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Adiposity and weight change in mid-life in relation to healthy survival after age 70 in women: prospective cohort study

BMJ 2009; 339 doi: (Published 30 September 2009) Cite this as: BMJ 2009;339:b3796
  1. Qi Sun, research associate1,
  2. Mary K Townsend, research fellow2,
  3. Olivia I Okereke, associate epidemiologist and associate psychiatrist3,
  4. Oscar H Franco, assistant clinical professor in public health4,
  5. Frank B Hu, professor of nutrition and epidemiology123,
  6. Francine Grodstein, associate professor of epidemiology23
  1. 1Department of Nutrition, Harvard School of Public Health, 655 Huntington Avenue, Boston, MA 02115, United States
  2. 2Department of Epidemiology, Harvard School of Public Health, Boston
  3. 3Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 181 Longwood Avenue, Boston
  4. 4B-160, Health Sciences Research Institute, University of Warwick, Coventry CV4 7AL
  1. Correspondence to: Q Sun qisun{at}
  • Accepted 22 June 2009


Objective To examine the hypothesis that mid-life adiposity is associated with a reduced probability of maintaining an optimal health status among those who survive to older ages.

Design Prospective cohort study.

Setting The Nurses’ Health Study, United States.

Participants 17 065 women who survived until at least the age of 70, provided information on occurrence of chronic disease, cognitive function, physical function, and mental health at older ages, and were free from major chronic diseases at mid-life (mean age was 50 at baseline in 1976).

Main outcome measures Healthy survival to age 70 and over was defined as having no history of 11 major chronic diseases and having no substantial cognitive, physical, or mental limitations.

Results Of the women who survived until at least age 70, 1686 (9.9%) met our criteria for healthy survival. Increased body mass index (BMI) at baseline was significantly associated with linearly reduced odds of healthy survival compared with usual survival, after adjustment for various lifestyle and dietary variables (P<0.001 for trend). Compared with lean women (BMI 18.5-22.9), obese women (BMI ≥30) had 79% lower odds of healthy survival (odds ratio 0.21, 95% confidence interval 0.15 to 0.29). In addition, the more weight gained from age 18 until mid-life, the less likely was healthy survival after the age of 70. The lowest odds of healthy survival were among women who were overweight (BMI ≥25) at age 18 and gained ≥10 kg weight (0.18, 0.09 to 0.36), relative to women who were lean (BMI 18.5-22.9) and maintained a stable weight.

Conclusions These data provide evidence that adiposity in mid-life is strongly related to a reduced probability of healthy survival among women who live to older ages, and emphasise the importance of maintaining a healthy weight from early adulthood.


  • Contributors: FG obtained funding and designed the cognitive function study. FG, FBH, and OIO collected data and had the idea for the current analysis. All authors contributed to defining the successful ageing phenotype. QS, MKT, OHF, FG, and FBH provided statistical expertise. QS, MKT, and OIO analysed the data. QS wrote the first draft of the manuscript. All authors contributed to the interpretation of the results and critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. FG is the guarantor.

  • Funding: The study was supported by the National Institutes of Health (grants AG13482, AG15424, and CA40356) and the Pilot and Feasibility program sponsored by the Boston Obesity Nutrition Research Center (DK46200). QS is supported by a postdoctoral fellowship from the Unilever Corporate Research. MKT is supported by the Yerby postdoctoral fellowship programme.

  • Competing interests: None declared.

  • Ethical approval: The study protocol was approved by the institutional review board of the Brigham and Women’s Hospital.

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