Thursday, August 20, 2009

Old and in is better to be fat!

Carrying on the theme thinking about age, this has just been published which I thought was interesting.

For old people in hospital, it is actually better for them to be fatter.

Fat mass protects hospitalized elderly persons against morbidity and mortality

Background: It is well established that the combination of protein-energy malnutrition and low body mass index (BMI) increases the risk of death in elderly patients, but recent studies indicate that the risk of death may decrease with higher body weight. However, these studies did not perform direct, separate, and reliable measurements of fat and lean mass by using a reference technique.

Objective: Our objective was to evaluate the relation between body composition, based on the 4-compartment model, and morbidity and mortality in hospitalized elderly patients.

Design: This prospective study enrolled 125 elderly patients evaluated at admission for body composition on the basis of BMI plus fat mass, lean mass, appendicular skeletal muscle mass, and body cell mass indexes (calculated as the ratio of the mass to the square of the height) measured by X-ray absorptiometry and bioelectrical impedance analysis. Outcomes were assessed 6 mo later by using a score system that takes into account complications (pressure ulcers and/or infections) and 6-mo mortality.

Results: The fat mass index correlated positively (r = 0.19 and P = 0.023 adjusted for sex; r = 0.18 and P = 0.043 adjusted for sex, albuminemia, and C-reactive protein) with outcome score (1: death, 2: complications, 3: no complications). There was no significant correlation between outcome score and BMI, lean mass, appendicular skeletal muscle mass, and body cell mass indexes.

Conclusions: This study clearly indicates that the generally accepted rule that overweight is associated with morbidity and mortality does not apply to hospitalized elderly patients, for whom fat mass is associated with a decreased risk of adverse events.


Anonymous said...

You can read up about Obesity paradoxes here:

strongerfasterfarther said...

Interesting study. Having had 5 relatives in their 80s-90s spend some time in the hospital over the past 10 years, I can definitely understand why this is: the minute they were hospitalized all 5 quit eating.
1) An act of defiance - asserting control over the last part of their lives that they could still control.
2) The meds they were taking reduced appetite.
3) Embarrassment over having to wear a diaper and be changed, so nothing in = nothing out.
Add to that the fact that the hospital food was pretty terrible and it makes sense to me that folks with more fat reserves do better.

Billy Oblivion said...

In addition to the stuff that sff makes, hospital routines are AWFUL. Patients, who are by definition sick or injuried, are woken up a couple times a night to get their "vitals" (if a good nights sleep is very important for recovering from a workout, what is it for recovering from a broken hip or MSRA?) or to give them medications?

I'm a big fan of our health care system--given it's various inputs (lazy disinterested people etc.) it's outputs are pretty good.

But there ARE things it could do better.

Oh, and I've worked in hospital food kitchens a couple times in my youth, and yeah, the food is AWFUL.


AT22 said...

Where do you go with a study like this? Possibly address the problem of the morbidity rate? Did this study need to be done for that?

This study baffles me.