Abstract
OBJECTIVE: Although obesity is a major health problem in Western countries, its impact may differ in another culture. This paper examines the association between body mass index (BMI; kg/m2) and mortality in Japan, where the mortality profile and BMI distribution differ substantially from Western countries.
DESIGN: The JPHC Study cohort I, a population-based prospective study in four public health center areas, started in 1990 and was followed-up to the end of 1999.
SUBJECTS: A total of 19 500 men and 21 315 women aged 40–59 y who submitted their body weight and height and did not report any serious disease at baseline.
MEASUREMENT: Risk of death by category of BMI.
RESULTS: During 10 y of follow-up, 943 and 483 deaths were documented in the men and women, respectively. The association between BMI and all-cause mortality was U-shaped: compared with a category of 23.0–24.9, the statistically significant elevations in relative risk were observed in both under- and overweight categories (2.26 in 14.0–18.9, 1.57 in 19.0–20.9, 1.33 in 21.0–22.9 and 1.38 in 27.0–29.9, 1.97 in 30.0–39.9 in men, 1.94 in 14.0–18.9 and 1.91 in 30.0–39.9 in women) after adjustment for possible confounders and weight change. The U-shaped association did not change after excluding deaths occurring in the first 5 y of follow-up or even after excluding subjects who reported a weight loss of 5 kg or more since 20-y-old, or after stratifying subjects by smoking status.
CONCLUSION: Both under- and overweight are important determinants of premature death among the Japanese population.
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References
Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB . Annual deaths attributable to obesity in the United States JAMA 1999 282: 1530–1538.
Mokdad AH, Serdula MK, Dietz WH, Bowman BA, Marks JS, Koplan JP . The spread of the obesity epidemic in the United States, 1991–1998 JAMA 1999 282: 1519–1522.
Ministry of Health and Welfare . Kokumin Eiyo no Genjou Results of National Nutrition Survey 1998) Daiichi Shuppan: Tokyo 2000 (in Japanese)
Yoshiike N, Matsumura Y, Zaman MM, Yamaguchi M . Descriptive epidemiology of body mass index in Japanese adults in a representative sample from the National Nutrition Survey 1990–1994 Int J Obes Relat Metab Disord 1998 22: 684–687.
Triano RP, Frongillo EA Jr, Sobal J, Levitsky DA . The relationship between body weight and mortality: a quantitative analysis of combined information from existing studies Int J Obes Relat Metab Disord 1996 20: 63–75.
Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL . The effect of age on the association between body-mass index and mortality New Engl J Med 1998 338: 1–7.
Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Health CW Jr . Body-mass index and mortality in a prospective cohort of US adults New Engl J Med 1999 341: 1097–1105.
Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, Hennekens CH, Speizer FE . Body weight and mortality among women New Engl J Med 1995 333: 677–685.
Baik I, Ascherio A, Rimm EB, Giovannucci E, Spiegelman D, Stampfer MJ, Willett WC . Adiposity and mortality in men Am J Epidemiol 2000 152: 264–271.
Tsukamoto H, Sano F . Body weight and longevity: insurance experience in Japan Diabetes Res Clin Pract 1990 10: S119–S125.
Tsubono Y, Fukao A, Hisamichi S . Health practice and mortality in a rural Japanese population Tohoku J Exp Med 1993 171: 339–348.
Ishii T, Momose Y, Esaki H, Une H . A prospective study on the relationship between body mass index and mortality in middle-aged and elderly people in Japan Jpn J Public Health 1998 45: 27–34 (in Japanese)
Yuan JM, Ross RK, Gao YT, Yu M . Body weight and mortality: a prospective evaluation in a cohort of middle-aged men in Shanghai, China Int J Epidemiol 1998 27: 824–832.
Tsugane S, Gey F, Ichinowatari Y et al. . Cross-sectional epidemiologic study for assessing cancer risks at the population level. I. Study design and participation rate J Epidemiol 1992 2: 75–81.
Tsugane S, Tsuda M, Gey F et al. . Cross-sectional study with multiple measurements of biological markers for assessing stomach cancer risks at the population level Environ Health Perspect 1992 98: 207–210.
Tsubono Y, Kobayashi M, Tsugane S . Food consumption and gastric cancer mortality in five regions of Japan Nutr Cancer 1997 27: 60–64.
SAS Institute Inc . SAS/STAT Software—changes and enhancements: the PHREG procedure SAS Institute Inc.; 1996 809–884.
Rockhill B, Newman B, Weinberg C . Use and misuse of population attributable fractions Am J Public Health 1998 88: 15–19.
Greenland S . Re: ‘Confidence limits made easy: interval estimation using a substitution method’ Am J Epidemiol 1999 149: 884.
Manson JE . Body weight and longevity: a reassessment JAMA 1987 257: 353–358.
Lee IM, Paffenbarger RS Jr . Change in body weight and longevity JAMA 1992 268: 2045–2049.
Harvard Center for Cancer Prevention . Harvard Report on Cancer Prevention Volume I: causes of human cancer Cancer Causes Controls 1996 7: S11–13.
Acknowledgements
This study was supported by grants-in-aid for Cancer Research and for the second Term Comprehensive Ten-Year Strategy for Cancer Control from the Ministry of Health and Welfare of Japan. The authors thank Dr Megumi Hara, National Cancer Center Research Institute East, for her assistance regarding data set preparation and Professor Chung-Cheng Hsieh, University of Massachusetts Cancer Center, for his assistance in statistical expertise.
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Tsugane, S., Sasaki, S. & Tsubono for the JPHC Study Group, Y. Under- and overweight impact on mortality among middle-aged Japanese men and women: a 10-y follow-up of JPHC Study cohort I. Int J Obes 26, 529–537 (2002). https://doi.org/10.1038/sj.ijo.0801961
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DOI: https://doi.org/10.1038/sj.ijo.0801961
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