Whether the association between body mass index (BMI) and all-cause mortality for older adults is the same as for younger adults is unclear. The objective was to determine the association between BMI and all-cause mortality risk in adults ≥65 y of age. A 2-stage random-effects meta-analysis was performed of studies published from 1990 to 2013 that reported the RRs of all-cause mortality for community-based adults aged ≥65 y. Thirty-two studies met the inclusion criteria; these studies included 197,940 individuals with an average follow-up of 12 y. With the use of a BMI (in kg/m2) of 23.0-23.9 as the reference, there was a 12% greater risk of mortality for a BMI range of 21.0-21.9 and a 19% greater risk for a range of 20.0-20.9 [BMI of 21.0-21.9; HR (95% CI): 1.12 (1.10, 1.13); BMI of 20.0-20.9; HR (95% CI): 1.19 (1.17, 1.22)]. Mortality risk began to increase for BMI >33.0 [BMI of 33.0-33.9; HR (95% CI): 1.08 (1.00, 1.15)]. Self-reported anthropometric measurements, adjustment for intermediary factors, and exclusion of early deaths or preexisting disease did not markedly alter the associations, although there was a slight attenuation of the association in never-smokers. For older populations, being overweight was not found to be associated with an increased risk of mortality; however, there was an increased risk for those at the lower end of the recommended BMI range for adults. Because the risk of mortality increased in older people with a BMI <23.0, it would seem appropriate to monitor weight status in this group to address any modifiable causes of weight loss promptly with due consideration of individual comorbidities.

Increased consumption of fruit and vegetables has been shown to be associated with a reduced risk of coronary heart disease (CHD) in many epidemiological studies, however, the extent of the association is uncertain. We quantitatively assessed the relation between fruit and vegetable intake and incidence of CHD by carrying out a meta-analysis of cohort studies. Studies were included if they reported relative risks (RRs) and corresponding 95% confidence interval (CI) of CHD with respect to frequency of fruit and vegetable intake. Twelve studies, consisting of 13 independent cohorts, met the inclusion criteria. There were 278 459 individuals (9143 CHD events) with a median follow-up of 11 years. Compared with individuals who had less than 3 servings/day of fruit and vegetables, the pooled RR of CHD was 0.93 (95% CI: 0.86–1.00, P=0.06) for those with 3–5 servings/day and 0.83 (0.77–0.89, P<0.0001) for those with more than 5 servings/day. Subgroup analyses showed that both fruits and vegetables had a significant protective effect on CHD. Our meta-analysis of prospective cohort studies demonstrates that increased consumption of fruit and vegetables from less than 3 to more than 5 servings/day is related to a 17% reduction in CHD risk, whereas increased intake to 3–5 servings/day is associated with a smaller and borderline significant reduction in CHD risk. These results provide strong support for the recommendations to consume more than 5 servings/day of fruit and vegetables.

To the Editor: Our scepticism about the value of many of the burgeoning number of clinical guidelines is reinforced by the position statement on vitamin D and health for adults.1 It was surprising not to find an explicit statement that there is Level I evidence that vitamin D monotherapy does not prevent falls2 or fractures3 or reduce mortality.4 Instead, Nowson and colleagues conclude that “there ...