General and abdominal adiposity and risk of death in Europe
Open accessAbstract
BACKGROUND: Previous studies have relied predominantly on the body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) to assess the association of adiposity with the risk of death, but few have examined whether the distribution of body fat contributes to the prediction of death. METHODS: We examined the association of BMI, waist circumference, and waist-to-hip ratio with the risk of death among 359,387 participants from nine countries in the European Prospective Investigation into Cancer and Nutrition (EPIC). We used a Cox regression analysis, with age as the time variable, and stratified the models according to study center and age at recruitment, with further adjustment for educational level, smoking status, alcohol consumption, physical activity, and height. RESULTS: During a mean follow-up of 9.7 years, 14,723 participants died. The lowest risks of death related to BMI were observed at a BMI of 25.3 for men and 24.3 for women. After adjustment for BMI, waist circumference and waist-to-hip ratio were strongly associated with the risk of death. Relative risks among men and women in the highest quintile of waist circumference were 2.05 (95% confidence interval [CI], 1.80 to 2.33) and 1.78 (95% CI, 1.56 to 2.04), respectively, and in the highest quintile of waist-to-hip ratio, the relative risks were 1.68 (95% CI, 1.53 to 1.84) and 1.51 (95% CI, 1.37 to 1.66), respectively. BMI remained significantly associated with the risk of death in models that included waist circumference or waist-to-hip ratio (P<0.001). CONCLUSIONS: These data suggest that both general adiposity and abdominal adiposity are associated with the risk of death and support the use of waist circumference or waist-to-hip ratio in addition to BMI in assessing the risk of death.
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In EPIC, BMI, waist circumference, and waist:hip ratio were all independently associated with all-cause mortality; authors recommended waist circumference or waist:hip ratio in addition to BMI; no direct comparisons of magnitudes were made.
“In the multicentre European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study, BMI, waist circumference, and waist:hip ratio were all independently associated with allcause mortality; the authors recommended the use of waist circumference or waist:hip ratio in addition to BMI for assessing risk of death; however, no direct comparisons of the magnitudes of associations between”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [372]
In Europe, general obesity and abdominal adiposity are both associated with increased risk of death.
“In Europe, a recent study of nearly 360 000 participants from nine European countries showed that general obesity and abdominal adiposity are both associated with increased risk of death.372”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [372]
A study of nearly 360,000 participants from nine European countries found that general obesity and abdominal adiposity are associated with mortality risk, supporting the use of waist circumference or waist-to-hip ratio in addition to BMI for mortality risk assessment.
“A recent study of nearly 360,000 participants from 9 European countries showed that both general obesity and abdominal adiposity are associated with risk of death and support the importance of WC or WHR in addition to BMI for assessing mortality risk (4).”
From Obesity and Cardiovascular Disease (2009) · cites this paper as [4]
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- Authors
- Pischon, T., Boeing, H., Hoffmann, K., Bergmann, M., Schulze, M. B., Overvad, K., van der Schouw, Y. T., Spencer, E., Moons, K. G. M., Tjønneland, A., Halkjaer, J., Jensen, M. K., Stegger, J., Clavel-Chapelon, F., Boutron-Ruault, M.-C., Chajes, V., Linseisen, J., Kaaks, R., Trichopoulou, A., Trichopoulos, D., Bamia, C., Sieri, S., Palli, D., Tumino, R., Vineis, P., Panico, S., Peeters, P. H. M., May, A. M., Bueno-de-Mesquita, H. B., van Duijnhoven, F. J. B., Hallmans, G., Weinehall, L., Manjer, J., Hedblad, B., Lund, E., Agudo, A., Arriola, L., Barricarte, A., Navarro, C., Martinez, C., Quirós, J. R., Key, T., Bingham, S., Khaw, K. T., Boffetta, P., Jenab, M., Ferrari, P., & Riboli, E.
- Affiliations
- German Institute of Human Nutrition (DE)
- Instituto de Salud Pública de Navarra (ES)
- Gobierno del Principado de Asturias (ES)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES)
- ORCID
- Pischon, T.
- Boeing, H.
- Bergmann, M.
- Schulze, M.B.
- Overvad, K.
- Spencer, E.
- Moons, K.G.M.
- Tjønneland, A.
- Jensen, M.K.
- Linseisen, J.
- Kaaks, R.
- Trichopoulou, A.
- Sieri, S.
- Palli, D.
- Tumino, R.
- Vineis, P.
- Panico, S.
- Peeters, P.H.M.
- May, A.M.
- Weinehall, L.
- Manjer, J.
- Lund, E.
- Agudo, A.
- Arriola, L.
- Barricarte, A.
- Navarro, C.
- Key, T.
- Khaw, K.T.
- Boffetta, P.
- Jenab, M.
- Ferrari, P.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2008-11-13
- Volume
- 359
- Issue
- 20
- Pages
- 2105-2120
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2106650290
- Cited by
- 2,155
- References
- 42
- Citations by year
- 2026: 47 · 2025: 72 · 2024: 102 · 2023: 106 · 2022: 109 · 2021: 109 · 2020: 97 · 2019: 100 · 2018: 105 · 2017: 117 · 2016: 134 · 2015: 130 · 2014: 143 · 2013: 149 · 2012: 153
- FWCI
- 156.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Rivm (National Institute for Public Health and the Environment) (submittedVersion)
- OPUS (Augsburg University) (submittedVersion)
- Funders
- Wellcome Trust
- Cancer Research UK
- National Institute for Health and Care Research
- British Heart Foundation
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Keywords
- abdominal fat, general adiposity, body mass index, waist circumference, waist-to-hip ratio, mortality risk, body fat distribution, EPIC cohort, cardiovascular risk assessment
- MeSH terms
- Abdomen, Adult, Aged, Alcohol Drinking, Body Height, Europe, Female, Humans, Male, Middle Aged, Mortality, Obesity, Risk, Smoking, Exercise, Body Mass Index, Proportional Hazards Models, Waist-Hip Ratio, Adiposity, Waist Circumference
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