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Increased mortality in the slim elderly: a 42 years follow-up study in a general population

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Abstract

The Bergen Clinical Blood Pressure Study in Norway was used to examine the relationship between body mass index (BMI (kg/m2)) and total mortality in different age segments. Of 6,811 invited subjects, 5,653 (84%) participated in the study (1965–1971) and 4,520 (66%) died during 182,798 person-years of follow-up (1965–2007). Mean age at baseline was 47.5 years; range 22–75 years. BMI (kg/m2) was calculated from standardized measurements of body height and weight and divided into four groups (<22.0, 22.0–24.9, 25.0–27.9, ≥28.0). The 20 years cumulative risk of death related to baseline BMI was U-shaped in the elderly (aged 65–75 years), whereas the pattern was more linear in the youngest age group (20–44 years). In contrast to the younger age groups, the highest mortality in the elderly was in the lower BMI range (<22.0 kg/m2) (adjusted Cox proportional Hazard Ratio 1.39, 95% Confidence Interval 1.10, 1.75) compared to the BMI reference group (22.0–24.9 kg/m2). This pattern persisted after 72 months of early follow-up exclusion and it was robust to adjustments for a wide range of possible confounders including gender, history of cardiovascular disease, respiratory disease or hypertension, smoking habits, physical activity, socioeconomic status, physical appearance and other anthropometric measures. The study shows that a low BMI is an appreciable independent risk factor of total mortality in the elderly, and not a result of subclinical disease or confounding factors such as current or previous smoking. Awareness of this issue ought to be emphasized in advice, care and treatment of elderly subjects.

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Abbreviations

BMI:

Body mass index

BP:

Blood pressure

CI:

Confidence interval

HR:

(Cox proportional) Hazard ratio

OR:

Odds ratio

SD:

Standard deviation

SPSS:

Statistical package of social science

WHO:

World health organization

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Acknowledgments

Thanks to professor Amund Gulsvik for access to the data file and helpful comments and support, to Dr Michael Abdelnoor for suggestions on choice of statistical presentation of results and to professor Petter Laake for comments on statistical method. Finally we would like to thank Dr Olav Sulheim most sincerely for his extensive work on collecting and recording all the clinical variables at baseline examinations.

Funding

The University of Oslo supported the research reported in this paper. Financial support for the Clinical Survey in Bergen in 1964–1971, data management and quality controls of the files were given by the Norwegian Council for Cardiovascular Disease, the World Health Organization and the Research Foundation for Thoracic Medicine, University of Bergen, Norway.

Contributors

All authors were responsible for study design, interpretation of the results and discussion of the article. Dr Gulsvik was responsible for the data integrity, accuracy of the analyses and drafting of the article.

Conflict of interest statement

Each coauthor asserts no proprietary interest in the results and no financial conflict of interest.

Author information

Authors and Affiliations

  1. Department of Geriatric Medicine, Ullevaal University Hospital, University of Oslo, 0407, Oslo, Norway

    Anne K. Gulsvik & Torgeir B. Wyller

  2. Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway

    Dag S. Thelle

  3. Department of Geriatric Medicine, Aker University Hospital, University of Oslo, Oslo, Norway

    Morten Mowé

Authors
  1. Anne K. Gulsvik
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  2. Dag S. Thelle
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  3. Morten Mowé
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  4. Torgeir B. Wyller
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Corresponding author

Correspondence to Anne K. Gulsvik.

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Gulsvik, A.K., Thelle, D.S., Mowé, M. et al. Increased mortality in the slim elderly: a 42 years follow-up study in a general population. Eur J Epidemiol 24, 683–690 (2009). https://doi.org/10.1007/s10654-009-9390-3

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  • DOI: https://doi.org/10.1007/s10654-009-9390-3

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