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. 2012 Mar;24(2):191-211.
doi: 10.1177/0898264311406268. Epub 2011 May 10.

Shape of the BMI-mortality association by cause of death, using generalized additive models: NHIS 1986-2006

Anna Zajacova  1 , Sarah A Burgard
Affiliations

Shape of the BMI-mortality association by cause of death, using generalized additive models: NHIS 1986-2006

Anna Zajacova et al. J Aging Health. 2012 Mar.

Abstract

Objective: Numerous studies have examined the association between body mass index (BMI) and mortality. The precise shape of their association, however, has not been established. We use nonparametric methods to determine the relationship between BMI and mortality.

Method: Data from the National Health Interview Survey-Linked Mortality Files 1986-2006 for adults aged 50 to 80 are analyzed using a Poisson approach to survival modeling within the generalized additive model (GAM) framework.

Results: The BMI-mortality association is more V shaped than U shaped, with the odds of dying rising steeply from the lowest risk point at BMIs of 23 to 26. The association varies considerably by time since interview and cause of death. For instance, the association has an inverted J shape for respiratory causes but is monotonically increasing for diabetes deaths.

Discussion: Our findings have implications for interpreting results from BMI-mortality studies and suggest caution in translating the findings into public health messages.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Comparison of results from GAM and GLM Poisson models of all-cause mortality as a function of BMI. In the first row (Panel A for men and Panel B for women), the shape of the BMI mortality association is freely estimated from the data. In the second row (Panel C for men and Panel D for women), the functional form for BMI is specified to be quadratic, in accordance with previous literature
Figure 2
Figure 2. The association between BMI and all-cause mortality across the duration of follow-up time, for men (Panel A) and women (Panel B)
Figure 3A
Figure 3A. The association between BMI and cause-specific mortality for selected causes of death, for men
Figure 3B
Figure 3B. The association between BMI and cause-specific mortality for selected causes of death, for women
See this image and copyright information in PMC

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