Background Evidence on body fat distribution shows opposing effects of waist circumference (WC) and hip circumference (HC) for coronary heart disease (CHD). We aimed to investigate the causality and the shape of such associations. Methods UK Biobank is a prospective cohort study of 0.5 million adults aged 40–69 years recruited between 2006 and 2010. Adjusted hazard ratios (HRs) for the associations of measured and genetically predicted body mass index (BMI), WC, HC and waist-to-hip ratio with incident CHD were obtained from Cox models. Mendelian randomization (MR) was used to assess causality. The analysis included 456 495 participants (26 225 first-ever CHD events) without prior CHD. Results All measures of adiposity demonstrated strong, positive and approximately log-linear associations with CHD risk over a median follow-up of 12.7 years. For HC, however, the association became inverse given the BMI and WC (HR per usual SD 0.95, 95% CI 0.93–0.97). Associations for BMI and WC remained independently positive after adjustment for other adiposity measures and were similar (1.14, 1.13–1.16 and 1.18, 1.15–1.20, respectively), with WC displaying stronger associations among women. Blood pressure, plasma lipids and dysglycaemia accounted for much of the observed excess risk. MR results were generally consistent with the observational, implying causality. Conclusions Body fat distribution measures displayed similar associations with CHD risk as BMI except for HC, which was inversely associated with CHD risk (given WC and BMI). These findings suggest that different measures of body fat distribution likely influence CHD risk through both overlapping and independent mechanisms.

中文翻译：

---

英国生物银行 50 万成年人肥胖指标与冠心病风险的独立相关性

背景 身体脂肪分布的证据表明腰围 (WC) 和臀围 (HC) 对冠心病 (CHD) 的影响相反。我们的目的是调查这种关联的因果关系和形式。方法 英国生物银行是一项前瞻性队列研究，在 2006 年至 2010 年间招募了 50 万名年龄在 40-69 岁的成年人。对测量的和基因预测的体重指数 (BMI)、WC、HC 和腰围之间的关系进行调整后的风险比 (HR)。从 Cox 模型中获得了与发生 CHD 相关的髋关节比。孟德尔随机化（MR）用于评估因果关系。该分析包括 456 495 名未患 CHD 的参与者（26 225 例首次 CHD 事件）。结果 在中位随访 12.7 年中，所有肥胖指标均显示出与 CHD 风险呈强正相关且近似对数线性关系。然而，对于 HC，考虑到 BMI 和 WC，这种关联变得相反（HR 通常 SD 0.95，95% CI 0.93-0.97）。在调整其他肥胖指标后，BMI 和 WC 的关联仍然独立为正，并且相似（分别为 1.14、1.13-1.16 和 1.18、1.15-1.20），其中 WC 在女性中表现出更强的关联。血压、血脂和血糖异常是观察到的超额风险的主要原因。MR 结果与观察结果基本一致，暗示着因果关系。结论 身体脂肪分布测量结果与 BMI 与 CHD 风险的相关性相似，但 HC 除外，HC 与 CHD 风险呈负相关（考虑到 WC 和 BMI）。这些发现表明，不同的身体脂肪分布测量方法可能通过重叠和独立的机制影响冠心病风险。