The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Advance Access published online on November 25, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, doi:10.1093/gerona/glp186
Frailty, Body Mass Index, and Abdominal Obesity in Older People
1 Geriatric Medicine Research Unit, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Canada
2 Epidemiology and Public Health Group, Peninsula Medical School, Royal Devon and Exeter Hospital Site, Exeter, UK
3 Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada
Address correspondence to Ruth E. Hubbard, MD, Geriatric Medicine Research Unit, Queen Elizabeth II Health Sciences Centre, 5955 Veterans’ Memorial Lane, Halifax, Canada, B3H 2E1. Email: ruth.hubbard{at}cdha.nshealth.ca
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Abstract |
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Background: Frailty has been conceptualized as a wasting disorder with weight loss as a key component. However, obesity is associated with disability and with physiological markers also recently linked with frailty, for example, increased inflammation and low antioxidant capacity. We aimed to explore the relationship between frailty and body mass index (BMI) in older people.
Methods: Data were from 3,055 community-dwelling adults aged 65 years and older who participated in the English Longitudinal Study of Ageing. Frailty was defined both by an index of accumulated deficits and by the Fried phenotype. BMI was divided into five categories, and waist circumference 88 cm or more (for women) and 102 cm or more (for men) was defined as high. Analyses were adjusted for sex, age, wealth, level of education, and smoking status.
Results: The association between BMI and frailty showed a U-shaped curve. This relationship was consistent across different frailty measures. The lowest frailty index (FI) scores and lowest prevalence of Fried frailty were in those with BMI 25–29.9. At each BMI category, and using either measure of frailty, those with a high waist circumference were significantly more frail.
Conclusions: Both the phenotypic definition of frailty and the FI show increased levels of frailty among those with low and very high BMIs. In view of the rise in obesity in older populations, the benefits and feasibility of diet and exercise for obese older adults should be a focus of urgent inquiries. The association of frailty with a high waist circumference, even among underweight older people, suggests that truncal obesity may be an additional target for intervention.
Keywords Frail older people; Body mass index; Obesity
Received: June 9, 2009; Accepted: October 31, 2009