Comparison of the associations of body mass index and measures of central adiposity and fat mass with coronary heart disease, diabetes, and all-cause mortality: a study using data from 4 UK cohorts
Open Access
- 1 March 2010
- journal article
- research article
- Published by Elsevier BV in The American Journal of Clinical Nutrition
- Vol. 91 (3), 547-556
- https://doi.org/10.3945/ajcn.2009.28757
Abstract
Background: Measures of regional adiposity have been proposed as alternatives to the measurement of body mass index (BMI) for identifying persons at risk of future disease. Objective: The objective was to compare the magnitudes of association of BMI and alternative measurements of adiposity with coronary heart disease, diabetes, and cardiovascular disease risk factors and all-cause mortality. Design: Data from 4 cohorts of adults [3937 women from the British Women’s Heart and Health Study (BWHHS); 2367 and 1950 men from phases 1 and 3, respectively, of the Caerphilly Prospective Study (CaPS); 403 men and women from the Boyd Orr Study; and 789 men and women from the Maidstone-Dewsbury Study] were analyzed. Results: The magnitudes of associations of BMI with incident coronary heart disease and cardiovascular disease risk factors were similar to those with measurements of central adiposity [waist circumference (WC), waist-hip ratio (WHR), or waist-height ratio (WHtR)] and more direct measurements of fat mass (bioimpedance/skinfold thickness). In CaPS (men only), there was no strong evidence of differences in the strengths of association with incident diabetes between BMI, WC, WHR, and WHtR (P for heterogeneity > 0.49 for all). In the BWHHS (women only), there was statistical evidence that WC [hazard ratio (HR): 2.35; 95% CI: 2.03, 2.73] and WHtR (HR: 2.29; 95% CI: 1.98, 2.66) were more strongly associated with diabetes than with BMI (HR: 1.80; 95% CI: 1.59, 2.04) (P for heterogeneity < 0.02 for both). Central adiposity measurements were positively associated with all-cause mortality, as was BMI, but only when those with a BMI (in kg/m2) Conclusion: No strong evidence supports replacing BMI in clinical or public health practice with other adiposity measures.Keywords
This publication has 30 references indexed in Scilit:
- The double jeopardy of clustered measurement and cluster randomisationBMJ, 2009
- Influence of Central and Extremity Circumferences on All‐cause Mortality in Men and WomenObesity, 2008
- General and Abdominal Adiposity and Risk of Death in EuropeThe New England Journal of Medicine, 2008
- Reliability of doctors' anthropometric measurements to detect obesityPreventive Medicine, 2008
- Is visceral obesity the cause of the metabolic syndrome?Annals of Medicine, 2006
- Obesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control studyThe Lancet, 2005
- Waist circumference and not body mass index explains obesity-related health riskThe American Journal of Clinical Nutrition, 2004
- Comparisons of waist circumferences measured at 4 sitesThe American Journal of Clinical Nutrition, 2003
- A comparative evaluation of waist circumference, waist-to-hip ratio and body mass index as indicators of cardiovascular risk factors. The Canadian Heart Health SurveysInternational Journal of Obesity, 2001
- Anthropometric Standardization Reference ManualMedicine & Science in Sports & Exercise, 1992