A Body Shape Index (ABSI) achieves better mortality risk stratification than alternative indices of abdominal obesity: results from a large European cohort
Sofia Christakoudi, Konstantinos K. Tsilidis, David C. Muller, Heinz Freisling, Elisabete Weiderpass, Kim Overvad, Stefan Söderberg, Christel Häggström, Tobias Pischon, Christina C. Dahm, Jie Zhang, Anne Tjønneland, Jytte Halkjær, Conor MacDonald, Marie‐Christine Boutron‐Ruault, Francesca Romana Mancini, Tilman Kühn, Rudolf Kaaks, Matthias B. Schulze, Antonia Trichopoulou, Anna Karakatsani, Eleni Peppa, Giovanna Masala, Valeria Pala, Salvatore Panico, Rosario Tumino, Carlotta Sacerdote, J. Ramón Quirós, Antonio Agudo, María‐José Sánchez, Lluís Cirera, Aurelio Barricarte, Pilar Amiano, Ensieh Memarian, Emily Sonestedt, Bas Bueno‐de‐Mesquita, Anne M. May, Kay‐Tee Khaw, Nicholas J. Wareham, Tammy Y. N. Tong, Inge Huybrechts, Hwayoung Noh, Elom K. Aglago, Merete Ellingjord‐Dale, Heather Ward, Dagfinn Aune, Elio Ríboli
Abstract
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/m 2 ) or obese (BMI ≥ 30 kg/m 2 ) 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.