General characteristics of the derivation and validation population.

<p>Data are means (SD) or percentages. Bl  =  Baseline.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0067429#pone-0067429-t003" target="_blank">Table 3</a>. Combined estimates of relative risk for the association of retained predictors with substantial weight gain*.</p

Flow diagram of participants excluded from the present study.

<p>¹No follow-up questionnaire (e.g. due to death before follow-up body weight assessment, not yet approached for follow-up body weight assessment, emigration or non-response to invitation). ²Pregnant at baseline or follow-up. ³10% missing items on FFQ. ⁴Ratio of energy intake (EI) to energy expenditure (EE) estimated from predicted resting energy expenditure. ⁵Missing data on baseline or follow-up weight, waist or height, missing follow-up time. ⁶Baseline height<130 cm, BMI<16 kg/m², 0160 cm, follow-up weight>700 kg. Combination of waist<60 cm and BMI>25 kg/m². ⁷Annual weight change>5 kg (either direction) or annual waist change>7 cm (either direction). ⁸ Baseline cancer, diabetes or cardiovascular disease.⁹ In contrast to the derivation of the model where it is important to obtain unbiased estimates of relative risk, we think only original data should be used in the validation sample and we therefore excluded individuals with missing values.</p

Calibration plot showing observed proportion of cases across tenths of predicted risk in the a) derivation sample and b) validation sample.

<p>Corresponding range of points for tenths in the derivation sample were <145, 145–<165, 165–<181, 181–<194, 194–<206, 206–<218, 218–<231, 231–<246, 246–<267, and ≥267. P for calibration  = 0.02. Corresponding range of points for tenths in the validation sample <162, 162–<185, 185–<200, 200–<212, 212–<223, 223–<234, 234–<246, 246–<259, 259–<280, and ≥280. P for calibration  = <001.</p

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

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

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

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

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

Baseline characteristics of the random sub-cohort participants in the InterAct study.

<p>Family history of diabetes was not ascertained in Italy, Spain, Heidelberg (Germany), and Oxford (UK) (excluded from these summaries): 7,226/5,719. WC and waist–hip ratio were not measured in Umeå (Sweden) (excluded from these summaries): 1,050/1,007. Weight at age 20 y was not ascertained in France, Spain, Florence (Italy), Ragusa (Italy), Turin (Italy), Netherlands, Heidelberg (Germany), and Umeå (Sweden) (excluded from these summaries): 9,462/7,692. Data from Denmark (<i>n = </i>2,164) are excluded from this table.</p