Document Detail

Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis.
MedLine Citation:
PMID:  23280227     Owner:  NLM     Status:  MEDLINE    
IMPORTANCE: Estimates of the relative mortality risks associated with normal weight, overweight, and obesity may help to inform decision making in the clinical setting.
OBJECTIVE: To perform a systematic review of reported hazard ratios (HRs) of all-cause mortality for overweight and obesity relative to normal weight in the general population.
DATA SOURCES: PubMed and EMBASE electronic databases were searched through September 30, 2012, without language restrictions.
STUDY SELECTION: Articles that reported HRs for all-cause mortality using standard body mass index (BMI) categories from prospective studies of general populations of adults were selected by consensus among multiple reviewers. Studies were excluded that used nonstandard categories or that were limited to adolescents or to those with specific medical conditions or to those undergoing specific procedures. PubMed searches yielded 7034 articles, of which 141 (2.0%) were eligible. An EMBASE search yielded 2 additional articles. After eliminating overlap, 97 studies were retained for analysis, providing a combined sample size of more than 2.88 million individuals and more than 270,000 deaths.
DATA EXTRACTION: Data were extracted by 1 reviewer and then reviewed by 3 independent reviewers. We selected the most complex model available for the full sample and used a variety of sensitivity analyses to address issues of possible overadjustment (adjusted for factors in causal pathway) or underadjustment (not adjusted for at least age, sex, and smoking).
RESULTS: Random-effects summary all-cause mortality HRs for overweight (BMI of 25-<30), obesity (BMI of ≥30), grade 1 obesity (BMI of 30-<35), and grades 2 and 3 obesity (BMI of ≥35) were calculated relative to normal weight (BMI of 18.5-<25). The summary HRs were 0.94 (95% CI, 0.91-0.96) for overweight, 1.18 (95% CI, 1.12-1.25) for obesity (all grades combined), 0.95 (95% CI, 0.88-1.01) for grade 1 obesity, and 1.29 (95% CI, 1.18-1.41) for grades 2 and 3 obesity. These findings persisted when limited to studies with measured weight and height that were considered to be adequately adjusted. The HRs tended to be higher when weight and height were self-reported rather than measured.
CONCLUSIONS AND RELEVANCE: Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.
Katherine M Flegal; Brian K Kit; Heather Orpana; Barry I Graubard
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  JAMA     Volume:  309     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-02     Completed Date:  2013-01-03     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  71-82     Citation Subset:  AIM; IM    
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MeSH Terms
Body Mass Index
Cause of Death
Middle Aged
Obesity / classification,  mortality*
Overweight / mortality*
Reference Values
Comment In:
JAMA. 2013 Apr 24;309(16):1680-1   [PMID:  23613065 ]
JAMA. 2013 Apr 24;309(16):1681   [PMID:  23613066 ]
JAMA. 2013 Jan 2;309(1):87-8   [PMID:  23280230 ]
Endocr Pract. 2013 Jan-Feb;19(1):166-8   [PMID:  23435046 ]
JAMA. 2013 Apr 24;309(16):1679   [PMID:  23613062 ]
JAMA. 2013 Apr 24;309(16):1680   [PMID:  23613064 ]
JAMA. 2013 Apr 24;309(16):1679-80   [PMID:  23613063 ]
Obesity (Silver Spring). 2013 Sep;21(9):1744-5   [PMID:  23929522 ]
Obesity (Silver Spring). 2013 Sep;21(9):1746-9   [PMID:  24078231 ]
JAMA. 2013 Apr 24;309(16):1681-2   [PMID:  23613067 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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