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. 2018 Nov 2;1(7):e184587.
doi: 10.1001/jamanetworkopen.2018.4587.

Association of Obesity With Mortality Over 24 Years of Weight History: Findings From the Framingham Heart Study

Hanfei Xu  1 , L Adrienne Cupples  1   2 , Andrew Stokes  3 , Ching-Ti Liu  1
Affiliations

Association of Obesity With Mortality Over 24 Years of Weight History: Findings From the Framingham Heart Study

Hanfei Xu et al. JAMA Netw Open. .

Erratum in

  • Erroneous Word in Methods Section.
    [No authors listed] [No authors listed] JAMA Netw Open. 2018 Dec 7;1(8):e186657. doi: 10.1001/jamanetworkopen.2018.6657. JAMA Netw Open. 2018. PMID: 30646270 Free PMC article. No abstract available.

Abstract

Importance: Many studies of the association between obesity and mortality rely on weight status at a single point in time, making it difficult to adequately address bias associated with reverse causality.

Objective: To investigate the association between maximum body mass index (BMI) and all-cause mortality without the consequences of reverse causality.

Design, setting, and participants: Prospective cohort studies for the original and offspring cohorts of the Framingham Heart Study. The follow-up period started from baseline examination 13 for the original cohort and from baseline examination 6 for the offspring cohort and ended December 31, 2014. The analyses were conducted in 2017. Participants were 6197 individuals with 3478 deaths during a mean of 17 years of follow-up.

Main outcomes and measures: Maximum BMI over 24 years of weight history before the beginning of follow-up for all-cause mortality and cause-specific mortality. All-cause mortality and cause-specific mortality (deaths due to cardiovascular disease, cancer, or other causes).

Results: Among 6197 participants (mean [SD] age at baseline, 62.79 [8.98] years; 55.5% female), 3478 (56.1%) died during the follow-up. A monotonic association was observed between maximum BMI and mortality, with increasing risks observed across obese I (BMI of 30 to <35; hazard ratio [HR], 1.27; 95% CI, 1.14-1.41) and obese II (BMI of 35 to <40; HR, 1.93; 95% CI, 1.68-2.20) categories. A significant association was not observed for the overweight category (BMI of 25 to <30; HR, 1.08; 95% CI, 0.99-1.18). Among never smokers, the risks increased, with a significant association emerging for individuals with maximum BMI in the overweight range (HR, 1.31; 95% CI, 1.13-1.51). The mortality rates of normal-weight individuals who were formerly overweight or obese were 47.48 and 66.67 per 1000 person-years, respectively, while individuals who never exceeded normal weight had a mortality rate of 27.93 per 1000 person-years.

Conclusions and relevance: A monotonic association was found between maximum BMI over 24 years of weight history and subsequent all-cause mortality. Maximum BMI in the normal-weight range was associated with the lowest risk of mortality in this cohort, highlighting the importance of obesity prevention.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Cupples reported receiving funds from the Veterans Administration; reported receiving personal fees from Boston Heart Diagnostics and The Dyslipidemia Foundation outside of the present work; and reported receiving grants from the National Heart, Lung, and Blood Institute of the National Institutes of Health during the conduct of the study. Dr Stokes reported receiving research grants from Johnson & Johnson outside of the present work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Diagram of the Study Design
Shown are the original cohort (A) and offspring cohort (B) of the Framingham Heart Study. BMI indicates body mass index.
Figure 2.
Figure 2.. Kaplan-Meier Curves for Categories of Maximum BMI
For numbers at risk, maximum body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is categorized as normal (18.5 to <25), overweight (25 to <30), obese I (30 to <35), or obese II (35 to <40).
Figure 3.
Figure 3.. Mortality Rates for Individuals Who Were Normal Weight at Baseline, Stratified by Maximum Body Mass Index
See this image and copyright information in PMC

Comment in

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