APPLIED NUTRITIONAL INVESTIGATION

Anthropometric Measurements in the Elderly Population of Santiago, Chile

J. L. Santos, PhD, C. Albala, MD, L. Lera, PhD, C. Garc a, BSc, P. Arroyo, MD, F. Pe rez-Bravo, PhD, B. Angel, MSc, and M. Pela ez, MD From the Public Health Nutrition Area, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile; and the Pan American Health Organization, Washington, DC, USA
OBJECTIVE: There are few studies on anthropometry and nutritional status in large and representative samples of elderly populations in Chile and South America. We describe age and sex differences in weight, height, body mass index, knee height, waist circumference, midarm circumference, triceps skinfold thickness, arm muscle area, and calf circumference in Chilean elderly subjects. METHODS: This was a population-based, cross-sectional study. A total of 1220 elderly persons (819 women and 411 men; age range, 60 99 y) were recruited in the city of Santiago (Chile) through a probabilistic sampling procedure carried out from October to December 1999. RESULTS: Men were signicantly heavier and taller than women in all age groups, whereas body mass index values were signicantly higher in women than in men. All anthropometric variables showed a decrease in average values with aging in men and women. The apparent negative slopes for the decline in average values of body weight with aging was of greater magnitude in women than in men (0.42 kg/y and 0.54 kg/y in male and female subjects, respectively). However, signicant age sex interaction was detected only for triceps skinfold thickness. In women, quadratic terms for age provided a signicantly better t than did the simple linear model for the association between age and weight, body mass index, waist circumference, triceps skinfold thickness, calf circumference, or midarm circumference. CONCLUSION: These observations indicated that body weight changes associated with aging might be more severe in Chilean women than in men, probably determining a differential pattern of lean and fat mass loss. Nutrition 2004;20:452 457. Elsevier Inc. 2004 KEY WORDS: elderly, anthropometry, body mass index, waist circumference

INTRODUCTION
The Chilean population has experienced an accelerated process of demographic and epidemiologic transition over the past three decades.1,2 This process has been characterized by a sharp decrease in infant mortality rates, reduction of fertility rates, and a progressive increase of the proportion of elderly people in the population. In this context, important changes in the causes of death have occurred over a relatively short period, with a clear indication that death from infections is on the decline, whereas death from noncommunicable chronic disease is on the rise.3 The improvement in the economic situation and the modernization of society have led to an increase in the consumption of high-calorie foods and an alarming increase of sedentary behavior, with subsequent effects from the high prevalence of overweight and obesity in schoolchildren and adults.3 In developed countries, fat accumulation during adulthood leads to an increased body mass index (BMI) in the elderly, with a maximum achieved near the age of 60 y. In contrast, loss of muscle mass starts in middle adulthood and continues to old age. In the elderly, decreased weight and height have been reported, with a decreased nutrient intake and lower energy expenditure.4

There are few studies on nutritional status in large and representative samples of elderly populations in South America. We assessed age and sex differences and percentiles for anthropometric indices (weight, height, BMI, knee height, waist circumference, midarm circumference, triceps skinfold thickness, and calf circumference) in a representative sample of elderly persons living in the city of Santiago, Chile. The results of this study are based on a cross-sectional study conducted in Santiago, Chile: Salud, Bienestar y Envejecimiento (Health, Well-Being and Aging). This study was part of a larger project evaluating health conditions of the elderly in Latin America and the Caribbean.5

MATERIALS AND METHODS

Area of Study The study was conducted in Gran Santiago, hereafter referred to as Santiago, which is the main urban nucleus of Chile, and where more than 35% of the Chilean population lives. Santiago comprises 34 highly urbanized administrative divisions called comunas and almost 300 districts. According to postcensus projections, the total population of Santiago in the year 2000 comprised 5 485 846 inhabitants6 who live in an area of approximately 2269 km2. The number of people older than 60 y in 2000 was 563 947. Subjects

This study was supported by the Pan American Health Organization, Institute of Nutrition and Food Technology, University of Chile, the Chilean Ministry of Health, and Fondecyt grant 1020703. Correspondence to: C. Albala, MD, Public Health Nutrition Area, Institute of Nutrition and Food Technology, University of Chile, El L bano 5524, Casilla 138-11, Santiago, Chile Nutrition 20:452 457, 2004 Elsevier Inc., 2004. Printed in the United States. All rights reserved.

From October to December 1999, a systematic recruitment of persons older than 60 y was carried out in the city of Santiago. The
0899-9007/04/$30.00 doi:10.1016/j.nut.2004.01.010

Nutrition Volume 20, Number 5, 2004 TABLE I.

BASELINE HEALTH CHARACTERISTICS OF 1220 CHILEAN ELDERLY SUBJECTS Men (n 411) Age (mean SD) Self-reported health status (%) Bad Fair Good Very good Excellent Smoking status (%) Current smoker Ex-smoker Never-smoker Self-report of diseases previously diagnosed by a physician (%) Diabetes Hypertension Pulmonary chronic disease Cancer history Coronary disease history Cerebrovascular stroke history SD, standard deviation. 70.6 7.4 17.8 39.8 32.7 5.6 4.1 15.6 45.1 39.3 Women (n 819) 71.9 7.4 23.1 44.5 27.7 3.6 1.1 9.2 26.3 64.5

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12.7 44.6 5.6 3.2 29.5 5.6

13.6 56.1 6.3 5.1 34.9 6.3

a chair or in the supine position when resting in bed (nonambulatory subjects). Measurements were made of the left leg by positioning the knee and ankle at a 90-degree angle. The xed blade of the caliper was placed under the heel, and the movable blade was positioned parallel to the bula over the lateral malleolus and just posterior to the head of the bula, and the two blades were pressed together to compress the soft tissues. The measurement was recorded to the nearest 0.1 cm. Waist circumference was assessed with a exible steel tape with the subject standing up and wrapping the tape at the level of the umbilicus. Triceps skinfold thickness was measured with a Lange skinfold caliper (model 68902, Vital Signs, Country Technology, MD, USA) at the posterior midpoint between the acromion and the olecranon. Measurements were recorded in millimeters. Midarm circumference was measured midway between the lateral projection of the acromion process of the scapula and the inferior margin of the olecranon process of the ulna. This middle point was marked with the elbow exed at 90 degrees, and the measurement was made with the arm hanging loosely at the side of the body. The midarm circumference was measured with a exible steel tape and recorded to the nearest 0.1 cm. Arm muscle area was calculated from midarm circumference and triceps skinfold thickness through the use of mathematical formulas with a gender correction.7,8 Calf circumference was registered at the middle of the eshy and bulky part of the calf with a metallic tape to the nearest 0.1 cm. Statistical Analysis Data were categorized according to sex and age groups of 60 to 64 y, 65 to 69 y, 70 to 74 y, 75 to 79 y, 80 to 84 y, and 85 y and older. Results are expressed as means, standard deviations, and 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles. Differences by study groups and statistical interactions were assessed by linear regression techniques.9,10 Due to the limitations imposed mainly by the cross-sectional nature of the study (see DISCUSSION), the slopes for estimating declines in average values in anthropometric measures with aging must be regarded as apparent slopes. Data analyses were performed with STATA 7.0 (1999, STATA Corp., College Station, TX, USA).

sampling process consisted of a probabilistic three-step procedure in which appropriate sampling units (districts, blocks, and households) were initially selected so that the number of selected households was proportional to the number of total households in each district. The total number of selected households in Santiago was 5440, and the number of eligible subjects for the study was 1563. Of these, we contacted 1301 subjects for a rst general interview related to health conditions (participation rate, 83%). Response rate was dependent on sex and was lower in men. During the rst months in 2000, the 1301 participants were contacted again, and 1220 subjects (94%) agreed to participate in a study on simple anthropometric measurements related to obesity (809 women and 411 men). The age range among the study participants was 60 to 99 y. The main reasons for not being included in the anthropometric study were refusal, death, or inability to stand upright. To keep the population-based nature of the sample, no special exclusion criteria based on socioeconomic status, unhealthy habits (e.g., smoking), unhealthy status (diseases), or medication use were considered. Therefore, participants in the sample constituted a heterogeneous group of persons living under very different social conditions and having different health statuses (Table I). This study was approved by the Ethics Committee of the Institute of Nutrition and Food Technology, University of Chile. Anthropometric Measurements Anthropometric measurements were carried out by paramedical personnel specially trained for this study. Height was measured with the subject standing barefoot with heels together, arms at the side, legs straight, shoulders relaxed, and head in the Frankfort horizontal plane, with heels, buttocks, scapulae, and back of the head lying against a vertical wall or a door. These measures were taken in centimeters by using a Harpenden Pocket Stadiometer (Holtain Ltd., Crosswell, UK). Weight was assessed with a SECA platform scale (Madison, WI, USA) graduated to the nearest 0.1 kg with the subject standing on the platform barefoot. Knee height was measured with a broad-blade caliper with the subject seated on

RESULTS
Summary statistics for anthropometric measurements are presented separately by sex and age groups by providing specic age and sex estimates that would avoid the effect of differential response rates11 (Tables II and III). Men were heavier (P 0.001) and taller (P 0.001) than women in all age groups. Weight and height showed a signicant decrease with age in men and women (P 0.001 for all weightversus-age and height-versus-age comparisons by sex). Knee height also was higher in men than in women (P 0.001). In contrast to height, knee height averages remained relatively constant across age groups in men (P 0.73) and women (P 0.30). The average BMI values were higher in women than in men in all age groups (P 0.001) with an apparent decline of BMI with age (P 0.001 in men and women). The prevalence of a BMI of at least 30 was estimated as 33.7% in women (95% condence interval, 30.4 37.0%) and 22.9% in men (95% condence interval, 18.9 27.3%). The odds ratio for a BMI of at least 30 by sex was estimated as 1.71 (95% condence interval, 1.30 2.25), indicating that obesity dened as a BMI of at least 30 is signicantly more prevalent in elderly women than in elderly men. The prevalence of a BMI lower than 20 was estimated as 5.0% in women (95% condence interval, 3.5 6.5%) and 4.9% in men (95% condence interval, 2.8 7.0%). Among those 85 y or older, the prevalence of a BMI below 20 was 17.8% in women (95% condence interval, 9.8 28.5%) and 13.6% in men (95% condence interval, 2.9 34.9%). The odds ratio for a BMI below 20 by sex

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Santos et al. TABLE II.

Nutrition Volume 20, Number 5, 2004

WEIGHT, HEIGHT, KNEE HEIGHT, BMI, AND WAIST CIRCUMFERENCE IN CHILEAN ELDERLY WOMEN Percentiles n Weight (kg) 6064 y 6569 y 7074 y 7579 y 8084 y 85 y All women Height (cm) 6064 y 6569 y 7074 y 7579 y 8084 y 85 y All women Knee height (cm) 6064 y 6569 y 7074 y 7579 y 8084 y 85 y All women Waist circumference (cm) 6064 y 6569 y 7074 y 7579 y 8084 y 85 y All women BMI (kg/m2) 6064 y 6569 y 7074 y 7579 y 8084 y 85 y All women Mean SD 5 10 25 50 75 90 95

178 186 149 134 87 75 809 178 186 149 133 87 74 807 180 187 150 134 89 79 819 178 186 150 133 87 74 808 178 186 149 133 87 73 806

67.8 66.8 64.1 62.0 58.5 53.1 63.6 151.2 151.0 150.1 149.4 147.7 145.7 149.8 46.5 46.3 46.5 46.3 46.2 45.8 46.3 93.9 93.7 93.7 93.9 91.0 88.7 93.0 29.6 29.3 28.5 27.9 26.8 25.2 28.3

13.5 14.0 11.6 12.4 11.6 10.7 13.4 6.0 5.8 6.1 6.5 6.0 6.8 6.3 2.4 2.5 2.3 2.3 2.5 2.3 2.4 11.3 12.5 11.6 11.7 11.8 11.2 11.8 5.2 5.6 5.1 5.4 4.8 5.2 5.4

50 47 47 42 40 35 44 142 142 140 139 137 135 140 43 43 43 42 42 42 43 77 74 75 72 72 70 74 21.6 21.3 21.5 19.3 19.0 18.8 20.0

53 51 51 46 42 40 47 145 144 143 142 140 137 142 44 44 44 44 43 43 44 79 78 79 80 76 74 78 23.2 22.7 22.4 21.1 20.0 19.3 21.8

58 57 57 53 53 46 55 147 147 146 146 144 141 146 45 45 45 45 45 45 45 87 86 86 87 83 81 86 25.8 25.5 25.3 24.3 24.1 21.8 24.7

66 65 63 62 57 53 63 150 150 150 149 148 146 150 47 46 46 46 47 46 46 93 93 93 94 92 89 93 29.3 28.7 27.6 27.5 26.5 25.0 27.8

77 75 72 70 65 60 72 155 155 154 153 151 151 154 48 48 48 48 48 48 48 101 100 102 102 99 95 100 32.3 32.5 31.6 31.0 30.1 27.6 31.4

86 83 79 80 73 67 81 158 159 158 157 155 154 158 50 50 50 49 50 49 50 109 109 109 107 104 102 108 36.6 36.1 35.6 35.0 32.5 31.2 35.6

91 91 82 84 79 72 86 162 161 160 161 158 157 161 50 50 51 51 50 50 50 114 115 111 113 108 110 112 39.1 38.8 37.0 36.9 34.4 33.6 37.8

BMI, body mass index; SD, standard deviation

was estimated as 1.02 (95% condence interval, 0.59 1.77), indicating no apparent differences by sex for this condition. Waist circumference decreased signicantly with age in both sexes (P 0.001 in women and P 0.03 in men). Midarm circumference, triceps skinfold thickness, arm muscle area, and calf circumference measurements (Table IV) showed a trend for decreased values in older age groups that was statistically significant (P 0.001) for decline by age in all such variables and both sexes. Table V shows sex-specic intercepts and slopes for the decline of anthropometric variables with aging. Regression models for weight-versus-age or height-versus-age including knee height as a covariate produced a small change in the slope coefcients (10%) in comparison with the unadjusted models. In women, the quadratic model including age2 provided a signicantly better t than the simple linear model for the variables weight, BMI, waist circumference, triceps skinfold, calf circumference, and midarm

circumference. This circumstance indicates a possible acceleration in the decline of average values of anthropometric variables in the oldest female subjects. In contrast, quadratic terms related to decline with age were not statistically signicant in men for any of the anthropometric variables. The slopes for decline with age in average values of all anthropometric variables were of greater magnitude in women than in men (Table VI), except for arm muscle area. A signicant age sex interaction was detected only for triceps skinfold thickness measurements, with a signicant, more negative slope in women than in men (P 0.03).

DISCUSSION
The present study provides summary statistics for obesity-related anthropometric variables in a large representative sample of

Nutrition Volume 20, Number 5, 2004 TABLE III.

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WEIGHT, HEIGHT, KNEE HEIGHT, BMI, AND WAIST CIRCUMFERENCE IN CHILEAN ELDERLY MEN Percentiles n Weight (kg) 6064 y 6569 y 7074 y 7579 y 8084 y 85 y All men Height (cm) 6064 y 6569 y 7074 y 7579 y 8084 y 85 y All men Knee height (cm) 6064 y 6569 y 7074 y 7579 y 8084 y 85 y All men Waist circumference (cm) 6064 y 6569 y 7074 y 7579 y 8084 y 85 y All men BMI (kg/m2) 6064 y 6569 y 7074 y 7579 y 8084 y 85 y All men Mean SD 5 10 25 50 75 90 95

96 121 79 62 31 22 411 95 122 79 62 31 22 411 94 122 79 62 31 22 410 96 121 79 62 30 22 410 95 121 79 62 31 22 410

78.0 73.4 72.0 71.7 69.1 64.6 73.2 165.8 165.3 164.7 163.5 162.5 161.6 164.6 50.9 51.3 50.9 50.9 50.5 50.5 50.9 100.6 97.8 98.1 98.1 98.6 93.7 98.4 28.4 26.9 26.5 26.8 26.0 24.7 27.0

13.1 14.0 10.5 11.8 13.0 11.0 13.0 7.2 7.2 6.8 6.8 7.9 5.7 7.1 3.0 2.7 2.9 2.9 2.7 2.4 2.8 10.4 10.6 8.5 8.9 10.4 8.9 9.9 4.3 4.5 3.4 4.4 3.7 4.0 4.2

58 50 56 48 46 52 51 154 153 154 155 146 154 153 46 47 46 47 46 47 46 85 80 86 82 83 84 82 20.8 19.7 20.9 21.2 21.0 19.4 20.2

61 53 59 60 56 54 57 157 156 156 157 153 155 156 48 48 47 48 47 48 48 87 83 89 87 87 84 86 22.8 20.6 22.7 21.5 21.5 19.6 21.5

68 65 65 65 60 55 65 161 160 159 160 159 157 160 49 50 49 49 49 49 49 94 92 94 92 93 88 92 25.2 24.5 24.5 23.2 23.4 22.4 24.3

78 74 72 73 69 65 73 165 165 165 163 164 161 164 51 51 51 51 51 50 51 100 98 98 99 99 94 98 28.2 26.5 26.1 27.1 26.3 23.5 26.8

88 84 79 80 80 72 81 171 170 170 167 167 167 169 53 53 53 53 52 53 53 107 105 102 105 104 98 105 31.0 29.7 28.4 29.0 29.7 27.2 29.7

97 91 85 84 85 78 90 175 174 175 171 172 170 174 55 54 55 55 53 54 55 114 111 107 108 111 104 110 34.2 32.2 31.6 32.0 30.7 30.3 32.2

101 94 87 90 89 80 95 178 178 177 175 175 170 177 575 56 56 57 54 55 56 121 116 112 110 112 110 115 36.3 34.0 32.4 32.7 31.2 32.2 34.2

BMI, body mass index; SD, standard deviation.

Chilean elderly subjects living in the city of Santiago. The growing proportion of elderly population in Chile and the entire world demands the conduction of epidemiologic studies to consider effective public health interventions aimed at preventing death and disabilities focused on this age group.12 There are previous reports of anthropometric measurements in the Chilean elderly population.1318 In one study,13 885 elderly subjects living in Santiago were recruited in different periods from 1984 to 1987. However, the sample used in that study was not representative of the entire population of Santiago, and no specic hypotheses were tested in relation to body changes according to age. Table VI shows a comparative analysis of BMI averages by sex and age groups in the 885 Chilean elderly subjects tested in 1985 and the data from the present study conducted during 2000. Visual analysis of Table VI indicates that, for most subjects grouped by age and sex, there is an increase of approximately one

unit of BMI when comparing data gathered in 2000 with those gathered during the 1980s. This difference may be the consequence of the epidemiologic changes that occurred in Chile during the past decades such as the adoption of sedentary habits and the increase in the consumption of high-calorie diets. Another study19 focused on nutritional habits of elders living in poor communities in Santiago and found a decient consumption of most relevant nutrients, with signicantly lower intakes of energy, protein, calcium, iron, and folic acid in elderly women compared with men. Concurrently, it has been estimated that the adequacy of nutritional intake in Chile is dependent on socioeconomic status.20 For these reasons, the Ministry of Health in 1999 started a program to provide nutritional supplements to Chilean elderly people.19 Important reductions in average height with age were estimated in this study. The mean differences in height between the youngest group (60 to 65 y) and the oldest one (85 y) were 4.2 cm in men

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Santos et al. TABLE IV.

Nutrition Volume 20, Number 5, 2004 relatively constant across age groups, we conclude that it is unlikely that secular trends account for the height differences observed in elderly subjects. However, this idea must be considered with caution because women 85 y and older showed lower mean values for knee height than did women 60 to 84 y old, although this difference was not statistically signicant. A limitation of this study is its cross-sectional nature, which restricts inferences with regard to body changes with aging. However, it is worth noting that similar height changes have been estimated in other crosssectional and longitudinal studies.11,21 Weight reductions also were estimated in this study, especially among those 80 y and older. The mean differences in weight when comparing the youngest group (60 to 65 y) with the oldest one (85 y) were 13.4 kg in men (17.2% of initial weight) and 14.7 kg in women (21.7% of initial weight). It is important to consider that weight reductions, especially in women, are more pronounced in Chilean populations than those observed in European elderly populations.11,22 This fact is likely due to a lower economic income and less social support for Chilean elderly people than for Europeans that leads to a decient diet and inadequate health care.17 Although the slope for weight loss with age was higher in women than in men, there was no signicant difference between regression coefcients by sex. However, variables related to socioeconomic status might have been specic to sex when determining the rate of weight loss, fat-free mass loss, and fat mass loss in Chilean elderly subjects. In this study, a high average BMI was estimated in the 60- to 69-y group, reecting the well-known fat accumulation process that occurs during adulthood. After this age, a decrease in BMI occurs in both sexes, with an increased decline in women compared with men. In this context, it is worth noting that mortality by nutritional status may lead to differential BMI distribution values across age groups. However, it has been observed that baseline BMI does not predict mortality in elderly people, whereas weight changes are more suitable for this purpose.23 In any case, it is

MID-ARM CIRCUMFERENCE, TRICEPS SKINFOLD THICKNESS, ARM MUSCLE AREA, AND CALF CIRCUMFERENCE IN 1220 CHILEAN ELDERLY SUBJECTS* Midarm circumference (cm) Women 6064 y 6569 y 7074 y 7579 y 8084 y 85 y All women Men 6064 y 6569 y 7074 y 7579 y 8084 y 85 y All men Triceps skinfold (mm) Calf Arm muscle circumference area (cm) (cm2)

31.4 4.2 31.1 4.0 30.1 3.8 30.0 4.2 28.2 3.8 26.5 4.2 30.1 4.3 31.3 3.7 29.8 3.9 29.8 3.4 29.3 3.5 28.4 2.8 26.8 3.1 29.8 3.7

24.9 6.9 25.4 7.5 23.6 7.3 22.4 7.6 19.0 6.5 16.7 6.1 22.9 7.6 18.6 8.4 17.1 8.4 16.5 7.7 16.1 7.5 14.8 6.6 12.1 3.8 16.7 7.9

38.4 12.6 36.8 10.7 35.0 8.9 36.0 10.9 33.2 8.9 30.3 10.1 35.7 10.9 42.1 11.8 38.4 10.8 38.5 10.0 37.3 9.1 35.0 6.9 32.5 8.3 38.5 10.5

35.8 3.5 35.5 3.8 35.0 3.2 34.8 4.4 33.4 4.3 31.8 4.0 34.8 4.0 37.2 3.9 36.2 3.6 35.7 2.5 36.0 3.3 34.9 3.3 33.3 3.3 36.0 3.5

* Mean standard deviation.

and 5.5 cm in women. A secular trend is a possible explanation for the differences in stature found in the present study. In this context, if different environmental conditions affecting stature occurred at young ages, this fact would have an effect in differences in knee height measured in the elderly. Because knee height remained

TABLE V.
REGRESSION COEFFICIENTS FOR THE ASSOCIATION BETWEEN AGE AND ANTHROPOMETRIC VARIABLES IN 1220 CHILEAN ELDERLY SUBJECTS* Men Dependent variable Weight (kg) Height (cm) BMI (kg/m2) Calf circumference (cm) Waist circumference (cm) Triceps skinfold thickness (mm) Mid-arm circumference (cm) Arm muscle area (cm2) Intercept 102.5 (6.0) 175.8 (3.31) 34.4 (1.97) 43.8 (1.60) 108.5 (4.65) 30.6 (3.67) 39.8 (1.68) 61.5 (4.81) Slope for age (y) 0.42 (0.08) 0.16 (0.05) 0.10 (0.03) 0.11 (0.02) 0.14 (0.07) 0.20 (0.05) 0.14 (0.02) 0.33 (0.07) Intercept 102.5 (3.91) 164.9 (1.90) 39.8 (1.64) 45.1 (1.17) 104.7 (3.7) 46.2 (2.19) 42.9 (1.23) 55.8 (3.25) Women Slope for age (y) 0.54 (0.05) 0.21 (0.03) 0.16 (0.02) 0.14 (0.02) 0.16 (0.05) 0.32 (0.03) 0.18 (0.02) 0.28 (0.04) P, age sex interaction 0.21 0.31 0.16 0.26 0.84 0.03 0.23 0.58

* Regression coefcients correspond to 16 sex-specic simple linear regression models with age (y) as an independent variable and each anthropometric variable as dependent variables. All anthropometric variables showed signicant negative associations with age. Standard errors are shown into parentheses. In women, quadratic terms including age squared provided a signicant better t than the simple linear model for the variables weight, BMI, waist circumference, triceps skinfold thickness, calf circumference, and mid-arm circumference. In men, quadratic terms were not statistically signicant for any of the estimated regression equations. Regression models for weight-versus-age or height-versus-age including knee height as a covariate produced a small change in the slope coefcients (10%) in comparison with the unadjusted models. Correction by sex in arm muscle area7 does not affect sex-specic slopes, although it affects intercepts and average values in this table. P value for interaction refers to the slope comparisons by sex of simple regression models for the association between age and each anthropometric variable. BMI, body mass index.

Nutrition Volume 20, Number 5, 2004 TABLE VI.

BODY MASS INDEX BY AGE AND SEX IN CHILEAN ELDERLY PERSONS RECRUITED DURING THE 1980s AND 2000* 1980s Age groups 6069 y 7079 y 80 y Total Men 26.3 3.5 25.6 3.5 24.1 3.7 25.9 3.5 Women 28.4 5.1 26.6 5.2 25.2 3.7 27.3 5.3 Men 27.5 4.5 26.6 3.9 25.5 3.9 27.0 4.2 2000 Women 29.4 5.4 28.2 5.2 26.0 5.0 28.3 5.4

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In summary, the observations derived from this study indicate that body weight changes associated with aging might be more severe in Chilean women than in men, likely indicating a differential pattern of lean and fat mass loss in the oldest subjects.

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1. Albala C, Vio F. Epidemiologic transition in Latin America: the case of Chile. Public Health 1995;109:431 2. Albala C, Vio F, Kain J, Uauy R. Nutrition transition in Latin America: the case of Chile. Nutr Rev 2001;56:170 3. Uauy R, Albala C, Kain J. Obesity trends in Latin America: transiting from under to overweight. J Nutr 2001;131:893S 4. Elia M. Obesity in the elderly. Obes Res 2001;9:244S 5. Palloni A, Pinto-Aguirre G, Pelaez M. Demographic and health conditions of ageing in Latin America and the Caribbean. Int J Epidemiol 2002;31:762 6. Censo de poblacio n y vivienda Chile 1992. Santiago: Instituto Nacional de Estad sticas, 1993 7. Heymseld S, McManus C, Smith J, et al. Anthropometric measurement of muscle mass: revised equations for calculating bone-free arm muscle area. Am J Clin Nutr 1982;36:680 8. Miller MD, Diet M, Crotty M, et al. Corrected arm muscle area: an independent predictor of long-term mortality in community-dwelling older adults? J Am Geriatr Soc 2002;50:1272 9. Kleinbaum DG, Kupper LL, Muller RT. Applied regression analysis and other multivariable methods. Boston: PWS-Kent, 1988 10. Fitzmaurice G. The meaning and interpretation of interaction. Nutrition 2002;16: 313 11. Perissinotto E, Pisent C, Sergi G, Grigoletto F, Enzi G. Anthropometric measurements in the elderly: age and gender differences. Br J Nutr 2002;87:177 12. Ebrahim S. Ageing, health and society. Int J Epidemiol 2002;31:715 13. Valiente S, Jimenez M, Valiente G, Trufello I, Albala C. Diet and malnutrition in Chilean elderly. In: Valiente S, Avila B, Valiente G, Valenzuela S, Robledo A, eds. Food and nutrition policies and programs in Chile: a successful experience. 1993:179 14. Valiente S. Problema tica nutricional del adulto mayor en Chile. Rev Chil Nutr 1999;26:263 15. Soto D, Cariaga L, Gaete MC, Pen a E, Cancino E, Rojas D. Clasicacio n nutricional de senescentes de centros institucionales de la ciudad de Santiago, Chile. Rev Chil Nutr 1998;16:306 16. Soto D, Gaete MC, Cariaga L, et al. Caracter sticas epidemiolo gicas y nutricionales del adulto mayor. Rev Med Chile 1993;121:209 17. Atalah E, Benavides X, Avila L, Barahona S, Cardenas R. Alimentary features of elders living in poor communities of the Metropolitan region of Chile. Rev Med Chile 1998;126:489 18. Marin PP, Cubillos AM. Evaluacio n del estado nutricional, perl de morbilidad y situacio n socioecono mica de una poblacio n ambulatoria de mayores de 65 an os. Rev Chil Nutr 1991;19:63 19. Atalah E, Benavides X, Ca rdenas R, Barahona S, Espinoza M. Aceptabilidad y consumo de un suplemento alimentario en el adulto mayor. Rev Chil Nutr 2001;28:438 20. Labran a AM, Dura n E, Asenjo D, Bacard M, Reyes R. Nivel de ingreso familiar y su relacio n con la calidad de la dieta de dos grupos de adultos mayores de 60 an os de la ciudad de Concepcio n, Chile. Rev Chil Nutr 1999;26:301 21. Dey DK, Rothemberg E, Sundh V, Bosaeus I, Steen B. Height and body weight in the elderly. I. A 25 year longitudinal study of a population aged 70 to 95 years. Eur J Clin Nutr 1999;53:905 22. Gillette-Guyonnet S, Nourhashemi F, Andrieu S, et al. Body composition in French women 75 years of age: the EPIDOS study. Mech Age Dev 2003;124: 311 23. Somes GW, Kritchevsky SB, Shorr RI, Pahor M, Applegate WB. Body mass index, weight change, and death in older adults. Am J Epidemiol 2002;156:132 24. Lee RD, Nieman DC. Nutritional assessment. Madison: Brown and Benchmark Publishers, 1993

* Average standard deviation. Chilean elderly subjects (n 885) were recruited on different occasions from 1984 to 1987.13 Present study (n 1220).

important to consider the possible bias generated when comparing weight and BMI across age groups due to differential survival. The high prevalence of subjects with a BMI below 20, especially in women, may be related to the unfavorable social conditions suffered by an important proportion of the elderly population in developing countries in general and in Chile in particular.17 In this context, we have to emphasize that there is no consensus on BMI cutoff points for dening nutritional status in elderly subjects in Chile. The slopes for decline with age in average values of all anthropometric variables were of greater magnitude in women than in men, with the exception of arm muscle area (Table VI). However, a signicant age sex interaction was detected only for triceps skinfold measurements. In women, quadratic terms including age2 provided a signicantly better t than the simple linear model for the variables weight, BMI, waist circumference, triceps skinfold, calf circumference, and midarm circumference, indicating a possible acceleration in the averages of these variables in female subjects with aging. Although comparison of sex-specic slopes did not achieve statistical signicance for weight, this study suggests that age-related changes may act in a sex-specic manner differentially affecting anthropometric variables such as weight, height, and BMI. Midarm and calf circumferences are measures of muscle and subcutaneous adipose tissue, and triceps skinfold thickness is a measure of subcutaneous adipose tissue. Arm muscle area was calculated from midarm circumference and triceps skinfold thickness with a sex-specic correction.7,8 Regarding the arm muscle area, we have to consider the mathematical assumptions involved in the calculation of arm muscle area,24 the fat inltration into arm muscle that occurs with aging, and the lack of validation studies for Chilean elderly subjects. Despite these limitations, we believe that arm muscle area may constitute a rough and crude indicator of changes in muscle mass with aging. In this context, Table VI shows that total weight and triceps skinfold thickness decreased with aging more rapidly in women than in men, whereas arm muscle area seemed to decrease slightly more rapidly in men than in women (without achieving statistical signicance for weight or arm muscle area).