Overweight and Obesity and Multimorbidity in Community-Living Older Persons in the Philippines
DOI:
https://doi.org/10.15605/jafes.040.02.05Keywords:
obesity, multimorbidity, older personsAbstract
Background. Overweight and obesity, as well as the coexistence of multimorbidity, have been recognized as global health challenges. However, less is known about the prevalence of obesity and multimorbidity among older people in the Philippines. This study sought to determine the prevalence of obesity and multimorbidity among community-living older people.
Methodology. A cross-sectional analysis of older persons aged 60 years and above was conducted from the Focused Intervention for Frail Older Adults Research and Development Program (FITforFrail). Height and weight were measured, and body mass index (BMI) was classified as follows: underweight, <18.5 kg/m²; normal, 18.5–22.9 kg/m²; overweight, 23–27.5 kg/m²; and obese, ≥27.5 kg/m². Multimorbidity was defined as the presence of two or more chronic diseases, assessed through a self-reported physician’s diagnosis.
Results. The prevalence of obesity was 15.4%, which was significantly more common among women (p <0.013) and nonsmokers (p <0.006). Multimorbidity, including overweight and obesity, was reported by 77.9% of older persons, and among those with overweight and obesity, multimorbidity was present in 76.5%. A higher number of chronic diseases were reported by older persons who were overweight and obese (p <0.006). Significantly more overweight and obese older women reported having multimorbidity (p <0.049) compared to older men. Hypertension, hyperlipidemia, musculoskeletal disorders, and hyperuricemia were the most commonly reported chronic diseases among older persons with overweight and obesity.
Conclusion. The results of this study highlight the importance of overweight and obesity as determinants of multimorbidity. Future research should explore gender differences in risk factors and multimorbidity patterns.
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References
1. World Health Organization. Controlling the global obesity epidemic. World Health Organization. Accessed August 22, 2023. https://www.who.int/activities/controlling-the-global-obesity-epidemic.
2. World Obesity Federation. World Obesity Atlas 2022. World Obesity Federation. Accessed August 22, 2023.
https://www.worldobesityday.org/assets/downloads/World_Obesity_Atlas_2022_WEB.pdf.
3. Dai H, Alsalhe TA, Chalghaf N, Riccò M, Bragazzi NL, Wu J. The global burden of disease attributable to high body mass index in 195 countries and territories, 1990–2017: An analysis of the global burden of disease study. PLoS Med. 2020;17(7): e1003198. https://pubmed.ncbi.nlm.nih.gov/32722671 https://pmc.ncbi.nlm.nih.gov/articles/PMC7386577 DOI: 10.1371/journal.pmed.1003198
4. Global BMI Mortality Collaboration, Di Angelantonio E, Bhupathiraju S, et al. Body-mass index and all-cause mortality: Individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016;388(10046):776-86. https://pubmed.ncbi.nlm.nih.gov/27423262 https://pmc.ncbi.nlm.nih.gov/articles/PMC4995441 DOI: 10.1016/S0140-6736(16)30175-1
5. Salvestrini V, Sell C, Lorenzini A. Obesity may accelerate the aging process. Front Endocrinol (Lausanne). 2019;10:266. https://pubmed.ncbi.nlm.nih.gov/31130916 https://pmc.ncbi.nlm.nih.gov/articles/PMC6509231 DOI: 10.3389/fendo.2019.00266
6. Malenfant JH, Batsis JA. Obesity in the geriatric population - a global health perspective. J Glob Health Rep. 2019;3:e2019045. https://pubmed.ncbi.nlm.nih.gov/34027129 https://pmc.ncbi.nlm.nih.gov/articles/PMC8136402 https://doi.org/10.29392/joghr.3.e2019045
7. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63. https://pubmed.ncbi.nlm.nih.gov/14726171 https://doi.org/10.1016/S0140-6736(03)15268-3
8. Schafer MH, Ferraro KF. Obesity and hospitalization over the adult life course: Does duration of exposure increase use? J Health Soc Behav. 2007;48(4):434-49. https://pubmed.ncbi.nlm.nih.gov/18198689 https://pmc.ncbi.nlm.nih.gov/articles/PMC2640491 https://doi.org/10.1177/002214650704800407
9. Calvin CM, Conroy MC, Moore SF, Kuzma E, Littlejohns TJ. Association of multimorbidity, disease clusters, and modification by genetic factors with risk of dementia. JAMA Netw Open. 2022;5(9):e2232124. https://pubmed.ncbi.nlm.nih.gov/36125811 https://pmc.ncbi.nlm.nih.gov/articles/PMC9490497 https://doi.org/10.1001/jamanetworkopen.2022.32124
10. Kivimäki M, Strandberg T, Pentti J, et al. Body-mass index and risk of obesity-related complex multimorbidity: An observational multicohort study. Lancet Diabetes Endocrinol. 2022;10(4):253-63. https://pubmed.ncbi.nlm.nih.gov/35248171 https://pmc.ncbi.nlm.nih.gov/articles/PMC8938400 https://doi.org/10.1016/S2213-8587(22)00033-X
11. United Nations Population Division. World Population Prospects 2022. 2022. Accessed August 17, 2023. https://www.un.org/development/desa/pd/sites/www.un.orzsg.development.desa.pd/files/wpp2022_summary_of_results.pdf
12. WHO ageing and health. Accessed January 2, 2024. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
13. Ladia MAJ, dela Vega SF, Jacalan MTA, Torres RV, Cruda MAMCC, Gillera JMA. Mixed methods studies on health status of older adults with focus on frailty (quantitative component): Frailty among older persons: Cases of robust, pre-frail, and frail Filipinos. Fit for frail: Final report, vol 3; 2020. Accessed September 22, 2022. https://drive.google.com/file/d/1I4jhv0aoHHdPiS3rGdxPTx_3PVYYwgMd/view
14. National Institutes of Health. Geriatric assessment methods for clinical decision making. NIH Consens statement. 1987;6(13):1-21. Accessed March 20, 2022.
15. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004 ;363(9403):157-63. https://pubmed.ncbi.nlm.nih.gov/14726171 https://doi.org/10.1016/S0140-6736(03)15268-3. Erratum in Lancet. 2004;363(9412):902.
16. Tan YH, Lim JP, Lim WS, et al. Obesity in older adults and associations with cardiovascular structure and function. Obes Facts. 2022;15(3):336-43. https://pubmed.ncbi.nlm.nih.gov/35249039 https://pmc.ncbi.nlm.nih.gov/articles/PMC9209947 https://doi.org/10.1159/000521729
17. Vapattanawong P, Aekplakorn W, Rakchanyaban U, Prasartkul P, Porapakkham Y. Obesity and mortality among older Thais: A four year follow up study. BMC Public Health. 2010;10:604. https://pubmed.ncbi.nlm.nih.gov/ 20942942 https://pmc.ncbi.nlm.nih.gov/articles/PMC2964629 https://doi.org/10.1186/1471-2458-10-604
18. Apalasamy YD, Awang H, Mansor N, AbRashid N, Kamarulzaman ND, Lih Yoong T. Factors associated with obesity and abdominal obesity among Malaysian older adults. Asia Pac J Public Health. 202l;33(5):547-54. https://pubmed.ncbi.nlm.nih.gov/34013778 https://doi.org/10.1177/10105395211014634
19. Chowdhury SR, Chandra Das D, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: A systematic review and meta-analysis. EClinicalMedicine. 2023;57:101860. https://pubmed.ncbi.nlm.nih.gov/36864977 https://pmc.ncbi.nlm.nih.gov/articles/PMC9971315 https://doi.org/10.1016/j.eclinm.2023.101860
20. Laude TMP, Merca EE, Torres R, et al. A descriptive study of the nutritional and frailty status of working and retired employees within an academic community in the Philippines. Acta Med Philipp. 2021;55(7):728-37. https://doi.org/10.47895/amp.vi0.2830
21. Marengoni A, Angleman S, Melis R, et al. Aging with multimorbidity: A systematic review of the literature. Ageing Res Rev. 2011;10(4):430-9. https://pubmed.ncbi.nlm.nih.gov/21402176 https://doi.org/10.1016/j.arr.2011.03.003
22. Nguyen H, Manolova G, Daskalopoulou C, Vitoratou S, Prince M, Prina AM. Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies. J Comorb. 2019;9:2235042X19870934. https://pubmed.ncbi.nlm.nih.gov/31489279 https://pmc.ncbi.nlm.nih.gov/articles/PMC6710708 https://doi.org/10.1177/2235042X19870934
23. Violan C, Foguet-Boreu Q, Flores-Mateo G, et al. Prevalence, determinants and patterns of multimorbidity in primary care: A systematic review of observational studies. PLoS One. 2014;9(7):e102149. https://pubmed.ncbi.nlm.nih.gov/25048354 https://pmc.ncbi.nlm.nih.gov/articles/PMC4105594 https://doi.org/10.1371/journal.pone.0102149
24. Fabbri E, Zoli M, Gonzalez-Freire M, Salive ME, Studenski SA, Ferrucci L. Aging and multimorbidity: New tasks, priorities, and frontiers for integrated gerontological and clinical research. J Am Med Dir Assoc. 2015;16(8):640-7. https://pubmed.ncbi.nlm.nih.gov/25958334 https://pmc.ncbi.nlm.nih.gov/articles/PMC5125299 https://doi.org/10.1016/j.jamda.2015.03.013
25. Maggio M, Cattabiani C, Lauretani F, et al. The concept of multiple hormonal dysregulation. Acta Biomed. 2010;81 Suppl 1(Suppl 1):19-29. https://pubmed.ncbi.nlm.nih.gov/20518188 https://pmc.ncbi.nlm.nih.gov/articles/PMC5220583.
26. Fraser HC, Kuan V, Johnen R, et al. Biological mechanisms of aging predict age-related disease co-occurrence in patients. Aging Cell. 2022;21(4):e13524. https://pubmed.ncbi.nlm.nih.gov/35259281 https://pmc.ncbi.nlm.nih.gov/articles/PMC9009120 https://doi.org/10.1111/acel.13524
27. Peytremann-Bridevaux I, Santos-Eggimann B. Health correlates of overweight and obesity in adults aged 50 years and over: Results from the Survey of Health, Ageing and Retirement in Europe (SHARE). Obesity and health in Europeans aged > or = 50 years. Swiss Med Wkly. 2008;138(17-18):261-6. https://pubmed.ncbi.nlm.nih.gov/18481232 https://doi.org/10.4414/smw.2008.12067
28. Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med. 2017;376(3):254-66. https://pubmed.ncbi.nlm.nih.gov/28099824 https://doi.org/10.1056/NEJMra1514009
29. Kanter R, Caballero B. Global gender disparities in obesity: A review. Adv Nutr. 2012;3(4):491-8. https://pubmed.ncbi.nlm.nih.gov/22797984 https://pmc.ncbi.nlm.nih.gov/articles/PMC3649717 https://doi.org/10.3945/an.112.002063
30. Enzi G, Gasparo M, Biondetti PR, Fiore D, Semisa M, Zurlo F. Subcutaneous and visceral fat distribution according to sex, age, and overweight, evaluated by computed tomography. Am J Clin Nutr. 1986;44(6):739-46. https://pubmed.ncbi.nlm.nih.gov/3788827 https://doi.org/10.1093/ajcn/44.6.739
31. Davis SR, Castelo-Branco C, Chedraui P, et al; Writing Group of the International Menopause Society for World Menopause Day 2012. Understanding weight gain at menopause. Climacteric. 2012;15(5):419-29. https://pubmed.ncbi.nlm.nih.gov/22978257 https://doi.org/10.3109/13697137.2012.707385
32. Hosseini Z, Veenstra G, Khan NA, Conklin AI. Associations between social connections, their interactions, and obesity differ by gender: A population-based, cross-sectional analysis of the Canadian longitudinal study on aging. PLoS One. 2020;15(7):e0235977. https://pubmed.ncbi.nlm.nih.gov/32730260 https://pmc.ncbi.nlm.nih.gov/articles/ PMC7392536 https://doi.org/10.1371/journal.pone.0235977
33. Maltagliati S, Saoudi I, Sarrazin P, et al. Women carry the weight of deprivation on physical inactivity: Moderated mediation analyses in a European sample of adults over 50 Years of age. SSM Popul Health. 2022;20:101272. https://pubmed.ncbi.nlm.nih.gov/36387017 https://pmc.ncbi.nlm.nih.gov/articles/PMC9641026 https://doi.org/10.1016/j.ssmph.2022.101272
34. Patel SR, Malhotra A, White DP, Gottlieb DJ, Hu FB. Association between reduced sleep and weight gain in women. Am J Epidemiol. 2006;164(10):947-54. https://pubmed.ncbi.nlm.nih.gov/16914506 https://pmc.ncbi.nlm.nih.gov/articles/PMC3496783 https://doi.org/10.1093/aje/kwj280
35. Blümel JE, Carrillo-Larco RM, Vallejo MS, Chedraui P. Multimorbidity in a cohort of middle-aged women: Risk factors and disease clustering. Maturitas. 2020;137:45-49. https://pubmed.ncbi.nlm.nih.gov/32498936 https://pmc.ncbi.nlm.nih.gov/articles/PMC7284304 https://doi.org/10.1016/j.maturitas.2020.04.016
36. Dhalwani NN, Zaccardi F, O'Donovan G, et al. Association between lifestyle factors and the incidence of multimorbidity in an older English population. J Gerontol A Biol Sci Med Sci. 2017;72(4):528-34. https://pubmed.ncbi.nlm.nih.gov/27470302 https://doi.org/10.1093/gerona/glw146
37. de S Santos Machado V, Valadares AL, Costa-Paiva LH, Osis MJ, Sousa MH, Pinto-Neto AM. Aging, obesity, and multimorbidity in women 50 years or older: A population-based study. Menopause. 2013;20(8):818-24. https://pubmed.ncbi.nlm.nih.gov/23549445 https://doi.org/10.1097/GME.0b013e31827fdd8c
38. Lewis M. Older women and health: An Overview. Women Health. 1985;10(2–3):1–16. https://pubmed.ncbi.nlm.nih.gov/3927595 https://doi.org/10.1300/j013v10n02_01
39. Castillo GPJ. Provision of care for Filipino older persons and responding to the needs of aging societies. 2019. Accessed August 22, 2023. https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/unpd_egm_201902_s8_pleneegracejcastillo.pdf
40. van der Meulen Rodgers Y, Zveglich JE Jr. Gender differences in access to health care among the elderly: Evidence from Southeast Asia. Asian Dev Rev. 2021;38(2):59-92. https://www.adb.org/sites/default/files/publication/677981/ewp-633-gender-health-care-elderly-southeast-asia.pdf
41. Natividad JN. Healthcare and healthcare utilisation. In: Cruz GT, Cruz CJP, Saito Y, eds. Ageing and Health in the Philippines. Jakarta, Indonesia: Economic Research Institute for ASEAN and East Asia; 2019. https://www.eria.org/uploads/media/Books/2019-Dec-Ageing-and-Health-Philippines/12-Ageing-and-Health-Philippines-Chapter-6-0208.pdf
42. Watanabe T, Tsujino I, Konno S, et al. Association between smoking status and obesity in a nationwide survey of Japanese adults. PLoS One. 2016;11(3):e0148926. https://pubmed.ncbi.nlm.nih.gov/27007232 https://pmc.ncbi.nlm.nih.gov/articles/PMC4805304 https://doi.org/10.1371/journal.pone.0148926
43. Chiolero A, Jacot-Sadowski I, Faeh D, Paccaud F, Cornuz J. Association of cigarettes daily smoked with obesity in a general European adult population. Obesity (Silver Spring). 2007;15(5):1311-8. https://pubmed.ncbi.nlm.nih.gov/17495208 https://doi.org/10.1038/oby.2007.153
44. John U, Hanke M, Rumpf HJ, Thyrian JR. Smoking status, cigarettes per day, and their relationship to overweight and obesity among former and current smokers in a national adult general population sample. Int J Obes (Lond). 2005;29(10):1289-94. https://pubmed.ncbi.nlm.nih.gov/15997244 https://doi.org/10.1038/sj.ijo.0803028
45. Andersson K, Arner P. Systemic nicotine stimulates human adipose tissue lipolysis through local cholinergic and catecholaminergic receptors. Int J Obes Relat Metab Disord. 2001;25(8):1225-32. https://pubmed.ncbi.nlm.nih.gov/11477508 https://doi.org/10.1038/sj.ijo.0801654
46. Hellerstein MK, Benowitz NL, Neese RA, et L. Effects of cigarette smoking and its cessation on lipid metabolism and energy expenditure in heavy smokers. J Clin Invest. 199;93(1):265-72. https://pubmed.ncbi.nlm.nih.gov/8282797 https://pmc.ncbi.nlm.nih.gov/articles/PMC293761 https://doi.org/10.1172/JCI116955
47. Marchesini G, Melchionda N, Apolone G, et al. The metabolic syndrome in treatment-seeking obese persons. Metabolism. 2004;53(4):435-40. https://pubmed.ncbi.nlm.nih.gov/15045688 https://doi.org/10.1016/j.metabol.2003.10.026
48. George C, Leslie SW, Minter DA. Hyperuricemia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Accessed July 10, 2024.
49. Nakagami T, Qiao Q, Carstensen B, et al. Age, body mass index and type 2 diabetes-associations modified by ethnicity. Diabetologia. 2003;46(8):1063-70. https://pubmed.ncbi.nlm.nih.gov/12827246. https://doi.org/10.1007/s00125-003-1158-9.
50. Van der Heyden J, De Bacquer D, Tafforeau J, et al. Reliability and validity of a global question on self-reported chronic morbidity. J Public Health. 2014;22:371–80. https://doi.org/10.1007/s10389-014-0624-9
51. Hwang K, Moore KJ, Chong TWH, Williams S, Batchelor F. Improving clinical practice guidelines for older people: Considerations and recommendations for more inclusive and ageing-relevant guidelines. Lancet Healthy Longev. 2022;3(5):e316-7. https://pubmed.ncbi.nlm.nih.gov/36098306 https://doi.org/10.1016/S2666-7568(22)00074-5
52. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: Implications for pay for performance. JAMA. 2005;294(6):716-24. https://pubmed.ncbi.nlm.nih.gov/16091574 https://doi.org/10.1001/jama.294.6.716
53. Nunes BP, Flores TR, Mielke GI, Thumé E, Facchini LA. Multimorbidity and mortality in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr. 2016;67:130-8. https://pubmed.ncbi.nlm.nih.gov/27500661 https://doi.org/10.1016/j.archger.2016.07.008
54. Makovski TT, Schmitz S, Zeegers MP, Stranges S, van den Akker M. Multimorbidity and quality of life: Systematic literature review and meta-analysis. Ageing Res Rev. 2019;53:100903. https://pubmed.ncbi.nlm.nih.gov/31048032 https://doi.org/10.1016/j.arr.2019.04.005
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