Indeks massa tubuh sebagai prediktor mortalitas

Hubungan antara indeks massa tubuh (IMT) dan mortalitas terlihat dalam penelitian prospektif berikut yang melibatkan 900 ribu subyek dewasa.

 

Kematian terendah adalah pada IMT 22,5 - 25 kg/m2.

 

Setiap peningkatan IMT 5 kg/m2 meningkatkan kematian (overall mortality) 30%.

Untuk kematian akibat penyakit vaskuler meningkat 40%.

Untuk kematian akibat diabetik, penyakit ginjal, dan penyakit hati meningkat 60-120%.

Untuk kematian akibat penyakit keganasan meningkat 10%.

Untuk penyakit pernapasan meningkat 20%.

 

IMT <22,5 kg/m2 terjadi peningkatan kematian akibat penyakit pernapasan dan kanker paru, terutama bagi perokok.

 

IMT 30-35 kg/m2 angka survival berkurang 2-4 tahun. IMT 40-45 kg/m2 angka survival berkurang 8-10 tahun (setara efek merokok)

 

 

The Lancet, Volume 373, Issue 9669, Pages 1083 - 1096, 28 March 2009

 

Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies

 

Background

The main associations of body-mass index (BMI) with overall and cause-specific mortality can best be assessed by long-term prospective follow-up of large numbers of people. The Prospective Studies Collaboration aimed to investigate these associations by sharing data from many studies.

Methods

Collaborative analyses were undertaken of baseline BMI versus mortality in 57 prospective studies with 894 576 participants, mostly in western Europe and North America (61% [n=541 452] male, mean recruitment age 46 [SD 11] years, median recruitment year 1979 [IQR 1975—85], mean BMI 25 [SD 4] kg/m2). The analyses were adjusted for age, sex, smoking status, and study. To limit reverse causality, the first 5 years of follow-up were excluded, leaving 66 552 deaths of known cause during a mean of 8 (SD 6) further years of follow-up (mean age at death 67 [SD 10] years): 30 416 vascular; 2070 diabetic, renal or hepatic; 22 592 neoplastic; 3770 respiratory; 7704 other.

Findings

In both sexes, mortality was lowest at about 22·5—25 kg/m2. Above this range, positive associations were recorded for several specific causes and inverse associations for none, the absolute excess risks for higher BMI and smoking were roughly additive, and each 5 kg/m2 higher BMI was on average associated with about 30% higher overall mortality (hazard ratio per 5 kg/m2 [HR] 1·29 [95% CI 1·27—1·32]): 40% for vascular mortality (HR 1·41 [1·37—1·45]); 60—120% for diabetic, renal, and hepatic mortality (HRs 2·16 [1·89—2·46], 1·59 [1·27—1·99], and 1·82 [1·59—2·09], respectively); 10% for neoplastic mortality (HR 1·10 [1·06—1·15]); and 20% for respiratory and for all other mortality (HRs 1·20 [1·07—1·34] and 1·20 [1·16—1·25], respectively). Below the range 22·5—25 kg/m2, BMI was associated inversely with overall mortality, mainly because of strong inverse associations with respiratory disease and lung cancer. These inverse associations were much stronger for smokers than for non-smokers, despite cigarette consumption per smoker varying little with BMI.

Interpretation

Although other anthropometric measures (eg, waist circumference, waist-to-hip ratio) could well add extra information to BMI, and BMI to them, BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22·5—25 kg/m2. The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal. At 30—35 kg/m2, median survival is reduced by 2—4 years; at 40—45 kg/m2, it is reduced by 8—10 years (which is comparable with the effects of smoking). The definite excess mortality below 22·5 kg/m2 is due mainly to smoking-related diseases, and is not fully explained.