title: Increased 1-year survival and discharge to independent living in overweight hip fracture patients: A prospective study of 843 patients.
abstract: OBJECTIVE
  Hip fracture patients usually have low body mass index (BMI), and suffer further postoperative catabolism. How BMI relates to outcome in relatively healthy hip fracture patients is not well investigated. We investigated the association between BMI, survival, and independent living 1 year postoperatively.
  
  
  METHODS
  This prospective multicenter study involved 843 patients with a hip fracture (mean age 82 (SD 7) years, 73% women), without severe cognitive impairment and living independently before admission. We investigated the relationship between BMI and both 1-year mortality and ability to return to independent living.
  
  
  RESULTS
  Patients with BMI > 26 had a lower mortality rate than those with BMI < 22 and those with BMI 22-26 (6%, 16%, and 18% respectively; p = 0.006). The odds ratio (OR) for 1-year survival in the group with BMI > 26 was 2.6 (95% CI: 1.2-5.5) after adjustment for age, sex, and physical status. Patients with BMI > 26 were also more likely to return to independent living after the hip fracture (OR = 2.6, 95% CI: 1.4-5.0). Patients with BMI < 22 had similar mortality and a similar likelihood of independent living to those with BMI 22-26.
  
  
  CONCLUSIONS
  In this selected group of patients with hip fracture, the overweight and obese patients (BMI > 26) had a higher survival rate at 1 year, and returned to independent living to a higher degree than those of normal (healthy) weight. The obesity paradox and the recommendations for optimal BMI need further consideration in patients with hip fracture.
authors.affiliation: a Department of Geriatric Medicine , Karolinska University Hospital , Huddinge .|b Department of Clinical Science , Intervention and Technology (CLINTEC) .|c Karolinska Institute , Stockholm .
authors.forename: Lena
authors.initials: L
authors.lastname: Flodin
authors.affiliation: c Karolinska Institute , Stockholm .
authors.forename: Agnes
authors.initials: A
authors.lastname: Laurin
authors.affiliation: a Department of Geriatric Medicine , Karolinska University Hospital , Huddinge .|c Karolinska Institute , Stockholm .|d Department of Neurobiology, Care Sciences and Society .
authors.forename: Johan
authors.initials: J
authors.lastname: Lökk
authors.affiliation: e Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism , Uppsala University , Uppsala .
authors.forename: Tommy
authors.initials: T
authors.lastname: Cederholm
authors.affiliation: b Department of Clinical Science , Intervention and Technology (CLINTEC) .|c Karolinska Institute , Stockholm .|f Department of Orthopedics , Karolinska University Hospital , Huddinge , Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Hedström
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology*; D005260:Female; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D057187:Independent Living; D008297:Male; D050177:Overweight; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome