A prospective study of body mass index and mortality in Bangladesh

Brandon L. Pierce, Tara Kalra, Maria Argos, Faruque Parvez, Yu Chen, Tariqul Islam, Alauddin Ahmed, Rabiul Hasan, Muhammad Rakibuz-Zaman, Joseph Graziano, Paul J. Rathouz, Habibul Ahsan

Research output: Contribution to journalArticle

Abstract

Background: Body mass index (BMI) (kg/m2) has a U-or J-shaped relationship with all-cause mortality in Western and East Asian populations. However, this relationship is not well characterized in Bangladesh, where the BMI distribution is shifted towards lower values. Methods: Using data on 11 445 individuals (aged 18-75 years) participating in the Health Effects of Arsenic Longitudinal Study (HEALS) in Araihazar, Bangladesh, we prospectively examined associations of BMI (measured at baseline) with all-cause mortality during ~6 years of follow-up. We also examined this relationship within strata of key covariates (sex, age, smoking, education and arsenic exposure). Cox proportional hazards models adjusted for these covariates and BMI-related illnesses were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for BMI categories defined by the World Health Organization. Results: Low BMI was strongly associated with increased mortality in this cohort (P-trend < 0.0001). Severe underweight (BMI < 16 kg/m2; HR 2.06, CI 1.53-2.77) and moderate underweight (16.0-16.9 kg/m2; HR 1.39, CI 1.01-2.90) were associated with increased all-cause mortality compared with normal BMI (18.6-22.9 kg/m2). The highest BMI category (≥23.0 kg/m2) did not show a clear association with mortality (HR 1.10, CI 0.77-1.53). The BMI-mortality association was stronger among individuals with <5 years of formal education (interaction P=0.02). Conclusions: Underweight (presumably due to malnutrition) is a major determinant of mortality in the rural Bangladeshi population.

Original languageEnglish (US)
Article numberdyp364
Pages (from-to)1037-1045
Number of pages9
JournalInternational Journal of Epidemiology
Volume39
Issue number4
DOIs
StatePublished - Dec 23 2009

Fingerprint

Bangladesh
Body Mass Index
Prospective Studies
Mortality
Thinness
Confidence Intervals
Arsenic
Education
Rural Population
Proportional Hazards Models
Malnutrition
Longitudinal Studies
Smoking

Keywords

  • Arsenic
  • Bangladesh
  • Body mass index
  • Mortality
  • Survival analysis

ASJC Scopus subject areas

  • Epidemiology

Cite this

Pierce, B. L., Kalra, T., Argos, M., Parvez, F., Chen, Y., Islam, T., ... Ahsan, H. (2009). A prospective study of body mass index and mortality in Bangladesh. International Journal of Epidemiology, 39(4), 1037-1045. [dyp364]. https://doi.org/10.1093/ije/dyp364

A prospective study of body mass index and mortality in Bangladesh. / Pierce, Brandon L.; Kalra, Tara; Argos, Maria; Parvez, Faruque; Chen, Yu; Islam, Tariqul; Ahmed, Alauddin; Hasan, Rabiul; Rakibuz-Zaman, Muhammad; Graziano, Joseph; Rathouz, Paul J.; Ahsan, Habibul.

In: International Journal of Epidemiology, Vol. 39, No. 4, dyp364, 23.12.2009, p. 1037-1045.

Research output: Contribution to journalArticle

Pierce, BL, Kalra, T, Argos, M, Parvez, F, Chen, Y, Islam, T, Ahmed, A, Hasan, R, Rakibuz-Zaman, M, Graziano, J, Rathouz, PJ & Ahsan, H 2009, 'A prospective study of body mass index and mortality in Bangladesh', International Journal of Epidemiology, vol. 39, no. 4, dyp364, pp. 1037-1045. https://doi.org/10.1093/ije/dyp364
Pierce, Brandon L. ; Kalra, Tara ; Argos, Maria ; Parvez, Faruque ; Chen, Yu ; Islam, Tariqul ; Ahmed, Alauddin ; Hasan, Rabiul ; Rakibuz-Zaman, Muhammad ; Graziano, Joseph ; Rathouz, Paul J. ; Ahsan, Habibul. / A prospective study of body mass index and mortality in Bangladesh. In: International Journal of Epidemiology. 2009 ; Vol. 39, No. 4. pp. 1037-1045.
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AU - Parvez, Faruque

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AU - Islam, Tariqul

AU - Ahmed, Alauddin

AU - Hasan, Rabiul

AU - Rakibuz-Zaman, Muhammad

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