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Cited by 62Cancer Risks and FactorsCardiovascular Disease and AdiposityObesity, Physical Activity, Diet

Changes in waist circumference and risk of all-cause and CVD mortality: results from the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) cohort study

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Mulligan, Angela A., Lentjes, Marleen A. H., Luben, Robert N., Wareham, Nicholas J., Khaw, Kay-Tee·2019·BMC Cardiovascular Disorders
DOI 10.1186/s12872-019-1223-zPMC PMC6819575
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Abstract

Background: Measures of abdominal adiposity are strongly associated with all-cause mortality and cardiovascular disease (CVD). However, data are limited and conflicting regarding the consequences of changes in body fat distribution. The main aims of this paper are to investigate the association between changes in waist circumference (WC) and all-cause and CVD mortality and to examine these changes in relation to concurrent changes in weight. Methods: The European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) study recruited 25,639 participants between 1993 and 1997, aged 39–79, a number of whom also attended a second examination (1998–2000), and were followed up to 2016 for mortality. Participants were eligible for inclusion if they had WC, weight and height measurements at both time-points; those with a self-reported history of CVD or cancer, body mass index < 18.5 kg/m2 or missing data on covariates were excluded, leaving 12,337 participants for analyses. The median (IQR) follow-up time was 16.4 (15.7, 17.2) years. Hazard Ratios (HRs) for all-cause (2866 deaths) and CVD mortality (822 deaths), by categories of WC change, were determined using Cox proportional hazards analyses. Results: After multivariable adjustment, the HRs (95% CIs) for all-cause mortality for men and women with a WC gain (WCG) > 5 cm were 1.51 (1.29–1.75) and 1.25 (1.06–1.46) respectively. For CVD mortality in men and women with a WCG > 5 cm, the HRs were 1.84 (1.39–2.43) and 1.15 (0.85–1.55) respectively. In analyses of concurrent changes in WC and weight, the greatest risk (HRs) (95% CIs) in men occurred with weight loss and WCG: 1.80 (1.13–2.86) for all-cause and 2.22 (1.03–4.82) for CVD mortality. In women, the greatest risk for both all-cause (HR 1.50 (1.16–1.95)) and CVD mortality (HR 1.81 (1.15–2.85)) was observed in those with weight loss and maintenance of WC (WCM). Conclusions: Objectively measured WCG > 5 cm, was associated with subsequent higher total mortality risk and higher CVD mortality risk in men. Interventions focusing on preventing increase in central adiposity rather than lowering weight per se in later life may potentially have greater health benefits.

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  • Serially-obtained CT-measured waist circumference may also provide prognostic information in obese patients, although further validation is required.

    “serially-obtained CT-measured WC may also provide prognostic information in obese patients, although further validation is required.”

    From Fully automated waist circumference measurement on abdominal CT: Comparison with manual measurements and potential value for identifying overweight and obesity as an adjunct output of CT scan (2021) · cites this paper as [22]

    The Conclusion (page unavailable) reports that increases in waist circumference over approximately four years were associated with later mortality, supporting the possibility that repeated measurements have prognostic value. But the Methods say nurses measured waist circumference with a tape, not CT, and the conclusion concerns a population-based cohort of middle-aged and elderly adults rather than obese patients specifically. The paper does not establish the claim's CT-specific application or its need for further validation. (LLM, conf=0.89)

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Authors
Mulligan, A. A., Lentjes, M. A. H., Luben, R. N., Wareham, N. J., & Khaw, K.-T.
Affiliations
University of Cambridge (GB)
Corresponding author
Mulligan, Angela A.
ORCID
Venue
BMC Cardiovascular Disorders
Publisher
Springer Science and Business Media LLC
Published
2019-10-28
Volume
19
Issue
1
Pages
238-238
ISSN
1471-2261 (ISSN-L)
DOI
10.1186/s12872-019-1223-z
PMC
PMC6819575
OpenAlex
W2982050587
Cited by
62
References
3
Citations by year
2026: 4 · 2025: 11 · 2024: 9 · 2023: 13 · 2022: 10 · 2021: 10 · 2020: 5
FWCI
2.61
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Cardiovascular Disorders (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Apollo (cc-by)
Funders
  • Medical Research Council (RG19715)
  • Cancer Research UK (RG14230, RG23772)
Topics
  • Health Sciences › Medicine › Oncology › Cancer Risks and Factors
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
waist circumference, abdominal fat, all-cause mortality, cardiovascular mortality, weight change, weight loss, body fat distribution, mortality risk, EPIC-Norfolk cohort, sex differences, body mass index, weight gain, body composition, cardiovascular risk factors
MeSH terms
Adult, Aged, Cardiovascular Diseases, Cause of Death, England, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Risk Factors, Time Factors, Prevalence, Risk Assessment, Abdominal Fat, Adiposity, Waist Circumference, Obesity, Abdominal

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