Journal article
Association of Normal-Weight Central Obesity With All-Cause and Cause-Specific Mortality Among Postmenopausal Women
JAMA Network Open, Vol.2(7), e197337
07/2019
DOI: 10.1001/jamanetworkopen.2019.7337
PMCID: PMC6659146
PMID: 31339542
Abstract
This cohort study uses data from women enrolled in the Women’s Health Initiative (WHI) to examine the associations of normal-weight central obesity with all-cause and cause-specific mortality among postmenopausal women in the United States.
Importance: Current public health guidelines for obesity prevention and control focus on promoting a normal body mass index (BMI), rarely addressing central obesity, which is reflected by high waist circumference (WC) and common in the general population. Studies of the association of normal-weight central obesity with long-term health outcomes are sparse.
Objective: To examine associations of normal-weight central obesity with all-cause and cause-specific mortality in postmenopausal women in the United States.
Design, Setting, and Participants: A nationwide prospective cohort study of 156 624 postmenopausal women enrolled in the Women’s Health Initiative at 40 clinical centers in the United States between 1993 and 1998. These women were observed through February 2017. Data analysis was performed from September 15, 2017, to March 13, 2019.
Exposures: Different combinations of BMI (calculated as weight in kilograms divided by height in meters squared; normal weight: BMI, 18.5-24.9; overweight: BMI, 25.0-29.9; and obesity: BMI, ≥30) and WC (normal: WC, ≤88 cm and high: WC, >88 cm).
Main Outcomes and Measures: Mortality from all causes, cardiovascular disease, and cancer.
Results: Of the 156 624 women (mean [SD] age, 63.2 [7.2] years), during 2 811 187 person-years of follow-up, 43 838 deaths occurred, including 12 965 deaths from cardiovascular disease (29.6%) and 11 828 deaths from cancer (27.0%). Compared with women with normal weight and no central obesity and adjusted for demographic characteristics, socioeconomic status, lifestyle factors, and hormone use, the hazard ratio for all-cause mortality was 1.31 (95% CI, 1.20-1.42) among women with normal weight and central obesity, 0.91 (95% CI, 0.89-0.94) among women with overweight and no central obesity, 1.16 (95% CI, 1.13-1.20) for women with overweight and central obesity, 0.93 (95% CI, 0.89-0.94) for women with obesity and no central obesity, and 1.30 (95% CI, 1.27-1.34) for women with obesity and central obesity. Compared with normal weight without central obesity, normal-weight central obesity was associated with higher risk of cardiovascular disease mortality (hazard ratio, 1.25; 95% CI, 1.05-1.46) and cancer mortality (hazard ratio, 1.20; 95% CI, 1.01-1.43).
Conclusions and Relevance: Normal-weight central obesity in women was associated with excess risk of mortality, similar to that of women with BMI-defined obesity with central obesity. These findings underscore the need for future public health guidelines to include the prevention and control of central obesity, even in individuals with normal BMI.
Details
- Title: Subtitle
- Association of Normal-Weight Central Obesity With All-Cause and Cause-Specific Mortality Among Postmenopausal Women
- Creators
- Yangbo Sun - University of Iowa, EpidemiologyBuyun Liu - University of Iowa, EpidemiologyLinda G Snetselaar - University of Iowa, Internal MedicineRobert B Wallace - University of Iowa, Internal MedicineBette J Caan - Kaiser PermanenteThomas E Rohan - Albert Einstein College of MedicineMarian L Neuhouser - Fred Hutch Cancer CenterAladdin H Shadyab - University of California San DiegoRowan T Chlebowski - City Of Hope National Medical CenterJoAnn E Manson - Harvard Medical SchoolWei Bao - University of Iowa, Epidemiology
- Resource Type
- Journal article
- Publication Details
- JAMA Network Open, Vol.2(7), e197337
- DOI
- 10.1001/jamanetworkopen.2019.7337
- PMID
- 31339542
- PMCID
- PMC6659146
- NLM abbreviation
- JAMA Netw Open
- ISSN
- 2574-3805
- eISSN
- 2574-3805
- Publisher
- American Medical Association
- Copyright
- ©2019 Sun Yang, et al.
- Grant note
- National Institutes of Health National Heart, Lung, and Blood Institute US Department of Health and Human Services Funding/Support: The Women’s Health Initiative (WHI) program is funded through contractsHHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, andHHSN268201600004C from the National Heart, Lung, and Blood Institute, the National Institutes of Health, and the US Department of Health and Human Services. Conflict of Interest Disclosures: Dr Chlebowski reported receiving grants through the National Institutes of Health, National Cancer Institute, and American Institute of Cancer Research during the conduct of this study and receiving personal fees from Novartis, AstraZeneca, Genentech, Amgen, Genomic Health, and Immunomedics outside the submitted work. Dr Manson reported grants from the National Institutes of Health during the conduct of the study and outside the submitted work. No other disclosures were reported.
- Alternative title
- Association of Normal-Weight Central Obesity With Mortality Among Postmenopausal Women
- Language
- English
- Date published
- 07/2019
- Academic Unit
- Epidemiology; Injury Prevention Research Center
- Record Identifier
- 9983763490802771
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