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Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies

Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Prospective Studies Collaboration Lancet 2009; 373: 1083-96. Blood pressure, cholesterol and BMI. Blood pressure. Cholesterol. 160. 5. M. Non-HDL-C. Systolic. M.

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Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies

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  1. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies Prospective Studies Collaboration Lancet 2009; 373: 1083-96

  2. Blood pressure, cholesterol and BMI Blood pressure Cholesterol 160 5 M Non-HDL-C Systolic M Ratio of means (non-HDL-C/HDL-C) 140 4 F F M 120 3 F mmol/L (or ratio) mm Hg 100 2 F M Diastolic HDL-C 80 F 1 M 0 15 25 35 50 15 25 35 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study Fig 1a & b, Lancet 2009; 373: 1083-96

  3. Ratio non-HDL:HDL cholesterol and BMI 5 M Mean of ratios 4 Ratio of means 3 F Ratio (Mean of ratios ~10% higher than ratio of means) 2 1 0 15 25 35 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study Fig 1b variant, Lancet 2009; 373: 1083-96

  4. Drinking, smoking, diabetes and BMI Female Male 100 100 80 80 Drinking 60 60 Prevalence% 40 40 Drinking Smoking 20 20 Smoking Diabetes Diabetes 0 0 15 25 35 50 15 25 35 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study Fig 1c & d, Lancet 2009; 373: 1083-96

  5. All-cause mortality and BMI 64 Male 32 Annual deaths per 1000 Female 16 & 95% CI (floated so matches PSC rate at ages 35-79) 8 4 15 20 25 30 35 40 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study; 1st 5 years of follow-up excluded Fig 2, Lancet 2009; 373: 1083-96

  6. IHD and stroke mortality and BMI IHD 8 4 Annual deaths per 1000 Stroke 2 & 95% CI (floated so matches PSC rate at ages 35-79) 1 0·5 15 20 25 30 35 40 50 Baseline BMI (kg/m2) Adjusted for age, sex, smoking and study; 1st 5 years of follow-up excluded Fig 3, Lancet 2009; 373: 1083-96

  7. IHD mortality and BMI in the range 25–50 kg/m2 only No. of Mean age HR & 95% CI deaths at death Follow-up period (years) 0-4* 2069 60·2 1·26 (1·16-1·36) 5-9 3291 62·9 1·33 (1·24-1·43) 10-14 3407 66·1 1·43 (1·33-1·53) 15+ 4085 71·2 1·42 (1·34-1·51) c 2 Trend, 4 groups: =6·6 (p=0·01) 1 Age at risk (years) 35-59 2461 54·1 1·50 (1·39-1·62) 60-69 3904 64·6 1·40 (1·32-1·49) 70-79 3264 74·0 1·31 (1·23-1·40) 80-89 1154 83·4 1·30 (1·17-1·45) c 2 Trend, 4 groups: =7·8 (p=0·005) 1 Sex Male 8556 65·7 1·42 (1·35-1·48) Female 2227 72·4 1·35 (1·28-1·43) c 2 Heterogeneity: =1·4 (p=0·2) 1 Smoking at entry Never smoker 2651 71·0 1·41 (1·33-1·50) Other/unknown 3442 68·0 1·45 (1·36-1·54) Current cigarette 4690 64·1 1·33 (1·25-1·41) c Heterogeneity: 2 =3·7 (p=0·2) 2 All (BMI 25-50 kg/m2, years 5+) 10 783 67·1 1·39 (1·34-1·44) 1·0 1·5 2 Hazard ratio (& 95% CI) for 5 kg/m2 higher baseline BMI Adjusted, when appropriate, for age, sex, smoking and study, and (except where marked *) 1st 5 years of follow-up excluded Fig 4a, Lancet 2009; 373: 1083-96

  8. Stroke mortality and BMI in the range 25–50 kg/m2 only No. of Mean age HR & 95% CI deaths at death Follow-up period (years) 0-4* 583 62·5 1·21 (1·05-1·41) 5-9 889 65·6 1·36 (1·20-1·54) 10-14 906 69·0 1·37 (1·20-1·56) 15+ 1369 73·4 1·38 (1·24-1·53) c 2 Trend, 4 groups: =1·4 (p=0·2) 1 Age at risk (years) 35-59 463 53·7 1·76 (1·52-2·04) 60-69 997 64·9 1·49 (1·34-1·67) 70-79 1152 74·3 1·33 (1·19-1·48) 80-89 552 83·5 1·10 (0·94-1·30) c 2 Trend, 4 groups: =19·4 (p<0·0001) 1 Sex Male 2132 68·4 1·50 (1·38-1·65) Female 1032 73·2 1·30 (1·19-1·42) c 2 Heterogeneity: =5·4 (p=0·02) 1 Smoking at entry Never smoker 1062 72·7 1·38 (1·25-1·52) Other/unknown 921 71·1 1·47 (1·30-1·65) Current cigarette 1181 66·5 1·34 (1·20-1·50) c Heterogeneity: 2 =1·2 (p=0·6) 2 Never smoker Stroke subtype 765 71·8 1·38 (1·23-1·56) Other/unknown 571 66·2 1·53 (1·32-1·78) Current cigarette 242 61·0 1·19 (0·94-1·52) Current cigarette 1586 71·8 1·40 (1·28-1·53) c 2 Heterogeneity: =3·2 (p=0·4) 3 All (BMI 25-50 kg/m2, years 5+) 3164 69·9 1·39 (1·31-1·48) 1 1·5 2 Hazard ratio (& 95% CI) for 5 kg/m2 higher baseline BMI Adjusted, when appropriate, for age, sex, smoking and study, and (except where marked *) 1st 5 years of follow-up excluded Fig 4b, Lancet 2009; 373: 1083-96

  9. IHD & stroke mortality and BMI in the range 25–50 kg/m2 only Approximately standardised to overall mean age at IHD, or at stroke, death IHD Stroke No. of Mean age No. of Mean age HR & 95% CI HR & 95% CI deaths at death deaths at death Follow­up period (years) 0-4* 2069 60·2 1·20 (1·10-1·30) 583 62·5 1·08 (0·93-1·26) 5-9 3291 62·9 1·29 (1·21-1·39) 889 65·6 1·27 (1·12-1·44) 10-14 3407 66·1 1·42 (1·32-1·52) 906 69·0 1·35 (1·19-1·54) 15+ 4085 71·2 1·46 (1·38-1·55) 1369 73·4 1·45 (1·31-1·61) Trend, 4 groups: Trend, 4 groups: c c 2 2 =10·1 (p=0·002) =17·3 (p<0·0001) 1 1 Sex Male 8556 65·7 1·40 (1·34-1·47) 2132 68·4 1·47 (1·34-1·61) Female 2227 72·4 1·40 (1·33-1·49) 1032 73·2 1·36 (1·25-1·49) Heterogeneity: Heterogeneity: c 2 c =0·0 (p=1·0) 2 =1·4 (p=0·2) 1 1 Smoking Never smoker 2651 71·0 1·45 (1·36-1·54) 1062 72·7 1·44 (1·31-1·59) at entry Other/unknown 3442 68·0 1·46 (1·37-1·55) 921 71·1 1·49 (1·33-1·68) Current cigarette 4690 64·1 1·30 (1·23-1·38) 1181 66·5 1·27 (1·13-1·43) Heterogeneity: Heterogeneity: c c 2 =8·1 (p=0·02) 2 =4·2 (p=0·1) 2 2 All (BMI 25-50, years 5+) 10 783 67·1 1·39 (1·34-1·44) 3164 69·9 1·39 (1·31-1·48) 1 1·5 2 1 1·5 2 Hazard ratio (& 95% CI) for 5 kg/m2 higher baseline BMI Adjusted, when appropriate, for age, sex, smoking and study, and (except where marked *) 1st 5 years of follow-up excluded Fig 4 variant, Lancet 2009; 373: 1083-96

  10. Main mortality categories and BMI Male Female 14 14 Vascular 12 12 Annual deaths per 1000 10 10 8 8 6 6 Vascular & 95% CI (floated so matches EU rate at ages 35-79) Cancer (other specified) 4 4 Cancer (other specified) Cancer (lung, mouth, pharynx, larynx, oes.) 2 2 Cancer (lung, mouth, pharynx, larynx, oes.) Resp. Respiratory 0 0 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study; 1st 5 years of follow-up excluded Fig 5, Lancet 2009; 373: 1083-96

  11. All-cause mortality and BMI, by smoking 30 Current cigarette smoker 25 Annual deaths per 1000 20 Never smoked regularly 15 & 95% CI (floated so matches EU rate at ages 35-79) 10 (N.B. The vertical separation of the curves underestimates effects of lifelong cigarette smoking) 5 0 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age, sex and study; 1st 5 years of follow-up excluded Fig 6, Lancet 2009; 373: 1083-96

  12. Lifespan and BMI in western Europe, year 2000 Male Female 100 100 88% 80 80 77% 84% 69% % alive 60 60 Yearly dots 40 40 BMI range, kg/m2 22.5-25 (mean 24) 20 20 25-30 (mean 27) 30-35 (mean 32) 0 0 40 50 60 70 80 90 100 40 50 60 70 80 90 100 Age (years) Causal PSC relative risks applied to EU mortality rates Fig 7 variant, Lancet 2009; 373: 1083-96

  13. Lifespan and BMI in western Europe, year 2000 Male Female 100 100 88% 77% 80 80 72% 60 60 % alive Yearly dots 49% BMI range, kg/m2 40 40 22.5-25 (mean 24) 25-30 30-35 (mean 32) 20 20 35-40 40-50 (mean 43) 0 0 40 50 60 70 80 90 100 40 50 60 70 80 90 100 Age (years) Causal PSC relative risks applied to EU mortality rates Fig 7, Lancet 2009; 373: 1083-96

  14. Comparison with smoking in the British Doctors’ Study From figure 3 in Doll, Peto et al., BMJ 2004: 328: 1519-33

  15. All-cause mortality and BMI, by age at risk Male Female Age at risk: 512 512 Age at risk: 80-89 256 256 80-89 70-79 128 128 Annual deaths per 1000 70-79 64 64 60-69 32 32 60-69 16 16 & 95% CI (floated so matches PSC rate at ages 35-89) 35-59 8 8 35-59 4 4 2 2 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study; 1st 5 years of follow-up excluded Webfig 1, Lancet 2009; 373: 1083-96

  16. IHD mortality and BMI in never smokers 16 8 Annual deaths per 1000 4 2 & 95% CI (floated so matches PSC rate at ages 35-79) 1 0·5 15 20 25 30 35 40 50 Baseline BMI (kg/m2) Adjusted for age, sex and study; 1st 5 years of follow-up excluded Webfig 2, Lancet 2009; 373: 1083-96

  17. Stroke mortality and BMI in specific subgroups Excluding: first 5 years of follow­up first 10 years of follow­up first 5 years and ever smokers 4 4 4 Annual deaths per 1000 2 2 2 & 95% CI (floated so matches PSC rate at ages 35-79) 1 1 1 15 20 25 30 35 50 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age, sex, study and, when appropriate, smoking Webfig 3, Lancet 2009; 373: 1083-96

  18. Stroke subtype mortality and BMI Ischaemic Haemorrhagic Unclassified 2 2 2 Annual deaths per 1000 1 1 1 1/2 1/2 1/2 & 95% CI (floated so matches PSC rate at ages 35-79) 1/4 1/4 1/4 15 20 25 30 35 50 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age, sex, smoking and study; 1st 5 years of follow-up excluded Webfig 4, Lancet 2009; 373: 1083-96

  19. IHD mortality and BMI by study No. of Study deaths Finnish Mobile Clinic 1724 Finrisk, Finland 1014 UK HDPP 703 Israeli IHD 571 Whitehall, UK 568 NHEFS, US 494 Framingham, US 481 Renfrew/Paisley, UK 438 Norwegian Counties 438 BUPA, UK 362 Oslo, Norway 339 Midspan, UK 318 Copenhagen, Denmark 231 BRHS, UK 227 Busselton, Australia 222 Tecumseh, US 215 Studies with <200 deaths 2438 0·8 1·0 1·4 2·0 2·8 ALL STUDIES 10 783 Hazard ratio (& 99% CI) for 2 c Test for heterogeneity: =22·5 (p=0·13) 16 5 kg/m2 higher baseline BMI Adjusted for age, sex and smoking; 1st 5 years of follow-up excluded Webfig 5a, Lancet 2009; 373: 1083-96

  20. Stroke mortality and BMI by study No. of Study deaths Finnish Mobile Clinic 556 Finrisk, Finland 270 Israeli IHD 206 NHEFS, US 148 Renfrew/Paisley, UK 143 Framingham, US 133 UK HDPP 122 Honolulu, US 111 Studies with <100 deaths 1475 0·8 1·0 1·4 2·0 2·8 ALL STUDIES 3164 c 2 Hazard ratio (& 99% CI) for Test for heterogeneity: =6·1 (p=0·64) 8 5 kg/m2 higher baseline BMI Adjusted for age, sex and smoking; 1st 5 years of follow-up excluded Webfig 5b, Lancet 2009; 373: 1083-96

  21. COPD mortality and BMI by follow-up period 0-4 years 5-9 years 10-14 years 15+ years 4 4 4 4 Annual deaths per 1000 2 2 2 2 1 1 1 1 1/2 1/2 1/2 1/2 1/4 1/4 1/4 1/4 & 95% CI (floated so matches PSC rate at ages 35-79) 1/8 1/8 1/8 1/8 15 20 25 30 35 15 20 25 30 35 15 20 25 30 35 15 20 25 30 35 Baseline BMI (kg/m2) Adjusted for age, sex, smoking and study Webfig 6, Lancet 2009; 373: 1083-96

  22. All-cause mortality and BMI by smoking Male (35-69 years) Female (35-69 years) 20 20 Current cigarette smoker 15 15 Annual deaths per 1000 Never smoked regularly Current cigarette smoker 10 10 & 95% CI (floated so matches EU rate at ages 35-69) Never smoked regularly 5 5 0 0 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age and study; 1st 5 years of follow-up excluded Webfig 7a & b, Lancet 2009; 373: 1083-96

  23. All-cause mortality and BMI by smoking Male (70-79 years) Female (70-79 years) 100 100 Current cigarette smoker 75 75 Annual deaths per 1000 Never smoked regularly Current cigarette smoker 50 50 & 95% CI (floated so matches EU rate at ages 70-79) Never smoked regularly 25 25 0 0 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age and study; 1st 5 years of follow-up excluded Webfig 7c & d, Lancet 2009; 373: 1083-96

  24. Vascular mortality and BMI by smoking Male (35-69 years) Female (35-69 years) 6 6 Current cigarette smoker Annual deaths per 1000 4 4 Never smoked regularly Current cigarette smoker & 95% CI (floated so matches EU rate at ages 35-69) 2 2 Never smoked regularly 0 0 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age and study; 1st 5 years of follow-up excluded Webfig 8a & b, Lancet 2009; 373: 1083-96

  25. Vascular mortality and BMI by smoking Male (70-79 years) Female (70-79 years) 30 30 Current cigarette smoker Annual deaths per 1000 Never smoked regularly 20 20 Current cigarette smoker & 95% CI (floated so matches EU rate at ages 35-79) Never smoked regularly 10 10 0 0 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age and study; 1st 5 years of follow-up excluded Webfig 8c & d, Lancet 2009; 373: 1083-96

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