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Mayo Clin Proc. 2014 Mar;89(3):335-45. doi: 10.1016/j.mayocp.2013.11.011.

A pooled analysis of waist circumference and mortality in 650,000 adults.

Author information

1
Division of Epidemiology, Mayo Clinic, Rochester, MN. Electronic address: cerhan.james@mayo.edu.
2
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
3
Epidemiology Research Program, American Cancer Society, Atlanta, GA.
4
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Harvard School of Public Health, Boston, MA.
5
Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN.
6
Centre for MEGA Epidemiology, The University of Melbourne, Melbourne, Australia.
7
Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia.
8
Cancer Prevention Institute of California, Fremont, CA.
9
University of Minnesota School of Public Health, Minneapolis, MN.
10
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway; Cancer Register of Norway, Oslo, Norway; Samfundet Folkhälsan, Helsinki, Finland.
11
Department of Nutrition, Harvard School of Public Health, Boston, MA.
12
Division of Nutritional Epidemiology, The National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
13
Department of Population Health, New York University School of Medicine, New York, NY.
14
City of Hope, Duarte, CA.

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.

PMID:
24582192
PMCID:
PMC4104704
DOI:
10.1016/j.mayocp.2013.11.011
[Indexed for MEDLINE]
Free PMC Article

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