Body mass index and mortality: results of a cohort of 184,697 adults in Austria
There is still a debate about the role of body mass index (BMI) as a risk factor for all-cause mortality. Most investigations with large sample sizes focused on populations from the United States, studies from Central-European cohorts are not available. We investigated the association between BMI and all-cause mortality and cause-specific mortality within a cohort in Austria. Design of this article is “Cohort study”. The Subjects used were 184,697 men and women (mean age 41.7 ± 15.4 years). Weight and height were measured. Cox proportional hazards models were used to estimate hazard ratios (HR). During a median follow-up of 15.1 years 15,557 deaths (6,077 from cardiovascular disease, 4,443 from cancer and 606 from respiratory disease) were seen. A U-shaped association between BMI and all-cause mortality was observed in men and women. Compared with the reference category (BMI 22.5–24.9 kg/m²) high risks were found both in the highest category of BMI (≥35 kg/m2) with HR of 2.13 (95% CI, 1.82–2.48) in men and 1.60 (95% CI, 1.42–1.81) in women and in the lowest category (<18.5 kg/m²) with HR of 2.57 (95% CI, 2.17–3.05) in men and 1.40 (95% CI, 1.21–1.62) in women. Similar patterns were seen among ever-smokers and non-smokers. Increased mortality with increasing BMI was driven by cardiovascular diseases and to a lesser extent by cancers. Respiratory diseases contributed to mortality in the lowest BMI category independently from smoking status. Underweight and obesity were both associated with higher all-cause mortality in men and women.
KeywordsBody mass index Mortality Epidemiology
Members of the VHM&PP study group are Guntram Hinteregger MD, Karin Parschalk MD, Wolfgang Metzler MD, Elmar Stimpfl (Agency for Preventive- and Social Medicine, Bregenz, Austria) and Stephan K Weiland † MD MSc (Institute of Epidemiology, Ulm University, Germany). We would like to thank all the participants and physicians of the VHM&PP. We are grateful to the Government of the State of Vorarlberg, Austria for funding the program and thank Elmar Bechter MD and Hans-Peter Bischof MD at the Health Department of the Vorarlberg State Government.
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