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Midlife Body Mass Index Trajectory and Risk of Frailty 8 Years Later in Taiwan

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The journal of nutrition, health & aging

Abstract

Objectives

Few studies have focused on weight change and frailty, especially in Asia. This research aimed to evaluate midlife body mass index (BMI) trajectory and assess its relationship with frailty 8 years later in Taiwan.

Design

A prospective cohort study.

Setting and Participants

Data were retrieved from the Taiwan Longitudinal Study on Aging conducted from 1999 to 2007. The analysis was restricted to respondents aged between 50 to 69 years old, who were not frail in 1999 and were alive in 2007 (n=1609).

Measurements

Frailty was defined using the Fried criteria. The group-based model of trajectory was used to estimate BMI trajectories among elderly participants. Logistic regression analysis was used to examine the association between BMI change and frailty.

Results

Four trajectory classes were identified and each remained stable during the 8-year follow-up. There were 316 participants (20.3%) in the low-normal weight group (baseline BMI=20.38 kg/m2), 737 participants (44.7%) in the high-normal weight group (baseline BMI=23.22 kg/m2), 449 participants (28.4%) in the overweight group (baseline BMI=26.24 kg/m2), and 107 participants (6.6%) in the obesity group (baseline BMI=30.65 kg/m2). After adjustment for confounding factors, the low-normal weight group and obesity group were associated with increased frailty compared with the high-normal weight group.

Conclusion

Our results showed that the BMI trajectories of midlife individuals tended to be constant and those in both the low-normal weight group and obesity group had an increased risk of developing frailty in later life. Therefore, an optimal weight-targeting strategy should be considered for Asian elderly individuals.

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References

  1. Fried LP, Walston JD, Ferrucci L. Chapter 52. Frailty. In: Halter JB, Ouslander JG, Tinetti ME, Studenski S, High KP, Asthana S, eds. Hazzard’s Geriatric Medicine and Gerontology, 6e. New York, NY: The McGraw-Hill Companies; 2009.

    Google Scholar 

  2. Kojima G, Iliffe S, Jivraj S, Walters K. Association between frailty and quality of life among community-dwelling older people: a systematic review and meta-analysis. Journal of epidemiology and community health. 2016;70:716–721.

    Article  Google Scholar 

  3. Redinger RN. The pathophysiology of obesity and its clinical manifestations. Gastroenterology & hepatology. 2007;3:856–863.

    Google Scholar 

  4. Heymsfield SB, Wadden TA. Mechanisms, Pathophysiology, and Management of Obesity. The New England journal of medicine. 2017;376:254–266.

    Article  CAS  Google Scholar 

  5. Hubbard RE, Lang IA, Llewellyn DJ, Rockwood K. Frailty, body mass index, and abdominal obesity in older people. J Gerontol A Biol Sci Med Sci. 2010;65:377–381.

    Article  Google Scholar 

  6. Garcia-Esquinas E, Jose Garcia-Garcia F, Leon-Munoz LM, Carnicero JA, Guallar-Castillon P, Gonzalez-Colaco Harmand M, et al. Obesity, fat distribution, and risk of frailty in two population-based cohorts of older adults in Spain. Obesity (Silver Spring). 2015;23:847–855.

    Article  Google Scholar 

  7. Stenholm S, Strandberg TE, Pitkala K, Sainio P, Heliovaara M, Koskinen S. Midlife obesity and risk of frailty in old age during a 22-year follow-up in men and women: the Mini-Finland Follow-up Survey. J Gerontol A Biol Sci Med Sci. 2014;69:73–78.

    Article  Google Scholar 

  8. Wang M, Yi Y, Roebothan B, Colbourne J, Maddalena V, Wang PP, et al. Body Mass Index Trajectories among Middle-Aged and Elderly Canadians and Associated Health Outcomes. J Environ Public Health. 2016;2016:7014857.

    Article  Google Scholar 

  9. Mezuk B, Lohman MC, Rock AK, Payne ME. Trajectories of body mass indices and development of frailty: Evidence from the health and retirement study. Obesity (Silver Spring). 2016;24:1643–1647.

    Article  Google Scholar 

  10. Chang CJ, Wu CH, Chang CS, Yao WJ, Yang YC, Wu JS, et al. Low body mass index but high percent body fat in Taiwanese subjects: implications of obesity cutoffs. International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity. 2003;27:253–259.

    Article  Google Scholar 

  11. Hsu HC, Chang WC. Trajectories of frailty and related factors of the older people in Taiwan. Experimental aging research. 2015;41:104–114.

    Article  Google Scholar 

  12. Pegorari MS, Tavares DM. Factors associated with the frailty syndrome in elderly individuals living in the urban area. Revista latino-americana de enfermagem. 2014;22:874–882.

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  14. de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Nijhuisvan der Sanden MW. Outcome instruments to measure frailty: a systematic review. Ageing Res Rev. 2011;10:104–114.

    Article  CAS  Google Scholar 

  15. Nagin DS, Odgers CL. Group-based trajectory modeling in clinical research. Annu Rev Clin Psychol. 2010;6:109–138.

    Article  Google Scholar 

  16. Liang J, Wang CN, Xu X, Hsu HC, Lin HS, Lin YH. Trajectory of functional status among older Taiwanese: Gender and age variations. Social science & medicine (1982). 2010;71:1208–1217.

    Article  Google Scholar 

  17. Dhana K, van Rosmalen J, Vistisen D, Ikram MA, Hofman A, Franco OH, et al. Trajectories of body mass index before the diagnosis of cardiovascular disease: a latent class trajectory analysis. European journal of epidemiology. 2016;31:583–592.

    Article  Google Scholar 

  18. Murayama H, Liang J, Bennett JM, Shaw BA, Botoseneanu A, Kobayashi E, et al. Trajectories of Body Mass Index and Their Associations With Mortality Among Older Japanese: Do They Differ From Those of Western Populations? Am J Epidemiol. 2015;182:597–605.

    Article  Google Scholar 

  19. Zajacova A, Ailshire J. Body mass trajectories and mortality among older adults: a joint growth mixture-discrete-time survival analysis. Gerontologist. 2014;54:221–231.

    Article  Google Scholar 

  20. Botoseneanu A, Liang J. Latent heterogeneity in long-term trajectories of body mass index in older adults. J Aging Health. 2013;25:342–363.

    Article  Google Scholar 

  21. Kuchibhatla MN, Fillenbaum GG, Kraus WE, Cohen HJ, Blazer DG. Trajectory classes of body mass index in a representative elderly community sample. J Gerontol A Biol Sci Med Sci. 2013;68:699–704.

    Article  Google Scholar 

  22. Peter RS, Keller F, Klenk J, Concin H, Nagel G. Body mass trajectories, diabetes mellitus, and mortality in a large cohort of Austrian adults. Medicine (Baltimore). 2016;95:e5608.

    Article  Google Scholar 

  23. Botoseneanu A, Liang J. Social stratification of body weight trajectory in middle-age and older americans: results from a 14-year longitudinal study. J Aging Health. 2011;23:454–480.

    Article  Google Scholar 

  24. Albrecht SS, Gordon-Larsen P. Ethnic differences in body mass index trajectories from adolescence to adulthood: a focus on Hispanic and Asian subgroups in the United States. PLoS One. 2013;8:e72983.

    Article  CAS  Google Scholar 

  25. Strandberg TE, Stenholm S, Strandberg AY, Salomaa VV, Pitkala KH, Tilvis RS. The “obesity paradox,” frailty, disability, and mortality in older men: a prospective, longitudinal cohort study. Am J Epidemiol. 2013;178:1452–1460.

    Article  Google Scholar 

  26. Windham BG, Griswold ME, Wang W, Kucharska-Newton A, Demerath EW, Gabriel KP, et al. The Importance of Mid-to-Late-Life Body Mass Index Trajectories on Late-Life Gait Speed. J Gerontol A Biol Sci Med Sci. 2016.

  27. Zheng H, Tumin D, Qian Z. Obesity and mortality risk: new findings from body mass index trajectories. Am J Epidemiol. 2013;178:1591–1599.

    Article  Google Scholar 

  28. Chiu CJ, Wray LA, Lu FH, Beverly EA. BMI change patterns and disability development of middle-aged adults with diabetes: a dual trajectory modeling approach. Journal of general internal medicine. 2013;28:1150–1156.

    Article  Google Scholar 

  29. 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;309:71–82.

    Article  CAS  Google Scholar 

  30. Heymsfield SB, Cefalu WT. Does body mass index adequately convey a patient’s mortality risk? Jama. 2013;309:87–88.

    Article  CAS  Google Scholar 

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Funding

Funding: We do not have funding in this study.

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Authors

Corresponding author

Correspondence to Meng-Chih Lee.

Ethics declarations

Conflict of Interest: There are no conflicts of interest to declare.

Ethical Standards: TLSA was initiated by the government and the protocols were approved with the Institutional Review Board. We obtained the data following the laws and informed consent was also obtained from all the participants.

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Ho, HE., Yeh, CJ., Chu, WM. et al. Midlife Body Mass Index Trajectory and Risk of Frailty 8 Years Later in Taiwan. J Nutr Health Aging 23, 849–855 (2019). https://doi.org/10.1007/s12603-019-1226-6

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  • DOI: https://doi.org/10.1007/s12603-019-1226-6

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