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British & Irish Longitudinal Studies of Ageing Meeting; Obesity & Frailty

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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British & Irish Longitudinal Studies of Ageing Meeting; Obesity & Frailty

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  1. British & Irish Longitudinal Studies of Ageing Meeting; Obesity & Frailty Siobhan Leahy 1st Nov 2013

  2. 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

  3. 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)

  4. 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

  5. Obesity & Sarcopenia/Dynapenia

  6. 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

  7. 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.

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