Sex-Dependent Effects of Body Fat on Cardiac Function and Outcomes in Community-Dwelling Older Adults

Background: Among older adults, sex hormones may exert differential effects on body fat and cardiac health. Objectives: The authors aimed to study the effects of sex on body fat composition and aging-related diastolic function, as well as their longitudinal changes. Methods: Community-dwelling older...

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Main Authors: Haowen Jiang, MBBS, Jie Jun Wong, MBBS, Glades H.M. Tan, BEng, Louis L.Y. Teo, MBBS, See Hooi Ewe, MBBS, PhD, Ru-San Tan, MBBS, Fei Gao, PhD, Angela S. Koh, MBBS, MPH, PhD
Format: Article
Language:English
Published: Elsevier 2025-09-01
Series:JACC: Advances
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Online Access:http://www.sciencedirect.com/science/article/pii/S2772963X25005228
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author Haowen Jiang, MBBS
Jie Jun Wong, MBBS
Glades H.M. Tan, BEng
Louis L.Y. Teo, MBBS
See Hooi Ewe, MBBS, PhD
Ru-San Tan, MBBS
Fei Gao, PhD
Angela S. Koh, MBBS, MPH, PhD
author_facet Haowen Jiang, MBBS
Jie Jun Wong, MBBS
Glades H.M. Tan, BEng
Louis L.Y. Teo, MBBS
See Hooi Ewe, MBBS, PhD
Ru-San Tan, MBBS
Fei Gao, PhD
Angela S. Koh, MBBS, MPH, PhD
author_sort Haowen Jiang, MBBS
collection DOAJ
description Background: Among older adults, sex hormones may exert differential effects on body fat and cardiac health. Objectives: The authors aimed to study the effects of sex on body fat composition and aging-related diastolic function, as well as their longitudinal changes. Methods: Community-dwelling older adults without cardiovascular disease underwent prospective baseline same-day anthropometry for body fat mass (BFM), percentage body fat (PBF), and waist hip ratio (WHR) quantification by bioimpedance and transthoracic Doppler echocardiography, with measurements repeated at 5 years. Study outcomes included diastolic grade, ratio of early to late diastolic inflow velocities (E/A), ratio of mitral early diastolic inflow velocity to the average of septal and lateral early diastolic annular tissue velocities (E/e') ratios, left ventricle mass index, left atrial volume index and clinical outcomes. Correlations between baseline or interval changes (Δ) of WHR, BFM and PBF with follow-up or Δ values of outcomes were analyzed, with multivariable linear regression model adjustments for significant variables. Results: Among 409 older adults (mean age 61 ± 12.7 years, 214 women) with median follow-up of 4.9 (4.5, 5.2) years, baseline BFM predicted echocardiographic diastolic dysfunction at follow-up in women (OR: 1.059; 95% CI: 1.051-1.115; P = 0.002). Baseline PBF was associated with ΔE/A (β: 0.010; P = 0.028) among women and ΔE/e' (β: −0.069; P = 0.020) among men, with significant interactions between sex and PBF in predicting ΔE/A (P < 0.05). ΔBFM (β: −0.007; P = 0.05) and ΔPBF (β: −0.005; P = 0.047) were associated with ΔE/A independent of baseline BFM/PBF among women. Baseline (HR: 1.141; 95% CI: 1.027-1.158; P = 0.005) and changes in WHR (HR: 0.857; 95% CI: 0.790-0.931; P < 0.001) predicted cardiovascular outcomes among women. Conclusions: Baseline and interval increase in fat quantity via bioimpedance defined differential trajectories of longitudinal cardiac functional deteriorations between sexes.
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spelling doaj-art-a2eadf01518840a797942acdd7524f8d2025-08-23T04:50:11ZengElsevierJACC: Advances2772-963X2025-09-014910209710.1016/j.jacadv.2025.102097Sex-Dependent Effects of Body Fat on Cardiac Function and Outcomes in Community-Dwelling Older AdultsHaowen Jiang, MBBS0Jie Jun Wong, MBBS1Glades H.M. Tan, BEng2Louis L.Y. Teo, MBBS3See Hooi Ewe, MBBS, PhD4Ru-San Tan, MBBS5Fei Gao, PhD6Angela S. Koh, MBBS, MPH, PhD7Department of Cardiology, National Heart Centre Singapore, SingaporeDepartment of Cardiology, National Heart Centre Singapore, SingaporeDepartment of Cardiology, National Heart Centre Singapore, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore; Address for correspondence: Dr Angela S. Koh, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609.Background: Among older adults, sex hormones may exert differential effects on body fat and cardiac health. Objectives: The authors aimed to study the effects of sex on body fat composition and aging-related diastolic function, as well as their longitudinal changes. Methods: Community-dwelling older adults without cardiovascular disease underwent prospective baseline same-day anthropometry for body fat mass (BFM), percentage body fat (PBF), and waist hip ratio (WHR) quantification by bioimpedance and transthoracic Doppler echocardiography, with measurements repeated at 5 years. Study outcomes included diastolic grade, ratio of early to late diastolic inflow velocities (E/A), ratio of mitral early diastolic inflow velocity to the average of septal and lateral early diastolic annular tissue velocities (E/e') ratios, left ventricle mass index, left atrial volume index and clinical outcomes. Correlations between baseline or interval changes (Δ) of WHR, BFM and PBF with follow-up or Δ values of outcomes were analyzed, with multivariable linear regression model adjustments for significant variables. Results: Among 409 older adults (mean age 61 ± 12.7 years, 214 women) with median follow-up of 4.9 (4.5, 5.2) years, baseline BFM predicted echocardiographic diastolic dysfunction at follow-up in women (OR: 1.059; 95% CI: 1.051-1.115; P = 0.002). Baseline PBF was associated with ΔE/A (β: 0.010; P = 0.028) among women and ΔE/e' (β: −0.069; P = 0.020) among men, with significant interactions between sex and PBF in predicting ΔE/A (P < 0.05). ΔBFM (β: −0.007; P = 0.05) and ΔPBF (β: −0.005; P = 0.047) were associated with ΔE/A independent of baseline BFM/PBF among women. Baseline (HR: 1.141; 95% CI: 1.027-1.158; P = 0.005) and changes in WHR (HR: 0.857; 95% CI: 0.790-0.931; P < 0.001) predicted cardiovascular outcomes among women. Conclusions: Baseline and interval increase in fat quantity via bioimpedance defined differential trajectories of longitudinal cardiac functional deteriorations between sexes.http://www.sciencedirect.com/science/article/pii/S2772963X25005228cardiometabolic riskleft ventricular functionobesity
spellingShingle Haowen Jiang, MBBS
Jie Jun Wong, MBBS
Glades H.M. Tan, BEng
Louis L.Y. Teo, MBBS
See Hooi Ewe, MBBS, PhD
Ru-San Tan, MBBS
Fei Gao, PhD
Angela S. Koh, MBBS, MPH, PhD
Sex-Dependent Effects of Body Fat on Cardiac Function and Outcomes in Community-Dwelling Older Adults
JACC: Advances
cardiometabolic risk
left ventricular function
obesity
title Sex-Dependent Effects of Body Fat on Cardiac Function and Outcomes in Community-Dwelling Older Adults
title_full Sex-Dependent Effects of Body Fat on Cardiac Function and Outcomes in Community-Dwelling Older Adults
title_fullStr Sex-Dependent Effects of Body Fat on Cardiac Function and Outcomes in Community-Dwelling Older Adults
title_full_unstemmed Sex-Dependent Effects of Body Fat on Cardiac Function and Outcomes in Community-Dwelling Older Adults
title_short Sex-Dependent Effects of Body Fat on Cardiac Function and Outcomes in Community-Dwelling Older Adults
title_sort sex dependent effects of body fat on cardiac function and outcomes in community dwelling older adults
topic cardiometabolic risk
left ventricular function
obesity
url http://www.sciencedirect.com/science/article/pii/S2772963X25005228
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