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The prognostic value of body-mass index on mortality in older adults with dementia living in nursing homes.
Clin Nutr. 2017 04; 36(2):423-428.CN

Abstract

BACKGROUND & AIMS

A protective effect of obesity on death has been reported in the context of various co-morbidities. We studied if the obesity paradox applied to nursing home (NH) older residents according to dementia status.

METHODS

Prospective data from 3741 NH residents from France. All-cause mortality was the dependent measure. Subjects were categorized according with body mass index (BMI) as underweight, normal-weight, overweight, and obese. Dementia status was obtained from medical charts. Cox regressions were performed.

RESULTS

There were 344 (9.2%) residents who were underweight, 1367 (43.8%) normal weight, 1069 (28.6%) overweight and 691 (18.5%) obese. 1083 (28.9%) people died during follow-up. In residents with dementia, mortality risk was reduced by almost half in overweight and obese people (HRs of 0.60 [0.48-0.76] and 0.53 [0.38-0.75], respectively; p < 0.001), and increased in underweight (HR = 1.65 [1.29-2.12]; p < 0.001) compared to normal-weight residents; moreover, each 1 kg/m2 increase in BMI decreased the risk of death by 12% and 9% in underweight and normal-weight subjects with dementia. For people without dementia, mortality risk was reduced in overweight and obese people (HRs of 0.80 [0.65-0.99], p = 0.042, and 0.77 [0.60-0.99], p = 0.044, respectively) compared to normal-weight; the 1-unit increase in BMI reduced the risk of death (23% reduction) only in underweight people.

CONCLUSIONS

This study showed that the presence of dementia amplifies the obesity paradox in very old and functionally limited NH residents. Therefore, weight loss in NH residents, particularly in people with dementia, should be considered with extreme caution even for obese people.

Authors+Show Affiliations

Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU-Toulouse), Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France. Electronic address: philipebarreto81@yahoo.com.br.Clinique des Minimes, Toulouse, France.Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU-Toulouse), Toulouse, France.Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU-Toulouse), Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France.Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU-Toulouse), Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26724185

Citation

de Souto Barreto, Philipe, et al. "The Prognostic Value of Body-mass Index On Mortality in Older Adults With Dementia Living in Nursing Homes." Clinical Nutrition (Edinburgh, Scotland), vol. 36, no. 2, 2017, pp. 423-428.
de Souto Barreto P, Cadroy Y, Kelaiditi E, et al. The prognostic value of body-mass index on mortality in older adults with dementia living in nursing homes. Clin Nutr. 2017;36(2):423-428.
de Souto Barreto, P., Cadroy, Y., Kelaiditi, E., Vellas, B., & Rolland, Y. (2017). The prognostic value of body-mass index on mortality in older adults with dementia living in nursing homes. Clinical Nutrition (Edinburgh, Scotland), 36(2), 423-428. https://doi.org/10.1016/j.clnu.2015.12.009
de Souto Barreto P, et al. The Prognostic Value of Body-mass Index On Mortality in Older Adults With Dementia Living in Nursing Homes. Clin Nutr. 2017;36(2):423-428. PubMed PMID: 26724185.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The prognostic value of body-mass index on mortality in older adults with dementia living in nursing homes. AU - de Souto Barreto,Philipe, AU - Cadroy,Yves, AU - Kelaiditi,Eirini, AU - Vellas,Bruno, AU - Rolland,Yves, Y1 - 2015/12/18/ PY - 2015/01/05/received PY - 2015/11/09/revised PY - 2015/12/11/accepted PY - 2016/1/3/pubmed PY - 2018/3/1/medline PY - 2016/1/3/entrez KW - Mortality KW - Nursing home KW - Obesity paradox KW - Older adults KW - Overweight KW - Underweight SP - 423 EP - 428 JF - Clinical nutrition (Edinburgh, Scotland) JO - Clin Nutr VL - 36 IS - 2 N2 - BACKGROUND & AIMS: A protective effect of obesity on death has been reported in the context of various co-morbidities. We studied if the obesity paradox applied to nursing home (NH) older residents according to dementia status. METHODS: Prospective data from 3741 NH residents from France. All-cause mortality was the dependent measure. Subjects were categorized according with body mass index (BMI) as underweight, normal-weight, overweight, and obese. Dementia status was obtained from medical charts. Cox regressions were performed. RESULTS: There were 344 (9.2%) residents who were underweight, 1367 (43.8%) normal weight, 1069 (28.6%) overweight and 691 (18.5%) obese. 1083 (28.9%) people died during follow-up. In residents with dementia, mortality risk was reduced by almost half in overweight and obese people (HRs of 0.60 [0.48-0.76] and 0.53 [0.38-0.75], respectively; p < 0.001), and increased in underweight (HR = 1.65 [1.29-2.12]; p < 0.001) compared to normal-weight residents; moreover, each 1 kg/m2 increase in BMI decreased the risk of death by 12% and 9% in underweight and normal-weight subjects with dementia. For people without dementia, mortality risk was reduced in overweight and obese people (HRs of 0.80 [0.65-0.99], p = 0.042, and 0.77 [0.60-0.99], p = 0.044, respectively) compared to normal-weight; the 1-unit increase in BMI reduced the risk of death (23% reduction) only in underweight people. CONCLUSIONS: This study showed that the presence of dementia amplifies the obesity paradox in very old and functionally limited NH residents. Therefore, weight loss in NH residents, particularly in people with dementia, should be considered with extreme caution even for obese people. SN - 1532-1983 UR - https://www.unboundmedicine.com/medline/citation/26724185/The_prognostic_value_of_body_mass_index_on_mortality_in_older_adults_with_dementia_living_in_nursing_homes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0261-5614(15)00347-7 DB - PRIME DP - Unbound Medicine ER -