Underweight in Men had a Closer Relationship with Falls than Women in Centenarians


The aim of the study was to assess the relationship between underweight and falls. It was a cross-sectional study in community-based participants from China Hainan Centenarian Cohort Study (CHCCS). A total of 942 centenarians (mean ages were 102.4 years in men and 102.9 years in women, 21.8% were semi-supercentenarians, and 3.2% were supercentenarians) were enrolled from July 2014 to December 2016. Height and weight were measured according to the standard protocol. Participants were interviewed face to face to self-report falls for recent 3 months. The risks of future falls were evaluated by Morse Fall Scale (MFS). The mean body mass index (BMI) was 19.04±2.79 kg/m2 in men and 18.07±3.27 kg/m2 in women. The 3-month incidences of once fall were 10.3% in men and 13.4% in women, recurrent falls were 15.4% in men and 13.4% in women, future high risks of falls were 36.6% in men and 44.3% in women. There were underweight by gender interactions on at least one fall (OR=1.39, 95% CI=1.04–1.86, P=0.026) and future high fall risk (OR=1.39, 95% CI=1.07–1.80, P=0.014). Men with underweight had higher ratios of at least one fall (OR=4.12, 95% CI=1.59–10.70, P=0.004), recurrent falls (OR=6.71, 95% CI=1.69–26.63, P=0.007) and high risk of future falls (OR=2.44, 95% CI=1.27–4.70, P=0.007), while women with underweight was only associated with high risk of future falls (OR=1.37, 95% CI=1.01–1.85, P=0.043). Compared with normal weight and overweight, underweight in men had a higher MFS Score (increased by average 7.6 points, P=0.010), yet this trend was not observed in women counterparts. Underweight was associated with incidences of 3-month and future high fall risk in centenarians, which was more pronounced in men. Underweight could be a marker in identifying potential falls in long-lived people, especially men, who need further measures to gaining weight to normal and preventing falling.

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  1. 1.

    Yoshida S. A global report on falls prevention: Epidemiology of falls. Geneva: World Health Organization, 2007.

    Google Scholar 

  2. 2.

    Cheng P, Wang L, Ning P, et al. Unintentional falls mortality in China, 2006–2016. J Glob Health. 2019; 9(1): 010603.

    Article  Google Scholar 

  3. 3.

    Burns E, Kakara R. Deaths from falls among persons aged ≥65 years-United States, 2007–2016. MMWR Morb Mortal Wkly Rep. 2018; 67(18): 509–514.

    Article  Google Scholar 

  4. 4.

    Khow KSF, Visvanathan R. Falls in the aging population. Clin Geriatr Med. 2017; 33(3): 357–368.

    Article  Google Scholar 

  5. 5.

    Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas. 2013; 75(1): 51–61.

    Article  Google Scholar 

  6. 6.

    Kang L, Han P, Wang J, et al. Timed Up and Go Test can predict recurrent falls: a longitudinal study of the community-dwelling elderly in China. Clin Interv Aging. 2017; 12: 2009–2016.

    Article  Google Scholar 

  7. 7.

    Hirko KA, Kantor ED, Cohen SS, et al. Body mass index in young adulthood, obesity trajectory, and premature mortality. Am J Epidemiol. 2015; 182(5): 441–450.

    Article  Google Scholar 

  8. 8.

    Dahl AK, Fauth EB, Ernsth-Bravell M, et al. Body mass index, change in body mass index, and survival in old and very old persons. J Am Geriatr Soc. 2013; 61(4): 512–518.

    Article  Google Scholar 

  9. 9.

    Bucholz EM, Krumholz HA, Krumholz HM. Underweight, markers of cachexia, and mortality in Acute Myocardial Infarction: A prospective cohort study of elderly medicare beneficiaries. PLoS Med. 2016; 13(4): e1001998.

    Article  Google Scholar 

  10. 10.

    Assumpção D, Borim FSA, Francisco PMSB, Neri AL. Factors associated with being underweight among elderly community-dwellers from seven Brazilian cities: the FIBRA Study. Cien Saude Colet. 2018; 23(4): 1143–1150.

    Article  Google Scholar 

  11. 11.

    Colón-Emeric CS, Lyles KW, Su G, et al. Clinical risk factors for recurrent fracture after hip fracture: A prospective study. Calcif Tissue Int. 2011; 88(5): 425–431.

    Article  Google Scholar 

  12. 12.

    He Y, Zhao Y, Yao Y, et al. Cohort profile: the China Hainan centenarian cohort study (CHCCS)[J]. Int J Epidemiol. 2018, 47(3): 694–695.

    Article  Google Scholar 

  13. 13.

    Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual, abridged edn. Champaign, Illinois, USA: Human Kinetics Inc.; 1988.

    Google Scholar 

  14. 14.

    Caselli G, Battaglini M, Capacci G. Beyond One hundred: A cohort analysis of Italian centenarians and semi-supercentenarians. J Gerontol B Psychol Sci Soc Sci. 2018. [Epub ahead of print].

  15. 15.

    Aprahamian I, Lin SM, Suemoto CK, et al. Feasibility and factor structure of the FRAIL Scale in older adults. J Am Med Dir Assoc. 2017; 18(4): 367.e11–367.e18.

    Article  Google Scholar 

  16. 16.

    Joint Committee for Guideline Revision. 2018 Chinese Guidelines for prevention and treatment of hypertension-A report of the Revision Committee of Chinese Guidelines for prevention and treatment of hypertension. J Geriatr Cardiol. 2019; 16(3): 182–241.

    PubMed Central  Google Scholar 

  17. 17.

    Hypertension Branch of the Chinese Geriatrics Society. 2019 Chinese Guidelines for the management of hypertension in elderly people. Chin J Mult Organ Dis Elderly. 2019; 18(2): 81–97.

    Google Scholar 

  18. 18.

    Chinese Society of Diabetes. Chinese Guidelines on prevention and treatment of type 2 diabetes (2017 edition). Chin J Diabetes Mellitus 2018; 10(1): 4–50.

    Google Scholar 

  19. 19.

    Joint Committee for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults. Chinese Guidelines on prevention and treatment of dyslipidemia in adults (2016 revised edition). Chin Circ J. 2016; 31(10): 937–953.

    Google Scholar 

  20. 20.

    Cai J, Wu M, Ren J. Evaluation of the efficiency of the reticulocyte hemoglobin content on diagnosis for iron deficiency anemia in Chinese adults. Nutrients. 2017; 9(5). pii: E450.

    Article  Google Scholar 

  21. 21.

    Chinese Society of Geriatrics. Geriatric Guidelines for the management of clinical nutrition. Chin J Geriatr. 2015; 34(12): 1388–1394.

    Google Scholar 

  22. 22.

    Ma YC, Zuo L, Chen JH, et al. Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol. 2006; 17(10): 2937–2944.

    Article  Google Scholar 

  23. 23.

    Nephrology Group of Chinese Society of Geriatrics. Expert consensus report on diagnosis and treatment of Chronic Kidney Disease in the Chinese elderly. Chin J Geriatr. 2018; 37(7): 725–728.

    Google Scholar 

  24. 24.

    Margolis KL, Buchner DM, LaMonte MJ, et al. Hypertension treatment and control and risk of falls in older women. J Am Geriatr Soc. 2019; 67(4): 726–733.

    Article  Google Scholar 

  25. 25.

    National Center of Cardiovascular Diseases, China. Report on Cardiovascular Diseases in China. 2014 edn. Beijing, China: Encyclopedia of China Publishing House; 2015.

    Google Scholar 

  26. 26.

    Obesity Group of Chinese Society of Endocrinology. Chinese expert consensus on prevention and treatment of Obesity in adults. Chin J Endocrinol Metab. 2011; 27(9): 711–717.

    Google Scholar 

  27. 27.

    Abellan van Kan G, Rolland YM, Morley JE, Vellas B. Frailty: toward a clinical definition. J Am Med Dir Assoc. 2008; 9(2): 71–72.

    Article  Google Scholar 

  28. 28.

    Leung SO, Chan CC, Shah S. Development of a Chinese version of the Modified Barthel Index-validity and reliability. Clin Rehabil. 2007; 21(10): 912–922.

    Article  Google Scholar 

  29. 29.

    Morse JM, Morse RM, Tylko SJ. Development of a scale to identify the fall-prone patient. Can J Aging. 1989; 8(4): 366–377.

    Article  Google Scholar 

  30. 30.

    Wang J, Chen Z, Song Y. Falls in aged people of the Chinese mainland: epidemiology, risk factors and clinical strategies. Ageing Res Rev. 2010; 9 Suppl 1: S13–S17.

    Article  Google Scholar 

  31. 31.

    Sun DQ, Huang J, Varadhan R, Agrawal Y. Race and fall risk: data from the National Health and Aging Trends Study (NHATS). Age Ageing. 2016; 45(1): 120–127.

    Article  Google Scholar 

  32. 32.

    Peng K, Tian M, Andersen M, et al. Incidence, risk factors and economic burden of fall-related injuries in older Chinese people: a systematic review. Inj Prev. 2019; 25(1): 4–12.

    Article  Google Scholar 

  33. 33.

    Metter EJ, Lynch N, Conwit R, et al. Muscle quality and age: cross-sectional and longitudinal comparisons. J Gerontol A Biol Sci Med Sci. 1999; 54(5): B207–B218.

    CAS  Article  Google Scholar 

  34. 34.

    Keller K, Engelhardt M. Strength and muscle mass loss with aging process. Age and strength loss. Muscles Ligaments Tendons J. 2014; 3(4): 346–350.

    Article  Google Scholar 

  35. 35.

    Lee YS, Choi EJ, Kim YH, Park HA. Factors influencing falls in high- and low-risk patients in a tertiary hospital in Korea. J Patient Saf. 2019. [Epub ahead of print].

  36. 36.

    Kitazoe Y, Kishino H, Tanisawa K, Udaka K, Tanaka M. Renormalized basal metabolic rate describes the human aging process and longevity. Aging Cell. 2019; 00: e12968.

  37. 37.

    Lorem GF, Schirmer H, Emaus N. What is the impact of underweight on self-reported health trajectories and mortality rates: A cohort study. Health Qual Life Outcomes. 2017; 15(1): 191.

    Article  Google Scholar 

  38. 38.

    Lee JY, Kim HC, Kim C, et al. Underweight and mortality. Public Health Nutr. 2016; 19(10): 1751–1756.

    Article  Google Scholar 

  39. 39.

    Trevisan C, Crippa A, Ek S, et al. Nutritional status, body Mass Index, and the risk of falls in community-dwelling older adults: A systematic review and meta-analysis. J Am Med Dir Assoc. 2019; 20(5): 569–582.e7.

    Article  Google Scholar 

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Author Contributions: ZYJ, YY, FSH, ZQ, NCX, LFX, ZF and ZYL: contributed to the design of the study, data collection process, statistical analysis and drafted the manuscript. All authors read and approved the final manuscript.


Funding disclosure: This work was supported by grants from National Key R&D Program of China (2018YFC2000400), National Natural Science Foundation of China (81903392, 819003S7, 81941021), National S&T Resource Sharing service platform Project of China (YCZYPT[2018]07), General Hospital of PLA Medical Big Data R&D Project (MBD2018030), China Postdoctoral Science Foundation funded project (2019M6S03S9).

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Correspondence to Ya-Li Zhao or Yao Yao.

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Conflict of Interest: The authors declare that they have no competing interests.

Ethical standards: The study was approved by Ethics Committee of Hainan Hospital of Chinese PLA General Hospital (No. 301hn11201601).

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Zhang, Y., Fu, S., Zhu, Q. et al. Underweight in Men had a Closer Relationship with Falls than Women in Centenarians. J Nutr Health Aging (2020). https://doi.org/10.1007/s12603-020-1411-7

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Key words

  • Underweight
  • falls
  • gender difference
  • centenarians