The Association of Weight Loss, Weight Status, and Abdominal Obesity with All-Cause Mortality in Older Adults

Alharbi, Tagrid Abdullah G; Ryan, Joanne; Freak‐Poli, Rosanne; Gasevic, Danijela; Scali, Jacqueline; Ritchie, Karen; Ancelin, Marie-Laure; Owen, Alice

doi:10.1159/000522040

Cited by 13 publications

(8 citation statements)

References 35 publications

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“…Previous studies have reported an association between weight loss and subsequent mortality, but these studies included only a small number of older adults, typically with multiple comorbidities (eTable 14 in Supplement 1). Our study extends the previous observations by demonstrating a similar association among relatively healthy community-dwelling individuals aged 65 years or older. The results also showed that weight loss was more associated with mortality among men than women.…”

Section: Discussionsupporting

confidence: 90%

Associations of Change in Body Size With All-Cause and Cause-Specific Mortality Among Healthy Older Adults

et al. 2023

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ImportanceThe association between weight change and subsequent cause-specific mortality among older adults is not well described. The significance of changes in waist circumference (WC) has also not been compared with weight change for this purpose.ObjectiveTo examine the associations of changes in body weight and WC with all-cause and cause-specific mortality.Design, Setting, and ParticipantsThis cohort study is a post hoc analysis of data from the Aspirin in Reducing Events in the Elderly (ASPREE) randomized clinical trial, which recruited participants between March 1, 2010, and December 31, 2014. The study included community-based older adults (16 703 Australian participants aged ≥70 years and 2411 US participants aged ≥65 years) without evident cardiovascular disease (CVD), dementia, physical disability, or life-limiting chronic illness. Data analysis was performed from April to September 2022.ExposuresBody weight and WC were measured at baseline and at annual visit 2. Analysis models were adjusted for baseline body mass index because height and weight were measured at baseline, allowing for calculation of body mass index and other variables. Both body weight and WC changes were categorized as change within 5% (stable), decrease by 5% to 10%, decrease by more than 10%, increase by 5% to 10%, and increase by more than 10%.Main Outcomes and MeasuresAll-cause, cancer-specific, CVD-specific, and noncancer non-CVD–specific mortality. Mortality events were adjudicated by an expert review panel. Cox proportional hazards regression and competing risk analyses were used to calculate hazard ratios (HRs) and 95% CIs.ResultsAmong 16 523 participants (mean [SD] age, 75.0 [4.3] years; 9193 women [55.6%]), 1256 deaths were observed over a mean (SD) of 4.4 (1.7) years. Compared with men with stable weight, those with a 5% to 10% weight loss had a 33% higher (HR, 1.33; 95% CI, 1.07-1.66) risk of all-cause mortality, and those with more than a 10% decrease in body weight had a 289% higher (HR, 3.89; 95% CI, 2.93-5.18) risk. Compared with women with stable weight, those with a 5% to 10% weight loss had a 26% higher (HR, 1.26; 95% CI, 1.00-1.60) risk of all-cause mortality, and those with more than a 10% decrease in body weight had a 114% higher (HR, 2.14; 95% CI, 1.58-2.91) risk. Weight loss was associated with a higher cancer-specific mortality (&gt;10% decrease among men: HR, 3.49; 95% CI, 2.26-5.40; 5%-10% decrease among women: HR, 1.44; 95% CI, 1.46-2.04; &gt;10% decrease among women: HR, 2.78; 95% CI, 1.82-4.26), CVD-specific mortality (&gt;10% decrease among men: HR, 3.14; 95% CI, 1.63-6.04; &gt;10% decrease among women: HR, 1.92; 95% CI, 1.05-3.51), and noncancer non-CVD–specific mortality (&gt;10% decrease among men: HR, 4.98; 95% CI, 3.14-7.91). A decrease in WC was also associated with mortality.Conclusions and RelevanceThis cohort study of healthy older adults suggests that weight loss was associated with an increase in all-cause and cause-specific mortality, including an increased risk of cancer, CVD, and other life-limiting conditions. Physicians should be aware of the significance of weight loss, especially among older men.

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Section: Discussionsupporting

confidence: 90%

Associations of Change in Body Size With All-Cause and Cause-Specific Mortality Among Healthy Older Adults

et al. 2023

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“…The obesity paradox may provide an explanation for this finding: Some studies found that weight loss rather than weight gain is associated with increased morbidity and mortality during follow-up [ 48 ]. Overweight individuals with multiple chronic diseases, especially the elderly, may have shown lower all-cause mortality and cardiovascular mortality compared to patients of normal weight [ 49 ], and an overweight condition in an elderly person seems to prevent death [ 50 ]. The same is true for overweight diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

Arm Circumference, Arm-to-Waist Ratio in Relation to Cardiovascular and All-Cause Mortality among Patients with Diabetes Mellitus

Xie

Zhu

et al. 2023

Nutrients

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Among patients with diabetes mellitus, limited studies have investigated the relationship between anthropometric parameters and cardiovascular disease (CVD), with all-cause mortality. We examined the associations of arm circumference (AC), arm-to-waist ratio (AC/WC), and CVD, with all-cause mortality among patients with diabetes. This is a cohort study of 5497 diabetic individuals aged 20 or over who were recruited in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014. Cox proportional hazards regression models were used to analyze the associations between AC, AC/WC, and CVD, with all-cause mortality. We also conducted stratified analyses and explored the possible non-linear relation by restricted cubic splines. During a median follow-up of 7.2 years, there were 271 and 1093 cases of CVD and all-cause death. The multivariable adjusted hazard ratios (HRs) with 95% confidence intervals (Cis) of CVD mortality in Q2, Q3, and Q4 groups compared with Q1 group were 0.37 (0.22, 0.62), 0.24 (0.12, 0.48), 0.18 (0.07, 0.46) for AC, and 0.18 (0.07, 0.46), 0.34 (0.20, 0.60), 0.28 (0.15, 0.53) for AC/WC. Similar results were observed in the analysis for all-cause mortality risk. AC and AC/WC were both inversely associated with CVD and all-cause mortality among individuals with diabetes. It is important to pay attention to these anthropometric parameters of diabetic patients.

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“…Polypharmacy is another factor that may impact both weight and mortality risk [ 46 ] but this was not able to be accounted for in these analyses. Changes in waist circumference have been shown to have a strong association with mortality risk in older adults, and it is thought that waist circumference may be a better measurement of risk conferred by adiposity in older adults than weight [ 14 , 47 , 48 ]. Waist circumference was only available at baseline and therefore change could not be assessed.…”

Section: Discussionmentioning

confidence: 99%

“…Many previous cohort studies have assessed the association between BMI and mortality by examining BMI or weight at only a single point in time [ 14 , 15 , 16 ]. This ignores the likely changes in weight over time.…”

Section: Introductionmentioning

confidence: 99%

Objectively Assessed Weight Change and All-Cause Mortality among Community-Dwelling Older People

et al. 2022

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Later life changes in body weight may be associated with an increased risk of mortality in older adults. The objective of this study was to examine whether weight change over four years was associated with a 17-year mortality risk in older adults. Participants were 1664 community-dwelling adults aged ≥65 years in the longitudinal Enquete de Sante’ Psychologique-Risques, Incidence et Traitement (ESPRIT) study. Outcomes were all-cause mortality, cardiovascular disease (CVD) and cancer mortality. Weight change was defined as difference between weight at baseline and 4 years, categorised into: weight stable (±<5% weight change), weight loss (≥5%) and weight gain (≥5%). Association between weight change and mortality risk was evaluated using Cox proportional hazards models. Over 17 years of follow-up (median 15 years), 565 participants died. Compared to stable weight participants, those with ≥ 5% weight loss had an increased risk of all-cause mortality (HR: 1.24, 95% CI: 1.00–1.56, p = 0.05) and CVD mortality (HR: 1.53, 95% CI: 1.10–2.14, p = 0.01), but not cancer mortality (HR: 0.83, 95% CI: 0.50–1.39, p = 0.49). Weight gain of ≥5% was not associated with increased mortality (HR: 1.05, 95% CI: 0.76–1.45, p = 0.74). Weight monitoring in older adults could help identify weight loss at its early stages to better target interventions to maintain nutritional reserve and prevent premature mortality.

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The Association of Weight Loss, Weight Status, and Abdominal Obesity with All-Cause Mortality in Older Adults

Cited by 13 publications

References 35 publications

Associations of Change in Body Size With All-Cause and Cause-Specific Mortality Among Healthy Older Adults

Associations of Change in Body Size With All-Cause and Cause-Specific Mortality Among Healthy Older Adults

Arm Circumference, Arm-to-Waist Ratio in Relation to Cardiovascular and All-Cause Mortality among Patients with Diabetes Mellitus

Objectively Assessed Weight Change and All-Cause Mortality among Community-Dwelling Older People

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