Normal weight obesity and functional outcomes in older adults

John A. Batsis, Karine R. Sahakyan, Juan P. Rodriguez-Escudero, Stephen J. Bartels, Francisco Lopez-Jimenez

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background Obesity defined by body mass index (BMI) is associated with higher levels of functional impairment. However, BMI strata misrepresent true adiposity, particularly in those with a normal BMI but elevated body fat (BF%) (normal weight obesity [NWO]) whom are at higher metabolic and mortality risk. Whether this subset of patients is associated with worsening functional outcomes is unclear. Methods Subjects aged ≥ 60 years with a BMI ≥ 18.5 kg/m 2 from NHANES III (1988-1994) were included. We created sex-specific tertiles of BF%. Data on physical limitations (PL), instrumental (IADL) and basic activities of daily living (BADL) were obtained. The analysis focused on the association between NWO and these outcomes. Comparative rates among each tertile using logistic regression (referent = lowest tertile) were assessed, incrementally adding co-variates. Results Of the 4484 subjects aged ≥ 60 years, 1528 had a normal BMI, and the range of the mean age of tertiles was 69.9-71.2 years. Lean mass was lowest in the elevated BF% group than in the middle or low tertiles (42.6 vs 44.9 vs 45.8; p < 0.001). Those with NWO had higher PL risk than the referent in females only in our adjusted model (males OR 1.18 [0.63-2.21]; females OR 1.90 [1.04-3.48]) but not after incorporating lean mass (males OR 1.11[0.56-2.20]; females (1.73 [0.92-3.25]). Neither sex with high BF% had higher IADL risk than the corresponding tertiles (males OR 0.67 [0.35-1.33]; females OR 1.20 [0.74-1.93]). NWO was protective in males only (OR 0.28 [0.10-0.83]) but not in females (OR 0.64 [0.40-1.03]). Conclusions NWO is associated with increased physical impairment in older adults in females only, highlighting the importance of recognizing the association of obesity with disability in elders.

Original languageEnglish (US)
Pages (from-to)517-522
Number of pages6
JournalEuropean Journal of Internal Medicine
Volume25
Issue number6
DOIs
StatePublished - 2014

Fingerprint

Obesity
Weights and Measures
Body Mass Index
Adipose Tissue
Nutrition Surveys
Adiposity
Activities of Daily Living
Logistic Models
Mortality

Keywords

  • Elderly
  • Epidemiology
  • Functional performance
  • Obesity

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

Cite this

Normal weight obesity and functional outcomes in older adults. / Batsis, John A.; Sahakyan, Karine R.; Rodriguez-Escudero, Juan P.; Bartels, Stephen J.; Lopez-Jimenez, Francisco.

In: European Journal of Internal Medicine, Vol. 25, No. 6, 2014, p. 517-522.

Research output: Contribution to journalArticle

Batsis, John A. ; Sahakyan, Karine R. ; Rodriguez-Escudero, Juan P. ; Bartels, Stephen J. ; Lopez-Jimenez, Francisco. / Normal weight obesity and functional outcomes in older adults. In: European Journal of Internal Medicine. 2014 ; Vol. 25, No. 6. pp. 517-522.
@article{b373617ff8e9424d8b9d77fba3224371,
title = "Normal weight obesity and functional outcomes in older adults",
abstract = "Background Obesity defined by body mass index (BMI) is associated with higher levels of functional impairment. However, BMI strata misrepresent true adiposity, particularly in those with a normal BMI but elevated body fat (BF{\%}) (normal weight obesity [NWO]) whom are at higher metabolic and mortality risk. Whether this subset of patients is associated with worsening functional outcomes is unclear. Methods Subjects aged ≥ 60 years with a BMI ≥ 18.5 kg/m 2 from NHANES III (1988-1994) were included. We created sex-specific tertiles of BF{\%}. Data on physical limitations (PL), instrumental (IADL) and basic activities of daily living (BADL) were obtained. The analysis focused on the association between NWO and these outcomes. Comparative rates among each tertile using logistic regression (referent = lowest tertile) were assessed, incrementally adding co-variates. Results Of the 4484 subjects aged ≥ 60 years, 1528 had a normal BMI, and the range of the mean age of tertiles was 69.9-71.2 years. Lean mass was lowest in the elevated BF{\%} group than in the middle or low tertiles (42.6 vs 44.9 vs 45.8; p < 0.001). Those with NWO had higher PL risk than the referent in females only in our adjusted model (males OR 1.18 [0.63-2.21]; females OR 1.90 [1.04-3.48]) but not after incorporating lean mass (males OR 1.11[0.56-2.20]; females (1.73 [0.92-3.25]). Neither sex with high BF{\%} had higher IADL risk than the corresponding tertiles (males OR 0.67 [0.35-1.33]; females OR 1.20 [0.74-1.93]). NWO was protective in males only (OR 0.28 [0.10-0.83]) but not in females (OR 0.64 [0.40-1.03]). Conclusions NWO is associated with increased physical impairment in older adults in females only, highlighting the importance of recognizing the association of obesity with disability in elders.",
keywords = "Elderly, Epidemiology, Functional performance, Obesity",
author = "Batsis, {John A.} and Sahakyan, {Karine R.} and Rodriguez-Escudero, {Juan P.} and Bartels, {Stephen J.} and Francisco Lopez-Jimenez",
year = "2014",
doi = "10.1016/j.ejim.2014.05.008",
language = "English (US)",
volume = "25",
pages = "517--522",
journal = "European Journal of Internal Medicine",
issn = "0953-6205",
publisher = "Elsevier",
number = "6",

}

TY - JOUR

T1 - Normal weight obesity and functional outcomes in older adults

AU - Batsis, John A.

AU - Sahakyan, Karine R.

AU - Rodriguez-Escudero, Juan P.

AU - Bartels, Stephen J.

AU - Lopez-Jimenez, Francisco

PY - 2014

Y1 - 2014

N2 - Background Obesity defined by body mass index (BMI) is associated with higher levels of functional impairment. However, BMI strata misrepresent true adiposity, particularly in those with a normal BMI but elevated body fat (BF%) (normal weight obesity [NWO]) whom are at higher metabolic and mortality risk. Whether this subset of patients is associated with worsening functional outcomes is unclear. Methods Subjects aged ≥ 60 years with a BMI ≥ 18.5 kg/m 2 from NHANES III (1988-1994) were included. We created sex-specific tertiles of BF%. Data on physical limitations (PL), instrumental (IADL) and basic activities of daily living (BADL) were obtained. The analysis focused on the association between NWO and these outcomes. Comparative rates among each tertile using logistic regression (referent = lowest tertile) were assessed, incrementally adding co-variates. Results Of the 4484 subjects aged ≥ 60 years, 1528 had a normal BMI, and the range of the mean age of tertiles was 69.9-71.2 years. Lean mass was lowest in the elevated BF% group than in the middle or low tertiles (42.6 vs 44.9 vs 45.8; p < 0.001). Those with NWO had higher PL risk than the referent in females only in our adjusted model (males OR 1.18 [0.63-2.21]; females OR 1.90 [1.04-3.48]) but not after incorporating lean mass (males OR 1.11[0.56-2.20]; females (1.73 [0.92-3.25]). Neither sex with high BF% had higher IADL risk than the corresponding tertiles (males OR 0.67 [0.35-1.33]; females OR 1.20 [0.74-1.93]). NWO was protective in males only (OR 0.28 [0.10-0.83]) but not in females (OR 0.64 [0.40-1.03]). Conclusions NWO is associated with increased physical impairment in older adults in females only, highlighting the importance of recognizing the association of obesity with disability in elders.

AB - Background Obesity defined by body mass index (BMI) is associated with higher levels of functional impairment. However, BMI strata misrepresent true adiposity, particularly in those with a normal BMI but elevated body fat (BF%) (normal weight obesity [NWO]) whom are at higher metabolic and mortality risk. Whether this subset of patients is associated with worsening functional outcomes is unclear. Methods Subjects aged ≥ 60 years with a BMI ≥ 18.5 kg/m 2 from NHANES III (1988-1994) were included. We created sex-specific tertiles of BF%. Data on physical limitations (PL), instrumental (IADL) and basic activities of daily living (BADL) were obtained. The analysis focused on the association between NWO and these outcomes. Comparative rates among each tertile using logistic regression (referent = lowest tertile) were assessed, incrementally adding co-variates. Results Of the 4484 subjects aged ≥ 60 years, 1528 had a normal BMI, and the range of the mean age of tertiles was 69.9-71.2 years. Lean mass was lowest in the elevated BF% group than in the middle or low tertiles (42.6 vs 44.9 vs 45.8; p < 0.001). Those with NWO had higher PL risk than the referent in females only in our adjusted model (males OR 1.18 [0.63-2.21]; females OR 1.90 [1.04-3.48]) but not after incorporating lean mass (males OR 1.11[0.56-2.20]; females (1.73 [0.92-3.25]). Neither sex with high BF% had higher IADL risk than the corresponding tertiles (males OR 0.67 [0.35-1.33]; females OR 1.20 [0.74-1.93]). NWO was protective in males only (OR 0.28 [0.10-0.83]) but not in females (OR 0.64 [0.40-1.03]). Conclusions NWO is associated with increased physical impairment in older adults in females only, highlighting the importance of recognizing the association of obesity with disability in elders.

KW - Elderly

KW - Epidemiology

KW - Functional performance

KW - Obesity

UR - http://www.scopus.com/inward/record.url?scp=84903279825&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84903279825&partnerID=8YFLogxK

U2 - 10.1016/j.ejim.2014.05.008

DO - 10.1016/j.ejim.2014.05.008

M3 - Article

C2 - 24909976

AN - SCOPUS:84903279825

VL - 25

SP - 517

EP - 522

JO - European Journal of Internal Medicine

JF - European Journal of Internal Medicine

SN - 0953-6205

IS - 6

ER -