Anthropometric estimates of muscle and fat mass in relation to cardiac and cancer mortality in men: the Paris Prospective Study.

BACKGROUND The associations of different components of body mass with disease outcomes are not well defined. OBJECTIVE We investigated the effects of body composition on risk of death from cardiac causes and cancer in adult men. DESIGN Middle-aged men (n = 7608) in the Paris Prospective Study were followed up for 15 y. At study entry, the following measurements were obtained: sagittal diameter, sum of midarm and midthigh circumferences, sum of 3 trunk skinfold thicknesses (estimate of trunk subcutaneous fat), and sum of 3 extremity skinfold thicknesses (estimate of extremity subcutaneous fat). To assess their relative contributions to cardiac and cancer mortality, we used multivariate Cox models in which the sagittal diameter adjusted for trunk skinfold thicknesses was used as an estimate of intraabdominal fat and the sum of midarm and midthigh circumferences adjusted for extremity skinfold thicknesses was used as an estimate of muscle mass. RESULTS In multivariate analyses in both smokers and nonsmokers, the sagittal diameter was the only significant predictor of cardiac death. The sum of midarm and midthigh circumferences was negatively associated and sagittal diameter was positively associated with cancer death, whereas extremity skinfold thicknesses exhibited a U-shape relation. Exclusion of subjects who died from cancer in the first 5 y of follow-up did not change these results. CONCLUSIONS Intraabdominal fat appears to be the main body compartment involved in risk of cardiac death, whereas increased risk of cancer death is associated with lower muscle mass and lower subcutaneous fat, independent of smoking and after the exclusion of early mortality. Increased central fat distribution may confer additional risk of death from cancer.