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

The Lancet (Impact Factor: 45.22). 04/2009; 373(9669):1083-96. DOI: 10.1016/S0140-6736(09)60318-4
Source: PubMed


The main associations of body-mass index (BMI) with overall and cause-specific mortality can best be assessed by long-term prospective follow-up of large numbers of people. The Prospective Studies Collaboration aimed to investigate these associations by sharing data from many studies.
Collaborative analyses were undertaken of baseline BMI versus mortality in 57 prospective studies with 894 576 participants, mostly in western Europe and North America (61% [n=541 452] male, mean recruitment age 46 [SD 11] years, median recruitment year 1979 [IQR 1975-85], mean BMI 25 [SD 4] kg/m(2)). The analyses were adjusted for age, sex, smoking status, and study. To limit reverse causality, the first 5 years of follow-up were excluded, leaving 66 552 deaths of known cause during a mean of 8 (SD 6) further years of follow-up (mean age at death 67 [SD 10] years): 30 416 vascular; 2070 diabetic, renal or hepatic; 22 592 neoplastic; 3770 respiratory; 7704 other.
In both sexes, mortality was lowest at about 22.5-25 kg/m(2). Above this range, positive associations were recorded for several specific causes and inverse associations for none, the absolute excess risks for higher BMI and smoking were roughly additive, and each 5 kg/m(2) higher BMI was on average associated with about 30% higher overall mortality (hazard ratio per 5 kg/m(2) [HR] 1.29 [95% CI 1.27-1.32]): 40% for vascular mortality (HR 1.41 [1.37-1.45]); 60-120% for diabetic, renal, and hepatic mortality (HRs 2.16 [1.89-2.46], 1.59 [1.27-1.99], and 1.82 [1.59-2.09], respectively); 10% for neoplastic mortality (HR 1.10 [1.06-1.15]); and 20% for respiratory and for all other mortality (HRs 1.20 [1.07-1.34] and 1.20 [1.16-1.25], respectively). Below the range 22.5-25 kg/m(2), BMI was associated inversely with overall mortality, mainly because of strong inverse associations with respiratory disease and lung cancer. These inverse associations were much stronger for smokers than for non-smokers, despite cigarette consumption per smoker varying little with BMI.
Although other anthropometric measures (eg, waist circumference, waist-to-hip ratio) could well add extra information to BMI, and BMI to them, BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22.5-25 kg/m(2). The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal. At 30-35 kg/m(2), median survival is reduced by 2-4 years; at 40-45 kg/m(2), it is reduced by 8-10 years (which is comparable with the effects of smoking). The definite excess mortality below 22.5 kg/m(2) is due mainly to smoking-related diseases, and is not fully explained.

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    • "We use the age and gender specific mortality of the Swedish general population in 2012 (Statistics Sweden 2013b). The mortality is accelerated using gender and BMI specific coefficients estimated from a recent analysis of some 900,000 adults (Whitlock et al. 2009), to account for excess mortality caused by "

    01/2015; 2(1). DOI:10.5617/njhe.207
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    • "Cependant, cette surmortalité n'a pas été observée chez les obèses de type 1 et même les taux de mortalité observés étaient significativement plus faibles chez les sujets en surpoids en comparaison aux personnes de poids normal. Si ces résultats n'ont fait que corroborer des observations antérieures, mais obtenues à partir d'effectifs moins persuasifs 10—12, d'autres grandes données épidémiologiques avaient déjà observé que le risque de mortalité associé au surpoids et à l'obésité déclinait lors du vieillissement [13] [14]. Il a même été décrit une relation inverse entre les plus hautes valeurs d'IMC et les taux de survie chez les personnes âgées et très âgées, dénommée le paradoxe de l'obésité 15—18. "

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    • "Previous large cohort studies have shown that high BMI is a risk factor for all cancer mortality, as well as site-specific cancer mortality [4–8]. Calle et al. investigated the relationship between BMI and cancer mortality among approximately 900,000 American people [5]. "
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    ABSTRACT: Background The aim of this study is to investigate the independent and joint effects of cardiorespiratory fitness (CRF) and body mass index (BMI) on cancer mortality in a low body mass index population. Methods We evaluated CRF and BMI in relation to cancer mortality in 8760 Japanese men. The median BMI was 22.6 kg/m2 (IQR: 21.0-24.3). The mean follow-up period was more than 20 years. Hazard ratios and 95% CI were obtained using a Cox proportional hazards model while adjusting for several confounding factors. Results Using the 2nd tertile of BMI (21.6-23.6 kg/m2) as reference, hazard ratios and 95% CI for the lowest tertile of BMI (18.5-21.5) were 1.26 (0.87–1.81), and 0.92 (0.64–1.34) for the highest tertile (23.7-37.4). Using the lowest tertile of CRF as reference, hazard ratios and 95% CIs for 2nd and highest tertiles of CRF were 0.78 (0.55–1.10) and 0.59 (0.40–0.88). We further calculated hazard ratios according to groups of men cross-tabulated by tertiles of CRF and BMI. Among men in the second tertile of BMI, those belonging to the lowest CRF tertile had a 53% lower risk of cancer mortality compared to those in the lowest CRF tertile (hazard ratio: 0.47, 95% CI: 0.23-0.97). Among those in the highest BMI tertile, the corresponding hazard ratio was 0.54 (0.25-1.17). Conclusion These results suggest that high CRF is associated with lower cancer mortality in a Japanese population of men with low average BMI.
    BMC Public Health 09/2014; 14(1):1012. DOI:10.1186/1471-2458-14-1012 · 2.26 Impact Factor
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