Body weight and mortality among men and women in China.
BACKGROUND
The effect of underweight and obesity on mortality has not been well characterized in Asian populations.


OBJECTIVE
To examine the relationship between body mass index (BMI) and mortality in Chinese adults.


METHODS
A prospective cohort study in a nationally representative sample of 169,871 Chinese men and women aged 40 years or older. Data on body weight and covariables were obtained at a baseline examination in 1991 using a standard protocol. Follow-up evaluation was conducted in 1999-2000, with a response rate of 93.4% (n = 158,666).


METHODS
Body mass index and all-cause mortality.


RESULTS
After excluding those participants with missing body weight or height values, 154,736 adults were included in the analysis. After adjustment for age, sex, cigarette smoking, alcohol consumption, physical activity, education, geographic region (north vs south), and urbanization (urban vs rural), a U-shaped association between BMI and all-cause mortality was observed (P<.001). Using those participants with a BMI of 24.0 to 24.9 as the reference group, the relative risks of all-cause mortality across categories of BMI were 1.65 (95% confidence interval [CI], 1.54-1.77) for BMI less than 18.5, 1.31 (95% CI, 1.22-1.41) for BMI 18.5 to 19.9, 1.20 (95% CI, 1.11-1.29) for BMI 20.0 to 20.9, 1.12 (95% CI, 1.04-1.21) for BMI 21.0 to 21.9, 1.11 (95% CI, 1.03-1.20) for BMI 22.0 to 22.9, 1.09 (95% CI, 1.01-1.19) for BMI 23.0 to 23.9, 1.00 (95% CI, 0.92-1.08) for BMI 25.0 to 26.9, 1.15 (95% CI, 1.06-1.24) for BMI 27.0 to 29.9, and 1.29 (95% CI, 1.16-1.42) for BMI 30.0 or more. The U-shaped association existed even after excluding participants who were current or former smokers, heavy alcohol drinkers, or who had prevalent chronic illness at the baseline examination, or who died during the first 3 years of follow-up. A similar association was observed between BMI and mortality from cardiovascular disease, cancer, and other causes.


CONCLUSIONS
Our results indicate that both underweight and obesity were associated with increased mortality in the Chinese adult population. Furthermore, our findings support the use of a single common recommendation for defining overweight and obesity among all racial and ethnic groups.
Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, and Chinese National Center for Cardiovascular Disease Control and Research, Beijing, China. gudongfeng@vip.sina.com
Dongfeng
D
Gu
Jiang
J
He
Xiufeng
X
Duan
Kristi
K
Reynolds
Xigui
X
Wu
Jing
J
Chen
Guangyong
G
Huang
Chung-Shiuan
CS
Chen
Paul K
PK
Whelton
D000328:Adult; D000368:Aged; D044466:Asian People; D015992:Body Mass Index; D001835:Body Weight / Q000208:ethnology; D002681:China; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016016:Proportional Hazards Models