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Central adiposity and the overweight risk paradox in aging: follow-up of 130,473 UK Biobank participants

Background: For older groups, being overweight [body mass index (BMI; in kg/m(2)): 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 weigh...

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Autores principales: Bowman, Kirsty, Atkins, Janice L, Delgado, João, Kos, Katarina, Kuchel, George A, Ble, Alessandro, Ferrucci, Luigi, Melzer, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society for Nutrition 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486197/
https://www.ncbi.nlm.nih.gov/pubmed/28566307
http://dx.doi.org/10.3945/ajcn.116.147157
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author Bowman, Kirsty
Atkins, Janice L
Delgado, João
Kos, Katarina
Kuchel, George A
Ble, Alessandro
Ferrucci, Luigi
Melzer, David
author_facet Bowman, Kirsty
Atkins, Janice L
Delgado, João
Kos, Katarina
Kuchel, George A
Ble, Alessandro
Ferrucci, Luigi
Melzer, David
author_sort Bowman, Kirsty
collection PubMed
description Background: For older groups, being overweight [body mass index (BMI; in kg/m(2)): 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.
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spelling pubmed-54861972017-07-19 Central adiposity and the overweight risk paradox in aging: follow-up of 130,473 UK Biobank participants Bowman, Kirsty Atkins, Janice L Delgado, João Kos, Katarina Kuchel, George A Ble, Alessandro Ferrucci, Luigi Melzer, David Am J Clin Nutr Aging Background: For older groups, being overweight [body mass index (BMI; in kg/m(2)): 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. American Society for Nutrition 2017-07 2017-05-31 /pmc/articles/PMC5486197/ /pubmed/28566307 http://dx.doi.org/10.3945/ajcn.116.147157 Text en http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the CC-BY license (http://creativecommons.org/licenses/by/3.0/).
spellingShingle Aging
Bowman, Kirsty
Atkins, Janice L
Delgado, João
Kos, Katarina
Kuchel, George A
Ble, Alessandro
Ferrucci, Luigi
Melzer, David
Central adiposity and the overweight risk paradox in aging: follow-up of 130,473 UK Biobank participants
title Central adiposity and the overweight risk paradox in aging: follow-up of 130,473 UK Biobank participants
title_full Central adiposity and the overweight risk paradox in aging: follow-up of 130,473 UK Biobank participants
title_fullStr Central adiposity and the overweight risk paradox in aging: follow-up of 130,473 UK Biobank participants
title_full_unstemmed Central adiposity and the overweight risk paradox in aging: follow-up of 130,473 UK Biobank participants
title_short Central adiposity and the overweight risk paradox in aging: follow-up of 130,473 UK Biobank participants
title_sort central adiposity and the overweight risk paradox in aging: follow-up of 130,473 uk biobank participants
topic Aging
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486197/
https://www.ncbi.nlm.nih.gov/pubmed/28566307
http://dx.doi.org/10.3945/ajcn.116.147157
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