Body weight and mortality among women

The relation between body weight and overall mortality remains controversial despite considerable investigation. We examined the association between body-mass index (defined as the weight in kilograms divided by the square of the height in meters) and both overall mortality and mortality from specific causes in a cohort of 115,195 U.S. women enrolled in the prospective Nurses' Health Study. These women were 30 to 55 years of age and free of known cardiovascular disease and cancer in 1976. During 16 years of follow-up, we documented 4726 deaths, of which 881 were from cardiovascular disease, 2586 from cancer, and 1259 from other causes. In analyses adjusted only for age, we observed a J-shaped relation between body-mass index and overall mortality. When women who had never smoked were examined separately, no increase in risk was observed among the leaner women, and a more direct relation between weight and mortality emerged (P for trend < 0.001). In multivariate analyses of women who had never smoked and had recently had stable weight, in which the first four years of follow-up were excluded, the relative risks of death from all causes for increasing categories of body-mass index were as follows: body-mass index <19.0 (the reference category), relative risk = 1.0; 19.0 to 21.9, relative risk = 1.2; 22.0 to 24.9, relative risk = 1.2; 25.0 to 26.9, relative risk = 1.3; 27.0 to 28.9, relative risk = 1.6; 29.0 to 31.9, relative risk = 2.1; and =32.0, relative risk = 2.2 (P for trend <0.001). Among women with body-mass indexes of 32.0 or higher who had never smoked, the relative risk of death from cardiovascular disease was 4.1 (95 percent confidence interval, 2.1 to 7.7), and that of death from cancer was 2.1 (95 percent confidence interval, 1.4 to 3.2), as compared with the risk among women with body-mass indexes below 19.0. A weight gain of 10 kg (22 lb) or more since the age of 18 was associated with increased mortality in middle adulthood. Body weight and mortality from all causes were directly related among these middle-aged women. Lean women did not have excess mortality. The lowest mortality rate was observed among women who weighed at least 15 percent less than the U.S. average for women of similar age and among those whose weight had been stable since early adulthood. The relation between body weight and mortality remains a subject of intense debate, particularly with respect to the optimal weight for longevity. Although severe obesity is clearly associated with increased mortality,¹ the health consequences of being mildly to moderately overweight remain controversial. Furthermore, leanness has been linked to elevated mortality in several studies, but the validity of this finding remains in dispute. Diverse findings concerning the nature of the relation between weight and mortality have included no association,²–⁵ a J-shaped²–⁴,⁶_⁹ or U-shaped¹⁰,¹¹ relation, a direct association,⁵,¹²–¹⁵ and an inverse association.¹⁶ Although the biologic.