MON-692 Adiposity measures and all-cause mortality: a dose-response meta-analysis of 70 prospective studies

Abstract Disclosure: J. Kim: None. J. Lee: None. D. Jeong: None. J. You: None. Y. Kim: None. Y. Cho: None. M.R. Guzman: None. H. Oh: None. Objective: Studies that used BMI as a surrogate measure of adiposity have shown a J-shaped relationship with mortality, suggesting the lowest mortality at overweight and obese range of BMI (“obesity paradox”). Because BMI cannot adequately reflect body composition, other studies used alternative measures, such as waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), a body shape index (ABSI), hip circumference (HC), weight-adjusted waist index (WWI), body adiposity index (BAI), and relative fat mass (RFM), to assess the relationship between adiposity and mortality. This study investigated the dose-response relationships of different adiposity measures with all-cause mortality and examined whether the relationships vary by region. Methods: We conducted a dose-response meta-analysis of prospective studies to quantify the associations between adiposity measures (WC, WHR, WHtR, ABSI, HC, WWI, BAI, and RFM) and all-cause mortality. Publications from 2010 to April 2024 were searched on PubMed and Embase. A random-effects dose-response meta-analysis was performed to estimate the summary hazard ratio (HR) and 95% confidence interval (CI). Non-linear dose-response relationships were assessed using restricted cubic splines. Results: After screening 75,714 publications, 70 prospective studies were included. Overall, WC, WHtR, HC, and BAI showed J- or U-shaped associations with the risk of all-cause mortality (nadir at WC = 81.3 cm, WHtR = 0.49, HC = 100.9 cm, and BAI = 29.6%). However, monotonically increasing trends were observed for WHR (per 0.1-unit increase: summary HR [95% CI] = 1.17 [1.11-1.23]), ABSI (per 0.01-unit increase: 1.30 [1.26-1.35]), WWI (per 1-unit increase: 1.27 [1.12-1.43]), and RFM (per 10% increase: 1.59 [1.11-2.29]). Among the adiposity measures that we evaluated, statistically significant regional difference was observed only with WHtR, suggesting the highest magnitude of association in North America and the lowest in Asia and South America (P-heterogeneity = 0.037). Regional differences could not be evaluated for WWI and RFM due to limited number of publications. Conclusions: Based on our findings on the shape of the relationships and regional differences, WHR and ABSI may be alternative measures that better reflect body composition and predict mortality in diverse populations. Presentation: Monday, July 14, 2025