The journal of nutrition, health & aging

, Volume 23, Issue 1, pp 9–13 | Cite as

Relationship of Incident Falls with Balance Deficits and Body Composition in Male and Female Community-Dwelling Elders

  • Debra L. WatersEmail author
  • C. R. Qualls
  • M. Cesari
  • Y. Rolland
  • L. Vlietstra
  • B. Vellas



Sarcopenia and obesity are reported risk factors for falls, although the data are not consistent and most studies do not make sex comparisons. We investigated whether falls were associated with balance, gait, and body composition, and whether these relationships are sex-specific.


Secondary analysis of 4-year follow-up data from of the New Mexico Aging Process Study.


Albuquerque, New Mexico.


307 participants (M, n=122, 75.8 yr. SD5.5; F, n=183, 74.6yr SD6.1).


Gait and balance were assessed annually using the Tinetti test. Lean body mass (LBM), appendicular skeletal muscle mass (ASM), fat free mass (FFM), total fat mass (FM) were assessed annually by DXA. Falls were assessed using bimonthly falls calendars. Hazard ratios (HR) for 2-point worsening in gait and balance score and falls were calculated by Cox proportional hazard for men and women.


Baseline balance deficits, and not body composition, represented the strongest predictor of falls. For the total balance score, the variables with significant sex interactions were ASM (Male-HR 1.02 95%CI 0.60-1.73; Female-HR 1.92 95%CI 1.05-3.52, p=0.03) and FFM (Male-HR 1.04 95%CI 0.64-1.70; Female-HR 1.91 95%CI 1.12-3.24, p=0.04), after adjustment for age, sarcopenia and physical activity. The body composition relationship with balance deficits was U-shaped with the strongest predictors being low LBM in males and high FM in females.


Specific body composition components and balance deficits are risk factors for falls following sex-specific patterns. Sex differences need to be explored and considered in interventions for worsening balance and falls prevention.

Key words

Body composition balance falls sex older adults 


  1. 1.
    Kelsey, J.L., et al., Heterogeneity of falls among older adults: implications for public health prevention. Am J Public Health, 2012. 102(11): p. 2149–56.CrossRefGoogle Scholar
  2. 2.
    Phelan, E.A., et al., Assessment and Management of Fall Risk in Primary Care Settings. Medical Clinics of North America, 2015. 99(2): p. 281–293.CrossRefGoogle Scholar
  3. 3.
    Tinetti, M.E., Preventing falls in elderly persons. New England Journal of Medicine, 2003. 348(1): p. 42–49.CrossRefGoogle Scholar
  4. 4.
    Kelsey, J.L., et al., Reevaluating the implications of recurrent falls in older adults: location changes the inference. J Am Geriatr Soc, 2012. 60(3): p. 517–24.CrossRefGoogle Scholar
  5. 5.
    Masud, T. and R.O. Morris, Epidemiology of falls. Age and Ageing, 2001. 30(S4): p. 3–7.CrossRefGoogle Scholar
  6. 6.
    Scott, D., et al., Sarcopenic obesity and dynapenic obesity: 5-year associations with falls risk in middle-aged and older adults. Obesity (Silver Spring), 2014. 22(6): p. 1568–74.CrossRefGoogle Scholar
  7. 7.
    Landi, F., et al., Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study. Clin Nutr, 2012. 31(5): p. 652–8.CrossRefGoogle Scholar
  8. 8.
    Himes, C.L. and S.L. Reynolds, Effect of obesity on falls, injury, and disability. J Am Geriatr Soc, 2012. 60(1): p. 124–9.CrossRefGoogle Scholar
  9. 9.
    Breton, T., et al., Gender-specific associations between functional autonomy and physical capacities in independent older adults: Results from the NuAge study. Archives of Gerontology and Geriatrics, 2014. 58(1): p. 56–62.CrossRefGoogle Scholar
  10. 10.
    Keevil, V.L., et al., The physical capability of community-based men and women from a British cohort: The European Prospective Investigation into Cancer (EPIC)-Norfolk study. BMC Geriatrics, 2013. 13(1).Google Scholar
  11. 11.
    Valentine, R.J., et al., Sex impacts the relation between body composition and physical function in older adults. Menopause, 2009. 16(3): p. 518–523.CrossRefGoogle Scholar
  12. 12.
    Visser, M., et al., Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: The Health, Aging and Body Composition Study. Journal of the American Geriatrics Society, 2002. 50(5): p. 897–904.CrossRefGoogle Scholar
  13. 13.
    Garry, P.J., S.J. Wayne, and B. Vellas, The New Mexico Aging Process Study (1979-2003): A Longitudinal Study of Nutrition, Health and Aging. JNHA, 2007. 11(2): p. 125–30.Google Scholar
  14. 14.
    Tinetti, M.E., Performance-Oriented Assessment of Mobility Problems in Elderly Patients. Journal of the American Geriatrics Society, 1986. 34(2): p. 119–126.CrossRefGoogle Scholar
  15. 15.
    Manckoundia, P., et al., Impact of clinical, psychological, and social factors on decreased Tinetti test score in community-living elderly subjects: A prospective study with two-year follow-up. Medical Science Monitor, 2008. 14(6): p. CR316–CR322.Google Scholar
  16. 16.
    World Health Organization. WHO global report on falls prevention in older age.. 2008; Available from:
  17. 17.
    Cruz-Jentoft, A.J., et al., Sarcopenia: European consensus on definition and diagnosis. Age and Ageing, 2010. 39(4): p. 412–423.CrossRefGoogle Scholar
  18. 18.
    Baumgartner, R.N., et al., Sarcopenic Obesity Predicts Instrumental Activities of Daily Living Disability in the Elderly. Obesity Research, 2004. 12(12): p. 1995–2004.CrossRefGoogle Scholar
  19. 19.
    Tinetti, M.E., T.F. Williams, and R. Mayewski, Fall Risk Index for Elderly Patients Based on Number of Chronic Disabilities. The American Journal of Medicine, 1986. 80: p. 429–434.CrossRefGoogle Scholar
  20. 20.
    Bouchard, D.R., M. Heroux, and I. Janssen, Association between muscle mass, leg strength, and fat mass with physical function in older adults: influence of age and sex. J Aging Health, 2011. 23(2): p. 313–28.CrossRefGoogle Scholar
  21. 21.
    Cesari, M., et al., Sarcopenia-related parameters and incident disability in older persons: results from the “invecchiare in Chianti” study. J Gerontol A Biol Sci Med Sci, 2015. 70(4): p. 457–63.CrossRefGoogle Scholar
  22. 22.
    Cruz-Gomez, N.S., et al., Influence of obesity and gender on the postural stability during upright stance. Obes Facts, 2011. 4(3): p. 212–7.CrossRefGoogle Scholar
  23. 23.
    Daly, R.M., et al., Gender specific age-related changes in bone density, muscle strength and functional performance in the elderly: a-10 year prospective populationbased study. BMC Geriatr, 2013. 13: p.71.CrossRefGoogle Scholar
  24. 24.
    Fragala, M.S., et al., Gender differences in anthropometric predictors of physical performance in older adults. Gend Med, 2012. 9(6): p. 445–56.CrossRefGoogle Scholar
  25. 25.
    Tseng, L.A., et al., Body composition explains sex differential in physical performance among older adults. J Gerontol A Biol Sci Med Sci, 2014. 69(1): p. 93–100.CrossRefGoogle Scholar
  26. 26.
    Friedmann, J.M., T. Elasy, and G.L. Jensen, The relationship between body mass index and self-reported functional limitation among older adults: A gender difference. Journal of the American Geriatrics Society, 2001. 49(4): p. 398–403.CrossRefGoogle Scholar
  27. 27.
    Rosenblatt, N.J. and M.D. Grabiner, Relationship between obesity and falls by middleaged and older women. Archives of Physical Medicine and Rehabilitation, 2012. 93(4): p. 718–722.CrossRefGoogle Scholar
  28. 28.
    Scott, D., et al., Sarcopenic Obesity and Its Temporal Associations With Changes in Bone Mineral Density, Incident Falls, and Fractures in Older Men: The Concord Health and Ageing in Men Project. Journal of Bone and Mineral Research, 2017. 32(3): p. 575–583.CrossRefGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Debra L. Waters
    • 1
    Email author
  • C. R. Qualls
    • 2
    • 3
  • M. Cesari
    • 4
    • 5
  • Y. Rolland
    • 6
  • L. Vlietstra
    • 7
  • B. Vellas
    • 6
    • 8
  1. 1.Department of Medicine and School of PhysiotherapyUniversity of OtagoDunedinNew Zealand
  2. 2.Department of Mathematics & Statistics and School of MedicineUniversity of New MexicoAlbuquerqueUSA
  3. 3.Biomedical Research Institute of New MexicoAlbuquerqueUSA
  4. 4.Fondazione IRCCS Ca’ Granda – Ospedale Maggiore PoliclinicoMilanItaly
  5. 5.Department of Clinical and Community SciencesUniversity of MilanMilanItaly
  6. 6.Centre HospitalierUniversitaire de ToulouseToulouseFrance
  7. 7.Department of MedicineUniversity of OtagoDunedinNew Zealand
  8. 8.Department of Internal and Geriatrics Medicine, GerontopoleCHU de Toulouse, UMR 1027 INSERM, University Toulouse IIIToulouseFrance

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