title: Body mass index and the risk of new-onset atrial fibrillation in middle-aged adults.
abstract: BACKGROUND
  Increased body mass index (BMI) and obesity are associated with increased risk of new-onset atrial fibrillation (AF) among middle-aged adults.
  
  
  OBJECTIVE
  The objective of the study is to investigate the association between BMI and the risk for new-onset AF among middle-aged adults.
  
  
  METHODS
  We investigated 18,290 men and women who were annually screened in a tertiary medical center. Participants were divided at baseline into 3 groups: normal weight (BMI ≥18 and <25 kg/m(2), n = 7,692), overweight (BMI ≥25 and <30 kg/m(2), n = 8,032), and obese (BMI ≥30 kg/m(2), n = 2,566). The primary end point was new-onset AF during follow-up.
  
  
  RESULTS
  Mean age of study population was 49 ± 11 years, and 73% were men. A total of 288 incident events (1.6%) occurred during 6 ± 4 years. Kaplan-Meier survival analysis showed that the cumulative probability of AF at 6 years was highest among obese participants, intermediate among overweight participants, and lowest among participants with normal weight (2.1%, 1.7%, and 0.8% respectively, P < .001). Multivariable Cox regression analysis showed that overweight and obesity were independently associated with increased AF risk (hazard ratio 1.54 [P = .004] and 2.41 [P < .001], respectively). Assessment of BMI change as a time-dependent covariate in the multivariable model showed that each 1 kg/m(2) reduction in BMI during follow-up was associated with a significant 7% reduction in the risk for the occurrence of a first AF event (hazard ratio 0.93, 95% CI 0.88-0.99, P = .019). Consistently, similar analysis showed that each 5-kg weight loss during follow-up was independently associated with a significant 12% reduced risk of new-onset AF (95% CI 0.81-0.98, P = .02).
  
  
  CONCLUSIONS
  Our findings suggest that overweight and obesity are associated with increased AF risk, whereas weight reduction is independently associated with reduced risk of de novo AF.
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine D, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Berkovitch
authors.affiliation: Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Department of Internal Medicine C, Chaim Sheba Medical Center, Tel Hashomer, Israel; Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel Hashomer, Israel; Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Shaye
authors.initials: S
authors.lastname: Kivity
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Robert
authors.initials: R
authors.lastname: Klempfner
authors.affiliation: Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Institute for Medical Screening, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Segev
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Department of Internal Medicine "E," Tel-Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Assi
authors.initials: A
authors.lastname: Milwidsky
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Aharon
authors.initials: A
authors.lastname: Erez
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Sabbag
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Department of Internal Medicine C, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Yechezkel
authors.initials: Y
authors.lastname: Sidi
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel Hashomer, Israel. Electronic address: Elad.Maor@sheba.health.gov.il.
authors.forename: Elad
authors.initials: E
authors.lastname: Maor
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D050177:Overweight / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends