Body weight and mortality among adults who never smoked

In a 12-year prospective study, the authors examined the relation between body mass index (BMI) and mortality among the 20,346 middle-aged (25-54 years) and older (55-84 years) non-Hispanic white cohort members of the Adventist Health Study (California, 1976-1988) who had never smoked cigarettes and had no history of coronary heart disease, cancer, or stroke. In analyses that accounted for putative indicators (weight change relative to 17 years before baseline, death during early follow-up) of pre-existing illness, the authors found a direct positive relation between BMI and all-cause mortality among middle-aged men (minimum risk at BMI (kg/m2) 15-22.3, older men (minimum risk at BMI 13.5-22.3), middle-aged women (minimum risk at BMI 13.9-20.6), and older women who had undergone postmenopausal hormone replacement (minimum risk at BMI 13.4-20.6). Among older women who had not undergone postmenopausal hormone replacement, the authors found a J-shaped relation (minimum risk at BMI 20.7-27.4) in which BMI <20.7 was associated with a twofold increase in mortality risk (hazard ratio (HR) = 2.2, 95% confidence interval (CI) 1.3, 3.5) that was primarily due to cardiovascular and respiratory disease. These findings not only identify adiposity as a risk factor among adults, but also raise the possibility that very lean older women can experience an increased mortality risk that may be due to their lower levels of adipose tissue-derived estrogen.     

Obesity has a greater impact on cardiovascular mortality in younger men than in older men among non-smoking Koreans

INTRODUCTION: We investigated the effects of age on the relationship between body mass index (BMI) and cardiovascular risk factors and cardiovascular mortality in non-smoking Korean men. METHODS: We performed a prospective cohort study of 246,146 non-smoking Korean men aged 20-69 years at baseline (1992) who were initially without history of cancer or weight change. The associations between BMI and cardiovascular risk factors and mortality during an 9-year follow-up period (2000) were stratified by age group after adjustment for family history, alcohol consumption, exercise habits, and economic status. RESULTS: Calculations of odds ratios (ORs) revealed that younger men (<40 years) with greater BMI (>or=28 kg/m2) were at greater risk of high blood pressure, high blood glucose, and high total cholesterol than older men. The ORs for cardiovascular risk factors associated with greater BMI declined linearly with age. The relative risks for mortality from stroke and from all cardiovascular diseases associated with greater BMI were also higher among younger men and declined linearly with age. CONCLUSIONS: The cardiovascular risk factors and mortality associated with greater BMI were higher among younger than older non-smoking Korean men. These findings indicate that obesity has a greater impact among younger men with respect to premature cardiovascular related deaths.     

Body mass index and mortality among US male physicians

PURPOSE: To assess the relationship between body mass index and mortality in a population homogeneous in educational attainment and socioeconomic status. METHODS: We analyzed the association between body mass index (BMI) and both all-cause and cause-specific mortality among 85,078 men aged 40 to 84 years from the Physicians' Health Study enrollment cohort. RESULTS: During 5 years of follow-up, we documented 2856 deaths (including 1212 due to cardiovascular diseases and 891 due to cancer). In age-adjusted analyses, we observed a U-shaped relation between BMI and all-cause mortality; among men who never smoked a linear relation was observed with no increase in mortality among leaner men (P for trend, <0.001). Among never smokers, in multivariate analyses adjusted for age, alcohol intake, and physical activity, the relative risks of all-cause mortality increased in a stepwise fashion with increasing BMI. Excluding the first 2 years of follow-up further strengthened the association (multivariate relative risks, from BMI<20 to > or = 30 kg/m2, were 0.93, 1.00, 1.00, 1.16, 1.45, and 1.71 [P for trend, <0.001]). In all age strata (40-54, 55-69, and 70-84 years), never smokers with BMIs of 30 or greater had approximately a 70% increased risk of death compared with the referent group (BMI 22.5-24.9). Higher levels of BMI were also strongly related to increased risk of cardiovascular mortality, regardless of physical activity level (P for trend, <0.01). CONCLUSIONS: All-cause and cardiovascular mortality was directly related to BMI among middle-aged and elderly men. Advancing age did not attenuate the increased risk of death associated with obesity. Lean men (BMI<20) did not have excess mortality, regardless of age.     

上海市中老年男性体重指数与死亡的前瞻性研究

目的探讨上海市区中老年男性体重指数(BMI)与死亡的关系及年龄对这种关系的影响。方法1986年1月至1989年9月调查上海市区45～64岁男性居民18244人,每年上门随访一次;用Cox比例风险模型计算相对危险度(RR)。结果至2002年度随访结束,全队列共随访235762人年,人均随访12.9年,在此期间共死亡3365人。在不吸烟者中,相对于正常BMI组(BMI18.5～23.9),低BMI组(BMI<18.5)、超重组(BMI24～27.9)和肥胖组(BMI≥28)总死亡RR值分别为1.20、1.12和1.61;在不吸烟者中去除随访开始头5年随访资料后,三组相应的RR值分别为1.01、1.12和1.75。结肠癌和心脑血管疾病死亡危险性随BMI增加而上升;除肿瘤和心脑血管疾病之外的死亡,其中主要为一些感染性疾病死亡的危险性在低BMI组显著升高,去除随访开始头5年随访资料对此结果无明显影响。在基线调查时≥55岁的对象中,肥胖组总死亡危险性上升更明显;而在<55岁的对象中,BMI与总死亡无显著相关。结论上海市区的中老年男性中肥胖会增加总死亡危险性,在年龄较大者中这种趋势更明显;结肠癌及心脑血管疾病死亡危险性随BMI增加而上升;感染性疾病的死亡危险性则在低BMI组显著升高。     

Body mass index, smoking, and risk of death between 40 and 70 years of age in a Norwegian cohort of 32,727 women and 33,475 men

Overweight-obesity and smoking are two main preventable causes of premature death. Because the relationship between smoking and body mass index (BMI) complicates the interpretation of associations between BMI and death risks, direct estimates of risks associated with joint exposures are helpful. We have studied the relationships of BMI and smoking to middle age (40–69 years) death risk—overall and by causes—in a Norwegian cohort of 32,727 women and 33,475 men who were 35–49 years old when baseline measurements and lifestyle information were collected in 1974–1988. Individuals with a history of cancer, cardiovascular disease or diabetes at baseline were excluded. Mortality follow-up was through 2009. The relationship between BMI and middle age death risk was U-shaped. Overall middle age death risks were 11 % in women and 21 % in men. The combination of obesity and heavy smoking resulted in fivefold increase in middle age death risks in both women and men: For women middle age death risk ranged from 6 % among never smokers in the 22.5–24.9 BMI group to 31 % (adjusted 28 %) in obese (BMI > 30 kg/m²) heavy smokers (≥20 cigarettes/day). The corresponding figures in men were 10 % and 53 % (adjusted 45 %). Obese never smokers and light (1–9 cigarettes/day) smokers in the 22.5–24.9 BMI groups both experienced a twofold increase in middle age risks of death. For women, cancer (56 %) was the most common cause of death followed by cardiovascular disease (22 %). In men, cardiovascular disease was most common (41 %) followed by cancer (34 %). Cardiovascular disease deaths were more strongly related to BMI than were cancer deaths.     

Weight and mortality in Finnish women

Mortality in relation to body mass index (BMI) was studied in 17,159 healthy Finnish women aged 25-79 followed up for a median of 12 years. Mortality from all cases was related to BMI only in non-smokers aged 25-64, among whom the mortality pattern was "U"-shaped, with a minimum in the second quintile of BMI (the reference range), and about 1.5 times higher in quintiles I and V. Most of the excess risk of mortality among overweight women was due to cardiovascular diseases. During the first 7 years of follow-up, and high risk (relative risk (RR) = 1.7, 95% confidence interval (CI) = 1.0-2.9 for quintile V compared to quintile II) depended on the association of BMI with the initial blood pressure level, but in the later years, the relative risk of cardiovascular death, ranging from 1.6 (95% CI = 1.0-2.5) for women in quintile III up to 2.6 (95% Ci = 1.7-4.0) for those in quintile V, was largely independent of the baseline levels of the main biological risk factors. The excess mortality among thin women under the age of 65 was mainly due to non-cardiovascular diseases (RR = 1.7, 95% CI = 1.2-2.3 for quintile I compared to quintile II) and was not attributable to antecedent disease, smoking or the biological risk factors studied. Among women aged 65 and over, overall mortality varied little with BMI, but thinness seemed to predict deaths from cancers (RR = 1.6, 95% CI = 0.9-3.0).(ABSTRACT TRUNCATED AT 250 WORDS)     

Weight and mortality in Finnish men

Mortality rates of 22,995 Finnish men aged 25 and over followed up for a median of 12 years were analyzed in relation to body mass index (BMI) at the initial examination. All-cause mortality followed a "U"-shaped distribution, being greatest for the thinnest and fattest men at all ages, or about 1.5-fold for those with BMI less than 19.0 kg/m2 and BMI greater than or equal to 34.0 kg/m2, as compared with men of normal weight (BMI 22.0-24.9 kg/m2). Mortality from cardiovascular diseases (CVD) increased with increasing BMI beyond the normal range. This depended mostly on the association of BMI with the biological risk factors of CVD. Mortality rates from CVD were also elevated among thin men under age 55, which could not be explained by the effect of the biological variables. Mortality rates from non-cardiovascular diseases, including cancers were inversely related to BMI among men of all ages. The high overall mortality of thin men was partly but not entirely attributable to smoking, low social class and antecedent disease. We conclude that both thinness and overweight are detrimental to longevity, but through differing mechanisms and disease patterns.     

Body mass index and mortality in an ethnically diverse population: the Multiethnic Cohort Study

Body mass index (BMI) has been strongly related to overall mortality, but the consistency of this association across diverse ethnic groups and the effects of early adult BMI versus BMI in later adulthood have not been adequately studied. A prospective analysis was performed using data from 183,211 adults aged 45-75 who enrolled the population-based Multiethnic Cohort Study by completing a questionnaire that included self-reported weight and height information in 1993-1996. Participants were African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites living in Hawaii and California. During an average 12.5?years of follow-up, 35,664 deaths were identified. To control for confounding caused by conditions that lead to weight loss and mortality, we excluded participants with a history of cancer or heart disease, who ever smoked, and who died within the first 3?years of follow-up. An increased risk of mortality was observed in participants with a BMI?≥?27.5 in both men and women compared with the reference category of BMI 23.0-24.9; a BMI?≥?35.0 carried a greater risk of mortality in men than in women. Although the findings were generally similar across ethnic groups, the association of higher BMI with mortality in Latino men appeared to be weaker than in the other groups. A BMI of 25.0-34.9 at age 21 showed a stronger positive association, with no further increase in risk for a BMI?≥?35.0, than did BMI in later adulthood. These results indicate that the association of BMI with mortality is generally consistent across sex and ethnic groups, with some variation in the strength of the effect. Most notably, the effect of overweight in young adulthood appears to be much stronger than that of overweight in later adulthood on mortality in later life. This emphasizes the importance of weight management in childhood and adolescence.     

Drinking and mortality. The Albany Study

The relation of alcohol consumption to mortality was examined in a cohort of 1,910 employed men aged 38-55 years, enrolled in the Albany Study, a prospective investigation of factors related to cardiovascular disease. Two follow-up periods were examined, one between 1953-1954 and 1971-1972 and the other after 1971-1972. In both periods, there was a positive relation between the rate of alcohol consumption and noncoronary heart disease death, not assignable to any specific cause. Coronary heart disease death was not associated with drinking during the initial follow-up but was negatively associated with drinking in the later follow-up. All-cause mortality was positively associated with alcohol consumption in the earlier follow-up, because of the greater cigarette use among drinkers, but not in the later follow-up. There was a significant positive relation of drinking to deaths from liver cirrhosis and diabetes but not to deaths from motor vehicle accidents.     

Race/ethnicity, income, major risk factors, and cardiovascular disease mortality

OBJECTIVES: We explored differences between Black and White men for cardiovascular disease (CVD) mortality across major risk factor levels. METHODS: Major CVD risk factors were measured among 300,647 White and 20,223 Black men aged 35 to 57 years who were screened for the Multiple Risk Factor Intervention Trial (MRFIT). Hazard ratios for CVD deaths for Black and White men over 25 years of follow-up were calculated for subgroups stratified according to risk factor levels. RESULTS: CVD was responsible for 2518 deaths among Black men and 30,772 deaths among White men. The age-adjusted Black-to-White CVD hazard ratio was 1.35 (95% confidence interval [CI]=1.29, 1.40); the risk- and income-adjusted ratio was 1.05 (95% CI=1.01, 1.10). CVD mortality rates were dramatically lower in cases of favorable risk profiles. However, fully adjusted Black-to-White CVD hazard ratios within groups at low, intermediate, high, and very high levels of overall risk were 1.76, 1.20, 1.10, and 0.94, respectively. Similar gradients were evident for individual risk factors. CONCLUSIONS: Higher CVD mortality rates among Black men were largely mediated by risk factors and income. These data underscore the need for sustained primordial risk factor prevention among Black men.     

Overweight adults may have the lowest mortality--do they have the best health?

Numerous recent studies have found that overweight adults experience lower overall mortality than those who are underweight, normal-weight, or obese. These highly publicized findings imply that overweight may be the optimal weight category for overall health via its association with longevity-a conclusion with important public health implications. In this study, the authors examined the association between body mass index (BMI; (weight (kg)/height (m)(2))) and 3 markers of health risks using a nationally representative sample of US adults aged 20-80 years (n = 9,255) from the National Health and Nutrition Examination Survey (2005-2008). Generalized additive models, a type of semiparametric regression model, were used to examine the relations between BMI and biomarkers of inflammation, metabolic function, and cardiovascular function (C-reactive protein, hemoglobin A(1c), and high density lipoprotein cholesterol, respectively). The association between BMI and each biomarker was monotonic, with higher BMI being consistently associated with worse health risk profiles at all ages, in contrast to the U-shaped relation between BMI and mortality. Prior results suggesting that the overweight BMI category corresponds to the lowest risk of mortality may not be generalizable to indicators of health risk.     

Risk factors for premature death in men 56--60 years old. A prospective study of men born 1914, living in Malm?, Sweden.

In a five-year follow-up of a random sample of men aged 55 the association between risk factors and premature death was analysed. The overall mortality in five years was 5.8%. The mortality among the smokers was 8%; among non-smokers 2%. Of 16 cancer deaths all were smokers except one who was an ex-smoker. In spite of treatment of hypertension (greater than 165/110 mmHg) there was an association between high blood pressure and premature death, particularly when cause of death was cardiovascular disease. There was no association between premature death and serum cholesterol, serum triglycerides or physical activity. The study is based on 703 men, of whom 41 died. The autopsy frequency was 93%. Only 3 men (0.4%) were lost to follow-up.     

Associations between white blood cell count and risk for cerebrovascular disease mortality: NHANES II Mortality Study, 1976-1992

PURPOSE: To examine associations between elevated white blood cell count (WBC) and cerebrovascular disease (CeVD) mortality independent of cigarette smoking and by gender. METHODS: We used Cox regression analyses of data from 8459 adults (3982 men; 4477 women) aged 30 to 75 years in the NHANES II Mortality Study (1976-1992) to estimate the relative risk of death from CeVD across quartiles of WBC. RESULTS: During 17 years of follow-up, there were 192 deaths from CeVD (93 men; 99 women). Compared with those with WBC (cells/mm(3))<5700, adults with WBC>8200 were at increased risk of CeVD mortality (relative risk [RR], 2.1; 95% confidence interval [CI], 1.2-3.7) after adjustment for smoking and other cardiovascular disease risk factors. Similar results were observed among never smokers (RR, 2.0; 95% CI, 1.0-3.8). The adjusted relative risk of CeVD mortality comparing those with WBC>8200 to those with WBC<5700 was 1.5 (95% CI, 0.7-3.5) among men and 2.7 (95% CI, 1.4-5.0) among women. CONCLUSIONS: Elevated WBC may predict CeVD mortality even after considering the effects of smoking and other cardiovascular disease risk factors.     

Anthropometric measurements and survival in older Americans: Results from the third national health and nutrition examination survey

Objectives

The impact of adiposity on mortality in older adults remains controversial. Some reports suggest that measures of general adiposity such as body mass index (BMI) predict better survival. We assessed the relationship between measures of adiposity and mortality in older adults.

Design

Cross-sectional analysis of a population-based sample.

Setting

Non-institutionalized persons in the United States participating in the National Health and Nutrition Examination Surveys III and its linked mortality dataset.

Participants

A subsample of 4,489 non-institutionalized survey participants aged >60 years with measures of body composition using bioimpedance. To account for possible residual confounding, smokers, subjects with heart failure, respiratory disease, kidney disease and cancer were excluded (n=2,920). Data from 1569 subjects were analysed.

Measurements

BMI, waist circumference (WC), waist-hip ratio (WHR), lean mass (LM) and % Body Fat (BF) were classified by tertiles (lowest=referent). Proportional-hazard models evaluated the association of anthropometric indices with overall and cardiovascular mortality.

Results

Mean age was 69.4years, and 265(16.9%) were >80 years. There were 717(47.6%) women and 792 deaths of which 284 [35.9%] were cardiovascular related. Elevated BMI was associated with reduced cardiovascular mortality (HR 0.53 [0.30–0.84]), and remained significant after adjusting for LM (HR 0.54 [0.31–0.93]). Elevated %BF was associated with reduced mortality from cardiovascular causes (HR 0.52 [0.29–0.91]). Low BMI was associated with higher risk of cardiovascular (HR 3.66 [1.25–10.69]) and overall death (HR 2.44 [1.22–4.90]).

Conclusion

Measures of adiposity in older participants are associated with lower mortality from cardiovascular causes that cannot be explained by major known confounders between obesity and mortality. Further studies need to elucidate a possible protective role and interplay between adiposity and skeletal muscle in older adults.     

Associations of weight change and weight variability with cardiovascular and all-cause mortality in the Chicago Western Electric Company Study

Few studies of associations between weight loss or weight fluctuations and mortality have been sufficiently long term to permit exclusion of early deaths for a portion of follow-up long enough to eliminate likely effects of illness-related weight loss. This study examined associations of the variation (standard deviation and standard deviation about the trend (slope)) and trend (weight loss or weight gain) in body mass index (weight (kg)/height (m2) between 1958 and 1966 (minimum of five measurements) with subsequent 25-year mortality among 1,281 men originally aged 40-56 years from the Chicago Western Electric Company Study. In multivariate Cox regression models that included two slope variables representing weight loss and weight gain and each variability measure separately, weight loss and weight gain were significantly related to 15-year mortality but weight variability was not. Relative risks for cardiovascular disease mortality were 1.25 (95% confidence interval (CI): 1.09, 1.45) and 1.14 (95% CI: 0.97, 1.33), respectively, for weight loss and weight gain slopes larger by 0.12 kg/m2 per year; corresponding relative risks for all-cause mortality were 1.23 (95% CI: 1.10, 1.38) and 1.15 (95% CI: 1.03, 1.29), respectively. For follow-up years 16-25, none of these weight variables were significantly related to mortality. These results indicate that an association between weight loss and mortality may not persist beyond 15 years, and that weight variability may not be related to mortality independently of weight loss or weight gain.     

Body mass index and mortality from ischaemic heart disease in a lean population: 10 year prospective study of 220,000 adult men

BACKGROUND: Increased body mass index (BMI) is known to be related to ischaemic heart disease (IHD) in populations where many are overweight (BMI>or=25 kg/m2) or obese (BMI>or=30). Substantial uncertainty remains, however, about the relationship between BMI and IHD in populations with lower BMI levels. METHODS: We examined the data from a population-based, prospective cohort study of 222,000 Chinese men aged 40-79. Relative and absolute risks of death from IHD by baseline BMI were calculated, standardized for age, smoking, and other potential confounding factors. RESULTS: The mean baseline BMI was 21.7 kg/m2, and 1942 IHD deaths were recorded during 10 years of follow-up (6.5% of all such deaths). Among men without prior vascular diseases at baseline, there was a J-shaped association between BMI and IHD mortality. Above 20 kg/m2 there was a positive association of BMI with risk, with each 2 kg/m2 higher in usual BMI associated with 12% (95% CI 6-19%, 2P=0.0001) higher IHD mortality. Below this BMI range, however, the association appeared to be reversed, with risk ratios of 1.00, 1.09, and 1.15, respectively, for men with BMI 20-21.9, 18-19.9, and <18 kg/m2. The excess IHD risk observed at low BMI levels persisted after restricting analysis to never smokers or excluding the first 3 years of follow-up, and became about twice as great after allowing for blood pressure. CONCLUSIONS: Lower BMI is associated with lower IHD risk among people in the so-called normal range of BMI values (20-25 kg/m2), but below that range the association may well be reversed.     

The burden of mortality of obesity at middle and old age is small. A life table analysis of the US Health and Retirement Survey

The evidence of effect of overweight and obesity on mortality at middle and old age is conflicting. The increased relative risk of cardiovascular disease and diabetes for overweight and obese individuals compared to normal weight is well documented, but the absolute risk of cardiovascular death has decreased spectacularly since the 1980s. We estimate the burden of mortality of obesity among middle and old aged adults in the Health and Retirement Survey (HRS), a US prospective longitudinal study. We calculate univariate and multivariate age-specific probabilities and proportional hazard ratios of death in relation to self-reported body mass index (BMI), smoking and education. The life table translates age specific adjusted event rates in survival times, dependent on risk factor distributions (smoking, levels of education and self reported BMI). 95% confidence intervals are calculated by bootstrapping. The highest life expectancy at age 55 was found in overweight (BMI 25-29.9), highly educated non smokers: 30.7 (29.5-31.9) years (men) and 33.2 (32.1-34.3) (women), slightly higher than a BMI 23-24.9 in both sexes. Smoking decreased the population life expectancy with 3.5 (2.7-4.4) years (men) and 1.8 (1.0-2.5) years (women). Less than optimal education cost men and women respectively 2.8 (2.1-3.6) and 2.6 (1.6-3.6) years. Obesity and low normal weight decreased population life expectancy respectively by 0.8 (0.2-1.3) and 0.8 (0.0-1.5) years for men and women in a contemporary, US population. The burden of mortality of obesity is limited, compared to smoking and low education.     

中国22万男性人群体重指数与缺血性心脏病关系的15年前瞻陛研究

目的 探讨中国人群尤其是低体重人群中体重指数(BMI)与缺血性心脏病(IHD)死亡之间的关系.方法 数据来源于1990-1991年已随访15年共涉及中国220 000名40～79岁男性对象的前瞻性队列研究.利用Cox比例风险模型,在调整年龄、吸烟史及其他潜在混杂因素后,计算BMI与IHD死亡间的相对危险度(解).结果 基线BMI平均值为21.7 kg/m~2.15年随访期间,共有2763例对象死于IHD(占总死亡的6.8%).在排除了基线调查时已报告息有心脑血管疾病史的对象后,BMI与IHD死亡率之间呈"J"形关系.当BMI＞20 kg/m~2时,BMI与IHD死亡风险呈正相关.BMI值每升高5 kg/m~2,IHD死亡率相应增高21%(95%CI:9%～35%,P=0.0004).而当BMI＜20kg/m~2时,IHD死亡风险反而随着BMI的下降呈上升的趋势.在BMI值为20～21.9、18～19.9、＜18 kg/m~2范围时,其对应的RR值分别为1.00、1.11和1.14.在排除了前3年随访中死亡的病例或将分析局限于从不吸烟者中,BMI与IHD死亡风险的关系仍呈现相同趋势.结论 对于处在所谓正常BMI范围值内(20～25 kg/m~2)的人群,BMI与IHD死亡风险呈正相关,但当BMI低于这一范围,两者的关联极有可能为负相关.     

体重指数与死亡的前瞻性研究

目的：探讨不同体重指数（BMI）水平与总死亡及不同死因死亡的关系。方法;1982－1985年在我国不同地区的10组人群中（年龄35－39岁）进行心血管病危险因素调查,并对研究对象中无脑卒中、无心肌梗死及无恶性肿瘤史的30560人（男性15723人,女性14837人）,随访至1999－2000年,登记各种死亡的发生情况。结果：在平均15．2年的随访中,共死亡3212例,其中冠心病和脑卒中共死亡676例,恶性肿瘤死亡1281例,其他原因死亡1255例。用Cox比例风险回归模型（调整年龄、性别0估计低BMI组（BMI＜18．5）、正常BMI组（BMI为18．5－23．9）、超重组（BMI为24－27．9）和肥胖组（BMI≥28）总死亡的相对危险分别为1．21,1．00,0．901,1．12,呈“U”形关系,当同时剔除前5年死亡病例及吸烟者后,低BMI组死亡的相对危险降低,而肥胖组增加,正常BMI组的相对危险最小。 随着BMI水平的上升,冠心病和脑卒中死亡的相对危险增加,恶性肿瘤死亡的相对危险降低,其他原因死亡的相对危险与BMI水平呈“U”形关系,当剔除早期死亡病例及吸烟者后,这些趋势依然存在。结论：BMI在正常范围内,总死亡的相对危险较低,且冠心病和脑卒中死亡,恶性肿瘤死亡及其它原因死亡的 综合风险也处于相对较低水平,有着重要的公共卫生学意义。     

Weight change,weight cycling and mortality in the ERFORT Male Cohort Study

Objective To investigate the effect of weight change and weight fluctuations on all-cause-mortality in men. Methods Within a prospective population-based cohort of 1160 men aged 40–59 years at recruitment, complete weight change patterns from baseline and three follow-up examinations during a period of 15 years of follow-up was used to categorize the 505 men into stable obese, stable non-obese, weight gain, weight loss and weight fluctuation groups. For these men (age range: 55–74 years at start time of survival analysis) further survival was analyzed during the subsequent 15 years. Results Overall, 183 deaths were observed among the 505 men. Only weight fluctuations had a clear significant impact on all-cause mortality. Adjusted hazard rate ratio (HRR (95%-CI)) was 1.86 (1.31–2.66) after adjustment for age group, pre-existing cardiovascular disease or diabetes mellitus, smoking and socio-economic status. The risk rate due to weight loss was borderline significant (HRR = 1.81 (0.99–3.31)). Risk of death due to weight gain (HRR = 1.15 (0.70–1.88)) or stable obesity (HRR = 1.16 (0.69–1.94)), however, were not significantly increased compared to men staying non-obese for the first 15 years after cohort recruitment. Conclusion Weight fluctuations are a major risk factor for all-cause mortality in middle aged men. Moreover, stable obesity does not increase further mortality in men aged 55–74 years in long-term follow-up.