title: Cardiovascular and all-cause mortality in relation to various anthropometric measures of obesity in Europeans.
abstract: OBJECTIVE
  Cardiovascular and all-cause mortality in relation to various anthropometric measures of obesity is still controversial.
  
  
  RESULTS
  Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), A Body Shape Index (ABSI) and waist-to-hip-to-height ratio (WHHR) were measured at baseline in a cohort of 46,651 European men and women aged 24-99 years. The relationship between anthropometric measures of obesity and mortality was evaluated by the Cox proportional hazards model with age as a time-scale and with threshold detected by a piecewise regression model. Over a median follow-up of 7.9 years, 2381 men and 1055 women died, 1071 men (45.0%) and 339 women (32.1%) from cardiovascular disease (CVD). BMI had a J-shaped relationship with CVD mortality, whereas anthropometric measures of abdominal obesity had positive linear relationships. BMI, WC and WHtR showed J-shaped associations with all-cause mortality, whereas WHR, ABSI and WHHR demonstrated positive linear relationships. Accordingly, a threshold value was detected at 29.29 and 30.98 kg/m(2) for BMI, 96.4 and 93.3 cm for WC, 0.57 and 0.60 for WHtR, 0.0848 and 0.0813 m(11/6) kg(-2/3) for ABSI with CVD mortality in men and women, respectively; 29.88 and 29.50 kg/m(2) for BMI, 104.3 and 105.6 for WC, 0.61 and 0.67 for WHtR, 0.95 and 0.86 for WHR, 0.0807 and 0.0765 for ABSI in men and women, respectively, and 0.52 for WHHR in women with all-cause mortality.
  
  
  CONCLUSIONS
  All anthropometric measures of abdominal obesity had positive linear associations with CVD mortality, whereas some showed linear and the others J-shaped relationships with all-cause mortality. BMI had a J-shaped relationship with either CVD or all-cause mortality. Thresholds detected based on mortality may help with clinical definition of obesity in relation to mortality.
authors.affiliation: Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland; Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland. Electronic address: xin.song@helsinki.fi.
authors.forename: X
authors.initials: X
authors.lastname: Song
authors.affiliation: Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Jousilahti
authors.affiliation: Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: C D A
authors.initials: CD
authors.lastname: Stehouwer
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Söderberg
authors.affiliation: Department of Cardiology, Turkish Society of Cardiology Cerrahpaşa Medical Faculty, Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Onat
authors.affiliation: Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Hospital District of North Karelia, Joensuu, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Laatikainen
authors.affiliation: Department of Primary Care & Population Sciences, Royal Free and University College Medical School, London, UK.
authors.forename: J S
authors.initials: JS
authors.lastname: Yudkin
authors.affiliation: Unit for Cardiovascular Epidemiology, The Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel; Division of Epidemiology and Prevention, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Dankner
authors.affiliation: Department of Primary Care & Population Sciences, Royal Free and University College Medical School, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Morris
authors.affiliation: Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland; Center for Vascular Prevention, Danube University Krems, Krems, Austria; King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: J
authors.initials: J
authors.lastname: Tuomilehto
authors.affiliation: Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland; Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland; R&D AstraZeneca AB, Mölndal, Sweden.
authors.forename: Q
authors.initials: Q
authors.lastname: Qiao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D056128:Obesity, Abdominal / Q000150:complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D055105:Waist Circumference; D049629:Waist-Hip Ratio; D044465:White People; D055815:Young Adult
keywords: Abdominal obesity; All-cause mortality; Cardiovascular mortality