Abstract
Most studies examining the association between body mass index (BMI) and mortality neglected changes in weight over time, which may have led to underestimation of the true association. The aim of this study is to examine the relationship between BMI and health related outcomes while accounting for variations of BMI over time. The association between BMI and both mortality and occupational disability was examined in a follow-up of 5,554 male construction workers in Württemberg/Germany, who participated at least two times in routine occupational health examinations between 1986 and 2005. Using Cox proportional hazards model with time dependent variables, hazard ratios were calculated with normal weight (<25 kg/m²) as reference after adjustment for potential confounding factors. Overall, an U-shaped association between baseline BMI and mortality (370 events) as well as occupational disability (658 events) was observed, with lowest risk at BMI levels between 25 and 30 kg/m². Men with a baseline BMI ≥ 30 kg/m² experienced a 10% higher mortality and disability risk than normal weight men. The association between BMI and occupational disability became stronger after accounting for temporal variability of BMI with a significant increased risk of 1.26 (95% confidence interval: 1.01–1.56) among obese men. In contrast, the association between BMI and mortality did not materially change after accounting for time dependent effects. Stable obesity as defined by a BMI of 30 kg/m² and above increases risk of disability in male construction workers. Accounting for changes of BMI over time is crucial for disclosing full impact of obesity.
Similar content being viewed by others
References
International Association for the Study of Obesity. Global prevalence of adult obesity. In: IASO prevalence data. International Association for the Study of Obesity. 2011. http://www.iaso.org/site_media/uploads/Prevalence_of_Adult_Obesity_April_2011_New.pdf. Accessed 11 Jan 2012.
World Health Organization. Obesity and overweight. In: Fact sheet 311. World Health Organization. 2011. http://www.who.int/mediacentre/factsheets/fs311/en/index.html. Accessed 11 Jan 2012.
Anandacoomarasamy A, Fransen M, March L. Obesity and the musculoskeletal system. Curr Opin Rheumatol. 2009;21:71–7.
Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348:1625–38.
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.
Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA. 1999;282:1523–9.
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.
Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293:1861–7.
Gurm HS, Brennan DM, Booth J, et al. Impact of body mass index on outcome after percutaneous coronary intervention (the obesity paradox). Am J Cardiol. 2002;90:42–5.
Romero-Corral A, Montori VM, Somers VK, et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006;368:666–78.
Sempos CT, Durazo-Arvizu R, McGee DL, Cooper RS, Prewitt TE. The influence of cigarette smoking on the association between body weight and mortality. The Framingham Heart Study revisited. Ann Epidemiol. 1998;8:289–300.
Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363:2211–9.
Reas DL, Nygard JF, Svensson E, Sorensen T, Sandanger I. Changes in body mass index by age, gender, and socio-economic status among a cohort of Norwegian men and women (1990–2001). BMC Public Health. 2007;7:269.
Corrada MM, Kawas CH, Mozaffar F, Paganini-Hill A. Association of body mass index and weight change with all-cause mortality in the elderly. Am J Epidemiol. 2006;163:938–49.
Harrington M, Gibson S, Cottrell RC. A review and meta-analysis of the effect of weight loss on all-cause mortality risk. Nutr Res Rev. 2009;22:93–108.
Keller HH, Ostbye T. Body Mass Index (BMI), BMI change and mortality in community-dwelling seniors without dementia. J Nutr Health Aging. 2005;9:316–20.
Korkeila M, Rissanen A, Sorensen TI, Kaprio J. BMI, weight stability and mortality among adults without clinical co-morbidities: a 22-year mortality follow-up in the Finnish twin cohort. Obes Facts. 2009;2:344–51.
Myrskyla M, Chang VW. Weight change, initial BMI, and mortality among middle- and older-aged adults. Epidemiology. 2009;20:840–8.
Rzehak P, Meisinger C, Woelke G, et al. Weight change, weight cycling and mortality in the ERFORT male cohort study. Eur J Epidemiol. 2007;22:665–73.
Saito I, Konishi M, Iso H, Inoue M, Tsugane S. Impact of weight change on specific-cause mortality among middle-aged Japanese individuals. J Epidemiol Community Health. 2009;63:447–54.
Sauvaget C, Ramadas K, Thomas G, et al. Body mass index, weight change and mortality risk in a prospective study in India. Int J Epidemiol. 2008;37:990–1004.
Shimazu T, Kuriyama S, Ohmori-Matsuda K, et al. Increase in body mass index category since age 20 years and all-cause mortality: a prospective cohort study (the Ohsaki Study). Int J Obes (Lond). 2009;33:490–6.
Sørensen TI, Rissanen A, Korkeila M, Kaprio J. Intention to lose weight, weight changes, and 18-y mortality in overweight individuals without co-morbidities. PLoS Med. 2005;. doi:10.1371/journal.pmed.0020171.
Yun KE, Park HS, Song YM, Cho SI. Increases in body mass index over a 7-year period and risk of cause-specific mortality in Korean men. Int J Epidemiol. 2010;39:520–8.
He J, McGee D, Niu X, Choi W. Examining the dynamic association of BMI and mortality in the Framingham Heart Study. Int J Environ Res Public Health. 2009;6:3115–26.
Claessen H, Arndt V, Drath C, Brenner H. Overweight, obesity and risk of work disability: a cohort study of construction workers in Germany. Occup Environ Med. 2009;66:402–9.
Neovius K, Johansson K, Kark M, Neovius M. Obesity status and sick leave: a systematic review. Obes Rev. 2009;10:17–27.
Neovius K, Johansson K, Rössner S, Neovius M. Disability pension, employment and obesity status: a systematic review. Obes Rev. 2008;9:572–81.
Visscher TL, Rissanen A, Seidell JC, et al. Obesity and unhealthy life-years in adult finns: an empirical approach. Arch Intern Med. 2004;164:1413–20.
Walter S, Kunst A, Mackenbach J, Hofman A, Tiemeier H. Mortality and disability: the effect of overweight and obesity. Int J Obes (Lond). 2009;33:1410–8.
Arndt V, Rothenbacher D, Zschenderlein B, Schuberth S, Brenner H. Body mass index and premature mortality in physically heavily working men–a ten-year follow-up of 20,000 construction workers. J Occup Environ Med. 2007;49:913–21.
Brenner H, Arndt V, Rothenbacher D, et al. Body weight, pre-existing disease, and all-cause mortality in a cohort of male employees in the German construction industry. J Clin Epidemiol. 1997;50:1099–106.
Arndt V, Rothenbacher D, Daniel U, et al. All-cause and cause specific mortality in a cohort of 20 000 construction workers;results from a 10 year follow up. Occup Environ Med. 2004;61:419–25.
Arrighi HM, Hertz-Picciotto I. The evolving concept of the healthy worker survivor effect. Epidemiology. 1994;5:189–96.
Van Gaal LF, Wauters MA, De Leeuw IH. The beneficial effects of modest weight loss on cardiovascular risk factors. Int J Obes Relat Metab Disord. 1997;21(Suppl 1):S5–9.
Elliott AM, Aucott LS, Hannaford PC, Smith WC. Weight change in adult life and health outcomes. Obes Res. 2005;13:1784–92.
Droyvold WB, Lund Nilsen TI, Lydersen S, et al. Weight change and mortality: the Nord-Trondelag health study. J Intern Med. 2005;257:338–45.
Wannamethee SG, Shaper AG, Walker M. Weight change, weight fluctuation, and mortality. Arch Intern Med. 2002;162:2575–80.
Bigaard J, Frederiksen K, Tjonneland A, et al. Waist and hip circumferences and all-cause mortality: usefulness of the waist-to-hip ratio? Int J Obes Relat Metab Disord. 2004;28:741–7.
Wormser D, Kaptoge S, Di Angelantonio E, et al. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet. 2011;377:1085–95.
Acknowledgments
Supported by the Association of the Workmen’s Compensation Board for Construction Workers, Germany, and by grants from the German Pension Fund (Deutsche Rentenversicherung Baden-Württemberg und Deutsche Rentenversicherung Bund) [grant number 0421/40-64-50-13].
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Claessen, H., Brenner, H., Drath, C. et al. Repeated measures of body mass index and risk of health related outcomes. Eur J Epidemiol 27, 215–224 (2012). https://doi.org/10.1007/s10654-012-9669-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10654-012-9669-7