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European Heart Journal Advance Access originally published online on May 9, 2009
European Heart Journal 2009 30(14):1720-1727; doi:10.1093/eurheartj/ehp162
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Explaining the obesity paradox: cardiovascular risk, weight change, and mortality during long-term follow-up in men{dagger}

Timo E. Strandberg1,*, Arto Y. Strandberg2, Veikko V. Salomaa3, Kaisu H. Pitkälä4, Reijo S. Tilvis2, Jonne Sirola4 and Tatu A. Miettinen2

1 Institute of Health Sciences/Geriatrics, University of Oulu and University Hospital, Unit of General Practice, Aapistie 1, PO Box 5000, FIN-90014 Oulu, Finland
2 Department of Medicine, Geriatric Clinic, University of Helsinki, Helsinki, Finland
3 KTL-National Public Health Institute, Helsinki, Finland
4 Helsinki University Central Hospital, Unit of General Practice, Helsinki, Finland

Received 17 September 2008; revised 5 March 2009; accepted 23 March 2009; online publish-ahead-of-print 9 May 2009.

* Corresponding author. Tel: +358 40596 9285, Fax: +358 8537 5661, Email: timo.strandberg{at}oulu.fi

Aims: To examine life-long weight trajectories behind the ‘obesity paradox’, and whether cardiovascular disease (CVD) risk contributes.

Methods and results: Cardiovascular disease risk and body mass index (BMI) at mean ages of 25, 47 (year 1974), and 73 years (year 2000) were available of a socioeconomically homogenous sample of 1114 men, without chronic diseases and diabetes in 1974. Overweight was defined as BMI > 25 kg/m2, and 7-year mortality (2000–06) from the mean age of 73 years determined (188 deaths). Between 1974 and 2000, 44.3% (n = 494) were constantly overweight, 31.0% (n = 345) constantly normal weight, 12.2% (n = 136) moved from normal to overweight, and 12.5% (n = 139) moved from overweight to normal. The last group had highest CVD risk in midlife, and in late life more co-morbidities and greatest total mortality (P < 0.001). Adjusted mortality hazard ratio was 2.0 (95% confidence interval, CI 1.3–3.0; constantly normal weight group as referent). The hazard ratio remained similar (1.9, 95% CI 1.2–3.0) after adjustment for prevalent diseases in 2000.

Conclusion: In old age, both normal weight and overweight men are a mixture of individuals with different weight trajectories during their life course. Overweight and high-CVD risk in midlife with subsequent weight decrease predict the worst prognosis in late life.

Key Words: Obesity • Cardiovascular risk • Weight change • Frailty

{dagger} Part of the data have been presented in abstract form at the 2008 European Society of Cardiology congress, 30 August to 3 September 2008, in Munich, Germany.


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