Batsis, John A.

Objectives To identify geriatric obesity interventions that can guide clinical recommendations. Design Systematic review using Medline (PubMed), Cochrane Central Register of Controlled Trials, Web of Science, CINAHL , EMBASE (Ovid), and Psyc INFO (Proquest) from January 1, 2005, to October 12, 2015, to identify English‐language randomized controlled trials. Participants Individuals aged 60 and older (mean age ≥65) and classified as having obesity (body mass index ≥30 kg/m 2 ). Interventions Behavioral weight loss interventions not involving pharmacological or procedural therapies lasting 6 months or longer. Measurements Two investigators performed the systematic review using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses criteria and achieved a high concordance rate (97.3%) in summarizing the primary outcomes. The three primary outcomes were weight loss, physical performance, and quality of life. Results Of 5,741 citations, 19 were included. (Six studies were unique, and the remaining 13 were based on the same study population.) Duration ranged from 6 to 18 months (n = 405 participants, age range 66.7–71.1). Weight loss in the intervention groups ranged from 0.5 to 10.7 kg (0.1–9.3%). Five studies had a resistance exercise program accompanying a dietary component. Greater weight loss was observed in groups with a dietary component than those with exercise alone. Exercise alone led to better physical function but no significant weight loss. Combined dietary and exercise components led to the greatest improvement in physical performance measures and quality of life and mitigated reductions in muscle and bone mass observed in diet‐only study arms. Heterogeneous outcomes were observed, which limited the ability to synthesize the data quantitatively. Conclusions The evidence supporting geriatric obesity interventions to improve physical function and quality of life is of low to moderate quality. Well‐designed trials are needed in this population.

AimObesity is a major cardiovascular (CV) risk factor. Bariatric surgery (BSx) is an approved therapeutic alternative for class II–III obesity, but little evidence focuses on older adults. We assessed the effect of BSx on cardiometabolic variables and long‐term CV risk in older adults.MethodsWe carried out a population‐based, observational study from 1990–2009, of 40 consecutive elderly (age ≥60 years) residents of Olmsted County, MN, USA, with class II–III obesity treated with BSx at a University‐based, academic health center. Data were obtained from the Rochester Epidemiology Project. Metabolic syndrome (MetS) was defined using American Heart Association/National Heart, Lung, Blood Institute (AHA/NHLBI) criteria (increased triglycerides, low high‐density lipoprotein, increased blood pressure, increased glucose and body mass index as a modified measure of obesity instead of waist circumference). Change in CV risk factors, MetS prevalence, and impact on predicted CV risk using the Framingham risk score was ascertained at 1 year postoperatively and assessed statistically.ResultsMean age and body mass index were 64.4 ± 3.7 and 45.0 ± 6.3 kg/m2, respectively, and 28 out of 40 (70%) were women. One participant died during the 11‐month study period after BSx from respiratory complications related to BSx, and one participant died at 2 years. Percentage of excess weight loss decreased by 57.5% at 1 year. Prevalence 1 year after BSx decreased for diabetes (57.5% to 22.5%; P < 0.03), hypertension 87.5% to 73.7% (P = 0.003), dyslipidemia (80% to 42.5%; P < 0.001) and sleep apnea (62.5% to 23.7%; P < 0.001).MetS prevalence decreased from 80% to 45% (P < 0.002). Baseline risk was 14.1%, which changed at follow up at 8.2%.ConclusionsIn older adults, BSx induces considerable weight loss, improves CV risk factors, decreases MetS prevalence and is an effective treatment in this population. Geriatr Gerontol Int 2016; 16: 618–624.

Objectives To determine the prevalence range for sarcopenic obesity and its relationship with sex, age, and ethnicity. Design Cross‐sectional analysis of a population‐based sample. Setting Noninstitutionalized persons in the U nited S tates participating in the N ational H ealth and N utrition E xamination S urveys 1999–2004. Participants Subsample of 4,984 subjects aged 60 and older with dual‐energy X‐ray absorptiometry body composition data. Measurements Eight definitions of sarcopenic obesity identified from six studies found using a systematic literature review ( B aumgartner, B ouchard, D avison, Z oico, L evine, K im‐1,2,3) were applied to the sample. Results were stratified according to sex, age, and ethnicity. Results Prevalence of sarcopenic obesity ranged from 4.4% to 84.0% in men and from 3.6% to 94.0% in women. Prevalence was higher in men using definitions from Baumgartner (17.9% vs 13.3%, P < .001), Levine (14.2% vs 6.6%, P < .001), and Kim‐1 (30.0% vs 9.3%, P < .001); lower for men using the Davison (4.4% vs 11.1%, P < .001) and Kim‐2 (83.7% vs 94.0%) definitions; and the same for men and women using the Bouchard (45.3% vs 44.3%, P = .32) and Kim‐3 (75.6% vs 77.0%, P = .51) definitions. For all but one definition, sarcopenic obesity increased with each decade and was lower in non‐ H ispanic blacks than whites. Conclusion Prevalence of sarcopenic obesity in older adults varies up to 26‐fold depending on current research definitions. Such a high degree of variability suggests the need to establish consensus criteria that can be reliably applied across clinical and research settings.

Background— There have been significant bidirectional changes in the prevalence of cardiovascular (CV) risk factors over time in the United States, making the net trend in risk for incident CV disease unknown. We assessed these trends by applying the Framingham Heart Study prediction model to national data. Methods and Results— The National Health and Nutrition Examination Survey (NHANES) II (1976–1980), NHANES III (1988–1994), and NHANES 1999–2004 are cross-sectional representative samples of the noninstitutionalized population of the United States. We excluded people with a history of CV disease, pregnant women, participants with missing CV risk factors data, and individuals outside the Framingham age range of 30 to 74 years. The Framingham risk function was used to estimate the 10-year risk for incident symptomatic CV disease. We calculated the slope of change or rate of change per year between NHANES II and III, and between NHANES III and 1999–2004. The difference between slopes was calculated and compared to zero. The average age-adjusted 10-year CV risk between NHANES II and III decreased from 10.0% to 7.9% between NHANES II and III, with a statistically significant slope ( P <0.001). However, the average age-adjusted CV risk decreased at a lesser magnitude between NHANES III and NHANES 1999–2004 from 7.9% to 7.4% ( P <0.001). These slopes were significantly different ( P <0.0001). In women and middle-aged participants, CV risk did not change between NHANES III and NHANES 1999–2004 ( P =0.40). Conclusions— The estimated net risk for CV disease in the US population decreased from 1976–1980 to 1988–1994 but has changed minimally from 1988–1994 to 1999–2004, particularly in women and middle-aged people.