American Journal of Epidemiology Vol. 146, No. 4: 339-349
Copyright © 1997 by The Johns Hopkins University School of Hygiene and Public Health
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Hypothesis Concerning the U-shaped Relation between Body Mass Index and Mortality
1Obesity Research Center, St. Luke's/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons New York, NY
2St. Luke's/Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons New York, NY
Reprint requests to Dr. David B. Allison, Obesity Research Center, St. Luke's/Roosevelt Hospital, 1090 Amsterdam Ave., 14th floor, New York, NY 10025
Numerous studies have documented a U- or J-shaped association between body mass index (BMI) (kg/m2) and mortality, such that increased mortality rate is associated with relatively low and high BMI values. It has been argued elsewhere that the elevated mortality rate observed at lower BMI values actually results from the effects of unmeasured confounding variables, in particular smoking status and preexisting disease. In this paper, the authors present an additional explanation for the phenomenon, i.e., nonspecific measurement. They propose that differential health consequences of fat mass and fat-free mass can be masked by the use of BMI when studied in relation to mortality. To illustrate this point, they use body composition data from 1,137 healthy adults and specify a hypothetical underlying BMI-mortality model in which the logit of death increased linearly with fat mass and decreased linearly with fat-free mass, and % fat increased monotonically with BMI. The results indicate that, even under these specifications, the authors can recover a U-shaped association between BMI and mortality. Consistent with previous suggestions in the literature, future epidemiologic studies that examine the association between adiposity and mortality should prioritize the use of body composition measures. Am J Epidemiol 1997;146:339-49.
body composition; body mass index; confounding factors (epidemiology); mortality; obesity; occult disease
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