Hypocholesterolemia as a predictor of death: a prospective study of 224 nursing home residents.

The relationship of cholesterol, albumin, hemoglobin and glucose levels, and anthropometric variables to risk of death was examined in all residents of a nursing home. Risk of death was a "U-shaped" function of the cholesterol levels. A tenfold increase in relative risk was associated with cholesterol less than 3.4 mmol/l, and the least risk was associated with the middle tertile of cholesterol levels (4.0-5.0 mmol/l). For any level of plasma cholesterol, risk was constant with time for at least 6 months. Low albumin, low hemoglobin, and high fasting glucose levels were also associated with increased mortality; cholesterol levels were nonlinearly related to levels of these risk factors. Proportional hazards models showed that immobility, presence of decubitus ulcers of at least stage II, and use of enteral feeding were also risk factors for death. Because hypocholesterolemia correlated significantly (p less than .05) with the presence of decubiti, elevated white blood cell count, and use of enteral feeding, the association between hypocholesterolemia and risk of death was most likely due to its association with malnutrition and infection.