Abdominal adiposity is associated with risk of death in a large, European cohort

Pischon T et al. (2008) General and abdominal adiposity and risk of death in Europe. N Engl J Med 359: 2105–2120

Large studies of the association between abdominal adiposity and risk of death are scarce, despite the fact that abdominal adiposity is more closely related to the risk of certain chronic diseases than is BMI. In a large, European, multicenter study, Pischon et al. assessed the association of BMI, waist circumference and waist-to-hip ratio with risk of death.

The study included 359,387 participants of the Prospective Investigation into Cancer and Nutrition. Participants did not have a history of cancer, heart disease or stroke and had a mean age of 51.5 years at baseline. During follow-up (mean 9.7 years), 14,723 participants died. The association of BMI with risk of death was J-shaped, such that the lowest risk of death was observed in men and women with a BMI of 25.3 kg/m² and 24.3 kg/m², respectively. Even after adjustment for BMI, both waist circumference and waist-to-hip ratio were strongly associated with risk of death. Interestingly, associations between the two measures of abdominal adiposity and risk of death were stronger in participants with a lower BMI than in those with a higher BMI.

The findings support the use of waist circumference or waist-to-hip ratio measurements, in addition to BMI, to assess patients' risk of death. These additional assessments may be particularly useful for patients of normal weight who, nonetheless, might have an increased risk of death owing to increased abdominal adiposity.