Anthropometry and Mortality in Older Women: Potential Survival Benefit of Overweight and Obesity

  • Chantal Matkin Dolan
  • Michelle Hansen
  • Kathryn Fisher


This chapter examines the reported relationship between body mass index (BMI kg/m2) and other measures of anthropometry, such as fat mass and waist circumference, and the risk of all-cause mortality in older women. The World Health Organization (WHO) and the NHLBI have defined overweight as body mass index (BMI) 25.0–29.9 kg/m2 and obesity as BMI of 30.0 kg/m2 or greater and stated that all individuals who are overweight or obese are at risk for increased morbidity and mortality. The application of this single set of cutpoints to define mortality risk associated with overweight and obesity is controversial, particularly when applied to older women. Some studies support a linear relation while the majority of studies of older women have reported a J- or U-shaped relation between BMI and mortality in older women. Other studies have reported a “flattening” of this J- or U-shape relation between BMI and mortality among very elderly women. The totality of the evidence suggests that the BMI associated with lowest risk of mortality in older women is much higher than in younger women and that it includes overweight and possibly moderately obese women. The WHO and NHLBI guidelines are not appropriate when interpreting BMI levels and risk of mortality in older women, since many of the women categorized as overweight or obese are at the lowest risk of mortality. There does appear to be some survivor effect or protective effect of increased adiposity for risk of mortality in older women. Recent data suggests, however, that the possible protective effect of obesity on mortality may not provide protection against disability. More data are needed to understand fully the nature of the relation between anthropometry and risk of mortality and the link with morbidity and disability. There continues to be a striking lack of information on the risk of increased adiposity and mortality in non-White women. Although there is very little data on other measures of anthropometry other than BMI, BMI is highly correlated with other measures of anthropometry and is an easy and practical method of studying these relationships.


Obesity Europe Attenuation 
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Bioelectric Impedance Analysis


Body Mass Index


Bone Mineral Density




Confidence Interval


Dual X-ray Absorptiometry


Hazard Ratio






National Health and Nutrition Examination Survey


National Heart Lung and Blood Institute


Relative Risk


Study of Osteoporotic Fractures


Waist Circumference


Waist-to-Hip Ratio


World Health Organization





We would like to acknowledge Dr. Jennifer Kelsey for her thoughtful review of a draft version of this chapter.
Table 88.3

Key features of three large cohort studies that included multiple measures of anthropometry and adiposity and risk of mortality in older women


Study population

Body-size measures included

Average length of follow-up period

Number of deaths during follow-up period

Variables controlled for in analyses

Study Results



(Dolan et al. 2007)

•Predominantly white (98%) women aged 65 and older

•From Baltimore, MD, Minneapolis, MN, Portland, OR, and near Pittsburgh, PA

•Recruited from voter registration lists, driver’s license and ID card information, and HMO membership lists

•Baseline dates: September 1986–October 1988

N = 9704

•Mean Age: 73.2 years

•Mean BMI: 26.2 kg/m2

•BIA (Lean Mass, Fat mass, and % Body Fat

•BMI (Height and Weight)

•Waist circumference (WC)

8 years



•Smoking status

•Alcohol use

•Femoral-neck bone density

•Self-reported health status

•Physical activity level

•Grip strength

•Non-thiazide diuretic use

U-shaped relations were observed between all measures of body size and mortality throughout the age ranges in the study.

For BMI, the lowest mortality rates were in the range 24.6 to 29.8 kg/m2.

Results not attributable to smoking or measures of preexisting illness.


Malmö Diet and Cancer Study

(Lahmann et al. 2002)

•Men and women aged 45–73 years

•Randomly sampled from Sweden’s National Population Registry

•Baseline dates: 1991–1996

N = 16,814*

•Mean age: 59.2 years*

•Average BMI: 25.5 kg/m2*

•BIA (Lean Mass, % Body Fat)

•BMI (Height and Weight)

•Waist-to Hip Ratio (Waist and Hip circumference)

5.7 years




•Smoking status

•Physical activity level

The association between % body fat and mortality was modified by age.

Weaker associations were seen for BMI than for % body fat.

WHR stronger predictor of mortality in women

Results not explained by bias from early death or preexisting illness.


Melbourne Collaborative Cohort Study (Simpson et al., 2007)

•Men and women aged 27–75 years from the Melbourne metropolitan area (99.3% of subjects were 40–69 years of age)

•Recruited through electoral rolls and advertising

•Baseline dates: 1990–1994

N = 24,344*

•Median BMI: 25.9 kg/m2*

•BIA (Fat Mass, % Body Fat)

•BMI (Height and Weight)

•Waist-to-Hip Ratio (Waist and Hip Circumference)


11 years



•Country of birth

•Physical activity level

•Alcohol use


•Previous history of heart attack, angina, diabetes, stroke, and cancer

•Smoking status

U-shaped relation between WC and mortality.

WHR was positively, linearly related to mortality risk

Little or no increased mortality risk for BMI, fat mass, or % body fat




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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Chantal Matkin Dolan
    • 1
  • Michelle Hansen
  • Kathryn Fisher
  1. 1.President CMD Consulting, Inc.Palo AltoUSA

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