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Ong SWX, Young BE, Leo YS, Lye DC. Association of Higher Body Mass Index With Severe Coronavirus Disease 2019 (COVID-19) in Younger Patients. Clin Infect Dis 2020; 71:2300-2302. [PMID: 32382755 PMCID: PMC7239262 DOI: 10.1093/cid/ciaa548] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Sean Wei Xiang Ong
- National Centre for Infectious Diseases, Singapore.,Tan Tock Seng Hospital, Singapore
| | - Barnaby Edward Young
- National Centre for Infectious Diseases, Singapore.,Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore.,Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore.,Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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52
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Jung SW, Cho M, Oh W, Ko GJ, Moon JY, Lee SH, Kim YG. Incremental Effect of Aging on Obesity-Related Incident Chronic Kidney Disease in the Korean General Population. J Am Med Dir Assoc 2020; 22:1751-1756.e2. [PMID: 33238141 DOI: 10.1016/j.jamda.2020.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/16/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Obesity may increase the risk of kidney function decline. However, few studies have addressed how age modifies obesity-associated risk of chronic kidney disease (CKD) in the Asian general population. DESIGN A community-based prospective cohort study. SETTING AND PARTICIPANTS 6538 Korean general population with normal kidney function from the Korean Genome and Epidemiology Study Database. METHODS Participants were stratified according to age (40-49, 50-59, and 60-69 years old) and body mass index [≥18.5-<23 (normal-weight), ≥23-<27.5 (overweight), and ≥27.5 (obese)]. We conducted Kaplan-Meier and multivariable-adjusted Cox regression analyses to investigate the association of aging and obesity with incident CKD. RESULTS During the 12-year follow-up, an overall incidence rate of CKD was 6.1 cases per 1000 person-years. Obese, but not overweight, people had an increased risk of incident CKD compared with normal-weight people in multivariable models adjusted for metabolic factors. When analyzed by 10-year increments, this association was significant only in 60-69-year-old individuals. Kaplan-Meier analysis showed that the incidence of CKD associated with overweight or obesity showed an accentuated increase with age. With reference to normal-weight individuals aged 40-49 years, the adjusted hazard ratio of CKD increased with age regardless of body mass index, and the positive association between obesity and incident CKD was more prominent with increasing age. CONCLUSIONS AND IMPLICATIONS Obesity-associated risk of incident CKD was accentuated in older people, and this association was independent of metabolic abnormalities.
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Affiliation(s)
- Su Woong Jung
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Minhae Cho
- School of Social Work, University of Memphis, Memphis, TN, USA
| | - Wonsuk Oh
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Gang Jee Ko
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ju-Young Moon
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sang-Ho Lee
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Yang Gyun Kim
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
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53
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Kuzuya M. Nutritional status related to poor health outcomes in older people: Which is better, obese or lean? Geriatr Gerontol Int 2020; 21:5-13. [PMID: 33200583 DOI: 10.1111/ggi.14088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/14/2020] [Accepted: 10/29/2020] [Indexed: 12/30/2022]
Abstract
Good nutritional status is crucial for maintaining growth and health in all stages of life. However, the relationship between nutritional status and health and the effect on various health-related outcomes differ, depending on the life stage. Many adverse outcomes in older adults, directly linked to different nutritional status, are not present in middle-aged adults, and their ideal nutritional status may differ. This article will review the optimal nutritional status, mainly evaluated by anthropometric measurements such as body mass index, for older adults from various perspectives. Overall, in older adults low body mass index is at higher risk of health problems such as mortality and difficulties in physical functioning compared with middle-aged adults, reducing the risk of health problems for overweight and (abdominal) obesity. Overweight may be more beneficial than lower level of normal weight in older-old and vulnerable older people. While, with or without obesity, skeletal muscle loss or weakness as well as unintentional weight loss induces health problems in older adults. The impact of metabolic syndrome on the prognosis of older adults is clearly reduced compared with middle-aged adults, requiring a shift in medical attention in older adults from metabolic syndrome to frailty. There are still many unclear points regarding the optimal nutritional status of older people, and further research is needed to support healthy longevity. Geriatr Gerontol Int 2021; 21: 5-13.
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Affiliation(s)
- Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Institutes of Innovation for Future Society, Nagoya University, Nagoya, Japan
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54
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Khaddour K, Gomez-Perez SL, Jain N, Patel JD, Boumber Y. Obesity, Sarcopenia, and Outcomes in Non-Small Cell Lung Cancer Patients Treated With Immune Checkpoint Inhibitors and Tyrosine Kinase Inhibitors. Front Oncol 2020; 10:576314. [PMID: 33194687 PMCID: PMC7607047 DOI: 10.3389/fonc.2020.576314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/24/2020] [Indexed: 02/06/2023] Open
Abstract
Body composition refers to the proportional content of body fat mass and lean body mass that can lead to a continuum of different phenotypes ranging from cachectic/sarcopenic state to obesity. The heterogenetic phenotypes of body composition can contribute to formation of some cancer types and can sometimes lead to disparate outcomes. Both of these extremes of the spectrum exist in patients with non-small cell lung carcinoma (NSCLC). The discovery of new pathways that drive tumorigenesis contributing to cancer progression and resistance have expanded our understanding of cancer biology leading to development of new targeted therapies including tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) that have changed the landscape of NSCLC treatment. However, in the new era of precision medicine, the impact of body composition phenotypes on treatment outcomes and survival is now being elucidated. In this review, we will discuss the emerging evidence of a link between body composition and outcomes in patients with NSCLC treated with TKI and ICI. We will also discuss suggested mechanisms by which body composition can impact tumor behavior and anti-tumor immunological response.
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Affiliation(s)
- Karam Khaddour
- Department of Medicine, Rosalind Franklin University of Medicine and Science, McHenry, IL, United States.,Department of Medicine, Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL, United States
| | - Sandra L Gomez-Perez
- Department of Clinical Nutrition, Rush University Medical Center, Chicago, IL, United States
| | - Nikita Jain
- Department of Medicine, Rosalind Franklin University of Medicine and Science, McHenry, IL, United States
| | - Jyoti D Patel
- Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, United States
| | - Yanis Boumber
- Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, United States.,Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
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55
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Pursnani S, Merchant M. South Asian ethnicity as a risk factor for coronary heart disease. Atherosclerosis 2020; 315:126-130. [PMID: 33317714 DOI: 10.1016/j.atherosclerosis.2020.10.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 09/14/2020] [Accepted: 10/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS South Asian ethnicity has been associated with increased cardiovascular risk, in the context of a greater burden of traditional cardiovascular disease risk factors. We aimed to identify the 10-year incidence of coronary heart disease (CHD) in South Asians, as compared to other racial-ethnic groups, in a retrospective cohort study, using the Kaiser Permanente Northern California integrated health care system, and to understand whether traditional risk factors could explain differences in outcomes. METHODS AND RESULTS A study cohort established in 2006, with 10-year follow-up, identified a total n = 341,309 patients, including 5149 South Asians, aged 30-70 years who underwent a screening lipid panel and had no prior history of CHD. There were a total of 460 (8.93%) patients with at least one cardiovascular event, including cardiovascular death, coronary artery revascularization, and myocardial infarction, in South Asians, as compared to 5.66% patients in the total population (p < 0.0001). In a multivariable logistic regression analysis, South Asian ethnicity, compared to White race, was associated with an adjusted odds ratio (aOR) = 2.04 (95%CI: 1.83, 2.28) in predicting the cardiovascular outcomes. CONCLUSIONS South Asian ethnicity, even after adjustment for traditional risk factors, is associated with an increased risk of coronary heart disease outcomes. This risk was greater than other studied racial-ethnic groups and second only to diabetes in CHD risk prediction.
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Affiliation(s)
- Seema Pursnani
- The Permanente Medical Group, Kaiser Permanente, Santa Clara, CA, USA.
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56
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Gao M, Lv J, Yu C, Guo Y, Bian Z, Yang R, Du H, Yang L, Chen Y, Li Z, Zhang X, Chen J, Qi L, Chen Z, Huang T, Li L. Metabolically healthy obesity, transition to unhealthy metabolic status, and vascular disease in Chinese adults: A cohort study. PLoS Med 2020; 17:e1003351. [PMID: 33125374 PMCID: PMC7598496 DOI: 10.1371/journal.pmed.1003351] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Metabolically healthy obesity (MHO) and its transition to unhealthy metabolic status have been associated with risk of cardiovascular disease (CVD) in Western populations. However, it is unclear to what extent metabolic health changes over time and whether such transition affects risks of subtypes of CVD in Chinese adults. We aimed to examine the association of metabolic health status and its transition with risks of subtypes of vascular disease across body mass index (BMI) categories. METHODS AND FINDINGS The China Kadoorie Biobank was conducted during 25 June 2004 to 15 July 2008 in 5 urban (Harbin, Qingdao, Suzhou, Liuzhou, and Haikou) and 5 rural (Henan, Gansu, Sichuan, Zhejiang, and Hunan) regions across China. BMI and metabolic health information were collected. We classified participants into BMI categories: normal weight (BMI 18.5-23.9 kg/m²), overweight (BMI 24.0-27.9 kg/m²), and obese (BMI ≥ 28 kg/m²). Metabolic health was defined as meeting less than 2 of the following 4 criteria (elevated waist circumference, hypertension, elevated plasma glucose level, and dyslipidemia). The changes in obesity and metabolic health status were defined from baseline to the second resurvey with combination of overweight and obesity. Among the 458,246 participants with complete information and no history of CVD and cancer, the mean age at baseline was 50.9 (SD 10.4) years, and 40.8% were men, and 29.0% were current smokers. During a median 10.0 years of follow-up, 52,251 major vascular events (MVEs), including 7,326 major coronary events (MCEs), 37,992 ischemic heart disease (IHD), and 42,951 strokes were recorded. Compared with metabolically healthy normal weight (MHN), baseline MHO was associated with higher hazard ratios (HRs) for all types of CVD; however, almost 40% of those participants transitioned to metabolically unhealthy status. Stable metabolically unhealthy overweight or obesity (MUOO) (HR 2.22, 95% confidence interval [CI] 2.00-2.47, p < 0.001) and transition from metabolically healthy to unhealthy status (HR 1.53, 1.34-1.75, p < 0.001) were associated with higher risk for MVE, compared with stable healthy normal weight. Similar patterns were observed for MCE, IHD, and stroke. Limitations of the analysis included lack of measurement of lipid components, fasting plasma glucose, and visceral fat, and there might be possible misclassification. CONCLUSIONS Among Chinese adults, MHO individuals have increased risks of MVE. Obesity remains a risk factor for CVD independent of major metabolic factors. Our data further suggest that metabolic health is a transient state for a large proportion of Chinese adults, with the highest vascular risk among those remained MUOO.
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Affiliation(s)
- Meng Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
- Peking University Institute of Environmental Medicine, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Ruotong Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Huaidong Du
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Ling Yang
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yiping Chen
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Zhongxiao Li
- Maiji Center for Disease Control and Prevention, Maiji, Gansu, China
| | - Xi Zhang
- Maiji Center for Disease Control and Prevention, Maiji, Gansu, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Tao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
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57
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Eme PE, Burlingame B, Kim ND, Foliaki S, Wham C, Douwes J. Obesity measures in the Kiribati population: a need to reclassify body mass index cut-points. BMC Public Health 2020; 20:1092. [PMID: 32652963 PMCID: PMC7353766 DOI: 10.1186/s12889-020-09217-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 07/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is a public health problem in Micronesia. The objective of the study was to assess obesity, the relationship between body mass index (BMI) and body fat percentage (BF%) among adults, and determine the appropriate BMI cut-points in Kiribati. METHODS A cross-sectional study was undertaken among 483 adults randomly selected from South Tarawa (ST) and Butaritari (BT). Weight, height, BF% and physical activity level (PAL) was measured using standard methods. Linear and quadratic regression analyses were conducted to assess the association between BF% and BMI whilst controlling for age and gender. Receiver operating characteristics (ROC) curve analyses were used to assess whether for the Kiribati population alternative BMI cut-off points for obesity are needed. RESULTS Approximately 75% of participants were obese using standard BMI and BF% cut-offs, with the highest prevalence observed in South Tarawa. BF% was significantly (p < 0.001) and positively associated with age (males, r = 0.78; females, r = 0.67; p < 0.001) and BMI. Based on ROC-curve analyses the BMI cut-offs for predicting high BF% among I-Kiribati people were 24.5 kg/m2 for males and 32.9 kg/m2 for females. CONCLUSIONS In conclusion, the majority of adults in Kiribati were either obese or overweight and had high BF%. We suggest that ethnic-specific BMI cut-points to define obesity for the population of Kiribati may be more appropriate than the currently used international cut-points.
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Affiliation(s)
- P. E. Eme
- Department of Nutrition and Dietetics, University of Nigeria, Nsukka, Enugu State Nigeria
| | - B. Burlingame
- School of Health Sciences, College of Health, Massey University, PO Box 756, Wellington, 6140 New Zealand
| | - N. D. Kim
- School of Health Sciences, College of Health, Massey University, PO Box 756, Wellington, 6140 New Zealand
| | - S. Foliaki
- Centre of Public Health Research, Massey University, PO Box 756, Wellington, 6140 New Zealand
| | - C. Wham
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Private Bag 102904, North Shore City, Auckland, 0745 New Zealand
| | - J. Douwes
- Centre of Public Health Research, Massey University, PO Box 756, Wellington, 6140 New Zealand
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58
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Xu H, Jin C, Guan Q. Causal Effects of Overall and Abdominal Obesity on Insulin Resistance and the Risk of Type 2 Diabetes Mellitus: A Two-Sample Mendelian Randomization Study. Front Genet 2020; 11:603. [PMID: 32714368 PMCID: PMC7343715 DOI: 10.3389/fgene.2020.00603] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/18/2020] [Indexed: 12/21/2022] Open
Abstract
Overall and abdominal obesity were significantly associated with insulin resistance and type 2 diabetes mellitus (T2DM) risk in observational studies, though these associations cannot avoid the bias induced by confounding effects and reverse causation. This study aimed to test whether these associations are causal, and it compared the causal effects of overall and abdominal obesity on T2DM risk and glycemic traits by using a two-sample Mendelian randomization (MR) design. Based on summary-level statistics from genome-wide association studies, the instrumental variables for body mass index (BMI), waist-to-hip ratio (WHR), and WHR adjusted for BMI (WHRadjBMI) were extracted, and the horizontal pleiotropy was analyzed using MR-Egger regression and the MR-pleiotropy residual sum and outlier (PRESSO) method. Thereafter, by using the conventional MR method, the inverse-variance weighted method was applied to assess the causal effect of BMI, WHR, and WHRadjBMI on T2DM risk, Homeostatic model assessment of insulin resistance (HOMA-IR), fasting insulin, fasting glucose, and Hemoglobin A1c (HbA1c). A series of sensitivity analyses, including the multivariable MR (diastolic blood pressure, systolic blood pressure, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol as covariates), MR-Egger regression, weighted median, MR-PRESSO, and leave-one-out method, were conducted to test the robustness of the results from the conventional MR. Despite the existence of horizontal pleiotropy, consistent results were found in the conventional MR results and sensitivity analyses, except for the association between BMI and fasting glucose, and WHRadjBMI and fasting glucose. Each one standard deviation higher BMI was associated with an increased T2DM risk [odds ratio (OR): 2.741; 95% confidence interval (CI): 2.421-3.104], higher HbA1c [1.054; 1.04-1.068], fasting insulin [1.202; 1.173-1.231], and HOMA-IR [1.221; 1.187-1.255], similar to findings for causal effect of WHRadjBMI on T2DM risk [1.993; 1.704-2.33], HbA1c [1.061; 1.042-1.08], fasting insulin [1.102; 1.068-1.136], and HOMA-IR [1.127; 1.088-1.167]. Both BMI (P = 0.546) and WHRadjBMI (P = 0.443) were unassociated with fasting glucose in the multivariable MR analysis. In conclusion, overall and abdominal obesity have causal effects on T2DM risk and insulin resistance but no causal effect on fasting glucose. Individuals can substantially reduce their insulin resistance and T2DM risk through reduction of body fat mass and modification of body fat distribution.
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Affiliation(s)
- Hua Xu
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, China
| | - Chuandi Jin
- Institute for Medical Dataology, Shandong University, Jinan, China
| | - Qingbo Guan
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, China
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Rico-Martín S, Calderón-García JF, Sánchez-Rey P, Franco-Antonio C, Martínez Alvarez M, Sánchez Muñoz-Torrero JF. Effectiveness of body roundness index in predicting metabolic syndrome: A systematic review and meta-analysis. Obes Rev 2020; 21:e13023. [PMID: 32267621 DOI: 10.1111/obr.13023] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/07/2020] [Accepted: 03/08/2020] [Indexed: 01/02/2023]
Abstract
Body roundness index (BRI) is a new anthropometric index developed to predict both body fat and the percentage of visceral adipose tissue. Our aim was to investigate whether BRI is superior to traditional anthropometric indices in predicting metabolic syndrome (MetS). This systematic review and meta-analysis was conducted using Pubmed, Scopus and Web of Sciences databases. The estimated pooled areas under curve (AUCs) for BRI predicting MetS was higher than body mass index (BMI), waist-to-hip ratio (WHR), body shape index (ABSI) and body adiposity index (BAI), similar to waist circumference (WC) and lower than waist-to-height ratio (WHtR). However, the difference between BRI and BMI, WC and WHtR predicting MetS was statistically non-significant. Similar results were found with the summary receiver operating characteristic curve (AUC-SROC). In addition, the non-Chinese population had pooled AUCs greater than the Chinese population for all indices. Pooled ORs showed that BRI is associated with an increased MetS risk. In conclusion, BRI had good discriminatory power for MetS in adults of both sexes from diverse populations (AUC > 0.7; AUC-SROC>0.7). However, WC and WHtR offer the best performance when screening for MetS, and non-significant differences were found with BRI. In contrast, BRI was superior to BMI, WHR, ABSI and BAI in predicting MetS.
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Affiliation(s)
- Sergio Rico-Martín
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - Julían F Calderón-García
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - Purificación Sánchez-Rey
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - Cristina Franco-Antonio
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
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60
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Kim SM, Choi JH, Son MJ, Rim H, Shin HS. Is Body Mass Index a Significant Independent Risk Factor for Graft Failure and Patient Death in the Modern Immunosuppressive Era? Transplant Proc 2020; 52:3058-3068. [PMID: 32475532 DOI: 10.1016/j.transproceed.2020.02.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/09/2020] [Accepted: 02/15/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Previous studies have shown that kidney transplant recipients with a high body mass index (BMI) have inferior graft and patient outcomes compared to patients with a lower BMI. We hypothesized that there would be secular improvements in outcomes among high BMI recipients. We used data from the United Network for Organ Sharing (UNOS) to determine whether obesity affects patient and graft outcomes following kidney transplantation in the modern immunosuppressive era. METHODS The study sample consisted of 69,749 recipients from 1987 to 1999 and 197,986 recipients from 2000 to 2016. BMI values were categorized into 11 tiers: below 18 kg/m2, from 18 to 36 kg/m2 at 2 kg/m2-unit increments, and above 36 kg/m2. We created multivariate models to evaluate the independent effect of BMI on graft and patient outcomes, adjusting for factors known to affect graft success and patient survival. RESULTS Overall graft and patient survival has improved for all BMI categories. Cox regression modeling hazard ratios showed that the relative risk for graft loss, patient death, and patient death with a functioning graft in the modern immunosuppressive era (2000 to 2016) has significantly decreased compared to the earlier era (1987 to 1999), especially for living kidney transplant recipients. CONCLUSIONS The relative risk of graft failure and patient death with increasing BMI has appreciably decreased in the modern immunosuppressive era, especially for living donor transplant recipients. Withholding transplantation from patients with higher BMIs may no longer be justifiable on grounds of worse clinical outcomes.
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Affiliation(s)
- Sun Min Kim
- Renal Division, Department of Internal Medicine, Kosin University, College of Medicine, Busan, Republic of Korea
| | - Jae Hyuc Choi
- Renal Division, Department of Internal Medicine, Kosin University, College of Medicine, Busan, Republic of Korea
| | - Mu Jin Son
- Renal Division, Department of Internal Medicine, Kosin University, College of Medicine, Busan, Republic of Korea
| | - Hark Rim
- Renal Division, Department of Internal Medicine, Kosin University, College of Medicine, Busan, Republic of Korea
| | - Ho Sik Shin
- Renal Division, Department of Internal Medicine, Kosin University, College of Medicine, Busan, Republic of Korea.
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61
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Lyons MM, Bhatt NY, Pack AI, Magalang UJ. Global burden of sleep-disordered breathing and its implications. Respirology 2020; 25:690-702. [PMID: 32436658 DOI: 10.1111/resp.13838] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/01/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022]
Abstract
One-seventh of the world's adult population, or approximately one billion people, are estimated to have OSA. Over the past four decades, obesity, the main risk factor for OSA, has risen in striking proportion worldwide. In the past 5 years, the WHO estimates global obesity to affect almost two billion adults. A second major risk factor for OSA is advanced age. As the prevalence of the ageing population and obesity increases, the vulnerability towards having OSA increases. In addition to these traditional OSA risk factors, studies of the global population reveal select contributing features and phenotypes, including extreme phenotypes and symptom clusters that deserve further examination. Untreated OSA is associated with significant comorbidities and mortality. These represent a tremendous threat to the individual and global health. Beyond the personal toll, the economic costs of OSA are far-reaching, affecting the individual, family and society directly and indirectly, in terms of productivity and public safety. A better understanding of the pathophysiology, individual and ethnic similarities and differences is needed to better facilitate management of this chronic disease. In some countries, measures of the OSA disease burden are sparse. As the global burden of OSA and its associated comorbidities are projected to further increase, the infrastructure to diagnose and manage OSA will need to adapt. The use of novel approaches (electronic health records and artificial intelligence) to stratify risk, diagnose and affect treatment are necessary. Together, a unified multi-disciplinary, multi-organizational, global approach will be needed to manage this disease.
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Affiliation(s)
- M Melanie Lyons
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Nitin Y Bhatt
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Allan I Pack
- Division of Sleep Medicine/Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ulysses J Magalang
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Donini LM, Pinto A, Giusti AM, Lenzi A, Poggiogalle E. Obesity or BMI Paradox? Beneath the Tip of the Iceberg. Front Nutr 2020; 7:53. [PMID: 32457915 PMCID: PMC7221058 DOI: 10.3389/fnut.2020.00053] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/30/2020] [Indexed: 12/16/2022] Open
Abstract
The obesity paradox refers to extant evidence showing that obesity in older subjects or in patients with several chronic diseases may be protective and associated with decreased mortality. A number of mechanisms have been postulated to support the existence of obesity paradox; however, marked heterogeneity was found across studies and this has cast doubt on the actual presence of this phenomenon. The aim of the present narrative review is to summarize evidence underlying the concept of obesity paradox, focusing on limitations and bias related to this phenomenon, with emphasis on the use of body mass index (BMI). A major cause of the discrepancy between studies may be related to the use of BMI in the definition of obesity, that should consider, instead, excess body fat as the main characteristic of this disease and as the unique determinant of its complications. In addition, the adjustment for potential confounders (e.g., stage and grade of diseases, smoking habit, inability to capture the presence of signs of undernutrition in the normal-weight comparative group, consideration of body composition) may significantly scale down the protective role of obesity in terms of mortality. However, it is still necessary to acknowledge few biases (e.g., reverse causation, attrition bias, selection bias of healthy obese subjects or resilient survivors) that would still apply to obesity even when defined according with body composition. Further research should be prompted in order to promote correct phenotyping of patients in order to capture properly the trajectories of mortality in a number of diseases.
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Affiliation(s)
| | - Alessandro Pinto
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Anna Maria Giusti
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University, Rome, Italy
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Tyrer F, Ling S, Bhaumik S, Gangadharan SK, Khunti K, Gray LJ, Dunkley AJ. Diabetes in adults with intellectual disability: prevalence and associated demographic, lifestyle, independence and health factors. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:287-295. [PMID: 31976599 DOI: 10.1111/jir.12718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 10/01/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND As people with intellectual disabilities (ID) are now living longer, they are more at risk of developing non-communicable diseases, including type 2 diabetes mellitus. However, understanding of factors associated with diabetes for targeted management and prevention strategies is limited. This study aimed to investigate prevalence of diabetes in adults (aged ≥18 years) with ID and its relationship with demographic, lifestyle, independence and health factors. METHOD This was a cross-sectional analysis of interview data from 1091 adults with ID from the Leicestershire Learning Disability Register from 1 January 2010 to 31 December 2016. Logistic regression models were used to identify factors associated with diabetes in the study population. RESULTS The study population did not have healthy lifestyles: just under half reported having lower physical activity levels than people without ID of a similar age; one-quarter consumed fizzy drinks daily; and 20% consumed five or more fruit and/or vegetables per day. Prevalence of carer/self-reported diabetes was 7.3% (95% confidence interval 5.9-9.0). After adjustment, diabetes was positively associated with South Asian ethnicity (P = 0.03) and older age groups (P < 0.001). Diabetes was less common in people living with family members (P = 0.02). We did not find a relationship between any of the lifestyle, independence and health factors investigated. CONCLUSIONS A significant proportion of people with ID are living with diabetes. Diabetes management and prevention strategies should be tailored to individuals' complex needs and include consideration of lifestyle choices. Such strategies may want to focus on adults of South Asian ethnicity and people living in residential homes where prevalence appears to be higher.
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Affiliation(s)
- F Tyrer
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - S Ling
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
| | - S Bhaumik
- Learning Disability Services, Leicestershire Partnership NHS Trust, Leicester, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - S K Gangadharan
- Learning Disability Services, Leicestershire Partnership NHS Trust, Leicester, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
| | - L J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - A J Dunkley
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Gupta S, Bansal S. Does a rise in BMI cause an increased risk of diabetes?: Evidence from India. PLoS One 2020; 15:e0229716. [PMID: 32236106 PMCID: PMC7112218 DOI: 10.1371/journal.pone.0229716] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/06/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Overnutrition increases the risk of diabetes. Evidence on the causal impact of overnutrition on diabetes is scarce for India. Considering a representative sample from India, this study examines the causal effect of a rise in the Body Mass Index (BMI) of an individual on the likelihood of being diabetic while addressing the issue of unobserved endogeneity between overnutrition and diabetes. METHODS The study considers individual level data from Demographic and Health Surveys (DHS) of India, namely, National Family Health Survey (NFHS) for the year 2015-16. The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India. The survey covers females having age 15-49 years and males having age 15-54 years. The instrument variable approach is used to address the potential endogeneity in the relationship between BMI and diabetes. We instrument BMI of an individual by BMI of a non-biologically related household member. Ordered Probit, Probit and IV-Probit models are estimated using two alternative definitions for measuring diabetes-self-reported diabetes status and blood glucose levels (ordinal measure). RESULTS The coefficients obtained from the Ordered Probit and Probit models are much smaller than those estimated by an IV-Probit model. The latter estimates the causal impact of a rise in BMI on diabetes by taking into account the effect of the unobserved genetic and other related factors. The likelihood of being diabetic is twice or more among the overweight and obese individuals as compared to non-overweight individuals in all the specifications. With a unit increase in BMI the probability of being diabetic increases by about 1.5% among overweight and obese individuals and by 0.5% among the non-overweight individuals in the IV-Probit model. Similar results from the Ordered Probit model show that on average, the overweight and obese individuals experience about 0.2% increase in the probability of being diabetic and about 0.4% increase in the probability of being prediabetic. CONCLUSION Our study demonstrates that the likelihood of being both prediabetic and diabetic is higher among the overweight and obese individuals as compared to the non-overweight individuals. We also find that the level of risk of being prediabetic or diabetic differs across gender, wealth quintiles and regions and the effects are more severe among population in the urban areas, belonging to the richest wealth quintile and men. Our findings have significant implications for the policy formulation as diabetes has a substantial health and economic burden associated with it. Future studies may investigate the effect of abdominal obesity on diabetes.
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Affiliation(s)
- Shivani Gupta
- Centre for International Trade and Development, School of International Studies, Jawaharlal Nehru University, New Delhi, India
| | - Sangeeta Bansal
- Centre for International Trade and Development, School of International Studies, Jawaharlal Nehru University, New Delhi, India
- * E-mail:
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Mechanick JI, Apovian C, Brethauer S, Timothy Garvey W, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring) 2020; 28:O1-O58. [PMID: 32202076 DOI: 10.1002/oby.22719] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. METHODS Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. RESULTS New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). CONCLUSIONS Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.
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Affiliation(s)
- Jeffrey I Mechanick
- Guideline Task Force Chair (AACE); Professor of Medicine, Medical Director, Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart; Director, Metabolic Support Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York; Past President, AACE and ACE
| | - Caroline Apovian
- Guideline Task Force Co-Chair (TOS); Professor of Medicine and Director, Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Stacy Brethauer
- Guideline Task Force Co-Chair (ASMBS); Professor of Surgery, Vice Chair of Surgery, Quality and Patient Safety; Medical Director, Supply Chain Management, Ohio State University, Columbus, Ohio
| | - W Timothy Garvey
- Guideline Task Force Co-Chair (AACE); Butterworth Professor, Department of Nutrition Sciences, GRECC Investigator and Staff Physician, Birmingham VAMC; Director, UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aaron M Joffe
- Guideline Task Force Co-Chair (ASA); Professor of Anesthesiology, Service Chief, Otolaryngology, Oral, Maxillofacial, and Urologic Surgeries, Associate Medical Director, Respiratory Care, University of Washington, Harborview Medical Center, Seattle, Washington
| | - Julie Kim
- Guideline Task Force Co-Chair (ASMBS); Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Robert F Kushner
- Guideline Task Force Co-Chair (TOS); Professor of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard Lindquist
- Guideline Task Force Co-Chair (OMA); Director, Medical Weight Management, Swedish Medical Center; Director, Medical Weight Management, Providence Health Services; Obesity Medicine Consultant, Seattle, Washington
| | - Rachel Pessah-Pollack
- Guideline Task Force Co-Chair (AACE); Clinical Associate Professor of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, New York
| | - Jennifer Seger
- Guideline Task Force Co-Chair (OMA); Adjunct Assistant Professor, Department of Family and Community Medicine, Long School of Medicine, UT Health Science Center, San Antonio, Texas
| | - Richard D Urman
- Guideline Task Force Co-Chair (ASA); Associate Professor of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephanie Adams
- Writer (AACE); AACE Director of Clinical Practice Guidelines Development, Jacksonville, Florida
| | - John B Cleek
- Writer (TOS); Associate Professor, Department of Nutrition Sciences, University of Alabama, Birmingham, Alabama
| | - Riccardo Correa
- Technical Analysis (AACE); Assistant Professor of Medicine and Endocrinology, Diabetes and Metabolism Fellowship Director, University of Arizona College of Medicine, Phoenix, Arizona
| | - M Kathleen Figaro
- Technical Analysis (AACE); Board-certified Endocrinologist, Heartland Endocrine Group, Davenport, Iowa
| | - Karen Flanders
- Writer (ASMBS); Massachusetts General Hospital Weight Center, Boston, Massachusetts
| | - Jayleen Grams
- Writer (AACE); Associate Professor, Department of Surgery, University of Alabama at Birmingham; Staff Surgeon, Birmingham VA Medical Center, Birmingham, Alabama
| | - Daniel L Hurley
- Writer (AACE); Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Shanu Kothari
- Writer (ASMBS); Fellowship Director of MIS/Bariatric Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Michael V Seger
- Writer (OMA); Bariatric Medical Institute of Texas, San Antonio, Texas, Clinical Assistant Professor, University of Texas Health Science Center, Houston, Texas
| | - Christopher D Still
- Writer (TOS); Medical Director, Center for Nutrition and Weight Management Director, Geisinger Obesity Institute; Medical Director, Employee Wellness, Geisinger Health System, Danville, Pennsylvania
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Gi YM, Jung B, Kim KW, Cho JH, Ha IH. Low handgrip strength is closely associated with anemia among adults: A cross-sectional study using Korea National Health and Nutrition Examination Survey (KNHANES). PLoS One 2020; 15:e0218058. [PMID: 32196502 PMCID: PMC7083305 DOI: 10.1371/journal.pone.0218058] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 02/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background Anemia, which is a major public health problem worldwide, represents a decline in the oxygenation function, and can therefore be related to low strength. However, hemoglobin cannot repair muscles directly, but is beneficial only in a supportive role. Previous studies on the relationship between handgrip strength and anemia have been controversial. Thus, we aimed to analyze the association between handgrip strength and anemia in Korean adults. Methods This cross-sectional study used the 2013–2017 data from the 6th and 7th Korean National Health and Nutrition Examination Survey (KNHANES) that included 16,638 Korean adults, aged ≥19 years, who met the inclusion or exclusion criteria. Differences in sociodemographic factors (sex, age, education, income, and employment), lifestyle factors (alcohol consumption, smoking, and physical activity), and illness and health factors [body mass index (BMI), vitamin intake, iron intake, comorbid illnesses, and handgrip strength] by existence of anemia, were analyzed using the Chi square test. Binary logistic regression analysis was used to measure the association between handgrip strength and anemia, while adjusting for other possible confounders. Subgroup analysis, stratified by sex and age, was performed. Results Among Korean adults aged ≥19 years, 745,296 (7.7%) had anemia. A higher odds ratio, adjusted for other covariates/factors (OR) of anemia occurred in the weak handgrip strength group than in the strong handgrip strength group (OR = 1.92, 95% CI: 1.58–2.33). The subgroup analysis showed a higher OR adjusted for other covariates/factors of anemia in the weak handgrip strength group than in the strong handgrip strength group, regardless of sex or age. However, the association was greater for males (OR = 2.13, 95% CI: 1.35–3.34) and for those aged ≥65 years (OR = 1.92, 95% CI: 1.42–2.58). Conclusion This study showed a strong association between handgrip strength and anemia that was particularly strong for males and those aged ≥65 years.
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Affiliation(s)
- Yu-mi Gi
- Jaseng Hospital of Korean Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Boyoung Jung
- Department of Health Administration, Hanyang Women’s University, Seongdong-gu, Seoul, South Korea
- * E-mail: (BJ); (IHH)
| | - Koh-Woon Kim
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - Jae-Heung Cho
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Gangnam-gu, Seoul, Republic of Korea
- * E-mail: (BJ); (IHH)
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Maffetone PB, Laursen PB. Revisiting the Global Overfat Pandemic. Front Public Health 2020; 8:51. [PMID: 32158742 PMCID: PMC7052125 DOI: 10.3389/fpubh.2020.00051] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/11/2020] [Indexed: 01/03/2023] Open
Abstract
The previously described overfat pandemic, estimated to be 62-76% worldwide, is comprised of individuals with excess body fat sufficient to impair health. The overfat condition is common in those who are overweight and obese, and can also occur in significant numbers of normal-weight non-obese individuals. Being overfat increases the risk for a wide spectrum of common cardiovascular and metabolic (cardiometabolic) abnormalities, chronic diseases and physical impairment. In some ethnicities, up to 40% or more of those who are normal-weight and non-obese may be overfat, a figure twice that used in the original global overfat estimates. In addition to the rates of overfat outpacing overweight and obesity, non-White populations outnumber Whites 6:1, with the recently estimated overfat prevalence being low when considering ethnicities such as Asians, Chinese, Africans and Latin Americans, including these individuals living among predominantly White populations. An awareness of the extent of the overfat pandemic is important because excess body fat can precede cardiometabolic risk factors, chronic diseases, and physical disabilities, and can reduce quality of life and increase healthcare expenditure. The purpose of this Perspective is to demonstrate that the global overfat prevalence of 62-76% may be considerably underestimated.
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Commodore-Mensah Y, Agyemang C, Aboagye JA, Echouffo-Tcheugui JB, Beune E, Smeeth L, Klipstein-Grobusch K, Danquah I, Schulze M, Boateng D, Meeks KAC, Bahendeka S, Ahima RS. Obesity and cardiovascular disease risk among Africans residing in Europe and Africa: the RODAM study. Obes Res Clin Pract 2020; 14:151-157. [PMID: 32061582 DOI: 10.1016/j.orcp.2020.01.007] [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: 11/07/2019] [Revised: 12/28/2019] [Accepted: 01/24/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND The association between anthropometric variables and cardiovascular disease (CVD) risk among Africans is unclear. We examined the discriminative ability of anthropometric variables and estimate cutoffs for predicting CVD risk among Africans. METHODS The Research on Obesity and Diabetes among African Migrants (RODAM) study was a multisite cross-sectional study of Africans in Ghana and Europe. We calculated AHA/ACC Pooled Cohort Equations (PCE) scores for 3661 participants to ascertain CVD risk, and compared a body shape index (ABSI), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), Relative Fat Mass (RFM), and Waist to Height Ratio (WHtR). Logistic regression and receiver operating curve analyses were performed to derive cutoffs for identifying high predicted CVD risk (PCE score ≥7.5%). RESULTS Among men, WC (adjusted Odds Ratio (aOR): 2.25, 95% CI; 1:50-3:37) was strongly associated with CVD risk. Among women, WC (aOR: 1.69, 95% CI: 1:33-2:14) also displayed the strongest association with CVD risk in the BMI-adjusted model but WHR displayed the strongest fit. All variables were superior discriminators of high CVD risk in men (c-statistic range: 0.887-0.891) than women (c-statistic range: 0.677-0.707). The optimal WC cutoff for identifying participants at high CVD risk was 89 cm among men and identified the most cases (64%). Among women, the recommended WC cutoff of 94 cm or WHR cutoff of 0.90 identified the most cases (92%). CONCLUSIONS Anthropometric variables were stronger discriminators of high CVD risk in African men than women. Greater WC was associated with high CVD risk in men while WHR and WC were associated with high CVD risk in women.
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Affiliation(s)
- Y Commodore-Mensah
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Johns Hopkins School of Nursing, MD, United States.
| | - C Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - J A Aboagye
- Department of Surgery, Howard University, Washington, District of Columbia, United States
| | - J B Echouffo-Tcheugui
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - E Beune
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - L Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - K Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - I Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany; Charité - Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - M Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany; Institute of Nutritional Sciences, University of Potsdam, Nuthetal, Germany
| | - D Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - K A C Meeks
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands; Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - S Bahendeka
- MKPGMS-Uganda Martyrs University, Kampala, Uganda
| | - R S Ahima
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Johns Hopkins School of Nursing, MD, United States; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Hu H, Wang J, Han X, Li Y, Miao X, Yuan J, Yang H, He M. Prediction of 5-year risk of diabetes mellitus in relatively low risk middle-aged and elderly adults. Acta Diabetol 2020; 57:63-70. [PMID: 31190268 DOI: 10.1007/s00592-019-01375-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/03/2019] [Indexed: 01/19/2023]
Abstract
AIMS To determine the potential risk factors and construct the predictive model of diabetic risk among a relatively low risk middle-aged and elderly Chinese population. METHODS Information of participants was collected in the Dongfeng-Tongji cohort study, a perspective cohort study of Chinese occupational population. The main outcome was incident type 2 diabetes (T2DM). Based on the conventional risk factors of diabetes, we defined low risk participants without underlying diseases such as coronary heart disease, stroke, cancer, dyslipidemia, hypertension, metabolic syndrome, obesity and family history of diabetes. Totally, 4833 participants from the Dongfeng-Tongji cohort study were enrolled, and of them, 171 had an incident diagnosis of T2DM during 4.6 years of follow-up period. A Cox proportional hazards model was used to estimate effects of risk factors. The restricted cubic spline regression and the Youden index were used to explore the optimal cutoffs of risk factors, and the C index was used to assess the discrimination power of prediction models. RESULTS There were significant linear relationships between BMI/TG level/fasting glucose level and incident diabetic risk among low risk participants. In the restricted cubic spline regression, when fasting glucose level was above 5.4 mmol/L, TG above 1.06 mmol/L and BMI above 22 kg/m2, the HRs (95% CIs) of diabetes were above 1.0. The detailed HRs (95% CI) were 1.29 (1.01, 1.64), 2.57 (1.00, 6.58), and 1.49 (1.00, 2.22), respectively. The optimal cutoff determined by the Yonden index was 1.1 mmol/L for TG, 24 kg/m2 for BMI and 5.89 mmol/L for fasting plasma glucose, respectively. The C index was 0.75 (95% CI: 0.7-0.81) when age, sex, smoke status, physical activity, BMI (< 24 kg/m2 and ≥ 24 kg/m2), TG (< 1.1 mmol/L and ≥ 1.1 mmol/L), and FPG (< 5.89 mmol/L and ≥ 5.89 mmol/L) were introduced into the diabetes predictive model. CONCLUSIONS Fasting plasma glucose level, BMI, and triglyceride level were still dominated factors to predict 5-year diabetic risk among the relatively low risk participants. The cutoff values for fasting plasma glucose, TG, and BMI set as 5.89 mmol/L, 1.1 mmol/L, and 24 kg/m2, respectively, had the best predictive discrimination of diabetes.
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Affiliation(s)
- Hua Hu
- Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Jing Wang
- Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Xu Han
- Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Yaru Li
- Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Xiaoping Miao
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Yuan
- Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Handong Yang
- Dongfeng Central Hospital, Dongfeng Motor Corporation and Hubei University of Medicine, Shiyan, Hubei, China
| | - Meian He
- Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China.
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Hutchins F, Abrams B, Brooks M, Colvin A, Moore Simas T, Rosal M, Sternfeld B, Crawford S. The Effect of Gestational Weight Gain Across Reproductive History on Maternal Body Mass Index in Midlife: The Study of Women's Health Across the Nation. J Womens Health (Larchmt) 2019; 29:148-157. [PMID: 31794347 DOI: 10.1089/jwh.2019.7839] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Excessive weight gain during pregnancy is common and has been shown to be associated with increased long-term maternal weight. However, less is known on whether there is a cumulative effect of excessive gestational weight gain (GWG) over multiple pregnancies. Methods: Data from the Study of Women's Health Across the Nation were used, restricted to parous women with no history of stillbirth or premature birth. The effect of the number of excessive GWG pregnancies on body mass index (BMI) in midlife (age 42-53) was analyzed using multivariable linear regression. Fully adjusted models included parity, inadequate GWG, demographic, and behavioral characteristics. Results: The 1181 women included in this analysis reported a total of 2693 births. Overall, 466 (39.5%) were categorized as having at least one pregnancy with excessive GWG. The median BMI at midlife was 26.0 kg/m2 (interquartile range 22.5-31.1). In fully adjusted models, each additional pregnancy with excessive GWG was associated with 0.021 higher estimated log BMI (p = 0.031). Among women with 1-3 births, adjusted mean (95% confidence interval) BMI for those with 0, 1, 2, and 3 excessive GWG pregnancies was 25.4 (24.9-25.9), 26.8 (26.1-27.5), 27.5 (26.6-28.4), and 28.8 (27.3-30.5), respectively. Conclusions: In this multiethnic study of women with a history of term live births, the number of pregnancies with excessive GWG was associated with increased maternal BMI in midlife. Our findings suggest that prevention of excessive GWG at any point in a woman's reproductive history can have an impact on long-term maternal health.
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Affiliation(s)
- Franya Hutchins
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Maria Brooks
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alicia Colvin
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tiffany Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Milagros Rosal
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Sybil Crawford
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
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71
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Liu X, Zhang W, Wang L, Wang S, Yu Y, Chen S, Ao H. Male patients with diabetes undergoing coronary artery bypass grafting have increased major adverse cerebral and cardiovascular events. Interact Cardiovasc Thorac Surg 2019; 28:607-612. [PMID: 30325425 DOI: 10.1093/icvts/ivy287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/20/2018] [Accepted: 08/29/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The role of body mass index (BMI) in the prognosis of patients with diabetes undergoing coronary artery bypass grafting (CABG) has been of great interest for a long time. However, the precise relationship between BMI and major adverse cerebral and cardiovascular events (MACCEs) in these patients is still unclear. The goal of this study was to investigate the outcome of patients with diabetes with different BMIs undergoing CABG and the results from the 5-year follow-up. METHODS This study included 771 patients with diabetes undergoing CABG from 1 January 2003 to 31 December 2009. They were classified based on the Chinese standard for BMI as follows: underweight: <18.5 kg/m2; normal weight: 18.5-23.9 kg/m2; overweight: 24-27.9 kg/m2; and obese: >28 kg/m2. Short-term outcomes and 5-year MACCEs were compared among various BMI groups after surgery. RESULTS Obese and overweight patients with diabetes tended to be younger than normal weight patients [57 years (49-64) vs 62 years (54-68) and 64 years (59-69); P < 0.001]. There were fewer male patients (25.20% vs 17.78% and 16.54%, P = 0.041). More smokers were in the 2 groups (38.8% vs 51.55% and 57.14%, P < 0.001). Glucose concentration was highest in the overweight group [6.40 (5.40-7.80) vs 6.96 (5.69-8.22) and 6.80 (5.90-8.40); P = 0.041)]. Cox regression analysis of the 5-year follow-up data indicated that various BMI groups were not associated with significant differences in 5-year MACCEs; however, male sex was the risk factor for MACCEs (hazard ratio 1.83, 95% confidence interval 1.11-3.04; P = 0.019). CONCLUSIONS The BMI of the patients with diabetes undergoing CABG had no effect on MACCEs. Male sex was the risk factor in these patients.
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Affiliation(s)
- Xiaojie Liu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Wenyuan Zhang
- Department of Anesthesiology, The First affiliated Hospital, Nanchang University, Nanchang, China
| | - Lijuan Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Sudena Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yang Yu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Sipeng Chen
- The Department of Information Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hushan Ao
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis 2019; 16:175-247. [PMID: 31917200 DOI: 10.1016/j.soard.2019.10.025] [Citation(s) in RCA: 235] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The development of these updated clinical practice guidelines (CPG) was commissioned by the American Association of Clinical Endocrinologists, The Obesity Society, the American Society of Metabolic and Bariatric Surgery, the Obesity Medicine Association, and the American Society of Anesthesiologists boards of directors in adherence to the American Association of Clinical Endocrinologists 2017 protocol for standardized production of CPG, algorithms, and checklists. METHODS Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. RESULTS New or updated topics in this CPG include contextualization in an adiposity-based, chronic disease complications-centric model, nuance-based, and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current healthcare arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). CONCLUSIONS Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence-based within the context of a chronic disease. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
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Affiliation(s)
- Jeffrey I Mechanick
- Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, New York; Metabolic Support Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Caroline Apovian
- Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | | | - W Timothy Garvey
- Department of Nutrition Sciences, Birmingham VA Medical Center, Birmingham, Alabama; UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aaron M Joffe
- University of Washington, Harborview Medical Center, Seattle, Washington
| | - Julie Kim
- Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Robert F Kushner
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Rachel Pessah-Pollack
- Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, New York
| | - Jennifer Seger
- Department of Family and Community Medicine, Long School of Medicine, UT Health Science Center, San Antonio, Texas
| | | | - Stephanie Adams
- American Association of Clinical Endocrinologists, Jacksonville, Florida
| | - John B Cleek
- Department of Nutrition Sciences, Birmingham VA Medical Center, Birmingham, Alabama
| | | | | | - Karen Flanders
- Massachusetts General Hospital Weight Center, Boston, Massachusetts
| | - Jayleen Grams
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Birmingham VA Medical Center, Birmingham, Alabama
| | - Daniel L Hurley
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | | | - Michael V Seger
- Bariatric Medical Institute of Texas, San Antonio, Texas, University of Texas Health Science Center, Houston, Texas
| | - Christopher D Still
- Center for Nutrition and Weight Management Director, Geisinger Obesity Institute, Danville, Pennsylvania; Employee Wellness, Geisinger Health System, Danville, Pennsylvania
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73
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Malik MS, Qayyum W, Farooq A, Waqas A, Sukhera AB, Khalid MA, Baig AA. Dietary Patterns, Exercise, and the Metabolic Syndrome Among Young People in Urban Pakistan (Lahore). Metab Syndr Relat Disord 2019; 18:56-64. [PMID: 31638468 DOI: 10.1089/met.2019.0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Increasing urbanization, mechanization, and rural-to-urban migration has led to deranged sleeping patterns, surplus energy intake, and sedentary lifestyles in South Asian young people. This shift poses an insidious health risk for the development of metabolic syndrome (MetS). Early detection is needed because in the South Asian population, this syndrome carries an increased risk of comorbidities compared to people without the syndrome. This study was designed to elucidate the prevalence of MetS and its risk factors in young people in urban areas of Pakistan. Methods: A cross-sectional study was conducted in four undergraduate institutions in Lahore, Pakistan. Five hundred and nine young people participated, and each provided their informed consent for the collection of data on their demographic, physical, and biochemical characteristics along with information on their dietary, sleep, and physical activity habits. Results: Most participants reported consuming greater-than-recommended amounts of protein and smaller-than-recommended amounts of vegetables and fruits. The International Diabetes Federation criteria for MetS were fulfilled by 6.1% of the students. Hypertension (67.7%) and hypo-HDL-emia (64.5%) were the most common risk factors. More than 50% of the respondents slept fewer hours per day than recommended, and 33% had a sedentary lifestyle. Men, participants with a family history of metabolic illness and those with low physical activity levels had higher odds of a positive result on screening for MetS. Conclusions: The early detection of MetS and early identification of probable risk factors may make beneficial contributions to both public health and clinical interventions directed at high-risk individuals. Establishing and using cutoff values for modified waist circumference and specific body mass index in Asian populations may aid in early detection.
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Affiliation(s)
| | - Wahhaj Qayyum
- Combined Military Hospital, Lahore, Punjab, Pakistan
| | - Ayesha Farooq
- Combined Military Hospital, Lahore, Punjab, Pakistan
| | - Ahmed Waqas
- Combined Military Hospital, Lahore, Punjab, Pakistan
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74
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Double burden of underweight and overweight among women of reproductive age in Bangladesh. Public Health Nutr 2019; 22:3163-3174. [PMID: 31544733 DOI: 10.1017/s1368980019002611] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Bangladesh, like many emerging economies of South-East Asia, has started to experience a double burden of continuing high rates of undernutrition and increasing rates of overweight and obesity. A lack of assessment of the nutritional shift leaves a gap in current policies: the growing overweight and obesity is yet to be addressed. The present paper investigates the change in nutritional status, particularly the shift in BMI, of Bangladeshi women of reproductive age (15-49 years) and characterizes the vulnerable households for both underweight and overweight status during a period of 10 years (2004-2014). DESIGN Generalized linear mixed-effect models were fitted for both urban and rural residents to assess underweight and overweight status. SETTING Bangladesh Demographic and Health Surveys. PARTICIPANTS Women aged 15-49 years (n 53 077). RESULTS The proportion of overweight increased during 2004-2014 from 10·7 to 25·1 % and the proportion of underweight decreased from 32·6 to 18·2 %. Prevalence of underweight status remained high in rural areas and prevalence of overweight increased rapidly in both rural and urban areas, creating a double burden. The significant contributors to this double burden were the change in women's level of education, increased household wealth, divisional location and rapid urbanization. CONCLUSIONS The findings indicate that specific cohort- or area-based intervention policy studies in line with the UN Decade of Action on Nutrition are required to address the nutritional double burden in Bangladesh.
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75
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Warnakulasuriya LS, Fernando MAM, Adikaram AVN, Thawfeek ARM, Anurasiri WML, Elisabet R, Bergsten P, Silva KDRR, Samaranayake DL, Wickramasinghe VP. Assessment of Nutritional Status in Sri Lankan Children: Validity of Current Anthropometry Cutoffs? Asia Pac J Public Health 2019; 31:633-642. [PMID: 31529983 DOI: 10.1177/1010539519872061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Despite socioeconomic improvement, undernutrition rates stagnate in Sri Lanka, while a slow rise in obesity and noncommunicable diseases (NCD) is seen. Inability to improve undernutrition and detection of NCD could be due to overdiagnosing stunting/wasting and underdiagnosing overweight/obesity. Obesity, being a risk factor for NCDs, needs correct tools for early diagnosis. Although body mass index (BMI) is a commonly used surrogate index, the validity of universal cutoffs is questioned. Evidence shows that body composition varies with ethnic origin and cutoff value reflecting fat mass (FM) varies in different ethnic groups. This study was conducted in 12 788, 5- to 15-year-old children from 8 schools in Negombo, Sri Lanka, to identify the validity of current anthropometric cutoffs. Obesity prevalence identified by body fat content was high. International BMI cutoffs had high specificity but varied sensitivity. Locally developed BMI cutoffs had high sensitivity and specificity. Validity of internationally developed anthropometric cutoffs in South Asian children is unsatisfactory; hence, locally/regionally developed anthropometric tools should be used for screening of obesity.
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76
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Abstract
Purpose of the review In this review, we discuss the roles of the gut microbiota, dietary phytochemicals in improving human health. Recent studies have reported that the human gut microbiota can be altered by dietary phytochemicals including phenolics, carotenoids, and dietary fibers. In addition, both pathogenic and nonpathogenic bacteria show regulatory effects with phytochemicals, suggesting potential synergistic effects in the improvement of human gut health and prevention of chronic diseases. Recent findings Numerous studies have been conducted on gut microbial alterations induced by phytochemicals, such as phenolics and carotenoids. Butyrate, a short-chain fatty acid produced via bacterial fermentation in the colon, also shows a significantly beneficial effect in the maintenance of gut microbial homeostasis. However, the molecular mechanisms underlying the effects of diets and the interactions of the gut microorganisms remain poorly understood. The gut microbiome profile changes have been observed in chronic inflammation-induced diseases including colitis, Crohn's disease, immune dysfunction, colon cancer, obesity and diabetes. The anti-inflammatory effects of dietary phytochemicals against these diseases may be partially mediated by regulation of microbial profiles. Latest advances in biomedical technology such as the next-generation sequencing (NGS), and continuous cost reduction associated with these technologies, enabled researchers to perform ever-increasing number of large-scale, high-throughput computational analyses to elucidate the potential mechanism of phytochemical-microbiome interactions. Summary Information obtained from these studies may provide valuable insights to guide future clinical research for the development of therapeutics, botanicals and drug efficacy testing, many of which will be discussed in this review.
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77
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van Eyk HJ, Paiman EHM, Bizino MB, de Heer P, Geelhoed-Duijvestijn PH, Kharagjitsingh AV, Smit JWA, Lamb HJ, Rensen PCN, Jazet IM. A double-blind, placebo-controlled, randomised trial to assess the effect of liraglutide on ectopic fat accumulation in South Asian type 2 diabetes patients. Cardiovasc Diabetol 2019; 18:87. [PMID: 31288820 PMCID: PMC6615254 DOI: 10.1186/s12933-019-0890-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/23/2019] [Indexed: 01/06/2023] Open
Abstract
Background South Asians have a high risk to develop type 2 diabetes, which may be related to substantial ectopic fat deposition. Since glucagon-like peptide-1 analogues can reduce ectopic fat accumulation, the aim of the present study was to assess the effect of treatment with liraglutide for 26 weeks on ectopic fat deposition and HbA1c in South Asian patients with type 2 diabetes. Methods In a placebo-controlled trial, 47 South Asian patients with type 2 diabetes were randomly assigned to treatment with liraglutide (1.8 mg/day) or placebo added to standard care. At baseline and after 26 weeks of treatment we assessed abdominal subcutaneous, visceral, epicardial and paracardial adipose tissue volume using MRI. Furthermore, myocardial and hepatic triglyceride content were examined with proton magnetic resonance spectroscopy. Results In the intention-to-treat analysis, liraglutide decreased body weight compared to placebo (− 3.9 ± 3.6 kg vs − 0.6 ± 2.2 kg; mean change from baseline (liraglutide vs placebo): − 3.5 kg; 95% CI [− 5.3, − 1.8]) without significant effects on the different adipose tissue compartments. HbA1c was decreased in both groups without between group differences. In the per-protocol analysis, liraglutide did decrease visceral adipose tissue volume compared to placebo (− 23 ± 27 cm2 vs − 2 ± 17 cm2; mean change from baseline (liraglutide vs placebo): − 17 cm2; 95% CI [− 32, − 3]). Furthermore, HbA1c was decreased by liraglutide compared to placebo (− 1.0 ± 0.8% (− 10.5 ± 9.1 mmol/mol)) vs (− 0.6 ± 0.8% (− 6.1 ± 8.8 mmol/mol)), with a between group difference (mean change from baseline (liraglutide vs placebo): − 0.6% (− 6.5 mmol/mol); 95% CI [− 1.1, − 0.1 (− 11.5, − 1.5)]). Interestingly, the decrease of visceral adipose tissue volume was associated with the reduction of HbA1c (β: 0.165 mmol/mol (0.015%) per 1 cm2 decrease of visceral adipose tissue volume; 95% CI [0.062, 0.267 (0.006, 0.024%)]). Conclusions While the intention-to-treat analysis did not show effects of liraglutide on ectopic fat and HbA1c, per-protocol analysis showed that liraglutide decreases visceral adipose tissue volume, which was associated with improved glycaemic control in South Asians. Trial registration NCT02660047 (clinicaltrials.gov). Registered 21 January 2016
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Affiliation(s)
- Huub J van Eyk
- Dept. Medicine, Div. Endocrinology, Leiden University Medical Center (LUMC), Post Zone C7Q, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. .,Einthoven Laboratory for Experimental Vascular Medicine, LUMC, Leiden, The Netherlands.
| | | | - Maurice B Bizino
- Dept. Medicine, Div. Endocrinology, Leiden University Medical Center (LUMC), Post Zone C7Q, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.,Dept. Radiology, LUMC, Leiden, The Netherlands
| | - Paul de Heer
- Dept. Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Aan V Kharagjitsingh
- Dept. Medicine, Div. Endocrinology, Leiden University Medical Center (LUMC), Post Zone C7Q, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.,Dept. Diabetology and Endocrinology, University Hospital Brussels, Brussels, Belgium
| | - Johannes W A Smit
- Dept. Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Patrick C N Rensen
- Dept. Medicine, Div. Endocrinology, Leiden University Medical Center (LUMC), Post Zone C7Q, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, LUMC, Leiden, The Netherlands
| | - Ingrid M Jazet
- Dept. Medicine, Div. Endocrinology, Leiden University Medical Center (LUMC), Post Zone C7Q, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, LUMC, Leiden, The Netherlands
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78
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Jain RK, Vokes T. The Prediction of Body Composition in African Americans From Spine and Hip Dual-Energy Absorptiometry. J Clin Densitom 2019; 22:444-450. [PMID: 29173816 DOI: 10.1016/j.jocd.2017.10.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 01/06/2023]
Abstract
Body composition, the makeup of the body's fat and lean tissue, is associated with important health outcomes and provides useful clinical information. Although body composition can be measured with total body dual-energy X-ray absorptiometry (DXA), this is rarely performed. As an alternative to total body DXA measurement, methods for estimation of body composition have been developed. These methods use soft tissue measures from spine and hip DXA to predict body composition and include prediction equations previously published by Leslie and proprietary equations within General Electric densitometry software. However, these estimates have not been tested in African Americans (AA), an ethnicity with a different distribution of fat than Caucasians (CA). Therefore, we examined the performance of the existing models in 99 CA and 162 AA subjects over the age of 40 who had total body, spine, and hip DXA measurements. We observed that existing models estimated body composition well in CA but underestimated fat mass and overestimated lean mass in AA. AA subjects were then randomly divided into 2 equal-sized subgroups-the first to develop new prediction equations and the second to independently validate them. We found that body composition can be more accurately estimated using either a new model that we derived in AA subjects using backward stepwise elimination or by adding a fixed offset for AA to the previously published model. Our results demonstrate that body composition estimates from spine and hip DXA require consideration of race/ethnicity.
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Affiliation(s)
- Rajesh K Jain
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago, Illinois.
| | - Tamara Vokes
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago, Illinois
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79
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Matsha TE, Ismail S, Speelman A, Hon GM, Davids S, Erasmus RT, Kengne AP. Visceral and subcutaneous adipose tissue association with metabolic syndrome and its components in a South African population. Clin Nutr ESPEN 2019; 32:76-81. [PMID: 31221294 DOI: 10.1016/j.clnesp.2019.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/28/2019] [Accepted: 04/29/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS A number of studies concur that visceral abdominal tissue (VAT) is a metabolic organ that mostly contributes to the metabolic consequences of obesity, however reports regarding subcutaneous adipose tissue (SAT) are controversial. We aimed to investigate the association between computed tomography measured visceral and subcutaneous adipose tissue and metabolic syndrome as well as its individual components. METHODS Computed tomography at level L4/L5 intervertebral disc space was performed in 401 mixed ancestry individuals from the Bellville South community of Cape Town. Data collections included OGTT, anthropometric, blood pressure, lipids, insulin cotinine, and alcohol consumption history. RESULTS Both VAT and SAT were increased in subjects with metabolic syndrome (p < 0.0001). In logistic regression, adjusted for age, gender, BMI, smoking, alcohol use, hypertension, diabetes and dyslipidaemia treatment (for women also adjusted for menopausal age) increasing quartiles of VAT were associated with metabolic syndrome {odds ratio (95% confidence interval) ≥ 4.14 (1.92-8.93), p < 0.001} and any type of hyperglycaemia (≥4.45 (1.89-10.47), p ≤ 0.001) whilst decreasing quartiles of SAT were associated with metabolic syndrome, p ≤ 0.037. In gender specific multivariate linear regression models, increased SAT levels were associated with 2-h plasma glucose, insulin levels and triglycerides in men, β ≥ 0.999, p ≤ 0.01. CONCLUSIONS Our study shows that increased VAT and decreased SAT are associated with metabolic syndrome in women, but in men increased SAT has deleterious effects to metabolic syndrome components. Therefore, in men increased SAT may like VAT increase the risk of diabetes development.
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Affiliation(s)
- Tandi E Matsha
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa.
| | - Saaiga Ismail
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa; MITS, Faculty of Health and Wellness Science, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Aladdin Speelman
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa; MITS, Faculty of Health and Wellness Science, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Gloudina M Hon
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Saarah Davids
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Rajiv T Erasmus
- Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa
| | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
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80
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Chung ST, Onuzuruike AU, Magge SN. Cardiometabolic risk in obese children. Ann N Y Acad Sci 2019; 1411:166-183. [PMID: 29377201 DOI: 10.1111/nyas.13602] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/29/2017] [Accepted: 12/31/2017] [Indexed: 02/06/2023]
Abstract
Obesity in childhood remains a significant and prevalent public health concern. Excess adiposity in youth is a marker of increased cardiometabolic risk (CMR) in adolescents and adults. Several longitudinal studies confirm the strong association of pediatric obesity with the persistence of adult obesity and the future development of cardiovascular disease, diabetes, and increased risk of death. The economic and social impact of childhood obesity is further exacerbated by the early onset of the chronic disease burden in young adults during their peak productivity years. Furthermore, rising prevalence rates of severe obesity in youth from disadvantaged and/or minority backgrounds have prompted the creation of additional classification schemes for severe obesity to improve CMR stratification. Current guidelines focus on primary obesity prevention efforts, as well as screening for clustering of multiple CMR factors to target interventions. This review summarizes the scope of the pediatric obesity epidemic, the new severe obesity classification scheme, and examines the association of excess adiposity with cardiovascular and metabolic risk. We will also discuss potential questions for future investigation.
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Affiliation(s)
- Stephanie T Chung
- Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland.,Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Anthony U Onuzuruike
- Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland
| | - Sheela N Magge
- Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
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81
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Fu Q. Sex differences in sympathetic activity in obesity and its related hypertension. Ann N Y Acad Sci 2019; 1454:31-41. [PMID: 31087350 DOI: 10.1111/nyas.14095] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/15/2019] [Accepted: 03/21/2019] [Indexed: 01/15/2023]
Abstract
The prevalence of obesity is rapidly increasing in the United States, particularly among women. Approximately 60-70% of hypertension in adults may be directly attributed to obesity. In addition, maternal obesity is a major risk factor for hypertensive disorders during pregnancy. The underlying mechanisms for the association between obesity and cardiovascular risk are multifactorial, but activation of the sympathetic nervous system is one significant contributing factor. This brief review summarizes the current knowledge on sex differences in sympathetic activity in obesity and its related hypertension, with a focus on studies in humans. Evidence suggests that abdominal visceral fat, rather than subcutaneous fat, is related to augmented sympathetic activity regardless of sex. Race/ethnicity may affect the relationship between obesity and sympathetic activity. Obesity-related hypertension has an important neurogenic component, which is characterized by sympathetic overactivity. However, sex may influence the association between hypertension and sympathetic overactivity in obese people. Finally, both body weight and sympathetic overactivity seem to be involved in the development of gestational hypertensive disorders in women. Chronic hyperinsulinemia due to insulin resistance, high plasma levels of leptin, and/or obstructive sleep apnea may be responsible for sympathetic overactivity in obesity-related hypertension.
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Affiliation(s)
- Qi Fu
- Women's Heart Health Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center, Dallas, Texas
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82
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Zheng Y, Bao L, Chen J, Pan Y, Wang Q, Chen L, Gao X. The influence of sex on the prognostic value of body mass index in non-metastasis renal cell carcinoma. Cancer Manag Res 2019; 11:3869-3886. [PMID: 31118803 PMCID: PMC6502441 DOI: 10.2147/cmar.s197457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/29/2019] [Indexed: 01/20/2023] Open
Abstract
Purpose: The prognostic value of obesity in patients with renal cell carcinoma (RCC) remains controversial. This study aimed to assess the sex-dependent prognostic role of body mass index (BMI) in patients with nonmetastatic RCC who underwent radical or partial nephrectomy. Patients and methods: We retrospectively analyzed 643 consecutive patients with nonmetastatic RCC who underwent curative nephrectomy in our center between 2004 and 2014. Associations among BMI, sex, overall survival (OS), cancer-specific survival (CSS), and metastasis-free survival (MFS) were analyzed. Results: Males were more likely to have a higher BMI than females (BMI as a categorical variable: P<0.001; BMI as a continuous variable: P=0.002). In men, a high BMI was significantly correlated with better 5-year OS, CSS, and MFS rates (P=0.001, 0.014, and 0.001, respectively), and multivariate analysis identified that a high BMI was independently associated with greater OS, CSS, and MFS (OS: hazard ratio [HR]=0.207, P=0.011; CSS: HR=0.225, P=0.005; MFS: HR=0.243, P=0.004). However, in women, there was no significant difference in 5-year OS, CSS, and MFS rates according to BMI (P=0.781, 0.812, and 0.538, respectively). Moreover, a high BMI was no longer independently associated with OS, CSS, or MFS (P=0.821, 0.832, and 0.801, respectively). Among patients with clear cell RCC, BMI was significantly associated with OS, CSS, and MFS only among men (all P<0.05) and not among women (all P>0.05). Conclusion: Among patients with nonmetastatic RCC, a high BMI was a favorable prognostic factor in males rather than females. Therefore, sex might influence the correlation between obesity and urological outcomes in nonmetastatic RCC.
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Affiliation(s)
- Yangqin Zheng
- Department of Hematology, The Third Clinical Institute Affiliated to Wenzhou Medical University, People's Hospital of Wenzhou, Wenzhou, Zhejiang 325006, People's Republic of China
| | - Lianmin Bao
- Department of Respiratory, Rui'an People's Hospital, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325200, People's Republic of China
| | - Jingfeng Chen
- Department of Anorectal Surgery, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People's Hospital, Lishui, Zhejiang 323000, People's Republic of China
| | - Yue Pan
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325006, People's Republic of China
| | - Qinquan Wang
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325006, People's Republic of China
| | - Lianguo Chen
- Department of Clinical Pharmacy, Wenzhou People's Hospital & The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China
| | - Xiaomin Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, People's Republic of China
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83
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Sung H, Siegel RL, Torre LA, Pearson-Stuttard J, Islami F, Fedewa SA, Goding Sauer A, Shuval K, Gapstur SM, Jacobs EJ, Giovannucci EL, Jemal A. Global patterns in excess body weight and the associated cancer burden. CA Cancer J Clin 2019; 69:88-112. [PMID: 30548482 DOI: 10.3322/caac.21499] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The prevalence of excess body weight and the associated cancer burden have been rising over the past several decades globally. Between 1975 and 2016, the prevalence of excess body weight in adults-defined as a body mass index (BMI) ≥ 25 kg/m2 -increased from nearly 21% in men and 24% in women to approximately 40% in both sexes. Notably, the prevalence of obesity (BMI ≥ 30 kg/m2 ) quadrupled in men, from 3% to 12%, and more than doubled in women, from 7% to 16%. This change, combined with population growth, resulted in a more than 6-fold increase in the number of obese adults, from 100 to 671 million. The largest absolute increase in obesity occurred among men and boys in high-income Western countries and among women and girls in Central Asia, the Middle East, and North Africa. The simultaneous rise in excess body weight in almost all countries is thought to be driven largely by changes in the global food system, which promotes energy-dense, nutrient-poor foods, alongside reduced opportunities for physical activity. In 2012, excess body weight accounted for approximately 3.9% of all cancers (544,300 cases) with proportion varying from less than 1% in low-income countries to 7% or 8% in some high-income Western countries and in Middle Eastern and Northern African countries. The attributable burden by sex was higher for women (368,500 cases) than for men (175,800 cases). Given the pandemic proportion of excess body weight in high-income countries and the increasing prevalence in low- and middle-income countries, the global cancer burden attributable to this condition is likely to increase in the future. There is emerging consensus on opportunities for obesity control through the multisectoral coordinated implementation of core policy actions to promote an environment conducive to a healthy diet and active living. The rapid increase in both the prevalence of excess body weight and the associated cancer burden highlights the need for a rejuvenated focus on identifying, implementing, and evaluating interventions to prevent and control excess body weight.
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Affiliation(s)
- Hyuna Sung
- Principal Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Scientific Director, Scientist Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Lindsey A Torre
- Scientist, Surveillance and Health Services Research, American Cancer Society, Scientist, Atlanta, GA
| | | | - Farhad Islami
- Scientific Director, Scientist Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Senior Principal Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Ann Goding Sauer
- Senior Associate Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Kerem Shuval
- Senior Principal Scientist, Physical Activity and Nutrition Research, Economic and Health Policy Research Program, Atlanta, GA
| | - Susan M Gapstur
- Senior Vice President, Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Eric J Jacobs
- Senior Scientific Director, Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Edward L Giovannucci
- Professor, Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Ahmedin Jemal
- Scientific Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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84
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Halim AA, Basu A, Kirk R. The Prevalence of Body Mass Index-Associated Chronic Diseases in Diverse Ethnic Groups in New Zealand. Asia Pac J Public Health 2019; 31:84-91. [PMID: 30614240 DOI: 10.1177/1010539518822438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of universal body mass index (BMI) cutoffs do not take into account variation in the association between BMI and health risk across diverse ethnic groups. We used the New Zealand Health Survey data collected between 2002/2003 and 2014/2015 to calculate the predictive marginal means of hypertension, cardiovascular diseases, and type 2 diabetes mellitus (T2DM) after adjusting for demographic variables and health-related behaviors. Compared with European group, we found that Pacific had a lower prevalence of hypertension at a BMI of ≥35 kg/m2, and Māori had a higher prevalence of hypertension, T2DM, and cardiovascular diseases at higher BMI intervals. Whereas Asian had a higher T2DM prevalence compared with Māori, Pacific, and European at some BMI intervals. Using universal BMI cutoffs on the ethnically diverse population to compare obesity rates does not address the risk of chronic diseases associated with high BMI and may stigmatize certain ethnic groups.
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Affiliation(s)
| | - Arindam Basu
- 1 University of Canterbury, Christchurch, New Zealand
| | - Ray Kirk
- 1 University of Canterbury, Christchurch, New Zealand
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85
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Arun Thomas ET, Shaji B, Gracious N. The ongoing epidemic of diabetes mellitus in India: genetics or lifestyle? Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-018-0630-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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86
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Hardy LL, Jin K, Mihrshahi S, Ding D. Trends in overweight, obesity, and waist-to-height ratio among Australian children from linguistically diverse backgrounds, 1997 to 2015. Int J Obes (Lond) 2019; 43:116-124. [PMID: 29980760 PMCID: PMC6331387 DOI: 10.1038/s41366-018-0139-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/10/2018] [Accepted: 05/09/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To report the cross-sectional prevalence and 18-year trends in overweight, obesity and abdominal obesity among Australian children from culturally and linguistically diverse (CALD) backgrounds. SUBJECTS/METHODS Four cross-sectional population health surveys conducted among children (age 4-16 years; n=26, 449) in 1997-2004-2010-2015 in New South Wales, (NSW) Australia. Adiposity outcomes were measured by trained field staff using standard procedures. Binomial regression models with a robust error variance were used to estimate prevalence ratio (PR) and 95% confidence intervals (CI) for overweight and obesity, obesity, and waist-to-height ratio (WHtR) ≥ 0.5 for children from Asian, European, and Middle Eastern language backgrounds compared with children from English-speaking backgrounds, adjusted for sociodemographic characteristics. RESULTS Over time, children from Middle Eastern language backgrounds were consistently more likely to be overweight-obese (PR: 1.29-1.42), obese (PR: 1.49-1.65), and have WHtR ≥ 0.5 (PR: 1.42-1.90), compared with children from English-speaking backgrounds. Children from European language backgrounds generally had higher prevalence and children from Asian language backgrounds had lower prevalence, compared with children from English-speaking backgrounds. Between 1997 and 2015, there were significant trends in the prevalence of overweight and obesity combined among children from English-speaking (PR: 1.06, 95%CI: 1.02, 1.09), Middle Eastern (PR: 1.14, 95%CI: 1.05, 1.24), and Asian language backgrounds (PR: 1.14, 95%CI: 1.05, 1.24). The prevalence of WHtr ≥ 0.5 increased among children from English-speaking (PR: 1.21, 95%CI: 1.13, 1.31) and Middle Eastern (PR: 1.35, 95%CI: 1.16, 1.56) language backgrounds. CONCLUSIONS Overall, the prevalence of overweight and obesity and abdominal obesity is high among NSW children from CALD backgrounds and has increased over time. This suggests that there is a greater scope in understanding, developing, and implementing interventions across the early life-course of children from CALD backgrounds.
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Affiliation(s)
- Louise L Hardy
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.
| | - Kai Jin
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
| | - Seema Mihrshahi
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Ding Ding
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
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87
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Divia Paul A, Ashraf SM, Subramanyam K, Ramakrishna A. Gender-associated dimensional differences among normal to non-flow limiting coronary artery dimensions. Indian Heart J 2019; 70 Suppl 3:S295-S298. [PMID: 30595278 PMCID: PMC6309284 DOI: 10.1016/j.ihj.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/11/2018] [Accepted: 06/04/2018] [Indexed: 11/11/2022] Open
Abstract
Aim and objectives To study gender-specific differences in coronary artery diameters among subjects with normal to non-flow limiting disease (NFLD) coronary arteries (up to 0 - 20% of stenosis) and to assess the possible association of body-mass index (BMI) with coronary dimensions, among the west coastal population of Karnataka and Kerala. Materials and Methods A prospective cohort study was conducted for a period of one year. Two thousand angiograms samples were collected and assessed from two study centers (one from each state), after obtaining the ethical clearance. Patients with past history of myocardial infarction and those with recanalized normal looking coronary arteries and those who had diabetes for more than five years were excluded. Ten segments of coronary arteries- left main coronary artery, ostial and proximal segments of left anterior descending artery and its first diagonal branch, ostial and proximal segments of left circumflex coronary artery and its obtuse marginal branch, ramus intermedius and the ostial and proximal segments of the right coronary artery- were included in diameter measurement. BMI values of the patients were calculated. Results Out of 2000 patients included in the study, 454 (22.7%; mean age 53.4 ± 14.2 years) had normal to NFLD coronaries of which 253 (55.7%) were males and 201 (44.3%) were females. As compared to women, men had larger diameters of coronary arteries for eight segments, except the obtuse marginal branch and the proximal right coronary artery. A weak, yet statistically significant, negative correlation existed between BMI and coronary artery diameters in total cohort, indicating that an increase in BMI was associated with a decrease in artery diameters. No such association was seen when men and women were assessed separately. Conclusions The present study indicates that men have higher caliber for coronary arteries compared to women. The study also indicates that when BMI increases there is a relative decrease in the coronary artery diameter.
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Affiliation(s)
- A Divia Paul
- Department of Anatomy, Yenepoya Medical College, Karnataka, India.
| | - S M Ashraf
- Department of Cardio Vascular Sciences, Sahakarana Hrudayalaya, Pariyaram Medical college, Kerala, India.
| | - K Subramanyam
- Department of Cardiology, K.S Hegde Medical Academy and Hospital, Karnataka, India.
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Palaniappan L, Garg A, Enas E, Lewis H, Bari S, Gulati M, Flores C, Mathur A, Molina C, Narula J, Rahman S, Leng J, Gany F. South Asian Cardiovascular Disease & Cancer Risk: Genetics & Pathophysiology. J Community Health 2018; 43:1100-1114. [PMID: 29948525 PMCID: PMC6777562 DOI: 10.1007/s10900-018-0527-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
South Asians (SAs) are at heightened risk for cardiovascular disease as compared to other ethnic groups, facing premature and more severe coronary artery disease, and decreased insulin sensitivity. This disease burden can only be partially explained by conventional risk factors, suggesting the need for a specific cardiovascular risk profile for SAs. Current research, as explored through a comprehensive literature review, suggests the existence of population specific genetic risk factors such as lipoprotein(a), as well as population specific gene modulating factors. This review catalogues the available research on cardiovascular disease and genetics, anthropometry, and pathophysiology, and cancer genetics among SAs, with a geographical focus on the U.S. A tailored risk profile will hinge upon population customized classification and treatment guidelines, informed by continued research.
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Affiliation(s)
| | - Arun Garg
- Laboratory Medicine and Pathology, Fraser Health Authority, New Westminster, BC, Canada
| | - Enas Enas
- Coronary Artery Disease among Asian Indians (CADI) Research Foundation, Lisle, IL, USA
| | - Henrietta Lewis
- Rollins School of Public Health, Global Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Cristina Flores
- The Warren Alpert Medical School, The Brown Human Rights Asylum Clinic (BHRAC), Brown University, Providence, RI, USA
| | - Ashish Mathur
- South Asian Heart Center, El Camino Hospital, Mountain View, CA, USA
| | - Cesar Molina
- South Asian Heart Center, El Camino Hospital, Mountain View, CA, USA
| | | | - Shahid Rahman
- I-Say, Bangladeshi American Youth Association, Teach & Travel, New York, NY, USA
| | - Jennifer Leng
- Immigrant Health and Cancer Disparities Center, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Francesca Gany
- Immigrant Health and Cancer Disparities Center, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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Short-term prognosis of emergently hospitalized dialysis-independent chronic kidney disease patients: A nationwide retrospective cohort study in Japan. PLoS One 2018; 13:e0208258. [PMID: 30496295 PMCID: PMC6264841 DOI: 10.1371/journal.pone.0208258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 11/14/2018] [Indexed: 12/22/2022] Open
Abstract
In patients with chronic kidney disease (CKD), low body mass index (BMI) is associated with high mortality. This relationship in emergently hospitalized CKD patients is unknown. We investigated the association between obesity and short-term mortality in emergently admitted patients with dialysis-independent CKD (DI-CKD) with and without infection. This retrospective cohort study examined Diagnosis Procedure Combination data of 26103 emergently hospitalized DI-CKD patients. Patients were divided into 8 groups according to their BMI and the presence of infectious diseases. The primary outcome was in-hospital death within 100 days. Cox proportional hazards models adjusted for baseline characteristics showed that low BMI was associated with the outcome both in infected and in non-infected patients (reference group as non-infected and medium BMI [24–26 kg/m2] group): infected and the lowest BMI (≤20 kg/m2) group, hazard ratio (HR) 1.82 (95% confidence interval 1.51, 2.19); non-infected and the lowest BMI group, 1.39 (1.16, 1.67). When patients were stratified according to presence of diabetes mellitus (DM), patients with DM showed that low BMI was associated with the outcome both in infected and in non-infected patients, whereas in non-DM patients, this relationship was attenuated in the non-infected group. For emergently hospitalized CKD patients with infection, high BMI was associated with lower mortality irrespective of the DM status. For non-infected patients, the effects of obesity for in-hospital mortality were modified by the DM status.
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90
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Misra A, Soares MJ, Mohan V, Anoop S, Abhishek V, Vaidya R, Pradeepa R. Body fat, metabolic syndrome and hyperglycemia in South Asians. J Diabetes Complications 2018; 32:1068-1075. [PMID: 30115487 DOI: 10.1016/j.jdiacomp.2018.08.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 12/26/2022]
Abstract
The prevalence of overweight and obesity is escalating in South Asian countries. South Asians display higher total and abdominal obesity at a lower BMI when compared to Whites. Consequently, metabolic dysfunction leading to metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) will account for a majority of the health burden of these countries. In this review, we discuss those factors that contribute to MetS and T2DM in South Asians when compared to whites, focusing on adiposity. Abdominal obesity is the single-most important risk factor for MetS and its predisposition to T2DM. Excessive ectopic fat deposition in the liver (non-alcoholic fatty liver disease) has been linked to insulin resistance in Asian Indians, while the effects of ectopic fat accumulation in pancreas and skeletal muscle need more investigation. South Asians also have lower skeletal muscle mass than Whites, and this may contribute to their higher risk T2DM. Lifestyle factors contributing to MetS and T2DM in South Asians include inadequate physical activity and high intakes of refined carbohydrates and saturated fats. These are reflective of the recent but rapid economic transition and urbanization of the South Asian region. There is need to further the research into genetic determinants of dysmetabolism as well as gene x environment interactions. Collectively, MetS and T2DM have multi-factorial antecedents in South Asians and efforts to combat it through low-cost and socio-culturally appropriate lifestyle interventions need to be supported.
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Affiliation(s)
- A Misra
- Centre of Nutrition & Metabolic Research (C-NET), National Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, India; Diabetes Foundation (India), SDA, New Delhi, India; Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, Nehru Place, New Delhi, India.
| | - Mario J Soares
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Viswanathan Mohan
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialties Centre, Chennai, India
| | - Shajith Anoop
- Centre of Nutrition & Metabolic Research (C-NET), National Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, India; Diabetes Foundation (India), SDA, New Delhi, India
| | - Vishnu Abhishek
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialties Centre, Chennai, India
| | - Ruchi Vaidya
- Genetics of Obesity and Related Traits Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rajendra Pradeepa
- Department of Foods Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
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91
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Macagnan FE, Feoli AMP, Russomano T. Acute Physical Effort Increases Sympathovagal Balance Responses to Autonomic Stimulation in Metabolic Syndrome. Metab Syndr Relat Disord 2018; 17:67-74. [PMID: 30325696 DOI: 10.1089/met.2018.0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is little evidence of how metabolic syndrome (MS) affects sympathovagal balance responses to acute physical effort (APE) and autonomic stimulation (AS). This study aimed to evaluate the heart rate variability (HRV) responses to the combined APE and AS challenges. METHODS Fourteen subjects (8 men; 49.15 ± 8.67 years) divided into two groups: 7 healthy volunteers [control group (CG)] and 7 patients with MS. Sympathovagal balance [low frequency (LF)/high frequency (HF) ratio] was accessed by HRV through the beat-to-beat heart rate (HR) electrocardiogram. Other variables analyzed were as follows: HR, RR-interval variance (VAR/ms2), LF and HF normalized units (un). The APE consisted of a 30-min walk at 65%-75% of the age-predicted maximal HR. The AS was achieved by changing from the supine to standing position (activity orthostatic position). RESULTS At rest, all HRV variables differ with on MS, but after APE and AS LF (nu) and HF (nu) become similar to the CG. However, the LF/HF ratio responses to the AS were significantly different after APE, but only in the MS (CG rest: 367% ± 59% vs. recovery 495% ± 116%, P > 0.05; MS rest: 316% ± 88% vs. recovery: 665% ± 165%; P = 0.045). Comparing the difference between AS in rest and recovery (ΔAS = rest - recovery), the LF/HF ratio was notably higher in the MS group (CG: 94% ± 29% vs. MS: 415% ± 76%; P < 0.0001). CONCLUSIONS The APE and AS induced by body posture changes activated a clear distinction in sympathovagal balance response in MS.
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Affiliation(s)
- Fabrício Edler Macagnan
- 1 Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Ana Maria Pandolfo Feoli
- 2 Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Thais Russomano
- 3 Centre of Human and Applied Physiological Sciences, Department of Physiology, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
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92
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Muilwijk M, Vaz FM, Celis-Morales C, Peters RJG, van Valkengoed IGM. The Association of Acylcarnitines and Amino Acids With Age in Dutch and South-Asian Surinamese Living in Amsterdam. J Clin Endocrinol Metab 2018; 103:3783-3791. [PMID: 30113646 DOI: 10.1210/jc.2018-00809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/30/2018] [Indexed: 01/01/2023]
Abstract
CONTEXT Type 2 diabetes and cardiovascular disease occur more frequently and at a younger age in South-Asians than Europeans. This may be related to differences in regulation of the fatty acid metabolism during aging. We compared age-related acylcarnitine and amino acid concentrations in Dutch and South-Asian Surinamese study participants. METHODS We measured types of acylcarnitine and amino acid concentrations in plasma (by tandem mass spectrometry) in a random subsample of 350 Dutch and 350 South-Asian Surinamese origin participants of the Healthy Life in an Urban Setting study (Amsterdam, Netherlands). We derived principal components (PCs) from the metabolites. Linear regression was used to assess differences in PCs and individual metabolite concentrations, and their age trends between the groups by sex. We adjusted for body mass index and intake of fat and total energy. RESULTS Mean age was 44.8 (SD, 13.3) years. Amino acid concentrations were higher among South-Asian Surinamese women compared with Dutch women; acylcarnitine and amino acid levels were higher among South-Asian Surinamese men than Dutch men. Metabolite levels increased similarly with age in both ethnic groups. Results remained similar after adjustment. CONCLUSION Ethnic differences in metabolite concentrations suggest that fatty acid and amino acid metabolism are more dysregulated among South-Asian Surinamese compared with Dutch from a young age. During adulthood, metabolites increase similarly in both ethnic groups.
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Affiliation(s)
- Mirthe Muilwijk
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Frédéric M Vaz
- Laboratory Genetic Metabolic Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Carlos Celis-Morales
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ron J G Peters
- Department of Cardiology, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Irene G M van Valkengoed
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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93
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LeBlanc ES, Patnode CD, Webber EM, Redmond N, Rushkin M, O'Connor EA. Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2018; 320:1172-1191. [PMID: 30326501 DOI: 10.1001/jama.2018.7777] [Citation(s) in RCA: 269] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Overweight and obesity have been associated with adverse health effects. OBJECTIVE To systematically review evidence on benefits and harms of behavioral and pharmacotherapy weight loss and weight loss maintenance interventions in adults to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed Publisher-Supplied Records, PsycINFO, and the Cochrane Central Register of Controlled Trials for studies published through June 6, 2017; ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials through August 2017; and ongoing surveillance in targeted publications through March 23, 2018. Studies from previous reviews were reevaluated for inclusion. STUDY SELECTION Randomized clinical trials (RCTs) focusing on weight loss or weight loss maintenance in adults. DATA EXTRACTION AND SYNTHESIS Data were abstracted by one reviewer and confirmed by another. Random-effects meta-analyses were conducted for weight loss outcomes in behavior-based interventions. MAIN OUTCOMES AND MEASURES Health outcomes, weight loss or weight loss maintenance, reduction in obesity-related conditions, and adverse events. RESULTS A total of 122 RCTs (N = 62 533) and 2 observational studies (N = 209 993) were identified. Compared with controls, participants in behavior-based interventions had greater mean weight loss at 12 to 18 months (-2.39 kg [95% CI, -2.86 to -1.93]; 67 studies [n = 22065]) and less weight regain (-1.59 kg [95% CI, -2.38 to -0.79]; 8 studies [n = 1408]). Studies of medication-based weight loss and maintenance interventions also reported greater weight loss or less weight regain in intervention compared with placebo groups at 12 to 18 months (range, -0.6 to -5.8 kg; no meta-analysis). Participants with prediabetes in weight loss interventions had a lower risk of developing diabetes compared with controls (relative risk, 0.67 [95% CI, 0.51 to 0.89]). There was no evidence of other benefits, but most health outcomes such as mortality, cardiovascular disease, and cancer were infrequently reported. Small improvements in quality of life in some medication trials were noted but were of unclear clinical significance. There was no evidence of harm such as cardiovascular disease from behavior-based interventions; higher rates of adverse events were associated with higher dropout rates in medication groups than in placebo groups. CONCLUSIONS AND RELEVANCE Behavior-based weight loss interventions with or without weight loss medications were associated with more weight loss and a lower risk of developing diabetes than control conditions. Weight loss medications, but not behavior-based interventions, were associated with higher rates of harms. Long-term weight and health outcomes data, as well as data on important subgroups, were limited.
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Affiliation(s)
- Erin S LeBlanc
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Carrie D Patnode
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Elizabeth M Webber
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan Rushkin
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Elizabeth A O'Connor
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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94
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Houehanou YC, Mizéhoun-Adissoda C, Amidou S, Désormais I, Houénassi M, Preux PM, Marin B, Houinato D, Lacroix P. Feasibility of a cardiovascular cohort in a Sub-Saharan Africa community: preliminary report of the pilot project TAHES (Tanvè Health Study) in Benin. Glob Health Action 2018; 10:1270528. [PMID: 28498739 PMCID: PMC5496170 DOI: 10.1080/16549716.2017.1270528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Faced with the growing burden of cardiovascular disease (CVD) including atherosclerotic in Sub-Saharan Africa (SSA), the development of appropriate prediction tools, based on large cohorts, appears useful for prevention. OBJECTIVE The objective of the pilot project TAHES (Tanvè Health Study) was to explore the feasibility of a large cohort study focused on CVD and risk factors in Benin. METHODS We implemented a prospective cohort over 2 years. The sample consisted of all people aged 25 years or older who had lived for at least the previous 6 months in the villages of Tanvè or Dékanmè. At baseline in February 2015, behaviours and medical histories were recorded using a standardized questionnaire adapted from the WHO Steps instrument; screening questionnaires for angina, claudication, congestive heart failure, and stroke were applied; anthropometric measures and fasting capillary blood glucose were taken. All participants were included in the follow-up phase. Surveillance of target CVD and deaths was implemented through a medical and a community network. RESULTS A total of 1,195 participants were enrolled at baseline; women represented 65.5% and the median age was 39 years. The high participation rate (91.4%), the quality of baseline data, and the functionality of the events surveillance network over 8 months indicated good perspective for the feasibility of a large cohort. We recorded a 3.8% prevalence of daily smoking, 3.6% of harmful use of alcohol, 10.7% of obesity, 25.5% of high blood pressure, and 3.5% of diabetes. Prevalence of angina pectoris (2.7%), intermittent claudication (2.0%), congestive heart failure (0.9%), and stroke survival with motor impairment (3‰) were also recorded. Ten deaths occurred during the first 8 months, all within households; a cardiovascular cause was suspected in four cases. CONCLUSION These preliminary results support the feasibility of establishing a cohort in Benin. It would require technical and resource support.
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Affiliation(s)
- Yessito Corine Houehanou
- a U1094, Tropical Neuroepidemiology , INSERM , Limoges , France.,b UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology , University Limoges , Limoges , France.,c Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology , University of Abomey-Calavi , Cotonou , Bénin
| | - Carmelle Mizéhoun-Adissoda
- a U1094, Tropical Neuroepidemiology , INSERM , Limoges , France.,b UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology , University Limoges , Limoges , France.,c Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology , University of Abomey-Calavi , Cotonou , Bénin
| | - Salimanou Amidou
- a U1094, Tropical Neuroepidemiology , INSERM , Limoges , France.,b UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology , University Limoges , Limoges , France.,c Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology , University of Abomey-Calavi , Cotonou , Bénin
| | - Iléana Désormais
- a U1094, Tropical Neuroepidemiology , INSERM , Limoges , France.,b UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology , University Limoges , Limoges , France.,d Vascular Medicine Unit , CHU Limoges , Limoges , France
| | | | - Pierre-Marie Preux
- a U1094, Tropical Neuroepidemiology , INSERM , Limoges , France.,b UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology , University Limoges , Limoges , France.,d Vascular Medicine Unit , CHU Limoges , Limoges , France
| | - Benoit Marin
- a U1094, Tropical Neuroepidemiology , INSERM , Limoges , France.,b UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology , University Limoges , Limoges , France.,f Functional Unit of Clinical Research and Biostatistics , CHU Limoges , Limoges , France
| | - Dismand Houinato
- a U1094, Tropical Neuroepidemiology , INSERM , Limoges , France.,c Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology , University of Abomey-Calavi , Cotonou , Bénin.,g Neurology Unit , CNHU Cotonou , Cotonou , Bénin
| | - Philippe Lacroix
- a U1094, Tropical Neuroepidemiology , INSERM , Limoges , France.,b UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology , University Limoges , Limoges , France.,d Vascular Medicine Unit , CHU Limoges , Limoges , France
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95
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Ramezankhani A, Ehteshami-Afshar S, Hasheminia M, Hajebrahimi MA, Azizi F, Hadaegh F. Optimum cutoff values of anthropometric indices of obesity for predicting hypertension: more than one decades of follow-up in an Iranian population. J Hum Hypertens 2018; 32:838-848. [PMID: 30082689 DOI: 10.1038/s41371-018-0093-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/11/2018] [Indexed: 12/13/2022]
Abstract
We determined cutoff points of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR), for predicting hypertension in an Iranian population. Study sample included 6359 (3678 female) participants aged ≥20 and <60 years of a prospective cohort. The sex stratified multivariate hazard ratios (HRs) for all indices were estimated using Cox regression in two age groups (20-39 and 40-59 years). Receiver operating characteristic (ROC) was used to evaluate the predictive ability and determine the optimal cut-off values of the indices. In both genders and two age groups, the confounders adjusted HRs were significant for general and central obesity measures indices. AUCs of the indices were similar in men; however, among women 40-59 years, WC and WHtR had significantly higher AUC compared to BMI. Generally, the optimal cut-off values were higher in the 40-59 year age group. Optimal BMI, WC and WHR and WHtR cut-off values were 24.15 kg/m2, 90.5 cm, 0.90 and 0.49 among men, aged 20-39 years; the corresponding values were 28.41 kg/m2, 86.5 cm, 0.96 and 0.50 in men aged 40-59 years, respectively. In women, the aforementioned values were 26.38 kg/m2, 83.5 cm, 0.79 and 0.51 in the age group of 20-39 years, and 29.57 kg/m2, 90.5 cm, 0.88 and 0.59 in the 40-59 year age group, respectively. Our results suggest that gender and age differences in the association between anthropometric indices and hypertension should be considered.
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Affiliation(s)
- Azra Ramezankhani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Solmaz Ehteshami-Afshar
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Hasheminia
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Hajebrahimi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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96
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Mahoney S, Bryant M, Sahota P, Barber S. Dietary intake in the early years and its relationship to BMI in a bi-ethnic group: the Born in Bradford 1000 study. Public Health Nutr 2018; 21:2242-2254. [PMID: 29607793 PMCID: PMC11106021 DOI: 10.1017/s1368980018000654] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 01/30/2018] [Accepted: 02/23/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess relationships between dietary intake at age 12, 18 and 36 months and BMI Z-scores at age 36 months in a bi-ethnic group. DESIGN A prospective cohort study comparing cross-sectional and longitudinal data. Exposures included dietary intake at 12, 18 and 36 months (FFQ) with an outcome of BMI Z-score at age 36 months. SETTING Born in Bradford 1000 study, Bradford, UK. SUBJECTS Infants at age 12 months (n 722; 44 % White British, 56 % Pakistani), 18 months (n 779; 44 % White British, 56 % Pakistani) and 36 months (n 845; 45 % White British, 55 % Pakistani). RESULTS Diet at age 12 months was not associated with BMI Z-score at age 36 months. Higher consumption of vegetables at 18 and 36 months was associated with a lower BMI Z-score at 36 months (model coefficient (95 % CI): -0·20 (-0·36, -0·03) and -0·16 (-0·31, -0·02), respectively). Higher consumption of high-fat chips at age 36 months was associated with a lower BMI Z-score at age 36 months (-0·16 (-0·32, 0·00)). Overall, White British children had higher 36-month BMI Z-scores than Pakistani children (adjusted mean difference (95 % CI): 0·21 (0·02, 0·41)). CONCLUSIONS Our findings indicate that dietary intake at 18 and 36 months was somewhat related to BMI Z-score at age 36 months and suggest the importance of early interventions aimed at establishing healthy eating behaviours.
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Affiliation(s)
- Samuel Mahoney
- School of Mathematics, University of Leeds, Leeds LS2 9JT, UK
| | - Maria Bryant
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Pinki Sahota
- Institute for Health & Wellbeing, Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Stuart Barber
- School of Mathematics, University of Leeds, Leeds LS2 9JT, UK
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97
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Muilwijk M, Nicolaou M, Qureshi SA, Celis-Morales C, Gill JMR, Sheikh A, Sattar N, Beune E, Jenum AK, Stronks K, van Valkengoed IGM. Dietary and physical activity recommendations to prevent type 2 diabetes in South Asian adults: A systematic review. PLoS One 2018; 13:e0200681. [PMID: 30011314 PMCID: PMC6047810 DOI: 10.1371/journal.pone.0200681] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/02/2018] [Indexed: 02/07/2023] Open
Abstract
Intervention trials and guidelines for the prevention of type 2 diabetes (T2D) in populations of South Asian origin often include strategies to improve diet and physical activity that are based on those developed for other populations. These may be suboptimal for the South Asian target populations. We aimed to provide an overview of included recommended dietary and physical activity components, and to identify whether these were supported by evidence of their effectiveness. Databases were searched until September 2017 for intervention studies and guidelines with an adult South Asian population without T2D. The protocol was registered in PROSPERO, registration number: CRD42015207067. The quality of included studies and guidelines was assessed. Dietary and physical activity components, and effects on T2D incidence, glycemic status and adiposity measures, were summarized in tabular format and evaluated narratively. Eighteen intervention studies and four guidelines were identified. Dietary and physical activity components were similar to recommendations for the general population. Intervention studies and guidelines did not reference evidence to support the effectiveness of components included in the intervention for South Asian populations in particular. Moreover, we were unable to assess patterns of components to determine the effects of specific components. Evaluation of current and emerging components among South Asian populations and subgroups seems necessary to formulate more specific recommendations in future intervention studies and guidelines.
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Affiliation(s)
- Mirthe Muilwijk
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Mary Nicolaou
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Samera A. Qureshi
- The Norwegian Centre for Migrant and Minority Health Research, Oslo, Norway
| | - Carlos Celis-Morales
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jason M. R. Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Erik Beune
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne Karen Jenum
- Department of General Practice, Faculty of Medicine, Institute of Health and Society, Blindern, Oslo, Norway
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene G. M. van Valkengoed
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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98
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Abstract
Purpose of review The obesity epidemic is a global health crisis of staggering proportion. Excess body weight is a major risk factor for the development of cardiovascular disease (CVD). We review temporal trends in obesity rates, pertinent pathophysiology to understand mechanisms of disease, and treatment strategies in the context of reducing cardiovascular risk. Recent findings The prevalence of obesity is increasing in recent decades and is driven by a complex interplay of economic, environmental, and biological factors. In developed countries, changes in foodintake, such as increased consumption of energy-dense and added sugar have contributed significantly to weight gain. Single nucleotide variations in genes and alterations in the gut microbiome have been associated with the obese phenotype. The description of an obesity paradox in patients with CVD may have several explanations, including limitations of body mass index (BMI) to assess adiposity, selection bias, and lead-time bias with earlier onset of disease. Evidence-based treatments for weight loss include lifestyle intervention, pharmacotherapy, and bariatric surgery. Data on the long-term effects of these therapies on cardiovascular risk are limited. Summary Overweight and obesity are associated with increased cardiovascular morbidity and mortality over the lifespan. Despite our increasing understanding of biological and environmental drivers of obesity, more work is needed in developing effective prevention strategies and implementation of evidence-based treatments to promote cardiovascular health and reduce cardiovascular risk. Ultimately, efforts to prevent and postpone cardiovascular morbidity should include focus on maintenance of normal BMI (primordial prevention) for a longer and healthier life, free of CVD.
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99
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Lancki N, Siddique J, Schneider JA, Kanaya AM, Fujimoto K, Dave SS, Puri-Taneja A, Kandula NR. Social network body size is associated with body size norms of South Asian adults. ACTA ACUST UNITED AC 2018; 11:25-30. [PMID: 31338475 DOI: 10.1016/j.obmed.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Aims To examine the association between social network body size and body size norms in South Asian adults. Methods Participants (n = 766) from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study (2014-2018) provided detailed information about their five closest network members. Participants' perceptions of their network members' body sizes, their own body size (self-body size), and a healthy body size for men and women (body size norms) were assessed using the Stunkard 9-figure scale. Adjusted hierarchical linear regression models were used to examine associations between the average body size of network members and perceived body size norms. Results Participants' average age was 59.1 years (SD = 9.2) and 44.1% were women. Participants reported an average network body size of 4.0 (SD = 1.1). The average body size norm for male and female Stunkard images was 3.6 (SD = 1.0) and 3.4 (SD = 0.8), respectively. Social network body size was positively associated with increasing body size norms (β-coefficient = 0.31, 95% CI: 0.26, 0.36), independent of self-body size. Discussion Social networks may influence body size norms in South Asian adults. Long-term follow up of the MASALA cohort will determine if social network body size and body size norms are associated with weight- control behaviors and weight change.
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Affiliation(s)
- Nicola Lancki
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, 750 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Juned Siddique
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, 420 E Superior, Chicago, IL, 60611, United States
| | - John A Schneider
- Department of Medicine and Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, Chicago, IL, 60637, United States
| | - Alka M Kanaya
- Division of General Internal Medicine, University of California San Francisco, 1545 Divisadero, San Francisco, CA, 94115, United States
| | - Kayo Fujimoto
- Division of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Swapna S Dave
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, 750 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Ankita Puri-Taneja
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, 750 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Namratha R Kandula
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, 750 N Lake Shore Drive, Chicago, IL, 60611, United States.,Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, 420 E Superior, Chicago, IL, 60611, United States
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100
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Leong DP, Yusuf S. Adiposity and mortality in South Asians: challenges to the existing paradigm. LANCET GLOBAL HEALTH 2018; 6:e712-e713. [PMID: 29903366 DOI: 10.1016/s2214-109x(18)30281-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Darryl P Leong
- Population Health Research Institute, David Braley Building, Hamilton General Hospital, Hamilton, ON L8L 2X2, Canada.
| | - Salim Yusuf
- Population Health Research Institute, David Braley Building, Hamilton General Hospital, Hamilton, ON L8L 2X2, Canada
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