title: Obesity indexes and total mortality among elderly subjects at high cardiovascular risk: the PREDIMED study.
abstract: BACKGROUND
  Different indexes of regional adiposity have been proposed for identifying persons at higher risk of death. Studies specifically assessing these indexes in large cohorts are scarce. It would also be interesting to know whether a dietary intervention may counterbalance the adverse effects of adiposity on mortality.
  
  
  METHODS
  We assessed the association of four different anthropometric indexes (waist-to-height ratio (WHtR), waist circumference (WC), body mass index (BMI) and height) with all-cause mortality in 7447 participants at high cardiovascular risk from the PREDIMED trial. Forty three percent of them were men (55 to 80 years) and 57% were women (60 to 80 years). All of them were initially free of cardiovascular disease. The recruitment took place in 11 recruiting centers between 2003 and 2009.
  
  
  RESULTS
  After adjusting for age, sex, smoking, diabetes, hypertension, intervention group, family history of coronary heart disease, and leisure-time physical activity, WC and WHtR were found to be directly associated with a higher mortality after 4.8 years median follow-up. The multivariable-adjusted HRs for mortality of WHtR (cut-off points: 0.60, 0.65, 0.70) were 1.02 (0.78-1.34), 1.30 (0.97-1.75) and 1.55 (1.06-2.26). When we used WC (cut-off points: 100, 105 and 110 cm), the multivariable adjusted Hazard Ratios (HRs) for mortality were 1.18 (0.88-1.59), 1.02 (0.74-1.41) and 1.57 (1.19-2.08). In all analyses, BMI exhibited weaker associations with mortality than WC or WHtR. The direct association between WHtR and overall mortality was consistent within each of the three intervention arms of the trial.
  
  
  CONCLUSIONS
  Our study adds further support to a stronger association of abdominal obesity than BMI with total mortality among elderly subjects at high risk of cardiovascular disease. We did not find evidence to support that the PREDIMED intervention was able to counterbalance the harmful effects of increased adiposity on total mortality.
  
  
  BACKGROUND
  Controlled-Trials.com ISRCTN35739639.
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; The PREDIMED (Prevención con Dieta Mediterránea) Network (RD 06/0045) Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Navarra-Osasunbidea, Servicio Navarro de Salud, Pamplona, Spain.
authors: Miguel A
authors: MA
authors: Martínez-González
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; The PREDIMED (Prevención con Dieta Mediterránea) Network (RD 06/0045) Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Navarra-Osasunbidea, Servicio Navarro de Salud, Pamplona, Spain.
authors: Ana
authors: A
authors: García-Arellano
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; The PREDIMED (Prevención con Dieta Mediterránea) Network (RD 06/0045) Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Navarra-Osasunbidea, Servicio Navarro de Salud, Pamplona, Spain.
authors: Estefanía
authors: E
authors: Toledo
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; The PREDIMED (Prevención con Dieta Mediterránea) Network (RD 06/0045) Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Navarra-Osasunbidea, Servicio Navarro de Salud, Pamplona, Spain.
authors: Maira
authors: M
authors: Bes-Rastrollo
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; The PREDIMED (Prevención con Dieta Mediterránea) Network (RD 06/0045) Instituto de Salud Carlos III, Madrid, Spain; Human Nutrition Department, Hospital Universitari Sant Joan, Institut d'Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, Reus, Spain.
authors: Mónica
authors: M
authors: Bulló
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; Department of Preventive Medicine, University of Valencia, Valencia, Spain.
authors: Dolores
authors: D
authors: Corella
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; Cardiovascular and Nutrition Research Group, Institut de Recerca Hospital del Mar, Barcelona, Spain.
authors: Montserrat
authors: M
authors: Fito
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors: Emilio
authors: E
authors: Ros
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; The PREDIMED (Prevención con Dieta Mediterránea) Network (RD 06/0045) Instituto de Salud Carlos III, Madrid, Spain; Department of Nutrition and Food Science, School of Pharmacy, Xarxa de Referència en Tecnologia dels Aliments, Instituto de Investigación en Nutrición y Seguridad Alimentaria, University of Barcelona, Barcelona, Spain.
authors: Rosa Maria
authors: RM
authors: Lamuela-Raventós
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; The PREDIMED (Prevención con Dieta Mediterránea) Network (RD 06/0045) Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, University Hospital of Alava, Vitoria, Spain.
authors: Javier
authors: J
authors: Rekondo
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; The PREDIMED (Prevención con Dieta Mediterránea) Network (RD 06/0045) Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine, University of Malaga, Malaga, Spain.
authors: Enrique
authors: E
authors: Gómez-Gracia
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; Institute of Health Sciences, University of Balearic Islands, and Hospital Son Espases, Palma de Mallorca, Spain.
authors: Miquel
authors: M
authors: Fiol
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; Department of Family Medicine, Primary Care Division of Seville, San Pablo Health Center, Seville, Spain.
authors: Jose Manuel
authors: JM
authors: Santos-Lozano
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; The PREDIMED (Prevención con Dieta Mediterránea) Network (RD 06/0045) Instituto de Salud Carlos III, Madrid, Spain; Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain.
authors: Lluis
authors: L
authors: Serra-Majem
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; The PREDIMED (Prevención con Dieta Mediterránea) Network (RD 06/0045) Instituto de Salud Carlos III, Madrid, Spain; Department of Nutrition and Food Sciences, Physiology and Toxicology, University of Navarra, Pamplona, Spain.
authors: J Alfredo
authors: JA
authors: Martínez
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Navarra-Osasunbidea, Servicio Navarro de Salud, Pamplona, Spain.
authors: Sonia
authors: S
authors: Eguaras
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; The PREDIMED (Prevención con Dieta Mediterránea) Network (RD 06/0045) Instituto de Salud Carlos III, Madrid, Spain; Department of Biochemistry and Molecular Biology-Service of Clinical Analysis- University of Valencia, Valencia, Spain.
authors: Guillermo
authors: G
authors: Sáez-Tormo
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; The PREDIMED (Prevención con Dieta Mediterránea) Network (RD 06/0045) Instituto de Salud Carlos III, Madrid, Spain; Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
authors: Xavier
authors: X
authors: Pintó
authors: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain; The PREDIMED (Prevención con Dieta Mediterránea) Network (RD 06/0045) Instituto de Salud Carlos III, Madrid, Spain; Department of Internal Medicine Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors: Ramon
authors: R
authors: Estruch
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology*; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors; D055105:Waist Circumference; D049629:Waist-Hip Ratio