title: Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects.
abstract: Body mass index (BMI) and mortality in old adults from the general population have been related in a U-shaped or J-shaped curve. However, limited information is available for elderly nursing home populations, particularly about specific cause of death. A systematic PubMed/EMBASE/CINAHL/SCOPUS search until 31 May 2014 without language restrictions was conducted. As no published study reported mortality in standard BMI groups (<18.5, 18.5-24.9, 25-29.9, ≥30 kg/m(2)), the most adjusted hazard ratios (HRs) according to a pre-defined list of covariates were obtained from authors and pooled by random-effect model across each BMI category. Out of 342 hits, 20 studies including 19,538 older nursing home residents with 5,223 deaths during a median of 2 years of follow-up were meta-analysed. Compared with normal weight, all-cause mortality HRs were 1.41 (95% CI = 1.26-1.58) for underweight, 0.85 (95% CI = 0.73-0.99) for overweight and 0.74 (95% CI = 0.57-0.96) for obesity. Underweight was a risk factor for higher mortality caused by infections (HR = 1.65 [95% CI = 1.13-2.40]). RR results corroborated primary HR results, with additionally lower infection-related mortality in overweight and obese than in normal-weight individuals. Like in the general population, underweight is a risk factor for mortality in old nursing home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting.
authors.affiliation: Department of Medicine - DIMED, Geriatrics Section, University of Padova, Padova, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Veronese
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Cereda
authors.affiliation: Department of Neurosciences, University of Padova, Padova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Solmi
authors.affiliation: Becker Medical Library, Washington University, St. Louis, MO, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Fowler
authors.affiliation: Department of Medicine - DIMED, Geriatrics Section, University of Padova, Padova, Italy.|National Research Council, Institute of Neuroscience, Padova, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Manzato
authors.affiliation: National Research Council, Institute of Neuroscience, Padova, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Maggi
authors.affiliation: The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA.|Hofstra North Shore LIJ School of Medicine, Hempstead, New York, USA.|The Feinstein Institute for Medical Research, Manhasset, New York, USA.|Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: P
authors.initials: P
authors.lastname: Manu
authors.affiliation: Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Abe
authors.affiliation: Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: Toronto General Hospital, University Health Network, Toronto, Canada.|Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: J P
authors.initials: JP
authors.lastname: Allard
authors.affiliation: Toronto General Hospital, University Health Network, Toronto, Canada.
authors.forename: B M
authors.initials: BM
authors.lastname: Arendt
authors.affiliation: Research Unit for Nutrition (EFFECT), Herlev University Hospital, Herlev, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Beck
authors.affiliation: Department of Geriatric Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore.
authors.forename: M
authors.initials: M
authors.lastname: Chan
authors.affiliation: Department of Geriatric Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore.
authors.forename: Y J P
authors.initials: YJ
authors.lastname: Audrey
authors.affiliation: Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.|School of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: W-Y
authors.initials: WY
authors.lastname: Lin
authors.affiliation: Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.|School of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: H-S
authors.initials: HS
authors.lastname: Hsu
authors.affiliation: Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.|School of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: C-C
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Diekmann
authors.affiliation: The Gilad Geriatric Center, Ramat-Gan, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Kimyagarov
authors.affiliation: Nutrition and Dietetics, Flinders University, Adelaide, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Miller
authors.affiliation: Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia.
authors.forename: I D
authors.initials: ID
authors.lastname: Cameron
authors.affiliation: Unit of Primary Health Care, Department of General Practice, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: K H
authors.initials: KH
authors.lastname: Pitkälä
authors.affiliation: The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China.|Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.affiliation: The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China.|Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: J
authors.initials: J
authors.lastname: Woo
authors.affiliation: Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Smiley
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: G
authors.initials: G
authors.lastname: Umpierrez
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, University of Pavia, Pavia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Rondanelli
authors.affiliation: Faculty of Health Sciences, University of Linköping, Linköping, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Sund-Levander
authors.affiliation: Section of Dietetics, Department of Agriculture and Food Sciences, University of Applied Sciences, Neubrandenburg, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Valentini
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Schindler
authors.affiliation: Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Törmä
authors.affiliation: Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Volpato
authors.affiliation: Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Zuliani
authors.affiliation: Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: M
authors.initials: M
authors.lastname: Wong
authors.affiliation: Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: K
authors.initials: K
authors.lastname: Lok
authors.affiliation: The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA.|Hofstra North Shore LIJ School of Medicine, Hempstead, New York, USA.|The Feinstein Institute for Medical Research, Manhasset, New York, USA.|Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Kane
authors.affiliation: Department of Medicine - DIMED, Geriatrics Section, University of Padova, Padova, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Sergi
authors.affiliation: The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA.|Hofstra North Shore LIJ School of Medicine, Hempstead, New York, USA.|The Feinstein Institute for Medical Research, Manhasset, New York, USA.|Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: C U
authors.initials: CU
authors.lastname: Correll
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D009747:Nutritional Physiological Phenomena; D050177:Overweight / Q000401:mortality*; D012307:Risk Factors; D013851:Thinness / Q000401:mortality*
keywords: Body mass index; elderly; mortality; nursing home