A review and meta-analysis of the effect of weight loss on all-cause mortality risk

Overweight and obesity are associated with increased morbidity and mortality, although the range of body weights that is optimal for health is controversial. It is less clear whether weight loss benefits longevity and hence whether weight reduction is justified as a prime goal for all individuals who are overweight (normally defined as BMI>25 kg/m2). The purpose of the present review was to examine the evidence base for recommending weight loss by diet and lifestyle change as a means of prolonging life. An electronic search identified twenty-six eligible prospective studies that monitored subsequent mortality risk following weight loss by lifestyle change, published up to 2008. Data were extracted and further analysed by meta-analysis, giving particular attention to the influence of confounders. Moderator variables such as reason for weight loss (intentional, unintentional), baseline health status (healthy, unhealthy), baseline BMI (normal, overweight, obese), method used to estimate weight loss (measured weight loss, reported weight loss) and whether models adjusted for physical activity (adjusted data, unadjusted data) were used to classify subgroups for separate analysis. Intentional weight loss per se had a neutral effect on all-cause mortality (relative risk (RR) 1·01; P = 0·89), while weight loss which was unintentional or ill-defined was associated with excess risk of 22 to 39 %. Intentional weight loss had a small benefit for individuals classified as unhealthy (with obesity-related risk factors) (RR 0·87 (95 % CI 0·77, 0·99); P = 0·028), especially unhealthy obese (RR 0·84 (95 % CI 0·73, 0·97); P = 0·018), but appeared to be associated with slightly increased mortality for healthy individuals (RR 1·11 (95 % CI 1·00, 1·22); P = 0·05), and for those who were overweight but not obese (RR 1·09 (95 % CI 1·02, 1·17); P = 0·008). There was no evidence for weight loss conferring either benefit or risk among healthy obese. In conclusion, the available evidence does not support solely advising overweight or obese individuals who are otherwise healthy to lose weight as a means of prolonging life. Other aspects of a healthy lifestyle, especially exercise and dietary quality, should be considered. However, well-designed intervention studies are needed clearly to disentangle the influence of physical activity, diet strategy and body composition, in order to define appropriate advice to those populations that might be expected to benefit.

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Intentional Weight Loss and All-Cause Mortality: A Meta-Analysis of Randomized Clinical Trials

PLoS ONE ◽

10.1371/journal.pone.0121993 ◽

2015 ◽

Vol 10 (3) ◽

pp. e0121993 ◽

Cited By ~ 79

Author(s):

Stephen B. Kritchevsky ◽

Kristen M. Beavers ◽

Michael E. Miller ◽

M. Kyla Shea ◽

Denise K. Houston ◽

...

Keyword(s):

Weight Loss ◽

Clinical Trials ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Intentional Weight Loss ◽

All Cause Mortality

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Complex interaction of obesity, intentional weight loss and heart failure: a systematic review and meta-analysis

Heart ◽

10.1136/heartjnl-2019-314770 ◽

2019 ◽

Vol 106 (1) ◽

pp. 58-68 ◽

Cited By ~ 10

Author(s):

Rajiv Mahajan ◽

Michael Stokes ◽

Adrian Elliott ◽

Dian A Munawar ◽

Kashif B Khokhar ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Myocardial Function ◽

Meta Analysis ◽

Obesity Paradox ◽

Left Ventricular ◽

Cardiac Structure ◽

Intentional Weight Loss ◽

All Cause Mortality ◽

Overweight Group

ObjectiveThe aim of the meta-analysis was to determine the association of obesity and heart failure (HF) and the cardiac impact of intentional weight loss following bariatric surgery on cardiac structure and myocardial function in obese subjects.MethodsMEDLINE, Embase and Web of Science were searched up to 3 April 2018. Studies reporting association and prognostic impact of obesity in HF and the impact of intentional weight loss following bariatric surgery on cardiac structure and myocardial function in obesity were included in the meta-analysis.Results4959 citations were reviewed. After exclusions, 29 studies were analysed. A ‘J curve’ relationship was observed between body mass index (BMI) and risk of HF with maximum risk in the morbidly obese (1.73 (95% CI 1.30 to 2.31), p<0.001, n=11). Although ‘obesity paradox’ was observed for all-cause mortality, the overweight group was associated with lower cardiovascular (CV) mortality (OR=0.86 (95% CI 0.79 to 0.94), n=11) with no significant differences across other BMI groups. Intentional weight loss induced by bariatric surgery in obese patients (n=9) without established HF, atrial fibrillation or known coronary artery disease, was associated with a reduction in left ventricular mass index (p<0.0001), improvement in left ventricular diastolic function (p≤0.0001) and a reduction in left atrial size (p=0.02).ConclusionsDespite the increased risk of HF with obesity, an ‘obesity paradox’ is observed for all-cause mortality. However, the nadir for CV mortality is observed in the overweight group. Importantly, intentional weight loss was associated with improvement in indices of cardiac structure and myocardial function in obese patients.Trial registration numberAPP 74412.

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Effect of Polyglucosamine on Weight Loss and Metabolic Parameters in Overweight and Obesity: A Systematic Review and Meta-Analysis

Nutrients ◽

10.3390/nu12082365 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2365

Author(s):

Simone Perna ◽

Sana N. M. Basharat ◽

Khawla F. Ali ◽

Abdulla Eid ◽

Clara Gasparri ◽

...

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Waist Circumference ◽

Caloric Restriction ◽

Meta Analysis ◽

Overweight And Obesity ◽

Metabolic Parameters ◽

Control Group ◽

Long Term Effects ◽

The Individual

The use of dietary supplements for weight loss has gained significant momentum. Polyglucosamine, a chitosan derivative, is a dietary supplement increasingly used for weight loss. In this meta-analysis, we systematically summarized and quantified the key findings of four randomized, placebo-controlled clinical trials examining the effects of polyglucosamine supplementation and caloric restriction, and physical activity on body weight, body mass index (BMI), and waist circumference in subjects with overweight and obesity. The control group was set with a physical activity from 6–7 MET-h/week activity and up to 21 MET-h/week activity with caloric restriction. Compliance in the latter trials was reported via a follow-up questionnaire with the individual participants. The analysis included 399 subjects followed for a period ranging from 12 weeks to one year. Subjects’ age ranged from 21–75 years, BMI from 26–45 kg/m2, and all were white European or Caucasian in ethnicity. The meta-analyzed mean differences for random effects showed that polyglucosamine supplementation improves weight loss by −1.78 kg [−2.78, −0.79], BMI by −1.52 kg/m2 [−3.58, 0.54], and improves waist circumference reduction by −1.45 cm [−2.77, −0.12]. In conclusion, the use of polyglucosamine supplementation in conjunction with lifestyle behavioral therapies can be effective for weight reduction. Further studies are needed to examine the long-term effects of polyglucosamine supplementation on weight loss and other metabolic parameters

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The association of weight change and all-cause mortality in older adults: a systematic review and meta-analysis

Age and Ageing ◽

10.1093/ageing/afaa231 ◽

2020 ◽

Author(s):

Tagrid A Alharbi ◽

Susan Paudel ◽

Danijela Gasevic ◽

Joanne Ryan ◽

Rosanne Freak-Poli ◽

...

Keyword(s):

Older Adults ◽

Weight Loss ◽

Weight Gain ◽

Mortality Risk ◽

Weight Change ◽

Meta Analysis ◽

Community Dwelling ◽

Weight Fluctuation ◽

All Cause Mortality ◽

The Impact

Abstract Objective there may be age-related differences in the impact of weight change on health. This study systematically reviewed the evidence on the relationship between weight change and all-cause mortality in adults aged 65 years and older. Methods MEDLINE, EMBASE and CINAHL were searched from inception to 11 June 2020, PROSPERO CRD 42019142268. We included observational studies reporting on the association between weight change and all-cause mortality in older community-dwelling adults. A random-effects meta-analysis was performed to calculate pooled hazard ratios and scored based on the Agency for Healthcare Research and Quality guidelines. Results a total of 30 studies, including 1,219,279 participants with 69,255 deaths, demonstrated that weight loss was associated with a 59% increase in mortality risk (hazard ratio (HR): 1.59; 95% confidence interval (CI): 1.45–1.74; P < 0.001). Twenty-seven studies that reported outcomes for weight gain (1,210,116 participants with 65,481 deaths) indicated that weight gain was associated with a 10% increase in all-cause mortality (HR: 1.10; 95%CI: 1.02, 1.17; P = 0.01). Four studies investigated weight fluctuation (2,283 events among 6,901 participants), which was associated with a 63% increased mortality risk (HR: 1.66; 95%CI: 1.28, 2.15). No evidence of publication bias was observed (all P > 0.05). Conclusion for community-dwelling older adults, weight changes (weight loss, gain or weight fluctuation) are associated with an increased risk of all-cause mortality risk relative to stable weight. Further research is needed to determine whether these associations vary depending upon initial weight, and whether or not the weight loss/gain was intentional.

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Fad Diets: Dietary Dilemmas, Predicaments, and Recommendations for its Use

Current Nutrition & Food Science ◽

10.2174/1573401316999200407092922 ◽

2020 ◽

Vol 16 (9) ◽

pp. 1362-1380

Author(s):

Jyoti Singh ◽

Prasad Rasane ◽

Vidisha Tomer ◽

Sawinder Kaur ◽

Yogesh Gat ◽

...

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Health Care Expenditures ◽

Overweight And Obesity ◽

Lifestyle Changes ◽

Health Issues ◽

Lifestyle Modifications ◽

Treatment Measures ◽

Long Time ◽

Extra Weight

The health issues, mainly overweight and obesity are the growing concerns nowadays due to the associated factors and lifestyle changes which significantly have increased the individual’s health care expenditures. Fad diets are promoted as the easiest and simplest way of shedding the extra weight despite the availability of several treatments available. The prevention and treatment measures, including modification in lifestyle, dietary pattern, and physical activity, are the foundation of weight loss. However, the standard treatment measures are not effective for certain populations as they require long time adherence, which leads to the search for other approaches like fad diet. We steered a comprehensive literature review to present the facts related to fad diets to their efficacy and sustainability. Although fad diets have yielded tremendous positive results in weight loss and cardiovascular risk prevention, the studies reported death in long-term interventions and the results and some of them show side effects too. Randomized controlled trials have significantly reported weight loss in comparison with the popular fad diets; however, persisting on the same diet has also reported kidney problems, ketosis, and other metabolic related problems. The conclusion of this critical review reported that gradual weight loss could be attained by the combination of lifestyle modifications, physical activity, and recommended dietary approaches.

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Prognostic Value of Serum Magnesium in Mortality Risk among Patients on Hemodialysis: A Meta-Analysis of Observational Studies

Kidney Diseases ◽

10.1159/000510513 ◽

2020 ◽

pp. 1-10

Author(s):

Hongwei Wu ◽

Qiang Li ◽

Lijing Fan ◽

Dewang Zeng ◽

Xianggeng Chi ◽

...

Keyword(s):

Mortality Risk ◽

Cardiovascular Mortality ◽

Observational Studies ◽

Prognostic Value ◽

Meta Analysis ◽

Serum Magnesium ◽

Cochrane Library ◽

Lower Serum ◽

All Cause Mortality ◽

End Stage

Background: Previous studies have reported that serum magnesium (Mg) deficiency is involved in the development of heart failure, particularly in patients with end-stage kidney disease. The association between serum Mg levels and mortality risk in patients receiving hemodialysis is controversial. We aimed to estimate the prognostic value of serum Mg concentration on all-cause mortality and cardiovascular mortality in patients receiving hemodialysis. Methods: We did a systematic literature search in PubMed, EMBASE, Cochrane Library, and Web of Science to identify eligible studies that reported the prognostic value of serum Mg levels in mortality risk among patients on hemodialysis. We performed a meta-analysis by pooling and analyzing hazard ratios (HRs) and 95% confidence intervals (CIs). Results: We identified 13 observational studies with an overall sample of 42,967 hemodialysis patients. Higher all-cause mortality (adjusted HR 1.58 [95% CI: 1.31–1.91]) and higher cardiovascular mortality (adjusted HR 3.08 [95% CI: 1.27–7.50]) were found in patients with lower serum Mg levels after multivariable adjustment. There was marked heterogeneity (I2 = 79.6%, p < 0.001) that was partly explained by differences in age stratification and study area. In addition, subgroup analysis showed that a serum Mg concentration of ≤1.1 mmol/L might be the vigilant cutoff value. Conclusion: A lower serum Mg level was associated with higher all-cause mortality and cardiovascular mortality in patients receiving hemodialysis.

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Combined effects of weight loss and physical activity on all-cause mortality of overweight men and women

Yearbook of Sports Medicine ◽

10.1016/s0162-0908(10)79724-5 ◽

2011 ◽

Vol 2011 ◽

pp. 169-172

Author(s):

R.J. Shephard

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Combined Effects ◽

Men And Women ◽

All Cause Mortality

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Aspirin Exposure and Mortality Risk among Prostate Cancer Patients: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2019/9379602 ◽

2019 ◽

Vol 2019 ◽

pp. 1-15 ◽

Cited By ~ 1

Author(s):

Lai lai Fan ◽

Cheng Peng Xie ◽

Yi Ming Wu ◽

Xi jie Gu ◽

Ying he Chen ◽

...

Keyword(s):

Prostate Cancer ◽

Frequency Response ◽

Mortality Risk ◽

Meta Analysis ◽

Random Effect ◽

Response Analysis ◽

Dose Frequency ◽

All Cause Mortality ◽

Cancer Specific Mortality ◽

Random Effect Models

Background. Prostate cancer (PCa) is the ninth most common cause of cancer death globally. Many studies have investigated aspirin exposure and mortality risk among PCa patients, returning inconsistent results. We conducted a comprehensive meta-analysis to explore the association between aspirin exposure and mortality risk among PCa patients and to investigate potential dose/duration/frequency-response relationships. Methods and Results. Studies published from 1980 to 2018 of PubMed and EMBASE databases were searched. We included 14 studies with 110,000 participants. Multivariate-adjusted odds ratios (ORs) were pooled using random-effect models. Potential dose/duration/frequency-response relationships were evaluated for aspirin exposure and prostate cancer-specific mortality (PCSM) risk. We did not detect an association between the highest aspirin exposure and mortality risk (PCSM of prediagnostic aspirin exposure, OR: 0.96, 95% confidence interval [CI]: 0.87-1. 07, I2 = 0%; PCSM of postdiagnostic aspirin exposure, OR:0.92, 95% CI: 0.77-1.10, I2 = 56.9%; all-cause mortality [ACM] of prediagnostic aspirin exposure, OR: 0.96, 95% CI: 0.88-1.04, I2 = 9.4%; ACM of postdiagnostic aspirin exposure, OR: 0.95, 95% CI: 0.73-1.23, I2 = 88.9%). There was no significant dose/frequency-response association observed for aspirin exposure and PCSM risk. On duration-response analysis, we found that short-term postdiagnostic aspirin exposure (shorter than 2.5 years) increased the risk of PCSM. Conclusions. Our meta-analysis suggests that there is no association between aspirin exposure and PCSM risk. Nor is there an association between the highest aspirin exposure and ACM risk among PCa patients. More studies are needed for a further dose/duration/frequency-response meta-analysis.

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Physical Activity and Mortality in Cancer Survivors: A Systematic Review and Meta-Analysis

JNCI Cancer Spectrum ◽

10.1093/jncics/pkz080 ◽

2019 ◽

Vol 4 (1) ◽

Cited By ~ 11

Author(s):

Christine M Friedenreich ◽

Chelsea R Stone ◽

Winson Y Cheung ◽

Sandra C Hayes

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Dose Response ◽

Meta Analysis ◽

Menopausal Status ◽

Optimal Dose ◽

Primary Objective ◽

Survival Outcomes ◽

All Cause Mortality ◽

Pa Domain

Abstract Background Recommendations for improved survival after cancer through physical activity (PA) exist, although the evidence is still emerging. Our primary objective was to conduct a systematic review and meta-analysis of the association between prediagnosis and postdiagnosis PA and survival (cancer-specific, all-cause, and cardiovascular disease mortality) for all cancers and by tumor site. Secondary objectives were to examine the associations within population subgroups, by PA domain, and to determine the optimal dose of PA related to survival. Methods PubMed, EMBASE, and SportsDiscus databases were searched from inception to November 1, 2018. DerSimonian-Laird random-effects models were used to estimate the summary hazard ratios (HRs) and 95% confidence intervals (CI) for primary and secondary analyses and to conduct dose-response analyses. Results Evidence from 136 studies showed improved survival outcomes with highest vs lowest levels of prediagnosis or postdiagnosis total or recreational PA for all-cancers combined (cancer specific mortality: HR = 0.82, 95% CI = 0.79 to 0.86, and HR = 0.63, 95% CI = 0.53 to 0.75, respectively) as well as for 11 specific cancer sites. For breast and colorectal cancers, greater reductions were observed for postdiagnosis PA (HR = 0.58–0.63) compared with prediagnosis PA (HR = 0.80–0.86) for cancer-specific and all-cause mortality. Survival benefits through PA were observed in most subgroups (within sex, body mass index, menopausal status, colorectal subtypes, and PA domain) examined. Inverse dose-response relationships between PA and breast cancer-specific and all-cause mortality were observed, with steep reductions in hazards to 10–15 metabolic equivalent hours per week. Conclusion Higher prediagnosis and postdiagnosis levels of PA were associated with improved survival outcomes for at least 11 cancer types, providing support for global promotion of PA guidelines following cancer.

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