Current body mass index (BMI) strata likely misrepresent the accuracy of true adiposity
in older adults. Subjects with normal BMI with elevated body fat may metabolically
have higher cardiovascular and overall mortality than previously suspected. We identified
4,489 subjects aged ≥60 years (BMI = 18.5 to 25 kg/m2) with anthropometric and bioelectrical impedance measurements from the National Health
and Nutrition Examination Surveys III (1988 to 1994) and mortality data linked to
the National Death Index. Normal weight obesity (NWO) was classified in 2 ways: creation
of tertiles with highest percentage of body fat and body fat percent cutoffs (men
>25% and women >35%). We compared overall and cardiovascular mortality rates, models
adjusted for age, gender, smoking, race, diabetes, and BMI. The final sample included
1,528 subjects, mean age was 70 years, median (interquartile range) follow-up was
12.9 years (range 7.5 to 15.3) with 902 deaths (46.5% cardiovascular). Prevalence
of NWO was 27.9% and 21.4% in men and 20.4% and 31.3% in women using tertiles and
cutoffs, respectively. Subjects with NWO had higher rates of abnormal cardiovascular
risk factors. Lean mass decreased, whereas leptin increased with increasing tertile.
There were no gender-specific differences in overall mortality. Short-term mortality
(<140 person-months) was higher in women, whereas long-term mortality (>140 person-months)
was higher in men. We highlight the importance of considering body fat in gender-specific
risk stratification in older adults with normal weight. In conclusion, NWO in older
adults is associated with cardiometabolic dysregulation and is a risk for cardiovascular
mortality independent of BMI and central fat distribution.
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Article Info
Publication History
Published online: September 03, 2013
Accepted:
July 16,
2013
Received in revised form:
July 16,
2013
Received:
April 9,
2013
Footnotes
See page 1597 for disclosure information.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
