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Central adiposity and the overweight risk paradox in aging: follow-up of 130,473 UK Biobank participants.
Am J Clin Nutr 2017; 106(1):130-135AJ

Abstract

Background:

For older groups, being overweight [body mass index (BMI; in kg/m2): 25 to <30] is reportedly associated with a lower or similar risk of mortality than being normal weight (BMI: 18.5 to <25). However, this "risk paradox" is partly explained by smoking and disease-associated weight loss. This paradox may also arise from BMI failing to measure fat redistribution to a centralized position in later life.

Objective:

This study aimed to estimate associations between combined measurements of BMI and waist-to-hip ratio (WHR) with mortality and incident coronary artery disease (CAD).

Design:

This study followed 130,473 UK Biobank participants aged 60-69 y (baseline 2006-2010) for ≤8.3 y (n = 2974 deaths). Current smokers and individuals with recent or disease-associated (e.g., from dementia, heart failure, or cancer) weight loss were excluded, yielding a "healthier agers" group. Survival models were adjusted for age, sex, alcohol intake, smoking history, and educational attainment. Population and sex-specific lower and higher WHR tertiles were <0.91 and ≥0.96 for men and <0.79 and ≥0.85 for women, respectively.

Results:

Ignoring WHR, the risk of mortality for overweight subjects was similar to that for normal-weight subjects (HR: 1.09; 95% CI: 0.99, 1.19; P = 0.066). However, among normal-weight subjects, mortality increased for those with a higher WHR (HR: 1.33; 95% CI: 1.08, 1.65) compared with a lower WHR. Being overweight with a higher WHR was associated with substantial excess mortality (HR: 1.41; 95% CI: 1.25, 1.61) and greatly increased CAD incidence (sub-HR: 1.64; 95% CI: 1.39, 1.93) compared with being normal weight with a lower WHR. There was no interaction between physical activity and BMI plus WHR groups with respect to mortality.

Conclusions:

For healthier agers (i.e., nonsmokers without disease-associated weight loss), having central adiposity and a BMI corresponding to normal weight or overweight is associated with substantial excess mortality. The claimed BMI-defined overweight risk paradox may result in part from failing to account for central adiposity, rather than reflecting a protective physiologic effect of higher body-fat content in later life.

Authors+Show Affiliations

Epidemiology and Public Health Group and.Epidemiology and Public Health Group and.Epidemiology and Public Health Group and.Diabetes and Obesity Research Group, Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Exeter, United Kingdom.UConn Center on Aging, University of Connecticut Health Center, Farmington, CT; and.Epidemiology and Public Health Group and.National Institute on Aging, Baltimore, MD.Epidemiology and Public Health Group and d.melzer@exeter.ac.uk. UConn Center on Aging, University of Connecticut Health Center, Farmington, CT; and.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28566307

Citation

Bowman, Kirsty, et al. "Central Adiposity and the Overweight Risk Paradox in Aging: Follow-up of 130,473 UK Biobank Participants." The American Journal of Clinical Nutrition, vol. 106, no. 1, 2017, pp. 130-135.
Bowman K, Atkins JL, Delgado J, et al. Central adiposity and the overweight risk paradox in aging: follow-up of 130,473 UK Biobank participants. Am J Clin Nutr. 2017;106(1):130-135.
Bowman, K., Atkins, J. L., Delgado, J., Kos, K., Kuchel, G. A., Ble, A., ... Melzer, D. (2017). Central adiposity and the overweight risk paradox in aging: follow-up of 130,473 UK Biobank participants. The American Journal of Clinical Nutrition, 106(1), pp. 130-135. doi:10.3945/ajcn.116.147157.
Bowman K, et al. Central Adiposity and the Overweight Risk Paradox in Aging: Follow-up of 130,473 UK Biobank Participants. Am J Clin Nutr. 2017;106(1):130-135. PubMed PMID: 28566307.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Central adiposity and the overweight risk paradox in aging: follow-up of 130,473 UK Biobank participants. AU - Bowman,Kirsty, AU - Atkins,Janice L, AU - Delgado,João, AU - Kos,Katarina, AU - Kuchel,George A, AU - Ble,Alessandro, AU - Ferrucci,Luigi, AU - Melzer,David, Y1 - 2017/05/31/ PY - 2016/10/10/received PY - 2017/05/02/accepted PY - 2017/6/2/pubmed PY - 2017/8/2/medline PY - 2017/6/2/entrez KW - UK Biobank KW - adiposity KW - aging KW - body mass index KW - coronary artery disease KW - mortality KW - older persons KW - overweight KW - waist-hip ratio SP - 130 EP - 135 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 106 IS - 1 N2 - Background: For older groups, being overweight [body mass index (BMI; in kg/m2): 25 to <30] is reportedly associated with a lower or similar risk of mortality than being normal weight (BMI: 18.5 to <25). However, this "risk paradox" is partly explained by smoking and disease-associated weight loss. This paradox may also arise from BMI failing to measure fat redistribution to a centralized position in later life.Objective: This study aimed to estimate associations between combined measurements of BMI and waist-to-hip ratio (WHR) with mortality and incident coronary artery disease (CAD).Design: This study followed 130,473 UK Biobank participants aged 60-69 y (baseline 2006-2010) for ≤8.3 y (n = 2974 deaths). Current smokers and individuals with recent or disease-associated (e.g., from dementia, heart failure, or cancer) weight loss were excluded, yielding a "healthier agers" group. Survival models were adjusted for age, sex, alcohol intake, smoking history, and educational attainment. Population and sex-specific lower and higher WHR tertiles were <0.91 and ≥0.96 for men and <0.79 and ≥0.85 for women, respectively.Results: Ignoring WHR, the risk of mortality for overweight subjects was similar to that for normal-weight subjects (HR: 1.09; 95% CI: 0.99, 1.19; P = 0.066). However, among normal-weight subjects, mortality increased for those with a higher WHR (HR: 1.33; 95% CI: 1.08, 1.65) compared with a lower WHR. Being overweight with a higher WHR was associated with substantial excess mortality (HR: 1.41; 95% CI: 1.25, 1.61) and greatly increased CAD incidence (sub-HR: 1.64; 95% CI: 1.39, 1.93) compared with being normal weight with a lower WHR. There was no interaction between physical activity and BMI plus WHR groups with respect to mortality.Conclusions: For healthier agers (i.e., nonsmokers without disease-associated weight loss), having central adiposity and a BMI corresponding to normal weight or overweight is associated with substantial excess mortality. The claimed BMI-defined overweight risk paradox may result in part from failing to account for central adiposity, rather than reflecting a protective physiologic effect of higher body-fat content in later life. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/28566307/Central_adiposity_and_the_overweight_risk_paradox_in_aging:_follow_up_of_130473_UK_Biobank_participants_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.116.147157 DB - PRIME DP - Unbound Medicine ER -