Revisiting obesity thresholds for cardiovascular disease and mortality risk in Chinese adults: Age- and gender-specific insights
Xiaojing Jia, Chunyan Hu, Yu Xu, Yue Yin, Hong Lin, Ruizhi Zheng, Mian Li, Min Xu, Tiange Wang, Zhiyun Zhao, Hong Qiao, Guijun Qin, Yingfen Qin, Xulei Tang, Zhen Ye, Ruying Hu, Lixin Shi, Qing Su, Xuefeng Yu, Yan Li, Qin Wan, Gang Chen, Zhengnan Gao, Guixia Wang, Feixia Shen, Xuejiang Gu, Zuojie Luo, Li Chen, Xinguo Hou, Yanan Huo, Qiang Li, Yinfei Zhang, Tianshu Zeng, Chao Liu, Y Wang, Shengli Wu, Tao Yang, Huacong Deng, Donghui Li, Shenghan Lai, Lulu Chen, Jiajun Zhao, Mu Yiming, Guang Ning, Yuhong Chen, Jieli Lu, Yufang Bi, Weiqing Wang
Abstract
Current obesity classifications may not adequately reflect age- and gender-specific risks in diverse populations. In a prospective cohort study of 166,285 Chinese adults aged ≥40 years without prior cardiovascular disease (CVD) or cancer, we evaluate optimal thresholds of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) for predicting incident CVD and all-cause mortality. We observe monotonically increasing dose-response associations of BMI, WC, and WHR with CVD risk but U-shaped relationships with all-cause mortality. The optimal obesity thresholds based on all-cause mortality risk differ by gender, with the lowest mortality risks occurring at BMI 26.3 kg/m 2 , WC 88 cm, and WHR 0.90 in men and BMI 25.4 kg/m 2 , WC 83 cm, and WHR 0.85 in women. Moreover, higher adiposity appears protective in older adults. These findings highlight the need for population-specific obesity criteria to enhance clinical risk assessment and public health strategies.