Waist circumference trumps BMI for mortality risk prediction

Body mass index versus waist circumference as predictors of mortality in Canadian adults

Int J Obes (Lond). 2012 Nov;36(11):1450-4. doi: 10.1038/ijo.2011.268. Epub 2012 Jan 17.

A E Staiano, B A Reeder, S Elliott, M R Joffres, P Pahwa, S A Kirkland, G Paradis and P T Katzmarzyk



Elevated body mass index (BMI) and waist circumference (WC) are associated with increased mortality risk, but it is unclear which anthropometric measurement most highly relates to mortality. We examined single and combined associations between BMI, WC, waist–hip ratio (WHR) and all-cause, cardiovascular disease (CVD) and cancer mortality.


We used Cox proportional hazard regression models to estimate relative risks of all-cause, CVD and cancer mortality in 8061 adults (aged 18–74 years) in the Canadian Heart Health Follow-Up Study (1986–2004). Models controlled for age, sex, exam year, smoking, alcohol use and education.


There were 887 deaths over a mean 13 (SD 3.1) years follow-up. Increased risk of death from all-causes, CVD and cancer were associated with elevated BMI, WC and WHR (P


BMI and WC predicted higher all-cause and cause-specific mortality, and WC predicted the highest risk for death overall and among overweight and obese adults. Elevated WC has clinical significance in predicting mortality risk beyond BMI.

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2 Responses to Waist circumference trumps BMI for mortality risk prediction

  1. Reuben Lorenson says:

    I believe this illustrates that BMI is really just a kind of fancy way of looking at weight height ratio which does not decriminate well between muscle and fat whereas the WC helps to dicriminate and also tends to indicate where the fat is stored which makes a significant difference in how it effects morbidity risk. Dr. R.G.Lorenson Dr. PH, MSc., MPH, CNS, CHESS

  2. …except that the new CMS obesity payments hinge on BMI? I know this correlation of waist circumference to risk was made a few years ago but it seems CMS has decided to go the same way of the USDA’s Food Pyramid – contradicting science in favor of tradition.

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