Body Mass Index, Diabetes, Hypertension, and Short-Term Mortality: A Population-Based Observational Study, 2000–2006

Background: Published studies about the association of obesity with mortality have used body mass index (BMI) data collected more than 10 years ago, potentially limiting their current applicability, particularly given evidence of a secular decline in obesity-related mortality. The objective of this study was to examine the association between BMI and mortality in a representative, contemporary United States sample. Methods: This was a population-based observational study of data from 50,994 adults aged 18 to 90 years who responded to the 2000 to 2005 Medical Expenditures Panel Surveys. Cox regression analyses were employed to model survival during up to 6 years of follow-up (ascertained via National Death Index linkage) by self-reported BMI category (underweight, <20 kg/m2; normal weight, 20-<25 [reference]; overweight, 25-<30; obese, 30-<35; severely obese, ≥35), without and with adjustment for diabetes and hypertension. Survival by BMI category also was modeled for diabetic and hypertensive individuals. All models were adjusted for sociodemographics, smoking, and Medical Expenditures Panel Surveys response year. Results: In analyses not adjusted for diabetes or hypertension, only severe obesity was associated with mortality (adjusted hazard ratio, 1.26; 95% confidence interval, 1.00–1.59). After adjusting for diabetes and hypertension, severe obesity was no longer associated with mortality, and milder obesity (BMI 30-<35) was associated with decreased mortality (adjusted hazard ratio, 0.81; 95% confidence interval, 0.68–0.97). There was a significant interaction between diabetes (but not hypertension) and BMI (F [4, 235] = 2.71; P = .03), such that the mortality risk of diabetes was lower among mildly and severely obese persons than among those in lower BMI categories. Conclusions: Obesity-associated mortality risk was lower than estimated in studies employing older BMI data. Only severe obesity (but not milder obesity or overweight) was associated with increased mortality, an association accounted for by coexisting diabetes and hypertension. Mortality in diabetes was lower among obese versus normal weight individuals.

[1]  Jonathan E. Dickerson,et al.  Supplementary webappendix , 2010 .

[2]  K. Fiscella,et al.  The relative health burden of selected social and behavioral risk factors in the United States: implications for policy. , 2010, American journal of public health.

[3]  T. Koepsell,et al.  All-Cause Mortality Risk Among a National Sample of Individuals With Diabetes , 2010, Diabetes Care.

[4]  S. Blair,et al.  Should health policy focus on physical activity rather than obesity? Yes , 2010, BMJ : British Medical Journal.

[5]  D. Allison,et al.  The ‘Obesity Paradox:’ a parsimonious explanation for relations among obesity, mortality rate, and aging? , 2010, International Journal of Obesity.

[6]  E. Finkelstein,et al.  Individual and Aggregate Years‐of‐life‐lost Associated With Overweight and Obesity , 2010, Obesity.

[7]  M. Tremblay,et al.  The Bias in Self‐reported Obesity From 1976 to 2005: A Canada–US Comparison , 2010, Obesity.

[8]  K. Flegal,et al.  Prevalence and trends in obesity among US adults, 1999-2008. , 2010, JAMA.

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

[10]  L. Fried,et al.  Temporal patterns in overweight and obesity in Type 1 diabetes , 2009, Diabetic medicine : a journal of the British Diabetic Association.

[11]  W. Kannel,et al.  Hazards of obesity--the Framingham experience. , 2009, Acta medica Scandinavica. Supplementum.

[12]  Wei Zhang,et al.  The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis , 2009, BMC public health.

[13]  J. Klenk,et al.  Body mass index and mortality: results of a cohort of 184,697 adults in Austria , 2009, European Journal of Epidemiology.

[14]  M. Tremblay,et al.  The feasibility of establishing correction factors to adjust self-reported estimates of obesity. , 2008, Health reports.

[15]  Jennifer G. Robinson,et al.  Validity of diabetes self-reports in the Women's Health Initiative: comparison with medication inventories and fasting glucose measurements , 2008, Clinical trials.

[16]  Jeffrey A. Johnson,et al.  An algorithm to differentiate diabetic respondents in the Canadian Community Health Survey. , 2008, Health reports.

[17]  L. Råstam,et al.  The Validity of Obesity Based on Self‐reported Weight and Height: Implications for Population Studies , 2007, Obesity.

[18]  P. Muennig,et al.  Gender and the burden of disease attributable to obesity. , 2006, American journal of public health.

[19]  Michael J. Pencina,et al.  Trends in the Incidence of Type 2 Diabetes Mellitus From the 1970s to the 1990s: The Framingham Heart Study , 2006, Circulation.

[20]  C. Sempos,et al.  Ethnic variation in validity of classification of overweight and obesity using self-reported weight and height in American women and men: the Third National Health and Nutrition Examination Survey , 2005, Nutrition journal.

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

[22]  Excess Deaths Associated With Underweight, Overweight, and Obesity , 2005 .

[23]  S. Olshansky,et al.  A potential decline in life expectancy in the United States in the 21st century. , 2005, The New England journal of medicine.

[24]  Elvira Agrón,et al.  Associations of mortality and diabetes complications in patients with type 1 and type 2 diabetes: early treatment diabetic retinopathy study report no. 27. , 2005, Diabetes care.

[25]  D. McGee,et al.  Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. , 2005, Annals of epidemiology.

[26]  J. Seidell,et al.  Overweight and obesity in the mortality rate data: current evidence and research issues. , 1999, Medicine and science in sports and exercise.

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

[28]  P. Raskin,et al.  Report of the expert committee on the diagnosis and classification of diabetes mellitus. , 1999, Diabetes care.

[29]  J. Widimský,et al.  Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus , 1998, Diabetes Care.

[30]  R. Gillum,et al.  Validity of self-reported hypertension in the National Health and Nutrition Examination Survey III, 1988-1991. , 1997, Preventive medicine.

[31]  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.

[32]  D. Kromhout,et al.  Overweight, underweight, and mortality. A prospective study of 48,287 men and women. , 1996, Archives of internal medicine.

[33]  L. Sjöström.  Mortality of severely obese subjects. , 1992, The American journal of clinical nutrition.

[34]  W. Kannel,et al.  Is obesity-related hypertension less of a cardiovascular risk? The Framingham Study. , 1990, American heart journal.

[35]  T. Van Itallie,et al.  Obesity: adverse effects on health and longevity. , 1979 .

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

[37]  V. Preedy,et al.  National Health and Nutrition Examination Survey , 2010 .

[38]  M. Stommel,et al.  Accuracy and usefulness of BMI measures based on self-reported weight and height: findings from the NHANES & NHIS 2001-2006. , 2009, BMC public health.

[39]  J. Gerberding,et al.  State-specific incidence of diabetes among adults--participating states, 1995-1997 and 2005-2007. , 2008, MMWR. Morbidity and mortality weekly report.

[40]  J. Gronniger,et al.  A semiparametric analysis of the relationship of body mass index to mortality. , 2006, American journal of public health.

[41]  G. Foster,et al.  The National Health and Nutrition Examination Survey , 2006 .

[42]  Claude Bouchard,et al.  Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: Executive summary , 1998 .

[43]  Claude Bouchard,et al.  Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. , 1998, WMJ : official publication of the State Medical Society of Wisconsin.

[44]  E. Frongillo,et al.  The relationship between body weight and mortality: a quantitative analysis of combined information from existing studies. , 1996, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.