Body mass index and mortality in men: evaluating the shape of the association

Gelber, Rebecca P.; Kurth, Tobias; Manson, JoAnn E.; Buring, Julie E.; Gaziano, J. Michael

doi:10.1038/sj.ijo.0803564

Cited by 53 publications

(43 citation statements)

References 40 publications

(41 reference statements)

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“…Several previous studies have also demonstrated varying associations between BMI and mortality depending on the analytic approaches used. 5,6,[12][13][14][15][16][17] For example, in the Nurses' Health Study, a J-shaped association was observed in an initial analysis of the entire cohort; however, as seen in our study, a clear linear association emerged in a separate analysis that excluded ever smokers, early deaths and those with significant weight change. 12 In the National Institutes of Health-AARP Diet and Health Study, similar to our finding, BMI at the age of 50 years showed a much stronger positive association with mortality than BMI at study baseline when participants were 50-71 years old.…”

Section: Bmi At Various Ages and Mortality In Chinese Women X Zhang Esupporting

confidence: 38%

Body mass index at various ages and mortality in Chinese women: impact of potential methodological biases

et al. 2008

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Background: Inadequate control for potential methodological biases has been suggested as an explanation for the conflicting findings concerning the relationship between body mass index (BMI) and mortality. Methods: Using data from the Shanghai Women's Health Study, a prospective cohort study conducted in a relatively lean population, we examined the associations of BMI at various ages and average adult BMI with mortality and evaluated the impact of potential biases related to preexisting illness and cigarette smoking on the associations. Included in the analysis were 74 896 women aged 40-70 years with anthropometrics taken by trained interviewers at baseline (1996)(1997)(1998)(1999)(2000). Recalled body sizes at ages 20 and 50 years were also obtained for older women. Participants were followed through April 2007 by biennial home visits and linkage with the vital statistics registry. Results: During a mean follow-up of 7.4 years, 2389 deaths occurred. In initial analyses, both low and high levels of baseline BMI were associated with an increase in mortality, whereas mortality increased monotonically with increasing levels of average adult BMI, BMI at the age of 50 years and, to a lesser extent, BMI at the age of 20 years. A direct monotonic relationship between baseline BMI and mortality emerged after accounting for potential biases. Controlling for potential biases also strengthened the positive associations of average adult BMI and BMI at ages 20 and 50 years with mortality, with a hazard ratio comparing the highest vs the lowest quartiles of average adult BMI reaching 2.19 (95% CI, 1.67-2.88). Conclusion: High BMI during adulthood consistently predicts mortality risk after accounting for potential biases.

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Section: Bmi At Various Ages and Mortality In Chinese Women X Zhang Esupporting

confidence: 38%

Body mass index at various ages and mortality in Chinese women: impact of potential methodological biases

et al. 2008

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“…33 Conversely, overweight/obesity has been found to confer greater odds for the development of the previously mentioned risk factors. 35,36 Co-occurrence of psychosocial stress and overweight/obesity has indeed conferred greater odds for CVD risk factors as observed in this study. Accordingly, as the constellation of risk factors increases, so does the risk of disease.…”

Section: Discussionsupporting

confidence: 69%

Effect of co-occurrence of overweight/obesity and psychosocial stress dimensions on risk factors for cardiovascular disease among construction workers

Ekpenyong

Davies

2016

Int J Community Med Public Health

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“…18 Another important consideration is potential overcontrolling by adjustment for weight-related risk factors. 9,19 If BMI contributes to the development of a risk factor (eg, type 2 diabetes mellitus or systemic hypertension), statistical adjustment for such risk factors is misleading with regard to the contribution of BMI. What remains after adjustment is only the residual association of BMI to the outcome, which is not mediated through the weight-related risk factors included in the model.…”

Section: Methodological and Conceptual Issuesmentioning

confidence: 99%

Mortality, Health Outcomes, and Body Mass Index in the Overweight Range

Lewis¹,

McTigue²,

Burke³

et al. 2009

Circulation

159

116

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H ealth hazards of obesity have been recognized for centuries, appearing, for example, in writings attributed to Hippocrates. From the later decades of the 20th century through the present, there have been numerous epidemiological studies of the relationship between excess weight and the total, or all-cause, mortality rate, 1 a critical cumulative measure of the public health impact of any health condition. Using body mass index (BMI), an indicator of relative weight for height (weight [kg]/height [m] 2 ) and a frequently used surrogate for assessment of excess body fat, these studies have found linear, U-shaped, or J-shaped relationships between total mortality and BMI. That is, in some studies, both the thin and the obese were more likely to die than those in between. There is, however, always a point at which increasing BMI is associated with increasing mortality risk, but the BMI at which this occurs varies across studies and populations. 2 Currently, 3 overweight in adults is defined as a BMI of 25.0 to Ͻ30.0 kg/m 2 and obesity as a BMI of Ն30.0 kg/m 2 (Table 1). A number of studies have found no significant relationship between BMI in the overweight range and mortality rate 4 and have shown the nadir of mortality risk to be in the overweight range. In particular, commentaries in both the lay press 5-7 and scientific literature 2,8,9 subsequent to recent reports from National Health and Nutrition Examination Surveys (NHANES) 10,11 have highlighted the confusion and controversy regarding this issue. Some have interpreted the recent data to mean that overweight is not detrimental to health and is not in itself a public health concern and that drawing attention to the need for weight loss in this range will have negative effects on the health and well-being of the general population. 8 Others have argued that the overweight range of BMI harbors substantial health risk 9 and is also a pipeline for later obesity, so that aggressive public health interventions are warranted. The purpose of the present science advisory is to briefly review and place into context the potential health implications of overweight as distinct from obesity. Clarity on this issue is particularly important given the substantial proportion of the population in the overweight range. Although this advisory discusses the important issue of the BMI-total mortality relationship, it also broadens the topic to include other important considerations, such as outcomes besides total mortality.We begin with a brief review of population-wide weight trends, then of key methodological issues that influence the evaluation and comparison of studies that attempt to link overweight with mortality, and then we describe selected recent studies to illustrate the potential for drawing conflicting conclusions. The discussion that follows highlights possible differences in the association of BMI and total mortality rate by age, ethnicity, or sex; how body fat distribution may modify the association; and the need to incorporate other considerations, including ho...

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Body mass index and mortality in men: evaluating the shape of the association

Cited by 53 publications

References 40 publications

Body mass index at various ages and mortality in Chinese women: impact of potential methodological biases

Body mass index at various ages and mortality in Chinese women: impact of potential methodological biases

Effect of co-occurrence of overweight/obesity and psychosocial stress dimensions on risk factors for cardiovascular disease among construction workers

Mortality, Health Outcomes, and Body Mass Index in the Overweight Range

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