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European Journal of Epidemiology

, Volume 27, Issue 7, pp 489–497 | Cite as

Body mass index and mortality in an ethnically diverse population: the Multiethnic Cohort Study

  • Song-Yi Park
  • Lynne R. Wilkens
  • Suzanne P. Murphy
  • Kristine R. Monroe
  • Brian E. Henderson
  • Laurence N. Kolonel
MORTALITY

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.

Keywords

Body mass index Cohort studies Mortality Multiethnic population Obesity 

Notes

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.

References

  1. 1.
    Rothman KJ. BMI-related errors in the measurement of obesity. Int J Obes. 2008;32:S56–9.CrossRefGoogle Scholar
  2. 2.
    Bouchard C. BMI, fat mass, abdominal adiposity and visceral fat: where is the ‘beef’? Int J Obes. 2007;31:1552–3.CrossRefGoogle Scholar
  3. 3.
    Hu F. Obesity epidemiology. New York: Oxford University Press; 2008.CrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    Baik I, Ascherio A, Rimm EB, et al. Adiposity and mortality in men. Am J Epidemiol. 2000;152:264–71.PubMedCrossRefGoogle Scholar
  9. 9.
    Ajani UA, Lotufo PA, Gaziano JM, et al. Body mass index and mortality among US male physicians. Ann Epidemiol. 2004;14:731–9.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293:1861–7.PubMedCrossRefGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    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.CrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    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.CrossRefGoogle Scholar
  18. 18.
    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.PubMedCrossRefGoogle Scholar
  19. 19.
    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.PubMedCrossRefGoogle Scholar
  20. 20.
    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.PubMedCrossRefGoogle Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    World Health Organization. Obesity: preventing and managing the global epidemic. WHO Technical Report Series 894. Geneva: World Health Organization; 2000.Google Scholar
  23. 23.
    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.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    Solomon CG, Manson JE. Obesity and mortality: a review of the epidemiologic data. Am J Clin Nutr. 1997;66:1044S–50S.PubMedGoogle Scholar
  26. 26.
    Flanders WD, Augestad LB. Adjusting for reverse causality in the relationship between obesity and mortality. Int J Obes. 2008;32(Suppl 3):S42–6.CrossRefGoogle Scholar
  27. 27.
    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.PubMedCrossRefGoogle Scholar
  28. 28.
    Geer EB, Shen W. Gender differences in insulin resistance, body composition, and energy balance. Gend Med. 2009;6(Suppl 1):60–75.PubMedCrossRefGoogle Scholar
  29. 29.
    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.PubMedCrossRefGoogle Scholar
  30. 30.
    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.PubMedCrossRefGoogle Scholar
  31. 31.
    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.Google Scholar
  32. 32.
    Goran MI. Ethnic-specific pathways to obesity-related disease: the Hispanic vs. African-American paradox. Obesity. 2008;16:2561–5.PubMedCrossRefGoogle Scholar
  33. 33.
    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.PubMedCrossRefGoogle Scholar
  34. 34.
    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.Google Scholar
  35. 35.
    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.PubMedCrossRefGoogle Scholar
  36. 36.
    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.CrossRefGoogle Scholar
  37. 37.
    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.CrossRefGoogle Scholar
  38. 38.
    Villanueva EV. The validity of self-reported weight in US adults: a population based cross-sectional study. BMC Public Health. 2001;1:11.PubMedCrossRefGoogle Scholar
  39. 39.
    Johnson WD, Bouchard C, Newton RL Jr, Ryan DH, Katzmarzyk PT. Ethnic differences in self-reported and measured obesity. Obesity. 2009;17:571–7.PubMedCrossRefGoogle Scholar
  40. 40.
    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.CrossRefGoogle Scholar
  41. 41.
    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.PubMedCrossRefGoogle Scholar
  42. 42.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Song-Yi Park
    • 1
  • Lynne R. Wilkens
    • 1
  • Suzanne P. Murphy
    • 1
  • Kristine R. Monroe
    • 2
  • Brian E. Henderson
    • 2
  • Laurence N. Kolonel
    • 1
  1. 1.Epidemiology ProgramUniversity of Hawaii Cancer CenterHonoluluUSA
  2. 2.Department of Preventive Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA

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