1
|
Chen Y, Yu W, Lv J, Sun D, Pei P, Du H, Yang L, Chen Y, Zhang H, Chen J, Chen Z, Li L, Yu C. Early adulthood BMI and cardiovascular disease: a prospective cohort study from the China Kadoorie Biobank. Lancet Public Health 2024:S2468-2667(24)00043-4. [PMID: 38885669 DOI: 10.1016/s2468-2667(24)00043-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The associations of early adulthood BMI with cardiovascular diseases have yet to be completely delineated. There is little reliable evidence about these associations among east Asian populations, that differ in fat distribution, disease patterns, and lifestyle factors from other populations. We aimed to study the associations between early adulthood BMI and cardiovascular diseases in a Chinese population, and the effect of midlife lifestyle factors on outcomes. METHODS In this prospective analysis, we used data from the China Kadoorie Biobank, a large and long-term cohort from five urban areas and five rural areas, using participants aged 35-70 years. The primary outcome was the incidence of cardiovascular diseases as a group, ischaemic heart disease, haemorrhagic stroke, and ischaemic stroke, which were obtained mainly through linkage to disease registries and the national database for health insurance claims. Early adulthood BMI was assessed through self-report at baseline survey. We used Cox proportional hazards regression models to examine the prospective associations. We also undertook multiplicative and additive interaction analyses to investigate the potential modification effect of midlife healthy lifestyle factors (a combined score covering smoking, drinking, physical activity, and diet). FINDINGS Participants were recruited for baseline survey between June, 2004, and July, 2008. During a median follow-up of 12·0 years (IQR 11·3-13·1), we documented 57 203 (15·9%) of incident cardiovascular diseases in 360 855 participants. After adjustment for potential confounders, monotonic dose-response associations were observed between higher early adulthood BMI and increased risks of incident cardiovascular diseases. Compared with an early adulthood BMI of 20·5-22·4 kg/m2 (the reference group), the hazard ratios for a BMI of less than 18·5 kg/m2 was 0·97 (95% CI 0·94-1·00), 18·5-20·4 kg/m2 was 0·97 (0·95-0·99), 22·5-23·9 kg/m2 was 1·04 (1·02-1·07), 24·0-25·9 kg/m2 was 1·12 (1·09-1·15), 26·0-27·9 kg/m2 was 1·19 (1·14-1·24), 28·0-29·9 kg/m2 was 1·34 (1·25-1·44), and ≥30·0 kg/m2 was 1·58 (1·42-1·75). Except for haemorrhagic stroke, lower early adulthood BMI (<20·5 kg/m2) was associated with decreased incident cardiovascular disease risks. No significant interaction was found between midlife healthy lifestyle factors and early adulthood BMI on cardiovascular disease risks. INTERPRETATION Increased risks of cardiovascular disease incidence were found among participants with high early adulthood adiposity, including ischaemic heart disease, haemorrhagic stroke, and ischaemic stroke. Our findings suggest early adulthood as an important time to focus on weight management and obesity prevention for cardiovascular health later in life. FUNDING National Natural Science Foundation of China, National Key Research and Development Program of China, Chinese Ministry of Science and Technology, Kadoorie Charitable Foundation, and the Wellcome Trust.
Collapse
Affiliation(s)
- Yuanyuan Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Wei Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Bejing, China
| | - Dianjianyi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China; Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
| | - Pei Pei
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
| | - Huaidong Du
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Huanxu Zhang
- Tongxiang Center for Disease Control and Prevention, Zhejiang, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China; Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Bejing, China.
| |
Collapse
|
2
|
Beamish AJ, Ryan Harper E, Järvholm K, Janson A, Olbers T. Long-term Outcomes Following Adolescent Metabolic and Bariatric Surgery. J Clin Endocrinol Metab 2023; 108:2184-2192. [PMID: 36947630 PMCID: PMC10438888 DOI: 10.1210/clinem/dgad155] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023]
Abstract
Severe obesity in adolescence negatively impacts upon health and wellbeing. Lifestyle modifications do not usually achieve a sufficient degree or durability of weight loss to mitigate the risk of medical complications. In recent years, metabolic and bariatric surgery (MBS), already a well-established treatment for adults with severe obesity, has emerged as an option in adolescents. Controlled studies in this age group have demonstrated substantial and sustained weight loss, improvements in associated health parameters, and a safety profile surpassing that observed in adult patients. This review aims to present published data on the results of MBS in adolescents with a focus on long-term outcomes. Indications for bariatric surgery and aspects of timing in the young person's life are also presented, along with safety considerations and factors influencing patient selection for surgery. We conclude, predominantly from short- to medium-term outcomes data, that MBS is a safe and valuable therapeutic option for adolescents with severe obesity. Considering the poor health and social wellbeing prognosis in this group, MBS appears to be underutilized. The need for continued research, multiprofessional specialist provision, coherent contemporary clinical guidelines, and routine long-term follow-up in adolescents undergoing MBS is highlighted.
Collapse
Affiliation(s)
- Andrew J Beamish
- Department of General Surgery, Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, Swansea, UK
- Department of Medicine, Swansea University Medical School, Swansea, UK
| | | | - Kajsa Järvholm
- Department of Psychology, Lund University, Lund, Sweden
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
| | - Annika Janson
- National Childhood Obesity Centre, Karolinska University Hospital, Stockholm, Sweden
- Division of Pediatric Endocrinology, Department of Women's and Children's Health Karolinska Institutet, Stockholm, Sweden
| | - Torsten Olbers
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
- Department of Biomedical and Clinical Sciences and Wallenberg Centre for Molecular Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
3
|
Jonsson KR, Corell M, Löfstedt P, Adjei NK. The clustering of multiple health and lifestyle behaviors among Swedish adolescents: a person-oriented analysis. Front Public Health 2023; 11:1178353. [PMID: 37538263 PMCID: PMC10394625 DOI: 10.3389/fpubh.2023.1178353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/16/2023] [Indexed: 08/05/2023] Open
Abstract
Background Knowledge of the distribution, prevalence, and clustering of multiple health and lifestyle related behaviors (HLBs) among adolescents can inform the development of effective health-promoting policies and interventions. We assessed the clustering of multiple HLBs among 11, 13 and 15-year-old Swedish adolescents and examined the socioeconomic and demographic correlates for the identified clusters. Methods We used data from the 2017/2018 Swedish Health Behaviour in School-aged children (HBSC) study to conduct sex and age-stratified latent class analysis (LCA). The LCA was based on five HLBs: eating behavior and habits (EBH), physical activity (PA), tobacco usage (TU), alcohol consumption (AC) and sleeping habits and patterns (SHPs). Multinomial logistic regression models were used to assess the associations between the identified clusters and the socioeconomic and demographic characteristics of adolescents and their parents. Results Health behaviors varied by sex and age. Four distinct clusters were identified based on sex: cluster 1 (Mixed eating behaviors and habits, physical activity and low alcohol consumption), cluster 2 (Healthy lifestyle behaviors), cluster 3 (Unhealthy lifestyle behaviors), and cluster 4 (Breakfast, low alcohol consumption and tobacco usage). In the age-stratified analyzes, three clusters were identified: cluster 1 (Unhealthy lifestyle behaviors), cluster 2 (Moderately healthy lifestyle behaviors) and cluster 3 (Healthy lifestyle behaviors). The multinomial analysis showed that sex, age, family situation and perceived family wealth were strong predictors of health behaviors. Unhealthy behaviors were most commonly associated with socioeconomic disadvantage, having a migrant background, and living in reconstructed families or single-parent households. Conclusion Health behaviors vary significantly based on socioeconomic and demographic circumstances. Targeted policies and intervention programs are necessary to improve HLBs among vulnerable and at-risk adolescents.
Collapse
Affiliation(s)
- Kenisha Russell Jonsson
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Göteborg, Sweden
| | - Maria Corell
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Göteborg, Sweden
| | - Petra Löfstedt
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Göteborg, Sweden
| | - Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| |
Collapse
|
4
|
Lee HY, Han KD, Woo IS, Kwon HS. Association of Metabolic Syndrome Components and Nutritional Status with Kidney Cancer in Young Adult Population: A Nationwide Population-Based Cohort Study in Korea. Biomedicines 2023; 11:biomedicines11051425. [PMID: 37239096 DOI: 10.3390/biomedicines11051425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
The aim of this study was to determine the association of metabolic syndrome (MetS) with kidney cancer and the impact of age and gender on such an association. Using the Korean National Health Insurance Service database, 9,932,670 subjects who had check-ups in 2009 were followed up until the diagnosis of kidney cancer or death or until 2019. Kidney cancer was significantly associated with MetS (HR 1.56). This association was higher in the younger age group (HR: 1.82, 1.5, and 1.37 in 20-39 years, 40-64 years, and ≥65 years, respectively). In terms of the association of kidney cancer with obesity and central obesity, young-aged males showed higher HR for kidney cancer than old-aged ones (HR of obesity: 1.96, 1.52, and 1.25; HR of central obesity: 1.94, 1.53, and 1.3 in 20-39 years, 40-64 years, ≥65 years, respectively), while young-aged females showed lower HR. Kidney cancer was associated with obesity and MetS. The association was higher in younger populations than in older ones. Regarding gender, MetS, obesity, and central obesity showed higher associations with kidney cancer in younger aged male population, while there was no significant difference in such associations according to age in the female population.
Collapse
Affiliation(s)
- Hee Yeon Lee
- Division of Oncology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea
| | - In Sook Woo
- Division of Oncology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea
| |
Collapse
|
5
|
Järvholm K, Janson A, Peltonen M, Neovius M, Gronowitz E, Engström M, Laurenius A, Beamish AJ, Dahlgren J, Sjögren L, Olbers T. Metabolic and bariatric surgery versus intensive non-surgical treatment for adolescents with severe obesity (AMOS2): a multicentre, randomised, controlled trial in Sweden. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:249-260. [PMID: 36848922 DOI: 10.1016/s2352-4642(22)00373-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 03/01/2023]
Abstract
BACKGROUND Severe obesity in adolescents has a profound impact on current and future health. Metabolic and bariatric surgery (MBS) is increasingly used in adolescents internationally. However, to our knowledge, there are no randomised trials examining the currently most used surgical techniques. Our aim was to evaluate changes in BMI and secondary health and safety outcomes after MBS. METHODS The Adolescent Morbid Obesity Surgery 2 (AMOS2) study is a randomised, open-label, multicentre trial done at three university hospitals in Sweden (located in Stockholm, Gothenburg, and Malmö). Adolescents aged 13-16 years with a BMI of at least 35 kg/m2, who had attended treatment for obesity for at least 1 year, passed assessments from a paediatric psychologist and a paediatrician, and had a Tanner pubertal stage of at least 3, were randomly assigned (1:1) to MBS or intensive non-surgical treatment. Exclusion criteria included monogenic or syndromic obesity, major psychiatric illness, and regular self-induced vomiting. Computerised randomisation was stratified for sex and recruitment site. Allocation was concealed for both staff and participants until the end of the inclusion day, and then all participants were unmasked to treatment intervention. One group underwent MBS (primarily gastric bypass), while the other group received intensive non-surgical treatment starting with 8 weeks of low-calorie diet. The primary outcome was 2-year change in BMI, analysed as intention-to-treat. The trial is registered at ClinicalTrials.gov, NCT02378259. FINDINGS 500 people were assessed for eligibility between Aug 27, 2014, and June 7, 2017. 450 participants were excluded (397 did not meet inclusion criteria, 39 declined to participate, and 14 were excluded for various other reasons). Of the 50 remaining participants, 25 (19 females and six males) were randomly assigned to receive MBS and 25 (18 females and seven males) were assigned to intensive non-surgical treatment. Three participants (6%; one in the MBS group and two in the intensive non-surgical treatment group) did not participate in the 2-year follow-up, and in total 47 (94%) participants were assessed for the primary endpoint. Mean age of participants was 15·8 years (SD 0·9) and mean BMI at baseline was 42·6 kg/m2 (SD 5·2). After 2 years, BMI change was -12·6 kg/m2 (-35·9 kg; n=24) among adolescents undergoing MBS (Roux-en-Y gastric bypass [n=23], sleeve gastrectomy [n=2]) and -0·2 kg/m2 (0·4 kg; [n=23]) among participants in the intensive non-surgical treatment group (mean difference -12·4 kg/m2 [95% CI -15·5 to -9·3]; p<0·0001). Five (20%) patients in the intensive non-surgical group crossed over to MBS during the second year. Adverse events (n=4) after MBS were mild but included one cholecystectomy. Regarding safety outcomes, surgical patients had a reduction in bone mineral density, while controls were unchanged after 2 years (z-score change mean difference -0·9 [95% CI -1·2 to -0·6]). There were no significant differences between the groups in vitamin and mineral levels, gastrointestinal symptoms (except less reflux in the surgical group), or in mental health at the 2-year follow-up. INTERPRETATION MBS is an effective and well tolerated treatment for adolescents with severe obesity resulting in substantial weight loss and improvements in several aspects of metabolic health and physical quality of life over 2 years, and should be considered in adolescents with severe obesity. FUNDING Sweden's Innovation Agency, Swedish Research Council Health.
Collapse
Affiliation(s)
- Kajsa Järvholm
- Department of Psychology, Lund University, Lund, Sweden; Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden.
| | - Annika Janson
- National Childhood Obesity Centre, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Martin Neovius
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Eva Gronowitz
- Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - My Engström
- Institute of Clinical Sciences, and Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Laurenius
- Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andrew J Beamish
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, Swansea, UK; Swansea University Medical School, Swansea University, Swansea, UK
| | - Jovanna Dahlgren
- Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Regional Obesity Center, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lovisa Sjögren
- Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Regional Obesity Center, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Torsten Olbers
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden; Department of Biomedical and Clinical Sciences and Wallenberg Center for Molecular Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
6
|
Thiravetyan B, Vathesatogkit P. Long-Term Effects of Cigarette Smoking on All-Cause Mortality and Cardiovascular Outcomes in Thai Population: Results From a 30-Year Cohort Study. Asia Pac J Public Health 2022; 34:761-769. [PMID: 35703388 DOI: 10.1177/10105395221106860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite the overwhelming evidences on the health consequences of smoking, studies in Asian population in low-to-middle income countries are very limited. Baseline data of a prospective cohort study were collected in year 1985. Endpoints regarding all-cause mortality and major adverse cardiovascular events (MACE) were followed for 30 years. Cox proportional hazard models were used for analysis. Participants had an average age of 43 years, 23% were female, and 43% were current smokers. All-cause mortality was significantly higher in ex-smokers (hazard ratio [HR] 1.32) and current smokers (HR 1.70) when compared with never smokers. Participants with any history of smoking had significantly higher risk of developing MACE. Furthermore, all-cause death, cardiovascular death, and MACE increased with increasing pack years. Statistically significant dose-response relationships were established. Therefore, cigarette smoking increased the risk of all-cause mortality, cardiovascular mortality, and MACE in Thai population. Results emphasized the importance of tobacco control in Thailand.
Collapse
Affiliation(s)
- Ben Thiravetyan
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Prin Vathesatogkit
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
7
|
O'Connor RM, Kenny PJ. Utility of 'substance use disorder' as a heuristic for understanding overeating and obesity. Prog Neuropsychopharmacol Biol Psychiatry 2022; 118:110580. [PMID: 35636576 DOI: 10.1016/j.pnpbp.2022.110580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 02/07/2023]
Abstract
Rates of obesity and obesity-associated diseases have increased dramatically in countries with developed economies. Substance use disorders (SUDs) are characterized by the persistent use of the substance despite negative consequences. It has been hypothesized that overconsumption of palatable energy dense food can elicit SUD-like maladaptive behaviors that contribute to persistent caloric intake beyond homeostatic need even in the face of negative consequences. Palatable food and drugs of abuse act on many of the same motivation-related circuits in the brain, and can induce, at least superficially, similar molecular, cellular, and physiological adaptations on these circuits. As such, applying knowledge about the neurobiological mechanisms of SUDs may serve as useful heuristic to better understand the persistent overconsumption of palatable food that contributes to obesity. However, many important differences exist between the actions of drugs of abuse and palatable food in the brain. This warrants caution when attributing weight gain and obesity to the manifestation of a putative SUD-related behavioral disorder. Here, we describe similarities and differences between compulsive drug use in SUDs and overconsumption in obesity and consider the merit of the concept of "food addiction".
Collapse
Affiliation(s)
- Richard M O'Connor
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, United States of America
| | - Paul J Kenny
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, United States of America.
| |
Collapse
|
8
|
Ludvigsson JF, Berglind D, Sundquist K, Sundström J, Tynelius P, Neovius M. The Swedish military conscription register: opportunities for its use in medical research. Eur J Epidemiol 2022; 37:767-777. [PMID: 35810240 PMCID: PMC9329412 DOI: 10.1007/s10654-022-00887-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 06/01/2022] [Indexed: 11/24/2022]
Abstract
In Sweden, conscription around age 18y was mandatory for young men until June 30, 2010. From July 1, 2017, it became mandatory again for both sexes but the proportion of summoned people for standardised testing has so far been low. This paper describes the history, structure and content of the Swedish Military Conscription Register (SMCR). We retrieved information about the SMCR from written sources and through e-mail interviews with key personnel at the Swedish Defence Conscription and Assessment Agency. We also analysed data from the SMCR between 1969 and 2018. Between 1969 and 2018 the SMCR contains digital data on approximately 2 million individuals (98.6% men). Most conscripts were born between 1951 and 1988 (n = 1,900,000; tested between 1969 and 2006). For the 1951-1987 birth cohorts, the register has a population coverage of approximately 90% for men. Conscripts underwent written tests focusing on verbal, spatial, logical and technical ability, medical, physical, and psychological tests. The medical assessment included hearing, vision, muscle and exercise capacity, height, weight, blood pressure and resting heart rate. The SMCR has been widely used to study, e.g., obesity, cardiovascular disease, mental health, crime, cardiovascular fitness, muscle strength, sick leave and disability pension. Severe disease could qualify for exemption from military service. Thus, the prevalence of such diseases is underestimated in the SMCR population. Between 1990 and 2018, about 25,000 women also volunteered for testing. The SMCR contains population-based data on physical and psychological health in about 90% of all men born between 1951 and 1987 (corresponding to testing between 1969 and 2006), and can be used to address a host of research questions.
Collapse
Affiliation(s)
- Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Daniel Berglind
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Johan Sundström
- Clinical Epidemiology Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Per Tynelius
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
| |
Collapse
|
9
|
Kim Y, Cubbin C. Neighborhood Poverty Histories and Physical Activity Among Children: Findings From the Geographic Research on Wellbeing (GROW) Study. Am J Health Promot 2020; 34:876-885. [PMID: 32390465 PMCID: PMC7839318 DOI: 10.1177/0890117120923948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Examine the association between neighborhood poverty histories and physical activity, and the moderation effect of family poverty and the mediation effect of built environments in such association. DESIGN A cross-sectional study of the Geographic Research on Wellbeing (2012-2013), a follow-up survey of statewide-representative Maternal and Infant Health Assessment (2003-2007). SETTING California. PARTICIPANTS A total of 2493 women with children. MEASURES Outcome measures are (1) daily leisure physical activity and (2) days of physical activity among children. An independent variable is poverty histories of census tract where the child resided. Mediators were mother-perceived social cohesion, mother-perceived neighborhood safety, distance to the closest park, and park acreage within 0.5 miles from the home. A moderator is family poverty. ANALYSIS Weighted regression analysis. RESULTS Family poverty was a significant moderator (P < .05); poor children in neighborhoods with long-term moderate poverty, long-term high poverty, or increasing poverty (vs long-term low poverty) had greater odds of daily physical activity (odds ratio [OR] = 1.46, 1.50, 1.66, respectively). Nonpoor children in neighborhoods with long-term moderate poverty or increasing poverty (vs long-term low poverty) were associated with decreased odds of daily physical activity (OR = 0.61 and 0.44, respectively). Mediation associations were insignificant (P > .05). CONCLUSION The combined effect of family financial strains and neighborhood economic resources might prevent poor children in neighborhoods with long-term low poverty and decreasing poverty from utilizing health-promoting resources in neighborhoods.
Collapse
Affiliation(s)
- Yeonwoo Kim
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas at Austin, TX, USA
- Population Research Center, The University of Texas at Austin, TX, USA
| |
Collapse
|
10
|
Lindberg L, Danielsson P, Persson M, Marcus C, Hagman E. Association of childhood obesity with risk of early all-cause and cause-specific mortality: A Swedish prospective cohort study. PLoS Med 2020; 17:e1003078. [PMID: 32187177 PMCID: PMC7080224 DOI: 10.1371/journal.pmed.1003078] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 02/19/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pediatric obesity is associated with increased risk of premature death from middle age onward, but whether the risk is already increased in young adulthood is unclear. The aim was to investigate whether individuals who had obesity in childhood have an increased mortality risk in young adulthood, compared with a population-based comparison group. METHODS AND FINDINGS In this prospective cohort study, we linked nationwide registers and collected data on 41,359 individuals. Individuals enrolled at age 3-17.9 years in the Swedish Childhood Obesity Treatment Register (BORIS) and living in Sweden on their 18th birthday (start of follow-up) were included. A comparison group was matched by year of birth, sex, and area of residence. We analyzed all-cause mortality and cause-specific mortality using Cox proportional hazards models, adjusted according to group, sex, Nordic origin, and parental socioeconomic status (SES). Over 190,752 person-years of follow-up (median follow-up time 3.6 years), 104 deaths were recorded. Median (IQR) age at death was 22.0 (20.0-24.5) years. In the childhood obesity cohort, 0.55% (n = 39) died during the follow-up period, compared to 0.19% (n = 65) in the comparison group (p < 0.001). More than a quarter of the deaths among individuals in the childhood obesity cohort had obesity recorded as a primary or contributing cause of death. Male sex and low parental SES were associated with premature all-cause mortality. Suicide and self-harm with undetermined intent were the main cause of death in both groups. The largest difference between the groups lay within endogenous causes of death, where children who had undergone obesity treatment had an adjusted mortality rate ratio of 4.04 (95% CI 2.00-8.17, p < 0.001) compared with the comparison group. The main study limitation was the lack of anthropometric data in the comparison group. CONCLUSIONS Our study shows that the risk of mortality in early adulthood may be higher for individuals who had obesity in childhood compared to a population-based comparison group.
Collapse
Affiliation(s)
- Louise Lindberg
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Pernilla Danielsson
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Martina Persson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Diabetes and Endocrinology, Sachsska Children’s Hospital, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Emilia Hagman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
11
|
Esdaile E, Hernandez E, Moores CJ, Vidgen HA. Enrolment of families with overweight children into a program aimed at reducing childhood obesity with and without a weight criterion: a natural experiment. BMC Public Health 2019; 19:756. [PMID: 31200674 PMCID: PMC6570944 DOI: 10.1186/s12889-019-6894-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Difficulties engaging families with overweight children to enrol into programs aimed at reducing childhood obesity have been well documented. During the implementation of the Parenting, Eating and Activity for Child Health Program (PEACH™) over a large geographical area (Queensland (QLD), Australia), a natural experiment developed. This experiment provided an opportunity to observe if there was a difference in enrolment for families with overweight children with a weight criterion (referred to as the period with a Targeted Eligibility Criterion (TEC)) compared to when a weight criterion was removed (the period referred to as Universal Eligibility Criterion (UEC)). We also examined the eligibility criterion’s relationship with attendance, parental concern about their child’s weight, estimation of overweight and obesity from parent-reported data. Methods A secondary analysis of baseline data from 926 overweight/obese children from 817 families enrolled in PEACH™ QLD was performed. Analyses were adjusted to control for the presence of clustered data. Bivariate statistics were performed using Pearson chi-square test with the second-order Rao-Scott correction, and Mann–Whitney U-test for non-parametric continuous variables. Generalized Estimating Equations (GEE) explored the association between weight status-based eligibility criteria and enrolment of overweight children. GEE were adjusted for sex, age and socioeconomic index and stratified for weight category. Results Compared to obese children, overweight children were almost twice as likely to be enrolled when the program did not have weight status-based eligibility criteria (during UEC period) (OR = 1.90 (CI 95% 1.35–2.68, p < 0.001)). Parents of overweight children enrolled during the UEC period were more likely to regard their child’s weight as less of a concern than during the TEC period (UEC 67% vs. TEC 45%, p = 0.036). Children whose parent-reported data underestimated their weight category were more likely to be enrolled while the program did not have weight-related eligibility criteria OR = 2.27 (CI 1.38–3.70, p < 0.01). Program session attendance did not appear to be impacted by the changes in eligibility criteria. Conclusions The omission of weight criteria for healthy lifestyle programs is a consideration for health professionals and decision-makers alike when encouraging the enrolment of children who are overweight into healthy lifestyle programs. Trial registration ACTRN12617000315314. Retrospectively registered 28 February 2017. Electronic supplementary material The online version of this article (10.1186/s12889-019-6894-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Emma Esdaile
- School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Level 4, A Wing, O Block, Kelvin Grove, Brisbane, Queensland, Qld 4059, Australia.
| | - Emely Hernandez
- School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Level 4, A Wing, O Block, Kelvin Grove, Brisbane, Queensland, Qld 4059, Australia
| | - Carly Jane Moores
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Helen Anna Vidgen
- School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Level 4, A Wing, O Block, Kelvin Grove, Brisbane, Queensland, Qld 4059, Australia
| |
Collapse
|
12
|
Luijckx E, Lohse T, Faeh D, Rohrmann S. Joints effects of BMI and smoking on mortality of all-causes, CVD, and cancer. Cancer Causes Control 2019; 30:549-557. [DOI: 10.1007/s10552-019-01160-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/13/2019] [Indexed: 01/01/2023]
|
13
|
Roos ET, Lallukka T, Lahelma E, Rahkonen O. Joint associations between smoking and obesity as determinants of premature mortality among midlife employees. Eur J Public Health 2018; 27:135-139. [PMID: 28177439 DOI: 10.1093/eurpub/ckw111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Eira T Roos
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| |
Collapse
|
14
|
Rossner S. Rössner looking into the crystal ball. Eur J Clin Nutr 2018; 73:159-162. [PMID: 29872159 DOI: 10.1038/s41430-018-0172-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Stephan Rossner
- Department of Medicine, Karolinska Institute, Stockholm, Sweden.
| |
Collapse
|
15
|
Bottino CJ, Puente GC, Burrage A, Tannis C, Cheng JK, Epee-Bounya A, Cox JE. Primary Care Group Visits for Childhood Obesity: Clinical Program Evaluation. Clin Pediatr (Phila) 2018; 57:442-450. [PMID: 28929794 DOI: 10.1177/0009922817728696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We conducted 29 group visits targeting children with elevated body mass index (BMI) and their families. Visit activities focused on social support, mind-body techniques, exercise, and nutrition. Measures included attendance, family satisfaction scores, and per-patient change in BMI percentile. Ninety-six patients attended ≥1 group visit, mean 2.0 (SD ±1.8; range 1-14). Mean patient age was 9.6 years (SD ±2.4; range 4-15 years); 53.1% were female; 44.8% had a BMI 95th to 99th percentile for age/sex; 35.4% had a BMI >99th percentile. Mean attendance per group visit was 6.8 patients (SD ±3.8; range 1-16 patients). Mean family satisfaction scores were 9.8 (SD ±0.8) with 10/10 "would recommend to family or friends." Of 42 patients who attended ≥2 group visits, 5 (11.9%) experienced a ≥5 BMI percentile reduction between first and last visits; 3 (7.1%) maintained this reduction 2 years later. Group visits were associated with high family satisfaction scores, though few patients experienced a reduction in BMI percentile.
Collapse
Affiliation(s)
- Clement J Bottino
- 1 Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Gabriella C Puente
- 1 Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Amanda Burrage
- 3 Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Candace Tannis
- 3 Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer K Cheng
- 1 Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Alexandra Epee-Bounya
- 1 Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Joanne E Cox
- 1 Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| |
Collapse
|
16
|
Yoshimoto K, Noda T, Imamura T. Influence of Underlying Diseases and Age on the Association between Obesity and All-Cause Mortality in Post-Middle Age. Health (London) 2018. [DOI: 10.4236/health.2018.109089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
17
|
A developmental etiological model for drug abuse in men. Drug Alcohol Depend 2017; 179:220-228. [PMID: 28806639 PMCID: PMC5623952 DOI: 10.1016/j.drugalcdep.2017.06.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/07/2017] [Accepted: 06/09/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND We attempt to develop a relatively comprehensive structural model of risk factors for drug abuse (DA) in Swedish men that illustrates developmental and mediational processes. METHODS We examined 20 risk factors for DA in 48,369 men undergoing conscription examinations in 1969-70 followed until 2011 when 2.34% (n=1134) of them had DA ascertained in medical, criminal and pharmacy registries. Risk factors were organized into four developmental tiers reflecting i) birth, ii) childhood/early adolescence, iii) late adolescence, and iv) young adulthood. Structural equational model fitting was performed using Mplus. RESULTS The best fitting model explained 47.8% of the variance in DA. The most prominent predictors, in order, were: early adolescent externalizing behavior, early adult criminal behavior, early adolescent internalizing behavior, early adult unemployment, early adult alcohol use disorder, and late adolescent drug use. Two major inter-connecting pathways emerged reflecting i) genetic/familial risk and ii) family dysfunction and psychosocial adversity. Generated on a first and tested on a second random half of the sample, a model from these variables predicted DA with an ROC area under the curve of 83.6%. Fifty-nine percent of DA cases arose from subjects in the top decile of risk. CONCLUSIONS DA in men is a highly multifactorial syndrome with risk arising from familial-genetic, psychosocial, behavioral and psychological factors acting and interacting over development. Among the multiple predisposing factors for DA, a range of psychosocial adversities, externalizing psychopathology and lack of social constraints in early adulthood are predominant.
Collapse
|
18
|
Pethrus CM, Johansson K, Neovius K, Reutfors J, Sundström J, Neovius M. Suicide and all-cause mortality in Swedish deployed military veterans: a population-based matched cohort study. BMJ Open 2017; 7:e014034. [PMID: 28864685 PMCID: PMC5588943 DOI: 10.1136/bmjopen-2016-014034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate suicide and mortality risk in deployed military veterans versus non-deployed comparators who had gone through military conscription testing. DESIGN Population-based matched cohort study. SETTING Sweden. PARTICIPANTS Participants were identified from the Military Service Conscription Register and deployment status from the Swedish Military Information Personnel Register. Of 1.9 million conscripts, 21 721 had deployed at some time between 1990 and 2013 (deployed military veterans). Non-deployed comparators were matched to deployed military veterans in two ways: (1) by cognitive ability, psychological assessment, mental health, body mass index, sex, birth-year and conscription-year (carefully matched), with further adjustment for exercise capacity and suicide attempt history; and (2) by sex, birth-year and conscription-year (age- and sex-matched). MAIN OUTCOME Suicide retrieved from the Swedish National Patient and Causes of Death Register until 31 December 2013. RESULTS During a median follow-up of 12 years, 39 and 211 deaths by suicide occurred in deployed military veterans (n=21 627) and carefully matched non-deployed comparators (n=107 284), respectively (15 vs 16/100 000 person-years; adjusted HR (aHR) 1.07; 95% CI 0.75 to 1.52; p=0.72) and 329 in age- and sex-matched non-deployed comparators (n=108 140; 25/100 000 person-years; aHR 0.59; 95% CI 0.42 to 0.82; p=0.002). There were 284 and 1444 deaths by suicide or attempted suicides in deployed military veterans and carefully matched non-deployed comparators, respectively (109 vs 112; aHR 0.99; 95% CI 0.88 to 1.13; p=0.93) and 2061 in age- and sex-matched non-deployed comparators (158; aHR 0.69; 95% CI 0.61 to 0.79; p<0.001). The corresponding figures for all-cause mortality for carefully matched non-deployed comparators were 159 and 820 (61 vs 63/100 000 person-years; aHR 0.97; 95% CI 0.82 to 1.15; p=0.71) and 1289 for age- and sex-matched non-deployed comparators (98/100 000 person-years; aHR 0.62; 95% CI 0.52 to 0.73; p<0.001). CONCLUSION Deployed military veterans had similar suicide and mortality risk as non-deployed comparators after accounting for psychological, psychiatric and physical factors. Studies of mental health in deployed veterans need to adjust for more factors than age and sex for comparisons to be meaningful.
Collapse
Affiliation(s)
- Carl-Martin Pethrus
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kari Johansson
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Johan Reutfors
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
19
|
Joosten SA, Hamilton GS, Naughton MT. Impact of Weight Loss Management in OSA. Chest 2017; 152:194-203. [DOI: 10.1016/j.chest.2017.01.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/15/2017] [Accepted: 01/21/2017] [Indexed: 02/05/2023] Open
|
20
|
Olbers T, Beamish AJ, Gronowitz E, Flodmark CE, Dahlgren J, Bruze G, Ekbom K, Friberg P, Göthberg G, Järvholm K, Karlsson J, Mårild S, Neovius M, Peltonen M, Marcus C. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study. Lancet Diabetes Endocrinol 2017; 5:174-183. [PMID: 28065734 PMCID: PMC5359414 DOI: 10.1016/s2213-8587(16)30424-7] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Severe obesity in adolescence is associated with reduced life expectancy and impaired quality of life. Long-term benefits of conservative treatments in adolescents are known to be modest, whereas short-term outcomes of adolescent bariatric surgery are promising. We aimed to compare 5-year outcomes of adolescent surgical patients after Roux-en-Y gastric bypass with those of conservatively treated adolescents and of adults undergoing Roux-en-Y gastric bypass, in the Adolescent Morbid Obesity Surgery (AMOS) study. METHODS We did a nationwide, prospective, non-randomised controlled study of adolescents (aged 13-18 years) with severe obesity undergoing Roux-en-Y gastric bypass at three specialised paediatric obesity treatment centres in Sweden. We compared clinical outcomes in adolescent surgical patients with those of matched adolescent controls undergoing conservative treatment and of adult controls undergoing Roux-en-Y gastric bypass. The primary outcome measure was change in BMI over 5 years. We used multilevel mixed-effect regression models to assess longitudinal changes. This trial is registered with ClinicalTrials.gov, number NCT00289705. FINDINGS Between April, 2006, and May, 2009, 100 adolescents were recruited to the study, of whom 81 underwent Roux-en-Y gastric bypass (mean age 16·5 years [SD 1·2], bodyweight 132·8 kg [22·1], and BMI 45·5 kg/m2 [SD 6·1]). 80 matched adolescent controls and 81 matched adult controls were enrolled for comparison of outcomes. The change in bodyweight in adolescent surgical patients over 5 years was -36·8 kg (95% CI -40·9 to -32·8), resulting in a reduction in BMI of -13·1 kg/m2 (95% CI -14·5 to -11·8), although weight loss less than 10% occurred in nine (11%). Mean BMI rose in adolescent controls (3·3 kg/m2, 95% CI 1·1-4·8) over the 5-year study period, whereas the BMI change in adult controls was similar to that in adolescent surgical patients (mean change -12·3 kg/m2, 95% CI -13·7 to -10·9). Comorbidities and cardiovascular risk factors in adolescent surgical patients showed improvement over 5 years and compared favourably with those in adolescent controls. 20 (25%) of 81 adolescent surgical patients underwent additional abdominal surgery for complications of surgery or rapid weight loss and 58 (72%) showed some type of nutritional deficiency; health-care consumption (hospital attendances and admissions) was higher in adolescent surgical patients compared with adolescent controls. 20 (25%) of 81 adolescent controls underwent bariatric surgery during the 5-year follow-up. INTERPRETATION Adolescents with severe obesity undergoing Roux-en-Y gastric bypass had substantial weight loss over 5 years, alongside improvements in comorbidities and risk factors. However, gastric bypass was associated with additional surgical interventions and nutritional deficiencies. Conventional non-surgical treatment was associated with weight gain and a quarter of patients had bariatric surgery within 5 years. FUNDING Swedish Research Council; Swedish Governmental Agency for Innovation Systems; National Board of Health and Welfare; Swedish Heart and Lung Foundation; Swedish Childhood Diabetes Foundation; Swedish Order of Freemasons Children's Foundation; Stockholm County Council; Västra Götaland Region; Mrs Mary von Sydow Foundation; Stiftelsen Göteborgs Barnhus; Stiftelsen Allmänna Barnhuset; and the US National Institute of Diabetes, Digestive, and Kidney Diseases (National Institutes of Health).
Collapse
Affiliation(s)
- Torsten Olbers
- Department of Gastrosurgical Research, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
| | - Andrew J Beamish
- Department of Gastrosurgical Research, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Research, Royal College of Surgeons of England, London, UK
| | - Eva Gronowitz
- Department of Gastrosurgical Research, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | - Jovanna Dahlgren
- Department of Paediatrics, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Gustaf Bruze
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Stockholm, Sweden
| | - Kerstin Ekbom
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Peter Friberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Gunnar Göthberg
- Department of Paediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Kajsa Järvholm
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden; Department of Psychology, Lund University, Lund, Sweden
| | - Jan Karlsson
- Department of Psychology, Lund University, Lund, Sweden
| | - Staffan Mårild
- Department of Health and Care Sciences, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Stockholm, Sweden
| | - Markku Peltonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
21
|
Falkstedt D, Wolff V, Allebeck P, Hemmingsson T, Danielsson AK. Cannabis, Tobacco, Alcohol Use, and the Risk of Early Stroke: A Population-Based Cohort Study of 45 000 Swedish Men. Stroke 2017; 48:265-270. [PMID: 28028147 DOI: 10.1161/strokeaha.116.015565] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/23/2016] [Accepted: 11/28/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Current knowledge on cannabis use in relation to stroke is based almost exclusively on clinical reports. By using a population-based cohort, we aimed to find out whether there was an association between cannabis use and early-onset stroke, when accounting for the use of tobacco and alcohol. METHODS The cohort comprises 49 321 Swedish men, born between 1949 and 1951, who were conscripted into compulsory military service between the ages of 18 and 20. All men answered 2 detailed questionnaires at conscription and were subject to examinations of physical aptitude, psychological functioning, and medical status. Information on stroke events up to ≈60 years of age was obtained from national databases; this includes strokes experienced before 45 years of age. RESULTS No associations between cannabis use in young adulthood and strokes experienced ≤45 years of age or beyond were found in multivariable models: cannabis use >50 times, hazard ratios=0.93 (95% confidence interval [CI], 0.34-2.57) and 0.95 (95% CI, 0.59-1.53). Although an almost doubled risk of ischemic stroke was observed in those with cannabis use >50 times, this risk was attenuated when adjusted for tobacco usage: hazards ratio=1.47 (95% CI, 0.83-2.56). Smoking ≥20 cigarettes per day was clearly associated both with strokes before 45 years of age, hazards ratio=5.04 (95% CI, 2.80-9.06), and with strokes throughout the follow-up, hazards ratio=2.15 (95% CI, 1.61-2.88). CONCLUSIONS We found no evident association between cannabis use in young adulthood and stroke, including strokes before 45 years of age. Tobacco smoking, however, showed a clear, dose-response shaped association with stroke.
Collapse
Affiliation(s)
- Daniel Falkstedt
- From the Department of Public Health Sciences (D.F., P.A., A.-K.D.) and Institute of Environmental Medicine (T.H.), Karolinska Institutet, Stockholm, Sweden; Stroke Unit, Department of Neurology, Strasbourg University Hospital, University of Strasbourg, France (V.W.); Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden (P.A.); and Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden (T.H.)
| | - Valerie Wolff
- From the Department of Public Health Sciences (D.F., P.A., A.-K.D.) and Institute of Environmental Medicine (T.H.), Karolinska Institutet, Stockholm, Sweden; Stroke Unit, Department of Neurology, Strasbourg University Hospital, University of Strasbourg, France (V.W.); Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden (P.A.); and Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden (T.H.)
| | - Peter Allebeck
- From the Department of Public Health Sciences (D.F., P.A., A.-K.D.) and Institute of Environmental Medicine (T.H.), Karolinska Institutet, Stockholm, Sweden; Stroke Unit, Department of Neurology, Strasbourg University Hospital, University of Strasbourg, France (V.W.); Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden (P.A.); and Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden (T.H.)
| | - Tomas Hemmingsson
- From the Department of Public Health Sciences (D.F., P.A., A.-K.D.) and Institute of Environmental Medicine (T.H.), Karolinska Institutet, Stockholm, Sweden; Stroke Unit, Department of Neurology, Strasbourg University Hospital, University of Strasbourg, France (V.W.); Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden (P.A.); and Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden (T.H.)
| | - Anna-Karin Danielsson
- From the Department of Public Health Sciences (D.F., P.A., A.-K.D.) and Institute of Environmental Medicine (T.H.), Karolinska Institutet, Stockholm, Sweden; Stroke Unit, Department of Neurology, Strasbourg University Hospital, University of Strasbourg, France (V.W.); Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden (P.A.); and Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden (T.H.).
| |
Collapse
|
22
|
Ohlsson C, Bygdell M, Sondén A, Rosengren A, Kindblom JM. Association between excessive BMI increase during puberty and risk of cardiovascular mortality in adult men: a population-based cohort study. Lancet Diabetes Endocrinol 2016; 4:1017-1024. [PMID: 27815089 DOI: 10.1016/s2213-8587(16)30273-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Being overweight during childhood and adolescence is associated with increased risk of cardiovascular disease in adulthood, but the relative contribution of prepubertal childhood BMI and BMI change during puberty to adult mortality due to cardiovascular disease is unknown. We assessed the contribution of these two distinct developmental BMI parameters for cardiovascular mortality in adult men. METHODS As a part of the ongoing population-based BMI Epidemiology Study (BEST) in Gothenburg, Sweden, men born between 1945 and 1961 with information on both their childhood BMI at age 8 years and BMI change during puberty were included in the study and followed up until December, 2013. Participants who died or emigrated before age 20 years were excluded from the analysis. BMI was collected from paediatric growth charts and mandatory military conscription tests. Childhood overweight (BMI of ≥17·9 kg/m2) was defined according to the Centers for Disease Control and Prevention's cutoff at 8 years of age, and BMI change during puberty was defined as the difference between young adult BMI and childhood BMI (BMI at age 20 years minus BMI at age 8 years). Information on mortality was retrieved from high quality national registers with the participants' ten-digit personal identity number. We used Cox proportional hazard regression to analyse the association between exposures and mortality. The ethics committee of the University of Gothenburg, Sweden, approved the study and waived the requirement for written informed consent. FINDINGS We followed 37 672 Swedish men from age 20 years for a mean of 37·8 years (1 422 185 person-years follow-up). 3188 all-cause deaths and 710 cardiovascular deaths occurred during follow-up. The correlation between childhood BMI and BMI change during puberty was marginal (r=0·06). BMI change during puberty, but not childhood BMI, was independently associated with adult all-cause and cardiovascular mortality in men. Boys that became overweight during puberty (HR 2·39; 95% CI 1·86-3·09) and boys who were overweight consistently throughout childhood and puberty (1·85; 1·28-2·67), but not boys overweight in childhood that normalised during puberty (0·99, 0·65-1·50), had increased risk of cardiovascular mortality compared with participants who were not overweight in childhood or as young adults. The association between BMI change during puberty and cardiovascular mortality was non-linear with a substantial association above a threshold of 6·7 units increase in BMI. INTERPRETATION Excessive BMI increase during puberty is a risk marker of adult cardiovascular mortality. These results indicate that BMI should be monitored during puberty to identify boys with increased risk of adult cardiovascular mortality. FUNDING Swedish Research Council, the Swedish Government (under the Avtal om Läkarutbildning och Medicinsk Forskning [Agreement for Medical Education and Research]), the Lundberg Foundation, the Torsten Söderberg Foundation, the Novo Nordisk Foundation, the Knut and Alice Wallenberg Foundation, and the Anna Ahrenberg Foundation.
Collapse
Affiliation(s)
- Claes Ohlsson
- Centre for Bone and Arthritis Research, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Bygdell
- Centre for Bone and Arthritis Research, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Arvid Sondén
- Bioinformatics Core Facility, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny M Kindblom
- Centre for Bone and Arthritis Research, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| |
Collapse
|
23
|
Jørgensen TSH, Osler M, Ängquist LH, Zimmermann E, Christensen GT, Sørensen TIA. The U-shaped association of body mass index with mortality: Influence of the traits height, intelligence, and education. Obesity (Silver Spring) 2016; 24:2240-7. [PMID: 27589069 DOI: 10.1002/oby.21615] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/17/2016] [Accepted: 06/20/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The U-shaped association between body mass index (BMI) and mortality may depend on other traits with permanent health effects. Whether the association between BMI and mortality depends on levels of health-related traits known to be inversely associated with mortality throughout adult life such as height, intelligence, and education was investigated. METHODS The study was based on a cohort of young men with data on weight, height, intelligence test score, and education from the Danish Conscription Database. In total, 346,500 men born 1939 to 1959 were followed until December 2013. The association between BMI and mortality was analyzed using Cox-regression models including interactions between BMI and height, intelligence, and education, respectively. RESULTS BMI and mortality showed the U-shaped association from the start of the follow-up period, and it persisted through the subsequent 56 years. As expected, the mortality was inversely associated with height, intelligence, and education, but the U shape of the association between BMI and mortality was unaffected by the levels of these traits except at higher BMI values, where the slopes were steeper for men with higher levels of height, intelligence, and education. CONCLUSIONS High and low BMI was associated with higher mortality throughout life regardless of the levels of height, intelligence, and education.
Collapse
Affiliation(s)
- Terese Sara Høj Jørgensen
- Research Centre for Prevention and Health, Rigshospitalet-Glostrup, The Capital Region, Denmark
- Bispebjerg and Frederiksberg Hospital-The Capital Region, Institute of Preventive Medicine, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Merete Osler
- Research Centre for Prevention and Health, Rigshospitalet-Glostrup, The Capital Region, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Danish Aging Research Center, Denmark, Department of Public Health, University of Southern Denmark Odense, Denmark
| | - Lars Henrik Ängquist
- Bispebjerg and Frederiksberg Hospital-The Capital Region, Institute of Preventive Medicine, Copenhagen, Denmark
| | - Esther Zimmermann
- Bispebjerg and Frederiksberg Hospital-The Capital Region, Institute of Preventive Medicine, Copenhagen, Denmark
| | - Gunhild Tidemann Christensen
- Research Centre for Prevention and Health, Rigshospitalet-Glostrup, The Capital Region, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Danish Aging Research Center, Denmark, Department of Public Health, University of Southern Denmark Odense, Denmark
| | - Thorkild I A Sørensen
- Bispebjerg and Frederiksberg Hospital-The Capital Region, Institute of Preventive Medicine, Copenhagen, Denmark.
- Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| |
Collapse
|
24
|
Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S, Romundstad P, Vatten LJ. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ 2016; 353:i2156. [PMID: 27146380 PMCID: PMC4856854 DOI: 10.1136/bmj.i2156] [Citation(s) in RCA: 484] [Impact Index Per Article: 60.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of cohort studies of body mass index (BMI) and the risk of all cause mortality, and to clarify the shape and the nadir of the dose-response curve, and the influence on the results of confounding from smoking, weight loss associated with disease, and preclinical disease. DATA SOURCES PubMed and Embase databases searched up to 23 September 2015. STUDY SELECTION Cohort studies that reported adjusted risk estimates for at least three categories of BMI in relation to all cause mortality. DATA SYNTHESIS Summary relative risks were calculated with random effects models. Non-linear associations were explored with fractional polynomial models. RESULTS 230 cohort studies (207 publications) were included. The analysis of never smokers included 53 cohort studies (44 risk estimates) with >738 144 deaths and >9 976 077 participants. The analysis of all participants included 228 cohort studies (198 risk estimates) with >3 744 722 deaths among 30 233 329 participants. The summary relative risk for a 5 unit increment in BMI was 1.18 (95% confidence interval 1.15 to 1.21; I(2)=95%, n=44) among never smokers, 1.21 (1.18 to 1.25; I(2)=93%, n=25) among healthy never smokers, 1.27 (1.21 to 1.33; I(2)=89%, n=11) among healthy never smokers with exclusion of early follow-up, and 1.05 (1.04 to 1.07; I(2)=97%, n=198) among all participants. There was a J shaped dose-response relation in never smokers (Pnon-linearity <0.001), and the lowest risk was observed at BMI 23-24 in never smokers, 22-23 in healthy never smokers, and 20-22 in studies of never smokers with ≥20 years' follow-up. In contrast there was a U shaped association between BMI and mortality in analyses with a greater potential for bias including all participants, current, former, or ever smokers, and in studies with a short duration of follow-up (<5 years or <10 years), or with moderate study quality scores. CONCLUSION Overweight and obesity is associated with increased risk of all cause mortality and the nadir of the curve was observed at BMI 23-24 among never smokers, 22-23 among healthy never smokers, and 20-22 with longer durations of follow-up. The increased risk of mortality observed in underweight people could at least partly be caused by residual confounding from prediagnostic disease. Lack of exclusion of ever smokers, people with prevalent and preclinical disease, and early follow-up could bias the results towards a more U shaped association.
Collapse
Affiliation(s)
- Dagfinn Aune
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway Department of Epidemiology and Biostatistics, Imperial College, London, UK
| | - Abhijit Sen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Manya Prasad
- Department of Community Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, Imperial College, London, UK
| | - Imre Janszky
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Serena Tonstad
- Department of Community Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Pål Romundstad
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars J Vatten
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
25
|
Song M, Hu FB, Wu K, Must A, Chan AT, Willett WC, Giovannucci EL. Trajectory of body shape in early and middle life and all cause and cause specific mortality: results from two prospective US cohort studies. BMJ 2016; 353:i2195. [PMID: 27146280 PMCID: PMC4856853 DOI: 10.1136/bmj.i2195] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To assess body shape trajectories in early and middle life in relation to risk of mortality. DESIGN Prospective cohort study. SETTING Nurses' Health Study and Health Professionals Follow-up Study. POPULATION 80 266 women and 36 622 men who recalled their body shape at ages 5, 10, 20, 30, and 40 years and provided body mass index at age 50, followed from age 60 over a median of 15-16 years for death. MAIN OUTCOME MEASURES All cause and cause specific mortality. RESULTS Using a group based modeling approach, five distinct trajectories of body shape from age 5 to 50 were identified: lean-stable, lean-moderate increase, lean-marked increase, medium-stable/increase, and heavy-stable/increase. The lean-stable group was used as the reference. Among never smokers, the multivariable adjusted hazard ratio for death from any cause was 1.08 (95% confidence interval 1.02 to 1.14) for women and 0.95 (0.88 to 1.03) for men in the lean-moderate increase group, 1.43 (1.33 to 1.54) for women and 1.11 (1.02 to 1.20) for men in the lean-marked increase group, 1.04 (0.97 to 1.12) for women and 1.01 (0.94 to 1.09) for men in the medium-stable/increase group, and 1.64 (1.49 to 1.81) for women and 1.19 (1.08 to 1.32) for men in the heavy-stable/increase group. For cause specific mortality, participants in the heavy-stable/increase group had the highest risk, with a hazard ratio among never smokers of 2.30 (1.88 to 2.81) in women and 1.45 (1.23 to 1.72) in men for cardiovascular disease, 1.37 (1.14 to 1.65) in women and 1.07 (0.89 to 1.30) in men for cancer, and 1.59 (1.38 to 1.82) in women and 1.10 (0.95 to 1.29) in men for other causes. The trajectory-mortality association was generally weaker among ever smokers than among never smokers (for all cause mortality: P for interaction <0.001 in women and 0.06 in men). When participants were classified jointly according to trajectories and history of type 2 diabetes, the increased risk of death associated with heavier body shape trajectories was more pronounced among participants with type 2 diabetes than those without diabetes, and those in the heavy-stable/increase trajectory and with a history of diabetes had the highest risk of death. CONCLUSIONS Using the trajectory approach, we found that heavy body shape from age 5 up to 50, especially the increase in middle life, was associated with higher mortality. In contrast, people who maintained a stably lean body shape had the lowest mortality. These results indicate the importance of weight management across the lifespan.
Collapse
Affiliation(s)
- Mingyang Song
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114, USA Departments of Nutrition and Epidemiology, Harvard T H Chan School of Public Health, Boston, MA 02115, USA
| | - Frank B Hu
- Departments of Nutrition and Epidemiology, Harvard T H Chan School of Public Health, Boston, MA 02115, USA Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Kana Wu
- Departments of Nutrition and Epidemiology, Harvard T H Chan School of Public Health, Boston, MA 02115, USA
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114, USA Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Walter C Willett
- Departments of Nutrition and Epidemiology, Harvard T H Chan School of Public Health, Boston, MA 02115, USA Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Edward L Giovannucci
- Departments of Nutrition and Epidemiology, Harvard T H Chan School of Public Health, Boston, MA 02115, USA Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| |
Collapse
|
26
|
Abstract
OBJECTIVE Many psychosocial factors have been associated with coronary heart disease (CHD), including hostility, anger, and depression. We tested the hypothesis that these factors may have their basis in emotion regulation abilities. Our aim was to determine whether poor emotional control predicted long-term risk of CHD. METHODS This Swedish national study includes 46,393 men who were conscripted for military service in 1969 and 1970. The men were aged 18 to 20 years at the time of conscription. Psychologists used a brief semistructured interview to retrospectively assess the conscripts' level of emotional control in childhood and adolescence. The outcome measure was a first fatal or nonfatal event of CHD. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for poor and adequate versus good emotional control. RESULTS After 38 years of follow-up (1971-2009), 2456 incident cases of CHD had occurred. Poor emotional control increased the risk of CHD (HR = 1.31, 95% CI = 1.18-1.45), adjusting for childhood socioeconomic position, anxiety, depression, and parental history of CHD. Further adjustment for life-style-related factors, for example, smoking and body mass index, attenuated the HR to 1.08 (95% CI = 0.97-1.21). In stratified analyses, the fully adjusted association between poor emotional control with CHD remained significantly elevated among men with a parental history of CHD (HR = 1.49, 95% CI = 1.11-2.01, p interaction = .037). CONCLUSIONS In the overall study population, poor emotional control had no direct effect on CHD beyond life-style-related factors. However, in men with a parental history of CHD, poor emotional control in adolescence remained significantly predictive of long-term CHD risk even when adjusting for life-style-related factors.
Collapse
|
27
|
Yu Y. The Changing Body Mass-Mortality Association in the United States: Evidence of Sex-Specific Cohort Trends from Three National Health and Nutrition Examination Surveys. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2016; 62:143-163. [PMID: 27337551 DOI: 10.1080/19485565.2015.1108835] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The association between body mass index (BMI) categories and mortality remains uncertain. Using three National Health and Nutrition Examination Surveys covering the 1971-2006 period for cohorts born between 1896 and 1968, this study estimates separately for men and women models for year-of-birth (cohort) and year-of-observation (period) trends in how age-specific mortality rates differ across BMI categories. Among women, relative to the normal weight (BMI 18.5-24.9 kg/m(2)), there are increasing trends in mortality rates for the overweight (BMI 25-29.9) or obese (BMI ≥ 30). Among men, mortality rates relative to the normal weight decrease for the overweight, do not change for the moderately obese (BMI 30-34.9), and increase for the severely obese (BMI ≥ 35). Period and cohort trends are similar, but the cohort trends are more consistent. In the latest cohorts, compared with the normal weight, mortality rates are 50 percent lower for overweight men, not different for moderately obese men, and 100-200 percent higher for severely obese men and for overweight or obese women. For U.S. cohorts born after the 1920s, a lower overweight than normal weight mortality is confined to men. I speculate on possible reasons why the mortality association with overweight and obesity varies by sex and cohort.
Collapse
Affiliation(s)
- Yan Yu
- a Crawford School of Public Policy , Australian National University , Acton , Australia
| |
Collapse
|
28
|
Maximova K, Khan MK, Austin SB, Kirk SF, Veugelers PJ. The role of underestimating body size for self-esteem and self-efficacy among grade five children in Canada. Ann Epidemiol 2015; 25:753-9. [DOI: 10.1016/j.annepidem.2015.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/22/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
|
29
|
Geller JS, Dube ET, Cruz GA, Stevens J, Keating Bench K. Pediatric Obesity Empowerment Model Group Medical Visits (POEM-GMV) as Treatment for Pediatric Obesity in an Underserved Community. Child Obes 2015; 11:638-46. [PMID: 26398311 DOI: 10.1089/chi.2014.0163] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND This is a retrospective cohort study to evaluate a novel group medical visit (GMV) program using an empowerment curriculum as treatment for pediatric obesity in a federally qualified community health center. METHODS Biometric and self-reported data were reviewed from 417 overweight or obese children ages 5-18 attending the pediatric obesity empowerment model GMV program (POEM-GMV) at least twice during a 3-year period. Variables were evaluated using paired means t-test. Pearson's correlation test was used to evaluate variables and the BMI z-score. Subanalysis by gender was performed. RESULTS The average participant was 10.48 ± 2.53 years old and participated for 301 ± 287 days. BMI z-score reduced from 2.99 ± 0.96 to 2.88 ± 0.88 (p < 0.0001). Overall, 62.6% of participants had improved weight outcome. Statistically significant improvement was noted in stress, exercise, beverage consumption, fast food intake, television viewing, and bedtime. Stress and beverage consumption had the highest correlation with BMI z-score. By sex, 71.4% of boys (n = 196; p < 0.0001) and 54.8% (n = 221; p < 0.014) of girls realized a reduction in BMI z-score, 61.2% (p < 0.001) of boys and 47.1% (p = 0.097) of girls had a reduction in their percent overweight. CONCLUSIONS POEM-GMV may be a useful approach in the treatment of pediatric obesity in an underserved community. There were statistically significantly improved outcomes in obesity, especially for boys. Significant improvement was observed in many lifestyle factors associated with obesity. Weight loss most closely correlated with reduced stress levels and sugary beverage consumption. Additional studies are needed to further evaluate the efficacy of POEM-GMV.
Collapse
Affiliation(s)
- Jeffrey S Geller
- 1 Department of Family Medicine, Greater Lawrence Family Health Center , Lawrence, MA
| | - Eileen T Dube
- 2 Department of Alternative Medicine, Greater Lawrence Family Health Center , Lawrence, MA
| | - Glavielinys A Cruz
- 3 Department of Psychology, Massachusetts School of Professional Psychology , Lawrence, MA
| | - Jason Stevens
- 4 Department of Physics, University of Massachusetts , Amherst, MA
| | - Kara Keating Bench
- 1 Department of Family Medicine, Greater Lawrence Family Health Center , Lawrence, MA
| |
Collapse
|
30
|
Andersen K, Rasmussen F, Held C, Neovius M, Tynelius P, Sundström J. Exercise capacity and muscle strength and risk of vascular disease and arrhythmia in 1.1 million young Swedish men: cohort study. BMJ 2015; 351:h4543. [PMID: 26378015 PMCID: PMC4768156 DOI: 10.1136/bmj.h4543] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the associations of exercise capacity and muscle strength in late adolescence with risk of vascular disease and arrhythmia. DESIGN Cohort study. SETTING General population in Sweden. PARTICIPANTS 1.1 million men who participated in mandatory military conscription between 1 August 1972 and 31 December 1995, at a median age of 18.2 years. Participants were followed until 31 December 2010. MAIN OUTCOMES Associations between exercise capacity and muscle strength with risk of vascular disease and subgroups (ischaemic heart disease, heart failure, stroke, and cardiovascular death) and risk of arrhythmia and subgroups (atrial fibrillation or flutter, bradyarrhythmia, supraventricular tachycardia, and ventricular arrhythmia or sudden cardiac death). Maximum exercise capacity was estimated by the ergometer bicycle test, and muscle strength was measured as handgrip strength by a hand dynamometer. High exercise capacity or muscle strength was deemed as above the median level. RESULTS During a median follow-up of 26.3 years, 26 088 vascular disease events and 17 312 arrhythmia events were recorded. Exercise capacity was inversely associated with risk of vascular disease and its subgroups. Muscle strength was also inversely associated with vascular disease risk, driven by associations of higher muscle strength with lower risk of heart failure and cardiovascular death. Exercise capacity had a U shaped association with risk of arrhythmia, driven by a direct association with risk of atrial fibrillation and a U shaped association with bradyarrhythmia. Higher muscle strength was associated with lower risk of arrhythmia (specifically, lower risk of bradyarrhythmia and ventricular arrhythmia). The combination of high exercise capacity and high muscle strength was associated with a hazard ratio of 0.67 (95% confidence interval 0.65 to 0.70) for vascular events and 0.92 (0.88 to 0.97) for arrhythmia compared with the combination of low exercise capacity and low muscle strength. CONCLUSIONS Exercise capacity and muscle strength in late adolescence are independently and jointly associated with long term risk of vascular disease and arrhythmia. The health benefit of lower risk of vascular events with higher exercise capacity was not outweighed by higher risk of arrhythmia.
Collapse
Affiliation(s)
- Kasper Andersen
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala, SE-751 85, Sweden
| | - Finn Rasmussen
- Child and Adolescent Public Health Epidemiology Unit, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Claes Held
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala, SE-751 85, Sweden
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Per Tynelius
- Child and Adolescent Public Health Epidemiology Unit, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala, SE-751 85, Sweden
| |
Collapse
|
31
|
Hirko KA, Kantor ED, Cohen SS, Blot WJ, Stampfer MJ, Signorello LB. Body mass index in young adulthood, obesity trajectory, and premature mortality. Am J Epidemiol 2015; 182:441-50. [PMID: 25977515 DOI: 10.1093/aje/kwv084] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/30/2015] [Indexed: 01/17/2023] Open
Abstract
Although much research has been conducted on the role adult body mass index (BMI) plays in mortality, there have been fewer studies that evaluated the associations of BMI in young adulthood and adult weight trajectory with mortality, and it remains uncertain whether associations differ by race or sex. We prospectively examined the relationships of BMI in young adulthood (21 years of age) and adult obesity trajectory with later-life mortality rates among 75,881 men and women in the Southern Community Cohort Study. Study participants were enrolled between 2002 and 2009 at ages 40-79 years and were followed through December, 2011. Multivariable Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals. There were 7,301 deaths in the 474,970 person-years of follow-up. Participants who reported being overweight or obese as young adults had mortality rates that were 19% (95% confidence interval: 12, 27) and 64% (95% confidence interval: 52, 78) higher, respectively, than those of their normal weight counterparts. The results did not significantly differ by race or sex. Participants who reported being obese in young adulthood only or in both young and middle adulthood experienced mortality rates that were 40%-90% higher than those of participants who were nonobese at either time. These results suggest that obesity in young adulthood is associated with higher mortality risk regardless of race, sex, and obesity status in later life.
Collapse
|
32
|
Meyer J, Rohrmann S, Bopp M, Faeh D. Impact of Smoking and Excess Body Weight on Overall and Site-Specific Cancer Mortality Risk. Cancer Epidemiol Biomarkers Prev 2015. [PMID: 26215293 DOI: 10.1158/1055-9965.epi-15-0415] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Smoking and excess body weight are major preventable risk factors for premature death. This study aimed at analyzing their single and combined association with site-specific cancer mortality. METHODS Our study population comprised 35,784 men and women of ages 14 to 99 years, who participated in population-based health surveys conducted 1977-1993 in Switzerland and were followed up for mortality until 2008. Multivariable Cox proportional hazards models were calculated for different cancer sites, and population attributable fractions were derived. RESULTS The hazard ratio of dying from cancer (all sites) was 2.32 (95% confidence interval, 2.04-2.63) for heavy smokers (vs. never smokers) and 1.15 (1.01-1.32) for obese [body mass index (BMI) ≥ 30 kg/m(2)] vs. normal weight individuals. Heavy smoking (≥20 cigarettes/day) was associated with increased mortality due to cancer of the lung, upper aero-digestive tract, pancreas, bladder, liver, and the total of remaining sites. Obesity was associated with higher risk of dying from cancer of the liver and the female genital tract (essentially corpus or cervix uteri and ovary). More than 20% of all cancer deaths in our population were attributable to ever smoking and overweight (BMI ≥ 25 kg/m(2)). CONCLUSIONS Smoking was a much stronger risk factor for cancer than excess body weight. For lung, liver, and pancreatic cancer, the combination of excess body weight and smoking lead to cumulated higher risks. IMPACT Our findings support recommendations for obese persons to quit smoking despite potential postcessation weight gain.
Collapse
Affiliation(s)
- Julia Meyer
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Matthias Bopp
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - David Faeh
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | | |
Collapse
|
33
|
Gardner RM, Lee BK, Magnusson C, Rai D, Frisell T, Karlsson H, Idring S, Dalman C. Maternal body mass index during early pregnancy, gestational weight gain, and risk of autism spectrum disorders: Results from a Swedish total population and discordant sibling study. Int J Epidemiol 2015; 44:870-83. [PMID: 26045508 PMCID: PMC4521130 DOI: 10.1093/ije/dyv081] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prenatal environmental factors such as maternal adiposity may influence the risk of offspring autism spectrum disorders (ASD), though current evidence is inconsistent. The objective of this study was to assess the relationship of parental BMI and gestational weight gain (GWG) with risk of offspring ASD in a population-based cohort study using family-based study designs. METHODS The cohort was based in Stockholm County, Sweden, including 333,057 individuals born 1984-2007, of whom 6420 were diagnosed with an ASD. We evaluated maternal body mass index (BMI) at first antenatal visit, GWG and paternal BMI at the time of conscription into the Swedish military as exposures using general estimating equation (GEE) models with logit link. RESULTS At the population level, maternal overweight/obesity was associated with increased risk of offspring ASD [odds ratio (OR)25 ≤ BMI < 30 1.31, 95% confidence interval = 1.21-1.41; ORBMI ≥ 30 1.94, 1.72-2.17], as was paternal underweight (ORBMI < 18.5, 1.19, 1.06-1.33) and obesity (ORBMI ≥ 30 1.47, 1.12-1.92) in mutually adjusted models. However, in matched sibling analyses, the relationship between elevated maternal BMI and ASD risk was not apparent. GWG had a U-shaped association with offspring ASD at the population level (ORinsufficient 1.22, 1.07-1.40; ORexcessive 1.23, 1.08-1.40). Matched sibling analyses were suggestive of elevated risk with excessive GWG (ORinsufficient 1.12, 0.68-1.84; ORexcessive 1.48, 0.93-2.38). CONCLUSIONS Whereas population-level results suggested that maternal BMI was associated with ASD, sibling analyses and paternal BMI analyses indicate that maternal BMI may also be a proxy marker for other familial risk factors. Evidence is stronger for a direct link between GWG and ASD risk.
Collapse
Affiliation(s)
- Renee M Gardner
- Department of Public Health Sciences, and Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden,
| | - Brian K Lee
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA, USA, A.J. Drexel Autism Institute, Philadelphia, PA, USA
| | - Cecilia Magnusson
- Department of Public Health Sciences, and Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Dheeraj Rai
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Avon and Wiltshire Partnership NHS Mental Health Trust, Bristol, UK
| | - Thomas Frisell
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden and
| | - Håkan Karlsson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Selma Idring
- Department of Public Health Sciences, and Neurodevelopmental Psychiatry Unit, Child and Youth Psychiatry, Stockholm County Council, Stockholm, Sweden
| | - Christina Dalman
- Department of Public Health Sciences, and Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| |
Collapse
|
34
|
Sanders RH, Han A, Baker JS, Cobley S. Childhood obesity and its physical and psychological co-morbidities: a systematic review of Australian children and adolescents. Eur J Pediatr 2015; 174:715-46. [PMID: 25922141 DOI: 10.1007/s00431-015-2551-3] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/14/2015] [Accepted: 04/16/2015] [Indexed: 12/11/2022]
Abstract
UNLABELLED Australia is predicted to have the highest overweight/obesity rate in the world by 2022 outranking the USA and UK. The purpose of this systematic review was to evaluate the associations between childhood obesity and physical and psychological health co-morbidities. Therefore, a systematic literature search was conducted from six databases (2004-2014). Studies were included if they investigated obesity-related co-morbidities with participants residing in Australia aged 0-18 years. Forty-seven studies fulfilled selection criteria. Evidence suggests that overweight/obese Australian children and adolescents, compared to normal-weight peers, had more cardio-metabolic risk factors and higher risk factors of non-alcohol fatty liver disease and were experiencing more negative psychological outcomes (depression, low self-esteem and lower scores of health-related quality of life). Many other health consequences have either not been investigated in Australia, or as frequently as in other countries. CONCLUSIONS Given Australia's current overweight/obesity prevalence and trajectory, Australia-based studies are needed to identify the suspected co-morbidities, understand the range of individual, social and environmental mechanisms driving obesity, and help identify policies, interventions and strategies that will change the future trajectory and 'disease burden' both in Australia and internationally. WHAT IS KNOWN • Trend analyses have shown that obesity prevalence in Australia is increasing and will outrank UK and the USA by 2022. • Every third Australian child/adolescent between 5 and 19 years old is predicted to be classified as overweight or obese by 2025. • Childhood obesity is associated with multiple immediate physical and psychological health co-morbidities as well as co-morbidities in adulthood. These have often been identified and examined individually. What is New: • This paper presents a holistic picture of childhood obesity and the associated multiple co-morbidities in Australia. • The extensive health-related outcomes from childhood obesity and those requiring further research are identified. • The findings of this paper will influence the development of local/regional, state and national strategies to change Australia's future trajectory.
Collapse
Affiliation(s)
- Ross H Sanders
- Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, Cumberland Campus C42, 75 East Street, Sydney, NSW, 2141, Australia,
| | | | | | | |
Collapse
|
35
|
Döring N, de Munter J, Rasmussen F. The associations between overweight, weight change and health related quality of life: Longitudinal data from the Stockholm Public Health Cohort 2002-2010. Prev Med 2015; 75:12-7. [PMID: 25770434 DOI: 10.1016/j.ypmed.2015.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/27/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Cross-sectional studies have shown that people with obesity and overweight report lower health related quality of life (HRQoL). With a lack of longitudinal studies, this study aims to assess the association between eight-year weight change and HRQoL measured by the EQ-5D instrument and to investigate whether the association differs with regard to baseline body mass index (BMI). METHOD A population-based survey was conducted among a random sample of 31,182 individuals from Stockholm County aged 18-84years in 2002 and reassessed in 2010 and supplemented by record linkage with regional and national registers. Multivariate Poisson regression and linear regression were conducted with adjustments for socio-demographic and health-related variables and baseline BMI category as effect modifier for the association between weight change and HRQoL. RESULTS Individuals with overweight and obesity respectively have 0.014 and 0.039 lower EQ-5D indexes compared to those being normal weight. Over the eight-year follow-up, 17.6% gained moderately (≥5% body weight) and 13.9% gained heavily (≥10% body weight) in weight. In the fully adjusted analysis, heavy weight gain was associated with a significantly lower overall EQ-5D index and an increased risk of reporting impairment in all but one EQ-5D dimensions irrespective of baseline BMI category. Weight reduction had no significant preventive effect. CONCLUSION Next to obesity status itself, weight gain leads to impairment in HRQoL irrespective of BMI category at baseline while eight year weight loss seems not to have the reversed effect on HRQoL, emphasizing the importance of primary prevention of weight gain.
Collapse
Affiliation(s)
- N Döring
- Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - J de Munter
- Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - F Rasmussen
- Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden
| |
Collapse
|
36
|
Barber SE, Akhtar S, Jackson C, Bingham DD, Hewitt C, Routen A, Richardson G, Ainsworth H, Moore HJ, Summerbell CD, Pickett KE, O’Malley C, Brierley S, Wright J. Preschoolers in the Playground: a pilot cluster randomised controlled trial of a physical activity intervention for children aged 18 months to 4 years. PUBLIC HEALTH RESEARCH 2015. [DOI: 10.3310/phr03050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThe preschool years are considered critical for establishing healthy lifestyle behaviours such as physical activity. Levels of physical activity track through childhood into adulthood and establishing habitual physical activity early in life is therefore vital. Time spent outdoors is associated with greater physical activity and playground interventions have been shown to increase physical activity in school-aged children. There are few preschool, playground-based interventions and these have given inconclusive results. A report published by the UK’s Chief Medical Officer (CMO) highlighted the need for new interventions to promote movement in the early years (0–5 years).ObjectivesThis study aimed to undertake a pilot cluster randomised controlled trial (RCT) of an outdoor playground-based physical activity intervention for parents and their children aged from 18 months to 4 years (Preschoolers in the Playground or PiP) and to assess the feasibility of conducting a full-scale cluster RCT.DesignThe study was a two-armed pilot cluster RCT with economic and qualitative evaluations. Participants were randomised on a 1 : 1 basis to the PiP intervention (n = 83) or usual practice (control;n = 81).SettingBradford, West Yorkshire, UK.ParticipantsChildren aged from 18 months to 4 years.InterventionThe PiP intervention is grounded in behavioural theory (social cognitive theory) and is in accordance with CMO guidance for physical activity in the early years. It is informed by existing literature and data collected from focus groups with parents. The intervention was delivered in primary school playgrounds. Six 30-minute PiP sessions per week were available for 30 weeks; families were encouraged to come to three a week. The 10-week initiation phase was facilitated by a member of school staff and the maintenance phase was unsupervised.Main outcome measuresRecruitment and retention of schools and families to the trial were the main outcome measures. The acceptability of trial procedures and the intervention, the feasibility of collecting health outcome data and the fidelity of the implementation of the intervention were also evaluated. A preliminary assessment of cost-effectiveness and a sample size calculation for a full trial were conducted.ResultsIn total, 37% of schools and 48% of parents approached agreed to take part. Levels of retention were good at 10 and 52 weeks’ follow-up (82.3% and 83.5% respectively). Both the trial procedures and the intervention were acceptable. However, attendance was low during the autumn and winter/spring initiation phases but somewhat better in the summer initiation phase. Attendance was poor throughout all maintenance phases. The accelerometry protocol for measuring physical activity requires modification. The fidelity of intervention implementation was good (81% adherence). The intervention was borderline cost-effective. A sample size of 600 children from 38 schools is required for a full trial.ConclusionA full RCT of the PiP intervention is feasible. The PiP intervention requires some modification, for example running the intervention during the summer term only, but was found to be acceptable to schools and families.Trial registrationCurrent Controlled Trials ISRCTN54165860.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 3, No. 5. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
| | | | - Cath Jackson
- Department of Health Sciences, University of York, York, UK
| | - Daniel D Bingham
- Bradford Institute for Health Research, Bradford, UK
- School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Ash Routen
- School of Medicine and Health, University of Durham, Durham, UK
| | | | | | - Helen J Moore
- School of Medicine and Health, University of Durham, Durham, UK
| | | | - Kate E Pickett
- Department of Health Sciences, University of York, York, UK
| | - Claire O’Malley
- School of Medicine and Health, University of Durham, Durham, UK
| | - Shirley Brierley
- Public Health, City of Bradford Metropolitan District Council, Bradford, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford, UK
| |
Collapse
|
37
|
von Bonsdorff MB, Törmäkangas T, Rantanen T, Salonen MK, Osmond C, Kajantie E, Eriksson JG. Early life body mass trajectories and mortality in older age: findings from the Helsinki Birth Cohort Study. Ann Med 2015; 47:34-9. [PMID: 25307361 DOI: 10.3109/07853890.2014.963664] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Overweight and obesity in childhood have been linked to an increased risk of adult mortality, but evidence is still scarce. METHODS We identified trajectories of body mass index (BMI) development in early life and investigated their mortality risk. Data come from the Helsinki Birth Cohort Study, in which 4943 individuals, born 1934-1944, had serial measures of weight and height from birth to 11 years extracted from health care records, weight and height data in adulthood, and register-based mortality data for 2000-2010. RESULTS Three early BMI trajectories (increasing, average, and average-to-low for men and increasing, average, and low-to-high BMI for women) were identified. Women with an increasing or low-to-high BMI (BMI lower in early childhood, later exceeded average) trajectory had an increased risk of all-cause mortality compared to those with an average BMI trajectory (HR 1.55, 95% CI 1.07-2.23; and HR 1.57, 95% CI 1.04-2.37, respectively). Similar associations were observed for cancer mortality. Among men, BMI trajectories were not associated with all-cause mortality, but those with average-to-low BMI (BMI first similar then dropped below average) had an increased risk of cancer mortality. CONCLUSIONS An increasing BMI in early life may shorten the lifespan of maturing cohorts as they age, particularly among women.
Collapse
Affiliation(s)
- Mikaela B von Bonsdorff
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä , Jyväskylä , Finland
| | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
Obesity is a national public health concern linked to numerous chronic health conditions among Americans of all age groups. Evidence suggests that discretionary calories from sugary drink consumption have been a significant contributor to excess caloric intake among both children and adults. Research has established strong links between retail food environments and purchasing habits of consumers, but little information exists on the sugary drink retail environment in urban neighborhoods. The objective of this assessment was to compare various aspects of the sugary drink retail environment across New York City (NYC) neighborhoods with disparate self-reported sugary drink consumption patterns. In-store retail audits were conducted at 883 corner stores, chain pharmacies, and grocery stores in 12 zip codes throughout NYC. Results showed that among all beverage types assessed, sugary drinks had the most prominent presence in the retail environment overall, which was even more pronounced in higher-consumption neighborhoods. In higher- versus lower-consumption neighborhoods, the mean number of sugary drink varieties available at stores was higher (11.4 vs. 10.4 varieties), stores were more likely to feature sugary drink advertising (97 vs. 89 %) and advertising at multiple places throughout the store (78 vs. 57 %), and several sugary drinks, including 20-oz Coke® or Pepsi®, were less expensive ($1.38 vs. $1.60). These results, all statistically significant, indicate that neighborhoods characterized by higher levels of sugary drink consumption expose shoppers to sugary drinks to a greater extent than lower-consumption neighborhoods. This builds upon evidence documenting the association between the environment and individual behavior.
Collapse
|
39
|
de Mutsert R, Sun Q, Willett WC, Hu FB, van Dam RM. Overweight in early adulthood, adult weight change, and risk of type 2 diabetes, cardiovascular diseases, and certain cancers in men: a cohort study. Am J Epidemiol 2014; 179:1353-65. [PMID: 24786797 DOI: 10.1093/aje/kwu052] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The relative importance of overweight after childhood and excess weight gain during adulthood remains unclear. In 39,909 male participants of the Health Professionals Follow-Up Study who were 40-75 years of age in 1986 and were followed until 2008, we documented 8,755 incident cases of obesity-related chronic diseases (type 2 diabetes mellitus, cardiovascular diseases, and colorectal, renal, pancreatic, and esophageal cancers). We calculated composite and cause-specific hazard ratios using a model that included body mass index (BMI; weight (kg)/height (m)(2)) at 21 years of age, weight change since age 21 years, smoking, alcohol consumption, and family histories of myocardial infarction, colon cancer, and diabetes. Compared with a BMI at 21 years of 18.5-22.9, the composite hazard ratio for a BMI of 23-24.9 was 1.22 (95% confidence interval (CI): 1.16, 1.29), that for a BMI of 25.0-27.4 was 1.57 (95% CI: 1.48, 1.67), that for a BMI of 27.5-29.9 was 2.40 (95% CI: 2.17, 2.65), and that for a BMI ≥30.0 was 3.15 (95% CI: 2.76, 3.60). The composite hazard ratios for adult weight gain compared with a stable weight were 1.12 (95% CI: 1.03, 1.22) for a gain of 2.5-4.9 kg, 1.41 (95% CI: 1.31, 1.52) for a gain of 5-9.9 kg, 1.72 (95% CI: 1.59, 1.86) for a gain of 10-14.9 kg, and 2.45 (95% CI: 2.27, 2.63) for a gain ≥15 kg. Adiposity in early adulthood and adult weight gain were both associated with marked increases in the risk of major chronic diseases in middle-aged and older men, and these associations were already apparent at modest levels of overweight and weight gain.
Collapse
|
40
|
Silventoinen K, Tynelius P, Rasmussen F. Weight status in young adulthood and survival after cardiovascular diseases and cancer. Int J Epidemiol 2014; 43:1197-204. [PMID: 24733247 DOI: 10.1093/ije/dyu091] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Some studies have suggested that overweight is associated with lower mortality, but these results may be affected by reverse causality. We analysed how body mass index (BMI) in young adulthood is associated with mortality in the general population and after the diagnoses of coronary heart disease (CHD), stroke and cancer. METHODS BMI was measured at an average age of 18 years in 734 438 Swedish men born in 1950-65. Diagnoses of CHD, stroke and cancer as well as all-cause mortality were derived from registers covering the whole population, up to 31 December 2010. The follow-up of 24.56 million person-years included 33 067 cases of mortality and 19 843 CHD, 13 578 stroke and 27 365 cancer diagnoses. Hazard ratios (HR) [with 95% confidence intervals (CI)] were estimated by the Cox proportional hazards model. RESULTS Higher mortality in the whole cohort (HR = 1.26, 1.21-1.32) as well as after the diagnosis of CHD (HR = 1.33, 1.09-1.63) or cancer (HR = 1.13, 1.01-1.25) was found in moderately overweight men (BMI 25.0-27.4 kg/m(2)) as compared with normal weight men (BMI 20.1-22.4 kg/m(2)); for stroke patients the result for the same BMI categories was not statistically significant (HR = 1.17, 0.94-1.45). Mortality increased with increasing weight status and was highest in obese men (BMI >30 kg/m(2)): HR = 2.17 (2.02-2.34) for the whole cohort, 2.35 (1.81-3.05) after the diagnosis of CHD, 2.08 (1.56-2.77) after stroke and 1.68 (1.40-2.01) after cancer. CONCLUSIONS Even moderate overweight in young adulthood increases all-cause mortality and mortality after the diagnosis of CHD, stroke and cancer in men. Preventing overweight in young adulthood remains as an important public health issue.
Collapse
Affiliation(s)
- Karri Silventoinen
- Department of Social Research and Department of Public Health, University of Helsinki, Helsinki, Finland and Department of Public Health Sciences, Karolinska Institutet, Stockholm, SwedenDepartment of Social Research and Department of Public Health, University of Helsinki, Helsinki, Finland and Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Per Tynelius
- Department of Social Research and Department of Public Health, University of Helsinki, Helsinki, Finland and Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Finn Rasmussen
- Department of Social Research and Department of Public Health, University of Helsinki, Helsinki, Finland and Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
41
|
Jenkins TM, Buncher CR, Akers R, Daniels SR, Lawson ML, Khoury PR, Wilson TP, Inge TH. Validation of a weight history questionnaire to identify adolescent obesity. Obes Surg 2014; 23:1404-12. [PMID: 23475789 DOI: 10.1007/s11695-013-0901-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Past body weight may be a more informative factor than current weight for risk of chronic disease development. Often, investigators must rely on subject recall to gauge past body weights. The Cincinnati Weight History Questionnaire (CWHQ) was developed to aid in the retrospective identification of adults who were obese during adolescence. METHODS To assess validity, the CWHQ was administered to a subset of National Heart, Lung, and Blood Growth and Health Study (NGHS) participants, a group of young adult females for whom historical measured anthropometrics were available. One hundred ninety-eight NGHS participants were contacted, of whom 191 (97 %) responded (age 26-29). Participants were asked to recall height and weight from ages 13 and 18, which were compared to previously measured values. Multiple indices of validity (Bland-Altman plots, sensitivity, and specificity) were calculated. RESULTS The CWHQ was moderately sensitive (range, 19-66 %), but highly specific (range, 89-100 %). Recalled height and weight values used to determine body mass index (BMI) underestimated BMI based on recorded height and weight at ages 13 and 18. Differences in calculated BMI based on recalled and measured height and weight were found to increase with BMI calculated using measured values. CONCLUSIONS The CWHQ proved to be a moderately sensitive, but highly specific instrument for detecting adolescent obesity in a cohort of young adult females. Epidemiologic research seeking to discriminate between adults with adult-onset vs. adolescent-onset obesity may find the CWHQ useful.
Collapse
Affiliation(s)
- Todd M Jenkins
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7000, Cincinnati, OH 45229-3039, USA.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Etemadi A, Abnet CC, Kamangar F, Islami F, Khademi H, Pourshams A, Poustchi H, Bagheri M, Sohrabpour AA, Aliasgar A, Khoshnia M, Wacholder S, Matthews CC, Pharoah PD, Brennan P, Boffetta P, Malekzadeh R, Dawsey SM. Impact of body size and physical activity during adolescence and adult life on overall and cause-specific mortality in a large cohort study from Iran. Eur J Epidemiol 2014; 29:95-109. [PMID: 24557643 DOI: 10.1007/s10654-014-9883-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 02/03/2014] [Indexed: 12/13/2022]
Abstract
We conducted this study to examine life-course body size and physical activity in relation to total and cause-specific mortality, which has not previously been studied in the low and middle-income countries in Asia. The Golestan Cohort Study is a population-based cohort in northeastern Iran in which 50,045 people above the age of 40 have been followed since 2004. Participants were shown a validated pictogram to assess body size at ages 15, 30, and the time of recruitment. Information on occupational physical activity at these ages was also collected. Subjects were followed up annually, and cause of death was determined. Cox regression models were adjusted for age at cohort start, smoking, socioeconomic status, ethnicity, place of residence, education, and opium use. Models for body size were also adjusted for physical activity at the same age, and vice versa. During a total of 252,740 person-years of follow-up (mean follow-up duration 5.1 ± 1.3 years) through December 2011, 2,529 of the cohort participants died. Larger body sizes at ages 15 or 30 in both sexes were associated with increased overall mortality. Cancer mortality was more strongly associated with adolescent obesity, and cardiovascular mortality with early adulthood body size. Weight gain between these ages was associated with cardiovascular mortality. Obese adolescents who lost weight still had increased mortality from all medical causes in both sexes. Physical activity during adolescence and early adulthood had no association with mortality, but at cohort baseline higher levels of activity were associated with reduced mortality. Mortality in this Middle-Eastern population was associated with obesity both during adolescence and early adult life.
Collapse
Affiliation(s)
- Arash Etemadi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Timpka S, Petersson IF, Zhou C, Englund M. Muscle strength in adolescent men and future musculoskeletal pain: a cohort study with 17 years of follow-up. BMJ Open 2013; 3:bmjopen-2013-002656. [PMID: 23793706 PMCID: PMC3668417 DOI: 10.1136/bmjopen-2013-002656] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Musculoskeletal pain is highly prevalent throughout adulthood with a major impact on health, function and participation in the society. Still, the association between muscle strength and development of musculoskeletal pain is unclear. We aimed to study whether overall muscle strength in adolescent men is inversely associated with self-reported musculoskeletal pain in adulthood. DESIGN Cohort study with baseline data from the Swedish Conscription Register and outcome information from the random population-based Swedish Living Conditions Surveys. SETTING Sweden, 1970-2005. PARTICIPANTS 5489 men who at age 17-19 years tested their isometric muscle strength (hand grip, arm flexion and knee extension) during the compulsory conscription. OUTCOME MEASURES The men were surveyed regarding self-reported musculoskeletal pain; mean follow-up time of 17 (range 1-35) years. Our primary outcome was a self-report of musculoskeletal pain, and secondary outcomes were a report of 'severe pain', 'pain in back/hips', 'pain in neck/shoulders' or 'pain in arms/legs', respectively. We categorised muscle strength into three groups: low, average and high, using the 25th-75th percentile to define the reference category (average). We estimated relative risks using log binomial regression with adjustment for smoking, body mass index, education and physical activity. RESULTS In the adjusted model, men with low overall muscle strength had decreased risk of self-reported musculoskeletal pain (0.93, 95% CI 0.87 to 0.99). We observed no such association in men with high strength (0.99, 0.93 to 1.05). Furthermore, no statistically significant increase or decrease in risk was observed for any of the secondary outcomes. CONCLUSIONS In men, low overall isometric muscle strength in youth was not associated with an increased risk of future musculoskeletal pain. Contrarily, we observed a slightly decreased risk of self-reported musculoskeletal pain in adulthood. Our results do not support a model in which low muscle strength is a risk factor for future musculoskeletal pain.
Collapse
Affiliation(s)
- Simon Timpka
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ingemar F Petersson
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Caddie Zhou
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Martin Englund
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
44
|
Ma J, Jemal A, Flanders WD, Ward EM. Joint association of adiposity and smoking with mortality among U.S. adults. Prev Med 2013; 56:178-84. [PMID: 23276778 DOI: 10.1016/j.ypmed.2012.12.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 10/05/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Assessment of death risk for different combinations of body-mass index (BMI) and smoking status among a nationally representative cohort of U.S. adults. METHOD A total of 210,818 participants of the National Health Interview Surveys 1987-1995 were followed through 2006. Relative risks of death from all causes, cardiovascular disease (CVD), and cancer were estimated for each joint group of smoking and BMI by age, using Cox models with the adjustment for age, gender, education, and race. RESULTS Across all the joint groups of BMI and smoking, extremely obese and underweight current smokers were the two groups having the highest risks of death from all causes, CVD, and cancer. For example, among middle-aged adults, the hazard ratios of death from all causes were 4.47 (95% confidence interval [CI], 3.59-5.57) and 5.28 (4.38-6.37) for extremely obese and underweight current smokers, respectively. Overweight was associated with a higher risk of death in middle-aged never smokers, but not in the elderly or in current smokers. CONCLUSION The coexistence of obesity or underweight with current smoking was associated with an especially large risk of death and the associations of BMI with mortality varied by smoking status, age, and cause of death.
Collapse
Affiliation(s)
- Jiemin Ma
- Department of Intramural Research, American Cancer Society, Atlanta, GA, USA.
| | | | | | | |
Collapse
|
45
|
Schmidt M, Johannesdottir SA, Lemeshow S, Lash TL, Ulrichsen SP, Bøtker HE, Toft Sørensen H. Obesity in young men, and individual and combined risks of type 2 diabetes, cardiovascular morbidity and death before 55 years of age: a Danish 33-year follow-up study. BMJ Open 2013; 3:bmjopen-2013-002698. [PMID: 23628994 PMCID: PMC3641453 DOI: 10.1136/bmjopen-2013-002698] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To examine the association between body mass index (BMI) in young adulthood and cardiovascular risks, including venous thromboembolism, before 55 years of age. DESIGN Cohort study using population-based medical databases. SETTING Outcomes registered from all hospitals in Denmark from 1977 onwards. PARTICIPANTS 6502 men born in 1955 and eligible for conscription in Northern Denmark. MAIN OUTCOME MEASURES Follow-up began at participants' 22nd birthday and continued until death, emigration or 55 years of age, whichever came first. Using regression analyses, we calculated the risks and HRs, adjusting for cognitive test score and years of education. RESULTS 48% of all obese young men (BMI ≥30 kg/m(2)) were either diagnosed with type 2 diabetes, hypertension, myocardial infarction, stroke or venous thromboembolism or died before reaching 55 years of age. Comparing obese men with normal weight men (BMI 18.5 to <25.0 kg/m(2)), the risk difference for any outcome was 28% (95% CI 19% to 38%) and the HR was 3.0 (95% CI 2.3 to 4.0). Compared with normal weight, obesity was associated with an event rate that was increased more than eightfold for type 2 diabetes, fourfold for venous thromboembolism and twofold for hypertension, myocardial infarction and death. CONCLUSIONS In this cohort of young men, obesity was strongly associated with adverse cardiometabolic events before 55 years of age, including venous thromboembolism. Compared with those of normal weight, young obese men had an absolute risk increase for type 2 diabetes, cardiovascular morbidity or premature death of almost 30%.
Collapse
Affiliation(s)
- Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Sigrun A Johannesdottir
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Stanley Lemeshow
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Timothy L Lash
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sinna P Ulrichsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| |
Collapse
|
46
|
Ortega FB, Silventoinen K, Tynelius P, Rasmussen F. Muscular strength in male adolescents and premature death: cohort study of one million participants. BMJ 2012; 345:e7279. [PMID: 23169869 PMCID: PMC3502746 DOI: 10.1136/bmj.e7279] [Citation(s) in RCA: 346] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To explore the extent to which muscular strength in adolescence is associated with all cause and cause specific premature mortality (<55 years). DESIGN Prospective cohort study. SETTING Sweden. PARTICIPANTS 1,142,599 Swedish male adolescents aged 16-19 years were followed over a period of 24 years. MAIN OUTCOME MEASURES Baseline examinations included knee extension, handgrip, and elbow flexion strength tests, as well as measures of diastolic and systolic blood pressure and body mass index. Cox regression was used to estimate hazard ratios for mortality according to muscular strength categories (tenths). RESULTS During a median follow-up period of 24 years, 26,145 participants died. Suicide was a more frequent cause of death in young adulthood (22.3%) than was cardiovascular diseases (7.8%) or cancer (14.9%). High muscular strength in adolescence, as assessed by knee extension and handgrip tests, was associated with a 20-35% lower risk of premature mortality due to any cause or cardiovascular disease, independently of body mass index or blood pressure; no association was observed with mortality due to cancer. Stronger adolescents had a 20-30% lower risk of death from suicide and were 15-65% less likely to have any psychiatric diagnosis (such as schizophrenia and mood disorders). Adolescents in the lowest tenth of muscular strength showed by far the highest risk of mortality for different causes. All cause mortality rates (per 100,000 person years) ranged between 122.3 and 86.9 for the weakest and strongest adolescents; corresponding figures were 9.5 and 5.6 for mortality due to cardiovascular diseases and 24.6 and 16.9 for mortality due to suicide. CONCLUSIONS Low muscular strength in adolescents is an emerging risk factor for major causes of death in young adulthood, such as suicide and cardiovascular diseases. The effect size observed for all cause mortality was equivalent to that for well established risk factors such as elevated body mass index or blood pressure.
Collapse
Affiliation(s)
- Francisco B Ortega
- Department of Physical Education and Sport, School of Sport Sciences, University of Granada, Granada, Spain
| | | | | | | |
Collapse
|
47
|
Jackson AS, Sui X, O'Connor DP, Church TS, Lee DC, Artero EG, Blair SN. Longitudinal cardiorespiratory fitness algorithms for clinical settings. Am J Prev Med 2012; 43:512-9. [PMID: 23079174 PMCID: PMC3479664 DOI: 10.1016/j.amepre.2012.06.032] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/04/2012] [Accepted: 06/27/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND Non-exercise algorithms are cost-effective methods to estimate cardiorespiratory fitness (CRF) in healthcare settings. The limitation of current non-exercise models is that they were developed with cross-sectional data. PURPOSE To extend the non-exercise research by developing algorithms for men and women using longitudinal data on indicators available in healthcare settings. METHODS The sample included 1325 women (aged 20-78 years) and 10,040 men (aged 20-86 years) who completed two to 21 maximal treadmill tests between 1977 and 2005. The data were analyzed in 2011 and 2012. The dependent variable was CRF measured by treadmill test. The independent variables were age; body composition (percentage fat or BMI); waist circumference; self-reported physical activity; resting heart rate; and smoking behavior. RESULTS Linear mixed-models regression showed that all variables were independently related to CRF. There was a positive association between CRF and physical activity. Higher levels of body composition were linked to lower CRF. High resting heart rate and smoking resulted in lower estimates of CRF. The error estimates of the percentage fat algorithms were as follows: women, 1.41 METs (95% CI=1.35, 1.47); and men, METs 1.54 (95% CI=1.51, 1.55). The BMI models were somewhat less accurate: women, METs 1.51 (95% CI=1.45, 1.58); and men, 1.66 METs (95% CI=1.63, 1.68). CONCLUSIONS These results showed that the CRF of women and men can be estimated from easily obtained health indicators. The longitudinal non-exercise algorithms provide models to accurately estimate CRF changes associated with aging and provide cost-effective algorithms to track CRF over time with health indicators available in healthcare settings.
Collapse
Affiliation(s)
- Andrew S Jackson
- Department of Health and Human Performance, University of Houston, Houston, Texas 77204-6015, USA.
| | | | | | | | | | | | | |
Collapse
|
48
|
Park MH, Falconer C, Viner RM, Kinra S. The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. Obes Rev 2012; 13:985-1000. [PMID: 22731928 DOI: 10.1111/j.1467-789x.2012.01015.x] [Citation(s) in RCA: 449] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The objective of this study was to evaluate the evidence on whether childhood obesity is a risk factor for adult disease, independent of adult body mass index (BMI). Ovid MEDLINE (1948-May 2011), EMBASE (1980-2011 week 18) and the Cochrane Library (1990-2011) were searched for published studies of BMI from directly measured weight and height in childhood (2-19 years) and disease outcomes in adulthood. Data were synthesized in a narrative fashion. Thirty-nine studies (n 181-1.1 million) were included in the review. There was evidence for associations between childhood BMI and type 2 diabetes, hypertension and coronary heart disease. Few studies examined associations independent of adult BMI; these showed that effect sizes were attenuated after adjustment for adult BMI in standard regression analyses. Although there is a consistent body of evidence for associations between childhood BMI and cardiovascular outcomes, there is a lack of evidence for effects independent of adult BMI. Studies have attempted to examine independent effects using standard adjustment for adult BMI, which is subject to over-adjustment and problems with interpretation. Studies that use more robust designs and analytical techniques are needed to establish whether childhood obesity is an independent risk factor for adult disease.
Collapse
Affiliation(s)
- M H Park
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | | |
Collapse
|
49
|
Whitley E, Lee IM, Sesso HD, Batty GD. Association of cigarette smoking from adolescence to middle-age with later total and cardiovascular disease mortality: theHarvard Alumni Health Study. J Am Coll Cardiol 2012; 60:1839-40. [PMID: 23040571 PMCID: PMC4170773 DOI: 10.1016/j.jacc.2012.06.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 06/08/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Elise Whitley
- Department of Epidemiology and Public Health, University College London, London, UK
| | - I-Min Lee
- Department of Epidemiology, Harvard School of Public Health, Boston, USA
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Howard D Sesso
- Department of Epidemiology, Harvard School of Public Health, Boston, USA
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - G. David Batty
- Department of Epidemiology and Public Health, University College London, London, UK
| |
Collapse
|
50
|
Önnerfält J, Erlandsson LK, Orban K, Broberg M, Helgason C, Thorngren-Jerneck K. A family-based intervention targeting parents of preschool children with overweight and obesity: conceptual framework and study design of LOOPS- Lund overweight and obesity preschool study. BMC Public Health 2012; 12:879. [PMID: 23072247 PMCID: PMC3538526 DOI: 10.1186/1471-2458-12-879] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 10/09/2012] [Indexed: 11/10/2022] Open
Abstract
Background As the rate of overweight among children is rising there is a need for evidence-based research that will clarify what the best interventional strategies to normalize weight development are. The overall aim of the Lund Overweight and Obesity Preschool Study (LOOPS) is to evaluate if a family-based intervention, targeting parents of preschool children with overweight and obesity, has a long-term positive effect on weight development of the children. The hypothesis is that preschool children with overweight and obesity, whose parents participate in a one-year intervention, both at completion of the one-year intervention and at long term follow up (2-, 3- and 5-years) will have reduced their BMI-for-age z-score. Methods/Design The study is a randomized controlled trial, including overweight (n=160) and obese (n=80) children 4-6-years-old. The intervention is targeting the parents, who get general information about nutrition and exercise recommendations through a website and are invited to participate in a group intervention with the purpose of supporting them to accomplish preferred lifestyle changes, both in the short and long term. To evaluate the effect of various supports, the parents are randomized to different interventions with the main focus of: 1) supporting the parents in limit setting by emphasizing the importance of positive interactions between parents and children and 2) influencing the patterns of daily activities to induce alterations of everyday life that will lead to healthier lifestyle. The primary outcome variable, child BMI-for-age z-score will be measured at referral, inclusion, after 6 months, at the end of intervention and at 2-, 3- and 5-years post intervention. Secondary outcome variables, measured at inclusion and at the end of intervention, are child activity pattern, eating habits and biochemical markers as well as parent BMI, exercise habits, perception of health, experience of parenthood and level of parental stress. Discussion The LOOPS project will provide valuable information on how to build effective interventions to influence an unhealthy weight development to prevent the negative long-term effects of childhood obesity. Trial registration ClinicalTrials.gov NCT00916318
Collapse
Affiliation(s)
- Jenny Önnerfält
- Department of Paediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden.
| | | | | | | | | | | |
Collapse
|