The longitudinal association between chronic stress and (visceral) obesity over seven years in the general population: The Hoorn Studies

Noreen Z. Siddiqui*, Joline W. J. Beulens, Nina van der Vliet, Nicole R. den Braver, Petra J. M. Elders, Femke Rutters

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: 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. Results: 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. Conclusions: 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.
Original languageEnglish
Pages (from-to)1808-1817
Number of pages10
JournalInternational Journal of Obesity
Issue number10
Early online date2022
Publication statusPublished - Oct 2022

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