A pooled analysis of waist circumference and mortality in 650,000 adults

Cerhan JR, Moore SC, Jacobs EJ, Kitahara CM, Rosenberg PS, Adami HO, Ebbert JO, English DR, Gapstur SM, Giles GG, Horn-Ross PL, Park Y, Patel AV, Robien K, Weiderpass E, Willett WC, Wolk A, Zeleniuch-Jacquotte A, Hartge P, Bernstein L, Berrington de Gonzalez A (2014) A pooled analysis of waist circumference and mortality in 650,000 adults. Mayo Clinic proceedings 89:335-345

OBJECTIVES: To assess the independent effect of waist circumference on mortality across the entire body mass index (BMI) range and to estimate the loss in life expectancy related to a higher waist circumference. PATIENTS AND METHODS: We pooled data from 11 prospective cohort studies with 650,386 white adults aged 20 to 83 years and enrolled from January 1, 1986, through December 31, 2000. We used proportional hazards regression to estimate hazard ratios (HRs) and 95% CIs for the association of waist circumference with mortality. RESULTS: During a median follow-up of 9 years (maximum, 21 years), 78,268 participants died. After accounting for age, study, BMI, smoking status, alcohol consumption, and physical activity, a strong positive linear association of waist circumference with all-cause mortality was observed for men (HR, 1.52 for waist circumferences of >/=110 vs <90 cm;="" 95%="" ci,="" 1.45-1.59;="" hr,="" 1.07="" per="" 5-cm="" increment="" in="" waist="" circumference;="" 95%="" ci,="" 1.06-1.08)="" and="" women="" (hr,="" 1.80="" for="" waist="" circumferences="" of="">/=95 vs <70 cm;="" 95%="" ci,="" 1.70-1.89;="" hr,="" 1.09="" per="" 5-cm="" increment="" in="" waist="" circumference;="" 95%="" ci,="" 1.08-1.09).="" the="" estimated="" decrease="" in="" life="" expectancy="" for="" highest="" vs="" lowest="" waist="" circumference="" was="" approximately="" 3="" years="" for="" men="" and="" approximately="" 5="" years="" for="" women.="" the="" hr="" per="" 5-cm="" increment="" in="" waist="" circumference="" was="" similar="" for="" both="" sexes="" at="" all="" bmi="" levels="" from="" 20="" to="" 50="" kg/m(2),="" but="" it="" was="" higher="" at="" younger="" ages,="" higher="" for="" longer="" follow-up,="" and="" lower="" among="" male="" current="" smokers.="" the="" associations="" were="" stronger="" for="" heart="" and="" respiratory="" disease="" mortality="" than="" for="" cancer.="" conclusions:="" in="" white="" adults,="" higher="" waist="" circumference="" was="" positively="" associated="" with="" higher="" mortality="" at="" all="" levels="" of="" bmi="" from="" 20="" to="" 50="" kg/m(2).="" 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="">