European Journal of Epidemiology

, Volume 24, Issue 2, pp 83–91 | Cite as

Body mass index and mortality: results of a cohort of 184,697 adults in Austria

  • Jochen Klenk
  • Gabriele Nagel
  • Hanno Ulmer
  • Alexander Strasak
  • Hans Concin
  • Günter Diem
  • Kilian Rapp
  • The VHM&PP Study Group


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.


Body 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.

Supplementary material

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Supplementary material 1 (DOCX 13 kb)
10654_2009_9312_MOESM2_ESM.doc (45 kb)
Supplementary material 2 (DOC 45 kb)


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Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Jochen Klenk
    • 1
  • Gabriele Nagel
    • 1
  • Hanno Ulmer
    • 2
    • 3
  • Alexander Strasak
    • 3
  • Hans Concin
    • 2
  • Günter Diem
    • 2
  • Kilian Rapp
    • 1
    • 4
  • The VHM&PP Study Group
  1. 1.Institute of EpidemiologyUniversity of UlmUlmGermany
  2. 2.Agency for Preventive and Social MedicineBregenzAustria
  3. 3.Department of Medical Statistics, Informatics and Health EconomicsMedical University of InnsbruckInnsbruckAustria
  4. 4.Department of Clinical GerontologyRobert-Bosch-HospitalStuttgartGermany

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