title: Association of midlife obesity and cardiovascular risk with old age frailty: a 26-year follow-up of initially healthy men.
abstract: OBJECTIVE
  To investigate whether old age frailty is predicted by midlife overweight/obesity and cardiovascular disease (CVD) risk.
  
  
  METHODS
  Longitudinal observational study (the Helsinki Businessmen Study).
  
  
  METHODS
  In their midlife in 1974, 1815 initially healthy men (mean age 47 years) were clinically investigated, whereupon their weight status (normal weight < 25 kg m(-2), overweight 25 ≤ body mass index <30 kg m(-2) and obese ≥ 30 kg m(-2)), CVD risk factors and a composite risk score (%) of coronary artery disease (CAD) were assessed. After a 26-year follow-up in 2000, when 425 men had died, the frailty status of survivors (80.9%, n=1125, mean age 73 years) was assessed using a postal questionnaire including the RAND-36/SF-36 instrument. Phenotypic criteria were used to define frailty, and according to these criteria, 40.0% (n=450), 50.4% (n=567) and 9.6% (n=108) were classified as not frail, prefrail and frail, respectively. Risks are presented as odds ratios (OR) with 95% confidence intervals (CI).
  
  
  RESULTS
  Compared with normal weight, the development of frailty was significantly higher among those men who were overweight or obese in midlife, with fully adjusted ORs (95% CI) of 2.06 (1.21-3.52) and 5.41 (1.94-15.1), respectively. Even the development of prefrailty was significantly increased with midlife overweight (OR 1.39; 95% CI, 1.03-1.87) and obesity (OR 2.96; 95% CI, 1.49-5.88). Age-adjusted composite CAD score in midlife predicted similarly 26-year total mortality (OR per 1% increase:1.16; 95% CI, 1.08-1.24) and development of frailty (OR 1.16; 95% CI, 1.02-1.33).
  
  
  CONCLUSIONS
  Overweight/obesity and higher CAD risk in midlife were associated with frailty 26 years later. Preventing old age frailty should be recognized as an important goal of obesity and CVD risk control.
authors.affiliation: Institute of Health Sciences/Geriatrics, University of Oulu and Oulu University Hospital, Unit of General Practice, Oulu, Finland. timo.strandberg@oulu.fi
authors.forename: T E
authors.initials: TE
authors.lastname: Strandberg
authors.forename: J
authors.initials: J
authors.lastname: Sirola
authors.forename: K H
authors.initials: KH
authors.lastname: Pitkälä
authors.forename: R S
authors.initials: RS
authors.lastname: Tilvis
authors.forename: A Y
authors.initials: AY
authors.lastname: Strandberg
authors.forename: S
authors.initials: S
authors.lastname: Stenholm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D004185:Disability Evaluation; D018450:Disease Progression; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment; D015438:Health Behavior; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires