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Association between complementary anthropometric measures and all-cause mortality risk in adults: NHANES 2011–2016

European Journal of Clinical Nutrition volume 79, pages 71–78 (2025)Cite this article

Subjects

Abstract

Background

Previous studies using a single obesity indicator cannot fully assess the association between body shape and mortality. We aimed to investigate the association between complementary anthropometric measures and all-cause mortality risk.

Methods

We combined National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2016 with mortality data up to December 31, 2019. After excluding individuals with cancer at baseline, 13,728 participants were included. Cox regression models and restricted cubic spline (RCS) analyses were used to explore the association between general obesity, central obesity, and peripheral fat indicators and all-cause mortality risk.

Results

A total of 743 deaths occurred over a median follow-up of 5.83 years. In multivariable-adjusted Cox models, each 10-cm increase in waist circumference (WC), each 0.1-unit increase in waist-to-height ratio (WHtR), and each 0.01-unit increase in A Body Shape Index (ABSI) were associated with 20% (HR = 1.20; 95% CI: 1.02–1.41), 119% (2.19; 1.70–2.83), and 5% (1.05; 1.03–1.08) increased all-cause mortality risk, respectively. Conversely, each 1-cm increment in mid-arm circumference (MAC) was associated with 13% (HR = 0.87; 95% CI: 0.83–0.92) decreased mortality risk. Compared with normal group (body mass index (BMI): 18.5- <25.0), underweight (HR = 1.97; 95% CI: 1.12–3.45) and grade 3 obesity (1.37; 1.04–1.81) were at higher mortality risk. However, after further adjustment for WC, the effect of grade 3 obesity disappeared, and the RCS analyses for BMI changed from a J-shaped (P < 0.05 for non-linearity test) to a negative association (P < 0.01).

Conclusions

Underweight, grade 3 obesity, and central obesity were associated with an increased mortality risk, while peripheral fat was inversely associated with mortality.

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Fig. 1: Restricted cubic spline analyses in the whole population.

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Data availability

Publicly available datasets were analyzed in this study. This data can be found here: https://wwwn.cdc.gov/nchs/nhanes/ (accessed on 27 May 2023).

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Acknowledgements

We acknowledge the staff at the National Center for Health Statistics at the CDC, who design, collect, administer the NHANES data and release the data available for public use. We are thankful to all study participants for their cooperation.

Funding

This work was supported by Natural Science Foundation of Shandong Province (ZR2023QH188), China Postdoctoral Science Foundation (2023M731839), Qingdao Postdoctoral Innovation Project (QDBSH20230102012), Qingdao University Scientific Research Startup Fund (DC2200002531), Mount Taishan Scholar Youth Program. The funders had no role in the study design, data collection, data analysis and interpretation, writing of the report, or the decision to submit the article for publication.

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Authors and Affiliations

  1. Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, China

    Xiaoyi Shi, Lirong Chai, Dongfeng Zhang & Junning Fan

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  1. Xiaoyi Shi
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  2. Lirong Chai
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Contributions

JF conceived and designed the study. XS and LC analyzed the data. XS drafted the manuscript. JF and LC helped the interpretation of the results. JF contributed to the critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. All authors reviewed and approved the final manuscript. DZ is the guarantor.

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Correspondence to Junning Fan.

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Shi, X., Chai, L., Zhang, D. et al. Association between complementary anthropometric measures and all-cause mortality risk in adults: NHANES 2011–2016. Eur J Clin Nutr 79, 71–78 (2025). https://doi.org/10.1038/s41430-024-01496-8

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