Overweight as predictor of long-term mortality among healthy, middle-aged men: a prospective cohort study.

Oslo University Hospital, Kirkeveien 166, N-0407 Oslo, Norway.
Preventive Medicine (Impact Factor: 2.93). 01/2011; 52(3-4):223-6. DOI: 10.1016/j.ypmed.2011.01.010
Source: PubMed

ABSTRACT Large epidemiological studies of non-smokers have demonstrated an association between overweight during midlife and increased mortality. However, little is known about whether this association may be explained by physical fitness. Thus, we aimed to examine this association in a long-term follow-up, with adjustment for fitness.
We prospectively studied mortality in relation to overweight in 2014 healthy Norwegian men 40-59 years of age at enrollment in 1972-1975, and recorded cardiovascular and non-cardiovascular mortality during 25-27 years follow-up. Physical fitness was measured in a maximal exercise tolerance bicycle test.
At baseline 717 men had overweight (body mass index 25.0-29.9) and 1221 had normal weight (body mass index<25.0). During follow-up 746 men died, 377 from cardiovascular causes. Among non-smokers with overweight/normal weight, cardiovascular death rates were 19.4%/11.3%, and non-cardiovascular death rates were 13.2%/14.4%. Overweight was related to cardiovascular mortality, even after adjustment for age, physical fitness, blood pressure and cholesterol level (RR: 1.52, p=0.010), but not to non-cardiovascular mortality (RR: 0.84, p=0.32). Among smokers overweight was not associated with cardiovascular or non-cardiovascular mortality. The difference in cardiovascular mortality between non-smokers with overweight and normal weight first appeared after 15 years of follow-up.
Overweight appears to be an independent long-term predictor of cardiovascular mortality in middle-aged healthy non-smoking men, even after adjustment for physical fitness.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Estimates of the relative mortality risks associated with normal weight, overweight, and obesity may help to inform decision making in the clinical setting. To perform a systematic review of reported hazard ratios (HRs) of all-cause mortality for overweight and obesity relative to normal weight in the general population. PubMed and EMBASE electronic databases were searched through September 30, 2012, without language restrictions. Articles that reported HRs for all-cause mortality using standard body mass index (BMI) categories from prospective studies of general populations of adults were selected by consensus among multiple reviewers. Studies were excluded that used nonstandard categories or that were limited to adolescents or to those with specific medical conditions or to those undergoing specific procedures. PubMed searches yielded 7034 articles, of which 141 (2.0%) were eligible. An EMBASE search yielded 2 additional articles. After eliminating overlap, 97 studies were retained for analysis, providing a combined sample size of more than 2.88 million individuals and more than 270,000 deaths. Data were extracted by 1 reviewer and then reviewed by 3 independent reviewers. We selected the most complex model available for the full sample and used a variety of sensitivity analyses to address issues of possible overadjustment (adjusted for factors in causal pathway) or underadjustment (not adjusted for at least age, sex, and smoking). Random-effects summary all-cause mortality HRs for overweight (BMI of 25-<30), obesity (BMI of ≥30), grade 1 obesity (BMI of 30-<35), and grades 2 and 3 obesity (BMI of ≥35) were calculated relative to normal weight (BMI of 18.5-<25). The summary HRs were 0.94 (95% CI, 0.91-0.96) for overweight, 1.18 (95% CI, 1.12-1.25) for obesity (all grades combined), 0.95 (95% CI, 0.88-1.01) for grade 1 obesity, and 1.29 (95% CI, 1.18-1.41) for grades 2 and 3 obesity. These findings persisted when limited to studies with measured weight and height that were considered to be adequately adjusted. The HRs tended to be higher when weight and height were self-reported rather than measured. Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.
    JAMA The Journal of the American Medical Association 01/2013; 309(1):71-82. · 29.98 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to quantify the joint association of cardiorespiratory fitness (CRF) and weight status on mortality from all causes using meta-analytical methodology. Studies were included if they were (1) prospective, (2) objectively measured CRF and body mass index (BMI), and (3) jointly assessed CRF and BMI with all-cause mortality. Ten articles were included in the final analysis. Pooled hazard ratios were assessed for each comparison group (i.e. normal weight-unfit, overweight-unfit and -fit, and obese-unfit and -fit) using a random-effects model. Compared to normal weight-fit individuals, unfit individuals had twice the risk of mortality regardless of BMI. Overweight and obese-fit individuals had similar mortality risks as normal weight-fit individuals. Furthermore, the obesity paradox may not influence fit individuals. Researchers, clinicians, and public health officials should focus on physical activity and fitness-based interventions rather than weight-loss driven approaches to reduce mortality risk.
    Progress in cardiovascular diseases. 01/2013; 56(4):382-390.
  • [Show abstract] [Hide abstract]
    ABSTRACT: A high-caloric intake combined with a sedentary lifestyle is an important player in the development of type 2 diabetes mellitus (T2DM). The present study was undertaken to examine if the level of physical activity has impact on the metabolic effects of a high-caloric (+2,000 kcal/day) intake. Therefore, healthy individuals on a high caloric intake were randomized to either 10,000 or 1,500 steps per day for 14 days. Step-number, total energy expenditure, dietary records, neuropsychological tests, maximal oxygen uptake (VO2max), whole body dual-energy X-ray absorptiometry (DXA)- and abdominal magnetic resonance imaging (MRI)- scans, continuous glucose monitoring (CGM), and oral glucose tolerance tests (OGTT) with stable isotopes were performed before and after the intervention. Both study groups gained the same amount of body weight. However, the inactive group accumulated significantly more visceral fat compared to the active group. Following the two-week period, the inactive group also experienced a poorer glycaemic control, increased endogenous glucose production, decreased hepatic insulin extraction, increased baseline plasma levels of total cholesterol and LDL, and a decreased cognitive function with regard to capacity of attention. In conclusion, we find evidence to support that habitual physical activity may prevent pathophysiological symptoms associated with diet-induced obesity.
    Journal of Applied Physiology 11/2013; · 3.43 Impact Factor


Available from
May 23, 2014