@article{2988284,
    title = "Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: The European prospective investigation into cancer and nutrition study (EPIC)",
    author = "Ekelund, U. and Ward, H.A. and Norat, T. and Luan, J. and May, A.M. and Weiderpass, E. and Sharp, S.J. and Overvad, K. and Østergaard, J.N. and Tjønneland, A. and Johnsen, N.F. and Mesrine, S. and Fournier, A. and Fagherazzi, G. and Trichopoulou, A. and Lagiou, P. and Trichopoulos, D. and Li, K. and Kaaks, R. and Ferrari, P. and Licaj, I. and Jenab, M. and Bergmann, M. and Boeing, H. and Palli, D. and Sieri, S. and Panico, S. and Tumino, R. and Vineis, P. and Peeters, P.H. and Monnikhof, E. and Bueno-De-Mesquita, H.B. and Quirós, J.R. and Agudo, A. and Sánchez, M.-J. and Huerta, J.M. and Ardanaz, E. and Arriola, L. and Hedblad, B. and Wirfält, E. and Sund, M. and Johansson, M. and Key, T.J. and Travis, R.C. and Khaw, K.-T. and Brage, S. and Wareham, N.J. and Riboli, E.",
    journal = "AMERICAN JOURNAL OF CLINICAL NUTRITION",
    year = "2015",
    volume = "101",
    number = "3",
    pages = "613-621",
    publisher = "American Society for Nutrition",
    issn = "0002-9165",
    doi = "10.3945/ajcn.114.100065",
    keywords = "abdominal obesity;  adult;  alcohol consumption;  Article;  body height;  body mass;  body weight;  cohort analysis;  disease association;  female;  follow up;  human;  life expectancy;  life table;  major clinical study;  male;  physical activity;  physical inactivity;  prospective study;  self report;  waist circumference;  abdominal fat;  clinical trial;  Europe;  middle aged;  mortality;  motor activity;  multicenter study;  obesity;  Obesity, Abdominal;  outpatient department;  pathology;  proportional hazards model;  risk factor;  sexual development;  university hospital, Abdominal Fat;  Adiposity;  Adult;  Body Mass Index;  Cohort Studies;  Europe;  Female;  Follow-Up Studies;  Hospitals, University;  Humans;  Male;  Middle Aged;  Mortality;  Motor Activity;  Obesity, Abdominal;  Outpatient Clinics, Hospital;  Proportional Hazards Models;  Prospective Studies;  Risk Factors;  Self Report;  Sex Characteristics;  Waist Circumference",
    abstract = "Background: The higher risk of death resulting from excess adiposity may be attenuated by physical activity (PA). However, the theoretical number of deaths reduced by eliminating physical inactivity compared with overall and abdominal obesity remains unclear. Objective: We examined whether overall and abdominal adiposity modified the association between PA and all-cause mortality and estimated the population attributable fraction (PAF) and the years of life gained for these exposures. Design: This was a cohort study in 334,161 European men and women. The mean follow-up time was 12.4 y, corresponding to 4,154,915 person-years. Height, weight, and waist circumference (WC) were measured in the clinic. PA was assessed with a validated self-report instrument. The combined associations between PA, BMI, and WC with mortality were examined with Cox proportional hazards models, stratified by center and age group, and adjusted for sex, education, smoking, and alcohol intake. Centerspecific PAF associated with inactivity, body mass index (BMI; in kg/m2) (>30), and WC (≥102 cm for men, ≥88 cm for women) were calculated and combined in random-effects meta-analysis. Life-tables analyses were used to estimate gains in life expectancy for the exposures. Results: Significant interactions (PA × BMI and PA × WC) were observed, so HRs were estimated within BMI and WC strata. The hazards of all-cause mortality were reduced by 16-30% in moderately inactive individuals compared with those categorized as inactive in different strata of BMI and WC. Avoiding all inactivity would theoretically reduce all-cause mortality by 7.35% (95% CI: 5.88%, 8.83%). Corresponding estimates for avoiding obesity (BMI >30) were 3.66% (95% CI: 2.30%, 5.01%). The estimates for avoiding high WC were similar to those for physical inactivity. Conclusion: The greatest reductions in mortality risk were observed between the 2 lowest activity groups across levels of general and abdominal adiposity, which suggests that efforts to encourage even small increases in activity in inactive individuals may be beneficial to public health. © 2015 American Society for Nutrition."
}