title: Normal-Weight Central Obesity: Implications for Total and Cardiovascular Mortality.
abstract: BACKGROUND
  The relationship between central obesity and survival in community-dwelling adults with normal body mass index (BMI) is not well-known.
  
  
  OBJECTIVE
  To examine total and cardiovascular mortality risks associated with central obesity and normal BMI.
  
  
  METHODS
  Stratified multistage probability design.
  
  
  METHODS
  NHANES III (Third National Health and Nutrition Examination Survey).
  
  
  METHODS
  15,184 adults (52.3% women) aged 18 to 90 years.
  
  
  METHODS
  Multivariable Cox proportional hazards models were used to evaluate the relationship of obesity patterns defined by BMI and waist-to-hip ratio (WHR) and total and cardiovascular mortality risk after adjustment for confounding factors.
  
  
  RESULTS
  Persons with normal-weight central obesity had the worst long-term survival. For example, a man with a normal BMI (22 kg/m2) and central obesity had greater total mortality risk than one with similar BMI but no central obesity (hazard ratio [HR], 1.87 [95% CI, 1.53 to 2.29]), and this man had twice the mortality risk of participants who were overweight or obese according to BMI only (HR, 2.24 [CI, 1.52 to 3.32] and 2.42 [CI, 1.30 to 4.53], respectively). Women with normal-weight central obesity also had a higher mortality risk than those with similar BMI but no central obesity (HR, 1.48 [CI, 1.35 to 1.62]) and those who were obese according to BMI only (HR, 1.32 [CI, 1.15 to 1.51]). Expected survival estimates were consistently lower for those with central obesity when age and BMI were controlled for.
  
  
  CONCLUSIONS
  Body fat distribution was assessed based on anthropometric indicators alone. Information on comorbidities was collected by self-report.
  
  
  CONCLUSIONS
  Normal-weight central obesity defined by WHR is associated with higher mortality than BMI-defined obesity, particularly in the absence of central fat distribution.
  
  
  BACKGROUND
  National Institutes of Health, American Heart Association, European Regional Development Fund, and Czech Ministry of Health.
authors.forename: Karine R
authors.initials: KR
authors.lastname: Sahakyan
authors.forename: Virend K
authors.initials: VK
authors.lastname: Somers
authors.forename: Juan P
authors.initials: JP
authors.lastname: Rodriguez-Escudero
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.forename: Rickey E
authors.initials: RE
authors.lastname: Carter
authors.forename: Ondrej
authors.initials: O
authors.lastname: Sochor
authors.forename: Thais
authors.initials: T
authors.lastname: Coutinho
authors.forename: Michael D
authors.initials: MD
authors.lastname: Jensen
authors.forename: Véronique L
authors.initials: VL
authors.lastname: Roger
authors.forename: Prachi
authors.initials: P
authors.lastname: Singh
authors.forename: Francisco
authors.initials: F
authors.lastname: Lopez-Jimenez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D056128:Obesity, Abdominal / Q000150:complications*; D016016:Proportional Hazards Models; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D049629:Waist-Hip Ratio; D055815:Young Adult