The Wake Forest IASDR: A Resource for Studying the Effects of Caloric Restriction on Health Outcomes in Older Adults

Over the past 25+ years, a focus of the Wake Forest Claude D. Pepper Older Americans Independence Center (OAIC) has been to study the consequences of and treatments for geriatric obesity. The Wake Forest OAIC has provided support for 18 clinical trials of caloric restriction (CR), with and without various exercise regimens, in 2,545 adults (71% women, 21% African American) with a mean±SD age of 67.5±5.9 years and BMI ≥27 kg/m2. A priority of the Wake Forest OAIC is to collate and store common data (e.g., demographics, physical performance, cognitive function), biospecimens (blood, muscle, adipose), and images (DXA, CT) from these trials in the Integrated Aging Studies Databank and Repository (IASDR; https://www.peppercenter.org/public/dspIASDR.cfm). This IASDR serves as a resource for the scientific community to foster new scientific questions and analyses. This symposium will provide an overview of CR trials and participants included in the IASDR and how the IASDR supports secondary analyses of CR by highlighting several secondary analyses using data and/or samples from the IASDR. Justice and colleagues examined the effect of CR on a geroscience-guided biomarker index using blood samples from the biorepository. Weaver and colleagues examined the effect of different exercise regimens on CT-derived muscle and bone measures during CR. Miller and colleagues pooled data from 11 trials to determine if CR-induced appendicular lean mass loss is associated with changes in physical performance. Finally, Hsieh and colleagues pooled data from eight trials to examine whether the effect of CR on gait speed differed by baseline BMI and inflammation.

The Role of Obesity in Frailty Incidence: The San Antonio Longitudinal Study of Aging

Background Although initially conceptualized as a wasting syndrome, obesity has been associated with frailty in prior studies. The goal of this study was to examine the associations of obesity and waist circumference with frailty and determine whether they predict incident frailty in an ethnically diverse population of older Mexican Americans (MAs) and European Americans (EAs). Methods 749 MA and EA community-dwelling older adults (65+) participated in the baseline examination of the San Antonio Longitudinal Study of Aging (SALSA), and 474 participants completed the first follow up approximately 6 years later. Frailty was classified using Fried criteria. Baseline characteristics, including body mass index (BMI) and waist circumference (WC) were summarized by frailty category (non-frail, pre-frail, frail) using ANOVA. The odds of becoming frail at follow-up by baseline BMI and WC were estimated using separate logistic regression models, adjusting for age, sex, ethnicity, diabetes, comorbidity (presence of ≥2 chronic diseases not including diabetes), baseline frailty score, and follow-up time. Results At baseline, participants were 69 ±3 years old, 61% female, and 50% MA. BMI and WC increased with increasing frailty category (p <0.01 for both). BMI was a significant predictor of incident frailty (OR=1.08, 95% confidence interval [CI]: 1.02-1.14, p=0.011). WC also predicted frailty (OR=1.03, 95% CI: 1.01-1.05, p =0.017). Conclusion These results demonstrate that BMI and WC are significant predictors of frailty. Interventions which target obesity may reduce the incidence of frailty; however, more research in this area is needed.

Effect of Baseline BMI and IL-6 on Gait Speed Response to Caloric Restriction in Older Adults

We examined whether the effect of caloric restriction (CR) on gait speed change in older adults (67.3±5.27 years) varied by BMI and interleukin 6 (IL-6). Data from eight six-month randomized controlled trials were pooled, with 1268 participants randomized to CR (n=710) and non-CR (n=558) conditions. Baseline BMI/IL-6 subgroups were constructed using BMI≥35 kg/m2 and IL-6>2.5 pg/dL, and participants were jointly classified as high/high (n=395), high/low (n=208), low/high (n=271), or low/low (n=344). Overall treatment effects showed significant improvements in gait speed in CR versus non-CR [mean difference: 0.02 m/s (95% CI: 0.01, 0.04)]; however, CR assignment significantly interacted with BMI/IL-6 subgroup (p=0.03). Greatest gait speed improvement was observed in the high/high CR subgroup [+0.06 m/s (0.03, 0.09)] and appeared to be driven by no gait speed change among the high/high non-CR subgroup. Gait speed response to CR was greatest in older adults with elevated baseline BMI and IL-6.

Associations of Sleep Duration and Screen Time with Incidence of Overweight in European Children: The IDEFICS/I.Family Cohort

<b><i>Introduction:</i></b> Over the past decades, children have been increasingly using screen devices, while at the same time their sleep duration has decreased. Both behaviors have been associated with excess weight, and it is possible they act as mutually reinforcing behaviors for weight gain. The aim of the study was to explore independent, prospective associations of screen time and sleep duration with incident overweight in a sample of European children. <b><i>Methods:</i></b> Data from 4,285 children of the IDEFICS/I.Family cohort who were followed up from 2009/2010 to 2013/2014 were analyzed. Hours per day of screen time and of sleep duration were reported by parents at baseline. Logistic regression analyses were carried out in separate and mutually adjusted models controlled for sex, age, European country region, parental level of education, and baseline BMI <i>z</i>-scores. <b><i>Results:</i></b> Among normal weight children at baseline (<i>N</i> = 3,734), separate models suggest that every hour increase in screen time and every hour decrease in sleep duration were associated with higher odds of the child becoming overweight or obese at follow-up (OR = 1.16, 95% CI: 1.02–1.32 and OR = 1.23, 95% CI: 1.05–1.43, respectively). In the mutually adjusted model, both associations were attenuated slightly ( screen time OR = 1.13, 95% CI: 0.99–1.28; sleep duration OR = 1.20, 95% CI: 1.03–1.40), being consistently somewhat stronger for sleep duration. <b><i>Discussion/Conclusion:</i></b> Both screen time and sleep duration increased the incidence of overweight or obesity by 13–20%. Interventions that include an emphasis on adequate sleep and minimal screen time are needed to establish their causal role in the prevention of overweight and obesity among European children.

Body mass index trajectory from childhood to puberty and high blood pressure: the China Health and Nutrition Survey

ObjectivesThe prevalence of childhood hypertension is rising in parallel with the increasing prevalence of overweight and obesity in children. How growth trajectories from childhood to puberty relate to high blood pressure (HBP) is not well defined. We aimed to characterise potential body mass index (BMI) dynamic changing trajectories from childhood to puberty and investigate their association with HBP.DesignA dynamic prospective cohort.SettingChina Health and Nutrition Survey 1991–2015.ParticipantsThere were 1907 participants (1027 men and 880 women) in this study.OutcomesThe primary outcome was HBP defined as systolic blood pressure (SBP)/diastolic blood pressure (DBP) exceeding the standards or diagnosis by medical records or taking antihypertensive medication.ResultsA model of cubic parameters with three groups was chosen, labelled as normal increasing group (85.16%, n=1624), high increasing group (9.81%, n=187) and resolving group (5.03%, n=96). Compared with the normal increasing group, the unadjusted HRs (95% CIs) for the resolving and high increasing groups were 0.91 (0.45 to 1.86) and 1.88 (1.26 to 2.81), respectively. After adjusting for baseline age, region, sex, baseline BMI z-score, baseline SBP and baseline DBP in model 3, the HRs (95% CIs) for the resolving and high increasing groups were 0.66 (0.30 to 1.45) and 1.56 (1.02 to 2.38).ConclusionsThese results indicate that the BMI trajectories from childhood to puberty have significant impact on HBP risk. Puberty is a crucial period for the development of HBP.

Body mass index and leptin are related to cognitive performance over 10 years in women with and without HIV infection

Objective To determine whether body mass index (BMI) and leptin were longitudinally associated over 10 years with neuropsychological performance (NP) among middle-aged women with HIV (WWH) versus without HIV. Methods Women’s Interagency HIV Study (WIHS) participants (301 WWH, 113 women without HIV from Brooklyn, New York City and Chicago had baseline and 10-year BMI (kg/m2) and fasting plasma leptin levels using commercial ELISA (ng/mL); and demographically-adjusted NP T-scores (attention/working memory, executive function (EF), processing speed, memory, learning, verbal fluency, motor function, global) at 10-year follow-up. Multivariable linear regression analyses, stratified by HIV-serostatus, examined associations between BMI, leptin, and NP. Results Over 10 years, women (baseline age 39.8+/-9.2 years, 73% Black, 73% WWH) transitioned from average overweight (29.1+/-7.9 kg/m 2) to obese (30.5+/-7.9 kg/m 2) BMI. Leptin increased 11.4+/-26.4 ng/mL (p&lt;0.0001). Higher baseline BMI and leptin predicted poorer 10-year EF among all women (BMI B=-6.97, 95%CI(-11.5, -2.45) p=0.003; leptin B=-1.90, 95%CI(-3.03, -0.76), p=0.001); higher baseline BMI predicted better memory performance (B=6.35, 95%CI(1.96, 10.7), p=0.005). Greater 10-year leptin increase predicted poorer EF (p=0.004), speed (p=0.029), verbal (p=0.021) and global (p=0.005) performance among all women, and WWH. Greater 10-year BMI increase predicted slower processing speed (p=0.043) among all women; and among WWH, poorer EF (p=0.012) and global (p=0.035) performance. Conclusions In middle-aged WIHS participants, 10-year increases in BMI and leptin were associated with poorer performance across multiple NP domains among all and WWH. Trajectories of adiposity measures over time may provide insight into the role of adipose tissue in brain health with aging.

Genetic propensity for obesity, socioeconomic position, and trajectories of body mass index in older adults

Identifying how socioeconomic positioning and genetic factors interact in the development of obesity is imperative for population-level obesity prevention strategies. The current study investigated whether social positioning, either independently or through interaction with a polygenic score for Body Mass Index (BMI-PGS), influences BMI trajectories across older adulthood. Data were analysed from 7,183 individuals from the English Longitudinal Study of Aging (ELSA). Interactions between the BMI-PGS and; lower educational attainment, self-perceived social status (SSS), and income, on BMI trajectories over 12 years across older adulthood were investigated through linear mixed effects models. Lower educational attainment, SSS and income were each associated with a higher baseline BMI for women, but not for men. There were interaction effects between BMI-PGS and social positioning such that men aged > 65 with a lower educational attainment (β = 0.62; 95%CI 0.00 – 1.24, p < 0.05), men aged ≤ 65 of a lower income (β = − 0.72, 95%CI − 1.21 - − 0.23, p < 0.01) and women aged ≤ 65 of lower SSS (β = − 1.41; 95%CI − 2.46 – 0.36, p < 0.01) showed stronger associations between the BMI-PGS and baseline BMI. There were few associations between markers of socioeconomic position and rate of change in BMI over the follow-up period. In sum, lower socioeconomic positioning showed adverse associations with women’s BMI in older adulthood. Moreover, the expression of the BMI-PGS, or extent to which it translates to a higher BMI, was subtly influenced by socioeconomic standing in both women and in men.

Fast Foods, Snacks and Non-Alcoholic Beverages Intake among School Children and Baseline Body Mass Index in an Urban Government School, Nepal

Introduction: Body Mass Index (BMI) is a screening tool that indicates whether a person is underweight, healthy weight or obesity. Fast foods are commercial, ready-to-eat meals with high fat, little fiber, and minimal vitamins or calcium. This study intended to identify baseline BMI and fast foods, snacks and non-alcoholic beverages intake and expenditure on those foods among school children in an urban government school. Method: A cross-sectional study was conducted among 463 students, studying in grade 8-12 of Tri-Padma Vidyashram Secondary School during 21/02/2021 – 12/04/2021. Non probability convenience sampling and self developed structured questionnaire was used to collect data. SPSS 16 was used for analysis. BMI, frequency and amount of fast foods, snacks and non-alcoholic beverages consumption and their monthly expenditure on those foods were measured using descriptive statistics. Results: The study shows that 382(82.5%) had normal BMI, 38(8.2%) overweight, 10(2.2%) obese, 28(6.0%) were in moderate malnutrition and 5(1.1%) were in severe malnutrition; therefore, the baseline BMI is ≥-2 to ≤ + 1 SD. 458(98.92%) respondents consume fast foods, snacks and non-alcoholic beverage. Instant noodles (chowmein and packaged chow-chow) are the highly consumed fast foods 412(89.95%), followed by panipuri 394(86.02%) and samosa 386(84.27%). 263(57.42%) students/participants frequently consume fast foods, snacks and non-alcoholic beverage. The mean expenditure on fast foods, snacks and non-alcoholic beverage (Mean ± SD) is Rs.2676.82 ± 1363.43. Conclusion: Majority of the respondents have normal BMI. More than half respondents frequently consume fast foods, snacks and non-alcoholic beverage and expense much money though they study in government school. Key words: Body Mass Index (BMI), Fast foods, Non-alcoholic beverages, School children, Snacks.

Post hoc Analysis of Clinical Outcomes in Placebo- and Pirfenidone-Treated Patients with IPF Stratified by BMI and Weight Loss

Background: Weight loss is frequently reported in patients with idiopathic pulmonary fibrosis (IPF) and may be associated with worse outcomes in these patients. Objective: The aim of this study was to investigate the relationships between body mass index (BMI) and weight loss, and outcomes over 1 year in patients with IPF. Methods: Data were included from placebo patients enrolled in ASCEND (NCT01366209) and CAPACITY (NCT00287716 and NCT00287729), and all patients in INSPIRE (NCT00075998) and RIFF Cohort A (NCT01872689). An additional analysis included data from pirfenidone-treated patients. Outcomes (annualized change in percent predicted forced vital capacity [%FVC], percent predicted carbon monoxide diffusing capacity, 6-min walk distance, St. George’s Respiratory Questionnaire total score, hospitalization, mortality, and serious adverse events) were analyzed by baseline BMI (<25 kg/m2, 25 kg/m2–<30 kg/m2, or ≥30 kg/m2) and annualized percent change in body weight (no loss, >0–<5% loss, or ≥5% loss). Results: Placebo-treated patients with a baseline BMI <25 kg/m2 or annualized weight loss may experience worse outcomes versus those with a baseline BMI ≥25 kg/m2 or no weight loss. The proportion of placebo-treated patients who experienced a relative decline of ≥10% in %FVC or death up to 1 year post-randomization was highest in patients with a baseline BMI <25 kg/m2. Pirfenidone-treated patients with an annualized weight loss ≥5% may also experience worse outcomes versus those with no weight loss. Conclusions: Patients with a baseline BMI <25 kg/m2 or annualized weight loss of >0–<5% or ≥5% may experience worse outcomes over 1 year versus those with a baseline BMI ≥25 kg/m2 or no weight loss.