Journal of Gerontology 1978. Vol. 33, No. 5. 657-662
Nutritional Status of the Elderly: Anthropometric and Clinical Findings1 Elisabeth S. Yearick, PhD2
BESITY, or excessive accumulation of O body fat, has been implicated as a significant coronary risk factor (Inter-society Commission for Heart Disease Resources, 1972). For this reason, it is essential to identify clinically-usable methods of assessing body fat. Indices of adiposity have commonly been based on body weight, despite the fact that fat constitutes a variable fraction of the total body weight. One frequently-used measure is the relative weight (i.e., the observed weight compared with the desirable weight according to sex, height, and frame). The validity of relative weight as a measure of adiposity in older people has been open to question. The tables of weights suggested as desirable have not been adjusted for age, on the theory that an individual should maintain his ideal weight throughout adult life. However, body composition changes with age; decreases in water, cell mass, and bone mineral result in decreased density (Brozek, 1952). Thus, the aged individual may have accumulated fat, even though his total weight remained stable throughout adult life. Densitometry provides the most reliable estimate of body fat but the method is not clinically feasible. Body fat also may be assessed by the simple technique of measuring the thickness of adipose tissue with standardized skinfold calipers. In young adults, the skinfold thicknesses correlate well with body fat as "From the Nutrition Research Laboratory, School of Home Economics, Oregon State Univ., Corvallis 97331. Contribution to Regional Project, W-116. Supported by Oregon Agricultural Experiment Station. OAES technical paper No. 4736. 2 Prof., Foods and Nutrition, Oregon State Univ., Corvallis 97331.
estimated by densitometry (Damon & Goldman, 1964; Katch & Michael, 1968; Sloan, 1967; Sloan et al., 1962). The data reported in this paper show the relationships between adiposity indices based on weight measurements and three skinfold thicknesses in a group of elderly persons. Because hypertension, hypercholesteremia, and hyperglycemia have also been identified as risk factors for ischemic heart disease, we have examined the relationships between relative weight and blood pressure, serum cholesterol, and serum glucose concentrations. MATERIALS AND METHODS
Anthropometric and clinical data were collected as part of a study of nutritional status of apparently healthy, noninstitutionalized, elderly people. The population consisted of 75 women and 25 men, aged 63-96 years, who lived in or near Corvallis, Oregon. For the most part, participants were recruited from senior citizens' groups and other voluntary organizations; 20 of them lived in a retirement community. All physical measurements were performed by a single physician during the clinical examination in his office. Heights and weights were recorded in centimeters and kilograms; measurements were taken on subjects wearing indoor clothing but with shoes removed. Skinfold thicknesses at the triceps, subscapular, and suprailiac sites were measured with a Lange skinfold caliper (Cambridge Instruments Co., Cambridge, Md.), exerting a pressure 657
Downloaded from http://geronj.oxfordjournals.org/ at The Univesity of Calgary on November 23, 2012
Relationships between adiposity indices based on weight and skinfold measurements were examined in 75 women and 25 men, aged 63-96 years. For both men and women, relative weight, weight/height, and body mass index (weight/height2) were positively correlated (p < 0.001) with the triceps and the subscapular skinfold thicknesses. Correlations with the suprailiac skinfold also were significant but of lesser magnitude. Weights of 42% of the subjects exceeded the ideal weight for height by 20% or more; triceps fatfolds of 18% were in the obesity range. One-third of the group was judged to be hypertensive. Relative weight was positively associated with systolic (p < 0.05) and diastolic (p < 0.01) blood pressures. Relative weight was correlated with fasting serum glucose of women (p < 0.01), but unrelated to serum cholesterol concentrations. None of the anthropometric or clinical findings were associated with current level of dietary kilocalories.
658
YEARICK
Table 1. Anthropometric Measurements, Blood Pressures, Serum Cholesterol and Glucose Concentrations of Elderly Men and Women (Means and Standard Deviations). Measurement
Women (n = 75)
(n = 25)
74.0 ± 7.7
73.8 dt 7.3 159.4 dt 5.3 66.0 dt 10.2 41.4 dt 6.1
74.2 ± 9.0 171.7 ± 6.6 77.1 ±13.3 44.9 ± 7.6
26.0 dt 3.8 122.2 dt 17.8 20.0 dt 6.7 18.8 dt 7.3 21.1 dt 7.4
26.2 ± 4.6 113.7 ±19.8
Age — years Height — cm Weight - kg
162.5 ± 7.7
Weight/Height — kg/M Body mass index — kg/M2 Relative weight — %
42.2 ± 6.6 26.0 ± 4.0 120.0 ±18.6
Triceps skinfold — mm Subscapular skinfold — mm Suprailiac skinfold — mm
18.1 ± 7.5 18.1 ± 7.3 20.4 ± 7.1 147.4 ±22.5 79.7 ±12.4
Systolic pressure — mm Hg Diastolic pressure — mm Hg Serum cholesterol — mg/dl Serum glucose — gm/dl
Men
Both Sexes (n = 100)
68.8 ±12.0
206.9 ± 35.0
147.9 dt 22.4 79.7 d: 12.0 212.6 d: 34.0
99.4 ± 26.9
97.6 d: 24.8
12.3 ± 7.0
16.0 ± 7.2 18.4± 5.8 145.7 ±23.3 79.8 ±14.1 189.6 ±32.7 104.7 + 32.4
Downloaded from http://geronj.oxfordjournals.org/ at The Univesity of Calgary on November 23, 2012
of 10 g/mm2. Systolic and diastolic blood RESULTS AND DISCUSSION pressures were measured with the use of a standard cuff and standard clinical sphygmo- Relationships Among Indices of Adiposity The means and standard deviations of the manometer. The subjects recorded their total food and anthropometric data and the three indices of beverage intake for a period of three days, ac- adiposity are shown in Table 1. The simple cording to the directions of a qualified nutri- ratio W/H was 41.4 kg/M for women and 44.9 tionist. The completed records were verified by kg/M for men; the mean BMI was 26.0 kg/M2 interview. The average daily caloric intake of for women and 26.2 kg/M2 for men. Both ineach subject was computed as a percentage of dices are similar to those computed from data the recommended dietary allowance (Food on elderly women and men, but higher than and Nutrition Board, 1974), adjusted for age those computed for young persons in the 1972 (Food and Nutrition Board, 1968). A single National Health Survey (National Center for blood sample was obtained at fasting and the Health Statistics, 1976). Although Florey serum cholesterol (Levine & Zak, 1964) and (1970) found that W/H was the index of choice glucose (Hoffman, 1937; Technicon Auto- for women in his study, most investigators Analyzer Bulletin N-2A) concentrations were report that the simple ratio is not constant for persons of different stature. For example, determined by AutoAnalyzer. Three indices of adiposity were computed computed from the table of suggested weights on the basis of weight and height measure- for height (Food and Nutrition Board, 1974), ments: weight/height (W/H), body mass index the ratio increases with height, ranging from (BMI) or weight/height2, and relative weight. 32.9 to 37.7 kg/M for women and 36.8 to 43.0 To obtain relative weight, the observed weight kg/M for men. On the other hand, the ratio was expressed as a percentage of the suggested based on the square of height is relatively inweight for the adult man or woman of similar dependent of stature (Keys et al., 1972; Khosla height and medium frame (Food and Nutrition & Lowe, 1967). When the BMI is computed from the table of suggested weights for height, Board, 1974). Correlations were computed among the the ranges are smaller and not directly related various measures of body fatness: W/H, BMI, to height: 20.6 to 21.6 kg/M2 for women and relative weight, and the three skinfold thick- 22.3 to 23.0 kg/M2 for men. On the basis of the nesses. Further correlations were computed BMI values, the women in our study exceeded between relative weight and blood pressures, the values computed from the table of sugserum cholesterol, serum glucose, and caloric gested weight for height by 24%, and the men by 16%. intake.
ANTHROPOMETRIC FINDINGS IN THE ELDERLY
subjects in our study are shown in Table 1. For the women, the triceps thickness of 20.0 mm and the subscapular thickness of 18.8 mm were somewhat less than those reported for older women by other investigators (Gibson et al., 1975; Montoye et al., 1965; Young et al., 1963). The mean triceps and subscapular thicknesses of 12.3 mm and 16.0 mm recorded for the men in our study were comparable to values recorded for elderly men by other investigators (Gibson et al., 1975; Montoye et al., 1965; National Center for Health Statistics, 1970). There appear to be few reports of suprailiac measurements on elderly people. Young et al. (1963) reported suprailiac measurements for older women that were comparable to the 21.1 mm for women in our study. The suprailiac thicknesses for both men and women in our study were greater than the mean values recorded for middle-aged women (Pollack et al., 1975) and men (Pollack et al., 1976). In the Ten-state Nutrition Survey (Center for Disease Control, 1972), the criterion for obesity was set at a triceps thickness of greater than 25.1 mm for women or 18.6 mm for men. These values represented the 85th percentiles for young adults. The mean triceps measurements of women and men in our study were well below the obesity levels; instead, they were comparable to mean values recorded for 20-30 yearold people (Center for Disease Control, 1972).
Table 2. Simple Correlations Between Body Measurements^ Group
W/H
BMI
Triceps
Subscapular
Relative weight
All n = 100 Women n = 75 Men n = 25
0.89 0.98 0.97
0.97 1.00 0.99
0.61 0.58 0.63
0.67 0.64 0.72
0.55 0.57 0.47*
Weight/Height (W/H)
All n = 100 Women n = 75 Men n = 25
0.95 0.97 0.98
0.41 0.57 0.63
0.60 0.65 0.72
0.50 0.59 0.53**
Body mass index (BMI)
All n = 100 Women n = 75 Men n = 25
0.52 0.57 0.65
0.65 0.63 0.75
0.52 0.55 0.48*
Triceps skinfold
All n = 100 Women n = 75 Men n = 25
0.70 0.70 0.76
0.57 0.63 0.34***
Subscapular skinfold
All n = 100 Women n = 75 Men n = 25
a
AU correlations significant (p < 0.001) except where indicated. *p < 0.05 **p < 0.01 ***not significant
Suprailiac
0.70 0.72 0.59**
Downloaded from http://geronj.oxfordjournals.org/ at The Univesity of Calgary on November 23, 2012
Billewicz et al. (1962) stated that the best index of obesity is the relative weight, or observed weight as a percentage of desirable weight. According to this index, our average subject was 20% above the suggested weight for height (Table 1). The mean deviation from suggested weight was greater in women (22%) than in men (14%). About XA of the men and Vi of the women were 20% or more above the suggested weight, a finding that is similar to actuarial statistics for persons over the age of 60 years (Metropolitan Life Insurance Co., 1960). Although our sample represented a 30-year age span, we did not find a significant correlation between either relative weight or BMI and age. Skinfold thicknesses have been considered better indices of adiposity than statistics based on body weight; they are highly correlated with body fat as estimated by densitometry (Damon & Goldman, 1964; Katch & Michael, 1968; Sloan, 1967; Sloan et al., 1962) and are independent of height (Ward et al., 1975). Damon & Goldman (1964) and Ward et al. (1975) found that the triceps and subscapular measurements were the best predictors of body fat in young people; Sloan et al. (1962) reported that body density was best correlated with the suprailiac thickness. In a group of older women, it was the subscapular skinfold that correlated most closely with body density (Young et al., 1963). Mean skinfold measurements of the elderly
659
660
YEARICK
Downloaded from http://geronj.oxfordjournals.org/ at The Univesity of Calgary on November 23, 2012
Body Weight and Blood Pressure The mean systolic and diastolic pressures of the women were 147.9 and 79.7 mm Hg; for men the values were 145.7 and 79.8 mm Hg (Table 1). The systolic means are essentially the same as those recorded for elderly persons in the 1972 National Health Survey (National Center for Health Statistics, 1975). The mean diastolic pressures of individuals in our study were considerably lower than those of 60-74 year-old persons in the 1972 survey; they correspond more closely with mean diastolic pressures recorded for middle-aged and younger individuals. In the evaluation of blood pressure data collected in 1960-62 (National Center for Health Statistics, 1966), the normotensive individual was defined as having systolic and diastolic pressures of less than 140 and less than 90 mm Hg, respectively. Persons with systolic pressures of 160mm Hg or greater and/ or diastolic pressures of 95 mm Hg or greater were considered to be hypertensive. According to these criteria, 33% of the women and 40% of the men in our study were normotensive; 37% of the women and 28% of the men would be considered hypertensive. The percentages of persons in the two categories are almost identical to those found in the 1972 survey for women and men, 60-74 years of age. Significant positive correlations were obtained between both relative weight and BMI of the subjects and systolic pressures (r = 0.20, p < 0.05) and diastolic pressures (r = 0.29, p < 0.01). This confirms the clinical impression that overweight can contribute to hypertension. There were 24 subjects who identified high blood pressure as a medical problem; 20 of them were taking medications to control The mean daily energy intake was 1734 kilo- hypertension. calories, or 99% of the recommended dietary allowance adjusted forage. Diets of the women Body Weight and Serum Cholesterol and averaged 99% and diets of the men averaged Glucose 97% of the allowances. Although some individMean serum cholesterol concentrations of uals consumed more than 3000 kilocalories 212.6 mg/dl were recorded for the women and per day, energy intake was not correlated with 189.6 mg/dl for the men (Table 1). The means any of the indices of adiposity. Of the 38 indi- were considerably lower than the corrected viduals who considered themselves over- values reported for elderly persons in the 1971weight, only 8 had attempted weight reduction 1974 health survey (National Center for Health diets. Since none of the subjects reported re- Statistics, 1977). They did, however, support cent weight gain or loss, those who were obese the finding that the cholesterol in serum of oldmust have accumulated the excess weight dur- er women exceeds that of older men. Because ing their middle years. Their current caloric of the wide inter- and intra-subject variations intake appears to have been just sufficient to in serum cholesterol, and because the values maintain a stable weight. may differ with different analytical methods, However, when individual data were examined, there were 19% of the women and 16% of the men whose triceps measurements exceeded the criteria for obesity. The prevalence among older persons in the Ten-state Survey was 24% of the women and 9% of the men. Simple correlations among the various indices of adiposity appear in Table 2. Highly significant correlations (p < 0.001) were obtained among the three indices derived from body weight, and between the weight indices and triceps and subscapular skinfold thicknesses. For both men and women, the subscapular measurement gave the highest correlation with the other skinfolds and with the weight indices. Although 42% of these older people were more than 20% above ideal weight, only 18% could be considered obese as judged by the triceps measurement. It is possible that, in older women at least, the subscapular thickness provides a more valid measure of fatness than does the triceps. Younget al. (1963) found that the subscapular thickness was most closely correlated with densitometric estimates of body fat in women. They suggested that the fat deposits may be more central in the aged woman. Furthermore, examination of data from other surveys (Gibson et al., 1975; Montoye et al., 1965) shows that the age-related increase in subscapular thickness of women is greater than the increase in the triceps skinfold. In men, there is no evidence that the two skinfold measurements respond differently to age, however. Criteria for defining obesity on the basis of the subscapular skinfold have not been established.
ANTHROPOMETRIC FINDINGS IN THE ELDERLY
CONCLUSIONS
Forty-two percent of these elderly people were obese by relative weight standards. About half that number were obese according to the triceps fatfold criteria. Nevertheless,
the highly significant correlations between weight indices and skinfold thicknesses appear to justify the clinical use of relative weight as a measure of body fatness. Of the three skinfold measurements, the subscapular was the best index of adiposity. More than V?> of the group was judged to be hypertensive by prevailing standards. The positive correlation between relative weight and blood pressure supports the use of weight reduction as part of the therapy for hypertension. Relative weight was also positively correlated with serum glucose concentrations in women, although fasting glucose levels were generally in the normal range. There was no indication that overweight or adiposity was associated with serum cholesterol concentrations in this group. Although nearly half of the subjects were overweight, their weight appeared to be stable and unrelated to current energy intake. No correlation was shown between dietary calories and any of the anthropometric or clinical findings. REFERENCES
Acheson, R. M., & Baird, J. T., Jr. Serum cholesterol in a national sample of U. S. adults: A study from prevalence data of its relationship to physique, blood pressure, blood glucose and other variables. International Journal of Epidemiology, 1973,2, 283-292. Billewicz, W. Z., Kemsley, W. F. F., & Thomson, A. M. Indices of adiposity. British Journal of Preventive and Social Medicine, 1962,16, 183-188.
Brozek, J. Changes of body composition in man during maturity and their nutritional implications. Federation Proceedings, 1952, //, 784-793. Center for Disease Control. Ten-state nutrition survey in the United States, 1968-70. III. Clinical, anthropometry, dental. DHEW Pub. No. (HSM) 72-8131. Atlanta, 1972. Damon, A., & Goldman, R. F. Predicting body fat from body measurements: Densitometric validation of ten anthropometric equations. Human Biology, 1964, 36, 32-44. Florey, C. du V. The use and interpretation of ponderal index and other height-weight ratios in epidemiological studies. Journal of Chronic Diseases, 1970,25, 93-103. Food and Nutrition Board. National Research Council. Recommended dietary allowances, 7th Ed. National Academy of Sciences, Washington, 1968. Food and Nutrition Board, National Research Council. Recommended dietary allowances, 8th Ed. National Academy of Sciences, Washington, 1974. Gibson, T. C , Horton, E. S., & Whorton, E. B. Interrelationships of insulin, glucose, lipid and anthropometric data in a natural population. American Journal of Clinical Nutrition, 1915,28, 1387-1394. Gordon, T. The Framingham diet study: Diet and the regulation of serum cholesterol. Section 24. The Framingham Study. An epidemiological investigation of cardiovascular disease. NIH, Bethesda, Md., 1969.
Downloaded from http://geronj.oxfordjournals.org/ at The Univesity of Calgary on November 23, 2012
it is difficult to specify a level that would define hypercholesteremia. Nevertheless, a concentration of 260 mg/dl has been taken as a cut-off point between normal and high cholesterol values (National Center for Health Statistics, 1967). By this criterion, only 7 women and none of the men in our study could be considered hypercholesteremic. In contrast to the findings of Acheson and Baird (1973), no significant correlation was obtained between serum cholesterol concentrations and either relative weight (r = 0.14) or blood pressure (r = 0.07). The possibility that serum cholesterol levels were associated with diet was also explored. The mean daily energy intake of the subjects was 99% of the recommended allowances and fat accounted for 36% of the calories. The dietary cholesterol averaged only 272 mg/day but individual intakes ranged from 66 mg to 716 mg. No significant correlations were found between serum cholesterol and either dietary calories (r = -0.09), fat (r = -0.08), or cholesterol (r = 0.003). The failure to demonstrate an association between diet and serum cholesterol levels was also reported in the Framingham study (Gordon, 1969). While it does not negate the concept that blood lipids can be altered by diet, it suggests that diet is not the sole controlling factor. The mean serum concentrations of glucose at fasting were well within normal limits (Table 1). Two men and two women had concentrations above 200 mg/dl. Of these, two were acknowledged diabetics. Three other diabetic subjects were maintaining their blood glucose levels below 120 mg/dl. For the nondiabetic subjects, a significant correlation (p < 0.01) was obtained between serum glucose levels and relative weight in women (r = 0.44) but not in men (r = 0.16). In a survey of randomly selected middle-aged and older men and women, Gibson et al. (1975) were unable to demonstrate any significant correlation between relative weight and fasting glucose levels, although relative weight was significantly correlated with the log of fasting insulin level.
661
662
YEARICK
National Center for Health Statistics. Blood pressure of person 18-74 years. United States, 1971-72. Vital and Health Statistics. Series 11-No. 150. DHEW Pub. No. • (HRS) 75-1632. Washington, 1975. National Center for Health Statistics. Height and weight of adults 18-74 of age in the United States. Advance data from Vital and Health Statistics. DHEW Pub. No. (HRA) 77-1250, No. 3, Washington, 1976. National Center for Health Statistics. A comparison of levels of serum cholesterol of adults 18-74 years of age in the United States in 1960-62 and 1971-74. Advance data from Vital and Health Statistics. DHEW Pub. No. (HRA) 77-1250, No. 5, Washington, 1977. Pollack, M. L., Eddins, E. L., Coleman, B., Linnerud, A. C , & Jackson, A. Prediction of body density in young and middle-aged women. Journal of Applied Physiology, 1975, 38, 745-749. Pollack, M. J., Hickman, T., Kendrick, Z., Jackson, A., Linnerud, A. C , & Dawson, G. Prediction of body density in young and middle-aged men. Journal of Applied Physiology, 1976, 40, 300-304. Sloan, A. W. Estimation of body fat in young men. Journal of Applied Physiology, 1967, 23, 311-315. Sloan, A. W., Burt, J. J., & Blyth, C. S. Estimation of body fat in young women. Journal of Applied Physiology, 1962, 17, 967-970. Technicon AutoAnalyzer Bulletin N-2A. Technicon Corporation, Ardsley, N. Y., 1970. Ward, G. M., Krzywicki, H. J., Rahman, D. P., Quass, R. L., Nelson, R. A., & Consolazio, C. F. Relationship of anthropometric measurements of body fat as determined by densitometry, potassium-40, and body water. American Journal of Clinical Nutrition, 1975, 28, 162-169. Young, C. M., Blondin, J., Tensuan, R., & Fryer, J. H. Body composition studies of older women. Annals of the New York Academy of Science, 1963,7/0, 589-607.
Downloaded from http://geronj.oxfordjournals.org/ at The Univesity of Calgary on November 23, 2012
Hoffman, W. S. A rapid photoelectric method for the determination of glucose in blood. Journal of Biological Chemistry, 1937, 120, 51-55. Inter-society Commission for Heart Disease Resources. Primary prevention of the atherosclerotic diseases. Circulation, 1970,42, A55-A95. Rev., April, 1972. Katch, F. I., & Michael, E. D., Jr. Prediction of body density from skinfold and girth measurements of college females. Journal of Applied Physiology, 1968,25, 92-94. Keys, A., Fidanza, F., Karvonen, M. J., & Taylor, H. S. Indices of relative weight and obesity. Journal of Chronic Diseases, 1972, 25, 329-343. Khosla, T., & Lowe, C. R. Indices of obesity derived from body weight and height. British Journal of Preventive and Social Medicine, 1967,2/, 122-128. Levine, J. B., & Zak, B. Automated determination of serum total cholesterol. Clinica Chimica Ada, 1964, 10, 381-384. Metropolitan Life Insurance Co. Frequency of overweight and underweight. Metropolitan Life Insurance Co. Statistical Bulletin, 1960,4/, 4. Montoye, H. J., Epstein, F. H., & Kjelsberg, M. O. The measurement of body fatness: A study in a total community. American Journal of Clinical Nutrition, 1965, 16, 417-427. National Center for Health Statistics. Hypertension and hypertensive heart disease in adults. United States 1960-1962. Vital and Health Statistics, PHS Pub. No. 1000-Series 11-No. 13. Washington, 1966. National Center for Health Statistics. Serum cholesterol levels of adults. United States 1960-62. Vital and Health Statistics, PHS Pub. No. 1000-Series 11-No. 22. Washington, 1967. National Center for Health Statistics. Skinfolds, body girths, biacromial diameter, and selected anthropometric indices of adults, 1960-62. Vital and Health Statistics, PHS Pub. No. 1000-Series 11-No. 34. Washington, 1970.
Nutritional Status of the Elderly: Anthropometric and Clinical Findings1 Elisabeth S. Yearick, PhD2
BESITY, or excessive accumulation of O body fat, has been implicated as a significant coronary risk factor (Inter-society Commission for Heart Disease Resources, 1972). For this reason, it is essential to identify clinically-usable methods of assessing body fat. Indices of adiposity have commonly been based on body weight, despite the fact that fat constitutes a variable fraction of the total body weight. One frequently-used measure is the relative weight (i.e., the observed weight compared with the desirable weight according to sex, height, and frame). The validity of relative weight as a measure of adiposity in older people has been open to question. The tables of weights suggested as desirable have not been adjusted for age, on the theory that an individual should maintain his ideal weight throughout adult life. However, body composition changes with age; decreases in water, cell mass, and bone mineral result in decreased density (Brozek, 1952). Thus, the aged individual may have accumulated fat, even though his total weight remained stable throughout adult life. Densitometry provides the most reliable estimate of body fat but the method is not clinically feasible. Body fat also may be assessed by the simple technique of measuring the thickness of adipose tissue with standardized skinfold calipers. In young adults, the skinfold thicknesses correlate well with body fat as "From the Nutrition Research Laboratory, School of Home Economics, Oregon State Univ., Corvallis 97331. Contribution to Regional Project, W-116. Supported by Oregon Agricultural Experiment Station. OAES technical paper No. 4736. 2 Prof., Foods and Nutrition, Oregon State Univ., Corvallis 97331.
estimated by densitometry (Damon & Goldman, 1964; Katch & Michael, 1968; Sloan, 1967; Sloan et al., 1962). The data reported in this paper show the relationships between adiposity indices based on weight measurements and three skinfold thicknesses in a group of elderly persons. Because hypertension, hypercholesteremia, and hyperglycemia have also been identified as risk factors for ischemic heart disease, we have examined the relationships between relative weight and blood pressure, serum cholesterol, and serum glucose concentrations. MATERIALS AND METHODS
Anthropometric and clinical data were collected as part of a study of nutritional status of apparently healthy, noninstitutionalized, elderly people. The population consisted of 75 women and 25 men, aged 63-96 years, who lived in or near Corvallis, Oregon. For the most part, participants were recruited from senior citizens' groups and other voluntary organizations; 20 of them lived in a retirement community. All physical measurements were performed by a single physician during the clinical examination in his office. Heights and weights were recorded in centimeters and kilograms; measurements were taken on subjects wearing indoor clothing but with shoes removed. Skinfold thicknesses at the triceps, subscapular, and suprailiac sites were measured with a Lange skinfold caliper (Cambridge Instruments Co., Cambridge, Md.), exerting a pressure 657
Downloaded from http://geronj.oxfordjournals.org/ at The Univesity of Calgary on November 23, 2012
Relationships between adiposity indices based on weight and skinfold measurements were examined in 75 women and 25 men, aged 63-96 years. For both men and women, relative weight, weight/height, and body mass index (weight/height2) were positively correlated (p < 0.001) with the triceps and the subscapular skinfold thicknesses. Correlations with the suprailiac skinfold also were significant but of lesser magnitude. Weights of 42% of the subjects exceeded the ideal weight for height by 20% or more; triceps fatfolds of 18% were in the obesity range. One-third of the group was judged to be hypertensive. Relative weight was positively associated with systolic (p < 0.05) and diastolic (p < 0.01) blood pressures. Relative weight was correlated with fasting serum glucose of women (p < 0.01), but unrelated to serum cholesterol concentrations. None of the anthropometric or clinical findings were associated with current level of dietary kilocalories.
658
YEARICK
Table 1. Anthropometric Measurements, Blood Pressures, Serum Cholesterol and Glucose Concentrations of Elderly Men and Women (Means and Standard Deviations). Measurement
Women (n = 75)
(n = 25)
74.0 ± 7.7
73.8 dt 7.3 159.4 dt 5.3 66.0 dt 10.2 41.4 dt 6.1
74.2 ± 9.0 171.7 ± 6.6 77.1 ±13.3 44.9 ± 7.6
26.0 dt 3.8 122.2 dt 17.8 20.0 dt 6.7 18.8 dt 7.3 21.1 dt 7.4
26.2 ± 4.6 113.7 ±19.8
Age — years Height — cm Weight - kg
162.5 ± 7.7
Weight/Height — kg/M Body mass index — kg/M2 Relative weight — %
42.2 ± 6.6 26.0 ± 4.0 120.0 ±18.6
Triceps skinfold — mm Subscapular skinfold — mm Suprailiac skinfold — mm
18.1 ± 7.5 18.1 ± 7.3 20.4 ± 7.1 147.4 ±22.5 79.7 ±12.4
Systolic pressure — mm Hg Diastolic pressure — mm Hg Serum cholesterol — mg/dl Serum glucose — gm/dl
Men
Both Sexes (n = 100)
68.8 ±12.0
206.9 ± 35.0
147.9 dt 22.4 79.7 d: 12.0 212.6 d: 34.0
99.4 ± 26.9
97.6 d: 24.8
12.3 ± 7.0
16.0 ± 7.2 18.4± 5.8 145.7 ±23.3 79.8 ±14.1 189.6 ±32.7 104.7 + 32.4
Downloaded from http://geronj.oxfordjournals.org/ at The Univesity of Calgary on November 23, 2012
of 10 g/mm2. Systolic and diastolic blood RESULTS AND DISCUSSION pressures were measured with the use of a standard cuff and standard clinical sphygmo- Relationships Among Indices of Adiposity The means and standard deviations of the manometer. The subjects recorded their total food and anthropometric data and the three indices of beverage intake for a period of three days, ac- adiposity are shown in Table 1. The simple cording to the directions of a qualified nutri- ratio W/H was 41.4 kg/M for women and 44.9 tionist. The completed records were verified by kg/M for men; the mean BMI was 26.0 kg/M2 interview. The average daily caloric intake of for women and 26.2 kg/M2 for men. Both ineach subject was computed as a percentage of dices are similar to those computed from data the recommended dietary allowance (Food on elderly women and men, but higher than and Nutrition Board, 1974), adjusted for age those computed for young persons in the 1972 (Food and Nutrition Board, 1968). A single National Health Survey (National Center for blood sample was obtained at fasting and the Health Statistics, 1976). Although Florey serum cholesterol (Levine & Zak, 1964) and (1970) found that W/H was the index of choice glucose (Hoffman, 1937; Technicon Auto- for women in his study, most investigators Analyzer Bulletin N-2A) concentrations were report that the simple ratio is not constant for persons of different stature. For example, determined by AutoAnalyzer. Three indices of adiposity were computed computed from the table of suggested weights on the basis of weight and height measure- for height (Food and Nutrition Board, 1974), ments: weight/height (W/H), body mass index the ratio increases with height, ranging from (BMI) or weight/height2, and relative weight. 32.9 to 37.7 kg/M for women and 36.8 to 43.0 To obtain relative weight, the observed weight kg/M for men. On the other hand, the ratio was expressed as a percentage of the suggested based on the square of height is relatively inweight for the adult man or woman of similar dependent of stature (Keys et al., 1972; Khosla height and medium frame (Food and Nutrition & Lowe, 1967). When the BMI is computed from the table of suggested weights for height, Board, 1974). Correlations were computed among the the ranges are smaller and not directly related various measures of body fatness: W/H, BMI, to height: 20.6 to 21.6 kg/M2 for women and relative weight, and the three skinfold thick- 22.3 to 23.0 kg/M2 for men. On the basis of the nesses. Further correlations were computed BMI values, the women in our study exceeded between relative weight and blood pressures, the values computed from the table of sugserum cholesterol, serum glucose, and caloric gested weight for height by 24%, and the men by 16%. intake.
ANTHROPOMETRIC FINDINGS IN THE ELDERLY
subjects in our study are shown in Table 1. For the women, the triceps thickness of 20.0 mm and the subscapular thickness of 18.8 mm were somewhat less than those reported for older women by other investigators (Gibson et al., 1975; Montoye et al., 1965; Young et al., 1963). The mean triceps and subscapular thicknesses of 12.3 mm and 16.0 mm recorded for the men in our study were comparable to values recorded for elderly men by other investigators (Gibson et al., 1975; Montoye et al., 1965; National Center for Health Statistics, 1970). There appear to be few reports of suprailiac measurements on elderly people. Young et al. (1963) reported suprailiac measurements for older women that were comparable to the 21.1 mm for women in our study. The suprailiac thicknesses for both men and women in our study were greater than the mean values recorded for middle-aged women (Pollack et al., 1975) and men (Pollack et al., 1976). In the Ten-state Nutrition Survey (Center for Disease Control, 1972), the criterion for obesity was set at a triceps thickness of greater than 25.1 mm for women or 18.6 mm for men. These values represented the 85th percentiles for young adults. The mean triceps measurements of women and men in our study were well below the obesity levels; instead, they were comparable to mean values recorded for 20-30 yearold people (Center for Disease Control, 1972).
Table 2. Simple Correlations Between Body Measurements^ Group
W/H
BMI
Triceps
Subscapular
Relative weight
All n = 100 Women n = 75 Men n = 25
0.89 0.98 0.97
0.97 1.00 0.99
0.61 0.58 0.63
0.67 0.64 0.72
0.55 0.57 0.47*
Weight/Height (W/H)
All n = 100 Women n = 75 Men n = 25
0.95 0.97 0.98
0.41 0.57 0.63
0.60 0.65 0.72
0.50 0.59 0.53**
Body mass index (BMI)
All n = 100 Women n = 75 Men n = 25
0.52 0.57 0.65
0.65 0.63 0.75
0.52 0.55 0.48*
Triceps skinfold
All n = 100 Women n = 75 Men n = 25
0.70 0.70 0.76
0.57 0.63 0.34***
Subscapular skinfold
All n = 100 Women n = 75 Men n = 25
a
AU correlations significant (p < 0.001) except where indicated. *p < 0.05 **p < 0.01 ***not significant
Suprailiac
0.70 0.72 0.59**
Downloaded from http://geronj.oxfordjournals.org/ at The Univesity of Calgary on November 23, 2012
Billewicz et al. (1962) stated that the best index of obesity is the relative weight, or observed weight as a percentage of desirable weight. According to this index, our average subject was 20% above the suggested weight for height (Table 1). The mean deviation from suggested weight was greater in women (22%) than in men (14%). About XA of the men and Vi of the women were 20% or more above the suggested weight, a finding that is similar to actuarial statistics for persons over the age of 60 years (Metropolitan Life Insurance Co., 1960). Although our sample represented a 30-year age span, we did not find a significant correlation between either relative weight or BMI and age. Skinfold thicknesses have been considered better indices of adiposity than statistics based on body weight; they are highly correlated with body fat as estimated by densitometry (Damon & Goldman, 1964; Katch & Michael, 1968; Sloan, 1967; Sloan et al., 1962) and are independent of height (Ward et al., 1975). Damon & Goldman (1964) and Ward et al. (1975) found that the triceps and subscapular measurements were the best predictors of body fat in young people; Sloan et al. (1962) reported that body density was best correlated with the suprailiac thickness. In a group of older women, it was the subscapular skinfold that correlated most closely with body density (Young et al., 1963). Mean skinfold measurements of the elderly
659
660
YEARICK
Downloaded from http://geronj.oxfordjournals.org/ at The Univesity of Calgary on November 23, 2012
Body Weight and Blood Pressure The mean systolic and diastolic pressures of the women were 147.9 and 79.7 mm Hg; for men the values were 145.7 and 79.8 mm Hg (Table 1). The systolic means are essentially the same as those recorded for elderly persons in the 1972 National Health Survey (National Center for Health Statistics, 1975). The mean diastolic pressures of individuals in our study were considerably lower than those of 60-74 year-old persons in the 1972 survey; they correspond more closely with mean diastolic pressures recorded for middle-aged and younger individuals. In the evaluation of blood pressure data collected in 1960-62 (National Center for Health Statistics, 1966), the normotensive individual was defined as having systolic and diastolic pressures of less than 140 and less than 90 mm Hg, respectively. Persons with systolic pressures of 160mm Hg or greater and/ or diastolic pressures of 95 mm Hg or greater were considered to be hypertensive. According to these criteria, 33% of the women and 40% of the men in our study were normotensive; 37% of the women and 28% of the men would be considered hypertensive. The percentages of persons in the two categories are almost identical to those found in the 1972 survey for women and men, 60-74 years of age. Significant positive correlations were obtained between both relative weight and BMI of the subjects and systolic pressures (r = 0.20, p < 0.05) and diastolic pressures (r = 0.29, p < 0.01). This confirms the clinical impression that overweight can contribute to hypertension. There were 24 subjects who identified high blood pressure as a medical problem; 20 of them were taking medications to control The mean daily energy intake was 1734 kilo- hypertension. calories, or 99% of the recommended dietary allowance adjusted forage. Diets of the women Body Weight and Serum Cholesterol and averaged 99% and diets of the men averaged Glucose 97% of the allowances. Although some individMean serum cholesterol concentrations of uals consumed more than 3000 kilocalories 212.6 mg/dl were recorded for the women and per day, energy intake was not correlated with 189.6 mg/dl for the men (Table 1). The means any of the indices of adiposity. Of the 38 indi- were considerably lower than the corrected viduals who considered themselves over- values reported for elderly persons in the 1971weight, only 8 had attempted weight reduction 1974 health survey (National Center for Health diets. Since none of the subjects reported re- Statistics, 1977). They did, however, support cent weight gain or loss, those who were obese the finding that the cholesterol in serum of oldmust have accumulated the excess weight dur- er women exceeds that of older men. Because ing their middle years. Their current caloric of the wide inter- and intra-subject variations intake appears to have been just sufficient to in serum cholesterol, and because the values maintain a stable weight. may differ with different analytical methods, However, when individual data were examined, there were 19% of the women and 16% of the men whose triceps measurements exceeded the criteria for obesity. The prevalence among older persons in the Ten-state Survey was 24% of the women and 9% of the men. Simple correlations among the various indices of adiposity appear in Table 2. Highly significant correlations (p < 0.001) were obtained among the three indices derived from body weight, and between the weight indices and triceps and subscapular skinfold thicknesses. For both men and women, the subscapular measurement gave the highest correlation with the other skinfolds and with the weight indices. Although 42% of these older people were more than 20% above ideal weight, only 18% could be considered obese as judged by the triceps measurement. It is possible that, in older women at least, the subscapular thickness provides a more valid measure of fatness than does the triceps. Younget al. (1963) found that the subscapular thickness was most closely correlated with densitometric estimates of body fat in women. They suggested that the fat deposits may be more central in the aged woman. Furthermore, examination of data from other surveys (Gibson et al., 1975; Montoye et al., 1965) shows that the age-related increase in subscapular thickness of women is greater than the increase in the triceps skinfold. In men, there is no evidence that the two skinfold measurements respond differently to age, however. Criteria for defining obesity on the basis of the subscapular skinfold have not been established.
ANTHROPOMETRIC FINDINGS IN THE ELDERLY
CONCLUSIONS
Forty-two percent of these elderly people were obese by relative weight standards. About half that number were obese according to the triceps fatfold criteria. Nevertheless,
the highly significant correlations between weight indices and skinfold thicknesses appear to justify the clinical use of relative weight as a measure of body fatness. Of the three skinfold measurements, the subscapular was the best index of adiposity. More than V?> of the group was judged to be hypertensive by prevailing standards. The positive correlation between relative weight and blood pressure supports the use of weight reduction as part of the therapy for hypertension. Relative weight was also positively correlated with serum glucose concentrations in women, although fasting glucose levels were generally in the normal range. There was no indication that overweight or adiposity was associated with serum cholesterol concentrations in this group. Although nearly half of the subjects were overweight, their weight appeared to be stable and unrelated to current energy intake. No correlation was shown between dietary calories and any of the anthropometric or clinical findings. REFERENCES
Acheson, R. M., & Baird, J. T., Jr. Serum cholesterol in a national sample of U. S. adults: A study from prevalence data of its relationship to physique, blood pressure, blood glucose and other variables. International Journal of Epidemiology, 1973,2, 283-292. Billewicz, W. Z., Kemsley, W. F. F., & Thomson, A. M. Indices of adiposity. British Journal of Preventive and Social Medicine, 1962,16, 183-188.
Brozek, J. Changes of body composition in man during maturity and their nutritional implications. Federation Proceedings, 1952, //, 784-793. Center for Disease Control. Ten-state nutrition survey in the United States, 1968-70. III. Clinical, anthropometry, dental. DHEW Pub. No. (HSM) 72-8131. Atlanta, 1972. Damon, A., & Goldman, R. F. Predicting body fat from body measurements: Densitometric validation of ten anthropometric equations. Human Biology, 1964, 36, 32-44. Florey, C. du V. The use and interpretation of ponderal index and other height-weight ratios in epidemiological studies. Journal of Chronic Diseases, 1970,25, 93-103. Food and Nutrition Board. National Research Council. Recommended dietary allowances, 7th Ed. National Academy of Sciences, Washington, 1968. Food and Nutrition Board, National Research Council. Recommended dietary allowances, 8th Ed. National Academy of Sciences, Washington, 1974. Gibson, T. C , Horton, E. S., & Whorton, E. B. Interrelationships of insulin, glucose, lipid and anthropometric data in a natural population. American Journal of Clinical Nutrition, 1915,28, 1387-1394. Gordon, T. The Framingham diet study: Diet and the regulation of serum cholesterol. Section 24. The Framingham Study. An epidemiological investigation of cardiovascular disease. NIH, Bethesda, Md., 1969.
Downloaded from http://geronj.oxfordjournals.org/ at The Univesity of Calgary on November 23, 2012
it is difficult to specify a level that would define hypercholesteremia. Nevertheless, a concentration of 260 mg/dl has been taken as a cut-off point between normal and high cholesterol values (National Center for Health Statistics, 1967). By this criterion, only 7 women and none of the men in our study could be considered hypercholesteremic. In contrast to the findings of Acheson and Baird (1973), no significant correlation was obtained between serum cholesterol concentrations and either relative weight (r = 0.14) or blood pressure (r = 0.07). The possibility that serum cholesterol levels were associated with diet was also explored. The mean daily energy intake of the subjects was 99% of the recommended allowances and fat accounted for 36% of the calories. The dietary cholesterol averaged only 272 mg/day but individual intakes ranged from 66 mg to 716 mg. No significant correlations were found between serum cholesterol and either dietary calories (r = -0.09), fat (r = -0.08), or cholesterol (r = 0.003). The failure to demonstrate an association between diet and serum cholesterol levels was also reported in the Framingham study (Gordon, 1969). While it does not negate the concept that blood lipids can be altered by diet, it suggests that diet is not the sole controlling factor. The mean serum concentrations of glucose at fasting were well within normal limits (Table 1). Two men and two women had concentrations above 200 mg/dl. Of these, two were acknowledged diabetics. Three other diabetic subjects were maintaining their blood glucose levels below 120 mg/dl. For the nondiabetic subjects, a significant correlation (p < 0.01) was obtained between serum glucose levels and relative weight in women (r = 0.44) but not in men (r = 0.16). In a survey of randomly selected middle-aged and older men and women, Gibson et al. (1975) were unable to demonstrate any significant correlation between relative weight and fasting glucose levels, although relative weight was significantly correlated with the log of fasting insulin level.
661
662
YEARICK
National Center for Health Statistics. Blood pressure of person 18-74 years. United States, 1971-72. Vital and Health Statistics. Series 11-No. 150. DHEW Pub. No. • (HRS) 75-1632. Washington, 1975. National Center for Health Statistics. Height and weight of adults 18-74 of age in the United States. Advance data from Vital and Health Statistics. DHEW Pub. No. (HRA) 77-1250, No. 3, Washington, 1976. National Center for Health Statistics. A comparison of levels of serum cholesterol of adults 18-74 years of age in the United States in 1960-62 and 1971-74. Advance data from Vital and Health Statistics. DHEW Pub. No. (HRA) 77-1250, No. 5, Washington, 1977. Pollack, M. L., Eddins, E. L., Coleman, B., Linnerud, A. C , & Jackson, A. Prediction of body density in young and middle-aged women. Journal of Applied Physiology, 1975, 38, 745-749. Pollack, M. J., Hickman, T., Kendrick, Z., Jackson, A., Linnerud, A. C , & Dawson, G. Prediction of body density in young and middle-aged men. Journal of Applied Physiology, 1976, 40, 300-304. Sloan, A. W. Estimation of body fat in young men. Journal of Applied Physiology, 1967, 23, 311-315. Sloan, A. W., Burt, J. J., & Blyth, C. S. Estimation of body fat in young women. Journal of Applied Physiology, 1962, 17, 967-970. Technicon AutoAnalyzer Bulletin N-2A. Technicon Corporation, Ardsley, N. Y., 1970. Ward, G. M., Krzywicki, H. J., Rahman, D. P., Quass, R. L., Nelson, R. A., & Consolazio, C. F. Relationship of anthropometric measurements of body fat as determined by densitometry, potassium-40, and body water. American Journal of Clinical Nutrition, 1975, 28, 162-169. Young, C. M., Blondin, J., Tensuan, R., & Fryer, J. H. Body composition studies of older women. Annals of the New York Academy of Science, 1963,7/0, 589-607.
Downloaded from http://geronj.oxfordjournals.org/ at The Univesity of Calgary on November 23, 2012
Hoffman, W. S. A rapid photoelectric method for the determination of glucose in blood. Journal of Biological Chemistry, 1937, 120, 51-55. Inter-society Commission for Heart Disease Resources. Primary prevention of the atherosclerotic diseases. Circulation, 1970,42, A55-A95. Rev., April, 1972. Katch, F. I., & Michael, E. D., Jr. Prediction of body density from skinfold and girth measurements of college females. Journal of Applied Physiology, 1968,25, 92-94. Keys, A., Fidanza, F., Karvonen, M. J., & Taylor, H. S. Indices of relative weight and obesity. Journal of Chronic Diseases, 1972, 25, 329-343. Khosla, T., & Lowe, C. R. Indices of obesity derived from body weight and height. British Journal of Preventive and Social Medicine, 1967,2/, 122-128. Levine, J. B., & Zak, B. Automated determination of serum total cholesterol. Clinica Chimica Ada, 1964, 10, 381-384. Metropolitan Life Insurance Co. Frequency of overweight and underweight. Metropolitan Life Insurance Co. Statistical Bulletin, 1960,4/, 4. Montoye, H. J., Epstein, F. H., & Kjelsberg, M. O. The measurement of body fatness: A study in a total community. American Journal of Clinical Nutrition, 1965, 16, 417-427. National Center for Health Statistics. Hypertension and hypertensive heart disease in adults. United States 1960-1962. Vital and Health Statistics, PHS Pub. No. 1000-Series 11-No. 13. Washington, 1966. National Center for Health Statistics. Serum cholesterol levels of adults. United States 1960-62. Vital and Health Statistics, PHS Pub. No. 1000-Series 11-No. 22. Washington, 1967. National Center for Health Statistics. Skinfolds, body girths, biacromial diameter, and selected anthropometric indices of adults, 1960-62. Vital and Health Statistics, PHS Pub. No. 1000-Series 11-No. 34. Washington, 1970.
