Randomized trial results of alerting primary clinicians to severe weight loss among older adults in the Low Indexes of Metabolism Intervention Trial part A

Abstract

Aim To test whether alerting clinicians to severe weight loss in older patients leads to higher dietitian visit rates, to higher body mass index (BMI) levels and, mainly, to lower annual death risk. Methods The randomized controlled trial included patients aged ≥75 years, with BMI ≤23 kg/m2 that decreased ≥2 kg/m2 during the previous 2 years. All participants received usual care. Additionally, an email alert was sent only to clinicians of participants assigned to the email alert group. The follow‐up period was 12 months. Results Among 706 participants (mean age 83 ± 6 years; mean baseline BMI 20.5 kg/m2), the BMI record was updated in 541 (77%) participants, and 123 participants died. Dietitian visits were reported for 22 patients (6%) in the email group (n = 362) and 14 patients (4%) in the control group (n = 344; OR 1.5, 95% CI 0.8–2.9; P = 0.24). Measured BMI were raised by a mean of 0.69 (95% CI 0.43–0.95) kg/m2 versus 0.79 (95% CI 0.48–1.1) kg/m2 (P = 0.63). A total of 77 patients (21%) died in the intervention group versus 47 (14%) in the control group (P = 0.008; number needed to harm = 13; 95% CI 7–43). Conclusions In this trial, alerting clinical staff to severe weight loss in patients aged ≥75 years was not associated with higher visit rates to a dietitian or change in BMI, but was associated with a significantly higher death rate than usual clinical care. Geriatr Gerontol Int 2020; 20: 329–335.

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

“…In summary, the results from other populations for both long‐term (nine studies 93,143,178,182–187 ; 31,812 participants; Table S2; Figure S1) and short‐term (six studies 93,188–192 ; 517,818 participants; Figure S2) outcomes were similar to that of the categorized populations. Mortality risk was not significantly associated with BMI.…”

“…In summary, the results from other populations for both long-term (nine studies 93,143,178,[182][183][184][185][186][187] ; 31,812 participants; Table S2;…”