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Cruz C, Prado CM, Gillis C, Martindale R, Bémeur C, Lai JC, Tandon P. Nutritional aspects of prehabilitation in adults with cirrhosis awaiting liver transplant. Hepatology 2024:01515467-990000000-00825. [PMID: 38546288 DOI: 10.1097/hep.0000000000000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/20/2024] [Indexed: 04/21/2024]
Abstract
Malnutrition, sarcopenia (low muscle mass), and physical frailty have gained increasing recognition in candidates for liver transplant (LT) as these conditions can impact postoperative functional capacity. Multidimensional prehabilitation programs have been proposed as a safe intervention in adults awaiting LT but the nutritional pillar of prehabilitation has been understudied. This review summarizes the nutritional recommendations for prehabilitation for individuals with cirrhosis awaiting LT. Three major aspects of nutritional prehabilitation are discussed: (1) Assess: Evaluate nutritional status and assess for malnutrition, sarcopenia, and frailty to guide the nutritional prehabilitation intervention intensity, increasing across universal, targeted, and specialist levels; (2) Intervene: Prescribe a nutritional prehabilitation intervention to meet established nutrition guidelines in cirrhosis with a targeted focus on improving nutritional status and muscle health; (3) Reassess: Follow-up based on the required intensity of nutritional care with as needed intervention adjustment. Topics covered in the review include nutritional care levels for prehabilitation, energy prescriptions across body mass index strata, detailed considerations around protein intake (amount, distribution, and quality), carbohydrate and fat intake, other nutritional considerations, and the potential role of dietary supplements and nutraceuticals. Future research is warranted to more accurately evaluate energy needs, evaluate emerging dietary supplementation strategies, and establish the role of nutraceuticals alongside food-based interventions. While the general principles of nutritional prehabilitation are ready for immediate application, future large-scale randomized controlled trials in this space will help to quantify the benefit that can be gained by transitioning the LT approach from passive "transplant waitlist time" to active "transplant preparation time."
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Affiliation(s)
- Christofer Cruz
- Department of Medicine, Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
- Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada
| | - Robert Martindale
- Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Chantal Bémeur
- Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer C Lai
- Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Puneeta Tandon
- Department of Medicine, Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
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Dagenais S, Clark S, Fielding RA, Cantu C, Prasad S, Dai F, Groarke JD. Risk of mortality in older adults with loss of appetite: An analysis of Medicare fee-for-service data. J Nutr Health Aging 2024; 28:100035. [PMID: 38308921 DOI: 10.1016/j.jnha.2023.100035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVES Prior research suggested that loss of appetite (LOA) among adults with Medicare fee-for-service (FFS) insurance in the United States increased the risk of mortality within 1 year; those findings were not adjusted for risk factors and confounders. The objective of this study was to compare the risk of mortality among Medicare FFS beneficiaries with LOA to a control group without LOA while controlling or adjusting for age, comorbidities, body mass index (BMI), and weight loss. DESIGN Retrospective and observational analysis of Medicare FFS health insurance claims data from October 1, 2015 to December 31, 2021. SETTING Claims from all settings (e.g., hospital inpatient/outpatient, office, assisted living facility, skilled nursing facility, hospice, rehabilitation facility, home) were included in these analyses. PARTICIPANTS The LOA group included all individuals aged 65-115 years with continuous Medicare FFS medical coverage (Parts A and/or B) for at least 12 months before a claim with ICD-10 diagnosis code "R63.0 Anorexia". The control group was drawn from individuals aged 65-115 years with continuous Medicare FFS coverage who did not have a diagnosis of R63.0. Individuals with LOA were matched 1:3 to those in the control group based on age, sex, and race/ethnicity. MEASUREMENTS Mortality in the LOA group was compared to mortality in the control group using Kaplan-Meier and Cox regression analyses and stratified or adjusted in terms of Charlson Comorbidity Index (CCI), claims-based frailty index (CFI), BMI, and weight loss. RESULTS The study population of 1,707,031 individuals with LOA and 5,121,093 controls without LOA was 61.7% female and 82.2% White. More individuals with LOA compared with the control group had a CCI score 5+ (52.4% vs. 19.4%), CFI score 5+ (31.6% vs. 6.4%), and BMI < 20 kg/m2 (11.2% vs. 2.1%). Median follow-up was 12 months (individuals with LOA) and 49 months (control group). In a matched population, the risk of mortality was significantly higher (unadjusted hazard ratio 4.40, 95% confidence interval 4.39-4.42) for individuals with LOA than the control group. Median survival time was 4 months (individuals with LOA) and 26 months (control group); differences in survival time remained when stratifying by CCI, BMI, and weight loss. CONCLUSION Individuals with LOA had a substantially increased risk of death even after matching for age, sex, race/ethnicity, and adjusting for comorbidities. These findings highlight the burden of illness in older adults with LOA and the need for therapies.
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Affiliation(s)
| | | | - Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
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Fosdahl MA, Berg B, Risberg MA, Øiestad BE, Holm I. Body Mass Index, Quality of Life and Activity Limitation Trajectories over 2 Years in Patients with Knee or Hip Osteoarthritis: A Dual Trajectory Approach Based on 4265 Patients Included in the AktivA Quality Register. J Clin Med 2023; 12:7094. [PMID: 38002706 PMCID: PMC10672133 DOI: 10.3390/jcm12227094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Recent studies claim that weight-neutral approaches emphasizing physical activity might be as effective as weight-loss-centered approaches for improving pain and physical function in patients with knee and hip osteoarthritis. The objectives were to identify distinctive groups of individuals with similar BMI, quality of life and activity limitation trajectories over two years, to compare the overall differences between BMI trajectory groups for baseline variables and to explore the probabilities of the quality of life and activity limitation trajectory groups conditional on the BMI group. (2) Methods: Baseline data for age, gender, BMI, quality of life, activity limitations, pain, general health, knee or hip osteoarthritis and follow-up data on BMI, quality of life and activity limitations at 3, 12 and 24 months were retrieved from the "Active with osteoarthritis" (AktivA) electronic quality register. Group-based trajectory modeling was used to identify distinct trajectories for BMI, quality of life and activity limitations. (3) Results: 4265 patients were included in the study. Four distinct BMI trajectories were identified, normal weight (31%), slightly overweight (43%), overweight (20%) and obese (6%). At baseline, there were highly significant differences between all BMI groups, pain increased and age and general health decreased with higher BMI. Irrespective of weight category, minimal changes in BMI were found over the two-year follow-up period. Over 80% of the participants showed moderate-to-considerable improvements both in quality of life and activity limitations. (4) Conclusions: Almost 70% of the participants belonged to the overweight trajectories. Despite no significant weight reduction over the two years, eight in every 10 participants improved their quality of life and reduced their activity limitations after participating in the AktivA program.
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Affiliation(s)
- Merete Aarsland Fosdahl
- Division of Orthopaedic Surgery, Oslo University Hospital, 0424 Oslo, Norway (M.A.R.)
- Department of Clinical Neurosciences for Children, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Bjørnar Berg
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Science, Oslo Metropolitan University, 0130 Oslo, Norway;
| | - May Arna Risberg
- Division of Orthopaedic Surgery, Oslo University Hospital, 0424 Oslo, Norway (M.A.R.)
- Department of Sports Medicine, Norwegian School of Sport Sciences, 0863 Oslo, Norway
| | - Britt Elin Øiestad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, 0130 Oslo, Norway;
| | - Inger Holm
- Division of Orthopaedic Surgery, Oslo University Hospital, 0424 Oslo, Norway (M.A.R.)
- Department of Interdisciplinary Health Sciences, Medical Faculty, University of Oslo, 0318 Oslo, Norway
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Gil-Salcedo A, Dugravot A, Fayosse A, Landré B, Yerramalla MS, Sabia S, Schnitzler A. Role of age and sex in the association between BMI and functional limitations in stroke patients: Cross-sectional analysis in three European and US cohorts. J Stroke Cerebrovasc Dis 2023; 32:107270. [PMID: 37481939 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND A U- or J-shaped association between BMI and different post-stroke outcomes is suggested. Thus, the aim is to evaluate the association between BMI with ADL, IADL and mobility limitations in the ageing post-stroke population at different ages, as well as the differences in this association by sex. METHODS A total of 5,468 participants with stroke and 21,872 without stroke over 50 years of age were assessed for the number of limitations in basic or instrumental activities of daily living (ADL/IADL) as well as mobility tasks. The association between BMI at the interview (continuous time-dependent variable) and the level of limitations was assessed using a linear mixed model stratified by sex and stroke status. RESULTS The association between BMI and ADL/IADL and mobility limitations were found to be significant in both men and women regardless of stroke status (p<0.001 for all). The association differs between those who have suffered a stroke and those who have not (p<0.001 for all). In ADL/IADL limitations, men with stroke showed a transition from an inverted J-shape to a U-shape association with age. In women, the BMI showed a less pronounced association between BMI and ADL/IADL limitations compared to men but with similar trends. A effect of sex was observed in the association between BMI and mobility, with women with and without stroke showing a linear association that differed from the inverted J-shaped or U-shaped association of men. CONCLUSION Our results suggest that BMI is associated with limitations in ADL, IADL and mobility in stroke patients. In addition, this association differs between men and women and is also influenced by age.
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Affiliation(s)
- Andres Gil-Salcedo
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Benjamin Landré
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Manasa S Yerramalla
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Séverine Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Alexis Schnitzler
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France; Université Versailles Saint Quentin en Yvelines, EA 4047 Handi-Resp, Service de neurologie hôpital A. Mignot, Garches, France.
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5
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Wang Y, Luo D, Liu J, Song Y, Jiang B, Jiang H. Low skeletal muscle mass index and all-cause mortality risk in adults: A systematic review and meta-analysis of prospective cohort studies. PLoS One 2023; 18:e0286745. [PMID: 37285331 DOI: 10.1371/journal.pone.0286745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE The relationship between low skeletal muscle mass index (SMI) and all-cause mortality risk in the general adults remains unclear. Our study was conducted to examine and quantify the associations between low SMI and all-cause mortality risks. METHODS PubMed, Web of Science, and Cochrane Library for primary data sources and references to relevant publications retrieved until 1 April 2023. A random-effect model, subgroup analyses, meta-regression, sensitivity analysis, and publication bias were conducted using STATA 16.0. RESULTS Sixteen prospective studies were included in the meta-analysis of low SMI and the risk of all-cause mortality. A total of 11696 deaths were ascertained among 81358 participants during the 3 to 14.4 years follow-up. The pooled RR of all-cause mortality risk was 1.57 (95% CI, 1.25 to 1.96, P < 0.001) across the lowest to the normal muscle mass category. The results of meta-regression showed that BMI (P = 0.086) might be sources of heterogeneity between studies. Subgroup analysis showed that low SMI was significantly associated with an increased risk of all-cause mortality in studies with a body mass index (BMI) between 18.5 to 25 (1.34, 95% CI, 1.24-1.45, P<0.001), 25 to 30 (1.91, 95% CI, 1.16-3.15, P = 0.011), and over 30 (2.58, 95% CI, 1.20-5.54 P = 0.015). CONCLUSIONS Low SMI was significantly associated with the increased risk of all-cause mortality, and the risk of all-cause mortality associated with low SMI was higher in adults with a higher BMI. Low SMI Prevention and treatment might be significant for reducing mortality risk and promoting healthy longevity.
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Affiliation(s)
- Yahai Wang
- College of Arts and Physical Education, Nanchang Normal College of Applied Technology, Nanchang, Jiangxi, China
| | - Donglin Luo
- Faculty of Health Service, Naval Medical University, Shanghai, China
| | - Jiahao Liu
- Faculty of Health Service, Naval Medical University, Shanghai, China
| | - Yu Song
- College of Arts and Physical Education, Nanchang Normal College of Applied Technology, Nanchang, Jiangxi, China
| | - Binggang Jiang
- Faculty of Health Service, Naval Medical University, Shanghai, China
| | - Haichao Jiang
- Faculty of Health Service, Naval Medical University, Shanghai, China
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Haapanen M, Mikkola T, Kortelainen L, Jylhävä J, Wasenius N, Kajantie E, Eriksson J, von Bonsdorff M. Body Composition in Late Midlife as a Predictor of Accelerated Age-associated Deficit-accumulation From Late Midlife into Old Age: A Longitudinal Birth Cohort Study. J Gerontol A Biol Sci Med Sci 2023; 78:980-987. [PMID: 36434783 PMCID: PMC10235203 DOI: 10.1093/gerona/glac233] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Body mass index (BMI) may not be an optimal predictor of frailty as its constituents, lean and fat mass, may have opposite associations with frailty. METHODS A linear mixed model analysis was performed in the Helsinki Birth Cohort Study (n = 2 000) spanning from 57 to 84 years. A 39-item frailty index (FI) was calculated on three occasions over 17 years. Body composition in late midlife included BMI, percent body fat (%BF), waist-to-hip ratio (WHR), lean mass index (LMI), and fat mass index (FMI). RESULTS Mean FI levels increased by 0.28%/year among men and by 0.34%/year among women. Among women, per each kg/m2 higher BMI and each unit higher %BF the increases in FI levels per year were 0.013 percentage points (PP) steeper (95% CI = 0.004, 0.023) and 0.009 PP steeper (95% CI = 0.002, 0.016) from late midlife into old age. Among men, per each 0.1-unit greater WHR the increase in FI levels was 0.074 PP steeper per year (95% CI = -0.0004, 0.148). Cross-sectionally, greater FMI and LMI in late midlife were associated with higher FI levels but the direction of the association regarding LMI changed after adjustment for FMI. The categories "high FMI and high LMI" and "high FMI and low LMI" showed the highest FI levels relative to the category "low FMI and low LMI". CONCLUSIONS In late midlife, greater adiposity (%BF) among women and abdominal obesity (WHR) among men may predispose to higher levels of frailty from late midlife into old age. Greater lean mass alone may be protective of frailty, but not in the presence of high fat mass.
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Affiliation(s)
- Markus J Haapanen
- Folkhälsan Research Center, Helsinki, Finland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tuija M Mikkola
- Folkhälsan Research Center, Helsinki, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Lauri Kortelainen
- Folkhälsan Research Center, Helsinki, Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Juulia Jylhävä
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, Tampere University, Tampere, Finland
| | - Niko S Wasenius
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Eero Kajantie
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- PEDEGO Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki, Finland
- Department of Obstetrics and Gynecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Mikaela B von Bonsdorff
- Folkhälsan Research Center, Helsinki, Finland
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Masters RK. Sources and severity of bias in estimates of the BMI-mortality association. POPULATION STUDIES 2023; 77:35-53. [PMID: 36756765 PMCID: PMC9992219 DOI: 10.1080/00324728.2023.2168035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/13/2022] [Indexed: 02/10/2023]
Abstract
Estimates of mortality differences by body mass index (BMI) are likely biased by: (1) confounding bias from heterogeneity in body shape; (2) positive survival bias in high-BMI samples due to recent weight gain; and (3) negative survival bias in low-BMI samples due to recent weight loss. I investigate these sources of bias in the National Health and Nutrition Examination Survey (NHANES) 1988-94 and 1999-2006 linked to mortality up to 2015 (17,784 cases; 4,468 deaths). I use Cox survival models to estimate BMI differences in all-cause mortality risks among adults aged [45-85) in the United States. I test for age-based differences in BMI-mortality associations and estimate functional forms of the association using nine BMI levels. Estimates of the BMI-mortality association in NHANES data are significantly affected by all three biases, and obesity-mortality associations adjusted for bias are substantively strong at all ages. The mortality consequences of overweight and obesity have likely been underestimated, especially at older ages.
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Affiliation(s)
- Ryan K. Masters
- Department of Sociology, University of Colorado Boulder
- University of Colorado Population Center
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Park JH, Park DJ, Kim H, Park H, Lee B, Nam H, Kim S, Kim SH, Kong SH, Lee HJ, Yang HK. Twelve-Year Trajectory of Disease Burden and Mortality by Obesity Level in Korea: Analysis of the National Health Insurance Service Database. Obes Surg 2023; 33:105-116. [PMID: 36344728 DOI: 10.1007/s11695-022-06327-y] [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: 07/05/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Despite increases in obesity prevalence, awareness of obesity as a disease requiring active treatment remains lacking in Korea. We investigated differences in medical problems and expenditures and mortality across obesity categories using 12-year data from the National Health Insurance Service. MATERIALS AND METHODS Individuals aged 40-79 years who underwent medical examinations during 2003-2004 (n = 415,201) were divided based on Asian body mass index (kg/m2) criteria: normal weight (18.5 to < 23.0, 36.4%), overweight (23.0 to < 25.0, 28.3%), obesity (25.0 to < 30.0, 32.5%), and severe obesity (≥ 30.0, 2.8%). Medical problems and expenditures were fitted to linear mixed models. Mortality was analyzed via Cox proportional-hazards model. RESULTS More severe obesity was associated with a higher rate of medical problems, relative to normal weight: coefficient = 0.31 (95% confidence interval [CI], 0.30-0.32) for overweight, 0.61 (0.60-0.61) for obesity, and 1.07 (1.04-1.09) for severe obesity. A similar association was observed for medical expenditure: coefficient = 8.85 (95%CI, 6.80-10.89) for overweight, 20.04 (18.07-22.01) for obesity, and 48.76 (43.66-53.86) for severe obesity. Relative to overweight participants, those with normal weight and severe obesity exhibited a higher mortality risk (hazard ratio [HR] 1.21 [95%CI, 1.18-1.25] for normal; 1.27 [1.19-1.36] for severe obesity). In age-specific analyses, mortality risk was the highest for participants with severe obesity, aged < 60 years (HR, 1.58 [95%CI, 1.41-1.77]). CONCLUSION Disease burden including medical problems and expenditure, and mortality in middle-aged adults, increased proportionally to the degrees of obesity. Health policies and medical systems aimed at reducing the burden of obesity may help reduce the burden of disease on society.
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Affiliation(s)
- Ji-Hyeon Park
- Department of Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Surgery, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Department of Surgery, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Cancer Research Institute, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Hyesung Kim
- Health Economics & Market Access, Johnson & Johnson MedTech Korea, 24F LS Yongsan Tower, 92, Hangang-daero, Yongsan-gu, Seoul, 04386, Republic of Korea
| | - HyeJin Park
- Health Economics & Market Access, Johnson & Johnson MedTech Korea, 24F LS Yongsan Tower, 92, Hangang-daero, Yongsan-gu, Seoul, 04386, Republic of Korea
| | - Bora Lee
- Institute of Health & Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.,RexSoft Corp., Room 222, Room 223, Seoul National University Research Park Main Building, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Hyeryeong Nam
- RexSoft Corp., Room 222, Room 223, Seoul National University Research Park Main Building, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Sara Kim
- Department of Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sa-Hong Kim
- Department of Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Surgery, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Surgery, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Cancer Research Institute, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Surgery, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Cancer Research Institute, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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Mandalà C, Veronese N, Dominguez LJ, Candore G, Accardi G, Smith L, Herrero MT, Barbagallo M. Use of bioelectrical impedance analysis in centenarians: a systematic review. Aging Clin Exp Res 2023; 35:1-7. [PMID: 36287324 PMCID: PMC9816227 DOI: 10.1007/s40520-022-02282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/12/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Centenarians often represent one of the best examples of aging successfully. However, the role of body composition or hydration status assessed with bioelectrical impedance analysis (BIA) is poorly explored in this population. Therefore, the aim of this systematic review was to better understand the use and the role of BIA for evaluating body composition and hydration status in centenarians. METHODS We conducted a systematic review of the literature up to the 1st of May, 2022 for published articles providing data on BIA to evaluate body composition parameters or hydration status in centenarians. Data were summarized descriptively because a meta-analysis was not possible due to the scarcity of available studies. RESULTS Among 2222 articles screened, four were eligible including 291 centenarians (mean age: 100.5 years) who were mainly women (88%). In one study, BIA overestimated fat-free mass and underestimated fat mass when compared to deuterium oxide dilution. Another study carried out in Italy including 14 centenarians found a significant correlation between BIA and fat-free mass evaluated using anthropometric tools. In one study, BIA showed a significant agreement with anthropometric measures of fat mass. In the same sample, sarcopenia and dehydration, evaluated with BIA, had a high prevalence. CONCLUSION BIA may be used for assessing body composition in centenarians, but research is limited to a few studies suggesting the need of future research in this area.
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Affiliation(s)
- Caterina Mandalà
- Geriatric Unit, Department of Medicine, University of Palermo, Via del Vespro 141, 90127 Palermo, Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Medicine, University of Palermo, Via del Vespro 141, 90127 Palermo, Italy
| | - Ligia J. Dominguez
- Geriatric Unit, Department of Medicine, University of Palermo, Via del Vespro 141, 90127 Palermo, Italy ,School of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy
| | - Giuseppina Candore
- Laboratory of Immunopathology and Immunosenescence, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Giulia Accardi
- Laboratory of Immunopathology and Immunosenescence, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Maria Trinidad Herrero
- Clinical and Experimental Neuroscience (NiCE-IMIB). School of Medicine, Department of Human Anatomy and Psychobiology, Institute for Aging Research, Universidad de Murcia, Campus Mare Nostrum, Murcia, Spain
| | - Mario Barbagallo
- Geriatric Unit, Department of Medicine, University of Palermo, Via del Vespro 141, 90127 Palermo, Italy
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Mediterranean Diet Adherence in Community-Dwelling Older Adults in Spain: Social Determinants Related to the Family. Nutrients 2022; 14:nu14235141. [PMID: 36501170 PMCID: PMC9736247 DOI: 10.3390/nu14235141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
The Mediterranean diet (MD), a well-established quality diet model, and regular physical activity are associated with reducing the appearance or progression of several chronic diseases and reducing morbidity and mortality. However, reduction of these goals, adherence to the MD, and regular physical activity occur at all ages, including older individuals in Mediterranean countries such as Spain, where at least adherence to the MD is culturally rooted. Objective: To evaluate the degree of adherence to the MD and physical activity in older individuals. Methods: The sample comprises 679 older adults aged 60 and over who attended activities in municipal centers for older adults in Valencia. Adherence to the Mediterranean diet, frequency of physical activity, and anthropometric assessment were used. Results: High adherence (score ≥ 9) to MD was observed only in 23.7% of the study sample. Smoking habits or having meals in fast-food restaurants on a weekly basis were significantly (p < 0.05) associated with lower MD adherence. Age, BMI, marital status, and physical activity were not significantly associated with MD adherence. Physical activity was significantly (p < 0.05) lower in individuals who were divorced or widow/ers and in those taking care of their grandchildren several times a week. Conclusions: Adherence to the MD in a big Spanish city is low among older individuals. Socio-family factors seem to play a role. Public health and governmental strategies should reinforce adherence to the MD among older individuals as a gold standard for nutrition.
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Objectively Assessed Weight Change and All-Cause Mortality among Community-Dwelling Older People. Nutrients 2022; 14:nu14142983. [PMID: 35889940 PMCID: PMC9320907 DOI: 10.3390/nu14142983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 02/01/2023] Open
Abstract
Later life changes in body weight may be associated with an increased risk of mortality in older adults. The objective of this study was to examine whether weight change over four years was associated with a 17-year mortality risk in older adults. Participants were 1664 community-dwelling adults aged ≥65 years in the longitudinal Enquete de Sante’ Psychologique-Risques, Incidence et Traitement (ESPRIT) study. Outcomes were all-cause mortality, cardiovascular disease (CVD) and cancer mortality. Weight change was defined as difference between weight at baseline and 4 years, categorised into: weight stable (±<5% weight change), weight loss (≥5%) and weight gain (≥5%). Association between weight change and mortality risk was evaluated using Cox proportional hazards models. Over 17 years of follow-up (median 15 years), 565 participants died. Compared to stable weight participants, those with ≥ 5% weight loss had an increased risk of all-cause mortality (HR: 1.24, 95% CI: 1.00−1.56, p = 0.05) and CVD mortality (HR: 1.53, 95% CI: 1.10−2.14, p = 0.01), but not cancer mortality (HR: 0.83, 95% CI: 0.50−1.39, p = 0.49). Weight gain of ≥5% was not associated with increased mortality (HR: 1.05, 95% CI: 0.76−1.45, p = 0.74). Weight monitoring in older adults could help identify weight loss at its early stages to better target interventions to maintain nutritional reserve and prevent premature mortality.
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Mathur MB, Smith LH, Yoshida K, Ding P, VanderWeele TJ. E-values for effect heterogeneity and approximations for causal interaction. Int J Epidemiol 2022; 51:1268-1275. [PMID: 35460421 PMCID: PMC9365630 DOI: 10.1093/ije/dyac073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 04/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background Estimates of effect heterogeneity (i.e. the extent to which the causal effect of one exposure varies across strata of a second exposure) can be biased if the exposure–outcome relationship is subject to uncontrolled confounding whose severity differs across strata of the second exposure. Methods We propose methods, analogous to the E-value for total effects, that help to assess the sensitivity of effect heterogeneity estimates to possible uncontrolled confounding. These E-value analogues characterize the severity of uncontrolled confounding strengths that would be required, hypothetically, to ‘explain away’ an estimate of multiplicative or additive effect heterogeneity in the sense that appropriately controlling for those confounder(s) would have shifted the effect heterogeneity estimate to the null, or alternatively would have shifted its confidence interval to include the null. One can also consider shifting the estimate or confidence interval to an arbitrary non-null value. All of these E-values can be obtained using the R package EValue. Results We illustrate applying the proposed E-value analogues to studies on: (i) effect heterogeneity by sex of the effect of educational attainment on dementia incidence and (ii) effect heterogeneity by age on the effect of obesity on all-cause mortality. Conclusion Reporting these proposed E-values could help characterize the robustness of effect heterogeneity estimates to potential uncontrolled confounding.
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Affiliation(s)
- Maya B Mathur
- Quantitative Sciences Unit and Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Louisa H Smith
- Roux Institute, Northeastern University, Portland, ME, USA
| | - Kazuki Yoshida
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Peng Ding
- Department of Statistics, University of California at Berkeley, Berkeley, CA, USA
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Jia H, Lubetkin EI. Association between self-reported body mass index and active life expectancy in a large community-dwelling sample of older U.S. adults. BMC Geriatr 2022; 22:310. [PMID: 35397523 PMCID: PMC8994875 DOI: 10.1186/s12877-022-03021-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 04/01/2022] [Indexed: 11/26/2022] Open
Abstract
Background Obesity may have a protective effect (greater survival) in older adults, a finding known as the “obesity paradox.” This study examined the association between self-reported body mass index (BMI) and active life expectancy (ALE) among older U.S. adults. Methods Using the Medicare Health Outcomes Survey Cohort 15 (2012 baseline, 2014 follow-up), we estimated life expectancy and ALE by participants’ baseline BMI and age using multi-state models. A participant was classified as in an active state if this person reported having no difficulty for any of these six activities of daily living (ADLs). Results Small differences in life expectancy were noted among persons in normal weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25–29.9 kg/m2), and obesity ranges (BMI 30 kg/m2 and higher). However, persons with obesity had a significantly lower ALE. ALE at age 65 was 11.1 (11.0–11.2) years for persons with obesity, 1.2 (1.1–1.3) years less than that for the normal weight and overweight persons (12.3 years for both, 12.2–12.4). Persons with class III obesity had a significantly lower life expectancy and ALE than normal weight persons. Although persons with class I or II obesity had a similar life expectancy as normal weight persons, they have a shorter ALE. Conclusions Although older adults with obesity have a similar life expectancy as normal weight persons, they have a significantly shorter ALE. Given the complex relationship of BMI and ALE, a “one size fits all” approach to weight management is not advisable. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03021-7.
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Is BMI a reliable prognostic parameter in metastatic prostate cancer patients? Prostate Cancer Prostatic Dis 2022; 25:797. [PMID: 34811500 DOI: 10.1038/s41391-021-00474-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 01/14/2023]
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Yuan Y, Lin S, Lin W, Huang F, Zhu P. Modifiable predictive factors and all-cause mortality in the non-hospitalized elderly population: An umbrella review of meta-analyses. Exp Gerontol 2022; 163:111792. [PMID: 35367595 DOI: 10.1016/j.exger.2022.111792] [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: 01/29/2022] [Revised: 03/20/2022] [Accepted: 03/28/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This umbrella review aimed to summarize the association between modifiable predictive factors and all-cause mortality in the non-hospitalized elderly population, and estimated the credibility and strength of the current evidence. METHODS PubMed, Embase, Web of science, and EBSCOhost were searched up to February 28, 2022. Random-effect summary effect sizes and 95% confidence intervals (CIs), heterogeneity, small-study effect, excess significance bias, as well as 95% prediction intervals (PIs) were calculated. Methodological quality was assessed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. The credibility of the included meta-analyses was graded from convincing to weak using established criteria. This umbrella review was registered with PROSPERO, CRD 42021282183. RESULTS In total, 32 predictive factors involving 49 associations extracted from 35 meta-analyses were analyzed. Forty-three of the 49 (87.8%) associations presented nominal significant effects by the random-effect model (P < 0.05), of which 34 had harmful associations and nine had beneficial associations with all-cause mortality. Frailty (FRAIL scale), low short physical performance battery (SPPB) score, and fewer daily steps carried a more than three-fold risk for all-cause mortality. Convincing evidence showed that weight fluctuation, prefrailty and frailty status, sarcopenia, low SPPB score, fewer daily steps, and fatigue increased the risk of all-cause mortality, while daily moderate-to-vigorous physical activity (MVPA) duration and total physical activity participation reduced the risk of death. There were twenty, nine, five, and six associations that yielded highly suggestive, suggestive, weak, and non-significant grades of evidence. Thirty-four (69.4%) of the associations exhibited significant heterogeneity. Twenty-two associations presented 95% PIs excluding the null value, two indicated small-study effects, and three had evidence for excess significance bias, respectively. The methodological quality of most meta-analyses was rated as low (37.1%) or critically low (42.9%). CONCLUSIONS A summary of the currently available meta-analyses suggests that a broad range of modifiable predictive factors are significantly associated with all-cause mortality risk in the non-hospitalized elderly population. The most credible evidence indicates that physical function represented by frailty and sarcopenia, as well as physical activity, are significant predictors for all-cause mortality. This umbrella review may provide prognostic information to direct appropriate diagnostic evaluation and treatment goals in the future. More solid evidence is still needed coming from moderate-to-high quality meta-analyses.
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Affiliation(s)
- Yin Yuan
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, China; Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China; Fujian Provincial Institute of Clinical Geriatrics, Fuzhou, China; Fujian Provincial Center of Geriatrics, Fuzhou, China; Fujian Provincial Key Laboratory of Geriatrics, Fuzhou, China
| | - Siyang Lin
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, China; Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China; Fujian Provincial Institute of Clinical Geriatrics, Fuzhou, China; Fujian Provincial Center of Geriatrics, Fuzhou, China; Fujian Provincial Key Laboratory of Geriatrics, Fuzhou, China
| | - Wenwen Lin
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, China; Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China; Fujian Provincial Institute of Clinical Geriatrics, Fuzhou, China; Fujian Provincial Center of Geriatrics, Fuzhou, China; Fujian Provincial Key Laboratory of Geriatrics, Fuzhou, China
| | - Feng Huang
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, China; Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China; Fujian Provincial Institute of Clinical Geriatrics, Fuzhou, China; Fujian Provincial Center of Geriatrics, Fuzhou, China; Fujian Provincial Key Laboratory of Geriatrics, Fuzhou, China.
| | - Pengli Zhu
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, China; Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China; Fujian Provincial Institute of Clinical Geriatrics, Fuzhou, China; Fujian Provincial Center of Geriatrics, Fuzhou, China; Fujian Provincial Key Laboratory of Geriatrics, Fuzhou, China.
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García-Sánchez J, Mafla-España MA, Tejedor-Cabrera C, Avellán-Castillo O, Torregrosa MD, Cauli O. Plasma Aromatase Activity Index, Gonadotropins and Estrone Are Associated with Frailty Syndrome in Post-Menopausal Women with Breast Cancer. Curr Oncol 2022; 29:1744-1760. [PMID: 35323344 PMCID: PMC8947022 DOI: 10.3390/curroncol29030144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 01/04/2023] Open
Abstract
Frailty syndrome is associated with poor outcomes, morbidity and premature mortality. We performed a cross-sectional study to evaluate the presence of frailty syndrome based on Fried’s frailty phenotype in post-menopausal women with breast cancer. We further analyzed the association between frailty syndrome with geriatric assessments and the association with the concentration of gonadotropins LH and FSH, estrogens, androgens and the aromatase activity index in the blood. We enrolled 47 post-menopausal women with localized breast cancer (mean age 66.8 ± 1.3 years (range 52−83)) prior to the starting of adjuvant endocrine therapy. Patients were identified as “non-frail” (robust) or “prefrail/frail” if they fulfilled at least one frailty criteria. In order to determine associations among variables and to control for other variables potentially affecting frailty syndrome (age, comorbidity index and previous chemotherapy treatment), we performed a logistic regression analysis. The receiver operating characteristic curve was performed to assess the sensitivity and specificity of the hormonal concentration to discriminate prefrail/frail versus non-frail individuals. Significant positive associations were observed between the severity of frailty syndrome and estrone, FSH and LH concentrations and the aromatase activity index in the blood (p < 0.05). Further research into the role of hormonal biomarkers should be evaluated in follow-up studies in order to recommend their use as suitable biomarkers of frailty syndrome in breast cancer patients.
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Affiliation(s)
- Javier García-Sánchez
- Medical Oncology Department, Doctor Peset University Hospital, 46017 Valencia, Spain; (J.G.-S.); (M.D.T.)
- Medical Oncology Department, Hospital Center of Wallonie Picardy, 7500 Tournai, Belgium
| | - Mayra Alejandra Mafla-España
- Frailty Research Organized Group, University of Valencia, 46010 Valencia, Spain;
- Department of Nursing, University of Valencia, 46010 Valencia, Spain; (C.T.-C.); (O.A.-C.)
| | - Carlos Tejedor-Cabrera
- Department of Nursing, University of Valencia, 46010 Valencia, Spain; (C.T.-C.); (O.A.-C.)
| | - Olga Avellán-Castillo
- Department of Nursing, University of Valencia, 46010 Valencia, Spain; (C.T.-C.); (O.A.-C.)
| | - María Dolores Torregrosa
- Medical Oncology Department, Doctor Peset University Hospital, 46017 Valencia, Spain; (J.G.-S.); (M.D.T.)
| | - Omar Cauli
- Frailty Research Organized Group, University of Valencia, 46010 Valencia, Spain;
- Department of Nursing, University of Valencia, 46010 Valencia, Spain; (C.T.-C.); (O.A.-C.)
- Correspondence:
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Fiorindi C, Dragoni G, Scaringi S, Staderini F, Nannoni A, Ficari F, Giudici F. Relationship between Nutritional Screening Tools and GLIM in Complicated IBD Requiring Surgery. Nutrients 2021; 13:3899. [PMID: 34836154 PMCID: PMC8623109 DOI: 10.3390/nu13113899] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/14/2021] [Accepted: 10/29/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Accurate identification of malnutrition and preoperative nutritional care in Inflammatory Bowel Disease (IBD) surgery is mandatory. There is no validated nutritional screening tool for IBD patients. We developed a novel nutritional screening tool for IBD patients requiring surgery and compared it with other tools. METHODS we included 62 consecutive patients scheduled for elective surgery. The IBD Nutritional Screening tool (NS-IBD) was developed to screen patients for further comprehensive assessment. NRS-2002, MUST, MST, MIRT, SaskIBD-NR are compared with the new test. All screening tests were subsequently related to new GLIM criteria. RESULTS according to GLIM criteria, 25 (40%) IBD patients were malnourished (15 CD and 10 UC, 33% vs. 63%, p = 0.036). Stage 1 malnutrition was reported in ten patients, while stage 2 was detected in 15 patients. The comparison of each nutritional risk tool with GLIM criteria showed sensitivity of 0.52, 0.6, 0.6, 0.84, 0.84 and 0.92 for SASKIBD-NR, MUST, MST, NRS-2002, MIRT, and the new NS-IBD, respectively. CONCLUSIONS in IBD, currently adopted nutritional screening tools are characterized by a low sensitivity when malnutrition diagnosis is performed with recent GLIM criteria. Our proposed tool to detect malnutrition performed the best in detecting patients that may require nutritional assessment and preoperative intervention.
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Affiliation(s)
- Camilla Fiorindi
- Department of Health Science, Careggi University Hospital, 50134 Florence, Italy; (C.F.); (A.N.)
| | - Gabriele Dragoni
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy;
| | - Stefano Scaringi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (S.S.); (F.S.); (F.F.)
| | - Fabio Staderini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (S.S.); (F.S.); (F.F.)
| | - Anita Nannoni
- Department of Health Science, Careggi University Hospital, 50134 Florence, Italy; (C.F.); (A.N.)
| | - Ferdinando Ficari
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (S.S.); (F.S.); (F.F.)
| | - Francesco Giudici
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (S.S.); (F.S.); (F.F.)
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Gaesser GA, Angadi SS. Obesity treatment: Weight loss versus increasing fitness and physical activity for reducing health risks. iScience 2021; 24:102995. [PMID: 34755078 PMCID: PMC8560549 DOI: 10.1016/j.isci.2021.102995] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We propose a weight-neutral strategy for obesity treatment on the following grounds: (1) the mortality risk associated with obesity is largely attenuated or eliminated by moderate-to-high levels of cardiorespiratory fitness (CRF) or physical activity (PA), (2) most cardiometabolic risk markers associated with obesity can be improved with exercise training independent of weight loss and by a magnitude similar to that observed with weight-loss programs, (3) weight loss, even if intentional, is not consistently associated with lower mortality risk, (4) increases in CRF or PA are consistently associated with greater reductions in mortality risk than is intentional weight loss, and (5) weight cycling is associated with numerous adverse health outcomes including increased mortality. Adherence to PA may improve if health care professionals consider PA and CRF as essential vital signs and consistently emphasize to their patients the myriad benefits of PA and CRF in the absence of weight loss.
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Affiliation(s)
- Glenn A. Gaesser
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | - Siddhartha S. Angadi
- Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesville, VA 22904, USA
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Ryg J, Anru PL, Engberg H, Jorgensen MG, Masud T, Christensen K, Andersen-Ranberg K. Association of Body Mass Index With All-Cause Mortality in Acutely Hospitalized Older Patients. J Am Med Dir Assoc 2021; 23:507-513.e1. [PMID: 34389336 DOI: 10.1016/j.jamda.2021.07.015] [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: 03/03/2021] [Revised: 06/29/2021] [Accepted: 07/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim was to examine the relationship between body mass index (BMI) and mortality in older hospitalized patients taking activities of daily living (ADLs) into account. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Nationwide population-based study of all patients aged ≥65 years admitted to Danish geriatric medical departments during 2005 to 2014 and included in the National Danish Geriatric Database. METHODS Patients were followed until death, emigration, or study termination (December 31, 2015). Primary outcome was all-cause mortality. BMI and ADLs were routinely assessed on admission and linked at an individual level to the Danish national health registers. Kaplan-Meier analysis was used to estimate crude survival according to each BMI subcategory and Cox regression to examine the association with mortality adjusting for age, comorbidity, polypharmacy, ADLs, marital status, prior hospitalizations, and admission year. RESULTS In total, 74,589 patients (63% women) were included aged [mean (SD)] 82.5 (7.5) years with BMI [mean (SD)] of 23.9 (5.1) kg/m2. During follow-up 51,188 died. Follow-up time was 191,972 person-years. Unadjusted and adjusted hazard ratio (HR) for overall, 30-day, and 1-year mortality decreased significantly with increasing BMI. In women, the highest adjusted HR (95% confidence interval) for overall mortality was seen for underweight patients (BMI <16) 1.83 (1.72-1.95) and the lowest for obesity grade II patients (BMI = 35.0-39.9) 0.66 (0.60-0.73) when using normal weight (BMI = 18.5-24.9) as reference. In men, the HR for BMI <16 and BMI = 35.0-39.9 were 1.98 (1.76-2.23) and 0.56 (0.49-0.65), respectively. CONCLUSIONS AND IMPLICATIONS In hospitalized older patients, association between mortality and BMI did not show a U-shaped or J-shaped curve after adjustment of multiple confounders, including ADLs. Instead, mortality was highest in patients with low BMI and decreased with increasing BMI before leveling off in the obese range. Our study highlights the need for a debate and reassessment of what should be the ideal BMI in this vulnerable patient group.
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Affiliation(s)
- Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark; Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Pavithra Laxsen Anru
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Henriette Engberg
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | | | - Tahir Masud
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark; Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Geriatric Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Kaare Christensen
- Danish Ageing Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark; Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Association of BMI, comorbidities and all-cause mortality by using a baseline mortality risk model. PLoS One 2021; 16:e0253696. [PMID: 34242241 PMCID: PMC8270162 DOI: 10.1371/journal.pone.0253696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/10/2021] [Indexed: 11/25/2022] Open
Abstract
Objective The association of body mass index (BMI) and all-cause mortality is controversial, frequently referred to as a paradox. Whether the cause is metabolic factors or statistical biases is still controversial. We assessed the association of BMI and all-cause mortality considering a wide range of comorbidities and baseline mortality risk. Methods Retrospective cohort study of Olmsted County residents with at least one BMI measurement between 2000–2005, clinical data in the electronic health record and minimum 8 year follow-up or death within this time. The cohort was categorized based on baseline mortality risk: Low, Medium, Medium-high, High and Very-high. All-cause mortality was assessed for BMI intervals of 5 and 0.5 Kg/m2. Results Of 39,739 subjects (average age 52.6, range 18–89; 38.1% male) 11.86% died during 8-year follow-up. The 8-year all-cause mortality risk had a “U” shape with a flat nadir in all the risk groups. Extreme BMI showed higher risk (BMI <15 = 36.4%, 15 to <20 = 15.4% and ≥45 = 13.7%), while intermediate BMI categories showed a plateau between 10.6 and 12.5%. The increased risk attributed to baseline risk and comorbidities was more obvious than the risk based on BMI increase within the same risk groups. Conclusions There is a complex association between BMI and all-cause mortality when evaluated including comorbidities and baseline mortality risk. In general, comorbidities are better predictors of mortality risk except at extreme BMIs. In patients with no or few comorbidities, BMI seems to better define mortality risk. Aggressive management of comorbidities may provide better survival outcome for patients with body mass between normal and moderate obesity.
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A high lean body mass is not protecting from type 2 diabetes in the presence of a high body fat mass. DIABETES & METABOLISM 2021; 47:101219. [PMID: 33418084 DOI: 10.1016/j.diabet.2020.101219] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 02/01/2023]
Abstract
AIM Most studies examining the associations between body composition and type 2 diabetes have been cross-sectional with prevalent diabetes diagnosis or they have analyzed only fat or lean body mass. Hence, the combined effect of fat and lean body mass on the risk of developing type 2 diabetes remains unclear. We investigated whether baseline lean and fat body mass taken simultaneously into account are associated with incidence of type 2 diabetes over a 15-year follow-up in older adults. METHODS We studied 704 men (n = 297) and women (n = 407) from the Helsinki Birth Cohort Study (mean age 61 years at baseline) without diabetes at baseline. Bioelectrical impedance analysis was used to derive baseline fat mass index (FMI, fat mass/height2) and lean mass index (LMI, lean mass/height2), dichotomized at sex-specific medians. Incident diabetes was defined as the composite of fasting plasma glucose (FPG) ≥ 7.0 mmol/l, haemoglobin A1c (HbA1C) ≥ 6.5% (48 mmol/mol) or physician-based diagnosis. RESULTS After a median 14.8 (range 12.5-16.8) years of follow-up, 110 incident diabetes cases occurred (15.6%). Participants with high FMI and LMI at baseline had higher composite incidence of type 2 diabetes (P < 0.001), and significantly increased risk of type 2 diabetes after adjustment for potential confounding factors (sex, physical activity, education and body mass index) compared to the other participants. CONCLUSION Contrary to a general belief greater muscle mass is not protective against type 2 diabetes. High LMI accompanied with high FMI seem to predict subsequent development of type 2 diabetes.
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Changes in body composition and lipid profile in prostate cancer patients without bone metastases given Degarelix treatment: the BLADE prospective cohort study. Prostate Cancer Prostatic Dis 2021; 24:852-859. [PMID: 33723362 PMCID: PMC7958940 DOI: 10.1038/s41391-021-00345-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Luteinizing hormone-releasing hormone (LHRH)-agonists in prostate cancer (PCa) patients induce sarcopenic obesity. The effect of LHRH-antagonist on body composition has never been explored. We evaluated changes in fat (FBM) and lean body mass (LBM) in PCa patients undergoing Degarelix. METHODS This is a single-center prospective study, enrolling 29 non-metastatic PCa patients eligible to LHRH-antagonist from 2017 to 2019. All patients received monthly subcutaneous injection of Degarelix for 12 months. Changes in FBM and LBM between baseline and 12-month Degarelix, as measured by dual-energy x-ray absorptiometry, were the co-primary endpoints. Secondary endpoints were changes in serum lipids, glucose profile and follicle-stimulating hormone (FSH). Appendicular lean mass index (ALMI) and ALMI/FBM ratio were assessed as post-hoc analyses. Linear mixed models with random intercept tested for estimated least squared means differences (EMD). RESULTS FBM significantly increased after 12 months (EMD +2920.7, +13.8%, p < 0.001), whereas LBM remained stable (EMD -187.1, -0.3%, p = 0.8). No differences occurred in lipid profile. Glycated hemoglobin significantly increased and serum FSH significantly decreased. A significant inverse relationship was found between serum FSH and ALMI/FBM ratio after 12 month (r = -0.44, p = 0.02). CONCLUSIONS The BLADE study prospectively evaluated changes in body composition after LHRH-antagonist. LHRH-antagonist therapy is associated to an increased risk of obesity and diabetes, but lean body mass and serum lipids are not affected. This may represent an additional evidence supporting the reduced cardiovascular risk associated with LHRH-antagonist. The role of FSH in influencing sarcopenic obesity in PCa after androgen deprivation deserves to be further explored.
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Chaising S, Temdee P, Prasad R. Weighted objective distance for the classification of elderly people with hypertension. Knowl Based Syst 2020. [DOI: 10.1016/j.knosys.2020.106441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Javed AA, Aljied R, Allison DJ, Anderson LN, Ma J, Raina P. Body mass index and all-cause mortality in older adults: A scoping review of observational studies. Obes Rev 2020; 21:e13035. [PMID: 32319198 DOI: 10.1111/obr.13035] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/14/2020] [Accepted: 03/24/2020] [Indexed: 12/17/2022]
Abstract
In older age, body composition changes as fat mass increases and redistributes. Therefore, the current body mass index (BMI) classification may not accurately reflect risk in older adults (65+). This study aimed to review the evidence on the association between BMI and all-cause mortality in older adults and specifically, the findings regarding overweight and obese BMI. A systematic search of the OVID MEDLINE and Embase databases was conducted between 2013 and September 2018. Observational studies examining the association between BMI and all-cause mortality within a community-dwelling population aged 65+ were included. Seventy-one articles were included. Studies operationalized BMI categorically (n = 60), continuously (n = 8) or as a numerical change/group transition (n = 7). Reduced risk of mortality was observed for the overweight BMI class compared with the normal BMI class (hazard ratios [HR] ranged 0.41-0.96) and for class 1 or 2 obesity in some studies. Among studies examining BMI change, increases in BMI demonstrated lower mortality risks compared with decreases in BMI (HR: 0.83-0.95). Overweight BMI classification or a higher BMI value may be protective with regard to all-cause mortality, relative to normal BMI, in older adults. These findings demonstrate the potential need for age-specific BMI cut-points in older adults.
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Affiliation(s)
- Ayesha A Javed
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Rumaisa Aljied
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - David J Allison
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada.,Labarge Centre for Mobility in Aging, Hamilton, Canada
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Clinical outcomes of basal insulin and oral antidiabetic agents as an add-on to dual therapy in patients with type 2 diabetes mellitus. Sci Rep 2020; 10:5746. [PMID: 32238842 PMCID: PMC7113251 DOI: 10.1038/s41598-020-62646-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 03/06/2020] [Indexed: 12/21/2022] Open
Abstract
While basal insulin remains the most effective antidiabetic agent and substantially reduces the risk of hypoglycemia, few studies have examined the comparative effect of basal insulin in the real-world setting. This study aimed to assess the outcomes of adding basal insulin compared with thiazolidinediones (TZDs) or dipeptidyl peptidase-4 inhibitors (DPP-4is) as a third antidiabetic agent in patients with type 2 diabetes mellitus (T2DM). A retrospective cohort study involving T2DM was conducted with health administrative data in Taiwan. Patients starting a third antidiabetic agent after receiving a metformin-containing dual combination were identified. The study endpoints included composite major adverse cardiovascular events (MACEs), all-cause mortality, and hypoglycemia. Propensity score matching and Cox modeling were used for analysis. After matching, the basal insulin and TZD groups contained 6,101 and 11,823 patients, respectively, and the basal insulin and DPP-4i groups contained 6,051 and 11,900 patients, respectively. TZDs and DPP-4is were both associated with similar risks of MACEs and hypoglycemia but a lower risk of all-cause mortality than basal insulin (TZDs: HR 0.55, 95% CI 0.38-0.81; DPP-4is: HR 0.56, 95% CI 0.39-0.82). Further studies are needed to elucidate the findings of increased all-cause mortality risk in patients receiving basal insulin, especially those with advanced diabetes.
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Mikkola TM, Kautiainen H, von Bonsdorff MB, Salonen MK, Wasenius N, Kajantie E, Eriksson JG. Body composition and changes in health-related quality of life in older age: a 10-year follow-up of the Helsinki Birth Cohort Study. Qual Life Res 2020; 29:2039-2050. [PMID: 32124264 PMCID: PMC7363735 DOI: 10.1007/s11136-020-02453-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 12/19/2022]
Abstract
Purpose Most studies examining the associations between body composition and health-related quality of life (HRQoL) in older age have been cross-sectional and analyzed only fat or lean mass. Hence, it is poorly known whether fat and lean mass are independently associated with subsequent changes in HRQoL. We investigated whether baseline lean and fat mass are associated with changes in HRQoL over a 10-year period in older adults. Methods We studied 1044 men and women from the Helsinki Birth Cohort Study (age 57–70 years at baseline). Bioelectrical impedance analysis was used to derive baseline fat mass index (FMI, fat mass/height2) and lean mass index (lean mass/height2), dichotomized at sex-specific medians. HRQoL was assessed using RAND 36-item Health Survey at baseline and follow-up 10 years later. Results When controlled for lean mass and adjusted for potential confounders, high baseline FMI was associated with a greater decline in general health (standardized regression coefficient [β] = − 0.13, p = 0.001), physical functioning (β = − 0.11, p = 0.002), role physical (β = − 0.13, p = 0.003), vitality (β = − 0.08, p = 0.027), role emotional (β = − 0.12, p = 0.007), and physical component score (β = − 0.14, p < 0.001). High baseline FMI was also associated with low HRQoL in all physical domains at baseline (β: from − 0.38 to − 0.10). Lean mass was not strongly associated with HRQoL at baseline or change in HRQoL. Conclusion In older community-dwelling adults, higher fat mass is, independent of lean mass, associated with lower physical HRQoL and greater decline in HRQoL. Prevention of adiposity may contribute to preservation of a good quality of life in older age.
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Affiliation(s)
- Tuija M Mikkola
- Folkhälsan Research Center, Helsinki, Finland. .,Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland.,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Mikaela B von Bonsdorff
- Folkhälsan Research Center, Helsinki, Finland.,Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
| | - Minna K Salonen
- Folkhälsan Research Center, Helsinki, Finland.,Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Niko Wasenius
- Folkhälsan Research Center, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Kajantie
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland.,PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Clinical and Molecular Medicine, Norwegian University for Science and Technology, Trondheim, Norway.,Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore.,Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Amann VR, Santos LPD, Gigante DP. [Association of excess weight and obesity and mortality in Brazilian state capitals and Argentine provinces]. CAD SAUDE PUBLICA 2019; 35:e00192518. [PMID: 31800787 DOI: 10.1590/0102-311x00192518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 06/03/2019] [Indexed: 01/04/2023] Open
Abstract
This study aimed to assess the association between prevalence of excess weight and obesity and overall and disease-specific mortality rates in Brazilian state capitals and Argentine provinces. This was an ecological study with secondary data, where the principal exposures were prevalence rates for excess weight and obesity, estimated with data from Brazil's Vigitel survey (Risk and Protective Factors Surveillance System for Chronic Non-Communicable Diseases Through Telephone Interveiew) in 2014 and Argentina's National Risk Factor Survey in 2013. Overall and specific mortality rates for the year 2015 were obtained from the Brazilian Mortality Information System in the Brazilian Health Informatics Department and the Division of Health Statistics and Information of the Argentine Ministry of Health. Brazilian mortality rates were standardized with the age structure of the Argentine population as the standard. Crude and adjusted linear regressions were used to assess the association between the prevalence rates for excess weight and obesity and the overall and specific mortality rates. After adjusting for potential confounding factors, prevalence of obesity was positively associated with the overall mortality rate both in Brazil (β = 0.18; 95%CI: 0.01; 0.35) and in Argentina (β = 0.06; 95%CI: 0.01; 0.13). There was no association with the specific cardiovascular and cancer mortality rates. We conclude that the Brazilian state capitals and Argentine provinces with the highest prevalence of obesity present higher overall mortality rates, while this association was inconsistent for the specific rates.
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Affiliation(s)
- Valeria Romina Amann
- Programa de Pós-graduação em Nutrição e Alimentos, Universidade Federal de Pelotas, Pelotas, Brasil
| | | | - Denise Petrucci Gigante
- Programa de Pós-graduação em Nutrição e Alimentos, Universidade Federal de Pelotas, Pelotas, Brasil.,Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
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Impact of functional status on 6-month mortality in elderly patients with acute venous thromboembolism: results from a prospective cohort. J Thromb Thrombolysis 2018; 46:325-331. [DOI: 10.1007/s11239-018-1685-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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