Unintentional weight loss as a predictor of all-cause and cardiovascular disease mortality in older Korean men

Background and objective: Little is known regarding the prognostic role of unintentional weight loss (UWL) in mortality risk among older Korean men. This study examined the associations of UWL and unhealthy behaviors with all-cause and cardiovascular disease (CVD) mortality in Korean men aged 60 years and older.

Material and Methods: Data (n = 2,309) obtained from the Korean longitudinal study of aging were analyzed. Exposures were UWL, smoking, alcohol abuse, underweight/obesity, and physical inactivity. Primary outcomes were all-cause mortality and CVD mortality. Covariates included parameters of sociodemographics and health conditions.

Results: Individuals with three or more risk factors had significantly higher risks of all-cause mortality (hazard ratio [HR] = 1.536, 95% confidence interval [CI] = 1.084∼2.175, P = 0.016) and CVD mortality (HR = 2.925, 95% CI = 1.386∼6.174, P = 0.005) even after adjustments for parameters of sociodemographics, health conditions, and UWL compared to individuals with zero risk factors (HR = 1). Additionally, individuals with UWL had a significantly higher risk of all-cause mortality (HR = 1.307, 95% CI = 1.052∼1.623, P = 0.016) even after adjustments for the covariates and lifestyle risk factors compared to individuals with normal weight (HR = 1).

Conclusion: The current findings show that exposure to three or more lifestyle risk factors is an independent predictor of all-cause mortality and CVD mortality, and UWL was a predictor of all-cause mortality in older Korean men.

Premature death; Behavioral risk factors; Unintentional weight loss; Koreans

[1] Kim HC, Oh SM. Noncommunicable diseases: current status of major modifiable risk factors in Korea. Journal of Preventive Medicine & Public Health. 2013; 46: 165-172.

[2] Lee J, Yoo J, Shin J, Keum J. Weight loss and all-cause mortality in the elderly: a meta-analysis. Korean Journal of Family Practice. 2017; 7: 10-19.

[3] Yun JE, Won S, Kimm H, Jee SH. Effects of a combined lifestyle score on 10-year mortality in Korean men and women: a prospective cohort study. BMC Public Health. 2012; 12: 673.

[4] Kim JY, Ko Y, Rhee CW, Park B, Kim D, Bae J, et al. Cardiovascular health metrics and all-cause and cardiovascular disease mortality among middle-aged men in Korea. Journal of Preventive Medicine and Public Health. 2013; 46: 319-328.

[5] Zou H, Yin P, Liu L, Liu W, Zhang Z, Yang Y, et al. Body-weight fluctuation was associated with increased risk for cardiovascular disease, all-cause and cardiovascular mortality: a systematic review and meta-analysis. Frontiers in Endocrinology. 2019; 10: 728.

[6] Zamora E, Díez-López C, Lupón J, de Antonio M, Domingo M, Santesmases J, et al. Weight loss in obese patients with heart failure. Journal of the American Heart Association. 2016; 5: e002468.

[7] De Stefani FdC, Pietraroia PS, Fernandes-Silva MM, Faria-Neto J, Baena CP. Observational evidence for unintentional weight loss in all-cause mortality and major cardiovascular events: a systematic review and meta-analysis. Scientific Reports. 2018; 8: 15447-15447.

[8] Bosch X, Monclús E, Escoda O, Guerra-García M, Moreno P, Guasch N, et al. Unintentional weight loss: clinical characteristics and outcomes in a prospective cohort of 2677 patients. PLoS ONE. 2017; 12: e0175125.

[9] Wong CJ. Involuntary weight loss. Medical Clinics of North America. 2014; 98: 625-643.

[10] Jin Y, Cho J, Lee I, Park S, Kim D, Kong J, et al. Involuntary weight loss and late-life depression in Korean older adults. Iranian Journal of Public Health. 2020; 49: 637-644.

[11] Agostini JV, Han L, Tinetti ME. The relationship between number of medications and weight loss or impaired balance in older adults. Journal of the American Geriatrics Society. 2004; 52: 1719-1723.

[12] Moriguti JC, Moriguti EK, Ferriolli E, de Castilho Cação J, Iucif N, Marchini JS. Involuntary weight loss in elderly individuals: assessment and treatment. Sao Paulo Medical Journal. 2001; 119: 72-77.

[13] Lee I, Kim S, Kang H. Lifestyle risk factors and all-cause and cardiovascular disease mortality: data from the Korean longitudinal study of aging. International Journal of Environmental Research and Public Health. 2019; 16: E3040.

[14] Jang SN. Korean longitudinal study of aging (KLoSA): overview of research design and contents. Singapore: Springer. 2016.

[15] Zahra A, Cheong H, Park J. Burden of disease attributable to smoking in Korea. Asia-Pacific Journal of Public Health. 2017; 29: 47-59.

[16] Plunk AD, Syed-Mohammed H, Cavazos-Rehg P, Bierut LJ, Grucza RA. Alcohol consumption, heavy drinking, and mortality: rethinking the J-shaped curve. Alcoholism, Clinical and Experimental Research. 2014; 38: 471-478.

[17] Ko Y, Choi K. Prevalence of frailty and associated factors in Korean older women: the KLoSA study. Journal of Women & Aging. 2017; 29: 15-25.

[18] Kim GR, Sun J, Han M, Nam CM, Park S. Evaluation of the directional relationship between handgrip strength and cognitive function: the Korean longitudinal study of ageing. Age and Ageing. 2019; 48: 426-432.

[19] Krokstad S, Ding D, Grunseit AC, Sund ER, Holmen TL, Rangul V, et al. Multiple lifestyle behaviours and mortality, findings from a large population-based Norwegian cohort study - the HUNT Study. BMC Public Health. 2017; 17: 58.

[20] Knoops KTB, de Groot LCPGM, Kromhout D, Perrin A, Moreiras-Varela O, Menotti A, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. Journal of the American Medical Association. 2004; 292: 1433-1439.

[21] Li Y, Pan A, Wang DD, Liu X, Dhana K, Franco OH, et al. Impact of healthy lifestyle factors on life expectancies in the US population. Circulation. 2018; 138: 345-355.

[22] Yang JJ, Yu D, Wen W, Shu XO, Saito E, Rahman S, et al. Tobacco smoking and mortality in Asia: a pooled meta-analysis. JAMA Netw Open. 2019; 2: e191474.

[23] Kunzmann AT, Coleman HG, Huang WY, Berndt SI. The association of lifetime alcohol use with mortality and cancer risk in older adults: a cohort study. PLoS Medicine. 2018; 15: e1002585.

[24] Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009; 373: 1083-1096.

[25] Paganini-Hill A, Kawas CH, Corrada MM. Activities and mortality in the elderly: the Leisure World cohort study. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2011; 66: 559-567.

[26] Zou H, Yin P, Liu L, Liu W, Zhang Z, Yang Y, et al. Body-weight fluctuation was associated with increased risk for cardiovascular disease, all-cause and cardiovascular mortality: a systematic review and meta-analysis. Frontiers in Endocrinology. 2019; 10: 728.

[27] Kritchevsky SB, Beavers KM, Miller ME, Shea MK, Houston DK, Kitzman DW, et al. Intentional weight loss and all-cause mortality: a meta-analysis of randomized clinical trials. PLoS ONE. 2015; 10: e0121993.

[28] Gaddey HL, Holder K. Unintentional weight loss in older adults. American Family Physician. 2014; 89: 718-722.

[29] Alhurani RE, Vassilaki M, Aakre JA, Mielke MM, Kremers WK, Machulda MM, et al. Decline in weight and incident mild cognitive impairment: Mayo Clinic study of aging. JAMA Neurology. 2016; 73: 439-446.

[30] Fearon KCH, Glass DJ, Guttridge DC. Cancer cachexia: mediators, signaling, and metabolic pathways. Cell Metabolism. 2012; 16: 153-166.

[31] Sahyoun NR, Serdula MK, Galuska DA, Zhang XL, Pamuk ER. The epidemiology of recent involuntary weight loss in the United States population. Journal of Nutrition, Health & Aging. 2004; 8: 510-517.

[32] Fan Y, Gu X, Zou C. Prediction of all-cause and cardiovascular mortality with weight losss in paitents with chronic heart failure: a meta-analysis. European Journal of Preventive Cardiology. 2020; 27: 2155-2158.

[33] Kim MK, Han K, Koh ES, Kim ES, Lee M, Nam GE, et al. Weight change and mortality and cardiovascular outcomes in patients with new-onset diabetes mellitus: a nationwide cohort study. Cardiovas-cular Diabetology. 2019; 18: 36.

[34] Gambardella J, Santulli G. Integrating diet and inflammation to calculate cardiovascular risk. Atherosclerosis. 2016; 253: 258-261.

[35] Ding D, Rogers K, van der Ploeg H, Stamatakis E, Bauman AE. Tradi-tional and emerging lifestyle risk behaviors and all-cause mortality in middle-aged and older adults: evidence from a large population-based Australian cohort. PLoS Medicine. 2016; 12: e1001917.