Abstract
BackgroundThe relationship between body mass index (BMI) and mortality may differ by ethnicity, but its exact nature remains unclear among Koreans. The study aim was to prospectively examine the association between BMI and mortality in Korean.Methods6166 residents (2636 men; 3530 women) of rural communities (Kangwha County, Republic of Korea) aged 55 and above were followed up for deaths from 1985–2008. The multivariable-adjusted hazard ratios were calculated using the Cox proportional hazards model.ResultsDuring the 23.8 years of follow-up (an average of 12.5 years in men and 15.7 years in women), 2174 men and 2372 women died. Men with BMI of 21.0–27.4 and women with BMI of 20.0–27.4 had a minimal risk for all-cause mortality. A lower BMI as well as a higher BMI increased the hazard ratio of death. For example, multivariable-adjusted hazard ratios associated with BMI below 16, and with BMI of 27.5 and above, were 2.4 (95% CI = 1.6–3.5) and 1.5 (95% CI = 1.1–1.9) respectively, in men, compared to those with BMI of 23.0–24.9. This reverse J-curve association was maintained among never smokers, and among people with no known chronic diseases. Higher BMI increased vascular mortality, while lower BMI increased deaths from vascular diseases, cancers, and, especially, respiratory diseases. Except for cancers, these associations were generally weaker in women than in men.ConclusionsA reverse J-curve association between BMI and all-cause mortality may exist. BMI of 21–27.4 (rather than the range suggested by WHO of 18.5–23 for Asians) may be considered a normal range with acceptable risk in Koreans aged 55 and above, and may be used as cut points for interventions. More concern should be given to people with BMI above and below a BMI range with acceptable risk. Further studies are needed to determine ethnicity-specific associations.
Highlights
Obesity defined by body-mass index (BMI) has been a common indicator to determine clinical and public health intervention [1]
Men with body mass index (BMI) of 21.0–27.4 and women with BMI of 20.0–27.4 had a minimal risk for all-cause mortality
More concern should be given to people with BMI above and below a BMI range with acceptable risk
Summary
Obesity defined by body-mass index (BMI) has been a common indicator to determine clinical and public health intervention [1]. In contrast to the obesity, being underweight has seldom been recognized as a health risk, despite the fact that several studies have reported this risk [7,10,11] This is partly due to the low proportion of people with low BMI in North American and European populations [12], and partly to the hypothesis of reverse causation (that is, that low BMI is not a risk but a consequence of underlying conditions leading to poor health outcomes) [8,10]. More studies of ethnic and regional groups are needed to better understand the association of low BMI (and high BMI) with the risk of morbidity and mortality from various diseases [6]. The study aim was to prospectively examine the association between BMI and mortality in Korean
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