To evaluate the association between body mass index (BMI, kg m−2) and mortality rate among Hispanic adults.
METHODS AND PROCEDURES:
Analysis of five data sets (total N=16 798) identified after searching for publicly available, prospective cohort data sets containing relevant information for at least 500 Hispanic respondents (⩾18 years at baseline), at least 5 years of mortality follow-up, and measured height and weight. Data sets included the third National Health and Nutrition Examination Survey, the Puerto Rico Heart Health Program (PRHHP), the Hispanic Established Population for Epidemiologic Studies of the Elderly (HEPESE), the San Antonio Heart Study (SAHS) and the Sacramento Area Latino Study on Aging.
Cox proportional hazards regression models, adjusting for sex and smoking, were fit within three attained-age strata (18 to younger than 60 years, 60 to younger than 70 years, and 70 years and older). We found that underweight was associated with elevated mortality rate for all age groups in the PRHHP (hazard ratios [HRs]=1.38–1.60) and the SAHS (HRs=1.88–2.51). Overweight (HRs=0.38 and 0.84) and obesity grade 2–3 (HRs=0.75 and 0.60) associated with reduced mortality rate in the HEPESE dataset for those in the 60 to younger than 70 years, and 70 years and older attained-age strata. Weighted estimates combining the HRs across the data sets revealed a similar pattern.
Among Hispanic adults, there was no clear evidence that overweight and obesity associate with elevated mortality rate.
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Arias E . United States life tables by Hispanic origin. National Center for Health Statistics. Vital Health Stat 2010; 2: 152.
Population Division, US Census Bureau. Annual estimates of the population by sex, race and Hispanic or Latino origin for the United States: 1 April 2000–1 July 2004 (NC-EST2004-03), 2005.
Flegal KM, Carroll MD, Ogden CL, Curtin LR . Prevalence and trends in obesity among US adults, 1999–2008. JAMA 2010; 303: 235–241.
Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM . Prevalence of overweight and obesity in the US, 1999–2004. JAMA 2006; 295: 1549–1555.
Misra A, Khurana L . Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab 2008; 93 (11 Suppl 1): S9–S30.
de Gonzalez AB, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med 2010; 363: 2211–2219.
Ford ES, Giles WH, Dietz WH . Prevalence of the metabolic syndrome among US adults: findings from the Third National Health and Nutrition Examination Survey. JAMA 2002; 287: 356–359.
Centers for Disease Control and Prevention. National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States, 2011. US Department of Health and Human Services, Centers for Disease Control and Prevention: Atlanta, GA, 2011.
Hunninghake GM, Weiss ST, Celedon JC . Asthma in Hispanics. Am J Respir Crit Care Med 2006; 173: 143–163.
Ahluwalia IB, Mack KA, Murphy W, Mokdad AH, Bales VS . State-specific prevalence of selected chronic disease-related characteristics: Behavioral Risk Factor Surveillance System, 2001. Morb Mortal Wkly Rep 2003; 52: 1–80.
Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analysis of 57 prospective studies. Lancet 2009; 373: 362–369.
Plan and operation of the Third National Health and Nutrition Examination Survey, 1988-94. Series 1: programs and collection procedures. Vital Health Stat 1 1994; 32: 1–407.
National Center for Health Statistics. The Third National Health and Nutrition Examination Survey (NHANES III) Linked Mortality File, Mortality Follow-Up through 2006: Matching Methodology May 2009. Office of Analysis and Epidemiology: Hyattsville, MD.
Garcia-Palmieri MR, Feliberti M, Costas Jr R, Colón AA, Cruz-Vidal M, Cortés-Alicea M et al. An epidemiological study on coronary heart disease in Puerto Rico: the Puerto Rico Heart Health Program. Biol Asoc Med PR 1969; 61: 174–179.
Garcia-Palmieri MR, Costas Jr R, Cruz-Vidal M, Sorlie PD, Havlik RJ . Increased physical activity: a protective factor against heart attacks in Puerto Rico. Am J Cardiol 1982; 50: 749–755.
Garcia-Palmieri MR, Sorlie P, Costas R, Havlik R . An apparent inverse relationship between serum cholesterol and cancer mortality in Puerto Rico. Am J Epidemiol 1981; 114: 29–40.
Garcia-Palmieri MR, Sorlie PD, Havlik RJ, Costas Jr R, Cruz-Vidal M . Urban-rural differences in 12 year coronary heart disease mortality: the Puerto Rico Heart Health Program. J Clin Epidemiol 1988; 41: 285–292.
Black SA, Ray LA, Angel RJ, Espino DV, Miranda M, Markides KS (eds). Resource Book of the Hispanic Established Population for the Epidemiological Study of the Elderly. National Archive of Computerized on Aging: Ann Arbor, 2005.
Markides KS, Rudkin L, Angel RJ, Espino DV . Health status of Hispanic elderly in the United States. In: Martin LG, Soldo BJ and Foote K (eds). Racial and Ethnic Differences in Late Life Health in the United States. National Academy Press: Washington DC, 1997.
Stern MP, Rosenthal M, Haffner SM, Hazuda HP, Franco LJ . Sex differences in the effect of sociocultural status on diabetes and cardiovascular risk factors in Mexican-Americans: the San Antonio Heart Study. Am J Epidemiol 1984; 120: 834–851.
Haan MN, Mungas DM, Gonzalez HM, Ortiz TA, Acharya A, Jaqust WJ . Prevalence of dementia in older Latinos: the influence of type 2 diabetes mellitus, stroke and genetic factors. J Am Geriatr Soc 2003; 51: 169–177.
Thiébaut A, Bénichou J . Choice of time-scale in Cox's model analysis of epidemiologic cohort data: a simulation study. Stat Med 2004; 23: 3803–3820.
Korn E, Graubard B, Midthune D . Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol 1997; 145: 72–80.
Flegal K, Graubard B, Williamson D, Gail M . Excess deaths associated with underweight, overweight, and obesity. JAMA 2005; 293: 1861–1867.
Flegal K, Graubard B, Williamson D, Gail M . Impact of smoking and preexisting illness on estimates of the fractions of deaths associated with underweight, overweight, and obesity in the US population. Am J Epidemiol 2007; 166: 975–982.
Anderson PK, Gill RD . Cox's regression model for counting processes: a large sample study. Ann Stat 1982; 10: 1100–1120.
Gail M, Graubard B, Williamson D, Flegal K . Comments on ′Choice of time scale and its effect on significance of predictors in longitudinal studies′. Stat Med 2009; 28: 1315–1317.
National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. http://www.nhlbi.nih.gov/guidelines/obesity (accessed 25 August 2010).
Flegal KM, Grubard BI, Williamson DF . Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 2007; 298: 2028–2037.
Grambsch P, Therneau T . Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 1994; 81: 515–526.
R Development Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna, Austria, 2010, http://www.R-project.org.
Lumley T . Analysis of complex survey samples. J Stat Software 2004; 9: 1–19.
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. N Engl J Med 1998; 338: 1–7.
Fontaine KR, Heo M, Cheskin LJ, Allison DB . Body mass index, smoking, and mortality among older American women. J Wom Health 1998; 7: 1257–1261.
Brill FA, Giles WH, Keenan NL, Croft JB, Davis DR, Jackson KL et al. Effect of body mass index on activity limitation and mortality among older women. The National Health Interview Survey, 1986–1990. J Wom Health 1997; 6: 435–440.
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 Pub Health 1998; 88: 623–629.
Stevens J . Impact of age on associations between weight and mortality. Nutr Rev 2000; 58: 129–137.
Calle EE, Teras LR, Thun MJ . Obesity and mortality. N Engl J Med 2005; 353: 2197–2199.
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.
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.
Lankisch P, Gerzmann M, Gerzmann JF, Lehnick D . Unintentional weight loss: diagnosis and prognosis. The first prospective follow-up study from a secondary referral centre. J Intern Med 2001; 249: 41–46.
Metalidis C, Knockaert DC, Bobbaers H, Vanderschueren S . Involuntary weight loss. Does a negative baseline evaluation provide adequate reassurance? Eur J Intern Med 2008; 19: 345–349.
Sorlie PD, Backlund E, Johnson NJ, Rogot E . Mortality by Hispanic status in the United States. JAMA 1993; 270: 2464–2468.
Liao Y, Cooper RS, Cao G, : Durazo-Arvizu R, : Kaufman JS, : Like A et al. Mortality patterns among adult Hispanics: findings from NHIS, 1986 to 1990. Am J Pub Health 1998; 88: 227–232.
Markides KS, Coreil J . The health of Hispanics in the southwestern United States: an epidemiologic paradox. Public Health Rep 1986; 101: 253–265.
Palloni A, Arias E . Paradox lost: explaining the Hispanic adult mortality advantage. Dem 2004; 41: 385–415.
Patel KV, Eschback K, Ray LA, Markides KS . Evaluation of mortality data for older Mexican-Americans: implications for the Hispanic paradox. Am J Epidemiol 2004; 159: 707–715.
Turra CM, Elo IT . The impact of salmon bias on the Hispanic mortality advantage: new evidence from social security data. Pop Res Policy Rev 2008; 27: 515–530.
Arias E, Schauman WS, Eschbach K, Sorlie PD, Backlund EL . The validity of race and hispanic origin reporting on death certificates in the United States. national center for health statistics. Vital Health Stat 2008; 2: 148.
Arias E, Eschbach K, Schauman WS, Backlund EL, Sorlie PD . The Hispanic mortality advantage and ethnic misclassification on US death certificates. Am J Pub Health 2010; 100: S171–S177.
Elo IT, Turra CM, Kestenbaum B, Fergusson BR . Mortality among elderly hispanics in the United States: past evidence and new results. Dem 2004; 41: 109–128.
Powell TM, de Lemos JA, Banks K, Ayers CR, Rohatgi A, Khera A et al. Body size misperception: a novel determinant in the obesity epidemic. Arch Intern Med 2010; 170: 1695–1697.
Petti YM, Cowell JM . An assessment of measures of body image, body attitude, acculturation, and weight status among Mexican American women. Am Acad Nurse Pract 2011; 23: 84–91.
Kuchler F, Variyam JN . Mistakes were made: misperception as a barrier to reducing overweight. Int J Obes Relat Metab Disord 2003; 27: 856–861.
This project was partially supported by NIH Grants, R21DK077959, T32HL072757, AG12975 and DK60753. We gratefully thank the investigators who provided us with data.
DBA has received grants, honoraria, donations, and consulting fees from numerous food, beverage, pharmaceutical companies, and other commercial, government and nonprofit entities with interests in obesity. The remaining authors declare no conflict of interest.
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Fontaine, K., McCubrey, R., Mehta, T. et al. Body mass index and mortality rate among Hispanic adults: a pooled analysis of multiple epidemiologic data sets. Int J Obes 36, 1121–1126 (2012). https://doi.org/10.1038/ijo.2011.194