Associations of Weight Gain From Early to Middle Adulthood With Major Health Outcomes Later in Life

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.

Figure 1.. Associations of Weight Gain From Early to Middle Adulthood With the Risk of a Composite Outcome Measure of Major Chronic Diseases

Assessed from the age of 55 years to 2012. The composite outcome measure of major chronic diseases was composed of incident cases of type 2 diabetes, cardiovascular disease, cancer, and nontraumatic death. Among the 81 603 women, 35 148 developed at least 1 of the major chronic diseases, including 14 709 cases of cancer, 6888 cases of type 2 diabetes, 4317 cases of cardiovascular disease, and 9234 nontraumatic deaths. Among the 22 394 men, 6831 developed at least 1 of the major chronic diseases, including 3608 cases of cancer, 1302 cases of type 2 diabetes, 953 cases of cardiovascular disease, and 968 nontraumatic deaths. After adjustment for age at cohort recruitment (continuous), height (continuous), race (nonwhite or white), pack-years of smoking (never smokers; past smoker with <5, 5-20, or >20 pack-years; and current smoker with <5, 5-20, or >20 pack-years), regular aspirin use (yes or no), status of menopause and hormone therapy (women only: premenopausal, postmenopausal and hormone therapy never use, postmenopausal and current use, or postmenopausal and past use), parity (women only: nulliparous, 1, 2, 3, or ≥4 children), physical activity (in quintiles for women: <2.9, 2.9-7.1, 7.2-13.1, 13.2-23.6, or ≥23.7 metabolic equivalent task [MET]-h/wk; and men: <8.3, 8.3-17.2, 17.3-28.6, 28.7-46.9, or ≥47.0 MET-h/wk), alcohol consumption (women: 0, 0.1-0.4, 0.5-1.9, 2.0-7.0, or ≥8.0 g/d; men: 0-4, 5-9, 10-14, 15-29, or ≥30 g/d), dietary qualify (Alternative Healthy Eating Index in quintiles), family history of diabetes, cardiovascular disease, cancer, and weight at age of 18 years in women and at age of 21 years in men. IQR indicates interquartile range; error bars, 95% CIs.

Figure 2.. Associations of Weight Gain From Early to Middle Adulthood With Risk of Individual Health Outcomes

After adjustment for age at cohort recruitment (continuous), height (continuous), race (nonwhite or white), pack-years of smoking (never smokers; past smoker with <5, 5-20, or >20 pack-years; and current smoker with <5, 5-20, or >20 pack-years), regular aspirin use (yes or no), status of menopause and hormone therapy (women only: premenopausal, postmenopausal and never use, postmenopausal and current use, or postmenopausal and past use), parity (women only: nulliparous, 1, 2, 3, or ≥4 children), physical activity (in quintiles for women: <2.9, 2.9-7.1, 7.2-13.1, 13.2-23.6, or ≥23.7 metabolic equivalent task [MET]-h/wk; and men: <8.3, 8.3-17.2, 17.3-28.6, 28.7-46.9, or ≥47.0 MET-h/wk), alcohol consumption (women: 0, 0.1-0.4, 0.5-1.9, 2-7, or ≥8 g/d; men: 0-4, 5-9, 10-14, 15-29, or ≥30 g/d), dietary qualify (Alternative Healthy Eating Index in quintiles), family history of respective diseases and weight at age of 18 years in women and at age of 21 years in men. Obesity-related cancer includes the esophagus (adenocarcinoma only), colon and rectum, pancreas, breast (after menopause, women only), endometrium (women only), ovaries (women only), prostate (advanced only, men only), kidney, liver, and gallbladder. ^aA composite healthy aging outcome was defined as being free of 11 chronic diseases and major cognitive or physical impairment. Expressed as odds ratio (95% CI) per 5-kg weight gain.