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Body-Mass Index and Mortality among 1.46 Million White Adults

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Berrington de Gonzalez, Amy, Hartge, Patricia, Cerhan, James R., Flint, Alan J., Hannan, Lindsay, MacInnis, Robert J., Moore, Steven C., Tobias, Geoffrey S., Anton-Culver, Hoda, Freeman, Laura Beane, Beeson, W. Lawrence, Clipp, Sandra L., English, Dallas R., Folsom, Aaron R., Freedman, D. Michal, Giles, Graham, Hakansson, Niclas, Henderson, Katherine D., Hoffman-Bolton, Judith, Hoppin, Jane A., Koenig, Karen L., Lee, I-Min, Linet, Martha S., Park, Yikyung, Pocobelli, Gaia, Schatzkin, Arthur, Sesso, Howard D., Weiderpass, Elisabete, Willcox, Bradley J., Wolk, Alicja, Zeleniuch-Jacquotte, Anne, Willett, Walter C., Thun, Michael J.·2010·New England Journal of Medicine

DOI 10.1056/nejmoa1000367PMC PMC3066051

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Abstract

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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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
DOI: 10.1056/nejmoa1000367
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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Body-Mass Index and Mortality among 1.46 Million White Adults

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