Body mass index as predictor of overall mortality both above and below the apparent optimum
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The aim of the Prospective Studies Collaboration was to investigate the associations of body mass index with overall and cause-specific mortality by using data from 57 prospective studies including 894,576 participants from Western Europe and North America. Mortality was lowest at about 22.5-25.0 kg/m2 for both genders. Above this range, each 5.0 kg/m2 increase in BMI was on average associated with a 30% higher overall mortality, 40% higher vascular mortality, 60-120% higher diabetic, renal, and hepatic mortality, 10% higher neoplastic mortality and 20% higher respiratory and all other mortality. Below this range, BMI was inversely associated with overall mortality, mainly due to strong associations with respiratory disease and lung cancer. These inverse associations were much stronger for smokers than for non-smokers. Thus, BMI appears to be a strong predictor of overall mortality both above and below the apparent optimum of 22.5-25.0 kg/m2. The progressive excess mortality above this range appears to be primarily due to vascular disease, while the definite excess mortality below this range is mainly due to smoking-related diseases.
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