Association of Body Mass Index with All-Cause Mortality and Cause-Specific Mortality in Rural China: 10-Year Follow-up of a Population-Based Multicenter Prospective Study.

Juan Juan HUANG; Yuan Zhi DI; Ling Yu SHEN; Jian Guo LIANG; Jiang DU; Xue Fang CAO; Wei Tao DUAN; Ai Wei HE; Jun LIANG; Li Mei ZHU; Zi Sen LIU; Fang LIU; Shu Min YANG; Zu Hui XU; Cheng CHEN; Bin ZHANG; Jiao Xia YAN; Yan Chun LIANG; Rong LIU; Tao ZHU; Hong Zhi LI; Fei SHEN; Bo Xuan FENG; Yi Jun HE; Zi Han LI; Ya Qi ZHAO; Tong Lei GUO; Li Qiong BAI; Wei LU; Qi JIN; Lei GAO; He Nan XIN

Return

Association of Body Mass Index with All-Cause Mortality and Cause-Specific Mortality in Rural China: 10-Year Follow-up of a Population-Based Multicenter Prospective Study.

Author: Juan Juan HUANG ¹ ; Yuan Zhi DI ¹ ; Ling Yu SHEN ¹ ; Jian Guo LIANG ¹ ; Jiang DU ¹ ; Xue Fang CAO ¹ ; Wei Tao DUAN ² ; Ai Wei HE ³ ; Jun LIANG ⁴ ; Li Mei ZHU ⁵ ; Zi Sen LIU ² ; Fang LIU ³ ; Shu Min YANG ³ ; Zu Hui XU ⁴ ; Cheng CHEN ⁵ ; Bin ZHANG ² ; Jiao Xia YAN ² ; Yan Chun LIANG ⁶ ; Rong LIU ⁷ ; Tao ZHU ⁸ ; Hong Zhi LI ⁹ ; Fei SHEN ⁹ ; Bo Xuan FENG ¹ ; Yi Jun HE ¹ ; Zi Han LI ¹ ; Ya Qi ZHAO ¹ ; Tong Lei GUO ¹ ; Li Qiong BAI ⁴ ; Wei LU ⁵ ; Qi JIN ¹ ; Lei GAO ¹ ; He Nan XIN ¹
Author Information

1. NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 102629, China;Key Laboratory of Pathogen Infection Prevention and Control (Ministry of Education), National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 102629, China.
2. Zhongmu County Center for Disease Control and Prevention, Zhengzhou 451450, Henan, China.
3. Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730000, Gansu, China.
4. Hunan Provincial Institute of Tuberculosis Prevention and Control, Changsha 410000, Hunan, China.
5. Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing 210000, Jiangsu, China.
6. Longxi County Center for Disease Control and Prevention, Longxi 748100, Fujian, China.
7. Xiangtan County Center for Disease Control and Prevention, Xiangtan 411100, Hunan, China.
8. Danyang City Center for Disease Control and Prevention, Danyang 212300, Jiangsu, China.
9. Zhengzhou Sixth People's Hospital, Zhengzhou 450000, Henan, China.
Publication Type:Multicenter Study
Keywords: Body mass index; Mortality; Overweight; Prospective study; Underweight
MeSH: Humans; Body Mass Index; China/epidemiology*; Male; Female; Middle Aged; Prospective Studies; Rural Population/statistics & numerical data*; Aged; Follow-Up Studies; Adult; Mortality; Cause of Death; Obesity/mortality*; Overweight/mortality*
From: Biomedical and Environmental Sciences 2025;38(10):1179-1193
CountryChina
Language:English
Abstract: OBJECTIVE:This study aimed to explore the association between body mass index (BMI) and mortality based on the 10-year population-based multicenter prospective study.
METHODS:A general population-based multicenter prospective study was conducted at four sites in rural China between 2013 and 2023. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to assess the association between BMI and mortality. Stratified analyses were performed based on the individual characteristics of the participants.
RESULTS:Overall, 19,107 participants with a sum of 163,095 person-years were included and 1,910 participants died. The underweight (< 18.5 kg/m ²) presented an increase in all-cause mortality (adjusted hazards ratio [ aHR] = 2.00, 95% confidence interval [ CI]: 1.66-2.41), while overweight (≥ 24.0 to < 28.0 kg/m ²) and obesity (≥ 28.0 kg/m ²) presented a decrease with an aHR of 0.61 (95% CI: 0.52-0.73) and 0.51 (95% CI: 0.37-0.70), respectively. Overweight ( aHR = 0.76, 95% CI: 0.67-0.86) and mild obesity ( aHR = 0.72, 95% CI: 0.59-0.87) had a positive impact on mortality in people older than 60 years. All-cause mortality decreased rapidly until reaching a BMI of 25.7 kg/m ² ( aHR = 0.95, 95% CI: 0.92-0.98) and increased slightly above that value, indicating a U-shaped association. The beneficial impact of being overweight on mortality was robust in most subgroups and sensitivity analyses.
CONCLUSION:This study provides additional evidence that overweight and mild obesity may be inversely related to the risk of death in individuals older than 60 years. Therefore, it is essential to consider age differences when formulating health and weight management strategies.