Highlights
- •Greater lean tissue had a protective association with all-cause and cardiovascular mortality.
- •The lowest quartile of fat was associated with greater all-cause mortality.
- •The upper quartile of fat was not associated with outcomes.
- •Prevention efforts in older adults may be best targeted toward improvements in lean mass.
Abstract
Background and aims
Understanding contributions of lean and fat tissue to cardiovascular and non-cardiovascular
mortality may help clarify areas of prevention in older adults. We aimed to define
distributions of lean and fat tissue in older adults and their contributions to cause-specific
mortality.
Methods and results
A total of 1335 participants of the Cardiovascular Health Study (CHS) who underwent
dual-energy x-ray absorptiometry (DEXA) scans were included. We used principal components
analysis (PCA) to define two independent sources of variation in DEXA-derived body
composition, corresponding to principal components composed of lean (“lean PC”) and
fat (“fat PC”) tissue. We used Cox proportional hazards regression using these PCs
to investigate the relationship between body composition with cardiovascular and non-cardiovascular
mortality. Mean age was 76.2 ± 4.8 years (56% women) with mean body mass index 27.1 ± 4.4 kg/m2. A greater lean PC was associated with lower all-cause (HR = 0.91, 95% CI 0.84–0.98,
P = 0.01) and cardiovascular mortality (HR = 0.84, 95% CI 0.74–0.95, P = 0.005). The
lowest quartile of the fat PC (least adiposity) was associated with a greater hazard
of all-cause mortality (HR = 1.24, 95% CI 1.04–1.48, P = 0.02) relative to fat PCs
between the 25th–75th percentile, but the highest quartile did not have a significantly
greater hazard (P = 0.70).
Conclusion
Greater lean tissue mass is associated with improved cardiovascular and overall mortality
in the elderly. The lowest levels of fat tissue mass are linked with adverse prognosis,
but the highest levels show no significant mortality protection. Prevention efforts
in the elderly frail may be best targeted toward improvements in lean muscle mass.
Keywords
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Article info
Publication history
Published online: June 28, 2016
Accepted:
June 22,
2016
Received in revised form:
June 21,
2016
Received:
April 25,
2016
Identification
Copyright
© 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
