The journal of nutrition, health & aging

, Volume 22, Issue 8, pp 975–981 | Cite as

BMI, Waist Circumference and All-Cause Mortality in a Middle-Aged and Elderly Chinese Population

  • H. Hu
  • J. Wang
  • X. Han
  • Y. Li
  • F. Wang
  • J. Yuan
  • X. Miao
  • H. Yang
  • Meian HeEmail author



To investigate the association of obesity and all-cause mortality in a sample of middle-aged and elderly population.

Design and Setting

Information of participants was collected in the Dongfeng-Tongji study, a perspective cohort study of Chinese occupational population. The main outcome was risk of death after 8.5 years of follow-up.

Participants and measurements

We examined the association of BMI, waist circumference (WC, and waist–height ratio (WHtR) with all-cause mortality in the Dongfeng-Tongji cohort study (n=26,143). Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality. Area under the receiver operating characteristic curves and net reclassification improvement (NRI) were used to calculate the power of prediction models.


During a mean of 8.5 years of follow-up, 2,246 deaths were identified. There is a U-shaped association of BMI with all-cause mortality in the middle-aged and elderly Chinese population. Compared with individuals with normal BMI, underweight was positively (HR=2.16, 95% CI: 1.73, 2.69) while overweight (HR=0.75, 95% CI: 0.67, 0.84) and obesity (HR=0.67, 95% CI: 0.56, 0.79) were negatively associated with all-cause mortality after adjustment for potential confounders including WC. In contrast, WC (Q5 vs. Q1, HR=1.55, 95% CI: 1.29, 1.86) and WHtR (Q5 vs.Q1, HR=1.69, 95% CI: 1.40, 2.04) were positively associated with mortality after further adjustment for BMI (P trend < 0.001). Addition of both BMI and WC into the all-cause mortality predictive model significantly increased AUC (P =0.0002) and NRI (NRI = 2.57%, P = 0.0007).


BMI and WC/WHtR were independently associated with all-cause mortality after mutual adjustment. Combination of BMI and WC/WHtR improved the predictive ability of all-cause mortality risk in the middle-aged and elderly population.

Key words

Prospective cohort body-shape death 

Supplementary material

12603_2018_1047_MOESM1_ESM.docx (654 kb)
Supplemental Document


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Copyright information

© Serdi and Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • H. Hu
    • 1
  • J. Wang
    • 1
  • X. Han
    • 1
  • Y. Li
    • 1
  • F. Wang
    • 1
  • J. Yuan
    • 1
  • X. Miao
    • 2
  • H. Yang
    • 3
  • Meian He
    • 1
    Email author
  1. 1.Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhan, HubeiChina
  2. 2.Department of Epidemiology and Biostatistics, School of Public HealthTongji Medical College Huazhong University of Science and TechnologyWuhan, HubeiChina
  3. 3.Dongfeng Central HospitalDongfeng Motor Corporation and Hubei University of MedicineShiyan, HubeiChina

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