Abstract:
OBJECTIVE:To assess body shape trajectories in early and middle life in relation to risk of mortality. DESIGN:Prospective cohort study. SETTING:Nurses' Health Study and Health Professionals Follow-up Study. POPULATION:80 266 women and 36 622 men who recalled their body shape at ages 5, 10, 20, 30, and 40 years and provided body mass index at age 50, followed from age 60 over a median of 15-16 years for death. MAIN OUTCOME MEASURES:All cause and cause specific mortality. RESULTS:Using a group based modeling approach, five distinct trajectories of body shape from age 5 to 50 were identified: lean-stable, lean-moderate increase, lean-marked increase, medium-stable/increase, and heavy-stable/increase. The lean-stable group was used as the reference. Among never smokers, the multivariable adjusted hazard ratio for death from any cause was 1.08 (95% confidence interval 1.02 to 1.14) for women and 0.95 (0.88 to 1.03) for men in the lean-moderate increase group, 1.43 (1.33 to 1.54) for women and 1.11 (1.02 to 1.20) for men in the lean-marked increase group, 1.04 (0.97 to 1.12) for women and 1.01 (0.94 to 1.09) for men in the medium-stable/increase group, and 1.64 (1.49 to 1.81) for women and 1.19 (1.08 to 1.32) for men in the heavy-stable/increase group. For cause specific mortality, participants in the heavy-stable/increase group had the highest risk, with a hazard ratio among never smokers of 2.30 (1.88 to 2.81) in women and 1.45 (1.23 to 1.72) in men for cardiovascular disease, 1.37 (1.14 to 1.65) in women and 1.07 (0.89 to 1.30) in men for cancer, and 1.59 (1.38 to 1.82) in women and 1.10 (0.95 to 1.29) in men for other causes. The trajectory-mortality association was generally weaker among ever smokers than among never smokers (for all cause mortality: P for interaction <0.001 in women and 0.06 in men). When participants were classified jointly according to trajectories and history of type 2 diabetes, the increased risk of death associated with heavier body shape trajectories was more pronounced among participants with type 2 diabetes than those without diabetes, and those in the heavy-stable/increase trajectory and with a history of diabetes had the highest risk of death. CONCLUSIONS:Using the trajectory approach, we found that heavy body shape from age 5 up to 50, especially the increase in middle life, was associated with higher mortality. In contrast, people who maintained a stably lean body shape had the lowest mortality. These results indicate the importance of weight management across the lifespan.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Song M,Hu FB,Wu K,Must A,Chan AT,Willett WC,Giovannucci ELdoi
10.1136/bmj.i2195subject
Has Abstractpub_date
2016-05-04 00:00:00pages
i2195eissn
0959-8138issn
1756-1833journal_volume
353pub_type
评论,杂志文章abstract:OBJECTIVES:To determine general practitioners' responses to and explanations for variation in rates of referral to hospital and how feedback of data on rates of referral could be used to facilitate practices in auditing their own referral behaviour. DESIGN:Visits by audit facilitators to general practices after feedba...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6917.1465
更新日期:1993-12-04 00:00:00
abstract:OBJECTIVE:To determine the incidence of cervical cancer after several negative cervical smear tests at different ages. DESIGN:Prospective observational study of incidence of cervical cancer after the third consecutive negative result based on individual level data in a national registry of histopathology and cytopatho...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b1354
更新日期:2009-04-24 00:00:00
abstract:OBJECTIVES:To assess the acceptability of screening newborn boys for Duchenne muscular dystrophy. DESIGN:Screening is offered on the basis of informed consent in response to an information sheet entitled "A new test for baby boys--Do you want it?" The programme includes a prospective long term evaluation of family res...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6874.357
更新日期:1993-02-06 00:00:00
abstract:OBJECTIVE:To assess predictors of mortality in a population of people prescribed methadone. DESIGN:Retrospective cohort study. SETTING:Geographically defined population in Tayside, Scotland. PARTICIPANTS:2378 people prescribed and dispensed liquid methadone between January 1993 and February 2004. MAIN OUTCOME MEASU...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b2225
更新日期:2009-06-16 00:00:00
abstract::Seventy five consecutive users of the Leeds disabled living foundation were surveyed. Two thirds of these users were at least moderately severely disabled. Forty eight of the 65 people (74%) who completed the questionnaire were recommended aids, and 33 had received some at the end of the survey. Only 10 of 28 people h...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6662.1523
更新日期:1988-12-10 00:00:00
abstract:OBJECTIVE:To investigate clinical trialists' opinions and experiences of sharing of clinical trial data with investigators who are not directly collaborating with the research team. DESIGN AND SETTING:Cross sectional, web based survey. PARTICIPANTS:Clinical trialists who were corresponding authors of clinical trials ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.e7570
更新日期:2012-11-20 00:00:00
abstract:OBJECTIVE:To determine the effect of four monthly vitamin D supplementation on the rate of fractures in men and women aged 65 years and over living in the community. DESIGN:Randomised double blind controlled trial of 100 000 IU oral vitamin D3 (cholecalciferol) supplementation or matching placebo every four months ove...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.326.7387.469
更新日期:2003-03-01 00:00:00
abstract:OBJECTIVE:To determine whether the intervention of a physiotherapist improved mobility in patients seen more than one year after stroke. DESIGN:Randomised crossover trial comparing two groups offered intervention by a physiotherapist, one immediately after entry into the trial and the other after a delay of three mont...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.304.6827.609
更新日期:1992-03-07 00:00:00
abstract:OBJECTIVE:To estimate the prevalence of emotionalism after stroke, to assess its relation with other mood disorders, and to identify clinical variables with which it is associated. DESIGN:Descriptive study of a cohort of patients consecutively entered on a community stroke register. SETTING:Community based research p...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.298.6679.991
更新日期:1989-04-15 00:00:00
abstract:OBJECTIVE:To assess the risk of cerebral thromboembolism in women using low dose oral contraceptives. DESIGN:A retrospective case-control study. SETTING:All Danish medical, neurological, neurosurgical, and gynaecological departments. SUBJECTS:All 794 women in Denmark aged 15-44 who had suffered a cerebral thromboemb...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6883.956
更新日期:1993-04-10 00:00:00
abstract::The author is one of the medical advisers to the judge who led a government inquiry into allegations that an experimental research program at the National Women's Hospital in Auckland, New Zealand, to study the natural course of cervical carcinoma in situ had withheld conventional treatment from some patients. She ar...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6647.533
更新日期:1988-08-20 00:00:00
abstract:OBJECTIVE:To determine whether use of tinzaparin, a low molecular weight heparin introduced for prophylactic management of deep vein thrombosis, increases the risk of serious postoperative bleeding leading to a higher than expected 28 day readmission rate after discharge for hysterectomy. DESIGN:Retrospective case-con...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.38783.624444.55
更新日期:2006-04-08 00:00:00
abstract:OBJECTIVES:To summarise evidence on the association between white rice consumption and risk of type 2 diabetes and to quantify the potential dose-response relation. DESIGN:Meta-analysis of prospective cohort studies. DATA SOURCES:Searches of Medline and Embase databases for articles published up to January 2012 using...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.e1454
更新日期:2012-03-15 00:00:00
abstract:OBJECTIVE:To test whether the relation between income inequality and mortality found in US states is because of different levels of formal education. DESIGN:Cross sectional, multiple regression analysis. SETTING:All US states and the District of Columbia (n=51). DATA SOURCES:US census statistics and vital statistics...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.324.7328.23
更新日期:2002-01-05 00:00:00
abstract::This paper summarizes the key findings of a U.S. study of 48 primary care physicians acting as gatekeepers in a large health maintenance organization to determine the effects of their cost containment role on the doctor patient relationship. Taylor highlights some of the findings and conclusions that he believes are ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.299.6711.1323
更新日期:1989-11-25 00:00:00
abstract:OBJECTIVE:To determine patient, institution, and machine characteristics that contribute to variation in radiation doses used for computed tomography (CT). DESIGN:Prospective cohort study. SETTING:Data were assembled and analyzed from the University of California San Francisco CT International Dose Registry. PARTICI...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.k4931
更新日期:2019-01-02 00:00:00
abstract:OBJECTIVE:To assess the effectiveness of two mechanical methods of blood conservation in reducing the need for allogeneic red blood cells or coagulation products during cardiac surgery. DESIGN:Randomised controlled trial. SETTING:Regional cardiac centre in a teaching hospital in Southampton. PARTICIPANTS:263 adults ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.324.7349.1299
更新日期:2002-06-01 00:00:00
abstract::Objective To determine the attributable risk of community acquired pneumonia on incidence of heart failure throughout the age range of affected patients and severity of the infection.Design Cohort study.Setting Six hospitals and seven emergency departments in Edmonton, Alberta, Canada, 2000-02.Participants 4988 adults...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.j413
更新日期:2017-02-13 00:00:00
abstract:OBJECTIVE:To determine whether abnormal results for liver function tests are investigated in primary care and findings on full investigation. DESIGN:Retrospective audit and prospective clinical investigation. SETTING:University hospital and surrounding general practices serving around 330 000 people. SUBJECTS:Adults...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.322.7281.276
更新日期:2001-02-03 00:00:00
abstract:OBJECTIVE:To investigate the effect of vitamin A supplementation and BCG vaccination at birth in low birthweight neonates. DESIGN:Randomised, placebo controlled, two by two factorial trial. SETTING:Bissau, Guinea-Bissau. PARTICIPANTS:1717 low birthweight neonates born at the national hospital. INTERVENTION:Neonates...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.c1101
更新日期:2010-03-09 00:00:00
abstract:OBJECTIVE:To investigate the risk factors for HIV infection in patients attending clinics for sexually transmitted diseases in India. DESIGN:Descriptive study of HIV serology, risk behaviour, and findings on physical examination. SUBJECTS:2800 patients presenting to outpatient clinics between 13 May 1993 and 15 July ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.311.7000.283
更新日期:1995-07-29 00:00:00
abstract::The identification of the gene for cystic fibrosis has led to the possibility of population based screening for carriers of cystic fibrosis to identify couples at risk of having an affected child. Pilot studies have shown that screening is feasible and does not cause untoward anxiety, though the uptake of testing vari...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6908.849
更新日期:1993-10-02 00:00:00
abstract:OBJECTIVES:To investigate the cost effectiveness of cyclo-oxygenase-2 (COX 2) selective inhibitors and traditional non-steroidal anti-inflammatory drugs (NSAIDs), and the addition of proton pump inhibitors to these treatments, for people with osteoarthritis. DESIGN:An economic evaluation using a Markov model and data ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.b2538
更新日期:2009-07-14 00:00:00
abstract:OBJECTIVE:To systematically review and describe currently available approaches to supporting maintenance of weight loss in obese adults and to assess the evidence for the effectiveness of these interventions. DESIGN:Systematic review with meta-analysis. DATA SOURCES:Medline, PsycINFO, Embase, and the Cochrane Central...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.g2646
更新日期:2014-05-14 00:00:00
abstract:OBJECTIVE:To investigate the risks of adverse pregnancy and birth outcomes for treated and untreated bipolar disorder during pregnancy. DESIGN:Population based cohort study using data from national health registers. SETTING:Sweden. PARTICIPANTS:332,137 women with a last menstrual period anytime after 1 July 2005 and...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.e7085
更新日期:2012-11-08 00:00:00
abstract:OBJECTIVES:To examine the concerns of singlehanded general practitioners working in an inner London area and to compare the views of general practitioners in partnerships. DESIGN:Qualitative analysis of semistructured interviews with a random sample of singlehanded general practitioners and a sample of general practit...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6904.607
更新日期:1993-09-04 00:00:00
abstract:OBJECTIVE:To compare the effectiveness of corticosteroid injections with physiotherapy for the treatment of painful stiff shoulder. DESIGN:Randomised trial. SETTING:40 general practices. SUBJECTS:109 patients consulting general practitioners for shoulder pain were enrolled in the trial. INTERVENTIONS:Patients were ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.317.7168.1292
更新日期:1998-11-07 00:00:00
abstract:OBJECTIVES:To study the effects of metformin on the incidence of vitamin B-12 deficiency (<150 pmol/l), low concentrations of vitamin B-12 (150-220 pmol/l), and folate and homocysteine concentrations in patients with type 2 diabetes receiving treatment with insulin. DESIGN:Multicentre randomised placebo controlled tri...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.c2181
更新日期:2010-05-20 00:00:00
abstract::Lifetime fertility, abortion rates, and the proportion of pregnancies resulting in induced abortion were investigated in 105 district health authorities in England. In 1995, a total of 147,851 abortions occurred among women living in England, compared with 613,257 live births; a ratio of 1:4. This was equivalent to ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.316.7146.1711
更新日期:1998-06-06 00:00:00
abstract::Robots designed for surgery have three main advantages over humans. They have greater three dimensional spatial accuracy, are more reliable, and can achieve much greater precision. Although few surgical robots are yet in clinical trials one or two have advanced to the stage of seeking approval from the UK's Medical De...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.311.7018.1479
更新日期:1995-12-02 00:00:00