A comparison of body mass index, waist–hip ratio and waist circumference as predictors of all-cause mortality among the elderly: the Rotterdam study
Abstract
Objective To compare body mass index (BMI), waist-hip ratio (WHR) and waist circumference as predictors of all-cause mortality among the elderly.Design Population-based cohort study; mean follow-up was 5.4 y.Setting The Rotterdam Study.Participants A total of 6296 men and women; baseline age 55-102 y.Measurements Sex-specific all-cause mortality was compared between quintiles of BMI, WHR and waist circumference and between predefined categories of BMI and waist circumference, stratified for smoking category.Results High quintiles of waist circumference, but not high quintiles of BMI and WHR were related to increased mortality among never smoking men, without reaching statistical significance. Only the highest category of BMI (BMI>30 kg/m2) among never smoking men was related to increased mortality, compared to normal BMI (hazard ratio 2.6 (95% confidence interval: 1.3-5.3)). Waist circumference between 94 and 102 cm and waist circumference 102 cm and larger were related to increased mortality, compared to normal waist circumference (hazard ratios 1.7 (95% confidence interval 1.1-2.8) and 1.6 (95% confidence interval 1.0-2.8), respectively). The proportion of mortality attributable to large waist circumference among never smoking men was three-fold the proportion attributable to high BMI. Among never smoking women and ex- and current smokers, categories of large body fatness did not predict increased mortality.Conclusion Among never smoking elderly men waist circumference may have more potential for detecting overweight than the BMI.
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Recent prospectively designed studies have found higher waist circumference increases cardiovascular disease risk in older adults.
“Recent prospectively designed studies have found higher WC increases CVD risk in older adults [27, 28]”
From Obesity pharmacotherapy in older adults: a narrative review of evidence (2025) · cites this paper as [28]
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- Authors
- Visscher, T., Seidell, J., Molarius, A., van der Kuip, D., Hofman, A., & Witteman, J.
- Affiliations
- Erasmus MC (NL)
- Corresponding author
- Visscher, TLS
- ORCID
- Venue
- International Journal of Obesity
- Published
- 2001-11
- Volume
- 25
- Issue
- 11
- Pages
- 1730-1735
- ISSN
- 0307-0565 (ISSN-L)
- 1476-5497
- OpenAlex
- W2044104326
- Cited by
- 434
- References
- 35
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 8 · 2023: 4 · 2022: 10 · 2021: 15 · 2020: 16 · 2019: 16 · 2018: 9 · 2017: 14 · 2016: 19 · 2015: 15 · 2014: 20 · 2013: 39 · 2012: 40
- FWCI
- 6.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- International Journal of Obesity (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- VU Research Portal (submittedVersion)
- Rivm (National Institute for Public Health and the Environment) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- body mass index, waist-to-hip ratio, waist circumference, all-cause mortality, older adults, overweight, abdominal obesity, smoking, sex differences, attributable mortality, Rotterdam Study
- MeSH terms
- Abdomen, Aged, Aged, 80 and over, Anthropometry, Body Constitution, Female, Humans, Male, Middle Aged, Netherlands, Obesity, Predictive Value of Tests, Cohort Studies, Body Mass Index
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