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Lipids and cardiovascular/metabolic health

Comparison of various surrogate obesity indicators as predictors of cardiovascular mortality in four European populations

Abstract

Background/Objectives:

Body mass index (BMI) is the most commonly used surrogate marker for evaluating the risk of cardiovascular disease (CVD) mortality in relation to general obesity, while abdominal obesity indicators have been proposed to be more informative in risk prediction.

Subject/Methods:

A prospective cohort study consisting of 46 651 Europeans aged 24–99 years was conducted to investigate the relationship between CVD mortality and different obesity indicators including BMI, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), A Body Shape Index (ABSI) and waist-to-hip-to-height ratio (WHHR). Hazard ratio (HR) was estimated by the Cox proportional hazards model using age as timescale, and compared using paired homogeneity test.

Results:

During a median follow-up of 7.9 years, 3435 participants died, 1409 from CVD. All obesity indicators were positively associated with increased risk of CVD mortality, with HRs (95% confidence intervals) per standard deviation increase of 1.19 (1.12–1.27) for BMI, 1.29 (1.21–1.37) for WC, 1.28 (1.20–1.36) for WHR, 1.35 (1.27–1.44) for WSR, 1.34 (1.26–1.44) for ABSI and 1.34 (1.25–1.42) for WHHR in men and 1.37 (1.24–1.51), 1.49 (1.34–1.65), 1.45 (1.31–1.60), 1.52 (1.37–1.69), 1.32 (1.18–1.48) and 1.45 (1.31–1.61) in women, respectively. The prediction was stronger with abdominal obesity indicators than with BMI or ABSI (P<0.05 for all paired homogeneity tests). WSR appeared to be the strongest predictor among all the indicators, with a linear relationship with CVD mortality in both men and women.

Conclusions:

Abdominal obesity indicators such as WC, WHR, WSR and WHHR, are stronger predictors for CVD mortality than general obesity indicator of BMI.

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Acknowledgements

This study was supported by grants from Academy Finland (1129197, 136895 and 141005).

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Correspondence to Q Qiao.

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Appendix

Appendix

Studies and investigators in this collaborative study are as follows:

Finland National FINRISK 1987, 1992 and 1997 Cohorts: J. Tuomilehto1,2,3, P. Jousilahti2, J. Lindström2, 1. Department of Public Health, University of Helsinki, Helsinki; 2. Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki; 3. South Ostrobothnia Central Hospital, Seinäjoki, Finland.

National FINRISK 2002 Study: J. Tuomilehto1,2, T. Laatikainen2,3,4, M. Peltonen2, J. Lindström2, 1. Department of Public Health, University of Helsinki, Helsinki; 2. Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki; 3. Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; 4. Hospital District of North Karelia, Joensuu, Finland.

Sweden Northern Sweden MONICA Survey: S. Söderberg1,2, M. Eliasson1, 1. Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; 2. Baker IDI Heart and Diabetes Institute, Melbourne, Australia.

The Uppsala Longitudinal Study of Adult Men (ULSAM): B. Zethelius, Department of Public Health/Geriatrics, Uppsala University Hospital, Uppsala.

Turkey Turkish Adult Risk Factor Study (TARFS): A Onat1,2. 1Turkish Society of Cardiology, Istanbul; 2Department of Cardiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul.

United Kingdom Whitehall II Study: M.G.Marmot1, A.G. Tabák1,2, M. Kivimäki1,3, E.J. Brunner1, D.R. Witte1,4, 1. Department of Epidemiology and Public Health, University College London, London, UK; 2. Semmelweis University Faculty of Medicine, 1st Department of Medicine, Budapest, Hungary; 3. Finnish Institute of Occupational Health, Helsinki, Finland; 4. Steno Diabetes Center, Gentofte, Denmark.

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Song, X., Jousilahti, P., Stehouwer, C. et al. Comparison of various surrogate obesity indicators as predictors of cardiovascular mortality in four European populations. Eur J Clin Nutr 67, 1298–1302 (2013). https://doi.org/10.1038/ejcn.2013.203

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