ArticlePloS one2021
Association of BMI, comorbidities and all-cause mortality by using a baseline mortality risk model.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Obesity in Adults: A 2022 Adapted Clinical Practice Guideline for Ireland.Obesity facts · 2022Guideline
- Baseline and Follow-Up Association between Adiposity and Renal Function: Data from the ILERVAS Cohort.Obesity facts · 2026Article
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- The legality of weight discrimination in Canada: an environmental scan of case law and the limits of Canadian legislation.International journal for equity in health · 2025Review
- Weight stigma amid pediatric healthcare providers: a cross-sectional survey study assessing the roles of weight controllability beliefs and blame.BMC pediatrics · 2025Article
- Subclassification of obesity for precision prediction of cardiometabolic diseases.Nature medicine · 2025Article
- Joint Effects of Physical Activity and Body Mass Index on Prevalent Diabetes in a Nationally Representative Sample of 1.9 Million US Adults.Journal of diabetes research · 2025Article
- Autonomic Function in Obese Children and Adolescents: Systematic Review and Meta-Analysis.Journal of clinical medicine · 2024Review
- Changing the global obesity narrative to recognize and reduce weight stigma: A position statement from the World Obesity Federation.Obesity reviews : an official journal of the International Association for the Study of Obesity · 2024Review
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Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveThe association of body mass index (BMI) and all-cause mortality is controversial, frequently referred to as a paradox. Whether the cause is metabolic factors or statistical biases is still controversial. We assessed the association of BMI and all-cause mortality considering a wide range of comorbidities and baseline mortality risk.
methodsRetrospective cohort study of Olmsted County residents with at least one BMI measurement between 2000-2005, clinical data in the electronic health record and minimum 8 year follow-up or death within this time. The cohort was categorized based on baseline mortality risk: Low, Medium, Medium-high, High and Very-high. All-cause mortality was assessed for BMI intervals of 5 and 0.5 Kg/m2.
resultsOf 39,739 subjects (average age 52.6, range 18-89; 38.1% male) 11.86% died during 8-year follow-up. The 8-year all-cause mortality risk had a "U" shape with a flat nadir in all the risk groups. Extreme BMI showed higher risk (BMI <15 = 36.4%, 15 to <20 = 15.4% and ≥45 = 13.7%), while intermediate BMI categories showed a plateau between 10.6 and 12.5%. The increased risk attributed to baseline risk and comorbidities was more obvious than the risk based on BMI increase within the same risk groups.
conclusionsThere is a complex association between BMI and all-cause mortality when evaluated including comorbidities and baseline mortality risk. In general, comorbidities are better predictors of mortality risk except at extreme BMIs. In patients with no or few comorbidities, BMI seems to better define mortality risk. Aggressive management of comorbidities may provide better survival outcome for patients with body mass between normal and moderate obesity.
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Registered trials
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.