Background: The impact of body mass index (BMI; kg/m(2)) and waist circumference (WC) on mortality in elderly individuals is controversial and previous research has largely focused on obesity.
Methods: With special attention to the lower BMI categories, associations between BMI and both total and cause-specific mortality were explored in 7604 men and 9107 women aged ≥ 65 years who participated in the Tromsø Study (1994-1995) or the North-Trøndelag Health Study (1995-1997). A Cox proportional hazards model adjusted for age, marital status, education and smoking was used to estimate HRs for mortality in different BMI categories using the BMI range of 25-27.5 as a reference. The impact of each 2.5 kg/m(2) difference in BMI on mortality in individuals with BMI < 25.0 and BMI ≥ 25.0 was also explored. Furthermore, the relations between WC and mortality were assessed.
Results: We identified 7474 deaths during a mean follow-up of 9.3 years. The lowest mortality was found in the BMI range 25-29.9 and 25-32.4 in men and women, respectively. Mortality was increased in all BMI categories below 25 and was moderately increased in obese individuals. U-shaped relationships were also found between WC and total mortality. About 40% of the excess mortality in the lower BMI range in men was explained by mortality from respiratory diseases.
Conclusions: BMI below 25 in elderly men and women was associated with increased mortality. A modest increase in mortality was found with increasing BMI among obese men and women. Overweight individuals (BMI 25-29.9) had the lowest mortality.