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Epidemiology and Population Health

Body fat and risk of all-cause mortality: a systematic review and dose-response meta-analysis of prospective cohort studies

Abstract

Background/objectives

We aimed to evaluate the relationships between body fat percentage (BF%), fat mass (FM), fat mass index (FMI) and visceral (VAT) and subcutaneous adipose tissue (SAT) with risk of all-cause mortality.

Methods

We did a systematic search in PubMed, Scopus, and Web of Science to June 2021. We selected prospective cohorts of the relationship between body fat with risk of all-cause mortality in the general population. We applied random-effects models to calculate the relative risks (RRs) and 95%CIs.

Results

A total of 35 prospective cohort studies with 923,295 participants and 68,389 deaths were identified. The HRs of all-cause mortality for a 10% increment in BF were 1.11 (95%CI: 1.02, 1.20; I2 = 93%, n = 11) in the general adult populations, and 0.92 (95%CI: 0.79, 1.06; I2 = 76%, n = 7) in adults older than 60 years. The HRs were 1.06 (95%CI: 1.01, 1.12; I2 = 86%, n = 10) for a 5 kg increment in FM, 1.11 (95%CI: 1.06, 1.16; I2 = 79%, n = 7) for a 2 kg/m2 increment in FMI, and 1.17 (95%CI: 1.03, 1.33; I2 = 72%, n = 8) and 0.81 (0.66, 0.99; I2 = 59%, n = 6) for a 1-SD increment in VAT and SAT, respectively. There was a J shaped association between BF% and FM and all-cause mortality risk, with the lowest risk at BF% of 25% and FM of 20 kg. In subgroup analyses, although there was little evidence of between-subgroup heterogeneity, the observed positive associations were more pronounced in studies which had a longer duration, excluded participants with prevalent cardiovascular disease and cancer at baseline, with adjustment for smoking or restricted to never smokers, and less pronounced in studies which adjusted for potential intermediates, suggesting an impact of reverse causation, confounding and over-adjustment in some of the studies.

Conclusions

Higher body fat content was related to a higher risk of mortality in a J shaped manner. Any future studies should further assess the impact of reverse causation and residual confounding on these associations.

Registration

PROSPERO (CRD42021240743).

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Fig. 1: Dose-response association of body fat percentage with the risk of all-cause mortality (Pnonlinearity < 0.001, n = 14).
Fig. 2: Dose-response association of body fat percentage with the risk of all-cause mortality in the general adult populations.
Fig. 3: Dose-response association of body fat percentage with the risk of all-cause mortality in men (Pnon-linearity < 0.001, n = 9).
Fig. 4: Dose-response association of body fat percentage with the risk of all-cause mortality in women (Pnon-linearity < 0.001, n = 8).
Fig. 5: Dose-response association of fat mass with the risk of all-cause mortality (Pnon-linearity = 0.01, n = 6).
Fig. 6: Dose-response association of fat mass index with the risk of all-cause mortality (Pnon-linearity < 0.001, n = 4).

Data availability

The data and analytical codes used for the present review will be available upon request.

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AJ contributed to the study conception, literature search, data extraction, data analysis, and manuscript drafting. AE contributed to the literature search, data extraction, and manuscript drafting. SSB contributed to study conception, data analysis, and manuscript drafting. TK contributed to the data analysis, provided STATA syntax for dose-response meta-analysis, and approving the final manuscript. DA critically revised the manuscript and contributed to the interpretation of the findings. All authors acknowledge full responsibility for the analyses and interpretation of the report. All authors have read and approved the final manuscript. SS-B is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

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Correspondence to Sakineh Shab-Bidar.

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AJ, DA, AE, and SSB: have no relevant financial or non-financial interests to disclose. Dr. Tauseef A Khan has received research support from the Canadian Institutes of Health Research (CIHR), the International Life Science Institute (ILSI), and National Honey Board, outside the submitted work.

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Jayedi, A., Khan, T.A., Aune, D. et al. Body fat and risk of all-cause mortality: a systematic review and dose-response meta-analysis of prospective cohort studies. Int J Obes (2022). https://doi.org/10.1038/s41366-022-01165-5

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