Relationship Among Body Fat Percentage, Body Mass Index, and All-Cause Mortality: A Cohort Study
Abstract
BACKGROUND: Prior mortality studies have concluded that elevated body mass index (BMI) may improve survival. These studies were limited because they did not measure adiposity directly. OBJECTIVE: To examine associations of BMI and body fat percentage (separately and together) with mortality. DESIGN: Observational study. SETTING: Manitoba, Canada. PARTICIPANTS: Adults aged 40 years or older referred for bone mineral density (BMD) testing. MEASUREMENTS: Participants had dual-energy x-ray absorptiometry (DXA), entered a clinical BMD registry, and were followed using linked administrative databases. Adjusted, sex-stratified Cox models were constructed. Body mass index and DXA-derived body fat percentage were divided into quintiles, with quintile 1 as the lowest, quintile 5 as the highest, and quintile 3 as the reference. RESULTS: The final cohort included 49 476 women (mean age, 63.5 years; mean BMI, 27.0 kg/m2; mean body fat, 32.1%) and 4944 men (mean age, 65.5 years; mean BMI, 27.4 kg/m2; mean body fat, 29.5%). Death occurred in 4965 women over a median of 6.7 years and 984 men over a median of 4.5 years. In fully adjusted mortality models containing both BMI and body fat percentage, low BMI (hazard ratio [HR], 1.44 [95% CI, 1.30 to 1.59] for quintile 1 and 1.12 [CI, 1.02 to 1.23] for quintile 2) and high body fat percentage (HR, 1.19 [CI, 1.08 to 1.32] for quintile 5) were associated with higher mortality in women. In men, low BMI (HR, 1.45 [CI, 1.17 to 1.79] for quintile 1) and high body fat percentage (HR, 1.59 [CI, 1.28 to 1.96] for quintile 5) were associated with increased mortality. LIMITATIONS: All participants were referred for BMD testing, which may limit generalizability. Serial measures of BMD and weight were not used. Some measures, such as physical activity and smoking, were unavailable. CONCLUSION: Low BMI and high body fat percentage are independently associated with increased mortality. These findings may help explain the counterintuitive relationship between BMI and mortality. PRIMARY FUNDING SOURCE: None.
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When obesity was defined by BF%, obesity became related to higher death rate.
“When obesity was defined by BF%, obesity became related to higher death rate (14).”
From The role of obesity in sarcopenia and the optimal body composition to prevent against sarcopenia and obesity (2023) · cites this paper as [14]
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- Authors
- Padwal, R., Leslie, W. D., Lix, L. M., & Majumdar, S. R.
- Affiliations
- University of Alberta (CA)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2016-04-19
- Volume
- 164
- Issue
- 8
- Pages
- 532-541
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2317448648
- Cited by
- 235
- References
- 36
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 31 · 2023: 21 · 2022: 36 · 2021: 23 · 2020: 26 · 2019: 28 · 2018: 22 · 2017: 18 · 2016: 14
- FWCI
- 22.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Keywords
- body mass index, all-cause mortality, adiposity, obesity paradox, sex differences, bone mineral density, older adults, dual-energy X-ray absorptiometry, mortality risk factors, physical activity, smoking, alcohol consumption, cardiovascular disease, cancer, dementia, chronic kidney disease, chronic liver disease, chronic obstructive pulmonary disease
- MeSH terms
- Aged, Female, Humans, Male, Manitoba, Middle Aged, Mortality, Obesity, Cohort Studies, Absorptiometry, Photon, Body Mass Index, Proportional Hazards Models, Adiposity, Overweight
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