Joint association between body fat and its distribution with all-cause mortality: A data linkage cohort study based on NHANES (1988-2011).

PloS one. 2018;13(2):e0193368

Plain language summary

Recent findings suggest both underweight and obesity based on body mass index (BMI) were associated with the increased risk of mortality. As BMI cannot discriminate between lean mass and body fat mass, it is unclear whether the amount and distribution of body fat impacts mortality risk. Therefore, the aim of this study was to assess whether fat distribution confers any additional risk of mortality in addition to fat amount. This data linkage cohort study included 16415 participants aged 18 to 89 from the National Health and Nutrition Examination Survey (NHANES) and its linked mortality data. A total of 4999 deaths occurred during the 19-year follow up and body fat percentages were estimated based on bioelectrical impedance analysis and waist-hip ratio (WHR). This study showed both body fat percentage and WHR are independently associated with mortality. Based on these findings the authors conclude both the amount of body fat and its distribution should be considered with assessing all-cause mortality risk.

Abstract

OBJECTIVE Although obesity is recognized as an important risk of mortality, how the amount and distribution of body fat affect mortality risk is unclear. Furthermore, whether fat distribution confers any additional risk of mortality in addition to fat amount is not understood. METHODS This data linkage cohort study included 16415 participants (8554 females) aged 18 to 89 years from National Health and Nutrition Examination Survey III (1988-1994) and its linked mortality data (31 December 2011). Cox proportional hazard models and parametric survival models were used to estimate the association between body fat percentage (BF%), based on bioelectrical impedance analysis, and waist-hip ratio (WHR) with mortality. RESULTS A total of 4999 deaths occurred during 19-year follow-up. A U-shaped association between BF% and mortality was found in both sexes, with the adjusted hazard ratios for other groups between 1.02 (95% confidence interval: 0.89, 1.18) and 2.10 (1.47, 3.01) when BF% groups of 25-30% in males and 30-35% in females were used as references. A non-linear relationship between WHR and mortality was detected in males, with the adjusted hazard ratios among other groups ranging from 1.05 (0.94, 1.18) to 1.52 (1.15, 2.00) compared with the WHR category of 0.95-1.0. However in females, the death risk constantly increased across the WHR spectrum. Joint impact of BF% and WHR suggested males with BF% of 25-30% and WHR of 0.95-1.0 and females with BF% of 30-35% and WHR <0.9 were associated with the lowest mortality risk and longest survival age compared with their counterparts in other categories. CONCLUSIONS This study supported the use of body fat distribution in addition to fat amount in assessing the risk of all-cause mortality.

Lifestyle medicine

Fundamental Clinical Imbalances : Structural
Patient Centred Factors : Mediators/Body fat
Environmental Inputs : Diet ; Nutrients
Personal Lifestyle Factors : Nutrition ; Exercise and movement
Functional Laboratory Testing : Not applicable

Methodological quality

Allocation concealment : Not applicable

Metadata

Nutrition Evidence keywords : NHANES ; Obesity ; BMI ; Body mass index ; Body fat percentage ; WHR