Original articleA Pooled Analysis of Waist Circumference and Mortality in 650,000 Adults
Section snippets
Study Cohorts
Prospective cohort studies from the BMI and mortality pooling project5 were eligible for this analysis. All individual studies were approved by an institutional review board, and participants provided informed consent. We excluded studies that did not collect waist circumference data within 3 years of ascertaining baseline weight; all10, 11, 14, 17, 23, 24, 25, 26 but 3 studies16, 27, 28 collected waist circumference data at the same time as weight data. Waist circumference was measured by a
Characteristics of Cohorts
We included 650,386 participants from 11 cohorts, with baseline years ranging from January 1, 1986, through December 31, 2000 (Table 1). The median age at baseline was 62 years; 58% of participants were female, and 52% were ever smokers. The mean ± SD BMI was 26.5±3.8 kg/m2 for men and 25.3±4.7 kg/m2 for women; the mean ± SD waist circumference was 97.4±10.5 cm for men and 81.5±13.1 cm for women. For men, waist circumference was positively associated with BMI and former smoking status and
Discussion
In this pooled analysis of 11 cohort studies with more than 650,000 participants, we found a strong positive association of waist circumference in 5-cm increments with total mortality after accounting for BMI, and this association was observed across a wide range of BMI. This association remained after adjustment for a variety of demographic and lifestyle factors, physical activity, and BMI and held also for healthy never smokers. Although broadly similar across almost all subgroups, the
Conclusion
In white adults, higher waist circumference was positively associated with higher mortality at all levels of BMI from 20 to 50 kg/m2. Waist circumference should be assessed in combination with BMI, even for those in the normal BMI range, as part of risk assessment for obesity-related premature mortality.
Acknowledgment
We thank Sondra Buehler for editorial assistance.
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Grant Support: The National Institutes of Health–AARP Diet and Health study was supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health. The Breast Cancer Detection Demonstration Project Follow-up Study has been supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health. The California Teachers Study was supported by National Cancer Institute grant CA77398 and contract 97-10500 from the California Breast Cancer Research Fund. The Cancer Prevention Study II was supported by the American Cancer Society. The Cohort of Swedish Men was supported by the Swedish Research Council, the Swedish Council for Working Life and Social Research, and the Swedish Cancer Society. The Health Professionals Follow-up Study is supported by National Cancer Institute grant P01 CA055075. The Iowa Women's Health Study is supported by the National Cancer Institute grant R01 CA39742. The Melbourne Collaborative Cohort Study receives core funding from The Cancer Council Victoria and is additionally supported by grants 209057, 251533, and 396414 from the Australian National Health and Medical Research Council. The New York University Women’s Health Study is supported by National Cancer Institute grants R01 CA098661 and P30 CA016087 and by center grant ES000260 from the National Institute of Environmental Health Sciences. The Swedish Mammography Cohort was supported by the Swedish Research Council, Swedish Council for Working Life and Social Research, and the Swedish Cancer Society. The Women’s Lifestyle and Health project was supported by the Swedish Cancer Society and the Swedish Research Council.