Association between body mass index (BMI), relative fat mass (RFM) and mortality and potential mediators: Prospective findings from the Moli-sani study
Authors' conclusion
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.
Study context
- Population
- General Italian population, Moli-sani cohort; mean age 54 ± 11, 52% womenanalysed
- Participants
- 20,587 participants
- Exposure
- BMI and RFM categories and mortality
- Outcome
- All-cause mortality
- Follow-up
- Median 11.2 years (IQR 1.96 years)
Methodological detailssex-stratified analyses, mediation analysis
- Sex-stratified analyses
- Mediation analysis
Main finding
As reported in the abstract
Mortality
Hazard ratio (95% CI)
BMI > 35 kg/m² (men)
1.71(1.30–2.26)
BMI > 35 kg/m² (women)
1.37(1.01–1.85)
RFM 4th quartile (men)
1.37(1.11–1.68)
Observational data: associations, not effects.
Further findings
Dose-response (cubic splines)
- U-shaped association for BMI in men and women, and for RFM in men
Mediation of association with mortality
- BMI in men mediated by glucose, CRP, FEV1, cystatin C
- 46.5%
- BMI in women mediated by HOMA index, cystatin C, FEV1
- 82.9%
- RFM mediated by glucose, FEV1, cystatin C
- 55%
Models including BMI and RFM
- RFM drives most of the risk in men, but is not predictive in women
Original publication
Association between BMI, RFM and mortality and potential mediators: Prospective findings from the Moli-sani study. Int J Obes (Lond). Published 19 May 2023. doi:10.
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