IJE Advance Access originally published online on November 12, 2005
International Journal of Epidemiology 2006 35(1):169-178; doi:10.1093/ije/dyi212
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Cause-specific mortality in old age in relation to body mass index in middle age and in old age: follow-up of the Whitehall cohort of male civil servants
1 Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
2 Department of Epidemiology and Public Health, University College London, London, UK
3 Clinical Trial Service Unit, University of Oxford, Oxford, UK
* Corresponding author. Department of Epidemiology and Public, University College, 1-19 Torrington Place, London WC1E 6BT, UK. E-mail: e.breeze{at}ucl.ac.uk
Background The relevance of body mass index (BMI) to cause-specific mortality in old age is uncertain.
Objectives To examine cause-specific 5 year mortality in old age by BMI in old age and middle age (40–69 years).
Methods Cox proportional hazards for mortality rates among 4862 former male civil servants in relation to quartiles of BMI measured when screened in 1968–70 and when resurveyed in 1997–98 (median age 76 years).
Results The association between all-cause mortality after resurvey and BMI in old age was U-shaped with hazard ratios (HRs) of 1.3 (95% CI 1.1–1.5) for the lightest and heaviest categories relative to the middle two. Among ‘healthy’ men the lightest (<22.7 kg/m2) had greatest all-cause mortality. The heaviest men (>26.6 kg/m2) had increased risk of cardiovascular disease (CVD) mortality in the first two years or for the whole period if never-smokers. Respiratory mortality was inversely associated with BMI in old age [adjusted HR for trend per BMI category increase 0.6 (0.5–0.7)] but cancer mortality lacked a clear pattern. Net gain or loss of 10 kg or more between middle and old age was a strong predictor of all-cause and CVD mortality.
Conclusions The shape of the association between BMI in old age and mortality differs by cause of death. Major weight change over time is a warning signal for higher CVD mortality. Having BMI <22.7 kg/m2 in old age is associated with above-average mortality rates even if apparently healthy.
Keywords Body mass index, aged, aged 80 and over, mortality, body weight change, cardiovascular diseases, respiratory tract diseases
Accepted 26 September 2005
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