Body mass index, abdominal fatness, fat mass and the risk of atrial fibrillation: a systematic review and dose-response meta-analysis of prospective studies

Different adiposity measures have been associated with increased risk of atrial fibrillation, however, results have previously only been summarized for BMI. We therefore conducted a systematic review and meta-analysis of prospective studies to clarify the association between different adiposity measures and risk of atrial fibrillation. PubMed and Embase databases were searched up to October 24th 2016. Summary relative risks (RRs) were calculated using random effects models. Twenty-nine unique prospective studies (32 publications) were included. Twenty-five studies (83,006 cases, 2,405,381 participants) were included in the analysis of BMI and atrial fibrillation. The summary RR was 1.28 (95% confidence interval: 1.20-1.38, I-2 = 97%) per 5 unit increment in BMI, 1.18 (95% CI: 1.12-1.25, I-2 = 73%, n = 5) and 1.32 (95% CI: 1.16-1.51, I-2 = 91%, n = 3) per 10 cm increase in waist and hip circumference, respectively, 1.09 (95% CI: 1.02-1.16, I-2 = 44%, n = 4) per 0.1 unit increase in waist-to- hip ratio, 1.09 (95% CI: 1.02-1.16, I-2 = 94%, n = 4) per 5 kg increase in fat mass, 1.10 (95% CI: 0.92-1.33, I-2 = 90%, n = 3) per 10% increase in fat percentage, 1.10 (95% CI: 1.08-1.13, I-2 = 74%, n = 10) per 5 kg increase in weight, and 1.08 (95% CI: 0.97-1.19, I-2 = 86%, n = 2) per 5% increase in weight gain. The association between BMI and atrial fibrillation was non-linear, p(nonlinearity) < 0.0001, with a stronger association at higher BMI levels, however, increased risk was observed even at a BMI of 22-24 compared to 20. In conclusion, general and abdominal adiposity and higher body fat mass increase the risk of atrial fibrillation.