Underweight as a risk factor for respiratory death in the Whitehall cohort study: exploring reverse causality using a 45-year follow-up

Mika Kivimäki; Martin J Shipley; Joshua A Bell; Eric J Brunner; G David Batty; Archana Singh-Manoux

doi:10.1136/thoraxjnl-2015-207449

Underweight as a risk factor for respiratory death in the Whitehall cohort study: exploring reverse causality using a 45-year follow-up

Mika Kivimäki, Martin J Shipley, Joshua A Bell, Eric J Brunner, G David Batty, Archana Singh-Manoux

Bristol Medical School (PHS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

Abstract

Underweight adults have higher rates of respiratory death than the normal weight but it is unclear whether this association is causal or reflects illness-induced weight loss (reverse causality). Evidence from a 45-year follow-up of underweight participants for respiratory mortality in the Whitehall study (N=18 823; 2139 respiratory deaths) suggests that excess risk among the underweight is attributable to reverse causality. The age-adjusted and smoking-adjusted risk was 1.55-fold (95% CI 1.32 to 1.83) higher among underweight compared with normal weight participants, but attenuated in a stepwise manner to 1.14 (95% CI 0.76 to 1.71) after serial exclusions of deaths during the first 5-35 years of follow-up (P(trend)<0.001).

Original language	English
Pages (from-to)	84-5
Number of pages	2
Journal	Thorax
Volume	71
Issue number	1
DOIs	https://doi.org/10.1136/thoraxjnl-2015-207449
Publication status	Published - Jan 2016

Keywords

Adult
Aged
Causality
Chronic Disease
Female
Follow-Up Studies
Humans
Male
Middle Aged
Population Surveillance
Respiratory Tract Diseases
Risk Factors
Thinness

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title = "Underweight as a risk factor for respiratory death in the Whitehall cohort study: exploring reverse causality using a 45-year follow-up",

abstract = "Underweight adults have higher rates of respiratory death than the normal weight but it is unclear whether this association is causal or reflects illness-induced weight loss (reverse causality). Evidence from a 45-year follow-up of underweight participants for respiratory mortality in the Whitehall study (N=18 823; 2139 respiratory deaths) suggests that excess risk among the underweight is attributable to reverse causality. The age-adjusted and smoking-adjusted risk was 1.55-fold (95% CI 1.32 to 1.83) higher among underweight compared with normal weight participants, but attenuated in a stepwise manner to 1.14 (95% CI 0.76 to 1.71) after serial exclusions of deaths during the first 5-35 years of follow-up (P(trend)<0.001).",

keywords = "Adult, Aged, Causality, Chronic Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Population Surveillance, Respiratory Tract Diseases, Risk Factors, Thinness",

author = "Mika Kivim{\"a}ki and Shipley, {Martin J} and Bell, {Joshua A} and Brunner, {Eric J} and Batty, {G David} and Archana Singh-Manoux",

note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/",

year = "2016",

month = jan,

doi = "10.1136/thoraxjnl-2015-207449",

language = "English",

volume = "71",

pages = "84--5",

journal = "Thorax",

issn = "0040-6376",

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Underweight as a risk factor for respiratory death in the Whitehall cohort study : exploring reverse causality using a 45-year follow-up. / Kivimäki, Mika; Shipley, Martin J; Bell, Joshua A; Brunner, Eric J; Batty, G David; Singh-Manoux, Archana.

In: Thorax, Vol. 71, No. 1, 01.2016, p. 84-5.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - Underweight as a risk factor for respiratory death in the Whitehall cohort study

T2 - exploring reverse causality using a 45-year follow-up

AU - Kivimäki, Mika

AU - Shipley, Martin J

AU - Bell, Joshua A

AU - Brunner, Eric J

AU - Batty, G David

AU - Singh-Manoux, Archana

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

PY - 2016/1

Y1 - 2016/1

N2 - Underweight adults have higher rates of respiratory death than the normal weight but it is unclear whether this association is causal or reflects illness-induced weight loss (reverse causality). Evidence from a 45-year follow-up of underweight participants for respiratory mortality in the Whitehall study (N=18 823; 2139 respiratory deaths) suggests that excess risk among the underweight is attributable to reverse causality. The age-adjusted and smoking-adjusted risk was 1.55-fold (95% CI 1.32 to 1.83) higher among underweight compared with normal weight participants, but attenuated in a stepwise manner to 1.14 (95% CI 0.76 to 1.71) after serial exclusions of deaths during the first 5-35 years of follow-up (P(trend)<0.001).

AB - Underweight adults have higher rates of respiratory death than the normal weight but it is unclear whether this association is causal or reflects illness-induced weight loss (reverse causality). Evidence from a 45-year follow-up of underweight participants for respiratory mortality in the Whitehall study (N=18 823; 2139 respiratory deaths) suggests that excess risk among the underweight is attributable to reverse causality. The age-adjusted and smoking-adjusted risk was 1.55-fold (95% CI 1.32 to 1.83) higher among underweight compared with normal weight participants, but attenuated in a stepwise manner to 1.14 (95% CI 0.76 to 1.71) after serial exclusions of deaths during the first 5-35 years of follow-up (P(trend)<0.001).

KW - Adult

KW - Aged

KW - Causality

KW - Chronic Disease

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Middle Aged

KW - Population Surveillance

KW - Respiratory Tract Diseases

KW - Risk Factors

KW - Thinness

U2 - 10.1136/thoraxjnl-2015-207449

DO - 10.1136/thoraxjnl-2015-207449

M3 - Article (Academic Journal)

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SP - 84

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JO - Thorax

JF - Thorax

SN - 0040-6376

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ER -