The bigger a person's waistline, the more likely they are to die of any cause, regardless of whether they are overweight or not, a study says.
Researchers at the American Cancer Society in Atlanta looked at the association between the waistlines of 48,500 men and 56,343 women aged 50 years and older, and death from any illness.
After adjusting for body mass index and other risk factors, the researchers found that men and women with very large waists - 120 centimeters (47 inches) or greater in men, and 110 centimeters (42 inches) or more in women - were around twice as likely to die of any cause as people with smaller waists.
The risk of dying was greater regardless of whether a man or woman was normal weight, overweight or obese, found the study published in the American Medical Association's Archives of Internal Medicine.
The study also found that men and women with very large waists were "more likely than those with smaller waists to be less educated, to have a high BMI (body mass index), to be physically inactive, to be former smokers, and to have a history of cardiovascular disease, cancer or respiratory disease."
Respiratory disease was the most likely cause of death among the very large-girthed, followed by cardiovascular disease and cancer, the study said.
Previous studies have associated large waistlines with heart disease, inflammatory illness, insulin resistance, high blood cholesterol and type two diabetes.
The link between waist circumference and mortality from a host of illnesses "may be because waist circumference is strongly correlated with fat tissue in the viscera - surrounding the organs in the abdomen - which is thought to be more dangerous than fat tissue under the skin," the study said.
"Our results suggest that, regardless of weight, avoiding gains in waist circumference may reduce the risk of premature mortality," the authors of the study said.