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Atella V, Belotti F, Giaccherini M, Medea G, Nicolucci A, Sbraccia P, Mortari AP. Lifetime costs of overweight and obesity in Italy. ECONOMICS AND HUMAN BIOLOGY 2024; 53:101366. [PMID: 38354596 DOI: 10.1016/j.ehb.2024.101366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/16/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024]
Abstract
We use longitudinal electronic clinical data on a large representative sample of the Italian population to estimate the lifetime profile costs of different BMI classes - normal weight, overweight, and obese (I, II, and III) - in a primary care setting. Our research reveals that obese patients generate the highest cost differential throughout their lives compared to normal weight patients. Moreover, we show that overweight individuals spend less than those with normal weight, primarily due to reduced expenditures beginning in early middle age. Our estimates could serve as a vital benchmark for policymakers looking to prioritize public interventions that address the obesity pandemic while considering the increasing obesity rates projected by the OECD until 2030.
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Affiliation(s)
- Vincenzo Atella
- Department of Economics and Finance, Tor Vergata University of Rome, Italy; CEIS Tor Vergata, Tor Vergata University of Rome, Italy.
| | - Federico Belotti
- Department of Economics and Finance, Tor Vergata University of Rome, Italy; CEIS Tor Vergata, Tor Vergata University of Rome, Italy
| | | | - Gerardo Medea
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | | | - Paolo Sbraccia
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Andrea Piano Mortari
- Department of Economics and Finance, Tor Vergata University of Rome, Italy; Department Programming, Ministry of Health, Rome, Italy
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Wong ES, Stechuchak KM, Smith VA, Hung A, Dennis PA, Hoerster KD, Maciejewski ML. Differences in healthcare costs over 10 years following discharge from military service by weight trajectory. Obes Res Clin Pract 2024; 18:88-93. [PMID: 38565463 DOI: 10.1016/j.orcp.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
The prevalence of overweight and obesity among military personnel has increased substantially in the past two decades. Following military discharge many personnel can receive integrated health care from the Veterans Health Administration. Prior research related to the economic impacts of obesity has not examined health care costs following the transition into civilian life following military discharge. To address this evidence gap, this study sought to compare longitudinal costs over 10 years across weight categories among VA enrollees recently discharged from the military.
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Affiliation(s)
- Edwin S Wong
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, MS-152, Seattle, WA 98108, USA; Department of Health Systems and Population Health, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA.
| | - Karen M Stechuchak
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA
| | - Valerie A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC 27701, USA; Division of General Internal Medicine, Department of Medicine, Duke University, 200 Morris St., Durham, NC 27701, USA
| | - Anna Hung
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC 27701, USA
| | - Paul A Dennis
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC 27701, USA
| | - Katherine D Hoerster
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, MS-152, Seattle, WA 98108, USA; Department of Health Systems and Population Health, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC 27701, USA; Division of General Internal Medicine, Department of Medicine, Duke University, 200 Morris St., Durham, NC 27701, USA; Duke-Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC 27708, USA
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3
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Khan SS, Krefman AE, Zhao L, Liu L, Chorniy A, Daviglus ML, Schiman C, Liu K, Shih T, Garside D, Vu THT, Lloyd-Jones DM, Allen NB. Association of Body Mass Index in Midlife With Morbidity Burden in Older Adulthood and Longevity. JAMA Netw Open 2022; 5:e222318. [PMID: 35289856 PMCID: PMC8924714 DOI: 10.1001/jamanetworkopen.2022.2318] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Abundant evidence links obesity with adverse health consequences. However, controversies persist regarding whether overweight status compared with normal body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is associated with longer survival and whether this occurs at the expense of greater long-term morbidity and health care expenditures. OBJECTIVE To examine the association of BMI in midlife with morbidity burden, longevity, and health care expenditures in adults 65 years and older. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study at the Chicago Heart Association Detection Project in Industry, with baseline in-person examination between November 1967 and January 1973 linked with Medicare follow-up between January 1985 and December 2015. Participants included 29 621 adults who were at least age 65 years in follow-up and enrolled in Medicare. Data were analyzed from January 2020 to December 2021. EXPOSURES Standard BMI categories. MAIN OUTCOMES AND MEASURES (1) Morbidity burden at 65 years and older assessed with the Gagne combined comorbidity score (ranging from -2 to 26, with higher score associated with higher mortality), which is a well-validated index based on International Classification of Diseases, Ninth Revision codes for use in administrative data sets; (2) longevity (age at death); and (3) health care costs based on Medicare linkage in older adulthood (aged ≥65 years). RESULTS Among 29 621 participants, mean (SD) age was 40 (12) years, 57.1% were men, and 9.1% were Black; 46.0% had normal BMI, 39.6% were overweight, and 11.9% had classes I and II obesity at baseline. Higher cumulative morbidity burden in older adulthood was observed among those who were overweight (7.22 morbidity-years) and those with classes I and II obesity (9.80) compared with those with a normal BMI (6.10) in midlife (P < .001). Mean age at death was similar between those who were overweight (82.1 years [95% CI, 81.9-82.2 years]) and those who had normal BMI (82.3 years [95% CI, 82.1-82.5 years]) but shorter in those who with classes I and II obesity (80.8 years [95% CI, 80.5-81.1 years]). The proportion (SE) of life-years lived in older adulthood with Gagne score of at least 1 was 0.38% (0.00%) in those with a normal BMI, 0.41% (0.00%) in those with overweight, and 0.43% (0.01%) in those with classes I and II obesity. Cumulative median per-person health care costs in older adulthood were significantly higher among overweight participants ($12 390 [95% CI, $10 427 to $14 354]) and those with classes I and II obesity ($23 396 [95% CI, $18 474 to $28 319]) participants compared with those with a normal BMI (P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, overweight in midlife, compared with normal BMI, was associated with higher cumulative burden of morbidity and greater proportion of life lived with morbidity in the context of similar longevity. These findings translated to higher total health care expenditures in older adulthood for those who were overweight in midlife.
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Affiliation(s)
- Sadiya S. Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy E. Krefman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lei Liu
- Division of Biostatistics, Washington University in St Louis, St Louis, Missouri
| | - Anna Chorniy
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Martha L. Daviglus
- Institute for Minority Health Research, College of Medicine, University of Illinois at Chicago, Chicago
| | - Cuiping Schiman
- Department of Economics, Georgia Southern University, Statesboro
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tina Shih
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel Garside
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Thanh-Huyen T. Vu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M. Lloyd-Jones
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norrina B. Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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4
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Goldman DP, Cohen BG, Ho JY, McFadden DL, Ryan MS, Tysinger B. Improved survival for individuals with common chronic conditions in the Medicare population. HEALTH ECONOMICS 2021; 30 Suppl 1:80-91. [PMID: 32996226 DOI: 10.1002/hec.4168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/28/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
It is well established that the United States lags behind peer nations in life expectancy, but it is less established that there is heterogeneity in life expectancy trends. We compared mortality trends from 2004 to 2014 for the United States with 17 high-income countries for persons under and over 65. The United States ranked last in survival gains for the young but ranked near the middle for persons over 65, the group with universal access to public insurance. To explore the over-65 mortality trend, we estimated Cox proportional hazards models for individuals soon after entering Medicare. These were estimated separately by race and sex, controlling for 26 chronic conditions and condition-specific time trends. The separate regressions enabled survival comparisons for the 2004 and 2014 cohorts by race and sex, conditional on baseline health. We predicted 5-year survival for all combinations of diabetes, hyperlipidemia, hypertension, and ischemic heart disease (IHD). All 16 combinations of these conditions showed survival gains, with diabetes as a key driver. Notably, survival improved and racial disparities narrowed for individuals with diabetes, hypertension, and IHD. White females, black females, white males, and black males gained 3.61, 3.90, 3.57, and 5.89 percentage points in 5-year survival, respectively.
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Affiliation(s)
- Dana P Goldman
- USC School of Pharmacy, University of Southern California, Los Angeles, California, USA
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
| | - Benjamin G Cohen
- USC School of Pharmacy, University of Southern California, Los Angeles, California, USA
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
| | - Jessica Y Ho
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
- Leonard Davis School of Gerontology and Department of Sociology, University of Southern California, Los Angeles, California, USA
| | - Daniel L McFadden
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
- University of California, Berkeley, California, USA
| | - Martha S Ryan
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
| | - Bryan Tysinger
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
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Schell RC, Just DR, Levitsky DA. Methodological Challenges in Estimating the Lifetime Medical Care Cost Externality of Obesity. JOURNAL OF BENEFIT-COST ANALYSIS 2021; 12:441-465. [PMID: 35419252 PMCID: PMC9004795 DOI: 10.1017/bca.2021.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
There is a great deal of variability in estimates of the lifetime medical care cost externality of obesity, partly due to a lack of transparency in the methodology behind these cost models. Several important factors must be considered in producing the best possible estimate, including age-related weight gain, differential life expectancy, identifiability, and cost model selection. In particular, age-related weight gain represents an important new component to recent cost estimates. Without accounting for age-related weight gain, a study relies on the untenable assumption that people remain the same weight throughout their lives, leading to a fundamental misunderstanding of the evolution and development of the obesity crisis. This study seeks to inform future researchers on the best methods and data available both to estimate age-related weight gain and to accurately and consistently estimate obesity's lifetime external medical care costs. This should help both to create a more standardized approach to cost estimation as well as encourage more transparency between all parties interested in the question of obesity's lifetime cost and, ultimately, evaluating the benefits and costs of interventions targeting obesity at various points in the life course.
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Affiliation(s)
- Robert C Schell
- School of Public Health, University of California at Berkeley, 2121 Berkeley Way 5302, Berkeley, CA 94720
| | - David R Just
- Charles H. Dyson School of Applied Economics and Management, Cornell University, 137 Reservoir Ave, Ithaca NY 14850
| | - David A Levitsky
- College of Human Ecology, Cornell University, Martha Van Rensselaer Hall, Ithaca, NY 14850
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Dereń K, Wyszyńska J, Nyankovskyy S, Nyankovska O, Yatsula M, Łuszczki E, Sobolewski M, Mazur A. Secular Trends of Underweight, Overweight, and Obesity in Children and Adolescents from Ukraine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063302. [PMID: 33806798 PMCID: PMC8004989 DOI: 10.3390/ijerph18063302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 12/19/2022]
Abstract
Overweight and obesity, as well as underweight in children and adolescents, pose a significant public health issue. This study aimed to investigate the secular trend of the incidence of underweight, overweight, and obesity in children from Ukraine in 2013/2014 and 2018/2019. The studies were conducted in randomly selected primary and secondary schools in Ukraine. In total, 13,447 children (6468 boys and 6979 girls) participated in the study in 2013/2014 and 18,144 children (8717 boys and 9427 girls) participated in 2018/2019. Measurements of body weight and height were performed in triplicate. Underweight, overweight, and obesity were diagnosed according to the standards of the World Health Organization (WHO). In the group of girls, a significant difference between 2013/2014 and 2018/2019 measurements was found only among 7-year-olds. The percentage of girls at this age exceeding the body mass index (BMI) norm was lower in the 2018/2019 study. In boys, a significant difference was also found in 7-year-olds, and, as in girls, a lower share of overweight and obesity was found in 2018/2019. But for the ages of 12, 13, and 15, the significant differences had a different character-more overweight or obese boys were found in the 2018/2019 study. The proportion of underweight children was similar for the majority of age groups in both genders and did not differ in a statistically significant way.
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Affiliation(s)
- Katarzyna Dereń
- Institute of Health Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (J.W.); (S.N.); (E.Ł.)
- Correspondence: ; Tel.: +48-17-851-89-61
| | - Justyna Wyszyńska
- Institute of Health Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (J.W.); (S.N.); (E.Ł.)
| | - Serhiy Nyankovskyy
- Institute of Health Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (J.W.); (S.N.); (E.Ł.)
- Pediatrics Department #1, Danylo Halytsky L’viv National Medical University, 79010 Lviv, Ukraine;
| | - Olena Nyankovska
- Department of Pediatrics and Neonatology, Danylo Halytsky L’viv National Medical University, 79010 Lviv, Ukraine;
| | - Marta Yatsula
- Pediatrics Department #1, Danylo Halytsky L’viv National Medical University, 79010 Lviv, Ukraine;
| | - Edyta Łuszczki
- Institute of Health Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (J.W.); (S.N.); (E.Ł.)
| | - Marek Sobolewski
- Faculty of Management, Rzeszow University of Technology, 35-959 Rzeszow, Poland;
| | - Artur Mazur
- Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland;
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7
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O'Halloran R, Mihaylova B, Cairns BJ, Kent S. BMI and Cause-Specific Hospital Admissions and Costs: The UK Biobank Cohort Study. Obesity (Silver Spring) 2020; 28:1332-1341. [PMID: 32437090 DOI: 10.1002/oby.22812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/20/2020] [Accepted: 03/10/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To estimate the effect of BMI on cause-specific hospital admissions and costs in men and women is not well understood, and this study's aim is to address this. METHODS For 451,320 men and women aged 40 years or older recruited into the UK Biobank, followed up for 6 years on average, this study estimated annual rates and costs (at 2016 UK prices) of hospital admissions, overall and by diagnostic category (using International Classification of Diseases, Tenth Revision chapters), in relation to BMI. RESULTS Among those who were never smokers, a 2-kg/m2 higher BMI (above 20 kg/m2 ) was associated with a 6.2% (99% CI: 5.3% to 7.2%) higher admission rate and an 8.6% (99% CI: 7.3% to 10.0%) higher annual cost in men and with a 5.7% (99% CI: 4.9% to 6.6%) higher admission rate and an 8.4% (99% CI: 7.5% to 9.3%) higher annual cost in women. Higher BMI was associated with higher admission rates and costs for many types of health conditions, particularly for endocrine, skin, and musculoskeletal disorders in both men and women and for circulatory diseases in men. CONCLUSIONS BMI beyond healthy weight is strongly associated with higher annual rates of hospital admission and higher costs in both men and women across a wide range of health conditions.
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Affiliation(s)
- Richard O'Halloran
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Benjamin J Cairns
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Seamus Kent
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Science Policy and Research, National Institute for Health and Care Excellence, London, UK
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8
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Melaro JA, Majaj RM, Powell DW, DeVita P, Paquette MR. Lower Limb Joint Kinetics During Walking in Middle-Aged Runners With Low or High Lifetime Running Exposure. J Appl Biomech 2020; 36:126-133. [PMID: 32126525 DOI: 10.1123/jab.2019-0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 11/18/2022]
Abstract
Aging is associated with a distal-to-proximal shift in joint kinetics during walking. This plasticity of gait is amplified rather than attenuated in old adults with high physical capacity. Because running is associated with greater kinetic demands at the ankle, older individuals with more versus less lifetime running exposure may retain a larger proportion of their ankle kinetics. The purpose of the study was to compare lower-extremity joint kinetics during walking between middle-aged runners with high and low lifetime running exposure. Eighteen middle-aged runners (9 per group) participated. Joint kinetics were calculated from kinematic and ground reaction force data during overground walking at 1.3 m·s-1 and compared between groups. High exposure runners produced 50% greater positive hip work (P = .03; Cohen d = 1.02) during walking compared with low exposure runners, but ankle kinetics were not different between groups. No other differences in joint kinetics or kinematics were observed between groups. These findings suggest that the age-related increase in hip joint kinetics during walking could be a compensatory gait strategy that is not attenuated by lifetime running exposure alone. Finally, the amount of lifetime running exposure did not affect ankle kinetics during walking in middle-aged runners.
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9
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Edwards CH, Aas E, Kinge JM. Body mass index and lifetime healthcare utilization. BMC Health Serv Res 2019; 19:696. [PMID: 31615572 PMCID: PMC6794833 DOI: 10.1186/s12913-019-4577-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/30/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Overweight and obesity is a major global public health challenge, and understanding the implications for healthcare systems is essential for policy planning. Past studies have typically found positive associations between obesity and healthcare utilization, but these studies have not taken into consideration that obesity is also associated with early mortality. We examined associations between body mass index (BMI, reported as kg/m2) and healthcare utilization with and without taking BMI-specific survival into consideration. METHODS We used nationally representative data on 33 882 adults collected between 2002 and 2015. We computed BMI- and age-specific primary and secondary care utilization and multiplied the estimated values with gender-, age-, and BMI-specific probabilities of surviving to each age. Then, we summed the average BMI-specific utilization between 18 and 85 years. RESULTS During a survival-adjusted lifetime, males with normal weight (BMI: 18.5-24.9) had, on average, 167 primary care, and 77 secondary care contacts. In comparison, males with overweight (BMI: 25.0-29.9), category I obesity (BMI: 30.0-34.9), and category II/III obesity (BMI ≥35.0) had 11%, 41%, and 102% more primary care, and 14%, 29%, and 78% more secondary care contacts, respectively. Females with normal weight had, on average, 210 primary care contacts and 91 secondary care contacts. Females with overweight, category I obesity, and category II/III obesity had 20%, 34%, and 81% more primary care contacts, and 26%, 16%, and 16% more secondary care contacts, respectively. CONCLUSION The positive association between BMI and healthcare utilization was reduced, but not offset, when BMI-specific survival was taken into consideration. Our findings underpin previous research and suggest that interventions to offset the increasing prevalence of overweight, and especially obesity, are warranted.
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Affiliation(s)
- Christina Hansen Edwards
- Centre for Fertility and Health, Norwegian Institute of Public Health, Folkehelseinstituttet, Postboks 222 Skøyen, 0213, Oslo, Norway.
| | - Eline Aas
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Postboks 1089, Blindern, 0317, Oslo, Norway
| | - Jonas Minet Kinge
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Postboks 1089, Blindern, 0317, Oslo, Norway
- Centre for Fertility and Health & Centre for Disease Burden, Norwegian Institute of Public Health, Oslo, Norway
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10
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Dong Y, Branscum P. What Motivates Individuals to Get Obesity Related Direct-To-Consumer Genetic Tests? A Reasoned Action Approach. AMERICAN JOURNAL OF HEALTH EDUCATION 2019. [DOI: 10.1080/19325037.2019.1663379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Khan SS, Ning H, Wilkins JT, Allen N, Carnethon M, Berry JD, Sweis RN, Lloyd-Jones DM. Association of Body Mass Index With Lifetime Risk of Cardiovascular Disease and Compression of Morbidity. JAMA Cardiol 2019; 3:280-287. [PMID: 29490333 DOI: 10.1001/jamacardio.2018.0022] [Citation(s) in RCA: 509] [Impact Index Per Article: 101.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Importance Prior studies have demonstrated lower all-cause mortality in individuals who are overweight compared with those with normal body mass index (BMI), but whether this may come at the cost of greater burden of cardiovascular disease (CVD) is unknown. Objective To calculate lifetime risk estimates of incident CVD and subtypes of CVD and to estimate years lived with and without CVD by weight status. Design, Setting, and Participants In this population-based study, we used pooled individual-level data from adults (baseline age, 20-39, 40-59, and 60-79 years) across 10 large US prospective cohorts, with 3.2 million person-years of follow-up from 1964 to 2015. All participants were free of clinical CVD at baseline with available BMI index and CVD outcomes data. Data were analyzed from October 2016 to July 2017. Exposures World Health Organization-standardized BMI categories. Main Outcomes and Measures Total CVD and CVD subtype, including fatal and nonfatal coronary heart disease, stroke, congestive heart failure, and other CVD deaths. Heights and weights were measured directly by investigators in each study, and BMI was calculated as weight in kilograms divided by height in meters squared. We performed (1) modified Kaplan-Meier analysis to estimate lifetime risks, (2) adjusted competing Cox models to estimate joint cumulative risks for CVD or noncardiovascular death, and (3) the Irwin restricted mean to estimate years lived free of and with CVD. Results Of the 190 672 in-person examinations included in this study, the mean (SD) age was 46.0 (15.0) years for men and 58.7 (12.9) years for women, and 140 835 patients (73.9%) were female. Compared with individuals with a normal BMI (defined as a BMI of 18.5 to 24.9), lifetime risks for incident CVD were higher in middle-aged adults in the overweight and obese groups. Compared with normal weight, among middle-aged men and women, competing hazard ratios for incident CVD were 1.21 (95% CI, 1.14-1.28) and 1.32 (95% CI, 1.24-1.40), respectively, for overweight (BMI, 25.0-29.9), 1.67 (95% CI, 1.55-1.79) and 1.85 (95% CI, 1.72-1.99) for obesity (BMI, 30.0-39.9), and 3.14 (95% CI, 2.48-3.97) and 2.53 (95% CI, 2.20-2.91) for morbid obesity (BMI, ≥40.0). Higher BMI had the strongest association with incident heart failure among CVD subtypes. Average years lived with CVD were longer for middle-aged adults in the overweight and obese groups compared with adults in the normal BMI group. Similar patterns were observed in younger and older adults. Conclusions and Relevance In this study, obesity was associated with shorter longevity and significantly increased risk of cardiovascular morbidity and mortality compared with normal BMI. Despite similar longevity compared with normal BMI, overweight was associated with significantly increased risk of developing CVD at an earlier age, resulting in a greater proportion of life lived with CVD morbidity.
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Affiliation(s)
- Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John T Wilkins
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norrina Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mercedes Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jarett D Berry
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas.,Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Ranya N Sweis
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M Lloyd-Jones
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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12
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Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: What Is More Effective, Aerobic or Resistance Exercise for Obese Older Adults? Am J Phys Med Rehabil 2019; 98:e28-e31. [PMID: 30893075 DOI: 10.1097/phm.0000000000001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Estrella ML, Pirzada A, Durazo-Arvizu RA, Cai J, Giachello AL, Espinoza Gacinto R, Siega-Riz AM, Daviglus ML. Correlates of and Body Composition Measures Associated with Metabolically Healthy Obesity Phenotype in Hispanic/Latino Women and Men: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). J Obes 2019; 2019:1251456. [PMID: 30775036 PMCID: PMC6350597 DOI: 10.1155/2019/1251456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/27/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Individuals with "metabolically healthy obesity" (MHO) phenotype (i.e., obesity and absence of cardiometabolic abnormalities: favorable levels of blood pressure, lipids, and glucose) experience lower risk of cardiovascular disease compared with those with "metabolically at-risk obesity" (MAO) phenotype (i.e., obesity with concurrent cardiometabolic abnormalities). Among Hispanic/Latino women and men with obesity, limited data exist on the correlates of and body composition measures associated with obesity phenotypes. METHODS Data from the Hispanic Community Health Study/Study of Latinos (2008-2011) were used to estimate the age-adjusted distribution of obesity phenotypes among 5,426 women and men (aged 20-74 years) with obesity (BMI ≥ 30 kg/m2) and to compare characteristics between individuals with MHO and MAO phenotypes. Weighted Poisson regression models were used to examine cross-sectional associations between 1-standard deviation (SD) increase in body composition measures (i.e., body fat percentage, waist circumference, and body lean mass) and MHO phenotype prevalence. RESULTS The age-adjusted proportion of the MHO phenotype was low (i.e., 12.5% in women and 6.5% in men). In bivariate analyses, women and men with the MHO phenotype were more likely to be younger, have higher education and acculturation levels, report lower lifetime cigarette use, and have fasting insulin and waist circumference levels than MAO. Adjusting for sociodemographic and lifestyle factors, among women, each 1-SD increase in body fat percentage, waist circumference, and lean body mass was, respectively, associated with a 21%, 33%, and 31% lower prevalence of the MHO phenotype. Among men, each 1-SD increase in waist circumference and lean body mass was, respectively, associated with a 20% and 15% lower prevalence of the MHO phenotype. CONCLUSIONS We demonstrated that higher waist circumference and higher lean body mass were independently associated with a lower proportion of the MHO phenotype in Hispanic/Latino women and men. Findings support the need for weight reduction interventions to manage cardiometabolic health among Hispanics/Latinos.
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Affiliation(s)
- Mayra L. Estrella
- Institute for Minority Health Research, University of Illinois at Chicago, 1819 West Polk Street, Chicago, IL 60612, USA
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois at Chicago, 1819 West Polk Street, Chicago, IL 60612, USA
| | - Ramon A. Durazo-Arvizu
- Division of Biostatistics, Public Health Sciences, Loyola University Chicago, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Jianwen Cai
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, 123 W. Franklin Street, Chapel Hill, NC 27516, USA
| | - Aida L. Giachello
- Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Dr Suite, Chicago, IL 60611, USA
| | - Rebeca Espinoza Gacinto
- Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Anna Maria Siega-Riz
- School of Nursing and Departments of Public Health Sciences and Obstetrics and Gynecology, School of Medicine, University of Virginia, P.O. Box 800717, Charlottesville, VA 22908, USA
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, 1819 West Polk Street, Chicago, IL 60612, USA
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14
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Levine ME, Crimmins EM. Is 60 the New 50? Examining Changes in Biological Age Over the Past Two Decades. Demography 2018; 55:387-402. [PMID: 29511995 DOI: 10.1007/s13524-017-0644-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Increasing life expectancy has been interpreted as improving health of a population. However, mortality is not always a reliable proxy for the pace of aging and could instead reflect achievement in keeping ailing people alive. Using data from NHANES III (1988-1994) and NHANES IV (2007-2010), we examined how biological age, relative to chronological age, changed in the United States between 1988 and 2010, while estimating the contribution of changes in modifiable health behaviors. Results suggest that biological age is lower for more recent periods; however, the degree of improvement varied across age and sex groups. Overall, older adults experienced the greatest improvement or decreases in biological age. Males, especially those in the youngest and oldest groups, experienced greater declines in biological age than females. These differences were partially explained by age- and sex-specific changes in behaviors, such as smoking, obesity, and medication use. Slowing the pace of aging, along with increasing life expectancy, has important social and economic implications; thus, identifying modifiable risk factors that contribute to cohort differences in health and aging is essential.
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Affiliation(s)
- Morgan E Levine
- Department of Pathology, Yale School of Medicine, New Haven, CT, 06510, USA.
| | - Eileen M Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, 90089, USA
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15
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Kim GL, Hwang HR, Kim YJ, Lee SY, Lee JG, Jeong DW, Yi YH, Tak YJ, Lee SH, Park AR. The Association of Body Fat and Arterial Stiffness Using the Brachial-Ankle Pulse Wave Velocity. Korean J Fam Med 2018; 39:347-354. [PMID: 30376701 PMCID: PMC6250948 DOI: 10.4082/kjfm.17.0045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/12/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND BMI alone may not serve as an index of obesity because it does not reflect body composition. The present study aimed to compare arterial stiffness as assessed by the brachial-ankle pulse wave velocity (ba-PWV) among groups defined by body fat percentage (pBF) and BMI. METHODS This cross-sectional study was based on 1,700 participants (1,044 men and 656 women) who completed a health screening examination at a national hospital between January 2011 and February 2016. Participants were divided into four groups according to BMI and pBF: normal fat and normal weight (NFNW); excessive fat and normal weight (EFNW); normal fat and obese (NFO); and excessive fat and obese (EFO). The ba-PWV and other cardiometabolic factors were compared among the four groups in men and women separately. RESULTS For both sexes, the NFNW group had a lower metabolic risk compared to that in the other groups (EFNW, NFO, and EFO). After adjusting for multiple variables, the NFO males had a significantly lower ba-PWV compared to those in the other groups, including NFNW males. The NFO group had significantly more skeletal muscle mass and muscle mass compared the other groups (P<0.05). Among women, the NFNW group had a significantly lower ba-PWV compared the other groups, even after adjusting for multiple variables. CONCLUSION Lower pBF in obese men may be associated with improved cardiovascular risk.
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Affiliation(s)
- Gyu Lee Kim
- Department of Family Medicine, Pusan National University Hospital, Busan, Korea
| | - Hye Rim Hwang
- Department of Family Medicine, Pusan National University Hospital, Busan, Korea.,Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Yun Jin Kim
- Department of Family Medicine, Pusan National University Hospital, Busan, Korea.,Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sang Yeoup Lee
- Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea.,Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,Medical Education Unit and Medical Research Institute, Pusan National University School of Medicine, Yangsan, Korea
| | - Jeong Gyu Lee
- Department of Family Medicine, Pusan National University Hospital, Busan, Korea.,Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Dong Wook Jeong
- Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea.,Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yu Hyeon Yi
- Department of Family Medicine, Pusan National University Hospital, Busan, Korea.,Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Young Jin Tak
- Department of Family Medicine, Pusan National University Hospital, Busan, Korea.,Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seung Hun Lee
- Department of Family Medicine, Pusan National University Hospital, Busan, Korea.,Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea
| | - A Rum Park
- Department of Family Medicine, Pusan National University Hospital, Busan, Korea
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16
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Willis BL, Leonard D, Barlow CE, Martin SB, DeFina LF, Trivedi MH. Association of Midlife Cardiorespiratory Fitness With Incident Depression and Cardiovascular Death After Depression in Later Life. JAMA Psychiatry 2018; 75:911-917. [PMID: 29955781 PMCID: PMC6142909 DOI: 10.1001/jamapsychiatry.2018.1467] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Cardiorespiratory fitness (hereinafter referred to as fitness) as estimated by exercise testing is a modifiable risk factor independently associated with chronic diseases, cardiovascular disease (CVD) events, and mortality, but the association of fitness at midlife with incidence of later-life depression and the risk of CVD mortality after a depression diagnosis is unknown. OBJECTIVE To determine whether fitness measured in midlife would be inversely associated with later-life CVD mortality with antecedent depression. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study at a single-center, community-based preventive medicine clinic was performed as part of the Cooper Center Longitudinal Study. Data were collected from January 13, 1971, through December 31, 2009, and analyzed from October 6, 2015, through August 14, 2017. Participants included generally healthy men and women who presented for preventive medicine examinations at midlife and who were eligible for Medicare from 1999 to 2010. Those with a self-reported history of depression, myocardial infarction, or stroke at examination were excluded. EXPOSURES Objective midlife fitness estimated from results of treadmill exercise testing. MAIN OUTCOMES AND MEASURES Depression diagnosis from Medicare claims files using established algorithms and CVD mortality from National Death Index records. RESULTS A total of 17 989 participants (80.2% men) with a mean (SD) age of 50.0 (8.7) years were included. After 117 218 person-years of Medicare follow-up, 2701 depression diagnoses, 610 deaths due to CVD without prior depression, and 231 deaths due to CVD after depression were observed. A high level of fitness in midlife was associated with a 16% lower risk of depression (hazard ratio [HR], 0.84; 95% CI, 0.74-0.95) compared with a low level of fitness. A high fitness level was also associated with a 61% lower risk of death due to CVD without depression (HR, 0.39; 95% CI, 0.31-0.48) compared with a low level of fitness. After a diagnosis of depression, a high fitness level was associated with a 56% lower risk of death due to CVD (HR, 0.44; 95% CI, 0.31-0.64) compared with a low fitness level. CONCLUSIONS AND RELEVANCE Midlife fitness is associated with a lower risk of later-life depression, CVD mortality, and CVD mortality after incident later-life depression. These findings suggest the importance of midlife fitness in primary prevention of depression and subsequent CVD mortality in older age and should encourage physicians to consider fitness and physical activity in promoting healthy aging.
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Affiliation(s)
| | | | | | - Scott B. Martin
- Department of Kinesiology, Recreation, and Health Promotion, University of North Texas, Denton
| | | | - Madhukar H. Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
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17
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Kroeger RA, Frank R. Race-Ethnicity, Union Status, and Change in Body Mass Index in Young Adulthood. JOURNAL OF MARRIAGE AND THE FAMILY 2018; 80:444-462. [PMID: 29773921 PMCID: PMC5950716 DOI: 10.1111/jomf.12454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 10/09/2017] [Indexed: 06/08/2023]
Abstract
This study used data from three waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health) and fixed-effects regression to consider whether associations between change in union status and change in BMI were moderated by race/ethnicity. The results indicated that intimate unions were differentially associated with gains in BMI along race/ethnic lines, especially for women. Compared to White women, marriage was associated with larger increases in BMI for Black, Hispanic and Multiracial women, and cohabitation was associated with larger increases for Black and Hispanic women. In contrast, both marriage and cohabitation were associated with less weight gain for Asian compared to White women. Among men, racial/ethnic differences in the relationship between union status and BMI were similarly patterned but less pronounced. The results suggest that, particularly for women, marital status-already its own source of stratification, further exacerbates racial/ethnic disparities in BMI from adolescence to young adulthood.
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Affiliation(s)
| | - Reanne Frank
- Department of Sociology, The Ohio State University
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18
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Goodnough LH, Finlay AK, Huddleston JI, Goodman SB, Maloney WJ, Amanatullah DF. Obesity Is Independently Associated With Early Aseptic Loosening in Primary Total Hip Arthroplasty. J Arthroplasty 2018; 33:882-886. [PMID: 29089226 DOI: 10.1016/j.arth.2017.09.069] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Obesity affects millions of patients in the United States and is associated with several complications after total hip arthroplasty (THA). The effect of obesity on the rate and mode of primary THA failure remains poorly understood, especially given other potentially confounding patient characteristics. We hypothesized that, among patients with a failed primary THA, obesity is independently associated with aseptic loosening and a higher rate of early revision. METHODS Six hundred eighty-four consecutive cases with failed THA referred to a single academic center for revision during a 10-year period were retrospectively reviewed. Multivariate logistic regression analysis was used to test the independent association between obesity and the timing as well as cause of THA failure. RESULTS The rate of primary THA failure before 5 years was 48.8% in obese and 37.1% in nonobese patients (odds ratio [OR] = 1.57, P = .010). Primary THA failure before 5 years was more likely with increasing body mass index (BMI) (BMI: 35-40 kg/m2, OR = 2.31, P = .008; BMI >40 kg/m2, OR = 2.51, P = .049). The rate of primary THA failure for aseptic loosening before 5 years was 30% in obese and 18% in nonobese patients (OR = 1.88, P = .023). Obesity was not a risk for revision for infection, whereas an American Society of Anesthesiologists class ≥3 was independently associated with primary THA failure for infection (OR = 2.33, P < .001). CONCLUSION Among patients with a failed THA, comorbidities may account for the risk of revision due to infection in obese patients. Obesity is independently associated with early primary THA failure for aseptic loosening.
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Affiliation(s)
- Lawrence H Goodnough
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, Stanford, California
| | - Andrea K Finlay
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, Stanford, California
| | - James I Huddleston
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, Stanford, California
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, Stanford, California
| | - William J Maloney
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, Stanford, California
| | - Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, Stanford, California
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19
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Hurr C, Patik JC, Kim K, Brothers RM. Blunted cerebral vascular responsiveness to hypercapnia in obese individuals. Exp Physiol 2017; 102:1300-1308. [DOI: 10.1113/ep086446] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/18/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Chansol Hurr
- Department of Kinesiology and Health Education; University of Texas at Austin; Austin TX USA
- Department of Pharmacology and Physiology; George Washington University; DC USA
| | - Jordan C. Patik
- Department of Kinesiology and Health Education; University of Texas at Austin; Austin TX USA
- Department of Kinesiology; University of Texas at Arlington; Arlington TX USA
| | - KiYoung Kim
- Department of Kinesiology and Health Education; University of Texas at Austin; Austin TX USA
- Department of Pathology; University of Alabama at Birmingham; Birmingham AL USA
| | - R. Matthew Brothers
- Department of Kinesiology and Health Education; University of Texas at Austin; Austin TX USA
- Department of Kinesiology; University of Texas at Arlington; Arlington TX USA
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20
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Kent S, Fusco F, Gray A, Jebb SA, Cairns BJ, Mihaylova B. Body mass index and healthcare costs: a systematic literature review of individual participant data studies. Obes Rev 2017; 18:869-879. [PMID: 28544197 DOI: 10.1111/obr.12560] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/15/2017] [Accepted: 03/31/2017] [Indexed: 11/28/2022]
Abstract
Excess weight is associated with increased total healthcare costs, but it is less well known how the associations between excess weight and costs vary across different types of healthcare service. We reviewed studies using individual participant data to estimate associations between body mass index and healthcare costs, and summarized how annual healthcare costs for overweight (body mass index 25 to <30 kg/m2 ) and obese (≥30 kg/m2 ) individuals compared with those for healthy weight individuals (18.5 to <25 kg/m2 ). EMBASE and MEDLINE were searched from January 1990 to September 2016, and 75 studies were included in the review. Of these, 34 studies presented adequate information to contribute to a quantitative summary of results. Compared with individuals at healthy weight, the median increases in mean total annual healthcare costs were 12% for overweight and 36% for obese individuals. The percentage increases in costs were highest for medications (18% for overweight and 68% for obese), followed by inpatient care (12% and 34%) and ambulatory care (4% and 26%). Percentage increases in costs associated with obesity were higher for women than men. The substantial costs associated with excess weight in different healthcare settings emphasize the need for investment to tackle this major public health problem.
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Affiliation(s)
- Seamus Kent
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Francesco Fusco
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Services, University of Oxford, Oxford, UK
| | - Benjamin J Cairns
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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21
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Kent S, Green J, Reeves G, Beral V, Gray A, Jebb SA, Cairns BJ, Mihaylova B. Hospital costs in relation to body-mass index in 1·1 million women in England: a prospective cohort study. Lancet Public Health 2017; 2:e214-e222. [PMID: 29253487 PMCID: PMC6196771 DOI: 10.1016/s2468-2667(17)30062-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/17/2017] [Accepted: 02/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Excess weight is associated with poor health and increased health-care costs. However, a detailed understanding of the effects of excess weight on total hospital costs and costs for different health conditions is needed. METHODS Women in England aged 50-64 years were recruited into the prospective Million Women Study cohort in 1996-2001 through 60 NHS breast cancer screening centres. Participants were followed up and annual hospital costs and admission rates were estimated for April 1, 2006, to March 31, 2011, in relation to body-mass index (BMI) at recruitment, overall and for categories of health conditions defined by the International Classification of Diseases 10th revision chapter of the primary diagnosis at admission. Associations of BMI with hospital costs were projected to the 2013 population of women aged 55-79 years in England. FINDINGS 1 093 866 women who provided information on height and weight, had a BMI of at least 18·5 kg/m2, and had no previous cancer at recruitment, were followed up for an average of 4·9 years from April 1, 2006 (12·3 years from recruitment), during which time 1·84 million hospital admissions were recorded. Annual hospital costs were lowest for women with a BMI of 20·0 kg/m2 to less than 22·5 kg/m2 (£567 per woman per year, 99% CI 556-577). Every 2 kg/m2 increase in BMI above 20 kg/m2 was associated with a 7·4% (7·1-7·6) increase in annual hospital costs. Excess weight was associated with increased costs for all diagnostic categories, except respiratory conditions and fractures. £662 million (14·6%) of the estimated £4·5 billion of total annual hospital costs among all women aged 55-79 years in England was attributed to excess weight (BMI ≥25 kg/m2), of which £517 million (78%) arose from hospital admissions with procedures. £258 million (39%) of the costs attributed to excess weight were due to musculoskeletal admissions, mainly for knee replacement surgeries. INTERPRETATION Excess body weight is associated with increased hospital costs for middle-aged and older women in England across a broad range of conditions, especially knee replacement surgery and diabetes. These results provide reliable up-to-date estimates of the health-care costs of excess weight and emphasise the need for investment to tackle this public health issue. FUNDING Cancer Research UK; Medical Research Council; National Institute for Health Research.
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Affiliation(s)
- Seamus Kent
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Jane Green
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gillian Reeves
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Valerie Beral
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Benjamin J Cairns
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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22
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Kroeger RA. Union Status, Educational Attainment, and Body Mass Index Among Emerging Adults. EMERGING ADULTHOOD (PRINT) 2017; 5:357-363. [PMID: 29430339 PMCID: PMC5802423 DOI: 10.1177/2167696817701601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study uses fixed-effects regression modeling and three waves of data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine whether union status and educational attainment interact to influence change in body mass index (BMI) during emerging adulthood. The results support the hypothesis that the effect of union status on change in BMI is smaller for those with more educational attainment. In particular, emerging adults with no college education experience significant increases in BMI associated with both marriage and cohabitation. The increases in BMI associated with marriage and cohabitation are significantly smaller for those with some college education-but are still somewhat present. Among emerging adults with college degrees, however, involvement in cohabitation/marriage is not associated with increases in BMI at all. Potential explanations for this pattern of results and suggestions for future research are discussed.
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23
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Sairenchi T, Iso H, Yamagishi K, Irie F, Nagao M, Umesawa M, Haruyama Y, Kobashi G, Watanabe H, Ota H. Impact and attribute of each obesity-related cardiovascular risk factor in combination with abdominal obesity on total health expenditures in adult Japanese National Health insurance beneficiaries: The Ibaraki Prefectural health study. J Epidemiol 2017; 27:354-359. [PMID: 28258883 PMCID: PMC5549251 DOI: 10.1016/j.je.2016.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 08/13/2016] [Indexed: 12/15/2022] Open
Abstract
Background The aim of this study was to examine the attribution of each cardiovascular risk factor in combination with abdominal obesity (AO) on Japanese health expenditures. Methods The health insurance claims of 43,469 National Health Insurance beneficiaries aged 40–75 years in Ibaraki, Japan, from the second cohort of the Ibaraki Prefectural Health Study were followed-up from 2009 through 2013. Multivariable health expenditure ratios (HERs) of diabetes mellitus (DM), high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C), and hypertension with and without AO were calculated with reference to no risk factors using a Tweedie regression model. Results Without AO, HERs were 1.58 for DM, 1.06 for high LDL-C, 1.27 for low HDL-C, and 1.31 for hypertension (all P < 0.05). With AO, HERs were 1.15 for AO, 1.42 for DM, 1.03 for high LDL-C, 1.11 for low HDL-C, and 1.26 for hypertension (all P < 0.05, except high LDL-C). Without AO, population attributable fractions (PAFs) were 2.8% for DM, 0.8% for high LDL-C, 0.7% for low HDL-C, and 6.5% for hypertension. With AO, PAFs were 1.0% for AO, 2.3% for DM, 0.4% for low HDL-C, and 5.0% for hypertension. Conclusions Of the obesity-related cardiovascular risk factors, hypertension, independent of AO, appears to impose the greatest burden on Japanese health expenditures. The highest population attributable fraction was for hypertension without obesity. The total population attributable fraction of hypertension was 11.7%. Hypertension could impose the greatest attribute on Japanese health expenditures.
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Affiliation(s)
- Toshimi Sairenchi
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsugagun-Mibu, Japan; Ibaraki Health Plaza, Mito, Japan; Ibaraki Health Service Association, Mito, Japan.
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazumasa Yamagishi
- Ibaraki Health Plaza, Mito, Japan; Ibaraki Health Service Association, Mito, Japan; Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Fujiko Irie
- Department of Health and Welfare, Ibaraki Prefectural Office, Mito, Japan
| | - Masanori Nagao
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsugagun-Mibu, Japan; Ibaraki Health Plaza, Mito, Japan; Ibaraki Health Service Association, Mito, Japan
| | - Mitsumasa Umesawa
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsugagun-Mibu, Japan; Ibaraki Health Plaza, Mito, Japan; Ibaraki Health Service Association, Mito, Japan
| | - Yasuo Haruyama
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsugagun-Mibu, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsugagun-Mibu, Japan
| | | | - Hitoshi Ota
- Ibaraki Health Plaza, Mito, Japan; Ibaraki Health Service Association, Mito, Japan
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Kjellberg J, Tange Larsen A, Ibsen R, Højgaard B. The Socioeconomic Burden of Obesity. Obes Facts 2017; 10:493-502. [PMID: 29020681 PMCID: PMC5741162 DOI: 10.1159/000480404] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/17/2017] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To evaluate the socioeconomic impact of obesity by estimating the direct and indirect costs associated with obesity in Denmark, based on individual level data. METHODS Costs were assessed for different BMI groups, and the relative risks for change in direct and indirect costs per BMI point above 30 were estimated. A fourth analysis estimated the odds ratio for comorbidities per BMI point above 30. Individual data on income, social transfer payments, healthcare costs and diagnoses were retrieved from national registries. RESULTS One BMI point above 30 was associated with a 2% decrease in income, a 3% increase in social transfer payments, and a 4% increase in healthcare costs. In absolute numbers, income contributed to most of the total economic burden. One BMI point above 30 was also associated with increased comorbidity, which explains the increase in both direct and indirect costs. CONCLUSION Obesity is associated with increased comorbidity, giving rise to an increase in both direct and indirect costs. Especially income is affected, which emphasizes the importance of including both measures when evaluating the total socioeconomic burden of obesity. Our findings draw attention to the potential for saving public resources and preventing loss of income by preventing obesity.
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Affiliation(s)
- Jakob Kjellberg
- Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
- *Dr. Jakob Kjellberg, Danish Institute for Local and Regional Government Research, Købmagergade 22, Copenhagen, Denmark,
| | | | | | - Betina Højgaard
- Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
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Bradway C, Felix HC, Whitfield T, Li X. Barriers in Transitioning Patients With Severe Obesity From Hospitals to Nursing Homes. West J Nurs Res 2016; 39:1151-1168. [PMID: 28322638 DOI: 10.1177/0193945916683682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This cross-sectional, descriptive study explored perspectives of discharge planners regarding transitions of hospitalized patients who are severely obese seeking discharge to a nursing home. Attention has been focused on care transitions regarding high hospital readmission rates, yet specific needs of patients who are severely obese have been largely overlooked. Ninety-seven (response rate 39.8%) discharge planners returned surveys addressing frequency of, and issues encountered when, arranging placements. Community and hospital characteristics were also collected. One third of the respondents from Pennsylvania and Arkansas reported inability to transfer patients; barriers included reimbursement, staffing, and equipment. Respondents perceiving nursing homes to have equipment concerns were nearly 7 times more likely to report patient size as a barrier ( p = .001). Given increasing obesity rates, health care delivery systems must be prepared to provide necessary resources and all levels of care, including transitions for hospitalized patients who are severely obese needing nursing home care post-discharge.
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Affiliation(s)
| | | | | | - Xiaocong Li
- 2 University of Arkansas at Little Rock, USA
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Abstract
Objective: The authors examine how trends in disability prevalence and in inflation-adjusted per capita, per annum Medicare costs, 1982 to 1999 and 1989 to 1999, affected total Medicare costs projected to 2004 and 2009. Method: To describe disability trends, the authors applied grade of membership analyses to 27 measures of disability from the 1982 to 1999 National Long Term Care Surveys (NLTCS). This identified seven disability profiles for which individual scores were calculated. These were used to calculate sample weighted Medicare costs and cost trends. Results: Significant declines (up to 19%) in Medicare costs were found in 2004 and 2009 assuming continuation of the 1982 to 1999 disability declines and Medicare cost trends. In addition to declines in disability prevalence, inflation-adjusted per capita, per annum Medicare costs declined for nondisabled persons aged 65 to 84. Discussion: Preserving health in the growing nondisabled population did not require increased health care expenditures.
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Acree LS, Montgomery PS, Gardner AW. The influence of obesity on arterial compliance in adult men and women. Vasc Med 2016; 12:183-8. [PMID: 17848474 DOI: 10.1177/1358863x07079323] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to determine whether differences in large and small arterial compliance existed among normal weight, overweight, and obese older men and women, and whether large and small arterial compliance were associated with abdominal, hip, and subcutaneous fat distribution. A total of 134 individuals who were 40 years of age and older (age = 62 ± 11 years; mean ± SD) were grouped into normal weight (BMI: 18.5—24.9 kg/m2; n = 33), overweight (BMI: 25.0—29.9 kg/m2; n = 48), or obese (BMI: ≥30.0 kg/m2; n = 53) categories. The hemodynamic and arterial compliance measurements were obtained using the HDI/PulseWave CR-2000 CardioVascular Profiling System (Hypertension Diagnostics, Inc). Body mass index, nine-site sum of skinfolds, and circumference measures around the hip and waist were used for analysis. Large and small arterial compliance was lower (p < 0.001) in the obese group (12.4 ± 4.8 ml/mmHg × 10 vs 4.6 ± 2.5 ml/mmHg × 100, respectively) than the normal weight (16.2 ± 4.9 ml/mmHg × 10 vs 5.5 ± 2.7 ml/mmHg × 100) and overweight (15.2 ± 4.3 ml/mmHg × 10 vs 5.0 ± 2.2 ml/mmHg × 100) groups. This difference remained (p < 0.001) after adjusting for body surface area, sex, hyperlipidemia, and hypertension. Additionally, large arterial compliance correlated (p < 0.05) with sum of skinfolds (r = — 0.209), while small arterial compliance correlated with hip circumference (r = — 0.189). Arterial compliance measures were not related (p > 0.05) to waist circumference or waist-to-hip ratio. In conclusion, obesity was associated with a decrease in large and small arterial compliance independent of conventional risk factors. Additionally, subcutaneous fat and fat around the hips were inversely related to arterial compliance.
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Affiliation(s)
- Luke S Acree
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
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Challenges in the Management of Geriatric Obesity in High Risk Populations. Nutrients 2016; 8:nu8050262. [PMID: 27153084 PMCID: PMC4882675 DOI: 10.3390/nu8050262] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/12/2016] [Accepted: 04/25/2016] [Indexed: 01/26/2023] Open
Abstract
The global prevalence of obesity in the older adult population is growing, an increasing concern in both the developed and developing countries of the world. The study of geriatric obesity and its management is a relatively new area of research, especially pertaining to those with elevated health risks. This review characterizes the state of science for this “fat and frail” population and identifies the many gaps in knowledge where future study is urgently needed. In community dwelling older adults, opportunities to improve both body weight and nutritional status are hampered by inadequate programs to identify and treat obesity, but where support programs exist, there are proven benefits. Nutritional status of the hospitalized older adult should be optimized to overcome the stressors of chronic disease, acute illness, and/or surgery. The least restrictive diets tailored to individual preferences while meeting each patient’s nutritional needs will facilitate the energy required for mobility, respiratory sufficiency, immunocompentence, and wound healing. Complications of care due to obesity in the nursing home setting, especially in those with advanced physical and mental disabilities, are becoming more ubiquitous; in almost all of these situations, weight stability is advocated, as some evidence links weight loss with increased mortality. High quality interdisciplinary studies in a variety of settings are needed to identify standards of care and effective treatments for the most vulnerable obese older adults.
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Ellulu MS, Khaza'ai H, Rahmat A, Patimah I, Abed Y. Obesity can predict and promote systemic inflammation in healthy adults. Int J Cardiol 2016; 215:318-24. [PMID: 27128554 DOI: 10.1016/j.ijcard.2016.04.089] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/11/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND To find out the differences on biomedical data between obese and non-obese participants, and to identify risk factors associated with systemic inflammation in healthy Palestinian adults. METHODOLOGY A cross-sectional study involved 105 apparently healthy adults. Interview questionnaire was used to collect personal information. Participants were excluded if they suffered from acute or chronic inflammatory diseases, or continued using medicines, which might affect the biomedical results. RESULTS In association with increased Body Mass Index (BMI), the obese group displayed significant higher markers including: interleukin 6 (IL-6), high sensitivity C reactive protein (hs-CRP), total cholesterol (TC), systolic blood pressure (SBP), and diastolic blood pressure (DBP). Obese group in association with increased waist circumference (WC) was higher significantly in inflammatory markers (IL-6, hs-CRP), lipid profile (TC) and triglyceride (TG), and blood pressure (SBP, DBP). A tertile of a feature of systemic inflammation (hs-CRP) was created, by Ordinal Logistic Regression, after adjusting for the age, gender, smoking habits, physical activity pattern, father and mother's health history; risk factors were the increased BMI [OR: 1.24] (95% CI: 1.005-1.548, P=0.050), IL-6 [OR: 3.35] (95% CI: 1.341-8.398, P=0.010), DBP [OR: 1.19] (95% CI: 1.034-1.367, P=0.015), and reduced Adiponectin [OR: 0.59] (95% CI: 0.435-0.820, P=0.001). Finally, BMI correlated with IL-6 and hs-CRP (r=0.326, P=0.005; r=0.347, P<0.001; respectively), and hs-CRP correlated with IL-6 (r=0.303, P=0.010), and inversely with Adiponectin (r=-0.342, P=0.001). CONCLUSION The increased level of IL-6 and reduced Adiponectin, which strongly associated with obesity, indicated that having high BMI is a useful marker in association with IL-6 and further developed systemic inflammation.
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Affiliation(s)
- Mohammed S Ellulu
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Malaysia.
| | - Huzwah Khaza'ai
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Malaysia
| | - Asmah Rahmat
- Cancer Resource and Education Centre (CARE), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Malaysia
| | - Ismail Patimah
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Malaysia
| | - Yehia Abed
- Primary Health Care Specialist (Gaza 2020: Health Matters), Gaza, Palestine
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Bachmann JM, DeFina LF, Franzini L, Gao A, Leonard DS, Cooper KH, Berry JD, Willis BL. Cardiorespiratory Fitness in Middle Age and Health Care Costs in Later Life. J Am Coll Cardiol 2015; 66:1876-85. [DOI: 10.1016/j.jacc.2015.08.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 08/08/2015] [Accepted: 08/11/2015] [Indexed: 10/22/2022]
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Felix HC, Bradway C, Chisholm L, Pradhan R, Weech-Maldonado R. Prevalence of Moderate to Severe Obesity Among U.S. Nursing Home Residents, 2000–2010. Res Gerontol Nurs 2015; 8:173-8. [DOI: 10.3928/19404921-20150223-01] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/24/2014] [Indexed: 11/20/2022]
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Moore Simas TA, Corvera S, Lee MM, Zhang N, Leung K, Olendzki B, Barton B, Rosal MC. Understanding multifactorial influences on the continuum of maternal weight trajectories in pregnancy and early postpartum: study protocol, and participant baseline characteristics. BMC Pregnancy Childbirth 2015; 15:71. [PMID: 25885002 PMCID: PMC4389494 DOI: 10.1186/s12884-015-0490-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/25/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Maternal and offspring immediate and long-term health are affected by pregnancy weight gain and maternal weight. This study was designed to determine feasibility of: 1) recruiting a socio-economically and racially/ethnically diverse sample of pregnant women into a longitudinal observational study, including consenting the women for serial biologic specimen evaluations; 2) implementing comprehensive assessments (including biologic, anthropometric, behavioral, cognitive/psychosocial and socio-demographic, and cultural measures) at multiple time points over the study period, including collecting biologic specimens at planned and unplanned pregnancy delivery times; and 3) retaining the sample for one year into the postpartum period. Additionally, the study will provide preliminary data of associations among hypothesized predictors, mediators and moderators of pregnancy and post-partum maternal and infant weight trajectories. The study was conceptualized under a Biopsychosocial Model using a lifespan approach. Study protocol and baseline characteristics are described. METHODS/DESIGN We sought to recruit a sample of 100 healthy women age 18-45 years, between 28-34 weeks gestation, with singleton pregnancies, enrolled in care prior to 17 weeks gestation. Women provide written consent for face-to-face (medical history, anthropometrics, biologic specimens), and paper-and-pencil assessments, at five time points: baseline (third trimester), delivery-associated, and 6-weeks, 3-months and 6-months postpartum. Additional telephone-based assessments (diet, physical activity and breastfeeding) administered baseline and three-months postpartum. Infant weights are collected until 1-year of life. We seek to retain 80% of participants at six-months postpartum and 80% of offspring at 12-months. 110 women were recruited. Sample characteristics include: mean age 28.3 years, BMI 25.7 kg/m(2), and gestational age at baseline visit of 32.5 weeks. One-third of cohort was non-white, over a quarter were Latina, and almost a quarter were non-US born. The cohort majority was multigravida, had graduated high school and/or had higher levels of education, and worked outside the home. DISCUSSION Documentation of study feasibility and preliminary data for theory-driven hypothesis of maternal and child factors associated with weight trajectories will support future large scale longitudinal studies of risk and protective factors for maternal and child health. This research will also inform intervention targets facilitating healthy maternal and child weight.
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Affiliation(s)
- Tiffany A Moore Simas
- Department of Obstetrics & Gynecology, Division of Research, University of Massachusetts Medical School/UMass Memorial Health Care, Memorial Campus - 119 Belmont Street, Worcester, MA, 01605, USA.
| | - Silvia Corvera
- Department of Medicine, Program in Molecular Medicine, University of Massachusetts Medical School, Biotech 2 - 373 Plantation Street, Worcester, MA, 01605, USA.
| | - Mary M Lee
- Department of Pediatrics, University of Massachusetts Medical School/UMass Memorial Health Care, University Campus - 55 Lake Avenue, Worcester, MA, 01655, USA.
| | - NingNing Zhang
- Department of Pediatrics, University of Massachusetts Medical School/UMass Memorial Health Care, University Campus - 55 Lake Avenue, Worcester, MA, 01655, USA.
| | - Katherine Leung
- Department of Obstetrics & Gynecology, Division of Research, University of Massachusetts Medical School/UMass Memorial Health Care, Memorial Campus - 119 Belmont Street, Worcester, MA, 01605, USA.
| | - Barbara Olendzki
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, University Campus - 55 Lake Avenue, Worcester, MA, 01655, USA.
| | - Bruce Barton
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, University Campus - 55 Lake Avenue, Worcester, MA, 01655, USA.
| | - Milagros C Rosal
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, University Campus - 55 Lake Avenue, Worcester, MA, 01655, USA.
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Leung MYM, Pollack LM, Colditz GA, Chang SH. Life years lost and lifetime health care expenditures associated with diabetes in the U.S., National Health Interview Survey, 1997-2000. Diabetes Care 2015; 38:460-8. [PMID: 25552420 PMCID: PMC4338508 DOI: 10.2337/dc14-1453] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 11/20/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study analyzed the lifetime health care expenditures and life years lost associated with diabetes in the U.S. RESEARCH DESIGN AND METHODS Data from the National Health Interview Survey (NHIS), the Medical Expenditure Panel Survey from 1997 to 2000, and the NHIS Linked Mortality Public-use Files with a mortality follow-up to 2006 were used to estimate age-, race-, sex-, and BMI-specific risk of diabetes, mortality, and annual health care expenditures for both patients with diabetes and those without diabetes. A Markov model populated by the risk and cost estimates was used to compute life years and total lifetime health care expenditures by age, race, sex, and BMI classifications for patients with diabetes and without diabetes. RESULTS Predicted life expectancy for patients with diabetes and without diabetes demonstrated an inverted U shape across most BMI classifications, with highest life expectancy being for the overweight. Lifetime health care expenditures were higher for whites than blacks and for females than males. Using U.S. adults aged 50 years as an example, we found that diabetic white females with a BMI >40 kg/m(2) had 17.9 remaining life years and lifetime health expenditures of $185,609, whereas diabetic white females with normal weight had 22.2 remaining life years and lifetime health expenditures of $183,704. CONCLUSIONS Our results show that diabetes is associated with large decreases in life expectancy and large increases in lifetime health care expenditures. In addition to decreasing life expectancy by 3.3 to 18.7 years, diabetes increased lifetime health care expenditures by $8,946 to $159,380 depending on age-race-sex-BMI classification groups.
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Affiliation(s)
- Man-Yee Mallory Leung
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Lisa M Pollack
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
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El Anshasy AA, Katsaiti MS. Are natural resources bad for health? Health Place 2015; 32:29-42. [DOI: 10.1016/j.healthplace.2014.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 12/11/2014] [Accepted: 12/19/2014] [Indexed: 11/15/2022]
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Pandey A, Patel M, Gao A, Willis BL, Das SR, Leonard D, Drazner MH, de Lemos JA, DeFina L, Berry JD. Changes in mid-life fitness predicts heart failure risk at a later age independent of interval development of cardiac and noncardiac risk factors: the Cooper Center Longitudinal Study. Am Heart J 2015; 169:290-297.e1. [PMID: 25641539 DOI: 10.1016/j.ahj.2014.10.017] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/03/2014] [Indexed: 12/12/2022]
Abstract
AIMS Low mid-life fitness is associated with higher risk for heart failure (HF). However, it is unclear to what extent this HF risk is modifiable and mediated by the burden of cardiac and noncardiac comorbidities. We studied the effect of cardiac and noncardiac comorbidities on the association of mid-life fitness and fitness change with HF risk. METHODS Linking individual subject data from the Cooper Center Longitudinal Study (CCLS) with Medicare claims files, we studied 19,485 subjects (21.2% women) who survived to receive Medicare coverage from 1999 to 2009. Fitness estimated by Balke treadmill time at mean age of 49 years was analyzed as a continuous variable (in metabolic equivalents [METs]) and according to age- and sex-specific quintiles. Associations of mid-life fitness and fitness change with HF hospitalization after age of 65 years were assessed by applying a proportional hazards recurrent events model to the failure time data with each comorbidity entered as time-dependent covariates. RESULTS After 127,110 person years of Medicare follow-up, we observed 1,038 HF hospitalizations. Higher mid-life fitness was associated with a lower risk for HF hospitalization (hazard ratio [HR] 0.82 [0.76-0.87] per MET) after adjustment for traditional risk factors. This remained unchanged after further adjustment for the burden of Medicare-identified cardiac and noncardiac comorbidities (HR 0.83 [0.78-0.89]). Each 1 MET improvement in mid-life fitness was associated with a 17% lower risk for HF hospitalization in later life (HR 0.83 [0.74-0.93] per MET). CONCLUSIONS Mid-life fitness is an independent and modifiable risk factor for HF hospitalization at a later age.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Minesh Patel
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ang Gao
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Sandeep R Das
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Mark H Drazner
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Jarett D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX; Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX.
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Murayama H, Liang J, Bennett JM, Shaw BA, Botoseneanu A, Kobayashi E, Fukaya T, Shinkai S. Socioeconomic Status and the Trajectory of Body Mass Index Among Older Japanese: A Nationwide Cohort Study of 1987-2006. J Gerontol B Psychol Sci Soc Sci 2015; 71:378-88. [PMID: 25577567 DOI: 10.1093/geronb/gbu183] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 12/03/2014] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This research analyzed the body mass index (BMI) level and rate of change, and their association with socioeconomic status among older Japanese adults. METHODS Data came from a national sample of over 4,800 Japanese adults aged 60 and older at baseline, with up to 7 repeated observations over a period of 19 years (1987-2006). Hierarchical linear modeling was used to analyze the intrapersonal and interpersonal differences in BMI. RESULTS Average BMI among older Japanese was 22.26 at baseline and decreased with an accelerating rate over time. Relative to those with less education, BMI among older Japanese with more education was lower and it declined linearly at a faster rate over time. In contrast, higher household income at baseline was associated with a higher level of BMI but similar rates of decline over time. Furthermore, we found no evidence for age variations in the SES-BMI linkage as predicted by prior investigators. DISCUSSION These findings provide new insights into the complex relationship between socioeconomic factors and BMI, and help to inform the design of health policies and interventions related to weight control among older adults with diverse socioeconomic backgrounds.
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Affiliation(s)
- Hiroshi Murayama
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan. Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan.
| | - Jersey Liang
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Joan M Bennett
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Benjamin A Shaw
- Department of Health Policy, Management and Behavior, School of Public Health, State University of New York at Albany, Rensselaer
| | - Anda Botoseneanu
- Department of Behavioral Sciences, University of Michigan-Dearborn, Dearborn, Michigan. Department of Internal Medicine/Geriatrics, Yale University, New Haven, Connecticut
| | - Erika Kobayashi
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Taro Fukaya
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Shoji Shinkai
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan
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Altirriba J, Poher AL, Rohner-Jeanrenaud F. Chronic Oxytocin Administration as a Treatment Against Impaired Leptin Signaling or Leptin Resistance in Obesity. Front Endocrinol (Lausanne) 2015; 6:119. [PMID: 26300847 PMCID: PMC4525065 DOI: 10.3389/fendo.2015.00119] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 07/22/2015] [Indexed: 12/31/2022] Open
Abstract
This review summarizes the existing literature on the effects of oxytocin administration in the treatment of obesity in different animal models and in humans, focusing on the central control of food intake, the oxytocin effects on adipose tissue, and the relationships between oxytocin and leptin. Oxytocin is a hypothalamic nonapeptide synthesized mainly in the paraventricular and supraoptic nuclei projecting to the pituitary, where it reaches the peripheral circulation, as well as to other brain regions. Moreover, leptin modulates oxytocin levels and activates oxytocin neurons in the hypothalamic paraventricular nucleus, which innervates the nucleus of the solitary tract, partly responsible for the brain-elicited oxytocin effects. Taking into account that oxytocin is located downstream leptin, it was hypothesized that oxytocin treatment would be effective in decreasing body weight in leptin-resistant DIO animals, as well as in those with leptin or with leptin receptor deficiency. Several groups have demonstrated that in such animal models (rats, mice, and rhesus monkeys), central or peripheral oxytocin administration decreases body weight, mainly due to a decrease in fat mass, demonstrating that an oxytocin treatment is able to partly overcome leptin deficiency or resistance. Moreover, a pilot clinical study demonstrated the efficiency of oxytocin in the treatment of obesity in human subjects, confirming the results obtained in the different animal models. Larger multicenter studies are now needed to determine whether the beneficial effects of oxytocin treatment can apply not only to obese but also to type 2 diabetic patients. These studies should also shed some light on the molecular mechanisms of oxytocin action in humans.
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Affiliation(s)
- Jordi Altirriba
- Laboratory of Metabolism, Department of Internal Medicine Specialties, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- *Correspondence: Jordi Altirriba, Laboratory of Metabolism, Department of Internal Medicine Specialties, Faculty of Medicine, University of Geneva, 1, rue Michel-Servet, Geneva CH-1211, Switzerland,
| | - Anne-Laure Poher
- Laboratory of Metabolism, Department of Internal Medicine Specialties, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Françoise Rohner-Jeanrenaud
- Laboratory of Metabolism, Department of Internal Medicine Specialties, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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The intake of energy and selected nutrients by thai urban sedentary workers: an evaluation of adherence to dietary recommendations. J Nutr Metab 2014; 2014:145182. [PMID: 25525512 PMCID: PMC4267465 DOI: 10.1155/2014/145182] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 11/04/2014] [Accepted: 11/05/2014] [Indexed: 12/20/2022] Open
Abstract
Rapid changes in Thailand's nutrition and lifestyles have led to increasing diet-related pathologies among people with sedentary occupations. This study examines the extent to which the dietary intake of nutrients and energy by a sample of Thai sedentary workers conforms to the Thai Dietary Reference Intakes (Thai DRIs). The nutrients and energy intake estimates were based on self-reported information collected with a single 24-hour dietary recall and nonweighed 2-day food record. The study participants were Thai adults aged 20-50 years employed in sedentary occupations. A convenience sample of 215 healthy individuals (75 males and 140 females) was based on four randomly selected worksites in the Bangkok metropolitan area. For male participants, the study found a median energy intake of 1,485 kcal/day, with 54.4% of energy coming from carbohydrate, 15.9% from protein, and 29.6% from fat. Females' median energy intake was 1,428 kcal/day, 56% of which came from carbohydrate, 16.2% from protein, and 28.6% from fat. Both genders showed insufficient intake of fiber and most micronutrients. This study provides the material for preventive public health interventions focusing on nutrition-related diseases affecting Thailand's rapidly growing sedentary workforce.
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Sanada H, Yokokawa H, Yatabe J, Williams SM, Felder RA, Jose PA, Takenosita S. Association between lifestyle-related disorders and visceral fat mass in Japanese males: a hospital based cross-sectional study. Environ Health Prev Med 2014; 19:429-35. [PMID: 25248615 PMCID: PMC4235847 DOI: 10.1007/s12199-014-0411-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE This study aimed to examine the association between lifestyle-related disorders and visceral fat mass, and to estimate an appropriate cutoff value for visceral fat mass that correlated with body mass index (BMI) and waist circumference (WC). METHODS This cross-sectional study was conducted between July 2012 and August 2013 at Bange Kosei General Hospital, in Fukushima, Japan. All study participants were adult males who had completed voluntary medical check-ups that included estimation of visceral fat mass by bioelectrical impedance analysis (BIA). Participants were without past histories of atherosclerotic complications or were not currently taking medications for lifestyle-related disorders. Multivariate analysis was performed to estimate the association between lifestyle-related disorders and quartiles of visceral fat mass. RESULTS Of 536 total respondents, 442 were included in the analysis. Mean participant age was 56 years, and mean values of BMI, WC, and visceral fat mass were 24.1 kg/m(2), 85.9 cm, and 2.1 kg, respectively. Visceral fat mass ≥1.8 kg was positively associated with an increased prevalence of dyslipidemia, elevated blood pressure, and impaired glucose tolerance. Cutoff values that correlated with visceral fat mass (≥1.8 kg) were 85.3 cm for WC and 23.25 kg/m(2) for BMI. CONCLUSION Visceral fat mass ≥1.8 kg was positively associated with lifestyle-related disorders and closely related to WC and BMI cutoff values used to diagnose obesity. BIA may be a useful method for assessing visceral fat mass, and these findings provide important evidence for the use of BIA in the early detection of central obesity for preventing lifestyle-related disorders.
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Affiliation(s)
- Hironobu Sanada
- />Division of Health Science Research, Fukushima Welfare Federation of Agricultural Cooperatives, Aizubange Town, Fukushima, Japan
- />Department of Tumor and Host Bioscience, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hirohide Yokokawa
- />Department of General Medicine, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Junichi Yatabe
- />Division of Health Science Research, Fukushima Welfare Federation of Agricultural Cooperatives, Aizubange Town, Fukushima, Japan
| | - Scott M. Williams
- />Department of Medicine, Division of Cardiovascular Medicine, Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, TN 37232 USA
| | - Robin A. Felder
- />Department of Pathology, The University of Virginia Health Sciences Center, Charlottesville, VA 22908 USA
| | - Pedro A. Jose
- />Department of Medicine and Physiology, Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD 21201 USA
| | - Seiichi Takenosita
- />Department of Tumor and Host Bioscience, Fukushima Medical University School of Medicine, Fukushima, Japan
- />Department of Organ Regulatory Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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Specchia ML, Veneziano MA, Cadeddu C, Ferriero AM, Mancuso A, Ianuale C, Parente P, Capri S, Ricciardi W. Economic impact of adult obesity on health systems: a systematic review. Eur J Public Health 2014; 25:255-62. [PMID: 25320051 DOI: 10.1093/eurpub/cku170] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Obesity represents an important public health issue. An assessment of its costs would be useful to provide recommendations for policy and decision-making strategies. The aims of our study were to carry out a systematic review to assess the economic burden of adult obesity in terms of direct and indirect costs and to perform a quality appraisal of the analysed studies. METHODS A literature search was carried out on PubMed, Scopus and Cochrane Library to retrieve cost-of-illness (COI) analyses focused on adult (aged 18 years or more) overweight or obese people and published up to 2013. COI analyses that considered direct and indirect costs were included. Each included manuscript was independently appraised by three groups of researchers on the basis of the British Medical Journal Drummond's checklist. RESULTS Approximately 2044 articles were initially retrieved, and 17 were included in the current review. The included studies showed a medium-high-quality level. The available studies seemed to be heterogeneous both in terms of methodology and results reporting. However, as many studies have been conducted from the payer perspective, just direct medical costs can be considered exhaustive. As only three studies included considered also indirect costs, there is no strong evidence to give a comprehensive picture of this phenomenon also from the societal perspective. CONCLUSION The review confirmed that obesity absorbs a huge amount of health-care resources. Further research is therefore needed to better understand the economic impact and to identify and promote public health strategies to tackle obesity.
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Affiliation(s)
- Maria Lucia Specchia
- 1 Department of Public Health - Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Assunta Veneziano
- 1 Department of Public Health - Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - Chiara Cadeddu
- 1 Department of Public Health - Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Maria Ferriero
- 1 Department of Public Health - Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - Agostino Mancuso
- 1 Department of Public Health - Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - Carolina Ianuale
- 1 Department of Public Health - Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - Paolo Parente
- 1 Department of Public Health - Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Capri
- 1 Department of Public Health - Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy 2 School of Economics and Management, LIUC University, Castellanza (VA), Italy
| | - Walter Ricciardi
- 1 Department of Public Health - Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
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Yoon K, Jang SN, Chun H, Cho SI. Self-reported anthropometric information cannot vouch for the accurate assessment of obesity prevalence in populations of middle-aged and older Korean individuals. Arch Gerontol Geriatr 2014; 59:584-92. [PMID: 25179443 DOI: 10.1016/j.archger.2014.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 08/10/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
Abstract
While there are strong correlations between self-reported and directly measured anthropometric data, the discrepancy and systematic errors associated with these, particularly among middle-aged and older persons residing in South Korea, remain a contentious issue. All participants were selected from the Korean Longitudinal Study of Aging (KLoSA), a panel study conducted by the Korea Labor Institute; data from 510 participants (290 females; 56.9%) were analyzed. We considered general characteristics, including sex, age, education, marital status, employment, income, and residential region, and used self-rated health (SRH) as a generic indicator of health status. One-way ANOVA, t-test, and Scheffé's test (α=0.1) were employed to explore the difference between directly measured and self-reported values. Sensitivity and specificity values were used to assess the validity of obesity diagnoses based on self-reported body mass index (BMI: body weight in kilograms divided by the square of height in meters). The means of BMI differences were 1.3 (±1.2)kg/m(2) among men and 1.8 (±1.5)kg/m(2) among women. In men, the difference could be attributed to measured BMI and residential region; among women, age and education level influenced the discrepancy in BMI. Scheffé's test (α=0.1) for multiple comparisons of group means revealed that women over the age of 65 years, with lower than middle-school education, who lived in rural areas, and had a measured BMI of 25kg/m(2) or more, were more likely to have significant BMI discrepancies. In contrast, for men, significant predictors were living in rural areas and being obese. Although adequate correlations were seen in self-reported BMI, they indicated low sensitivity, with 46.5% and 60.1% among males and females, respectively. However, specificities were very high, at 97.8% and 98.0% for males and females, respectively. The diagnostic performance of self-reported BMI is insufficient for assessing obesity prevalence among middle-aged or older Koreans.
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Affiliation(s)
- Kyuhyun Yoon
- Department of Epidemiology, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Soong-Nang Jang
- Nursing Science Research Institute and College of Nursing, Chung-Ang University, Seoul, Republic of Korea.
| | - Heeran Chun
- School of Health Science, Jungwon University, Chungbuk, Republic of Korea
| | - Sung-Il Cho
- Department of Epidemiology, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
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Cheng S, Claggett B, Correia AW, Shah AM, Gupta DK, Skali H, Ni H, Rosamond WD, Heiss G, Folsom AR, Coresh J, Solomon SD. Temporal trends in the population attributable risk for cardiovascular disease: the Atherosclerosis Risk in Communities Study. Circulation 2014; 130:820-8. [PMID: 25210095 DOI: 10.1161/circulationaha.113.008506] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The extent to which the relative contributions of traditional cardiovascular risk factors to incident cardiovascular disease (CVD) may have changed over time remains unclear. METHODS AND RESULTS We studied 13 541 participants (56% women, 26% black) in the Atherosclerosis Risk in Communities Study, aged 52 to 66 years and free of CVD at exams in 1987 through 1989, 1990 through 1992, 1993 through 1995, or 1996 through 1998. At each examination, we estimated the population attributable risks (PAR) of traditional risk factors (hypertension, diabetes mellitus, obesity, hypercholesterolemia, and smoking) for the 10-year incidence of CVD. Overall, the PAR of all risk factors combined appeared to decrease from the late 1980s to the late 1990s (0.58 to 0.53). The combined PAR was higher in women than men in 1987 through 1989 (0.68 versus 0.51, P<0.001) but not by the late 1990s (0.58 versus 0.48, P=0.08). The combined PAR was higher in blacks than whites in the late 1980s (0.67 versus 0.57, P=0.049), and this difference was more pronounced by the late 1990s (0.67 versus 0.48, P=0.002). By the late 1990s, the PAR of hypertension had become higher in women than men (P=0.02) and also appeared higher in blacks than whites (P=0.08). By the late 1990s, the PAR of diabetes mellitus remained higher in women than men (P<0.0001) and in blacks than whites (P<0.0001). CONCLUSIONS The contribution to CVD of all traditional risk factors combined is greater in blacks than whites, and this difference may be increasing. The contributions of hypertension and diabetes mellitus remain especially high, in women as well as blacks. These findings underscore the continued need for individual as well as population approaches to CVD risk factor modification.
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Affiliation(s)
- Susan Cheng
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., D.K.G., H.S., S.D.S.); NMR Group Inc, Somerville, MA (A.W.C.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (W.D.R., G.H.); the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (A.R.F.); the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (J.C.); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.).
| | - Brian Claggett
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., D.K.G., H.S., S.D.S.); NMR Group Inc, Somerville, MA (A.W.C.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (W.D.R., G.H.); the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (A.R.F.); the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (J.C.); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
| | - Andrew W Correia
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., D.K.G., H.S., S.D.S.); NMR Group Inc, Somerville, MA (A.W.C.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (W.D.R., G.H.); the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (A.R.F.); the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (J.C.); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
| | - Amil M Shah
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., D.K.G., H.S., S.D.S.); NMR Group Inc, Somerville, MA (A.W.C.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (W.D.R., G.H.); the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (A.R.F.); the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (J.C.); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
| | - Deepak K Gupta
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., D.K.G., H.S., S.D.S.); NMR Group Inc, Somerville, MA (A.W.C.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (W.D.R., G.H.); the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (A.R.F.); the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (J.C.); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
| | - Hicham Skali
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., D.K.G., H.S., S.D.S.); NMR Group Inc, Somerville, MA (A.W.C.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (W.D.R., G.H.); the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (A.R.F.); the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (J.C.); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
| | - Hanyu Ni
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., D.K.G., H.S., S.D.S.); NMR Group Inc, Somerville, MA (A.W.C.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (W.D.R., G.H.); the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (A.R.F.); the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (J.C.); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
| | - Wayne D Rosamond
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., D.K.G., H.S., S.D.S.); NMR Group Inc, Somerville, MA (A.W.C.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (W.D.R., G.H.); the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (A.R.F.); the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (J.C.); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
| | - Gerardo Heiss
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., D.K.G., H.S., S.D.S.); NMR Group Inc, Somerville, MA (A.W.C.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (W.D.R., G.H.); the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (A.R.F.); the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (J.C.); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
| | - Aaron R Folsom
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., D.K.G., H.S., S.D.S.); NMR Group Inc, Somerville, MA (A.W.C.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (W.D.R., G.H.); the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (A.R.F.); the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (J.C.); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
| | - Josef Coresh
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., D.K.G., H.S., S.D.S.); NMR Group Inc, Somerville, MA (A.W.C.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (W.D.R., G.H.); the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (A.R.F.); the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (J.C.); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
| | - Scott D Solomon
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., D.K.G., H.S., S.D.S.); NMR Group Inc, Somerville, MA (A.W.C.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (W.D.R., G.H.); the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (A.R.F.); the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (J.C.); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
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Rejeski WJ, Bray GA, Chen SH, Clark JM, Evans M, Hill JO, Jakicic JM, Johnson KC, Neiberg R, Ip EH. Aging and physical function in type 2 diabetes: 8 years of an intensive lifestyle intervention. J Gerontol A Biol Sci Med Sci 2014; 70:345-53. [PMID: 24986062 DOI: 10.1093/gerona/glu083] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Compared with adults without type 2 diabetes mellitus, those with the disease experience more limitations in their physical functioning (PF). Look AHEAD is a large multicenter trial that examined the effects of an intensive lifestyle intervention (ILI) for weight loss on cardiovascular outcomes compared with diabetes support and education (DSE). Although the current study compared treatment differences between ILI and DSE on PF, the primary goal was to examine whether this effect was moderated by age and history of cardiovascular disease at enrollment. METHODS Overweight or obese adults with type 2 diabetes mellitus (n = 5,145) were randomly assigned to either ILI or DSE. The mean (±SD) age and % females in ILI was 58.9 years (±6.9) and 59.8%; it was 58.6 years (6.8) and 59.5% in DSE. Analysis in 4,998 participants assessed the differential rates of decline in PF across a period of 8 years for the ILI and DSE groups. RESULTS ILI resulted in improved PF compared with DSE after 1 year (p < .0001) and was maintained across time. Within the ILI, older adults experienced greater improvements than younger adults (p < .0001). By year 2, persons in ILI with preexisting cardiovascular disease were no different in PF than in DSE participants with preexisting cardiovascular disease. CONCLUSION With the exception of persons who had a history of cardiovascular disease, ILI slowed the decline in PF with type 2 diabetes mellitus despite weight regain, an effect that was stronger for older than younger participants and could translate into reductions in falls and disability.
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Affiliation(s)
- W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Reynolda Campus, Winston-Salem, North Carolina.
| | - George A Bray
- Pennington Biomedical Research Center/LSU, Baton Rouge, Louisiana
| | - Shyh-Huei Chen
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jeanne M Clark
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - James O Hill
- Department of Pediatrics and Medicine, University of Colorado School of Medicine, Denver
| | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pennsylvania
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Rebecca Neiberg
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Edward H Ip
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Abstract
BACKGROUND AND OBJECTIVES An estimate of the lifetime medical costs of an obese child provides a benchmark of the potential per capita savings that could accrue from successful childhood obesity prevention efforts. We reviewed the literature to identify the best current estimate of the incremental lifetime per capita medical cost of an obese child in the United States today relative to a normal weight child. METHODS We searched PubMed and Web of Science for US-based studies published within the 15 years preceding May 2013 from which lifetime medical cost estimates can be extracted or imputed. Two reviewers independently screened search results and extracted data from eligible articles. All estimates were inflated to 2012 dollars and discounted to reflect costs from the perspective of a 10-year-old child today. RESULTS We identified 6 studies. The incremental lifetime direct medical cost from the perspective of a 10-year-old obese child relative to a 10-year-old normal weight child ranges from $12 660 to $19 630 when weight gain through adulthood among normal weight children is accounted for and from $16 310 to $39 080 when this adjustment is not made. CONCLUSIONS We recommend use of an estimate of $19 000 as the incremental lifetime medical cost of an obese child relative to a normal weight child who maintains normal weight throughout adulthood. The alternative estimate, which considers the reality of eventual weight gain among normal weight youth, is $12 660. Additional research is needed to include estimates of indirect costs of childhood obesity.
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Affiliation(s)
- Eric Andrew Finkelstein
- Duke-NUS Graduate Medical School, Singapore; and Duke Global Health Institute, Durham, North Carolina
| | | | - Rahul Malhotra
- Duke-NUS Graduate Medical School, Singapore; and Duke Global Health Institute, Durham, North Carolina
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Kwok CS, Pradhan A, Khan MA, Anderson SG, Keavney BD, Myint PK, Mamas MA, Loke YK. Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis. Int J Cardiol 2014; 173:20-8. [PMID: 24636546 DOI: 10.1016/j.ijcard.2014.02.026] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/19/2014] [Accepted: 02/13/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bariatric surgery has been shown to improve cardiovascular risk factors but long term benefits for survival and cardiovascular events are still uncertain. METHODS We searched MEDLINE and EMBASE for parallel group studies that evaluated the clinical outcomes associated with bariatric surgery as compared to non-surgical treatment. Relevant studies were pooled using random effects meta-analysis for risk of myocardial infarction, stroke, cardiovascular events and mortality. RESULTS 14 studies met the inclusion criteria, which included 29,208 patients who underwent bariatric surgery and 166,200 nonsurgical controls (mean age 48 years, 30% male, follow up period ranged from 2 years to 14.7 years). Four studies were considered at moderate-high risk of bias, whilst ten studies were at moderate or lower risk of bias. Compared to nonsurgical controls there was more than 50% reduction in mortality amongst patients who had bariatric surgery (OR 0.48 95% CI 0.35-0.64, I2=86%, 14 studies). In pooled analysis of four studies with adjusted data, bariatric surgery was associated with a significantly reduced risk of composite cardiovascular adverse events (OR 0.54 95% CI 0.41-0.70, I2=58%). Bariatric surgery was also associated with significant reduction in specific endpoints of myocardial infarction (OR 0.46 95% CI 0.30-0.69, I2=79%, 4 studies) and stroke (OR 0.49 95% CI 0.32-0.75, I2=59%, 4 studies). CONCLUSIONS Data from observational studies indicates that patients undergoing bariatric surgery have a reduced risk of myocardial infarction, stroke, cardiovascular events and mortality compared to non-surgical controls. Future randomized studies should investigate whether these observations are reproduced in a clinical trials setting.
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Affiliation(s)
- Chun Shing Kwok
- Cardiovascular Institute, University of Manchester, Manchester, UK.
| | | | - Muhammad A Khan
- Cardiovascular Institute, University of Manchester, Manchester, UK
| | - Simon G Anderson
- Cardiovascular Institute, University of Manchester, Manchester, UK
| | | | - Phyo Kyaw Myint
- School of Medicine & Dentistry, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Mamas A Mamas
- Cardiovascular Institute, University of Manchester, Manchester, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
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Gandjour A. Cost–effectiveness of preventing weight gain and obesity: what we know and what we need to know. Expert Rev Pharmacoecon Outcomes Res 2014; 12:297-305. [DOI: 10.1586/erp.12.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Daviglus ML, Pirzada A. In the long run, healthcare costs appear to be related to overweight and obesity at younger ages. Expert Rev Pharmacoecon Outcomes Res 2014; 5:125-30. [DOI: 10.1586/14737167.5.2.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
SUMMARY As obesity becomes a major health and economic issue of the current age, interventions and policies are being targeted to influence individuals' diet and exercise behaviors. Examining the deviations of reality from a baseline model of rational choice provides insights into the economic rationales for interventions to modify individuals' choices. In addition to the more classical economic rationales for intervention, insights from behavioral economics and psychology have recently led to a focus on the role of time-inconsistent preferences, in particular present-biased preferences, in the choices that lead to obesity. While individuals can use self-control techniques to mitigate the problem, there is also potential for targeted interventions and policies to improve the welfare of individuals. Further interdisciplinary research in the area may lead to behavioral obesity interventions tailored to individuals' incentives, resulting in higher compliance rates.:
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Affiliation(s)
- Mark Dodd
- School of Economics, The University of Adelaide, SA 5005, Australia.
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