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The obesity paradox is mostly driven by decreased noncardiovascular disease mortality in the oldest old in China: a 20-year prospective cohort study
Abstract
National and international recommendations of healthy body mass index (BMI) are primarily based on evidence in young and middle-aged populations, with an insufficient representation of the oldest old (aged ≥80 years). Here, we report associations between BMI and mortality risk in 27,026 community-dwelling oldest old (mean age, 92.7 ± 7.5 years) in China from 1998 to 2018. Nonlinear curves showed reverse J-shaped associations of BMI with cardiovascular disease (CVD), non-CVD and all-cause mortality, with a monotonic decreased risk up to BMIs in the overweight and mild obesity range and flat hazard ratios thereafter. Compared to normal weight, overweight and obesity were significantly associated with decreased non-CVD and all-cause mortality, but not with CVD mortality. Similar associations were found for waist circumference. Our results lend support to the notion that optimal BMI in the oldest old may be around the overweight or mild obesity range and challenge the application of international and national guidelines on optimal BMI in this age group.
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“A recent cohort study indicated that increased body mass index (BMI) was associated with lower all-cause and non-cardiovascular disease mortality in Chinese old people (2).”
From The role of obesity in sarcopenia and the optimal body composition to prevent against sarcopenia and obesity (2023) · cites this paper as [2]
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“It is well known that BMI only considers body mass rather than body composition, which may not be appropriate for old individuals (2)”
From The role of obesity in sarcopenia and the optimal body composition to prevent against sarcopenia and obesity (2023) · cites this paper as [2]
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Self-citation
Metadata
- Authors
- Lv, Y., Mao, C., Gao, X., Ji, J. S., Kraus, V. B., Yin, Z., Yuan, J., Chen, H., Luo, J., Zhou, J., Li, Z., Duan, J., Zhu, Q., Zeng, Y., Wang, W., Wang, J., & Shi, X.
- Affiliations
- Chinese Center For Disease Control and Prevention (CN)
- Southern Medical University (CN)
- Fudan University (CN)
- Duke University (US)
- Emory University (US)
- Corresponding author
- Shi, Xiaoming
- ORCID
- Venue
- Nature Aging
- Published
- 2022-04-25
- Volume
- 2
- Issue
- 5
- Pages
- 389-396
- ISSN
- 2662-8465 (ISSN-L)
- OpenAlex
- W4224310527
- Cited by
- 102
- References
- 48
- Citations by year
- 2026: 19 · 2025: 23 · 2024: 33 · 2023: 20 · 2022: 7
- FWCI
- 12.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nature Aging (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Physiology (medical) › Body Composition Measurement Techniques
- Keywords
- obesity paradox, body mass index, oldest old, mortality, cardiovascular mortality, all-cause mortality, waist circumference, overweight, mild obesity, community-dwelling older adults, China
- MeSH terms
- Obesity Paradox, Aged, 80 and over, Cardiovascular Diseases, China, Humans, Middle Aged, Obesity, Prospective Studies, Risk Factors, Overweight
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