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Epidemiology

The association of education with long-term weight change in the EPIC-PANACEA cohort

European Journal of Clinical Nutrition volume 66, pages 957–963 (2012)Cite this article

Subjects

Abstract

Background/objectives:

Cross-sectionally, educational attainment is strongly associated with the prevalence of obesity, but this association is less clear for weight change during adult life. The objective of this study is to examine the association between educational attainment and weight change during adult life in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Subjects/methods:

EPIC is a cohort study with 361 467 participants and up to 10 years of follow-up. Educational attainment was categorized according to the highest obtained school level (primary school or less, vocational secondary training, other secondary education and university). Multivariate mixed-effects linear regression models were used to study education in relation to weight at age 20 years (self-reported), to annual change in weight between age 20 years and measured weight at recruitment, and to annual change in weight during follow-up time.

Results:

Higher educational attainment was associated with on average a lower body mass index (BMI) at age 20 years and a lower increase in weight up to recruitment (highest vs lowest educational attainment in men: −60 g per year (95% confidence interval (CI) −80; −40), women −110 g per year (95% CI −130; −80)). Although during follow-up after recruitment an increase in body weight was observed in all educational levels, gain was lowest in men and women with a university degree (high vs low education −120 g per year (95% CI −150; −90) and −70 g per year (95% CI −90; −60), respectively).

Conclusions:

Existing differences in BMI between higher and lower educated individuals at early adulthood became more pronounced during lifetime, which possibly impacts on obesity-related chronic disease risk in persons with lower educational attainment.

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Acknowledgements

The work described in this paper was carried out with support of the European Commission: Grant No. DG Sanco, Project No.: 2 005 328. The work was further financially supported by the European Commission: Public Health and Consumer Protection Directorate 1993–2004; Research Directorate General 2005'; Ligue contre le Cancer, Societé 3M, Mutuelle Générale de l'Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Centre, Federal Ministry of Education and Research (Germany); Danish Cancer Society (Denmark); Health Research Fund (FIS) of the Spanish Ministry of Health, the participating regional governments and institutions (Spain); Cancer Research UK, Medical Research Council, Stroke Association, British Heart Foundation, Department of Health, Food Standards Agency, Wellcome Trust (UK); Greek Ministry of Health and Social Solidarity, Hellenic Health Foundation and Stavros Niarchos Foundation (Greece); Italian Association for Research on Cancer, National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports, Dutch Ministry of Health, Dutch Prevention Funds, LK Research Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF; The Netherlands); Swedish Research Council, Swedish Heart-Lung Foundation, Swedish Cancer Foundation, Swedish Cancer Society, Swedish Scientific Council, Regional Government of Skane (Sweden); Norwegian Cancer Society (Norway).

Author contributions

PHMP: principal investigator of the EPIC-PANACEA project and guarantor of the article; the EPIC study was conceptualized, designed and implemented in collaboration with the main investigators in the collaborating countries as follows: Denmark (A Tjønneland, KO), France (FC-C and M-CB-R), Germany (RK), Greece (A Trichopoulou), Italy (RT), Netherlands (HBB-d-M and PHMP), Norway (EL), Spain (M-DC, LR and M-JS), Sweden (IJ) and United Kingdom (NW and K-TK; these authors contributed to the study design, subject recruitment, and data collection and acquisition, and are responsible for the ongoing follow-up and management of the EPIC cohort); SR, J Linseisen and SH: conceived the current study; SR, A Steinbrecher and J Linseisen: responsible for the design of the study, analyses of data, interpretation of results and drafting of the manuscript, with close assistance from SH, AMM, J Luan and PHMP, and taking into account the comments and suggestions of the coauthors; contributors from the collaborating centers (UE, JH, GF, CA, GM, AM, FR, NT, PA, EA, LR, LMN, BH, MR, TB, AN, PO, SvdB, MMB, A Steffen, BT, FLC, A-KI, SN, VG, TM, TN): provided the original data, information on the respective populations, and advice on study design, analysis and interpretation of the results; and all coauthors had the opportunity to comment on the analysis and interpretation of the findings, and approved the final version of the manuscript.

Author information

Authors and Affiliations

  1. Department of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland

    S Rohrmann

  2. Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany

    S Rohrmann, A Steinbrecher, J Linseisen, S Hermann, R Kaaks & B Teucher

  3. Institute of Epidemiology, German Research Centre for Environmental Health (HMGU), Neuherberg, Germany

    J Linseisen

  4. Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands

    A May & P H M Peeters

  5. National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands

    A May, S van den Berg & H B Bueno-de-Mesquita

  6. Medical Research Council, Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK

    J Luan, U Ekelund & N J Wareham

  7. Department of Cardiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark

    K Overvad

  8. Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg, Denmark

    K Overvad

  9. Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark

    A Tjønneland & J Halkjær

  10. Inserm ERI20 and Paris South University, Institut Gustave-Roussy, Villejuif, France

    G Fagherazzi, M-C Boutron-Ruault & F Clavel-Chapelon

  11. Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    C Agnoli

  12. Cancer Registry and Histopathology Unit, ‘Civile MP Arezzo’ Hospital, Ragusa, Italy

    R Tumino

  13. Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute – ISPO, Florence, Italy

    G Masala

  14. Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy

    A Mattiello

  15. Human Genetics Foundation and Department of Genetics, Biology and Biochemistry, University of Turin, Turin, Italy

    F Ricceri

  16. Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Barcelona, Spain

    N Travier

  17. Public Health Division of Gipuzkoa, IIS Institute Investigation BioDonostia, Basque Country, Spain

    P Amiano

  18. Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Spain

    P Amiano, E Ardanaz, M-D Chirlaque & M-J Sanchez

  19. Navarre Public Health Institute, Pamplona, Spain

    E Ardanaz

  20. Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain

    M-D Chirlaque

  21. Andalusian School of Public Health, Granada, Spain

    M-J Sanchez

  22. Public Health and Participation Directorate, Health and Health Care Services Council, Asturias, Spain

    L Rodríguez

  23. Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

    L M Nilsson

  24. Department of Odontology, Umeå University, Umeå, Sweden

    I Johansson

  25. Department of Clinical Sciences in Malmö, Lund University, Skane University Hospital, Malmö, Sweden

    B Hedblad & M Rosvall

  26. Institute of Community Medicine, University of Tromsø, Tromsø, Norway

    E Lund & T Braaten

  27. Department of Hygiene, WHO Collaborating Center for Food and Nutrition Policies, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece

    A Naska, P Orfanos & A Trichopoulou

  28. Hellenic Health Foundation, Athens, Greece

    A Naska, P Orfanos & A Trichopoulou

  29. Department of Gastroenterology and Hepatology, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands

    H B Bueno-de-Mesquita

  30. German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany

    M M Bergmann & A Steffen

  31. Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

    K-T Khaw

  32. Nuffield Department of Clinical Medicine, Cancer Epidemiology Unit, University of Oxford, Oxford, UK

    F L Crowe

  33. International Agency for Research on Cancer, Lyon, France

    A-K Illner & N Slimani

  34. Department of Epidemiology and Biostatistics, Imperial College School of Public Health, London, UK

    V Gallo, T Mouw & T Norat

  35. Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK

    V Gallo

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  1. S Rohrmann
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Corresponding author

Correspondence to S Rohrmann.

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Rohrmann, S., Steinbrecher, A., Linseisen, J. et al. The association of education with long-term weight change in the EPIC-PANACEA cohort. Eur J Clin Nutr 66, 957–963 (2012). https://doi.org/10.1038/ejcn.2012.55

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