The association between body mass index, waist circumference and waist-to-hip-ratio with all-cause mortality in older adults: A systematic review

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-03-28 DOI:10.1016/j.clnesp.2025.03.051

Gabriela Ueta Ortiz , Leonardo Santos Lopes da Silva , Leonardo da Silva Gonçalves , Gabriela Ferreira Abud , Ana Claudia Rossini Venturini , Adelino Sanchez Ramos da Silva , Ellen Cristini de Freitas

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Abstract

Background & aims

The association between anthropometric obesity parameters and all-cause mortality in older adults is of significant interest due to the implications for public health and clinical practice. This systematic review aims to assess and synthesize the literature on the relationship between anthropometric obesity parameters, such as the body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), with all-cause mortality in older adults.

Methods

This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO - CRD42024521886). A systematic search was conducted across five databases: PubMed, EMBASE, Web of Science, SCOPUS, and LILACS. The study included: (1) older adults (≥60 years); (2) an observational-longitudinal study design (prospective and retrospective cohorts); (3) different anthropometric methods for the diagnosis of obesity; and (4) all-cause mortality as an outcome. The National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies was employed to assess the methodological quality of the included studies.

Results

A total of 38 studies were included. Most studies have investigated associations between BMI and all-cause mortality. Among them, 9 studies found no significant association, 25 reported a protective effect, 1 identified BMI as a risk factor, and 4 observed a U-shaped relationship. Regarding WC, the results were conflicting: 15 studies found no association with mortality, 8 identified WC as a risk factor, and 6 suggested a protective effect. As for WHR, although it was the least frequently assessed measure, 8 studies identified it as a risk factor for mortality in older adults, 4 found no significant association, and 1 reported an inverse relationship. These findings highlight discrepancies in the associations between obesity measures and mortality.

Conclusion

BMI appears to be inversely associated with mortality in older adults, while findings for WC remain controversial. WHR demonstrates a positive association with mortality, but further research is needed to confirm these findings. Clinicians should ensure that older patients do not remain at lower BMI thresholds, as higher BMI values appear protective, particularly in the presence of diseases. This recommendation should be made on an individualized basis, considering the individual's health status. Recommendations at the individual level should also consider functional status and body composition measurements. Moreover, WHR may provide additional insights into mortality risk beyond BMI, highlighting its importance for clinical practice. These findings support an integrative approach to monitoring both metrics to better inform preventative strategies and resource allocation for aging populations. Cut-off points for anthropometric measures of obesity should be reassessed and standardized for older adults.

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老年人体重指数、腰围和腰臀比与全因死亡率之间的关系：一项系统综述。

背景与目的：由于对公共卫生和临床实践的影响，人体测量肥胖参数与老年人全因死亡率之间的关系具有重要意义。本系统综述旨在评估和综合有关老年人体重指数（BMI）、腰围（WC）、腰臀比（WHR）等人体测量肥胖参数与全因死亡率之间关系的文献。方法：本系统评价已在国际前瞻性系统评价注册（PROSPERO - CRD42024521886）上注册。系统地检索了五个数据库：PubMed， EMBASE, Web of Science， SCOPUS和LILACS。研究对象包括：(1)老年人（≥60岁）；(2)观察性纵向研究设计（前瞻性和回顾性队列）；(3)不同的人体测量方法诊断肥胖；(4)结果是全因死亡率。采用美国国立卫生研究院的观察性队列和横断面研究质量评估工具来评估纳入研究的方法学质量。结果：共纳入38项研究。大多数研究都调查了BMI和全因死亡率之间的关系。其中，9项研究未发现显著相关性，25项研究报告了保护作用，1项研究将BMI确定为危险因素，4项研究观察到u型关系。关于饮水量，结果是相互矛盾的：15项研究发现与死亡率无关，8项研究认为饮水量是危险因素，6项研究认为有保护作用。至于腰宽比，虽然它是最不常被评估的指标，但有8项研究将其确定为老年人死亡的一个危险因素，4项研究发现没有显著关联，1项研究报告了负相关关系。这些发现强调了肥胖测量和死亡率之间的关联差异。结论：BMI似乎与老年人的死亡率呈负相关，而WC的研究结果仍有争议。WHR显示与死亡率呈正相关，但需要进一步研究来证实这些发现。临床医生应确保老年患者不保持较低的BMI阈值，因为较高的BMI值似乎具有保护作用，特别是在存在疾病的情况下。这一建议应考虑到个人的健康状况，在个体化的基础上提出。个人水平的建议还应考虑功能状态和身体成分测量。此外，WHR可以提供除了BMI之外的更多关于死亡风险的见解，强调其在临床实践中的重要性。这些发现支持采用综合方法监测这两种指标，以便更好地为老龄化人口的预防战略和资源分配提供信息。老年人肥胖人体测量测量的分界点应重新评估和标准化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.