title: Low mid-upper arm circumference, calf circumference, and body mass index and mortality in older persons.
abstract: BACKGROUND
  Low body mass index is a general measure of thinness. However, its measurement can be cumbersome in older persons and other simple anthropometric measures may be more strongly associated with mortality. Therefore, associations of low mid-upper arm circumference, calf circumference, and body mass index with mortality were examined in older persons.
  
  
  METHODS
  Data of the Longitudinal Aging Study Amsterdam, a population-based cohort study in the Netherlands, were used. The present study included community-dwelling persons 65 years and older in 1992-1993 (n = 1,667), who were followed until 2007 for their vital status. Associations between anthropometric measures and 15-year mortality were examined by spline regression models and, below the nadir, Cox regression models, transforming all measures to sex-specific Z scores.
  
  
  RESULTS
  Mortality rates were 599 of 826 (73%) in men and 479 of 841 (57%) in women. Below the nadir, the hazard ratio of mortality per 1 standard deviation lower mid-upper arm circumference was 1.79 (95% confidence interval, 1.48-2.16) in men and 2.26 (1.71-3.00) in women. For calf circumference, the hazard ratio was 1.45 (1.22-1.71) in men and 1.30 (1.15-1.48) in women and for body mass index 1.38 (1.17-1.61) in men and 1.56 (1.10-2.21) in women. Excluding deaths within the first 3 years after baseline did not change these associations. Excluding those with a smoking history, obstructive lung disease, or cancer attenuated the associations of calf circumference (men) and body mass index (women).
  
  
  CONCLUSIONS
  Based on the stronger association with mortality and given a more easy assessment in older persons, mid-upper arm circumference seems a more feasible and valid anthropometric measure of thinness than body mass index in older men and women.
authors.affiliation: Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, the Netherlands. hanneke.wijnhoven@falw.vu.nl
authors.forename: Hanneke A H
authors.initials: HA
authors.lastname: Wijnhoven
authors.forename: Marian A E
authors.initials: MA
authors.lastname: van Bokhorst-de van der Schueren
authors.forename: Martijn W
authors.initials: MW
authors.lastname: Heymans
authors.forename: Henrica C W
authors.initials: HC
authors.lastname: de Vet
authors.forename: Hinke M
authors.initials: HM
authors.lastname: Kruizenga
authors.forename: Jos W
authors.initials: JW
authors.lastname: Twisk
authors.forename: Marjolein
authors.initials: M
authors.lastname: Visser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D001132:Arm / Q000033:anatomy & histology* / Q000502:physiology; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007866:Leg / Q000033:anatomy & histology* / Q000502:physiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009426:Netherlands; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012738:Sex Hormone-Binding Globulin
chemical_list: D012738:Sex Hormone-Binding Globulin