Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 338

Redistribution of body fat with ageing further limits the applicability of BMI as a risk indicator in older adults. There is evidence in younger adults that those who have the majority of their adipose tissue around their waist (high waist‐to‐hip ratio) have a higher prevalence of diabetes mellitus, hypertension, and coronary artery disease than those who have predominantly hip adiposity. Folsom et al.¹¹ examined the role of body fatness on mortality in a random sample of 31,702 Iowan women age 55–69, followed for 11–12 years. A higher waist‐to‐hip ratio was associated with increased mortality independent of smoking, alcohol, and oestrogen use. The waist‐to‐hip ratio is difficult to interpret with ageing. Whereas the waist measures abdominal fatness, hip circumference may also reflect variations in pelvic width and gluteal musculature. In elders, narrow hips may reflect peripheral muscle wasting, which may correlate with chronic conditions.

The current literature on the utility of BMI, waist‐to‐hip ratio, or waist circumference is inconsistent. So far, except for the oldest age group, the conclusion of Canoy¹² based on current epidemiology states, ‘adipose tissue distribution assessment ideally should provide a single risk estimate that captures the separate effects of abdominal and peripheral adiposity’. Although far from perfect, waist‐hip ratio or just waist circumference is a simple and inexpensive measure that captures these effects and can help to improve other chronic disease risk assessments. Further research and development are needed for an appropriate protocol for the diagnosis of adipose tissue distribution, including the search into cut‐off points for specific ethnic, age, and other population groups.