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Epidemiology and Population Health

Association of body mass index and weight change with pneumonia mortality in a Japanese population: Japan Public Health Center-based Prospective Study



Accumulating evidence suggests that pneumonia mortality is lower for individuals with high body mass index (BMI) compared to normal BMI, but it remains unclear whether weight change during adulthood influences subsequent mortality due to pneumonia in Asian populations, who have a relatively lean body mass. This study aimed to examine the association of BMI and weight change over 5 years with the subsequent risk of pneumonia mortality in a Japanese population.


The present analysis included 79,564 Japan Public Health Center (JPHC)-based Prospective Study participants who completed a questionnaire between 1995 and 1998 were followed for death through 2016. BMI was categorized into four groups: underweight (<18.5 kg/m2), normal weight (BMI: 18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (BMI: ≥30.0 kg/m2). Weight change was defined as the difference of body weight between questionnaire surveys with a 5-year interval. Cox proportional hazards regression was used to estimate hazard ratios of baseline BMI and weight change for pneumonia mortality.


During a median follow-up of 18.9 y, we identified 994 deaths from pneumonia. Compared with participants with normal weight, an elevated risk was observed among those who were underweight (hazard ratio = 2.29, 95% confidence interval [CI]: 1.83–2.87), whereas a decreased risk was found among those who were overweight (hazard ratio = 0.63, 95% CI: 0.53–0.75). Regarding weight change, the multivariable-adjusted hazard ratio (95% CI) of pneumonia mortality for a weight loss of 5 kg or more versus a weight change of less than 2.5 kg was 1.75 (1.46–2.10), whereas that for a weight gain of 5 kg or more was 1.59 (1.27–2.00).


Underweight and greater weight change was associated with an increase in the risk of pneumonia mortality in Japanese adults.

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Fig. 1: Flowchart of the study population.
Fig. 2: Multivariable-adjusted hazard ratio (a group of individuals with normal weight at baseline and stable weight for 5 years was used as reference).

Data availability

Access to Japan Public Health Centre-based Prospective Study data will be made available upon reasonable request. Please follow the instructions at


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We are indebted to the Aomori, Iwate, Ibaraki, Niigata, Osaka, Kochi, Nagasaki, and Okinawa Cancer Registries for providing their incidence data. We would like to thank all members of the Japan Public Health Center-based Prospective Study Group for their valuable contributions. JPHC study members (as of April 2021) are listed at:


This work was supported by the National Cancer Center Research and Development Fund (23-A-31[toku], 26-A-2 and 29-A-4) (since 2011), a Grant-in-Aid for Cancer Research from the Ministry of Health, Labour and Welfare of Japan (from 1989 to 2010). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; and the decision to submit the manuscript for publication.

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ST was involved in the design of the study as the principal investigator; ST and NS conducted the surveys; T Miki, AN, T Mizoue, AG, MN. NS, and ST drafted the plan for data analyses; T Miki conducted the data analyses; T Mizoue provided statistical expertise; T Miki drafted the manuscript; T Miki, and T Mizoue had primary responsibility for the final content. All authors were involved in the interpretation of the results and revision of the manuscript and approved the final version of the manuscript.

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Correspondence to Takako Miki.

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Miki, T., Nanri, A., Mizoue, T. et al. Association of body mass index and weight change with pneumonia mortality in a Japanese population: Japan Public Health Center-based Prospective Study. Int J Obes 47, 479–486 (2023).

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