Abstract
Waist circumference, a measure of abdominal obesity, is associated with all-cause mortality in general adult population. However, the link between abdominal obesity with all-cause mortality in the studies of older adults is unclear. This study aims to determine the association between waist circumference and all-cause mortality in older adults in Indonesia. The association between waist circumference and all-cause mortality was examined in 10,997 men and women aged 50 years and older, in the World Health Organization (WHO) and International Network of field sites for continuous Demographic Evaluation of Populations and their Health in developing countries (INDEPTH) collaboration Study on global AGEing and adult health (SAGE) in Purworejo District Central Java, Indonesia during 2007–2010. Multivariate Cox regression analysis with restricted cubic splines was used to assess the non-linear association between waist circumference and all-cause mortality. During the 3-year follow-up, a total of 511 men and 470 women died. The hazard ratio plot shows a pattern of U-shape relationship between waist circumference and all-cause mortality among rich women, though the result was significant only for women in the lower end of waist circumference distribution (p < 0.05). Poor men with a low waist circumference (5th percentile) have a two times higher mortality risk (HR = 2.1; 95% CI = 1.3, 3.3) relative to those with a waist circumference of 90 cm. Poor women with a low waist circumference (25th percentile) have a 1.4 times higher mortality risk (HR = 1.4; 95% CI = 1.1, 1.8) relative to those with a waist circumference of 80 cm. This study shows a significant association between low waist circumference measure and mortality, particularly among poor men and women. Though the association between large waist circumference and mortality was not significant, we observed a trend of higher mortality risk particularly among rich women with large waist circumference measure. Public health intervention should include efforts to improve nutritional status among older people and promoting healthy lifestyle behaviours including healthy food and active lifestyle.
Highlights
Obesity is one of the main risk factors for chronic diseases
This study shows a significant association between low waist circumference measure and mortality, among poor men and women
Though the association between large waist circumference and mortality was not significant, we observed a trend of higher mortality risk among rich women with large waist circumference measure
Summary
Obesity is one of the main risk factors for chronic diseases. Worldwide, the prevalence of obesity has nearly doubled between 1980 and 2014 [1]. The World Health Organization (WHO) has estimated that in 2014, 11% of men and 15% of women aged 18 years and above were obese while another 38% of men and 40% of women were overweight [1]. With regard to the general adult population, obesity is known to be associated with many health problems such as cardiovascular diseases (CVDs), diabetes, certain cancers [1], as well as premature deaths [2], but for the older population, the associations are less clear [3,4,5,6,7,8,9]. With the increase of overweight and obesity in the older population [10], an assessment of the associated health problems will be necessary in order to develop prevention strategies.
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