Associations of relative fat mass, a new index of adiposity, with type-2 diabetes in the general population

Suthahar, Navin; Wang, Kan; Zwartkruis, Victor W; Bakker, Stephan J. L.; Inzucchi, Silvio E.; Meems, Laura M.G.; Eijgenraam, Tim R.; Ahmadizar, Fariba; Sijbrands, Eric G; Gansevoort, Ron T.; Kieneker, Lyanne M.; Veldhuisen, Dirk J. van; Kavousi, Maryam; Boer, Rudolf A. de

doi:10.1016/j.ejim.2022.12.024

Cited by 14 publications

(17 citation statements)

References 30 publications

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“…Because of its association with mortality, body fat percentage is of great clinical relevance. Recent studies support the utility of RFM to predict type 2 diabetes60 and heart failure 61…”

Section: Discussionmentioning

confidence: 95%

Temporal trends in obesity defined by the relative fat mass (RFM) index among adults in the United States from 1999 to 2020: a population-based study

Woolcott,

Seuring

2023

BMJ Open

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ObjectivesThe body mass index (BMI) largely underestimates excess body fat, suggesting that the prevalence of obesity could be underestimated. Biologically, women are known to have higher body fat than men. This study aimed to compare the temporal trends in general obesity by sex, ethnicity and age among adults in the USA using the relative fat mass (RFM), a validated surrogate for whole-body fat percentage and BMI.DesignPopulation-based study.SettingUS National Health and Nutrition Examination Survey, from 1999–2000 to 2017–March 2020.ParticipantsA representative sample of adults 20–79 years in the USA.Main outcome measuresAge-adjusted prevalence of general obesity. RFM-defined obesity was diagnosed using validated cut-offs to predict all-cause mortality: RFM≥40% for women and ≥30% for men. BMI-defined obesity was diagnosed using a cut-off of 30 kg/m2.ResultsAnalysis included data from 47 667 adults. Among women, RFM-defined obesity prevalence was 64.7% (95% CI 62.1% to 67.3%) in 2017–2020, a linear increase of 13.9 percentage points (95% CI 9.0% to 18.9%; p<0.001) relative to 1999–2000. In contrast, the prevalence of BMI-defined obesity was 42.2% (95% CI 39.4% to 45.0%) in 2017–2020. Among men, the corresponding RFM-defined obesity prevalence was 45.8% (95% CI 42.0% to 49.7%), a linear increase of 12.0 percentage points (95% CI 6.6% to 17.3%; p<0.001). In contrast, the prevalence of BMI-defined obesity was 42.0 (95% CI 37.8% to 46.3%). The highest prevalence of RFM-defined obesity across years was observed in older adults (60–79 years) and Mexican Americans, in women and men. Conversely, the highest prevalence of BMI-defined obesity across years was observed in middle-age (40–59 years) and older adults, and in African American women.ConclusionsThe use of a surrogate for whole-body fat percentage revealed a much higher prevalence of general obesity in the USA from 1999 to 2020, particularly among women, than that estimated using BMI, and detected a disproportionate higher prevalence of general obesity in older adults and Mexican Americans.

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“…Because of its association with mortality, body fat percentage is of great clinical relevance. Recent studies support the utility of RFM to predict type 2 diabetes60 and heart failure 61…”

Section: Discussionmentioning

confidence: 95%

Temporal trends in obesity defined by the relative fat mass (RFM) index among adults in the United States from 1999 to 2020: a population-based study

Woolcott,

Seuring

2023

BMJ Open

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“…Third, the PREVEND study, by design, enrolled a higher proportion of individuals with mildly elevated UAE [20]. For interpretation of results, this may not be consequential because previous studies have shown that results from the PREVEND study are comparable to the results from general population cohorts such as LifeLines [39] and the Framingham Heart Study [40]. Fourth, our study was conducted on a predominantly White population from the northern Netherlands, limiting generalizability to other population groups and ethnicities.…”

Section: Discussionmentioning

confidence: 99%

Associations of relative fat mass and BMI with all‐cause mortality: Confounding effect of muscle mass

Suthahar,

Zwartkruis,

Geelhoed

et al. 2024

Obesity

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ObjectiveThe study objective was to examine associations of relative fat mass (RFM) and BMI with all‐cause mortality in the Dutch general population and to investigate whether additional adjustment for muscle mass strengthened these associations.MethodsA total of 8433 community‐dwelling adults from the PREVEND general population cohort (1997–1998) were included. Linear regression models were used to examine associations of RFM and BMI with 24‐h urinary creatinine excretion, a marker of total muscle mass. Cox regression models were used to examine associations of RFM and BMI with all‐cause mortality.ResultsThe mean age of the cohort was 49.8 years (range: 28.8–75.7 years), and 49.9% (n = 4209) were women. In age‐ and sex‐adjusted models, both RFM and BMI were associated with total muscle mass (24‐h urinary creatinine excretion), and these associations were stronger with BMI (standardized beta [Sβ]RFM: 0.29; 95% CI: 0.27–0.31 vs. SβBMI: 0.38; 95% CI: 0.36–0.40; pdifference < 0.001). During a median follow‐up period of 18.4 years, 1640 deaths (19.4%) occurred. In age‐ and sex‐adjusted models, RFM was significantly associated with all‐cause mortality (hazard ratio per 1‐SD [HRRFM]: 1.16; 95% CI: 1.09–1.24), whereas BMI was not (HRBMI: 1.04; 95% CI: 0.99–1.10). After additional adjustment for muscle mass, associations of both RFM and BMI with all‐cause mortality increased in magnitude (HRRFM: 1.24; 95% CI: 1.16–1.32 and HRBMI: 1.12; 95% CI: 1.06–1.19). Results were broadly similar in multivariable adjusted models.ConclusionsIn the general population, a higher RFM was significantly associated with mortality risk, whereas a higher BMI was not. Adjusting for total muscle mass increased the strength of associations of both RFM and BMI with all‐cause mortality.

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“…Bergman reviewed his work in population studies with dual‐energy X‐ray absorptiometry measurement of fat mass. Analysis of a variety of possible relationships between sex, height, weight, and waist circumference led Bergman to propose a new measure, relative fat mass (RFM), calculated as: RFM = 64 – (20*Height/WC) + (12*sex), with sex = 0 in men and sex = 1 (women) 2,3 . Bergman reviewed studies showing good prediction of risks of diabetes, heart failure, and coronary disease with this measure.…”

Section: Agent Brand Name Administration Manufacturer % Weight Lossa ...mentioning

confidence: 99%

The 2023 WCIRDC: Obesity

Bloomgarden

2024

Journal of Diabetes

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Associations of relative fat mass, a new index of adiposity, with type-2 diabetes in the general population

Cited by 14 publications

References 30 publications

Temporal trends in obesity defined by the relative fat mass (RFM) index among adults in the United States from 1999 to 2020: a population-based study

Temporal trends in obesity defined by the relative fat mass (RFM) index among adults in the United States from 1999 to 2020: a population-based study

Associations of relative fat mass and BMI with all‐cause mortality: Confounding effect of muscle mass

The 2023 WCIRDC: Obesity

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