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Weight fluctuation, mortality, and cardiovascular disease in adults in 18 years of follow-up: Tehran Lipid and Glucose Study

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Abstract

Purpose

Controversies exist in the effect of body weight loss and fluctuation on cardiovascular disease (CVD) and mortality. This study aims to assess the effect of weight variability on CVD and all-cause and cardiovascular mortality in the Tehran Lipid and Glucose Study (TLGS) cohort.

Method

Participants aged  ≥ 40 year at the baseline period with at least 3 BMI measurements were included in this study. After excluding individuals with cancer, CVD, end-stage renal disease, systemic use of glucocorticoids, pregnancy, and missing covariates at the baseline, a total of 3461 participants were enrolled and followed for 18 years. BMI variability was defined using root mean squared error (RMSE) and average successive variability (ASV). In the RMSE method, BMI variability was calculated using the best-fitting model for BMI trend of each subject. Multivariate Cox proportional hazard models were applied to assess BMI variability’s effect on CVD and mortality.

Results

Among the 3461 participants in this study, the group with the highest weight variability had an increased risk of death for all-cause (HR 1.65; 95% CI 1.21–2.25), non-cardiovascular (HR 1.77; 95% CI 1.24–2.53), and non-cancer (HR 1.77; 95% CI 1.25–2.50) mortality. However, BMI variability showed to be protective against CVD (HR 0.76; 95% CI 0.6–0.97). These findings were significant in males, non-smokers, participants with age  ≤ 60 year, BMI < 30, negative BMI slope, and both diabetic and non-diabetic subjects.

Conclusion

High BMI variability is associated with increased risk of all-cause, non-CVD, and non-cancer mortality, although protective for the CVD event. Appropriate strategies for body weight maintenance after weight loss could be adopted to avoid weight variability, particularly in non-obese subjects.

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Acknowledgements

The authors express our appreciation to TLGS participants and the research team members for their contribution to the study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 23, Parvaneh Street, Velenjak, P.O. Box: 19395-4763, Tehran, Islamic Republic of Iran

    L. Mehran, M. Honarvar, S. Masoumi, A. Amouzegar & F. Azizi

  2. Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran

    S. Masoumi

  3. Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran

    D. Khalili

  4. Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran

    D. Khalili

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  1. L. Mehran
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  3. S. Masoumi
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Correspondence to A. Amouzegar.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the ethics committee of the Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involving human participants

All procedures followed were in accordance with the ethical standards of the ethics committee of the Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences (IR.SBMU.ENDOCRINE.REC. 1398.103), and with the Helsinki Declaration of 1964 and later versions.

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Informed consent was obtained from all participants for being included in the study.

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Mehran, L., Honarvar, M., Masoumi, S. et al. Weight fluctuation, mortality, and cardiovascular disease in adults in 18 years of follow-up: Tehran Lipid and Glucose Study. J Endocrinol Invest 46, 37–49 (2023). https://doi.org/10.1007/s40618-022-01881-9

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