The association between waist circumference and risk of mortality considering body mass index in 65- to 74-year-olds: A meta-analysis of 29 cohorts involving more than 58 000 elderly persons

Ellen L. de Hollander, Wanda JE Bemelmans, Hendriek C. Boshuizen, Nele Friedrich, Henri Wallaschofski, Pilar Guallar-castillón, Stefan Walter, M. Carola Zillikens, Annika Rosengren, Lauren Lissner, Julie K. Bassett, Graham G. Giles, Nicola Orsini, Noor Heim, Marjolein Visser, Lisette CPGM De groot, V. Sundh, S. Blair, D. C. Lee, X. SuiM. Woodward, T. Welborn, S. Dhaliwal, G. Wannamethee, E. Roure, C. Castell, M. L. Biggs, A. Wolk, P. Ducimetiere, M. Verschuren, J. Kaprio, A. Menotti, I. M. Lee, H. Sesso, P. Knekt, K. Sääksjärvi, J. Dekker, G. Nijpels, C. Stehouwer, S. Bandinelli, A. M. Corsi, F. Lauretani, M. Visser, T. Seeman, S. Ishii, A. Spiro, C. Phillips, D. Blazer, L. Lind, A. Uitterlinden, A. Hofman, H. Tiemeier, H. Wallaschofski, S. Baumeister, F. Rodríguez-artalejo, I. Skoog, H. Tunstall-pedoe, M. Shipley, M. Kivimäki

Research output: Contribution to journalArticlepeer-review

Abstract

Background For the elderly, the association between waist circumference (WC) and mortality considering body mass index (BMI) remains unclear, and thereby also the evidence base for using these anthropometric measures in clinical practice. This meta-analysis examined the association between WC categories and (cause-specific) mortality within BMI categories. Furthermore, the association of continuous WC with lowest and increased mortality risks was examined. Methods Age- and smoking-adjusted relative risks (RRs) of mortality associated with WC-BMI categories and continuous WC (including WC and WC2) were calculated by the investigators and pooled by means of random-effects models. Results During a 5-year-follow-up of 32 678 men and 25 931 women, we ascertained 3318 and 1480 deaths, respectively. A large WC (men: >102 cm, women: >88 cm) was associated with increased all-cause mortality RRs for those in the 'healthy' weight {1.7 [95% confidence interval (CI): 1.2-2.2], 1.7 (95% CI: 1.3-2.3)}, overweight [1.1(95% CI: 1.0-1.3), 1.4 (95%: 1.1-1.7)] and obese [1.1 (95% CI: 1.0-1.3), 1.6 (95% CI: 1.3-1.9)] BMI category compared with the 'healthy' weight (20-24.9 kg/m2) and a small WC (<94 cm, men; <80 cm, women) category. Underweight was associated with highest all-cause mortality RRs in men [2.2 (95% CI: 1.8-2.8)] and women [2.3 (95% CI: 1.8-3.1]. We found a J-shaped association for continuous WC with all-cause, cardiovascular (CVD) and cancer, and a U-shaped association with respiratory disease mortality (P < 0.05). An all-cause (CVD) mortality RR of 2.0 was associated with a WC of 132 cm (123 cm) in men and 116 cm (105 cm) in women. Conclusions Our results showed increased mortality risks for elderly people with an increased WC-even across BMI categories- and for those who were classified as 'underweight' using BMI. The results provide a solid basis for re-evaluation of WC cut-points in ageing populations. Published by Oxford University Press on behalf of the International Epidemiological Association

Original languageEnglish (US)
Article numberdys008
Pages (from-to)805-817
Number of pages13
JournalInternational journal of epidemiology
Volume41
Issue number3
DOIs
StatePublished - Jun 2012

Keywords

  • Body mass index
  • Elderly
  • Mortality
  • Waist circumference

ASJC Scopus subject areas

  • Epidemiology

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