L Mehran1, M Honarvar1, S Masoumi1,2, D Khalili3,4, A Amouzegar5, F Azizi1. 1. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 23, Parvaneh Street, Velenjak, P.O. Box: 19395-4763, Tehran, Islamic Republic of Iran. 2. Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran. 3. Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran. 4. Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran. 5. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 23, Parvaneh Street, Velenjak, P.O. Box: 19395-4763, Tehran, Islamic Republic of Iran. amouzegar@endocrine.ac.ir.
Abstract
PURPOSE: Controversies exist in the effect of body weight loss and fluctuation on cardiovascular disease (CVD) and mortality. This study aims to assess the effect of weight variability on CVD and all-cause and cardiovascular mortality in the Tehran Lipid and Glucose Study (TLGS) cohort. METHOD: Participants aged ≥ 40 year at the baseline period with at least 3 BMI measurements were included in this study. After excluding individuals with cancer, CVD, end-stage renal disease, systemic use of glucocorticoids, pregnancy, and missing covariates at the baseline, a total of 3461 participants were enrolled and followed for 18 years. BMI variability was defined using root mean squared error (RMSE) and average successive variability (ASV). In the RMSE method, BMI variability was calculated using the best-fitting model for BMI trend of each subject. Multivariate Cox proportional hazard models were applied to assess BMI variability's effect on CVD and mortality. RESULTS: Among the 3461 participants in this study, the group with the highest weight variability had an increased risk of death for all-cause (HR 1.65; 95% CI 1.21-2.25), non-cardiovascular (HR 1.77; 95% CI 1.24-2.53), and non-cancer (HR 1.77; 95% CI 1.25-2.50) mortality. However, BMI variability showed to be protective against CVD (HR 0.76; 95% CI 0.6-0.97). These findings were significant in males, non-smokers, participants with age ≤ 60 year, BMI < 30, negative BMI slope, and both diabetic and non-diabetic subjects. CONCLUSION: High BMI variability is associated with increased risk of all-cause, non-CVD, and non-cancer mortality, although protective for the CVD event. Appropriate strategies for body weight maintenance after weight loss could be adopted to avoid weight variability, particularly in non-obese subjects.
PURPOSE: Controversies exist in the effect of body weight loss and fluctuation on cardiovascular disease (CVD) and mortality. This study aims to assess the effect of weight variability on CVD and all-cause and cardiovascular mortality in the Tehran Lipid and Glucose Study (TLGS) cohort. METHOD: Participants aged ≥ 40 year at the baseline period with at least 3 BMI measurements were included in this study. After excluding individuals with cancer, CVD, end-stage renal disease, systemic use of glucocorticoids, pregnancy, and missing covariates at the baseline, a total of 3461 participants were enrolled and followed for 18 years. BMI variability was defined using root mean squared error (RMSE) and average successive variability (ASV). In the RMSE method, BMI variability was calculated using the best-fitting model for BMI trend of each subject. Multivariate Cox proportional hazard models were applied to assess BMI variability's effect on CVD and mortality. RESULTS: Among the 3461 participants in this study, the group with the highest weight variability had an increased risk of death for all-cause (HR 1.65; 95% CI 1.21-2.25), non-cardiovascular (HR 1.77; 95% CI 1.24-2.53), and non-cancer (HR 1.77; 95% CI 1.25-2.50) mortality. However, BMI variability showed to be protective against CVD (HR 0.76; 95% CI 0.6-0.97). These findings were significant in males, non-smokers, participants with age ≤ 60 year, BMI < 30, negative BMI slope, and both diabetic and non-diabetic subjects. CONCLUSION: High BMI variability is associated with increased risk of all-cause, non-CVD, and non-cancer mortality, although protective for the CVD event. Appropriate strategies for body weight maintenance after weight loss could be adopted to avoid weight variability, particularly in non-obese subjects.
Authors: Goodarz Danaei; James M Robins; Jessica G Young; Frank B Hu; JoAnn E Manson; Miguel A Hernán Journal: Epidemiology Date: 2016-03 Impact factor: 4.822
Authors: Victoria L Stevens; Eric J Jacobs; Juzhong Sun; Alpa V Patel; Marjorie L McCullough; Lauren R Teras; Susan M Gapstur Journal: Am J Epidemiol Date: 2012-01-27 Impact factor: 4.897
Authors: Pierluigi Costanzo; John G F Cleland; Pierpaolo Pellicori; Andrew L Clark; David Hepburn; Eric S Kilpatrick; Pasquale Perrone-Filardi; Jufen Zhang; Stephen L Atkin Journal: Ann Intern Med Date: 2015-05-05 Impact factor: 25.391
Authors: Wolfram Doehner; Erland Erdmann; Richard Cairns; Andrew L Clark; John A Dormandy; Ele Ferrannini; Stefan D Anker Journal: Int J Cardiol Date: 2011-10-29 Impact factor: 4.164
Authors: Krista Casazza; Kevin R Fontaine; Arne Astrup; Leann L Birch; Andrew W Brown; Michelle M Bohan Brown; Nefertiti Durant; Gareth Dutton; E Michael Foster; Steven B Heymsfield; Kerry McIver; Tapan Mehta; Nir Menachemi; P K Newby; Russell Pate; Barbara J Rolls; Bisakha Sen; Daniel L Smith; Diana M Thomas; David B Allison Journal: N Engl J Med Date: 2013-01-31 Impact factor: 91.245
Authors: Angela A Mulligan; Marleen A H Lentjes; Robert N Luben; Nicholas J Wareham; Kay-Tee Khaw Journal: Eur J Epidemiol Date: 2017-12-20 Impact factor: 8.082