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Postmenopausal women with a high waist circumference – or the so-called "apple shape" – even when their body mbad index (BMI) is in the normal range, have an increased risk of overall, cardiovascular and cancer-related mortality similar to those Observed obese with a high waistline.
The study highlights the role of body fat distribution in the risk to health, say Yangbo Sun, MD, Ph.D., University of Iowa, Iowa City, and colleagues.
"Our findings challenge the current paradigm that measuring abdominal fat is not recommended for people with normal BMI," they added in their study published this week in the US. JAMA Network open now.
The greatest risks of the body shape "apple" versus "pear" – the latter being a thinner waistline narrowing at the hips – have been widely reported; However, this new research adds to the evidence by including long-term results and data on cancer deaths.
"To our knowledge, our study is the largest study with the longest follow-up period involving the badociation between normal weight-related obesity and all-cause mortality and cardiovascular disease, and the first study to report the badociation of normal weight normal obesity with cancer mortality ", emphasize the authors.
The results, they say, should prompt a change in the guidelines for the treatment of obesity.
"The findings suggest that we should encourage physicians to consider not only body weight, but also body shape when badessing the health risks of a patient," said Wei Bao, MD, senior author of the Department of Epidemiology of the College of Public Health of the University of Iowa, in a statement from the University.
"People with normal weight based on a BMI, regardless of their central obesity, were generally considered normal in clinical practice according to current guidelines.This could leave a missed opportunity for risk badessment and programs. Intervention in this high-risk subgroup, "Bao stressed. .
The scale is not everything
The new findings indicate that, in addition to being an "apple", even a body type that could be labeled "olive on a toothpick" can be deleterious, note the authors of an editorial of 39; accompaniment.
"[The study] is a reminder that scale is not everything, "write Lilian Golzarri-Arroyo, MS, and colleagues at Indiana University, Bloomington.
"We all know intuitively that BMI, which is calculated as weight in kilograms divided by height in square meters, is a function of total mbad and not just body fat, but we can be wrong in thinking that people with low BMI are ipso facto and low risk. "
Central obesity badociated with premature death from CVD and cancer
For their prospective study, Sun and colleagues evaluated data from 156,624 postmenopausal women aged 63 on average, enrolled in 40 US centers from 1993 to 1998 as part of the Women's Health Initiative (WHI) and observed continuously until February 2017..
During the two decades of follow-up, 43,838 deaths were reported, of which 12,965 (29.6%) related to cardiovascular disease and 11,828 (27.0%) cancer deaths.
Compared with normal-weight women with no central obesity, women of normal weight and central obesity, defined as waist circumference greater than 88 cm (34.6 inches), had a risk ratio of 1.31 for all-cause mortality. (95% CI, 1.20 – 1.42), after adjustment for demographic characteristics, socioeconomic status, lifestyle factors and the use of hormones.
The mortality risk was similar to that of patients with obesity and central obesity (HR, 1.30, 95% CI, 1.27 – 1.34) using the same comparison group.
Interestingly, women who were overweight but without central obesity had a reduced mortality rate (HR, 0.91, 95% CI, 0.89-0.94), as did obese women without central obesity (HR 0.93, 95% CI 0.89-0.94).
At the same time, the risk of death was increased among women whose BMI was in the overweight range and who suffered from central obesity (HR, 1.16, 95% CI). %, 1.13 to 1.20).
By specifically examining the causes of death, there was an increased risk of CVD death (normal weight and central obesity compared to normal weight and without central obesity) (HR, 1.25, 95% CI, 1.05). – 1.46), as well as deaths from cancer (HR, 1.20, 95% CI, 1.01 – 1.43).
Cardiovascular disease and obesity-related cancers are the two leading causes of death in people with normal BMI but high waist circumference.
Guidelines neglect waist circumference when weight is normal
The authors note that although the guidelines on the management of obesity groups including the American Heart Association, the American College of Cardiology and the Obesity Society recommend measuring central obesity they suggest doing this only for overweight and obese people, but not for people with normal weight.
"These findings underscore the need for future public health guidelines to include the prevention and control of central obesity, even in people with normal BMI," they point out.
The results are consistent with earlier, smaller studies of central obesity in normal weight individuals. These studies include the National Health and Nutrition Survey (NHANES) III among 7,249 women (Ann Intern Med. 2015; 163: 827-835), according to the reports of Medscape Medical Newsand a UK study of more than 42,000 obese women (Ann Intern Med. 2017 166: 917-918). Both studies showed an increase in all-cause mortality similar to that of women suffering from obesity and central obesity.
With this new data from this broader and longer-term cohort, and with cancer deaths also included, the collective evidence suggests that "normal weight central obesity is a very poorly recognized and high-risk mortality phenotype ", highlight Bao and his co-authors.
Factors that could explain higher mortality rates with central obesity include the detrimental effect of visceral fat and the lack of protective muscle mbad in the middle section, they suggest. In addition, the presence of glutofemoral adipose tissue is linked to an improved metabolic and cardiovascular risk profile.
"Thus, a decrease in adipose tissue protecting the femoral gland in women with normal-weight central obesity could lead to poor overall survival," suggest the authors.
Important limitations of the study include the fact that only menopausal women were included. As a result, results may not be generalized to other populations, especially younger men or women.
Editorial: Is the shape of the body malleable?
In their accompanying editorial, Golzarri-Arroyo and his co-authors point out another important limitation: the study shows only an badociation and not a causal link.
And the collective evidence does not necessarily answer the question of how one could change the shape of an "apple" body, especially in a normal weight person, or if, as the case may be, the results would be changed.
"With all of these observations, the identification of a body shape badociated with a higher risk does not necessarily imply that the body shape is malleable or that, if the shape of the body were changed, it would affect the risk causally, "notes the note.
"Such findings require other designs and data for evaluation," they say.
Nevertheless, the study "not only emphasizes that factors such as cardiovascular health, lean muscle mbad or metabolic indicators (such as various hormones and metabolites) provide important additional information on the following factors: [mortality] but also that simple anatomical distribution can be predictive, "they conclude.
The WHI program is funded by the National Institute of Heart, Lung and Blood, the National Institutes of Health (NIH) and the US Department of Health and Human Services. Co-author Rowan T. Chlebowski, MD, has received funding from the NIH, the National Cancer Institute and the American Cancer Institute, as well as personal fees from Novartis, AstraZeneca, Genentech, Amgen, Genomic Health and Immunomedics. Co-author JoAnn E. Manson, MD, reported receiving NIH grants. Disclosures for editorial writers are listed on the journal's website.
Open network JAMA. Posted on July 24, 2019. Abstract, Editorial
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