Central adiposity as a predictor of mortality in older adults: Identification of cutoffs using generalized additive models

Dalila Pinto de Souza Fernandes; Leidjaira Lopes Juvanhol; Aline Araújo Nobre; Ângela Maria Natal de Souza; Andréia Queiroz Ribeiro

doi:10.3389/fnut.2023.1132006

Central adiposity as a predictor of mortality in older adults: Identification of cutoffs using generalized additive models

Front Nutr. 2023 Apr 18:10:1132006. doi: 10.3389/fnut.2023.1132006. eCollection 2023.

Authors

Dalila Pinto de Souza Fernandes¹, Leidjaira Lopes Juvanhol¹, Aline Araújo Nobre², Ângela Maria Natal de Souza¹, Andréia Queiroz Ribeiro^{1

3}

Affiliations

¹ Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Brazil.
² Scientific Computing Program, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
³ Department of Population Studies, Institute Abel Salazar, University of Porto, Porto, Portugal.

Abstract

Background: Obesity is associated with premature mortality in adults; however, this association has been inconsistent in the older adult population. In addition, there is a lack of specific cutoff points for indicators of negative health outcomes in older adults. Methods: This is a prospective study with 796 non-institutionalized older adults. Data on sociodemographic characteristics, lifestyle, food consumption, and nutritional status were obtained at baseline. Generalized additive models were used to identify cutoff points for the waist circumference (WC) and waist-to-height ratio (WHtR) and Cox proportional hazards models to assess the independent association between adiposity and mortality.

Results: Over the 9 years of follow-up, 197 deaths (24.7%) occurred, of which 51.8% were men, with a mean age of 76.1 ± 9.0 years. Older adults at higher risk of death had WHtR of <0.52 or ≥0.63 and WC of <83 cm or ≥101 cm. An increased risk of death was observed in older adults with high WC (HR: 2.03 95% CI: 1.20-3.41) and high WHtR (HR: 1.51 95% CI: 1.01-2.26) in the adjusted models, and an increase in WC was a risk factor for higher CVD mortality (HR: 2.09, 95% CI: 1.12-3.88) in the adjusted models.

Conclusion: Adiposity was associated with an increased risk of death in older adults. In view of these results and considering the lack of cutoff points for anthropometric indices in Brazilian older adults, further studies are needed to confirm the WC and WHtR cutoff values found in this study.

Keywords: anthropometry; central adiposity; cutoff points; mortality; older adults.