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Waist circumference is a better predictor of risk for frailty than BMI in the community-dwelling elderly in Beijing

  • Qiuju Liao
  • Zheng Zheng
  • Shuangling Xiu
  • Piu Chan
Original Article
  • 99 Downloads

Abstract

Aim

Obesity is found to be associated with frailty. Body mass index (BMI) and waist circumference (WC) are the commonly used measures for obesity, the former is more closely related to general obesity and body weight; the latter can more accurately reflect abdominal obesity and is more closely associated with metabolic disorders. In this study, we intend to study the relationship between frailty, BMI and WC among older people.

Methods

Data were derived from the Beijing Longitudinal Study on Aging II Cohort, which included 6320 people 65 years or older from three urban districts in Beijing. A Frailty Index derived from 33 items was developed according to Rockwood’s cumulative deficits method. A Frailty Index ≥ 0.25 was used as the cut-off criteria. BMI was classified as underweight, normal, overweight, or obese (< 18.5, 18.5–< 24.0, 24.0–27.9, ≥ 28.0 kg/m2, respectively). High WC was defined as WC ≥ 85 cm in men and ≥ 80 cm in women.

Results

People with a larger BMI (≥ 28.0 kg/m2, 22.6%) or a larger WC (18.5%) were more likely to be frail. People with normal BMI and overweight people do not suffer from higher prevalence for frailty. In comparison with individuals with normal BMI (18.5–< 24.0 kg/m2) and normal WC (< 85 cm in men, <80 cm in women), the risk of frailty was higher among individuals who have normal BMI and large WC (odds ratio 1.68; 95% CI 1.33–2.12), have overweight and large WC (odds ratio 1.58; 95% CI 1.23–1.96), or have obesity and large WC (odds ratio 2.28; 95% CI 1.79–2.89). In people with normal WC, only those who are underweight have a higher risk for frailty (odds ratio 1.65, 95% CI 1.08–2.52). In comparison with BMI, the relation of WC with the risk for frailty was much closer.

Conclusions

Abdominal obesity is more closely associated with incidence of frailty than general obesity in the elderly. Older adults with large waist circumference are more likely to be frail. Frailty in the elderly might be more closely related to metabolic disorders. WC might be a better measurement to detect frailty than BMI, given its relationship with metabolic disorders.

Keywords

Body mass index Waist circumference Frailty Older adults Prevalence 

Notes

Acknowledgements

This project was funded by grants from the Beijing Municipal Commission on Science and Technology (D07050701130000 and D07050701130701), and Ministry of Health of China (201002011), Ministry of Science and Technology of China (2012AA02A514, 0S2012GR0150, 2012ZX09303-005). We thank all the participants and their families and the healthcare professionals involved.

Author contribution

Study concept and design: Dr. Piu Chan, Dr. Qiuju Liao; acquisition of subjects and/or data: Dr. Piu Chan; analysis and interpretation of data: Dr. QiujuLiao, Dr. Zheng Zheng, Dr. Shuangling Xiu; preparation of manuscript: Dr. Piu Chan, Dr. Qiuju Liao.

Funding

This project was funded by grants from the Beijing Municipal Commission on Science and Technology (D07050701130000 and D07050701130701), and Ministry of Health of China (201002011), Ministry of Science and Technology of China (2012AA02A514, 0S2012GR0150, 2012ZX09303-005).

Compliance with ethical standards

Conflict of interest

No potential conflicts of interest were disclosed.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Research Ethics Committee of Xuanwu Hospital, Capital Medical University. In addition, this study was performed in accordance with the ethical principles of the Declaration of Helsinki.

Informed consent

Written informed consent was obtained from all participants.

References

  1. 1.
    Wang XQ, Chen PJ (2014) Population ageing challenges health care in China. Lancet 383:870.  https://doi.org/10.1016/S0140-6736(14)60443-8 CrossRefPubMedGoogle Scholar
  2. 2.
    Lee L, Heckman G, Molnar FJ (2015) Frailty: Identifying elderly patients at high risk of poor outcomes. Can Fam Physician 61:227–231PubMedPubMedCentralGoogle Scholar
  3. 3.
    Lao XQ, Ma WJ, Sobko T et al (2015) Overall obesity is leveling-off while abdominal obesity continues to rise in a Chinese population experiencing rapid economic development: analysis of serial cross-sectional health survey data 2002–2010. Int J Obesity (Lond) 39:288–294.  https://doi.org/10.1038/ijo.2014.95 CrossRefGoogle Scholar
  4. 4.
    Frasca D, Blomberg BB, Paganelli R (2017) Aging, obesity, and inflammatory age-related diseases. Front Immunol 8:1745.  https://doi.org/10.3389/fimmu.2017.01745 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Srivastava S (2017) The mitochondrial basis of aging and age-related disorders. Genes (Basel)  https://doi.org/10.3390/genes8120398 Google Scholar
  6. 6.
    Kalyani RR, Egan JM (2013) Diabetes and altered glucose metabolism with aging. Endocrinol Metab Clin North Am 42:333–347.  https://doi.org/10.1016/j.ecl.2013.02.010 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Bowen ME (2012) The relationship between body weight, frailty, and the disablement process. J Gerontol B Psychol Sci Soc Sci 67:618–626.  https://doi.org/10.1093/geronb/gbs067 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Pérez-Tasigchana RF, León-Muñoz LM, Lopez-Garcia E et al (2017) Metabolic syndrome and insulin resistance are associated with frailty in older adults: a prospective cohort study. Age Ageing 46:807–812.  https://doi.org/10.1093/ageing/afx023 CrossRefPubMedGoogle Scholar
  9. 9.
    García-Esquinas E, Graciani A, Guallar-Castillón P, et al (2015) Diabetes and risk of frailty and its potential mechanisms: a prospective cohort study of older adults. J Am Med Dir Assoc 16:748–754.  https://doi.org/10.1016/j.jamda.2015.04.008 CrossRefPubMedGoogle Scholar
  10. 10.
    Castrejón-Pérez RC, Aguilar-Salinas CA, Gutiérrez-Robledo LM et al (2017) Frailty, diabetes, and the convergence of chronic disease in an age-related condition: a population-based nationwide cross-sectional analysis of the Mexican nutrition and health survey. Aging Clin Exp Res.   https://doi.org/10.1007/s40520-017-0852-2 PubMedGoogle Scholar
  11. 11.
    Janssen I, Katzmarzyk PT, Ross R (2004) Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr 79:379–384CrossRefPubMedGoogle Scholar
  12. 12.
    Kashiwagi R, Iwahashi H, Yamada Y et al (2017) Effective waist circumference reduction rate necessary to avoid the development of type 2 diabetes in Japanese men with abdominal obesity. Endocr J 64:881–894.  https://doi.org/10.1507/endocrj.EJ17-0113 CrossRefPubMedGoogle Scholar
  13. 13.
    Ravensbergen HR, Lear SA, Claydon VE (2014) Waist circumference is the best index for obesity-related cardiovascular disease risk in individuals with spinal cord injury. J Neurotrauma 31:292–300.  https://doi.org/10.1089/neu.2013.3042 CrossRefPubMedGoogle Scholar
  14. 14.
    Cerhan JR, Moore SC, Jacobs EJ et al (2014) A pooled analysis of waist circumference and mortality in 650,000 adults. Mayo Clin Proc 89:335–345.  https://doi.org/10.1016/j.mayocp.2013.11.011 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Zuliani G, Volpato S, Galvani M et al (2009) Elevated C-reactive protein levels and metabolic syndrome in the elderly: the role of central obesity data from the in Chianti study. Atherosclerosis 203:626–632.  https://doi.org/10.1016/j.atherosclerosis.2008.07.038 CrossRefPubMedGoogle Scholar
  16. 16.
    Weinbrenner T, schröder H, Escurriol V et al (2006) Circulating oxidized LDL is associated with increased waist circumference independent of body mass index in men and women. Am J Clin Nutr 83:30–35CrossRefPubMedGoogle Scholar
  17. 17.
    Barzilay JI, Blaum C, Moore T et al (2007) Insulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study. Arch Intern Med 167: 635–641CrossRefPubMedGoogle Scholar
  18. 18.
    Zheng Z, Guan S, Ding H et al (2016) Prevalence and incidence of frailty in community-dwelling older people: Beijing longitudinal study of aging II. J Am Geriatr Soc 64:1281–1286.  https://doi.org/10.1111/jgs.14135 CrossRefPubMedGoogle Scholar
  19. 19.
    Chhetri JK, Zheng Z, Xu X et al (2017) The prevalence and incidence of frailty in Pre-diabetic and diabetic community-dwelling older population: results from Beijing longitudinal study of aging II (BLSA-II). BMC Geriatr 17:47.  https://doi.org/10.1186/s12877-017-0439-y CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173:489–495CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Rockwood K, Andrew M, Mitnitski A (2007) A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci 62:738–743CrossRefPubMedGoogle Scholar
  22. 22.
    Searle SD, Mitnitski A, Gahbauer EA et al (2008) A standard procedure for creating a frailty index. BMC Geriatr 8:24.  https://doi.org/10.1186/1471-2318-8-24 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Guigoz Y, Vellas B, Garry PJ (1996) Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation. Nutr Rev 54:S59–S65CrossRefPubMedGoogle Scholar
  24. 24.
    Tinetti ME (1986) Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 34:119–126CrossRefPubMedGoogle Scholar
  25. 25.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefPubMedGoogle Scholar
  26. 26.
    Burke WJ, Roccaforte WH, Wengel SP (1991) The short form of the Geriatric Depression Scale: a comparison with the 30-item form. J Geriatr Psychiatry Neurol 4:173–178PubMedGoogle Scholar
  27. 27.
    Zhou BF; Cooperative Meta-Analysis Group of the Working Group on Obesity in China (2002) Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults-study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomed Environ Sci 15:83–96Google Scholar
  28. 28.
    Hubbard RE, Lang IA, Llewellyn DJ et al (2010) Frailty, body mass index, and abdominal obesity in older people. J Gerontol A Biol Sci Med Sci 65:377–381.  https://doi.org/10.1093/gerona/glp186 CrossRefPubMedGoogle Scholar
  29. 29.
    Blaum CS, Xue QL, Michelon E, et al (2005) The association between obesity and the frailty syndrome in older women: the Women’s Health and Aging Studies. J Am Geriatr Soc 53:927–934CrossRefPubMedGoogle Scholar
  30. 30.
    Woods NF, LaCroix AZ, Gray SL et al (2005) Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc 53:1321–1330CrossRefPubMedGoogle Scholar
  31. 31.
    Onat A, Can G, Örnek E et al (2013) Abdominal obesity with hypertriglyceridaemia, lipoprotein(a) and apolipoprotein A-I determine marked cardiometabolic risk. Eur J Clin Invest 43:1129–1139.  https://doi.org/10.1111/eci.12150 PubMedGoogle Scholar
  32. 32.
    Herghelegiu AM, Nacu RM, Prada GI (2016) Metabolic parameters and cognitive in a cohort of older diabetic patients. Aging Clin Exp Res 28:1105–1112.  https://doi.org/10.1007/s40520-015-0515-0 CrossRefPubMedGoogle Scholar
  33. 33.
    Seabolt LA, Welch EB, Silver HJ (2015) Imaging methods for analyzing body composition in human obesity and cardiometabolic disease. Ann NY Acad Sci 1353:41–59.  https://doi.org/10.1111/nyas.12842 CrossRefPubMedGoogle Scholar
  34. 34.
    Ramsay SE, Arianayagam DS, Whincup PH et al (2015) Cardiovascular risk profile and frailty in a population-based study of older British men. Heat 101:616–622.  https://doi.org/10.1136/heartjnl-2014-306472 Google Scholar
  35. 35.
    García-Esquinas E, José García-García F, León-Muñoz LM et al (2015) Obesity, fat distribution, and risk of frailty in two population-based cohorts of older adults in Spain. Obesity 23:847–855.  https://doi.org/10.1002/oby.21013 CrossRefPubMedGoogle Scholar
  36. 36.
    Ritz P (2009) Editorial: obesity in the elderly: should we be using new diagnostic criteria? J Nutr Health Aging 13:168–169CrossRefPubMedGoogle Scholar
  37. 37.
    Pasco JA, Nicholson GC, Brennan SL et al (2012) Prevalence of obesity and the relationship between the body mass index and body fat: cross-sectional, population-based data. PLoS One 7:e29580.  https://doi.org/10.1371/journal.pone.0029580 CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Kissebah AH, Peiris AN (1989) Biology of regional body fat distribution: relationship to non-insulin-dependent diabetes mellitus. Diabetes Metab Rev 5:83–109CrossRefPubMedGoogle Scholar
  39. 39.
    Després JP, Lemieux I, Bergeron J et al (2008) Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler Thromb Vasc Biol 28:1039–1049.  https://doi.org/10.1161/ATVBAHA.107.159228 CrossRefPubMedGoogle Scholar
  40. 40.
    Hardy OT, Czech MP, Corvera S (2012) What causes the insulin resistance underlying obesity? Curr Opin Endocrinol Diabetes Obes 19:81–87.  https://doi.org/10.1097/MED.0b013e3283514e13 CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Soysal P, Isik AT, Carvalho AF et al (2017) Oxidative stress and frailty: a systematic review and synthesis of the best evidence. Maturitas 99:66–72.  https://doi.org/10.1016/j.maturitas.2017.01.006 CrossRefPubMedGoogle Scholar
  42. 42.
    Sakakura K, Hoshide S, Ishikawa J et al (2008) Association of body mass index with cognitive function in elderly hypertensive Japanese. Am J Hypertens 21:627–632.  https://doi.org/10.1038/ajh.2008.157 CrossRefPubMedGoogle Scholar
  43. 43.
    Felson DT, Zhang Y, Hannan MT et al (1993) Effects of weight and body mass index on bone mineral density in men and women: the Framingham study. J Bone Miner Res 8:567–573CrossRefPubMedGoogle Scholar
  44. 44.
    Rolland Y, Abellan van Kan G, Gillette-Guyonnet S et al (2011) Cachexia versus sarcopenia. Curr Opin Clin Nutr Metab Care 14:15–21.  https://doi.org/10.1097/MCO.0b013e328340c2c2 CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Qiuju Liao
    • 2
    • 4
  • Zheng Zheng
    • 1
    • 2
    • 6
  • Shuangling Xiu
    • 2
    • 5
  • Piu Chan
    • 1
    • 2
    • 3
    • 6
  1. 1.Department of Neurobiology, Beijing Institute of GeriatricsXuanwu Hospital of Capital Medical UniversityBeijingChina
  2. 2.Department of Geriatrics, Beijing Institute of GeriatricsXuanwu Hospital of Capital Medical UniversityBeijingChina
  3. 3.Department of Neurology, Beijing Institute of GeriatricsXuanwu Hospital of Capital Medical UniversityBeijingChina
  4. 4.Department of Rheumatology, Beijing Institute of GeriatricsXuanwu Hospital of Capital Medical UniversityBeijingChina
  5. 5.Department of Endocrinology, Beijing Institute of GeriatricsXuanwu Hospital of Capital Medical UniversityBeijingChina
  6. 6.Key Laboratory on Neurodegenerative Disease of Ministry of Education, and Beijing Key Laboratory for Parkinson’s DiseaseParkinson’s Disease Center of Beijing Institute for Brain DisordersBeijingChina

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