Associations of general and central obesity with risk of premature mortality among Chinese adults: A nationwide prospective cohort study

Abstract Aims To investigate the associations of general and central obesity with premature mortality in a Chinese population. Materials and Methods A total of 162 776 participants from the China Cardiometabolic Disease and Cancer Cohort Study were included in the current analysis. General and central obesity were assessed using body mass index ( BMI ) and waist‐to‐hip ratio ( WHR ), respectively. Premature mortality was defined as all‐cause mortality occurring before the age of 75 years, including cardiovascular disease ( CVD )‐related and non‐ CVD ‐related premature mortality. Cox proportional hazards models were used to estimate the hazard ratios ( HRs ) and 95% confidence intervals ( CIs ). Results During a median follow‐up of 10.1 years, 5477 (3.36%) premature deaths were documented. Compared with normal weight (18.5 to <24 kg/m 2 ), those with general obesity ( BMI ≥28 kg/m 2 ) were associated with elevated risk of CVD ‐related premature mortality ( HR : 1.53; 95% CI : 1.30–1.82). Central obesity ( WHR ≥0.95 for men or ≥0.90 for women) was associated with increased risks of all‐cause ( HR : 1.20; 95% CI : 1.11–1.31), CVD ‐related ( HR : 1.51; 95% CI : 1.29–1.77) and non‐ CVD ‐related premature mortality ( HR : 1.11; 95% CI : 1.01–1.22). These associations persisted after mutual adjustment for BMI and WHR . A significant interaction between BMI and WHR on the risk of premature mortality was observed ( p for interaction = 0.028). Individuals with normal weight but central obesity exhibited the highest risk of all‐cause premature death ( HR : 1.21; 95% CI : 1.06–1.37), whereas the highest risk of CVD ‐related mortality was observed in those with both general and central obesity ( HR : 1.89; 95% CI : 1.50–2.39). Conclusions The combination of normal weight and central obesity significantly increases premature mortality risk, emphasizing the importance of integrating WHR into obesity assessments to improve risk stratification and prevention strategies among Chinese adults.