Abstract
Objectives
To assess the independent effect of waist circumference on mortality across the entire
body mass index (BMI) range and to estimate the loss in life expectancy related to
a higher waist circumference.
Patients and Methods
We pooled data from 11 prospective cohort studies with 650,386 white adults aged 20
to 83 years and enrolled from January 1, 1986, through December 31, 2000. We used
proportional hazards regression to estimate hazard ratios (HRs) and 95% CIs for the
association of waist circumference with mortality.
Results
During a median follow-up of 9 years (maximum, 21 years), 78,268 participants died.
After accounting for age, study, BMI, smoking status, alcohol consumption, and physical
activity, a strong positive linear association of waist circumference with all-cause
mortality was observed for men (HR, 1.52 for waist circumferences of ≥110 vs <90 cm;
95% CI, 1.45-1.59; HR, 1.07 per 5-cm increment in waist circumference; 95% CI, 1.06-1.08)
and women (HR, 1.80 for waist circumferences of ≥95 vs <70 cm; 95% CI, 1.70-1.89;
HR, 1.09 per 5-cm increment in waist circumference; 95% CI, 1.08-1.09). The estimated
decrease in life expectancy for highest vs lowest waist circumference was approximately
3 years for men and approximately 5 years for women. The HR per 5-cm increment in
waist circumference was similar for both sexes at all BMI levels from 20 to 50 kg/m
2, but it was higher at younger ages, higher for longer follow-up, and lower among
male current smokers. The associations were stronger for heart and respiratory disease
mortality than for cancer.
Conclusions
In white adults, higher waist circumference was positively associated with higher
mortality at all levels of BMI from 20 to 50 kg/m
2. Waist circumference should be assessed in combination with BMI, even for those in
the normal BMI range, as part of risk assessment for obesity-related premature mortality.
Abbreviations and Acronyms:
BMI ( body mass index), CVD ( cardiovascular disease), EPIC ( European Prospective Investigation into Cancer and Nutrition), HR ( hazard ratio)To read this article in full you will need to make a payment
Subscribe to Mayo Clinic Proceedings
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults.N Engl J Med. 2003; 348: 1625-1638
- Cause-specific excess deaths associated with underweight, overweight, and obesity.JAMA. 2007; 298: 2028-2037
- General and abdominal adiposity and risk of death in Europe.N Engl J Med. 2008; 359: 2105-2120
- Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies.Lancet. 2009; 373: 1083-1096
- Body-mass index and mortality among 1.46 million white adults.N Engl J Med. 2010; 363: 2211-2219
- BMI and mortality: results from a national longitudinal study of Canadian adults.Obesity (Silver Spring). 2010; 18: 214-218
- What aspects of body fat are particularly hazardous and how do we measure them?.Int J Epidemiol. 2006; 35: 83-92
- Accuracy of body mass index in diagnosing obesity in the adult general population.Int J Obes. 2008; 32: 959-966
- Body mass index and waist circumference independently contribute to the prediction of nonabdominal, abdominal subcutaneous, and visceral fat.Am J Clin Nutr. 2002; 75: 683-688
- Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women's Health Study.Arch Intern Med. 2000; 160: 2117-2128
- Adiposity and mortality in men.Am J Epidemiol. 2000; 152: 264-271
- Waist circumference, BMI, smoking, and mortality in middle-aged men and women.Obes Res. 2003; 11: 895-903
- Body mass index is inversely related to mortality in older people after adjustment for waist circumference.J Am Geriatr Soc. 2005; 53: 2112-2118
- A comparison of adiposity measures as predictors of all-cause mortality: the Melbourne Collaborative Cohort Study.Obesity (Silver Spring). 2007; 15: 994-1003
- Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women.Circulation. 2008; 117: 1658-1667
- Waist circumference and mortality.Am J Epidemiol. 2008; 167: 1465-1475
- Waist circumference and all-cause mortality in a large US cohort.Arch Intern Med. 2010; 170: 1293-1301
- Weight, shape, and mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death.Am J Clin Nutr. 2006; 84: 449-460
- Mortality and disability: the effect of overweight and obesity.Int J Obes. 2009; 33: 1410-1418
- Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk.Arterioscler Thromb Vac Biol. 2008; 28: 1039-1049
- Screening for and management of obesity in adults: U.S. Preventive Services Task Force Recommendation Statement.Ann Intern Med. 2012; 157: 1-6
- Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults–The Evidence Report. National Institutes of Health.Obes Res. 1998; 6: 51S-209S
- Past body mass index and risk of mortality among women.Int J Obes. 2008; 32: 730-739
- Long-term fatty fish consumption and renal cell carcinoma incidence in women.JAMA. 2006; 296: 1371-1376
- Combined effects of obesity and physical activity in predicting mortality among men.J Intern Med. 2008; 264: 442-451
- Prospective study of body size and risk for stroke amongst women below age 60.J Intern Med. 2006; 260: 442-450
- A prospective study of endogenous estrogens and breast cancer in postmenopausal women.J Natl Cancer Inst. 1995; 87: 190-197
- Body size and the risk of postmenopausal breast cancer subtypes in the California Teachers Study cohort.Cancer Causes Control. 2012; 23: 473-485
- Accuracy and reliability of self-measurement of body girths.Am J Epidemiol. 1988; 128: 740-748
- Validity of self-reported waist and hip circumferences in men and women.Epidemiology. 1990; 1: 466-473
- Obesity and mortality.in: Hu F.B. Obesity Epidemiology. Oxford University Press, New York, NY2008: 216-233
- Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558
- Adjusted survival curve estimation using covariates.J Chronic Dis. 1982; 35: 437-443
- Accuracy of self-reported waist and hip measurements in 4492 EPIC-Oxford participants.Public Health Nutr. 2004; 7: 723-727
- Obesity paradoxes.J Sports Sci. 2011; 29: 773-782
- Optimal cutoff values for high-risk waist circumference in older adults based on related health outcomes.Am J Epidemiol. 2011; 174: 479-489
- Obesity paradox and the heart: which indicator of obesity best describes this complex relationship?.Curr Opin Clin Nutr Metab Care. 2013; 16: 517-524
- Elevated body mass index and mortality risk in the elderly.Obes Rev. 2007; 8: 41-59
- Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies.Lancet. 2011; 377: 1085-1095
- Estimates of excess deaths associated with body mass index and other anthropometric variables.Am J Clin Nutr. 2009; 89: 1213-1219
- Variable contributions of fat content and distribution to metabolic syndrome risk factors.Metab Syndr Relat Disord. 2008; 6: 281-288
- The future of obesity reduction: beyond weight loss.Nat Rev Endocrinol. 2009; 5: 319-325
Article Info
Footnotes
Grant Support: The National Institutes of Health–AARP Diet and Health study was supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health. The Breast Cancer Detection Demonstration Project Follow-up Study has been supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health. The California Teachers Study was supported by National Cancer Institute grant CA77398 and contract 97-10500 from the California Breast Cancer Research Fund. The Cancer Prevention Study II was supported by the American Cancer Society. The Cohort of Swedish Men was supported by the Swedish Research Council, the Swedish Council for Working Life and Social Research, and the Swedish Cancer Society. The Health Professionals Follow-up Study is supported by National Cancer Institute grant P01 CA055075 . The Iowa Women's Health Study is supported by the National Cancer Institute grant R01 CA39742 . The Melbourne Collaborative Cohort Study receives core funding from The Cancer Council Victoria and is additionally supported by grants 209057 , 251533 , and 396414 from the Australian National Health and Medical Research Council . The New York University Women’s Health Study is supported by National Cancer Institute grants R01 CA098661 and P30 CA016087 and by center grant ES000260 from the National Institute of Environmental Health Sciences . The Swedish Mammography Cohort was supported by the Swedish Research Council, Swedish Council for Working Life and Social Research, and the Swedish Cancer Society. The Women’s Lifestyle and Health project was supported by the Swedish Cancer Society and the Swedish Research Council.
Identification
Copyright
© 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
