Adiposity and mortality in Korean adults: a population-based prospective cohort study

Abstract

Background The Asia-Pacific obesity classification recommends using lower BMI cutoffs in Asians compared with those in Western populations. However, the supporting evidence is scarce and little is known about the exact shape of the relations between adiposity and mortality in Asians. Objectives We investigated the relations of BMI (in kg/m2), waist circumference, and predicted body fat mass with mortality using a population-based prospective cohort of Korean men and women. Methods This analysis included 44,060 Korea National Health and Nutrition Examination Survey 2007–2014 participants who agreed to mortality follow-up through 31 December, 2016. At baseline, height, weight, and waist circumference were measured. Using DXA data, we derived predicted body fat and fat-free mass. Cox proportional hazards models were used to estimate HRs and 95% CIs for the associations with mortality, adjusting for potential confounders. We tested for nonlinearity using the likelihood ratio test comparing nonlinear restricted cubic spline models with linear models. Results During ≤9.5 y of follow-up, 1682 deaths were identified. The relations of BMI with all-cause and cardiovascular mortality were J-shaped with the nadir at BMI = 25.0–29.9 (P-nonlinearity < 0.001). Among participants without a history of cancer or cardiovascular disease, waist circumference (≥95 compared with 75.0–79.9 cm: HR: 2.10; 95% CI: 1.54, 2.86) and predicted body fat mass (highest compared with lowest sextiles: 2.55; 95% CI: 1.60, 4.06) were positively associated with all-cause mortality (all P-nonlinearity ≤ 0.03), as well as cancer and cardiovascular mortality. The highest mortality was observed among participants who had both high predicted fat mass and low fat-free mass. Conclusions Our data suggest a strong positive association between adiposity and mortality in a population without pre-existing disease. We observed the lowest mortality at BMI = 25.0–29.9, suggesting that the current cutoff for overweight (BMI ≥23) may require re-evaluation and that BMI alone may not be a useful measure for indicating adiposity in Asians.

Non‐alcoholic fatty liver disease and sarcopenia additively increase mortality: a Korean nationwide survey

“…The J‐shaped relationship between BMI and mortality has been reported across the diverse population. 48 In the Korean population, the lowest mortality rate was observed in obese subjects (25–29.9 kg/m 2 ), 49 , 50 which suggests that among the Korean population with BMI < 30 kg/m 2 , there might be an inverse association between their BMI and mortality rate. In addition, Asians have a relatively higher proportion of non‐obese NAFLD, which exhibits distinct metabolic features and genetic alterations in PNPLA3 and TM6SF2 compared with obese NAFLD in Western population.…”

Effectiveness of Oral Hypoglycaemics in Type-2 Diabetes Mellitus Patients at a Tertiary Care Hospital : A Comparative Observational Study

“…As per statistical analysis, there was a solid clinical association between obesity and Type-2 DM [15].…”

Association of muscle wasting with mortality risk among adults: A systematic review and meta‐analysis of prospective studies

“…Forty‐nine articles with 66 reports reported muscle wasting‐related effect sizes for mortality risks due to all causes, 16–20,37–79 eight articles with 11 reports due to CVD, 45,49,51,55,61,65,68,74 three articles with 4 reports due to cancer, 51,61,65 three articles with 4 reports due to respiratory disease 51,61,68 and one article with 2 reports due to diabetes 55 . No available information was found for mortality from other causes.…”

“…The sample size ranged from 191 to 405 980. The total number of deaths was 61 055 (one trial not reported 46 ), 7520 (two trials not reported 51,65 ), 3726 (two trials not reported 51,65 ), 3537 (one trial not reported 51 ) and 107 from all causes, CVD, cancer, respiratory disease and diabetes, respectively. The mean age of participants ranged from 38.7 to 93.5 years.…”