Association of body mass index with all-cause and cause-specific mortality: findings from a prospective cohort study in Mumbai (Bombay), India

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The association between extremes of relative body weight and mortality has not been well characterized in developing countries. A prospective cohort study was conducted in Mumbai (India) to study the association of relative body weight, as estimated by body mass index [BMI=weight (kg)/height2 (m2)], with mortality.


Using the voters’ list as the selection frame, 148 173 men and women aged ≥35 years were recruited during 1991–97 in Mumbai city and were followed-up during 1997–2003.


During 774 129 person-years of follow-up, 13 261 deaths were observed. After adjusting for the potential confounders, increased mortality was observed in all under-weight categories [relative risk (RR)=1.94 for BMI < 16.0 kg/m2, 1.38 for BMI 16.0 to <17.0 and 1.24 for BMI 17.0 to <18.5 among women; the corresponding values for men were 2.24, 1.45 and 1.27, respectively] when compared with the rate in the normal weight category (BMI 18.5 to <25.0). Extremely thin (BMI < 16.0 kg/m2) cohort members were at highest risk for death due to tuberculosis (TB) (RR=7.20 and 14.94 in women and men, respectively), cancer (RR=1.87 and 2.44, respectively) and respiratory diseases (RR=3.46 and 4.35, respectively). Subjects with above normal BMI had lower mortality risk than those with normal BMI values. Over-weight (BMI 25.0 to <30.0) women (RR=0.89) and men (RR=0.87) were at a lower risk; however, obese (BMI ≥ 30.0) men <60 years of age had an increased mortality risk (RR=1.22).


In Mumbai, under-weight was associated with an increased risk of pre-mature death. Despite the growing concerns regarding the gradual transition toward increasing rates of obesity, under-nutrition remains a major health problem in India. This study suggests the need for public health policies focusing on reducing under-nutrition.

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