The relationship between central obesity and survival in community-dwelling adults with normal body mass index (BMI) is not well-known.
To examine total and cardiovascular mortality risks associated with central obesity and normal BMI.
Stratified multistage probability design.
NHANES III (Third National Health and Nutrition Examination Survey).
15 184 adults (52.3% women) aged 18 to 90 years.
Multivariable Cox proportional hazards models were used to evaluate the relationship of obesity patterns defined by BMI and waist-to-hip ratio (WHR) and total and cardiovascular mortality risk after adjustment for confounding factors.
Persons with normal-weight central obesity had the worst long-term survival. For example, a man with a normal BMI (22 kg/m2) and central obesity had greater total mortality risk than one with similar BMI but no central obesity (hazard ratio [HR], 1.87 [95% CI, 1.53 to 2.29]), and this man had twice the mortality risk of participants who were overweight or obese according to BMI only (HR, 2.24 [CI, 1.52 to 3.32] and 2.42 [CI, 1.30 to 4.53], respectively). Women with normal-weight central obesity also had a higher mortality risk than those with similar BMI but no central obesity (HR, 1.48 [CI, 1.35 to 1.62]) and those who were obese according to BMI only (HR, 1.32 [CI, 1.15 to 1.51]). Expected survival estimates were consistently lower for those with central obesity when age and BMI were controlled for.
Body fat distribution was assessed based on anthropometric indicators alone. Information on comorbidities was collected by self-report.
Normal-weight central obesity defined by WHR is associated with higher mortality than BMI-defined obesity, particularly in the absence of central fat distribution.
Primary Funding Source:
National Institutes of Health, American Heart Association, European Regional Development Fund, and Czech Ministry of Health.
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Author, Article, and Disclosure Information
Karine R. Sahakyan,
From the Mayo Clinic, Rochester, Minnesota; St. Anne's University Hospital Brno, Brno, Czech Republic; and University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Grant Support: By the National Institutes of Health (grant HL00711-36; Dr. Sahakyan), American Heart Association (grant 11SDG7260046; Dr. Singh), European Regional Development Fund (Project FNUSA-ICRC [grant CZ.1.05/1.1.00/02.0123; Drs. Somers, Sochor, Singh, and Lopez-Jimenez]), and Czech Ministry of Health (grant NT13434-4/2012; Dr. Sochor).
Disclosures: Dr. Somers reports grants from the National Institutes of Health and Philips Respironics (to the Mayo Foundation for the study of sleep and cardiovascular disease); personal fees from Respicardia, ResMed, Sorin Group, Philips Respironics, GlaxoSmithKline, U-Health (China; www.ttdoc.cn), and Ronda Grey; and other compensation for work with Mayo Health Solutions and their industry partners on intellectual property related to sleep and cardiovascular disease, outside the submitted work. Dr. Sochor's institution, St. Anne's Hospital, was supported by the European Regional Development Fund (Project FNUSA-ICRC [grant CZ.1.05/1.1.00/02.0123]); further, Dr. Sochor was awarded grants from the Ministry of Health of the Czech Republic and SCOPES (NT13434-4/2012 and IZ73Z0_152616, respectively). Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2525.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol: Available at ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/nhanes/nhanes3/1A/ADULT-acc.pdf. Statistical code and data: Available at www.cdc.gov/nchs/nhanes/nh3data.htm.
Corresponding Author: Francisco Lopez-Jimenez, MD, MS, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905; e-mail, lopez@mayo.
Current Author Addresses: Drs. Sahakyan, Somers, Rodriguez-Escudero, Sochor, Roger, Singh, and Lopez-Jimenez: Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905.
Mr. Hodge and Dr. Carter: Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905.
Dr. Coutinho: University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
Dr. Jensen: Division of Endocrinology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905.
Author Contributions: Conception and design: K.R. Sahakyan, J.P. Rodriguez-Escudero, R.E. Carter, T. Coutinho, F. Lopez-Jimenez.
Analysis and interpretation of the data: K.R. Sahakyan, V.K. Somers, D.O. Hodge, R.E. Carter, O. Sochor, T. Coutinho, M.D. Jensen, V.L. Roger, P. Singh, F. Lopez-Jimenez.
Drafting of the article: K.R. Sahakyan, V.K. Somers, J.P. Rodriguez-Escudero, R.E. Carter, P. Singh, F. Lopez-Jimenez.
Critical revision of the article for important intellectual content: K.R. Sahakyan, V.K. Somers, J.P. Rodriguez-Escudero, D.O. Hodge, R.E. Carter, O. Sochor, T. Coutinho, M.D. Jensen, V.L. Roger, P. Singh, F. Lopez-Jimenez.
Final approval of the article: K.R. Sahakyan, V.K. Somers, J.P. Rodriguez-Escudero, R.E. Carter, T. Coutinho, M.D. Jensen, P. Singh, F. Lopez-Jimenez.
Provision of study materials or patients: F. Lopez-Jimenez.
Statistical expertise: D.O. Hodge, R.E. Carter, F. Lopez-Jimenez.
Obtaining of funding: V.L. Roger.
Administrative, technical, or logistic support: V.K. Somers, P. Singh, F. Lopez-Jimenez.
Collection and assembly of data: R.E. Carter.
This article was published online first at www.annals.org on 10 November 2015.