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Kingma JS, Burgers DMT, Monpellier VM, Wiezer MJ, Blussé van Oud-Alblas HJ, Vaughns JD, Sherwin CMT, Knibbe CAJ. Oral drug dosing following bariatric surgery: General concepts and specific dosing advice. Br J Clin Pharmacol 2021; 87:4560-4576. [PMID: 33990981 PMCID: PMC9291886 DOI: 10.1111/bcp.14913] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/06/2021] [Accepted: 05/01/2021] [Indexed: 11/30/2022] Open
Abstract
Bariatric or weight‐loss surgery is a popular option for weight reduction. Depending on the surgical procedure, gastric changes like decreased transit time and volume and increased pH, decreased absorption surface in the small intestine, decreased exposure to bile acids and enterohepatic circulation, and decreased gastrointestinal transit time may be expected. In the years after bariatric surgery, patients will also substantially lose weight. As a result of these changes, the absorption, distribution, metabolism and/or elimination of drugs may be altered. The purpose of this article is to report the general influence of bariatric surgery on oral drug absorption, and to provide guidance for dosing of commonly used drugs in this special population. Upon oral drug administration, the time to maximum concentration is often earlier and this concentration may be higher with less consistent effects on trough concentrations and exposure. Additionally, prescription of liquid formulations to bariatric patients is supported by some reports, even though the high sugar load of these suspensions may be of concern. Studies on extended‐release medications result in an unaltered exposure for a substantial number of drugs. Also, studies evaluating the influence of timing after surgery show dynamic absorption profiles. Although for this group specific advice can be proposed for many drugs, we conclude that there is insufficient evidence for general advice for oral drug therapy after bariatric surgery, implying that a risk assessment on a case‐by‐case basis is required for each drug.
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Affiliation(s)
- Jurjen S Kingma
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands.,Department of Clinical Pharmacy, Division of Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Desirée M T Burgers
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Valerie M Monpellier
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, The Netherlands
| | - Marinus J Wiezer
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Janelle D Vaughns
- Department of Anesthesia and Pain Medicine, Children's National Health System, Washington, DC, USA.,Division of Clinical Pharmacology, Children's National Health System, Washington, DC, USA
| | - Catherine M T Sherwin
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, Ohio, USA
| | - Catherijne A J Knibbe
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands.,Division of Systems Biomedicine & Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands
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152
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Tsekrekos A, Lovece A, Chrysikos D, Ndegwa N, Schizas D, Kumagai K, Rouvelas I. Impact of obesity on the outcomes after gastrectomy for gastric cancer: A meta-analysis. Asian J Surg 2021; 45:15-26. [PMID: 33965317 DOI: 10.1016/j.asjsur.2021.04.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 12/25/2022] Open
Abstract
The impact of body mass index (BMI) on surgical outcomes has previously been studied in relation to several oncological procedures. Regarding gastric cancer surgery, published results have been contradicting in terms of degree of technical difficulty, risk of postoperative complications and survival. In an attempt to clarify these issues, we performed a meta-analysis to evaluate the impact of obesity (defined as BMI ≥ 30 kg/m2) on outcomes after gastrectomy for gastric cancer. The meta-analysis was performed according to the PRISMA guidelines. Eligible studies were identified through search of PubMed, EMBASE, Web of Science and Cochrane Library databases. Quality assessment was performed using the Newcastle-Ottawa scale. The meta-analysis was conducted using random-effects modeling. A total of 11 studies with 13 538 patients were eligible for analysis. Obesity was associated with a significantly longer operation time (WMD = 19.38 min, 95% CI 12.72-26.04; p < 0.001), increased risk of overall complications (RR = 1.23, 95% CI 1.06-1.42; p = 0.005) and pulmonary complications (RR = 3.81, 95% CI 2.24-6.46; p < 0.001). These findings remained irrespective type of surgery (laparoscopic vs. open) and type of gastrectomy. No differences were found regarding blood loss, number of resected lymph nodes, anastomotic leakage, hospital stay, 30-day mortality and 5-year overall survival. The conclusion of the current meta-analysis is that high BMI in gastric cancer patients is associated with longer operative time and more frequent overall postoperative complications. However, it has no negative impact on survival, indicating that gastrectomy is a safe procedure for this group of patients.
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Affiliation(s)
- Andrianos Tsekrekos
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Andrea Lovece
- Division of General Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Dimosthenis Chrysikos
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Nelson Ndegwa
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Ioannis Rouvelas
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Surgery, Karolinska University Hospital, Stockholm, Sweden.
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153
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Knowles R, Carter J, Jebb SA, Bennett D, Lewington S, Piernas C. Associations of Skeletal Muscle Mass and Fat Mass With Incident Cardiovascular Disease and All-Cause Mortality: A Prospective Cohort Study of UK Biobank Participants. J Am Heart Assoc 2021; 10:e019337. [PMID: 33870707 PMCID: PMC8200765 DOI: 10.1161/jaha.120.019337] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/01/2021] [Indexed: 02/06/2023]
Abstract
Background There is debate whether body mass index is a good predictor of health outcomes because different tissues, namely skeletal muscle mass (SMM) and fat mass (FM), may be differentially associated with risk. We investigated the association of appendicular SMM (aSMM) and FM with fatal and nonfatal cardiovascular disease (CVD) and all-cause mortality. We compared their prognostic value to that of body mass index. Methods and Results We studied 356 590 UK Biobank participants aged 40 to 69 years with bioimpedance analysis data for whole-body FM and predicted limb muscle mass (to calculate aSMM). Associations between aSMM and FM with CVD and all-cause mortality were examined using multivariable Cox proportional hazards models. Over 3 749 501 person-years of follow-up, there were 27 784 CVD events and 15 844 all-cause deaths. In men, aSMM was positively associated with CVD incidence (hazard ratio [HR] per 1 SD 1.07; 95% CI, 1.06-1.09) and there was a curvilinear association in women. There were stronger positive associations between FM and CVD with HRs per SD of 1.20 (95% CI, 1.19-1.22) and 1.25 (95% CI, 1.23-1.27) in men and women respectively. Within FM tertiles, the associations between aSMM and CVD risk largely persisted. There were J-shaped associations between aSMM and FM with all-cause mortality in both sexes. Body mass index was modestly better at discriminating CVD risk. Conclusions FM showed a strong positive association with CVD risk. The relationship of aSMM with CVD risk differed between sexes, and potential mechanisms need further investigation. Body fat and SMM bioimpedance measurements were not superior to body mass index in predicting population-level CVD incidence or all-cause mortality.
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Affiliation(s)
- Rebecca Knowles
- Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Jennifer Carter
- Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordUnited Kingdom
| | - Derrick Bennett
- Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Sarah Lewington
- Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Carmen Piernas
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordUnited Kingdom
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154
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Abstract
PURPOSE OF REVIEW Despite attention to racial disparities in outcomes for heart failure (HF) and other chronic diseases, progress against these inequities has been gradual at best. The disparities of COVID-19 and police brutality have highlighted the pervasiveness of systemic racism in health outcomes. Whether racial bias impacts patient access to advanced HF therapies is unclear. RECENT FINDINGS As documented in other settings, racial bias appears to operate in HF providers' consideration of patients for advanced therapy. Multiple medical and psychosocial elements of the evaluation process are particularly vulnerable to bias. SUMMARY Reducing gaps in access to advanced therapies will require commitments at multiple levels to reduce barriers to healthcare access, standardize clinical operations, research the determinants of patient success and increase diversity among providers and researchers. Progress is achievable but likely requires as disruptive and investment of immense resources as in the battle against COVID-19.
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Affiliation(s)
- Raymond C Givens
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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155
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Sundaram V, Jalan R, Shah P, Singal AK, Patel AA, Wu T, Noureddin M, Mahmud N, Wong RJ. Acute on Chronic Liver Failure From Nonalcoholic Fatty Liver Disease: A Growing and Aging Cohort With Rising Mortality. Hepatology 2021; 73:1932-1944. [PMID: 32961608 DOI: 10.1002/hep.31566] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS We assessed the burden of nonalcoholic fatty liver disease (NAFLD)-related acute on chronic liver failure (ACLF) among transplant candidates in the United States, along with waitlist outcomes for this population. APPROACH AND RESULTS We analyzed the United Network for Organ Sharing registry from 2005 to 2017. Patients with ACLF were identified using the European Association for the Study of the Liver/Chronic Liver Failure criteria and categorized into NAFLD, alcohol-associated liver disease (ALD), and hepatitis C virus (HCV) infection. We used linear regression and Chow's test to determine significance in trends and evaluated waitlist outcomes using Fine and Gray's competing risks regression and Cox proportional hazards regression. Between 2005 and 2017, waitlist registrants for NAFLD-ACLF rose by 331.6% from 134 to 574 candidates (P < 0.001), representing the largest percentage increase in the study population. ALD-ACLF also increased by 206.3% (348-1,066 registrants; P < 0.001), whereas HCV-ACLF declined by 45.2% (P < 0.001). As of 2017, the NAFLD-ACLF population consisted primarily of persons aged ≥60 years (54.1%), and linear regression demonstrated a significant rise in the proportion of patients aged ≥65 in this group (β = 0.90; P = 0.011). Since 2014, NAFLD-ACLF grade 1 was associated with a greater risk of waitlist mortality relative to ALD-ACLF (subhazard ratio [SHR] = 1.24; 95% confidence interval [CI], 1.05-1.44) and HCV-ACLF (SHR = 1.35; 95% CI, 1.08-1.71), among patients aged ≥60 years. Mortality was similar among the three groups for patients with ACLF grade 2 or 3. CONCLUSIONS NAFLD is the fastest rising etiology of cirrhosis associated with ACLF among patients listed in the United States. As the NAFLD population continues to grow and age, patients with NAFLD-ACLF will likely have the highest risk of waitlist mortality.
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Affiliation(s)
- Vinay Sundaram
- Karsh Division of Gastroenterology and Hepatology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Rajiv Jalan
- Liver Failure Group, Institute for Liver and Digestive Health, UCL Medical School, London, United Kingdom
| | - Parth Shah
- Karsh Division of Gastroenterology and Hepatology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ashwani K Singal
- University of South Dakota Sanford School of Medicine and Avera Transplant Institute, Sioux Falls, SD
| | - Arpan A Patel
- Veterans Affairs (VA) Greater Los Angeles Healthcare System and Division of Digestive Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Tiffany Wu
- Karsh Division of Gastroenterology and Hepatology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mazen Noureddin
- Karsh Division of Gastroenterology and Hepatology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Nadim Mahmud
- Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA.,Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA
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156
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Rudasill SE, Dillon D, Karunungan K, Mardock AL, Hadaya J, Sanaiha Y, Tran Z, Benharash P. The obesity paradox: Underweight patients are at the greatest risk of mortality after cholecystectomy. Surgery 2021; 170:675-681. [PMID: 33933284 DOI: 10.1016/j.surg.2021.03.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/10/2021] [Accepted: 03/14/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Elevated body mass index is a risk factor for gallstone disease and cholecystectomy, but outcomes for low body mass index patients remain uncharacterized. We examined the association of body mass index with morbidity, mortality, and resource use after cholecystectomy. METHODS The 2005 to 2016 American College of Surgeons National Surgical Quality Improvement Program was retrospectively analyzed for adult patients undergoing laparoscopic and open cholecystectomy. Patients were stratified into 5 groups: body mass index <18.5 (underweight), body mass index 18.5 to 24.9 (normal weight), body mass index 25 to 29.9 (overweight), body mass index 30 to 34.9 (class I obesity), body mass index 35 to 39.9 (class II obesity), and body mass index ≥40 (class III obesity). Multivariable regressions identified independent associations of covariates with 30-day mortality, complications, and resource use. RESULTS Of 327,473 cholecystectomy patients, 1.0% were underweight, 19.5% normal weight, 30.3% overweight, 24.0% class I obesity, 13.5% class II obesity, and 11.7% class III obesity. After multivariable analysis, underweight patients had a higher risk of mortality (adjusted odds ratio = 1.53; P = .029) and postoperative bleeding (adjusted odds ratio = 1.45; P = .011) relative to normal weight patients. Conversely, class III obesity patients had lower mortality (adjusted odds ratio = 0.66; P = .005) but increased operative time (β = 10.2 minutes; P < .001), wound infection (adjusted odds ratio = 1.38; P < .001), and wound dehiscence (adjusted odds ratio = 2.20; P < .001). Hospital duration of stay and readmission rates were highest for underweight patients. CONCLUSION Underweight patients experience increased risk of mortality and readmission, while class III obesity patients have higher rates of wound infection and dehiscence as well as prolonged operative time. These findings may guide choice of intervention.
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Affiliation(s)
- Sarah E Rudasill
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Dustin Dillon
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Krystal Karunungan
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Alexandra L Mardock
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Zachary Tran
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles, CA.
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157
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Chen Y, Wang N, Dong X, Wang X, Zhu J, Chen Y, Jiang Q, Fu C. Underweight rather than adiposity is an important predictor of death in rural Chinese adults: a cohort study. J Epidemiol Community Health 2021; 75:1123-1128. [PMID: 33879539 DOI: 10.1136/jech-2020-214821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 02/23/2021] [Accepted: 04/06/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND To assess the associations of body mass index (BMI) with all-cause and cause-specific mortalities among rural Chinese. METHODS A prospective study of 28 895 individuals was conducted from 2006 to 2014 in rural Deqing, China. Height and weight were measured. The association of BMI with mortality was assessed by using Cox proportional hazards model and restricted cubic spline regression. RESULTS There were a total of 2062 deaths during an average follow-up of 7 years. As compared with those with BMI of 22.0-24.9 kg/m2, an increased risk of all-cause mortality was found for both underweight men (BMI <18.5 kg/m2) (adjusted HR (aHR): 1.45, 95% CI: 1.18 to 1.79) and low normal weight men (BMI of 18.5-21.9 kg/m2) (aHR: 1.20, 95% CI: 1.03 to 1.38). A J-shaped association was observed between BMI and all-cause mortality in men. Underweight also had an increased risk of cardiovascular disease and cancer mortalities in men. The association of underweight with all-cause mortality was more pronounced in ever smokers and older men (60+ years). The results remained after excluding participants who were followed up less than 1 year. CONCLUSION The present study suggests that underweight is an important predictor of mortality, especially for elderly men in the rural community of China.
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Affiliation(s)
- Yun Chen
- School of Public Health,NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Na Wang
- School of Public Health,NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Xiaolian Dong
- Department of Office, Deqing County Center for Disease Control and Prevention, Deqing, China
| | - Xuecai Wang
- Department of Office, Deqing County Center for Disease Control and Prevention, Deqing, China
| | - Jianfu Zhu
- Department of Office, Deqing County Center for Disease Control and Prevention, Deqing, China
| | - Yue Chen
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Qingwu Jiang
- School of Public Health,NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Chaowei Fu
- School of Public Health,NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
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158
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Changes in the Composition and Function of Lipoproteins after Bariatric Surgery in Patients with Severe Obesity. J Clin Med 2021; 10:jcm10081716. [PMID: 33923393 PMCID: PMC8071565 DOI: 10.3390/jcm10081716] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
The effect of bariatric surgery on lipid profile and the qualitative characteristics of lipoproteins was analyzed in morbidly obese subjects. Thirteen obese patients underwent bariatric surgery. Plasma samples were obtained before surgery and at 6 and 12 months after the intervention. Thirteen healthy subjects comprised the control group. Lipid profile, hsCRP, and the composition and functional characteristics of VLDL, LDL, and HDL were assessed. At baseline, plasma from subjects with obesity had more triglycerides, VLDLc, and hsCRP, and less HDLc than the control group. These levels progressively normalized after surgery, although triglyceride and hsCRP levels remained higher than those in the controls. The main differences in lipoprotein composition between the obese subjects and the controls were increased apoE in VLDL, and decreased cholesterol and apoJ and increased apoC-III content in HDL. The pro-/anti-atherogenic properties of LDL and HDL were altered in the subjects with obesity at baseline compared with the controls, presenting smaller LDL particles that are more susceptible to modification and smaller HDL particles with decreased antioxidant capacity. Bariatric surgery normalized the composition of lipoproteins and improved the qualitative characteristics of LDL and HDL. In summary, patients with obesity present multiple alterations in the qualitative properties of lipoproteins compared with healthy subjects. Bariatric surgery reverted most of these alterations.
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159
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Associations between different measurements of sarcopenic obesity and health outcomes among non-frail community-dwelling older adults in Taiwan. Br J Nutr 2021; 126:1749-1757. [PMID: 33849669 DOI: 10.1017/s0007114521001288] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The most important issue for the clinical application of sarcopenic obesity (SO) is the lack of a consensus definition. The aim of the present study was to determine the best measurement for SO by estimating the association between various definitions and the risk of falls and metabolic syndrome (MS). We studied a community of 765 adults aged 65 years and older in 2015-2017. Sarcopenia obesity was measured by sarcopenia (defined by low muscle mass with either low handgrip strength or low gait speed or both) plus obesity (defined by waist circumference, body fat percentage and BMI). The MS was defined according to the National Cholesterol Education Program ATP III. Logistic regression models were constructed to examine the relationships between sarcopenia obesity and risk of fall and MS. In the analysis of the fall risk with SO defined by waist circumference, the participants with non-sarcopenia/non-obesity were treated as the reference group. The OR to fall in participants with SO was 10·16 (95 % CI 2·71, 38·13) after adjusting for confounding covariates. In the analysis of the risk of the MS between participants with individual components of sarcopenia coupled with obesity defined by waist circumference, the risk was statistically significant for low gait speed (OR: 7·19; 95 % CI 3·61, 14·30) and low grip strength (OR: 9·19; 95 % CI 5·00, 16·91). A combination of low grip strength and abdominal obesity for identifying SO may be a more precise and practical method for predicting target populations with unfavourable health risks, such as falls risk and MS.
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160
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Siegel RM, Ostfeld RJ, Aboodi MS, Vittorio TJ, Mehlman Y, Travin MI. Relationship between extreme obesity and mortality in patients with reduced ejection fraction. J Cardiovasc Med (Hagerstown) 2021; 22:279-284. [PMID: 33633043 DOI: 10.2459/jcm.0000000000001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Although obesity is associated with increased mortality, epidemiologic studies in heart failure have reported lower mortality in obese patients compared with matched nonobese patients (the 'obesity paradox'). However, the relationship between survival and extreme (morbid) obesity (BMI ≥ 40) is poorly understood. We evaluate survival in low ejection fraction patients across a range of BMI categories, including extreme obesity. METHODS In a retrospective review, 12 181 consecutive patients receiving nuclear stress testing at a tertiary care center were stratified based on BMI and ejection fraction. Eight-year mortality data were collected using the social security death index. RESULTS Normal ejection fraction patients (internal control, ejection fraction ≥50%) exhibited the J-shaped association between mortality and BMI that is observed in the general population. Among patients with reduced ejection fraction (<50%), survival improved as obesity increased (P < 0.0001). Those with extreme obesity had the lowest mortality (n = 1134, P < 0.05). CONCLUSION In this cohort of reduced Ejection fraction patients, the obesity paradox was observed in all weight categories, with the highest survival of all observed in the extremely obese BMI category. This further supports hypotheses that an obesity-related physiologic phenomenon affects mortality in reduced ejection fraction patients.
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Affiliation(s)
- Robert M Siegel
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Robert J Ostfeld
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael S Aboodi
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Timothy J Vittorio
- Division of Cardiology, BronxCare Hospital Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yonatan Mehlman
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mark I Travin
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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161
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Gokalp F, Koras O, Ugur M, Yildirak E, Sigva H, Porgali SB, Tamkac N, Gorur S. Bariatric surgery has positive effects on patients' and their partners' sexual function: A prospective study. Andrology 2021; 9:1119-1125. [PMID: 33686805 DOI: 10.1111/andr.13000] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/19/2021] [Accepted: 03/05/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Obesity has been associated with severe conditions and sexual dysfunction. Bariatric surgery has effects positively patients' sexual function. OBJECTIVES To assess the effect of bariatric surgery on sexual functions of couples. MATERIALS AND METHODS The study included 57 obese patients and their sexually active partners. Male participations were assessed with the International Index of Erectile Function (IIEF) and Male Sexual Health Questionaries (MSHQ-4), and female participations were assessed with the Female Sexual Function Index (FSFI). RESULTS There were 31 (54.4%) male patients and 26 (45.6%) female patients in the study. The median IIEF score of the male patients statistically increased postoperatively (p < 0.001). The IIEF subgroup areas were found to have increased after surgery. The median FSFI score of the female patients statistically increased postoperatively (p < 0.001). The median FSFI of male patients' partners significantly increased postoperatively (p < 0.001). All FSFI domains were statistically significantly increased (p < 0.001, all areas). The median IIEF value of the postoperative partners of the female patients also increased statistically significant (p < 0.001). In addition, the increases in the IIEF's subdomains in terms of sexual desire (p < 0.001), intercourse satisfaction (p < 0.001), and general satisfaction (p < 0.001) were statistically significant. CONCLUSION The sexual functions of both males and females and also their' partners were improved after bariatric surgery. Patients with preoperative poor sexual function achieve significant benefits over patients without sexual dysfunction.
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Affiliation(s)
- Fatih Gokalp
- Department of Urology, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Omer Koras
- Department of Urology, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Mustafa Ugur
- Department of General Surgery, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Ekrem Yildirak
- Department of Urology, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Hakan Sigva
- Department of Urology, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Sefa B Porgali
- Department of Urology, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Nezih Tamkac
- Department of Urology, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Sadik Gorur
- Department of Urology, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
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162
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Sreenivasan J, Khan MS, Sharedalal P, Hooda U, Fudim M, Demmer RT, Yuzefpolskaya M, Ahmad H, Khan SS, Lanier GM, Colombo PC, Rich JD. Obesity and Outcomes Following Cardiogenic Shock Requiring Acute Mechanical Circulatory Support. Circ Heart Fail 2021; 14:e007937. [PMID: 33706552 DOI: 10.1161/circheartfailure.120.007937] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The association of obesity on outcomes in patients with cardiogenic shock requiring acute mechanical circulatory support has not been thoroughly investigated. METHODS We evaluated the National Readmission Database for adults with either acute myocardial infarction or heart failure complicated by cardiogenic shock requiring acute mechanical circulatory support between January 2016 and November 2017. Exposure was assessed using International Classification of Diseases, Tenth Revision codes for the degree of obesity with the reference being body mass index (BMI) of 20.0 to 29.9 group. Multiple logistic regression and Cox regression analysis were used to analyze in-hospital mortality and 30-day readmission, respectively. RESULTS The survey-weighted sample included a total of 35 555 hospitalizations with a mean age of 65.4±0.2 years and 29.8% females. Obesity was associated with higher in-hospital mortality (no obesity, 26.4% [BMI, 20.0-29.9] versus class I obesity, 25.0% [BMI, 30.0-34.9] versus class II obesity, 28.7% [BMI, 35.0-39.9] versus class III obesity, 34.9% [BMI, ≥40]; P<0.001). On stratified analysis, compared with a nonobese phenotype, younger adults (age <60) with class II and class III obesity (odds ratio, 1.9 [95% CI, 1.1-3.5], P=0.02; odds ratio, 2.1 [95% CI, 1.2-3.7], P=0.01) and older adults (age ≥60) with class III obesity (odds ratio, 1.7 [95% CI, 1.2-2.4], P=0.005) had higher mortality. There was no association between the degree of obesity and 30-day readmission. CONCLUSIONS Among adults with acute myocardial infarction or acute heart failure resulting in cardiogenic shock requiring acute mechanical circulatory support, younger adults with class II and class III obesity and older patients with class III obesity have a higher risk of in-hospital mortality compared with nonobese patients.
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Affiliation(s)
- Jayakumar Sreenivasan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY (J.S., P.S., U.H., H.A., G.M.L.)
| | | | - Parija Sharedalal
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY (J.S., P.S., U.H., H.A., G.M.L.)
| | - Urvashi Hooda
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY (J.S., P.S., U.H., H.A., G.M.L.)
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, NC (M.F.).,Division of Cardiology, Duke University Medical Center, Durham, NC, (M.F.)
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (R.T.D.)
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, NY (M.Y., P.C.C.)
| | - Hasan Ahmad
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY (J.S., P.S., U.H., H.A., G.M.L.)
| | - Sadiya S Khan
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.K., J.D.R.)
| | - Gregg M Lanier
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY (J.S., P.S., U.H., H.A., G.M.L.)
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, NY (M.Y., P.C.C.)
| | - Jonathan D Rich
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.K., J.D.R.)
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163
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Eum MJ, Jung HS. The interplay of sleep duration, working hours, and obesity in Korean male workers: The 2010-2015 Korea National Health and Nutrition Examination Survey. PLoS One 2021; 16:e0247746. [PMID: 33651799 PMCID: PMC7924799 DOI: 10.1371/journal.pone.0247746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/12/2021] [Indexed: 12/29/2022] Open
Abstract
The purpose of this study was to clarify the odds ratio for association between working hours and obesity in Korean male wage workers and investigate the role of sleep duration. This study is a cross-sectional one using large-scale national data from the Korea National Health and Nutrition Examination Survey collected between 2010 and 2015 to evaluate 2,592 male wage workers (between the ages of 19 and 60 years). Obesity was defined as 25kg/m2 or more and working hours per week were categorized into <40, 40–49, 50–59, and ≥60 hours. Multiple regression analysis was performed to examine the odds ratio for association between working hours and obesity, after controlling for age, education, income, marital status, smoking, drinking, physical activity, daily energy intake, sleep duration, hypertension, diabetes, dyslipidemia, work schedule, and job category. Next, to study the mediating effect of sleep duration on the association between working hours and obesity, an analysis was performed using the Baron and Kenny method and the Sobel test. Results showed that workers with 50 to 59 hours had 1.4 times higher odds (odds ratio [OR] = 1.4, confidence interval [CI]: 1.11–1.85) of obesity and workers with 60 hours or more had 1.4 times higher odds (OR = 1.4, CI: 1.06–1.90) of obesity than workers with less than 40 hours. Sleep was found to have a mediating effect on the association between working time and body mass index. Therefore, the results of this analysis suggest that practitioners should identify potential factors such as working time and sleeping time when preventing work-related obesity.
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Affiliation(s)
- Mi-Jung Eum
- Department of Public Health, Graduate School, The Catholic University of Korea, Secho-gu, Seoul, Republic of Korea
| | - Hye-Sun Jung
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Secho-gu, Seoul, Republic of Korea
- * E-mail:
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164
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Davidson T, Vinneau-Palarino J, Goode JA, Boardman JD. Utilizing genome wide data to highlight the social behavioral pathways to health: The case of obesity and cardiovascular health among older adults. Soc Sci Med 2021; 273:113766. [PMID: 33621753 PMCID: PMC8005483 DOI: 10.1016/j.socscimed.2021.113766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
We use genome-wide data from the 1992-2016 Health and Retirement Study (n = 12,090) to characterize obesity among older adults as genetically or socially oriented. To illustrate the significance of this approach for social epidemiological research, we deem those with the lowest genetic risk for obesity to be socially-behaviorally obese and obesity among those with the highest polygenic risk is characterized as genetically oriented. We then examine the association between obesity and four indicators of cardiovascular health (type-2 diabetes, hypertension, heart problems, and stroke) among those with low, average, and high genetic risk. Our results show that the association between obesity and cardiovascular health is significantly higher for those with the lowest genetic risk (e.g., social-behavioral obesity). We also demonstrate important sex differences such that this association is particularly strong for heart problems among men and hypertension and stroke among women. Our results further demonstrate the centrality of the social and behavioral determinants of health by utilizing detailed information across the human genome and add to both social and genetic epidemiology literatures.
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Affiliation(s)
- Trent Davidson
- Department of Sociology, University of Colorado Boulder, Boulder, CO, USA; Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA; Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA.
| | - Justin Vinneau-Palarino
- Department of Sociology, University of Colorado Boulder, Boulder, CO, USA; Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA; Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - Joshua A Goode
- Department of Sociology, University of Colorado Boulder, Boulder, CO, USA; Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA; Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - Jason D Boardman
- Department of Sociology, University of Colorado Boulder, Boulder, CO, USA; Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA; Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
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165
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Kumar S, Mahmud N, Goldberg DS, Datta J, Kaplan DE. Disentangling the obesity paradox in upper gastrointestinal cancers: Weight loss matters more than body mass index. Cancer Epidemiol 2021; 72:101912. [PMID: 33647837 DOI: 10.1016/j.canep.2021.101912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/08/2021] [Accepted: 02/20/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The obesity paradox, whereby obesity appears to confer protection against cancer-related mortality, remains controversial. This has not yet been evaluated in upper gastrointestinal cancers. DESIGNS We identified esophageal, cardia, and non-cardia gastric adenocarcinomas in the Veterans Health Administration between 2006-2016. Multivariable Cox proportional hazard models evaluate the impact of BMI at- and prior to- cancer diagnosis on mortality, adjusting for demographics, clinical characteristics, weight loss, and clinical stage (early: T1B/2N0; locally advanced: ≥T2N+). RESULTS We identify 1308 patients: 99 % male, median 66 years. In early disease, relative to BMI 30, BMI 18 and 20 at diagnosis had increased risk of death (HR 1.83, 95 %CI: 1.38-2.44 and HR 1.50, 95 %CI: 1.20-1.87, respectively, p < 0.0001). Patients with BMI > 30 did not. In locally advanced disease, at diagnosis BMI 18 (HR 1.58, 95 %CI: 1.0001-1.48, p = 0.05), BMI 20 (HR 1.46, 95 %CI: 1.01-2.09, p = 0.04), and BMI 25 (HR 1.20, 95 %CI: 1.04-1.38, p = 0.01) had increased risk of death, but BMI > 30 did not. In models assessing premorbid BMI and weight loss, increasing amounts of weight loss were associated with mortality independent of BMI in early cancers. For locally advanced cancers, without weight loss, there was no association with death, regardless of BMI. CONCLUSION The predominant driver of mortality across clinical stages is weight loss. The obesity paradox appears to exist in early stage disease only. Future studies should investigate mechanisms for the obesity paradox, accompanying physiologic changes with weight loss preceding diagnosis, and if patients with low BMI and weight loss benefit from early nutritional support.
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Affiliation(s)
- Shria Kumar
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania, United States
| | - Nadim Mahmud
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania, United States
| | - David S Goldberg
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, United States
| | - Jashodeep Datta
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, United States
| | - David E Kaplan
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania, United States; Gastroenterology Section, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, United States.
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Dedov II, Shestakova MV, Melnichenko GA, Mazurina NV, Andreeva EN, Bondarenko IZ, Gusova ZR, Dzgoeva FK, Eliseev MS, Ershova EV, Zhuravleva MV, Zakharchuk TA, Isakov VA, Klepikova MV, Komshilova KA, Krysanova VS, Nedogoda SV, Novikova AM, Ostroumova OD, Pereverzev AP, Rozhivanov RV, Romantsova TI, Ruyatkina LA, Salasyuk AS, Sasunova AN, Smetanina SA, Starodubova AV, Suplotova LA, Tkacheva ON, Troshina EA, Khamoshina MV, Chechelnitskaya SM, Shestakova EA, Sheremet’eva EV. INTERDISCIPLINARY CLINICAL PRACTICE GUIDELINES "MANAGEMENT OF OBESITY AND ITS COMORBIDITIES". OBESITY AND METABOLISM 2021; 18:5-99. [DOI: 10.14341/omet12714] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - M. S. Eliseev
- Research Institute of Rheumatogy named after V.A. Nasonova
| | | | | | | | - V. A. Isakov
- Federal Research Center of Nutrition, Biotechnology and Food Safety
| | - M. V. Klepikova
- Russian Medical Academy of Continuous Professional Education
| | | | | | | | - A. M. Novikova
- Research Institute of Rheumatogy named after V.A. Nasonova
| | - O. D. Ostroumova
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - A. P. Pereverzev
- Russian National Research Medical University named after N.I. Pirogov
| | | | | | | | | | - A. N. Sasunova
- Federal Research Center of Nutrition, Biotechnology and Food Safety
| | | | | | | | - O. N. Tkacheva
- Russian National Research Medical University named after N.I. Pirogov
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Turner A, Veysey M, Keely S, Scarlett CJ, Lucock M, Beckett EL. Genetic Variation in the Bitter Receptors Responsible for Epicatechin Detection Are Associated with BMI in an Elderly Cohort. Nutrients 2021; 13:nu13020571. [PMID: 33572225 PMCID: PMC7914776 DOI: 10.3390/nu13020571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/01/2021] [Accepted: 02/07/2021] [Indexed: 11/16/2022] Open
Abstract
Globally, more than one-third of adults are overweight. Overweight and obesity are complex and multifaceted conditions, associated with an increased risk of chronic illness and early mortality. While there are known risk factors, these alone do not fully explain the varying outcomes between individuals. Recently, taste receptors have been proposed to have a role in the risk for obesity. These receptors are expressed throughout the gastrointestinal tract. In this system, they may be involved in modulating dietary intake and metabolic processes. The taste 2 family of receptors (T2Rs) detects bitter compounds. Receptors T2R4 and T2R5 detect (-)-epicatechin (epicatechin), an antioxidant polyphenol, which may have protective effects against obesity. However, the potential role for taste receptors in this association has not been explored. This study assessed whether polymorphisms in TAS2R4 (rs2233998 and rs2234001) and TAS2R5 (rs2227264) were associated with body mass index (BMI). Genotyping (Taqman qPCR assays) was performed on DNA extracted from blood samples (n = 563) from an elderly cohort. Homozygosity for the minor allele of all polymorphisms was significantly associated with a lower BMI in males. The TAS2R4-rs2233998 CC genotype, the TAS2R4-rs2234001 CC genotype and the TAS2R5-rs2227264 TT genotype were associated with lower BMI (2.1, 2.1 and 2.2 units; p = 0.002, 0.003 and 0.001, respectively). Epicatechin intake was not associated with BMI and genotype was not associated with epicatechin intake. This suggests that the association between TAS2R genotype and elevated BMI risk occurs through altered extra-oral responses and not directly via altered epicatechin intake.
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Affiliation(s)
- Alexandria Turner
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah 2258, Australia; (C.J.S.); (M.L.); (E.L.B.)
- Correspondence: ; Tel.: +(02)-4348-4158
| | - Martin Veysey
- School of Medicine and Public Health, University of Newcastle, Ourimbah 2258, Australia;
- Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan 2308, Australia;
- Hunter Medical Research Institute, New Lambton Heights 2305, Australia
| | - Christopher J. Scarlett
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah 2258, Australia; (C.J.S.); (M.L.); (E.L.B.)
| | - Mark Lucock
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah 2258, Australia; (C.J.S.); (M.L.); (E.L.B.)
| | - Emma L. Beckett
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah 2258, Australia; (C.J.S.); (M.L.); (E.L.B.)
- Hunter Medical Research Institute, New Lambton Heights 2305, Australia
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Pistis G, Milaneschi Y, Vandeleur CL, Lasserre AM, Penninx BW, Lamers F, Boomsma DI, Hottenga JJ, Marques-Vidal P, Vollenweider P, Waeber G, Aubry JM, Preisig M, Kutalik Z. Obesity and atypical depression symptoms: findings from Mendelian randomization in two European cohorts. Transl Psychiatry 2021; 11:96. [PMID: 33542229 PMCID: PMC7862438 DOI: 10.1038/s41398-021-01236-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 02/08/2023] Open
Abstract
Studies considering the causal role of body mass index (BMI) for the predisposition of major depressive disorder (MDD) based on a Mendelian Randomization (MR) approach have shown contradictory results. These inconsistent findings may be attributable to the heterogeneity of MDD; in fact, several studies have documented associations between BMI and mainly the atypical subtype of MDD. Using a MR approach, we investigated the potential causal role of obesity in both the atypical subtype and its five specific symptoms assessed according to the Statistical Manual of Mental Disorders (DSM), in two large European cohorts, CoLaus|PsyCoLaus (n = 3350, 1461 cases and 1889 controls) and NESDA|NTR (n = 4139, 1182 cases and 2957 controls). We first tested general obesity measured by BMI and then the body fat distribution measured by waist-to-hip ratio (WHR). Results suggested that BMI is potentially causally related to the symptom increase in appetite, for which inverse variance weighted, simple median and weighted median MR regression estimated slopes were 0.68 (SE = 0.23, p = 0.004), 0.77 (SE = 0.37, p = 0.036), and 1.11 (SE = 0.39, p = 0.004). No causal effect of BMI or WHR was found on the risk of the atypical subtype or for any of the other atypical symptoms. Our findings show that higher obesity is likely causal for the specific symptom of increase in appetite in depressed participants and reiterate the need to study depression at the granular level of its symptoms to further elucidate potential causal relationships and gain additional insight into its biological underpinnings.
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Affiliation(s)
- Giorgio Pistis
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Yuri Milaneschi
- grid.420193.d0000 0004 0546 0540Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Vrije Universiteit Medical Center and GGZ inGeest, Amsterdam, The Netherlands
| | - Caroline L. Vandeleur
- grid.8515.90000 0001 0423 4662Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Aurélie M. Lasserre
- grid.8515.90000 0001 0423 4662Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Brenda W.J.H. Penninx
- grid.420193.d0000 0004 0546 0540Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Vrije Universiteit Medical Center and GGZ inGeest, Amsterdam, The Netherlands
| | - Femke Lamers
- grid.420193.d0000 0004 0546 0540Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Vrije Universiteit Medical Center and GGZ inGeest, Amsterdam, The Netherlands
| | - Dorret I. Boomsma
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jouke-Jan Hottenga
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Pedro Marques-Vidal
- grid.8515.90000 0001 0423 4662Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Peter Vollenweider
- grid.8515.90000 0001 0423 4662Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gérard Waeber
- grid.8515.90000 0001 0423 4662Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Michel Aubry
- grid.150338.c0000 0001 0721 9812Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Martin Preisig
- grid.8515.90000 0001 0423 4662Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Zoltán Kutalik
- grid.9851.50000 0001 2165 4204Institute of Primary Care and Public Health (Unisante), University of Lausanne, Lausanne, Switzerland ,grid.419765.80000 0001 2223 3006Swiss Institute of Bioinformatics, Lausanne, Switzerland
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Genua I, Tuneu L, Ramos A, Stantonyonge N, Caimari F, Balagué C, Fernández-Ananin S, Sánchez-Quesada JL, Pérez A, Miñambres I. Effectiveness of Bariatric Surgery in Patients with the Metabolically Healthy Obese Phenotype. Obes Surg 2021; 31:517-522. [PMID: 32915359 DOI: 10.1007/s11695-020-04967-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND To evaluate the effectiveness and safety of bariatric surgery in metabolically healthy obese (MHO) patients. METHODS In this retrospective, observational study, we reviewed the medical records of patients who underwent bariatric surgery at a tertiary care hospital between January 2007 and March 2015. Patients who underwent revisional surgery and patients with type 1 diabetes were excluded from the analysis. MHO patients were defined as those without a previous diagnosis of diabetes or atherogenic dyslipidemia and absence of hypoglycemic treatment or treatment with fibrates. RESULTS A total of 188 patients were included (mean age 48.97 ± 10.32 years, 68.6% of women). Sleeve gastrectomy was performed in 121 patients (64%) and a gastric bypass in 67 patients (36%). Prior to surgery, 36 patients (19%) were MHO. In the second- and third-year post-surgery, MHO patients presented a higher percentage of total weight loss (%TWL) (35.16% vs. 30.34%; p = 0.02 and 33.97% vs. 27.78%; p = 0.013 respectively). Multiple regression analysis showed that MHO was associated with a higher weight loss irrespective of age, sex, baseline BMI, and type of surgery. We did not detect any differences in acute complications between patients with and without MHO after bariatric surgery. CONCLUSIONS Bariatric surgery in MHO patients in our study was associated with higher weight loss than that in MUHO patients. There were no differences between the two groups in respect to acute complications following surgery.
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Affiliation(s)
- Idoia Genua
- Endocrinology and Nutrition department, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08041, Barcelona, Spain
- Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain
| | - Laura Tuneu
- Endocrinology and Nutrition department, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08041, Barcelona, Spain
| | - Analía Ramos
- Endocrinology and Nutrition department, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08041, Barcelona, Spain
- Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain
| | - Nicole Stantonyonge
- Endocrinology and Nutrition department, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08041, Barcelona, Spain
- Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain
| | - Francisca Caimari
- Endocrinology and Nutrition department, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08041, Barcelona, Spain
| | - Carmen Balagué
- Surgery Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Antonio Pérez
- Endocrinology and Nutrition department, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08041, Barcelona, Spain.
- Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain.
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, CIBERDEM, 28029, Madrid, Spain.
| | - Inka Miñambres
- Endocrinology and Nutrition department, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08041, Barcelona, Spain.
- Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain.
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, CIBERDEM, 28029, Madrid, Spain.
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170
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Marois G, Aktas A. Projecting health-ageing trajectories in Europe using a dynamic microsimulation model. Sci Rep 2021; 11:1785. [PMID: 33469046 PMCID: PMC7815779 DOI: 10.1038/s41598-021-81092-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 01/01/2021] [Indexed: 02/07/2023] Open
Abstract
The extent of the challenges and opportunities that population ageing presents depends heavily on the population's health. Hence, for the development of appropriate strategies that enable countries to adopt the emerging demographic and epidemiological realities, information on future health trajectories of elderly population is a natural requirement. This study presents an innovative methodological framework for projecting the health of individuals using a dynamic microsimulation model that considers interactions between sociodemographic characteristics, health, mortality, bio-medical and behavioral risk factors. The model developed, called ATHLOS-Mic, is used to project the health of cohorts born before 1960 for the period 2015-2060 for selected European Countries using SHARE data to illustrate the possible effects of some selected risk factors and education on future health trajectories. Results show that, driven by a better educational attainment, each generation will be healthier than the previous one at same age. Also, we see that, on average, an individual of our base population will live about 18 more years since the start of the projection period, but only 5 years in good health. Finally, we find that a scenario that removes the effect of having a low level of education on individual health has the largest impact on the projected average health, the average number of years lived per person, and the average number of years lived in good health.
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Affiliation(s)
- Guillaume Marois
- Asian Demographic Research Institute, School of Sociology and Political Sciences, Shanghai University, 99 Shangda Rd., Shanghai, 200444, China. .,Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), International Institute for Applied Systems Analysis, Schlossplatz 1, 2361, Laxenburg, Austria.
| | - Arda Aktas
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), International Institute for Applied Systems Analysis, Schlossplatz 1, 2361, Laxenburg, Austria
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171
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Ohori K, Yano T, Katano S, Kouzu H, Honma S, Shimomura K, Inoue T, Takamura Y, Nagaoka R, Koyama M, Nagano N, Fujito T, Nishikawa R, Ishigo T, Watanabe A, Hashimoto A, Miura T. High percent body fat mass predicts lower risk of cardiac events in patients with heart failure: an explanation of the obesity paradox. BMC Geriatr 2021; 21:16. [PMID: 33407196 PMCID: PMC7789382 DOI: 10.1186/s12877-020-01950-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022] Open
Abstract
Background Although high body mass index (BMI) is a risk factor of heart failure (HF), HF patients with a higher BMI had a lower mortality rate than that in HF patients with normal or lower BMI, a phenomenon that has been termed the “obesity paradox”. However, the relationship between body composition, i.e., fat or muscle mass, and clinical outcome in HF remains unclear. Methods We retrospectively analyzed data for 198 consecutive HF patients (76 years of age; males, 49%). Patients who were admitted to our institute for diagnosis and management of HF and received a dual-energy X-ray absorptiometry scan were included regardless of left ventricular ejection fraction (LVEF) categories. Muscle wasting was defined as appendicular skeletal muscle mass index < 7.0 kg/m2 in males and < 5.4 kg/m2 in females. Increased percent body fat mass (increased FM) was defined as percent body fat > 25% in males and > 30% in females. Results The median age of the patients was 76 years (interquartile range [IQR], 67–82 years) and 49% of them were male. The median LVEF was 47% (IQR, 33–63%) and 33% of the patients had heart failure with reduced ejection fraction. Increased FM and muscle wasting were observed in 58 and 67% of the enrolled patients, respectively. During a 180-day follow-up period, 32 patients (16%) had cardiac events defined as cardiac death or readmission by worsening HF or arrhythmia. Kaplan-Meier survival curves showed that patients with increased FM had a lower cardiac event rate than did patients without increased FM (11.4% vs. 22.6%, p = 0.03). Kaplan-Meier curves of cardiac event rates did not differ between patients with and those without muscle wasting (16.5% vs. 15.4%, p = 0.93). In multivariate Cox regression analyses, increased FM was independently associated with lower cardiac event rates (hazard ratio: 0.45, 95% confidence interval: 0.22–0.93) after adjustment for age, sex, diabetes, muscle wasting, and renal function. Conclusions High percent body fat mass is associated with lower risk of short-term cardiac events in HF patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-020-01950-9.
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Affiliation(s)
- Katsuhiko Ohori
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.,Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Satoshi Katano
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Suguru Honma
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Kanako Shimomura
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Takuya Inoue
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Yuhei Takamura
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Ryohei Nagaoka
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Masayuki Koyama
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.,Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Nobutaka Nagano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Takefumi Fujito
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Ryo Nishikawa
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Tomoyuki Ishigo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Ayako Watanabe
- Division of Nursing, Sapporo Medical University Hospital, Sapporo, Japan
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.,Division of Health Care Administration and Management, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
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172
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Kanic V, Vollrath M, Frank B, Kanic Z. An obesity paradox in patients with myocardial infarction undergoing percutaneous intervention. Nutr Metab Cardiovasc Dis 2021; 31:127-136. [PMID: 33097411 DOI: 10.1016/j.numecd.2020.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/20/2020] [Accepted: 08/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Data concerning the relationship between body mass index (BMI) and outcome in myocardial infarction (MI) patients are inconclusive. Long-term data on the influence of BMI on survival in patients with MI who have undergone percutaneous intervention (PCI) are lacking. We aimed to assess the effect of different categories of BMI on long-term mortality. METHODS AND RESULTS A single-center retrospective study of 6496 patients with MI who underwent PCI was performed. Patients were divided into six categories according to their BMI and these were compared. All-cause mortality was assessed over a median period of 6.0 years. An inverse J-shaped relationship was observed between BMI and long-term mortality. The lowest mortality was observed in patients with class I obesity. The patients with a BMI below 25.0 kg/m2 were more likely to die than patients with class I obesity. A gradual decrease in BMI below 25.0 kg/m2 was associated with a progressively increased risk of dying, with underweight patients showing a 2.18-fold increase in mortality risk. An obesity paradox was present. In addition, the patients with class III obesity had a more than 70% higher long-term mortality risk as compared to the reference group. Both lower and higher degrees of BMI were found to be harmful in patients with MI who underwent PCI. CONCLUSION The obesity paradox was present in a very long-term follow-up of patients with MI who underwent PCI. However, both lower and higher BMI values are harmful, and an inverse J-shaped relationship between BMI and outcome was observed.
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Affiliation(s)
- Vojko Kanic
- University Medical Center Maribor, Maribor, Slovenia.
| | | | - Barbara Frank
- University Medical Center Maribor, Maribor, Slovenia.
| | - Zlatka Kanic
- University Medical Center Maribor, Maribor, Slovenia.
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173
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Al-Rashed F, Sindhu S, Al Madhoun A, Alghaith A, Azim R, Al-Mulla F, Ahmad R. Short Sleep Duration and Its Association with Obesity and Other Metabolic Risk Factors in Kuwaiti Urban Adults. Nat Sci Sleep 2021; 13:1225-1241. [PMID: 34335063 PMCID: PMC8318215 DOI: 10.2147/nss.s311415] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Efficient sleep duration and its quality are increasingly recognized as important contributors for maintaining normal body weight. However, lifestyle and social structure within the Arab-gulf region differ compared to those in the western world. This study was specifically conducted in Kuwait's population to investigate the link between sleep quality (SQ) and obesity in the absence of sleep apnea (SA) onset. METHODS SQ was measured by the Pittsburgh Sleep Quality Index (PQSI) in 984 participants, then verified in 60 individuals including 20 lean (Body mass index/BMI: 18.5-24.9 kg/m2), 20 overweight (BMI: 25-29.9 kg/m2) and 20 obese (BMI: ≥30 kg/m2) through actigraph worn over the right-hip for 7 consecutive days to characterize their sleep-wake cycle, rest-activity, and physical activity. Blood samples were collected for metabolic markers. RESULTS 59.6% of participants reported a PSQI score higher than 5, with 57.6% of the participants reporting less than 6 hours of sleep per day. The data show that both SQ and sleep duration are considered inadequate in comparison to the international SQ standards. We found a significant association between SQ and obesity independent of age and sex. Actigraph data further supported the independent association of sleep duration on BMI within the population (p < 0.001). Additionally, total sleep time (TST) was found to significantly correlate with several other metabolic factors including diastolic blood pressure, elevated resting heart rate (RHR), triglycerides, total cholesterol, homeostatic model assessment for insulin resistance (HOMA-IR), C-peptide, and C-Reactive Protein (CRP) secretion. Further multiple-regression analysis showed a significant independent association between blood pressure (p < 0.03), HOMA-IR (p < 0.04), and C-peptide (p < 0.3) and sleep duration. CONCLUSION These findings suggest that sleep deprivation and disturbance could be indirect factors involved in the development of not only obesity in Kuwait but also other metabolic syndromes such as type 2 diabetes.
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Affiliation(s)
- Fatema Al-Rashed
- Immunology & Microbiology Department, Dasman Diabetes Institute, Dasman, Kuwait
| | - Sardar Sindhu
- Animal and Imaging Core Facility, Dasman Diabetes Institute, Dasman, Kuwait
| | - Ashraf Al Madhoun
- Animal and Imaging Core Facility, Dasman Diabetes Institute, Dasman, Kuwait.,Genetics and Bioinformatics Department, Dasman Diabetes Institute, Dasman, Kuwait
| | | | - Rafaat Azim
- Immunology & Microbiology Department, Dasman Diabetes Institute, Dasman, Kuwait
| | - Fahd Al-Mulla
- Genetics and Bioinformatics Department, Dasman Diabetes Institute, Dasman, Kuwait
| | - Rasheed Ahmad
- Immunology & Microbiology Department, Dasman Diabetes Institute, Dasman, Kuwait
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174
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Huang W, Chen Y, Yin G, Wang N, Wei C, Xu W. Obesity and Overweight Are Independently Associated with Greater Survival in Critically Ill Diabetic Patients: A Retrospective Cohort Study. J Diabetes Res 2021; 2021:6681645. [PMID: 33614789 PMCID: PMC7875646 DOI: 10.1155/2021/6681645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/10/2020] [Accepted: 01/04/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The relationship between obesity and the outcomes of critically ill diabetic patients is not completely clear. We aimed to assess the effects of obesity and overweight on the outcomes among diabetic patients in the intensive care unit (ICU). METHODS Critically ill diabetic patients in the ICU were classified into three groups according to their body mass index. The primary outcomes were 30-day and 90-day mortality. ICU and hospital length of stay (LOS) and incidence and duration of mechanical ventilation were also assessed. Cox regression models were developed to evaluate the relationship between obesity and overweight and mortality. RESULTS A total of 6108 eligible patients were included. The 30-day and 90-day mortality in the normal weight group were approximately 1.8 times and 1.5 times higher than in the obesity group and overweight group, respectively (P < 0.001, respectively). Meanwhile, the ICU (median (IQ): 2.9 (1.7, 5.3) vs. 2.7 (1.6, 4.8) vs. 2.8 (1.8, 5.0)) and hospital (median (IQ): 8.3 (5.4, 14.0) vs. 7.9 (5.1, 13.0) vs. 8.3 (5.3, 13.6)) LOS in the obesity group and overweight group were not longer than in the normal weight group. Compared with normal weight patients, obese patients had significantly higher incidence of mechanical ventilation (58.8% vs. 64.7%, P < 0.001) but no longer ventilation duration (median (IQ): 19.3 (7.0, 73.1) vs. 19.0 (6.0, 93.7), P = 1). Multivariate Cox regression showed that obese and overweight patients had lower 30-day (HR (95% CI): 0.62 (0.51, 0.75); 0.76 (0.62, 0.92), respectively) and 90-day (HR (95% CI): 0.60 (0.51, 0.70); 0.79 (0.67, 0.93), respectively) mortality risks than normal weight patients. CONCLUSIONS Obesity and overweight were independently associated with greater survival in critically ill diabetic patients, without increasing the ICU and hospital LOS. Large multicenter prospective studies are needed to confirm our findings and the underlying mechanisms warrant further investigation.
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Affiliation(s)
- Wentao Huang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Shantou 515041, China
- Shantou University Medical College, No. 22 Xinling Road, Shantou 515041, China
| | - Yongsong Chen
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Shantou 515041, China
| | - Guoshu Yin
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Shantou 515041, China
| | - Nasui Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Shantou 515041, China
| | - Chiju Wei
- Multidisciplinary Research Center, Shantou University, No. 243 Daxue Road, Shantou 515041, China
| | - Wencan Xu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Shantou 515041, China
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175
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Cui XB, Fei J, Chen S, Edwards GL, Chen SY. ADAR1 deficiency protects against high-fat diet-induced obesity and insulin resistance in mice. Am J Physiol Endocrinol Metab 2021; 320:E131-E138. [PMID: 33252250 PMCID: PMC8194408 DOI: 10.1152/ajpendo.00175.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 11/22/2022]
Abstract
Obesity is an important independent risk factor for type 2 diabetes, cardiovascular diseases, and many other chronic diseases. The objective of this study was to determine the role of adenosine deaminase acting on RNA 1 (ADAR1) in the development of obesity and insulin resistance. Wild-type (WT) and heterozygous ADAR1-deficient (Adar1+/-) mice were fed normal chow or a high-fat diet (HFD) for 12 wk. Adar1+/- mice fed with HFD exhibited a lean phenotype with reduced fat mass compared with WT controls, although no difference was found under chow diet conditions. Blood biochemical analysis and insulin tolerance test showed that Adar1+/- improved HFD-induced dyslipidemia and insulin resistance. Metabolic studies showed that food intake was decreased in Adar1+/- mice compared with the WT mice under HFD conditions. Paired feeding studies further demonstrated that Adar1+/- protected mice from HFD-induced obesity through decreased food intake. Furthermore, Adar1+/- restored the increased ghrelin expression in the stomach and the decreased serum peptide YY levels under HFD conditions. These data indicate that ADAR1 may contribute to diet-induced obesity, at least partially, through modulating the ghrelin and peptide YY expression and secretion.NEW & NOTEWORTHY This study identifies adenosine deaminase acting on RNA 1 as a novel factor promoting high-fat diet-induced obesity, at least partially, through modulating appetite-related genes ghrelin and PYY.
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Affiliation(s)
- Xiao-Bing Cui
- Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri
- Department of Physiology & Pharmacology, University of Georgia, Athens, Georgia
| | - Jia Fei
- Department of Physiology & Pharmacology, University of Georgia, Athens, Georgia
| | - Sisi Chen
- Department of Physiology & Pharmacology, University of Georgia, Athens, Georgia
| | - Gaylen L Edwards
- Department of Physiology & Pharmacology, University of Georgia, Athens, Georgia
| | - Shi-You Chen
- Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri
- Department of Physiology & Pharmacology, University of Georgia, Athens, Georgia
- Department of Medical Pharmacology & Physiology, University of Missouri School of Medicine, Columbia, Missouri
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176
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Han K, Jia W, Wang S, Cao W, Song Y, Wang J, Liu M, Yang S, He Y. Synergistic Impact of Body Mass Index and Cognitive Function on All-Cause Mortality in Older Adults: A Nationwide Longitudinal Study. Front Endocrinol (Lausanne) 2021; 12:620261. [PMID: 34267724 PMCID: PMC8276260 DOI: 10.3389/fendo.2021.620261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/07/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Body mass index (BMI) and cognitive function are independent predictors of mortality risk. However, little is known about the combined impact of BMI and cognitive function on the risk of all-cause mortality in older adults. In this study, we aimed to examine the associations between BMI, cognitive function, and all-cause mortality, including between-factor interactions, in the general population of older adults in China. METHODS We used the data between 2011 and 2018 from the Chinese Longitudinal Healthy Longevity Survey that included adults aged ≥65 years residing in the 23 provinces of China. The association between BMI and cognitive function on all-cause mortality was examined with the Cox proportional hazards regression model. RESULTS The study included 8,293 Chinese older adults. Low BMI (underweight) and cognitive impairment were associated with the highest risk of death after adjustments [hazard ratio (HR) = 2.18; 95% confidence interval (CI), 1.96-2.41]; this combined effect was more prominent among adults aged <100 years and women. In addition, there was an interaction effect of BMI and cognitive impairment on all-cause mortality (P <0.001). Concurrently, among older adults with normal cognition, the risk of mortality related to underweight was higher than among their cognitively impaired counterparts [55% (normal cognition) vs. 38% (cognitive impairment)]. CONCLUSIONS Low BMI (underweight) and cognitive impairment were independently and jointly associated with increased risk of all-cause mortality among Chinese older adults, and females showed a stronger effect in this association. The association between BMI and mortality was more pronounced in the participants with normal cognition than in their cognitively impaired counterparts.
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Affiliation(s)
- Ke Han
- Medical School of Chinese PLA, Beijing, China
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Disease, The 2nd Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wangping Jia
- Medical School of Chinese PLA, Beijing, China
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Disease, The 2nd Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shengshu Wang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Disease, The 2nd Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wenzhe Cao
- Medical School of Chinese PLA, Beijing, China
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Disease, The 2nd Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yang Song
- Medical School of Chinese PLA, Beijing, China
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Disease, The 2nd Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jianwei Wang
- Medical School of Chinese PLA, Beijing, China
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Disease, The 2nd Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Miao Liu
- Department of Statistics and Epidemiology, Medical School of Chinese PLA, Beijing, China
| | - Shanshan Yang
- Department of Disease Prevention and Control, The 1st Medical Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Yao He, ; Shanshan Yang,
| | - Yao He
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Disease, The 2nd Medical Center of Chinese PLA General Hospital, Beijing, China
- *Correspondence: Yao He, ; Shanshan Yang,
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177
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Liu D, Nguyen TTL, Gao H, Huang H, Kim DC, Sharp B, Ye Z, Lee JH, Coombes BJ, Ordog T, Wang L, Biernacka JM, Frye MA, Weinshilboum RM. TCF7L2 lncRNA: a link between bipolar disorder and body mass index through glucocorticoid signaling. Mol Psychiatry 2021; 26:7454-7464. [PMID: 34535768 PMCID: PMC8872993 DOI: 10.1038/s41380-021-01274-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/21/2021] [Accepted: 08/19/2021] [Indexed: 02/08/2023]
Abstract
Bipolar disorder (BD) and obesity are highly comorbid. We previously performed a genome-wide association study (GWAS) for BD risk accounting for the effect of body mass index (BMI), which identified a genome-wide significant single-nucleotide polymorphism (SNP) in the gene encoding the transcription factor 7 like 2 (TCF7L2). However, the molecular function of TCF7L2 in the central nervous system (CNS) and its possible role in the BD and BMI interaction remained unclear. In the present study, we demonstrated by studying human induced pluripotent stem cell (hiPSC)-derived astrocytes, cells that highly express TCF7L2 in the CNS, that the BD-BMI GWAS risk SNP is associated with glucocorticoid-dependent repression of the expression of a previously uncharacterized TCF7L2 transcript variant. That transcript is a long non-coding RNA (lncRNA-TCF7L2) that is highly expressed in the CNS but not in peripheral tissues such as the liver and pancreas that are involved in metabolism. In astrocytes, knockdown of the lncRNA-TCF7L2 resulted in decreased expression of the parent gene, TCF7L2, as well as alterations in the expression of a series of genes involved in insulin signaling and diabetes. We also studied the function of TCF7L2 in hiPSC-derived astrocytes by integrating RNA sequencing data after TCF7L2 knockdown with TCF7L2 chromatin-immunoprecipitation sequencing (ChIP-seq) data. Those studies showed that TCF7L2 directly regulated a series of BD risk genes. In summary, these results support the existence of a CNS-based mechanism underlying BD-BMI genetic risk, a mechanism based on a glucocorticoid-dependent expression quantitative trait locus that regulates the expression of a novel TCF7L2 non-coding transcript.
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Affiliation(s)
- Duan Liu
- grid.66875.3a0000 0004 0459 167XDepartment of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN USA
| | - Thanh Thanh Le Nguyen
- grid.66875.3a0000 0004 0459 167XDepartment of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN USA ,grid.66875.3a0000 0004 0459 167XGraduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN USA
| | - Huanyao Gao
- grid.66875.3a0000 0004 0459 167XDepartment of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN USA
| | - Huaizhi Huang
- grid.66875.3a0000 0004 0459 167XDepartment of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN USA ,grid.66875.3a0000 0004 0459 167XGraduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN USA
| | - Daniel C. Kim
- grid.66875.3a0000 0004 0459 167XDepartment of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN USA
| | - Brenna Sharp
- grid.66875.3a0000 0004 0459 167XDepartment of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN USA
| | - Zhenqing Ye
- grid.66875.3a0000 0004 0459 167XDivision of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Jeong-Heon Lee
- grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - Brandon J. Coombes
- grid.66875.3a0000 0004 0459 167XDivision of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Tamas Ordog
- grid.66875.3a0000 0004 0459 167XDepartment of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN USA ,grid.66875.3a0000 0004 0459 167XDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Liewei Wang
- grid.66875.3a0000 0004 0459 167XDepartment of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN USA
| | - Joanna M. Biernacka
- grid.66875.3a0000 0004 0459 167XDivision of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA ,grid.66875.3a0000 0004 0459 167XDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN USA
| | - Mark A. Frye
- grid.66875.3a0000 0004 0459 167XDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN USA
| | - Richard M. Weinshilboum
- grid.66875.3a0000 0004 0459 167XDepartment of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN USA
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178
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Ratwatte S, Hyun K, D'Souza M, Barraclough J, Chew DP, Shetty P, Patel S, Amos D, Brieger D. Relation of Body Mass Index to Outcomes in Acute Coronary Syndrome. Am J Cardiol 2021; 138:11-19. [PMID: 33058799 DOI: 10.1016/j.amjcard.2020.09.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 12/20/2022]
Abstract
We assessed the association of BMI with all-cause and cardiovascular (CV) mortality in a contemporary acute coronary syndrome cohort. Patients from the Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events and Global Registry of Acute Coronary Events between 2009 and 2019, were divided into BMI subgroups (underweight: <18.5, healthy: 18.5 to 24.9, overweight: 25 to 29.9, obese: 30 to 39.9, extremely obese: >40). Logistic regression was used to determine the association between BMI group and outcomes of all cause and CV death in hospital, and at 6 months. 8,503 patients were identified, mean age 64 ± 13, 72% male. The BMI breakdown was: underweight- 95, healthy- 2,140, overweight- 3,258, obese- 2,653, extremely obese- 357. Obese patients were younger (66 ± 12 vs 67 ± 13), with more hypertension, diabetes, and dyslipidemia vs healthy (all p < 0.05). Obese had lower hospital mortality than healthy: all-cause: 1% versus 4%, aOR (95% CI): 0.49(0.27, 0.87); CV: 1% versus 3%, 0.51(0.27, 0.96). At 6-month underweight had higher mortality than healthy: all-cause: 11% versus 4%, 2.69(1.26, 5.76); CV: 7% versus 1%, 3.54(1.19, 10.54); whereas obese had lower mortality: all-cause: 1% versus 4%, 0.48(0.29, 0.77); CV: 0.4% versus 1%, 0.42(0.19, 0.93). When BMI was plotted as a continuous variable against outcome a U-shaped relationship was demonstrated, with highest event rates in the most obese (>60). In conclusion, BMI is associated with mortality following an acute coronary syndrome. Obese patients had the best outcomes, suggesting persistence of the obesity paradox. However, there was a threshold effect, and favorable outcomes did not extend to the most obese.
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Affiliation(s)
- Seshika Ratwatte
- Department of Cardiology, Concord Repatriation General Hospital, Concord, Australia
| | - Karice Hyun
- ANZAC Research Institute, NSW, Australia; Westmead Applied Research Centre, University of Sydney, NSW, Australia
| | - Mario D'Souza
- University of Sydney, NSW, Australia; Clinical Research Centre, Sydney Local Health District, NSW, Australia
| | | | - Derek P Chew
- Department of Cardiology, Flinders University, Australia
| | - Pratap Shetty
- Department of Cardiology Wollongong Hospital, NSW, Australia
| | - Sanjay Patel
- Department of Cardiology Royal Prince Alfred Hospital, NSW, Australia
| | - David Amos
- Department of Cardiology, Orange Base Hospital, NSW, Australia
| | - David Brieger
- Department of Cardiology, Concord Repatriation General Hospital, Concord, Australia.
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Onozaki A, Nagayama D, Azuma N, Sugai K, Shitara E, Sakai T, Masai M, Shirai K, Tatsuno I. Relation of Maximum Lifetime Body Mass Index with Age at Hemodialysis Initiation and Vascular Complications in Japan. Obes Facts 2021; 14:550-558. [PMID: 34515199 PMCID: PMC8546452 DOI: 10.1159/000518049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/16/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate the association of the maximum lifetime body mass index (max BMI) with hemodialysis initiation and comorbidities in Japanese hemodialysis patients. METHODS In a retrospective cross-sectional study on 724 hemodialysis patients, max BMI, age at hemodialysis initiation, and comorbidities including sleep apnea syndrome, cerebro-cardiovascular diseases, and proliferative diabetic retinopathy (PDR) were analyzed. Early hemodialysis initiation was defined as age <50 years. RESULT Diabetes patients showed a higher max BMI and prevalence of atherosclerotic diseases than nondiabetes patients, despite almost the same age at hemodialysis initiation. Patients with early hemodialysis initiation showed higher male ratio, prevalence of PDR, and max BMI than those with later initiation, despite almost equal prevalence of diabetes. Receiver-operating characteristic curve analysis determined a max BMI of 28.4 kg/m2 as a reliable cutoff value for predicting early hemodialysis initiation, and this parameter was identified as an independent predictor of early hemodialysis initiation using bivariate logistic regression analysis. Vitrectomy for PDR also tended to contribute independently to early hemodialysis initiation. CONCLUSION A high max BMI contributed to early hemodialysis initiation independent of diabetes. Furthermore, PDR was associated with a high max BMI and early hemodialysis initiation. These results suggest that weight reduction in young chronic kidney disease patients with obesity may prevent hemodialysis and blindness.
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Affiliation(s)
- Akira Onozaki
- Internal Medicine, Tokatsu Clinic Hospital, Chiba, Japan
| | - Daiji Nagayama
- Internal Medicine, Nagayama Clinic, Tochigi, Japan
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
- *Daiji Nagayama,
| | - Nakanobu Azuma
- Internal Medicine, Tokatsu Clinic Hospital, Chiba, Japan
| | - Keita Sugai
- Nutrition Management Division, Mihama Hospital, Chiba, Japan
| | - Etsuko Shitara
- Nutrition Management Division, Mihama Hospital, Chiba, Japan
| | | | | | - Kohji Shirai
- Internal Medicine, Mihama Hospital, Chiba, Japan
| | - Ichiro Tatsuno
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
- Chiba Prefectural University of Health Sciences, Chiba, Japan
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180
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Mikus E, Calvi S, Brega C, Zucchetta F, Tripodi A, Pin M, Manfrini M, Cimaglia P, Masiglat J, Albertini A. Minimally invasive aortic valve surgery in obese patients: Can the bigger afford the smaller? J Card Surg 2020; 36:582-588. [PMID: 33345384 DOI: 10.1111/jocs.15267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Ministernotomy and right minithoracotomy are well-known minimally invasive approaches for aortic valve replacement (AVR); however, controversial opinions exist for their utilization in obese patients. The aim of this study is to check a potential positive role of minimally invasive surgery in this population. METHODS From January 2010 to November 2019, 613 obese patients (defined by a body mass index ≥30) underwent isolated AVR at our institution. Surgical approach included standard median sternotomy (176 patients), partial upper sternotomy (271 patients), or right anterior minithoracotomy (166 patients). Intra- and postoperative data were retrospectively collected. RESULTS Patients treated with minimally invasive approaches had shorter cardiopulmonary bypass time (p = .012) and aortic cross-clamp time (p = .022), mainly due to the higher utilization of sutureless valve implantation. They also presented advantages in terms of reduced postoperative ventilation time (p = .010), incidence of wound infection (p = .009), need of inotropic support (p = .004), and blood transfusion (p = .001). The univariable logistic regression showed the traditional full sternotomy approach as compared with ministernotomy (p = .026), active smoking (p = .009), peripheral vascular disease (p = .003), ejection fraction (p = .026), as well Logistic European system for cardiac operative risk evaluation (EuroSCORE; p = .015) as factors associated with hospital mortality. The multivariable logistic regression adjusted for the logistic EuroSCORE revealed that surgical approaches do not influence hospital mortality. CONCLUSIONS Obese patients with severe aortic valve pathology can be treated with minimally invasive approaches offering a less biological insult and reduced postoperative complications, but without impact on hospital mortality.
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Affiliation(s)
- Elisa Mikus
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Simone Calvi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Carlotta Brega
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Fabio Zucchetta
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Alberto Tripodi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Maurizio Pin
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Marco Manfrini
- Biostatistics and Epidemiology Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Paolo Cimaglia
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Joyce Masiglat
- Department of Cardio-Thoracic and Vascular Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Alberto Albertini
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
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181
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Sorjonen K, Nilsonne G, Falkstedt D, Hemmingsson T, Melin B, Ingre M. A comparison of models with weight, height, and BMI as predictors of mortality. Obes Sci Pract 2020; 7:168-175. [PMID: 33841886 PMCID: PMC8019270 DOI: 10.1002/osp4.473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction Body mass index (BMI) is a composite variable of weight and height, often used as a predictor of health outcomes, including mortality. The main purpose of combining weight and height in one variable is to obtain a measure of obesity independent of height. It is however unclear how accurate BMI is as a predictor of mortality compared with models including both weight and height or a weight × height interaction as predictors. Methods The current study used conscription data on weight, height, and BMI of Swedish men (N = 48,904) in 1969/70 as well as linked data on mortality (3442 deaths) between 1969 and 2008. Cox proportional hazard models including combinations of weight, height, and BMI at conscription as predictors of subsequent all-cause and cause-specific mortality were fitted to data. Results An increase by one standard deviation on weight and BMI were associated with an increase in hazard for all-cause mortality by 5.4% and 11.5%, respectively, while an increase by one standard deviation on height was associated with a decrease in hazard for all-cause mortality by 9.4%. The best-fitting model indicated lowest predicted all-cause mortality for those who weighed 60.5 kg at conscription, regardless of height. Further analyses of cause-specific mortality suggest that this weight seems to be a compromise between lower optimal weights to avoid cancer and CVD mortality and a higher optimal weight to not die by suicide. Conclusions According to the present findings, there are several ways to make better use of measured weight and height than to calculate BMI when predicting mortality.
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Affiliation(s)
- Kimmo Sorjonen
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Gustav Nilsonne
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden.,Department of Psychology Stockholm University Stockholm Sweden
| | - Daniel Falkstedt
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - Tomas Hemmingsson
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden.,Department of Public Health Sciences Stockholm University Stockholm Sweden
| | - Bo Melin
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Michael Ingre
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden.,Department of Psychology Stockholm University Stockholm Sweden.,Institute for Globally Distributed Open Research and Education (IGDORE) Stockholm Sweden
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182
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Association between characteristics of physical activity in leisure time and obesity in Brazilians adults and elderly. Obes Res Clin Pract 2020; 15:37-41. [PMID: 33272842 DOI: 10.1016/j.orcp.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 11/05/2020] [Accepted: 11/15/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To verify the association of obesity with volume, intensity and types of physical activity in leisure time among Brazilian adults and elderly. STUDY DESIGN Cross-sectional study, with a secondary analysis of data from "Surveillance of Risk Factors and Protection for Chronic Diseases by Telephone Survey". METHODS The target population comprised adults aged ≥18 years. The outcome was obesity (BMI≥30.0 kg/m²) and the exposures were the volume, intensity, and main type of physical activity in leisure time. Binary logistic regression was used and the results were expressed as odds ratio (OR) and 95% confidence intervals (CI95%), with a significance level of 5%. RESULTS Compared to inactive, the highest volume of leisure time physical activity (≥300min/week) had a lower occurrence of obesity in adults (OR=0.76; CI95%: 0.63, 0.92; p=0.001) and elderly (OR=0.62; CI95%: 0.46, 0.82; p=0.001). In adults, vigorous activities (OR=0.65; CI95%: 0.55, 0.78; p<0.001) and, in the elderly, light/moderate activities (OR=0.75; CI95%: 0.62, 0.89; p<0.001) and vigorous (OR=0.54; CI95%: 0.37, 0.78; p<0.001) presented protective effect for obesity. Among the types of physical activity, running was the most strongly associated with a lower occurrence of obesity in adults (OR=0.54; CI95%: 0.32, 0.92; p=0.024) and elderly (OR=0.27; CI95%: 0.10, 0.69; p=0.006). In adults, strength training (p<0.001), gymnastics (p=0.032) and sports (p=0.013) and in elderly, walking (p=0.001) and sports (p=0.003) also had protective effect. CONCLUSION A greater volume, vigorous intensity and physical activities of a structuring character and intensity progression, such as running, were associated with the lower occurrence of obesity.
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183
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Sato T, Aizawa Y, Yuasa S, Fujita S, Ikeda Y, Okabe M. The Effect of Dapagliflozin Treatment on Epicardial Adipose Tissue Volume and P-Wave Indices: An Ad-hoc Analysis of The Previous Randomized Clinical Trial. J Atheroscler Thromb 2020; 27:1348-1358. [PMID: 32115470 PMCID: PMC7840164 DOI: 10.5551/jat.48009] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/14/2020] [Indexed: 12/12/2022] Open
Abstract
AIM Epicardial adipose tissue (EAT) may be associated with arrhythmogenesis. P-wave indices such as P-wave dispersion and P-wave variation indicated a slowed conduction velocity within the atria. This study investigated the effect of dapagliflozin on EAT volume and P-wave indices. METHODS In the present ad hoc analysis, 35 patients with type 2 diabetes mellitus and coronary artery disease were classified into dapagliflozin group (n=18) and conventional treatment group (n=17). At baseline, EAT volume, HbA1c and plasma level of tumor necrotic factor-α (TNF-α) levels, echocardiography, and 12-lead electrocardiogram (ECG) were performed. EAT volume was measured using computed tomography. Using 12-lead ECG, P-wave indices were measured. RESULTS At baseline, EAT volumes in the dapagliflozin and conventional treatment groups were 113±20 and 110±27 cm3, respectively. Not only HbA1c and plasma level of TNF-α but also echocardiography findings including left atrial dimension and P-wave indices were comparable between the two groups. After 6 months, plasma level of TNF-α as well as EAT volume significantly decreased in the dapagliflozin group only. P-wave dispersion and P-wave variation significantly decreased in the dapagliflozin group only (-9.2±8.7 vs. 5.9±19.9 ms, p=0.01; -3.5±3.5 vs. 1.7±5.9 ms, p=0.01). The change in P-wave dispersion correlated with changes in EAT volume and plasma level of TNF-α. In multivariate analysis, the change in EAT volume was an independent determinant of the change in P-wave dispersion. CONCLUSION Dapagliflozin reduced plasma level of TNF-α, EAT volume, and P-wave indices, such as P-wave dispersion. The changes in P-wave indices were especially associated with changes in EAT volume.The number and date of registration: UMIN000035660, 24/Jan/2019.
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Affiliation(s)
- Takao Sato
- Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | | | - Sho Yuasa
- Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | | | - Yoshio Ikeda
- Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | - Masaaki Okabe
- Cardiology, Tachikawa General Hospital, Nagaoka, Japan
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184
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Lurbe I Puerto K, Bruzzi M, Rives-Lange C, Poghosyan T, Bretault M, Chatellier G, Vilfaillot A, Chevallier JM, Czernichow S, Carette C. Telemedicine intervention on physical activity recovery after bariatric surgery: the MyGoodTrip randomized controlled trial (Preprint). JMIR Form Res 2020; 7:e26077. [PMID: 36976624 PMCID: PMC10132008 DOI: 10.2196/26077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 10/19/2021] [Accepted: 01/25/2023] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite bariatric surgery showing significant weight loss trajectories for many patients, a substantial proportion regain weight after the first year following surgery. The addition of telemedicine to standard care could support patients with engaging in a more active lifestyle and thus improve clinical outcomes. OBJECTIVE Our aim was to evaluate a telemedicine intervention program dedicated to the promotion of physical activity including digital devices, teleconsultation, and telemonitoring the first 6 months following bariatric surgery. METHODS This study employed a mixed methods design based on an open-label randomized controlled trial. Patients were included during the first week after bariatric surgery; then, they were randomized into 2 intervention groups: The TelePhys group received a monthly telemedicine consultation focusing on physical activity coaching, while the TeleDiet group received a monthly telemedicine consultation involving diet coaching. Data were collected using a watch pedometer and body weight scale, both of which were connected wirelessly. The primary outcome was the difference between the 2 groups in the mean numbers of steps at the first and sixth postoperative months. Weight change was also evaluated, and focus groups and interviews were conducted to enrich the results and capture perceptions of the telemedicine provided. RESULTS Among the 90 patients (mean age 40.6, SD 10.4 years; 73/90, 81% women; 62/90, 69% gastric bypass), 70 completed the study until the sixth month (n=38 TelePhys; n=32 TeleDiet), and 18 participants agreed to be interviewed (n=8 Telephys; n=10 TeleDiet). An increase in the mean number of steps between the first and sixth months was found in both groups, but this change was significant only in the TeleDiet group (P=.01). No difference was found when comparing both intervention groups. Interviewed participants reported having appreciated the teleconsultations, as the individualized tailored counseling helped them to make better choices about behaviors that could increase their likelihood of a daily life in better health. Weight loss followed by social factors (such as social support) were identified as the main facilitators to physical activity. Family responsibilities, professional constraints as well as poor urban policies promoting physical activity, and lack of accessibility to sport infrastructure were their major barriers to postoperative lifestyle adherence. CONCLUSIONS Our study did not show any difference in mobility recovery after bariatric surgery related to a telemedicine intervention dedicated to physical activity. The early postoperative timing for our intervention may explain the null findings. eHealth interventions aiming to change behaviors and carried out by clinicians require support from structured public health policies that tackle patients' obesogenic environment in order to be efficient in their struggle against sedentary lifestyle-related pathologies. Further research will need to focus on long-term interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02716480, https://clinicaltrials.gov/ct2/show/NCT02716480.
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Affiliation(s)
- Katia Lurbe I Puerto
- Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Matthieu Bruzzi
- Service de Chirurgie Digestive, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Claire Rives-Lange
- Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
- METHODS team, Epidemiology and Biostatistics Sorbonne Paris Cité Center, INSERM 1153, Paris, France
| | - Tigran Poghosyan
- Service de Chirurgie Digestive, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Marion Bretault
- Service de Nutrition, Centre Spécialisé Obésité, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancour, France
| | - Gilles Chatellier
- Université de Paris, Paris, France
- Unité de recherche clinique, Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurelie Vilfaillot
- Unité de recherche clinique, Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Marc Chevallier
- Service de Chirurgie Digestive, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Sebastien Czernichow
- Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
- METHODS team, Epidemiology and Biostatistics Sorbonne Paris Cité Center, INSERM 1153, Paris, France
| | - Claire Carette
- Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
- Centre d'investigation clinique, INSERM 1418, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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Kaneda K, Yamashita Y, Morimoto T, Amano H, Takase T, Hiramori S, Kim K, Oi M, Akao M, Kobayashi Y, Toyofuku M, Morita Y, Tada T, Chen PM, Murata K, Tsuyuki Y, Nakagawa Y, Nishimoto Y, Saga S, Sakamoto J, Kinoshita M, Togi K, Ishii K, Mabuchi H, Takabayashi K, Hojo S, Kawaji T, Kushiyama A, Yaku H, Nakatsuma K, Kato M, Yokomatsu T, Miki S, Kimura T. Influence of low body weight on long-term clinical outcomes in patients with venous thromboembolism: From the COMMAND VTE registry. Thromb Res 2020; 198:26-33. [PMID: 33264736 DOI: 10.1016/j.thromres.2020.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/20/2020] [Accepted: 11/18/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There is a paucity of data on the influence of low body weight on clinical outcomes in patients with acute venous thromboembolism (VTE). MATERIALS AND METHODS The COMMAND VTE registry is a multicenter cohort study enrolling 3027 consecutive patients with acute symptomatic VTE. The current study population consisted of 2778 patients with available body weight value, who were divided into 2 groups; 1705 patients with lower body weight (≤60 kg) and 1073 patients with higher body weight (>60 kg). RESULTS Patients with lower body weight were older (70.8 versus 60.9 years, P < 0.001), and more often women (75% versus 38%, P < 0.001), and more often had active cancer (27% versus 19%, P < 0.001) than those with higher body weight. The cumulative 5-year incidence of recurrent VTE was not significantly different between the 2 groups (10.6% versus 10.7%, P = 0.51). The cumulative 5-year incidences of major bleeding and all-cause death were significantly higher in patients with lower body weight than in those with higher body weight (14.6% versus 9.6%, P < 0.001, and 35.8% versus 19.8%, P < 0.001, respectively). The excess adjusted risk of patients with lower body weight relative to those with higher body weight remained significant for major bleeding and all-cause death (HR 1.57, 95%CI: 1.16-2.12, P = 0.003, and HR 1.50, 95%CI: 1.24-1.81, P < 0.001, respectively). CONCLUSIONS In the current Japanese real-world registry, there were a high proportion of patients with low body weight, who had a higher risk for major bleeding and mortality without significant excess risk for recurrent VTE.
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Affiliation(s)
- Kazuhisa Kaneda
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hideo Amano
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Toru Takase
- Department of Cardiology, Kinki University Hospital, Osaka, Japan
| | - Seiich Hiramori
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Maki Oi
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yohei Kobayashi
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yusuke Morita
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Tomohisa Tada
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Po-Min Chen
- Department of Cardiology, Saiseikai Noe Hospital, Osaka, Japan
| | - Koichiro Murata
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Yoshiaki Tsuyuki
- Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yuji Nishimoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Syunsuke Saga
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Jiro Sakamoto
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Minako Kinoshita
- Department of Cardiology, Nishi Kobe Medical Center, Kobe, Japan
| | - Kiyonori Togi
- Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Denryoku Hospital, Osaka, Japan
| | - Hiroshi Mabuchi
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | | | - Shun Hojo
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Tetsuma Kawaji
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | | | - Hidenori Yaku
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Kenji Nakatsuma
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | | | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Relationship between a single measurement at baseline of body mass index, glycated hemoglobin, and the risk of mortality and cardiovascular morbidity in type 2 diabetes mellitus. Cardiovasc Endocrinol Metab 2020; 9:177-182. [PMID: 33225234 DOI: 10.1097/xce.0000000000000202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 03/23/2020] [Indexed: 11/25/2022]
Abstract
Objective This study aims to evaluate the relationship between a single measurement at baseline of body mass index (BMI), glycated hemoglobin (HbA1c) and subsequent clinical outcomes in patients with type 2 diabetes mellitus (T2DM). Method Patients with T2DM were recruited from an outpatient diabetes clinic in a single large teaching hospital in Kingston upon Hull, UK. At baseline, demographics and HbA1c were recorded. Patients were categorized by BMI: normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (>30 kg/m2). Multivariable Cox regression models that included demographic, risk factors, and comorbidities were separately constructed for all-cause, cardiovascular, cancer and sepsis-related mortality, using four groups of HbA1c (<6%, 6.0-6.9%, 7.0-7.9%, and >8%). Results In total, 6220 patients with T2DM (median age 62 years, 54% male) were followed for a median of 10.6 years. HbA1c levels >8.0% were associated with increased risk of all-cause mortality and cardiovascular death. However, this increased risk was not consistent across the weight categories and reached statistical significance only in overweight patients (BMI 25-29.9 kg/m2). Conclusions In a large cohort of patients with T2DM elevated HbA1c levels at baseline did not consistently predict increased risk of all-cause and cardiovascular mortality across the different BMI categories.
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187
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Similar rates of fat oxidation during graded submaximal exercise in women of different body composition. PLoS One 2020; 15:e0242551. [PMID: 33206727 PMCID: PMC7673546 DOI: 10.1371/journal.pone.0242551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/04/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Moderate intensity exercise ranging 40-60% of maximum oxygen uptake is advised to promote energy expenditure and fat oxidation in overweight and obese people. Although fat oxidation has been shown to be highly variable among individual, there is still a relative uncertainty regarding exercise prescription for women specifically. This article aimed to determine whether indicators of body composition can be used to narrow the exercise intensity range for exercise prescription in women. METHODS A total of 35 healthy women (age 30.8±9.5 yr) classified according to their BMI in normal weight (NOR; ≤24.9 kg·m2), overweight (OVW; 25-29.9 kg·m2) and obese groups (OBE; ≥30 kg·m2) completed a submaximal graded test (intensities eliciting ~30%, 40%, 50% and 60% of maximum oxygen uptake). Blood lactate, perceived exertion and absolute and relative substrate oxidation for fat (OXFAT) and carbohydrates (OXCHO) were measured at each stage. RESULTS Perceived exertion and blood lactate increased as a function of exercise but did not differ across groups. There were no significant changes in absolute and relative OXFAT across groups, or as a function of exercise intensity. Peak OXFAT occurred at the 40%, 50% and 40% stages for NOR, OVW and OBE groups, respectively, with no significant differences across groups. CONCLUSION We measured no differences, but considerable inter-individual variation, in fat oxidation in women of different body composition. This result is in agreement with previous research based on exercise performed at constant rate and in independent participant groups. Our findings do not support the fat oxidation hypothesis, and further emphasise the perspective that exercise prescription should be individualised and likely be based on considerations other than substrate oxidation.
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188
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Obesity and Pancreatic Cancer: A Matched-Pair Survival Analysis. J Clin Med 2020; 9:jcm9113526. [PMID: 33142763 PMCID: PMC7693315 DOI: 10.3390/jcm9113526] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Morbid obesity is a risk factor for pancreatic ductal adenocarcinoma (PDAC). However, the impact of obesity on postoperative outcomes and overall survival in patients with PDAC remains a controversial topic. METHODS Patients who underwent pancreatic surgery for PDAC between 1997 and 2018 were included in this study. Matched pairs (1:1) were generated according to age, gender and American Society of Anesthesiologists status. Obesity was defined according to the WHO definition as BMI ≥ 30 kg/m2. The primary endpoint was the difference in overall survival between patients with and without obesity. RESULTS Out of 553 patients, a total of 76 fully matched pairs were generated. Obese patients had a mean BMI-level of 33 compared to 25 kg/m2 in patients without obesity (p = 0.001). The frequency of arterial hypertension (p = 0.002), intraoperative blood loss (p = 0.039), and perineural invasion (p = 0.033) were also higher in obese patients. Clinically relevant postoperative complications (p = 0.163) and overall survival rates (p = 0.885) were comparable in both study groups. Grade II and III obesity resulted in an impaired overall survival, although this was not statistically significant. Subgroup survival analyses revealed no significant differences for completion of adjuvant chemotherapy and curative-intent surgery. CONCLUSIONS Obesity did not affect overall survival and postoperative complications in these patients with PDAC. Therefore, pancreatic surgery should not be withheld from obese patients.
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Jacob L, Haro JM, Smith L, Koyanagi A. Association between intelligence quotient and obesity in England. LIFESTYLE MEDICINE 2020. [DOI: 10.1002/lim2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Louis Jacob
- Faculty of Medicine University of Versailles Saint‐Quentin‐en‐Yvelines Montigny‐le‐Bretonneux France
- Research and Development Unit, Parc Sanitari Sant Joan de Déu Universitat de Barcelona Barcelona Spain
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu Universitat de Barcelona Barcelona Spain
- Instituto de Salud Carlos III Centro de Investigación Biomédica en Red de Salud Mental Madrid Spain
| | - Lee Smith
- Cambridge Center for Exercise Science Anglia Ruskin University Cambridge UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu Universitat de Barcelona Barcelona Spain
- Instituto de Salud Carlos III Centro de Investigación Biomédica en Red de Salud Mental Madrid Spain
- ICREA Barcelona Spain
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Intravenous Glutamine Administration Improves Glucose Tolerance and Attenuates the Inflammatory Response in Diet-Induced Obese Mice after Sleeve Gastrectomy. Nutrients 2020; 12:nu12103192. [PMID: 33086562 PMCID: PMC7603202 DOI: 10.3390/nu12103192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/08/2020] [Accepted: 10/15/2020] [Indexed: 11/17/2022] Open
Abstract
Obesity is a health problem associated with many metabolic disorders. Weight reduction can effectively alleviate obesity-associated complications. Sleeve gastrectomy is a commonly used bariatric surgery and is considered safe and effective for improving outcomes. Glutamine (GLN) is an amino acid with anti-oxidative and anti-inflammatory properties. This study used a mouse model of sleeve gastrectomy to investigate the impacts of intravenous GLN administration on glucose tolerance and adipocyte inflammation short-term after surgery. C57BL6 male mice were divided into normal control (NC) and high-fat diet groups. The high-fat diet provided 60% of energy from fat for 10 weeks to induce obesity. Mice fed the high-fat diet were then assigned to a sham (SH) or sleeve gastrectomy with saline (S) or GLN (G) groups. The S group was intravenously injected with saline, while the G group was administered GLN (0.75 g/kg body weight) via a tail vein postoperatively. Mice in the experimental groups were sacrificed on day 1 or 3 after the surgery. Results showed that obesity resulted in fat accumulation, elevated glucose levels, and adipokines production. Sleeve gastrectomy aggravated expressions of inflammatory cytokine and macrophage infiltration markers, cluster of differentiation 68 (CD68), epidermal growth factor-like module-containing mucin-like hormone receptor-like 1 (EMR-1), and macrophage chemoattractant protein-1, in adipose tissues. Treatment of obese mice with GLN downregulated hepatic proteomic profiles associated with the gluconeogenesis pathway and improved glucose tolerance. Moreover, macrophage infiltration and adipose tissue inflammation were attenuated after the sleeve gastrectomy. These findings imply that postoperative intravenous GLN administration may improve glucose tolerance and attenuate inflammation shortly after the bariatric surgery in subjects with obesity.
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Association between Body Mass Index and Short-Term Clinical Outcomes in Critically Ill Patients with Sepsis: A Real-World Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5781913. [PMID: 33123579 PMCID: PMC7584974 DOI: 10.1155/2020/5781913] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/02/2020] [Accepted: 09/24/2020] [Indexed: 02/06/2023]
Abstract
Background Obesity is now recognized as one of the major public health threats, especially for patients with a critical illness. However, studies regarding whether and how body mass index (BMI) affects clinical outcomes in patients with sepsis are still scarce and controversial. The aim of our study was to determine the effect of BMI on critically ill patients with sepsis. Materials and Methods We performed this study using data from the Medical Information Center for Intensive Care III database. A multivariate Cox regression model was used to assess the independent association of BMI with the primary outcome. Results A total of 7,967 patients were enrolled in this study. Firstly, we found that the 28-day mortality was reduced by 22% (HR = 0.78, 95% CI 0.69–0.88) and 13% (HR = 0.87, 95% CI 0.78–0.98) for obese and overweight compared to normal weight, respectively. Subsequently, a U-shaped association of BMI with 28-day mortality was observed in sepsis patients, with the lowest 28-day mortality at the BMI range of 30–40 kg/m2. Finally, significant interactions were observed only for sex (P = 0.0071). Male patients with a BMI of 25-30 kg/m2 (HR = 0.74, 95% CI 0.63–0.86) and 30-40 kg/m2 (HR = 0.63, 95% CI 0.53–0.76) had a significantly lower risk of 28-day mortality. Conclusions A U-shaped association of BMI with 28-day mortality in critically ill sepsis patients was found, with the lowest 28-day mortality at a BMI range of 30–40 kg/m2. Notably, male patients were protected by a higher BMI more effectively than female patients as males had a significantly lower mortality risk.
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Zhu J, Zhao Z, Wu B, Shi Z, Nie Q, Fu Z, Zeng Z, Hu W, Dong M, Xiong M, Hu K. Effect of Body Mass Index on Lung Function in Chinese Patients with Chronic Obstructive Pulmonary Disease: A Multicenter Cross-Sectional Study. Int J Chron Obstruct Pulmon Dis 2020; 15:2477-2486. [PMID: 33116464 PMCID: PMC7568679 DOI: 10.2147/copd.s265676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/31/2020] [Indexed: 12/04/2022] Open
Abstract
Objective The aim of this study was to explain “obesity paradox” in chronic obstructive pulmonary disease (COPD) by evaluating the effect of body mass index (BMI) on lung function in Chinese patients with COPD. Methods A total of 1644 patients diagnosed with COPD were recruited from four Chinese tertiary hospitals and were divided into four groups including underweight, normal weight, overweight and obese according to BMI classification standard. The medical data of these patients were collected and used for the multiple linear regression analyses. Results After adjustment for age, sex, educational level, economic status, smoking status, alcohol consumption, duration of COPD history, events of acute exacerbation in previous year, hypertension, diabetes mellitus, cardiovascular disease, cerebrovascular disease and osteoporosis, BMI had a curvilinear correlation with the forced expiratory volume in the first second (FEV1) in patients with Global Initiative for Obstructive Lung Disease (GOLD) 1–2 grade (first-order coefficient β, 0.09; 95% CI, 0.03–0.16; second-order coefficient β, −0.002; 95% CI, −0.003–-0.001; P<0.01). However, BMI had a positive correlation with FEV1 in patients with GOLD 3–4 grade (β, 0.01; 95% CI, 0.008–0.017; P<0.01) when BMI was used as a quantitative variable. When BMI was used as a qualitative variable, only FEV1 in overweight group with GOLD 1–2 grade was significantly higher than that of normal weight group (P<0.01). Interestingly, both overweight and obese groups had higher FEV1 in GOLD 3–4 grade compared with normal weight group (β, 0.06; 95% CI, 0.02–0.11; β, 0.11; 95% CI, 0.04–0.18; P<0.01). The effect of BMI on predicted percentage of FEV1 (FEV1%) was similar to that of FEV1 in different GOLD grades. Conclusion Obesity only had a protective effect on lung function in COPD patients with GOLD 3–4 grade rather than GOLD 1–2 grade. Trial Registry ClinicalTrials.gov, No.: NCT 03182309, URL: www.clinicaltrials.gov.
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Affiliation(s)
- Jing Zhu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China.,Department of Respiratory and Critical Care Medicine, The People's Hospital of China Three Gorges University, Yichang, Hubei, People's Republic of China
| | - Zhiling Zhao
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Bin Wu
- Institute of Respiratory Diseases, Department of Respiratory, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China
| | - Zhihong Shi
- Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xian Jiaotong University, Xian, Shanxi, People's Republic of China
| | - Qingrong Nie
- Division of Respiratory Disease, Liangxiang Hospital of Yanjing Medical College, Capital Medical University, Beijing, People's Republic of China
| | - Zhen Fu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Zhaofu Zeng
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Weihua Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Minglin Dong
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Mengqing Xiong
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
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Lea AJ, Martins D, Kamau J, Gurven M, Ayroles JF. Urbanization and market integration have strong, nonlinear effects on cardiometabolic health in the Turkana. SCIENCE ADVANCES 2020; 6:eabb1430. [PMID: 33087362 PMCID: PMC7577730 DOI: 10.1126/sciadv.abb1430] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 09/04/2020] [Indexed: 05/11/2023]
Abstract
The "mismatch" between evolved human physiology and Western lifestyles is thought to explain the current epidemic of cardiovascular disease (CVD) in industrialized societies. However, this hypothesis has been difficult to test because few populations concurrently span ancestral and modern lifestyles. To address this gap, we collected interview and biomarker data from individuals of Turkana ancestry who practice subsistence-level, nomadic pastoralism (the ancestral way of life for this group), as well as individuals who no longer practice pastoralism and live in urban areas. We found that Turkana who move to cities exhibit poor cardiometabolic health, partially because of a shift toward "Western diets" high in refined carbohydrates. We also show that being born in an urban area independently predicts adult health, such that life-long city dwellers will experience the greatest CVD risk. By focusing on a substantial lifestyle gradient, our work thus informs the timing, magnitude, and evolutionary causes of CVD.
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Affiliation(s)
- Amanda J Lea
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
- Lewis Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
| | - Dino Martins
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
- Mpala Research Centre, Nanyuki, Kenya
| | - Joseph Kamau
- Department of Biochemistry, School of Medicine, University of Nairobi, Nairobi, Kenya
- Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
| | - Michael Gurven
- Department of Anthropology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Julien F Ayroles
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA.
- Lewis Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
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Yu T, Bo Y, Chang LY, Liu X, Tam T, Lao XQ. Adiposity and risk of death: A prospective cohort study of 463,002 adults. Clin Nutr 2020; 40:1932-1941. [PMID: 32988652 DOI: 10.1016/j.clnu.2020.09.008] [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: 04/08/2020] [Revised: 08/07/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is crucial to have simple and appropriate measures to identify people with adiposity-related risk. We compared the associations of mortality with body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and body fat percentage (BF%) in a prospective cohort. METHODS A total of 463,002 adults were recruited between 1996 and 2017. Vital data were obtained from the National Death Registry System in Taiwan. Cox proportional hazards model was used to assess the associations of BMI, WC, WHtR, and BF% with mortality. RESULT Clear U-shape relationships were observed for all four parameters. In both men and women, the lowest risk of mortality was observed in the BMI category of 23.5-24.9 kg/m2. Regarding WC, men in the third quintile (79.0-82.9 cm) and women in the fourth quintile (70.0-74.9 cm) had the lowest risk of mortality. For WHtR, men in the third quintile (0.46-0.49) and women in the fourth quintile (0.45-0.48) had the lowest risk of mortality. For BF%, both men and women in the fourth quintile (24.0-27.2% and 28.7-32.8%, respectively) had the lowest risk of mortality. The WC, WHtR, and BF% exhibited slightly associations with the risk of mortality across the three BMI categories [low (10.8-20.9 kg/m2), normal (21.0-27.4 kg/m2) and high (27.5-51.7 kg/m2)]. C-statistics of the four parameters ranged from 0.51 to 0.69. CONCLUSION Our results suggest that BMI should remain the primary marker for screening excessive adiposity. However, our findings also support the use of the WC, WHtR, and/or BF%, in addition to BMI when assessing the risk of mortality.
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Affiliation(s)
- Tsung Yu
- Department of Public Health, College of Medicine, National Cheng Kung University, Taiwan
| | - Yacong Bo
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong; Department of Nutrition and Food Hygiene, School of Public Health, Zhengzhou University, China
| | - Ly-Yun Chang
- Gratia Christian College, Hong Kong; Institute of Sociology, Academia Sinica, Taiwan
| | - Xudong Liu
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong; School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Tony Tam
- Department of Sociology, The Chinese University of Hong Kong, Hong Kong
| | - Xiang Qian Lao
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
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Evans-Hudnall G, Odafe MO, Johnson A, Armenti N, O'Neil J, Lawson E, Trahan LH, Rassu FS. Using an Adjunctive Treatment to Address Psychological Distress in a National Weight Management Program: Results of an Integrated Pilot Study. Mil Med 2020; 185:e1662-e1670. [PMID: 32728734 DOI: 10.1093/milmed/usaa145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Obesity is highly comorbid with psychological symptoms in veterans, particularly post-traumatic stress disorder (PTSD), depression, and anxiety. Obese veterans with comorbid psychological symptoms often display suboptimal weight loss and poor physical functioning when participating in weight management programs. The MOVE! program aims to increase healthy eating and physical activity to promote weight loss in obese veterans. Adequately addressing psychological barriers is necessary to maximize outcomes in MOVE! for veterans with PTSD, depression, and anxiety. We examined the preliminary outcomes of administering the Healthy Emotions and Improving Health BehavioR Outcomes (HERO) intervention. HERO is adjunctive cognitive-behavioral therapy to MOVE! that addresses PTSD, depression, and anxiety symptom barriers to engagement in physical activity. MATERIALS AND METHODS All recruitment and study procedures were approved by the institutional review board and research and development committees of the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine in Houston, Texas. Participants gave written informed consent before enrollment. Thirty-four obese veterans with a diagnosis of PTSD, depression, and/or anxiety who were attending MOVE! were assigned to the 8-session HERO group or the usual care (UC) group. Veterans completed assessments of PTSD, depression and anxiety symptoms, physical activity, physical functioning, and weight at baseline, 8 and 16 weeks post treatment. Changes from baseline to 8- and 16-week follow-up on the self-report and clinician-rated measures were assessed, using independent samples t-tests and analyses of covariance. RESULTS At 8 weeks post treatment, participants in the HERO group had significantly higher step counts per day than participants in the UC group. Similarly, at 16 weeks post-treatment, participants in the HERO group continued to experience a significant increase in daily steps taken per day, as well as statistically and clinically significantly lower scores on the depression symptom and PTSD symptom severity. Participants in the HERO group also demonstrated significantly higher scores on the physical functioning inventory than participants in the UC group (44.1 ± 12.1 vs. 35.7 ± 10.7, P = 0.04) at 16 weeks post treatment. CONCLUSIONS Findings of this small trial have important implications pending replication in a more rigorously designed large-scale study. Providing an adjunctive treatment to MOVE! that addresses psychological distress has potential benefits for psychological symptom reduction, engagement in healthy dietary habits, and greater physical activity for individuals who traditionally experience barriers to making positive weight management changes.
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Affiliation(s)
- Gina Evans-Hudnall
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030.,VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center)
| | - Mary O Odafe
- Department of Clinical Psychology, University of Houston, Heyne building # 126, Houston, TX 77204
| | - Adrienne Johnson
- William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI 53705.,University of Wisconsin Center for Tobacco Research and Intervention, 1930 Monroe St., #200, Madison, WI 53711
| | - Nicholas Armenti
- Department of Clinical Psychology, University of Houston, Heyne building # 126, Houston, TX 77204
| | - Jennifer O'Neil
- Department of Psychiatry and Behavioral Medicine, One Baylor Plaza, Baylor College of Medicine, Houston, TX 77030.,Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030
| | - Evan Lawson
- Department of Counseling Psychology, University of North Texas, 1155 Union Circle #311280, Denton, Texas 76203-5017
| | - Lisa H Trahan
- Trahan Counseling, 631 Mill Street, Suite 101 San Marcos, Texas 78666
| | - Fenan S Rassu
- Department of Psychiatry and Behavioral Medicine, One Baylor Plaza, Baylor College of Medicine, Houston, TX 77030.,Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030
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Clemens KK, Reid JN, Shariff SZ, Welk B. Validity of Hospital Codes for Obesity in Ontario, Canada. Can J Diabetes 2020; 45:243-248.e4. [PMID: 33109445 DOI: 10.1016/j.jcjd.2020.08.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Obesity has a significant impact on population health and health care. Administrative databases may be a useful tool to study obesity at a population level. In this work, we aimed to determine the validity of hospital codes for obesity in Ontario, Canada. METHODS Using linked health-care databases (ICES), we conducted a validation study in adults ≥18 years of age who had their height and weight recorded during a hospitalization in southwestern Ontario. We considered a body mass index ≥30 kg/m2 as our gold standard definition for obesity. We then examined the validity of 2 International Classification of Diseases---10th revision (ICD-10) coding algorithms for obesity (Algorithm 1, ICD-10 E66.X; and Algorithm 2, ICD-10 E65.X-68.X). As additional analyses, we examined the validity of algorithms in different obesity classes (i.e. obese classes 1, 2 and 3), and in patients with diagnosed diabetes and hypertension. RESULTS There were 34,588 patients included in our study (mean age, 62 years; 47% female). Algorithm 1 performed best, with a sensitivity, specificity, positive predictive value and negative predictive value of 8.8%, 99.8%, 95.4% and 65.1%, respectively. The sensitivity of this algorithm was highest in patients with obesity class 3 (27.4%) and in those with diagnosed diabetes. CONCLUSIONS Hospital codes for obesity have a high positive predictive value and specificity. These codes can be used to build and study cohorts of patients with obesity in administrative database studies. However, given their limited sensitivity, administrative codes provide inaccurate incidence and prevalence estimates.
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Affiliation(s)
- Kristin K Clemens
- Department of Medicine, Division of Endocrinology and Metabolism, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; ICES, Ontario, Canada; Centre for Diabetes, Endocrinology and Metabolism, St. Joseph's Health Care London, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada.
| | | | | | - Blayne Welk
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; ICES, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
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Michaëlsson K, Baron JA, Byberg L, Höijer J, Larsson SC, Svennblad B, Melhus H, Wolk A, Warensjö Lemming E. Combined associations of body mass index and adherence to a Mediterranean-like diet with all-cause and cardiovascular mortality: A cohort study. PLoS Med 2020; 17:e1003331. [PMID: 32941436 PMCID: PMC7497998 DOI: 10.1371/journal.pmed.1003331] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND It is unclear whether the effect on mortality of a higher body mass index (BMI) can be compensated for by adherence to a healthy diet and whether the effect on mortality by a low adherence to a healthy diet can be compensated for by a normal weight. We aimed to evaluate the associations of BMI combined with adherence to a Mediterranean-like diet on all-cause and cardiovascular disease (CVD) mortality. METHODS AND FINDINGS Our longitudinal cohort design included the Swedish Mammography Cohort (SMC) and the Cohort of Swedish Men (COSM) (1997-2017), with a total of 79,003 women (44%) and men (56%) and a mean baseline age of 61 years. BMI was categorized into normal weight (20-24.9 kg/m2), overweight (25-29.9 kg/m2), and obesity (30+ kg/m2). Adherence to a Mediterranean-like diet was assessed by means of the modified Mediterranean-like diet (mMED) score, ranging from 0 to 8; mMED was classified into 3 categories (0 to <4, 4 to <6, and 6-8 score points), forming a total of 9 BMI × mMED combinations. We identified mortality by use of national Swedish registers. Cox proportional hazard models with time-updated information on exposure and covariates were used to calculate the adjusted hazard ratios (HRs) of mortality with their 95% confidence intervals (CIs). Our HRs were adjusted for age, baseline educational level, marital status, leisure time physical exercise, walking/cycling, height, energy intake, smoking habits, baseline Charlson's weighted comorbidity index, and baseline diabetes mellitus. During up to 21 years of follow-up, 30,389 (38%) participants died, corresponding to 22 deaths per 1,000 person-years. We found the lowest HR of all-cause mortality among overweight individuals with high mMED (HR 0.94; 95% CI 0.90, 0.98) compared with those with normal weight and high mMED. Using the same reference, obese individuals with high mMED did not experience significantly higher all-cause mortality (HR 1.03; 95% CI 0.96-1.11). In contrast, compared with those with normal weight and high mMED, individuals with a low mMED had a high mortality despite a normal BMI (HR 1.60; 95% CI 1.48-1.74). We found similar estimates among women and men. For CVD mortality (12,064 deaths) the findings were broadly similar, though obese individuals with high mMED retained a modestly increased risk of CVD death (HR 1.29; 95% CI 1.16-1.44) compared with those with normal weight and high mMED. A main limitation of the present study is the observational design with self-reported lifestyle information with risk of residual or unmeasured confounding (e.g., genetic liability), and no causal inferences can be made based on this study alone. CONCLUSIONS These findings suggest that diet quality modifies the association between BMI and all-cause mortality in women and men. A healthy diet may, however, not completely counter higher CVD mortality related to obesity.
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Affiliation(s)
- Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - John A. Baron
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Liisa Byberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jonas Höijer
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Susanna C. Larsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bodil Svennblad
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Håkan Melhus
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Alicja Wolk
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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198
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Miljkovic T, Wang X. Identifying subgroups of age and cohort effects in obesity prevalence. Biom J 2020; 63:168-186. [PMID: 32869390 DOI: 10.1002/bimj.201900287] [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: 09/22/2019] [Revised: 05/04/2020] [Accepted: 06/01/2020] [Indexed: 01/03/2023]
Abstract
The obesity epidemic represents an important public health issue in the United States. Studying obesity trends across age groups over time helps to identify crucial relationships between the disease and medical treatment allowing for the development of effective prevention policies. We aim to define subgroups of age and cohort effects in obesity prevalence over time by considering an optimization approach applied to the age-period-cohort (APC) model. We consider a heterogeneous regression problem where the regression coefficients are age dependent and belong to subgroups with unknown grouping information. Using the APC model, we apply the alternating direction method of multipliers (ADMM) algorithm to develop a two-step algorithm for (1) subgrouping of cohort effects based on similar characteristics and (2) subgrouping age effects over time. The proposed clustering approach is illustrated for the United States population, aged 18-79, during the period 1990-2017.
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Affiliation(s)
| | - Xin Wang
- Department of Statistics, Miami University, OH, USA
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199
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Hong KY. Fat grafts enriched with adipose-derived stem cells. Arch Craniofac Surg 2020; 21:211-218. [PMID: 32867409 PMCID: PMC7463121 DOI: 10.7181/acfs.2020.00325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023] Open
Abstract
Autologous fat grafts are widely used in soft-tissue augmentation and reconstruction. To reduce the unpredictability of fat grafts and to improve their long-term survival, cell-assisted lipotransfer (CAL) was introduced. In this alternative method, autologous fat is mixed and grafted with stromal vascular fraction cells or adipose-derived stem/stromal cells (ASCs). In regenerative medicine, ASCs exhibit excellent therapeutic potential and are also simple to harvest. Although the efficacy of CAL has been demonstrated in experimental and clinical research, studies on its safety in terms of oncologic risk have reported inconclusive results. In order to establish CAL as a viable stem cell therapeutic approach, it will be necessary to demonstrate its oncologic safety in basic and clinical studies. Doing so could transform the paradigm of clinical strategy and practice for the treatment of a wide variety of diseases.
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Affiliation(s)
- Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
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200
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Ortolan A, Lorenzin M, Felicetti M, Ramonda R. Do obesity and overweight influence disease activity measures in axial spondyloarthritis? A systematic review and meta‐analysis. Arthritis Care Res (Hoboken) 2020; 73:1815-1825. [DOI: 10.1002/acr.24416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/06/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Augusta Ortolan
- Rheumatology Unit Department of Medicine DIMED University of Padova Padova Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit Department of Medicine DIMED University of Padova Padova Italy
| | - Mara Felicetti
- Rheumatology Unit Department of Medicine DIMED University of Padova Padova Italy
| | - Roberta Ramonda
- Rheumatology Unit Department of Medicine DIMED University of Padova Padova Italy
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