Waist circumference (WC), body mass index (BMI), and disability among older adults in Latin American and the Caribbean (LAC)
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
References (30)
- et al.
Waist circumference BMI and the prevalence of self-reported diabetes among the elderly of the United States and six cities of Latin America and the Caribbean
Diabetes Research and Clinical Practice
(2007) - et al.
Anthropomertric measurements in the elderly population of Santiago
Chile. Nutrition
(2004) - et al.
Obesity trends in Latin America: Transiting from under- to overweight
Journal of Nutrition
(2001) - et al.
Obesity and disability: Relation among older adults living in Latin America and the Caribbean
American Journal of Epidemiology
(2010) - et al.
The Health, Well-Being, and Aging (“SABE”) survey: Methodology applied and profile of the study population
Revista Panamericana de Salud Publica
(2005) - et al.
The role of waist circumference in predicting disability in periretirement age adults
International Journal of Obesity
(2006) - et al.
Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men
Diabetes Care
(1994) - et al.
Obesity and functional disability in elderly Americans
Journal of the American Geriatrics Society
(2008) Population, ageing and development
(2004)- et al.
Obesity prevalence and trends in Latin-American countries
Obesity Reviews
(2001)
Waist circumference as a predictor of disability among older adults
Obesity
Agreement between questionnaire data and medical records of chronic diseases in middle-aged and elderly Finnish men and women
American Journal of Epidemiology
Overweight and obesity over the adult life course and incident mobility limitation in older adults: The health, aging and body composition study
American Journal of Epidemiology
Waist circumference and all-cause mortality in a large US cohort
Archives of Internal Medicine
Body mass index is inversely related to mortality in older people after adjustment for waist circumference
Journal of the American Geriatrics Society
Cited by (33)
The combination of dynapenia and abdominal obesity as a risk factor for worse trajectories of IADL disability among older adults
2018, Clinical NutritionCitation Excerpt :Model 2 was additionally adjusted for socioeconomic covariates. Model 3 was additionally adjusted for behavioral characteristics, Model 4 was additionally adjusted for clinical conditions, and Model 5 was additionally adjusted for BMI since both BMI and waist circumference have been associated with disability [36,37]. The time interactions represent the difference in the annual rate of change (slope) between particular dynapenic abdominal obese group and the reference (neither dynapenia nor abdominal obesity) in disability.
Prevalence of abdominal obesity and its association with cardio metabolic risk factors among older adults in Ecuador
2017, Diabetes and Metabolic Syndrome: Clinical Research and ReviewsCitation Excerpt :In men, abdominal obesity prevalence rates were significantly lower than those described in Latin America cities and among older adults in the U.S. In fact, only older men in Havana and Bridgetown had slightly lower rates than their counterparts in Ecuador [5,23]. The geographic difference in the prevalence of abdominal obesity among older men described in these studies may be explained in part by the racial distribution of the study populations and waist circumference cutoffs used to define obesity.
Anthropometric, functional capacity, and oxidative stress changes in Brazilian community-living elderly subjects. A longitudinal study
2016, Archives of Gerontology and GeriatricsAssociation between changes in waist circumferences and disability among older adults: WHO-INDEPTH study on global ageing and adult health (SAGE) in Indonesia
2019, Obesity Research and Clinical PracticeCitation Excerpt :As medical discoveries and advanced technology in chronic diseases have increased people’s life expectancy, chronic diseases among older people are closely related to disability [9]. Several studies have demonstrated the association between obesity in older people with a broad range of diseases, complications, and disabilities [8,14,16,17,19,26,30]. In Indonesia, the national basic health survey showed that in 2013 the prevalence of disability among older persons aged 55–64, 65–74 and ≥75 years was 19%, 35% and 56%, respectively [32].
Rural-urban differences in the association between disability and body mass index among the oldest-old in China
2019, Archives of Gerontology and GeriatricsCitation Excerpt :Body mass index (BMI) is usually used as an indicator of general obesity status (Yin et al., 2014). There are many evidences certificate that obesity is associated with disability in developed countries (Alley & Chang, 2007; Backholer et al. 2012a; Launer, Harris, Rumpel, & Madans, 1994; Nam, Kuo, Markides, & Al Snih, 2012; Wee, Huskey, & Ngo, 2011). However, few studies pay attention to relationship between them in developing countries and among the oldest-old.