Send to

Choose Destination
Am J Clin Nutr. 2015 Mar;101(3):613-21. doi: 10.3945/ajcn.114.100065. Epub 2015 Jan 14.

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 information

From the Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, United Kingdom (UE, JL, SJS, SB, and NJW); the Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway (UE); Imperial College, London, United Kingdom (HAW, TN, PV, HBB-d-M, and ER; University Medical Centre Utrecht, Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands (AMM, PHP, and EM); the Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway (EW); the Department of Research, Cancer Registry of Norway, Oslo, Norway (EW); the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (EW); Samfundet Folkhälsan, Helsinki, Finland (EW); the Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO and JNØ); the Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark (KO and JNØ); Danish Cancer Society, Copenhagen, Denmark (A Tjønneland and NFJ); Inserm, Centre for Research in Epidemiology and Population Health, Nutrition, Hormones and Women's Health team, Villejuif, France (SM, AF, and GF); the Univeristy of Paris Sud, UMRS 1018, Villejuif, France (SM, AF, and GF); IGR, Villejuif, France (SM, AF, and GF); WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (A Trichopoulou and PL); Hellenic Health Foundation, Athens Greece (A Trichopoulou and DT); the Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL and DT); the Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL and DT); the Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany (KL and RK); International Agency for Research on Cancer (IARC), Lyon, France (PF, IL, and MJ); the Department of Epidemiology, Deutsches Institut fü



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.


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.


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. Center-specific 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.


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.


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.


cohort study; epidemiology; exercise; mortality; obesity; physical activity; population attributable fraction

[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center