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.

  • Original Article
  • Published:

Epidemiology and Population Health

Is body mass index associated with lowest mortality increasing over time?

International Journal of Obesity volume 41, pages 1171–1175 (2017)Cite this article

Subjects

Abstract

Background:

It is debatable whether the body mass index (BMI) value that is associated with the lowest all-cause mortality has increased over time. Such an increase might indicate that the WHO BMI categories for normal weight and overweight need to be revised over time. This study assessed whether the BMI associated with the lowest all-cause mortality increased over time among US adults in the National Health Interview Survey.

Methods:

This survey with up to 25 years of follow-up included 901 197 participants, aged 20 to 79 years with baseline BMI between 18.5 and 39.9 kg m−2 and known mortality status between the original survey dates and 31 December 2011. The BMI values associated with the lowest mortality were estimated for different survey time periods: 1986–1989, 1990–1994, 1995–1999, 2000–2004 and 2000–2009.

Results:

Among 901 197 participants, 130 495 died during over 14.5 million person-years of follow-up. There was a U-shaped BMI–mortality association in all the survey periods. When we used the original follow-up durations, the BMI associated with the lowest mortality increased monotonically from 23.9 kg m−2 in 1986–1989 to 28.6 kg m−2 in 2005–2009. When using a fixed follow-up duration of 5, 10, 15 or 20 years, we found no monotonic increasing pattern in the BMI associated with the lowest mortality. With duration of 15 years, the estimates of BMI associated with lowest mortality appeared to be relatively stable over time among both the general population and never smokers free from cardiovascular disease and cancer at baseline.

Conclusions:

With a fixed long-term follow-up duration, the BMI value associated with the lowest mortality remains relatively stable over time.

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

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

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

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Afzal S, Tybjaerg-Hansen A, Jensen GB, Nordestgaard BG . Change in body mass index associated with lowest mortality in Denmark, 1976-2013. JAMA 2016; 315: 1989–1996.

    Article  CAS  Google Scholar 

  2. Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S et al. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ 2016; 353: i2156.

    Article  Google Scholar 

  3. Flegal KM, Kit BK, Orpana H, Graubard BI . Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 2013; 309: 71–82.

    Article  CAS  Google Scholar 

  4. Global BMI Mortality Collaboration. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet 2016; 388: 776–786.

    Article  CAS  Google Scholar 

  5. Flegal KM, Graubard BI, Williamson DF, Cooper RS . Reverse causation and illness-related weight loss in observational studies of body weight and mortality. Am J Epidemiol 2011; 173: 1–9.

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  7. Flegal KM, Graubard BI, Williamson DF, Gail MH . Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 2007; 298: 2028–2037.

    Article  CAS  Google Scholar 

  8. Greenberg JA . The obesity paradox in the US population. Am J Clin Nutr 2013; 97: 1195–1200.

    Article  CAS  Google Scholar 

  9. Zheng W, McLerran DF, Rolland B, Zhang X, Inoue M, Matsuo K et al. Association between body-mass index and risk of death in more than 1 million Asians. N Engl J Med 2011; 364: 719–729.

    Article  CAS  Google Scholar 

  10. Berrington de Gonzalez A, 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.

    Article  CAS  Google Scholar 

  11. Prospective Studies C, Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009; 373: 1083–1096.

    Article  Google Scholar 

  12. Wang Z, Liu M, Pan T, Tong S . Lower mortality associated with overweight in the US National Health Interview Survey: is overweight protective? Medicine 2016; 95: e2424.

    Article  Google Scholar 

  13. Wang Z . Body mass index and all-cause mortality. JAMA 2016; 316: 991–992.

    Article  Google Scholar 

  14. Bhupathiraju SN, Willett WC, Hu FB . Body mass index and all-cause mortality. JAMA 2016; 316: 991.

    Article  Google Scholar 

  15. Parsons VL, Moriarity C, Jonas K, Moore TF, Davis KE, Tompkins L . Design and estimation for the national health interview survey, 2006-2015. Vital Health Stat 2 2014; 165: 1–53.

    Google Scholar 

  16. Botman SL, Moore TF, Moriarity CL, Parsons VL. Design and estimation for the National Health Interview Survey, 1995-2004. Vital Health Stat 2 2000; 130: 1–31.

  17. Royston P, Lambert PC . Flexible Parametric Survival Analysis Using Stata : Beyond the Cox Model. Stata Press: College Station, TX, USA, 2011, xxvi, 347p.

    Google Scholar 

  18. StataCorp Stata Statistical Software: Release 14. StataCorp LP: College Station, TX, USA, 2015.

  19. He J . Modeling the dynamic association of BMI and mortality in the Framingham Heart Study. Ann Epidemiol 2011; 21: 517–525.

    Article  Google Scholar 

  20. Brug J, Wammes B, Kremers S, Giskes K, Oenema A . Underestimation and overestimation of personal weight status: associations with socio-demographic characteristics and weight maintenance intentions. J Hum Nutr Diet 2006; 19: 253–262.

    Article  CAS  Google Scholar 

  21. Gillum RF, Sempos CT . Ethnic variation in validity of classification of overweight and obesity using self-reported weight and height in American women and men: the Third National Health and Nutrition Examination Survey. Nutr J 2005; 4: 27.

    Article  CAS  Google Scholar 

  22. Hattori A, Sturm R . The obesity epidemic and changes in self-report biases in BMI. Obesity (Silver Spring) 2013; 21: 856–860.

    Article  Google Scholar 

  23. Jeffery RW . Bias in reported body weight as a function of education, occupation, health and weight concern. Addict Behav 1996; 21: 217–222.

    Article  CAS  Google Scholar 

  24. Peter RS, Mayer B, Concin H, Nagel G . The effect of age on the shape of the BMI-mortality relation and BMI associated with minimum all-cause mortality in a large Austrian cohort. Int J Obes (Lond) 2015; 39: 530–534.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge the Centers for Disease Control and Prevention, USA, for access to the NHIS public-use data. We thank Drs Katherine Flegal (Stanford University) and Barry Graubard (National Cancer Institute) for their critical comments and suggestions. This work was supported by the National Health and Medical Research Council of Australia (APP1042343, ZW) and a University of Queensland International Scholarship (44078179, YP). These funding sources had no role in the design of this study and did not have any role during its execution, analyses, interpretation of the data or decision to submit results.

Author contributions

ZW conceived and designed the study, acquired the data and drafted the manuscript. ZW and YP obtained the funding. ZW, YP and BD played an important role in interpreting the results and revising the manuscript. All authors have approved the final manuscript for submission.

Author information

Authors and Affiliations

  1. Centre for Chronic Disease, Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia

    Z Wang, Y Peng & B Dong

  2. Institute of Child and Adolescent Health, School of Public Health, Peking University Health Sciences Center, Beijing, China

    B Dong

Authors
  1. Z Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Z Wang.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, Z., Peng, Y. & Dong, B. Is body mass index associated with lowest mortality increasing over time?. Int J Obes 41, 1171–1175 (2017). https://doi.org/10.1038/ijo.2017.107

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2017.107

This article is cited by

Search

Advanced search

Quick links