Journal
NEW ENGLAND JOURNAL OF MEDICINE
Volume 359, Issue 20, Pages 2105-2120Publisher
MASSACHUSETTS MEDICAL SOC
DOI: 10.1056/NEJMoa0801891
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Funding
- European Commission: Public Health and Consumer Protection Directorate
- Research Directorate-General
- Deutsche Krebshilfe
- German Cancer Research Center
- German Federal Ministry of Education and Research
- Danish Cancer Society
- Health Research Fund of the Spanish Ministry of Health (Network of Centers of Research in Epidemiology and Public Health C03/09)
- Spanish Regional Governments of Andalucia, Asturia, Basque Country, Murcia, and Navarra
- Cancer Research UK
- Medical Research Council, United Kingdom
- Stroke Association, United Kingdom
- British Heart Foundation
- Department of Health, United Kingdom
- Food Standards Agency, United Kingdom
- Wellcome Trust, United Kingdom
- Greek Ministry of Health and Social Solidarity and Hellenic Health Foundation
- Greek Ministry of Education
- Italian Association for Research on Cancer
- Dutch Ministry of Public Health, Welfare, and Sports
- National Cancer Registry and the Regional Cancer Registries Amsterdam, East
- Maastricht of the Netherlands
- World Cancer Research Fund
- Swedish Cancer Society
- Swedish Scientific Council
- Regional Government of Skane, Sweden
- French League Against Cancer
- 3M Company
- Mutuelle Generale de l'Education Nationale, France
- Institut Gustave Roussy, France
- Institut National de la Sante et de la Recherche Medicale, France.
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BACKGROUND Previous studies have relied predominantly on the body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) to assess the association of adiposity with the risk of death, but few have examined whether the distribution of body fat contributes to the prediction of death. METHODS We examined the association of BMI, waist circumference, and waist-to-hip ratio with the risk of death among 359,387 participants from nine countries in the European Prospective Investigation into Cancer and Nutrition (EPIC). We used a Cox regression analysis, with age as the time variable, and stratified the models according to study center and age at recruitment, with further adjustment for educational level, smoking status, alcohol consumption, physical activity, and height. RESULTS During a mean follow-up of 9.7 years, 14,723 participants died. The lowest risks of death related to BMI were observed at a BMI of 25.3 for men and 24.3 for women. After adjustment for BMI, waist circumference and waist-to-hip ratio were strongly associated with the risk of death. Relative risks among men and women in the highest quintile of waist circumference were 2.05 (95% confidence interval [CI], 1.80 to 2.33) and 1.78 (95% CI, 1.56 to 2.04), respectively, and in the highest quintile of waist-to-hip ratio, the relative risks were 1.68 (95% CI, 1.53 to 1.84) and 1.51 (95% CI, 1.37 to 1.66), respectively. BMI remained significantly associated with the risk of death in models that included waist circumference or waist-to-hip ratio (P<0.001). CONCLUSIONS These data suggest that both general adiposity and abdominal adiposity are associated with the risk of death and support the use of waist circumference or waist-tohip ratio in addition to BMI in assessing the risk of death.
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