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ORIGINAL RESEARCH article

Front. Endocrinol.
Sec. Obesity
Volume 15 - 2024 | doi: 10.3389/fendo.2024.1419715

Body Mass Index and Waist-to-height Ratio Effect on Mortality in Non-alcoholic Fatty Liver: Revisiting the Obesity Paradox

Provisionally accepted
Hao Jiang Hao Jiang 1Kai Ming Li Kai Ming Li 1*Sheng Hong Yu Sheng Hong Yu 1Nan Yi Huang Nan Yi Huang 1*Lan Bi Yang Lan Bi Yang 2*Bin Wu Bin Wu 1Dong Yi Yang Dong Yi Yang 1*
  • 1 Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
  • 2 The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China

The final, formatted version of the article will be published soon.

    Purpose: Emerging research indicates that individuals with non-alcoholic fatty liver disease (NAFLD) who carry excess weight have similar or even higher survival rates than their normal-weight counterparts. This puzzling "obesity paradox" may be attributed to underlying biases. To explore this phenomenon, we examined data extracted from the third National Health and Nutrition Examination Survey (NHANES) III , which spanned from 1988-1994.We specifically targeted participants diagnosed wit h NAFLD through ultrasound due to fatty liver presence and employed multivariate Cox regression to assess mortality risk associated with body mass index (BMI) and the waist-to-height ratio (WHtR).Results: Over a median follow-up period of 20.3 [19.9-20.7] years, 1832 2 participants passed away. The study revealed an intriguing "obesitysurvival paradox", in which individuals classified as overweight (HR 0.926, 95% CI 0.925-0.927) or obese (HR 0.982, 95% CI 0.981-0.984) presented reduced mortality risks compared with those categorized as normal weight.However, this paradox vanished upon adjustments for smoking and exclusion of the initial 5-year follow-up period (HR 1.046, 95% CI 1. 044-1.047 for overweight; HR 1.122, 95% CI 1. 120-1.124 for obesity class I).Notably, the paradox was less pronounced with the WHtR, which was significantly different only in quartile 2 (HR 0.907, 95% CI 0.906-0.909) than in quartile 1, and was resolved after appropriate adjustments. In particular, when BMI and WHtR were considered together, higher levels of adiposity indicated a greater risk of mortality with WHtR, whereas BMI did not demonstrate the same trend ( p <0.05).The "obesity paradox" in NAFLD patients can be explained by smoking and reverse causation. WHtR was a better predictor of mortality than BMI.

    Keywords: anthropometrics, Body Mass Index, Mortality, Overweight, Waist-to-height ratio

    Received: 28 Jul 2024; Accepted: 20 Nov 2024.

    Copyright: © 2024 Jiang, Li, Yu, Huang, Yang, Wu and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Kai Ming Li, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
    Nan Yi Huang, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
    Lan Bi Yang, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
    Dong Yi Yang, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

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