Abstract
BackgroundBody mass index (BMI) is an inadequate marker of obesity, and cannot distinguish between fat mass, fat free mass and distribution of adipose tissue. The purpose of this study was twofold. First, to assess cross-sectional relationship of BMI with fat mass index (FMI), fat free mass index (FFMI) and ratio of fat mass to fat free mass (FM/FFM). Second, to study the association of FMI, FFMI and FM/FFM with physical function including sarcopenia, and cognition in pre-frail older adults.MethodsCross-sectional study of 191 pre-frail participants ≥ 65 years, 57.1% females. Data was collected on demographics, cognition [Montreal Cognitive Assessment (MoCA)], function, frailty, calf circumference, handgrip strength (HGS), short physical performance battery (SPPB) and gait speed. Body composition was measured using InBody S10. FMI, FFMI and FM/FFM were classified into tertiles (T1, T2, T3) with T1 classified as lowest and T3 highest tertile respectively and stratified by BMI.ResultsHigher FFMI and lower FM/FFM in the high BMI group were associated with better functional outcomes. Prevalence of low muscle mass was higher in the normal BMI group. FMI and FM/FFM were significantly higher in females and FFMI in males with significant gender differences except for FFMI in ≥ 80 years old. Small calf circumference was significantly less prevalent in the highest tertile of FMI, FM/FMI and FFMI. Prevalence of sarcopenic obesity and low physical function (HGS, gait speed and SPPB scores) were significantly higher in the highest FMI and FM/FFM tertile. Highest FFMI tertile group had higher physical function, higher MoCA scores, lower prevalence of sarcopenic obesity and sarcopenia, After adjustment, highest tertile of FFMI was associated with lower odds of sarcopenia especially in the high BMI group. Highest tertile of FM/FFM was associated with higher odds of sarcopenia. Higher BMI was associated with lower odds of sarcopenia.ConclusionFFMI and FM/FFM may be a better predictor of functional outcomes in pre-frail older adults than BMI. Cut-off values for healthy BMI values and role of calf circumference as a screening tool for sarcopenia need to be validated in larger population. Health promotion intervention should focus on FFMI increment.
Highlights
Population ageing and rise in obesity prevalence worldwide are the two biggest risk factors for non-communicable diseases, including degenerative diseases, sarcopenia, frailty, dementia, increased morbidity, and mortality putting a strain on finite healthcare resources [1,2,3,4,5]
Our study has shown that body composition especially higher fat free mass index (FFMI) and lower fat mass to fat free mass (FM/FFM) were associated with better functional outcomes in the pre-frail
High body mass index (BMI) is a composite of fat mass and fat free mass, and BMI cannot distinguish between fat mass, fat free mass and distribution of adipose tissue
Summary
Population ageing and rise in obesity prevalence worldwide are the two biggest risk factors for non-communicable diseases, including degenerative diseases, sarcopenia, frailty, dementia, increased morbidity, and mortality putting a strain on finite healthcare resources [1,2,3,4,5]. Several recent studies have shown that ratio of fat mass to fat free mass (FM/FFM) was associated with cardio-metabolic disorders, non-alcoholic fatty liver disease and adverse outcomes [16, 22, 23]. This is thought to be mediated through myokines, osteokines and adipokines regulating muscle, bone, and fat metabolism [24]. To study the association of FMI, FFMI and FM/FFM with physical function including sarcopenia, and cognition in pre-frail older adults
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