Advertisement

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

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Nutrition, Metabolism and Cardiovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Flegal K.M.
        • Kit B.K.
        • Orpana H.
        • Graubard B.I.
        Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis.
        JAMA. 2013; 309: 71-82
        • Stevens J.
        • Cai J.
        • Pamuk E.R.
        • Williamson D.F.
        • Thun M.J.
        • Wood J.L.
        The effect of age on the association between body-mass index and mortality.
        N Engl J Med. 1998; 338: 1-7
        • Janssen I.
        • Katzmarzyk P.T.
        • Ross R.
        Body mass index is inversely related to mortality in older people after adjustment for waist circumference.
        J Am Geriatr Soc. 2005; 53: 2112-2118
        • Auyeung T.W.
        • Lee J.S.
        • Leung J.
        • Kwok T.
        • Leung P.C.
        • Woo J.
        Survival in older men may benefit from being slightly overweight and centrally obese–a 5-year follow-up study in 4,000 older adults using DXA.
        J Gerontol A Biol Sci Med Sci. 2010; 65: 99-104
        • Cesari M.
        • Pahor M.
        • Lauretani F.
        • Zamboni V.
        • Bandinelli S.
        • Bernabei R.
        • et al.
        Skeletal muscle and mortality results from the InCHIANTI Study.
        J Gerontol Ser A Biol Sci Med Sci. 2009; 64: 377-384
        • Lee C.G.
        • Boyko E.J.
        • Nielson C.M.
        • Stefanick M.L.
        • Bauer D.C.
        • Hoffman A.R.
        • et al.
        Mortality risk in older men associated with changes in weight, lean mass, and fat mass.
        J Am Geriatr Soc. 2011; 59: 233-240
        • Rolland Y.
        • Gallini A.
        • Cristini C.
        • Schott A.M.
        • Blain H.
        • Beauchet O.
        • et al.
        Body-composition predictors of mortality in women aged >/= 75 y: data from a large population-based cohort study with a 17-y follow-up.
        Am J Clin Nutr. 2014; 100: 1352-1360
        • Padwal R.
        • Leslie W.D.
        • Lix L.M.
        • Majumdar S.R.
        Relationship among body fat percentage, body mass index, and all-cause mortality: a cohort study.
        Ann Intern Med. 2016; 164: 532-541
        • Srikanthan P.
        • Horwich T.B.
        • Tseng C.H.
        Relation of muscle mass and fat mass to cardiovascular disease mortality.
        Am J Cardiol. 2016; 117: 1355-1360
        • Allison D.B.
        • Zhu S.K.
        • Plankey M.
        • Faith M.S.
        • Heo M.
        Differential associations of body mass index and adiposity with all-cause mortality among men in the first and second National Health and Nutrition Examination Surveys (NHANES I and NHANES II) follow-up studies.
        Int J Obes Relat Metab Disord. 2002; 26: 410-416
        • Baumgartner R.N.
        • Wayne S.J.
        • Waters D.L.
        • Janssen I.
        • Gallagher D.
        • Morley J.E.
        Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly.
        Obes Res. 2004; 12: 1995-2004
        • Batsis J.A.
        • Mackenzie T.A.
        • Barre L.K.
        • Lopez-Jimenez F.
        • Bartels S.J.
        Sarcopenia, sarcopenic obesity and mortality in older adults: results from the National Health and Nutrition Examination Survey III.
        Eur J Clin Nutr. 2014; 68: 1001-1007
        • Fried L.P.
        • Borhani N.O.
        • Enright P.
        • Furberg C.D.
        • Gardin J.M.
        • Kronmal R.A.
        • et al.
        The Cardiovascular Health Study: design and rationale.
        Ann Epidemiol. 1991; 1: 263-276
        • Ives D.G.
        • Fitzpatrick A.L.
        • Bild D.E.
        • Psaty B.M.
        • Kuller L.H.
        • Crowley P.M.
        • et al.
        Surveillance and ascertainment of cardiovascular events. The Cardiovascular Health Study.
        Ann Epidemiol. 1995; 5: 278-285
        • Kern L.M.
        • Powe N.R.
        • Levine M.A.
        • Fitzpatrick A.L.
        • Harris T.B.
        • Robbins J.
        • et al.
        Association between screening for osteoporosis and the incidence of hip fracture.
        Ann Intern Med. 2005; 142: 173-181
        • Hankinson J.L.
        • Odencrantz J.R.
        • Fedan K.B.
        Spirometric reference values from a sample of the general U.S. population.
        Am J Respir Crit Care Med. 1999; 159: 179-187
        • Mannino D.M.
        • Davis K.J.
        • Kiri V.A.
        Chronic obstructive pulmonary disease and hospitalizations for pneumonia in a US cohort.
        Respir Med. 2009; 103: 224-229
        • Vestbo J.
        • Hurd S.S.
        • Agusti A.G.
        • Jones P.W.
        • Vogelmeier C.
        • Anzueto A.
        • et al.
        Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.
        Am J Respir Crit Care Med. 2013; 187: 347-365
        • Fang J.
        • Austin P.C.
        • Tu J.V.
        Test for linearity between continuous confounder and binary outcome first, run a multivariate regression analysis second.
        in: Institute S Proceedings of the SAS Global Forum 2009 Conference. Cary, NC: Paper 252. 2009
        • Heinzl H.
        • Kaider A.
        Gaining more flexibility in Cox proportional hazards regression models with cubic spline functions.
        Comput Methods Programs Biomed. 1997; 54: 201-208
        • Durrleman S.
        • Simon R.
        Flexible regression models with cubic splines.
        Stat Med. 1989; 8: 551-561
        • Shah R.V.
        • Murthy V.L.
        • Abbasi S.A.
        • Blankstein R.
        • Kwong R.Y.
        • Goldfine A.B.
        • et al.
        Visceral adiposity and the risk of metabolic syndrome across body mass index: the MESA Study.
        JACC Cardiovasc Imaging. 2014; 7: 1221-1235
        • Flegal K.M.
        • Graubard B.I.
        • Williamson D.F.
        • Gail M.H.
        Excess deaths associated with underweight, overweight, and obesity.
        JAMA. 2005; 293: 1861-1867
        • Bender R.
        • Jockel K.H.
        • Trautner C.
        • Spraul M.
        • Berger M.
        Effect of age on excess mortality in obesity.
        JAMA. 1999; 281: 1498-1504
        • Berrington de Gonzalez A.
        • Hartge P.
        • Cerhan J.R.
        • Flint A.J.
        • Hannan L.
        • MacInnis R.J.
        • et al.
        Body-mass index and mortality among 1.46 million white adults.
        N Engl J Med. 2010; 363: 2211-2219
        • Han S.S.
        • Kim K.W.
        • Kim K.I.
        • Na K.Y.
        • Chae D.W.
        • Kim S.
        • et al.
        Lean mass index: a better predictor of mortality than body mass index in elderly Asians.
        J Am Geriatr Soc. 2010; 58: 312-317
        • Lisko I.
        • Tiainen K.
        • Stenholm S.
        • Luukkaala T.
        • Hurme M.
        • Lehtimaki T.
        • et al.
        Are body mass index, waist circumference and waist-to-hip ratio associated with leptin in 90-year-old people?.
        Eur J Clin Nutr. 2013; 67: 420-422
        • Srikanthan P.
        • Seeman T.E.
        • Karlamangla A.S.
        Waist-hip-ratio as a predictor of all-cause mortality in high-functioning older adults.
        Ann Epidemiol. 2009; 19: 724-731
        • Wannamethee S.G.
        • Shaper A.G.
        • Lennon L.
        • Whincup P.H.
        Decreased muscle mass and increased central adiposity are independently related to mortality in older men.
        Am J Clin Nutr. 2007; 86: 1339-1346
        • Hays J.C.
        • Keller H.H.
        • Ostbye T.
        The effects of nutrition-related factors on four-year mortality among a biracial sample of community-dwelling elders in the North Carolina piedmont.
        J Nutr Elder. 2005; 25: 41-67
        • Cruz-Jentoft A.J.
        • Baeyens J.P.
        • Bauer J.M.
        • Boirie Y.
        • Cederholm T.
        • Landi F.
        • et al.
        Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People.
        Age Ageing. 2010; 39: 412-423
        • Nikolov J.
        • Spira D.
        • Aleksandrova K.
        • Otten L.
        • Meyer A.
        • Demuth I.
        • et al.
        Adherence to a Mediterranean-style diet and appendicular lean mass in community-dwelling older people: results from the Berlin aging study II.
        J Gerontol Ser A Biol Sci Med Sci. 2015; 00 (ISSN: 1758-535X (Electronic), ISSN: 1079-5006 (Linking)): 1-7https://doi.org/10.1093/gerona/glv218
        • Meyer A.
        • Salewsky B.
        • Spira D.
        • Steinhagen-Thiessen E.
        • Norman K.
        • Demuth I.
        Leukocyte telomere length is related to appendicular lean mass: cross-sectional data from the Berlin Aging Study II (BASE-II).
        Am J Clin Nutr. 2016; 103: 178-183
        • Eibich P.
        • Buchmann N.
        • Kroh M.
        • Wagner G.G.
        • Steinhagen-Thiessen E.
        • Demuth I.
        • et al.
        Exercise at different ages and appendicular lean mass and strength in later life: results from the Berlin aging study II.
        J Gerontol Ser A Biol Sci Med Sci. 2016; 71: 515-520
        • Kim T.N.
        • Park M.S.
        • Kim Y.J.
        • Lee E.J.
        • Kim M.K.
        • Kim J.M.
        • et al.
        Association of low muscle mass and combined low muscle mass and visceral obesity with low cardiorespiratory fitness.
        PLoS One. 2014; 9: e100118
        • Srikanthan P.
        • Hevener A.L.
        • Karlamangla A.S.
        Sarcopenia exacerbates obesity-associated insulin resistance and dysglycemia: findings from the National Health and Nutrition Examination Survey III.
        PLoS One. 2010; 5: e10805
        • Ko B.J.
        • Chang Y.
        • Jung H.S.
        • Yun K.E.
        • Kim C.W.
        • Park H.S.
        • et al.
        Relationship between low relative muscle mass and coronary artery calcification in healthy adults.
        Arterioscler Thromb Vasc Biol. 2016; 36: 1016-1021
        • Topcu Y.
        • Tufan F.
        • Karan M.A.
        Resistance training might have improved insulin resistance by attenuating sarcopenia.
        Clin Interv Aging. 2015; 10: 1935-1936
        • Lawlor D.A.
        • Hart C.L.
        • Hole D.J.
        • Davey Smith G.
        Reverse causality and confounding and the associations of overweight and obesity with mortality.
        Obesity (Silver Spring). 2006; 14: 2294-2304