title: Trajectory of body shape in early and middle life and all cause and cause specific mortality: results from two prospective US cohort studies.
abstract: To assess body shape trajectories in early and middle life in relation to risk of mortality.
  
  
  
  Prospective cohort study.
  
  
  
  Nurses' Health Study and Health Professionals Follow-up Study.
  
  
  
  80 266 women and 36 622 men who recalled their body shape at ages 5, 10, 20, 30, and 40 years and provided body mass index at age 50, followed from age 60 over a median of 15-16 years for death.
  
  
  
  All cause and cause specific mortality.
  
  
  
  Using a group based modeling approach, five distinct trajectories of body shape from age 5 to 50 were identified: lean-stable, lean-moderate increase, lean-marked increase, medium-stable/increase, and heavy-stable/increase. The lean-stable group was used as the reference. Among never smokers, the multivariable adjusted hazard ratio for death from any cause was 1.08 (95% confidence interval 1.02 to 1.14) for women and 0.95 (0.88 to 1.03) for men in the lean-moderate increase group, 1.43 (1.33 to 1.54) for women and 1.11 (1.02 to 1.20) for men in the lean-marked increase group, 1.04 (0.97 to 1.12) for women and 1.01 (0.94 to 1.09) for men in the medium-stable/increase group, and 1.64 (1.49 to 1.81) for women and 1.19 (1.08 to 1.32) for men in the heavy-stable/increase group. For cause specific mortality, participants in the heavy-stable/increase group had the highest risk, with a hazard ratio among never smokers of 2.30 (1.88 to 2.81) in women and 1.45 (1.23 to 1.72) in men for cardiovascular disease, 1.37 (1.14 to 1.65) in women and 1.07 (0.89 to 1.30) in men for cancer, and 1.59 (1.38 to 1.82) in women and 1.10 (0.95 to 1.29) in men for other causes. The trajectory-mortality association was generally weaker among ever smokers than among never smokers (for all cause mortality: P for interaction <0.001 in women and 0.06 in men). When participants were classified jointly according to trajectories and history of type 2 diabetes, the increased risk of death associated with heavier body shape trajectories was more pronounced among participants with type 2 diabetes than those without diabetes, and those in the heavy-stable/increase trajectory and with a history of diabetes had the highest risk of death.
  
  
  
  Using the trajectory approach, we found that heavy body shape from age 5 up to 50, especially the increase in middle life, was associated with higher mortality. In contrast, people who maintained a stably lean body shape had the lowest mortality. These results indicate the importance of weight management across the lifespan.
authors.affiliation: Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114, USA Departments of Nutrition and Epidemiology, Harvard T H Chan School of Public Health, Boston, MA 02115, USA.
authors.forename: Mingyang
authors.initials: M
authors.lastname: Song
authors.affiliation: Departments of Nutrition and Epidemiology, Harvard T H Chan School of Public Health, Boston, MA 02115, USA Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.affiliation: Departments of Nutrition and Epidemiology, Harvard T H Chan School of Public Health, Boston, MA 02115, USA.
authors.forename: Kana
authors.initials: K
authors.lastname: Wu
authors.affiliation: Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA.
authors.forename: Aviva
authors.initials: A
authors.lastname: Must
authors.affiliation: Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114, USA Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Chan
authors.affiliation: Departments of Nutrition and Epidemiology, Harvard T H Chan School of Public Health, Boston, MA 02115, USA Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.affiliation: Departments of Nutrition and Epidemiology, Harvard T H Chan School of Public Health, Boston, MA 02115, USA Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Giovannucci
mesh_terms: D015992:Body Mass Index; D002318:Cardiovascular Diseases; D002423:Cause of Death; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2; D005500:Follow-Up Studies; D006801:Humans; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors