Total and regional adiposity measured by dual-energy X-ray absorptiometry and mortality in NHANES 1999-2006.
Associations of overall and regional body fat measured by dual-energy X-ray absorptiometry with total and cause-specific mortality in the National Health and Nutrition Examination Survey (NHANES) 1999-2006 were investigated.



This study included 9,471 participants (≥20 years) free of major chronic diseases at baseline. Death information was obtained from the National Death Index (mean follow-up duration: 8.8 years).



A total of 682 participants died after 12 months since baseline, with 206 and 170 deaths attributed to cardiovascular diseases (CVD) and cancer, respectively. The second quartile of fat mass percentages (FM%) was used as the reference to account for potential nonlinearity. In the multivariate-adjusted model, participants in the highest quartile of total FM% had increased total mortality; hazard ratio (HR; 95% confidence interval, 95% CI) was 1.48 (1.07-2.04; P < 0.05). Higher total and trunk FM%, but not leg FM%, were significantly associated with an increased CVD mortality; HRs (95% CIs) in the highest quartiles of total, trunk, and leg FM% were 2.24 (1.17-4.31), 1.93 (1.02-3.66), and 1.50 (0.77-2.94), respectively.



Higher total body fat was associated with increased total mortality in U.S. adults. Higher total and trunk fat contents were also associated with increased CVD mortality, although fat accumulation in the lower body was not an independent predictor of mortality.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Geng
G
Zong
Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Zefeng
Z
Zhang
Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Quanhe
Q
Yang
Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Hongyu
H
Wu
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.|Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Frank B
FB
Hu
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. qisun@hsph.harvard.edu.|Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. qisun@hsph.harvard.edu.
Qi
Q
Sun
D015502:Absorptiometry, Photon / Q000379:methods*; D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D050154:Adiposity; D000328:Adult; D002423:Cause of Death; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity; D016016:Proportional Hazards Models; D060726:Torso / Q000000981:diagnostic imaging; D014481:United States
Nat Med. 1996 Jul;2(7):800-3
8673927
JAMA. 2013 Jan 2;309(1):71-82
23280227
Ann Intern Med. 2016 Apr 19;164(8):532-41
26954388
N Engl J Med. 2010 Dec 2;363(23):2211-9
21121834
Obesity (Silver Spring). 2013 Apr;21(4):824-30
23404933
Cell Metab. 2013 May 7;17(5):644-56
23583168
Am J Epidemiol. 2004 Oct 15;160(8):741-9
15466496
J Am Coll Cardiol. 2013 Sep 3;62(10):921-5
23850922
Am J Epidemiol. 2007 Oct 15;166(8):975-82
17670912
Obesity (Silver Spring). 2006 Feb;14(2):336-41
16571861
Diabetes Care. 1999 Aug;22(8):1310-7
10480776
Am J Clin Nutr. 2014 Nov;100(5):1352-60
25332333
Metabolism. 1999 Oct;48(10):1332-5
10535400
Hypertension. 2005 Oct;46(4):645-6
16157787
Scand J Clin Lab Invest. 2008;68(3):204-11
18446527
Age Ageing. 2012 Sep;41(5):677-81
22820447
JAMA. 2005 Apr 20;293(15):1861-7
15840860
Diabetes. 2007 May;56(5):1369-75
17287467
J Clin Endocrinol Metab. 2005 Aug;90(8):4573-8
15886255
Ann Med. 1995 Aug;27(4):435-8
8519504
Obesity (Silver Spring). 2015 Apr;23(4):893-7
25755182
Am J Epidemiol. 2010 Dec 15;172(12):1442-54
20952596
J Clin Endocrinol Metab. 2010 Sep;95(9):4389-98
20519350
Ann Epidemiol. 2015 Mar;25(3):201-7
25511307
Physiol Rev. 1994 Oct;74(4):761-811
7938225
JAMA. 2013 Apr 24;309(16):1681
23613066
Age (Dordr). 2012 Jun;34(3):597-608
21667162
J Gerontol A Biol Sci Med Sci. 2010 Jan;65(1):99-104
19628635
Obes Rev. 2001 Aug;2(3):141-7
12120099
Am J Clin Nutr. 2009 Sep;90(3):499-504
19571212
Lancet. 2009 Mar 28;373(9669):1083-96
19299006
N Engl J Med. 2014 Jan 16;370(3):233-44
24428469
N Engl J Med. 2011 Feb 24;364(8):719-29
21345101
Diabetes Care. 1991 Dec;14(12):1132-43
1773700
Diabetes Care. 2012 Feb;35(2):296-8
22190675
Obes Res. 2003 Jul;11(7):895-903
12855760
Eur J Clin Nutr. 2013 Jun;67(6):573-85
23511854
J Am Geriatr Soc. 2009 Nov;57(11):2077-84
19754497