Aging Clinical and Experimental Research · 9 authors, 6 centres
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Dynapenic abdominal obesity (DAO) significantly increased the risk of developing multimorbidity over 10 years in older adults (OR=1.671, p=0.002). Abdominal obesity alone also increased risk (OR=1.505, p<0.0001), but dynapenia alone did not. Addressing DAO through lifestyle interventions may help prevent multimorbidity.
**Background:** Multimorbidity, defined as the presence of two or more chronic conditions, is a growing public health concern in aging populations, associated with lower quality of life, increased healthcare utilization, and higher mortality. Dynapenic abdominal obesity (DAO), characterized by low muscle strength (dynapenia) and high waist circumference, has been linked to adverse outcomes such as falls, metabolic alterations, disability, and premature death. However, the longitudinal association between DAO and incident multimorbidity had not been previously investigated. This study aimed to examine this association over 10 years in a large representative sample of older English adults.
**Methods:** Data were drawn from waves 2 to 7 (2004–2015) of the English Longitudinal Study of Ageing (ELSA), a nationally representative prospective cohort. At baseline (wave 2), 9432 participants were assessed; after excluding those with missing data on dynapenia (n=1922), waist circumference (n=220), prevalent multimorbidity (n=3685), or missing follow-up data (n=303), 3302 participants without multimorbidity at baseline were included. Dynapenia was defined using the revised European consensus criteria: handgrip strength <27 kg for men and <16 kg for women (mean of three dominant-hand measurements). Abdominal obesity was defined as waist circumference >102 cm in men and >88 cm in women. DAO was the combination of both conditions. Multimorbidity was defined as having ≥2 self-reported doctor-diagnosed chronic conditions from a list of 15 (e.g., hypertension, diabetes, cancer, arthritis). Incident multimorbidity was assessed at each subsequent wave over 10 years. Covariates included age, sex, education, ethnicity, marital status, smoking, alcohol use, and physical activity. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for covariates significantly associated with multimorbidity in univariate analyses (p<0.10). Analyses were weighted using longitudinal survey weights.
**Key Results:** The 3302 participants had a mean age of 63.4 years (SD 8.9), 50.3% male, and 98.1% white. Over 10 years, 1810 participants (55.0%) developed multimorbidity. Compared to those without incident multimorbidity, those who developed multimorbidity were older (mean 64.6 vs. 59.6 years, p<0.0001), less educated (7.8 vs. 9.9 years, p<0.0001), more likely to be ever smokers (61.4% vs. 57.0%, p=0.03), less likely to drink alcohol (92.3% vs. 95.0%, p=0.01), and had lower physical activity (high activity: 21.7% vs. 35.1%, p<0.0001). At baseline, 8.3% had DAO, 36.3% had only abdominal obesity, and 11.1% had only dynapenia. In the fully adjusted model, compared to the reference group (no dynapenia nor abdominal obesity), only dynapenia was not significantly associated with incident multimorbidity (OR=0.97, 95%CI: 0.73–1.28, p=0.81). Only abdominal obesity significantly increased risk (OR=1.505, 95%CI: 1.272–1.780, p<0.0001), and DAO showed the highest risk (OR=1.671, 95%CI: 1.201–2.325, p=0.002). Other significant risk factors included older age (OR=1.07 per year, p<0.0001), male sex (OR=0.78, p=0.02), fewer years of education (OR=0.98, p=0.02), and being separated vs. married (OR=0.39, p=0.04). For individual conditions, compared to the reference group, DAO was significantly associated with higher risk of diabetes (OR=5.87, 95%CI: 3.13–11.03, p<0.0001) and arthritis (OR=1.92, 95%CI: 1.27–2.92, p=0.002). Only abdominal obesity was associated with hypertension (OR=1.43, p=0.001), diabetes (OR=4.56, p<0.0001), arthritis (OR=1.48, p=0.001), and high cholesterol (OR=1.24, p=0.02). Only dynapenia was associated with diabetes (OR=2.44, p=0.001).
**Clinical Implications:** This is the first prospective study to demonstrate that DAO is a significant risk factor for incident multimorbidity over 10 years, independent of other risk factors. The findings suggest that interventions targeting both muscle strength and central adiposity—such as resistance training combined with nutritional strategies—may help prevent the development of multiple chronic conditions, particularly diabetes and arthritis. Given the high prevalence of multimorbidity in aging populations, identifying modifiable risk factors like DAO is crucial for public health. Limitations include self-reported medical conditions, a predominantly white sample, and potential residual confounding. Future intervention studies are needed to confirm these findings.