Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-19

L. Kananen; M. Eriksdotter; A. M. Boström; M. Kivipelto; M. Annetorp; C. Metzner; V. Bäck Jerlardtz; M. Engström; P. Johnson; L. G. Lundberg; E. Åkesson; C. Sühl Öberg; S. Hägg; D. Religa; J. Jylhävä; T. Cederholm

doi:10.1016/j.clnu.2021.07.025

Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-19

L. Kananen, M. Eriksdotter, A. M. Boström, M. Kivipelto, M. Annetorp, C. Metzner, V. Bäck Jerlardtz, M. Engström, P. Johnson, L. G. Lundberg, E. Åkesson, C. Sühl Öberg, S. Hägg, D. Religa, J. Jylhävä, T. Cederholm

Health Sciences

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Abstract

Background & aims: Overweight and obesity have been consistently reported to carry an increased risk for poorer outcomes in coronavirus disease 2019 (COVID-19) in adults. Existing reports mainly focus on in-hospital and intensive care unit mortality in patient cohorts usually not representative of the population with the highest mortality, i.e. the very old and frail patients. Accordingly, little is known about the risk patterns related to body mass and nutrition in very old patients. Our aim was to assess the relationship between body mass index (BMI), nutritional status and in-geriatric hospital mortality among geriatric patients treated for COVID-19. As a reference, the analyses were performed also in patients treated for other diagnoses than COVID-19. Methods: We analyzed up to 10,031 geriatric patients with a median age of 83 years of which 1409 (14%) were hospitalized for COVID-19 and 8622 (86%) for other diagnoses in seven geriatric hospitals in the Stockholm region, Sweden during March 2020–January 2021. Data were available in electronic hospital records. The associations between 1) BMI and 2) nutritional status, assessed using the Mini-Nutritional Assessment - Short Form (MNA-SF) scale, and short-term in-geriatric hospital mortality were analyzed using logistic regression. Results: After adjusting for age, sex, comorbidity, polypharmacy, frailty and the wave of the pandemic (first vs. second), underweight defined as BMI<18.5 increased the risk of in-hospital mortality in COVID-19 patients (odds ratio [OR] = 2.30; confidence interval [CI] = 1.17–4.31). Overweight and obesity were not associated with in-hospital mortality. Malnutrition; i.e. MNA-SF 0–7 points, increased the risk of in-hospital mortality in patients treated for COVID-19 (OR = 2.03; CI = 1.16–3.68) and other causes (OR = 6.01; CI = 2.73–15.91). Conclusions: Our results indicate that obesity is not a risk factor for very old patients with COVID-19, but emphasize the role of underweight and malnutrition for in-hospital mortality in geriatric patients with COVID-19.

Original language	English
Pages (from-to)	2973-2979
Journal	CLINICAL NUTRITION
Volume	41
Issue number	12
Early online date	29 Jul 2021
DOIs	https://doi.org/10.1016/j.clnu.2021.07.025
Publication status	Published - 2022
Publication type	A1 Journal article-refereed

Keywords

BMI
COVID-19
Malnutrition
MNA-SF
Mortality
Obesity

Publication forum classification

Publication forum level 2

ASJC Scopus subject areas

Nutrition and Dietetics
Critical Care and Intensive Care Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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1-s2.0-S0261561421003605-mainFinal published version, 868 KBLicence: CC BY

https://urn.fi/URN:NBN:fi:tuni-202205034283Licence: CC BY

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Kananen, L., Eriksdotter, M., Boström, A. M., Kivipelto, M., Annetorp, M., Metzner, C., Bäck Jerlardtz, V., Engström, M., Johnson, P., Lundberg, L. G., Åkesson, E., Sühl Öberg, C., Hägg, S., Religa, D., Jylhävä, J., & Cederholm, T. (2022). Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-19. CLINICAL NUTRITION, 41(12), 2973-2979. https://doi.org/10.1016/j.clnu.2021.07.025

@article{52d68cf7c6dd42f29872e6eea1c76660,

title = "Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-19",

abstract = "Background & aims: Overweight and obesity have been consistently reported to carry an increased risk for poorer outcomes in coronavirus disease 2019 (COVID-19) in adults. Existing reports mainly focus on in-hospital and intensive care unit mortality in patient cohorts usually not representative of the population with the highest mortality, i.e. the very old and frail patients. Accordingly, little is known about the risk patterns related to body mass and nutrition in very old patients. Our aim was to assess the relationship between body mass index (BMI), nutritional status and in-geriatric hospital mortality among geriatric patients treated for COVID-19. As a reference, the analyses were performed also in patients treated for other diagnoses than COVID-19. Methods: We analyzed up to 10,031 geriatric patients with a median age of 83 years of which 1409 (14%) were hospitalized for COVID-19 and 8622 (86%) for other diagnoses in seven geriatric hospitals in the Stockholm region, Sweden during March 2020–January 2021. Data were available in electronic hospital records. The associations between 1) BMI and 2) nutritional status, assessed using the Mini-Nutritional Assessment - Short Form (MNA-SF) scale, and short-term in-geriatric hospital mortality were analyzed using logistic regression. Results: After adjusting for age, sex, comorbidity, polypharmacy, frailty and the wave of the pandemic (first vs. second), underweight defined as BMI<18.5 increased the risk of in-hospital mortality in COVID-19 patients (odds ratio [OR] = 2.30; confidence interval [CI] = 1.17–4.31). Overweight and obesity were not associated with in-hospital mortality. Malnutrition; i.e. MNA-SF 0–7 points, increased the risk of in-hospital mortality in patients treated for COVID-19 (OR = 2.03; CI = 1.16–3.68) and other causes (OR = 6.01; CI = 2.73–15.91). Conclusions: Our results indicate that obesity is not a risk factor for very old patients with COVID-19, but emphasize the role of underweight and malnutrition for in-hospital mortality in geriatric patients with COVID-19.",

keywords = "BMI, COVID-19, Malnutrition, MNA-SF, Mortality, Obesity",

author = "L. Kananen and M. Eriksdotter and Bostr{\"o}m, {A. M.} and M. Kivipelto and M. Annetorp and C. Metzner and {B{\"a}ck Jerlardtz}, V. and M. Engstr{\"o}m and P. Johnson and Lundberg, {L. G.} and E. {\AA}kesson and {S{\"u}hl {\"O}berg}, C. and S. H{\"a}gg and D. Religa and J. Jylh{\"a}v{\"a} and T. Cederholm",

note = "Funding Information: This work was supported financially by the Swedish Research Council grants ( 2016-02317 , 2018–02077 , 2020-06101 ) and the regional agreement on medical training and clinical research between the Stockholm county council and the Karolinska Institutet (ALF), The Strategic Research Area in Epidemiology and Biostatistics grant, and the Academy of Finland through its funding to the Centre of Excellence in Research of Ageing and Care (CoEAgeCare , grant numbers 335870 , 326567 and 336670 ). Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2022",

doi = "10.1016/j.clnu.2021.07.025",

language = "English",

volume = "41",

pages = "2973--2979",

journal = "CLINICAL NUTRITION",

issn = "0261-5614",

publisher = "Elsevier",

number = "12",

}

Kananen, L, Eriksdotter, M, Boström, AM, Kivipelto, M, Annetorp, M, Metzner, C, Bäck Jerlardtz, V, Engström, M, Johnson, P, Lundberg, LG, Åkesson, E, Sühl Öberg, C, Hägg, S, Religa, D, Jylhävä, J & Cederholm, T 2022, 'Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-19', CLINICAL NUTRITION, vol. 41, no. 12, pp. 2973-2979. https://doi.org/10.1016/j.clnu.2021.07.025

TY - JOUR

T1 - Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-19

AU - Kananen, L.

AU - Eriksdotter, M.

AU - Boström, A. M.

AU - Kivipelto, M.

AU - Annetorp, M.

AU - Metzner, C.

AU - Bäck Jerlardtz, V.

AU - Engström, M.

AU - Johnson, P.

AU - Lundberg, L. G.

AU - Åkesson, E.

AU - Sühl Öberg, C.

AU - Hägg, S.

AU - Religa, D.

AU - Jylhävä, J.

AU - Cederholm, T.

N1 - Funding Information: This work was supported financially by the Swedish Research Council grants ( 2016-02317 , 2018–02077 , 2020-06101 ) and the regional agreement on medical training and clinical research between the Stockholm county council and the Karolinska Institutet (ALF), The Strategic Research Area in Epidemiology and Biostatistics grant, and the Academy of Finland through its funding to the Centre of Excellence in Research of Ageing and Care (CoEAgeCare , grant numbers 335870 , 326567 and 336670 ). Publisher Copyright: © 2021 The Authors

PY - 2022

Y1 - 2022

N2 - Background & aims: Overweight and obesity have been consistently reported to carry an increased risk for poorer outcomes in coronavirus disease 2019 (COVID-19) in adults. Existing reports mainly focus on in-hospital and intensive care unit mortality in patient cohorts usually not representative of the population with the highest mortality, i.e. the very old and frail patients. Accordingly, little is known about the risk patterns related to body mass and nutrition in very old patients. Our aim was to assess the relationship between body mass index (BMI), nutritional status and in-geriatric hospital mortality among geriatric patients treated for COVID-19. As a reference, the analyses were performed also in patients treated for other diagnoses than COVID-19. Methods: We analyzed up to 10,031 geriatric patients with a median age of 83 years of which 1409 (14%) were hospitalized for COVID-19 and 8622 (86%) for other diagnoses in seven geriatric hospitals in the Stockholm region, Sweden during March 2020–January 2021. Data were available in electronic hospital records. The associations between 1) BMI and 2) nutritional status, assessed using the Mini-Nutritional Assessment - Short Form (MNA-SF) scale, and short-term in-geriatric hospital mortality were analyzed using logistic regression. Results: After adjusting for age, sex, comorbidity, polypharmacy, frailty and the wave of the pandemic (first vs. second), underweight defined as BMI<18.5 increased the risk of in-hospital mortality in COVID-19 patients (odds ratio [OR] = 2.30; confidence interval [CI] = 1.17–4.31). Overweight and obesity were not associated with in-hospital mortality. Malnutrition; i.e. MNA-SF 0–7 points, increased the risk of in-hospital mortality in patients treated for COVID-19 (OR = 2.03; CI = 1.16–3.68) and other causes (OR = 6.01; CI = 2.73–15.91). Conclusions: Our results indicate that obesity is not a risk factor for very old patients with COVID-19, but emphasize the role of underweight and malnutrition for in-hospital mortality in geriatric patients with COVID-19.

AB - Background & aims: Overweight and obesity have been consistently reported to carry an increased risk for poorer outcomes in coronavirus disease 2019 (COVID-19) in adults. Existing reports mainly focus on in-hospital and intensive care unit mortality in patient cohorts usually not representative of the population with the highest mortality, i.e. the very old and frail patients. Accordingly, little is known about the risk patterns related to body mass and nutrition in very old patients. Our aim was to assess the relationship between body mass index (BMI), nutritional status and in-geriatric hospital mortality among geriatric patients treated for COVID-19. As a reference, the analyses were performed also in patients treated for other diagnoses than COVID-19. Methods: We analyzed up to 10,031 geriatric patients with a median age of 83 years of which 1409 (14%) were hospitalized for COVID-19 and 8622 (86%) for other diagnoses in seven geriatric hospitals in the Stockholm region, Sweden during March 2020–January 2021. Data were available in electronic hospital records. The associations between 1) BMI and 2) nutritional status, assessed using the Mini-Nutritional Assessment - Short Form (MNA-SF) scale, and short-term in-geriatric hospital mortality were analyzed using logistic regression. Results: After adjusting for age, sex, comorbidity, polypharmacy, frailty and the wave of the pandemic (first vs. second), underweight defined as BMI<18.5 increased the risk of in-hospital mortality in COVID-19 patients (odds ratio [OR] = 2.30; confidence interval [CI] = 1.17–4.31). Overweight and obesity were not associated with in-hospital mortality. Malnutrition; i.e. MNA-SF 0–7 points, increased the risk of in-hospital mortality in patients treated for COVID-19 (OR = 2.03; CI = 1.16–3.68) and other causes (OR = 6.01; CI = 2.73–15.91). Conclusions: Our results indicate that obesity is not a risk factor for very old patients with COVID-19, but emphasize the role of underweight and malnutrition for in-hospital mortality in geriatric patients with COVID-19.

KW - BMI

KW - COVID-19

KW - Malnutrition

KW - MNA-SF

KW - Mortality

KW - Obesity

U2 - 10.1016/j.clnu.2021.07.025

DO - 10.1016/j.clnu.2021.07.025

M3 - Article

AN - SCOPUS:85112538425

SN - 0261-5614

VL - 41

SP - 2973

EP - 2979

JO - CLINICAL NUTRITION

JF - CLINICAL NUTRITION

IS - 12

ER -

Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-19

Abstract

Keywords

Publication forum classification

ASJC Scopus subject areas

UN SDGs

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