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PLoS One. 2014 Jul 11;9(7):e102589. doi: 10.1371/journal.pone.0102589. eCollection 2014.

Association of body mass index with all-cause and cardiovascular disease mortality in the elderly.

Author information

1
Institute of Public Health, National Yang Ming University, Taipei, Taiwan; Department of Dermatology, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan.
2
Institute of Public Health, National Yang Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
3
Department of Education and Research, Taipei City Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
4
Institute of Public Health, National Yang Ming University, Taipei, Taiwan.
5
Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan.

Abstract

OBJECTIVES:

To evaluate the associations of body mass index (BMI) with all-cause, cardiovascular disease (CVD), and expanded CVD mortality in the elderly.

DESIGN:

Observational cohort study.

SETTING:

Annual physical examination program for the elderly from 2006 to 2010.

PARTICIPANTS:

We included 77,541 Taipei residents aged ≥ 65 years (39,365 men and 38,176 women).

MEASUREMENTS:

BMI was categorized as underweight (BMI<18.5), normal weight (18.5 ≤ BMI<25), overweight (25 ≤ BMI<30), grade 1 obesity (30 ≤ BMI<35), or grade 2-3 obesity (BMI ≥ 35). Mortality was ascertained by national death files.

RESULTS:

Underweight (hazard ratios [HRs] of all-cause, CVD, and expanded CVD mortality: 1.92, 1.74, and 1.77, respectively), grade 2-3 obesity (HRs: 1.59, 2.36, and 2.22, respectively), older age, male sex, smoking, and high fasting blood sugar were significant predictors of mortality. Meanwhile, being married/cohabitating, higher education, alcohol consumption, more regular exercise, and high total cholesterol were inversely associated with mortality. Multivariate stratified subgroup analyses verified smokers (HRs of all-cause, CVD, and expanded CVD mortality: 3.25, 10.71, and 7.86, respectively, for grade 2-3 obesity), the high triglyceride group (HRs: 5.82, 10.99, and 14.22, respectively for underweight), and patients with 3-4 factors related to metabolic syndrome (HRs: 4.86, 12.72, and 11.42, respectively, for underweight) were associated with mortality.

CONCLUSION:

The associations of BMI with all-cause, CVD, expanded CVD mortality in the elderly are represented by U-shaped curves, suggesting unilateral promotions or interventions in weight reduction in the elderly may be inappropriate. Heterogeneous effects of grades 1 and 2-3 obesity on mortality were observed and should be treated as different levels of obesity.

PMID:
25014070
PMCID:
PMC4094563
DOI:
10.1371/journal.pone.0102589
[Indexed for MEDLINE]
Free PMC Article

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