Overweight and all-cause mortality in a Swedish rural population: Skaraborg Hypertension and Diabetes Project

Abstract

Aims: To explore the prevalence of overweight in men and women in a Swedish rural community and to examine its associations with all-cause mortality. Methods: A community-based cohort study. A total of 1,109 men and women aged ≥40 years participated in a survey of cardiovascular disease (CVD) risk factors in the city of Skara in Skaraborg, Sweden, in 1993—94. Overweight was defined as a BMI≥25.0 kg m^-2. Vital status was ascertained to 31 December 1999 and sex-specific associations between overweight and mortality were explored. Results: The prevalence of overweight according to the WHO's criteria exceeded 50% in men and 35% in women. In men there was an inverse association between BMI and mortality. Men in the lowest quartile of BMI experienced the highest mortality with 44.1 deaths per 1,000 person-years. The hazard ratio (HR) in the highest quartile was 0.6 (95% CI 0.4—0.9). In women there were no significant differences in mortality between quartiles of BMI. In both men and women with previous CVD the mortality rates decreased with quartiles of increasing BMI. The inverse association between BMI and mortality was confined to elderly men with a history of CVD. Conclusion: In both sexes the association between BMI and mortality differed across subgroups of age and of a history of previous CVD. No indication of overweight being negative for longevity was found in this population. Higher age and a history of previous CVD contribute to the excess mortality seen in subjects with low BMI.

Keywords

Abdominal obesity physical activity overweight smoking survival

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References

Seidell JC Obesity in Europe: scaling an epidemic. Int J Obes 1995;19:S1—S4.

Lindström M. , Isacsson SO , Merlo J. Increasing prevalence of overweight, obesity and physical inactivity: Two population-based studies 1986 and 1994. Eur J Public Health 2003;13:306—12.

Calle EE , Thun MJ , Peterelli JM , Rodriguez C. , Heath CWJ Body mass index and mortality in a prospective cohort of US adults . N Engl J Med 1999;341:1097—1105.

Meyer HE , Sogaard AJ , Tverdal A, Selmer Ra. Body mass index and mortality: The influence of physical activity and smoking. Med Sci Sports Exerc 2002;34:1065—70.

Engeland A. , Bjorge T. , Selmer RM , Tverdal A. Height and body mass index in relation to total mortality. Epidemiology 2003;14:293—9.

Schulte H. , Cullen P. , Assmann G. Obesity, mortality and cardiovascular disease in the Munster Heart Study (PROCAM) . Atherosclerosis 1999;1444:199—209.

Keys A. Longevity of man: Relative weight and fatness in middle age. Ann Med 1988;21:163—8.

Haapanen-Niemi N. , Miilunpalo S. , Pasanen M. , Vuori I. , Oja P. , Malmberg J. Body mass index, physical activity and low levels of physical fitness as determinants of all-cause mortality and cardiovascular disease mortality — 16 y follow-up of middle-aged and elderly men and women. Int J Obes Relat Metab Disord 2000;24:1465—74.

Bigaard J. , Tjonneland A. , Thomsen BL , Overvad K. , Heitmann BL , Sorensen TI Waist circumference, BMI, smoking, and mortality in middle-aged men and women. Obes Res 2003 ;11:895—903.

10.

Molarius A. The contribution of lifestyle factors to socioeconomic differences in obesity in men and women — a population-based study in Sweden. Eur J Epidemiol 2003;18:227—34.

11.

Jonsson S. , Hedblad B. , Engström G. , Nilsson P. , Berglund G. , Janzon L. Influence of obesity on cardiovascular risk. Twenty-three-year follow-up of 22,025 men from an urban Swedish population . Int J Obes Relat Metab Disord 2002;26:1046—53.

12.

Rosengren A. , Wilhelmsen L. , Lappas G. , Johansson S. Body Mass index, coronary heart disease and stroke in Swedish women. A prospective 19-year follow-up in the BEDA study . Eur J Card 2003 ;10:443—50.

13.

Östergren CJ , Lindblad U. , Bog-Hansen E. , Ranstam J. , Melander A. , Råstam L. Differences in treatment and metabolic abnormalities between normo- and hypertensive patients with type 2 diabetes: The Skaraborg Hypertension and Diabetes Project. Diabetes, Obes and Metab 1999;1:105—12.

14.

Råstam L. , Berglund G. , Isacsson SOL The Skaraborg Hypertension Project III. Feasibility of a medical care program for hypertension. Acta Med Scand 1986;286: 261—9.

15.

World Health Organization. Obesity-prevention and managing the global epidemic. Report of a WHO consultation on obesity. Geneva, 3—5 June 1997 . Geneva: WHO/ NUT/NCD Publication 98.1; 1998.

16.

Groop L. , Orho-Melander M. The dysmetabolic syndrome. J Intern Med 2001 ;250:105—20.

17.

Råstam L. , Sjönell G. A new device for measuring blood pressure in adults. Lancet 1991;337:249—50.

18.

Andersen L. , Dinesen B. , Jorgensen PN , Roder ME Enzyme immunoassay for intact human insulin in serum or plasma. Clin Chem 1993;38:578—82.

19.

Haffner SM , Miettinen H. , Stern MP The homeostatis model in San Antonio Heart Study. Diabetes Care 1997;20:1087—92.

20.

Salonen JT , Puskaa P. , Tuomilehto J. Physical activity and risk of myocardial infarction, cerebral stroke and death. Am J Epidemiol 1982;115:526—37.

21.

Haglund BJA Geographical and socioeconomic distribution of physical activity at work and leisure time and its relation to morbidity in a Swedish rural county. Scand J Soc Med 1984;12:155—64.

22.

Grimby G. , Wilhelmsen L. , Björntorp P. , Saltin B. , Tibblin G. Habitual physical activity. In: Saltin B , editor. Muscle metabolism during exercise. New York : Plenum Press; 1971:469—81.

23.

Norius MJ SPSS Inc. SPSS for Windows Base. System User's Guide. Release 6. Chicago, IL: SPSS Inc; 1993.

24.

Persson LÅ , Wall S. Epidemiology for public health. Print & Media [Umeå, Sweden], 2003:98—103.

25.

Fang J. , Wylie-Rosett J. , Cohen HW , Kaplan RC , Alderman MH Exercise, body mass index, caloric intake, and cardiovascular mortality . Am J Prev Med 2003; 25:283—9.

26.

Schuit AJ , van Loon AJ , Tijhuis M. , Ocke M. Clustering of lifestyle risk factors in a general adult population. Prev Med 2002;35:219—24.

27.

Kannel WB , Wilson PW , Nam BH , D'Agostino RB Risk stratification of obesity as a coronary risk factor. Am J Cardiol 2002;90:697—701.

28.

Seidell JC , Verschuren WM , van Leer EM , Kromhout D. Overweight, underweight and mortality. Arch Intern Med 1996;156:958—63.

29.

Lahman PH , Lissner L. , Gullberg B. , Berglund G. A prospective study of adiposity and all-cause mortality: the Malmö Diet and Cancer study . Obes Res 2002;10:361—9.

30.

Nilsson PM , Nilsson JÅ , Hedblad B. , Berglund G. , Lingärde F. The enigma of increased non-cancer mortality after weight loss in healthy men who are overweight or obese. J Intern Med 2002;252:70—8.

31.

Wardle J. , Waller J. , Jarvis MJ Sex differences in the association of socioeconomic status with obesity. Am J Public Health 2002 ;92:1299—1304.

32.

Wamala SP , Lynch J. , Horsten M. , Mittelman MA , Schenck-Gustafsson K. , Orth-Gomer K. Education and the metabolic syndrome in women. Diabetes Care 1999;22:1999—2003.

33.

Montoye H. , Kemper HCG , Saris WHM , Washburn RA Measuring physical activity and energy expenditure. Illinois: Human Kinetics Publishers; 1996: 42—71.

34.

Tayback M. , Kumanyika S. Chee E Body weight as a risk factor in the elderly. Arch Intern Med 1990;150:1065—72.

35.

Heiat A. , Vaccarino V. , Krumholz HM An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons. Arch Intern Med 2001;161:1194—1203.