title: A pooled analysis of waist circumference and mortality in 650,000 adults.
abstract: OBJECTIVE
  To assess the independent effect of waist circumference on mortality across the entire body mass index (BMI) range and to estimate the loss in life expectancy related to a higher waist circumference.
  
  
  METHODS
  We pooled data from 11 prospective cohort studies with 650,386 white adults aged 20 to 83 years and enrolled from January 1, 1986, through December 31, 2000. We used proportional hazards regression to estimate hazard ratios (HRs) and 95% CIs for the association of waist circumference with mortality.
  
  
  RESULTS
  During a median follow-up of 9 years (maximum, 21 years), 78,268 participants died. After accounting for age, study, BMI, smoking status, alcohol consumption, and physical activity, a strong positive linear association of waist circumference with all-cause mortality was observed for men (HR, 1.52 for waist circumferences of ≥110 vs <90 cm; 95% CI, 1.45-1.59; HR, 1.07 per 5-cm increment in waist circumference; 95% CI, 1.06-1.08) and women (HR, 1.80 for waist circumferences of ≥95 vs <70 cm; 95% CI, 1.70-1.89; HR, 1.09 per 5-cm increment in waist circumference; 95% CI, 1.08-1.09). The estimated decrease in life expectancy for highest vs lowest waist circumference was approximately 3 years for men and approximately 5 years for women. The HR per 5-cm increment in waist circumference was similar for both sexes at all BMI levels from 20 to 50 kg/m(2), but it was higher at younger ages, higher for longer follow-up, and lower among male current smokers. The associations were stronger for heart and respiratory disease mortality than for cancer.
  
  
  CONCLUSIONS
  In white adults, higher waist circumference was positively associated with higher mortality at all levels of BMI from 20 to 50 kg/m(2). Waist circumference should be assessed in combination with BMI, even for those in the normal BMI range, as part of risk assessment for obesity-related premature mortality.
authors.affiliation: Division of Epidemiology, Mayo Clinic, Rochester, MN. Electronic address: cerhan.james@mayo.edu.
authors.forename: James R
authors.initials: JR
authors.lastname: Cerhan
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Moore
authors.affiliation: Epidemiology Research Program, American Cancer Society, Atlanta, GA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Jacobs
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
authors.forename: Cari M
authors.initials: CM
authors.lastname: Kitahara
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Rosenberg
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Harvard School of Public Health, Boston, MA.
authors.forename: Hans-Olov
authors.initials: HO
authors.lastname: Adami
authors.affiliation: Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Jon O
authors.initials: JO
authors.lastname: Ebbert
authors.affiliation: Centre for MEGA Epidemiology, The University of Melbourne, Melbourne, Australia.
authors.forename: Dallas R
authors.initials: DR
authors.lastname: English
authors.affiliation: Epidemiology Research Program, American Cancer Society, Atlanta, GA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Gapstur
authors.affiliation: Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia.
authors.forename: Graham G
authors.initials: GG
authors.lastname: Giles
authors.affiliation: Cancer Prevention Institute of California, Fremont, CA.
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Horn-Ross
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
authors.forename: Yikyung
authors.initials: Y
authors.lastname: Park
authors.affiliation: Epidemiology Research Program, American Cancer Society, Atlanta, GA.
authors.forename: Alpa V
authors.initials: AV
authors.lastname: Patel
authors.affiliation: University of Minnesota School of Public Health, Minneapolis, MN.
authors.forename: Kim
authors.initials: K
authors.lastname: Robien
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway; Cancer Register of Norway, Oslo, Norway; Samfundet Folkhälsan, Helsinki, Finland.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, MA.
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.affiliation: Division of Nutritional Epidemiology, The National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Alicja
authors.initials: A
authors.lastname: Wolk
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY.
authors.forename: Anne
authors.initials: A
authors.lastname: Zeleniuch-Jacquotte
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
authors.forename: Patricia
authors.initials: P
authors.lastname: Hartge
authors.affiliation: City of Hope, Duarte, CA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Bernstein
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
authors.forename: Amy
authors.initials: A
authors.lastname: Berrington de Gonzalez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000401:mortality*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D055105:Waist Circumference; D044465:White People