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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  • Sofia Christakoudi, MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, United Kingdom., Department of Epidemiology and Biostatistics, , The School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG London, United Kingdom., United Kingdom
  • Konstantinos K Tsilidis, Department of Epidemiology and Biostatistics, , The School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG London, United Kingdom., Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45100, Ioannina, United Kingdom
  • David C Muller, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary’s Campus, Norfolk Place, W2 1PG London, United Kingdom, United Kingdom
  • Heinz Freisling, International Agency for Research on Cancer, World Health Organization, Lyon, France
  • Elisabete Weiderpass, International Agency for Research on Cancer, World Health Organization, Lyon, France
  • Kim Overvad
  • Stefan Söderberg, Umeå University, Sweden
  • Christel Häggström, Umeå University, Uppsala University, Sweden
  • Tobias Pischon, Max Delbrück Center for Molecular Medicine, Berlin, Charité Universitätsmedizin Berlin, Berlin Institute of Health (BIH), Germany
  • Christina C Dahm
  • Jie Zhang
  • Anne Tjønneland, Danish Cancer Society Research Center, The Danish Cancer Society, Copenhagen, University of Copenhagen, Denmark
  • Jytte Halkjær, Danish Cancer Society Research Center, The Danish Cancer Society, Copenhagen, Denmark
  • Conor MacDonald, 1] Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France [2] Paris-Sud University, UMRS 1018, F-94805 Villejuif, France [3] Institut Gustave Roussy, F-94805 Villejuif, France., France
  • Marie-Christine Boutron-Ruault, 1] Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France [2] Paris-Sud University, UMRS 1018, F-94805 Villejuif, France [3] Institut Gustave Roussy, F-94805 Villejuif, France., France
  • Francesca Romana Mancini, 1] Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France [2] Paris-Sud University, UMRS 1018, F-94805 Villejuif, France [3] Institut Gustave Roussy, F-94805 Villejuif, France., France
  • Tilman Kühn, German Cancer Research Center (DKFZ), Germany
  • Rudolf Kaaks, German Cancer Research Center (DKFZ), Germany
  • Matthias B Schulze, German Institute of Human Nutrition Potsdam-Rehbruecke, Potsdam, Germany., Institute of Nutritional Sciences, University of Potsdam, Nuthetal, Germany., Germany
  • Antonia Trichopoulou, Hellenic Health Foundation, Athens, Greece., Greece
  • Anna Karakatsani, “ATTIKON” University Hospital, Hellenic Health Foundation, Athens, Greece., Greece
  • Eleni Peppa, Hellenic Health Foundation, Athens, Greece., Greece
  • Giovanna Masala, Institute for Cancer Research, Italy
  • Valeria Pala, Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy., Italy
  • Salvatore Panico, Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy., Italy
  • Rosario Tumino, Cancer Registry and Histopathology Department, Azienda Sanitaria Provinciale (ASP) Ragusa, Italy., Italy
  • Carlotta Sacerdote, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Italy
  • J Ramón Quirós, Public Health Directorate, Asturias, Spain., Spain
  • Antonio Agudo, Unit of Nutrition and Cancer. Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain., Spain
  • Maria-Jose Sánchez, Andalusian School of Public Health (EASP), Granada, Instituto de Investigación Biosanitaria (ibs.GRANADA), Universidad de Granada, CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
  • Lluís Cirera, CIBER Epidemiology and Public Health (CIBERESP), Madrid, Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain., Department of Health and Social Sciences, University of Murcia, Murcia, Spain., Spain
  • Aurelio Barricarte-Gurrea, Navarra Public Health Institute, CIBER Epidemiology and Public Health (CIBERESP), Madrid, Navarre Public Health Institute, Pamplona, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain., Spain
  • Pilar Amiano, Biodonostia Health Research Institute, Department of Health and Social Sciences, University of Murcia, Murcia, Spain., Spain
  • Ensieh Memarian, Department of Nephrology in Lund, Clinical Sciences Lund, Skåne University Hospital and Lund University, Lund, Sweden., Sweden
  • Emily Sonestedt, Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, CRC, hus 60 plan 13 205 02 Malmö, Sweden., Sweden
  • Bas Bueno-de-Mesquita, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary’s Campus, Norfolk Place, W2 1PG London, United Kingdom, Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands., Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia., United Kingdom
  • Anne M May, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands
  • Kay-Tee Khaw, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, United Kingdom
  • Nicholas J Wareham, MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom., United Kingdom
  • Tammy Y N Tong, Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, United Kingdom., United Kingdom
  • Inge Huybrechts, International Agency for Research on Cancer, World Health Organization, Lyon, France
  • Hwayoung Noh, International Agency for Research on Cancer, World Health Organization, Lyon, France
  • Elom K Aglago, International Agency for Research on Cancer, World Health Organization, Lyon, France
  • Merete Ellingjord-Dale, Department of Epidemiology and Biostatistics, Imperial College London, London, England., United Kingdom
  • Heather A Ward, Department of Epidemiology and Biostatistics, Imperial College London, London, England., United Kingdom
  • Dagfinn Aune, Department of Epidemiology and Biostatistics, Imperial College London, London, England., Department of Nutrition, Bjørknes University College, Oslo, Norway., Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0372 Oslo, Norway. d.aune@imperial.ac.uk., United Kingdom
  • Elio Riboli, Department of Epidemiology and Biostatistics, Imperial College London, London, England., United Kingdom

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.

Original languageEnglish
Article number14541
JournalScientific Reports
Volume10
Issue1
Number of pages15
ISSN2045-2322
DOIs
Publication statusPublished - 2020

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