Body mass index, waist circumference, and mortality in subjects older than 80 years: a Mendelian randomization study,European Heart Journal

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Body mass index, waist circumference, and mortality in subjects older than 80 years: a Mendelian randomization study
European Heart Journal ( IF 39.3 ) Pub Date : 2024-04-16 , DOI: 10.1093/eurheartj/ehae206
Yuebin Lv ₁ , Yue Zhang ₂ , Xinwei Li _{1,

3} , Xiang Gao ₄ , Yongyong Ren ₂ , Luojia Deng ₂ , Lanjing Xu _{1,

5} , Jinhui Zhou ₁ , Bing Wu _{1,

6} , Yuan Wei _{1,

3} , Xingyao Cui _{1,

3} , Zinan Xu _{1,

7} , Yanbo Guo _{1,

3} , Yidan Qiu _{1,

5} , Lihong Ye _{1,

8} , Chen Chen ₁ , Jun Wang ₁ , Chenfeng Li _{1,

9} , Yufei Luo _{1,

9} , Zhaoxue Yin ₁₀ , Chen Mao ₇ , Qiong Yu ₃ , Hui Lu ₂ , Virginia Byers Kraus ₁₁ , Yi Zeng ₁₂ , Shilu Tong _{1,

13} , Xiaoming Shi ₁

Affiliation

China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention , #7 Panjiayuan Nanli, Chaoyang, Beijing 100021 , China
Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University , Shanghai , China
Department of Epidemiology and Biostatistics, School of Public Health, Jilin University , Changchun , China
Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University , Shanghai , China
Department of Big Data in Health Science, School of Public Health, Zhejiang University , Hangzhou , China
Center for Global Health, School of Public Health, Nanjing Medical University , Nanjing , China
Department of Epidemiology, School of Public Health, Southern Medical University , Guangzhou , China
School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College , Beijing , China
Department of Occupational Health and Environment Health, School of Public Health, Anhui Medical University , Hefei , China
Division of Non-Communicable Disease and Healthy Aging Management, Chinese Center for Disease Control and Prevention , Beijing , China
Department of Medicine, Duke Molecular Physiology Institute and Division of Rheumatology, Duke University School of Medicine , Durham, NC , USA
Center for Study of Healthy Aging and Development Studies, Peking University , Beijing , China
School of Public Health and Social Work, Queensland University of Technology , Brisbane , Australia

Background and Aims Emerging evidence has raised an obesity paradox in observational studies of body mass index (BMI) and health among the oldest-old (aged ≥80 years), as an inverse relationship of BMI with mortality was reported. This study was to investigate the causal associations of BMI, waist circumference (WC), or both with mortality in the oldest-old people in China. Methods A total of 5306 community-based oldest-old (mean age 90.6 years) were enrolled in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 1998 and 2018. Genetic risk scores were constructed from 58 single-nucleotide polymorphisms (SNPs) associated with BMI and 49 SNPs associated with WC to subsequently derive causal estimates for Mendelian randomization (MR) models. One-sample linear MR along with non-linear MR analyses were performed to explore the associations of genetically predicted BMI, WC, and their joint effect with all-cause mortality, cardiovascular disease (CVD) mortality, and non-CVD mortality. Results During 24 337 person-years of follow-up, 3766 deaths were documented. In observational analyses, higher BMI and WC were both associated with decreased mortality risk [hazard ratio (HR) 0.963, 95% confidence interval (CI) 0.955–0.971 for a 1-kg/m2 increment of BMI and HR 0.971 (95% CI 0.950–0.993) for each 5 cm increase of WC]. Linear MR models indicated that each 1 kg/m2 increase in genetically predicted BMI was monotonically associated with a 4.5% decrease in all-cause mortality risk [HR 0.955 (95% CI 0.928–0.983)]. Non-linear curves showed the lowest mortality risk at the BMI of around 28.0 kg/m2, suggesting that optimal BMI for the oldest-old may be around overweight or mild obesity. Positive monotonic causal associations were observed between WC and all-cause mortality [HR 1.108 (95% CI 1.036–1.185) per 5 cm increase], CVD mortality [HR 1.193 (95% CI 1.064–1.337)], and non-CVD mortality [HR 1.110 (95% CI 1.016–1.212)]. The joint effect analyses indicated that the lowest risk was observed among those with higher BMI and lower WC. Conclusions Among the oldest-old, opposite causal associations of BMI and WC with mortality were observed, and a body figure with higher BMI and lower WC could substantially decrease the mortality risk. Guidelines for the weight management should be cautiously designed and implemented among the oldest-old people, considering distinct roles of BMI and WC.

更新日期：2024-04-16

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