Body mass index, waist-hip ratio and risk of chronic medical condition in the elderly population: results from the Well-being of the Singapore Elderly (WiSE) Study

Restria Fauziana, Anitha Jeyagurunathan, Edimansyah Abdin, Janhavi Vaingankar, Vathsala Sagayadevan, Saleha Shafie, Rajeswari Sambasivam, Siow Ann Chong, Mythily Subramaniam, Restria Fauziana, Anitha Jeyagurunathan, Edimansyah Abdin, Janhavi Vaingankar, Vathsala Sagayadevan, Saleha Shafie, Rajeswari Sambasivam, Siow Ann Chong, Mythily Subramaniam

Abstract

Background: The aim of the current study was to establish the prevalence and relationship of Body Mass Index (BMI) and Waist-Hip Ratio (WHR) with chronic health conditions and their associated socio-demographic correlates in the elderly population of Singapore.

Methods: The data was extracted from the Well-being of the Singapore Elderly (WiSE) study, a comprehensive single phase, cross-sectional, population-based, epidemiological study conducted in 2013 among Singaporean residents (n = 2565) aged 60 years and above with a mean age of 72.7 years (range 60 to 105, SD = 9.53). The respondents were assessed with anthropometric measurements including height, weight, BMI, waist circumference, hip circumference and WHR. Participants provided information on their socio-demographic details and chronic health conditions.

Results: Prevalence of those who were obese, overweight, normal and underweight based on BMI was 8.7 %, 33.4 %, 52.5 % and 5.5 % respectively. Malays were more likely to be overweight compared to Chinese and Indians, while Malays and Indians were more likely to be obese compared to Chinese. Participants who were never married were less likely to be overweight compared to married. Participants aged 85 years and above were more likely to be underweight compared to those aged 60-75 years. Prevalence of high WHR (above 0.90 for men and 0.80 for women) was 79.8 % and this was more pervasive amongst Indians. Participants who were homemakers were more likely to have high WHR while those with tertiary education tended to have low WHR. Being overweight was associated with hypertension and heart problems, while obesity was associated with hypertension and diabetes, and a high WHR was associated with hypertension and diabetes. There were no significant differences in the other chronic conditions in this elderly population.

Conclusions: This study demonstrates the importance of anthropometric measurements in the elderly and its association with certain chronic physical conditions, indicating their utility in the clinical management of these conditions in the elderly.

Keywords: Body mass index; chronic medical conditions; elderly; waist-hip ratio.

References

    1. Kothiyal K, Tettey S. Anthropometry for design for the elderly. Int J Occup Saf Ergon. 2001;7(1):15–34. doi: 10.1080/10803548.2001.11076474.
    1. Singapore Department of Statistics. Population Trends 20142014.
    1. Saw SH. The Population of Singapore. Singapore: Institute of Southeast Asian Studies; 1999.
    1. Government of Singapore Prime Minister's Office. A Sustainable Population for a Dynamic Singapore Population White Paper. In: Division NPaT, editor.2013.
    1. Buffa R, Floris G, Lodde M, Cotza M, Marini E. Nutritional status in the healthy longeval population from Sardinia (Italy) J Nutr Health Aging. 2010;14(2):97–102. doi: 10.1007/s12603-010-0018-9.
    1. Dey DK, Rothenberg E, Sundh V, Bosaeus I, Steen B. Height and body weight in the elderly. I. A 25-year longitudinal study of a population aged 70 to 95 years. Eur J Clin Nutr. 1999;53(12):905–914. doi: 10.1038/sj.ejcn.1600852.
    1. Steen B. Body composition and Aging. Nutr Rev. 1988;46(2):45–51. doi: 10.1111/j.1753-4887.1988.tb05386.x.
    1. Schwartz AV, Kelsey JL, Sidney S, Grisso JA. Characteristics of falls and risk of hip fracture in elderly men. Osteoporos Int. 1998;8(3):240–246. doi: 10.1007/s001980050060.
    1. Goh LG, Dhaliwal SS, Welborn TA, Lee AH, Della PR. Anthropometric measurements of general and central obesity and the prediction of cardiovascular disease risk in women: a cross-sectional study. BMJ open. 2014;4(2):e004138. doi: 10.1136/bmjopen-2013-004138.
    1. Whitehead C, Finucane P. Malnutrition in elderly people. Aust N Z J Med. 1997;27:68–74. doi: 10.1111/j.1445-5994.1997.tb00917.x.
    1. Santos JL, Albala C, Lera L, Garcia C, Arroyo P, Perez-Bravo F, et al. Anthropometric measurements in the elderly population of Santiago, Chile. Nutrition. 2004;20(5):452–457. doi: 10.1016/j.nut.2004.01.010.
    1. World Health Organization. Preventing and Managing the global epidemic. Geneva: Switzerland, obesity RoaWco; 1998.
    1. Danaei G, Pan A, Hu FB, Hernan MA. Hypothetical midlife interventions in women and risk of type 2 diabetes. Epidemiology. 2013;24(1):122–128. doi: 10.1097/EDE.0b013e318276c98a.
    1. Hall D, Cole T. What use is the BMI? Arch Dis Child. 2006;91(4):283–286. doi: 10.1136/adc.2005.077339.
    1. Woo J, Ho SC, Yuen YK, Yu LM, Lau J. Cardiovascular risk factors and 18-month mortality and morbidity in an elderly Chinese population aged 70 years and over. Gerontology. 1998;44(1):51–55. doi: 10.1159/000021983.
    1. National Heart, Lung, and Blood Institute(NHLBI), North American Association for the Study of Obesity (NAASO). The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults(No 00-4084). Rockville: National Institutes of Health; 2000.
    1. Centre for Public Health Excellence at NICE (UK, and National Collaborating Centre for Primary Care) UK. "Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children." (2006).
    1. Janssen I, Katzmarzyk PT, Ross R. Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch Intern Med. 2002;162(18):2074–2079. doi: 10.1001/archinte.162.18.2074.
    1. Rexrode KM, Carey VJ, Hennekens CH, Walters EE, Colditz GA, Stampfer MJ, et al. Abdominal adiposity and coronary heart disease in women. Jama. 1998;280(21):1843–1848. doi: 10.1001/jama.280.21.1843.
    1. Ardern CI, Katzmarzyk PT, Janssen I, Ross R. Discrimination of health risk by combined body mass index and waist circumference. Obes Res. 2003;11(1):135–142. doi: 10.1038/oby.2003.22.
    1. Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care. 1994;17(9):961–969. doi: 10.2337/diacare.17.9.961.
    1. Broe GA, Akhtar AJ, Andrews GR, Caird FI, Gilmore AJ, McLennan WJ. Neurological disorders in the elderly at home. J Neurol Neurosurg Psychiatry. 1976;39(4):362–366. doi: 10.1136/jnnp.39.4.362.
    1. Subramaniam M, Chong SA, Vaingankar JA, Abdin E, Chua BY, Chua HC, et al. Prevalence of Dementia in People Aged 60 Years and Above: Results from the WiSE Study. J Alzheimers Dis. 2015;45(4):1127–1138.
    1. World Health Organisation. Waist Circumference and Waist-hip Ratio: Report of a WHO Expert Consultation, Geneva, 8-11 December 2008, World Health Organization. 2011. . Accessed Nov 2014
    1. Azur MJ, Stuart EA, Frangakis C, Leaf PJ. Multiple imputation by chained equations: what is it and how does it work? Int J Methods Psychiatr Res. 2011;20(1):40–49. doi: 10.1002/mpr.329.
    1. Ministry of Health. Singapore National Health Survey 2010. In: Division. EaDC, editor.2011. . Accessed Nov 2014
    1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. Jama. 2012;307(5):491–497. doi: 10.1001/jama.2012.39.
    1. Maggi S, Zucchetto M, Grigoletto F, Baldereschi M, Candelise L, Scarpini E, et al. The Italian longitudinal study on aging (ILSA): design and methods. Aging Clin Exp Res. 1994;6(6):464–473. doi: 10.1007/BF03324279.
    1. Schäfer I, Hansen H, Schön G, Höfels S, Altiner A, Dahlhaus A, et al. The influence of age, gender and socio-economic status on multimorbidity patterns in primary care. First results from the multicare cohort study. BMC Health Serv Res. 2012;12(1):1. doi: 10.1186/1472-6963-12-89.
    1. Huffman GB. Evaluating and treating unintentional weight loss in the elderly. Am Fam Physician. 2002;65(4):640–650.
    1. Murden RA, Ainslie NK. Recent weight loss is related to short-term mortality in nursing homes. J Gen Intern Med. 1994;9(11):648–650. doi: 10.1007/BF02600311.
    1. Margetts BM, Thompson RL, Elia M, Jackson AA. Prevalence of risk of undernutrition is associated with poor health status in older people in the UK. Eur J Clin Nutr. 2003;57(1):69–74. doi: 10.1038/sj.ejcn.1601499.
    1. Ahmed T, Haboubi N. Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging. 2010;5:207–216.
    1. Tzotzas T, Vlahavas G, Papadopoulou SK, Kapantais E, Kaklamanou D, Hassapidou M. Marital status and educational level associated to obesity in Greek adults: data from the National Epidemiological Survey. BMC Public Health. 2010;10(1):1. doi: 10.1186/1471-2458-10-732.
    1. Andrade FBD, Caldas Junior ADF, Kitoko PM, Batista JEM, Andrade TBD. Prevalence of overweight and obesity in elderly people from Vitória-ES, Brazil. Cien Saude Colet. 2012;17(3):749–756. doi: 10.1590/S1413-81232012000300022.
    1. Averett SL, Sikora A, Argys LM. For better or worse: relationship status and body mass index. Economics & Human Biology. 2008;6(3):330–349. doi: 10.1016/j.ehb.2008.07.003.
    1. Department of Health PA, Health Improvement and Protection. Start active, stay active: report on physical activity from the four home countries’ Chief Medical Officers. In: Health Do, editor. UK: ; 2011. p. 62.
    1. AO Sanya OO, Ige AP, Ayanniyi OA. Relationship of waist-hip ratio and body mass index to blood pressure of individuals in Ibadan North local government. African J Physiother Rehabilitative Sci. 2009;1(1):7–11.
    1. Zhang L, Zhang WH, Zhang L, Wang PY. Prevalence of overweight/obesity and its associations with hypertension, diabetes, dyslipidemia, and metabolic syndrome: a survey in the suburban area of Beijing, 2007. Obes Facts. 2011;4(4):284–289. doi: 10.1159/000331014.
    1. Nicklas BJ, Cesari M, Penninx BW, Kritchevsky SB, Ding J, Newman A, et al. Abdominal obesity is an independent risk factor for chronic heart failure in older people. J Am Geriatr Soc. 2006;54(3):413–420. doi: 10.1111/j.1532-5415.2005.00624.x.
    1. Nyamdorj R, Qiao Q, Lam TH, Tuomilehto J, Ho SY, Pitkaniemi J, et al. BMI compared with central obesity indicators in relation to diabetes and hypertension in Asians. Obesity (Silver Spring) 2008;16(7):1622–1635. doi: 10.1038/oby.2008.73.
    1. Ford ES, Mokdad AH, Giles WH. Trends in waist circumference among U.S. adults. Obes Res. 2003;11(10):1223–1231. doi: 10.1038/oby.2003.168.
    1. Cartwright MJ, Tchkonia T, Kirkland JL. Aging in adipocytes: potential impact of inherent, depot-specific mechanisms. Exp Gerontol. 2007;42(6):463–471. doi: 10.1016/j.exger.2007.03.003.
    1. Lahmann PH, Lissner L, Gullberg B, Berglund G. Sociodemographic factors associated with long-term weight gain, current body fatness and central adiposity in Swedish women. Int J Obes Relat Metab Disord. 2000;24(6):685–694. doi: 10.1038/sj.ijo.0801219.
    1. Rosmond R, Bjorntorp P. Psychosocial and socio-economic factors in women and their relationship to obesity and regional body fat distribution. Int J Obes Relat Metab Disord. 1999;23(2):138–145. doi: 10.1038/sj.ijo.0800782.
    1. David M. Cutler AL-M. Education and Health: Evaluating Theories and Evidence. The NBER Bulletin on Aging and Health. 2006. doi:10.3386/w12352.
    1. Yoon YS, Oh SW, Park HS. Socioeconomic status in relation to obesity and abdominal obesity in Korean adults: a focus on sex differences. Obesity (Silver Spring) 2006;14(5):909–919. doi: 10.1038/oby.2006.105.
    1. Deurenberg-Yap M, Yian TB, Kai CS, Deurenberg P, Vans WA. Manifestation of cardiovascular risk factors at low levels of body mass index and waist-to-hip ratio in Singaporean Chinese. Asia Pac J Clin Nutr. 1999;8(3):177–183. doi: 10.1046/j.1440-6047.1999.00091.x.
    1. Olinto M, Nacul L, Gigante D, Costa J, Menezes A, Macedo S. Waist circumference as a determinant of hypertension and diabetes in Brazilian women: a population-based study. Public Health Nutr. 2004;7(05):629–635. doi: 10.1079/PHN2003582.
    1. Dowse GK, Gareeboo H, Zimmet PZ, Alberti KG, Tuomilehto J, Fareed D, et al. High prevalence of NIDDM and impaired glucose tolerance in Indian, Creole, and Chinese Mauritians. Mauritius Noncommunicable Disease Study Group. Diabetes. 1990;39(3):390–396. doi: 10.2337/diab.39.3.390.
    1. Schmidt MI, Duncan BB, Canani LH, Karohl C, Chambless L. Association of waist-hip ratio with diabetes mellitus. Strength and possible modifiers. Diabetes Care. 1992;15(7):912–914. doi: 10.2337/diacare.15.7.912.
    1. Grievink L, Alberts J, O’niel J, Gerstenbluth I. Waist circumference as a measurement of obesity in the Netherlands Antilles; associations with hypertension and diabetes mellitus. Eur J Clin Nutr. 2004;58(8):1159–1165. doi: 10.1038/sj.ejcn.1601944.
    1. Deurenberg-Yap M, Chew SK, Lin VF, Tan BY, van Staveren WA, Deurenberg P. Relationships between indices of obesity and its co-morbidities in multi-ethnic Singapore. Int J Obes Relat Metab Disord. 2001;25(10):1554–1562. doi: 10.1038/sj.ijo.0801739.
    1. Deurenberg-Yap M, Schmidt G, van Staveren WA, Deurenberg P. The paradox of low body mass index and high body fat percentage among Chinese, Malays and Indians in Singapore. Int J Obes Relat Metab Disord. 2000;24(8):1011–1017. doi: 10.1038/sj.ijo.0801353.
    1. Beydoun MA, Wang Y. Gender-ethnic disparity in BMI and waist circumference distribution shifts in US adults. Obesity (Silver Spring) 2009;17(1):169–176. doi: 10.1038/oby.2008.492.
    1. Mohamud WN, Musa KI, Khir AS, Ismail AA, Ismail IS, Kadir KA, et al. Prevalence of overweight and obesity among adult Malaysians: an update. Asia Pac J Clin Nutr. 2011;20(1):35–41.
    1. Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev. 2002;3(3):141–146. doi: 10.1046/j.1467-789X.2002.00065.x.
    1. Rush E, Plank L, Chandu V, Laulu M, Simmons D, Swinburn B, et al. Body size, body composition, and fat distribution: a comparison of young New Zealand men of European, Pacific Island, and Asian Indian ethnicities. N Z Med J. 2004;117(1207):U1203.
    1. Hu FB. Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care. 2011;34(6):1249–1257. doi: 10.2337/dc11-0442.
    1. World Health Organization Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i–xii.
    1. Han T, Tajar A, Lean M. Obesity and weight management in the elderly. Br Med Bull. 2011;97(1):169–196. doi: 10.1093/bmb/ldr002.
    1. Hannan MT, Felson DT, Dawson‐Hughes B, Tucker KL, Cupples LA, Wilson PW, et al. Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res. 2000;15(4):710–720. doi: 10.1359/jbmr.2000.15.4.710.

Source: PubMed

3
Abonnieren