Health and mortality consequences of abdominal obesity: evidence from the AusDiab study

Adrian J Cameron, David W Dunstan, Neville Owen, Paul Z Zimmet, Elizabeth L M Barr, Andrew M Tonkin, Dianna J Magliano, Shirley G Murray, Timothy A Welborn and Jonathan E Shaw
Med J Aust 2009; 191 (4): 202-208.


Objective: To provide an estimate of the morbidity and mortality resulting from abdominal overweight and obesity in the Australian population.

Design and setting: Prospective, national, population-based study (the Australian Diabetes, Obesity and Lifestyle [AusDiab] study).

Participants: 6072 men and women aged ≥ 25 years at study entry between May 1999 and December 2000, and aged ≤ 75 years, not pregnant and for whom there were waist circumference data at the follow-up survey between June 2004 and December 2005.

Main outcome measures: Incident health outcomes (type 2 diabetes, hypertension, dyslipidaemia, the metabolic syndrome and cardiovascular diseases) at 5 years and mortality at 8 years. Comparison of outcome measures between those classified as abdominally overweight or obese and those with a normal waist circumference at baseline, and across quintiles of waist circumference, and (for mortality only) waist-to-hip ratio.

Results: Abdominal obesity was associated with odds ratios of between 2 and 5 for incident type 2 diabetes, dyslipidaemia, hypertension and the metabolic syndrome. The risk of myocardial infarction among obese participants was similarly increased in men (hazard ratio [HR], 2.75; 95% CI, 1.08–7.03), but not women (HR, 1.43; 95% CI, 0.37–5.50). Abdominal obesity-related population attributable fractions for these outcomes ranged from 13% to 47%, and were highest for type 2 diabetes. No significant associations were observed between all-cause mortality and increasing quintiles of abdominal obesity.

Conclusions: Our findings confirm that abdominal obesity confers a considerably heightened risk for type 2 diabetes, the metabolic syndrome (as well as its components) and cardiovascular disease, and they provide important information that enables a more precise estimate of the burden of disease attributable to obesity in Australia.

  • Adrian J Cameron1
  • David W Dunstan1
  • Neville Owen2
  • Paul Z Zimmet1
  • Elizabeth L M Barr1
  • Andrew M Tonkin3
  • Dianna J Magliano1
  • Shirley G Murray1
  • Timothy A Welborn4
  • Jonathan E Shaw1

  • 1 Baker IDI Heart and Diabetes Institute, Melbourne, VIC.
  • 2 School of Population Health, University of Queensland, Brisbane, QLD.
  • 3 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC.
  • 4 University of Western Australia, Perth, WA.


We are most grateful to the many people involved in organising and conducting the AusDiab study, and especially to the study participants for volunteering their valuable time. Adrian Cameron is supported by a postgraduate research scholarship (PP04M1794) from the National Heart Foundation of Australia. Elizabeth Barr is supported by a National Health and Medical Research Council (NHMRC) (379305)/National Heart Foundation of Australia (PP05M2346) joint postgraduate scholarship. David Dunstan is supported by Victorian Health Promotion Foundation Public Health Research Fellowships. Neville Owen is supported by a Queensland Health Core Research Infrastructure grant and by NHMRC Program Grant funding (301200). The AusDiab study was supported by a project grant from the NHMRC (233200). Collection and adjudication of non-fatal CVD outcomes was supported by a National Heart Foundation of Australia Research Grant in Aid (RES 17-01 2005). The AusDiab study, co-coordinated by the Baker IDI Heart and Diabetes Institute, gratefully acknowledges the generous support given by: Australian Government Department of Health and Ageing, Abbott Australasia, Alphapharm, AstraZeneca, Aventis Pharma, Bristol-Myers Squibb, City Health Centre Diabetes Service — Canberra, Diabetes Australia, Healthy Living NT, Eli Lilly Australia, Estate of the late Edward Wilson, GlaxoSmithKline, Jack Brockhoff Foundation, Janssen-Cilag, Kidney Health Australia, Marian & E.H. Flack Trust, Menzies Research Institute, Merck Sharp & Dohme, New South Wales Health, Northern Territory Department of Health and Families, Novartis, Novo Nordisk, Pfizer, Pratt Foundation, Queensland Health, Roche Diagnostics Australia, Royal Prince Alfred Hospital (Sydney), Sanofi-Synthelabo, South Australia Health, Tasmanian Department of Health and Human Services, Victorian Department of Human Services, and Western Australia Health.

Competing interests:

None identified.

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