title: Association of body mass index with all-cause and cause-specific mortality: findings from a prospective cohort study in Mumbai (Bombay), India.
abstract: BACKGROUND
  The association between extremes of relative body weight and mortality has not been well characterized in developing countries. A prospective cohort study was conducted in Mumbai (India) to study the association of relative body weight, as estimated by body mass index [BMI = weight (kg)/height(2) (m(2))], with mortality.
  
  
  METHODS
  Using the voters' list as the selection frame, 148 173 men and women aged >/=35 years were recruited during 1991-97 in Mumbai city and were followed-up during 1997-2003.
  
  
  RESULTS
  During 774 129 person-years of follow-up, 13 261 deaths were observed. After adjusting for the potential confounders, increased mortality was observed in all under-weight categories [relative risk (RR) = 1.94 for BMI < 16.0 kg/m(2), 1.38 for BMI 16.0 to <17.0 and 1.24 for BMI 17.0 to <18.5 among women; the corresponding values for men were 2.24, 1.45 and 1.27, respectively] when compared with the rate in the normal weight category (BMI 18.5 to <25.0). Extremely thin (BMI < 16.0 kg/m(2)) cohort members were at highest risk for death due to tuberculosis (TB) (RR = 7.20 and 14.94 in women and men, respectively), cancer (RR = 1.87 and 2.44, respectively) and respiratory diseases (RR = 3.46 and 4.35, respectively). Subjects with above normal BMI had lower mortality risk than those with normal BMI values. Over-weight (BMI 25.0 to <30.0) women (RR = 0.89) and men (RR = 0.87) were at a lower risk; however, obese (BMI >/= 30.0) men <60 years of age had an increased mortality risk (RR = 1.22).
  
  
  CONCLUSIONS
  In Mumbai, under-weight was associated with an increased risk of pre-mature death. Despite the growing concerns regarding the gradual transition toward increasing rates of obesity, under-nutrition remains a major health problem in India. This study suggests the need for public health policies focusing on reducing under-nutrition.
authors.affiliation: Healis-Sekhsaria Institute for Public Health, Mumbai 400614, India. pednekarmangesh@rediffmail.com
authors.forename: Mangesh S
authors.initials: MS
authors.lastname: Pednekar
authors.forename: Matti
authors.initials: M
authors.lastname: Hakama
authors.forename: James R
authors.initials: JR
authors.lastname: Hebert
authors.forename: Prakash C
authors.initials: PC
authors.lastname: Gupta
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002423:Cause of Death; D002947:Cities; D003644:Death Certificates; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors