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. 2018 Feb 23;13(2):e0193368.
doi: 10.1371/journal.pone.0193368. eCollection 2018.

Joint association between body fat and its distribution with all-cause mortality: A data linkage cohort study based on NHANES (1988-2011)

Bin Dong  1 , Yang Peng  2 , Zhiqiang Wang  2 , Odewumi Adegbija  2 , Jie Hu  3 , Jun Ma  1 , Ying-Hua Ma  1
Affiliations

Joint association between body fat and its distribution with all-cause mortality: A data linkage cohort study based on NHANES (1988-2011)

Bin Dong et al. PLoS One. .

Abstract

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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Conflict of interest statement

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

Figures

Fig 1
Fig 1
Association between body fat percentage (A and B) and waist-hip ratio (C and D) with hazard ratio of all-cause mortality in males and females, NHAHES 1988–2011. Notes: Solid lines and dash lines represent the hazard ratios and their 95% confidence intervals after adjusting for baseline age and ethnicity.
Fig 2
Fig 2
Hazard ratios of all-cause mortality in males (A and B) and females (C and D) with various body fat percentage categories, NHAHES 1988–2011. Notes: CI, confidence interval. Body fat percentage categories of 25–30 in males and 30–35 in females were used as the reference groups. Model 1 (A and C) was adjusted for baseline age and ethnicity. Model 2 (B and D) was adjusted for baseline age, ethnicity, household income, year of education, urbanization, physical activity, alcohol intake, smoking status, and hypertension.
Fig 3
Fig 3
Hazard ratios of all-cause mortality in males (A and B) and females (C and D) with various waist-hip ratio (WHR) categories, NHAHES 1988–2011. Notes: CI, confidence interval. WHR category of 0.95–1.00 in males and 0.90–0.95 in females was used as the reference group. Model 1 (A and C) was adjusted for baseline age and ethnicity. Model 2 (B and D) was adjusted for baseline age, ethnicity, household income, year of education, urbanization, physical activity, alcohol intake, smoking status, and hypertension.
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