Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2014 Jul 11;9(7):e102589.
doi: 10.1371/journal.pone.0102589. eCollection 2014.

Association of Body Mass Index With All-Cause and Cardiovascular Disease Mortality in the Elderly

Affiliations
Free PMC article
Observational Study

Association of Body Mass Index With All-Cause and Cardiovascular Disease Mortality in the Elderly

Chen-Yi Wu et al. PLoS One. .
Free PMC article

Abstract

Objectives: To evaluate the associations of body mass index (BMI) with all-cause, cardiovascular disease (CVD), and expanded CVD mortality in the elderly.

Design: Observational cohort study.

Setting: Annual physical examination program for the elderly from 2006 to 2010.

Participants: We included 77,541 Taipei residents aged ≥ 65 years (39,365 men and 38,176 women).

Measurements: BMI was categorized as underweight (BMI<18.5), normal weight (18.5 ≤ BMI<25), overweight (25 ≤ BMI<30), grade 1 obesity (30 ≤ BMI<35), or grade 2-3 obesity (BMI ≥ 35). Mortality was ascertained by national death files.

Results: Underweight (hazard ratios [HRs] of all-cause, CVD, and expanded CVD mortality: 1.92, 1.74, and 1.77, respectively), grade 2-3 obesity (HRs: 1.59, 2.36, and 2.22, respectively), older age, male sex, smoking, and high fasting blood sugar were significant predictors of mortality. Meanwhile, being married/cohabitating, higher education, alcohol consumption, more regular exercise, and high total cholesterol were inversely associated with mortality. Multivariate stratified subgroup analyses verified smokers (HRs of all-cause, CVD, and expanded CVD mortality: 3.25, 10.71, and 7.86, respectively, for grade 2-3 obesity), the high triglyceride group (HRs: 5.82, 10.99, and 14.22, respectively for underweight), and patients with 3-4 factors related to metabolic syndrome (HRs: 4.86, 12.72, and 11.42, respectively, for underweight) were associated with mortality.

Conclusion: The associations of BMI with all-cause, CVD, expanded CVD mortality in the elderly are represented by U-shaped curves, suggesting unilateral promotions or interventions in weight reduction in the elderly may be inappropriate. Heterogeneous effects of grades 1 and 2-3 obesity on mortality were observed and should be treated as different levels of obesity.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. HRs for all-cause, CVD, and expanded CVD mortality according to BMI category.
Figure 2
Figure 2. Subgroup analysis of all-cause, CVD, and expanded CVD mortality.

Similar articles

See all similar articles

Cited by 28 articles

See all "Cited by" articles

References

    1. Flegal KM, Carroll MD, Ogden CL, Johnson CL (2002) Prevalence and trends in obesity among US adults, 1999–2000. JAMA 288: 1723–1727. - PubMed
    1. Kumanyika SK, Obarzanek E, Stettler N, Bell R, Field AE, et al. (2008) Population-based prevention of obesity: the need for comprehensive promotion of healthful eating, physical activity, and energy balance: a scientific statement from American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (formerly the expert panel on population and prevention science). Circulation 118: 428–464. - PubMed
    1. Lavie CJ, Milani RV, Ventura HO (2008) Untangling the heavy cardiovascular burden of obesity. Nat Clin Pract Cardiovasc Med 5: 428–429. - PubMed
    1. Yazdanyar A, Newman AB (2009) The burden of cardiovascular disease in the elderly: morbidity, mortality, and costs. Clin Geriatr Med 25: 563–577, vii. - PMC - PubMed
    1. Artham SM, Lavie CJ, Milani RV, Ventura HO (2008) The obesity paradox: impact of obesity on the prevalence and prognosis of cardiovascular diseases. Postgrad Med 120: 34–41. - PubMed

Publication types

MeSH terms

Grant support

This study was supported by the Taiwan Ministry of Education through its “Aim for the Top University Plan,” by the Department of Health of the Taipei City Government (Grant 10301-62-001), and by Taiwan's National Science Council (Grant 98-2314-B-010-015-MY2). This study is based on data from the Taipei City Public Health Database provided by the Department of Health of the Taipei City Government and managed by the Databank for Public Health Analysis. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Feedback