Body mass index and mortality among hospitalized patients

Background: Body mass index (weight in kilograms divided by the square of t he height in meters [BMI]) is known to be associated with overall mortality . However, the effect of age on excess mortality from all causes associated with obesity is controversial. The aim of the present study is to determin e the effect of age on the relationship between BMI and mortality. Methods: We analyzed data from a large collaborative observational study gr oup, the Italian Group of Pharmacoepidemiology in the Elderly (GIFA), that collected data on hospitalized patients. A total of 18316 patients consecut ively admitted to 79 clinical centers during 5 different surveys in 1998, 1 991, 1993, 1995, and 1997 were enrolled in the present study. The main outc ome measure was the relative hazard ratio of death for different levels of BMI. Results: Mortality rate was lowest among men and women with BMIs from 25.0 through 27.4 kg/m(2) (relative risk, 0.24; 95% confidence interval, 0.15-0. 38). The graphed relationship between BMI and mortality in younger patients was hyperbolic, with increased death rates at the lowest and highest BMI r ankings. On the contrary, the older patients showed an increased death rate at the lowest BMIs with only a slight elevation at the highest BMIs (>35 k g/m(2)). Conclusions: Our results suggest that BMI, a simple anthropometric measure of nutritional status, is an important predictor of mortality among young a nd old hospitalized patients. Even when controlling for clinical and functi onal variables, a low BMI remained a significant and independent predictor of shortened survival. Furthermore, the finding of the high BMI associated with minimum hazard in elderly subjects supports some past findings and opp oses others and, if confirmed, has important implications for geriatric cli nical guidelines.