Body mass index and mortality in the general population and in subjects with chronic disease in Korea: A nationwide cohort study (2002-2010)

Nam Hoon Kim, Juneyoung Lee, Tae Joon Kim, Nan Hee Kim, Kyung Mook Choi, Sei-Hyun Baik, Dong Seop Choi, Rodica Pop-Busui, Yousung Park, Sin Gon Kim

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background: The association between body mass index (BMI) and mortality is not conclusive, especially in East Asian populations. Furthermore, the association has been neither supported by recent data, nor assessed after controlling for weight changes. Methods: We evaluated the relationship between BMI and all-cause or cause-specific mortality, using prospective cohort data by the National Health Insurance Service in Korea, which consisted of more than one million subjects. A total of 153,484 Korean adults over 30 years of age without pre-existing cardiovascular disease or cancer at baseline were followed-up until 2010 (mean follow-up period = 7.91 ± 0.59 years). Study subjects repeatedly measured body weight 3.99 times, on average. Results: During follow-up, 3,937 total deaths occurred; 557 deaths from cardiovascular disease, and 1,224 from cancer. In multiple-adjusted analyses, U-shaped associations were found between BMI and mortality from any cause, cardiovascular disease, and cancer after adjustment for age, sex, smoking status, alcohol consumption, physical activity, socioeconomic status, and weight change. Subjects with a BMI < 23 kg/m2 and ≥ 30 kg/m2 had higher risks of all-cause and cause-specific mortality compared with the reference group (BMI 23-24.9 kg/m2). The lowest risk of all-cause mortality was observed in subjects with a BMI of 25-26.4 kg/m2 (adjusted hazard ratio [HR] 0.86; 95% CI 0.77 to 0.97). In subgroup analyses, including the elderly and those with chronic diseases (diabetes mellitus, hypertension, and chronic kidney disease), subjects with a BMI of 25-29.9 kg/m2 (moderate obesity) had a lower risk of mortality compared with the reference. However, this association has been attenuated in younger individuals, in those with higher socioeconomic status, and those without chronic diseases. Conclusion: Moderate obesity was associated more strongly with a lower risk of mortality than with normal, underweight, and overweight groups in the general population of South Korea. This obesity paradox was prominent in not only the elderly but also individuals with chronic disease.

Original languageEnglish
Article numbere0139924
JournalPLoS One
Volume10
Issue number10
DOIs
Publication statusPublished - 2015 Oct 13

Fingerprint

Korea
cohort studies
chronic diseases
Korean Peninsula
body mass index
Body Mass Index
Chronic Disease
Cohort Studies
Mortality
Population
cardiovascular diseases
obesity
Cardiovascular Diseases
Obesity
National Health Programs
socioeconomic status
Social Class
neoplasms
Health insurance
death

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Body mass index and mortality in the general population and in subjects with chronic disease in Korea : A nationwide cohort study (2002-2010). / Kim, Nam Hoon; Lee, Juneyoung; Kim, Tae Joon; Kim, Nan Hee; Choi, Kyung Mook; Baik, Sei-Hyun; Choi, Dong Seop; Pop-Busui, Rodica; Park, Yousung; Kim, Sin Gon.

In: PLoS One, Vol. 10, No. 10, e0139924, 13.10.2015.

Research output: Contribution to journalArticle

@article{f8953bf2e4bb447c9581e73c495ce84b,
title = "Body mass index and mortality in the general population and in subjects with chronic disease in Korea: A nationwide cohort study (2002-2010)",
abstract = "Background: The association between body mass index (BMI) and mortality is not conclusive, especially in East Asian populations. Furthermore, the association has been neither supported by recent data, nor assessed after controlling for weight changes. Methods: We evaluated the relationship between BMI and all-cause or cause-specific mortality, using prospective cohort data by the National Health Insurance Service in Korea, which consisted of more than one million subjects. A total of 153,484 Korean adults over 30 years of age without pre-existing cardiovascular disease or cancer at baseline were followed-up until 2010 (mean follow-up period = 7.91 ± 0.59 years). Study subjects repeatedly measured body weight 3.99 times, on average. Results: During follow-up, 3,937 total deaths occurred; 557 deaths from cardiovascular disease, and 1,224 from cancer. In multiple-adjusted analyses, U-shaped associations were found between BMI and mortality from any cause, cardiovascular disease, and cancer after adjustment for age, sex, smoking status, alcohol consumption, physical activity, socioeconomic status, and weight change. Subjects with a BMI < 23 kg/m2 and ≥ 30 kg/m2 had higher risks of all-cause and cause-specific mortality compared with the reference group (BMI 23-24.9 kg/m2). The lowest risk of all-cause mortality was observed in subjects with a BMI of 25-26.4 kg/m2 (adjusted hazard ratio [HR] 0.86; 95{\%} CI 0.77 to 0.97). In subgroup analyses, including the elderly and those with chronic diseases (diabetes mellitus, hypertension, and chronic kidney disease), subjects with a BMI of 25-29.9 kg/m2 (moderate obesity) had a lower risk of mortality compared with the reference. However, this association has been attenuated in younger individuals, in those with higher socioeconomic status, and those without chronic diseases. Conclusion: Moderate obesity was associated more strongly with a lower risk of mortality than with normal, underweight, and overweight groups in the general population of South Korea. This obesity paradox was prominent in not only the elderly but also individuals with chronic disease.",
author = "Kim, {Nam Hoon} and Juneyoung Lee and Kim, {Tae Joon} and Kim, {Nan Hee} and Choi, {Kyung Mook} and Sei-Hyun Baik and Choi, {Dong Seop} and Rodica Pop-Busui and Yousung Park and Kim, {Sin Gon}",
year = "2015",
month = "10",
day = "13",
doi = "10.1371/journal.pone.0139924",
language = "English",
volume = "10",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "10",

}

TY - JOUR

T1 - Body mass index and mortality in the general population and in subjects with chronic disease in Korea

T2 - A nationwide cohort study (2002-2010)

AU - Kim, Nam Hoon

AU - Lee, Juneyoung

AU - Kim, Tae Joon

AU - Kim, Nan Hee

AU - Choi, Kyung Mook

AU - Baik, Sei-Hyun

AU - Choi, Dong Seop

AU - Pop-Busui, Rodica

AU - Park, Yousung

AU - Kim, Sin Gon

PY - 2015/10/13

Y1 - 2015/10/13

N2 - Background: The association between body mass index (BMI) and mortality is not conclusive, especially in East Asian populations. Furthermore, the association has been neither supported by recent data, nor assessed after controlling for weight changes. Methods: We evaluated the relationship between BMI and all-cause or cause-specific mortality, using prospective cohort data by the National Health Insurance Service in Korea, which consisted of more than one million subjects. A total of 153,484 Korean adults over 30 years of age without pre-existing cardiovascular disease or cancer at baseline were followed-up until 2010 (mean follow-up period = 7.91 ± 0.59 years). Study subjects repeatedly measured body weight 3.99 times, on average. Results: During follow-up, 3,937 total deaths occurred; 557 deaths from cardiovascular disease, and 1,224 from cancer. In multiple-adjusted analyses, U-shaped associations were found between BMI and mortality from any cause, cardiovascular disease, and cancer after adjustment for age, sex, smoking status, alcohol consumption, physical activity, socioeconomic status, and weight change. Subjects with a BMI < 23 kg/m2 and ≥ 30 kg/m2 had higher risks of all-cause and cause-specific mortality compared with the reference group (BMI 23-24.9 kg/m2). The lowest risk of all-cause mortality was observed in subjects with a BMI of 25-26.4 kg/m2 (adjusted hazard ratio [HR] 0.86; 95% CI 0.77 to 0.97). In subgroup analyses, including the elderly and those with chronic diseases (diabetes mellitus, hypertension, and chronic kidney disease), subjects with a BMI of 25-29.9 kg/m2 (moderate obesity) had a lower risk of mortality compared with the reference. However, this association has been attenuated in younger individuals, in those with higher socioeconomic status, and those without chronic diseases. Conclusion: Moderate obesity was associated more strongly with a lower risk of mortality than with normal, underweight, and overweight groups in the general population of South Korea. This obesity paradox was prominent in not only the elderly but also individuals with chronic disease.

AB - Background: The association between body mass index (BMI) and mortality is not conclusive, especially in East Asian populations. Furthermore, the association has been neither supported by recent data, nor assessed after controlling for weight changes. Methods: We evaluated the relationship between BMI and all-cause or cause-specific mortality, using prospective cohort data by the National Health Insurance Service in Korea, which consisted of more than one million subjects. A total of 153,484 Korean adults over 30 years of age without pre-existing cardiovascular disease or cancer at baseline were followed-up until 2010 (mean follow-up period = 7.91 ± 0.59 years). Study subjects repeatedly measured body weight 3.99 times, on average. Results: During follow-up, 3,937 total deaths occurred; 557 deaths from cardiovascular disease, and 1,224 from cancer. In multiple-adjusted analyses, U-shaped associations were found between BMI and mortality from any cause, cardiovascular disease, and cancer after adjustment for age, sex, smoking status, alcohol consumption, physical activity, socioeconomic status, and weight change. Subjects with a BMI < 23 kg/m2 and ≥ 30 kg/m2 had higher risks of all-cause and cause-specific mortality compared with the reference group (BMI 23-24.9 kg/m2). The lowest risk of all-cause mortality was observed in subjects with a BMI of 25-26.4 kg/m2 (adjusted hazard ratio [HR] 0.86; 95% CI 0.77 to 0.97). In subgroup analyses, including the elderly and those with chronic diseases (diabetes mellitus, hypertension, and chronic kidney disease), subjects with a BMI of 25-29.9 kg/m2 (moderate obesity) had a lower risk of mortality compared with the reference. However, this association has been attenuated in younger individuals, in those with higher socioeconomic status, and those without chronic diseases. Conclusion: Moderate obesity was associated more strongly with a lower risk of mortality than with normal, underweight, and overweight groups in the general population of South Korea. This obesity paradox was prominent in not only the elderly but also individuals with chronic disease.

UR - http://www.scopus.com/inward/record.url?scp=84948757299&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84948757299&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0139924

DO - 10.1371/journal.pone.0139924

M3 - Article

C2 - 26462235

AN - SCOPUS:84948757299

VL - 10

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 10

M1 - e0139924

ER -