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

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

doi:10.1016/S0140-6736(16)30175-1

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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.