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Changes in the Relationships Between Body Mass Index and Health Outcomes Across Middle Age and Older Adulthood

      Abstract

      Objective

      To examine patterns of the incidence of diabetes, hypertension, and mortality by single units of body mass index (BMI) and 5-year age groups using longitudinal data from middle-aged and older women.

      Patients and Methods

      Middle-aged (born between 1946 and 1951; N=13,715) and older (born between 1921 and 1926; N=12,432) participants in the Australian Longitudinal Study on Women’s Health completed surveys in 1996 and at approximately 3-year intervals thereafter until 2011. Proportions of women with diabetes, hypertension, and mortality over 3-year intervals were estimated for each unit of BMI and 5-year age group (45 to <50, 50 to <55, 55 to <60, 70 to <75, 75 to <80, and 80 to <85 years) using generalized additive modeling with adjustment for time-varying covariates.

      Results

      Three-year incidence of diabetes (1.2%-3.6%), hypertension (5.2%-17.8%), and death (0.4%-9.5%) increased with age. For both diabetes and hypertension, the associations with BMI were curvilinear in middle-aged women and became almost linear in older women. With increasing age, the slope became steeper, and the increase started at lower BMI values. For hypertension, there was a marked increase in intercept from 75 years onward. In contrast, mortality risks were highest for low BMI (≤20) in all age groups. A clear U-shaped curve was observed only in the oldest age group.

      Conclusion

      The shapes of the relationships between BMI and incidence of diabetes, hypertension, and mortality change with age, suggesting that weight management interventions should be tailored for different age groups.

      Abbreviations and Acronyms:

      BMI (body mass index)
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      References

        • Brown W.J.
        • Dobson A.J.
        • Mishra G.
        What is a healthy weight for middle aged women?.
        Int J Obes Relat Metab Disord. 1998; 22: 520-528
        • Canning K.L.
        • Brown R.E.
        • Jamnik V.K.
        • Kuk J.L.
        Relationship between obesity and obesity-related morbidities weakens with aging.
        J Gerontol A Biol Sci Med Sci. 2014; 69: 87-92
        • Andres R.
        The obesity-mortality association: where is the nadir of the U-shaped curve?.
        Trans Assoc Life Insur Med Dir Am. 1980; 64: 185-197
        • Stevens J.
        • Cai J.
        • Pamuk E.R.
        • Williamson D.F.
        • Thun M.J.
        • Wood J.L.
        The effect of age on the association between body-mass index and mortality.
        N Engl J Med. 1998; 338: 1-7
        • Tsai A.C.
        • Hsiao M.L.
        The association of body mass index (BMI) with all-cause mortality in older Taiwanese: results of a national cohort study.
        Arch Gerontol Geriatr. 2012; 55: 217-220
        • Cohen-Mansfield J.
        • Perach R.
        Is there a reversal in the effect of obesity on mortality in old age?.
        J Aging Res. 2011; 2011: 765071
        • Lee C.
        • Dobson A.J.
        • Brown W.J.
        • et al.
        Cohort profile: the Australian Longitudinal Study on Women's Health.
        Int J Epidemiol. 2005; 34: 987-991
        • Brown W.J.
        • Bryson L.
        • Byles J.E.
        • et al.
        Women's Health Australia: recruitment for a national longitudinal cohort study.
        Women Health. 1998; 28: 23-40
        • Brown W.J.
        • Burton N.W.
        • Marshall A.L.
        • Miller Y.D.
        Reliability and validity of a modified self-administered version of the Active Australia physical activity survey in a sample of mid-age women.
        Aust N Z J Public Health. 2008; 32: 535-541
        • Ainsworth B.E.
        • Haskell W.L.
        • Herrmann S.D.
        • et al.
        2011 Compendium of Physical Activities: a second update of codes and MET values.
        Med Sci Sports Exerc. 2011; 43: 1575-1581
      1. Australian Longitudinal Study on Women’s Health. Surveys. Australian Longitudinal Study on Women’s Health website. http://www.alswh.org.au/for-researchers/surveys. Accessed April 27, 2015.

        • Hastie T.
        • Tibshirani R.
        Generalized additive models for medical research.
        Stat Methods Med Res. 1995; 4: 187-196
        • Bowman T.S.
        • Gaziano J.M.
        • Buring J.E.
        • Sesso H.D.
        A prospective study of cigarette smoking and risk of incident hypertension in women.
        J Am Coll Cardiol. 2007; 50: 2085-2092
        • Connolly V.
        • Unwin N.
        • Sherriff P.
        • Bilous R.
        • Kelly W.
        Diabetes prevalence and socioeconomic status: a population based study showing increased prevalence of type 2 diabetes mellitus in deprived areas.
        J Epidemiol Community Health. 2000; 54: 173-177
        • Espelt A.
        • Borrell C.
        • Roskam A.J.
        • et al.
        Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century.
        Diabetologia. 2008; 51: 1971-1979
        • Forman J.P.
        • Stampfer M.J.
        • Curhan G.C.
        Diet and lifestyle risk factors associated with incident hypertension in women.
        JAMA. 2009; 302: 401-411
        • Jeon C.Y.
        • Lokken R.P.
        • Hu F.B.
        • van Dam R.M.
        Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review.
        Diabetes Care. 2007; 30: 744-752
        • Leng B.
        • Jin Y.
        • Li G.
        • Chen L.
        • Jin N.
        Socioeconomic status and hypertension: a meta-analysis.
        J Hypertens. 2015; 33: 221-229
        • Willi C.
        • Bodenmann P.
        • Ghali W.A.
        • Faris P.D.
        • Cornuz J.
        Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis.
        JAMA. 2007; 298: 2654-2664
        • Ford E.S.
        • Williamson D.F.
        • Liu S.
        Weight change and diabetes incidence: findings from a national cohort of US adults.
        Am J Epidemiol. 1997; 146: 214-222
        • Krishnan S.
        • Rosenberg L.
        • Djoussé L.
        • Cupples L.A.
        • Palmer J.R.
        Overall and central obesity and risk of type 2 diabetes in U.S. black women.
        Obesity (Silver Spring). 2007; 15: 1860-1866
        • Nagaya T.
        • Yoshida H.
        • Takahashi H.
        • Kawai M.
        Increases in body mass index, even within non-obese levels, raise the risk for Type 2 diabetes mellitus: a follow-up study in a Japanese population.
        Diabet Med. 2005; 22: 1107-1111
        • Fujita M.
        • Hata A.
        Sex and age differences in the effect of obesity on incidence of hypertension in the Japanese population: a large historical cohort study.
        J Am Soc Hypertens. 2014; 8: 64-70
        • Field A.E.
        • Coakley E.H.
        • Must A.
        • et al.
        Impact of overweight on the risk of developing common chronic diseases during a 10-year period.
        Arch Intern Med. 2001; 161: 1581-1586
        • Winter J.E.
        • MacInnis R.J.
        • Wattanapenpaiboon N.
        • Nowson C.A.
        BMI and all-cause mortality in older adults: a meta-analysis.
        Am J Clin Nutr. 2014; 99: 875-890
        • Abdullah A.
        • Wolfe R.
        • Stoelwinder J.U.
        • et al.
        The number of years lived with obesity and the risk of all-cause and cause-specific mortality.
        Int J Epidemiol. 2011; 40: 985-996
        • Prospective Studies Collaboration
        Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies.
        Lancet. 2009; 373: 1083-1096
        • Tran T.D.H.
        Correlates of Mortality Among Middle-aged Women: Results From a Nationally Representative Prospective Australian Cohort Study [thesis].
        University of Queensland School of Population Health, Brisbane, Australia2012
        • Morley J.E.
        • Vellas B.
        • van Kan G.A.
        • et al.
        Frailty consensus: a call to action.
        J Am Med Dir Assoc. 2013; 14: 392-397
        • Brown R.E.
        • Kuk J.L.
        Consequences of obesity and weight loss: a devil's advocate position.
        Obes Rev. 2015; 16: 77-87
        • Pack Q.R.
        • Rodriguez-Escudero J.P.
        • Thomas R.J.
        • et al.
        The prognostic importance of weight loss in coronary artery disease: a systematic review and meta-analysis.
        Mayo Clin Proc. 2014; 89: 1368-1377
        • Chapman I.M.
        Weight loss in older persons.
        Med Clin North Am. 2011; 95 (xi): 579-593
        • Twig G.
        • Afek A.
        • Shamiss A.
        • et al.
        Adolescence BMI and trends in adulthood mortality: a study of 2.16 million adolescents.
        J Clin Endocrinol Metab. 2014; 99: 2095-2103
        • Flicker L.
        • McCaul K.A.
        • Hankey G.J.
        • et al.
        Body mass index and survival in men and women aged 70 to 75.
        J Am Geriatr Soc. 2010; 58: 234-241
        • Burton N.W.
        • Brown W.
        • Dobson A.
        Accuracy of body mass index estimated from self-reported height and weight in mid-aged Australian women.
        Aust N Z J Public Health. 2010; 34: 620-623
        • Lowe J.
        • Byles J.
        • Dolja-Gore X.
        • Young A.
        Does systematically organized care improve outcomes for women with diabetes?.
        J Eval Clin Pract. 2010; 16: 887-894
        • Sluijs I.
        • van der A.D.L.
        • Beulens J.W.
        • et al.
        Ascertainment and verification of diabetes in the EPIC-NL study.
        Neth J Med. 2010; 68 ([published correction appears in Neth J Med. 2010;68(9):342]): 333-339
        • Martin L.M.
        • Leff M.
        • Calonge N.
        • Garrett C.
        • Nelson D.E.
        Validation of self-reported chronic conditions and health services in a managed care population.
        Am J Prev Med. 2000; 18: 215-218
        • Okura Y.
        • Urban L.H.
        • Mahoney D.W.
        • Jacobsen S.J.
        • Rodeheffer R.J.
        Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure.
        J Clin Epidemiol. 2004; 57: 1096-1103
        • Oksanen T.
        • Kivimäki M.
        • Pentti J.
        • Virtanen M.
        • Klaukka T.
        • Vahtera J.
        Self-report as an indicator of incident disease.
        Ann Epidemiol. 2010; 20: 547-554
        • Abdullah A.
        • Peeters A.
        • de Courten M.
        • Stoelwinder J.
        The magnitude of association between overweight and obesity and the risk of diabetes: a meta-analysis of prospective cohort studies.
        Diabetes Res Clin Pract. 2010; 89: 309-319
        • Oguma Y.
        • Sesso H.D.
        • Paffenbarger Jr., R.S.
        • Lee I.M.
        Weight change and risk of developing type 2 diabetes.
        Obes Res. 2005; 13: 945-951
        • Haslam D.W.
        • James W.P.
        Obesity.
        Lancet. 2005; 366: 1197-1209