Association of body mass index with blood pressure in elderly Japanese American men. The Honolulu Heart Program

A cross-sectional study on the effects of bedtime administration of selective α1 adrenoceptor antagonists on nocturnal blood pressure in elderly patients with benign prostate hyperplasia

Background

It remains uncertain whether a bedtime dose of selective α1 adrenoceptor antagonist could result in nocturnal hypotension in elderly patients with benign prostate hyperplasia (BPH).

Methods

A total of 253 older men with BPH who had taken selective α1 adrenoceptor antagonists before sleep were consecutively recruited from the Geriatric Department of Shanghai Ninth People's Hospital. A total of 221 patients were finally included in the analysis with qualified data including office blood pressure examinations, biochemical tests of blood, and 24-hour ambulatory blood pressure monitoring. Nocturnal hypotension was defined according to the nighttime average systolic blood pressure of ambulatory blood pressure ≤ 100 mmHg and/or diastolic blood pressure ≤ 60 mmHg. Explore the presence of night hypotension, compare the characteristics of the two groups with or without nocturnal hypotension, and analyze the related risk factors.

Results

Among all 221 patients included in the analysis, nocturnal hypotension occurred in 38 patients (17.2%). Compared with those without, patients with nocturnal hypotension were older, had less body mass index, lower office diastolic blood pressure, and lower ambulatory blood pressure in a 24 hour day, and night systolic and diastolic blood pressure, and were less likely to have hypertension. Age (OR 1.064, 95% CI [1.012-1.118], P = 0.015) and no hypertension (OR 2.548, 95% CI [1.211-5.359], P = 0.014) were independently associated with the presence of nocturnal hypotension.

Discussion

Nocturnal hypotension was common in men 60 years and older with BPH treated with selective α1 adrenoceptor antagonists before sleep. Age and no hypertension were independently associated with nocturnal hypotension positively. Related factors may help clinicians identify hypotension tendencies in the elderly when prescribing such drugs.

Temporal trends in obesity defined by the relative fat mass (RFM) index among adults in the United States from 1999 to 2020: a population-based study

OBJECTIVES

The body mass index (BMI) largely underestimates excess body fat, suggesting that the prevalence of obesity could be underestimated. Biologically, women are known to have higher body fat than men. This study aimed to compare the temporal trends in general obesity by sex, ethnicity and age among adults in the USA using the relative fat mass (RFM), a validated surrogate for whole-body fat percentage and BMI.

DESIGN

Population-based study.

SETTING

US National Health and Nutrition Examination Survey, from 1999-2000 to 2017-March 2020.

PARTICIPANTS

A representative sample of adults 20-79 years in the USA.

MAIN OUTCOME MEASURES

Age-adjusted prevalence of general obesity. RFM-defined obesity was diagnosed using validated cut-offs to predict all-cause mortality: RFM≥40% for women and ≥30% for men. BMI-defined obesity was diagnosed using a cut-off of 30 kg/m2.

RESULTS

Analysis included data from 47 667 adults. Among women, RFM-defined obesity prevalence was 64.7% (95% CI 62.1% to 67.3%) in 2017-2020, a linear increase of 13.9 percentage points (95% CI 9.0% to 18.9%; p<0.001) relative to 1999-2000. In contrast, the prevalence of BMI-defined obesity was 42.2% (95% CI 39.4% to 45.0%) in 2017-2020. Among men, the corresponding RFM-defined obesity prevalence was 45.8% (95% CI 42.0% to 49.7%), a linear increase of 12.0 percentage points (95% CI 6.6% to 17.3%; p<0.001). In contrast, the prevalence of BMI-defined obesity was 42.0 (95% CI 37.8% to 46.3%). The highest prevalence of RFM-defined obesity across years was observed in older adults (60-79 years) and Mexican Americans, in women and men. Conversely, the highest prevalence of BMI-defined obesity across years was observed in middle-age (40-59 years) and older adults, and in African American women.

CONCLUSIONS

The use of a surrogate for whole-body fat percentage revealed a much higher prevalence of general obesity in the USA from 1999 to 2020, particularly among women, than that estimated using BMI, and detected a disproportionate higher prevalence of general obesity in older adults and Mexican Americans.

BMI mediates the association of family medical history with self-reported hypertension and diabetes among older adults: Evidence from baseline wave of the longitudinal aging study in India

Background

This study explored the association between family history of hypertension and diabetes with their diagnosis among older Indian adults. The study further examined the role of body mass index (BMI) as a potential mediator in these associations.

Methods

Data from the Longitudinal Ageing Study in India (LASI, 2017-18), wave-1 were used. The sample for the study included 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis has been conducted to assess the prevalence of self-reported hypertension and diabetes. Further, multivariable logistic regression models were used to test the research hypotheses of this study. The Karlson-Holm-Breen (KHB) mediation analysis was conducted to recover the direct and indirect effects of BMI in the association of family medical history and diagnosis of hypertension and diabetes.

Results

A proportion of 32.70% of older adults were diagnosed with hypertension and 14.23% of older adults were diagnosed with diabetes. A proportion of 19.48% and 14.69% of older adults had a family history of hypertension and diabetes, respectively. Also, 16.57% and 5.53% of older adults were overweight and obese, respectively in the current study. Older adults who had family history of hypertension had higher odds of being diagnosed with hypertension [aOR: 2.23, CI: 2.07-2.39] than those who had no such family history. This association was mediated by BMI (percent mediated: 6.31%). Similarly, older adults who had family history of diabetes had higher odds of being diagnosed with diabetes [aOR: 2.63, CI: 2.41-2.88] than those who had no such family history. This association was mediated by BMI (percent effect mediated: 6.66%).

Conclusion

The study highlights the relevance of using family medical history data along with information on BMI as potential source for the control and management of hypertension and diabetes among older population.

The association between overweight/obesity and psychological distress: A population based cross-sectional study in Saudi Arabia

Objectives

The objective of this study was to compare the association between mental well-being between obese (classes 1 and 2), over-weight and non-obese population-based individuals

Methods

A population-based cross-sectional study was conducted in Al-Kharj, Saudi Arabia. A total of 1019 Saudi nationals aged ≥ 18 years participated in the survey. BMI scores were used to categorize participants into three groups: Obese, overweighted and non-obese/non-overweight. Mental well-being was evaluated by using the validated Arabic version of the General Health Questionnaire version 12 (GHQ-12).

Results

We used total GHQ score (Mean=12; SD=5.23) to compare mental well-being between the four BMI class categories. The overall one-way ANOVA model was statistically significant (F = 7.018, d = 6, P < 0.001). In multivariate analysis, after adjusting for sociodemographic variables, diabetes and smoking statuses we found that higher psychological distress (as evident by a higher total GHQ score) was associated with higher BMI. The unstandardized Beta regression coefficient = 2.627; P = 0.034). Females were more likely to have higher psychological distress than males (unstandardized Beta = 1.466, P = 0.003). Job status whether being unemployed or ‘civilian’ (civil worker) was significantly associated with higher psychological distress (unstandardized Beta = 1.405, P = 0.041). Being diabetic has a 1.6 times higher risk of psychological distress (unstandardized Beta = 1.604, P = 0.027).

Conclusion

The study highlights the public health implications of psychological distress amongst individuals with overweight and obesity in Saudi Arabia. Future longitudinal studies should explore the temporality of this relationship.

Prevalence of overweight and obesity based on the body mass index; a cross-sectional study in Alkharj, Saudi Arabia

BACKGROUND

Obesity and overweight are accompanied with several different chronic diseases. Overweight and obesity can be measured by using body mass index (BMI) and is also used widely as an index of relative adiposity among any population. The aim of the study is to evaluate the prevalence of overweight and obesity among general population in Al-Kharj, Saudi Arabia.

METHODS

Cross-sectional analysis was undertaken from a representative sample (N = 1019) of the Al Kharj population. Anthropometric measurements including the waist circumference (in centimeters), height (in meters), and weight (in kilograms) of the subjects were undertaken by means of standard apparatus. SPSS 24.0 was utilized for statistical analysis of the data.

RESULTS

Majority of respondents in this study were overweight and obese (54.3%) compared with 45.7% being non-obese. A linear positive association of increasing BMI with older age groups was present in males and females. Men had larger waist circumference, weight and height measures as compared with their female counterparts. Regression analysis showed increasing age, being married and high serum cholesterol to be the significant predictors of overweight and obesity while gender, education level, job status, and having diabetes were not.

CONCLUSIONS

The obesity-overweight prevalence in the Saudi population is high mainly across both genders. However, the associated factors are potentially preventable and modifiable. The regional barriers to lifestyle modifications and interventions to encourage active lifestyles, especially among adolescents to limit the occurrence of obesity and ultimately promote health and wellbeing, are warranted. Furthermore, prospective studies are needed in future to confirm the aetiological nature of such associations.

Prevalence and Risk Factors of Undetected Elevated Blood Pressure in an Elderly Southeast Asian Population

Data on the prevalence of Hypertension (HTN) among elderly Asians is limited. We investigated the prevalence of elevated blood pressure (EBP) and its risk factors in a multiracial Southeast Asian elderly population who participated in the National Kidney Foundation Singapore nationwide screening programme. Among 19,848 subjects ≥ 65 years (approximately 6% of the total Singapore population), the mean age was 70.6 ± 5.26 yrs. After excluding 36.6% with known HTN, analysis revealed that 5,889 (46.8%) of the remaining population had previously undetected EBP >140/ 90. Increasing age, male gender, BMI ≥ 23 kg/m2 and pre-existing diabetes were significantly associated with previously undetected EBP on multivariate analysis. 6% of cases with undetected EBP had proteinuria suggestive of longstanding EBP and renal damage. We conclude that there is a high prevalence of undetected EBP in elderly Asians, suggesting the need for increased e forts in screening in the elderly population. Asia Pac J Public Health 2007; 19(2): 3—9.

Hypertension in rural communities in Delta State, Nigeria: Prevalence, risk factors and barriers to health care

INTRODUCTION

Hypertension is a global health challenge and its prevalence is increasing rapidly amongst adults in many African countries. Some studies on the prevalence and risk factors of hypertension have been conducted in Nigeria, but none within Delta State. We assessed the prevalence of hypertension and associated risk factors amongst adults in three villages in the Ibusa community in Delta State, Nigeria.

METHOD

Homesteads were randomly selected and all consenting adults (≥ 18 years of age) were recruited for this cross-sectional study (134 individuals: 48 men, 86 women). Sociodemographic data and anthropometric measurements (weight, height and abdominal circumference) were recorded. Diagnosis of hypertension was based on blood pressure ≥ 140/90 mmHg.

RESULT

Hypertension prevalence in this rural community was 44%. Results from one village (Ogboli: 82%) and ethnic group (Ibo: 50%) were significantly higher than in others in the same variable category. Multivariate logistic regression analysis suggested increasing age, increasing body mass index and high salt intake as prominent risk factors for hypertension. Lack of funds and equipment shortage in clinics were most often reported as barriers to healthcare.

CONCLUSION

A nutritional education programme to promote low-cholesterol and low-salt diets is recommended to specifically target people in higher-risk areas and of higher-risk ethnicity. Local barriers to accessing health care need to be addressed.

Assessing factors related to waist circumference and obesity: application of a latent variable model

BACKGROUND

Because the use of BMI (Body Mass Index) alone as a measure of adiposity has been criticized, in the present study our aim was to fit a latent variable model to simultaneously examine the factors that affect waist circumference (continuous outcome) and obesity (binary outcome) among Iranian adults.

METHODS

Data included 18,990 Iranian individuals aged 20-65 years that are derived from the third National Survey of Noncommunicable Diseases Risk Factors in Iran. Using latent variable model, we estimated the relation of two correlated responses (waist circumference and obesity) with independent variables including age, gender, PR (Place of Residence), PA (physical activity), smoking status, SBP (Systolic Blood Pressure), DBP (Diastolic Blood Pressure), CHOL (cholesterol), FBG (Fasting Blood Glucose), diabetes, and FHD (family history of diabetes).

RESULTS

All variables were related to both obesity and waist circumference (WC). Older age, female sex, being an urban resident, physical inactivity, nonsmoking, hypertension, hypercholesterolemia, hyperglycemia, diabetes, and having family history of diabetes were significant risk factors that increased WC and obesity.

CONCLUSIONS

Findings from this study of Iranian adult settings offer more insights into factors associated with high WC and high prevalence of obesity in this population.

BMI better explains hypertension in Chinese senior adults and the relationship declines with age

BACKGROUND

Researchers have been examining the relationship between obesity and hypertension. However, whether overall or abdominal obesity better explains senior adults' hypertension has not been studied.

OBJECTIVES

The purpose of the study was to examine whether body mass index or waist circumference better predicts hypertension in Chinese senior adults and how the magnitude of the relationship is attenuated as they continue to age.

METHODS

The study was based on the 2010 National Physique Monitoring data. There were 7,542 senior adults aged 60-69 years living in urban, suburban, and rural areas of Shanghai City. The participants were categorized into five age groups: 60-61, 62-63, 64-65, 66-67, and 68-69 years.

RESULTS

The percentage of participants who had hypertension increased as people aged, which was mainly caused by the increase of systolic blood pressure. Logistic regression analysis showed that when body mass index or waist circumference was entered into the model, both were significant predictors for hypertension (p < 0.05). However, when body mass index and waist circumference were mutually entered into the model, body mass index was the only important predictor (p < 0.05). The values of odds ratios were found to decrease from the 60-61 to 68-69 years age groups. More senior adults have hypertension as they age.

CONCLUSION

Body mass index, and not waist circumference, better predicts Chinese senior adults' hypertension. However, age attenuates the effects of obesity on hypertension as the senior adults continue to age.

Obesity in Older Adults: Technical Review and Position Statement of the American Society for Nutrition and NAASO, The Obesity Society

Obesity causes serious medical complications and impairs quality of life. Moreover, in older persons, obesity can exacerbate the age-related decline in physical function and lead to frailty. However, appropriate treatment for obesity in older persons is controversial because of the reduction in relative health risks associated with increasing body mass index and the concern that weight loss could have potential harmful effects in the older population. This joint position statement from the American Society for Nutrition and NAASO, The Obesity Society reviews the clinical issues related to obesity in older persons and provides health professionals with appropriate weight-management guidelines for obese older patients. The current data show that weight-loss therapy improves physical function, quality of life, and the medical complications associated with obesity in older persons. Therefore, weight-loss therapy that minimizes muscle and bone losses is recommended for older persons who are obese and who have functional impairments or medical complications that can benefit from weight loss.

Obesity paradox in elderly patients with cardiovascular diseases

Many elderly people are affected by cardiovascular diseases (CVD) and the majority of CVD patients are elderly people. For both patient populations, studies have shown that a high body mass index (BMI) is associated with lower mortality when compared to normal weight subjects, a fact commonly known as the "obesity paradox". Whether the correlation between obesity and better survival is based on methodological influences and other non-causal factors alone, or whether there is a causal link between obesity and a better survival in these subjects remains widely unexplored. The interrelation between aging, obesity, CVD, frailty and inflammation is a current issue of intensive research. For the elderly, parameters which include measures of body composition, fat and fat-free mass are of greater importance than BMI. Weight management in elderly people with cardiovascular diseases should aim at improvement and maintenance of physical function and quality of life rather than prevention of medical problems associated with obesity in younger and middle aged patients. Although many studies have shown that weight loss in elderly patients is associated with a poor prognosis, recent data demonstrate that intentional weight reduction in obese elderly people ameliorates the cardiovascular risk profile, reduces chronic inflammation and is correlated with an improved quality of life. An individual approach to weight management that includes the participation of the patient, co-morbidity, functional status, and social support should be aspired.

Obesity and weight management in the elderly

Our population is ageing, and obesity is increasing in the elderly bringing massive and rapidly changing burdens of ill health related to increased body weights and fat as well as the main drivers of poor diet and inactivity. Overweight and obesity, and a static body mass index (BMI) commonly conceal sarcopenia (gain in body fat but loss of muscle mass and functional capacity) in older people, aggravated by inactivity. A systematic computerized literature search using an iterative manipulation process of the keywords: obesity, elderly, weight loss. The following databases were accessed on 20 October 2010: Medline, Cochrane Collaboration, Ovid and Scholar Google. A large number of clinical consequences of overweight and obesity are particularly problematic for elderly individuals, including type 2 diabetes mellitus, arthritis, urinary incontinence and depression. The observation that the BMI value associated with the lowest relative mortality is slightly higher in older than in younger adults has often been misinterpreted that obesity is not as harmful in the elderly. BMI may be a less appropriate index in the elderly. All the medical consequences of obesity are multi-factorial but all are alleviated by modest, achievable weight loss (5-10 kg) with an evidence-based maintenance strategy. Since sarcopenic obesity is common in the elderly, a combination of exercise and modest calorie restriction appears to be the optimal method of reducing fat mass and preserving muscle mass. Reduction in polypharmacy is a valuable target for weight management. Age is not an obstacle to weight management interventions using moderate calorie restriction and exercise, and the currently licensed drug orlistat appears to have no age-related hazards. Overall balance of clinical outcomes has not been evaluated. In older people the risks from bariatric surgery outweigh benefits. Obesity, and specifically sarcopenic obesity, should also be prevented not only from younger age, but also during major life transitions including retirement, to improve better health outcomes and quality of life in later years, with a focus on those in 'obese families', where the main increases in obesity are located. Randomized controlled trials to determine health benefits and risks from long-term weight management in obese elderly are necessary.

Envelhecimento, obesidade e consumo alimentar em idosos

RESUMO Com o envelhecimento da população predominam as enfermidades crônicas e, nesse conjunto, destaca-se a obesidade, por sua prevalência sempre crescente nos diversos grupos etários, incluindo os idosos, e por suas complicações, quer de forma isolada ou associada a outros eventos mórbidos, como: hipertensão arterial, diabetes mellitus não-insulino dependente e doenças cardiovasculares, enfermidades com prevalências já elevadas entre pessoas idosas. A obesidade, considerada um problema de saúde pública, representa para o idoso um risco adi cional de importância considerável. Apesar dos múltiplos fatores que determinam o consumo alimentar, aspectos relacionados à adoção de dietas com elevado valor energético, ricas em gorduras de origem animal, açúcares, alimentos refinados e com reduzido teor de frutas, verduras e fibras, sugerem contribuição favorável à ocorrência da obesidade.

Changes in plasma ghrelin levels, gastric ghrelin production, and body weight after Helicobacter pylori cure

BACKGROUND

Ghrelin is a body weight-regulating peptide produced and secreted primarily by the gastric mucosa. Helicobacter pylori infection impairs gastric ghrelin production, leading to a lower plasma ghrelin concentration. However, the effect of H. pylori eradication on plasma ghrelin levels and its relation to body weight change after H. pylori cure are still uncertain. We examined the association of plasma ghrelin levels with gastric ghrelin production and body weight change before and after H. pylori eradication.

METHODS

Plasma ghrelin concentrations, gastric ghrelin expression, and body weight were determined in a total of 134 consecutive individuals before and 12 weeks after successful H. pylori eradication. Gastric ghrelin expression was evaluated by determining mRNA expression levels and the number of ghrelin-producing cells in gastric mucosa biopsy specimens by real-time reverse transcriptase-polymerase chain reaction and immunohistochemistry, respectively.

RESULTS

Plasma ghrelin concentration increased in 50 patients and decreased in 84 patients after H. pylori eradication. After H. pylori cure, however, gastric preproghrelin mRNA expression was increased nearly fourfold (P < 0.0001), and the number of ghrelin-positive cells was increased or unchanged. In contrast, plasma ghrelin changes after H. pylori cure were inversely correlated with both body weight change (P < 0.0001) and initial plasma ghrelin levels (P < 0.0001).

CONCLUSIONS

Changes in plasma ghrelin concentrations before and after H. pylori cure were inversely correlated with body weight change and initial plasma ghrelin levels but not with gastric ghrelin production in Japanese patients.

Unexpected changes in blood pressure and hematological parameters among fasting and nonfasting workers during Ramadan in Indonesia

OBJECTIVE

To examine the effect of Ramadan fasting on basic hematological parameters, in addition to the effects on body weight and blood pressure of fasters and nonfasters.

DESIGN, SETTING, AND SUBJECTS

One hundred male outdoor workers at a vehicle terminal in a city in East Java were recruited for this study. Anthropometric measurements and blood sampling were conducted on two separate occasions, just before the start of Ramadan and in the third week of the month of Ramadan (October-November 2004). The degree of subjective compliance with Ramadan fasting (complete, partial, or none) was evaluated using a questionnaire.

RESULTS

The mean body mass index (BMI) of the fasting group was, as expected, significantly lower at the second sampling period, and the decrease in BMI correlated significantly with decreased blood pressure in this group. The blood pressure was also reduced in the partial fasting and nonfasting groups, which was an unexpected result. While red blood cell production was suppressed, as evidenced by lower levels of hemoglobin, red blood cell (RBC), and packed cell volume (PCV) at the second sampling, the subjects were normocytic and normochromic, based on normal mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) levels.

CONCLUSIONS

These results indicate that, regardless of fasting status, blood pressure is lower and RBC production is suppressed in subjects during the Ramadan period. These findings should be taken into account when evaluating the effects of Ramadan on the general population. To avoid the adverse effects of anemia, increased intake of iron-rich foodstuffs is recommended during the Ramadan month, regardless of fasting practice.

Body mass index and change in blood pressure over a 7-year period in older Mexican Americans

Obesity and hypertension are major public health concerns in the US. We examined the relationship between body mass index (BMI) and blood pressure in older Mexican Americans using data from the Hispanic Established Population for the Epidemiological Study of the Elderly (EPESE), a longitudinal study of Mexican Americans aged 65 and over residing in the southwestern US. The study sample was 2404 older Mexican American adults with a mean age of 72.6 years of age at baseline (1993-4). Both systolic and diastolic blood pressures were higher in subjects with high BMI categories. The rate of change in systolic blood pressure and diastolic blood pressure were -0.11 mm Hg and -0.32 mm Hg per year over a 7-year period, respectively. The rate of decline in systolic and diastolic blood pressure over a 7-year period was greater in subjects with BMI categories of 25- < 30 kg/m2 and 30- < 35 kg/m2 as compared with those subjects with in the lowest and in the highest BMI categories. Hypertension is one of the most prevalent medical conditions affecting older adults. Understanding possible modifiable risk factors that may play a role in the management of hypertension will be beneficial.

Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society

Obesity causes serious medical complications and impairs quality of life. Moreover, in older persons, obesity can exacerbate the age-related decline in physical function and lead to frailty. However, appropriate treatment for obesity in older persons is controversial because of the reduction in relative health risks associated with increasing body mass index and the concern that weight loss could have potential harmful effects in the older population. This joint position statement from the American Society for Nutrition and the NAASO, The Obesity Society reviews the clinical issues related to obesity in older persons and provides health professionals with appropriate weight-management guidelines for obese older patients. The current data show that weight-loss therapy improves physical function, quality of life, and the medical complications associated with obesity in older persons. Therefore, weight-loss therapy that minimizes muscle and bone losses is recommended for older persons who are obese and who have functional impairments or medical complications that can benefit from weight loss.

Influence of childhood socioeconomic circumstances, height, and obesity on pulse pressure and systolic and diastolic blood pressure in older people

This study assesses the association of childhood socioeconomic circumstances, height, and obesity with components of blood pressure. We selected 4009 people representative of the Spanish population aged 60 years and older, and estimated systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) according to childhood social class, height, and obesity. No association was found between childhood social class and blood pressure. SBP showed an inverse gradient and DBP a direct gradient with height, although an independent association between height and DBP was found only in women. Stature was independently associated with increased DBP in women with central obesity, but there was no association between height and DBP in women without central obesity. Short stature was independently associated with increased PP. Body mass index and waist-to-hip ratio were independently associated with increased DBP in women, and waist-to-hip ratio was independently associated with increased PP in men, while waist circumference was independently associated with increased DBP and increased PP in women. These results do not support the assumed effect of socioeconomic circumstances in early life on blood pressure, which may depend on the context and/or study population. The relations observed between height and blood pressure support the hypothesis that PP could be a mediator of the association between short stature and increased cardiovascular risk. The relationship between obesity measures and components of blood pressure reinforces the recommendation to reduce body weight in order to reduce blood pressure.

A retrospective cohort study on obesity and hypertension risk among Korean adults

A retrospective cohort of adult Korean males and females was conducted to evaluate the influence of obesity on the development of hypertension and to determine the level of the body mass index at which the risk of hypertension significantly increases. The subjects of this study were 1,467 men and 944 women aged 20 to 75 yr who were normotensive at the time of their initial examinations from 1990 to 1991, who had a follow-up examination at least 1 yr after their initial examinations, or whose blood pressure status could be confirmed by reviewing their medical records until June 2000. During an average follow-up period of 6.2 yr, 234 new cases of hypertension were identified. An analysis using the Cox proportional hazards model showed that the risk of developing hypertension increased with increasing age, body mass index, and amount of daily alcohol consumption in men; and with increasing age and body mass index in women. Comparing men and women whose body mass indices were smaller than 23 kg/m(2), the relative risks of hyper-tension were 2.56 times greater in men and 3.17 times greater in women, whose body mass indices were greater than 27 kg/m(2). Our study confirmed that obesity is a strong risk factor for hypertension among Korean adults. In addition, high alcohol consumption may be a significant risk factor for men.

Overweight and obesity and the burden of disease and disability in elderly men

OBJECTIVE

To examine the prevalence of disease burden and disability associated with overweight and obesity in men aged 60-79 y and to assess whether the current WHO weight guidelines are appropriate in the elderly.

DESIGN

Cross-sectional survey 20 y after enrollment.

SETTING

General practices in 24 British towns.

PARTICIPANTS

In total, 4232 men aged 60-79 y (77% of survivors) with measured weight and height.

MAIN OUTCOME MEASURES

Cardiovascular (CV) risk factors, prevalence of diabetes, cardiovascular disease, cancer, disability and regular medication.

RESULTS

In total, 17% of the men were obese (body mass index (BMI) >/=30 kg/m(2)) and a further 52% were overweight (BMI 25-29.9 kg/m(2)). Prevalence of hypertension, low HDL-cholesterol, high triglycerides and insulin resistance and the prevalence of most disease outcomes increased with increasing degrees of overweight/obesity. Men in the normal weight range (18.5-24.9 kg/m(2)) had the lowest prevalence of ill health. Compared with normal weight men, obese men showed a two-fold risk of major CVD (odds ratio (OR)=1.96, 95% CI 1.44-2.67) and locomotor disability (OR=2.26, 95% CI 1.66, 3.09) and were nearly three times as likely to have diabetes, CV interventions or to be on CV medication. Over 60% of the prevalence of high insulin resistance was attributable to overweight and obesity as was over a third of diabetes and hypertension, a quarter of locomotor disability and a fifth of major CVD.

CONCLUSION

In elderly men, overweight and obesity are associated with a significantly increased burden of disease, in particular CV-related disorders and disability. The current guidelines for overweight and obesity appear to be appropriate in elderly men.

[Epidemiology of lipid profile of the Spanish elderly population: the EPICARDIAN study]

BACKGROUND AND OBJECTIVE

The aim of this study was to describe the lipid profile, the levels of serum total cholesterol (TC), LDL cholesterol (C-LDL), HDL cholesterol (C-HDL) and triglyceride (TG), to compare these levels between geographical areas and to estimate the prevalence of dyslipidemia in elderly residents (65 years and older) from urban and rural areas of Spain.

PATIENTS AND METHOD

Epidemiological, observational, multicentre study of Spanish elderly people residents (>or= 65 years old) of 3 communities in 3 Spanish regions: Arévalo (Avila) and Begonte (Lugo) as rural areas and Lista (Central Madrid) as urban area. Stratified randomized sample by age and sex from population census of each area. The participation rate was: 84.6%. At-home interviews (phase 1) (n = 4522): with determination of capillary blood cholesterol levels (Reflotron) and clinical visit (phase 2) (1/3 selected randomly, n = 1907): determination of serum TC levels (enzymatic colorimetric method CHOP-PAD), C-HDL, C-LDL (Friedewald equation) and TG (Trinder Method).

RESULTS

Mean concentrations of TC was 230.3 (46.8) mg/dl. These levels decreased significantly with increasing age (p < 0.001), higher in women (p = 0.001); lower in Lugo (226.4 [49.7] mg/dl) than in Madrid (233.2 [42.3] mg/dl) and Arévalo (236.5 [43] mg/dl) (p = 0.002). Global prevalence of hypercholesterolemia by SEA simplified criteria was: 68.9% (95% confidence interval, 66.8-71). Mean concentrations of C-LDL was: 159.4 (37.9) mg/dl; C-HDL: 48.2 (15) mg/dl, and TG: 119.7 (63.85) mg/dl. 31% of cases were awarded about the hypercholesterolemia. Only 30% of them were under treatment with lipid lowering drugs; and 30% of the subjects showed CT concentrations < 200 mg/dl, with no differences by sex, age, study area or education level. Female sex, urban habitat and hypertension were the only variables independently associated to hypercholesterolemia in the logistic model.

CONCLUSIONS

The prevalence of dyslipidemia is slightly higher to SEA estimation for the European elderly population (50%), greater in women and in younger groups. The awareness, treatment and control of hypercholesterolemia are low among the Spanish elderly population.

Obesity in the elderly: who should we be treating, and why, and how?

PURPOSE OF REVIEW

To investigate emerging data on the relationship between obesity, increased morbidity and mortality, and decreased function in the elderly. To examine what is known about the effectiveness of interventions, and how treatment might be improved.

RECENT FINDINGS

Obesity is a common problem in the elderly, although its prevalence decreases in extreme old age. Decreased physical activity and decreased energy expenditure with ageing predispose to fat accumulation and fat redistribution. Reduction in muscle mass (sarcopenic obesity) is an important determinant of physical function and metabolic rate. Chronic inflammation and endocrine changes contribute to the changes in metabolism and body composition that accompany ageing, and are potential therapeutic targets. Body weight and body mass index are imperfect indicators of risk from obesity. The focus of treatment should be on reduction of intra-abdominal fat and preservation of muscle mass and strength. A number of recent studies have confirmed the effectiveness of exercise interventions in the elderly. Progressive resistance training, rather than endurance exercise, may be more effective in many cases. Reduced function and decreased quality of life accompany development of the complications of obesity such as diabetes and vascular disorders. There is considerable scope to impede the development of these complications in the elderly with lifestyle interventions.

SUMMARY

Sarcopenic obesity, with accumulation of intra-abdominal fat, is a major determinant of health status in the elderly. As in the younger population, prevention and treatment programmes have the potential to decrease the impact of diabetes, vascular disease, and other complications of obesity.

Lifestyle risk factors and chronic kidney disease

PURPOSE

To examine the effects of lifestyle risk factors such as alcohol consumption, cigarette smoking and body mass index (BMI) on the development of chronic kidney disease.

METHODS

We used a case-control study of 554 hospital cases and 516 age, race, and gender-matched community controls. The main outcome measure was newly-diagnosed chronic kidney disease, assessed by chart review. Self-reported history of alcohol consumption, smoking, and BMI as well as other co-variables were obtained during telephone interviews. Logistic regression models assessed the association between lifestyle risk factors and chronic kidney disease and were adjusted for important co-variables.

RESULTS

We found no significant associations between alcohol consumption and chronic kidney disease, with the exception of moonshine, which resulted in an increased risk of chronic kidney disease (including all subtypes). The effects of smoking on chronic kidney disease were inconsistent, but pointed to no appreciable excess risk among smokers. Increasing quartiles of BMI were positively and significantly associated with nephrosclerosis (ORs [95% CI]: 2.5 [1.0-6.0], 2.8 [1.2-6.8] and 4.6 [1.8-11.6], for the second, third, and fourth quartiles of BMI, respectively).

CONCLUSIONS

Our study revealed a significant positive association between BMI and nephrosclerosis. We did not find an increased risk of chronic kidney disease associated with alcohol or cigarette smoking.

Association of body mass index with blood pressure in 80-year-old subjects

OBJECTIVE

Little data are available on the association between obesity and high blood pressure in elderly individuals, particularly in subjects over 80 years of age. The aim of the present study was to determine the association between body mass index (BMI) and blood pressure in 80-year-old subjects.

METHODS

This study was part of the 8020 Data Bank Survey, which was designed to collect the baseline data of systemic and dental health conditions in 80-year-old subjects. We studied the cross-sectional association of BMI with blood pressures in 645 Japanese (258 men and 387 women), who were 80 years old.

RESULTS

Mean systolic blood pressure rose from 146.6 mmHg in the first quintile of BMI to 147.5 mmHg in the second, 150.3 mmHg in the third, 151.6 mmHg in the fourth, and 156.4 mmHg in the fifth quintiles (test for trend, P = 0.006). Mean diastolic blood pressure rose from 75.8 mmHg in the lowest quintile of BMI to 81.8 mmHg in the highest (test for trend, P = 0.002). We performed multiple regression analysis, controlling for factors known to influence blood pressure values, such as sex, alcohol intake, current smoking status and serum glucose, total cholesterol and creatinine concentrations. The association between BMI and systolic and diastolic blood pressure, respectively, was highly statistically significant in all analyses.

CONCLUSION

These results show that a close relationship is present between obesity and high blood pressure, even in very old subjects.

Obesidade em idosos: prevalência, distribuição e associação com hábitos e co-morbidades

Objetivos: Identificar a prevalência de obesidade global e central através do índice de massa corpórea (IMC) e razão cintura-quadril (RCQ), e suas associações como o diabetes melito (DM), a hipertensão arterial (HA), a hipercolesterolemia, os baixos níveis de lipoproteína colesterol de alta densidade (HDL-c), a hipertrigliceridemia, nível social, a atividade física e o tabagismo em população de idosos atendida em ambulatórios. Metodologia: Foram avaliados 847 idosos ambulatoriais com 60 anos ou mais, através de um estudo transversal. Resultados: A obesidade definida pelo IMC > ou = 30kg/m² foi identificada em 9,3% dos homens e 23,8% das mulheres (p< 0,001), sendo menor entre os idosos com 80 anos ou mais, em ambos os sexos (p< 0,05). Em homens obesos, identificou-se uma maior freqüência de DM, HDL-c baixo e hipertrigliceridemia, quando comparados aos homens com IMC< 30kg/m². As mulheres obesas apresentavam uma freqüência maior apenas de HA. Os pacientes com RCQ<FONT FACE=Symbol>³</FONT>percentil 75 (RCQ> 1,01 para homens e RCQ> 0,96 para mulheres) apresentavam maiores freqüências de HA, DM, HDL-c baixo e hipertrigliceridemia no sexo masculino e HA e DM no sexo feminino. Conclusões: Os resultados revelam diferenças em relação ao sexo, com os homens apresentando menor prevalência de obesidade e maiores associações entre IMC ou RCQ com os fatores de riscos relacionados à gordura corpórea. Os dados obtidos por este estudo contribuem para ampliação do referencial antropométrico dos idosos, além de identificarem as correlações entre os indicadores antropométricos e as alterações metabólicas associadas à obesidade.

Obesity in the elderly--a future matter of concern?

In most studies mean body weight increases with age up to about age 60 and then levels off, but information about the association between body weight and mortality at higher ages is sparse, since most studies published are cross-sectional, thus introducing a bias in selectivity. Some studies actually suggest a protective effect of overweight in the oldest age groups. Indices of visceral obesity may be better indicators of risk than body mass index (BMI) in these age groups. Not only actual weight, but also weight development over the last decades may predict outcome. Most clinical trials exclude older patients and little is known about benefits of diets or drugs inducing weight loss in these age groups. More information is available suggesting multiple benefits of physical activity. Mechanical complications of obesity, such as osteoarthritis and static respiratory complications seem to improve with weight loss even at higher ages. For health economic reasons it will become important to address treatment strategies in the elderly in the future, since they will constitute a large segment of the population. Recent studies suggest that bariatric surgery, previously considered contraindicated in obese patients above age 60 can be safely performed even in patients above age 70 and with the same benefits as for younger subjects.

Standard definitions of overweight and central adiposity for determining diabetes risk in Japanese Americans

BACKGROUND

Despite having lower average body mass indexes (BMIs) than do whites, Asians are at high risk of type 2 diabetes, possibly because of their greater central adiposity. The criteria for identifying individuals at risk of obesity-related conditions are usually not population specific.

OBJECTIVE

Our goal was to determine whether the National Heart, Lung, and Blood Institute (NHLBI) overweight and obesity guidelines are useful for identifying diabetes risk in Japanese Americans.

DESIGN

This was a prospective, cohort study of 466 nondiabetic Japanese Americans [age: 52.2 +/- 0.6 y; BMI (in kg/m(2)): 24.1 +/- 0.2; +/- SEM]. Diabetes status at a 5-y follow-up visit was assessed with an oral-glucose-tolerance test.

RESULTS

Among 240 subjects aged < or = 55 y, incident diabetes was strongly associated with overweight (BMI > or = 25) at baseline [relative risk (RR): 22.4; 95% CI: 2.7, 183; adjusted for age, sex, smoking, and family history] and weight gain of > 10 kg since the age of 20 y (adjusted RR: 4.5; 95% CI: 1.4, 14.5). NHLBI definitions of central obesity (waist circumference > or = 88 cm for women and > or = 102 cm for men) were unsuitable for this population because only 15 of 240 subjects met these criteria. A waist circumference greater than or equal to the third tertile was associated with diabetes (adjusted RR: 5.4; 95% CI: 1.7, 17.0). Among 226 subjects aged >55 y, incident diabetes was not associated with BMI, weight gain, or waist circumference.

CONCLUSIONS

NHLBI definitions are useful for identifying overweight Japanese Americans aged < 55 y who are at high risk of diabetes. Although central adiposity is an important risk factor, the guidelines for waist circumference are insensitive predictors of diabetes risk in this population.

Hypertension in elderly persons: its prevalence and associated cardiovascular risk factors in Tainan City, southern Taiwan

BACKGROUND

Hypertension was the eighth leading cause of death in Taiwan in 1996, and the prevalence of hypertension has increased recently. The purpose of the study was to assess the prevalence of hypertension and its associated cardiovascular risk factors in elderly persons in Tainan City, southern Taiwan.

METHODS

The study was a cross-sectional, population-based study. We used the stratified cluster sampling method to enroll subjects aged 65 years and above, 1435 persons in total, into our study. Questionnaire interview, body weight, body height, and blood pressure measurement were completed for 876 participants (response rate of 70.2%) at each subject's home by home visit.

RESULTS

Hypertension was defined according to the criteria of the Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The crude prevalence of hypertension was 60.4% (men 59.1%, women 61.9%); previously diagnosed hypertension was 31.1% (men 29.4%, women 33.1%); and newly diagnosed hypertension was 29.3% (men 29.7%, women 28.8%). The hypertensive group had a higher body mass index (BMI) than the normotensive group. There were no lifestyle differences such as smoking, drinking, eating a vegetarian diet, reading health information, and undergoing a health examination in the past year between the hypertensive and normotensive groups. However, the hypertensive group had a higher prevalence of regular exercise than did the normal blood pressure group on univariate analysis. Only BMI and family history of hypertension had a significantly positive association with hypertension on multiple logistic regression analysis.

CONCLUSIONS

The crude prevalence of hypertension was 60.4% in elderly persons in Tainan City. Subjects who had family history of hypertension and higher BMI had a higher risk of hypertension, so they should be screened for high blood pressure regularly.

Mechanisms of hypertension and kidney disease in obesity

Abnormal kidney function is an important cause as well as a consequence of obesity. Excess renal sodium reabsorption, probably in the loop of Henle, and a hypertensive shift of pressure natriuresis play a major role in initiating increased blood pressure associated with weight gain. The mechanisms responsible for increased sodium reabsorption and altered pressure natriuresis in obesity include activation of the renin-angiotension and sympathetic nervous systems, and physical compression of the kidneys due to accumulation of intrarenal fat and extracellular matrix. Sympathetic activation may be mediated, in part, by elevated circulating leptin and interactions with neuropeptides in the hypothalamus. Renal remodeling and extracellular matrix proliferation likely involve complex interactions between intrarenal physical forces, neurohumoral factors, and local growth factors and cytokines. Although glomerular hyperfiltration and increased arterial pressure help to compensate for increased renal tubular reabsorption in the early phases of obesity, these changes also increase glomerular capillary wall stress which, along with activation of neurohumoral systems and increased lipids and glucose intolerance, cause glomerular cell proliferation, matrix accumulation, and eventually glomerulosclerosis and loss of nephron function in the early phases of obesity. This creates a slowly developing vicious cycle that requires additional increases in arterial pressure to maintain sodium balance and therefore makes effective antihypertensive therapy more difficult. Because obesity is the main cause of Type 2 diabetes and an important cause of human essential hypertension, it seems likely that obesity is also one of the most important risk factors for end-stage renal disease.