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Impact of body size and physical activity during adolescence and adult life on overall and cause-specific mortality in a large cohort study from Iran

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Abstract

We conducted this study to examine life-course body size and physical activity in relation to total and cause-specific mortality, which has not previously been studied in the low and middle-income countries in Asia. The Golestan Cohort Study is a population-based cohort in northeastern Iran in which 50,045 people above the age of 40 have been followed since 2004. Participants were shown a validated pictogram to assess body size at ages 15, 30, and the time of recruitment. Information on occupational physical activity at these ages was also collected. Subjects were followed up annually, and cause of death was determined. Cox regression models were adjusted for age at cohort start, smoking, socioeconomic status, ethnicity, place of residence, education, and opium use. Models for body size were also adjusted for physical activity at the same age, and vice versa. During a total of 252,740 person-years of follow-up (mean follow-up duration 5.1 ± 1.3 years) through December 2011, 2,529 of the cohort participants died. Larger body sizes at ages 15 or 30 in both sexes were associated with increased overall mortality. Cancer mortality was more strongly associated with adolescent obesity, and cardiovascular mortality with early adulthood body size. Weight gain between these ages was associated with cardiovascular mortality. Obese adolescents who lost weight still had increased mortality from all medical causes in both sexes. Physical activity during adolescence and early adulthood had no association with mortality, but at cohort baseline higher levels of activity were associated with reduced mortality. Mortality in this Middle-Eastern population was associated with obesity both during adolescence and early adult life.

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Acknowledgments

This work was supported in part by the intramural research program of the Division of Cancer Epidemiology and Genetics, National Cancer Institute; the Digestive Disease Research Center of Tehran University of Medical Sciences [Grant No. 82-603]; and by the International Agency for Research on Cancer.

Conflict of interest

None.

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Authors and Affiliations

  1. Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran

    Arash Etemadi, Farin Kamangar, Farhad Islami, Hooman Khademi, Akram Pourshams, Hossein Poustchi, Mohammad Bagheri, Amir Ali Sohrabpour, Ali Aliasgar & Reza Malekzadeh

  2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA

    Arash Etemadi, Christian C. Abnet, Sholom Wacholder, Charles C. Matthews & Sanford M. Dawsey

  3. Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA

    Farin Kamangar

  4. International Agency for Research on Cancer, Lyon, France

    Hooman Khademi & Paul Brennan

  5. The Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, NY, USA

    Farhad Islami & Paolo Boffetta

  6. Gorgan University of Medical Sciences, Gorgan, Iran

    Masoud Khoshnia

  7. Departments of Oncology and Public Health and Primary Care, University of Cambridge, Cambridge, UK

    Paul D. Pharoah

  8. International Prevention Research Institute, Lyon, France

    Paolo Boffetta

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  1. Arash Etemadi
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  2. Christian C. Abnet
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  3. Farin Kamangar
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Correspondence to Arash Etemadi.

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Etemadi, A., Abnet, C.C., Kamangar, F. et al. Impact of body size and physical activity during adolescence and adult life on overall and cause-specific mortality in a large cohort study from Iran. Eur J Epidemiol 29, 95–109 (2014). https://doi.org/10.1007/s10654-014-9883-6

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