PMID- 31945095
OWN - NLM
STAT- MEDLINE
DCOM- 20200420
LR  - 20200420
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 15
IP  - 1
DP  - 2020
TI  - Obesity, smoking habits, and serum phosphate levels predicts mortality after 
      life-style intervention.
PG  - e0227692
LID - 10.1371/journal.pone.0227692 [doi]
LID - e0227692
AB  - BACKGROUND: Life-style interventions, including smoking cessation and weight 
      control are of importance for managing future escalating prevalence of obesity. 
      Smoking habits and obesity have jointly great impact on mortality, however 
      mechanisms behind the effect and variables involved in the obesity paradox is 
      still unknown. OBJECTIVES: This study examines risk factors for all-cause, 
      cardiovascular, and cancer mortality in males and females with high 
      cardiovascular risk, mediated by smoking habits, body mass index (BMI, kg/m2), 
      and serum phosphate (S-P) levels. METHODS: Patients were admitted to the Vindeln 
      Patient Education Center in groups of 30 for a four-week residential 
      comprehensive program (114 hours) focusing on smoking cessation, stress 
      reduction, food preferences and selections, and physical exercise. The follow-up, 
      in years from 1984 to 2014 corresponds to 30 years. This study included 2,504 
      patients (1,408 females and 1,096 males). Cox regression analysis was used to 
      assess mortality risk associated with smoking habits, low and high BMI, and low 
      and high S-P levels. RESULTS: High BMI (>34,2 kg/m2), current smoking, type 2 
      diabetes mellitus (T2DM), high serum calcium (S-Ca), mmol/L and high systolic 
      blood pressure (SBP, mmHg) were associated with all-cause mortality irrespective 
      of sex. Former and current smoking females had a high all-cause mortality 
      (adjusted hazard ratio [HR] 1.581; 95% CI 1.108-2.256, adjusted hazard ratio [HR] 
      1.935; 95% CI 1.461-2.562, respectively) while current smoking and high BMI 
      increased risk for cardiovascular mortality (adjusted hazard ratio [HR] 3.505; 
      95% CI 2.140-5.740 and [HR] 1.536; 95% CI 1.058-2.231, respectively). Neither low 
      nor high levels of S-P predicted all-cause, cardiovascular disease (CVD) and 
      cancer mortality in males or females while low levels of S-P predicted all-cause 
      mortality in smokers (adjusted hazard ratio [HR] 1.713; 95% CI 1.211-2.424). In 
      non-smokers, low BMI (<27.6 kg/m2) was protecting and high BMI a risk for 
      all-cause mortality. In males, ischemic heart disease (IHD), and low serum 
      albumin (S-Alb) were associated with all-cause mortality. In females, an 
      interaction between high BMI and smoking (HbmiSM) decreased the cardiovascular 
      mortality (adjusted hazard ratio [HR] 0.410; 95% CI 0.179-0.937, respectively). 
      CONCLUSIONS: High BMI and current smoking were associated with all-cause 
      mortality in both males and females in the present high cardiovascular-risk 
      cohort. In current smokers and non-smokers, T2DM and high S-Ca were associated 
      with an increase in all-cause mortality, while low S-P was associated with 
      all-cause mortality in smokers. Interaction between high BMI and smoking 
      contribute to the obesity paradox by being protective for cardiovascular 
      mortality in females.
FAU - Haglin, Lena
AU  - Haglin L
AUID- ORCID: 0000-0001-6526-7417
AD  - Department of Public Health and Clinical Medicine, Family Medicine, Umea 
      University, Umea, Sweden.
FAU - Tornkvist, Birgitta
AU  - Tornkvist B
AD  - Department of Public Health and Clinical Medicine, Family Medicine, Umea 
      University, Umea, Sweden.
FAU - Backman, Lennart
AU  - Backman L
AD  - Department of Public Health and Clinical Medicine, Family Medicine, Umea 
      University, Umea, Sweden.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200116
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Phosphates)
SB  - IM
MH  - Adult
MH  - Body Mass Index
MH  - Cohort Studies
MH  - Female
MH  - Health Promotion/*methods
MH  - Healthy Lifestyle
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Obesity/blood/*mortality/therapy
MH  - Phosphates/*blood
MH  - Risk Factors
MH  - Smoking/blood/*mortality/therapy
MH  - Smoking Cessation
MH  - Sweden/epidemiology
MH  - Weight Reduction Programs
PMC - PMC6964906
COIS- The authors have declared that no competing interests exist.
EDAT- 2020/01/17 06:00
MHDA- 2020/04/21 06:00
PMCR- 2020/01/16
CRDT- 2020/01/17 06:00
PHST- 2019/02/12 00:00 [received]
PHST- 2019/12/23 00:00 [accepted]
PHST- 2020/01/17 06:00 [entrez]
PHST- 2020/01/17 06:00 [pubmed]
PHST- 2020/04/21 06:00 [medline]
PHST- 2020/01/16 00:00 [pmc-release]
AID - PONE-D-19-04197 [pii]
AID - 10.1371/journal.pone.0227692 [doi]
PST - epublish
SO  - PLoS One. 2020 Jan 16;15(1):e0227692. doi: 10.1371/journal.pone.0227692. 
      eCollection 2020.