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Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC)

Ekelund, Ulf; Ward, Heather A.; Norat, Teresa; Luan, Jian'an; May, Anne M.; Weiderpass, Elisabete; Sharp, Stephen J.; Overvad, Kim; Ostergaard, Jane Nautrup and Tjonneland, Anne, et al. (2015) In American Journal of Clinical Nutrition 101(3). p.613-621
Abstract
Background: The higher risk of death resulting from excess adiposity may be attenuated by physical activity (PA). However, the theoretical number of deaths reduced by eliminating physical inactivity compared with overall and abdominal obesity remains unclear. Objective: We examined whether overall and abdominal adiposity modified the association between PA and all-cause mortality and estimated the population attributable fraction (PAF) and the years of life gained for these exposures. Design: This was a cohort study in 334,161 European men and women. The mean follow-up time was 12.4 y, corresponding to 4,154,915 person-years. Height, weight, and waist circumference (WC) were measured in the clinic. PA was assessed with a validated... (More)
Background: The higher risk of death resulting from excess adiposity may be attenuated by physical activity (PA). However, the theoretical number of deaths reduced by eliminating physical inactivity compared with overall and abdominal obesity remains unclear. Objective: We examined whether overall and abdominal adiposity modified the association between PA and all-cause mortality and estimated the population attributable fraction (PAF) and the years of life gained for these exposures. Design: This was a cohort study in 334,161 European men and women. The mean follow-up time was 12.4 y, corresponding to 4,154,915 person-years. Height, weight, and waist circumference (WC) were measured in the clinic. PA was assessed with a validated self-report instrument. The combined associations between PA, BMI, and WC with mortality were examined with Cox proportional hazards models, stratified by center and age group, and adjusted for sex, education, smoking, and alcohol intake. Center-specific PAF associated with inactivity, body mass index (BMI; in kg/m(2)) (>30), and WC (>= 102 cm for men, >= 88 cm for women) were calculated and combined in random-effects meta-analysis. Life-tables analyses were used to estimate gains in life expectancy for the exposures. Results: Significant interactions (PA x BMI and PA x WC) were observed, so HRs were estimated within BMI and WC strata. The hazards of all-cause mortality were reduced by 16-30% in moderately inactive individuals compared with those categorized as inactive in different strata of BMI and WC. Avoiding all inactivity would theoretically reduce all-cause mortality by 7.35% (95% CI: 5.88%, 8.83%). Corresponding estimates for avoiding obesity (BMI >30) were 3.66% (95% CI: 2.30%, 5.01%). The estimates for avoiding high WC were similar to those for physical inactivity. Conclusion: The greatest reductions in mortality risk were observed between the 2 lowest activity groups across levels of general and abdominal adiposity, which suggests that efforts to encourage even small increases in activity in inactive individuals may be beneficial to public health. (Less)
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keywords
cohort study, epidemiology, obesity, physical activity, exercise, mortality, population attributable fraction
in
American Journal of Clinical Nutrition
volume
101
issue
3
pages
613 - 621
publisher
American Society for Clinical Nutrition
external identifiers
  • wos:000350538800026
  • scopus:84928705057
ISSN
1938-3207
DOI
10.3945/ajcn.114.100065
language
English
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yes
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1840c8aa-e65b-4a3f-9e4a-bf111594eeb0 (old id 5297029)
date added to LUP
2015-05-04 08:31:43
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2017-10-22 04:23:48
@article{1840c8aa-e65b-4a3f-9e4a-bf111594eeb0,
  abstract     = {Background: The higher risk of death resulting from excess adiposity may be attenuated by physical activity (PA). However, the theoretical number of deaths reduced by eliminating physical inactivity compared with overall and abdominal obesity remains unclear. Objective: We examined whether overall and abdominal adiposity modified the association between PA and all-cause mortality and estimated the population attributable fraction (PAF) and the years of life gained for these exposures. Design: This was a cohort study in 334,161 European men and women. The mean follow-up time was 12.4 y, corresponding to 4,154,915 person-years. Height, weight, and waist circumference (WC) were measured in the clinic. PA was assessed with a validated self-report instrument. The combined associations between PA, BMI, and WC with mortality were examined with Cox proportional hazards models, stratified by center and age group, and adjusted for sex, education, smoking, and alcohol intake. Center-specific PAF associated with inactivity, body mass index (BMI; in kg/m(2)) (>30), and WC (>= 102 cm for men, >= 88 cm for women) were calculated and combined in random-effects meta-analysis. Life-tables analyses were used to estimate gains in life expectancy for the exposures. Results: Significant interactions (PA x BMI and PA x WC) were observed, so HRs were estimated within BMI and WC strata. The hazards of all-cause mortality were reduced by 16-30% in moderately inactive individuals compared with those categorized as inactive in different strata of BMI and WC. Avoiding all inactivity would theoretically reduce all-cause mortality by 7.35% (95% CI: 5.88%, 8.83%). Corresponding estimates for avoiding obesity (BMI >30) were 3.66% (95% CI: 2.30%, 5.01%). The estimates for avoiding high WC were similar to those for physical inactivity. Conclusion: The greatest reductions in mortality risk were observed between the 2 lowest activity groups across levels of general and abdominal adiposity, which suggests that efforts to encourage even small increases in activity in inactive individuals may be beneficial to public health.},
  author       = {Ekelund, Ulf and Ward, Heather A. and Norat, Teresa and Luan, Jian'an and May, Anne M. and Weiderpass, Elisabete and Sharp, Stephen J. and Overvad, Kim and Ostergaard, Jane Nautrup and Tjonneland, Anne and Johnsen, Nina Fons and Mesrine, Sylvie and Foamier, Agnes and Fagherazzi, Guy and Trichopoulou, Antonia and Lagiou, Pagona and Trichopoulos, Dimitrios and Li, Kuanrong and Kaaks, Rudolf and Ferrari, Pietro and Licaj, Idlir and Jenab, Mazda and Bergmann, Manuela and Boeing, Heiner and Palli, Domenico and Sieri, Sabina and Panico, Salvatore and Tumino, Rosario and Vineis, Paolo and Peeters, Petra H. and Monnikhof, Evelyn and Bueno-de-Mesquita, H. Bas and Ramon Quiros, J. and Agudo, Antonio and Sanchez, Maria-Jose and Maria Huerta, Jose and Ardanaz, Eva and Arriola, Larraitz and Hedblad, Bo and Wirfält, Elisabet and Sand, Malin and Johansson, Mattias and Key, Timothy J. and Travis, Ruth C. and Khaw, Kay-Tee and Brage, Soren and Wareham, Nicholas J. and Riboli, Elio},
  issn         = {1938-3207},
  keyword      = {cohort study,epidemiology,obesity,physical activity,exercise,mortality,population attributable fraction},
  language     = {eng},
  number       = {3},
  pages        = {613--621},
  publisher    = {American Society for Clinical Nutrition},
  series       = {American Journal of Clinical Nutrition},
  title        = {Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC)},
  url          = {http://dx.doi.org/10.3945/ajcn.114.100065},
  volume       = {101},
  year         = {2015},
}