Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents
Authors
di, Angelantonio Emanuele
Bhupathiraju, Shilpa N
Wormser, David
Gao, Pei
Berrington, de Gonzalez Amy
Cairns, Benjamin J
Huxley, Rachel
Jackson, Chandra L
Joshy, Grace
Lewington, Sarah
Manson, JoAnn E
Murphy, Neil
Patel, Alpa V
Samet, Jonathan M
Woodward, Mark
Zheng, Wei
Zhou, Maigen
Barricarte, Aurelio
Carter, Brian
Cerhan, James R
Collins, Rory
Smith, George Davey
Fang, Xianghua
Franco, Oscar H
Green, Jane
Halsey, Jim
Hildebrand, Janet S
Jung, Keum Ji
Korda, Rosemary J
McLerran, Dale F
Moore, Steven C
O'Keeffe, Linda M
Paige, Ellie
Reeves, Gillian K
Rolland, Betsy
Sacerdote, Carlotta
Sattar, Naveed
Sofianopoulou, Eleni
Stevens, June
Thun, Michael
Ueshima, Hirotsugu
Yang, Ling
Yun, Young Duk
Willeit, Peter
Banks, Emily
Beral, Valerie
Chen, Zhengming
Gapstur, Susan M
Gunter, Marc J
Hartge, Patricia
Jee, Sun Ha
Lam, Tai-Hing
Peto, Richard
Potter, John D
Willett, Walter C
Hu, Frank B
Publication Date
2016-07-13Journal Title
The Lancet
ISSN
0140-6736
Publisher
Elsevier
Volume
388
Pages
776-786
Language
English
Type
Article
Metadata
Show full item recordCitation
di, A. E., Bhupathiraju, S. N., Wormser, D., Gao, P., Kaptoge, S., Berrington, d. G. A., Cairns, B. J., et al. (2016). Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. The Lancet, 388 776-786. https://doi.org/10.1016/S0140-6736(16)30175-1
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 the prospective studies of body mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding prior disease and the first 5 years of follow-up.
Methods:
Of 10,625,411 participants in Asia, Australia/New Zealand, Europe, and North America from 239 prospective studies (median follow-up 13·7 [IQR: 11·4-14·7] years), 3,951,455 in 189 studies were never-smokers without specific chronic diseases at recruitment who survived 5 years, of whom 385,879 died. The primary analyses are of these deaths, using age and sex-adjusted hazard ratios (HRs).
Findings:
All-cause mortality was minimal (HR=1) at BMI (kg/m^2 ) 20-25, and increased significantly both just below this range (BMI 18·5-<20: HR=1·13, 95%CI 1·09-1·17; BMI 15-<18·5: HR=1·51, 1·43-1·59) and throughout the overweight range just above it (BMI 25-<27·5: HR=1·07, 1·07-1·08; BMI 27·5-<30: HR=1·20, 1·18-1·22). Continuing upwards, HRs for obesity grade I, II, and III (BMI 30-<35, 35-<40, 40-<60) were 1·45 (1·41-1·48), 1·94 (1·87-2.01), and 2·76 (2·60-2·92), respectively. For BMI>25, mortality increased approximately log-linearly with BMI; HR per 5 units higher BMI was 1·31 (1·29-1·33) in all regions; 1·39 (1·35-1·43) 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/New Zealand. This HR per 5 units higher BMI (for BMI>25) was greater in younger than older people (1.52 at 35–49 years vs 1·21 at 70-89 years; P heterogeneity <0·0001), greater in men than women (1·51 vs 1·30; P heterogeneity <0·0001), but similar in studies with self-reported and measured BMI.
Interpretation:
The associations of both overweight and obesity wit h higher all-cause mortality were broadly consistent in four continents. This supports strategies to combat the entire spectrum of excess adiposity in many populations.
Sponsorship
UK MRC, BHF, NIHR; US NIH
Funder references
MRC (MR/L003120/1)
MRC (G0800270)
Embargo Lift Date
2100-01-01
Identifiers
External DOI: https://doi.org/10.1016/S0140-6736(16)30175-1
This record's URL: https://www.repository.cam.ac.uk/handle/1810/254969
Rights
Attribution 4.0 International, Attribution 4.0 International, Attribution 4.0 International, Attribution 4.0 International