Abstract:
Background Obesity is a significant public health issue，as obesity and being overweight are risk factors for various chronic diseases. However，the "obesity paradox" proposed in recent years has garnered widespread attention. The relationship between Body Mass Index（BMI）and mortality in the elderly remains unclear. Objective To explore the impact of BMI on mortality in the elderly in China. Methods The demographic features，BMI，chronic diseases and laboratory tests among the elderly at ages of 60 years and greater were recruited from April 2015 to December 2015. The patients were followed up with a cut-off date of April 30，2024，with all-cause mortality and death from cardiovascular causes as the endpoint events. A multivariable Cox proportional hazards regression model was used to examine the association between BMI and the risk of death. Results otally 599 subjects were enrolled，including 477 men（79.6%）and an average age of （77±8） years. There were 18 subjects（3.0%）with underweight，273（45.6%）with overweight and 87（14.5%）with obesity. During the follow-up period（8.81 years），158 subjects died. Restricted cubic splines revealed a U-shaped association between BMI and mortality. Multivariable Cox proportional hazards regression analysis revealed an increased risk of all-causes mortality among the underweight elderly（HR=2.76，95%CI=1.37-5.55）after adjustment for age，gender，chronic diseases，and so on. Additionally，a low BMI is an independent risk factor for cardiovascular event mortality in the elderly（HR=5.55，95%CI=1.83-16.78）. However，no association was observed between overweight and obesity and death. Conclusion The relationship between BMI and mortality forms a U-shaped curve，with underweight being an independent risk factor for mortality in the elderly. No association has been found between being overweight/obese and an increased risk of mortality. Therefore，attention should be given to weight management in the elderly.
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