Two-Year Weight Loss but Not Body Mass Index Predicts Mortality and Disability in an Older Japanese Community-Dwelling Population

Nishida, Mitsuo; Okura, Mika; Ogita, Mihoko; Aoyama, Tomoki; Tsuboyama, Tadao; Arai, Hidenori

doi:10.1016/j.jamda.2019.04.029

Cited by 16 publications

(12 citation statements)

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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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“…Table 1 summarizes the characteristics of the studies included in the review. All studies were observational cohorts; 41 were prospective [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] and 17 were retrospective [ 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , …”

Section: Resultsmentioning

confidence: 99%

The Obesity Paradox and Mortality in Older Adults: A Systematic Review

Dramé

Godaert

2023

Nutrients

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“Obesity paradox” describes the counterintuitive finding that aged overweight and obese people with a particular disease may have better outcomes than their normal weight or underweight counterparts. This systematic review was performed to summarize the publications related to the obesity paradox in older adults, to gain an in-depth understanding of this phenomenon. PubMed©, Embase©, and Scopus© were used to perform literature search for all publications up to 20 March 2022. Studies were included if they reported data from older adults on the relation between BMI and mortality. The following article types were excluded from the study: reviews, editorials, correspondence, and case reports and case series. Publication year, study setting, medical condition, study design, sample size, age, and outcome(s) were extracted. This review has been registered with PROSPERO (no. CRD42021289015). Overall, 2226 studies were identified, of which 58 were included in this systematic review. In all, 20 of the 58 studies included in this review did not find any evidence of an obesity paradox. Of these 20 studies, 16 involved patients with no specific medical condition, 1 involved patients with chronic diseases, and 2 involved patients with type 2 diabetes mellitus. Seven out of the nine studies that looked at short-term mortality found evidence of the obesity paradox. Of the 28 studies that examined longer-term mortality, 15 found evidence of the obesity paradox. In the studies that were conducted in people with a particular medical condition (n = 24), the obesity paradox appeared in 18 cases. Our work supports the existence of an obesity paradox, especially when comorbidities or acute medical problems are present. These findings should help guide strategies for nutritional counselling in older populations.

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“…5 It was also reported that weight loss over 2 years rather than BMI was associated with a higher mortality and disability risk in older individuals. 22 In comparison with these population-based studies, the major strength of this study was the availability of insurance records that made conditional analysis of the participants' disease background possible. Therefore, we tried to clarify possible confounders of several comorbidities in the association between BMI and all-cause mortality.…”

Section: Discussionmentioning

confidence: 99%

Body mass index, functional disability and all‐cause mortality in 330 000 older adults: The Shizuoka study

Tabara

Nakatani²

2021

Geriatrics Gerontology Int

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Aim: A J-shaped association has been observed between body mass index (BMI) and allcause mortality, but its relationship with functional disability is uncertain. We aim to clarify the association between BMI and functional disability, as well as all-cause mortality, by analyzing prefecture-wide annual health checkup data, and health and care insurance data. Methods:The dataset analyzed in this study consisted of 332 405 community residents aged ≥65 years who subscribed to the National Health Insurance. Basic clinical information was obtained from the annual health checkup data. The presence of comorbidities at baseline and the incidence of functional disability and all-cause mortality were obtained from the health insurance data. Results:The mean age and standard deviation of the study participants was 73.5 AE 6.0 years. During a 4-year follow-up period, we observed 31 508 incident cases of functional disability and 16 640 deaths. The incidence rates of functional disability and allcause mortality were higher in both lower and higher BMI subgroups, and the lowest risk was observed in the range of 21-27 kg/m 2 in men and 20-25 kg/m 2 in women. These associations were independent of age, sex, current smoking and possible confounding factors, including a cardiovascular diseases history, hospitalization during the half-year period before baseline, and baseline comorbidities. A similar association was observed between BMI and all-cause mortality even when individuals who developed functional disabilities before death were excluded from the analysis.Conclusions: Maintaining the bodyweight within the recommended range could be an effective method of reducing the risk of functional disability and mortality.

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Two-Year Weight Loss but Not Body Mass Index Predicts Mortality and Disability in an Older Japanese Community-Dwelling Population

Cited by 16 publications

References 45 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

The Obesity Paradox and Mortality in Older Adults: A Systematic Review

Body mass index, functional disability and all‐cause mortality in 330 000 older adults: The Shizuoka study

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