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Abdominal and gluteo-femoral markers of adiposity and risk of vascular-metabolic mortality in a prospective study of 150 000 Mexican adults.

  • Gnatiuc, Louisa1
  • Tapia-Conyer, Roberto2
  • Wade, Rachel1, 3
  • Ramirez-Reyes, Raúl2
  • Aguilar-Ramirez, Diego1
  • Herrington, William1, 3
  • Hill, Michael1, 3
  • Lewington, Sarah1, 3, 4
  • Torres, Jason1
  • Trichia, Eirini1
  • Collins, Rory1
  • Peto, Richard1
  • Clarke, Robert1
  • Kuri-Morales, Pablo2
  • Emberson, Jonathan R1, 3
  • Alegre-Díaz, Jesus2
  • 1 Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK.
  • 2 School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico. , (Mexico)
  • 3 MRC Population Health Research Unit, NDPH, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK.
  • 4 UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia. , (Malaysia)
Published Article
European Journal of Preventive Cardiology
SAGE Publications
Publication Date
May 05, 2022
DOI: 10.1093/eurjpc/zwab038
PMID: 33693634


Results of previous studies of abdominal adiposity and risk of vascular-metabolic mortality in Hispanic populations have been conflicting. We report results from a large prospective study of Mexican adults with high levels of abdominal adiposity. A total of 159 755 adults aged ≥35 years from Mexico City were enrolled in a prospective study and followed for 16 years. Cox regression, adjusted for confounders, yielded mortality rate ratios (RRs) associated with three markers of abdominal adiposity (waist circumference, waist-hip ratio, and waist-height ratio) and one marker of gluteo-femoral adiposity (hip circumference) for cause-specific mortality before age 75 years. To reduce reverse causality, deaths in the first 5 years of follow-up and participants with diabetes or other prior chronic disease were excluded. Among 113 163 participants without prior disease and aged 35-74 years at recruitment, all adiposity markers were positively associated with vascular-metabolic mortality. Comparing the top versus bottom tenth of the sex-specific distributions, the vascular-metabolic mortality RRs at ages 40-74 years were 2.32 [95% confidence interval (CI) 1.84-2.94] for waist circumference, 2.22 (1.71-2.88) for the waist-hip ratio, 2.63 (2.06-3.36) for the waist-height ratio, and 1.58 (1.29-1.93) for hip circumference. The RRs corresponding to each standard deviation (SD) higher usual levels of these adiposity markers were 1.34 (95% CI 1.27-1.41), 1.31 (1.23-1.39), 1.38 (1.31-1.45), and 1.18 (1.13-1.24), respectively. For the markers of abdominal adiposity, the RRs did not change much after further adjustment for other adiposity markers, but for hip circumference the association was reversed; given body mass index and waist circumference, the RR for vascular-metabolic mortality for each one SD higher usual hip circumference was 0.80 (0.75-0.86). In this study of Mexican adults, abdominal adiposity (and in particular the waist-height ratio) was strongly and positively associated with vascular-metabolic mortality. For a given amount of general and abdominal adiposity, however, higher hip circumference was associated with lower vascular-metabolic mortality. © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

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