title: Obesity and life expectancy among long-lived Black adults.
abstract: BACKGROUND
  In samples of African Americans and the elderly adults, obesity is often not found to be a risk factor for mortality. These data contradict the evidence linking obesity to chronic disease in these groups. Our objective was to determine whether obesity remains a risk factor for mortality among long-lived black adults.
  
  
  METHODS
  The Adventist Health Study 2 is a large prospective cohort study of Seventh-day Adventist church members who are encouraged by faith-based principles to avoid tobacco, alcohol, and meat consumption. We conducted an attained age survival analysis of 22,884 U.S. blacks of the cohort-half of whom attained an age of 58-108 years during the follow-up (adult life expectancy of 84 years in men, 89 years in women).
  
  
  RESULTS
  Women in the highest body mass index quintile (>33.8) experienced a significant 61% increase (hazard ratio [95% CI] = 1.62 [1.23, 2.11] relative to the middle quintile) in mortality risk and a 6.2-year (95% CI = 2.8-10.2 years) decrease in life expectancy. Men in the highest body mass index quintile (>30.8) experienced a significant 87% increase (hazard ratio [95% CI] = 1.87 [1.28, 2.73] relative to the middle quintile) in mortality risk and 5.9-year (95% CI = 2.1- 9.5 years) decrease in life expectancy. Obesity (>30) was a significant risk factor relative to normal weight (18.5-24.9) in never-smokers. Instantaneous hazards indicated excess risk from obesity was evident through at least age 85 years. The nonobese tended to follow plant-based diets and exercise vigorously.
  
  
  CONCLUSIONS
  Avoiding obesity promotes gains in life expectancy through at least the eighth decade of life in black adults. Evidence for weight control through plant-based diets and active living was found in long-lived nonobese blacks.
authors.affiliation: DrPH, Center for Health Research, Nichol Hall Room 1710, School of Public Health, Loma Linda, CA 92350. psingh@llu.edu.
authors.forename: Pramil N
authors.initials: PN
authors.lastname: Singh
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Clark
authors.forename: Patti
authors.initials: P
authors.lastname: Herring
authors.forename: Joan
authors.initials: J
authors.lastname: Sabaté
authors.forename: David
authors.initials: D
authors.lastname: Shavlik
authors.forename: Gary E
authors.initials: GE
authors.lastname: Fraser
mesh_terms: D000328:Adult; D001741:Black or African American; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008017:Life Expectancy / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009765:Obesity / Q000208:ethnology*; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
keywords: African American; Aging; BMI.; Black*; Caribbean; Obesity; Southern