Skip to main content
SpringerLink
Log in

Association of dynamics in lean and fat mass measures with mortality in frail older women

  • Published:
The journal of nutrition, health & aging

Abstract

Objective

The relationship between body composition and mortality in frail older people is unclear. We used dual-x-ray absorptiometry (DXA) data to examine the association between dynamics in whole-body composition and appendicular (4 limbs) and central (trunk) compartments and all-cause mortality in frail older women.

Design

Prospective study with up to 19 years of follow up.

Setting

Community dwelling older (≥65) women.

Participants

876 frail older participants of the Women’s Health Initiative Observational Study with a single measure of body composition and 581 participants with two measures.

Measurements

Frailty was determined using modified Fried’s criteria. All-cause mortality hazard was modeled as a function of static (single-occasion) or dynamic changes (difference between two time points) in body composition using Cox regression.

Results

Analyses adjusted for age, ethnicity, income, smoking, cardiovascular disease, diabetes, stroke, number of frailty criteria and whole-body lean mass showed progressively decreased rates of mortality in women with higher appendicular fat mass (FM) (P for trend=0.01), higher trunk FM (P for trend=0.03) and higher whole-body FM (P for trend=0.01). The hazard rate ratio for participants with more than a 5% decline in FM between two time points was 1.91; 1.67 and 1.71 for appendicular, trunk and whole-body compartment respectively as compared to women with relatively stable adiposity (p<0.05 for all). Dynamics of more than 5% in lean mass were not associated with mortality.

Conclusion

Low body fat or a pronounced decline in adiposity is associated with increased risks of mortality in frail older women. These results indicate a need to re-evaluate healthy weight in persons with frailty.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table 1
Table 2
Figure 1A–1C
Table 3

Similar content being viewed by others

References

  1. Fried LP, Tangen CM, Walston J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–156.

    Article  CAS  PubMed  Google Scholar 

  2. Ensrud KE, Ewing SK, Taylor BC et al. Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007;62:744–751. doi: 10.1093/gerona/62.7.744

    Article  PubMed  Google Scholar 

  3. Woods NF, LaCroix AZ, Gray SL et al. Frailty: Emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc. 2005;53:1321–1330. doi: 10.1111/j.1532-5415.2005.53405.x

    Article  PubMed  Google Scholar 

  4. Walston J, McBurnie MA, Newman A et al. Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch Intern Med. 2002;162:2333–2341.

    Article  PubMed  Google Scholar 

  5. Xue QL. The frailty syndrome: Definition and natural history. Clin Geriatr Med. 2011;27:1–15. doi: 10.1016/j.cger.2010.08.009

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Baumgartner RN, Heymsfield SB, Roche AF. Human body composition and the epidemiology of chronic disease. Obes Res. 1995;3:73–95. doi: 10.1002/j.1550-8528.1995.tb00124.x

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  8. Villareal DT, Banks M, Siener C, Sinacore DR, Klein S. Physical frailty and body composition in obese elderly men and women. Obes Res. 2004;12:913–920. doi: 10.1038/oby.2004.111

    Article  PubMed  Google Scholar 

  9. Chen Z, Wang Z, Lohman T, Heymsfield SB, Outwater E, Nicholas JS. Dual-energy X-ray absorptiometry is a valid tool for assessing skeletal muscle mass in older women. J Nutr. 2007;137:2775–2780.

    CAS  PubMed  Google Scholar 

  10. Cesari M, Leeuwenburgh C, Lauretani F, Onder G, Bandinelli S, Maraldi C. Frailty syndrome and skeletal muscle: results from the Invecchiare in Chianti study. Am J Clin Nutr. 2006;83:1142–1148.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Cesari M, Pahor M, Lauretani F, Zamboni V, Bandinelli S, Bernabei R. Skeletal muscle and mortality results from the InCHIANTI Study. J Gerontol A Biol Sci Med Sci. 2009;64:377–384. doi: 10.1093/gerona/gln031

    Article  PubMed  Google Scholar 

  12. Szulc P, Munoz F, Marchand F, Chapurlat R, Delmas PD. Rapid loss of appendicular skeletal muscle mass is associated with higher all-cause mortality in older men: the prospective MINOS study. Am J Clin Nutr. 2010;91:1227–1236. doi: 10.3945/ajcn.2009.28256

    Article  CAS  PubMed  Google Scholar 

  13. Jung HW, Kim SW, Lim JY, Kim KW, Jang HC, Kim CH. Frailty status can predict further lean body mass decline in older adults. J Am Geriatr Soc. 2014;62:2110–2117. doi: 10.1111/jgs.13107

    Article  PubMed  Google Scholar 

  14. Deurenberg P, van der Kooij K, Evers P, Hulshof T. Assessment of body composition by bioelectrical impedance in a population aged greater than 60 y. Am J Clin Nutr. 1990;51:3–6.

    CAS  PubMed  Google Scholar 

  15. Anderson GL, Manson J, Wallace R, Lund B, Hall D, Davis S. Implementation of the Women’s Health Initiative study design. Ann Epidemiol. 2003;13:S5–S17. doi: 10.1016/S1047-2797(03)00043-7

    Article  PubMed  Google Scholar 

  16. Beasley JM, LaCroix AZ, Neuhouser ML, Huang Y, Tinker L, Woods N. Protein intake and incident frailty in the Women’s Health Initiative observational study. J Am Geriatr Soc. 2010;58:1063–1071. doi: 10.1111/j.1532-5415.2010.02866.x

    Article  PubMed  PubMed Central  Google Scholar 

  17. LaCroix AZ, Gray SL, Aragaki A et al. Statin use and incident frailty in women aged 65 years or older: prospective findings from the Women’s Health Initiative Observational Study. J Gerontol A Biol Sci Med Sci. 2008;63:369–375. doi: 10.1093/ gerona/63.4.369

    Article  PubMed  Google Scholar 

  18. Lee CG, Boyko EJ, Nielson CM et al. Mortality risk in older men associated with changes in weight, lean mass, and fat mass. J Am Geriatr Soc. 2011;59:233–240. doi: 10.1111/j.1532-5415.2010.03245.x

    Article  PubMed  PubMed Central  Google Scholar 

  19. Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH, Kritchevsky SB. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci. 2006;61:72–77. doi: 10.1093/gerona/61.1.72

    Article  PubMed  Google Scholar 

  20. 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 follow-up study in 4,000 older adults using DXA. J Gerontol A Biol Sci Med Sci. 2010;65:99–104. doi: 10.1093/gerona/glp099

    Article  PubMed  Google Scholar 

  21. Graf CE, Karsegard VL, Spoerri A, Makhlouf AM, Ho S, Herrmann FR. Body composition and all-cause mortality in subjects older than 65 y. Am J Clin Nutr. 2015;101:760–767. doi: 10.3945/ajcn.114.102566

    Article  CAS  PubMed  Google Scholar 

  22. Rolland Y, Gallini A, Cristini C, Schott AM, Blain H, Beauchet O. Body-composition predictors of mortality in women aged >= 75 y: data from a large population-based cohort study with a 17-y follow-up. Am J Clin Nutr. 2014;100:1352–1360. doi: 10.3945/ajcn.114.086728

    Article  CAS  PubMed  Google Scholar 

  23. Han C, Jo SA, Seo JA, Kim BG, Kim NH, Jo I. Adiposity parameters and cognitive function in the elderly: application of «Jolly Fat» hypothesis to cognition. Arch Gerontol Geriatr. 2009;49:e133–e138. doi: 10.1016/j.archger.2008.11.005

    Article  Google Scholar 

  24. Johansson H, Kanis JA, Oden A, McCloskey E, Chapurlat RD, Christiansen C. A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res. 2014;29:223–233. doi: 10.1002/jbmr.2017

    Article  PubMed  Google Scholar 

  25. Arnold AM, Newman AB, Cushman M, Ding J, Kritchevsky S. Body weight dynamics and their association with physical function and mortality in older adults: the Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci. 2010;65:63–70. doi: 10.1093/gerona/glp050

    Article  PubMed  Google Scholar 

  26. Kuk JL, Katzmarzyk PT, Nichaman MZ, Church TS, Blair SN, Ross R. Visceral fat is an independent predictor of all-cause mortality in men. Obesity (Silver Spring, Md). 2006;14:336–341. doi: 10.1038/oby.2006.43

    Article  Google Scholar 

  27. Goodpaster BH, Krishnaswami S, Harris TB et al. Obesity, regional body fat distribution, and the metabolic syndrome in older men and women. Arch Intern Med. 2005;165:777–783. doi: 10.1001/archinte.165.7.777

    Article  PubMed  Google Scholar 

  28. Ibrahim MM. Subcutaneous and visceral adipose tissue: structural and functional differences. Obes Rev. 2010;11:11–18. doi: 10.1111/j.1467-789X.2009.00623.x

    Article  PubMed  Google Scholar 

  29. Zaslavsky O, Rillamas-Sun E, LaCroix A et al. The association of anthropometric measures with long-term survival among frail older women: observations from the Women’s Health Initiative Observational Study (WHI OS). Journal of American Geriatric Society 2016;64(2):277–84. doi: 10.1111/jgs.13930.

    Article  Google Scholar 

  30. Newman AB, Yanez D, Harris T et al. Weight change in old age and its association with mortality. Journal of the American Geriatrics Society. 2001;49(10), 1309–1318.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Nursing, University of Washington, Seattle, WA, USA

    Oleg Zaslavsky

  2. Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    E. Rillamas-Sun

  3. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA

    W. Li

  4. College Agriculture and Life Sciences, University of Arizona, Tucson, AZ, USA

    S. Going

  5. Department of Nutrition Science, Purdue University, West Lafayette, IN, USA

    M. Datta

  6. Department of Epidemiology, University of Iowa, Iowa City, IA, USA

    L. Snetselaar

  7. Faculty of Health Science and Social Welfare, University of Haifa, Haifa, Israel

    S. Zelber-Sagi

  8. Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA

    Oleg Zaslavsky

Authors
  1. Oleg Zaslavsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Rillamas-Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Going
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Datta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Snetselaar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Zelber-Sagi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Oleg Zaslavsky.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zaslavsky, O., Rillamas-Sun, E., Li, W. et al. Association of dynamics in lean and fat mass measures with mortality in frail older women. J Nutr Health Aging 21, 112–119 (2017). https://doi.org/10.1007/s12603-016-0730-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-016-0730-1

Key words

Search

Navigation