title: Body mass index and mortality from ischaemic heart disease in a lean population: 10 year prospective study of 220,000 adult men.
abstract: BACKGROUND
  Increased body mass index (BMI) is known to be related to ischaemic heart disease (IHD) in populations where many are overweight (BMI>or=25 kg/m2) or obese (BMI>or=30). Substantial uncertainty remains, however, about the relationship between BMI and IHD in populations with lower BMI levels.
  
  
  METHODS
  We examined the data from a population-based, prospective cohort study of 222,000 Chinese men aged 40-79. Relative and absolute risks of death from IHD by baseline BMI were calculated, standardized for age, smoking, and other potential confounding factors.
  
  
  RESULTS
  The mean baseline BMI was 21.7 kg/m2, and 1942 IHD deaths were recorded during 10 years of follow-up (6.5% of all such deaths). Among men without prior vascular diseases at baseline, there was a J-shaped association between BMI and IHD mortality. Above 20 kg/m2 there was a positive association of BMI with risk, with each 2 kg/m2 higher in usual BMI associated with 12% (95% CI 6-19%, 2P=0.0001) higher IHD mortality. Below this BMI range, however, the association appeared to be reversed, with risk ratios of 1.00, 1.09, and 1.15, respectively, for men with BMI 20-21.9, 18-19.9, and <18 kg/m2. The excess IHD risk observed at low BMI levels persisted after restricting analysis to never smokers or excluding the first 3 years of follow-up, and became about twice as great after allowing for blood pressure.
  
  
  CONCLUSIONS
  Lower BMI is associated with lower IHD risk among people in the so-called normal range of BMI values (20-25 kg/m2), but below that range the association may well be reversed.
authors.affiliation: Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Radcliffe Infirmary, University of Oxford, UK. zhengming.chen@ctsu.ox.ac.uk
authors.forename: Zhengming
authors.initials: Z
authors.lastname: Chen
authors.forename: Gonghuan
authors.initials: G
authors.lastname: Yang
authors.forename: Maigeng
authors.initials: M
authors.lastname: Zhou
authors.forename: Margaret
authors.initials: M
authors.lastname: Smith
authors.forename: Alison
authors.initials: A
authors.lastname: Offer
authors.forename: Jieming
authors.initials: J
authors.lastname: Ma
authors.forename: Lijun
authors.initials: L
authors.lastname: Wang
authors.forename: Hongchao
authors.initials: H
authors.lastname: Pan
authors.forename: Gary
authors.initials: G
authors.lastname: Whitlock
authors.forename: Rory
authors.initials: R
authors.lastname: Collins
authors.forename: Shiru
authors.initials: S
authors.lastname: Niu
authors.forename: Richard
authors.initials: R
authors.lastname: Peto
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D015992:Body Mass Index; D002423:Cause of Death; D002681:China / Q000453:epidemiology; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality* / Q000503:physiopathology*; D009765:Obesity / Q000150:complications; D012907:Smoking / Q000009:adverse effects; D013851:Thinness / Q000401:mortality*