Associations of body mass index categories with all-cause mortality across metabolic status in 3518 Japanese adults: a 10- and 22-year prospective cohort follow-up study.
- 1Department of Community and General Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon-city, Ehime, 791-0295, Japan. [email protected].
- 2Department of Community and General Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon-city, Ehime, 791-0295, Japan.
Abstract
Background
This study aimed to evaluate whether metabolic status modifies the association between body mass index (BMI) and all-cause mortality in a Japanese general population.Methods
We analyzed data from 3518 community-dwelling adults (1554 men and 1964 women; mean age: 64 ± 13 years) enrolled in the Nomura cohort studies (baseline surveys in 2002 or 2014). Mortality status was confirmed using Japan's Basic Resident Register. Participants were classified into phenotypes based on BMI categories and the number of MetS components. Cox proportional hazards models with age as the time scale were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality.Results
Over a median follow-up period of 17.3 years, 34.0% of participants died. Mortality risks varied according to BMI category and metabolic status. Among participants with 0-1 and 2 MetS components, underweight individuals consistently exhibited the highest incidence rates, the lowest cumulative survival, and significantly increased HRs for all-cause mortality (1.71; 95% CI, 1.25-2.34 and 2.26; 95% CI, 1.47-3.48, respectively). In contrast, among individuals with 3-4 MetS components, mortality risk was highest in those with obesity (2.07; 95% CI, 1.18-3.64), followed by those with underweight. A significant interaction was observed between BMI and metabolic status (p = 0.030). Across BMI categories, participants with greater numbers of MetS components generally exhibited higher incidence rates of all-cause mortality.Conclusions
The association between BMI and all-cause mortality differed according to metabolic status. These findings suggest that metabolic status may influence the relationship between BMI and mortality risk in Japanese adults.
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BibTeX
@article{kawamoto2026associations,
title = {{Associations of body mass index categories with all-cause mortality across metabolic status in 3518 Japanese adults: a 10- and 22-year prospective cohort follow-up study.}},
author = {Ryuichi Kawamoto and Asuka Kikuchi and Daisuke Ninomiya and Masanori Abe and Teru Kumagi},
journal = {Diabetology \& metabolic syndrome},
year = {2026},
month = jul,
doi = {10.1186/s13098-026-02245-6},
url = {https://europepmc.org/article/MED/42894258},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Associations of body mass index categories with all-cause mortality across metabolic status in 3518 Japanese adults: a 10- and 22-year prospective cohort follow-up study.
AU - Ryuichi Kawamoto
AU - Asuka Kikuchi
AU - Daisuke Ninomiya
AU - Masanori Abe
AU - Teru Kumagi
PY - 2026
DA - 2026/07/01
JO - Diabetology & metabolic syndrome
DO - 10.1186/s13098-026-02245-6
UR - https://europepmc.org/article/MED/42894258
AB - Background This study aimed to evaluate whether metabolic status modifies the association between body mass index (BMI) and all-cause mortality in a Japanese general population.Methods We analyzed data from 3518 community-dwelling adults (1554 men and 1964 women; mean age: 64 ± 13 years) enrolled in the Nomura cohort studies (baseline surveys in 2002 or 2014). Mortality status was confirmed using Japan's Basic Resident Register. Participants were classified into phenotypes based on BMI categories and the number of MetS components. Cox proportional hazards models with age as the time scale were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality.Results Over a median follow-up period of 17.3 years, 34.0% of participants died. Mortality risks varied according to BMI category and metabolic status. Among participants with 0-1 and 2 MetS components, underweight individuals consistently exhibited the highest incidence rates, the lowest cumulative survival, and significantly increased HRs for all-cause mortality (1.71; 95% CI, 1.25-2.34 and 2.26; 95% CI, 1.47-3.48, respectively). In contrast, among individuals with 3-4 MetS components, mortality risk was highest in those with obesity (2.07; 95% CI, 1.18-3.64), followed by those with underweight. A significant interaction was observed between BMI and metabolic status (p = 0.030). Across BMI categories, participants with greater numbers of MetS components generally exhibited higher incidence rates of all-cause mortality.Conclusions The association between BMI and all-cause mortality differed according to metabolic status. These findings suggest that metabolic status may influence the relationship between BMI and mortality risk in Japanese adults.
SN - 1758-5996
ER -