Abstract
ObjectiveThe relationship between weight loss and mortality has important clinical and public health significance but has proved to be complex. Evidence is mixed and particularly limited on the association between weight loss in mid-life and premature death (i.e. before 65 years of age), a small albeit important segment of total mortality. We aimed to study the association between midlife weight change and mortality accounting for health and lifestyle characteristics, and also considering potential bias due to preexisting chronic diseases and smoking status.DesignLongitudinal, population-based, ‘the 1946 British’ birth cohort study.Subjects and MeasuresIn 2750 men and women, mortality from age 53 through 65 years was analyzed according to categories of measured 10 year weight change between 43 and 53 years. Cox's hazard ratios (HR) were progressively adjusted for socio-demographic, lifestyle and health characteristics.ResultsNearly 20% of participants lost weight and over 50% gained 5 kg or more in midlife. There were 164 deaths. Compared to those who gained between 2 and 5 kg, those who lost 5 kg or more had an increased risk of premature death independently of midlife physical activity, socio-economic circumstances and educational attainment. This association was unaltered when highest weight loss (lost more than 15 Kg) (p = 0.04) and early deaths were excluded (p<0.001), but was no longer significant after adjustment for cardiovascular risk factors and health status (HR = 1.8; 95% CI: 0.9 to 3.5).ConclusionThe inverse association between weight loss in midlife and higher risk of premature death may be explained by vascular risk factors and ill health. In consideration of the burden of premature death, closer monitoring of weight loss in mid-life is warranted.
Highlights
Premature death is a small segment of total mortality but of great clinical and public health importance [1]
There is the possibility that health status and clinical conditions which lead to mortality cause weight loss either through the clinical disease process or by prompting attempts to lose weight after a condition is diagnosed [14]
Mortality risks by weight change categories are reported in table 2, the highest weight loss group has a high rate compared with all other groups
Summary
Similar percentages of men and women experienced weight loss, and 11% lost more than 2 kg and 48% gained more than 5 kg between 43 and 53 years. The increased mortality rate in the highest weight loss group (compared to the reference) was stronger and remained significant after full adjustment (model 4) in non-smokers (HR = 2.9; 95% CI: 1.00, 6.7) but not in smokers at age 43 years (HR = 1.42; 95% CI: 0.5, 3.8) (p value for smoking by weight change interaction in model 4 = 0.09). We found that participants who were obese at 43 years (n = 334; 12% of the study sample) had a higher mortality risk (HR = 1.7; 95% CI: 1.1, 2.7) compared to those who were in the normal weight category (18.5,BMI,; n = 1 421) at the same age This association was independent of their weight change between 43 and 53 years and was hardly attenuated by adjustment for all other covariates.
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