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Epidemiology and Population Health

Associations of obesity indices change with cardiovascular outcomes: a dose-response meta-analysis

International Journal of Obesity (2024)Cite this article

Subjects

Abstract

Background

Little is known about the degrees and shapes of associations of changes in obesity indices with cardiovascular disease (CVD) and mortality risks. We aimed to conduct a dose-response meta-analysis for the associations of changes in weight, body mass index (BMI), waist circumference (WC), waist-to-hip ratio, and waist-to-height ratio with CVD events, CVD-specific deaths, and all-cause mortality.

Methods

We searched MEDLINE via OvidSP, Embase via OvidSP, Web of Science, CINAHL, and Scopus for articles published before January 8th, 2023. Dose-response relationships were modeled using the one-stage mixed-effects meta-analysis. Random-effects models were used to pool the relative risk (RR) and 95% confidence interval (CI).

Results

We included 122 articles. Weight change was negatively associated with deaths from CVD and any cause, while WC change elevated CVD-specific mortality. Non-linear relationships also confirmed the adverse effects of increased WC on CVD-specific mortality. Additionally, gains of 5 kg in weight and 1 kg/m2 in BMI or more were associated with elevated CVD events, especially among young adults and individuals without CVD. Conversely, reductions of 5 kg in weight and 1 kg/m2 in BMI or more were associated with higher CVD-specific and all-cause deaths than increased counterparts, particularly among old adults and individuals with CVD. Similar non-linear relationships between relative changes in weight and BMI and deaths from CVD and any cause were observed.

Conclusions

The effects of changes in weight and BMI on CVD outcomes were affected by age and cardiovascular health. Tailored weight management and avoidance of increased WC should be recommended.

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Fig. 1: The flow chart of the selection process.
Fig. 2: Dose-response relationships between changes in obesity indices and cardiovascular disease events.
Fig. 3: Dose-response relationships between changes in obesity indices and cardiovascular disease mortality.
Fig. 4: Dose-response relationships between changes in obesity indices and all-cause mortality.

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Data availability

The data used in this publication are readily available from original source papers included in the study.

Code availability

R codes for data analysis associated with the current study is available at https://zenodo.org/records/10467654.

References

  1. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study (vol 76, pg 2982, 2020). J Am Coll Cardiol. 2021;77:1958–9.

    Google Scholar 

  2. Powell-Wiley TM, Poirier P, Burke LE, Després JP, Gordon-Larsen P, Lavie CJ, et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;143:e984–e1010.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, Lee A, et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017;377:13–27.

    Article  PubMed  Google Scholar 

  4. Wong MCS, Huang JJ, Wang JX, Chan PSF, Lok V, Chen X, et al. Global, regional and time-trend prevalence of central obesity: a systematic review and meta-analysis of 13.2 million subjects. Eur J Epidemiol. 2020;35:673–83.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Huang YY, Jiang CQ, Xu L, Zhang WS, Zhu F, Jin YL, et al. Adiposity change and mortality in middle-aged to older Chinese: An 8-year follow-up of the Guangzhou Biobank Cohort Study. BMJ Open. 2020;10:e039239.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Anyanwagu U, Mamza J, Donnelly R, Idris I. Association between insulin-induced weight change and CVD mortality: Evidence from a historic cohort study of 18,814 patients in UK primary care. Diabetes Metab Res Rev. 2018;34:01.

    Article  Google Scholar 

  7. Karahalios A, English DR, Simpson JA. Change in body size and mortality: a systematic review and meta-analysis. Int J Epidemiol. 2017;46:526–46.

    PubMed  Google Scholar 

  8. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:e596–e646.

    PubMed  PubMed Central  Google Scholar 

  9. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42:3227–337.

    Article  PubMed  Google Scholar 

  10. Alharbi TA, Paudel S, Gasevic D, Ryan J, Freak-Poli R, Owen AJ. The association of weight change and all-cause mortality in older adults: a systematic review and meta-analysis. Age Ageing. 2021;50:697–704.

    Article  PubMed  Google Scholar 

  11. Cheng FW, Gao X, Jensen GL. Weight Change and all-cause mortality in older adults: a meta-analysis. J Nutr Gerontol Geriatr. 2015;34:343–68.

    Article  PubMed  Google Scholar 

  12. Darbandi M, Pasdar Y, Moradi S, Mohamed HJJ, Hamzeh B, Salimi Y. Discriminatory Capacity of Anthropometric Indices for Cardiovascular Disease in Adults: A Systematic Review and Meta-Analysis. Prev Chronic Dis. 2020;17:E131.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev. 2012;13:275–86.

    Article  CAS  PubMed  Google Scholar 

  14. Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 2007;8:16.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Wells, GA, Shea, B, O’Connell, D, Peterson, J, Welch, V, Losos, M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2021. Available from https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.

  16. Sun J, Xi B, Yang L, Zhao M, Juonala M, Magnussen CG. Weight change from childhood to adulthood and cardiovascular risk factors and outcomes in adulthood: A systematic review of the literature. Obes Rev. 2021;22:e13138.

    Article  PubMed  Google Scholar 

  17. Grant RL. Converting an odds ratio to a range of plausible relative risks for better communication of research findings. BMJ. 2014;348:f7450.

    Article  PubMed  Google Scholar 

  18. van Dooren FE, Nefs G, Schram MT, Verhey FR, Denollet J, Pouwer F. Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis. PLoS ONE. 2013;8:e57058.

    Article  ADS  PubMed  PubMed Central  Google Scholar 

  19. Shim SR, Lee J. Dose-response meta-analysis: application and practice using the R software. Epidemiol Health. 2019;41:e2019006.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Crippa A, Discacciati A, Bottai M, Spiegelman D, Orsini N. One-stage dose-response meta-analysis for aggregated data. Stat Methods Med Res. 2019;28:1579–96.

    Article  MathSciNet  PubMed  Google Scholar 

  21. Suh J, Cho YJ, Kim HJ, Choi SS. Age-related difference in weight change and all-cause mortality in middle-aged and older korean populations: Korean Longitudinal Study of Aging. Korean J Fam Med. 2021;42:297–302.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Grundvold I, Bodegard J, Nilsson PM, Svennblad B, Johansson G, Östgren CJ et al. Body weight and risk of atrial fibrillation in 7,169 patients with newly diagnosed type 2 diabetes: an observational study. Cardiovasc. Diabetol. 2015;14:5.

  23. de Hollander EL, Bemelmans WJ, de Groot LC. Associations between changes in anthropometric measures and mortality in old age: a role for mid-upper arm circumference? J Am Med Dir Assoc. 2013;14:187–93.

    Article  PubMed  Google Scholar 

  24. Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, et al. European Guidelines for Obesity Management in Adults. Obes Facts. 2015;8:402–24.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Mousavi SV, Mohebi R, Mozaffary A, Sheikholeslami F, Azizi F, Hadaegh F. Changes in body mass index, waist and hip circumferences, waist to hip ratio and risk of all-cause mortality in men. Eur J Clin Nutr. 2015;69:927–32.

    Article  CAS  PubMed  Google Scholar 

  26. Harrell FE. Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. Springer, 2001. Available from https://link.springer.com/book/10.1007/978-3-319-19425-7.

  27. Orsini N, Li R, Wolk A, Khudyakov P, Spiegelman D. Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software. Am J Epidemiol. 2012;175:66–73.

    Article  PubMed  Google Scholar 

  28. Higgins JPTTJ, Chandler J, Cumpston M, Li T, Page MJ, Welch VA. Cochrane Handbook for Systematic Reviews of Interventions version 6.4. The Cochrane Collaboration, 2023. Available from https://training.cochrane.org/handbook/current.

  29. Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343:d4002.

    Article  PubMed  Google Scholar 

  30. Wang S, Ren J. Obesity Paradox in Aging: From Prevalence to Pathophysiology. Progr Cardiovasc Dis. 2018;61:182–9.

    Article  Google Scholar 

  31. Newman AB, Lee JS, Visser M, Goodpaster BH, Kritchevsky SB, Tylavsky FA, et al. Weight change and the conservation of lean mass in old age: the Health, Aging and Body Composition Study. Am J Clin Nutr. 2005;82:872–8.

    Article  CAS  PubMed  Google Scholar 

  32. Srikanthan P, Horwich TB, Tseng CH. Relation of Muscle Mass and Fat Mass to Cardiovascular Disease Mortality. Am J Cardiol. 2016;117:1355–60.

    Article  PubMed  Google Scholar 

  33. Larsson L, Degens H, Li M, Salviati L, Lee YI, Thompson W, et al. Sarcopenia: aging-related loss of muscle mass and function. Physiol Rev. 2019;99:427–511.

    Article  PubMed  Google Scholar 

  34. Ashtary-Larky D, Bagheri R, Abbasnezhad A, Tinsley GM, Alipour M, Wong A. Effects of gradual weight loss v. rapid weight loss on body composition and RMR: a systematic review and meta-analysis. Br J Nutr. 2020;124:1121–32.

    Article  CAS  PubMed  Google Scholar 

  35. Braha A, Albai A, Timar B, Negru Ș, Sorin S, Roman D, et al. Nutritional Interventions to Improve Cachexia Outcomes in Cancer-A Systematic Review. Medicina. 2022;58:966.

  36. Klingberg S, Mehlig K, Lanfer A, Björkelund C, Heitmann BL, Lissner L. Increase in waist circumference over 6 years predicts subsequent cardiovascular disease and total mortality in nordic women. Obesity. 2015;23:2123–30.

    Article  CAS  PubMed  Google Scholar 

  37. Piché M-E, Poirier P, Lemieux I, Després J-P. Overview of epidemiology and contribution of obesity and body fat distribution to cardiovascular disease: an update. Prog Cardiovasc Dis. 2018;61:103–13.

    Article  PubMed  Google Scholar 

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Acknowledgements

We showed great thanks to all authors who contributed to this study and librarians who gave support in building search strategies.

Author information

Author notes

  1. These authors contributed equally: Lyu Wang, Hanyue Ding.

Authors and Affiliations

  1. The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China

    Lyu Wang, Yunyang Deng, Junjie Huang & Martin C. S. Wong

  2. School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Hanyue Ding

  3. Department of Biomedical Science, City University of Hong Kong, Hong Kong SAR, China

    Xiangqian Lao

  4. School of Public Health, Zhengzhou University, Zhengzhou, China

    Xiangqian Lao

  5. School of Public Health, Peking University, Beijing, China

    Martin C. S. Wong

  6. Centre for Health Education and Health Promotion, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China

    Junjie Huang & Martin C. S. Wong

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Contributions

LW and HD designed the research and conducted the literature search and screening. YD worked as the third reviewer. LW performed the statistical analysis of the data. LW and HD wrote the manuscript draft. MW, XL, JH, and YD contributed to the critical revision of the manuscript. All authors have approved the final draft of the manuscript.

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Correspondence to Martin C. S. Wong.

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Wang, L., Ding, H., Deng, Y. et al. Associations of obesity indices change with cardiovascular outcomes: a dose-response meta-analysis. Int J Obes (2024). https://doi.org/10.1038/s41366-024-01485-8

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