JACC: Advances (Sep 2025)

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

  • 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

DOI
https://doi.org/10.1016/j.jacadv.2025.102097
Journal volume & issue
Vol. 4, no. 9
p. 102097

Abstract

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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.

Keywords