Body Mass Index Variability and Long-term Risk of New-Onset Atrial Fibrillation in the General Population: A Korean Nationwide Cohort Study

Yeong Min Lim, Pil Sung Yang, Eunsun Jang, Hee Tae Yu, Tae Hoon Kim, Jae Sun Uhm, Jong Youn Kim, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung, Gregory Y.H. Lip

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32 Citations (Scopus)


Objective: To assess the effects of body mass index (BMI) variability on the incidence of new-onset atrial fibrillation (AF), stroke, cardiovascular (CV) risk factors, and CV outcomes in a general Asian population. Patients and Methods: Data from the National Health Insurance Service–Health Screening cohort in Korea were used: 171,324 patients without AF were included, and BMI measurements occurred biennially from January 1, 2002, through December 31, 2009. Patient outcomes were followed through 2013. The BMI intraindividual variability between visits was measured. Results: During mean ± SD follow-up of 47.4±3.9 months, 1959 patients (1.1%) developed new-onset AF. Overweight or obesity (BMI ≥25) had a greater risk of new-onset AF compared with BMI of 20 to 22.5, with a hazard ratio (HR) of 1.24 (95% CI, 1.10-1.41; P<.001). In underweight or normal-weight participants (initial BMI <25), a 1-kg/m2 increase of BMI variability increased the risk of new-onset AF, with an adjusted HR (aHR) of 1.13 (95% CI, 1.01-1.25; P=.02). Weight gain increased the risk of new-onset AF (aHR, 1.32; 95% CI, 1.01-1.71; P=.04) and myocardial infarction (aHR, 1.52; 95% CI, 1.06-2.18; P=.02) but not stroke. In this group, blood pressure, glucose level, and total cholesterol level were higher in individuals with the greatest BMI variability compared with those with stable BMI. Conclusion: In the underweight and normal-weight Asian population, BMI variability, especially weight gain, was related to increased risk of new-onset AF and myocardial infarction. Avoiding weight gain is important to improve CV outcomes.

Original languageEnglish
Pages (from-to)225-235
Number of pages11
JournalMayo Clinic Proceedings
Issue number2
Publication statusPublished - 2019 Feb

Bibliographical note

Funding Information:
Grant Support: This research was supported by the Basic Science Research Program through grant NRF-2017R1A2B3003303 from the National Research Foundation of Korea funded by the Ministry of Science, ICT and Future Planning and by grants HI16C0058 and HI15C1200 from the Korean Healthcare Technology R&D Project funded by the Ministry of Health and Welfare.

Publisher Copyright:
© 2018 Mayo Foundation for Medical Education and Research

All Science Journal Classification (ASJC) codes

  • Medicine(all)


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