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dc.contributor.authorKitahara, Cari M.en_US
dc.contributor.authorFlint, Alan J.en_US
dc.contributor.authorBerrington de Gonzalez, Amyen_US
dc.contributor.authorBernstein, Leslieen_US
dc.contributor.authorBrotzman, Michelleen_US
dc.contributor.authorMacInnis, Robert J.en_US
dc.contributor.authorMoore, Steven C.en_US
dc.contributor.authorRobien, Kimen_US
dc.contributor.authorRosenberg, Philip S.en_US
dc.contributor.authorSingh, Pramil N.en_US
dc.contributor.authorWeiderpass, Elisabeteen_US
dc.contributor.authorAdami, Hans Oloven_US
dc.contributor.authorAnton-Culver, Hodaen_US
dc.contributor.authorBallard-Barbash, Rachelen_US
dc.contributor.authorBuring, Julie E.en_US
dc.contributor.authorFreedman, D. Michalen_US
dc.contributor.authorFraser, Gary E.en_US
dc.contributor.authorBeane Freeman, Laura E.en_US
dc.contributor.authorGapstur, Susan M.en_US
dc.contributor.authorGaziano, John Michaelen_US
dc.contributor.authorGiles, Graham G.en_US
dc.contributor.authorHåkansson, Niclasen_US
dc.contributor.authorHoppin, Jane A.en_US
dc.contributor.authorHu, Frank B.en_US
dc.contributor.authorKoenig, Karenen_US
dc.contributor.authorLinet, Martha S.en_US
dc.contributor.authorPark, Yikyungen_US
dc.contributor.authorPatel, Alpa V.en_US
dc.contributor.authorPurdue, Mark P.en_US
dc.contributor.authorSchairer, Catherineen_US
dc.contributor.authorSesso, Howard D.en_US
dc.contributor.authorVisvanathan, Kalaen_US
dc.contributor.authorWhite, Emilyen_US
dc.contributor.authorWolk, Alicjaen_US
dc.contributor.authorZeleniuch-Jacquotte, Anneen_US
dc.contributor.authorHartge, Patriciaen_US
dc.date.accessioned2014-08-13T13:58:17Z
dc.date.issued2014en_US
dc.identifier.citationKitahara, C. M., A. J. Flint, A. Berrington de Gonzalez, L. Bernstein, M. Brotzman, R. J. MacInnis, S. C. Moore, et al. 2014. “Association between Class III Obesity (BMI of 40–59 kg/m2) and Mortality: A Pooled Analysis of 20 Prospective Studies.” PLoS Medicine 11 (7): e1001673. doi:10.1371/journal.pmed.1001673. http://dx.doi.org/10.1371/journal.pmed.1001673.en
dc.identifier.issn1549-1277en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:12717386
dc.description.abstractBackground: The 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 Findings: In 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. Conclusions: Class 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' Summaryen
dc.language.isoen_USen
dc.publisherPublic Library of Scienceen
dc.relation.isversionofdoi:10.1371/journal.pmed.1001673en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4087039/pdf/en
dash.licenseLAAen_US
dc.subjectBiology and Life Sciencesen
dc.subjectPhysiologyen
dc.subjectPhysiological Parametersen
dc.subjectBody Weighten
dc.subjectObesityen
dc.subjectNutritionen
dc.subjectMedicine and Health Sciencesen
dc.subjectEpidemiologyen
dc.subjectCancer Epidemiologyen
dc.subjectCardiovascular Disease Epidemiologyen
dc.subjectPublic and Occupational Healthen
dc.titleAssociation between Class III Obesity (BMI of 40–59 kg/m2) and Mortality: A Pooled Analysis of 20 Prospective Studiesen
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalPLoS Medicineen
dash.depositing.authorFlint, Alan J.en_US
dc.date.available2014-08-13T13:58:17Z
dc.identifier.doi10.1371/journal.pmed.1001673*
dash.authorsorderedfalse
dash.contributor.affiliatedFlint, Alan
dash.contributor.affiliatedBuring, Julie
dash.contributor.affiliatedHu, Frank
dash.contributor.affiliatedSesso, Howard
dash.contributor.affiliatedGaziano, John


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