Most studies have used body-mass index (BMI) to evaluate the association of body fat content with the risk of death. However, body fat distribution is also associated with the risk of death, according to a new study published in the New England Journal of Medicine.

European investigators from multiple institutions examined the association of BMI, waist size, and waist-to-hip ratio with the risk of death among 359,387 participants from nine countries in a study called European Prospective Investigation into Cancer and Nutrition (EPIC). During an average follow-up period of over 9 years, 14,723 of the study participants died. The investigators found that larger waist circumference and waist-to-hip ratio were both associated with an increased risk of death. These findings suggest that both the amount of fat and the distribution of that fat in the body are related to the risk of death.

The results of this study highlight the importance of assessing the distribution of body fat, even among people who are not overweight. Increased general body fat and increased abdominal fat (more commonly referred to as a 'spare tire') both seem to increase the risk of death.