Observational Evidence for Unintentional Weight Loss in All-Cause Mortality and Major Cardiovascular Events: A Systematic Review and Meta-Analysis

Challenges in identifying malnutrition in obesity; An overview of the state of the art and directions for future research

(Protein-energy) malnutrition in individuals living with obesity presents complex diagnostic challenges due to the distinctive physiological characteristics of obesity. This narrative review critically examines the identification of malnutrition within the population with obesity, distinguishing malnutrition in obesity from related conditions such as sarcopenic obesity. While noting some shared features, the review highlights key differences between these conditions. The review also highlights the limitations of current malnutrition screening tools, which are not designed for individuals living with obesity. These tools primarily rely on anthropometric measurements, neglecting (among others) nutrient intake assessment, which hinders accurate malnutrition detection. Additionally, this review discusses limitations in existing diagnostic criteria, including the Global Leadership Initiative on Malnutrition (GLIM) criteria, when applied to individuals living with obesity. Challenges include the identification of appropriate cut-off values for phenotypic criteria (unintentional weight loss, low body mass index and muscle mass) and aetiological criteria such as reduced food intake and inflammation for the population with obesity. Overall, this review emphasises the need for modified screening tools and diagnostic criteria to recognise and assess malnutrition in obesity, leading to improved clinical outcomes and overall wellbeing.

Weight change and cardiovascular disease incidence in breast cancer survivors: a nationwide cohort study

BACKGROUND

Breast cancer survivors (BCS) face a higher risk of cardiovascular disease (CVD) due to treatment-related cardiotoxicity and pre-existing conditions. We investigated how post-diagnosis weight changes and obesity impact CVD risk in this population.

METHOD

Using the Korean National Health Insurance Service database (2010-2019), BCS without previous history of CVD were enrolled. Weight change was determined using standardized anthropometric protocols during biennial health examinations pre- and post-diagnosis. The primary outcome was incident CVD, a composite of myocardial infarction (MI) and ischemic stroke. Adjusted hazard ratios (aHRs) and confidence intervals (CIs) were estimated, accounting for cardiovascular risk factors, cancer treatments, and sociodemographic variables.

RESULTS

During a mean follow-up of 3.70 years among the 42,547 BCS (mean [SD] age 53.4 [9.4] years), substantial weight gain (> 10%) was associated with increased CVD risk (aHR 1.66, 95% CI 1.05-2.62) and MI risk (aHR 1.83, 95% CI 1.01-3.33) compared to those who maintained their weight. The association between change in obesity status and CVD risk was not significant. Among BCS with sustained obesity, CVD risk was more pronounced in younger survivors (< 50 years) (aHR 3.58, 95% CI 1.94-6.61), and in those using tamoxifen (aHR 1.74, 95% CI 1.11-2.75) (P-interactions < 0.05).

CONCLUSIONS

Our findings suggest that BCS who experience substantial weight gain post-diagnosis have an increased risk of CVD. Further intervention studies (e.g., GLP-1 agonist) are needed to ascertain the effects of weight changes on CVD risks in BCS.

Association between weight changes and infective endocarditis in patients with diabetes: A nationwide population-based cohort study

BACKGROUNDS

The association between weight change in patients with diabetes, and the development of infective endocarditis (IE) has never been studied. Therefore, we evaluated the associations of weight changes in patients with diabetes with the development of IE.

METHODS

In this Korean population-based cohort study, we included patients with diabetes aged ≥20 years who underwent health screenings twice in a 2-year interval between 2009 and 2012. Patients were categorized into five groups according to the degree of weight change between the two health screenings and were followed up until December 2018. A patient with a weight change of ≤-10% was designated to the severe weight loss group, -10 to ≤-5% to the moderate weight loss group, -5 to ≤5% to the stable weight group, 5 to ≤10% to the moderate weight gain group, and ≥10% to the severe weight gain group. The primary outcome was the incidence of IE.

RESULTS

A total of 1,762,108 patients with diabetes were included. There were 67,580 (3.9%) individuals with severe weight loss, 247,969 (14.1%) with moderate weight loss, 1,267,849 (72.0%) with stable weight, 135,774 (7.7%) with moderate weight gain, 42,936 (2.4%) with severe weight gain. During the follow-up (median, 5.21 years), 828 cases of IE occurred. After adjusting for covariates, both weight loss (HR: 2.41, 95% CI: 1.87-3.12 for the severe weight loss group; HR: 1.28, 95% CI: 1.05-1.55 for the moderate weight loss group) and weight gain (HR: 1.17, 95% CI: 0.91-1.50 for the moderate weight gain group; HR: 1.59, 95% CI: 1.11-2.28 for the severe weight gain group) were associated with an increased risk of IE compared to those for the stable weight group.

CONCLUSION

Both weight gain and weight loss are associated with an increased incidence of IE, and the greater the degree of weight change, the greater the risk.

Body mass index trajectories and all-cause mortality in older Chinese adults: Hong Kong's Elderly Health Service Cohort

BACKGROUND

Weight loss at older ages appears to be associated with higher mortality in Western and some East Asian countries, despite differences in the prevalence of obesity; whether it is relevant to China is unknown. We examined the association of body mass index (BMI) trajectories with all-cause mortality in older Chinese adults by sex and baseline age (65-69 years, 70+ years).

METHODS

54 160 participants aged 65 or above from Hong Kong's Elderly Health Service Cohort with at least five BMI measurements were included. We identified distinct BMI trajectories using group-based trajectory modelling. We assessed the associations of BMI trajectories with mortality risk using a Cox model stratified by sex and age.

RESULTS

Compared with 'normal weight, stable', the 'low-normal weight, decreasing' had higher mortality risk in both sexes and age groups (eg, HR 1.43, 95% CI 1.24 to 1.66 in men aged 65-69 years). The 'overweight, stable' and 'obese, stable' had lower mortality risk, especially in men at older ages. However, the proportion in the 'low-normal weight, decreasing' was greater at 70+ years than at 65-69 years, while the proportion in the 'overweight, stable' and 'obese, stable' was lower in the older group.

CONCLUSIONS

Decreasing BMI is a likely symptom of ill health in older adults. Inconsistency between the risks and the proportion in each BMI trajectory group by age suggests the observed associations could be driven by changes in weight and preferential recruitment of survivors. Maintaining a healthy weight remains relevant at older ages.

Metabolomic characterization of unintentional weight loss among community-dwelling older Black and White men and women

This study aims to understand the metabolic mechanisms of unintentional weight loss in older adults. We investigated plasma metabolite associations of subsequent weight change over 2 years in 1536 previously weight stable participants (mean age 74.6 years, 50% women, 35% Black) from the Health, Aging and Body Composition (Health ABC) Study. Multinomial logistic regressions were used to examine associations of the 442 metabolites with weight loss with/without an intention and weight gain >3% annually relative to weight stability. The metabolite associations of unintentional weight loss differed from those of intentional weight loss and weight gain. Lower levels of aromatic amino acids, phospholipids, long-chain poly-unsaturated triglycerides, and higher levels of amino acid derivatives, poly-unsaturated fatty acids, and carbohydrates were associated with higher odds of unintentional weight loss after adjusting for age, sex, race, and BMI categories. Prevalent diseases attenuated four and lower mid-thigh muscle mass and poorer appetite each attenuated 2 of 77 identified metabolite associations by >20%, respectively. Other factors (e.g., energy expenditure, diet, and medication) attenuated all associations by <20%. While 16 metabolite associations were attenuated by 20%-48% when adjusting for all these risk factors, 47 metabolite associations remained significant. Altered amino acid metabolism, impaired mitochondrial fatty acid oxidation, and inflammaging implicated by identified metabolites appear to precede unintentional weight loss in Health ABC older adults. Furthermore, these pathways seem to be associated with prevalent diseases especially diabetes, lower muscle mass, and poorer appetite.

Poor Activities of Daily Living Predict Future Weight Loss in Older Adults After Hospital Discharge-Secondary Analysis of a Randomized Trial

This study examined whether participants with poor activities of daily living (ADLs) at hospital discharge had increased weight loss after 6 months of follow-up and whether nutrition therapy can prevent this weight loss. This dietary randomized controlled trial (N = 104) examined community-dwelling older adults (66-95 years) discharged from hospital and at risk for malnutrition, receiving either 6 months of nutrition therapy (intervention) or only standard care (control). ADL was assessed using seven questions on self-care based on the Katz et al.'s method. At discharge, 45 (43%), 36 (35%), and 23 (22%) had high, medium, and poor ADL, respectively, with no differences between the control and intervention groups according to chi-square test. Participants in the control group with poor ADL had significantly higher weight loss than participants with high ADL (age- and sex-adjusted analysis of covariance: 3.6 kg; 95% confidence interval [1.0, 6.1] kg, p = .007). No such difference was observed in the intervention group. Participants with poor ADL at hospital discharge develop lower body weight by around 3.5 kg 6 months later when compared with participants with high ADL. Receiving nutrition therapy could help older adults with poor ADL to maintain body weight after hospital discharge.

Association between self-reported weight loss and new long-term care insurance certifications: A 9-year Japanese older adult cohort study

AIM

This cohort study aimed to assess weight loss associated with new long-term care insurance (LTCI) certifications over a 9-year period, accounting for the competing risk of death.

METHODS

We analyzed data from 3749 Japanese individuals aged ≥65 years in Kami Town, Hyogo Prefecture, Japan. Weight loss was assessed using the Kihon Checklist during the baseline survey. Data regarding LTCI certifications were collected until March 2022. Cox proportional hazards models were used to calculate adjusted hazard ratios (HRs) of 9-year LTCI certification because of weight loss, adjusted for confounding factors. To exclude the effect of competing risks, Fine-Gray regression was used to estimate subdistribution HRs. Subgroup analyses were carried out after the examination of potential interactions between subjective cognitive function, body mass index categories and weight loss.

RESULTS

The incidence rate of new LTCI certifications was 5.16 per 100 person-years overall - broken down into 7.02 for those with weight loss and 4.97 for those without. The adjusted HR for weight loss to new LTCI certifications was 1.35 (95% CI 1.15-1.59). Considering mortality as a competing risk, the adjusted subdistribution HR was 1.37 (95% CI 1.16-1.61). Conversely, no interaction was observed between weight loss and subjective cognitive function or body mass index categories.

CONCLUSIONS

Excluding the effect of mortality, weight loss was identified as a risk factor for new LTCI certifications. However, no interaction was observed between weight loss and subjective cognitive function or body mass index categories. Geriatr Gerontol Int 2024; 24: 1320-1327.

The Prevalence and Characteristics of Anemia in Romanian Patients with Type 2 Diabetes: A Cross-Sectional Study

Background/Objectives: Anemia is a prevalent comorbidity of diabetes, and although various mechanisms have been shown to link these two conditions, their interaction has not been sufficiently explored. Our cross-sectional, non-interventional study aimed to evaluate the prevalence of anemia and its subtypes, as well as their interactions, in patients with type 2 diabetes (T2D). Methods: A total of 227 patients previously diagnosed with T2D were enrolled. These patients were assessed regarding their medical history and the evolution of their diabetes, and were screened for anemia. Results: Anemia was encountered in 32.6% of the 227 hospitalized patients previously diagnosed with T2D enrolled in this study. Its presence was associated with a higher prevalence of complications and comorbidities, such as chronic kidney disease (CKD), retinopathy, and atrial fibrillation. The most common types of anemia observed were those associated with CKD, other chronic conditions, and iron deficiency. A moderate, positive correlation (r = 0.307; p < 0.0001) has been observed between estimated glomerular filtration rate (eGFR) and hemoglobin, and a moderate, negative correlation has been observed between age and hemoglobin (r = -0.351; p < 0.0001), with the results also analyzed using multiple regression and ROC curve analysis. Additionally, a weak, positive, yet statistically significant correlation was observed between glycemic values and hemoglobin levels, which requires further research. Conclusions: Anemia is frequently encountered in patients with T2D, especially in those with increased age, decreased eGFR, and additional chronic degenerative complications or other comorbidities; thus, a systematic screening for an early diagnosis and interdisciplinary management is recommended for improved outcomes related to morbidity, mortality, and quality of life.

Predicting all-cause mortality and premature death using interpretable machine learning among a middle-aged and elderly Chinese population

Objective

To develop machine learning-based prediction models for all-cause and premature mortality among the middle-aged and elderly population in China.

Method

Adults aged 45 years or older at baseline of 2011 from the China Health and Retirement Longitudinal Study (CHARLS) were included. The stacked ensemble model was built utilizing five selected machine learning algorithms. These models underwent training and testing using the CHARLS 2011-2015 cohort (derivation cohort) and subsequently underwent external validation using the CHARLS 2015-2018 cohort (validation cohort). SHapley Additive exPlanations (SHAP) was introduced to quantify the importance of risk factors and explain machine learning algorithms.

Result

In derivation cohort, a total of 10,677 subjects were included, 478 died during the follow-up. The stacked ensemble model demonstrated the highest efficacy in terms of its discrimination capability for predicting all-cause mortality and premature death, with an AUC[95 % CI] of 0.826[0.792-0.859] and 0.773[0.725-0.821], respectively. In validation cohort, the corresponding AUC[95 % CI] were 0.803[0.743-0.864] and 0.791[0.719-0.863], respectively. Risk factors including age, sex, self-reported health, activities of daily living, cognitive function, ever smoker, levels of systolic blood pressure, Cystatin C and low density lipoprotein were strong predictors for both all-cause mortality and premature death.

Conclusion

Stacked ensemble models performed well in predicting all-cause and premature death in this Chinese cohort. Interpretable techniques can aid in identifying significant risk factors and non-linear relationships between predictors and mortality.

Adulthood weight changes, body mass index in youth, genetic susceptibility and risk of atrial fibrillation: a population-based cohort study

BACKGROUND

Epidemiological evidence on weight change and atrial fibrillation (AF) remains limited and inconsistent. Previous studies on body mass index (BMI) in youth and AF rarely considered subsequent BMI. This study aimed to assess the associations of AF with weight change and BMI in youth, as well as modified effect by genetic susceptibility of AF.

METHODS

The study included 21,761 individuals (mean age 57.8 years) from the Malmö Diet and Cancer cohort. Weight information was obtained at three time points, including recalled weight at age 20 years, measured weight at baseline (middle adulthood), and reported weight at 5-year follow-up examination (late middle adulthood). A weighted genetic risk score of AF was created using 134 variants.

RESULTS

During a median follow-up of 23.2 years, a total of 4038 participants developed AF. The association between weight change from early to middle adulthood and AF risk was modified by sex (Pinteraction = 0.004); weight loss was associated with a lower AF risk in females, but not in males. Conversely, weight gain was positively associated with AF risk in a linear manner in females, whereas increased AF risk appeared only when weight gain exceeded a threshold in males. Participants with weight gain of > 5 kg from middle to late middle adulthood had a 19% higher risk of AF relative to those with stable weight, whereas weight loss showed a null association. Compared to individuals with a lower BMI at age 20 years, those with a BMI above 25 kg/m2 had an increased risk of AF (HR = 1.14; 95% CI: 1.02-1.28), after controlling for baseline BMI; this association was more pronounced in males or those with a lower genetic risk of AF.

CONCLUSIONS

Weight gain in middle adulthood was associated with higher AF risk. Weight loss from early to middle adulthood, but not from middle to late middle adulthood, was associated with a lower risk of AF only in females. Higher BMI in youth was associated with an increased risk of AF, particularly among males or those with a lower genetic risk of AF.

Underweight, overweight, and weight change in older family caregivers and their care recipients: longitudinal evidence from a randomized controlled trial

This study aimed to identify differences among body mass index (BMI) categories of older family caregivers (≥60 years) and their care recipients (≥65 years). Secondly, this study aimed to examine group differences and factors associated with weight change during a nutrition and oral health intervention. This secondary analysis of a randomized controlled trial (ClinicalTrial.gov (NCT04003493)) involved individually tailored nutritional guidance from a clinical nutritionist and oral health guidance from a dental hygienist. Baseline BMI differences were analyzed, followed by further analyses of group differences and associated factors of weight change over a 6-month period using generalized estimating equations. Among the participants (113 family caregivers and 107 care recipients), 36.3% and 35.1% were overweight (BMI >29 kg/m2), while 18.6% and 21.6% were underweight (BMI <24 kg/m2) at baseline, respectively. For family caregivers differences in BMI categories included age, mid-arm and calf circumferences, and plasma prealbumin concentration. For care recipients differences were observed in medication use, mid-arm and calf circumferences, Mini Nutritional Assessment scores, physical function, and number of teeth. During the 6-month intervention, there were no differences in weight change between intervention and control groups for both caregivers and care recipients. Factors significantly associated (p < 0.05) with weight loss included female sex for both caregivers and care recipients, and frailty for caregivers. Family caregivers' characteristics were not significantly associated with weight change in their care recipients. In conclusion, being overweight is a prevalent among older family caregivers and care recipients. Factors such as age, medication use, physical function, number of teeth, and Mini Nutritional Assessment scores varied across BMI categories. Female sex was associated with weight loss in both older family caregivers and care recipients, and frailty was associated with weight loss in caregivers. However, the characteristics of family caregivers did not explain the weight loss of their care recipients. Clinical Trial Registration: [https://www.ClinicalTrial.gov/], identifier [NCT04003493].

Post-diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis

The adiposity influence on colorectal cancer prognosis remains poorly characterised. We performed a systematic review and meta-analysis on post-diagnosis adiposity measures (body mass index [BMI], waist circumference, waist-to-hip ratio, weight) or their changes and colorectal cancer outcomes. PubMed and Embase were searched through 28 February 2022. Random-effects meta-analyses were conducted when at least three studies had sufficient information. The quality of evidence was interpreted and graded by the Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel. We reviewed 124 observational studies (85 publications). Meta-analyses were possible for BMI and all-cause mortality, colorectal cancer-specific mortality, and cancer recurrence/disease-free survival. Non-linear meta-analysis indicated a reverse J-shaped association between BMI and colorectal cancer outcomes (nadir at BMI 28 kg/m2). The highest risk, relative to the nadir, was observed at both ends of the BMI distribution (18 and 38 kg/m2), namely 60% and 23% higher risk for all-cause mortality; 95% and 26% for colorectal cancer-specific mortality; and 37% and 24% for cancer recurrence/disease-free survival, respectively. The higher risk with low BMI was attenuated in secondary analyses of RCTs (compared to cohort studies), among studies with longer follow-up, and in women suggesting potential methodological limitations and/or altered physiological state. Descriptively synthesised studies on other adiposity-outcome associations of interest were limited in number and methodological quality. All the associations were graded as limited (likelihood of causality: no conclusion) due to potential methodological limitations (reverse causation, confounding, selection bias). Additional well-designed observational studies and interventional trials are needed to provide further clarification.

Weight change and all-cause and cause-specific mortality: A 25-year follow-up study

BACKGROUND

Whether the dynamic weight change is an independent risk factor for mortality remains controversial. This study aimed to examine the association between weight change and risk of all-cause and cause-specific mortality based on the Linxian Nutrition Intervention Trial (NIT) cohort.

METHODS

Body weight of 21,028 healthy residents of Linxian, Henan province, aged 40-69 years was measured two times from 1986 to 1991. Outcome events were prospectively collected up to 2016. Weight maintenance group (weight change <2 kg) or stable normal weight group was treated as the reference. Cox proportional hazard model was performed to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) to estimate the risk of mortality.

RESULTS

A total of 21,028 subjects were included in the final analysis. Compared with the weight maintenance group, subjects with weight loss ≥2 kg had an increased risk of death from all-cause (HR All-cause  = 1.14, 95% CI: 1.09-1.19, P  <0.001), cancer (HR Cancer  = 1.12, 95% CI: 1.03-1.21, P  = 0.009), and heart disease (HR Heart diseases  = 1.21, 95% CI: 1.11-1.31, P  <0.001), whereas subjects with weight gain ≥5 kg had 11% (HR Cancer  = 0.89, 95% CI: 0.79-0.99, P  = 0.033) lower risk of cancer mortality and 23% higher risk of stroke mortality (HR Stroke  = 1.23,95% CI: 1.12-1.34, P  <0.001). For the change of weight status, both going from overweight to normal weight and becoming underweight within 5 years could increase the risk of total death (HR Overweight to normal = 1.18, 95% CI: 1.09-1.27; HR Becoming underweight = 1.35, 95% CI: 1.25-1.46) and cancer death (HR Overweight to normal = 1.20, 95% CI: 1.04-1.39; HR Becoming underweight = 1.44, 95% CI: 1.24-1.67), while stable overweight could increase the risk of total death (HR Stable overweight = 1.11, 95% CI: 1.05-1.17) and death from stroke (HR Stable overweight = 1.44, 95% CI: 1.33-1.56). Interaction effects were observed between age and weight change on cancer mortality, as well as between baseline BMI and weight change on all-cause, heart disease, and stroke mortality (all Pinteraction  <0.01).

CONCLUSIONS

Weight loss was associated with an increased risk of all-cause, cancer, and heart disease mortality, whereas excessive weight gain and stable overweight were associated with a higher risk of stroke mortality. Efforts of weight management should be taken to improve health status.

TRIAL REGISTRATION

https://classic.clinicaltrials.gov/ , NCT00342654.

Body Size, Diet Quality, and Epigenetic Aging: Cross-Sectional and Longitudinal Analyses

Epigenetic age is an emerging marker of health that is highly predictive of disease and mortality risk. There is a lack of evidence on whether lifestyle changes are associated with changes in epigenetic aging. We used data from 1 041 participants in the Melbourne Collaborative Cohort Study with blood DNA methylation measures at baseline (1990-1994, mean age: 57.4 years) and follow-up (2003-2007, mean age: 68.8 years). The Alternative Healthy Eating Index-2010 (AHEI-2010), the Mediterranean Dietary Score, and the Dietary Inflammatory Index were used as measures of diet quality, and weight, waist circumference, and waist-to-hip ratio as measures of body size. Five age-adjusted epigenetic aging measures were considered: GrimAge, PhenoAge, PCGrimAge, PCPhenoAge, and DunedinPACE. Multivariable linear regression models including restricted cubic splines were used to assess the cross-sectional and longitudinal associations of body size and diet quality with epigenetic aging. Associations between weight and epigenetic aging cross-sectionally at both time points were positive and appeared greater for DunedinPACE (per SD: β ~0.24) than for GrimAge and PhenoAge (β ~0.10). The longitudinal associations with weight change were markedly nonlinear (U-shaped) with stable weight being associated with the lowest epigenetic aging at follow-up, except for DunedinPACE, for which only weight gain showed a positive association. We found negative, linear associations for AHEI-2010 both cross-sectionally and longitudinally. Other adiposity measures and dietary scores showed similar results. In middle-aged to older adults, declining diet quality and weight gain may increase epigenetic age, while the association for weight loss may require further investigation. Our study sheds light on the potential of weight management and dietary improvement in slowing aging processes.

Inpatient outcomes of transcatheter aortic valve replacement based on class of obesity

Transcatheter aortic valve replacement (TAVR) is a transformative option for severe aortic stenosis, especially in elderly patients. obesity's impact on TAVR outcomes is limited. Using the National Inpatient Sample from 2016 to 2020, We analyzed 217,300 TAVR hospitalizations across BMI groups. No difference in in-hospital mortality was observed, class III obesity experienced longer hospital stays (adjusted β: 0.43 days, P < 0.05), higher costs (adjusted β: $3,126, P < 0.05), increased heart failure exacerbation (adjusted odds ratio [aOR]: 2.68, 95% confidence interval [CI]: [1.03-7.01], p < 0.05), vascular access complications (aOR: 1.29, 95% CI: [1.07-1.52], P < 0.05), and post-operative pulmonary complications (Pneumonia (aOR: 1.42, 95% CI: [1.16-1.74], p < 0.05), acute hypoxic respiratory failure (aOR: 1.99, 95% CI: [1.67-2.36], p < 0.05), and non-invasive ventilation (aOR: 1.62, 95% CI: [1.07-2.44], p < 0.05). Complete heart block and permanent pacemaker requirement were higher in both class II and class III ((aOR: 1.30, 95% CI: [1.11-1.51], P < 0.05), (aOR:1.25, 95% CI: [1.06-1.46], P < 0.05) and ((aOR: 1.18, 95% CI: [1.00-1.40], P < 0.05), (aOR:1.22, 95% CI: [1.02-1.45], P < 0.05)) respectively. Understanding these links is crucial for optimizing TAVR care in obesity, ensuring enhanced outcomes, and procedural safety.

Extent of Abdominal Aortic Calcification Is Associated With Incident Rapid Weight Loss Over 5 Years: The Perth Longitudinal Study of Ageing Women

BACKGROUND

Abdominal aortic calcification (AAC), a marker of vascular disease, is associated with disease in other vascular beds including gastrointestinal arteries. We investigated whether AAC is related to rapid weight loss over 5 years and whether rapid weight loss is associated with 9.5-year all-cause mortality in community-dwelling older women.

METHODS

Lateral spine images from dual-energy x-ray absorptiometry (1998/1999) were used to assess AAC (24-point AAC scoring method) in 929 older women. Over 5 years, body weight was assessed at 12-month intervals. Rapid weight loss was defined as >5% decrease in body weight within any 12-month interval. Multivariable-adjusted logistic regression was used to assess AAC and rapid weight loss and Cox regression to assess the relationship between rapid weight loss and 9.5-year all-cause mortality.

RESULTS

Mean±SD age of women was 75.0±2.6 years. During the initial 5 years, 366 (39%) women presented with rapid weight loss. Compared with women with low AAC (24-point AAC score 0-1), those with moderate (24-point AAC score 2-5: odds ratio, 1.36 [95% CI, 1.00-1.85]) and extensive (24-point AAC score 6+: odds ratio, 1.59 [95% CI, 1.10-2.31]) AAC had higher odds for presenting with rapid weight loss. Results remained similar after further adjustment for dietary factors (alcohol, protein, fat, and carbohydrates), diet quality, blood pressure, and cholesterol measures. The estimates were similar in subgroups of women who met protein intake (n=599) and physical activity (n=735) recommendations (extensive AAC: odds ratios, 1.81 [95% CI, 1.12-2.92] and 1.58 [95% CI, 1.02-2.44], respectively). Rapid weight loss was associated with all-cause mortality over the next 9.5 years (hazard ratio, 1.49 [95% CI, 1.17-1.89]; P=0.001).

CONCLUSIONS

AAC extent was associated with greater risk for rapid weight loss over 5 years in older women, a risk for all-cause mortality. Since the association was unchanged after taking nutritional intakes into account, these data support the possibility that vascular disease may play a role in the maintenance of body weight.

Body mass index trajectories and mortality risk in Japan using a population-based prospective cohort study: the Japan Public Health Center-based Prospective Study

BACKGROUND

Recent studies have found that long-term changes in weight during adulthood are associated with a high risk of mortality. The objective of this study was to characterize body mass index (BMI) trajectories during adulthood and to examine the association between BMI trajectories and risk of death in the Japanese population.

METHODS

The data were extracted from Japan Public Health Center-based Prospective Study-a population-based prospective cohort study in Japan with participants aged 40-69 years followed over 20 years. The participants were categorized into multiple BMI trajectory groups using the latent class growth model. The Cox proportional-hazards model was conducted using all-cause mortality and cause-specific mortality as outcomes and the identified BMI trajectory groups as a predictor. In total, 65 520 participants were included in the analysis.

RESULTS

Six BMI trajectory groups were identified: underweight stable (Group 1), low-to-high normal (Group 2), high-to-low normal (Group 3), normal to overweight (Group 4), overweight to normal (Group 5) and normal to obese (Group 6). Our Cox models showed a higher hazard (risk) of all-cause mortality among participants in the BMI-declining groups [Group 3, adjusted hazard ratio (aHR): 1.10, 95% CI: 1.05-1.16; Group 5, aHR: 1.16, 95% CI: 1.08-1.26], underweight stable group (Group 1, aHR: 1.27, 95% CI: 1.21-1.33) and normal to obese group (Group 6, aHR: 1.22, 95% CI: 1.13-1.33) than Group 2 (low-to-high normal BMI trajectory).

CONCLUSIONS

Stable underweight and weight loss were associated with a high risk of mortality, both of which were uniquely observed in a Japanese population.

Association of Later-Life Weight Changes With Survival to Ages 90, 95, and 100: The Women's Health Initiative

BACKGROUND

Associations of weight changes and intentionality of weight loss with longevity are not well described.

METHODS

Using longitudinal data from the Women's Health Initiative (N = 54 437; 61-81 years), we examined associations of weight changes and intentionality of weight loss with survival to ages 90, 95, and 100. Weight was measured at baseline, year 3, and year 10, and participants were classified as having weight loss (≥5% decrease from baseline), weight gain (≥5% increase from baseline), or stable weight (<5% change from baseline). Participants reported intentionality of weight loss at year 3.

RESULTS

A total of 30 647 (56.3%) women survived to ≥90 years. After adjustment for relevant covariates, 3-year weight loss of ≥5% vs stable weight was associated with lower odds of survival to ages 90 (OR, 0.67; 95% CI, 0.64-0.71), 95 (OR, 0.65; 95% CI, 0.60-0.71), and 100 (OR, 0.62; 95% CI, 0.49-0.78). Compared to intentional weight loss, unintentional weight loss was more strongly associated with lower odds of survival to age 90 (OR, 0.83; 95% CI, 0.74-0.94 and OR, 0.49; 95% CI, 0.44-0.55, respectively). Three-year weight gain of ≥5% vs stable weight was not associated with survival to age 90, 95, or 100. The pattern of results was similar among normal weight, overweight, and obese women in body mass index (BMI)-stratified analyses.

CONCLUSIONS

Weight loss of ≥5% vs stable weight was associated with lower odds of longevity, more strongly for unintentional weight loss than for intentional weight loss. Potential inaccuracy of self-reported intentionality of weight loss and residual confounding were limitations.

A synthesis of pathways linking diet, metabolic risk and cardiovascular disease: a framework to guide further research and approaches to evidence-based practice

Cardiovascular disease (CVD) is the most common non-communicable disease occurring globally. Although previous literature has provided useful insights into the important role that diet plays in CVD prevention and treatment, understanding the causal role of diets is a difficult task considering inherent and introduced weaknesses of observational (e.g. not properly addressing confounders and mediators) and experimental research designs (e.g. not appropriate or well designed). In this narrative review, we organised current evidence linking diet, as well as conventional and emerging physiological risk factors, with CVD risk, incidence and mortality in a series of diagrams. The diagrams presented can aid causal inference studies as they provide a visual representation of the types of studies underlying the associations between potential risk markers/factors for CVD. This may facilitate the selection of variables to be considered and the creation of analytical models. Evidence depicted in the diagrams was systematically collected from studies included in the British Nutrition Task Force report on diet and CVD and database searches, including Medline and Embase. Although several markers and disorders linked to conventional and emerging risk factors for CVD were identified, the causal link between many remains unknown. There is a need to address the multifactorial nature of CVD and the complex interplay between conventional and emerging risk factors with natural and built environments, while bringing the life course into the spotlight.

How do sex-specific BMI trajectories shape diabetes risk? A longitudinal analysis of Indonesian adults

Introduction

Sex is a critical predictor of body mass index (BMI) trajectory over the life span, playing a role in disparities in the risk of diabetes. While there is some evidence of the effect of BMI on the risk of diabetes, little is known about sex differences in BMI trajectories over the life span and their later life association with diabetes, especially in low-income and middle-income settings.

Methods

Using panel data from the Indonesian Family Life Survey, this study examines the impact of an individual's BMI trajectory throughout adulthood on diabetes onset. Analysis for men and women were conducted separately. First, growth curve modelling estimates individuals' BMI trajectories over age. Second, the effect of BMI trajectories on diabetes is estimated using logistic regression adjusted for individual socioeconomic status. Finally, we perform relative dominance analysis to test the importance of BMI trajectories as a predictor of diabetes in later life against abdominal obesity measurements.

Results

BMI trajectories over adulthood strongly predict the probability of diabetes in both men and women. A rapidly increasing BMI significantly increases the probability of diabetes in men regardless of individuals' initial BMI. Among women, those who started out with an overweight/obese BMI and experienced a rapid loss in BMI over age had the highest risk of diabetes. Greater educational attainment is associated with an increase in the likelihood of diabetes in men, but higher education level is a protective factor from diabetes in women.

Conclusion

The findings suggest that maintaining BMI at normal cut-off over the life course can lower the likelihood of diabetes onset in later adulthood. This study emphasises that simple monitoring of BMI trajectory over adulthood could be a useful tool to identify the population at risk of diabetes in contexts with substantial underdiagnoses of diabetes.

Weight Loss Is a Strong Predictor of Memory Disorder Independent of Genetic Influences

BACKGROUND

Past studies identified a link between weight loss and dementia, but lacked consistent conclusions. We sought to establish this link by examining the weight change profiles before and after dementia diagnosis.

METHODS

Using data from the Health and Retirement Study (1996-2020), we examined 13,123 participants. We conducted a nested case-control analysis to assess differences in biennial weight change profile while controlling for BMI, longevity polygenic risk scores, and APOE gene variants.

RESULTS

Participants with a memory disorder lost weight (-0.63%) biennially, whereas those without a diagnosis did not (+0.013%, p-value < 0.0001). Our case-control study shows a significant difference (p-value < 0.01) in pre-dementia % weight changes between the cases (-0.29%) and controls (0.19%), but not in post-dementia weight changes. The weight loss group have the highest risk (OR = 2.01; p-value < 0.0001) of developing a memory disorder compared to the stable weight and weight gain groups. The observations hold true after adjusting for BMI, longevity polygenic risk scores, and APOE variant in a multivariable model.

CONCLUSIONS

We observe that weight loss in dementia is a physiological process independent of genetic factors associated with BMI and longevity. Pre-dementia weight loss may be an important prognostic criterion to assess a person's risk of developing a memory disorder.

Updates on obesity and the obesity paradox in cardiovascular diseases

The prevalence of obesity has reached pandemic proportions worldwide and certainly in the United States. Obesity is a well-established independent risk factor for development of many cardiovascular diseases (CVD), including heart failure, coronary heart disease, atrial fibrillation, and hypertension. Therefore, it is logical to expect obesity would have a strong correlation with CVD mortality. However, a substantial body of literature demonstrates a paradox with improved prognosis of overweight and obese patients with established CVD compared to lean patients with the identical CVD. Surprisingly, similar data has also shown that cardiovascular fitness, rather than weight loss alone, influences the relationship between obesity and mortality in those with established CVD. The impact of fitness, exercise, physical activity (PA), and weight loss and their relationship to the obesity paradox are all reviewed here.

Association of body weight change with all-cause and cause-specific mortality: A nationwide population-based study

AIMS

Weight gain and loss increase the risk of all-cause mortality. This study explored the association of short-term weight change with all-cause and cause-specific mortality in middle-aged to older people.

METHODS

This was a 8.4-year retrospective cohort study of 645,260 adults aged 40 to 80 who underwent health checkups twice within a 2-year interval between January 2009 and December 2012. Cox analyses were used to analyze the association between short-term weight change and all-cause and cause-specific mortality.

RESULTS

Weight gain and loss were associated with an increased risk of all-cause mortality: the hazard ratios were 2.05 (95% confidence interval [CI], 1.93-2.16), 1.21 (95% CI, 1.16-1.25), 1.12 (95% CI 1.08-1.17), and 1.60 (95% CI, 1.49-1.70) for the severe weight loss, moderate weight loss, moderate weight gain, and severe weight gain groups, respectively. This U-shaped association was also seen between weight change and cause-specific mortality. Within the weight loss group, those who regained weight after two years had a reduced mortality risk.

CONCLUSIONS

In a middle-aged and elderly population, weight gain or loss of more than 3% during a 2-year interval was related to an elevated risk of all-cause and cause-specific mortality.

Associations of Change in Body Size With All-Cause and Cause-Specific Mortality Among Healthy Older Adults

Importance

The association between weight change and subsequent cause-specific mortality among older adults is not well described. The significance of changes in waist circumference (WC) has also not been compared with weight change for this purpose.

Objective

To examine the associations of changes in body weight and WC with all-cause and cause-specific mortality.

Design, Setting, and Participants

This cohort study is a post hoc analysis of data from the Aspirin in Reducing Events in the Elderly (ASPREE) randomized clinical trial, which recruited participants between March 1, 2010, and December 31, 2014. The study included community-based older adults (16 703 Australian participants aged ≥70 years and 2411 US participants aged ≥65 years) without evident cardiovascular disease (CVD), dementia, physical disability, or life-limiting chronic illness. Data analysis was performed from April to September 2022.

Exposures

Body weight and WC were measured at baseline and at annual visit 2. Analysis models were adjusted for baseline body mass index because height and weight were measured at baseline, allowing for calculation of body mass index and other variables. Both body weight and WC changes were categorized as change within 5% (stable), decrease by 5% to 10%, decrease by more than 10%, increase by 5% to 10%, and increase by more than 10%.

Main Outcomes and Measures

All-cause, cancer-specific, CVD-specific, and noncancer non-CVD-specific mortality. Mortality events were adjudicated by an expert review panel. Cox proportional hazards regression and competing risk analyses were used to calculate hazard ratios (HRs) and 95% CIs.

Results

Among 16 523 participants (mean [SD] age, 75.0 [4.3] years; 9193 women [55.6%]), 1256 deaths were observed over a mean (SD) of 4.4 (1.7) years. Compared with men with stable weight, those with a 5% to 10% weight loss had a 33% higher (HR, 1.33; 95% CI, 1.07-1.66) risk of all-cause mortality, and those with more than a 10% decrease in body weight had a 289% higher (HR, 3.89; 95% CI, 2.93-5.18) risk. Compared with women with stable weight, those with a 5% to 10% weight loss had a 26% higher (HR, 1.26; 95% CI, 1.00-1.60) risk of all-cause mortality, and those with more than a 10% decrease in body weight had a 114% higher (HR, 2.14; 95% CI, 1.58-2.91) risk. Weight loss was associated with a higher cancer-specific mortality (>10% decrease among men: HR, 3.49; 95% CI, 2.26-5.40; 5%-10% decrease among women: HR, 1.44; 95% CI, 1.46-2.04; >10% decrease among women: HR, 2.78; 95% CI, 1.82-4.26), CVD-specific mortality (>10% decrease among men: HR, 3.14; 95% CI, 1.63-6.04; >10% decrease among women: HR, 1.92; 95% CI, 1.05-3.51), and noncancer non-CVD-specific mortality (>10% decrease among men: HR, 4.98; 95% CI, 3.14-7.91). A decrease in WC was also associated with mortality.

Conclusions and Relevance

This cohort study of healthy older adults suggests that weight loss was associated with an increase in all-cause and cause-specific mortality, including an increased risk of cancer, CVD, and other life-limiting conditions. Physicians should be aware of the significance of weight loss, especially among older men.

In-hospital malnutrition among adult patients in a national referral hospital in Indonesia

BACKGROUND/OBJECTIVES

Malnutrition during hospitalization is linked to increased morbidity and mortality, but there are insufficient studies observing clinical factors contributing to weight loss during hospitalization in Indonesia. This study was therefore undertaken to determine the rate of weight loss during hospitalization and the contributing factors.

SUBJECTS/METHODS

This was a prospective study involving hospitalized adult patients aged 18-59 yrs, conducted between July and September 2019. Body weight measurement was taken at the time of admission and on the last day of hospitalization. The factors studied were malnutrition at admission (body mass index < 18.5 kg/m2), immobilization, depression (Beck Depression Inventory-II Indonesia), polypharmacy, inflammatory status (neutrophil-lymphocytes ratio; NLR), comorbidity status (Charlson Comorbidity Index; CCI), and length of stay.

RESULTS

Totally, 55 patients were included in the final analysis, with a median age of 39 (18-59 yrs) yrs. Of these, 27% had malnutrition at admission, 31% had a CCI score > 2, and 26% had an NLR value of ≥ 9. In all, 62% presented with gastrointestinal symptoms, and depression was documented in one-third of the subjects at admission. Overall, we recorded a mean weight loss of 0.41 kg (P = 0.038) during hospitalization, with significant weight loss observed among patients hospitalized for 7 days or more (P = 0.009). The bivariate analysis revealed that inflammatory status (P = 0.016) was associated with in-hospital weight loss, while the multivariate analysis determined that the contributing factors were length of stay (P < 0.001) and depression (P = 0.019).

CONCLUSIONS

We found that inflammatory status of the patient might influence the incidence of weight loss during hospitalization, while depression and length of stay were independent predictors of weight loss during hospitalization.

Malnutrition screening tool and malnutrition universal screening tool as a predictors of prolonged hospital stay and hospital mortality: A cohort study

BACKGROUND & AIMS

Different nutrition screening tools have been proposed to screen inpatients, although, there is still no consensus regarding the reference method for identifying patients at nutritional risk. This retrospective cohort study aimed to evaluate the concurrent and predictive validity of the Malnutrition Screening Tool (MST) and Malnutrition Universal Screening Tool (MUST) to identify inpatients at nutritional risk.

METHODS

Data from electronic medical records were collected from adult and elderly inpatients in wards of a public tertiary hospital (Hospital de Clínicas de Porto Alegre, Brazil) over one year. Only the first nutritional evaluation was considered for each patient. GLIM criteria was used for malnutrition status (concurrent validity) and hospital stay length and mortality were outcomes to predictive validity.

RESULTS

A total of 5270 patients were included in this study. The mean patient age was 59 ± 16 years old, and 50.7% were males. More than 60% of the patients (65.8%) were admitted to a surgical unit, 63.8% had mild disease-related metabolic stress, 50.7% experienced prolonged hospital stays (more than ten days), and 1.9% of the patients died. Considering the availability of nutritional data, it was possible to perform nutritional screening of 98.1% of patients by MST and 96.7% of patients by MUST. A higher proportion of patients at risk were identified by MUST (53.6%) as compared to MST (21.3%; P < 0.001). MST had 89.9% of Specificity, 60.4% of PPV, 94.6% of NPV, and a moderate agreement with malnutrition by GLIM criteria (κ = 0.591; P < 0.001). A prolonged hospital stay was positively associated with the classification of nutritional risk based on both screening tools. Death was positively associated with nutritional risk by MST (hazard ratio [HR] 2.09; 95% confidence interval [CI] 1.37-3.16) and by MUST (HR 1.79; 95% CI 1.00-3.18) after adjustment based on sex, age, admission type (surgical or clinical), and disease-related metabolic stress.

CONCLUSIONS

MST may be good concurrent validity to malnutrition by GLIM criteria as compared to MUST. However, both risk nutritional tools were positively associated with predicting a prolonged hospital stay and mortality.

Clinical Evidence of Low-Carbohydrate Diets against Obesity and Diabetes Mellitus

The popularity of low-carbohydrate diets (LCDs) in the last few decades has motivated several research studies on their role in a variety of metabolic and non-morbid conditions. The available data of the results of these studies are put under the research perspective of the present literature review of clinical studies in search of the effects of LCDs on Obesity and Diabetes Mellitus. The electronic literature search was performed in the databases PubMed, Cochrane, and Embase. The literature search found seven studies that met the review's inclusion and exclusion criteria out of a total of 2637 studies. The included studies involved randomized controlled trials of at least 12 weeks' duration, in subjects with BMI ≥ 25 kg/m², with dietary interventions. The results of the study on the effects of LCDs on obesity showed their effectiveness in reducing Body Mass Index and total body fat mass. In addition, LCDs appear to cause drops in blood pressure, low-density lipoprotein (LDL), and triglycerides, and seem to improve high-density lipoprotein (HDL) values. Regarding the effectiveness of LCDs in Diabetes Mellitus, their effect on reducing insulin resistance and fasting blood glucose and HbA1c values are supported. In conclusion, the results suggest the critical role of LCDs to improve the health of people affected by obesity or diabetes.

Associations Between Low Serum Urate, Body Composition, and Mortality

OBJECTIVE

Controversy remains as to whether low serum urate or uric acid (UA) levels contribute to adverse outcomes. We evaluated the relation between low serum UA levels and sarcopenia and assessed whether sarcopenia confounds associations between these low levels and mortality.

METHODS

We utilized data from the National Health and Nutrition Examination Survey (1999-2006). Participants with available whole-body dual x-ray absorptiometry body composition measurements and serum UA concentrations were included. Body composition assessments included body mass index (BMI), waist circumference, maximum lifetime BMI, and age-, sex-, and race-specific appendicular lean mass index (ALMI) and fat mass index (FMI) Z scores. We also calculated Z scores for ALMI relative to FMI (ALMIFMI ). We evaluated associations between serum UA levels and body composition using logistic regression and assessed associations between serum UA levels and mortality before and after adjusting for differences in body composition using Cox proportional hazards regression.

RESULTS

Among the 13,979 participants, low serum UA concentrations (<2.5 mg/dl in women, <3.5 mg/dl in men) were associated with low lean mass (ALMI and ALMIFMI Z scores), underweight BMI (<18.5 kg/m2 ), and higher rates of weight loss. The proportion of patients with low ALMI Z scores was 29% in the low serum UA group and 16% in the normal serum UA group (P = 0.001). Low serum UA levels were associated with increased mortality before we adjusted for body composition (hazard ratio 1.61 [95% confidence interval 1.14-2.28]; P = 0.008) but was attenuated and not significant after adjustment for body composition and weight loss (hazard ratio 1.30 [95% confidence interval 0.92-1.85], P = 0.13).

CONCLUSION

Sarcopenia and weight loss are more common among patients with low serum UA concentrations. Differences in body composition may help to explain associations between low levels of serum UA and higher mortality.

TOMM40 genetic variants associated with healthy aging and longevity: a systematic review

Introduction

Healthy aging relies on mitochondrial functioning because this organelle provides energy and diminishes oxidative stress. Single nucleotide polymorphisms (SNPs) in TOMM40, a critical gene that produces the outer membrane protein TOM40 of mitochondria, have been associated with mitochondrial dysfunction and neurodegenerative processes. Yet it is not clear whether or how the mitochondria may impact human longevity. We conducted this review to ascertain which SNPs have been associated with markers of healthy aging.

Methods

Using the PRISMA methodology, we conducted a systematic review on PubMed and Embase databases to identify associations between TOMM40 SNPs and measures of longevity and healthy aging.

Results

Twenty-four articles were selected. The TOMM40 SNPs rs2075650 and rs10524523 were the two most commonly identified and studied SNPs associated with longevity. The outcomes associated with the TOMM40 SNPs were changes in BMI, brain integrity, cognitive functions, altered inflammatory network, vulnerability to vascular risk factors, and longevity.

Discussions

Our systematic review identified multiple TOMM40 SNPs potentially associated with healthy aging. Additional research can help to understand mechanisms in aging, including resilience, prevention of disease, and adaptation to the environment.

U-Shaped Associations Between Body Weight Changes and Major Cardiovascular Events in Type 2 Diabetes Mellitus: A Longitudinal Follow-up Study of a Nationwide Cohort of Over 1.5 Million

OBJECTIVE

Despite the benefits of weight loss on metabolic profiles in patients with type 2 diabetes mellitus (T2DM), its association with myocardial infarction (MI), ischemic stroke (IS), atrial fibrillation (AF), heart failure (HF), and all-cause death remains elusive.

RESEARCH DESIGN AND METHODS

Using the National Health Insurance Service Database, we screened subjects who underwent general health checkups twice in a 2-year interval between 2009 and 2012. After identifying 1,522,241 patients with T2DM without a previous history of MI, IS, AF, and HF, we followed them until December 2018. Patients were stratified according to the magnitude of weight changes between two general health checkups: ≤ -10%, -10 to ≤ -5%, -5 to ≤5%, 5 to ≤10%, and >10%.

RESULTS

During the follow-up (median 7.0 years), 32,106 cases of MI, 44,406 cases of IS, 34,953 cases of AF, 68,745 cases of HF, and 84,635 all-cause deaths occurred. Patients with weight changes of -5 to ≤5% showed the lowest risk of each cardiovascular event. Both directions of weight change were associated with an increased cardiovascular risk. Stepwise increases in the risks of MI, IS, AF, HF, and all-cause death were noted with progressive weight gain (all P < 0.0001). Similarly, the more weight loss occurred, the higher the cardiovascular risks observed (all P < 0.0001). The U-shaped associations were consistently observed in both univariate and multivariate analyses. Explorative subgroup analyses also consistently showed a U-shaped association.

CONCLUSIONS

Both weight loss and gain >5% within a 2-year interval were associated with an increased risk of major cardiovascular events in patients with T2DM.

Microbiota and body weight control: Weight watchers within?

BACKGROUND

Despite several decades of research, managing body weight remains an unsolved clinical problem. Health problems associated with dysregulated body weight, such as obesity and cachexia, exhibit several gut microbiota alterations. There is an increased interest in utilising the gut microbiota for body weight control, as it responds to intervention and plays an important role in energy extraction from food, as well as biotransformation of nutrients.

SCOPE OF THE REVIEW

This review provides an overview of the role of the gut microbiota in the physiological and metabolic alterations observed in two body weight dysregulation-related disorders, namely obesity and cachexia. Second, we assess the available evidence for different strategies, including caloric restriction, intermittent fasting, ketogenic diet, bariatric surgery, probiotics, prebiotics, synbiotics, high-fibre diet, and fermented foods - effects on body weight and gut microbiota composition. This approach was used to give insights into the possible link between body weight control and gut microbiota configuration.

MAJOR CONCLUSIONS

Despite extensive associations between body weight and gut microbiota composition, limited success could be achieved in the translation of microbiota-related interventions for body weight control in humans. Manipulation of the gut microbiota alone is insufficient to alter body weight and future research is needed with a combination of strategies to enhance the effects of lifestyle interventions.

Mortality risks of body mass index and energy intake trajectories in institutionalized elderly people: a retrospective cohort study

Background

Many factors can identify the mortality risks of institutionalized elderly people; among all such factors, body mass index (BMI) and energy intake (EI) can be employed as independent predictors. The objective of this study was to elucidate about the mortality risks and the trajectory of two parameters obtained from continuously monitored data.

Methods

This retrospective cohort study targeted 218 elderly people who were admitted to a nursing home for at least 6 months between 2007 and 2020 and passed away at the nursing home. BMI and EI (kcal) per body weight (BW) were continuously measured until death.

Results

BMI continued to decrease for 5 years until death. The rate of change of BMI significantly increased for 3 years before death (P = 0.004). In contrast, the rate of change of EI per BW significantly increased after 1 year before death (P < 0.001); in addition, 2 months before death, this rate of change significantly exceeded that of BMI (P = 0.007). In the four risk groups that were examined, a BMI of <18.0 + EI per BW of <29.2 and a BMI of <17.3 + EI per BW of <28.3 were significantly correlated with a high risk of death (log-rank test: P < 0.001, P = 0.002, respectively). There was no significant difference in the hazard ratio based on the age at the time of admission; however, when EI per BW was <23.8, the risk of death was significantly higher [hazard ratio = 4.36; 95% confidence interval: 2.31–8.24].

Conclusions

Elderly people in the current study presented a tendency toward decreasing BMI starting 60 months prior to death even if EI per BW remained constant. In the 1 year before death, EI per BW rapidly decreased. When the rate of change of EI per BW exceeded the rate of decrease of BMI, it was considered to be the point of no return when death was imminent. Our study showed that identifying mortality risks from the relationship between the trajectories of the two parameters that were continuously measured for several months to years is possible.

Impact of Behavioral Risk Factors on Mortality Risk in Older Korean Women

BACKGROUND

To investigate the impact of lifestyle risk factors on all-cause and cardiovascular disease (CVD) mortality in Korean women aged 60 yr and older.

METHODS

Data (n = 3,034) obtained from the Korean longitudinal study of aging were analyzed. Exposures included lifestyle risk factors, such as smoking, alcohol abuse, underweight/obesity, physical inactivity, and unintentional weight loss. Primary outcomes were premature deaths from specific and all-causes.

RESULTS

During 9.6±2.0 yr of follow-up, there were 628 cases (20.7%) of death from all causes, of which 137 cases (4.5%) were from CVD. Compared to zero risk factor (hazard ratio, HR=1), crude HR of all-cause mortality was 2.277 (95% confidence interval, CI, 1.712 ∼ 3.030, P < 0.001) for one risk factor, 2.977 (95% CI, 2.124 ∼ 4.003, P < 0.001) for two risk factors, and 5.154 (95% CI, 3.515 ∼ 7.557, P < 0.001) for three or more risk factors. Compared to zero risk factor (HR=1), crude HR of CVD mortality was 2.035 (95% CI, 1.422 ∼ 2.913, P < 0.001) for one risk factor, 2.468 (95% CI, 1.708 ∼ 3.567, P < 0.001) for two risk factor, and 4.484 (95% CI, 2.830 ∼ 7.102, P < 0.001) for three or more risk factors. Adjusted HRs of all-cause (P = 0.016) and CVD (P = 0.050) for three or more risk factors only remained significant for three or more risk factors.

CONCLUSION

The current findings showed that individual and combined lifestyle risk factors were significantly associated with increased risks of all-cause and CVD mortality in older Korean women.

The importance of weight stabilization amongst those with overweight or obesity: Results from a large health care system

Data on patterns of weight change among adults with overweight or obesity are minimal. We aimed to examine patterns of weight change and associated hospitalizations in a large health system, and to develop a model to predict 2-year significant weight gain. Data from the Duke University Health System was abstracted from 1/1/13 to 12/31/16 on patients with BMI ≥ 25 kg/m2 in 2014. A regression model was developed to predict patients that would increase their weight by 10% within 2 years. We estimated the association between weight change category and all-cause hospitalization using Cox proportional hazards models. Of the 37,253 patients in our cohort, 59% had stable weight over 2 years, while 24% gained ≥ 5% weight and 17% lost ≥ 5% weight. Our predictive model had reasonable discriminatory capacity to predict which individuals would gain ≥ 10% weight over 2 years (AUC 0.73). Compared with stable weight, the risk of hospitalization was increased by 37% for individuals with > 10% weight loss [adj. HR (95% CI): 1.37 (1.25,1.5)], by 30% for those with > 10% weight gain [adj. HR (95% CI): 1.3 (1.19,1.42)], by 18% for those with 5-10% weight loss [adj. HR (95% CI): 1.18 (1.09,1.28)], and by 10% for those with 5-10% weight gain [adj. HR (95% CI): 1.1 (1.02,1.19)]. In this examination of a large health system, significant weight gain or loss of > 10% was associated with increased all-cause hospitalization over 2 years compared with stable weight. This analysis adds to the increasing observational evidence that weight stability may be a key health driver.

Associations of weight loss with obesity-related comorbidities in a large integrated health system

AIMS

To determine the health outcomes associated with weight loss in individuals with obesity, and to better understand the relationship between disease burden (disease burden; ie, prior comorbidities, healthcare utilization) and weight loss in individuals with obesity by analysing electronic health records (EHRs).

MATERIALS AND METHODS

We conducted a case-control study using deidentified EHR-derived information from 204 921 patients seen at the Cleveland Clinic between 2000 and 2018. Patients were aged ≥20 years with body mass index ≥30 kg/m² and had ≥7 weight measurements, over ≥3 years. Thirty outcomes were investigated, including chronic and acute diseases, as well as psychological and metabolic disorders. Weight change was investigated 3, 5 and 10 years prior to an event.

RESULTS

Weight loss was associated with reduced incidence of many outcomes (eg, type 2 diabetes, nonalcoholic steatohepatitis/nonalcoholic fatty liver disease, obstructive sleep apnoea, hypertension; P < 0.05). Weight loss >10% was associated with increased incidence of certain outcomes including stroke and substance abuse. However, many outcomes that increased with weight loss were attenuated by disease burden adjustments.

CONCLUSIONS

This study provides the most comprehensive real-world evaluation of the health impacts of weight change to date. After comorbidity burden and healthcare utilization adjustments, weight loss was associated with an overall reduction in risk of many adverse outcomes.

Continuing regular physical activity and maintaining body weight have a synergistic interaction in improving survival: a population-based cohort study including 6.5 million people

AIMS

Continuing physical activity (PA) and maintaining body weight are tightly intertwined; however, no study investigated whether these two factors have interactions in terms of the mortality. The aim of this study is to elucidate whether continuing regular PA and maintaining body weight have interactions in terms of all-cause mortality risk.

METHODS AND RESULTS

Participants with health screening from both 2009 and 2011 without underlying cancer or cardiovascular disease were included. Physical activity change was grouped as remained active, inactive-to-active, active-to-inactive, or remained inactive. Body weight change was categorized as stable (weight change < 5%), weight gain, or loss. Outcome included all-cause mortality. Of 6 572 984 total participants, 91 347 deaths occurred during a median 7.4-year follow-up. Compared with the remained active and stable weight group, most other groups had a higher mortality risk. The weight loss and remained inactive group [adjusted hazard ratio (aHR), 2.30; 95% confidence interval (CI), 2.22-2.38] and the weight gain and remained inactive group (aHR, 2.17; 95% CI, 2.09-2.25) showed the highest mortality risks. Among stable weight participants, the ranking of the groups from highest to lowest in terms of mortality risk was as follows: remained inactive (aHR, 1.46; 95% CI, 1.41-1.50), active-to-inactive (aHR, 1.24; 95% CI, 1.19-1.29), inactive-to-active (aHR, 1.15; 95% CI, 1.11-1.20), and remained active (reference). Remaining active and maintaining a stable body weight had a synergistic interaction on decreasing all-cause mortality risk (multiplicative P for interaction < 0.001; relative excess risk due to interaction, 0.38; 95% CI, 0.31-0.46; attributable proportion, 0.18; 95% CI, 0.15-0.22).

CONCLUSIONS

Continuing regular PA as recommended and maintaining body weight have multiplicative and additive interactions on reducing all-cause mortality. Healthcare providers should emphasize the importance of both regular PA and body weight maintenance for the general public.

Relationship between weight loss and regular dental management of older adults residing in long-term care facilities: a 1-year multicenter longitudinal study

PURPOSE

This study aimed to determine the association between home visits by a dentist and regular oral hygiene management by a dental hygienist (regular dental management: RDM) and weight loss among older adults in long-term care facilities.

METHODS

A total of 468 older residents from 26 Japanese long-term care facilities participated in two surveys in 2018 and 2019. Participants were divided into two groups based on their diet during the baseline survey (regular diet, n = 256; dysphagia diet, n = 212). Participants with a regular diet were further divided into those who exhibited a weight loss ≥ 5% over 1 year (weight loss group: n = 77) and those with a weight loss < 5% (consistent weight group: n = 179). The explanatory variables were age, sex, baseline weight, Barthel index, and clinical dementia rating, as well as the patients' medical history of pneumonia, stroke, diabetes, and depression (which is reportedly associated with weight). Additionally, a Poisson regression with robust standard error, was carried out to analyze the explanatory variables, namely the prevalence of RDM noted during the study and functional teeth (which seemed to affect weight loss).

RESULTS

A multivariate analysis revealed that older residents' lack of RDM, clinical dementia assessment, and their history of pneumonia (prevalence rate ratio: 0.35, 95% confidence interval 0.24-0.95) were all significantly associated with weight loss when on a regular diet.

CONCLUSION

Thus, weight loss and RDM were related to each other. Weight loss may be suppressed by incorporating RDMs during the early nursing care for older residents on regular diets.

Association between Weight Loss and Food Form in Older Individuals Residing in Long-Term Care Facilities: 1-Year Multicenter Longitudinal Study

Changing the food form for older adults requiring nursing care from a regular to dysphagia diet is thought to impact their nutritional status. We assessed the association between changes in food form and weight loss over 1 year in older adults. Older adults residing in long-term care facilities in Japan (n = 455) who participated in the baseline (2018) and follow-up (2019) surveys were divided into two groups (regular diet, n = 284; dysphagia diet, n = 171). The regular diet group was further divided into the weight loss (n = 80; weight loss ≥5% over 1 year) and weight maintenance (n = 204; weight loss <5%) groups. After 1 year, the Barthel Index significantly decreased, and the proportion of participants who switched from a regular diet to a dysphagia diet significantly increased in the weight loss group than in the weight maintenance group. Multivariate logistic regression analysis found that Barthel index variation (odds ratio (OR): 0.97, 95% confidence interval (CI): 0.94‒0.99), change from a regular diet to a dysphagia diet (OR: 4.41, 95% CI: 1.87‒10.41), and body weight at baseline (OR = 1.06, 95% CI: 1.01‒1.11) were significantly associated with weight loss. Our results suggest that maintaining the food form inhibits weight loss and improves health outcomes in older adults.

Weight change and risk of cardiovascular disease among adults with type 2 diabetes: more than 14 years of follow-up in the Tehran Lipid and Glucose Study

BACKGROUND

To examine the impact of weight change on incident cardiovascular disease and coronary heart disease (CVD/CHD) among an Iranian population with type 2 diabetes mellitus (T2DM).

METHODS

The study population included 763 participants with T2DM aged ≥ 30 years without a history of CVD and cancer at baseline. Two weight measurements done at baseline and about 3 years later. Based on their weight change, they categorized into: > 5% loss, 3-5% loss, stable (± < 3%), 3-5% gain, > 5% gain. Participants were then followed for incident CVD/CHD annually up to 20 March 2018. Multivariable Cox proportional hazard models, adjusted for age, sex, body mass index, educational level, current smoking, glucose-lowering drug use, family history of CVD, hypertension, hypercholesterolemia, chronic kidney disease, and fasting plasma glucose (FPG) were applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of weight change categories for incident CVD/CHD, considering stable weight as reference.

RESULTS

After the weight change measurement, during a median follow-up of 14.4 years, 258 CVD and 214 CHD occurred. Over 5% weight gain was associated with reduced risks of CVD and CHD development by the HRs of 0.70 [95% CI 0.48-1.01; P-value: 0.058] and 0.61 [0.40-0.93], respectively, in multivariable analysis. After further adjustment for FPG change, the HRs of weight gain > 5% were attenuated to 0.75 [0.51-1.10; P-value: 0.138] and 0.66 [043-1.01; P-value: 0.053] for incident CVD and CHD, respectively. The effect of weight loss > 5% was in opposite direction among those older versus younger than 60 years; with suggestive increased risk (not statistically significant) of incident CHD/CVD for the older group. Moreover, weight gain > 5% significantly reduced the risk of CHD only among those older than 60 years (P-value for interaction < 0.2). Furthermore, weight gain > 5% had an association with lower risk of CVD and CHD among sulfonylurea users (0.56 [0.32-0.98] for CVD and 0.54 [0.29-0.99] for CHD).

CONCLUSIONS

Our results with a long-term follow-up showed that weight gain > 5% was associated with better CVD/CHD outcomes among Iranian participants with T2DM, especially older ones. Moreover, we did not find an unfavorable impact on incident CVD/CHD for sulfonylurea-induced weight gain.

Nutrition in chronic heart failure patients: a systematic review

Nutrition is the primary source of energy production for myocardial contractility and to maintaining cardiac efficiency. Although many studies provided evidence of the benefits of nutritional intervention in chronic heart failure patients (CHF), these effects are not still completely understood. We searched in PubMed and Embase articles related to the following keywords: "chronic heart failure" with "diet," "nutrition," "insulin resistance," and "caloric restriction." Of the 975 retrieved articles, 20 have been selected. The primary endpoint was the left ventricular (LV) function and the secondary mortality rate in HF patients. Some studies showed that the Mediterranean diet (MedDiet) had a beneficial effect on cardiac function, while others did not find any positive impact. Nutritional supplements and hypercaloric intake had positive effects on underweight HF patients, while hypocaloric diet was beneficial in obese HF patients improving glucose control and cardiac function. The effect of MedDiet in HF patients showed conflicting results. Changes in the dietary pattern can reduce the evolution of HF, considering not only the quality of food but also the caloric intake. The discriminant factor to prescribe a diet regime in HF patients is represented by body mass index (BMI). A well-balanced caloric diet represents an effective therapy in overweight HF patients to reduce the mortality rate. Long-term studies evaluating cause-effect of energy and macronutrients intake on cardiac function in HF patients are necessary.

Dental prosthetic treatment reduced the risk of weight loss among older adults with tooth loss

OBJECTIVES

Weight loss is a critical health issue in older adults. Oral function is essential for nutrient intake and can be restored using dental prosthetic treatments in patients with tooth loss. This study aimed to investigate the relationship between tooth loss and weight loss among the older adults and to evaluate the magnitude of its risk reduction by dental prosthetic treatment.

DESIGN

Three-year follow-up longitudinal study based on a self-reported questionnaire.

SETTING

Community-dwelling older adults in Japan.

PARTICIPANTS

Adults aged 65 and older (n = 53,690).

MEASUREMENTS

We used >10% weight loss during follow-up, the number of remaining teeth, and the use of dental prostheses as the outcome variable, exposure variable, and mediator, respectively. We fitted the logistic regression model including possible confounders and calculated the odds ratios (ORs) and 95% confidence intervals (95% CIs) of the controlled direct effect (CDE) at the level of use or nonuse of the dental prosthesis based on a causal mediation analysis framework. Additionally, we calculated the proportion eliminated by the dental prosthesis.

RESULTS

The mean age of participants was 72.6 years (1 SD = 5.5), and 47.4% were males. About 5.8% (n = 3132) of them experienced >10% weight loss during the follow-up. Weight loss was observed in 6.8% of the participants with 0-19 remaining teeth and in 4.3% of them with ≥20 remaining teeth. The CDE of 0-19 remaining teeth was greater when no one used dental prosthesis (OR = 1.41; 95% CI = 1.26-1.59) compared with that when all participants used dental prosthesis (OR = 1.26; 95% CI = 1.08-1.46). This indicated that dental prosthesis decreased the risk of weight loss by 37.3%.

CONCLUSION

Our study revealed that tooth loss increased the risk of clinically critical levels of weight loss among community-dwelling older adults. However, this risk was reduced by dental prosthetic treatment.

Weight change during middle age and risk of stroke and coronary heart disease: The Japan Public Health Center-based Prospective Study

BACKGROUND AND AIMS

The impact of weight changes in middle age on the incidence of cardiovascular disease has not been well elucidated. We investigated whether a 5-year weight change was associated with risk of stroke and coronary heart disease (CHD) in middle-aged individuals.

METHODS

We analyzed data of 74,928 participants aged 40-69 years who provided responses to the baseline and 5-year follow-up questionnaires in the Japan Public Health Center-based Prospective Study. Weight change was calculated by subtracting self-reported weight at baseline from that at 5-year follow-up. Stroke and CHD events were confirmed by reviewing hospital records.

RESULTS

During 997,406 person-years of follow-up, we documented 3,975 stroke and 914 CHD events. The multivariable HRs of stroke for losing ≥5 kg compared to stable weight (change ≤2 kg) was 1.17 (95% CI, 1.01-1.37) in men versus 1.33 (1.13-1.57) for losing ≥5 kg and 1.61 (1.36-1.92) for gaining ≥5 kg in women (U-shaped association). These associations did not change after the exclusion of early events. The multivariable HR of CHD for gaining ≥5 kg was 1.22 (0.95-1.58) in men. After exclusion of early events within another 5 years, that positive association became stronger [multivariable HR 1.34 (1.00-1.82)].

CONCLUSIONS

Weight gain during middle age was associated with an increased risk of stroke in women and an increased risk of CHD in men. Weight loss was associated with an increased risk of stroke in both men and women.

Age-Group Differences in Body Mass Index, Weight, and Height in Adults With Down Syndrome and Adults With Intellectual Disability From the United States

The authors examined if body mass index (BMI), weight, and height across age groups differ between adults with Down syndrome (DS) and adults with intellectual disability but without DS. They conducted secondary analyses of cross-sectional data from 45,803 individuals from the United States from 2009 to 2014 of the National Core Indicators Adult Consumer Survey across five age groups: 18-29, 30-39, 40-49, 50-59, and 60+ years. For both men and women with DS, BMI and weight increased between the 18- to 29- and the 30- to 39-year age groups and decreased thereafter. For both men and women with intellectual disability, BMI and weight increased between the 18- to 29- and the 30- to 39-year age groups, stayed about the same until the 50- to 59-year age group, and decreased thereafter. Height demonstrated a small but significant decrease with older age in all groups. These cross-sectional comparisons indicate that BMI and weight may start decreasing at a younger age in adults with DS than in adults with intellectual disability.

Impact of Body Mass Index Change on the Prognosis of Chronic Obstructive Pulmonary Disease

BACKGROUND

Low body mass index (BMI) is an important prognostic factor in chronic obstructive pulmonary disease (COPD). However, the prognostic value of longitudinal BMI change in COPD has not been well studied.

OBJECTIVE

We aimed to evaluate the association between longitudinal change of BMI and prognosis of COPD in Korean COPD cohort.

METHODS

This study was conducted in a prospective Korean Obstructive Lung Disease (KOLD) cohort where COPD patients were recruited on an outpatient basis at 17 hospitals in South Korea. Annual BMI was measured over a period of 3 years or more. All patients were categorized into underweight (UW), normal weight (NW), and overweight (OW) groups by BMI. Clinical characteristics and outcomes including exacerbation and mortality were compared based on initial BMI grade and longitudinal change of BMI.

RESULTS

This analysis included 537 COPD patients (mean age = 67.4 ± 7.9 years, male = 97.0%, mean BMI = 23.0 ± 3.1) of KOLD cohort. The proportions of UW, NW, and OW groups were 6.9% (n = 37), 68.9% (n = 370), and 24.2% (n = 130) respectively. The UW group showed lower forced expiratory volume in 1 s (FEV1) (p < 0.001), shorter 6-minute walk distance (p < 0.001), higher modified Medical Research Council score (p = 0.002), higher St. George Respiratory Questionnaire score (p < 0.001), higher emphysema index (p < 0.001) and air-trapping index (p < 0.001), and more frequent (p < 0.001) and severe exacerbations (p = 0.003). Multivariable analyses demonstrated that decrease of BMI (hazard ratio [HR] = 0.786, p = 0.038) and the descent of BMI group (HR = 3.167, p = 0.016) at 3-year follow-up along with age, initial BMI, post-bronchodilator FEV1, and severe exacerbations were significantly associated with mortality.

CONCLUSIONS

This study demonstrated that BMI decrease during follow-up was independently associated with exacerbation and higher mortality of COPD, suggesting BMI reduction in COPD should be carefully managed.

Nutritional status related to poor health outcomes in older people: Which is better, obese or lean?

Good nutritional status is crucial for maintaining growth and health in all stages of life. However, the relationship between nutritional status and health and the effect on various health-related outcomes differ, depending on the life stage. Many adverse outcomes in older adults, directly linked to different nutritional status, are not present in middle-aged adults, and their ideal nutritional status may differ. This article will review the optimal nutritional status, mainly evaluated by anthropometric measurements such as body mass index, for older adults from various perspectives. Overall, in older adults low body mass index is at higher risk of health problems such as mortality and difficulties in physical functioning compared with middle-aged adults, reducing the risk of health problems for overweight and (abdominal) obesity. Overweight may be more beneficial than lower level of normal weight in older-old and vulnerable older people. While, with or without obesity, skeletal muscle loss or weakness as well as unintentional weight loss induces health problems in older adults. The impact of metabolic syndrome on the prognosis of older adults is clearly reduced compared with middle-aged adults, requiring a shift in medical attention in older adults from metabolic syndrome to frailty. There are still many unclear points regarding the optimal nutritional status of older people, and further research is needed to support healthy longevity. Geriatr Gerontol Int 2021; 21: 5-13.

The Association Between BMI and Inpatient Mortality Outcomes in Older Adults With COVID-19

Background and aim

Coronavirus disease 2019 (COVID-19) is known to cause a broad spectrum of illnesses. There is evidence that obesity-related conditions may increase the severity of COVID-19 disease, especially in those below the age of 60. However, there has been limited research on mortality rate based on body mass index (BMI) in the older adult population, defined as age over 65. The objective of this study was to characterize outcomes in older adults infected with COVID-19 based on BMI.

Study design and methods

It is a single-center retrospective cohort study of older adults with COVID-19 infection. The primary outcome was hospital mortality. Secondary outcomes assessed were oxygen requirements, need for mechanical ventilation, duration of mechanical ventilation, and hospital length of stay. Data were analyzed with the Student’s t-test, Fisher’s exact test, and multiple logistic regression analyses as appropriate.

Results

A total of 290 patients were included in this study. The mean age was 77.6 years. The median BMI was >30 kg/m2. The primary outcome of hospital mortality occurred in 49.7% of patients. BMI was not found to be a predictor of mortality. Age 75-79 and age ≥ 85 were associated with an increased risk of mortality (OR: 2.58; 95% CI: 1.15 - 5.79; OR: 3.17; 95% CI: 1.35 - 7.44, respectively). Patients with a BMI < 18.5, BMI 18.5 - 25, and age ≥ 85 were less likely to require mechanical ventilation (OR: 0.06; 95% CI: 0.00 - 0.83; OR:0.11; 95% CI: 0.02 - 0.64 and OR:0.28; 95% CI: 0.09 - 0.92, respectively). Past medical history was not associated with mortality.

Conclusion

In a cohort of older adults with COVID-19 disease, BMI was not an independent predictor of in-hospital mortality. Patients with BMI ≤ 25 and age ≥ 85 years were less likely to require mechanical ventilation.