The Combination of Fat Distribution and BMI Redefines Obesity: Result From NHANES
ABSTRACT Background Body mass index (BMI) has well‐recognized limitations, particularly in the context of the ‘obesity paradox’, where higher BMI does not consistently evaluate adverse outcomes. These limitations underscore the need for alternative approaches. This study aimed to redefine obesity us...
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| Format: | Article |
| Language: | English |
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Wiley
2025-08-01
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| Series: | Journal of Cachexia, Sarcopenia and Muscle |
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| Online Access: | https://doi.org/10.1002/jcsm.70013 |
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| author | Liuqing Yang Yizhong Ge Qiankun Zhu Qi Zhang Lin Wang Xin Wang Yun Yang Hanping Shi |
| author_facet | Liuqing Yang Yizhong Ge Qiankun Zhu Qi Zhang Lin Wang Xin Wang Yun Yang Hanping Shi |
| author_sort | Liuqing Yang |
| collection | DOAJ |
| description | ABSTRACT Background Body mass index (BMI) has well‐recognized limitations, particularly in the context of the ‘obesity paradox’, where higher BMI does not consistently evaluate adverse outcomes. These limitations underscore the need for alternative approaches. This study aimed to redefine obesity using anthropometric indicators and to assess their prognostic value for mortality. Methods The original cohort included participants from the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006. Additional dual‐energy X‐ray absorptiometry (DXA) data on fat distribution were sourced from NHANES 1999–2006 and 2011–2018. Ten fat distribution indicators were adopted to assess the fat distribution in the target population, including five centripetal obesity indicators, three global obesity indicators and two limb obesity indicators. All‐cause, cardiovascular‐specific and cancer‐specific mortality outcomes were examined using weighted Cox proportional hazards models. Logistic regression was employed to evaluate associations between fat distribution indicators and the prevalence of specific diseases. Results This study included 14 936 participants (weighted 152 823 236 participants, mean age: 45.56 ± 17.60 years) and two DXA‐assessed cohorts. Fat distribution indicators were correlated with various DXA‐defined fat components. All 10 indicators demonstrated significant associations with mortality. Notably, the relationship between centripetal obesity indicators and all‐cause mortality was approximately linear in both sexes. Centripetal obesity was also strongly associated with cardiovascular and cancer‐specific mortality (p < 0.001). Although fat distribution indicators were significantly linked to the prevalence of cardiovascular disease (CVD), they showed no clear association with cancer incidence. Individuals with obesity but without centripetal fat accumulation exhibited a similar or slightly higher mortality risk compared with those with normal BMI and no centripetal obesity. Conclusion Centripetal obesity indicators emerged as the strongest independent evaluators of mortality, regardless of BMI classification. These findings highlight the clinical value of incorporating fat distribution metrics alongside BMI to more accurately assess obesity‐related mortality risk. |
| format | Article |
| id | doaj-art-7bc5f998066a4d31b49e4ce212c3638d |
| institution | Kabale University |
| issn | 2190-5991 2190-6009 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wiley |
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| series | Journal of Cachexia, Sarcopenia and Muscle |
| spelling | doaj-art-7bc5f998066a4d31b49e4ce212c3638d2025-08-22T07:30:52ZengWileyJournal of Cachexia, Sarcopenia and Muscle2190-59912190-60092025-08-01164n/an/a10.1002/jcsm.70013The Combination of Fat Distribution and BMI Redefines Obesity: Result From NHANESLiuqing Yang0Yizhong Ge1Qiankun Zhu2Qi Zhang3Lin Wang4Xin Wang5Yun Yang6Hanping Shi7Department of Clinical Nutrition Beijing Shijitan Hospital, Capital Medical University Beijing ChinaThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou ChinaDepartment of Orthopedics Surgery Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute Beijing ChinaDepartment of Genetics Yale School of Medicine New Haven Connecticut USADepartment of General Surgery/Center for Cancer Nutrition and Metabolism Beijing Shijitan Hospital, Capital Medical University Beijing ChinaDepartment of General Surgery/Center for Cancer Nutrition and Metabolism Beijing Shijitan Hospital, Capital Medical University Beijing ChinaDepartment of Clinical Nutrition Beijing Shijitan Hospital, Capital Medical University Beijing ChinaKey Laboratory of Cancer FSMP for State Market Regulation Beijing ChinaABSTRACT Background Body mass index (BMI) has well‐recognized limitations, particularly in the context of the ‘obesity paradox’, where higher BMI does not consistently evaluate adverse outcomes. These limitations underscore the need for alternative approaches. This study aimed to redefine obesity using anthropometric indicators and to assess their prognostic value for mortality. Methods The original cohort included participants from the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006. Additional dual‐energy X‐ray absorptiometry (DXA) data on fat distribution were sourced from NHANES 1999–2006 and 2011–2018. Ten fat distribution indicators were adopted to assess the fat distribution in the target population, including five centripetal obesity indicators, three global obesity indicators and two limb obesity indicators. All‐cause, cardiovascular‐specific and cancer‐specific mortality outcomes were examined using weighted Cox proportional hazards models. Logistic regression was employed to evaluate associations between fat distribution indicators and the prevalence of specific diseases. Results This study included 14 936 participants (weighted 152 823 236 participants, mean age: 45.56 ± 17.60 years) and two DXA‐assessed cohorts. Fat distribution indicators were correlated with various DXA‐defined fat components. All 10 indicators demonstrated significant associations with mortality. Notably, the relationship between centripetal obesity indicators and all‐cause mortality was approximately linear in both sexes. Centripetal obesity was also strongly associated with cardiovascular and cancer‐specific mortality (p < 0.001). Although fat distribution indicators were significantly linked to the prevalence of cardiovascular disease (CVD), they showed no clear association with cancer incidence. Individuals with obesity but without centripetal fat accumulation exhibited a similar or slightly higher mortality risk compared with those with normal BMI and no centripetal obesity. Conclusion Centripetal obesity indicators emerged as the strongest independent evaluators of mortality, regardless of BMI classification. These findings highlight the clinical value of incorporating fat distribution metrics alongside BMI to more accurately assess obesity‐related mortality risk.https://doi.org/10.1002/jcsm.70013BMIcentripetal obesityobesity |
| spellingShingle | Liuqing Yang Yizhong Ge Qiankun Zhu Qi Zhang Lin Wang Xin Wang Yun Yang Hanping Shi The Combination of Fat Distribution and BMI Redefines Obesity: Result From NHANES Journal of Cachexia, Sarcopenia and Muscle BMI centripetal obesity obesity |
| title | The Combination of Fat Distribution and BMI Redefines Obesity: Result From NHANES |
| title_full | The Combination of Fat Distribution and BMI Redefines Obesity: Result From NHANES |
| title_fullStr | The Combination of Fat Distribution and BMI Redefines Obesity: Result From NHANES |
| title_full_unstemmed | The Combination of Fat Distribution and BMI Redefines Obesity: Result From NHANES |
| title_short | The Combination of Fat Distribution and BMI Redefines Obesity: Result From NHANES |
| title_sort | combination of fat distribution and bmi redefines obesity result from nhanes |
| topic | BMI centripetal obesity obesity |
| url | https://doi.org/10.1002/jcsm.70013 |
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