Underweight,overweight and obesity as risk factors for mortality and hospitalization

Abstract

Aims: The prevalence of overweight and obesity is increasing in many countries. We aimed to investigate differences in mortality and severe morbidity between underweight people (body mass index (BMI)<18.5), overweight people (BMI 25 to <30), obese people (BMI≥30), and those with normal weights (BMI 18.5 to <25). Methods: Random samples of the Swedish population aged 16—74 years in 1980—81 and 1988—89 were followed for 12 years with regard to all-cause mortality and mortality from circulatory diseases, all inpatient care, and inpatient care for circulatory and musculoskeletal diseases. Relative risks (RRs) for different levels of BMI were adjusted for age, longstanding illness, smoking, and educational level at baseline. In addition, analyses were made with delayed entry until the fourth-year after interview. Results: Obesity and underweight, but not overweight, was associated with higher all-cause mortality. Among underweight men, the adjusted RR for all-cause mortality was 2.4 (95% confidence interval 1.6—3.6), and among underweight women it was 2.0 (1.5—2.7), but population attributable risks (PARs) were small, at 1.2% and 2.7%, respectively. Overweight was associated with increased risks for inpatient care for circulatory diseases, with PARs being 13.4% among men and 8.1% among women, and musculoskeletal diseases (PARs were 12.7% and 12.9%, respectively). Obese men and women had about 50% higher risks of all-cause mortality than normal-weight people, PARs being 3.2% and 3.8% respectively. Conclusions: This study supports the findings of other studies, in that overweight seems to be an exaggerated risk factor for all-cause mortality, but is related to other chronic disease. Underweight and obesity generally implies greater increases of RRs, but avoidance of overweight may have greater effect on the population level with regard to reduced cardiovascular and locomotor disease.

Keywords

Body mass index epidemiology ischaemic heart disease morbidity mortality

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References

Folkhälsorapport 2005 [Public Health Report Sweden 2005]. Stockholm: Socialstyrelsen, EpC; 2005.

Flegal KM , Williamsson DF , Pamuk ER , Rosenberg HM Estimating deaths attributable to obesity in the United States . Am J Public Health 2004;94:1486—89.

McGee DL Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies . Ann Epidemiol 2005;15:87—97.

Peeters A. , Barendregt JJ , Willekens F. , et al. Obesity in adulthood and its consequences for life expectancy: a life-table analysis . Ann Intern Med 2003;138:24—32.

Rosengren A. , Wedel H. , Wilhelmsen L. Body weight and weight gain during adult life in men in relation to coronary heart disease and mortality. A prospective population study . Eur Heart J 1999;20:246—8.

Flegal KM , Graubard BI , Williamson DF , Gail MH Excess deaths associated with underweight, overweight and obesity . JAMA 2005;293:1861—7.

Adams KF , Schatzkin A. , Harris TB , et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old . N Engl J Med 2006;355:763—78.

Wilson PW , D'Agostino RB , Sullivan L. , Parise H. , Kannel WB Overweight and obesity as determinants of cardiovascular risk: the Framingham experience . Arch Intern Med 2002;162:1867—72.

Field AE , Coakley EH , Must A. , et al. Impact of overweight on the risk of developing common chronic diseases during a 10-year period . Arch Intern Med 2001;161:1581—6.

10.

Jonsson S. , Hedblad B. , Engström G. , Nilsson P. , Berglund G. , Janzon L. Influence of obesity on cardiovascular risk. Twenty-three year follow-up of 22,025 men from an urban Swedish population . Int J Obes Relat Metab Disord 2002;26:1046—53.

11.

Järvholm B. , Lewold S. , Malchau H. , Vinga°rd E. Age, bodyweight, smoking habits and the risk of severe osteoarthritis in the hip and knee in men . Eur J Public Health 2005;20:537—42.

12.

Felson DT , Lawrence RC , Dieppe PA , et al. Osteoarthritis: new insights. Part 1: The disease and its risk factors . Ann Intern Med 2000;133:655—46.

13.

Heo M. , Allison DB , Faith MS , Zhu S. , Fontaine KR Obesity and quality of life: mediating effects of pain and comorbidities . Obes Res 2003;11:209—16.

14.

Fontaine KR , Barlofsky I. Obesity and health-related quality of life . Obes Res 2001;2:173—82.

15.

Statistics Sweden. Supplement to Appendix 15: Technical report regarding 1990—91 and 1992—93 Swedish Survey of Living conditions. Stockholm: Statistics Sweden; 1995.

16.

Allison DB , Faith MS , Heo M. , Townsend-Butterworth D. , Williamson DF Meta-analysis of the effect of excluding early deaths on the estimated relationship between body mass index and mortality . Obes Res 1999 ;7:342—54.

17.

Sorensen TI , Rissanen A. , Korkeila M. , Kaprio J. [Intention to lose weight, weight changes, and 18-year mortality in overweight individuals without co-morbidities PloS Med 2005;6: Epub June 28.

18.

R Heiat A. , Vaccarino V. , Krumholz HM An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons . Arch Intern Med 2001; 161:1194—203.

19.

Haapanen-Niemi N. , Miilunpalo S. , Pasanen M. , Vuori I. , Oja P. , Malmberg J. Body mass index, physical inactivity and low level of physical fitness as determinants of all-cause and cardiovascular disease mortality — 16 year follow-up of middle-aged and elderly men and women . Int J Obes Relat Metab Disord 2000 ;24:1465—74.

20.

Field AE , Coakley EH , Must A. , et al. Impact of overweight on the risk of developing common chronic diseases during a 10-year period . Arch Intern Med 2001;161:1581—6.

21.

Calling S. Obesity and cardiovascular disease. Aspects of methods and susceptibility. Doctoral thesis. Malmö : Department of Clinical Medicine in Malmö, Malmö University Hospital ; 2006.

22.

Rosén M. National health data registers: a Nordic heritage to public health . Scand J Public Health 2002;30:81—5.

23.

Bolton-Smith C. , Woodward M. , Tunstall-Pedoe H. , Morrison C. Accuracy of the estimated prevalence of obesity from self-reported height and weight in an adult Scottish population . J Epidemiol Community Health 2000;54:143—8.

24.

Kuskowska-Wolk A. , Bergström R. , Boström G. Relationship between questionnaire data and medical records of height, weight, and body mass index . Int J Obes Relat Metab Disord 1992;16:1—9.

25.

Kuskowska-Wolk A. , Karlsson P. , Stolt M. , Rössner S. The predictive validity of body mass index based on self-reported weight and height . Int J Obes 1989;13:441—53.

26.

Spencer EA , Appleby PN , Davey GK , Key TJ Validity of self-reported height and weight in 4808 EPIC-Oxford participants . Public Health Nutrition 2002;5:561—5.

27.

Boström G. , Diderichsen F. Socioeconomic differentials in misclassification of height, weight and body mass index based on questionnaire data . Int J Epidemiol 1997;26: 860—6.

28.

Jusuf S. , Hawken S. , Ounpuu S. , et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study . Lancet 2005;366:1589—91.

29.

Lahmann PH , Lissner L. , Gullberg B. , Berglund G. A prospective study of adiposity and all-cause mortality: the Malmö diet and cancer study . Obes Res 2002;10:361—9.

30.

Strawbridge WJ , Wallhagen MI , Shema SJ New NHLBI clinical guidelines for obesity and overweight: will they promote health ? Am J Public Health 2000;90:340—3.

31.

Gronniger JT A semiparametric analysis of the relationship of body mass index to mortality . Am J Public Health 2006;99:173—8.