The Obesity Paradox in the Elderly: Potential Mechanisms and Clinical Implications

Clinics in Geriatric Medicine

Volumn 25, Issue 4, 2009, Pages 643-659

  Oreopoulos, Antigone ^a   Kalantar Zadeh, Kamyar ^b   Sharma, Arya M ^a   Fonarow, Gregg C ^c  

^a UNIVERSITY OF ALBERTA   (Canada)

^b HARBOR UCLA MEDICAL CENTER   (United States)

^c UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

Body composition; Elderly; Epidemiology; Mortality; Obesity

Indexed keywords

AGE DISTRIBUTION; AGED; AGING; BODY COMPOSITION; BODY FAT DISTRIBUTION; BODY MASS; CALORIC INTAKE; COGNITIVE DEFECT; ELDERLY CARE; EXERCISE; FITNESS; FUNCTIONAL STATUS; HIGH RISK POPULATION; HUMAN; MEDICAL DECISION MAKING; MORBIDITY; MORTALITY; OBESITY; PATHOPHYSIOLOGY; PHYSICAL ACTIVITY; QUALITY OF LIFE; REVIEW; WEIGHT REDUCTION;

ACTIVITIES OF DAILY LIVING; ADULT; AGE FACTORS; AGED; AGED, 80 AND OVER; BODY MASS INDEX; CARDIOVASCULAR DISEASES; CAUSE OF DEATH; CROSS-SECTIONAL STUDIES; FEMALE; HUMANS; MALE; MIDDLE AGED; NUTRITION SURVEYS; OBESITY; PHYSICAL FITNESS; QUALITY OF LIFE; RISK; SEX FACTORS; SURVIVAL RATE; WEIGHT LOSS;

EID: 70449753776     PISSN: 07490690     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.cger.2009.07.005     Document Type: Review

References (108)

1. Bray G.A., and Macdiarmid J. The epidemic of obesity. West J Med 172 (2000) 78-79
2. Must A., Spadano J., Coakley E.H., et al. The disease burden associated with overweight and obesity. JAMA 282 (1999) 1523-1529
3. Calle E., Thun M.J., Petrelli J.M., et al. Body mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 341 (1999) 1097-1105
4. Pardo Silva M.C., De Laet C., Nusselder W.J., et al. Adult obesity and number of years lived with and without cardiovascular disease. Obesity (Silver Spring) 14 (2006) 1264-1273
5. Ogden C.L., Carroll M.D., Curtin L.R., et al. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA 295 (2006) 1549-1555
6. Sokar-Todd H.B., and Sharma A.M. Obesity research in Canada: literature overview of the last 3 decades. Obes Res 12 (2004) 1547-1553
7. Flegal K.M., Carroll M.D., Ogden C.L., et al. Prevalence and trends in obesity among US adults, 1999-2000. JAMA 288 (2002) 1723-1727
8. Yusuf S. The global problem of cardiovascular disease. Int J Clin Pract Suppl 94 (1998) 3-6
9. Haslam D.W., and James W.P. Obesity. Lancet 366 (2005) 1197-1209
10. Organization for Economic Co-operation and Development (OECD) Factbook 2008. Economic, environmental and social statistics (2008), OECD Publishing, Paris (France)
11. Moore E., and Rosenberg M. Canada's elderly population: the challenges of diversity. Can Geogr 45 (2001) 145
12. Projections of the population by selected age groups and sex for the United States: 2010 to 2050. Available at: http://www.census.gov/population/www/projections/summarytables.html. Accessed April 1, 2009.
13. Losonczy K., Harris T., Coroni-Huntley J., et al. Does weight loss from middle age to old age explain the inverse weight mortality relation in old age?. Am J Epidemiol 141 (1995) 312-321
14. Thorpe R., and Ferraro K. Aging, obesity and mortality. Res Aging 26 (2004) 108-129
15. Folsom A.R., Kushi L.H., Anderson K.E., et al. Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women's Health Study. Arch Intern Med 160 (2000) 2117-2128
16. Reuser M., Bonneux L., and Willekens F. The burden of mortality of obesity at middle and old age is small: a life table analysis of the US Health and Retirement Survey. Eur J Epidemiol 23 (2008) 601-607
17. Bender R., Jockel K.H., Trautner C., et al. Effect of age on excess mortality in obesity. JAMA 281 (1999) 1498-1504
18. Dey D.K., Rothenberg E., Sundh V., et al. Body mass index, weight change and mortality in the elderly: a 15 y longitudinal population study of 70 y olds. Eur J Clin Nutr 55 (2001) 482-492
19. Diehr P., O'Meara E.S., Fitzpatrick A., et al. Weight, mortality, years of healthy life, and active life expectancy in older adults. J Am Geriatr Soc 56 (2008) 76-83
20. Grabowski D., and Ellis J. High body mass index does not predict mortality in older people: an analysis of the Longitudinal Study of Aging. J Am Geriatr Soc 49 (2001) 968-979
21. Grabowski D.C., Campbell C.M., and Ellis J.E. Obesity and mortality in elderly nursing home residents. J Gerontol A Biol Sci Med Sci 60 (2005) 1184-1189
22. Landi F., Onder G., Gambassi G., et al. Body mass index and mortality among hospitalized patients. Arch Intern Med 160 (2000) 2641-2644
23. Allison D., Gallagher D., Heo M., et al. Body mass index and all-cause mortality among people age 70 and over: the Longitudinal Study of Aging. Int J Obes 21 (1997) 424-431
24. McAuley P., Myers J., Abella J., et al. Body mass, fitness and survival in veteran patients: another obesity paradox?. Am J Med 120 (2007) 518-524
25. Menotti A., Kromhout D., Nissinen A., et al. Short-term all-cause mortality and its determinants in elderly male populations in Finland, The Netherlands, and Italy: the FINE Study. Finland, Italy, Netherlands Elderly Study. Prev Med 25 (1996) 319-326
26. Al Snih S., Ottenbacher K.J., Markides K.S., et al. The effect of obesity on disability vs mortality in older Americans. Arch Intern Med 167 (2007) 774-780
27. Wassertheil-Smoller S., Fann C., Allman R.M., et al. Relation of low body mass to death and stroke in the systolic hypertension in the elderly program. The SHEP Cooperative Research Group. Arch Intern Med 160 (2000) 494-500
28. Kinney E., and Caldwall J. Relationship between body weight and mortality in men aged 75 years and older. South Med J 83 (1990) 1256-1258
29. Weiss A., Beloosesky Y., Boaz M., et al. Body mass index is inversely related to mortality in elderly subjects. J Gen Intern Med 23 (2007) 19-24
30. Takata Y., Ansai T., Soh I., et al. Association between body mass index and mortality in an 80-year-old population. J Am Geriatr Soc 55 (2007) 913-917
31. 2) was associated with the most favorable mortality in older women. Am J Public Health 97 (2007) 93-98
32. Mazza A., Zamboni S., Tikhonoff V., et al. Body mass index and mortality in elderly men and women from general population: the experience of Cardiovascular Study in the Elderly (CASTEL). Gerontology 53 (2007) 36-45
33. Woo J., Ho S., Yu A., et al. Is waist circumference a useful measure in predicting health outcomes in the elderly?. Int J Obes 26 (2002) 1349-1355
34. Price G.M., Uauy R., Breeze E., et al. Weight, shape, and mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death. Am J Clin Nutr 84 (2006) 449-460
35. Heitmann B.L., Erikson H., Ellsinger B.M., et al. Mortality associated with body fat, fat-free mass and body mass index among 60-year-old Swedish men-a 22-year follow-up. The study of men born in 1913. Int J Obes Relat Metab Disord 24 (2000) 33-37
36. Janssen I., and Bacon E. Effect of current and midlife obesity status on mortality risk in the elderly. Obesity (Silver Spring) 16 (2008) 2504-2509
37. Lahmann P.H., Lissner L., Gullberg B., et al. A prospective study of adiposity and all-cause mortality: the Malmo Diet and Cancer Study. Obes Res 10 (2002) 361-369
38. Corrada M.M., Kawas C.H., Mozaffar F., et al. Association of body mass index and weight change with all-cause mortality in the elderly. Am J Epidemiol 163 (2006) 938-949
39. McTigue K.M., Hess R., and Ziouras J. Obesity in older adults: a systematic review of the evidence for diagnosis and treatment. Obesity (Silver Spring) 14 (2006) 1485-1497
40. Bales C., and Buhr G. Is obesity bad for older persons? A systematic review of the pros and cons of weight reduction in later life. J Am Med Dir Assoc 9 (2008) 302-312
41. Heiat A., Vaccarino V., and Krumholz H.M. An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons. Arch Intern Med 161 (2001) 1194-1203
42. Zamboni M., Mazzali G., Zoico E., et al. Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes 29 (2005) 1011-1029
43. Heiat A. Impact of age on definition of standards for ideal weight. Prev Cardiol 6 (2003) 104-107
44. Villareal D.T., Apovian C.M., Kushner R.F., et al. Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, the Obesity Society. Obes Res 13 (2005) 1849-1863
45. Kalantar-Zadeh K., Horwich T.B., Oreopoulos A., et al. Risk factor paradox in wasting diseases. Curr Opin Clin Nutr Metab Care 10 (2007) 433-442
46. Kalantar-Zadeh K., Kilpatrick R.D., Kuwae N., et al. Reverse epidemiology: a spurious hypothesis or a hardcore reality?. Blood Purif 23 1 (2005) 57-63
47. Smith Jr. S.C., Allen J., Blair S.N., et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol 47 (2006) 2130-2139
48. Pi-Sunyer F.X. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults (1998), National Institutes of Health, Bethesda (MD) Publication NIH 98-4083
49. Sorkin J.D., Muller D.C., and Andres R. Longitudinal change in height of men and women: implications for interpretation of the body mass index: the Baltimore Longitudinal Study of Aging. Am J Epidemiol 150 (1999) 969-977
50. Elia M. Organ and tissue contribution to metabolic rate (1992), Raven Press, New York
51. Baumgartner R.N., Heymsfield S.B., and Roche A.F. Human body composition and the epidemiology of chronic disease. Obes Res 3 (1995) 73-95
52. Villareal D.T., Banks M., Siener C., et al. Physical frailty and body composition in obese elderly men and women. Obes Res 12 (2004) 913-920
53. Zamboni M., Armellini F., Harris T., et al. Effects of age on body fat distribution and cardiovascular risk factors in women. Am J Clin Nutr 66 (1997) 111-115
54. Bjorntorp P. Portal adipose tissue as a generator of risk factors for cardiovascular disease and diabetes. Arteriosclerosis 10 (1990) 493-496
55. Turcato E., Bosello O., Di Francesco V., et al. Waist circumference and abdominal sagittal diameter as surrogates of body fat distribution in the elderly: their relation with cardiovascular risk factors. Int J Obes Relat Metab Disord 24 (2000) 1005-1010
56. Harris T.B., Visser M., Everhart J., et al. Waist circumference and sagittal diameter reflect total body fat better than visceral fat in older men and women. The Health, Aging and Body Composition Study. Ann N Y Acad Sci 904 (2000) 462-473
57. Segal K., Dunaif A., Gutin B., et al. Body composition, not body weight, is related to cardiovascular disease risk factors and sex hormone levels in men. J Clin Invest 80 (1987) 1050-1055
58. Andres R., Elahi D., Tobin J.D., et al. Impact of age on weight goals. Ann Intern Med 103 (1985) 1030-1033
59. Hallfrisch J., Muller D., Drinkwater D., et al. Continuing diet trends in men: the Baltimore Longitudinal Study of Aging (1961-1987). J Gerontol 45 (1990) M186-M191
60. Elia M., Ritz P., and Stubbs R.J. Total energy expenditure in the elderly. Eur J Clin Nutr 54 Suppl 3 (2000) S92-103
61. Corpas E., Harman S.M., and Blackman M.R. Human growth hormone and human aging. Endocr Rev 14 (1993) 20-39
62. Matsumoto A.M. Andropause: clinical implications of the decline in serum testosterone levels with aging in men. J Gerontol A Biol Sci Med Sci 57 (2002) M76-M99
63. Moller N., O'Brien P., and Nair K.S. Disruption of the relationship between fat content and leptin levels with aging in humans. J Clin Endocrinol Metab 83 (1998) 931-934
64. Fontaine K., Redden D., Wang C., et al. Years of life lost due to obesity. JAMA 289 (2003) 187-193
65. Stevens J., Cai J., Pamuk E.R., et al. The effect of age on the association between body-mass index and mortality. N Engl J Med 338 (1998) 1-7
66. Jee S.H., Sull J.W., Park J., et al. Body-mass index and mortality in Korean men and women. N Engl J Med 355 (2006) 779-787
67. Su D. Body mass index and old-age survival: a comparative study between the Union Army Records and the NHANES-I Epidemiological Follow-Up Sample. Am J Hum Biol 17 (2005) 341-354
68. Janssen I., and Mark A.E. Elevated body mass index and mortality risk in the elderly. Obes Rev 8 (2007) 41-59
69. Wannamethee S.G., Shaper A.G., Lennon L., et al. Decreased muscle mass and increased central adiposity are independently related to mortality in older men. Am J Clin Nutr 86 (2007) 1339-1346
70. Janssen I., Katzmarzyk P., and Ross R. Body mass index is inversely related to mortality in older people after adjustment for waist circumference. J Am Geriatr Soc 52 (2005) 2112-2118
71. Bigaard J., Tjonneland A., Thomsen B.L., et al. Waist circumference, BMI, smoking, and mortality in middle-aged men and women. Obes Res 11 (2003) 895-903
72. Kalmijn S., Curb J.D., Rodriguez B.L., et al. The association of body weight and anthropometry with mortality in elderly men: the Honolulu Heart Program. Int J Obes Relat Metab Disord 23 (1999) 395-402
73. Baik I., Ascherio A., Rimm E.B., et al. Adiposity and mortality in men. Am J Epidemiol 152 (2000) 264-271
74. Taylor Jr. D.H., and Ostbye T. The effect of middle- and old-age body mass index on short-term mortality in older people. J Am Geriatr Soc 49 (2001) 1319-1326
75. Yan L.L., Daviglus M.L., Liu K., et al. Midlife body mass index and hospitalization and mortality in older age. JAMA 295 (2006) 190-198
76. Adams K.F., Schatzkin A., Harris T.B., et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 355 (2006) 763-778
77. Newman A.B., Yanez D., Harris T., et al. Weight change in old age and its association with mortality. J Am Geriatr Soc 49 (2001) 1309-1318
78. Heo M., Pietrobelli A., Fontaine K.R., et al. Depressive mood and obesity in US adults: comparison and moderation by sex, age, and race. Int J Obes (Lond) 30 (2006) 513-519
79. Barberger-Gateau P., and Fabrigoule C. Disability and cognitive impairment in the elderly. Disabil Rehabil 19 (1997) 175-193
80. Sakakura K., Hoshide S., Ishikawa J., et al. Association of body mass index with cognitive function in elderly hypertensive Japanese. Am J Hypertens 21 (2008) 627-632
81. Deschamps V., Astier X., Ferry M., et al. Nutritional status of healthy elderly persons living in Dordogne, France, and relation with mortality and cognitive or functional decline. Eur J Clin Nutr 56 (2002) 305-312
82. Han C., Jo S.A., Seo J.A., et al. Adiposity parameters and cognitive function in the elderly: application of "Jolly Fat" hypothesis to cognition. Arch Gerontol Geriatr 49 (2009) e133-e138
83. Felson D.T., Zhang Y., Hannan M.T., et al. Effects of weight and body mass index on bone mineral density in men and women: the Framingham study. J Bone Miner Res 8 (1993) 567-573
84. Schoptt A., Cormier C., Hans D., et al. How hip and whole-body bone mineral density predict hip fracture in elderly women: the EPIDOS prospective study. Osteoporos Int 8 (1998) 247-254
85. Imbeault P., Tremblay A., Simoneau J.A., et al. Weight loss-induced rise in plasma pollutant is associated with reduced skeletal muscle oxidative capacity. Am J Physiol Endocrinol Metab 282 (2002) E574-E579
86. Nelson K.J., Coulston A.M., Sucher K.P., et al. Prevalence of malnutrition in the elderly admitted to long-term-care facilities. J Am Diet Assoc 93 (1993) 459-461
87. Chlebowski R.T., Grosvenor M., Lillington L., et al. Dietary intake and counseling, weight maintenance, and the course of HIV infection. J Am Diet Assoc 95 (1995) 428-432 [quiz 433-435]
88. Yeh S., Wu S.Y., Levine D.M., et al. Quality of life and stimulation of weight gain after treatment with megestrol acetate: correlation between cytokine levels and nutritional status, appetite in geriatric patients with wasting syndrome. J Nutr Health Aging 4 (2000) 246-251
89. Horwich T., Fonarow G.C., Hamilton M.A., et al. The relationship between obesity and mortality in patients with heart failure. J Am Coll Cardiol 38 (2001) 789-795
90. Kalantar-Zadeh K., Block G., Humphreys M.H., et al. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int 63 (2003) 793-808
91. Elia M. Hunger disease. Clin Nutr 19 (2000) 379-386
92. DeFronzo R.A., and Ferrannini E. Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 14 (1991) 173-194
93. Ramsay S.E., Whincup P.H., Shaper A.G., et al. The relations of body composition and adiposity measures to ill health and physical disability in elderly men. Am J Epidemiol 164 (2006) 459-469
94. Oppert J.M., Charles M.A., Thibult N., et al. Anthropometric estimates of muscle and fat mass in relation to cardiac and cancer mortality in men: the Paris Prospective Study. Am J Clin Nutr 75 (2002) 1107-1113
95. Ensrud K.E., Nevitt M.C., Yunis C., et al. Correlates of impaired function in older women. J Am Geriatr Soc 42 (1994) 481-489
96. Lang I.A., Llewellyn D.J., Alexander K., et al. Obesity, physical function, and mortality in older adults. J Am Geriatr Soc 56 (2008) 1474-1478
97. Reynolds S.L., Saito Y., and Crimmins E.M. The impact of obesity on active life expectancy in older American men and women. Gerontologist 45 (2005) 438-444
98. Sternfeld B., Ngo L., Satariano W.A., et al. Associations of body composition with physical performance and self-reported functional limitation in elderly men and women. Am J Epidemiol 156 (2002) 110-121
99. Janssen I., Heymsfield S.B., and Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 50 (2002) 889-896
100. DiPietro L. Physical activity, body weight, and adiposity: an epidemiologic perspective. Exerc Sport Sci Rev 23 (1995) 275-303
101. McAuley P.A., Myers J.N., Abella J.P., et al. Exercise capacity and body mass as predictors of mortality among male veterans with type 2 diabetes. Diabetes Care 30 (2007) 1539-1543
102. Haapanen-Niemi N., Miilunpalo S., Pasanen M., et al. Body mass index, physical inactivity and low level of physical fitness as determinants of all-cause and cardiovascular disease mortality: 16 y follow-up of middle-aged and elderly men and women. Int J Obes Relat Metab Disord 24 (2000) 1465-1474
103. Dziura J., Leon C., Kasl S., et al. Can physical activity attenuate aging-related weight loss in older people. Am J Epidemiol 159 (2004) 759-767
104. Whelton P.K., Appel L.J., Espeland M.A., et al. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA 279 (1998) 839-846
105. Rejeski W.J., Focht B.C., Messier S.P., et al. Obese, older adults with knee osteoarthritis: weight loss, exercise, and quality of life. Health Psychol 21 (2002) 419-426
106. Messier S.P., Loeser R.F., Miller G.D., et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum 50 (2004) 1501-1510
107. Chao D., Espeland M.A., Farmer D., et al. Effect of voluntary weight loss on bone mineral density in older overweight women. J Am Geriatr Soc 48 (2000) 753-759
108. Daly R., Dunstan D., Owen N., et al. Does high-intensity resistance training maintain bone mass during moderate weight loss in older overweight adults with type 2 diabetes?. Osteoporos Int 16 (2005) 1703-1712