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Introduction: Abdominal fat is associated with an elevated mortality risk and higher healthcare costs. Body mass index (BMI), commonly used to measure body fatness, underestimates excess abdominal fat due to its limited accuracy in reflecting fat and muscle distribution. Waist circumference (WC) is a more precise indicator of central obesity, which is defined as excess abdominal fat accumulation. The joint associations of combined BMI and WC with mortality risk in the diabetes population are not fully understood. Methods: We included individuals with diabetes and at least one measure of BMI and WC, from 2011, 2013, and 2015 waves with follow-up to 2018 in CHARLS. All individuals were classified into four groups: normal weight without central obesity, normal weight with central obesity (WC, male ≥ 90 cm, female ≥ 85 cm), overweight (BMI ≥ 24 kg/m 2 ) without central obesity, and overweight with central obesity. Multivariable logistic regression was used to model the associations between four groups and the mortality risk among people with diabetes adjusted for demographic characteristics, smoking, drinking, multimorbidities, and diabetes treatment. Results: Among 940 participants (mean age 60.4 years, 58.3% women), there were 124 incident cases of death recorded. Compared to normal weight without central obesity group, the mortality risk was increased among normal weight with central obesity group (Adjusted odds ratio = 2.11, 95% CI: 1.07, 4.18). Other groups exhibited no statistically significant association with mortality risk (Figure 1). In sensitivity analysis excluding individuals with BMI ≤ 18.5 kg/m 2 , results were largely consistent with the previous findings. Conclusions: A significant association between central obesity and increased mortality risk in diabetes population was revealed. While, overweight with central obesity showed no significant association to mortality risk. Our findings stress the importance of customized strategies for central obesity in the diabetes population to reduce medical expenses.
Zhang et al. (Tue,) studied this question.