BMI and mortality

This is a major review of a very important topic and the mortality and morbidity associated with obesity. The main associations of body-mass index (BMI) with overall and cause-specific mortality can best be assessed by long-term prospective follow-up of large numbers of people. The Prospective Studies Collaboration examined these associations by sharing data from many studies.
Collaborative analyses were undertaken of baseline BMI versus mortality in 57 prospective studies with 894576 participants, mostly in western Europe and North America (61% [n=541452] male, mean recruitment age 46 [SD 11] years, median recruitment year 1979 [IQR 1975-85], mean BMI 25 [SD 4] kg/m2). The analyses were adjusted for age, sex, smoking status, and study. To limit reverse causality, the first 5 years of follow-up were excluded, leaving 66552 deaths of known cause during a mean of 8 (SD 6) further years of follow-up (mean age at death 67 [SD 10] years): 30416 vascular; 2070 diabetic, renal or hepatic; 22592 neoplastic; 3770 respiratory; 7704 other.
In both sexes, mortality was lowest at about 22·5-25 kg/m2. Above this range, positive associations were recorded for several specific causes and inverse associations for none, the absolute excess risks for higher BMI and smoking were roughly additive, and each 5 kg/m2 higher BMI was on average associated with about 30% higher overall mortality (hazard ratio per 5 kg/m2 [HR] 1·29 [95% Cl 1.27-1·32]): 40% for vascular mortality (HR 1·41 [1·37-1·45]); 60-120% for diabetic, renal, and hepatic mortality (HRs 2·16 [1·89-2.46], 1·59 [1·27-1·99], and 1· 82 [1. 59-2·09], respectively); 10% for neoplastic mortality (HR 1·10 [1· 06-1·15]); and 20% for respiratory and for all other mortality (HRs 1· 20 [1·07-1·34] and 1·20 [1·16-1·25], respectively). Below the range 22· 5-25 kg/m2, BMI was associated inversely with overall mortality, mainly because of strong inverse associations with respiratory disease and lung cancer. These inverse associations were much stronger for smokers than for non-smokers, despite cigarette consumption per smoker varying little with BM!.
Although other measures (eg, waist circumference, waist-to-hip ratio) could well add extra information to BMI, and BMI to them, BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22·5-25 kg/m2. The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal. At 30-35 kg/m2, median survival is reduced by 2-4 years; at 40-45 k/jm2, it is reduced by 8-10 years (which is comparable with the effects of smoking). The definite excess mortality below 22·5 kg/m2 is due mainly to smoking-related diseases, and is not fully explained.
Prospective Studies Collaboration 2009 Body-mass index and cause-specific mortality in 900000 adults: collaborative analyses of 57 prospective studies Lancet vol 373 pp 1083-1096
And a eview
Lopez-Jiminez 2009 Speakable and unspeakable facts abut BMI and mortality Lancert vol 373 pp 1055 – 1056

Martin Eastwood
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