Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

A comparison of body mass index, waist–hip ratio and waist circumference as predictors of all-cause mortality among the elderly: the Rotterdam study


OBJECTIVE: To compare body mass index (BMI), waist–hip ratio (WHR) and waist circumference as predictors of all-cause mortality among the elderly.

DESIGN: Population-based cohort study; mean follow-up was 5.4 y.

SETTING: The Rotterdam Study.

PARTICIPANTS: A total of 6296 men and women; baseline age 55–102 y.

MEASUREMENTS: Sex-specific all-cause mortality was compared between quintiles of BMI, WHR and waist circumference and between predefined categories of BMI and waist circumference, stratified for smoking category.

RESULTS: High quintiles of waist circumference, but not high quintiles of BMI and WHR were related to increased mortality among never smoking men, without reaching statistical significance. Only the highest category of BMI (BMI>30 kg/m2) among never smoking men was related to increased mortality, compared to normal BMI (hazard ratio 2.6 (95% confidence interval: 1.3–5.3)). Waist circumference between 94 and 102 cm and waist circumference 102 cm and larger were related to increased mortality, compared to normal waist circumference (hazard ratios 1.7 (95% confidence interval 1.1–2.8) and 1.6 (95% confidence interval 1.0–2.8), respectively). The proportion of mortality attributable to large waist circumference among never smoking men was three-fold the proportion attributable to high BMI. Among never smoking women and ex- and current smokers, categories of large body fatness did not predict increased mortality.

CONCLUSION: Among never smoking elderly men waist circumference may have more potential for detecting overweight than the BMI.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1


  1. Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL . The effect of age on the association between body-mass index and mortality New Engl J Med 1998 338: 1–7.

    CAS  Article  Google Scholar 

  2. Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW . Body-mass index and mortality in a prospective cohort of U.S. adults New Engl J Med 1999 341: 1097–1105.

    CAS  Article  Google Scholar 

  3. Visscher TLS, Seidell JC, Menotti A, Blackburn H, Nissinen A, Feskens EJM, Kromhout D . Under- and overweight in relation to mortality among men aged 40–59 and 50–69: the Seven Countries Study Am J Epidemiol 2000 151: 660–666.

    CAS  Article  Google Scholar 

  4. Lew EA, Garfinkel L . Variations in mortality by weight among 750,000 men and women J Chron Dis 1979 32: 563–576.

    CAS  Article  Google Scholar 

  5. Andres R, Elahi D, Tobin JD, Muller BA, Brant L . Impact of weight goals Ann Intern Med 1985 103: 1030–1033.

    CAS  Article  Google Scholar 

  6. Rissanen A, Heliövaara M, Knekt P, Aromaa A, Reunanen A, Matelaa J . Weight and mortality in Finnish men J Clin Epidemiol 1989 42: 781–789.

    CAS  Article  Google Scholar 

  7. Tayback M, Kumayika S, Chee E . Body weight as risk factor in the elderly Arch Intern Med 1990 150: 1065–1072.

    CAS  Article  Google Scholar 

  8. Cornoni-Huntley JC, Harris TB, Everett DF, Albanes D, Micozzi MS, Miles TP, Feldman JJ . An overview of body weight of older persons including the impact of mortality. The national health and nutrition examination survey I-epidemiologic follow-up study J Clin Epidemiol 1991 44: 743–753.

    CAS  Article  Google Scholar 

  9. Rissanen A, Knekt P, Heliövaara M, Aromaa A, Reunanen A, Maatela J . Weight and mortality in Finnish women Int J Obes Relat Metab Disord 1995 19: (Suppl 6): S1–S5.

    Google Scholar 

  10. Allison DB, Gallagher D, Heo M, Pi-Sunyer FX, Heymsfield SB . Body mass index and all-cause mortality among people aged 70 and over: the longitudinal study of ageing Int J Obes Relat Metab Disord 1997 21: 424–431.

    CAS  Article  Google Scholar 

  11. Seidell JC, Visscher TLS . Body weight and weight change and their health implications for the elderly Eur J Clin Nutr 2000 54: S33–S39.

    Article  Google Scholar 

  12. Borkan GA, Norris AH . Fat redistribution and the changing body dimensions of the adult male Hum Biol 1977 49: 495–514.

    CAS  PubMed  Google Scholar 

  13. Gallagher D, Visser M, Sepúlveda D, Pierson RN, Harris T, Heymsfield SB . How useful is body mass index for comparison of body fatness across age, sex, and ethnic groups? Am J Epidemiol 1996 143: 228–239.

    CAS  Article  Google Scholar 

  14. Han TS, van Leer EM, Seidell JC, Lean MEJ . Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample Br Med J 1995 311: 1401–1405.

    CAS  Article  Google Scholar 

  15. Lean MEJ, Han TS, Seidell JC . Impairment of health and quality of life in people with large waist circumference Lancet 1998 351: 853–856.

    CAS  Article  Google Scholar 

  16. Hofman A, Grobbee DE, de Jong PT, van den Ouweland FA . Determinants of disease and disability in the elderly: the Rotterdam elderly study Eur J Epidemiol 1991 7: 403–422.

    CAS  Article  Google Scholar 

  17. WHO Expert Committee . Physical status: The use and interpretation of anthropometry. WHO technical report Series 854 1995

    Google Scholar 

  18. Lean MEJ, Han TS, Morrison CE . Waist circumference as a measure for indicating need for weight management Br Med J 1995 311: 158–161.

    CAS  Article  Google Scholar 

  19. Molarius A, Seidell JC . Selection of anthropometric indicators for classification of abdominal fatness -- a critical review Int J Obes Relat Metab Disord 1998 22: 719–727.

    CAS  Article  Google Scholar 

  20. Manson JE, Stampfer MJ, Hennekens CH, Willet WC . Body weight and longevity. A reassessment JAMA 1987 257: 353–358.

    CAS  Article  Google Scholar 

  21. Larsson B, Svardsudd K, Welin L, Wilhelmsen L, Björntorp P, Tibblin G . Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 y follow up of participants in the study of men born in 1913 Br Med J 1984 288: 1401–1404.

    CAS  Article  Google Scholar 

  22. Seidell JC, Andres R, Sorkin JD, Muller DC . The sagittal waist diameter and mortality in men: the Baltimore Longitudinal Study on Aging Int J Obes Relat Metab Disord 1994 18: 61–67.

    CAS  PubMed  Google Scholar 

  23. Tremollieres FA, Pouilles JM, Ribot CA . Relative influence of age and menopause on total and regional body composition changes in postmenopausal women Am J Obstet Gynecol 1996 175: 1594–1600.

    CAS  Article  Google Scholar 

  24. Bruning PF, Bonfrer JMG, van Noord PAH, Hart AAM, De Jong-Bakker M, Nooijen WJ . Insulin resistance and breast cancer risk Int J Cancer 1992 52: 511–516.

    CAS  Article  Google Scholar 

  25. Seidell JC, Bouchard C . Visceral fat in relation to health: is it a major culprit or simply an innocent bystander? Int J Obes Relat Metab Disord 1997 21: 626–631.

    CAS  Article  Google Scholar 

  26. Seidell JC, Bouchard C . Abdominal adiposity and risk of heart disease JAMA 1999 281: 2284–2285.

    CAS  Article  Google Scholar 

  27. Rexrode KM, Carey VJ, Hennekens CH, Walters EE, Colditz GA, Stampfer MJ, Willett WC, Manson JE . Abdominal adiposity and coronary heart disease in women JAMA 1998 280: 1843–1848.

    CAS  Article  Google Scholar 

  28. Chumlea WM, Garry PJ, Hunt WC et al. Distributions of serial changes in stature and weight in a healthy elderly population Hum Biol 1988 60: 917–925.

    CAS  PubMed  Google Scholar 

  29. Kalmijn S, Curb JD, Rodriquez BL, Abott RD . The association of body weight and anthropometry with mortality in elderly men: the Honolulu Heart Program Int J Obes Relat Metab Disord 1999 23: 395–402.

    CAS  Article  Google Scholar 

  30. Seidell JC, Björntorp P, Sjöström L, Sannerstedt R, Krotkiewksi M, Kvist H . Regional distribution of muscle and fat mass in men—new insight into the risk of abdominal obesity using computed tomography Int J Obes 1989 13: 289–303.

    CAS  PubMed  Google Scholar 

  31. Allison DB, Paultre F, Goran MI, Poehlman ET, Heymsfield SB . Statistical considerations regarding the use of ratios to adjust data Int J Obes Relat Metab Disord 1995 19: 644–652.

    CAS  Google Scholar 

  32. Allison DB, Faith MS, Heo M, Townsend-Butterworth D, Williamson DF . Meta-analysis of the effect of excluding early deaths on the estimated relationship between body mass index and mortality Obes Res 1999 7: 342–354.

    CAS  Article  Google Scholar 

  33. Han TS, Lean MEJ . Self-reported waist circumference compared with the ‘Waist Watcher’ tape measure to identify individuals at increased health risk through intra-abdominal fat accumulation Br J Nutr 1998 80: 81–88.

    CAS  Article  Google Scholar 

  34. Fries JF . Aging, natural death, and the compression of morbidity New Engl J Med 1980 303: 130–135.

    CAS  Article  Google Scholar 

Download references


The Rotterdam study is supported in part by the NESTOR program for geriatric research (Ministry of Health and Ministry of Education), The Netherlands Heart Foundation, The Netherlands Organisation for Scientific Research (NWO), and the municipality of Rotterdam.

Author information

Authors and Affiliations


Corresponding author

Correspondence to TLS Visscher.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Visscher, T., Seidell, J., Molarius, A. et al. A comparison of body mass index, waist–hip ratio and waist circumference as predictors of all-cause mortality among the elderly: the Rotterdam study. Int J Obes 25, 1730–1735 (2001).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • aged
  • body mass index
  • follow-up studies
  • mortality
  • overweight
  • waist circumference
  • waist–hip ratio

Further reading


Quick links