 |
|
Cause-Specific Excess Deaths Associated With Underweight, Overweight, and Obesity
Katherine M. Flegal, PhD;
Barry I. Graubard, PhD;
David F. Williamson, PhD;
Mitchell H. Gail, MD, PhD
JAMA. 2007;298(17):2028-2037.
Context The association of body mass index (BMI) with cause-specific mortality has not been reported for the US population.
Objective To estimate cause-specific excess deaths associated with underweight (BMI <18.5), overweight (BMI 25-<30), and obesity (BMI  30).
Design, Setting, and Participants Cause-specific relative risks of mortality from the National Health and Nutrition Examination Survey (NHANES) I, 1971-1975; II, 1976-1980; and III, 1988-1994, with mortality follow-up through 2000 (571 042 person-years of follow-up) were combined with data on BMI and other covariates from NHANES 1999-2002 with underlying cause of death information for 2.3 million adults 25 years and older from 2004 vital statistics data for the United States.
Main Outcome Measures Cause-specific excess deaths in 2004 by BMI levels for categories of cardiovascular disease (CVD), cancer, and all other causes (noncancer, non-CVD causes).
Results Based on total follow-up, underweight was associated with significantly increased mortality from noncancer, non-CVD causes (23 455 excess deaths; 95% confidence interval [CI], 11 848 to 35 061) but not associated with cancer or CVD mortality. Overweight was associated with significantly decreased mortality from noncancer, non-CVD causes (–69 299 excess deaths; 95% CI, –100 702 to –37 897) but not associated with cancer or CVD mortality. Obesity was associated with significantly increased CVD mortality (112 159 excess deaths; 95% CI, 87 842 to 136 476) but not associated with cancer mortality or with noncancer, non-CVD mortality. In further analyses, overweight and obesity combined were associated with increased mortality from diabetes and kidney disease (61 248 excess deaths; 95% CI, 49 685 to 72 811) and decreased mortality from other noncancer, non-CVD causes (–105 572 excess deaths; 95% CI, –161 816 to –49 328). Obesity was associated with increased mortality from cancers considered obesity-related (13 839 excess deaths; 95% CI, 1920 to 25 758) but not associated with mortality from other cancers. Comparisons across surveys suggested a decrease in the association of obesity with CVD mortality over time.
Conclusions The BMI-mortality association varies by cause of death. These results help to clarify the associations of BMI with all-cause mortality.
Author Affiliations: National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville (Dr Flegal) and Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda (Drs Graubard and Gail), Maryland; and Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Williamson).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Nonsurgical Management of Obesity in Adults
Eckel
NEJM 2008;358:1941-1950.
FULL TEXT
Obesity reduction and its possible consequences: What can we learn from Cuba's Special Period?
Franco et al.
CMAJ 2008;178:1032-1034.
FULL TEXT
The Hope and Fear of Rimonabant
Rumsfeld and Nallamothu
JAMA 2008;299:1601-1602.
FULL TEXT
Parental Responsibility and Obesity in Children
Holm
Public Health Ethics 2008;1:21-29.
ABSTRACT
| FULL TEXT
Cardiovascular Risk Factors, Mortality, and Overweight
McTigue and Kuller
JAMA 2008;299:1260-1261.
FULL TEXT
Turning the Disability Tide: The Importance of Definitions
Iezzoni and Freedman
JAMA 2008;299:332-334.
FULL TEXT
Weight, Mortality, and Disability
JWatch General 2007;2007:3-3.
FULL TEXT
Is Disability Obesity's Price of Longevity?
Gregg and Guralnik
JAMA 2007;298:2066-2067.
FULL TEXT
|
