Body-mass index and mortality among 1.46 million white adults
- PMID: 21121834
- PMCID: PMC3066051
- DOI: 10.1056/NEJMoa1000367
Body-mass index and mortality among 1.46 million white adults
Erratum in
- N Engl J Med. 2011 Sep 1;365(9):869
Abstract
Background: A high body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) is associated with increased mortality from cardiovascular disease and certain cancers, but the precise relationship between BMI and all-cause mortality remains uncertain.
Methods: We used Cox regression to estimate hazard ratios and 95% confidence intervals for an association between BMI and all-cause mortality, adjusting for age, study, physical activity, alcohol consumption, education, and marital status in pooled data from 19 prospective studies encompassing 1.46 million white adults, 19 to 84 years of age (median, 58).
Results: The median baseline BMI was 26.2. During a median follow-up period of 10 years (range, 5 to 28), 160,087 deaths were identified. Among healthy participants who never smoked, there was a J-shaped relationship between BMI and all-cause mortality. With a BMI of 22.5 to 24.9 as the reference category, hazard ratios among women were 1.47 (95 percent confidence interval [CI], 1.33 to 1.62) for a BMI of 15.0 to 18.4; 1.14 (95% CI, 1.07 to 1.22) for a BMI of 18.5 to 19.9; 1.00 (95% CI, 0.96 to 1.04) for a BMI of 20.0 to 22.4; 1.13 (95% CI, 1.09 to 1.17) for a BMI of 25.0 to 29.9; 1.44 (95% CI, 1.38 to 1.50) for a BMI of 30.0 to 34.9; 1.88 (95% CI, 1.77 to 2.00) for a BMI of 35.0 to 39.9; and 2.51 (95% CI, 2.30 to 2.73) for a BMI of 40.0 to 49.9. In general, the hazard ratios for the men were similar. Hazard ratios for a BMI below 20.0 were attenuated with longer-term follow-up.
Conclusions: In white adults, overweight and obesity (and possibly underweight) are associated with increased all-cause mortality. All-cause mortality is generally lowest with a BMI of 20.0 to 24.9.
Conflict of interest statement
Dr. Sesso reports receiving consulting fees from Iovate Health Sciences USA. No other potential conflict of interest relevant to this article was reported.
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Comment in
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Body-mass index and mortality among white adults.N Engl J Med. 2011 Feb 24;364(8):782; author reply 782-3. doi: 10.1056/NEJMc1014730. N Engl J Med. 2011. PMID: 21345119 No abstract available.
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Body-mass index and mortality among white adults.N Engl J Med. 2011 Feb 24;364(8):781-2; author reply 782-3. doi: 10.1056/NEJMc1014730. N Engl J Med. 2011. PMID: 21345120 No abstract available.
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Body-mass index and mortality among white adults.N Engl J Med. 2011 Feb 24;364(8):781; author reply 782-3. doi: 10.1056/NEJMc1014730. N Engl J Med. 2011. PMID: 21345121 No abstract available.
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