Impact of Body Mass Index on Obesity-Related Cancer and Cardiovascular Disease Mortality; The Japan Collaborative Cohort Study

Association of obesity with cardiovascular disease in the absence of traditional risk factors

BACKGROUND

The association between obesity and cardiovascular disease (CVD) in people without traditional CVD risk factors is unclear. This study aimed to investigate the association of obesity with CVD and its subtypes in people without traditional CVD risk factors.

METHODS

Based on the Kailuan cohort study, the included participants were divided into different groups according to levels of body mass index (BMI) and waist height ratio (WHtR), respectively. Multivariate Cox proportional hazard models were used to evaluate the associations.

RESULTS

This study included 31,955 participants [men 63.99%; mean age (48.14 ± 3.33) years]. During a median follow-up period of 12.97 (interquartile range: 12.68-13.17) years, 1298 cases of CVD were observed. Compared with the normal BMI group, the hazard ratios (HRs) for CVD, stroke, and myocardial infarction (MI) in the BMI obese group were 1.31 (95% confidence interval [CI] 1.11-1.55), 1.21 (95%CI 1.01-1.46), 1.62 (95%CI 1.13-2.33), respectively. Compared with the WHtR non-obese group, the HRs for CVD, stroke, and MI in the obese group were 1.25(95%CI 1.11-1.41), 1.18 (95%CI 1.03-1.34), 1.57 (95%CI 1.18-2.09), respectively. There was an interaction between age and WHtR (P for interaction was 0.043). The association between WHtR and CVD was stronger in people under 60 years old, with a HR of 1.44 (95%CI 1.24-1.67).

CONCLUSION

We found that obesity increased the risk of CVD in people without traditional CVD risk factors. The association of WHtR with CVD was stronger in people under 60 years old.

Dietary intake of polychlorinated dibenzo-p-dioxins and furans, adiposity and obesity status

INTRODUCTION

The principal source of exposure to Polychlorinated dibenzo-p-dioxins and polychlorinated dibenzo-p-furans (PCDD/Fs) in humans comes from food intake. PCDD/Fs, are a family of potential endocrine disruptors and have been associated with different chronic diseases such as diabetes and hypertension. However, studies assessing the relationship between dietary exposure to PCDD/Fs and adiposity or obesity status in a middle-aged population are limited.

OBJECTIVE

To assess cross-sectionally and longitudinally the associations between estimated dietary intake (DI) of PCDD/Fs and body mass index (BMI), waist circumference, and the prevalence/incidence of obesity and abdominal obesity in a middle-aged population.

METHODS

In 5899 participants aged 55-75 years (48% women) living with overweight/obesity from the PREDIMED-plus cohort, PCDD/Fs DI was estimated using a 143-item validated food-frequency questionnaire, and the levels of food PCDD/F expressed as Toxic Equivalents (TEQ). Consequently, cross-sectional and prospective associations between baseline PCDD/Fs DI (in pgTEQ/week) and adiposity or obesity status were assessed at baseline and after 1-year follow-up using multivariable cox, logistic or linear regression models.

RESULTS

Compared to participants in the first PCDD/F DI tertile, those in the highest tertile presented a higher BMI (β-coefficient [confidence interval]) (0.43kg/m2 [0.22; 0.64]; P-trend <0.001), a higher waist circumference (1.11 cm [0.55; 1.66]; P-trend <0.001), and a higher prevalence of obesity and abdominal obesity (1.05 [1.01; 1.09] and 1.02 [1.00; 1.03]; P-trend = 0.09 and 0.027, respectively). In the prospective analysis, participants in the top PCDD/F DI baseline tertile showed an increase in waist circumference compared with those in the first tertile after 1-year of follow-up (β-coefficient 0.37 cm [0.06; 0.70]; P-trend = 0.015).

CONCLUSION

Higher DI of PCDD/Fs was positively associated with adiposity parameters and obesity status at baseline and with changes in waist circumference after 1-year of follow-up in subjects living with overweight/obesity. Further large prospective studies using a different population with longer follow-up periods are warranted in the future to strengthen our results.

Body Mass Index and Mortality from Nonrheumatic Aortic Valve Disease among Japanese Men and Women

AIM

We aimed to examine the impact of overweight and obesity on mortality from nonrheumatic aortic valve disease.

METHODS

In the Japan Collaborative Cohort Study, we analyzed data of 98,378 participants aged 40-79 years, with no history of coronary heart disease, stroke, or cancer at baseline (1988-1990) and who completed a lifestyle questionnaire including height and body weight; they were followed for mortality until the end of 2009. The Cox proportional hazards model was used to calculate the multivariable hazard ratios (HRs) with 95% confidence intervals (CIs) of nonrheumatic aortic valve disease mortality according to body mass index (BMI) after adjusting for potential confounding factors.

RESULTS

During the median 19.2 years follow-up, 60 deaths from nonrheumatic aortic valve disease were reported. BMI was positively associated with the risk of mortality from nonrheumatic aortic valve disease; the multivariable HRs (95% CIs) were 0.90 (0.40-2.06) for persons with BMI ＜21 kg/m², 1.71 (0.81-3.58) for BMI 23-24.9 kg/m², 1.65 (0.69-3.94) for BMI 25-26.9 kg/m², and 2.83 (1.20-6.65) for BMI ≥ 27 kg/m² (p for trend=0.006), compared with persons with BMI 21-22.9 kg/m². Similar associations were observed between men and women (p for interaction=0.56). Excluding those who died during the first ten years of follow-up or a competing risk analysis with other causes of death as competing risk events did not change the association materially.

CONCLUSIONS

Overweight and obesity may be independent risk factors for nonrheumatic aortic valve disease mortality in Asian populations.

Effect of Mid-Adolescent Dietary Practices on Eating Behaviors and Attitudes in Adulthood

This paper aimed to clarify the association of mid-adolescent dietary practices and experiences with adult eating behavior and attitudes using individual data from the "Survey of Attitudes toward Shokuiku (food and nutrition education), 2019" put forth by the Ministry of Agriculture, Forestry and Fisheries of Japan. We applied conditional mixed-process models to estimate the parameters simultaneously, and used them to predict current eating consciousness, current eating behaviors in a balanced diet, dietary behavior, and attitudes toward preventing or improving lifestyle-related diseases as dependent variables. As a result, compared to those who did not have good dietary practices and experiences in mid-adolescence, participants who had good dietary practices and experiences in the same period displayed greater interest in practicing a healthier diet. These participants frequently consumed a combination of staple foods, main dishes, and side dishes, and were more concerned about preventing or improving lifestyle-related diseases. In conclusion, mid-adolescent dietary practices and experiences had a lasting influence on adult eating behaviors and attitudes in Japanese participants.

Association of fatty liver index with all-cause and disease-specific mortality: A nationwide cohort study

BACKGROUND

Population-based data regarding the prognostic implications of hepatic steatosis have been inconsistent. We examined the association between the fatty liver index (FLI) with all-cause and disease-specific mortality in the general population.

METHODS

We included subjects who underwent a health examination in 2009 using the Korean nationwide health screening database. Death and cause of death data were provided by Statistics Korea. The causes of death were classified using 10th Revision of the International Classification of Diseases codes.

RESULTS

Among the included 10,585,844 participants, there were 418,296 deaths during a median follow-up period of 8.3 years. When adjusting for possible confounding factors, the risk of all-cause mortality linearly increased with a higher FLI score (hazard ratio [HR], 95% confidence interval [CI]: FLI 30-59, 1.19, 1.18-1.20; FLI ≥ 60, 1.67, 1.65-1.69, P for trend <0.001). The risk of disease-specific mortality including cardiovascular disease (CVD), cancer, respiratory disease and liver disease, linearly increased as the FLI score became higher (HR, 95% CI: FLI 30-59, 1.18, 1.16-1.20, FLI ≥ 60: 1.61, 1.56-1.65 for CVD; FLI 30-59, 1.13, 1.11-1.14, FLI ≥ 60, 1.41, 1.38-1.44 for cancer; FLI 30-59, 1.26, 1.22-1.29, FLI ≥ 60, 1.96, 1.88-2.05 for respiratory disease, FLI 30-59, 2.29, 2.21-2.38, FLI ≥ 60, 5.57, 5.31-5.85 for liver disease). The risk of all-cause mortality increased as the FLI score became higher across all the body mass index groups, and the greatest risk was observed in those who were underweight (HR, 95% CI = 2.43, 2.09-2.82 in FLI ≥ 60).

CONCLUSION

FLI may serve as a prognostic indicator of death and a high FLI is associated with a poor prognosis particularly in the underweight group.

The Lifelong Health Support 10: a Japanese prescription for a long and healthy life

Background

Although the age-adjusted incidence and mortality of cancer and cardiovascular disease (CVD) have been decreasing steadily in Japan, both diseases remain major contributors to morbidity and mortality along with the aging society. Herein, we aim to provide a prescription of 10 health tips for long and healthy life named the “Lifelong Health Support 10 (LHS10).”

Method

The LHS10 was developed by the preventive medicine specialists at the National Cerebral and Cardiovascular Center in Suita, where it has been used for health guidance to prevent CVD, cancer, and cognitive decline in addition to their major risk factors such as hypertension, diabetes, and obesity. It consisted of the lifestyle modification recommendations of the 2014 Japanese Society of Hypertension guidelines and the 2017 Japan Atherosclerosis Society Guidelines for preventing atherosclerotic CVD. Further, it came in line with other international lifestyle modification guidelines. In this narrative review, we summarized the results of several Japanese epidemiological studies investigating the association between the LHS10 items and the risk of cancer, CVD, and other chronic diseases including dementia, diabetes, and chronic kidney disease.

Results

The LHS10 included avoiding smoking and secondhand smoke exposure, engaging in physical activity, refraining from excessive alcohol drinking, reducing fried foods and sugary soft drinks, cutting salt in food, consuming more vegetables, fruits, fish, soy foods, and fibers, and maintaining proper body weight. All items of the LHS10 were shown to reduce the risk of cancer, CVD, and other chronic diseases.

Conclusions

The LHS10 can be a helpful tool for health guidance.

Supplementary information

The online version contains supplementary material available at https://doi.org/10.1265/ehpm.22-00085.