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IJE Advance Access published online on November 12, 2005
International Journal of Epidemiology, doi:10.1093/ije/dyi212
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2005; all rights reserved.
Accepted September 26, 2005

Original paper

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

Elizabeth Breeze 1 *, Robert Clarke 2, Martin J. Shipley 3, Michael G. Marmot 3, and Astrid E. Fletcher 4

1 Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Department of Epidemiology and Public Health, University College London, London, UK
2 Clinical Trial Service Unit, University of Oxford, Oxford, UK
3 Department of Epidemiology and Public Health, University College London, London, UK
4 Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK

* To whom correspondence should be addressed.
Elizabeth Breeze, E-mail: e.breeze{at}ucl.ac.uk


  Abstract

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.
A Commentary has been commissioned to accompany this paper and will appear with this article in the printed issue.
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Commentary: BMI and mortality in the elderly--a life course perspective
Rebecca Hardy and Diana Kuh
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