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Association between BMI, RFM and mortality and potential mediators: Prospective findings from the Moli-sani study

医学 体质指数 四分位间距 内科学 人口学 比例危险模型 人口 前瞻性队列研究 四分位数 队列研究 瘦体质量 置信区间 环境卫生 社会学 体重
作者
Anwal Ghulam,Francesco Gianfagna,Marialaura Bonaccio,Simona Costanzo,Augusto Di Castelnuovo,Amalia De Curtis,Alessandro Gialluisi,Chiara Cerletti,Maria Benedetta Donati,Giovanni de Gaetano,Licia Iacoviello,Giovanni de Gaetano,Americo Bonanni,Amalia De Curtis,Augusto Di Castelnuovo,Mariarosaria Persichillo,Teresa Di Prospero,Jos Vermylen,Renzo Pegoraro,Antonio G. Spagnolo
出处
期刊:International Journal of Obesity [Springer Nature]
卷期号:47 (8): 697-708 被引量:9
标识
DOI:10.1038/s41366-023-01313-5
摘要

Body mass index (BMI) is the most frequently used adiposity measure, yet it is unable to differentiate fat mass from lean mass. Relative fat mass (RFM) has been proposed as an alternative. This paper aims to study RFM and BMI association with mortality in a general Italian population and potential mediators of such association.20,587 individuals from the Moli-sani cohort were analysed (mean age = 54 ± 11, women = 52%, median follow up = 11.2 years, interquartile range = 1.96 years). Cox regressions were used to assess BMI, RFM, and their interactive association with mortality. Dose-response relationships were computed with spline regression, mediation analysis was performed. All analyses were separated for men and women.Men and women with BMI > 35 kg/m2 and men in the 4th quartile of RFM showed an independent association with mortality (HR = 1.71, 95% CI = 1.30-2.26 BMI in men, HR = 1.37, 95%CI = 1.01-1.85 BMI in women, HR = 1.37 CI 95% = 1.11-1.68 RFM in men), that was lost once adjusted for potential mediators. Cubic splines showed a U-shaped association for BMI in men and women, and for RFM in men. Mediation analysis showed that 46.5% of the association of BMI with mortality in men was mediated by glucose, C reactive protein, forced expiratory volume in 1 s (FEV1), and cystatin C; 82.9% of the association of BMI in women was mediated by HOMA index, cystatin C and FEV1; lastly, 55% of RFM association with mortality was mediated by glucose, FEV1 and cystatin C. Regression models including BMI and RFM showed that RFM drives most of the risk in men, but is not predictive in women.The association between anthropometric measures and mortality was U shaped and it was largely dependent on sex. Associations were mediated by glucose metabolism, renal and lung function. Public health interventions should mainly focus on people with severe obesity or impaired metabolic, renal, or respiratory function.
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