Advertisement

Cancer Causes & Control

, Volume 30, Issue 5, pp 549–557 | Cite as

Joints effects of BMI and smoking on mortality of all-causes, CVD, and cancer

  • Eefje Luijckx
  • Tina Lohse
  • David Faeh
  • Sabine RohrmannEmail author
Original Paper

Abstract

Obesity, underweight, and smoking are associated with an increased mortality. We investigated the joint effects of body mass index and smoking on all-cause and cause-specific mortality. Data of the Third National Health and Nutrition Examination Survey (1988–1994) including mortality follow-up until 2011 were used (n = 17,483). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause, cardiovascular disease (CVD), and cancer mortality with BMI, smoking, and their combinations as exposure, stratified by sex. Normal weight never smokers were considered as reference group. Compared to normal weight never smokers, obese and underweight current smokers were the two combinations with the highest mortality from all-causes, CVD, and cancer. Among underweight current smokers, the HR of death from all-causes was 3.49 (95% CI 2.42–5.02) and for obese current smokers 2.76 (2.12–3.58). All-cause mortality was particularly high in women who were underweight and current smoker (3.88 [2.47–6.09]). CVD mortality risk was the highest among obese current smokers (3.33 [2.98–5.33]). Cancer mortality risk was the highest among underweight current smokers (5.28 [2.68–10.38]). Obese current smokers in the middle age group (between 40 and 59 years old) had the highest risk of all-cause mortality (4.48 [2.94–7.97]). No statistically significant interaction between BMI and smoking on all-cause and cause-specific mortality was found. The current study indicates that obesity and underweight in combination with smoking may emerge as a serious public health problem. Hence, public health messages should stress the increased mortality risk for smokers who are underweight or obese. Also, health messages regarding healthy lifestyle are aimed at maintaining a healthy body weight rather than just “losing weight” and at not starting smoking at all.

Keywords

NHANES III Obesity Underweight Smoking Mortality 

Notes

Author contributions

EL collected, analyzed, and interpreted study data. EL wrote the first draft of the manuscript. SR, TL, and DF critically revised and improved the content of the manuscript. All authors read and improved the final manuscript.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Informed consent

Informed consent was obtained from all participants when participating in NHANES III.

Ethical approval

The protocols for the conduct of NHANES III were approved by the institutional review board of the National Center for Health Statistics, US Centers for Disease Control and Prevention.

Data sharing statement

No additional unpublished data from the study are available. However, NHANES data are publically available.

Supplementary material

10552_2019_1160_MOESM1_ESM.pptx (236 kb)
Supplementary material 1 (PPTX 236 KB)

References

  1. 1.
    Freedman DM, Sigurdson AJ, Rajaraman P, Doody MM, Linet MS, Ron E (2006) The mortality risk of smoking and obesity combined. Am J Prev Med 31(5):355–362.  https://doi.org/10.1016/j.amepre.2006.07.022 CrossRefGoogle Scholar
  2. 2.
    Global BMIM, Collaboration (2016) Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet 388(10046):776–786CrossRefGoogle Scholar
  3. 3.
    Prospective Studies Collaboration (2009) Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 373(9669):1083–1096CrossRefGoogle Scholar
  4. 4.
    Romero-Corral A, Montori VM, Somers VK et al (2006) Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet 368(9536):666–678CrossRefGoogle Scholar
  5. 5.
    Pednekar MS, Gupta PC, Hebert JR, Hakama M (2008) Joint effects of tobacco use and body mass on all-cause mortality in Mumbai, India: results from a population-based cohort study. Am J Epidemiol 167(3):330–340CrossRefGoogle Scholar
  6. 6.
    Aune D, Sen A, Prasad M et al (2016) BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ 353:i2156CrossRefGoogle Scholar
  7. 7.
    GBD 2015 Tobacco Collaborators (2017) Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet 389(10082):1885–1906CrossRefGoogle Scholar
  8. 8.
    Maag J, Braun J, Bopp M, Faeh D (2013) Direct estimation of death attributable to smoking in Switzerland based on record linkage of routine and observational data. Nicotine Tob Res 15(9):1588–1597CrossRefGoogle Scholar
  9. 9.
    Jha P, Ramasundarahettige C, Landsman V et al (2013) 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med 368(4):341–350.  https://doi.org/10.1056/NEJMsa1211128 CrossRefGoogle Scholar
  10. 10.
    Meyer J, Rohrmann S, Bopp M, Faeh D (2015) Impact of smoking and excess body weight on overall and site-specific cancer mortality risk. Cancer Epidemiol Biomarkers Prev.  https://doi.org/10.1158/1055-9965.EPI-15-0415 Google Scholar
  11. 11.
    Ma J, Jemal A, Flanders WD, Ward EM (2013) Joint association of adiposity and smoking with mortality among U.S. adults. Prev Med 56(3–4):178–184.  https://doi.org/10.1016/j.ypmed.2012.12.012 CrossRefGoogle Scholar
  12. 12.
    Neovius M, Sundstrom J, Rasmussen F (2009) Combined effects of overweight and smoking in late adolescence on subsequent mortality: nationwide cohort study. BMJ 338(feb24 2):b496–b496b.  https://doi.org/10.1136/bmj.b496 CrossRefGoogle Scholar
  13. 13.
    Flegal KM, Graubard BI, Williamson DF, Gail MH (2007) 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 166(8):975–982.  https://doi.org/10.1093/aje/kwm152 CrossRefGoogle Scholar
  14. 14.
    Koster A, Leitzmann M, Schatzkin A et al (2008) The combined relations of adiposity and smoking on mortality. Am J Clin Nutr 88:1206–1212Google Scholar
  15. 15.
    Diverse Population Collaboration Group (1999) Effect of smoking on the body mass index-mortality relation. Am J Epidemiol 150:1297–1308CrossRefGoogle Scholar
  16. 16.
    National Center for Health Statistics (1994) Plan and operation of the Third National Health and Nutrition Examination Survey (1988-94) Series 1: programs and collection procedures. Vital Health Stat 32(1):1–407Google Scholar
  17. 17.
    Flegal KM, Kit BK, Graubard BI (2014) Body mass index categories in observational studies of weight and risk of death. Am J Epidemiol 180(3):288–296.  https://doi.org/10.1093/aje/kwu111 CrossRefGoogle Scholar
  18. 18.
    Adams K, Harris SA, Kipnis T, Mouw V (2006) et al: Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 355:763–778CrossRefGoogle Scholar
  19. 19.
    Faeh D, Braun J, Tarnutzer S, Bopp M: Obesity but not overweight is associated with increased mortality risk. Eur J Epidemiol 2011;26(8):647–655.  https://doi.org/10.1007/s10654-011-9593-2 CrossRefGoogle Scholar
  20. 20.
    Chiolero A, Wietlisbach V, Ruffieux C, Paccaud F, Cornuz J (2006) Clustering of risk behaviors with cigarette consumption: a population-based survey. Prev Med 42(5):348–353.  https://doi.org/10.1016/j.ypmed.2006.01.011 CrossRefGoogle Scholar
  21. 21.
    Lohse T, Rohrmann S, Bopp M, Faeh D: Heavy smoking is more strongly associated with general unhealthy lifestyle than obesity and underweight. PLoS ONE 2016;11(2).  https://doi.org/10.1371/journal.pone.0148563
  22. 22.
    Clair C, Chiolero A, Feah D et al (2011) Dose-dependent positive association between cigarette smoking, abdominal obesity and body fat- cross-sectional data from a population-based survey. BMC Public Health 11:23CrossRefGoogle Scholar
  23. 23.
    McGee DL, Diverse Populations Collaboration (2005) Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. Am J Epidemiol 15(2):87–97Google Scholar
  24. 24.
    Taghizadeh N, Boezen HM, Schouten JP et al (2015) BMI and Lifetime changes in BMI and cancer mortality risk. PLoS ONE 10(4):e0125261.  https://doi.org/10.1371/journal.pone.0125261 CrossRefGoogle Scholar
  25. 25.
    Ungefroren H, Gieseler F, Lehnert H (2015) Obesity and cancer. Internist (Berl) 56(2):127–128CrossRefGoogle Scholar
  26. 26.
    Roh L, Braun J, Chiolero A, Bopp M, Rohrmann S, Faeh D (2014) Mortality risk associated with underweight: a census-linked cohort of 31,578 individuals with up to 32 years of follow-up. BMC Public Health 14:371CrossRefGoogle Scholar
  27. 27.
    Carter BD, Abnet CC, Feskanich D et al (2015) Smoking and mortality beyond established causes. N Engl J Med 372(7):631–640.  https://doi.org/10.1056/NEJMsa1407211 CrossRefGoogle Scholar
  28. 28.
    Borrell LN, Samuel L (2014) Body mass index categories and mortality risk in US adults: the effect of overweight and obesity on advancing death. Am J Public Health 104(3):512–519CrossRefGoogle Scholar
  29. 29.
    Lee JYKH, Kim C, Par K, Hahn SV et al (2015) Underweight and mortality. Public Health Nutr.  https://doi.org/10.1017/S136898001500302X Google Scholar
  30. 30.
    Sempos CT, Durazo-Arvizu R, McGee DL, Cooper RS, Prewitt TE (1998) The influence of cigarette smoking on the association between body weight and mortality. The Framingham Heart Study Revisited. AEP 8(5):289–300Google Scholar
  31. 31.
    Schuit AJ, van Loon AJM, Tijhuis M, Ocké MC (2002) Clustering of lifestyle risk factors in a general adult population. Prev Med 35(3):219–224.  https://doi.org/10.1006/pmed.2002.1064 CrossRefGoogle Scholar
  32. 32.
    Kitsantas P, Wu H (2013) Body mass index, smoking, age and cancer mortality among women: a classification tree analysis. J Obstet Gynaecol Res 39(8):1330–1338.  https://doi.org/10.1111/jog.12065 CrossRefGoogle Scholar
  33. 33.
    Po-Huang C, Burchfiel CM, Katsuhiko Y et al (1997) Obesity, alcohol consumption, smoking, and mortality. AUP 7(4):31I–317Google Scholar
  34. 34.
    Maki NE, Martikainen PT, Eikemo T et al (2014) The potential for reducing differences in life expectancy between educational groups in five European countries: the effects of obesity, physical inactivity and smoking. J Epidemiol Community Health 68(7):635–640.  https://doi.org/10.1136/jech-2013-203501 CrossRefGoogle Scholar
  35. 35.
    Tan AKG, Yen ST, Feisul MI (2013) The association between smoking and body mass index: results from a national sample of Malaysian adults. J Public Health 21(5):403–412.  https://doi.org/10.1007/s10389-013-0569-4 CrossRefGoogle Scholar
  36. 36.
    Travier N, Agudo A, May AM et al (2009) Smoking and body fatness measurements: a cross-sectional analysis in the EPIC-PANACEA study. Prev Med 49(5):365–373.  https://doi.org/10.1016/j.ypmed.2009.08.009 CrossRefGoogle Scholar
  37. 37.
    Demetrius A. Jones Y, Micozzi MS, Mattson ME (1987) Associations between Smoking and Body Weight In the US Population: Analysis of NHANES II. AJPH 77(4):439–444CrossRefGoogle Scholar
  38. 38.
    World Health Organisation: Diet, nutrition and the prevention of chronic diseases. WHO Technical Report Series. 2003:1-160Google Scholar
  39. 39.
    Gallagher D, Visser M, Sepulveda D, Pierson R, Harris T et al (1996) How useful is body mass index for comparison of body fatness across age, sex, and ethnic groups. Am J Epidemiol 143(3):229–239CrossRefGoogle Scholar
  40. 40.
    Klatsky AL, Zhang J, Udaltsova N, Li Y, Tran HN (2017) Body mass index and mortality in a very large cohort: is it really healthier to be overweight? Perm J 21:16–142Google Scholar
  41. 41.
    Arngrimsson SA, McAuley E, Evans EM (2009) Change in body mass index is a stronger predictor of change in fat mass than lean mass in elderly black and white women. Am J Hum Biol 21(1):124–126.  https://doi.org/10.1002/ajhb.20833 CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention InstituteUniversity of ZurichZurichSwitzerland
  2. 2.Health Division - PhysiotherapyBern University of Applied Sciences (BFH)BernSwitzerland
  3. 3.Health Division - Nutrition and DieteticsBern University of Applied Sciences (BFH)BernSwitzerland

Personalised recommendations