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Under- and overweight impact on mortality among middle-aged Japanese men and women: a 10-y follow-up of JPHC Study cohort I


OBJECTIVE: Although obesity is a major health problem in Western countries, its impact may differ in another culture. This paper examines the association between body mass index (BMI; kg/m2) and mortality in Japan, where the mortality profile and BMI distribution differ substantially from Western countries.

DESIGN: The JPHC Study cohort I, a population-based prospective study in four public health center areas, started in 1990 and was followed-up to the end of 1999.

SUBJECTS: A total of 19 500 men and 21 315 women aged 40–59 y who submitted their body weight and height and did not report any serious disease at baseline.

MEASUREMENT: Risk of death by category of BMI.

RESULTS: During 10 y of follow-up, 943 and 483 deaths were documented in the men and women, respectively. The association between BMI and all-cause mortality was U-shaped: compared with a category of 23.0–24.9, the statistically significant elevations in relative risk were observed in both under- and overweight categories (2.26 in 14.0–18.9, 1.57 in 19.0–20.9, 1.33 in 21.0–22.9 and 1.38 in 27.0–29.9, 1.97 in 30.0–39.9 in men, 1.94 in 14.0–18.9 and 1.91 in 30.0–39.9 in women) after adjustment for possible confounders and weight change. The U-shaped association did not change after excluding deaths occurring in the first 5 y of follow-up or even after excluding subjects who reported a weight loss of 5 kg or more since 20-y-old, or after stratifying subjects by smoking status.

CONCLUSION: Both under- and overweight are important determinants of premature death among the Japanese population.

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This study was supported by grants-in-aid for Cancer Research and for the second Term Comprehensive Ten-Year Strategy for Cancer Control from the Ministry of Health and Welfare of Japan. The authors thank Dr Megumi Hara, National Cancer Center Research Institute East, for her assistance regarding data set preparation and Professor Chung-Cheng Hsieh, University of Massachusetts Cancer Center, for his assistance in statistical expertise.

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Tsugane, S., Sasaki, S. & Tsubono for the JPHC Study Group, Y. Under- and overweight impact on mortality among middle-aged Japanese men and women: a 10-y follow-up of JPHC Study cohort I. Int J Obes 26, 529–537 (2002).

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