General and abdominal obesity parameters and their combination in relation to mortality: a systematic review and meta-regression analysis

Abstract

Epidemiological studies assessing general and abdominal obesity measures or their combination for mortality prediction have shown inconsistent results. We aimed to systematically review the associations of body mass index (BMI), waist-to-hip ratio (WHR), waist circumference (WC) and waist-to-height ratio (WHtR) with all-cause mortality in prospective cohort studies. In this systematic review, which includes a meta-regression analysis, we analysed the associations with all-cause mortality of BMI, WHR, WC and WHtR in prospective cohort studies available in Medline, Embase, the Cochrane Database of Systematic Reviews and Esbiobase from inception through 7 May 2010. A total of 18 studies met the inclusion criteria, comprising 689, 465 participants and 48, 421 deaths during 5-24 years of follow-up. The studies were heterogeneous, mainly due to differences in categorization of anthropometric parameters (AP) and different approaches to statistical analysis. Both general and abdominal obesity measures were significantly associated with mortality. In analyses using categorical variables, BMI and WC showed predominantly U- or J-shaped associations with mortality, whereas WHR and WHtR demonstrated positive relationships with mortality. All measures showed similar risk patterns for upper quantiles in comparison to reference quantiles. The parameters of general and abdominal obesity each remained significantly associated with mortality when adjusted for the other. This evidence suggests that abdominal obesity measures such as WC or WHR, show information independent to measures of general obesity and should be used in clinical practice, in addition to BMI, to assess obesity-related mortality in adults.

Obesidad y riesgo de infarto de miocardio en una muestra de varones europeos. El índice cintura-cadera sesga el riesgo real de la obesidad abdominal

“…El ICCad, como significante predictor de infartos agudos y mortalidad cardiovascular (11,25,27,28), concuerda con el tercil superior del estudio INTERHEART que evidencia mayor riesgo poblacional atribuible Trazado de las curvas ROC para los indicadores antropométricos compuestos discriminatorios (ICCad: índice cintura-cadera; ICT: índice cintura-talla; ICUCad: índice cintura umbilical-cadera; ICUT: índice cintura umbilical-talla; IMC: índice de masa corporal). Trazado de las curvas ROC para las medidas antropométricas simples (CC: circunferencia de cintura; CCad: circunferencia de cadera; CU: cintura umbilical).…”

Variaciones en el estado nutricional y su refl ejo en la composición corporal en mujeres chilenas con síndrome metabólico

“…Sin embargo, en nuestra investigación encontramos que al utilizar aquel punto de corte del IMC la concordancia de clasificación del riesgo promedio era más baja respecto a los índices antropométricos de salud; mientras que si se considera como punto de corte el sobrepeso (IMC ≥ 25 kg/m 2 ), existe una mejor concordancia de clasificación, lo que podría orientar hacia la necesidad de tomar en consideración de riesgo metabólico (estimado por los parámetros antropométricos) no solo a las mujeres con SM que presenten un estado nutricional de obesidad, sino a toda mujer que se encuentre con exceso de peso. Esto estaría en relación tanto con los hallazgos encontrados en los valores de los porcentajes de adiposidad en los diferentes grupos de mujeres de nuestro estudio como con lo señalado por diversos autores respecto a la potenciación de estos métodos de análisis morfológicos en su capacidad de identificación y asociación del riesgo de morbilidad y mortalidad de la población (6,7,13,34,35), aunque otros autores indiquen la superioridad diagnóstica de un método sobre otro (6,13,35). Según nuestra propuesta de considerar que el exceso de peso sería clínicamente relevante en mujeres con SM, el IMC presentaría una mejor sensibilidad que especificidad respecto a los índices considerados para determinar riesgo metabólico en mujeres con SM.…”

Influence of Male Obesity on Fertility

“…WHR can also be used to predict serious health consequences as a result of increased body fat (normal WHR: males ≤0.9 and females <0.85) 18 . Although general and abdominal obesity measurements were found to be reliable predictors of obesity-related mortality, evidence from a recent meta-analysis suggests that WC or WHR provides additional information that is independent to BMI and should therefore be used in clinical practice 19 . During the last decade, the conventional BIA, a safe and cost-effi cient method, has been widely used to estimate body composition and in particular the body fat content in clinical setting.…”

“…In addition to BMI, alternative measurements such as WC, WHR and to a lesser extent the waist to height ratio can be used to more accurately describe the distribution of body fat. Th ese methods have been suggested as superior to BMI in predicting health problems associated with central or visceral adiposity because abdominal or white fat tissue, rather than the total amount of fat, has been linked to obesity-related disorders [17][18][19] . WC is usually measured at the narrowest point between the lower border of the rib cage and the iliac crest.…”

“…Th e terms also identify ranges of weight that have been shown to increase the likelihood of certain diseases, as well as other health problems 14 . Numerous simple and accessible anthropometric techniques have been developed to evaluate the body fat content such as BMI, waist to hip ratio (WHR), WC, bioelectrical impedance analysis (BIA), ultrasound and skinfold measurements [15][16][17][18][19][20][21][22][23] . Traditionally, BMI has been the most widely used method in classifying overweight and obesity in adult populations because it provides a relatively good estimate of the risks associated with developing diseases that occur more frequently in people with higher body fat content.…”