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Body weight: implications for the prevention of coronary heart disease, stroke, and diabetes mellitus in a cohort study of middle aged men

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7090.1311 (Published 03 May 1997) Cite this as: BMJ 1997;314:1311
  1. A Gerald Shaper, emeritus professor of clinical epidemiologya,
  2. S Goya Wannamethee, British Heart Foundation research fellowa,
  3. Mary Walker, research administratora
  1. a Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London NW3 2PF
  1. Correspondence to: Professor Shaper
  • Accepted 11 March 1997

Abstract

Objective:To determine the body mass index associated with the lowest morbidity and mortality.

Design:Prospective study of a male cohort.

Setting:One general practice in each of 24 British towns.

Subjects:7735 men aged 40-59 years at screening.

Main outcome measures:All cause death rate, heart attacks, and stroke (fatal and non-fatal) and development of diabetes, or any of these outcomes (combined end point) over an average follow up of 14.8 years.

Results:There were 1271 deaths from all causes, 974 heart attacks, 290 strokes, and 245 new cases of diabetes mellitus. All cause mortality was increased only in men with a body mass index (kg/m2) <20 and in men with an index ≥30. However, risk of cardiovascular death, heart attack, and diabetes increased progressively from an index of <20 even after age, smoking, social class, alcohol consumption, and physical activity were adjusted for. For the combined end point the lowest risks were seen for an index of 20.0-23.9. In never smokers and former smokers, deaths from any cause rose progressively from an index of 20.0-21.9 and for the combined end point, from 20.0-23.9. Age adjusted levels of a wide range of cardiovascular risk factors rose or fell progressively from an index <20.

Conclusion:A healthy body mass index in these middle aged British men seems to be about 22.

Key messages

  • The body mass index associated with the lowest mortality and the lowest incidence of coronary heart disease, stroke, and diabetes mellitus is not known

  • In this study of middle aged men the risk of cardiovascular mortality, heart attack, and diabetes increased progressively from a body mass index <20

  • For a combined end point (heart attack, stroke, diabetes, or death from any cause) the lowest risk was in the range 20-24

  • Levels of a wide range of cardiovascular risk factors increased progressively from an index of <20

  • A healthy body mass index in middle aged men seems to be around 22

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