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Epidemiology and population health

The relationship between body mass index and disability-free survival in elderly Japanese: the Ohsaki Cohort 2006 Study



The relationship between body mass index (BMI) and disability-free survival (DFS) remains unclear.


We conducted a 10-year prospective cohort study of 12,666 Japanese individuals aged ≥ 65 y. Information on BMI and lifestyle factors was collected via a questionnaire in 2006. Functional disability data were retrieved from the public Long-term Care Insurance database. Subjects were divided into seven groups according to BMI (<19, 19−21, 21−23, 23−25, 25−27, 27−29 and ≥29). Fiftieth percentile differences (PDs) and 95% confidence intervals (CIs) in the DFS period (differences of period until the first 50% of the composite outcome (disability or death) occurred in each of the BMI groups) were calculated using the Laplace regression model.


There was a U-shaped relationship between BMI and the risk of incident composite outcome, with a BMI nadir of 25−27. Based on BMI 25−27 as a reference, the 50th PDs (95% CIs) (in months) in age at disability or death (median DFS) were −20.8 (−26.4, −15.2) (P < 0.001) months for BMI <19, −13.5 (−18.2, −8.7) (P < 0.001) months for BMI 19−21, −9.8 (−14.2, −5.4) (P < 0.001) months for BMI 21−23, −2.9 (−7.5, 1.7) (P = 0.21) months for BMI 23−25, −2.7 (−8.4, 2.9) (P = 0.34) months for BMI 27−29, and −11.5 (−19.6, −3.5) (P = 0.005) months for BMI ≥ 29. These relationships did not differ by sex.


Older individuals with a BMI of <23 or ≥29 have a significantly shorter DFS period than those with a BMI of 25−27. It is suggested that the optimal BMI range for maximization of disability-free life expectancy in the elderly population is 23−29.

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We would like to thank Yoshitaka Murakami, Shuji Hashimoto, Toshiyuki Ojima, Jun Aida, Takahiro Tabuchi, Naoki Kondo, Tetsuji Yokoyama, and Kazuyo Tsushita for their valuable comments. We are also grateful to Yoshiko Nakata and Mami Takahashi for technical assistance.


This work was supported by the Health Sciences Research grants (no. H28-Junkankitou-Ippan-008) from the Ministry of Health, Labour and Welfare of Japan. Sponsors play no role in the design, methods, subject recruitment, data collections, analysis and preparation of paper.

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SZ and IT designed the research; YT and IT conducted the research; SZ and YT analyzed the data; SZ wrote the paper; YT, FT, YS and IT gave constructive suggestions; SZ had primary responsibility for the final content. All authors read and approved the final manuscript.

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Correspondence to Shu Zhang.

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The authors declare that they have no conflict of interest.

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Consent for publication had been obtained from all participants included in the analyses in the present study.

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Informed consent was obtained from all individual participants included in the study. We considered the return of completed questionnaires to imply consent to participate in the study involving the baseline survey data and subsequent follow-up of death and emigration. We also confirmed information regarding LTCI certification status after obtaining written consent from the subjects. The Ethics Committee of Tohoku University Graduate School of Medicine (Sendai, Japan) reviewed and approved the study protocol. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Zhang, S., Tomata, Y., Tanji, F. et al. The relationship between body mass index and disability-free survival in elderly Japanese: the Ohsaki Cohort 2006 Study. Int J Obes 43, 2254–2263 (2019).

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