title: Body mass index, disability, and 13-year mortality in older French adults.
abstract: OBJECTIVE
  To investigate the relationship between mortality and BMI in older people, taking into account other established mortality risk factors.
  
  
  METHODS
  A total of 3,646 French community dwellers aged 65 years and older from PAQUID cohort study were included. Cox proportional-hazards analysis was used to assess association between BMI and mortality.
  
  
  RESULTS
  Death occurred in 54.1% of the cohort more than 13 years: 68.99% of the underweight (BMI <19), 52.13% of the obese (BMI >30), 51.66% of the overweight (BMI 25-30), and 51.79% of the reference participants (BMI 22-25) died.The relative risk of death as a function of BMI, adjusted for gender and age, formed a U-shaped pattern, with larger risks associated with lower BMI (<22.0) and for BMI of 25.0 to 30.0 and BMI >/=30. (BMI 22.0-24.9 was the reference.) After adjustment for demographic factors, smoking history, and comorbidity, increased mortality risk persisted in underweight older people, BMI <18.5 and BMI 18.5-22 (respectively, HR = 1.45, 95% CI 1.17-1.78; HR = 1.27, 95% CI 1.12-1.43) compared with reference. Overweight (BMI 25-29.9) and obesity (>/=30) were not associated with increased mortality compared with the reference category (respectively, HR = 0.98, 95% IC 0.88-1.10; HR = 1.06, 95% IC 0.89-1.27). Similar relationships persisted for disabled participant. For nondisabled participant disability did not alter the associations for BMI of 25.0 and higher but for BMI less than 22.0, the risks become insignificantly different from those for the reference group.
  
  
  CONCLUSIONS
  BMI below 22 kg/ m(2) is a risk factor for 13-year mortality in older people, but our findings suggest that overweight and obesity may not be associated to mortality after adjustment for established mortality risk factors.
authors.affiliation: Department of Epidemiology, Clinical Research and Community Health, Faculty of Medicine, Fez University, BP 1893, Km 2.2 Route Sidi Hrazem, Fez, Morocco. maberraho@yahoo.fr
authors.forename: Mohamed
authors.initials: M
authors.lastname: Berraho
authors.forename: Chakib
authors.initials: C
authors.lastname: Nejjari
authors.forename: Chantal
authors.initials: C
authors.lastname: Raherison
authors.forename: Youness
authors.initials: Y
authors.lastname: El Achhab
authors.forename: Nabil
authors.initials: N
authors.lastname: Tachfouti
authors.forename: Zineb
authors.initials: Z
authors.lastname: Serhier
authors.forename: Jean François
authors.initials: JF
authors.lastname: Dartigues
authors.forename: Pascale
authors.initials: P
authors.lastname: Barberger-Gateau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002423:Cause of Death / Q000639:trends; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D009765:Obesity / Q000401:mortality; D050177:Overweight / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D013851:Thinness / Q000401:mortality*