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Epidemiology and Population Health

Relative fat mass and prediction of incident atrial fibrillation, heart failure and coronary artery disease in the general population

International Journal of Obesity volume 47, pages 1256–1262 (2023)Cite this article

Subjects

Abstract

Background

Relative fat mass (RFM) is an emerging marker of obesity that estimates body fat percentage using a sex-specific formula containing height and waist circumference (WC). We studied the association of RFM with incident atrial fibrillation (AF), heart failure (HF), and coronary artery disease (CAD) and explored RFM cutoffs for cardiovascular disease (CVD) prediction.

Methods

We studied 95,003 participants (age 45 ± 13 years, 59% women) without prevalent AF, HF or CAD from the population-based Lifelines study. Outcomes were ascertained using electrocardiography and self-reported questionnaire data. We used logistic regression to study the association of RFM with individual outcomes and a composite outcome (incident AF, HF, and/or CAD). Multivariable models were adjusted for components of the SCORE risk model (age, sex, systolic blood pressure, cholesterol, and smoking). Optimal cutoffs were determined using the Youden index.

Results

During a median follow-up of 3.8 (3.0–4.6) years, 224 (0.2%) participants developed AF, 1003 (1.1%) HF and 657 (0.7%) CAD. After multivariable adjustment, RFM was significantly associated with all outcomes (standardised OR 1.26, 95% CI 1.18–1.34 for the composite outcome). Optimal RFM cutoffs ( ≥26 for men, ≥38 for women) were lower than previously proposed RFM cutoffs ( ≥30 for men, ≥40 for women). In general, overall discriminative ability of RFM and its cutoffs was at least similar (in women) or better (in men) compared to BMI and WC. Since RFM was substantially correlated with age, we additionally determined age-specific cutoffs, which ranged from 23 to 27 in men and 33 to 43 in women.

Conclusions

RFM is associated with incident AF, HF, and CAD and may be used as a simple and intuitive marker of obesity and cardiovascular risk in the general population. This study provides potential RFM cutoffs for CVD prediction that may be used by future studies or preventive strategies targeting obesity and cardiovascular risk.

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Fig. 1: Association of relative fat mass with incident cardiovascular disease in men and women.

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Data availability

Data may be obtained from a third party and are not publicly available. Researchers can apply to use the Lifelines data used in this study. More information about how to request Lifelines data and the conditions of use can be found on the Lifelines website (https://www.lifelines.nl/researcher/how-to-apply).

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Acknowledgements

Part of this work was presented during the ESC Heart Failure 2022 Congress and published as a conference abstract (European Journal of Heart Failure 2022; 24 (Suppl. S2): 243, https://doi.org/10.1002/ejhf.2569).

Funding

Funding

This work was supported by the Dutch Heart Foundation (CVON RED-CVD, grant 2017-11).

Author information

Authors and Affiliations

  1. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

    Victor W. Zwartkruis, Navin Suthahar, Belend Mahmoud, Colinda van Deutekom & Michiel Rienstra

  2. Department of Cardiology, Thorax Center, Erasmus University Medical Center, Rotterdam, the Netherlands

    Navin Suthahar & Rudolf A. de Boer

  3. Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

    Demy L. Idema

  4. Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

    Frans H. Rutten

  5. Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

    Yvonne T. van der Schouw

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  1. Victor W. Zwartkruis
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Contributions

VWZ, NS, DI, MR, and RAdB contributed to the conception, design and acquisition of the work, data analysis and interpretation. VWZ drafted the manuscript. All authors contributed to the critical revision of the manuscript, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Rudolf A. de Boer.

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Competing interests

For the current manuscript, the authors declare no potential conflicts of interest. Outside of the submitted work, the authors disclosed the following financial support: RAdB reports grants from the Dutch Heart Foundation (CVON SHE-PREDICTS-HF, grant 2017-21; CVON RED-CVD, grant 2017-11; CVON PREDICT2, grant 2018-30; and CVON DOUBLE DOSE, grant 2020B005), leDucq Foundation (Cure PhosphoLambaN induced Cardiomyopathy) and the European Research Council (SECRETE-HF, ERC CoG 818715). RAdB has received research grants and/or fees from AstraZeneca, Abbott, Boehringer Ingelheim, Cardior Pharmaceuticals Gmbh, Ionis Pharmaceuticals, Inc., Novo Nordisk and Roche. RAdB has received speaker fees from Abbott, AstraZeneca, Bayer, Novartis, and Roche. MR reports grants from the Dutch Heart Foundation (CVON RACE V, grant 2014-09; CVON RED-CVD, grant 2017-11; CVON-AI, grant 2018B017; DECISION, grant 2018B024). The UMCG, which employs MR, received grants from SJM/Abbott (VIP-HF study) and Medtronic (Cryoballoon AF registry/biobank study).

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Zwartkruis, V.W., Suthahar, N., Idema, D.L. et al. Relative fat mass and prediction of incident atrial fibrillation, heart failure and coronary artery disease in the general population. Int J Obes 47, 1256–1262 (2023). https://doi.org/10.1038/s41366-023-01380-8

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