O-64 The Obesity Paradox in Older Adults: a Counterintuitive Phenomenon. A Cohort Study and Systematic Review
Author(s):
M Dramé, L Godaert
Year of Presentation:
2025
Objective: To analyse the role of BMI in different mortality timepoints, and realise a systematic review in order to
summarise the knowledge in the literature on the obesity
paradox (OP) phenomenon in older adults
Methods: The prospective study included adults over the age of 75 years hospitalised via the emergency department. They underwent a comprehensive geriatric assessment, and were followed up for 24 months. BMI was used to determine four groups: <18.0 kg/m2; 18-24.9 kg/m2; 25-29. 9 kg/m2 and ≥30.0 kg/m2. The systematic review was based on the PRISMA guidelines. The main outcome was death.
Results: In all, 1306 subjects were included in the cohort (age=85±6 years). By Cox analysis, 12- and 24-month mortality were inversely associated with a BMI >30 kg/m2 (HR=0.8, 95%CI=0.6-1.0, p=0.05; HR=0.8, 95%CI=0.6- 1.0, p=0.03, respectively). Six-week mortality was not significantly associated with BMI. In the systematic review, 58 studies were included. Of these, 38 found evidence of the OP. Regarding timepoints, 7 out of the 9 studies that looked at short-term mortality found evidence of the OP. Of the 28 studies that examined longer-term mortality, 15 found evidence of the OP. In the studies that included people with a specific medical condition (n=24), there was OP in 18 cases. In studies with no specific medical condition (n=34), there was OP in 17 cases.
Conclusion: Our findings seem to support existence of the OP in older adults mainly when they have comorbidities and/or an acute event. Nonetheless, as BMI does not really reflect body composition, the term “BMI paradox” would be more suitable.