title: Waist circumference, BMI, smoking, and mortality in middle-aged men and women.
abstract: OBJECTIVE
  Measurement of waist circumference alone as a proxy of abdominal fat mass has been suggested as a simple clinical alternative to BMI for detecting adults with possible health risks due to obesity.
  
  
  METHODS
  From 1993 to 1997, 27,178 men and 29,875 women, born in Denmark, 50 to 64 years of age, were recruited in the Danish prospective study Diet, Cancer and Health. By the end of the year 2000, 1465 deaths had occurred. We evaluated the relationship between waist circumference and BMI (simultaneously included in the model) and all-cause mortality. We used Cox regression models to estimate the mortality-rate ratios and to consider possible confounding from smoking.
  
  
  RESULTS
  Waist circumference among both men and women showed a strong dose-response type of relationship with mortality when adjusted for BMI, whereas the low range of BMI was inversely associated with mortality when adjusted for waist circumference. A 10% larger waist circumference corresponded to a 1.48 (95% confidence interval: 1.36 to 1.61) times higher mortality over the whole range of waist circumference. The associations were independent of age and time since baseline examination. Restriction to never smokers showed a similar pattern, but a weakening of the associations.
  
  
  CONCLUSIONS
  Despite the high correlation between waist circumference and BMI, the combination may be very relevant in clinical practice because waist circumference for given BMI was a strong predictor of all-cause mortality. The inverse association between BMI and mortality for given waist circumference was diminished in never smokers, particularly for high values of BMI.
authors.affiliation: Institute of Cancer Epidemiology, The Danish Cancer Society, Copenhagen, Denmark. janne@cancer.dk
authors.forename: Janne
authors.initials: J
authors.lastname: Bigaard
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.forename: Birthe Lykke
authors.initials: BL
authors.lastname: Thomsen
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.forename: Berit Lilienthal
authors.initials: BL
authors.lastname: Heitmann
authors.forename: Thorkild I A
authors.initials: TI
authors.lastname: Sørensen
mesh_terms: D001824:Body Constitution; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012907:Smoking / Q000453:epidemiology*