Body mass index, physical inactivity and low level of physical fitness as determinants of all-cause and cardiovascular disease mortality—16 y follow-up of middle-aged and elderly men and women

Abstract

OBJECTIVE: To investigate the independent associations and the possible interaction of body mass index (BMI), leisure time physical activity (LTPA) and perceived physical ®tness and functional capability with the risk of mortality. DESIGN: Prospective 16 y follow-up study. SUBJECTS: A regionally representative cohort of 35 ± 63 -y-old Finnish men (n 1090) and women (n 1122). MEASUREMENTS: All-cause, cardiovascular disease (CVD) and coronary heart disease (CHD) mortality were derived from the national census data until the end of September 1996 while the initial levels of BMI, LTPA, physical ®tness and function were determined from self-administered questionnaires. RESULTS: After adjustment for age, marital and employment status, perceived health status, smoking and alcohol consumption, the Cox proportional hazards model showed that BMI was not associated with the risk of death among the men or the women. Compared with the most active subjects the men and women with no weekly vigorous activity had relative risks of 1.61 (95% con®dence interval, CI, 0.98 ± 2.64) and 4.68 (95% CI, 1.41 ± 15.57), respectively, for CVD mortality, and for the men there was a relative risk of 1.66 (95% CI, 0.92 ± 2.99) for CHD mortality. When compared with the men who perceived their ®tness as better than their age-mates, the men with the`worse' assessment had a relative risk of 3.29 (95% CI, 1.80 ± 6.02) for all-cause mortality and 4.37 (95% CI, 1.80 ± 10.6) for CVD mortality. Men with at least some dif®culty in walking a distance of 2 km had a relative risk of 1.62 (95% CI, 1.05 ± 2.50) for all-cause mortality when compared with those who had no functional dif®culties. In addition, in the comparison with subjects with no functional dif®culties, the men and women who had some dif®culty climbing several¯ights of stairs had relative risks of 1.47 (95% CI, 0.97 ± 2.23) and 2.39 (95% CI, 1.25 ± 4.60) for all-cause mortality, respectively. For CVD mortality the relative risks were 1.85 (95% CI, 1.04 ± 3.30) and 3.38 (1.22 ± 9.41), respectively. CONCLUSIONS: Although BMI did not prove to be an independent risk factor for mortality from CVD, CHD or from all causes combined, perceived physical ®tness and functional capability did. An increase in LTPA seems to have a similar bene®cial effect on the mortality risk of obese and nonobese men and women, and the effect also seems to be similar for ®t and un®t subjects.

Body mass index and all-cause mortality in a nationwide US cohort

“…Other studies that have validated self-reported weight or height, however, have found strong correlations with measured values. 5,14,44 Nonetheless, it is likely that heavy participants under-reported their weight, leading to some overestimating of risks at lower BMI categories. Data on BMI was missing on less than 3% of the study population who were excluded from the analysis.…”

“…In recent years, many prospective epidemiologic studies have evaluated the relationship between mortality and body mass index (BMI) (weight adjusted for height (kg/m 2 )), [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] which is commonly considered a surrogate for body fat. Study findings vary as to whether the relationship is best described as direct, J-or U-shaped, the latter two characterizations suggesting higher risks among both heavier and leaner individuals.…”

Effects of physical activity, body mass index, waist-to-hip ratio and waist circumference on total mortality risk in the Swedish National March Cohort

“…Epidemiological studies have shown an inconsistent relationship between body mass index (BMI) and mortality risk, with associations being J-or U-shaped [4][5][6][7][8][9][10][11][12], direct linear [13][14][15][16] or absent [17,18]. This could be due to the inadequate control for smoking status and pre-existing chronic diseases, both of which are associated with a low BMI and an increased risk of death [19].…”

The effects of physical activity and body mass index on cardiovascular, cancer and all-cause mortality among 47 212 middle-aged Finnish men and women

“…Several, but not all, previous studies have reported a curvilinear association between body weight and mortality, in which the risk is increased among both the leanest and the heaviest persons. 10,[14][15][16][17][18][19][20][21] In most studies, the increased risk in the leanest individuals attenuated or even disappeared after excluding smokers or subjects with pre-existing diseases.…”