Associations with Weight Loss and Subsequent Mortality Risk

doi:10.1016/j.annepidem.2004.12.003

Annals of Epidemiology

Volume 15, Issue 7, August 2005, Pages 483-491

https://doi.org/10.1016/j.annepidem.2004.12.003 Get rights and content

Purpose

Studies have shown a high prevalence of weight loss in older adults is associated with an increased risk of death. We investigated this in a population-based study.

Methods

Persons living in Beaver Dam, Wisconsin, participated in a baseline examination between 1988 and 1990 (n = 4926). A medical examination and standardized questionnaire were administered. Weight loss was defined as percent loss in body weight from highest lifetime weight to measured weight at baseline.

Results

Weight loss was associated with older age, higher rates of diseases such as diabetes, and lower baseline levels of blood pressure and serum total cholesterol. After controlling for age, medical, and lifestyle factors, both men and women had higher mortality rates over a 10+ year period for increasing categories of weight loss (hazard ratio [ 95% CI]: 1.16 [1.06, 1.27] for men and 1.23 [1.13, 1.34] for women). Increased mortality rates with increasing weight loss was shown in stratified analyses of age, body mass index (BMI) at highest weight, smoking, and disease status, but did not always reach statistical significance. Persons on weight loss diets within the year prior to baseline did not have increased mortality with increasing weight loss.

Conclusion

The strong association between weight loss (likely involuntary) and mortality may be a useful way of estimating overall risks to longevity in populations.

Introduction

An association between weight loss and increased mortality has been demonstrated in many epidemiological studies 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14. This association has been demonstrated defining weight loss over short intervals (4), from an average weight (7), or highest lifetime weight (2). It also has been demonstrated for a wide variety of causes of death 8, 12. However, the conclusions reached from these studies remain controversial, in part, because voluntary and involuntary weight loss may not be distinguished 15, 16, 17. The underlying assumption is that involuntary weight loss indicates illness, perhaps occult, while voluntary weight loss does not. Despite this controversy, an increased risk of mortality in persons who have voluntarily lost weight has been shown 6, 8. This may in part be attributable to diseases such as diabetes or hypertension, where the treatment may involve weight loss. To attempt to compensate for underlying diseases and treatments, statistical methods such as adjusting for pre-existing illness and excluding deaths in early follow-up are used. After employing these methods the results between weight loss and increased mortality are generally attenuated, but many times remain statistically significant, although some researchers have argued that there is still uncontrolled confounding 12, 18.

In the current study, we measured weight loss and subsequent mortality risks over 10 years in persons ranging in age from 43 to 86 years in a large population-based study and attempted to determine whether or not weight loss was an independent marker for mortality.

Section snippets

Population

A private census of the population of Beaver Dam, Wisconsin, was performed from September 15, 1987 to May 4, 1988, to identify all eligible residents in the city or township of Beaver Dam, WI (19). Of the 5924 eligible individuals, 4926 (83%) persons aged 43 to 86 years participated in the baseline examination between March 1, 1988 and September 14, 1990. Differences between participants and non-participants have been published in a previous report (19). Ninety-nine percent of the population

Associations of Weight Loss

The prevalence of weight loss for men from highest self-reported weight was 24%, 21%, and 7% for losing 5% to 9.9%, 10% to 19.9%, and ⩾ 20%, respectively. Corresponding rates for women were 21%, 17%, and 8%. Table 1 describes various baseline characteristics by weight loss status for both men and women. Results were consistent for men and women for most characteristics. In general, the older the person was the greater the percent weight loss at baseline. After controlling for age, persons who

Discussion

For the current report, we investigated associations of various personal characteristics with weight loss from highest self-reported weight and subsequent mortality risks in a large cohort of adults aged between 43 and 86 years. Weight loss was associated with lower levels of blood pressure and serum total cholesterol. In contrast, those with a greater weight loss were more likely to have diabetes and/or a history of cardiovascular disease. Whether these observations, which are cross-sectional,

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However, to date, no other studies have reported an association between an increase in MUAC and increased mortality risk among older persons. This study's finding of an increased mortality risk associated with BMI decrease corresponds with most other studies on BMI/weight loss, which also found an increased mortality risk [1–6,20,35,36]. However, large differences in the association between men and women have not yet been reported, apart from one study [7] that found a stronger association between weight loss and mortality in men.
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: This study was supported by NIH grant: EY06594 (Klein R, Klein BEK).

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Associations with Weight Loss and Subsequent Mortality Risk

Purpose

Methods

Results

Conclusion

Introduction

Section snippets

Population

Associations of Weight Loss

Discussion

J Clin Epidemiol

J Clin Epidemiol

Ophthalmology

Ophthalmology

Ann Epidemiol

Weight loss and mortality in a national cohort of adults, 1971–1987

Am J Epidemiol

Weight loss and subsequent death in a cohort of U.S. adults

Ann Intern Med

Involuntary weight loss in older outpatients: Incidence and clinical significance

J Am Geriatr Soc

Does weight loss from middle age to old age explain the inverse weight mortality relation in old age?

Am J Epidemiol

Voluntary and involuntary weight loss: Associations with long-term mortality in 9228 middle-aged and elderly men

Am J Epidemiol

Weight, weight change, mortality in a random sample of older community-dwelling women

J Am Geriatr Soc

Prospective study of intentionality of weight loss and mortality in older women: The Iowa Women's Health Study

Am J Epidemiol

Weight change in old age and its association with mortality

J Am Geriatr Soc

Weight change, weight fluctuation, and mortality

Arch Intern Med

Body mass index, weight change, and death in older adults: The Systolic Hypertension in the Elderly Program

Am J Epidemiol