A1 Refereed original research article in a scientific journal
The Obesity Paradox, Frailty, Disability, and Mortality in Older Men: A Prospective, Longitudinal Cohort Study
Authors: Strandberg TE, Stenholm S, Strandberg AY, Salomaa VV, Pitkala KH, Tilvis RS
Editors: Moyses Szklo
Publisher: OXFORD UNIV PRESS INC
Publication year: 2013
Journal: American Journal of Epidemiology
Journal name in source: AMERICAN JOURNAL OF EPIDEMIOLOGY
Journal acronym: AM J EPIDEMIOL
Number in series: 9
Volume: 178
Issue: 9
First page : 1452
Last page: 1460
Number of pages: 9
ISSN: 0002-9262
DOI: https://doi.org/10.1093/aje/kwt157
Abstract
An inverse relationship between overweight and mortality (the obesity paradox) is well documented, but there are scarce data on how body weight during the life course affects this relationship. In the Helsinki Businessmen Study, we examined the effect of weight trajectories on incident disability, frailty, and mortality by stratifying 1,114 men (mean age of 47 years in 1974) into the following 4 groups based on body mass index (weight (kg)/height (m)(2)) values measured twice, in 1974 and 2000: 1) constantly normal weight (n 340, reference group); 2) constantly overweight (n 495); 3) weight gain (n 136); and 4) weight loss (n 143). Twelve-year mortality rates (from 2000 to 2012) and frailty and mobility-related disability in late life were determined. Compared with constantly normal weight, weight loss was associated with disability (odds ratio (OR) 2.4, 95 confidence interval (CI): 1.1, 4.9) and frailty (OR 3.7, 95 CI: 1.3, 10.5) in late life. Constant overweight was associated with increased disability (OR 1.9, 95 CI: 1.1, 3.2). Men with constantly normal weight had the fewest comorbidities in late life (P 0.001). Higher 12-year mortality rates were observed both with weight loss (hazard ratio 1.8, 95 CI: 1.3, 2.3) and with constant overweight (hazard ratio 1.3, 95 CI: 1.03, 1.7). Those with constantly normal weight or weight gain had similar outcomes. We observed no obesity paradox in late life when earlier weight trajectories were taken into account.
An inverse relationship between overweight and mortality (the obesity paradox) is well documented, but there are scarce data on how body weight during the life course affects this relationship. In the Helsinki Businessmen Study, we examined the effect of weight trajectories on incident disability, frailty, and mortality by stratifying 1,114 men (mean age of 47 years in 1974) into the following 4 groups based on body mass index (weight (kg)/height (m)(2)) values measured twice, in 1974 and 2000: 1) constantly normal weight (n 340, reference group); 2) constantly overweight (n 495); 3) weight gain (n 136); and 4) weight loss (n 143). Twelve-year mortality rates (from 2000 to 2012) and frailty and mobility-related disability in late life were determined. Compared with constantly normal weight, weight loss was associated with disability (odds ratio (OR) 2.4, 95 confidence interval (CI): 1.1, 4.9) and frailty (OR 3.7, 95 CI: 1.3, 10.5) in late life. Constant overweight was associated with increased disability (OR 1.9, 95 CI: 1.1, 3.2). Men with constantly normal weight had the fewest comorbidities in late life (P 0.001). Higher 12-year mortality rates were observed both with weight loss (hazard ratio 1.8, 95 CI: 1.3, 2.3) and with constant overweight (hazard ratio 1.3, 95 CI: 1.03, 1.7). Those with constantly normal weight or weight gain had similar outcomes. We observed no obesity paradox in late life when earlier weight trajectories were taken into account.
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