Associations of changes in body mass index with all-cause and cardiovascular mortality in healthy middle-aged adults

In Jeong Cho, Hyuk Jae Chang, Ji Min Sung, Young Mi Yun, Hyeon Chang Kim, Namsik Chung

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15 Scopus citations


Background: Conflicting data exist regarding the association of body mass index (BMI) changes with all-cause and cardiovascular (CV) mortality. The current study investigated the association between changes in BMI and all-cause, CV, and non-CV mortality in a large cohort of middle-aged adults. Methods: A total of 379,535 adults over 40 years of age without pre-existing CV disease or cancer at baseline were enrolled to undergo a series of at least three health examinations of biennial intervals. Changes in BMI between baseline, midpoint follow-up, and final health examination during mean 9.3 years were defined according to the pattern of BMI change as follows: stable, sustained gain, sustained loss, and fluctuation. The relationship between BMI change category and mortality was assessed by multivariate Cox regression reporting hazard ratio (HR) with 95% confidence interval (95% CI). Results: During a mean follow-up of 10.7 years for mortality, 12,378 deaths occurred from all causes, of which 2,114 were CV and 10,264 were non-CV deaths. Sustained BMI gain was associated with the lower risk of all-cause (HR 0.89, 95% CI: 0.83–0.95), CV (HR 0.84, 95% CI 0.72–0.98), and non-CV mortality (HR 0.90, 95% CI 0.84–0.96) compared with stable BMI. Conversely, sustained BMI loss (HR 1.25, 95% CI 1.19–1.32) and fluctuation (HR 1.13, 95% CI 1.08–1.19) displayed a higher risk of all-cause mortality compared with stable BMI, which was mainly attributable to the increase in non-CV mortality. Conclusion: Sustained BMI gains were associated with reduced risk of all-cause, CV, and non-CV mortality in middle-aged healthy adults.

Original languageEnglish
Article numbere0189180
JournalPLoS ONE
Issue number12
StatePublished - Dec 2017

Bibliographical note

Funding Information:
This research was supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (MSIP) (No. 2012027176) and the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HI13C0715). This study used NHIS-HEALS data (NHIS-2016-2-147) generated by the National Health Insurance Service (NHIS). The authors declare no conflict of interest with NHIS.

Publisher Copyright:
© 2017 Cho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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