Author + information
- Received November 9, 2016
- Revision received February 27, 2017
- Accepted March 14, 2017
- Published online May 15, 2017.
- Morten Fenger-Grøn, MSca,∗ (, )
- Kim Overvad, MD, PhDb,c,
- Anne Tjønneland, MD, PhD, DMScd and
- Lars Frost, MD, PhD, DMSce
- aResearch Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- bSection for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- cDepartment of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- dDanish Cancer Society Research Center, Copenhagen, Denmark
- eDepartment of Clinical Medicine, Aarhus University, Silkeborg Hospital, Denmark
- ↵∗Address for correspondence:
Mr. Morten Fenger-Grøn, Research Unit for General Practice, Aarhus University, Bartholins Allé 2, Aarhus C, Central Region 8000, Denmark.
Background Obesity is repeatedly emphasized as a risk factor for atrial fibrillation or flutter (AF). However, the underlying evidence may be questioned, as the obvious correlations between various anthropometric measures hamper identification of the characteristics that are biologically driving AF risk, and recent studies suggest that fat carries limited or no independent risk of AF.
Objectives This study sought to assess mutually adjusted associations among AF risk and height, weight, body mass index, hip and waist circumference, waist-to-hip ratio, and bioelectrical impedance-derived measures of fat mass, lean body mass, and fat percentage.
Methods Anthropometric measures and self-reported life-style information were collected from 1993 to 1997 in a population-based cohort including 55,273 persons age 50 to 64 years who were followed in Danish registers until June 2013.
Results During a median of 17 years of follow-up, 3,868 persons developed AF. Adjusted hazard ratios per population SD difference (HRs) showed highly statistically significant, positive associations for all 9 anthropometric measures (HRs ranging from 1.08 [95% confidence interval (CI): 1.05 to 1.12] for waist-to-hip ratio to 1.37 [95% CI: 1.33 to 1.42] for lean body mass). Pairwise mutual adjustment of the 9 measures left the association for lean body mass virtually unchanged (lowest HR: 1.33 [95% CI: 1.28 to 1.39] when adjusting for height), whereas no other association remained substantial when adjusted for lean body mass (highest HR: 1.05 [95% CI: 1.01 to 1.10] for height).
Conclusions Lean body mass was the predominant anthropometric risk factor for AF, whereas no association was observed for either of the obesity-related anthropometric measures after adjustment for lean body mass.
The study was supported by the Danish Council for Strategic Research (grant 09-066965). The Diet, Cancer and Health cohort study was funded by the Danish Cancer Society. Mr. Fenger-Grøn is supported by a grant from the Faculty of Health, Aarhus University, Denmark, and from the Lundbeck Foundation, Denmark. Funders had no role in the design and conduct of the study; management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 9, 2016.
- Revision received February 27, 2017.
- Accepted March 14, 2017.
- 2017 American College of Cardiology Foundation