title: Is obesity a marker of robustness in vulnerable hospitalized aged populations? Prospective, multicenter cohort study of 1 306 acutely ill patients.
abstract: BACKGROUND
  The "obesity paradox" is poorly understood in vulnerable older hospitalized populations.
  
  
  OBJECTIVE
  To prospectively analyze the impact of body mass index (BMI) and comorbidities on early (6-week), one- and two-year mortality.
  
  
  METHODS
  Prospective multicenter study with a two-year follow-up of old patients participating in the SAFES cohort study.
  
  
  METHODS
  Nine university hospitals in France.
  
  
  METHODS
  Patients aged 75 or older hospitalized in medical divisions through the emergency department.
  
  
  METHODS
  Inpatients' characteristics were obtained through a comprehensive geriatric assessment of inpatients, conducted in the first week of hospitalization. All-cause mortalities at 6-week, one- and two-year were determined using bivariable and multivariable Cox proportional hazard model.
  
  
  RESULTS
  The SAFES cohort included 1,306 patients, aged 85±6 years, with a majority of women (65%). One- and two-year mortality were inversely associated with BMI ≥30 kg/m2 while early mortality was not, and positively associated with age, burden of comorbidities, walking disorders, level of dependency and presence of a dementia syndrome. Survival rates between patients in low (< 18.0 kg/m2) and intermediate (18-24.9 and 25-29.9 kg/m2) BMI categories were not significant.
  
  
  CONCLUSIONS
  While our findings seem to confirm the reality of the "obesity paradox" in vulnerable older hospitalized population, the exact understanding of underlying mechanisms and even the truthfulness of this paradoxical relationship are still fraught with considerable methodological, epidemiological and metabolic challenges.
authors.affiliation: Pierre Olivier Lang, MD, MPH, PD, PhD. Nescens Centre of Preventive Medicine, Clinic of Genolier, Route du Muids, 3, CH-1272 Genolier, Switzerland, Phone: + 412236693 09 - fax: + 4122 36693 49-E-mail: polang@nescens.com.
authors.forename: P-O
authors.initials: PO
authors.lastname: Lang
authors.forename: R
authors.initials: R
authors.lastname: Mahmoudi
authors.forename: J-L
authors.initials: JL
authors.lastname: Novella
authors.forename: E
authors.initials: E
authors.lastname: Tardieu
authors.forename: L-A
authors.initials: LA
authors.lastname: Bertholon
authors.forename: P
authors.initials: P
authors.lastname: Nazeyrollas
authors.forename: F
authors.initials: F
authors.lastname: Blanchard
authors.forename: D
authors.initials: D
authors.lastname: Jolly
authors.forename: M
authors.initials: M
authors.lastname: Dramé
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002423:Cause of Death; D015897:Comorbidity; D003704:Dementia / Q000150:complications; D004636:Emergency Service, Hospital; D005260:Female; D005602:France / Q000453:epidemiology; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D009765:Obesity / Q000150:complications / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D035862:Vulnerable Populations