title: Association Between Anthropometric Measures and Long-Term Survival in Frail Older Women: Observations from the Women's Health Initiative Study.
abstract: OBJECTIVE
  To evaluate the association between currently recommended guidelines and commonly used clinical criteria for body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) and all-cause mortality in frail older women.
  
  
  METHODS
  Longitudinal prospective cohort study.
  
  
  METHODS
  Women's Health Initiative (WHI)-Observational Study.
  
  
  METHODS
  A sample of women aged 65-84 with complete data to characterize frailty in the third year of WHI follow-up (N = 11,070).
  
  
  METHODS
  Frailty phenotype was determined using the modified Fried criteria. Information on anthropometric measures (BMI, WC, WHR) was collected in clinical examinations. Cox proportional hazards models were used to estimate the effect of BMI, WC, and WHR on mortality adjusted for demographic characteristics and health behaviors.
  
  
  RESULTS
  Over a mean follow-up of 11.5 years, there were 2,911 (26%) deaths in the sample. Women with a BMI from 25.0 to 29.9 kg/m(2) (hazard rate ratio (HR) = 0.80, 95% confidence interval (CI) = 0.73-0.88) and those with a BMI from 30.0 to 34.9 kg/m(2) (HR = 0.79, 95% CI = 0.71-0.88) had lower mortality than those with a BMI from 18.5 to 24.9 kg/m(2) . Women with a WHR greater than 0.8 had higher mortality (HR = 1.16, 95% CI = 1.07-1.26) than those with a WHR of 0.8 or less. No difference in mortality was observed according to WC. Stratifying according to chronic morbidity or smoking status or excluding women with early death and unintentional weight loss did not substantially change these findings.
  
  
  CONCLUSIONS
  In frail, older women, having a BMI between 25.0 and 34.9 kg/m(2) or a WHR of 0.8 or less was associated with lower mortality. Currently recommended healthy BMI guidelines should be reevaluated for frail older women.
authors.affiliation: Faculty of Health Science and Social Welfare, University of Haifa, Haifa, Israel.
authors.forename: Oleg
authors.initials: O
authors.lastname: Zaslavsky
authors.affiliation: Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Eileen
authors.initials: E
authors.lastname: Rillamas-Sun
authors.affiliation: Division of Epidemiology, School of Medicine, University of California at San Diego, San Diego, California.
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
authors.affiliation: School of Nursing, University of Washington, Seattle, Washington.
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Woods
authors.affiliation: Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Lesley F
authors.initials: LF
authors.lastname: Tinker
authors.affiliation: Faculty of Health Science and Social Welfare, University of Haifa, Haifa, Israel.
authors.forename: Anna
authors.initials: A
authors.lastname: Zisberg
authors.affiliation: Faculty of Health Science and Social Welfare, University of Haifa, Haifa, Israel.
authors.forename: Efrat
authors.initials: E
authors.lastname: Shadmi
authors.affiliation: School of Nursing, University of Washington, Seattle, Washington.
authors.forename: Barbara
authors.initials: B
authors.lastname: Cochrane
authors.affiliation: Department of General Internal Medicine, MD Anderson Cancer Center, University of Texas, Houston, Texas.
authors.forename: Beatrice J
authors.initials: BJ
authors.lastname: Edward
authors.affiliation: School of Medicine, Sticht Center on Aging, Winston-Salem, North Carolina.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kritchevsky
authors.affiliation: Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, California.
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Stefanick
authors.affiliation: Department of Epidemiology and Prevention, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Mara Z
authors.initials: MZ
authors.lastname: Vitolins
authors.affiliation: Department of Epidemiology and Environmental Health, University of Buffalo, Buffalo, New York.
authors.forename: Jean
authors.initials: J
authors.lastname: Wactawski-Wende
authors.affiliation: Faculty of Health Science and Social Welfare, University of Haifa, Haifa, Israel.
authors.forename: Shira
authors.initials: S
authors.lastname: Zelber-Sagi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D015992:Body Mass Index; D002423:Cause of Death; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008137:Longitudinal Studies; D009026:Mortality / Q000639:trends*; D010641:Phenotype; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D055105:Waist Circumference; D049629:Waist-Hip Ratio
keywords: body mass index; frailty; mortality; obesity; women's health