{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T14:41:21Z","timestamp":1792593681813,"version":"4.5.0"},"reference-count":71,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006095","name":"Helse S\u00f8r-\u00d8st RHF","doi-asserted-by":"publisher","award":["2017076"],"award-info":[{"award-number":["2017076"]}],"id":[{"id":"10.13039\/501100006095","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Epidemiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Few studies have investigated the association between adiposity and risk of aortic dissection and data is lacking on adiposity measures other than body mass index (BMI). We analyzed the association between adiposity and risk of aortic dissection in the UK Biobank, and the Japan Specific Health Checkups (J-SHC) Study, and conducted a meta-analysis of cohort studies to clarify the associations between adiposity and risk of aortic dissection. The analytical cohorts included 496,255 participants in the UK Biobank and 630,841 participants in the J-SHC Study. Multivariable Cox proportional hazards regression models were used to analyze associations between adiposity and risk of aortic dissection. PubMed and Embase were searched for relevant studies up to February 27, 2026. Random effects models were used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs) for the association between adiposity and risk of aortic dissection. In the UK Biobank and J-SHC, there were 371 and 105 aortic dissections during 12.3 and 4 years follow-up, respectively. In the UK Biobank, positive associations (HRs, 95% CIs) were observed between high BMI (1.54, 1.01\u20132.37, p\n                    <jats:sub>trend<\/jats:sub>\n                    =0.01), waist circumference (1.82, 1.27\u20132.60, p\n                    <jats:sub>trend<\/jats:sub>\n                    =0.001), hip circumference (1.77, 1.25\u20132.50, p\n                    <jats:sub>trend<\/jats:sub>\n                    &lt;0.001), waist-to-height ratio (1.88, 1.30\u20132.70, p\n                    <jats:sub>trend<\/jats:sub>\n                    =0.10), and fat mass (1.36, 0.97\u20131.91, p\n                    <jats:sub>trend<\/jats:sub>\n                    =0.02) and aortic dissection risk, but no clear association was observed for waist-to-hip ratio (1.28, 0.90\u20131.81, p\n                    <jats:sub>trend<\/jats:sub>\n                    =0.08) and body fat percentage (1.09, 0.77\u20131.54, p\n                    <jats:sub>trend<\/jats:sub>\n                    =0.53). In the J-SHC Study, higher BMI (2.36, 0.98\u20134.84, p\n                    <jats:sub>trend<\/jats:sub>\n                    =0.018), waist circumference (2.26, 1.18\u20134.60, p\n                    <jats:sub>trend<\/jats:sub>\n                    =0.003), and waist-to-height ratio (2.61, 1.27\u20135.92, p\n                    <jats:sub>trend<\/jats:sub>\n                    =0.009) were positively associated with aortic dissection mortality. Five cohort studies were included in the meta-analysis on BMI and aortic dissection (2007 cases and 4,962,288 participants). The summary RR per 5\u00a0kg\/m\n                    <jats:sup>2<\/jats:sup>\n                    increment in BMI was 1.09 (1.00-1.20, I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200943%), per 10\u00a0cm increment in waist circumference was 1.21 (1.05\u20131.40, I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200950%,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20092), and per 0.1 unit increment in waist-to-height ratio was 1.32 (1.08\u20131.61, I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200939%,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20092). These findings provide evidence for a positive association between both general and abdominal adiposity and the risk of aortic dissection, with the strongest associations observed for high waist-to-height ratio. Although further large-scale studies are warranted for confirmation, these findings suggest avoiding excess weight may be an important strategy for the prevention of aortic dissection.\n                  <\/jats:p>","DOI":"10.1007\/s10654-026-01456-5","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T01:41:57Z","timestamp":1792546917000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adiposity and the risk of aortic dissection incidence and mortality: results from the UK Biobank, the J-SHC study and a meta-analysis of cohort studies"],"prefix":"10.1007","author":[{"given":"Alison","family":"Dillman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoichiro","family":"Otaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Sanchez-Perez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Momina Yawar","family":"Irfan Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Hibino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuneo","family":"Konta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunihiro","family":"Yamagata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shouichi","family":"Fujimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiko","family":"Tsuruya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichiei","family":"Narita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Kasahara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yugo","family":"Shibagaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunitoshi","family":"Iseki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiki","family":"Moriyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahide","family":"Kondo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Asahi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsu","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4533-1722","authenticated-orcid":false,"given":"Dagfinn","family":"Aune","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"key":"1456_CR1","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/S0140-6736(08)60994-0","volume":"372","author":"J Golledge","year":"2008","unstructured":"Golledge J, Eagle KA. Acute aortic dissection. Lancet. 2008;372:55\u201366.","journal-title":"Lancet"},{"key":"1456_CR2","doi-asserted-by":"publisher","first-page":"16053","DOI":"10.1038\/nrdp.2016.53","volume":"2","author":"CA Nienaber","year":"2016","unstructured":"Nienaber CA, Clough RE, Sakalihasan N, et al. Aortic dissection. Nat Rev Dis Primers. 2016;2:16053.","journal-title":"Nat Rev Dis Primers"},{"key":"1456_CR3","first-page":"694","volume":"38","author":"FJ Criado","year":"2011","unstructured":"Criado FJ. Aortic dissection: a 250-year perspective. Tex Heart Inst J. 2011;38:694\u2013700.","journal-title":"Tex Heart Inst J"},{"key":"1456_CR4","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1016\/S0140-6736(14)61005-9","volume":"385","author":"CA Nienaber","year":"2015","unstructured":"Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet. 2015;385:800\u201311.","journal-title":"Lancet"},{"key":"1456_CR5","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1177\/1538574410362118","volume":"44","author":"A Karthikesalingam","year":"2010","unstructured":"Karthikesalingam A, Holt PJ, Hinchliffe RJ, Thompson MM, Loftus IM. The diagnosis and management of aortic dissection. Vasc Endovascular Surg. 2010;44:165\u20139.","journal-title":"Vasc Endovascular Surg"},{"key":"1456_CR6","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.001513","volume":"4","author":"M Landenhed","year":"2015","unstructured":"Landenhed M, Engstrom G, Gottsater A, et al. Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: a prospective cohort study. J Am Heart Assoc. 2015;4:e001513.","journal-title":"J Am Heart Assoc"},{"key":"1456_CR7","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1002\/bjs.1800780407","volume":"78","author":"DP Strachan","year":"1991","unstructured":"Strachan DP. Predictors of death from aortic aneurysm among middle-aged men: the Whitehall study. Br J Surg. 1991;78:401\u20134.","journal-title":"Br J Surg"},{"key":"1456_CR8","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1161\/CIRCULATIONAHA.121.056546","volume":"145","author":"M Hibino","year":"2022","unstructured":"Hibino M, Otaki Y, Kobeissi E, et al. Blood pressure, hypertension, and the risk of aortic dissection incidence and mortality: results from the J-SCH study, the UK Biobank study, and a meta-analysis of cohort studies. Circulation. 2022;145:633\u201344.","journal-title":"Circulation"},{"key":"1456_CR9","doi-asserted-by":"publisher","first-page":"57594","DOI":"10.18632\/oncotarget.16338","volume":"8","author":"PH Sung","year":"2017","unstructured":"Sung PH, Yang YH, Chiang HJ, et al. Risk of aortic aneurysm and dissection in patients with autosomal-dominant polycystic kidney disease: a nationwide population-based cohort study. Oncotarget. 2017;8:57594\u2013604.","journal-title":"Oncotarget"},{"key":"1456_CR10","doi-asserted-by":"publisher","first-page":"12083","DOI":"10.1038\/s41598-025-96529-y","volume":"15","author":"MYI Khan","year":"2025","unstructured":"Khan MYI, Dillman A, Sanchez-Perez M, Hibino M, Aune D. Tobacco smoking and the risk of aortic dissection in the UK Biobank and a meta-analysis of prospective studies. Sci Rep. 2025;15:12083.","journal-title":"Sci Rep"},{"key":"1456_CR11","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1097\/01.md.0000145366.40805.f8","volume":"83","author":"MA Gonzalez-Gay","year":"2004","unstructured":"Gonzalez-Gay MA, Garcia-Porrua C, Pineiro A, Pego-Reigosa R, Llorca J, Hunder GG. Aortic aneurysm and dissection in patients with biopsy-proven giant cell arteritis from northwestern Spain: a population-based study. Medicine (Baltimore). 2004;83:335\u201341.","journal-title":"Medicine (Baltimore)"},{"key":"1456_CR12","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000036499","volume":"102","author":"C Elendu","year":"2023","unstructured":"Elendu C, Amaechi DC, Elendu TC, Ibhiedu JO, Torubiri AO, Okoye OK. Comprehensive review of aortic aneurysms, dissections, and cardiovascular complications in connective tissue disorders. Medicine (Baltimore). 2023;102:e36499.","journal-title":"Medicine (Baltimore)"},{"key":"1456_CR13","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1161\/01.CIR.85.1.205","volume":"85","author":"D Reed","year":"1992","unstructured":"Reed D, Reed C, Stemmermann G, Hayashi T. Are aortic aneurysms caused by atherosclerosis? Circulation. 1992;85:205\u201311.","journal-title":"Circulation"},{"key":"1456_CR14","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.007618","author":"T Avdic","year":"2018","unstructured":"Avdic T, Franzen S, Zarrouk M, et al. Reduced long-term risk of aortic aneurysm and aortic dissection among individuals with type 2 diabetes mellitus: a nationwide observational study. J Am Heart Assoc. 2018. https:\/\/doi.org\/10.1161\/JAHA.117.007618.","journal-title":"J Am Heart Assoc"},{"key":"1456_CR15","doi-asserted-by":"publisher","first-page":"e027045","DOI":"10.1161\/JAHA.122.027045","volume":"12","author":"A Koba","year":"2023","unstructured":"Koba A, Yamagishi K, Sairenchi T, et al. Risk Factors for Mortality From Aortic Aneurysm and Dissection: Results From a 26-Year Follow-Up of a Community-Based Population. J Am Heart Assoc. 2023;12:e027045.","journal-title":"J Am Heart Assoc"},{"key":"1456_CR16","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1016\/j.jdiacomp.2018.09.009","volume":"32","author":"D Aune","year":"2018","unstructured":"Aune D, Schlesinger S, Norat T, Riboli E. Diabetes mellitus and the risk of abdominal aortic aneurysm: a systematic review and meta-analysis of prospective studies. J Diabetes Complicat. 2018;32:1169\u201374.","journal-title":"J Diabetes Complicat"},{"key":"1456_CR17","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1016\/S0140-6736(16)30175-1","volume":"388","author":"BMI Global","year":"2016","unstructured":"Global BMI, Mortality Collaboration. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016;388:776\u201386.","journal-title":"Lancet"},{"key":"1456_CR18","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1161\/CIRCULATIONAHA.115.016801","volume":"133","author":"D Aune","year":"2016","unstructured":"Aune D, Sen A, Norat T, et al. Body Mass Index, Abdominal Fatness and Heart Failure Incidence and Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies. Circulation. 2016;133:639\u201349.","journal-title":"Circulation"},{"key":"1456_CR19","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-017-0232-4","author":"D Aune","year":"2017","unstructured":"Aune D, Sen A, Schlesinger S, et al. Body mass index, abdominal fatness, fat mass and the risk of atrial fibrillation: a systematic review and dose-response meta-analysis of prospective studies. Eur J Epidemiol. 2017. https:\/\/doi.org\/10.1007\/s10654-017-0232-4.","journal-title":"Eur J Epidemiol"},{"key":"1456_CR20","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-017-0353-9","author":"D Aune","year":"2018","unstructured":"Aune D, Schlesinger S, Norat T, Riboli E. Body mass index, abdominal fatness, and the risk of sudden cardiac death: a systematic review and dose-response meta-analysis of prospective studies. Eur J Epidemiol. 2018. https:\/\/doi.org\/10.1007\/s10654-017-0353-9.","journal-title":"Eur J Epidemiol"},{"key":"1456_CR21","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1016\/S2213-8587(18)30288-2","volume":"6","author":"K Bhaskaran","year":"2018","unstructured":"Bhaskaran K, Dos-Santos-Silva I, Leon DA, Douglas IJ, Smeeth L. Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3.6 million adults in the UK. Lancet Diabetes Endocrinol. 2018;6:944\u201353.","journal-title":"Lancet Diabetes Endocrinol"},{"key":"1456_CR22","doi-asserted-by":"publisher","first-page":"2776","DOI":"10.1253\/circj.CJ-18-0721","volume":"82","author":"Y Otaki","year":"2018","unstructured":"Otaki Y, Watanabe T, Konta T, et al. Effect of hypertension on aortic artery disease-related mortality\u2009\u2212\u20093.8-year nationwide community-based prospective cohort study. Circ J. 2018;82:2776\u201382.","journal-title":"Circ J"},{"key":"1456_CR23","doi-asserted-by":"publisher","first-page":"338","DOI":"10.5551\/jat.57232","volume":"28","author":"M Takada","year":"2021","unstructured":"Takada M, Yamagishi K, Tamakoshi A, Iso H. Body mass index and mortality from aortic aneurysm and dissection. J Atheroscler Thromb. 2021;28:338\u201348.","journal-title":"J Atheroscler Thromb"},{"key":"1456_CR24","doi-asserted-by":"publisher","DOI":"10.5551\/jat.63753","author":"Y Otaki","year":"2022","unstructured":"Otaki Y, Watanabe T, Konta T, et al. A body shape index and aortic disease-related mortality in Japanese general population. J Atheroscler Thromb. 2022. https:\/\/doi.org\/10.5551\/jat.63753.","journal-title":"J Atheroscler Thromb"},{"key":"1456_CR25","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-026-01402-5","author":"D Aune","year":"2026","unstructured":"Aune D, Otaki Y, Mahamat-Saleh Y, et al. Adiposity and the risk of aortic aneurysm: results from the UK Biobank, Japan-specific health check-ups study and a systematic review and meta-analysis of cohort studies. Eur J Epidemiol. 2026. https:\/\/doi.org\/10.1007\/s10654-026-01402-5.","journal-title":"Eur J Epidemiol"},{"key":"1456_CR26","doi-asserted-by":"publisher","first-page":"e1001779","DOI":"10.1371\/journal.pmed.1001779","volume":"12","author":"C Sudlow","year":"2015","unstructured":"Sudlow C, Gallacher J, Allen N, et al. UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS Med. 2015;12:e1001779.","journal-title":"PLoS Med"},{"key":"1456_CR27","doi-asserted-by":"publisher","first-page":"408","DOI":"10.5551\/jat.63416","volume":"30","author":"T Tanimura","year":"2023","unstructured":"Tanimura T, Teramoto M, Tamakoshi A, Iso H. Association of physical activity with aortic disease in Japanese men and women: the Japan collaborative cohort study. J Atheroscler Thromb. 2023;30:408\u201314.","journal-title":"J Atheroscler Thromb"},{"key":"1456_CR28","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1111\/obr.12656","volume":"19","author":"A Jayedi","year":"2018","unstructured":"Jayedi A, Rashidy-Pour A, Khorshidi M, Shab-Bidar S. Body mass index, abdominal adiposity, weight gain and risk of developing hypertension: a systematic review and dose-response meta-analysis of more than 2.3 million participants. Obes Rev. 2018;19:654\u201367.","journal-title":"Obes Rev"},{"key":"1456_CR29","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.atherosclerosis.2021.08.004","volume":"332","author":"T Kosugi","year":"2021","unstructured":"Kosugi T, Eriguchi M, Yoshida H, et al. Association between chronic kidney disease and new-onset dyslipidemia: The Japan Specific Health Checkups (J-SHC) study. Atherosclerosis. 2021;332:24\u201332.","journal-title":"Atherosclerosis"},{"key":"1456_CR30","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.","journal-title":"BMJ"},{"key":"1456_CR31","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","volume":"7","author":"R DerSimonian","year":"1986","unstructured":"DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177\u201388.","journal-title":"Control Clin Trials"},{"key":"1456_CR32","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1093\/oxfordjournals.aje.a116237","volume":"135","author":"S Greenland","year":"1992","unstructured":"Greenland S, Longnecker MP. Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol. 1992;135:1301\u20139.","journal-title":"Am J Epidemiol"},{"key":"1456_CR33","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1093\/aje\/kwh142","volume":"159","author":"V Bagnardi","year":"2004","unstructured":"Bagnardi V, Zambon A, Quatto P, Corrao G. Flexible meta-regression functions for modeling aggregate dose-response data, with an application to alcohol and mortality. Am J Epidemiol. 2004;159:1077\u201386.","journal-title":"Am J Epidemiol"},{"key":"1456_CR34","doi-asserted-by":"publisher","first-page":"1831","DOI":"10.1002\/1097-0258(20000730)19:14<1831::AID-SIM502>3.0.CO;2-1","volume":"19","author":"P Royston","year":"2000","unstructured":"Royston P. A strategy for modelling the effect of a continuous covariate in medicine and epidemiology. Stat Med. 2000;19:1831\u201347.","journal-title":"Stat Med"},{"key":"1456_CR35","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","volume":"21","author":"JP Higgins","year":"2002","unstructured":"Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539\u201358.","journal-title":"Stat Med"},{"key":"1456_CR36","unstructured":"Wells G, Shea B, O\u2019Connell D et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp, Accessed 11.08.2025."},{"key":"1456_CR37","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1136\/bmjnph-2020-000218","volume":"4","author":"RE Halvorsen","year":"2021","unstructured":"Halvorsen RE, Elvestad M, Molin M, Aune D. Fruit and vegetable consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of prospective studies. BMJ Nutr Prev Health. 2021;4:519\u201331.","journal-title":"BMJ Nutr Prev Health"},{"key":"1456_CR38","doi-asserted-by":"publisher","first-page":"268","DOI":"10.7326\/M16-2607","volume":"167","author":"TJ VanderWeele","year":"2017","unstructured":"VanderWeele TJ, Ding P. Sensitivity analysis in observational research: introducing the E-value. Ann Intern Med. 2017;167:268\u201374.","journal-title":"Ann Intern Med"},{"key":"1456_CR39","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","volume":"315","author":"M Egger","year":"1997","unstructured":"Egger M, Davey SG, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629\u201334.","journal-title":"BMJ"},{"key":"1456_CR40","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.2307\/2533446","volume":"50","author":"CB Begg","year":"1994","unstructured":"Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088\u2013101.","journal-title":"Biometrics"},{"key":"1456_CR41","unstructured":"World Cancer Research Fund & American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. The Third Expert Report. 2018."},{"key":"1456_CR42","doi-asserted-by":"publisher","first-page":"2338","DOI":"10.1093\/eurjpc\/zwac205","volume":"29","author":"Y Suzuki","year":"2022","unstructured":"Suzuki Y, Kaneko H, Yano Y, et al. Dose-dependent relationship of blood pressure and glycaemic status with risk of aortic dissection and aneurysm. Eur J Prev Cardiol. 2022;29:2338\u201346.","journal-title":"Eur J Prev Cardiol"},{"key":"1456_CR43","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2024.12.003","author":"D Chen","year":"2024","unstructured":"Chen D, Fang K, Luo M, Xiao Y, Zhao Y, Shu C. Aortic dissection incidence and risk factor analysis: findings from the China Kadoorie Biobank. Eur J Vasc Endovasc Surg. 2024. https:\/\/doi.org\/10.1016\/j.ejvs.2024.12.003.","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"1456_CR44","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1038\/nature05487","volume":"444","author":"LF Van Gaal","year":"2006","unstructured":"Van Gaal LF, Mertens IL, De Block CE. Mechanisms linking obesity with cardiovascular disease. Nature. 2006;444:875\u201380.","journal-title":"Nature"},{"key":"1456_CR45","doi-asserted-by":"publisher","first-page":"e0177175","DOI":"10.1371\/journal.pone.0177175","volume":"12","author":"MG Swainson","year":"2017","unstructured":"Swainson MG, Batterham AM, Tsakirides C, Rutherford ZH, Hind K. Prediction of whole-body fat percentage and visceral adipose tissue mass from five anthropometric variables. PLoS ONE. 2017;12:e0177175.","journal-title":"PLoS ONE"},{"issue":"1","key":"1456_CR46","doi-asserted-by":"publisher","first-page":"18575","DOI":"10.1038\/s41598-020-75667-5","volume":"10","author":"EB Parente","year":"2020","unstructured":"Parente EB, Mutter S, Harjutsalo V, Ahola AJ, Forsblom C, Groop PH. Waist-height ratio and waist are the best estimators of visceral fat in type 1 diabetes. Sci Rep. 2020;10:18575.","journal-title":"Sci Rep"},{"key":"1456_CR47","doi-asserted-by":"publisher","first-page":"e14740","DOI":"10.1097\/MD.0000000000014740","volume":"98","author":"JY Yu","year":"2019","unstructured":"Yu JY, Choi WJ, Lee HS, Lee JW. Relationship between inflammatory markers and visceral obesity in obese and overweight Korean adults: An observational study. Med (Baltim). 2019;98:e14740.","journal-title":"Med (Baltim)"},{"key":"1456_CR48","doi-asserted-by":"publisher","first-page":"5117","DOI":"10.1038\/s41467-022-32658-6","volume":"13","author":"Y Adachi","year":"2022","unstructured":"Adachi Y, Ueda K, Nomura S, et al. Beiging of perivascular adipose tissue regulates its inflammation and vascular remodeling. Nat Commun. 2022;13:5117.","journal-title":"Nat Commun"},{"key":"1456_CR49","doi-asserted-by":"publisher","first-page":"1094","DOI":"10.1161\/ATVBAHA.120.312464","volume":"40","author":"L Chang","year":"2020","unstructured":"Chang L, Garcia-Barrio MT, Chen YE. Perivascular adipose tissue regulates vascular function by targeting vascular smooth muscle cells. Arterioscler Thromb Vasc Biol. 2020;40:1094\u2013109.","journal-title":"Arterioscler Thromb Vasc Biol"},{"issue":"1","key":"1456_CR50","doi-asserted-by":"publisher","first-page":"20052","DOI":"10.1038\/s41598-021-99577-2","volume":"11","author":"S Boumiza","year":"2021","unstructured":"Boumiza S, Chahed K, Tabka Z, Jacob MP, Norel X, Ozen G. MMPs and TIMPs levels are correlated with anthropometric parameters, blood pressure, and endothelial function in obesity. Sci Rep. 2021;11:20052.","journal-title":"Sci Rep"},{"key":"1456_CR51","doi-asserted-by":"publisher","first-page":"2993","DOI":"10.1210\/jc.2009-2623","volume":"95","author":"R Unal","year":"2010","unstructured":"Unal R, Yao-Borengasser A, Varma V, et al. Matrix metalloproteinase-9 is increased in obese subjects and decreases in response to pioglitazone. J Clin Endocrinol Metab. 2010;95:2993\u20133001.","journal-title":"J Clin Endocrinol Metab"},{"key":"1456_CR52","doi-asserted-by":"publisher","first-page":"w14489","DOI":"10.4414\/smw.2017.14489","volume":"147","author":"J Gawinecka","year":"2017","unstructured":"Gawinecka J, Schonrath F, von Eckardstein A. Acute aortic dissection: pathogenesis, risk factors and diagnosis. Swiss Med Wkly. 2017;147:w14489.","journal-title":"Swiss Med Wkly"},{"key":"1456_CR53","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14217876","author":"H Zhang","year":"2025","unstructured":"Zhang H, Lun Y, Zhang J. Obesity: an underlying risk for acute aortic dissection. J Clin Med. 2025. https:\/\/doi.org\/10.3390\/jcm14217876.","journal-title":"J Clin Med"},{"key":"1456_CR54","doi-asserted-by":"publisher","first-page":"1642","DOI":"10.1053\/euhj.2001.2782","volume":"22","author":"R Erbel","year":"2001","unstructured":"Erbel R, Alfonso F, Boileau C, et al. Diagnosis and management of aortic dissection. Eur Heart J. 2001;22:1642\u201381.","journal-title":"Eur Heart J"},{"key":"1456_CR55","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1161\/ATVBAHA.109.192658","volume":"29","author":"SB Police","year":"2009","unstructured":"Police SB, Thatcher SE, Charnigo R, Daugherty A, Cassis LA. Obesity promotes inflammation in periaortic adipose tissue and angiotensin II-induced abdominal aortic aneurysm formation. Arterioscler Thromb Vasc Biol. 2009;29:1458\u201364.","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"1456_CR56","doi-asserted-by":"publisher","first-page":"H1932","DOI":"10.1152\/ajpheart.00961.2009","volume":"298","author":"SB Police","year":"2010","unstructured":"Police SB, Putnam K, Thatcher S, Batifoulier-Yiannikouris F, Daugherty A, Cassis LA. Weight loss in obese C57BL\/6 mice limits adventitial expansion of established angiotensin II-induced abdominal aortic aneurysms. Am J Physiol Heart Circ Physiol. 2010;298:H1932\u20138.","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"1456_CR57","doi-asserted-by":"publisher","first-page":"1603","DOI":"10.1016\/j.soard.2021.05.015","volume":"17","author":"LF Okida","year":"2021","unstructured":"Okida LF, Sasson M, Wolfers M, et al. Bariatric surgery is associated with reduced admission for aortic dissection: a nationwide case-control analysis. Surg Obes Relat Dis. 2021;17:1603\u201310.","journal-title":"Surg Obes Relat Dis"},{"key":"1456_CR58","doi-asserted-by":"publisher","first-page":"2690778","DOI":"10.1080\/14017431.2026.2690778","volume":"60","author":"L Skoglund Larsson","year":"2026","unstructured":"Skoglund Larsson L, Sjolander S, Johansson L, Soderberg S, Brunstrom M. Body size in young adulthood is associated with thoracic aortic events later in life. Scand Cardiovasc J. 2026;60:2690778.","journal-title":"Scand Cardiovasc J"},{"key":"1456_CR59","doi-asserted-by":"publisher","DOI":"10.1038\/s41440-026-02730-5","author":"Y Suzuki","year":"2026","unstructured":"Suzuki Y, Kaneko H, Okada A, et al. Prediction model for aortic dissection, aortic aneurysm, and peripheral artery disease. Hypertens Res. 2026. https:\/\/doi.org\/10.1038\/s41440-026-02730-5.","journal-title":"Hypertens Res"},{"key":"1456_CR60","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1079\/PHN2001322","volume":"5","author":"EA Spencer","year":"2002","unstructured":"Spencer EA, Appleby PN, Davey GK, Key TJ. Validity of self-reported height and weight in 4808 EPIC-Oxford participants. Public Health Nutr. 2002;5:561\u20135.","journal-title":"Public Health Nutr"},{"key":"1456_CR61","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-11-213","volume":"11","author":"M Bes-Rastrollo","year":"2011","unstructured":"Bes-Rastrollo M, Sabate J, Jaceldo-Siegl K, Fraser GE. Validation of self-reported anthropometrics in the Adventist Health Study 2. BMC Public Health. 2011;11:213.","journal-title":"BMC Public Health"},{"key":"1456_CR62","doi-asserted-by":"publisher","first-page":"30","DOI":"10.2188\/jea.JE20100058","volume":"21","author":"DH Lee","year":"2011","unstructured":"Lee DH, Shin A, Kim J, Yoo KY, Sung J. Validity of self-reported height and weight in a Korean population. J Epidemiol. 2011;21:30\u20136.","journal-title":"J Epidemiol"},{"key":"1456_CR63","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1093\/aje\/kwx246","volume":"186","author":"A Fry","year":"2017","unstructured":"Fry A, Littlejohns TJ, Sudlow C, et al. Comparison of sociodemographic and health-related characteristics of UK Biobank participants with those of the general population. Am J Epidemiol. 2017;186:1026\u201334.","journal-title":"Am J Epidemiol"},{"key":"1456_CR64","doi-asserted-by":"publisher","first-page":"2031","DOI":"10.1161\/CIRCULATIONAHA.112.000483","volume":"127","author":"DP Howard","year":"2013","unstructured":"Howard DP, Banerjee A, Fairhead JF, Perkins J, Silver LE, Rothwell PM. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation. 2013;127:2031\u20137.","journal-title":"Circulation"},{"key":"1456_CR65","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2021.762437","volume":"12","author":"SF Vatner","year":"2021","unstructured":"Vatner SF, Zhang J, Vyzas C, Mishra K, Graham RM, Vatner DE. Vascular stiffness in aging and disease. Front Physiol. 2021;12:762437.","journal-title":"Front Physiol"},{"key":"1456_CR66","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1161\/ATVBAHA.117.310433","volume":"38","author":"SK Prakash","year":"2018","unstructured":"Prakash SK, Milewicz DM. X Marks the Spot: The Profound Impact of Sex on Aortic Disease. Arterioscler Thromb Vasc Biol. 2018;38:9\u201311.","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"1456_CR67","doi-asserted-by":"publisher","first-page":"1436","DOI":"10.1016\/j.jvs.2019.02.032","volume":"70","author":"L\u00c5 Nyr\u00f8nning","year":"2019","unstructured":"Nyr\u00f8nning L\u00c5, Videm V, Romundstad PR, Hultgren R, Mattsson E. Female sex hormones and risk of incident abdominal aortic aneurysm in Norwegian women in the HUNT study. J Vasc Surg. 2019;70:1436\u201345.","journal-title":"J Vasc Surg"},{"key":"1456_CR68","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1161\/CIRCULATIONAHA.106.171016","volume":"113","author":"P Poirier","year":"2006","unstructured":"Poirier P, Giles TD, Bray GA, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2006;113:898\u2013918.","journal-title":"Circulation"},{"key":"1456_CR69","doi-asserted-by":"publisher","first-page":"2372","DOI":"10.1093\/eurheartj\/ehaf057","volume":"46","author":"A Peikert","year":"2025","unstructured":"Peikert A, Vaduganathan M, Claggett BL, et al. Near-universal prevalence of central adiposity in heart failure with preserved ejection fraction: the PARAGON-HF trial. Eur Heart J. 2025;46:2372\u201390.","journal-title":"Eur Heart J"},{"key":"1456_CR70","doi-asserted-by":"publisher","first-page":"1613","DOI":"10.1136\/heartjnl-2014-305816","volume":"100","author":"PK Myint","year":"2014","unstructured":"Myint PK, Kwok CS, Luben RN, Wareham NJ, Khaw KT. Body fat percentage, body mass index and waist-to-hip ratio as predictors of mortality and cardiovascular disease. Heart. 2014;100:1613\u20139.","journal-title":"Heart"},{"key":"1456_CR71","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/S2213-8587(24)00316-4","volume":"13","author":"F Rubino","year":"2025","unstructured":"Rubino F, Cummings DE, Eckel RH, et al. Definition and diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol. 2025;13:221\u201362.","journal-title":"Lancet Diabetes Endocrinol"}],"container-title":["European Journal of Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10654-026-01456-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10654-026-01456-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10654-026-01456-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T14:01:58Z","timestamp":1792591318000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10654-026-01456-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,21]]},"references-count":71,"alternative-id":["1456"],"URL":"https:\/\/doi.org\/10.1007\/s10654-026-01456-5","relation":{},"ISSN":["0393-2990","1573-7284"],"issn-type":[{"value":"0393-2990","type":"print"},{"value":"1573-7284","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,21]]},"assertion":[{"value":"4 June 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The UK Biobank has ethical approval from the North West Multi-Centre Research Ethics Committee, the National Information Governance Board for Health and Social Care in England and Wales, and the Community Health Index Advisory Group in Scotland. In addition, an independent Ethics and Governance Council was formed in 2004 to oversee the UK Biobank\u2019s continuous adherence to the Ethics and Governance framework, which were developed for the study.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that there are no competing interests associated with this manuscript.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}