title: Association of body mass index with all-cause and cardiovascular disease mortality in the elderly.
abstract: OBJECTIVE
  To evaluate the associations of body mass index (BMI) with all-cause, cardiovascular disease (CVD), and expanded CVD mortality in the elderly.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Annual physical examination program for the elderly from 2006 to 2010.
  
  
  METHODS
  We included 77,541 Taipei residents aged ≥ 65 years (39,365 men and 38,176 women).
  
  
  METHODS
  BMI was categorized as underweight (BMI<18.5), normal weight (18.5 ≤ BMI<25), overweight (25 ≤ BMI<30), grade 1 obesity (30 ≤ BMI<35), or grade 2-3 obesity (BMI ≥ 35). Mortality was ascertained by national death files.
  
  
  RESULTS
  Underweight (hazard ratios [HRs] of all-cause, CVD, and expanded CVD mortality: 1.92, 1.74, and 1.77, respectively), grade 2-3 obesity (HRs: 1.59, 2.36, and 2.22, respectively), older age, male sex, smoking, and high fasting blood sugar were significant predictors of mortality. Meanwhile, being married/cohabitating, higher education, alcohol consumption, more regular exercise, and high total cholesterol were inversely associated with mortality. Multivariate stratified subgroup analyses verified smokers (HRs of all-cause, CVD, and expanded CVD mortality: 3.25, 10.71, and 7.86, respectively, for grade 2-3 obesity), the high triglyceride group (HRs: 5.82, 10.99, and 14.22, respectively for underweight), and patients with 3-4 factors related to metabolic syndrome (HRs: 4.86, 12.72, and 11.42, respectively, for underweight) were associated with mortality.
  
  
  CONCLUSIONS
  The associations of BMI with all-cause, CVD, expanded CVD mortality in the elderly are represented by U-shaped curves, suggesting unilateral promotions or interventions in weight reduction in the elderly may be inappropriate. Heterogeneous effects of grades 1 and 2-3 obesity on mortality were observed and should be treated as different levels of obesity.
authors.affiliation: Institute of Public Health, National Yang Ming University, Taipei, Taiwan; Department of Dermatology, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan.
authors.forename: Chen-Yi
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Institute of Public Health, National Yang Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Yi-Chang
authors.initials: YC
authors.lastname: Chou
authors.affiliation: Department of Education and Research, Taipei City Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Nicole
authors.initials: N
authors.lastname: Huang
authors.affiliation: Institute of Public Health, National Yang Ming University, Taipei, Taiwan.
authors.forename: Yiing-Jenq
authors.initials: YJ
authors.lastname: Chou
authors.affiliation: Institute of Public Health, National Yang Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Hsiao-Yun
authors.initials: HY
authors.lastname: Hu
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Chung-Pin
authors.initials: CP
authors.lastname: Li
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001823:Body Composition; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D002423:Cause of Death / Q000639:trends; D015331:Cohort Studies; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D050177:Overweight / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D012307:Risk Factors; D012907:Smoking; D012959:Socioeconomic Factors; D015996:Survival Rate; D013624:Taiwan; D013851:Thinness / Q000150:complications / Q000401:mortality* / Q000503:physiopathology