title: The influence of hip circumference on the relationship between abdominal obesity and mortality.
abstract: BACKGROUND
  Higher waist circumference and lower hip circumference are both associated with increased cardiovascular disease (CVD) risk, despite being directly correlated. The real effects of visceral obesity may therefore be underestimated when hip circumference is not fully taken into account. We hypothesized that adding waist and hip circumference to traditional risk factors would significantly improve CVD risk prediction.
  
  
  METHODS
  In a population-based survey among South Asian and African Mauritians (n = 7978), 1241 deaths occurred during 15 years of follow-up. In a model that included variables used in previous CVD risk calculations (a Framingham-type model), the association between waist circumference and mortality was examined before and after adjustment for hip circumference. The percentage with an increase in estimated 10-year cumulative mortality of >25% and a decrease of >20% after waist and hip circumference were added to the model was calculated.
  
  
  RESULTS
  Waist circumference was strongly related to mortality only after adjustment for hip circumference and vice versa. Adding waist and hip circumference to a Framingham-type model increased estimated 10-year cumulative CVD mortality by >25% for 23.7% of those who died and 15.7% of those censored. Cumulative mortality decreased by >20% for 4.5% of those who died and 14.8% of those censored.
  
  
  CONCLUSIONS
  The effect of central obesity on mortality risk is seriously underestimated without adjustment for hip circumference. Adding waist and hip circumference to a Framingham-type model for CVD mortality substantially increased predictive power. Both may be important inclusions in CVD risk prediction models.
authors.affiliation: Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia. adrian.cameron@deakin.edu.au
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Cameron
authors.forename: Dianna J
authors.initials: DJ
authors.lastname: Magliano
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Shaw
authors.forename: Paul Z
authors.initials: PZ
authors.lastname: Zimmet
authors.forename: Bendix
authors.initials: B
authors.lastname: Carstensen
authors.forename: K George Mm
authors.initials: KG
authors.lastname: Alberti
authors.forename: Jaakko
authors.initials: J
authors.lastname: Tuomilehto
authors.forename: Elizabeth L M
authors.initials: EL
authors.lastname: Barr
authors.forename: Vassen K
authors.initials: VK
authors.lastname: Pauvaday
authors.forename: Sudhirsen
authors.initials: S
authors.lastname: Kowlessur
authors.forename: Stefan
authors.initials: S
authors.lastname: Söderberg
mesh_terms: D050153:Abdominal Fat; D000328:Adult; D000349:Africa / Q000208:ethnology; D001208:Asia / Q000208:ethnology; D002423:Cause of Death; D015987:Effect Modifier, Epidemiologic; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000401:mortality*; D011159:Population Surveillance; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D014739:Victoria / Q000453:epidemiology; D055105:Waist Circumference; D049629:Waist-Hip Ratio