An EU-funded study of approximately 360,000 individuals in 9 European countries has shown that having a very large waistline almost doubles the risk of premature death, even in individuals with a 'normal' body mass index. The results are published online in the New England Journal of Medicine. The researchers recommend that, given the fact that storing excess fat around the waist poses a significant health risk, routine health check-ups should include waist and hip measurements. The results, they conclude, 'support the use of waist circumference or waist-to-hip ratio in addition to BMI in the assessment of the risk of death, particularly among persons with a low BMI.' The study was part of the EPIC project ('European prospective investigation into cancer, chronic diseases, nutrition and lifestyle'), which received approximately EUR 1 million from the EU's Sixth Framework Programme (FP6) under the Thematic area 'Research for policy support'. Body mass index (BMI, a metric ratio of weight to height) has often been used in studies to associate body fat with the risk of premature death. However, BMI is a general measurement and does not take into account the way fat is distributed in the body. The current study addressed the fact that while fat around the waist is more likely to result in chronic disease than fat around the hips, few studies have examined the relationship between body-fat distribution and premature death. The researchers looked at BMI, waist circumference and waist-to-hip ratio in 359,387 study participants, whose average age was 51 years. Women made up 65.4% of the study sample. After approximately 10 years, 14,723 of the subjects had died: among those, higher BMI was associated with cardiovascular disease and cancer, and lower BMI with respiratory disease. When analysing the data, the researchers adjusted for educational level, smoking status, alcohol consumption, physical activity and height. The study's main finding was that very large waist size increases the risk of premature death independently of body mass index (BMI). People who had a larger waistline (over 120 cm for men and over 100 cm for women) had an almost twofold risk for premature death compared to smaller-waisted subjects; each 5-cm increase in waist circumference increased the mortality risk by 17% in men and 13% in women. According to Dr Tobias Pischon of the German Institute of Human Nutrition, 'The most important result of our study is the finding that not just being overweight, but also the distribution of body fat, affects the risk of premature death of each individual.' He explained that abdominal fat is not just 'a mere energy depot', but it also releases cytokines, hormones and metabolically active compounds that can contribute to the development of chronic diseases. 'This may be the reason for the link,' he said. The study also provided further evidence that a higher body mass index is significantly related to mortality, and determined that a BMI of approximately 25.3 in men and 24.3 in women provided the lowest risk for premature death. 'Our study shows that accumulating excess fat around your middle can put your health at risk even if your weight is normal based on body mass index scores,' said Professor Elio Riboli of Imperial College London in the UK. 'There aren't many simple individual characteristics that can increase a person's risk of premature death to this extent, independently from smoking and drinking.' 'The good news is that you don't need to take an expensive test and wait ages for the result to assess this aspect of your health,' said Professor Riboli. 'It costs virtually nothing to measure your waist and hip size. Doctors and nurses can easily identify people who need to take certain steps to improve their health by routinely monitoring these measurements. If you have a large waist, you probably need to increase the amount of exercise you do every day, avoid excessive alcohol consumption and improve your diet. This could make a huge difference in reducing your risk of an early death.'