title: Effects of body mass index, abdominal obesity, and type 2 diabetes on mortality in community-dwelling elderly in Sao Paulo, Brazil: analysis of prospective data from the SABE study.
abstract: BACKGROUND
  The majority of studies on the effects of adiposity on mortality in the elderly have been conducted in developed countries with mixed results. We investigated the association between adiposity and mortality in a cohort of community-dwelling elderly in Sao Paulo, Brazil.
  
  
  METHODS
  Body mass index (BMI), waist circumference, waist-to-hip ratio, and type 2 diabetes were evaluated in 1,882 participants (mean age 71.0 ± 8.3 years old, 61% female). Mortality was confirmed by national vital statistics records during a maximum of 10 years of follow-up. Proportional hazards models were used to estimate hazard ratios (HRs) for mortality after adjusting for sociodemographics and comorbidities. In a subsample of 897 participants, the effects of changes in measures of adiposity on mortality were investigated during a median follow-up of 4.6 years.
  
  
  RESULTS
  Having type-2 diabetes at baseline was associated with increased mortality (HR = 1.44, 95% CI: 1.17-1.77), with a higher HR among men. When compared with normal weight participants (BMI = 20-<25kg/m(2)), overweight and obesity were not associated with mortality (overweight: HR = 0.84 [0.70, 1.02]; obesity: HR = 0.82 [0.64, 1.06]), whereas participants with low-normal weight (BMI = 18.5<20 kg/m(2)) had increased risk of death (HR = 1.51 [1.08-2.10]). Higher waist circumference and waist-to-hip ratio were not associated with increased mortality. Weight gain was protective against mortality in all BMI categories, except in obese participants, and weight loss increased the risk of death in all BMI categories by 42-63%.
  
  
  CONCLUSIONS
  In community-dwelling elderly in Sao Paulo, overweight and obesity were not associated with a higher risk of death, and weight gain seemed to reduce mortality, except in the obese.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts. Discipline of Geriatrics, University of Sao Paulo Medical School, Brazil. csuemoto@hsph.harvard.edu.
authors.forename: Claudia K
authors.initials: CK
authors.lastname: Suemoto
authors.affiliation: Department of Epidemiology, School of Public Health and.
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Lebrao
authors.affiliation: Medical Surgical Nursing Department, School of Nursing, University of Sao Paulo, Brazil.
authors.forename: Yeda A
authors.initials: YA
authors.lastname: Duarte
authors.affiliation: Department of Global Health and Population and Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Goodarz
authors.initials: G
authors.lastname: Danaei
mesh_terms: D050154:Adiposity; D000368:Aged; D000375:Aging; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D001938:Brazil / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057187:Independent Living; D008297:Male; D056128:Obesity, Abdominal / Q000150:complications / Q000401:mortality*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055105:Waist Circumference; D049629:Waist-Hip Ratio
keywords: Aged.; Body mass index; Diabetes; Mortality; Obesity; Overweight; Waist circumference