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