Original Article

International Journal of Obesity (2008) 32, 730–739; doi:10.1038/sj.ijo.0803801; published online 22 January 2008

Past body mass index and risk of mortality among women

S C Moore1,2,5, S T Mayne2,6, B I Graubard3,5, A Schatzkin1,5, D Albanes1,5, C Schairer3,5, R N Hoover4,5 and M F Leitzmann1,5

  1. 1Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, MD, USA
  2. 2Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA
  3. 3Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, MD, USA
  4. 4Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, MD, USA

Correspondence: Dr SC Moore, Division of Cancer Epidemiology and Genetics, National Cancer Institute, EPS South, Room 3033, 6120 Executive Boulevard, Bethesda, MD 20892, USA.
E-mail: moorest@mail.nih.gov

5Current address: Division of Cancer Epidemiology and Genetics, National Cancer Institute, EPS South, 6120 Executive Boulevard, MSC 7232, Bethesda, MD 20892, USA.

6Current address: Department of Epidemiology and Public Health, Yale University School of Medicine, 60 College Street, New Haven, CT 06520-8034, USA.

Received 24 June 2007; Revised 3 December 2007; Accepted 9 December 2007; Published online 22 January 2008.

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Abstract

Background:

 

Epidemiologic studies of body mass index (BMI) in relation to mortality commonly exclude persons with health conditions and/or a history of smoking to prevent bias resulting from illness-related weight loss ('reverse causation'). Analysis of BMI from an earlier time period may minimize reverse causation without requiring exclusion of participants based on disease or smoking history.

Methods:

 

We prospectively examined BMI based on technician measurements of weight and height from 10 years prior to start of follow-up in relation to subsequent mortality in a cohort of 50 186 women who were 40–93 years old at baseline in 1987–1989. Deaths were ascertained through the US National Death Index. Proportional hazards regression was used to estimate hazard ratios (HRs) of mortality, adjusted for age, education, race/ethnicity, income, menopausal hormone use, smoking and physical activity.

Results:

 

During 10 years of follow-up through 1997, 5201 women died. Overall, we observed a J-shaped association between BMI and mortality, with increased risk for women who were underweight, overweight or obese. The HRs and 95% confidence intervals of mortality for BMI categories of <18.5, 18.5–20.9, 21.0–23.4 (reference), 23.5–24.9, 25.0–27.4, 27.5–29.9, 30.0–34.9 and 35.0+ kg m- 2 were 1.43 (1.19, 1.72), 1.07 (0.98, 1.17), 1.00 (reference), 1.10 (1.00, 1.20), 1.20 (1.11, 1.31), 1.23 (1.11, 1.37), 1.60 (1.44, 1.77) and 1.92 (1.64, 2.24). There was little evidence that pre-existing conditions (heart disease, diabetes and/or cancer) or smoking history modified the past BMI and mortality relation (P=0.54 and 0.76).

Conclusions:

 

In this large cohort of women, BMI based on technician measurements of weight and height from 10 years prior to baseline showed increased risk for mortality across the range of overweight and obesity, regardless of disease and smoking history. Observed associations between overweight, obesity and mortality in healthy individuals may also apply to persons with a history of disease or smoking.

Keywords:

body mass, weight, overweight, mortality, life expectancy, epidemiology

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