Body mass index, dementia, and mortality in the elderly

Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY 10032, USA.
The Journal of Nutrition Health and Aging (Impact Factor: 3). 03/2008; 12(2):127-31. DOI: 10.1007/BF02982565
Source: PubMed


To explore the association between body mass index and mortality in the elderly taking the diagnosis of dementia into account.
Cohort study.
cohort study of aging in Medicare recipients in New York City.
1,452 elderly individuals 65 years and older of both genders.
We used proportional hazards regression for longitudinal multivariate analyses relating body mass index (BMI) and weight change to all-cause mortality.
There were 479 deaths during 9,974 person-years of follow-up. There were 210 cases of prevalent dementia at baseline, and 209 cases of incident dementia during follow-up. Among 1,372 persons with BMI information, the lowest quartile of BMI was associated with a higher mortality risk compared to the second quartile (HR=1.5; 95% CI: 1.1,2.0) after adjustment for age, gender, education, ethnic group, smoking, cancer, and dementia. When persons with dementia were excluded, both the lowest (HR=1.9; 95% CI=.3,2.6) and highest (HR=1.6; 95% CI: 1.1,2.3) quartiles of BMI were related to higher mortality. Weight loss was related to a higher mortality risk (HR=1.5; 95% CI: 1.2,1.9) but this association was attenuated when persons with short follow-up or persons with dementia were excluded.
The presence of dementia does not explain the association between low BMI and higher mortality in the elderly. However, dementia may explain the association between weight loss and higher mortality.

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    • "To our knowledge there are few studies that compare the relevance of weight loss and a low BMI in older persons within a single data set [1] [3] [9] [11] [13]. None of these studies analyzed the possible interference and interaction of these two risk factors and some have conflicting results with regard to the prognostic impact of both factors. "
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    ABSTRACT: Weight loss and low body-mass-index (BMI) are well-known risk factors for mortality among older persons. Both items represent a reduced nutritional state but their nature is different. It is, however, unclear which of these factors is more important for prognosis and if there is interference or interaction between them. To measure the prevalence of low BMI and weight loss in nursing home residents and to analyze their impact on mortality. The nutritionDay in nursing homes is an international annual one-day cross sectional survey evaluating malnutrition and 6-months mortality. The data collected from 2007 to 2012 were analyzed. The mortality risk due to a BMI <20 kg/m(2) and weight loss >5 kg was calculated by logistic regression analysis with adjustment for confounding factors. In total, 10,298 residents with a mean age of 85 years (78% female) from 191 nursing homes in 13 countries were included in the analysis. Eighteen percent (17.7%) had a low BMI < 20 kg/m(2), and 11.3% lost > 5 kg of body weight in the previous year. Low BMI <20 kg/m(2) and weight loss >5 kg were both independent and significant risk factors for 6-months mortality (OR 1.7 and 1.5; p < 0.001 in the adjusted model). In comparison to the effect size of low BMI and weight loss alone, the interaction of both factors was substantial (OR = 1.4; p = 0.056). The average 6-months mortality was 13.8%. Subjects with BMI ≥20 kg/m(2) without weight loss >5 kg presented the lowest mortality of 11.2%. In subjects with one of the two features, weight loss >5 kg or low BMI <20 kg/m(2), mortality was significantly increased to 17.4% and 19.8%, respectively. However, if both features were present simultaneously the mortality increased disproportionally to 35.7% (OR 3.5; p < 0.001). In addition, this study presents an overlap and a strong dose-effect relationship of both items with regard to the 6-month mortality. A BMI <20 kg/m(2) and weight loss >5 kg in one year are both independent and equally relevant risk factors for the 6-months mortality of nursing home residents aged 65 years or older. For this reason weight loss should be avoided and residents with a low BMI and weight loss should receive particular attention and nutritional care. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
    Clinical nutrition (Edinburgh, Scotland) 06/2015; DOI:10.1016/j.clnu.2015.06.003 · 4.48 Impact Factor
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    • "Hazard Ratios for All - Cause Mortality Relative to Normal Weight in Studies That Used Measured Data for Participants With a Body Mass Index of 30 or Greater 5 1 . 0 0 . 1 Hazard Ratio ( 95% CI ) Source Stessman et al , 35 2009 ( women ) Uretsky et al , 36 2010 Lisko et al , 33 2011 ( men ) Iribarren et al , 45 2005 Luchsinger et al , 24 2008 Cabrera et al , 65 2005 Lisko et al , 33 2011 ( women ) Janssen , 55 2007 Visscher et al , 38 2004 ( women ≥65 "
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    ABSTRACT: Estimates of the relative mortality risks associated with normal weight, overweight, and obesity may help to inform decision making in the clinical setting. To perform a systematic review of reported hazard ratios (HRs) of all-cause mortality for overweight and obesity relative to normal weight in the general population. PubMed and EMBASE electronic databases were searched through September 30, 2012, without language restrictions. Articles that reported HRs for all-cause mortality using standard body mass index (BMI) categories from prospective studies of general populations of adults were selected by consensus among multiple reviewers. Studies were excluded that used nonstandard categories or that were limited to adolescents or to those with specific medical conditions or to those undergoing specific procedures. PubMed searches yielded 7034 articles, of which 141 (2.0%) were eligible. An EMBASE search yielded 2 additional articles. After eliminating overlap, 97 studies were retained for analysis, providing a combined sample size of more than 2.88 million individuals and more than 270,000 deaths. Data were extracted by 1 reviewer and then reviewed by 3 independent reviewers. We selected the most complex model available for the full sample and used a variety of sensitivity analyses to address issues of possible overadjustment (adjusted for factors in causal pathway) or underadjustment (not adjusted for at least age, sex, and smoking). Random-effects summary all-cause mortality HRs for overweight (BMI of 25-<30), obesity (BMI of ≥30), grade 1 obesity (BMI of 30-<35), and grades 2 and 3 obesity (BMI of ≥35) were calculated relative to normal weight (BMI of 18.5-<25). The summary HRs were 0.94 (95% CI, 0.91-0.96) for overweight, 1.18 (95% CI, 1.12-1.25) for obesity (all grades combined), 0.95 (95% CI, 0.88-1.01) for grade 1 obesity, and 1.29 (95% CI, 1.18-1.41) for grades 2 and 3 obesity. These findings persisted when limited to studies with measured weight and height that were considered to be adequately adjusted. The HRs tended to be higher when weight and height were self-reported rather than measured. Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.
    JAMA The Journal of the American Medical Association 01/2013; 309(1):71-82. DOI:10.1001/jama.2012.113905 · 35.29 Impact Factor
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    • "Inadequate food intake leads to poor nutritional status and is a key determinate of morbidity and mortality for people with dementia (Luchsinger et al. 2008). However, food represents far more than its nutritional elements. "

    Journal of Clinical Nursing 10/2010; 19(19-20):2950-1. DOI:10.1111/j.1365-2702.2010.03464.x · 1.26 Impact Factor
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