Over 650,000 white adults aged 20 to 83 years from 11 prospective cohort studies were followed for up to 21 years (median follow-up of 9 years). During the follow-up 78,268 participants died. 


After accounting for age, study, BMI, smoking, alcohol consumption, and physical activity, a strong positive linear association of waist circumference with all-cause mortality was observed for both sexes: 

Men with a waist circumference of over 39 in (110 cm) vs. below 35 in (90 cm) had 52% increased risk for all-cause mortality. Every 2 inch increment in waist circumference increased the risk for all-cause mortality by 7% in men.

Women with a waist circumference of over 37 in (95 cm) vs. below 28 in (70 cm) had 80% increased risk for all-cause mortality. Every 2 inch increment in waist circumference increased the risk for all-cause mortality by 9% in women.

The increased risk for all-cause mortality per 2 in increment in waist circumference was similar for both sexes at all BMI levels (20 to 50), but it was higher at younger ages and higher for longer follow-up. The associations were stronger for heart disease and respiratory disease mortality than for cancer.

The estimated decrease in life expectancy for highest vs. lowest waist circumference (men: >39 in vs. <35 in, women: >37 in vs. <28 in) was approximately 3 years for men and approximately 5 years for women. 


In both young, middle age and older adults, a larger waist circumference is associated with higher mortality, regardless of total body fat mass, and can shorten life span by up to 3-5 years. 

These finding confirm the results from previous studies which demonstrated that waist circumference for any given BMI is a strong predictor of mortality (all-cause, cardiovascular disease and cancer) [6, 8], that measures of central adiposity are better predictors of mortality compared with measures of overall adiposity [7], and that elevated waist circumference is associated with significantly increased cardiovascular disease mortality even among normal-weight people.[8]

Waist circumference should therefore be measured routinely, regardless of body weight status, as part of risk assessment for premature mortality.


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