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Concurrent and separate effects of body mass index and waist-to-hip ratio on 24-year mortality in the Population Study of Women in Gothenburg: Evidence of age-dependency

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Abstract

Obesity is generally assumed to be an important risk factor for death and morbidity. However, the association between excess body weight and all-cause mortality among younger and older women and the impact of body mass index (BMI) and waist-to-hip ratio (WHR) concurrently is not fully understood. In 1968–1969 we initiated a prospective study comprising a population sample of 1,462 women from Gothenburg, Sweden. During a 24 year period, until 1992–1993, 265 women had died. A multivariable Cox Proportional Hazards Regression model was used to estimate the relative risk of death in relation to BMI and WHR, with age and other covariates of age-specific interest as smoking, physical activity at work and leisure time and serum triglyceride concentration, at start of the study. BMI and WHR were analyzed as independent variables. Younger women (38 and 46 years at baseline) presented a statistically significant non-linear (U-shaped) relation between BMI and mortality. Among older women (50, 54 and 60 years at baseline), a significant negative linear relationship with decreasing mortality in relation to increasing BMI values was seen. For all women a higher WHR was related to an increased risk of death. The lowest risk of death among younger women corresponded to a low WHR and a BMI within the middle range. For older women the highest survival was observed for those with lowest WHR and highest BMI. Thus, in older women a high BMI seems not to be an increased risk as long as adiposity is not centrally located.

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Abbreviations

BMI:

Body mass index

WHR:

Waist-to-hip ratio

References

  1. Lapidus L, Bengtsson C, Larsson B, Pennert K, Rybo E, Sjöström L (1984) Distribution of adipose tissue and risk of cardiovascular disease and death: A 12-year follow up of participants in the population study of women in Gothenburg, Sweden. Br Med J 289: 1257–1261

    Article  CAS  Google Scholar 

  2. Bengtsson C, Björkelund C, Lapidus L, Lissner L (1993) Associations of serum lipid concentrations and obesity with mortality in women: 20 year follow up of participants in prospective population study in Gothenburg, Sweden. Br Med J 307: 1385–1388

    CAS  Google Scholar 

  3. Manson JE, Willet WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, et al. (1995) Body weight and mortality among women. N Engl J Med 333: 677–685

    Article  PubMed  CAS  Google Scholar 

  4. Hjartåker A, Adami H-O, Lund E, Weiderpass E (2005) Body mass index and mortality in a prospectively studied cohort of Scandinavian women: The women’s lifestyle and health cohort study. Eur J Epidemiol 20: 747–754

    Article  PubMed  Google Scholar 

  5. Dorn JM, Schisterman EF, Winkelstein W Jr, Trevisan M (1997) Body mass index and mortality in a general population sample of men and women. The Buffalo Health Study. Am J Epidemiol 146: 919–931

    PubMed  CAS  Google Scholar 

  6. Bengtsson C (1973) Ischaemic heart disease in women. A study based on a randomized population sample of women and women with myocardial infarction in Göteborg, Sweden. Thesis. Acta Med Scand 549(Suppl): 1–128

    CAS  Google Scholar 

  7. Bengtsson C, Ahlqvist M, Andersson K, Björkelund C, Lissner L, Söderström M (1997) The prospective Population Study of Women in Gothenburg, Sweden, 1968–69 to 1992–93. A 24 year follow up with respect to participation, representativeness and mortality. Scand J Prim Health Care 15: 214–219

    PubMed  CAS  Google Scholar 

  8. SAS Institute Inc. (1999) SAS/STAT® User’s Guide, Version 8, SAS Institute Inc, Cary, NC

    Google Scholar 

  9. Lissner L, Bengtsson C, Björkelund C, Wedel H (1996) Physical activity levels and changes in relation to longevity. A prospective study of Swedish women. Am J Epidemiol 143: 54–62

    PubMed  CAS  Google Scholar 

  10. Lapidus L, Bengtsson C, Lindqvist O, Sigurdsson JA, Rybo E (1985) Triglycerides – main lipid risk factor for cardiovascular disease in women? Acta Med Scand 217: 481–489

    Article  PubMed  CAS  Google Scholar 

  11. Hokanson JE, Austin MA (1996) Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk 3: 213–219

    Article  PubMed  CAS  Google Scholar 

  12. Lindqvist P, Bengtsson C, Lissner L, Björkelund C (2002) Cholesterol and triglyceride concentration as risk factors for myocardial infarction and death in women, with special reference to influence of age. J Intern Med 251: 484–489

    Article  CAS  Google Scholar 

  13. Rexrode KM, Carey VJ, Hennekens CH, Walters EE, Colditz GA, Stampfer MJ, et al. (1998) Abdominal adiposity and coronary heart disease in women. JAMA 280: 1843–1848

    Article  PubMed  CAS  Google Scholar 

  14. Seccareccia F, Lanti M, Menotti A, Scanga M (1998) Role of body mass index in the prediction of all cause mortality in over 62 000 men and women. The Italian RIFLE Pooling Project. Risk Factor and Life Expectancy. J Epidemiol Commun Hlth 52: 20–26

    Article  CAS  Google Scholar 

  15. Losonczy KG, Harris TB, Cornoni-Huntley J, Simonsick EM, Wallace RB, Cook NR, et al (1995) Does weight loss from middle age to old age explain inverse weight mortality relation in old age? Am J Epidemiol 141: 312–321

    Article  PubMed  CAS  Google Scholar 

  16. Allison DB, Gallagher D, Heo M, Pi-Sunyer FX, Heymsfield SB (1997) Body mass index and all-cause mortality among people age 70 and over: the Longitudinal Study of Aging. Int J Obes Relat Metab Disord 21: 424–431

    Article  PubMed  CAS  Google Scholar 

  17. Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL (1988) The effect of age on the association between body-mass index and mortality. N Engl J Med 338: 1–7

    Article  Google Scholar 

  18. Grabowski DC, Ellis JE (2001) High body mass index does not predict mortality in older people: analysis of the Longitudinal Study of Aging. J Am Geriatr Soc 49: 968–979

    Article  PubMed  CAS  Google Scholar 

  19. Bender R, Jockel KH, Trautner C, Spraul M, Berger M (1999) Effect of age on excess mortality in obesity. JAMA 281: 1498–1504

    Article  PubMed  CAS  Google Scholar 

  20. Flegal KM, Graubard BI, Williamson DF, Gail MH (2005) Excess deaths associated with underweight, overweight and obesity. JAMA 293: 1861–1867

    Article  PubMed  CAS  Google Scholar 

  21. Adams KF, Schatzkin A, Harris TB, Kipnis V, Mouw T, Ballard-Barbash R, et al. (2006) Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 355: 763–778

    Article  PubMed  CAS  Google Scholar 

  22. Visscher TLS, Seidell JC, Molarius A, van der Kuip D’ Hofman A, Witteman JCM (2001) A comparison of body mass index, waist-hip ratio and waist circumference as predictors of all-cause mortality among the elderly: the Rotterdam study. Int J Obes 25: 1730–1735

    Article  CAS  Google Scholar 

  23. Katzmarzyk PT, Craig CL, Bouchard C. (2002) Adiposity, adipose tissue distribution and mortality rates in the Canada Fitness Survey follow-up study. Int J Obes 26: 1054–1059

    Article  CAS  Google Scholar 

  24. Folsom AR, Kushi CA, Anderson KE, Mink PJ, Olson JE, Hong CP, et al. (2000) Associations of general and abdominal obesity with multiple health outcomes in older women: The Iowa Women’s Health Study. Arch Intern Med 160: 2117–2128

    Article  PubMed  CAS  Google Scholar 

  25. Janssen I, Katzmarzyk PT, Ross R (2005) Body mass index is inversely related to mortality in older people after adjustment for waist circumference. J Am Geriatr Soc 53: 2112–2118

    Article  PubMed  Google Scholar 

  26. Bigaard J, Tjønneland A, Lykke Thomsen B, Overvad K, Lilienthal Heitmann B, Sørensen TIA (2003) Waist circumference, BMI, smoking, and mortality in middle-aged men and women. Obes Res 11: 895–903

    Article  PubMed  Google Scholar 

  27. Lissner L, Björkelund C, Heitmann BL, Seidell JC, Bengtsson C (2001) Larger hip circumference independently predicts health and longlivety in a Swedish female cohort. Obes Res 9: 644–646

    PubMed  CAS  Google Scholar 

  28. Obesity (1979) Preventing and managing the global epidemic. Report of WHO Consulting on Obesity, Geneva, 3–5 June 1997, WHO/NUT/NCD/98; 3–5 June

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Acknowledgements

The study was supported by the Swedish Medical Council (27X-04578-27C), the Swedish Council for Planning and Coordination of Research (0950:5 A19-5/67), the Swedish Research Council (345-2001-6652, 27X-04578, 2002-3724), the Bank of Sweden Tercentary Foundation, and the Medical Faculty, the Sahlgrenska Academy at Göteborg University.

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Authors and Affiliations

  1. Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at Göteborg University, P.O. Box 454, SE 405 30, Göteborg, Sweden

    Peter Lindqvist, Kate Andersson, Valter Sundh, Lauren Lissner, Cecilia Björkelund & Calle Bengtsson

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  1. Peter Lindqvist
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  2. Kate Andersson
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  3. Valter Sundh
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  4. Lauren Lissner
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  5. Cecilia Björkelund
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  6. Calle Bengtsson
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Correspondence to Peter Lindqvist.

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Lindqvist, P., Andersson, K., Sundh, V. et al. Concurrent and separate effects of body mass index and waist-to-hip ratio on 24-year mortality in the Population Study of Women in Gothenburg: Evidence of age-dependency. Eur J Epidemiol 21, 789–794 (2006). https://doi.org/10.1007/s10654-006-9074-1

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  • DOI: https://doi.org/10.1007/s10654-006-9074-1

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