General and Abdominal Adiposity and Risk of Death in Europe
T. Pischon, M.D., M.P.H., H. Boeing, Ph.D., M.S.P.H., K. Hoffmann, Ph.D., M. Bergmann, Ph.D., M.B. Schulze, Dr.P.H., K. Overvad, M.D., Ph.D., Y.T. van der Schouw, Ph.D., E. Spencer, Ph.D., K.G.M. Moons, Ph.D., A. Tjønneland, M.D., Ph.D., Dr.Med.Sci., J. Halkjaer, Ph.D., M.K. Jensen, Ph.D., J. Stegger, M.D., F. Clavel-Chapelon, Ph.D., M.-C. Boutron-Ruault, Ph.D., V. Chajes, Ph.D., J. Linseisen, Ph.D., R. Kaaks, Ph.D., A. Trichopoulou, M.D., Ph.D., D. Trichopoulos, M.D., Ph.D., C. Bamia, Ph.D., S. Sieri, Ph.D., D. Palli, M.D., R. Tumino, M.D., P. Vineis, M.D., M.P.H., S. Panico, M.D., M.Sc., P.H.M. Peeters, M.D., Ph.D., A.M. May, Ph.D., H.B. Bueno-de-Mesquita, M.D., Ph.D., M.P.H., F.J.B. van Duijnhoven, Ph.D., G. Hallmans, M.D., L. Weinehall, M.D., Ph.D., J. Manjer, M.D., Ph.D., B. Hedblad, M.D., Ph.D., E. Lund, M.D., Ph.D., A. Agudo, Ph.D., L. Arriola, Ph.D., A. Barricarte, Ph.D., C. Navarro, M.D., Ph.D., C. Martinez, M.D., J.R. Quirós, M.D., T. Key, D.Phil., S. Bingham, Ph.D., K.T. Khaw, M.B., B.Chir., P. Boffetta, M.D., M.P.H., M. Jenab, Ph.D., P. Ferrari, Ph.D., and E. Riboli, M.D., M.P.H., Sc.M.
Background Previous studies have relied predominantly on thebody-mass index (BMI, the weight in kilograms divided by thesquare of the height in meters) to assess the association ofadiposity with the risk of death, but few have examined whetherthe distribution of body fat contributes to the prediction ofdeath.
Methods We examined the association of BMI, waist circumference,and waist-to-hip ratio with the risk of death among 359,387participants from nine countries in the European ProspectiveInvestigation into Cancer and Nutrition (EPIC). We used a Coxregression analysis, with age as the time variable, and stratifiedthe models according to study center and age at recruitment,with further adjustment for educational level, smoking status,alcohol consumption, physical activity, and height.
Results During a mean follow-up of 9.7 years, 14,723 participantsdied. The lowest risks of death related to BMI were observedat a BMI of 25.3 for men and 24.3 for women. After adjustmentfor BMI, waist circumference and waist-to-hip ratio were stronglyassociated with the risk of death. Relative risks among menand women in the highest quintile of waist circumference were2.05 (95% confidence interval [CI], 1.80 to 2.33) and 1.78 (95%CI, 1.56 to 2.04), respectively, and in the highest quintileof waist-to-hip ratio, the relative risks were 1.68 (95% CI,1.53 to 1.84) and 1.51 (95% CI, 1.37 to 1.66), respectively.BMI remained significantly associated with the risk of deathin models that included waist circumference or waist-to-hipratio (P<0.001).
Conclusions These data suggest that both general adiposity andabdominal adiposity are associated with the risk of death andsupport the use of waist circumference or waist-to-hip ratioin addition to BMI in assessing the risk of death.
Source Information
The authors' affiliations are listed in the Appendix. Dr. Kurt Hoffmann is deceased.
Address reprint requests to Dr. Tobias Pischon at the Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany, or at pischon{at}dife.de.
Obesity and Risk of Death
Gaglione M. M., Can A. S., Schneider H. J., Wittchen H.-U., Wallaschofski H., Pischon T., Boeing H., Riboli E.
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N Engl J Med 2009;
360:1042-1044, Mar 5, 2009.
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