European Journal of Epidemiology

, Volume 29, Issue 2, pp 95–109 | Cite as

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

  • Arash Etemadi
  • Christian C. Abnet
  • Farin Kamangar
  • Farhad Islami
  • Hooman Khademi
  • Akram Pourshams
  • Hossein Poustchi
  • Mohammad Bagheri
  • Amir Ali Sohrabpour
  • Ali Aliasgar
  • Masoud Khoshnia
  • Sholom Wacholder
  • Charles C. Matthews
  • Paul D. Pharoah
  • Paul Brennan
  • Paolo Boffetta
  • Reza Malekzadeh
  • Sanford M. Dawsey
MORTALITY

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.

Keywords

Obesity Physical activity Adolescence Mortality Cancer Cardiovascular disease 

Supplementary material

10654_2014_9883_MOESM1_ESM.doc (140 kb)
Supplementary material 1 (DOC 140 kb)

References

  1. 1.
    Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307(5):491–7. doi:10.1001/jama.2012.39.PubMedCrossRefGoogle Scholar
  2. 2.
    Rokholm B, Baker JL, Sorensen TI. The levelling off of the obesity epidemic since the year 1999–a review of evidence and perspectives. Obes Rev. 2010;11(12):835–46. doi:10.1111/j.1467-789X.2010.00810.x.PubMedCrossRefGoogle Scholar
  3. 3.
    de Onis M, Blossner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr. 2010;92(5):1257–64. doi:10.3945/ajcn.2010.29786.PubMedCrossRefGoogle Scholar
  4. 4.
    Mirmiran P, Sherafat-Kazemzadeh R, Jalali-Farahani S, Azizi F. Childhood obesity in the Middle East: a review. East Mediterr Health J. 2010;16(9):1009–17.PubMedGoogle Scholar
  5. 5.
    Lakshman R, Elks CE, Ong KK. Childhood obesity. Circulation. 2012;126(14):1770–9. doi:10.1161/CIRCULATIONAHA.111.047738.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Baker JL, Olsen LW, Sorensen TI. Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med. 2007;357(23):2329–37. doi:10.1056/NEJMoa072515.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363(23):2211–9. doi:10.1056/NEJMoa1000367.PubMedCrossRefGoogle Scholar
  8. 8.
    Flegal KM, Graubard BI, Williamson DF, Gail MH. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA. 2007;298(17):2028–37. doi:10.1001/jama.298.17.2028.PubMedCrossRefGoogle Scholar
  9. 9.
    Zheng W, McLerran DF, Rolland B, Zhang X, Inoue M, Matsuo K, et al. Association between body-mass index and risk of death in more than 1 million Asians. N Engl J Med. 2011;364(8):719–29. doi:10.1056/NEJMoa1010679.PubMedCrossRefGoogle Scholar
  10. 10.
    Jee SH, Sull JW, Park J, Lee S, Ohrr H, Guallar E, et al. Body-mass index and mortality in Korean men and women. N Engl J Med. 2006;355(8):779–87.PubMedCrossRefGoogle Scholar
  11. 11.
    Parr CL, Batty GD, Lam TH, Barzi F, Fang X, Ho SC, et al. Body-mass index and cancer mortality in the Asia-Pacific Cohort Studies Collaboration: pooled analyses of 424,519 participants. Lancet Oncol. 2010;11(8):741–52. doi:10.1016/S1470-2045(10)70141-8.PubMedCrossRefGoogle Scholar
  12. 12.
    Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes (Lond). 2011;35(7):891–8. doi:10.1038/ijo.2010.222.CrossRefGoogle Scholar
  13. 13.
    Stevens J, Cai J, Evenson KR, Thomas R. Fitness and fatness as predictors of mortality from all causes and from cardiovascular disease in men and women in the lipid research clinics study. Am J Epidemiol. 2002;156(9):832–41.PubMedCrossRefGoogle Scholar
  14. 14.
    Kvaavik E, Klepp KI, Tell GS, Meyer HE, Batty GD. Physical fitness and physical activity at age 13 years as predictors of cardiovascular disease risk factors at ages 15, 25, 33, and 40 years: extended follow-up of the Oslo Youth Study. Pediatrics. 2009;123(1):e80–6. doi:10.1542/peds.2008-1118.PubMedCrossRefGoogle Scholar
  15. 15.
    Waller K, Kujala UM, Rantanen T, Kauppinen M, Silventoinen K, Koskenvuo M, et al. Physical activity, morbidity and mortality in twins: a 24-year prospective follow-up. Eur J Epidemiol. 2010;25(10):731–9. doi:10.1007/s10654-010-9493-x.PubMedCrossRefGoogle Scholar
  16. 16.
    Esmaillzadeh A, Mirmiran P, Azadbakht L, Etemadi A, Azizi F. High prevalence of the metabolic syndrome in Iranian adolescents. Obesity (Silver Spring). 2006;14(3):377–82. doi:10.1038/oby.2006.50.CrossRefGoogle Scholar
  17. 17.
    Hajian-Tilaki K, Heidari B. Prevalences of overweight and obesity and their association with physical activity pattern among Iranian adolescents aged 12–17 years. Public Health Nutr. 2012;15(12):2246-52. doi:10.1017/S1368980012001048.Google Scholar
  18. 18.
    Golozar A, Khademi H, Kamangar F, Poutschi H, Islami F, Abnet CC, et al. Diabetes mellitus and its correlates in an Iranian adult population. PLoS ONE. 2011;6(10):e26725. doi:10.1371/journal.pone.0026725.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Pourshams A, Khademi H, Malekshah AF, Islami F, Nouraei M, Sadjadi AR, et al. Cohort profile: the Golestan Cohort Study—a prospective study of oesophageal cancer in northern Iran. Int J Epidemiol. 2010;39(1):52–9. doi:10.1093/ije/dyp161.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Islami F, Kamangar F, Nasrollahzadeh D, Aghcheli K, Sotoudeh M, Abedi-Ardekani B, et al. Socio-economic status and oesophageal cancer: results from a population-based case-control study in a high-risk area. Int J Epidemiol. 2009;38(4):978–88. doi:10.1093/Ije/Dyp195.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Keshtkar AA, Semnani S, Pourshams A, Khademi H, Roshandel G, Boffetta P, et al. Pictogram use was validated for estimating individual’s body mass index. J Clin Epidemiol. 2010;63(6):655–9. doi:10.1016/j.jclinepi.2009.08.014.PubMedCrossRefGoogle Scholar
  22. 22.
    Khademi H, Etemadi A, Kamangar F, Nouraie M, Shakeri R, Abaie B, et al. Verbal autopsy: reliability and validity estimates for causes of death in the Golestan Cohort Study in Iran. PLoS ONE. 2010;5(6):e11183. doi:10.1371/journal.pone.0011183.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Khademi H, Malekzadeh R, Pourshams A, Jafari E, Salahi R, Semnani S, et al. Opium use and mortality in Golestan Cohort Study: prospective cohort study of 50,000 adults in Iran. BMJ. 2012;344:e2502.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    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 1935. N Engl J Med. 1992;327(19):1350–5. doi:10.1056/NEJM199211053271904.PubMedCrossRefGoogle Scholar
  25. 25.
    Engeland A, Bjorge T, Tverdal A, Sogaard AJ. Obesity in adolescence and adulthood and the risk of adult mortality. Epidemiology. 2004;15(1):79–85. doi:10.1097/01.ede.0000100148.40711.59.PubMedCrossRefGoogle Scholar
  26. 26.
    Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371(9612):569–78. doi:10.1016/S0140-6736(08)60269-X.PubMedCrossRefGoogle Scholar
  27. 27.
    Etemadi A, Golozar A, Kamangar F, Freedman ND, Shakeri R, Matthews C, et al. Large body size and sedentary lifestyle during childhood and early adulthood and esophageal squamous cell carcinoma in a high-risk population. Ann Oncol. 2012;23(6):1593–600. doi:10.1093/annonc/mdr494.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Bjorge T, Engeland A, Tverdal A, Smith GD. Body mass index in adolescence in relation to cause-specific mortality: a follow-up of 230,000 Norwegian adolescents. Am J Epidemiol. 2008;168(1):30–7. doi:10.1093/aje/kwn096.PubMedCrossRefGoogle Scholar
  29. 29.
    Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer. 2004;4(8):579–91. doi:10.1038/nrc1408.PubMedCrossRefGoogle Scholar
  30. 30.
    Yeung EH, Zhang C, Louis GM, Willett WC, Hu FB. Childhood size and life course weight characteristics in association with the risk of incident type 2 diabetes. Diabetes Care. 2010;33(6):1364–9. doi:10.2337/dc10-0100.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Zhang Y, Daquinag AC, Amaya-Manzanares F, Sirin O, Tseng C, Kolonin MG. Stromal progenitor cells from endogenous adipose tissue contribute to pericytes and adipocytes that populate the tumor microenvironment. Cancer Res. 2012;72(20):5198–208. doi:10.1158/0008-5472.CAN-12-0294.PubMedCrossRefGoogle Scholar
  32. 32.
    Maumus M, Sengenes C, Decaunes P, Zakaroff-Girard A, Bourlier V, Lafontan M, et al. Evidence of in situ proliferation of adult adipose tissue-derived progenitor cells: influence of fat mass microenvironment and growth. J Clin Endocrinol Metab. 2008;93(10):4098–106. doi:10.1210/jc.2008-0044.PubMedCrossRefGoogle Scholar
  33. 33.
    Lloyd LJ, Langley-Evans SC, McMullen S. Childhood obesity and adult cardiovascular disease risk: a systematic review. Int J Obes (Lond). 2010;34(1):18–28. doi:10.1038/ijo.2009.61.CrossRefGoogle Scholar
  34. 34.
    Raghuveer G. Lifetime cardiovascular risk of childhood obesity. Am J Clin Nutr. 2010;91(5):1514S–9S. doi:10.3945/ajcn.2010.28701D.PubMedCrossRefGoogle Scholar
  35. 35.
    Freedman DS, Patel DA, Srinivasan SR, Chen W, Tang R, Bond MG, et al. The contribution of childhood obesity to adult carotid intima-media thickness: the Bogalusa Heart Study. Int J Obes (Lond). 2008;32(5):749–56. doi:10.1038/sj.ijo.0803798.CrossRefGoogle Scholar
  36. 36.
    Bibbins-Domingo K, Coxson P, Pletcher MJ, Lightwood J, Goldman L. Adolescent overweight and future adult coronary heart disease. N Engl J Med. 2007;357(23):2371–9. doi:10.1056/NEJMsa073166.PubMedCrossRefGoogle Scholar
  37. 37.
    Jeffreys M, Smith GD, Martin RM, Frankel S, Gunnell D. Childhood body mass index and later cancer risk: a 50-year follow-up of the Boyd Orr study. Int J Cancer. 2004;112(2):348–51. doi:10.1002/ijc.20423.PubMedCrossRefGoogle Scholar
  38. 38.
    van Dam RM, Willett WC, Manson JE, Hu FB. The relationship between overweight in adolescence and premature death in women. Ann Intern Med. 2006;145(2):91–7.PubMedCrossRefGoogle Scholar
  39. 39.
    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(26):2694–703. doi:10.1056/NEJMoa042135.PubMedCrossRefGoogle Scholar
  40. 40.
    Twisk JW, Kemper HC, van Mechelen W. Prediction of cardiovascular disease risk factors later in life by physical activity and physical fitness in youth: introduction. Int J Sports Med. 2002;23(Suppl 1):S5–7. doi:10.1055/s-2002-28454.PubMedCrossRefGoogle Scholar
  41. 41.
    Twisk JW, Kemper HC, van Mechelen W. The relationship between physical fitness and physical activity during adolescence and cardiovascular disease risk factors at adult age. The Amsterdam Growth and Health Longitudinal Study. Int J Sports Med. 2002;23(Suppl 1):S8–14. doi:10.1055/s-2002-28455.PubMedCrossRefGoogle Scholar
  42. 42.
    Corrada MM, Kawas CH, Mozaffar F, Paganini-Hill A. Association of body mass index and weight change with all-cause mortality in the elderly. Am J Epidemiol. 2006;163(10):938–49. doi:10.1093/aje/kwj114.PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Adams KF, Schatzkin A, Harris TB, Kipnis V, Mouw T, Ballard-Barbash R, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006;355(8):763–78. doi:10.1056/NEJMoa055643.PubMedCrossRefGoogle Scholar
  44. 44.
    Neovius M, Sundstrom J, Rasmussen F. Combined effects of overweight and smoking in late adolescence on subsequent mortality: nationwide cohort study. BMJ. 2009;338:b496.PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Stevens J, Keil JE, Waid LR, Gazes PC. Accuracy of current, 4-year, and 28-year self-reported body weight in an elderly population. Am J Epidemiol. 1990;132(6):1156–63.PubMedGoogle Scholar
  46. 46.
    Baer HJ, Tworoger SS, Hankinson SE, Willett WC. Body fatness at young ages and risk of breast cancer throughout life. Am J Epidemiol. 2010;171(11):1183–94. doi:10.1093/aje/kwq045.PubMedCentralPubMedCrossRefGoogle Scholar
  47. 47.
    Hardy R, Wadsworth M, Kuh D. The influence of childhood weight and socioeconomic status on change in adult body mass index in a British national birth cohort. Int J Obes Relat Metab Disord. 2000;24(6):725–34.PubMedCrossRefGoogle Scholar
  48. 48.
    Must A, Willett WC, Dietz WH. Remote recall of childhood height, weight, and body build by elderly subjects. Am J Epidemiol. 1993;138(1):56–64.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht (outside the USA) 2014

Authors and Affiliations

  • Arash Etemadi
    • 1
    • 2
  • Christian C. Abnet
    • 2
  • Farin Kamangar
    • 1
    • 3
  • Farhad Islami
    • 1
    • 5
  • Hooman Khademi
    • 1
    • 4
  • Akram Pourshams
    • 1
  • Hossein Poustchi
    • 1
  • Mohammad Bagheri
    • 1
  • Amir Ali Sohrabpour
    • 1
  • Ali Aliasgar
    • 1
  • Masoud Khoshnia
    • 6
  • Sholom Wacholder
    • 2
  • Charles C. Matthews
    • 2
  • Paul D. Pharoah
    • 7
  • Paul Brennan
    • 4
  • Paolo Boffetta
    • 5
    • 8
  • Reza Malekzadeh
    • 1
  • Sanford M. Dawsey
    • 2
  1. 1.Digestive Oncology Research Center, Digestive Disease Research InstituteTehran University of Medical SciencesTehranIran
  2. 2.Division of Cancer Epidemiology and GeneticsNational Cancer Institute, NIHBethesdaUSA
  3. 3.Department of Public Health Analysis, School of Community Health and PolicyMorgan State UniversityBaltimoreUSA
  4. 4.International Agency for Research on CancerLyonFrance
  5. 5.The Tisch Cancer Institute and Institute for Translational EpidemiologyMount Sinai School of MedicineNew YorkUSA
  6. 6.Gorgan University of Medical SciencesGorganIran
  7. 7.Departments of Oncology and Public Health and Primary CareUniversity of CambridgeCambridgeUK
  8. 8.International Prevention Research InstituteLyonFrance

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