title: Body mass index and mortality: results of a cohort of 184,697 adults in Austria.
abstract: There is still a debate about the role of body mass index (BMI) as a risk factor for all-cause mortality. Most investigations with large sample sizes focused on populations from the United States, studies from Central-European cohorts are not available. We investigated the association between BMI and all-cause mortality and cause-specific mortality within a cohort in Austria. Design of this article is "Cohort study". The Subjects used were 184,697 men and women (mean age 41.7 +/- 15.4 years). Weight and height were measured. Cox proportional hazards models were used to estimate hazard ratios (HR). During a median follow-up of 15.1 years 15,557 deaths (6,077 from cardiovascular disease, 4,443 from cancer and 606 from respiratory disease) were seen. A U-shaped association between BMI and all-cause mortality was observed in men and women. Compared with the reference category (BMI 22.5-24.9 kg/m(2)) high risks were found both in the highest category of BMI (> or =35 kg/m(2)) with HR of 2.13 (95% CI, 1.82-2.48) in men and 1.60 (95% CI, 1.42-1.81) in women and in the lowest category (<18.5 kg/m(2)) with HR of 2.57 (95% CI, 2.17-3.05) in men and 1.40 (95% CI, 1.21-1.62) in women. Similar patterns were seen among ever-smokers and non-smokers. Increased mortality with increasing BMI was driven by cardiovascular diseases and to a lesser extent by cancers. Respiratory diseases contributed to mortality in the lowest BMI category independently from smoking status. Underweight and obesity were both associated with higher all-cause mortality in men and women.
authors.affiliation: Institute of Epidemiology, University of Ulm, Helmholtzstrasse 22, 89081 Ulm, Germany. jochen.klenk@uni-ulm.de
authors.forename: Jochen
authors.initials: J
authors.lastname: Klenk
authors.forename: Gabriele
authors.initials: G
authors.lastname: Nagel
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.forename: Alexander
authors.initials: A
authors.lastname: Strasak
authors.forename: Hans
authors.initials: H
authors.lastname: Concin
authors.forename: Günter
authors.initials: G
authors.lastname: Diem
authors.forename: Kilian
authors.initials: K
authors.lastname: Rapp
mesh_terms: D000328:Adult; D001317:Austria / Q000453:epidemiology; D015992:Body Mass Index; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D016016:Proportional Hazards Models; D012307:Risk Factors