Altern und Gesundheit

Erstellt am 07 Feb 2017 12:19 - Zuletzt geändert: 12 Apr 2019 10:36

Allgemeines, Demographie und Epidemiologie

Gewichtsverlust

Veränderungen der BMI-Klassen in den höheren Altersgruppen:

Wann genau der Wechselpunkt der Gewichtskurve im Verlauf des Lebens eintritt, ist möglicherweise je nach Land etwas verschieden und hat sich wahrscheinlich auch im Laufe der Jahre (also mit den jeweiligen Geburtskohorten) etwas verändert.
Einigkeit besteht aktuell einigermaßen unter den Epidemiologen dahingehend, dass negative Effekte eines erhöhten Körpergewichts nur bei höheren BMI-Graden nachweisbar sind (wobei gestritten wird, ob die Negativ-Effekte nun bei BMIs von 25, 27, 30 oder gar erst 34 losgehen…) und dass die Negativ-Effekte sich vorwiegend bei jüngeren bis maximal mittel-alten Menschen nachweisen lassen.

Finnland:

Die "dünneren" Personen nahmen mit dem Alter zwar an Gewicht zu - aber die extrem Adipösen nahmen (mit zunehmendem Alter) ab. In der Gesamtsumme ergab das dann einen Anstieg des mittleren BMI mit dem Alter, obwohl es weniger extrem Adipöse gab.

Schweden:

Diese Studie von 2014 setzte den Wendepunkt bei etwa 65 Jahren an (Grundsätzlich zeigen die Daten jedenfalls, dass man mit Ende 50 nicht mehr viele neu auftretende Adipositas-Grad-III-Fälle (oder Grad-IV-Fälle, wenn man diesen Grad hinzunehmen möchte) vermeiden kann - die existieren in der Regel in diesem Alter schon…

Niederlande

CONCLUSION:
Results do not support the hypothesis that an increased body weight reduces total life expectancy in the older people. Although increased body weight was associated with a higher risk of becoming and remaining disabled. These results remained using waist circumference (WC).

Kanada

Abstract
Although a clear risk of mortality is associated with obesity, the risk of mortality associated with overweight is equivocal. The objective of this study is to estimate the relationship between BMI and all-cause mortality in a nationally representative sample of Canadian adults. A sample of 11,326 respondents aged >or=25 in the 1994/1995 National Population Health Survey (Canada) was studied using Cox proportional hazards models. A significant increased risk of mortality over the 12 years of follow-up was observed for underweight (BMI <18.5; relative risk (RR) = 1.73, P < 0.001) and obesity class II+ (BMI >35; RR = 1.36, P <0.05). Overweight (BMI 25 to <30) was associated with a significantly decreased risk of death (RR = 0.83, P < 0.05). The RR was close to one for obesity class I (BMI 30-35; RR = 0.95, P >0.05). Our results are similar to those from other recent studies, confirming that underweight and obesity class II+ are clear risk factors for mortality, and showing that when compared to the acceptable BMI category, overweight appears to be protective against mortality. Obesity class I was not associated with an increased risk of mortality.

USA

CONCLUSIONS:
For any given follow-up duration, the association between obesity and mortality weakens with age. The previously reported strengthening of the obesity-mortality association with increasing age was caused by the failure to take all the model specifications into consideration when calculating adjusted hazard ratios.
Eine Analyse britischer Epidemiologen, die die Arbeit von Zheng et al. 2016 zitieren und meinen "We interpret the association with later BMI as being probably distorted by reverse causality, although it remains possible instead that the optimum BMI increases with age."
CONCLUSION:
Our findings demonstrate that seemingly similar increases in obesity prevalence can be accompanied by very different patterns of distribution change. We find that the early phase of the obesity epidemic in the US was largely driven by increasing skewness, whereas more recent growth is a population-wide experience, regardless of demographic characteristics. Increasing morbid obesity certainly played an important role in the initial phase of the epidemic, but more recently the BMI distribution has largely horizontally shifted to the right.
Diese Studie der Universität von Ohio fand, dass Personen mit einer Adipositas Grad II oder III in den höheren Altersgruppen ein - gegenüber den Normalgewichtigen - verringertes Sterberisiko aufwiesen; sogar dann, wenn relevante Komorbiditäten (Diabetes etc.) bestanden.
Abstract
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/m(2)) 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.
Abstract
In this study, we analyzed age variation in the association between obesity status and US adult mortality risk. Previous studies have found that the association between obesity and mortality risk weakens with age. We argue that existing results were derived from biased estimates of the obesity-mortality relationship because models failed to account for confounding influences from respondents' ages at survey and/or cohort membership. We employed a series of Cox regression models in data from 19 cross-sectional, nationally representative waves of the US National Health Interview Survey (1986-2004), linked to the National Death Index through 2006, to examine age patterns in the obesity-mortality association between ages 25 and 100 years. Findings suggest that survey-based estimates of age patterns in the obesity-mortality relationship are significantly confounded by disparate cohort mortality and age-related survey selection bias. When these factors are accounted for in Cox survival models, the obesity-mortality relationship is estimated to grow stronger with age.
CONCLUSION:
The adverse effects of obesity on mortality risk are apparent only in adults younger than 65. Obesity as characterized using several different measures was not generally associated with greater mortality risk in older adults. Although weight loss is beneficial for reducing morbidity in obese adults of any age, it is unclear whether weight loss is equally beneficial for reducing mortality risk in older adults.
  • NHANES-Studie
Extrem hohe BMIs ab 40 gehen ab einem Lebensalter von etwa 60 Jahren deutlich zurück und ab 70 Jahren ist ein BMI über 35 in der Grafik nicht mehr darstellbar. In NHANES ist bei Menschen zwischen 40 und etwa 55 ein BMI von etwa 30 am häufigsten und ein BMI um 35 in der Altersgruppe 45 bis 50 sowie in der Altersgruppe von ca. 70-75 am häufigsten anzutreffen.

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