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

Mortality risk relationship using standard categorized BMI or knee-height based BMI - does the overweight/lower mortality paradox hold true?

BACKGROUND

The body mass index (BMI) is prone to misclassification of obesity due to age-related height loss and resulting measurement errors. Knee-height based BMI (KH-BMI) has not been previously studied in relation to mortality risk in older adults.

AIM

To evaluate the age- and sex-specific mortality risk relationship using classic BMI and knee height predicted BMI (KH-BMI) overweight and obesity in a 15-year follow-up study including older Swedish adults aged 60-93 years.

METHODS

A 15-year follow-up study among 2,786 individuals aged ≥ 60 years. Height, weight and KH were measured. KH-predicted height was estimated using formulated gender-specific equations. Classic BMI and KH-BMI (kg/m2) were calculated. Mortality data was obtained from the Swedish death registry. Questionnaires were used to collect data on obesity-related lifestyle factors and comorbidities.

RESULTS

Cox regression revealed that using the classic BMI, when comparing with the normal/underweight reference group, there was a mortality risk among overweight men (HR = 0.67, 0.52-0.87), overweight women (HR = 0.79, 0.65-0.97), and obese men (HR = 0.60, 0.41-0.89) aged ≥ 80 years old. Using the KH-BMI, only overweight men and overweight women aged ≥ 80 years had a lower mortality risk, men (HR = 0.71, 0.55-0.92); women (HR = 0.77, 0.62-0.95) after adjusting for obesity-related lifestyle factors and comorbidities.

DISCUSSION

There is evidence that obesity is overestimated by the BMI, in comparison with the KH-BMI classification. In terms of mortality risk and after adjusting for height, there remains a paradoxical protective association between overweight and mortality.

CONCLUSION

Regardless of classic BMI or KH-BMI estimation, overweight men and women aged ≥ 80 years had a lower mortality risk compared to normal/underweight men and women ≥ 80 years.

Association of body mass index with long-term outcomes in older adults hospitalized for COVID-19: an observational study

Both underweight and obesity have been associated with poor prognosis in COVID-19. In an older populations of patients hospitalized for SARS-CoV-2 infection, we aimed to evaluate the association between body mass index (BMI) and short and long-term prognosis. Among 434 consecutive patients aged ≥ 70 years and hospitalized for suspected COVID-19 at a university hospital, 219 patients (median age of 83 years, 53% male) testing positive for COVID-19 and for whom BMI was recorded at admission, agreed to participate. Among them, 39 had a BMI < 20 kg/m2, 73 had a BMI between 20 and 24.9 kg/m2 and 107 had a BMI ≥ 25 kg/m2. After adjustment for confounders, BMI < 20 kg/m2 was associated with a higher risk of one-year mortality (hazard ratio (HR) [95% confidence interval]: 1.75 [1.00-3.05], p = 0.048), while BMI ≥ 25 kg/m2 was not (HR: 1.04 [0.64-1.69], p = 0.9). However, BMI was linearly correlated with both in-hospital acute respiratory failure (p = 0.02) and cardiovascular events (p = 0.07). In this cohort of older patients hospitalized for COVID-19, low BMI, rather than high BMI, appears as an independent risk factor for death after COVID-19. The pathophysiological patterns underlying this excess mortality remain to be elucidated.

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.

Association of Nutritional Status and Diet Diversity with Skeletal Muscle Strength and Quality of Life among Older Arab Adults: A Cross-Sectional Study

There is little research evaluating skeletal muscle strength, nutritional status, and quality of life in older Arab adults. This study examined the association of nutritional status with skeletal muscle strength and quality of life among older adults living in Saudi Arabia. A cross-sectional study was conducted among older adults (n = 166 older adults; 57.8% females) who visited primary outpatient clinics at King Khalid University Hospital in Riyadh City. Sociodemographic data, Mini Nutritional Assessment short-form (MNA-SF), diet variety score (DVS), and health-related quality of life (HR-QoL) were assessed. Furthermore, handgrip strength (HGS) and knee extension strength (KES) were measured to evaluate skeletal muscle strength. Malnourishment and risk of malnutrition were found in 16.9% of our sample. Nutritional status was significantly associated with muscle strength and HR-QoL (p < 0.05). The well-nourished group had higher HGS, KES, and total HR-QoL scores compared to the at risk of malnutrition or malnourished group. Moreover, there was a moderate positive correlation between MNA-SF and total HR-QoL scores (r = 0.40). The percentage of individuals in the well-nourished group categorized with a high or moderate DVS was significantly higher than those at risk of malnutrition or are malnourished; however, DVS was not associated with muscle strength and HR-QoL. The MNA-SF score had a significant positive correlation with HGS (r = 0.30) and KES (r = 0.23). An increase in the MNA-SF score was significantly associated with higher odds of being moderate/high (HGS and HR-QoL) in the crude and adjusted models. In conclusion, maintaining adequate nutritional status is beneficial for preserving skeletal muscle strength and promoting better HR-QoL among older individuals. Therefore, applications of appropriate nutritional and muscle strength assessments in geriatric care institutions are recommended.

Cluster analysis for the overall health status of elderly, multimorbid patients with diabetes

Purpose

To evaluate the overall health status and health-related abilities and problems of elderly patients with diabetes and multimorbidity compared with those with diabetes only. Additionally, we aimed to identify different subgroups of elderly, multimorbid patients with diabetes.

Methods

This cross-sectional study included 538 elderly patients with diabetes. The participants completed a series of questionnaires on self-rated health (SRH), diabetes self-management, self-efficacy, health literacy, depression, and diabetes distress. Differences in health-related abilities and problems were compared between elderly patients with diabetes and multimorbidity and those with diabetes only, with adjustments for covariates using propensity score matching. A cluster analysis was also performed to identify the overall health status subgroups of elderly, multimorbid patients with diabetes. Additionally, we conducted a multinomial logistic regression analysis to examine the predictors of health-related abilities and problem-cluster group membership.

Results

Elderly patients with diabetes and multimorbidity experienced more health-related abilities and problems than those with diabetes only, particularly within the domains of depression (p &lt; 0.001), and diabetes distress. The level of health literacy (p &lt; 0.001) and self-management (p = 0.013) in elderly, multimorbid patients with diabetes was also significantly higher than that in elderly patients with diabetes only. Cluster analysis of elderly, multimorbid patients with diabetes revealed three distinct overall health status clusters. Multinomial logistic regression analysis indicated that age (OR = 1.090, p = 0.043), sex (OR = 0.503, p = 0.024), living situation (OR = 2.769, p = 0.011), BMI (OR = 0.838, p = 0.034), regular exercise (OR = 2.912, p = 0.041 in poor vs. good; OR = 3.510, p &lt; 0.001 in intermediate vs. good), and cerebral infarction (OR = 26.280, p &lt; 0.001) independently and significantly predicted cluster membership.

Conclusion

Compared with elderly patients with diabetes only, those with diabetes and multimorbidity experienced more health-related abilities and problems within the domains of depression, and diabetes distress. Additionally, the level of health literacy and self-management in elderly, multimorbid patients with diabetes was significantly higher than that in those with diabetes only. Among the multimorbid diabetes group, old age, male sex, living without a partner, slightly lower BMIs, not exercising regularly, and experiencing cerebral infarctions were all positively correlated with worse overall health status.