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Body mass index and mortality in men: evaluating the shape of the association

International Journal of Obesity volume 31, pages 1240–1247 (2007)Cite this article

Abstract

Objective:

Controversy regarding the relationship between body mass index (BMI) and mortality continues to exist. Most of the previous studies have not comprehensively accounted for major sources of bias. We examined the association between BMI and all-cause mortality according to pre-existing disease and smoking status in a large prospective cohort.

Methods:

Participants were 99 253 male physicians in the Physicians' Health Study enrollment cohort (40–84 years) who provided self-reported information in 1982. We used Cox proportional hazards regression to examine the association between baseline BMI and mortality.

Results:

A total of 5438 men died (median follow-up, 5.7 years). Although a U-shaped association between BMI and all-cause mortality was seen among all men, we found a linear relationship when accounting for potential sources of bias. In the optimal model excluding men who died within 2 years, and adjusting for age, smoking, alcohol consumption, physical activity, prior disease and interactions between BMI and prior disease, and between BMI and smoking, those with BMI <20.0 kg/m2 had a relative risk (RR) of death of 0.88 (95% confidence interval (CI), 0.56–1.40), as compared to men with BMI 22.5–24.9 kg/m2. By contrast, men with BMI 30.0–34.9 kg/m2 had an RR of 1.45 (95% CI, 1.10–1.91) and those with BMI ⩾35.0 kg/m2 had an RR of 1.62 (95% CI, 1.12–2.35; P for linear trend, <0.001). According to WHO categories, men in the ‘overweight’ range (BMI 25.0–29.9 kg/m2) had an RR of 1.20 (95% CI, 1.05–1.38) as compared to men in the ‘normal’ range (BMI <25.0 kg/m2).

Conclusions:

In this large, prospective cohort, we found a consistent linear association between higher BMI and increased risk of mortality after accounting for several potential sources of bias, even among those within the ‘overweight’ range of BMI. Public health messages should emphasize the preponderance of evidence supporting the adverse health effects associated with higher body weight.

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References

  1. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM . Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 2004; 291/23: 2847–2850.

    Article  Google Scholar 

  2. Finkelstein EA, Fiebelkorn IC, Wang G . National medical spending attributable to overweight obesity: how much, who's paying? Health Aff (Millwood) 2003; Suppl Web Exclusives/:W3 219–226.

    Google Scholar 

  3. Colditz GA, Willett WC, Stampfer MJ, Manson JE, Hennekens CH, Arky RA et al. Weight as a risk factor for clinical diabetes in women. Am J Epidemiol 1990; 132/3: 501–513.

    Article  Google Scholar 

  4. Stamler J . Epidemiologic findings on body mass and blood pressure in adults. Ann Epidemiol 1991; 1/4: 347–362.

    Article  Google Scholar 

  5. Gelber RP, Kurth T, Kausz AT, Manson JE, Buring JE, Levey AS et al. Association between body mass index and CKD in apparently healthy men. Am J Kidney Dis 2005; 46/5: 871–880.

    Article  Google Scholar 

  6. Kurth T, Gaziano JM, Berger K, Kase CS, Rexrode KM, Cook NR et al. Body mass index and the risk of stroke in men. Arch Intern Med 2002; 162/22: 2557–2562.

    Article  Google Scholar 

  7. Hubert HB, Feinleib M, McNamara PM, Castelli WP . Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983; 67/5: 968–977.

    Article  Google Scholar 

  8. Manson JE, Colditz GA, Stampfer MJ, Willett WC, Rosner B, Monson RR et al. A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med 1990; 322/13: 882–889.

    Article  Google Scholar 

  9. Willett WC, Manson JE, Stampfer MJ, Colditz GA, Rosner B, Speizer FE et al. Weight, weight change, and coronary heart disease in women. Risk within the ‘normal’ weight range. JAMA 1995; 273/6: 461–465.

    Article  Google Scholar 

  10. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ . Overweight obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 2003; 348/17: 1625–1638.

    Article  Google Scholar 

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

    Article  Google Scholar 

  12. Ajani UA, Lotufo PA, Gaziano JM, Lee IM, Spelsberg A, Buring JE et al. Body mass index and mortality among US male physicians. Ann Epidemiol 2004; 14/10: 731–739.

    Article  Google Scholar 

  13. Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE et al. Body weight and mortality among women. N Engl J Med 1995; 333/11: 677–685.

    Article  Google Scholar 

  14. van Dam RM, Willett WC, Manson JE, Hu FB . The relationship between overweight in adolescence and premature death in women. Ann Intern Med 2006; 145/2: 91–97.

    Article  Google Scholar 

  15. Steering Committee of the Physicians' Health Study Research Group. Final report on the aspirin component of the ongoing Physicians' Health Study. N Engl J Med 1989; 321/3: 129–135.

    Article  Google Scholar 

  16. Hennekens CH, Buring JE, Manson JE, Stampfer M, Rosner B, Cook NR et al. Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease. N Engl J Med 1996; 334/18: 1145–1149.

    Article  Google Scholar 

  17. Sesso HD, Gaziano JM, VanDenburgh M, Hennekens CH, Glynn RJ, Buring JE . Comparison of baseline characteristics and mortality experience of participants and nonparticipants in a randomized clinical trial: the Physicians' Health Study. Control Clin Trials 2002; 23/6: 686–702.

    Article  Google Scholar 

  18. Rimm EB, Stampfer MJ, Colditz GA, Chute CG, Litin LB, Willett WC . Validity of self-reported waist and hip circumferences in men and women. Epidemiology 1990; 1/6: 466–473.

    Article  Google Scholar 

  19. Rich-Edwards JW, Corsano KA, Stampfer MJ . Test of the National Death Index and Equifax Nationwide Death Search. Am J Epidemiol 1994; 140/11: 1016–1019.

    Article  Google Scholar 

  20. Lee IM, Manson JE, Hennekens CH, Paffenbarger Jr RS . Body weight and mortality. A 27-year follow-up of middle-aged men. JAMA 1993; 270/23: 2823–2828.

    Article  Google Scholar 

  21. Hu FB, Willett WC, Li T, Stampfer MJ, Colditz GA, Manson JE . Adiposity as compared with physical activity in predicting mortality among women. N Engl J Med 2004; 351/26: 2694–2703.

    Article  Google Scholar 

  22. Widlansky ME, Sesso HD, Rexrode KM, Manson JE, Gaziano JM . Body mass index and total and cardiovascular mortality in men with a history of cardiovascular disease. Arch Intern Med 2004; 164/21: 2326–2332.

    Article  Google Scholar 

  23. Baik I, Ascherio A, Rimm EB, Giovannucci E, Spiegelman D, Stampfer MJ et al. Adiposity and mortality in men. Am J Epidemiol 2000; 152/3: 264–271.

    Article  Google Scholar 

  24. Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath Jr CW . Body-mass index and mortality in a prospective cohort of US adults. N Engl J Med 1999; 341/15: 1097–1105.

    Article  Google Scholar 

  25. Willett WC, Dietz WH, Colditz GA . Guidelines for healthy weight. N Engl J Med 1999; 341/6: 427–434.

    Article  Google Scholar 

  26. Sempos CT, Durazo-Arvizu R, McGee DL, Cooper RS, Prewitt TE . The influence of cigarette smoking on the association between body weight and mortality. The Framingham Heart Study revisited. Ann Epidemiol 1998; 8/5: 289–300.

    Article  Google Scholar 

  27. Flegal KM, Graubard BI, Williamson DF, Gail MH . Excess deaths associated with underweight, overweight, and obesity. JAMA 2005; 293/15: 1861–1867.

    Article  Google Scholar 

  28. Gu D, He J, Duan X, Reynolds K, Wu X, Chen J et al. Body weight and mortality among men and women in China. JAMA 2006; 295/7: 776–783.

    Article  Google Scholar 

  29. Thomas F, Bean K, Pannier B, Oppert JM, Guize L, Benetos A . Cardiovascular mortality in overweight subjects: the key role of associated risk factors. Hypertension 2005; 46/4: 654–659.

    Article  Google Scholar 

  30. Diehr P, Bild DE, Harris TB, Duxbury A, Siscovick D, Rossi M . Body mass index and mortality in nonsmoking older adults: the Cardiovascular Health Study. Am J Public Health 1998; 88/4: 623–629.

    Article  Google Scholar 

  31. Colditz GA, Martin P, Stampfer MJ, Willett WC, Sampson L, Rosner B et al. Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. Am J Epidemiol 1986; 123/5: 894–900.

    Article  Google Scholar 

  32. Stevens J, Keil JE, Waid LR, Gazes PC . Accuracy of current, 4-year, and 28-year self-reported body weight in an elderly population. Am J Epidemiol 1990; 132/6: 1156–1163.

    Article  Google Scholar 

  33. Folsom AR, Kaye SA, Sellers TA, Hong CP, Cerhan JR, Potter JD et al. Body fat distribution and 5-year risk of death in older women. JAMA 1993; 269/4: 483–487.

    Article  Google Scholar 

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Acknowledgements

We are indebted to the participants in the Physicians' Health Study for their outstanding commitment and cooperation and to the entire Physicians' Health Study staff for their expert and unfailing assistance.

This work was supported by Grants CA 34944 and CA 40360 from the National Cancer Institute, and Grants HL 26490 and HL 34595 from the National Heart, Lung, and Blood Institute, Bethesda, MD.

Author information

Authors and Affiliations

  1. Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

    R P Gelber, T Kurth, J E Buring & J M Gaziano

  2. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

    T Kurth, J E Manson, J E Buring & J M Gaziano

  3. Massachusetts Veterans Epidemiology Research and Information Center , VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA

    J M Gaziano

  4. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    T Kurth, J E Manson & J E Buring

  5. Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA, USA

    J E Buring

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  1. R P Gelber
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Correspondence to T Kurth.

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Gelber, R., Kurth, T., Manson, J. et al. Body mass index and mortality in men: evaluating the shape of the association. Int J Obes 31, 1240–1247 (2007). https://doi.org/10.1038/sj.ijo.0803564

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