title: 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.
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 WC(2)) 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/m(2)) 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.
authors.affiliation: Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. ellen.de.hollander@rivm.nl
authors.forename: Ellen L
authors.initials: EL
authors.lastname: de Hollander
authors.forename: Wanda Je
authors.initials: WJ
authors.lastname: Bemelmans
authors.forename: Hendriek C
authors.initials: HC
authors.lastname: Boshuizen
authors.forename: Nele
authors.initials: N
authors.lastname: Friedrich
authors.forename: Henri
authors.initials: H
authors.lastname: Wallaschofski
authors.forename: Pilar
authors.initials: P
authors.lastname: Guallar-Castillón
authors.forename: Stefan
authors.initials: S
authors.lastname: Walter
authors.forename: M Carola
authors.initials: MC
authors.lastname: Zillikens
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
authors.forename: Lauren
authors.initials: L
authors.lastname: Lissner
authors.forename: Julie K
authors.initials: JK
authors.lastname: Bassett
authors.forename: Graham G
authors.initials: GG
authors.lastname: Giles
authors.forename: Nicola
authors.initials: N
authors.lastname: Orsini
authors.forename: Noor
authors.initials: N
authors.lastname: Heim
authors.forename: Marjolein
authors.initials: M
authors.lastname: Visser
authors.forename: Lisette Cpgm
authors.initials: LC
authors.lastname: de Groot
mesh_terms: D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality; D009369:Neoplasms / Q000401:mortality; D050177:Overweight / Q000401:mortality; D012140:Respiratory Tract Diseases / Q000401:mortality; D018570:Risk Assessment; D055105:Waist Circumference