Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents

Emanuele Di Angelantonio; Shilpa N. Bhupathiraju; David Wormser; Pei Gao; Stephen Kaptoge; Amy Berrington de Gonzalez; Benjamin J. Cairns; Rachel Huxley; Chandra L. Jackson; Grace Joshy; Sarah Lewington; Jo Ann E. Manson; Neil Murphy; Alpa V. Patel; Jonathan M. Samet; Mark Woodward; Wei Zheng; Maigen Zhou; Narinder Bansal; Aurelio Barricarte; Brian Carter; James R. Cerhan; Rory Collins; George Davey Smith; Xianghua Fang; Oscar H. Franco; Jane Green; Jim Halsey; Janet S. Hildebrand; Keum Ji Jung; Rosemary J. Korda; Dale F. McLerran; Steven C. Moore; Linda M. O'Keeffe; Ellie Paige; Anna Ramond; Gillian K. Reeves; Betsy Rolland; Carlotta Sacerdote; Naveed Sattar; Eleni Sofi Anopoulou; June Stevens; Michael Thun; Hirotsugu Ueshima; Ling Yang; Young Duk Yun; Peter Willeit; Emily Banks; Valerie Beral; Zhengming Chen; Susan M. Gapstur; Marc J. Gunter; Patricia Hartge; Sun Ha Jee; Tai Hing Lam; Richard Peto; John D. Potter; Walter C. Willett; Simon G. Thompson; John Danesh; Frank B. Hu

doi:10.1016/S0140-6736(16)30175-1

Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents

Emanuele Di Angelantonio, Shilpa N. Bhupathiraju, David Wormser, Pei Gao, Stephen Kaptoge, Amy Berrington de Gonzalez, Benjamin J. Cairns, Rachel Huxley, Chandra L. Jackson, Grace Joshy, Sarah Lewington, Jo Ann E. Manson, Neil Murphy, Alpa V. Patel, Jonathan M. Samet, Mark Woodward, Wei Zheng, Maigen Zhou, Narinder Bansal, Aurelio BarricarteBrian Carter, James R. Cerhan, Rory Collins, George Davey Smith, Xianghua Fang, Oscar H. Franco, Jane Green, Jim Halsey, Janet S. Hildebrand, Keum Ji Jung, Rosemary J. Korda, Dale F. McLerran, Steven C. Moore, Linda M. O'Keeffe, Ellie Paige, Anna Ramond, Gillian K. Reeves, Betsy Rolland, Carlotta Sacerdote, Naveed Sattar, Eleni Sofi Anopoulou, June Stevens, Michael Thun, Hirotsugu Ueshima, Ling Yang, Young Duk Yun, Peter Willeit, Emily Banks, Valerie Beral, Zhengming Chen, Susan M. Gapstur, Marc J. Gunter, Patricia Hartge, Sun Ha Jee, Tai Hing Lam, Richard Peto, John D. Potter, Walter C. Willett, Simon G. Thompson, John Danesh, Frank B. Hu

Quantitative Health Sciences

Research output: Contribution to journal › Article › peer-review

850 Scopus citations

Abstract

Background Overweight and obesity are increasing worldwide. To help assess their relevance to mortality in different populations we conducted individual-participant data meta-analyses of prospective studies of body-mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding pre-existing disease and the first 5 years of follow-up. Methods Of 10 625 411 participants in Asia, Australia and New Zealand, Europe, and North America from 239 prospective studies (median follow-up 13·7 years, IQR 11·4–14·7), 3 951 455 people in 189 studies were never-smokers without chronic diseases at recruitment who survived 5 years, of whom 385 879 died. The primary analyses are of these deaths, and study, age, and sex adjusted hazard ratios (HRs), relative to BMI 22·5–<25·0 kg/m². Findings All-cause mortality was minimal at 20·0–25·0 kg/m² (HR 1·00, 95% CI 0·98–1·02 for BMI 20·0–<22·5 kg/m²; 1·00, 0·99–1·01 for BMI 22·5–<25·0 kg/m²), and increased significantly both just below this range (1·13, 1·09–1·17 for BMI 18·5–<20·0 kg/m²; 1·51, 1·43–1·59 for BMI 15·0–<18·5) and throughout the overweight range (1·07, 1·07–1·08 for BMI 25·0–<27·5 kg/m²; 1·20, 1·18–1·22 for BMI 27·5–<30·0 kg/m²). The HR for obesity grade 1 (BMI 30·0–<35·0 kg/m²) was 1·45, 95% CI 1·41–1·48; the HR for obesity grade 2 (35·0–<40·0 kg/m²) was 1·94, 1·87–2·01; and the HR for obesity grade 3 (40·0–<60·0 kg/m²) was 2·76, 2·60–2·92. For BMI over 25·0 kg/m², mortality increased approximately log-linearly with BMI; the HR per 5 kg/m² units higher BMI was 1·39 (1·34–1·43) in Europe, 1·29 (1·26–1·32) in North America, 1·39 (1·34–1·44) in east Asia, and 1·31 (1·27–1·35) in Australia and New Zealand. This HR per 5 kg/m² units higher BMI (for BMI over 25 kg/m²) was greater in younger than older people (1·52, 95% CI 1·47–1·56, for BMI measured at 35–49 years vs 1·21, 1·17–1·25, for BMI measured at 70–89 years; p_{heterogeneity}<0·0001), greater in men than women (1·51, 1·46–1·56, vs 1·30, 1·26–1·33; p_{heterogeneity}<0·0001), but similar in studies with self-reported and measured BMI. Interpretation The associations of both overweight and obesity with higher all-cause mortality were broadly consistent in four continents. This finding supports strategies to combat the entire spectrum of excess adiposity in many populations. Funding UK Medical Research Council, British Heart Foundation, National Institute for Health Research, US National Institutes of Health.

Original language	English (US)
Pages (from-to)	776-786
Number of pages	11
Journal	The Lancet
Volume	388
Issue number	10046
DOIs	https://doi.org/10.1016/S0140-6736(16)30175-1
State	Published - Aug 20 2016

ASJC Scopus subject areas

General Medicine

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Di Angelantonio, E., Bhupathiraju, S. N., Wormser, D., Gao, P., Kaptoge, S., de Gonzalez, A. B., Cairns, B. J., Huxley, R., Jackson, C. L., Joshy, G., Lewington, S., Manson, J. A. E., Murphy, N., Patel, A. V., Samet, J. M., Woodward, M., Zheng, W., Zhou, M., Bansal, N., ... Hu, F. B. (2016). Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. The Lancet, 388(10046), 776-786. https://doi.org/10.1016/S0140-6736(16)30175-1

Di Angelantonio, E, Bhupathiraju, SN, Wormser, D, Gao, P, Kaptoge, S, de Gonzalez, AB, Cairns, BJ, Huxley, R, Jackson, CL, Joshy, G, Lewington, S, Manson, JAE, Murphy, N, Patel, AV, Samet, JM, Woodward, M, Zheng, W, Zhou, M, Bansal, N, Barricarte, A, Carter, B, Cerhan, JR, Collins, R, Smith, GD, Fang, X, Franco, OH, Green, J, Halsey, J, Hildebrand, JS, Ji Jung, K, Korda, RJ, McLerran, DF, Moore, SC, O'Keeffe, LM, Paige, E, Ramond, A, Reeves, GK, Rolland, B, Sacerdote, C, Sattar, N, Anopoulou, ES, Stevens, J, Thun, M, Ueshima, H, Yang, L, Duk Yun, Y, Willeit, P, Banks, E, Beral, V, Chen, Z, Gapstur, SM, Gunter, MJ, Hartge, P, Jee, SH, Lam, TH, Peto, R, Potter, JD, Willett, WC, Thompson, SG, Danesh, J & Hu, FB 2016, 'Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents', The Lancet, vol. 388, no. 10046, pp. 776-786. https://doi.org/10.1016/S0140-6736(16)30175-1

@article{ff1e98db38f7420fbfe2ab49fa5136f9,

title = "Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents",

abstract = "Background Overweight and obesity are increasing worldwide. To help assess their relevance to mortality in different populations we conducted individual-participant data meta-analyses of prospective studies of body-mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding pre-existing disease and the first 5 years of follow-up. Methods Of 10 625 411 participants in Asia, Australia and New Zealand, Europe, and North America from 239 prospective studies (median follow-up 13·7 years, IQR 11·4–14·7), 3 951 455 people in 189 studies were never-smokers without chronic diseases at recruitment who survived 5 years, of whom 385 879 died. The primary analyses are of these deaths, and study, age, and sex adjusted hazard ratios (HRs), relative to BMI 22·5–<25·0 kg/m2. Findings All-cause mortality was minimal at 20·0–25·0 kg/m2 (HR 1·00, 95% CI 0·98–1·02 for BMI 20·0–<22·5 kg/m2; 1·00, 0·99–1·01 for BMI 22·5–<25·0 kg/m2), and increased significantly both just below this range (1·13, 1·09–1·17 for BMI 18·5–<20·0 kg/m2; 1·51, 1·43–1·59 for BMI 15·0–<18·5) and throughout the overweight range (1·07, 1·07–1·08 for BMI 25·0–<27·5 kg/m2; 1·20, 1·18–1·22 for BMI 27·5–<30·0 kg/m2). The HR for obesity grade 1 (BMI 30·0–<35·0 kg/m2) was 1·45, 95% CI 1·41–1·48; the HR for obesity grade 2 (35·0–<40·0 kg/m2) was 1·94, 1·87–2·01; and the HR for obesity grade 3 (40·0–<60·0 kg/m2) was 2·76, 2·60–2·92. For BMI over 25·0 kg/m2, mortality increased approximately log-linearly with BMI; the HR per 5 kg/m2 units higher BMI was 1·39 (1·34–1·43) in Europe, 1·29 (1·26–1·32) in North America, 1·39 (1·34–1·44) in east Asia, and 1·31 (1·27–1·35) in Australia and New Zealand. This HR per 5 kg/m2 units higher BMI (for BMI over 25 kg/m2) was greater in younger than older people (1·52, 95% CI 1·47–1·56, for BMI measured at 35–49 years vs 1·21, 1·17–1·25, for BMI measured at 70–89 years; pheterogeneity<0·0001), greater in men than women (1·51, 1·46–1·56, vs 1·30, 1·26–1·33; pheterogeneity<0·0001), but similar in studies with self-reported and measured BMI. Interpretation The associations of both overweight and obesity with higher all-cause mortality were broadly consistent in four continents. This finding supports strategies to combat the entire spectrum of excess adiposity in many populations. Funding UK Medical Research Council, British Heart Foundation, National Institute for Health Research, US National Institutes of Health.",

author = "{Di Angelantonio}, Emanuele and Bhupathiraju, {Shilpa N.} and David Wormser and Pei Gao and Stephen Kaptoge and {de Gonzalez}, {Amy Berrington} and Cairns, {Benjamin J.} and Rachel Huxley and Jackson, {Chandra L.} and Grace Joshy and Sarah Lewington and Manson, {Jo Ann E.} and Neil Murphy and Patel, {Alpa V.} and Samet, {Jonathan M.} and Mark Woodward and Wei Zheng and Maigen Zhou and Narinder Bansal and Aurelio Barricarte and Brian Carter and Cerhan, {James R.} and Rory Collins and Smith, {George Davey} and Xianghua Fang and Franco, {Oscar H.} and Jane Green and Jim Halsey and Hildebrand, {Janet S.} and {Ji Jung}, Keum and Korda, {Rosemary J.} and McLerran, {Dale F.} and Moore, {Steven C.} and O'Keeffe, {Linda M.} and Ellie Paige and Anna Ramond and Reeves, {Gillian K.} and Betsy Rolland and Carlotta Sacerdote and Naveed Sattar and Anopoulou, {Eleni Sofi} and June Stevens and Michael Thun and Hirotsugu Ueshima and Ling Yang and {Duk Yun}, Young and Peter Willeit and Emily Banks and Valerie Beral and Zhengming Chen and Gapstur, {Susan M.} and Gunter, {Marc J.} and Patricia Hartge and Jee, {Sun Ha} and Lam, {Tai Hing} and Richard Peto and Potter, {John D.} and Willett, {Walter C.} and Thompson, {Simon G.} and John Danesh and Hu, {Frank B.}",

note = "Publisher Copyright: {\textcopyright} 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC-BY license",

year = "2016",

month = aug,

day = "20",

doi = "10.1016/S0140-6736(16)30175-1",

language = "English (US)",

volume = "388",

pages = "776--786",

journal = "The Lancet",

issn = "0140-6736",

publisher = "Elsevier Limited",

number = "10046",

}

TY - JOUR

T1 - Body-mass index and all-cause mortality

T2 - individual-participant-data meta-analysis of 239 prospective studies in four continents

AU - Di Angelantonio, Emanuele

AU - Bhupathiraju, Shilpa N.

AU - Wormser, David

AU - Gao, Pei

AU - Kaptoge, Stephen

AU - de Gonzalez, Amy Berrington

AU - Cairns, Benjamin J.

AU - Huxley, Rachel

AU - Jackson, Chandra L.

AU - Joshy, Grace

AU - Lewington, Sarah

AU - Manson, Jo Ann E.

AU - Murphy, Neil

AU - Patel, Alpa V.

AU - Samet, Jonathan M.

AU - Woodward, Mark

AU - Zheng, Wei

AU - Zhou, Maigen

AU - Bansal, Narinder

AU - Barricarte, Aurelio

AU - Carter, Brian

AU - Cerhan, James R.

AU - Collins, Rory

AU - Smith, George Davey

AU - Fang, Xianghua

AU - Franco, Oscar H.

AU - Green, Jane

AU - Halsey, Jim

AU - Hildebrand, Janet S.

AU - Ji Jung, Keum

AU - Korda, Rosemary J.

AU - McLerran, Dale F.

AU - Moore, Steven C.

AU - O'Keeffe, Linda M.

AU - Paige, Ellie

AU - Ramond, Anna

AU - Reeves, Gillian K.

AU - Rolland, Betsy

AU - Sacerdote, Carlotta

AU - Sattar, Naveed

AU - Anopoulou, Eleni Sofi

AU - Stevens, June

AU - Thun, Michael

AU - Ueshima, Hirotsugu

AU - Yang, Ling

AU - Duk Yun, Young

AU - Willeit, Peter

AU - Banks, Emily

AU - Beral, Valerie

AU - Chen, Zhengming

AU - Gapstur, Susan M.

AU - Gunter, Marc J.

AU - Hartge, Patricia

AU - Jee, Sun Ha

AU - Lam, Tai Hing

AU - Peto, Richard

AU - Potter, John D.

AU - Willett, Walter C.

AU - Thompson, Simon G.

AU - Danesh, John

AU - Hu, Frank B.

PY - 2016/8/20

Y1 - 2016/8/20

N2 - Background Overweight and obesity are increasing worldwide. To help assess their relevance to mortality in different populations we conducted individual-participant data meta-analyses of prospective studies of body-mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding pre-existing disease and the first 5 years of follow-up. Methods Of 10 625 411 participants in Asia, Australia and New Zealand, Europe, and North America from 239 prospective studies (median follow-up 13·7 years, IQR 11·4–14·7), 3 951 455 people in 189 studies were never-smokers without chronic diseases at recruitment who survived 5 years, of whom 385 879 died. The primary analyses are of these deaths, and study, age, and sex adjusted hazard ratios (HRs), relative to BMI 22·5–<25·0 kg/m2. Findings All-cause mortality was minimal at 20·0–25·0 kg/m2 (HR 1·00, 95% CI 0·98–1·02 for BMI 20·0–<22·5 kg/m2; 1·00, 0·99–1·01 for BMI 22·5–<25·0 kg/m2), and increased significantly both just below this range (1·13, 1·09–1·17 for BMI 18·5–<20·0 kg/m2; 1·51, 1·43–1·59 for BMI 15·0–<18·5) and throughout the overweight range (1·07, 1·07–1·08 for BMI 25·0–<27·5 kg/m2; 1·20, 1·18–1·22 for BMI 27·5–<30·0 kg/m2). The HR for obesity grade 1 (BMI 30·0–<35·0 kg/m2) was 1·45, 95% CI 1·41–1·48; the HR for obesity grade 2 (35·0–<40·0 kg/m2) was 1·94, 1·87–2·01; and the HR for obesity grade 3 (40·0–<60·0 kg/m2) was 2·76, 2·60–2·92. For BMI over 25·0 kg/m2, mortality increased approximately log-linearly with BMI; the HR per 5 kg/m2 units higher BMI was 1·39 (1·34–1·43) in Europe, 1·29 (1·26–1·32) in North America, 1·39 (1·34–1·44) in east Asia, and 1·31 (1·27–1·35) in Australia and New Zealand. This HR per 5 kg/m2 units higher BMI (for BMI over 25 kg/m2) was greater in younger than older people (1·52, 95% CI 1·47–1·56, for BMI measured at 35–49 years vs 1·21, 1·17–1·25, for BMI measured at 70–89 years; pheterogeneity<0·0001), greater in men than women (1·51, 1·46–1·56, vs 1·30, 1·26–1·33; pheterogeneity<0·0001), but similar in studies with self-reported and measured BMI. Interpretation The associations of both overweight and obesity with higher all-cause mortality were broadly consistent in four continents. This finding supports strategies to combat the entire spectrum of excess adiposity in many populations. Funding UK Medical Research Council, British Heart Foundation, National Institute for Health Research, US National Institutes of Health.

AB - Background Overweight and obesity are increasing worldwide. To help assess their relevance to mortality in different populations we conducted individual-participant data meta-analyses of prospective studies of body-mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding pre-existing disease and the first 5 years of follow-up. Methods Of 10 625 411 participants in Asia, Australia and New Zealand, Europe, and North America from 239 prospective studies (median follow-up 13·7 years, IQR 11·4–14·7), 3 951 455 people in 189 studies were never-smokers without chronic diseases at recruitment who survived 5 years, of whom 385 879 died. The primary analyses are of these deaths, and study, age, and sex adjusted hazard ratios (HRs), relative to BMI 22·5–<25·0 kg/m2. Findings All-cause mortality was minimal at 20·0–25·0 kg/m2 (HR 1·00, 95% CI 0·98–1·02 for BMI 20·0–<22·5 kg/m2; 1·00, 0·99–1·01 for BMI 22·5–<25·0 kg/m2), and increased significantly both just below this range (1·13, 1·09–1·17 for BMI 18·5–<20·0 kg/m2; 1·51, 1·43–1·59 for BMI 15·0–<18·5) and throughout the overweight range (1·07, 1·07–1·08 for BMI 25·0–<27·5 kg/m2; 1·20, 1·18–1·22 for BMI 27·5–<30·0 kg/m2). The HR for obesity grade 1 (BMI 30·0–<35·0 kg/m2) was 1·45, 95% CI 1·41–1·48; the HR for obesity grade 2 (35·0–<40·0 kg/m2) was 1·94, 1·87–2·01; and the HR for obesity grade 3 (40·0–<60·0 kg/m2) was 2·76, 2·60–2·92. For BMI over 25·0 kg/m2, mortality increased approximately log-linearly with BMI; the HR per 5 kg/m2 units higher BMI was 1·39 (1·34–1·43) in Europe, 1·29 (1·26–1·32) in North America, 1·39 (1·34–1·44) in east Asia, and 1·31 (1·27–1·35) in Australia and New Zealand. This HR per 5 kg/m2 units higher BMI (for BMI over 25 kg/m2) was greater in younger than older people (1·52, 95% CI 1·47–1·56, for BMI measured at 35–49 years vs 1·21, 1·17–1·25, for BMI measured at 70–89 years; pheterogeneity<0·0001), greater in men than women (1·51, 1·46–1·56, vs 1·30, 1·26–1·33; pheterogeneity<0·0001), but similar in studies with self-reported and measured BMI. Interpretation The associations of both overweight and obesity with higher all-cause mortality were broadly consistent in four continents. This finding supports strategies to combat the entire spectrum of excess adiposity in many populations. Funding UK Medical Research Council, British Heart Foundation, National Institute for Health Research, US National Institutes of Health.

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ER -

Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents

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