• Berrington de GonzalezAmyADivision of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA. berringtona@mail.nih.gov, Patricia Hartge, James R Cerhan, Alan J Flint, Lindsay Hannan, Robert J MacInnis, Steven C Moore, Geoffrey S Tobias, Hoda Anton-Culver, Laura Beane Freeman, W Lawrence Beeson, Sandra L Clipp, Dallas R English, Aaron R Folsom, D Michal Freedman, Graham Giles, Niclas Hakansson, Katherine D Henderson, Judith Hoffman-Bolton, Jane A Hoppin, Karen L Koenig, I-Min Lee, Martha S Linet, Yikyung Park, Gaia Pocobelli, Arthur Schatzkin, Howard D Sesso, Elisabete Weiderpass, Bradley J Willcox, Alicja Wolk, Anne Zeleniuch-Jacquotte, Walter C Willett, and Michael J Thun.
• Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA. berringtona@mail.nih.gov
• N. Engl. J. Med. 2010 Dec 2; 363 (23): 221122192211-9.

BackgroundA high body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) is associated with increased mortality from cardiovascular disease and certain cancers, but the precise relationship between BMI and all-cause mortality remains uncertain.MethodsWe used Cox regression to estimate hazard ratios and 95% confidence intervals for an association between BMI and all-cause mortality, adjusting for age, study, physical activity, alcohol consumption, education, and marital status in pooled data from 19 prospective studies encompassing 1.46 million white adults, 19 to 84 years of age (median, 58).ResultsThe median baseline BMI was 26.2. During a median follow-up period of 10 years (range, 5 to 28), 160,087 deaths were identified. Among healthy participants who never smoked, there was a J-shaped relationship between BMI and all-cause mortality. With a BMI of 22.5 to 24.9 as the reference category, hazard ratios among women were 1.47 (95 percent confidence interval [CI], 1.33 to 1.62) for a BMI of 15.0 to 18.4; 1.14 (95% CI, 1.07 to 1.22) for a BMI of 18.5 to 19.9; 1.00 (95% CI, 0.96 to 1.04) for a BMI of 20.0 to 22.4; 1.13 (95% CI, 1.09 to 1.17) for a BMI of 25.0 to 29.9; 1.44 (95% CI, 1.38 to 1.50) for a BMI of 30.0 to 34.9; 1.88 (95% CI, 1.77 to 2.00) for a BMI of 35.0 to 39.9; and 2.51 (95% CI, 2.30 to 2.73) for a BMI of 40.0 to 49.9. In general, the hazard ratios for the men were similar. Hazard ratios for a BMI below 20.0 were attenuated with longer-term follow-up.ConclusionsIn white adults, overweight and obesity (and possibly underweight) are associated with increased all-cause mortality. All-cause mortality is generally lowest with a BMI of 20.0 to 24.9.

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