Validation of the 2024 European Association for the Study of Obesity diagnostic criteria: A comprehensive assessment of obesity-related mortality risks

IF 5.7 2区医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes, Obesity & Metabolism Pub Date : 2025-02-14 DOI:10.1111/dom.16236

Xiao-Yue Liu MD, San-Yu Ge MD, Chen-An Liu MD, Bing Yin MSc, Zhao-Ting Bu MD, Xin Zheng MSc, Yue Chen MSc, Xiang-Rui Li MD, Han-Ping Shi MD

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Abstract

Aims

Obesity is a global public health challenge, and the traditional WHO-proposed diagnostic criteria based on body mass index (BMI) often fail to fully assess related health risks. The European Association for the Study of Obesity (EASO) has proposed new criteria that combine BMI, waist-to-height ratio (WtHR) and complications to more accurately evaluate obesity-related health risks.

Materials and Methods

This study utilized data from the National Health and Nutrition Examination Survey database, covering the years 1999–2018. The study validated the new EASO criteria for diagnosing obesity, defined as BMI ≥25 kg/m², WtHR ≥0.5 and the presence of 12 obesity-related complications. The associations between obesity and mortality were assessed using Kaplan–Meier survival curves and Cox proportional hazards regression analyses. Mediation analysis was conducted to explore potential mechanisms by which obesity impacts patient prognosis.

Results

A total of 39 066 participants were included, with a mean age of 43.6 years; 51.3% were male. Over a median follow-up period of 141 months, 3708 deaths were recorded. The prevalence of obesity was 63.04% according to the new EASO criteria. The obesity rate based on BMI ≥30 is only 35.55%. The EASO criteria achieved a C-index of 0.5549, which surpasses the predictive accuracy of the traditional BMI ≥30 kg/m² criterion, with a C-index of 0.5265. Cox regression analysis indicated that when using the traditional BMI ≥30 criterion to diagnose obesity, it was associated with all-cause mortality and cardiovascular disease (CVD)-related mortality, but it did not predict cancer-related mortality. Obesity diagnosed by EASO criteria was significantly associated with an increased risk of all-cause mortality (hazard ratio [HR] and 95% confidence interval [CI]: 1.13 [1.02, 1.24]), CVD mortality (HR and 95% CI: 1.48 [1.20, 1.83]) and cancer mortality (HR and 95% CI: 1.26 [1.03, 1.54]). When using simplified BMI ≥25 kg/m², WtHR ≥0.5 and any of the top five complications (diabetes mellitus, hypertension, CVD, metabolic syndrome and ageing) as diagnostic criteria, which had the highest C-index (0.612), obesity remained an independent prognostic factor for poor overall survival (HR and 95% CI for all-cause mortality: 1.41 [1.26, 1.58], HR for CVD mortality: 2.08 [1.61, 2.68] and HR for cancer mortality: 1.32 [1.06, 1.65]).

Conclusions

This study confirms the prognostic value of the new obesity diagnostic criteria proposed by EASO, suggesting that these criteria offer a more accurate assessment of obesity-related health risks.

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验证2024年欧洲肥胖诊断标准研究协会：肥胖相关死亡风险的综合评估。

目的：肥胖是一项全球公共卫生挑战，世卫组织提出的基于体重指数（BMI）的传统诊断标准往往不能充分评估相关的健康风险。欧洲肥胖研究协会（EASO）提出了结合BMI、腰高比（WtHR）和并发症的新标准，以更准确地评估肥胖相关的健康风险。材料与方法：本研究使用的数据来自国家健康与营养检查调查数据库，时间跨度为1999-2018年。该研究验证了EASO诊断肥胖的新标准，定义为BMI≥25 kg/m2， WtHR≥0.5，存在12种肥胖相关并发症。使用Kaplan-Meier生存曲线和Cox比例风险回归分析评估肥胖与死亡率之间的关系。通过中介分析探讨肥胖影响患者预后的潜在机制。结果：共纳入39 066名参与者，平均年龄43.6岁；51.3%为男性。在141个月的中位随访期间，记录了3708例死亡。根据新的EASO标准，肥胖患病率为63.04%。BMI≥30的肥胖率仅为35.55%。EASO标准的c指数为0.5549，超过了传统BMI≥30 kg/m2标准的c指数0.5265的预测精度。Cox回归分析显示，当使用传统的BMI≥30标准诊断肥胖时，它与全因死亡率和心血管疾病（CVD）相关死亡率相关，但不能预测癌症相关死亡率。EASO标准诊断的肥胖与全因死亡率（风险比[HR]和95%置信区间[CI]: 1.13[1.02, 1.24]）、心血管疾病死亡率（HR和95% CI: 1.48[1.20, 1.83]）和癌症死亡率（HR和95% CI: 1.26[1.03, 1.54]）增加的风险显著相关。当以简化BMI≥25 kg/m2、WtHR≥0.5和前5大并发症（糖尿病、高血压、心血管疾病、代谢综合征和衰老）中的任何一项作为诊断标准时，c指数最高（0.612），肥胖仍然是总生存差的独立预后因素（全因死亡率HR和95% CI: 1.41[1.26, 1.58]，心血管疾病死亡率HR: 2.08[1.61, 2.68]，癌症死亡率HR: 1.32[1.06, 1.65]）。结论：本研究证实了EASO提出的新的肥胖诊断标准的预后价值，表明这些标准可以更准确地评估肥胖相关的健康风险。

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来源期刊

Diabetes, Obesity & Metabolism 医学-内分泌学与代谢

CiteScore

10.90

自引率

6.90%

发文量

319

审稿时长

3-8 weeks

期刊介绍： Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.