Cognitive impairment and the association between frailty and functional deficits are linked to abdominal obesity in the elderly

Assaf Buch, Eli Carmeli, Gabi Shefer, Lital Keinan-Boker, Yitshal Berner, Yonit Marcus, Rebecca Goldsmith, Naftali Stern

Research output: Contribution to journalArticlepeer-review


Objective: To evaluate whether specific obesity phenotypes in community-dwelling elderly: (a) affect differently the relationship between frailty and functional impairment and (b) are related to cognitive impairment. Study design: A post-hoc cross-sectional analysis of the last Israeli national health and nutrition survey of the elderly (≥ 65 yrs.; n = 1619). Main outcome measures: We implemented a previously validated frailty model based on frailty-related variables that were obtained in the survey. Mild cognitive impairment was defined using the Mini-Mental State Examination (a score <24 and >17). The Katz's scale of activities of daily living was used for functional assessment. Data were clustered according to different obesity phenotypes using measured body mass index (BMI) and waist circumference (WC). Results: The link between frailty and disability was most prominent in subjects with abdominal obesity who were non-obese by BMI: compared with non-obese subjects as defined by WC and BMI, the odds ratio (OR) for functional limitations in this phenotype was 8.34 (95 % CI, 2.14–32.48) for pre-frail subjects and 69.26 (10.58–453.55) for frail subjects. The rate of cognitive impairment was 3.3 times higher (p =.023) in women who were obese by WC but not by BMI. Conclusions: In elderly people with a large WC and BMI < 30 kg/m2, disability is more tightly linked to frailty than for any other form of obesity. Cognitive impairment was more prominent in women with central obesity and BMI < 30 kg/m2 than in the other anthropometric phenotypes. WC should be used for early detection of individuals at risk of progression of frailty to functional incapacity.

Original languageEnglish
Pages (from-to)46-53
Number of pages8
StatePublished - Aug 2018

Bibliographical note

Funding Information:
This work was supported by the Sagol Foundation for the Metabolic Syndrome Research Center (charity sponsor). The sponsor of this work had no role in the study design, methods, data collections, analyses, interpretation of the results and the preparation of this manuscript.

Funding Information:
The authors wish to acknowledge the support of: The Israel National Institute for Health Policy and Health Services Research (NIHP 2002/15/A); The Israel Hypertension Society ; The Association for the Planning and Development of Services for the Aged in Israel − ESHEL (all supported the original survey).

Publisher Copyright:
© 2018 Elsevier B.V.


  • Abdominal obesity
  • Cognitive impairment
  • Frailty
  • Functional level
  • Obesity
  • “Mabat-Zahav”

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology (all)
  • Obstetrics and Gynecology


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