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7/30/2019 4 PSC BMI Slides 18 March 2009
1/25
Body-mass index and cause-specificmortality in 900 000 adults: collaborative
analyses of 57 prospective studies
Prospective Studies Collaboration
Lancet 2009; 373: 1083-96
7/30/2019 4 PSC BMI Slides 18 March 2009
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Blood pressure, cholesterol and BMI
Systolic
Diastolic
15 25 35 50
80
100
120
140
160
Non-HDL-C
HDL-C
Ratio of means
(non-HDL-C/HDL-C)
15 25 35 500
1
2
3
4
5
mm Hg
Baseline BMI (kg/m2)
mmol/L
(or ratio)
M
Adjusted for age, smoking and study
F
M
F M
F
FM
M
F
Fig 1a & b, Lancet 2009; 373: 1083-9
Blood pressure Cholesterol
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Ratio non-HDL:HDL cholesterol and BMI
15 25 35 500
1
2
3
4
5
Ratio of meansMean of ratios
Ratio
Baseline BMI (kg/m2)
Adjusted for age, smoking and study
M
F
(Mean of ratios
~10% higher than
ratio of means)
Fig 1b variant, Lancet 2009; 373: 1083-9
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Drinking, smoking, diabetes and BMI
15 25 35 500
20
40
60
80
100
15 25 35 500
20
40
60
80
100
Adjusted for age, smoking and study
Male Female
Baseline BMI (kg/m2)
Drinking
Smoking
Diabetes
Drinking
Smoking
Diabetes
Prevalence%
Fig 1c & d, Lancet 2009; 373: 1083-9
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All-cause mortality and BMI
15 20 25 30 35 40 504
8
16
32
64
Annual
deaths
per 1000
Baseline BMI (kg/m2)
Adjusted for age, smoking and study; 1st 5 years of follow-up excluded
Male
Female
Fig 2, Lancet 2009; 373: 1083-9
& 95% CI (floated
so matches PSC
rate at ages 35-79)
7/30/2019 4 PSC BMI Slides 18 March 2009
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IHD and stroke mortality and BMI
15 20 25 30 35 40 5005
1
2
4
8 IHD
Stroke
Adjusted for age, sex, smoking and study; 1st 5 years of follow-up excluded Fig 3, Lancet 2009; 373: 1083-9
Baseline BMI (kg/m2)
Annual
deaths
per 1000& 95% CI (floated
so matches PSC
rate at ages 35-79)
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IHD mortality and BMI in the range 2550 kg/m2 onlyNo. of
deathsMean age
at deathHR & 95% CI
0-4* 2069 602 126 (116-136)
5-9 3291 629 133 (124-143)
10-14 3407 661 143 (133-153)
15+ 4085 712 142 (134-151)Trend, 4 groups: c12=66 (p=001)
35-59 2461 541 150 (139-162)
60-69 3904 646 140 (132-149)
70-79 3264 740 131 (123-140)
80-89 1154 834 130 (117-145)Trend, 4 groups: c12=78 (p=0005)
Male 8556 657 142 (135-148)
Female 2227 724 135 (128-143)Heterogeneity: c
1
2=14 (p=02)
Never smoker 2651 710 141 (133-150)
Other/unknown 3442 680 145 (136-154)
Current cigarette 4690 641 133 (125-141)Heterogeneity: c22=37 (p=02)
All (BMI 25-50 kg/m2, years 5+) 10 783 671 139 (134-144)
10 15 2
Hazard ratio (& 95% CI) for5 kg/m2 higher baseline BMI
Follow-up period
(years)
Age at risk
(years)
Sex
Smoking at
entry
Fig 4a, Lancet 2009; 373: 1083-9
Adjusted, when appropriate, for age, sex,
smoking and study, and (except where
marked *) 1st 5 years of follow-up excluded
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Stroke mortality and BMI in the range 2550 kg/m2 only
583 625 121 (105-141)
889 656 136 (120-154)
906 690 137 (120-156)
1369 734 138 (124-153)
Trend, 4 groups: c12 =14 (p=02)
463 537 176 (152-204)
997 649 149 (134-167)
1152 743 133 (119-148)
552 835 110 (094-130)
Trend, 4 groups: c12 =194 (p
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IHD & stroke mortality and BMI in the range 2550 kg/m2 onlyApproximately standardised to overall mean age at IHD, or at stroke, death
Fig 4 variant, Lancet 2009; 373: 1083-9
IHDNo. of
deaths
Mean age
at deathHR & 95% CI
Followupperiod
(years)
0-4* 2069 602 120 (110-130)
5-9 3291 629 129 (121-139)
10-14 3407 661 142 (132-152)
15+ 4085 712 146 (138-155)
Trend, 4 groups:c
1
2
=173 (p
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Male Female
2
4
6
8
10
12
14
0
2
4
6
8
10
12
14
015 20 25 30 35 50 15 20 25 30 35 50
Vascular
Respiratory
Cancer (lung,mouth, pharynx,
larynx, oes.)
Vascular
Resp.
Main mortality categories and BMI
Cancer (otherspecified)
Baseline BMI (kg/m2)
Cancer (lung,mouth, pharynx,larynx, oes.)
Cancer (otherspecified)
Fig 5, Lancet 2009; 373: 1083-9Adjusted for age, smoking and study; 1st 5 years of follow-up excluded
Annual
deaths
per 1000
& 95% CI (floated
so matches EU rate
at ages 35-79)
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All-cause mortality and BMI, by smoking
15 20 25 30 35 500
5
10
15
20
25
30
Baseline BMI (kg/m2)
Currentcigarette
smoker
Neversmokedregularly
Adjusted for age, sex and study; 1st 5 years of follow-up excluded Fig 6, Lancet 2009; 373: 1083-9
Annual
deaths
per 1000
& 95% CI (floated
so matches EU rate
at ages 35-79)(N.B. The vertical separation of the
curves underestimates effects of
lifelongcigarette smoking)
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Lifespan and BMI in western Europe, year 2000
40 50 60 70 80 90 100
Yearly dots
BMI range, kg/m2
22.5-25 (mean 24)
25-30 (mean 27)
30-35 (mean 32)
0
20
40
60
80
100
Age (years)
40 50 60 70 80 90 1000
20
40
60
80
100
Male Female
Causal PSC relative risks applied to EU mortality rates Fig 7 variant, Lancet 2009; 373: 1083-9
%alive
77%
69%
88%
84%
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Lifespan and BMI in western Europe, year 2000
40 50 60 70 80 90 100
Yearly dots
Male
BMI range, kg/m2
22.5-25 (mean 24)
25-30
30-35 (mean 32)
35-40
40-50 (mean 43)
0
20
40
60
80
100
Age (years)
40 50 60 70 80 90 100
Female
0
20
40
60
80
100
Causal PSC relative risks applied to EU mortality rates Fig 7, Lancet 2009; 373: 1083-9
%
alive
77%
49%
88%
72%
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Comparison with smoking in the British Doctors Study
From figure 3 in Doll, Peto et al., BMJ 2004: 328: 1519-33
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All-cause mortality and BMI, by age at risk
15 20 25 30 35 50
2
4
8
16
32
64
128
256
512
35-59
60-69
70-79
80-89
Age at
risk:
15 20 25 30 35 50
2
4
8
16
32
64
128
256
512
Male Female
Baseline BMI (kg/m2)
35-59
60-69
70-79
80-89
Age atrisk:
Adjusted for age, smoking and study; 1st 5 years of follow-up excluded Webfig 1, Lancet 2009; 373: 1083-9
Annual
deaths
per 1000
& 95% CI (floated
so matches PSC
rate at ages 35-89)
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IHD mortality and BMI in never smokers
15 20 25 30 35 40 5005
1
2
4
8
16
Baseline BMI (kg/m2)
Adjusted for age, sex and study; 1st 5 years of follow-up excluded Webfig 2, Lancet 2009; 373: 1083-9
Annual
deaths
per 1000
& 95% CI (floated
so matches PSC
rate at ages 35-79)
S f
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Stroke mortality and BMI in specific subgroups
15 20 25 30 35 50
1
2
4
first 5 years of
followup
15 20 25 30 35 50
1
2
4
first 10 years of
followup
15 20 25 30 35 50
1
2
4
first 5 years and
ever smokers
Adjusted for age, sex, study and, when appropriate, smoking Webfig 3, Lancet 2009; 373: 1083-9
Baseline BMI (kg/m2)
Excluding:
Annual
deaths
per 1000
& 95% CI (floated
so matches PSC
rate at ages 35-79)
St k bt t lit d BMI
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Stroke subtype mortality and BMI
15 20 25 30 35 50
1/4
1/2
1
2
Ischaemic
15 20 25 30 35 50
1/4
1/2
1
2
Haemorrhagic
15 20 25 30 35 50
1/4
1/2
1
2
Unclassified
Baseline BMI (kg/m2)
Adjusted for age, sex, smoking and study; 1st 5 years of follow-up excluded Webfig 4, Lancet 2009; 373: 1083-9
Annual
deaths
per 1000
& 95% CI (floated
so matches PSC
rate at ages 35-79)
IHD t lit d BMI b t d
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IHD mortality and BMI by study
No. ofdeaths
Finnish Mobile Clinic 1724
Finrisk, Finland 1014UK HDPP 703
Israeli IHD 571
Whitehall, UK 568
NHEFS, US 494
Framingham, US 481
Renfrew/Paisley, UK 438
Norwegian Counties 438
BUPA, UK 362
Oslo, Norway 339
Midspan, UK 318
Copenhagen, Denmark 231
BRHS, UK 227
Busselton, Australia 222
Tecumseh, US 215
Studies with
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Stroke mortality and BMI by study
Finnish Mobile Clinic 556
Finrisk, Finland 270
Israeli IHD 206
NHEFS, US 148
Renfrew/Paisley, UK 143
Framingham, US 133
UK HDPP 122
Honolulu, US 111
Studies with
7/30/2019 4 PSC BMI Slides 18 March 2009
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COPD mortality and BMI by follow-up period
15 20 25 30 35
1/8
1/4
1/2
1
2
40-4 years
15 20 25 30 35
1/8
1/4
1/2
1
2
45-9 years
15 20 25 30 35
1/8
1/4
1/2
1
2
410-14 years
15 20 25 30 35
1/8
1/4
1/2
1
2
415+ years
Baseline BMI (kg/m2)
Adjusted for age, sex, smoking and study Webfig 6, Lancet 2009; 373: 1083-9
Annual
deaths
per 1000
& 95% CI (floated
so matches PSC
rate at ages 35-79)
All cause mortality and BMI by smoking
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All-cause mortality and BMI by smoking
15 20 25 30 35 50
5
10
15
20
0
Male (35-69 years)
15 20 25 30 35 50
5
10
15
20
0
Female (35-69 years)
Baseline BMI (kg/m2)
Currentcigarettesmoker
Neversmokedregularly
Currentcigarettesmoker
Neversmokedregularly
Adjusted for age and study; 1st 5 years of follow-up excluded Webfig 7a & b, Lancet 2009; 373: 1083-9
Annual
deaths
per 1000& 95% CI (floated
so matches EU rate
at ages 35-69)
All cause mortality and BMI by smoking
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All-cause mortality and BMI by smoking
15 20 25 30 35 50
25
50
75
100
015 20 25 30 35 50
25
50
75
100
0
Male (70-79 years) Female (70-79 years)
Currentcigarettesmoker
Neversmokedregularly
Current
cigarettesmoker
Neversmokedregularly
Adjusted for age and study; 1st 5 years of follow-up excluded Webfig 7c & d, Lancet 2009; 373: 1083-9
Baseline BMI (kg/m2)
Annual
deaths
per 1000& 95% CI (floated
so matches EU rate
at ages 70-79)
Vascular mortality and BMI by smoking
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Vascular mortality and BMI by smoking
15 20 25 30 35 500
2
4
6
15 20 25 30 35 500
2
4
6
Male (35-69 years) Female (35-69 years)
Baseline BMI (kg/m2)
Currentcigarettesmoker
Neversmokedregularly
Currentcigarettesmoker
Neversmokedregularly
Adjusted for age and study; 1st 5 years of follow-up excluded Webfig 8a & b, Lancet 2009; 373: 1083-9
Annual
deaths
per 1000& 95% CI (floated
so matches EU rate
at ages 35-69)
Vascular mortality and BMI by smoking
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Vascular mortality and BMI by smoking
15 20 25 30 35 500
10
20
30
15 20 25 30 35 500
10
20
30Current
cigarettesmoker
Neversmokedregularly Current
cigarettesmoker
Neversmokedregularly
Adjusted for age and study; 1st 5 years of follow-up excluded Webfig 8c & d, Lancet 2009; 373: 1083-9
Baseline BMI (kg/m2)
Male (70-79 years) Female (70-79 years)
Annual
deaths
per 1000& 95% CI (floated
so matches EU rate
at ages 35-79)