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      A Cross-Sectional Analysis of Body Composition Among Healthy Elderly From the European NU-AGE Study: Sex and Country Specific Features

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          Abstract

          Body composition (BC) is an emerging important factor for the characterization of metabolic status. The assessment of BC has been studied in various populations and diseases such as obesity, diabetes, endocrine diseases as well as physiological and paraphysiological conditions such as growth and aging processes, and physical training. A gold standard technique for the assessment of human BC at molecular level is represented by dual-energy X-ray absorptiometry (DXA), which is able to precisely assess the body mass (and areal bone mineral density-aBMD) on a regional and whole-body basis. For the first time, within the framework of the NU-AGE project, BC has been assessed by means of a whole-body DXA scan in 1121 sex-balanced free-living, apparently healthy older adults aged 65–79 years enrolled in 5 European countries (Italy, France, United Kingdom, Netherlands, and Poland). The aim of this analysis is to provide a complete profile of BC in healthy elderly participants from five European countries and to investigate country- and sex-related differences by state-of-the-art DXA technology. To compare BC data collected in different centers, specific indexes and ratios have been used. Non-parametric statistical tests showed sex-specific significant differences in certain BC parameters. In particular, women have higher fat mass (FM) (Fat/Lean mass ratio: by 67%, p < 2.2e-16) and lower lean mass (Lean Mass index: by -18%, p < 2.2e-16) than men. On the other hand, men have higher android FM than women (Android/gynoid FM ratio: by 56%, p < 2.2e-16). Interesting differences also emerged among countries. Polish elderly have higher FM (Fat/Lean mass ratio: by 52%, p < 2.2e-16) and lower lean mass (Skeletal Mass index: by -23%, p < 2.2e-16) than elderly from the other four countries. At variance, French elderly show lower FM (Fat/Lean mass ratio: by -34%, p < 2.2e-16) and higher lean mass (Skeletal Mass index: by 18%, p < 2.2e-16). Moreover, five BC profiles in women and six in men have been identified by a cluster analysis based on BC parameters. Finally, these data can serve as reference for normative average and variability of BC in the elderly populations across Europe.

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          Beyond body mass index.

          Body mass index (BMI) is the cornerstone of the current classification system for obesity and its advantages are widely exploited across disciplines ranging from international surveillance to individual patient assessment. However, like all anthropometric measurements, it is only a surrogate measure of body fatness. Obesity is defined as an excess accumulation of body fat, and it is the amount of this excess fat that correlates with ill-health. We propose therefore that much greater attention should be paid to the development of databases and standards based on the direct measurement of body fat in populations, rather than on surrogate measures. In support of this argument we illustrate a wide range of conditions in which surrogate anthropometric measures (especially BMI) provide misleading information about body fat content. These include: infancy and childhood; ageing; racial differences; athletes; military and civil forces personnel; weight loss with and without exercise; physical training; and special clinical circumstances. We argue that BMI continues to serve well for many purposes, but that the time is now right to initiate a gradual evolution beyond BMI towards standards based on actual measurements of body fat mass.
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            General and abdominal obesity parameters and their combination in relation to mortality: a systematic review and meta-regression analysis.

            Epidemiological studies assessing general and abdominal obesity measures or their combination for mortality prediction have shown inconsistent results. We aimed to systematically review the associations of body mass index (BMI), waist-to-hip ratio (WHR), waist circumference (WC) and waist-to-height ratio (WHtR) with all-cause mortality in prospective cohort studies. In this systematic review, which includes a meta-regression analysis, we analysed the associations with all-cause mortality of BMI, WHR, WC and WHtR in prospective cohort studies available in Medline, Embase, the Cochrane Database of Systematic Reviews and Esbiobase from inception through 7 May 2010. A total of 18 studies met the inclusion criteria, comprising 689, 465 participants and 48, 421 deaths during 5-24 years of follow-up. The studies were heterogeneous, mainly due to differences in categorization of anthropometric parameters (AP) and different approaches to statistical analysis. Both general and abdominal obesity measures were significantly associated with mortality. In analyses using categorical variables, BMI and WC showed predominantly U- or J-shaped associations with mortality, whereas WHR and WHtR demonstrated positive relationships with mortality. All measures showed similar risk patterns for upper quantiles in comparison to reference quantiles. The parameters of general and abdominal obesity each remained significantly associated with mortality when adjusted for the other. This evidence suggests that abdominal obesity measures such as WC or WHR, show information independent to measures of general obesity and should be used in clinical practice, in addition to BMI, to assess obesity-related mortality in adults.
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              Associations between body composition and gait-speed decline: results from the Health, Aging, and Body Composition study.

              In older adults, every 0.1-m/s slower gait speed is associated with a 12% higher mortality. However, little research has identified risk factors for gait-speed decline. We assessed the association between several measures of body composition and age-related decline in gait speed. Data were from 2306 older adults who were participating in the Health, Aging, and Body Composition cohort and were followed for 4 y (50% women; 38% black). Usual walking speed (m/s) over 20 m was measured in years 2 through 6, and the baseline and changes in several measures of body composition were included in mixed-effects models. Gait speed declined by 0.06 ± 0.00 m/s over the 4-y period. Baseline thigh intermuscular fat predicted the annual gait-speed decline (±SE) in both men and women (-0.01 ± 0.00 and -0.02 ± 0.00 m/s per 0.57 cm(2), respectively; P < 0.01). In men, but not in women, this relation was independent of total body adiposity. In longitudinal analyses, changes in thigh intermuscular fat and total thigh muscle were the only body-composition measures that predicted gait-speed decline in men and women combined. When modeled together, every 5.75-cm(2) increase in thigh intermuscular fat was associated with a 0.01 ± 0.00-m/s decrease in gait speed, whereas every 16.92-cm(2) decrease in thigh muscle was associated with a 0.01 ± 0.00-m/s decrease in gait speed. High and increasing thigh intermuscular fat are important predictors of gait-speed decline, implying that fat infiltration into muscle contributes to a loss of mobility with age. Conversely, a decreasing thigh muscle area is also predictive of a decline in gait speed.
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                Author and article information

                Contributors
                Journal
                Front Physiol
                Front Physiol
                Front. Physiol.
                Frontiers in Physiology
                Frontiers Media S.A.
                1664-042X
                30 November 2018
                2018
                : 9
                : 1693
                Affiliations
                [1] 1Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna , Bologna, Italy
                [2] 2C.I.G. Interdepartmental Centre “L. Galvani”, Alma Mater Studiorum, University of Bologna , Bologna, Italy
                [3] 3IRCCS Istituto Ortopedico Rizzoli , Bologna, Italy
                [4] 4Department of Physics, Alma Mater Studiorum, University of Bologna , Bologna, Italy
                [5] 5Institute of Neurological Sciences (IRCCS) , Bologna, Italy
                [6] 6Division of Human Nutrition and Health, Wageningen University and Research , Wageningen, Netherlands
                [7] 7Department of Human Nutrition, Warsaw University of Life Sciences - SGGW , Warsaw, Poland
                [8] 8Norwich Medical School, University of East Anglia , Norwich, United Kingdom
                [9] 9CHU Clermont-Ferrand , Clermont-Ferrand, France
                [10] 10School of Health and Medical Sciences, Örebro University , Örebro, Sweden
                [11] 11Unité de Nutrition Humaine, INRA, Université Clermont Auvergne , Clermont-Ferrand, France
                [12] 12Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork , Cork, Ireland
                Author notes

                Edited by: Francine Marques, Baker Heart and Diabetes Institute, Australia

                Reviewed by: Ayse Zengin, Monash University, Australia; Gillian Sandra Butler-Browne, Centre of Research in Myology, France

                *Correspondence: Aurelia Santoro, aurelia.santoro@ 123456unibo.it

                This article was submitted to Integrative Physiology, a section of the journal Frontiers in Physiology

                Article
                10.3389/fphys.2018.01693
                6283977
                515d3506-837a-4950-9635-75fc866d6eac
                Copyright © 2018 Santoro, Bazzocchi, Guidarelli, Ostan, Giampieri, Mercatelli, Scurti, Berendsen, Surala, Jennings, Meunier, Caumon, Gillings, Kadi, Capel, Cashman, Pietruszka, Feskens, De Groot, Battista, Salvioli and Franceschi.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 05 July 2018
                : 09 November 2018
                Page count
                Figures: 2, Tables: 6, Equations: 0, References: 56, Pages: 16, Words: 0
                Funding
                Funded by: Seventh Framework Programme 10.13039/100011102
                Categories
                Physiology
                Original Research

                Anatomy & Physiology
                body composition,dxa,elderly,sex,europe,fat,lean and bone mass
                Anatomy & Physiology
                body composition, dxa, elderly, sex, europe, fat, lean and bone mass

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