The association of lean and fat mass with all-cause mortality in older adults: The Cardiovascular Health Study

Spahillari, Aferdita; Mukamal, Kenneth J.; deFilippi, Christopher; Kizer, Jorge R.; Gottdiener, John S.; Djoussé, Luc; Lyles, Mary F.; Bartz, Traci M.; Murthy, Venkatesh L.; Shah, Ravi

doi:10.1016/j.numecd.2016.06.011

Cited by 97 publications

(82 citation statements)

References 39 publications

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“…Low muscle mass contributes to frailty and reflects decreased physiological reserves that may promote unfavourable outcomes under physiological stress such as after surgery or during illnesses because of poorer intrinsic adaptive mechanisms. Previous studies showed lean mass and muscle area to be protective of all‐cause mortality reducing the incidence by 9–20% independently of indicators of obesity (central obesity and fat tissue mass), chronic diseases, and strength . Low ALM/BMI has also been associated with mortality, but it may be possibly explained by factors that are different than those explaining the association between low ALMI and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies showed lean mass and muscle area to be protective of allcause mortality reducing the incidence by 9-20% independently of indicators of obesity (central obesity and fat tissue mass), chronic diseases, and strength. [55][56][57] Low ALM/BMI has also been associated with mortality, 58 but it may be possibly explained by factors that are different than those explaining the association between low ALMI and mortality. For example, a cross-sectional study in Australian (n = 1005, mean age 62) and Korean (n = 376, mean age 58) cohorts showed greater likelihood of having the metabolic syndrome attributed to higher waist circumference, blood pressure, and triglycerides in participants with lower ALM/BMI, while opposite results were observed for sarcopenia as defined by low ALMI (kg/ht 2 ).…”

Section: Other Health Implications Of Low Appendicular Lean Mass: Illmentioning

confidence: 99%

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Physical function‐derived cut‐points for the diagnosis of sarcopenia and dynapenia from the Canadian longitudinal study on aging

Tessier

Wing

Rahme

et al. 2019

J cachexia sarcopenia muscle

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Background Aging is associated with sarcopenia (low muscle mass) and dynapenia (low muscle strength) leading to disability and mortality. Widely used previous cut‐points for sarcopenia were established from dated, small, or pooled cohorts. We aimed to identify cut‐points of low strength as a determinant of impaired physical performance and cut‐points of low appendicular lean mass (ALM) as a predictor of low strength in a single, large, and contemporary cohort of community‐dwelling older adults and compare these criteria with others. Methods Cross‐sectional analyses were conducted on baseline data from 4725 and 4363 community‐dwelling men and women (65–86 years, 96.8% Caucasian) of the Canadian longitudinal study on aging comprehensive cohort. Physical performance was evaluated from gait speed, timed up‐and‐go, chair rise, and balance tests; a weighted‐sum score was computed using factor analysis. Strength was measured by handgrip dynamometry; ALM, by dual‐energy X‐ray absorptiometry and ALM index (ALMI; kg/m2), was calculated. Classification and regression tree analyses determined optimal sex‐specific cut‐points of ALMI predicting low strength and of strength predicting impaired physical performance (score < 1.5 SD below the sex‐specific mean). Results Modest associations were found between ALMI and strength and between strength and physical performance score in both sexes. ALMI was not an independent predictor of physical performance score. Cut‐points of <33.1 and <20.4 kg were found to define dynapenia in men and in women, respectively, corresponding to 21.5% and 24.0% prevalence rates. Sarcopenia cut‐points were <7.76 kg/m2 in men and <5.72 kg/m2 in women; prevalence rates of 21.7% and 13.7%. Overall, 8.3% of men and 5.5% of women had sarco‐dynapenia. Sarcopenic were older and had lower fat mass and body mass index (BMI) than non‐sarcopenic participants. While the agreement between current criteria and the updated European Working Group for Sarcopenia in Older Persons recommendations was fair, we found only slight agreement with the Foundation for the National Institute of Health sarcopenia project. Older persons identified with sarcopenia as per the Foundation for the National Institute of Health criteria (using ALM/BMI as the index) have higher BMI and fat mass compared with non‐sarcopenic and have normal ALMI as per our criteria. Conclusions The proposed function‐derived cut‐points established from this single, large, and contemporary Canadian cohort should be used for the identification of sarcopenia and dynapenia in Caucasian older adults. We advise on using criteria based on ALMI in the diagnosis of sarcopenia. The modest agreement between sarcopenia and dynapenia denotes potential distinct health implications justifying to study both components separately.

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Section: Discussionmentioning

confidence: 99%

Section: Other Health Implications Of Low Appendicular Lean Mass: Illmentioning

confidence: 99%

Physical function‐derived cut‐points for the diagnosis of sarcopenia and dynapenia from the Canadian longitudinal study on aging

Tessier

Wing

Rahme

et al. 2019

J cachexia sarcopenia muscle

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“…Specifically, although the crude body weight was similar between patients with and without physical frailty, the former group had significantly lower lean tissue mass but higher adipose tissue mass (Table 2), indicating concomitant muscle atrophy and accumulation of body fat due to the lack of physical activity. Previous study showed that frailty exacerbates protein catabolism and loss of muscle mass [34], which is related to the cardiovascular and overall mortality in the elderly population [35]. To the best of our knowledge, alterations of adipose tissue mass in frail elderly patients have not been reported previously.…”

Section: Discussionmentioning

confidence: 83%

Depression and Physical Frailty Have Additive Effect on the Nutritional Status and Clinical Outcome of Chinese Peritoneal Dialysis

Szeto¹,

Chan²,

Ng³

et al. 2018

Kidney Blood Press Res

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Background/Aims: Frailty and depression both contribute to malnutrition and adverse clinical outcome of peritoneal dialysis (PD) patients. However, their interaction is incompletely defined. Methods: We studied 178 adult Chinese PD patients. Physical frailty was assessed by a validated in-house questionnaire; depressive symptoms was screened by the Geriatric Depression Scale; nutritional status was determined by subjective global assessment (SGA) and malnutrition inflammation score (MIS). All patients were followed for up to 24 months for survival and hospitalization analysis. Results: There were 111 patients (62.4%) physically frail, amongst those 48 (43.2%) had depressive symptoms. Only 1 patient had depressive symptoms without frailty. There was an additive effect of depressive symptoms and physical frailty on nutritional status. For the groups with no frailty, frail but no depressive symptoms, and frail with depressive symptoms, serum albumin decreased in a stepwise manner (35.8 ± 5.6, 34.9 ± 4.4, and 32.9 ± 5.3 g/L, respectively, p=0.025); overall SGA score was 5.75 ± 0.61, 5.41 ± 0.59, and 5.04 ± 0.77, respectively (p< 0.0001), and MIS was 5.12 ± 2.30, 7.13 ± 3.22, and 9.48 ± 3.97, respectively (p< 0.0001). At 24 months, patient survival was 86.6%, 71.4%, and 62.5% for patients with no frailty, frail but no depressive symptoms, and frail with depressive symptoms, respective (p=0.001). The median number of hospital stay was 8.04 (inter-quartile range [IQR] 0.91 – 19.42), 14.05 (IQR 3.57 – 37.27), and 26.62 (IQR 10.65 – 61.18) days per year of follow up, respectively (p< 0.0001). Conclusion: Physical frailty and depressive symptoms are both common in Chinese PD patients, and they have additive adverse effect on the nutritional status and clinical outcome.

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“…CV risk factors are highly prevalent in patients with NAFLD, and CV mortality contributes significantly to their overall loss of life time . It has been estimated that 5% to 10% of patients with NAFLD die from CVD, and patients with NAFLD exhibit a 2‐fold increased risk of CVD . A meta‐analysis exploring more than 17,000 patient‐years observed CVD to be the leading cause of mortality in patients with NAFLD .…”

Section: Discussionmentioning

confidence: 99%

“…(26) It has been estimated that 5% to 10% of patients with NAFLD die from CVD, and patients with NAFLD exhibit a 2-fold increased risk of CVD. (27,28) A meta-analysis exploring more than 17,000 patient-years observed CVD to be the leading cause of mortality in patients with NAFLD. (6) In a recent exploration of the National Health and Nutrition Examination Survey III, a 42% higher overall mortality rate and doubling of the risk of CV mortality for patients with NAFLD were observed.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Risk Categories in Patients With Nonalcoholic Fatty Liver Disease and the Role of Low‐Density Lipoprotein Cholesterol

et al. 2019

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Cardiovascular disease (CVD) is the leading cause of death in patients with nonalcoholic fatty liver disease (NAFLD). The current analysis expands the knowledge on atherogenic lipid profiles in NAFLD by modeling changes in low‐density lipoprotein cholesterol (LDL‐C) and total cholesterol (TC) in a prospectively enrolling real‐life study cohort to inform physicians on the cardiovascular (CV) event risk based on these changes. A total of 304 patients with histologically confirmed NAFLD were included (mean age, 52 years; equal sex distribution). Of these, 129 (42.4%) patients exhibited a NAFLD activity score ≥4 and 186 (61.2%) had at least intermediate fibrosis ≥F2. The median TC levels were 209 mg/dL (interquartile range [IQR], 183, 239), LDL‐C 131 mg/dL (IQR, 103, 152), and high‐density lipoprotein cholesterol (HDL‐C) 45 mg/dL (IQR, 38, 52). Only 16.9% of patients received lipid‐lowering therapy. According to the LDL/HDL ratio, 69 (23.7%) patients exhibited a high CV risk. The 10‐year CV event risk according to the Framingham risk score (FRS) was low in 91 (41.2%), intermediate in 59 (26.7%), and high in 71 (32.1%) patients and higher in the ≥F2 NAFLD population. A moderate increase in LDL‐C levels by 20 mg/dL led to a transition of 20% of patients into the high‐risk group when assessing the LDL/HDL ratio. According to the FRS, 6 (2.7%) patients moved from low to intermediate and 11 (4.9%) from intermediate to high CV risk. Conclusion: Patients with NAFLD exhibit a substantial CV event risk and are frequently undertreated with lipid‐lowering medication. Moderate increases in LDL‐C would result in worsening of the CV event risk in approximately 7.8% of all patients without a history of CVD.

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The association of lean and fat mass with all-cause mortality in older adults: The Cardiovascular Health Study

Cited by 97 publications

References 39 publications

Physical function‐derived cut‐points for the diagnosis of sarcopenia and dynapenia from the Canadian longitudinal study on aging

Physical function‐derived cut‐points for the diagnosis of sarcopenia and dynapenia from the Canadian longitudinal study on aging

Depression and Physical Frailty Have Additive Effect on the Nutritional Status and Clinical Outcome of Chinese Peritoneal Dialysis

Cardiovascular Risk Categories in Patients With Nonalcoholic Fatty Liver Disease and the Role of Low‐Density Lipoprotein Cholesterol

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