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Alò R, Fazzari G, Zizza M, Avolio E, Di Vito A, Bruno R, Cuda G, Barni T, Canonaco M, Facciolo RM. Daidzein Pro-cognitive Effects Coincided with Changes of Brain Neurotensin1 Receptor and Interleukin-10 Expression Levels in Obese Hamsters. Neurotox Res 2021; 39:645-657. [PMID: 33428179 DOI: 10.1007/s12640-020-00328-4] [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: 09/26/2020] [Revised: 12/07/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
At present, concerns are pointing to "tasteful" high-fat diets as a cause of conditioning physical-social states that through alterations of some key emotional- and nutritional-related limbic circuits such as hypothalamic and amygdalar areas lead to obesity states. Feeding and energetic homeostatic molecular mechanisms are part of a complex neuronal circuit accounting for this metabolic disorder. In an attempt to exclude conventional drugs for treating obesity, daidzein, a natural glycosidic isoflavone, which mimics estrogenic neuroprotective properties against increased body weight, is beginning to be preferred. In this study, evident anxiolytic-like behaviors were detected following treatment of high-fat diet hamsters with daidzein as shown by extremely evident (p < 0.001) exploration tendencies in novel object recognition test and a notably greater amount of time spent (p < 0.01) in open arms of elevated plus maze. Moreover, the isoflavone promoted a protective role against neurodegeneration processes as shown by few, if any, amino cupric silver granules in amygdalar, hypothalamic and hippocampal neuronal fields when compared with obese hamsters. Interestingly, elevated expression levels of the anorexic neuropeptide receptor neurotensin1 in the above limbic areas of obese hamsters were extremely reduced by daidzein, especially during recovery of cognitive events. Contextually, such effects were strongly paralleled by increased levels of the anti-neuroinflammatory cytokine, interleukin-10. Our results corroborate a neuroprotective ability of this natural glycosidic isoflavone, which through its interaction with the receptor neurotensin1 and interleukin-10 pathways is correlated not only to improved feeding states, and subsequently obesity conditions, but above all to cognitive performances.
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Affiliation(s)
- Raffaella Alò
- Comparative Neuroanatomy Laboratory of Biology, Ecology and Earth Science Department (DiBEST), University of Calabria, Arcavacata Di Rende, Ponte P. Bucci 4B, 87036, Cosenza, Italy
| | - Gilda Fazzari
- Comparative Neuroanatomy Laboratory of Biology, Ecology and Earth Science Department (DiBEST), University of Calabria, Arcavacata Di Rende, Ponte P. Bucci 4B, 87036, Cosenza, Italy
| | - Merylin Zizza
- Comparative Neuroanatomy Laboratory of Biology, Ecology and Earth Science Department (DiBEST), University of Calabria, Arcavacata Di Rende, Ponte P. Bucci 4B, 87036, Cosenza, Italy
| | - Ennio Avolio
- Comparative Neuroanatomy Laboratory of Biology, Ecology and Earth Science Department (DiBEST), University of Calabria, Arcavacata Di Rende, Ponte P. Bucci 4B, 87036, Cosenza, Italy
| | - Anna Di Vito
- Department of Clinical and Experimental Medicine, University of Catanzaro "Magna Græcia", Viale Europa, 88100, Catanzaro, Italy
| | - Rosalinda Bruno
- Department of Pharmacy and Science of Health and Nutrition, Polyfunctional Building, University of Calabria, Arcavacata Di Rende, 87036, Cosenza, Italy
| | - Giovanni Cuda
- Department of Clinical and Experimental Medicine, University of Catanzaro "Magna Græcia", Viale Europa, 88100, Catanzaro, Italy
| | - Tullio Barni
- Department of Clinical and Experimental Medicine, University of Catanzaro "Magna Græcia", Viale Europa, 88100, Catanzaro, Italy
| | - Marcello Canonaco
- Comparative Neuroanatomy Laboratory of Biology, Ecology and Earth Science Department (DiBEST), University of Calabria, Arcavacata Di Rende, Ponte P. Bucci 4B, 87036, Cosenza, Italy.
| | - Rosa Maria Facciolo
- Comparative Neuroanatomy Laboratory of Biology, Ecology and Earth Science Department (DiBEST), University of Calabria, Arcavacata Di Rende, Ponte P. Bucci 4B, 87036, Cosenza, Italy
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Liu C, Li G, Laukkanen JA, Hao L, Zhao Q, Zhang J, Zhang X. Overweight and obesity are associated with cardiac adverse structure remodeling in Chinese elderly with hypertension. Sci Rep 2019; 9:17896. [PMID: 31784593 PMCID: PMC6884627 DOI: 10.1038/s41598-019-54359-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 11/13/2019] [Indexed: 12/12/2022] Open
Abstract
There is limited information on the association of overweight and obesity with cardiac remodeling in elderly population. Therefore, we investigated whether overweight and obesity are associated with cardiac geometric structures and function in Chinese elderly. A total of 1183 hospitalized patients (aged 65–99 years) with primary hypertension were collected retrospectively in a cross-sectional study, and divided into underweight, normal weight, overweight and obesity patient groups according to their body mass index (BMI). Cardiac echocardiographic parameters were compared between the groups. BMI was 17.2 ± 1.2, 21.4 ± 1.2, 25.1 ± 1.2, 30.2 ± 2.6 kg/m2 in underweight, normal weight, overweight and obesity groups respectively. Aortic and left atrial diameter, interventricular septal and left ventricular (LV) posterior wall thickness, LV end-diastolic and end-systolic diameter, and indexed LV mass, and prevalence of E/A reversal were higher, while LV ejection fraction and fractional shortening were lower in elderly with overweight or obesity, as compared with whose with underweight or normal weight separately (All P < 0.05). However, multivariable regression analysis showed that overweight and obesity are independently related to increased LV wall thickness, end-diastolic diameter and mass (All P < 0.05). In conclusions, this study demonstrates that overweight and obesity are associated with increased LV wall thickness, end-diastolic diameter and mass in Asian elderly.
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Affiliation(s)
- Cheng Liu
- Division of Cardiology, Department of Geriatrics and General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Li
- Division of Cardiology, Department of Geriatrics and General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Lan Hao
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, Institute of Ultrasound Imaging, Chongqing Medical University, Chongqing, China
| | - Qianping Zhao
- Division of Cardiology, Department of Geriatrics and General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Zhang
- Division of Cardiology, Department of Geriatrics and General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xu Zhang
- Division of Cardiology, Department of Geriatrics and General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Owusu ESA, Samanta M, Shaw JE, Majeed A, Khunti K, Paul SK. Weight loss and mortality risk in patients with different adiposity at diagnosis of type 2 diabetes: a longitudinal cohort study. Nutr Diabetes 2018; 8:37. [PMID: 29855473 PMCID: PMC5981299 DOI: 10.1038/s41387-018-0042-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/15/2018] [Accepted: 03/18/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Undiagnosed comorbid diseases that independently lead to weight loss before type 2 diabetes mellitus (T2DM) diagnosis could explain the observed increased mortality risk in T2DM patients with normal weight. OBJECTIVES To evaluate the impact of weight change patterns before the diagnosis of T2DM on the association between body mass index (BMI) at diagnosis and mortality risk. METHODS This was a longitudinal cohort study using 145,058 patients from UK primary care, with newly diagnosed T2DM from January 2000. Patients aged 18-70, without established disease history at diagnosis (defined as the presence of cardiovascular diseases, cancer, and renal diseases on or before diagnosis) were followed up to 2014. Longitudinal 6-monthly measures of bodyweight three years before (used to define groups of patients who lost bodyweight or not before diagnosis) and 2 years after diagnosis were obtained. The main outcome was all-cause mortality. RESULTS At diagnosis, mean (SD) age was 52 (12) years, 56% were male, 52% were current or ex-smokers, mean BMI was 33 kg/m2, and 66% were obese. Normal weight and overweight patients experienced a small but significant reduction in body weight 6 months before diagnosis. Among all categories of obese patients, consistently increasing body weight was observed within the same time window. Among patients who did not lose body weight pre-diagnosis (n = 117,469), compared with the grade 1 obese, normal weight patients had 35% (95% CI of HR: 1.17, 1.55) significantly higher adjusted mortality risk. However, among patients experiencing weight loss before diagnosis (n = 27,589), BMI at diagnosis was not associated with mortality risk (all p > 0.05). CONCLUSIONS Weight loss before the diagnosis of T2DM was not associated with the observed increased mortality risk in normal weight patients with T2DM. This emphasises the importance of addressing risk factors post diagnosis for excess mortality in this group.
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Affiliation(s)
- Ebenezer S Adjah Owusu
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Mayukh Samanta
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Kamlesh Khunti
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sanjoy K Paul
- QIMR Berghofer Medical Research Institute, Brisbane, Australia. .,Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia.
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Gao F, Wang ZJ, Shen H, Yang SW, Nie B, Zhou YJ. Impact of obesity on mortality in patients with diabetes: Meta-analysis of 20 studies including 250,016 patients. J Diabetes Investig 2018; 9:44-54. [PMID: 28593750 PMCID: PMC5754523 DOI: 10.1111/jdi.12677] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/28/2017] [Accepted: 04/04/2017] [Indexed: 01/03/2023] Open
Abstract
AIMS/INTRODUCTION The impact of body mass index on mortality among patients with diabetes remains controversial. Therefore, we carried out a meta-analysis of pertinent studies. MATERIALS AND METHODS We searched OVID/MEDLINE, EMBASE and Cochrane databases for all reported studies, which investigated the relationship between body mass index and mortality in patients with diabetes. Summary estimates of hazard ratios (HRs) were obtained with a random effects model. Univariate meta-regressions were carried out. RESULTS A total of 20 studies including 250,016 patients with diabetes were identified. The results of the present study showed a significantly reduced risk of all-cause mortality in overweight patients (HR 0.82, 95% CI: 0.74-0.91, P < 0.0001, and I2 = 91.6%) as compared with normal weight patients. The survival benefits of obesity were only observed in the elderly patients (HR 0.69, 95% CI: 0.63-0.75, P < 0.0001, and I2 = 50.4%), but not in the younger patients (HR 1.01, 95% CI: 0.84-1.20, P = 0.96, I2 = 80.1%). Furthermore, the beneficial prognostic impacts on overweight (coefficient = 0.030, P = 0.041) and obesity (coefficient = 0.032, P = 0.010) were attenuated with clinical follow-up duration. CONCLUSIONS The present meta-analysis showed a significantly lower risk of all-cause mortality in overweight patients with diabetes compared with normal weight patients. However, the survival benefits of obesity were only observed among the elderly patients.
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Affiliation(s)
- Fei Gao
- Department of CardiologyAn Zhen HospitalCapital Medical UniversityBeijingChina
| | - Zhi Jian Wang
- Department of CardiologyAn Zhen HospitalCapital Medical UniversityBeijingChina
| | - Hua Shen
- Department of CardiologyAn Zhen HospitalCapital Medical UniversityBeijingChina
| | - Shi Wei Yang
- Department of CardiologyAn Zhen HospitalCapital Medical UniversityBeijingChina
| | - Bin Nie
- Department of CardiologyAn Zhen HospitalCapital Medical UniversityBeijingChina
| | - Yu Jie Zhou
- Department of CardiologyAn Zhen HospitalCapital Medical UniversityBeijingChina
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5
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Zhao Q, Laukkanen JA, Li Q, Li G. Body mass index is associated with type 2 diabetes mellitus in Chinese elderly. Clin Interv Aging 2017; 12:745-752. [PMID: 28496312 PMCID: PMC5422331 DOI: 10.2147/cia.s130014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background There is limited information on the association between metabolic syndrome components including body mass index (BMI) and type 2 diabetes mellitus in elderly Chinese population. Therefore, we investigated whether components of metabolic syndrome are associated with type 2 diabetes mellitus in elderly. Methods A total of 479 hospitalized patients (aged 65–95 years) with recently diagnosed type 2 diabetes mellitus were studied retrospectively in a cross-sectional study and compared with 183 subjects with prediabetes and 62 subjects without glucose metabolism abnormalities. Results BMI (24.69±3.59 versus 23.92±3.08 and 23.56±3.25 kg/m2), blood pressure, cholesterol, triglyceride, liver enzymes and prevalence of fatty liver were higher in patients with type 2 diabetes mellitus as compared with elderly subjects with prediabetes or normal glucose metabolism separately (all P<0.05). Multivariable regression analysis showed that BMI was associated positively with insulin resistance and inversely with insulin sensitivity in type 2 diabetes mellitus group (all P<0.05). Conclusion Higher BMI was associated with increased insulin resistance and decreased insulin sensitivity in elderly Asian population with type 2 diabetes mellitus.
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Affiliation(s)
- Qianping Zhao
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Department of Medicine, Central Finland Central Hospital, Jyväskylä, Finland
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Gang Li
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Zaccardi F, Dhalwani NN, Papamargaritis D, Webb DR, Murphy GJ, Davies MJ, Khunti K. Nonlinear association of BMI with all-cause and cardiovascular mortality in type 2 diabetes mellitus: a systematic review and meta-analysis of 414,587 participants in prospective studies. Diabetologia 2017; 60:240-248. [PMID: 27888288 PMCID: PMC6518080 DOI: 10.1007/s00125-016-4162-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/04/2016] [Indexed: 12/12/2022]
Abstract
AIMS/HYPOTHESIS The relationship between BMI and mortality has been extensively investigated in the general population; however, it is less clear in people with type 2 diabetes. We aimed to assess the association of BMI with all-cause and cardiovascular mortality in individuals with type 2 diabetes mellitus. METHODS We searched electronic databases up to 1 March 2016 for prospective studies reporting associations for three or more BMI groups with all-cause and cardiovascular mortality in individuals with type 2 diabetes mellitus. Study-specific associations between BMI and the most-adjusted RR were estimated using restricted cubic splines and a generalised least squares method before pooling study estimates with a multivariate random-effects meta-analysis. RESULTS We included 21 studies including 24 cohorts, 414,587 participants, 61,889 all-cause and 4470 cardiovascular incident deaths; follow-up ranged from 2.7 to 15.9 years. There was a strong nonlinear relationship between BMI and all-cause mortality in both men and women, with the lowest estimated risk from 31-35 kg/m2 and 28-31 kg/m2 (p value for nonlinearity <0.001) respectively. The risk of mortality at higher BMI values increased significantly only in women, whilst lower values were associated with higher mortality in both sexes. Limited data for cardiovascular mortality were available, with a possible inverse linear association with BMI (higher risk for BMI <27 kg/m2). CONCLUSIONS/INTERPRETATION In type 2 diabetes, BMI is nonlinearly associated with all-cause mortality with lowest risk in the overweight group in both men and women. Further research is needed to clarify the relationship with cardiovascular mortality and assess causality and sex differences.
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Affiliation(s)
- Francesco Zaccardi
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Nafeesa N Dhalwani
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.
| | - Dimitris Papamargaritis
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - David R Webb
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Gavin J Murphy
- University of Leicester, Department of Cardiovascular Sciences, Clinical Sciences Wing, Glenfield General Hospital, Leicester, LE3 9QP, UK
| | - Melanie J Davies
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
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7
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Tobias DK, Manson JE. The Obesity Paradox in Type 2 Diabetes and Mortality. Am J Lifestyle Med 2016; 12:244-251. [PMID: 30202394 DOI: 10.1177/1559827616650415] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 04/27/2016] [Accepted: 04/27/2016] [Indexed: 12/20/2022] Open
Abstract
The obesity paradox for survival among individuals with type 2 diabetes has been observed in some but not all studies. Conflicting evidence for the role of overweight and obesity in all-cause mortality may largely be a result of differences in study populations, epidemiological methods, and statistical analysis. For example, analyses among populations with long-term prevalent diabetes and the accrual of other chronic health conditions are more likely to observe that the sickest participants have lower body weights, and therefore, relative to normal weight, overweight and even obesity appear advantageous. Other mortality risk factors, such as smoking, also confound the relationship between body weight and survival, but this behavior varies widely in intensity and duration, making it difficult to assess and effectively adjust for in statistical models. Disentangling the potential sources of bias is imperative in understanding the relevance of excess body weight to mortality in diabetes. In this review, we summarize methodological considerations underlying the observed obesity paradox. Based on the available evidence, we conclude that the obesity paradox is likely an artifact of biases, and once these are accounted for, it is evident that compared with normal body weight, excess body weight is associated with a greater mortality risk.
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Affiliation(s)
- Deirdre K Tobias
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (DKT, JEM), Boston, Massachusetts.,Harvard Medical School (DKT, JEM), Boston, Massachusetts.,Department of Epidemiology, Harvard T. H. Chan School of Public Health (JEM), Boston, Massachusetts
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (DKT, JEM), Boston, Massachusetts.,Harvard Medical School (DKT, JEM), Boston, Massachusetts.,Department of Epidemiology, Harvard T. H. Chan School of Public Health (JEM), Boston, Massachusetts
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8
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Gucuk S. Effects of the behavior of elderly type 2 diabetic patients and their relatives as caregivers on diabetes follow-up parameters in Bolu, Turkey. Geriatr Gerontol Int 2016; 16:182-90. [PMID: 25613591 DOI: 10.1111/ggi.12449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2014] [Indexed: 01/01/2023]
Abstract
AIM In the present study, patients with type 2 diabetes mellitus and their relatives as caregivers during the treatment period, and the effects on treatment success were evaluated. METHODS A cross-sectional study of type 2 diabetes mellitus patients aged 65 years and older and their relatives as caregivers was carried out. The questionnaire given to the participants consisted of three sections: the first section included questions regarding sociodemographic characteristics; the second section included questions on patient treatment, habits of drug use, lifestyle changes such as dietary habits; and the third section included anthropometric measurements and laboratory evaluations. The questionnaire given to the patients' relatives as caregivers consisted of questions regarding their sociodemographic characteristics and information regarding the patient. RESULTS The present study consisted of 115 patients diagnosed with type 2 diabetes mellitus and their relatives as caregivers. The average duration of diabetes was 12.14 ± 6.74 years. Body mass index was 30.2 ± 4.2 kg/m(2) , average hemoglobin A1c level was 7.09 ± 0.64%, and 40.1% of the patients lived with their partners only. As the frequency of physical exercise increased, hemoglobin A1c levels decreased to <7.5% (P < 0.05).The patients whose caregivers were college-educated or equivalent had a significantly low body mass index (P < 0.05). Patients who lived with their partners showed a significant correlation with lower hemoglobin A1c levels (<7.5%; P = 0.002). CONCLUSION In order to improve diabetic conditions in the elderly and to overcome obstacles to disease management, maximizing the cooperative efforts between the patients and their caregivers is necessary.
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Affiliation(s)
- Sebahat Gucuk
- Family Medicine, Izzet Baysal Family Health Center, Bolu, Turkey
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Liu XM, Liu YJ, Zhan J, He QQ. Overweight, obesity and risk of all-cause and cardiovascular mortality in patients with type 2 diabetes mellitus: a dose–response meta-analysis of prospective cohort studies. Eur J Epidemiol 2014; 30:35-45. [DOI: 10.1007/s10654-014-9973-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 11/16/2014] [Indexed: 10/24/2022]
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Ishii S, Tanaka T, Akishita M, Ouchi Y, Tuji T, Iijima K. Metabolic syndrome, sarcopenia and role of sex and age: cross-sectional analysis of Kashiwa cohort study. PLoS One 2014; 9:e112718. [PMID: 25405866 PMCID: PMC4236117 DOI: 10.1371/journal.pone.0112718] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/14/2014] [Indexed: 12/25/2022] Open
Abstract
Recent epidemiological evidence suggests that effects of cardiovascular risk factors may vary depending on sex and age. In this study, we assessed the associations of metabolic syndrome (MetS) with sarcopenia and its components in older adults, and examined whether the associations vary by sex and age. We also tested if any one of the MetS components could explain the associations. We conducted a cross-sectional analysis of the baseline data from the cohort study conducted in Kashiwa city, Chiba, Japan in 2012 which included 1971 functionally-independent, community-dwelling Japanese adults aged 65 years or older (977 men, 994 women). Sarcopenia was defined based on appendicular skeletal muscle mass, grip strength and usual gait speed. MetS was defined based on the National Cholesterol Education Program’s Adult Treatment Panel-III criteria. The prevalence of sarcopenia was 14.2% in men and 22.1% in women, while the prevalence of MetS was 43.6% in men and 28.9% in women. After adjustment for potential confounders, MetS was positively associated with sarcopenia in men aged 65 to 74 years (odds ratio 5.5; 95% confidence interval 1.9–15.9) but not in older men or women. Among the sarcopenia components, MetS was associated with lower muscle mass and grip strength, particularly in men aged 65 to 74 years. The associations of MetS with sarcopenia and its components were mainly driven by abdominal obesity regardless of sex or age. In conclusion, MetS is positively associated with sarcopenia in older men. The association is modified by sex and age, but abdominal obesity is the main contributor to the association across sex and age.
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Affiliation(s)
- Shinya Ishii
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 Japan
| | - Tomoki Tanaka
- Institute of Gerontology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 Japan
| | - Yasuyoshi Ouchi
- Federation of National Public Service Personnel Mutual Aid Associations, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Tetsuo Tuji
- Institute of Gerontology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
- * E-mail:
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Nutritional status and quality of life in different populations of older people in Poland. Eur J Clin Nutr 2014; 68:1210-5. [PMID: 25205321 DOI: 10.1038/ejcn.2014.172] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/16/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES To estimate the potential association of three distinct nutritional status measures (body mass index (BMI), calf circumference (CC) and the Mini Nutritional Assessment (MNA)) with health-related quality of life (HRQL) assessed with Euroqol 5D questionnaire in different populations of elderly people in Poland. SUBJECTS/METHODS The study group was comprised of 1003 community-dwelling subjects from the urban environment, 890 subjects from the rural environment and 879 subjects from an institutional environment (nursing homes). Bivariate and multivariate associations were identified between nutritional status measures and HRQL adjusted for demographic and social variables, health status, physical function and mental status. RESULTS Nutrition status indices (BMI, CC and MNA) were generally higher in the urban than in the rural environment and clearly worse in institutionalised elderly. In both community-dwelling groups, BMI and CC were negatively related to several Euroqol scores. In institutional residents, of opposite relationships were observed: higher values of these variables were connected with less frequent reporting of problems in Euroqol. In all the three groups, associations between HRQL scores and MNA were very similar: higher values of MNA were significantly connected with less frequent reporting of problems in Euroqol. CONCLUSIONS BMI and CC, as overweight/obesity measures, are independent predictors of lower HRQL in urban and rural community-dwelling seniors and higher HRQL in institutionalised elderly. Poor nutritional state as measured by MNA is a similar determinant of well-being in all the three environments. This different relationship of popular overweight/obesity measures to HRQL should be taken into account while designing care for older people.
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13
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Leibovitz E, Giryes S, Makhline R, Zikri Ditch M, Berlovitz Y, Boaz M. Malnutrition risk in newly hospitalized overweight and obese individuals: Mr NOI. Eur J Clin Nutr 2013; 67:620-4. [PMID: 23549203 DOI: 10.1038/ejcn.2013.45] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Malnutrition risk and its consequences have not been reported in obese and overweight newly hospitalized patients. To estimate malnutrition risk among newly hospitalized overweight or obese patients, and to assess the effect of body mass index (BMI) on duration of hospitalization and risk of in-hospital death among hospitalized adults at increased risk of malnutrition. SUBJECTS/METHODS In this survey, all adults newly admitted to internal medicine and surgical departments at a large tertiary medical center, during the 5-week data acquisition period in 2010, were screened for malnutrition risk using the Nutrition Risk Screen (NRS 2002). Malnutrition risk was compared across body weight categories. In addition, overweight/obese subjects were compared by malnutrition risk category. RESULTS Of the 431 individuals analyzed, 138 were overweight and 105 were obese. Among overweight or obese patients, 23.2% and 24.8%, respectively, were at increased risk for malnutrition. Elevated risk for malnutrition prolonged hospitalization for both overweight and obese patients (from 5.6 ± 7.9 to 10.0 ± 10.3 days (P=0.04) and from 4.8 ± 4.6 to 15.1 ± 25.7 days (P=0.001), respectively). Prolonged hospital stay remained associated with malnutrition risk after controlling for age and BMI. Malnutrition risk significantly increased odds of in-hospital death: odds ratio (OR) 6.4, 95% confidence interval (CI) 1.2-33.2, P=0.03, even after controlling for age and BMI. CONCLUSIONS Increased malnutrition risk is a frequent finding in newly hospitalized overweight/obese adults, prolongs length of hospital stay and increases risk of in-hospital mortality.
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Affiliation(s)
- E Leibovitz
- Internal Medicine Department 'A', E Wolfson Medical Center, Holon, Israel
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Ma SH, Park BY, Yang JJ, Jung EJ, Yeo Y, Whang Y, Chang SH, Shin HR, Kang D, Yoo KY, Park SK. Interaction of body mass index and diabetes as modifiers of cardiovascular mortality in a cohort study. J Prev Med Public Health 2012; 45:394-401. [PMID: 23230470 PMCID: PMC3514470 DOI: 10.3961/jpmph.2012.45.6.394] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/10/2012] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Diabetes and obesity each increases mortality, but recent papers have shown that lean Asian persons were at greater risk for mortality than were obese persons. The objective of this study is to determine whether an interaction exists between body mass index (BMI) and diabetes, which can modify the risk of death by cardiovascular disease (CVD). METHODS Subjects who were over 20 years of age, and who had information regarding BMI, past history of diabetes, and fasting blood glucose levels (n=16 048), were selected from the Korea Multi-center Cancer Cohort study participants. By 2008, a total of 1290 participants had died; 251 and 155 had died of CVD and stroke, respectively. The hazard for deaths was calculated with hazard ratio (HR) and 95% confidence interval (95% CI) by Cox proportional hazard model. RESULTS Compared with the normal population, patients with diabetes were at higher risk for CVD and stroke deaths (HR, 1.84; 95% CI, 1.33 to 2.56; HR, 1.82; 95% CI, 1.20 to 2.76; respectively). Relative to subjects with no diabetes and normal BMI (21 to 22.9 kg/m(2)), lean subjects with diabetes (BMI <21 kg/m(2)) had a greater risk for CVD and stroke deaths (HR, 2.83; 95% CI, 1.57 to 5.09; HR, 3.27; 95% CI, 1.58 to 6.76; respectively), while obese subjects with diabetes (BMI ≥25 kg/m(2)) had no increased death risk (p-interaction <0.05). This pattern was consistent in sub-populations with no incidence of hypertension. CONCLUSIONS This study suggests that diabetes in lean people is more critical to CVD deaths than it is in obese people.
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Affiliation(s)
- Seung Hyun Ma
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Bo-Young Park
- Cancer Epidemiology Branch, National Cancer Center, Goyang, Korea
| | - Jae Jeong Yang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - En-Joo Jung
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yohwan Yeo
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yungi Whang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
| | - Soung-Hoon Chang
- Department of Preventive Medicine, Konkuk University School of Medicine, Chungju, Korea
| | - Hai-Rim Shin
- Non-communicable Disease and Health Promotion, Western Pacific Regional Office, World Health Organization, Manila, Philippines
| | - Daehee Kang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
| | - Keun-Young Yoo
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sue Kyung Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
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15
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External validation of the KORA S4/F4 prediction models for the risk of developing type 2 diabetes in older adults: the PREVEND study. Eur J Epidemiol 2012; 27:47-52. [PMID: 22215562 DOI: 10.1007/s10654-011-9648-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 12/23/2011] [Indexed: 02/03/2023]
Abstract
Recently, prediction models for type 2 diabetes mellitus (T2DM) in older adults (aged ≥55 year) were developed in the KORA S4/F4 study, Augsburg, Germany. We aimed to externally validate the KORA models in a Dutch population. We used data on both older adults (n = 2,050; aged ≥55 year) and total non-diabetic population (n = 6,317; aged 28-75 year) for this validation. We assessed performance of base model (model 1: age, sex, BMI, smoking, parental diabetes and hypertension) and two clinical models: model 1 plus fasting glucose (model 2); and model 2 plus uric acid (model 3). For 7-year risk of T2DM, we calculated C-statistic, Hosmer-Lemeshow χ(2)-statistic, and integrated discrimination improvement (IDI) as measures of discrimination, calibration and reclassification, respectively. After a median follow-up of 7.7 years, 199 (9.7%) and 374 (5.9%) incident cases of T2DM were ascertained in the older and total population, respectively. In the older adults, C-statistic was 0.66 for model 1. This was improved for model 2 and model 3 (C-statistic = 0.81) with significant IDI. In the total population, these respective C-statistics were 0.77, 0.85 and 0.85. All models showed poor calibration (P < 0.001). After adjustment for the intercept and slope of each model, we observed good calibration for most models in both older and total populations. We validated the KORA clinical models for prediction of T2DM in an older Dutch population, with discrimination similar to the development cohort. However, the models need to be corrected for intercept and slope to acquire good calibration for application in a different setting.
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Zekry D, Frangos E, Graf C, Michel JP, Gold G, Krause KH, Herrmann FR, Vischer UM. Diabetes, comorbidities and increased long-term mortality in older patients admitted for geriatric inpatient care. DIABETES & METABOLISM 2011; 38:149-55. [PMID: 22115993 DOI: 10.1016/j.diabet.2011.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 10/05/2011] [Accepted: 10/05/2011] [Indexed: 12/25/2022]
Abstract
AIMS To study the specific impact of diabetes on long-term mortality in very old subjects with multiple comorbidities and functional disabilities. METHODS The prevalence of vascular disorders, global comorbidity load (cumulative illness rating scale [CIRS]) and functional disabilities (activities of daily living [ADL] and Lawton's instrumental ADL [IADL] scores) were determined according to diabetes status in a cohort of 444 patients (mean age 85.3±6.7 years; 74.0% women) admitted to our geriatric service. Also, the specific impact of diabetes on 4-year mortality was analyzed using Cox proportional-hazards models. RESULTS Diabetic patients had higher BMI scores (27.1±4.9 vs. 23.4±4.7 kg/m(2) in controls; P<0.001), and higher prevalences of hypertension (81.9% vs. 65.1%, respectively; P=0.003) and ischaemic heart disease (33.7% vs. 22.2%, respectively; P=0.033), but not of stroke and renal insufficiency. They also had more comorbidities (CIRS score excluding diabetes: 15.1±4.5 vs. 13.8±4.8, respectively; P=0.016) and functional disabilities. Diabetes was associated with mortality (HR: 1.42, 95% CI: 1.02-1.99; P=0.041) after adjusting for age, gender and BMI, and this persisted after adjusting for individual vascular comorbidities, but disappeared after adjusting for CIRS, ADL or IADL scores. CONCLUSION Diabetes was associated with 4-year mortality after adjusting for the inverse relationship between mortality and BMI. This association was better accounted for by the global comorbidity load and functional disabilities than by the individual vascular comorbidities. These findings suggest that the active management of all--rather than selected--comorbidities is the key to improving the prognosis for older diabetic patients.
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Affiliation(s)
- D Zekry
- Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, 3 chemin du Pont-Bochet, Thônex, Switzerland
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Sluik D, Boeing H, Montonen J, Pischon T, Kaaks R, Teucher B, Tjønneland A, Halkjaer J, Berentzen TL, Overvad K, Arriola L, Ardanaz E, Bendinelli B, Grioni S, Tumino R, Sacerdote C, Mattiello A, Spijkerman AMW, van der A DL, Beulens JW, van der Schouw YT, Nilsson PM, Hedblad B, Rolandsson O, Franks PW, Nöthlings U. Associations between general and abdominal adiposity and mortality in individuals with diabetes mellitus. Am J Epidemiol 2011; 174:22-34. [PMID: 21616928 DOI: 10.1093/aje/kwr048] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Individuals with diabetes mellitus are advised to achieve a healthy weight to prevent complications. However, fat mass distribution has hardly been investigated as a risk factor for diabetes complications. The authors studied associations between body mass index, waist circumference, waist/hip ratio, and waist/height ratio and mortality among individuals with diabetes mellitus. Within the European Prospective Investigation into Cancer and Nutrition, a subcohort was defined as 5,435 individuals with a confirmed self-report of diabetes mellitus at baseline in 1992-2000. Participants were aged 57.3 (standard deviation, 6.3) years, 54% were men, the median diabetes duration was 4.6 (interquartile range, 2.0-9.8) years, and 22% of the participants used insulin. Body mass index, as indicator of general obesity, was not associated with higher mortality, whereas all measurements of abdominal obesity showed a positive association. Associations generally were slightly weaker in women. The strongest association was observed for waist/height ratio: In the fifth quintile, the hazard rate ratio was 1.88 (95% confidence interval: 1.33, 2.65) for men and 2.46 (95% confidence interval: 1.46, 4.14) for women. Measurements of abdominal, but not general, adiposity were associated with higher mortality in diabetic individuals. The waist/height ratio showed the strongest association. Respective indicators might be investigated in risk prediction models.
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Affiliation(s)
- Diewertje Sluik
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrucke, Arthur-Scheunert-Allee 114–116, 14558 Nuthetal, Germany.
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Rathmann W, Kowall B, Heier M, Herder C, Holle R, Thorand B, Strassburger K, Peters A, Wichmann HE, Giani G, Meisinger C. Prediction models for incident type 2 diabetes mellitus
in the older population: KORA S4/F4 cohort study. Diabet Med 2010; 27:1116-23. [PMID: 20854378 DOI: 10.1111/j.1464-5491.2010.03065.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim was to derive Type 2 diabetes prediction models for the older population and to check to what degree addition of 2-h glucose measurements (oral glucose tolerance test) and biomarkers improves the predictive power of risk scores which are based on non-biochemical as well as conventional clinical parameters. METHODS Oral glucose tolerance tests were carried out in a population-based sample of 1353 subjects, aged 55-74 years (62% response) in Augsburg (Southern Germany) from 1999 to 2001. The cohort was reinvestigated in 2006-2008. Of those individuals without diabetes at baseline, 887 (74%) participated in the follow-up. Ninety-three (10.5%) validated diabetes cases occurred during the follow-up. In logistic regression analyses for model 1, variables were selected from personal characteristics and additional variables were selected from routinely measurable blood parameters (model 2) and from 2-h glucose, adiponectin, insulin and homeostasis model assessment of insulin resistance (HOMA-IR) (model 3). RESULTS Age, sex, BMI, parental diabetes, smoking and hypertension were selected for model 1. Model 2 additionally included fasting glucose, HbA(1c) and uric acid. The same variables plus 2-h glucose were selected for model 3. The area under the receiver operating characteristic curve significantly increased from 0.763 (model 1) to 0.844 (model 2) and 0.886 (model 3) (P<0.01). Biomarkers such as adiponectin and insulin did not improve the predictive abilities of models 2 and 3. Cross-validation and bootstrap-corrected model performance indicated high internal validity. CONCLUSIONS This longitudinal study in an older population provides models to predict the future risk of Type 2 diabetes. The OGTT, but not biomarkers, improved discrimination of incident diabetes.
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Affiliation(s)
- W Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf.
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Stessman J, Jacobs JM, Ein-Mor E, Bursztyn M. Normal body mass index rather than obesity predicts greater mortality in elderly people: the Jerusalem longitudinal study. J Am Geriatr Soc 2009; 57:2232-8. [PMID: 19925614 DOI: 10.1111/j.1532-5415.2009.02567.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the association between body mass index (BMI) and mortality in older people. DESIGN A longitudinal cohort study of an age-homogenous, representative sample born in 1920/21. SETTING Community-based home assessments. PARTICIPANTS West Jerusalem residents born in 1920/21 examined at baseline in 1990 (n=447), with additional recruitment waves in 1998 (n=870) and 2005 (n=1,086). MEASUREMENTS Comprehensive assessment of health variables including BMI (m/kg(2)) at ages 70, 78, and 85. The primary outcome of mortality was collected from age 70 to 88 (1990-2008). Adjusted Cox proportional hazards analysis was used to calculate hazard ratios (HRs) for mortality according to unit increase in BMI. RESULTS A unit increase in BMI in women resulted in HRs of 0.94, (95% confidence interval (CI)=0.89-0.99) at age 70, 0.95 (95% CI=0.91-0.98) at age 78, and 0.91 (95% CI=0.86-0.98) at age 85. Similarly, in men, HRs were 0.99 (95% CI=0.95-1.05) at age 70, 0.94 (95% CI=0.91-0.98) at age 78, and 0.91 (95% CI=0.86-0.98) at age 85. A time-dependent analysis of 450 subjects followed for 18 years confirmed the above findings; a unit increase in BMI resulted in HRs of 0.93 (95% CI=0.87-0.99) in women and 0.93(95% CI=0.88-0.98) in men. Eliminating the first third of follow-up mortality to account for possibility of reverse causality did not change the results. CONCLUSION Higher BMI was associated with lower mortality from age 70 to 88.
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Affiliation(s)
- Jochanan Stessman
- Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel
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Elia M. Nutrition, hospital food and in-hospital mortality. Clin Nutr 2009; 28:481-3. [DOI: 10.1016/j.clnu.2009.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 06/24/2009] [Indexed: 10/20/2022]
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