Journal
AMERICAN JOURNAL OF CLINICAL NUTRITION
Volume 101, Issue 3, Pages 613-621Publisher
OXFORD UNIV PRESS
DOI: 10.3945/ajcn.114.100065
Keywords
cohort study; epidemiology; obesity; physical activity; exercise; mortality; population attributable fraction
Categories
Funding
- European Commission: Public Health and Consumer Protection Directorate
- Research Directorate-General present
- Deutsche Krebshilfe
- German Cancer Research Center
- German Federal Ministry of Education and Research
- Danish Cancer Society
- Health Research Fund of the Spanish Ministry of Health (Network of Centers of Research in Epidemiology and Public Health) [C03/09]
- Spanish Regional Government of Andalucia
- Cancer Research United Kingdom
- Medical Research Council, United Kingdom
- Stroke Association, United Kingdom
- British Heart Foundation
- Department of Health, United Kingdom
- Food Standards Agency, United Kingdom
- Wellcome Trust, United Kingdom
- Greek Ministry of Health and Social Solidarity
- Hellenic Health Foundation
- Greek Ministry of Education
- Italian Association for Research on Cancer
- Dutch Ministry of Public Health, Welfare, and Sports
- Regional Cancer Registry Amsterdam of the Netherlands
- World Cancer Research Fund
- Statistics Netherlands
- Swedish Cancer Society
- Swedish Scientific Council
- Regional Government of Skane, Sweden
- French League Against Cancer
- 3M Company
- Mutuelle Generale de l'Education Nationale, France
- Institut Gustave Roussy, France
- Institut National de la Sante et de la Recherche Medicale, France
- MRC Epidemiology Unit Programmes [MC_UU_12015/1, MC_UU_12015/4]
- Spanish Regional Government of Asturias
- Spanish Regional Government of Basque Country
- Spanish Regional Government of Murcia
- Spanish Regional Government of Navarra
- National Cancer Registry
- Regional Cancer Registry East of the Netherlands
- Regional Cancer Registry Maastricht of the Netherlands
- MRC [MC_UU_12015/4, G0501294, MC_UU_12015/1, MC_UU_12015/3, MC_U106179473] Funding Source: UKRI
- Cancer Research UK [16491, 14136] Funding Source: researchfish
- Medical Research Council [MC_UU_12015/3, G0401527, MC_U106179473, MC_UU_12015/4, G1000143, MC_UU_12015/1, G0501294, MC_U106179471] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0512-10135, NF-SI-0512-10114] Funding Source: researchfish
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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.
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