Body mass index and mortality among US male physicians

PURPOSE: To assess the relationship between body mass index and mortality in a population homogeneous in educational attainment and socioeconomic status. METHODS: We analyzed the association between body mass index (BMI) and both all-cause and cause-specific mortality among 85,078 men aged 40 to 84 years from the Physicians' Health Study enrollment cohort. RESULTS: During 5 years of follow-up, we documented 2856 deaths (including 1212 due to cardiovascular diseases and 891 due to cancer). In age-adjusted analyses, we observed U-shaped relation between BMI and all-cause mortality; among men who never smoked a linear relation was observed with no increase in mortality among leaner men (P for trend, <0.001). Among never smokers, in multivariate analyses adjusted for age, alcohol intake, and physical activity, the relative risks of all-cause mortality increased in a stepwise fashion with increasing BMI. Excluding the first 2 years of follow-up further strengthened the association (multivariate relative risks, from BMI <20 to greater than or equal to30 kg/m(2), were 0.93, 1.00, 1.00, 1.16, 1.45, and 1.71 [P for trend, <0.001]). In all age strata (40-54, 55-69, and 70-84 years), never smokers with BMIs of 30 or greater had approximately a 70% increased risk of death compared with the referent group (BMI 22.5-24.9). Higher levels of BMI were also strongly related to increased risk of cardiovascular mortality, regardless of physical activity level (P for trend, <0.01). CONCLUSIONS: All-cause and cardiovascular mortality was directly related to BMI among middle-aged and elderly men. Advancing age did not attenuate the increased risk of death associated with obesity. Lean men (BMI <20) did not have excess mortality, regardless of age. (C) 2004 Elsevier Inc. All rights reserved.