The growing obesity epidemic in the US has heightened the importance of its primary prevention across all ages;however, prevention efforts generally focus upon community-based intervention studies in pediatric settings or clinical intervention studies among already overweight or obese adults. Obesity commonly develops during adulthood and necessitates an improved understanding of long- term strategies to prevent adult-onset obesity. The epidemiologic literature is limited regarding specific types or intensities of physical activity beyond total physical activity, as well as dietary patterns that may be associated with the development of obesity and long-term weight gain during middle and late adulthood. Therefore, this revised proposal responds to PA-06-256 (Exploratory/Developmental Clinical Research Grants in Obesity) and seeks to develop incident obesity as a new endpoint within two large existing prospective cohort studies of men and women. The Harvard Alumni Health Study includes 12,805 men aged e55 years who completed a baseline questionnaire in 1988 along with 10 years of follow-up, and the Women's Health Study consists of 39,876 women aged e45 years with baseline information in 1992 plus more than 12 years of follow-up for the development of obesity and long-term weight gain. In this proposal, we will carefully evaluate the roles of physical activity, physical inactivity, and diet in the prevention of adult-onset obesity and long-term weight gain in initially non- obese men and women. Our first primary aim will examine whether physical inactivity is associated with an increased risk of becoming obese or greater increases in body weight during long-term follow- up. We will also examine the type (e.g. walking and other common forms of exercise), frequency, and intensity (e.g. moderate, vigorous) of physical activity. Second, we will determine whether specific dietary factors (e.g. Western versus prudent dietary patterns, fruits and vegetables, fiber, carbohydrates, dairy products, and alcohol) are associated with an increased risk of becoming obese or greater increases in body weight. Finally, we will determine whether the above associations are modified by the presence or absence of intermediate clinical factors such as hypertension, diabetes, hypercholesterolemia, or parental history of obesity (available in men only). We have excellent power to assess our hypotheses to draw clinically meaningful conclusions regarding the role of different types and intensities of physical activity, sedentary behaviors, and dietary factors in the primary prevention of obesity. With the successful development of adult-onset obesity and long-term weight gain in these cohorts, we hope this proposal will lead to larger R01 grants with greater scope to examine additional aspects of physical activity, physical inactivity, diet, and related biomarkers and genetic factors to identify promising mechanisms and innovative approaches for the prevention of obesity in adults.

Public Health Relevance

Project Narrative The growing obesity epidemic in the US has heightened the need to improve our understanding of how to prevent adult-onset obesity. We are responding to PA-06-256 (Exploratory/Developmental Clinical Research Grants in Obesity) to develop adult-onset obesity as a new endpoint in two large existing prospective cohort studies, the Harvard Alumni Health Study and the Women's Health Study. We will carefully evaluate the roles of physical activity, physical inactivity, and diet in the prevention of adult-onset obesity and long-term weight gain in initially non-obese middle-aged and older men and women. The clinically relevant results generated from this proposal will help establish obesity as a viable endpoint in these two large cohort studies and provide an opportunity to expand research to other mechanistically relevant biomarkers, genetic factors, and risk factors in the primary prevention of obesity.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21DK081141-02
Application #
7896797
Study Section
Kidney, Nutrition, Obesity and Diabetes (KNOD)
Program Officer
Everhart, James
Project Start
2009-07-20
Project End
2012-09-30
Budget Start
2010-07-01
Budget End
2012-09-30
Support Year
2
Fiscal Year
2010
Total Cost
$199,625
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
Rautiainen, Susanne; Wang, Lu; Lee, I-Min et al. (2015) Higher Intake of Fruit, but Not Vegetables or Fiber, at Baseline Is Associated with Lower Risk of Becoming Overweight or Obese in Middle-Aged and Older Women of Normal BMI at Baseline. J Nutr 145:960-8
Rautiainen, Susanne; Lee, I-Min; Rist, Pamela M et al. (2015) Multivitamin use and cardiovascular disease in a prospective study of women. Am J Clin Nutr 101:144-52
Shiroma, Eric J; Sesso, Howard D; Moorthy, M V et al. (2014) Do moderate-intensity and vigorous-intensity physical activities reduce mortality rates to the same extent? J Am Heart Assoc 3:e000802
Lee, I-Min; Wolin, Kathleen Y; Freeman, Sarah E et al. (2014) Physical activity and survival after cancer diagnosis in men. J Phys Act Health 11:85-90
Gray, L; Lee, I-M; Sesso, H D et al. (2012) Association of body mass index in early adulthood and middle age with future site-specific cancer mortality: the Harvard Alumni Health Study. Ann Oncol 23:754-9
Britton, Kathryn A; Lee, I-Min; Wang, Lu et al. (2012) Physical activity and the risk of becoming overweight or obese in middle-aged and older women. Obesity (Silver Spring) 20:1096-103
Whitley, Elise; Lee, I-Min; Sesso, Howard D et al. (2012) Association of cigarette smoking from adolescence to middle-age with later total and cardiovascular disease mortality: theHarvard Alumni Health Study. J Am Coll Cardiol 60:1839-40
Shiroma, E J; Sesso, H D; Lee, I-M (2012) Physical activity and weight gain prevention in older men. Int J Obes (Lond) 36:1165-9
Gray, Linsay; Lee, I-Min; Sesso, Howard D et al. (2011) Blood pressure in early adulthood, hypertension in middle age, and future cardiovascular disease mortality: HAHS (Harvard Alumni Health Study). J Am Coll Cardiol 58:2396-403
Gray, Linsay; Lee, I-Min; Sesso, Howard D et al. (2011) Body weight in early and mid-adulthood in relation to subsequent coronary heart disease mortality: 80-year follow-up in the Harvard Alumni Study. Arch Intern Med 171:1768-70; discussion 1770

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