@article{3140452,
    title = "General and Abdominal Adiposity and Risk of Death in Europe",
    author = "Pischon, T. and Boeing, H. and Hoffmann, K. and Bergmann, M. and and Schulze, M. B. and Overvad, K. and van der Schouw, Y. T. and Spencer, E. and and Moons, K. G. M. and Tjonneland, A. and Halkjaer, J. and Jensen, M. and K. and Stegger, J. and Clavel-Chapelon, F. and Boutron-Ruault, M. -C. and and Chajes, V. and Linseisen, J. and Kaaks, R. and Trichopoulou, A. and and Trichopoulos, D. and Bamia, C. and Sieri, S. and Palli, D. and Tumino, and R. and Vineis, P. and Panico, S. and Peeters, P. H. M. and May, A. M. and and Bueno-de-Mesquita, H. B. and van Duijnhoven, F. J. B. and Hallmans, and G. and Weinehall, L. and Manjer, J. and Hedblad, B. and Lund, E. and and Agudo, A. and Arriola, L. and Barricarte, A. and Navarro, C. and and Martinez, C. and Quiros, J. R. and Key, T. and Bingham, S. and Khaw, K. and T. and Boffetta, P. and Jenab, M. and Ferrari, P. and Riboli, E.",
    journal = "The New England journal of medicine",
    year = "2008",
    volume = "359",
    number = "20",
    pages = "2105-2120",
    publisher = "MASSACHUSETTS MEDICAL SOC",
    doi = "10.1056/NEJMoa0801891",
    abstract = "BACKGROUND Previous studies have relied predominantly on the body-mass
index (BMI, the weight in kilograms divided by the square of the height
in meters) to assess the association of adiposity with the risk of
death, but few have examined whether the distribution of body fat
contributes to the prediction of death.
METHODS We examined the association of BMI, waist circumference, and
waist-to-hip ratio with the risk of death among 359,387 participants
from nine countries in the European Prospective Investigation into
Cancer and Nutrition (EPIC). We used a Cox regression analysis, with age
as the time variable, and stratified the models according to study
center and age at recruitment, with further adjustment for educational
level, smoking status, alcohol consumption, physical activity, and
height.
RESULTS During a mean follow-up of 9.7 years, 14,723 participants died.
The lowest risks of death related to BMI were observed at a BMI of 25.3
for men and 24.3 for women. After adjustment for BMI, waist
circumference and waist-to-hip ratio were strongly associated with the
risk of death. Relative risks among men and women in the highest
quintile of waist circumference were 2.05 (95% confidence interval
[CI], 1.80 to 2.33) and 1.78 (95% CI, 1.56 to 2.04), respectively,
and in the highest quintile of waist-to-hip ratio, the relative risks
were 1.68 (95% CI, 1.53 to 1.84) and 1.51 (95% CI, 1.37 to 1.66),
respectively. BMI remained significantly associated with the risk of
death in models that included waist circumference or waist-to-hip ratio
(P<0.001).
CONCLUSIONS These data suggest that both general adiposity and abdominal
adiposity are associated with the risk of death and support the use of
waist circumference or waist-tohip ratio in addition to BMI in assessing
the risk of death."
}