title: Differences between adiposity indicators for predicting all-cause mortality in a representative sample of United States non-elderly adults.
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]).
  
  
  RESULTS
  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) unless assessed by WTR (aHR 1.4 [95%CI 1.0-1.9]). Women in adiposity midrange, however, tended toward elevated risk (aHRs 1.2-1.5), except for black women assessed by BMI, WC or WHtR (aHRs 0.7-0.8). Men or women in adiposity quartile 4 (compared to midrange) were generally at 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<1.0).
  
  
  CONCLUSIONS
  Predictions of mortality risk associated with top-quartile adiposity vary with the indicator used, sex, ancestry, and other characteristics. Interpretations of adiposity should consider how variation in the physiology and expandability of regional adipose-tissue depots impacts health.
authors.affiliation: Division of Diabetes Translation, U. S. Centers for Disease Control and Prevention, Atlanta, GA, USA. hkahn@cdc.gov
authors.forename: Henry S
authors.initials: HS
authors.lastname: Kahn
authors.forename: Kai McKeever
authors.initials: KM
authors.lastname: Bullard
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Barker
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Imperatore
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D050154:Adiposity; D000293:Adolescent; D000328:Adult; D044383:Black People; D001823:Body Composition; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D017058:Mexican Americans; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000208:ethnology / Q000401:mortality* / Q000473:pathology; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking; D012923:Social Class; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference; D049629:Waist-Hip Ratio; D044465:White People; D001741:Black or African American