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Relative fat mass most strongly associated with incident HF risk
Literature - Suthahar N, Meems LMG, Withaar C et al. - Sci Rep. 2022 Jan 7;12(1):147. doi: 10.1038/s41598-021-02409-6.

Introduction and methods


Studies have demonstrated that excessive adipose tissue accumulation increases the risk of incident HF [1-3]. Established indices of adiposity include BMI, waist circumference (WC), and waist-hip ratio (WHR). In the last years, novel indices of adiposity have been introduced that are also easy to measure and calculate, but better reflect the body fat distribution and total fat mass than the traditional indices. Novel indices of adiposity include body shape index (BSI) [4], body roundness index (BRI) [5], weight-adjusted-weight index (WWI) [6] and relative fat mass (RFM) [7].

Aim of the study

This study investigated the association between multiple indices of adiposity (BMI, WC, WHR. BSI, BRI, WWI and RFM) and the risk of incident HF in a community-based cohort.


This study included 8295 individuals from the PREVEND observational cohort [8-10]. PREVEND enrolled adults from the general population of the city of Groningen, The Netherlands.

Mean age was 49.8±12.6 years, 49.8% were women, 41% were overweight and 16% were obese. Body weight, hight, WC and hip circumference were measured at baseline. These measures were used to calculate the different indices of adiposity.

Individuals were followed for the first occurrence of HF or death within 13.5 years of baseline. Associations of adiposity indices with incident HF were analyzed. Reported hazard ratios (HR) represent HR per standard deviation (SD) change in adiposity index and are adjusted for age, sex, smoking, cholesterol, SBP, glucose, and history of MI, stroke and AF.

Main results

Association between adiposity indices and incident HF

  • 363 individuals (4.1%) developed HF during a median follow-up of 11.3 ± 3.1 years.
  • Six out of seven investigated adiposity indices were significantly associated with incident HF (P<0.001). BSI was not significantly associated with incident HF.
  • Amongst investigated adiposity indices, RFM showed the strongest association with incident HF (HR 1.67 per 1 SD increase, 95% CI 1.37-2.04).
  • All adiposity indices were similarly associated with incident HF in men and women.

Association between adiposity indices and incident HFpEF and HFrEF

  • LVEF was available for all HF cases; 120 individuals developed HFpEF and 243 developed HFrEF during follow-up.
  • Amongst the investigated indices of adiposity, RFM displayed the strongest associations with HFpEF (HF 1.76, 95% CI 1.26-2.45, P<0.001) and HFrEF(HR 1.61, 95% CI 1.25-2.06, P<0.001).
  • All adiposity indices were similarly associated with incident HFpEF in both sexes. In contrast, RFM, WHR and BMI were more strongly associated with HFrEF in men than in women (P for interaction= 0.07, 0.06 and 0.09, respectively).

Improvement in model fit

  • Addition of all adiposity indices, except BSI, substantially improved the fit of a clinical HF model by reducing the prediction error. Addition of BRI and RFM led to the strongest improvements. However, none of the adiposity indices improved discrimination of HF.


This study assessed the association between multiple novel and established indices of adiposity and the risk of incident HF in community-dwelling individuals. Results showed that RFM was most strongly associated with incident HF risk.

The authors of the article wrote ‘RFM could potentially be used in routine clinical practice or public health surveillance programmes—even in resource poor settings. This is because RFM not only correlates strongly with HF risk, but can also be calculated using a relatively simple formula*, requiring only height and waist circumference—both of which could be determined using a measuring tape.’ They also noted that the value of including RFM in HF risk prediction models should be subject of future studies.

* [64 - (20 × Height/WC) + (12 × sex), with sex = 0 in men, and sex = 1 in women] [7]


1. Pandey, A. et al. Association between regional adipose tissue distribution and risk of heart failure among blacks. Circ. Hear. Fail. https:// doi. org/ 10. 1161/ CIRCH EARTF AILURE. 118. 005629 (2018).

2. Aune, D. et al. Body mass index, abdominal fatness, and heart failure incidence and mortality: A systematic review and dose response meta-analysis of prospective studies. Circulation 133, 639–649 (2016).

3. Kenchaiah, S. et al. Obesity and the risk of heart failure. N. Engl. J. Med. 347, 305–313 (2002).

4. Krakauer, N. Y. & Krakauer, J. C. A new body shape index predicts mortality hazard independently of body mass index. PLoS ONE 7, e39504 (2012).

5. Thomas, D. M. et al. Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model. Obesity (Silver Spring) 21, 2264–2271 (2013).

6. Park, Y., Kim, N. H., Kwon, T. Y. & Kim, S. G. A novel adiposity index as an integrated predictor of cardiometabolic disease morbidity and mortality. Sci. Rep. 8, 16753 (2018).

7. Woolcott, O. O. & Bergman, R. N. Relative fat mass (RFM) as a new estimator of whole-body fat percentage—A cross-sectional study in American adult individuals. Sci. Rep. 8, 10980 (2018).

8. Brouwers, F. P. et al. Incidence and epidemiology of new onset heart failure with preserved vs. reduced ejection fraction in a community-based cohort: 11-year follow-up of PREVEND. Eur. Heart J. 34, 1424–1431 (2013).

9. de Boer, R. A. et al. Association of cardiovascular biomarkers with incident heart failure with preserved and reduced ejection fraction. JAMA Cardiol. 3, 215 (2018).

10. Suthahar, N. et al. High-sensitivity troponin-T and cardiovascular outcomes in the community: Differences between women and men. Mayo Clin. Proc. 95, 1158–1168 (2020).

Find this article online at Sci Rep.

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Schedule27 May 2024