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Journal ArticleDOI

The number of years lived with obesity and the risk of all-cause and cause-specific mortality

01 Aug 2011-International Journal of Epidemiology (Oxford University Press)-Vol. 40, Iss: 4, pp 985-996
TL;DR: The number of years lived with obesity is directly associated with the risk of mortality and needs to be taken into account when estimating its burden on mortality.
Abstract: Background The role of the duration of obesity as an independent risk factor for mortality has not been investigated. The aim of this study was to analyse the association between the duration of obesity and the risk of mortality. Methods A total of 5036 participants (aged 28–62 years) of the Framingham Cohort Study were followed up every 2 years from 1948 for up to 48 years. The association between obesity duration and all-cause and cause-specific mortality was analysed using time-dependent Cox models adjusted for body mass index. The role of biological intermediates and chronic diseases was also explored. Results The adjusted hazard ratio (HR) for mortality increased as the number of years lived with obesity increased. For those who were obese for 1–4.9, 5–14.9, 15–24.9 and ≥25 years of the study follow-up period, adjusted HRs for all-cause mortality were 1.51 [95% confidence interval (CI) 1.27–1.79], 1.94 (95% CI 1.71–2.20), 2.25 (95% CI 1.89–2.67) and 2.52 (95% CI 2.08–3.06), respectively, compared with those who were never obese. A dose–response relation between years of duration of obesity was also clear for all-cause, cardiovascular, cancer and other-cause mortality. For every additional 2 years of obesity, the HRs for all-cause, cardiovascular disease, cancer and other-cause mortality were 1.06 (95% CI 1.05–1.07), 1.07 (95% CI 1.05–1.08), 1.03 (95% CI 1.01–1.05) and 1.07 (95% CI 1.05–1.11), respectively. Conclusions The number of years lived with obesity is directly associated with the risk of mortality. This needs to be taken into account when estimating its burden on mortality.
Citations
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Journal ArticleDOI
TL;DR: Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls, and by contrast, the rise in BMI has accelerated in east and south Asia forboth sexes, and southeast Asia for boys.

4,317 citations

Journal ArticleDOI
11 Sep 2018
TL;DR: A Bayesian hierarchical model was used to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5–19 years: moderate and severe underweight.
Abstract: Methods We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5–19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5–19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity).

1,224 citations

Journal ArticleDOI
TL;DR: The continuation of current patterns of population weight gain will lead to continuing increases in the future burden of cancer, and the need for a global effort to abate the increasing numbers of people with high BMI is emphasised.
Abstract: Summary Background High body-mass index (BMI; defined as 25 kg/m 2 or greater) is associated with increased risk of cancer. To inform public health policy and future research, we estimated the global burden of cancer attributable to high BMI in 2012. Methods In this population-based study, we derived population attributable fractions (PAFs) using relative risks and BMI estimates in adults by age, sex, and country. Assuming a 10-year lag-period between high BMI and cancer occurrence, we calculated PAFs using BMI estimates from 2002 and used GLOBOCAN2012 data to estimate numbers of new cancer cases attributable to high BMI. We also calculated the proportion of cancers that were potentially avoidable had populations maintained their mean BMIs recorded in 1982. We did secondary analyses to test the model and to estimate the effects of hormone replacement therapy (HRT) use and smoking. Findings Worldwide, we estimate that 481 000 or 3·6% of all new cancer cases in adults (aged 30 years and older after the 10-year lag period) in 2012 were attributable to high BMI. PAFs were greater in women than in men (5·4% vs 1·9%). The burden of attributable cases was higher in countries with very high and high human development indices (HDIs; PAF 5·3% and 4·8%, respectively) than in those with moderate (1·6%) and low HDIs (1·0%). Corpus uteri, postmenopausal breast, and colon cancers accounted for 63·6% of cancers attributable to high BMI. A quarter (about 118 000) of the cancer cases related to high BMI in 2012 could be attributed to the increase in BMI since 1982. Interpretation These findings emphasise the need for a global effort to abate the increasing numbers of people with high BMI. Assuming that the association between high BMI and cancer is causal, the continuation of current patterns of population weight gain will lead to continuing increases in the future burden of cancer. Funding World Cancer Research Fund International, European Commission (Marie Curie Intra-European Fellowship), Australian National Health and Medical Research Council, and US National Institutes of Health.

718 citations

Journal ArticleDOI
TL;DR: A scientifically based harmonized definition of MHO is proposed, which will hopefully contribute to more comparable data in the future and a better understanding on the MHO subgroup and its CVD prognosis.
Abstract: The prevalence of obesity has increased worldwide over the past few decades. In 2013, the prevalence of obesity exceeded the 50% of the adult population in some countries from Oceania, North Africa, and Middle East. Lower but still alarmingly high prevalence was observed in North America (≈30%) and in Western Europe (≈20%). These figures are of serious concern because of the strong link between obesity and disease. In the present review, we summarize the current evidence on the relationship of obesity with cardiovascular disease (CVD), discussing how both the degree and the duration of obesity affect CVD. Although in the general population, obesity and, especially, severe obesity are consistently and strongly related with higher risk of CVD incidence and mortality, the one-size-fits-all approach should not be used with obesity. There are relevant factors largely affecting the CVD prognosis of obese individuals. In this context, we thoroughly discuss important concepts such as the fat-but-fit paradigm, the metabolically healthy but obese (MHO) phenotype and the obesity paradox in patients with CVD. About the MHO phenotype and its CVD prognosis, available data have provided mixed findings, what could be partially because of the adjustment or not for key confounders such as cardiorespiratory fitness, and to the lack of consensus on the MHO definition. In the present review, we propose a scientifically based harmonized definition of MHO, which will hopefully contribute to more comparable data in the future and a better understanding on the MHO subgroup and its CVD prognosis.

712 citations

Journal ArticleDOI
TL;DR: It is recognised that the key drivers of this epidemic form an obesogenic environment, which includes changing food systems and reduced physical activity, and there is a need to implement effective programmes and policies in multiple sectors to address overnutrition, undernutrition, mobility and physical activity.
Abstract: In recent decades, the prevalence of obesity in children has increased dramatically. This worldwide epidemic has important consequences, including psychiatric, psychological and psychosocial disorders in childhood and increased risk of developing non-communicable diseases (NCDs) later in life. Treatment of obesity is difficult and children with excess weight are likely to become adults with obesity. These trends have led member states of the World Health Organization (WHO) to endorse a target of no increase in obesity in childhood by 2025. Estimates of overweight in children aged under 5 years are available jointly from the United Nations Children’s Fund (UNICEF), WHO and the World Bank. The Institute for Health Metrics and Evaluation (IHME) has published country-level estimates of obesity in children aged 2–4 years. For children aged 5–19 years, obesity estimates are available from the NCD Risk Factor Collaboration. The global prevalence of overweight in children aged 5 years or under has increased modestly, but with heterogeneous trends in low and middle-income regions, while the prevalence of obesity in children aged 2–4 years has increased moderately. In 1975, obesity in children aged 5–19 years was relatively rare, but was much more common in 2016. It is recognised that the key drivers of this epidemic form an obesogenic environment, which includes changing food systems and reduced physical activity. Although cost-effective interventions such as WHO ‘best buys’ have been identified, political will and implementation have so far been limited. There is therefore a need to implement effective programmes and policies in multiple sectors to address overnutrition, undernutrition, mobility and physical activity. To be successful, the obesity epidemic must be a political priority, with these issues addressed both locally and globally. Work by governments, civil society, private corporations and other key stakeholders must be coordinated.

524 citations

References
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Journal ArticleDOI
TL;DR: A sex-specific multivariable risk factor algorithm can be conveniently used to assess general CVD risk and risk of individual CVD events (coronary, cerebrovascular, and peripheral arterial disease and heart failure) and can be used to quantify risk and to guide preventive care.
Abstract: Background—Separate multivariable risk algorithms are commonly used to assess risk of specific atherosclerotic cardiovascular disease (CVD) events, ie, coronary heart disease, cerebrovascular disease, peripheral vascular disease, and heart failure. The present report presents a single multivariable risk function that predicts risk of developing all CVD and of its constituents. Methods and Results—We used Cox proportional-hazards regression to evaluate the risk of developing a first CVD event in 8491 Framingham study participants (mean age, 49 years; 4522 women) who attended a routine examination between 30 and 74 years of age and were free of CVD. Sex-specific multivariable risk functions (“general CVD” algorithms) were derived that incorporated age, total and high-density lipoprotein cholesterol, systolic blood pressure, treatment for hypertension, smoking, and diabetes status. We assessed the performance of the general CVD algorithms for predicting individual CVD events (coronary heart disease, stroke, peripheral artery disease, or heart failure). Over 12 years of follow-up, 1174 participants (456 women) developed a first CVD event. All traditional risk factors evaluated predicted CVD risk (multivariable-adjusted P0.0001). The general CVD algorithm demonstrated good discrimination (C statistic, 0.763 [men] and 0.793 [women]) and calibration. Simple adjustments to the general CVD risk algorithms allowed estimation of the risks of each CVD component. Two simple risk scores are presented, 1 based on all traditional risk factors and the other based on non–laboratory-based predictors. Conclusions—A sex-specific multivariable risk factor algorithm can be conveniently used to assess general CVD risk and risk of individual CVD events (coronary, cerebrovascular, and peripheral arterial disease and heart failure). The estimated absolute CVD event rates can be used to quantify risk and to guide preventive care. (Circulation. 2008;117: 743-753.)

5,959 citations

Journal ArticleDOI
TL;DR: Below the range 22.5-25 kg/m(2), BMI was associated inversely with overall mortality, mainly because of strong inverse associations with respiratory disease and lung cancer, despite cigarette consumption per smoker varying little with BMI.

3,847 citations

Journal ArticleDOI
TL;DR: From an analysis of the effect of obesity on longevity, it is concluded that the steady rise in life expectancy during the past two centuries may soon come to an end.
Abstract: Forecasts of life expectancy are an important component of public policy that influence age-based entitlement programs such as Social Security and Medicare. Although the Social Security Administration recently raised its estimates of how long Americans are going to live in the 21st century, current trends in obesity in the United States suggest that these estimates may not be accurate. From our analysis of the effect of obesity on longevity, we conclude that the steady rise in life expectancy during the past two centuries may soon come to an end.

2,798 citations

Journal ArticleDOI
20 Apr 2005-JAMA
TL;DR: For example, this paper found that obesity was associated with 111 909 excess deaths (95% confidence interval [CI], 53 754170 064) and underweight with 33 746 excess deaths.
Abstract: Results Relative to the normal weight category (BMI 18.5 to 25), obesity (BMI 30) was associated with 111 909 excess deaths (95% confidence interval [CI], 53 754170 064) and underweight with 33 746 excess deaths (95% CI, 15 726-51 766). Overweight was not associated with excess mortality (�86 094 deaths; 95% CI, �161 223 to �10 966). The relative risks of mortality associated with obesity were lower in NHANES II and NHANES III than in NHANES I. Conclusions Underweight and obesity, particularly higher levels of obesity, were associated with increased mortality relative to the normal weight category. The impact of obesity on mortality may have decreased over time, perhaps because of improvements in public health and medical care. These findings are consistent with the increases in life expectancy in the United States and the declining mortality rates from ischemic heart disease.

2,566 citations

Journal ArticleDOI
TL;DR: Underweight and obesity, particularly higher levels of obesity, were associated with increased mortality relative to the normal weight category and these findings are consistent with the increases in life expectancy in the United States and the declining mortality rates from ischemic heart disease.
Abstract: This study was an attempt to estimate deaths associated with being underweight (body mass index [BMI] less than 18.5 kg/m 2 ), overweight (BMI 25-29 kg/m 2 ), and obese (BMI 30 or higher kg/m 2 ). Relative mortality risks associated with different BMI levels were estimated from 3 National Health and Nutrition Examination Survey (NHANES) trials covering the years 1971-1975 (NHANES I), 1976-1980 with follow up through 1992 (NHANES II), and 1988-1994 with follow up through 2000 (NHANES III), respectively. Relative risk estimates were applied to the distribution of BMI and other covariates from NHANES 1999-2002 to estimate mortality risk while adjusting for possible confounding factors, including age. Deaths in the NHANES I, II, and III trials totalled 3923, 2133, and 2793, respectively. Obesity was associated with an increased mortality risk, especially for younger subjects. Relative risk was low in overweight individuals. Relative risk figures for underweight persons generally exceeded unity. A similar pattern was evident for each of the 3 surveys. Although a BMI of 35 kg/m 2 or above was relatively infrequent, these individuals accounted for a majority of obesity-related excess deaths in the year 2000. The relative mortality risk associated with obesity was higher in NHANES I than in the other 2 trials. Compared with normal-weight subjects, those who were overweight had a slight reduction in mortality. Of the 111,909 excess deaths associated with obesity, a majority occurred in persons less than 70 years of age. The opposite was the case for underweight persons. In NHANES surveys dating back to 1971, both underweight and obesity-especially a high degree of obesity-are associated with increased mortality compared with normal-weight persons. Possibly better medical care and improved public health measures have lessened the effect of obesity on mortality. The findings are in accord with increased life expectancy in the United States and with decreasing mortality from ischemic heart disease.

1,719 citations

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