Cited by 3,643Obesity, Physical Activity, DietCancer Risks and FactorsDiabetes, Cardiovascular Risks, and Lipoproteins

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Body-Mass Index and Mortality in a Prospective Cohort of U.S. Adults

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Calle, Eugenia E., Thun, Michael J., Petrelli, Jennifer M., Rodriguez, Carmen, Heath, Clark W.·1999·New England Journal of Medicine

DOI 10.1056/nejm199910073411501

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Abstract

BACKGROUND: Body-mass index (the weight in kilograms divided by the square of the height in meters) is known to be associated with overall mortality. We investigated the effects of age, race, sex, smoking status, and history of disease on the relation between body-mass index and mortality. METHODS: In a prospective study of more than 1 million adults in the United States (457,785 men and 588,369 women), 201,622 deaths occurred during 14 years of follow-up. We examined the relation between body-mass index and the risk of death from all causes in four subgroups categorized according to smoking status and history of disease. In healthy people who had never smoked, we further examined whether the relation varied according to race, cause of death, or age. The relative risk was used to assess the relation between mortality and body-mass index. RESULTS: The association between body-mass index and the risk of death was substantially modified by smoking status and the presence of disease. In healthy people who had never smoked, the nadir of the curve for body-mass index and mortality was found at a body-mass index of 23.5 to 24.9 in men and 22.0 to 23.4 in women. Among subjects with the highest body-mass indexes, white men and women had a relative risk of death of 2.58 and 2.00, respectively, as compared with those with a body-mass index of 23.5 to 24.9. Black men and women with the highest body-mass indexes had much lower risks of death (1.35 and 1.21), which did not differ significantly from 1.00. A high body-mass index was most predictive of death from cardiovascular disease, especially in men (relative risk, 2.90; 95 percent confidence interval, 2.37 to 3.56). Heavier men and women in all age groups had an increased risk of death. CONCLUSIONS: The risk of death from all causes, cardiovascular disease, cancer, or other diseases increases throughout the range of moderate and severe overweight for both men and women in all age groups. The risk associated with a high body-mass index is greater for whites than for blacks.

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Authors: Calle, E. E., Thun, M. J., Petrelli, J. M., Rodriguez, C., & Heath, C. W.
Affiliations: American Cancer Society (US)
ORCID: Calle, Eugenia E.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1999-10-07
Volume: 341
Issue: 15
Pages: 1097-1105
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm199910073411501
OpenAlex: W2323202746
Cited by: 3,643
References: 41
Citations by year: 2026: 14 · 2025: 29 · 2024: 48 · 2023: 66 · 2022: 73 · 2021: 76 · 2020: 114 · 2019: 79 · 2018: 81 · 2017: 118 · 2016: 128 · 2015: 138 · 2014: 178 · 2013: 178 · 2012: 165
FWCI: 132.54
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Health Sciences › Medicine › Oncology › Cancer Risks and Factors
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords: body mass index, obesity, mortality, cardiovascular mortality, cancer mortality, smoking status, racial differences, sex differences, age differences, overweight, disease history
MeSH terms: Adult, Age Factors, Black or African American, Cardiovascular Diseases, Cause of Death, Female, Humans, Male, Mortality, Neoplasms, Obesity, Prospective Studies, Risk, Smoking, United States, Body Mass Index, Multivariate Analysis, Black People, White People

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Body-Mass Index and Mortality in a Prospective Cohort of U.S. Adults

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