HALS and NHANES means of body measures.

<p>Comparison of mean values in HALS1 and in NHANES 1999–2004 nonpregnant adults. ABSI z scores are based on the NHANES 1999–2004 population normals.</p

HALS1 mortality hazard association with ABSI versus waist to hip ratio.

<p>Results of Cox proportional hazard modeling for mortality risk with ABSI or WHR z scores, or both, taken as linear predictors. Ranges in parentheses are 95% confidence intervals. Only the subsample with hip measurements in HALS1 is used (; 1408 deaths).</p><p>SD = standard deviation; Δ<i>_i</i>  = Akaike information criterion score difference relative to the best performing model shown (see Methods); <i>R</i>² = coefficient of determination.</p

Body size and shape and mortality hazard.

<p>Results of Cox proportional hazard modeling for mortality risk with ABSI, BMI, or WC, as well as sex, taken as linear predictors. Ranges in parentheses are 95% confidence intervals. The restricted models are unadjusted but included only those people who had all the measurements required for the adjusted model. The adjusted models included as additional predictors ethnicity, smoking, presence of diabetes, blood pressure, and serum cholesterol.</p><p>This is the same as <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0039504#pone-0039504-t002" target="_blank">Table 2</a>, but with ABSI, BMI, or WC, rather than their z scores, used as predictors.</p><p>SD  =  standard deviation. The population standard deviations used here are for ABSI, for BMI, and for WC.</p

Mortality hazard association with HALS1 ABSI z score.

<p>Results of Cox proportional hazard modeling for mortality risk at different lead times with ABSI (N) at HALS1 taken as a linear predictor. Ranges in parentheses are 95% confidence intervals.</p><p>SD = standard deviation.</p

Mean and standard deviation of ABSI, BMI, and WC by age and sex.

<p>Markers show the sample quantities for each age; the smooth curves shown were used to convert values to z scores. Units are for ABSI, for BMI, and for WC.</p

A New Body Shape Index Predicts Mortality Hazard Independently of Body Mass Index

<div><h3>Background</h3><p>Obesity, typically quantified in terms of Body Mass Index (BMI) exceeding threshold values, is considered a leading cause of premature death worldwide. For given body size (BMI), it is recognized that risk is also affected by body shape, particularly as a marker of abdominal fat deposits. Waist circumference (WC) is used as a risk indicator supplementary to BMI, but the high correlation of WC with BMI makes it hard to isolate the added value of WC.</p> <h3>Methods and Findings</h3><p>We considered a USA population sample of 14,105 non-pregnant adults () from the National Health and Nutrition Examination Survey (NHANES) 1999–2004 with follow-up for mortality averaging 5 yr (828 deaths). We developed A Body Shape Index (ABSI) based on WC adjusted for height and weight:</p><p></p><p></p> <p>ABSI had little correlation with height, weight, or BMI. Death rates increased approximately exponentially with above average baseline ABSI (overall regression coefficient of per standard deviation of ABSI [95% confidence interval: –]), whereas elevated death rates were found for both high and low values of BMI and WC. (–) of the population mortality hazard was attributable to high ABSI, compared to (–) for BMI and (–) for WC. The association of death rate with ABSI held even when adjusted for other known risk factors including smoking, diabetes, blood pressure, and serum cholesterol. ABSI correlation with mortality hazard held across the range of age, sex, and BMI, and for both white and black ethnicities (but not for Mexican ethnicity), and was not weakened by excluding deaths from the first 3 yr of follow-up.</p> <h3>Conclusions</h3><p>Body shape, as measured by ABSI, appears to be a substantial risk factor for premature mortality in the general population derivable from basic clinical measurements. ABSI expresses the excess risk from high WC in a convenient form that is complementary to BMI and to other known risk factors.</p> </div

Mortality hazard association with ABSI from HALS1 and HALS2.

<p>Results of Cox proportional hazard modeling for mortality risk with ABSI1 or ABSI2 (ABSI from HALS1 or HALS2 measurements, respectively) or ΔABSI (ABSI2 minus ABSI1), or combinations thereof, taken as linear predictors. Ranges in parentheses are 95% confidence intervals. Only the subsample with measurements in both HALS1 and HALS2 is used (; 1094 deaths).</p><p>SD = standard deviation.</p

Body size and shape z scores and mortality hazard.

<p>Results of Cox proportional hazard modeling for mortality risk with ABSI, BMI, or WC z scores taken as linear predictors. Ranges in parentheses are 95% confidence intervals. The restricted models are unadjusted but included only those people who had all the measurements required for the adjusted model. The adjusted models included as additional predictors sex, ethnicity, smoking, presence of diabetes, blood pressure, and serum cholesterol.</p><p>SD  =  standard deviation.</p

Mortality hazard by ABSI, BMI, and WC.

<p>Estimates are from proportional hazard modeling where log mortality hazard is a smoothing-spline function in ABSI, BMI, or WC. Dashed curves show 95% confidence intervals. Corresponding population percentiles are given in the top axis; the range shown is the 1st through 99th percentiles. The vertical axis is logarithmic. This is the same as <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0039504#pone-0039504-g002" target="_blank">Figure 2</a>, but with ABSI, BMI, or WC, rather than their z scores, used as predictors. Units are for ABSI, for BMI, and for WC.</p

Mortality by quintile.

<p>Cox proportional hazard modeling for mortality risk with ABSI, BMI or WC z score quintiles taken as the predictors. Hazard ratios are relative to the middle quintile in each case. Ranges in parentheses are 95% confidence intervals.</p><p>The between-quintile cut points are for ABSI; for BMI; and for WC.</p