Abstract

Abdominal and general adiposity are independently associated with mortality, but there is no consensus on how best to assess abdominal adiposity. We compared the ability of alternative waist indices to complement body mass index (BMI) when assessing all-cause mortality. We used data from 352,985 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) and Cox proportional hazards models adjusted for other risk factors. During a mean follow-up of 16.1 years, 38,178 participants died. Combining in one model BMI and a strongly correlated waist index altered the association patterns with mortality, to a predominantly negative association for BMI and a stronger positive association for the waist index, while combining BMI with the uncorrelated A Body Shape Index (ABSI) preserved the association patterns. Sex-specific cohort-wide quartiles of waist indices correlated with BMI could not separate high-risk from low-risk individuals within underweight (BMI < 18.5 kg/m2) or obese (BMI ≥ 30 kg/m2) categories, while the highest quartile of ABSI separated 18–39% of the individuals within each BMI category, which had 22–55% higher risk of death. In conclusion, only a waist index independent of BMI by design, such as ABSI, complements BMI and enables efficient risk stratification, which could facilitate personalisation of screening, treatment and monitoring.

Details

Title
A Body Shape Index (ABSI) achieves better mortality risk stratification than alternative indices of abdominal obesity: results from a large European cohort
Author
Christakoudi Sofia 1 ; Tsilidis, Konstantinos K 2 ; Muller, David C 3 ; Freisling Heinz 4 ; Weiderpass Elisabete 4 ; Overvad Kim 5 ; Söderberg, Stefan 6 ; Häggström Christel 7 ; Pischon Tobias 8 ; Dahm, Christina C 9 ; Zhang, Jie 9 ; Tjønneland, Anne 10 ; Halkjær Jytte 11 ; MacDonald, Conor 12 ; Marie-Christine, Boutron-Ruault 12 ; Mancini, Francesca Romana 12 ; Kühn Tilman 13 ; Kaaks Rudolf 13 ; Schulze, Matthias B 14 ; Trichopoulou Antonia 15 ; Karakatsani, Anna 16 ; Peppa Eleni 15 ; Masala Giovanna 17 ; Pala Valeria 18 ; Panico Salvatore 19 ; Tumino Rosario 20 ; Sacerdote Carlotta 21 ; Ramón, Quirós J 22 ; Agudo Antonio 23 ; Maria-Jose, Sánchez 24 ; Cirera Lluís 25 ; Barricarte-Gurrea Aurelio 26 ; Amiano Pilar 27 ; Memarian Ensieh 28 ; Sonestedt Emily 29 ; Bueno-de-Mesquita, Bas 30 ; May, Anne M 31 ; Kay-Tee, Khaw 32 ; Wareham, Nicholas J 33 ; Tong Tammy Y N 34 ; Huybrechts Inge 4 ; Noh Hwayoung 4 ; Aglago, Elom K 4 ; Ellingjord-Dale Merete 3 ; Ward, Heather A 3 ; Aune Dagfinn 35 ; Riboli Elio 3 

1  Imperial College London, Department of Epidemiology and Biostatistics, London, UK (GRID:grid.7445.2) (ISNI:0000 0001 2113 8111); King’s College London, MRC Centre for Transplantation, London, UK (GRID:grid.13097.3c) (ISNI:0000 0001 2322 6764) 
2  Imperial College London, Department of Epidemiology and Biostatistics, London, UK (GRID:grid.7445.2) (ISNI:0000 0001 2113 8111); University of Ioannina, Department of Hygiene and Epidemiology, School of Medicine, Ioannina, Greece (GRID:grid.9594.1) (ISNI:0000 0001 2108 7481) 
3  Imperial College London, Department of Epidemiology and Biostatistics, London, UK (GRID:grid.7445.2) (ISNI:0000 0001 2113 8111) 
4  World Health Organization, International Agency for Research on Cancer, Lyon CEDEX 08, France (GRID:grid.17703.32) (ISNI:0000000405980095) 
5  Aarhus University, Department of Public Health, Aarhus, Denmark (GRID:grid.7048.b) (ISNI:0000 0001 1956 2722); Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark (GRID:grid.27530.33) (ISNI:0000 0004 0646 7349) 
6  Umeå University, Department of Public Health and Clinical Medicine, Umeå, Sweden (GRID:grid.12650.30) (ISNI:0000 0001 1034 3451) 
7  Umeå University, Department of Biobank Research, Umeå, Sweden (GRID:grid.12650.30) (ISNI:0000 0001 1034 3451); Uppsala University, Department of Surgical Sciences, Uppsala, Sweden (GRID:grid.8993.b) (ISNI:0000 0004 1936 9457) 
8  Max Delbrück Center for Molecular Medicine, Berlin, Germany (GRID:grid.419491.0) (ISNI:0000 0001 1014 0849); Charité – Universitätsmedizin Berlin, Berlin, Germany (GRID:grid.6363.0) (ISNI:0000 0001 2218 4662); Berlin Institute of Health (BIH), Berlin, Germany (GRID:grid.484013.a) 
9  Aarhus University, Department of Public Health, Aarhus, Denmark (GRID:grid.7048.b) (ISNI:0000 0001 1956 2722) 
10  Danish Cancer Society Research Center, Copenhagen Ø, Denmark (GRID:grid.417390.8) (ISNI:0000 0001 2175 6024); University of Copenhagen, Department of Public Health, Copenhagen, Denmark (GRID:grid.5254.6) (ISNI:0000 0001 0674 042X) 
11  Danish Cancer Society Research Center, Copenhagen Ø, Denmark (GRID:grid.417390.8) (ISNI:0000 0001 2175 6024) 
12  Université Paris-Saclay, Centre de recherche en Epidemiologie et Sante des Populations (CESP), Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Villejuif, France (GRID:grid.460789.4) (ISNI:0000 0004 4910 6535); Gustave Roussy, Villejuif, France (GRID:grid.14925.3b) (ISNI:0000 0001 2284 9388) 
13  Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (GRID:grid.7497.d) (ISNI:0000 0004 0492 0584) 
14  German Institute of Human Nutrition Potsdam-Rehbruecke, Department of Molecular Epidemiology, Nuthetal, Germany (GRID:grid.418213.d) (ISNI:0000 0004 0390 0098); University of Potsdam, Institute of Nutritional Sciences, Nuthetal, Germany (GRID:grid.11348.3f) (ISNI:0000 0001 0942 1117) 
15  Hellenic Health Foundation, Athens, Greece (GRID:grid.424637.0) 
16  Hellenic Health Foundation, Athens, Greece (GRID:grid.424637.0); “ATTIKON” University Hospital, 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, Haidari, Greece (GRID:grid.411449.d) (ISNI:0000 0004 0622 4662) 
17  Prevention and Clinical Network - ISPRO, Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Florence, Italy (GRID:grid.424637.0) 
18  Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Epidemiology and Prevention Unit, Milan, Italy (GRID:grid.417893.0) (ISNI:0000 0001 0807 2568) 
19  Federico II University, Dipartimento di Medicina Clinica e Chirurgia, Naples, Italy (GRID:grid.4691.a) (ISNI:0000 0001 0790 385X) 
20  Azienda Sanitaria Provinciale Ragusa (ASP), Cancer Registry and Histopathology Department, Ragusa, Italy (GRID:grid.4691.a) 
21  Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy (GRID:grid.4691.a) 
22  Public Health Directorate, Asturias, Spain (GRID:grid.4691.a) 
23  Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Barcelona, Spain (GRID:grid.417656.7) 
24  Andalusian School of Public Health (EASP), Granada, Spain (GRID:grid.413740.5) (ISNI:0000 0001 2186 2871); Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Granada, Spain (GRID:grid.507088.2); Universidad de Granada, Granada, Spain (GRID:grid.4489.1) (ISNI:0000000121678994); CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain (GRID:grid.4489.1) 
25  CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain (GRID:grid.4489.1); Murcia Regional Health Council, IMIB - Arrixaca, Department of Epidemiology, Murcia, Spain (GRID:grid.452553.0); University of Murcia, Department of Health and Social Sciences, Murcia, Spain (GRID:grid.10586.3a) (ISNI:0000 0001 2287 8496) 
26  CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain (GRID:grid.10586.3a); Navarra Public Health Institute, Pamplona, Spain (GRID:grid.10586.3a); Navarra Institute for Health Research (IdiSNA) Pamplona, Pamplona, Spain (GRID:grid.10586.3a) 
27  CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain (GRID:grid.10586.3a); Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain (GRID:grid.10586.3a) 
28  Lund University, Dept. Clinical Sciences, Skane University Hospital, Malmö, Sweden (GRID:grid.4514.4) (ISNI:0000 0001 0930 2361) 
29  Lund University, Nutritional Epidemiology, Department of Clinical Sciences Malmö, Malmö, Sweden (GRID:grid.4514.4) (ISNI:0000 0001 0930 2361) 
30  Imperial College London, Department of Epidemiology and Biostatistics, London, UK (GRID:grid.7445.2) (ISNI:0000 0001 2113 8111); National Institute for Public Health and the Environment (RIVM), Department for Determinants of Chronic Diseases (DCD), Bilthoven, The Netherlands (GRID:grid.31147.30) (ISNI:0000 0001 2208 0118); University Medical Centre, Department of Gastroenterology and Hepatology, Utrecht, The Netherlands (GRID:grid.7692.a) (ISNI:0000000090126352); University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, Kuala Lumpur, Malaysia (GRID:grid.10347.31) (ISNI:0000 0001 2308 5949) 
31  Utrecht University, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (GRID:grid.5477.1) (ISNI:0000000120346234) 
32  University of Cambridge, School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK (GRID:grid.5335.0) (ISNI:0000000121885934) 
33  University of Cambridge, MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, Cambridge, UK (GRID:grid.5335.0) (ISNI:0000000121885934) 
34  University of Oxford, Cancer Epidemiology Unit, Nuffield Department of Population Health, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948) 
35  Imperial College London, Department of Epidemiology and Biostatistics, London, UK (GRID:grid.7445.2) (ISNI:0000 0001 2113 8111); Bjørknes University College, Department of Nutrition, Oslo, Norway (GRID:grid.7445.2); Oslo University Hospital, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo, Norway (GRID:grid.55325.34) (ISNI:0000 0004 0389 8485) 
Publication year
2020
Publication date
2020
Publisher
Nature Publishing Group
e-ISSN
20452322
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1038/s41598-020-71302-5
ProQuest document ID
1888631113
Copyright
© The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.