title: Combined impact of lifestyle factors on prospective change in body weight and waist circumference in participants of the EPIC-PANACEA study.
abstract: BACKGROUND
  The evidence that individual dietary and lifestyle factors influence a person's weight and waist circumference is well established; however their combined impact is less well documented. Therefore, we investigated the combined effect of physical activity, nutrition and smoking status on prospective gain in body weight and waist circumference.
  
  
  METHODS
  We used data of the prospective EPIC-PANACEA study. Between 1992 and 2000, 325,537 participants (94,445 men and 231,092 women, aged between 25-70) were recruited from nine European countries. Participants were categorised into two groups (positive or negative health behaviours) for each of the following being physically active, adherent to a healthy (Mediterranean not including alcohol) diet, and never-smoking for a total score ranging from zero to three. Anthropometric measures were taken at baseline and were mainly self-reported after a medium follow-up time of 5 years.
  
  
  RESULTS
  Mixed-effects linear regression models adjusted for age, educational level, alcohol consumption, baseline body mass index and follow-up time showed that men and women who reported to be physically active, never-smoking and adherent to the Mediterranean diet gained over a 5-year period 537 (95% CI -706, -368) and 200 (-478, -87) gram less weight and 0.95 (-1.27, -0.639) and 0.99 (-1.29, -0.69) cm less waist circumference, respectively, compared to participants with zero healthy behaviours.
  
  
  CONCLUSIONS
  The combination of positive health behaviours was associated with significantly lower weight and waist circumference gain.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. a.m.may@umcutrecht.nl
authors.forename: Anne M
authors.initials: AM
authors.lastname: May
authors.forename: Dora
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authors.lastname: Romaguera
authors.forename: Noémie
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authors.lastname: Travier
authors.forename: Ulf
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authors.lastname: Ekelund
authors.forename: Manuela M
authors.initials: MM
authors.lastname: Bergmann
authors.forename: Rudolf
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authors.forename: Birgit
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authors.forename: Annika
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authors.forename: Heiner
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authors.forename: Jytte
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authors.lastname: Halkjaer
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authors.lastname: Tjonneland
authors.forename: Marianne Uhre
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authors.lastname: Jakobsen
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authors.lastname: Overvad
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authors.lastname: Dartois
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authors.lastname: Fagherazzi
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.forename: J Ramón
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authors.lastname: Quirós
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authors.forename: Carlos
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authors.forename: María-José
authors.initials: MJ
authors.lastname: Sánchez
authors.forename: Pilar
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authors.lastname: Amiano
authors.forename: Jose-Maria
authors.initials: JM
authors.lastname: Huerta
authors.forename: Eva
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authors.lastname: Ardanaz
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.forename: Francesca L
authors.initials: FL
authors.lastname: Crowe
authors.forename: Androniki
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authors.lastname: Naska
authors.forename: Philippos
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authors.lastname: Orfanos
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.forename: Domenico
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authors.lastname: Palli
authors.forename: Claudia
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authors.lastname: Agnoli
authors.forename: Rosario
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authors.lastname: Tumino
authors.forename: Paolo
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authors.lastname: Vineis
authors.forename: Salvatore
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authors.lastname: Panico
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.forename: Monique
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authors.lastname: Verschuren
authors.forename: Isabel
authors.initials: I
authors.lastname: Drake
authors.forename: Emily
authors.initials: E
authors.lastname: Sonestedt
authors.forename: Tonje
authors.initials: T
authors.lastname: Braaten
authors.forename: Sabina
authors.initials: S
authors.lastname: Rinaldi
authors.forename: Isabelle
authors.initials: I
authors.lastname: Romieu
authors.forename: Nadia
authors.initials: N
authors.lastname: Slimani
authors.forename: Teresa
authors.initials: T
authors.lastname: Norat
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authors.lastname: Riboli
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authors.initials: PH
authors.lastname: Peeters
mesh_terms: D000328:Adult; D000368:Aged; D001835:Body Weight; D004032:Diet / Q000009:adverse effects / Q000706:statistics & numerical data*; D005060:Europe; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects*; D055105:Waist Circumference