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Cited by 288Obesity, Physical Activity, DietBody Composition Measurement TechniquesDiabetes, Cardiovascular Risks, and Lipoproteins

General and abdominal obesity parameters and their combination in relation to mortality: a systematic review and meta-regression analysis

Carmienke, S, Freitag, M H, Pischon, T, Schlattmann, P, Fankhaenel, T, Goebel, H, Gensichen, J·2013·European Journal of Clinical Nutrition
DOI 10.1038/ejcn.2013.61
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Abstract

Epidemiological studies assessing general and abdominal obesity measures or their combination for mortality prediction have shown inconsistent results. We aimed to systematically review the associations of body mass index (BMI), waist-to-hip ratio (WHR), waist circumference (WC) and waist-to-height ratio (WHtR) with all-cause mortality in prospective cohort studies. In this systematic review, which includes a meta-regression analysis, we analysed the associations with all-cause mortality of BMI, WHR, WC and WHtR in prospective cohort studies available in Medline, Embase, the Cochrane Database of Systematic Reviews and Esbiobase from inception through 7 May 2010. A total of 18 studies met the inclusion criteria, comprising 689, 465 participants and 48, 421 deaths during 5-24 years of follow-up. The studies were heterogeneous, mainly due to differences in categorization of anthropometric parameters (AP) and different approaches to statistical analysis. Both general and abdominal obesity measures were significantly associated with mortality. In analyses using categorical variables, BMI and WC showed predominantly U- or J-shaped associations with mortality, whereas WHR and WHtR demonstrated positive relationships with mortality. All measures showed similar risk patterns for upper quantiles in comparison to reference quantiles. The parameters of general and abdominal obesity each remained significantly associated with mortality when adjusted for the other. This evidence suggests that abdominal obesity measures such as WC or WHR, show information independent to measures of general obesity and should be used in clinical practice, in addition to BMI, to assess obesity-related mortality in adults.

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  • The diverse presentations of obesity-generalized versus central-suggest that BMI alone may not capture the nuances of body fat distribution and muscle composition effectively.

    “However, the diverse presentations of obesity—generalized versus central—suggest that BMI alone may not capture the nuances of body fat distribution and muscle composition effectively26,27.”

    From The nonlinear association between body roundness index and infertility in married women (2025) · cites this paper as [26]

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Authors
Carmienke, S., Freitag, M. H., Pischon, T., Schlattmann, P., Fankhaenel, T., Goebel, H., & Gensichen, J.
Affiliations
  • Jena University Hospital (DE)
  • Max Delbrück Center (DE)
  • Friedrich Schiller University Jena (DE)
Corresponding author
Freitag, M H
ORCID
Venue
European Journal of Clinical Nutrition
Publisher
Springer Science and Business Media LLC
Published
2013-03-20
Volume
67
Issue
6
Pages
573-585
ISSN
  • 0954-3007 (ISSN-L)
  • 1476-5640
DOI
10.1038/ejcn.2013.61
OpenAlex
W2044071701
Cited by
288
References
14
Citations by year
2026: 10 · 2025: 22 · 2024: 31 · 2023: 20 · 2022: 26 · 2021: 22 · 2020: 25 · 2019: 18 · 2018: 18 · 2017: 24 · 2016: 20 · 2015: 21 · 2014: 27 · 2013: 3 · 2012: 1
FWCI
3.38
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • European Journal of Clinical Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • MDC Repository (Max-Delbrueck-Center for Molecular Medicine) (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
general obesity, abdominal obesity, all-cause mortality, body mass index, waist-to-hip ratio, waist circumference, waist-to-height ratio, anthropometric measures, mortality prediction, U-shaped relationship, prospective cohort
MeSH terms
Adult, Algorithms, Body Height, Follow-Up Studies, Humans, Mortality, Obesity, Prospective Studies, Risk Factors, Cohort Studies, Body Mass Index, Waist-Hip Ratio, Waist Circumference, Obesity, Abdominal

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