A Body Shape Index (ABSI) achieves better mortality risk stratification than alternative indices of abdominal obesity: results from a large European cohort
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All-cause mortalityAnthropometric measuresMass indexOverweightCancerPredictionAdipositySize
Christakoudi, S., Tsilidis, K. K., Muller, D. C., Freisling, H., Weiderpass, E., Overvad, K., ... & Zhang, J. (2020). A Body Shape Index (ABSI) achieves better mortality risk stratification than alternative indices of abdominal obesity: results from a large European cohort. Scientific reports, 10(1), 1-15. [https://doi.org/10.1038/s41598-020-71302-5]
SponsorshipEuropean Commission European Commission Joint Research Centre; International Agency for Research on Cancer; Danish Cancer Society; Ligue nationale contre le cancer; Institut Gustave Roussy; Mutuelle Generale de l'Education Nationale (France); Institut National de la Sante et de la Recherche Medicale (Inserm); Deutsche Krebshilfe; Helmholtz Association; Federal Ministry of Education & Research (BMBF); Deutsche Krebshilfe; Deutsches Krebsforschungszentrum (Germany); Federal Ministry of Education & Research (BMBF); Hellenic Health Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro (AIRC); Italian National Research Council; Dutch Ministry of Public Health, Welfare and Sports (VWS); Netherlands Cancer Registry (NKR); LK Research Funds; Dutch Prevention Funds; Netherlands Organization for Scientific Research (NWO); Netherlands Government World Cancer Research Fund International (WCRF); Netherlands Government; European Research Council (Norway) ERC-2009AdG 232997; Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health (Norway); Instituto de Salud Carlos III PI13/00061 PI13/01162; Junta de Andalucia; Regional Government of Asturias (Spain); Regional Government of Basque Country (Spain); Regional Government of Murcia (Spain); Regional Government of Navarra (Spain); Catalan Institute of Oncology (Barcelona) (Spain); Swedish Cancer Society; Swedish Research Council; County Council of Skane (Sweden); County Council of Vasterbotten (Sweden); Cancer Research UK 14136 C570/A16491 C8221/A19170; Medical Research Council UK (MRC) 1000143 MR/M012190/1
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.