Extract
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The data on the associations of body mass index with cardiovascular risk, especially the low categories, are conflicting.1 Consistent detrimental effects,2 healthy obesity,3 and even an ‘obesity paradox’ with apparent protective effects4 have been reported. In their manuscript entitled ‘The impact of confounding on the associations of different adiposity measures with the incidence of cardiovascular disease: a cohort study of 296535 adults of white European descent’, Stamatina Iliodromiti and colleagues from the University of Glasgow School of Medicine Dentistry and Nursing in Glasgow, UK examined body composition as assessed by five different measures and cardiovascular outcomes in 296 535 healthy individuals.5 Low body mass index (≤18.5 kg m–2) was associated with higher incidence of cardiovascular disease, and the lowest cardiovascular disease risk was exhibited at a body mass index of 22– 23 kg m–2 beyond which the risk of cardiovascular disease increased (Figure 1). This J-shaped association was attenuated if participants with co-morbidities were excluded. In contrast, the associations for the remaining adiposity measures were more linear; one standard deviation increase in waist circumference was associated with a hazard ratio of 1.16 for women and 1.10 for men. Thus, increasing adiposity has a detrimental association with cardiovascular disease health in middle-aged men and women. The association of body mass index with cardiovascular disease appears more susceptible to confounding due to pre-existing co-morbidities as compared with other adiposity measures. Any public misconception of a potential ‘protective’ effect of fat on cardiovascular disease risk should be challenged, as further outlined in an Editorial by Natalie Staplin from the University of Oxford in the UK.6
