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Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents

Authors
 Emanuele Di Angelantonio  ;  Shilpa N Bhupathiraju  ;  David Wormser  ;  Pei Gao  ;  Stephen Kaptoge  ;  Amy Berrington de Gonzalez  ;  Benjamin J Cairns  ;  Rachel Huxley  ;  Chandra L Jackson  ;  Grace Joshy  ;  Sarah Lewington  ;  JoAnn E Manson  ;  Neil Murphy  ;  Alpa V Patel  ;  Jonathan M Samet  ;  Mark Woodward  ;  Wei Zheng  ;  Maigen Zhou  ;  Narinder Bansal  ;  Aurelio Barricarte  ;  Brian Carter  ;  James R Cerhan  ;  Rory Collins  ;  George Davey Smith  ;  Xianghua Fang  ;  Oscar H Franco  ;  Jane Green  ;  Jim Halsey  ;  Janet S Hildebrand  ;  Keum Ji Jung  ;  Rosemary J Korda  ;  Dale F McLerran  ;  Steven C Moore  ;  Linda M O'Keeffe  ;  Ellie Paige  ;  Anna Ramond  ;  Gillian K Reeves  ;  Betsy Rolland  ;  Carlotta Sacerdote  ;  Naveed Sattar  ;  Eleni Sofianopoulou  ;  June Stevens  ;  Michael Thun  ;  Hirotsugu Ueshima  ;  Ling Yang  ;  Young Duk Yun  ;  Peter Willeit  ;  Emily Banks  ;  Valerie Beral  ;  Zhengming Chen  ;  Susan M Gapstur  ;  Marc J Gunter  ;  Patricia Hartge  ;  Sun Ha Jee  ;  Tai-Hing Lam  ;  Richard Peto  ;  John D Potter  ;  Walter C Willett  ;  Simon G Thompson  ;  John Danesh  ;  Frank B Hu 
Citation
 Lancet, Vol.10046 : 776-786, 2016 
Journal Title
 Lancet 
ISSN
 0140-6736 
Issue Date
2016
MeSH
Adult ; Aged ; Asia/epidemiology ; Australia/epidemiology ; Body Mass Index* ; Cause of Death* ; Europe/epidemiology ; Female ; Humans ; Linear Models ; Male ; Middle Aged ; Mortality/trends* ; New Zealand/epidemiology ; North America/epidemiology ; Overweight/mortality ; Prospective Studies
Abstract
BACKGROUND: Overweight and obesity are increasing worldwide. To help assess their relevance to mortality in different populations we conducted individual-participant data meta-analyses of prospective studies of body-mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding pre-existing disease and the first 5 years of follow-up. METHODS: Of 10 625 411 participants in Asia, Australia and New Zealand, Europe, and North America from 239 prospective studies (median follow-up 13·7 years, IQR 11·4-14·7), 3 951 455 people in 189 studies were never-smokers without chronic diseases at recruitment who survived 5 years, of whom 385 879 died. The primary analyses are of these deaths, and study, age, and sex adjusted hazard ratios (HRs), relative to BMI 22·5-<25·0 kg/m(2). FINDINGS: All-cause mortality was minimal at 20·0-25·0 kg/m(2) (HR 1·00, 95% CI 0·98-1·02 for BMI 20·0-<22·5 kg/m(2); 1·00, 0·99-1·01 for BMI 22·5-<25·0 kg/m(2)), and increased significantly both just below this range (1·13, 1·09-1·17 for BMI 18·5-<20·0 kg/m(2); 1·51, 1·43-1·59 for BMI 15·0-<18·5) and throughout the overweight range (1·07, 1·07-1·08 for BMI 25·0-<27·5 kg/m(2); 1·20, 1·18-1·22 for BMI 27·5-<30·0 kg/m(2)). The HR for obesity grade 1 (BMI 30·0-<35·0 kg/m(2)) was 1·45, 95% CI 1·41-1·48; the HR for obesity grade 2 (35·0-<40·0 kg/m(2)) was 1·94, 1·87-2·01; and the HR for obesity grade 3 (40·0-<60·0 kg/m(2)) was 2·76, 2·60-2·92. For BMI over 25·0 kg/m(2), mortality increased approximately log-linearly with BMI; the HR per 5 kg/m(2) units higher BMI was 1·39 (1·34-1·43) in Europe, 1·29 (1·26-1·32) in North America, 1·39 (1·34-1·44) in east Asia, and 1·31 (1·27-1·35) in Australia and New Zealand. This HR per 5 kg/m(2) units higher BMI (for BMI over 25 kg/m(2)) was greater in younger than older people (1·52, 95% CI 1·47-1·56, for BMI measured at 35-49 years vs 1·21, 1·17-1·25, for BMI measured at 70-89 years; pheterogeneity<0·0001), greater in men than women (1·51, 1·46-1·56, vs 1·30, 1·26-1·33; pheterogeneity<0·0001), but similar in studies with self-reported and measured BMI. INTERPRETATION: The associations of both overweight and obesity with higher all-cause mortality were broadly consistent in four continents. This finding supports strategies to combat the entire spectrum of excess adiposity in many populations. FUNDING: UK Medical Research Council, British Heart Foundation, National Institute for Health Research, US National Institutes of Health.
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DOI
10.1016/S0140-6736(16)30175-1
Appears in Collections:
1. Journal Papers (연구논문) > 4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원)
Yonsei Authors
정금지(Jung, Keum Ji) ORCID logo https://orcid.org/0000-0003-4993-0666
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/165063
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