Your waistline not only makes or breaks your esthetic appearance; if you belly gets too large, it may greatly jeopardize your health and even longevity.
Waist circumference strongly correlates with abdominal obesity and is the most commonly used measure of body fat distribution.[1, 2] Many studies have found enlarged waist circumferences to be associated with all-cause mortality, in most cases independently of general obesity.[3-11]
Abdominal obesity (aka visceral obesity) appears to be more strongly associated with multiple chronic diseases than is gluteo-femoral obesity (fat deposition around the butt and thighs). Increased waist circumference confers a health risk even in normal weight people.
A notable large study investigated the association of waist circumference with mortality using intuitive 2 in (5 cm) increments for men and women, and also evaluated risk within narrow categories of body fatness (BMI). In addition, the study estimated years of life lost due to a large waist circumference.
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 , and that elevated waist circumference is associated with significantly increased cardiovascular disease mortality even among normal-weight people.
Waist circumference should therefore be measured routinely, regardless of body weight status, as part of risk assessment for premature mortality.
- Snijder MB, van Dam RM, Visser M, et al. What aspects of body fat are particularly hazardous and how do we measure them? International journal of epidemiology. 2006;35(1):83-92.
- Chan DC, Watts GF, Barrett PH, et al. Waist circumference, waist-to-hip ratio and body mass index as predictors of adipose tissue compartments in men. QJM : monthly journal of the Association of Physicians. 2003;96(6):441-447.
- Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. The New England journal of medicine. 2008;359(20):2105-2120.
- Folsom AR, Kushi LH, Anderson KE, et al. Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women's Health Study. Archives of internal medicine. 2000;160(14):2117-2128.
- Baik I, Ascherio A, Rimm EB, et al. Adiposity and mortality in men. American journal of epidemiology. 2000;152(3):264-271.
- Bigaard J, Tjonneland A, Thomsen BL, et al. Waist circumference, BMI, smoking, and mortality in middle-aged men and women. Obesity research. 2003;11(7):895-903.
- Simpson JA, MacInnis RJ, Peeters A, et al. A comparison of adiposity measures as predictors of all-cause mortality: the Melbourne Collaborative Cohort Study. Obesity (Silver Spring). 2007;15(4):994-1003.
- Zhang C, Rexrode KM, van Dam RM, et al. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women. Circulation. 2008;117(13):1658-1667.
- Koster A, Leitzmann MF, Schatzkin A, et al. Waist circumference and mortality. American journal of epidemiology. 2008;167(12):1465-1475.
- Jacobs EJ, Newton CC, Wang Y, et al. Waist circumference and all-cause mortality in a large US cohort. Archives of internal medicine. 2010;170(15):1293-1301.
- Pi-Sunyer FX. The epidemiology of central fat distribution in relation to disease. Nutrition reviews. 2004;62(7 Pt 2):S120-126.
- Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obesity research. 1998;6 Suppl 2:51S-209S.
- Cerhan JR, Moore SC, Jacobs EJ, et al. A pooled analysis of waist circumference and mortality in 650,000 adults. Mayo Clinic proceedings Mayo Clinic. 2014;89(3):335-345.
Medical Writer & Nutritionist
University of Stockholm & Karolinska Institute, Sweden
Baylor University, TX, USA
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