1. Prospective Studies Collaboration Lancet 2009; 373: 1083-96
Body-mass index and cause-specific mortality in adults: collaborative analyses of 57 prospective studies
Prospective Studies Collaboration
Lancet 2009; 373:

2. Blood pressure, cholesterol and BMI
160 5 M
Non-HDL-C
Systolic M
140 4
Ratio of means (non-HDL-C/HDL-C) F F
120 M 3 F
mmol/L
(or ratio)
mm Hg
100 2 F M
Diastolic
Blood pressure and cholesterol fractions versus BMI at baseline in the range 15–50 kg/m². Adjusted for baseline age, baseline smoking status and study. Numerical values are shown for 20–22·5 kg/m², for 30–32·5 kg/m², and for the extreme BMI groups. Boundaries of BMI groups are indicated by tick marks. 95% CIs are not shown, but most are narrower than the heights of the plotted symbols. Blood pressure on left (in males and females). Blood cholesterol fractions on right (in males and females with total and HDL cholesterol both measured); dashed line indicates the ratio of mean non-HDL cholesterol to mean HDL cholesterol (mean of the individual ratios is about 8–12% greater: see next slide).
HDL-C 80 F 1 M 15 25 35 50 15 25 35 50
Baseline BMI (kg/m2)
Adjusted for age, smoking and study
Fig 1a & b, Lancet 2009; 373:

3. Ratio non-HDL:HDL cholesterol and BMI5 M
Mean of ratios 4
Ratio of means 3
Ratio F 2
(Mean of ratios ~10% higher than ratio of means)
Cholesterol fractions versus BMI at baseline in the range 15–50 kg/m². Blood cholesterol fractions (in males and females with total and HDL cholesterol both measured) versus BMI. Symbols connected by dashed line indicates the ratio of mean non-HDL cholesterol to mean HDL cholesterol (as in the previous slide); symbols not connected by any line indicate the mean of the individual ratios. Conventions as in the previous slide. 1 15 25 35 50
Baseline BMI (kg/m2)
Adjusted for age, smoking and study
Fig 1b variant, Lancet 2009; 373:

4. Drinking, smoking, diabetes and BMI
Male
Female
100
100 80 80
Drinking 60 60
Prevalence% 40 40
Drinking
Smoking
Drinking, smoking and diabetes versus BMI at baseline in the range 15–50 kg/m². Adjusted for baseline age, baseline smoking status (apart from the smoking findings), and study. Numerical values are shown for 20–22·5 kg/m², for 30–32·5 kg/m², and for the extreme BMI groups. Boundaries of BMI groups are indicated by tick marks. 95% CIs are not shown, but most are narrower than the heights of the plotted symbols. At left are the prevalences in males for alcohol drinking ( ), cigarette smoking ( ), and diabetes ( ). At right are the prevalences in females for alcohol drinking ( ), cigarette smoking ( ), and diabetes ( ). 20 20
Smoking
Diabetes
Diabetes 15 25 35 50 15 25 35 50
Baseline BMI (kg/m2)
Adjusted for age, smoking and study
Fig 1c & d, Lancet 2009; 373:

5. All-cause mortality and BMI64
Male 32
Annual deaths per 1000
Female 16
& 95% CI (floated so matches PSC rate at ages 35-79)
All-cause mortality versus BMI for each sex in the range 15–50 kg/m² (excluding the first 5 years of follow-up). Relative risks at ages 35–89 years, adjusted for age at risk, smoking, and study, were multiplied by a common factor (ie, floated) to make the weighted average match the PSC mortality rate at ages 35–79 years. Floated mortality rates shown above each square and numbers of deaths below. Area of square is inversely proportional to the variance of the log risk. Boundaries of BMI groups are indicated by tick marks. 95% CIs for floated rates reflect uncertainty in the log risk for each single rate. Dotted vertical line indicates 25 kg/m² (boundary between upper and lower BMI ranges in this report). 8 4 15 20 25 30 35 40 50
Baseline BMI (kg/m2)
Adjusted for age, smoking and study; 1st 5 years of follow-up excluded
Fig 2, Lancet 2009; 373:

6. IHD and stroke mortality and BMI8
IHD
Annual deaths per 1000 4
Stroke 2
& 95% CI (floated so matches PSC rate at ages 35-79)
Ischaemic heart disease and stroke mortality versus BMI in the range 15–50 kg/m² (excluding the first 5 years of follow-up). Relative risks at ages 35–89 years, adjusted for age at risk, sex, smoking, and study, were multiplied by a common factor (ie, floated) to make the weighted average match the PSC mortality rate at ages 35–79 years. Floated mortality rates shown above each square and numbers of deaths below. Area of square is inversely proportional to the variance of the log risk. Boundaries of BMI groups are indicated by tick marks. 95% CIs for floated rates reflect uncertainty in the log risk for each single rate. 1
0·5 15 20 25 30 35 40 50
Baseline BMI (kg/m2)
Adjusted for age, sex, smoking and study; 1st 5 years of follow-up excluded
Fig 3, Lancet 2009; 373:

7. Main mortality categories and BMI
Male
Female 14 14
Vascular 12 12
Annual deaths per 1000 10 10 8 8 6 6
& 95% CI (floated so matches EU rate at ages 35-79)
Vascular
Cancer (other specified)
Mortality rates at ages 35–79 years for main disease categories versus BMI in the range 15–50 kg/m² (excluding the first 5 years of follow-up). Relative risks at ages 35–79 years, adjusted for age at risk, smoking, and study, were multiplied by a common factor (ie, floated) to make the weighted average match the age-standardised European Union (15 countries) mortality rate at ages 35–79 years in Neoplastic mortality is split into the types most strongly associated with smoking (cancers of the lung and upper aerodigestive tract) and all other specified types. By contrast with figures 2–4, risk is indicated on an additive rather than multiplicative scale, with floated mortality rates shown above or below each symbol. The estimates for 35–50 kg/m² are based on limited data, so lines connecting to those estimates are dashed. Boundaries of BMI groups are indicated by tick marks. 95% CIs for floated rates reflect uncertainty in the log risk for each single rate. 4 4
Cancer (other specified)
Cancer (lung, mouth, pharynx, larynx, oes.) 2 2
Cancer (lung, mouth, pharynx, larynx, oes.)
Resp.
Respiratory 15 20 25 30 35 50 15 20 25 30 35 50
Baseline BMI (kg/m2)
Adjusted for age, smoking and study; 1st 5 years of follow-up excluded
Fig 5, Lancet 2009; 373:

8. All-cause mortality and BMI, by smoking30
Current cigarette smoker 25
Annual deaths per 1000 20
Never smoked regularly 15
& 95% CI (floated so matches EU rate at ages 35-79) 10
(N.B. The vertical separation of the curves underestimates effects of lifelong cigarette smoking)
All-cause mortality at ages 35–79 years versus BMI in the range 15–50 kg/m², by smoking status (excluding the first 5 years of follow-up). Relative risks at ages 35–79 years, adjusted for age at risk, sex, and study, were multiplied by a common factor (ie, floated) so that the mean for all participants (including ex-smokers and anyone with missing smoking data) matches the European rate at ages 35–79 years in Results for ex-smokers and those with missing smoking data not shown (but are, taken together, only slightly above those for never smokers). Note that many smokers were at only limited risk, since they had not smoked many cigarettes during early adult life, or had stopped shortly after the baseline survey. Risk is indicated on an additive rather than multiplicative scale. The estimates for 35–50 kg/m² are based on limited data, so lines connecting to those estimates are dashed. Floated mortality rates shown above each square and numbers of deaths below. Area of square is inversely proportional to the variance of the log risk. Boundaries of BMI groups are indicated by tick marks. 95% CIs for floated rates reflect uncertainty in the log risk for each single rate. 5 15 20 25 30 35 50
Baseline BMI (kg/m2)
Adjusted for age, sex and study; 1st 5 years of follow-up excluded
Fig 6, Lancet 2009; 373:

9. Lifespan and BMI in western Europe, year 2000
Male
Female
100
100
88% 80
77% 80
84%
69%
% alive 60 60
Yearly dots 40 40
BMI range, kg/m2
BMI versus lifespan in western Europe, year 2000 (3 main BMI categories). Estimated effects of the BMI that would be reached by about 60 years of age on survival from age 35 years, identifying European Union (EU) mortality rates in 2000 with those for BMI 25–30 kg/m² and combining the disease-specific EU mortality rates with disease-specific relative risks (for details, see webappendix pp 18–20). The absolute differences in median survival (but probably not in survival to age 70 years) should be robust to changes in mortality rates, and therefore generalisable decades hence.
(mean 24) 20 20
25-30 (mean 27)
30-35 (mean 32) 40 50 60 70 80 90
100 40 50 60 70 80 90
100
Age (years)
Causal PSC relative risks applied to EU mortality rates
Fig 7 variant, Lancet 2009; 373:

10. Lifespan and BMI in western Europe, year 2000
Male
Female
100
100
88% 80
77% 80
72%
% alive 60 60
Yearly dots
49% 40
BMI range, kg/m2 40
(mean 24)
25-30
BMI versus lifespan in western Europe, year 2000 (3 main and 2 higher BMI categories). Estimated effects of the BMI that would be reached by about 60 years of age on survival from age 35 years, identifying European Union (EU) mortality rates in 2000 with those for BMI 25–30 kg/m² and combining the disease-specific EU mortality rates with disease-specific relative risks (for details, see webappendix pp 18–20). The absolute differences in median survival (but probably not in survival to age 70 years) should be robust to changes in mortality rates, and therefore generalisable decades hence. (Note that the 2 higher BMI categories account for just 2% of PSC participants, and so are indicated by dashed lines.) 20
30-35 (mean 32) 20
35-40
40-50 (mean 43) 40 50 60 70 80 90
100 40 50 60 70 80 90
100
Age (years)
Causal PSC relative risks applied to EU mortality rates
Fig 7, Lancet 2009; 373:

11. Comparison with smoking in the British Doctors’ Study
British Doctors’ Study. Survival from age 35 for continuing cigarette smokers and lifelong non-smokers among UK male doctors born , with percentages alive at each decade of age.
From figure 3 in Doll, Peto et al., BMJ 2004: 328:

12. All-cause mortality and BMI by smoking
Male (35-69 years)
Female (35-69 years) 20 20
Current cigarette smoker 15 15
Annual deaths per 1000
Never smoked regularly
Current cigarette smoker 10 10
& 95% CI (floated so matches EU rate at ages 35-69)
All-cause mortality at age years vs. BMI by baseline smoking status (excluding the first 5 years of follow-up). Conventions as in figure 6 (ie, slide 11). For kg/m2, only the upper or only the lower part of the CI is shown.
Never smoked regularly 5 5 15 20 25 30 35 50 15 20 25 30 35 50
Baseline BMI (kg/m2)
Adjusted for age and study; 1st 5 years of follow-up excluded
Webfig 7a & b, Lancet 2009; 373:

13. All-cause mortality and BMI by smoking
Male (70-79 years)
Female (70-79 years)
100
100
Current cigarette smoker
Annual deaths per 1000 75 75
Never smoked regularly
Current cigarette smoker 50 50
& 95% CI (floated so matches EU rate at ages 70-79)
Never smoked regularly
All-cause mortality at age years vs. BMI by baseline smoking status (excluding the first 5 years of follow-up). Conventions as in figure 6 (ie, slide 11). For kg/m2, only the upper or only the lower part of the CI is shown. 25 25 15 20 25 30 35 50 15 20 25 30 35 50
Baseline BMI (kg/m2)
Adjusted for age and study; 1st 5 years of follow-up excluded
Webfig 7c & d, Lancet 2009; 373:

14. Vascular mortality and BMI by smoking
Male (35-69 years)
Female (35-69 years) 6 6
Current cigarette smoker
Annual deaths per 1000 4 4
Never smoked regularly
Current cigarette smoker
& 95% CI (floated so matches EU rate at ages 35-69) 2 2
Vascular mortality at age years vs. BMI by baseline smoking status (excluding the first 5 years of follow-up). Conventions as in figure 6 (ie, slide 11). Results for kg/m2 not plotted because of small numbers of deaths.
Never smoked regularly 15 20 25 30 35 50 15 20 25 30 35 50
Baseline BMI (kg/m2)
Adjusted for age and study; 1st 5 years of follow-up excluded
Webfig 8a & b, Lancet 2009; 373:

15. Vascular mortality and BMI by smoking
Male (70-79 years)
Female (70-79 years) 30 30
Current cigarette smoker
Annual deaths per 1000 20
Never smoked regularly 20
Current cigarette smoker
& 95% CI (floated so matches EU rate at ages 35-79)
Never smoked regularly 10 10
Vascular mortality at age years vs. BMI by baseline smoking status (excluding the first 5 years of follow-up). Conventions as in figure 6 (ie, slide 11). Results for kg/m2 not plotted because of small numbers of deaths. 15 20 25 30 35 50 15 20 25 30 35 50
Baseline BMI (kg/m2)
Adjusted for age and study; 1st 5 years of follow-up excluded
Webfig 8c & d, Lancet 2009; 373: