The journal of nutrition, health & aging

, Volume 16, Issue 1, pp 89–98 | Cite as

A systematic review of the literature concerning the relationship between obesity and mortality in the elderly

  • Lorenzo M. Donini
  • C. Savina
  • E. Gennaro
  • M. R. De Felice
  • A. Rosano
  • M. M. Pandolfo
  • V. Del Balzo
  • C. Cannella
  • P. Ritz
  • Wm. C. Chumlea
JNHA: Geriatric Science



Obesity is a risk factor for chronic diseases and premature mortality, but the extent of these associations among the elderly is under debate. The aim of this systematic literature review (SR) is to collate and critically assess the available information of the impact of obesity on mortality in the elderly.


In PubMed, there are three-hundred twelve papers on the relationship between obesity and mortality among older adults. These papers were analysed on the basis of their abstracts, and sixteen studies were considered suitable for the purpose of the study. It was possible to perform a pooled estimate for aggregated data in three different studies.


The results of this SR document that an increased mortality in obese older adults. The limitation of BMI to index obesity and the noted protective action of a moderate increase in BMI on mortality are highlighted. Waist circumference is an indicator of central adiposity and potentially as good a risk factor for mortality as BMI in obese elderly adults.

Key words

Obesity elderly BMI mortality sarcopenic obesity 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Flegal KM, Carroll MD, Odgen CL, Johson CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002;288: 1723–1727PubMedCrossRefGoogle Scholar
  2. 2.
    Arterburn DE, Crane PK, Sullivan SD. The coming epidemic of obesity in elderly Americans. J Am Geriatr Soc 2004; 52: 1907–1912PubMedCrossRefGoogle Scholar
  3. 3.
    Villareal DT, Banks M, Siener C, Sinacore DR, Klein S: Physical frailty and body composition in obese elderly men and women. Obes Res 2004;12(6):913–920.PubMedCrossRefGoogle Scholar
  4. 4.
    Chumlea WMC, Sun SS: The availability of body composition reference data for the elderly. JNHA 2004;8(2):76–78Google Scholar
  5. 5.
    Villareal DT, Apovian CM: Obesity in the older adults: technical review and position statement of the American society for nutrition and NAASO. Obes Res 2005; 13: 1849–1863PubMedCrossRefGoogle Scholar
  6. 6.
    Moller N, O’Brien P, Nair KS: Disruption of the relationship between fat content and leptin levels with aging in humans. J Clin Endocrinol Metab 1998; 83: 931–934PubMedCrossRefGoogle Scholar
  7. 7.
    Corrada MM, Hawas CH, Mozaffar F, Paganini-Hill A: Association of body fat index and weight change with all-cause mortality in the elderly. Am J Epidemiol 2006; 163: 938–949PubMedCrossRefGoogle Scholar
  8. 8.
    Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Boneux L Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med 2003; 138, 24–32PubMedGoogle Scholar
  9. 9.
    Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB: Years of life lost due to obesity. JAMA 2003; 289, 187–193PubMedCrossRefGoogle Scholar
  10. 10.
    Kennedy Rl, Chokkalingham K, Srinivasesn R: Obesity in the elderly: who should we be treating, and why, and how? Curr Opin Clin Nutr Metab Care 2004; 7(1): 3–9PubMedCrossRefGoogle Scholar
  11. 11.
    Systematic Reviews in Health Care: Meta-analysis in context. Ed. By: M Egger, GD Smith, DG Altman. Second edition, London 2001. BMJ. Pag.: 3–68Google Scholar
  12. 12.
    Friedenreich CM. Methods for pooled analyses of epidemiologic studies Epidemiology. 1993;4(4):295–302Google Scholar
  13. 13.
    Dey DK, Rothenberg E: Body mass index, weight change and mortality in the elderly. A 15y longitudinal population study of 70y olds. Eur J Clin Nutr. 2001; 55: 482–492PubMedCrossRefGoogle Scholar
  14. 14.
    Stevens J, Cai J: The effect of age on the association between body-mass index and mortality. N Engl J Med 1998; 338: 1–7PubMedCrossRefGoogle Scholar
  15. 15.
    Diehr P, Bild E: Body mass index and mortality in non-smoking older adults: the cardiovascular health study. Am J Public Health 1998; 88: 623–629PubMedCrossRefGoogle Scholar
  16. 16.
    Calle E, Thun J: Body mass index and mortality in a prospective cohort of US adults. N Engl J Med 1999; 341: 1097–1105PubMedCrossRefGoogle Scholar
  17. 17.
    Adams KF, Ph. D., Schatzkin A., Harris TB: Overweight, obesity and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 2006; 355: 763–778PubMedCrossRefGoogle Scholar
  18. 18.
    Wassertheil-Smoller S et al: Relation of low body mass to death and stroke in the systolic hypertension in the elderly program. Arch Intern Med. 2000; 160: 494–500PubMedCrossRefGoogle Scholar
  19. 19.
    Hillier TA, Rizzo JH.: Increased mortality associated with the metabolic syndrome in older women with diabetes. Diabetes Care 2005; 28(9):2258–2260PubMedCrossRefGoogle Scholar
  20. 20.
    Dorn JM, Schisterman EF: Body mass index and mortality in a general population sample of men and women. The Buffalo Health Study. Am J Epidemiol 1997; 146(11): 919–931PubMedGoogle Scholar
  21. 21.
    Ajani UA, Lotufo PA: Body mass index and mortality among US male physicians. Am Epidemiol 2004; 14(10): 731–739CrossRefGoogle Scholar
  22. 22.
    Taylor DH: The effect of middle- and old-age body mass index on short-term mortality in older people. JAGS 2001; 49: 1319–1326CrossRefGoogle Scholar
  23. 23.
    Wallhagen MI: New NHLBI clinical guidelines for obesity and overweight will they promote health. Am J Public Health 2000; 90: 340–343PubMedCrossRefGoogle Scholar
  24. 24.
    Grabowski DC, Ellis JE: High body mass index does not predict mortality in older people: analysis of the longitudinal study of aging. JAGS 2001; 49: 968–979CrossRefGoogle Scholar
  25. 25.
    Janssen I. Morbidity and mortality risk associated with an overweight BMI in older men and women. Obesity 2007; 15(7): 1827–1840PubMedCrossRefGoogle Scholar
  26. 26.
    Janssen I, Katzmarzyk PT.: Body mass index is inversely related to mortality in older people after adjustment for waist circumference. JAGS 2005; 53(12):2112–2118CrossRefGoogle Scholar
  27. 27.
    Harris TB, Visser M, Everhart J, Cauley J, Tylavsky F, Fuerst T, Zamboni M: Waist circumference and sagittal diameter reflect total body fat better than visceral fat in older men and women. The health, aging and body composition study. Ann NY Acad Sci 2000; 904: 462–473PubMedCrossRefGoogle Scholar
  28. 28.
    Visscher TLS, Seidell JC, Molarius: A comparison of body mass index, waist-hip ratio and waist circumference as predictors of all-cause mortality among the elderly: the Rotterdam study. Int J of Ob 2001; 25: 1730–1735CrossRefGoogle Scholar
  29. 29.
    Michelle D. Miller, MNut Diet: Corrected arm muscle area: an independent predictor of long-term mortality in community-dwelling older adults? JAGS 2002; 50: 1272–1277CrossRefGoogle Scholar
  30. 30.
    Volpato S, Romagnoni F: Body mass index, body cell mass, and 4-year all-cause mortality risk in older nursing home residents. JAGS 2004; 52: 886–891CrossRefGoogle Scholar
  31. 31.
    WHO: Preventing anda managing the global epidemic of obesity: report of the World Health Organisation Consultation of Obessity. WHO: Geneva, June 1997Google Scholar
  32. 32.
    Deurenberg P, Van Der Kooy K, Hulshof T, Evers P: Body mass index as a measure of body fatness in the elderly. Eur J Clin Nutr 1989; 43: 231–236PubMedGoogle Scholar
  33. 33.
    Gallagher D, Visser M, Sepúlveda D, Pierson RN, Harris T, Heymsfield SB: How useful is body mass index for comparison of body fatness across age, sex and ethnic groups ? Am J Epidemiol. 1996 Feb 1;143(3):228–239PubMedGoogle Scholar
  34. 34.
    Baumgartner RN, Stauber PM, McHugh D, Koehler KM, Garry PJ: Cross-sectional age differences in body composition in persons 60+ years of age. J Gerontol 1995; 70: 1025–1103Google Scholar
  35. 35.
    Smalley KJ, Knerr AN, Kendrick ZV, Colliver JA, Owen OE.: Reassessment of body mass indices. Am J Clin Nutr. 1990 Sep;52(3):405–408PubMedGoogle Scholar
  36. 36.
    Prentice AM, Jebb SA: Beyond body mass index. Obes Rev 2001; 2: 141–147PubMedCrossRefGoogle Scholar
  37. 37.
    de Groot CP, Enzi G, Matthys O, Roszkiwski W, Scholl M: Ten-years changes in anthropometric characteristics of elderly Europeans. J Nutr Health Aging 2002; 6: 4–8PubMedGoogle Scholar
  38. 38.
    Sorkin JD, Muller DC, Andres R: Longitudinal Change in height of men and women: implications for interpretation of the body mass index. The Baltimore Longitdinal Study of Aging. Am J Epidemiol 1999; 150: 969–977PubMedGoogle Scholar
  39. 39.
    Wong S, Janssen I, Ross R.: Abdominal adipose tissue distribution and metabolic risk. Sports Med. 2003;33(10):709–726PubMedCrossRefGoogle Scholar
  40. 40.
    Ferreira I, Snijder MB, Twisk JW, van Mechelen W, Kemper HC, Seidell JC, Stehouwer CD.: Central fat mass versus peripheral fat and lean mass: opposite (averse versus favorable) associations with arterial stiffness? The Amsterdam Growth and Health Longitudinal Study. J Clin Endocrinol Metab. 2004 Jun;89(6):2632–2639PubMedCrossRefGoogle Scholar
  41. 41.
    National Institutes of Health (NIH); National Heart, Lung, and Blood Pressure (NHLB); North American Association for the Study of Obesity (NAASO.) The practical guide: identification, evaluation, and treatment of overweight and obesity in adults, NIH Publication No 00-4084 National Institutes of Health: Rockeville, MD; 2000Google Scholar
  42. 42.
    Zamboni M, Mazzali G: Health consequences of obesity in the elderly: a review of four unresolved question. Int J Obes 2005; 29(9): 1011–1029CrossRefGoogle Scholar
  43. 43.
    Heiat A, Vaccarino V: An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons. Arch Intern Med. 2001; 161: 1194–1203PubMedCrossRefGoogle Scholar
  44. 44.
    Harris T, Cook EF, Garrison R, Higgins M, Kannel W, Goldman L: Body mass index and mortality among older persons. The Framingham Heart Study. JAMA 1988; 259: 1520–1524PubMedCrossRefGoogle Scholar
  45. 45.
    Cornoni-Huntley JC, Harris TB, Everett DF: An overview of body weight of older persons, including the impact on mortality. The National Health and Nutrition Examination Survey I-Epidemiologic Follow-up Study. J Clin EpidemioI 1991; 44: 743–753CrossRefGoogle Scholar
  46. 46.
    Allison DB, Gallagher D, Heo M, Pi-Sunyer FX. Heymsfield SB. Body mass index and all-cause mortality among people age 70 and over: the Longitudinal Study of Aging. Int J Obes Relat Metab Disord 1997; 21: 424–431PubMedCrossRefGoogle Scholar
  47. 47.
    Andres R, Elahi D, Tobin JD, Muller DC, Brant L. Impact of age on weight goals. Ann Intem Med 1985; 103: 1030–1033Google Scholar
  48. 48.
    Rossner S.: Obesity in the elderly — A future matter of concern? Obes Rev 2001; 2: 183–188PubMedCrossRefGoogle Scholar
  49. 49.
    Inelmen EM, Sergi G, Coin A, Miotto F, Peruzza S, Enzi G: Can obesity be a risk factor in elderly people? Obes Rev 2003; 4: 147–155.PubMedCrossRefGoogle Scholar
  50. 50.
    Janssen I, Mark AE. Elevated body mass index and mortality risk in the elderly. Obes Rev. 2007; 8(1): 41–59PubMedCrossRefGoogle Scholar
  51. 51.
    Galanos AN, Pieper CF: Nutrition and function: is there a relation between body mass index and functional capabilities of community-dwelling elderly? JAGS 1994; 42: 368–373Google Scholar

Copyright information

© Serdi and Springer Verlag France 2012

Authors and Affiliations

  • Lorenzo M. Donini
    • 1
    • 6
  • C. Savina
    • 2
  • E. Gennaro
    • 1
  • M. R. De Felice
    • 2
  • A. Rosano
    • 3
  • M. M. Pandolfo
    • 1
  • V. Del Balzo
    • 1
  • C. Cannella
    • 1
  • P. Ritz
    • 4
  • Wm. C. Chumlea
    • 5
  1. 1.Department of Experimental MedicineSapienza University of RomeRomeItaly
  2. 2.Rehabilitation Clinical InstituteVilla delle QuerceNemi RomeItaly
  3. 3.Agenzia di Sanità PubblicaRegione LazioItaly
  4. 4.Laboratoire de Biochimie et Biologie MoléculaireUniversité of Angers, INSERMAngersFrance
  5. 5.Lifespan Health Research Center, Department of Community Health, Boonshoft School of MedicineWright State UniversityDaytonUSA
  6. 6.Department of Medical Physiopathology (Food Science Unit)“Sapienza” University of RomeRomeItaly

Personalised recommendations