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Original Investigation |

Obesity and Late-Age Survival Without Major Disease or Disability in Older Women

Eileen Rillamas-Sun, PhD, MPH1,2; Andrea Z. LaCroix, PhD1,2; Molly E. Waring, PhD3; Candyce H. Kroenke, ScD4; Michael J. LaMonte, PhD5; Mara Z. Vitolins, DrPH6; Rebecca Seguin, PhD1,7; Christina L. Bell, MD8; Margery Gass, MD9; Todd M. Manini, PhD10; Kamal H. Masaki, MD8; Robert B. Wallace, MD11
[+] Author Affiliations
1Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
2Group Health Research Institute, Seattle, Washington
3Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
4Division of Research, Kaiser Permanente, Oakland, California
5Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, Buffalo
6Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
7Division of Nutritional Sciences, Cornell University, Ithaca, New York
8Department of Geriatric Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
9The North American Menopause Society, Cleveland, Ohio
10Department of Aging and Geriatric Research, University of Florida, Gainesville
11Department of Epidemiology, University of Iowa College of Public Health, Iowa City
JAMA Intern Med. 2014;174(1):98-106. doi:10.1001/jamainternmed.2013.12051.
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Importance  The effect of obesity on late-age survival in women without disease or disability is unknown.

Objective  To investigate whether higher baseline body mass index and waist circumference affect women’s survival to 85 years of age without major chronic disease (coronary disease, stroke, cancer, diabetes mellitus, or hip fracture) and mobility disability.

Design, Setting, and Participants  Examination of 36 611 women from the Women’s Health Initiative observational study and clinical trial programs who could have reached 85 years or older if they survived to the last outcomes evaluation on September 17, 2012. Recruitment was from 40 US clinical centers from October 1993 through December 1998. Multinomial logistic regression models were used to estimate odds ratios and 95% CIs for the association of baseline body mass index and waist circumference with the outcomes, adjusting for demographic, behavioral, and health characteristics.

Main Outcomes and Measures  Mutually exclusive classifications: (1) survived without major chronic disease and without mobility disability (healthy); (2) survived with 1 or more major chronic disease at baseline but without new disease or disability (prevalent diseased); (3) survived and developed 1 or more major chronic disease but not disability during study follow-up (incident diseased); (4) survived and developed mobility disability with or without disease (disabled); and (5) did not survive (died).

Results  Mean (SD) baseline age was 72.4 (3.0) years (range, 66-81 years). The distribution of women classified as healthy, prevalent diseased, incident diseased, disabled, and died was 19.0%, 14.7%, 23.2%, 18.3%, and 24.8%, respectively. Compared with healthy-weight women, underweight and obese women were more likely to die before 85 years of age. Overweight and obese women had higher risks of incident disease and mobility disability. Disability risks were striking. Relative to healthy-weight women, adjusted odds ratios (95% CIs) of mobility disability were 1.6 (1.5-1.8) for overweight women and 3.2 (2.9-3.6), 6.6 (5.4-8.1), and 6.7 (4.8-9.2) for class I, II, and III obesity, respectively. Waist circumference greater than 88 cm was also associated with higher risk of earlier death, incident disease, and mobility disability.

Conclusions and Relevance  Overall and abdominal obesity were important and potentially modifiable factors associated with dying or developing mobility disability and major chronic disease before 85 years of age in older women.

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