Nutrition/Obesity
Association of Adiposity Measures and Metabolic Health with All-Cause Mortality in the Cooper Center Longitudinal Study Kimberly N. Doughty* Kimberly Doughty Qing Li David Leonard Carolyn E. Barlow Clare Meernik Tammy Leonard Valentine Y. Njike David L. Katz Jarett Berry Andjelka Pavlovic Laura DeFina Kerem Shuval
The validity of body mass index (BMI) as an indicator of health risk has been criticized, particularly when applied to those without obesity-associated metabolic dysfunction (i.e., “metabolically healthy obesity”). Some have proposed that BMI should be replaced by alternative measures of adiposity. However, how well alternative adiposity measures indicate health risk at the population level has not been clearly established. Long-term mortality risk related to metabolically healthy obesity also remains uncertain.
We analyzed data from 59,778 men and women who received examinations between 1978 and 2017. We used a parametric (Gompertz) proportional hazards mortality model to examine associations between adiposity measures (BMI, body fat, waist circumference, waist:height ratio, waist:hip ratio, and relative fat mass) and all-cause mortality, independently and jointly with metabolic health (0 vs. ≥ 1 metabolic syndrome criteria, excluding WC).
All adiposity measures were associated with increased mortality. As z-scores, body fat had the weakest association (aHR 1.11, 95% CI 1.08-1.14) and WC the strongest (aHR 1.21, 95% CI 1.18-1.24), although similar to BMI and waist:height (both aHR 1.19, 95% CI 1.16-1.22). Among metabolically healthy individuals (i.e., those with no metabolic syndrome criteria), increasing adiposity was associated with increased mortality for all adiposity measures. Risk associated with adiposity was further increased among those who also met ≥ 1 metabolic syndrome criteria. For example, BMI z-score was associated with mortality among metabolically healthy individuals (aHR 1.25, 95% CI, 1.09-1.41) and those with any metabolic syndrome criteria (aHR 1.51, 95% CI 1.32-1.69).
In this study, all adiposity measures were associated with mortality, even among metabolically healthy individuals and were more strongly associated with mortality among those with additional metabolic risk factors. BMI was one of the strongest predictors of mortality overall.
