Joint association between body fat and its distribution with all-cause mortality: A data linkage cohort study based on NHANES (1988-2011)
Open accessAbstract
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.
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BMI estimates fat amount but is not precise in measuring fat distribution, such as abdominal fat or central fatness, which are better predictors of the risk of mortality.
“As mentioned previously, BMI estimates fat amount but is not precise in measuring fat distribution, as with abdominal fat or central fatness, which are better predictors of the risk of mortality [50].”
From Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity (2024) · cites this paper as [50]
The Introduction (page unavailable) says BMI cannot determine body-fat distribution, and the Discussion (page unavailable) says waist–hip ratio provides additional information about distribution and is associated with mortality. The paper does not establish that abdominal or central fatness measures are better predictors of mortality than BMI. (LLM, conf=0.86)
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- Authors
- Dong, B., Peng, Y., Wang, Z., Adegbija, O., Hu, J., Ma, J., & Ma, Y.-H.
- Affiliations
- Peking University (CN)
- The University of Queensland (AU)
- Institute for Urban Indigenous Health (AU)
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-02-23
- Volume
- 13
- Issue
- 2
- Pages
- e0193368
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5825095
- OpenAlex
- W2791036074
- Semantic Scholar
- ae07e87179053bb363de48c2b604261a45131a6e
- Cited by
- 36
- References
- 27
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 6 · 2023: 6 · 2022: 3 · 2021: 7 · 2020: 3 · 2019: 4 · 2018: 1
- FWCI
- 3.57
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Griffith Research Online (submittedVersion, cc-by)
- Funders
- National Health and Medical Research Council (APP1042343)
- University of Queensland International Scholarship (44078179)
- Excellent Talents Fund Program of Peking University Health Science Center (BMU2017YJ002)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- body fat percentage, body fat distribution, waist-to-hip ratio, all-cause mortality, obesity, U-shaped relationship, sex differences, bioelectrical impedance analysis, NHANES, mortality risk
- MeSH terms
- Adipose Tissue, Adolescent, Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mortality, Risk Factors, United States, Proportional Hazards Models, Electric Impedance, Waist-Hip Ratio, Body Fat Distribution, Young Adult
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