Abstract
To examine the association between body mass index (BMI) trajectories, early and recent BMI changes, and phenotypic age acceleration (PhenoAgeAccel), addressing inconsistent findings in previous studies on weight change and aging. Data from the National Health and Nutrition Examination Survey from 2005 to 2018 were used, selecting participants aged 50 years and older. A growth mixture model was employed to identify BMI trajectories. The association between different BMI trajectories and PhenoAgeAccel was assessed using linear and multinomial logistic regression models. The nonlinear effects of BMI changes were identified through threshold effect analysis. Among 5404 participants, the four BMI trajectories identified were as follows: stable weight (29.07%), midlife weight gain (24.31%), late-life weight gain (32.22%), and chronic obesity (14.41%). The chronic obesity group exhibited the most significant elevations in PhenoAgeAccel, indicating they were phenotypically older compared to other groups (β = 4.34, 95% confidence interval 3.67-5.02). Early BMI changes of less than 6% were associated with being phenotypically younger (β = - 5.06, P = 0.029), whereas increases exceeding 6% were linked to being phenotypically older (β = 2.83, P < 0.001). The key threshold for recent BMI changes was 2%; changes below this level were associated with being phenotypically younger, while those exceeding this threshold were linked to being phenotypically older (P < 0.001). This cross-sectional study suggests that individuals with long-term chronic obesity tend to be phenotypically older, whereas those with stable body weight are more likely to be phenotypically younger.