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Body fat percentage, body mass index and waist-to-hip ratio as predictors of mortality and cardiovascular disease
  1. Phyo Kyaw Myint1,
  2. Chun Shing Kwok1,2,
  3. Robert N Luben3,
  4. Nicholas J Wareham4,
  5. Kay-Tee Khaw3
  1. 1Division of Applied Health Sciences, School of Medicine & Dentistry, University of Aberdeen, Aberdeen, UK
  2. 2Cardiovascular Institute, University of Manchester, Manchester, UK
  3. 3Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  4. 4MRC Epidemiology Unit, Cambridge, UK
  1. Correspondence to Professor Phyo Kyaw Myint, Division of Applied Health Sciences, School of Medicine & Dentistry, University of Aberdeen, Room 4:013, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK; phyo.myint{at}


Objective To study the utility of body fat percentage in predicting health outcomes when other obesity indices are considered.

Methods We conducted a prospective cohort study to evaluate the independent utility of body fat percentage and other obesity indices in predicting mortality and cardiovascular disease (CVD).

Results We prospectively followed 15 062 European Prospective Investigation into Cancer (EPIC)-Norfolk participants who attended a health examination during 1997–2000 for all-cause mortality and incidence of CVD up to end of December 2011 and end of March 2009, respectively. During the follow-up, 2420 died and 4665 had incident CVD. After exclusion of prior stroke, myocardial infarction and cancer and adjusting for potential confounders, body mass index (BMI) and waist-to-hip ratio (WHR), the HR of mortality for men were 0.86 (0.68 to 1.09), 0.81 (0.61 to 1.07) and 0.76 (0.55 to 1.05) and for women were 0.91 (0.70 to 1.17), 0.75 (0.55 to 1.02) and 0.87 (0.61 to 1.23) for second, third and fourth quartile compared with the first (bottom) quartile of body fat percentage. The respective HRs for incident CVD were 0.99 (0.83 to 1.19), 0.85 (0.69 to 1.04) and 0.81 (0.64 to 1.03) for men and 0.98 (0.82 to 1.17), 0.89 (0.73 to 1.10) and 1.02 (0.81 to 1.29) for women. In contrast, higher BMI and WHR were associated with an increased risk of both outcomes and WHR appeared to have the best predictive value among three indices.

Conclusions Once BMI and WHR are taken into account, fat percentage does not add to prediction of mortality or CVD in middle-aged and older-aged adults.

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