Unintended Weight Loss in Older Adults

UWL: Association With Outcomes (2009)

Citation:

Sanchez-Garcia S, Garcia-Pena C, Duque-Lopez MX, Juarez-Cedillo T, Cortes-Nunez AR, Reyes-Beaman S. Anthropometric measures and nutritional status in a healthy elderly population. BMC Public Health. 2007; 7: 2-11.

PubMed ID: 17201919
 
Study Design:
Cross-Sectional Study
Class:
D - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
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 64d
 
64.3±11.7
 
71.8±12.5
 
67.8±12.6
 
60 to 64d
 
0.89±0.08
 
0.95±0.06
 
0.92±0.08
 
65 to 69d
 
63.6±10.4
 
71.8±11.9
 
68.6±12.0
 
65 to 69d
 
0.90±0.07
 
0.94±0.05
 
0.93±0.06
 
70 to 74d
 
61.9±11.1
 
69.6±12.2
 
66.6±12.3
 
70 to 74d
 
0.91±0.10
 
0.95±0.06
 
0.93±0.08
 
75 to 79d
 
58.2±11.7
 
67.7±12.9
 
64.1±13.2
 
75 to 79d
 
0.89±0.07
 
0.95±0.06
 
0.93±0.07
 
80 or mored
 
57.4±12.2
 
66.1±10.4
 
62.8±11.9
 
80 or mored
 
0.91±0.10
 
0.96±0.07
 
0.94±0.09
 
Totald
 
62.7±11.6
 
70.3±12.3
 
66.9±12.6
 
Totald
 
0.90±0.08
 
0.95±0.06
 
0.93±0.07
 
Height (cm)abc
 

 

 

 
Waist Circumference (cm)c
 

 

 

 
60 to 64d
 
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 69d
 
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 74d
 
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 79d
 
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 mored
 
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
 
Totald
 
152.6±7.5
 
163.2±8.5
 
158.5±9.6
 
Totald
 
93.7±13.4
 
95.5±11.4
 
94.7±12.4
 
BMI (kg/m2)abc
 

 

 

 
Hip Circumference (cm)ac
 

 

 

 
60 to 64
 
27.1±4.5
 
26.8±4.4
 
26.9±4.4
 
60 to 64d
 
104.8±12.8
 
100.4±10.3
 
102.8±11.9
 
65 to 69d
 
27.3±4.2
 
26.7±3.9
 
26.9±4.1
 
65 to 69d
 
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 74d
 
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
 
Totald
 
26.8±4.4
 
26.4±4.4
 
26.6±4.4
 
Totald
 
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
 
Totald
 
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 64d
 
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 69d
 
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 74d
 
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 79d
 
46.6±4.0
 
50.2±5.0
 
48.8±4.9
 
80 or mored
 
31.3±4.2
 
34.7±8.7
 
33.4±7.5
 
80 or mored
 
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
 
Totald
 
46.3±4.1
 
49.9±5.2
 
48.3±5.1
 

a Significant differences between age range in women (P<0.05).

b Significant differences between age range in men (P<0.05).

c Significant differences between age range (P<0.05).

d Significant 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