Weight change in relation to mortality in middle-aged and elderly chinese: the singapore chinese health study

ABSTRACT OBJECTIVES To examine the association between weight change and mortality in middle-aged and elderly Chinese. METHODS We used data from the Singapore Chinese Health Study among 36 

338 participants aged 45 to 74 years at recruitment (1993–1998). Weight change was computed as the difference between weights at baseline and the follow-up 1 (1999–2004) surveys and

classified as moderate-to-large weight loss (≥10%), small weight loss (5.1–9.9%), stable weight (±5%), small weight gain (5.1–9.9%) and moderate-to-large weight gain (≥10%). The participants

were free of cancer and cardiovascular disease (CVD) at the follow-up 1 survey and were followed for mortality through linkage with the Singapore Birth and Death Registry. RESULTS: Until 31

December 2016, a total of 7551 deaths were identified during 517 128 person-years of follow-up (mean follow-up: 14.2 years). Compared to those with stable weight, significantly increased

risk of all-cause mortality was found for participants with moderate-to-large weight loss (hazard ratio [HR]: 1.39; 95% CI: 1.30, 1.49), small loss (1.14; 1.06, 1.22), and moderate-to-large

gain (1.13; 1.05, 1.22). Moderate-to-large weight loss was significantly associated with increased risk of mortality from CVD (including both ischemic heart disease and stroke) and

respiratory disease, while moderate-to-large weight gain was significantly associated with CVD mortality. Associations were generally consistent in stratified analyses by sex, age groups

(<60 and ≥60 years old), smoking status (never, former and current smoking), and baseline body mass index (<23 and ≥23 kg/m2), although significant effect modifications were found for

certain strata. CONCLUSIONS Our findings showed that both moderate-to-large weight gain and loss conferred excess risk for all-cause and CVD mortality in middle-aged and elderly Chinese,

with slightly higher risk for weight loss than weight gain. However, it remains to be examined in clinical trials whether maintaining stable body weight should be proposed to reduce

mortality risk in middle-aged and elderly populations. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS

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institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS PROSPECTIVE STUDY OF WEIGHT LOSS AND ALL-CAUSE-, CARDIOVASCULAR-, AND CANCER

MORTALITY Article Open access 06 April 2023 ASSOCIATION OF WEIGHT FLUCTUATION WITH CARDIOVASCULAR DISEASE RISK AMONG INITIALLY OBESE ADULTS Article Open access 12 May 2021 METABOLIC OBESITY

PHENOTYPES AND ALL-CAUSE MORTALITY AMONG THE CHINESE OLDEST-OLD POPULATION: A PROSPECTIVE COHORT STUDY Article 26 June 2024 REFERENCES * Lyall DM, Celis-Morales C, Ward J, Iliodromiti S,

Anderson JJ, Gill JMR, et al. Association of body mass index with cardiometabolic disease in the UK Biobank: a Mendelian randomization study. JAMA Cardiol. 2017;2:882–9. Article  Google

Scholar  * Hruby A, Manson JE, Qi L, Malik VS, Rimm EB, Sun Q, et al. Determinants and consequences of obesity. Am J Public Health. 2016;106:1656–62. Article  Google Scholar  * Narayan KM,

Boyle JP, Thompson TJ, Gregg EW, Williamson DF. Effect of BMI on lifetime risk for diabetes in the U.S. Diabetes Care. 2007;30:1562–6. Article  CAS  Google Scholar  * Global BMI Mortality

Collaboration, Di Angelantonio E, Bhupathiraju ShN, Wormser D, Gao P, Kaptoge S, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective

studies in four continents. Lancet. 2016;388:776–86. Article  CAS  Google Scholar  * Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S, et al. BMI and all cause mortality: systematic

review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ. 2016;353:i2156. Article  Google Scholar  * Zheng W,

McLerran DF, Rolland B, Zhang X, Inoue M, Matsuo K, et al. Association between body-mass index and risk of death in more than 1 million Asians. N Engl J Med. 2011;364:719–29. Article  CAS 

Google Scholar  * Karahalios A, English DR, Simpson JA. Change in body size and mortality: a systematic review and meta-analysis. Int J Epidemiol. 2017;46:526–46. PubMed  Google Scholar  *

Cheng FW, Gao X, Jensen GL. Weight change and all-cause mortality in older adults: a meta-analysis. J Nutr Gerontol Geriatr. 2015;34:343–68. Article  Google Scholar  * WHO Expert

Consultation.. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–63. Article  Google Scholar  * Nanri A,

Mizoue T, Takahashi Y, Noda M, Inoue M, Tsugane S, et al. Weight change and all-cause, cancer and cardiovascular disease mortality in Japanese men and women: the Japan Public Health

Center-Based Prospective Study. Int J Obes. 2010;34:348–56. Article  CAS  Google Scholar  * Yun KE, Park HS, Song Y-M, Cho S-I. Increases in body mass index over a 7-year period and risk of

cause-specific mortality in Korean men. Int J Epidemiol. 2009;39:520–8. Article  Google Scholar  * Kim Y-H, Kim SM, Han K-d, Son J-W, Lee S-S, Oh SW, et al. Change in weight and body mass

index associated with all-cause mortality in Korea: a nationwide longitudinal study. J Clin Endocrinol Metab. 2017;102:4041–50. Article  Google Scholar  * Odegaard AO, Pereira MA, Koh WP,

Gross MD, Duval S, Yu MC, et al. BMI, all-cause and cause-specific mortality in Chinese Singaporean men and women: the Singapore Chinese Health Study. PLoS One. 2010;5:e14000. Article 

Google Scholar  * Hankin JH, Stram DO, Arakawa K, Park S, Low SH, Lee HP, et al. Singapore Chinese Health Study: development, validation, and calibration of the quantitative food frequency

questionnaire. Nutr Cancer. 2001;39:187–95. Article  CAS  Google Scholar  * Odegaard AO, Pereira MA, Koh WP, Arakawa K, Lee HP, Yu MC. Coffee, tea, and incident type 2 diabetes: the

Singapore Chinese Health Study. Am J Clin Nutr. 2008;88:979–85. Article  CAS  Google Scholar  * Talaei M, Pan A, Yuan JM, Koh WP. Dairy Food Intake Is Inversely Associated with Risk of

Hypertension: The Singapore Chinese Health Study. J Nutr. 2017;147:235–41. Article  CAS  Google Scholar  * Butler LM, Wang R, Koh WP, Yu MC. Prospective study of dietary patterns and

colorectal cancer among Singapore Chinese. Br J Cancer. 2008;99:1511–6. Article  CAS  Google Scholar  * Odegaard AO, Koh WP, Yuan JM, Gross MD, Pereira MA. Dietary patterns and mortality in

a Chinese population. Am J Clin Nutr. 2014;100:877–83. Article  CAS  Google Scholar  * National Registry of Diseases Office. Singapore Cancer Registry Annual Registry Report 2015. In: 5.6

Mortality Rates by Gender, 2011–5. Singapore: National Registry of Diseases Office; 2017. * Durrleman S, Simon R. Flexible regression models with cubic splines. Stat Med. 1989;8:551–61.

Article  CAS  Google Scholar  * Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, et al. Research agenda for frailty in older adults: toward a better understanding of

physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006;54:991–1001. Article

  Google Scholar  * Kritchevsky SB, Beavers KM, Miller ME, Shea MK, Houston DK, Kitzman DW, et al. Intentional weight loss and all-cause mortality: a meta-analysis of randomized clinical

trials. PLoS One. 2015;10:e0121993. Article  Google Scholar  * Simonsen MK, Hundrup YA, Obel EB, Gronbaek M, Heitmann BL. Intentional weight loss and mortality among initially healthy men

and women. Nutr Rev. 2008;66:375–86. Article  Google Scholar  * Berentzen T, Sorensen TI. Effects of intended weight loss on morbidity and mortality: possible explanations of controversial

results. Nutr Rev. 2006;64:502–7. Article  Google Scholar  * Gill LE, Bartels SJ, Batsis JA. Weight management in older adults. Curr Obes Rep. 2015;4:379–88. Article  Google Scholar  * Park

SY, Wilkens LR, Maskarinec G, Haiman CA, Kolonel LN, Marchand LL. Weight change in older adults and mortality: the Multiethnic Cohort Study. Int J Obes. 2017;42:205–12. Article  Google

Scholar  * Mulligan AA, Lentjes MAH, Luben RN, Wareham NJ, Khaw KT. Weight change and 15 year mortality: results from the European Prospective Investigation into Cancer in Norfolk

(EPIC-Norfolk) cohort study. Eur J Epidemiol. 2018;33:37–53. Article  Google Scholar  * Sauvaget C, Ramadas K, Thomas G, Vinoda J, Thara S, Sankaranarayanan R. Body mass index, weight change

and mortality risk in a prospective study in India. Int J Epidemiol. 2008;37:990–1004. Article  Google Scholar  * Frank BH. Obesity epidemiology. Vol. 1. Oxford University Press: New York;

2008. * Wada K, Tamakoshi K, Tsunekawa T, Otsuka R, Zhang H, Murata C, et al. Validity of self-reported height and weight in a Japanese workplace population. Int J Obes. 2005;29:1093–9.

Article  CAS  Google Scholar  * Okamoto N, Hosono A, Shibata K, Tsujimura S, Oka K, Fujita H, et al. Accuracy of self-reported height, weight and waist circumference in a Japanese sample.

Obes Sci Pract. 2017;3:417–24. Article  CAS  Google Scholar  * Lee CG, Boyko EJ, Nielson CM, Stefanick ML, Bauer DC, Hoffman AR, et al. Mortality risk in older men associated with changes in

weight, lean mass, and fat mass. J Am Geriatr Soc. 2011;59:233–40. Article  Google Scholar  Download references ACKNOWLEDGEMENTS We thank Siew-Hong Low of the National University of

Singapore for supervising the fieldwork in the Singapore Chinese Health Study and Renwei Wang for the maintenance of the cohort study database. We thank the Ministry of Health in Singapore

for assistance with the identification of deaths from cirrhosis and other causes via database linkages. This study was supported by the National Institutes of Health, USA (R01 CA144034 and

UM1 CA182876). W-P Koh is supported by the National Medical Research Council, Singapore (NMRC/CSA/0055/2013). A Pan is supported by the National Key Research and Development Program of China

(2017YFC0907504). XF Pan is supported by the 2018 Australian Endeavour Research Fellowship (69362018). The sponsors have no role in the study design, and collection, analysis or

interpretation of data. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State

Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China Xiong-Fei

Pan & An Pan * Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA Jian-Min Yuan * Department of Epidemiology,

Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA Jian-Min Yuan * Health Services and Systems Research, Duke-NUS Medical School, Singapore, Republic of

Singapore Woon-Puay Koh * Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore Woon-Puay Koh

Authors * Xiong-Fei Pan View author publications You can also search for this author inPubMed Google Scholar * Jian-Min Yuan View author publications You can also search for this author

inPubMed Google Scholar * Woon-Puay Koh View author publications You can also search for this author inPubMed Google Scholar * An Pan View author publications You can also search for this

author inPubMed Google Scholar CORRESPONDING AUTHORS Correspondence to Woon-Puay Koh or An Pan. ETHICS DECLARATIONS CONFLICT OF INTEREST The authors declare that they have no conflict of

interest. ELECTRONIC SUPPLEMENTARY MATERIAL FIGURE S1 ASSOCIATION BETWEEN ABSOLUTE WEIGHT CHANGE AND RISK OF MORTALITY IN THE SCHS TABLE S1 ASSOCIATIONS OF ANNUAL WEIGHT CHANGE WITH

CAUSE-SPECIFIC MORTALITY IN THE SCHS TABLE S2 ASSOCIATIONS OF WEIGHT CHANGE WITH MORTALITY FROM MAJOR CANCER TYPES IN THE SCHS 41366_2018_259_MOESM4_ESM.DOCX Table S3 Associations of weight

change with all-cause and cause-specific mortality in the SCHS: subgroup analysis by sex 41366_2018_259_MOESM5_ESM.DOCX Table S4 Associations of weight change with all-cause and

cause-specific mortality in the SCHS: subgroup analysis by age 41366_2018_259_MOESM6_ESM.DOCX Table S5 Associations of weight change with all-cause and cause-specific mortality in the SCHS:

subgroup analysis by BMI (cut-off of 23.0 kg/m2) 41366_2018_259_MOESM7_ESM.DOCX Table S6 Associations of weight change with all-cause and cause-specific mortality in the SCHS: subgroup

analysis by BMI (cut-off of 25.0 kg/m2) 41366_2018_259_MOESM8_ESM.DOCX Table S7 Associations of weight change with all-cause and cause-specific mortality in the SCHS: subgroup analysis by

smoking status 41366_2018_259_MOESM9_ESM.DOCX Table S8 Associations of weight change with all-cause and cause-specific mortality among 29,158 never smokers in the SCHS RIGHTS AND PERMISSIONS

Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Pan, XF., Yuan, JM., Koh, WP. _et al._ Weight change in relation to mortality in middle-aged and elderly Chinese: the Singapore

Chinese Health Study. _Int J Obes_ 43, 1590–1600 (2019). https://doi.org/10.1038/s41366-018-0259-y Download citation * Received: 08 April 2018 * Revised: 29 August 2018 * Accepted: 08

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