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.

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

International Journal of Obesity volume 47, pages 479–486 (2023)Cite this article

Subjects

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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

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

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

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

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 https://epi.ncc.go.jp/en/jphc/805/8155.html.

References

  1. Troeger C, Blacker B, Khalil IA, Rao PC, Cao J, Zimsen SRM, et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018;18:1191–210.

    Article  Google Scholar 

  2. Statistics bureau of Japan. [Portal site of official statistics of Japan (e-Stat)]. Available online: https://www.e-stat.go.jp (Accessed 17 December 2022).

  3. Almirall J, Serra-Prat M, Bolíbar I, Balasso V. Risk factors for community-acquired pneumonia in adults: a systematic review of observational studies. Respiration. 2017;94:299–311.

    Article  PubMed  Google Scholar 

  4. Ritz BW, Gardner EM. Malnutrition and energy restriction differentially affect viral immunity. J Nutr. 2006;136:1141–4.

    Article  CAS  PubMed  Google Scholar 

  5. Karlsson EA, Beck MA. The burden of obesity on infectious disease. Exp Biol Med. 2010;235:1412–24.

    Article  CAS  Google Scholar 

  6. Phung DT, Wang Z, Rutherford S, Huang C, Chu C. Body mass index and risk of pneumonia: a systematic review and meta-analysis. Obes Rev. 2013;14:839–57.

    Article  CAS  PubMed  Google Scholar 

  7. Hamer M, O’Donovan G, Stamatakis E. Lifestyle risk factors, obesity and infectious disease mortality in the general population: linkage study of 97,844 adults from England and Scotland. Prev Med. 2019;123:65–70.

    Article  PubMed  Google Scholar 

  8. Inoue Y, Koizumi A, Wada Y, Iso H, Watanabe Y, Date C, et al. Risk and protective factors related to mortality from pneumonia among middleaged and elderly community residents: the JACC Study. J Epidemiol. 2007;17:194–202.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Takata Y, Ansai T, Soh I, Akifusa S, Sonoki K, Fujisawa K, et al. Association between body mass index and mortality in an 80-year-old population. J Am Geriatr Soc. 2007;55:913–7.

    Article  PubMed  Google Scholar 

  10. Nakayama K, Koyohara Y, Kato I, Iwamoto H, Ueda K, Fujishima M. Effect of body mass index on morbidity and mortality in a general Japanese population–the Hisayama study. Nihon Ronen Igakkai Zasshi. 1997;34:935–41.

    Article  CAS  PubMed  Google Scholar 

  11. Nie W, Zhang Y, Jee SH, Jung KJ, Li B, Xiu Q. Obesity survival paradox in pneumonia: a meta-analysis. BMC Med. 2014;12:61.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ministry of Health, Labour and Welfare, Japan. The National Health and Nutrition Survey in Japan, 2019. Available online: https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/kenkou/eiyou/r1-houkoku_00002.html (in Japanese) (Accessed 17 December 2022).

  13. LaCroix AZ, Lipson S, Miles TP, White L. Prospective study of pneumonia hospitalizations and mortality of U.S. older people: the role of chronic conditions, health behaviors, and nutritional status. Public Health Rep. 1989;104:350–60.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Loftfield E, Freedman ND, Graubard BI, Guertin KA, Black A, Huang WY, et al. Association of coffee consumption with overall and cause-specific mortality in a large US prospective cohort study. Am J Epidemiol. 2015;182:1010–22.

    PubMed  PubMed Central  Google Scholar 

  15. Watanabe I, Kuriyama S, Kakizaki M, Sone T, Ohmori-Matsuda K, Nakaya N, et al. Green tea and death from pneumonia in Japan: the Ohsaki cohort study. Am J Clin Nutr. 2009;90:672–9.

    Article  CAS  PubMed  Google Scholar 

  16. Hemilä H, Louhiala P. Vitamin C may affect lung infections. J R Soc Med. 2007;100:495–8.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Zhou YF, Luo BA, Qin LL. The association between vitamin D deficiency and community-acquired pneumonia: a meta-analysis of observational studies. Medicine. 2019;98:e17252.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Barnett JB, Hamer DH, Meydani SN. Low zinc status: a new risk factor for pneumonia in the elderly? Nutr Rev. 2010;68:30–7.

    Article  PubMed  Google Scholar 

  19. Nanri A, Mizoue T, Takahashi Y, Noda M, Inoue M, Tsugane S. Weight change and all-cause, cancer and cardiovascular disease mortality in Japanese men and women: the Japan Public Health Center-Based Prospective Study. Int J Obes (Lond). 2010;34:348–56.

    Article  CAS  PubMed  Google Scholar 

  20. Mulligan AA, Lentjes MAH, Luben RN, Wareham NJ, Khaw KT. Weight change and 15 year mortality: results from the European prospective investigation into Cancer in Norfolk (EPIC-Norfolk) cohort study. Eur J Epidemiol. 2018;33:37–53.

    Article  PubMed  Google Scholar 

  21. Tsugane S, Sawada N. The JPHC study: design and some findings on the typical Japanese diet. Jpn J Clin Oncol. 2014;44:777–82.

    Article  PubMed  Google Scholar 

  22. World Health Organization. Obesity: Preventing and Managing the Global Epidemic. WHO Technical Report Series 894. 2000. Available online: https://apps.who.int/iris/handle/10665/42330 (Accessed 17 December 2022).

  23. Tsugane S, Sasaki S, Tsubono 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 Relat Metab Disord. 2002;26:529–37.

    Article  CAS  PubMed  Google Scholar 

  24. Nanri A, Mizoue T, Takahashi Y, Matsushita Y, Noda M, Inoue M, et al. Association of weight change in different periods of adulthood with risk of type 2 diabetes in Japanese men and women: the Japan Public Health Center-Based Prospective Study. J Epidemiol Community Health. 2011;65:1104–10.

    Article  PubMed  Google Scholar 

  25. World Health Organization. ICD-10: International Statistical Classification of Diseases and Related Health Problems: 10th Revision. World Health Organization; 1992.

    Google Scholar 

  26. Sasaki S, Kobayashi M, Ishihara J, Tsugane S. Self-administered food frequency questionnaire used in the 5-year follow-up survey of the JPHC Study: questionnaire structure, computation algorithms, and area-based mean intake. J Epidemiol. 2003;13:S13–22.

    Article  PubMed  Google Scholar 

  27. Science and Technology Agency. 5th revised and enlarged. Printing Bureau of the Ministry of Finance, 2005. [Standard Tables of Food Composition in Japan].

  28. Sasaki S, Ishihara J, Tsugane S. Reproducibility of a self-administered food frequency questionnaire used in the 5-year follow-up survey of the JPHC Study Cohort I to assess food and nutrient intake. J Epidemiol. 2003;13:S115–24.

    Article  PubMed  Google Scholar 

  29. Ishihara J, Sobue T, Yamamoto S, Yoshimi I, Sasaki S, Kobayashi M, et al. Validity and reproducibility of a self-administered food frequency questionnaire in the JPHC Study Cohort II: study design, participant profile and results in comparison with Cohort I. J Epidemiol. 2003;13:S134–47.

    Article  PubMed  Google Scholar 

  30. Gavazzi G, Herrmann F, Krause KH. Aging and infectious diseases in the developing world. Clin Infect Dis. 2004;39:83–91.

    Article  PubMed  Google Scholar 

  31. Pan XF, Yuan JM, Koh WP, Pan A. Weight change in relation to mortality in middle-aged and elderly Chinese: the Singapore Chinese Health Study. Int J Obes (Lond). 2019;43:1590–600.

    Article  PubMed  Google Scholar 

  32. Deeg DJ, Miles TP, Van Zonneveld RJ, Curb JD. Weight change, survival time and cause of death in Dutch elderly. Arch Gerontol Geriatr. 1990;10:97–111.

    Article  CAS  PubMed  Google Scholar 

  33. Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006;54:991–1001.

    Article  PubMed  Google Scholar 

  34. Xie WQ, Xiao GL, Fan YB, He M, Lv S, Li YS. Sarcopenic obesity: research advances in pathogenesis and diagnostic criteria. Aging Clin Exp Res. 2021;33:247–52.

    Article  PubMed  Google Scholar 

  35. Chiolero A, Faeh D, Paccaud F, Cornuz J. Consequences of smoking for body weight, body fat distribution, and insulin resistance. Am J Clin Nutr. 2008;87:801–9.

    Article  CAS  PubMed  Google Scholar 

  36. Bello S, Menéndez R, Antoni T, Reyes S, Zalacain R, Capelastegui A, et al. Tobacco smoking increases the risk for death from pneumococcal pneumonia. Chest. 2014;146:1029–37.

    Article  PubMed  Google Scholar 

  37. Mancuso P. Obesity and lung inflammation. J Appl Physiol. 2010;108:722–8.

    Article  PubMed  Google Scholar 

  38. Shade ED, Ulrich CM, Wener MH, Wood B, Yasui Y, Lacroix K, et al. Frequent intentional weight loss is associated with lower natural killer cell cytotoxicity in postmenopausal women: possible long-term immune effects. J Am Diet Assoc. 2004;104:903–12.

    Article  PubMed  Google Scholar 

  39. Culley FJ. Natural killer cells in infection and inflammation of the lung. Immunology. 2009;128:151–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

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: https://epi.ncc.go.jp/en/jphc/781/8896.html.

Funding

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.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan

    Takako Miki, Akiko Nanri & Tetsuya Mizoue

  2. Division of Public Health, Department of Hygiene and Public Health, School of Medicine, Tokyo Women’s Medical University, Tokyo, Japan

    Takako Miki

  3. Department of Food and Health Sciences, International College of Arts and Sciences, Fukuoka Women’s University, Fukuoka, Japan

    Akiko Nanri

  4. Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan

    Atsushi Goto

  5. Department of Diabetes, Metabolism and Endocrinology, Ichikawa Hospital, International University of Health and Welfare, Ichikawa, Japan

    Mitsuhiko Noda

  6. Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan

    Norie Sawada & Shoichiro Tsugane

  7. National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan

    Shoichiro Tsugane

Authors
  1. Takako Miki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akiko Nanri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tetsuya Mizoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Atsushi Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mitsuhiko Noda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Norie Sawada
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shoichiro Tsugane
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

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.

Corresponding author

Correspondence to Takako Miki.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.1038/s41366-023-01289-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41366-023-01289-2

Search

Advanced search

Quick links