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. 2012;7(11):e50428.
doi: 10.1371/journal.pone.0050428. Epub 2012 Nov 30.

Differences between adiposity indicators for predicting all-cause mortality in a representative sample of United States non-elderly adults

Henry S Kahn  1 , Kai McKeever Bullard, Lawrence E Barker, Giuseppina Imperatore
Affiliations

Differences between adiposity indicators for predicting all-cause mortality in a representative sample of United States non-elderly adults

Henry S Kahn et al. PLoS One. 2012.

Abstract

Background: Adiposity predicts health outcomes, but this relationship could depend on population characteristics and adiposity indicator employed. In a representative sample of 11,437 US adults (National Health and Nutrition Examination Survey, 1988-1994, ages 18-64) we estimated associations with all-cause mortality for body mass index (BMI) and four abdominal adiposity indicators (waist circumference [WC], waist-to-height ratio [WHtR], waist-to-hip ratio [WHR], and waist-to-thigh ratio [WTR]). In a fasting subsample we considered the lipid accumulation product (LAP; [WC enlargement*triglycerides]).

Methods and findings: For each adiposity indicator we estimated linear and categorical mortality risks using sex-specific, proportional-hazards models adjusted for age, black ancestry, tobacco exposure, and socioeconomic position. There were 1,081 deaths through 2006. Using linear models we found little difference among indicators (adjusted hazard ratios [aHRs] per SD increase 1.2-1.4 for men, 1.3-1.5 for women). Using categorical models, men in adiposity midrange (quartiles 2+3; compared to quartile 1) were not at significantly increased risk (aHRs<1.1) unless assessed by WTR (aHR 1.4 [95%CI 1.0-1.9]). Women in adiposity midrange, however, tended toward elevated risk (aHRs 1.2-1.5), except for black women assessed by BMI, WC or WHtR (aHRs 0.7-0.8). Men or women in adiposity quartile 4 (compared to midrange) were generally at risk (aHRs>1.1), especially black men assessed by WTR (aHR 1.9 [1.4-2.6]) and black women by LAP (aHR 2.2 [1.4-3.5]). Quartile 4 of WC or WHtR carried no significant risk for diabetic persons (aHRs 0.7-1.1), but elevated risks for those without diabetes (aHRs>1.5). For both sexes, quartile 4 of LAP carried increased risks for tobacco-exposed persons (aHRs>1.6) but not for non-exposed (aHRs<1.0).

Conclusions: Predictions of mortality risk associated with top-quartile adiposity vary with the indicator used, sex, ancestry, and other characteristics. Interpretations of adiposity should consider how variation in the physiology and expandability of regional adipose-tissue depots impacts health.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Interactions with ancestral group for mortality risk at p25, by 6 adiposity indicators. (aHR = multiply adjusted hazard ratio).
Figure 2
Figure 2. Interactions with ancestral group for mortality risk at p75, by 6 adiposity indicators. (aHR = multiply adjusted hazard ratio).
Figure 3
Figure 3. Interactions with socioeconomic position (poverty-income ratio or high-school completion) for mortality risk at p75, by 6 adiposity indicators. (aHR = multiply adjusted hazard ratio).
Figure 4
Figure 4. Interactions with tobacco exposure for mortality risk at p75, by 6 adiposity indicators. (aHR multiply adjusted hazard ratio).
Figure 5
Figure 5. Interactions with baseline diabetes for mortality risk at p75, by 6 adiposity indicators. (aHR = multiply adjusted hazard ratio).
See this image and copyright information in PMC

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