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      The influence of hip circumference on the relationship between abdominal obesity and mortality

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          Abstract

          Background Higher waist circumference and lower hip circumference are both associated with increased cardiovascular disease (CVD) risk, despite being directly correlated. The real effects of visceral obesity may therefore be underestimated when hip circumference is not fully taken into account. We hypothesized that adding waist and hip circumference to traditional risk factors would significantly improve CVD risk prediction.

          Methods In a population-based survey among South Asian and African Mauritians ( n = 7978), 1241 deaths occurred during 15 years of follow-up. In a model that included variables used in previous CVD risk calculations (a Framingham-type model), the association between waist circumference and mortality was examined before and after adjustment for hip circumference. The percentage with an increase in estimated 10-year cumulative mortality of >25% and a decrease of >20% after waist and hip circumference were added to the model was calculated.

          Results Waist circumference was strongly related to mortality only after adjustment for hip circumference and vice versa. Adding waist and hip circumference to a Framingham-type model increased estimated 10-year cumulative CVD mortality by >25% for 23.7% of those who died and 15.7% of those censored. Cumulative mortality decreased by >20% for 4.5% of those who died and 14.8% of those censored.

          Conclusions The effect of central obesity on mortality risk is seriously underestimated without adjustment for hip circumference. Adding waist and hip circumference to a Framingham-type model for CVD mortality substantially increased predictive power. Both may be important inclusions in CVD risk prediction models.

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          General cardiovascular risk profile for use in primary care: the Framingham Heart Study.

          Ralph B. D’Agostino, Ramachandran S. Vasan, Michael J. Pencina … (2008)
          Separate multivariable risk algorithms are commonly used to assess risk of specific atherosclerotic cardiovascular disease (CVD) events, ie, coronary heart disease, cerebrovascular disease, peripheral vascular disease, and heart failure. The present report presents a single multivariable risk function that predicts risk of developing all CVD and of its constituents. We used Cox proportional-hazards regression to evaluate the risk of developing a first CVD event in 8491 Framingham study participants (mean age, 49 years; 4522 women) who attended a routine examination between 30 and 74 years of age and were free of CVD. Sex-specific multivariable risk functions ("general CVD" algorithms) were derived that incorporated age, total and high-density lipoprotein cholesterol, systolic blood pressure, treatment for hypertension, smoking, and diabetes status. We assessed the performance of the general CVD algorithms for predicting individual CVD events (coronary heart disease, stroke, peripheral artery disease, or heart failure). Over 12 years of follow-up, 1174 participants (456 women) developed a first CVD event. All traditional risk factors evaluated predicted CVD risk (multivariable-adjusted P<0.0001). The general CVD algorithm demonstrated good discrimination (C statistic, 0.763 [men] and 0.793 [women]) and calibration. Simple adjustments to the general CVD risk algorithms allowed estimation of the risks of each CVD component. Two simple risk scores are presented, 1 based on all traditional risk factors and the other based on non-laboratory-based predictors. A sex-specific multivariable risk factor algorithm can be conveniently used to assess general CVD risk and risk of individual CVD events (coronary, cerebrovascular, and peripheral arterial disease and heart failure). The estimated absolute CVD event rates can be used to quantify risk and to guide preventive care.
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            Excess deaths associated with underweight, overweight, and obesity.

            Katherine Flegal (2005)
            As the prevalence of obesity increases in the United States, concern over the association of body weight with excess mortality has also increased. To estimate deaths associated with underweight (body mass index [BMI] or =30) in the United States in 2000. We estimated relative risks of mortality associated with different levels of BMI (calculated as weight in kilograms divided by the square of height in meters) from the nationally representative National Health and Nutrition Examination Survey (NHANES) I (1971-1975) and NHANES II (1976-1980), with follow-up through 1992, and from NHANES III (1988-1994), with follow-up through 2000. These relative risks were applied to the distribution of BMI and other covariates from NHANES 1999-2002 to estimate attributable fractions and number of excess deaths, adjusted for confounding factors and for effect modification by age. Number of excess deaths in 2000 associated with given BMI levels. Relative to the normal weight category (BMI 18.5 to or =30) was associated with 111,909 excess deaths (95% confidence interval [CI], 53,754-170,064) and underweight with 33,746 excess deaths (95% CI, 15,726-51,766). Overweight was not associated with excess mortality (-86,094 deaths; 95% CI, -161,223 to -10,966). The relative risks of mortality associated with obesity were lower in NHANES II and NHANES III than in NHANES I. Underweight and obesity, particularly higher levels of obesity, were associated with increased mortality relative to the normal weight category. The impact of obesity on mortality may have decreased over time, perhaps because of improvements in public health and medical care. These findings are consistent with the increases in life expectancy in the United States and the declining mortality rates from ischemic heart disease.
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              Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old.

              Kenneth F Adams, Arthur Schatzkin, Tamara Harris … (2006)
              Obesity, defined by a body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters) of 30.0 or more, is associated with an increased risk of death, but the relation between overweight (a BMI of 25.0 to 29.9) and the risk of death has been questioned. We prospectively examined BMI in relation to the risk of death from any cause in 527,265 U.S. men and women in the National Institutes of Health-AARP cohort who were 50 to 71 years old at enrollment in 1995-1996. BMI was calculated from self-reported weight and height. Relative risks and 95 percent confidence intervals were adjusted for age, race or ethnic group, level of education, smoking status, physical activity, and alcohol intake. We also conducted alternative analyses to address potential biases related to preexisting chronic disease and smoking status. During a maximum follow-up of 10 years through 2005, 61,317 participants (42,173 men and 19,144 women) died. Initial analyses showed an increased risk of death for the highest and lowest categories of BMI among both men and women, in all racial or ethnic groups, and at all ages. When the analysis was restricted to healthy people who had never smoked, the risk of death was associated with both overweight and obesity among men and women. In analyses of BMI during midlife (age of 50 years) among those who had never smoked, the associations became stronger, with the risk of death increasing by 20 to 40 percent among overweight persons and by two to at least three times among obese persons; the risk of death among underweight persons was attenuated. Excess body weight during midlife, including overweight, is associated with an increased risk of death. Copyright 2006 Massachusetts Medical Society.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Epidemiol
                Journal ID (iso-abbrev): Int J Epidemiol
                Journal ID (publisher-id): ije
                Journal ID (hwp): intjepid
                Title: International Journal of Epidemiology
                Publisher: Oxford University Press
                ISSN (Print): 0300-5771
                ISSN (Electronic): 1464-3685
                Publication date (Print): April 2012
                Publication date (Electronic): 20 January 2012
                Publication date PMC-release: 20 January 2012
                Volume: 41
                Issue: 2
                Pages: 484-494
                Affiliations
                1Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia, 2Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, Victoria, Australia, 3Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, 4Steno Diabetes Centre, Copenhagen, Denmark, 5Department of Endocrinology and Metabolism, St Mary's Hospital campus, Imperial College, London, UK, 6Department of Public Health, University of Helsinki, Helsinki, Finland, 7South Ostrobothnia Central Hospital, Seinajoki, Finland, 8Red RECAVA Grupo RD06/0014/0015, Hospital Universitario La Paz, Madrid, Spain, 9Ministry of Health and Quality of Life, Port Louis, Mauritius and 10Department of Public Health and Clinical Medicine, Medicine and Heart Centre, University of Umeå, Umeå, Sweden
                Author notes
                *Corresponding author. Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia . E-mail: adrian.cameron@ 123456deakin.edu.au

                †These authors contributed equally to this work.

                Article
                Publisher ID: dyr198
                DOI: 10.1093/ije/dyr198
                PMC ID: 3324456
                PubMed ID: 22266094
                SO-VID: 8fa600ef-efe0-47fc-8364-2441a0e10a7b
                Copyright © Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2012; all rights reserved.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date accepted : 9 November 2011
                Page count
                Pages: 11
                Categories
                Subject: Non-communicable Diseases

                ScienceOpen disciplines: Public health
                Keywords: south asian,hip circumference,waist circumference,obesity,african,mortality
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: south asian, hip circumference, waist circumference, obesity, african, mortality

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