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Int J Epidemiol. 2006 Feb;35(1):169-78. Epub 2005 Nov 12.

Cause-specific mortality in old age in relation to body mass index in middle age and in old age: follow-up of the Whitehall cohort of male civil servants.

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  • 1Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.



The relevance of body mass index (BMI) to cause-specific mortality in old age is uncertain.


To examine cause-specific 5 year mortality in old age by BMI in old age and middle age (40-69 years).


Cox proportional hazards for mortality rates among 4862 former male civil servants in relation to quartiles of BMI measured when screened in 1968-70 and when resurveyed in 1997-98 (median age 76 years).


The association between all-cause mortality after resurvey and BMI in old age was U-shaped with hazard ratios (HRs) of 1.3 (95% CI 1.1-1.5) for the lightest and heaviest categories relative to the middle two. Among 'healthy' men the lightest (<22.7 kg/m2) had greatest all-cause mortality. The heaviest men (>26.6 kg/m2) had increased risk of cardiovascular disease (CVD) mortality in the first two years or for the whole period if never-smokers. Respiratory mortality was inversely associated with BMI in old age [adjusted HR for trend per BMI category increase 0.6 (0.5-0.7)] but cancer mortality lacked a clear pattern. Net gain or loss of 10 kg or more between middle and old age was a strong predictor of all-cause and CVD mortality.


The shape of the association between BMI in old age and mortality differs by cause of death. Major weight change over time is a warning signal for higher CVD mortality. Having BMI<22.7 kg/m2 in old age is associated with above-average mortality rates even if apparently healthy.

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