Abdominal Adiposity and mortality in Chinese women

Department of Medicine, Vanderbilt University, Нашвилл, Michigan, United States
Archives of Internal Medicine (Impact Factor: 17.33). 05/2007; 167(9):886-92. DOI: 10.1001/archinte.167.9.886
Source: PubMed


Increased abdominal adiposity has been linked to an increase in mortality in populations where many are overweight or obese; it is unclear whether the same is true in relatively lean populations.
We examined the association between waist-hip ratio and mortality in the Shanghai Women's Health Study, a population-based, prospective cohort study of Chinese women aged 40 to 70 years enrolled from December 28, 1996, through May 23, 2000, 95% of whom had a body mass index (calculated as weight in kilograms divided by height in meters squared) of less than 30.0. Included in this analysis were 72 773 nonsmoking women who had anthropometrics taken by trained interviewers at enrollment and who were followed up through December 31, 2004. Deaths were ascertained by biennial home visits and linkage with the vital statistics registry.
During a mean follow-up of 5.7 years, 1456 deaths occurred. The waist-hip ratio was positively and significantly associated with deaths from all causes, cardiovascular disease, and diabetes (P<.01 for trend). A less significant positive association was found for death from cancer. After adjustment for body mass index and other potential confounders, the relative risks of total mortality were 1 (reference group), 1.28 (95% confidence interval [CI], 1.04-1.58), 1.40 (95% CI, 1.14-1.72), 1.54 (95% CI, 1.26-1.88), and 1.95 (95% CI, 1.60-2.38) across the lowest to the highest waist-hip ratio quintiles. The positive association appeared to be more evident in women with a lower body mass index. The relative risks of total mortality comparing the extreme waist-hip ratio quintiles were 2.36 (95% CI, 1.71-3.27), 1.60 (95% CI, 1.10-2.34), and 1.46 (95% CI, 0.97-2.20) for women with a body mass index of less than 22.3, 22.3 to 25.1, and 25.2 or greater, respectively.
Abdominal adiposity independently predicts mortality risk, particularly for nonobese women.

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    • "However, the relationship between mortality, and waist circumference and WHR is controversial among the older population (Reis et al. 2009; Visscher et al. 2001; Woo et al. 2002; Price et al. 2006; Pischon et al. 2008; Jacobs et al. 2010). While some found a more linear relationship between WHR and mortality (Lindqvist et al. 2006; Price et al. 2006; Zhang et al. 2007), others were more in favor of the waist circumference (Visscher et al. 2001; Woo et al. 2002; Pischon et al. 2008; Jacobs et al. 2010). Dualenergy X-ray absorptiometry (DXA) can provide both accurate measurements of overall and regional adiposity (Snijder et al. 2006) and thus may help to elucidate the relationship between different measurements of abdominal fat, fat distribution, and mortality. "
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    ABSTRACT: In contrast to that in the middle-aged, higher body mass index (BMI) in older people is associated with higher survival rates. Yet, BMI makes no distinction between fat elsewhere and abdominal fat, the latter being metabolically more harmful. We hypothesized that overall adiposity might be protective in old age, but that central fat might offset that benefit and remained harmful as in the middle-aged. Three thousand nine hundred seventy-eight Chinese elderly ≥65 years had demographics, medical conditions, physical activity, and body composition by DXA recorded at baseline. Overall adiposity was measured as whole body fat%, and abdominal adiposity as waist circumference, waist-hip ratio, and relative abdominal fat (RAF) (relative abdominal fat = abdominal fat according to anatomical landmarks/whole body fat). Deaths within 1 year from baseline were excluded from analysis. All-cause and cardiovascular mortality were analyzed using Cox regression, adjusted for covariates. The lowest quintile of adiposity measurements was used for comparison. After a mean follow-up of 72.3 months, 13.7% men and 4.5% women had died. In men, the highest two quintiles of whole body fat % and the upper four quintiles of RAF were associated with significantly lower all-cause mortality, and adjusted hazard ratio (95% CI) in ascending quintiles of RAF compared with the lowest quintile was 0.62 (0.43-0.89), 0.58 (0.4-0.85), 0.52 (0.36-0.77), and 0.67 (0.47-0.96). No relationship was found between abdominal adiposity and cardiovascular mortality in both genders. Higher whole body fat % as well as higher proportion of abdominal fat was associated with lower all-cause mortality in men. No such relation was found in women.
    Age 06/2011; 34(3):597-608. DOI:10.1007/s11357-011-9272-y · 3.45 Impact Factor
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    • "There are sex differences between fat depots, as women have greater abdominal subcutaneous fat and far less intra-abdominal fat than men (Schreiner et al., 1996). Waist circumference (WC) and waist-to-hip ratio (WHR) are accurate predictors of disease and have shown to be better markers of all-cause mortality than BMI (vander Brandt and Goldbohm, 2006; Calling et al., 2006; Simpson et al., 2001; Zhang et al., 2007). A limitation of this method is that established cutoff points for abdominal obesity as set out by the World Health Organization (2000) may not be appropriate for non-Caucasian or nonadult age groups (Snijder et al., 2005). "
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