Relative fat mass and prediction of incident atrial fibrillation, heart failure and coronary artery disease in the general population

Victor W. Zwartkruis, Navin Suthahar, Demy L. Idema, Belend Mahmoud, Colinda van Deutekom, Frans H. Rutten, Yvonne T. van der Schouw, Michiel Rienstra, Rudolf A. de Boer*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)



Relative fat mass (RFM) is an emerging marker of obesity that estimates body fat percentage using a sex-specific formula containing height and waist circumference (WC). We studied the association of RFM with incident atrial fibrillation (AF), heart failure (HF), and coronary artery disease (CAD) and explored RFM cutoffs for cardiovascular disease (CVD) prediction. 


We studied 95,003 participants (age 45 ± 13 years, 59% women) without prevalent AF, HF or CAD from the population-based Lifelines study. Outcomes were ascertained using electrocardiography and self-reported questionnaire data. We used logistic regression to study the association of RFM with individual outcomes and a composite outcome (incident AF, HF, and/or CAD). Multivariable models were adjusted for components of the SCORE risk model (age, sex, systolic blood pressure, cholesterol, and smoking). Optimal cutoffs were determined using the Youden index. 


During a median follow-up of 3.8 (3.0–4.6) years, 224 (0.2%) participants developed AF, 1003 (1.1%) HF and 657 (0.7%) CAD. After multivariable adjustment, RFM was significantly associated with all outcomes (standardised OR 1.26, 95% CI 1.18–1.34 for the composite outcome). Optimal RFM cutoffs (≥26 for men, ≥38 for women) were lower than previously proposed RFM cutoffs (≥30 for men, ≥40 for women). In general, overall discriminative ability of RFM and its cutoffs was at least similar (in women) or better (in men) compared to BMI and WC. Since RFM was substantially correlated with age, we additionally determined age-specific cutoffs, which ranged from 23 to 27 in men and 33 to 43 in women. 


RFM is associated with incident AF, HF, and CAD and may be used as a simple and intuitive marker of obesity and cardiovascular risk in the general population. This study provides potential RFM cutoffs for CVD prediction that may be used by future studies or preventive strategies targeting obesity and cardiovascular risk.

Original languageEnglish
Pages (from-to)1256-1262
Number of pages7
JournalInternational Journal of Obesity
Issue number12
Publication statusPublished - Dec 2023

Bibliographical note

Funding Information:
This work was supported by the Dutch Heart Foundation (CVON RED-CVD, grant 2017-11).

Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer Nature Limited.


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