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Body mass index, dementia, and mortality in the elderly

  • Published:
The Journal of Nutrition Health and Aging

Abstract

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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References

  1. Guehne U, Riedel-Heller S, Angermeyer MC. Mortality in Dementia. Neuroepidemiology 2005;25: 153–162.

    Article  PubMed  Google Scholar 

  2. Tisdale MJ. Cachexia in cancer patients. NatRevCancer2002;2: 862–871.

    CAS  Google Scholar 

  3. Ansari A. Syndromes of cardiac cachexia and the cachectic heart: current perspective. Prog Cardiovasc Dis 1987;30: 45–60.

    Article  PubMed  CAS  Google Scholar 

  4. Wannamethee SG, Shaper AG, Walker M. Weight change, weight fluctuation, and mortality. Arch Intern Med 2002;162: 2575–2580.

    Article  PubMed  Google Scholar 

  5. Allison DB, Faith MS, Heo M, Kotler DP. Hypothesis concerning the U-shaped relation between body mass index and mortality. 339–349,1997 Aug 1915.

  6. Allison DB, Faith MS, Heo M, Townsend-Butterworth D, Williamson DF. Meta-analysis of the effect of excluding early deaths on the estimated relationship between body mass index and mortality.[see comment].342–354,1999 Jul.

  7. Wang SY. Weight loss and metabolic changes in dementia. 201–205,2002 May.

  8. Wang SY, Fukagawa N, Hossain M, Ooi WL. Longitudinal weight changes, length of survival, and energy requirements of long-term care residents with dementia 1189–1195, 1997 Oct.

  9. Nourhashemi F, Deschamps V, Larrieu S, Letenneur L, Dartigues J-F, Barberger-Gateau P. Body mass index and incidence of dementia: The PAQUID study. Neurology 2003;60: 117–119.

    Article  PubMed  CAS  Google Scholar 

  10. Foley DJ, Brock DB, Lanska DJ. Trends in dementia mortality from two National Mortality Followback Surveys. Neurology 2003;60: 709–711.

    PubMed  Google Scholar 

  11. Tang MX, Cross P, Andrews H, et al. Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan. Neurology 2001;56: 49–56.

    PubMed  CAS  Google Scholar 

  12. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Am J Clin Nutr 1998;68: 899–917.

    Google Scholar 

  13. Heiat A, Vaccarino V, Krumholz HM. An Evidence-Based Assessment of Federal Guidelines for Overweight and Obesity as They Apply to Elderly Persons. Arch Intern Med 2001;161: 1194–1203.

    Article  PubMed  CAS  Google Scholar 

  14. Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr 2004;79: 379–384.

    PubMed  CAS  Google Scholar 

  15. Lopes-Virella MF, Stone P, Ellis S, Colwell JA. Cholesterol determination in high-density lipoproteins separated by three different methods. Clin Chem 1977;23: 882–884.

    PubMed  CAS  Google Scholar 

  16. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18: 499–502.

    PubMed  CAS  Google Scholar 

  17. Diagnostic and Statistical manual of mental disorders. 4th edition. Washington, DC.: American Psychiatric Association; 1994.

  18. Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140: 566–572.

    Article  PubMed  CAS  Google Scholar 

  19. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984;34: 939–944.

    PubMed  CAS  Google Scholar 

  20. The ICD-10 Classification of mental and behabioral disorders: diagnostic criteria for reserach. Geneva, Switzerland: World Health Organization; 1993.

  21. Fleiss JL. Statistical methods for rates and proportions. Second ed: Joseph Wiley and Sons; 1981.

  22. Cox DR, Oakes D. Analysis of survival data. London: Chapman & Hall; 1984.

    Google Scholar 

  23. Mueller WH, Wear ML, Hanis CL, et al. Which measure of body fat distribution is best for epidemiologic research? Am J Epidemiol 1991; 133: 858–869.

    PubMed  CAS  Google Scholar 

  24. Bender R, Jockei KH, Trautner C, Spraul M, Berger M. Effect of age on excess mortality in obesity. JAMA 1999;281: 1498–1504.

    Article  PubMed  CAS  Google Scholar 

  25. Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL. The effect of age on the association between body-mass index and mortality. New Engl J Med 1998;338: 1–7.

    Article  PubMed  CAS  Google Scholar 

  26. Baik I, Ascherio A, Rimm EB, et al. Adiposity and mortality in men. Am J Epidemiol 2000;152: 264–271.

    Article  PubMed  CAS  Google Scholar 

  27. 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. Journal of the International Association for the Study of Obesity. 21(26): 424–431, 1997 Jun.

    Article  CAS  Google Scholar 

  28. Allison DB, Zhu SK, Plankey M, Faith MS, Heo M. Differential associations of body mass index and adiposity with all-cause mortality among men in the first and second National Health and Nutrition Examination Surveys (NHANES I and NHANES II) follow-up studies. Journal of the International Association for the Study of Obesity. 26(23): 410–416, 2002 Mar.

    Article  CAS  Google Scholar 

  29. Fontaine KR, Heo M, Cheskin LJ, Allison DB. Body mass index, smoking, and mortality among older American women. J Womens Health 1998;7: 1257–1261.

    Article  PubMed  CAS  Google Scholar 

  30. Stewart R, Masaki K, Xue Q-L, et al. A 32-Year Prospective Study of Change in Body Weight and Incident Dementia: The Honolulu-Asia Aging Study. Arch Neurol 2005;62: 55–60.

    Article  PubMed  Google Scholar 

  31. Commenges D, Joly P, Letenneur L, Dartigues JF. Incidence and mortality of Alzheimer’s disease or dementia using an illness-death model. Stat Med 2004;23: 199–210.

    Article  PubMed  CAS  Google Scholar 

  32. Noale M, Maggi S, Minicuci N, et al. Dementia and disability: impact on mortality. The Italian Longitudinal Study on Aging. Dement Geriatr Cogn Disord 2003;16: 7–14.

    Article  PubMed  CAS  Google Scholar 

  33. Helmer C, Joly P, Letenneur L, Commenges D, Dartigues JF. Mortality with dementia: results from a French prospective community-based cohort. Am J Epidemiol 2001;154: 642–648.

    Article  PubMed  CAS  Google Scholar 

  34. Ostbye T, Hill G, Steenhuis R. Mortality in elderly Canadians with and without dementia: a 5-year follow-up. Neurology 1999;53: 521–526.

    PubMed  CAS  Google Scholar 

  35. Aguero-Torres H, Fratiglioni L, Guo Z, Viitanen M, Winblad B. Mortality from dementia in advanced age: a 5-year follow-up study of incident dementia cases. J Clin Epidemiol 1999;52: 737–743.

    Article  PubMed  CAS  Google Scholar 

  36. Persson MD, Brismar KE, Katzarski KS, Nordenstrom J, Cederholm TE. Nutritional status using mini nutritional assessment and subjective global assessment predict mortality in geriatric patients. J Am Geriatr Soc 2002;50: 1996–2002.

    Article  PubMed  Google Scholar 

  37. Volpato S, Romagnoni F, Soattin L, et al. Body mass index, body cell mass, and 4-year all-cause mortality risk in older nursing home residents. J Am Geriatr Soc 2004;52: 886–891.

    Article  PubMed  Google Scholar 

  38. Liu L, Bopp MM, Roberson PK, Sullivan DH. Undernutrition and risk of mortality in elderly patients within 1 year of hospital discharge. J Gerontol A Biol Sci Med Sci 2002;57: M741–746.

    PubMed  Google Scholar 

  39. Wallace JI, Schwartz RS, LaCroix AZ, Uhlmann RF, Pearlman RA. Involuntary weight loss in older outpatients: incidence and clinical significance. J Am Geriatr Soc 1995;43: 329–337,1995 Apr.

    PubMed  CAS  Google Scholar 

  40. Singh PN, Lindsted KD, Fraser GE. Body weight and mortality among adults who never smoked. Am J Epidemiol 1999;150: 1152–1164.

    PubMed  CAS  Google Scholar 

  41. 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.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to J. A. Luchsinger.

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Luchsinger, J.A., Patel, B., Tang, M.X. et al. Body mass index, dementia, and mortality in the elderly. J Nutr Health Aging 12, 127–131 (2008). https://doi.org/10.1007/BF02982565

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  • DOI: https://doi.org/10.1007/BF02982565

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