Inverse relationship between body mass index and mortality in older nursing home residents: A meta-analysis of 19,538 elderly subjects

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Obesity Reviews Volume 16, Issue 11, November 2015, Pages 1001-1015 Inverse relationship between body mass index and mortality in older nursing home residents: A meta-analysis of 19,538 elderly subjects (Review) Veronese, N.a, Cereda, E.b, Solmi, M.c, Fowler, S.A.d, Manzato, E.ae, Maggi, S.e, Manu, P.fghi, Abe, E.j, Hayashi, K.j, Allard, J.P.kl, Arendt, B.M.k, Beck, A.m, Chan, M.n, Audrey, Y.J.P.n, Lin, W.-Y.op, Hsu, H.-S.op, Lin, C.-C.op, Diekmann, R.q, Kimyagarov, S.r, Miller, M.s, Cameron, I.D.t, Pitkälä, K.H.u, Lee, J.vw, Woo, J.vw, Nakamura, K.x, Smiley, D.y, Umpierrez, G.y, Rondanelli, M.z, Sund-Levander, M.aa, Valentini, L.ab, Schindler, K.ac, Törmä, J.ad, Volpato, S.ae, Zuliani, G.ae, Wong, M.af, Lok, K.af, Kane, J.M.fghi, Sergi, G.a, Correll, C.U.fghi a Department of Medicine - DIMED, Geriatrics Section, University of Padova, Padova, Italy b Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy c Department of Neurosciences, University of Padova, Padova, Italy d Becker Medical Library, Washington University, St. Louis, MO, United States e National Research Council, Institute of Neuroscience, Padova, Italy f The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, United States g Hofstra North Shore LIJ School of Medicine, Hempstead, NY, United States h The Feinstein Institute for Medical Research, Manhasset, NY, United States i Albert Einstein College of Medicine, Bronx, NY, United States j Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan k Toronto General Hospital, University Health Network, Toronto, Canada l Department of Medicine, University of Toronto, Toronto, Canada m Research Unit for Nutrition (EFFECT), Herlev University Hospital, Herlev, Denmark n Department of Geriatric Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore o Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan p School of Medicine, China Medical University, Taichung, Taiwan q Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany r The Gilad Geriatric Center, Ramat-Gan, Israel s Nutrition and Dietetics, Flinders University, Adelaide, Australia t Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia u Unit of Primary Health Care, Department of General Practice, Helsinki University Central Hospital, Helsinki, Finland v The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong w Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong x Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan y Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States z Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, University of Pavia, Pavia, Italy aa Faculty of Health Sciences, University of Linköping, Linköping, Sweden ab Section of Dietetics, Department of Agriculture and Food Sciences, University of Applied Sciences, Neubrandenburg, Germany ac Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria ad Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden ae Department of Medical Sciences, University of Ferrara, Ferrara, Italy af Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Hide additional affiliations View references (82) Abstract Body mass index (BMI) and mortality in old adults from the general population have been related in a U-shaped or J-shaped curve. However, limited information is available for elderly nursing home populations, particularly about specific cause of death. A systematic PubMed/EMBASE/CINAHL/SCOPUS search until 31 May 2014 without language restrictions was conducted. As no published study reported mortality in standard BMI groups (<18.5, 18.5-24.9, 25-29.9, >=30kg/m2), the most adjusted hazard ratios (HRs) according to a pre-defined list of covariates were obtained from authors and pooled by random-effect model across each BMI category. Out of 342 hits, 20 studies including 19,538 older nursing home residents with 5,223 deaths during a median of 2 years of follow-up were meta-analysed. Compared with normal weight, all-cause mortality HRs were 1.41 (95% CI=1.26-1.58) for underweight, 0.85 (95% CI=0.73-0.99) for overweight and 0.74 (95% CI=0.57-0.96) for obesity. Underweight was a risk factor for higher mortality caused by infections (HR=1.65 [95% CI=1.13-2.40]). RR results corroborated primary HR results, with additionally lower infection-related mortality in overweight and obese than in normal-weight individuals. Like in the general population, underweight is a risk factor for mortality in old nursing home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting.