Re: BMI and Chronic Disease

[Guest guest]

Hi Bill:

And this paper, although ten years old, may shed a little more light

on this issue. In particular the abstract includes the following:

" The increased risk in underweight men could be attributed to deaths

within the first 5 years of follow-up and to lung cancer mortality

among smokers. "

The " deaths within the first 5 years " refers largely, of course, to

subjects who were sub-clinically sick at time of enrollment. It is a

reasonable presumption that there were fewer who were sub-clinically

sick among those in the higher weight categories.

=================================

Here is the full abstract:

" Overweight, underweight, and mortality. A prospective study of

48,287 men and women.

Seidell JC, Verschuren WM, van Leer EM, Kromhout D.

Department of Chronic Disease and Environmental Epidemiology,

National Institute of Public Health and Environmental Protection,

Bilthoven, The Netherlands.

BACKGROUND: The relative contributions of a low and high body mass

index (BMI [weight in kilograms divided by height in meters squared])

to all-cause and cause-specific mortality are still controversial.

OBJECTIVE: To examine mortality rates in relation to BMI in a

prospective cohort study of 48,287 Dutch men and women aged 30 to 54

years at baseline from 1974 to 1980. METHODS: During an average 12-

year follow-up, 1319 deaths occurred. Relative risks (RRs) were

calculated from the proportional hazard model by using a BMI

between 18.5 and 24.9 kg/m2 as the reference category. RESULTS: All-

cause mortality was significantly increased in obese men (BMI, > or =

30 kg/m2; RR, 1.5; 95% confidence interval [CI], 1.1-2.0) and in

underweight men (BMI, < 18.5 kg/m2; RR, 2.6; 95% CI, 1.8-3.9) but not

in women. The increased risk in underweight men could be attributed

to deaths within the first 5 years of follow-up and to lung cancer

mortality among smokers. Coronary heart disease (CHD) mortality was

about 3-fold higher among obese men and women. About 21% and 28% of

CHD mortality in men and women, respectively, could be attributed to

being overweight (BMI, > or = 25 kg/m2). The RR (but not the absolute

risk) for CHD among obese men was still significant after adjustment

for the presence of smoking, hypertension, hypercholesterolemia, and

diabetes mellitus at baseline, and it was more pronounced for CHD

among nonsmokers than among smokers (RR, 7.1; 95% CI, 2.3-21.7; and

RR, 2.7; 95% CI, 1.5-4.7, respectively). CONCLUSIONS: Total mortality

was increased in obese and underweight men but not in women. The

increased mortality in overweight men was mainly attributable to CHD

and, in underweight men, to early mortality and especially lung

cancer mortality among smokers. "

PMID: 8624176

Rodney.

>

> Another BMI study :

>

>

> " Impact of Overweight on the Risk of Developing Common Chronic

Diseases

> During a 10-Year Period

>

> Alison E. Field, ScD; Eugenie H. Coakley; Aviva Must, PhD;

> L. Spadano, MA; Nan Laird, PhD; H. Dietz, MD, PhD;

Rimm,

> ScD; Graham A. Colditz, MD, DrPH

>

> Background: Overweight adults are at an increased risk of developing

> numerous chronic diseases.

>

> Methods: Ten-year follow-up (1986-1996) of middle-aged women in the

> Nurses' Health Study and men in the Health Professionals Follow-up

> Study to assess the health risks associated with overweight.

> Results The risk of developing diabetes, gallstones, hypertension,

> heart disease, and stroke increased with severity of overweight

among

> both women and men. Compared with their same-sex peers with a body

> mass index (BMI) (calculated as weight in kilograms divided by the

> square of height in meters) between 18.5 and 24.9, those with BMI of

> 35.0 or more were approximately 20 times more likely to develop

> diabetes (relative risk [RR], 17.0; 95% confidence interval [CI],

> 14.2-20.5 for women; RR, 23.4; 95% CI, 19.4-33.2 for men). Women who

> were overweight but not obese (ie, BMI between 25.0 and 29.9) were

> also significantly more likely than their leaner peers to develop

> gallstones (RR, 1.9), hypertension (RR, 1.7), high cholesterol level

> (RR, 1.1), and heart disease (RR, 1.4). The results were similar in

> men.

>

> Conclusions: During 10 years of follow-up, the incidence of

diabetes,

> gallstones, hypertension, heart disease, colon cancer, and stroke

(men

> only) increased with degree of overweight in both men and women.

> Adults who were overweight but not obese (ie, 25.0BMI29.9) were at

> significantly increased risk of developing numerous health

conditions.

> Moreover, the dose-response relationship between BMI and the risk of

> developing chronic diseases was evident even among adults in the

upper

> half of the healthy weight range (ie, BMI of 22.0-24.9), suggesting

> that adults should try to maintain a BMI between 18.5 and 21.9 to

> minimize their risk of disease.

>

> Arch Intern Med. 2001;161:1581-1586

>