Association between adiposity and disability in the Lc65+ cohort



To examine the longitudinal association between body mass index (BMI) and waist circumference (WC) with mortality and incident disability in Lc65+ cohort.


Population-based cohort of non-institutionalized adults with up to 8.9 years of follow-up.


City of Lausanne, Switzerland.


1,293 individuals aged 65 to 70 at baseline (58% women).


BMI, WC and covariates were measured at baseline in 2004-2005. Vital status was obtained up to the 31st December 2013 and difficulty with basic activities of daily living (BADL) was reported in a self-administered questionnaire sent to participants every year. Main outcomes were total mortality and disability, defined as difficulty with BADL for ≥2 years or institutionalization. Cox regression was used with BMI/WC quintiles 2 as the reference.


130 persons died over a median follow-up of 8.47 years (crude mortality rate, men: 16.5/1,000 person-years, women: 9.7/1,000 person-years). In Cox regression adjusted for age, sex, education, financial situation, smoking and involuntary weight loss (IWL) at baseline, mortality was significantly associated with neither BMI nor WC, but there were trends towards non-significant J-curves across both BMI and WC quintiles. Disability (231 cases) tended to increase monotonically across both BMI and WC quintiles and was significantly associated with BMI quintile 5 (HR=2.44, 95% CI [1.65-3.63]), and WC quintiles 4 (HR=1.81 [1.15-2.85]) and 5 (HR=2.58, [1.67-4.00]).


Almost half of the study population had a substantially increased HR of disability, as compared to the reference BMI/WC categories. This observation emphasizes the need for life-long strategies aimed at preventing excess weight, muscle loss and functional decline through adequate nutrition and regular physical activity, starting at early age and extending throughout life.

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  1. 1.

    Flegal KM, Carroll MD, Ogden CL, Johnson CL: Prevalence and trends in obesity among US adults, 1999-2000. JAMA 2002, 288(14): 1723–1727.

    Article  PubMed  Google Scholar 

  2. 2.

    Marques-Vidal P, Bochud M, Mooser V, Paccaud F, Waeber G, Vollenweider P: Prevalence of obesity and abdominal obesity in the Lausanne population. BMC Public Health 2008, 8:330.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Flegal KM, Graubard BI, Williamson DF, Gail MH: Excess deaths associated with underweight, overweight, and obesity. JAMA 2005, 293(15): 1861–1867.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Adams KF, Schatzkin A, Harris TB, Kipnis V, Mouw T, Ballard-Barbash R, Hollenbeck A, Leitzmann MF: Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 2006, 355(8): 763–778.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Kuk JL, Ardern CI: Influence of age on the association between various measures of obesity and all-cause mortality. J Am Geriatr Soc 2009, 57(11): 2077–2084.

    Article  PubMed  Google Scholar 

  6. 6.

    Dolan CM, Kraemer H, Browner W, Ensrud K, Kelsey JL: Associations between body composition, anthropometry, and mortality in women aged 65 years and older. Am J Public Health 2007, 97(5): 913–918.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Auyeung TW, Lee JS, Leung J, Kwok T, Leung PC, Woo J: Survival in older men may benefit from being slightly overweight and centrally obese—a 5-year followup study in 4,000 older adults using DXA. J Gerontol A Biol Sci Med Sci 2010, 65(1): 99–104.

    Article  PubMed  Google Scholar 

  8. 8.

    Oreopoulos A, Kalantar-Zadeh K, Sharma AM, Fonarow GC: The obesity paradox in the elderly: potential mechanisms and clinical implications. Clin Geriatr Med 2009, 25(4): 643–659, viii.

    Article  PubMed  Google Scholar 

  9. 9.

    Price GM, Uauy R, Breeze E, Bulpitt CJ, Fletcher AE: Weight, shape, and mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death. Am J Clin Nutr 2006, 84(2): 449–460.

    CAS  PubMed  Google Scholar 

  10. 10.

    Padwal R.L W.D., Lix, L.M., Majumdar, S.R.: Relationship among body fat percentage, body mass index, and all-cause mortality. Ann Intern Med 2016, 164.

    Google Scholar 

  11. 11.

    Kyle UG, Morabia A, Schutz Y, Pichard C: Sedentarism affects body fat mass index and fat-free mass index in adults aged 18 to 98 years. Nutrition 2004, 20(3): 255–260.

    Article  PubMed  Google Scholar 

  12. 12.

    Bouchard DR, Choquette S, Dionne IJ, Brochu M: Is fat mass distribution related to impaired mobility in older men and women? Nutrition as a determinant of successful aging: the Quebec longitudinal study. Exp Aging Res 2011, 37(3): 346–357.

    Article  PubMed  Google Scholar 

  13. 13.

    Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB: Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women. Circulation 2008, 117(13): 1658–1667.

    Article  PubMed  Google Scholar 

  14. 14.

    Huxley R, Mendis S, Zheleznyakov E, Reddy S, Chan J: Body mass index, waist circumference and waist:hip ratio as predictors of cardiovascular risk—a review of the literature. Eur J Clin Nutr 2010, 64(1): 16–22.

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Houston DK, Stevens J, Cai J: Abdominal fat distribution and functional limitations and disability in a biracial cohort: the Atherosclerosis Risk in Communities Study. Int J Obes (Lond) 2005, 29(12): 1457–1463.

    CAS  Article  Google Scholar 

  16. 16.

    Bannerman E: Anthropometric indices predict physical function and mobility in older Australians: the Australian Longitudinal Study of Ageing. Public Health Nutr 2002, 5(5):655–662.

    Article  PubMed  Google Scholar 

  17. 17.

    Woo J, Ho SC, Sham A: Longitudinal changes in body mass index and body composition over 3 years and relationship to health outcomes in Hong Kong Chinese age 70 and older. J Am Geriatr Soc 2001, 49(6): 737–746.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Koenig J, Windham BG, Ferrucci L, Sonntag D, Fischer JE, Thayer JF, Jarczok MN: Association strength of three adiposity measures with autonomic nervous system function in apparently healthy employees. J Nutr Health Aging 2015, 19(9): 879–882.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Losonczy KG, Harris TB, Cornoni-Huntley J, Simonsick EM, Wallace RB, Cook NR, Ostfeld AM, Blazer DG: Does weight loss from middle age to old age explain the inverse weight mortality relation in old age? Am J Epidemiol 1995, 141(4): 312–321.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Visscher TL, Seidell JC, Molarius A, van der Kuip D, Hofman A, Witteman JC: A comparison of body mass index, waist-hip ratio and waist circumference as predictors of all-cause mortality among the elderly: the Rotterdam study. Int J Obes Relat Metab Disord 2001, 25(11): 1730–1735.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Wannamethee SG, Shaper AG, Lennon L, Whincup PH: Decreased muscle mass and increased central adiposity are independently related to mortality in older men. Am J Clin Nutr 2007, 86(5): 1339–1346.

    CAS  PubMed  Google Scholar 

  22. 22.

    Janssen I, Bacon E: Effect of current and midlife obesity status on mortality risk in the elderly. Obesity (Silver Spring) 2008, 16(11): 2504–2509.

    Article  Google Scholar 

  23. 23.

    Ding J, Kritchevsky SB, Newman AB, Taaffe DR, Nicklas BJ, Visser M, Lee JS, Nevitt M, Tylavsky FA, Rubin SM et al: Effects of birth cohort and age on body composition in a sample of community-based elderly. Am J Clin Nutr 2007, 85(2): 405–410.

    CAS  PubMed  Google Scholar 

  24. 24.

    Newman AB, Haggerty CL, Goodpaster B, Harris T, Kritchevsky S, Nevitt M, Miles TP, Visser M, Health A, Body Composition Research G: Strength and muscle quality in a well-functioning cohort of older adults: the Health, Aging and Body Composition Study. J Am Geriatr Soc 2003, 51(3): 323–330.

    Article  PubMed  Google Scholar 

  25. 25.

    Seematter-Bagnoud L, Paccaud F, Robine J: Le futur de la longévité en Suisse. In: Statistique de la Suisse. Edited by Federal Statistical Office S. Neuchâtel: Federal Statistical Office, Switzerland;2009.

    Google Scholar 

  26. 26.

    Walter S, Kunst A, Mackenbach J, Hofman A, Tiemeier H: Mortality and disability: the effect of overweight and obesity. Int J Obes (Lond) 2009, 33(12): 1410–1418.

    CAS  Article  Google Scholar 

  27. 27.

    Reynolds SL, Saito Y, Crimmins EM: The impact of obesity on active life expectancy in older American men and women. Gerontologist 2005, 45(4): 438–444.

    Article  PubMed  Google Scholar 

  28. 28.

    Majer IM, Nusselder WJ, Mackenbach JP, Kunst AE: Life expectancy and life expectancy with disability of normal weight, overweight, and obese smokers and nonsmokers in Europe. Obesity (Silver Spring) 2011, 19(7): 1451–1459.

    Article  Google Scholar 

  29. 29.

    Wong E, Woodward M, Stevenson C, Backholer K, Sarink D, Peeters A: Prevalence of disability in Australian elderly: Impact of trends in obesity and diabetes. Prev Med 2016, 82:105–110.

    Article  PubMed  Google Scholar 

  30. 30.

    Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, Singh GM, Gutierrez HR, Lu Y, Bahalim AN et al: National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011, 377(9765): 557–567.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Artaud F, Singh-Manoux A, Dugravot A, Tavernier B, Tzourio C, Elbaz A: Body mass index trajectories and functional decline in older adults: Three-City Dijon cohort study. Eur J Epidemiol 2016, 31(1): 73–83.

    Article  PubMed  Google Scholar 

  32. 32.

    Alley DE, Chang VW: The changing relationship of obesity and disability, 1988-2004. JAMA 2007, 298(17): 2020–2027.

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    Mahoney FI, Barthel DW: Functional Evaluation: The Barthel Index. Md State Med J 1965, 14:61–65.

    CAS  PubMed  Google Scholar 

  34. 34.

    Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G: Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004, 59(3): 255–263.

    Article  PubMed  Google Scholar 

  35. 35.

    Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW: Studies of Illness in the Aged. The Index of Adl: A Standardized Measure of Biological and Psychosocial Function. JAMA 1963, 185:914–919.

    CAS  PubMed  Google Scholar 

  36. 36.

    Santos-Eggimann B, Karmaniola A, Seematter-Bagnoud L, Spagnoli J, Bula C, Cornuz J, Rodondi N, Vollenweider P, Waeber G, Pecoud A: The Lausanne cohort Lc65+: a population-based prospective study of the manifestations, determinants and outcomes of frailty. BMC Geriatr 2008, 8:20.

    Google Scholar 

  37. 37.

    Danon-Hersch N, Rodondi N, Spagnoli J, Santos-Eggimann B: Prefrailty and chronic morbidity in the youngest old: an insight from the Lausanne cohort Lc65+. J Am Geriatr Soc 2012, 60(9): 1687–1694.

    Article  PubMed  Google Scholar 

  38. 38.

    Camicioli R, Mizrahi S, Spagnoli J, Bula C, Demonet JF, Vingerhoets F, von Gunten A, Santos-Eggimann B: Handwriting and pre-frailty in the Lausanne cohort 65+ (Lc65+) study. Arch Gerontol Geriatr 2015, 61(1): 8–13.

    Article  PubMed  Google Scholar 

  39. 39.

    Danon-Hersch N, Santos-Eggimann B: Physical activity in daily life is associated with lower adiposity values than doing weekly sports in Lc65+ cohort at baseline. BMC Public Health 2013, 13:1175.

    Article  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Emerging Risk Factors C: Adult height and the risk of cause-specific death and vascular morbidity in 1 million people: individual participant meta-analysis. Int J Epidemiol 2012, 41(5): 1419–1433.

    Article  Google Scholar 

  41. 41.

    French SA, Folsom AR, Jeffery RW, Williamson DF: Prospective study of intentionality of weight loss and mortality in older women: the Iowa Women’s Health Study. Am J Epidemiol 1999, 149(6): 504–514.

    CAS  Article  PubMed  Google Scholar 

  42. 42.

    Flegal KM, Kit BK, Orpana H, Graubard BI: Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 2013, 309(1): 71–82.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Zamboni M, Mazzali G, Zoico E, Harris TB, Meigs JB, Di Francesco V, Fantin F, Bissoli L, Bosello O: Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes (Lond) 2005, 29(9): 1011–1029.

    CAS  Article  Google Scholar 

  44. 44.

    Dyer AR, Stamler J, Garside DB, Greenland P: Long-term consequences of body mass index for cardiovascular mortality: the Chicago Heart Association Detection Project in Industry study. Ann Epidemiol 2004, 14(2): 101–108.

    Article  PubMed  Google Scholar 

  45. 45.

    Fang J, Wylie-Rosett J, Cohen HW, Kaplan RC, Alderman MH: Exercise, body mass index, caloric intake, and cardiovascular mortality. Am J Prev Med 2003, 25(4): 283–289.

    Article  PubMed  Google Scholar 

  46. 46.

    Ritchie CS, Locher JL, Roth DL, McVie T, Sawyer P, Allman R: Unintentional weight loss predicts decline in activities of daily living function and life-space mobility over 4 years among community-dwelling older adults. The journals of gerontology Series A, Biological sciences and medical sciences 2008, 63(1): 67–75.

    Article  PubMed  Google Scholar 

  47. 47.

    Stokes A, Preston SH: Revealing the burden of obesity using weight histories. Proc Natl Acad Sci U S A 2016.

    Google Scholar 

  48. 48.

    Stevens J, Bradshaw PT, Truesdale KP, Jensen MD: Obesity Paradox should not interfere with public health efforts. Int J Obes (Lond) 2015, 39(1): 80–81.

    CAS  Article  Google Scholar 

  49. 49.

    Rillamas-Sun E, LaCroix AZ, Waring ME, Kroenke CH, LaMonte MJ, Vitolins MZ, Seguin R, Bell CL, Gass M, Manini TM et al: Obesity and late-age survival without major disease or disability in older women. JAMA internal medicine 2014, 174(1): 98–106.

    Article  PubMed  PubMed Central  Google Scholar 

  50. 50.

    Pischon T, Boeing H, Hoffmann K, Bergmann M, Schulze MB, Overvad K, van der Schouw YT, Spencer E, Moons KG, Tjonneland A et al: General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008, 359(20): 2105–2120.

    CAS  Article  PubMed  Google Scholar 

  51. 51.

    Houston DK, Stevens J, Cai J, Morey MC: Role of weight history on functional limitations and disability in late adulthood: the ARIC study. Obes Res 2005, 13(10): 1793–1802.

    Article  PubMed  Google Scholar 

  52. 52.

    Friedmann JM, Elasy T, Jensen GL: The relationship between body mass index and self-reported functional limitation among older adults: a gender difference. J Am Geriatr Soc 2001, 49(4): 398–403.

    CAS  Article  PubMed  Google Scholar 

  53. 53.

    Macklai NS, Spagnoli J, Junod J, Santos-Eggimann B: Prospective association of the SHARE-operationalized frailty phenotype with adverse health outcomes: evidence from 60+ community-dwelling Europeans living in 11 countries. BMC Geriatr 2013, 13:3.

    Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Jensen GL, Friedmann JM: Obesity is associated with functional decline in community-dwelling rural older persons. J Am Geriatr Soc 2002, 50(5): 918–923.

    Article  PubMed  Google Scholar 

  55. 55.

    Merrill SS, Seeman TE, Kasl SV, Berkman LF: Gender differences in the comparison of self-reported disability and performance measures. J Gerontol A Biol Sci Med Sci 1997, 52(1):M19–26.

    CAS  Article  PubMed  Google Scholar 

  56. 56.

    Backholer K, Pasupathi K, Wong E, Hodge A, Stevenson C, Peeters A: The relationship between body mass index prior to old age and disability in old age. Int J Obes (Lond) 2012, 36(9): 1180–1186.

    CAS  Article  Google Scholar 

  57. 57.

    Al SS, Ottenbacher KJ, Markides KS, Kuo YF, Eschbach K, Goodwin JS: The effect of obesity on disability vs mortality in older Americans. Arch Intern Med 2007, 167(8): 774–780.

    Article  Google Scholar 

  58. 58.

    Nam S, Kuo YF, Markides KS, Al Snih S: Waist circumference (WC), body mass index (BMI), and disability among older adults in Latin American and the Caribbean (LAC). Arch Gerontol Geriatr 2012, 55(2):e40–47.

    Article  PubMed  PubMed Central  Google Scholar 

  59. 59.

    Yin Z, Shi X, Kraus VB, Brasher MS, Chen H, Liu Y, Lv Y, Zeng Y: Genderdependent association of body mass index and waist circumference with disability in the Chinese oldest old. Obesity (Silver Spring) 2014, 22(8): 1918–1925.

    Article  Google Scholar 

  60. 60.

    Backholer K, Wong E, Freak-Poli R, Walls HL, Peeters A: Increasing body weight and risk of limitations in activities of daily living: a systematic review and metaanalysis. Obes Rev 2012, 13(5): 456–468.

    CAS  Article  PubMed  Google Scholar 

  61. 61.

    Stenholm S, Mehta NK, Elo IT, Heliovaara M, Koskinen S, Aromaa A: Obesity and muscle strength as long-term determinants of all-cause mortality—a 33-year follow-up of the Mini-Finland Health Examination Survey. Int J Obes (Lond) 2014, 38(8): 1126–1132.

    CAS  Article  Google Scholar 

  62. 62.

    Tell GS, Fried LP, Hermanson B, Manolio TA, Newman AB, Borhani NO: Recruitment of adults 65 years and older as participants in the Cardiovascular Health Study. Ann Epidemiol 1993, 3(4): 358–366.

    CAS  Article  PubMed  Google Scholar 

  63. 63.

    Jacobsen SJ, Mahoney DW, Redfield MM, Bailey KR, Burnett JC., Rodeheffer RJ: Participation bias in a population-based echocardiography study. Ann Epidemiol 2004, 14(8): 579–584.

    Article  PubMed  Google Scholar 

  64. 64.

    Galea S, Tracy M: Participation rates in epidemiologic studies. Ann Epidemiol 2007, 17(9): 643–653.

    Article  PubMed  Google Scholar 

  65. 65.

    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G et al: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001, 56(3):M146–M156.

    CAS  Article  PubMed  Google Scholar 

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Danon-Hersch, N., Fustinoni, S., Bovet, P. et al. Association between adiposity and disability in the Lc65+ cohort. J Nutr Health Aging 21, 799–810 (2017).

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Key words

  • Body mass index
  • waist circumference
  • adiposity
  • disability
  • mortality