We aimed to study the mediating role of diet quality, physical activity, smoking, and alcohol intake in the association of stressful life events with visceral obesity over a seven-year period and assessed effect modification by sex and SES. Methods: In total, 2416 participants with a mean age of 56.1 (±7.3) years, of which 51.4% were women, and 12.5% had a lower educational level from the Hoorn studies were followed for seven years. Stress was measured with a ‘Serious Life Events’ questionnaire, which was summed into a total score (range zero to ten events) and stratified to account for nonlinearity. Changes in visceral obesity were assessed by changes in BMI (kg/m2) and waist circumference (cm) in seven years. We used the product of coefficient approach to assess mediation of the following lifestyle factors: diet, physical activity, smoking, and alcohol intake. We analyzed associations between stressful life events and change in BMI and waist circumference with linear regression models.
Within the low education group, we observed a significant association between ≥3 stressful life events and a change in BMI (0.60 kg/m2 (CI: 0.05, 1.14)) and waist circumference (2.23 cm (CI: 0.19, 4.48)), compared to experiencing no events. For both BMI and waist circumference, no significant associations were observed when experiencing 1 or 2 events. In the moderate to high education group, we observed only statistically significant associations for waist circumference when experiencing ≥3 stressful life events (0.86 cm (CI: 0.05, 1.41)) and not for the other event groups. Our mediation analyses showed that the proportion mediated by smoking was 13.2%, while the other lifestyle factors showed no mediating effect.
Multiple stressful life events are associated with an increase in waist circumference and BMI in those with lower education. Smoking might play a mediating role in this association.
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Due to privacy regulations and informed consent of the participants, the dataset generated for this study cannot be made publicly available. However, the steering committee of the Hoorn Studies will consider sharing data upon request.
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We are grateful for the dedication of the participants and all individuals that contribute to the Hoorn Studies.
The authors declare no competing interests.
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Supplemental Table 1 Descriptive characteristics of the Hoorn study participants with missing stressful life events, N = 2721
Supplemental Table 2 Mediation analyses of stressful life events measured at baseline and change in BMI (kg/m2) after seven years follow-up, with DHD15-index (energy intake), physical activity, smok
Supplemental Table 3 Mediation analyses of stressful life events measured at baseline and change in waist circumference (cm) after seven years follow-up, with DHD15-index (energy intake), physical ac
Supplemental Table 4 Linear regression models per stressful life events item measured at baseline and follow-up and change in BMI (kg/m2) and waist circumference (cm) after 7 years in the general po
Supplemental Table 5 Linear regression models of number of stressful life events measured at baseline and change in BMI (kg/m2) and waist circumference (cm) after 7 years in the general population
Supplemental Table 6 Linear regression models of number of stressful life events measured at baseline plus follow-up and outcome change in BMI (kg/m2) adjusted for waist circumference and outcome wa
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Siddiqui, N.Z., Beulens, J.W.J., van der Vliet, N. et al. The longitudinal association between chronic stress and (visceral) obesity over seven years in the general population: The Hoorn Studies. Int J Obes 46, 1808–1817 (2022). https://doi.org/10.1038/s41366-022-01179-z