Current and early life weight and associations with mortality in rheumatoid arthritis

Joshua F. Baker, Andrew Stokes, Ted R. Mikuls, Michael George, Bryant R. England, Harlan Sayles, Kaleb Michaud

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

OBJECTIVES: Obesity is paradoxically associated with a lower risk of mortality in chronic illnesses including rheumatoid arthritis (RA). Weight loss in patients with poor health, however, may in part explain this observation. This study evaluated the impact of weight early in life and weight loss on mortality in patients with RA. METHODS: Patients with RA (age >40 years) were active participants in a prospective clinical registry with up to 17 years of follow-up. Current and age-30 body mass index (BMI) were determined from self-report of height and weight from semi-annual questionnaires. Mortality was assessed from National Death Index. Risks of obesity reported from both early in life and at enrolment in the registry were evaluated using Cox proportional hazards models. RESULTS: Among 12,679 participants (80% female), there were 1,520 deaths in 80,502 person-years. Obesity at enrolment (BMI >30 kg/m2) was modestly associated with greater mortality [HR: 1.34 (1.18,1.53) p=0.001]. Adjusting for disability and comorbidities hypothesised to be mediators in the causal pathway between obesity and mortality further attenuated this association [HR: 0.92 (0.80,1.06) p=0.24]. In contrast, obesity at age 30 was strongly associated with mortality [HR: 2.00 (1.65,2.42) p<0.001]. Additionally, weight loss since age-30 was a strong, dose-dependent predictor of mortality independent of enrolment BMI. CONCLUSIONS: The risk of obesity is substantially underestimated when epidemiologic methods do not account for long-term weight changes. Both obesity and weight loss are strongly associated with mortality risk in patients with RA.

Original languageEnglish (US)
Pages (from-to)768-773
Number of pages6
JournalClinical and experimental rheumatology
Volume37
Issue number5
StatePublished - Sep 1 2019

Fingerprint

Rheumatoid Arthritis
Obesity
Weights and Measures
Mortality
Weight Loss
Body Mass Index
Registries
Epidemiologic Methods
Proportional Hazards Models
Self Report
Comorbidity
Chronic Disease
Health

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

Cite this

Current and early life weight and associations with mortality in rheumatoid arthritis. / Baker, Joshua F.; Stokes, Andrew; Mikuls, Ted R.; George, Michael; England, Bryant R.; Sayles, Harlan; Michaud, Kaleb.

In: Clinical and experimental rheumatology, Vol. 37, No. 5, 01.09.2019, p. 768-773.

Research output: Contribution to journalArticle

@article{42bc5f686e484cc5ad05308d9bf6d8e2,
title = "Current and early life weight and associations with mortality in rheumatoid arthritis",
abstract = "OBJECTIVES: Obesity is paradoxically associated with a lower risk of mortality in chronic illnesses including rheumatoid arthritis (RA). Weight loss in patients with poor health, however, may in part explain this observation. This study evaluated the impact of weight early in life and weight loss on mortality in patients with RA. METHODS: Patients with RA (age >40 years) were active participants in a prospective clinical registry with up to 17 years of follow-up. Current and age-30 body mass index (BMI) were determined from self-report of height and weight from semi-annual questionnaires. Mortality was assessed from National Death Index. Risks of obesity reported from both early in life and at enrolment in the registry were evaluated using Cox proportional hazards models. RESULTS: Among 12,679 participants (80{\%} female), there were 1,520 deaths in 80,502 person-years. Obesity at enrolment (BMI >30 kg/m2) was modestly associated with greater mortality [HR: 1.34 (1.18,1.53) p=0.001]. Adjusting for disability and comorbidities hypothesised to be mediators in the causal pathway between obesity and mortality further attenuated this association [HR: 0.92 (0.80,1.06) p=0.24]. In contrast, obesity at age 30 was strongly associated with mortality [HR: 2.00 (1.65,2.42) p<0.001]. Additionally, weight loss since age-30 was a strong, dose-dependent predictor of mortality independent of enrolment BMI. CONCLUSIONS: The risk of obesity is substantially underestimated when epidemiologic methods do not account for long-term weight changes. Both obesity and weight loss are strongly associated with mortality risk in patients with RA.",
author = "Baker, {Joshua F.} and Andrew Stokes and Mikuls, {Ted R.} and Michael George and England, {Bryant R.} and Harlan Sayles and Kaleb Michaud",
year = "2019",
month = "9",
day = "1",
language = "English (US)",
volume = "37",
pages = "768--773",
journal = "Clinical and Experimental Rheumatology",
issn = "0392-856X",
publisher = "Clinical and Experimental Rheumatology S.A.S.",
number = "5",

}

TY - JOUR

T1 - Current and early life weight and associations with mortality in rheumatoid arthritis

AU - Baker, Joshua F.

AU - Stokes, Andrew

AU - Mikuls, Ted R.

AU - George, Michael

AU - England, Bryant R.

AU - Sayles, Harlan

AU - Michaud, Kaleb

PY - 2019/9/1

Y1 - 2019/9/1

N2 - OBJECTIVES: Obesity is paradoxically associated with a lower risk of mortality in chronic illnesses including rheumatoid arthritis (RA). Weight loss in patients with poor health, however, may in part explain this observation. This study evaluated the impact of weight early in life and weight loss on mortality in patients with RA. METHODS: Patients with RA (age >40 years) were active participants in a prospective clinical registry with up to 17 years of follow-up. Current and age-30 body mass index (BMI) were determined from self-report of height and weight from semi-annual questionnaires. Mortality was assessed from National Death Index. Risks of obesity reported from both early in life and at enrolment in the registry were evaluated using Cox proportional hazards models. RESULTS: Among 12,679 participants (80% female), there were 1,520 deaths in 80,502 person-years. Obesity at enrolment (BMI >30 kg/m2) was modestly associated with greater mortality [HR: 1.34 (1.18,1.53) p=0.001]. Adjusting for disability and comorbidities hypothesised to be mediators in the causal pathway between obesity and mortality further attenuated this association [HR: 0.92 (0.80,1.06) p=0.24]. In contrast, obesity at age 30 was strongly associated with mortality [HR: 2.00 (1.65,2.42) p<0.001]. Additionally, weight loss since age-30 was a strong, dose-dependent predictor of mortality independent of enrolment BMI. CONCLUSIONS: The risk of obesity is substantially underestimated when epidemiologic methods do not account for long-term weight changes. Both obesity and weight loss are strongly associated with mortality risk in patients with RA.

AB - OBJECTIVES: Obesity is paradoxically associated with a lower risk of mortality in chronic illnesses including rheumatoid arthritis (RA). Weight loss in patients with poor health, however, may in part explain this observation. This study evaluated the impact of weight early in life and weight loss on mortality in patients with RA. METHODS: Patients with RA (age >40 years) were active participants in a prospective clinical registry with up to 17 years of follow-up. Current and age-30 body mass index (BMI) were determined from self-report of height and weight from semi-annual questionnaires. Mortality was assessed from National Death Index. Risks of obesity reported from both early in life and at enrolment in the registry were evaluated using Cox proportional hazards models. RESULTS: Among 12,679 participants (80% female), there were 1,520 deaths in 80,502 person-years. Obesity at enrolment (BMI >30 kg/m2) was modestly associated with greater mortality [HR: 1.34 (1.18,1.53) p=0.001]. Adjusting for disability and comorbidities hypothesised to be mediators in the causal pathway between obesity and mortality further attenuated this association [HR: 0.92 (0.80,1.06) p=0.24]. In contrast, obesity at age 30 was strongly associated with mortality [HR: 2.00 (1.65,2.42) p<0.001]. Additionally, weight loss since age-30 was a strong, dose-dependent predictor of mortality independent of enrolment BMI. CONCLUSIONS: The risk of obesity is substantially underestimated when epidemiologic methods do not account for long-term weight changes. Both obesity and weight loss are strongly associated with mortality risk in patients with RA.

UR - http://www.scopus.com/inward/record.url?scp=85069940359&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85069940359&partnerID=8YFLogxK

M3 - Article

C2 - 30719967

AN - SCOPUS:85069940359

VL - 37

SP - 768

EP - 773

JO - Clinical and Experimental Rheumatology

JF - Clinical and Experimental Rheumatology

SN - 0392-856X

IS - 5

ER -