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Epidemiology and Population Health

Mortality risk associated with general and central obesity in inflammatory bowel disease patients: a long-term prospective cohort study

International Journal of Obesity (2025)Cite this article

Subjects

Abstract

Aim

To comprehensively investigate the long-term risk of all-cause mortality associated with general and central obesity in patients with inflammatory bowel disease (IBD).

Methods

Overall, 5107 IBD patients [mean age 57.0 (SD: 8.0) years; 51.7% female] were included in the prospective cohort. General obesity was assessed using body mass index (BMI), while central obesity was evaluated using hip circumference, waist circumference (WC), waist-to-hip ratio (WHR), weight-adjusted waist index (WWI), conicity index (CI) and A Body Shape Index (ABSI). Primary outcome was all-cause death. Cox proportional hazards models were employed to examine the associations.

Results

During a median of 14.6 years’ follow-up, 591 all-cause deaths occurred. At baseline, 1681(32.9%), 2229(43.6%), 1161(22.7%) and 36(0.70%) patients were BMI-defined normal, overweight, obesity and underweight. Underweight individuals had a 2.22-fold increased mortality risk than those with normal BMI (HR = 3.22, 95% CI:1.70–6.11), while null associations were observed for overweight or obesity. As for central obesity, individuals with the highest quartiles of WC (HR = 1.34, 1.02–1.76), WHR (HR = 1.56, 1.13–2.15), WWI (HR = 1.64, 1.24–2.16), CI (HR = 1.72, 1.28–2.30) and ABSI (HR = 1.64, 1.23–2.20) had a 34%, 56%, 64%, 72% and 64% greater mortality risk versus the lowest quartiles, with significant dose-response relationships (all P values < 0.05).

Conclusions

Central obesity and underweight, rather than general obesity, are associated with an increased risk of all-cause mortality in IBD patients. These findings underscore the importance of adequate nutrition and reduced visceral adiposity for long-term prognosis improvement of IBD patients.

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Data availability

The data underlying this study are available in the paper and in its online supplementary material. The data will be shared on reasonable request to the corresponding author.

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Funding

This work was supported by the National Key Research and Development Program of China (No. 2022YFC3602100 and 2022YFC3602104), Beijing Nova Program (No. 20230484349) and Beijing Hospitals Authority Innovation Studio of Young Staff (No. 202303). None of the funding organizations had any role in the design and conduct of the study; in the collection, analysis and interpretation of the data; in the preparation, review and approval of the manuscript.

Author information

Author notes

  1. These authors contributed equally: Qian Zhang, Yutao Wang.

  2. These authors jointly supervised this work: Zhirong Yang, Shanshan Wu.

Authors and Affiliations

  1. Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, State Key Laboratory of Digestive Health, National Clinical Research Center for Digestive Disease, Beijing Key Laboratory of Early Gastrointestinal Cancer Medicine and Medical Devices, Beijing, China

    Qian Zhang, Yutao Wang, Si Liu, Shengtao Zhu, Peng Li, Shutian Zhang & Shanshan Wu

  2. Department of Computational Biology and Medical Big Data, Faculty of Computer Science and Control Engineering, Shenzhen University of Advanced Technology, Shenzhen, China

    Yang Zhirong

  3. Center for AI in Medicine, Artificial Intelligence Research Institute, Shenzhen University of Advanced Technology, Shenzhen, China

    Yang Zhirong

  4. Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China

    Yang Zhirong

Authors
  1. Qian Zhang
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Contributions

SSW and ZRY designed the study. QZ and YTW drafted the manuscript. QZ and YTW analyzed the data. SSW and QZ verified the analysis. SL, STZhu, PL, STZhang and ZRY interpreted the results, incorporated comments for the co-authors and finalized the manuscript. All authors approved the final version of the paper.

Corresponding authors

Correspondence to Yang Zhirong or Shanshan Wu.

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Zhang, Q., Wang, Y., Liu, S. et al. Mortality risk associated with general and central obesity in inflammatory bowel disease patients: a long-term prospective cohort study. Int J Obes (2025). https://doi.org/10.1038/s41366-025-01879-2

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