A Pooled Analysis of Waist Circumference and Mortality in 650,000 Adults
Open accessAbstract
Objectives To assess the independent effect of waist circumference on mortality across the entire body mass index (BMI) range and to estimate the loss in life expectancy related to a higher waist circumference.Patients and methods We pooled data from 11 prospective cohort studies with 650,386 white adults aged 20 to 83 years and enrolled from January 1, 1986, through December 31, 2000. We used proportional hazards regression to estimate hazard ratios (HRs) and 95% CIs for the association of waist circumference with mortality.Results During a median follow-up of 9 years (maximum, 21 years), 78,268 participants died. After accounting for age, study, BMI, smoking status, alcohol consumption, and physical activity, a strong positive linear association of waist circumference with all-cause mortality was observed for men (HR, 1.52 for waist circumferences of ≥110 vs <90 cm; 95% CI, 1.45-1.59; HR, 1.07 per 5-cm increment in waist circumference; 95% CI, 1.06-1.08) and women (HR, 1.80 for waist circumferences of ≥95 vs <70 cm; 95% CI, 1.70-1.89; HR, 1.09 per 5-cm increment in waist circumference; 95% CI, 1.08-1.09). The estimated decrease in life expectancy for highest vs lowest waist circumference was approximately 3 years for men and approximately 5 years for women. The HR per 5-cm increment in waist circumference was similar for both sexes at all BMI levels from 20 to 50 kg/m(2), but it was higher at younger ages, higher for longer follow-up, and lower among male current smokers. The associations were stronger for heart and respiratory disease mortality than for cancer.Conclusions In white adults, higher waist circumference was positively associated with higher mortality at all levels of BMI from 20 to 50 kg/m(2). Waist circumference should be assessed in combination with BMI, even for those in the normal BMI range, as part of risk assessment for obesity-related premature mortality.
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Waist circumference is associated with all-cause or cardiovascular mortality.
“growing evidence suggests that WC is associated with all-cause [7–9] or cardiovascular mortality [10].”
Waist circumference provides independent or additive value to body mass index for predicting obesity-related health risks.
“but also provides independent or additive value to BMI for predicting obesity-related health risks [7–10].”
Abdominal adiposity is independently associated with all-cause mortality and is recognized as a better predictor of obesity-related conditions than either body weight or BMI.
“Beyond total body fat, abdominal adiposity is independently associated with all‐cause mortality and is recognized as a better predictor of obesity‐related conditions than either BW or BMI. 83 , 84 , 85”
From What exercise prescription is optimal to improve body composition and cardiorespiratory fitness in adults living with obesity? A network meta‐analysis (2021) · cites this paper as [83]
Using a combination of BMI and waist circumference in MetS risk assessment may prove better than either measure alone.
“Given these findings, using a combination of BMI and waist circumference in MetS risk assessment may prove better than either measure alone (22).”
From The CardioMetabolic Health Alliance (2015) · cites this paper as [22]
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- Authors
- Cerhan, J. R., Moore, S. C., Jacobs, E. J., Kitahara, C. M., Rosenberg, P. S., Adami, H.-O., Ebbert, J. O., English, D. R., Gapstur, S. M., Giles, G. G., Horn-Ross, P. L., Park, Y., Patel, A. V., Robien, K., Weiderpass, E., Willett, W. C., Wolk, A., Zeleniuch-Jacquotte, A., Hartge, P., Bernstein, L., & Berrington de Gonzalez, A.
- Affiliations
- Mayo Clinic (US)
- National Cancer Institute (US)
- American Cancer Society (US)
- Harvard University (US)
- The University of Melbourne (AU)
- Cancer Council Victoria (AU)
- University of Minnesota (US)
- Karolinska Institutet (SE)
- City Of Hope National Medical Center (US)
- Corresponding author
- Cerhan, James R.
- ORCID
- Venue
- Mayo Clinic Proceedings
- Publisher
- Elsevier BV
- Published
- 2014-03
- Volume
- 89
- Issue
- 3
- Pages
- 335-345
- ISSN
- 0025-6196 (ISSN-L)
- PMC
- PMC4104704
- OpenAlex
- W2049966070
- Cited by
- 443
- References
- 45
- Citations by year
- 2026: 28 · 2025: 47 · 2024: 42 · 2023: 48 · 2022: 32 · 2021: 33 · 2020: 49 · 2019: 32 · 2018: 36 · 2017: 30 · 2016: 29 · 2015: 24 · 2014: 13
- FWCI
- 31.44
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Mayo Clinic Proceedings (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Funders
- National Institutes of Health
- National Cancer Institute (R01CA077398, CA 77398, R01CA098661, R01CA039742, P01CA055075, P30CA016087)
- National Institute of Environmental Health Sciences (ES-000260, P30ES000260)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Keywords
- waist circumference, all-cause mortality, body mass index, abdominal obesity, life expectancy, sex differences, heart disease mortality, respiratory mortality, cancer mortality, smoking, White adults
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Humans, Life Expectancy, Male, Middle Aged, Obesity, Risk Factors, Sex Factors, Body Mass Index, Proportional Hazards Models, Risk Assessment, White People, Waist Circumference
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