Early and middle adulthood weight gain increases chronic disease risk

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Weight gain from early adulthood (age 18 or 21 years) to age 55 was associated with an increased risk of major chronic diseases, such as type 2 diabetes, hypertension, cardiovascular disease, and death, and a decreased odds of healthy ageing, according to a US analysis.

Obesity is a major global health challenge. Among US adults, the average weight gain is 1.1 to 2.2 pounds per year from early to middle adulthood and this modest yearly accumulation of weight eventually leads to obesity over time. It is unclear how weight gain during the transition from early to middle adulthood, when most weight gain occurs, relates to subsequent health consequences.

Dr Frank B Hu, of the Harvard TH Chan School of Public Health, Boston, and colleagues analysed data from the Nurses’ Health Study and the Health Professionals Follow-Up Study of participants who recalled weight during early adulthood (at age 18 years in women; 21 years in men), and reported current weight during middle adulthood (at age of 55 years).

A total of 92,837 women (average weight gain, 27.8 pounds over 37 years) and 25,303 men (average weight gain, 21.4 pounds over 34 years) were included in the analysis. Among the findings, weight gain of as little as 11 pounds from early to middle adulthood was associated with a significantly elevated incidence of a composite measure of major chronic diseases, consisting of type 2 diabetes, cardiovascular disease, cancer, and non-traumatic death. Higher amounts of weight gain were associated with greater risks of major chronic diseases and lower likelihood of healthy aging.

A limitation of the study was that weight at early adulthood was recalled at a later age, and some mis-classifications of weight change were inevitable.

“These findings may help counsel patients regarding the risks of weight gain,” the authors write.

Abstract
Importance: Data describing the effects of weight gain across adulthood on overall health are important for weight control.
Objective: To examine the association of weight gain from early to middle adulthood with health outcomes later in life.
Design, Setting, and Participants: Cohort analysis of US women from the Nurses’ Health Study (1976-June 30, 2012) and US men from the Health Professionals Follow-Up Study (1986-January 31, 2012) who recalled weight during early adulthood (at age of 18 years in women; 21 years in men), and reported current weight during middle adulthood (at age of 55 years).
Exposures: Weight change from early to middle adulthood (age of 18 or 21 years to age of 55 years).
Main Outcomes and Measures: Beginning at the age of 55 years, participants were followed up to the incident disease outcomes. Cardiovascular disease, cancer, and death were confirmed by medical records or the National Death Index. A composite healthy aging outcome was defined as being free of 11 chronic diseases and major cognitive or physical impairment.
Results: A total of 92 837 women (97% white; mean [SD] weight gain: 12.6 kg [12.3 kg] over 37 years) and 25 303 men (97% white; mean [SD] weight gain: 9.7 kg [9.7 kg] over 34 years) were included in the analysis. For type 2 diabetes, the adjusted incidence per 100 000 person-years was 207 among women who gained a moderate amount of weight (≥2.5 kg to <10 kg) vs 110 among women who maintained a stable weight (weight loss ≤2.5 kg or gain <2.5 kg) (absolute rate difference [ARD] per 100 000 person-years, 98; 95% CI, 72 to 127) and 258 vs 147, respectively, among men (ARD, 111; 95% CI, 58 to 179); hypertension: 3415 vs 2754 among women (ARD, 662; 95% CI, 545 to 782) and 2861 vs 2366 among men (ARD, 495; 95% CI, 281 to 726); cardiovascular disease: 309 vs 248 among women (ARD, 61; 95% CI, 38 to 87) and 383 vs 340 among men (ARD, 43; 95% CI, −14 to 109); obesity-related cancer: 452 vs 415 among women (ARD, 37; 95% CI, 4 to 73) and 208 vs 165 among men (ARD, 42; 95% CI, 0.5 to 94). Among those who gained a moderate amount of weight, 3651 women (24%) and 2405 men (37%) achieved the composite healthy aging outcome. Among those who maintained a stable weight, 1528 women (27%) and 989 men (39%) achieved the composite healthy aging outcome. The multivariable-adjusted odds ratio for the composite healthy aging outcome associated with moderate weight gain was 0.78 (95% CI, 0.72 to 0.84) in women and 0.88 (95% CI, 0.79 to 0.97) in men. Higher amounts of weight gain were associated with greater risks of major chronic diseases and lower likelihood of healthy aging.
Conclusions and Relevance: In these cohorts of health professionals, weight gain during adulthood was associated with significantly increased risk of major chronic diseases and decreased odds of healthy aging. These findings may help counsel patients regarding the risks of weight gain.

Authors
Yan Zheng; JoAnn E Manson; Changzheng Yuan; Matthew H Liang; Francine Grodstein; Meir J Stampfer; Walter C Willett; Frank B Hu

JAMA material
JAMA abstract
JAMA editorial


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