{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T12:15:46Z","timestamp":1794485746883,"version":"4.9.1"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T00:00:00Z","timestamp":1688515200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Much of the data on BMI-mortality associations stem from 20<jats:sup>th<\/jats:sup> century U.S. cohorts. The purpose of this study was to determine the association between BMI and mortality in a contemporary, nationally representative, 21<jats:sup>st<\/jats:sup> century, U.S. adult population.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This was a retrospective cohort study of U.S. adults from the 1999\u20132018 National Health Interview Study (NHIS), linked to the National Death Index (NDI) through December 31<jats:sup>st<\/jats:sup>, 2019. BMI was calculated using self-reported height &amp; weight and categorized into 9 groups. We estimated risk of all-cause mortality using multivariable Cox proportional hazards regression, adjusting for covariates, accounting for the survey design, and performing subgroup analyses to reduce analytic bias.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The study sample included 554,332 adults (mean age 46 years [SD 15], 50% female, 69% non-Hispanic White). Over a median follow-up of 9 years (IQR 5\u201314) and maximum follow-up of 20 years, there were 75,807 deaths. The risk of all-cause mortality was similar across a wide range of BMI categories: compared to BMI of 22.5\u201324.9 kg\/m<jats:sup>2<\/jats:sup>, the adjusted HR was 0.95 [95% CI 0.92, 0.98] for BMI of 25.0\u201327.4 and 0.93 [0.90, 0.96] for BMI of 27.5\u201329.9. These results persisted after restriction to healthy never-smokers and exclusion of subjects who died within the first two years of follow-up. A 21\u2013108% increased mortality risk was seen for BMI \u226530. Older adults showed no significant increase in mortality between BMI of 22.5 and 34.9, while in younger adults this lack of increase was limited to the BMI range of 22.5 to 27.4.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The risk of all-cause mortality was elevated by 21\u2013108% among participants with BMI \u226530. BMI may not necessarily increase mortality independently of other risk factors in adults, especially older adults, with overweight BMI. Further studies incorporating weight history, body composition, and morbidity outcomes are needed to fully characterize BMI-mortality associations.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0287218","type":"journal-article","created":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T17:21:00Z","timestamp":1688577660000},"page":"e0287218","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":85,"title":["Body mass index and all-cause mortality in a 21st century U.S. population: A National Health Interview Survey analysis"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2170-212X","authenticated-orcid":true,"given":"Aayush","family":"Visaria","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soko","family":"Setoguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,7,5]]},"reference":[{"issue":"10026","key":"pone.0287218.ref001","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1016\/S0140-6736(16)30054-X","article-title":"Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19\u00b72 million participants.","volume":"387","author":"NCD Risk Factor Collaboration","year":"2016","journal-title":"The Lancet"},{"issue":"21","key":"pone.0287218.ref002","first-page":"e984","article-title":"Obesity and cardiovascular disease: a scientific statement from the American Heart Association","volume":"143","author":"TM Powell-Wiley","year":"2021","journal-title":"Circulation"},{"issue":"15","key":"pone.0287218.ref003","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1056\/NEJM199910073411501","article-title":"Body-mass index and mortality in a prospective cohort of US adults","volume":"341","author":"EE Calle","year":"1999","journal-title":"New England Journal of Medicine"},{"issue":"23","key":"pone.0287218.ref004","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1056\/NEJMoa1000367","article-title":"Body-mass index and mortality among 1.46 million white adults","volume":"363","author":"A Berrington de Gonzalez","year":"2010","journal-title":"New England Journal of Medicine"},{"issue":"10046","key":"pone.0287218.ref005","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/S0140-6736(16)30175-1","article-title":"Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents","volume":"388","author":"E Di Angelantonio","year":"2016","journal-title":"The Lancet"},{"issue":"1","key":"pone.0287218.ref006","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1001\/jama.2012.113905","article-title":"Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis","volume":"309","author":"KM Flegal","year":"2013","journal-title":"JAMA"},{"issue":"4","key":"pone.0287218.ref007","doi-asserted-by":"crossref","first-page":"875","DOI":"10.3945\/ajcn.113.068122","article-title":"BMI and all-cause mortality in older adults: a meta-analysis","volume":"99","author":"JE Winter","year":"2014","journal-title":"The American Journal of Clinical Nutrition"},{"issue":"9669","key":"pone.0287218.ref008","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/S0140-6736(09)60318-4","article-title":"Prospective Studies Collaboration. 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