Normal-weight central obesity: Implications for total and cardiovascular mortality

Karine R. Sahakyan, Virend Somers, Juan P. Rodriguez-Escudero, David O. Hodge, Rickey E. Carter, Ondrej Sochor, Thais Coutinho, Michael Dennis Jensen, Veronique Lee Roger, Prachi Singh, Francisco Lopez-Jimenez

Research output: Contribution to journalArticle

146 Citations (Scopus)

Abstract

Background: The relationship between central obesity and survival in community-dwelling adults with normal body mass index (BMI) is not well-known. Objective: To examine total and cardiovascular mortality risks associated with central obesity and normal BMI. Design: Stratified multistage probability design. Setting: NHANES III (Third National Health and Nutrition Examination Survey). Participants: 15 184 adults (52.3% women) aged 18 to 90 years. Measurements: Multivariable Cox proportional hazards models were used to evaluate the relationship of obesity patterns defined by BMI and waist-To-hip ratio (WHR) and total and cardiovascular mortality risk after adjustment for confounding factors. Results: Persons with normal-weight central obesity had the worst long-Term survival. For example, a man with a normal BMI (22 kg/m2) and central obesity had greater total mortality risk than one with similar BMI but no central obesity (hazard ratio [HR], 1.87 [95% CI, 1.53 to 2.29]), and this man had twice the mortality risk of participants who were overweight or obese according to BMI only (HR, 2.24 [CI, 1.52 to 3.32] and 2.42 [CI, 1.30 to 4.53], respectively). Women with normal-weight central obesity also had a higher mortality risk than those with similar BMI but no central obesity (HR, 1.48 [CI, 1.35 to 1.62]) and those who were obese according to BMI only (HR, 1.32 [CI, 1.15 to 1.51]). Expected survival estimates were consistently lower for those with central obesity when age and BMI were controlled for. Limitations: Body fat distribution was assessed based on anthropometric indicators alone. Information on comorbidities was collected by self-report. Conclusion: Normal-weight central obesity defined by WHR is associated with higher mortality than BMI-defined obesity, particularly in the absence of central fat distribution. Primary Funding Source: National Institutes of Health, American Heart Association, European Regional Development Fund, and Czech Ministry of Health.

Original languageEnglish (US)
Pages (from-to)827-835
Number of pages9
JournalAnnals of Internal Medicine
Volume163
Issue number11
DOIs
StatePublished - Dec 1 2015

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Abdominal Obesity
Body Mass Index
Weights and Measures
Mortality
Waist-Hip Ratio
Nutrition Surveys
Survival
Obesity
Independent Living
Body Fat Distribution
Risk Adjustment
National Institutes of Health (U.S.)
Proportional Hazards Models
Self Report
Comorbidity
Fats

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Normal-weight central obesity : Implications for total and cardiovascular mortality. / Sahakyan, Karine R.; Somers, Virend; Rodriguez-Escudero, Juan P.; Hodge, David O.; Carter, Rickey E.; Sochor, Ondrej; Coutinho, Thais; Jensen, Michael Dennis; Roger, Veronique Lee; Singh, Prachi; Lopez-Jimenez, Francisco.

In: Annals of Internal Medicine, Vol. 163, No. 11, 01.12.2015, p. 827-835.

Research output: Contribution to journalArticle

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title = "Normal-weight central obesity: Implications for total and cardiovascular mortality",
abstract = "Background: The relationship between central obesity and survival in community-dwelling adults with normal body mass index (BMI) is not well-known. Objective: To examine total and cardiovascular mortality risks associated with central obesity and normal BMI. Design: Stratified multistage probability design. Setting: NHANES III (Third National Health and Nutrition Examination Survey). Participants: 15 184 adults (52.3{\%} women) aged 18 to 90 years. Measurements: Multivariable Cox proportional hazards models were used to evaluate the relationship of obesity patterns defined by BMI and waist-To-hip ratio (WHR) and total and cardiovascular mortality risk after adjustment for confounding factors. Results: Persons with normal-weight central obesity had the worst long-Term survival. For example, a man with a normal BMI (22 kg/m2) and central obesity had greater total mortality risk than one with similar BMI but no central obesity (hazard ratio [HR], 1.87 [95{\%} CI, 1.53 to 2.29]), and this man had twice the mortality risk of participants who were overweight or obese according to BMI only (HR, 2.24 [CI, 1.52 to 3.32] and 2.42 [CI, 1.30 to 4.53], respectively). Women with normal-weight central obesity also had a higher mortality risk than those with similar BMI but no central obesity (HR, 1.48 [CI, 1.35 to 1.62]) and those who were obese according to BMI only (HR, 1.32 [CI, 1.15 to 1.51]). Expected survival estimates were consistently lower for those with central obesity when age and BMI were controlled for. Limitations: Body fat distribution was assessed based on anthropometric indicators alone. Information on comorbidities was collected by self-report. Conclusion: Normal-weight central obesity defined by WHR is associated with higher mortality than BMI-defined obesity, particularly in the absence of central fat distribution. Primary Funding Source: National Institutes of Health, American Heart Association, European Regional Development Fund, and Czech Ministry of Health.",
author = "Sahakyan, {Karine R.} and Virend Somers and Rodriguez-Escudero, {Juan P.} and Hodge, {David O.} and Carter, {Rickey E.} and Ondrej Sochor and Thais Coutinho and Jensen, {Michael Dennis} and Roger, {Veronique Lee} and Prachi Singh and Francisco Lopez-Jimenez",
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AU - Sahakyan, Karine R.

AU - Somers, Virend

AU - Rodriguez-Escudero, Juan P.

AU - Hodge, David O.

AU - Carter, Rickey E.

AU - Sochor, Ondrej

AU - Coutinho, Thais

AU - Jensen, Michael Dennis

AU - Roger, Veronique Lee

AU - Singh, Prachi

AU - Lopez-Jimenez, Francisco

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