Abstract
BackgroundPrevious data on the association between central obesity and mortality are controversial. The aim of this study was to determine the associations between central obesity, as measured by the waist-to-height ratio (WtHR) and waist circumference (WC), with all cause and cause-specific mortality in U.S. adults.MethodsThe study subjects comprised a nationally representative sample of 33,569 adults >20 years of age who were recruited in the National Health and Nutrition Examination Survey between 1999 and 2014. Anthropometric data, including weight, height, and WC, were measured at each of the eight waves using consistent methodology. Death and underlying causes of death were ascertained through 31 December 2015. The association between central obesity and mortality were determined using weighted Cox proportional hazards regression models.ResultsA total of 4013 deaths occurred during a median follow-up of 7.33 years (263,029 person-years). Compared with the subjects in WtHR tertile 1, the subjects in tertiles 2 and 3 were at a higher risk of mortality from all-cause (tertile 2-hazard ratio [HR]: 1.29; 95% confidence interval [CI]: 1.13–1.47; tertile 3-HR: 1.96; 95% CI: 1.64–2.34) and cardiovascular diseases [CVDs] (tertile 2-HR: 1.40; 95% CI: 1.09–1.79; tertile 3-HR: 2.00; 95% CI: 1.47–2.73). Similarly, compared with the subjects in WC tertile 1, the subjects in tertiles 2 and 3 were at a higher risk of mortality from all-cause (tertile 2-HR: 1.15; 95% CI: 1.00–1.31; tertile 3-HR: 1.39; 95% CI: 1.15–1.67) and CVD (tertile 2-HR: 1.48; 95% CI: 1.14–1.93; tertile 3-HR: 1.74; 95% CI: 1.26–2.42). Restricted cubic spline analyses revealed an S-shaped and linear dose-relationship between WtHR and WC with all-cause mortality. Moreover, a WtHR> 0.58 or a WC > 0.98m was shown to be a risk factor for all-cause mortality.ConclusionsCentral obesity was significantly associated with increased risk of all-cause and CVD-related mortality, especially heart diseases-related mortality, even among normal weight adults. In addition to weight control, guideline designer should provide recommendations for people to decrease abdominal fat accumulation, in their effort to reduce mortality risk in later life.
Highlights
Central obesity has become a major public health problem in the United States (U.S.), and the estimated prevalence of central obesity in U.S adults increased from 43.5% in men and 64.7% in women between 2011 and 2012, to 50.1 and 72.5%, respectively, in 2020 [1, 2]
Our findings suggest that the guidelines for obesity need to be updated to recognize the potential high-risk subgroup population
The number of deaths cases in some subgroups such as the obese subjects in waist-to-height ratio (WtHR) or waist circumference (WC) tertile 1 was insufficient to generate precise estimations. This prospective cohort study of U.S adults showed that central obesity is significantly associated with an increased risk of all-cause and cardiovascular disease (CVD) mortality, especially heart diseasesrelated mortality, even among normal adults, as weight measured by the Body Mass Index (BMI)
Summary
Central obesity has become a major public health problem in the United States (U.S.), and the estimated prevalence of central obesity in U.S adults increased from 43.5% in men and 64.7% in women between 2011 and 2012, to 50.1 and 72.5%, respectively, in 2020 [1, 2]. Most studies evaluating the association between central obesity and mortality in select populations such as postmenopausal women, those with chronic health conditions, older adults, or participants located in a given city, rather than a nationally-representative general population [11,12,13,14]. Some large scale cohort studies have used selfreported measures rather than technician-measured data to perform analyses, which could result in inaccurate assessment of central obesity because participants tend to over-report their height [6, 15, 16]. A dose-response metaanalysis involving 72 prospective cohort studies reported a nearly J-shaped association between central obesity indices and all cause mortality [17]; the potential effects of reverse causality were not restricted. The aim of this study was to determine the associations between central obesity, as measured by the waist-to-height ratio (WtHR) and waist circumference (WC), with all cause and cause-specific mortality in U.S adults
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