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Weight change and all-cause, cancer and cardiovascular disease mortality in Japanese men and women: the Japan Public Health Center-Based Prospective Study

Abstract

Background:

It is unclear whether weight change during adulthood influences subsequent mortality in Asian populations, who have a relatively lean body mass.

Objective:

To assess the relation of weight change over 5 years to all-cause, cancer and cardiovascular disease mortality among Japanese men and women.

Design:

Subjects were 36 220 men and 44 091 women aged between 45 and 75 years without a history of serious disease at baseline. Weight change was calculated as the difference of body weight between two surveys with a 5-year interval.

Results:

During 699 963 person-years of follow-up, we identified 4232 deaths of all-cause, 1872 cancer deaths and 1021 cardiovascular deaths. The relation between weight change and all-cause mortality was reverse J-shaped. Multivariate hazard ratios (95% confidence interval) for weight loss of 5 kg or more versus weight change of less than 2.5 kg were 1.62 (1.45–1.81) in men and 1.76 (1.51–2.05) in women, whereas those for weight gain of 5 kg or more were 1.40 (1.22–1.59) in men and 1.25 (1.02–1.54) in women. These associations remained statistically significant even after the exclusion of deaths in the first 3 years of follow-up. The weight change–mortality association was pronounced in underweight persons or in nonsmoking men. The risk of cancer mortality increased in both men and women who lost weight by 5 kg or more. With regard to cardiovascular disease, mortality risk tended to increase with weight loss both in men and women, whereas its increase with weight gain was observed only in women.

Conclusions:

A large weight change, both loss and gain, was associated with an increased risk of mortality. Weight loss and gain may be predictors of early death in apparently healthy adult Japanese.

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References

  1. Haslam DW, James WP . Obesity. Lancet 2005; 366: 1197–1209.

    Article  PubMed  Google Scholar 

  2. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003; 289: 76–79.

    Article  PubMed  Google Scholar 

  3. McLellan F . Obesity rising to alarming levels around the world. Lancet 2002; 359: 1412.

    Article  PubMed  Google Scholar 

  4. Yoon KH, Lee JH, Kim JW, Cho JH, Choi YH, Ko SH et al. Epidemic obesity and type 2 diabetes in Asia. Lancet 2006; 368: 1681–1688.

    Article  PubMed  Google Scholar 

  5. Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath Jr CW . Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999; 341: 1097–1105.

    Article  CAS  PubMed  Google Scholar 

  6. Jee SH, Sull JW, Park J, Lee SY, Ohrr H, Guallar E et al. Body-mass index and mortality in Korean men and women. N Engl J Med 2006; 355: 779–787.

    Article  CAS  PubMed  Google Scholar 

  7. Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE et al. Body weight and mortality among women. N Engl J Med 1995; 333: 677–685.

    Article  CAS  PubMed  Google Scholar 

  8. Adams KF, Schatzkin A, Harris TB, Kipnis V, Mouw T, Ballard-Barbash R et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 2006; 355: 763–778.

    Article  CAS  PubMed  Google Scholar 

  9. Tsugane S, Sasaki S, Tsubono Y . Under- and overweight impact on mortality among middle-aged Japanese men and women: a 10-y follow-up of JPHC study cohort I. Int J Obes Relat Metab Disord 2002; 26: 529–537.

    Article  CAS  PubMed  Google Scholar 

  10. Amador LF, Al Snih S, Markides KS, Goodwin JS . Weight change and mortality among older Mexican Americans. Aging Clin Exp Res 2006; 18: 196–204.

    Article  PubMed  Google Scholar 

  11. Andres R, Muller DC, Sorkin JD . Long-term effects of change in body weight on all-cause mortality. A review. Ann Intern Med 1993; 119: 737–743.

    Article  CAS  PubMed  Google Scholar 

  12. Dey DK, Rothenberg E, Sundh V, Bosaeus I, Steen B . Body mass index, weight change and mortality in the elderly. A 15 y longitudinal population study of 70 y olds. Eur J Clin Nutr 2001; 55: 482–492.

    Article  CAS  PubMed  Google Scholar 

  13. Droyvold WB, Lund Nilsen TI, Lydersen S, Midthjell K, Nilsson PM, Nilsson JA et al. Weight change and mortality: the Nord-Trondelag Health Study. J Intern Med 2005; 257: 338–345.

    Article  CAS  PubMed  Google Scholar 

  14. Higgins M, D’Agostino R, Kannel W, Cobb J, Pinsky J . Benefits and adverse effects of weight loss. Observations from the Framingham Study. Ann Intern Med 1993; 119: 758–763.

    Article  CAS  PubMed  Google Scholar 

  15. Ho SC, Woo J, Sham A . Risk factor change in older persons, a perspective from Hong Kong: weight change and mortality. J Gerontol 1994; 49: M269–M272.

    Article  CAS  PubMed  Google Scholar 

  16. Lee IM, Paffenbarger Jr RS . Change in body weight and longevity. JAMA 1992; 268: 2045–2049.

    Article  CAS  PubMed  Google Scholar 

  17. Newman AB, Yanez D, Harris T, Duxbury A, Enright PL, Fried LP . Weight change in old age and its association with mortality. J Am Geriatr Soc 2001; 49: 1309–1318.

    Article  CAS  PubMed  Google Scholar 

  18. Pamuk ER, Williamson DF, Serdula MK, Madans J, Byers TE . Weight loss and subsequent death in a cohort of U.S. adults. Ann Intern Med 1993; 119: 744–748.

    Article  CAS  PubMed  Google Scholar 

  19. Sauvaget C, Ramadas K, Thomas G, Vinoda J, Thara S, Sankaranarayanan R . Body mass index, weight change and mortality risk in a prospective study in India. Int J Epidemiol 2008; 37: 990–1004.

    Article  PubMed  Google Scholar 

  20. Iribarren C, Sharp DS, Burchfiel CM, Petrovitch H . Association of weight loss and weight fluctuation with mortality among Japanese American men. N Engl J Med 1995; 333: 686–692.

    Article  CAS  PubMed  Google Scholar 

  21. Maru S, van der Schouw YT, Gimbrere CH, Grobbee DE, Peeters PH . Body mass index and short-term weight change in relation to mortality in Dutch women after age 50 y. Am J Clin Nutr 2004; 80: 231–236.

    Article  CAS  PubMed  Google Scholar 

  22. Wannamethee SG, Shaper AG, Walker M . Weight change, body weight and mortality: the impact of smoking and ill health. Int J Epidemiol 2001; 30: 777–786.

    Article  CAS  PubMed  Google Scholar 

  23. Tsugane S, Sobue T . Baseline survey of JPHC study—design and participation rate. Japan public health center-based prospective study on cancer and cardiovascular diseases. J Epidemiol 2001; 11 (Suppl 6): S24–S29.

    Article  CAS  PubMed  Google Scholar 

  24. Wannamethee SG, Shaper AG, Walker M . Weight change, weight fluctuation, and mortality. Arch Intern Med 2002; 162: 2575–2580.

    Article  PubMed  Google Scholar 

  25. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ . Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003; 348: 1625–1638.

    Article  PubMed  Google Scholar 

  26. Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D . Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ 2007; 335: 1134.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Parkin DM, Bray F, Ferlay J, Pisani P . Global cancer statistics, 2002. CA Cancer J Clin 2005; 55: 74–108.

    Article  PubMed  Google Scholar 

  28. Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 2006; 113: 898–918.

    Article  PubMed  Google Scholar 

  29. Ford ES, Williamson DF, Liu S . Weight change and diabetes incidence: findings from a national cohort of US adults. Am J Epidemiol 1997; 146: 214–222.

    Article  CAS  PubMed  Google Scholar 

  30. Wannamethee SG, Shaper AG . Weight change and duration of overweight and obesity in the incidence of type 2 diabetes. Diabetes Care 1999; 22: 1266–1272.

    Article  CAS  PubMed  Google Scholar 

  31. Huang Z, Willett WC, Manson JE, Rosner B, Stampfer MJ, Speizer FE et al. Body weight, weight change, and risk for hypertension in women. Ann Intern Med 1998; 128: 81–88.

    Article  CAS  PubMed  Google Scholar 

  32. Norman JE, Bild D, Lewis CE, Liu K, West DS . The impact of weight change on cardiovascular disease risk factors in young black and white adults: the CARDIA study. Int J Obes Relat Metab Disord 2003; 27: 369–376.

    Article  CAS  PubMed  Google Scholar 

  33. Fogarty AW, Glancy C, Jones S, Lewis SA, McKeever TM, Britton JR . A prospective study of weight change and systemic inflammation over 9 y. Am J Clin Nutr 2008; 87: 30–35.

    Article  CAS  PubMed  Google Scholar 

  34. Wulsin LR, Vaillant GE, Wells VE . A systematic review of the mortality of depression. Psychosom Med 1999; 61: 6–17.

    Article  CAS  PubMed  Google Scholar 

  35. Miller SL, Wolfe RR . The danger of weight loss in the elderly. J Nutr Health Aging 2008; 12: 487–491.

    Article  CAS  PubMed  Google Scholar 

  36. Seidell JC, Visscher TL . Body weight and weight change and their health implications for the elderly. Eur J Clin Nutr 2000; 54 (Suppl 3): S33–S39.

    Article  PubMed  Google Scholar 

  37. Despres JP, Moorjani S, Lupien PJ, Tremblay A, Nadeau A, Bouchard C . Regional distribution of body fat, plasma lipoproteins, and cardiovascular disease. Arteriosclerosis 1990; 10: 497–511.

    Article  CAS  PubMed  Google Scholar 

  38. Brand-Miller JC . Glycemic load and chronic disease. Nutr Rev 2003; 61: S49–S55.

    Article  PubMed  Google Scholar 

  39. Yazaki Y, Kadowaki T . Combating diabetes and obesity in Japan. Nat Med 2006; 12: 73–74.

    Article  CAS  PubMed  Google Scholar 

  40. Mizoue T, Tokunaga S, Kasai H, Kawai K, Sato M, Kubo T . Body mass index and oxidative DNA damage: a longitudinal study. Cancer Sci 2007; 98: 1254–1258.

    Article  CAS  PubMed  Google Scholar 

  41. Ames BN . Endogenous oxidative DNA damage, aging, and cancer. Free Radic Res Commun 1989; 7: 121–128.

    Article  CAS  PubMed  Google Scholar 

  42. Shade ED, Ulrich CM, Wener MH, Wood B, Yasui Y, Lacroix K et al. Frequent intentional weight loss is associated with lower natural killer cell cytotoxicity in postmenopausal women: possible long-term immune effects. J Am Diet Assoc 2004; 104: 903–912.

    Article  PubMed  Google Scholar 

  43. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–M156.

    Article  CAS  PubMed  Google Scholar 

  44. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G . Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004; 59: 255–263.

    Article  PubMed  Google Scholar 

  45. Bortz 2nd WM . A conceptual framework of frailty: a review. J Gerontol A Biol Sci Med Sci 2002; 57: M283–M288.

    Article  PubMed  Google Scholar 

  46. Coussens LM, Werb Z . Inflammation and cancer. Nature 2002; 420: 860–867.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon 3rd RO, Criqui M et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107: 499–511.

    Article  PubMed  Google Scholar 

  48. French SA, Folsom AR, Jeffery RW, Williamson DF . Prospective study of intentionality of weight loss and mortality in older women: the Iowa Women's Health Study. Am J Epidemiol 1999; 149: 504–514.

    Article  CAS  PubMed  Google Scholar 

  49. Gregg EW, Gerzoff RB, Thompson TJ, Williamson DF . Intentional weight loss and death in overweight and obese U.S. adults 35 years of age and older. Ann Intern Med 2003; 138: 383–389.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Drs Yumi Matsushita, Kyoko Kirii (both International Medical Center of Japan) and Masayuki Kato (Japan Foundation for the Promotion of International Medical Research Cooperation) for their helpful discussions. This work was supported by Grants-in-Aid for Cancer Research (19shi-2) and a Health Sciences Research Grant (Research on Comprehensive Research on Cardiovascular Diseases H19-016) from the Ministry of Health, Labour and Welfare of Japan.

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Correspondence to A Nanri.

Appendix

Appendix

Study group members

Members of the Japan Public Health Center-Based Prospective Study (JPHC Study) Group are: S Tsugane (principal investigator), M Inoue, T Sobue and T Hanaoka, National Cancer Center, Tokyo, Japan; J Ogata, S Baba, T Mannami, A Okayama and Y Kokubo, National Cardiovascular Center, Osaka, Japan; K Miyakawa, F Saito, A Koizumi, Y Sano, I Hashimoto, T Ikuta and Y Tanaba, Iwate Prefectural Ninohe Public Health Center, Iwate, Japan; Y Miyajima, N Suzuki, S Nagasawa, Y Furusugi and N Nagai, Akita Prefectural Yokote Public Health Center, Akita, Japan; H Sanada, Y Hatayama, F Kobayashi, H Uchino, Y Shirai, T Kondo, R Sasaki, Y Watanabe, Y Miyagawa and Y Kobayashi, Nagano Prefectural Saku Public Health Center, Nagano, Japan; Y Kishimoto, E Takara, T Fukuyama, M Kinjo, M Irei and H Sakiyama, Okinawa Prefectural Chubu Public Health Center, Okinawa, Japan; K Imoto, H Yazawa, T Seo, A Seiko, F Ito, F Shoji and R Saito, Katsushika Public Health Center, Tokyo, Japan; A Murata, K Minato, K Motegi and T Fujieda, Ibaraki Prefectural Mito Public Health Center, Ibaraki, Japan; K Matsui, T Abe, M Katagiri and M Suzuki, Niigata Prefectural Kashiwazaki and Nagaoka Public Health Center, Niigata, Japan; M Doi, A Terao, Y Ishikawa and T Tagami, Kochi Prefectural Chuo-higashi Public Health Center, Kochi, Japan; H Sueta, H Doi, M Urata, N Okamoto and F Ide, Nagasaki Prefectural Kamigoto Public Health Center, Nagasaki, Japan; H Sakiyama, N Onga, H Takaesu and M Uehara, Okinawa Prefectural Miyako Public Health Center, Okinawa, Japan; F Horii, I Asano, H Yamaguchi, K Aoki, S Maruyama, M Ichii and M Takano, Osaka Prefectural Suita Public Health Center, Osaka, Japan; Y Tsubono, Tohoku University, Miyagi, Japan; K Suzuki, Research Institute for Brain and Blood Vessels Akita, Akita, Japan; Y Honda, K Yamagishi, S Sakurai and N Tsuchiya, Tsukuba University, Ibaraki, Japan; M Kabuto, National Institute for Environmental Studies, Ibaraki, Japan; M Yamaguchi, Y Matsumura, S Sasaki and S Watanabe, National Institute of Health and Nutrition, Tokyo, Japan; M Akabane, Tokyo University of Agriculture, Tokyo, Japan; T Kadowaki, Tokyo University, Tokyo, Japan; M Noda and T Mizoue, International Medical Center of Japan, Tokyo, Japan; Y Kawaguchi, Tokyo Medical and Dental University, Tokyo, Japan; Y Takashima and M Yoshida, Kyorin University, Tokyo, Japan; K Nakamura, Niigata University, Niigata, Japan; S Matsushima and S Natsukawa, Saku General Hospital, Nagano, Japan; H Shimizu, Sakihae Institute, Gifu, Japan; H Sugimura, Hamamatsu University, Shizuoka, Japan; S Tominaga, Aichi Cancer Center Research Institute, Aichi, Japan; H Iso, Osaka University, Osaka, Japan; M Iida, W Ajiki and A Ioka, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; S Sato, Chiba Prefectural Institute of Public Health, Chiba, Japan; E Maruyama, Kobe University, Hyogo, Japan; M Konishi, K Okada and I Saito, Ehime University, Ehime, Japan; N Yasuda, Kochi University, Kochi, Japan; and S Kono, Kyushu University, Fukuoka, Japan.

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Nanri, A., Mizoue, T., Takahashi, Y. et al. Weight change and all-cause, cancer and cardiovascular disease mortality in Japanese men and women: the Japan Public Health Center-Based Prospective Study. Int J Obes 34, 348–356 (2010). https://doi.org/10.1038/ijo.2009.234

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