background The influence of excess body weight on the risk of death from cancer has not been fully characterized. methods In a prospectively studied population of more than 900,000 U.S. adults (404,576 men and 495,477 women) who were free of cancer at enrollment in 1982, there were 57,145 deaths from cancer during 16 years of follow-up. We examined the relation in men and women between the body-mass index in 1982 and the risk of death from all cancers and from cancers at individual sites, while controlling for other risk factors in multivariate proportional-hazards models. We calculated the proportion of all deaths from cancer that was attributable to overweight and obesity in the U.S. population on the basis of risk estimates from the current study and national estimates of the prevalence of overweight and obesity in the U.S. adult population. results The heaviest members of this cohort (those with a body-mass index [the weight in kilograms divided by the square of the height in meters] of at least 40) had death rates from all cancers combined that were 52 percent higher (for men) and 62 percent higher (for women) than the rates in men and women of normal weight. For men, the relative risk of death was 1.52 (95 percent confidence interval, 1.13 to 2.05); for women, the relative risk was 1.62 (95 percent confidence interval, 1.40 to 1.87). In both men and women, body-mass index was also significantly associated with higher rates of death due to cancer of the esophagus, colon and rectum, liver, gallbladder, pancreas, and kidney; the same was true for death due to non-Hodgkin’s lymphoma and multiple myeloma. Significant trends of increasing risk with higher body-mass-index values were observed for death from cancers of the stomach and prostate in men and for death from cancers of the breast, uterus, cervix, and ovary in women. On the basis of associations observed in this study, we estimate that current patterns of overweight and obesity in the United States could account for 14 percent of all deaths from cancer in men and 20 percent of those in women. conclusions Increased body weight was associated with increased death rates for all cancers combined and for cancers at multiple specific sites.

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Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults.

ContextModifiable behavioral risk factors are leading causes of mortality in
the United States. Quantifying these will provide insight into the effects
of recent trends and the implications of missed prevention opportunities.ObjectivesTo identify and quantify the leading causes of mortality in the United
States.DesignComprehensive MEDLINE search of English-language articles that identified
epidemiological, clinical, and laboratory studies linking risk behaviors and
mortality. The search was initially restricted to articles published during
or after 1990, but we later included relevant articles published in 1980 to
December 31, 2002. Prevalence and relative risk were identified during the
literature search. We used 2000 mortality data reported to the Centers for
Disease Control and Prevention to identify the causes and number of deaths.
The estimates of cause of death were computed by multiplying estimates of
the cause-attributable fraction of preventable deaths with the total mortality
data.Main Outcome MeasuresActual causes of death.ResultsThe leading causes of death in 2000 were tobacco (435 000 deaths;
18.1% of total US deaths), poor diet and physical inactivity (400 000
deaths; 16.6%), and alcohol consumption (85 000 deaths; 3.5%). Other
actual causes of death were microbial agents (75 000), toxic agents (55 000),
motor vehicle crashes (43 000), incidents involving firearms (29 000),
sexual behaviors (20 000), and illicit use of drugs (17 000).ConclusionsThese analyses show that smoking remains the leading cause of mortality.
However, poor diet and physical inactivity may soon overtake tobacco as the
leading cause of death. These findings, along with escalating health care
costs and aging population, argue persuasively that the need to establish
a more preventive orientation in the US health care and public health systems
has become more urgent.

/pdf/actual-causes-of-death-in-the-united-states-2000-3bff2yf5eo.pdf

Actual causes of death in the United States, 2000.

Background Body-mass index (the weight in kilograms divided by the square of the height in meters) is known to be associated with overall mortality. We investigated the effects of age, race, sex, smoking status, and history of disease on the relation between body-mass index and mortality. Methods In a prospective study of more than 1 million adults in the United States (457,785 men and 588,369 women), 201,622 deaths occurred during 14 years of follow-up. We examined the relation between body-mass index and the risk of death from all causes in four subgroups categorized according to smoking status and history of disease. In healthy people who had never smoked, we further examined whether the relation varied according to race, cause of death, or age. The relative risk was used to assess the relation between mortality and body-mass index. Results The association between body-mass index and the risk of death was substantially modified by smoking status and the presence of disease. In healthy people who had ne...

Body-Mass Index and Mortality in a Prospective Cohort of U.S. Adults

The prevalence of obesity is rapidly increasing globally. Epidemiological studies have associated obesity with a range of cancer types, although the mechanisms by which obesity induces or promotes tumorigenesis vary by cancer site. These include insulin resistance and resultant chronic hyperinsulinaemia, increased bioavailability of steroid hormones and localized inflammation. Gaining a better understanding of the relationship between obesity and cancer can provide new insight into mechanisms of cancer pathogenesis.

/pdf/overweight-obesity-and-cancer-epidemiological-evidence-and-3aap682afc.pdf

Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms

Objective. —To examine trends in overweight prevalence and body mass index of the US adult population. Design. —Nationally representative cross-sectional surveys with an in-person interview and a medical examination, including measurement of height and weight. Setting/Participants. —Between 6000 and 13000 adults aged 20 through 74 years examined in each of four separate national surveys during 1960 to 1962 (the first National Health Examination Survey [NHES I]), 1971 to 1974 (the first National Health and Nutrition Examination Survey [NHANES I]), 1976 to 1980 (NHANESII), and 1988 to 1991 (NHANES III phase 1). Results. —In the period 1988 to 1991,33.4% of US adults 20 years of age or older were estimated to be overweight. Comparisons of the 1988 to 1991 overweight prevalence estimates with data from earlier surveys indicate dramatic increases in all race/sex groups. Overweight prevalence increased 8% between the 1976 to 1980 and 1988 to 1991 surveys. During this period, for adult men and women aged 20 through 74 years, mean body mass index increased from 25.3 to 26.3; mean body weight increased 3.6 kg. Conclusions. —These nationally representative data document a substantial increase in overweight among US adults and support the findings of other investigations that show notable increases in overweight during the past decade. These observations suggest that the Healthy People 2000 objective of reducing the prevalence of overweight US adults to no more than 20% may not be met by the year 2000. Understanding the reasons underlying the increase in the prevalence of overweight in the United States and elucidating the potential consequences in terms of morbidity and mortality present a challenge to our understanding of the etiology, treatment, and prevention of overweight. ( JAMA . 1994;272:205-211)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=376504&pdfFileName=jama_272_3_027.pdf

Increasing Prevalence of Overweight Among US Adults: The National Health and Nutrition Examination Surveys, 1960 to 1991

Variations in mortality by weight among 750,000 men and women.

Some implications of mortality statistics relating to coronary artery disease.

This paper presents considerably detailed death rates according to smoking habits and health status, based on the American Cancer Society Cancer Prevention Study I, which constitutes the largest body of data currently available for the study of smoking habits. This study involved over one million men and women, selected largely from the middle class, traced from July 1, 1960 through June 30, 1972. The overall mortality of the subjects in this study was found to resemble that of persons covered by group life insurance during 1970-74. At ages 65 and older the experience was similar to that of contemporaneous ultimate mortality among persons insured under ordinary policies. The data on death rates according to smoking habits and health status provide valuable guidance for pricing smoker/nonsmoker policies. They also provide better measures of intrinsic sex differentials than have hitherto been available.

Differences in mortality and longevity by sex, smoking habits and health status

In the fall of 1959 the American Cancer Society began a comprehensive epidemiologic study of over one million men and women drawn mainly from the middle-class population [4]. The experience among the subjects of this study who were initially at least 65 years old or who subsequently attained age 65 was analyzed by attained age, age at entry, calendar-year periods, cause of death, and a number of demographic and other factors. Three sets of mortality tables were prepared: for the total population, for the ostensibly healthy, and for those not in good health. The aggregate experience among the male subjects under study was similar to the contemporary experience among standard ordinary male risks insured 16 years or longer. The corresponding experience among female subjects was lower than that among standard ordinary female risks insured 16 years or longer. The death rates among the ostensibly healthy subjects of either sex resembled closely the contemporary select mortality rates among standard ordinary risks in the age range 65-74. Thus the experience in this study among the ostensibly healthy subjects provides credible estimates of the mortality likely to be experienced among standard ordinary risks at the advanced ages, where adequate information from insurance sources is lacking. The death rates among the ostensibly healthy subjects in this study also furnish a more relevant standard of normal mortality at ages 65 and over than either population death rates or ultimate death rates among insured lives. This paper examines the effects of selection procedures such as those used in epidemiologic studies and suggests that similar procedures could be employed to select standard ordinary insurance risks at the older ages. The analysis of mortality by cause shows that selection has little effect on cancer death rates and that most of the excess mortality among those not in good health can be attributed to extra mortality from heart disease. Analysis of the mortality at ages 65 and over according to demographic and personal characteristics indicates that a good family history of longevity and higher educational attainment have an appreciable effect on * Mr. Garfinkel, not a member of the Society, is Vice President for Epidemiology and Statistics of the American Cancer Society.

Mortality at ages 65 and over in a middle- class population

In the fall of 1959 the American Cancer Society began a comprehensive epidemiologic investigation of more than one million men and women drawn mainly from the middle-class population. The study reported here presents a portion of the investigation relating to the mortality among 49,469 subjects who attained age 75 years and older during the course of the study. Both men and women who at entry into this study (1960) were judged to be in good health registered distinctly lower mortality than those judged to be in poor health. Men and women with some college education had significantly lower death rates than those with lesser schooling. Men and women who reported a good family history of longevity showed consistently lower death rates in each five-year age group than those with average or poor family history of longevity. Persons with an average family history of longevity generally had lower death rates than those with a poor family history of longevity. Analysis of mortality by cause indicated that at ages 75 and older nearly half the deaths were attributed to all forms of heart disease. Coronary heart disease accounted for about 35 percent of all deaths, with the proportion decreasing with age. Deaths from stroke rose from 15 to about 20 percent with increase in age. Deaths from all sites of cancer declined with advancing age in both sexes, from about 16 percent of all deaths at ages 75 to 79 to about six percent at ages 90 to 99. Among men, cancer of the prostate accounted for 3.5 percent of deaths at ages 75 to 84, decreasing to about one half this proportion in the early-90s age group. Colorectal cancer decreased from about three percent of total deaths at ages 75 to 84 to about 1.5 percent in the early 90s. Lung cancer and stomach cancer remained at the same level at these ages.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/canjclin.40.4.210

Edward A. Lew

Papers

Variations in mortality by weight among 750,000 men and women.

Some implications of mortality statistics relating to coronary artery disease.

Differences in mortality and longevity by sex, smoking habits and health status

Mortality at ages 65 and over in a middle- class population

Mortality at ages 75 and older in the Cancer Prevention Study (CPS I).