Change in weight and body mass index associated with all-cause mortality in Korea: A nationwide longitudinal study

Context: Many studies have reported conflicting evidence on the association between weight change and mortality. Objective: We investigated the association between weight change and subsequent all-cause mortality, using a large-scale, population-based cohort from the National Health Insurance System health checkup data between 2005 and 2015. Methods: A total of 11,524,763 subjects older than age 20 years were included. Weight was measured every 2 years and weight change over 4 years was divided into eight categories, from weight loss $15% to weight gain $20%, for every 5% of weight change. The hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality were analyzed using multivariable Cox proportional hazard models compared with the stable weight group (weight change,5%) after adjusting for age, sex, smoking, drinking, exercise, diabetes mellitus, hypertension, dyslipidemia, cancer, and income. Results: Weight loss was associated with increased mortality rates compared with weight gain; the group with weight loss $15% had the highest HR for all-cause mortality (HR, 2.598; 95% CI, 2.537 to 2.659). The HR for all-cause mortality in the $20% weight gain group was 1.784 (95% CI, 1.695 to 1.877). Across all body mass index (BMI) categories, weight loss $15% was associated with increased mortality rates and the highest mortality rates were found in the BMI $30 kg/m² group (HR, 3.469; 95% CI, 2.236 to 5.381). Conclusions: Weight change over 4 years showed a reverse J-shaped all-cause mortality curve, independent of BMI status. Weight loss was associated with a greater risk of mortality than was weight gain.