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Waist Circumference
Waist Circumference
https://doi.org/10.1007/s40520-018-0933-x
ORIGINAL ARTICLE
Abstract
Aim Obesity is found to be associated with frailty. Body mass index (BMI) and waist circumference (WC) are the commonly
used measures for obesity, the former is more closely related to general obesity and body weight; the latter can more accu-
rately reflect abdominal obesity and is more closely associated with metabolic disorders. In this study, we intend to study
the relationship between frailty, BMI and WC among older people.
Methods Data were derived from the Beijing Longitudinal Study on Aging II Cohort, which included 6320 people 65 years
or older from three urban districts in Beijing. A Frailty Index derived from 33 items was developed according to Rockwood’s
cumulative deficits method. A Frailty Index ≥ 0.25 was used as the cut-off criteria. BMI was classified as underweight, nor-
mal, overweight, or obese (< 18.5, 18.5–< 24.0, 24.0–27.9, ≥ 28.0 kg/m2, respectively). High WC was defined as WC ≥ 85 cm
in men and ≥ 80 cm in women.
Results People with a larger BMI (≥ 28.0 kg/m2, 22.6%) or a larger WC (18.5%) were more likely to be frail. People with
normal BMI and overweight people do not suffer from higher prevalence for frailty. In comparison with individuals with
normal BMI (18.5–< 24.0 kg/m2) and normal WC (< 85 cm in men, <80 cm in women), the risk of frailty was higher among
individuals who have normal BMI and large WC (odds ratio 1.68; 95% CI 1.33–2.12), have overweight and large WC (odds
ratio 1.58; 95% CI 1.23–1.96), or have obesity and large WC (odds ratio 2.28; 95% CI 1.79–2.89). In people with normal
WC, only those who are underweight have a higher risk for frailty (odds ratio 1.65, 95% CI 1.08–2.52). In comparison with
BMI, the relation of WC with the risk for frailty was much closer.
Conclusions Abdominal obesity is more closely associated with incidence of frailty than general obesity in the elderly. Older
adults with large waist circumference are more likely to be frail. Frailty in the elderly might be more closely related to meta-
bolic disorders. WC might be a better measurement to detect frailty than BMI, given its relationship with metabolic disorders.
Keywords Body mass index · Waist circumference · Frailty · Older adults · Prevalence
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* Piu Chan Department of Rheumatology, Beijing Institute of Geriatrics,
pbchan@hotmail.com Xuanwu Hospital of Capital Medical University,
Beijing 100053, China
Qiuju Liao
5
qiujumm@sina.com Department of Endocrinology, Beijing Institute of Geriatrics,
Xuanwu Hospital of Capital Medical University,
1
Department of Neurobiology, Beijing Institute of Geriatrics, Beijing 100053, China
Xuanwu Hospital of Capital Medical University, No. 45 6
Key Laboratory on Neurodegenerative Disease of Ministry
Changchun St., Xicheng District, Beijing 100053, China
of Education, and Beijing Key Laboratory for Parkinson’s
2
Department of Geriatrics, Beijing Institute of Geriatrics, Disease, Parkinson’s Disease Center of Beijing Institute
Xuanwu Hospital of Capital Medical University, for Brain Disorders, Beijing 100053, China
Beijing 100053, China
3
Department of Neurology, Beijing Institute of Geriatrics,
Xuanwu Hospital of Capital Medical University,
Beijing 100053, China
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Vol.:(0123456789)
Aging Clinical and Experimental Research
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Aging Clinical and Experimental Research
Age (years)
65–74 3513(55.6) 3067(87.3) 446(12.7) < 0.0001
75–84 2568(40.6) 2015(78.5) 553(21.5)
≥ 85 239(3.8) 177(74.1) 62(25.9)
Gender
Women 3888(61.5) 3154(81.1) 734(18.9) < 0.0001
Men 2432(38.5) 2105(86.6) 327(13.4)
Marriage
Unmarried, widowed or divorced 1497(23.7) 1148(76.7) 349(23.3) < 0.0001
Married 4823(76.3) 4111(85.2) 712(14.8)
Education
Less than high school 3644(57.7) 3083(84.6) 561(15.4) 0.0005
High school/GED/some college 2670(42.3) 2171(81.3) 499(18.7)
BMI (kg/m2)
Underweight (< 18.5) 199(3.2) 167(83.9) 32(16.1) 0.67
Normal (18.5–< 24.0) 2379(37.9) 2023(85) 356(15) Ref
Overweight (24.0–27.9) 2640(42.1) 2212(83.8) 428(16.2) 0.22
Obese (≥ 28.0) 1051(16.8) 813(77.4) 238(22.6) < 0.0001
WC (cm)
Normal WC (< 85men, < 80 women) 1658(26.4) 1458(87.9) 200(12.1) Ref
High WC (≥ 85 men, ≥ 80 women) 4631(73.6) 3772(81.5) 859(18.5) < 0.0001
Chi-square test was used to compare prevalence rates of frailty among subgroups
BMI body mass index, WC waist circumference
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Aging Clinical and Experimental Research
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Aging Clinical and Experimental Research
the risk of frailty [29]. However, results from 40,657 their findings, and, in fact, there were quite other studies
women aged 65–79 who participated in the Women’s that also replicated the results [34, 35].
Health Initiative [30], and were followed up for 3 years, As people grow old, muscle mass and strength decrease,
confirmed that being overweight could markedly increase and body fat increases, and BMI is the most commonly used
the risk of frailty. Although it is now known the exact anthropometric measurement to assess adiposity [36, 37].
cause of this discrepancy, our study showed that being However, our study has shown that overweight individuals
overweight (BMI 24.0–27.9 kg/m2) increased the risk of did not have an increased risk for frailty if they had a normal
frailty only for those with increased but not normal WC, WC, only those with a larger WC had an increased risk for
suggesting that it is the abdominal obesity that is associ- frailty even if with a normal BMI. These results suggest that
ated with frailty. Since we have adjusted sex and age in the WC is a better indicator of frailty than BMI. We speculate
analysis, it is less likely that this relationship between WC that WC is associated with abdominal obesity or more vis-
and frailty was only relevant for oldest old. ceral fat, and with metabolic disorders [17, 35]. Fat cells can
Despite numerous studies focused on relationship secrete cytokines such as leptin, adiponectin, resistin, TNF,
between BMI and frailty, there were only few on WC and IL-6 and visfatin, which play important roles in metabolism,
frailty. There were quite few studies on relationship of inflammation, blood coagulation, fibrinolysis, endothelium
frailty related to metabolic disorders. Metabolic disorders function and transmitting metabolic information between
are well known to be closely related to cardiovascular dis- different organs [17, 31, 35, 38, 39]. Abdominal obesity
eases and diabetes. Older people with metabolic disorders exerts an anti-insulin effect, which leads to abnormal glu-
are more likely to suffer from chronic diseases and are cose tolerance. Moreover, people with abdominal obesity
prone to suffer adverse health outcomes [31, 32]. One of also suffer from chronic stress and chronic inflammation
the most accepted indicators of abdominal obesity is WC. [40]. All these factors have been proposed to mediate the
To some extent, it reflects how fats are distributed across mechanisms leading to frailty [35]. Furthermore, increased
the body. Although CT or MRI are more precisely discern WC has also suggested to be markers of oxidative stress,
specific components of body composition (e.g., visceral independent from BMI [16]. Excessive and unopposed oxi-
versus subcutaneous adipose tissue or ectopic fat in tis- dative stress may be the core mechanism leading to age-
sues and organs) [33], WC is widely used for its ease of associated frailty [41]. Increased overall adiposity is a factor
measurement. The earliest report on frailty and abdomi- linked to higher rates of depression, cognitive decline [42]
nal obesity was a British cross-sectional study, suggested and osteoporosis [43] in the elderly, ailments which all are
that a large WC was closely related to frailty, even among components related to frailty. BMI is affected by many fac-
underweight people [28]. Our results are consistent with tors, such as body size (humpback in the elderly), skeletal
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Aging Clinical and Experimental Research
and muscular weight, and it does not reflect the body fat Ministry of Science and Technology of China (2012AA02A514,
distribution [16]. In the elderly in particular, body weight 0S2012GR0150, 2012ZX09303-005).
could be an important indication of their health status, more
weight (a higher BMI) may demonstrate a better preserve Compliance with ethical standards
or healthy as compared to the adults. While larger WC may
Conflict of interest No potential conflicts of interest were disclosed.
suggest increased risk for metabolic disturbance even when
the elderly with a normal body weight. Therefore, these data Ethics approval All procedures performed in studies involving human
support that people with large WC are more prone to be frail. participants were in accordance with the ethical standards of the
It is interesting to note that we found those who were Research Ethics Committee of Xuanwu Hospital, Capital Medical
University. In addition, this study was performed in accordance with
underweight but with a normal WC had a higher risk for the ethical principles of the Declaration of Helsinki.
frailty, while the risk for frailty decreased when WC was
increased. Our results are different from previous report Informed consent Written informed consent was obtained from all
by Hubbard et al. that found people with large WC but participants.
underweighted had an increased risk for frailty [28]. These
contradicted results might be explained by possible differ-
ent mechanisms leading to frailty between underweighted
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