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Epidemiology and Population Health

Gender differences in midlife to later-life cumulative burden and variability of obesity measures and risk of all-cause and cause-specific mortality

International Journal of Obesity volume 48, pages 495–502 (2024)Cite this article

Subjects

Abstract

Background/Objectives

Previous studies have reported the gender-specific association between general and central obesity measures, using snapshot assessments, and mortality events. This study seeks to further explore this link by examining how the longitudinal cumulative burden and variability of obesity measures from midlife to later-life impact mortality events in the Atherosclerosis Risk in Communities (ARIC) study population, specifically in relation to gender differences.

Subjects/Methods

Using data from the ARIC study, a total of 7615 (4360 women) participants free of cardiovascular disease, cancer, and early mortality events were included in the data analysis. Longitudinal cumulative burden (estimated by the area under the curve (AUC) using a quadratic mixed-effects method) and variability (calculated according to average successive variability (ASV)) were considered as exposures, separately and all together. Cox proportional hazard regression models were used to estimate multivariable-adjusted standardized hazard ratios.

Results

The mean age was 62.4 and the median follow-up was 16.9 years. In men, AUCs of waist-related obesity measures, and also ASVs of all obesity measures were associated with increased all-cause mortality risk. In women, waist circumference and waist-to-height ratio AUCs were associated with increased all-cause mortality risk. Regarding cardiovascular mortality, all adiposity measures ASVs in both genders and waist-related obesity measures AUCs in men were associated with increased risk. Significant gender differences were found for the associations between cumulative and variability of waist-to-hip ratio for all-cause mortality and all adiposity measures ASVs for cardiovascular mortality risk with higher impact among men.

Conclusions

Cumulative burden and variability in general and central obesity measures were associated with higher all-cause and cardiovascular mortalities among men. In women, general obesity measures variability, as well as cumulative and variability of central adiposity measure, increased all-cause mortality risk.

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Fig. 1: Longitudinal trajectories of anthropometric measures during middle age to later life in men and women.
Fig. 2: Standardized hazard ratios (HRs) and 95% confidence intervals (CIs) of cumulative burden (AUC) and variability (ASV) of anthropometric measures after adjustment for each other in final multivariable-adjusted models for mortality events.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank the participants ARIC study and the Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC) website staff for their contributions.

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Authors and Affiliations

  1. Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Karim Kohansal, Siamak Afaghi, Davood Khalili, Danial Molavizadeh & Farzad Hadaegh

  2. Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Karim Kohansal & Davood Khalili

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Contributions

FH and KK were responsible for the study conceptualization and design, analysis of demographic data, interpretation of results, and preparation of the manuscript. KK was responsible for analytic design and data analysis. KK, FH, SA, DK, and DM were responsible for the conceptualization of the study. All listed authors reviewed the manuscript and agree to be accountable for all aspects of this work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Farzad Hadaegh.

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Kohansal, K., Afaghi, S., Khalili, D. et al. Gender differences in midlife to later-life cumulative burden and variability of obesity measures and risk of all-cause and cause-specific mortality. Int J Obes 48, 495–502 (2024). https://doi.org/10.1038/s41366-023-01440-z

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