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)

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)
Authors: Ekelund, U
Ward, HA
Norat, T
Luan, J
May, AM
Weiderpass, E
Sharp, SJ
Overvad, K
Ostergaard, JN
TjOnneland, A
Johnsen, NF
Mesrine, S
Foamier, A
Fagherazzi, G
Trichopoulou, A
Lagiou, P
Trichopoulos, D
Li, K
Kaaks, R
Ferrari, P
Licaj, I
Jenab, M
Bergmann, M
Boeing, H
Palli, D
Sieri, S
Panico, S
Tumino, R
Vineis, P
Peeters, PH
Monnikhof, E
Bueno-de-Mesquita, HB
Ramon Quiros, J
Agudo, A
Sanchez, M-J
Maria Huerta, J
Ardanaz, E
Arriola, L
Hedblad, B
Wirfalt, E
Sand, M
Johansson, M
Key, TJ
Travis, RC
Khaw, K-T
Brage, S
Wareham, NJ
Riboli, E
Item Type: Journal Article
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/m2) (>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 × BMI and PA × 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.
Issue Date: 1-Mar-2015
Date of Acceptance: 12-Dec-2014
ISSN: 0002-9165
Publisher: American Society for Nutrition
Start Page: 613
End Page: 621
Journal / Book Title: American Journal of Clinical Nutrition
Volume: 101
Issue: 3
Copyright Statement: © The Authors 2015 This is an open access article distributed under the CC-BY license (
Sponsor/Funder: Imperial College Trust
Funder's Grant Number: P47328
Keywords: Science & Technology
Life Sciences & Biomedicine
Nutrition & Dietetics
cohort study
physical activity
population attributable fraction
Abdominal Fat
Body Mass Index
Cohort Studies
Follow-Up Studies
Hospitals, University
Middle Aged
Motor Activity
Obesity, Abdominal
Outpatient Clinics, Hospital
Proportional Hazards Models
Prospective Studies
Risk Factors
Self Report
Sex Characteristics
Waist Circumference
11 Medical And Health Sciences
09 Engineering
Publication Status: Published
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care

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