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British & Irish Longitudinal Studies of Ageing Meeting; Obesity & Frailty. Siobhan Leahy 1 st Nov 2013. Background. Cross-sectional association between obesity and frailty identified in ELSA and other studies ( Blaum et al 2005; Hubbard et al 2010)

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Presentation Transcript
slide1

British & Irish Longitudinal Studies of Ageing Meeting;

Obesity

&

Frailty

Siobhan Leahy 1st Nov 2013

slide2

Background

  • Cross-sectional association between obesity and frailty identified in ELSA and other studies (Blaum et al 2005; Hubbard et al 2010)
  • Midlife obesity associated with later-life pre-frailty & frailty after 26y follow up in men (Strandberg et al 2012)
  • Waist circumference more strongly associated with frailty than body mass index
  • Common factors implicated in Obesity and Frailty;
  • Increased inflammatory markers (e.g. CRP, IL6)
  • Reduced antioxidant capacity
  • Decreased high density lipoprotein
  • Decreased physical activity
  • Poor muscle quality
slide3

Objectives

  • To assess the cross sectional relationship between BMI ≥30 kg.m², central adiposity and frailty in the Irish Longitudinal Study on Ageing.
  • To determine if, for older robust adults, a BMI ≥30 kg.m² or central adiposity at baseline is a risk factor for the development of frailty
  • Other variables
  • BMI≥30kg.m2
  • WC ≥88cm (F)/102cm (M)
  • Age, sex, education, morbidities, falls history, polypharmacy, HDL, mini-mental state examination
  • Frailty Criteria
  • Low activity (IPAQ)
  • Slowness (TUG)
  • Exhaustion (CESD)
  • Weight Loss (Subjective)
  • Weakness (Subjective –
  • difficulty carrying >10lb)
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Results

  • N=2258 age 65+
  • Cross-sectional;
  • Elevated BMI (OR=1.9 CI: 1.2, 3.2) and WC (OR=1.6 CI: 1.0, 2.6) independently associated with frailty status at baseline
  • Driven by gait speed and physical activity components of frailty
  • Trend for negative association between weakness, BMI & WC-
  • ? Self-report nature of ‘weakness’
  • Longitudinal;
  • Increased WC but not BMI independently associated with frailty development at follow up (OR=1.4 CI: 1.0, 2.0)
  • Reduced gait speed and weakness most common newly reported frailty components
slide5

Obesity

&

Sarcopenia/Dynapenia

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Issues

  • Sarcopenia defined as ‘age-associated loss of skeletal muscle mass and function’ (IWGOS 2011)
    • Difficulty accurately measuring muscle mass in population studies
    • Relationship between low muscle mass and functional decline largely explained by muscle strength (Health ABC Study 2005)
    • Poor muscle quality in older age more detrimental than low muscle mass
  • Dynapenia defined as ‘age-associated loss of strength’
    • Low grip strength & obesity independently associated with physical limitation, ADL disability & reduced walking speed
    • Potential mechanisms include insulin resistance, inflammation, Vitamin D deficiency
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Proposal

  • Define dynapenia as lowest age & sex specific tertile of grip strength
  • Define obesity as objectively measured BMI≥30kg.m2
  • Four phenotypes;

Preliminary analysis suggests greater number of baseline physical limitations, ADL disabilities, falls and lower gait speed in Dynapenic Obese than any other group.