title: Body Mass Index, Waist Circumference, and Mortality in a Large Multiethnic Postmenopausal Cohort-Results from the Women's Health Initiative.
abstract: OBJECTIVE
  To determine whether the relationship between anthropometric measurements of obesity and mortality varies according to age, race, and ethnicity in older women.
  
  
  METHODS
  Prospective cohort study of multiethnic postmenopausal women.
  
  
  METHODS
  Women's Health Initiative (WHI) observational study and clinical trials in 40 clinics.
  
  
  METHODS
  Postmenopausal women aged 50-79 participating in WHI (N = 161,808).
  
  
  METHODS
  Baseline height, weight, and waist circumference (WC) were measured, and body mass index (BMI) was calculated based on height and weight. Demographic, health, and lifestyle data from a baseline questionnaire were used as covariates. The outcome was adjudicated death (n = 18,320) during a mean follow-up of 11.4 ± 3.2 years.
  
  
  RESULTS
  Hazard ratios (HRs) and 95% confidence intervals (95% CIs) indicated that ethnicity and age modified (P < .01) the relationship between obesity and mortality. Underweight was associated with higher mortality, but overweight or slight obesity was not a risk factor for mortality in most ethnic groups except for Hispanic women in the obesity I category (HR = 1.42, 95% CI = 1.04-1.95). BMI was not or was only weakly associated with mortality in individuals aged 70-79 (HR = 0.90, 95% CI = 0.85-0.95 for overweight; HR = 0.98, 95 CI = 0.92-1.06 for obese I; HR = 1.11, 95% CI = 1.00-1.23 for obese II; HR = 1.08, 95% CI = 0.92-1.26 for obese III). In contrast, higher central obesity measured using WC was consistently associated with higher mortality in all groups.
  
  
  CONCLUSIONS
  Underweight is a significant risk factor for mortality in older women, and healthy BMI ranges may need to be specific for age, race, and ethnicity. The findings support a consistent relationship between central obesity and mortality.
authors.affiliation: Mel and Enid Zuckerman College of Public Health, Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Mel and Enid Zuckerman College of Public Health, Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona.
authors.forename: Yann C
authors.initials: YC
authors.lastname: Klimentidis
authors.affiliation: Cancer Center, University of Arizona, Tucson, Arizona.
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Bea
authors.affiliation: Mel and Enid Zuckerman College of Public Health, Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona.
authors.forename: Kacey C
authors.initials: KC
authors.lastname: Ernst
authors.affiliation: Mel and Enid Zuckerman College of Public Health, Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona.
authors.forename: Chengcheng
authors.initials: C
authors.lastname: Hu
authors.affiliation: Center for Clinical and Translational Science, Ohio State University, Columbus, Ohio.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jackson
authors.affiliation: Cancer Center, University of Arizona, Tucson, Arizona.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Thomson
mesh_terms: D000368:Aged; D015992:Body Mass Index; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009026:Mortality; D017698:Postmenopause; D011446:Prospective Studies; D044469:Racial Groups / Q000706:statistics & numerical data; D055105:Waist Circumference; D016387:Women's Health
keywords: body mass index; minority health; mortality; waist circumference; women