Elsevier

Archives of Gerontology and Geriatrics

Volume 55, Issue 2, September–October 2012, Pages e40-e47
Archives of Gerontology and Geriatrics

Waist circumference (WC), body mass index (BMI), and disability among older adults in Latin American and the Caribbean (LAC)

https://doi.org/10.1016/j.archger.2012.04.006Get rights and content

Abstract

Purpose

To examine the association between WC and BMI on disability among older adults from LAC.

Methods

Cross-sectional, multicenter city study of 5786 subjects aged 65 years and older from the Health, Well-Being and Aging in Latin America and the Caribbean (SABE) study (1999–2000). Sociodemographic variables, smoking status, medical conditions, BMI, WC, and activities of daily living (ADL) were obtained.

Results

Prevalence of high WC (HWC) (>88 cm) in women ranged from 48.5% (Havana) to 72.7% (Mexico City), while among men (>102 cm) it ranged from 12.5% (Bridgetown) to 32.5% (Santiago). The associations between WC and ADL disability were “J” shaped, with higher risks of ADL disability observed above 110 cm for women in Bridgetown, Santiago, Havana, and Montevideo. The association in Sao Paulo is plateau with higher risk above 100 cm, and the association in Mexico City is closer to linear. Among men the associations were “U” (Bridgetown, Sao Paulo, and Havana), “J” shaped (Montevideo), plateau (Santiago), and closer to linear in Mexico City. When WC and BMI were analyzed together, we found that participants from Sao Paulo, Santiago, Havana, and Montevideo in the overweight or obese category with HWC were significantly more likely to report ADL disability after adjusting for all covariates.

Conclusion

The findings of this study suggest that both general and abdominal adiposity are associated with disability and support the use of WC in addition to BMI to assess risk of disability in older adults.

Introduction

The proportion of older adults has been growing dramatically in the LAC countries during the few decades, and this region now has one of the most rapidly aging populations in the developing nations (Filozof, Gonzalez, Sereday, Mazza, & Braguinsky, 2001; Santos et al., 2004). The percentage of individuals 65 years and over in the region is projected to increase from 13.9% in 2020 to 25.6% in 2040 (Kinsell & He, 2009). The increase in the prevalence of obesity in this aging population is a public health concern, not only in these developing countries but also in developed countries (Filozof et al., 2001, United Nations, 2002). The prevalence of obesity in LAC countries when assessed by BMI, calculated as weight in kilograms divided by height in meters squared (kg/m2), ranges from 13.3% to 37.6% (Al Snih et al., 2010). The rise of this trend toward obesity is expected to cause a subsequent increase in many chronic diseases, which in turn would result in an increase in disability rates (Guallar-Castillon et al., 2007, Uauy et al., 2001).

Several studies have shown that body composition changes with aging, as evidenced by an increase in fat mass and a decrease in muscle mass (Villareal et al., 2005, Zamboni et al., 2005); and that aging is associated with fat redistribution, indicated by an increase in visceral fat and a decrease in subcutaneous fat in the abdomen, thighs and calves (Zamboni et al., 2005). BMI has often been criticized as an inadequate measure of obesity among older adults due to these age-related changes in body composition (Villareal et al., 2005, Zamboni et al., 2005). WC, a measure of visceral fatness, has been recommended as a better predictor of obesity in older adults (Chen and Guo, 2008, Guallar-Castillon et al., 2007, Visscher et al., 2001).

Several studies have compared the individual and combined effect of BMI and WC on health outcomes in older adults (Angleman et al., 2006, Guallar-Castillon et al., 2007, Jacobs et al., 2010, Janssen et al., 2005). Findings from the Cardiovascular Health Study showed that WC was a positive predictor of mortality independent of BMI (Janssen et al., 2005). Similarly, Jacobs et al., using the Cancer Prevention Study II Nutrition Cohort, found that within all categories of BMI, higher WC was positively associated with mortality (Jacobs et al., 2010). Barcelo et al. reported that WC was more clearly associated than BMI with prevalence of diabetes (Barceló et al., 2007). Cross-sectional and longitudinal studies have shown that WC is a better predictor of disability than BMI. For example, in a prospective cohort study of elderly Spanish individuals, WC was a better 2-year predictor of disability, independent of BMI (Guallar-Castillon et al., 2007). Angleman et al. found that WC was the best predictor of disability outcomes compared with BMI, weight, hip circumference and waist–hip ratio (Angleman et al., 2006).

Current guidelines with respect to obesity recommend measuring WC in persons with a BMI between 25 and 35 kg/m2 using the cutoff points of 102 cm in men and 88 cm in women to define abdominal obesity and identify persons at risk for disease (National Heart, 2002). Little is known about the association between HWC and disability among older adults in LAC. The objectives of this study are to investigate the association between HWC and disability, and the association of the combined effect of BMI and WC on disability among older adults from six Latin American cities participating in the SABE study.

Section snippets

Sample

We examined data from the SABE study (Albala et al., 2005). The SABE study is a cross-sectional representative survey of non-institutionalized older adults living in Buenos Aires (Argentina), Bridgetown (Barbados), Sao Paulo (Brazil), Santiago (Chile), Havana (Cuba), Mexico City (Mexico) and Montevideo (Uruguay) (Palloni et al., 2002, Peláez et al., 2003). Participants were selected based on a multistage cluster sampling design. In each city, the primary sampling unit (PSU) was a cluster of

Results

Table 1 presents the descriptive characteristics for older women by WC (low ≤88 and high >88 cm) for each city. The prevalence of HWC ranged from 48.5% (Havana) to 72.7% (Mexico City). Women with HWC were younger than those with LWC across all cities. Women from Mexico City and Montevideo who had HWC were significantly more likely to have lower level of education, and those from Havana and Montevideo were significantly more likely to be married when compared with those with LWC. The prevalence

Discussion

This study examined the prevalence of HWC (>88 cm in women and >102 cm in men) and the combined effect of BMI and WC on ADL disability among older adults from six LAC cities. The highest prevalence of HWC was found in Mexico City for women and Santiago for men. The highest prevalence of ADL disability among those with HWC was seen in men and women from Santiago. The association between WC and ADL disability was mostly “J” shaped among women and “U” or “J” shaped among men. When examining the

Conclusions

We found a “J” or “U” shaped association between WC and ADL disability, and that overweight and obese participants with HWC have significant odds of ADL disability. The findings of this study suggest that both general and abdominal adiposity are associated with disability and support the use of WC in addition to BMI to assess risk of disability in older adults.

Conflict of interest statement

None.

Funding

This study is supported by grants R03-AG029959, R01-AG010939, R24-HD065702, and by the UTMB Claude D. Pepper Older Americans Independence Center Grant # P30 AG024832 from the NIH/National Institute of Aging, U.S. Dr. Al Snih was supported by a research career development award (K12HD052023: Building Interdisciplinary Research Careers in Women's Health Program – BIRCWH) from the Eunice Kennedy Shriver National Institute of Child Health & Human Development; the National Institute of Allergy and

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