A pot belly in middle age can double the risk of becoming frail

By Jim Leffman via SWNS

Carrying a pot belly or muffin top in middle age can more than double the risk of becoming frail when you're older, a new study reveals.

Many people think of frailty as a wasting condition but researchers from Oslo University found that keeping trim throughout life is a good way of reducing your risk.

They looked at 4,500 people aged over 45 who had been monitored for an average of 21 years as part of the Tromso Study.

They defined pre-frailty by at least two and frailty by at least three of five signs.

These are unintentional weight loss, exhaustion, weak grip strength, slow walking speed and low physical activity levels.

People with the condition are vulnerable to falls, disability, hospital admission, reduced quality of life and death.

They were looking to add to the evidence that overweight middle-aged people had a higher risk of frailty later because being fat aggravates the decline in muscle strength, aerobic capacity, and physical function.

However, there were few studies that tracked weight changes and frailty risk over the long term.

The study, published in the journal BMJ Open, concluded that on BMI alone, those with a high BMI in 1994 were two and a half times more likely to be frail in 2015.

Head of the Department and one of the authors, Professor Lene Frost Andersen said: "Carrying far too much weight, including a midriff bulge, from mid-life onwards, is linked to a heightened risk of physical frailty in older age.

"Our conclusions align with the findings from two previous longitudinal studies with a similar follow-up period of 26 and 22 years that reported a significant positive association between midlife overweight or obesity and the development of pre-frailty and frailty in later life.

“In the context where the population is rapidly aging and the obesity epidemic is rising, growing evidence recognizes the subgroup of ‘fat and frail’ older individuals in contrast to viewing frailty only as a wasting disorder.

"Our study highlights the importance of routinely assessing and maintaining optimal BMI and waist circumference throughout adulthood to lower the risk of frailty in older age."

The team studied whether general, BMI and abdominal, waist circumference obesity, separately and jointly, might affect the risk of pre-frailty or frailty.

The average age at the beginning was 51.

A BMI of less than 18.5 was categorized as underweight, normal as 18.5-24.9, overweight as 25–29.9, and obesity as 30 and above.

Waist circumference was categorized as normal, 94 cm (37 inches) or less for men and 80 cm (31 inches) or less for women, moderately high as 95–102 cm for men and 81–88 cm for women and high was above 102 cm for men and above 88 cm for women.

By 2015-16, 28% of participants were pre-frail, 1% were frail, and 70.5% were strong. In all, nearly 51% of those who were strong and 55% of those categorized as pre-frail were women.

While participants in both the strong, pre-frail and frail groups put on weight and expanded their waistlines during the monitoring period, there were higher proportions of participants with normal BMIs and waistlines at the start of the monitoring period in the strong group.

Conditions, such as diabetes and potentially influential factors, including drinking and smoking, education, marital status and social support, and physical activity levels differed significantly between the strong and pre-frail and frail groups and were accounted for in the analysis.

Those who were obese in 1994, assessed by BMI alone, were nearly 2.5 times more likely to be pre-frail/frail at the end of the monitoring period than those with a normal BMI.

Similarly, those with a moderately high or high waist circumference, to start off with, were, respectively, 57% and twice as likely, to be pre-frail or frail than those with a normal waistline.

Those who started off with a normal BMI but moderately-high waist circumference or who were overweight but had a normal waistline weren’t significantly more likely to be pre-frail or frail at the end of the monitoring period.

However, those who were both obese and who had a moderately-high waist circumference at the start of the monitoring period were.

Higher odds of pre-frailty or frailty were also observed among those who put on weight and among those whose waistlines expanded than in those whose weight and waistlines remained the same throughout.

While the findings echo those of previous long-term studies, this is an observational study, which didn’t track potentially influential changes in lifestyle, diet, and friendship networks that might have occurred during the monitoring period.

And the researchers point out that the findings were still significant for participants with baseline obesity and higher waist circumference when those over 60s were excluded from the analysis. Few underweight people were included in the study.

But there are some plausible biological explanations for their findings, the researchers suggest.

These include the increased inflammatory capacity of fat cells and their infiltration into muscle cells, both of which likely boost naturally occurring age-related decline in muscle mass and strength, so heightening the risk of frailty.