What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: General population (n=441199). Intervention: Body-weight fluctuation vs. Stable weight. Primary outcome: All-cause mortality (RR 1.41, 95% CI 1.27-1.57, p=<0.001).

November 7, 2019Open Access

Body-Weight Fluctuation Was Associated With Increased Risk for Cardiovascular Disease, All-Cause and Cardiovascular Mortality: A Systematic Review and Meta-Analysis

Q: What are the key findings of this study?

Body-weight fluctuation was associated with a 41% increased risk of all-cause mortality (RR 1.41) and a 36% increased risk of cardiovascular mortality (RR 1.36) compared to stable weight.

HZHuajie ZouQinghai University Affiliated Hospital PYPing YinShandong Agricultural University LLLiegang LiuHuazhong University of Science and Technology

Key Result

Body-weight fluctuation was associated with a 41% increased risk of all-cause mortality (RR 1.41) and a 36% increased risk of cardiovascular mortality (RR 1.36) compared to stable weight.

Study Design

Type

Meta-Analysis (n=441,199)

Structured PICO

Does body-weight fluctuation increase the risk of mortality and cardiovascular diseases in adults?

Population

441,199 participants from 23 cohort studies (25 publications). Participants were aged 18-79 years, with more than half being middle-aged or older (≥50 years). 64.5% of participants (n=284,631) had an average BMI ≥25, and 17.7% (n=78,247) had a BMI ≥30.

Intervention

Body-weight fluctuation (weight cycling)

Outcome

All-cause mortality, cardiovascular disease (CVD) mortality, morbidity of CVD, and morbidity of hypertensionhard clinical

Body-weight fluctuation is significantly associated with an increased risk of all-cause mortality, cardiovascular mortality, and cardiovascular morbidity, highlighting the potential cardiometabolic hazards of weight cycling.

Main Result

Effect estimate: RR 1.41 (95% CI 1.27-1.57)

p-value: p=<0.001

Limitations

Findings are based on observational data, precluding causal conclusions.
Different definitions and measurements for weight fluctuation across included studies.
Most studies could not differentiate between intentional and unintentional weight fluctuation.
Did not directly compare clinical outcomes of body-weight fluctuation with maintenance of overweight/obesity or stable weight loss.
Did not account for other anthropometric measurements such as waist circumference or loss of lean body mass.

Abstract

Background: The aim of this study was to evaluate associations between body-weight fluctuation and risk of mortality and cardiovascular diseases (CVD). Methods: PubMed, EMBASE databases and Cochrane Library were searched for cohort studies published up to May 20, 2019, reporting on associations of body-weight fluctuation and mortality from all causes, CVD and cancer, as well as morbidity of CVD and hypertension. Summary relative risks (RRs) were estimated using a random-effects model. Results: Twenty-five eligible publications from 23 studies with 441,199 participants were included. Body-weight fluctuation was associated with increased risk for all-cause mortality (RR, 1.41; 95% confidence interval (CI): 1.27-1.57), CVD mortality (RR, 1.36; 95% CI 1.22-1.52), and morbidity of CVD (RR, 1.49, 95% CI 1.26-1.76) and hypertension (RR, 1.35, 95% CI 1.14-1.61). However, there was no significant association between weight fluctuation and cancer mortality (RR, 1.01; 95% CI 0.90-1.13). No evidence of publication bias was observed (all P > 0.05) except for studies on all-cause mortality (Egger‘s test, P = 0.001; Begg’s test, P = 0.014). Conclusions: Body-weight fluctuation was associated with higher mortality due to all causes and CVD and a higher morbidity of CVD and hypertension. Key Words: body-weight fluctuation, weight cycling, mortality, CVD, meta-analysis

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