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Association between class III obesity (BMI of 40-59 kg/m2) and mortality: a pooled analysis of 20 prospective studies.
PLoS Med. 2014 Jul;11(7):e1001673
Publication Type
Cari M Kitahara
Alan J Flint
Amy Berrington de Gonzalez
Leslie Bernstein
Michelle Brotzman
Robert J MacInnis
Steven C Moore
Kim Robien
Philip S Rosenberg
Pramil N Singh
Elisabete Weiderpass
Hans Olov Adami
Hoda Anton-Culver
Rachel Ballard-Barbash
Julie E Buring
D Michal Freedman
Gary E Fraser
Laura E Beane Freeman
Susan M Gapstur
John Michael Gaziano
Graham G Giles
Niclas Håkansson
Jane A Hoppin
Frank B Hu
Karen Koenig
Martha S Linet
Yikyung Park
Alpa V Patel
Mark P Purdue
Catherine Schairer
Howard D Sesso
Kala Visvanathan
Emily White
Alicja Wolk
Anne Zeleniuch-Jacquotte
Patricia Hartge
PLoS Med. 2014 Jul;11(7):e1001673
Publication Type
Australia - epidemiology
Body mass index
Life expectancy
Obesity - mortality
Prospective Studies
Risk factors
Sweden - epidemiology
United States - epidemiology
The prevalence of class III obesity (body mass index [BMI]=40 kg/m2) has increased dramatically in several countries and currently affects 6% of adults in the US, with uncertain impact on the risks of illness and death. Using data from a large pooled study, we evaluated the risk of death, overall and due to a wide range of causes, and years of life expectancy lost associated with class III obesity.
In a pooled analysis of 20 prospective studies from the United States, Sweden, and Australia, we estimated sex- and age-adjusted total and cause-specific mortality rates (deaths per 100,000 persons per year) and multivariable-adjusted hazard ratios for adults, aged 19-83 y at baseline, classified as obese class III (BMI 40.0-59.9 kg/m2) compared with those classified as normal weight (BMI 18.5-24.9 kg/m2). Participants reporting ever smoking cigarettes or a history of chronic disease (heart disease, cancer, stroke, or emphysema) on baseline questionnaires were excluded. Among 9,564 class III obesity participants, mortality rates were 856.0 in men and 663.0 in women during the study period (1976-2009). Among 304,011 normal-weight participants, rates were 346.7 and 280.5 in men and women, respectively. Deaths from heart disease contributed largely to the excess rates in the class III obesity group (rate differences?=?238.9 and 132.8 in men and women, respectively), followed by deaths from cancer (rate differences?=?36.7 and 62.3 in men and women, respectively) and diabetes (rate differences?=?51.2 and 29.2 in men and women, respectively). Within the class III obesity range, multivariable-adjusted hazard ratios for total deaths and deaths due to heart disease, cancer, diabetes, nephritis/nephrotic syndrome/nephrosis, chronic lower respiratory disease, and influenza/pneumonia increased with increasing BMI. Compared with normal-weight BMI, a BMI of 40-44.9, 45-49.9, 50-54.9, and 55-59.9 kg/m2 was associated with an estimated 6.5 (95% CI: 5.7-7.3), 8.9 (95% CI: 7.4-10.4), 9.8 (95% CI: 7.4-12.2), and 13.7 (95% CI: 10.5-16.9) y of life lost. A limitation was that BMI was mainly ascertained by self-report.
Class III obesity is associated with substantially elevated rates of total mortality, with most of the excess deaths due to heart disease, cancer, and diabetes, and major reductions in life expectancy compared with normal weight. Please see later in the article for the Editors' Summary.
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PubMed ID
25003901 View in PubMed
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Blood levels of cadmium and lead in relation to breast cancer risk in three prospective cohorts.
Int J Cancer. 2019 03 01; 144(5):1010-1016
Publication Type
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Mia M Gaudet
Emily L Deubler
Rachel S Kelly
W Ryan Diver
Lauren R Teras
James M Hodge
Keith E Levine
Laura G Haines
Thomas Lundh
Per Lenner
Domenico Palli
Paolo Vineis
Ingvar A Bergdahl
Susan M Gapstur
Soterios A Kyrtopoulos
Author Affiliation
Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA.
Int J Cancer. 2019 03 01; 144(5):1010-1016
Publication Type
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Aged, 80 and over
Breast Neoplasms - blood - etiology
Cadmium - blood
Carcinogens - toxicity
Case-Control Studies
Environmental Exposure - adverse effects
Lead - blood
Middle Aged
Prospective Studies
Risk factors
Cadmium and lead have been classified as carcinogens by the International Agency for Research on Cancer. However, their associations with breast cancer risk are unknown despite their persistence in the environment and ubiquitous human exposure. We examined associations of circulating levels of cadmium and lead with breast cancer risk in three case-control studies nested within the Cancer Prevention Study-II (CPS-II) LifeLink Cohort, European Prospective Investigation into Cancer and Nutrition - Italy (EPIC-Italy) and the Northern Sweden Health and Disease Study (NSHDS) cohorts. Metal levels were measured in stored erythrocytes from 1,435 cases and 1,433 controls using inductively coupled plasma-mass spectrometry. Summary relative risks (RR) and 95% confidence intervals (CI) were calculated using random-effects models with each study result weighted by the within- and between-study variances. I2 values were calculated to estimate proportion of between study variation. Using common cut-points, cadmium levels were not associated with breast cancer risk in the CPS-II cohort (continuous RR = 1.01, 95% CI 0.76-1.34), but were inversely associated with risk in the EPIC- Italy (continuous RR = 0.80, 95% CI 0.61-1.03) and NSHDS cohorts (continuous RR = 0.73, 95% CI 0.54-0.97). The inverse association was also evident in the meta-analysis (continuous RR = 0.84, 95% CI 0.69-1.01) with low between-study heterogeneity. Large differences in lead level distributions precluded a meta-analysis of their association with breast cancer risk; no associations were found in the three studies. Adult cadmium and lead levels were not associated with higher risk of breast cancer in our large meta-analysis.
PubMed ID
30117163 View in PubMed
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