Arch Iran Med. 2019;22(6): 301-309.
PMID: 31356096
Scopus ID: 85070763587
  Abstract View: 2507
  PDF Download: 1300

Original Article

Comparing Anthropometric Indicators of Visceral and General Adiposity as Determinants of Overall and Cardiovascular Mortality

Mahdi Nalini 1,2, Maryam Sharafkhah 1,3, Hossein Poustchi 1,4, Sadaf G. Sepanlou 1, Akram Pourshams 1,4, Amir Reza Radmard 1,5, Masoud Khoshnia 4,6, Abdolsamad Gharavi 4,6, Sanford M. Dawsey 7, Christian C. Abnet 7, Paolo Boffetta 8, Paul Brennan 9, Masoud Sotoudeh 1,4, Arash Nikmanesh 1,4, Shahin Merat 1,10, Arash Etemadi 1,7, Ramin Shakeri 1,4, Reza Malekzadeh 1,4,10*, Farin Kamangar 1,11*

1 Digestive Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
3 Department of Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
4 Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
5 Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
6 Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
7 Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, USA
8 The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
9 Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
10 Liver and Pancreaticobiliary Disease Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
11 Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, Maryland, USA
*Corresponding Authors: Email: malek@tums.ac.ir; Email: farin.kamangar@morgan.edu


Background: It is unclear which anthropometric obesity indicator best predicts adverse health outcomes. This study aimed to investigate the association of body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and hip-adjusted WC with all-cause and cardiovascular mortality.

Methods: 50045 people aged 40–75 (58% women, median BMI: 26.3 kg /m2 ) participated in the population-based Golestan Cohort Study. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) for the association of obesity indicators with mortality. We also examined the association of these indicators with intermediate outcomes, including hypertension, blood glucose, dyslipidemia, carotid atherosclerosis, nonalcoholic fatty liver, and visceral abdominal fat.

Results: After a median follow-up of 10.9 years (success rate: 99.1%), 6651 deaths (2778 cardiovascular) occurred. Comparing 5th to the 1st quintile, HRs (95% CIs) for all-cause and cardiovascular mortality were 1.12 (1.02–1.22) and 1.59 (1.39–1.83) for BMI, 1.16 (1.07–1.27) and 1.66 (1.44–1.90) for WC, 1.28 (1.17–1.40) and 1.88 (1.63–2.18) for WHtR, 1.44 (1.32–1.58) and 2.04 (1.76–2.36) for WHR, and 1.84 (1.62–2.09) and 2.72 (2.23–3.32) for hip-adjusted WC, respectively. Hip-adjusted WC had the strongest associations with the intermediate outcomes.

Conclusion: Indicators of visceral adiposity (e.g., hip-adjusted WC) were much stronger predictors of overall and cardiovascular mortality than were indicators of general adiposity (e.g., BMI). The full-strength effect of visceral adiposity becomes apparent only when both WC, as a risk factor, and hip circumference, as a protective factor, are individually and simultaneously taken into consideration.

Cite this article as: Nalini M, Sharafkhah M, Poustchi H, Sepanlou SG, Pourshams A, Radmard AR, et al. Comparing anthropometric indicators of visceral and general adiposity as determinants of overall and cardiovascular mortality. Arch Iran Med. 2019;22(6):301– 309.
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Submitted: 26 Mar 2019
Accepted: 16 Apr 2019
ePublished: 01 Jun 2019
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