EAL

UWL: Association With Outcomes (2009)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To evaluate anthropometric measures and nutritional status as they relate to age and gender in healthy elderly people (age greater than 60 years) with no chronic disease diagnosed in the last 20 years and no hospital admission in the two months prior to assessment.

Inclusion Criteria:

Data from more than 16,000 randomly-selected participants in a larger study were examined and data from 1,968 participants selected because they reported:

No chronic disease diagnosed in the past 20 years
No hospital admission up to two months prior to the survey.

Exclusion Criteria:

Diabetes mellitus
Dyslipidemia
Gout
Arterial hypertension
Heart attack
Vascular brain events
Chronic pulmonary obstructive disease
Mental disorders
Liver cirrhosis
Gallbladder lithiasis
Gastric or duodenal ulcer
Chronic renal failure
Kidney lithiasis
Prostate hyperplasia
Hip or femur fracture
Other fractures

Description of Study Protocol:

Recruitment

Data are from a larger study in which participants were randomly selected beneficiaries of the Mexican Social Security Institute. A two-stage recruitment process was used with two family medicine units from each state randomly selected, then two exam rooms within each unit were selected. Households in the areas covered by the consulting rooms were visited door to door to find people aged 60 or over who were covered by IMSS.

Design

Cross-sectional analysis of cohort data. Data from the original study were analyzed and patients selected according to specified inclusion and exclusion criteria.

Statistical Analysis

Frequency and distribution of the characteristics of the sample were analyzed using ANOVA with T-tests used for between group analysis.

Data Collection Summary:

Timing of Measurements

Single anthropometric measurements were taken by trained staff at the subjects' home.

Dependent Variables

Weight measured on a portable scale
Height measured with subject standing against a wall
Body circumferences (mid-brachial, calf, waist and hip circumferences) using a non-flexible tape with subjects standing
Knee-heel length using Chumlea's technique
Body-mass index (BMI) was estimated by dividing weight in kilograms by height in meters².Individuals were considered malnourished if BMI was less than 18.5, normal if 18.5 to 24.9 and overweight if greater than or equal to 25.
Waist-to-hip ratio was estimated by dividing waist circumference by hip circumference. The threshold weight to hip ratio was 0.85 or higher for women and 1.00 or more for men, above which superior distribution of adipose tissue was considered.

Independent Variables

Age
Gender.

Control Variables

Age greater than 60 years
Absence of chronic disease or hospitalization within the prior two months.

Description of Actual Data Sample:

Initial N: Data from 16,084 individuals were reviewed and 1,968 records met the inclusion criteria
Attrition (final N): 1,968 subjects ( 870 females and 1,098 males)
Age: Mean age was 68.6±7.0 years; 67.8±7.0 for women and 69.4±6.8 for men
Location: Mexico.

Summary of Results:

Anthropometric Values According to Age and Gender Participating Subjects
	Women	Men	Total		Women	Men	Total
	Mean±SD	Mean±SD	Mean±SD		Mean±SD	Mean±SD	Mean±SD
Weight (kg)^abc				Waist to Hip Ratio (WHR)^c
60 to 64^d	64.3±11.7	71.8±12.5	67.8±12.6	60 to 64^d	0.89±0.08	0.95±0.06	0.92±0.08
65 to 69^d	63.6±10.4	71.8±11.9	68.6±12.0	65 to 69^d	0.90±0.07	0.94±0.05	0.93±0.06
70 to 74^d	61.9±11.1	69.6±12.2	66.6±12.3	70 to 74^d	0.91±0.10	0.95±0.06	0.93±0.08
75 to 79^d	58.2±11.7	67.7±12.9	64.1±13.2	75 to 79^d	0.89±0.07	0.95±0.06	0.93±0.07
80 or more^d	57.4±12.2	66.1±10.4	62.8±11.9	80 or more^d	0.91±0.10	0.96±0.07	0.94±0.09
Total^d	62.7±11.6	70.3±12.3	66.9±12.6	Total^d	0.90±0.08	0.95±0.06	0.93±0.07
Height (cm)^abc				Waist Circumference (cm)^c
60 to 64^d	153.9±7.2	163.8±7.5	158.5±8.8	60 to 64	93.8±13.8	95.5±11.6	94.5±12.9
65 to 69^d	152.6±7.6	163.8±8.1	159.4±9.6	65 to 69	95.3±14.0	96.1±10.8	95.8±12.2
70 to 74^d	151.3±7.1	163.3±8.7	158.6±10.0	70 to 74	93.2±11.9	95.4±10.8	94.5±11.3
75 to 79^d	150.5±7.4	161.3±10.1	157.3±10.5	75 to 79	91.1±11.5	94.1±12.5	93.0±12.2
80 or more^d	150.4±8.2	162.0±9.4	157.5±10.6	80 or more	92.8±15.1	95.7±12.2	94.6±13.4
Total^d	152.6±7.5	163.2±8.5	158.5±9.6	Total^d	93.7±13.4	95.5±11.4	94.7±12.4
BMI (kg/m²)^abc				Hip Circumference (cm)^a^c
60 to 64	27.1±4.5	26.8±4.4	26.9±4.4	60 to 64^d	104.8±12.8	100.4±10.3	102.8±11.9
65 to 69^d	27.3±4.2	26.7±3.9	26.9±4.1	65 to 69^d	105.3±13.0	101.1±9.6	102.8±11.2
70 to 74	27.0±4.4	26.0±4.1	26.4±4.3	70 to 74^d	102.5±11.5	100.1±9.6	101.1±10.5
75 to 79	25.5±4.2	26.0±5.0	25.8±4.8	75 to 79	101.6±10.9	98.8±10.4	99.9±10.6
80 or more	25.2±4.4	25.3±5.0	25.3±4.7	80 or more	101.6±14.5	98.8±10.2	99.8±12.1
Total^d	26.8±4.4	26.4±4.4	26.6±4.4	Total^d	104.0±12.6	100.2±10.0	101.9±11.4
Mid-brachial Circumference (cm)^abc				Elbow Amplitude (cm)^abc
60 to 64	30.5±4.0	30.8±4.0	30.7±4.0	60 to 64	27.8±12.3	29.4±11.5	28.6±11.9
65 to 69	29.8±4.5	30.4±4.1	30.1±4.3	65 to 69	28.6±11.8	28.6±12.5	28.6±12.2
70 to 74	30.1±4.2	29.5±3.8	29.7±4.0	70 to 74	24.6±10.3	26.0±13.7	25.4±12.5
75 to 79	29.2±4.7	28.6±3.7	28.8±4.1	75 to 79	25.3±13.7	25.8±14.1	25.6±13.9
80 or more	27.3±5.7	28.8±3.9	28.2±4.7	80 or more	23.9±11.9	24.5±12.0	24.3±11.9
Total	29.9±4.4	29.9±4.0	29.9±4.2	Total^d	27.0±12.1	27.6±12.7	27.3±12.5
Calf Circumference (cm)^a				Knee-heel Length (cm)
60 to 64	35.2±8.1	35.8±8.0	35.5±8.1	60 to 64^d	46.2±4.4	50.0±5.6	47.9±5.3
65 to 69	34.8±9.2	35.6±8.6	35.3±8.8	65 to 69^d	46.3±3.5	49.5±5.9	48.2±5.4
70 to 74	33.7±7.4	34.9±9.1	34.4±8.5	70 to 74^d	46.4±4.1	50.0±4.1	48.6±4.5
75 to 79	34.1±9.2	33.6±8.7	33.8±8.9	75 to 79^d	46.6±4.0	50.2±5.0	48.8±4.9
80 or more^d	31.3±4.2	34.7±8.7	33.4±7.5	80 or more^d	46.3±4.9	50.0±3.9	48.6±4.6
Total	34.5±8.3	35.2±8.6	34.9±8.4	Total^d	46.3±4.1	49.9±5.2	48.3±5.1
^aSignificant differences between age range in women (P<0.05). ^bSignificant differences between age range in men (P<0.05). ^cSignificant differences between age range (P<0.05). ^dSignificant differences between women and men (P<0.05).
Sánchez-García et al. BMC Public Health. 2007; 7: 2. doi:10.1186/1471-2458-7-2

Body Mass Index (BMI) According to Age and Gender in 60-year-old-or-older Participating Subjects
		Edad
		60 to 64 Years		65 to 69 Years		70 to 74 Years		75 to 79 Years		80 Years or more		Total
Sex	BMI	N	%	N	%	N	%	N	%	N	%	N	%
Women	<18.5	4	1.1	2	1.0	4	2.8	2	2.2	2	3.4	14	1.6
	18.5 to 24.99	123	33.2	57	27.3	42	29.8	39	42.9	26	44.8	287	33.0
	≥25	244	65.8	150	71.8	95	67.4	50	54.9	30	51.7	569	65.4
Men	<18.5	3	0.9	2	0.6	3	1.4	2	1.3	3	3.2	13	1.2
	18.5 to 24.99	110	34.7	117	36.7	91	41.9	66	43.4	43	46.2	427	38.9
	≥25	204	64.4	200	62.7	123	56.7	84	55.3	47	50.5	658	59.9
Total	<18.5	7	1.0	4	0.8	7	2.0	4	1.6	5	3.3	27	1.4
	18.5 to 24.99	233	33.9	174	33.0	133	37.2	105	43.2	69	45.7	714	36.3
	≥25	448	65.1	350	66.3	218	60.9	134	55.1	77	51.0	1227	62.3
Sánchez-García et al. BMC Public Health. 2007; 7: 2. doi:10.1186/1471-2458-7-2

Distribution of Body Mass Index (BMI) and Waist-to-hip ratio (WHR) Participating Subjects
WHR	BMI
	<18.5		18.5 – 24.99		≥25
Women	N		N		N
0.85 or more	5	35.7	80	27.9	144	25.3
Less than 0.85	9	64.3	207	72.1	425	74.7
Total	14	100.0	287	100.0	569	100.0
Men
1.00 or more	1	7.7	57	13.3	152	23.1
Less than 1.00	12	92.3	370	86.7	506	76.9
Total	13	100.0	427	100.0	658	100.0
Sánchez-García et al. BMC Public Health. 2007; 7: 2. doi:10.1186/1471-2458-7-2

Other Findings

The average weights were 62.7kg for women and 70.3kg for men (P<0.05), and the mean heights were 1.52m for women and 1.63m for men (P<0.05)
Age-related changes in anthropometric values were identified
BMI values indicated that 62.3% of the population was overweight, and 73.6% of women and 16.5% of men had high fat tissue distribution.

Author Conclusion:

Findings suggest that applying the BMI thresholds that identify being overweight in the general adult population may lead to an overestimation in the number of overweight elderly. Similar problems appear to exist when assessing waist circumference and WHR values. Prospective studies are required to determine the associations between health and BMI, waist circumference and WHR in the elderly.

Funding Source:

Government:

National Council of Science and Technology in Mexico, Mexican Institute of Social Security

Reviewer Comments:

Study population represented 12.2% of the original number in the national survey in urban area beneficiaries of the Mexican Institute of Social Security. The authors reported the prevalence of BMI less than 18.5 as an indicator of malnutrition. There was no "gold" standard used to verify the existence of malnutrition.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	N/A
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	N/A

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		???
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	Yes
	2.2.	Were criteria applied equally to all study groups?	N/A
	2.3.	Were health, demographics, and other characteristics of subjects described?	Yes
	2.4.	Were the subjects/patients a representative sample of the relevant population?	???
3.	Were study groups comparable?		N/A
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	N/A
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	N/A
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	N/A
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	N/A
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		???
	4.1.	Were follow-up methods described and the same for all groups?	N/A
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	N/A
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	???
	4.4.	Were reasons for withdrawals similar across groups?	???
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		???
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	???
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	???
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		Yes
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	Yes
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	N/A
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	N/A
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	N/A
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	N/A
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		???
	7.1.	Were primary and secondary endpoints described and relevant to the question?	N/A
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	N/A
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	???
	7.5.	Was the measurement of effect at an appropriate level of precision?	???
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	Yes
	7.7.	Were the measurements conducted consistently across groups?	N/A
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	Yes
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	N/A
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	N/A
	8.6.	Was clinical significance as well as statistical significance reported?	Yes
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	N/A
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	Yes