Background
Methods
Source of data
Study participants and covariates
Outcome ascertainment
Analyses
Results
Study population
Total n (%) N = 264,230 | Male n (%) N = 99,590 | Female n (%) N = 164,640 | |
---|---|---|---|
Age in years (mean (SD)) | 49.5 (12.7) | 51.2 (11.7) | 48.5 (13.2) |
Body mass index (kg/m2) | 33.8 (6.1) | 33.2 (5.4) | 34.2 (6.4) |
Ethnicity | |||
White | 168,330 (63.7) | 62,873 (63.1) | 105,457 (64.1) |
Black African | 2154 (0.8) | 548 (0.6) | 1606 (1.0) |
Black Caribbean | 2059 (0.8) | 495 (0.5) | 1564 (1.0) |
Black other | 595 (0.2) | 146 (0.2) | 449 (0.3) |
Bangladeshi | 334 (0.1) | 98 (0.1) | 236 (0.1) |
Chinese | 158 (0.1) | 56 (0.1) | 102 (0.1) |
Indian | 2908 (1.1) | 1032 (1.0) | 1876 (1.1) |
Pakistani | 1852 (0.7) | 603 (0.6) | 1249 (0.8) |
Mixed | 595 (0.2) | 170 (0.2) | 425 (0.3) |
Other Asian | 1306 (0.5) | 518 (0.5) | 788 (0.5) |
Other (unspecified) | 2498 (1.0) | 920 (0.9) | 1578 (1.0) |
Missing ethnicity records | 81,441 (30.8) | 32,131 (32.3) | 49,310 (30.0) |
IMD quintile | |||
1 (least deprived) | 25,534 (9.7) | 10,186 (10.2) | 15,348 (9.3) |
2 | 29,958 (11.3) | 11,404 (11.5) | 18,554 (11.3) |
3 | 28,070 (10.6) | 10,260 (10.3) | 17,810 (10.8) |
4 | 30,167 (11.4) | 10,697(10.7) | 19,470 (11.8) |
5 (most deprived) | 24,911 (9.4) | 8517 (8.6) | 16,394 (10.0) |
Missing records | 125,590 (47.5) | 48,526 (48.7) | 77,064 (46.8) |
Smoking status | |||
Ex-smoker | 78,539 (29.7) | 37,187 (37.3) | 41,352 (25.1) |
Light smoker (1–9 cigs/day) | 18,053 (6.8) | 7209 (7.2) | 10,844 (6.6) |
Moderate smoker (10–19/day) | 13,182 (5.0) | 4173 (4.2) | 9009 (5.5) |
Heavy smoker (20–39/day) | 11,213 (4.2) | 4622 (4.6) | 6591 (4.0) |
Non-smoker | 142,969 (54.1) | 46,289 (46.5) | 96,680 (58.7) |
Missing | 274 (0.1) | 110 (0.1) | 164 (0.1) |
Alcohol consumption | |||
Trivial (< 1 unit/day) | 88,408 (33.5) | 28,902 (29.0) | 59,506 (36.1) |
Light (1–2 units/day) | 39,423 (14.9) | 19,986 (20.1) | 19,437 (11.8) |
Moderate (3–6 units/day) | 22,394 (8.5) | 13,231 (13.3) | 9163 (5.6) |
Heavy (7–9 units/day) | 7090 (2.7) | 5271 (5.3) | 1819 (1.1) |
Very heavy (> 9 units/day) | 4377 (1.7) | 3621 (3.6) | 756 (0.5) |
Ex-alcohol consumption | 9660 (3.7) | 4477 (4.5) | 5183 (3.2) |
No alcohol consumption | 84,698 (32.1) | 21,433 (21.5) | 63,265 (38.4) |
Missing | 8180 (3.1) | 2669 (2.7) | 5511 (3.4) |
Co-morbidities | |||
Atrial fibrillation | 2144 (0.8) | 1266 (1.3) | 878 (0.5) |
Chronic kidney disease | 2460 (0.9) | 953 (1.0) | 1507 (0.9) |
Hypertension | 52,574 (19.9) | 22,203 (22.3) | 30,371 (18.4) |
Type-2 diabetes | 22,844 (8.6) | 11,682 (11.7) | 11,162 (6.8) |
Rheumatoid arthritis /inflammatory diseases | 4857 (1.8) | 1078 (1.1) | 3779 (2.3) |
Trajectory 1 (overweight-S) (n = 95,944) | Trajectory 2 (Obese 1-S) (n = 104,616) | Trajectory 3 (obese 2-S) (n = 50,866) | Trajectory 4 (obese 3-S) (n = 12,804) | |
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Patient characteristics (Sociodemographic characteristics) | ||||
Age at start of study (mean (SD)) | 49.5 (13.2) | 49.9 (12.7) | 49.1 (12.2) | 48.8 (11.2) |
Male gender n (%) | 37,882 (39.5) | 41,685 (39.9) | 16,652 (32.7) | 3371 (26.3) |
Smoking | ||||
Ex-smoker | 27,950 (29.1) | 31,763 (30.4) | 15,123 (29.7) | 3703 (28.9) |
Light smoker (1–9 cigs/day) | 6918 (7.2) | 7071 (6.8) | 3270 (6.4) | 794 (6.2) |
Moderate smoker (10–19 cigs/day) | 5118 (5.3) | 5214 (5.0) | 2347 (4.6) | 503 (3.9) |
Heavy smoker (20–39 cigs/day) | 3827 (4.0) | 4470 (4.3) | 2297 (4.5) | 619 (4.8) |
Non-smoker | 52,070 (54.3) | 55,989 (53.5) | 27,757 (54.6) | 7153 (55.9) |
Missing | 61 (0.1) | 109 (0.1) | 72 (0.1) | 32 (0.3) |
Alcohol consumption | ||||
Trivial (< 1 unit/day) | 31,978 (33.3) | 35,035 (33.5) | 17,192 (33.8) | 4203 (32.8) |
Light (1–2 units/day) | 16,405 (17.1) | 15,773 (15.1) | 6133 (12.1) | 1112 (8.7) |
Moderate (3–6 units/day) | 9746 (10.2) | 8748 (8.4) | 3314 (6.5) | 586 (4.6) |
Heavy (7–9 units/day) | 2883 (3.0) | 2961 (2.8) | 1076 (2.1) | 170 (1.3) |
Very heavy (> 9 units/day) | 1621 (1.7) | 1905 (1.8) | 722 (1.4) | 129 (1.0) |
Ex-alcohol consumption | 3086 (3.2) | 3759 (3.6) | 2174 (4.3) | 641 (5.0) |
No alcohol consumption | 28,076 (29.3) | 33,168 (31.7) | 18,113 (35.6) | 5341 (41.7) |
Missing | 2149 (2.2) | 3267 (3.1) | 2142 (4.2) | 622 (4.9) |
Deprivation (IMD quintile) | ||||
1 (least deprived) | 10,122 (10.6) | 10,251 (9.8) | 4334 (8.5) | 827 (6.5) |
2 | 11,043 (11.5) | 12,124 (11.6) | 5549 (10.9) | 1242 (9.7) |
3 | 9644 (10.1) | 11,386 (10.9) | 5654 (11.1) | 1386 (10.8) |
4 | 9889 (10.3) | 12,173 (11.6) | 6412 (12.6) | 1693 (13.2) |
5 (most deprived) | 7528 (7.9) | 9818 (9.4) | 5799 (11.4) | 1766 (13.8) |
Missing records | 47,718 (49.7) | 48,864 (46.7) | 23,118 (45.5) | 5890 (46.0) |
Weight profile and clinical characteristics | ||||
Body mass index in kg/m2 (mean (SD)) | ||||
Baseline BMI | 28.7 (2.2) | 33.7 (2.7) | 39.9 (3.5) | 49.1 (5.7) |
BMI at 2 years | 28.6 (2.2) | 33.7 (2.4) | 39.9 (3.2) | 49.1 (5.4) |
BMI at 5 years | 29.2 (2.3) | 34.5 (2.4) | 40.8 (3.1) | 50.0 (5.3) |
BMI at 8 years | 29.5 (2.5) | 34.8 (2.6) | 41.1 (3.3) | 50.1 (5.4) |
BMI at 10 years | 29.7 (2.8) | 34.9 (3.0) | 41.1 (3.7) | 49.8 (5.7) |
Mean BMI change over 10 years | 1.0 (3.1) | 1.2 (3.7) | 1.0 (4.6) | 0.6 (6.3) |
Prevalence of comorbidities at baseline | ||||
Atrial fibrillation | 671 (0.7) | 865 (0.8) | 452 (0.9) | 156 (1.2) |
Chronic kidney disease | 771 (0.8) | 998 (1.0) | 532 (1.0) | 159 (1.2) |
Hypertension | 15,708 (16.4) | 21,438 (20.5) | 12,009 (23.6) | 3419 (26.7) |
Type-2 diabetes | 6384 (6.7) | 8930 (8.5) | 5609 (11.0) | 1921 (15.0) |
Rheum arthritis/inflammatory diseases | 1674 (1.7) | 1970 (1.9) | 952 (1.9) | 261 (2.0) |
Cardiovascular disease, heart failure and mortality outcomes
Trajectory 1 (overweight-S) (n = 95,944) | Trajectory 2 (obese class 1-S) (n = 104,616) | Trajectory 3 (obese class 2-S) (n = 50,866) | Trajectory 4 (obese class 3-S) (n = 12,804) | |
---|---|---|---|---|
Cardiovascular disease and heart failure outcomes | ||||
Age (years) at first CVD diagnosis (mean (SD)) | 65.9 (12.0) | 66.2 (11.8) | 65.2 (11.8) | 64.1 (10.9) |
Follow-up (1000 person years) | 1100 | 1100 | 517.7 | 123.1 |
Number of events (%) | ||||
Any CVD | 10,054 (10.5) | 12,666 (12.1) | 6137 (12.1) | 1543 (12.1) |
CHD | 6074 (6.3) | 7569 (7.2) | 3329 (6.5) | 714 (5.6) |
Stroke/TIA | 2675 (2.8) | 3152 (3.0) | 1436 (2.8) | 300 (2.3) |
PVD | 1246 (1.3) | 1425 (1.4) | 595 (1.2) | 108 (0.8) |
Heart failure | 1836 (1.9) | 3175 (3.0) | 1947 (3.8) | 702 (5.5) |
Incidence rate (95% CI) of CVD and heart failure, per (1000 person-years) | ||||
Any CVD | 9.30 (9.1–9.5) | 11.44 (11.2–11.6) | 11.86 (11.6–12.2) | 12.54 (11.9–13.2) |
Coronary heart disease | 5.62 (5.5–5.8) | 6.83 (6.7–7.0) | 6.43 (6.2–6.7) | 5.80 (5.4–6.2) |
Stroke/TIA | 2.48 (2.4–2.6) | 2.85 (2.7–2.90) | 2.77 (2.6–2.9) | 2.44 (2.2–2.7) |
Peripheral vascular disease | 1.15 (1.1–1.2) | 1.29 (1.2–1.4) | 1.15 (1.1–1.2) | 0.88 (0.7–1.1) |
Heart failure | 1.70 (1.6–1.8) | 2.87 (2.8–3.0) | 3.76 (3.6–3.9) | 5.70 (5.3–6.1) |
Mortality outcomes | ||||
Deaths during follow-up n(%) (total n = 24,022) | 7938 (8.3) | 9175 (8.8) | 5092 (10.0) | 1817 (14.2) |
Age (years) at death (mean (SD)) | 74.5 (12.1) | 73.6 (12.0) | 70.9 (12.3) | 67.3 (11.8) |
CVD related death n(%) (total n = 2827) | 761 (0.8) | 1165 (1.1) | 679 (1.3) | 222 (1.7) |
Mortality rate (95% CI), number of events per 1000 person-years | ||||
All-cause mortality rate | 7.35 (7.2–7.5) | 8.28 (8.1–8.5) | 9.84 (9.6–10.1) | 14.76 (14.1–15.5) |
CVD-related mortality rate | 0.70 (0.7–0.8) | 1.05 (1.0–1.1) | 1.31 (1.2–1.4) | 1.80 (1.6–2.1) |
Unadjusted Hazards ratio (95% CI) | Adjusted hazards ratio (95% CI) | |||
---|---|---|---|---|
CVD outcome | Trajectory group | Model adjusted for age and sex | Model adjusted for age, sex and comorbiditiesa | |
Overall CVD | overweight-S | 1.00 | 1.00 | 1.00 |
obese 1-S | 1.25 (1.22–1.28) | 1.24 (1.21–1.28) | 1.15 (1.12–1.19) | |
obese 2-S | 1.32 (1.28–1.36) | 1.46 (1.41–1.51) | 1.27 (1.23–1.31) | |
obese 3-S | 1.42 (1.35–1.50) | 1.75 (1.66–1.85) | 1.40 (1.33–1.48 | |
Coronary heart disease | overweight-S | 1.00 | 1.00 | 1.00 |
obese 1-S | 1.23 (1.19–1.28) | 1.23 (1.18–1.27) | 1.14 (1.10–1.18) | |
obese 2-S | 1.17 (1.12–1.22) | 1.30 (1.24–1.35) | 1.13 (1.09–1.18) | |
obese 3-S | 1.07 (0.99–1.16) | 1.31 (1.22–1.42) | 1.06 (0.99–1.16) | |
Stroke/ TIA | overweight-S | 1.00 | 1.00 | 1.00 |
obese 1-S | 1.18 (1.12–1.24) | 1.16 (1.10–1.22) | 1.09 (1.03–1.15) | |
obese 2-S | 1.16 (1.09–1.24) | 1.27 (1.19–1.36) | 1.13 (1.06–1.20) | |
obese 3-S | 1.04 (0.93–1.18) | 1.26 (1.12–1.42) | 1.04 (0.92–1.18) | |
Peripheral vascular disease | overweight-S | 1.00 | 1.00 | 1.00 |
obese 1-S | 1.13 (1.05–1.22) | 1.13 (1.04–1.22) | 0.99 (0.92–1.07) | |
obese 2-S | 1.02 (0.92–1.12) | 1.16 (1.06–1.29) | 0.92 (0.83–1.01) | |
obese 3-S | 0.79 (0.65–0.96) | 1.03 (0.85–1.25) | 0.73 (0.60–0.89) | |
Heart failure | overweight-S | 1.00 | 1.00 | 1.00 |
obese 1-S | 1.73 (1.63–1.83) | 1.73 (1.63–1.83) | 1.51 (1.42–1.60) | |
obese 2-S | 2.31 (2.16–2.46) | 2.70 (2.53–2.88) | 2.09 (1.96–2.23) | |
obese 3-S | 3.58 (3.28–3.91) | 4.94 (4.53–5.40) | 3.26 (2.98–3.57) | |
All-cause mortality | overweight-S | 1.00 | 1.00 | 1.00 |
obese 1-S | 1.16 (1.13–1.20) | 1.16 (1.12–1.19) | 1.12 (1.09–1.16) | |
obese 2-S | 1.41 (1.36–1.46) | 1.63 (1.58–1.69) | 1.55 (1.50–1.61) | |
obese 3-S | 2.17 (2.06–2.29) | 2.96 (2.81–3.12) | 2.72 (2.58–2.87) | |
CVD-related deaths | overweight-S | 1.00 | 1.00 | 1.00 |
obese 1-S | 1.53 (1.40–1.68) | 1.54 (1.40–1.68) | 1.44 (1.31–1.58) | |
obese 2-S | 1.94 (1.75–2.15) | 2.33 (2.10–2.59) | 2.06 (1.86–2.29) | |
obese 3-S | 2.73 (2.35–3.17) | 3.98 (3.42–4.63) | 3.31 (2.84–3.86) |