Aims To assess the risk of death from coronary disease, and all causes associated with body mass index and weight gain from age 20 to middle age.
Methods and Results In this study, 6874 men aged 47 to 55 years at baseline and free of a history of myocardial infarction were followed with respect to mortality from coronary disease and from all causes over an average follow-up of 19·7 years, and with respect to non-fatal myocardial infarction for 11·8 years. High body mass index predicted death from coronary disease, but only at levels above 27·5m.kg−2. Men with stable weight (defined as ±4% change from age 20) had the lowest death rate from coronary disease and the lowest risk of non-fatal myo-cardial infarction. Relative risk of coronary death increased with increasing weight gain, from 1·57 (1·14–2·15) (after adjustment for age, physical activity, and smoking) in the group who gained 4 to 10%, to 2·76 (1·97–3·85) in men with a weight gain of more than 35% (Pfor trend 0·0001), compared to men who remained stable. After further adjustment for serum cholesterol, systolic blood pressure, and diabetes, relative risks were reduced but still significantly elevated in all weight gain groups (Pfor trend 0·004). Data concerning non-fatal myocardial infarction were available for the first 11·8 years and showed a relative risk of 3·35 (2·05–5·47) after adjustment for age, physical activity, and smoking in men with a weight gain of more than 35%.
Conclusion Weight gain from age 20, even a very moderate increase, is strongly associated with an increased risk of coronary death and non-fatal myocardial infarction.