title: Job strain in relation to body mass index: pooled analysis of 160 000 adults from 13 cohort studies.
abstract: BACKGROUND
  Evidence of an association between job strain and obesity is inconsistent, mostly limited to small-scale studies, and does not distinguish between categories of underweight or obesity subclasses.
  
  
  OBJECTIVE
  To examine the association between job strain and body mass index (BMI) in a large adult population.
  
  
  METHODS
  We performed a pooled cross-sectional analysis based on individual-level data from 13 European studies resulting in a total of 161 746 participants (49% men, mean age, 43.7 years). Longitudinal analysis with a median follow-up of 4 years was possible for four cohort studies (n = 42 222).
  
  
  RESULTS
  A total of 86 429 participants were of normal weight (BMI 18.5-24.9 kg m(-2) ), 2149 were underweight (BMI < 18.5 kg m(-2) ), 56 572 overweight (BMI 25.0-29.9 kg m(-2) ) and 13 523 class I (BMI 30-34.9 kg m(-2) ) and 3073 classes II/III (BMI ≥ 35 kg m(-2) ) obese. In addition, 27 010 (17%) participants reported job strain. In cross-sectional analyses, we found increased odds of job strain amongst underweight [odds ratio 1.12, 95% confidence interval (CI) 1.00-1.25], obese class I (odds ratio 1.07, 95% CI 1.02-1.12) and obese classes II/III participants (odds ratio 1.14, 95% CI 1.01-1.28) as compared with participants of normal weight. In longitudinal analysis, both weight gain and weight loss were related to the onset of job strain during follow-up.
  
  
  CONCLUSIONS
  In an analysis of European data, we found both weight gain and weight loss to be associated with the onset of job strain, consistent with a 'U'-shaped cross-sectional association between job strain and BMI. These associations were relatively modest; therefore, it is unlikely that intervention to reduce job strain would be effective in combating obesity at a population level.
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland.solja.nyberg@ttl.fi
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authors.lastname: Jöckel
authors.forename: F
authors.initials: F
authors.lastname: Kittel
authors.forename: A
authors.initials: A
authors.lastname: Knutsson
authors.forename: M
authors.initials: M
authors.lastname: Koskenvuo
authors.forename: C
authors.initials: C
authors.lastname: Leineweber
authors.forename: T
authors.initials: T
authors.lastname: Lunau
authors.forename: I E H
authors.initials: IE
authors.lastname: Madsen
authors.forename: L L Magnusson
authors.initials: LL
authors.lastname: Hanson
authors.forename: M G
authors.initials: MG
authors.lastname: Marmot
authors.forename: M L
authors.initials: ML
authors.lastname: Nielsen
authors.forename: M
authors.initials: M
authors.lastname: Nordin
authors.forename: T
authors.initials: T
authors.lastname: Oksanen
authors.forename: J
authors.initials: J
authors.lastname: Pentti
authors.forename: R
authors.initials: R
authors.lastname: Rugulies
authors.forename: J
authors.initials: J
authors.lastname: Siegrist
authors.forename: S
authors.initials: S
authors.lastname: Suominen
authors.forename: J
authors.initials: J
authors.lastname: Vahtera
authors.forename: M
authors.initials: M
authors.lastname: Virtanen
authors.forename: P
authors.initials: P
authors.lastname: Westerholm
authors.forename: H
authors.initials: H
authors.lastname: Westerlund
authors.forename: M
authors.initials: M
authors.lastname: Zins
authors.forename: J E
authors.initials: JE
authors.lastname: Ferrie
authors.forename: T
authors.initials: T
authors.lastname: Theorell
authors.forename: A
authors.initials: A
authors.lastname: Steptoe
authors.forename: M
authors.initials: M
authors.lastname: Hamer
authors.forename: A
authors.initials: A
authors.lastname: Singh-Manoux
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mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004651:Employment / Q000523:psychology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000523:psychology; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology* / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology*; D015430:Weight Gain
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