Background Body-mass index (the weight in kilograms dividedby the square of the height in meters) is known to be associatedwith overall mortality. We investigated the effects of age,race, sex, smoking status, and history of disease on the relationbetween body-mass index and mortality.
Methods In a prospective study of more than 1 million adultsin the United States (457,785 men and 588,369 women), 201,622deaths occurred during 14 years of follow-up. We examined therelation between body-mass index and the risk of death fromall causes in four subgroups categorized according to smokingstatus and history of disease. In healthy people who had neversmoked, we further examined whether the relation varied accordingto race, cause of death, or age. The relative risk was usedto assess the relation between mortality and body-mass index.
Results The association between body-mass index and the riskof death was substantially modified by smoking status and thepresence of disease. In healthy people who had never smoked,the nadir of the curve for body-mass index and mortality wasfound at a body-mass index of 23.5 to 24.9 in men and 22.0 to23.4 in women. Among subjects with the highest body-mass indexes,white men and women had a relative risk of death of 2.58 and2.00, respectively, as compared with those with a body-massindex of 23.5 to 24.9. Black men and women with the highestbody-mass indexes had much lower risks of death (1.35 and 1.21),which did not differ significantly from 1.00. A high body-massindex was most predictive of death from cardiovascular disease,especially in men (relative risk, 2.90; 95 percent confidenceinterval, 2.37 to 3.56). Heavier men and women in all age groupshad an increased risk of death.
Conclusions The risk of death from all causes, cardiovasculardisease, cancer, or other diseases increases throughout therange of moderate and severe overweight for both men and womenin all age groups. The risk associated with a high body-massindex is greater for whites than for blacks.
Source Information
From the Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta.
Address reprint requests to Dr. Calle at the American Cancer Society, 1599 Clifton Rd. NE, Atlanta, GA 30329.
Body-Mass Index and Mortality
Byers T., Durazo-Arvizu R. A., Goldbourt U., McGee D. L., Calle E. E., Thun M. J., Rodriguez C.
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N Engl J Med 2000;
342:286-289, Jan 27, 2000.
Correspondence
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