Attitudes of medical students to general practice: a multinational cross-sectional survey.

BACKGROUND: A shortage of general practitioners (GPs) is common to many European countries. To counteract this, it is essential to understand the factors that encourage or discourage medical students from choosing to become a GP. OBJECTIVE: To evaluate medical students' attitudes towards general practice and to identify factors that discourage them from considering a career as a GP. METHODS: In this multinational cross-sectional online survey, 29 284 students from nine German, four Austrian and two Slovenian universities were invited to answer a questionnaire consisting of 146 closed and 13 open-ended items. RESULTS: Of the 4486 students that responded (response rate: 15.3%), 3.6% wanted to become a GP, 48.1% were undecided and 34.6% did not want to be a GP. Significant predictors for interest in becoming a GP were higher age [odds ratio (OR) = 1.06; 95% confidence interval (CI) = 1.02-1.10], positive evaluation of the content of a GP's work (OR = 4.44; 95% CI = 3.26-6.06), organizational aspects (OR = 1.42; 95% CI = 1.13-1.78), practical experience of general practice (OR = 1.66; 95% CI = 1.08-2.56) and the country of the survey [Slovenian versus German students (Reference): OR = 2.19; 95% CI = 1.10-4.38; Austrian versus German students (Reference): OR = 0.50; 95% CI = 0.32-0.79]. CONCLUSION: Strategies to convince undecided students to opt for a career as a GP should include a positive representation of a GP's work and early and repeated experience of working in a general practice during medical school.

Impact of a nutrition education programme on free sugar intake & nutrition-related knowledge in fifth-grade schoolchildren.

BACKGROUND: The objective was to evaluate a 5-week nutrition education programme (ACTION) in fifth-grade schoolchildren in Austria on free sugar intake, nutrition-related knowledge (NRK) and with the RE-AIM framework on the overall public health impact. METHODS: A prospective case-controlled cohort (pre-post design) from seven secondary schools in Vienna tested programme efficacy. NRK was assessed with a 20-item questionnaire and dietary behaviour and free sugar intake with a semi-quantitative Food Frequency Questionnaire. A total of 12 intervention classes (IG) received the programme, conducted by teachers and integrated in the curriculum, and 6 control classes followed their usual curriculum. RESULTS: In 344 children, aged 10.4 (0.8) years, free sugar intake decreased significantly over time in IG by 13% (P=0.001) with a group difference of -10.1 (95% CI -18.8, -1.5; P=0.021) g/day. The food groups 'sweets & pastries', 'soft drinks', 'fast food' and 'salty snacks' mainly contributed to this reduction. Moreover, NRK increased significantly over time in IG with a group difference of 9.0% of correct answers (95% CI 5.8, 12.2; P<0.001; Cohen's d 0.57). The programme was disseminated to 10% of fifth-grade classrooms in Austrian secondary schools and to 12% in Vienna. CONCLUSIONS: The ACTION programme shows potential for public health impact with improving dietary behaviour as free sugar intake, NRK, and its dissemination. It required a minimum of money per schoolchild as the programme was conducted by teachers and was integrated in the curriculum.

Gradual reduction of free sugars in beverages on sale by implementing the beverage checklist as a public health strategy.

Background: Sugar-sweetened beverages (SSBs) are a major source of free sugar intake and contribute to obesity and obesity-related diseases. Therefore, we analyzed the effect of a gradual sugar reduction strategy within the so-called 'beverage checklist' on free sugar content in beverages on sale in Austria. Methods: From 2010 until 2017, data on the amount of free sugar of sweetened beverages (sweetened with sugars, fruit juice and artificial sweeteners) with 0.20-0.75l serving sizes in all main supermarkets and from industry was collected. These data were published annually as the beverage checklist, which displays beverages on sale in Austria. The checklist aims to encourage beverage production with a free sugar content of ≤7.4 g/100 ml and no artificial sweeteners. Results: Free sugar content in the total supply decreased significantly [7.53 (2.86) vs. 6.75 (2.79) g/100 ml; 10.4%; P < 0.001] over time and also in those for which follow-up data were available until 2017 (n = 100) [7.55 (2.46) vs. 7.28 (2.44) g/100 ml; 3.5%; P < 0.001]. The percentage of beverages fulfilling the guiding criteria increased by 12.8% (P < 0.001) and of those containing sweeteners decreased by 13.3% (after 2012; P = 0.034). Conclusions: This public health strategy, conducted by a small non-profit organization, showed a reduction in the mean free sugar content by working with the industry to voluntarily reformulate beverages. More beverages with less added sugar were brought to the market, which implies healthier choices. The challenge now is to further engage the industry and also policy makers to achieve a greater reduction in the future.

Changes of dietary patterns during participation in a web-based weight-reduction programme.

OBJECTIVE: To examine the weight-loss success associated with distinct dietary patterns and to determine changes of these dietary patterns during participation in a web-based weight-reduction programme. DESIGN: Factor analysis was used to identify the dietary patterns of twenty-two food groups that were administered in 14 d dietary protocols at baseline and after 3 months. Successful weight loss (≥5% of initial weight) and BMI were calculated. Logistic regression analyses were used to assess the rates of weight-loss success from each dietary pattern and changing or remaining in the initial dietary pattern. A generalised linear mixed model was used to estimate the effects of changing or staying in a dietary pattern on change in BMI. SUBJECTS: Adults (n 1635) aged 18-81 years. SETTING: Users of a web-based weight-reduction programme (2006-2012). RESULTS: Participants who aligned to a healthful dietary pattern at baseline (OR=1·8; 95% CI 1·5, 2·3) and after 3 months (OR=1·5; 95% CI 1·2, 1·9) had a greater chance of successfully losing weight. After adjusting for age, sex, initial dietary pattern and BMI, participants who started with or changed to the healthful dietary pattern had a greater chance of being successful (OR=1·4; 95% CI 1·1, 1·7) and a higher BMI reduction of 0·30 (95% CI 0·2, 0·5) kg/m(2) compared with those who started with or changed to the energy-dense or high-carbohydrate dietary pattern. CONCLUSIONS: A favourable healthful dietary pattern at the beginning and after 3 months was positively associated with anthropometry. However, successful weight loss was feasible in each dietary pattern.

Preventive medicine: self-assessment of knowledge, skills and attitudes of medical students at the Medical University of Vienna.

Prevention and health promotion are gaining importance in modern medical curricula. Aim of this study was to evaluate the self-assessment of knowledge, skills and attitudes of medical students towards health promotion and prevention. In 2012, at the Medical University of Vienna, 27% of the 633 fourth-year medical students (50.3% male and 49.7% female; mean age: 24 years) completed a questionnaire. Results show a high assessment of prevention in most respondents. Knowledge gaps were detected on occupational health and mother-child pass examinations. However, almost all students reported sufficient knowledge on screening and risk assessment of developing cardiovascular diseases. Almost all respondents estimated to be able to identify risky behaviours. Overall, estimation towards prevention of tomorrow's physicians is very positive. However, only 40% believed to have been adequately trained on preventive medicine so far. Relevant preventive aspects were added to the medical curriculum in 2012-2013 with the new block 'Public Health'.

Experiences of Vegans with General Practitioners in the Austrian Health Care System: A Qualitative Study.

This article explores the factors influencing the choice of general practitioners (GPs) and their role in the health care of vegans in Austria. The number of people identifying as vegan is on the rise, and GPs are increasingly confronted with vegan patients. A qualitative method was chosen for this study, and 14 semi-structured interviews with vegans were conducted between April 2022 and July 2022. Participants were recruited primarily through vegan social media groups. In their experiences with health care, vegans felt treated unequally or sometimes incorrectly. The experiences described highlight that participants felt that most GPs were biased against their veganism. Information exchange among vegans primarily takes place online and through publications of vegan associations, while GPs play a minor role in information provision. As the number of vegans grows, an appreciative way of communicating between GPs and vegan patients ought to be promoted. Voluntary interdisciplinary nutritional training, collaboration of the medical field with support organizations, provision of evidence-based information, and collaboration with dietitians and nutritionists could enrich the care of patients with a vegan diet.

Health information regarding diabetes mellitus reduces misconceptions and underestimation of consequences in the general population.

OBJECTIVE: To evaluate self-assessed knowledge about diabetes mellitus, to assess determinants of health knowledge and to evaluate consequences of health knowledge on appraisal about consequences of the disease. DESIGN: Population-based computer-assisted web interview survey, supplemented with a paper-and-pencil survey via post. SETTING: Representative sample of the general Austrian population aged 15 years and older. SUBJECTS: Men (n 1935) and women (n 2065) with and without diabetes mellitus. RESULTS: Some 20.5% of men and 17.7% of women with diabetes, and 46.2% of men and 36.7% of women without diabetes, rated their knowledge about diabetes mellitus to be 'very bad' or 'rather bad'. Individuals with diabetes and individuals with a family member with diabetes rated their information level more often as 'very good' or 'rather good', with adjusted OR (95% CI) of 1.7 (1.1, 2.8) and 2.1 (1.6, 2.7), respectively, in men and 2.7 (1.5, 4.8) and 2.7 (2.1, 3.5), respectively, in women. Additional significant influencing factors on diabetes knowledge were age and educational level in both sexes, and city size in men. Independent of personal diabetes status, diabetes knowledge was associated with a lower perception of restrictions on daily life of diabetes patients and with a lower probability of underestimating health consequences of diabetes. CONCLUSIONS: Health knowledge is associated with fewer misconceptions and less underestimation of health consequences in individuals both with and without diabetes mellitus. Thus health information about diabetes is important on the individual level towards disease management as well as on the public health level towards disease prevention.

Predictors of participation in preventive health examinations in Austria.

BACKGROUND: Preventive health check-ups in Austria are offered free of charge to all insured adults (98% of the population) and focus on early detection of chronic diseases, primary prevention, and health counseling. The study aims to explore predictors of compliance with the recommended interval of preventive health check-up performance. METHODS: Source of data was the Austrian Health Interview Survey 2006/07 (15,474 subjects). Participation in a preventive health examination during the last three years was used as dependent variable. Socio-demographic and health-related characteristics were used as independent variables in a multivariate logistic regression analysis. RESULTS: Results show that 41.6% of men and 41.8% of women had attended a preventive health check-up within the last three years. In multivariate analysis, subjects ≥ 40 years, with higher education, higher income or born in Austria were significantly more likely to attend a preventive health check-up. Furthermore, a chronic disease was associated with a higher attendance rate (OR: 1.21; CI: 1.07-1.36 in men; OR: 1.19; CI: 1.06-1.33 in women). CONCLUSIONS: Attendance rates for health check-ups in the general Austrian population are comparatively high but not equally distributed among subgroups. Health check-ups must increase among people at a young age, with a lower socio-economic status, migration background and in good health.

Access points to the different levels of health care and demographic predictors in a country without a gatekeeping system. Results of a cross-sectional study from Austria.

BACKGROUND: The challenges for health care systems are evident both in terms of costs and of healthy life expectancy. It was the aim of this study to assess the access points towards the different levels of care and predictors for consulting a specialist without having consulted a general practitioner (GP), a common way of access to the Austrian health care system, a system without gatekeeping function. METHOD: The database used for this analysis was the Austrian Health Interview Survey 2006-07, with data from 15 474 people. Statistical analyses included descriptive statistics as well as multivariate logistic regression models. RESULTS: In the 12 months before the survey, 78.8% consulted a GP, 67.4% consulted a specialist, 18.6% visited an outpatient department and 22.8% had a hospital stay at least once. Overall, 15.1% visited a specialist, 8.5% an outpatient department and 8.1% a hospital without consulting a GP concomitantly. One of the main reasons for direct specialist use was a preventive check-up visit. Tertiary education and migration background increased significantly the chance of having been to a specialist without GP contact for both sexes. CONCLUSION: The overall access rates for specialists as well as the access rates for specialist without GP consultations were high. The findings point into the direction of a benefit through a structurally supported advocacy role for primary health care professionals. The knowledge gained could contribute to the health policy debate on the importance of coordination and continuity with special respect to demographic factors showing the importance of target-group-specific interventions.

Women show a closer association between educational level and hypertension or diabetes mellitus than males: a secondary analysis from the Austrian HIS.

BACKGROUND: Lifestyle diseases and cardiovascular complications are dramatically increasing, but little is known about the impact of educational level and health behaviour in men and women in different populations. Therefore, we aimed to investigate the association between educational level (EL) and self-reported chronic diseases and health behaviour in both sexes. METHODS: Data were derived from the Austrian Health Interview Surveys 2006/2007, which includes 13 558 persons (50.9% females). The associations between EL and the risk of obesity, hypertension, diabetes, myocardial infarction, stroke and anxiety disorders or depression, nutrition, exercise, and smoking were evaluated. University education served as the reference category (EL4), the lowest educational level was required schooling only (EL0). RESULTS: Only among women did the risk for diabetes mellitus and hypertension increase with decreasing educational level with the highest rates for EL0 OR [95% CI] adjusted for age, income, family status and lifestyle: 3.7 [1.7-8.0], and 2.5 [1.8-3.5], respectively. Only among the men, however, did the risk for stroke increase with decreasing educational level adjusted OR for EL0: 8.5 [1.7-42.7]. For anthropometric measures and lifestyle factors in both sexes the risk increased with decreasing EL. CONCLUSION: EL affects lifestyle, overweight and obesity in both sexes. The apparent sex-specific differences in the association between the prevalence of some chronic disease with EL call for further investigation.

Obesity, Fruit and Vegetable Intake, and Physical Activity Patterns in Austrian Farmers Compared to the General Population.

Low fruit and vegetable (F&V) intake, sedentary behavior, excessive alcohol consumption, and smoking are risk factors for the development of non-communicable diseases. This study describes the patterns and factors of nutrition (F&V and alcohol intake), physical activity (PA), obesity, and other chronic diseases of 10,053 adult farmers (52.7% female) in Austria, based on the cross-sectional survey from the Austrian Social Insurance Institution for the Self-Employed and compared with the results of the general Austrian population from 2019 (n = 14,606; 53.7% female). Compared to the general Austrian population, farmers showed a higher prevalence of overweight and obesity (42.8% vs. 36.5%; 18.8% vs. 17.1%), as well as hypertension, hypercholesterolemia, and diabetes mellitus. Additionally, farmers ate less F&V (0 servings/day 39.7% vs. 14.0%; 1−4 servings/day 55.5% vs. 80.8%) and only 4.8% vs. 5.1% (p < 0.001) fulfilled the F&V recommendations. Lower participation in endurance training (38.3% vs. 52.1%) was found, whereas farmers did more strength training (64.1% vs. 27.6%). Those who failed to fulfill the PA recommendations reported worse health status (OR: 3.14; 95%-CI: 2.08−4.76) and a higher chance for obesity (OR: 1.68; 95%-CI: 1.38−2.05). Since obesity rates among farmers are high and recommendations have rarely been met, every opportunity should be taken to promote healthy eating and adequate PA.

Gender differences in examination behavior of 4th grade medical students : Results from an observational study on ECG e-learning.

BACKGROUND: Computer-assisted teaching is becoming increasingly more important to acquire new knowledge and skills in medical curricula. The consequence of gender-characteristic personality traits on academic performance in e­learning examinations are difficult to forecast. This study investigated gender-related differences in examination behavior among undergraduate medical students taking a web-based quiz. METHODS: A total of 1315 4th grade medical students at the Medical University of Vienna completing the compulsory online moodle-based ECG quiz 2017/2018 were enrolled into this observational study. Individual data of examination behavior and quiz results as well as results of the final annual exam were extracted. Students were grouped into 10 strata according to academic performance. Variables between both sexes were compared using a nonparametrical test. Examination variables were correlated to performance. RESULTS: Of the total study population 686 (52%) were female and 629 (48%) were male. The time until the first attempt and number of attempts performed was comparable between both sexes, however female students spent more time on the first attempt compared to their male colleagues (1592 sec [Q1-Q3: 999-2536] vs 1405 sec [Q1-Q3: 828-2395], p = 0.002), suggesting a higher self-discipline and risk-aversity. There was no difference regarding quiz scores or final ECG examination scores between female and male students (p = 0.869 and p = 0.396). Students who accessed the quiz earlier and less time spent for the first attempt tended to perform better at the final examination (rs = 0.20, p < 0.001 and rs = -0.15, p < 0.001). CONCLUSIONS: Gender-related differences in examination behavior already described for nononline based examinations are similarly observable in e­learning. For this test, gender-immanent traits seem not to twist final examination results and impact academic performance.

East-West gradient in cardio-vascular mortality in Austria: how much can we explain by following the pattern of risk factors?

BACKGROUND: Various studies show major regional differences in the prevalence of cardio-vascular disease morbidity and mortality, both in Europe and within European countries. In Austria, these differences are documented by an East-West gradient with declining morbidity and mortality rates when moving from the East to the West of the country. It was the aim of this study to analyse if, and to what extent, socio-demographic and socio-economic determinants, social resources and health behaviour can contribute to the clarification of this East-West gradient by conducting secondary analyses of an existing Austrian health dataset. RESULTS: The data were analysed using bivariate analyses, as well as univariate and multivariate logistic regression models. These analyses revealed significant East-West gradients for various risk factors, as well as socio-demographic and socio-economic health determinants. There was a gradual decrease of hypertension, diabetes mellitus, obesity, and psycho-social discomfort in both sexes, with the highest prevalences in those Austrian regions with the highest cardio-vascular mortality and a stepwise decrease to the regions with the lowest cardio-vascular mortality. Controlling for educational level significantly raised the odds for diabetes, hypertension and obesity. In the results of the multivariate analyses, factors that significantly and independently predicted diabetes mellitus were geographic location, psycho-social discomfort, lack of physical exercise, and age in both sexes. For women these factors additionally included a low educational level, lack of social support, and being born abroad. CONCLUSIONS: Our study shows a clear gradual decline of cardio-vascular mortality and some of its risk factors from East to West in Austria. Concerning these risk factors, the geographic region and psycho-social discomfort showed the greatest association with diabetes mellitus, hypertension, and obesity. Hence, they contribute to the explanation of the variance in spatial cardio-vascular disease mortality. Yet, a large proportion of this variance remains unexplained. It would be of great importance to public health and preventive measures to take a closer look at spatial differences in cardio-vascular disease morbidity and mortality to better tailor programmes to the regional environments and settings. Our results also call for a greater importance of preventative measures for psycho-social discomfort and increase of social support.

Effect of daily intake of yoghurt and bread enriched with biologically active substances on blood lipids and vitamin A in adolescents and young adults.

OBJECTIVE: The aim was to investigate whether the daily intake of special nutrients, enriched with supplements from natural origins, has any effect on blood parameters. DESIGN AND SUBJECTS: In this double-blind placebo-controlled clinical trial, 80 healthy subjects (mean age 26.3 years) were statistically assigned to two groups. Group I had to eat two special yoghurt and bread products a day. The other probands represented the control group (II). SETTING: Plasma concentrations of blood parameters were measured at the beginning and at the end of the study, and dietary intake was calculated. RESULTS: In group I, total cholesterol decreased. This was due to a significant drop of low-density lipoprotein-cholesterol from 106.0 to 99.0 mg/dl. A significant reduction of the apolipoprotein B and an increase of vitamin A in group I were also observed. CONCLUSION: Regular intake of specially fortified food influences parameters, especially lipids and lipoproteins.

Coverage of recommended vaccinations in subjects with diabetes mellitus and ischemic heart disease: results for women and men.

Vaccination is an important public health strategy to prevent adverse health outcomes in the general population and in subjects with chronic diseases. It was the aim of this study to compare data on coverage of recommended vaccinations in men and women with diabetes mellitus and after myocardial infarction (MI) and to analyse trends in three different interview surveys: 1991, 1999 and 2006-07. The data show a rise in influenza vaccination coverage rate in men and women in the general population and in high-risk groups. However, coverage rates in all analysed groups were still strikingly low. Although in soft reported earlier surveys women were vaccinated more often than men, there was a reverse trend observed in the most recent survey. In the survey of 2006-07, men with diabetes or after MI had a higher chance of being vaccinated against influenza when compared to men without these diseases (age adjusted OR: 1.61; 95% CI: 1.29-1.99 and 1.61; 95% CI: 1.21-2.15, respectively). This was, however, not the case in women (OR: 1.10; 95% CI: 0.89-1.35 and 0.87; 95% CI: 0.58-1.33, respectively). Neither men nor women with diabetes mellitus or MI had a significantly higher chance of having pneumococcal vaccination when compared to subjects without these diseases. The observed sex-specific differences demand more research regarding the underlying causes. Strategies to reach higher vaccination coverage in men and women are needed.

Differences in health status, health behaviour and healthcare utilisation between Immigrant and native homeless people in Spain: An exploratory study.

Few studies have examined the differences between immigrant and native-born homeless populations. Our aim was to conduct an exploratory study to examine the differences in health status, health behaviour and healthcare utilisation in a sample of Spanish immigrant and native homeless people. Study was conducted in eight different temporary accommodations in the Valencia region in August 2018. Overall, 86 participants were included in the analysis who answered questionnaires concerning socio-demographic characteristics, immigration status, health status and behaviour, healthcare utilisation and experienced discrimination in healthcare and health literacy. In total, 76.7% were men with a mean age of 41.91 (14.17) years, with 60.4% having immigration background with an average of 4.8 (4.2) years since arrival in Spain. No differences were found in the subjective health status, however, native homeless participants reported significantly higher prevalence of heart disease (87.5% vs. 12.5%), hypertension (84.6% vs. 15.4%), psychological illness (63.6% vs. 36.4%) and were also more often smokers (73.5% vs. 28.8%), reported smoking more cigarettes per day (12.0 vs. 7.4) and were more often illegal drug users (17.6% vs. 2.0%). Immigrant participants were significantly more often not insured, reported more problems in healthcare access and had lower rates of visits to general practitioners and less hospital admissions. Differences were also observed in social status with the native homeless more often reporting receiving income, and living in less crowded accommodations. Our results show a variety of issues that the immigrant homeless population in Spain is confronted with that also prevents adequate social inclusion and achieving good health. However, the immigrant population engaged less often in risky health behaviour. More, and continuous, monitoring of social, mental and physical health of the homeless population is necessary. Public health interventions aiming at health promotion in the immigrant homeless populations need to focus on increasing overall social integration.

Associations between Physical Activity, Sitting Time, and Time Spent Outdoors with Mental Health during the First COVID-19 Lock Down in Austria.

Measures implemented to reduce the spread of SARS-CoV-2 have resulted in a decrease in physical activity (PA) while sedentary behaviour increased. The aim of the present study was to explore associations between PA and mental health in Austria during COVID-19 social restrictions. In this web-based cross-sectional study (April-May 2020) moderate-to-vigorous physical activity (MVPA), sitting time, and time spent outdoors were self-reported before and during self-isolation. Mental well-being was assessed with the Warwick-Edinburgh Mental Well-being Scale, and the Beck depression and anxiety inventories. The majority of the participants (n = 652) were female (72.4%), with a mean age of 36.0 years and a standard deviation (SD) of 14.4. Moreover, 76.5% took part in ≥30 min/day of MVPA, 53.5% sat ≥10 h/day, and 66.1% spent ≥60 min/day outdoors during self-isolation. Thirty-eight point five percent reported high mental well-being, 40.5% reported depressive symptoms, and 33.9% anxiety symptoms. Participating in higher levels of MVPA was associated with higher mental well-being (odds ratio = OR: 3.92; 95% confidence interval = 95%CI: 1.51-10.15), less depressive symptoms (OR: 0.44; 95%CI: 0.29-0.66) and anxiety symptoms (OR = 0.62; 95%CI: 0.41-0.94), and less loneliness (OR: 0.46; 95%CI: 0.31-0.69). Participants sitting <10 h/day had higher odds of mental well-being (OR: 3.58; 95%CI: 1.13-11.35). Comparable results were found for spending ≥60 min/day outdoors. Maintaining one's MVPA levels was associated with higher mental well-being (OR = 8.61, 95%CI: 2.68-27.62). In conclusion, results show a positive association between PA, time spent outdoors and mental well-being during COVID-19 social restrictions. Interventions aiming to increase PA might mitigate negative effects of such restrictions.

Body mass index and the risk of infections in institutionalised geriatric patients.

The objective was to examine the effect of BMI on the incidence of various infectious diseases in institutionalised, geriatric subjects. In a retrospective cohort study we analysed medical records of 619 patients aged 75 years and older (mean age 87.6 (sd 6.4) years) who were treated in a geriatric hospital in Vienna, Austria. The total incidence rate of infection in this population was 0.80 per person-year. The most frequent infections were urinary tract infections (0.30 per person-year), followed by infections of the lower respiratory tract (0.19 per person-year), diarrhoea (0.12 per person-year) and other infections (0.20 per person-year). Incidence risk ratios were obtained by a multiplicative Poisson regression model. There was a J-shaped curve in the incidence of infections recorded by BMI with a nadir at 27-28 kg/m2. Compared with the reference group with a BMI of 24-27.9 kg/m2, subjects with a lower BMI had a higher incidence rate of infections. The incidence risk ratios, adjusted for sex, age and chronic diseases, were 1.62 (95 % CI 1.21, 2.17) for those with a BMI of < 20 kg/m2 and 1.84 (95 % CI 1.40, 2.42) for those with a BMI of 20-23.9 kg/m2. However, also patients with a BMI of 28 kg/m2 and above had a higher incidence rate of infections, with an incidence risk ratio of 1.54 (95 % CI 1.07, 2.22). These results show that both underweight and obesity are associated with a higher risk of infections in institutionalised geriatric patients.