Joshua F Baker1, Andrew Stokes2, Ted R Mikuls3, Michael George4, Bryant R England3, Harlan Sayles5, Kaleb Michaud5. 1. Philadelphia VA Medical Center; Perelman School of Medicine, University of Pennsylvania; and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. bakerjo@uphs.upenn.edu. 2. Department of Global Health, Boston University School of Public Health, Boston, MA, USA. 3. Medicine Service, VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, USA. 4. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 5. Medicine Service, VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha; and National Data Bank for Rheumatic Diseases, Wichita, USA.
Abstract
OBJECTIVES: Obesity is paradoxically associated with a lower risk of mortality in chronic illnesses including rheumatoid arthritis (RA). Weight loss in patients with poor health, however, may in part explain this observation. This study evaluated the impact of weight early in life and weight loss on mortality in patients with RA. METHODS: Patients with RA (age >40 years) were active participants in a prospective clinical registry with up to 17 years of follow-up. Current and age-30 body mass index (BMI) were determined from self-report of height and weight from semi-annual questionnaires. Mortality was assessed from National Death Index. Risks of obesity reported from both early in life and at enrolment in the registry were evaluated using Cox proportional hazards models. RESULTS: Among 12,679 participants (80% female), there were 1,520 deaths in 80,502 person-years. Obesity at enrolment (BMI >30 kg/m2) was modestly associated with greater mortality [HR: 1.34 (1.18,1.53) p=0.001]. Adjusting for disability and comorbidities hypothesised to be mediators in the causal pathway between obesity and mortality further attenuated this association [HR: 0.92 (0.80,1.06) p=0.24]. In contrast, obesity at age 30 was strongly associated with mortality [HR: 2.00 (1.65,2.42) p<0.001]. Additionally, weight loss since age-30 was a strong, dose-dependent predictor of mortality independent of enrolment BMI. CONCLUSIONS: The risk of obesity is substantially underestimated when epidemiologic methods do not account for long-term weight changes. Both obesity and weight loss are strongly associated with mortality risk in patients with RA.
OBJECTIVES:Obesity is paradoxically associated with a lower risk of mortality in chronic illnesses including rheumatoid arthritis (RA). Weight loss in patients with poor health, however, may in part explain this observation. This study evaluated the impact of weight early in life and weight loss on mortality in patients with RA. METHODS:Patients with RA (age >40 years) were active participants in a prospective clinical registry with up to 17 years of follow-up. Current and age-30 body mass index (BMI) were determined from self-report of height and weight from semi-annual questionnaires. Mortality was assessed from National Death Index. Risks of obesity reported from both early in life and at enrolment in the registry were evaluated using Cox proportional hazards models. RESULTS: Among 12,679 participants (80% female), there were 1,520 deaths in 80,502 person-years. Obesity at enrolment (BMI >30 kg/m2) was modestly associated with greater mortality [HR: 1.34 (1.18,1.53) p=0.001]. Adjusting for disability and comorbidities hypothesised to be mediators in the causal pathway between obesity and mortality further attenuated this association [HR: 0.92 (0.80,1.06) p=0.24]. In contrast, obesity at age 30 was strongly associated with mortality [HR: 2.00 (1.65,2.42) p<0.001]. Additionally, weight loss since age-30 was a strong, dose-dependent predictor of mortality independent of enrolment BMI. CONCLUSIONS: The risk of obesity is substantially underestimated when epidemiologic methods do not account for long-term weight changes. Both obesity and weight loss are strongly associated with mortality risk in patients with RA.
Authors: Austin M Wheeler; Punyasha Roul; Yangyuna Yang; Kaitlyn M Brittan; Harlan Sayles; Namrata Singh; Brian C Sauer; Grant W Cannon; Joshua F Baker; Ted R Mikuls; Bryant R England Journal: Arthritis Care Res (Hoboken) Date: 2022-04-05 Impact factor: 5.178
Authors: James M Gwinnutt; Maud Wieczorek; Giulio Cavalli; Andra Balanescu; Heike A Bischoff-Ferrari; Annelies Boonen; Savia de Souza; Annette de Thurah; Thomas E Dorner; Rikke Helene Moe; Polina Putrik; Javier Rodríguez-Carrio; Lucía Silva-Fernández; Tanja Stamm; Karen Walker-Bone; Joep Welling; Mirjana I Zlatković-Švenda; Francis Guillemin; Suzanne M M Verstappen Journal: RMD Open Date: 2022-03