Association of Body Mass Index With All-Cause Mortality in Acutely Hospitalized Older Patients

Introduction: J relationships of body mass index (BMI) with mortality have been described. However, little data are available on long-term follow-up in controlled clinical trials with respect to cardiovascular (CV) and all cause mortality. Hypothesis: We tested whether there is a J shape relationship between BMI with CV and all cause mortality at 22 years in the Systolic Hypertension in the Elderly Program (SHEP). Methods: SHEP was a placebo controlled, randomized clinical trial of antihypertensive therapy in patients with isolated systolic hypertension aged 60 and older. The relationship between CV and all cause mortality with baseline BMI was examined in 4,211 SHEP participants. Results: In unadjusted analyses, a J relationship was observed for all-cause mortality (linear term p=0.0318, quadratic term p=0.3217 and tricubic term p=0.0046) and for CV mortality (linear term p=0.0962, quadratic term p=0.6866 and tricubic term p=0.0908, left figure). The lowest risk was at a BMI of 25.9 for all-cause and 25.5 for CV mortality. The J shaped relationship between BMI and mortality was attenuated after adjustment for age, gender, comorbidities (e.g. diabetes, heart failure) and risk factors for CV disease (e.g. smoking and dyslipidemia, right figure). Age and gender were significant predictors of both all- cause and CV mortality: age p<0.0001, female gender p=0.0063 for all-cause mortality and p<0.0001 for age and p=0.0004 for female gender for CV mortality. <br/Conclusions: This study indicates that both very low and very high BMI are markers of high risk. The J relationship between BMI and mortality is mediated by age, female gender, comorbidities and risk factors for CV disease.

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Impact of hypoalbuminemia, frailty, and body mass index on early prognosis in older patients (≥85 years) with ST-elevation myocardial infarction

Journal of Cardiology ◽

10.1016/j.jjcc.2014.12.001 ◽

2015 ◽

Vol 66 (3) ◽

pp. 263-268 ◽

Cited By ~ 32

Author(s):

Yasumori Sujino ◽

Jun Tanno ◽

Shintaro Nakano ◽

Shuhei Funada ◽

Yoshie Hosoi ◽

...

Keyword(s):

Myocardial Infarction ◽

Body Mass Index ◽

Body Mass ◽

Older Patients ◽

St Elevation Myocardial Infarction ◽

St Elevation

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The effects of physical activity and body mass index on cardiovascular, cancer and all-cause mortality among 47 212 middle-aged Finnish men and women

International Journal of Obesity ◽

10.1038/sj.ijo.0802870 ◽

2005 ◽

Vol 29 (8) ◽

pp. 894-902 ◽

Cited By ~ 176

Author(s):

G Hu ◽

J Tuomilehto ◽

K Silventoinen ◽

N C Barengo ◽

M Peltonen ◽

...

Keyword(s):

Physical Activity ◽

Body Mass Index ◽

Body Mass ◽

Middle Aged ◽

Men And Women ◽

All Cause Mortality

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Associations of Body Mass Index and Waist Circumference with 3-Year All-Cause Mortality Among the Oldest Old: Evidence from a Chinese Community-Based Prospective Cohort Study

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2018.03.015 ◽

2018 ◽

Vol 19 (8) ◽

pp. 672-678.e4 ◽

Cited By ~ 9

Author(s):

Yue-Bin Lv ◽

Simin Liu ◽

Zhao-Xue Yin ◽

Xiang Gao ◽

Virginia Byers Kraus ◽

...

Keyword(s):

Body Mass Index ◽

Cohort Study ◽

Waist Circumference ◽

Body Mass ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Oldest Old ◽

Community Based ◽

All Cause Mortality ◽

Old Evidence

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Association of Body Mass Index and Waist Circumference with All-Cause Mortality in Hemodialysis Patients

Journal of Clinical Medicine ◽

10.3390/jcm9051289 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1289

Author(s):

Chang Seong Kim ◽

Kyung-Do Han ◽

Hong Sang Choi ◽

Eun Hui Bae ◽

Seong Kwon Ma ◽

...

Keyword(s):

Body Mass Index ◽

Waist Circumference ◽

Mortality Rate ◽

Body Mass ◽

The Body ◽

National Health Insurance System ◽

Cox Regression Analysis ◽

Risk Of Mortality ◽

All Cause Mortality ◽

Nationally Representative

In this study based on a large nationally representative sample of Korean adults, we investigated the potential associations of the body mass index (BMI) and waist circumference (WC) with mortality in patients undergoing hemodialysis. We obtained the data of 18,699 participants >20 years of age who were followed up with for 4 years and for whom BMI and WC information were available, using a nationally representative dataset from the Korean National Health Insurance System. Patients were stratified into five levels by their baseline BMI and into six levels by their WC (5-cm increments). A total of 4975 deaths occurred during a median follow-up period of 48.2 months. Participants with a higher BMI had a lower mortality rate than those with a lower BMI. In a fully adjusted Cox regression analysis, being overweight and obese was associated with a significantly lower relative risk of all-cause mortality relative to the reference group. Conversely, the mortality rate was higher among participants with a high WC than among those with a low WC. Participants with the highest WC had a higher risk of mortality, while those with the lowest WC level had a significantly lower risk of mortality. In conclusion, all-cause mortality was positively associated with WC, a measure of abdominal obesity, and inversely associated with BMI, a measure of body volume, in patients undergoing hemodialysis.

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The association of dialysis adequacy, body mass index, and mortality among hemodialysis patients

BMC Nephrology ◽

10.1186/s12882-019-1570-0 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Woong-pyo Hong ◽

Yu-Ji Lee

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Mortality Risk ◽

Cox Regression ◽

Target Range ◽

Dialysis Adequacy ◽

Cox Regression Analysis ◽

Increased Risk ◽

All Cause Mortality ◽

High Bmi

Abstract Background Although hemodialysis (HD) adequacy, single-pool Kt/Vurea (spKt/V), is inversely correlated with body size, each is known to affect patient survival in the same direction. Therefore, we sought to examine the relationship between HD adequacy and mortality according to body mass index (BMI) in HD patients and explore a combination effect of BMI and HD adequacy on mortality risk. Methods We retrospectively reviewed patient data from the Korean Society of Nephrology registry, a nationwide database of medical records of HD patients, from January 2001 to June 2017. We included patients ≥18 years old who were receiving maintenance HD. Patients were categorized into three groups according to baseline BMI (< 20 (low), 20 to < 23 (normal), and ≥ 23 (high) kg/m2). Baseline spKt/V was divided into six categories. Results Among 18,242 patients on HD, the median follow-up duration was 5.2 (IQR, 1.9–8.9) years. Cox regression analysis showed that, compared to the reference (spKt/V 1.2–1.4), lower and higher baseline spKt/V were associated with greater and lower risks for all-cause mortality, respectively. However, among patients with high BMI (n = 5588), the association between higher spKt/V and lower all-cause mortality was attenuated in all adjusted models (Pinteraction < 0.001). Compared to patients with normal BMI and spKt/V within the target range (1.2–1.4), those with low BMI had a higher risk for all-cause mortality at all spKt/V levels. However, the gap in mortality risk became narrower for higher values of spKt/V. Compared to patients with normal BMI and spKt/V in the target range, those with high BMI and spKt/V < 1.2 were not at increased risk for mortality despite low dialysis adequacy. Conclusions The association between spKt/V and mortality in HD patients may be modified by BMI.

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