Body-Mass Index and Mortality among 1.46 Million White Adults

González, Amy Berrington de; Hartge, Patricia; Cerhan, James R.; Flint, Alan; Hannan, Lindsay M.; MacInnis, Robert J.; Moore, Steven C.; Tobias, Geoffrey S.; Anton‐Culver, Hoda; Freeman, Laura Beane; Beeson, W. Lawrence; Clipp, Sandra; English, Dallas R.; Folsom, Aaron R.; Freedman, D. Michal; Giles, Graham G.; Håkansson, Niclas; Henderson, Katherine D.; Hoffman‐Bolton, Judith; Hoppin, Jane A.; Koenig, Karen L.; Lee, I. Min; Linet, Martha S.; Park, Yikyung; Pocobelli, Gaia; Schatzkin, Arthur; Sesso, Howard D.; Weiderpass, Elisabete; Willcox, Bradley J.; Wolk, Alicja; Zeleniuch‐Jacquotte, Anne; Willett, Walter C.; Thun, Michael J.

doi:10.1056/nejmoa1000367

Cited by 2,043 publications

(1,571 citation statements)

References 36 publications

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“…Thus, smoking may significantly confound and attenuate the association between body weight and mortality 42. Consistent with previous studies,5 43 we found that body shape trajectory was more strongly associated with mortality among never smokers than among ever smokers. This difference seemed to be more striking in women than in men, which may be a result of the higher proportion of current smokers among women than among men (14% v 7%) in our cohorts.…”

Section: Discussionsupporting

confidence: 90%

Trajectory of body shape in early and middle life and all cause and cause specific mortality: results from two prospective US cohort studies

Song

et al. 2016

BMJ

103

101

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Objective To assess body shape trajectories in early and middle life in relation to risk of mortality.Design Prospective cohort study.Setting Nurses’ Health Study and Health Professionals Follow-up Study.Population 80 266 women and 36 622 men who recalled their body shape at ages 5, 10, 20, 30, and 40 years and provided body mass index at age 50, followed from age 60 over a median of 15-16 years for death.Main outcome measures All cause and cause specific mortality.Results Using a group based modeling approach, five distinct trajectories of body shape from age 5 to 50 were identified: lean-stable, lean-moderate increase, lean-marked increase, medium-stable/increase, and heavy-stable/increase. The lean-stable group was used as the reference. Among never smokers, the multivariable adjusted hazard ratio for death from any cause was 1.08 (95% confidence interval 1.02 to 1.14) for women and 0.95 (0.88 to 1.03) for men in the lean-moderate increase group, 1.43 (1.33 to 1.54) for women and 1.11 (1.02 to 1.20) for men in the lean-marked increase group, 1.04 (0.97 to 1.12) for women and 1.01 (0.94 to 1.09) for men in the medium-stable/increase group, and 1.64 (1.49 to 1.81) for women and 1.19 (1.08 to 1.32) for men in the heavy-stable/increase group. For cause specific mortality, participants in the heavy-stable/increase group had the highest risk, with a hazard ratio among never smokers of 2.30 (1.88 to 2.81) in women and 1.45 (1.23 to 1.72) in men for cardiovascular disease, 1.37 (1.14 to 1.65) in women and 1.07 (0.89 to 1.30) in men for cancer, and 1.59 (1.38 to 1.82) in women and 1.10 (0.95 to 1.29) in men for other causes. The trajectory-mortality association was generally weaker among ever smokers than among never smokers (for all cause mortality: P for interaction <0.001 in women and 0.06 in men). When participants were classified jointly according to trajectories and history of type 2 diabetes, the increased risk of death associated with heavier body shape trajectories was more pronounced among participants with type 2 diabetes than those without diabetes, and those in the heavy-stable/increase trajectory and with a history of diabetes had the highest risk of death.Conclusions Using the trajectory approach, we found that heavy body shape from age 5 up to 50, especially the increase in middle life, was associated with higher mortality. In contrast, people who maintained a stably lean body shape had the lowest mortality. These results indicate the importance of weight management across the lifespan.

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Section: Discussionsupporting

confidence: 90%

Trajectory of body shape in early and middle life and all cause and cause specific mortality: results from two prospective US cohort studies

Song

et al. 2016

BMJ

103

101

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“…We therefore used Cox proportional hazard models to calculate adjusted hazard ratios for all cause, cancer, and cardiovascular mortality with their 95% confidence intervals across the categories of BMI (<18.5, 18.5-22.4, 22.5-24.9, 25.0-27.4, 27.5-29.9, 30.0-34.9, 35.0-39.9, and ≥40) 23. We defined the BMI range of 22.5-24.9 as the reference category, as in previous studies 24. In our cohorts this was also the range of BMI associated with the lowest mortality (fig A in appendix 2).…”

Section: Methodsmentioning

confidence: 94%

Combined associations of body weight and lifestyle factors with all cause and cause specific mortality in men and women: prospective cohort study

Veronese

Manson

et al. 2016

BMJ

105

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Objective To evaluate the combined associations of diet, physical activity, moderate alcohol consumption, and smoking with body weight on risk of all cause and cause specific mortality.Design Longitudinal study with up to 32 years of follow-up.Setting Nurses’ Health Study (1980-2012) and Health Professionals Follow-up Study (1986-2012).Participants 74 582 women from the Nurses’ Health Study and 39 284 men from the Health Professionals Follow-up Study who were free from cardiovascular disease and cancer at baseline.Main outcome measures Exposures included body mass index (BMI), score on the alternate healthy eating index, level of physical activity, smoking habits, and alcohol drinking while outcome was mortality (all cause, cardiovascular, cancer). Cox proportional hazard models were used to calculate the adjusted hazard ratios of all cause, cancer, and cardiovascular mortality with their 95% confidence intervals across categories of BMI, with 22.5-24.9 as the reference.Results During up to 32 years of follow-up, there were 30 013 deaths (including 10 808 from cancer and 7189 from cardiovascular disease). In each of the four categories of BMI studied (18.5-22.4, 22.5-24.9, 25-29.9, ≥30), people with one or more healthy lifestyle factors had a significantly lower risk of total, cardiovascular, and cancer mortality than individuals with no low risk lifestyle factors. A combination of at least three low risk lifestyle factors and BMI between 18.5-22.4 was associated with the lowest risk of all cause (hazard ratio 0.39, 95% confidence interval 0.35 to 0.43), cancer (0.40, 0.34 to 0.47), and cardiovascular (0.37, 0.29 to 0.46) mortality, compared with those with BMI between 22.5-24.9 and none of the four low risk lifestyle factors.Conclusion Although people with a higher BMI can have lower risk of premature mortality if they also have at least one low risk lifestyle factor, the lowest risk of premature mortality is in people in the 18.5-22.4 BMI range with high score on the alternate healthy eating index, high level of physical activity, moderate alcohol drinking, and who do not smoke. It is important to consider diet and lifestyle factors in the evaluation of the association between BMI and mortality.

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“…Our study advances the existing literature by examining a cohort with extensive serial data collection—allowing careful control for chronic health conditions and sociodemographic factors. Our measures of baseline health status include not only measures of comorbidity but also previous hospital admissions, BMI,31 functional status,32 self rating of health,33 and measures of poverty (wealth and government assistance)34—all important predictors of long term mortality that have not been included in previous studies of late mortality after sepsis.…”

Section: Discussionmentioning

confidence: 99%

Late mortality after sepsis: propensity matched cohort study

Prescott

Osterholzer

Langa

et al. 2016

BMJ

264

214

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Objectives To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.Deign Observational cohort study.Setting US Health and Retirement Study.Participants 960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions.Main outcome measures Late (31 days to two years) mortality and odds of death at various intervals.Results Sepsis was associated with a 22.1% (95% confidence interval 17.5% to 26.7%) absolute increase in late mortality relative to adults not in hospital, a 10.4% (5.4% to 15.4%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2% (10.2% to 22.2%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital.Conclusions More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.

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Body-Mass Index and Mortality among 1.46 Million White Adults

Cited by 2,043 publications

References 36 publications

Trajectory of body shape in early and middle life and all cause and cause specific mortality: results from two prospective US cohort studies

Trajectory of body shape in early and middle life and all cause and cause specific mortality: results from two prospective US cohort studies

Combined associations of body weight and lifestyle factors with all cause and cause specific mortality in men and women: prospective cohort study

Late mortality after sepsis: propensity matched cohort study

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