Trajectories of Body Mass Index and Their Associations With Mortality Among Older Japanese: Do They Differ From Those of Western Populations?

Am J Epidemiol. 2015 Oct 1;182(7):597-605. doi: 10.1093/aje/kwv107. Epub 2015 Sep 12.


Few studies have focused on the relationship between the trajectories of long-term changes in body mass index (BMI; weight (kg)/height (m)(2)) and all-cause mortality in old age, particularly in non-Western populations. We evaluated this association by applying group-based mixture models to data derived from the National Survey of the Japanese Elderly, which included 4,869 adults aged 60 or more years, with up to 7 repeated observations between 1987 and 2006. Four distinct BMI trajectories were identified: "low-normal weight, decreasing" (baseline BMI = 18.7; 23.8% of sample); "mid-normal weight, decreasing" (baseline BMI = 21.9; 44.6% of sample); "high-normal weight, decreasing" (baseline BMI = 24.8; 26.5% of sample); and "overweight, stable" (baseline BMI = 28.7; 5.2% of sample). Survival analysis with an average follow-up of 13.8 years showed that trajectories of higher BMI were associated with lower mortality. In particular, relative to those with a mid-normal weight, decreasing BMI trajectory, those with an overweight, stable BMI trajectory had the lowest mortality, and those with a low-normal, decreasing BMI trajectory had the highest mortality. In sharp contrast with prior observations from Western populations, BMI changes lie primarily within the normal-weight range, and virtually no older Japanese are obese. The association between BMI trajectories and mortality varies according to the distribution of BMI within the population.

Keywords: Japan; body mass index; mortality; older adults; trajectories.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Asian Continental Ancestry Group / statistics & numerical data*
  • Body Mass Index*
  • Female
  • Humans
  • Japan / epidemiology
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Mortality*