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Muscle mass, BMI, and mortality among adults in the United States: A population-based cohort study

PLoS ONE, ISSN: 1932-6203, Vol: 13, Issue: 4, Page: e0194697
2018
  • 158
    Citations
  • 0
    Usage
  • 217
    Captures
  • 12
    Mentions
  • 292
    Social Media
Metric Options:   Counts1 Year3 Year

Metrics Details

  • Citations
    158
  • Captures
    217
  • Mentions
    12
    • News Mentions
      10
      • 10
    • Blog Mentions
      2
      • Blog
        2
  • Social Media
    292
    • Shares, Likes & Comments
      292
      • Facebook
        292

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Article Description

Background The level of body-mass index (BMI) associated with the lowest risk of death remains unclear. Although differences in muscle mass limit the utility of BMI as a measure of adiposity, no study has directly examined the effect of muscle mass on the BMI-mortality relationship. Methods Body composition was measured by dual-energy x-ray absorptiometry in 11,687 participants of the National Health and Nutrition Examination Survey 1999–2004. Low muscle mass was defined using sex-specific thresholds of the appendicular skeletal muscle mass index (ASMI). Proportional hazards models were created to model associations with all-cause mortality. Results At any level of BMI 22, participants with low muscle mass had higher body fat percentage (%TBF), an increased likelihood of diabetes, and higher adjusted mortality than other participants. Increases in %TBF manifested as 30–40% smaller changes in BMI than were observed in participants with preserved muscle mass. Excluding participants with low muscle mass or adjustment for ASMI attenuated the risk associated with low BMI, magnified the risk associated with high BMI, and shifted downward the level of BMI associated with the lowest risk of death. Higher ASMI was independently associated with lower mortality. Effects were similar in never-smokers and ever-smokers. Additional adjustment for waist circumference eliminated the risk associated with higher BMI. Results were unchanged after excluding unintentional weight loss, chronic illness, early mortality, and participants performing muscle-strengthening exercises or recommended levels of physical activity. Conclusions Muscle mass mediates associations of BMI with adiposity and mortality and is inversely associated with the risk of death. After accounting for muscle mass, the BMI associated with the greatest survival shifts downward toward the normal range. These results provide a concrete explanation for the obesity paradox.

Bibliographic Details

http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85045186256&origin=inward; http://dx.doi.org/10.1371/journal.pone.0194697; http://www.ncbi.nlm.nih.gov/pubmed/29641540; https://dx.plos.org/10.1371/journal.pone.0194697.g007; http://dx.doi.org/10.1371/journal.pone.0194697.g007; https://dx.plos.org/10.1371/journal.pone.0194697.g005; http://dx.doi.org/10.1371/journal.pone.0194697.g005; https://dx.plos.org/10.1371/journal.pone.0194697.g004; http://dx.doi.org/10.1371/journal.pone.0194697.g004; https://dx.plos.org/10.1371/journal.pone.0194697.g003; http://dx.doi.org/10.1371/journal.pone.0194697.g003; https://dx.plos.org/10.1371/journal.pone.0194697.g002; http://dx.doi.org/10.1371/journal.pone.0194697.g002; https://dx.plos.org/10.1371/journal.pone.0194697.t002; http://dx.doi.org/10.1371/journal.pone.0194697.t002; https://dx.plos.org/10.1371/journal.pone.0194697.t001; http://dx.doi.org/10.1371/journal.pone.0194697.t001; https://dx.plos.org/10.1371/journal.pone.0194697.g001; http://dx.doi.org/10.1371/journal.pone.0194697.g001; https://dx.plos.org/10.1371/journal.pone.0194697.g006; http://dx.doi.org/10.1371/journal.pone.0194697.g006; https://dx.plos.org/10.1371/journal.pone.0194697; https://dx.doi.org/10.1371/journal.pone.0194697; https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0194697; https://dx.doi.org/10.1371/journal.pone.0194697.t002; https://journals.plos.org/plosone/article/figure?id=10.1371/journal.pone.0194697.t002; https://dx.doi.org/10.1371/journal.pone.0194697.g007; https://journals.plos.org/plosone/article/figure?id=10.1371/journal.pone.0194697.g007; https://dx.doi.org/10.1371/journal.pone.0194697.g001; https://journals.plos.org/plosone/article/figure?id=10.1371/journal.pone.0194697.g001; https://dx.doi.org/10.1371/journal.pone.0194697.g005; https://journals.plos.org/plosone/article/figure?id=10.1371/journal.pone.0194697.g005; https://dx.doi.org/10.1371/journal.pone.0194697.g004; https://journals.plos.org/plosone/article/figure?id=10.1371/journal.pone.0194697.g004; https://dx.doi.org/10.1371/journal.pone.0194697.g006; https://journals.plos.org/plosone/article/figure?id=10.1371/journal.pone.0194697.g006; https://dx.doi.org/10.1371/journal.pone.0194697.g002; https://journals.plos.org/plosone/article/figure?id=10.1371/journal.pone.0194697.g002; https://dx.doi.org/10.1371/journal.pone.0194697.g003; https://journals.plos.org/plosone/article/figure?id=10.1371/journal.pone.0194697.g003; https://dx.doi.org/10.1371/journal.pone.0194697.t001; https://journals.plos.org/plosone/article/figure?id=10.1371/journal.pone.0194697.t001; http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0194697; https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0194697&type=printable

Matthew K. Abramowitz; Charles B. Hall; Afolarin Amodu; Deep Sharma; Lagu Androga; Meredith Hawkins; Olga Y. Gorlova

Public Library of Science (PLoS)

Biochemistry, Genetics and Molecular Biology; Agricultural and Biological Sciences; Multidisciplinary

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