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Epidemiology and Population Health

Body composition and mortality from middle to old age: a prospective cohort study from the UK Biobank

International Journal of Obesity volume 47, pages 709–716 (2023)Cite this article

Subjects

Abstract

Background

How the association between adiposity and the risk of death changes with age, and which is the optimal level of adiposity to reduce mortality in older ages, is still not completely understood. We aimed to ascertain the age-specific risks of mortality associated with different measures of adiposity.

Methods

This was a prospective UK Biobank cohort study. Participants were categorized based on five different adiposity and body composition metrics. We explored the age-varying associations between body composition indices and all-cause mortality from 45 to 85 years of age at follow-up using hazard ratios (HR) from flexible parametric survival models with multivariable adjustment and age as timescale. Participants were followed from baseline (2006–2010) through 31 March 2020.

Results

We included 369,752 participants (mean baseline age = 56.3 ± 8.1 years; range 38.9–73.7 years; 54.1% women) and 10,660 deaths during a median follow-up of 11.4 years. Associations between body mass index and mortality were similar when using the fat mass index in magnitude and shape. Compared to participants with normal weight, overweight was not associated with the risk of death regardless of age and the adiposity measure used. Participants with obesity class I showed an HR of 1.20 (95% confidence interval [CI]: 1.08, 1.33) and 1.14 (95%CI: 0.98, 1.30) at ages 60 and 80, respectively, and participants with obesity class II an HR about 1.55 across all age. More attenuated associations with higher age were found in individuals with the highest obesity using the fat mass index. Very high lean mass was associated with an increased risk of mortality in those aged 55–75 years (HR about 1.20 across all ages).

Conclusion

Obesity should be prevented at any age. Attenuated associations with older age were observed only among the individuals with the highest obesity, but the risk remained higher compared to normal-weight participants. Lean mass did not reduce mortality risk at any age.

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Fig. 1: Age-varying hazard ratios for all-cause mortality in categories of body mass index, fat mass index and lean mass index in the total sample (n = 369,752).
Fig. 2: Age-varying hazard ratios for all-cause mortality in categories of body mass index, fat mass index, and lean mass index in never-smokers (n = 212,071).

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Data availability

The datasets analyzed in the present study are globally accessible to approved researchers in the UK Biobank repository, https://www.ukbiobank.ac.uk/.

Code availability

The code used for data curation and analysis is summarized in Supplementary Table 2 and the full code is available upon request to the corresponding author.

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Acknowledgements

This research received no specific funding. MASL was funded during the development of the study by the Spanish Ministry of Universities under application 33.50.460A.752 and by the European Union NextGenerationEU/PRTR through a Margarita Salas contract of the University of Vigo. DD was funded by a National Health and Medical Research Council Emerging Leader Grant (Application ID 2009254). BdPC was supported by the Government of Andalusia, Research Talent Recruitment Program (EMERGIA 2020/00158).

Author information

Authors and Affiliations

  1. Department of Special Didactics, University of Vigo, 36005, Pontevedra, Spain

    Miguel Adriano Sanchez-Lastra

  2. Wellness and Movement Research Group (WellMove), Galicia-Sur Health Research Institute (IIS Galicia Sur). SERGAS-UVIGO, Vigo, Spain

    Miguel Adriano Sanchez-Lastra

  3. Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway

    Miguel Adriano Sanchez-Lastra & Ulf Ekelund

  4. Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia

    Ding Ding

  5. Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia

    Ding Ding

  6. Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway

    Knut Eirik Dalene & Ulf Ekelund

  7. Centre for Active and Healthy Ageing, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

    Borja del Pozo Cruz

  8. Faculty of Education, University of Cádiz, Cádiz, Spain

    Borja del Pozo Cruz

  9. Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain

    Borja del Pozo Cruz

  10. Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark

    Jakob Tarp

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  1. Miguel Adriano Sanchez-Lastra
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Contributions

MASL, DD, KED, UE, and JT conceptualized and designed the study. MASL verified and analyzed the data with help from JT, KED and BDPC. MASL takes responsibility for integrity of the data and the data analysis. MASL and JT wrote the first draft of the report. All other authors assisted in developing the statistical models, reviewed results, provided guidance on methods, and critically reviewed the manuscript. All authors had full access to the data and accept the responsibility to submit for publication.

Corresponding author

Correspondence to Miguel Adriano Sanchez-Lastra.

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Sanchez-Lastra, M.A., Ding, D., Dalene, K.E. et al. Body composition and mortality from middle to old age: a prospective cohort study from the UK Biobank. Int J Obes 47, 709–716 (2023). https://doi.org/10.1038/s41366-023-01314-4

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