Elisa Fabbri1,2, Toshiko Tanaka1, Yang An1, Marco Zoli2, Stefania Bandinelli3, Jack M Guralnik4, Eleanor M Simonsick1, Cynthia M Boyd5, Stephanie A Studenski1, Tamara B Harris6, Luigi Ferrucci1. 1. Intramural Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland. 2. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 3. Department of Geriatric Medicine, Azienda Sanitaria di Firenze, Florence, Italy. 4. Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland. 5. Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland. 6. Geriatric Epidemiology Section, Laboratory of Epidemiology, Demography, and Biometry, National Institutes of Health, Bethesda, Maryland.
Abstract
OBJECTIVES: To determine whether weight loss in older adults may be a marker of impending burden of multimorbidity regardless of initial weight, testing the hypotheses that obesity but not overweight in elderly adults is associated with greater number of diseases than normal weight and that obese older adults who lose weight over time have the greatest burden of multimorbidity. DESIGN: Longitudinal cohort study (Invecchiare in Chianti Study). SETTING: Community. PARTICIPANTS: Individuals aged 60 and older at baseline followed for an average of 4 years (N = 1,025). MEASUREMENTS: Multimorbidity was measured as number of diagnosed diseases. Baseline body mass index (BMI) was categorized as normal weight (<25.0 kg/m(2)), overweight (25.0-29.9 kg/m(2)), and obese (≥30.0 kg/m(2)). Loss of weight was defined as decrease over time in BMI of at least 0.15 kg/m(2) per year. Age, sex, and education were covariates. RESULTS: Baseline obesity was cross-sectionally associated with high multimorbidity and greater longitudinal increase of multimorbidity than normal weight (P = .005) and overweight (P < .001). Moreover, obese participants who lost weight over follow-up had a significantly greater increase in multimorbidity than other participants, including obese participants who maintained or gained weight over time (P = .005). In nonobese participants, changes in weight had no effect on changes in multimorbidity over time. Sensitivity analyses confirmed that one specific disease did not drive the association and that competing mortality did not bias the association. CONCLUSION: Loss of weight in obese older persons is a strong biomarker of impending expansion of multimorbidity. Older obese individuals who lose weight should receive thoughtful medical attention.
OBJECTIVES: To determine whether weight loss in older adults may be a marker of impending burden of multimorbidity regardless of initial weight, testing the hypotheses that obesity but not overweight in elderly adults is associated with greater number of diseases than normal weight and that obese older adults who lose weight over time have the greatest burden of multimorbidity. DESIGN: Longitudinal cohort study (Invecchiare in Chianti Study). SETTING: Community. PARTICIPANTS: Individuals aged 60 and older at baseline followed for an average of 4 years (N = 1,025). MEASUREMENTS: Multimorbidity was measured as number of diagnosed diseases. Baseline body mass index (BMI) was categorized as normal weight (<25.0 kg/m(2)), overweight (25.0-29.9 kg/m(2)), and obese (≥30.0 kg/m(2)). Loss of weight was defined as decrease over time in BMI of at least 0.15 kg/m(2) per year. Age, sex, and education were covariates. RESULTS: Baseline obesity was cross-sectionally associated with high multimorbidity and greater longitudinal increase of multimorbidity than normal weight (P = .005) and overweight (P < .001). Moreover, obeseparticipants who lost weight over follow-up had a significantly greater increase in multimorbidity than other participants, including obeseparticipants who maintained or gained weight over time (P = .005). In nonobese participants, changes in weight had no effect on changes in multimorbidity over time. Sensitivity analyses confirmed that one specific disease did not drive the association and that competing mortality did not bias the association. CONCLUSION: Loss of weight in obese older persons is a strong biomarker of impending expansion of multimorbidity. Older obese individuals who lose weight should receive thoughtful medical attention.
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