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The enigma of increased non‐cancer mortality after weight loss in healthy men who are overweight or obese
Author(s) -
NILSSON P. M.,
NILSSON J.Å.,
HEDBLAD B.,
BERGLUND G.,
LINDGäRDE F.
Publication year - 2002
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1046/j.1365-2796.2002.01010.x
Subject(s) - medicine , overweight , body mass index , obesity , population , weight loss , confounding , cancer , demography , environmental health , sociology
Abstract. Nilsson PM, Nilsson J‐A, Hedblad B, Berglund G, Lindgärde F. (University Hospital, Malmö, Sweden). The enigma of increased non‐cancer mortality after weight loss in healthy men who are overweight or obese. J Intern Med 2002; 252: 70−78. Objective. To study effects on non‐cancer mortality of observational weight loss in middle‐aged men stratified for body mass index (BMI), taking a wide range of possible confounders into account. Design. Prospective, population based study. Setting. Male population of Malmö, Sweden. Participants. In all 5722 men were screened twice with a mean time interval of 6 years in Malmö, southern Sweden. They were classified according to BMI category at baseline (<21, 22−25, overweight: 26−30, and obesity: 30+ kg m −2 ) and weight change category until second screening (weight stable men defined as having a baseline BMI ± 0.1 kg m −2 year −1 at follow‐up re‐screening). Main outcome measures. Non‐cancer mortality calculated from national registers during 16 years of follow‐up after the second screening. Data from the first year of follow‐up were excluded to avoid bias by mortality caused by subclinical disease at re‐screening. Results. The relative risk (RR; 95% CI) for non‐cancer mortality during follow‐up was higher in men with decreasing BMI in all subgroups: RR 2.64 (1.46−4.71, baseline BMI <21 kg m −2 ), 1.39 (0.98−1.95, baseline BMI 22−25 kg m −2 ), and 1.71 (1.18−2.47, baseline BMI 26+ kg m −2 ), using BMI‐stable men as reference group. Correspondingly, the non‐cancer mortality was also higher in men with increasing BMI, but only in the obese group (baseline BMI 26+ kg m −2 ) with RR 1.86 (1.31−2.65). In a subanalysis, nonsmoking obese (30+ kg m −2 ) men with decreased BMI had an increased non‐cancer mortality compared with BMI‐stable obese men (Fischer's test: P =0.001). The mortality risk for nonsmoking overweight men who increased their BMI compared with BMI‐stable men was also significant ( P =0.006), but not in corresponding obese men ( P =0.094). Conclusions. Weight loss in self‐reported healthy but overweight middle‐aged men, without serious disease, is associated with an increased non‐cancer mortality, which seems even more pronounced in obese, nonsmoking men, as compared with corresponding but weight‐stable men. The explanation for these observational findings is still enigmatic but could hypothetically be because of premature ageing effects causing so‐called weight loss of involution.