Prediction of All-Cause Mortality by Obesity Metabolic Phenotypes: A Waist Circumference-Driven Risk Stratification
Xiaowei Liu1,2, Yunshuang Chen1, Chan Yang1
1Ningxia Medical University, Yinchuan, China.
Metabolic Syndrome and Related Disorders
|August 11, 2026
Summary
Waist circumference (WC) better predicts mortality risk than body mass index (BMI), especially in men. Metabolically healthy obesity (MHO) defined by WC increases mortality risk, particularly in younger men.
Area of Science:
- Cardiovascular Health
- Metabolic Health
- Epidemiology
Background:
- Body mass index (BMI) has limitations in assessing obesity-related mortality.
- Central adiposity and metabolic status are critical factors in mortality risk.
Purpose of the Study:
- To evaluate if waist circumference (WC) and metabolic status predict all-cause mortality better than BMI.
- To examine how age and sex influence these mortality associations.
Main Methods:
- A prospective cohort study in rural China with 2703 participants at baseline and 2071 at follow-up.
- Phenotype categorization: metabolically healthy normal weight, metabolically healthy with obesity (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy with obesity (MUO) based on BMI or WC and metabolic status.
- Cox regression models used to estimate hazard ratios (HRs) for all-cause mortality.
Main Results:
- Waist circumference (WC) identified both MHO and MUO phenotypes as having significantly higher mortality risks, unlike BMI.
- WC-defined MHO was associated with increased mortality risk, particularly in men and younger participants (<64 years).
- 193 deaths were recorded during the follow-up period.
Conclusions:
- Waist circumference (WC) is a superior predictor of all-cause mortality compared to BMI, especially in men.
- The metabolically healthy obesity (MHO) phenotype is not always benign, particularly when defined by central adiposity (WC).
- Recommended risk stratification should incorporate WC, metabolic status, age, and sex for improved mortality prediction.
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