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Weight History, All-Cause and Cause-Specific Mortality in Three Prospective Cohort Studies
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5 02 2017
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Source: Ann Intern Med. 166(9):613-620
[PDF-233.90 KB]
Details:
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Alternative Title:Ann Intern Med
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Description:BACKGROUND
The relationship between body mass index (BMI) and mortality remains controversial.
OBJECTIVE
To investigate the relationship between maximum BMI over 16 years and subsequent mortality.
DESIGN
Three prospective cohort studies.
SETTING
Nurses’ Health Study I and II, Health Professionals Follow-up Study.
PARTICIPANTS
225,072 men and women accruing 32,571 deaths over a mean of 12.3 years of follow-up.
MEASUREMENTS
Maximum BMI over 16 years of weight history and all-cause and cause-specific mortality.
RESULTS
Maximum BMIs in the overweight (25.0 to 29.9 kg/m2) (multivariate hazard ratio (HR), 1.06; 95% confidence interval (CI), 1.03 – 1.08), obese I (30.0 to 34.9 kg/m2), (HR, 1.24; 95% CI, 1.20 – 1.29), and obese II (≥ 35.0 kg/m2) (HR, 1.73; 95% CI, 1.66 – 1.80) categories were associated with increases in risk of all-cause mortality. The pattern of excess risk with a maximum BMI above normal weight was maintained across strata defined by smoking status, sex, and age, but the excess was greatest among those <70 years old and never smokers. In contrast, a significant inverse association between overweight and mortality (HR, 0.96; 95% CI, 0.94 – 0.99) was observed when BMI was defined using a single baseline measurement. Maximum overweight was also associated with increased cause-specific mortality, including deaths from cardiovascular diseases and coronary heart disease.
LIMITATIONS
Residual confounding and misclassification.
CONCLUSIONS
The paradoxical association between overweight and mortality is reversed in analyses incorporating weight history. Maximum BMI may be a useful metric to minimize reverse causation bias associated with a single baseline BMI assessment.
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Pubmed ID:28384755
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Pubmed Central ID:PMC5518318
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