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Cited by 790Obesity, Physical Activity, DietNutrition and Health in AgingCancer Risks and Factors

BMI and all-cause mortality in older adults: a meta-analysis

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Winter, Jane E, MacInnis, Robert J, Wattanapenpaiboon, Naiyana, Nowson, Caryl A·2014·The American Journal of Clinical Nutrition
DOI 10.3945/ajcn.113.068122
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Abstract

Background Whether the association between body mass index (BMI) and all-cause mortality for older adults is the same as for younger adults is unclear.Objective The objective was to determine the association between BMI and all-cause mortality risk in adults ≥65 y of age.Design A 2-stage random-effects meta-analysis was performed of studies published from 1990 to 2013 that reported the RRs of all-cause mortality for community-based adults aged ≥65 y.Results Thirty-two studies met the inclusion criteria; these studies included 197,940 individuals with an average follow-up of 12 y. With the use of a BMI (in kg/m2) of 23.0-23.9 as the reference, there was a 12% greater risk of mortality for a BMI range of 21.0-21.9 and a 19% greater risk for a range of 20.0-20.9 [BMI of 21.0-21.9; HR (95% CI): 1.12 (1.10, 1.13); BMI of 20.0-20.9; HR (95% CI): 1.19 (1.17, 1.22)]. Mortality risk began to increase for BMI >33.0 [BMI of 33.0-33.9; HR (95% CI): 1.08 (1.00, 1.15)]. Self-reported anthropometric measurements, adjustment for intermediary factors, and exclusion of early deaths or preexisting disease did not markedly alter the associations, although there was a slight attenuation of the association in never-smokers.Conclusions For older populations, being overweight was not found to be associated with an increased risk of mortality; however, there was an increased risk for those at the lower end of the recommended BMI range for adults. Because the risk of mortality increased in older people with a BMI <23.0, it would seem appropriate to monitor weight status in this group to address any modifiable causes of weight loss promptly with due consideration of individual comorbidities.

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  • Meta-analyses indicate that the mortality risk of healthy older people is lowest in the overweight range.

    “as meta-analyses indicate that the mortality risk of healthy older people is lowest in the overweight range (279-281).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [280]

    Table 2 and the Discussion (page not supplied) place the lowest estimated mortality risk in the overweight BMI range for adults aged 65 or older. The meta-analysis studied community-dwelling older adults, not a population restricted to healthy people, so the claim's health qualifier is not established by this source. (LLM, conf=0.84)

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  • A meta-analysis including approximately 200,000 individuals aged ≥65 years showed being overweight was not associated with increased risk of mortality and BMIs lower than 23 kg/m2 and higher than 33 kg/m2 were associated with increased risk of mortality, suggesting a U-shaped curve of BMI for mortality.

    “A meta-analysis including approximately 200 000 individuals aged ≥ 65 years showed that being overweight was not associated with an increased risk of mortality and that BMIs lower than 23 kg/m2 and higher than 33 kg/m2 were associated with an increased risk of mortality, suggesting a U-shaped curve of BMI for mortality (11).”

    From Sarcopenic obesity: epidemiology, pathophysiology, cardiovascular disease, mortality, and management (2023) · cites this paper as [11]

  • People living longer with obesity may have associated comorbidity involving musculoskeletal, cardiometabolic and mental health complications, with higher rates of malignancy.

    “People living longer with obesity may have associated comorbidity [16], involving musculoskeletal, cardiometabolic and mental health complications, with higher rates of malignancy [17]”

    From Obesity pharmacotherapy in older adults: a narrative review of evidence (2025) · cites this paper as [16]

  • A meta-analysis concludes that in older populations, being overweight was not found to be associated with an increased risk of mortality.

    “Moreover, another meta-analysis concludes that older populations, being overweight was not found to be associated with an increased risk of mortality [16].”

    From Obesity pharmacotherapy in older adults: a narrative review of evidence (2025) · cites this paper as [16]

  • The effect of obesity on years-of-life-lost is greatest in younger adults, and the magnitude of years lost with obesity decreases with ageing, irrespective of sex, smoking status, physical activity level, or socioeconomic status.

    “although the effect of obesity on years-of-life-lost is greatest in younger adults, and the magnitude of years lost with obesity decreases with ageing [16], irrespective of sex, smoking status, physical activity level, or socioeconomic status [35]”

    From Obesity pharmacotherapy in older adults: a narrative review of evidence (2025) · cites this paper as [16]

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Authors
Winter, J. E., MacInnis, R. J., Wattanapenpaiboon, N., & Nowson, C. A.
Affiliations
Deakin University (AU)
ORCID
Venue
The American Journal of Clinical Nutrition
Publisher
Elsevier BV
Published
2014-04
Volume
99
Issue
4
Pages
875-890
ISSN
0002-9165 (ISSN-L)
DOI
10.3945/ajcn.113.068122
OpenAlex
W2120919020
Cited by
790
References
63
Citations by year
2026: 48 · 2025: 69 · 2024: 84 · 2023: 78 · 2022: 84 · 2021: 93 · 2020: 74 · 2019: 56 · 2018: 50 · 2017: 60 · 2016: 47 · 2015: 34 · 2014: 11 · 2013: 1
FWCI
7.97
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Clinical Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • Own your potential (DEAKIN) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Medicine › Oncology › Cancer Risks and Factors
Keywords
body mass index, all-cause mortality, older adults, overweight, underweight, weight loss, weight status, mortality risk, comorbidities, smoking
MeSH terms
Aged, Aged, 80 and over, Aging, Humans, Longitudinal Studies, Mortality, Obesity, Thinness, Weight Loss, Body Mass Index, Overweight

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