Comparison of various surrogate obesity indicators as predictors of cardiovascular mortality in four european populations

ABSTRACT BACKGROUND/OBJECTIVES: Body mass index (BMI) is the most commonly used surrogate marker for evaluating the risk of cardiovascular disease (CVD) mortality in relation to general

obesity, while abdominal obesity indicators have been proposed to be more informative in risk prediction. SUBJECT/METHODS: A prospective cohort study consisting of 46 651 Europeans aged

24–99 years was conducted to investigate the relationship between CVD mortality and different obesity indicators including BMI, waist circumference (WC), waist-to-hip ratio (WHR),

waist-to-stature ratio (WSR), A Body Shape Index (ABSI) and waist-to-hip-to-height ratio (WHHR). Hazard ratio (HR) was estimated by the Cox proportional hazards model using age as timescale,

and compared using paired homogeneity test. RESULTS: During a median follow-up of 7.9 years, 3435 participants died, 1409 from CVD. All obesity indicators were positively associated with

increased risk of CVD mortality, with HRs (95% confidence intervals) per standard deviation increase of 1.19 (1.12–1.27) for BMI, 1.29 (1.21–1.37) for WC, 1.28 (1.20–1.36) for WHR, 1.35

(1.27–1.44) for WSR, 1.34 (1.26–1.44) for ABSI and 1.34 (1.25–1.42) for WHHR in men and 1.37 (1.24–1.51), 1.49 (1.34–1.65), 1.45 (1.31–1.60), 1.52 (1.37–1.69), 1.32 (1.18–1.48) and 1.45

(1.31–1.61) in women, respectively. The prediction was stronger with abdominal obesity indicators than with BMI or ABSI (_P_<0.05 for all paired homogeneity tests). WSR appeared to be the

strongest predictor among all the indicators, with a linear relationship with CVD mortality in both men and women. CONCLUSIONS: Abdominal obesity indicators such as WC, WHR, WSR and WHHR,

are stronger predictors for CVD mortality than general obesity indicator of BMI. Access through your institution Buy or subscribe This is a preview of subscription content, access via your

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* Learn about institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS WAIST-TO-HEIGHT RATIO IS A BETTER DISCRIMINATOR OF CARDIOVASCULAR

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ADULTS: NHANES 2011–2016 Article 21 August 2024 COMPARISON OF CONVENTIONAL AND UNCONVENTIONAL OBESITY INDICES ASSOCIATED WITH NEW-ONSET HYPERTENSION IN DIFFERENT SEX AND AGE POPULATIONS

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I. _Circulation_ 2004; 110: 2781–2785. Article  CAS  Google Scholar  Download references ACKNOWLEDGEMENTS This study was supported by grants from Academy Finland (1129197, 136895 and

141005). AUTHOR INFORMATION Author notes * X Song, P Jousilahti, C D A Stehouwer, S Söderberg, A Onat, T Laatikainen, J S Yudkin, R Dankner, R Morris, J Tuomilehto and Q Qiao: See Appendix

for the list of members. AUTHORS AND AFFILIATIONS * Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland X Song & Q Qiao * Department of Chronic

Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland X Song, P Jousilahti, T Laatikainen, J Tuomilehto & Q Qiao * Department of Internal Medicine and

Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands C D A Stehouwer * Department of Public Health and Clinical Medicine,

Umeå University, Umeå, Sweden S Söderberg * Baker IDI Heart and Diabetes Institute, Melbourne, Australia S Söderberg * Department of Cardiology, Turkish Society of Cardiology Cerrahpaşa

Medical Faculty, Istanbul, Turkey A Onat * Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland T Laatikainen * Hospital District of North

Karelia, Joensuu, Finland T Laatikainen * Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK J S Yudkin & R Morris * Unit

for Cardiovascular Epidemiology, The Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel R Dankner * Division of Epidemiology and Prevention, School of Public Health, Sackler

School of Medicine, Tel Aviv University, Tel Aviv, Israel R Dankner * Center for Vascular Prevention, Danube University Krems, Krems, Austria J Tuomilehto * King Abdulaziz University,

Jeddah, Saudi Arabia J Tuomilehto * R&D AstraZeneca AB, Mölndal, Sweden Q Qiao Authors * X Song View author publications You can also search for this author inPubMed Google Scholar * P

Jousilahti View author publications You can also search for this author inPubMed Google Scholar * C D A Stehouwer View author publications You can also search for this author inPubMed Google

Scholar * S Söderberg View author publications You can also search for this author inPubMed Google Scholar * A Onat View author publications You can also search for this author inPubMed 

Google Scholar * T Laatikainen View author publications You can also search for this author inPubMed Google Scholar * J S Yudkin View author publications You can also search for this author

inPubMed Google Scholar * R Dankner View author publications You can also search for this author inPubMed Google Scholar * R Morris View author publications You can also search for this

author inPubMed Google Scholar * J Tuomilehto View author publications You can also search for this author inPubMed Google Scholar * Q Qiao View author publications You can also search for

this author inPubMed Google Scholar CONSORTIA FOR THE DECODE STUDY GROUP CORRESPONDING AUTHOR Correspondence to Q Qiao. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no

conflict of interest. ADDITIONAL INFORMATION Supplementary Information accompanies this paper on European Journal of Clinical Nutrition website SUPPLEMENTARY INFORMATION SUPPLEMENTARY TABLE

(DOC 53 KB) APPENDIX APPENDIX STUDIES AND INVESTIGATORS IN THIS COLLABORATIVE STUDY ARE AS FOLLOWS: Finland National FINRISK 1987, 1992 and 1997 Cohorts: J. Tuomilehto1,2,3, P. Jousilahti2,

J. Lindström2, 1. Department of Public Health, University of Helsinki, Helsinki; 2. Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki; 3. South

Ostrobothnia Central Hospital, Seinäjoki, Finland. National FINRISK 2002 Study: J. Tuomilehto1,2, T. Laatikainen2,3,4, M. Peltonen2, J. Lindström2, 1. Department of Public Health, University

of Helsinki, Helsinki; 2. Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki; 3. Institute of Public Health and Clinical Nutrition, University of

Eastern Finland, Kuopio, Finland; 4. Hospital District of North Karelia, Joensuu, Finland. Sweden Northern Sweden MONICA Survey: S. Söderberg1,2, M. Eliasson1, 1. Department of Public Health

and Clinical Medicine, Umeå University, Umeå, Sweden; 2. Baker IDI Heart and Diabetes Institute, Melbourne, Australia. The Uppsala Longitudinal Study of Adult Men (ULSAM): B. Zethelius,

Department of Public Health/Geriatrics, Uppsala University Hospital, Uppsala. Turkey Turkish Adult Risk Factor Study (TARFS): A Onat1,2. 1Turkish Society of Cardiology, Istanbul; 2Department

of Cardiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul. United Kingdom Whitehall II Study: M.G.Marmot1, A.G. Tabák1,2, M. Kivimäki1,3, E.J. Brunner1, D.R. Witte1,4, 1.

Department of Epidemiology and Public Health, University College London, London, UK; 2. Semmelweis University Faculty of Medicine, 1st Department of Medicine, Budapest, Hungary; 3. Finnish

Institute of Occupational Health, Helsinki, Finland; 4. Steno Diabetes Center, Gentofte, Denmark. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Song,

X., Jousilahti, P., Stehouwer, C. _et al._ Comparison of various surrogate obesity indicators as predictors of cardiovascular mortality in four European populations. _Eur J Clin Nutr_ 67,

1298–1302 (2013). https://doi.org/10.1038/ejcn.2013.203 Download citation * Received: 23 May 2013 * Revised: 07 August 2013 * Accepted: 04 September 2013 * Published: 23 October 2013 * Issue

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