Complementary Role of BMI and EOSS in Predicting All-Cause and Cause-Specific Mortality in People with Overweight and Obesity.

OBJECTIVE

To assess the complementary role of the Body Mass Index (BMI) and Edmonton Obesity Staging System (EOSS) in predicting all-cause and cause-specific mortality in people living with overweight and obesity (PLwOW/O).

METHODS

A longitudinal analysis of prospectively collected data from the 1999-2018 cycles of the National Health and Nutrition Examination Survey (NHANES) was conducted. The association between BMI, EOSS, and mortality was evaluated through Cox regression models, adjusted for confounders.

RESULTS

The analysis included 36,529 subjects; 5329 deaths occurred over a median follow-up of 9.1 years (range: 0-20.8). An increased mortality risk was observed for obesity class II and III (HR = 1.21, 95% CI 1.08-1.36, = 0.001 and HR = 1.58, 95% CI 1.39-1.80, < 0.001; compared to overweight), and for EOSS stage 2 and 3 (HR = 1.36, 95% CI 1.16-1.58, < 0.001 and HR = 2.66, 95% CI 2.26-3.14, < 0.001; compared to stage 0/1). The prognostic role of BMI was more pronounced in younger patients, males, and non-Black individuals, while that of EOSS was stronger in women. Both BMI and EOSS independently predicted cardiovascular- and diabetes-related mortality. EOSS stage 3 was the only predictor of death from malignancy or renal causes.

CONCLUSIONS

BMI and EOSS independently predict all-cause and cause-specific mortality in PLwOW/O. Their integrated use seems advisable to best define the obesity-related mortality risk.