Both general and abdominal adiposity associated with risk of all-cause death in Europe
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Few studies have examined whether the distribution of body fat contributes to the prediction of death. For this reason, the association of body mass index (BMI, a measure of general adiposity), waist circumference, and waist-to-hip ratio (both indicative of abdominal adiposity) with the risk of death was examined among 359,387 participants from nine countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 14,723 participants died during a mean follow-up of 9.7 years. Cox regression analysis revealed that the lowest risk of death related to BMI was observed at a BMI of 25.3 for men and 24.3 for women. After adjusting for BMI, waist circumference and waist-to-hip ratio were strongly associated with risk of death. In models that included waist circumference and waist-to-hip ratio, BMI remained significantly associated with risk of death. Both general adiposity and abdominal adiposity were independently associated with risk of death. This supports the use of waist circumference or waist-to-hip ratio in addition to BMI in the assessment of the risk of death. These observations also suggest that body fat distribution is worth assessing even among persons with normal weight.
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