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.

Waist and hip circumferences and all-cause mortality: usefulness of the waist-to-hip ratio?


OBJECTIVE: To investigate whether waist and hip circumferences, in addition to body mass index (BMI), are related to all-cause mortality. We studied these associations and tested the usefulness of the waist-to-hip ratio for mortality prediction.

DESIGN: A Danish prospective cohort study with data collected between 1993 and 1997.

SUBJECTS: A total of 27 179 men and 29 875 women born in Denmark and aged 50–64 years were followed for a median of 6.8 years.

MEASUREMENTS: BMI, waist and hip circumferences at baseline.

RESULTS: The associations between hip circumference and all-cause mortality were inverse for both men and women, but only after adjustment for waist circumference, or BMI, or both. The mortality rate ratios of mutually adjusted waist and hip circumferences were 0.63 (95% CI: 0.56, 0.71), and 0.70 (95% CI: 0.63, 0.79) times higher per 10% larger hip circumference in men and women, respectively, and 1.45 (95% CI: 1.34, 1.57) and 1.22 (95% CI: 1.14, 1.31) times higher per 10% larger waist circumference. The adequacy of the waist-to-hip ratio as a substitute for separate measurements of waist and hip circumferences depended on which other variables the analysis was adjusted for, indicating that the waist-to-hip ratio should be used with precaution.

CONCLUSION: When mutually adjusted, waist and hip circumferences show opposite associations with all-cause mortality, probably due to different effects of adipose tissue in the abdominal and gluteofemoral regions. The waist-to-hip ratio cannot always capture these relations adequately.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1


  1. Lapidus L, Bengtsson C, Larsson B, Pennert K, Rybo E, Sjostrom L . Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. BMJ 1984; 289: 1257–1261.

    Article  CAS  Google Scholar 

  2. Larsson B, Svardsudd K, Welin L, Wilhelmsen L, Bjorntorp P, Tibblin G . Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. BMJ 1984; 288: 1401–1404.

    Article  CAS  Google Scholar 

  3. Folsom AR, Kushi LH, Anderson KE, Mink PJ, Olson JE, Hong CP, Sellers TA, Lazovich D, Prineas RJ . 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.

    Article  CAS  Google Scholar 

  4. Kalmijn S, Curb JD, Rodriguez BL, Yano K, Abbott 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.

    Article  CAS  Google Scholar 

  5. Lahmann PH, Lissner L, Gullberg B, Berglund G . A prospective study of adiposity and all-cause mortality: The Malmo Diet and Cancer Study. Obes Res 2002; 10: 361–369.

    Article  Google Scholar 

  6. Baik I, Ascherio A, Rimm EB, Giovannucci E, Spiegelman D, Stampfer MJ, Willett WC . Adiposity and mortality in men. Am J Epidemiol 2000; 152: 264–271.

    Article  CAS  Google Scholar 

  7. Folsom AR, Kaye SA, Sellers TA, Hong CP, Cerhan JR, Potter JD, Prineas RJ . Body fat distribution and 5-year risk of death in older women. JAMA 1993; 269: 483–487.

    Article  CAS  Google Scholar 

  8. Lissner L, Bjorkelund C, Heitmann BL, Seidell JC, Bengtsson C . Larger hip circumference independently predicts health and longevity in a Swedish female cohort. Obes Res 2001; 9: 644–646.

    Article  CAS  Google Scholar 

  9. Carey VJ, Walters EE, Colditz GA, Solomon CG, Willett WC, Rosner BA, Speizer FE, Manson JE . Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The Nurses’ Health Study. Am J Epidemiol 1997; 145: 614–619.

    Article  CAS  Google Scholar 

  10. Wei M, Gaskill SP, Haffner SM, Stern MP . Waist circumference as the best predictor of noninsulin dependent diabetes mellitus (NIDDM) compared to body mass index, waist/hip ratio and other anthropometric measurements in Mexican Americans—a 7-year prospective study. Obes Res 1997; 5: 16–23.

    Article  CAS  Google Scholar 

  11. Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC . Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994; 17: 961–969.

    Article  CAS  Google Scholar 

  12. Seidell JC, Perusse L, Despres JP, Bouchard C . Waist and hip circumferences have independent and opposite effects on cardiovascular disease risk factors: the Quebec Family Study. Am J Clin Nutr 2001; 74: 315–321.

    Article  CAS  Google Scholar 

  13. Han TS, Bijnen FC, Lean ME, Seidell JC . Separate associations of waist and hip circumference with lifestyle factors. Int J Epidemiol 1998; 27: 422–430.

    Article  CAS  Google Scholar 

  14. 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.

    Article  CAS  Google Scholar 

  15. 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 

  16. Korn EL, Graubard BI, Midthune D . Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol 1997; 145: 72–80.

    Article  CAS  Google Scholar 

  17. Greenland S . Dose–response and trend analysis in epidemiology: alternatives to categorical analysis. Epidemiology 1995; 6: 356–365.

    Article  CAS  Google Scholar 

  18. WHO. Obesity: preventing and managing the global epidemic, Report of a WHO consultation, WHO Technical Report Series No. 894. World Health Organization: Geneva; 2000.

  19. Tjønneland A, Overvad OK . Diet, cancer and health—a population study and establishment of a biological bank in Denmark (in Danish). Ugeskr Laeger 2000; 162: 350–354.

    PubMed  Google Scholar 

  20. Snijder MB, Dekker JM, Visser M, Yudkin JS, Stehouwer CD, Bouter LM, Heine RJ, Nijpels G, Seidell JC . Larger thigh and hip circumferences are associated with better glucose tolerance: the hoorn study. Obes Res 2003; 11: 104–111.

    Article  Google Scholar 

  21. Seidell JC, Han TS, Feskens EJ, Lean ME . Narrow hips and broad waist circumferences independently contribute to increased risk of non-insulin-dependent diabetes mellitus. J Intern Med 1997; 242: 401–406.

    Article  CAS  Google Scholar 

  22. Wajchenberg BL . Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev 2000; 21: 697–738.

    Article  CAS  Google Scholar 

  23. WHO. Physical status: the use and interpretation of anthropometry, Report of a WHO expert committee, WHO Technical Report Series No. 854. World Health Organization: Geneva; 1995.

  24. Bjorntorp P . Abdominal fat distribution and disease: an overview of epidemiological data. Ann Med 1992; 24: 15–18.

    Article  CAS  Google Scholar 

  25. Baumgartner RN, Heymsfield SB, Roche AF . Human body composition and the epidemiology of chronic disease. Obes Res 1995; 3: 73–95.

    Article  CAS  Google Scholar 

Download references


This study was financially supported by grants from The Danish Research Councils, Ref. Nr. 9801264 and The Danish Cancer Society. We thank programmer Katja Boll for preparation of the data set and Jytte Fogh Larsen for collection of the data. The Danish National Research Foundation supports the Danish Epidemiology Science Centre.

Author information

Authors and Affiliations


Corresponding author

Correspondence to J Bigaard.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bigaard, J., Frederiksen, K., Tjønneland, A. et al. Waist and hip circumferences and all-cause mortality: usefulness of the waist-to-hip ratio?. Int J Obes 28, 741–747 (2004).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • hip circumference
  • waist circumference
  • waist-to-hip ratio
  • all-cause mortality
  • epidemiology

This article is cited by


Quick links