Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents

Di Angelantonio, E. et al. (2016) Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet, 388(10046), pp. 776-786. (doi: 10.1016/S0140-6736(16)30175-1) (PMID:27423262) (PMCID:PMC4995441)

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/m282 ) 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; Pheterogeneity<0·0001), greater in men than women (1·51 vs 1·30; Pheterogeneity<0·0001), but similar in studies with self-reported and measured BMI. Interpretation: The associations of both overweight and obesity with higher all-cause mortality were broadly consistent in four continents. This supports strategies to combat the entire spectrum of excess adiposity in many populations.

• Item Type: Articles
• Additional Information: The coordinating centre at the University of Cambridge was funded by the UK Medical Research Council (G0800270), British Heart Foundation (SP/09/002), British Heart Foundation Cambridge Cardiovascular Centre of Excellence, and National Institute for Health Research Cambridge Biomedical Research Centre. The work of the coordinating centre at the Harvard TH Chan School of Public Health was funded by grants P01 CA87969, UM1 CA176726, UM1 CA167552, DK58845, P30 DK046200, and U54 CA155626 from the National Institutes of Health. This research has been conducted using the UK Biobank resource.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Sattar, Professor Naveed
• Authors: Di Angelantonio, E., Bhupathiraju, S. N., Wormser, D., Gao, P., Kaptoge, S., Berrington de Gonzalez, A., Cairns, B. J., Huxley, R., Jackson, C. L., Joshy, G., Lewington, S., Manson, J. E., Murphy, N., Patel, A. V., Samet, J. M., Woodward, M., Zheng, W., Zhou, M., Bansal, N., Barricarte, A., Carter, B., Cerhan, J. R., Collins, R., Smith, G. D., Fang, X., Franco, O. H., Green, J., Halsey, J., Hildebrand, J. S., Jung, K. J., Korda, R. J., McLerran, D. F., Moore, S. C., O'Keeffe, L. M., Paige, E., Ramond, A., Reeves, G. K., Rolland, B., Sacerdote, C., Sattar, N., Sofianopoulou, E., Stevens, J., Thun, M., Ueshima, H., Yang, L., Yun, Y. D., Willeit, P., Banks, E., Beral, V., Chen, Z., Gapstur, S. M., Gunter, M. J., Hartge, P., Jee, S. H., Lam, T.-H., Peto, R., Potter, J. D., Willett, W. C., Thompson, S. G., Danesh, J., and Hu, F. B.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Lancet
• Publisher: Elsevier
• ISSN: 0140-6736
• ISSN (Online): 1474-547X
• Published Online: 13 July 2016
• Copyright Holders: Copyright © 2016 The Authors
• First Published: First published in The Lancet 388(10046): 776-786
• Publisher Policy: Reproduced under a Creative Commons License