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Bernardelli LV, Kortt MA, Charles MB. The association between BMI and self-reported health among a Brazilian sample: a cross-sectional study. Qual Life Res 2024:10.1007/s11136-023-03583-y. [PMID: 38217772 DOI: 10.1007/s11136-023-03583-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To examine the association between Body Mass Index (BMI) and self-rated health status among a representative sample of the Brazilian population. METHODS This study consists of a secondary analysis of the existing 2019 Brazilian National Health Survey (PNS). Logistic regression models were then used to examine the association between self-reported health status and BMI, while controlling for obesity-related medical conditions and socio-demographic characteristics. RESULTS The representative sample included 34,021 men and 34,430 women, comprising a total sample of 68,451. Men living with obesity (BMI ≥ 30 kg/m2) had, on average, a lower self-reported health status score (OR = 0.69, p < 0.01) compared to men within a healthy weight BMI range (18.5-25 kg/m2). Women living with obesity had, on average, a lower self-reported health status score (OR = 0.56, p < 0.01) compared to women within a healthy weight BMI range (18.5-25 kg/m2). There was also a statistically significant negative association (p < 0.01) between our obesity-related medical conditions and self-reported health for men and women. We also find some evidence of a non-linear association between BMI and health status for men. CONCLUSIONS The findings indicate that there is a statistically significant negative association between BMI and self-reported health for Brazilian men and women living with obesity. These findings reinforce the importance of addressing this growing public health challenge and the value of preventive measures and effective public health programs that focus on improving overall health and quality of life for individuals living with obesity.
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Affiliation(s)
- Luan Vinicius Bernardelli
- Federal University of Goiás, Câmpus Goiás, Bom Pastor Avenue, Setor Areião, Goiás, GO, 76600-000, Brazil.
| | - Michael A Kortt
- Faculty of Business, Law and Arts, Southern Cross University, Gold Coast, Australia
| | - Michael B Charles
- Faculty of Business, Law and Arts, Southern Cross University, Gold Coast, Australia
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2
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Akpa OM, Okekunle AP, Sarfo FS, Akinyemi RO, Akpalu A, Wahab KW, Komolafe M, Obiako R, Owolabi L, Jenkins C, Abiodun A, Ogbole G, Fawale B, Akinyemi J, Agunloye A, Uvere EO, Fakunle A, Ovbiagele B, Owolabi MO. Sociodemographic and behavioural risk factors for obesity among community-dwelling older adults in Ghana and Nigeria: A secondary analysis of data from the SIREN study. Chronic Illn 2023; 19:40-55. [PMID: 34787475 DOI: 10.1177/17423953211054023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To explore the prevalence and risk factors of obesity among older adults from low- and middle-income countries (LMICs). METHODS This is a secondary analysis of data obtained from the SIREN study through in-person interviews and measurements from healthy stroke-free older adults (≥60 years). Overweight/obesity was defined as body mass index ≥25 kg/m2. Abdominal obesity was defined as waist-to-hip ratio (WHR) of >0.90 for males and >0.85/females or waist circumference (WC) of >102 cm for males/>88 cm for females. Adjusted odds ratio (aORs) with 95% confidence interval (CIs) of the relationship between obesity and sociodemographic factors were assessed at P < 0.05. RESULTS Overall, 47.5% of participants were overweight/obese, 76.6% had a larger than recommended WHR, and 54.4% had a larger than recommended WC. Abdominal obesity (WC; aOR: 9.43, CI: 6.99-12.50), being a Nigerian (aOR: 0.55; CI: 0.42-0.72), living in an urban setting (aOR: 1.92; CI: 1.49-2.46), earning >$100/month (aOR: 1.53; CI: 1.19-1.96), and having formal education (aOR: 1.42; CI: 1.08-1.87) were associated with overweight/obesity. CONCLUSION Living in urban settings, earning a higher income, and having a formal education were associated with a higher odds of obesity among older adults from LMICs.
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Affiliation(s)
- Onoja M Akpa
- Department of Epidemiology and Medical Statistics, 113092College of Medicine, University of Ibadan, Nigeria.,Center for Genomic and Precision Medicine, 113092College of Medicine, University of Ibadan, Nigeria.,Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, 113092College of Medicine, University of Ibadan, Nigeria
| | - Akinkunmi P Okekunle
- Department of Epidemiology and Medical Statistics, 113092College of Medicine, University of Ibadan, Nigeria.,The Postgraduate College, 58987University of Ibadan, Nigeria.,Department of Food and Nutrition, Seoul National University, Korea
| | - Fred S Sarfo
- Department of Medicine, 98763Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rufus O Akinyemi
- Center for Genomic and Precision Medicine, 113092College of Medicine, University of Ibadan, Nigeria.,Department of Medicine, Sacred Heart Hospital, Abeokuta, Nigeria
| | - Albert Akpalu
- Department of Medicine, 108322University of Ghana Medical School, Accra, Ghana
| | - Kolawole W Wahab
- Department of Medicine, 361345University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, 292064Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Reginald Obiako
- Department of Medicine, 431806Ahmadu Bello University, Zaria, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Carolyn Jenkins
- College of Nursing, 2345Medical University of South Carolina, Charleston, USA
| | - Adeoye Abiodun
- Center for Genomic and Precision Medicine, 113092College of Medicine, University of Ibadan, Nigeria
| | - Godwin Ogbole
- Department of Radiology, 58987University of Ibadan, Nigeria
| | - Bimbo Fawale
- Department of Medicine, 292064Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, 113092College of Medicine, University of Ibadan, Nigeria
| | | | - Ezinne O Uvere
- Department of Medicine, 113092College of Medicine, University of Ibadan, Nigeria
| | - Adekunle Fakunle
- Department of Medicine, 113092College of Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, 8785University of California San-Francisco, USA
| | - Mayowa O Owolabi
- Center for Genomic and Precision Medicine, 113092College of Medicine, University of Ibadan, Nigeria.,Department of Medicine, 113092College of Medicine, University of Ibadan, Nigeria
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Zulfiqar AA, Habchi P, Dembele IA. Obesity and Frailty Syndrome in the Elderly: Prospective Study in Primary Care. MEDICINES 2022; 9:medicines9070038. [PMID: 35877816 PMCID: PMC9320530 DOI: 10.3390/medicines9070038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022]
Abstract
Background: Obesity is a chronic pathology that affects people of all ages, from infants to the elderly, residing in both developed and developing countries. Objective: Our aim is to study the link between obesity and frailty in the elderly. Method: A prospective study was carried out in 12 General Medicine practices in Champagne-Ardenne, in the Departments of Marne and the Ardennes, France, for a period of 12 months (from 2 May 2019 through 30 April 2020). All patients included were aged 65 or older, in consultation with a general practitioner, and had an ADL (Activity of Daily Living) greater than or equal to 4. Frailty was measured using the Fried scale and the simplified ZULFIQAR frailty scale. Results: 268 patients aged 65 and over were included, with an average age of 77.5 years. A total of 100 were obese according to BMI. The mean Fried (/5) in the series was 1.57, and the mean sZFS (/5) was 0.91. Our study shows that obesity is not significantly correlated with frailty according to the FRIED sarcopenic scale, but is significantly correlated with frailty according to the sZFS scale. Conclusions: The link between obesity and frailty remains much debated, with the underlying emergence of sarcopenic obesity equally prevalent among the elderly. This is a preliminary study that should be followed by large-scale outpatient studies to better clarify the links between sarcopenia and obesity.
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Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Service de Médecine Interne, Diabète et Maladies Métaboliques de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg et Equipe EA 3072 “Mitochondrie, Stress Oxydant et Protection Musculaire”, Faculté de Médecine-Université de Strasbourg, 67000 Strasbourg, France;
- Correspondence:
| | - Perla Habchi
- Anesthesiology Consultant, Aman Hospital, F Ring Rd, Zone 47, Building 412, Doha P.O. Box 8199, Qatar;
| | - Ibrahima Amadou Dembele
- Service de Médecine Interne, Diabète et Maladies Métaboliques de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg et Equipe EA 3072 “Mitochondrie, Stress Oxydant et Protection Musculaire”, Faculté de Médecine-Université de Strasbourg, 67000 Strasbourg, France;
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4
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He K, Zhang W, Hu X, Zhao H, Song R, Bai K, Shi W, Shi S, Shi Z, Yan M. Stronger Associations of Body Mass Index and Waist Circumference with Diabetes than Waist-Height Ratio and Triglyceride Glucose Index in the Middle-Aged and Elderly Population: A Retrospective Cohort Study. J Diabetes Res 2022; 2022:9982390. [PMID: 35257014 PMCID: PMC8898128 DOI: 10.1155/2022/9982390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 10/13/2021] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND It remains controversial whether body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), or triglyceride glucose (TyG) index has a stronger association with diabetes. The aims of the study were to compare the magnitude of associations of four indicators with diabetes risk. METHODS Data collected from annual health examination dataset in the Xinzheng during 2011 and 2019. A total of 41,242 participants aged ≥ 45 years were included in this study. Cox proportional hazard regression models were used to examine associations between the four indicators and diabetes risk. RESULTS After 205,770 person-years of follow up, diabetes developed in 2,472 subjects. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of diabetes (highest vs reference group) were 1.92 (1.71-2.16) for BMI, 1.99 (1.78-2.23) for WC, 1.65 (1.47-1.86) for WHtR, and 1.66 (1.47-1.87) for TyG, respectively. In addition, the risk of diabetes increased with baseline BMI (HR: 1.30; 95% CI: 1.25, 1.35) and TyG (HR: 1.25; 95% CI: 1.20, 1.30), but the lowest HR was 0.78 (95% CI 0.65-0.92) when WC was approximately 72 cm, and 0.85 (95% CI 0.72-0.99) when WHtR was approximately 0.47 in women. In joint analyses, the highest risk was observed in participants with a high BMI combined with a high WC (HR: 2.26; 95% CI: 1.98, 2.58). CONCLUSIONS In middle-aged and elderly Chinese population, BMI and WC were more strongly associated with diabetes than WHtR or TyG, especially the combined effect of BMI and WC.
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Affiliation(s)
- Kun He
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Wenli Zhang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xueqi Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Hao Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Rui Song
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Kaizhi Bai
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Wenlong Shi
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Songhe Shi
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhan Shi
- Department of Pharmacy, Zhengzhou People's Hospital, Zhengzhou, Henan, China
| | - Mingshu Yan
- College of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
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5
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Kumar V, Encinosa W. Revisiting the Obesity Paradox in Health Care Expenditures Among Adults With Diabetes. Clin Diabetes 2022; 40:185-195. [PMID: 35669295 PMCID: PMC9160553 DOI: 10.2337/cd20-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recent studies of diabetes suggest an obesity paradox: mortality risk increases with weight in people without diabetes but decreases with weight in people with diabetes. A recent study also reports the paradox more generally with health care utilization. Whether this paradox in health care utilization and spending is causal or instead the result of empirical biases and confounding factors has yet to be examined in detail. This study set out to examine changes in the relationship between BMI and health care expenditures in populations with versus without diabetes, controlling for confounding risk factors. It found that the obesity paradox does not exist and is the result of statistical biases such as confounding and reverse causation. Obesity is not cost-saving for people with diabetes. Thus, insurers and physicians should renew efforts to prevent obesity in people with diabetes.
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Affiliation(s)
| | - William Encinosa
- Agency for Healthcare Research and Quality, Rockville, MD
- Georgetown University, Washington, DC
- Corresponding author: William Encinosa,
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6
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Veronese N, Ferrari G, Barbagallo M. Nutritional Issues of Older People in Primary Care. PRACTICAL ISSUES IN GERIATRICS 2022:59-69. [DOI: 10.1007/978-3-030-78923-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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7
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Explaining the obesity paradox in healthcare utilization among people with type 2 diabetes. Diabetol Int 2021; 13:232-243. [PMID: 34513549 PMCID: PMC8422058 DOI: 10.1007/s13340-021-00530-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/12/2021] [Indexed: 12/02/2022]
Abstract
Background Several studies of diabetes suggest an obesity paradox: persons without diabetes have an increased risk of death due to obesity, whereas obesity decreases the risk of death for people with diabetes. A recent study finds the same obesity paradox with the number of healthcare visits. Whether empirical biases and confounding lead to this paradox is yet to be determined. Objective To examine changes in the relationship between BMI and number of visits in diabetic vs nondiabetic populations, controlling for confounding risk factors. Methods Using adults in the nationally representative Medical Expenditure Panel Survey (MEPS) from 2008 to 2016, N = 210,317, we examine the proposed relationship using six measures of healthcare visits with zero-inflated negative binomial regressions controlling for age, gender, race/ethnicity, income, education, region, health insurance, chronic conditions, and smoking. We excluded persons with type 1 diabetes and gestational diabetes. Results We find an obesity paradox among people with diabetes for three measures. That is, relative to people without diabetes, normal weight people with diabetes have more emergency room visits, inpatient, and office-based physician visits than do the obese with diabetes. However, we do not find an obesity paradox in any of the six measures once we exclude smokers and persons ever diagnosed with cancer or cardiovascular disease. Conclusion The obesity paradox does not exist at the utilization level and is due to the presence of statistical biases such as confounding and reverse causation. Physicians should continue to focus on efforts to prevent obesity in patients with diabetes.
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8
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Jabre JF, Bland JDP. Body mass index changes: an assessment of the effects of age and gender using the e-norms method. BMC Med Res Methodol 2021; 21:40. [PMID: 33618666 PMCID: PMC7898735 DOI: 10.1186/s12874-021-01222-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background To validate e-norms methodology in establishing a reference range for body mass index measures. A new method, the extrapolated norms (e-norms) method of determining normal ranges for biological variables is easy to use and recently was validated for several biological measurements. We aimed to determine whether this new method provides BMI results in agreement with established traditionally collected BMI values. Methods We applied the e-norms method to BMI data from 34,384 individuals and compared the ranges derived from this method with those from a large actuarially based study and explored differences in the normal range by gender, and age. Results The e-norms derived range of healthy BMI in adults is from 22.7 to 30.6, and showed that BMI is consistently higher in men than in women and increases with age, except in subjects aged 80–98 years in whom healthy BMI appears to be lower. Conclusions Our e-norms derived healthy BMI ranges agree with traditionally obtained actuarially based methods, supporting the validity and ease of use of our method.
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Affiliation(s)
- Joe F Jabre
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Jeremy D P Bland
- Dept of Clinical Neurophysiology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
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9
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Gaston SA, Nguyen-Rodriguez S, Aiello AE, McGrath J, Jackson WB, Nápoles A, Pérez-Stable EJ, Jackson CL. Hispanic/Latino heritage group disparities in sleep and the sleep-cardiovascular health relationship by housing tenure status in the United States. Sleep Health 2020; 6:451-462. [PMID: 32622645 DOI: 10.1016/j.sleh.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/13/2019] [Accepted: 01/07/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The objective of this study was to investigate whether the sleep-cardiovascular health (CVH) association varies by Hispanic/Latino heritage group and housing tenure status (i.e., homeownership, unassisted housing, government-assisted housing), which is an important social determinant of health. DESIGN Cross-sectional analysis of pooled National Health Interview Survey (2004-2017) data. SETTING United States. PARTICIPANTS US-born/non-US-born Mexican, Puerto Rican, Cuban, Dominican, Central/South American, and US-born non-Hispanic (NH)-white adults. MEASUREMENTS Within each housing tenure category, Poisson regressions with robust variance estimated the adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) of (1) habitual sleep duration (<6-hours, 6-<7-hours, and >9-hours vs. 7-9 hours) and sleep quality for Hispanic/Latino heritage groups compared with NH-whites and (2) ideal CVH for Hispanic/Latino heritage groups within each sleep duration category, separately, compared with NH-whites who reported 7-9 hours sleep duration. RESULTS Among 283,767 NH-white and Hispanic/Latino adults (mean age=47.0±0.09 years, 50.1% female), 33% rented housing (4% government-assisted; 29% unassisted), and 67% were homeowners. Compared with their NH-white housing tenure counterparts, only Puerto Rican homeowners were more likely to report <6-hours (PR=1.70 [95% CI: 1.44-2.01]) and 6-<7-hours (PR=1.31 [1.19-1.44]) sleep duration. Overall, Hispanic/Latino heritage groups were either less likely or no more likely to report >9-hours sleep duration and poor sleep quality compared with NH-whites. Disparities in CVH were large between Puerto Rican unassisted renters and homeowners who reported >9-hours of habitual sleep compared with their NH-white housing tenure counterparts who reported 7-9 hours. CONCLUSIONS Hispanic/Latino-white disparities in the sleep-CVH relationship may vary by Hispanic/Latino heritage group and housing tenure.
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Affiliation(s)
- Symielle A Gaston
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | | | - Allison E Aiello
- Department of Epidemiology and Carolina Population Center, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John McGrath
- Social & Scientific Systems, Inc., Research Triangle Park, NC, USA
| | | | - Anna Nápoles
- Office of the Scientific Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Eliseo J Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities and the Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA; Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
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10
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Chen TB, Weng SC, Chou YY, Lee YS, Liang CK, Lin CS, Lan TH, Lin SY, Lin YT. Predictors of Mortality in the Oldest Old Patients with Newly Diagnosed Alzheimer Disease in a Residential Aged Care Facility. Dement Geriatr Cogn Disord 2020; 48:93-104. [PMID: 31600747 DOI: 10.1159/000503059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/01/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Taiwan, the causes of death and related factors in the oldest old people with Alzheimer disease (AD) are not well characterized. We investigated the factors associated with mortality in the oldest old patients with newly diagnosed AD admitted to a long-stay residential facility. METHODS We performed a prospective study of newly diagnosed AD patients at a veterans' home between 2012 and 2016. At admission, all eligible participants received a comprehensive geriatric assessment, including demographic variables, lifestyle habits, cognitive evaluations, medical conditions (comorbidities, Age-Adjusted Charlson Comorbidity Index score, and polypharmacy), nutritional status evaluated by the Mini Nutritional Assessment-Short Form and body mass index (BMI), and global functional status. A Cox proportional hazards model was used to evaluate the predictive values of clinical parameters for all-cause mortality. RESULTS The cohort comprised 84 newly diagnosed AD patients (mean age 86.6 ± 3.9 years) with a mean follow-up period of 2.1 ± 1.2 years. The overall median survival was 3.5 years from the time of AD diagnosis (95% confidence interval, 3.1-3.9 years). BMI was significantly lower in the deceased group than in the alive group (20.7 ± 2.9 vs. 22.6 ± 3.4, p = 0.023). Logistic regression demonstrated that the clinical parameters significantly associated with mortality were high global comorbidity, low nutritional status (malnutrition and underweight), and impaired physical function at the time of AD diagnosis. CONCLUSION Comorbidity burden, nutritional status, and physical functional status at the time of dementia diagnosis are important contributors to poor outcome in the oldest old. Efforts to control concurrent chronic disorders, nutritional interventions, and physical independency as a long-term care strategy for dementia may provide survival benefit.
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Affiliation(s)
- Ting-Bin Chen
- Department of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shuo-Chun Weng
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Yin Chou
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Shan Lee
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chih-Kaung Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chu-Sheng Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsuo-Hung Lan
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Shih-Yi Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,
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11
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Son KY, Kwon H, Park JH, Joh HK, Hwang SE, Cho SH, Han K, Cho B, Park YG. Association between weight change over a period of 4 years and mortality in Korean older adults. Geriatr Gerontol Int 2020; 20:474-481. [PMID: 32196904 DOI: 10.1111/ggi.13908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/06/2020] [Accepted: 02/28/2020] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to evaluate the association between weight change and mortality in Korean older adults. METHODS We collected data pertaining to National Screening Program participants aged ≥65 years from the Korean National Health Insurance Corporation records during 2005-2011. To this data, we included mortality data, such as the date of death, of these patients (up to and including 2017) from Statistics Korea. We defined weight change as a difference in bodyweight measured in the National Screening Program over a period of 4 years. Cox proportional hazards models were used to evaluate the association between weight change and mortality. RESULTS The study population consisted of 1 100 256 participants, and a total of 46 415 deaths were observed during a mean follow-up period of 3.2 ± 0.8 years (maximum 5.0 years). For 3 531 585 person-year follow up, the mortality rate for stable weight was 10.79 per 1000 person-years (PY). Weight loss increased the mortality rate by 68%, whereas weight gain increased the rate by 10% compared with stable weight (weight loss: mortality rate 20.28 per 1000 PY, adjusted hazard ratio 1.68, 95% confidence interval 1.65-1.72; weight gain: mortality rate 12.86 per 1000 PY, adjusted hazard ratio 1.10, 95% confidence interval 1.07-1.13). However, in subgroup analysis, for participants who were underweight at baseline, current cigarette smokers or heavy alcohol drinkers, weight gain did not increase the mortality rate. CONCLUSIONS In Korean older adults, regardless of the risk factors, both weight loss and weight gain increased the mortality rate compared with stable weight. Geriatr Gerontol Int 2020; 20: 474-481.
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Affiliation(s)
- Ki Young Son
- Department of Family Medicine, Asan Medical Center, Seoul, Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Health Promotion Center, Seoul National University Hospital, Seoul, Korea.,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Health Promotion Center, Seoul National University Hospital, Seoul, Korea.,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Kyung Joh
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seo Eun Hwang
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Health Promotion Center, Seoul National University Hospital, Seoul, Korea.,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Su Hwan Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Belong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Health Promotion Center, Seoul National University Hospital, Seoul, Korea.,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Gyu Park
- Department of Biostatistics, The Catholic University of Korea College of Medicine, Seoul, Korea
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12
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Dose–response relationship between body mass index and risks of all-cause mortality and disability among the elderly: A systematic review and meta-analysis. Clin Nutr 2019; 38:1511-1523. [DOI: 10.1016/j.clnu.2018.07.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/18/2018] [Indexed: 01/01/2023]
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13
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Observational Evidence for Unintentional Weight Loss in All-Cause Mortality and Major Cardiovascular Events: A Systematic Review and Meta-Analysis. Sci Rep 2018; 8:15447. [PMID: 30337578 PMCID: PMC6194006 DOI: 10.1038/s41598-018-33563-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 09/26/2018] [Indexed: 02/07/2023] Open
Abstract
The obesity paradox has been described in several observational cohorts and meta-analysis. However, evidence of the intentionality of weight loss in all-cause deaths and major cardiovascular events (MACE) in prospective cohorts is unclear. We analysed whether involuntary weight loss is associated with increased cardiovascular events and mortality. In a systematic review, we searched multiple electronic databases for observational studies published up to October 2016. Studies reporting risk estimates for unintentional weight loss compared with stable weight in MACE and mortality were included. Fifteen studies met the selection criteria, with a total of 178,644 participants. For unintentional weight loss, we found adjusted risk ratios (RRs) with confidence intervals (CIs) of 1.38 (95% CI: 1.23, 1.53) and 1.17 (95% CI: 0.98, 1.37) for all-cause mortality and MACE, respectively. Participants with comorbidities, overweight and obese populations, and older adults yielded RRs (95% CI) of 1.49 (1.30, 1.68), 1.11 (1.04, 1.18), and 1.81 (1.59, 2.03), respectively. Unintentional weight loss had a significant impact on all-cause mortality. We found no protective effect of being overweight or obese for unintentional weight loss and MACE.
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14
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Kim H, Yoon JL, Lee A, Jung Y, Kim MY, Cho JJ, Ju YS. Prognostic effect of body mass index to mortality in Korean older persons. Geriatr Gerontol Int 2018; 18:538-546. [PMID: 29214747 DOI: 10.1111/ggi.13213] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/05/2017] [Accepted: 10/09/2017] [Indexed: 02/06/2023]
Abstract
AIM Body mass index (BMI) is regarded as a predictor of life expectancy and a determinant of mortality. However, the effect of age on BMI-related mortality remains unclear. The aim of the present study was to examine the prognostic effect of BMI to mortality risk among Korean older persons. METHODS Data were collected from the Korean National Health Insurance Services' Senior Cohort database. This study analyzed the data of 79 341 men and 91 298 women aged ≥65 years who underwent health examinations in the 2007 fiscal year. Individual mortality was identified 5 years after 2008. The participants were stratified into seven groups according to basal BMI. Hazard ratios of death were calculated through Cox proportional hazards model after adjusting for age, sex, smoking status, exercise, alcohol intake and income. RESULTS During the 5-year follow up, 11 651 men and 7 235 women died. In both sexes, a lower BMI had a higher hazard ratio (HR), but the trend of increasing HR at high BMI was not clear. For men, the lowest HR was 0.79 (95% CI 0.71-0.87) at a BMI of 27.5-30.0 kg/m2 . For women, the lowest HR was 0.84 (95% CI 0.78-0.91) at a BMI of 25.0-27.5 kg/m2 . For both sexes, the relative mortality risk was associated with a lower BMI. CONCLUSIONS A high BMI is not associated with increased mortality in older adults aged ≥65 years, whereas a lower BMI is associated with an increased mortality risk in later life in this population. Geriatr Gerontol Int 2018; 18: 538-546.
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Affiliation(s)
- Haksun Kim
- Department of Family Medicine, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jong L Yoon
- Department of Family Medicine, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Department of Family Medicine, Hallym University, College of Medicine, Chuncheon, Korea
| | - Aeyoung Lee
- Department of Family Medicine, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Yujin Jung
- Department of Family Medicine, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Mee Y Kim
- Department of Family Medicine, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Department of Family Medicine, Hallym University, College of Medicine, Chuncheon, Korea
| | - Jung J Cho
- Department of Family Medicine, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Department of Family Medicine, Hallym University, College of Medicine, Chuncheon, Korea
| | - Young S Ju
- Department of Occupational and Environmental Medicine, Hallym University, College of Medicine, Chuncheon, Korea
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15
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Lee SW, Son JY, Kim JM, Hwang SS, Han JS, Heo NJ. Body fat distribution is more predictive of all-cause mortality than overall adiposity. Diabetes Obes Metab 2018; 20:141-147. [PMID: 28671751 DOI: 10.1111/dom.13050] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/18/2017] [Accepted: 06/28/2017] [Indexed: 12/20/2022]
Abstract
AIMS The relationship between directly measured body fat and all-cause mortality has been rarely studied. The aim of this study was to evaluate the predictive significance of computed tomography (CT)-measured body fat, including both visceral fat area (VFA) and subcutaneous fat area (SFA), for mortality. METHODS The study included 36 656 participants who underwent abdominal CT as part of a health check-up at a single university-affiliated healthcare center in 2007 to 2015. Of those, 32 593 participants with data regarding vital status as of May 2016 were included in the final analysis. The main factors evaluated were VFA, SFA and visceral-to-subcutaneous fat area ratio (VSR), and the primary outcome was all-cause mortality. RESULTS There were 253 deaths during a mean follow-up of 5.7 years. Increased SFA was associated with decreased all-cause mortality, whereas an increased VFA and VSR were related to increased all-cause mortality. Compared with the predictive power of body mass index (BMI), SFA and VSR showed a larger area under the curve than did BMI. In Kaplan-Meier survival curve analysis, increased SFA and VSR were associated with decreased and increased hazard of all-cause death, respectively. However, in multivariate Cox proportional hazard regression analysis, only VSR was independently associated with all-cause mortality. Moreover, this relationship was paralleled by the harmful impact of increased VSR on metabolic profiles. CONCLUSION Increased VSR was an independent predictor of all-cause mortality. This suggests that the location of fat deposits may be more important than the actual amount of body fat.
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Affiliation(s)
- Sung Woo Lee
- Department of Internal Medicine, Seoul National University Postgraduate School, Seoul, South Korea
- Department of Internal Medicine, Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Jee Young Son
- Department of Radiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
| | - Jeong Min Kim
- Department of Internal Medicine, Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Seung-Sik Hwang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Jin Suk Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Nam Ju Heo
- Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
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16
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Schrock JM, McClure HH, Snodgrass JJ, Liebert MA, Charlton KE, Arokiasamy P, Naidoo N, Kowal P. Food insecurity partially mediates associations between social disadvantage and body composition among older adults in india: Results from the study on global AGEing and adult health (SAGE). Am J Hum Biol 2017; 29. [PMID: 28681406 DOI: 10.1002/ajhb.23033] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 05/18/2017] [Accepted: 06/08/2017] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Our objective was to test whether food insecurity mediates cross-sectional associations between social disadvantage and body composition among older adults (aged 50+) in India (n = 6556). METHODS Adjusting for key sociodemographic and dietary variables, we examined whether markers of social disadvantage (lower educational attainment, lower household wealth, belonging to a disadvantaged caste/tribe, and belonging to a minority religion) were associated with food insecurity. We then examined whether food insecurity, in turn, was associated with anthropometric measures of body composition, body mass index (BMI), and waist circumference (WC). We also tested whether food insecurity mediated the relationship between social disadvantage and body composition. RESULTS In adjusted models, lower household wealth [lowest quintile (Q5) vs highest quintile (Q1): odds ratio (OR) = 13.57, P < .001], having less than a high-school education (OR = 2.12. P < .005), being Muslim (OR = 1.82, P < .001), and being in a scheduled caste (historically marginalized) (OR = 1.49, P < .005) were associated with greater food insecurity. Those who were severely food insecure had greater odds of being underweight (OR = 1.36, P < .01) and lower odds of high WC (OR = 0.70, P < .01). Mediation analyses estimated that food insecurity explained 4.7%-29.7% of the relationship between social disadvantage and body composition, depending on the variables considered. CONCLUSIONS Our results are consistent with the hypothesis that food insecurity is a mechanism linking social disadvantage and body composition among older adults in India. These analyses contribute to a better understanding of processes leading to variation in body composition, which may help enhance the design of interventions aimed at improving population nutritional status.
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Affiliation(s)
- Joshua M Schrock
- Department of Anthropology, University of Oregon, Eugene, Oregon, 97403
| | - Heather H McClure
- Center for Equity Promotion, College of Education, University of Oregon, Eugene, Oregon, 97403
| | - J Josh Snodgrass
- Department of Anthropology, University of Oregon, Eugene, Oregon, 97403
| | - Melissa A Liebert
- Department of Anthropology, University of Oregon, Eugene, Oregon, 97403
| | - Karen E Charlton
- School of Medicine, University of Wollongong, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, 2522, Australia
| | - Perianayagam Arokiasamy
- Department of Development Studies, International Institute for Population Sciences, Mumbai, 400088, India
| | - Nirmala Naidoo
- Study on global AGEing and adult health (SAGE), World Health Organization, Geneva, 1211, Switzerland
| | - Paul Kowal
- Study on global AGEing and adult health (SAGE), World Health Organization, Geneva, 1211, Switzerland.,Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, New South Wales, 2308, Australia
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17
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Abstract
It would be difficult to overstate the urgency that U.S. government and health officials have placed on the dangers posed by obesity. Given the increasing numbers of individuals being diagnosed as overweight and obese and the emphasis on the contribution of weight to health and disease, it is critical that all health professionals examine the validity of the claims being made. A thorough examination of the research literature does not support the claims that overweight and obesity are major causes of premature mortality, excess fat is pathological and a direct cause of disease, and weight loss is practical and beneficial to health for most individuals. The literature also does not provide any significant evidence-based support for current approaches to weight management. In fact, it suggests that these approaches may likely be doing more harm than good.
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Affiliation(s)
- Jon Robison
- Michigan State University, East Lansing, MI, USA
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18
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Disability, Physical Inactivity, and Impaired Health-Related Quality of Life Are Not Different in Metabolically Healthy vs. Unhealthy Obese Subjects. Nutrients 2016; 8:nu8120759. [PMID: 27897994 PMCID: PMC5188414 DOI: 10.3390/nu8120759] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/06/2016] [Accepted: 11/16/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Obesity represents a major health hazard, affecting morbidity, psychological status, physical functionality, quality of life, and mortality. The aim of the present study was to explore the differences between metabolically healthy (MHO) and metabolically unhealthy (MUO) obese subjects with regard to physical activity, disability, and health-related quality of life (HR-QoL). METHODS All subjects underwent a multidimensional evaluation, encompassing the assessment of body composition, metabolic biomarkers and inflammation, physical activity level (IPAQ questionnaire), disability (TSD-OC test), and HR-QoL (SF-36 questionnaire). MHO and MUO were defined based on the absence or the presence of the metabolic syndrome, respectively. RESULTS 253 subjects were included (54 men and 199 women; age: 51.7 ± 12.8 vs. 50.3 ± 11.7 years, p = 0.46; BMI: 38.1 ± 5.7 vs. 38.9 ± 6.7 kg/m², p = 0.37). No significant difference was observed in body composition. There was no difference between MHO and MUO considering inflammation (hs-CRP: 6517.1 ± 11,409.9 vs. 5294.1 ± 5612.2 g/L; p = 0.37), physical inactivity (IPAQ score below 3000 METs-min/week in 77.6% of MHO vs. 80% of MUO subjects; p = 0.36), obesity-related disability (TSD-OC score > 33%, indicating a high level of obesity-related disability, in 20.2% of MHO vs. 26.5% of MUO subjects; p = 0.28), and the HR-QoL (SF-36 total score: 60 ± 20.8 vs. 62.8 ± 18.2, p = 0.27). DISCUSSION AND CONCLUSION The metabolic comorbidity and the impairment of functional ability and psycho-social functioning may have a different timing in the natural history of obesity. Alterations in the physical activity level and mobility disabilities may precede the onset of metabolic abnormalities. (Trial registration 2369 prot 166/12-registered 23 February 2012; Amendment 223/14-registered 13 February 2014).
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19
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Jacob ME, Yee LM, Diehr PH, Arnold AM, Thielke SM, Chaves PHM, Gobbo LD, Hirsch C, Siscovick D, Newman AB. Can a Healthy Lifestyle Compress the Disabled Period in Older Adults? J Am Geriatr Soc 2016; 64:1952-1961. [PMID: 27603679 DOI: 10.1111/jgs.14314] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 01/17/2016] [Accepted: 02/13/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To determine whether lifestyle factors, measured late in life, could compress the disabled period toward the end of life. DESIGN Community-based cohort study of older adults followed from 1989 to 2015. SETTING Four U.S. communities. PARTICIPANTS Community-living men and women aged 65 and older (N = 5,248, mean age 72.7 ± 5.5, 57% female, 15.2% minority) who were not wheelchair dependent and were able to give informed consent at baseline. MEASUREMENTS Multiple lifestyle factors, including smoking, alcohol consumption, physical activity, diet, body mass index (BMI), social networks, and social support, were measured at baseline. Activities of daily living (ADLs) were assessed at baseline and throughout follow-up. Years of life (YoL) was defined as years until death. Years of able life (YAL) was defined as years without any ADL difficulty. YAL/YoL%, the proportion of life lived able, was used to indicate the relative compression or expansion of the disabled period. RESULTS The average duration of disabled years was 4.5 (out of 15.4 mean YoL) for women and 2.9 (out of 12.4 mean YoL) for men. In a multivariable model, obesity was associated with 7.3 percentage points (95% confidence interval (CI) = 5.4-9.2) lower YAL/YoL% than normal weight. Scores in the lowest quintile of the Alternate Healthy Eating Index were associated with a 3.7% (95% CI = 1.6-5.9) lower YAL/YoL% than scores in the highest quintile. Every 25 blocks walked in a week was associated with 0.5 percentage points (95% CI = 0.3-0.8) higher YAL/YoL%. CONCLUSION The effects of healthy lifestyle factors on the proportion of future life lived free of disability indicate that the disabled period can be compressed, given the right combination of these factors.
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Affiliation(s)
- Mini E Jacob
- Geriatric Research, Education, and Clinical Center, Boston, Massachusetts.,Health and Disability Research Institute, School of Public Health, Boston University, Boston, Massachusetts.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Laura M Yee
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Paula H Diehr
- Department of Biostatistics, University of Washington, Seattle, Washington.,Department of Health Services, University of Washington, Seattle, Washington
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Stephen M Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.,Geriatric Research, Education, and Clinical Center, Seattle Veterans Affairs Medical Center, Seattle, Washington
| | - Paulo H M Chaves
- Benjamin Leon Center for Geriatric Research and Education, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Liana Del Gobbo
- Division of Cardiovascular Medicine, Stanford University, Palo, Alto
| | - Calvin Hirsch
- Division of General Medicine, University of California Davis Medical Center, Sacramento, California
| | | | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
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20
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Thorpe RJ, Ferraro KF. Aging, Obesity, and Mortality: Misplaced Concern About Obese Older People? Res Aging 2016; 26:108-129. [PMID: 22707808 DOI: 10.1177/0164027503258738] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Although there is widespread agreement that obesity (body mass index [BMI] ≥ 30 kg/m(2)) raises health risks, debate has ensued on whether obese older adults are also at greater risk. This study examines the effect of obesity on mortality for younger and older adults to determine whether the risk of obesity is lessened in later life. Data from a 20-year follow-up of a national sample of adults were used to examine the risk of obesity on mortality (N = 6,767). Cox models reveal that obesity raises mortality risk for adults of all ages, but this relationship is nearly twice as strong for persons younger than 50 years of age. Being slightly overweight in later life is associated with lower mortality risk, but obesity raises mortality risk, especially for ischemic heart disease. Obesity in middle age is a grave public health concern, but obesity in later life also merits attention.
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21
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Spillmann F, De Geest B, Muthuramu I, Amin R, Miteva K, Pieske B, Tschöpe C, Van Linthout S. Apolipoprotein A-I gene transfer exerts immunomodulatory effects and reduces vascular inflammation and fibrosis in ob/ob mice. JOURNAL OF INFLAMMATION-LONDON 2016; 13:25. [PMID: 27486384 PMCID: PMC4969975 DOI: 10.1186/s12950-016-0131-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/19/2016] [Indexed: 12/31/2022]
Abstract
Background Obesity is associated with vascular inflammation, fibrosis and reduced high-density lipoproteins (HDL)-cholesterol. We aimed to investigate whether adenoviral gene transfer with human apolipoprotein (apo) A-I (Ad.A-I), the main apo of HDL, could exert immunomodulatory effects and counteract vascular inflammation and fibrosis in ob/ob mice. Methods Ad.A-I transfer was performed in 8 weeks (w) old ob/ob mice, which were sacrificed 7 w later. The aorta was excised for mRNA analysis and the spleen for splenocyte isolation for subsequent flow cytometry and co-culture with murine fibroblasts. HDL was added to mononuclear cells (MNC) and fibroblasts to assess their impact on adhesion capacity and collagen deposition, respectively. Results Ad.A-I led to a 1.8-fold (p < 0.05) increase in HDL-cholesterol versus control ob/ob mice at the day of sacrifice, which was paralleled by a decrease in aortic TNF-α and VCAM-1 mRNA expression. Pre-culture of MNC with HDL decreased their adhesion to TNF-α-activated HAEC. Ad.A-I exerted immunomodulatory effects as evidenced by a downregulation of aortic NOD2 and NLRP3 mRNA expression and by a 12 %, 6.9 %, and 15 % decrease of the induced proliferation/activity of total splenic MNC, CD4+, and CD8+ cells in ob/ob Ad.A-I versus control ob/ob mice, respectively (p < 0.05). Ad.A-I further reduced aortic collagen I and III mRNA expression by 62 % and 66 %, respectively (p < 0.0005), and abrogated the potential of ob/ob splenocytes to induce the collagen content in murine fibroblasts upon co-culture. Finally, HDL decreased the TGF-ß1-induced collagen deposition of murine fibroblasts in vitro. Conclusions Apo A-I transfer counteracts vascular inflammation and fibrosis in ob/ob mice. Electronic supplementary material The online version of this article (doi:10.1186/s12950-016-0131-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frank Spillmann
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Bart De Geest
- Catholic University of Leuven, Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, Leuven, Belgium
| | - Ilayaraja Muthuramu
- Catholic University of Leuven, Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, Leuven, Belgium
| | - Ruhul Amin
- Catholic University of Leuven, Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, Leuven, Belgium
| | - Kapka Miteva
- Berlin-Brandenburg Center for Regenerative Therapy (BCRT), Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Südstrasse 2, 13353 Berlin, Germany
| | - Burkert Pieske
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany ; Deutsches Zentrum für Herz Kreislaufforschung (DZHK), Standort Berlin/Charité, Berlin, Germany ; Department of Cardiology, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany ; Berlin-Brandenburg Center for Regenerative Therapy (BCRT), Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Südstrasse 2, 13353 Berlin, Germany ; Deutsches Zentrum für Herz Kreislaufforschung (DZHK), Standort Berlin/Charité, Berlin, Germany
| | - Sophie Van Linthout
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany ; Berlin-Brandenburg Center for Regenerative Therapy (BCRT), Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Südstrasse 2, 13353 Berlin, Germany ; Deutsches Zentrum für Herz Kreislaufforschung (DZHK), Standort Berlin/Charité, Berlin, Germany
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22
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Abstract
OBJECTIVES The present study evaluated the association between energy intake, energy required and mortality in older adults. DESIGN A cohort study with a mean of 10·67 (sd 4·74) years of follow-up. Participants completed a 24 h dietary recall. Energy required per day was computed by BMR. Deaths through 2006 were identified from the National Death Index. A Cox regression was used to estimate the hazard ratios (HR) of quantiles of energy intake and energy required on all-cause and CVD mortality, adjusting for demographics, socio-economic status and co-morbidity. SETTING The National Health and Nutrition Examination Survey (NHANES) III, 1988-1994. SUBJECTS A total of 4846 participants aged 60 years or above were analysed. RESULTS Within the follow-up period, there were a total of 2954 deaths (61·0 %), 51·9 % were caused by CVD. Relative to those in quartile 1 of energy intake, only quartile 4 was associated with all-cause mortality and CVD mortality with HR of 0·86 (95 % CI 0·77, 0·96, P=0·006) and 0·76 (95 % CI 0·65, 0·89, P=0·001), respectively. On the other hand, relative to those in quartile 1 of energy required, all quartiles of participants had a lower risk of all-cause mortality and CVD mortality. The interaction effects between energy intake and energy required with all-cause and CVD mortality were insignificant (P=0·70 and 0·61, respectively). CONCLUSIONS Independent of energy required, higher energy intake was associated with lower HR of both all-cause and CVD mortality in older adults.
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23
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Bliwise DL. Never too old: beneficial neurobehavioural effects of continuous positive airway pressure in the elderly. Eur Respir J 2016; 46:13-5. [PMID: 26130775 DOI: 10.1183/09031936.00039915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Donald L Bliwise
- Sleep Center, Dept of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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24
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Abstract
OBJECTIVES Although critical care physicians view obesity as an independent poor prognostic marker, growing evidence suggests that obesity is, instead, associated with improved mortality following ICU admission. However, this prior empirical work may be biased by preferential admission of obese patients to ICUs, and little is known about other patient-centered outcomes following critical illness. We sought to determine whether 1-year mortality, healthcare utilization, and functional outcomes following a severe sepsis hospitalization differ by body mass index. DESIGN Observational cohort study. SETTING U.S. hospitals. PATIENTS We analyzed 1,404 severe sepsis hospitalizations (1999-2005) among Medicare beneficiaries enrolled in the nationally representative Health and Retirement Study, of which 597 (42.5%) were normal weight, 473 (33.7%) were overweight, and 334 (23.8%) were obese or severely obese, as assessed at their survey prior to acute illness. Underweight patients were excluded a priori. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Using Medicare claims, we identified severe sepsis hospitalizations and measured inpatient healthcare facility use and calculated total and itemized Medicare spending in the year following hospital discharge. Using the National Death Index, we determined mortality. We ascertained pre- and postmorbid functional status from survey data. Patients with greater body mass indexes experienced lower 1-year mortality compared with nonobese patients, and there was a dose-response relationship such that obese (odds ratio = 0.59; 95% CI, 0.39-0.88) and severely obese patients (odds ratio = 0.46; 95% CI, 0.26-0.80) had the lowest mortality. Total days in a healthcare facility and Medicare expenditures were greater for obese patients (p < 0.01 for both comparisons), but average daily utilization (p = 0.44) and Medicare spending were similar (p = 0.65) among normal, overweight, and obese survivors. Total function limitations following severe sepsis did not differ by body mass index category (p = 0.64). CONCLUSIONS Obesity is associated with improved mortality among severe sepsis patients. Due to longer survival, obese sepsis survivors use more healthcare and result in higher Medicare spending in the year following hospitalization. Median daily healthcare utilization was similar across body mass index categories.
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25
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Oga EA, Eseyin OR. The Obesity Paradox and Heart Failure: A Systematic Review of a Decade of Evidence. J Obes 2016; 2016:9040248. [PMID: 26904277 PMCID: PMC4745816 DOI: 10.1155/2016/9040248] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/27/2015] [Accepted: 12/27/2015] [Indexed: 01/09/2023] Open
Abstract
There is scientific consensus that obesity increases the risk of cardiovascular diseases, including heart failure. However, among persons who already have heart failure, outcomes seem to be better in obese persons as compared with lean persons: this has been termed the obesity paradox, the mechanisms of which remain unclear. This study systematically reviewed the evidence of the relationship between heart failure mortality (and survival) and weight status. Search of the PubMed/MEDLINE and EMBASE databases was done according to the PRISMA protocol. The initial search identified 9879 potentially relevant papers, out of which ten studies met the inclusion criteria. One study was a randomized clinical trial and 9 were observational cohort studies: 6 prospective and 3 retrospective studies. All studies used the BMI, WC, or TSF as measure of body fatness and NYHA Classification of Heart Failure and had single outcomes, death, as study endpoint. All studies included in review were longitudinal studies. All ten studies reported improved outcomes for obese heart failure patients as compared with their normal weight counterparts; worse prognosis was demonstrated for extreme obesity (BMI > 40 kg/m(2)). The findings of this review will be of significance in informing the practice of asking obese persons with heart failure to lose weight. However, any such recommendation on weight loss must be consequent upon more conclusive evidence on the mechanisms of the obesity paradox in heart failure and exclusion of collider bias.
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Affiliation(s)
- Emmanuel Aja Oga
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD 21201, USA
- *Emmanuel Aja Oga:
| | - Olabimpe Ruth Eseyin
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, MA 02115, USA
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Holme I, Tonstad S. Survival in elderly men in relation to midlife and current BMI. Age Ageing 2015; 44:434-9. [PMID: 25609234 DOI: 10.1093/ageing/afu202] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 10/08/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND the relationship between BMI and mortality is U-shaped in the elderly but may be modified by midlife BMI and change in weight. OBJECTIVE to elucidate mortality prediction by BMI trajectory in older men. SUBJECTS the Oslo cohort of men born in 1923-32 were screened for BMI and cardiovascular risk in 1972-73. Survivors were rescreened at ages of 68-77 years, and all-cause mortality was followed from 2000 to 2011. METHODS we calculated Cox regression proportional hazards for 11-year mortality rates in relation to BMI change among 5,240 men with no reported disease in 1972-73 and complete data. Models were adjusted for demographics, medications and disease. Men with BMI < 25 kg/m(2) in midlife (1972-73) and in 2000 were the reference group. RESULTS men whose BMI changed from <25 kg/m(2) in midlife to 25-29.9 kg/m(2) in 2000 carried the lowest mortality risk (hazard ratio [HR] 0.84; 95% confidence interval [CI] 0.75-0.94). Men with BMI ≥ 30 kg/m(2) in midlife were at highest risk (HR 1.79; 95% CI 1.12-2.88 if reclassified to 25-29.9 kg/m(2) in 2000 and HR 1.39; 95% CI 1.05-1.85 if BMI remained ≥30 kg/m(2) in 2000). Men with BMI 25-29.9 kg/m(2) in midlife that reclassified to <25 kg/m(2) in 2000 had increased risk. Findings were similar when percentage change in BMI was the outcome. CONCLUSION survival in older men with normal weight at midlife was associated with BMI gain after midlife while midlife obesity increased risk regardless of subsequent change.
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Affiliation(s)
- Ingar Holme
- Oslo Center of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital Ullevål, Building 2, Kirkevn 166, Oslo, Norway Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Serena Tonstad
- Department of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
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Noh JW, Kwon YD, Park J, Kim J. Body mass index and depressive symptoms in middle aged and older adults. BMC Public Health 2015; 15:310. [PMID: 25884564 PMCID: PMC4383216 DOI: 10.1186/s12889-015-1663-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 03/19/2015] [Indexed: 01/21/2023] Open
Abstract
Background The relationship between weight problems and depression has been the focus of many studies; however, results from these studies vary. The purpose of this study is to describe the association between depression and BMI using data from a national sample of middle aged and older Koreans and to examine whether gender moderates the relationship between depression and weight. Methods We used data from the Korean Longitudinal Study of Aging (KLoSA). Of the 7,920 respondents that participated in KLoSA in 2010, 7,672 adults aged between 50 and 102 years were included in the final analysis. The relationship between depression and obesity status was examined in both the full sample and in sub-samples stratified by gender. The observed U-shaped association between obesity status and CES-D score was tested by regressing CES-D score on linear and quadratic terms of BMI scores. Results The distribution of CES-D scores by respondents’ obesity status (i.e., underweight, normal weight, overweight, obese and severely obese) showed a U-shaped association. Specifically, the highest CES-D scores were found in underweight individuals; this was followed by the severely obese and obese groups in the full sample and in gender-specific subsamples. The lowest CES-D scores were found in the overweight group when considering the entire population and males alone and in the normal weight group for females. This U-shaped association between CES-D and obesity status was confirmed by a model in which CES-D scores were regressed on BMI scores and other covariates. Conclusions This study found a U-shaped association between BMI and levels of depressive symptoms among adults in Korea overall and also within each gender. Specifically, the highest level of depressive symptoms was found among the underweight, followed by the severely obese and then the obese. Slightly different patterns between male and female adults were found regarding the weight status associated with the fewest depressive symptoms.
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Affiliation(s)
- Jin-Won Noh
- Department of Healthcare Management, Eulji University, Seongnam, Korea.
| | - Young Dae Kwon
- Department of Humanities and Social Medicine, College of Medicine and Catholic Institute for Healthcare Management, the Catholic University of Korea, Seoul, Korea.
| | - Jumin Park
- University of Maryland School of Nursing, Baltimore, MD, USA.
| | - Jinseok Kim
- Department of Social Welfare, Seoul Women's University, Rm. #721, Insa-Kwan Bldg., 126 Kongneung 2-Dong, Nowon-Ku, Seoul, Korea.
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Shil Hong E, Khang AR, Roh E, Jeong Ku E, An Kim Y, Min Kim K, Hoon Moon J, Hee Choi S, Soo Park K, Woong Kim K, Chul Jang H, Lim S. Counterintuitive relationship between visceral fat and all-cause mortality in an elderly Asian population. Obesity (Silver Spring) 2015; 23:220-7. [PMID: 25294681 DOI: 10.1002/oby.20914] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 09/06/2014] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Abdominal obesity is considered to be a risk factor for mortality. However, recent studies indicate that overweight may be negatively associated with mortality ("obesity paradox"). The relationships between mortality and various obesity markers in an elderly Asian cohort were evaluated. METHODS Subjects of the Korean Longitudinal Study on Health and Aging (KLoSHA) (n = 1000, age ≥65 years) were included. The visceral fat area (VFA) and subcutaneous fat area (SFA) were measured using computed tomography. RESULTS A total of 222 deaths occurred during the 6-year follow-up (median = 5.2 [range 0.1-6.3] years). Body mass index (BMI), VFA, SFA, and total fat mass were negatively associated with all-cause mortality in the univariable analyses (hazard ratio [HR] 0.67 per 1 SD [95% CI 0.57-0.77], 0.66 [0.55-0.79], 0.73 [0.61-0.86], and 0.74 [0.63-0.87], respectively). BMI and VFA were significantly associated with all-cause mortality in the multivariable analyses (HR 0.85 per 1 SD [95% CI 0.73-0.99] and 0.64 [0.47-0.87], respectively). When stratified by quartiles, the HR associated with VFA was the lowest in the third quartile. CONCLUSIONS In this observational study with a short follow-up of elderly Asian people, higher amounts of visceral fat, a marker for central obesity, were associated with decreased all-cause mortality.
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Affiliation(s)
- Eun Shil Hong
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea; Department of Internal Medicine, Konkuk University College of Medicine and Konkuk University Chungju Hospital, Chungju, Korea
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He J, Yu Q, Zhang H, Mahnken JD. The dynamic association of body mass index and all-cause mortality in multiple cohorts and its impacts. Emerg Themes Epidemiol 2014; 11:17. [PMID: 25352909 PMCID: PMC4211318 DOI: 10.1186/1742-7622-11-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 10/02/2014] [Indexed: 11/13/2022] Open
Abstract
Background In the literature, different shapes of associations have been found between body mass index (BMI) and mortality and some of the findings were opposite to each other. The association of BMI and mortality in a single cohort has been found to be dynamic that can lead to different findings under different settings. The identified dynamic features were consistent with the heterogeneity in the literature. It is meaningful to find out whether such dynamic associations exist in other populations. Methods Data of six different cohorts were used for analysis and comparison. The proportional hazards assumptions for BMI in Cox models were tested to identify dynamic associations in each cohort. Time-dependent covariates Cox model was used to model the association of BMI and mortality risk as functions of follow-up time. The Cox model was applied to the pooled data with survival times censored at 5 to 40 years to show the potential impact of the dynamic association on traditional Meta-analysis. Results and discussion Dynamic associations were identified in six models (4 for men and 2 for women), four of which showed the same changing pattern: the elevated mortality risk for low BMI decreased while that for high BMI increased with follow-up time. When the Cox model was applied to the pooled data excluding the largest and also the shortest cohort, low BMI was but high BMI was not associated with high mortality for men with censoring at 5 years but the association for low BMI became weaker and that for high BMI became much stronger when censoring time was at 40 years. The dynamic association indicated that shorter studies tend to obtain inverse associations between BMI and mortality while longer studies tend to obtain J-shaped associations. Conclusions Different or even opposite results about body weight and mortality in the literature may be in part due to the underlying dynamic association of BMI and mortality. The dynamic features need to be taken into consideration in future studies.
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Affiliation(s)
- Jianghua He
- Department of Biostatistics, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, 66160 Kansas City, KS, USA
| | - Qing Yu
- Department of Biostatistics, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, 66160 Kansas City, KS, USA
| | - Huiquan Zhang
- Sanofi Pasteur Research & Development in China, Beijing, China
| | - Jonathan D Mahnken
- Department of Biostatistics, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, 66160 Kansas City, KS, USA
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Obayashi K, Saeki K, Kurumatani N. Association between urinary 6-sulfatoxymelatonin excretion and arterial stiffness in the general elderly population: the HEIJO-KYO cohort. J Clin Endocrinol Metab 2014; 99:3233-9. [PMID: 24878050 DOI: 10.1210/jc.2014-1262] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
CONTEXT Melatonin may have a preventive effect on atherosclerosis by regulating sleep quality and circadian biological rhythmicity. However, whether endogenous melatonin is associated with arterial stiffness, a marker reflecting atherosclerosis, is unclear. OBJECTIVE The objective of the study was to determine the association between endogenous melatonin and arterial stiffness. DESIGN AND PARTICIPANTS A total of 641 community-based elderly individuals were enrolled in this cross-sectional study (mean age 71.4 y). MEASURES We measured overnight urinary 6-sulfatoxymelatonin excretion (UME) and cardioankle vascular index (CAVI) as indices of melatonin secretion and arterial stiffness, respectively. RESULTS The median UME was 6.8 μg (interquartile range 4.1-10.5) and the mean value of CAVI was 9.1 ± 1.1. High CAVI (ie, ≥ 9.0) was observed in 334 participants (52.1%). Univariate logistic regression models revealed marginal to significant associations between high CAVI and age, gender, body mass index, hypertension, diabetes, estimated glomerular filtration rate, log-transformed UME, bedtime, duration in bed, daytime physical activity, and log-transformed nighttime physical activity. In the multivariate logistic regression model, simultaneously adjusted for the former independent variables, higher log-transformed UME was significantly associated with a lower odds ratio (OR) for high CAVI (adjusted OR 0.708; 95% confidence interval 0.536-0.935; P = .015). This inverse association between log-transformed UME and high CAVI indicated that an increase in log-transformed UME by 1 SD was associated with an 18.1% (95% confidence interval 1.4-31.9) decrease in high CAVI prevalence. CONCLUSIONS UME is significantly and inversely associated with arterial stiffness in the general elderly population. The association was independent of several major causes of atherosclerosis.
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Affiliation(s)
- Kenji Obayashi
- Department of Community Health and Epidemiology, Nara Medical University School of Medicine, Nara 634-8521, Japan
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Albanese E, Strand BH, Guralnik JM, Patel KV, Kuh D, Hardy R. Weight loss and premature death: the 1946 British birth cohort study. PLoS One 2014; 9:e86282. [PMID: 24466002 PMCID: PMC3897675 DOI: 10.1371/journal.pone.0086282] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 12/11/2013] [Indexed: 01/26/2023] Open
Abstract
Objective The relationship between weight loss and mortality has important clinical and public health significance but has proved to be complex. Evidence is mixed and particularly limited on the association between weight loss in mid-life and premature death (i.e. before 65 years of age), a small albeit important segment of total mortality. We aimed to study the association between midlife weight change and mortality accounting for health and lifestyle characteristics, and also considering potential bias due to preexisting chronic diseases and smoking status. Design Longitudinal, population-based, ‘the 1946 British’ birth cohort study. Subjects and Measures In 2750 men and women, mortality from age 53 through 65 years was analyzed according to categories of measured 10 year weight change between 43 and 53 years. Cox's hazard ratios (HR) were progressively adjusted for socio-demographic, lifestyle and health characteristics. Results Nearly 20% of participants lost weight and over 50% gained 5 kg or more in midlife. There were 164 deaths. Compared to those who gained between 2 and 5 kg, those who lost 5 kg or more had an increased risk of premature death independently of midlife physical activity, socio-economic circumstances and educational attainment. This association was unaltered when highest weight loss (lost more than 15 Kg) (p = 0.04) and early deaths were excluded (p<0.001), but was no longer significant after adjustment for cardiovascular risk factors and health status (HR = 1.8; 95% CI: 0.9 to 3.5). Conclusion The inverse association between weight loss in midlife and higher risk of premature death may be explained by vascular risk factors and ill health. In consideration of the burden of premature death, closer monitoring of weight loss in mid-life is warranted.
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Affiliation(s)
- Emiliano Albanese
- Laboratory of Population Science, National Institute on Aging, Bethesda, Maryland, United States of America
- * E-mail:
| | | | - Jack M. Guralnik
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Kushang V. Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, United States of America
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
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Kinge JM, Morris S. Variation in the relationship between BMI and survival by socioeconomic status in Great Britain. ECONOMICS AND HUMAN BIOLOGY 2014; 12:67-82. [PMID: 23809617 DOI: 10.1016/j.ehb.2013.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 05/21/2013] [Accepted: 05/21/2013] [Indexed: 06/02/2023]
Abstract
We investigate the relationship between obesity and survival, and the extent to which this relationship varies by socioeconomic status (SES). The underlying model is based on the "Pathways to health" framework in which SES affects health by modifying the relationship between lifestyles and health. We use data from the British Health and Lifestyle Survey (1984-1985) and the longitudinal follow-up in June 2009, and run parametric Gompertz survival models to investigate the association between obesity and survival, also accounting for interactions between obesity and both age and SES. Generally we find that obesity is negatively associated with survival, and that SES is positively associated with survival, in both men and women. The interactions between obesity and SES predict survival among women but not among men. Obesity compared with normal weight is associated with a reduction in survival of 3.3, 3.2 and 2.8 years in men aged 40, 50 and 60 years, respectively. Corresponding numbers among women in the lowest SES group are 13.1, 9.7 and 6.1 years, respectively; in the highest SES group they are 6.2, 3.1 and 0.1 years, respectively, a difference of approximately 6 years between the highest and lowest SES groups.
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Affiliation(s)
- Jonas Minet Kinge
- Statistics Norway, Research Department, Pb 8131 Dep, 0033 Oslo, Norway.
| | - Stephen Morris
- University College London, Department of Applied Health Research, Gower Street, London WC1E 6BT, United Kingdom
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Barry VW, Baruth M, Beets MW, Durstine JL, Liu J, Blair SN. Fitness vs. fatness on all-cause mortality: a meta-analysis. Prog Cardiovasc Dis 2013; 56:382-90. [PMID: 24438729 DOI: 10.1016/j.pcad.2013.09.002] [Citation(s) in RCA: 386] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to quantify the joint association of cardiorespiratory fitness (CRF) and weight status on mortality from all causes using meta-analytical methodology. Studies were included if they were (1) prospective, (2) objectively measured CRF and body mass index (BMI), and (3) jointly assessed CRF and BMI with all-cause mortality. Ten articles were included in the final analysis. Pooled hazard ratios were assessed for each comparison group (i.e. normal weight-unfit, overweight-unfit and -fit, and obese-unfit and -fit) using a random-effects model. Compared to normal weight-fit individuals, unfit individuals had twice the risk of mortality regardless of BMI. Overweight and obese-fit individuals had similar mortality risks as normal weight-fit individuals. Furthermore, the obesity paradox may not influence fit individuals. Researchers, clinicians, and public health officials should focus on physical activity and fitness-based interventions rather than weight-loss driven approaches to reduce mortality risk.
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Affiliation(s)
- Vaughn W Barry
- Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN.
| | - Meghan Baruth
- Health Science, Saginaw Valley, State University, University Center, MI
| | - Michael W Beets
- Exercise Science, University of South Carolina, Columbia, SC
| | | | - Jihong Liu
- Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Steven N Blair
- Exercise Science, University of South Carolina, Columbia, SC; Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
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Pantell M, Rehkopf D, Jutte D, Syme SL, Balmes J, Adler N. Social isolation: a predictor of mortality comparable to traditional clinical risk factors. Am J Public Health 2013; 103:2056-62. [PMID: 24028260 DOI: 10.2105/ajph.2013.301261] [Citation(s) in RCA: 362] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We explored the relationship between social isolation and mortality in a nationally representative US sample and compared the predictive power of social isolation with that of traditional clinical risk factors. METHODS We used data on 16,849 adults from the Third National Health and Nutrition Examination Survey and the National Death Index. Predictor variables were 4 social isolation factors and a composite index. Comparison predictors included smoking, obesity, elevated blood pressure, and high cholesterol. Unadjusted Kaplan-Meier tables and Cox proportional hazards regression models controlling for sociodemographic characteristics were used to predict mortality. RESULTS Socially isolated men and women had worse unadjusted survival curves than less socially isolated individuals. Cox models revealed that social isolation predicted mortality for both genders, as did smoking and high blood pressure. Among men, individual social predictors included being unmarried, participating infrequently in religious activities, and lacking club or organization affiliations; among women, significant predictors were being unmarried, infrequent social contact, and participating infrequently in religious activities. CONCLUSIONS The strength of social isolation as a predictor of mortality is similar to that of well-documented clinical risk factors. Our results suggest the importance of assessing patients' level of social isolation.
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Affiliation(s)
- Matthew Pantell
- At the time of the study, Matthew Pantell was with the University of California, Berkeley-University of California, San Francisco Joint Medical Program, San Francisco. David Rehkopf is with the Stanford University School of Medicine, Stanford, CA. Douglas Jutte and S. Leonard Syme are with the School of Public Health, University of California, Berkeley. John Balmes is with the School of Public Health, University of California, Berkeley, and the School of Medicine, University of California, San Francisco. Nancy Adler is with the School of Medicine, University of California, San Francisco
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Murphy RA, Register TC, Shively CA, Carr JJ, Ge Y, Heilbrun ME, Cummings SR, Koster A, Nevitt MC, Satterfield S, Tylvasky FA, Strotmeyer ES, Newman AB, Simonsick EM, Scherzinger A, Goodpaster BH, Launer LJ, Eiriksdottir G, Sigurdsson S, Sigurdsson G, Gudnason V, Lang TF, Kritchevsky SB, Harris TB. Adipose tissue density, a novel biomarker predicting mortality risk in older adults. J Gerontol A Biol Sci Med Sci 2013; 69:109-17. [PMID: 23707956 DOI: 10.1093/gerona/glt070] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Knowledge of adipose composition in relation to mortality may help delineate inconsistent relationships between obesity and mortality in old age. We evaluated relationships between abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) density, mortality, biomarkers, and characteristics. METHODS VAT and SAT density were determined from computed tomography scans in persons aged 65 and older, Health ABC (n = 2,735) and AGES-Reykjavik (n = 5,131), and 24 nonhuman primates (NHPs). Associations between adipose density and mortality (4-13 years follow-up) were assessed with Cox proportional hazards models. In NHPs, adipose density was related to serum markers and tissue characteristics. RESULTS Higher density adipose tissue was associated with mortality in both studies with adjustment for risk factors including adipose area, total fat, and body mass index. In women, hazard ratio and 95% CI for the densest quintile (Q5) versus least dense (Q1) for VAT density were 1.95 (1.36-2.80; Health ABC) and 1.88 (1.31-2.69; AGES-Reykjavik) and for SAT density, 1.76 (1.35-2.28; Health ABC) and 1.56 (1.15-2.11; AGES-Reykjavik). In men, VAT density was associated with mortality in Health ABC, 1.52 (1.12-2.08), whereas SAT density was associated with mortality in both Health ABC, 1.58 (1.21-2.07), and AGES-Reykjavik, 1.43 (1.07-1.91). Higher density adipose tissue was associated with smaller adipocytes in NHPs. There were no consistent associations with inflammation in any group. Higher density adipose tissue was associated with lower serum leptin in Health ABC and NHPs, lower leptin mRNA expression in NHPs, and higher serum adiponectin in Health ABC and NHPs. CONCLUSION VAT and SAT density provide a unique marker of mortality risk that does not appear to be inflammation related.
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Affiliation(s)
- Rachel A Murphy
- Laboratory of Population Science, National Institute on Aging, 7201 Wisconsin Ave, 3C-309 Bethesda, MD 20814.
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Falba TA, Busch SH. Survival Expectations of the Obese: Is Excess Mortality Reflected in Perceptions? ACTA ACUST UNITED AC 2012; 13:754-61. [PMID: 15897485 DOI: 10.1038/oby.2005.85] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study compared self-reported subjective life expectancy (i.e., probability of living to age 75) for normal-weight, overweight, and obese weight groups to examine whether individuals are internalizing information about the health risks due to excessive weight. RESEARCH METHODS AND PROCEDURES Using data from the Health and Retirement Study, a total of 9035 individuals 51 to 61 years old were analyzed by BMI category. The primary outcome measure was individuals' reports about their own expectations of survival to age 75. Absolute and relative risks of survival were compared with published estimates of survival to age 75. RESULTS Consistently, higher levels of BMI were associated with lower self-estimated survival probabilities. Differences relative to normal weight ranged from 4.9% (p < 0.01) for male nonsmokers to 8.8% (p < 0.001) for female nonsmokers. However, these differences were substantially less than those obtained from published survival curve estimates, suggesting that obese individuals tended to underestimate mortality risks. DISCUSSION Individuals appeared to underestimate the mortality risks of excessive weight; thus, knowledge campaigns about the risks of obesity should remain a top priority.
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Affiliation(s)
- Tracy A Falba
- Department of Epidemiology and Public Health, Yale University School of Medicine, P.O. Box 208034, 60 College Street, New Haven, CT 06520-8034, USA.
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Villareal DT, Apovian CM, Kushner RF, Klein S. Obesity in Older Adults: Technical Review and Position Statement of the American Society for Nutrition and NAASO, The Obesity Society. ACTA ACUST UNITED AC 2012; 13:1849-63. [PMID: 16339115 DOI: 10.1038/oby.2005.228] [Citation(s) in RCA: 344] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
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.
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Affiliation(s)
- Dennis T Villareal
- Division of Geriatrics and Nutritional Sciences, Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO 63110, USA
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Walls HL, Backholer K, Proietto J, McNeil JJ. Obesity and trends in life expectancy. J Obes 2012; 2012:107989. [PMID: 22655173 PMCID: PMC3359718 DOI: 10.1155/2012/107989] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 02/14/2012] [Indexed: 12/16/2022] Open
Abstract
Background. Increasing levels of obesity over recent decades have been expected to lead to an epidemic of diabetes and a subsequent reduction in life expectancy, but instead all-cause and cardiovascular-specific mortality rates have decreased steadily in most developed countries and life expectancy has increased. Methods. This paper suggests several factors that may be masking the effects of obesity on life expectancy. Results. It is possible that health and life expectancy gains could be even greater if it was not for the increasing prevalence of extreme obesity. It is also possible that the principal impact of obesity is on disability-free life expectancy rather than on life expectancy itself. Conclusion. If the principal impact of obesity were through disability-free life expectancy rather than on life expectancy itself, this would have substantial implications for the health of individuals and the future burden on the health care system.
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Affiliation(s)
- Helen L. Walls
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT 0200, Australia
| | - Kathryn Backholer
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia
| | - Joseph Proietto
- Department of Medicine, University of Melbourne, Repatriation Hospital, Heidelberg, VIC 3084, Australia
| | - John J. McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia
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Abstract
Sarcopenia is a multifactorial age-related condition associated with a sedentary lifestyle and protein intakes during weight loss that are inadequate to maintain muscle mass. Sarcopenic obesity in the elderly is associated with a loss of independence and metabolic complications and represents a major public health challenge in individuals over the age of 65 years. It is likely that age-related losses of muscle mass and coincident increases in fat mass could be reduced through regular resistance exercise combined with adequate protein intake to maintain muscle mass. It has been established that increased protein intake will maintain muscle mass during calorie-restricted diets to a greater extent than usual protein intake. Other strategies, including the use of high-protein meal replacements or supplementation with specific ergogenic or branched-chain amino acids, may be beneficial.
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Affiliation(s)
- Zhaoping Li
- Center for Human Nutrition, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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41
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Mohile SG, Klepin HD, Rao AV. Considerations and controversies in the management of older patients with advanced cancer. Am Soc Clin Oncol Educ Book 2012:321-328. [PMID: 24451757 DOI: 10.14694/edbook_am.2012.32.168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The incidence of cancer increases with age. Oncologists need to be adept at assessing physiologic and functional capacity in older patients in order to provide safe and efficacious cancer treatment. Assessment of underlying health status is especially important for older patients with advanced cancer, for whom the benefits of treatment may be low and the toxicity of treatment high. The comprehensive geriatric assessment (CGA) is the criterion standard for evaluation of the older patient. The combined data from the CGA can be used to stratify patients into categories to better predict risk for chemotherapy toxicity as well as overall outcomes. The CGA can also be used to identify and follow-up on possible functional consequences from treatment. A variety of screening tools might be useful in the oncology practice setting to identify patients who may benefit from further testing and intervention. In this chapter, we discuss how the principles of geriatrics can help improve the clinical care of older adults with advanced cancer. Specifically, we discuss assessing tolerance for treatment, options for chemotherapy scheduling and dosing for older patients with advanced cancer, and management of under-recognized symptoms in older patients with cancer.
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Affiliation(s)
- Supriya Gupta Mohile
- From the Geriatric Oncology Program at the James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY; Wake Forest School of Medicine, Winston-Salem, NC; Division of Geriatrics, Duke University Medical Center, Durham NC
| | - Heidi D Klepin
- From the Geriatric Oncology Program at the James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY; Wake Forest School of Medicine, Winston-Salem, NC; Division of Geriatrics, Duke University Medical Center, Durham NC
| | - Arati V Rao
- From the Geriatric Oncology Program at the James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY; Wake Forest School of Medicine, Winston-Salem, NC; Division of Geriatrics, Duke University Medical Center, Durham NC
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Donini LM, Savina C, Gennaro E, De Felice MR, Rosano A, Pandolfo MM, Del Balzo V, Cannella C, Ritz P, Chumlea WC. A systematic review of the literature concerning the relationship between obesity and mortality in the elderly. J Nutr Health Aging 2012; 16:89-98. [PMID: 22238007 PMCID: PMC3988674 DOI: 10.1007/s12603-011-0073-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Obesity is a risk factor for chronic diseases and premature mortality, but the extent of these associations among the elderly is under debate. The aim of this systematic literature review (SR) is to collate and critically assess the available information of the impact of obesity on mortality in the elderly. METHODS In PubMed, there are three-hundred twelve papers on the relationship between obesity and mortality among older adults. These papers were analysed on the basis of their abstracts, and sixteen studies were considered suitable for the purpose of the study. It was possible to perform a pooled estimate for aggregated data in three different studies. CONCLUSION The results of this SR document that an increased mortality in obese older adults. The limitation of BMI to index obesity and the noted protective action of a moderate increase in BMI on mortality are highlighted. Waist circumference is an indicator of central adiposity and potentially as good a risk factor for mortality as BMI in obese elderly adults.
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Affiliation(s)
- L M Donini
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
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Wong ES, Wang BCM, Garrison LP, Alfonso-Cristancho R, Flum DR, Arterburn DE, Sullivan SD. Examining the BMI-mortality relationship using fractional polynomials. BMC Med Res Methodol 2011; 11:175. [PMID: 22204699 PMCID: PMC3273446 DOI: 10.1186/1471-2288-11-175] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 12/28/2011] [Indexed: 11/10/2022] Open
Abstract
Background Many previous studies estimating the relationship between body mass index (BMI) and mortality impose assumptions regarding the functional form for BMI and result in conflicting findings. This study investigated a flexible data driven modelling approach to determine the nonlinear and asymmetric functional form for BMI used to examine the relationship between mortality and obesity. This approach was then compared against other commonly used regression models. Methods This study used data from the National Health Interview Survey, between 1997 and 2000. Respondents were linked to the National Death Index with mortality follow-up through 2005. We estimated 5-year all-cause mortality for adults over age 18 using the logistic regression model adjusting for BMI, age and smoking status. All analyses were stratified by sex. The multivariable fractional polynomials (MFP) procedure was employed to determine the best fitting functional form for BMI and evaluated against the model that includes linear and quadratic terms for BMI and the model that groups BMI into standard weight status categories using a deviance difference test. Estimated BMI-mortality curves across models were then compared graphically. Results The best fitting adjustment model contained the powers -1 and -2 for BMI. The relationship between 5-year mortality and BMI when estimated using the MFP approach exhibited a J-shaped pattern for women and a U-shaped pattern for men. A deviance difference test showed a statistically significant improvement in model fit compared to other BMI functions. We found important differences between the MFP model and other commonly used models with regard to the shape and nadir of the BMI-mortality curve and mortality estimates. Conclusions The MFP approach provides a robust alternative to categorization or conventional linear-quadratic models for BMI, which limit the number of curve shapes. The approach is potentially useful in estimating the relationship between the full spectrum of BMI values and other health outcomes, or costs.
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Affiliation(s)
- Edwin S Wong
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, USA.
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Body mass index and mortality rate among Hispanic adults: a pooled analysis of multiple epidemiologic data sets. Int J Obes (Lond) 2011; 36:1121-6. [PMID: 21986709 DOI: 10.1038/ijo.2011.194] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the association between body mass index (BMI, kg m⁻²) and mortality rate among Hispanic adults. METHODS AND PROCEDURES Analysis of five data sets (total N=16,798) identified after searching for publicly available, prospective cohort data sets containing relevant information for at least 500 Hispanic respondents (≥18 years at baseline), at least 5 years of mortality follow-up, and measured height and weight. Data sets included the third National Health and Nutrition Examination Survey, the Puerto Rico Heart Health Program (PRHHP), the Hispanic Established Population for Epidemiologic Studies of the Elderly (HEPESE), the San Antonio Heart Study (SAHS) and the Sacramento Area Latino Study on Aging. RESULTS Cox proportional hazards regression models, adjusting for sex and smoking, were fit within three attained-age strata (18 to younger than 60 years, 60 to younger than 70 years, and 70 years and older). We found that underweight was associated with elevated mortality rate for all age groups in the PRHHP (hazard ratios [HRs]=1.38-1.60) and the SAHS (HRs=1.88-2.51). Overweight (HRs=0.38 and 0.84) and obesity grade 2-3 (HRs=0.75 and 0.60) associated with reduced mortality rate in the HEPESE dataset for those in the 60 to younger than 70 years, and 70 years and older attained-age strata. Weighted estimates combining the HRs across the data sets revealed a similar pattern. CONCLUSION Among Hispanic adults, there was no clear evidence that overweight and obesity associate with elevated mortality rate.
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Kortt MA, Dollery B. Association Between Body Mass Index and Health-Related Quality of Life Among an Australian Sample. Clin Ther 2011; 33:1466-74. [DOI: 10.1016/j.clinthera.2011.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2011] [Indexed: 10/17/2022]
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He J. Modeling the dynamic association of BMI and mortality in the Framingham Heart Study. Ann Epidemiol 2011; 21:517-25. [PMID: 21641526 DOI: 10.1016/j.annepidem.2011.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 03/18/2011] [Accepted: 04/02/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE To examine and model the dynamic association of BMI and mortality in the Framingham Heart Study (FHS). METHODS BMI is transformed to facilitate modeling curvature associations. Logistic models are used to demonstrate whether different conclusions may be obtained for the same group of individuals under different settings created from FHS. Time-dependent covariates Cox models are used to model the association of BMI and mortality when the proportional hazards assumptions for Cox models are violated. RESULTS Both the measurement time of BMI and the length of follow-up affect the conclusions obtained from logistic models, especially for men. Time-dependent covariates Cox models show that the association between BMI and mortality for men depends on the follow-up time, while that for women depends on the age of BMI measurement. CONCLUSION The association of BMI and mortality in FHS is a dynamic system that traditional analyses methods may lead to different conclusions for different study designs. This finding is consistent with the results of several other studies done from different perspectives, suggesting that the dynamic features demonstrated in FHS may apply to other populations. Advanced methods such as time-dependent covariates Cox models may be helpful for future analysis.
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Affiliation(s)
- Jianghua He
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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Azar Sharabiani MT, Vermeulen R, Scoccianti C, Hosnijeh FS, Minelli L, Sacerdote C, Palli D, Krogh V, Tumino R, Chiodini P, Panico S, Vineis P. Immunologic profile of excessive body weight. Biomarkers 2011; 16:243-51. [DOI: 10.3109/1354750x.2010.547948] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | | | | | | | | | | | | | | | | | | | - Paolo Vineis
- MRC/HPA Centre for Environment and Health, School of Public Health, Imperial College, London, UK
- Imperial College, London, UK
- HuGeF Foundation, Torino, Italy
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Chronic kidney disease and the risk of end-stage renal disease versus death. J Gen Intern Med 2011; 26:379-85. [PMID: 20853156 PMCID: PMC3055978 DOI: 10.1007/s11606-010-1511-x] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 08/17/2010] [Accepted: 08/26/2010] [Indexed: 10/29/2022]
Abstract
BACKGROUND Among older adults with chronic kidney disease (CKD), the comparative event rates of end-stage renal disease (ESRD) and cause-specific death are unknown. OBJECTIVE To compare the rates of ESRD, cardiovascular and non-cardiovascular death and examine risk factors for ESRD and all-cause mortality in Cardiovascular Health Study (CHS) participants. DESIGN The CHS is a longitudinal cohort study of community-dwelling adults aged 65 years and older. PARTICIPANTS 1,268 participants with an estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m(2) were followed until the time of first event (ESRD, cardiovascular or non-cardiovascular death) or until March 31, 2003. MAIN MEASURES The outcomes were ESRD, cardiovascular- and non-cardiovascular death. Rates of each event were calculated, and a Cox Proportional Hazards Model with a competing risk framework was used to examine risk factors for ESRD as compared with death. Predictors included age, gender, race, BMI, hypertension, diabetes, cardiovascular disease, heart failure, tobacco use, eGFR, and total cholesterol. KEY RESULTS During 9.7 years of follow-up, 5% of the cohort progressed to ESRD, and 61% of the cohort died. The rate (per 100 person-years) was 0.5 for ESRD and 6.8 for all-cause mortality (3.0 for cardiovascular and 3.8 for non-cardiovascular mortality). In the competing risk framework, lower eGFR, male gender, African-American race, and higher BMI were associated with an increased risk of ESRD. CONCLUSIONS Older adults with CKD are 13-fold more likely to die from any cause than progress to ESRD and are 6-fold more likely to die from cardiovascular causes than develop ESRD.
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Dorner TE, Rieder A. Obesity paradox in elderly patients with cardiovascular diseases. Int J Cardiol 2011; 155:56-65. [PMID: 21345498 DOI: 10.1016/j.ijcard.2011.01.076] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 01/01/2011] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Thomas E Dorner
- Institute of Social Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.
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Abstract
CONTEXT Prevalence of obesity is increasing globally. The effect of obesity on mortality and morbidity and its implication on the future prevalence of disability in the older population has not been conclusively analyzed. OBJECTIVE To determine the influence of overweight and obesity on mortality and disability by quantifying the effect in terms of disability-free life expectancy and years lost to disability (YLD) in the older people. DESIGN, SETTING AND PARTICIPANTS For 5980 participants from the Rotterdam Study cohort, regression techniques were used to estimate the association of body mass index (BMI) and waist circumference (WC) separately with mortality, incident disability and recovery from disability. Disability was assessed using the Stanford Health Assessment Questionnaire Disability Index, an activity of daily living scale. Multistate life table methodology was used to calculate life expectancies. MAIN OUTCOME MEASURES In total, 15-year mortality risk, 6-year disability incidence, total life expectancy, healthy life expectancy and years of disabled life expectancy. RESULTS We observed 2388 deaths. Our analysis revealed no association between body mass index, or WC and mortality in the healthy population. Body mass index and WC were related to disability ('overweight' 25 < or =BMI <30, odd ratio (OR)=1.33, 95% confidence interval (CI) (1.10; 1.61), 'obesity I' 30< or = BMI <35, OR=2.03, 95% CI (1.55; 2.65)) and negatively to recovery from disability. We observed an increase of years lost to disability with increasing weight for men ('normal weight'-4.69 years, 'overweight'-5.87 years and 'obesity I'-7.06 years) and for women ('normal weight'-10.95 years, 'overweight'-12.82 years, 'obesity I'-15.17 years and 'obesity II/III'-13.13 years). CONCLUSION Results do not support the hypothesis that an increased body weight reduces total life expectancy in the older people. Although increased body weight was associated with a higher risk of becoming and remaining disabled. These results remained using WC.
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