JAMA sub-journal: Middle-aged and elderly people need to be more vigilant about "beer belly"! Nearly 60,000 Chinese 4 years of follow-up data suggest that people who lost weight but increased waist circumference were associated with a 69% increased risk of death

*For medical professionals only

As the saying goes, a fat destroys all! The harm of obesity, everyone has long seen the

Some studies have pointed out that the average weight and obesity rate of Chinese residents have risen alarmingly [1-2].

Weight and waist circumference are common criteria for determining obesity, and they are also important influencing factors in all-cause mortality in the population [3-4].

Recently, a research team led by Professor Pan An and Professor Wu Tangchun of the School of Public Health of Tongji School of Medicine of Huazhong University of Science and Technology published important research results in the journal JAMA Network Open.

After analyzing data from 58,132 middle-aged and elderly people in China, they found that changes in weight or waist circumference were U-shaped in

Data from two longitudinal cohort studies, the Dongfeng-Tongji Cohort (DFTJ) and the Kailuan Cohort Cohort in China, were used

In the DFTJ cohort, the median age of participants was 62 years, with 4203 males (38.

Participants measured weight and waist circumference

During the follow-up period, 4028 participants died, including 523 in the DFTJ cohort and 3505 in the Kailuan cohort

To explore the association between changes in weight or waist circumference and all-cause risk, the researchers used Cox regression analysis to adjust
for a variety of influencing factors.

Factors adjusted by the researchers included gender, age, smoking and drinking habits, eating patterns, educational attainment, physical activity, history of diabetes, and history of hypertension
.

In the fully tuned model, the investigators found that participants who lost weight or gained weight were associated with a higher risk of all-cause death compared to participants with stable weight (weight loss: risk ratio (HR), 1.
33; weight gain: HR, 1.
10) (Figure 1
).

Figure 1 Association of weight changes with risk of all-cause death

A decrease or increase in waist circumference was associated with a higher risk of all-cause death in participants compared with participants with stable waist circumference (decreased waist circumference: HR, 1.
14; increased waist circumference: HR, 1.
11) (Figure 2
).

Figure 2 Association of changes in waist circumference with risk of all-cause death

Is there a linear relationship between changes in participant weight or waist circumference and the risk of all-cause death?

To this end, the researchers built a restrictive spline model for evaluation
.

As shown in Figure 3 below, a U-shaped association between weight changes and death risk was observed in both the DFTJ and the Kailuan cohort
.

In both queues, the p-value representing the nonlinear association is less than 0.
0001 (Figure 3
).

In addition, the association between changes in waist circumference and risk of all-cause death showed similar characteristics
.

Figure 3 Relationship between weight changes and participants' risk of all-cause death

So what does the participant's change in weight and waist circumference have to do with the risk of all-cause death?

As shown in Figure 4 below, weight gain or loss, regardless of waist circumference change status, was associated with an increased risk of death of more than 20% among participants compared to people with stable waist circumference (waist circumference reduction: HR, 1.
22; waist circumference stabilization: HR, 1.
20; increased waist circumference: HR, 1.
26).

Notably, participants who lost more than 2.
5 kg and increased waist circumference by more than 3 cm were associated with a 69% increased risk of death (HR, 1.
69
).

Figure 4 The participants' risk of all-cause death when their weight and waist circumference changed

In addition, the researchers explored factors associated with changes in participants' weight and waist circumference in two cohorts
.

The researchers found that as they age, participants tended to lose weight and increase waist
circumference.

Participants' baseline weight was positively correlated with weight loss but increased waist circumference; Participants' baseline height and waist circumference were positively correlated
with weight gain but decreased waist circumference.

In addition, participants' smoking and low educational attainment were positively correlated
with increased waist circumference.

Therefore, the researchers further speculated that people in the two cohorts who were older, heavier, lower in height, less waist circumference, and less educated were more likely to experience weight loss but increased
waist circumference than participants with stable weight and waist circumference.

This population may be at high risk and should be of concern
.

Taken together, this cohort study further expands our understanding
of the association between changes in weight and waist circumference and the risk of all-cause death.

The study showed that weight gain but reduced waist circumference were important risk factors, as the group with body shape changes had the highest
risk of death during follow-up.

The findings may have important clinical implications, and at present, the potential health risks in people who are weight-loss but have increased waist circumference have not been given sufficient attention
.

The study also has several limitations
.

First of all, there may be errors in the determination of weight and waist circumference, and it is impossible to completely avoid interference from other factors; Second, participants included in the study were older and had shorter
follow-up periods.

As a result, the reliability of the relevant findings may be affected
.

In addition, as an observational study, the study can not establish a causal relationship, and more research is still needed to support it in the
future.

In short, after reading this article, my first thought is to lose weight and should lose weight more and avoid abdominal obesity! "Beer belly" is more terrible, not only affecting personal image, but also harmful to health
.

Friends who have purchased courses,

Directly enter the mini program to listen to the addition of food Oh ~

References:

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Epidemiology and determinants of obesity in China [published correction appears in Lancet Diabetes Endocrinol.
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doi:10.
1016/S2213-8587(21)00045-0

[2] Wang L, Zhou B, Zhao Z, et al.
Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004-18.
Lancet.
2021; 398(10294):53-63.
doi:10.
1016/S0140-6736(21)00798-4

[3] Global BMI Mortality Collaboration, Di Angelantonio E, Bhupathiraju ShN, et al.
Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents.
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doi:10.
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[4] Pischon T, Boeing H, Hoffmann K, et al.
General and abdominal adiposity and risk of death in Europe [published correction appears in N Engl J Med.
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N Engl J Med.
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doi:10.
1056/NEJMoa0801891

[5] Yuan Y, Liu K, Zheng M, et al.
Analysis of Changes in Weight, Waist Circumference, or Both, and All-Cause Mortality in Chinese Adults.
JAMA Netw Open.
2022; 5(8):e2225876.
doi:10.
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2022.
25876

The author of this article Jiang Yongmao

Responsible editor dai siyu