University of Oulu

Markus J Haapanen, Tuija M Mikkola, Lauri Kortelainen, Juulia Jylhävä, Niko S Wasenius, Eero Kajantie, Johan G Eriksson, Mikaela B von Bonsdorff, Body Composition in Late Midlife as a Predictor of Accelerated Age-associated Deficit-accumulation From Late Midlife into Old Age: A Longitudinal Birth Cohort Study, The Journals of Gerontology: Series A, Volume 78, Issue 6, June 2023, Pages 980–987,

Body composition in late midlife as a predictor of accelerated age-associated deficit-accumulation from late midlife into old age : a longitudinal birth cohort study

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Author: Haapanen, Markus J.1,2; Mikkola, Tuija M.1,3; Kortelainen, Lauri1,4;
Organizations: 1Folkhälsan Research Center, Helsinki, Finland
2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
3Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
4Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
5Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, Tampere University, Tampere, Finland
6Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
7Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
8PEDEGO Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
9Department of Obstetrics and Gynecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University Singapore, Singapore
10Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 2.2 MB)
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Language: English
Published: Oxford University Press, 2022
Publish Date: 2023-10-24


Background: Body mass index (BMI) may not be an optimal predictor of frailty as its constituents, lean and fat mass, may have opposite associations with frailty.

Methods: A linear mixed model analysis was performed in the Helsinki Birth Cohort Study (n = 2 000) spanning from 57 to 84 years. A 39-item frailty index (FI) was calculated on three occasions over 17 years. Body composition in late midlife included BMI, percent body fat (%BF), waist-to-hip ratio (WHR), lean mass index (LMI), and fat mass index (FMI).

Results: Mean FI levels increased by 0.28%/year among men and by 0.34%/year among women. Among women, per each kg/m2 higher BMI and each unit higher %BF the increases in FI levels per year were 0.013 percentage points (PP) steeper (95% CI = 0.004, 0.023) and 0.009 PP steeper (95% CI = 0.002, 0.016) from late midlife into old age. Among men, per each 0.1-unit greater WHR the increase in FI levels was 0.074 PP steeper per year (95% CI = −0.0004, 0.148). Cross-sectionally, greater FMI and LMI in late midlife were associated with higher FI levels but the direction of the association regarding LMI changed after adjustment for FMI. The categories “high FMI and high LMI” and “high FMI and low LMI” showed the highest FI levels relative to the category “low FMI and low LMI”.

Conclusions: In late midlife, greater adiposity (%BF) among women and abdominal obesity (WHR) among men may predispose to higher levels of frailty from late midlife into old age. Greater lean mass alone may be protective of frailty, but not in the presence of high fat mass.

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Series: Journals of gerontology. A, Biological sciences and medical sciences
ISSN: 1079-5006
ISSN-E: 1758-535X
ISSN-L: 1079-5006
Volume: 78
Issue: 6
Pages: 980 - 987
DOI: 10.1093/gerona/glac233
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This work was supported by Medicinska Understödföreningen Liv och Hälsa, Finska Läkaresällskapet, and the Academy of Finland grant no. 349336.
Copyright information: © The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.