title: Association of BMI with risk of CVD mortality and all-cause mortality.
abstract: OBJECTIVE
  To determine the relationship between BMI and risk of CVD mortality and all-cause mortality among Malaysian adults.
  
  
  METHODS
  Population-based, retrospective cohort study. Participants were followed up for 5 years from 2006 to 2010. Mortality data were obtained via record linkages with the Malaysian National Registration Department. Multiple Cox regression was applied to compare risk of CVD and all-cause mortality between BMI categories adjusting for age, gender and ethnicity. Models were generated for all participants, all participants the first 2 years of follow-up, healthy participants, healthy never smokers, never smokers, current smokers and former smokers.
  
  
  METHODS
  All fourteen states in Malaysia.
  
  
  METHODS
  Malaysian adults (n 32 839) aged 18 years or above from the third National Health and Morbidity Survey.
  
  
  RESULTS
  Total follow-up time was 153 814 person-years with 1035 deaths from all causes and 225 deaths from CVD. Underweight (BMI<18·5 kg/m2) was associated with a significantly increased risk of all-cause mortality, while obesity (BMI ≥30·0 kg/m2) was associated with a heightened risk of CVD mortality. Overweight (BMI=25·0-29·9 kg/m2) was inversely associated with risk of all-cause mortality. Underweight was significantly associated with all-cause mortality in all models except for current smokers. Overweight was inversely associated with all-cause mortality in all participants. Although a positive trend was observed between BMI and CVD mortality in all participants, a significant association was observed only for severe obesity (BMI≥35·0 kg/m2).
  
  
  CONCLUSIONS
  Underweight was associated with increased risk of all-cause mortality and obesity with increased risk of CVD mortality. Therefore, maintaining a normal BMI through leading an active lifestyle and healthy dietary habits should continue to be promoted.
authors.affiliation: 1Epidemiology & Biostatistics Unit,Institute for Medical Research,Jalan Pahang,50588 Kuala Lumpur,Malaysia.
authors.forename: Chee Cheong
authors.identifier: http://orcid.org/0000-0003-1372-9549
authors.initials: CC
authors.lastname: Kee
authors.affiliation: 1Epidemiology & Biostatistics Unit,Institute for Medical Research,Jalan Pahang,50588 Kuala Lumpur,Malaysia.
authors.forename: Mohd Ghazali
authors.initials: MG
authors.lastname: Sumarni
authors.affiliation: 2Non Communicable Diseases Research Center,Institute for Public Health,Jalan Bangsar,Kuala Lumpur,Malaysia.
authors.forename: Kuang Hock
authors.initials: KH
authors.lastname: Lim
authors.affiliation: 3Clinical Epidemiology Unit,Clinical Research Centre,Jalan Pahang,Kuala Lumpur,Malaysia.
authors.forename: Sharmini
authors.initials: S
authors.lastname: Selvarajah
authors.affiliation: 3Clinical Epidemiology Unit,Clinical Research Centre,Jalan Pahang,Kuala Lumpur,Malaysia.
authors.forename: Jamaiyah
authors.initials: J
authors.lastname: Haniff
authors.affiliation: 4Centre for Communicable Disease,Institute for Public Health,Jalan Bangsar,Kuala Lumpur,Malaysia.
authors.forename: Guat Hiong Helen
authors.initials: GHH
authors.lastname: Tee
authors.affiliation: 4Centre for Communicable Disease,Institute for Public Health,Jalan Bangsar,Kuala Lumpur,Malaysia.
authors.forename: Kaur
authors.initials: K
authors.lastname: Gurpreet
authors.affiliation: 1Epidemiology & Biostatistics Unit,Institute for Medical Research,Jalan Pahang,50588 Kuala Lumpur,Malaysia.
authors.forename: Yusoff Ahmad
authors.initials: YA
authors.lastname: Faudzi
authors.affiliation: 1Epidemiology & Biostatistics Unit,Institute for Medical Research,Jalan Pahang,50588 Kuala Lumpur,Malaysia.
authors.forename: Nasir Mustafa
authors.initials: NM
authors.lastname: Amal
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D008019:Life Style; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009765:Obesity / Q000453:epidemiology; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013851:Thinness / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D002784:Cholesterol
keywords: BMI; CVD; Mortality; Obesity; Overweight