Category Archives: BMI and all-cause mortality

Blood Test Analysis In A 100 Year Old Subject

What are the blood biomarkers of a centenarian, and is there room for improvement? Find out in the video below!

Life Expectancy Increase (12-14 Years) With 5 Factors

Following five lifestyle-related factors is associated with a gain in average life expectancy (Li et al. 2018). What are these factors? Not smoking, having a BMI between 18.5 to 24.9 kg/m2, engaging in more than 30 minutes of moderate to vigorous physical activity (at a minimum, walking ~3 miles per hour; 30 minutes of that = 1.5 miles of walking per day), moderate alcohol intake (5 to 15 g/d for women and 5 to 30 g/d for men), and a high diet quality score.

Starting at age 50y, having all 5 of these factors was associated with a life expectancy of an additional 43.1 years for women, and 37.6 years for men, which is an increase in average life expectancy of 14 years for women and 12 years for men, respectively:

Screen Shot 2019-09-29 at 12.49.55 PM.png

Quantifying whether or not you have the first 4 factors is easy, but what qualifies as having a high dietary score? The alternative healthy eating index (AHEI; McCullough et al. 2002) was used to define the dietary score. An AHEI score of more than 43.5 in women and 50 in men qualifies as having a high dietary quality. How is the AHEI defined?

If you eat more than 5 servings of vegetables (1 serving = ~3 ounces, or 80g) per day, you get 10 points. Similarly, more than 4 servings of fruit gets you 10 points. If you eat 1 serving (= 1.5 ounces, or 42 grams) of nuts and or soy protein (tofu) you get 10 points. If your intake of white meat (including fish, poultry) divided by red meat is greater than 4, you get 10 points. If you eat > 9 grams of cereal fiber (not 9 grams of grains, but the actual fiber content) per day, you get 10 points. For example, 9 grams of cereal fiber corresponds to 90g/day of dry oats. Alcohol is also included within the AHEI: if you have 1.5 – 2.5 servings of alcoholic drinks per day (for men) or 0.5 – 1.5 servings/day for women, that’s 10 points. Zero points would be not consuming alcoholic drinks, or > 3.5 drinks for men, and > 2.5 drinks per day for women. Having a polyunsaturated/saturated fat (P:S) intake > 0.5 yields 8 points, whereas a ratio > 0.7 yields 10 points. Consuming < 0.9 grams of trans fat per day yields 10 points, and finally, using a multivitamin for more than 5 years yields 10 points. To determine your score, have a a look at the median AHEI values reported for men:

Screen Shot 2019-09-29 at 10.11.15 AM

And for women:

Screen Shot 2019-09-29 at 10.13.37 AM.png

How many of the 5 factors do I have? I don’t smoke, my BMI is within the BMI range (my body weight was 158 this morning, so barely!), and I easily walk more than an hour/day + 3-4 days of exercise/week, so I qualify for the first 3 factors. However, I rarely drink alcohol, so I don’t qualify for that factor. What about the diet quality factor? To determine that, I’ll need to calculate if I have more than 50 AHEI points.

For the AHEI index, getting 5, 4, and 1 servings of veggies, fruit, and nuts per day is easy for me, so I’ve got 30 points so far. I eat oats once or twice/week, but not enough to get 9g of cereal fiber/day, so 0 points there. I eat 80 grams of sardines every day (560 grams/week), and ~150 grams of red meat per week, for a ratio of 3.7. That wouldn’t qualify me for 10 points, but 8 instead (see Quintile 4), where the white/red meat ratio would need to be higher than 2.5. I rarely drink alcohol, so 0 points for me there. Using last week’s dietary data, my P:S ratio is about 0.5, and my trans fat intake (almost exclusively from full-fat dairy) is 0.7 g/day, so I get 8 points and 10 points, respectively. In terms of multivitamin use, I only supplement with Vitamin D in the winter, and with a methylfolate-methylcobalamin-B6 stack (to reduce my homocysteine by ~10%). I haven’t been supplementing with that stack for more than five years, so I get a 0 there. Nonetheless, my score is 56 points, which would qualify me as having a high diet quality score.

Collectively, I have 4 of the 5 lifestyle factors that are associated with an increase in life expectancy. Based on the data from Li et al., my average life expectancy would be 85.4y. Adding in moderate alcohol intake would give me all 5 factors, and would result in a life expectancy gain of an additional 2.2 years. I’ve included 1-2 glasses of wine in my diet in the past, but it had no effect on my HDL or other circulating biomarkers, so I removed it. For me, the risk related to alcohol intake may not be worth the gain in life expectancy. Also note that these are average, population-based values, and I expect an additional gain in life expectancy gain because of my continuous quest for biological age optimization (!


Li Y, Pan A, Wang DD, Liu X, Dhana K, Franco OH, Kaptoge S, Di Angelantonio E, Stampfer M, Willett WC, Hu FB. Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population. Circulation. 2018 Jul 24;138(4):345-355. doi: 10.1161/CIRCULATIONAHA.117.032047.

McCullough ML, Feskanich D, Stampfer MJ, Giovannucci EL, Rimm EB, Hu FB, Spiegelman D, Hunter DJ, Colditz GA, Willett WC. Diet quality and major chronic disease risk in men and womenmoving toward improved dietary guidanceAm J Clin Nutr. 2002 Dec;76(6):1261-71.

If you’re interested, please have a look at my book!


BMI: What’s Optimal For Longevity?

Is there a BMI that is associated with maximally reduced risk of death from all causes? Let’s have a look at the data!

In a meta-analysis of 19 studies that included 1,460,000 adults (median age, 58 years) a BMI between 20-25 kg/m2 was associated with maximally reduced all-cause mortality risk (Berrington de Gonzalez et al. 2010):

both gend nonsmok bmi mort

However, in a meta-analysis of 32 studies that included 197,140 older adults (65 years+), a BMI between 24 and 31 kg/m2 was associated with maximally reduced all-cause mortality risk (Winter et al. 2014). More specifically, a BMI between 26-26.9 kg/m2 was associated with maximally reduced all-cause mortality risk for never-smokers (Winter et al. 2014):

acm 65

So what’s optimal for longevity in terms of BMI, is it 20-25 kg/m2, or potentially higher, as reported in older adults? For additional insight about the association between BMI with all-cause mortality, I looked up the published BMI data for centenarians:

bmi cent

In these 11 studies that included 1075 centenarians, the BMI range was between 19.3-24.4 kg/m2, with an average BMI of 21.8. Shouldn’t that be the BMI reference range for those interested in living past 100?

If you’re interested, please have a look at my book!



Arai Y, Hirose N, Yamamura K, Shimizu K, Takayama M, Ebihara Y, Osono Y. Serum insulin-like growth factor-1 in centenarians: implications of IGF-1 as a rapid turnover protein. J Gerontol A Biol Sci Med Sci. 2001 Feb;56(2):M79-82.

Arai Y, Takayama M, Gondo Y, Inagaki H, Yamamura K, Nakazawa S, Kojima T, Ebihara Y, Shimizu K, Masui Y, Kitagawa K, Takebayashi T, Hirose N. Adipose endocrine function, insulin-like growth factor-1 axis, and exceptional survival beyond 100 years of age. J Gerontol A Biol Sci Med Sci. 2008 Nov;63(11):1209-18.

Baranowska B, Bik W, Baranowska-Bik A, Wolinska-Witort E, Szybinska A, Martynska L, Chmielowska M. Neuroendocrine control of metabolic homeostasis in Polish centenarians. J Physiol Pharmacol. 2006 Nov;57 Suppl 6:55-61.

Barzilai N, Atzmon G, Schechter C, Schaefer EJ, Cupples AL, Lipton R, Cheng S, Shuldiner AR. Unique lipoprotein phenotype and genotype associated with exceptional longevity. JAMA 2003;290:2030–40.

Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ, Moore SC, Tobias GS, Anton-Culver H, Freeman LB, Beeson WL, Clipp SL, English DR, Folsom AR, Freedman DM, Giles G, Hakansson N, Henderson KD, Hoffman-Bolton J, Hoppin JA, Koenig KL, Lee IM, Linet MS, Park Y, Pocobelli G, Schatzkin A, Sesso HD, Weiderpass E, Willcox BJ, Wolk A, Zeleniuch-Jacquotte A, Willett WC, Thun MJ. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010 Dec 2;363(23):2211-9. doi: 10.1056/NEJMoa1000367. Erratum in: N Engl J Med. 2011 Sep 1;365(9):869.

Bik W, Baranowska-Bik A, Wolinska-Witort E, Kalisz M, Broczek K, Mossakowska M, Baranowska B. Assessment of adiponectin and its isoforms in Polish centenarians. Exp Gerontol. 2013 Apr;48(4):401-7.

Chan YC, Suzuki M, Yamamoto S. Dietary, anthropometric, hematological and biochemical assessment of the nutritional status of centenarians and elderly people in Okinawa, Japan. J Am Coll Nutr. 1997 Jun;16(3):229-35.

Hausman DB, Johnson MA, Davey A, Poon LW. Body mass index is associated with dietary patterns and health conditions in georgia centenarians. J Aging Res. 2011;2011:138015.

Magri F, Muzzoni B, Cravello L, Fioravanti M, Busconi L, Camozzi D, Vignati G, Ferrari E. Thyroid function in physiological aging and in centenarians: possible relationships with some nutritional markers. Metabolism. 2002 Jan;51(1):105-9.

Montoliu I, Scherer M, Beguelin F, DaSilva L, Mari D, Salvioli S, Martin FP, Capri M, Bucci L, Ostan R, Garagnani P, Monti D, Biagi E, Brigidi P, Kussmann M, Rezzi S, Franceschi C, Collino S. Serum profiling of healthy aging identifies phospho- and sphingolipid species as markers of human longevity. Aging (Albany NY). 2014 Jan;6(1):9-25.

Paolisso G, Ammendola S, Del Buono A, Gambardella A, Riondino M, Tagliamonte MR, Rizzo MR, Carella C, Varricchio M. Serum levels of insulin-like growth factor-I (IGF-I) and IGF-binding protein-3 in healthy centenarians: relationship with plasma leptin and lipid concentrations, insulin action, and cognitive function. J Clin Endocrinol Metab. 1997 Jul;82(7):2204-9.

Vasto S, Scapagnini G, Rizzo C, Monastero R, Marchese A, Caruso C. Mediterranean diet and longevity in Sicily: survey in a Sicani Mountains population. Rejuvenation Res. 2012 Apr;15(2):184-8.

Winter JE, MacInnis RJ, Wattanapenpaiboon N, Nowson CA. BMI and all-cause mortality in older adults: a meta-analysisAm J Clin Nutr. 2014 Apr;99(4):875-90.