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Multicenter Study
. 2015 Jul;67(7):1711-7.
doi: 10.1002/art.39136.

Weight Loss, the Obesity Paradox, and the Risk of Death in Rheumatoid Arthritis

Joshua F Baker  1 , Erica Billig  2 , Kaleb Michaud  3 , Said Ibrahim  1 , Liron Caplan  4 , Grant W Cannon  5 , Andrew Stokes  6 , Vikas Majithia  7 , Ted R Mikuls  8
Affiliations
Multicenter Study

Weight Loss, the Obesity Paradox, and the Risk of Death in Rheumatoid Arthritis

Joshua F Baker et al. Arthritis Rheumatol. 2015 Jul.

Abstract

Objective: In contrast to what is observed in the general population, a low body mass index (BMI) has been associated with accelerated mortality in patients with rheumatoid arthritis (RA). The aim of this study was to assess whether weight loss might explain these seemingly paradoxical observations.

Methods: Our study included patients identified from the Veterans Affairs (VA) RA Registry. Dates of death were abstracted from VA electronic medical records. The BMI at each study visit and the change from the previous visit were determined. The maximum BMI of each patient was also obtained from medical records. The annualized rate of BMI loss was determined from the slope of change (per year) in BMI over visits within the preceding 13 months. Cox multivariable proportional hazards models were used to assess associations between BMI measures and mortality.

Results: In a sample of 1,674 patients, 312 deaths occurred over 9,183 person-years. A loss in BMI of ≥1 kg/m(2) was associated with a greater risk of death, after adjustment for demographics, comorbidities, BMI, smoking, and RA therapies (hazard ratio [HR] 1.99, 95% confidence interval [95% CI] 1.53-2.59, P < 0.001). This association remained significant in a subsample analysis adjusting for C-reactive protein and physical function (HR 1.81, 95% CI 1.36-2.41, P < 0.001). Weight loss at an annualized rate of ≥3 kg/m(2) was associated with the greatest risk of death (HR 2.49, 95% CI 1.73-3.57, P < 0.001). Low BMI (<20 kg/m(2) ) in patients with a history of obesity (>30 kg/m(2) ) was associated with the greatest risk (HR 8.52, 95% CI 4.10-17.71, P < 0.001).

Conclusion: Weight loss is a strong predictor of death in patients with RA. These observations may explain the observed obesity paradox and do not support a biologically protective role of obesity.

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Figures

Figure 1
Figure 1
Lowess curve illustrating the mean body mass index and 95% confidence interval prior to the date of death in patients who died compared with those who survived to the date when the database was queried.
Figure 2
Figure 2
Calculated hazard ratios for death in patients with different body weight histories. Values above each column are the number of observations for each weight history. Only 7 patients were maximally underweight, and data for these patients are not shown.
See this image and copyright information in PMC

Comment in

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