mass and body fat to combat functional and cognitive decline in nursing home residents.
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Despite the adverse metabolic and functional consequences of obesity, caloric restriction- (CR) induced weight loss is often contra-indicated in older adults with obesity due to the accompanying loss of areal bone mineral density (aBMD) and subsequent increased risk of fracture. Several studies show a positive effect of exercise on aBMD among weight-stable older adults; however, data on the ability of exercise to mitigate bone loss secondary to CR are surprisingly equivocal. The purpose of this review is to provide a focused update of the randomized controlled trial literature assessing the efficacy of exercise as a countermeasure to CR-induced bone loss among older adults. Secondarily, we present data demonstrating the occurrence of exercise-induced changes in bone biomarkers, offering insight into why exercise is not more effective than observed in mitigating CR-induced bone loss.
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Sarcopenia is an age-related muscle mass and strength loss, which, if accompanied by higher percentages of adipose tissue, constitutes a state known as sarcopenic obesity. Accumulating evidence suggests that at a global level, sarcopenic obesity among adults, especially the elderly, is increasing. Nevertheless, comparisons between epidemiologic studies remain a challenge because of the lack of a universally accepted definition. What is known so far is that the coexistence of sarcopenia and obesity seems to amplify functional decline, cardiometabolic multi-morbidity, and mortality. Sarcopenic obesity is a developing field that highlights the evolving and still under investigated cross talk between muscle and adipose tissue physiology. In this chapter, we intend to shed light on what is already known in the emerging field of sarcopenic obesity and highlight some gaps that can be addressed to increase our limited understanding of this clinically important pathology.
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There is growing evidence that excess body weight increases the risk of cancer at several sites, including kidney, endometrium, colon, prostate, gallbladder and breast in post‐menopausal women. The proportion of all cancers attributable to overweight has, however, never been systematically estimated. We reviewed the epidemiological literature and quantitatively summarised, by meta‐analysis, the relationship between excess weight and the risk of developing cancer at the 6 sites listed above. Estimates were then combined with sex‐specific estimates of the prevalence of overweight [body mass index (BMI) 25–29 kg/m²] and obesity (BMI ≥30 kg/m²) in each country in the European Union to obtain the proportion of cancers attributable to excess weight. Overall, excess body mass accounts for 5% of all cancers in the European Union, 3% in men and 6% in women, corresponding to 27,000 male and 45,000 female cancer cases yearly. The attributable proportion varied, in men, between 2.1% for Greece and 4.9% for Germany and, in women, between 3.9% for Denmark and 8.8% for Spain. The highest attributable proportions were obtained for cancers of the endometrium (39%), kidney (25% in both sexes) and gallbladder (25% in men and 24% in women). The largest number of attributable cases was for colon cancer (21,500 annual cases), followed by endometrium (14,000 cases) and breast (12,800 cases). Some 36,000 cases could be avoided by halving the prevalence of overweight and obese people in Europe. © 2001 Wiley‐Liss, Inc.
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Context The prevalence of obesity and overweight increased in the United States between 1978 and 1991. More recent reports have suggested continued increases but are based on self-reported data.Objective To examine trends and prevalences of overweight (body mass index [BMI] ≥25) and obesity (BMI ≥30), using measured height and weight data.Design, Setting, and Participants Survey of 4115 adult men and women conducted in 1999 and 2000 as part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US population.Main Outcome Measure Age-adjusted prevalence of overweight, obesity, and extreme obesity compared with prior surveys, and sex-, age-, and race/ethnicity–specific estimates.Results The age-adjusted prevalence of obesity was 30.5% in 1999-2000 compared with 22.9% in NHANES III (1988-1994; P<.001). The prevalence of overweight also increased during this period from 55.9% to 64.5% (P<.001). Extreme obesity (BMI ≥40) also increased significantly in the population, from 2.9% to 4.7% (P = .002). Although not all changes were statistically significant, increases occurred for both men and women in all age groups and for non-Hispanic whites, non-Hispanic blacks, and Mexican Americans. Racial/ethnic groups did not differ significantly in the prevalence of obesity or overweight for men. Among women, obesity and overweight prevalences were highest among non-Hispanic black women. More than half of non-Hispanic black women aged 40 years or older were obese and more than 80% were overweight.Conclusions The increases in the prevalences of obesity and overweight previously observed continued in 1999-2000. The potential health benefits from reduction in overweight and obesity are of considerable public health importance.
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Advanced age is considered a relative contraindication to primary bariatric surgery at some institutions. As life expectancy is steadily increasing and quality of life is improving in our elderly population, we may need to reconsider the health benefits that obese elderly patients can obtain from bariatric surgery. Therefore, we examine the operative outcomes, weight loss, reduction of comorbidities, and medication requirements in patients older than 60 years compared with those younger than 60 years undergoing laparoscopic Roux-en-Y gastric bypass. The null hypothesis tested in this study is that patients older than 60 years who undergo laparoscopic Roux-en-Y gastric bypass experience a medical benefit not significantly different from that experienced by younger patients in terms of the number of medications and comorbid conditions. The number of preoperative and postoperative comorbid conditions and the medications required for those conditions were compared between consecutive patients older than 60 years and those younger than 60 years who underwent Roux-en-Y laparoscopic gastric bypass. Early operative outcomes were also assessed. Analysis of 110 patients younger than 60 years compared with 20 patients older than 60 years revealed no difference in complication rate or length of hospital stay. Younger patients lost more weight and had a significantly greater reduction in body mass index. Younger patients also demonstrated more complete resolution of comorbid conditions, although this difference was not significant. Older patients, who had more comorbid conditions requiring more medication at the time of surgery, experienced a greater medication reduction during follow-up, although this was not statistically significant. Patients of advanced age can safely undergo laparoscopic Roux-en-Y gastric bypass. Younger patients can be expected to demonstrate greater weight loss and experience more complete resolution of their comorbid conditions. Older patients demonstrated greater overall reduction in medication requirements. Therefore, patients older than 60 years can be considered good candidates for obesity surgery and can be expected to enjoy substantial health benefits similar to those experienced by younger patients.
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Orlistat, a gastrointestinal lipase inhibitor that reduces dietary fat absorption by approximately 30%, may promote weight loss and reduce cardiovascular risk factors. To test the hypothesis that orlistat combined with dietary intervention is more effective than placebo plus diet for weight loss and maintenance over 2 years. Randomized, double-blind, placebo-controlled study conducted from October 1992 to October 1995. Obese adults (body mass index [weight in kilograms divided by the square of height in meters], 30-43 kg/m2) evaluated at 18 US research centers. Subjects received placebo plus a controlled-energy diet during a 4-week lead-in. On study day 1, the diet was continued and subjects were randomized to receive placebo 3 times a day or orlistat, 120 mg 3 times a day, for 52 weeks. After 52 weeks, subjects began a weight-maintenance diet, and the placebo group (n = 133) continued to receive placebo and orlistat-treated subjects were rerandomized to receive placebo 3 times a day (n = 138), orlistat, 60 mg (n = 152) or 120 mg (n = 153) 3 times a day, for an additional 52 weeks. Body weight change and changes in blood pressure and serum lipid, glucose, and insulin levels. A total of 1187 subjects entered the protocol, and 892 were randomly assigned on day 1 to double-blind treatment. For intent-to-treat analysis, 223 placebo-treated subjects and 657 orlistat-treated subjects were evaluated. During the first year orlistat-treated subjects lost more weight (mean +/- SEM, 8.76+/-0.37 kg) than placebo-treated subjects (5.81+/-0.67 kg) (P<.001). Subjects treated with orlistat, 120 mg 3 times a day, during year 1 and year 2 regained less weight during year 2 (3.2+/-0.45 kg; 35.2% regain) than those who received orlistat, 60 mg (4.26+/-0.57 kg; 51.3% regain), or placebo (5.63+/-0.42 kg; 63.4% regain) in year 2 (P<.001). Treatment with orlistat, 120 mg 3 times a day, was associated with improvements in fasting low-density lipoprotein cholesterol and insulin levels. Two-year treatment with orlistat plus diet significantly promotes weight loss, lessens weight regain, and improves some obesity-related disease risk factors.
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Context Recent reports show that obesity and diabetes have increased in the United States in the past decade.Objective To estimate the prevalence of obesity, diabetes, and use of weight control strategies among US adults in 2000.Design, Setting, and Participants The Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted in all states in 2000, with 184 450 adults aged 18 years or older.Main Outcome Measures Body mass index (BMI), calculated from self-reported weight and height; self-reported diabetes; prevalence of weight loss or maintenance attempts; and weight control strategies used.Results In 2000, the prevalence of obesity (BMI ≥30 kg/m2) was 19.8%, the prevalence of diabetes was 7.3%, and the prevalence of both combined was 2.9%. Mississippi had the highest rates of obesity (24.3%) and of diabetes (8.8%); Colorado had the lowest rate of obesity (13.8%); and Alaska had the lowest rate of diabetes (4.4%). Twenty-seven percent of US adults did not engage in any physical activity, and another 28.2% were not regularly active. Only 24.4% of US adults consumed fruits and vegetables 5 or more times daily. Among obese participants who had had a routine checkup during the past year, 42.8% had been advised by a health care professional to lose weight. Among participants trying to lose or maintain weight, 17.5% were following recommendations to eat fewer calories and increase physical activity to more than 150 min/wk.Conclusions The prevalence of obesity and diabetes continues to increase among US adults. Interventions are needed to improve physical activity and diet in communities nationwide.
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Background Recent clinical guidelines on the health risks of obesity use body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) and waist circumference, but the waist-hip ratio may provide independent information. Methods To assess the joint and relative associations of BMI, waist circumference, and waist-hip ratio with multiple disease end points, we conducted a prospective cohort study of 31,702 Iowa women, aged 55 to 69 years and free of cancer, heart disease, and diabetes, assembled by random sampling and mail survey in 1986. Study end points were total and cause-specific mortality and incidence of site-specific cancers and self-reported diabetes, hypertension, and hip fracture over 11 to 12 years. Results The waist-hip ratio was the best anthropometric predictor of total mortality, with the multivariable-adjusted relative risk for quintile 5 vs 1 of 1.2 (95% confidence interval, 1.1-1.4), compared with 0.91 (95% confidence interval, 0.8-1.0) for BMI and 1.1 (95% confidence interval, 1.0-1.3) for waist circumference. The waist-hip ratio was also associated positively with mortality from coronary heart disease, other cardiovascular diseases, cancer, and other causes. The waist-hip ratio was associated less consistently than BMI or waist circumference with cancer incidence. All anthropometric indexes were associated with incidence of diabetes and hypertension. For example, women simultaneously in the highest quintiles of BMI and waist-hip ratio had a relative risk of diabetes of 29 (95% confidence interval, 18-46) vs women in the lowest combined quintiles. Conclusion The waist-hip ratio offers additional prognostic information beyond BMI and waist circumference.
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Context.— Nonpharmacologic interventions are frequently recommended for treatment of hypertension in the elderly, but there is a paucity of evidence from randomized controlled trials in support of this recommendation.Objective.— To determine whether weight loss or reduced sodium intake is effective in the treatment of older persons with hypertension.Design.— Randomized controlled trial.Participants.— A total of 875 men and women aged 60 to 80 years with systolic blood pressure lower than 145 mm Hg and diastolic blood pressure lower than 85 mm Hg while receiving treatment with a single antihypertensive medication.Setting.— Four academic health centers.Intervention.— The 585 obese participants were randomized to reduced sodium intake, weight loss, both, or usual care, and the 390 nonobese participants were randomized to reduced sodium intake or usual care. Withdrawal of antihypertensive medication was attempted after 3 months of intervention.Main Outcome Measure.— Diagnosis of high blood pressure at 1 or more follow-up visits, or treatment with antihypertensive medication, or a cardiovascular event during follow-up (range, 15-36 months; median, 29 months).Results.— The combined outcome measure was less frequent among those assigned vs not assigned to reduced sodium intake (relative hazard ratio, 0.69; 95% confidence interval [CI], 0.59-0.81; P<.001) and, in obese participants, among those assigned vs not assigned to weight loss (relative hazard ratio, 0.70; 95% CI, 0.57-0.87; P<.001). Relative to usual care, hazard ratios among the obese participants were 0.60 (95% CI, 0.45-0.80; P<.001) for reduced sodium intake alone, 0.64 (95% CI, 0.49-0.85; P=.002) for weight loss alone, and 0.47 (95% CI, 0.35-0.64; P<.001) for reduced sodium intake and weight loss combined. The frequency of cardiovascular events during follow-up was similar in each of the 6 treatment groups.Conclusion.— Reduced sodium intake and weight loss constitute a feasible, effective, and safe nonpharmacologic therapy of hypertension in older persons. Figures in this Article CLINICAL TRIALS have repeatedly demonstrated that antihypertensive drug therapy reduces the risk of stroke and coronary heart disease.1- 2 During the past 2 decades, these findings have been confirmed in trials restricted to older patients with hypertension.3- 4 Despite the proven benefits of antihypertensive medication, increasing interest in nonpharmacologic approaches to prevent and treat hypertension has been prompted by the knowledge that antihypertensive medication reduces rather than eliminates risk5; the potential for medication-related adverse effects,6 adverse events,7 and biochemical changes8; the high cost of many antihypertensive medications9; and the fact that observational and experimental studies have demonstrated a strong relationship between nutrition and blood pressure (BP).10 Clinical trials have demonstrated that weight loss and sodium reduction are effective in the treatment of middle-aged patients with hypertension.11 These interventions are also recommended for the treatment of hypertension in older persons.4 Observational data support the latter approach,12 but the experimental basis for the recommendation is limited.13 With this in mind, we conducted the Trial of Nonpharmacologic Interventions in the Elderly (TONE) to determine the feasibility, efficacy, and safety of sodium reduction and weight loss in older persons with hypertension.
Article
This study examined the effects of dietary weight loss and exercise on the health-related quality of life (HRQL) of overweight and obese, older adults with knee osteoarthritis. A total of 316 older men and women with documented evidence of knee osteoarthritis were randomly assigned to 1 of 4 18-month interventions: dietary weight loss, exercise, dietary weight loss and exercise, or healthy lifestyle control. Measures included the SF-36 Health Survey and satisfaction with body function and appearance. Results revealed that the combined diet and exercise intervention had the most consistent, positive effect on HRQL compared with the control group; however, findings were restricted to measures of physical health or psychological outcomes that are related to the physical self.
Article
Background: Although changes in body weight with aging are common, little is known about the effects of weight change on health in old age.Objectives: To study the effects of weight loss and weight gain from age 50 years to old age on the risk of hip fracture among postmenopausal white women aged 67 years and older and to determine if the level of weight at age 50 years modifies this risk.Methods: The association between weight change and the risk of hip fracture was studied in 3683 communitydwelling white women aged 67 years and older from three sites of the Established Populations for Epidemiologic Studies of the Elderly.Results: Extreme weight loss (10% or more) beginning at age 50 years was associated in a proportional hazards model with increased risk of hip fracture (relative risk [RR], 2.9; 95% confidence interval [CI], 2.0-4.1). This risk was greatest among women in the lowest (RR, 2.3; CI, 1.1-4.8) and middle (RR, 2.8; CI, 1.5-5.3) tertiles of body mass index at age 50 years. Among the thinnest women, even more modest weight loss (5% to <10%) was associated with increased risk of hip fracture (RR, 2.3; CI, 1.0-5.2). Weight gain of 10% or more beginning at age 50 years provided borderline protection against the risk of hip fracture (RR, 0.7; CI, 0.4-1.0). The RRs for weight gain of 10% or more were protective only among women in the middle and high tertiles of body mass index at age 50 years and were not significant (middle tertile RR, 0.8; CI, 0.3-1.8; high tertile RR, 0.6; CI, 0.2-1.9).Conclusions: Weight history is an important determinant of the risk of hip fracture. Weight loss beginning at age 50 years increases the risk of hip fracture in older white women, especially among those who are thin at ahip50 years; weight gain of 10% or more decreases the risk of bip fracture. Physicians should include weight history in their assessment of postmenopausal older women for risk of hip fracture.(Arch Intern Med. 1996;156:989-994)
Article
OBJECTIVE: To identify modifiable predictors of functional decline among community-residing older women and to derive and validate a clinical prediction tool for functional decline based only on modifiable predictors. DESIGN: A prospective cohort study. SETTING: Four geographic areas of the United States. PARTICIPANTS: Community-residing women older than age 65 recruited from population-based listings between 1986 and 1988 (n = 6632). MEASUREMENTS: Modifiable predictors were considered to be those that a clinician seeing an older patient for the first time could reasonably expect to change over a 4-year period: benzodiazepine use, depression, low exercise level, low social functioning, body-mass index, poor visual acuity, low bone mineral density, slow gait, and weak grip. Known predictors of functional decline unlikely to be amenable to intervention included age, education, medical comorbidity, cognitive function, smoking history, and presence of previous spine fracture. All variables were measured at baseline; only modifiable predictors were candidates for the prediction tool. Functional decline was defined as loss of ability over the 4—year interval to perform one or more of five vigorous or eight basic daily activities. RESULTS: Slow gait, short-acting benzodiazepine use, depression, low exercise level, and obesity were significant modifiable predictors of functional decline in both vigorous and basic activities. Weak grip predicted functional decline in vigorous activities, whereas long-acting benzodiazepine use and poor visual acuity predicted functional decline in basic activities. A prediction rule based on these eight modifiable predictors classified women in the derivation set into three risk groups for decline in vigorous activities (12%, 25%, and 39% risk) and two risk groups for decline in basic activities (2% and 10% risk). In the validation set, the probabilities of functional decline were nearly identical. CONCLUSIONS: A substantial portion of the variation of functional decline can be attributed to risk factors amenable to intervention over the short term. Using eight modifiable predictors that can be identified in a single office visit, clinicians can identify older women at risk for functional decline. J Am Geriatr Soc 48: 170–178, 2000.
Article
Background: We undertook a randomised controlled trial to assess the efficacy and tolerance of orlistat, a gastrointestinal lipase inhibitor, in promoting weight loss and preventing weight regain in obese patients over a 2-year period. Methods: 743 patients (body-mass index 28-47 kg/m2), recruited at 15 European centres, entered a 4-week, single-blind, placebo lead-in period on a slightly hypocaloric diet (600 kcal/day deficit). 688 patients who completed the lead-in were assigned double-blind treatment with orlistat 120 mg (three times a day) or placebo for 1 year in conjunction with the hypocaloric diet. In a second 52-week double-blind period patients were reassigned orlistat or placebo with a weight maintenance (eucaloric) diet. Findings: From the start of lead-in to the end of year 1, the orlistat group lost, on average, more bodyweight than the placebo group (10.2% [10.3 kg] vs 6.1% [6.1 kg]; LSM difference 3.9 kg [p < 0.001] from randomisation to the end of year 1). During year 2, patients who continued with orlistat regained, on average, half as much weight as those patients switched to placebo (p < 0.001). Patients switched from placebo to orlistat lost an additional 0.9 kg during year 2, compared with a mean regain of 2.5 kg in patients who continued on placebo (p < 0.001). Total cholesterol, low-density lipoprotein (LDL) cholesterol, LDL/high-density lipoprotein ratio, and concentrations of glucose and insulin decreased more in the orlistat group than in the placebo group. Gastrointestinal adverse events were more common in the orlistat group. Other adverse symptoms occurred at a similar frequency during both treatments. Interpretation: Orlistat taken with an appropriate diet promotes clinically significant weight loss and reduces weight regain in obese patients over a 2-year period. The use of orlistat beyond 2 years needs careful monitoring with respect to efficacy and adverse events.
Article
Chronic diseases and disabilities increase with age, affecting more than 60% of those over 75 y, and limiting activities in about half of them. Therefore, total energy expenditure (TEE) and its components are assessed separately in health and disease. An analysis of 568 doubly labelled water measurements in 'healthy' subjects (184 measurements in subjects over 65 years) suggests that there is a decrease of 0.69 and 0.43 MJ/day/decade respectively in men (standard weight 75 kg) and women (standard weight 67 kg). Physical activity (PA) accounted for 46% of the decrease in TEE, basal metabolic rate (BMR) for 44% of the decrease and thermogenesis (T) for the remaining 10%. TEE was found to be 10.79+/-2.09 and 8.62+/-1.49 MJ/day in 150 men and 100 women aged over 60 y, respectively. Of the total variance in TEE, measured with doubly labelled water over a 2 week period, 69% was considered to be due to differences between individuals, and 31% to differences within individuals. The variance due to PA plus T was threefold greater than that due to BMR. Physiological factors were far more important than methodological factors in influencing measurements of TEE, BMR and PA+T. An analysis of 136 measurements of TEE (doubly labelled water and bicarbonate-urea methods) in free-living elderly patients suffering from a variety of diseases suggests a frequent decrease in TEE, which may occur despite an increase in BMR. This is largely due to a reduction is PA (eg up to approximately 50% reduction), but in some cases it is also due to a reduction in BMR (loss of body weight). More comprehensive information is required about TEE and its components, partly because of a probable selection bias in recruitment of subjects participating in specific tracer studies, and partly because of the variable effects of different diseases and factors that operate at different times in the course of the same disease.
Article
Objective: The Diabetes Prevention Program (DPP) showed that intensive lifestyle intervention reduced the risk of diabetes by 58%. This paper examines demographic, psychosocial, and behavioral factors related to achieving weight loss and physical activity goals in the DPP lifestyle participants. Research Methods and Procedures: Lifestyle participants (n = 1079; mean age = 50.6, BMI = 33.9, 68% female, and 46% from minority groups) had goals of 7% weight loss and 150 min/wk of physical activity. Goal achievement was assessed at the end of the 16-session core curriculum (approximately week 24) and the final intervention visit (mean = 3.2 years) as a function of demographic, psychosocial, and behavioral variables. Results: Forty-nine percent met the weight loss goal and 74% met the activity goal initially, while 37% and 67%, respectively, met these goals long-term. Men and those with lower initial BMI were more likely to meet activity but not weight loss goals. Hispanic, Asian, and Native Americans were more likely to meet the long-term activity goals, and whites were more likely to meet the initial weight loss goal. In multivariate analyses, meeting the long-term weight loss goal and both activity goals increased with age, while psychosocial and depression measures were unrelated to goal achievement. Dietary self-monitoring was positively related to meeting both weight loss and activity goals, and meeting the activity goal was positively related to meeting the weight loss goal. Participants who met initial goals were 1.5 to 3.0 times more likely to meet these goals long-term. Discussion: Success at meeting the weight loss and activity goals increased with age. Initial success predicted long-term success. Self-monitoring and meeting activity goals were related to achieving and sustaining weight loss.
Article
Overweight and obesity represent a rapidly growing threat to the health of populations in an increasing number of countries. Indeed they are now so common that they are replacing more traditional problems such as undernutrition and infectious diseases as the most significant causes of ill-health. Obesity comorbidities include coronary heart disease, hypertension and stroke, certain types of cancer, non-insulin-dependent diabetes mellitus, gallbladder disease, dyslipidaemia, osteoarthritis and gout, and pulmonary diseases, including sleep apnoea. In addition, the obese suffer from social bias, prejudice and discrimination, on the part not only of the general public but also of health professionals, and this may make them reluctant to seek medical assistance. WHO therefore convened a Consultation on obesity to review current epidemiological information, contributing factors and associated consequences, and this report presents its conclusions and recommendations. In particular, the Consultation considered the system for classifying overweight and obesity based on the body mass index, and concluded that a coherent system is now available and should be adopted internationally. The Consultation also concluded that the fundamental causes of the obesity epidemic are sedentary lifestyles and high-fat energy-dense diets, both resulting from the profound changes taking place in society and the behavioural patterns of communities as a consequence of increased urbanization and industrialization and the disappearance of traditional lifestyles. A reduction in fat intake to around 20-25% of energy is necessary to minimize energy imbalance and weight gain in sedentary individuals. While there is strong evidence that certain genes have an influence on body mass and body fat, most do not qualify as necessary genes, i.e. genes that cause obesity whenever two copies of the defective allele are present; it is likely to be many years before the results of genetic research can be applied to the problem. Methods for the treatment of obesity are described, including dietary management, physical activity and exercise, and antiobesity drugs, with gastrointestinal surgery being reserved for extreme cases.
Article
Background The metabolic syndrome is an important cluster of coronary heart disease risk factors with common insulin resistance. The extent to which the metabolic syndrome is associated with demographic and potentially modifiable lifestyle factors in the US population is unknown.Methods Metabolic syndrome–associated factors and prevalence, as defined by Adult Treatment Panel III criteria, were evaluated in a representative US sample of 3305 black, 3477 Mexican American, and 5581 white men and nonpregnant or lactating women aged 20 years and older who participated in the cross-sectional Third National Health and Nutrition Examination Survey.Results The metabolic syndrome was present in 22.8% and 22.6% of US men and women, respectively (P = .86). The age-specific prevalence was highest in Mexican Americans and lowest in blacks of both sexes. Ethnic differences persisted even after adjusting for age, body mass index, and socioeconomic status. The metabolic syndrome was present in 4.6%, 22.4%, and 59.6% of normal-weight, overweight, and obese men, respectively, and a similar distribution was observed in women. Older age, postmenopausal status, Mexican American ethnicity, higher body mass index, current smoking, low household income, high carbohydrate intake, no alcohol consumption, and physical inactivity were associated with increased odds of the metabolic syndrome.Conclusions The metabolic syndrome is present in more than 20% of the US adult population; varies substantially by ethnicity even after adjusting for body mass index, age, socioeconomic status, and other predictor variables; and is associated with several potentially modifiable lifestyle factors. Identification and clinical management of this high-risk group is an important aspect of coronary heart disease prevention.
Article
Osteoarthritis (OA) is the most common of the arthropathies. The prevalence increases significantly with age, with as many as 68% of women and 58% of men aged 65 years or older having radiological evidence of disease. With an aging population, OA will represent an increasingly significant healthcare burden. The current treatment of patients with OA is purely symptomatic. As yet, there is no evidence that treatment changes the course of the disease. The current optimal treatment involves a combined approach which includes modification of risk factors, particularly obesity, and nonpharmacological treatments such as physiotherapy. If drugs are required in the treatment of OA, full dose regular paracetamol (acetaminophen) should be the first line of analgesic therapy. There is little evidence that the current over-reliance on long term treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) is justified. If NSAIDs are used, it is necessary to regularly review their use and to be aware of their potential toxicity, particularly in the older age group.
Article
Objective: To summarize published studies analyzing the effects of long-term change in body weight on all-cause mortality and have not been reported elsewhere in these proceedings. Data Sources: Thirteen reports from 11 diverse population studies, 7 from the United States and 4 from Europe. Study Selection: All studies included a weight change period of 4 or more years, followed by a mortality assessment period of 8 or more years. All weight changes occurred in persons 17 years or older
Article
Objective. —As disability is highly prevalent among older women, is costly, and affects the quality of life, preventable causes of disability must be identified. In this study, we investigated the relationship between the body mass index (BMI), weight change, and the onset of disability in older women.Design. —Prospective cohort study.Setting. —The nationally representative US epidemiologic follow-up study of the National Health and Nutrition Examination Survey (NHANES) I (1971 through 1987).Patients. —White women classified as young-old (mean age 60 years at baseline, mean age 65 years at follow-up) and old-old (mean age 76 years at baseline, mean age 80 years at follow-up).Main Outcome Measures. —The relative odds for the onset of mobility disability associated with tertiles of past BMI (measured 8 to 16 years prior to disability ascertainment) and current BMI (measured 2 to 5 years prior to disability ascertainment) and with weight change between the two weight measurements.Results. —In both cohorts, women in the high past BMI group (>27 in the young-old and >28.1 in the old-old cohort) had a twofold increase in the risk for disability compared with women in the low past BMI group. High current BMI was as strongly related as past BMI to risk of disability in the young-old women; it was not as strong a predictor in old-old women. In the old-old group only, women who experienced a weight loss of more than 5% had a twofold increase in risk of disability compared with weight-stable women. These results were adjusted for age, smoking, education, and study time and were not importantly modified with the addition into the models of single or multiple health conditions.Conclusions. —These prospective data suggest that high BMI is a strong predictor of long-term risk for mobility disability in older women and that this risk persists even to very old age. However, the paradoxical increase in risk associated with weight loss in the old-old women requires further study. Programs to prevent overweight may have potential for decreasing disability in women.(JAMA. 1994;271:1093-1098)
Article
DEPRESSION in the aging and the aged is a major public health problem. It causes suffering to many who go undiagnosed, and it burdens families and institutions providing care for the elderly by disabling those who might otherwise be able-bodied. What makes depression in the elderly so insidious is that neither the victim nor the health care provider may recognize its symptoms in the context of the multiple physical problems of many elderly people. Depressed mood, the typical signature of depression, may be less prominent than other depressive symptoms such as loss of appetite, sleeplessness, anergia, and loss of interest in, and enjoyment of, the normal pursuits of life. There is a wide spectrum of depressive symptoms as well as types of available therapies. Because of the many physical illnesses and social and economic problems of the elderly, individual health care providers often conclude that depression is a normal consequence
Article
Objective: To evaluate the relation between weight variability and death in high;risk, middle-aged men participating in the Multiple Risk Factor Intervention Trial (MRFIT). Design: Cohort study with 3.8 years of follow-up. Setting: Multicenter, collaborative, primary prevention trial conducted at 22 clinical centers in the United States. Participants: Men (n=10 529) who were 35 to 57 years old at baseline and who were in the upper 10% to 15% of risk for coronary heart disease because of smoking, high blood pressure, and elevated cholesterol level. Participants were seen at least annually for 6 to 7 years for medical evaluations in study clinical centers