Roles of general and central adiposity in cardiometabolic multimorbidity: revisiting the obesity paradox using a multistate model
Authors' conclusion
Central adiposity indices such as WHR were associated with an increased risk of CMD and mortality, showing no evidence for the obesity paradox and thereby supporting a shift of public focus from BMI only to both general obesity and adiposity distribution.
Study context
- Population
- CMD-free participants of the Kailuan cohort
- Participants
- 86,169 participants
- Exposure
- Quartiles of general and central adiposity indices (BMI, waist to hip ratio (WHR), weight-adjusted waist index, waist to height ratio); fourth vs first quartile
- Outcome
- Transitions to first cardiometabolic disease (first onset of diabetes, stroke or MI), cardiometabolic multimorbidity (≥2 CMDs) and death
Methodological detailsmultistate model
- Multistate model
Main finding
As reported in the abstract
Transitions to death, fourth vs first quartile
Q4 vs Q1Hazard ratio (95% CI)
BMI; health to death
0.86(0.80–0.91)
BMI; FCMD to death
0.66(0.59–0.74)
WHR; health to death
1.22(1.14–1.31)
WHR; FCMD to death
1.16(1.02–1.32)
- Developed first cardiometabolic disease (FCMD)
- 18,461
- Progressed from FCMD to cardiometabolic multimorbidity (CMM)
- 1476
- Died during follow-up
- 10,009
Observational data: associations, not effects.
Original publication
Roles of general and central adiposity in cardiometabolic multimorbidity: revisiting the obesity paradox using a multistate model. Obesity (Silver Spring). Published 28 January 2024. doi:10.
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