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Better than BMI?

A Body Shape Index - a new predictor of mortality

ABSI appears to outperform other popular anthropometry-based measures of adiposity

A Body Shape Index (ABSI), is a more effective predictor of mortality than Body Mass Index (BMI), according to at study published by the online journal PLoS ONE.

In 2012, Dr Nir Krakauer, an assistant professor of civil engineering in City College of New York's Grove School of Engineering, and his father, Dr Jesse Krakauer, developed a new method to quantify the risk specifically associated with abdominal obesity.

The team analyzed data for 7,011 adults, 18+, who participated in the first Health and Lifestyle Survey (HALS1), conducted in Great Britain in the mid-1980s, and a follow-up survey seven years later (HALS2). The sample was broadly representative of the British population in terms of region, employment status, national origin, and age. They used National Health Service records through 2009 to identify deaths and cancer cases: 2,203 deaths were recorded among the sample population.

Comparison of mortality hazard by ABSI for NHANES 1999–2004 compared to HALS1. Estimates are from proportional hazard modeling where log mortality hazard is a smoothing-spline function in ABSI z score (calculated using NHANES normals). Curves are positioned so that an ABSI z score of 0 has a relative death rate of 1. Dashed curves show 95% confidence intervals. The ranges shown cover the 1st through 99th percentiles of ABSI in each sample. The vertical axis is logarithmic. (Credit: Image courtesy of City College of New York)

Then, they compared all-cause mortality from the HALS sample with ABSI and other variables, including BMI, waist circumference, waist - hip ratio and waist - height ratio.

The analysis found ABSI to be a strong indicator of mortality hazard among the HALS population. Death rates increased by a factor of 1.13 (95% confidence interval, 1.09-1.16) for each standard deviation increase in ABSI. Persons with ABSI in the top 20% were found to have death rates 61% higher than those with ABSI in the bottom 20%.

The results tracked closely with the earlier study, which used data from the National Health and Nutrition Examination Survey (NHANES), conducted in the United States between 1999 and 2004. This provides stronger evidence that ABSI is a valid indicator of the risk of premature death across different populations. Further, they showed that ABSI outperformed commonly used measures of abdominal obesity, including waist circumference, waist - hip ratio and waist - height ratio.

Also, because the data came from two surveys seven years apart, the researchers were able to assess the effect of change in ABSI on mortality. The found an increase in ABSI correlated with increased risk of death, and that the more recent ABSI measurement was a more reliable predictor. Noting this, the researchers contend that further investigation is warranted into whether lifestyle or other interventions could reduce ABSI and help people live longer.

“ABSI appears to outperform other popular anthropometry-based measures of adiposity, such as WHtR and WHR. Mortality risk appears to track changes in ABSI over time, motivating further research into whether lifestyle or other interventions could trigger reduction in ABSI and incur the longevity benefits seen in this study for those with lower ABSI,” the researchers concluded.

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