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BMI and all-cause mortality in older adults: a meta-analysis
Open accessAbstract
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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“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]
Experimental — accuracy not yet measuredIn the citing paper
“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]
In the citing paper
“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]
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“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]
In the citing paper
“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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“Body composition analyses have also reported that excess body fat increases all-cause and disease-cause mortality, and people with low lean mass have been found to have higher death rates (4, 5).”
From The role of obesity in sarcopenia and the optimal body composition to prevent against sarcopenia and obesity (2023) · cites this paper as [5]
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Metadata
- Authors
- Winter, J. E., MacInnis, R. J., Wattanapenpaiboon, N., & Nowson, C. A.
- Affiliations
- Deakin University (AU)
- 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)
- 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
- FWCI
- 7.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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 (medical) › 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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