Weight, shape, and mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death

Price, Gill M; Uauy, Ricardo; Breeze, Elizabeth; Bulpitt, Christopher J.; Fletcher, Astrid

doi:10.1093/ajcn/84.2.449

Cited by 296 publications

(260 citation statements)

References 48 publications

Supporting

Mentioning

232

Contrasting

Unclassified

Order By: Relevance

“…The ideal BMI may be higher in older adults than in middle-aged adults. It was recently reported in approximately 4000 persons aged 75 years and older that WHR rather than WC predicted mortality in nonsmoking men and women, mainly because of the association with cardiovascular deaths (54). In the Health Professionals Study, in men 65 years and older, WC and WHR were significantly related to CVD mortality (51).…”

Section: Clinical Targeting Of Higher Risk Obesitymentioning

confidence: 99%

Targeting abdominal obesity in cardiology: Can we be effective?

Poirier

2008

Canadian Journal of Cardiology

View full text Add to dashboard Cite

Section: Clinical Targeting Of Higher Risk Obesitymentioning

confidence: 99%

Targeting abdominal obesity in cardiology: Can we be effective?

Poirier

2008

Canadian Journal of Cardiology

View full text Add to dashboard Cite

“…[1][2][3][4][5][6][7] Weight loss is known to be associated with improvement of intermediate risk factors for disease, 8 suggesting that weight loss would also reduce mortality. Although four retrospective, bariatric cohort studies have indicated that this may be the case, 9-12 the prospective, controlled, interventional studies showing that weight loss is in fact reducing mortality have been lacking.…”

Section: Introductionmentioning

confidence: 99%

Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study

2008

View full text Add to dashboard Cite

Obesity is associated with increased morbidity and mortality. Intentional weight loss results in improvement of cardiovascular risk factors, but most observational studies suggest that weight reduction is associated with increased overall and cardiovascular mortality. No prospective intervention studies on mortality have earlier been reported in obese subjects. The prospective, controlled Swedish Obese Subjects Study enrolled obese subjects who either underwent bariatric surgery (n ¼ 2010) or were allocated to a contemporaneously matched, conventionally treated obese control group (n ¼ 2037). This review sums up effects on morbidity and mortality over an average of 10 years. The mean weight change of the control group was less than ± 2% over up to 15 years of weight recording. Maximum weight losses in the surgical subgroups were observed after 1-2 years. After 10 years, the weight losses from baseline were stabilized at 25, 16 and 14%, respectively. Bariatric surgery improved all traditional cardiovascular risk states except hypercholesterolemia over 10 years. There were 129 deaths in the control group compared with 101 in the surgery group. The unadjusted overall mortality was reduced by 23.7% (P ¼ 0.0419) in the surgery group (relative to controls), whereas the gender-, age-and risk factor-adjusted mortality reduction was 30.7% (P ¼ 0.0102). The most common causes of death were myocardial infarction (controls n ¼ 25, surgery n ¼ 13) and cancer (47/29). Bariatric surgery for severe obesity is associated with long-term weight loss, improved risk factors and decreased overall mortality.

show abstract

“…Mortality was lowest in the BMI's between 24.6 and 29.8 kg/m 2 but also in the middle of the distribution of waist circumference. Price et al (2006) studied 14 833 subjects aged 75 years or older (follow-up 5.9 years, 649 deaths). In non-smoking men and women (90% of the cohort), compared with the lowest quintile, the hazard ratios were below 1.0 for all other quintiles of BMI.…”

mentioning

confidence: 99%

Waist circumference and waist/hip ratio in relation to all-cause mortality, cancer and sleep apnea

2009

View full text Add to dashboard Cite

Abdominal obesity assessed by waist or waist/hip ratio are both related to increased risk of all-cause mortality throughout the range of body mass index (BMI). The relative risks (RRs) seem to be relatively stronger in younger than in older adults and in those with relatively low BMI compared with those with high BMI. Absolute risks and risk differences are preferable measures of risk in a public health context but these are rarely presented. There is a great lack of studies in ethnic groups (groups of African and Asian descent particularly). Current cut-points as recommended by the World Health Organization seem appropriate, although it may be that BMI-specific and ethnic-specific waist cut-points may be warranted. Waist alone could replace both waist-hip ratio and BMI as a single risk factor for all-cause mortality. There is much less evidence for waist to replace BMI for cancer risk mainly because of the relative lack of prospective cohort studies on waist and cancer risk. Obesity is also a risk factor for sleep apnoea where neck circumference seems to give the strongest association, and waist-hip ratio is a risk factor especially in severe obstructive sleep apnoea syndrome. The waist circumference and waist-hip ratio seem to be better indicators of all-cause mortality than BMI. Waist circumference, waist-hip ratio and all-cause mortalityWhat is the optimal cut-point for assessing risk of premature death?-purposes of cut-points There are not very many studies that directly compare mortality risks by waist circumference and waist-hip ratio. Those who do usually show a continuous relationship between waist, waist/hip and mortality, making any decision about cut-points and classification rather arbitrary. It is also important to think about the uses for cut-points (WHO Expert Consultation, 2004). Cut-points can be applied to population data to describe prevalence and to provide information that may trigger policy actions, to facilitate prevention programmes and to measure the effect of interventions. They can also be used in epidemiological studies to describe the strength and effect size of relationships of determinants on health outcomes. Finally, they can be used to identify individuals who are at risk, to determine the type and intensity of treatment and to evaluate the effects of treatment.The focus of this paper is to evaluate the nature and form of the relationships between waist, waist/hip and all-cause mortality in prospective epidemiological studies and to identify potential cut-points based on for example, statistical grounds (e.g. quintiles), the flexing of the curves or of absolute and relative risk (RR) estimates.The evaluation of the impact of anthropometric measures on mortality can be done by calculating absolute risks (and rate or risk differences), RR or population attributable risk. The RR gives an impression of the slope of the association but has the disadvantage of being dependent on the level of background risk. The risk difference gives the best assessment of the impact on mortality but...

show abstract

Weight, shape, and mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death

Abstract: Current guidelines for BMI-based risk categories overestimate risks due to excess weight in persons aged >/=75 y. Increased mortality risk is more clearly indicated for relative abdominal obesity as measured by high WHR.

Cited by 296 publications

References 48 publications

Targeting abdominal obesity in cardiology: Can we be effective?

Targeting abdominal obesity in cardiology: Can we be effective?

Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study

Waist circumference and waist/hip ratio in relation to all-cause mortality, cancer and sleep apnea

Contact Info

Product

Resources

About