Normal-weight central obesity: Implications for total and cardiovascular mortality

Karine R. Sahakyan, Virend K. Somers, Juan P. Rodriguez-Escudero, David O. Hodge, Rickey E. Carter, Ondrej Sochor, Thais Coutinho, Michael D. Jensen, Veronique L. Roger, Prachi Singh, Francisco Lopez-Jimenez

Research output: Contribution to journalArticlepeer-review

211 Scopus citations


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. Design: Stratified multistage probability design. Setting: NHANES III (Third National Health and Nutrition Examination Survey). Participants: 15 184 adults (52.3% women) aged 18 to 90 years. Measurements: 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. Limitations: Body fat distribution was assessed based on anthropometric indicators alone. Information on comorbidities was collected by self-report. Conclusion: Normal-weight central obesity defined by WHR is associated with higher mortality than BMI-defined obesity, particularly in the absence of central fat distribution. Primary Funding Source: National Institutes of Health, American Heart Association, European Regional Development Fund, and Czech Ministry of Health.

Original languageEnglish (US)
Pages (from-to)827-835
Number of pages9
JournalAnnals of internal medicine
Issue number11
StatePublished - Dec 1 2015

ASJC Scopus subject areas

  • Internal Medicine


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