Severe central obesity or diabetes can replace weight loss in the detection of frailty in obese younger elderly – a preliminary study

Abstract

PurposeUnwanted weight loss is one of the established criteria for the diagnosis of frailty. However, the relevance of this criterion to detect frailty in obese older adults has not been assessed. In particular, with the exception of malignancy, unwanted weight loss is not commonly seen in older obese subjects. Therefore, we tested the possibility that some obesity phenotypes and/or diabetes might be more useful in the detection of frailty in this setting.Patients and methodsA preliminary cross-sectional study of 50 consecutive subjects was conducted at The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center. Inclusion criteria were: young elderly (aged 65–75 years), with general and/or abdominal obesity, without cancer. Frailty was assessed directly using the Fried model, the five-item fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale. Eventually, in the assessment of frailty, the weight loss criterion was replaced by one or several of obesity/diabetes-related variables each time: severity of obesity by body mass index, waist circumference (and their interaction), body fat, and diabetes. The receiver operating characteristic curves for functional impairment indices were plotted to compare the usefulness of the frailty accepted and adjusted models.ResultsThe prevalence of frailty and pre-frailty in this cohort were 7/50 (14%) and 27/50 (54%), respectively, but unwanted weight loss was seen in three subjects (6%) only. The level of abdominal obesity had the strongest correlation with functional score (r=0.292, P<0.05). Frailty models which included either severe abdominal obesity or diabetes in lieu of unwanted weight loss had good sensitivity rates per each frailty score as compared with the original Fried model.ConclusionFor detecting and/or screening for the frailty syndrome in obese young elderly, the level of abdominal obesity or diabetes may provide a useful marker.

Fatores associados à síndrome de fragilidade em idosos: análise de modelagem de equações estruturais

“…As morbidades como mediadoras da associação das condições de fragilidade e IMC não foram encontradas em inquérito nacional, o qual não obteve associação entre essas variáveis (p= 0,078). 37 No entanto, pesquisas internacionais observam a relação entre as morbidades com a fragilidade; 38,39 em coorte de idosos italianos o sexo feminino, a obesidade e outras morbidades, como: doenças cardiovasculares, osteoartrite, hipovitaminose D, hiperuricemia foram significativamente associadas ao maior risco de se tornar frágil. 38 Em Israel, o número de comorbidades foi a variável explicativa mais fortemente associada no modelo de Fried.…”

“…38 Em Israel, o número de comorbidades foi a variável explicativa mais fortemente associada no modelo de Fried. 39 É relevante que os serviços de saúde estejam atentos às comorbidades entre idosos, especialmente àquelas que tem apresentado relação com a diminuição da funcionalidade física.…”

“…16 Fato também relatado em pesquisa realizada em Israel, a qual evidenciou que para detectar e/ou rastrear a síndrome da fragilidade em jovens idosos obesos o nível de obesidade abdominal pode ser um marcador útil. 39 Nesse sentido, as ações em saúde devem abranger especialmente entre as idosas e os obesos o acompanhamento e controle das comorbidades. A aferição da CA deve ser averiguada em todas as consultas estimulando a redução para os parâmetros preconizados pela OMS.…”

Sarcopenia in Older Adults

“…These three conditions are frailty, sarcopenia, and obesity. When sarcopenia or frailty is also accompanied by obesity, a sarcopenic/frail-obese phenotype is established [1]. Moreover, the presence of these "unhappy triads" of health conditions, in one person, poses a significant threat to one's quality of life and longevity.…”

Effects of Exergames and Protein Supplementation on Body Composition and Musculoskeletal Function of Prefrail Community-Dwelling Older Women: A Randomized, Controlled Clinical Trial

“…According to the frailty phenotype, a pre-frail older person presents one or two of the following criteria: unintentional weight loss, muscle weakness, exhaustion, low physical activity, and slowness [5]. Factors such as chronic inflammation, obesity, muscle quality, physical inactivity, and inadequate nutrition may culminate in adverse outcomes in the musculoskeletal function of the physically frail older adults [6][7][8].…”