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: 2.66). 03/2008; 12(2):127-31. DOI: 10.1007/BF02982565
Source: PubMed

ABSTRACT 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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    ABSTRACT: This review comprehensively examines the current knowledge on the relationship between body mass index (BMI) and dementia. The association between BMI and cognition is complex: in younger adults, higher BMIs are associated with impaired cognition. Overweight and obesity in middle age are linked to increased future dementia risk in old age. However, when examined in old age, higher BMIs are associated with better cognition and decreased mortality. Little is known about the optimal BMI for well-being and survival in populations already suffering from dementia. Lifetime trends in weight, rather than single measures, might predict prognosis better and help untangle these apparent contradictions. Thus, the need arises to properly monitor BMI trends in affected dementia patients. Registries can include BMI, improving the management of dementia patients throughout the whole course of the disease. The role of central obesity and systemic inflammation on brain pathology and cognitive decline are discussed in this review. Understanding the life-course changes in BMI and their influence on dementia risk, cognitive prognosis and mortality after diagnosis may provide new insights into the underlying pathophysiology of dementia and shape possible intervention and treatment strategies.European Journal of Clinical Nutrition advance online publication, 1 October 2014; doi:10.1038/ejcn.2014.199.
    European Journal of Clinical Nutrition 10/2014; 68(11). DOI:10.1038/ejcn.2014.199 · 2.95 Impact Factor
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