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Cited by 43Obesity, Physical Activity, DietDiabetes, Cardiovascular Risks, and LipoproteinsCancer Risks and Factors

General and Abdominal Adiposity and Mortality in Mexico City: A Prospective Study of 150 000 Adults

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Gnatiuc, Louisa, Alegre-Díaz, Jesus, Wade, Rachel, Ramirez-Reyes, Raúl, Tapia-Conyer, Roberto, Garcilazo-Ávila, Adrián, Chiquete, Erwin, Gonzáles-Carballo, Carlos +9 more·2019·Annals of Internal Medicine
DOI 10.7326/m18-3502PMC PMC6949137
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Abstract

Background: Some reports suggest that body mass index (BMI) is not strongly associated with mortality in Hispanic populations. Objective: To assess the causal relevance of adiposity to mortality in Mexican adults, avoiding reverse causality biases. Design: Prospective study. Setting: 2 Mexico City districts. Participants: 159 755 adults aged 35 years and older at recruitment, followed for up to 14 years. Participants with a hemoglobin A1c level of 7% or greater, diabetes, or other chronic diseases were excluded. Measurements: BMI, waist-to-hip ratio, waist circumference, and cause-specific mortality. Cox regression, adjusted for confounders, yielded mortality hazard ratios (HRs) after at least 5 years of follow-up and before age 75 years. Results: Among 115 400 participants aged 35 to <75 years at recruitment, mean BMI was 28.0 kg/m2 (SD, 4.1 kg/m2) in men and 29.6 kg/m2 (SD, 5.1 kg/m2) in women. The association of BMI at recruitment with all-cause mortality was J-shaped, with the minimum at 25 to <27.5 kg/m2. Above 25 kg/m2, each 5-kg/m2 increase in BMI was associated with a 30% increase in all-cause mortality (HR, 1.30 [95% CI, 1.24 to 1.36]). This association was stronger at ages 40 to <60 years (HR, 1.40 [CI, 1.30 to 1.49]) than at ages 60 to <75 years (HR, 1.24 [CI, 1.17 to 1.31]) but was not materially affected by sex, smoking, or other confounders. The associations of mortality with BMI and waist-to-hip ratio were similarly strong, and each was weakened only slightly by adjustment for the other. Waist circumference was strongly related to mortality and remained so even after adjustment for BMI and hip circumference. Limitation: Analyses were limited to mortality. Conclusion: General, and particularly abdominal, adiposity were strongly associated with mortality in this Mexican population. Primary Funding Source: Mexican Health Ministry, Mexican National Council of Science and Technology, Wellcome Trust, Medical Research Council, and Kidney Research UK.

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Authors
Gnatiuc, L., Alegre-Díaz, J., Wade, R., Ramirez-Reyes, R., Tapia-Conyer, R., Garcilazo-Ávila, A., Chiquete, E., Gonzáles-Carballo, C., Solano-Sanchez, M., Clarke, R., Collins, R., Herrington, W. G., Hill, M., Lewington, S., Peto, R., Emberson, J. R., & Kuri-Morales, P.
Affiliations
  • University of Oxford (GB)
  • National Autonomous University of Mexico, Mexico City, Mexico (J.A., R.R., R.T., A.G., C.G., M.S., P.K.)
  • Universidad Nacional Autónoma de México (MX)
  • Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (MX)
ORCID
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
2019-09-17
Volume
171
Issue
6
Pages
397-405
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/m18-3502
PMC
PMC6949137
OpenAlex
W2966964591
Cited by
43
References
17
Citations by year
2026: 7 · 2025: 4 · 2024: 10 · 2023: 6 · 2022: 5 · 2021: 6 · 2020: 5
FWCI
3.68
Type
journal article
Language
en
Open access
Licence
www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Wellcome Trust (098381, 090532, 058299)
  • British Heart Foundation (CH/1996001/9454)
  • Kidney Research UK (JFDKcsf2/2017)
  • Medical Research Council (MC_UU_00017/2, MR/R007764/1)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Oncology › Cancer Risks and Factors
Keywords
body mass index, abdominal fat, waist-to-hip ratio, waist circumference, all-cause mortality, Hispanic population, Mexican adults, reverse causality, J-shaped association, age-specific mortality, Mexico City
MeSH terms
Adult, Aged, Female, Humans, Male, Mexico, Middle Aged, Prospective Studies, Urban Population, Body Mass Index, Waist-Hip Ratio, Adiposity, Waist Circumference, Obesity, Abdominal

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