Abstract
Objective
Patients and Methods
Results
Conclusion
Abbreviations and Acronyms:
BF (body fat percentage), BMI (body mass index), CVD (cardiovascular disease), HR (hazard ratio), MET (metabolic equivalent), MVPA (moderate-to-vigorous physical activity), WC (waist circumference)- Lu Y.
- Hajifathalian K.
- et al.
Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1·8 million participants.
Methods
Data Source and Study Population
About UK Biobank.
Measurements
The IPAQ Group. Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire (IPAQ) – Short and Long Forms Contents. Biobank website, https://biobank.ctsu.ox.ac.uk/crystal/crystal/docs/ipaq_analysis.pdf. Accessed August 1, 2020.
Covariates
8 tips for healthy eating.
Outcome
Statistical Analyses
Results
PA quintile n Median | Women (n=152,563) | Men (n=143,354) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Q1 30,394 384 | Q2 30,556 1010 | Q3 30,539 1779 | Q4 30,537 2994 | Q5 30,537 5799 | Q1 28, 628 347 | Q2 28,625 1032 | Q3 28,708 1866 | Q4 28,719 3192 | Q5 28,674 6524 | |
Age, years, mean ± SD | 55.8 ± 7.9 | 55.8 ± 8.0 | 55.8 ± 8.0 | 55.8 ± 8.1 | 55.9 ± 8.0 | 56.2 ± 8.1 | 56.2 ± 8.1 | 56.3 ± 8.2 | 56.32 ± 8.2 | 56.3 ± 8.2 |
Adiposity-related variables | ||||||||||
BMI, kg/m2, mean ± SD | 28.1 ± 5.6 | 26.9 ± 4.9 | 26.5 ± 4.7 | 26.2 ± 4.5 | 26.05 ± 4.4 | 28.5 ± 4.5 | 27.7 ± 4.0 | 27.4 ± 3.8 | 27.3 ± 3.8 | 27.3 ± 3.8 |
BMI categories, kg/m2 | ||||||||||
18.5-24.9 | 33 | 41 | 44 | 46 | 48 | 21 | 26 | 28 | 29 | 28 |
25-29.9 | 37 | 37 | 37 | 37 | 36 | 48 | 51 | 52 | 51 | 52 |
30-34.9 | 19 | 15 | 13 | 12 | 12 | 23 | 18 | 17 | 17 | 17 |
≥35 | 11 | 7 | 6 | 5 | 4 | 8 | 5 | 4 | 4 | 4 |
WC, cm, mean ± SD | 86.9 ± 13.1 | 84.2 ± 11.9 | 83.1 ± 11.5 | 82.3 ± 11.2 | 81.8 ± 11.2 | 99.4 ± 11.8 | 96.8 ± 10.8 | 95.5 ± 10.3 | 94.8 ± 10.3 | 94.5 ± 10.3 |
WC categories | ||||||||||
<88 cm W, <102 cm M | 57 | 66 | 69 | 72 | 73 | 62 | 71 | 75 | 77 | 78 |
≥88 cm W, ≥102 cm M | 43 | 34 | 31 | 28 | 27 | 38 | 29 | 25 | 23 | 22 |
BF | 38.1 ± 6.7 | 36.5 ± 6.6 | 35.8 ± 6.5 | 35.2 ± 6.6 | 34.8 ± 6.7 | 26.4 ± 5.7 | 25.2 ± 5.5 | 24.5 ± 5.5 | 24.1 ± 5.6 | 23.9 ± 5.6 |
BF categories | ||||||||||
Low | 31.39 | 39.98 | 44.12 | 47.43 | 50.00 | 18.43 | 24.32 | 28.12 | 31.03 | 32.30 |
Medium-low | 38.22 | 38.03 | 37.35 | 36.30 | 34.83 | 49.13 | 51.37 | 51.28 | 49.99 | 49.72 |
Medium-high | 18.96 | 1524 | 12.82 | 11.66 | 10.98 | 23.77 | 19.03 | 16.73 | 15.32 | 14.92 |
High | 11.44 | 6.76 | 5.71 | 4.61 | 4.19 | 8.67 | 5.28 | 3.87 | 3.66 | 3.06 |
Sociodemographic variables | ||||||||||
Ethnicity | ||||||||||
White | 95 | 95 | 96 | 96 | 95 | 95 | 96 | 96 | 96 | 96 |
Asian | 2 | 2 | 2 | 2 | 2 | 3 | 2 | 2 | 2 | 2 |
Black | 2 | 2 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Others / Mixed background | 1 | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 1 |
Townsend deprivation index, mean ± SD | -1.6 ± 2.9 | -1.6 ± 2.9 | -1.6 ± 2.9 | -1.6 ± 2.9 | -1.5 ± 2.9 | -1.6 ± 3.0 | -1.7 ± 3.0 | -1.7 ± 2.9 | -1.6 ± 2.9 | -1.3 ± 3.0 |
Education | ||||||||||
No qualifications | 12 | 10 | 11 | 12 | 15 | 10 | 9 | 9 | 12 | 19 |
Not college/university degree | 52 | 50 | 50 | 51 | 55 | 48 | 45 | 46 | 49 | 56 |
University degree | 36 | 40 | 39 | 37 | 30 | 42 | 46 | 45 | 39 | 25 |
Marital status, living with partner | 71 | 71 | 72 | 71 | 71 | 80 | 80 | 80 | 80 | 80 |
Currently employed | 65 | 63 | 61 | 58 | 58 | 71 | 68 | 66 | 64 | 67 |
Lifestyle covariates c Dietary pattern is based on meeting at least two of three healthy eating targets related to food types: 1) ≤3 weekly servings of red meat and ≤1 servings/week of processed meat; 2) ≥2 servings per week of fish including at least one with oily fish; and 3) ≥5 servings per day of fruits and vegetables. | ||||||||||
Diet pattern, meeting 2 targets | 70 | 76 | 79 | 81 | 81 | 52 | 60 | 63 | 66 | 64 |
Salt intake | ||||||||||
Never/rarely | 56 | 58 | 59 | 60 | 59 | 54 | 56 | 57 | 56 | 55 |
Sometimes | 28 | 28 | 27 | 27 | 27 | 28 | 28 | 28 | 28 | 28 |
Usually | 11 | 10 | 10 | 10 | 10 | 13 | 12 | 12 | 12 | 13 |
Always | 5 | 4 | 4 | 3 | 4 | 5 | 4 | 3 | 4 | 4 |
Alcohol intake | ||||||||||
Never | 5 | 5 | 4 | 4 | 5 | 3 | 2 | 2 | 2 | 2 |
Previous | 3 | 2 | 3 | 3 | 3 | 3 | 2 | 2 | 2 | 3 |
Current, <3 times/week | 55 | 52 | 51 | 52 | 54 | 42 | 39 | 38 | 40 | 44 |
Current, ≥3 times/week | 37 | 41 | 42 | 41 | 38 | 52 | 57 | 58 | 56 | 51 |
Smoking status | ||||||||||
Never | 61 | 62 | 61 | 61 | 61 | 52 | 54 | 54 | 53 | 49 |
Previous | 30 | 31 | 32 | 32 | 31 | 36 | 36 | 36 | 37 | 38 |
Current | 9 | 7 | 7 | 7 | 8 | 12 | 10 | 10 | 10 | 13 |
Screen time, h/day | ||||||||||
<2 | 12 | 14 | 15 | 15 | 15 | 8 | 10 | 11 | 10 | 10 |
2-3 | 19 | 21 | 21 | 22 | 22 | 15 | 17 | 18 | 17 | 18 |
3-4 | 22 | 23 | 24 | 23 | 24 | 20 | 22 | 22 | 23 | 24 |
4-5 | 19 | 18 | 18 | 18 | 18 | 19 | 19 | 19 | 20 | 21 |
>5 | 28 | 23 | 22 | 22 | 21 | 38 | 32 | 30 | 30 | 27 |
Health-related covariates | ||||||||||
Diagnosed asthma | 13 | 11 | 12 | 11 | 11 | 12 | 10 | 11 | 10 | 10 |
History of depression | 8 | 6 | 6 | 5 | 6 | 5 | 4 | 3 | 3 | 3 |
Taking HRT, women | 8 | 7 | 7 | 7 | 8 | NA | NA | NA | NA | NA |
Diabetes | 4 | 3 | 3 | 3 | 3 | 9 | 6 | 5 | 5 | 5 |
Hypertension | 48 | 45 | 44 | 44 | 44 | 61 | 59 | 58 | 59 | 60 |
Taking statins medication | 10 | 8 | 8 | 8 | 7 | 18 | 16 | 15 | 14 | 12 |
Hazard ratios (95% CI) | |||
---|---|---|---|
Model 1 | Model 1a | Model 3a | |
PA quintiles | |||
Q1 (less active) | 1 (reference) | 1 (reference) | 1 (reference) |
Q2 | 0.82 (0.77 to 0.89) | 0.85 (0.79 to 0.92) | 0.89 (0.82 to 0.95) |
Q3 | 0.80 (0.74 to 0.86) | 0.84 (0.78 to 0.91) | 0.88 (0.81 to 0.95) |
Q4 | 0.83 (0.77 to 0.89) | 0.87 (0.81 to 0.94) | 0.89 (0.83 to 0.96) |
Q5 (most active) | 0.80 (0.75 to 0.86) | 0.85 (0.79 to 0.92) | 0.84 (0.78 to 0.91) |
BMI, kg/m2 | |||
18.5-24.9 | 1 (reference) | 1 (reference) | 1 (reference) |
25-29.9 | 1.01 (0.96 to 1.08) | 1.01 (0.95 to 1.07) | 0.96 (0.91 to 1.02) |
30-34.9 | 1.28 (1.19 to 1.37) | 1.26 (1.17 to 1.35) | 1.10 (1.02 to 1.19) |
≥35 | 1.78 (1.62 to 1.95) | 1.72 (1.56 to 1.89) | 1.34 (1.21 to 1.49) |
Waist circumference, cm | |||
<88 Women, <102 men | 1 (reference) | 1 (reference) | 1 (reference) |
≥88 Women, ≥102 men | 1.41 (1.34 to 1.48) | 1.38 (1.31 to 1.45) | 1.21 (1.14 to 1.27) |
BF | |||
Low | 1 (reference) | 1 (reference) | 1 (reference) |
Medium-low | 1.05 (0.99 to 1.11) | 1.04 (0.98 to 1.11) | 0.99 (0.93 to 1.05) |
Medium-high | 1.32 (1.23 to 1.42) | 1.29 (1.20 to 1.39) | 1.13 (1.05 to 1.22) |
High | 1.71 (1.56 to 1.88) | 1.66 (1.51 to 1.82) | 1.30 (1.18 to 1.44) |

Q1 (least active) | Q2 | Q3 | Q4 | Q5 (most active) | |
---|---|---|---|---|---|
BMI, kg/m2 | |||||
18.5-24.9 | |||||
Model 3 | 1 (reference) | 0.93 (0.81 to 1.08) | 0.85 (0.73 to 0.99) | 0.87 (0.75 to 1.00) | 0.81 (0.70 to 0.93) |
Total n/n deaths | 16,205/342 | 19,863/378 | 21,314/368 | 22,415/399 | 22,573/401 |
25-29.9 | |||||
Model 3 | 1 (reference) | 0.87 (0.77 to 0.97) | 0.96 (0.85 to 1.07) | 0.94 (0.84 to 1.06) | 0.85 (0.76 to 0.96) |
Total n/n deaths | 24,921/614 | 25,960/547 | 26,197/600 | 25,852/602 | 25,709/561 |
30-34.9 | |||||
Model 3 | 1 (reference) | 0.82 (0.70 to 0.97) | 0.73 (0.61 to 0.86) | 0.80 (0.68 to 0.94) | 0.84 (0.71 to 0.98) |
Total n/n deaths | 12,149/393 | 9,841/257 | 8915/209 | 8496/227 | 8577/237 |
≥35 | |||||
Model 3 | 1 (reference) | 0.96 (0.76 to 1.22) | 0.91 (0.71 to 1.18) | 0.97 (0.75 to 1.26) | 0.94 (0.71 to 1.23) |
Total n/n deaths | 5,747/201 | 3517/111 | 2821/85 | 2493/80 | 2352/72 |
Waist circumference, cm | |||||
Low: <88 women, <102 men | |||||
Model 3 | 1 (reference) | 0.94 (0.85 to 1.04) | 0.94 (0.85 to 1.04) | 0.95 (0.86 to 1.04) | 0.88 (0.79 to 0.97) |
Total n/n deaths | 34,953/734 | 40,392/780 | 42,691/818 | 43,967/872 | 44,510/864 |
High: ≥88 women, ≥102 men | |||||
Model 3 | 1 (reference) | 0.83 (0.74 to 0.93) | 0.81 (0.72 to 0.91) | 0.84 (0.75 to 0.94) | 0.81 (0.72 to 0.92) |
Total n/n deaths | 24,069/816 | 18,789/513 | 16,556/444 | 15,289/436 | 14,701/407 |
BF | |||||
Low | |||||
Model 3 | 1 (reference) | 0.96 (0.82 to 1.14) | 0.95 (0.81 to 1.18) | 0.87 (0.74 to 1.02) | 0.94 (0.80 to 1.09) |
Total n/n deaths | 14,759/257 | 19,058/310 | 21,443/346 | 23,316/353 | 24,396/429 |
Medium-low | |||||
Model 3 | 1 (reference) | 0.90 (0.81 to 1.01) | 0.90 (0.80 to 1.01) | 0.99 (0.88 to 1.03) | 0.84 (0.75 to 0.95) |
Total n/n deaths | 25,715/617 | 26,406/574 | 26,182/565 | 25,461/629 | 24,993/552 |
Medium-high | |||||
Model 3 | 1 (reference) | 0.80 (0.70 to 0.93) | 0.81 (0.70 to 0.94) | 0.80 (0.68 to 0.94) | 0.80 (0.69 to 0.94) |
Total n/n deaths | 12,665/442 | 10,188/285 | 8799/255 | 8051/239 | 7684/229 |
High | |||||
Model 3 | 1 (reference) | 0.89 (0.71 to 1.10) | 0.87 (0.68 to 1.10) | 0.87 (0.68 to 1.11) | 0.70 (0.53 to 0.94) |
Total n/n deaths | 5,883/234 | 3,529/124 | 2823/96 | 2428/87 | 2138/61 |

Discussion
World Health Organization. Fact sheets: The Top 10 causes of death. WHO website, hettps://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. Published May 24, 2018. Accessed August 1, 2020.
Study Limitations
Conclusion
Supplemental Online Material
- Supplementary Tables 1–10 and Supplementary Figure 1
- https://www.mayoclinicproceedings.org/cms/asset/bda85344-9e6c-427d-a752-7e02ac753118/mmc2.mp4Loading ...
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Article Info
Publication History
Footnotes
Grant Support: The UK Biobank was supported by the Wellcome Trust, Medical Research Council, Department of Health, Scottish government, and Northwest Regional Development Agency. It has also had funding from the Welsh Assembly government and British Heart Foundation. The research was designed, conducted, analyzed, and interpreted by the authors entirely independently of the funding sources. This research was conducted under application 29717. MASL was funded by the Xunta de Galicia (grant ED481A-2017/213), JT was funded by the Research Council of Norway (grant 249932/F20), and DD by a Heart Foundation Australia Future Leader Fellowship (no. 101234) while contributing to this work. No funding directly supported the work.
Potential Competing Interests: The authors report no potential competing interests.
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