Elevated body mass index and mortality risk in the elderly

Janssen, Ian; Mark, Amy E.

doi:10.1111/j.1467-789x.2006.00248.x

Cited by 288 publications

(257 citation statements)

References 74 publications

(64 reference statements)

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“…For overweight, 75% of HRs with measured weight and height and 67% of HRs with self-reported weight and height were below 1. These results are broadly consistent with 2 previous meta-analyses 114,115 that used standard categories. In a pooled analysis of 26 observational studies, McGee et al 114 112 and 26% in England.…”

Section: Commentsupporting

confidence: 82%

Association of all-cause mortality with overweight and obesity using standard body mass index categories. A systematic review and meta-analysis

2013

Br Dent J

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Importance-Estimates of the relative mortality risks associated with normal weight, overweight, and obesity may help to inform decision making in the clinical setting.Objective-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.Data Sources-PubMed and EMBASE electronic databases were searched through September 30, 2012, without language restrictions.Corresponding Author: Katherine M. Flegal, PhD, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Rd, Room 4336, Hyattsville, MD 20782 (kmf2@cdc.gov). Author Contributions: Dr Flegal had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Flegal, Kit, Graubard. Acquisition of data: Flegal, Kit, Orpana, Graubard. Analysis and interpretation of data: Flegal, Kit, Orpana, Graubard. Drafting of the manuscript: Flegal. Critical revision of the manuscript for important intellectual content: Flegal, Kit, Orpana, Graubard. Statistical analysis: Flegal, Graubard. Conflict of Interest Disclosures:The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. Disclaimer:The findings and conclusions in this report are those of the authors and not necessarily the official views of the Centers for Disease Control and Prevention or the National Cancer Institute.Online-Only Material: The Author Video Interview, eTables 1 through 9, eFigure, and eReferences are available at http:// www.jama.com. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptStudy Selection-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 Extraction-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).Results-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 ...

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Section: Commentsupporting

confidence: 82%

Association of all-cause mortality with overweight and obesity using standard body mass index categories. A systematic review and meta-analysis

2013

Br Dent J

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“…This is consistent with other studies that have shown that older adults at normal or below normal BMIs have lower survival than those who are overweight or even obese. 21 We considered 12 measures of function: dependency in at least one activity of daily living (ADL: bathing, dressing, eating, getting in or out of bed or chairs, and using the toilet); dependency in at least one instrumental activity of daily living (IADL: handling household chores, doing necessary business, shopping or getting around for other purposes); any reported difficulty with (1) walking 1/4 mile, (2) walking up ten steps, (3) standing or (4) sitting for 2 h, (5) stooping, (6) reaching above the head, (7) grasping small objects, (8) lifting/carrying 10 pounds, (9) pushing/pulling large objects, or (10) going out to do things like shopping.…”

Section: Factors Of Interestmentioning

confidence: 99%

Index to Predict 5-Year Mortality of Community-Dwelling Adults Aged 65 and Older Using Data from the National Health Interview Survey

et al. 2009

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BACKGROUND: Prognostic information is becoming increasingly important for clinical decision-making.OBJECTIVE: To develop and validate an index to predict 5-year mortality among community-dwelling older adults. DESIGN AND PARTICIPANTS:A total of 24,115 individuals aged >65 who responded to the 1997-2000 National Health Interview Survey (NHIS) with follow-up through 31 December 2002 from the National Death Index; 16,077 were randomly selected for the development cohort and 8,038 for the validation cohort.MEASUREMENTS: 39 risk factors (functional measures, illnesses, behaviors, demographics) were included in a multivariable Cox proportional hazards model to determine factors independently associated with mortality. Risk scores were calculated for participants using points derived from the final model's beta coefficients. To evaluate external validity, we compared survival by quintile of risk between the development and validation cohorts.RESULTS: Seventeen percent of participants had died by the end of the study. The final model included 11 variables: age (1 point for 70-74 up to 7 points for >85); male: 3 points; BMI <25: 2 points; perceived health (good: 1 point, fair/poor: 2 points); emphysema: 2 points; cancer: 2 points; diabetes: 2 points; dependent in instrumental activities of daily living: 2 points; difficulty walking: 3 points; smoker-former: 1 point, smoker-current: 3 points; past year hospitalizationsone: 1 point, >2: 3 points. We observed close agreement between 5-year mortality in the two cohorts; which ranged from 5% in the lowest risk quintile to 50% in the highest risk quintile in the validation cohort.CONCLUSIONS: This validated mortality index can be used to account for participant life expectancy in analyses using NHIS data.

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“…Obesity prevalence in middle-aged and older adults continues to increase worldwide and has doubled since 1980 (1,2) . However, there is controversy surrounding the effects of overweight and obesity in older people, with many studies showing that being overweight, as defined by BMI of 25-29 kg/m 2 , does not appear to be as harmful in the elderly as in middle-aged populations and may even be associated with lower, rather than higher, mortality (3)(4)(5) . In addition, a large body of evidence indicates that overweight and obesity (BMI ⩾ 25 kg/m 2 ) are associated with increased survival in patients with CVD and in particular those with heart failure, an unexpected finding termed the obesity paradox (6)(7)(8)(9)(10) .…”

mentioning

confidence: 99%

Muscle loss and obesity: the health implications of sarcopenia and sarcopenic obesity

2015

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Conference on 'Nutrition and age-related muscle loss, sarcopenia and cachexia' Symposium 4: Sarcopenia and cachexia and social, clinical and public health dimensionsMuscle loss and obesity: the health implications of sarcopenia and sarcopenic obesity S. Goya Wannamethee* and Janice L. AtkinsDepartment of Primary Care and Population Health, University College London, Royal Free Campus, London NW3 2PF, UK This paper reviews the health implications of obesity, sarcopenia and sarcopenic obesity on CVD and mortality in older adults and discusses the obesity paradox seen in patients with CVD. Obesity is a major public health problem with increasing prevalence worldwide. It is an established risk factor for cardiovascular morbidity and mortality in adult populations. However, there is controversy surrounding the effects of obesity as measured by BMI in older people, and overweight and obesity (BMI ⩾ 25 kg/m 2 ) are apparently associated with increased survival in those with CVD (obesity paradox). Ageing is associated with an increase in visceral fat and a progressive loss of muscle mass which have opposing effects on mortality. Thus BMI is not a good indicator of obesity in older adults. Sarcopenia, the age-associated loss of skeletal muscle mass, is a major concern in ageing populations and has been associated with metabolic impairment, CVD risk factors, physical disability and mortality. Sarcopenia often coexists with obesity. Sarcopenic obesity is a new category of obesity in older adults who have high adiposity coupled with low muscle mass. To fully understand the effect of obesity on mortality in the elderly it is important to take muscle mass into account. The evidence suggests that sarcopenia with obesity may be associated with higher levels of metabolic disorders and an increased risk of mortality than obesity or sarcopenia alone. Efforts to promote healthy ageing should focus on both preventing obesity and maintaining or increasing muscle mass.Obesity: Muscle: Sarcopenia: CVD: Mortality: Older adults Obesity, i.e. excess body fat usually defined as BMI ⩾ 30 kg/m 2 , is a major public health problem and is well recognised as a risk factor for cardiovascular morbidity and mortality in adult populations. Obesity prevalence in middle-aged and older adults continues to increase worldwide and has doubled since 1980 (1,2) . However, there is controversy surrounding the effects of overweight and obesity in older people, with many studies showing that being overweight, as defined by BMI of 25-29 kg/m 2 , does not appear to be as harmful in the elderly as in middle-aged populations and may even be associated with lower, rather than higher, mortality (3)(4)(5) . In addition, a large body of evidence indicates that overweight and obesity (BMI ⩾ 25 kg/m 2 ) are associated with increased survival in patients with CVD and in particular those with heart failure, an unexpected finding termed the obesity paradox (6)(7)(8)(9)(10) . The mechanisms of these paradoxical association remain largely unexplained but a number of explana...

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Elevated body mass index and mortality risk in the elderly

Cited by 288 publications

References 74 publications

Association of all-cause mortality with overweight and obesity using standard body mass index categories. A systematic review and meta-analysis

Association of all-cause mortality with overweight and obesity using standard body mass index categories. A systematic review and meta-analysis

Index to Predict 5-Year Mortality of Community-Dwelling Adults Aged 65 and Older Using Data from the National Health Interview Survey

Muscle loss and obesity: the health implications of sarcopenia and sarcopenic obesity

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