title: Abdominal adiposity and mortality in Chinese women.
abstract: BACKGROUND
  Increased abdominal adiposity has been linked to an increase in mortality in populations where many are overweight or obese; it is unclear whether the same is true in relatively lean populations.
  
  
  METHODS
  We examined the association between waist-hip ratio and mortality in the Shanghai Women's Health Study, a population-based, prospective cohort study of Chinese women aged 40 to 70 years enrolled from December 28, 1996, through May 23, 2000, 95% of whom had a body mass index (calculated as weight in kilograms divided by height in meters squared) of less than 30.0. Included in this analysis were 72 773 nonsmoking women who had anthropometrics taken by trained interviewers at enrollment and who were followed up through December 31, 2004. Deaths were ascertained by biennial home visits and linkage with the vital statistics registry.
  
  
  RESULTS
  During a mean follow-up of 5.7 years, 1456 deaths occurred. The waist-hip ratio was positively and significantly associated with deaths from all causes, cardiovascular disease, and diabetes (P<.01 for trend). A less significant positive association was found for death from cancer. After adjustment for body mass index and other potential confounders, the relative risks of total mortality were 1 (reference group), 1.28 (95% confidence interval [CI], 1.04-1.58), 1.40 (95% CI, 1.14-1.72), 1.54 (95% CI, 1.26-1.88), and 1.95 (95% CI, 1.60-2.38) across the lowest to the highest waist-hip ratio quintiles. The positive association appeared to be more evident in women with a lower body mass index. The relative risks of total mortality comparing the extreme waist-hip ratio quintiles were 2.36 (95% CI, 1.71-3.27), 1.60 (95% CI, 1.10-2.34), and 1.46 (95% CI, 0.97-2.20) for women with a body mass index of less than 22.3, 22.3 to 25.1, and 25.2 or greater, respectively.
  
  
  CONCLUSIONS
  Abdominal adiposity independently predicts mortality risk, particularly for nonobese women.
authors.affiliation: Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37232-8300, USA. Xianglan.zhang@vanderbilt.edu
authors.forename: Xianglan
authors.initials: X
authors.lastname: Zhang
authors.forename: Xiao-Ou
authors.initials: XO
authors.lastname: Shu
authors.forename: Gong
authors.initials: G
authors.lastname: Yang
authors.forename: Honglan
authors.initials: H
authors.lastname: Li
authors.forename: Hui
authors.initials: H
authors.lastname: Cai
authors.forename: Yu-Tang
authors.initials: YT
authors.lastname: Gao
authors.forename: Wei
authors.initials: W
authors.lastname: Zheng
mesh_terms: D050154:Adiposity; D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D015992:Body Mass Index; D002423:Cause of Death; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009026:Mortality; D018570:Risk Assessment; D012959:Socioeconomic Factors; D049629:Waist-Hip Ratio