Body mass index and mortality among US male physicians |
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Authors: | Ajani Umed A Lotufo Paulo A Gaziano J Michael Lee I-Min Spelsberg Angela Buring Julie E Willett Walter C Manson Joann E |
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Institution: | From the Division of Preventive Medicine (U.A.A., P.A.L., J.M.G., I.-M.L., A.S., J.E.B., J.E.M.) and Channing Laboratory (W.C.W., J.E.M.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Departments of Epidemiology (I.-M.L., J.E.B., W.C.W., J.E.M.) and Nutrition (W.C.W.), Harvard School of Public Health, Boston, MA; Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Medical Center, Brockton/West Roxbury, MA (J.M.G.); School of Public Health, University of North Texas Health Science Center, Fort Worth, TX (U.A.A.); and the Department of Internal Medicine, School of Medicine and Division of General Internal Medicine, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil (P.A.L.) |
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Abstract: | 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. |
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Keywords: | Body Mass Index Obesity Death Mortality Smoking |
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