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BackgroundThe prevalence of class III obesity (body mass index [BMI]≥40 kg/m2) has increased dramatically in several countries and currently affects 6% of adults in the US, with uncertain impact on the risks of illness and death. Using data from a large pooled study, we evaluated the risk of death, overall and due to a wide range of causes, and years of life expectancy lost associated with class III obesity.Methods and findingsIn a pooled analysis of 20 prospective studies from the United States, Sweden, and Australia, we estimated sex- and age-adjusted total and cause-specific mortality rates (deaths per 100,000 persons per year) and multivariable-adjusted hazard ratios for adults, aged 19-83 y at baseline, classified as obese class III (BMI 40.0-59.9 kg/m2) compared with those classified as normal weight (BMI 18.5-24.9 kg/m2). Participants reporting ever smoking cigarettes or a history of chronic disease (heart disease, cancer, stroke, or emphysema) on baseline questionnaires were excluded. Among 9,564 class III obesity participants, mortality rates were 856.0 in men and 663.0 in women during the study period (1976-2009). Among 304,011 normal-weight participants, rates were 346.7 and 280.5 in men and women, respectively. Deaths from heart disease contributed largely to the excess rates in the class III obesity group (rate differences = 238.9 and 132.8 in men and women, respectively), followed by deaths from cancer (rate differences = 36.7 and 62.3 in men and women, respectively) and diabetes (rate differences = 51.2 and 29.2 in men and women, respectively). Within the class III obesity range, multivariable-adjusted hazard ratios for total deaths and deaths due to heart disease, cancer, diabetes, nephritis/nephrotic syndrome/nephrosis, chronic lower respiratory disease, and influenza/pneumonia increased with increasing BMI. Compared with normal-weight BMI, a BMI of 40-44.9, 45-49.9, 50-54.9, and 55-59.9 kg/m2 was associated with an estimated 6.5 (95% CI: 5.7-7.3), 8.9 (95% CI: 7.4-10.4), 9.8 (95% CI: 7.4-12.2), and 13.7 (95% CI: 10.5-16.9) y of life lost. A limitation was that BMI was mainly ascertained by self-report.ConclusionsClass III obesity is associated with substantially elevated rates of total mortality, with most of the excess deaths due to heart disease, cancer, and diabetes, and major reductions in life expectancy compared with normal weight. Please see later in the article for the Editors' Summary.

The optimal body-mass index (BMI) range is assessed and has provided stable estimates of the risks associated with being overweight, obese, and morbidly obese, with minimal confounding due to smoking or prevalent disease. The studies have shown that for non-Hispanic whites, both overweight and obesity are associated with increased all-cause mortality and also underweight.

Lori Pbert, PhD, Kenneth E. Fletcher, PhD, Alan J. Flint, MD, MPH, Martin H. Young, PhD, Susan Druker, MA, Joseph DiFranza, [...], OBJECTIVE. The goal was to evaluate the degree to which a smoking prevention and cessation intervention was delivered by providers to adolescents in the pediatric office setting. METHODS. Eight pediatric clinics in central Massachusetts were assigned randomly to either a special intervention (brief pediatric provider-delivered intervention plus peer counseling) or the usual care condition. Subjects (n = 2710) were adolescents 13 to 17 years of age, both smokers (smoked in the past 30 days) and nonsmokers/ former smokers. The degree to which smoking prevention and treatment interventions were delivered by providers was assessed through patient exit interviews with adolescents after their clinic visits; interviews assessed the occurrence of 10 possible intervention steps. RESULTS. The percentage of providers engaging in the smoking interventions differed significantly between the special intervention and usual care conditions, according to adolescent reports in the patient exit interviews. For nonsmokers/former smokers, overall patient exit interview scores were 7.24 for the special intervention condition and 4.95 for the usual care condition. For current smokers, overall patient exit interview scores were 8.40 and 6.24 for the special intervention and usual care conditions, respectively. Intervention fidelity of special intervention providers was 72.2% and 84.0% for nonsmokers/former smokers and current smokers, respectively. CONCLUSIONS. Pediatric providers who receive training and reminders to deliver a brief smoking prevention and cessation intervention to adolescents in the context of routine pediatric primary care practice can do so feasibly and with a high degree of fidelity to the intervention protocol. KEY WORDS. smoking prevention and cessation, adolescents, pediatric providers, intervention delivery, patient exit interview.

: In a pooled analysis of 20 prospective studies, Cari Kitahara and colleagues find that class III obesity (BMI of 40–59) is associated with excess rates of total mortality, particularly due to heart disease, cancer, and diabetes. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]

Objectives. We investigated the association between body mass index (BMI) and mortality among Asian Americans. Methods. We pooled data from prospective cohort studies with 20 672 Asian American adults with no baseline cancer or heart disease history. We estimated hazard ratios and 95% confidence intervals (CIs) with Cox proportional hazards models. Results. A high, but not low, BMI was associated with increased risk of total mortality among individuals aged 35 to 69 years. The BMI was not related to total mortality among individuals aged 70 years and older. With a BMI 22.5 to < 25 as the reference category among never-smokers aged 35 to 69 years, the hazard ratios for total mortality were 0.83 (95% CI = 0.47, 1.47) for BMI 15 to < 18.5; 0.91 (95% CI = 0.62, 1.32) for BMI 18.5 to < 20; 1.08 (95% CI = 0.86, 1.36) for BMI 20 to < 22.5; 1.14 (95% CI = 0.90, 1.44) for BMI 25 to < 27.5; 1.13 (95% CI = 0.79, 1.62) for BMI 27.5 to < 30; 1.82 (95% CI = 1.25, 2.64) for BMI 30 to < 35; and 2.09 (95% CI = 1.06, 4.11) for BMI 35 to 50. Higher BMI was also related to increased cardiovascular disease and cancer mortality. Conclusions. High BMI is associated with increased mortality risk among Asian Americans. [ABSTRACT FROM AUTHOR]

Background: Whole grains are rich in fiber, vitamins, minerals, and antioxidants that have favorable effects on health through multiple pathways. Although epidemiologic studies have suggested that whole grain intake may reduce risk of type 2 diabetes, hypertension and cardiovascular disease (CVD), limited evidence exists regarding whole grains' associations with mortality in prospective studies. Methods: Whole grain consumption was measured using a validated food frequency questionnaire every 2-4 years among 74,341 women in the Nurses' Health Study (1984-2010) and 43,990 men in the Health Professionals Follow-Up Study (1986- 2010) who were free of CVD, diabetes, and cancers at baseline. Intake of whole grain foods including brown rice, dark breads, whole-grain ready-to-eat cereals, cooked cereal, popcorn, wheat germ, bran and other grains. We used the cumulative average of whole grain intake from all available dietary questionnaires from baseline through the end of follow-up were used to better represent longterm or habitual intake, and to minimize within-person variation. Cox regression models were used to evaluate the associations between whole grain intake and mortality. Results: We documented 26,918 deaths in these two cohorts during 2,731,264 person-years of follow-up through 2010. After multivariate adjustment for potential confounders, including age, smoking, BMI, physical activity, and alternate healthy eating index, the hazard ratios (HRs) of total mortality comparing the highest with the lowest quintile of whole grain intake was 0.89 (95% confidence interval [CI] 0.84, 0.94, P for trend < 0.0001) in NHS and 0.92 (95%CI 0.87, 0.98, P for trend = 0.01) in HPFS; and the pooled HR was 0.91 (95% CI 0.85, 0.95). An inverse association was observed for CVD mortality: the pooled HRs (95% CIs) comparing extreme quintiles were 0.85 (95%CI 0.78, 0.92, P for trend < 0.0001). Whole grain intake was not significantly associated with cancer mortality, the pooled HR was 0.98 (95% CI 0.91, 1.04, P for trend = 0.49). In addition, total bran intake was observed to be significantly inversely associated with CVD mortality, with pooled HR 0.80 (95% CI 0.73, 0.87, P for trend < 0.0001), while total germ intake was not associated with risk of mortality after adjustment for bran intake. These associations did not change materially among men and women who had a healthful lifestyle or diet. In sensitivity analysis, to minimize reverse causation, we used a 4-year lagged analysis or further stopped updating diet after participants reported occurrence of hypertension and high cholesterol, and all these sensitivity analysis indicated the robustness of our results. Conclusions: Our data support the hypothesis that higher whole grain consumption may have beneficial effects on lowering total and CVD mortality in US men and women. [ABSTRACT FROM AUTHOR]

Background: Whole grains are rich in fiber, vitamins, minerals, and antioxidants that have favorable effects on health through multiple pathways. Although epidemiologic studies have suggested that whole grain intake may reduce risk of type 2 diabetes, hypertension and cardiovascular disease (CVD), limited evidence exists regarding whole grains' associations with mortality in prospective studies. Methods: Whole grain consumption was measured using a validated food frequency questionnaire every 2-4 years among 74,341 women in the Nurses' Health Study (1984-2010) and 43,990 men in the Health Professionals Follow-Up Study (1986-2010) who were free of CVD, diabetes, and cancers at baseline. Intake of whole grain foods including brown rice, dark breads, whole-grain ready-to-eat cereals, cooked cereal, popcorn, wheat germ, bran and other grains. We used the cumulative average of whole grain intake from all available dietary questionnaires from baseline through the end of follow-up were used to better represent long-term or habitual intake, and to minimize within-person variation. Cox regression models were used to evaluate the associations between whole grain intake and mortality. Results: We documented 26,918 deaths in these two cohorts during 2,731,264 person-years of follow-up through 2010. After multivariate adjustment for potential confounders, including age, smoking, BMI, physical activity, and alternate healthy eating index, the hazard ratios (HRs) of total mortality comparing the highest with the lowest quintile of whole grain intake was 0.89 (95% confidence interval [CI] 0.84, 0.94, P for trend < 0.0001) in NHS and 0.92 (95%CI 0.87, 0.98, P for trend = 0.01) in HPFS; and the pooled HR was 0.91 (95% CI 0.85, 0.95). An inverse association was observed for CVD mortality: the pooled HRs (95% CIs) comparing extreme quintiles were 0.85 (95%CI 0.78, 0.92, P for trend < 0.0001). Whole grain intake was not significantly associated with cancer mortality, the pooled HR was 0.98 (95% CI 0.91, 1.04, P for trend = 0.49). In addition, total bran intake was observed to be significantly inversely associated with CVD mortality, with pooled HR 0.80 (95% CI 0.73, 0.87, P for trend < 0.0001), while total germ intake was not associated with risk of mortality after adjustment for bran intake. These associations did not change materially among men and women who had a healthful lifestyle or diet. In sensitivity analysis, to minimize reverse causation, we used a 4-year lagged analysis or further stopped updating diet after participants reported occurrence of hypertension and high cholesterol, and all these sensitivity analysis indicated the robustness of our results. Conclusions: Our data support the hypothesis that higher whole grain consumption may have beneficial effects on lowering total and CVD mortality in US men and women. [ABSTRACT FROM AUTHOR]