title: Associations of BMI and adipose tissue area and density with incident mobility limitation and poor performance in older adults.
abstract: BACKGROUND
  Obesity is a risk factor for disability, but risk of specific adipose depots is not completely understood.
  
  
  OBJECTIVE
  We investigated associations between mobility limitation, performance, and the following adipose measures: body mass index (BMI) and areas and densities of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and intermuscular adipose tissue (IMAT) in older adults.
  
  
  METHODS
  This was a prospective population-based study of men (n = 1459) and women (n = 1552) initially aged 70-79 y and free from mobility limitation. BMI was determined from measured height and weight. Adipose tissue area and density in Hounsfield units were measured in the thigh and abdomen by using computed tomography. Mobility limitation was defined as 2 consecutive reports of difficulty walking one-quarter mile or climbing 10 steps during semiannual assessments over 13 y. Poor performance was defined as a gait speed <1 m/s after 9 y of follow-up (n = 1542).
  
  
  RESULTS
  In models adjusted for disability risk factors, BMI, and areas of VAT, abdominal SAT, and IMAT were positively associated with mobility limitation in men and women. In women, thigh SAT area was positively associated with mobility limitation risk, whereas VAT density was inversely associated. Associations were similar for poor performance. BMI and thigh IMAT area (independent of BMI) were particularly strong indicators of incident mobility limitation and poor performance. For example, in women, the HR (95% CI) and OR (95% CI) associated with an SD increment in BMI for mobility limitation and poor performance were 1.31 (1.21, 1.42) and 1.41 (1.13, 1.76), respectively. In men, the HR (95% CI) and OR (95% CI) associated with an SD increment in thigh IMAT for mobility limitation and poor performance were 1.37 (1.27, 1.47) and 1.54 (1.18, 2.02), respectively.
  
  
  CONCLUSIONS
  Even into old age, higher BMI is associated with mobility limitation and poor performance. The amount of adipose tissue in abdominal and thigh depots may also convey risk beyond BMI.
authors: Laboratory of Epidemiology, and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD (RAM, IR, and TBH); the Sections on Comparative Medicine Pathology, Radiology (TCR), and Gerontology and Geriatrics (SBK), Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC; the Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (HNA); the Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (ABN); the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN (SS); the Center for Aging and Population Health, Department of Medicine, University of Pittsburgh, Pittsburgh, PA (BHG); and the Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, Baltimore, MD (EMS).
authors: Rachel A
authors: RA
authors: Murphy
authors: Ilse
authors: I
authors: Reinders
authors: Thomas C
authors: TC
authors: Register
authors: Hilsa N
authors: HN
authors: Ayonayon
authors: Anne B
authors: AB
authors: Newman
authors: Suzanne
authors: S
authors: Satterfield
authors: Bret H
authors: BH
authors: Goodpaster
authors: Eleanor M
authors: EM
authors: Simonsick
authors: Stephen B
authors: SB
authors: Kritchevsky
authors: Tamara B
authors: TB
authors: Harris
mesh_terms: D000273:Adipose Tissue; D050154:Adiposity; D000368:Aged; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D051346:Mobility Limitation; D009043:Motor Activity; D018482:Muscle, Skeletal / Q000737:chemistry; D009765:Obesity / Q000503:physiopathology*; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report; D013848:Thigh