A prospective study of body mass index and mortality in Bangladesh

Brandon L. Pierce, Tara Kalra, Maria Argos, Faruque Parvez, Yu Chen, Tariqul Islam, Alauddin Ahmed, Rabiul Hasan, Muhammad Rakibuz-Zaman, Joseph Graziano, Paul J. Rathouz, Habibul Ahsan

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Background: Body mass index (BMI) (kg/m2) has a U-or J-shaped relationship with all-cause mortality in Western and East Asian populations. However, this relationship is not well characterized in Bangladesh, where the BMI distribution is shifted towards lower values. Methods: Using data on 11 445 individuals (aged 18-75 years) participating in the Health Effects of Arsenic Longitudinal Study (HEALS) in Araihazar, Bangladesh, we prospectively examined associations of BMI (measured at baseline) with all-cause mortality during ~6 years of follow-up. We also examined this relationship within strata of key covariates (sex, age, smoking, education and arsenic exposure). Cox proportional hazards models adjusted for these covariates and BMI-related illnesses were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for BMI categories defined by the World Health Organization. Results: Low BMI was strongly associated with increased mortality in this cohort (P-trend < 0.0001). Severe underweight (BMI < 16 kg/m2; HR 2.06, CI 1.53-2.77) and moderate underweight (16.0-16.9 kg/m2; HR 1.39, CI 1.01-2.90) were associated with increased all-cause mortality compared with normal BMI (18.6-22.9 kg/m2). The highest BMI category (≥23.0 kg/m2) did not show a clear association with mortality (HR 1.10, CI 0.77-1.53). The BMI-mortality association was stronger among individuals with <5 years of formal education (interaction P=0.02). Conclusions: Underweight (presumably due to malnutrition) is a major determinant of mortality in the rural Bangladeshi population.

Original languageEnglish (US)
Pages (from-to)1037-1045
Number of pages9
JournalInternational Journal of Epidemiology
Issue number4
StatePublished - Dec 23 2009


  • Arsenic
  • Bangladesh
  • Body mass index
  • Mortality
  • Survival analysis

ASJC Scopus subject areas

  • Epidemiology

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    Pierce, B. L., Kalra, T., Argos, M., Parvez, F., Chen, Y., Islam, T., Ahmed, A., Hasan, R., Rakibuz-Zaman, M., Graziano, J., Rathouz, P. J., & Ahsan, H. (2009). A prospective study of body mass index and mortality in Bangladesh. International Journal of Epidemiology, 39(4), 1037-1045. https://doi.org/10.1093/ije/dyp364