Does Weight Loss from Middle Age to Old Age Explain the inverse Weight Mortality Relation in Old Age?

Losonczy, Katalin G.; Harris, Tamara B.; Cornoni‐Huntley, Joan; Simonsick, Eleanor M.; Wallace, Robert B.; Cook, Nancy R.; Ostfeld, Adrian M.; Blazer, Dan G.

doi:10.1093/aje/141.4.312

Cited by 186 publications

(154 citation statements)

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“…Several previous studies have also demonstrated varying associations between BMI and mortality depending on the analytic approaches used. 5,6,[12][13][14][15][16][17] For example, in the Nurses' Health Study, a J-shaped association was observed in an initial analysis of the entire cohort; however, as seen in our study, a clear linear association emerged in a separate analysis that excluded ever smokers, early deaths and those with significant weight change. 12 In the National Institutes of Health-AARP Diet and Health Study, similar to our finding, BMI at the age of 50 years showed a much stronger positive association with mortality than BMI at study baseline when participants were 50-71 years old.…”

Section: Bmi At Various Ages and Mortality In Chinese Women X Zhang Esupporting

confidence: 39%

Body mass index at various ages and mortality in Chinese women: impact of potential methodological biases

et al. 2008

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Background: Inadequate control for potential methodological biases has been suggested as an explanation for the conflicting findings concerning the relationship between body mass index (BMI) and mortality. Methods: Using data from the Shanghai Women's Health Study, a prospective cohort study conducted in a relatively lean population, we examined the associations of BMI at various ages and average adult BMI with mortality and evaluated the impact of potential biases related to preexisting illness and cigarette smoking on the associations. Included in the analysis were 74 896 women aged 40-70 years with anthropometrics taken by trained interviewers at baseline (1996)(1997)(1998)(1999)(2000). Recalled body sizes at ages 20 and 50 years were also obtained for older women. Participants were followed through April 2007 by biennial home visits and linkage with the vital statistics registry. Results: During a mean follow-up of 7.4 years, 2389 deaths occurred. In initial analyses, both low and high levels of baseline BMI were associated with an increase in mortality, whereas mortality increased monotonically with increasing levels of average adult BMI, BMI at the age of 50 years and, to a lesser extent, BMI at the age of 20 years. A direct monotonic relationship between baseline BMI and mortality emerged after accounting for potential biases. Controlling for potential biases also strengthened the positive associations of average adult BMI and BMI at ages 20 and 50 years with mortality, with a hazard ratio comparing the highest vs the lowest quartiles of average adult BMI reaching 2.19 (95% CI, 1.67-2.88). Conclusion: High BMI during adulthood consistently predicts mortality risk after accounting for potential biases.

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Section: Bmi At Various Ages and Mortality In Chinese Women X Zhang Esupporting

confidence: 39%

Body mass index at various ages and mortality in Chinese women: impact of potential methodological biases

et al. 2008

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“…This is an issue shared with many other studies 5,26,30 evaluating the BMI mortality relationship. Heyms®eld et al 31 extensively tabulated studies reporting the correlation between self-reported height and weight.…”

Section: Discussionmentioning

confidence: 93%

“…However, after adjusting for weight change from middle-to-old age, BMI in old age was a signi®cant predictor of mortality. This study 30 highlights the value of assessing weight change in addition to utilizing a single weight time-point in understanding mortality outcome.…”

Section: Discussionmentioning

confidence: 99%

Body mass index and all-cause mortality among people age 70 and over: the Longitudinal Study of Aging

et al. 1997

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OBJECTIVES: To assess the relationship between body mass index (BMI; kgam 2 ) and mortality in a large nationally representative sample of US adults over age 70 years. DESIGN: Prospective longitudinal cohort study, the Longitudinal Study of Aging (LSOA). Subjects were all those 7260 black and white people (2769 men, 4491 women) initially interviewed in 1984 for whom height and weight were available. These subjects were followed through to 1990. MEASUREMENTS: Measurements included self-reported height and weight, date of death if subjects died, sex, age, race, measures of socio-economic status, number of living ®rst degree relatives, and responses to questions asking whether the subject had retired due to poor health, had dif®culty eating, worried about their health, and felt their health was worse than during the prior year. Smoking status was not assessed. RESULTS: When analyzed via Cox proportional hazard regression, the relationship between BMI and mortality, represented by means of hazard ratio, was clearly U-shaped for both men and women. The base of the curves was fairly wide suggesting that a broad range of BMIs are well tolerated by older adults. The minimum mortality (estimated from the ®tted proportional hazard models) occurred at a BMI of approximately 31.7 for women and 28.8 for men. The results were essentially unchanged, if analyses were weighted, if various disease states were controlled for, and if apparently unhealthy subjects were excluded. CONCLUSIONS: The ®nding of the relatively high BMI (27±30 for men, 30±35 for women) associated with minimum hazard in persons older than seventy years supports some previously documented ®ndings 1 and opposes others 2 and, if con®rmed in future research, has implications for public health and clinical recommendations.

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“…8,9 The cause of the decrease in BMI among the elderly (Figure 2) is probably mostly chronic fatal disease wasting. 21,22 However, other factors, not associated with poor health, may also play a role. 22 These include sarcopenia, 21 bone-mineral density loss, 23,24 and intentional weight loss.…”

Section: Biases In Mortality Risk Vs Bmi Curvementioning

confidence: 99%

“…21,22 However, other factors, not associated with poor health, may also play a role. 22 These include sarcopenia, 21 bone-mineral density loss, 23,24 and intentional weight loss. 25 One of the important implications of the present study and previously published studies is that a one-point (baseline) determination of BMI is not a reliable mortality predictor in follow-up survival analyses of the mortality risk vs BMI relationship.…”

Section: Biases In Mortality Risk Vs Bmi Curvementioning

confidence: 99%

Biases in the mortality risk versus body mass index relationship in the NHANES-1 Epidemiologic Follow-up Study

2001

Int J Obes

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BACKGROUND: Con¯icting research ®ndings have created uncertainty as to the ideal body weight. OBJECTIVE: To test whether average-adulthood BMI (body mass index, weight in kilograms per height in meters squared) is a more reliable predictor of mortality risk than the one-time baseline BMI measurement which has been used in previous studies. DESIGN: Prospective cohort study with a 20 y follow-up period, the First National Health and Examination Survey (NHANES 1) Epidemiologic Follow-up Study (NHEFS). SUBJECTS: A random probability sample of 14 407 adults aged 25±74 y in the 1971±1975 NHANES 1. MEASUREMENTS: Body-weight data were derived from measurements in the 1971±1975 and 1982±1984 NHEFS surveys, and current and recalled estimates by subjects in the 1971±1975, 1982±1984, 1986 and 1987 surveys. Height was measured in the 1971±1975 survey. Socio-economic and lifestyle covariates were derived from questionnaires administered in all four surveys. Almost all deaths were veri®ed by death certi®cates. RESULTS: The shape of the morality risk vs baseline BMI curve varied due to a bias (late-life bias) caused by a steep decrease in BMI among the elderly toward the end of the lifespan. In a particular analysis, the portion of subjects at baseline who were deceased elderly with lower BMI than age-matched censored subjects indicated the size of the bias, and appeared to be the proximate cause. Strong evidence was found to support the proximate cause being the actual cause. Excluding deaths during early follow-up was only able to remove the late-life bias in limited circumstances. Using average-adulthood BMI as mortality predictor and baseline BMI as covariate was very effective in removing the late-life bias. It also appeared to remove the reversecausation and regression-dilution biases, and yielded robustly positive mortality risk vs average-adulthood BMI curves in all analyses in which it was tested. CONCLUSIONS: Average-adulthood BMI appears to be an appropriate predictor of mortality risk, provided baseline BMI is used as a covariate. Among non-elderly persons, being leaner meant a lower mortality risk, down to the lowest category of leanness in the study Ð`20 kgam 2 . Future survival analyses of the mortality±BMI relationship should account for the effects of the regression-dilution, reverse-causation and late-life biases.

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Does Weight Loss from Middle Age to Old Age Explain the inverse Weight Mortality Relation in Old Age?

Cited by 186 publications

References 0 publications

Body mass index at various ages and mortality in Chinese women: impact of potential methodological biases

Body mass index at various ages and mortality in Chinese women: impact of potential methodological biases

Body mass index and all-cause mortality among people age 70 and over: the Longitudinal Study of Aging

Biases in the mortality risk versus body mass index relationship in the NHANES-1 Epidemiologic Follow-up Study

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