IJE Advance Access published online on February 14, 2008
International Journal of Epidemiology, doi:10.1093/ije/dyn001
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Association of body mass index with all-cause and cause-specific mortality: findings from a prospective cohort study in Mumbai (Bombay), India
1 Healis-Sekhsaria Institute for Public Health, Mumbai 400614, India.
2 Tampere School of Public Health, University of Tampere, Fi 33014, Finland.
3 Department of Epidemiology and Biostatistics, Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA.
* Corresponding author. Healis-Sekhsaria Institute for Public Health, 601/B, Great Eastern Chambers, Plot No. 28, Sector 11, CBD Belapur, Navi Mumbai 400614, India. E-mail: pednekarmangesh{at}rediffmail.com
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Abstract |
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Background The association between extremes of relative body weight and mortality has not been well characterized in developing countries. A prospective cohort study was conducted in Mumbai (India) to study the association of relative body weight, as estimated by body mass index [BMI = weight (kg)/height2 (m2)], with mortality.
Methods Using the voters’ list as the selection frame, 148 173 men and women aged 
35 years were recruited during 1991–97 in Mumbai city and were followed-up during 1997–2003.
Results During 774 129 person-years of follow-up, 13 261 deaths were observed. After adjusting for the potential confounders, increased mortality was observed in all under-weight categories [relative risk (RR) = 1.94 for BMI < 16.0 kg/m2, 1.38 for BMI 16.0 to <17.0 and 1.24 for BMI 17.0 to <18.5 among women; the corresponding values for men were 2.24, 1.45 and 1.27, respectively] when compared with the rate in the normal weight category (BMI 18.5 to <25.0). Extremely thin (BMI < 16.0 kg/m2) cohort members were at highest risk for death due to tuberculosis (TB) (RR = 7.20 and 14.94 in women and men, respectively), cancer (RR = 1.87 and 2.44, respectively) and respiratory diseases (RR = 3.46 and 4.35, respectively). Subjects with above normal BMI had lower mortality risk than those with normal BMI values. Over-weight (BMI 25.0 to <30.0) women (RR = 0.89) and men (RR = 0.87) were at a lower risk; however, obese (BMI 30.0) men <60 years of age had an increased mortality risk (RR = 1.22).
Conclusion In Mumbai, under-weight was associated with an increased risk of pre-mature death. Despite the growing concerns regarding the gradual transition toward increasing rates of obesity, under-nutrition remains a major health problem in India. This study suggests the need for public health policies focusing on reducing under-nutrition.
Keywords epidemiology, obesity, over-weight, under-weight, Asians, socioeconomic factors, mortality, tobacco
Accepted 19 December 2007
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