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Waist circumference and waist/hip ratio in relation to all-cause mortality, cancer and sleep apnea


Abdominal obesity assessed by waist or waist/hip ratio are both related to increased risk of all-cause mortality throughout the range of body mass index (BMI). The relative risks (RRs) seem to be relatively stronger in younger than in older adults and in those with relatively low BMI compared with those with high BMI. Absolute risks and risk differences are preferable measures of risk in a public health context but these are rarely presented. There is a great lack of studies in ethnic groups (groups of African and Asian descent particularly). Current cut-points as recommended by the World Health Organization seem appropriate, although it may be that BMI-specific and ethnic-specific waist cut-points may be warranted. Waist alone could replace both waist–hip ratio and BMI as a single risk factor for all-cause mortality. There is much less evidence for waist to replace BMI for cancer risk mainly because of the relative lack of prospective cohort studies on waist and cancer risk. Obesity is also a risk factor for sleep apnoea where neck circumference seems to give the strongest association, and waist–hip ratio is a risk factor especially in severe obstructive sleep apnoea syndrome. The waist circumference and waist–hip ratio seem to be better indicators of all-cause mortality than BMI.

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The author expresses his gratitude for the suggestions of the reviewers Thorkild IA Sörensen, Kay-Tee Khaw and Jim Mann.

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Correspondence to J C Seidell.

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Background paper for the expert consultation on waist circumference and waist-hip ratio of the World Health Organization, Geneva, 8–12 December 2008

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Seidell, J. Waist circumference and waist/hip ratio in relation to all-cause mortality, cancer and sleep apnea. Eur J Clin Nutr 64, 35–41 (2010).

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