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Body mass index and infectious disease mortality in midlife in a cohort of 2.3 million adolescents

International Journal of Obesity volume 42, pages 801–807 (2018)Cite this article

Subjects

Abstract

Background:

Obesity was linked to altered immunity, but also to favorable outcomes among patients with infectious disease (ID) in some settings. We assessed the association between adolescent body mass index (BMI) and ID mortality.

Methods:

BMI of 2 294 139 Israeli adolescents (60% men; age 17.4±0.3 years) was measured between 1967 and 2010. The outcome, obtained by linkage with official national records, was death due to ID as the underlying cause. Multivariable Cox proportional hazards models were applied.

Results:

During 42 297 007 person-years of follow-up (median 18.4 years), there were 689 deaths from ID (mean age 44.1±10.5 years). Adjusted hazard ratios (HR) were 1.039 (1.011–1.068) and 1.146 (1.099–1.194) among men and women, respectively, per unit increment in BMI (P for sex interaction=4.4 × 10−5). Adjusted hazard ratios among men were 1.2 (1.0–1.5), 1.9 (1.4–2.5) and 2.5 (1.5–4.2) for those with high-normal BMI (22.0–24.9 kg m−2), overweight and obese, respectively, compared with the 18.5⩽BMI<22 kg m−2 reference group, and 1.7 (1.1–2.6), 2.6 (1.6–4.3) and 6.6 (3.3–13.1) among women, respectively. The increased risk among underweight (<18.5 kg m−2) boys was attenuated when the study sample was restricted to those with unimpaired health at baseline. A multivariable spline model indicated a minimum risk for total ID mortality at 20.7 and 18.0 kg m−2 for men and women, respectively, with significantly increased risk seen above adolescent BMI values of 23.6 and 24.0 kg m−2, respectively. The association with BMI was particularly evident for bacterial infections (predominantly sepsis), airways and central nervous system infections (63% of the ID deaths).

Conclusions:

Adolescent overweight and obesity were strongly associated with ID mortality, especially of bacterial origin and among women.

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Acknowledgements

This study was supported by a research grant from the Environment and Health Fund, Jerusalem, Israel (Award No. RGA 1002) to JDK.

Author contributions

GT, JDK: study concept and design, acquisition and interpretation of data, statistical analyses and drafting and critical revision of the manuscript; ED: Data file management and statistical analysis; HL, NG, ZH: Data acquisition and comments on the manuscript. NG, AL: Critical revision of the manuscript. GT and JDK take full responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Department of Medicine, Sheba Medical Center, Tel Hashomer, Israel

    G Twig

  2. The Israel Defense Forces Medical Corps, Israel

    G Twig, N Geva, E Derazne & A Leiba

  3. The Dr Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center,

    G Twig

  4. The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    G Twig, E Derazne & A Leiba

  5. Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel

    H Levine & J D Kark

  6. Israel Ministry of Health, Jerusalem, Israel

    N Goldberger & Z Haklai

  7. Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA

    A Leiba

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Correspondence to G Twig.

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Twig, G., Geva, N., Levine, H. et al. Body mass index and infectious disease mortality in midlife in a cohort of 2.3 million adolescents. Int J Obes 42, 801–807 (2018). https://doi.org/10.1038/ijo.2017.263

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