Weight Loss Linked to Early Death in Older but Healthy Adults

Weight loss in otherwise healthy older adults is linked to an increased risk of mortality, even from conditions not typically associated with weight change, with a substantially stronger link in men versus women, suggesting the need for clinicians to be alert to such changes.

“Our study emphasizes the importance of weight loss even in relatively healthy individuals who are free from evident cardiovascular disease (CVD), dementia, physical disability, or life-limiting chronic illness,” first author Monira Hussain, MBBS, MPH, PhD, told Medscape Medical News.

“Clinicians should be aware that even minor weight loss of 5% or more in older adults without life-limiting illnesses can increase mortality risk,” Hussain said. “Regular monitoring of weight changes can help early identification of associated risks.”

The study was published online April 10 in JAMA Network Open.

The researchers note that data on the significance of weight changes among older individuals who are otherwise relatively healthy and not diagnosed with life-limited diseases are limited.

With the exception that “it is widely acknowledged that weight loss may precede a diagnosis of cancer,” they say. But the association with the other types of noncancer-related premature death is notable.

“In our study, weight loss also preceded an increased mortality from CVD and other causes, [such as] deaths from trauma, dementia, Parkinson disease, and other less common causes.”

Therefore, “a likely explanation for these findings is that weight loss can be an early prodromal indicator of the presence of various life-shortening diseases,” write Hussain, of the School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, and colleagues.

In terms of why weight loss shows such a stronger link to mortality in older men compared with women, Hussain speculated that this may be due to “differences in body composition,” between the two sexes. “Men have a higher proportion of muscle and bone mass, and weight loss [in men] primarily involves loss of these tissues,” she observed.

10% Weight Loss Quadrupled Risk of Premature Death Among Men

To investigate this phenomenon, the researchers conducted a posthoc analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) randomized trial, which included information on a variety of body size parameters, such as weight and waist circumference, measured annually, from a large population of healthy individuals with no evident cardiovascular disease (CVD), dementia, physical disability, or life-limiting chronic illness.

The 16,523 participants included in the study had a mean age of 75 years and 55.6% were women. During a mean follow-up of 4.4 years, 1256 deaths occurred in the cohort.

Looking at rates of all-cause mortality, stratified by gender, the results showed that among men who had a 5% to 10% decrease in weight over the course of the study, the risk of all-cause mortality was 33% higher than men who had a stable weight (less than 5% change; hazard ratio [HR], 1.33).

Among men who had a more than 10% decrease in weight, the mortality risk was as much as 289%, or nearly four times higher compared with those with a stable weight (HR, 3.89).

For women, the mortality risk was also increased, however, to a lesser degree. A 5% to 10% loss of body weight was associated with a 26% increased mortality risk (HR, 1.26), and a loss of more than 10% was linked to a 114% increased risk of all-cause mortality (HR, 2.14).

In terms of cancer-specific deaths, the risk was significantly increased only among men who had a greater than 10% weight decrease (HR, 3.49), while the increased risk in women was observed with a 5% to 10% decrease in weight (HR, 1.44) as well as a more than 10% decrease (HR, 2.78).

The risk of CVD-specific death was significantly increased with a more than 10% decrease in weight in both sexes, but the risk was again higher among men (HR, 3.14) than women (HR, 1.92), compared with stable weight groups.

And the noncancer, non-CVD–specific mortality risk was nearly five times higher among men who had a more than 10% decrease in weight versus stable weight (HR, 4.98); however, the association was not significant among women (HR, 1.49).

Looking at the effects of change in waist circumference, a decrease of more than 10% was associated with a higher risk in all-cause mortality that was again higher for men (HR, 2.14) versus women (HR, 1.34); however, no link with all-cause mortality was observed with a less than 10% decrease in either sex.

A greater than 10% decrease in waist circumference was also associated with higher risk of cancer death for men and women, and higher noncancer, non-CVD death among men, but not women, while there was no association between waist circumference and CVD mortality in men or women.

Association With Mortality Remained After Adjusting for Hospitalization

The results persisted after adjustment for age, frailty status, baseline body mass index (BMI), country of birth, smoking, hypertension, diabetes, and hospitalization in the previous 24 months.

The adjustment for recent hospitalization was especially important for ruling out weight loss that may have occurred due to hospitalization for acute conditions that could have contributed to mortality, the authors note.

The authors have reported no relevant financial relationships.

JAMA Netw Open. 2023;6:e237482. Full text

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