Freemantle, N; Ray, D; Falcaro, M; McNulty, D; Shallcross, L; Wood, J; Pagano, D; (2016) BMI upon discharge from hospital and its relationship with survival: an observational study utilising linked patient records. Journal of the Royal Society of Medicine , 109 (6) pp. 230-238. 10.1177/0141076816639047.

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Abstract

OBJECTIVE: Current advice for patients being discharged from hospital suggests a body mass index of 18.5 to 24 kgm(-2), although this aspirational target may often not be achieved. We examined the relationship between body mass index on discharge from hospital and subsequent mortality over a maximum follow-up of 3.8 years. DESIGN: We conducted a survival analysis using linked hospital records data with national hospital episode statistics and national death certification data. PARTICIPANTS & SETTING: The analysis included adult patients who were admitted to University Hospitals Birmingham NHS Foundation Trust for a period of over 24 h during 2011, excluding day cases and regular day case attenders. MAIN OUTCOME MEASURES: The relationship between body mass index and mortality at medium term was estimated separately in both men and women, after accounting for case-mix. RESULTS: For both males and females, the relationship between body mass index at discharge and the loge hazard of death was strongly non-linear (p = 0.0002 for females and p < 0.0001 for males) and predictive (both p < 0.0001). In all models, the optimal body mass index range associated with best survival was 25 to 35 kgm(-2), with a sharp increase in risk for lower body mass index. CONCLUSIONS: There was little evidence to support current aspirational body mass index targets in the discharge population. Hospitals should ensure adequate nutrition especially among those with a reduced body mass index.

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