Being overweight with a higher waist-to-hip ratio was associated with substantial excess mortality (HR 1.41; 95% CI 1.25-1.61) compared with being normal weight with a lower waist-to-hip ratio.
Cohort (n=130,473)
Does central adiposity combined with BMI predict mortality and incident CAD in older adults?
The apparent 'obesity paradox' in older adults may be explained by failing to account for central adiposity, as higher waist-to-hip ratio is associated with increased mortality and CAD regardless of BMI.
Hazard Ratio: 1.41 (95% CI 1.25–1.61)
For older groups, being overweight body mass index (BMI; in kg/m2): 25 to <30 is reportedly associated with a lower or similar risk of mortality than being normal weight (BMI: 18.5 to <25). However, this “risk paradox” is partly explained by smoking and disease-associated weight loss. This paradox may also arise from BMI failing to measure fat redistribution to a centralized position in later life. This study aimed to estimate associations between combined measurements of BMI and waist-to-hip ratio (WHR) with mortality and incident coronary artery disease (CAD). This study followed 130,473 UK Biobank participants aged 60–69 y (baseline 2006–2010) for ≤8.3 y (n = 2974 deaths). Current smokers and individuals with recent or disease-associated (e.g., from dementia, heart failure, or cancer) weight loss were excluded, yielding a “healthier agers” group. Survival models were adjusted for age, sex, alcohol intake, smoking history, and educational attainment. Population and sex-specific lower and higher WHR tertiles were <0.91 and ≥0.96 for men and <0.79 and ≥0.85 for women, respectively. Ignoring WHR, the risk of mortality for overweight subjects was similar to that for normal-weight subjects (HR: 1.09; 95% CI: 0.99, 1.19; P = 0.066). However, among normal-weight subjects, mortality increased for those with a higher WHR (HR: 1.33; 95% CI: 1.08, 1.65) compared with a lower WHR. Being overweight with a higher WHR was associated with substantial excess mortality (HR: 1.41; 95% CI: 1.25, 1.61) and greatly increased CAD incidence (sub-HR: 1.64; 95% CI: 1.39, 1.93) compared with being normal weight with a lower WHR. There was no interaction between physical activity and BMI plus WHR groups with respect to mortality. For healthier agers (i.e., nonsmokers without disease-associated weight loss), having central adiposity and a BMI corresponding to normal weight or overweight is associated with substantial excess mortality. The claimed BMI-defined overweight risk paradox may result in part from failing to account for central adiposity, rather than reflecting a protective physiologic effect of higher body-fat content in later life.
Bowman et al. (Thu,) conducted a cohort in Aging (n=130,473). Overweight with a higher waist-to-hip ratio (WHR) vs. Normal weight with a lower WHR was evaluated on mortality (HR 1.41, 95% CI 1.25, 1.61). Being overweight with a higher waist-to-hip ratio was associated with substantial excess mortality (HR 1.41; 95% CI 1.25-1.61) compared with being normal weight with a lower waist-to-hip ratio.
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