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J R Soc Med. 2016 Jun;109(6):230-238. doi: 10.1177/0141076816639047.

BMI upon discharge from hospital and its relationship with survival: an observational study utilising linked patient records.

Author information

1
1 Department of Primary Care and Population Health, University College London, London WC1E 6BT, UK.
2
2 Quality and Outcomes Research Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham B15 2PR, UK.
3
3 FARR Institute of Health Informatics, University College London, London WC1E 6BT, UK.
4
4 School of Clinic and Experimental Medicine, University of Birmingham, West Midlands B15 2TT, UK.

Abstract

OBJECTIVE:

Current advice for patients being discharged from hospital suggests a body mass index of 18.5 to 24 kgm-2, although this aspirational target may often not be achieved. We examined the relationship between body mass index on discharge from hospital and subsequent mortality over a maximum follow-up of 3.8 years.

DESIGN:

We conducted a survival analysis using linked hospital records data with national hospital episode statistics and national death certification data.

PARTICIPANTS & SETTING:

The analysis included adult patients who were admitted to University Hospitals Birmingham NHS Foundation Trust for a period of over 24 h during 2011, excluding day cases and regular day case attenders.

MAIN OUTCOME MEASURES:

The relationship between body mass index and mortality at medium term was estimated separately in both men and women, after accounting for case-mix.

RESULTS:

For both males and females, the relationship between body mass index at discharge and the loge hazard of death was strongly non-linear (p = 0.0002 for females and p < 0.0001 for males) and predictive (both p < 0.0001). In all models, the optimal body mass index range associated with best survival was 25 to 35 kgm-2, with a sharp increase in risk for lower body mass index.

CONCLUSIONS:

There was little evidence to support current aspirational body mass index targets in the discharge population. Hospitals should ensure adequate nutrition especially among those with a reduced body mass index.

KEYWORDS:

Evidence-based practice; metabolism; nutrition

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