Association of Obesity and Frailty in Older Adults: NHANES 1999-2004

ObjectivesBody composition changes with aging can increase rates of obesity, frailty and impact function. Measuring adiposity using body fat (%BF) or central adiposity using waist circumference (WC) have greater diagnostic accuracy than traditional measures such as body mass index (BMI).DesignThis is an observational study.SettingThis study focused on older community-dwelling participants.ParticipantsWe identified individuals age 60 years old using the 1999-2004 cross-sectional National Health and Nutrition Survey (NHANES).InterventionThe primary analysis evaluated the association between frailty and %BF or WC. Frailty was the primary predictor (robust=referent) and %BF and WC were considered continuous outcomes. Multiple imputation analyses accounted for missing characteristics.MeasurementDual energy x-ray absorptiometry was used to assess %BF and WC was objectively measured. Frailty was defined using an adapted version of Fried's criteria that was self-reported: (low BMI<18.5kg/m(2); slow walking speed [<0.8m/s]; weakness [unable to lift 10lbs]; exhaustion [difficulty walking between rooms on same floor] and low physical activity [compared to others]). Robust, pre-frail and frail persons met zero, 1 or 2, and 3 criteria, respectively.ResultsOf the 4,984 participants, the mean age was 71.10.2 (SE) years and 56.5% were females. We classified 2,246 (50.4%), 2,195 (40.3%), and 541 (9.2%) individuals as robust, pre-frail and frail, respectively. Percent BF was 35.9 +/- 0.13, 38.3 +/- 0.20 and 40.0 +/- 0.46 in the robust, pre-frail and frail individuals, respectively. WC was 99.5 +/- 0.32 in the robust, 100.1 +/- 0.43 in pre-frail, 104.7 +/- 1.17 in frail individuals. Compared to robust individuals, only frail individuals had greater %BF on average (=0.97 +/- 0.43,p=0.03); however, pre-frail and frail individuals had 2.18 and 4.80 greater WC, respectively (=2.18 +/- 0.64,p=0.002, and =4.80 +/- 1.1,p<0.001).ConclusionOur results demonstrate that in older adults, frailty and pre-frailty are associated with a greater likelihood of high WC (as dichotomized) and a greater average WC (continuous).