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)

Ulf Ekelund, Heather A. Ward, Teresa Norat, Jian'an Luan, Anne M. May, Elisabete Weiderpass, Stephen J. Sharp, Kim Overvad, Jane Nautrup Østergaard, Anne Tjønneland, Nina Føns Johnsen, Sylvie Mesrine, Agnès Fournier, Guy Fagherazzi, Antonia Trichopoulou, Pagona Lagiou, Dimitrios Trichopoulos, Kuanrong Li, Rudolf Kaaks, Pietro FerrariIdlir Licaj, Mazda Jenab, Manuela Bergmann, Heiner Boeing, Domenico Palli, Sabina Sieri, Salvatore Panico, Rosario Tumino, Paolo Vineis, Petra H. Peeters, Evelyn Monnikhof, H. Bas Bueno-De-Mesquita, J. Ramón Quirós, Antonio Agudo, María José Sánchez, José María Huerta, Eva Ardanaz, Larraitz Arriola, Bo Hedblad, Elisabet Wirfält, Malin Sund, Mattias Johansson, Timothy J. Key, Ruth C. Travis, Kay Tee Khaw, Søren Brage, Nicholas J. Wareham, Elio Riboli

Research output: Contribution to journalArticle

173 Citations (Scopus)

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. Centerspecific 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.

Original languageEnglish
Pages (from-to)613-621
Number of pages9
JournalAmerican Journal of Clinical Nutrition
Volume101
Issue number3
DOIs
Publication statusPublished - Mar 1 2015

Fingerprint

Adiposity
Waist Circumference
Exercise
Mortality
Neoplasms
Life Tables
Sex Education
Abdominal Obesity
Life Expectancy
Proportional Hazards Models
Self Report
Population
Meta-Analysis
Body Mass Index
Cohort Studies
Public Health
Age Groups
Obesity
Smoking
Alcohols

Keywords

  • Cohort study
  • Epidemiology
  • Exercise
  • Mortality
  • Obesity
  • Physical activity
  • Population attributable fraction

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

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; Østergaard, Jane Nautrup; Tjønneland, Anne; Johnsen, Nina Føns; Mesrine, Sylvie; Fournier, Agnès; Fagherazzi, Guy; Trichopoulou, Antonia; Lagiou, Pagona; Trichopoulos, Dimitrios; Li, Kuanrong; Kaaks, Rudolf; Ferrari, Pietro; Licaj, Idlir; Jenab, Mazda; Bergmann, Manuela; Boeing, Heiner; Palli, Domenico; Sieri, Sabina; Panico, Salvatore; Tumino, Rosario; Vineis, Paolo; Peeters, Petra H.; Monnikhof, Evelyn; Bueno-De-Mesquita, H. Bas; Quirós, J. Ramón; Agudo, Antonio; Sánchez, María José; Huerta, José María; Ardanaz, Eva; Arriola, Larraitz; Hedblad, Bo; Wirfält, Elisabet; Sund, Malin; Johansson, Mattias; Key, Timothy J.; Travis, Ruth C.; Khaw, Kay Tee; Brage, Søren; Wareham, Nicholas J.; Riboli, Elio.

In: American Journal of Clinical Nutrition, Vol. 101, No. 3, 01.03.2015, p. 613-621.

Research output: Contribution to journalArticle

Ekelund, U, Ward, HA, Norat, T, Luan, J, May, AM, Weiderpass, E, Sharp, SJ, Overvad, K, Østergaard, JN, Tjønneland, A, Johnsen, NF, Mesrine, S, Fournier, 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, Quirós, JR, Agudo, A, Sánchez, MJ, Huerta, JM, Ardanaz, E, Arriola, L, Hedblad, B, Wirfält, E, Sund, M, Johansson, M, Key, TJ, Travis, RC, Khaw, KT, Brage, S, Wareham, NJ & Riboli, E 2015, '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)', American Journal of Clinical Nutrition, vol. 101, no. 3, pp. 613-621. https://doi.org/10.3945/ajcn.114.100065
Ekelund, Ulf ; Ward, Heather A. ; Norat, Teresa ; Luan, Jian'an ; May, Anne M. ; Weiderpass, Elisabete ; Sharp, Stephen J. ; Overvad, Kim ; Østergaard, Jane Nautrup ; Tjønneland, Anne ; Johnsen, Nina Føns ; Mesrine, Sylvie ; Fournier, Agnès ; Fagherazzi, Guy ; Trichopoulou, Antonia ; Lagiou, Pagona ; Trichopoulos, Dimitrios ; Li, Kuanrong ; Kaaks, Rudolf ; Ferrari, Pietro ; Licaj, Idlir ; Jenab, Mazda ; Bergmann, Manuela ; Boeing, Heiner ; Palli, Domenico ; Sieri, Sabina ; Panico, Salvatore ; Tumino, Rosario ; Vineis, Paolo ; Peeters, Petra H. ; Monnikhof, Evelyn ; Bueno-De-Mesquita, H. Bas ; Quirós, J. Ramón ; Agudo, Antonio ; Sánchez, María José ; Huerta, José María ; Ardanaz, Eva ; Arriola, Larraitz ; Hedblad, Bo ; Wirfält, Elisabet ; Sund, Malin ; Johansson, Mattias ; Key, Timothy J. ; Travis, Ruth C. ; Khaw, Kay Tee ; Brage, Søren ; Wareham, Nicholas J. ; Riboli, Elio. / 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). In: American Journal of Clinical Nutrition. 2015 ; Vol. 101, No. 3. pp. 613-621.
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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. Centerspecific 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.",
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TY - JOUR

T1 - Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women

T2 - The European prospective investigation into cancer and nutrition study (EPIC)

AU - Ekelund, Ulf

AU - Ward, Heather A.

AU - Norat, Teresa

AU - Luan, Jian'an

AU - May, Anne M.

AU - Weiderpass, Elisabete

AU - Sharp, Stephen J.

AU - Overvad, Kim

AU - Østergaard, Jane Nautrup

AU - Tjønneland, Anne

AU - Johnsen, Nina Føns

AU - Mesrine, Sylvie

AU - Fournier, Agnès

AU - Fagherazzi, Guy

AU - Trichopoulou, Antonia

AU - Lagiou, Pagona

AU - Trichopoulos, Dimitrios

AU - Li, Kuanrong

AU - Kaaks, Rudolf

AU - Ferrari, Pietro

AU - Licaj, Idlir

AU - Jenab, Mazda

AU - Bergmann, Manuela

AU - Boeing, Heiner

AU - Palli, Domenico

AU - Sieri, Sabina

AU - Panico, Salvatore

AU - Tumino, Rosario

AU - Vineis, Paolo

AU - Peeters, Petra H.

AU - Monnikhof, Evelyn

AU - Bueno-De-Mesquita, H. Bas

AU - Quirós, J. Ramón

AU - Agudo, Antonio

AU - Sánchez, María José

AU - Huerta, José María

AU - Ardanaz, Eva

AU - Arriola, Larraitz

AU - Hedblad, Bo

AU - Wirfält, Elisabet

AU - Sund, Malin

AU - Johansson, Mattias

AU - Key, Timothy J.

AU - Travis, Ruth C.

AU - Khaw, Kay Tee

AU - Brage, Søren

AU - Wareham, Nicholas J.

AU - Riboli, Elio

PY - 2015/3/1

Y1 - 2015/3/1

N2 - 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. Centerspecific 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.

AB - 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. Centerspecific 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.

KW - Cohort study

KW - Epidemiology

KW - Exercise

KW - Mortality

KW - Obesity

KW - Physical activity

KW - Population attributable fraction

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