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Kim E, Seol EM, Lee HJ. The Association of Body Mass Index on Falls Risk and Mortality in Hospitalized Patients of Different Old-Age Categories Requiring Nutritional Support. Clin Nutr Res 2024; 13:96-107. [PMID: 38784849 PMCID: PMC11109932 DOI: 10.7762/cnr.2024.13.2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 05/25/2024] Open
Abstract
Malnutrition affect clinical outcomes in hospitalized old age patients, but the data on the related outcomes on the basis of different age categories are still limited. We aimed to investigate the interplay of associations among body mass index (BMI), falls risk, and mortality rate in different older adult patient age categories. This retrospective study included hospitalized patients aged ≥ 65 years who received artificial nutrition. Demographic, biochemical, and survival data were collected. BMI was evaluated using the World Health Organization BMI cutoffs for Asians, and patients were classified into high (≥ 23.0 kg/m2), normal (18.5-22.9 kg/m2), and low (< 18.5 kg/m2) BMI groups. The Morse Fall Scale was used to assess falls risk. By age categories, all patients (n = 4,642) were divided into the 65-74 (n = 2,649) and ≥ 75 (n = 1,993) years age groups. We found that the proportion of low-BMI and high risk of falls increased with age. Further, low-BMI was associated with increased falls risk in both age groups. Overall survival rate tended to be lower in the low-BMI and ≥ 75 years group than that in other patient groups, but did not differ significantly compared with the low-BMI and 65-74 years group. Low-BMI was associated with increased falls risk and mortality; however, the association depended on specific patient age groups.
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Affiliation(s)
- Eunjung Kim
- Department of Nutritional Support Team, Seoul National University Hospital, Seoul 03080, Korea
- Department of Nursing, Seoul National University Hospital, Seoul 03080, Korea
| | - Eun-Mi Seol
- Department of Nutritional Support Team, Seoul National University Hospital, Seoul 03080, Korea
- Department of Nursing, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyuk-Joon Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea
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2
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Tabara Y, Nakatani E, Miyachi Y. Body mass index, functional disability and all-cause mortality in 330 000 older adults: The Shizuoka study. Geriatr Gerontol Int 2021; 21:1040-1046. [PMID: 34609788 DOI: 10.1111/ggi.14286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/22/2021] [Accepted: 09/11/2021] [Indexed: 01/10/2023]
Abstract
AIM A J-shaped association has been observed between body mass index (BMI) and all-cause mortality, but its relationship with functional disability is uncertain. We aim to clarify the association between BMI and functional disability, as well as all-cause mortality, by analyzing prefecture-wide annual health checkup data, and health and care insurance data. METHODS The dataset analyzed in this study consisted of 332 405 community residents aged ≥65 years who subscribed to the National Health Insurance. Basic clinical information was obtained from the annual health checkup data. The presence of comorbidities at baseline and the incidence of functional disability and all-cause mortality were obtained from the health insurance data. RESULTS The mean age and standard deviation of the study participants was 73.5 ± 6.0 years. During a 4-year follow-up period, we observed 31 508 incident cases of functional disability and 16 640 deaths. The incidence rates of functional disability and all-cause mortality were higher in both lower and higher BMI subgroups, and the lowest risk was observed in the range of 21-27 kg/m2 in men and 20-25 kg/m2 in women. These associations were independent of age, sex, current smoking and possible confounding factors, including a cardiovascular diseases history, hospitalization during the half-year period before baseline, and baseline comorbidities. A similar association was observed between BMI and all-cause mortality even when individuals who developed functional disabilities before death were excluded from the analysis. CONCLUSIONS Maintaining the bodyweight within the recommended range could be an effective method of reducing the risk of functional disability and mortality. Geriatr Gerontol Int 2021; 21: 1040-1046.
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Affiliation(s)
- Yasuharu Tabara
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan.,Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eiji Nakatani
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Yoshiki Miyachi
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
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3
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Cardoso AS, Xavier MO, Dos Santos Costa C, Tomasi E, Cesar JA, Gonzalez MC, Domingues MR, Barbosa-Silva TG, Bielemann RM. Body mass index and mortality among community-dwelling elderly of Southern Brazil. Prev Med 2020; 139:106173. [PMID: 32592797 DOI: 10.1016/j.ypmed.2020.106173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 05/27/2020] [Accepted: 06/06/2020] [Indexed: 01/27/2023]
Abstract
This study aims to measure the association between body mass index (BMI), comparing two different classifications, and mortality among community-dwelling elderly considering myopenia in Pelotas, Brazil. This is a longitudinal study started in 2014, we followed 1451 elderly people (≥ 60 years) enrolled in the "COMO VAI?" study. BMI was classified according to the World Health Organization (WHO) and the classification with specific cutoff points for older adults. Myopenia was measured by calf circumference (≤33 cm for women and ≤34 cm for men). Cox proportional-hazards models were used to test associations controlling for sociodemographic and behavioral characteristics and number of morbidities. Nearly 10% (N = 145) of the elderly died during almost three years of follow-up. We observed a L-shaped relation between BMI and mortality. Elderly with underweight had a higher mortality risk compared to those with adequate BMI in both classifications. According to the WHO classification, overweight elderly presented protection for mortality (HR: 0.58; 95% CI 0.38-0.87) when compared to those with adequate BMI. Among elderly with myopenia, overweight by WHO continued to protect against mortality, although not significantly, while those with the specific classification underweight presented a higher risk of death compared to those with normal weight (HR: 2.09; 95% CI 1.06-4.14). In conclusion the underweight increased the risk of death in community-dwelling elderly people during a follow-up of three years. The specific classification seemed to be more adequate to indicate risk of mortality in this population. Higher BMI protect against mortality when muscle mass was not considered.
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Affiliation(s)
| | | | | | - Elaine Tomasi
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil
| | - Juraci Almeida Cesar
- Post-Graduate Program in Public Health, Federal University of Rio Grande, Brazil
| | - Maria Cristina Gonzalez
- School of Nutrition, Federal University of Pelotas, Brazil; Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil; Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Brazil
| | | | | | - Renata Moraes Bielemann
- School of Nutrition, Federal University of Pelotas, Brazil; Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil; School of Physical Education, Federal University of Pelotas, Brazil
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4
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Aleixo GFP, Deal AM, Nyrop KA, Muss HB, Damone EM, Williams GR, Yu H, Shachar SS. Association of body composition with function in women with early breast cancer. Breast Cancer Res Treat 2020; 181:411-421. [PMID: 32253683 DOI: 10.1007/s10549-020-05624-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/30/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Advances in breast cancer research are making treatment options increasingly effective and reducing mortality. Body composition is an example of a prognostic tool that can help personalize breast cancer treatments and further increase their effectiveness. In this study, we examine the association of several body composition measures with comorbidities, physical function, and quality of life. METHODS This study is a cross-sectional analysis of 99 women with early breast cancer scheduled for chemotherapy. Univariate regression models were used to identify significant associations of body composition metrics with patient demographics, clinical characteristics, measures of physical function, and patient-reported outcomes (PRO)s. Multivariable modeling was used to evaluate associations adjusted for age. RESULTS Median age was 58 (range 24-83), 27% were non-white, and, 47% were obese (≥ 30 kg/m2). Increasing age was associated with lower Skeletal Muscle Density (SMD) (p = 0.0001), lower Skeletal Muscle Gauge (SMG) (p = 0.0005), and higher Visceral Adipose Tissue (VAT) (p < 0.0001). In patients with a prolonged Timed Up and Go tests (> 14 s), mean VAT was 57.87 higher (p = 0.004), SMD 5.70 lower (p = 0.04), and SMG 325.4 lower (p = 0.02). For each point of higher performance on the Short Physical Performance Battery (SPPB), VAT decreased 12.24 (p = 0.002) and SMD rose 1.22 (p = 0.02). In multivariable analysis adjusting for age, the association of TUG > 14 with higher VAT remained significant (p = 0.02). CONCLUSIONS Suboptimal body composition prior to treatment is associated poor physical function and may be an indicator of clinical importance.
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Affiliation(s)
- G F P Aleixo
- Division of Hematology-Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr., Chapel Hill, NC, USA.
- Unoeste Universidade do Oeste Paulista, Presidente Prudente, São Paulo, SP, Brazil.
| | - A M Deal
- Division of Hematology-Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr., Chapel Hill, NC, USA
| | - K A Nyrop
- Division of Hematology-Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr., Chapel Hill, NC, USA
| | - H B Muss
- Division of Hematology-Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr., Chapel Hill, NC, USA
| | - E M Damone
- Division of Hematology-Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr., Chapel Hill, NC, USA
| | - G R Williams
- Division of Hematology/Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - H Yu
- Division of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S S Shachar
- Ruth and Bruce Rappaport Faculty of Medicine at Technion, Haifa, Israel
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The Burden of Malnutrition among Adults Residing in Arba Minch Health and Demographic Surveillance Site (HDSS): A WHO STEPS Survey. J Nutr Metab 2020; 2020:6986830. [PMID: 32082623 PMCID: PMC7007928 DOI: 10.1155/2020/6986830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/17/2019] [Accepted: 01/08/2020] [Indexed: 01/26/2023] Open
Abstract
Background Malnutrition is one of the main underlying risk factors for the deaths due to different diseases. The aim of this study was to assess the prevalence and factors associated with underweight and overweight among adults residing in Arba Minch Health and Demographic Surveillance Site (HDSS), Southern Ethiopia. Methods A community-based cross-sectional survey was conducted from April to June 2017. The data collection procedures and 3,368 calculated sample size were based on the World Health Organization (WHO) STEPwise approach to Surveillance guideline. Using the surveillance data of Arba Minch HDSS, simple random sampling technique was implemented to identify individuals for the study. To assess the presence of association, the multinomial logistic regression model was used. Results The mean (SD) body mass index of the participants was 21.5 4.90 kg/m2. From 3,346 participants, 23.3% of the study participants were affected by malnutrition (10.8% and 12.5% were overweight and underweight, respectively). The prevalence of underweight was increased significantly among individuals aged 45–54 years and 55–64 years (adjusted odds ratio (AOR) 1.70 and 1.93, respectively) compared with those who were 25–34 years old. Belonging to households with higher wealth index quintile (2nd quintile AOR is 0.58 and 4th quintile AOR is 0.66) has decreased the chance of adult individual to be underweight compared with the poorest households. On the other hand, the prevalence of overweight was significantly higher among females (AOR 1.60), urban residents (AOR 1.72), those with formal education (primary AOR 1.89 and secondary and above AOR 1.94), and higher wealth index (5th quintile AOR 1.87). Conclusion One in five adult individuals was malnourished in the study area. The double burden of malnutrition at the population level is becoming a challenge for this community, as both underweight and overweight are becoming prevalent. Sex, age, residency, educational status, current tobacco use, occupation, and wealth index were identified as important determinates of under- and overweight.
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Woolley C, Thompson C, Hakendorf P, Horwood C. The Effect of Age upon the Interrelationship of BMI and Inpatient Health Outcomes. J Nutr Health Aging 2019; 23:558-563. [PMID: 31233078 DOI: 10.1007/s12603-019-1206-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES There is growing evidence that the relationship between body mass index (BMI - defined as weight in kilograms divided by height in metres squared) and patient outcomes is age-dependent; specifically, a raised BMI may have a protective effect in older adults. This has been demonstrated clearly in the community setting; less clear is the effect of age on this relationship in the inpatient setting. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS Retrospective analysis of 22,903 electronic records for patients discharged from two large public hospitals in South Australia between January 2015 and September 2018 inclusively. Records were retained if the patient's height and weight had been recorded during the admission, BMI was between 10-99 kg/m2 and it was the patient's first admission during that time. Patients were grouped by BMI (<18.5 kg/m2 ("underweight"), 18.5-24.9 kg/m2 ("normal weight"), 25-29.9 kg/m2 ("overweight"), >30 kg/m2 ("obese")) and age (18-59 years, 60-79 years, > 80 years); for each group we measured the relative stay index (RSI) (actual length of stay divided by predicted length of stay), death in hospital and composite adverse outcome after discharge (unplanned readmission within 30 days and/or death within 30 days). RESULTS Underweight patients across all age groups generally experienced significantly poorer outcomes compared to those not underweight. In those aged 18-59 years there were no significant differences in outcomes between the normal weight, overweight and obese groups. In those aged 60-79 years overweight patients had a significantly reduced risk of RSI > 2 compared to those of normal weight (p=0.014), and both overweight and obese patients had a significantly reduced risk of adverse outcome after discharge when compared to those of normal weight (p=0.028 and p=0.009 respectively). In those aged 80 years or older, both overweight and obese patients had a significantly reduced risk of adverse outcome after discharge when compared to those of normal weight (p=0.028 and p=0.013 respectively), and obese patients had a significantly reduced risk of inpatient mortality and RSI >2 when compared to those of normal weight (p=0.027 and p=0.037 respectively). CONCLUSION A BMI > 25 kg/m2 in older patients is associated with reduced risk of prolonged admission, inpatient mortality and adverse outcomes following discharge. This adds to growing evidence that age-specific BMI guidelines are required for adults because the healthiest BMI in the older hospital patient is seemingly not in the range 18.5-24.9 kg/m2.
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Affiliation(s)
- C Woolley
- C Woolley, School of Medicine, University of Adelaide, South Australia, Australia,
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Huang TY, Liang CK, Shen HC, Chen HI, Liao MC, Chou MY, Lin YT, Chen LK. Gait Speed rather than Dynapenia Is a Simple Indicator for Complex Care Needs: A Cross-sectional Study Using Minimum Data Set. Sci Rep 2017; 7:8418. [PMID: 28827697 PMCID: PMC5566363 DOI: 10.1038/s41598-017-08791-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/13/2017] [Indexed: 12/25/2022] Open
Abstract
The impact of dynapenia on the complexity of care for residents of long-term care facilities (LTCF) remains unclear. The present study evaluated associations between dynapenia, care problems and care complexity in 504 residents of Veterans Care Homes (VCHs) in Taiwan. Subjects with dynapenia, defined as low muscle strength (handgrip strength <26 kg), were older adults with lower body mass index (BMI), slow gait speed, and higher numbers of Resident Assessment Protocol (RAP) triggers. After adjusting for age, education, BMI, and Charlson’s comorbidity index (CCI), only age, education, BMI and gait speed were independently associated with higher numbers of RAP triggers, but not dynapenia or handgrip strength (kg). Dividing subjects into groups based on quartiles of gait speed, those with gait speed ≤0.803 m/s were significantly associated with higher complexity of care needs (defined as ≥4 RAP triggers) compared to the reference group (gait speed >1 m/s). Significantly slow gait speed was associated with RAP triggers, including cognitive loss, poor communication ability, rehabilitation needs, urinary incontinence, depressed mood, falls, pressure ulcers, and use of psychotropic drugs. In conclusion, slow gait speed rather than dynapenia is a simple indicator for higher complexity of care needs of older male LTCF residents.
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Affiliation(s)
- Tzu-Ya Huang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiu-Chu Shen
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hon-I Chen
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Mei-Chen Liao
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. .,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan. .,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
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