Body-mass index and mortality among 1.46 million white adults
Open accessAbstract
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.
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Obesity is a major risk factor for type 2 diabetes, dyslipidemia, cardiometabolic disease, cancer, and death.
“Obesity, characterized by excessive body fat, constitutes a major risk factor for the development of type 2 diabetes (T2D), dyslipidemia, cardiometabolic disease1, cancer2, and overall mortality3.”
From Transforming obesity: The advancement of multi-receptor drugs (2024) · cites this paper as [3]
Experimental — accuracy not yet measuredRisk of death is elevated with BMI higher or lower than optimal ranges, with a U-shaped association.
“The risk was elevated with BMI levels either higher or lower than these ranges, with a U-shaped association.”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [364]
Overweight and obesity are associated with risk of death in CVD.
“Both overweight and obesity are associated with a risk of death in CVD.363 -365”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [364]
In pooled analysis of 19 prospective studies (1.46 million white adults), all-cause mortality was lowest with BMI 20.0-24.9.
“In a revised pooled analysis of 19 prospective studies (1.46 million white adults), 364 all-cause mortality was lowest with a BMI of 20.0 -24.9.”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [364]
All-cause mortality is lowest with a BMI of 20-25 kg/m2.
“All-cause mortality is lowest with a BMI of 20 -25 kg/m 2 .363 -365”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [364]
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- Authors
- Berrington de Gonzalez, A., Hartge, P., Cerhan, J. R., Flint, A. J., Hannan, L., MacInnis, R. J., Moore, S. C., Tobias, G. S., Anton-Culver, H., Freeman, L. B., Beeson, W. L., Clipp, S. L., English, D. R., Folsom, A. R., Freedman, D. M., Giles, G., Hakansson, N., Henderson, K. D., Hoffman-Bolton, J., Hoppin, J. A., Koenig, K. L., Lee, I.-M., Linet, M. S., Park, Y., Pocobelli, G., Schatzkin, A., Sesso, H. D., Weiderpass, E., Willcox, B. J., Wolk, A., Zeleniuch-Jacquotte, A., Willett, W. C., & Thun, M. J.
- Affiliations
- National Cancer Institute (US)
- Mayo Clinic (US)
- Harvard University (US)
- American Cancer Society (US)
- The University of Melbourne (AU)
- Loma Linda University (US)
- Johns Hopkins University (US)
- University of Minnesota (US)
- Cancer Council Victoria (AU)
- City Of Hope National Medical Center (US)
- National Institute of Environmental Health Sciences (US)
- New York University (US)
- Karolinska Institutet (SE)
- Brigham and Women's Hospital (US)
- Folkhälsans Forskningscentrum (FI)
- Queen's Medical Center (US)
- ORCID
- Cerhan, James R.
- MacInnis, Robert J.
- Moore, Steven C.
- Tobias, Geoffrey S.
- Beeson, W. Lawrence
- English, Dallas R.
- Folsom, Aaron R.
- Giles, Graham
- Hoppin, Jane A.
- Koenig, Karen L.
- Lee, I-Min
- Linet, Martha S.
- Park, Yikyung
- Pocobelli, Gaia
- Sesso, Howard D.
- Weiderpass, Elisabete
- Willcox, Bradley J.
- Wolk, Alicja
- Willett, Walter C.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2010-12-02
- Volume
- 363
- Issue
- 23
- Pages
- 2211-2219
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC3066051
- OpenAlex
- W1998451170
- Cited by
- 2,317
- References
- 40
- Citations by year
- 2026: 46 · 2025: 105 · 2024: 132 · 2023: 109 · 2022: 149 · 2021: 167 · 2020: 135 · 2019: 136 · 2018: 158 · 2017: 166 · 2016: 158 · 2015: 188 · 2014: 187 · 2013: 192 · 2012: 164
- FWCI
- 151.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Cancer Institute (R01CA077398, ZIACP010131)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK040561)
- 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, all-cause mortality, obesity, underweight, J-shaped relationship, White adults, cardiovascular mortality, cancer mortality, physical activity, alcohol consumption, marital status, educational attainment, smoking status, follow-up duration, sex differences
- MeSH terms
- Adult, Cause of Death, Female, Follow-Up Studies, Humans, Male, Mortality, Smoking, Socioeconomic Factors, Thinness, Exercise, Confounding Factors, Epidemiologic, Body Mass Index, Proportional Hazards Models, White People, Overweight
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