 |
|
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).
RELATED LETTERS
Cardiovascular Risk Factors, Mortality, and Overweight
Kathleen McTigue and Lewis Kuller
JAMA. 2008;299(11):1260-1261.
EXTRACT
| FULL TEXT
Cardiovascular Risk Factors, Mortality, and Overweight—Reply
Katherine M. Flegal, Barry I. Graubard, David F. Williamson, and Mitchell H. Gail
JAMA. 2008;299(11):1261.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Body Mass Index in Adolescence in Relation to Cause-specific Mortality: A Follow-up of 230,000 Norwegian Adolescents
Bjorge et al.
Am J Epidemiol 2008;0:kwn096v1-kwn096.
ABSTRACT
| FULL TEXT
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
|
