What is the clinical evidence from this study?

Study design: Cohort. Population: All-cause and cardiovascular disease-related mortality (n=90258). Intervention: BMI decrease of > 10% vs. Stable BMI (< 5% change). Primary outcome: All-cause mortality (aHR 1.86, 95% CI 1.43-2.43).

May 1, 2025Open Access

Modification of risk for all-cause and cardiovascular disease-related mortality with changes in the body mass index: a prospective cohort study with 12 years follow up

Q: What are the key findings of this study?

A BMI decrease of >10% was associated with a significantly higher risk of all-cause mortality (aHR 1.86) and cardiovascular disease-related mortality (aHR 2.20) compared to a stable BMI.

Key Result

A BMI decrease of >10% was associated with a significantly higher risk of all-cause mortality (aHR 1.86) and cardiovascular disease-related mortality (aHR 2.20) compared to a stable BMI.

Study Design

Type

Cohort (n=90,258)

Structured PICO

Does a change in body mass index (BMI) over time increase the risk of all-cause and cardiovascular disease-related mortality in adults without baseline cardiovascular disease?

Population

90,258 adults from the Taiwan MJ cohort without baseline cardiovascular disease, mean age 42.0, 50.8% male. Key exclusions: age <18 years, history of CVD prior to first screening, developed CVD between first and last screening, and incomplete covariate data.

Intervention

Changes in body mass index (BMI) over a 3.3-year interval, specifically categorized as >10% decrease, 5-10% decrease, 5-10% increase, and >10% increase.

Comparator

Stable BMI (defined as a change of <5% during the follow-up period).

Outcome

All-cause mortality and cardiovascular disease (CVD)-related mortality over 12.1 years follow-up, confirmed using Taiwan's national death certificate database.hard clinical

Significant fluctuations in BMI, particularly a decrease of >10% or an increase of >10% in obese individuals, are associated with increased risks of all-cause and cardiovascular mortality, highlighting the need for clinical evaluation in these patients.

Main Result

Effect estimate: aHR 1.86 (95% CI 1.43-2.43)

Absolute Event Rate: 3.7% vs 2.4%

Limitations

Unknown whether the decrease in BMI was intentional or unintentional
BMI may not capture visceral obesity as well as other indices like body roundness index or weight-adjusted waist index
Lack of information on income levels and use of antihypertensive drugs
Participants were not required to undergo annual health examinations repeatedly
Generalizability to non-Asian ethnic groups is uncertain

Abstract

BACKGROUND: The impact of changes in body mass index (BMI) on the risk of all-cause and cardiovascular disease (CVD)-related mortality has not been extensively studied. We examined whether changes in BMI status over time are associated with risk of all-cause and CVD-related mortality. METHODS: This longitudinal study recruited 90,258 adults between 2002 and 2008 from the Taiwan MJ cohort who underwent repeated BMI measurements at an interval of 3.3 years and were followed up for all-cause and CVD-related mortality over 12.1 years. Cox proportional hazard and Fine-Gray sub-distribution hazard models with death from non-CVD causes as the competing risk was used to determine the impact of changes in BMI status on the risk of all-cause or CVD-related mortality, respectively. RESULTS: Over 1,094,606 person-years of follow-up, 2,084 participants died, including 391 (18.8%) CVD-related deaths. After adjusting for other covariates, the risks of all cause (adjusted hazard ratio aHR, 1.86; 95% confidence interval CI, 1.43-2.43) and CVD-related (aHR, 2.20; 95% CI, 1.24-3.93) mortalities were significantly higher in those with a BMI decrease of > 10% than in those with stable BMI. Participants with obesity at baseline who had BMI increase of > 10% during the follow-up period had a significantly higher risk of all-cause (aHR = 2.30; 95% CI:1.38-3.85) and CVD-related mortality (aHR = 3.44; 95% CI:1.33-8.89). CONCLUSIONS: A BMI decrease of > 10% was associated with a high risk of all-cause and CVD-related mortalities. Thus, those experiencing significant BMI decreases should undergo a comprehensive evaluation to mitigate mortality risks.

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