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The journal of nutrition, health & aging

, Volume 22, Issue 8, pp 975–981 | Cite as

BMI, Waist Circumference and All-Cause Mortality in a Middle-Aged and Elderly Chinese Population

  • H. Hu
  • J. Wang
  • X. Han
  • Y. Li
  • F. Wang
  • J. Yuan
  • X. Miao
  • H. Yang
  • Meian He
Article

Abstract

Objective

To investigate the association of obesity and all-cause mortality in a sample of middle-aged and elderly population.

Design and Setting

Information of participants was collected in the Dongfeng-Tongji study, a perspective cohort study of Chinese occupational population. The main outcome was risk of death after 8.5 years of follow-up.

Participants and measurements

We examined the association of BMI, waist circumference (WC, and waist–height ratio (WHtR) with all-cause mortality in the Dongfeng-Tongji cohort study (n=26,143). Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality. Area under the receiver operating characteristic curves and net reclassification improvement (NRI) were used to calculate the power of prediction models.

Results

During a mean of 8.5 years of follow-up, 2,246 deaths were identified. There is a U-shaped association of BMI with all-cause mortality in the middle-aged and elderly Chinese population. Compared with individuals with normal BMI, underweight was positively (HR=2.16, 95% CI: 1.73, 2.69) while overweight (HR=0.75, 95% CI: 0.67, 0.84) and obesity (HR=0.67, 95% CI: 0.56, 0.79) were negatively associated with all-cause mortality after adjustment for potential confounders including WC. In contrast, WC (Q5 vs. Q1, HR=1.55, 95% CI: 1.29, 1.86) and WHtR (Q5 vs.Q1, HR=1.69, 95% CI: 1.40, 2.04) were positively associated with mortality after further adjustment for BMI (P trend < 0.001). Addition of both BMI and WC into the all-cause mortality predictive model significantly increased AUC (P =0.0002) and NRI (NRI = 2.57%, P = 0.0007).

Conclusions

BMI and WC/WHtR were independently associated with all-cause mortality after mutual adjustment. Combination of BMI and WC/WHtR improved the predictive ability of all-cause mortality risk in the middle-aged and elderly population.

Key words

Prospective cohort body-shape death 

Supplementary material

12603_2018_1047_MOESM1_ESM.docx (654 kb)
Supplemental Document

References

  1. 1.
    Zamboni M, Mazzali G, Zoico E, et al. Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes (Lond). 2005;29(9):1011–1029. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/15925957 CrossRefGoogle Scholar
  2. 2.
    Tamakoshi A, Yatsuya H, Lin Y, et al. BMI and all-cause mortality among Japanese older adults: findings from the Japan collaborative cohort study. Obesity (Silver Spring). 2010;18(2):362–369. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/19543206 CrossRefGoogle Scholar
  3. 3.
    Winter JE, MacInnis RJ, Wattanapenpaiboon N, Nowson CA. BMI and all-cause mortality in older adults: a meta-analysis. Am J Clin Nutr. 2014;99(4):875–890. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/24452240 CrossRefPubMedGoogle Scholar
  4. 4.
    Wirth R, Streicher M, Smoliner C, et al. The impact of weight loss and low BMI on mortality of nursing home residents -Results from the nutritionDay in nursing homes. Clin Nutr. 2015:1–7. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/26143743 Google Scholar
  5. 5.
    Price GM, Uauy R, Breeze E, Bulpitt CJ, Fletcher AE. Weight, shape, and mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death. Am J Clin Nutr. 2006;84(2):449–460. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/16895897 CrossRefPubMedGoogle Scholar
  6. 6.
    Flicker L, McCaul KA, Hankey GJ, et al. Body mass index and survival in men and women aged 70 to 75. J Am Geriatr Soc. 2010;58(2):234–241. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/20370857 CrossRefPubMedGoogle Scholar
  7. 7.
    Janssen I. Morbidity and mortality risk associated with an overweight BMI in older men and women. Obesity (Silver Spring). 2007;15:1827–1840. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/17636102 CrossRefGoogle Scholar
  8. 8.
    Flegal KM, Kit BK, Orpalna H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories. JAMA. 2013;309(1):71–82. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/23280227 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Zaccardi F, Dhalwani NN, Papamargaritis D, et al. Nonlinear association of BMI with all-cause and cardiovascular mortality in type 2 diabetes mellitus: a systematic review and meta-analysis of 414,587 participants in prospective studies. Diabetologia. 2017;60(2):240–248. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/27888288 CrossRefPubMedGoogle Scholar
  10. 10.
    Cameron AJ, Magliano DJ, Soderberg S. A systematic review of the impact of including both waist and hip circumference in risk models for cardiovascular diseases, diabetes and mortality. Obes Rev. 2013;14(1):86–94. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/23072327 CrossRefPubMedGoogle Scholar
  11. 11.
    Cerhan JR, Moore SC, Jacobs EJ, et al. A pooled analysis of waist circumference and mortality in 650,000 adults. Mayo Clin Proc. 2014;89(3):335–345. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/24582192 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Hollander EL, Bemelmans WJ, Boshuizen HC, et al. The association between waist circumference and risk of mortality considering body mass index in 65-to 74-yearolds: a meta-analysis of 29 cohorts involving more than 58 000 elderly persons. Int J Epidemiol. 2012;41(3):805–817. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/22467292 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Guallar-Castillon P, Balboa-Castillo T, Lopez-Garcia E, et al. BMI, waist circumference, and mortality according to health status in the older adult population of Spain. Obesity (Silver Spring). 2009;17(12):2232–2238. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/19360008 CrossRefGoogle Scholar
  14. 14.
    Wang F, Zhu J, Yao P, et al. Cohort profile: the Dongfeng-Tongji cohort study of retired workers. Int J Epidemiol. 2013;42(3):731–740. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/22531126 CrossRefPubMedGoogle Scholar
  15. 15.
    Sun DM, Li FF, Zhang Y, Xu XM. Associations of the pre-pregnancy BMI and gestational BMI gain with pregnancy outcomes in Chinese women with gestational diabetes mellitus. Int J Clin Exp Med. 2014;7(12):5784–5789. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/25664107 PubMedPubMedCentralGoogle Scholar
  16. 16.
    Ishikawa Y, Furuta R, Miyoshi T, et al. Loss of heterozygosity and the smoking index increase with decrease in differentiation of lung adenocarcinomas:etiologic implications. Cancer Letters. 2002;187:47–51. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/12359350 CrossRefPubMedGoogle Scholar
  17. 17.
    Roberson LL, Aneni EC, Maziak W, et al. Beyond BMI: The “Metabolically healthy obese”phenotype & its association with clinical/subclinical cardiovascular disease and all-cause mortality–a systematic review. BMC Public Health. 2014;14:14–27. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/24400816 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Rolland Y, Gallini A, Cristini C, et al. Body-composition predictors of mortality in women aged >/= 75 y: data from a large population-based cohort study with a 17-y follow-up. Am J Clin Nutr. 2014;100(5):1352–1360. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/25332333 CrossRefPubMedGoogle Scholar
  19. 19.
    Tam CH, Ho JS, Wang Y, et al. Use of net reclassification improvement (NRI) method confirms the utility of combined genetic risk score to predict type 2 diabetes. PLoS One. 2013;8(12):e83093. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/24376643 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Petursson H, Sigurdsson JA, Bengtsson C, Nilsen TI, Getz L. Body configuration as a predictor of mortality: comparison of five anthropometric measures in a 12 year follow-up of the Norwegian HUNT 2 study. PLoS One. 2011;6(10):e26621. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/22028926 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Gao S, Jin Y, Unverzagt FW, Cheng Y, Su L, Wang CK. Cognitive function, body mass index and mortality in a rural elderly Chinese cohort. Arch Public Health. 2014;72:9–17. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/24666663 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Pan WH, Yeh WT, Chen HJ, Chuang SY, Chang HY, Chen L. The U-shaped relationship between BMI and all-cause mortality contrasts with a progressive increase in medical expenditure: a prospective cohort study. Asia Pac J Clin Nutr. 2012;21(4):577–587. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/23017316 PubMedGoogle Scholar
  23. 23.
    Lin WY, Tsai SL, Albu JB, Lin CC, Li TC, Pi-Sunyer FX. Body mass index and allcause mortality in a large Chinese cohort. CMAJ. 2011;183(6):645–646. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/21398244 CrossRefGoogle Scholar
  24. 24.
    Nakajima K, Yamaoka H, Morita K, et al. Elderly people with low body weight may have subtle low-grade inflammation. Obesity (Silver Spring). 2009;17(4):803–808. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/19131938 CrossRefGoogle Scholar
  25. 25.
    Szulc P, Duboeuf F, Marchand F, Delmas PD. Hormonal and lifestyle determinants of appendicular skeletal muscle mass in men: the MINOS study. Am J Clin Nutr. 2004;80(2):496–503. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/15277176 CrossRefPubMedGoogle Scholar
  26. 26.
    Tobias DK, Pan A, Jackson CL, et al. Body-mass index and mortality among adults with incident type 2 diabetes. N Engl J Med. 2014;370(3):233–244. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/24428469 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Gary Whitlock SL. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083–1096. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/19299006 CrossRefPubMedGoogle Scholar
  28. 28.
    Aune D, Sen A, Prasad M, et al. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ. 2016;353:i2156. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/27146380 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Chung WS, Ho FM, Cheng NC, Lee MC, Yeh CJ. BMI and all-cause mortality among middle-aged and older adults in Taiwan: a population-based cohort study. Public Health Nutr. 2015;18(10):1839–1846. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/25482035 CrossRefPubMedGoogle Scholar
  30. 30.
    Wang Z, Dong B, Hu J, Adegbija O, Arnold LW. Exploring the non-linear association between BMI and mortality in adults with and without diabetes: the US National Health Interview Survey. Diabetic Medicine. 2016;33(12):1691–1699. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/26972695 CrossRefPubMedGoogle Scholar
  31. 31.
    Dankner R, Shanik M, Roth J, Luski A, Lubin F, Chetrit A. Sex and ethnic-origin specific BMI cut points improve prediction of 40-year mortality: the Israel GOH study. Diabetes Metab Res Rev. 2015;31(5):530–536. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/25689480 CrossRefPubMedGoogle Scholar
  32. 32.
    Padwal R, Leslie WD, Lix LM, Majumdar SR. Relationship Among Body Fat Percentage, Body Mass Index, and All-Cause Mortality: A Cohort Study. Ann Intern Med. 2016;164(8):532–541. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/26954388 CrossRefPubMedGoogle Scholar
  33. 33.
    Clark DO, Gao S, Lane KA, et al. Obesity and 10-year mortality in very old African Americans and Yoruba-Nigerians: exploring the obesity paradox. J Gerontol A Biol Sci Med Sci. 2014;69(9):1162–1169. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/24694355 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Thinggaard M, Jacobsen R, Jeune B, Martinussen T, Christensen K. Is the relationship between BMI and mortality increasingly U-shaped with advancing age? A 10-year follow-up of persons aged 70–95 years. J Gerontol A Biol Sci Med Sci. 2010;65(5):526–531. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/20089666 CrossRefPubMedGoogle Scholar
  35. 35.
    Angelantonio ED, Bhupathiraju SN, Wormser D, et al. Body-mass index and allcause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. The Lancet. 2016;388:776–786. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/27423262 CrossRefGoogle Scholar
  36. 36.
    Lu Y, Hajifathalian K, Majid Ezzati M, Woodward M, Rimm EB, Danaei G. Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1•8 million participants. The Lancet. 2014;383(9921):970–983. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/24269108 CrossRefGoogle Scholar
  37. 37.
    Staiano AE, Reeder BA, Elliott S, et al. Body mass index versus waist circumference as predictors of mortality in Canadian adults. Int J Obes (Lond). 2012;36(11):1450–1454. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/22249224 CrossRefPubMedCentralGoogle Scholar
  38. 38.
    Janssen I, Katzmarzyk PT, Ross R. Body mass index is inversely related to mortality in older people after adjustment for waist circumference. JAGS. 2005;53(12):2112–2118. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/16398895 CrossRefGoogle Scholar
  39. 39.
    Ferreira I, Snijder MB, Twisk JWR, et al. Central fat mass versus peripheral fat and lean mass: opposite (adverse versus favorable) associations with arterial stiffness? The amsterdam growth and health longitudinal study. J Clin Endocrinol Metab. 2004;89(6):2632–2639. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/15181034 CrossRefPubMedGoogle Scholar
  40. 40.
    Snijder MB, Dekker JM, Visser M, et al. Trunk fat and leg fat have independent and opposite associations with fasting and postload glucose levels: The Hoorn Study. Diabetes Care. 2004;27:372–377. https://doi.org/www.ncbi.nlm.nih.gov/pubmed/14747216 CrossRefPubMedGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • H. Hu
    • 1
  • J. Wang
    • 1
  • X. Han
    • 1
  • Y. Li
    • 1
  • F. Wang
    • 1
  • J. Yuan
    • 1
  • X. Miao
    • 2
  • H. Yang
    • 3
  • Meian He
    • 1
  1. 1.Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhan, HubeiChina
  2. 2.Department of Epidemiology and Biostatistics, School of Public HealthTongji Medical College Huazhong University of Science and TechnologyWuhan, HubeiChina
  3. 3.Dongfeng Central HospitalDongfeng Motor Corporation and Hubei University of MedicineShiyan, HubeiChina

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