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Body Fat Distribution and Risk of Coronary Heart Disease in Men and Women in the European Prospective Investigation Into Cancer and Nutrition in Norfolk Cohort: A Population-Based Prospective Study
Abstract
Background— Body fat distribution has been cross-sectionally associated with atherosclerotic disease risk factors, but the prospective relation with coronary heart disease remains uncertain. Methods and Results— We examined the prospective relation between fat distribution indices and coronary heart disease among 24 508 men and women 45 to 79 years of age using proportional hazards regression. During a mean 9.1 years of follow-up, 1708 men and 892 women developed coronary heart disease. The risk for developing subsequent coronary heart disease increased continuously across the range of waist-hip ratio. Hazard ratios (95% CI) of the top versus bottom fifth of waist-hip ratio were 1.55 (1.28 to 1.73) in men and 1.91 (1.44 to 2.54) in women after adjustment for body mass index and other coronary heart disease risk factors. Hazard ratios increased with waist circumference, but risk estimates for waist circumference without hip circumference adjustment were lower by 10% to 18%. After adjustment for waist circumference, body mass index, and coronary heart disease risk factors, hazard ratios for 1-SD increase in hip circumference were 0.80 (95% CI, 0.74 to 0.87) in men and 0.80 (95% CI, 0.69 to 0.93) in women. Hazard ratios for body mass index were greatly attenuated when we adjusted for waist-hip ratio or waist circumference and other covariates. Conclusions— Indices of abdominal obesity were more consistently and strongly predictive of coronary heart disease than body mass index. These simple and inexpensive measurements could be used to assess obesity-related coronary heart disease risk in relatively healthy men and women.
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“Literature shows that individuals with a healthy weight, but high visceral fat, are at higher cardiovascular risk than those with a higher BMI (Canoy et al., 2007; Stefan & Schulze, 2023).”
From Long-term cardiometabolic effects of early institutionalization and foster care: Evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Canoy et al., 2007
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“…level of serum lipids and chronic inflammatory factors, hence lead to higher risks of dyslipidemia, cardiovascular disease, and type 2 diabetes (T2D), even compared with the similar level of ‘‘total adiposity’’ (Canoy et al., 2007; Lotta et al., 2018; Oliveira et al., 2011; Wang et al., 2005).”
BackgroundScovronec, A., Provencher, A., Iceta, S., Pelletier, M., Leblanc, V., Nadeau, M., Simard, S., Biertho, L. D., Richard, D., Tchernof, A., et al. (2022) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2022.07.005 · Cited by 13
Assessment of the Correlation between Severity of Coronary Artery Disease and Waist–Hip Ratio
Rashiti, P., Behluli, I., & Rashiti-Bytyçi, A. (2017) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2017.211 · Cited by 13
Dervić, E., Deischinger, C., Haug, N., Leutner, M., Kautzky‐Willer, A., & Klimek, P. (2021) · JMIR Cardio · doi:10.2196/28015 · Cited by 13
Percepção da imagem corporal em mulheres: prevalência e associação com indicadores antropométricos.
Pelegrini, A., Sacomori, C., Santos, M. C., Sperandio, F. F., & Cardoso, F. L. (2013) · Brazilian Journal of Kinanthropometry and Human Performance · doi:10.5007/1980-0037.2014v16n1p58 · Cited by 13
Randrianarisoa, E., Stefan, N., Fritsche, A., Reis-Damaschke, N. V., Hieronimus, A., Balletshofer, B. M., Machann, J., Siegel-Axel, D. I., Häring, H., & Rittig, K. (2018) · Angiology · doi:10.1177/0003319718755581 · Cited by 13
“In this context, it is not primarily the extent of obesity, but rather the distribution of adipose tissue determining the overall metabolic and cardiovascular risk.(1,3) For example, in elderly men, central obesity but not the body mass index (BMI) was associated with CVD risk.”
BackgroundCorrelation of Abdominal Fat Distribution with Different Types of Diabetes in a Chinese Population
Zhu, A., Cui, B., Dang, H., Yao, D., Yu, H., Jia, H., Hu, Z., & Zhang, X. (2013) · Journal of Diabetes Research · doi:10.1155/2013/651462 · Cited by 13
Is Visceral Fat Really a Coronary Risk Factor?
Shimamoto, Y., Mizukoshi, M., Kuroi, A., Imanishi, T., Takeshita, T., Terada, M., & Akasaka, T. (2013) · International Heart Journal · doi:10.1536/ihj.54.273 · Cited by 11
Rao, H., Harischandra, P., & Yadav, S. (2020) · Current Diabetes Reviews · doi:10.2174/1573399816999200729124903 · Cited by 12
Fagherazzi, G., Vilier, A., Balkau, B., Clavel‐Chapelon, F., & Magliano, D. J. (2013) · International Journal of Cancer · doi:10.1002/ijc.28069 · Cited by 12
“HC has been shown to be inversely associated with blood glucose, blood pressure and lipids(7,8) and is also associated with a reduced risk of all-cause(9,10) and cardiovascular mortality,(11,12) particularly when adjusted for WC.(10,13,14) Furthermore, a specific protective role of gluteofemoral body fat (adiposity ar…”
BackgroundResultInfluentialSadeghi, M., Ghashghaei, F. E., Mostafavi, S., Heidari, H., & Sarrafzadegan, N. (2012) · Advanced Biomedical Research · doi:10.4103/2277-9175.96077 · Cited by 12
“Obesity is classified by body mass index (BMI) which is known as an indicator of total adiposity.[6] In adults, it is defined as a BMI≥30 kg/m2.”
BackgroundLiang, J.-J., Chen, Y.-J., Jin, Y., Yang, W.-H., Mai, J.-C., Ma, J., & Jin, J. (2015) · Journal of Human Hypertension · doi:10.1038/jhh.2015.16 · Cited by 13
van Dijk, S., van den Meiracker, A., van der Velde, N., Mattace-Raso, F. U. S., & van der Velde, N. (2012) · Age and Ageing · doi:10.1093/ageing/afs056 · Cited by 12
Mudie, K., Lawlor, D. A., Pearce, N. E., Crampin, A. C., Tomlinson, L. A., Tafatatha, T., Musicha, C., Nitsch, D., Smeeth, L. L., & Nyirenda, M. (2018) · International Journal of Epidemiology · doi:10.1093/ije/dyy047 · Cited by 12
“We considered a priori that WHR would be the best measure of health adiposity distribution, as both a smaller waist (less central adiposity) and larger hips (greater peripheral adiposity) have been associated with better cardiometabolic health.(2,4) We also assumed that WHR would be the measure of central adiposity th…”
BackgroundFlorath, I., Brandt, S., Weck, M. N., Moss, A., Gottmann, P., Rothenbacher, D., Wabitsch, M., & Brenner, H. (2014) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2014.04.005 · Cited by 12
Fain, J. N., Cheema, P. S., Tichansky, D. S., & Madan, A. K. (2010) · Journal of Inflammation · doi:10.1186/1476-9255-7-4 · Cited by 12
“There is increasing evidence that in central obesity of humans, it is the increase in visceral omental rather than abdominal subcutaneous adipose tissue that best correlates with measures of insulin resistance [1] and cardiovascular disease [ 2-4 ].”
BackgroundWu, Z., Huang, Z., Sun, L., Fu, Y., Chen, S., Wu, S., & Gao, X. (2024) · Nutrition Journal · doi:10.1186/s12937-024-01048-7 · Cited by 14
Berentzen, T. L., Jakobsen, M. U., Stegger, J. G., Halkjær, J., Tjønneland, A. M., Sørensen, T. I. A., & Overvad, K. (2011) · PLoS ONE · doi:10.1371/journal.pone.0026849 · Cited by 11
“Fatness, and in particular abdominal fatness, is assumed to increase the risk of MI [9–22].”
BackgroundResultInfluentialKuper, H., Taylor, A., Krishna, K. R., Ben-Shlomo, Y., Gupta, R., Kulkarni, B., Prabhakaran, D., Smith, G. D., Wells, J., Ebrahim, S., et al. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-1239 · Cited by 13
“BMI) [20-22], while others do not show this difference [43,44].”
BackgroundBMI Modifies Increased Mortality Risk of Post-PCI STEMI Patients with AKI
Schvartz, R., Lupu, L., Frydman, S., Banai, S., Shacham, Y., & Gal‐Oz, A. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11206104 · Cited by 11
“Other studies found abdominal obesity represented by the waist and hip circumflex to be a stronger predictor of coronary disease than BMI [38,39].”
BackgroundWohlers, L. M., Powers, B. L., Chin, E. R., & Spangenburg, E. E. (2013) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00617.2012 · Cited by 11
Clifton, P. M. (2018) · Journal of the American Heart Association · doi:10.1161/jaha.118.008675 · Cited by 11
“In the European Prospective Investigation into Cancer and Nutrition–Norfolk study, larger hip circumference was associated with a lower hazard ratio for coronary heart disease.(16) During weight loss, it is not clear if loss of these apparently protective depots weakens the beneficial effects of visceral fat loss.”
BackgroundChildhood adiposity, adult adiposity, and the ACE gene insertion/deletion polymorphism
Sun, C., Ponsonby, A., Carlin, J. B., Bui, M., Magnussen, C. G., Burns, T. L., Lehtimäki, T. J., Wardrop, N., Juonala, M., Viikari, J. S. A., et al. (2018) · Journal of Hypertension · doi:10.1097/hjh.0000000000001816 · Cited by 11
“BMI is closely related to overall subcutaneous fat mass [40].”
BackgroundMoura, B. A. B., Santos, I. S., Goulart, A. C., Schmidt, M. I., Lotufo, P. A., Benseñor, I. M., & Baena, C. P. (2020) · Brazilian Journal of Medical and Biological Research · doi:10.1590/1414-431x20209815 · Cited by 11
“Population data from the European Prospective Investigation into Cancer and Nutrition of the Norfolk cohort showed that WC and waist-to-hip ratio were more consistent predictors of coronary heart disease than BMI (1).”
BackgroundMethodDiaf, M., Khaled, M. B., & Sellam, F. (2015) · Libyan Journal of Medicine · doi:10.3402/ljm.v10.27400 · Cited by 11
Obesity and coronary artery calcification: Can it explain the obesity-paradox?
Aljizeeri, A. H., Coutinho, T. A., Pen, A., Chen, L., Yam, Y., Dent, R., McPherson, R., & Chow, B. J. W. (2015) · International journal of cardiac imaging · doi:10.1007/s10554-015-0643-9 · Cited by 11
“Abdominal and central obesity are strong predictors of coronary artery disease [32, 33] and visceral adipose tissue (VAT) has a stronger association with CAD than subcutaneous fat [34].”
Background
Metadata
- Authors
- Canoy, D., Boekholdt, S. M., Wareham, N., Luben, R., Welch, A., Bingham, S., Buchan, I., Day, N., & Khaw, K.-T.
- Affiliations
- University of Cambridge (GB)
- ORCID
- Venue
- Circulation
- Published
- 2007-12-18
- Volume
- 116
- Issue
- 25
- Pages
- 2933-2943
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1995930672
- Cited by
- 472
- References
- 59
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 17 · 2023: 11 · 2022: 19 · 2021: 30 · 2020: 10 · 2019: 18 · 2018: 22 · 2017: 24 · 2016: 13 · 2015: 27 · 2014: 39 · 2013: 50 · 2012: 37
- FWCI
- 22.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Funders
- Wellcome Trust
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Keywords
- body fat distribution, coronary artery disease, waist-to-hip ratio, waist circumference, hip circumference, abdominal obesity, body mass index, cardiovascular risk, sex differences, EPIC-Norfolk cohort
- MeSH terms
- Aged, Coronary Disease, Female, Follow-Up Studies, United Kingdom, Humans, Male, Middle Aged, Myocardial Infarction, Obesity, Predictive Value of Tests, Prospective Studies, Risk Factors, Cohort Studies, Proportional Hazards Models, Sex Distribution, Waist-Hip Ratio, Body Fat Distribution
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