The mortality risk of smoking and obesity combined

BACKGROUND: Both smoking and obesity have been linked to increased mortality, but evaluating the joint effect has been limited. This nationwide, prospective mortality study of U.S. radiologic technologists was designed to evaluate the combined mortality risks of obesity and smoking. METHODS: Mortality risk was investigated in 64,120 women and 18,760 men who completed a baseline questionnaire (1983 to 1989). Body mass index (BMI) (weight adjusted for height, or kilograms divided by meters squared) was calculated from self-reported weight and height at baseline, with five categories: less than 18.5 (underweight), 18.5 to 24.9 (normal), 25.0 to 29.9 (overweight), 30.0 to 34.9 (moderately obese), and 35.0 and higher (very obese). Participants were followed from the questionnaire until the date of death or through 2002, whichever occurred first. The combined association among BMI and smoking and all-cause, cancer, and circulatory disease mortality by gender and attained age (less than 65 years, 65 years and older) was examined using Cox proportional hazards regression analyses (conducted in 2005). Person-years at risk averaged 16 years (women aged less than 65), 6 years (women aged 65 and older), 15 years (men aged less than 65), and 7 years (men aged 65 and older), totaling 1.35 million person-years. RESULTS: In all gender/age groups, both obesity and smoking, particularly current smoking, contributed substantially to all-cause mortality, with 3.5- to 5-fold risks for very obese, current smokers compared to normal weight, never smokers. Current smoking was the predominant risk factor for cancer mortality. Combining obesity with current smoking increased circulatory disease mortality by 6- to 11-fold for people aged less than 65 years, compared to normal weight, never smokers. Obese former smokers (less than 65 years) had notably lower risks. CONCLUSIONS: Obese smokers (aged less than 65 years) had strikingly high mortality risks, particularly from circulatory disease mortality.     

Lifestyle-related risk factors for total and cancer mortality in men and women

We conducted a 14-year follow-up study to analyze the hazard ratio (HR) of mortality regarding lifestyle-related factors in Saga Prefecture, Japan. The subjects included 2,170 people, who were randomly selected from men and women aged from 40 to 69 years old, and who also completed the standardized questionnaire on lifestyle in 1983. Information about death and corresponding data were obtained either by mail and/or through the city offices in 1997. We found that a lower body weight, a lower physical fitness level, not consuming a balanced diet, and cigarette smoking to be significantly elevated risks for all-causes of death in males after adjustment by age and health status. In addition, these results did not change even after excluding subjects for early death. The HR of the female subjects who quit smoking was significantly high, although it changed to insignificant after excluding subjects for early death. These results suggested that being underweight might be an index of a positive risk of death, while maintaining a higher physical fitness level, being careful to consume a more balanced diet, and non smoking all appear to be indexes of a negative risk of death. In addition, these results might also be considered good evidence for improving poor health habits in health promotion activities.     

Underweight, overweight and obesity as risk factors for mortality and hospitalization

AIMS: The prevalence of overweight and obesity is increasing in many countries. We aimed to investigate differences in mortality and severe morbidity between underweight people (body mass index (BMI)<18.5), overweight people (BMI 25 to <30), obese people (BMI> or =30), and those with normal weights (BMI 18.5 to <25). METHODS: Random samples of the Swedish population aged 16-74 years in 1980-81 and 1988-89 were followed for 12 years with regard to all-cause mortality and mortality from circulatory diseases, all inpatient care, and inpatient care for circulatory and musculoskeletal diseases. Relative risks (RRs) for different levels of BMI were adjusted for age, longstanding illness, smoking, and educational level at baseline. In addition, analyses were made with delayed entry until the fourth-year after interview. RESULTS: Obesity and underweight, but not overweight, was associated with higher all-cause mortality. Among underweight men, the adjusted RR for all-cause mortality was 2.4 (95% confidence interval 1.6-3.6), and among underweight women it was 2.0 (1.5-2.7), but population attributable risks (PARs) were small, at 1.2% and 2.7%, respectively. Overweight was associated with increased risks for inpatient care for circulatory diseases, with PARs being 13.4% among men and 8.1% among women, and musculoskeletal diseases (PARs were 12.7% and 12.9%, respectively). Obese men and women had about 50% higher risks of all-cause mortality than normal-weight people, PARs being 3.2% and 3.8% respectively. CONCLUSIONS: This study supports the findings of other studies, in that overweight seems to be an exaggerated risk factor for all-cause mortality, but is related to other chronic disease. Underweight and obesity generally implies greater increases of RRs, but avoidance of overweight may have greater effect on the population level with regard to reduced cardiovascular and locomotor disease.     

The relationship between obesity and breast cancer risk and mortality

Obesity is an established risk factor for postmenopausal, but not premenopausal, development of breast cancer. Evidence for a positive association between obesity and breast cancer mortality is mounting. Avoiding adult weight gain and maintaining a healthy body weight may contribute importantly to decreasing breast cancer risk and mortality, especially in postmenopausal women.     

2型糖尿病患者肥胖状态与全因死亡风险的关联研究

目的 分析不同肥胖状态与2型糖尿病（T2DM）患者全因死亡风险的关联。方法 研究对象来自浙江农村社区T2DM队列,该队列2016年完成基线调查,本研究使用的随访数据截至 2021年12月31日,剔除随访期间失访或资料不全者,共纳入10 310例研究对象。根据BMI和腰围将研究对象分为低体重、正常体型、单纯中心性肥胖、单纯全身肥胖、复合超重和复合肥胖6种状态,采用Cox比例风险回归模型分析不同肥胖状态T2DM患者的全因死亡风险比（HR）值及其95%CI。结果 研究对象累计随访57 049.47人年,随访（5.53±0.89）人年,随访期间共死亡971例,死亡密度为1 702.03/10万人年。以正常体型患者为对照,调整混杂因素后低体重患者全因死亡风险增加104%（HR=2.04,95%CI：1.42~2.92）,单纯全身肥胖、复合超重、复合肥胖患者的全因死亡风险分别下降34%（HR=0.66,95%CI：0.53~0.82）、22%（HR=0.78,95%CI：0.66~0.92）、38%（HR=0.62,95%CI：0.49~0.78）,单纯中心性肥胖患者全因死亡风险差异无统计学意义。亚组分析显示,不同性别和不同年龄组低体重T2DM患者全因死亡风险增加,女性复合肥胖患者全因死亡风险较正常体型患者下降50%,而男性该肥胖状态患者全因死亡风险差异无统计学意义;≥65岁老年患者中,单纯全身肥胖、复合超重、复合肥胖患者的全因死亡风险均明显低于正常体型组（HR=0.61,95%CI：0.48~0.78;HR=0.76,95%CI：0.63~0.91;HR=0.56,95%CI：0.42~0.73）,而<65岁的各种肥胖状态患者全因死亡风险差异无统计学意义。敏感性分析结果未见明显变化。结论 T2DM患者全因死亡风险存在“肥胖悖论”现象,低体重患者的全因死亡风险明显高于正常体型者,全身型或复合型超重/肥胖患者的死亡风险明显降低。     

A mortality risk index for men in a Veterans Administration extended care facility

the purpose of this study was to develop (phase I) and validate (phase II) a mortality prognostic index, based on the annual clinical data base, for the men of this Veterans Administration extended care facility. The study population during phase I consisted of 123 men who were residing in three of the seven wards of the facility in August 1984. Sixty-six of these individuals were institutionalized because of a chronic neurologic (50) or medical (15) disorder ("nonpsychiatric group"). In 57 men, the reason for institutionalization was a chronic psychosis (schizophrenia, 53; manic depressive illness, 4) ("psychiatric group"). During August to October 1984, a comprehensive clinical data base comprising 70 attributes (including diagnoses and drugs) was collected. Deaths were recorded during the next 14 months. Death rate during the 14 months of observation was 33.3% in the nonpsychiatric group, and only 1.7% in the psychiatric group. In the nonpsychiatric men, univariate analysis yielded six attributes significantly correlated with death rate: serum cholesterol level, hematocrit, hemoglobin, midarm muscle circumference, triceps skinfold, and number of morbidity episodes. After serum cholesterol and hematocrit had been entered into a multivariate analysis model, none of the other four attributes contributed significant information about death rate. The multivariate analysis led to a mortality risk index (MRI) for nonpsychiatric patients, MRI = [hematocrit in %] + 10% [serum cholesterol in mg/dl]. As MRI varied from less than 50 to greater than 65, death rate in the nonpsychiatric group varied in parallel from 86-11%.(ABSTRACT TRUNCATED AT 250 WORDS)     

温州城区≥18岁居民代谢综合征流行特征分析

  目的  了解中老年男性部分雄激素缺乏症（PADAM）与血糖及血脂的关系,为PADAM的预防控制提供参考依据。  方法  于2011年1月 — 2015年10月在浙江省温州医科大学附属第一医院体检中心整群抽取7 153名≥20岁男性体检者,本研究抽取其中4 291名≥40岁男性体检者作为研究对象,按照测定的血清睾酮（T）水平并结合临床症状分为PADAM病例组和对照组,比较2组人群T水平以及血糖和血脂相关指标差异,分析PADAM与血糖及血脂相关指标的关系。  结果  4 291名≥40岁男性体检者中,病例组PADAM患者754例（17.57 %）,对照组非PADAM者3 537人（82.43 %）;病例组PADAM患者的血糖（GLU）、甘油三酯（TG）、非高密度脂蛋白胆固醇（non-HDL-C）、血浆致动脉硬化指数（AIP,× 100对数值）、动脉硬化指数（ASI）平均水平分别为5.70 mmol/L、2.02 mmol/L、3.87 mmol/L、2.29、3.57,均高于对照组非PADAM者的5.50 mmol/L、1.60 mmol/L、3.78 mmol/L、2.14、3.27 （均P < 0.05）,而T、高密度脂蛋白胆固醇（HDL-C）平均水平分别为9.67 nmol/L、2.84 mmol/L,均低于对照组非PADAM者的15.35 nmol/L、 2.96 mmol/L （均P < 0.01）;相关分析结果显示,T水平与GLU、TG、non-HDL-C、AIP（× 100对数值）和ASI均呈负相关（均P < 0.001）,与HDL-C呈正相关（r = 0.17,P = 0.002）;多因素logistic回归分析结果显示,年龄、GLU和AIP（× 100对数值）是PADAM患病的危险因素。  结论  PADAM与血糖及血脂具有相关性,T水平低下会导致GLU、TG、non-HDL-C、AIP（× 100对数值）和ASI水平升高而HDL-C水平降低。     

Protective factors and social risk factors for hospitalization and mortality among young men.

The association between presumed protective factors and social risk factors for hospitalization and mortality was studied during a 14-year follow-up period in a cohort of 8,168 Swedish men aged 18-20 years at baseline. Using Cox regression analysis, the authors found that five protective factors (high social class, home well-being, school well-being, good emotional control, and self-perceived good health) were associated with lower risks of hospitalization and death. Four social risk factors (contact with police or child welfare authorities, running away from home, having divorced parents, and ever using narcotics) were significantly associated with increased risk of hospitalization and mortality. The relative hazard decreased with the number of protective factors and increased with the number of social risk factors, almost linearly. The relative hazard was 0.24 for hospitalization among those with six protective factors and 0.24 for mortality for those with five or six protective factors. The relative hazard for hospitalization was 3.09 among those with five social risk factors compared with those with none, while for mortality the relative hazard among those with four or five social risk factors was 5.74 compared with those with none. While these results indicate strong cumulative effects for both the social risk factors and the protective factors, the associations of individual factors with the two outcome measures were generally reduced in models which simultaneously adjusted for all factors, which presumably indicates collinearity among the factors. There was only limited support for a buffering, or interacting, effect between the risk factors and the protective factors.     

Adiposity and mortality in men

The relation between measures of adiposity and mortality has been a controversial topic. The authors examined prospectively the relation between several measures of adiposity and risks of overall and cause-specific mortality in 39,756 US men aged 40-75 years. During 10 years of follow-up (1986-1996), 1,972 deaths (747 from cancer, 423 from cardiovascular disease, and 802 from other causes) were documented. An elevated risk of death among the leanest men was partly accounted for by excess mortality during early follow-up and high mortality among those with a history of recent weight loss. After exclusion of men with substantial recent weight loss and deaths occurring during the first 4 years of follow-up, overall and cardiovascular disease mortality among men aged <65 years increased linearly with greater body mass index (BMI) (weight (kg)/height (m)2); multivariate relative risks for overall mortality were 1.0 (referent) for a BMI of <23, 1.21 for a BMI of 23-24.9, 1.19 for a BMI of 25-26.9, 1.39 for a BMI of 27-29.9, and 1.97 for a BMI of >30 (test for trend: p< 0.001). Among men aged > or =65 years, there were no significant relations between BMI and overall, cardiovascular disease, or cancer mortality risk. However, waist circumference strongly predicted risk of death from cardiovascular disease among the older men. These findings indicated that the relation between body fat and mortality was influenced by reverse causation and varied by age.     

Dietary calcium and obesity in men

Increased calcium intake has been associated with lower body weight, BMI and adiposity, mostly in children, youth and women. In men results are inconclusive. In this study the relation between calcium intake and body weight and body fat in obese men was investigated. 200 men, the mean age 45.1 +/- 9.4 y, the mean BMI 33.2 +/- 4.8 kg/m2, were divided into 4 groups on the basis of their calcium/protein index. No significant differences in body weight, BMI, fat mass, percentage of body fat were found across subgroups and no significant correlations between calcium intake and body variables were stated. This study did not confirm the association between calcium intake and body weight and adiposity in men.     

Weight and mortality in Finnish men

Mortality rates of 22,995 Finnish men aged 25 and over followed up for a median of 12 years were analyzed in relation to body mass index (BMI) at the initial examination. All-cause mortality followed a "U"-shaped distribution, being greatest for the thinnest and fattest men at all ages, or about 1.5-fold for those with BMI less than 19.0 kg/m2 and BMI greater than or equal to 34.0 kg/m2, as compared with men of normal weight (BMI 22.0-24.9 kg/m2). Mortality from cardiovascular diseases (CVD) increased with increasing BMI beyond the normal range. This depended mostly on the association of BMI with the biological risk factors of CVD. Mortality rates from CVD were also elevated among thin men under age 55, which could not be explained by the effect of the biological variables. Mortality rates from non-cardiovascular diseases, including cancers were inversely related to BMI among men of all ages. The high overall mortality of thin men was partly but not entirely attributable to smoking, low social class and antecedent disease. We conclude that both thinness and overweight are detrimental to longevity, but through differing mechanisms and disease patterns.     

Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men

BACKGROUND: Obesity is a strong risk factor for type 2 diabetes. However, few studies have compared the predictive power of overall obesity with that of central obesity. The cutoffs for waist circumference (WC) and waist-to-hip ratio (WHR) as measures of abdominal adiposity remain controversial. OBJECTIVE: The objective was to compare body mass index (BMI), WC, and WHR in predicting type 2 diabetes. DESIGN: A prospective cohort study (Health Professionals Follow-Up Study) of 27 270 men was conducted. WC, WHR, and BMI were assessed at baseline. Covariates and potential confounders were assessed repeatedly during the follow-up. RESULTS: During 13 y of follow-up, we documented 884 incident type 2 diabetes cases. Age-adjusted relative risks (RRs) across quintiles of WC were 1.0, 2.0, 2.7, 5.0, and 12.0; those of WHR were 1.0, 2.1, 2.7, 3.6, and 6.9; and those of BMI were 1.0, 1.1, 1.8, 2.9, and 7.9 (P for trend < 0.0001 for all). Multivariate adjustment for diabetes risk factors only slightly attenuated these RRs. Adjustment for BMI substantially attenuated RRs for both WC and WHR. The receiver operator characteristic curve analysis indicated that WC and BMI were similar and were better than WHR in predicting type 2 diabetes. The cumulative proportions of type 2 diabetes cases identified according to medians of BMI (>/=24.8), WC (>/=94 cm), and WHR (>/=0.94) were 82.5%, 83.6%, and 74.1%, respectively. The corresponding proportions were 78.9%, 50.5%, and 65.7% according to the recommended cutoffs. CONCLUSIONS: Both overall and abdominal adiposity strongly and independently predict risk of type 2 diabetes. WC is a better predictor than is WHR. The currently recommended cutoff for WC of 102 cm for men may need to be reevaluated; a lower cutoff may be more appropriate.     

Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: I. White men.

OBJECTIVES: This study examined socioeconomic differentials in risk of death from a number of specific causes in a large cohort of White men in the United States. METHODS: For 300 685 White men screened for the Multiple Risk Factor Intervention Trial between 1973 and 1975, data were collected on median income of White households in the zip code of residence, age, cigarette smoking, blood pressure, serum cholesterol, previous myocardial infarction, and drug treatment for diabetes. The 31 737 deaths that occurred over the 16-year follow-up period were grouped into specific causes and related to median White family income. RESULTS: There was an inverse association between age- adjusted all-cause mortality and median family income. There was no attenuation of this association over the follow-up period, and the association was similar for the 22 clinical centers carrying out the screening. The gradient was seen for many-but not all-of the specific causes of death. Other risk factors accounted for some of the association between income and coronary heart disease and smoking-related cancers. CONCLUSIONS: Socioeconomic position, as measured by median family income of area of residence, is an important determinant of mortality risk in White men.     

Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: II. Black men.

OBJECTIVES: This study examined socioeconomic differentials in risk of death from a number of causes in a large cohort of Black men in the United States. METHODS: For 20 224 Black men screened for the Multiple Risk Factor Intervention Trial between 1973 and 1975, data were collected on median family income of Black households in zip code of residence, age, cigarette smoking, blood pressure, serum cholesterol, previous heart attack, and drug treatment for diabetes. The 2937 deaths that occurred over the 16-year follow-up period were grouped into specific causes and related to median Black family income. RESULTS: There was an inverse association between age-adjusted all-cause mortality and median family income. There was no attenuation of this association over the follow-up period, and the association was similar for the 22 clinical centers carrying out the screening. The gradient was seen for most of the specific causes of death, although the strength of the association varied. Median income was markedly lower for the Black men screened than for the White men, but the relationship between income and all-cause mortality was similar. CONCLUSIONS: Socioeconomic position is an important determinant of mortality risk for Black men. Even though Blacks lived in areas with substantially lower median family income than Whites, the association of income with mortality was similar for Blacks and Whites.     

Does equal socioeconomic status in black and white men mean equal risk of mortality?

Although concerns have been expressed that mortality from coronary disease and all other causes is greater among Blacks than Whites, we hypothesized that, when socioeconomic status is adequately considered, mortality inequalities between Blacks and Whites are insignificant. The study population was a random sampling of Black and White men who were 35 years of age or older when recruited into the Charleston Heart Study in 1960. Education level and occupational status at baseline were used to compare mortality over the ensuing 28 years between Black and White men, who were classified as low or high socioeconomic status. In no instance were Black-White differences in all-cause or coronary disease mortality rates significantly different when socioeconomic status was controlled. We conclude that socioeconomic status is an important predictor of mortality and that, when socioeconomic status is considered, differences in Black-White mortality rates may be small.     

Overweight and obesity in middle-aged British men

Overweight and obesity have been examined in 7735 middle-aged men in 24 British towns. Half the men exceeded the body mass index (BMI) range associated with minimum mortality (20-25 kg/m2). Social class differences in BMI were marked and obesity was more marked in manual workers. The association of reduced BMI with cigarette smoking and of increased BMI with stopping smoking was most clearly seen in manual workers. With increasing alcohol intake, BMI increased progressively, but the effect in the heaviest drinkers was probably diminished by concurrent heavy smoking. Mean BMI decreased with increasing levels of physical activity. There was considerable variation in the rate of obesity between the towns, from 11 to 28 per cent, determined to some extent by social class. Positive associations were observed between BMI and the presence of ischaemic heart disease, high blood pressure, gout, arthritis and gallbladder disease but not with diabetes mellitus. Peptic ulcer was inversely related to BMI and bronchitis showed a curvilinear relationship. For these men, overweight or obesity is virtually 'normal', and a considerable health education effort will be needed to produce a leaner, healthier society.     

Prognosis of risk factors and trends in mortality from external causes among middle-aged men in Lithuania

AIMS: The aims of this study were to investigate the risk of death and time trends from external causes, and to evaluate the significance of the effects of age, period and birth cohort on suicide mortality among middle-aged men during the period 1971-2000 in Lithuania. METHODS: Random samples of men aged 45-59 years from the Kaunas Rotterdam Intervention Study (conducted in 1972-74) and Study of Multifactorial Prevention of CHD (conducted in 1977-80) were examined (n?=?6,480). The participants of the two surveys were observed until 1 January 2001. Over this time 2,841 men had died, 230 of these from external causes. The Cox proportional hazards model was used to evaluate the risk of death from external causes. Trends in mortality from external causes and average annual changes were based on logarithmic regression analysis. For assessment of the effects of age, period, and birth cohort the Poisson regression model was applied. RESULTS: The risk of mortality from external causes among men was positively related to smoking habits and arterial hypertension and negatively related to education level and total serum cholesterol concentration but there was no association with consumption of alcohol. The risk of suicide mortality was associated with family status and occupation only. Trends in mortality from all external causes showed no significant changes during the period 1971-2000. After adjusting for age and cohort effects, the period effect was statistically significant. CONCLUSION: Prognosis of risk factors for mortality from external causes and period effect on suicide mortality rates will form important parts of future research agendas.