Abstract
Objectives
We examined the dose-response relationships of body composition indices with mortality
and identified the best predictor.
Design and setting
Kusatsu Longitudinal Study and Hatoyama Cohort Study, Japan.
Participants
In total, 1977 community-dwelling Japanese adults age ≥65 years (966 men and 1011
women) participated.
Measurements
Body mass index (BMI), fat mass index (FMI), fat-free mass index (FFMI), and skeletal
muscle mass index (SMI) were determined by segmental multifrequency bioelectrical
impedance analysis. The main outcome was all-cause mortality. We determined multivariate-adjusted
hazard ratios for mortality relative to sex-specific medians of each body composition
index and examined the association shapes.
Results
During the median follow-up of 5.3 years, 128 (13.3%) men and 75 (7.4%) women died.
Compared with median BMIs (23.3 kg/m2 in men and 22.8 kg/m2 in women), a BMI >23.3 and ≤26.1 kg/m2 was associated with significantly lower mortality risk in men, and a BMI <22.8 kg/m2 was associated with significantly higher mortality risk in women. The inverse dose-response
relationship with mortality was clearer for FFMI [hazard ratios (95% confidence interval)
of 10th and 90th percentiles: 1.58 (1.23–2.03) and 0.58 (0.44–0.79), respectively,
in men and 1.56 (1.12–2.16) and 0.68 (0.51–0.91), respectively, in women] and SMI
[1.57 (1.22–2.01) and 0.60 (0.45–0.80), respectively, in men and 1.45 (1.05–2.01)
and 0.77 (0.61–0.96), respectively, in women] than for BMI [1.30 (0.92–1.83) and 0.65
(0.41–1.03), respectively, in men and 1.87 (1.18–2.95) and 0.88 (0.54–1.42), respectively,
in women]. FMI was not associated with mortality in either sex.
Conclusions and Implications
FFMI and SMI were more definitive predictors of mortality than were BMI and FMI. The
lower mortality risk with higher FFMI, regardless of FMI, may explain the age-related
weakening of the association between higher BMI and mortality (the “obesity paradox”).
FFMI and SMI evaluation should be introduced to clinical assessments of older adults
because mortality risk might be reduced by maintaining muscle mass.
Keywords
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Article info
Publication history
Published online: February 14, 2020
Footnotes
This study was supported by grants from Tokyo Metropolitan Institute of Gerontology; Research Institute of Science and Technology for Society; the Japan Science and Technology Agency; Grants-In-Aid for Scientific Research (B) JP20390190, (B) JP21390212, (B) JP24390173, and (B) JP26310111 from the Ministry of Education, Culture, Sports, Science and Technology, Japan; the Japan Arteriosclerosis Prevention Fund for the Japan Arteriosclerosis Longitudinal Study (2001-2012); and the towns of Kusatsu and Hatoyama.
The authors declare no conflicts of interest.
Identification
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© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
