Raj Padwal, MD, MSc; William D. Leslie, MD, MSc; Lisa M. Lix, PhD; Sumit R. Majumdar, MD, MPH
Note: This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.
Disclaimer: The results and conclusions are those of the authors, and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, or other data providers is intended or should be inferred.
Acknowledgment: The authors thank the Manitoba Centre for Health Policy for the use of data contained in the Population Health Research Data Repository (Health Information Privacy Committee project number 2011/2012-31). The authors also thank Dr. Shuman Yang for assisting with R programming and figure preparation. Dr. Majumdar holds the Endowed Chair in Patient Health Management from the Faculties of Medicine and Dentistry and Pharmacy and Pharmaceutical Sciences, University of Alberta. Dr. Lix is supported by a Manitoba Research Chair from Research Manitoba.
Disclosures: Dr. Leslie reports grants from Genzyme and Amgen and speaker fees from Amgen, Eli Lilly, and Novartis outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1181.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol, statistical code, and data set: Not available.
Requests for Single Reprints: William D. Leslie, MD, Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada; e-mail, email@example.com.
Current Author Addresses: Drs. Padwal and Majumdar: General Internal Medicine, University of Alberta, 5-134 Clinical Sciences Building, 8440 112th Street, Edmonton, Alberta T6G 2G3, Canada.
Dr. Leslie: Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada.
Dr. Lix: Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, Manitoba R3P 2H5, Canada.
Author Contributions: Conception and design: R. Padwal, W.D. Leslie, S.R. Majumdar.
Analysis and interpretation of the data: R. Padwal, W.D. Leslie, L.M. Lix, S.R. Majumdar.
Drafting of the article: R. Padwal, W.D. Leslie.
Critical revision of the article for important intellectual content: R. Padwal, W.D. Leslie, L.M. Lix, S.R. Majumdar.
Final approval of the article: R. Padwal, W.D. Leslie, L.M. Lix, S.R. Majumdar.
Provision of study materials or patients: W.D. Leslie.
Statistical expertise: W.D. Leslie, L.M. Lix.
Administrative, technical, or logistic support: W.D. Leslie.
Collection and assembly of data: W.D. Leslie.
Padwal R, Leslie WD, Lix LM, Majumdar SR. Relationship Among Body Fat Percentage, Body Mass Index, and All-Cause Mortality: A Cohort Study. Ann Intern Med. 2016;164:532-541. doi: 10.7326/M15-1181
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Published: Ann Intern Med. 2016;164(8):532-541.
Published at www.annals.org on 8 March 2016
Prior mortality studies have concluded that elevated body mass index (BMI) may improve survival. These studies were limited because they did not measure adiposity directly.
To examine associations of BMI and body fat percentage (separately and together) with mortality.
Adults aged 40 years or older referred for bone mineral density (BMD) testing.
Participants had dual-energy x-ray absorptiometry (DXA), entered a clinical BMD registry, and were followed using linked administrative databases. Adjusted, sex-stratified Cox models were constructed. Body mass index and DXA-derived body fat percentage were divided into quintiles, with quintile 1 as the lowest, quintile 5 as the highest, and quintile 3 as the reference.
The final cohort included 49 476 women (mean age, 63.5 years; mean BMI, 27.0 kg/m2; mean body fat, 32.1%) and 4944 men (mean age, 65.5 years; mean BMI, 27.4 kg/m2; mean body fat, 29.5%). Death occurred in 4965 women over a median of 6.7 years and 984 men over a median of 4.5 years. In fully adjusted mortality models containing both BMI and body fat percentage, low BMI (hazard ratio [HR], 1.44 [95% CI, 1.30 to 1.59] for quintile 1 and 1.12 [CI, 1.02 to 1.23] for quintile 2) and high body fat percentage (HR, 1.19 [CI, 1.08 to 1.32] for quintile 5) were associated with higher mortality in women. In men, low BMI (HR, 1.45 [CI, 1.17 to 1.79] for quintile 1) and high body fat percentage (HR, 1.59 [CI, 1.28 to 1.96] for quintile 5) were associated with increased mortality.
All participants were referred for BMD testing, which may limit generalizability. Serial measures of BMD and weight were not used. Some measures, such as physical activity and smoking, were unavailable.
Low BMI and high body fat percentage are independently associated with increased mortality. These findings may help explain the counterintuitive relationship between BMI and mortality.
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