Impact of body size and physical activity during adolescence and adult life on overall and cause-specific mortality in a large cohort study from Iran

Abstract

Background We conducted this study to examine life-course body size and physical activity, in relation to total and cause-specific mortality, which have not been studied in the low and middle-income countries in Asia. Methods The Golestan Cohort Study is a population-based cohort in northeastern Iran in which 50,045 people above the age of 40 have been followed since 2004. Participants were shown a validated pictogram to assess body size at ages 15, 30, and the time of recruitment. Information on occupational physical activity at these ages was also collected. Subjects were followed up annually, and cause of death was determined. Cox regression models were adjusted for age at cohort start, smoking, socioeconomic status, ethnicity, place of residence, education, and opium use. Models for body size were also adjusted for physical activity at the same age, and vice-versa. Results During a total of 252,740 person-years of follow-up (mean follow-up duration 5.1±1.3 years) through December 2011, 2,529 of the cohort participants died. Larger body sizes at ages 15 or 30 in both sexes were associated with increased overall mortality. Cancer mortality was more strongly associated with adolescent obesity, and cardiovascular mortality with early adulthood body size. Weight gain between these ages was associated with cardiovascular mortality. Obese adolescents who lost weight still had increased mortality from all medical causes in both sexes. Physical activity during adolescence and early adulthood had no association with mortality, but at cohort baseline higher levels of activity were associated with reduced mortality. Conclusion Mortality in this Middle-Eastern population was associated with obesity both during adolescence and early adult life.

Adolescent Exercise in Association with Mortality from All Causes, Cardiovascular Disease, and Cancer among Middle-Aged and Older Chinese Women

“…This review also noted the lack of data on adolescent physical activity and adult morbidity and mortality overall, and specifically for non-Western populations. We identified only one cohort study of physical activity in adolescence and adult mortality (22). However, this study was limited to information on job-related activity, and did not have information on exercise participation in adolescence, which is more likely to be modifiable.…”

A Review on the Role of Physical Activity in Cancer Prevention: Middle East Reports

“…Adolescent obesity is more associated with cancer mortality, while early adulthood obesity is accompanied by cardiovascular mortality (10). In fact, obesity, sedentary lifestyle and two problem regarding diet (first one: the increasing trend toward fast food consumption can lead to its worldwide harmful effects, and the second one: poor quality fast food because of government inability to efficiently control on dietary material production) are the most serious etiologies of cancer surge in the Middle East region (3,11,12).…”

“…However, there is no consensus on the effects of other types of activity on morbidity and mortality in adults, especially in developing countries. Some researchers believe PA has long-term effects on morbidity, others state that this role decreases after the 4th decade (10). Eventually the most important point is that since a large proportion of people in developing countries have sedentary lifestyle, even a small risk may be associated with high attributable fraction.…”

“…The common specific causes of death were: cardiovascular disease (52%), consisted of mainly ischemic heart disease (IHD) and cerebrovascular accident (CVA), followed by cancer (21.5%) including stomach, breast and esophagus cancer as the most common sites for cancer in the country. The most fatal cancer types in Iran are stomach, esophagus, breast and lung (10). In Iran the incidence rates for esophageal and stomach cancer are much higher than the world average.…”

“…On the other hand, rate of lung, breast and cervix cancers is lower than the world rates (27). According to a 5-year cohort study which began in 2004 on more than 50,000 adult persons, 38% of all types of cancer in Iran are in gastro-intestinal system, while in the US this proportion is less than 20% (10) and about 19% in Jordan and Egypt (26).…”