Obesity Can Benefit Survival—A 9-Year Prospective Study in 1614 Chinese Nursing Home Residents

Relationship between nutritional status and clinical outcomes among older individuals using long-term care services: A systematic review and meta-analysis

BACKGROUND & AIMS

Nutritional status is a significant issue in an aging society; however, the impact of the nutritional status of older individuals using long-term care services on the caregiving burden remains unclear. This systematic review and meta-analysis aimed to investigate the impact of nutritional issues on adverse outcomes in older individuals using long-term care services.

METHODS

We used data from the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Web of Science, CINAHL, and Ichu-shi Web databases. Original articles published in English or Japanese between January 2000 and July 2022 were included. The inclusion criteria were interventional and observational studies on individuals using long-term care services with aged ≥65 years and a focus on body weight or weight loss. Data on adverse outcomes related to caregiving burden, including the number of people requiring care, mortality, complications, activities of daily living (ADL), and quality of life, were collected.

RESULTS

The literature search yielded 7873 studies, of which 35 were ultimately included. Seven observational studies investigated mortality outcomes, and seven examined ADL outcomes. The meta-analysis revealed significantly higher mortality rates in individuals classified as underweight (BMI <18.5 kg/m2) than in those with BMI ≥18.5 kg/m2 (risk ratio [RR] 1.49; 95 % confidence interval [CI] 1.31 to 1.73, 0.22; I2 93 %). Further, on categorising the participants based on a BMI cutoff of 25 kg/m2, those with a BMI of <25 kg/m2 had a significantly increased mortality rate (RR 1.21; 95 % CI 1.04-1.40; I2 = 98 %). BMI and weight loss did not affect ADL.

CONCLUSIONS

Our findings indicate that underweight and weight loss are significantly associated with increased mortality in older individuals using long-term care services. Therefore, appropriate weight management is recommended for this population. However, further research is necessary owing to the high heterogeneity observed in this study.

Associations between obesity, self-reported weakness and their combinations with mortality in nursing home residents

OBJECTIVES

There are studies on associations between obesity and mortality in nursing home (NH) residents, but the presence of concomitant muscle weakness has not been examined. We considered that self-reported weakness might be a low muscle strength proxy marker. We aimed to examine associations of obesity alone, self-reported muscle weakness alone, and their combination with mortality in NH residents.

METHODS

This is a retrospective longitudinal follow-up study. We noted age, sex, nutritional status, functionality, number of chronic diseases, and regular medication. Obesity was assessed by the body fat-percentage method estimated by bioimpedance analysis. Weakness was identified by self-reported muscle weakness. Survival was evaluated with a univariate log-rank test and multivariate Cox regression analyses.

RESULTS

We included 214 participants. In a median follow-up time of 46 months, mortality occurred in 37.4%. In multivariate analysis adjusted by age, sex, undernutrition, number of chronic diseases, and regular medication, functional scores; 'non-weak non-obese' participants or 'weak alone' participants or 'weak+obese' participants had higher mortality risk when compared with the 'obesity alone' participants [hazard ratio (HR) = 2.6, 95% confidence interval (CI) = 1.2-5.5, p = 0.01; HR = 2.6, 95% CI = 1.2-5.9, p = 0.02; HR = 3.0, 95% CI = 1.2-7.7, p = 0.02].

CONCLUSION

This is the first report showing that obesity was associated with lower mortality risk if the weakness was not present in NH residents. However, obesity with concomitant weakness was associated with mortality risk similar to non-weak non-obese or weak alone participants. Our study suggests a simple consideration of weakness that can easily be integrated into everyday practice.

Physical Activity versus Selected Health Behaviors, Subjective Physical and Psychological Health and Multimorbidity in a Large Cohort of Polish Seniors during the COVID-19 Pandemic (Results of the National Test for Poles' Health )

National Test for Poles' Health is an online study conducted on a large group of Polish Internet users. For the purpose of this study, 64,732 subjects (48.8% female) over 65 years old were included. Subjects provided answers on the level of physical activity (PA) they engage in, prevalence of non-communicable diseases (obesity, hypertension, diabetes, heart diseases, chronic obstructive pulmonary disease (COPD), depression, cancer) and subjective physical and psychological health. Additionally, their Body Mass Index (BMI) and prevalence of multimorbidity was assessed. We found that older people who engage in at least 2 h of physical activity/week had significantly lower prevalence of hypertension, obesity and heart diseases than those who engaged in 1-1.5 h/week or less than 1 h/week. Multimorbidity was present in 33.2% of subjects from the most active group and 52.6% of the least active ones. Subjective physical and psychological health was rated as "very good" by 26.6% and 41.2%, respectively, by subjects from the most active group. Only 9.1% of the least active subjects rated their physical health as "very good" and only 27.4% rated their psychological health as such. Regular physical activity may be a helpful tool in combating the reduced well-being of older people affected by the isolation caused by the COVID-19 pandemic. Unfortunately, over 65% of respondents claimed to engage in less than 1 h of PA a week or less.

Obesity may increase survival, regardless of nutritional status: a Swedish cohort study in nursing homes

Background

To investigate the associations between the body mass index (BMI), Mini Nutritional Assessment–Short Form (MNA-SF) scores, and 2-year mortality.

Methods

A nationwide cohort study using data from a national quality register of older (age ≥ 65 years) nursing home residents (N = 47,686). Individuals were categorized according to BMI as underweight (< 18.5 kg/m²), normal-weight (18.5–24.9 kg/m²), overweight (25.0–29.9 kg/m²), and obese (class I, 30.0–34.9 kg/m²; class II, 35.0–39.9 kg/m²; class III, ≥ 40.0 kg/m²). Participants’ nutritional status were categorized as good (MNA-SF score 12–14), at risk of malnutrition (MNA-SF score 8–11), or malnutrition (MNA-SF score 0–7). Associations with mortality were analysed using Cox proportional-hazards models.

Results

At baseline, 16.0% had obesity, and 14.6% were malnourished. During 2 years of follow-up, 23,335 (48.9%) individuals died. Compared with normal-weight individuals, mortality was greater among underweight individuals [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.55–1.69] and lesser among individuals with class I (HR 0.63, 95% CI 0.60–0.66), class II (HR 0.62, 95% CI 0.56–0.68), and class III (HR 0.80, 95% CI 0.69–0.94) obesity. Compared with individuals with good nutritional status, mortality was increased for those with malnutrition (HR 2.98,95% CI 2.87–3.10). Lower mortality among obese individuals was also seen in subgroups defined according to MNA-SF scores.

Conclusions

Among older nursing home residents, obesity, including severe obesity, was associated with lower 2-year mortality. Higher BMIs were associated with better survival, regardless of nutritional status according to MNA-SF.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03356-1.

Elevated All-Cause Mortality among Overweight Older People: AI Predicts a High Normal Weight Is Optimal

It has been proposed that being overweight may provide an advantage with respect to mortality in older people, although this has not been investigated fully. Therefore, to confirm that and elucidate the underlying mechanism, we investigated mortality in older people using explainable artificial intelligence (AI) with the gradient-boosting algorithm XGboost. Baseline body mass indexes (BMIs) of 5699 people (79.3 ± 3.9 years) were evaluated to determine the relationship with all-cause mortality over eight years. In the unadjusted model, the first negative (protective) BMI range for mortality was 25.9−28.4 kg/m2. However, in the adjusted cross-validation model, this range was 22.7−23.6 kg/m2; the second and third negative BMI ranges were then 25.8−28.2 and 24.6−25.8 kg/m2, respectively. Conversely, the first advancing BMI range was 12.8−18.7 kg/m2, which did not vary across conditions with high feature importance. Actual and predicted mortality rates in participants aged <90 years showed a negative-linear or L-shaped relationship with BMI, whereas predicted mortality rates in men aged ≥90 years showed a blunt U-shaped relationship. In conclusion, AI predicted that being overweight may not be an optimal condition with regard to all-cause mortality in older adults. Instead, it may be that a high normal weight is optimal, though this may vary according to the age and sex.

Prognostic impact of obesity in newly-diagnosed glioblastoma: a secondary analysis of CeTeG/NOA-09 and GLARIUS

Purpose

The role of obesity in glioblastoma remains unclear, as previous analyses have reported contradicting results. Here, we evaluate the prognostic impact of obesity in two trial populations; CeTeG/NOA-09 (n = 129) for MGMT methylated glioblastoma patients comparing temozolomide (TMZ) to lomustine/TMZ, and GLARIUS (n = 170) for MGMT unmethylated glioblastoma patients comparing TMZ to bevacizumab/irinotecan, both in addition to surgery and radiotherapy.

Methods

The impact of obesity (BMI ≥ 30 kg/m²) on overall survival (OS) and progression-free survival (PFS) was investigated with Kaplan–Meier analysis and log-rank tests. A multivariable Cox regression analysis was performed including known prognostic factors as covariables.

Results

Overall, 22.6% of patients (67 of 297) were obese. Obesity was associated with shorter survival in patients with MGMT methylated glioblastoma (median OS 22.9 (95% CI 17.7–30.8) vs. 43.2 (32.5–54.4) months for obese and non-obese patients respectively, p = 0.001), but not in MGMT unmethylated glioblastoma (median OS 17.1 (15.8–18.9) vs 17.6 (14.7–20.8) months, p = 0.26). The prognostic impact of obesity in MGMT methylated glioblastoma was confirmed in a multivariable Cox regression (adjusted odds ratio: 2.57 (95% CI 1.53–4.31), p < 0.001) adjusted for age, sex, extent of resection, baseline steroids, Karnofsky performance score, and treatment arm.

Conclusion

Obesity was associated with shorter survival in MGMT methylated, but not in MGMT unmethylated glioblastoma patients.

Impact of underweight on 3-year all-cause mortality in patients with acute severe hypertension: a retrospective cohort study

Body mass index (BMI) is used to measure body fat. We investigated the association between BMI and long-term clinical outcomes in patients with acute severe hypertension who visited the emergency department (ED). Cross-sectional study data were obtained from a single regional emergency medical center, including patients with elevated initial systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 100 mmHg. The patients were classified into five groups according to BMI level (underweight, normal, overweight, obese class I, II and III). Among 4867 patients who presented with acute severe hypertension at the ED, 935 (19.21%) died within 3-years. In particular, 140 (44.59%) patients in the underweight group died from any cause, which was the highest among the five groups, and there was a reverse J-shaped association between BMI and 3-year all-cause mortality. Underweight patients had a significantly increased risk of all-cause mortality by 1.55-fold during the 3-year follow-up. Rather, obesity was associated with a reduction in the 3-year all-cause mortality. Comorbidities, including chronic kidney disease and acute hypertension-mediated organ damage, were independent predictors of all-cause mortality in patients who were not underweight. Underweight contributes to worsening long-term clinical outcomes in patients with acute severe hypertension. Clinicians should consider BMI as one of the physical examination parameters in patients with acute severe hypertension, and management including lifestyle modifications such as diet control and exercise should be undertaken considering BMI and comorbidities.

Socioeconomic disadvantages over the life-course and their influence on obesity among older Hong Kong Chinese adults

BACKGROUND

The life-course perspective on socioeconomic inequality in health is a burgeoning field of research. Nonetheless, the three classic life-course models (i.e. sensitive period, cumulative risk and social mobility models) have rarely been simultaneously applied to studies on obesity. Therefore, this study examined the associations of socioeconomic positions (SEPs) across life stages and their associated life-course models with both general and abdominal obesity.

METHODS

Face-to-face interviews were conducted among 1077 community-dwelling adults aged 50 or above during 2014-15 in Hong Kong. Experiences of poverty, educational attainment and deprivation of necessities represented respondents' SEP in childhood, early adulthood and late adulthood, respectively. General and abdominal obesity were defined as body mass index ≥25 kg m-2 and waist-to-height ratio >0.5. Multivariable modified Poisson regression with a robust error variance was performed.

RESULTS

Respondents with low childhood SEP tended to have reduced risk of general obesity [relative risk (RR) = 0.85; 95% confidence interval (CI) = 0.72-1.00], whereas those with low childhood SEP and low late-adulthood SEP tended to have increased risk of abdominal obesity (RR = 1.10; 95% CI = 1.00-1.21 and RR = 1.14; 95% CI = 1.03-1.26, respectively). Cumulative socioeconomic disadvantages showed a dose-response relationship with abdominal obesity. Also, those with upward socioeconomic mobility had lower risk of abdominal obesity, whereas those with downward socioeconomic mobility had greater risk.

CONCLUSIONS

Low SEP, especially in childhood, exerted contrasting effects on general and abdominal obesity among older Hong Kong Chinese adults. The three life-course models operated simultaneously in determining the risk of abdominal obesity, while support for cumulative risk and social mobility models was weak in general obesity.

Obesity: Assessment and prevention: Module 23.2 from Topic 23 "Nutrition in obesity"

Obesity is one the major health problems of today showing an increasing prevalence among most countries. It is associated with increased risk of several diseases. The importance of early life strategies in the prevention of obesity is well established, whereas, in general, breastfed infants tend to have a lower body mass index (BMI) than formula-fed infants. There seem to be a series of behavioral and hormonal mechanisms that explain this difference. Lifestyle plays a crucial role in the development of overweight and/or obesity and targeted lifestyle modifications have an important impact on preventing obesity. In particular, sedentary behavior (viewing television, playing video games, doing cognitive work, and listening to music) and reduced overall physical activity along with shorter sleep duration promote the overconsumption of dietary macronutrients leading to obesity; at the same time physical activity or exercise in a sufficient dose seems to better facilitate long-term maintenance of new lower body weight. There is enough discussion about a potential effect of nutrients on obesity. Nevertheless, the most the crucial parameter regarding weight loss and prevention of obesity is to achieve a negative energy balance. In regard to specific diet regimes, again energy balance rather that any specific macronutrients composition and/or favoring of low glycemic index products, seems to be have a stronger effect on maintenance of lower weight after 12 months. It has to be noted, that for specific sup groups, obesity or overweight might be showing some favorable trends in survival. In particular, "obesity paradox" (OP) refers to an overall prognosis that is no worse and may even be better in some groups than non-obese patients. The OP could be explained by the fact that current classifications of obesity based on BMI may place together, in the same category, subjects with very different clinical and biochemical characteristics.

The performance of anthropometric tools to determine obesity: a systematic review and meta-analysis

The aim of this systematic review was to assess the performance of anthropometric tools to determine obesity in the general population (CRD42018086888). Our review included 32 studies. To detect obesity with body mass index (BMI), the meta-analyses rendered a sensitivity of 51.4% (95% CI 38.5-64.2%) and a specificity of 95.4% (95% CI 90.7-97.8%) in women, and 49.6% (95% CI 34.8-64.5%) and 97.3% (95% CI 92.1-99.1%), respectively, in men. For waist circumference (WC), the summary estimates for the sensitivity were 62.4% (95% CI 49.2-73.9%) and 88.1% for the specificity (95% CI 77.0-94.2%) in men, and 57.0% (95% CI 32.2-79.0%) and 94.8% (95% CI 85.8-98.2%), respectively, in women. The data were insufficient to pool the results for waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) but were similar to BMI and WC. In conclusion, BMI and WC have serious limitations for use as obesity screening tools in clinical practice despite their widespread use. No evidence supports that WHR and WHtR are more suitable than BMI or WC to assess body fat. However, due to the lack of more accurate and feasible alternatives, BMI and WC might still have a role as initial tools for assessing individuals for excess adiposity until new evidence emerges.

Interaction of central obesity and sarcopenia on nutritional status in the community-dwelling older people

OBJECTIVES

To investigate the interrelationships between central obesity, sarcopenia and nutritional status in the elderly.

METHODS

We enrolled 501 elderly (women: 47.5 %) with complete datasets. Biochemical and anthropometric data were measured after an overnight fast. Basic characteristics, psychosocial and behavioral factors, nutritional status, and history of chronic disease came from structured questionnaires. Central obesity was defined as waist circumference ≥ 90 cm for men, ≥ 80 cm for women. Sarcopenia was defined by the Asian consensus. Nutritional status was assessed using Mini Nutritional Assessment scores: abnormal nutritional status ≤ 23.5. Multiple logistic regression analysis was done to determine the independent factors of an abnormal nutritional status.

RESULTS

Ninety (18.0 %) participants had an abnormal nutritional status, 300 (59.9 %) had central obesity, 52 (10.4 %) sarcopenia and 3 (0.6 %) sarcopenic obesity. Central obesity (OR = 0.455, 95 % CI: 0.244-0.847) and total lymphocyte count (OR = 0.526, 95 % CI: 0.315-0.880) were negatively and sarcopenia (OR = 3.170, 95 % CI: 1.485-6.767), current smoking (OR = 4.071, 95 % CI: 1.357-12.211), and total number of chronic diseases (OR = 1.484, 95 % CI: 1.234-1.785) were positively associated with abnormal nutritional status. An analysis of the combine effects of central obesity and sarcopenia on nutritional status showed that significantly fewer participants with central obesity but not sarcopenia had abnormal nutrition than participants with sarcopenia with or without central obesity (12.8 % vs 38.5 or 65.4 %, p < 0.001).

CONCLUSIONS

Central obesity and sarcopenia were interactively associated with the nutritional status of older people living in a rural community.

Association of metabolic syndrome and its components with all-cause and cardiovascular mortality in the elderly: A meta-analysis of prospective cohort studies

There is increasing evidence regarding the relationship between metabolic syndrome and mortality. However, previous research examining metabolic syndrome and mortality in older populations has produced mixed results. In addition, there is a clear need to identify and manage individual components of metabolic syndrome to decrease cardiovascular disease (CVD) mortality. In this meta-analysis, we searched the MEDLINE databases using PubMed, Cochrane Library, and EMBASE databases. Based on 20 prospective cohort studies, metabolic syndrome was associated with a higher risk of all-cause mortality [relative risk (RR), 1.23; 95% confidence interval (CI), 1.15-1.32; I = 55.9%] and CVD mortality (RR, 1.24; 95% CI, 1.11-1.39; I = 58.1%). The risk estimates of all-cause mortality for single components of metabolic syndrome were significant for higher values of waist circumference or body mass index (RR, 0.94; 95% CI, 0.88-1.00), higher values of blood glucose (RR, 1.19; 95% CI, 1.05-1.34), and lower values of high-density lipoprotein (HDL) cholesterol (RR, 1.11; 95% CI, 1.02-1.21). In the elderly population, metabolic syndrome was associated with an increased risk of all-cause and CVD mortality. Among the individual components of metabolic syndrome, increased blood glucose and HDL cholesterol levels were significantly associated with increased mortality. However, older obese or overweight individuals may have a decreased mortality risk. Thus, the findings of the current meta-analysis raise questions about the utility of the definition of metabolic syndrome in predicting all-cause mortality and CVD mortality in the elderly population.

Anorexia of ageing: a key component in the pathogenesis of both sarcopenia and cachexia

The anorexia of aging was first recognized as a physiological syndrome 30 years ago. Its major causes are an alteration in fundal compliance with an increase in antral stretch and enhanced cholecystokinin activity leading to increased satiation.This anorexia leads to weight loss in aging persons and is one of the component causes of the aging related sarcopenia. This physiological anorexia also increases the risk of more severe anorexia when an older person has an increase in inflammatory cytokines such as occurs when they have an illness. This results in an increase in the anorexia due to cachexia in older persons.

Association between Body Mass Index and All-Cause Mortality in Hypertensive Adults: Results from the China Stroke Primary Prevention Trial (CSPPT)

The association between elevated body mass index (BMI) and risk of death has been reported in many studies. However, the association between BMI and all-cause mortality for hypertensive Chinese adults remains unclear. We conducted a post-hoc analysis using data from the China Stroke Primary Prevention Trial (CSPPT). Cox regression analysis was performed to determine the significance of the association of BMI with all-cause mortality. During a mean follow-up duration of 4.5 years, 622 deaths (3.0%) occurred among the 20,694 participants aged 45–75 years. A reversed J-shaped relationship was observed between BMI and all-cause mortality. The hazard ratios (HRs) for underweight (<18.5 kg/m²), overweight (24.0–27.9 kg/m²), and obesity (≥28.0 kg/m²) were calculated relative to normal weight (18.5–23.9 kg/m²). The summary HRs were 1.56 (95% CI, 1.11–2.18) for underweight, 0.78 (95% CI 0.64–0.95) for overweight and 0.64 (95% CI, 0.48–0.85) for obesity. In sex-age-specific analyses, participants over 60 years of age had optimal BMI in the obesity classification and the results were consistent in both males and females. Relative to normal weight, underweight was associated with significantly higher mortality. Excessive weight was not associated with increased risk of mortality. Chinese hypertensive adults had the lowest mortality in grade 1 obesity.

Challenges in the Management of Geriatric Obesity in High Risk Populations

The global prevalence of obesity in the older adult population is growing, an increasing concern in both the developed and developing countries of the world. The study of geriatric obesity and its management is a relatively new area of research, especially pertaining to those with elevated health risks. This review characterizes the state of science for this “fat and frail” population and identifies the many gaps in knowledge where future study is urgently needed. In community dwelling older adults, opportunities to improve both body weight and nutritional status are hampered by inadequate programs to identify and treat obesity, but where support programs exist, there are proven benefits. Nutritional status of the hospitalized older adult should be optimized to overcome the stressors of chronic disease, acute illness, and/or surgery. The least restrictive diets tailored to individual preferences while meeting each patient’s nutritional needs will facilitate the energy required for mobility, respiratory sufficiency, immunocompentence, and wound healing. Complications of care due to obesity in the nursing home setting, especially in those with advanced physical and mental disabilities, are becoming more ubiquitous; in almost all of these situations, weight stability is advocated, as some evidence links weight loss with increased mortality. High quality interdisciplinary studies in a variety of settings are needed to identify standards of care and effective treatments for the most vulnerable obese older adults.

Modifying Effect of Body Mass Index on Survival in Elderly Type 2 Diabetic Patients: Hong Kong Diabetes Registry

OBJECTIVE

There are nonlinear risk associations of body mass index (BMI) with mortality in type 2 diabetes (T2D) and elderly populations although similar information in elderly individuals with T2D are lacking.

RESEARCH DESIGN AND METHODS

We analyzed prospective data for 3186 Chinese patients with T2D with age 65 years or older. Baseline demographic data, risk factors, complications, and all-cause mortality were captured from the Hong Kong Diabetes Registry and the Hong Kong Hospital Authority Clinical Management System.

RESULTS

Over a median follow-up period of 6.0 years (medium-term), 816 (25.6%) deaths occurred and at 9.4 years (long-term), 1557 (48.9%) patients had died. Men were more likely to die than women with increased mortality rate with increasing age (morality rates of men with normal BMI at 9-year follow-up in the 65 to 69, 70 to 74, and 75 years or older age groups were 41.8, 70.3, and 101.4 per 1000 person-years, whereas that for women were 35.5, 50.4, and 78.8 respectively). Within each age group, high BMI was associated with increased survival, especially in the 75 years and older age group and with prolonged follow-up period. Using Cox regression analysis, after adjustment for confounders, high BMI (≥ 25.0 kg/m(2)) was associated with reduced risk of death in all subgroups, reaching significance in men in the older age groups at 9-year follow-up (for men 70 to 74 years old, hazard ratio [HR] of mortality was 0.67, 95% confidence interval [CI] 0.48-0.95, for those ≥ 75, HR was 0.62, 95% CI 0.44-0.89) compared with 18.5 to 22.9 kg/m(2) as referent.

CONCLUSIONS

In Chinese elderly patients with T2D, high BMI protected against mortality, calling for more attention to people with low BMI who might have unmet clinical needs.

Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects

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.

Effect of weight loss on mortality in overweight and obese nursing home residents during a 5-year follow-up

BACKGROUND/OBJECTIVES

The objective of this study was to ascertain the effect of weight loss over the course of 1 year on 5-year mortality in old nursing home (NH) residents in different classes of body mass index (BMI).

SUBJECTS/METHODS

A longitudinal study was conducted on 161 NH residents aged ⩾ 70 years at the Istituto di Riposo per Anziani, Padova, Italy. Data were collected using a comprehensive geriatric assessment at baseline and at a 1-year follow-up visit. Mortality was recorded over a 5-year follow-up. We divided our sample into four groups using as cutoffs a BMI of 25 and a weight gain or loss of 5% at 1 year (BMI ⩾ 25 and weight stable/gain, BMI ⩾ 25 and weight loss, BMI<25 and weight stable/gain and BMI <25 and weight loss).

RESULTS

People with a BMI ⩾ 25 and weight loss suffered the worst decline in activities of daily living, whereas those with a BMI <25 and weight loss had the most significant decline in nutritional status, which coincided with the worst decline in the Multidimensional Prognostic Index among the groups whose weight changed. Compared with those with a BMI ⩾ 25 and weight stable/gain (reference group), those with a BMI <25 were at the highest risk of dying (in association with weight loss: hazard ratio HR=3.60, P=0.005; in association with weight stable/gain: HR=2.45, P=0.01), and the mortality risk was also increased in people with a BMI ⩾ 25 and weight loss (HR=1.74, P=0.03).

CONCLUSIONS

In conclusion, weight loss increases the mortality risk in frail, disabled NH residents, even if they are overweight or obese.

Malnutrition in the nursing home

PURPOSE OF REVIEW

Malnutrition in the nursing home is increasingly recognized as a major international research priority, given the expanding geriatric populations, serious consequences, and challenges conducting research in nursing homes. This review examines the recent literature and suggests implications for research and practice.

RECENT FINDINGS

Across the recent studies, approximately 20% of nursing home residents had some form of malnutrition. However, malnutrition definitions were variable and prevalence ranged from 1.5 to 66.5%. Depression, cognitive impairment, functional impairment, and swallowing difficulty were consistently associated with malnutrition. Mortality was the major consequence of malnutrition among nursing home residents, whereas higher BMIs had lower risks of mortality. Beneficial interventions to reduce malnutrition in the nursing home included dietary supplements, greater resident role in food choice, and staff training programs.

SUMMARY

To truly tackle the issue of malnutrition in the nursing home setting, a consistent definition is needed. We strongly recommend that an expert consensus panel identify a standard set of measures to more accurately compare the prevalence across countries. Given the mortality consequences of malnutrition and the paucity of intervention studies, research on interventions for malnutrition in the nursing home needs to be a higher priority for facilities, researchers, and funding agencies.

Nutritional status and quality of life in different populations of older people in Poland

BACKGROUND/OBJECTIVES

To estimate the potential association of three distinct nutritional status measures (body mass index (BMI), calf circumference (CC) and the Mini Nutritional Assessment (MNA)) with health-related quality of life (HRQL) assessed with Euroqol 5D questionnaire in different populations of elderly people in Poland.

SUBJECTS/METHODS

The study group was comprised of 1003 community-dwelling subjects from the urban environment, 890 subjects from the rural environment and 879 subjects from an institutional environment (nursing homes). Bivariate and multivariate associations were identified between nutritional status measures and HRQL adjusted for demographic and social variables, health status, physical function and mental status.

RESULTS

Nutrition status indices (BMI, CC and MNA) were generally higher in the urban than in the rural environment and clearly worse in institutionalised elderly. In both community-dwelling groups, BMI and CC were negatively related to several Euroqol scores. In institutional residents, of opposite relationships were observed: higher values of these variables were connected with less frequent reporting of problems in Euroqol. In all the three groups, associations between HRQL scores and MNA were very similar: higher values of MNA were significantly connected with less frequent reporting of problems in Euroqol.

CONCLUSIONS

BMI and CC, as overweight/obesity measures, are independent predictors of lower HRQL in urban and rural community-dwelling seniors and higher HRQL in institutionalised elderly. Poor nutritional state as measured by MNA is a similar determinant of well-being in all the three environments. This different relationship of popular overweight/obesity measures to HRQL should be taken into account while designing care for older people.