Zhou Wei, Kozikowski Andrzej, Pekmezaris Renee, Lolis James, Tommasulo Barbara, Fishbein Joanna, Wolf-Klein Gisele
From the Division of Geriatric and Palliative Medicine, Northwell Health, Manhasset, the Department of Medicine, Northwell Health, Great Neck, and the Division of Biostatistics, Feinstein Institute for Medical Research, Manhasset, New York.
South Med J. 2017 Jul;110(7):459-465. doi: 10.14423/SMJ.0000000000000673.
Despite the numerous health risks associated with being overweight, the effect of weight loss on health and longevity remains controversial, particularly in older adults. We explored the association among weight changes, health outcomes, and mortality in older residents of a skilled nursing facility.
A 6-year retrospective chart review of residents of a long-term care facility was conducted, collecting monthly weights in addition to the clinical and demographic data of all residents for at least 1 year. Weight changes of 5% from baseline month 1 through month 12 were classified as stable, loss, or gain. Demographics, body mass index (BMI), comorbidities, number of hospitalizations, and mortality were analyzed. The association between weight change (and other demographic and clinical variables) and mortality outcomes, as well as number of hospitalizations, was assessed using the χ test, the Fisher exact test, Poisson regression, or negative binomial regression, as appropriate.
A total of 116 residents fit inclusion criteria; the median age was 84 years, with 71.6% being women and 88.7% white. The median length of stay was 877.5 days. Median body weight at baseline was 137.3 lb with a BMI of 23.5. More than one-third (36.2%) of residents had stable weight, 37.9% gained weight, and 25.9% lost weight during their stay. Neither weight change category nor baseline BMI was significantly associated with mortality ( = 0.056 and = 0.518, respectively). Multivariable models showed that receiving supplementation ( = 0.04) and having hypertension ( = 0.04) were significant predictors of mortality after adjusting for the other factors. Losing >5% body weight (compared with maintaining stable weight; = 0.0097), being a man ( = 0.0104), receiving a supplement ( = 0.0171), and being fed by tube ( = 0.0004) were associated with an increased number of hospitalizations after covariate adjustment.
Weight fluctuation and baseline BMI do not appear to be associated with increased risk of death in residents in a skilled nursing facility. Weight loss was associated with an increased number of hospitalizations, however.
尽管超重存在诸多健康风险，但体重减轻对健康和长寿的影响仍存在争议，尤其是在老年人中。我们探讨了专业护理机构中老年居民体重变化、健康状况和死亡率之间的关联。
对一家长期护理机构的居民进行了为期6年的回顾性病历审查，除收集所有居民至少1年的临床和人口统计学数据外，还收集每月体重数据。从基线第1个月到第12个月体重变化5%被分类为稳定、减轻或增加。分析了人口统计学、体重指数（BMI）、合并症、住院次数和死亡率。根据情况，使用χ检验、Fisher精确检验、泊松回归或负二项回归评估体重变化（以及其他人口统计学和临床变量）与死亡率结果以及住院次数之间的关联。
共有116名居民符合纳入标准；中位年龄为84岁，女性占71.6%，白人占88.7%。中位住院时间为877.5天。基线时的中位体重为137.3磅，BMI为23.5。超过三分之一（36.2%）的居民体重稳定，37.9%体重增加，25.9%体重减轻。体重变化类别和基线BMI均与死亡率无显著关联（分别为P = 0.056和P = 0.518）。多变量模型显示，在调整其他因素后，接受补充剂（P = 0.04）和患有高血压（P = 0.04）是死亡率的显著预测因素。体重减轻>5%（与体重保持稳定相比；P = 0.0097）、男性（P = 0.0104）、接受补充剂（P = 0.0171）和通过管饲喂养（P = 0.0004）与协变量调整后住院次数增加相关。
在专业护理机构的居民中，体重波动和基线BMI似乎与死亡风险增加无关。然而，体重减轻与住院次数增加相关。
