| Sex-specific All-cause Mortality is Associated with Adiposity in the Malaysian Elders Longitudinal Research (MELoR) Study |
Nurul Nabilah Akmal Hashim1, Sumaiyah Mat1,2, Phyo Kyaw Myint3, Mirela Delibegovic4, Sheng Hui Kioh1,5, Shahrul Bahyah Kamaruzzaman1,6, Noran Naqiah Hairi1,7, Selina Khoo8, Ai-Vyrn Chin1,6, Maw Pin Tan1,6,9 
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1Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
2Physiotherapy Program and Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Bangi, Malaysia
3Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, UK
4Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, University of Aberdeen, UK
5Department of Chiropractic, Centre for Complementary and Alternative Medicine (CCAM), International Medical University, Kuala Lumpur, Malaysia
6Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
7Centre for Epidemiology & Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
8Faculty of Sport and Exercise Sciences, Universiti Malaya, Kuala Lumpur, Malaysia
9Faculty of Healthcare and Medical Sciences, Sunway University, Petaling Jaya, Malaysia |
Correspondence:
Maw Pin Tan,
Email: mptan@ummc.edu.my
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Received: 17 October 2024 • Revised: 28 February 2025 • Accepted: 29 September 2025 |
| Abstract |
Background
While adiposity has been found to be protective against adverse outcomes in older adults, the role of muscle in this association remains underexplored. This study sought to evaluate sex-specific mortality associated with available adiposity indices in older adults and the potential role of muscle strength in this relationship.
Methods
Individuals aged ≥55 years were recruited from 2013 to 2015. Adiposity indices obtained were body mass index (BMI), percentage body fat (%BF), waist-to-hip ratio (WHR), and waist circumference (WC). Vital status up to June 2022 was determined through the National Registry Department.
Results
Of the 1,347 included participants, mean age of 68.45±7.21 years, 57.1% female, and 11.2% deaths were recorded. Male who were underweight had increased mortality compared to male with normal BMI (hazard ratio [HR]=3.17, 95% confidence interval [CI] 1.35–7.47). Mortality was greater in male with %BF within the highest quartile (Q4) compared to the lowest quartile (Q1) (HR=4.72, 95% CI 2.07–10.78). Increased mortality in both male and female in Q4 for WHR compared to Q1 was influenced by age, as was increased mortality in female in Q4 for %BF. WC did not predict mortality in male or female. Increased mortality risk was present in male with normal muscle strength and increased %BF, and reduced muscle strength in male with low BMI.
Conclusions
Adiposity measured with BMI, WHR and WC had limited value in determining mortality risk at 9-year follow-up among individuals aged ≥55 years. Increased mortality was, however, observed in male with higher %BF but this could not be attributed to muscle strength. |
| Key Words:
Aged, Body composition, Muscle strength, Obesity, Mortality |
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agmr-24-0167-Supplementary-Table-S1.pdf
