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Differences between Adiposity Indicators for Predicting All-Cause Mortality in a Representative Sample of United States Non-Elderly Adults

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  • Henry S Kahn
  • Kai McKeever Bullard
  • Lawrence E Barker
  • Giuseppina Imperatore

Abstract

Background: Adiposity predicts health outcomes, but this relationship could depend on population characteristics and adiposity indicator employed. In a representative sample of 11,437 US adults (National Health and Nutrition Examination Survey, 1988–1994, ages 18–64) we estimated associations with all-cause mortality for body mass index (BMI) and four abdominal adiposity indicators (waist circumference [WC], waist-to-height ratio [WHtR], waist-to-hip ratio [WHR], and waist-to-thigh ratio [WTR]). In a fasting subsample we considered the lipid accumulation product (LAP; [WC enlargement*triglycerides]). Methods and Findings: For each adiposity indicator we estimated linear and categorical mortality risks using sex-specific, proportional-hazards models adjusted for age, black ancestry, tobacco exposure, and socioeconomic position. There were 1,081 deaths through 2006. Using linear models we found little difference among indicators (adjusted hazard ratios [aHRs] per SD increase 1.2–1.4 for men, 1.3–1.5 for women). Using categorical models, men in adiposity midrange (quartiles 2+3; compared to quartile 1) were not at significantly increased risk (aHRs 1.1), especially black men assessed by WTR (aHR 1.9 [1.4–2.6]) and black women by LAP (aHR 2.2 [1.4–3.5]). Quartile 4 of WC or WHtR carried no significant risk for diabetic persons (aHRs 0.7–1.1), but elevated risks for those without diabetes (aHRs>1.5). For both sexes, quartile 4 of LAP carried increased risks for tobacco-exposed persons (aHRs>1.6) but not for non-exposed (aHRs

Suggested Citation

  • Henry S Kahn & Kai McKeever Bullard & Lawrence E Barker & Giuseppina Imperatore, 2012. "Differences between Adiposity Indicators for Predicting All-Cause Mortality in a Representative Sample of United States Non-Elderly Adults," PLOS ONE, Public Library of Science, vol. 7(11), pages 1-12, November.
    • Handle: RePEc:plo:pone00:0050428
    DOI: 10.1371/journal.pone.0050428
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    3. Galea, S. & Tracy, M. & Hoggatt, K.J. & DiMaggio, C. & Karpati, A., 2011. "Estimated deaths attributable to social factors in the united states," American Journal of Public Health, American Public Health Association, vol. 101(8), pages 1456-1465.
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