Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul;29(7):692-700.
doi: 10.1016/j.numecd.2019.03.005. Epub 2019 Mar 15.

Body mass index and body fat distribution and new-onset atrial fibrillation: Substudy of the European Prospective Investigation into Cancer and Nutrition in Norfolk (EPIC-Norfolk) study

J Neefs  1 , S M Boekholdt  1 , K-T Khaw  2 , R Luben  2 , R Pfister  3 , N J Wareham  4 , E R Meulendijks  1 , P Sanders  5 , J R de Groot  6
Affiliations

Body mass index and body fat distribution and new-onset atrial fibrillation: Substudy of the European Prospective Investigation into Cancer and Nutrition in Norfolk (EPIC-Norfolk) study

J Neefs et al. Nutr Metab Cardiovasc Dis. 2019 Jul.

Abstract

Background and aim: Obesity is a recognized risk factor for new-onset atrial fibrillation (AF). The association between body fat distribution, which is measured by body mass index (BMI) and waist-hip ratio (WHR), its changes, and new-onset AF is conflicting.

Methods and results: Participants of the European Prospective Investigation into Cancer and Nutrition in Norfolk cohort study were included, with exclusion criteria of prevalent AF, rheumatic heart disease, and cancer. AF was confirmed by the International Classification of Diseases-10 hospital discharge code I48. Adjusted sex-specific Cox proportional hazards models were used to quantify the AF risk per 1 standard deviation increase and for quintiles of adiposity indices. A total of 10,885 men and 12,857 women were followed up for a median of 19 years, yielding 451,098 person-years. New-onset AF was diagnosed in 1408 (12.9%) men and 1102 (8.6%) women. Multivariable analyses showed that BMI predicted new-onset AF in all, while WHR predicted only in men. New-onset AF risk gradually increased across the range of adiposity indices: for men in the highest BMI quintile, HR: 1.59 (CI 1.32-1.91, p for trend<0.001), whereas for women in the highest BMI quintile, HR: 1.52 (CI 1.23-1.88, p for trend<0.001). Further, for men in the highest WHR quintile, HR: 1.31 (CI 1.09-1.57, p for trend: 0.01), whereas for women in the highest WHR quintile, HR: 1.12 (CI 0.90-1.41, p for trend: 0.17). The change in BMI and WHR was similar in participants with or without new-onset AF.

Conclusions: An increased body mass, as measured by BMI, is associated with an increased risk of developing new-onset AF. More abdominal fat distribution, as measured by WHR, is associated with an increased risk of developing new-onset AF in men but not in women.

Keywords: Abdominal fat; Atrial arrhythmia; Body mass index; Visceral fat; Waist–hip ratio.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Absolute number of men and women with new-onset atrial fibrillation by the sex-specific WHO cut-off values for overweight. Cut-off values: BMI >25 kg/m2 and WHR > 0.90 (men) or 0.85 (women) indicating obesity.
Figure 2
Figure 2
Sex-specific event rates of new-onset atrial fibrillation per 1,000 person years by quintiles (Q) of adiposity indices and the sex-specific WHO cut-off values for overweight. Statistical significance was tested between quintiles around the WHO cut-off values for BMI and WHR indicating overweight.
Figure 3
Figure 3
Sex-specific cumulative hazard ratios of new-onset atrial fibrillation by quintiles (Q) of adiposity indices.
Figure 4
Figure 4
Sex-specific hazard ratios of new-onset atrial fibrillation among 9,454 men (1,406 cases) and 12,834 women (1,100 cases) by quintiles of adiposity indices, adjusted for age, diabetes mellitus, systolic blood pressure, thyroid disease and total cholesterol. CI: confidence interval.
See this image and copyright information in PMC

References

    1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace: European pacing, arrhythmias, and cardiac electrophysiology: journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2016;18(11):1609–1678. - PubMed
    1. Tedrow UB, Conen D, Ridker PM, Cook NR, Koplan BA, Manson JE, et al. The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (women's health study) Journal of the American College of Cardiology. 2010;55(21):2319–27. - PMC - PubMed
    1. Wanahita N, Messerli FH, Bangalore S, Gami AS, Somers VK, Steinberg JS. Atrial fibrillation and obesity--results of a meta-analysis. American heart journal. 2008;155(2):310–5. - PubMed
    1. Wang TJ, Parise H, Levy D, D'Agostino RB, Wolf PA, Vasan RS, et al. Obesity and the risk of new-onset atrial fibrillation. JAMA. 2004;292(20):2471–7. - PubMed
    1. Fenger-Gron M, Overvad K, Tjonneland A, Frost L. Lean Body Mass Is the Predominant Anthropometric Risk Factor for Atrial Fibrillation. Journal of the American College of Cardiology. 2017;69(20):2488–2497. - PubMed

Publication types

MeSH terms