Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies
Prospective Studies Collaboration, Gary Whitlock, Sarah Lewington, Paul Sherliker, Robert Clarke, Jonathan Emberson, Jim Halsey, Nawab Qizilbash, Rory Collins, Richard Peto, S Lewington, S MacMahon, A Aromaa, C Baigent, J Carstensen, Z Chen, R Clarke, R Collins, S Duffy, D Kromhout, J Neaton, N Qizilbash, A Rodgers, S Tominaga, S Törnberg, H Tunstall-Pedoe, L Chambless, G De Backer, D De Bacquer, M Kornitzer, P Whincup, S G Wannamethee, R Morris, N Wald, J Morris, M Law, M Knuiman, H Bartholomew, G Davey Smith, P Sweetnam, P Elwood, J Yarnell, R Kronmal, D Kromhout, S Sutherland, J Keil, G Jensen, P Schnohr, C Hames, A Tyroler, A Aromaa, P Knekt, A Reunanen, J Tuomilehto, P Jousilahti, E Vartiainen, P Puska, T Kuznetsova, T Richart, J Staessen, L Thijs, T Jørgensen, T Thomsen, D Sharp, J D Curb, N Qizilbash, H Iso, S Sato, A Kitamura, Y Naito, A Benetos, L Guize, U Goldbourt, M Tomita, Y Nishimoto, T Murayama, M Criqui, C Davis, C Hart, D Hole, C Gillis, D Jacobs, H Blackburn, R Luepker, J Neaton, L Eberly, C Cox, D Levy, R D'Agostino, H Silbershatz, A Tverdal, A Selmer, T Meade, K Garrow, J Cooper, F Speizer, M Stampfer, A Menotti, A Spagnolo, I Tsuji, Y Imai, T Ohkubo, S Hisamichi, L Haheim, I Holme, I Hjermann, P Leren, P Ducimetiere, J Empana, K Jamrozik, R Broadhurst, G Assmann, H Schulte, C Bengtsson, C Björkelund, L Lissner, P Sorlie, M Garcia-Palmieri, E Barrett-Connor, M Criqui, R Langer, C Hart, K Nakachi, K Imai, X Fang, S Li, R Buzina, A Nissinen, C Aravanis, A Dontas, A Kafatos, A Menotti, H Adachi, H Toshima, T Imaizumi, D Kromhout, S Nedeljkovic, M Ostojic, Z Chen, H Tunstall-Pedoe, T Nakayama, N Yoshiike, T Yokoyama, C Date, H Tanaka, J Keller, K Bonaa, E Arnesen, H Tunstall-Pedoe, E Rimm, M Gaziano, J E Buring, C Hennekens, S Törnberg, J Carstensen, M Shipley, D Leon, M Marmot, R Clarke, R Collins, J Emberson, J Halsey, S Lewington, A Palmer, S Parish, P Sherliker, G Whitlock, Prospective Studies Collaboration, Gary Whitlock, Sarah Lewington, Paul Sherliker, Robert Clarke, Jonathan Emberson, Jim Halsey, Nawab Qizilbash, Rory Collins, Richard Peto, S Lewington, S MacMahon, A Aromaa, C Baigent, J Carstensen, Z Chen, R Clarke, R Collins, S Duffy, D Kromhout, J Neaton, N Qizilbash, A Rodgers, S Tominaga, S Törnberg, H Tunstall-Pedoe, L Chambless, G De Backer, D De Bacquer, M Kornitzer, P Whincup, S G Wannamethee, R Morris, N Wald, J Morris, M Law, M Knuiman, H Bartholomew, G Davey Smith, P Sweetnam, P Elwood, J Yarnell, R Kronmal, D Kromhout, S Sutherland, J Keil, G Jensen, P Schnohr, C Hames, A Tyroler, A Aromaa, P Knekt, A Reunanen, J Tuomilehto, P Jousilahti, E Vartiainen, P Puska, T Kuznetsova, T Richart, J Staessen, L Thijs, T Jørgensen, T Thomsen, D Sharp, J D Curb, N Qizilbash, H Iso, S Sato, A Kitamura, Y Naito, A Benetos, L Guize, U Goldbourt, M Tomita, Y Nishimoto, T Murayama, M Criqui, C Davis, C Hart, D Hole, C Gillis, D Jacobs, H Blackburn, R Luepker, J Neaton, L Eberly, C Cox, D Levy, R D'Agostino, H Silbershatz, A Tverdal, A Selmer, T Meade, K Garrow, J Cooper, F Speizer, M Stampfer, A Menotti, A Spagnolo, I Tsuji, Y Imai, T Ohkubo, S Hisamichi, L Haheim, I Holme, I Hjermann, P Leren, P Ducimetiere, J Empana, K Jamrozik, R Broadhurst, G Assmann, H Schulte, C Bengtsson, C Björkelund, L Lissner, P Sorlie, M Garcia-Palmieri, E Barrett-Connor, M Criqui, R Langer, C Hart, K Nakachi, K Imai, X Fang, S Li, R Buzina, A Nissinen, C Aravanis, A Dontas, A Kafatos, A Menotti, H Adachi, H Toshima, T Imaizumi, D Kromhout, S Nedeljkovic, M Ostojic, Z Chen, H Tunstall-Pedoe, T Nakayama, N Yoshiike, T Yokoyama, C Date, H Tanaka, J Keller, K Bonaa, E Arnesen, H Tunstall-Pedoe, E Rimm, M Gaziano, J E Buring, C Hennekens, S Törnberg, J Carstensen, M Shipley, D Leon, M Marmot, R Clarke, R Collins, J Emberson, J Halsey, S Lewington, A Palmer, S Parish, P Sherliker, G Whitlock
Abstract
Background: The main associations of body-mass index (BMI) with overall and cause-specific mortality can best be assessed by long-term prospective follow-up of large numbers of people. The Prospective Studies Collaboration aimed to investigate these associations by sharing data from many studies.
Methods: Collaborative analyses were undertaken of baseline BMI versus mortality in 57 prospective studies with 894 576 participants, mostly in western Europe and North America (61% [n=541 452] male, mean recruitment age 46 [SD 11] years, median recruitment year 1979 [IQR 1975-85], mean BMI 25 [SD 4] kg/m(2)). The analyses were adjusted for age, sex, smoking status, and study. To limit reverse causality, the first 5 years of follow-up were excluded, leaving 66 552 deaths of known cause during a mean of 8 (SD 6) further years of follow-up (mean age at death 67 [SD 10] years): 30 416 vascular; 2070 diabetic, renal or hepatic; 22 592 neoplastic; 3770 respiratory; 7704 other.
Findings: In both sexes, mortality was lowest at about 22.5-25 kg/m(2). Above this range, positive associations were recorded for several specific causes and inverse associations for none, the absolute excess risks for higher BMI and smoking were roughly additive, and each 5 kg/m(2) higher BMI was on average associated with about 30% higher overall mortality (hazard ratio per 5 kg/m(2) [HR] 1.29 [95% CI 1.27-1.32]): 40% for vascular mortality (HR 1.41 [1.37-1.45]); 60-120% for diabetic, renal, and hepatic mortality (HRs 2.16 [1.89-2.46], 1.59 [1.27-1.99], and 1.82 [1.59-2.09], respectively); 10% for neoplastic mortality (HR 1.10 [1.06-1.15]); and 20% for respiratory and for all other mortality (HRs 1.20 [1.07-1.34] and 1.20 [1.16-1.25], respectively). Below the range 22.5-25 kg/m(2), BMI was associated inversely with overall mortality, mainly because of strong inverse associations with respiratory disease and lung cancer. These inverse associations were much stronger for smokers than for non-smokers, despite cigarette consumption per smoker varying little with BMI.
Interpretation: Although other anthropometric measures (eg, waist circumference, waist-to-hip ratio) could well add extra information to BMI, and BMI to them, BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22.5-25 kg/m(2). The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal. At 30-35 kg/m(2), median survival is reduced by 2-4 years; at 40-45 kg/m(2), it is reduced by 8-10 years (which is comparable with the effects of smoking). The definite excess mortality below 22.5 kg/m(2) is due mainly to smoking-related diseases, and is not fully explained.
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Source: PubMed