John A Batsis

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

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Publications (76)249.55 Total impact

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    ABSTRACT: Background: Body composition changes with aging lead to increased adiposity and decreased muscle mass, making the diagnosis of obesity challenging. Conventional anthropometry, including body mass index (BMI), while easy to use clinically may misrepresent adiposity. We determined the diagnostic accuracy of BMI using dual energy x-ray absorptiometry (DEXA) in assessing the degree of obesity in older adults. Methods: The National Health and Nutrition Examination Surveys 1999-2004 were used to identify adults aged ⩾60years with DEXA measures. They were categorized (yes/no) as having elevated body fat by gender (men⩾25%; females ⩾35%) and by body mass index (BMI) ⩾25 and ⩾30 kg/m(2). The diagnostic performance of BMI was assessed. Metabolic characteristics were compared in discordant cases of BMI/body fat. Weighting and analyses were performed per NHANES guidelines. Results: We identified 4984 subjects (men:2453; female:2531). Mean BMI and % body fat was 28.0 kg/m(2) and 30.8% in men, and 28.5 kg/m(2) and 42.1% in females. A BMI ⩾30 kg/m(2) had a low sensitivity and moderately high specificity (men:32.9 and 80.8%, concordance index 0.66; females:38.5 and 78.5%, concordance 0.69) correctly classifying 41.0 and 45.1% of obese subjects. A BMI ⩾25 kg/m(2) had a moderately high sensitivity and specificity (men:80.7 and 99.6%, concordance 0.81;females:76.9 and 98.8%, concordance 0.84) correctly classifying 80.8 and 78.5% of obese subjects. In subjects with BMI<30 kg/m(2) body fat was considered elevated in 67.1 and 61.5% of males and females, respectively.For a BMI⩾30 kg/m(2), sensitivity drops from 40.3 to 14.5% and 44.5 to 23.4%, while specificity remains elevated (>98%),in males and females, respectively in those 60-69.9years to subjects aged ⩾80years. Correct classification of obesity using a cutoff of 30 kg/m(2) drops from 48.1 to 23.9% and 49.0 to 19.6%, in males and females in these two age groups. Conclusions: Traditional measures poorly identify obesity in the elderly. In older adults, BMI may be a suboptimal marker for adiposity.International Journal of Obesity accepted article preview online, 01 December 2015. doi:10.1038/ijo.2015.243.
    No preview · Article · Dec 2015 · International journal of obesity (2005)
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    ABSTRACT: Background: Obesity is associated with functional impairment, institutionalization, and increased mortality risk in elders. Dynapenia is defined as reduced muscle strength and is a known independent predictor of adverse events and disability. The synergy between dynapenia and obesity leads to worse outcomes than either independently. We identified the impact of dynapenic obesity in a cohort at risk for and with knee osteoarthritis on function. Methods: We identified adults aged∈≥∈60 years from the Osteoarthritis Initiative. Obesity was defined as a body mass index∈≥∈30 kg/m2. Dynapenia was classified using the lowest sex-specific tertile of knee extensor strength. Participants were grouped according to obesity and knee strength: dynapenic obesity; dynapenia without obesity; obesity without dynapenia; and no dynapenia nor obesity. Four-year data was available. Self-reported activities of daily living (ADL) were assessed at follow-up. Outcomes of gait speed, 400 m walk distance, Late-life Disability and Function Index (LLFDI), and Short-Form (SF)-12 were analyzed using mixed effects and logistic regression models. Results: Of 2025 subjects (56.3 % female), mean age was 68.2 years and 182 (24.1 %) had dynapenic obesity. Dynapenic obesity was associated with reduced gait speed, LLFDI-limitations, and SF-12 physical score in both sexes and in the 400 m walk in men only (all p∈<∈0.001). A time∗group interaction was significant for dynapenic obese men in the 400 m walk distance only. Odds of ADL limitations in dynapenic obesity was OR 2.23 [1.42:3.50], in dynapenia 0.98 [0.66:1.46], and in obesity 1.98 [1.39:2.80] in males. In females, odds were 2.45 [1.63:3.68], 1.60 [1.15:2.22], and 1.47 [1.06:2.04] respectively. Conclusion: Dynapenic obesity may be a risk factor for functional decline suggesting the need to target subjects with low knee strength and obesity.
    Preview · Article · Dec 2015 · BMC Geriatrics
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    ABSTRACT: The Foundation for the National Institutes of Health Sarcopenia Project validated cutpoints for appendicular lean mass (ALM) to identify individuals with functional impairment. We hypothesized that the prevalence of sarcopenia and sarcopenic obesity would be similar based on the different Foundation for the National Institutes of Health criteria, increase with age, and be associated with risk of impairment limitations. We identified 4984 subjects at least 60 years of age from the National Health and Nutrition Examination Surveys 1999-2004. Sarcopenia was defined using ALM (men <19.75 kg, women <15.02 kg) and ALM adjusted for body mass index (BMI; men <0.789 kg/m(2), women <0.512 kg/m(2)). Sarcopenic obesity is defined as subjects fulfilling the criteria for sarcopenia and obesity by body fat (men ≥25%, women ≥35%). Prevalence rates of both sarcopenia and sarcopenic obesity were evaluated with respect to sex, age category (60-69, 70-79, and >80 years) and race. We assessed the association of physical limitations, basic and instrumental activities of daily living and sarcopenia status. The mean age was 70.5 years in men and 71.6 years in women. Half (50.8%; n = 2531) were female, and mean BMI was 28 kg/m(2) in both sexes. Appendicular lean mass was higher in men than in women (24.1 vs 16.3; P < .001), but fat mass was lower (30.9 vs 42.0; P < .001). In men, sarcopenia prevalence was 16.0% and 27.8% using the ALM and ALM/BMI criteria. In women, prevalence was 40.5% and 19.3% using the ALM and ALM/BMI criteria. Sarcopenia was associated with a 1.10 (0.86-1.41) and 0.93 (0.74-1.16), and 1.46 (1.10-1.94), and 2.13 (1.41-3.20) risk of physical limitations using the ALM and ALM/BMI definitions in men and women, respectively. Prevalence of sarcopenia and sarcopenic obesity varies greatly, and a uniform definition is needed to identify and characterize these high-risk populations.
    No preview · Article · Oct 2015 · Nutrition research
  • Sohaib Aleem · Rosalind Lasky · W Blair Brooks · John A Batsis
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    ABSTRACT: Background: Obesity recognition in primary care is important to address the epidemic. We aimed to evaluate primary care clinician-reported documentation, management practices, beliefs and attitudes toward obesity compared to body mass index (BMI) calculation, obesity prevalence and actual documentation of obesity as an active problem in electronic health record in a rural academic center. Methods: Our target population for previously validated clinician survey was 56 primary care providers working at 3 sites. We used calendar year 2012 data for assessment of baseline system performance for metrics of documentation of BMI in primary care visits, and proportion of visits in patients with obesity with obesity as a problem. Standard statistical methods assessed the data. Results: Survey response rate was 91%. Average age of respondents was 48.9 years and 62.7% were females. 72.5% clinicians reported having normal BMI. The majority of clinicians reported regularly documenting obesity as an active problem, and utilized motivational interviewing and basic good nutrition and healthy exercise. Clinicians identified lack of discipline and exercise time, access to unhealthy food and psychosocial issues as major barriers. Most denied disliking weight loss discussion or patients taking up too much time. In 21,945 clinic visits and 11,208 annual preventive care visits in calendar year 2012, BMI was calculated in 93% visits but obesity documentation as an active problem only 27% of patients meeting BMI criteria for obesity. Conclusions: Despite high clinician-reported documentation of obesity as an active problem, actual obesity documentation rates remained low in a rural academic medical center.
    No preview · Article · Sep 2015 · Obesity Research & Clinical Practice
  • Lydia E. Gill · Stephen J. Bartels · John A. Batsis
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    ABSTRACT: As the number of older adults increases rapidly, the national epidemic of obesity is also affecting our aging population. This is particularly concerning given the numerous health risks and increased costs associated with this condition. Weight management is extremely important for older adults given the risks associated with abdominal adiposity, which is a typical fat redistribution during aging, and the prevalence of comorbid conditions in this age group. However, approaches to weight loss must be considered critically given the dangers of sarcopenia (a condition that occurs when muscle mass and quality are lost), the increased risk of hip fracture with weight loss, and the association between reduced mortality and increased BMI in older adults. This overview highlights the challenges and implications of measuring adiposity in older adults and the dangers and benefits of weight loss in this population and provides an overview of the new Medicare Obesity Benefit. In addition, we provide a summary of outcomes from successful weight loss interventions for older adults and discuss implications for advancing clinical practice.
    No preview · Article · Sep 2015
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    ABSTRACT: To identify the risks of the combination of normal body mass index (BMI) and central obesity (normal weight and central obesity (NWCO)) on physical activity and function. Longitudinal Osteoarthritis Initiative Study. Community based. Adults aged 60 and older at risk of osteoarthritis (N = 2,210; mean age 68, range 67.1-69.0) were grouped according to BMI (normal 18.5-24.9 kg/m(2) , overweight 25.0-29.9 kg/m(2) , obese ≥30.0 kg/m(2) ). High waist circumference (WC) was defined as greater than 88 cm for women and greater than 102 cm for men. Subjects were subcategorized according to WC (five categories). Subjects with normal BMI and a large WC were considered to have NWCO (n = 280, 12.7%). Six-year changes in the Physical Component Summary of the Medical Outcomes Study 12-item Short Form Survey (PCS), Physical Activity Scale for the Elderly (PASE), and Late-Life Function and Disability Index (LL-FDI) were examined. The association between BMI and WC over 6 years was assessed (reference normal BMI, normal WC). Stratified analyses were performed according to age (60-69; ≥70). Physical component scores, PASE, and LL-FDI declined with time. Mean PASE scores at 6 years differed between the NWCO group and the group with normal BMI and WC (117.7 vs 141.5), but rate of change from baseline to 6 years was not significantly different (P = .35). In adjusted models, those with NWCO had greater decline in PCS over time, particularly those aged 70 and older than those with normal BMI and WC (time interaction β = -0.37, 95% confidence interval = -0.68 to -0.06). Normal weight and central obesity in older adults at risk of osteoarthritis may be a risk factor for declining function and physical activity, particularly in those aged 70 and older, suggesting the value of targeting those with NWCO who would otherwise be labeled as low risk. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.
    No preview · Article · Jul 2015 · Journal of the American Geriatrics Society
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    ABSTRACT: Older adults with obesity are at risk for osteoarthritis (OA) and are predisposed to functional decline and disability. We examined the association between obesity and disability, physical activity, and quality of life at 6 years. Using data from the longitudinal Osteoarthritis Initiative (OAI), we analysed older adults (age ≥ 60 years) with a body mass index (BMI) at baseline ≥ 18.5 kg/m(2) (n = 2378) using standard BMI categories. Outcomes were assessed at the 6-year follow-up and included: the Late-Life Function and Disability Index (LLDI), the 12-item Short Form Health Survey (SF-12), and the Physical Activity Scale for the Elderly (PASE). Linear regression predicted outcomes based on BMI category, adjusting for age, sex, race, education, smoking, cohort status, radiographic knee OA, co-morbidity scores, and baseline scores when available. Follow-up data were available for 1727 (71.9%) participants (mean age 67.9 ± 5.3 years; 61.6% female). At baseline, obese subjects compared to overweight and normal were on a greater number of medications (4.28 vs. 3.63 vs. 3.32), had lower gait speeds (1.22 vs. 1.32 vs. 1.36 m/s), higher Charlson scores (0.59 vs. 0.37 vs. 0.30), and higher Western Ontario and McMaster University OA Index (WOMAC) scores (right: 14.8 vs. 10.3 vs. 7.5; left: 14.4 vs. 9.9 vs. 7.5). SF-12 scores at 6 years were lower in obese patients than in overweight or normal [99.5 (95% CI 98.7-100.4) vs. 101.1 (95% CI 100.4-101.8) vs. 102.8 (95% CI 101.8-103.8)], as were PASE scores [115.1 (95% CI 110.3-119.8) vs. 126.2 (95% CI 122.2-130.2) vs. 131.4 (95% CI 125.8-137.0)]. The LLDI limitation component demonstrated differences in obese compared to overweight or normal [78.6 (95% CI 77.4-79.9) vs. 81.2 (95% CI 80.2-82.3) vs. 82.5 (95% CI 81.1-84.0)]. Obesity was associated with worse physical activity scores, lower quality of life, and higher risk of 6-year disability.
    No preview · Article · Jun 2015 · Scandinavian journal of rheumatology
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    ABSTRACT: AimObesity is a major cardiovascular (CV) risk factor. Bariatric surgery (BSx) is an approved therapeutic alternative for class II–III obesity, but little evidence focuses on older adults. We assessed the effect of BSx on cardiometabolic variables and long-term CV risk in older adults.Methods We carried out a population-based, observational study from 1990–2009, of 40 consecutive elderly (age ≥60 years) residents of Olmsted County, MN, USA, with class II–III obesity treated with BSx at a University-based, academic health center. Data were obtained from the Rochester Epidemiology Project. Metabolic syndrome (MetS) was defined using American Heart Association/National Heart, Lung, Blood Institute (AHA/NHLBI) criteria (increased triglycerides, low high-density lipoprotein, increased blood pressure, increased glucose and body mass index as a modified measure of obesity instead of waist circumference). Change in CV risk factors, MetS prevalence, and impact on predicted CV risk using the Framingham risk score was ascertained at 1 year postoperatively and assessed statistically.ResultsMean age and body mass index were 64.4 ± 3.7 and 45.0 ± 6.3 kg/m2, respectively, and 28 out of 40 (70%) were women. One participant died during the 11-month study period after BSx from respiratory complications related to BSx, and one participant died at 2 years. Percentage of excess weight loss decreased by 57.5% at 1 year. Prevalence 1 year after BSx decreased for diabetes (57.5% to 22.5%; P < 0.03), hypertension 87.5% to 73.7% (P = 0.003), dyslipidemia (80% to 42.5%; P < 0.001) and sleep apnea (62.5% to 23.7%; P < 0.001).MetS prevalence decreased from 80% to 45% (P < 0.002). Baseline risk was 14.1%, which changed at follow up at 8.2%.Conclusions In older adults, BSx induces considerable weight loss, improves CV risk factors, decreases MetS prevalence and is an effective treatment in this population. Geriatr Gerontol Int 2015; ●●: ●●–●●.
    No preview · Article · Jun 2015 · Geriatrics & Gerontology International
  • J. A. Batsis · C. M. Germain · E. Vasquez · S. J. Bartels

    No preview · Conference Paper · Apr 2015
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    ABSTRACT: To determine whether leptin is related to all-cause and cardiovascular (CV) mortality in older adults. Participants 60 years and older with plasma leptin level measurements from the National Health and Nutrition Examination Survey III (1988-1994) and mortality data linked to the National Death Index were included. We created sex-specific tertiles of leptin (men: 4.2-7.7 μg/L; women: 11.5-21.4 μg/L) to identify the effect of leptin on all-cause and CV mortality. We also determined whether leptin predicted mortality in patients with obesity. We classified obesity using 4 possible definitions: body mass index 30 kg/m(2) or greater; body fat 25% or more in men and 35% or more in women; waist circumference 102 cm or greater in men and 88 cm or greater in women; and waist-hip ratio 0.85 or higher in women and 0.95 or higher in men. Sex-specific proportional hazard models were used to assess the effect of leptin on all-cause and CV mortality. Of 1794 participants, 51.6% were women; the mean age was 70.3±0.4 years, and the follow-up period was 12.5 years with 994 deaths (469 were CV deaths). All-cause mortality in the highest leptin tertile was significant neither in men (hazard ratio [HR], 1.23; 95% CI, 0.93-1.63) nor in women (HR, 0.97; 95% CI, 0.68-1.40). CV mortality was the highest in the highest leptin tertile in men (HR, 1.69; 95% CI, 1.06-2.70) but not in women (HR, 1.21; 95% CI, 0.73-1.98). Evaluating the effect of leptin in subgroups of different obesity definitions, we found that high leptin levels as predict CV mortality in men as measured by waist circumference or body fat. Elevated leptin level is predictive of CV mortality only in men. Leptin may provide additional mortality discrimination in obese men. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Apr 2015 · Mayo Clinic Proceedings
  • C. M. Germain · J. A. Batsis · E. Vasque

    No preview · Conference Paper · Apr 2015
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    ABSTRACT: Physical activity reduces mobility impairments in elders. We examined the association of physical activity on risk of subjective and objective physical function in adults with and at risk for osteoarthritis (OA). Adults aged≥60years from the longitudinal Osteoarthritis Initiative (OAI), a prospective observational study of knee OA, were classified by sex-specific quartiles of Physical Activity Score for the Elderly (PASE) scores. Using linear mixed models, we assessed 6-year data on self-reported health, gait speed, Late-Life Disability Index (LLDI) and chair stand. Of 2,252 subjects, mean age ranged from 66-70 years. Within each quartile, physical component (PCS) of the Short Form-12 and gait speed decreased from baseline to follow-up in both sexes (all p<0.001), yet the overall changes across PASE quartiles between these two time points were no different(p=0.40 and 0.69, males and females, respectively).Decline in PCS occurred in the younger age group, but rates of change between quartiles over time were no different in any outcomes in either sex. LLDI scores declined in the 70+ age group. Adjusting for knee extensor strength reduced the strength of association. Higher physical activity is associated with maintained physical function, and is mediated by muscle strength highlighting the importance of encouraging physical activity in older adults with and at risk for osteoarthritis.
    No preview · Article · Apr 2015 · Journal of Physical Activity and Health

  • No preview · Conference Paper · Apr 2015
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    ABSTRACT: Obesity and physical inactivity are independently associated with declines in physical and functional limitations in older adults. The current study examines the impact of physical activity on odds of physical and functional limitations in older adults with central and general obesity. Data from 6279 community-dwelling adults aged 60 years or more from the Health and Retirement Study 2006 and 2008 waves were used to calculate prevalence and odds of physical and functional limitation among obese older adults with high waist circumference (waist circumference ≥88 cm in females and ≥102 cm in males) who were physically active versus inactive (engaging in moderate/vigorous activity less than once per week). Logistic regression models were adjusted for age, sex, race/ethnicity, education, smoking status, body mass index, and number of comorbidities. Physical activity was associated with lower odds of physical and functional limitations among older adults with high waist circumference (odds ratio [OR], 0.59; confidence interval [CI], 0.52-0.68, for physical limitations; OR, 0.52; CI, 0.44-0.62, for activities of daily living; and OR, 0.44; CI, 0.39-0.50, for instrumental activities of daily living). Physical activity is associated with significantly lower odds of physical and functional limitations in obese older adults regardless of how obesity is classified. Additional research is needed to determine whether physical activity moderates long-term physical and functional limitations.
    No preview · Article · Mar 2015
  • John A. Batsis · Kenneth M. Dolkart
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    ABSTRACT: The prevalence of obesity in the general population is increasing worldwide, and those surviving are at an increased risk for developing comorbidity and physical limitations. With aging, obesity places this high-risk population at an increased risk for future morbidity, institutionalization, and functional decline. Traditional weight loss programs lead to inconsistent improvements in comorbidity, function, and quality of life. Bariatric surgery may offer a reasonable alternative in selected patients to achieve improvements in these outcomes. We present our approach in assessing the physiologic age of older candidates for bariatric surgery from a geriatrician's perspective that may be useful for general internists, bariatricians, and general surgeons alike. We present how a focus on function and physiological parameters of aging provides more predictive power than that on chronological age alone.
    No preview · Article · Feb 2015 · Journal of Clinical Gerontology and Geriatrics
  • John A Batsis

    No preview · Article · Dec 2014 · The American Journal of Medicine
  • John A Batsis · Karen L Huyck · Stephen J Bartels
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    ABSTRACT: Obesity and the growing population of older adults are significant public health concerns in the United States. In 2011, the Centers for Medicare and Medicaid Services introduced a Medicare benefit for obesity counselling using Intensive Behavioral Therapy that would reimburse structured visits over a 12-month period. Although we applaud this new benefit that addresses the obesity epidemic in older adults, three major shortcomings limit its utility and potential effectiveness: 1) weight loss interventions differ in older and younger adults, yet the benefit relies predominantly on data from interventions studied in younger populations; 2) body mass index is not an accurate measure for identifying obesity; and 3) tying reimbursement to clinician visits may hamper the integration of this benefit into practice. To overcome these shortcomings, we propose: 1) obesity treatment should focus on improving quality of life and physical function and on mitigating muscle and bone loss rather than focusing solely on weight loss; 2) waist circumference or waist-hip ratio should be considered as additional anthropometric measures in ascertaining obesity; and 3) allied health professionals should be reimbursed for providing this benefit. Incorporating these suggestions will improve its usability in clinical practice and increase the chances that this well-meaning benefit will improve patient outcomes.
    No preview · Article · Sep 2014 · Journal of General Internal Medicine
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    ABSTRACT: Background We previously demonstrated that BMI is associated with functional decline and reduced quality of life. While BMI in older adults is fraught with challenges, waist circumference (WC) is a marker of visceral adiposity that can also predict mortality. However, its association with function and quality of life in older adults is not well understood and hence we sought to examine the impact of WC on six-year outcomes. Methods We identified adults aged ≥60 years from the longitudinal Osteoarthritis Initiative and stratified the cohort into quartiles based on WC. Our primary outcome measures of function at six year follow-up included: self-reported quality of life [Short Form-12 (SF-12)], physical function [Physical Activity Scale for the Elderly (PASE)] and disability [Late-life Disability Index (LLDI)]. Linear regression analyses predicted 6-year outcomes based on WC quartile category (lowest = referent), adjusted for age, sex, race, education, knee pain, smoking status, a modified Charlson co-morbidity index and baseline scores, where available. Results We identified 2,182 subjects meeting our inclusion criteria and stratified the study cohort by quartiles of WC. Mean age ranged from 67.5-68.7 years, 60-71% were female and 80-86% were white. The highest WC quartile compared to 50-75th, 25-50th or lowest quartile, was associated with a greater number of medications (4.3, 4.0, 3.6 and 3.4 [p < 0.001]), lower gait speeds (1.23, 1.27, 1.32, and 1.34 m/s[p < 0.001]), higher rates of knee osteoarthritis (70.2, 62.2, 60.2, 48.6;p < 0.001), higher Charlson co-morbidity scores and greater knee pain (WOMAC scores) (all p < 0.001). At follow-up, adjusted SF-12 physical function subscale and PASE scores, were lowest in the highest WC quartile as compared to the 50-75%, 25-50%, and lowest quartiles [(SF-12 scores: 45.5, 46.7, 47.6, and 47.9), and (PASE scores: 109.6, 128.7, 126.6, and 131.0). The LLDI limitation subscale for disability demonstrated lower scores in the high WC quartile as opposed to the referent group. Conclusions Elevated WC is associated with lower quality of life, a decline in physical function, and a slightly higher risk of disability over time. Intervention studies are needed to prevent functional decline in this high-risk population.
    Full-text · Article · Aug 2014 · Nutrition Journal
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    ABSTRACT: Physical activity (PA) improves function in older obese adults. However, body mass index is an unreliable adiposity indicator better reflected by waist circumference (WC). The impact of PA on physical impairment and mobility with high WC is unclear. We performed a secondary data analysis of 4,976 adults ≥60 years using National Health and Nutrition Examination Surveys (NHANES) 2005-2010. Physical limitations (PL), activities of daily living (ADL) impairments, and PA (low(<1day/week) or high (>1day/week) were self-reported. Waist circumference (WC) was dichotomized (females: 88cm; males: 102cm). Mean age was 70.1years, 55.1% were female. Prevalence of PL and ADL impairment in the high WC group were 57.7% and 18.8%, respectively, and high PA was present in 53.9%. Among high WC, high PA vs. low PA were at lower risk of PL (OR 0.58[0.48-0.70]) and ADL impairment (OR 0.46 [0.32-0.65]). High WC had higher odds of PL irrespective of PA (high PA: OR 1.57 [1.30-1.88]; low PA: OR 1.52[1.29-1.79]) and ADL impairment (high PA:OR 1.27 [1.02-1.57] and low PA:OR 1.24 [0.99-1.54]). High PA in viscerally obese individuals is associated with impairments.
    Full-text · Article · Aug 2014 · Journal of aging and physical activity
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    ABSTRACT: Background: Sarcopenia is defined as the loss of skeletal muscle mass and quality, which accelerates with aging and is associated with functional decline. Rising obesity prevalence has led to a high-risk group with both disorders. We assessed mortality risk associated with sarcopenia and sarcopenic obesity in elders. Methods: A subsample of 4652 subjects ≥60 years of age was identified from the National Health and Nutrition Examination Survey III (1988-1994), a cross-sectional survey of non-institutionalized adults. National Death Index data were linked to this data set. Sarcopenia was defined using a bioelectrical impedance formula validated using magnetic resonance imaging-measured skeletal mass by Janssen et al. Cutoffs for total skeletal muscle mass adjusted for height(2) were sex-specific (men: ≤5.75 kg/m(2); females ≤10.75 kg/m(2)). Obesity was based on % body fat (males: ≥27%, females: ≥38%). Modeling assessed mortality adjusting for age, sex, ethnicity (model 1), comorbidities (hypertension, diabetes, congestive heart failure, osteoporosis, cancer, coronary artery disease and arthritis), smoking, physical activity, self-reported health (model 2) and mobility limitations (model 3). Results: Mean age was 70.6±0.2 years and 57.2% were female. Median follow-up was 14.3 years (interquartile range: 12.5-16.1). Overall prevalence of sarcopenia was 35.4% in women and 75.5% in men, which increased with age. Prevalence of obesity was 60.8% in women and 54.4% in men. Sarcopenic obesity prevalence was 18.1% in women and 42.9% in men. There were 2782 (61.7%) deaths, of which 39.0% were cardiovascular. Women with sarcopenia and sarcopenic obesity had a higher mortality risk than those without sarcopenia or obesity after adjustment (model 2, hazard ratio (HR): 1.35 (1.05-1.74) and 1.29 (1.03-1.60)). After adjusting for mobility limitations (model 3), sarcopenia alone (HR: 1.32 ((1.04-1.69) but not sarcopenia with obesity (HR: 1.25 (0.99-1.58)) was associated with mortality. For men, the risk of death with sarcopenia and sarcopenic obesity was nonsignificant in both model-2 (HR: 0.98 (0.77-1.25), and HR: 0.99 (0.79-1.23)) and model 3 (HR: 0.98 (0.77-1.24) and HR: 0.98 (0.79-1.22)). Conclusions: Older women with sarcopenia have an increased all-cause mortality risk independent of obesity.
    No preview · Article · Jun 2014 · European Journal of Clinical Nutrition

Publication Stats

1k Citations
249.55 Total Impact Points


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