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BMC Public Health
Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

Mortality risk associated with underweight: a census-linked cohort of 31,578 individuals with up to 32 years of follow-up

Authors: Lucienne Roh, Julia Braun, Arnaud Chiolero, Matthias Bopp, Sabine Rohrmann, David Faeh, for the Swiss National Cohort Study Group

Published in: BMC Public Health | Issue 1/2014

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Abstract

Background

In contrast to obesity, information on the health risks of underweight is sparse. We examined the long-term association between underweight and mortality by considering factors possibly influencing this relationship.

Methods

We included 31,578 individuals aged 25–74 years, who participated in population based health studies between 1977 and 1993 and were followed-up for survival until 2008 by record linkage with the Swiss National Cohort (SNC). Body Mass Index (BMI) was calculated from measured (53% of study population) or self-reported height and weight. Underweight was defined as BMI < 18.5 kg/m2. Cox regression models were used to determine mortality Hazard Ratios (HR) of underweight vs. normal weight (BMI 18.5- < 25.0 kg/m2). Covariates were study, sex, smoking, healthy eating proxy, sports frequency, and educational level.

Results

Underweight individuals represented 3.0% of the total study population (n = 945), and were mostly women (89.9%). Compared to normal weight, underweight was associated with increased all-cause mortality (HR: 1.37; 95% CI: 1.14-1.65). Increased risk was apparent in both sexes, regardless of smoking status, and mainly driven by excess death from external causes (HR: 3.18; 1.96-5.17), but not cancer, cardiovascular or respiratory diseases. The HR were 1.16 (0.88-1.53) in studies with measured BMI and 1.59 (1.24-2.05) with self-reported BMI.

Conclusions

The increased risk of dying of underweight people was mainly due to an increased mortality risk from external causes. Using self-reported BMI may lead to an overestimation of mortality risk associated with underweight.
Appendix
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Metadata
Title
Mortality risk associated with underweight: a census-linked cohort of 31,578 individuals with up to 32 years of follow-up
Authors
Lucienne Roh
Julia Braun
Arnaud Chiolero
Matthias Bopp
Sabine Rohrmann
David Faeh
for the Swiss National Cohort Study Group
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-371

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