Association between body-mass index and risk of death in more than 1 million Asians
Open accessAbstract
BACKGROUND: Most studies that have evaluated the association between the body-mass index (BMI) and the risks of death from any cause and from specific causes have been conducted in populations of European origin. METHODS: We performed pooled analyses to evaluate the association between BMI and the risk of death among more than 1.1 million persons recruited in 19 cohorts in Asia. The analyses included approximately 120,700 deaths that occurred during a mean follow-up period of 9.2 years. Cox regression models were used to adjust for confounding factors. RESULTS: In the cohorts of East Asians, including Chinese, Japanese, and Koreans, the lowest risk of death was seen among persons with a BMI (the weight in kilograms divided by the square of the height in meters) in the range of 22.6 to 27.5. The risk was elevated among persons with BMI levels either higher or lower than that range--by a factor of up to 1.5 among those with a BMI of more than 35.0 and by a factor of 2.8 among those with a BMI of 15.0 or less. A similar U-shaped association was seen between BMI and the risks of death from cancer, from cardiovascular diseases, and from other causes. In the cohorts comprising Indians and Bangladeshis, the risks of death from any cause and from causes other than cancer or cardiovascular disease were increased among persons with a BMI of 20.0 or less, as compared with those with a BMI of 22.6 to 25.0, whereas there was no excess risk of either death from any cause or cause-specific death associated with a high BMI. CONCLUSIONS: Underweight was associated with a substantially increased risk of death in all Asian populations. The excess risk of death associated with a high BMI, however, was seen among East Asians but not among Indians and Bangladeshis.
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In East Asia, high BMI is associated with an excess risk of death, but not in India or Bangladesh.
“Zheng and colleagues found an excess risk of death associated with a high BMI in East Asia but not in India or Bangladesh.244”
From Global health 2050: the path to halving premature death by mid-century (2024) · cites this paper as [244]
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 [365]
Risk 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 [365]
In an Asian population (1.1 million persons in 19 cohorts), lowest risk of death was with BMI 22.6-27.5.
“In an Asian population (1.1 million persons recruited in 19 cohorts), 365 the lowest risk of death was seen with a BMI in the range of 22.6-27.5.”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [365]
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 [365]
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- Authors
- Zheng, W., McLerran, D. F., Rolland, B., Zhang, X., Inoue, M., Matsuo, K., He, J., Gupta, P. C., Ramadas, K., Tsugane, S., Irie, F., Tamakoshi, A., Gao, Y.-T., Wang, R., Shu, X.-O., Tsuji, I., Kuriyama, S., Tanaka, H., Satoh, H., Chen, C.-J., Yuan, J.-M., Yoo, K.-Y., Ahsan, H., Pan, W.-H., Gu, D., Pednekar, M. S., Sauvaget, C., Sasazuki, S., Sairenchi, T., Yang, G., Xiang, Y.-B., Nagai, M., Suzuki, T., Nishino, Y., You, S.-L., Koh, W.-P., Park, S. K., Chen, Y., Shen, C.-Y., Thornquist, M., Feng, Z., Kang, D., Boffetta, P., & Potter, J. D.
- Affiliations
- Vanderbilt University (US)
- Fred Hutch Cancer Center (US)
- National Cancer Centre Japan (JP)
- Aichi Cancer Center Research Institute (JP)
- Tulane University (US)
- Healis Sekhsaria Institute For Public Health (IN)
- Ibaraki Prefectural Government (JP)
- Aichi Medical University (JP)
- Shanghai Cancer Institute (CN)
- University of Minnesota (US)
- Tohoku University (JP)
- Academia Sinica (TW)
- Seoul National University (KR)
- National Taiwan University (TW)
- Dokkyo Medical University (JP)
- Nagoya City University (JP)
- Miyagi Prefectural Hospital Organization (JP)
- National University of Singapore (SG)
- New York University (US)
- ORCID
- Zheng, Wei
- Rolland, Betsy
- Zhang, Xianglan
- Inoue, Manami
- Matsuo, Keitaro
- He, Jiang
- Gupta, Prakash Chandra
- Ramadas, Kunnambath
- Tsugane, Shoichiro
- Irie, Fujiko
- Tamakoshi, Akiko
- Wang, Renwei
- Shu, Xiao-Ou
- Tsuji, Ichiro
- Kuriyama, Shinichi
- Tanaka, Hideo
- Satoh, Hiroshi
- Chen, Chien-Jen
- Yuan, Jian-Min
- Yoo, Keun-Young
- Ahsan, Habibul
- Pan, Wen-Harn
- Gu, Dongfeng
- Pednekar, Mangesh Suryakant
- Sauvaget, Catherine
- Sairenchi, Toshimi
- Yang, Gong
- Xiang, Yong-Bing
- Nagai, Masato
- Nishino, Yoshikazu
- You, San-Lin
- Koh, Woon-Puay
- Park, Sue K.
- Chen, Yu
- Shen, Chen-Yang
- Feng, Ziding
- Kang, Daehee
- Boffetta, Paolo
- Potter, John D.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2011-02-24
- Volume
- 364
- Issue
- 8
- Pages
- 719-729
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC4008249
- OpenAlex
- W2155458338
- Cited by
- 885
- References
- 21
- Citations by year
- 2026: 19 · 2025: 25 · 2024: 41 · 2023: 70 · 2022: 42 · 2021: 63 · 2020: 61 · 2019: 57 · 2018: 68 · 2017: 51 · 2016: 68 · 2015: 76 · 2014: 68 · 2013: 65 · 2012: 73
- FWCI
- 76.01
- 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)
- National University of Singapore (submittedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Funders
- National Cancer Institute (R01CA080205, R37CA070867, R01CA043092, R01CA082729)
- National Institute of Environmental Health Sciences (R01ES017541)
- 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, underweight, obesity, all-cause mortality, cancer mortality, cardiovascular mortality, U-shaped relationship, East Asian populations, South Asian populations, Asian populations
- MeSH terms
- Asia, Cause of Death, Female, Humans, Male, Mortality, Obesity, Risk, Cohort Studies, Body Mass Index, Proportional Hazards Models, Asian People, Overweight
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