The association of lean and fat mass with all-cause mortality in older adults: The Cardiovascular Health Study

A. Spahillari, K. J. Mukamal, C. DeFilippi, Jorge Kizer, J. S. Gottdiener, L. Djoussé, M. F. Lyles, T. M. Bartz, V. L. Murthy, R. V. Shah

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background and aims Understanding contributions of lean and fat tissue to cardiovascular and non-cardiovascular mortality may help clarify areas of prevention in older adults. We aimed to define distributions of lean and fat tissue in older adults and their contributions to cause-specific mortality. Methods and results A total of 1335 participants of the Cardiovascular Health Study (CHS) who underwent dual-energy x-ray absorptiometry (DEXA) scans were included. We used principal components analysis (PCA) to define two independent sources of variation in DEXA-derived body composition, corresponding to principal components composed of lean (“lean PC”) and fat (“fat PC”) tissue. We used Cox proportional hazards regression using these PCs to investigate the relationship between body composition with cardiovascular and non-cardiovascular mortality. Mean age was 76.2 ± 4.8 years (56% women) with mean body mass index 27.1 ± 4.4 kg/m2. A greater lean PC was associated with lower all-cause (HR = 0.91, 95% CI 0.84–0.98, P = 0.01) and cardiovascular mortality (HR = 0.84, 95% CI 0.74–0.95, P = 0.005). The lowest quartile of the fat PC (least adiposity) was associated with a greater hazard of all-cause mortality (HR = 1.24, 95% CI 1.04–1.48, P = 0.02) relative to fat PCs between the 25th–75th percentile, but the highest quartile did not have a significantly greater hazard (P = 0.70). Conclusion Greater lean tissue mass is associated with improved cardiovascular and overall mortality in the elderly. The lowest levels of fat tissue mass are linked with adverse prognosis, but the highest levels show no significant mortality protection. Prevention efforts in the elderly frail may be best targeted toward improvements in lean muscle mass.

Original languageEnglish (US)
Pages (from-to)1039-1047
Number of pages9
JournalNutrition, Metabolism and Cardiovascular Diseases
Volume26
Issue number11
DOIs
StatePublished - Nov 1 2016

Fingerprint

Fats
Mortality
Health
Body Composition
X-Rays
Frail Elderly
Adiposity
Principal Component Analysis
Body Mass Index
Muscles

Keywords

  • All-cause mortality
  • Cardiovascular Health Study
  • Cardiovascular mortality
  • DEXA
  • Fat
  • Lean mass

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics
  • Cardiology and Cardiovascular Medicine

Cite this

The association of lean and fat mass with all-cause mortality in older adults : The Cardiovascular Health Study. / Spahillari, A.; Mukamal, K. J.; DeFilippi, C.; Kizer, Jorge; Gottdiener, J. S.; Djoussé, L.; Lyles, M. F.; Bartz, T. M.; Murthy, V. L.; Shah, R. V.

In: Nutrition, Metabolism and Cardiovascular Diseases, Vol. 26, No. 11, 01.11.2016, p. 1039-1047.

Research output: Contribution to journalArticle

Spahillari, A, Mukamal, KJ, DeFilippi, C, Kizer, J, Gottdiener, JS, Djoussé, L, Lyles, MF, Bartz, TM, Murthy, VL & Shah, RV 2016, 'The association of lean and fat mass with all-cause mortality in older adults: The Cardiovascular Health Study', Nutrition, Metabolism and Cardiovascular Diseases, vol. 26, no. 11, pp. 1039-1047. https://doi.org/10.1016/j.numecd.2016.06.011
Spahillari, A. ; Mukamal, K. J. ; DeFilippi, C. ; Kizer, Jorge ; Gottdiener, J. S. ; Djoussé, L. ; Lyles, M. F. ; Bartz, T. M. ; Murthy, V. L. ; Shah, R. V. / The association of lean and fat mass with all-cause mortality in older adults : The Cardiovascular Health Study. In: Nutrition, Metabolism and Cardiovascular Diseases. 2016 ; Vol. 26, No. 11. pp. 1039-1047.
@article{f4857dde99814897b7da593c4c250af7,
title = "The association of lean and fat mass with all-cause mortality in older adults: The Cardiovascular Health Study",
abstract = "Background and aims Understanding contributions of lean and fat tissue to cardiovascular and non-cardiovascular mortality may help clarify areas of prevention in older adults. We aimed to define distributions of lean and fat tissue in older adults and their contributions to cause-specific mortality. Methods and results A total of 1335 participants of the Cardiovascular Health Study (CHS) who underwent dual-energy x-ray absorptiometry (DEXA) scans were included. We used principal components analysis (PCA) to define two independent sources of variation in DEXA-derived body composition, corresponding to principal components composed of lean (“lean PC”) and fat (“fat PC”) tissue. We used Cox proportional hazards regression using these PCs to investigate the relationship between body composition with cardiovascular and non-cardiovascular mortality. Mean age was 76.2 ± 4.8 years (56{\%} women) with mean body mass index 27.1 ± 4.4 kg/m2. A greater lean PC was associated with lower all-cause (HR = 0.91, 95{\%} CI 0.84–0.98, P = 0.01) and cardiovascular mortality (HR = 0.84, 95{\%} CI 0.74–0.95, P = 0.005). The lowest quartile of the fat PC (least adiposity) was associated with a greater hazard of all-cause mortality (HR = 1.24, 95{\%} CI 1.04–1.48, P = 0.02) relative to fat PCs between the 25th–75th percentile, but the highest quartile did not have a significantly greater hazard (P = 0.70). Conclusion Greater lean tissue mass is associated with improved cardiovascular and overall mortality in the elderly. The lowest levels of fat tissue mass are linked with adverse prognosis, but the highest levels show no significant mortality protection. Prevention efforts in the elderly frail may be best targeted toward improvements in lean muscle mass.",
keywords = "All-cause mortality, Cardiovascular Health Study, Cardiovascular mortality, DEXA, Fat, Lean mass",
author = "A. Spahillari and Mukamal, {K. J.} and C. DeFilippi and Jorge Kizer and Gottdiener, {J. S.} and L. Djouss{\'e} and Lyles, {M. F.} and Bartz, {T. M.} and Murthy, {V. L.} and Shah, {R. V.}",
year = "2016",
month = "11",
day = "1",
doi = "10.1016/j.numecd.2016.06.011",
language = "English (US)",
volume = "26",
pages = "1039--1047",
journal = "Nutrition, Metabolism and Cardiovascular Diseases",
issn = "0939-4753",
publisher = "Elsevier",
number = "11",

}

TY - JOUR

T1 - The association of lean and fat mass with all-cause mortality in older adults

T2 - The Cardiovascular Health Study

AU - Spahillari, A.

AU - Mukamal, K. J.

AU - DeFilippi, C.

AU - Kizer, Jorge

AU - Gottdiener, J. S.

AU - Djoussé, L.

AU - Lyles, M. F.

AU - Bartz, T. M.

AU - Murthy, V. L.

AU - Shah, R. V.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background and aims Understanding contributions of lean and fat tissue to cardiovascular and non-cardiovascular mortality may help clarify areas of prevention in older adults. We aimed to define distributions of lean and fat tissue in older adults and their contributions to cause-specific mortality. Methods and results A total of 1335 participants of the Cardiovascular Health Study (CHS) who underwent dual-energy x-ray absorptiometry (DEXA) scans were included. We used principal components analysis (PCA) to define two independent sources of variation in DEXA-derived body composition, corresponding to principal components composed of lean (“lean PC”) and fat (“fat PC”) tissue. We used Cox proportional hazards regression using these PCs to investigate the relationship between body composition with cardiovascular and non-cardiovascular mortality. Mean age was 76.2 ± 4.8 years (56% women) with mean body mass index 27.1 ± 4.4 kg/m2. A greater lean PC was associated with lower all-cause (HR = 0.91, 95% CI 0.84–0.98, P = 0.01) and cardiovascular mortality (HR = 0.84, 95% CI 0.74–0.95, P = 0.005). The lowest quartile of the fat PC (least adiposity) was associated with a greater hazard of all-cause mortality (HR = 1.24, 95% CI 1.04–1.48, P = 0.02) relative to fat PCs between the 25th–75th percentile, but the highest quartile did not have a significantly greater hazard (P = 0.70). Conclusion Greater lean tissue mass is associated with improved cardiovascular and overall mortality in the elderly. The lowest levels of fat tissue mass are linked with adverse prognosis, but the highest levels show no significant mortality protection. Prevention efforts in the elderly frail may be best targeted toward improvements in lean muscle mass.

AB - Background and aims Understanding contributions of lean and fat tissue to cardiovascular and non-cardiovascular mortality may help clarify areas of prevention in older adults. We aimed to define distributions of lean and fat tissue in older adults and their contributions to cause-specific mortality. Methods and results A total of 1335 participants of the Cardiovascular Health Study (CHS) who underwent dual-energy x-ray absorptiometry (DEXA) scans were included. We used principal components analysis (PCA) to define two independent sources of variation in DEXA-derived body composition, corresponding to principal components composed of lean (“lean PC”) and fat (“fat PC”) tissue. We used Cox proportional hazards regression using these PCs to investigate the relationship between body composition with cardiovascular and non-cardiovascular mortality. Mean age was 76.2 ± 4.8 years (56% women) with mean body mass index 27.1 ± 4.4 kg/m2. A greater lean PC was associated with lower all-cause (HR = 0.91, 95% CI 0.84–0.98, P = 0.01) and cardiovascular mortality (HR = 0.84, 95% CI 0.74–0.95, P = 0.005). The lowest quartile of the fat PC (least adiposity) was associated with a greater hazard of all-cause mortality (HR = 1.24, 95% CI 1.04–1.48, P = 0.02) relative to fat PCs between the 25th–75th percentile, but the highest quartile did not have a significantly greater hazard (P = 0.70). Conclusion Greater lean tissue mass is associated with improved cardiovascular and overall mortality in the elderly. The lowest levels of fat tissue mass are linked with adverse prognosis, but the highest levels show no significant mortality protection. Prevention efforts in the elderly frail may be best targeted toward improvements in lean muscle mass.

KW - All-cause mortality

KW - Cardiovascular Health Study

KW - Cardiovascular mortality

KW - DEXA

KW - Fat

KW - Lean mass

UR - http://www.scopus.com/inward/record.url?scp=84992597847&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84992597847&partnerID=8YFLogxK

U2 - 10.1016/j.numecd.2016.06.011

DO - 10.1016/j.numecd.2016.06.011

M3 - Article

C2 - 27484755

AN - SCOPUS:84992597847

VL - 26

SP - 1039

EP - 1047

JO - Nutrition, Metabolism and Cardiovascular Diseases

JF - Nutrition, Metabolism and Cardiovascular Diseases

SN - 0939-4753

IS - 11

ER -