ABSTRACT Aims Weight fluctuation and changes in relative fat mass ( RFM ) are independently linked to mortality, but few studies have examined the joint effects of weight and RFM changes on all‐cause and cardiovascular disease ( CVD ) mortality among older community‐dwellers. Methods We followed 203 962 Guangzhou residents aged ≥ 65 years (mean 71.9 years) who had baseline weight, waist and height measurements in 2018 and repeat assessment in 2019–2020. Weight and RFM changes were categorized as stable (±5%), 5%–10% increase, > 10% increase, 5%–10% decrease or > 10% decrease. Mortality from follow‐up visit until December 31, 2023. Multivariable Cox regression and restricted cubic splines analysis were used to explore the associations of changes in weight, RFM, or both with all‐cause and CVD mortality among participants. Results During median follow‐up of 5.6 years, 14 712 all‐cause and 6536 CVD deaths occurred. U‐shaped relationships were seen for both exposures. Compared with stable weight, all‐cause mortality was higher in participants who decreased > 10% (HR 1.89, 95% CI 1.76–2.03) or increased > 10% (1.50, 1.39–1.63); similar patterns were observed for RFM decrease. In joint analyses, the highest all‐cause mortality risk was seen when both weight and RFM decreased > 10% (HR 2.09, 1.82–2.41), whereas the highest CVD risk occurred with > 10% weight decrease coupled with > 10% RFM increase (HR 2.02, 1.53–2.67). Similar associations of changes in weight, RFM or both, and all‐cause and CVD mortality were observed in different subgroups. Conclusions Weight change exceeding 10% and any RFM decrease are associated with elevated all‐cause and CVD mortality among older community‐dwellers. Concurrent changes of more than 10% in both metrics confer the greatest risk. Maintaining stable weight and RFM may reduce premature mortality among older community‐dwellers. Trial Registration ClinicalTrials.gov identifier: ChiCTR2400089945
Lin et al. (Mon,) studied this question.