Abstract
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.
Similar content being viewed by others
References
Rothman KJ. BMI-related errors in the measurement of obesity. Int J Obes. 2008;32:S56–9.
Bouchard C. BMI, fat mass, abdominal adiposity and visceral fat: where is the ‘beef’? Int J Obes. 2007;31:1552–3.
Hu F. Obesity epidemiology. New York: Oxford University Press; 2008.
Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083–96.
Wilson PW, D’Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med. 2002;162:1867–72.
Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9:88.
Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999;341:1097–105.
Baik I, Ascherio A, Rimm EB, et al. Adiposity and mortality in men. Am J Epidemiol. 2000;152:264–71.
Ajani UA, Lotufo PA, Gaziano JM, et al. Body mass index and mortality among US male physicians. Ann Epidemiol. 2004;14:731–9.
Hu FB, Willett WC, Li T, Stampfer MJ, Colditz GA, Manson JE. Adiposity as compared with physical activity in predicting mortality among women. N Engl J Med. 2004;351:2694–703.
Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293:1861–7.
Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006;355:763–78.
Moore SC, Mayne ST, Graubard BI, et al. Past body mass index and risk of mortality among women. Int J Obes. 2008;32:730–9.
Orpana HM, Berthelot JM, Kaplan MS, Feeny DH, McFarland B, Ross NA. BMI and mortality: results from a national longitudinal study of Canadian adults. Obesity. 2010;18:214–8.
Boggs DA, Rosenberg L, Cozier YC, et al. General and abdominal obesity and risk of death among black women. N Engl J Med. 2011;365:901–8.
Hjartaker A, Adami HO, Lund E, Weiderpass E. Body mass index and mortality in a prospectively studied cohort of Scandinavian women: the women’s lifestyle and health cohort study. Eur J Epidemiol. 2005;20:747–54.
Hu G, Tuomilehto J, Silventoinen K, Barengo NC, Peltonen M, Jousilahti P. The effects of physical activity and body mass index on cardiovascular, cancer and all-cause mortality among 47 212 middle-aged Finnish men and women. Int J Obes. 2005;29:894–902.
Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med. 2008;359:2105–20.
Lawlor DA, Hart CL, Hole DJ, Davey SG. Reverse causality and confounding and the associations of overweight and obesity with mortality. Obesity. 2006;14:2294–304.
Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 146 million white adults. N Engl J Med. 2010;363:2211–9.
Kolonel LN, Henderson BE, Hankin JH, et al. A multiethnic cohort in Hawaii and Los Angeles: baseline characteristics. Am J Epidemiol. 2000;151:346–57.
World Health Organization. Obesity: preventing and managing the global epidemic. WHO Technical Report Series 894. Geneva: World Health Organization; 2000.
Flegal KM, Graubard BI, Williamson DF, Gail MH. Impact of smoking and preexisting illness on estimates of the fractions of deaths associated with underweight, overweight, and obesity in the US population. Am J Epidemiol. 2007;166:975–82.
Haiman CA, Stram DO, Wilkens LR, et al. Ethnic and racial differences in the smoking-related risk of lung cancer. N Engl J Med. 2006;354:333–42.
Solomon CG, Manson JE. Obesity and mortality: a review of the epidemiologic data. Am J Clin Nutr. 1997;66:1044S–50S.
Flanders WD, Augestad LB. Adjusting for reverse causality in the relationship between obesity and mortality. Int J Obes. 2008;32(Suppl 3):S42–6.
Zheng W, McLerran DF, Rolland B, et al. Association between body-mass index and risk of death in more than 1 million Asians. N Engl J Med. 2011;364:719–29.
Geer EB, Shen W. Gender differences in insulin resistance, body composition, and energy balance. Gend Med. 2009;6(Suppl 1):60–75.
McGee DL. Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. Ann Epidemiol. 2005;15:87–97.
Lewis CE, McTigue KM, Burke LE, et al. Mortality, health outcomes, and body mass index in the overweight range: a science advisory from the American Heart Association. Circulation. 2009;119:3263–71.
World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: American Institute for Cancer Research; 2007.
Goran MI. Ethnic-specific pathways to obesity-related disease: the Hispanic vs. African-American paradox. Obesity. 2008;16:2561–5.
Rush EC, Freitas I, Plank LD. Body size, body composition and fat distribution: comparative analysis of European, Maori, Pacific Island and Asian Indian adults. Br J Nutr. 2009;102:632–41.
Borrud LG, Flegal KM, Looker AC, Everhart JE. Body composition data for individuals 8 years of age and older: U.S. population, 1999–2004. Vital Health Stat 11(250). National Center for Health Statistics; 2010.
Wulan SN, Westerterp KR, Plasqui G. Ethnic differences in body composition and the associated metabolic profile: a comparative study between Asians and Caucasians. Maturitas. 2010;65:315–9.
Lim U, Ernst T, Buchthal S, et al. Asian women have greater abdominal and visceral adiposity than Caucasian women with similar body mass index. Obesity. 2011;19:S224.
Niedhammer I, Bugel I, Bonenfant S, Goldberg M, Leclerc A. Validity of self-reported weight and height in the French GAZEL cohort. Int J Obes. 2000;24:1111–8.
Villanueva EV. The validity of self-reported weight in US adults: a population based cross-sectional study. BMC Public Health. 2001;1:11.
Johnson WD, Bouchard C, Newton RL Jr, Ryan DH, Katzmarzyk PT. Ethnic differences in self-reported and measured obesity. Obesity. 2009;17:571–7.
Keith SW, Fontaine KR, Pajewski NM, Mehta T, Allison DB. Use of self-reported height and weight biases the body mass index-mortality association. Int J Obes. 2011;35:401–8.
Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women. Circulation. 2008;117:1658–67.
Srikanthan P, Seeman TE, Karlamangla AS. Waist-hip-ratio as a predictor of all-cause mortality in high-functioning older adults. Ann Epidemiol. 2009;19:724–31.
Acknowledgments
This work was supported in part by the National Cancer Institute at the National Institutes of Health [R37 CA54281].
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Park, SY., Wilkens, L.R., Murphy, S.P. et al. Body mass index and mortality in an ethnically diverse population: the Multiethnic Cohort Study. Eur J Epidemiol 27, 489–497 (2012). https://doi.org/10.1007/s10654-012-9695-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10654-012-9695-5