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Epidemiology

Relationship between body mass index and mortality among Europeans

European Journal of Clinical Nutrition volume 66, pages 156–165 (2012)Cite this article

Abstract

Background/Objectives:

To investigate the relationship between body mass index (BMI) and mortality from various causes.

Subjects/Methods:

Data of 72 947 European men and 62 798 women aged 24–99 years at baseline were collaboratively analyzed. Both absolute and relative mortality risks were estimated within each BMI categories. The hazard ratio was estimated using Cox regression analysis adjusting for age, cohort and smoking status.

Results:

Over a median follow-up of 16.8 years, 29 071 participants died, 13 502 from cardiovascular disease (CVD) and 8748 from cancers of all types. All-cause and cancer mortality showed a U-shaped relationship: decreased first, leveled off, and then increased with increasing BMI with the lowest mortality risk approximately between 23.0 and 28.0 kg/m2 of BMI in men and 21.0 and 28.0 kg/m2 in women. The U-shaped relationship held for all-cause mortality but disappeared for cancer mortality among non-smokers. The CVD mortality was constant until a BMI of approximately 28.0 kg/m2 and then increased gradually in both men and women, which was independent of age, cohort and smoking status.

Conclusions:

A U-shaped relationship of BMI with all-cause mortality but a graded relationship with CVD mortality at BMI >28.0 kg/m2 was detected. The relationship between cancer mortality and BMI largely depended on smoking status, and need to be further investigated with site-specific cancers.

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Acknowledgements

This study was supported by a grant from the Academy Finland (129197).

Author information

Author notes

  1. X Song, J Pitkäniemi, W Gao, R J Heine, K Pyörälä, S Söderberg, C D A Stehouwer, B Zethelius, J Tuomilehto, T Laatikainen, A G Tabák and Q Qiao: See Appendix.

Authors and Affiliations

  1. Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland

    X Song, J Pitkäniemi, W Gao, J Tuomilehto & Q Qiao

  2. Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland

    X Song, W Gao, J Tuomilehto, T Laatikainen & Q Qiao

  3. V,

    R J Heine

  4. U University of Medical Center, Amsterdam, The Netherlands

    R J Heine

  5. Eli Lilly and Company, Indianapolis, IN, USA

    R J Heine

  6. Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland

    K Pyörälä

  7. Department of Public Health and Clinical Medicine, Cardiology, Umeå University Hospital, Umeå, Sweden

    S Söderberg

  8. Baker IDI Heart and Diabetes Institute, Melbourne, Australia

    S Söderberg

  9. Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands

    C D A Stehouwer

  10. Department of Public Health/Geriatrics, Uppsala University Hospital, Uppsala, Sweden

    B Zethelius

  11. Department of Epidemiology and Public Health, University College London, London, UK

    A G Tabák

  12. 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary

    A G Tabák

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  7. C D A Stehouwer
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  8. B Zethelius
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for the DECODE Study Group

Corresponding author

Correspondence to X Song.

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The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies the paper on European Journal of Clinical Nutrition website

Supplementary information

Appendix

Appendix

Studies and investigators included in this collaborative study are:

Denmark Glostrups Study: T Jørgensen1,2, K Borch-Johnson3.

1Research Centre for Prevention and Health, Glostrup University Hospital; 2Faculty of Health Science, University of Copenhagen; 3Steno Diabetes Center, Gentofte.

Finland East–West Study: A Nissinen,1 J Pekkanen,1 J Tuomilehto1,2,3.

1Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland; 2Department of Public Health, University of Helsinki, Helsinki, Finland; 3South Ostrobothnia Central Hospital, Seinäjoki.

Helsinki Policemen Study: M Pyörälä, K Pyörälä.

Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio.

National FINRISK 1972–1997 Cohorts: J Tuomilehto1,2,3, P Jousilahti2, J Lindström2.

1Department of Public Health, University of Helsinki, Helsinki; 2Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki; 3South Ostrobothnia Central Hospital, Seinäjoki.

National FINRISK 2002 Study: J Tuomilehto1,2, T Laatikainen2, M Peltonen2, J Lindström2.

1Department of Public Health, University of Helsinki, Helsinki; 2Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki.

Oulu Study: S Keinänen-Kiukaanniemi1,2,3, U Rajala1, M Laakso1,3.

1The Institute of Health Sciences, University of Oulu, Oulu; 2Oulu Health Centre; 3Oulu University Hospital, Unit of General Practice.

Vantaa Study: R Tilvis1, J Tuomilehto2,3.

1Division of geriatrics, Department of medicine, University of Helsinki, Helsinki; 2Diabetes Prevention Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki; 3Department of Public Health, University of Helsinki, Helsinki.

Iceland Reykjavik Study: G Sigurdsson1,2.

1University of Iceland, Reykjavik, Iceland; Icelandic Heart Association, Kopavogur; 2Landspitali-Univerisity Hospital, Reykjavik.

Israel GOH-I Study: R Dankner1,2.

1Unit for Cardiovascular Epidemiology, The Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel; 2Division of Epidemiology and Prevention, School of Public Health, Sackler School of Medicine, Tel Aviv University, Israel.

Italy Cremona Study: MP Garancini1, G Calori1, G Ruotolo1,2, S Mannino3, M Villa3.

1Division of Metabolic and Cardiovascular Diseases, San Raffaele Scientific Institute, Milan; 2AstraZeneca R&D Mölndal, Sweden; 3ASL Provincia di Cremona, Cremona.

Poland POLMONICA: A Pajak, E Kawalec.

Department of Epidemiology and Population Studies, Institute of Public Health, Unit of Health Care, Collegium Medicum Jagiellonian University, Krakow.

Spain Catalonia Study: C Castell.

Division of Public Health, Department of Health, Generalitat of Catalonia, Barcelona.

Sweden Northern Sweden MONICA Survey: S Söderberg1,2, M Eliasson1.

1Department of Public Health and Clinical Medicine, Cardiology, Umeå University Hospital, Umeå; 2Baker IDI Heart and Diabetes Institute, Melbourne, Australia.

The Uppsala Longitudinal Study of Adult Men (ULSAM): B Zethelius.

Department of Public Health/Geriatrics, Uppsala University Hospital, Uppsala.

Malmo Preventive Project: PM Nilsson and G Berglund.

Department of Clinical Sciences, Lund University, University Hospital, Malmö.

The Netherlands Hoorn Study: JM Dekker1, G Nijpels1, CDA Stehouwer2.

1Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam; 2Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht.

Zutphen Study: Ed Feskens.

Department of Chronic Disease and Environmental Epidemiology, National Institute of Public Health and Environmental Protection, Bilthoven.

Turkey Turkish Adult Risk Factor Study: A Onat1,2.

1Turkish Society of Cardiology, Istanbul; 2Department of Cardiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul.

United Kingdom Isle of Ely Diabetes Project: NJ Wareham.

MRC Epidemiology Unit, Strangeways Research Labs, Cambridge.

Newcastle Heart Project: N Unwin1, N Ahmad1, KGMM Alberti2, L Hayes1.

1Department of Medicine and Epidemiology and Public Health, University of Newcastle, Newcastle; 2Imperial College, St Mary's Campus, St Mary's Hospital, London.

Goodinge Study: RW Morris, JS Yudkin, M Gould, A Haines.

Department of Primary Care & Population Sciences, Royal Free and University College Medical School, London.

Whitehall II Study: MG Marmot1, AG Tabák1,2, M Kivimäki1,3, EJ Brunner1, DR Witte1,4.

1Department of Epidemiology and Public Health, University College London, London; 2Semmelweis University Faculty of Medicine, 1st Department of Medicine, Budapest; 3Finnish Institute of Occupational Health, Helsinki; 4Steno Diabetes Center, Gentofte.

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Song, X., Pitkäniemi, J., Gao, W. et al. Relationship between body mass index and mortality among Europeans. Eur J Clin Nutr 66, 156–165 (2012). https://doi.org/10.1038/ejcn.2011.145

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