Association between Body-Mass Index and Risk of Death in More Than 1 Million Asians

Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt–Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA.
New England Journal of Medicine (Impact Factor: 55.87). 02/2011; 364(8):719-29. DOI: 10.1056/NEJMoa1010679
Source: PubMed


Most studies that have evaluated the association between the body-mass index (BMI) and the risks of death from any cause and from specific causes have been conducted in populations of European origin.
We performed pooled analyses to evaluate the association between BMI and the risk of death among more than 1.1 million persons recruited in 19 cohorts in Asia. The analyses included approximately 120,700 deaths that occurred during a mean follow-up period of 9.2 years. Cox regression models were used to adjust for confounding factors.
In the cohorts of East Asians, including Chinese, Japanese, and Koreans, the lowest risk of death was seen among persons with a BMI (the weight in kilograms divided by the square of the height in meters) in the range of 22.6 to 27.5. The risk was elevated among persons with BMI levels either higher or lower than that range--by a factor of up to 1.5 among those with a BMI of more than 35.0 and by a factor of 2.8 among those with a BMI of 15.0 or less. A similar U-shaped association was seen between BMI and the risks of death from cancer, from cardiovascular diseases, and from other causes. In the cohorts comprising Indians and Bangladeshis, the risks of death from any cause and from causes other than cancer or cardiovascular disease were increased among persons with a BMI of 20.0 or less, as compared with those with a BMI of 22.6 to 25.0, whereas there was no excess risk of either death from any cause or cause-specific death associated with a high BMI.
Underweight was associated with a substantially increased risk of death in all Asian populations. The excess risk of death associated with a high BMI, however, was seen among East Asians but not among Indians and Bangladeshis.

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Available from: Keitaro Matsuo, Oct 04, 2015
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    • "These prevalence rates reflect a progressive upward shift in the distribution of BMI across all populations. Excess body weight has been associated with an increased risk for chronic diseases including cardiovascular disease, diabetes, many forms of cancer, and numerous musculoskeletal problems [2] [3]. Further, it puts a significant economic burden on the society by contributing to significant medical costs [4] [5]. "
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    ABSTRACT: The purpose of this study was to examine differences in total daily energy expenditure (TDEE), energy expenditure in various intensities, as well as total daily energy intake (TDEI) and diet quality in normal weight, overweight and obese men and women. Further, the association of energy expenditure and energy intake with body fatness was examined. The cross-sectional analysis included 430 adults (27.7±3.8 years; 49.3% male). Body weight and height were measured according to standard procedures and percent body fat (BF) was assessed via dual X-ray absorptiometry. Energy expenditure was determined via the SenseWear Armband. Energy intake and the Healthy Eating Index (HEI) were calculated based on multiple 24-h recalls. Weight adjusted TDEI and TDEE were significantly lower in overweight and obese adults compared to their normal weight peers (p<0.001) and obese women had a lower HEI (p=0.006). Overweight and obese adults further displayed a higher proportion of energy expenditure spent in sedentary and in light activities (p<0.001), while the proportion of energy expenditure in moderate-to-vigorous physical activity (MVPA) was lower compared to their normal weight peers (p<0.001). The inverse relationship between BMI or BF and MVPA was stronger than the positive association between BMI or BF and the proportion of energy expended in sedentary or light pursuits (rMPA=-0.45 to -0.67/rMVPA=-0.51 to -0.66 vs. rSedentary=0.33 to 0.52/rlight=0.36 to 0.47; p<0.001). These findings emphasise the importance of MPA and bouts of MVPA regarding the maintenance of a normal body weight. Copyright © 2015 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
    Obesity Research & Clinical Practice 04/2015; DOI:10.1016/j.orcp.2015.03.007 · 1.18 Impact Factor
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    • "In a pooled analysis of 10 prospective cohort studies, risk of mortality increased with BMI values that were 30 kg/m 2 or greater in Asian Americans, with authors concluding that modified cutoffs may not be warranted in Asian American populations (Park et al., 2014). A pooled analysis across 20 prospective studies (the Asia Cohort Consortium) demonstrated that there was increased risk of cardiovascular disease at BMI values of 25 kg/m 2 in East Asians (Chinese, Japanese, Korean), but not in South Asians (Indians, Bangladeshi) (Chen et al., 2013; Zheng et al., 2011). Despite the lack of a formal recommendation and given a lack of evidence to the contrary, study authors have incorporated these modified cutoffs into their analyses of Asian Americans to highlight potential disparities across Asian subgroups and race/ethnicity (Jih et al., 2014; Maxwell et al., 2012). "
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    ABSTRACT: According to national estimates, obesity prevalence is lower in Asian Americans compared to other racial/ethnic groups, but this low prevalence may be misleading for three reasons. First, while a lower body mass index (BMI) cutoff as proposed by the World Health Organization may be more appropriate to use in Asian populations, evidence is limited to substantiate the potential costs and burden of adopting these cutoffs. Increasing BMI in Asians (as in other racial/ethnic groups) should be considered across the spectrum of BMI, with a minimum awareness of these modified cutoffs among healthcare researchers. Second, the need for disaggregated data across Asian American subgroups is illustrated by the higher obesity (and diabetes) prevalence estimates observed in South Asian Americans. Third, prevalence of obesity should be placed in the larger context of immigration and globalization through cross-national comparisons and examination of acculturation-related factors. However these types of studies and collection of salient variables are not routinely performed. Data from a metropolitan area where many Asian Americans settle is presented as a case study to illustrate these points. Clear evidence that incorporates these three considerations is necessary for program planning and resource allocation for obesity-related disparities in this rapidly growing and diverse population.
    Preventive Medicine 01/2015; 73. DOI:10.1016/j.ypmed.2015.01.007 · 3.09 Impact Factor
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    • "The results of their study showed that high BMI is a risk factor for overall cancer mortality, but they did not have measures of CRF for adjustment. Recently, Zheng et al. investigated the relation between BMI and mortality in a pooled analysis of more then 1.1 million Asians [23]. They reported a J-shaped association between BMI and the risk of cancer death in East Asians. "
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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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