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

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.

  • 1. Cameron AJ, Welborn TA, Zimmet PZ, et al. Overweight and obesity in Australia: the 1999–2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Med J Aust 2003; 178: 427-432. <MJA full text>
  • 2. Australian Bureau of Statistics. National health survey: summary of results, 2004–05. Canberra: ABS, 2006. (ABS Cat. No. 4364.0.) http://www.abs.gov.au/AUSSTATS/abs@.nsf/Details Page/4364.02004-05?OpenDocument (accessed Jun 2009).
  • 3. Van Gaal LF, Mertens IL, De Block CE. Mechanisms linking obesity with cardiovascular disease. Nature 2006; 444: 875-880.
  • 4. Australian Institute of Health and Welfare, National Heart Foundation of Australia. The relationship between overweight, obesity and cardiovascular disease: a literature review prepared for the National Heart Foundation of Australia. Cardiovascular disease series no. 23. Canberra: AIHW, 2004. (AIHW Cat. No. CVD 29.) http://www.aihw.gov.au/publications/index.cfm/title/10078 (accessed Jun 2009).
  • 5. Cameron AJ, Zimmet PZ. Expanding evidence for the multiple dangers of epidemic abdominal obesity. Circulation 2008; 117: 1624-1626.
  • 6. Australian Institute of Health and Welfare. Chronic diseases and associated risk factors in Australia, 2006. Canberra: AIHW, 2006. (AIHW Cat. No. PHE 81.) http://www.aihw.gov.au/publications/index.cfm/title/10319 (accessed Jun 2009).
  • 7. Dunstan DW, Zimmet PZ, Welborn TA, et al. The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) — methods and response rates. Diabetes Res Clin Pract 2002; 57: 119-129.
  • 8. Barr L, Magliano D, Zimmet P, et al. AusDiab 2005. The Australian Diabetes, Obesity and Lifestyle Study. Tracking the accelerating epidemic: its causes and outcomes. Report. Melbourne: International Diabetes Institute, 2006.
  • 9. Brown CD, Higgins M, Donato KA, et al. Body mass index and the prevalence of hypertension and dyslipidemia. Obes Res 2000; 8: 605-619.
  • 10. Sicree RA, Zimmet PZ, Dunstan DW, et al. Differences in height explain gender differences in the response to the oral glucose tolerance test — the AusDiab study. Diabet Med 2008; 25: 296-302.
  • 11. World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO consultation. Part 1: Diagnosis and classification of diabetes mellitus. WHO/NCD/NCS/99.2. Geneva: WHO Department of Noncommunicable Disease Surveillance, 1999. http://whqlibdoc.who.int/hq/1999/WHO_NCD_NCS_99.2.pdf (accessed Jun 2009).
  • 12. World Health Organization, International Diabetes Federation. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia. Report of a WHO/IDF consultation. Geneva: WHO, 2006. http://www.who.int/diabetes/publications/Definition%20and%20diagnosis %20of%20diabetes_new.pdf (accessed Jun 2009).
  • 13. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome — a new world-wide definition. A consensus statement from the International Diabetes Federation. Diabet Med 2006; 23: 469-480.
  • 14. World Health Organization. Obesity — preventing and managing the global epidemic. Report of a WHO consultation. WHO technical report series 894. Geneva: WHO, 2000. http://whqlibdoc.who.int/trs/WHO_TRS_894.pdf (accessed Jun 2009).
  • 15. Australian Institute of Health and Welfare. The Active Australia Survey. A guide and manual for implementation, analysis and reporting. Canberra: AIHW, 2003. (AIHW Cat. No. CVD 22.) http://www.aihw.gov.au/publications/cvd/aas/aas.pdf (accessed Jun 2009).
  • 16. Brown WJ, Trost SG, Bauman A, et al. Test–retest reliability of four physical activity measures used in population surveys. J Sci Med Sport 2004; 7: 205-215.
  • 17. World Health Organization. MONICA manual. Part IV: Event registration. Section 1: Coronary event registration data component. Geneva: WHO, 1999. http://www.ktl.fi/publications/monica/manual/part4/iv-1.htm (accessed Jun 2009).
  • 18. Barr ELM, Tonkin AM, Welborn TA, et al. Validity of self-reported cardiovascular disease events in comparison to medical record adjudication and a state-wide hospital morbidity database — the AusDiab study. Intern Med J 2009; 39: 49-53.
  • 19. Barr EL, Zimmet PZ, Welborn TA, et al. Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation 2007; 116: 151-157.
  • 20. Magliano D, Liew D, Pater H, et al. Accuracy of the Australian National Death Index: comparison with adjudicated fatal outcomes among Australian participants in the Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) study. Aust N Z J Public Health 2003; 27: 649-653.
  • 21. Greenland S. Applications of stratified analysis methods. In: Rothman KJ, Greenland S, editors. Modern epidemiology. Philadelphia: Lipincott-Raven, 1998.
  • 22. Zhang J, Yu KF. What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA 1998; 280: 1690-1691.
  • 23. Welborn TA, Dhaliwal SS, Bennett SA. Waist–hip ratio is the dominant risk factor predicting cardiovascular death in Australia. Med J Aust 2003; 179: 580-585. <MJA full text>
  • 24. Simpson JA, MacInnis RJ, Peeters A, et al. A comparison of adiposity measures as predictors of all-cause mortality: the Melbourne Collaborative Cohort Study. Obesity 2007; 15: 994-1003.
  • 25. World Health Organization. The SuRF Report 2: Surveillance of chronic disease risk factors. Country-level data and comparable estimates. Geneva: WHO, 2005. https://apps.who.int/infobase/surf2/start.html (accessed Jun 2009).
  • 26. Mathers C, Vos T, Stevenson C. The burden of disease and injury in Australia. Canberra: AIHW, 1999. (AIHW Cat. No. PHE 17.) http://www.aihw.gov.au/publications/index.cfm/title/5180 (accessed Jun 2009).
  • 27. Access Economics. The economic costs of obesity. Report by Access Economics Pty Limited to Diabetes Australia. Canberra: Access Economics, 2006. http://www.accesseconomics.com.au/publicationsreports/showreport.php?id=102 (accessed Jun 2009).
  • 28. Levine B. What does the population attributable fraction mean? Prev Chronic Dis 2007; 4: A14.
  • 29. Preventative Health Taskforce. Obesity in Australia: a need for urgent action. Technical Report No. 1. Canberra: Preventative Health Taskforce, 2008. http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/tech-obesity (accessed Jun 2009).
  • 30. Roxon N. Australia measures up — national obesity campaign [media release]. 17 Oct 2008. Canberra: Minister for Health and Ageing, 2008. http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr08-nr-nr137.htm (accessed Jul 2009).
  • 31. Dalton M, Cameron AJ, Zimmet PZ, et al. Waist circumference, waist–hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults. J Intern Med 2003; 254: 1-9.
  • 32. Zhang C, Rexrode KM, van Dam RM, et al. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women. Circulation 2008; 117: 1658-1667.
  • 33. Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008; 359: 2105-2120.
  • 34. Healy GN, Dunstan DW, Salmon J, et al. Breaks in sedentary time: beneficial associations with metabolic risk. Diabetes Care 2008; 31: 661-666.
  • 35. Healy GN, Dunstan DW, Salmon J, et al. Television time and continuous metabolic risk in physically active adults. Med Sci Sports Exerc 2008; 40: 639-645.
  • 36. Dunstan DW, Salmon J, Owen N, et al. Physical activity and television viewing in relation to risk of undiagnosed abnormal glucose metabolism in adults. Diabetes Care 2004; 27: 2603-2609.
  • 37. Owen N, Leslie E, Salmon J, et al. Environmental determinants of physical activity and sedentary behavior. Exerc Sport Sci Rev 2000; 28: 153-158.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article