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HOME > J Prev Med Public Health > Volume 59(3); 2026 > Article
Original Article
Associations of Body Mass Index and Waist Circumference With Falls Among Community-dwelling Older Adults in Korea
Seonho Kim1orcid, Jeong-Soo Im2orcid, Beomman Ha2orcid
Journal of Preventive Medicine and Public Health 2026;59(3):328-336.
DOI: https://doi.org/10.3961/jpmph.26.092
Published online: March 31, 2026
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1College of Nursing and Research Institute of Nursing Science, Chungbuk National University, Cheongju, Korea

2Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea

Corresponding author: Beomman Ha, Department of Preventive Medicine, Gachon University College of Medicine, 38-13 Dokjeom-ro 3beon-gil, Namdong-gu, Incheon 21565, Korea, E-mail: hbm1130@naver.com
• Received: January 29, 2026   • Revised: February 25, 2026   • Accepted: March 5, 2026

Copyright © 2026 The Korean Society for Preventive Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Objectives
    This study aimed to investigate the association between obesity and falls among community-dwelling older adults in Korea and to assess whether body mass index (BMI) or waist circumference (WC) more accurately predicts fall risk.
  • Methods
    This study included 4378 community-dwelling older adults aged ≥65 years from the seventh Korea National Health and Nutrition Examination Survey (2016–2018). Complex-sample logistic regression analyses were conducted to examine the associations between general and central obesity and falls, stratified by sex and age group. Predictive accuracy was evaluated using Harrell’s C-index, and differences between WC and BMI were assessed using the ΔC-index and the DeLong test.
  • Results
    BMI-defined general obesity was not significantly associated with falls. In contrast, WC-defined central obesity was significantly associated with falls among older adults overall (adjusted odds ratio, 1.82; 95% confidence interval, 1.20 to 2.76). In sex-stratified analyses, central obesity remained significantly associated with falls in both males and females. Age-stratified analyses showed a significant association between central obesity and falls among adults aged 65–74 years, but not among those aged ≥75 years. WC demonstrated a modest but statistically significant improvement in predictive ability compared with BMI (ΔC-index=0.047, p=0.044), although subgroup differences were not statistically significant.
  • Conclusions
    Central obesity, but not general obesity defined by BMI, was significantly associated with falls among community-dwelling older Korean adults. WC showed slightly better predictive performance than BMI. These findings suggest that WC may be a more appropriate indicator than BMI for identifying older adults at increased risk of falls.
Older adults are vulnerable to injury, with falls representing the most common cause [1]. Falls reduce quality of life among older adults [2], and severe falls can lead to functional decline, loss of independence, fear of falling, social isolation, and death [3,4]. In Korea, 15.9–25.1% of community-dwelling older adults experience falls annually [5], and the incidence increases substantially with age [6,7]. As Korea is experiencing population aging at an unprecedented pace worldwide, both the incidence of falls and the associated social burden are expected to increase further as the older population continues to grow.
General obesity is typically considered a risk factor for falls. However, previous studies in older adults have reported inconsistent findings, including increased fall risk [810], U-shaped associations [8,11], and no or inverse associations [1214], indicating that the relationship remains a topic of debate. These inconsistencies may reflect differences in socio-demographic characteristics (e.g., race/ethnicity), disease-related factors, and health-related characteristics across study populations. In particular, variation in the operational definition of obesity has been identified as an important methodological factor contributing to these discrepancies [15].
Among indicators used to assess obesity in large-scale population surveys, general obesity measured by body mass index (BMI) and central obesity defined by waist circumference (WC) are the most common. Recently, concerns have been raised that BMI, which does not distinguish between muscle and fat mass, may be inappropriate for assessing obesity in older adults [15,16]. In contrast, WC, an indicator of body fat distribution and abdominal obesity, has been reported to improve the prediction of various health outcomes in older adults [1719]. Regarding falls, emerging evidence suggests that WC may be a stronger predictor than BMI among older adults with obesity [15,16]. However, clear evidence supporting WC as a stronger predictor of falls than BMI remains limited. Furthermore, although several studies in Korea have examined the relationship between BMI and falls among older adults [8,13,20], research on the association between WC and falls remains limited [15].
Therefore, this study aimed to investigate the association between obesity and falls among community-dwelling older adults in Korea and to determine whether BMI or WC better predicts fall risk, overall and according to sex and age group.
Study Population
We used data from the seventh Korea National Health and Nutrition Examination Survey (KNHANES VII, 2016–2018). KNHANES, conducted annually by the Korea Disease Control and Prevention Agency (KDCA), is a nationwide, population-based survey designed to assess health-related behaviors, health status, and nutritional intake among Korean adults. The survey employs a stratified, multistage, clustered probability sampling design to obtain a representative sample of civilian, non-institutionalized adults in Korea. The raw data were obtained after completion of the required application process through the KNHANES website.
For this study, we selected participants aged ≥65 years from KNHANES VII, which includes the most recent data containing measurements for height, weight, and WC, as these are required to assess BMI and WC. Of the 4956 older adults aged ≥65 years, we excluded 418 individuals with missing data on falls, 46 with missing obesity-related indicators (BMI or WC), and 114 with missing covariates. A total of 4378 participants were included in the final analysis.
Measures

Falls

The presence of falls was assessed through self-reported interviews. Participants were asked, “Has there been a fall or slip requiring treatment at a hospital or emergency room during the past year?” Those who responded “yes” were classified as having experienced a fall [21].

Obesity

Obesity was assessed using BMI as an indicator of general obesity and WC as an indicator of central obesity; both were measured during the KNHANES health examination survey. BMI was calculated as weight in kilograms divided by height in meters squared (kg/m2), and classification followed the criteria of the Korean Society for the Study of Obesity [22]. Individuals with a BMI <18.5 were classified as underweight, those with a BMI of 18.5–22.9 as normal weight, those with a BMI of 23.0–24.9 as overweight, and those with a BMI ≥25.0 as obese. Central obesity was defined using WC cutoff values recommended by the Korean Society for the Study of Obesity [22]: ≥90 cm for males and ≥85 cm for females.

Covariates

Covariates included socio-demographic characteristics and health-related variables. Socio-demographic characteristics included sex (male, female), age (65–74, ≥75 years), education level (elementary school, middle school, high school, college/university), household income (lower, lower-middle, upper-middle, upper), employment status (yes, no), and living arrangement (living alone vs. living with family). Health-related variables included self-rated health status (good, normal, poor), current smoking (yes, no), current alcohol consumption (yes, no), aerobic physical activity (yes, no), number of chronic diseases (0, 1–2, ≥3), and number of medications (0, 1–2, ≥3). Aerobic physical activity was defined as ≥150 minutes of moderate-intensity activity, ≥75 minutes of vigorous-intensity activity, or an equivalent combination per week [23]. Chronic diseases included physician-diagnosed hypertension, dyslipidemia, stroke, myocardial infarction or angina pectoris, osteoarthritis or rheumatoid arthritis, osteoporosis, diabetes mellitus, and cancers (stomach, liver, colon, breast, cervix, and lung).
Statistical Analysis
Data were analyzed using SPSS version 30.0 (IBM Corp., Armonk, NY, USA), and R version 4.5.2 (R Foundation for Statistical Computing, Vienna, Austria), with appropriate weighting to account for the complex sampling design in accordance with KDCA guidelines. Participant characteristics were presented as unweighted frequencies and weighted percentages. Differences in falls according to participant characteristics were assessed using the Rao–Scott chi-square test. Complex-sample logistic regression analyses were conducted to estimate odds ratios and 95% confidence intervals (CIs) for the associations between obesity (defined by BMI and WC) and falls. Analyses were stratified by sex and age group and adjusted for potential confounders, including socio-demographic and health-related factors. Predictive accuracy was evaluated using Harrell’s C-index. Differences in predictive performance between WC and BMI were calculated as the ΔC-index (WC–BMI), and statistical significance was assessed using the DeLong test. A 2-sided p-value <0.05 was considered statistically significant.
Ethics Statement
This study used anonymized secondary data from the KNHANES. The KDCA, which oversees the survey, obtained approval from its institutional review board (IRB), and informed consent was obtained from all participants at the time of data collection. Additional ethical approval for this study was obtained from the IRB of Chungbuk National University (IRB No. CBNU-2026-A-0001).
Among the 4378 participants, 3.6% (n=157) had experienced a fall in the preceding year. Falls were more likely to be experienced by females (4.1 vs. 2.3%), individuals aged 65–74 years (3.9 vs. 2.8%), and participants who lived alone (4.7 vs. 3.0%). In addition, the proportion of falls increased across BMI categories (underweight, normal weight, overweight, and obese: 1.6, 2.8, 3.4, and 4.4%, respectively) and was higher among those with central obesity (4.7 vs. 2.4%) (Table 1).
Table 2 presents the logistic regression analyses examining the associations between falls and both general and central obesity. BMI-defined general obesity was not significantly associated with falls in the multivariable-adjusted model. In contrast, WC-defined central obesity was significantly associated with falls in the multivariable-adjusted model (adjusted odds ratio [aOR], 1.82; 95% CI, 1.20 to 2.76).
When the analyses were stratified by sex, general obesity was not significantly associated with falls in either males or females. In contrast, central obesity was significantly associated with falls in both males (aOR, 2.21; 95% CI, 1.07 to 4.55) and females (aOR, 1.64; 95% CI, 1.03 to 2.61) (Table 3).
When the analyses were stratified by age group, central obesity was significantly associated with falls among adults aged 65–74 years (aOR, 1.79; 95% CI, 1.09 to 2.93), whereas no significant association was observed among those aged ≥75 years (Table 4).
Overall, WC showed slightly higher predictive ability for falls than BMI (ΔC-index=0.047, p=0.044). In subgroup analyses stratified by sex and age group, the ΔC-index values were positive but did not reach statistical significance (Table 5).
This study examined the associations between obesity and falls among community-dwelling older adults in Korea, with a direct comparison of the predictive performance of BMI and WC. To our knowledge, this is the first large-scale study to evaluate whether central obesity provides additional predictive value beyond general obesity, with stratification by sex and age group.
Our main finding was that WC-defined central obesity showed a more consistent association with falls than BMI-defined general obesity and provided modest but statistically significant incremental predictive value beyond BMI. Although the improvement in predictive ability was small, these results suggest that incorporating WC into fall risk assessment may improve risk classification compared with relying on BMI alone.
In our study, BMI-defined general obesity was not significantly associated with falls, consistent with previous studies reporting no significant relationship between BMI-defined obesity and falls in older adults [12,15,16,24]. The absence of a significant association between BMI-defined general obesity and falls in older adults may be attributable to BMI’s inability to reflect body composition accurately. Aging is typically accompanied by decreased muscle mass and increased fat mass, which can lead to sarcopenic obesity even without substantial changes in body weight or BMI [25,26]. Because BMI is calculated solely from weight and height, it cannot distinguish between fat mass and lean mass, potentially misclassifying individuals with high body fat as having a normal BMI [27]. Recent studies have raised concerns that BMI may be an inappropriate measure of obesity in older adults [28,29], and our findings support this perspective. Therefore, healthcare providers should be cautious about using BMI alone to assess health risks, including fall risk, associated with obesity in older adults [16]. Nonetheless, some studies have reported a significant association between BMI-defined general obesity and falls in older adults [8,10,30,31], highlighting the need for further research.
In contrast, WC, which reflects central fat accumulation, has consistently been reported to be significantly associated with falls in older adults [15,16,24]. In this study, WC-defined central obesity was significantly associated with falls in all analyses except those involving participants aged ≥75 years, partially supporting previous evidence that abdominal obesity is an important indicator of fall risk. The association between central obesity and falls may be explained by several mechanisms. Excess abdominal fat shifts the body’s center of mass forward, resulting in postural instability, impaired balance [15,16,32], and inefficient gait patterns, including reduced walking speed [33,34]. Moreover, abdominal obesity is associated with systemic inflammation, oxidative stress, and insulin resistance, which may accelerate muscle loss, exacerbate muscle weakness, and impair neuromuscular function [35,36]. Therefore, the increased fall risk observed in individuals with central obesity likely reflects not only increased body weight but also altered fat distribution and functional impairments affecting balance, posture, and gait.
A notable finding of this study is that, among adults aged ≥75 years, neither general obesity nor central obesity was significantly associated with falls. This finding suggests that, in very old adults, factors other than obesity—such as frailty, multimorbidity, polypharmacy, sensory deficits, and prior falls—may play a more prominent role in fall risk. Recent studies have emphasized the importance of age-stratified analyses within older populations [37,38]. Such stratification is necessary because treating all adults aged ≥65 years as a single older population may overlook age-related differences within this heterogeneous group [37]. Indeed, risk factors for falls differ across age groups among older adults [39,40]. Future research should examine age-specific associations between obesity and falls in older adults to inform tailored interventions and policies.
The prevalence of obesity varied according to the definition used. In this study, BMI-defined general obesity was 25.5%, whereas WC-defined central obesity was 42.2%, consistent with previous studies reporting a higher prevalence of abdominal obesity than general obesity in older populations [15,16]. This finding suggests that BMI, which does not account for age-related increases in fat mass and decreases in muscle mass, may substantially underestimate obesity in older adults [15]. This is particularly relevant for individuals with a normal BMI but excess central fat. Although some studies have reported associations between BMI-defined obesity and falls [8,10,30,31], BMI alone may be insufficient in this population. Furthermore, international guidelines define obesity as BMI ≥30 kg/m2, whereas a lower cutoff (BMI ≥25 kg/m2) is recommended for Asian populations because of differences in body composition and metabolic risk. In our sample, only 66 participants met the BMI ≥30 kg/m2 criterion, limiting statistical power for reliable analysis. Therefore, we applied the Korean BMI criteria. Differences in cutoff values should be considered when comparing results across studies, and future research, including larger numbers of individuals with BMI ≥30 kg/m2 in Asian populations, is warranted.
From a public health perspective, indicators that improve risk prediction are particularly important for designing fall-prevention strategies. In addition, because WC can be measured easily without specialized equipment, incorporating routine WC assessment into clinical practice may be a practical and meaningful approach to fall risk screening.
This study has several limitations. First, the cross-sectional design precludes causal inference regarding the relationships among general obesity, central obesity, and falls, making it unclear whether obesity contributes to falls or whether falls lead to changes in body composition. Second, selective survival or response bias among adults aged ≥75 years may have influenced the observed associations, as participants in this age group may represent a healthier subset of the population. Third, some fall-related variables and covariates were self-reported and may therefore be subject to reporting errors or recall bias. Fourth, because this study used secondary data, residual confounding and unmeasured variables cannot be fully ruled out. Future longitudinal studies are needed to clarify the causal relationship between obesity and falls and to further evaluate the predictive utility of WC. Despite these limitations, this study is meaningful as the first to analyze the association between obesity and falls using nationally representative data in Korea and to compare whether general obesity or central obesity better predicts falls.
In conclusion, WC-defined central obesity showed a more consistent association with falls than BMI and offered modest but meaningful additional predictive value. These findings suggest that, among Korean older adults, WC may be a more useful anthropometric measure than BMI for assessing fall risk. Central obesity may therefore warrant prioritization as a screening measure for fall risk in older adults, and individuals with central obesity may benefit from targeted fall-prevention strategies. Prioritizing central obesity in fall risk screening may help strengthen prevention strategies for the older adult population.

Conflict of Interest

The authors have no conflicts of interest associated with the material presented in this paper.

Funding

None.

Acknowledgements

None.

Author Contributions

Conceptualization: Kim S, Im JS, Ha B. Data curation: Kim S, Ha B. Formal analysis: Kim S, Ha B. Funding acquisition: None. Methodology: Kim S, Im JS, Ha B. Project administration: Kim S, Ha B. Visualization: Kim S, Ha B. Writing – original draft: Kim S, Im JS, Ha B. Writing – review & editing: Kim S, Im JS, Ha B.

Table 1
Characteristics of study participants according to falls
Characteristics Fall Non-fall p-value1
Total 157 (3.6) 4221 (96.4)
Sex 0.004
 Male 40 (2.3) 1861 (97.7)
 Female 117 (4.1) 2360 (95.9)
Age (y) 0.048
 65–74 92 (3.9) 2540 (96.1)
 ≥75 65 (2.8) 1681 (97.2)
Education level 0.176
 Elementary school 102 (3.7) 2457 (96.3)
 Middle school 24 (3.4) 626 (96.6)
 High school 25 (3.6) 711 (96.4)
 College/university 6 (1.4) 427 (98.6)
Household income 0.451
 Lower 86 (3.5) 1989 (96.5)
 Lower middle 43 (3.5) 1148 (96.5)
 Upper middle 14 (2.2) 644 (97.8)
 Upper 14 (3.9) 440 (96.1)
Employment status 0.684
 Yes 50 (3.6) 1405 (96.4)
 No 107 (3.3) 2816 (96.7)
Living arrangement 0.015
 Live alone 54 (4.7) 962 (95.3)
 Live with family 103 (3.0) 3259 (97.0)
Self-rated health status 0.069
 Good 31 (3.3) 866 (96.7)
 Normal 61 (2.7) 2006 (97.3)
 Poor 65 (4.4) 1349 (95.6)
Current smoking 0.556
 Yes 10 (2.8) 386 (97.2)
 No 147 (3.4) 3835 (96.6)
Current alcohol consumption 0.602
 Yes 51 (3.2) 1482 (96.8)
 No 106 (3.5) 2739 (96.5)
Aerobic physical activity 0.696
 Yes 42 (3.2) 1313 (96.8)
 No 115 (3.4) 2908 (96.6)
No. of chronic diseases2 0.047
 0 21 (3.1) 659 (96.9)
 1–2 70 (3.1) 2216 (96.9)
 ≥3 66 (3.9) 1346 (96.1)
No. of medications 0.144
 0 37 (3.2) 1117 (96.8)
 1–2 78 (3.0) 2340 (97.0)
 ≥3 42 (4.7) 764 (95.3)
General obesity (kg/m2) 0.048
 Underweight (BMI<18.5) 5 (1.6) 302 (98.4)
 Normal (18.5≤BMI<23.0) 54 (2.8) 1588 (97.2)
 Overweight (23.0≤BMI<25.0) 45 (3.4) 1269 (96.6)
 Obese (BMI≥25.0) 53 (4.4) 1062 (95.6)
Central obesity (cm) <0.001
 Non-obese (WC: male <90; female <85) 61 (2.4) 2470 (97.6)
 Obese (WC: male ≥90; female ≥85) 96 (4.7) 1751 (95.3)

Values are presented unweighted number (weighted %).

BMI, body mass index; WC, waist circumference.

1 Using Rao-Scott chi-square test.

2 Chronic diseases include hypertension, dyslipidemia, stroke, myocardial infarction or angina pectoris, osteoarthritis or rheumatoid arthritis, osteoporosis, diabetes mellitus, and various cancer.

Table 2
Association between falls and general and central obesity
Variables n OR (95% CI) aOR (95% CI)1
General obesity (kg/m2)
 Underweight (BMI<18.5) 307 0.54 (0.12, 2.36) 0.51 (0.11, 2.35)
 Normal (18.5≤BMI<23.0) 1642 1.00 (reference) 1.00 (reference)
 Overweight (23.0≤BMI<25.0) 1314 1.19 (0.77, 1.84) 1.10 (0.71, 1.72)
 Obese (BMI≥25.0) 1115 1.59 (1.03, 2.46) 1.44 (0.91, 2.26)
Central obesity (cm)
 Non-obese (WC: male <90; female <85) 2531 1.00 (reference) 1.00 (reference)
 Obese (WC: male ≥90; female ≥85) 1847 1.97 (1.32, 2.92) 1.82 (1.20, 2.76)

OR, odds ratio; aOR, adjusted odds ratio; CI, confidence interval; BMI, body mass index; WC, waist circumference.

1 Age, sex, education level, household income, job, living arrangement, self-rated health status, current smoking, current alcohol consumption, aerobic physical activity, number of chronic diseases, and number of medications are adjusted for statistical comparisons.

Table 3
Association between falls and general and central obesity stratified by sex
Variables Male (n=1901) Female (n=2477)
n OR (95% CI) aOR (95% CI)1 n OR (95% CI) aOR (95% CI)1
General obesity (kg/m2)
 Underweight (BMI<18.5) 141 0.74 (0.07, 4.25) 0.69 (0.06, 4.96) 166 0.97 (0.21, 4.49) 0.89 (0.18, 4.36)
 Normal (18.5≤BMI<23.0) 784 1.00 (reference) 1.00 (reference) 858 1.00 (reference) 1.00 (reference)
 Overweight (23.0≤BMI<25.0) 557 0.56 (0.22, 1.37) 0.54 (0.21, 1.37) 757 1.58 (0.93, 2.68) 1.47 (0.84, 2.59)
 Obese (BMI≥25.0) 419 1.35 (0.59, 3.10) 1.31 (0.56, 3.06) 696 1.67 (0.97, 2.86) 1.54 (0.86, 2.75)
Central obesity (cm)
 Non-obese (WC: male <90; female <85) 1225 1.00 (reference) 1.00 (reference) 1306 1.00 (reference) 1.00 (reference)
 Obese (WC: male ≥90; female ≥85) 676 2.10 (1.03, 4.31) 2.21 (1.07, 4.55) 1171 1.75 (1.12, 2.72) 1.64 (1.03, 2.61)

OR, odds ratio; aOR, adjusted odds ratio; CI, confidence interval; BMI, body mass index; WC, waist circumference.

1 Age, education level, household income, job, living arrangement, self-rated health status, current smoking, current alcohol consumption, aerobic physical activity, number of chronic diseases, and number of medications are adjusted for statistical comparisons.

Table 4
Association between falls and general and central obesity stratified by age group
Variables 65–74 y (n=2642) ≥75 y (n=1736)
n OR (95% CI) aOR (95% CI)1 n OR (95% CI) aOR (95% CI)1
General obesity (kg/m2)
 Underweight (BMI<18.5) 164 0.75 (0.09, 5.43) 0.67 (0.08, 5.62) 143 0.40 (0.05,3.05) 0.37 (0.04, 3.23)
 Normal (18.5≤BMI<23.0) 941 1.00 (reference) 1.00 (reference) 701 1.00 (reference) 1.00 (reference)
 Overweight (23.0≤BMI<25.0) 849 1.24 (0.71, 2.16) 1.21 (0.70, 2.11) 465 1.06 (0.49, 2.30) 0.88 (0.38, 2.04)
 Obese (BMI≥25.0) 688 1.72 (1.01, 2.95) 1.72 (0.99, 2.99) 427 1.34 (0.64, 2.81) 0.97 (0.43, 2.20)
Central obesity (cm)
 Non-obese (WC: male <90; female <85) 1523 1.00 (reference) 1.00 (reference) 1008 1.00 (reference) 1.00 (reference)
 Obese (WC: male ≥90; female ≥85) 1119 1.88 (1.16, 3.04) 1.79 (1.09, 2.93) 728 2.19 (1.20, 4.02) 1.72 (0.90, 3.28)

OR, odds ratio; aOR, adjusted odds ratio; CI, confidence interval; BMI, body mass index; WC, waist circumference.

1 Sex, education level, household income, job, living arrangement, self-rated health status, current smoking, current alcohol consumption, aerobic physical activity, number of chronic diseases, and number of medications are adjusted for statistical comparisons.

Table 5
Comparison of discriminatory ability of BMI and WC for falls in older adults using Harrell’s C-index1
Variables n BMI WC ΔC-index (WC-BMI) p-value2
Total 4378 0.650 (0.617, 0.703) 0.697 (0.635, 0.719) +0.047 0.044
Sex
 Male 1901 0.654 (0.578, 0.749) 0.665 (0.571, 0.758) +0.011 0.676
 Female 2477 0.634 (0.583, 0.685) 0.654 (0.604, 0.704) +0.020 0.107
Age (y)
 65–74 2642 0.669 (0.619, 0.719) 0.681 (0.631, 0.731) +0.012 0.282
 ≥75 1736 0.676 (0.616, 0.756) 0.698 (0.626, 0.770) +0.022 0.273

Values are presented as C-index (95% confidence interval).

BMI, body mass index; WC, waist circumference.

1 All models were adjusted for education level, household income, job, living arrangement, self-rated health status, current smoking, current alcohol consumption, aerobic physical activity, number of chronic diseases, and number of medications.

2 For comparison of C-index between BMI and WC models using DeLong’s test.

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      Associations of Body Mass Index and Waist Circumference With Falls Among Community-dwelling Older Adults in Korea
      Associations of Body Mass Index and Waist Circumference With Falls Among Community-dwelling Older Adults in Korea
      Characteristics Fall Non-fall p-value1
      Total 157 (3.6) 4221 (96.4)
      Sex 0.004
       Male 40 (2.3) 1861 (97.7)
       Female 117 (4.1) 2360 (95.9)
      Age (y) 0.048
       65–74 92 (3.9) 2540 (96.1)
       ≥75 65 (2.8) 1681 (97.2)
      Education level 0.176
       Elementary school 102 (3.7) 2457 (96.3)
       Middle school 24 (3.4) 626 (96.6)
       High school 25 (3.6) 711 (96.4)
       College/university 6 (1.4) 427 (98.6)
      Household income 0.451
       Lower 86 (3.5) 1989 (96.5)
       Lower middle 43 (3.5) 1148 (96.5)
       Upper middle 14 (2.2) 644 (97.8)
       Upper 14 (3.9) 440 (96.1)
      Employment status 0.684
       Yes 50 (3.6) 1405 (96.4)
       No 107 (3.3) 2816 (96.7)
      Living arrangement 0.015
       Live alone 54 (4.7) 962 (95.3)
       Live with family 103 (3.0) 3259 (97.0)
      Self-rated health status 0.069
       Good 31 (3.3) 866 (96.7)
       Normal 61 (2.7) 2006 (97.3)
       Poor 65 (4.4) 1349 (95.6)
      Current smoking 0.556
       Yes 10 (2.8) 386 (97.2)
       No 147 (3.4) 3835 (96.6)
      Current alcohol consumption 0.602
       Yes 51 (3.2) 1482 (96.8)
       No 106 (3.5) 2739 (96.5)
      Aerobic physical activity 0.696
       Yes 42 (3.2) 1313 (96.8)
       No 115 (3.4) 2908 (96.6)
      No. of chronic diseases2 0.047
       0 21 (3.1) 659 (96.9)
       1–2 70 (3.1) 2216 (96.9)
       ≥3 66 (3.9) 1346 (96.1)
      No. of medications 0.144
       0 37 (3.2) 1117 (96.8)
       1–2 78 (3.0) 2340 (97.0)
       ≥3 42 (4.7) 764 (95.3)
      General obesity (kg/m2) 0.048
       Underweight (BMI<18.5) 5 (1.6) 302 (98.4)
       Normal (18.5≤BMI<23.0) 54 (2.8) 1588 (97.2)
       Overweight (23.0≤BMI<25.0) 45 (3.4) 1269 (96.6)
       Obese (BMI≥25.0) 53 (4.4) 1062 (95.6)
      Central obesity (cm) <0.001
       Non-obese (WC: male <90; female <85) 61 (2.4) 2470 (97.6)
       Obese (WC: male ≥90; female ≥85) 96 (4.7) 1751 (95.3)
      Variables n OR (95% CI) aOR (95% CI)1
      General obesity (kg/m2)
       Underweight (BMI<18.5) 307 0.54 (0.12, 2.36) 0.51 (0.11, 2.35)
       Normal (18.5≤BMI<23.0) 1642 1.00 (reference) 1.00 (reference)
       Overweight (23.0≤BMI<25.0) 1314 1.19 (0.77, 1.84) 1.10 (0.71, 1.72)
       Obese (BMI≥25.0) 1115 1.59 (1.03, 2.46) 1.44 (0.91, 2.26)
      Central obesity (cm)
       Non-obese (WC: male <90; female <85) 2531 1.00 (reference) 1.00 (reference)
       Obese (WC: male ≥90; female ≥85) 1847 1.97 (1.32, 2.92) 1.82 (1.20, 2.76)
      Variables Male (n=1901) Female (n=2477)
      n OR (95% CI) aOR (95% CI)1 n OR (95% CI) aOR (95% CI)1
      General obesity (kg/m2)
       Underweight (BMI<18.5) 141 0.74 (0.07, 4.25) 0.69 (0.06, 4.96) 166 0.97 (0.21, 4.49) 0.89 (0.18, 4.36)
       Normal (18.5≤BMI<23.0) 784 1.00 (reference) 1.00 (reference) 858 1.00 (reference) 1.00 (reference)
       Overweight (23.0≤BMI<25.0) 557 0.56 (0.22, 1.37) 0.54 (0.21, 1.37) 757 1.58 (0.93, 2.68) 1.47 (0.84, 2.59)
       Obese (BMI≥25.0) 419 1.35 (0.59, 3.10) 1.31 (0.56, 3.06) 696 1.67 (0.97, 2.86) 1.54 (0.86, 2.75)
      Central obesity (cm)
       Non-obese (WC: male <90; female <85) 1225 1.00 (reference) 1.00 (reference) 1306 1.00 (reference) 1.00 (reference)
       Obese (WC: male ≥90; female ≥85) 676 2.10 (1.03, 4.31) 2.21 (1.07, 4.55) 1171 1.75 (1.12, 2.72) 1.64 (1.03, 2.61)
      Variables 65–74 y (n=2642) ≥75 y (n=1736)
      n OR (95% CI) aOR (95% CI)1 n OR (95% CI) aOR (95% CI)1
      General obesity (kg/m2)
       Underweight (BMI<18.5) 164 0.75 (0.09, 5.43) 0.67 (0.08, 5.62) 143 0.40 (0.05,3.05) 0.37 (0.04, 3.23)
       Normal (18.5≤BMI<23.0) 941 1.00 (reference) 1.00 (reference) 701 1.00 (reference) 1.00 (reference)
       Overweight (23.0≤BMI<25.0) 849 1.24 (0.71, 2.16) 1.21 (0.70, 2.11) 465 1.06 (0.49, 2.30) 0.88 (0.38, 2.04)
       Obese (BMI≥25.0) 688 1.72 (1.01, 2.95) 1.72 (0.99, 2.99) 427 1.34 (0.64, 2.81) 0.97 (0.43, 2.20)
      Central obesity (cm)
       Non-obese (WC: male <90; female <85) 1523 1.00 (reference) 1.00 (reference) 1008 1.00 (reference) 1.00 (reference)
       Obese (WC: male ≥90; female ≥85) 1119 1.88 (1.16, 3.04) 1.79 (1.09, 2.93) 728 2.19 (1.20, 4.02) 1.72 (0.90, 3.28)
      Variables n BMI WC ΔC-index (WC-BMI) p-value2
      Total 4378 0.650 (0.617, 0.703) 0.697 (0.635, 0.719) +0.047 0.044
      Sex
       Male 1901 0.654 (0.578, 0.749) 0.665 (0.571, 0.758) +0.011 0.676
       Female 2477 0.634 (0.583, 0.685) 0.654 (0.604, 0.704) +0.020 0.107
      Age (y)
       65–74 2642 0.669 (0.619, 0.719) 0.681 (0.631, 0.731) +0.012 0.282
       ≥75 1736 0.676 (0.616, 0.756) 0.698 (0.626, 0.770) +0.022 0.273
      Table 1 Characteristics of study participants according to falls

      Values are presented unweighted number (weighted %).

      BMI, body mass index; WC, waist circumference.

      Using Rao-Scott chi-square test.

      Chronic diseases include hypertension, dyslipidemia, stroke, myocardial infarction or angina pectoris, osteoarthritis or rheumatoid arthritis, osteoporosis, diabetes mellitus, and various cancer.

      Table 2 Association between falls and general and central obesity

      OR, odds ratio; aOR, adjusted odds ratio; CI, confidence interval; BMI, body mass index; WC, waist circumference.

      Age, sex, education level, household income, job, living arrangement, self-rated health status, current smoking, current alcohol consumption, aerobic physical activity, number of chronic diseases, and number of medications are adjusted for statistical comparisons.

      Table 3 Association between falls and general and central obesity stratified by sex

      OR, odds ratio; aOR, adjusted odds ratio; CI, confidence interval; BMI, body mass index; WC, waist circumference.

      Age, education level, household income, job, living arrangement, self-rated health status, current smoking, current alcohol consumption, aerobic physical activity, number of chronic diseases, and number of medications are adjusted for statistical comparisons.

      Table 4 Association between falls and general and central obesity stratified by age group

      OR, odds ratio; aOR, adjusted odds ratio; CI, confidence interval; BMI, body mass index; WC, waist circumference.

      Sex, education level, household income, job, living arrangement, self-rated health status, current smoking, current alcohol consumption, aerobic physical activity, number of chronic diseases, and number of medications are adjusted for statistical comparisons.

      Table 5 Comparison of discriminatory ability of BMI and WC for falls in older adults using Harrell’s C-index1

      Values are presented as C-index (95% confidence interval).

      BMI, body mass index; WC, waist circumference.

      All models were adjusted for education level, household income, job, living arrangement, self-rated health status, current smoking, current alcohol consumption, aerobic physical activity, number of chronic diseases, and number of medications.

      For comparison of C-index between BMI and WC models using DeLong’s test.


      JPMPH : Journal of Preventive Medicine and Public Health
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