The combined relations of adiposity and smoking on mortality

Am J Clin Nutr. 2008 Nov;88(5):1206-12. doi: 10.3945/ajcn.2008.26298.


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/m(2)) <18.5 or >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 >or= 35 or a large waist circumference is related to an especially high mortality risk.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • Abdominal Fat / metabolism
  • Aged
  • Alcohol Drinking / adverse effects
  • Body Mass Index*
  • Cause of Death
  • Cohort Studies
  • Educational Status
  • Exercise / physiology
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Mortality / trends*
  • Obesity / epidemiology
  • Obesity / mortality*
  • Predictive Value of Tests
  • Risk Assessment*
  • Risk Factors
  • Smoking / epidemiology
  • Smoking / mortality*
  • Surveys and Questionnaires
  • United States
  • Waist-Hip Ratio