ArticleMedicine2017
Underweight: another risk factor for cardiovascular disease?: A cross-sectional 2013 Behavioral Risk Factor Surveillance System (BRFSS) study of 491,773 individuals in the USA.
Article in Medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 74 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
74 citing papers in PubMed, 3 syntheses or guidelines pooled it, 139 citations in OpenAlex.
- Effectiveness of exercise snacks on physical function: a systematic reviews with meta-analysis of randomized controlled trials.The journal of nutrition, health & aging · 2026Pooled it
- Update on antithrombotic therapy and body mass: a clinical consensus statement of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and the European Society of Cardiology Working Group on Thrombosis.European heart journal. Cardiovascular pharmacotherapy · 2024Pooled it
- Association between Body Mass Index and Outcomes in Patients with Return of Spontaneous Circulation after Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis.International journal of environmental research and public health · 2021Pooled it
- De novo electrocardiographic abnormalities in persons living with HIV.Scientific reports · 2021Trial
- Associations of nutritional intake and body mass index with branch retinal vein occlusion: A cross-sectional study using data from a Korean national survey.Science progress · 2026Article
- The Association Between Height-Related Novel Anthropometric Indices and Cardiovascular Events: A Cross-Sectional Insight From the MASHAD Cohort Study.Health science reports · 2026Article
- Short sleep, lifestyle, cardiovascular risk, and health awareness among Polish final-year secondary school students: findings from a nationwide study.Frontiers in sleep · 2026Article
- A pilot prospective study of arterial stiffness during weight restoration in adolescents with anorexia nervosa.Eating and weight disorders : EWD · 2025Article
- Socioeconomic disparities in physiological dysregulation: a longitudinal mediation analysis of cardiometabolic multimorbidity among middle-aged and elderly Chinese.BMC public health · 2025Observational
- The Influence of the Sympathetic Nervous System on Cardiometabolic Health in Response to Weight Gain or Weight Loss.Metabolites · 2025Review
- Body mass index trajectories in older adulthood and all-cause mortality: a cohort study in China.BMC public health · 2025Article
- Predictors of self-reported hypertension among women of reproductive age in North Dakota.BMC public health · 2025Article
- Impact of the obesity paradox on 28-day mortality in elderly patients critically ill with cardiogenic shock: a retrospective cohort study.Diabetology & metabolic syndrome · 2024Article
- Is there an obesity paradox in cardiovascular outcomes for patients undergoing Transcatheter Edge-to-Edge Repair? A pilot meta-analysis.International journal of cardiology. Heart & vasculature · 2024Review
- Article
- Modelling prevalent cardiovascular disease in an urban Indigenous population.Canadian journal of public health = Revue canadienne de sante publique · 2024Article
- Age-appropriate BMI cut-offs for malnutrition among older adults in India.Scientific reports · 2024Article
- Treatment intensification and therapeutic inertia of antihypertensive therapy among patients with type 2 diabetes and hypertension with uncontrolled blood pressure.Scientific reports · 2024Article
- Integrating classification and regression learners with bioimpedance methods for estimating weight status in infants and juveniles from the southern Cuba region.BMC pediatrics · 2024Article
- The longitudinal association of adipose-to-lean ratio with incident cardiometabolic morbidity: The CARDIA study.Journal of diabetes and its complications · 2024Article
14 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Obesity is a well-established risk factor for cardiovascular disease (CVD), but the underweight population of body mass index (BMI) below 18.5 kg/m has not been an object of concern. The objective of this study is to investigate whether underweight could be an independent risk factor for CVD in a population-based cross-sectional study.Cross-sectional data of 2013 Behavioral Risk Factor Surveillance System (BRFSS) database encompassing 491,773 US adult subjects were used to assess risk for CVD. Primary outcomes were the incidence and relative risks (RRs) of CVD including stroke, heart attack/myocardial infarction, or coronary artery disease according to BMI category. All analyses used weighted sampling probabilities of data source.The underweight population had a 19.7% greater risk of CVD than did the normal-weight, and the overweight and obese population had a 50% and 96% increased risk, respectively. When adjusted with covariates, the relative risk for CVD elevated in underweight population (adjusted RR 1.34 [95% confidence interval (CI) 1.335-1.348]). Conversely, the adjusted relative risk was significantly attenuated in the obese group (adjusted RR 1.149 [95% CI 1.147-1.151]) and it was even insignificant in the overweight group (adjusted RR 1.00 [95% CI 1.000-1.003]). In subanalysis for each CVD category, being underweight among BMI status was the strongest independent risk factor for stroke (adjusted RR 1.441 [95% CI 1.431-1.450]), heart attack/ myocardial infarction (MI) (adjusted RR 1.23 [95% CI 1.217-1.233]), and angina/coronary artery disease (adjusted RR 1.20 [95% CI 1.189-1.206]). Especially among the population below 40-year old, relative risk estimates remained increased in the underweight population; persons who were underweight had a 2.3-fold greater adjusted relative risk of CVD as compared with those with normal weight when we stratified with age.Underweight below BMI 18.5 kg/m may be another risk factor for CVD, and CVD risk of the overweight and obese population largely depended on other comorbidities accompanied by obesity.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.