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/m2, 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/m2. 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
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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.
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