Obesity but not overweight is associated with increased mortality risk

The association between body mass index (BMI) and survival has been described in various populations. However, the results remain controversial and information from low-prevalence Western countries is sparse. Our aim was to examine this association and its public health impact in Switzerland, a country with internationally low mortality rate and obesity prevalence. We included 9,853 men and women aged 25-74years who participated in the Swiss MONICA (MONItoring of trends and determinants in CArdiovscular disease) study (1983-1992) and could be followed up for survival until 2008 by using anonymous record linkage. Cox regression models were used to calculate mortality hazard ratios (HRs) and to estimate excess deaths. Independent variables were age, sex, survey wave, diet, physical activity, smoking, educational class. After adjustment for age and sex the association between BMI and all-cause mortality was J shaped (non-smokers) or U shaped (smokers). Compared to BMI 18.5-24.9, among those with BMI≥30 (obesity) HR for all-cause mortality was 1.41 (95% confidence interval: 1.23-1.62), for cardiovascular disease (CVD) 2.05 (1.60-2.62), for cancer 1.29 (1.04-1.60). Further adjustment attenuated the obesity-mortality relationship but the associations remained statistically significant. No significant increase was found for overweight (BMI 25-29.9). Between 4 and 6.5% of all deaths, 8.8-13.7% of CVD deaths and 2.4-3.9% of cancer deaths could be attributed to obesity. Obesity, but not overweight was associated with excess mortality, mainly because of an increased risk of death from CVD and cancer. Public health interventions should focus on preventing normal- and overweight persons from becoming obes

Italianity is associated with lower risk of prostate cancer mortality in Switzerland

Purpose: Different prostate cancer mortality rates observed in European countries may depend on cultural background. We aimed at exploring variation in prostate cancer mortality in the language regions of Switzerland as a function of "Italianity”, a proxy for adherence to an Italian lifestyle. Methods: We used data of the Swiss National Cohort, a census-based record linkage study, consisting of census (1990 and 2000) and mortality (until 2008) data. 1,163,271 Swiss and Italian nationals 40+-year old were included. Multivariate age-standardized prostate cancer mortality rates and hazard ratios (HR) from Cox proportional hazards regression analysis were performed. Italianity was defined by an individual's nationality, place of birth and principal language, resulting in a score of 0-3 points. Results: Age-standardized prostate cancer mortality rates (per 100,000 person-years) were lowest in the Italian-speaking region of Switzerland (66.7 vs. 87.3 in the German-speaking region). Both Italian nationality and/or place of birth were significantly associated with lower mortality. There was a graded inverse association between mortality rates and increasing Italianity score. Individuals with the highest level of Italianity had a HR of 0.67 (95% CI 0.59-0.76) compared to those with an Italianity score of zero. Results were similar when looking at language regions separately. Conclusions: The strong and consistent association between Italianity and prostate cancer mortality suggests protective properties of an Italian lifestyle. Further research is required in order to determine which factors specific for Italian culture are responsible for the lower prostate cancer mortality

Public health significance of four cardiovascular risk factors assessed 25 years ago in a low prevalence country

Background: The individual and combined effect of cardiovascular disease (CVD) risk factors (RFs) on CVD mortality varies between populations. Our aim was to examine this association and its public health impact in Switzerland, a country with comparably low CVD mortality. Methods: We included 9853 men and women aged 25-74 years who participated in the Swiss MONICA (MONItoring of trends and determinants in CArdiovscular disease) study (1983-1992) and were followed up for survival until 2008. Adjusted Cox regression was used to calculate CVD mortality hazard ratios (HR). CVD-RFs were obesity (body mass index ≥30 kg/m(2)), smoking (≥1 cig/d), high blood pressure (≥140 or ≥90 mmHg), and total: high-density lipoprotein cholesterol ratio (≥5.0). Besides age and sex, models were adjusted for diet, physical activity, educational class, marital status, and the respective other CVD-RFs. Results: After adjustment for age and sex, the HR of CVD death was for obesity 1.86 (95% CI 1.50-2.31), for smoking 1.63 (95% CI 1.32-2.01), for high blood pressure 1.42 (95% CI 1.16-1.73), and for high cholesterol ratio 1.30 (95% CI 1.06-1.60). Adjustment for other covariates moderately attenuated estimates. CVD-RFs had an independent and synergistic effect and accounted for 43.0% of population attributable risk. The presence of all four compared to zero CVD-RFs was associated with a 9.6 years shorter expected survival for a man aged 50. Conclusions: Most CVD deaths could be avoided by prevention of four traditional CVD-RFs. Reduction of smoking prevalence and avoidance of weight gain in the population are the most effective measures. Particular attention should be dedicated to persons with multiple CVD-RFs

Obesity but not overweight is associated with increased mortality risk

The association between body mass index (BMI) and survival has been described in various populations. However, the results remain controversial and information from low-prevalence Western countries is sparse. Our aim was to examine this association and its public health impact in Switzerland, a country with internationally low mortality rate and obesity prevalence. We included 9,853 men and women aged 25-74 years who participated in the Swiss MONICA (MONItoring of trends and determinants in CArdiovscular disease) study (1983-1992) and could be followed up for survival until 2008 by using anonymous record linkage. Cox regression models were used to calculate mortality hazard ratios (HRs) and to estimate excess deaths. Independent variables were age, sex, survey wave, diet, physical activity, smoking, educational class. After adjustment for age and sex the association between BMI and all-cause mortality was J shaped (non-smokers) or U shaped (smokers). Compared to BMI 18.5-24.9, among those with BMI ≥ 30 (obesity) HR for all-cause mortality was 1.41 (95% confidence interval: 1.23-1.62), for cardiovascular disease (CVD) 2.05 (1.60-2.62), for cancer 1.29 (1.04-1.60). Further adjustment attenuated the obesity-mortality relationship but the associations remained statistically significant. No significant increase was found for overweight (BMI 25-29.9). Between 4 and 6.5% of all deaths, 8.8-13.7% of CVD deaths and 2.4-3.9% of cancer deaths could be attributed to obesity. Obesity, but not overweight was associated with excess mortality, mainly because of an increased risk of death from CVD and cancer. Public health interventions should focus on preventing normal- and overweight persons from becoming obese