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 (2006â2010) through 31 March 2020.
Results
We included 369,752 participants (mean baseline ageâ=â56.3â±â8.1 years; range 38.9â73.7 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 55â75 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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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).
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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.
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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, 709â716 (2023). https://doi.org/10.1038/s41366-023-01314-4
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DOI: https://doi.org/10.1038/s41366-023-01314-4
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