Body Mass Index, Waist Circumference, and Mortality in a Large Multiethnic Postmenopausal Cohort-Results from the Women's Health Initiative

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Abstract

Objectives: To determine whether the relationship between anthropometric measurements of obesity and mortality varies according to age, race, and ethnicity in older women. Design: Prospective cohort study of multiethnic postmenopausal women. Setting: Women's Health Initiative (WHI) observational study and clinical trials in 40 clinics. Participants: Postmenopausal women aged 50-79 participating in WHI (N = 161,808). Measurements: Baseline height, weight, and waist circumference (WC) were measured, and body mass index (BMI) was calculated based on height and weight. Demographic, health, and lifestyle data from a baseline questionnaire were used as covariates. The outcome was adjudicated death (n = 18,320) during a mean follow-up of 11.4 ± 3.2 years. Results: Hazard ratios (HRs) and 95% confidence intervals (95% CIs) indicated that ethnicity and age modified (P < .01) the relationship between obesity and mortality. Underweight was associated with higher mortality, but overweight or slight obesity was not a risk factor for mortality in most ethnic groups except for Hispanic women in the obesity I category (HR = 1.42, 95% CI = 1.04-1.95). BMI was not or was only weakly associated with mortality in individuals aged 70-79 (HR = 0.90, 95% CI = 0.85-0.95 for overweight; HR = 0.98, 95 CI = 0.92-1.06 for obese I; HR = 1.11, 95% CI = 1.00-1.23 for obese II; HR = 1.08, 95% CI = 0.92-1.26 for obese III). In contrast, higher central obesity measured using WC was consistently associated with higher mortality in all groups. Conclusion: Underweight is a significant risk factor for mortality in older women, and healthy BMI ranges may need to be specific for age, race, and ethnicity. The findings support a consistent relationship between central obesity and mortality.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StateAccepted/In press - 2017

Fingerprint

Waist Circumference
Women's Health
Body Mass Index
Mortality
Confidence Intervals
Obesity
Abdominal Obesity
Thinness
Weights and Measures
Hispanic Americans
Ethnic Groups
Observational Studies
Life Style
Cohort Studies
Demography
Clinical Trials
Prospective Studies
Health

Keywords

  • Body mass index
  • Minority health
  • Mortality
  • Waist circumference
  • Women

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

@article{b079066117014fccab3865c68d0ad3fb,
title = "Body Mass Index, Waist Circumference, and Mortality in a Large Multiethnic Postmenopausal Cohort-Results from the Women's Health Initiative",
abstract = "Objectives: To determine whether the relationship between anthropometric measurements of obesity and mortality varies according to age, race, and ethnicity in older women. Design: Prospective cohort study of multiethnic postmenopausal women. Setting: Women's Health Initiative (WHI) observational study and clinical trials in 40 clinics. Participants: Postmenopausal women aged 50-79 participating in WHI (N = 161,808). Measurements: Baseline height, weight, and waist circumference (WC) were measured, and body mass index (BMI) was calculated based on height and weight. Demographic, health, and lifestyle data from a baseline questionnaire were used as covariates. The outcome was adjudicated death (n = 18,320) during a mean follow-up of 11.4 ± 3.2 years. Results: Hazard ratios (HRs) and 95{\%} confidence intervals (95{\%} CIs) indicated that ethnicity and age modified (P < .01) the relationship between obesity and mortality. Underweight was associated with higher mortality, but overweight or slight obesity was not a risk factor for mortality in most ethnic groups except for Hispanic women in the obesity I category (HR = 1.42, 95{\%} CI = 1.04-1.95). BMI was not or was only weakly associated with mortality in individuals aged 70-79 (HR = 0.90, 95{\%} CI = 0.85-0.95 for overweight; HR = 0.98, 95 CI = 0.92-1.06 for obese I; HR = 1.11, 95{\%} CI = 1.00-1.23 for obese II; HR = 1.08, 95{\%} CI = 0.92-1.26 for obese III). In contrast, higher central obesity measured using WC was consistently associated with higher mortality in all groups. Conclusion: Underweight is a significant risk factor for mortality in older women, and healthy BMI ranges may need to be specific for age, race, and ethnicity. The findings support a consistent relationship between central obesity and mortality.",
keywords = "Body mass index, Minority health, Mortality, Waist circumference, Women",
author = "Zhao Chen and Klimentidis, {Yann C} and Bea, {Jennifer W} and Ernst, {Kacey C} and Chengcheng Hu and Rebecca Jackson and Cynthia Thomson",
year = "2017",
doi = "10.1111/jgs.14790",
language = "English (US)",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Body Mass Index, Waist Circumference, and Mortality in a Large Multiethnic Postmenopausal Cohort-Results from the Women's Health Initiative

AU - Chen, Zhao

AU - Klimentidis, Yann C

AU - Bea, Jennifer W

AU - Ernst, Kacey C

AU - Hu, Chengcheng

AU - Jackson, Rebecca

AU - Thomson, Cynthia

PY - 2017

Y1 - 2017

N2 - Objectives: To determine whether the relationship between anthropometric measurements of obesity and mortality varies according to age, race, and ethnicity in older women. Design: Prospective cohort study of multiethnic postmenopausal women. Setting: Women's Health Initiative (WHI) observational study and clinical trials in 40 clinics. Participants: Postmenopausal women aged 50-79 participating in WHI (N = 161,808). Measurements: Baseline height, weight, and waist circumference (WC) were measured, and body mass index (BMI) was calculated based on height and weight. Demographic, health, and lifestyle data from a baseline questionnaire were used as covariates. The outcome was adjudicated death (n = 18,320) during a mean follow-up of 11.4 ± 3.2 years. Results: Hazard ratios (HRs) and 95% confidence intervals (95% CIs) indicated that ethnicity and age modified (P < .01) the relationship between obesity and mortality. Underweight was associated with higher mortality, but overweight or slight obesity was not a risk factor for mortality in most ethnic groups except for Hispanic women in the obesity I category (HR = 1.42, 95% CI = 1.04-1.95). BMI was not or was only weakly associated with mortality in individuals aged 70-79 (HR = 0.90, 95% CI = 0.85-0.95 for overweight; HR = 0.98, 95 CI = 0.92-1.06 for obese I; HR = 1.11, 95% CI = 1.00-1.23 for obese II; HR = 1.08, 95% CI = 0.92-1.26 for obese III). In contrast, higher central obesity measured using WC was consistently associated with higher mortality in all groups. Conclusion: Underweight is a significant risk factor for mortality in older women, and healthy BMI ranges may need to be specific for age, race, and ethnicity. The findings support a consistent relationship between central obesity and mortality.

AB - Objectives: To determine whether the relationship between anthropometric measurements of obesity and mortality varies according to age, race, and ethnicity in older women. Design: Prospective cohort study of multiethnic postmenopausal women. Setting: Women's Health Initiative (WHI) observational study and clinical trials in 40 clinics. Participants: Postmenopausal women aged 50-79 participating in WHI (N = 161,808). Measurements: Baseline height, weight, and waist circumference (WC) were measured, and body mass index (BMI) was calculated based on height and weight. Demographic, health, and lifestyle data from a baseline questionnaire were used as covariates. The outcome was adjudicated death (n = 18,320) during a mean follow-up of 11.4 ± 3.2 years. Results: Hazard ratios (HRs) and 95% confidence intervals (95% CIs) indicated that ethnicity and age modified (P < .01) the relationship between obesity and mortality. Underweight was associated with higher mortality, but overweight or slight obesity was not a risk factor for mortality in most ethnic groups except for Hispanic women in the obesity I category (HR = 1.42, 95% CI = 1.04-1.95). BMI was not or was only weakly associated with mortality in individuals aged 70-79 (HR = 0.90, 95% CI = 0.85-0.95 for overweight; HR = 0.98, 95 CI = 0.92-1.06 for obese I; HR = 1.11, 95% CI = 1.00-1.23 for obese II; HR = 1.08, 95% CI = 0.92-1.26 for obese III). In contrast, higher central obesity measured using WC was consistently associated with higher mortality in all groups. Conclusion: Underweight is a significant risk factor for mortality in older women, and healthy BMI ranges may need to be specific for age, race, and ethnicity. The findings support a consistent relationship between central obesity and mortality.

KW - Body mass index

KW - Minority health

KW - Mortality

KW - Waist circumference

KW - Women

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U2 - 10.1111/jgs.14790

DO - 10.1111/jgs.14790

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JO - Journal of the American Geriatrics Society

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