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

Abstract

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 (>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; >10% decrease among women: HR, 2.78; 95% CI, 1.82-4.26), CVD-specific mortality (>10% decrease among men: HR, 3.14; 95% CI, 1.63-6.04; >10% decrease among women: HR, 1.92; 95% CI, 1.05-3.51), and noncancer non-CVD–specific mortality (>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.

Association of adiposity and its changes over time with COVID-19 risk in older adults with overweight/obesity and metabolic syndrome: a longitudinal evaluation in the PREDIMED-Plus cohort

“…In this context of our study findings, the recent highlight on the need to monitor and investigate weight loss in older adults aged over 65 years by the ASPREE trial is informative [ 32 ]. This trial reported that a weight loss of 5% or more and reductions in waist circumference were associated with increased mortality [ 32 ].…”

“…In this context of our study findings, the recent highlight on the need to monitor and investigate weight loss in older adults aged over 65 years by the ASPREE trial is informative [ 32 ]. This trial reported that a weight loss of 5% or more and reductions in waist circumference were associated with increased mortality [ 32 ]. The authors of the ASPREE trial explained that weight loss commonly precedes a diagnosis of chronic diseases in older adults and that it is associated with a reduced appetite and food intake.…”

Relationship between BMI and prognosis of chronic heart failure outpatients in Vietnam: a single-center study

“…On the other hand, the importance of recognizing and addressing frailty, sarcopenia, cachexia, and malnutrition in HF patients should also be acknowledged in order to improve their clinical outcomes. Particularly, identifying loss of weight over time may also be an important marker in this population as this has recently shown to be associated with increased all-cause and CVD specific mortality in a healthy elderly cohort ( 65 ). To achieve those goals, we recommend managing stable chronic HF patients in an outpatient heart failure program with the collaboration of a multidisciplinary team consisting of cardiologists, nutritionists, and geriatricians.…”

Racial and ethnic disparities in the association between financial hardship and self-reported weight change during the first year of the pandemic in the U.S.

“…Weight gain (≥ 2.5-<10.0 kg) from early to middle adulthood may increase the risk of development of major chronic diseases (e.g., type 2 diabetes, cardiovascular disease, obesity-related cancers), and increased risk of morality among US adults compared with participants who maintained a stable weight [ 9 ]. Weight l loss of 5–10% of body weight in older adults was associated with an increase in all-cause mortality than those who had stable weight [ 10 – 12 ]. Additionally, significant weight gain or loss (> 10%) is associated with increased all-cause hospitalization compared to those with stable weight.…”