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Sex-age-specific association of body mass index with all-cause mortality among 12.8 million Korean adults: a prospective cohort study.

ABSTRACT: Despite differences in body shape and adiposity characteristics according to sex and age, a single range of healthy weight [body mass index (BMI, kg/m(2)) of 18.5-24.9) regardless of sex and age has been recommended. The aim of the study is to examine whether the association between BMI and all-cause mortality varies by sex and age, and, if relevant, to estimate sex-age-specific optimal BMIs associated with a minimal risk of death.A total of 12,832,637 Korean adults aged 18-99 years who participated in health examinations during 2001-04 were followed up until 2013. Hazard ratios of death in sex-age groups were calculated using Cox regression models after adjustment for age, smoking status and known pre-existing illness.During follow-up, 456,175 men and 241,208 women died. Among men, the age-specific optimal BMI was 23.0-25.9 (kg/m(2)) at 18-34 years, 24.0-27.9 at 45-54 year, and 25.0-28.9 at 65-74 years. Among women, it was 15.5-24.9 at 18-34 years, 21.0-26.9 at 45-54 years and 24.0-28.9 at 65-74 years. Patterns of sex-age-specific association generally did not differ between never-smokers with no known illness and all participants. Progressively increased risks above and below sex-age-specific optimums were observed (reverse J-curve). Smoking had a limited impact on the observed associations.Women had a lower optimal BMI than men, especially at younger ages. The optimal BMI increased with age. Change in optimal BMI with age, however, was more profound in women than in men. Sex-age-specific optimums were generally higher than the current normal weight (BMI of 18.5-24.9), except in women below 50 years. Sex-age-specific guidelines related to body weight may be needed to guide people for better health.

SUBMITTER: Yi SW

PROVIDER: S-EPMC4681110 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature

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Sex-age-specific association of body mass index with all-cause mortality among 12.8 million Korean adults: a prospective cohort study.

Yi Sang-Wook SW Ohrr Heechoul H Shin Soon-Ae SA Yi Jee-Jeon JJ

International journal of epidemiology 20151001 5

<h4>Background</h4>Despite differences in body shape and adiposity characteristics according to sex and age, a single range of healthy weight [body mass index (BMI, kg/m(2)) of 18.5-24.9) regardless of sex and age has been recommended. The aim of the study is to examine whether the association between BMI and all-cause mortality varies by sex and age, and, if relevant, to estimate sex-age-specific optimal BMIs associated with a minimal risk of death.<h4>Methods</h4>A total of 12,832,637 Korean a ...[more]

PMID: 26208807

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Project description:BackgroundHigh body mass index (BMI) is associated with mortality, but the pervasive problem of confounding and reverse causality in observational studies limits inference about the direction and magnitude of causal effects. We aimed to obtain estimates of the causal association of BMI with all-cause and cause-specific mortality.Methods and findingsIn a record-linked, intergenerational prospective study from the general population of Sweden, we used two-sample instrumental variable (IV) analysis with data from 996,898 fathers (282,407 deaths) and 1,013,083 mothers (153,043 deaths) and their sons followed up from January 1, 1961, until December 31, 2004. Sons' BMI was used as the instrument for parents' BMI to compute hazard ratios (HRs) for risk of mortality per standard deviation (SD) higher parents' BMI. Using offspring exposure as an instrument for parents' exposure is unlikely to be affected by reverse causality (an important source of bias in this context) and reduces confounding. IV analyses supported causal associations between higher BMI and greater risk of all-cause mortality (HR [95% confidence interval (CI)] per SD higher fathers' BMI: 1.29 [1.26-1.31] and mothers' BMI: 1.39 [1.35-1.42]) and overall cancer mortality (HR per SD higher fathers' BMI: 1.20 [1.16-1.24] and mothers' BMI: 1.29 [1.24-1.34]), including 9 site-specific cancers in men (bladder, colorectum, gallbladder, kidney, liver, lung, lymphatic system, pancreas, and stomach) and 11 site-specific cancers in women (gallbladder, kidney, liver, lung, lymphatic system, ovaries, pancreas, stomach, uterus, cervix, and endometrium). There was evidence supporting causal associations between higher BMI in mothers and greater risk of mortality from kidney disease (HR: 2.17 [1.68-2.81]) and lower risk of mortality from suicide (HR: 0.77 [0.65-0.90]). In both sexes, there was evidence supporting causal associations between higher BMI and mortality from cardiovascular diseases (CVDs), stroke, diabetes, and respiratory diseases. We were unable to test the association between sons' and mothers' BMIs (as mothers' data were unavailable) or whether the instrument was independent of unmeasured or residual confounding; however, the associations between parents' mortality and sons' BMI were negligibly influenced by adjustment for available confounders.ConclusionsConsistent with previous large-scale meta-analyses and reviews, results supported the causal role of higher BMI in increasing the risk of several common causes of death, including cancers with increasing global incidence. We also found positive effects of BMI on mortality from respiratory disease, prostate cancer, and lung cancer, which has been inconsistently reported in the literature, suggesting that the causal role of higher BMI in mortality from these diseases may be underestimated. Furthermore, we expect different patterns of bias in the current observational and IV analyses; therefore, the similarities between our findings from both methods increases confidence in the results. These findings support efforts to understand the mechanisms underpinning these effects to inform targeted interventions and develop population-based strategies to reduce rising obesity levels for disease prevention.

Project description:RationaleObesity hypoventilation syndrome (OHS) is often underdiagnosed, with significant morbidity and mortality. Bicarbonate, as a surrogate of arterial carbon dioxide, has been proposed as a screening tool for OHS. Understanding the predictors of serum bicarbonate could provide insights into risk factors for OHS. We hypothesized that the bicarbonate levels would increase with an increase in body mass index (BMI), since the prevalence of OHS increases with obesity.MethodsWe used the TriNetX Research Network, an electronic health record database with de-identified clinical data from participating healthcare organizations across the United States, to identify 93,320 adults without pulmonary or advanced renal diseases who had serum bicarbonate and BMI measurements within 6 months of each other between 2017 and 2022. We used linear regression analysis to examine the associations between bicarbonate and BMI, age, and their interactions for the entire cohort and stratified by sex. We also applied a non-linear machine learning algorithm (XGBoost) to examine the relative importance of age, BMI, sex, race/ethnicity, and obstructive sleep apnea (OSA) status on bicarbonate.ResultsThis cohort population was 56% women and 72% white and 80% non-Hispanic individuals, with an average (SD) age of 49.4 (17.9) years and a BMI of 29.1 (6.1) kg/m2. The mean bicarbonate was 24.8 (2.8) mmol/L, with higher levels in men (mean 25.2 mmol/L) than in women (mean 24.4 mmol/L). We found a small negative association between bicarbonate and BMI, with an expected change of -0.03 mmol/L in bicarbonate for each 1 kg/m2 increase in BMI (p < 0.001), in the entire cohort and both sexes. We found sex differences in the bicarbonate trajectory with age, with women exhibiting lower bicarbonate values than men until age 50, after which the bicarbonate levels were modestly higher. The non-linear machine learning algorithm similarly revealed that age and sex played larger roles in determining bicarbonate levels than the BMI or OSA status.ConclusionContrary to our hypothesis, BMI is not associated with elevated bicarbonate levels, and age modifies the impact of sex on bicarbonate.

Project description:BackgroundPrevious studies found normal weight compared to overweight/obese adults with type 2 diabetes had a higher mortality risk, and body-mass index (BMI)-mortality studies do not typically account for baseline diabetes status.ObjectiveTo determine if diabetes influences the BMI-mortality relationship.DesignUsing a prospective study design, we analyzed data from a nationally representative sample of US adults participating in the National Health Interview Survey from 1997 to 2002, and followed for mortality through 2006.ParticipantsExcluding those with heart disease or cancer, our final analytic sample included 74,710 (34,805 never smoker) adults.Main measuresBMI was calculated from self-reported height and weight. Diabetes status was based on self-reported diagnosis from a health professional. We used direct age standardization to calculate all-cause mortality rates and adjusted Cox models for all-cause mortality hazard ratios by BMI quintile; this was done separately for adults with diabetes and without diabetes.Key resultsAmong never smokers, mean age was 50.1 years and 43 % were men. Mean BMI was 27.4 kg/m(2), 26 % were obese, and 2,035 (5 %) reported diagnosed diabetes. After 9 years, there were 4,355 deaths (754 of 4,740 with diabetes; 3,601 of 69,970 without) among 74,710 participants, and 1,238 (247 of 2,035 with diabetes; 991 of 32,770 without) among 34,805 never smokers. We observed a qualitative interaction with diabetes on the BMI-mortality relationship (p = 0.002). Death rates were substantially higher among participants with diabetes compared to those without diabetes across all BMI quintiles. However, death rates in participants with diabetes fell with increasing BMI quintile, while rates followed a J-shaped curve among those without diabetes. In adjusted Cox models, BMI was positively associated with mortality in adults without diabetes, but inversely associated with mortality among participants with diabetes.ConclusionsMortality increased with increasing BMI in adults without diabetes, but decreased with increasing BMI among their counterparts with diabetes. Future studies need to be better designed to answer the question of whether normal weight adults with diabetes have a higher risk of mortality, by minimizing the possibility of reverse causation. Future studies should also account for prevalent diabetes in all investigations of the BMI-mortality relationship.

Dataset Information

Sex-age-specific association of body mass index with all-cause mortality among 12.8 million Korean adults: a prospective cohort study.

Publications

Sex-age-specific association of body mass index with all-cause mortality among 12.8 million Korean adults: a prospective cohort study.

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