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Epidemiology and Population Health

Which adiposity marker is most strongly associated with all‑cause and cause‑specific mortality? a prospective study of 158,699 Mexican adults

International Journal of Obesity volume 49, pages 1792–1799 (2025)Cite this article

Subjects

Abstract

Background

Various methods have been used to assess adiposity and its associations with morbidity and mortality. In this study, we aimed to examine the association of four adiposity markers with all‑cause and cause‑specific mortality, while evaluating the potential influence of reverse causation bias.

Methods

This prospective cohort study included 158,699 participants from the Mexico City Prospective Study. Cox regression models were performed to estimate the associations of body mass index, waist circumference, waist-to-height ratio, and waist-to-hip ratio with mortality risk. To minimize the influence of reverse causation, we excluded participants with prevalent diseases at baseline and conducted additional analyses excluding deaths occurring within the first 2, 5, and 10 years of follow-up.

Results

Over a median of 15.5 years, 28,296 death were recorded. Waist circumference values above the recommended cutoff considered high were associated with higher all-cause mortality after the exclusion of the first 2, 5, and 10 years of follow-up (HR: 1.83; 95% CI: 1.26–2.55, HR: 1.83; 95% CI: 1.23–2.62, and HR: 1.85; 95% CI: 1.14–2.70, respectively). Elevated waist-to-hip ratio was associated with increased all-cause mortality across the same exclusion periods (HR: 1.71; 95% CI: 1.07–2.30, HR: 1.70; 95% CI: 1.05–2.49, and HR: 1.71; 95% CI: 1.01-2.52). High waist circumference was strongly associated with CVD mortality after exclusion of the first 2, 5, and 10 years (HR: 4.76; 95% CI: 1.70–11.82, HR: 4.75; 95% CI: 1.56–11.88, and HR: 4.73; 95% CI: 1.42–12.90, respectively). Elevated waist-to-hip ratio similarly showed associations with CVD mortality (HR: 2.69; 95% CI: 1.10–5.60, HR: 2.66; 95% CI: 1.12–5.75, and HR: 2.64; 95% CI: 1.03–7.32). Body mass index, waist circumference, waist-to-height ratio, and waist-hip ratio were not associated with respiratory and cancer mortality.

Conclusions

Waist circumference was the adiposity marker most strongly associated with all-cause and CVD mortality, even after excluding the first 10 years of follow-up.

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Data availability

Data from the Mexico City Prospective Study are available to bona fide researchers for collaborative and/or open-access research purposes. The study’s Data and Sample Sharing policy can be downloaded (in English or Spanish: https://www.ctsu.ox.ac.uk/research/mcps). Available study data can be examined in the study Data Showcase (https://datashare.ndph.ox.ac.uk/mexico).

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Acknowledgements

This research has been conducted using Mexico City Prospective Study (MCPS) Data under Application Number 2022-020. MCPS (https://www.ctsu.ox.ac.uk/research/mcps) has received funding from the Mexican Health Ministry, the National Council of Science and Technology for Mexico, Wellcome, and core grants from the UK Medical Research Council to the MRC Population Health Research Unit at the University of Oxford. We would like to thank the participants from the Mexico City Prospective Study. We thank everyone who took part in the Mexico City Prospective Study.

Funding

The present research received financial support from Vicerrectoría de Investigación y Doctorados, Universidad Autónoma de Chile. National Council for Scientific and Technological Development - CNPq (311109-2023-3; LFMR). This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001 (WAdS). GF was funded by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) – Code: 88887.979411/2024-00.

Author information

Authors and Affiliations

  1. Graduate Program in Human Movement and Rehabilitation of Evangelical University of Goias, Anápolis, Goiás, Brazil

    Weder Alves da Silva

  2. Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

    Leandro F. M. Rezende

  3. Chronic Disease Epidemiology Research Center, Universidade Federal de São Paulo, São Paulo, Brazil

    Leandro F. M. Rezende

  4. CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal

    Adilson Marques

  5. Núcleo de Investigación en Ciencias del Movimiento, Universidad Arturo Prat, Iquique, Chile

    Adilson Marques

  6. Department of Physical Education, Federal University of Vale do São Francisco, Petrolina, Brazil

    Marcelo de Maio Nascimento

  7. Programa de Alimentação, Nutrição e Cultura, Fundação Oswaldo Cruz, Brasília, Brazil

    Eduardo Nilson

  8. Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Providencia, Chile

    Eduardo Nilson, Roberto Fernandes da Costa & Gerson Ferrari

  9. School of Technology and Sciences, São Paulo State University (UNESP), Presidente Prudente (SP), São Paulo, Brazil

    Diego G. D. Christofaro

  10. Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Santiago, Chile

    Gerson Ferrari

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  1. Weder Alves da Silva
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Contributions

WAdS, and GF, contributed to the conception and design of the study. WAdS, and GF advised on all statistical aspects. LFMR, AM, MdMN, EN, DC, and RFdC performed the literature search, the analyses and interpreted the data. All authors critically reviewed this and previous drafts. All authors approved the final draft for submission.

Corresponding author

Correspondence to Gerson Ferrari.

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da Silva, W.A., Rezende, L.F.M., Marques, A. et al. Which adiposity marker is most strongly associated with all‑cause and cause‑specific mortality? a prospective study of 158,699 Mexican adults. Int J Obes 49, 1792–1799 (2025). https://doi.org/10.1038/s41366-025-01827-0

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