The prevalence of overweight and obesity is increasing in

Size: px
Start display at page:

Download "The prevalence of overweight and obesity is increasing in"

Transcription

1 Annals of Internal Medicine Article The Relationship between Overweight in Adolescence and Premature Death in Women Rob M. van Dam, PhD; Walter C. Willett, MD; JoAnn E. Manson, MD; and Frank B. Hu, MD Background: The impact of adiposity in adolescence on death during adulthood is uncertain. Objective: To examine the relation between adiposity in adolescence and premature death in women. Design: Prospective cohort study. Setting: United States. Participants: women from the Nurses Health Study II who were 24 to 44 years of age and free of cancer at baseline. Ninety percent were of non-hispanic white ethnicity. Measurements: In 1989, current weight and height and recalled weight at age 18 years were assessed by using validated questionnaires, and body mass index (BMI) was calculated. Hazard ratios for death and 95% CIs were adjusted for potential confounders, including cigarette smoking, alcohol use, and physical activity during adolescence. hazard ratio for premature death was 0.98 (95% CI, 0.78 to 1.23) for a BMI less than 18.5 kg/m 2, 1.18 (CI, 0.97 to 1.43) for a BMI of 22.0 to 24.9 kg/m 2, 1.66 (CI, 1.31 to 2.10) for a BMI of 25.0 to 29.9 kg/m 2, and 2.79 (CI, 2.04 to 3.81) for a BMI of 30 kg/m 2 or greater. Among participants who never smoked, a BMI of 22.0 to 24.9 kg/m 2 at age 18 years was also associated with increased premature death (hazard ratio, 1.50 [CI, 1.16 to 1.94]). Associations between BMI at age 18 years and death could only partly be explained by adult BMI measured in Limitations: Because of the observational study design, residual confounding by imperfectly measured or unknown confounders may still be present. Conclusion: Moderately higher adiposity at age 18 years is associated with increased premature death in younger and middle-aged U.S. women. Results: During 12 years of follow-up, 710 participants died. Compared with a BMI of 18.5 to 21.9 kg/m 2 at age 18 years, the Ann Intern Med. 2006;145: For author affiliations, see end of text. The prevalence of overweight and obesity is increasing in the United States and worldwide in children and adults (1 3). Being overweight during childhood and adolescence can have detrimental consequences on psychological and social factors, cardiovascular risk factors, and risk for chronic diseases and is associated with a higher prevalence of obesity in adulthood (4). Several studies have examined whether adiposity in childhood and adolescence is also related to premature death in adulthood (5 15). However, these studies largely concerned older birth cohorts that included few participants who were overweight during youth and few who never smoked (6, 8 10, 12 14). In addition, data from more recent studies are needed to address the proposition that the impact of obesity on death may have decreased recently because of advances in public health and medical care (16). Whether weight management in adulthood can prevent detrimental effects of childhood adiposity on adult health is relevant for prioritization of preventive efforts. Few studies have examined whether associations between childhood adiposity and adult death are merely due to tracking of adiposity between childhood and adulthood or whether independent effects of childhood adiposity exist (9, 17). Other issues that require study include the degree of adiposity that is associated with elevated rates of premature mortality and the shape of this association. U-shaped associations between body mass index (BMI) in middle age and death have been reported, and whether the higher mortality rates for the leanest persons represent a biological effect or a methodologic artifact remains controversial (16, 18). Weight loss due to health conditions that precede death can bias associations between BMI and death in middle-aged and older populations (19, 20). Such a reverse causation bias (19) is less likely to affect associations for adolescent adiposity because the prevalence of chronic disease is very low at this age. Data on the association between adolescent adiposity and premature death can provide insight into the importance of preventing excessive weight gain during childhood and adolescence. We therefore examined BMI at age 18 years in relation to death during 12 years of follow-up (1989 to 2001) in a large cohort of younger and middleaged U.S. women. See also: Print Editors Notes Editorial comment Related article Summary for Patients....I-34 Web-Only Conversion of figure and tables into slides 2006 American College of Physicians 91

2 Article Overweight and Mortality Context Do overweight female adolescents have a higher risk for premature death during adulthood? Contribution The authors of this prospective cohort study recruited U.S. female nurses, 24 to 44 years of age, asked about their weight at age 18 years, and then monitored deaths that occurred within 12 years after recruitment. Compared with a reported body mass index (BMI) of 18.5 to 21.9 kg/m 2, the hazard ratio for death was 1.18 for a BMI of 22.0 to 24.9 kg/m 2, 1.66 for a BMI of 25.0 to 29.9 kg/m 2, and 2.79 for a BMI of 30 kg/m 2 or greater. Implications Adiposity at age 18 years is associated with increased mortality rates in younger and middle-aged women. The Editors METHODS Study Population We used data from the prospective Nurses Health Study II. This cohort included female U.S. nurses who were 24 to 44 years of age at study initiation in Information has been collected using biennial mailed questionnaires, and response rates have been approximately 90% for each follow-up questionnaire. The response rate to the baseline mailing was 24%. Our strategy was to use a single baseline mailing to enroll only the most enthusiastic potential participants who would complete a questionnaire after 1 request, allowing us to achieve high response rates for follow-up questionnaires. We excluded participants with a history of cancer (except nonmelanoma skin cancer) (0.9%), pregnancy at study initiation (4.3%), or missing information for any of the variables used in the analyses (7.0% of the remaining women). A total of women remained for the current analysis. Mean age (34.4 years [SD, 4.7] vs years [SD, 4.7]), ethnicity (non- Hispanic white, 90.3% vs. 90.0%), and BMI at age 18 years (available for 99.0% of the total study population; 21.3 kg/m 2 [SD, 3.4] vs kg/m 2 [SD, 3.4] were very similar for the total study population and the sample that remained for the current analysis, respectively. The human research committees at Harvard School of Public Health and Brigham and Women s Hospital approved the study. Ascertainment of Death Deaths were reported by next of kin or by postal authorities (85.3%) or were ascertained through searching the National Death Index for nonresponders (14.7%). For the original Nurses Health Study, the follow-up for deaths using the National Death Index has been estimated to be 98% complete (21). Given the young age of the cohort, we considered all deaths to be premature. Information on the cause of death was obtained from next of kin for external deaths (such as those due to traffic accidents); death certificates; or medical records. We requested permission from the next of kin to review medical records for suspected deaths from cancer or cardiovascular diseases if we had not yet obtained these records for follow-up of disease incidence. The cause of death was determined after physician review and was primarily based on medical records if both medical records and death certificates were available. Collection of information on causes of death is an ongoing process, and coding of causes of death was 82% complete at the current analysis. International Classification of Diseases, Eighth Revision (ICD-8), codes were used to assign the underlying cause of death as cancer (codes 140 through 207), cardiovascular diseases (codes 390 through 459 and 795), all other diseases, and external causes (codes E800 through E999), including suicide (codes E950 through E959). Assessment of BMI and Body Circumference Measures On the 1989 baseline questionnaire, participants were asked to report current weight (in pounds) and height (in inches) and weight at age 18 years (in pounds). Body mass index was calculated as weight in kilograms divided by the square of height in meters. Among 118 participants, recalled weight at age 18 years and self-reported current height were compared with records from physical examinations conducted at college or nursing school entrance (22). The Spearman correlation was 0.87 for recalled and measured past weight, 0.94 for self-reported current height and measured past height, and 0.84 for BMI at age 18 years based on self-reports and measurements. The average reported weight was 1.4 kg lower than the measured weight, the average reported height was 0.6 cm higher than the measured past height, and the average BMI at age 18 years based on self-reports was 0.5 kg/m 2 lower than that based on measurements. Age in 1989 was not appreciably associated with the degree of underestimation of weight (r 0.01) or height (r 0.02) at age 18 years. The validation study did not include enough women who were overweight at age 18 years to allow comparison of accuracy of self-reports for women who were and who were not overweight at age 18 years. Reported current weight was validated among 140 participants from the original Nurses Health Study. The correlation between self-reported and technician-measured weight was 0.97; 99% were correctly classified within 1 quintile, and the average self-reported weight was 1.5 kg lower than the measured weight (23). In 1993, we mailed a paper tape measure and pictorial instructions to participants to obtain self-measured waist circumference at the umbilicus and the largest hip circumference between the waist and the thighs and compared these assessments with technician measurements in a validation study (r 0.89 for waist circumference and r 0.84 for hip circumference) (23) July 2006 Annals of Internal Medicine Volume 145 Number 2

3 Overweight and Mortality Article Table 1. Characteristics of the Study Sample by Body Mass Index at Age 18 Years* Variable BMI at Age 18 Years <18.5 kg/m kg/m kg/m kg/m 2 >30.0 kg/m 2 Median BMI, kg/m Participants, n Adolescent characteristics Cigarette smoker, % Alcohol consumption, g/d No vigorous physical activity, % Oral contraceptive use, % Baseline (adult) characteristics Age, y BMI, kg/m Obesity (BMI 30.0 kg/m 2 ), % Cigarette smoker, % Alcohol consumption, g/d Physical activity, metabolic equivalent h/wk Current oral contraceptive use, % Ever received hormone replacement therapy, % * Values are means unless otherwise indicated. Data (except for age) were directly standardized to the age distribution of the entire cohort. BMI body mass index. Adolescent characteristics refer to age 15 to 19 years for cigarette smoking, age 18 to 22 years for alcohol consumption and vigorous physical activity, and age 18 years for oral contraceptive use. Baseline characteristics were reported as current characteristics on the enrollment questionnaire in 1989 when participants were 24 to 44 years of age. Assessment of Adolescent and Adult Lifestyles and Medical History On the baseline questionnaire administered in 1989, we requested information about age, disease history, cigarette smoking habits at different ages and at present, usual frequency of consuming alcoholic beverages at different ages and during the past year, history of oral contraceptive use (24), history of hormone replacement therapy, average amount of participation in vigorous physical activities from age 18 to 22 years (number of months per year for at least twice per week), and current recreational and work-related physical activities (25). Statistical Analysis We grouped women into 5 categories of BMI at age 18 years by using the World Health Organization (WHO) categories (26) and an additional cutoff point within the normal weight category. Women contributed follow-up time from the date of return of the baseline questionnaire to the date of death or 1 July 2001, whichever came first. Mortality rates for categories of BMI were expressed as the number of deaths per person-years, and 95% CIs for rates were calculated on the logarithmic scale assuming an approximately normal distribution. Rate differences were calculated by subtracting rates, and 95% CIs for rate differences were calculated assuming an approximately normal distribution. Cox proportional hazards regression models stratified by 5-year age categories and 2-year calendar time periods were used to calculate hazard rate ratios for the association between BMI and premature death. The multivariate model with adjustment for adolescent covariates included cigarette smoking at age 15 to 19 years (0, 1 to 14, and 15 cigarettes per day), strenuous physical activity at age 18 to 22 years (none, 1 to 3 months per year, 4 to 6 months per year, 7 to 9 months per year, and 10 to 12 months per year), consumption of alcoholic beverages at age 18 to 22 years (0, 1 drink per week to 1 drink per month, 2 to 6 drinks per week, and 1 drink per day), and use of oral contraceptives at age 18 years (ever or never). The model with additional adjustment for adult covariates also included smoking status (0, 1 to 14, 15 to 24, and 25 cigarettes per day), physical activity (quintiles of metabolic equivalent hours per week), alcohol consumption (0, 0.1 to 4.9, 5.0 to 9.9, and 10 g/d), current use of oral contraceptives (yes or no), hormone replacement therapy (ever or never), and BMI ( 18.5 kg/m 2, 18.5 to 21.9 kg/m 2, 22.0 to 24.9 kg/m 2, 25.0 to 29.9 kg/m 2, 30.0 to 34.9 kg/m 2, and 35.0 kg/m 2 ) at baseline in For analysis of cause-specific deaths, the upper BMI categories were combined to avoid imprecision due to small numbers of deaths. For the analysis with adjustment for waist and hip circumference (quintiles), 1993 was used as the baseline. Two-tailed P values less than 0.05 were considered statistically significant. All analyses were done by using SAS software, version 8.2 (SAS Institute Inc., Cary, North Carolina). Role of the Funding Source The funding source had no role in the collection, analysis, or interpretation of the data or in the decision to submit the manuscript for publication. RESULTS During person-years of follow-up, we documented 710 deaths from all causes. Table 1 shows the characteristics of women during adolescence and at the baseline assessment in 1989 according to BMI at age 18 years. During adolescence, women with a higher BMI at age 18 years had higher levels of alcohol consumption, were more likely to smoke cigarettes, and were less likely to 18 July 2006 Annals of Internal Medicine Volume 145 Number 2 93

4 Article Overweight and Mortality Figure. Mortality rate by body mass index (BMI) at age 18 years during 12 years of follow-up in women who were 24 to 44 years of age at enrollment. Medians of the BMI categories ( 18.5 kg/m 2, 18.5 to 21.9 kg/m 2, 22.0 to 24.9 kg/m 2, 25.0 to 29.9 kg/m 2, and 30 kg/m 2 ) were used as values for the x-axis. Error bars represent 95% CIs. engage in vigorous physical activity or to use oral contraceptives. Women with a higher BMI at age 18 years had a higher adult BMI in 1989 (Pearson correlation, 0.63). In addition, women with a higher BMI at age 18 years were more likely to smoke in 1989, were more likely to have a history of hormone replacement therapy, and were less likely to use oral contraceptives as adults. The Figure shows mortality rates during 12 years of follow-up according to BMI at age 18 years in women who were 24 to 44 years of age at baseline in There was no indication of increased mortality rates for women with a low BMI. Compared with a BMI of 18.5 to 21.9 kg/m 2 at age 18 years, the age-adjusted hazard ratio was 0.99 (95% CI, 0.79 to 1.25) for a BMI less than 18.5 kg/m 2, 1.19 (CI, 0.98 to 1.45) for a BMI of 22.0 to 24.9 kg/m 2, 1.68 (CI, 1.33 to 2.13) for a BMI of 25.0 to 29.9 kg/m 2, and 2.83 (CI, 2.08 to 3.86) for a BMI of 30 kg/m 2 or greater. Adjustment for adolescent lifestyle factors did not substantially change the results (Table 2). To avoid residual confounding by smoking, we conducted additional analyses among participants who never smoked. In this group, a BMI of 22.0 to 24.9 kg/m 2 during adolescence was also associated with a statistically significant increase in premature mortality rates compared with a BMI of 18.5 to 21.9 kg/m 2 (Table 2). Among women who ever smoked, the hazard ratio adjusted for adolescent lifestyle was 0.88 (CI, 0.63 to 1.24) for a BMI less than 18.5 kg/m 2, 0.85 (CI, 0.63 to 1.16) for a BMI of 22.0 to 24.9 kg/m 2, 1.51 (CI, 1.08 to 2.11) for a BMI of 25.0 to 29.9 kg/m 2, and 2.70 (CI, 1.77 to 4.12) for a BMI of 30 kg/m 2 or greater compared with a BMI of 18.5 to 21.9 kg/m 2 at age 18 years. Adult lifestyle and BMI at baseline, which may act as intermediary factors, only partly explained the observed association between BMI at age 18 years and premature death (Table 2). Adjustment for adult waist and hip circumference instead of adult BMI did not weaken the association between BMI at age 18 years and premature mortality. Among women who were not obese as adults at baseline (BMI 30 kg/m 2 ), the multivariate mortality hazard ratios for BMI at age 18 years were 1.41 (CI, 1.01 to 1.99) for a BMI of 25.0 to 29.9 kg/m 2 and 2.89 (CI, 1.69 to 4.94) for a BMI of 30 kg/m 2 or greater compared with a BMI of 18.5 to 21.9 kg/m 2. Expressed as absolute differences in rates per person-years, mortality was increased by 36.4 (CI, 16.6 to 56.2) deaths for a BMI of 25.0 to 29.9 kg/m 2 and 92.5 (CI, 49.7 to 135.3) deaths for a BMI of 30 kg/m 2 or greater at age 18 years. We also examined the association between BMI at age 18 years and premature death stratified by updated age during follow-up (210 deaths/ person-years in participants 40 years of age and 500 deaths/ person-years in participants 40 years of age). Although the absolute excess mortality associated with increased adolescent adiposity differed substantially by age (53.5 deaths in women 40 years of age and deaths in women 40 years of age for BMI 30 kg/m 2 ), the hazard ratios adjusted for adolescent lifestyle were similar: In younger and older women, respectively, the hazard ratios for premature death were 1.66 (CI, 1.06 to 2.59) and 1.65 (CI, 1.25 to 2.19) for a BMI of 25.0 to 29.9 kg/m 2 and 2.78 (CI, 1.58 to 4.88) and 2.79 (CI, 1.92 to 4.06) for a BMI of 30 kg/m 2 or greater compared with a BMI of 18.5 to 21.9 kg/m 2. We also examined BMI at age 18 years in relation to cause-specific death with adjustment for adolescent lifestyle. Hazard ratios for a BMI of 25 kg/m 2 or greater compared with a BMI of 18.5 to 21.9 kg/m 2 were 1.40 (CI, 0.95 to 2.04) for death due to cancer (258 deaths), 3.24 (CI, 1.59 to 6.59) for death due to cardiovascular disease (55 deaths), 2.13 (CI, 1.34 to 3.37) for death due to other diseases (123 deaths), and 1.83 (CI, 1.18 to 2.81) for death due to external causes (144 deaths). Suicide was the most common cause of external death (61 deaths), and a BMI of 25 kg/m 2 or greater at age 18 years was associated with a hazard ratio of 2.31 (CI, 1.20 to 4.42) for death due to suicide compared with a BMI of 18.5 to 21.9 kg/m 2. To allow comparison of BMI at age 18 years and adult BMI in 1989 as predictors of premature death, the associations for BMI in 1989 are shown in Table 3. We conducted additional analyses to examine whether the increased mortality rate in women in the lowest BMI category may have reflected residual confounding by smoking or weight loss due to preclinical underlying diseases that preceded death. After exclusion of women with substantial weight loss between age 18 years and baseline ( 4 kg), the increased mortality rate associated with a BMI of less than 18.5 kg/m 2 largely disappeared (Table 3). Further restricting the analysis to participants who never smoked resulted in a hazard ratio of 1.18 (CI, 0.64 to 2.20) for a BMI of less than 18.5 kg/m 2 relative to a BMI of 18.5 to July 2006 Annals of Internal Medicine Volume 145 Number 2

5 Overweight and Mortality Article 21.9 kg/m 2. Weight gain between age 18 years and baseline was not associated with substantially increased rates of premature death from all causes (hazard ratio, 1.05 [CI, 0.84 to 1.31] for 15-kg weight gain vs. 4-kg weight change, adjusted for BMI at age 18 years and adolescent and adult lifestyle). DISCUSSION In this study of U.S. women who were 24 to 44 years of age at baseline, higher BMI in adolescence was associated with a higher mortality rate during 12 years of follow-up. Among participants who never smoked, mortality rate was already increased among women with a BMI of 22.0 to 24.9 kg/m 2 and there was no indication of excess mortality for women with a low BMI at age 18 years. Adult BMI at baseline only partly explained the association between BMI at age 18 years and premature death. We identified previous cohort studies on childhood or adolescent adiposity and death from a MEDLINE search (articles published until January 2006) and reference lists of retrieved articles. In line with the present findings, high BMI in childhood or adolescence has predicted increased coronary heart disease (9, 12, 27), cardiovascular disease (11), and all-cause (5 12, 14, 15) premature mortality rate in previous studies. No association was observed in a Swedish study (13) and in the women included in the Harvard Growth Study (9), possibly because these studies included few participants who were overweight in their youth. Our finding that adolescent BMI remained predictive of premature death after adjustment for adult BMI is concordant with findings for the male participants in the small Harvard Growth Study (9). In a Norwegian study, participants were 14 to 19 years of age during screening in 1963 to 1975 and subsequent mortality was documented for an average of 31.5 years (15). When projected BMI levels at age 18 years based on growth charts were used, the hazard ratio for premature death was 1.27 (CI, 1.12 to 1.43) for a BMI of 25.0 to 29.9 kg/m 2 and 2.14 (CI, 1.61 to 2.82) for a BMI of 30 kg/m 2 or greater compared with a BMI of less than 25.0 kg/m 2 in women; similar results were obtained for men (15). In a subgroup of participants for whom information on adult BMI was available, adjustment for adult BMI largely explained the association for adolescent BMI in men, but adolescent BMI remained associated with premature death in women (17). In contrast to findings from a study done in older women (18), our results show that weight gain after age 18 years was not substantially Table 2. Body Mass Index at Age 18 Years and Death from All Causes during 12 Years of Follow-up in Women Who Were 24 to 44 Years of Age at Enrollment* Variable BMI at Age 18 Years <18.5 kg/m kg/m kg/m kg/m 2 >30.0 kg/m 2 Median BMI, kg/m Primary analysis Person-years Deaths, n Age-adjusted hazard ratio (95% CI) 0.99 ( ) 1 (referent) 1.19 ( ) 1.68 ( ) 2.83 ( ) Adolescent lifestyle-adjusted hazard ratio (95% CI) 0.98 ( ) 1 (referent) 1.18 ( ) 1.66 ( ) 2.79 ( ) Adjustment for intermediary variables Hazard ratio, further adjusted for 1989 (adult) lifestyle (95% CI) Hazard ratio, further adjusted for 1989 (adult) lifestyle and BMI (95% CI) 0.97 ( ) 1 (referent) 1.14 ( ) 1.53 ( ) 2.42 ( ) 0.92 ( ) 1 (referent) 1.09 ( ) 1.39 ( ) 2.03 ( ) Analysis in participants who never smoked Person-years Deaths, n Hazard ratio adjusted for adolescent 1.06 ( ) 1 (referent) 1.50 ( ) 1.72 ( ) 2.63 ( ) lifestyle (95% CI) Hazard ratio, further adjusted for 1989 (adult) lifestyle and BMI (95% CI) 1.02 ( ) 1 (referent) 1.44 ( ) 1.52 ( ) 1.99 ( ) * BMI body mass index. Hazard ratio adjusted for age (5-year categories), cigarette smoking at age 15 to 19 years (0, 1 to 14, and 15 cigarettes/d), strenuous physical activity at age 18 to 22 years (none, 1 to 3 mo/y, 4 to 6 mo/y, 7 to 9 mo/y, and 10 to 12 mo/y), alcoholic beverage consumption at age 18 to 22 years (0 drinks, 1 drink/wk to 1 drink/mo, 2 to 6 drinks/wk, 1 drink/d), use of oral contraceptives at age 18 years (ever or never). Adjusted for age (5-year categories), smoking status in 1989 (0 cigarettes, 1 to 14 cigarettes/d, 15 to 24 cigarettes/d, and 25 cigarettes/d), physical activity in 1989 (quintiles of metabolic equivalent hours/wk), alcohol consumption in 1989 (0 g/d, 0.1 to 4.9 g/d, 5.0 to 9.9 g/d, and 10 g/d), hormone replacement therapy in 1989 (ever or never), use of oral contraceptives in 1989 (yes or no), cigarette smoking at age 15 to 19 years (0 cigarettes/d, 1 to 14 cigarettes/d, and 15 cigarettes/d), strenuous physical activity at age 18 to 22 years (none, 1 to 3 mo/y, 4 to 6 mo/y, 7 to 9 mo/y, and 10 to 12 mo/y), alcoholic beverage consumption at age 18 to 22 years (0 drinks, 1 drink/wk to 1 drink/mo, 2 to 6 drinks/wk, and 1 drink/d), use of oral contraceptives at age 18 years (ever or never). Further adjustment for 1989 (adult) BMI ( 18.5 kg/m 2, 18.5 to 21.9 kg/m 2, 22.0 to 24.9 kg/m 2, 25.0 to 29.9 kg/m 2, 30.0 to 34.9 kg/m 2, and 35.0 kg/m 2 ) July 2006 Annals of Internal Medicine Volume 145 Number 2 95

6 Article Overweight and Mortality Table 3. Body Mass Index in 1989 (Adulthood) and Death from All Causes during 12 Years of Follow-up in Women Who Were 24 to 44 Years of Age at Enrollment* Variable Baseline (Adult) BMI <18.5 kg/m kg/m kg/m kg/m kg/m 2 >35.0 kg/m 2 Median BMI, kg/m Age-adjusted hazard ratio (95% CI) 1.78 ( ) 1 (referent) 1.18 ( ) 1.34 ( ) 1.43 ( ) 2.31 ( ) Multivariate hazard ratio (95% CI) 1.67 ( ) 1 (referent) 1.16 ( ) 1.29 ( ) 1.35 ( ) 2.14 ( ) Multivariate hazard ratio excluding participants who lost weight (95% CI) 1.33 ( ) 1 (referent) 1.16 ( ) 1.29 ( ) 1.39 ( ) 2.24 ( ) * BMI body mass index. Hazard ratio adjusted for age (5-year categories), smoking status in 1989 (never, former, and current; 15 cigarettes/d, 15 to 24 cigarettes/d, 25 cigarettes/d), physical activity in 1989 (quintiles of metabolic equivalent hours/wk), alcohol consumption in 1989 (0 g/d, 0.1 to 4.9 g/d, 5.0 to 9.9 g/d, 10 g/d), hormone replacement therapy in 1989 (ever or never), and use of oral contraceptives in 1989 (never, former, current). Exclusion of participants who lost 4 kg after age 18 years as defined in reference 18. associated with premature death, but this association may become stronger after longer follow-up. Effects of overweight on disease-related death can be mediated by higher incidences of type 2 diabetes; coronary heart disease; stroke; postmenopausal breast cancer; and cancer of the endometrium, colon, and kidney (28 30), as well as elevated case-fatality rates (30). Our finding that women with high BMI during adolescence had higher suicide mortality rates agrees with previous findings of the association between overweight and suicide attempts in female U.S. high school students (31, 32). In a study of Swedish men, however, BMI at age 18 to 19 years was inversely associated with deaths from suicide, suggesting that this association may differ by sex or culture (33). An independent association between adolescent adiposity and premature death may reflect effects on physiologic and psychological development that are specific for that period in life (4), preferential central fat storage during adolescence (34), or effects of long-term exposure to increased adiposity. Alternatively, an independent association of adolescent adiposity may be due to a long latency period for effects of adiposity on death or to methodologic limitations related to studying adult BMI, such as residual confounding by long-term smoking habits or weight loss due to preclinical disease (19). Our study had several potential limitations. First, because of the observational study design, we cannot exclude residual confounding by imperfectly measured or unmeasured confounders. We conducted a sensitivity analysis (35) to evaluate what characteristics an unmeasured confounder should have to explain 50% of the crude association between a BMI of 25.0 to 29.9 kg/m 2 at age 18 years, relative to a BMI of 18.5 to 21.9 kg/m 2, and premature death (that is, a hazard ratio of 1.35 instead of 1.69). For example, such an unmeasured confounder should have a prevalence of 60% in women with the higher BMI and 30% in women with the reference BMI and a mortality hazard ratio of 2.0. We considered potential confounding in detail, and it seems unlikely that such strong unmeasured confounding remained. Second, the assessment of adiposity was based on self-reported weight and height. Our validation study indicated that self-reported weight and height were highly correlated with measurements but that some underreporting of weight occurred (22). We conducted a sensitivity analysis using lower BMI cutoff points: 24.5 kg/m 2 to reflect a measured BMI of 25.0 kg/m 2 and 29.0 kg/m 2 to reflect a measured BMI of 30.0 kg/m 2. Compared with an adolescent BMI of 18.5 to 21.9 kg/m 2, the mortality hazard ratio adjusted for adolescent lifestyle was 1.46 (CI, 1.15 to 1.86) for a BMI of 24.5 to 29.0 kg/m 2 and 2.49 (CI, 1.87 to 3.32) for a BMI of 29.0 kg/m 2 or greater. Measurement error for assessing BMI at age 18 years would also have led us to underestimate the variance of the estimates of association. Third, our cohort did not include women who died between 18 years of age and the time of recruitment for the study; therefore, differential previous death may have affected our findings. However, mortality rates are very low in early adulthood. In a previous study, excess all-cause mortality rates associated with adolescent overweight were not clearly manifested before participants reached their thirties (15). Fourth, the study sample consisted of registered nurses born between 1945 and 1965 who were predominantly white. One may expect that the association between BMI and premature death would be weaker rather than stronger in this population, which had ready access to medical treatment of complications due to overweight. Although our study included a more recent birth cohort than most previous studies, future mortality rates for current adolescent girls may be different. Our findings require confirmation in women from other ethnic groups, but the results are similar to those of a study that examined the relation between BMI at age 25 years and in middle age and death in men of Japanese ancestry (36). In conclusion, our findings indicate that adiposity in adolescence is associated with premature death in younger and middle-aged U.S. women. We observed an increased premature mortality rate for even moderately increased adolescent BMI. This association could not be fully explained by higher adult BMI. Even if effects of higher adolescent July 2006 Annals of Internal Medicine Volume 145 Number 2

7 Overweight and Mortality Article adiposity were largely mediated by adult adiposity, prevention of excessive weight gain during childhood would be important to prevent overweight and obesity in adulthood. Furthermore, effects of childhood overweight on quality of life at younger ages may be substantial (4, 32), and higher mortality rates in middle age may represent the tip of the iceberg of detrimental health consequences. Our findings support preventive action in children aimed at reducing their risk for becoming overweight. From Harvard School of Public Health, Brigham and Women s Hospital, and Harvard Medical School, Boston, Massachusetts; and Vrije Universiteit of Amsterdam, Amsterdam, the Netherlands. Acknowledgment: The authors thank the participants of the Nurses Health Study II for their continued cooperation. Grant Support: By the National Institutes of Health (grant CA50385). Potential Financial Conflicts of Interest: None disclosed. Corresponding Author: Rob M. van Dam, Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Building II, Boston, MA 02115; , rvandam@hsph.harvard.edu. Current author addresses and author contributions are available at References 1. Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, JAMA. 2002;288: [PMID: ] 2. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, JAMA. 2002;288: [PMID: ] 3. Popkin BM, Gordon-Larsen P. The nutrition transition: worldwide obesity dynamics and their determinants. Int J Obes Relat Metab Disord. 2004;28 Suppl 3:S2-9. [PMID: ] 4. Must A, Strauss RS. Risks and consequences of childhood and adolescent obesity. Int J Obes Relat Metab Disord. 1999;23 Suppl 2:S2-11. [PMID: ] 5. Sonne-Holm S, Sørensen TI, Christensen U. Risk of early death in extremely overweight young men. Br Med J (Clin Res Ed). 1983;287: [PMID: ] 6. Hoffmans MD, Kromhout D, de Lezenne Coulander C. The impact of body mass index of 78, year old Dutch men on 32-year mortality from all causes. J Clin Epidemiol. 1988;41: [PMID: ] 7. Allebeck P, Bergh C. Height, body mass index and mortality: do social factors explain the association? Public Health. 1992;106: [PMID: ] 8. Nieto FJ, Szklo M, Comstock GW. Childhood weight and growth rate as predictors of adult mortality. Am J Epidemiol. 1992;136: [PMID: ] 9. Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to N Engl J Med. 1992;327: [PMID: ] 10. DiPietro L, Mossberg HO, Stunkard AJ. A 40-year history of overweight children in Stockholm: life-time overweight, morbidity, and mortality. Int J Obes Relat Metab Disord. 1994;18: [PMID: ] 11. Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, et al. Body weight and mortality among women. N Engl J Med. 1995; 333: [PMID: ] 12. Gunnell DJ, Frankel SJ, Nanchahal K, Peters TJ, Davey Smith G. Childhood obesity and adult cardiovascular mortality: a 57-y follow-up study based on the Boyd Orr cohort. Am J Clin Nutr. 1998;67: [PMID: ] 13. Rosengren A, Wedel H, Wilhelmsen L. Body weight and weight gain during adult life in men in relation to coronary heart disease and mortality. A prospective population study. Eur Heart J. 1999;20: [PMID: ] 14. Yarnell JW, Patterson CC, Thomas HF, Sweetnam PM. Comparison of weight in middle age, weight at 18 years, and weight change between, in predicting subsequent 14 year mortality and coronary events: Caerphilly Prospective Study. J Epidemiol Community Health. 2000;54: [PMID: ] 15. Engeland A, Bjørge T, Søgaard AJ, Tverdal A. Body mass index in adolescence in relation to total mortality: 32-year follow-up of 227,000 Norwegian boys and girls. Am J Epidemiol. 2003;157: [PMID: ] 16. Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293: [PMID: ] 17. Engeland A, Bjørge T, Tverdal A, Søgaard AJ. Obesity in adolescence and adulthood and the risk of adult mortality. Epidemiology. 2004;15: [PMID: ] 18. Hu FB, Willett WC, Li T, Stampfer MJ, Colditz GA, Manson JE. Adiposity as compared with physical activity in predicting mortality among women. N Engl J Med. 2004;351: [PMID: ] 19. Manson JE, Stampfer MJ, Hennekens CH, Willett WC. Body weight and longevity. A reassessment. JAMA. 1987;257: [PMID: ] 20. Seidell JC, Visscher TL, Hoogeveen RT. Overweight and obesity in the mortality rate data: current evidence and research issues. Med Sci Sports Exerc. 1999;31:S [PMID: ] 21. Rich-Edwards JW, Corsano KA, Stampfer MJ. Test of the National Death Index and Equifax Nationwide Death Search. Am J Epidemiol. 1994; 140: [PMID: ] 22. Troy LM, Hunter DJ, Manson JE, Colditz GA, Stampfer MJ, Willett WC. The validity of recalled weight among younger women. Int J Obes Relat Metab Disord. 1995;19: [PMID: ] 23. Rimm EB, Stampfer MJ, Colditz GA, Chute CG, Litin LB, Willett WC. Validity of self-reported waist and hip circumferences in men and women. Epidemiology. 1990;1: [PMID: ] 24. Hunter DJ, Manson JE, Colditz GA, Chasan-Taber L, Troy L, Stampfer MJ,etal.Reproducibility of oral contraceptive histories and validity of hormone composition reported in a cohort of US women. Contraception. 1997;56: [PMID: ] 25. Wolf AM, Hunter DJ, Colditz GA, Manson JE, Stampfer MJ, Corsano KA, et al. Reproducibility and validity of a self-administered physical activity questionnaire. Int J Epidemiol. 1994;23: [PMID: ] 26. World Health Organization. Obesity. Preventing and managing the Global Epidemic. Report of a WHO consultation on obesity. Report No. WHO/NUT- NCD/98.1. Geneva: World Health Organization; Hoffmans MD, Kromhout D, Coulander CD. Body mass index at the age of 18 and its effects on 32-year-mortality from coronary heart disease and cancer. A nested case-control study among the entire 1932 Dutch male birth cohort. J Clin Epidemiol. 1989;42: [PMID: ] 28. Willett WC, Manson JE, Stampfer MJ, Colditz GA, Rosner B, Speizer FE, et al. Weight, weight change, and coronary heart disease in women. Risk within the normal weight range. JAMA. 1995;273: [PMID: ] 29. Huang Z, Hankinson SE, Colditz GA, Stampfer MJ, Hunter DJ, Manson JE, et al. Dual effects of weight and weight gain on breast cancer risk. JAMA. 1997;278: [PMID: ] 30. Willett WC, Dietz WH, Colditz GA. Guidelines for healthy weight. N Engl J Med. 1999;341: [PMID: ] 31. Eaton DK, Lowry R, Brener ND, Galuska DA, Crosby AE. Associations of body mass index and perceived weight with suicide ideation and suicide attempts among US high school students. Arch Pediatr Adolesc Med. 2005;159: [PMID: ] 32. Falkner NH, Neumark-Sztainer D, Story M, Jeffery RW, Beuhring T, Resnick MD. Social, educational, and psychological correlates of weight status in adolescents. Obes Res. 2001;9: [PMID: ] 33. Magnusson PK, Rasmussen F, Lawlor DA, Tynelius P, Gunnell D. Association of body mass index with suicide mortality: a prospective cohort study of more than one million men. Am J Epidemiol. 2006;163:1-8. [PMID: ] 34. Mueller WH. The changes with age of the anatomical distribution of fat. Soc Sci Med. 1982;16: [PMID: ] 35. Greenland S. Basic methods for sensitivity analysis of biases. Int J Epidemiol. 1996;25: [PMID: ] 36. Rhoads GG, Kagan A. The relation of coronary disease, stroke, and mortality to weight in youth and in middle age. Lancet. 1983;1: [PMID: ] 18 July 2006 Annals of Internal Medicine Volume 145 Number 2 97

8 Annals of Internal Medicine Current Author Addresses: Drs. van Dam, Willett, and Hu: Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Building II, Boston, MA Dr. Manson: Division of Preventive Medicine, Brigham and Women s Hospital, 900 Commonwealth Avenue East, Third Floor, Boston, MA Author Contributions: Conception and design: R.M. van Dam, W.C. Willett, J.E. Manson, F.B. Hu. Analysis and interpretation of the data: R.M. van Dam, J.E. Manson, F.B. Hu. Drafting of the article: R.M. van Dam. Critical revision of the article for important intellectual content: R.M. van Dam, W.C. Willett, J.E. Manson, F.B. Hu. Final approval of the article: R.M. van Dam, W.C. Willett, J.E. Manson, F.B. Hu. Statistical expertise: R.M. van Dam, J.E. Manson, F.B. Hu. Obtaining of funding: W.C. Willett, F.B. Hu. Administrative, technical, or logistic support: J.E. Manson, F.B. Hu. Collection and assembly of data: W.C. Willett July 2006 Annals of Internal Medicine Volume 145 Number 2 W-21

Dietary Fatty Acids and the Risk of Hypertension in Middle-Aged and Older Women

Dietary Fatty Acids and the Risk of Hypertension in Middle-Aged and Older Women 07/14/2010 Dietary Fatty Acids and the Risk of Hypertension in Middle-Aged and Older Women First Author: Wang Short Title: Dietary Fatty Acids and Hypertension Risk in Women Lu Wang, MD, PhD, 1 JoAnn E.

More information

YOUNG ADULT MEN AND MIDDLEaged

YOUNG ADULT MEN AND MIDDLEaged BRIEF REPORT Favorable Cardiovascular Profile in Young Women and Long-term of Cardiovascular and All-Cause Mortality Martha L. Daviglus, MD, PhD Jeremiah Stamler, MD Amber Pirzada, MD Lijing L. Yan, PhD,

More information

Risk Factors for Mortality in the Nurses Health Study: A Competing Risks Analysis

Risk Factors for Mortality in the Nurses Health Study: A Competing Risks Analysis American Journal of Epidemiology ª The Author 2010. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail:

More information

Elevated Risk of Cardiovascular Disease Prior to Clinical Diagnosis of Type 2 Diabetes

Elevated Risk of Cardiovascular Disease Prior to Clinical Diagnosis of Type 2 Diabetes Epidemiology/Health Services/Psychosocial Research O R I G I N A L A R T I C L E Elevated Risk of Cardiovascular Disease Prior to Clinical Diagnosis of Type 2 Diabetes FRANK B. HU, MD 1,2,3 MEIR J. STAMPFER,

More information

Obesity and Control. Body Mass Index (BMI) and Sedentary Time in Adults

Obesity and Control. Body Mass Index (BMI) and Sedentary Time in Adults Obesity and Control Received: May 14, 2015 Accepted: Jun 15, 2015 Open Access Published: Jun 18, 2015 http://dx.doi.org/10.14437/2378-7805-2-106 Research Peter D Hart, Obes Control Open Access 2015, 2:1

More information

Childhood, adolescent and early adult body mass index in relation to adult mortality: results from the British 1946 birth cohort

Childhood, adolescent and early adult body mass index in relation to adult mortality: results from the British 1946 birth cohort JECH Online First, published on October 1, 2010 as 10.1136/jech.2010.110155 Research report Childhood, adolescent and early adult body mass index in relation to adult mortality: results from the British

More information

Weight Cycling, Weight Gain, and Risk of Hypertension in Women

Weight Cycling, Weight Gain, and Risk of Hypertension in Women American Journal of Epidemiology Copyright 01999 by The Johns Hopkins University School of Hygiene and Public Health All rights reserved Vol.150, No. 6 Printed In USA. Weight Cycling, Weight Gain, and

More information

ORIGINAL INVESTIGATION. Weight Cycling and Mortality Among Middle-aged or Older Women

ORIGINAL INVESTIGATION. Weight Cycling and Mortality Among Middle-aged or Older Women ORIGINAL INVESTIGATION Weight Cycling and Mortality Among Middle-aged or Older Women Alison E. Field, ScD; Susan Malspeis, SM; Walter C. Willett, MD, DrPH Background: Controversy exists about whether weight

More information

Rotating night shift work and risk of psoriasis in US women

Rotating night shift work and risk of psoriasis in US women Rotating night shift work and risk of psoriasis in US women The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters. Citation Published

More information

Physical activity and risk of breast cancer in premenopausal women

Physical activity and risk of breast cancer in premenopausal women British Journal of Cancer (2003) 89, 847 851 All rights reserved 0007 0920/03 $25.00 www.bjcancer.com in premenopausal women GA Colditz*,1,2, D Feskanich 2, WY Chen 2,3, DJ Hunter 1,2,4 and WC Willett

More information

A Prospective Study of Breakfast Consumption and Weight Gain among U.S. Men

A Prospective Study of Breakfast Consumption and Weight Gain among U.S. Men Diet and Physical Activity A Prospective Study of Breakfast Consumption and Weight Gain among U.S. Men Amber A.W.A. van der Heijden,* Frank B. Hu,* Eric B. Rimm,* and Rob M. van Dam* Abstract VAN DER HEIJDEN,

More information

NIH Public Access Author Manuscript N Engl J Med. Author manuscript; available in PMC 2014 July 16.

NIH Public Access Author Manuscript N Engl J Med. Author manuscript; available in PMC 2014 July 16. NIH Public Access Author Manuscript Published in final edited form as: N Engl J Med. 2014 January 16; 370(3): 233 244. doi:10.1056/nejmoa1304501. Body-Mass Index and Mortality among Adults with Incident

More information

ORIGINAL INVESTIGATION. Impact of Overweight on the Risk of Developing Common Chronic Diseases During a 10-Year Period

ORIGINAL INVESTIGATION. Impact of Overweight on the Risk of Developing Common Chronic Diseases During a 10-Year Period ORIGINAL INVESTIGATION Impact of Overweight on the Risk of Developing Common Chronic Diseases During a 10-Year Period Alison E. Field, ScD; Eugenie H. Coakley; Aviva Must, PhD; Jennifer L. Spadano, MA;

More information

Measures of Obesity and Cardiovascular Risk Among Men and Women

Measures of Obesity and Cardiovascular Risk Among Men and Women Journal of the American College of Cardiology Vol. 52, No. 8, 2008 2008 by the American College of Cardiology Foundation ISSN 0735-1097/08/$34.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2008.03.066

More information

The New England Journal of Medicine PRIMARY PREVENTION OF CORONARY HEART DISEASE IN WOMEN THROUGH DIET AND LIFESTYLE. Population

The New England Journal of Medicine PRIMARY PREVENTION OF CORONARY HEART DISEASE IN WOMEN THROUGH DIET AND LIFESTYLE. Population PRIMARY PREVENTION OF CORONARY HEART DISEASE IN WOMEN THROUGH DIET AND LIFESTYLE MEIR J. STAMPFER, M.D., FRANK B. HU, M.D., JOANN E. MANSON, M.D., ERIC B. RIMM, SC.D., AND WALTER C. WILLETT, M.D. ABSTRACT

More information

The New England Journal of Medicine

The New England Journal of Medicine The New England Journal of Medicine Copyright, 1997, by the Massachusetts Medical Society VOLUME 336 J UNE 19, 1997 NUMBER 25 POSTMENOPAUSAL HORMONE THERAPY AND MORTALITY FRANCINE GRODSTEIN, SC.D., MEIR

More information

Relation of Height and Body Mass Index to Renal Cell Carcinoma in Two Million Norwegian Men and Women

Relation of Height and Body Mass Index to Renal Cell Carcinoma in Two Million Norwegian Men and Women American Journal of Epidemiology Copyright 2004 by the Johns Hopkins Bloomberg School of Public Health All rights reserved Vol. 160, No. 12 Printed in U.S.A. DOI: 10.1093/aje/kwh345 Relation of Height

More information

RESEARCH. Dagfinn Aune, 1,2 Abhijit Sen, 1 Manya Prasad, 3 Teresa Norat, 2 Imre Janszky, 1 Serena Tonstad, 3 Pål Romundstad, 1 Lars J Vatten 1

RESEARCH. Dagfinn Aune, 1,2 Abhijit Sen, 1 Manya Prasad, 3 Teresa Norat, 2 Imre Janszky, 1 Serena Tonstad, 3 Pål Romundstad, 1 Lars J Vatten 1 open access 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 Dagfinn Aune, 1,2 Abhijit

More information

Epidemiological studies indicate that a parental or family

Epidemiological studies indicate that a parental or family Maternal and Paternal History of Myocardial Infarction and Risk of Cardiovascular Disease in Men and Women Howard D. Sesso, ScD, MPH; I-Min Lee, MBBS, ScD; J. Michael Gaziano, MD, MPH; Kathryn M. Rexrode,

More information

The New England Journal of Medicine DIET, LIFESTYLE, AND THE RISK OF TYPE 2 DIABETES MELLITUS IN WOMEN. Study Population

The New England Journal of Medicine DIET, LIFESTYLE, AND THE RISK OF TYPE 2 DIABETES MELLITUS IN WOMEN. Study Population DIET, LIFESTYLE, AND THE RISK OF TYPE 2 DIABETES MELLITUS IN WOMEN FRANK B. HU, M.D., JOANN E. MANSON, M.D., MEIR J. STAMPFER, M.D., GRAHAM COLDITZ, M.D., SIMIN LIU, M.D., CAREN G. SOLOMON, M.D., AND WALTER

More information

Body Fat Distribution and Risk of Non-lnsulin-dependent Diabetes Mellitus in Women

Body Fat Distribution and Risk of Non-lnsulin-dependent Diabetes Mellitus in Women American Journal of Epidemiology Copyright O 1997 by The Johns Hopkins University School of Hygiene and Public Hearth All rights reserved Vol 145, No. 7 Printed In U SA. Body Fat Distribution and Risk

More information

The Impact of Diabetes Mellitus and Prior Myocardial Infarction on Mortality From All Causes and From Coronary Heart Disease in Men

The Impact of Diabetes Mellitus and Prior Myocardial Infarction on Mortality From All Causes and From Coronary Heart Disease in Men Journal of the American College of Cardiology Vol. 40, No. 5, 2002 2002 by the American College of Cardiology Foundation ISSN 0735-1097/02/$22.00 Published by Elsevier Science Inc. PII S0735-1097(02)02044-2

More information

A Population-based Study on the Prevalence and Factors Associated with Obesity in Selangor

A Population-based Study on the Prevalence and Factors Associated with Obesity in Selangor Malaysian Journal of Medicine and Health Sciences Vol. 2(2) June 2006: 89-97 A Population-based Study on the Prevalence and Factors Associated with Obesity in Selangor 1 GR Lekhraj Rampal, 2 R Sanjay,

More information

Adult BMI Calculator

Adult BMI Calculator For more information go to Center for Disease Control http://search.cdc.gov/search?query=bmi+adult&utf8=%e2%9c%93&affiliate=cdc-main\ About BMI for Adults Adult BMI Calculator On this page: What is BMI?

More information

Diabetologia 9 Springer-Verlag 1992

Diabetologia 9 Springer-Verlag 1992 Diabetologia (1992) 35:967-972 Diabetologia 9 Springer-Verlag 1992 Oral contraceptive use and the risk of Type 2 (non-insulin-dependent) diabetes mellitus in a large prospective study of women E. B. Rimm,

More information

Does Being Overweight Really Reduce Mortality?

Does Being Overweight Really Reduce Mortality? Does Being Overweight Really Reduce Mortality? The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters. Citation Published Version Accessed

More information

ORIGINAL INVESTIGATION. Glycemic Index, Glycemic Load, and Cereal Fiber Intake and Risk of Type 2 Diabetes in US Black Women

ORIGINAL INVESTIGATION. Glycemic Index, Glycemic Load, and Cereal Fiber Intake and Risk of Type 2 Diabetes in US Black Women ORIGINAL INVESTIGATION Glycemic Index, Glycemic Load, and Cereal Fiber Intake and Risk of Type 2 Diabetes in US Black Women Supriya Krishnan, DSc; Lynn Rosenberg, ScD; Martha Singer, MPH; Frank B. Hu,

More information

THE PREVALENCE OF OVERweight

THE PREVALENCE OF OVERweight ORIGINAL CONTRIBUTION Prevalence and Trends in Overweight Among US Children and Adolescents, 1999-2000 Cynthia L. Ogden, PhD Katherine M. Flegal, PhD Margaret D. Carroll, MS Clifford L. Johnson, MSPH THE

More information

O besity is associated with increased risk of coronary

O besity is associated with increased risk of coronary 134 RESEARCH REPORT Overweight and obesity and weight change in middle aged men: impact on cardiovascular disease and diabetes S Goya Wannamethee, A Gerald Shaper, Mary Walker... See end of article for

More information

Prevalence of Overweight Among Anchorage Children: A Study of Anchorage School District Data:

Prevalence of Overweight Among Anchorage Children: A Study of Anchorage School District Data: Department of Health and Social Services Division of Public Health Section of Epidemiology Joel Gilbertson, Commissioner Richard Mandsager, MD, Director Beth Funk, MD, MPH, Editor 36 C Street, Suite 54,

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Song M, Fung TT, Hu FB, et al. Association of animal and plant protein intake with all-cause and cause-specific mortality. JAMA Intern Med. Published online August 1, 2016.

More information

ORIGINAL INVESTIGATION. Alcohol Consumption and Mortality in Men With Preexisting Cerebrovascular Disease

ORIGINAL INVESTIGATION. Alcohol Consumption and Mortality in Men With Preexisting Cerebrovascular Disease ORIGINAL INVESTIGATION Alcohol Consumption and Mortality in Men With Preexisting Cerebrovascular Disease Vicki A. Jackson, MD; Howard D. Sesso, ScD; Julie E. Buring, ScD; J. Michael Gaziano, MD Background:

More information

Body-Mass Index and Mortality among Adults with Incident Type 2 Diabetes

Body-Mass Index and Mortality among Adults with Incident Type 2 Diabetes The new england journal of medicine original article Body-Mass Index and Mortality among Adults with Incident Type 2 Diabetes Deirdre K. Tobias, Sc.D., An Pan, Ph.D., Chandra L. Jackson, Ph.D., Eilis J.

More information

Why Do We Treat Obesity? Epidemiology

Why Do We Treat Obesity? Epidemiology Why Do We Treat Obesity? Epidemiology Epidemiology of Obesity U.S. Epidemic 2 More than Two Thirds of US Adults Are Overweight or Obese 87.5 NHANES Data US Adults Age 2 Years (Crude Estimate) Population

More information

Consideration of Anthropometric Measures in Cancer. S. Lani Park April 24, 2009

Consideration of Anthropometric Measures in Cancer. S. Lani Park April 24, 2009 Consideration of Anthropometric Measures in Cancer S. Lani Park April 24, 2009 Presentation outline Background in anthropometric measures in cancer Examples of anthropometric measures and investigating

More information

Does Body Mass Index Adequately Capture the Relation of Body Composition and Body Size to Health Outcomes?

Does Body Mass Index Adequately Capture the Relation of Body Composition and Body Size to Health Outcomes? American Journal of Epidemiology Copyright 1998 by The Johns Hopkins University School of Hygiene and Public Health All rights reserved Vol. 147, No. 2 Printed in U.S.A A BRIEF ORIGINAL CONTRIBUTION Does

More information

ISSN X (Print) Research Article. *Corresponding author P. Raghu Ramulu

ISSN X (Print) Research Article. *Corresponding author P. Raghu Ramulu Scholars Journal of Applied Medical Sciences (SJAMS) Sch. J. App. Med. Sci., 2014; 2(1B):133-137 Scholars Academic and Scientific Publisher (An International Publisher for Academic and Scientific Resources)

More information

Folate, vitamin B 6, and vitamin B 12 are cofactors in

Folate, vitamin B 6, and vitamin B 12 are cofactors in Research Letters Dietary Folate and Vitamin B 6 and B 12 Intake in Relation to Mortality From Cardiovascular Diseases Japan Collaborative Cohort Study Renzhe Cui, MD; Hiroyasu Iso, MD; Chigusa Date, MD;

More information

ORIGINAL INVESTIGATION. C-Reactive Protein Concentration and Incident Hypertension in Young Adults

ORIGINAL INVESTIGATION. C-Reactive Protein Concentration and Incident Hypertension in Young Adults ORIGINAL INVESTIGATION C-Reactive Protein Concentration and Incident Hypertension in Young Adults The CARDIA Study Susan G. Lakoski, MD, MS; David M. Herrington, MD, MHS; David M. Siscovick, MD, MPH; Stephen

More information

PAPER Abdominal and total adiposity and risk of coronary heart disease in men

PAPER Abdominal and total adiposity and risk of coronary heart disease in men (2001) 25, 1047±1056 ß 2001 Nature Publishing Group All rights reserved 0307±0565/01 $15.00 www.nature.com/ijo PAPER Abdominal and total adiposity and risk of coronary heart disease in men KM Rexrode 1

More information

Prevalence of Obesity among High School Children in Chennai Using Discriminant Analysis

Prevalence of Obesity among High School Children in Chennai Using Discriminant Analysis IOSR Journal of Mathematics (IOSR-JM) e-issn: 2278-5728, p-issn: 2319-765X. Volume 13, Issue 4 Ver. III (Jul. Aug. 2017), PP 50-56 www.iosrjournals.org Prevalence of Obesity among High School Children

More information

THE HEALTH consequences of

THE HEALTH consequences of ORIGINAL INVESTIGATION Weight Change, Weight Fluctuation, and Mortality S. Goya Wannamethee, PhD; A. Gerald Shaper, FRCP; Mary Walker, MA Objective: To examine the relation between weight change and weight

More information

ORIGINAL INVESTIGATION. Obesity and Unhealthy Life-Years in Adult Finns

ORIGINAL INVESTIGATION. Obesity and Unhealthy Life-Years in Adult Finns Obesity and Unhealthy Life-Years in Adult Finns An Empirical Approach ORIGINAL INVESTIGATION Tommy L. S. Visscher, PhD; Aila Rissanen, MD, PhD; Jacob C. Seidell, PhD; Markku Heliövaara, MD, PhD; Paul Knekt,

More information

Overweight and Obesity in Older Persons: Impact Upon Health and Mortality Outcomes

Overweight and Obesity in Older Persons: Impact Upon Health and Mortality Outcomes Overweight and Obesity in Older Persons: Impact Upon Health and Mortality Outcomes Gordon L Jensen, MD, PhD Senior Associate Dean for Research Professor of Medicine and Nutrition Objectives Health outcomes

More information

General and Abdominal Obesity and Risk of Death among Black Women

General and Abdominal Obesity and Risk of Death among Black Women T h e n e w e ngl a nd j o u r na l o f m e dic i n e original article General and Abdominal Obesity and Risk of Death among Black Women Deborah A. Boggs, Sc.D., Lynn Rosenberg, Sc.D., Yvette C. Cozier,

More information

Diabetes Care 35:12 18, 2012

Diabetes Care 35:12 18, 2012 Clinical Care/Education/Nutrition/Psychosocial Research O R I G I N A L A R T I C L E Dietary Patterns During Adolescence and Risk of Type 2 Diabetes in Middle-Aged Women VASANTI S. MALIK, SCD 1 TERESA

More information

ARTICLE. Prevalence of Diabetes and Impaired Fasting Glucose Levels Among US Adolescents. National Health and Nutrition Examination Survey,

ARTICLE. Prevalence of Diabetes and Impaired Fasting Glucose Levels Among US Adolescents. National Health and Nutrition Examination Survey, ARTICLE Prevalence of Diabetes and Impaired Fasting Glucose Levels Among US Adolescents National Health and Nutrition Examination Survey, 1999-2002 Glen E. Duncan, PhD, RCEPSM Objective: To determine the

More information

Changes in Body Weight and Body Fat Distribution as Risk Factors for Clinical Diabetes in US Men

Changes in Body Weight and Body Fat Distribution as Risk Factors for Clinical Diabetes in US Men American Journal of Epidemiology Copyright 2004 by the Johns Hopkins Bloomberg School of Public Health All rights reserved Vol. 159, No. 12 Printed in U.S.A. DOI: 10.1093/aje/kwh167 Changes in Body Weight

More information

Age 18 years and older BMI 18.5 and < 25 kg/m 2

Age 18 years and older BMI 18.5 and < 25 kg/m 2 Quality ID #128 (NQF 0421): Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan National Quality Strategy Domain: Community/Population Health 2018 OPTIONS F INDIVIDUAL MEASURES:

More information

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER, PHYSICAL HEALTH, AND LIFESTYLE IN OLDER ADULTS

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER, PHYSICAL HEALTH, AND LIFESTYLE IN OLDER ADULTS CHAPTER 5 ATTENTION-DEFICIT/HYPERACTIVITY DISORDER, PHYSICAL HEALTH, AND LIFESTYLE IN OLDER ADULTS J. AM. GERIATR. SOC. 2013;61(6):882 887 DOI: 10.1111/JGS.12261 61 ATTENTION-DEFICIT/HYPERACTIVITY DISORDER,

More information

The prevalence of obesity has increased markedly in

The prevalence of obesity has increased markedly in Brief Communication Use of Prescription Weight Loss Pills among U.S. Adults in 1996 1998 Laura Kettel Khan, PhD; Mary K. Serdula, MD; Barbara A. Bowman, PhD; and David F. Williamson, PhD Background: Pharmacotherapy

More information

Age 18 years and older BMI 18.5 and < 25 kg/m 2

Age 18 years and older BMI 18.5 and < 25 kg/m 2 Quality ID #128 (NQF 0421): Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan National Quality Strategy Domain: Community/Population Health 2018 OPTIONS F INDIVIDUAL MEASURES:

More information

Abundant evidence has accumulated supporting the association

Abundant evidence has accumulated supporting the association Folate, Vitamin B 6, and B 12 Intakes in Relation to Risk of Stroke Among Men Ka He, MD; Anwar Merchant, DMD; Eric B. Rimm, ScD; Bernard A. Rosner, PhD; Meir J. Stampfer, MD; Walter C. Willett, MD; Alberto

More information

BNORC: Contribution over 25 years to evidence on obesity and cancer

BNORC: Contribution over 25 years to evidence on obesity and cancer BNORC: Contribution over 25 years to evidence on obesity and cancer Graham A Colditz, MD DrPH Niess-Gain Professor Chief, Boston July 10, 2017 https://tinyurl.com/ybmnqorq Economic costs of diabetes:

More information

Overweight is defined as a body mass

Overweight is defined as a body mass THE DANGEROUS LIAISON: WEIGHT GAIN AND ITS ASSOCIATED COMORBIDITIES * Zachary T. Bloomgarden, MD ABSTRACT Overweight and obesity have tangible physical consequences that affect mortality and economics,

More information

LONG OR HIGHLY IRREGULAR MENstrual

LONG OR HIGHLY IRREGULAR MENstrual ORIGINAL CONTRIBUTION Long or Highly Irregular Menstrual Cycles as a Marker for Risk of Type 2 Diabetes Mellitus Caren G. Solomon, MD Frank B. Hu, MD Andrea Dunaif, MD Janet Rich-Edwards, DSci Walter C.

More information

Abstract. Background The effect of childhood risk factors for cardiovascular disease on adult mortality is poorly understood.

Abstract. Background The effect of childhood risk factors for cardiovascular disease on adult mortality is poorly understood. The new england journal of medicine established in 1812 february 11, 2010 vol. 362 no. 6 Childhood Obesity, Other Cardiovascular Risk Factors, and Premature Death Paul W. Franks, Ph.D., Robert L. Hanson,

More information

The effects of Aerobic Exercise vs. Progressive Resisted Exercise on body composition in obese children Dr.U.Ganapathy Sankar, Ph.

The effects of Aerobic Exercise vs. Progressive Resisted Exercise on body composition in obese children Dr.U.Ganapathy Sankar, Ph. The effects of Aerobic Exercise vs. Progressive Resisted Exercise on body composition in obese children Dr.U.Ganapathy Sankar, Ph.D Dean I/C, SRM College of Occupational Therapy, SRMUniversity, Kattankulathur,

More information

Dietary soy intake and changes of mammographic density in premenopausal Chinese women

Dietary soy intake and changes of mammographic density in premenopausal Chinese women Dietary soy intake and changes of mammographic density in premenopausal Chinese women 2010 WCRF International Conference, Nutrition, Physical Activity and Cancer Prevention: Current Challenges, New Horizons

More information

An evaluation of body mass index, waist-hip ratio and waist circumference as a predictor of hypertension across urban population of Bangladesh.

An evaluation of body mass index, waist-hip ratio and waist circumference as a predictor of hypertension across urban population of Bangladesh. An evaluation of body mass index, waist-hip ratio and waist circumference as a predictor of hypertension across urban population of Bangladesh. Md. Golam Hasnain 1 Monjura Akter 2 1. Research Investigator,

More information

ESPEN Congress Florence 2008

ESPEN Congress Florence 2008 ESPEN Congress Florence 2008 Severe obesity - Session organised in conjunction with ASPEN Long term mortality in cohorts of severely obese subjects D. Mirabelli (Italy) Long-term mortality in cohorts of

More information

Consistent with trends in other countries,1,2 the

Consistent with trends in other countries,1,2 the 9 Trends in weight change among Canadian adults Heather M. Orpana, Mark S. Tremblay and Philippe Finès Abstract Objectives Longitudinal analyses were used to examine the rate of change of self-reported

More information

John W G Yarnell, Christopher C Patterson, Hugh F Thomas, Peter M Sweetnam

John W G Yarnell, Christopher C Patterson, Hugh F Thomas, Peter M Sweetnam 344 Department of Epidemiology and Public Health, Queen s University of Belfast, Mulhouse Building, ICS, Grosvenor Road Belfast BT12 6BJ JWGYarnell C C Patterson MRC Epidemiology Unit (South Wales), Llandough

More information

Original Research Communications. Susanne Rautiainen, 4,5 * Lu Wang, 4 I-Min Lee, 4,6 JoAnn E Manson, 4,6 Julie E Buring, 4,6 and Howard D Sesso 4,6,7

Original Research Communications. Susanne Rautiainen, 4,5 * Lu Wang, 4 I-Min Lee, 4,6 JoAnn E Manson, 4,6 Julie E Buring, 4,6 and Howard D Sesso 4,6,7 Original Research Communications Dairy consumption in association with weight change and risk of becoming overweight or obese in middle-aged and older women: a prospective cohort study 1 3 Susanne Rautiainen,

More information

Diabetes is a condition with a huge health impact in Asia. More than half of all

Diabetes is a condition with a huge health impact in Asia. More than half of all Interventions to Change Health Behaviors and Prevention Rob M. van Dam, PhD Diabetes is a condition with a huge health impact in Asia. More than half of all people with diabetes live today in Asian countries,

More information

Progress in the Control of Childhood Obesity

Progress in the Control of Childhood Obesity William H. Dietz, MD, PhD a, Christina D. Economos, PhD b Two recent reports from the Centers for Disease Control and Prevention and reports from a number of states and municipalities suggest that we are

More information

Whole-grain consumption and risk of coronary heart disease: results from the Nurses Health Study 1 3

Whole-grain consumption and risk of coronary heart disease: results from the Nurses Health Study 1 3 Whole-grain consumption and risk of coronary heart disease: results from the Nurses Health Study 1 3 Simin Liu, Meir J Stampfer, Frank B Hu, Edward Giovannucci, Eric Rimm, JoAnn E Manson, Charles H Hennekens,

More information

Obesity and mortality

Obesity and mortality Obesity and mortality Sam Gutterman, FSA, FCAS, CERA, MAAA, HonFIA INTERNATIONAL MORTALITY AND LONGEVITY SYMPOSIUM 2014 15-17 September 2014, Birmingham Agenda Obesity where are we now Mortality how bad

More information

Both general adiposity, measured by body mass index

Both general adiposity, measured by body mass index Go Red for Women General and Abdominal Adiposity and Risk of Stroke in Chinese Women Xianglan Zhang, MD, MPH; Xiao-Ou Shu, MD, PhD; Yu-Tang Gao, MD; Gong Yang, MD, MPH; Honglan Li, MD; Wei Zheng, MD, PhD

More information

Influence of social relationships on obesity prevalence and management

Influence of social relationships on obesity prevalence and management Pacific University CommonKnowledge Physical Function CATs OT Critically Appraised Topics 2011 Influence of social relationships on obesity prevalence and management Alyssa Finn Pacific University Follow

More information

Eating habits of secondary school students in Erbil city.

Eating habits of secondary school students in Erbil city. Eating habits of secondary school students in Erbil city. Dr. Kareema Ahmad Hussein * Abstract Background and objectives: Adolescence are assuming responsibility for their own eating habits, changes in

More information

Plain-water intake and risk of type 2 diabetes in young and middle-aged women 1 4

Plain-water intake and risk of type 2 diabetes in young and middle-aged women 1 4 Plain-water intake and risk of type 2 diabetes in young and middle-aged women 1 4 An Pan, Vasanti S Malik, Matthias B Schulze, JoAnn E Manson, Walter C Willett, and Frank B Hu ABSTRACT Background: The

More information

Determinants of Obesity-related Underreporting of Energy Intake

Determinants of Obesity-related Underreporting of Energy Intake American Journal of Epidemiology Copyright 1998 by The Johns Hopkins University School of Hygiene and ublic Health All rights reserved Vol. 147, No. 11 rinted in U.S.A. Determinants of Obesity-related

More information

ORIGINAL INVESTIGATION. The Impact of Diabetes Mellitus on Mortality From All Causes and Coronary Heart Disease in Women

ORIGINAL INVESTIGATION. The Impact of Diabetes Mellitus on Mortality From All Causes and Coronary Heart Disease in Women The Impact of Mellitus on Mortality From All Causes and Coronary Heart Disease in Women 20 Years of Follow-up ORIGINAL INVESTIGATION Frank B. Hu, MD; Meir J. Stampfer, MD; Caren G. Solomon, MD; Simin Liu,

More information

Association of Changes in Diet Quality with Total and Cause-Specific Mortality

Association of Changes in Diet Quality with Total and Cause-Specific Mortality Original Article Association of Changes in Diet Quality with Total and Cause-Specific Mortality Mercedes Sotos Prieto, Ph.D., Shilpa N. Bhupathiraju, Ph.D., Josiemer Mattei, Ph.D., M.P.H., Teresa T. Fung,

More information

I t is established that regular light to moderate drinking is

I t is established that regular light to moderate drinking is 32 CARDIOVASCULAR MEDICINE Taking up regular drinking in middle age: effect on major coronary heart disease events and mortality S G Wannamethee, A G Shaper... See end of article for authors affiliations...

More information

POPULATION AGING, OBESITY, AND

POPULATION AGING, OBESITY, AND ORIGINAL CONTRIBUTION Cardiorespiratory Fitness and Adiposity as Mortality Predictors in Older Adults Xuemei Sui, MD Michael J. LaMonte, PhD James N. Laditka, PhD James W. Hardin, PhD Nancy Chase, BS Steven

More information

Prevalence and characteristics of misreporting of energy intake in US adults: NHANES

Prevalence and characteristics of misreporting of energy intake in US adults: NHANES British Journal of Nutrition (2015), 114, 1294 1303 The Authors 2015 doi:10.1017/s0007114515002706 Prevalence and characteristics of misreporting of energy intake in US adults: NHANES 2003 2012 Kentaro

More information

Sex-age-specific association of body mass index with all-cause mortality among 12.8 million Korean adults: a prospective cohort study

Sex-age-specific association of body mass index with all-cause mortality among 12.8 million Korean adults: a prospective cohort study International Journal of Epidemiology, 2015, 1696 1705 doi: 10.1093/ije/dyv138 Advance Access Publication Date: 23 July 2015 Original article Miscellaneous Sex-age-specific association of body mass index

More information

LOW FOLATE INTAKE HAS INcreased

LOW FOLATE INTAKE HAS INcreased ORIGINAL CONTRIBUTION A Prospective Study of Folate Intake and the Risk of Breast Cancer Shumin Zhang, MD, ScD David J. Hunter, MBBS, ScD Susan E. Hankinson, ScD Edward L. Giovannucci, MD, ScD Bernard

More information

PRIMARY CARE. Review Article

PRIMARY CARE. Review Article PRIMARY CARE Review Article Primary Care GUIDELINES FOR HEALTHY WEIGHT WALTER C. WILLETT, M.D., DR.P.H., WILLIAM H. DIETZ, M.D., PH.D., AND GRAHAM A. COLDITZ, M.D., DR.P.H. EXCESS body fat is a cause of

More information

Overweight and obesity are common problems seen in the primary. Self-Measured vs Professionally Measured Waist Circumference

Overweight and obesity are common problems seen in the primary. Self-Measured vs Professionally Measured Waist Circumference Self-Measured vs Professionally Measured Waist Circumference Barbara G. Carranza Leon, MD 1,2 Michael D. Jensen, MD 1 Jennifer J. Hartman, MD 3 Teresa B. Jensen, MD 3 1 Endocrine Research Unit, Mayo Clinic,

More information

Shared genetic influence of BMI, physical activity and type 2 diabetes: a twin study

Shared genetic influence of BMI, physical activity and type 2 diabetes: a twin study Diabetologia (2013) 56:1031 1035 DOI 10.1007/s00125-013-2859-3 SHORT COMMUNICATION Shared genetic influence of BMI, physical activity and type 2 diabetes: a twin study S. Carlsson & A. Ahlbom & P. Lichtenstein

More information

Stroke is the third leading cause of death in the United

Stroke is the third leading cause of death in the United Original Contributions Prospective Study of Major Dietary Patterns and Stroke Risk in Women Teresa T. Fung, ScD; Meir J. Stampfer, MD, DPH; JoAnn E. Manson, MD, DPH; Kathryn M. Rexrode, MD; Walter C. Willett,

More information

Procedures for taking physical measurements

Procedures for taking physical measurements Procedures for taking physical measurements Dr Diane Cooper PhD Exercise physiology and metabolism Partner in True Fitness Coordinator & lecturer on BSc Sports Science, AIT Metabolic researcher on European

More information

Cigarette Smoking and Incidence of Chronic Bronchitis and Asthma in Women*

Cigarette Smoking and Incidence of Chronic Bronchitis and Asthma in Women* Cigarette Smoking and ncidence of Chronic Bronchitis and Asthma in Women* Rebecca]. Troisi, SeD; Frank E. Speizer, MD, FCCP; Bernard Rosner, PhD; Dimitrios Trichopoulos, MD; and Walter C. Willett, MD Study

More information

BMI may underestimate the socioeconomic gradient in true obesity

BMI may underestimate the socioeconomic gradient in true obesity 8 BMI may underestimate the socioeconomic gradient in true obesity Gerrit van den Berg, Manon van Eijsden, Tanja G.M. Vrijkotte, Reinoud J.B.J. Gemke Pediatric Obesity 2013; 8(3): e37-40 102 Chapter 8

More information

Body Mass Index and Blood Pressure in Adult Type 2 Diabetic Patients in Taiwan

Body Mass Index and Blood Pressure in Adult Type 2 Diabetic Patients in Taiwan Circ J 2007; 71: 1749 1754 Body Mass Index and Blood Pressure in Adult Type 2 Diabetic Patients in Taiwan Chin-Hsiao Tseng, MD, PhD*, **,,, Background The correlation between body mass index (BMI)/obesity

More information

ORIGINAL INVESTIGATION. Alcohol Drinking Patterns and Risk of Type 2 Diabetes Mellitus Among Younger Women

ORIGINAL INVESTIGATION. Alcohol Drinking Patterns and Risk of Type 2 Diabetes Mellitus Among Younger Women ORIGINAL INVESTIGATION Alcohol Drinking Patterns and Risk of Type 2 Diabetes Mellitus Among Younger Women S. Goya Wannamethee, PhD; Carlos A. Camargo, Jr, MD, DrPH; JoAnn E. Manson, MD, DrPH; Walter C.

More information

ORIGINAL INVESTIGATION. Glycemic Index and Serum High-Density Lipoprotein Cholesterol Concentration Among US Adults

ORIGINAL INVESTIGATION. Glycemic Index and Serum High-Density Lipoprotein Cholesterol Concentration Among US Adults Glycemic Index and Serum High-Density Lipoprotein Cholesterol Concentration Among US Adults Earl S. Ford, MD; Simin Liu, MD ORIGINAL INVESTIGATION Background: Dietary glycemic index, an indicator of the

More information

ORIGINAL INVESTIGATION. A Prospective Study of Weight Training and Risk of Type 2 Diabetes Mellitus in Men

ORIGINAL INVESTIGATION. A Prospective Study of Weight Training and Risk of Type 2 Diabetes Mellitus in Men ORIGINAL INVESTIGATION A Prospective Study of Weight Training and Risk of Type 2 Diabetes Mellitus in Men Anders Grøntved, MPH, MSc; Eric B. Rimm, ScD; Walter C. Willett, MD, DrPH; Lars B. Andersen, PhD,

More information

A Study on Abdominal Obesity at Basra University Staffs

A Study on Abdominal Obesity at Basra University Staffs Clinical Medicine Research 2017; 6(3): 69-73 http://www.sciencepublishinggroup.com/j/cmr doi: 10.11648/j.cmr.20170603.12 ISSN: 2326-9049 (Print); ISSN: 2326-9057 (Online) A Study on Abdominal Obesity at

More information

Associations of Trying to Lose Weight, Weight Control Behaviors, and Current Cigarette Use Among US High School Students

Associations of Trying to Lose Weight, Weight Control Behaviors, and Current Cigarette Use Among US High School Students R ESEARCHA RTICLE Associations of Trying to Lose Weight, Weight Control Behaviors, and Current Cigarette Use Among US High School Students JONETTA L. JOHNSON,MPH a DANICE K. EATON,MPH,PhD b LINDA L. PEDERSON,PhD

More information

ORIGINAL INVESTIGATION. Physical Activity and Risk of Breast Cancer Among Postmenopausal Women

ORIGINAL INVESTIGATION. Physical Activity and Risk of Breast Cancer Among Postmenopausal Women ORIGINAL INVESTIGATION Physical Activity and Risk of Breast Cancer Among Postmenopausal Women A. Heather Eliassen, ScD; Susan E. Hankinson, RN, ScD; Bernard Rosner, PhD; Michelle D. Holmes, MD, DrPH; Walter

More information

Weight gained in two years by a population of mid-aged women: how much is too much?

Weight gained in two years by a population of mid-aged women: how much is too much? (2006) 30, 1229 1233 & 2006 Nature Publishing Group All rights reserved 0307-0565/06 $30.00 www.nature.com/ijo ORIGINAL ARTICLE Weight gained in two years by a population of mid-aged women: how much is

More information

A lthough the hazards of smoking are well described,

A lthough the hazards of smoking are well described, 702 RESEARCH REPORT Importance of light smoking and inhalation habits on risk of myocardial infarction and all cause mortality. A 22 year follow up of 12 149 men and women in The Copenhagen City Heart

More information

Policy Brief: Weight Loss Success among Overweight and Obese Women of Mexican-origin

Policy Brief: Weight Loss Success among Overweight and Obese Women of Mexican-origin Policy Brief: Weight Loss Success among Overweight and Obese Women of Mexican-origin Living In Mexico and the United States Sylvia Guendelman, Miranda Ritterman-Weintraub, Martha Kaufer-Horwitz (J Immigrant

More information

Relationship between body mass index and length of hospital stay for gallbladder disease

Relationship between body mass index and length of hospital stay for gallbladder disease Journal of Public Health Vol. 30, No. 2, pp. 161 166 doi:10.1093/pubmed/fdn011 Advance Access Publication 27 February 2008 Relationship between body mass index and length of hospital stay for gallbladder

More information