Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies

Whitlock, Gary; Lewington, Sarah; Sherliker, Paul; Clarke, Robert; Emberson, Jonathan; Halsey, Jim; Qizilbash, Nawab; Collins, Rory; Pető, Richárd

doi:10.1016/s0140-6736(09)60318-4

Cited by 3,711 publications

(1,450 citation statements)

References 34 publications

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“…In an analysis of >800 000 participants, obesity was associated with elevated mortality mainly due to cardiovascular causes 26. The underlying biological mechanisms are not fully clear yet 27.…”

Section: Discussionmentioning

confidence: 99%

Obesity Is Associated With Progression of Atherosclerosis During Statin Treatment

Sandfort

Lai²,

Ahlman

et al. 2016

JAHA

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BackgroundThis study aimed to determine the relationship of statin therapy and cardiovascular risk factors to changes in atherosclerosis in the carotid artery.Methods and ResultsCarotid magnetic resonance imaging was used to evaluate 106 hyperlipidemic participants at baseline and after 12 months of 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase inhibitor (statin) treatment. Multivariable logistic regression was used to determine factors associated with progression (change in carotid wall volume >0) or regression (change ≤0) of carotid atherosclerosis. Computed tomography coronary calcium scores were obtained at baseline for all participants. The median age was 65 years (interquartile range 60–69 years), and 63% of the participants were male. Body mass index >30, elevated C‐reactive protein, and hypertension were associated with increased carotid wall volume (obesity: odds ratio for progression 4.6, 95% CI 1.8–12.4, P<0.01; C‐reactive protein: odds ratio for progression 2.56, 95% CI 1.17–5.73, P=0.02; hypertension: odds ratio 2.4, 95% CI 1.1–5.3, P<0.05). Higher statin dose was associated with regression of carotid wall volume (P<0.05). In multivariable analysis, obesity remained associated with progression (P<0.01), whereas statin use remained associated with regression (P<0.05). Change in atheroma volume in obese participants was +4.8% versus −4.2% in nonobese participants (P<0.05) despite greater low‐density lipoprotein cholesterol reduction in obese participants.ConclusionsIn a population with hyperlipidemia, obese patients showed atheroma progression despite optimized statin therapy.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01212900.

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Section: Discussionmentioning

confidence: 99%

Obesity Is Associated With Progression of Atherosclerosis During Statin Treatment

Sandfort

Lai²,

Ahlman

et al. 2016

JAHA

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“…6 7 A recent meta-analysis of 97 studies using standard BMI categories reported that relative to normal weight (BMI 18.5-<25), all cause mortality was increased for obesity (BMI ≥30) but was decreased for overweight (BMI 25-29) 8. These data are far from conclusive owing to methodological limitations, particularly reverse causation by pre-existing illness and confounding by smoking, which may have contributed to the inverse association between overweight and mortality 9…”

Section: Introductionmentioning

confidence: 99%

Trajectory of body shape in early and middle life and all cause and cause specific mortality: results from two prospective US cohort studies

Song

et al. 2016

BMJ

102

101

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Objective To assess body shape trajectories in early and middle life in relation to risk of mortality.Design Prospective cohort study.Setting Nurses’ Health Study and Health Professionals Follow-up Study.Population 80 266 women and 36 622 men who recalled their body shape at ages 5, 10, 20, 30, and 40 years and provided body mass index at age 50, followed from age 60 over a median of 15-16 years for death.Main outcome measures All cause and cause specific mortality.Results Using a group based modeling approach, five distinct trajectories of body shape from age 5 to 50 were identified: lean-stable, lean-moderate increase, lean-marked increase, medium-stable/increase, and heavy-stable/increase. The lean-stable group was used as the reference. Among never smokers, the multivariable adjusted hazard ratio for death from any cause was 1.08 (95% confidence interval 1.02 to 1.14) for women and 0.95 (0.88 to 1.03) for men in the lean-moderate increase group, 1.43 (1.33 to 1.54) for women and 1.11 (1.02 to 1.20) for men in the lean-marked increase group, 1.04 (0.97 to 1.12) for women and 1.01 (0.94 to 1.09) for men in the medium-stable/increase group, and 1.64 (1.49 to 1.81) for women and 1.19 (1.08 to 1.32) for men in the heavy-stable/increase group. For cause specific mortality, participants in the heavy-stable/increase group had the highest risk, with a hazard ratio among never smokers of 2.30 (1.88 to 2.81) in women and 1.45 (1.23 to 1.72) in men for cardiovascular disease, 1.37 (1.14 to 1.65) in women and 1.07 (0.89 to 1.30) in men for cancer, and 1.59 (1.38 to 1.82) in women and 1.10 (0.95 to 1.29) in men for other causes. The trajectory-mortality association was generally weaker among ever smokers than among never smokers (for all cause mortality: P for interaction <0.001 in women and 0.06 in men). When participants were classified jointly according to trajectories and history of type 2 diabetes, the increased risk of death associated with heavier body shape trajectories was more pronounced among participants with type 2 diabetes than those without diabetes, and those in the heavy-stable/increase trajectory and with a history of diabetes had the highest risk of death.Conclusions Using the trajectory approach, we found that heavy body shape from age 5 up to 50, especially the increase in middle life, was associated with higher mortality. In contrast, people who maintained a stably lean body shape had the lowest mortality. These results indicate the importance of weight management across the lifespan.

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“…HRs and 95% CIs are presented in the figures so that they illustrate the absolute excess risk at different levels of BMI 2, 14. This was achieved by multiplying HRs by a common factor so that the inverse‐variance weighted average of the HRs matched the annual incidence of major vascular events in this cohort (Table S3).…”

Section: Methodsmentioning

confidence: 99%

“…Body mass index (BMI) is a commonly used measure of general adiposity and an established risk factor for vascular disease 1, 2, 3. Despite this, the association between BMI and incidence of major vascular events in older adults has not been well described.…”

Section: Introductionmentioning

confidence: 99%

“…Large studies of mainly middle‐aged adults have reported a J‐shaped association between BMI and major vascular events with the lowest risk in the normal BMI range 2, 3. The association in older adults (here defined as ≥65 years) is less well established, with some studies indicating that the optimal BMI range may be higher than for middle‐aged adults, whereas others report a more U‐shaped association with increased risk at the extremes of BMI only (ie, underweight or very obese) 5, 6, 7…”

Section: Introductionmentioning

confidence: 99%

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Body Mass Index and Vascular Disease in Men Aged 65 Years and Over: HIMS (Health In Men Study)

Lacey

Yeap

Golledge

et al. 2017

JAHA

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BackgroundUnderstanding the relationship between body mass index (BMI) and vascular disease at older age has become increasingly important in the many countries where both average age and BMI are rising.Methods and ResultsIn this prospective cohort study, 12 203 men (aged ≥65) were recruited in 1996–1999 from the general population in Perth, Australia. To limit reverse causality, analyses excluded those with past vascular disease and the first 4 years of follow‐up. During a further 8 (SD3) years of follow‐up, there were 1136 first‐ever major vascular events (nonfatal myocardial infarction, nonfatal stroke, or death from any vascular cause). Cox regression (adjusted for age, education, and smoking) related BMI at recruitment to incidence of major vascular events. At ages 65 to 94, the lowest risk of major vascular events was at ≈ 22.5 to 25 kg/m2. In the higher BMI range (≥25 kg/m2), 5 kg/m2 higher BMI was associated with 33% higher risk of major vascular events (hazard ratio, 1.33 [95% confidence interval, 1.18–1.49]): 24% higher risk of ischemic heart disease (1.24 [1.06–1.46]); 34% higher risk of stroke (1.34 [1.11–1.63]); and 78% higher risk of other vascular death (1.78 [1.32–2.41]). In the lower BMI range, there were fewer events and no strong evidence of an association (hazard ratio per 5 kg/m2 higher BMI, 0.82 [95% confidence interval, 0.61–1.12]).ConclusionsIn this population of older men, risk of major vascular events was lowest at ≈ 22.5 to 25 kg/m2. Above this range, BMI was strongly related to incidence of major vascular events, with each 5 kg/m2 higher BMI associated with ≈30% higher risk.

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Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies

Cited by 3,711 publications

References 34 publications

Obesity Is Associated With Progression of Atherosclerosis During Statin Treatment

Obesity Is Associated With Progression of Atherosclerosis During Statin Treatment

Trajectory of body shape in early and middle life and all cause and cause specific mortality: results from two prospective US cohort studies

Body Mass Index and Vascular Disease in Men Aged 65 Years and Over: HIMS (Health In Men Study)

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