Hypothesis Concerning the U-shaped Relation between Body Mass Index and Mortality

Allison, David B.; Faith, Myles S.; Heo, Moonseong; Kotler, Donald P.

doi:10.1093/oxfordjournals.aje.a009275

Cited by 198 publications

(148 citation statements)

References 30 publications

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“…The association between low BMI and mortality in the elderly does not seem to be explained by traditional confounders, such as cancer, and smoking 5,6,[27][28][29] . This may indicate that known pre-morbid conditions (e.g.…”

Section: Discussionmentioning

confidence: 87%

“…Thus we could properly adjust for dementia as a confounder only for those with prevalent dementia. All anthropometric measures have limitations in the measurement of adiposity in the elderly and direct measurement of body composition may be needed to capture this construct 5 .…”

Section: Discussionmentioning

confidence: 99%

“…BMI was categorized as quartiles for the main analyses. Since the association between BMI and adverse outcomes has been reported to be U or J shaped 5 we used the second quartile as the reference for all analyses. We conducted secondary analyses categorizing BMI into four categories according to the National Heart Lung and Blood Institute (NHLBI) guidelines: underweight (< 18.5 kg/m 2 ), normal (18.5 − 24.9 kg/m 2 ), overweight (25.0 − 29.9 kg/m 2 ), and obese (≥ 30.0 kg/m 2 ) 12 .…”

Section: Body Mass Index and Waist Circumferencementioning

confidence: 99%

“…The relation of anthropometric measures to mortality in the elderly may be confounded by premorbid conditions such as cancer 2 , heart disease 3 and habits such as smoking 4 that cause weight loss, but these conditions do not seem to account for the association between low BMI and mortality 5,6 , implying that low BMI directly causes mortality through unknown mechanisms, or that there is confounding by other conditions. Dementia has been identified as a condition associated with weight loss 7,8 , low BMI 9 , and increased mortality 10 , but most studies relating BMI and mortality do not control for the presence of dementia.…”

Section: Introductionmentioning

confidence: 99%

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Body mass index, dementia, and mortality in the elderly

Luchsinger

Patel²,

Tang

et al. 2008

The Journal of nutrition, health and aging

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Objectives-To explore the association between body mass index and mortality in the elderly taking the diagnosis of dementia into account. Design-Cohort study.Setting-cohort study of aging in Medicare recipients in New York City.Participants-1,452 elderly individuals 65 years and older of both genders.Measurements-We used proportional hazards regression for longitudinal multivariate analyses relating body mass index (BMI) and weight change to all-cause mortality.Results-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 =1.3,2.6) 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. Conclusion-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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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Body Mass Index and Waist Circumferencementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Body mass index, dementia, and mortality in the elderly

Luchsinger

Patel²,

Tang

et al. 2008

The Journal of nutrition, health and aging

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“…Allison et al (1997) speculated that the U-shaped relation between BMI and mortality resulted from an inverse linear association between lean body mass and mortality and a positive association between body fat mass and mortality. The BMI does not allow separation of these two phenomena (Allison et al, 1997). 2.…”

Section: Mortalitymentioning

confidence: 99%

Body weight and weight change and their health implications for the elderly

Seidell¹,

2000

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After the age of 60 y, body weight on average tends to decrease. The contribution of fat mass to this weight loss is relatively small, but fat tends to be redistributed with advancing age toward more abdominal (particularly visceral) fat. Anthropometric data are relatively poor indicators of these aging processes. This may be one of the explanations why the relationship between high body mass index and mortality is less pronounced in older than in younger people. Reduced lipolysis in the visceral fat depot with aging is among potential explanations why increased visceral fat seems to be less harmful in elderly subjects compared to young adults. Even though the relative contribution of increased fat mass to mortality may be less pronounced in elderly people, the impact on disability and functional limitations is found to be important from both a clinical and a public health point of view. At the other end of the scale studies have shown that low body mass index and weight loss in the elderly are both strong predictors of subsequent mortality. This cannot be explained by effects of smoking and early mortality after baseline. There are only few systematic studies comparing the predictive validity of different anthropometric data for mortality. One recent prospective study showed that a high waist circumference (in nonsmoking men) may be a better predictor of all-cause mortality than high body mass index and waistahip ratio. Low BMI was a better predictor of mortality than low waist circumference. In conclusion changes in body composition and fat distribution with aging are poorly captured by standard anthropometric data. Low lean body mass is probably better re¯ected by low BMI, whereas increased (abdominal) fatness is better re¯ected by increased waist circumference.

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Overweight, Obesity, and Health Risk

Billington¹,

Epstein²,

Goodwin³

et al. 2000

Arch Intern Med

862

105

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More than half of adult Americans are overweight or obese, and public health recommendations call for weight loss in those who are overweight with associated medical conditions or who are obese. However, some controversy exists in the lay press and in the medical literature about the health risks of obesity. We review briefly the large body of evidence indicating that higher levels of body weight and body fat are associated with an increased risk for the development of numerous adverse health consequences. Efforts to prevent further weight gain in adults at risk for overweight and obesity are essential. For those whose present or future health is at risk because of their obesity and who are motivated to make lifestyle changes, a recommendation for weight loss is appropriate.

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Hypothesis Concerning the U-shaped Relation between Body Mass Index and Mortality

Cited by 198 publications

References 30 publications

Body mass index, dementia, and mortality in the elderly

Body mass index, dementia, and mortality in the elderly

Body weight and weight change and their health implications for the elderly

Overweight, Obesity, and Health Risk

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