Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Differential associations of body mass index and adiposity with all-cause mortality among men in the first and second National Health and Nutrition Examination Surveys (NHANES I and NHANES II) follow-up studies

Abstract

OBJECTIVE: The frequently observed U-shaped relationship between body mass index (BMI; kg/m2) and mortality rate may be due to the opposing effects of fat mass (FM) and fat-free mass (FFM) components of BMI on mortality rate. The purpose is to test the hypothesis stated above.

DESIGN: Longitudinal prospective cohort studies. The mortality follow-up of the first and second National Health and Nutrition Examination Surveys (NHANES I and NHANES II).

SUBJECTS: A total of 10 169 male subjects aged 25–75 who participated in NHANES I and II were selected for analyses. Follow-up continued until 1992. The mean follow-up time was 14.6 y for NHANES I and 12.9 y for NHANES II. Ninety-eight percent of the participants were successfully followed representing a total of 3722 deaths.

MEASUREMENTS: Subscapular and triceps skinfolds thickness were used as FM indicators, whereas upper arm circumference was used as a FFM indicator. The Cox proportional hazards model tested the relationships of BMI, FM and FFM with all-cause mortality adjusting for age, smoking status, race and education levels.

RESULTS: BMI had a U-shaped relationship with mortality, with a nadir of approximately 27 kg/m2. However, when indicators of FM and FFM were added to the model, the relationship between BMI and mortality became more nearly monotonic increasing. Moreover, the relationship between FM indicator and mortality was monotonic increasing and the relationship between FFM indicator and mortality was monotonic decreasing.

CONCLUSION: These results support the hypothesis that the apparently deleterious effects of marked thinness may be due to low FFM and that, over the observed range of the data, marked leanness (as opposed to thinness) has beneficial effects.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1

References

  1. Troiano RP, Frongillo EA Jr, Sobal J, Levitsky DA . The relationship of body weight and mortality: a quantitative analysis of combined information from existing studies Int J Obes Relat Metab Disord 1996 20: 63–75.

    CAS  PubMed  Google Scholar 

  2. Allison DB, Saunders SE . Obesity in North America: an overview Med Clin N Am 2000 84: 305–332.

    Article  CAS  PubMed  Google Scholar 

  3. Manson JE, Stampfer MJ, Hennekens CH, Willett WC . Body weight and longevity: a reassessment JAMA 1987 257: 353–358.

    Article  CAS  PubMed  Google Scholar 

  4. Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, Hennekens CH, Speizer FE . Body weight and mortality among women New Engl J Med 1995 333: 677–685.

    Article  CAS  PubMed  Google Scholar 

  5. Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL . The effect of age on the association between body-mass index and mortality New Engl J Med 1998 338: 1–7.

    Article  CAS  PubMed  Google Scholar 

  6. The BMI in Diverse Populations Collaborative Group . Effect of smoking on the body mass index-mortality relation: empirical evidence from 15 studies Am J Epidemiol 1999 150: 1297–1308.

    Article  Google Scholar 

  7. Goldstein DJ . Beneficial effects of modest weight loss Int J Obes Relat Metab Disord 1992 16: 397–415.

    CAS  PubMed  Google Scholar 

  8. McCarter RJ . Role of caloric restriction in the prolongation of life Clin Geriatr Med 1995 11: 553–565.

    Article  CAS  PubMed  Google Scholar 

  9. Allison DB, Faith MS, Heo M, Kotler DP . Hypothesis concerning the U-shaped relation between body mass index and mortality Am J Epidemiol 1997 146: 339–349.

    Article  CAS  PubMed  Google Scholar 

  10. Comstock GW, Kendrick MA, Livesay VT . Subcutaneous fatness and mortality Am J Epidemiol 1966 83: 548–563.

    Article  CAS  PubMed  Google Scholar 

  11. Keys A, Taylor HL, Blackburn H, Brozek J, Anderson T, Simonson E . Mortality and coronary heart disease among men studied for 23 y Arch Intern Med 1971 128: 201–214.

    Article  CAS  PubMed  Google Scholar 

  12. Menotti A, Descovich GC, Lanti M, Spagnolo A, Dormi A, Seccareccia F . Indexes of obesity and all-causes mortality in Italian epidemiological data Prev Med 1993 22: 293–303.

    Article  CAS  PubMed  Google Scholar 

  13. Blair SN, Brodney S . Effects of physical inactivity and obesity on morbidity and mortality: current evidence and research issues Med Sci Sports Exerc 1999 31(Suppl): 646–662.

    Article  Google Scholar 

  14. Kalmijn S, Curb JD, Rodriguez BL, Yano K, Abbott RD . The association of body weight and anthropometry with mortality in elderly men: the Honolulu Heart Program Int J Obes Relat Metab Disord 1999 23: 395–402.

    Article  CAS  PubMed  Google Scholar 

  15. Heitmann BL, Erikson H, Ellsinger BM, Mikkelsen KL, Larsson B . Mortality associated with body fat, fat-free mass and body mass index among 60-year-old Swedish men—a 22-year follow-up. The study of men born in 1913 Int J Obes Relat Metab Disord 2000 24: 33–37.

    Article  CAS  PubMed  Google Scholar 

  16. Lee CD, Blair SN, Jackson AS . Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men Am J Clin Nutr 1999 69: 373–380.

    Article  CAS  PubMed  Google Scholar 

  17. Goran MI, Allison DB, Poehlman ET . Issues relating to normalization of body fat content in men and women Int J Obes Relat Metab Disord 1995 19: 638–643.

    CAS  PubMed  Google Scholar 

  18. Vague J . Les Obesities Etude Biometrique Biol Med 1947 36: 1.

    Google Scholar 

  19. Tuljapurkar S, Li N, Boe C . A universal pattern of mortality decline in the G7 countries Nature 2000 405: 789–792.

    Article  CAS  PubMed  Google Scholar 

  20. Cornoni-Huntley J, Harris T, Everett D, Albanes D, Micozzi MS, Miles TP, Feldman JJ . An overview of body weight of older persons, including the impact on mortality. The National Health and Nutrition Examination Survey I—Epidemiologic Follow-up Study J Clin Epidemiol 1991 44: 743–753.

    Article  CAS  PubMed  Google Scholar 

  21. Freedman D, Williamson D, Croft J, Byers T . Relation of body fat distribution to ischemic heart disease. The NHANES I Epidemiologic Follow-up Study Am J Epidemiol 1995 142: 53–63.

    Article  CAS  PubMed  Google Scholar 

  22. Department of Health and Human Services NCHS . Plan and operation of the second National Health and Nutrition Examination Survey 1976–1980. Vital and Health Statistics Series 1, Vol 15 DHHS Publication No. (PHS) 81-1317 US Government Printing Office: Washington, DC 1981.

  23. Department of Health and Human Services NCHS . Plan and operation of the NHANES I Epidemiologic Followup Study, 1987. Vital and Health Statistics Series 1, Vol 27, DHHS publication no. (PHS) 92–1303 National Center for Health Statistics, 1992.

  24. Allison DB, Heo M, Flanders DW, Faith MS, Williamson DF . Examination of ‘early mortality exclusion’ as an approach to control for confounding by occult disease in epidemiologic studies of mortality risk factors Am J Epidemiol 1997 146: 672–680.

    Article  CAS  PubMed  Google Scholar 

  25. Allison DB, Faith MS, Heo M, Townsend-Butterworth D, Wiliamson DF . Meta-analysis of the effect of excluding early deaths on the estimated relationship between body mass index and mortality Obes Res 1999 7: 342–354.

    Article  CAS  PubMed  Google Scholar 

  26. Allison DB, Heo M, Flanders DW, Faith MS, Carpenter KM, Williamson DF . Simulation study of the effects of excluding early deaths on risk factor–mortality analyses in the presence of confounding due to occult disease: the example of body mass index Ann Epidemiol 1999 9: 132–142.

    Article  CAS  PubMed  Google Scholar 

  27. Allison DB, Zannolli R, Faith MS, Heo M, Pietrobelli A, Vanltallie TB, Pi-Sunyer FX, Heymsfield SB . Weight loss increases and fat loss decreases all-cause mortality rate: results from two independent cohort studies Int J Obes Relat Metab Disord 1999 23: 603–611.

    Article  CAS  PubMed  Google Scholar 

  28. National Heart Lung and Blood Institute . Clinical guidelines for the identification, evaluation, and treatment of overweight and obesity in adults. The evidence report Obes Res 1998 6(Suppl 2): 51–209.

    Google Scholar 

  29. Heymsfield SB, Wang ZM, Baumgartner RN, Ross R . Human body composition: advances in models and methods A Rev Nutr 1997 17: 527–558.

    Article  CAS  Google Scholar 

  30. Heymsfield SB, Allison DB, Heshka S, Pierson RN Jr . Assessment of human body composition. In: Allison DB (ed). Handbook of assessment methods for eating behaviors and weight-related behaviors Sage: Thousand Oaks, CA 1995 515–560.

    Google Scholar 

  31. Norton K . Anthropometric estimation of body fat. In: Norton K, Olds T (eds.) Anthropometrica Sydney: UNSW Press 1996 172–198.

    Google Scholar 

  32. Couillard C, Gagnon J, Bergeron J, Leon AS, Rao DC, Skinner JS, Wilmore JH, Despres JP, Bouchard C . Contribution of body fatness and adipose tissue distribution to the age variation in plasma steroid hormone concentrations in men: the Heritage Family Study J Clin Endocrinol Metab 2000 85: 1026–1031.

    CAS  PubMed  Google Scholar 

  33. Pi-Sunyer FX . Medical hazards of obesity Ann Intern Med 1993 119: 655–660.

    Article  CAS  PubMed  Google Scholar 

  34. Mitsiopoulos N, Baumgartner RN, Heymsfield SB, Lyons W, Gallagher D, Ross R . Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography J Appl Physiol 1998 85: 115–122.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to David F Williamson for his helpful comments. This research was supported in part by NIH grants AG17166, DK51716 and DK26687, and unrestricted grants from Merck Pharmaceuticals, Tanita Incorporated Mead-Johnson and the Sugar Association.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to DB Allison.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Allison, D., Zhu, S., Plankey, M. et al. Differential associations of body mass index and adiposity with all-cause mortality among men in the first and second National Health and Nutrition Examination Surveys (NHANES I and NHANES II) follow-up studies. Int J Obes 26, 410–416 (2002). https://doi.org/10.1038/sj.ijo.0801925

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0801925

Keywords

This article is cited by

Search

Quick links