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ORIGINAL RESEARCH COMMUNICATION |
1 From the Centre for Ageing and Public Health (AEF, GMP, and EB) and the Nutrition and Public Health Interventions Research Unit (RU), London School of Hygiene and Tropical Medicine, London, United Kingdom, and the Section of Care of the Elderly, Faculty of Medicine, Imperial College, Hammersmith Campus, London, United Kingdom (CJB)
Background: Guidelines for optimal weight in older persons are limited by uncertainty about the ideal body mass index (BMI) or the usefulness of alternative anthropometric measures.
Objective: We investigated the association of BMI (in kg/m2), waist circumference, and waist-hip ratio (WHR) with mortality and cause-specific mortality.
Design: Subjects aged 
75 y (n = 14 833) from 53 family practices in the United Kingdom underwent a health assessment that included measurement of BMI and waist and hip circumferences; they also were followed up for mortality.
Results: During a median follow-up of 5.9 y, 6649 subjects died (46% of circulatory causes). In nonsmoking men and women (90% of the cohort), compared with the lowest quintile of BMI (<23 in men and <22.3 in women), adjusted hazard ratios (HRs) for mortality were <1 for all other quintiles of BMI (P for trend = 0.0003 and 0.0001 in men and women, respectively). Increasing WHR was associated with increasing HRs in men and women (P for trend = 0.008 and 0.0002, respectively). BMI was not associated with circulatory mortality in men (P for trend = 0.667) and was negatively associated in women (P for trend = 0.004). WHR was positively related to circulatory mortality in both men and women (P for trend = 0.001 and 0.005, respectively). Waist circumference was not associated with all-cause or circulatory mortality.
Conclusions: Current guidelines for BMI-based risk categories overestimate risks due to excess weight in persons aged 75 y. Increased mortality risk is more clearly indicated for relative abdominal obesity as measured by high WHR.
Key Words: Older persons • obesity • mortality • body mass index • waist-hip ratio
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