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Geriatr Gerontol Int. 2014 Apr;14(2):328-35. doi: 10.1111/ggi.12102. Epub 2013 Jun 10.

Underweight/overweight and the risk of long-term care: follow-up study using data of the Japanese long-term care insurance system.

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  • 1Division of Health Promotion, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; Niigata Prefectural Government, Niigata, Japan.



Both being underweight and overweight can lead to reduced activity of daily living, which subsequently can require long-term care. The aim of the present study was to clarify the association between underweight/overweight and the subsequent risk of long-term care introduction.


We tracked the data of long-term care insurance for 1580 men and women aged ≥65 years who had participated in the official population-based health check-up program in 2001 in Tsunan town and Sekikawa village, Japan. The health check-up data and medical expenditure data for the fiscal year 2001 were used as baseline data. Participants were classified into underweight (body mass index (BMI) <18.5 kg/m(2) ), normal range (BMI = 18.5 to <25.0 kg/m(2) ) and overweight (BMI ≥25.0 kg/m(2) ); the normal range was used as a reference category in Cox proportional hazards models.


During the average 5.8 years of follow up, 156 participants were identified to start using long-term care services. Among the young-old elderly (65-74 years-of-age), underweight was significantly associated with the risk of long-term care introduction (multivariable-adjusted HR 4.26, 95% CI 1.69-10.72), whereas overweight was not (multivariable-adjusted HR 1.45, 95% CI 0.69-3.06). Neither underweight nor overweight were significantly associated with long-term care introduction among the old-old elderly (≥75 years-of-age).


Underweight could be a good predictor of long-term care introduction in the young-old elderly. We should pay attention to underweight in the elderly, as it might be a manifestation of some physical or mental problems related to future long-term care introduction.

© 2013 Japan Geriatrics Society.


cohort studies; long-term care; overweight; risk factors; thinness

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