Steeper Change in Body Mass Across Four Decades Predicts Poorer Cardiometabolic Outcomes at Midlife

OBJECTIVE: We examined patterns of change in adiposity across four decades starting in young adulthood and their relationships with midlife cardiometabolic outcomes. METHODS: BMI was assessed at average age 20, 40, 56 and 62 years in 977 male veterans from the Vietnam Era Twin Study of Aging. Age 62 (range 56–66) cardiometabolic outcomes included hypertension, diabetes, dyslipidemia, inflammation, and ischemic heart disease. Analyses included latent growth modeling (LGM), latent class growth modeling (LCGM), and logistic regression models. RESULTS: Linear BMI slope was associated with all outcomes. Accelerated (quadratic) BMI slope was significantly associated with greater risk for hypertension, diabetes, dyslipidemia, and inflammation; odds ratios ranged from 1.93 (diabetes) to 3.15 (dyslipidemia). Initial BMI did not predict later outcomes. Linear slope contributed significant unique variance for diabetes and dyslipidemia even controlling for age 62 BMI. LCGM revealed three trajectories. Men with the relatively stable, lower BMI trajectory had significantly better outcomes than those with trajectories with accelerated increases, especially those including obesity. CONCLUSIONS: How individuals reach late midlife BMI is important. Steepness of BMI change across 40 years from young adulthood to late midlife, in addition to late midlife BMI itself, was robustly associated with greater risk for poor cardiometabolic outcomes.