Combined Impact of Lifestyle Factors on Prospective Change in Body Weight and Waist Circumference in Participants of the EPIC-PANACEA Study

<div><h3>Background</h3><p>The evidence that individual dietary and lifestyle factors influence a person’s weight and waist circumference is well established; however their combined impact is less well documented. Therefore, we investigated the combined effect of physical activity, nutrition and smoking status on prospective gain in body weight and waist circumference.</p> <h3>Methods</h3><p>We used data of the prospective EPIC-PANACEA study. Between 1992 and 2000, 325,537 participants (94,445 men and 231,092 women, aged between 25–70) were recruited from nine European countries. Participants were categorised into two groups (positive or negative health behaviours) for each of the following being physically active, adherent to a healthy (Mediterranean not including alcohol) diet, and never-smoking for a total score ranging from zero to three. Anthropometric measures were taken at baseline and were mainly self-reported after a medium follow-up time of 5 years.</p> <h3>Results</h3><p>Mixed-effects linear regression models adjusted for age, educational level, alcohol consumption, baseline body mass index and follow-up time showed that men and women who reported to be physically active, never-smoking and adherent to the Mediterranean diet gained over a 5-year period 537 (95% CI −706, −368) and 200 (−478, −87) gram less weight and 0.95 (−1.27, −0.639) and 0.99 (−1.29, −0.69) cm less waist circumference, respectively, compared to participants with zero healthy behaviours.</p> <h3>Conclusion</h3><p>The combination of positive health behaviours was associated with significantly lower weight and waist circumference gain.</p> </div

Independent association between individual health behaviours and weight change (kg/5 y) and waist circumference change (cm/5 y) in EPIC-PANACEA participants.

<p> <i>Abbreviations: CI – confidence interval, mMDS – modified Mediterranean Diet Score,</i></p>1<p>Linear mixed models adjusted for age, total energy intake, baseline body mass index, education, alcohol intake and follow-up time (men: n = 94,445; women n = 231,092). Individual health behaviours are also adjusted for each other.</p>2<p>Linear mixed models adjusted for age, total energy intake, baseline body mass index, baseline waist circumference, education, alcohol intake and follow-up time (men: n = 37,245; women n = 51,727). Individual health behaviours are also adjusted for each other.</p

Sensitivity analyses: Association between the health behaviour score and weight change (kg/5 y) and waist circumference change (cm/5 y) excluding EPIC-PANACEA participants who quit smoking during follow-up^1.

1<p>Information about smoking status at follow-up was available for 288,167 participants (81,227 men and 206,940 women).</p>2<p>Linear mixed models adjusted for age, total energy intake, baseline body mass index, education, alcohol intake and follow-up time (men: n = 81,227; women n = 206,940).</p>3<p>Linear mixed models adjusted for age, total energy intake, baseline body mass index, baseline waist circumference, education, alcohol intake and follow-up time (men: n = 36,949; women n = 51,221).</p

Characteristics of the population stratified according to sex and the health behaviour score (n = 325,537)¹.

<p> <i>Abbreviation: WC – waist circumference, mMDS – modified Mediterranean diet score.</i></p>1<p>Means (standard deviation) are presented for continuous variables and percentages are presented for categorical variables.</p>2<p>Uncorrected 5-y change means that self-reported weight or waist circumference at either baseline or follow-up (for individuals with no measured weight available) was used to calculate weight change.</p>3<p>Corrected 5-y change means that the “Oxford correction equations” <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050712#pone.0050712-Spencer1" target="_blank">[33]</a> were applied to individuals with self-reported weight at either baseline or follow-up to predict their likely measured weight, and to calculate weight change.</p>4<p>Waist circumference is available for a subsample of 37,245 men and 51,727 women.</p>5<p>Physically active is defined as a Cambridge Physical Activity Index <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050712#pone.0050712-Wareham1" target="_blank">[51]</a> of >1, i.e., not being inactive that is if a person has a sedentary occupation and perform at least half an hour of leisure time activity a day, such as cycling or swimming; or else a non-sedentary occupation with or without leisure time activity.</p>6<p>High mMDS includes person with a mMDS score above the median.</p>7<p>Highly educated is defined as a longer education than secondary school (including an university degree).</p

Subgroup analysis stratified baseline body mass index for the association between the health behaviour score and weight change (kg/5 y) and waist circumference change in EPIC-PANACEA participants.

<p><i>Abbreviations: CI – confidence interval, BMI – body mass index, WC – waist circumference</i>.</p>1<p>Linear mixed models adjusted for age, total energy intake, baseline body mass index, education, alcohol intake and follow-up time.</p>2<p>Linear mixed models adjusted for age, total energy intake, baseline body mass index, baseline waist circumference, education, alcohol intake and follow-up time.</p

Association between the health behaviour score and weight change (kg/5 y) and waist circumference change (cm/5 y) in EPIC-PANACEA participants.

1<p>Linear mixed models adjusted for age, total energy intake, baseline body mass index, education, alcohol intake and follow-up time (men: n = 94,445; women n = 231,092).</p>2<p>Linear mixed models adjusted for age, total energy intake, baseline body mass index, baseline waist circumference, education, alcohol intake and follow-up time (men: n = 37,245; women n = 51,727).</p

Results for associations of circulating n-3 and n-6 PUFAs and fatty acid ratios with incidence of T2D: EPIC-InterAct study and comparative meta-analysis of the published prospective studies^*.

<p>Results for associations of circulating n-3 and n-6 PUFAs and fatty acid ratios with incidence of T2D: EPIC-InterAct study and comparative meta-analysis of the published prospective studies^{<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002094#t002fn001" target="_blank">*</a>}.</p

The distribution of sociodemographic and dietary factors at baseline by future case and noncase status: EPIC-InterAct study.

<p>The distribution of sociodemographic and dietary factors at baseline by future case and noncase status: EPIC-InterAct study.</p

HRs of T2D and 95% CIs per 1 SD increase in total and individual n-6 PUFAs (LA, GLA, EDA, DGLA, AA, DTA, and n-6 DPA): EPIC-InterAct study.

<p>Model 1: displayed as diamonds. Age as underlying time variable, and adjusted for centre, sex, physical activity (inactive, moderately inactive, moderately active, or active), smoking (never, former, or current), education level (none, primary school, technical or professional school, secondary school, or higher education), and BMI (continuous, kg/m²). Model 2: displayed as circles. Adjusted as in Model 1 + total energy intake (continuous, kcal/d), alcohol (none, >0–<6, 6–<12, 12–<24 and ≥24 g/d), and (continuous, g/d intake of) meat, fruit and vegetables, dairy products, and soft drinks. Model 3: Displayed as squares. Adjusted as in Model 2 + (continuous, g/d intake of) fish and shellfish, nuts and seeds, vegetable oil, olive oil, and margarine.</p

Schematic showing the names of individual n-3 and n-6 PUFAs measured in EPIC-InterAct, their biosynthesis pathways, and major dietary sources.

<p>Schematic showing the names of individual n-3 and n-6 PUFAs measured in EPIC-InterAct, their biosynthesis pathways, and major dietary sources.</p