Body Mass Index (BMI) Change and All-Cause Mortality in the Middle-aged and Older Population
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2017-05
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Objectives (i) To investigate the BMI change distribution among middle-aged and older adults; (ii) to assess the magnitudes of the effect of BMI change on all-cause mortality; (iii) to examine the effect modification of the BMI change-mortality associations by gender and ethnicity among the middle-aged and older population.
Design This study utilizes a nationally representative dataset from the U.S. Health and Retirement Study (HRS). The HRS is an on-going biennial longitudinal survey began in 1992 and the survey is based on a multi-stage area probability design involving geographical stratification and clustering.
Participants There are a total of 24,984 participants (13,887 females and 11,097 males) aged 60 years or older with an average age of 75.68 after excluding participants without clear responses.
Main exposures BMI change.
Main outcomes Survival time and mortality.
Results The BMI change of our study sample is normally distributed, in which most participants cluster in the stable group and fewer participants are distributed in the severe loss and gain groups. Compared with participants with stable BMI, participants with severe BMI loss, severe BMI gain, and moderate BMI gain have greater risk of mortality, the hazard ratios (HRs) and 95% confidence intervals (CIs) are: 1.13 (1.06, 1.19); 1.11 (1.03, 1.20), and 1.15 (1.06, 1.24), respectively. For females, severe BMI loss, moderate BMI gain, and severe BMI gain are associated with increased mortality (Severe loss: 1.14 (1.06, 1.23); Moderate loss: 1.02 (0.94, 1.11); Moderate gain: 1.17 (1.05, 1.29); Severe gain: 1.19 (1.08, 1.32)). The association is weaker for males (Severe loss: 1.09 (1.00, 1.19); Moderate loss: 1.02 (0.94, 1.11); Moderate gain: 1.06 (0.95, 1.18); Severe gain: 1.12 (0.99, 1.27)).
Conclusion Severe BMI loss, severe BMI gain, and moderate BMI gain are associated with increased all-cause mortality among the middle-aged and older population in the United States, but moderate BMI loss is not a risk factor for mortality. The results of subgroup analysis suggest gender and racial differences in the association between BMI change and all-cause mortality. These results of subgroup analysis indicate that females are more sensitive than males, and Caucasians are more sensitive than African Americans. Public health efforts should encourage weight control among the middle-aged and older population.
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