{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:58:41Z","timestamp":1781650721173,"version":"3.54.5"},"reference-count":47,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Osaka Health Disparity Solution Program"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Low and high body mass index (BMI) are reported to be associated with frailty in older adults. Since the optimal BMI associated with a low risk of mortality varies with age, the association between BMI and frailty might also differ by age. This study examined the association between BMI and frailty in middle-aged and older adults in Japan.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We conducted face-to-face and mail surveys in Settsu city and mail survey in Hannan city in Osaka, Japan. The association between BMI and frailty was analyzed among 8,815 participants using mail surveys. Frailty was evaluated using two tools, the Kihon Checklist (KCL) and the Frailty Screening Index (FSI). BMI (kg\/m\n 2<\/jats:sup>\n ) was categorized into the <\u200918.5, \u2265\u200918.5\u2013<20.0, \u2265\u200920\u2013<22.5, \u2265\u200922.5\u2013<25.0, \u2265\u200925.0\u2013<27.5, and \u2265\u200927.5\u00a0kg\/m\n 2<\/jats:sup>\n groups. We analyzed the association between BMI and frailty using multivariable logistic regression, with BMI\u2009\u2265\u200922.5\u2013<25.0\u00a0kg\/m\n 2<\/jats:sup>\n as the reference to calculate the odds ratios (OR) and 95% confidence intervals (95%CI). Restricted cubic spline analyses were also performed, with knots placed at the 5th, 50th (as reference), and 95th percentiles of BMI. We performed all analyses separately for the <\u200965 and \u2265\u200965 years age groups.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n BMI\u2009<\u200918.5 (OR\u2009=\u20091.882, 95%CI: 1.263\u20132.805) was significantly associated with KCL-measured frailty in individuals aged\u2009<\u200965 years, and BMI\u2009<\u200918.5 (OR\u2009=\u20091.807, 95%CI: 1.291\u20132.531) and \u2265\u200927.5 (OR\u2009=\u20091.562, 95%CI: 1.156\u20132.111) were significantly associated with KCL-measured frailty in those aged\u2009\u2265\u200965 years. BMI\u2009\u2265\u200925.0\u2013<27.5 (OR\u2009=\u20091.426, 95%CI: 1.055\u20131.927) and \u2265\u200927.5 (OR\u2009=\u20091.473, 95%CI: 1.093\u20131.985) were significantly associated with FSI-measured frailty in individuals aged\u2009<\u200965 years, and BMI\u2009\u2265\u200927.5 (OR\u2009=\u20091.988, 95%CI: 1.432\u20132.759) was significantly associated with frailty in those aged\u2009\u2265\u200965 years. The spline models showed U-shaped associations for KCL-measured frailty for both age groups, a positive linear association for FSI-measured frailty among those aged\u2009<\u200965 years, and an L-shaped association for FSI-measured frailty among those aged\u2009\u2265\u200965 years.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The association between BMI and frailty differed by age. The collation of all the results of this study suggests that both low and high BMI are associated with frailty in middle-aged and older adults. Based on the results, it is speculated lifestyle habits that promote proximity to \u201cnormal weight\u201d may help prevent frailty.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n \n UMIN000008105 (Registration date: May 29th 2019; Website:\n https:\/\/upload.umin.ac.jp\/cgi-open-bin\/ctr_e\/ctr_view.cgi?recptno=R000042027<\/jats:ext-link>\n ).\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1186\/s12889-026-27331-2","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T04:06:08Z","timestamp":1776917168000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between body mass index and frailty for middle-aged and older adults in Japan: a cross-sectional study of the Osaka health disparity solution program"],"prefix":"10.1186","volume":"26","author":[{"given":"Tsukasa","family":"Yoshida","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Hikita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daiki","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Nakagata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Yamada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Sawada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megumi","family":"Okabayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidekazu","family":"Shimada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuo","family":"Nishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motohiko","family":"Miyachi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"27331_CR1","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1016\/S0140-6736(09)60318-4","volume":"373","author":"SC Prospective","year":"2009","unstructured":"Prospective SC, Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, et al. 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Age Ageing. 2019;48:16\u201331.","journal-title":"Age Ageing"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-026-27331-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-026-27331-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-026-27331-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:36:01Z","timestamp":1781649361000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12889-026-27331-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,23]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["27331"],"URL":"https:\/\/doi.org\/10.1186\/s12889-026-27331-2","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,23]]},"assertion":[{"value":"18 July 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The survey plan was approved by the Ethics Review Committee of the National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition. The face-to-face survey was approved (Approval No. I-ki-ken-hatsu 781-1) and registered with the UMIN Clinical Trials Registry (UMIN000036880). All participants provided written informed consent. Although we submitted an application for the mail survey to the committee (application No. Ken-ei 89), it was not reviewed by the committee because only city workers could access personal information and it was an anonymous mailing survey. The committee considered the mail survey to be a general survey. Article #33 of Japan Statistics Act permits use of general survey data for academic research.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1557"}}