Body-mass index and mortality among 1.46 million white adults.
BACKGROUND
A high body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) is associated with increased mortality from cardiovascular disease and certain cancers, but the precise relationship between BMI and all-cause mortality remains uncertain.


METHODS
We used Cox regression to estimate hazard ratios and 95% confidence intervals for an association between BMI and all-cause mortality, adjusting for age, study, physical activity, alcohol consumption, education, and marital status in pooled data from 19 prospective studies encompassing 1.46 million white adults, 19 to 84 years of age (median, 58).


RESULTS
The median baseline BMI was 26.2. During a median follow-up period of 10 years (range, 5 to 28), 160,087 deaths were identified. Among healthy participants who never smoked, there was a J-shaped relationship between BMI and all-cause mortality. With a BMI of 22.5 to 24.9 as the reference category, hazard ratios among women were 1.47 (95 percent confidence interval [CI], 1.33 to 1.62) for a BMI of 15.0 to 18.4; 1.14 (95% CI, 1.07 to 1.22) for a BMI of 18.5 to 19.9; 1.00 (95% CI, 0.96 to 1.04) for a BMI of 20.0 to 22.4; 1.13 (95% CI, 1.09 to 1.17) for a BMI of 25.0 to 29.9; 1.44 (95% CI, 1.38 to 1.50) for a BMI of 30.0 to 34.9; 1.88 (95% CI, 1.77 to 2.00) for a BMI of 35.0 to 39.9; and 2.51 (95% CI, 2.30 to 2.73) for a BMI of 40.0 to 49.9. In general, the hazard ratios for the men were similar. Hazard ratios for a BMI below 20.0 were attenuated with longer-term follow-up.


CONCLUSIONS
In white adults, overweight and obesity (and possibly underweight) are associated with increased all-cause mortality. All-cause mortality is generally lowest with a BMI of 20.0 to 24.9.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA. berringtona@mail.nih.gov
Amy
A
Berrington de Gonzalez
Patricia
P
Hartge
James R
JR
Cerhan
Alan J
AJ
Flint
Lindsay
L
Hannan
Robert J
RJ
MacInnis
Steven C
SC
Moore
Geoffrey S
GS
Tobias
Hoda
H
Anton-Culver
Laura Beane
LB
Freeman
W Lawrence
WL
Beeson
Sandra L
SL
Clipp
Dallas R
DR
English
Aaron R
AR
Folsom
D Michal
DM
Freedman
Graham
G
Giles
Niclas
N
Hakansson
Katherine D
KD
Henderson
Judith
J
Hoffman-Bolton
Jane A
JA
Hoppin
Karen L
KL
Koenig
I-Min
IM
Lee
Martha S
MS
Linet
Yikyung
Y
Park
Gaia
G
Pocobelli
Arthur
A
Schatzkin
Howard D
HD
Sesso
Elisabete
E
Weiderpass
Bradley J
BJ
Willcox
Alicja
A
Wolk
Anne
A
Zeleniuch-Jacquotte
Walter C
WC
Willett
Michael J
MJ
Thun
D000328:Adult; D015992:Body Mass Index; D002423:Cause of Death; D015986:Confounding Factors, Epidemiologic; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009026:Mortality / Q000208:ethnology; D050177:Overweight / Q000401:mortality*; D016016:Proportional Hazards Models; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D013851:Thinness / Q000401:mortality; D044465:White People / Q000706:statistics & numerical data