General and abdominal obesity and risk of death among black women.

BACKGROUND Recent pooled analyses show an increased risk of death with increasing levels of the body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of 25.0 or higher in populations of European ancestry, a weaker association among East Asians, and no association of an increased BMI with an increased risk of death among South Asians. The limited data available on blacks indicate that the risk of death is increased only at very high levels of BMI (≥35.0). METHODS We prospectively assessed the relation of both BMI and waist circumference to the risk of death among 51,695 black women with no history of cancer or cardiovascular disease who were 21 to 69 years of age at study enrollment. Our analysis was based on follow-up data from 1995 through 2008 in the Black Women's Health Study. Multivariable proportional-hazards models were used to estimate hazard ratios and 95% confidence intervals. RESULTS Of 1773 deaths identified during follow-up, 770 occurred among 33,916 women who had never smoked. Among nonsmokers, the risk of death was lowest for a BMI of 20.0 to 24.9. For a BMI above this range, the risk of death increased as the BMI increased. With a BMI of 22.5 to 24.9 as the reference category, multivariable-adjusted hazard ratios were 1.12 (95% confidence interval [CI], 0.87 to 1.44) for a BMI of 25.0 to 27.4, 1.31 (95% CI, 1.01 to 1.72) for a BMI of 27.5 to 29.9, 1.27 (95% CI, 0.99 to 1.64) for a BMI of 30.0 to 34.9, 1.51 (95% CI, 1.13 to 2.02) for a BMI of 35.0 to 39.9, and 2.19 (95% CI, 1.62 to 2.95) for a BMI of 40.0 to 49.9 (P<0.001 for trend). A large waist circumference was associated with an increased risk of death from any cause among women with a BMI of less than 30.0. CONCLUSIONS The risk of death from any cause among black women increased with an increasing BMI of 25.0 or higher, which is similar to the pattern observed among whites. Waist circumference appeared to be associated with an increased risk of death only among nonobese women. (Funded by the National Cancer Institute.).

[1]  S. Sidney,et al.  Body mass index and 15-year mortality in a cohort of black men and women. , 1990, Journal of clinical epidemiology.

[2]  Daniel L. McGee,et al.  Relative weight and mortality in U.S. blacks and whites: findings from representative national population samples. , 1997, Annals of epidemiology.

[3]  R. Shephard.  Body-Mass Index and Mortality among 1.46 Million White Adults , 2011 .

[4]  M. Thun,et al.  The body mass index-mortality relationship in white and African American women. , 1998, Obesity research.

[5]  T. Harris,et al.  Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. , 2006, The New England journal of medicine.

[6]  Chien-Jen Chen,et al.  Association between body-mass index and risk of death in more than 1 million Asians. , 2011, The New England journal of medicine.

[7]  M. Roizen.  General and Abdominal Adiposity and Risk of Death in Europe , 2009 .

[8]  J. Palmer,et al.  Risk factors for coronary heart disease in African American women. , 1999, American journal of epidemiology.

[9]  Frank B. Hu,et al.  Abdominal Obesity and the Risk of All-Cause, Cardiovascular, and Cancer Mortality: Sixteen Years of Follow-Up in US Women , 2008, Circulation.

[10]  R. Kominski,et al.  Educational Attainment in the United States: March 1993 and 1992. , 1992 .

[11]  M. Thun,et al.  Body-mass index and mortality in a prospective cohort of U.S. adults. , 1999, The New England journal of medicine.

[12]  M. Gail,et al.  Efficacy and Tolerability of Long-Acting Injectable Naltrexone for Alcohol Dependence: A Randomized Controlled Trial , 2005, Gynecologic oncology.

[13]  J. Palmer,et al.  Validation of physical activity instruments: Black Women's Health Study. , 2006, Ethnicity & disease.

[14]  P. Rust,et al.  Body mass index and body girths as predictors of mortality in black and white women. , 1992, Archives of internal medicine.

[15]  M. Beydoun,et al.  Gender‐ethnic Disparity in BMI and Waist Circumference Distribution Shifts in US Adults , 2009, Obesity.

[16]  Daniel L. McGee,et al.  Mortality and optimal body mass index in a sample of the US population. , 1998, American journal of epidemiology.

[17]  S. Marshall,et al.  Overall obesity and abdominal adiposity as predictors of mortality in u.s. White and black adults. , 2009, Annals of epidemiology.

[18]  J M Lepkowski,et al.  Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. , 1998, JAMA.

[19]  A. Jemal,et al.  Mortality from leading causes by education and race in the United States, 2001. , 2008, American journal of preventive medicine.

[20]  P. Deurenberg,et al.  Body mass index and percent body fat: a meta analysis among different ethnic groups , 1998, International Journal of Obesity.

[21]  M. Thun,et al.  Waist circumference and all-cause mortality in a large US cohort. , 2010, Archives of internal medicine.

[22]  T. Harris,et al.  Waist circumference and mortality. , 2008, American journal of epidemiology.

[23]  D. Spiegelman,et al.  Influence of Body Size and Body Fat Distribution on Risk of Uterine Leiomyomata in U.S. Black Women , 2005, Epidemiology.

[24]  J. Feldman,et al.  An overview of body weight of older persons, including the impact on mortality. The National Health and Nutrition Examination Survey I--Epidemiologic Follow-up Study. , 1991, Journal of clinical epidemiology.

[25]  M. Marmot,et al.  Health Behaviours, Socioeconomic Status, and Mortality: Further Analyses of the British Whitehall II and the French GAZEL Prospective Cohorts , 2011, PLoS medicine.

[26]  D. Feeny,et al.  BMI and Mortality: Results From a National Longitudinal Study of Canadian Adults , 2010, Obesity.