title: Association of waist circumference and body mass index with all-cause mortality in CKD: The REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study.
abstract: BACKGROUND
  Obesity management requires understanding the mortality risks associated with different adiposity measures.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  5,805 adults with body mass index (BMI) ≥18.5 kg/m(2) and stages 1-4 chronic kidney disease, defined as a spot urine albumin-creatinine ratio ≥30 mg/g and/or estimated glomerular filtration rate <60 mL/min/1.73 m(2), enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.
  
  
  METHODS
  BMI categorized as 18.5-24.9, 25.0-29.9, 30.0-34.9, 35.0-39.9, and ≥40 kg/m(2) and waist circumference categorized as <80, 80-87.9, 88-97.9, 98-107.9, and ≥108 cm in women and <94, 94-101.9, 102-111.9, 112-121.9, and ≥122 cm in men.
  
  
  RESULTS
  All-cause mortality.
  
  
  METHODS
  BMI and waist circumference were measured using a standardized protocol during the home visit.
  
  
  RESULTS
  686 (11.8%) deaths occurred during a median follow-up of 4 years. Compared with the referent BMI category of 25-29.9 kg/m(2), HRs for mortality were 1.27 (95% CI, 0.96-1.69) for BMI <25 kg/m(2) and 0.84 (95% CI, 0.62-1.13), 0.81 (95% CI, 0.52-1.26), and 0.95 (95% CI, 0.54-1.65) for BMI categories 30-34.9, 35-39.9, and ≥40 kg/m(2) after adjustment for covariates including waist circumference, respectively. In contrast, after adjustment for covariates including BMI, higher mortality rates were noted for all waist circumference categories compared with the referent (<80 cm in women and <94 cm in men), with HRs of 1.04 (95% CI, 0.77-1.41) for waist circumference of 80-87.9 cm in women and 94-101.9 cm in men, 1.29 (95% CI, 0.92-1.81) for waist circumference of 88-97.9 cm in women and 102-111.9 cm in men, 1.72 (95% CI, 1.12-2.62) for waist circumference of 98-107.9 cm in women and 112-121.9 cm in men, and 2.09 (95% CI, 1.26-3.46) for waist circumference ≥108 cm in women and ≥122 cm in men.
  
  
  CONCLUSIONS
  BMI and waist circumference measured at baseline only.
  
  
  CONCLUSIONS
  Waist circumference should be considered in conjunction with BMI when assessing mortality risk associated with obesity in adults with chronic kidney disease.
authors: Department of Preventive Medicine and Epidemiology, Loyola Medical Center, Maywood, 60153, USA. hkramer@lumc.edu
authors: Holly
authors: H
authors: Kramer
authors: David
authors: D
authors: Shoham
authors: Leslie A
authors: LA
authors: McClure
authors: Ramon
authors: R
authors: Durazo-Arvizu
authors: George
authors: G
authors: Howard
authors: Suzanne
authors: S
authors: Judd
authors: Paul
authors: P
authors: Muntner
authors: Monika
authors: M
authors: Safford
authors: David G
authors: DG
authors: Warnock
authors: William
authors: W
authors: McClellan
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