JoAnn E. Manson, M.D., Walter C. Willett, M.D., Meir J. Stampfer, M.D., Graham A. Colditz, M.B., B.S., David J. Hunter, M.B., B.S., Susan E. Hankinson, Sc.D., Charles H. Hennekens, M.D., and Frank E. Speizer, M.D.
Background The relation between body weight and overall mortalityremains controversial despite considerable investigation.
Methods We examined the association between body-mass index(defined as the weight in kilograms divided by the square ofthe height in meters) and both overall mortality and mortalityfrom specific causes in a cohort of 115,195 U.S. women enrolledin the prospective Nurses' Health Study. These women were 30to 55 years of age and free of known cardiovascular diseaseand cancer in 1976. During 16 years of follow-up, we documented4726 deaths, of which 881 were from cardiovascular disease,2586 from cancer, and 1259 from other causes.
Results In analyses adjusted only for age, we observed a J-shapedrelation between body-mass index and overall mortality. Whenwomen who had never smoked were examined separately, no increasein risk was observed among the leaner women, and a more directrelation between weight and mortality emerged (P for trend <0.001). In multivariate analyses of women who had never smokedand had recently had stable weight, in which the first fouryears of follow-up were excluded, the relative risks of deathfrom all causes for increasing categories of body-mass indexwere as follows: body-mass index <19.0 (the reference category),relative risk = 1.0; 19.0 to 21.9, relative risk = 1.2; 22.0to 24.9, relative risk = 1.2; 25.0 to 26.9, relative risk =1.3; 27.0 to 28.9, relative risk = 1.6; 29.0 to 31.9, relativerisk = 2.1; and >32.0, relative risk = 2.2 (P for trend <0.001).Among women with body-mass indexes of 32.0 or higher who hadnever smoked, the relative risk of death from cardiovasculardisease was 4.1 (95 percent confidence interval, 2.1 to 7.7),and that of death from cancer was 2.1 (95 percent confidenceinterval, 1.4 to 3.2), as compared with the risk among womenwith body-mass indexes below 19.0. A weight gain of 10 kg (22lb) or more since the age of 18 was associated with increasedmortality in middle adulthood.
Conclusions Body weight and mortality from all causes were directlyrelated among these middle-aged women. Lean women did not haveexcess mortality. The lowest mortality rate was observed amongwomen who weighed at least 15 percent less than the U.S. averagefor women of similar age and among those whose weight had beenstable since early adulthood.
Source Information
From the Channing Laboratory (J.E.M., W.C.W., M.J.S., G.A.C., D.J.H., S.E.H., C.H.H., F.E.S.) and the Division of Preventive Medicine (J.E.M., C.H.H.), Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, and the Departments of Epidemiology (W.C.W., M.J.S., G.A.C., D.J.H., C.H.H.) and Nutrition (W.C.W., M.J.S.), Harvard School of Public Health — all in Boston.
Address reprint requests to Dr. Manson at 180 Longwood Ave., Boston, MA 02115.
Body Weight and Mortality among Women
Hamburg P., Lipkowitz M. H., Frisch R. E., Jacobson T. A., Brown S., Manson J. E., Willett W. C., Speizer F. E.
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N Engl J Med 1996;
334:732-733, Mar 14, 1996.
Correspondence
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