Mid‐Arm Muscle and Subcutaneous Fat Associated with All‐Cause Mortality Independent of BMI: A Prospective Cohort Study

Objective This study aimed to systematically evaluate the association between triceps skinfold (TSF) thickness (which indicates subcutaneous fat) mid‐arm muscle circumference (MAMC; which reflects muscle mass), mid‐upper arm circumference (MUAC), and all‐cause mortality. Methods A total of 17,717 adults from the China Health and Nutrition Survey (1993‐2015) were included. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all‐cause mortality. The joint effect of TSF thickness and MAMC was examined, and planned subgroup analyses were performed. Results The highest quartiles of TSF thickness, MAMC, and MUAC were significantly associated with low all‐cause mortality, independent of BMI (TSF thickness: HR = 0.704 [95% CI: 0.575‐0.862]; MAMC: HR = 0.729 [95% CI: 0.607‐0.876]; MUAC: HR = 0.713 [95% CI: 0.583‐0.872]). A 1‐SD increase showed comparable risk reductions for TSF thickness and MAMC (14.6% and 14.0%), with 16.1% risk reductions in MUAC. There were positive additive interactions between TSF thickness and MAMC. The inverse association existed in young, middle‐aged, and elderly participants ( P ‐heterogeneity > 0.05). Conclusions Mid‐arm muscle and subcutaneous fat were inversely associated with all‐cause mortality, independent of BMI, beyond the elderly population. Mid‐arm muscle and subcutaneous fat made comparable contributions to and had positive joint effects on all‐cause mortality.