151
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Aiello M, Parma V, De Carlo S, Hummel T, Rumiati RI. Cognitive, Olfactory, and Affective Determinants of Body Weight in Aging Individuals. Arch Clin Neuropsychol 2020; 34:637-647. [PMID: 30272124 DOI: 10.1093/arclin/acy072] [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: 02/12/2018] [Revised: 07/12/2018] [Accepted: 08/09/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE A complex interplay of factors including cognitive, sensory and affective aspects has been associated in a controversial way with anthropometric measures related to body weight. METHODS Here we propose two studies to investigate whether and how cognitive, olfactory and affective variables resulted associated with body weight during healthy aging. In Study 1, we investigated the cognitive status, the odor identification skills, and the BMI of 209 individuals (50-96 yo). In Study 2 an extensive evaluation of cognitive functions (in particular executive functions and memory), odor threshold, discrimination and identification and affective skills (i.e., depression and anxiety) was performed in a group of 35 healthy, free-living aging individuals (58-85 yo). RESULTS In Study 1, greater BMI was not associated with performance on the odor identification task but was significantly associated with better cognitive skills. In Study 2, we observed that executive functions seemed to favor a successful managing of body weight, and individuals with greater BMI and waist circumference showed significantly better odor discrimination skills. Finally, lower waist circumference (but not BMI) was found significantly associated with greater levels of anxiety. CONCLUSIONS These results confirm that cognitive, olfactory and affective factors may influence body weight during healthy aging.
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Affiliation(s)
| | - Valentina Parma
- Area of Neuroscience, SISSA, Trieste, Italy.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,William James Research Center, Lisbon, Portugal
| | | | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
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152
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Outcomes Associated with Obesity in Patients Undergoing Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis. ASAIO J 2020; 66:401-408. [DOI: 10.1097/mat.0000000000001019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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153
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Frank RC, Min J, Abdelghany M, Paniagua S, Bhattacharya R, Bhambhani V, Pomerantsev E, Ho JE. Obesity Is Associated With Pulmonary Hypertension and Modifies Outcomes. J Am Heart Assoc 2020; 9:e014195. [PMID: 32079475 PMCID: PMC7335575 DOI: 10.1161/jaha.119.014195] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Experimental studies support a link between obesity and pulmonary hypertension (PH), yet clinical studies have been limited. This study sought to determine the association of obesity and pulmonary hemodynamic measures and mortality in PH. Methods and Results We examined patients undergoing right‐sided heart catherization (2005–2016) in a hospital‐based cohort. Multivariable regression models tested associations of body mass index and pulmonary vascular hemodynamics, with PH defined as mean pulmonary artery pressure >20 mm Hg, and further subclassified into precapillary, postcapillary, and mixed PH. Multivariable Cox models were used to examine the effect of PH and obesity on mortality. Among 8940 patients (mean age, 62 years; 40% women), 52% of nonobese and 69% of obese individuals had evidence of PH. Higher body mass index was independently associated with greater odds of overall PH (odds ratio, 1.34; 95% CI, 1.29–1.40; P<0.001 per 5‐unit increase in body mass index) as well as each PH subtype (P<0.001 for all). Patients with PH had greater risk of mortality compared with individuals without PH regardless of subgroup (P<0.001 for all). We found that obesity was associated with 23% lower hazard of mortality among patients with PH (hazard ratio, 0.77; 95% CI, 0.69–0.85; P<0.001). The effect of obesity was greatest among those with precapillary PH (hazard ratio, 0.57; 95% CI, 0.46–0.70; P<0.001), where obesity modified the effect of PH on mortality (P for interaction=0.02). Conclusions Obesity is independently associated with PH. PH is associated with greater mortality; this is modified by obesity such that obese patients with precapillary PH have lower mortality compared with nonobese counterparts. Further studies are needed to elucidate mechanisms underlying obesity‐related PH.
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Affiliation(s)
- Rachel C Frank
- Department of Medicine Massachusetts General Hospital Boston MA
| | - Jeff Min
- Department of Medicine Massachusetts General Hospital Boston MA
| | | | - Samantha Paniagua
- Cardiovascular Research Center Massachusetts General Hospital Boston MA.,Corrigan Minehan Heart Center Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA
| | - Romit Bhattacharya
- Corrigan Minehan Heart Center Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA
| | - Vijeta Bhambhani
- Corrigan Minehan Heart Center Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA
| | - Eugene Pomerantsev
- Corrigan Minehan Heart Center Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA.,Harvard Medical School Harvard University Boston MA
| | - Jennifer E Ho
- Cardiovascular Research Center Massachusetts General Hospital Boston MA.,Corrigan Minehan Heart Center Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA.,Harvard Medical School Harvard University Boston MA
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154
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Netley J, Howard K, Wilson W. Effects of body mass index on the safety and effectiveness of direct oral anticoagulants: a retrospective review. J Thromb Thrombolysis 2020; 48:359-365. [PMID: 30963393 DOI: 10.1007/s11239-019-01857-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The International Society on Thrombosis and Haemostasis recommends avoiding the use of direct oral anticoagulants (DOACs) in patients with a body mass index (BMI) greater than 40 kg/m2 or weight greater than 120 kg. HYPOTHESIS Higher BMI is associated with altered pharmacokinetics which may affect the safety and effectiveness for DOACs. METHODS Data were collected on 3458 patients taking a DOAC prior to admission to a Midwestern health system between February 2013 and August 2016. Of these, 43 patients had a thrombotic event and 70 patients had an overt bleeding event. Patients were stratified among the following three BMI groups: BMI < 30 kg/m2, BMI 30-40 kg/m2, and BMI > 40 kg/m2. RESULTS There was no statistically significant difference between BMI groups for thrombotic events (p = 0.598) or for overt bleeding events (p = 0.065). The BMI < 30 kg/m2 had the highest occurrence rate of bleeding events. It was observed that bleeding occurrence decreased as the BMI groups increased. The BMI > 40 kg/m2 group had the lowest risk of bleeding events, and was the only group to have a higher occurrence rate of thrombotic events compared to bleeding events. CONCLUSIONS Among patients admitted to a single health system on DOAC therapy over a three-and-a-half-year period, obesity did not significantly correlate with thrombotic or overt bleeding complications. This study is limited as a single health system study with low overall event rates. A preliminary finding of this study showed a trend towards decreased bleeding frequency as BMI increased.
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Affiliation(s)
- Jared Netley
- Department of Pharmacy, Parkview Health, 11109 Parkview Plaza Drive, Fort Wayne, IN, 46845, USA.
| | - Kris Howard
- Department of Pharmacy, Parkview Health, 11109 Parkview Plaza Drive, Fort Wayne, IN, 46845, USA
| | - William Wilson
- Department of Cardiology, Parkview Health, 11109 Parkview Plaza Drive, Fort Wayne, IN, 46845, USA
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155
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Kassam AF, Mirza A, Kim Y, Hanseman D, Woodle ES, Quillin RC, Johnson BL, Govil A, Cardi M, Schauer DP, Smith EP, Diwan TS. Long-term outcomes in patients with obesity and renal disease after sleeve gastrectomy. Am J Transplant 2020; 20:422-429. [PMID: 31605562 DOI: 10.1111/ajt.15650] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/06/2019] [Accepted: 10/03/2019] [Indexed: 01/25/2023]
Abstract
Morbid obesity is a barrier to kidney transplant in patients with end-stage renal disease (ESRD). Laparoscopic sleeve gastrectomy (SG) is an increasingly considered intervention, but the safety and long-term outcomes are uncertain. We reviewed prospectively collected data on patients with ESRD and chronic kidney disease (CKD) undergoing SG from 2011 to 2018. There were 198 patients with ESRD and 45 patients with CKD (stages 1-4) who met National Institutes of Health guidelines for bariatric surgery and underwent SG; 72% and 48% achieved a body mass index of ≤ 40 and ≤ 35 kg/m2 , respectively. The mean percentages of total weight loss and excess weight loss were 18.9 ± 10.8% and 38.2 ± 20.3%, respectively. SG reduced hypertension (85.8% vs 52.1%), decreased antihypertensive medication use (1.6 vs 1.0) (P < .01 each), and reduced incidence of diabetes (59.6% vs 32.5%, P < .01). Of the 71 patients with ESRD who achieved a body mass index of ≤ 40 kg/m2 , 45 were waitlisted and received a kidney transplant, whereas 10 remain on the waitlist. Mortality rate after SG was 1.8 per 100 patient-years, compared with 7.3 for non-SG. Patients with stage 3a or 3b CKD exhibited improved glomerular filtration rate (43.5 vs 58.4 mL/min, P = .01). In conclusion, SG safely improves transplant candidacy while providing significant, sustainable effects on weight loss, reducing medical comorbidities, and possibly improving renal function in stage 3 patients.
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Affiliation(s)
- Al-Faraaz Kassam
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Ahmad Mirza
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Young Kim
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Dennis Hanseman
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - E Steve Woodle
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Ralph C Quillin
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Bobby L Johnson
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Amit Govil
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Michael Cardi
- Department of Internal Medicine, The Christ Hospital, Cincinnati, Ohio
| | - Daniel P Schauer
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Eric P Smith
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Tayyab S Diwan
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
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156
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Ram P, Shah M, Lo KBU, Agarwal M, Patel B, Tripathi B, Arora S, Patel N, Jorde UP, Banerji S. Etiologies and predictors of readmission among obese and morbidly obese patients admitted with heart failure. Heart Fail Rev 2020; 26:829-838. [PMID: 32002731 DOI: 10.1007/s10741-020-09920-4] [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] [Indexed: 11/24/2022]
Abstract
The relationship between severity of obesity and outcomes in heart failure (HF) has long been under debate. We studied index HF admissions from the 2013-14 National Readmission Database. Admissions were separated into three weight-based categories: non-obese (Non-Ob), obese (Ob), and morbidly obese (Morbid-Ob) to analyze hospital mortality and readmission at 30 days and 6 months. We investigated etiologies and predictors of 30-day readmission among these weight categories. We studied a total of 578,213 patients of whom 3.0% died during index hospitalization (Non-Ob 3.3% vs. Ob 1.9% vs. Morbid-Ob 1.9%; p < 0.01). Non-Ob comprised 79.5%, Ob 9.9%, and Morbid-Ob 10.6% of patients. Morbid-Ob patients were the youngest among age categories and more likely to be female. In-hospital mortality during readmission at 30 days and 6 months was significantly lower among Morbid-Ob and Ob compared with Non-Ob patients (all p < 0.01). Thirty-day readmission among Morbid-Ob was lower than Non-Ob and higher than Ob patients (19.6% vs. 20.5% vs. 18.6%, respectively; p < 0.01). Morbid-Ob patients were less likely to be readmitted for cardiovascular etiologies compared with both Ob and Non-Ob (45.0% vs. 50.3% vs. 50.6%; p < 0.01). Multivariable regression analysis revealed that Ob (adjusted odds ratio 0.84, 95% confidence intervals 0.82-0.86) and Morbid-Ob (aOR 0.83, 95% CI 0.81-0.85) were independently associated with lower 30-day readmission. Readmission at 6 months was highest among Morbid-Ob followed by Non-Ob and Ob (51.1% vs. 50.2% vs. 49.1%, p < 0.01). Morbid-Ob and Ob patients experience lower in-hospital mortality during index HF admission and during readmission with 30 days or 6 months compared with Non-Ob. Morbid-Ob patients experience greater readmission at 6 months despite the lower rate at 30 days post discharge. Morbid-Ob patients are most likely to be readmitted for non-cardiovascular causes.
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Affiliation(s)
- Pradhum Ram
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, 19141, USA.
| | - Mahek Shah
- Department of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Kevin Bryan U Lo
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, 19141, USA
| | - Manyoo Agarwal
- Department of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Brijesh Patel
- Department of Cardiology, Henry Ford Health System, Jackson, MI, USA
| | - Byomesh Tripathi
- Department of Cardiology, Geisinger Medical Center, Danville, PA, USA
| | - Shilpkumar Arora
- Department of Medicine, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - Nilay Patel
- Department of Cardiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ulrich P Jorde
- Department of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Sourin Banerji
- Department of Cardiology, Christiana Care Health, Newark, DE, USA
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157
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Kassam AF, Taylor ME, Morris MC, Watkins BM, Thompson JR, Schauer DP, Smith EP, Diwan TS. The impact of sleeve gastrectomy on renal function in patients with chronic kidney disease varies with severity of renal insufficiency. Surg Obes Relat Dis 2020; 16:607-613. [PMID: 32093996 DOI: 10.1016/j.soard.2020.01.021] [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: 12/19/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although laparoscopic sleeve gastrectomy is known, in general, to improve renal function in patients with obesity and chronic kidney disease (CKD), its effect on estimated glomerular filtration rate (eGFR) stratified by the stage of CKD is less clear. OBJECTIVES We aimed to evaluate the impact of sleeve gastrectomy on renal function in a stratified cohort of patients with CKD. SETTING University Hospital. METHODS We performed a retrospective review of 1932 patients who met National Institutes of Health's guidelines for metabolic surgery and underwent laparoscopic sleeve gastrectomy performed by 1 of 3 surgeons. One hundred sixty-four patients with CKD stages 1 through 4 were identified. RESULTS Mean follow-up period was 1.57 ± 1.0 years. Mean age was 56.4 ± 9.9 years with a preoperative body mass index of 47 ± 9 kg/m2, which decreased to 38.9 ± 8.7 kg/m2 at most recent follow-up (P < .001). In the cohort of patients with diabetes, significant decreases were observed in mean glycated hemoglobin level, daily number of oral hypoglycemics, and daily long acting insulin use (P < .001 each). Of 67 patients with diabetes, 34.3% (n = 24) achieved complete remission. In patients with hypertension, average daily number of antihypertensives decreased (P < .001) and 22.3% (n = 31) of 133 patients with hypertension discontinued all antihypertensives. Patients with CKD stages 2, 3a, and 3b showed significant improvement in eGFR. Reinforcing this evidence of improvement, patients with CKD 3a and 3b were more likely to downstage disease compared with those with CKD 4 (58.1% versus 73.1% versus 22.7%, respectively) (P < .001). CONCLUSION Renal function, as measured by eGFR, in patients with stages 1 and 4 CKD did not improve after laparoscopic sleeve gastrectomy; in contrast, eGFR in patients with CKD stages 2 and 3 significantly improved. Early surgical referral and intervention may be important in achieving the greatest improvement in eGFR and possibly delaying or reversing progression to end-stage renal disease.
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Affiliation(s)
- Al-Faraaz Kassam
- University of Cincinnati, Department of Surgery, Cincinnati, Ohio
| | | | | | - Brad M Watkins
- University of Cincinnati, Department of Surgery, Cincinnati, Ohio
| | | | - Daniel P Schauer
- University of Cincinnati, Department of Internal Medicine, Cincinnati, Ohio
| | - Eric P Smith
- University of Cincinnati, Department of Internal Medicine, Cincinnati, Ohio
| | - Tayyab S Diwan
- University of Cincinnati, Department of Surgery, Cincinnati, Ohio.
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158
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Toida T, Sato Y, Ogata S, Wada A, Masakane I, Fujimoto S. Synergic Impact of Body Mass Index, Diabetes, and Age on Long-Term Mortality in Japanese Incident Hemodialysis Patients: A Cohort Study on a Large National Dialysis Registry. J Ren Nutr 2019; 30:333-340. [PMID: 31812321 DOI: 10.1053/j.jrn.2019.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/14/2019] [Accepted: 09/14/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES The relationships among body mass index (BMI), diabetes, age, and all-cause mortality in hemodialysis patients remain unclear. We examined BMI-stratified relationships between diabetes, age, and the risk of long-term mortality in incident hemodialysis patients. METHODS This is a cohort study. Data were obtained from the national dialysis registry in Japan 2007 that included 35,415 incident hemodialysis patients and 6,061 patients aged ≥20 years with BMI data. Patients were divided into 6 categories according to baseline BMI (low: <18.5, normal: 18.5-25, Obesity: ≥25) and the presence or absence of diabetes. The primary outcome was all-cause mortality during a 5-year follow-up. Hazard ratios were estimated using Cox's model for the relationships among diabetes, BMI categories, and all-cause mortality, and adjusted for potential confounders. Patients with a normal BMI and non-diabetic were the reference category. We also examined the effects of age on these relationships. RESULTS A total of 6,061 patients, including 3,239 with diabetes, were enrolled. During the follow-up, 31.0% and 30.7% of all and diabetic patients, respectively, died. Cox's regression analysis showed that low BMI, but not obesity, was independently associated with an increased risk of all-cause death in patients with and without diabetes. When patients were divided into 2 groups-younger and older than 60 years-the risk of mortality in both groups was increased in low BMI with diabetes. CONCLUSIONS Among Japanese incident hemodialysis patients, low BMI increases the risk of all-cause mortality. The markedly high mortality rate in diabetic patients with low BMI regardless of age warrants attention.
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Affiliation(s)
- Tatsunori Toida
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan; Department of Internal Medicine, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan.
| | - Yuji Sato
- Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan
| | - Satoshi Ogata
- Committee of Renal Data Registry, The Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Atsushi Wada
- Committee of Renal Data Registry, The Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Ikuto Masakane
- Committee of Renal Data Registry, The Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan; Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan
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159
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Nishida MM, Okura M, Ogita M, Aoyama T, Tsuboyama T, Arai H. Two-Year Weight Loss but Not Body Mass Index Predicts Mortality and Disability in an Older Japanese Community-Dwelling Population. J Am Med Dir Assoc 2019; 20:1654.e11-1654.e18. [DOI: 10.1016/j.jamda.2019.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 01/04/2023]
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160
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Saleh ZT, Lennie TA, Alhurani AS, Almansour IM, Alduraidi H, Moser DK. High Dietary Sodium Intake is Associated with Shorter Event-Free Survival in Patients with Heart Failure and Comorbid Diabetes. Clin Nurs Res 2019; 30:154-160. [PMID: 31735074 DOI: 10.1177/1054773819888743] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim was to determine whether 24-hour urine sodium excretion predicted event-free survival of patients with heart failure (HF) and diabetes mellitus (DM). Twenty-four hour urine sodium, as an indicator of dietary sodium, was collected from 107 patients with HF and comorbid DM. Patients were followed for a median period of 337 days to determine time to the first event of either all-cause hospitalization or cardiac-related mortality. There were 44 patients (41%) who had an event of death or hospitalization. Cox regression showed that higher urine sodium (>3.8 gm/day) was associated with 2.8 times greater risk for an event than lower urine sodium after controlling for age, gender, New York Heart Association class (I/II vs. III/IV), left ventricular ejection fraction, and body mass index. These data suggest that dietary sodium restriction may be beneficial for patients with HF and DM.
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Affiliation(s)
- Zyad T Saleh
- School of Nursing, The University of Jordan, Amman, Jordan
| | - Terry A Lennie
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | | | | | | | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, KY, USA
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161
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Foster PP, Baldwin CL, Thompson JC, Espeseth T, Jiang X, Greenwood PM. Editorial: Cognitive and Brain Aging: Interventions to Promote Well-Being in Old Age. Front Aging Neurosci 2019; 11:268. [PMID: 31680930 PMCID: PMC6803512 DOI: 10.3389/fnagi.2019.00268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/17/2019] [Indexed: 02/02/2023] Open
Affiliation(s)
- Philip P Foster
- Pulmonary Section, Department of Medicine, Center for Space Medicine, Baylor College of Medicine, Houston, TX, United States.,Department of Chemistry, Rice University, Houston, TX, United States.,Department of Medicine, McGovern Medical School, University of Texas, Houston, TX, United States.,Department of Mathematics and Statistics, University of Houston-Clear Lake, Houston, TX, United States
| | | | | | | | - Xiong Jiang
- Georgetown University, Washington, DC, United States
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162
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Growth curve modelling to determine distinct BMI trajectory groups in HIV-positive adults on antiretroviral therapy in South Africa. AIDS 2019; 33:2049-2059. [PMID: 31577571 DOI: 10.1097/qad.0000000000002302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Obesity is a major long-term concern in HIV-positive patients due to the pathogenic link between obesity and noncommunicable chronic diseases (NCDs). We aim to characterize changes in BMI over time on antiretroviral therapy (ART) and investigate the association between weight gain and survival in South Africa. DESIGN AND METHODS A prospective cohort study among HIV-positive adults on first-line ART between April 2004 and 2015 in Johannesburg, South Africa. We used latent-class growth modelling (adjusted for age, sex and CD4 cell count) to identify groups of individuals with similar patterns of change in BMI over time. RESULTS Eleven thousand, two hundred and sixty-three patients were included. The best fit model involved two linear and two quadratic trajectories. Thirty-five percent of patients were categorized into group one (mean BMI at ART initiation, 20.4 kg/m; mean BMI after 8 years of follow-up, 20.9 kg/m), 38% into group two (24.5-26.2 kg/m), 21% into group three (29.5-32.6 kg/m) and 6% into group four (36.5-40.0 kg/m). Over the 8 years of follow-up, 6% of our cohort went down in BMI standard category, while 45% went up. The largest increase occurred in the first 12 months on ART. In years 2 through 8, we saw a more gradual increase in BMI. CONCLUSION The largest gain in BMI in HIV patients occurred in the first year on ART. During follow-up, over 50% of our population changed BMI categories putting them at an increased risk for NCDs. Consistent counselling on nutritional and lifestyle changes could help improve ART patients' long-term health outcomes.
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163
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Brief Report: Body Mass Index and Cognitive Function Among HIV-1-Infected Individuals in China, India, and Nigeria. J Acquir Immune Defic Syndr 2019; 80:e30-e35. [PMID: 30422905 DOI: 10.1097/qai.0000000000001906] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Risk of cognitive impairment is increased among persons with high or low body mass index in HIV- and HIV+ populations in resource-rich settings. We examined this association among HIV+ patients in 3 resource-limited settings. METHODS This secondary analysis included data of 761 HIV+ volunteers pooled from 3 prospective cohort studies conducted in China (n = 404; 53%), India (n = 200; 26%), and Nigeria (n = 157; 21%). World Health Organization (WHO) weight classifications were based on body mass index. T scores, adjusted for demographics and practice effects, were derived from a 7-domain neuropsychological battery. Neurocognitive impairment (NCI) was defined as global deficit score of ≥0.5. RESULTS Overall, prevalence of NCI at baseline was 27.7% (similar across all cohorts). The overweight/obese and underweight constituted 37.3% and 15.5% of the total participants, respectively. In a multivariable logistic regression of pooled longitudinal data, adjusting for clinical and demographic variables, the odds of global NCI were 38% higher among the overweight/obese as compared to normal weight participants [odds ratio: 1.38 (95% confidence interval: 1.1 to 1.72); P = 0.005]. Similarly, the odds of global NCI were 39% higher among the underweight as compared to normal weight participants [odds ratio: 1.39 (95% confidence interval: 1.03 to 1.87); P = 0.029]. CONCLUSIONS NCI among HIV-1-infected patients was more prevalent in both overweight/obese and underweight than normal weight individuals in 3 resource-limited settings, confirming observations in resource-rich settings. Mechanisms underlying these associations are unclear but likely differ for underweight and overweight persons.
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164
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Contreras-Yáñez I, Guaracha-Basáñez G, Pascual-Ramos V. Cardiovascular risk factors' behavior during the early stages of the disease, in Hispanic rheumatoid arthritis patients: a cohort study. Rheumatol Int 2019; 40:405-414. [PMID: 31606775 DOI: 10.1007/s00296-019-04451-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/25/2019] [Indexed: 01/27/2023]
Abstract
Rheumatoid arthritis (RA) patients from Latin America present distinctive characteristics relevant when assessing their cardiovascular (CV) risk. The objective was to monitor CV risk factor behavior in the early stages of the disease and to identify predictors of major CV outcomes (MACE). A recent-onset RA cohort was initiated in 2004; data from 185 patients with ≥ 1 year of follow-up were analyzed. Patients underwent prospective assessments of CV risk factors. Incident MACE were confirmed according to standardized definitions. Appropriated statics was used based on the distribution of the variables. At baseline, patients were primarily middle-aged females (87.6%), with active disease (69.7%). Most prevalent CV risk factors were C-reactive-protein > 1 mg/L (90.3%), Castelli ratio > 3 (83.8%), and low-high-density lipoprotein levels (73.5%). The number of patients with an incident CV risk factor after 1 year was higher for a Castelli ratio > 3 (23%), low-high-density lipoprotein serum cholesterol (16.3%), high total serum cholesterol (10.6%), and BMI ≥ 30 kg/m2 (10%). A minority of patients met the age-range criteria for the application of ACC/AHA 2013 criteria and Reynolds Risk Score (45.8% and 34.1%, respectively). Fifteen patients were classified with high-CV risk during the first year of follow-up, according to ACC/AHA 2013 criteria. Until June 2018, the cohort underwent 1358 patient/years follow-up; six patients developed incidental MACE; high-CV risk at baseline failed to predict MACE. Recent-onset RA Hispanic patients present a distinctive pattern and first-year behavior of CV risk factors. During follow-up, few patients developed incidental MACE.
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Affiliation(s)
- Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia Belisario Domínguez, Sección XVI, CP 14080, Mexico City, Mexico
| | - Guillermo Guaracha-Basáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia Belisario Domínguez, Sección XVI, CP 14080, Mexico City, Mexico
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia Belisario Domínguez, Sección XVI, CP 14080, Mexico City, Mexico.
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165
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Maternal Smoking and Infant Low Birth Weight: Exploring the Biological Mechanism Through the Mother’s Pre-pregnancy Weight Status. POPULATION RESEARCH AND POLICY REVIEW 2019. [DOI: 10.1007/s11113-019-09554-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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166
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Frailty, Implantable Cardioverter Defibrillators, and Mortality: a Systematic Review. J Gen Intern Med 2019; 34:2224-2231. [PMID: 31264082 PMCID: PMC6816602 DOI: 10.1007/s11606-019-05100-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/08/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Evidence for the benefit of implantable cardioverter defibrillators (ICD) in preventing sudden cardiac death (SCD) in older adults is mixed; age alone may not predict benefit. Frailty may help identify patients in whom an ICD does not improve overall mortality risk. METHODS Structured search of PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials on 1/31/2019, without language restriction, with terms for ICD, frailty, and mortality. Frailty was defined broadly using any validated single component (e.g., walking speed, weight loss) or multi-component tool (e.g., cumulative deficit index). Each study was assessed for quality and risk of bias. RESULTS We identified and screened 2649 titles, reviewed 280 abstracts, and extracted 71 articles. Nine articles, including two RCTs, one prospective cohort, and six retrospective cohort studies met all criteria. The most common reason for exclusion was a lack of frailty definition. Frailty definitions were heterogeneous, including cumulative deficit models, low weight, and walking speed. Follow-up time for mortality differed: from days to > 6 years. All studies indicated that mortality was higher amongst individuals identified as frail, regardless of definition. In one RCT, slow walkers did not benefit from ICD therapy after 3 years. A cohort of 83,792 Medicare beneficiaries in an ICD registry reported higher 1-year mortality following ICD in those with frailty or dementia. Four studies reported an association between being underweight and increased mortality following ICD placement. CONCLUSION Existing literature suggests that individuals with frailty may not benefit from ICD placement for primary prevention of SCD.
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Body Mass Index and the Risk of Serious Non-AIDS Events and All-Cause Mortality in Treated HIV-Positive Individuals: D: A: D Cohort Analysis. J Acquir Immune Defic Syndr 2019; 78:579-588. [PMID: 29771788 DOI: 10.1097/qai.0000000000001722] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between body mass index (BMI) [weight (kg)/height (m)] and serious non-AIDS events is not well understood. METHODS We followed D:A:D study participants on antiretroviral therapy from their first BMI measurement to the first occurrence of the endpoint or end of follow-up (N = 41,149 followed for 295,147 person-years). The endpoints were cardiovascular disease (CVD); diabetes; non-AIDS-defining cancers (NADCs) and BMI-NADCs (cancers known to be associated with BMI in general population); and all-cause mortality. Using Poisson regression models, we analyzed BMI as time-updated, lagged by 1 year, and categorized at: 18.5, 23, 25, 27.5, and 30 kg/m. RESULTS Participants were largely male (73%) with the mean age of 40 years (SD 9.7) and baseline median BMI of 23.3 (interquartile range: 21.2-25.7). Overall, BMI showed a statistically significant J-shaped relationship with the risk of all outcomes except diabetes. The relative risk (RR) for the BMI of <18.5 and >30 (95% confidence interval) compared with 23-25, respectively, was as follows: CVD: 1.46 (1.15-1.84) and 1.31 (1.03-1.67); NADCs: 1.78 (1.39-2.28) and 1.17 (0.88-1.54); and "BMI-NADCs": 1.29 (0.66-2.55) and 1.92 (1.10-3.36). For all-cause mortality, there was an interaction by sex (P < 0.001): RR in males: 2.47 (2.12-2.89) and 1.21 (0.97-1.50); and in females: 1.60 (1.30-1.98) and 1.02 (0.74-1.42). RR remained around 1 for intermediate categories of BMI. The risk of diabetes linearly increased with increasing BMI (P < 0.001). CONCLUSIONS Risk of CVD, a range of cancers, and all-cause mortality increased at low BMI (<18.5) and then tended to increase only at BMI > 30 with a relatively low risk at BMI of 23-25 and 25-30. High BMI was also associated with risk of diabetes.
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168
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Pong JZ, Ho AFW, Tan TXZ, Zheng H, Pek PP, Sia CH, Hausenloy DJ, Ong MEH. ST-segment elevation myocardial infarction with non-chest pain presentation at the Emergency Department: Insights from the Singapore Myocardial Infarction Registry. Intern Emerg Med 2019; 14:989-997. [PMID: 31165979 DOI: 10.1007/s11739-019-02122-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/28/2019] [Indexed: 12/12/2022]
Abstract
ST-segment elevation myocardial infarction (STEMI) often presents acutely at the Emergency Department (ED). Although chest pain is a classical symptom, a significant proportion of patients do not present with chest pain. The impact of a non-chest pain (NCP) presentation on ED processes-of-care and outcomes is not fully understood. We utilised a national registry to characterise predictors, processes-of-care, and outcomes of NCP STEMI presentations. Retrospective data for all STEMI cases occurring between 2010 and 2012 were analysed from the Singapore Myocardial Infarction Registry. Cases of inpatient onset, inter-facility transfers, and out-of-hospital cardiac arrests were excluded. Univariable analysis of demographic, clinical, processes-of-care, and outcome variables was conducted. Multivariable logistic regression ascertained independent predictors of a NCP presentation and 28-day mortality. Of 4667 STEMI cases, 12.9% presented without chest pain. Patients with NCP presentation were older (median, years = 74 vs. 58; p < 0.001), more likely to be female (39.1% vs. 15.7%; p < 0.001), of the Chinese race (72.5% vs. 62.7%; p < 0.001), and with diabetes (48.6% vs. 36.7%; p < 0.001). These patients were more likely to present with syncope (6.0% vs. 1.9%; p < 0.001) or epigastric pain (10.6% vs. 4.9%; p < 0.001). Patients with NCP presentation were less likely to receive percutaneous coronary intervention (27.0% vs. 75.6%; p < 0.001), had longer door-to-balloon time (median, minutes = 83 vs. 63; p < 0.001), and experienced greater mortality at 28 days (31.2% vs. 4.5%; p < 0.001). On multivariable logistic regression, independent predictors of a NCP presentation included age (adjusted odds ratio [aOR] = 1.05, 95% confidence interval [CI] 1.04-1.07), diabetes (aOR = 1.76, 95% CI 1.40-2.19), BMI (aOR = 0.93, 95% CI 0.91-0.96), and dyslipidemia (aOR = 0.73, 95% CI 0.58-0.91). Absence of chest pain was an independent predictor for 28-day mortality (aOR = 3.46, 95% CI 2.64-4.52). Patients who presented with a NCP STEMI had a distinct clinical profile and experienced poorer outcomes. Routine triage ECG could be considered for patients with high-risk factors and non-classical symptoms.
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Affiliation(s)
- Jeremy Zhenwen Pong
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Andrew Fu Wah Ho
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore, Singapore
- Signature Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
| | | | - Huili Zheng
- National Registry of Diseases Office, Health Promotion Board, Singapore, Singapore
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Derek John Hausenloy
- Signature Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- The Hatter Cardiovascular Institute, University College London, London, UK
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, Research and Development, London, UK
- Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo León, Mexico
| | - Marcus Eng Hock Ong
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
- Health Service Research Centre, Singapore Health Services, Academia, 20 College Road, Singapore, 169856, Singapore.
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169
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Chen G, Yung R. Meta-inflammaging at the crossroad of geroscience. Aging Med (Milton) 2019; 2:157-161. [PMID: 31942529 PMCID: PMC6880720 DOI: 10.1002/agm2.12078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/19/2019] [Indexed: 12/28/2022] Open
Abstract
Geroscience posits that selected fundamental biological processes are the foundation of age-related chronic diseases and are responsible for the decline in physical and mental function in old age. Late-life chronic low-grade inflammation ("inflammaging") and altered signal transduction pathways in metabolism have been identified as two of the key themes in the aging process. Age-related changes in the immune and metabolic responses are also recognized as playing a critical pathogenic role in most common chronic medical conditions that plague the elderly. Emerging investigations emphasize the interconnectedness of the immune and metabolic responses in aging, an area of gerontological research that can be termed "meta-inflammaging."
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Affiliation(s)
- Guobing Chen
- Institute of Geriatric ImmunologySchool of MedicineJinan UniversityGuangzhouChina
- Department of Microbiology and ImmunologySchool of MedicineJinan UniversityGuangzhouChina
| | - Raymond Yung
- Geriatrics Center and Institute of GerontologyUniversity of MichiganAnn ArborMIUSA
- VA Ann Arbor Geriatrics Research, Education and Clinical CenterAnn ArborMIUSA
- Department of Internal MedicineDivision of Geriatric and Palliative MedicineUniversity of MichiganAnn ArborMIUSA
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170
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Abstract
Stable ischemic heart disease (SIHD) is a leading cause of death in the United States and many other countries. The defining pathobiology is an imbalance between the metabolic demands of the myocardium and its oxygen supply, which most often results from coronary artery atherosclerosis. The classic presenting symptom of SIHD is angina, but clinical presentation varies greatly among patients. Since the last In the Clinic on SIHD in 2014, several new drugs have been approved to reduce ischemic complications, such as myocardial infarction and congestive heart failure.
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Affiliation(s)
- Daniel Katz
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (D.K., M.C.G.)
| | - Michael C Gavin
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (D.K., M.C.G.)
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171
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Bariatric Surgery, Clinical Outcomes, and Healthcare Burden in Hispanics in the USA. Obes Surg 2019; 29:3646-3652. [DOI: 10.1007/s11695-019-04047-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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172
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Rivas DA, Rice NP, Ezzyat Y, McDonald DJ, Cooper BE, Fielding RA. Sphingosine-1-phosphate analog FTY720 reverses obesity but not age-induced anabolic resistance to muscle contraction. Am J Physiol Cell Physiol 2019; 317:C502-C512. [PMID: 31241988 DOI: 10.1152/ajpcell.00455.2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sarcopenia, the age-associated loss of skeletal muscle mass and function, is coupled with declines in physical functioning leading to subsequent higher rates of disability, frailty, morbidity, and mortality. Aging and obesity independently contribute to muscle atrophy that is assumed to be a result of the activation of mutual physiological pathways. Understanding mechanisms contributing to the induction of skeletal muscle atrophy with aging and obesity is important for determining targets that may have pivotal roles in muscle loss in these conditions. We find that aging and obesity equally induce an anabolic resistance to acute skeletal muscle contraction as observed with decreases in anabolic signaling activation after contraction. Furthermore, treatment with the sphingosine-1-phosphate analog FTY720 for 4 wk increased lean mass and strength, and the anabolic signaling response to contraction was improved in obese but not older animals. To determine the role of chronic inflammation and different fatty acids on anabolic resistance in skeletal muscle cells, we overexpressed IKKβ with and without exposure to saturated fatty acid (SFA; palmitic acid), polyunsaturated fatty acid (eicosapentaenoic acid), and monounsaturated fatty acid (oleic acid). We found that IKKβ overexpression increased inflammation markers in muscle cells, and this chronic inflammation exacerbated anabolic resistance in response to SFA. Pretreatment with FTY720 reversed the inflammatory effects of palmitic acid in the muscle cells. Taken together, these data demonstrate chronic inflammation can induce anabolic resistance, SFA aggravates these effects, and FTY720 can reverse this by decreasing ceramide accumulation in skeletal muscle.
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Affiliation(s)
- Donato A Rivas
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Nicholas P Rice
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Yassine Ezzyat
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Devin J McDonald
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Brittany E Cooper
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
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Leahy S, Cassarino M, O' Connell MDL, Glynn L, Galvin R. Dynapaenic obesity and its association with health outcomes in older adult populations: protocol for a systematic review. BMJ Open 2019; 9:e027728. [PMID: 31129591 PMCID: PMC6538200 DOI: 10.1136/bmjopen-2018-027728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/28/2019] [Accepted: 04/12/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Two major global health challenges are the rapidly ageing population and the high prevalence of obesity in all age groups. Older adults are also susceptible to age-related loss of muscle strength, termed dynapaenia. The co-occurrence of both obesity and dynapaenia, termed dynapaenic obesity (DO), has been associated with poorer health outcomes and increased healthcare usage compared with either state alone. The purpose of this systematic review is to quantify the prevalence and incidence of DO in older adult populations, and to explore the association between DO and health outcomes, specifically chronic disease and multimorbidity, functional disability and healthcare usage. METHODS AND ANALYSIS Using the Meta-analyses Of Observational Studies in Epidemiology guidelines, we will conduct a systematic review of cross-sectional and longitudinal observational studies of older adults, which include measures of DO and specified outcomes. Detailed literature searches of will be conducted using six electronic databases: Excerpta Medica dataBASE (EMBASE), PubMed, MEDLINE, SCOPUS, ScienceDirect and Cumulative Index of Nursing and Allied Health Complete (CINAHL), including articles published from database inception until Febuary 2019. The reference lists of included articles will also be searched. Two independent reviewers will undertake a three-step screening and review process using the Population, Risk Factor, Outcome framework to define eligibility. The Newcastle Ottawa Scale for non-randomised studies will be used to assess risk of bias and to rate study quality. The findings will be synthesised in a narrative summary, and a meta-analysis will be conducted where appropriate. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review. Findings from this research will be submitted for peer-reviewed publication in academic journals, and presented at relevant academic conferences. PROSPERO REGISTRATION NUMBER CRD42018112471.
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Affiliation(s)
- Siobhan Leahy
- Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Marica Cassarino
- School of Allied Health, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
| | | | - Liam Glynn
- Graduate Entry Medical School and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
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Ludhwani D, Wu J. Obesity Paradox in Peripheral Arterial Disease: Results of a Propensity Match Analysis from the National Inpatient Sample. Cureus 2019; 11:e4704. [PMID: 31249770 PMCID: PMC6581502 DOI: 10.7759/cureus.4704] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/21/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction The role of obesity in cardiovascular mortality is controversial. The obesity paradox has been widely attributed to smoking in the underweight. Large-scale studies analyzing the outcomes of peripheral arterial disease (PAD) in patients with a higher body mass index (BMI) while accounting for confounders such as smoking are lacking. Method The 2016 National Inpatient Sample (NIS) was used to identify all admissions with a primary discharge diagnosis of PAD. A secondary diagnosis of obesity or elevated BMI was used to segregate the admissions into two groups. Propensity scores were calculated to match and control both groups for age, smoking, and diabetes, amongst other confounders. A multivariate logistic and linear regression analysis was performed to calculate the odds ratio for in-hospital mortality, amputation, need for intervention (angioplasty or bypass), acute kidney injury, hospital charges, and length of stay. Non-obesity-related PAD admissions were selected as the reference groups. Results Among 248,288 PAD-related admissions, 41,618 had a secondary diagnosis of obesity. After calculating propensity scores for 1-1 matching, 41,589 admissions in the PAD and obesity group were compared to a similar number of admissions in the reference population. Patients with a concomitant diagnosis of obesity had lower odds of amputation (OR=0.90, 95% CI=0.84-0.95, p<0.001), need for intervention (OR=0.66, 95% CI=0.62-0.69, p<0.0001), and in-hospital mortality (OR=0.81, 95% CI=0.74-0.87, p<0.0001). On the contrary, the odds of having acute kidney injury were higher with elevated BMI (OR=1.30, 95% CI=1.26-1.34, p<0.0001). Conclusion Despite increasing the risk of hypertension, diabetes, and hypertriglyceridemia, the obesity paradox continues to exist with a better short-term prognosis in patients with PAD. Future studies looking into the pathophysiology behind this phenomenon are needed.
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Affiliation(s)
- Dipesh Ludhwani
- Internal Medicine, Chicago Medical School / Rosalind Franklin University of Medicine and Science, McHenry, USA
| | - Joyce Wu
- Biostatistics, University of Michigan, Ann Arbor, USA
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175
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The Obesity Paradox and Effects of Early Nutrition: Is There a Paradox, or Is There Not? Crit Care Med 2019; 45:918-919. [PMID: 28410312 DOI: 10.1097/ccm.0000000000002392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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176
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Zhao SX, Ziegler PD, Crawford MH, Kwong C, Koehler JL, Passman RS. Evaluation of a clinical score for predicting atrial fibrillation in cryptogenic stroke patients with insertable cardiac monitors: results from the CRYSTAL AF study. Ther Adv Neurol Disord 2019; 12:1756286419842698. [PMID: 31007721 PMCID: PMC6460885 DOI: 10.1177/1756286419842698] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background The HAVOC score was previously developed to predict the risk of atrial fibrillation (AF) after cryptogenic stroke (CS) or transient ischemic attack (TIA). The purpose of this study was to apply the HAVOC score to patients who received insertable cardiac monitors (ICMs) in the CRYSTAL AF study. Methods All patients from the CRYSTAL AF study who received an ICM were included. HAVOC score (one point each for peripheral vascular disease and obesity with body mass index >30, two points each for hypertension, age ⩾ 75, valvular heart disease, and coronary artery disease, 4 points for congestive heart failure) was computed for all patients. The primary endpoint was AF detection by 12 months of ICM monitoring. Results A total of 214 patients who received ICM were included. AF was detected in 40 patients while the remaining 174 patients were AF negative. The HAVOC score was significantly higher among patients with AF [median 3.0 with interquartile range (IQR) 2-4] than those without AF [median 2.0 (IQR 0-3)], p = 0.01. AF increased significantly across the three HAVOC score groups: 11% in Group A (score 0-1), 18% in Group B (score 2-3), and 32 % in Group C (score ⩾ 4) with p = 0.02. Conclusions The HAVOC score was shown in this post hoc analysis of CRYSTAL AF to successfully stratify AF risk post CS or TIA. The 11% AF rate in the lowest HAVOC score group highlights the significance of nontraditional contributors to AF and ischemic stroke.
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Affiliation(s)
- Susan X Zhao
- Division of Cardiology, Santa Clara Valley Medical Center, 751 S. Bascom Avenue, Suite # 340, San Jose, CA 95128, USA
| | | | - Michael H Crawford
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Rod S Passman
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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177
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Samanta R, Narayan A, Kovoor P, Thiagalingam A. Influence of BMI on Short and Long-Term Outcomes in Patients With STEMI and LV Dysfunction. Heart Lung Circ 2019; 29:361-367. [PMID: 31109890 DOI: 10.1016/j.hlc.2019.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/06/2019] [Accepted: 01/27/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recent studies suggest an obesity paradox in individuals with myocardial infarction with better outcomes in obese relative to normal weight patients. We assessed the influence of body mass index (BMI) on early and long-term outcomes in patients with ST elevation myocardial infarction (STEMI) and left ventricular (LV) dysfunction. METHODS Outcomes were assessed according to BMI status in 478 consecutive patients with STEMI and LV dysfunction (ejection fraction [EF]<40%) admitted to Westmead Hospital between 1 January 2004 and 16 April 2014. Normal weight, overweight and obesity were defined as BMI < 25, 25-29.9, and ≥30 kg/m2, respectively. RESULTS Obese patients were significantly younger (p = 0.01) and were more likely to have hypertension and diabetes (p = 0.04 and 0.001 respectively). In hospital outcomes and 30-day major adverse cardiac events (MACE) were similar in all three groups. There was no difference in recurrent myocardial infarction (MI) and target vessel revascularisation (TVR) during long-term follow-up (mean follow-up 809 days). Overall mortality following hospital discharge was significantly lower in overweight and obese patients. Adjusted hazard ratio for all-cause mortality in normal weight patients compared to overweight patients was 2.4 (95% C.I 1.1-5.3, p= -0.03). The adjusted hazard ratio for all-cause mortality in normal weight patients in comparison to obese patients was 2.7 (95% C.I, 1 -7.4, p = 0.05). Left ventricular ejection fraction (LVEF) and age were other predictors of all-cause mortality. CONCLUSIONS Normal weight, overweight and obese patients with STEMI and LV dysfunction had similar in hospital outcomes and 30-day outcomes. Long-term all-cause mortality was, however, higher in normal weight patients suggesting the presence of an obesity paradox in this cohort.
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Affiliation(s)
- Rahul Samanta
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Arun Narayan
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Aravinda Thiagalingam
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
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178
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Wubishet BL, Harris ML, Forder PM, Acharya SH, Byles JE. Predictors of 15-year survival among Australian women with diabetes from age 76-81. Diabetes Res Clin Pract 2019; 150:48-56. [PMID: 30807777 DOI: 10.1016/j.diabres.2019.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/06/2019] [Accepted: 02/15/2019] [Indexed: 12/14/2022]
Abstract
AIMS To assess the impact of diabetes on the survival of older women, adjusted for other all-cause mortality predictors. METHODS Data were used from the 1921-26 cohort of the Australian Longitudinal Study on Women's Health, when the women were aged 76-81 years at baseline, with linkage to the National Death Index. Survival curves were plotted to compare the survival of women with no diabetes, incident diabetes and prevalent diabetes over 15 years. Cox proportional hazards models were used to examine the association between diabetes and all-cause mortality risks. RESULTS A total of 972 (11.7%) of 8296 eligible women reported either incident, 522 (6.3%) or prevalent, 450 (5.4%) diabetes. The median survival times were 10.1, 11.4 and 12.7 years among women with prevalent, incident and no diabetes, respectively. The risks of death were 30% [HR: 1.30 (95% CI: 1.16-1.45)] and 73% [HR: 1.73 (CI: 1.57-1.92)] higher for women with incident and prevalent diabetes compared to women without diabetes. These associations were sustained after controlling for demographics, body mass index, smoking status, comorbidities and health care use. CONCLUSIONS This study revealed that diabetes is associated with reduced survival probabilities for older women with minimal moderation after adjustment for other predictors. Our findings suggest that diabetes management guidelines for older women need to integrate factors such as comorbidities, smoking and being underweight to reduce the risk of mortality.
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Affiliation(s)
- Befikadu L Wubishet
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia; Department of Pharmacy, Mekelle University, Mekelle, Tigray, Ethiopia.
| | - Melissa L Harris
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
| | - Peta M Forder
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
| | | | - Julie E Byles
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
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Samanta R, Narayan A, Pouliopoulos J, Kovoor P, Thiagalingam A. Influence of Body Mass Index on Recurrence of Ventricular Arrhythmia, Mortality in Defibrillator Recipients With Ischaemic Cardiomyopathy. Heart Lung Circ 2019; 29:254-261. [PMID: 30922553 DOI: 10.1016/j.hlc.2018.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/15/2018] [Accepted: 12/31/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obesity is associated with increased risk of cardiovascular disease. There is little known, however, about the influence of body mass index (BMI) on spontaneously occurring ventricular arrhythmias in patients with ischaemic heart disease. We sought to examine the effect of BMI on the ventricular arrhythmia (VA) recurrence and mortality in defibrillator recipients with ischaemic cardiomyopathy. METHODS Consecutive patients (n = 123) with ischaemic cardiomyopathy (left ventricular ejection fraction (LVEF) ≤ 40%) and a primary or secondary prevention defibrillator were included. Patients were classified according to their BMI as being normal (18.5-24.99, n = 54/ 43.9%), overweight (2 -29.99, n = 43/ 35%) or obese (>30, n = 26/20.3%). RESULTS The primary combined endpoint of VA recurrence and mortality occurred in 36%, 5.4% and 11.5% of patients with normal, overweight and obese BMI (p = 0.001). When adjusting for risk factors such as ejection fraction, age and triple vessel disease, on multivariable analysis, normal BMI remained a significant predictor for the primary outcome (Hazard Ratio, Normal vs Overweight = 7.1, 95% CI 1.8-25, p = 0.002: Hazard Ratio, Normal vs Obese = 5.5, 95% CI 1.11-25, p = 0.033). There was a non-significant trend towards reduced survival in patients with normal weight in comparison to overweight and obese patients (p = 0.08). CONCLUSION In defibrillator recipients with ischaemic cardiomyopathy, BMI appears to be a significant predictor for the combined primary outcome of spontaneously occurring ventricular arrhythmias and mortality. Normal BMI, compared to overweight and obese patients had worse outcomes, suggesting the presence of the obesity paradox in ventricular arrhythmogenesis late post infarction.
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Affiliation(s)
- Rahul Samanta
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
| | - Arun Narayan
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Jim Pouliopoulos
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
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180
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Risk Factors for Restenosis After Stenting or Angioplasty of Vertebral Artery Origin. Clin Neuroradiol 2019; 30:355-362. [DOI: 10.1007/s00062-019-00768-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/03/2019] [Indexed: 10/27/2022]
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Abstract
The organs require oxygen and other types of nutrients (amino acids, sugars, and lipids) to function, the heart consuming large amounts of fatty acids for oxidation and adenosine triphosphate (ATP) generation.
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182
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Lee HY, Yang HK, Song HJ, Chang HJ, Kang JY, Lee SH, Han S, Kim YK. Metabolic health is more closely associated with decrease in lung function than obesity. PLoS One 2019; 14:e0209575. [PMID: 30673715 PMCID: PMC6343891 DOI: 10.1371/journal.pone.0209575] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/08/2018] [Indexed: 01/21/2023] Open
Abstract
Objective Previous studies have evaluated the link between metabolic syndrome and obesity with impaired lung function, however findings have been controversial. We aimed to compare lung function among subjects with different metabolic health and obesity status. Methods Total 10,071 participants were evaluated at the Health Promotion Center in Seoul St. Mary’s Hospital between January 2012 and December 2014. Being metabolically healthy was defined as having fewer than three of the following risk factors: high blood pressure, high fasting blood glucose, high triglyceride, low high-density lipoprotein cholesterol and abdominal obesity. Obesity status was defined as body mass index (BMI) higher than 25 kg/m2. Analyses of pulmonary function were performed in four groups divided according to metabolic health and obesity: metabolically healthy non-obese (MHNO), metabolically health obese (MHO), metabolically unhealthy non-obese (MUHNO), and metabolically unhealthy obese (MUHO). Results Metabolically unhealthy subjects were more prone to decreased lung function compared with their metabolically healthy counterparts, regardless of obesity status. When multinomial logistic regression analysis was performed according to quartiles of forced vital capacity (FVC) or forced expiratory volume in 1 second (FEV1) (% pred), after adjusting for age, sex, and smoking status, odds ratio (OR) for the lowest FVC and FEV1 (% pred) quartiles were significantly higher in MUHO subjects (1.788 [95% CI, 1.531–2.089] and 1.603 [95% CI, 1.367–1.881]) and lower in MHO subjects (0.768 [95% CI, 0.654–0.902] and 0.826 [95% CI, 0.700–0.976]) with MHNO group as the reference, when OR for highest FVC and FEV1 quartiles were considered as 1.0 Conclusion Metabolic health is more closely associated with impaired lung function than obesity.
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Affiliation(s)
- Hea Yon Lee
- Department of Health Promotion Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae Kyung Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Jin Song
- Department of Health Promotion Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee Jae Chang
- Department of Health Promotion Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Young Kang
- Division of Pulmonary Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Haak Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Solji Han
- Department of Applied Statistics, Yonsei University, Seoul, Korea
| | - Young Kyoon Kim
- Division of Pulmonary Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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183
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McHugh MC, Chrisler JC. Making Space for Every Body: Ending Sizeism in Psychotherapy and Training. WOMEN & THERAPY 2019. [DOI: 10.1080/02703149.2018.1524062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Maureen C. McHugh
- Department of Psychology, Indiana University of Pennsylvania, Indiana, Pennsylvania
| | - Joan C. Chrisler
- Department of Psychology, Connecticut College, New London, Connecticut
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Pujilestari CU, Nyström L, Norberg M, Ng N. Waist Circumference and All-Cause Mortality among Older Adults in Rural Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16010116. [PMID: 30609857 PMCID: PMC6339011 DOI: 10.3390/ijerph16010116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/26/2018] [Accepted: 12/28/2018] [Indexed: 01/22/2023]
Abstract
Waist circumference, a measure of abdominal obesity, is associated with all-cause mortality in general adult population. However, the link between abdominal obesity with all-cause mortality in the studies of older adults is unclear. This study aims to determine the association between waist circumference and all-cause mortality in older adults in Indonesia. The association between waist circumference and all-cause mortality was examined in 10,997 men and women aged 50 years and older, in the World Health Organization (WHO) and International Network of field sites for continuous Demographic Evaluation of Populations and their Health in developing countries (INDEPTH) collaboration Study on global AGEing and adult health (SAGE) in Purworejo District Central Java, Indonesia during 2007⁻2010. Multivariate Cox regression analysis with restricted cubic splines was used to assess the non-linear association between waist circumference and all-cause mortality. During the 3-year follow-up, a total of 511 men and 470 women died. The hazard ratio plot shows a pattern of U-shape relationship between waist circumference and all-cause mortality among rich women, though the result was significant only for women in the lower end of waist circumference distribution (p < 0.05). Poor men with a low waist circumference (5th percentile) have a two times higher mortality risk (HR = 2.1; 95% CI = 1.3, 3.3) relative to those with a waist circumference of 90 cm. Poor women with a low waist circumference (25th percentile) have a 1.4 times higher mortality risk (HR = 1.4; 95% CI = 1.1, 1.8) relative to those with a waist circumference of 80 cm. This study shows a significant association between low waist circumference measure and mortality, particularly among poor men and women. Though the association between large waist circumference and mortality was not significant, we observed a trend of higher mortality risk particularly among rich women with large waist circumference measure. Public health intervention should include efforts to improve nutritional status among older people and promoting healthy lifestyle behaviours including healthy food and active lifestyle.
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Affiliation(s)
- Cahya Utamie Pujilestari
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, 90187 Umeå, Sweden.
| | - Lennarth Nyström
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, 90187 Umeå, Sweden.
| | - Margareta Norberg
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, 90187 Umeå, Sweden.
| | - Nawi Ng
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, 90187 Umeå, Sweden.
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185
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Duan D, Li H, Xu J, Wong L, Xu G, Kong F, Li S, Gong Q, Zhang X, Zhao J, Zhang L, Xu G, Xing W, Han L. Does Body Mass Index and Height Influence the Incident Risk of Ischemic Stroke in Newly Diagnosed Type 2 Diabetes Subjects? J Diabetes Res 2019; 2019:2591709. [PMID: 30805371 PMCID: PMC6362488 DOI: 10.1155/2019/2591709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/02/2018] [Accepted: 09/16/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To estimate the incident risk of ischemic stroke (IS) in newly diagnosed type 2 diabetes (T2D) subjects according to different body mass index (BMI) and height categories. METHODS A total of 25,130 newly diagnosed T2D subjects were included in this study. All T2D subjects were enrolled consecutively from the Chronic Disease Surveillance System (CDSS) of Ningbo. Standardized incidence ratio (SIR) and its 95% confidence interval (95% CI) stratified by BMI categories and height quartiles were used to estimate the incident risk of IS in T2D subjects. RESULTS In total, 22,795 subjects completed the follow-up. Among them, 1268 newly diagnosed IS cases were identified, with 149,675 person-years. The SIRs of normal BMI (18.5-24.0 kg/m2), overweight (24.0-28.0 kg/m2), and obese (≥28.0 kg/m2) in overall subjects were 2.56 (95% CI 1.90-3.13), 2.13 (95% CI 1.90-3.13), and 1.87 (95% CI 1.29-2.43), respectively (P trend < 0.01), comparing to the general population of Ningbo. For each 1 kg/m2 increment in BMI, the SIR was 0.948 (95% CI 0.903-0.999). For height quartiles, the SIRs of male subjects in quartile 1 (<160 cm), quartile 2 (161-165 cm), quartile 3 (165-170 cm), and quartile 4 (≥171 cm) were 2.27 (95% CI 1.99-2.56), 2.01 (95% CI 1.67-2.45), 1.37 (95% CI 1.05-1.68), and 0.91 (95% CI 0.40-1.32), respectively (P trend < 0.01). While for female subjects, the SIRs in quartile 1 (<155 cm), quartile 2 (156-160 cm), quartile 3 (161-165 cm), and quartile 4 (≥166 cm) were 3.57 (95% CI 3.11-3.49), 2.96 (95% CI 2.61-3.31), 1.94 (95% CI 1.51-2.36), and 1.71 (95% CI 0.95-2.47), respectively (P trend < 0.01). CONCLUSION Compared to the general population of Ningbo, T2D subjects had a higher incident risk of IS. Furthermore, the IS incident risk was not only higher in newly diagnosed T2D subjects with normal BMI but also lower in taller newly diagnosed T2D subjects.
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Affiliation(s)
- Donghui Duan
- Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
- Institute of Non-Communicable Disease Control and Prevention, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Hui Li
- Institute of Non-Communicable Disease Control and Prevention, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Jiaying Xu
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - Liping Wong
- Department of Social Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Guodong Xu
- Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
| | - Fanqian Kong
- Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
| | - Sixuan Li
- Institute of Non-Communicable Disease Control and Prevention, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Qinghai Gong
- Institute of Non-Communicable Disease Control and Prevention, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Xiaohong Zhang
- Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
| | - Jinshun Zhao
- Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
| | - Lina Zhang
- Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
| | - Guozhang Xu
- Institute of Non-Communicable Disease Control and Prevention, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Wenhua Xing
- Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
| | - Liyuan Han
- Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
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186
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Owusu Adjah ES, Ray KK, Paul SK. Ethnicity-specific association of BMI levels at diagnosis of type 2 diabetes with cardiovascular disease and all-cause mortality risk. Acta Diabetol 2019; 56:87-96. [PMID: 30167871 DOI: 10.1007/s00592-018-1219-7] [Citation(s) in RCA: 5] [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: 07/25/2018] [Accepted: 08/20/2018] [Indexed: 01/19/2023]
Abstract
AIM To evaluate the risk of CVD and all-cause mortality at different BMI levels in conjunction with weight change prior to diagnosis of T2DM in a multi-ethnic population. METHODS Longitudinal study of 51,455 patients with T2DM and without a history of comorbid diseases at diagnosis. Weight changes prior to diagnosis of T2DM were evaluated, and the risk of CVD and all-cause mortality at different BMI levels among three ethnic groups estimated using treatment effects model. RESULTS White Europeans (WE), African-Caribbeans (AC), and South Asians (SA) were mean 52, 49, and 47 years with a mean BMI of 33.0, 32.0, and 30.0 kg/m2 at diagnosis, respectively. Among WE, normal weight patients developed CVD significantly earlier by 0.5 years (95% CI 0.1, 0.9 years; p = 0.018) compared to obese patients. Furthermore, those with normal body weight at diagnosis were significantly more likely to die earlier by 0.6 years (95% CI 0.03, 1.2 years; p = 0.037) among WE and by 2.5 years (95% CI 0.3, 4.6 years; p = 0.023) among SA compared to their respective obese patients. However, BMI at diagnosis was not associated with increased risk of CVD and death among AC. CONCLUSIONS This study suggests a paradoxical association of BMI with cardiovascular and mortality risks in different ethnic groups, which may partially be driven by different cardiovascular and glycaemic risk profiles at diagnosis.
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Affiliation(s)
- Ebenezer S Owusu Adjah
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia.
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187
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Affiliation(s)
- Cat Pausé
- College of Humanities and Social Sciences, Massey University, Palmerston North, New Zealand
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188
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Lee DH, Giovannucci EL. Body composition and mortality in the general population: A review of epidemiologic studies. Exp Biol Med (Maywood) 2018; 243:1275-1285. [PMID: 30537867 DOI: 10.1177/1535370218818161] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IMPACT STATEMENT Current understanding of the association of body composition on mortality in the general population is limited. This review evaluated the available epidemiologic studies on body composition and mortality that leveraged diverse approaches to estimate body composition. Although studies showed inconsistent results, there was evidence suggesting that high fat mass and low lean body mass may be independently associated with mortality in the general population. This review may help partially explain the "obesity paradox" phenomenon and facilitate further studies to advance the understanding of the association of body composition on health in the general and patient populations.
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Affiliation(s)
- Dong Hoon Lee
- 1 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Edward L Giovannucci
- 1 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.,2 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.,3 Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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189
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Fulop T, Witkowski JM, Olivieri F, Larbi A. The integration of inflammaging in age-related diseases. Semin Immunol 2018; 40:17-35. [DOI: 10.1016/j.smim.2018.09.003] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 09/20/2018] [Accepted: 09/24/2018] [Indexed: 02/07/2023]
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190
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Druzhilov MA, Kuznetsova ТY, Druzhilova ОY. “Obesity paradoxes”: main causes of an “inverse” cardiovascular epidemiology. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2018. [DOI: 10.15829/1728-8800-2018-5-92-98] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Taken the continuous increase of obesity prevalence, most countries in the world deal with an epidemy, one of the main healthcare concerns. In the structure of nosology associated with overweight and obesity, cardiovascular is leading. Also, in the recent trials and meta analyses there is negative correlation found for body mass index and clinical outcomes characterizing better survival and lower events rate in those with higher BMI, as less chronic diseases. Such facts facilitated a number of discussions on the predictive value of overweight and obesity and consideration whether to correct those in cardiovascular patients as secondary prevention. Current article is focused on the main causes for an “inverse” cardiovascular epidemiology in overweight and obesity.
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Affiliation(s)
- M. A. Druzhilov
- Medical and Sanitary Institution of the FSS in Karelia Republic
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191
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Park Y, Kim NH, Kwon TY, Kim SG. A novel adiposity index as an integrated predictor of cardiometabolic disease morbidity and mortality. Sci Rep 2018; 8:16753. [PMID: 30425288 PMCID: PMC6233180 DOI: 10.1038/s41598-018-35073-4] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/30/2018] [Indexed: 12/23/2022] Open
Abstract
We propose a new anthropometric index, weight-adjusted-waist index (WWI), to assess adiposity by standardizing waist circumference (WC) for weight. WWI, calculated as WC (cm) divided by the square root of weight (kg) (cm/√kg), was measured from 465,629 subjects in the Korean nationwide cohort (2008-2013). Cox regression analysis was used to compare WWI with BMI, WC, waist-to-height ratio (WHtR), and a body shape index (ABSI) for cardiometabolic morbidity and mortality risk in diagnostic and prognostic prediction models. For incident hypertension, type 2 diabetes and cardiovascular disease (CVD), BMI had the strongest predictive power, followed by WWI and WC. However, WWI showed the best predictive performance for CVD mortality. Also, a linear positive association between adiposity indices and cardiovascular and all-cause mortality was only shown in WWI and ABSI, not BMI, WC and WHtR which showed inverse J-shaped patterns. In the test of joint effects of each index, WWI combined with BMI was the strongest in both diagnostic and prognostic models. WWI is a unique adiposity index that shows linear positive association with both cardiometabolic morbidity and mortality. It also predicts incident cardiometabolic disease, cardiovascular and all-cause mortality risk with excellence in predictive power, especially when combined with BMI.
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Affiliation(s)
- Yousung Park
- Department of Statistics, Korea University, Seoul, South Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Tae Yeon Kwon
- Department of International Finance, Hankuk University of Foreign Studies, Yongin-si, Gyeonggi-do, South Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.
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192
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Doi S, Iwata H, Wada H, Funamizu T, Shitara J, Endo H, Naito R, Konishi H, Tsuboi S, Ogita M, Dohi T, Kasai T, Okazaki S, Isoda K, Miyauchi K, Daida H. A novel and simply calculated nutritional index serves as a useful prognostic indicator in patients with coronary artery disease. Int J Cardiol 2018; 262:92-98. [PMID: 29706396 DOI: 10.1016/j.ijcard.2018.02.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/13/2018] [Accepted: 02/09/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE No nutritional index has been firmly established yet in patients with coronary artery disease (CAD). In this study, we propose a simple to calculate nutritional indicator in patients who underwent percutaneous coronary intervention (PCI) by using parameters routinely measured in CAD and evaluated its prognostic implication. METHODS This study is a retrospective observational analysis of a prospective database. The subjects were consecutive 3567 patients underwent their first PCI between 2000 and 2013 at Juntendo University Hospital in Tokyo. The median of the follow-up period was 6.3 years (range: 0-13.6 years). The novel nutritional index was calculated by the formula; Triglycerides (TG) × Total Cholesterol (TC) × Body Weight (BW) Index (TCBI) = TG × TC × BW / 1000 (TG and TC: mg/dl, and BW: kg). RESULTS The Spearman non-parametric correlation coefficient between TCBI and the most often used conventional nutritional index, Geriatric Nutritional Risk Index (GNRI), was 0.355, indicating modest correlation. Moreover, Unadjusted Kaplan-Meier analysis showed higher all-cause mortality, cardiovascular mortality, and cancer mortality in patients with low TCBI. Consistently, elevation of TCBI was associated with reduced all-cause (hazard ratio: 0.86, 95%CI: 0.77-0.96, p < 0.001), cardiovascular (0.78, 0.66-0.92, p = 0.003), and cancer mortality (0.76, 0.58-0.99, p = 0.041) in patients after PCI by multivariate Cox proportional hazard analyses. CONCLUSION TCBI, a novel and easy to calculate nutrition index, is a useful prognostic indicator in patients with CAD.
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Affiliation(s)
- Shinichiro Doi
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Takehiro Funamizu
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hirohisa Endo
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Ryo Naito
- Department of Cardiovascular Medicine, Juntendo University, Urayasu Hospital, Urayasu, Chiba, Japan
| | - Hirokazu Konishi
- Department of Cardiovascular Medicine, Juntendo University, Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Shuta Tsuboi
- Department of Cardiovascular Medicine, Juntendo University, Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Manabu Ogita
- Department of Cardiovascular Medicine, Juntendo University, Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kikuo Isoda
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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193
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Chu IJH, Lim AYT, Ng CLW. Effects of meaningful weight loss beyond symptomatic relief in adults with knee osteoarthritis and obesity: a systematic review and meta-analysis. Obes Rev 2018; 19:1597-1607. [PMID: 30051952 DOI: 10.1111/obr.12726] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/24/2018] [Accepted: 06/04/2018] [Indexed: 12/31/2022]
Abstract
Existing clinical guidelines recommend weight loss for adults with knee osteoarthritis and obesity, but the supporting evidence to date remains inadequate. There is also no pooled data on physical function and quality of life. This study aims to examine the efficacy of weight loss on pain, self-reported disability, physical function and quality of life in adults with knee osteoarthritis and obesity. A systematic database search (from 1990 to June 2017) was conducted, and seven studies were eligible for inclusion. The meta-analyses demonstrated that a 5% to 10% weight loss significantly improved pain (effect size 0.33, 95% confidence intervals 0.17 to 0.48), self-reported disability (effect size 0.42, 95% confidence intervals 0.25 to 0.59) and quality of life (physical) (effect size 0.39, 95% confidence intervals 0.24 to 0.54). The results were based on adults with mean body mass index 33.6 to 36.4 kg m-2 and mild to moderate knee osteoarthritis. Results for physical function were inconclusive due to the lack of eligible studies and incomprehensive outcome measures used.
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Affiliation(s)
- I J H Chu
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - A Y T Lim
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - C L W Ng
- Department of Physiotherapy, Singapore General Hospital, Singapore
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194
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Obesity in patients with end-stage heart failure. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 15:176-179. [PMID: 30310396 PMCID: PMC6180018 DOI: 10.5114/kitp.2018.78442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 03/10/2018] [Indexed: 11/22/2022]
Abstract
Obesity poses an increasing problem in patients with end-stage heart failure (HF). The most commonly used indicator of obesity is body mass index. The value of this parameter is widely taken into consideration when selecting the best way of treatment for patients with advanced HF. The aim of this paper is to outline the recent knowledge about obesity in the abovementioned group of patients.
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195
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Parikh JS, Randhawa AK, Wharton S, Edgell H, Kuk JL. The Association between Antihypertensive Medication Use and Blood Pressure Is Influenced by Obesity. J Obes 2018; 2018:4573258. [PMID: 30364090 PMCID: PMC6188586 DOI: 10.1155/2018/4573258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/28/2018] [Indexed: 01/19/2023] Open
Abstract
Introduction One in three US adults is living with obesity or hypertension, and more than 75% of hypertensive individuals are using antihypertensive medications. Therefore, it is important to examine blood pressure (BP) differences in populations that are using these medications with differing obesity status. Aim We examined whether BP attained when using various antihypertensive medications varies amongst different body mass index (BMI) categories and whether antihypertensive medication use is associated with differences in other metabolic risk factors, independent of BMI. Methods Adults with hypertension from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 were used (n=15,285). Linear regression analyses were used to examine the main effects and interaction between antihypertensive use and BMI. Results In general, users of antihypertensive medications had lower BP than those not taking BP medications (NoBPMed) (P < 0.05), whereby in women, the differences in systolic BP between angiotensin-converting-enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) users and NoBPMed were greater in those with obesity (ACE inhibitors: -14 ± 1 mmHg; ARB: -16 ± 1 mmHg) compared to normal weight individuals (ACE inhibitors: -9 ± 1 mmHg; ARB: -11 ± 1 mmHg) (P < 0.05). Diastolic BP differences between women ARB users and NoBPMed were also greatest in obesity (-5 ± 1 mmHg) (P < 0.05) whilst there were no differences in normal weight individuals (-1 ± 1 mmHg) (P>0.05). Furthermore, glucose levels and waist circumference in women were higher in those using ACE inhibitors compared to diuretics (P < 0.05). Conclusion ACE inhibitors and ARBs may be associated with more beneficial BP profiles in women with obesity, with no obesity-related BP differences for antihypertensive medication in men. However, there could be potential cardiometabolic effects for some antihypertensive medications that should be explored further.
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Affiliation(s)
- Jash S. Parikh
- York University, School of Kinesiology and Health Science, Toronto, ON, Canada M3J 1P3
| | - Arshdeep K. Randhawa
- York University, School of Kinesiology and Health Science, Toronto, ON, Canada M3J 1P3
| | - Sean Wharton
- York University, School of Kinesiology and Health Science, Toronto, ON, Canada M3J 1P3
- The Wharton Medical Clinic, Toronto, ON, Canada M4J 5B9
| | - Heather Edgell
- York University, School of Kinesiology and Health Science, Toronto, ON, Canada M3J 1P3
| | - Jennifer L. Kuk
- York University, School of Kinesiology and Health Science, Toronto, ON, Canada M3J 1P3
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196
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Tsai YW, Chan YL, Chen YC, Cheng YH, Chang SS. Association of elevated blood serum high-sensitivity C-reactive protein levels and body composition with chronic kidney disease: A population-based study in Taiwan. Medicine (Baltimore) 2018; 97:e11896. [PMID: 30200074 PMCID: PMC6133564 DOI: 10.1097/md.0000000000011896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/20/2018] [Indexed: 11/25/2022] Open
Abstract
Chronic kidney disease (CKD) is a risk factor for cardiovascular diseases and is associated with an increase in all-cause mortality. Studies regarding association among various body compositions in different inflamed states and the risk of CKD were rare. We aimed to evaluate the relationship among body composition, high-sensitivity C-reactive protein (hsCRP) level, and the risk of CKD.This was a retrospective cross-sectional study using annual health examination data from 2 medical centers in northern and southern Taiwan between January and December 2015. We performed a variance analysis of the estimated glomerular filtration rate (eGFR) distribution in groups based on hsCRP and body fat percentage (BFP), and a multivariate logistic regression model was used to assess the relationship among BFP, hsCRP levels, and CKD.A total of 10,267 subjects aged ≥18 years undergoing health examination were analyzed. In our study, overweight/obese patients were associated with increased risk of CKD. Nevertheless, in subjects with elevated hsCRP level, overweight/obese group with a higher BFP had a lower risk of CKD as compared with overweight/obese with normal BFP group (for BMI ≧ 23 kg/m, high BFP/high hsCRP: odds ratio [OR] for CKD 1.86, 95% confidence interval [CI] = 1.10-3.17, P = .02; normal BFP/high hsCRP group: OR 2.32, 95% CI = 1.23-4.37, P = .01) after adjusting for various confounders.Our findings suggest that various body compositions in different inflamed states may interfere with the risk of CKD. These results provide an important method for the early detection of impaired renal function by identifying various body compositions and inflammation states to detect CKD at an earlier stage.
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Affiliation(s)
- Yi-Wen Tsai
- Department of Family Medicine, Chang Gung Memorial Hospital, Keelung and Chang Gung University College of Medicine
| | | | - Yi-Chuan Chen
- Departments of Family Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan
| | - Yiu-Hua Cheng
- Department of Family Medicine, Chang Gung Memorial Hospital, Keelung and Chang Gung University College of Medicine
| | - Shy-Shin Chang
- Department of Family Medicine, Taipei Medical University Hospital and Taipei Medical University College of Medicine, Taipei, Taiwan
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197
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Tulinský L, Mitták M, Tomášková H, Ostruszka P, Penka I, Ihnát P. Obesity paradox in patients undergoing lung lobectomy - myth or reality? BMC Surg 2018; 18:61. [PMID: 30119623 PMCID: PMC6098611 DOI: 10.1186/s12893-018-0395-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/13/2018] [Indexed: 11/24/2022] Open
Abstract
Background The aim of the present study was to evaluate the impact of BMI on the short-term outcomes of patients undergoing lung lobectomy. Methods This was a retrospective clinical cohort study conducted in a single institution to assess the short-term outcomes of obese patients undergoing lung resection. Intraoperative and postoperative parameters were compared between the two study subgroups: obese (BMI ≥30 kg/m2) and non-obese patients (BMI < 30 kg/m2). Results In total, 203 patients were enrolled in the study (70 obese and 133 non-obese patients). Both study subgroups were comparable with regards to demographics, clinical data and surgical approach (thoracoscopy vs. thoracotomy). The surgery time was significantly longer in obese patients (p = 0.048). There was no difference in the frequency of intraoperative complications between the study subgroups (p = 0.635). The postoperative hospital stay was similar in both study subgroups (p = 0.366). A 30-day postoperative morbidity was higher in a subgroup of non-obese patients (33.8% vs. 21.7%), but the difference was not significant (p = 0.249). In the subgroup of non-obese patients, a higher frequency of mild and severe postoperative complications was observed. However, the differences between the study subgroups were not statistically significant due to the borderline p-value (p = 0.053). The 30-day postoperative mortality was comparable between obese and non-obese patients (p = 0.167). Conclusions Obesity does not increase the incidence and severity of intraoperative and postoperative complications after lung lobectomy. Slightly better outcomes in obese patients indicate that obesity paradox might be a reality in patients undergoing lung resection.
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Affiliation(s)
- Lubomír Tulinský
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, 708 52, Ostrava, Czech Republic.,Department of Surgical studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic
| | - Marcel Mitták
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, 708 52, Ostrava, Czech Republic.,Department of Surgical studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic
| | - Hana Tomášková
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic
| | - Petr Ostruszka
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, 708 52, Ostrava, Czech Republic.,Department of Surgical studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic
| | - Igor Penka
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, 708 52, Ostrava, Czech Republic.,Department of Surgical studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic
| | - Peter Ihnát
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, 708 52, Ostrava, Czech Republic. .,Department of Surgical studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic.
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198
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Influence of BMI on inducible ventricular tachycardia and mortality in patients with myocardial infarction and left ventricular dysfunction: The obesity paradox. Int J Cardiol 2018; 265:148-154. [DOI: 10.1016/j.ijcard.2018.03.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/05/2018] [Accepted: 03/12/2018] [Indexed: 12/28/2022]
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199
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Collier A, Connelly PJ, Hair M, Cameron L, Ghosh S, Waugh N. Mortality risk remains higher in individuals with type 1 diabetes: A population-based cohort study (the Ayrshire diabetes follow-up cohort [ADOC]). Diabetes Obes Metab 2018; 20:1965-1971. [PMID: 29687581 DOI: 10.1111/dom.13334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/09/2018] [Accepted: 04/19/2018] [Indexed: 12/15/2022]
Abstract
AIMS Type 1 diabetes is associated with an increased risk of cardiovascular disease and all-cause mortality. Numerous studies have demonstrated that outcomes for diabetes are improved by intensive glycaemic control, blood pressure control, and treatment of dyslipidaemia in addition to cessation of smoking. The aim of this study was to compare mortalities in individuals with type 1 diabetes with that in non-diabetic individuals, and to investigate the effects of age, gender, glycaemic control, socio-economic status, hypertension, ischaemic heart disease (IHD), smoking status, body mass index (BMI) and dyslipidaemia. METHODS A population-based analysis in Ayrshire and Arran, Scotland included 253 304 non-diabetic individuals and 1324 individuals with type 1 diabetes who were tracked from 2009 to 2014. RESULTS Patients with type 1 diabetes had higher mortality rates than non-diabetic individuals (HR, 3.20; P < .01), with relative mortality in female individuals with type 1 diabetes being higher than that in males (OR, 2.38 vs 1.52; P < .01). Increasing age (HR, 2.37), smoking (HR, 1.85), IHD (HR, 1.62) and hypertension (HR, 1.21) (all P < .01) increased mortality risk. A hypertensive female with type 1 diabetes and IHD who smoked had an HR of 11.6 compared with a non-smoking, normotensive non-diabetic female without IHD. For a hypertensive male with type 1 diabetes and IHD who smoked, HR was 6.96. BMI > 30 kg/m2 was associated with reduced mortality risk in both non-diabetic (HR, 0.61) and diabetic subjects (HR, 0.40). CONCLUSIONS This study confirmed that the risk of mortality in individuals with type 1 diabetes remains elevated. Further studies are required to understand how gender affects the disparity in mortality and why obesity appears to be protective.
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Affiliation(s)
- Andrew Collier
- Diabetes Day Centre, NHS Ayrshire and Arran, University Hospital Ayr, Ayr, UK
| | - Paul J Connelly
- Diabetes Day Centre, NHS Ayrshire and Arran, University Hospital Ayr, Ayr, UK
| | - Mario Hair
- Statistics Consultant, NHS Ayrshire and Arran, University Hospital Ayr, Ayr, UK
| | - Lyall Cameron
- Primary Care Quality and Development, NHS Ayrshire and Arran, Ailsa Hospital, Ayr, UK
| | - Sujoy Ghosh
- AMRI Institute of Diabetes and Hormonal Disorders, Kolkata, India
| | - Norman Waugh
- Division of Health Sciences, Warwick Medical School, Coventry, UK
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200
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Alexandre TDS, Aubertin-Leheudre M, Carvalho LP, Máximo RDO, Corona LP, Brito TRPD, Nunes DP, Santos JLF, Duarte YADO, Lebrão ML. Dynapenic obesity as an associated factor to lipid and glucose metabolism disorders and metabolic syndrome in older adults – Findings from SABE Study. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2017.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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