Revisiting obesity thresholds for cardiovascular disease and mortality risk in Chinese adults: Age- and gender-specific insights

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<sup>2</sup>, WC 88 cm, and WHR 0.90 in men and BMI 25.4 kg/m<sup>2</sup>, 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.

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Publication Details

Journal
Cell Reports Medicine
Published
2025-08-25
DOI
https://doi.org/10.1016/j.xcrm.2025.102309
Citations
8
Primary Topic
Diabetes, Cardiovascular Risks, and Lipoproteins
Type
article
Field-Weighted Citation Impact
10.36

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article

Revisiting obesity thresholds for cardiovascular disease and mortality risk in Chinese adults: Age- and gender-specific insights

Guang Ning, Ruizhi Zheng, Jiajun Zhao, Zuojie Luo et al.
8 citations
Cell Reports Medicine
Diabetes, Cardiovascular Risks, and Lipoproteins
10.36
article

Revisiting obesity thresholds for cardiovascular disease and mortality risk in Chinese adults: Age- and gender-specific insights

Guang Ning, Ruizhi Zheng, Jiajun Zhao, Zuojie Luo, Min Xu, Hong Lin, Yufang Bi, Ruying Hu, Lulu Chen, Yue Yin, Xulei Tang, Yanan Huo, Y Wang, Xuefeng Yu, Xiaojing Jia, Zhiyun Zhao, Guijun Qin, Zhengnan Gao, Tiange Wang, Tianshu Zeng, Chunyan Hu, Xinguo Hou, Guixia Wang, Donghui Li, Chao Liu, Weiqing Wang, Li Chen, Gang Chen, Qiang Li, Yuhong Chen, Yan Li, Qin Wan, Zhen Ye, Mian Li, Tao Yang, Mu Yiming, Hong Qiao, Lixin Shi, Yu Xu, Huacong Deng, Qing Su, Yingfen Qin, Jieli Lu, Shengli Wu, Feixia Shen, Shenghan Lai, Xuejiang Gu, Yinfei Zhang
article en
8 citations

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<sup>2</sup>, WC 88 cm, and WHR 0.90 in men and BMI 25.4 kg/m<sup>2</sup>, 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.

Cell Reports MedicineVol. 6(9)
University of Maryland, Baltimore (US), Fujian Medical University (CN), The University of Texas MD Anderson Cancer Center (US), Nanchang University (CN), Shandong University (CN), Harbin Medical University (CN), Sun Yat-sen University (CN), Guangxi Medical University (CN), Jilin University (CN), Anhui Medical University (CN), Wenzhou Medical University (CN), XinHua Hospital (CN), First Affiliated Hospital of Wenzhou Medical University (CN), Affiliated Hospital of Southwest Medical University (CN), Jiading District Central Hospital (CN), Sun Yat-sen Memorial Hospital (CN), Dalian Municipal Central Hospital (CN), Jiangxi Provincial People's Hospital (CN), Shandong Provincial Hospital (CN), First Hospital of Jilin University (CN), First Affiliated Hospital of GuangXi Medical University (CN), Wuhan Union Hospital (CN), The Affiliated Yongchuan Hospital of Chongqing Medical University (CN), Second Affiliated Hospital of Harbin Medical University (CN), Zhejiang Center for Disease Control and Prevention (CN), First Affiliated Hospital of Anhui Medical University (CN), Fujian Provincial Hospital (CN), Karamay Central Hospital (CN), Jiangsu Province Hospital (CN), First Affiliated Hospital of Zhengzhou University (CN), Shanghai Clinical Research Center (CN), Tongji Hospital (CN), Chinese People's Liberation Army (CN), Qilu Hospital of Shandong University (CN), First Hospital of Lanzhou University (CN), Huazhong University of Science and Technology (CN), Lanzhou University (CN), Nanjing Medical University (CN), Chongqing Medical University (CN)
Shanghai Municipal Health Commission, National Natural Science Foundation of China, Ministry of Science and Technology of the People's Republic of China, Science and Technology Commission of Shanghai Municipality, National Science and Technology Major Project
Good health and well-being
Openalex Percentile: Top 2%
Diabetes, Cardiovascular Risks, and Lipoproteins
10.36
DOIOpen Access PDFOpenAlex
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