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      Cause-specific excess deaths associated with underweight, overweight, and obesity.

      JAMA
      Adult, Aged, Body Mass Index, Cardiovascular Diseases, mortality, Cause of Death, Female, Humans, Male, Middle Aged, Neoplasms, Nutrition Surveys, Obesity, epidemiology, Overweight, Proportional Hazards Models, Risk, Thinness, United States

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          Abstract

          The association of body mass index (BMI) with cause-specific mortality has not been reported for the US population. To estimate cause-specific excess deaths associated with underweight (BMI <18.5), overweight (BMI 25-<30), and obesity (BMI > or =30). Cause-specific relative risks of mortality from the National Health and Nutrition Examination Survey (NHANES) I, 1971-1975; II, 1976-1980; and III, 1988-1994, with mortality follow-up through 2000 (571,042 person-years of follow-up) were combined with data on BMI and other covariates from NHANES 1999-2002 with underlying cause of death information for 2.3 million adults 25 years and older from 2004 vital statistics data for the United States. Cause-specific excess deaths in 2004 by BMI levels for categories of cardiovascular disease (CVD), cancer, and all other causes (noncancer, non-CVD causes). Based on total follow-up, underweight was associated with significantly increased mortality from noncancer, non-CVD causes (23,455 excess deaths; 95% confidence interval [CI], 11,848 to 35,061) but not associated with cancer or CVD mortality. Overweight was associated with significantly decreased mortality from noncancer, non-CVD causes (-69 299 excess deaths; 95% CI, -100 702 to -37 897) but not associated with cancer or CVD mortality. Obesity was associated with significantly increased CVD mortality (112,159 excess deaths; 95% CI, 87,842 to 136,476) but not associated with cancer mortality or with noncancer, non-CVD mortality. In further analyses, overweight and obesity combined were associated with increased mortality from diabetes and kidney disease (61 248 excess deaths; 95% CI, 49 685 to 72,811) and decreased mortality from other noncancer, non-CVD causes (-105,572 excess deaths; 95% CI, -161 816 to -49,328). Obesity was associated with increased mortality from cancers considered obesity-related (13,839 excess deaths; 95% CI, 1920 to 25,758) but not associated with mortality from other cancers. Comparisons across surveys suggested a decrease in the association of obesity with CVD mortality over time. The BMI-mortality association varies by cause of death. These results help to clarify the associations of BMI with all-cause mortality.

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