THIGH CIRCUMFERENCE AND RISK OF ALL-CAUSE, CARDIOVASCULAR AND CEREBROVASCULAR MORTALITY: RESULTS FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY 1999–2006

Abstract

Objective: Research gap exists regarding the relationship between thigh circumference and all-cause and cause-specific death, especially cardiovascular and cerebrovascular death. The objective of this study was to examine how thigh circumference associate with all-cause, cardiovascular and cerebrovascular mortality among US adults. Design and method: This cohort study included 19885 US adults who participated in the 1999–2006 National Health and Nutrition Examination Survey (NHANES), a national representative survey of the civilian, non-institutionalized U.S. population sponsored by the Centers for Disease Control and Prevention, with thigh circumference measurement at baseline and follow-up mortality assessment through 31 December 2015. In the 1999–2006 NHANES study, there were a total of 4,1474 participants. Adult subjects were enrolled. However, subjects missing mortality data and thigh circumference measurement were excluded. We used Cox proportional hazards models to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CI) for mortality according to thigh circumference in quartiles. Kaplan–Meier survival curve and restricted cubic spline regression were performed to examine the prospective association. Finally, subgroup analyses by age, gender, BMI, and baseline comorbid diseases were conducted. Results: During a median follow-up of 142.34 months, 3513 all-cause deaths occurred, with 432 cardiovascular disease deaths, and 143 cerebrovascular disease deaths. Multivariate Cox regression indicated that every 1 cm increase in thigh circumference was related to 4% and 6% decreased all-cause mortality and cardiovascular mortality, respectively. Compared to the reference group, the highest quartile of thigh circumference had a significantly negative relationship with all-cause mortality (HR 0.74, 95%CI 0.56–0.97, P < 0.05). However, the association of thigh circumference with cerebrovascular mortality was not significant. Subgroup analysis in lean participants (defined as BMI < 25 kg/m2) showed that thigh circumference had inverse correlations with all-cause mortality and cardiovascular mortality (P < 0.0001). Conclusions: A low thigh circumference seems to be associated with increased risk of all-cause and cardiovascular mortality, but not cerebrovascular mortality. The measure of thigh circumference might be a relevant anthropometric measure to help general practitioners in early identification of individuals at an increased risk of total and cardiovascular mortality.