Cardiovascular and all-cause mortality in relation to various anthropometric measures of obesity in Europeans

https://doi.org/10.1016/j.numecd.2014.09.004Get rights and content

Highlights

  • We use both parametric and nonparametric models to explore the shape of relationship between anthropometric measures of obesity and mortality.

  • The existence of threshold is estimated by a piecewise regression model.

  • All anthropometric measures of abdominal obesity had positive linear associations with CVD mortality.

  • Some anthropometric measures of abdominal obesity showed linear whereas the others showed J-shaped relationships with all-cause mortality.

  • BMI had a J-shaped relationship with either CVD or all-cause mortality.

Abstract

Background and aims

Cardiovascular and all-cause mortality in relation to various anthropometric measures of obesity is still controversial.

Methods and results

Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), A Body Shape Index (ABSI) and waist-to-hip-to-height ratio (WHHR) were measured at baseline in a cohort of 46,651 European men and women aged 24–99 years. The relationship between anthropometric measures of obesity and mortality was evaluated by the Cox proportional hazards model with age as a time-scale and with threshold detected by a piecewise regression model. Over a median follow-up of 7.9 years, 2381 men and 1055 women died, 1071 men (45.0%) and 339 women (32.1%) from cardiovascular disease (CVD). BMI had a J-shaped relationship with CVD mortality, whereas anthropometric measures of abdominal obesity had positive linear relationships. BMI, WC and WHtR showed J-shaped associations with all-cause mortality, whereas WHR, ABSI and WHHR demonstrated positive linear relationships. Accordingly, a threshold value was detected at 29.29 and 30.98 kg/m2 for BMI, 96.4 and 93.3 cm for WC, 0.57 and 0.60 for WHtR, 0.0848 and 0.0813 m11/6 kg−2/3 for ABSI with CVD mortality in men and women, respectively; 29.88 and 29.50 kg/m2 for BMI, 104.3 and 105.6 for WC, 0.61 and 0.67 for WHtR, 0.95 and 0.86 for WHR, 0.0807 and 0.0765 for ABSI in men and women, respectively, and 0.52 for WHHR in women with all-cause mortality.

Conclusion

All anthropometric measures of abdominal obesity had positive linear associations with CVD mortality, whereas some showed linear and the others J-shaped relationships with all-cause mortality. BMI had a J-shaped relationship with either CVD or all-cause mortality. Thresholds detected based on mortality may help with clinical definition of obesity in relation to mortality.

Introduction

Obesity is a major risk factor for development of chronic diseases and an important cause of mortality [1], [2]. Waist circumference (WC) and waist-to-height ratio (WHtR) appear to be better anthropometric measures of abdominal obesity than body mass index (BMI) and have stronger correlation with intra-abdominal fat content and cardiometabolic risk factors [3]. But to date, the association of anthropometric measures of obesity with all-cause mortality is still controversial: a J- or U-shaped [2], [4], [5], [6], [7], or a positive linear [8], [9] relationship for BMI, a J-shaped [2], [10] or a positive linear [10], [11], [12] relationship for WC, a positive linear [11], [12] or a U-shaped [2] relationship for waist-to-hip ratio (WHR). A positive linear [4], [6], a J- or U-shaped [5], [11], [12] relationship for BMI and a positive linear relationship [2], [11], [12] for these anthropometric measures of abdominal obesity with cardiovascular disease (CVD) mortality has been reported. In addition, A Body Shape Index (ABSI) has been proposed recently to combine WC, weight and height together in one algorithm to predict all-cause mortality [7], as well as waist-to-hip-to-height ratio (WHHR) was shown to be superior to BMI, WC or WHtR in predicting CVD risk in the elderly [13].

Considering the inconsistent findings we set up the study, based on the data of the Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe (DECODE) study, to investigate the relationships of mortality from CVD and all-cause with various anthropometric measures of obesity, and to detect whether there are potential thresholds existing. ABSI and WHHR that were introduced recently are evaluated together with BMI, WC, WHtR and WHR.

Section snippets

Study population

The DECODE collaboration includes 40 studies and their investigators from 14 European countries who have conducted population-based or large occupational surveys for diabetes and its risk factors applying standard 75 g oral glucose tolerance tests for diagnosis of diabetes [14]. All survey participants included in the data analysis are Caucasians. Individual participant data from each cohort was sent to the National Institute for Health and Welfare in Helsinki, Finland for collaborative data

Results

Table 1, Table 2 provide the descriptive characteristics of the cohorts. Over a median follow-up of 7.9 years, 2381 men and 1055 women died, 1071 men (45.0%) and 339 women (32.1%) from CVD. Table 3 shows that age, high distribution of anthropometric measures of obesity, smoking and leisure-time physical inactivity were significantly associated with CVD and all-cause mortality.

The best-fitting conventional model was conventional polynomial model for BMI with CVD and all-cause mortality as well

Discussion

We found that BMI had a J-shaped relationship with CVD mortality, whereas anthropometric measures of abdominal obesity had positive linear relationships. BMI, WC and WHtR showed J-shaped associations with all-cause mortality, whereas WHR, ABSI and WHHR demonstrated positive linear relationships. Thresholds detected based on mortality may help with clinical definition of obesity in relation to mortality.

Our findings are in line with previous studies that reported a J- or U-shaped relationship

Conflict of interest

The authors declare no conflict of interest.

Acknowledgments

This work was supported by the Academy of Finland (Suomen Akatemia) [1129197, 136895 and 141005].

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