da Silva Weder Alves, Rezende Leandro F M, Marques Adilson, de Maio Nascimento Marcelo, Nilson Eduardo, Christofaro Diego G D, da Costa Roberto Fernandes, Ferrari Gerson
Graduate Program in Human Movement and Rehabilitation of Evangelical University of Goias, Anápolis, Goiás, Brazil.
Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Int J Obes (Lond). 2025 Jul 1. doi: 10.1038/s41366-025-01827-0.
Various methods have been used to assess adiposity and its associations with morbidity and mortality. In this study, we aimed to examine the association of four adiposity markers with all‑cause and cause‑specific mortality, while evaluating the potential influence of reverse causation bias.
This prospective cohort study included 158,699 participants from the Mexico City Prospective Study. Cox regression models were performed to estimate the associations of body mass index, waist circumference, waist-to-height ratio, and waist-to-hip ratio with mortality risk. To minimize the influence of reverse causation, we excluded participants with prevalent diseases at baseline and conducted additional analyses excluding deaths occurring within the first 2, 5, and 10 years of follow-up.
Over a median of 15.5 years, 28,296 death were recorded. Waist circumference values above the recommended cutoff considered high were associated with higher all-cause mortality after the exclusion of the first 2, 5, and 10 years of follow-up (HR: 1.83; 95% CI: 1.26-2.55, HR: 1.83; 95% CI: 1.23-2.62, and HR: 1.85; 95% CI: 1.14-2.70, respectively). Elevated waist-to-hip ratio was associated with increased all-cause mortality across the same exclusion periods (HR: 1.71; 95% CI: 1.07-2.30, HR: 1.70; 95% CI: 1.05-2.49, and HR: 1.71; 95% CI: 1.01-2.52). High waist circumference was strongly associated with CVD mortality after exclusion of the first 2, 5, and 10 years (HR: 4.76; 95% CI: 1.70-11.82, HR: 4.75; 95% CI: 1.56-11.88, and HR: 4.73; 95% CI: 1.42-12.90, respectively). Elevated waist-to-hip ratio similarly showed associations with CVD mortality (HR: 2.69; 95% CI: 1.10-5.60, HR: 2.66; 95% CI: 1.12-5.75, and HR: 2.64; 95% CI: 1.03-7.32). Body mass index, waist circumference, waist-to-height ratio, and waist-hip ratio were not associated with respiratory and cancer mortality.
Waist circumference was the adiposity marker most strongly associated with all-cause and CVD mortality, even after excluding the first 10 years of follow-up.
已采用多种方法评估肥胖及其与发病率和死亡率的关联。在本研究中，我们旨在探讨四种肥胖标志物与全因死亡率和特定病因死亡率的关联，同时评估反向因果偏倚的潜在影响。
这项前瞻性队列研究纳入了来自墨西哥城前瞻性研究的158,699名参与者。采用Cox回归模型来估计体重指数、腰围、腰高比和腰臀比与死亡风险之间的关联。为尽量减少反向因果的影响，我们排除了基线时患有常见疾病的参与者，并进行了额外分析，排除随访前2年、5年和10年内发生的死亡。
在中位15.5年的随访期间，记录了28,296例死亡。在排除随访的前2年、5年和10年后，高于推荐的高截断值的腰围与较高的全因死亡率相关（风险比分别为：1.83；95%置信区间：1.26 - 2.55，1.83；95%置信区间：1.23 - 2.62，以及1.85；95%置信区间：1.14 - 2.70）。在相同的排除期内，升高的腰臀比与全因死亡率增加相关（风险比分别为：1.71；95%置信区间：1.07 - 2.30，1.70；95%置信区间：1.05 - 2.49，以及1.71；95%置信区间：1.01 - 2.52）。排除前2年、5年和10年后，高腰围与心血管疾病死亡率密切相关（风险比分别为：4.76；95%置信区间：1.70 - 11.82，4.75；95%置信区间：1.56 - 11.88，以及4.73；95%置信区间：1.42 - 12.90）。升高的腰臀比同样与心血管疾病死亡率相关（风险比分别为：2.69；95%置信区间：1.10 - 5.60，2.66；95%置信区间：1.12 - 5.75，以及2.64；95%置信区间：1.03 - 7.32）。体重指数、腰围、腰高比和腰臀比与呼吸和癌症死亡率无关。
即使排除随访的前10年，腰围仍是与全因死亡率和心血管疾病死亡率关联最密切的肥胖标志物。
