Body Mass Index and Risk of Cardiovascular Disease, Cancer and All-cause Mortality (original) (raw)

Abstract

Objectives: To determine the dose-response relationship between body mass index (BMI) and cause-specific mortality among Canadian adults.

Methods: The sample includes 10,522 adults 18–74 years of age who participated in the Canadian Heart Health Surveys (1986–1995). Participants were divided into 5 BMI categories (<18.5, 18.5–24.9, 25–29.9, 30–34.9, and =35 kg/m2). Multivariate-adjusted (age, sex, exam year, smoking status, alcohol consumption and education) hazard ratios for all-cause, cardiovascular disease (CVD) and cancer mortality were estimated using Cox proportional hazards regression.

Results: There were 1,149 deaths (402 CVD; 412 cancer) over an average of 13.9 years (range 0.5 to 19.1 years), and the analyses are based on 145,865 person-years. The hazard ratios (95% CI) across successive BMI categories for all-cause mortality were 1.25 (0.83–1.90), 1.00 (reference), 1.06 (0.92–1.22), 1.27 (1.07–1.51) and 1.65 (1.29–2.10). The corresponding hazard ratios for CVD mortality were 1.30 (0.60–2.83), 1.00 (reference), 1.57 (1.22–2.01), 1.72 (1.27–2.33) and 2.09 (1.35–3.22); and for cancer, the hazard ratios were 1.02 (0.48–2.21), 1.00 (reference), 1.14 (0.90–1.44), 1.34 (1.01–1.78) and 1.82 (1.22–2.71). There were significant linear trends across BMI categories for all-cause (p=0.0001), CVD (p<0.0001) and cancer mortality (p=0.003).

Conclusions: The results demonstrate significant relationships between BMI and mortality from all causes, CVD and cancer. The increased risk of all-cause, CVD and cancer mortality associated with an elevated BMI was significant at levels above 30 kg/m2; however, overweight individuals (BMI 25–29.9 kg/m2) also had an approximately 60% higher risk of CVD mortality.

Résumé

Objectif: Déterminer la relation dose-réponse entre l’indice de masse corporelle (IMC) et la mortalité par cause chez les Canadiens d’âge adulte.

Méthode: Notre échantillon comprenait 10 522 adultes de 18 à 74 ans ayant participé aux Enquêtes sur la santé cardiovasculaire des Canadiens (1986–1995). Les participants ont été divisés en cinq catégories d’IMC (<18,5, 18,5–24,9, 25–29,9, 30–34,9 et =35 kg/m2). À l’aide du modèle de régression à effet proportionnel de Cox, nous avons estimé des coefficients de danger ajustés selon plusieurs variables (âge, sexe, année d’examen, usage du tabac, consommation d’alcool et niveau d’instruction) pour la mortalité toutes causes confondues, la mortalité par maladie cardiovasculaire (MCV) et la mortalité par cancer.

Résultats: Il y a eu 1 149 décès (402 par MCV; 412 par cancer) sur une moyenne de 13,9 ans (intervalle de 0,5 à 19,1 ans), et les analyses sont basées sur 145 865 personnes-années. Les coefficients de danger (IC de 95 %) par catégorie successive d’IMC pour la mortalité toutes causes confondues étaient de 1,25 (0,83–1,90), 1,00 (référence), 1,06 (0,92–1,22), 1,27 (1,07–1,51) et 1,65 (1,29–2,10). Les coefficients de danger correspondants pour la mortalité par MCV étaient de 1,30 (0,60–2,83), 1,00 (référence), 1,57 (1,22–2,01), 1,72 (1,27–2,33) et 2,09 (1,35–3,22); pour le cancer, ils étaient de 1,02 (0,48–2,21), 1,00 (référence), 1,14 (0,90–1,44), 1,34 (1,01–1,78) et 1,82 (1,22–2,71). Nous avons relevé des tendances linéaires significatives d’une catégorie d’IMC à l’autre pour la mortalité toutes causes confondues (p=0,0001), la mortalité par MCV (p<0,0001) et la mortalité par cancer (p=0,003).

Conclusion: Ces résultats font état de relations significatives entre l’IMC et la mortalité toutes causes confondues, par MCV et par cancer. Dans les trois cas, le risque accru de mortalité associé à un IMC élevé était significatif à plus de 30 kg/m2; cependant, les sujets en surpoids (IMC 25–29,9 kg/m2) avaient aussi un risque plus élevé d’environ 60 % de mourir d’une MCV.

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Authors and Affiliations

  1. Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808-4124, Canada
    Peter T. Katzmarzyk PhD
  2. Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
    Bruce A. Reeder MD & Punam Pahwa PhD
  3. Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
    Susan Elliott PhD
  4. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
    Michel R. Joffres MD, PhD
  5. Centre for Health Promotion Studies, School of Public Health, University of Alberta, Edmonton, AB, Canada
    Kim D. Raine PhD
  6. Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
    Susan A. Kirkland PhD
  7. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and McGill University Health Centre Research Institute, Montreal, QC, Canada
    Gilles Paradis MD

Authors

  1. Peter T. Katzmarzyk PhD
  2. Bruce A. Reeder MD
  3. Susan Elliott PhD
  4. Michel R. Joffres MD, PhD
  5. Punam Pahwa PhD
  6. Kim D. Raine PhD
  7. Susan A. Kirkland PhD
  8. Gilles Paradis MD

Corresponding author

Correspondence to Peter T. Katzmarzyk PhD.

Additional information

Acknowledgements: This research was supported by a New Emerging Team grant from the Heart and Stroke Foundation of Canada and the Canadian Institutes of Health Research. PTK is partially supported by the Louisiana Public Facilities Authority Endowed Chair in Nutrition. KR and GP acknowledge salary support from the Applied Public Health Chairs program of the Canadian Institutes of Health Research. KR acknowledges additional funding from the Heart and Stroke Foundation of Canada. Special thanks to Alison Edwards for help with data management; Dr. Stephanie Broyles for help with multiple imputation procedures; and Paula Woollam and Georgia Roberts from Statistics Canada for their contributions to conducting the mortality linkage and assembling the resulting dataset.

Conflict of Interest: None to declare.

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Katzmarzyk, P.T., Reeder, B.A., Elliott, S. et al. Body Mass Index and Risk of Cardiovascular Disease, Cancer and All-cause Mortality.Can J Public Health 103, 147–151 (2012). https://doi.org/10.1007/BF03404221

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