BODY-WEIGHT CHANGE, ALL-CAUSE MORTALITY, AND CAUSE-SPECIFIC MORTALITY IN THE MULTIPLE RISK FACTOR INTERVENTION TRIAL

Objective: To evaluate the relation between weight variability and death in high-risk, middle-aged men participating in the Multiple Risk Factor Intervention Trial (MRFIT). Design: Cohort study with 3.8 years of follow-up. Setting. Multicenter, collaborative, primary prevention trial conducted at 22 clinical centers in the United States. Participants: Men (n = 10 529) who were 35 to 57 years old at baseline and who were in the upper 10% to 15% of risk for coronary heart disease because of smoking, high blood pressure, and elevated cholesterol level. Participants were seen at least annually for 6 to 7 years for medical evaluations in study clinical centers. Measurements. Death from cardiovascular disease (228 deaths) and from all causes (380 deaths). Results: The primary measure of weight variability was the intrapersonal standard deviation of weight (ISD), which was calculated from measured weights obtained at clinic visits during a 6- to 7-year period. All-cause death rates per 1000 person-years of follow-up across ISD quartiles were 8.28, 8.25,10.57, and 11.07 from the first to fourth quartiles, respectively. After adjusting for baseline risk factors associated with weight change, the relative risk for all-cause mortality in the fourth, compared with the first quartile was 1.64 (95% CI, 1.21 to 2.23). Cardiovascular death and ISD showed a similar pattern. The association between weight change and death was not observed in the heaviest men. Conclusion: Greater weight variability was associated with a greater risk for cardiovascular disease and all-cause mortality in some types of high-risk men.