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

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
1
F
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-HDLHDL 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
05
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
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)
Fig 5, Lancet 2009 373 1083-96
Adjusted for age, smoking and study 1st 5 years
of follow-up excluded
8
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
9
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
10
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
11
Comparison with smoking in the British Doctors
Study
From figure 3 in Doll, Peto et al., BMJ 2004
328 1519-33
12
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
13
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
14
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
15
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