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Survival benefit of abdominal adiposity: a 6-year follow-up study with Dual X-ray absorptiometry in 3,978 older adults

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Abstract

In contrast to that in the middle-aged, higher body mass index (BMI) in older people is associated with higher survival rates. Yet, BMI makes no distinction between fat elsewhere and abdominal fat, the latter being metabolically more harmful. We hypothesized that overall adiposity might be protective in old age, but that central fat might offset that benefit and remained harmful as in the middle-aged. Three thousand nine hundred seventy-eight Chinese elderly ≥65 years had demographics, medical conditions, physical activity, and body composition by DXA recorded at baseline. Overall adiposity was measured as whole body fat%, and abdominal adiposity as waist circumference, waist–hip ratio, and relative abdominal fat (RAF) (relative abdominal fat = abdominal fat according to anatomical landmarks/whole body fat). Deaths within 1 year from baseline were excluded from analysis. All-cause and cardiovascular mortality were analyzed using Cox regression, adjusted for covariates. The lowest quintile of adiposity measurements was used for comparison. After a mean follow-up of 72.3 months, 13.7% men and 4.5% women had died. In men, the highest two quintiles of whole body fat % and the upper four quintiles of RAF were associated with significantly lower all-cause mortality, and adjusted hazard ratio (95% CI) in ascending quintiles of RAF compared with the lowest quintile was 0.62 (0.43–0.89), 0.58 (0.4–0.85), 0.52 (0.36–0.77), and 0.67 (0.47–0.96). No relationship was found between abdominal adiposity and cardiovascular mortality in both genders. Higher whole body fat % as well as higher proportion of abdominal fat was associated with lower all-cause mortality in men. No such relation was found in women.

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References

  • Adams KF, Schatzkin A, Harris TB et al (2006) Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Eng J Med 355:763–778

    Article  CAS  Google Scholar 

  • Adler NE, Epil ES, Castellazzo G, Ickovics JR (2000) Relationship of subjective and objective social status with psychological and physiological functioning: preliminary data in healthy white women. Health Psychol 19:586–592

    Article  PubMed  CAS  Google Scholar 

  • Al Snih S, Ottenbacher KJ, Markides KS, Kuo Y-F, Eschbach K, Goodwin JS (2007) The effect of obesity on disability vs mortality in older Americans. Arch Intern Med 167:774–780

    Article  PubMed  Google Scholar 

  • Alberti KGMM, Zimmet P, Shaw J, IDF Epidemiology Task Force Consensus Group (2005) The metabolic syndrome—a new world-wide definition. Lancet 366:1059–1062

    Article  PubMed  Google Scholar 

  • Auyeung TW, Lee JS, Leung J, Kwok T, Leung PC, Woo J (2010) 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 65:99–104

    Article  PubMed  Google Scholar 

  • Bertin E, Marcus C, Ruiz JC, Eschard JP, Leutenegger M (2000) Measurement of visceral adipose tissue by DXA combined with anthropometry in obese humans. Int J Obes Relat Metab Disord 24:263–270

    Article  PubMed  CAS  Google Scholar 

  • Bourdel-Marchasson I, Dubroca B, Manciet G, Decamps A, Emeriau JP, Dartigues JF (1997) Prevalence of diabetes and effect on quality of life in older French living in the community: the PAQUID Epidemiological Survey. J Am Geriatr Soc 45:295–301

    PubMed  CAS  Google Scholar 

  • Chang CJ, Wu CH, Yao WJ, Yang YC, Wu JS, Lu FH (2000) Relationships of age, menopause and central obesity on cardiovascular disease risk factors in Chinese women. In J Obes Relat Metab Disord 24:1699–1704

    Article  CAS  Google Scholar 

  • Cheng YH, Chi I, Boey KW, Ko LS, Chou KL (2002) Self-rated economic condition and the health of elderly persons in Hong Kong. Soc Sci Med 55:1415–1424

    Article  PubMed  CAS  Google Scholar 

  • Chiu HFK, Lee HC, Chung WS, Kwong PK (1994) Reliability and validity of the Cantonese version of the Mini-Mental State Examination—a preliminary study. J Hong Kong Coll Psych 4(SP2):25–28

    Google Scholar 

  • de Ruijter W, Westendorp RG, Assendelft WJ, den Elzen WP, de Craen AJ, le Cessie S, Gussekloo J (2009) Use of Framingham risk score and new biomarkers to predict cardiovascular mortality in older people: population based observational cohort study. BMJ 338:a3083. doi:10.1136/bmj.a3083

    Article  PubMed  Google Scholar 

  • Flicker L, McCaul KA, Hankey GJ et al (2010) Body mass index and survival in men and women aged 70 to 75. J Am Geriatr Soc 58:234–241

    Article  PubMed  Google Scholar 

  • Folstein MF, Folstein SE, McHugh PR (1975) Mini-Mental State. A practical method for grading the cognitive state of patients for the clinician. J Psychiatric Research 12:189–198

    Article  CAS  Google Scholar 

  • Hamdy O, Porramatikul S, Al-Ozairi E (2006) Metabolic obesity: the paradox between visceral and subcutaneous fat. Curr Diab Rev 2:367–373

    Google Scholar 

  • Heim N, Snijder MB, Heymans MW, Deeg DJH, Seidell JC, Visser M (2010) Exploring cut-off values for large waist circumference in older adults: a new methodological approach. J Nutr Health Aging 14:272–277

    Article  PubMed  CAS  Google Scholar 

  • Jacobs EJ, Newton CC, Wang Y et al (2010) Waist circumference and all-cause mortality in a large US cohort. Arch Intern Med 170:1293–1301

    Article  PubMed  Google Scholar 

  • Janssen I (2007) Morbidity and mortality risk associated with an overweight BMI in older men and women. Obesity (Silver Spring) 15:1827–1840

    Article  Google Scholar 

  • Ko GTC, Cockram CS, Chow CC, Yeung V, Chan WB, So WY, Chan NN, Chan JCN (2005) High prevalence of metabolic syndrome in Hong Kong Chinese—comparison of three diagnostic criteria. Diab Res Clin Prac 69:160–168

    Article  Google Scholar 

  • Kopple JD (2005) The phenomenon of altered risk factor patterns or reverse epidemiology in persons with advanced chronic kidney failure. Am J Clin Nutr 81:1257–1266

    PubMed  CAS  Google Scholar 

  • Lafortuna CL, Agosti F, Proietti M, Adorni F, Sartorio A (2006) The combined effect of adiposity, fat distribution and age on cardiovascular risk factors and motor disability in a cohort of obese women (aged 18–83). J Endocrinol Invest 29:905–912

    PubMed  CAS  Google Scholar 

  • Lapidus L, Bengtsson C, Björntorp P (1994) The quantitative relationship between “the metabolic syndrome” and abdominal obesity in women. Obes Res 2:372–377

    PubMed  CAS  Google Scholar 

  • Lea JP, Crenshaw DO, Onufrak SJ, Newsome BB, McClellan WM (2009) Obesity, end-stage renal disease, and survival in an elderly cohort with cardiovascular disease. Obesity (Silver Spring) 17:2216–2222

    Article  Google Scholar 

  • Lindqvist P, Andersson K, Sundh V, Lissner L, Björkelund C, Bengtsson C (2006) Concurrent and separate effects of body mass index and waist-to-hip ratio on 24-year mortality in the Population Study of Women in Gothenburg: evidence of age-dependency. Eur J Epidemiol 21:789–794

    Article  PubMed  Google Scholar 

  • Lissner L, Björkelund C, Heitmann BL, Seidell JC, Bengtsson C (2001) Larger hip circumference independently predicts health and longevity in a Swedish female cohort. Obes Res 9:644–646

    Article  PubMed  CAS  Google Scholar 

  • McAuley P, Pittsley J, Myers J, Abella J, Froelicher VF (2009) Fitness and fatness as mortality predictors in healthy older men: the Veterans Exercise Testing Study. J Gerontol A Biol Sci Med Sci 64A:695–699

    Article  Google Scholar 

  • McAuley PA, Kokkinos PF, Oliveira RB, Emerson BT, Myers JN (2010) Obesity paradox and cardiorespiratory fitness in 12,417 male veterans aged 40 to 70 years. Mayo Clinic Proceedings 85:115–121

    Article  PubMed  Google Scholar 

  • McGuire LC, Ford ES, Ajani UA (2006) The impact of cognitive functioning on mortality and the development of functional disability in older adults with diabetes: the second longitudinal study on aging. BMC Geriatrics 6:8–14

    Article  PubMed  Google Scholar 

  • Motta M, Bennati E, Cardillo E, Passamonte M, Ferlito L, Malaguarnera M (2009) The metabolic syndrome (MS) in the elderly: considerations on the diagnostic criteria of the International Diabetes Federation (IDF) and some proposed modifications. Arch Gerontol Geriatr 48:380–384

    Article  PubMed  Google Scholar 

  • Newman AB, Yanez D, Harris T, Duxbury A, Enright PL, Fried LP, Cardiovascular Study Research Group (2001) Weight change in old age and its association with mortality. J Am Geriatr Soc 49:1309–1318

    Article  PubMed  CAS  Google Scholar 

  • Perry GS, Byers TE, Mokdad AH, Serdula MK, Williamson DF (1995) The validity of self-reports of past body weights by U.S. adults. Epidemiology 6:61–66

    Article  PubMed  CAS  Google Scholar 

  • Pischon T, Boeing H, Hoffmann K et al (2008) General and abdominal adiposity and risk of death in Europe. N Engl J Med 359:2105–2120

    Article  PubMed  CAS  Google Scholar 

  • Price GM, Uauy R, Breeze E, Bulpitt CJ, Fletcher AE (2006) Weight, shape, and mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death. Am J Clin Nutr 84:449–460

    PubMed  CAS  Google Scholar 

  • Reis JP, Macera CA, Araneta MR, Lindsay SP, Marshall SJ, Wingard DL (2009) Comparison of overall obesity and body fat distribution in predicting risk of mortality. Obesity 17:1232–1239

    PubMed  Google Scholar 

  • Schooling CM, Lam TH, Li ZB et al (2006) Obesity, physical activity and mortality in a prospective Chinese elderly cohort. Arch Intern Med 166:1498–1504

    Article  PubMed  Google Scholar 

  • Singh-Manoux A, Marmot MG, Adler NE (2005) Does subjective social status predict health and change in health status better than objective status? Psychosom Med 67:855–861

    Article  PubMed  Google Scholar 

  • Snijder MB, van Dam RM, Visser M, Seidell JC (2006) What aspects of body fat are particularly hazardous and how do we measure them? Int J Epidemiol 35:83–92

    Article  PubMed  CAS  Google Scholar 

  • Stevens J, Keil JE, Waid LR, Gazes PC (1990) Accuracy of current, 4-year, and 28-year self-reported body weight in an elderly population. Am J Epidemiol 132:1156–1163

    PubMed  CAS  Google Scholar 

  • Strandberg TE, Strandberg AY, Salomaa VV et al (2009) Explaining the obesity paradox: cardiovascular risk, weight change, and mortality during long-term follow-up in men. Eur Heart J 30:1720–1727

    Article  PubMed  Google Scholar 

  • Tamakoshi A, Yatsuya H, Lin Y, JACC Study Group et al (2010) BMI and all-cause mortality among Japanese older adults: findings from the Japan collaborative cohort study. Obesity (Silver Spring) 18:362–369

    Article  Google Scholar 

  • Visscher TL, Seidell JC, Molarius A, van der Kuip D, Hofman A, Witteman JC (2001) A comparison of body mass index, waist-hip ratio and waist circumference as predictors of all-cause mortality among the elderly: the Rotterdam study. Int J Obes Relat Metab Disord 25:1730–1735

    Article  PubMed  CAS  Google Scholar 

  • Washburn RA, Smith KW, Jette AM, Janny CA (1993) The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol 46:153–162

    Article  PubMed  CAS  Google Scholar 

  • Westerbacka J, Cornér A, Tiikkainen M, Tamminen M, Vehkavaara S, Häkkinen A-M (2004) Women and men have similar amounts of liver and intra-abdominal fat, despite more subcutaneous fat in women: implications for sex differences in markers of cardiovascular risk. Diabetologia 47:1360–1369

    Article  PubMed  CAS  Google Scholar 

  • Woo J, Ho SC, Yu ALM, Sham A (2002) Is waist circumference a useful measure in predicting health outcomes in the elderly? Int J Obes 26:1349–1355

    Article  CAS  Google Scholar 

  • World Health Organization Western Pacific Region (2000) International Association for the Study of Obesity and the International Obesity Task Force. The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia Pty Limited, Australia

  • Zamboni M, Mazzali G, Zoico E, Harris TB, Meigs JB, Di Francesco V, Fantin F, Bissoli L, Bosello O (2005) Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes 29:1011–1029

    Article  CAS  Google Scholar 

  • Zhang X, Shu XO, Yang G et al (2007) Abdominal adiposity and mortality in Chinese women. Arch Intern Med 167:886–892

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was funded by the Hong Kong Research Grant Council Grant (CUHK4101/02M). We thank The S H Ho Centre for Gerontology and Geriatrics, Faculty of Medicine, The Chinese University of Hong Kong for personnel support in data collection.

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Authors and Affiliations

  1. Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China

    Jenny Shun Wah Lee, Timothy Kwok, Martin Li & Jean Woo

  2. The S H Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China

    Jenny Shun Wah Lee, Tung Wai Auyeung & Jean Woo

  3. Department of Medicine and Geriatrics, Pok Oi Hospital, Hong Kong, China

    Tung Wai Auyeung

  4. The Jockey Club Centre of Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, China

    Jason Leung

  5. Department of Medicine and Geriatrics, Shatin Hospital, 33 A Kung Kok Street, Shatin, Hong Kong, China

    Jenny Shun Wah Lee

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  1. Jenny Shun Wah Lee
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  2. Tung Wai Auyeung
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  3. Timothy Kwok
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  4. Martin Li
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  6. Jean Woo
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Correspondence to Tung Wai Auyeung.

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Lee, J.S.W., Auyeung, T.W., Kwok, T. et al. Survival benefit of abdominal adiposity: a 6-year follow-up study with Dual X-ray absorptiometry in 3,978 older adults. AGE 34, 597–608 (2012). https://doi.org/10.1007/s11357-011-9272-y

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  • DOI: https://doi.org/10.1007/s11357-011-9272-y

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