Severe central obesity or diabetes can replace weight loss in the detection of frailty in obese younger elderly – a preliminary study

Assaf Buch,1–3 Lital Keinan-Boker,4,5 Ofer Kis,1 Eli Carmeli,1,6 Elena Izkhakov,1,2 Maya Ish-Shalom,1,2 Yitshal Berner,2,7 Gabi Shefer,1,2 Yonit Marcus,1,2 Naftali Stern1,2 1The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; 2The Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel; 3Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel; 4School of Public Health, University of Haifa, Haifa, Israel; 5Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel; 6The Department of Physical Therapy, University of Haifa, Haifa, Israel; 7Meir Medical Center, Kfar Saba, Israel Purpose: Unwanted weight loss is one of the established criteria for the diagnosis of frailty. However, the relevance of this criterion to detect frailty in obese older adults has not been assessed. In particular, with the exception of malignancy, unwanted weight loss is not commonly seen in older obese subjects. Therefore, we tested the possibility that some obesity phenotypes and/or diabetes might be more useful in the detection of frailty in this setting.Patients and methods: A preliminary cross-sectional study of 50 consecutive subjects was conducted at The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center. Inclusion criteria were: young elderly (aged 65–75 years), with general and/or abdominal obesity, without cancer. Frailty was assessed directly using the Fried model, the five-item fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale. Eventually, in the assessment of frailty, the weight loss criterion was replaced by one or several of obesity/diabetes-related variables each time: severity of obesity by body mass index, waist circumference (and their interaction), body fat, and diabetes. The receiver operating characteristic curves for functional impairment indices were plotted to compare the usefulness of the frailty accepted and adjusted models.Results: The prevalence of frailty and pre-frailty in this cohort were 7/50 (14%) and 27/50 (54%), respectively, but unwanted weight loss was seen in three subjects (6%) only. The level of abdominal obesity had the strongest correlation with functional score (r=0.292, P<0.05). Frailty models which included either severe abdominal obesity or diabetes in lieu of unwanted weight loss had good sensitivity rates per each frailty score as compared with the original Fried model.Conclusion: For detecting and/or screening for the frailty syndrome in obese young elderly, the level of abdominal obesity or diabetes may provide a useful marker. Keywords: abdominal obesity, anthropometrics, older adults, functional level, unwanted weight los