title: Body mass index and mortality among US male physicians.
abstract: OBJECTIVE
  To assess the relationship between body mass index and mortality in a population homogeneous in educational attainment and socioeconomic status.
  
  
  METHODS
  We analyzed the association between body mass index (BMI) and both all-cause and cause-specific mortality among 85,078 men aged 40 to 84 years from the Physicians' Health Study enrollment cohort.
  
  
  RESULTS
  During 5 years of follow-up, we documented 2856 deaths (including 1212 due to cardiovascular diseases and 891 due to cancer). In age-adjusted analyses, we observed a U-shaped relation between BMI and all-cause mortality; among men who never smoked a linear relation was observed with no increase in mortality among leaner men (P for trend, <0.001). Among never smokers, in multivariate analyses adjusted for age, alcohol intake, and physical activity, the relative risks of all-cause mortality increased in a stepwise fashion with increasing BMI. Excluding the first 2 years of follow-up further strengthened the association (multivariate relative risks, from BMI<20 to > or = 30 kg/m2, were 0.93, 1.00, 1.00, 1.16, 1.45, and 1.71 [P for trend, <0.001]). In all age strata (40-54, 55-69, and 70-84 years), never smokers with BMIs of 30 or greater had approximately a 70% increased risk of death compared with the referent group (BMI 22.5-24.9). Higher levels of BMI were also strongly related to increased risk of cardiovascular mortality, regardless of physical activity level (P for trend, <0.01).
  
  
  CONCLUSIONS
  All-cause and cardiovascular mortality was directly related to BMI among middle-aged and elderly men. Advancing age did not attenuate the increased risk of death associated with obesity. Lean men (BMI<20) did not have excess mortality, regardless of age.
authors.affiliation: Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Umed A
authors.initials: UA
authors.lastname: Ajani
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Lotufo
authors.forename: J Michael
authors.initials: JM
authors.lastname: Gaziano
authors.forename: I-Min
authors.initials: IM
authors.lastname: Lee
authors.forename: Angela
authors.initials: A
authors.lastname: Spelsberg
authors.forename: Julie E
authors.initials: JE
authors.lastname: Buring
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.forename: Joann E
authors.initials: JE
authors.lastname: Manson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010820:Physicians; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D014481:United States