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The combined relations of adiposity and smoking on mortality^1,2,3,4

¹ From the Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD (AK and TBH); the Faculty of Health, Medicine and Life Sciences, Universiteit Maastricht, Netherlands (AK and JTMvE); the Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (MFL, AS, and KFA); the AARP, Washington DC (AH)

Background: Smoking and high adiposity are strong independent health risk factors but are also interrelated. Smoking is related to a lower body mass index (BMI) but not necessarily with a smaller waist circumference. Smoking cessation is associated with increased body weight and a substantial increase in waist circumference. How this affects mortality risk is unknown.

Objective: This study examined the combined relations of smoking status with BMI and waist circumference and smoking status to all-cause mortality.

Design: Data were from 149 502 men and 88 184 women aged 51–72 y participating in the National Institutes of Health–AARP Diet and Health Study. All-cause mortality was assessed over 10 y of follow-up from 1996 to 2006.

Results: Current smokers with a BMI (in kg/m²) <18.5 or 35 had a mortality risk 6–8 times that of persons within the normal BMI range who never smoked. Current smokers with a large waist circumference had a mortality risk about 5 times that of never smokers with a waist circumference in the second quintile.

Conclusion: Both smoking and adiposity are independent predictors of mortality, but the combination of current or recent smoking with a BMI 35 or a large waist circumference is related to an especially high mortality risk.

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