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. 2017 May 2;166(9):613-620.
doi: 10.7326/M16-1390. Epub 2017 Apr 4.

Weight History and All-Cause and Cause-Specific Mortality in Three Prospective Cohort Studies

Edward Yu  1 , Sylvia H Ley  1 , JoAnn E Manson  1 , Walter Willett  1 , Ambika Satija  1 , Frank B Hu  1 , Andrew Stokes  1
Affiliations

Weight History and All-Cause and Cause-Specific Mortality in Three Prospective Cohort Studies

Edward Yu et al. Ann Intern Med. .

Abstract

Background: The relationship between body mass index (BMI) and mortality is controversial.

Objective: To investigate the relationship between maximum BMI over 16 years and subsequent mortality.

Design: 3 prospective cohort studies.

Setting: Nurses' Health Study I and II and Health Professionals Follow-Up Study.

Participants: 225 072 men and women with 32 571 deaths observed over a mean of 12.3 years of follow-up.

Measurements: Maximum BMI over 16 years of weight history and all-cause and cause-specific mortality.

Results: Maximum BMIs in the overweight (25.0 to 29.9 kg/m2) (multivariate hazard ratio [HR], 1.06 [95% CI, 1.03 to 1.08]), obese I (30.0 to 34.9 kg/m2) (HR, 1.24 [CI, 1.20 to 1.29]), and obese II (≥35.0 kg/m2) (HR, 1.73 [CI, 1.66 to 1.80]) categories were associated with increases in risk for all-cause death. The pattern of excess risk with a maximum BMI above normal weight was maintained across strata defined by smoking status, sex, and age, but the excess was greatest among those younger than 70 years and never-smokers. In contrast, a significant inverse association between overweight and mortality (HR, 0.96 [CI, 0.94 to 0.99]) was observed when BMI was defined using a single baseline measurement. Maximum overweight was also associated with increased cause-specific mortality, including death from cardiovascular disease and coronary heart disease.

Limitation: Residual confounding and misclassification.

Conclusion: The paradoxical association between overweight and mortality is reversed in analyses incorporating weight history. Maximum BMI may be a useful metric to minimize reverse causation bias associated with a single baseline BMI assessment.

Primary funding source: National Institutes of Health.

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Figures

FIGURE 1
FIGURE 1
Graph comparing hazard ratios for maximum BMI with 16 years of weight history and baseline BMI among all individuals.
FIGURE 2
FIGURE 2
Graph comparing hazard ratios for maximum BMI with 16 years of weight history and baseline BMI among never-smokers.
See this image and copyright information in PMC

Comment in

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