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Tseng CH. Factors Associated with Cancer- and Non-Cancer-Related Deaths among Taiwanese Patients with Diabetes after 17 Years of Follow-Up. PLoS One 2016; 11:e0147916. [PMID: 27906989 PMCID: PMC5132220 DOI: 10.1371/journal.pone.0147916] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 11/04/2016] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE A previous 12-year follow-up of a large diabetes cohort in Taiwan suggested a survival advantage in the patients with obesity. The present study further investigated additional determinants for cancer and non-cancer death in the cohort after a follow-up of 17 years. METHODS A cohort of 92546 diabetes patients recruited since 1995 was followed for vital status by matching the National Death Certificate Database until 2011. Cox regression estimated the hazard ratios for the following variables: age at baseline, sex, diabetes type, screen-detected diabetes (diabetes diagnosed accidentally through epidemiological screening programs or during visits to medical settings without a history of diabetes), diabetes duration, body mass index, insulin use, hypertension, smoking, and living region. Fasting glucose and history of dyslipidemia were available for additional adjustment in a subcohort of the patients (n = 14559). RESULTS A total of 40229 diabetes patients (43.5% of the cohort) died during follow-up and 10.9% died under the age of 60. Insulin use and smoking significantly predicted cancer and non-cancer death. The adjusted hazard ratio (95% confidence interval) associated with insulin use was 1.161 (1.052-1.281) for cancer death and 1.469 (1.413-1.526) for non-cancer death. Screen-detected diabetes and body mass index were consistently associated with a lower risk, but diabetes duration a higher risk, for non-cancer death, with adjusted hazard ratio of 0.683 (0.666-0.702), 0.955 (0.951-0.958) and 1.018 (1.017-1.020), respectively. Diabetes type had a null association disregarding the causes of death and living in rural areas was significantly associated with a higher mortality from non-cancer death. Hypertension, fasting glucose and dyslipidemia showed differential impacts on cancer and non-cancer death, and were significantly predictive for non-cancer death. CONCLUSIONS Screen-detected diabetes and a higher body mass index provide a survival advantage, especially for non-cancer death. However, insulin use is associated with a significantly higher risk of either cancer or non-cancer death.
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Affiliation(s)
- Chin-Hsiao Tseng
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Division of Environmental Health and Occupational Medicine of the National Health Research Institutes, Taipei, Taiwan
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252
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Wang Z, Dong B, Hu J, Adegbija O, Arnold LW. Exploring the non-linear association between BMI and mortality in adults with and without diabetes: the US National Health Interview Survey. Diabet Med 2016; 33:1691-1699. [PMID: 26972695 DOI: 10.1111/dme.13111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 12/11/2022]
Abstract
AIMS To assess the non-linear relationship between BMI and mortality and to determine the BMI values with the lowest mortality risk in adults with and without diabetes. METHODS This observational study assessed the relationship between BMI and mortality with flexible parametric survival models using data from the US National Health Interview Survey. Participants included 25 458 adults with diabetes and 315 939 adults without diabetes, aged 18-84 years at baseline surveys, conducted from 1997 to 2009. Mortality status data were obtained from the linked mortality data up to 2011. RESULTS We observed a U-shaped relationship between BMI and mortality in both adults with and without diabetes. With the BMI 25-29.9 kg/m2 group as reference, hazard ratios (95% CI) of mortality for those with BMI < 18.5, 18.5-24.9, 30-34.9, 35-39.9 and ≥ 40 kg/m2 were 2.67 (2.12, 3.35), 1.26 (1.18, 1.35), 1.04 (0.98, 1.12), 1.12 (1.02, 1.22) and 1.37 (1.24, 1.51), respectively, for adults with diabetes, adjusting for age, sex, race and survey year. The corresponding hazard ratios for adults without diabetes were 2.97 (2.78, 3.17), 1.27 (1.23, 1.30), 1.07 (1.03, 1.12), 1.36 (1.27, 1.45), and 1.77 (1.62, 1.92), respectively. The BMI values associated with the lowest mortality were 29.1 kg/m2 for adults with diabetes and 26.7 kg/m2 for those without diabetes. CONCLUSIONS Regardless of the presence of diabetes, there is a U-shaped relationship between BMI and mortality. The BMI values associated with the lowest mortality were above the current 'normal' range for adults with and without diabetes.
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Affiliation(s)
- Z Wang
- Centre for Chronic Disease, School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - B Dong
- Centre for Chronic Disease, School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - J Hu
- Centre for Chronic Disease, School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - O Adegbija
- Centre for Chronic Disease, School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - L W Arnold
- Centre for Chronic Disease, School of Medicine, The University of Queensland, Herston, Queensland, Australia
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253
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Virtue A, Johnson C, Lopez-Pastraña J, Shao Y, Fu H, Li X, Li YF, Yin Y, Mai J, Rizzo V, Tordoff M, Bagi Z, Shan H, Jiang X, Wang H, Yang XF. MicroRNA-155 Deficiency Leads to Decreased Atherosclerosis, Increased White Adipose Tissue Obesity, and Non-alcoholic Fatty Liver Disease: A NOVEL MOUSE MODEL OF OBESITY PARADOX. J Biol Chem 2016; 292:1267-1287. [PMID: 27856635 DOI: 10.1074/jbc.m116.739839] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/27/2016] [Indexed: 12/17/2022] Open
Abstract
Obesity paradox (OP) describes a widely observed clinical finding of improved cardiovascular fitness and survival in some overweight or obese patients. The molecular mechanisms underlying OP remain enigmatic partly due to a lack of animal models mirroring OP in patients. Using apolipoprotein E knock-out (apoE-/-) mice on a high fat (HF) diet as an atherosclerotic obesity model, we demonstrated 1) microRNA-155 (miRNA-155, miR-155) is significantly up-regulated in the aortas of apoE-/- mice, and miR-155 deficiency in apoE-/- mice inhibits atherosclerosis; 2) apoE-/-/miR-155-/- (double knock-out (DKO)) mice show HF diet-induced obesity, adipocyte hypertrophy, and present with non-alcoholic fatty liver disease; 3) DKO mice demonstrate HF diet-induced elevations of plasma leptin, resistin, fed-state and fasting insulin and increased expression of adipogenic transcription factors but lack glucose intolerance and insulin resistance. Our results are the first to present an OP model using DKO mice with features of decreased atherosclerosis, increased obesity, and non-alcoholic fatty liver disease. Our findings suggest the mechanistic role of reduced miR-155 expression in OP and present a new OP working model based on a single miRNA deficiency in diet-induced obese atherogenic mice. Furthermore, our results serve as a breakthrough in understanding the potential mechanism underlying OP and provide a new biomarker and novel therapeutic target for OP-related metabolic diseases.
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Affiliation(s)
- Anthony Virtue
- From the Centers for Metabolic Disease Research, Cardiovascular Research and Thrombosis Research, Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140
| | - Candice Johnson
- From the Centers for Metabolic Disease Research, Cardiovascular Research and Thrombosis Research, Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140
| | - Jahaira Lopez-Pastraña
- From the Centers for Metabolic Disease Research, Cardiovascular Research and Thrombosis Research, Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140
| | - Ying Shao
- From the Centers for Metabolic Disease Research, Cardiovascular Research and Thrombosis Research, Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140
| | - Hangfei Fu
- From the Centers for Metabolic Disease Research, Cardiovascular Research and Thrombosis Research, Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140
| | - Xinyuan Li
- From the Centers for Metabolic Disease Research, Cardiovascular Research and Thrombosis Research, Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140
| | - Ya-Feng Li
- From the Centers for Metabolic Disease Research, Cardiovascular Research and Thrombosis Research, Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140
| | - Ying Yin
- From the Centers for Metabolic Disease Research, Cardiovascular Research and Thrombosis Research, Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140
| | - Jietang Mai
- From the Centers for Metabolic Disease Research, Cardiovascular Research and Thrombosis Research, Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140
| | - Victor Rizzo
- From the Centers for Metabolic Disease Research, Cardiovascular Research and Thrombosis Research, Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140
| | - Michael Tordoff
- the Monell Chemical Senses Center, Philadelphia, Pennsylvania 19104, and
| | - Zsolt Bagi
- the Vascular Biology Center, Augusta University, Augusta, Georgia 30912
| | - Huimin Shan
- From the Centers for Metabolic Disease Research, Cardiovascular Research and Thrombosis Research, Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140
| | - Xiaohua Jiang
- From the Centers for Metabolic Disease Research, Cardiovascular Research and Thrombosis Research, Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140
| | - Hong Wang
- From the Centers for Metabolic Disease Research, Cardiovascular Research and Thrombosis Research, Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140
| | - Xiao-Feng Yang
- From the Centers for Metabolic Disease Research, Cardiovascular Research and Thrombosis Research, Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140,
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Chang LF, Vethakkan SR, Nesaretnam K, Sanders TA, Teng KT. Adverse effects on insulin secretion of replacing saturated fat with refined carbohydrate but not with monounsaturated fat: A randomized controlled trial in centrally obese subjects. J Clin Lipidol 2016; 10:1431-1441.e1. [DOI: 10.1016/j.jacl.2016.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/02/2016] [Accepted: 09/06/2016] [Indexed: 11/29/2022]
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Tsujimoto T, Kajio H, Sugiyama T. Risks for Cardiovascular and Cardiac Deaths in Nonobese Patients With Diabetes and Coronary Heart Disease. Mayo Clin Proc 2016; 91:1545-1554. [PMID: 27729109 DOI: 10.1016/j.mayocp.2016.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/06/2016] [Accepted: 08/22/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess whether obese diabetic patients with coronary heart disease (CHD) have a lower risk for cardiovascular or cardiac mortalities than do nonobese diabetic patients with CHD. PATIENTS AND METHODS We conducted a prospective cohort study using data from the National Health and Nutrition Examination Survey 1999-2010 and followed up the study participants from the survey participation date until December 31, 2011. For primary analyses, we built Cox proportional hazard models restricted to diabetic patients with CHD; unadjusted and adjusted hazard rates of cardiovascular mortality were compared between obese and nonobese participants. RESULTS A total of 3,056 diabetic participants (504 with and 2,552 without CHD) and 22,556 nondiabetic participants (953 with and 21,603 without CHD) aged 20 to 79 years without malignant disease were included. Follow-up was completed in 99.8% of study participants. Hazard ratio (HR) for cardiovascular mortality for diabetic participants with CHD was significantly lower among the obese than among the nonobese (adjusted HR, 0.38; 95% CI, 0.18-0.82; P=.01); these findings were not observed in diabetic participants without CHD. Among nondiabetic participants, cumulative event rates for cardiovascular deaths were not significantly different between the obese and the nonobese, regardless of CHD status. Similar results for cardiac mortality were observed in both diabetic and nondiabetic participants. CONCLUSION Obesity in diabetic patients with CHD was associated with lower cardiovascular and cardiac mortality risks compared with absence of obesity. That is, nonobese patients having diabetes and CHD may have an increased risk for serious cardiovascular events.
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Affiliation(s)
- Tetsuro Tsujimoto
- Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Hiroshi Kajio
- Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takehiro Sugiyama
- Department of Clinical Study and Informatics, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan; Department of Public Health/Health Policy, the University of Tokyo, Tokyo, Japan
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256
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Antonopoulos AS, Oikonomou EK, Antoniades C, Tousoulis D. From the BMI paradox to the obesity paradox: the obesity-mortality association in coronary heart disease. Obes Rev 2016; 17:989-1000. [PMID: 27405510 DOI: 10.1111/obr.12440] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/15/2016] [Accepted: 05/23/2016] [Indexed: 12/13/2022]
Abstract
Despite a strong association between body weight and mortality in the general population, clinical evidence suggests better clinical outcome of overweight or obese individuals with established coronary heart disease. This finding has been termed the 'obesity paradox', but its existence remains a point of debate, because it is mostly observed when body mass index (BMI) is used to define obesity. Inherent limitations of BMI as an index of adiposity, as well as methodological biases and the presence of confounding factors, may account for the observed findings of clinical studies. In this review, our aim is to present the data that support the presence of a BMI paradox in coronary heart disease and then explore whether next to a BMI paradox a true obesity paradox exists as well. We conclude by attempting to link the obesity paradox notion to available translational research data supporting a 'healthy', protective adipose tissue phenotype. © 2016 World Obesity.
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Affiliation(s)
- A S Antonopoulos
- 1st Cardiology Department, Hippokration Hospital, Athens Medical School, Athens, Greece. .,Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.
| | - E K Oikonomou
- 1st Cardiology Department, Hippokration Hospital, Athens Medical School, Athens, Greece.,Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - C Antoniades
- Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - D Tousoulis
- 1st Cardiology Department, Hippokration Hospital, Athens Medical School, Athens, Greece
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257
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Montaño M, Pérez-Ramos J, Esquivel A, Rivera-Rosales R, González-Avila G, Becerril C, Checa M, Ramos C. Obesity decreases the oxidant stress induced by tobacco smoke in a rat model. Toxicol Mech Methods 2016; 26:544-553. [PMID: 27470987 DOI: 10.1080/15376516.2016.1211208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
Abstract
Obesity and emphysema are associated with low-grade systemic inflammation and oxidant stress. Assuming that the oxidant stress induced by emphysema would be decreased by obesity, we analyzed the oxidant/antioxidant state in a rat model combining both diseases simultaneously. Obesity was induced using sucrose, while emphysema by exposure to tobacco smoke. End-points evaluated were: body weight, abdominal fat, plasma dyslipidemia and malondialdehyde (MDA), insulin and glucose AUC, activities of Mn-superoxide dismutase (Mn-SOD), glutathione reductase (GR), glutathione transferase (GST) and glutathione peroxidase (GPx); lung MnSOD and 3-nitrotyrosine (3-NT) immunostaining, and expression of αV and β6 integrin subunits. In rats with obesity, the body weight, abdominal fat, plasma triglyceride levels, glucose AUC, insulin levels, GST activity, and αV and β6 integrin expressions were amplified. The rats with emphysema had lower values of body weight, abdominal fat, plasma insulin, triglycerides and glucose AUC but higher values of plasma MDA, GPx activity, and the lung expression of the αV and β6 integrins. The combination of obesity and emphysema compared to either condition alone led to diminished body weight, abdominal fat, plasma insulin MDA levels, GPx and GST activities, and αV and β6 integrin expressions; these parameters were all previously increased by obesity. Immunostaining for MnSOD augmented in all experimental groups, but the staining for 3-NT only increased in rats treated with tobacco alone or combined with sucrose. Results showed that obesity reduces oxidant stress and integrin expression, increasing antioxidant enzyme activities; these changes seem to partly contribute to a protective mechanism of obesity against emphysema development.
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Affiliation(s)
- Martha Montaño
- a Departamento de Investigación en Fibrosis Pulmonar , Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas , México , Mexico
| | - J Pérez-Ramos
- b Departamento de Sistemas Biológicos , Universidad Autónoma Metropolitana-Xochimilco , México , Mexico
| | - A Esquivel
- b Departamento de Sistemas Biológicos , Universidad Autónoma Metropolitana-Xochimilco , México , Mexico
| | - R Rivera-Rosales
- c Departamento de Patología , Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas , México , Mexico
| | - G González-Avila
- d Departamento de Enfermedades Crónico Degenerativas , Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER) , México , Mexico
| | - C Becerril
- a Departamento de Investigación en Fibrosis Pulmonar , Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas , México , Mexico
| | - M Checa
- a Departamento de Investigación en Fibrosis Pulmonar , Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas , México , Mexico
| | - C Ramos
- a Departamento de Investigación en Fibrosis Pulmonar , Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas , México , Mexico
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258
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Wan EYF, Fung CSC, Fong DYT, Chan AKC, Lam CLK. A curvilinear association of body mass index with cardiovascular diseases in Chinese patients with type 2 diabetes mellitus - A population-based retrospective cohort study. J Diabetes Complications 2016; 30:1261-8. [PMID: 27233363 DOI: 10.1016/j.jdiacomp.2016.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/20/2016] [Accepted: 05/08/2016] [Indexed: 12/21/2022]
Abstract
AIMS This epidemiological and longitudinal study aimed to confirm the association between BMI and CVD and determine the optimal BMI range for Chinese patients with T2DM. METHOD A retrospective cohort study was conducted on 113,194 Chinese adult primary care T2DM patients without prior CVD history at baseline, and had a documented BMI in 2008-2010. Using the average of the annual mean of BMI records (updated BMI) over a median follow-up of 4.2years, the risk of CVD associated with BMI by gender, age group, smoking status and presence of chronic kidney disease group was evaluated using multivariable Cox proportional hazard regression adjusted by socio-demographics and clinical characteristics. RESULTS The updated BMI value and the incidence of CVD showed a J-shaped curvilinear relationship. Low (<18.5kg/m(2)) or high (≥25kg/m(2)) BMI range was associated with higher risk of CVD and the optimal BMI range associated with the lowest likelihood of CVD was 20-22.9kg/m(2) in overall cohort and all selected groups. CONCLUSIONS There was no evidence of benefit of underweight or adiposity with regard to the risk of CVD and thus the maintenance of a normal weight should be emphasized as an integral part of preventive intervention in the diabetes management.
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Affiliation(s)
- Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, the University of Hong Kong, Hong Kong; School of Nursing, the University of Hong Kong, Hong Kong.
| | | | | | - Anca Ka Chun Chan
- Department of Family Medicine and Primary Care, the University of Hong Kong, Hong Kong.
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, the University of Hong Kong, Hong Kong.
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259
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Enders D, Kollhorst B, Engel S, Linder R, Verheyen F, Pigeot I. Comparative risk for cardiovascular diseases of dipeptidyl peptidase-4 inhibitors vs. sulfonylureas in combination with metformin: Results of a two-phase study. J Diabetes Complications 2016; 30:1339-46. [PMID: 27245402 DOI: 10.1016/j.jdiacomp.2016.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/07/2016] [Accepted: 05/16/2016] [Indexed: 12/25/2022]
Abstract
AIMS The aim was to assess whether the use of additional data from the Disease Management Program (DMP) diabetes mellitus type 2 to minimize the potential for residual confounding will alter the estimated risk of either myocardial infarction, ischemic stroke or heart failure in patients with type 2 diabetes using sulfonylureas compared to dipeptidyl peptidase-4 (DPP-4) inhibitors in addition to metformin based on routine health care data. METHODS We conducted a nested two-phase case-control study using claims data of one German health insurance from 2004 to 2013 (phase 1) and data of the DMP from 2010 to 2013 (phase 2). Adjusted odds ratios (ORs) for the combined cardiovascular event myocardial infarction, ischemic stroke or heart failure were calculated using a two-phase logistic regression. RESULTS Phase 1 comprised 3179 patients (289 cases; 2890 controls) and phase 2 comprised 1968 patients (168 cases; 1800 controls). We observed an adjusted OR of 0.83 for the combined cardiovascular event (95% CI: 0.61-1.13). CONCLUSIONS We observed a non-significantly reduced risk for cardiovascular diseases in patients using DPP-4 inhibitors compared to sulfonylureas in addition to metformin. This finding was not altered by the inclusion of additional information of the DMP in the analysis. However, due to the low power of this study, further studies are needed to reproduce our findings.
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Affiliation(s)
- Dirk Enders
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Bianca Kollhorst
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Susanne Engel
- Scientific Institute of TK for Benefit and Efficiency in Health Care, Hamburg, Germany
| | - Roland Linder
- Scientific Institute of TK for Benefit and Efficiency in Health Care, Hamburg, Germany
| | - Frank Verheyen
- Scientific Institute of TK for Benefit and Efficiency in Health Care, Hamburg, Germany
| | - Iris Pigeot
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
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260
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Gupta T, Kolte D, Mohananey D, Khera S, Goel K, Mondal P, Aronow WS, Jain D, Cooper HA, Iwai S, Frishman WH, Bhatt DL, Fonarow GC, Panza JA. Relation of Obesity to Survival After In-Hospital Cardiac Arrest. Am J Cardiol 2016; 118:662-7. [PMID: 27381664 DOI: 10.1016/j.amjcard.2016.06.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 12/30/2022]
Abstract
Previous studies have shown that obesity is paradoxically associated with improved outcomes in many cardiovascular (CV) disease states; however, whether obesity affects survival after in-hospital cardiac arrest (IHCA) has not been well examined. We queried the 2003 to 2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years who underwent cardiopulmonary resuscitation for IHCA. Obese patients were identified using the co-morbidity variable for obesity, as defined in Nationwide Inpatient Sample databases. Survival to hospital discharge was compared between obese and nonobese patients using multivariate regression models. Of 836,289 patients with IHCA, 67,216 (8.0%) were obese. Obese patients were younger and more likely to be women compared with nonobese patients. Despite being younger, obese patients had significantly higher prevalence of most CV co-morbidities such as dyslipidemia, coronary artery disease, previous myocardial infarction, heart failure, diabetes mellitus, hypertension, peripheral vascular disease, and chronic renal failure (p <0.001 for all). Obese patients were more likely to have ventricular tachycardia or ventricular fibrillation as the initial cardiac arrest rhythm (22.3% vs 20.9%; p <0.001). After multivariate risk adjustment, obese patients had improved survival to hospital discharge compared with nonobese patients (31.4% vs 24.1%; unadjusted odds ratio 1.44, 95% CI 1.42 to 1.47, p <0.001; adjusted odds ratio 1.15, 95% CI 1.13 to 1.17, p <0.001). Similar results were seen in patients with CV or non-CV conditions as the primary diagnosis and in those with ventricular tachycardia/ventricular fibrillation or pulseless electrical activity/asystole as the cardiac arrest rhythm. In conclusion, this large retrospective analysis of a nationwide cohort of patients with IHCA demonstrated higher risk-adjusted odds of survival in obese patients, consistent with an "obesity paradox."
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Affiliation(s)
- Tanush Gupta
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Dhaval Kolte
- Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Divyanshu Mohananey
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Sahil Khera
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Kashish Goel
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Pratik Mondal
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Wilbert S Aronow
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York.
| | - Diwakar Jain
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Howard A Cooper
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Sei Iwai
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - William H Frishman
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Julio A Panza
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
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261
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Abdullahi A, Jeschke MG. White Adipose Tissue Browning: A Double-edged Sword. Trends Endocrinol Metab 2016; 27:542-552. [PMID: 27397607 PMCID: PMC5234861 DOI: 10.1016/j.tem.2016.06.006] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 12/16/2022]
Abstract
The study of white adipose tissue (WAT) 'browning' has become a 'hot topic' in various acute and chronic metabolic conditions, based on the idea that WAT browning might be able to facilitate weight loss and improve metabolic health. However, this view cannot be translated into all areas of medicine. Recent studies identified effects of browning associated with adverse outcomes, and as more studies are being conducted, a very different picture has emerged about WAT browning and its detrimental effect in acute and chronic hypermetabolic conditions. Therefore, the notion that browning is supposedly beneficial may be inadequate. In this review we analyze how and why browning in chronic hypermetabolic associated diseases can be detrimental and lead to adverse outcomes.
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Affiliation(s)
- Abdikarim Abdullahi
- Institute of Medical Science, University of Toronto, Canada; Sunnybrook Research Institute, Totonto, Canada
| | - Marc G Jeschke
- Institute of Medical Science, University of Toronto, Canada; Sunnybrook Research Institute, Totonto, Canada; Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada; Department of Surgery, Division of Plastic Surgery, Department of Immunology, University of Toronto, Canada.
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Nakajima K, Kanda E, Suwa K. Prevalent hyperglycemia in older obese population and age-dependent convergence of obese indices: Results of a cross-sectional study of Japanese generations over the adult life span. Endocr Res 2016; 41:236-47. [PMID: 26853545 DOI: 10.3109/07435800.2015.1111901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE/AIM An age-dependent decline has been observed in the association between obesity and type 2 diabetes, a major comorbidity of obesity, although the evidence is limited. Therefore, we investigated the association and the plausible underlying mechanism in a large epidemiological study. MATERIALS AND METHODS We examined the association between the degree of obesity and hyperglycemia in five age groups (20-39, 40-49, 50-59, 60-69, and 70-85 years) in a cross-sectional study of 78,776 apparently healthy Japanese men and women who underwent a checkup in 2012. Hyperglycemia was defined as glycosylated hemoglobin (HbA1c) of ≥5.7% and/or pharmacotherapy for diabetes. RESULTS The incidence of hyperglycemia was three times higher in the 70-85-year-old group (62%) than in the 20-39-year-old group (20%) in obese individuals (body mass index [BMI] ≥ 27.0 kg/m(2)). However, the incidence was 12 times higher in reference-weight individuals (21.0-22.9 kg/m(2); 48% and 4%, respectively). As age increased, mean BMI and waist circumference approached certain non-obese ranges (22-24 kg/m(2) and 80-86 cm, respectively), even in hyperglycemic subjects. Logistic regression analysis revealed an age-dependent decline in the association between obesity and hyperglycemia, relative to that in reference-weight individuals. CONCLUSIONS Our results confirmed the previously reported age-dependent decline in the association between obesity and hyperglycemia, although hyperglycemia was still prevalent in older obese subjects than in older reference-weight subjects. Therefore, the decline in the association may be accelerated due to an age-dependent increase in the prevalence of hyperglycemia in reference-weight individuals.
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Affiliation(s)
- Kei Nakajima
- a Division of Clinical Nutrition, Department of Medical Dietetics, Faculty of Pharmaceutical Sciences , Josai University , Saitama , Japan
- b Department of Metabolism , Kuki General Hospital , Kuki , Saitama , Japan
| | - Eiichiro Kanda
- c Department of Nephrology , Tokyo Kyosai Hospital , Tokyo , Japan
| | - Kaname Suwa
- d Saitama Health Promotion Corporation , Saitama , Japan
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263
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Ho AK, Bartels CM, Thorpe CT, Pandhi N, Smith MA, Johnson HM. Achieving Weight Loss and Hypertension Control Among Obese Adults: A US Multidisciplinary Group Practice Observational Study. Am J Hypertens 2016; 29:984-91. [PMID: 26917445 DOI: 10.1093/ajh/hpw020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 02/07/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Among adults with hypertension, obesity independently contributes to cardiovascular disease. Weight loss and hypertension control are critical to reduce cardiovascular events. The purpose of this study was to evaluate rates and predictors of achieving weight loss among adults who achieved hypertension control within 1 year of developing incident hypertension. METHODS Retrospective electronic health record analysis was performed of ≥18 year olds with a body mass index ≥30.0kg/m(2), who received regular primary care from 2008 to 2011 and achieved hypertension control. Exclusions were less than 60 days follow-up, prior hypertension diagnosis, prior antihypertensive prescription, or pregnancy. The primary outcome was clinically significant weight loss (≥5kg); the secondary outcome was modest (2.0-4.9kg) weight loss. Multinomial logistic regression identified predictors of achieving weight loss (≥5 or 2.0-4.9kg) compared to no significant weight loss (<2kg). RESULTS Of the 2,906 obese patients who achieved hypertension control, 72% (n = 2,089) did not achieve at least 2.0kg weight loss. Overall, 12% (n = 351) achieved ≥5kg weight loss. Young adults (18-39 year olds; odds ratio (OR): 2.47, 95% confidence interval (CI): 1.63-3.47), middle-aged adults (40-59 year olds; OR: 2.32, 95% CI: 1.59-3.37), and patients prescribed antihypertensive medication (OR: 1.37, 95% CI: 1.07-1.76) were more likely to achieve clinically significant weight loss and hypertension control. Age remained a significant predictor for 2.0-4.9kg weight loss. CONCLUSIONS Despite achieving hypertension control, the majority of obese patients did not achieve clinically significant weight loss. Effective weight loss interventions with dedicated hypertension treatment are needed to decrease cardiovascular events in this high-risk population.
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Affiliation(s)
- Aaron K Ho
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Christie M Bartels
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Carolyn T Thorpe
- Health Services Research and Development, Veterans Affairs Pittsburgh Healthcare System , Pittsburgh, Pennsylvania, USA; Department of Pharmacy & Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy Pandhi
- Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Maureen A Smith
- Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Heather M Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA;
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264
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Lee HS, Visco F, Mushiyev S, Pekler G, Savadkar A, Cativo EH, Garay HAR. The Obesity Paradox in Heart Failure: What Is Real Obesity in Heart Failure? CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0510-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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265
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Yang HK, Han K, Kwon HS, Park YM, Cho JH, Yoon KH, Kang MI, Cha BY, Lee SH. Obesity, metabolic health, and mortality in adults: a nationwide population-based study in Korea. Sci Rep 2016; 6:30329. [PMID: 27445194 PMCID: PMC4957204 DOI: 10.1038/srep30329] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/04/2016] [Indexed: 11/24/2022] Open
Abstract
BMI, metabolic health status, and their interactions should be considered for estimating mortality risk; however, the data are controversial and unknown in Asians. We aimed to investigate this issue in Korean population. Total 323175 adults were followed-up for 96 (60–120) (median [5–95%]) months in a nationwide population-based cohort study. Participants were classified as “obese” (O) or “non-obese” (NO) using a BMI cut-off of 25 kg/m2. People who developed ≥1 metabolic disease component (hypertension, diabetes, dyslipidaemia) in the index year were considered “metabolically unhealthy” (MU), while those with none were considered “metabolically healthy” (MH). The MUNO group had a significantly higher risk of all-cause (hazard ratio, 1.28 [95% CI, 1.21–1.35]) and cardiovascular (1.88 [1.63–2.16]) mortality, whereas the MHO group had a lower mortality risk (all-cause: 0.81 [0.74–0.88]), cardiovascular: 0.73 [0.57–0.95]), compared to the MHNO group. A similar pattern was noted for cancer and other-cause mortality. Metabolically unhealthy status was associated with higher risk of all-cause and cardiovascular mortality regardless of BMI levels, and there was a dose-response relationship between the number of incident metabolic diseases and mortality risk. In conclusion, poor metabolic health status contributed more to mortality than high BMI did, in Korean adults.
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Affiliation(s)
- Hae Kyung Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Kyungdo Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea
| | - Yong-Moon Park
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institute of Health, Department of Health and Human Services, Research Triangle Park, NC 27709, USA
| | - Jae-Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Kun-Ho Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Moo-Il Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Bong-Yun Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
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266
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Rios-Diaz AJ, Lin E, Williams K, Jiang W, Patel V, Shimizu N, Metcalfe D, Olufajo OA, Cooper Z, Havens J, Salim A, Askari R. The obesity paradox in patients with severe soft tissue infections. Am J Surg 2016; 214:385-389. [PMID: 28818282 DOI: 10.1016/j.amjsurg.2016.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/25/2016] [Accepted: 05/01/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND The "obesity paradox" has been demonstrated in chronic diseases but not in acute surgery. We sought to determine whether obesity is associated with improved outcomes in patients with severe soft tissue infections (SSTIs). METHODS The 2006 to 2010 Nationwide Inpatient Sample was used to identify adult patients with SSTIs. Patients were categorized into nonobese and obese (nonmorbid [body mass index 30 to 39.9] and morbid [body mass index ≥ 40]). Logistic regression provided risk-adjusted association between obesity categories and inhospital mortality. RESULTS There were 2,868 records with SSTI weighted to represent 14,080 patients. Obese patients were less likely to die in hospital than nonobese patients (odds ratio [OR] = .42; 95% confidence interval [CI], .25 to .70; P = .001). Subanalysis revealed a similar trend, with lower odds of mortality in nonmorbid obesity (OR = .46; 95% CI, .23 to .91; P = .025) and morbid obesity (OR = .39; 95% CI, .19 to .80; P = .011) groups. CONCLUSIONS Obesity is independently associated with reduced inhospital mortality in patients with SSTI regardless of the obesity classification. This suggests that the obesity paradox exists in this acute surgical population.
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Affiliation(s)
- Arturo J Rios-Diaz
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Heath, Boston, MA, USA
| | - Elissa Lin
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Heath, Boston, MA, USA
| | - Katherine Williams
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Heath, Boston, MA, USA; Trauma, Burn and Surgical Critical Care Division, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wei Jiang
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Heath, Boston, MA, USA
| | - Vihas Patel
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Heath, Boston, MA, USA
| | - Naomi Shimizu
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Heath, Boston, MA, USA
| | - David Metcalfe
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Olubode A Olufajo
- Trauma, Burn and Surgical Critical Care Division, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Heath, Boston, MA, USA; Trauma, Burn and Surgical Critical Care Division, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joaquim Havens
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Heath, Boston, MA, USA; Trauma, Burn and Surgical Critical Care Division, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ali Salim
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Heath, Boston, MA, USA; Trauma, Burn and Surgical Critical Care Division, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Reza Askari
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Heath, Boston, MA, USA; Trauma, Burn and Surgical Critical Care Division, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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267
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Mensinger JL, Calogero RM, Stranges S, Tylka TL. A weight-neutral versus weight-loss approach for health promotion in women with high BMI: A randomized-controlled trial. Appetite 2016; 105:364-74. [PMID: 27289009 DOI: 10.1016/j.appet.2016.06.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/04/2016] [Accepted: 06/06/2016] [Indexed: 12/29/2022]
Abstract
Weight loss is the primary recommendation for health improvement in individuals with high body mass index (BMI) despite limited evidence of long-term success. Alternatives to weight-loss approaches (such as Health At Every Size - a weight-neutral approach) have been met with their own concerns and require further empirical testing. This study compared the effectiveness of a weight-neutral versus a weight-loss program for health promotion. Eighty women, aged 30-45 years, with high body mass index (BMI ≥ 30 kg/m(2)) were randomized to 6 months of facilitator-guided weekly group meetings using structured manuals that emphasized either a weight-loss or weight-neutral approach to health. Health measurements occurred at baseline, post-intervention, and 24-months post-randomization. Measurements included blood pressure, lipid panels, blood glucose, BMI, weight, waist circumference, hip circumference, distress, self-esteem, quality of life, dietary risk, fruit and vegetable intake, intuitive eating, and physical activity. Intention-to-treat analyses were performed using linear mixed-effects models to examine group-by-time interaction effects and between and within-group differences. Group-by-time interactions were found for LDL cholesterol, intuitive eating, BMI, weight, and dietary risk. At post-intervention, the weight-neutral program had larger reductions in LDL cholesterol and greater improvements in intuitive eating; the weight-loss program had larger reductions in BMI, weight, and larger (albeit temporary) decreases in dietary risk. Significant positive changes were observed overall between baseline and 24-month follow-up for waist-to-hip ratio, total cholesterol, physical activity, fruit and vegetable intake, self-esteem, and quality of life. These findings highlight that numerous health benefits, even in the absence of weight loss, are achievable and sustainable in the long term using a weight-neutral approach. The trial positions weight-neutral programs as a viable health promotion alternative to weight-loss programs for women of high weight.
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Affiliation(s)
- Janell L Mensinger
- Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA, 19611, USA.
| | | | - Saverio Stranges
- Department of Population Health, Luxembourg Institute of Health, Luxembourg
| | - Tracy L Tylka
- Department of Psychology, The Ohio State University, USA
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268
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Li X, Handee W, Kuo MH. The slim, the fat, and the obese: guess who lives the longest? Curr Genet 2016; 63:43-49. [DOI: 10.1007/s00294-016-0617-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 05/16/2016] [Accepted: 05/18/2016] [Indexed: 02/08/2023]
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269
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Pérez LM, Pareja-Galeano H, Sanchis-Gomar F, Emanuele E, Lucia A, Gálvez BG. 'Adipaging': ageing and obesity share biological hallmarks related to a dysfunctional adipose tissue. J Physiol 2016; 594:3187-207. [PMID: 26926488 DOI: 10.1113/jp271691] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 01/21/2016] [Indexed: 12/15/2022] Open
Abstract
The increasing ageing of our societies is accompanied by a pandemic of obesity and related cardiometabolic disorders. Progressive dysfunction of the white adipose tissue is increasingly recognized as an important hallmark of the ageing process, which in turn contributes to metabolic alterations, multi-organ damage and a systemic pro-inflammatory state ('inflammageing'). On the other hand, obesity, the paradigm of adipose tissue dysfunction, shares numerous biological similarities with the normal ageing process such as chronic inflammation and multi-system alterations. Accordingly, understanding the interplay between accelerated ageing related to obesity and adipose tissue dysfunction is critical to gain insight into the ageing process in general as well as into the pathophysiology of obesity and other related conditions. Here we postulate the concept of 'adipaging' to illustrate the common links between ageing and obesity and the fact that, to a great extent, obese adults are prematurely aged individuals.
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Affiliation(s)
- Laura M Pérez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Helios Pareja-Galeano
- Universidad Europea de Madrid, Spain.,Research Institute Hospital 12 de Octubre ('i+12'), Madrid, Spain
| | | | | | - Alejandro Lucia
- Universidad Europea de Madrid, Spain.,Research Institute Hospital 12 de Octubre ('i+12'), Madrid, Spain
| | - Beatriz G Gálvez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Universidad Europea de Madrid, Spain
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270
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Wu CS, Gau SSF. Association Between Antipsychotic Treatment and Advanced Diabetes Complications Among Schizophrenia Patients With Type 2 Diabetes Mellitus. Schizophr Bull 2016; 42:703-11. [PMID: 26721264 PMCID: PMC4838103 DOI: 10.1093/schbul/sbv187] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Antipsychotic drug use is an established risk factor for the development of type 2 diabetes mellitus. However, the effect of antipsychotic drug on the progression of diabetes complications remains unclear. This study aimed to explore the association between antipsychotic treatment and advanced diabetes outcome among schizophrenia patients with type 2 diabetes. METHODS The authors conducted a retrospective cohort study using Taiwan's universal health insurance database. A total of 17 629 schizophrenia patients with newly-diagnosed diabetes were enrolled. The mean duration of follow-up, after excluding the first 6-month observation period, was 4.8 years, ranged from 1 month to 11.5 years. Antipsychotic treatment patterns within a 6-month time window were classified into none, irregular use, and regular use. Antipsychotics were further categorized into the high, intermediate, and low metabolic risks. The status of exposure was treated as time-dependent variables. The outcomes measures included any advanced diabetes complications, macrovascular and microvascular complications, and all-cause mortality. RESULTS Compared to no antipsychotic treatment in the past 6 months, regular antipsychotic use was associated with a lower risk of any advanced diabetes complications (adjusted hazard ratio, aHR = 0.81, 95% CI = 0.69-0.95), macrovascular complications (aHR = 0.80, 95% CI = 0.66-0.97), and all-cause mortality (aHR = 0.73, 95% CI = 0.62-0.85). The hazard ratios for advanced diabetes complications with regular use of antipsychotics with a high, intermediate, and low metabolic risk were 0.69 (95% CI = 0.53-0.91), 0.82 (95% CI = 0.68-0.99), and 0.85 (95% CI = 0.70-1.02), respectively. CONCLUSIONS Regular antipsychotic treatment in the past 6 months was associated with reduced risks of any diabetes complications, compared to no antipsychotic treatment.
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Affiliation(s)
- Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan;,Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Brain and Mind Sciences, and Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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271
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Abstract
Being overweight or obese is associated with a higher individual risk of venous thromboembolism and poorer postprocedural outcomes after hip or knee replacement surgery. In addition, there is evidence that obesity represents a significant driving factor for the current and projected prevalence of atrial fibrillation. Rivaroxaban and other direct oral anticoagulants offer fixed-dose regimens for these indications. They do not require therapeutic drug monitoring or dose adjustment according to the weight of the patient. However, primary care physicians seem to be hesitant to accept the concept of a fixed-dose regimen for patients at extremes of weight, perhaps because of familiarity with weight-based dosing of other drugs including low molecular weight heparins. The main concerns related to unadjusted dosing are increased exposure in underweight patients leading to a risk of excessive bleeding and conversely to underanticoagulation of overweight patients. Rivaroxaban has shown similar efficacy and a similar or better safety profile compared with standard treatment for several venous and arterial indications, including venous thromboembolism, nonvalvular atrial fibrillation, and acute coronary syndrome. Prespecified subgroup analyses of patients stratified by weight or body mass index demonstrated outcomes that were consistent with the overall analysis and within each weight and body mass index group. The results suggest that standard-dose rivaroxaban can be safely prescribed in adult patients of all weights.
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Affiliation(s)
- James Uprichard
- The Centre for Haemostasis and Thrombosis, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London SW17 0QT, UK
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272
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Leong A, Porneala B, Dupuis J, Florez JC, Meigs JB. Type 2 Diabetes Genetic Predisposition, Obesity, and All-Cause Mortality Risk in the U.S.: A Multiethnic Analysis. Diabetes Care 2016; 39:539-46. [PMID: 26884474 PMCID: PMC4806775 DOI: 10.2337/dc15-2080] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/27/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 2 diabetes (T2D) is associated with increased mortality in ethnically diverse populations, although the extent to which this association is genetically determined is unknown. We sought to determine whether T2D-related genetic variants predicted all-cause mortality, even after accounting for BMI, in the Third National Health and Nutrition Examination Survey. RESEARCH DESIGN AND METHODS We modeled mortality risk using a genetic risk score (GRS) from a weighted sum of risk alleles at 38 T2D-related single nucleotide polymorphisms. In age-, sex-, and BMI-adjusted logistic regression models, accounting for the complex survey design, we tested the association with mortality in 6,501 participants. We repeated the analysis within ethnicities (2,528 non-Hispanic white [NHW], 1,979 non-Hispanic black [NHB], and 1,994 Mexican American [MA]) and within BMI categories (<25, 25-30, and ≥30 kg/m(2)). Significance was set at P < 0.05. RESULTS Over 17 years, 1,556 participants died. GRS was associated with mortality risk (OR 1.04 [95% CI 1.00-1.07] per T2D-associated risk allele, P = 0.05). Within ethnicities, GRS was positively associated with mortality risk in NHW and NHB, but not in MA (0.95 [0.90-1.01], P = 0.07). The negative trend in MA was largely driven by those with BMI <25 kg/m(2) (0.91 [0.82-1.00]). In NHW, the positive association was strongest among those with BMI ≥30 kg/m(2) (1.07 [1.02-1.12]). CONCLUSIONS In the U.S., a higher T2D genetic risk was associated with increased mortality risk, especially among obese NHW. The underlying genetic basis for mortality likely involves complex interactions with factors related to ethnicity, T2D, and body weight.
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Affiliation(s)
- Aaron Leong
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA Harvard Medical School, Boston, MA
| | - Bianca Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Jose C Florez
- Harvard Medical School, Boston, MA Center for Human Genetic Research and Diabetes Unit, Massachusetts General Hospital, Boston, MA Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - James B Meigs
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA Harvard Medical School, Boston, MA
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273
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Prats-Puig A, Soriano-Rodríguez P, Oliveras G, Carreras-Badosa G, Espuña S, Díaz-Roldán F, de Zegher F, Ibáñez L, Bassols J, Puig T, López-Bermejo A. Soluble CRTC3: A Newly Identified Protein Released by Adipose Tissue That Is Associated with Childhood Obesity. Clin Chem 2016; 62:476-84. [DOI: 10.1373/clinchem.2015.249136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/29/2015] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
CREB-regulated transcription coactivator 3 (CRTC3) is found in adipocytes, where it may promote obesity through disruption of catecholamine signaling. We wished to assess whether CRTC3 is a soluble protein secreted by adipose tissue, explore whether CRTC3 is detectable and quantifiable in the circulation, and ascertain whether CRTC3 serum concentrations are related to metabolic markers in children.
METHODS
Explants of adipose tissue from 12 children were cultured to study adipocyte cell size and the secretion of CRTC3 (immunoblot and ELISA). We also performed a cross-sectional and longitudinal study in 211 asymptomatic prepubertal white children at age 7 years, 115 of whom were followed up at age approximately 10 years. We measured circulating concentrations of CRTC3 and studied associations between serum CRTC3 and metabolic markers.
RESULTS
Measurable concentrations of CRTC3 were found in conditioned media of adipose tissue explants and in serum samples. CRTC3 concentrations in visceral adipose tissue were negatively associated with adipocyte cell size and positively related to adipocyte cell number (P < 0.05). In the cross-sectional study, higher CRTC3 concentrations were associated with higher body mass index (P = 0.001), waist circumference (P = 0.003), and systolic blood pressure (P = 0.007) and lower high molecular weight adiponectin (P = 0.003). In the longitudinal study, serum concentrations of CRTC3 at age approximately 7 years were associated with changes in waist circumference (β = 0.254; P = 0.004; r = 0.145) and high molecular weight adiponectin (β=-0.271; P = 0.014; r = 0.101), respectively, at age approximately 10 years.
CONCLUSIONS
CRTC3, a newly identified protein that is related to childhood obesity, is present in the circulation, partly as a result of adipose tissue secretion. Higher serum CRTC3 concentrations are related to and predict a poorer metabolic profile in children.
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Affiliation(s)
- Anna Prats-Puig
- Pediatrics Research Group, Girona Institute for Biomedical Research, Girona, Spain
- Pediatrics, Dr. Josep Trueta Hospital, Girona, Spain
- Department of Physical Therapy, EUSES University School, University of Girona, Girona, Spain
| | | | - Glòria Oliveras
- New Therapeutic Targets Lab (TargetsLab), Unit of Oncology, University of Girona, Girona, Spain
- Department of Pathology and Anatomical Sciences, Dr. Josep Trueta Hospital, Girona, Spain
| | - Gemma Carreras-Badosa
- Pediatrics Research Group, Girona Institute for Biomedical Research, Girona, Spain
- Pediatrics, Dr. Josep Trueta Hospital, Girona, Spain
| | - Sílvia Espuña
- Pediatrics, Salut Empordà Foundation, Figueres, Spain
| | - Ferran Díaz-Roldán
- Pediatrics Research Group, Girona Institute for Biomedical Research, Girona, Spain
- Pediatrics, Dr. Josep Trueta Hospital, Girona, Spain
| | - Francis de Zegher
- Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Lourdes Ibáñez
- Pediatric Endocrinology, Sant Joan de Déu Children's Hospital, Esplugues, Barcelona
- CIBERDEM (Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders), Instituto de Salud Carlos III, Madrid, Spain
| | - Judit Bassols
- Pediatrics Research Group, Girona Institute for Biomedical Research, Girona, Spain
- Pediatrics, Dr. Josep Trueta Hospital, Girona, Spain
| | - Teresa Puig
- New Therapeutic Targets Lab (TargetsLab), Unit of Oncology, University of Girona, Girona, Spain
| | - Abel López-Bermejo
- Pediatrics Research Group, Girona Institute for Biomedical Research, Girona, Spain
- Pediatrics, Dr. Josep Trueta Hospital, Girona, Spain
- TransLab Research Group, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
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274
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Schloot NC, Haupt A, Schütt M, Badenhoop K, Laimer M, Nicolay C, Reaney M, Fink K, Holl RW. Risk of severe hypoglycemia in sulfonylurea-treated patients from diabetes centers in Germany/Austria: How big is the problem? Which patients are at risk? Diabetes Metab Res Rev 2016; 32:316-24. [PMID: 26409039 DOI: 10.1002/dmrr.2722] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 08/18/2015] [Accepted: 08/31/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND We investigated the rate of severe hypoglycemic events and confounding factors in patients with type 2 diabetes treated with sulfonylurea at specialized diabetes centers, documented in the German/Austrian DPV-Wiss database. METHODS Data from 29 485 sulfonylurea-treated patients were analyzed (median[IQR] age 70.8[62.2-77.8] years, diabetes duration 8.2[4.3-12.8] years). The primary objective was to estimate the event rate of severe hypoglycemia (requiring external help, causing unconsciousness/coma/convulsion and/or emergency hospitalization). Secondary objectives included exploration of confounding risk factors through group comparison and Poisson regression. RESULTS Severe hypoglycemic events were reported in 826(2.8%) of all patients during their most recent year of sulfonylurea treatment. Of these, n = 531(1.8%) had coma, n = 501(1.7%) were hospitalized at least once. The adjusted event rate of severe hypoglycemia [95%CI] was 3.9[3.7-4.2] events/100 patient-years (coma: 1.9[1.8-2.1]; hospitalization: 1.6[1.5-1.8]). Adjusted event rates by diabetes treatment were 6.7 (sulfonylurea + insulin), 4.9 (sulfonylurea + insulin + other OAD), 3.1 (sulfonylurea + other OAD) and 3.8 (sulfonylurea only). Patients with ≥1 severe event were older (p < 0.001) and had longer diabetes duration (p = 0.020) than patients without severe events. Participation in educational diabetes-programs and indirect measures of insulin-resistance (increased BMI, plasma-triglycerides) were associated with fewer events (all p < 0.001). Impaired renal function was common (n = 3113 eGFR; ≤30 mL/min) and associated with an increased rate of severe events (≤30 mL/min: 7.7; 30-60 mL/min: 4.8; >60 mL/min: 3.9). CONCLUSIONS These real-life data showed a rate of severe hypoglycemia of 3.9/100 patient-years in sulfonylurea-treated patients from specialized diabetes centers. Higher risk was associated with known risk factors including lack of diabetes education, older age and decreased eGFR but also with lower BMI and lower triglyceride levels, suggesting that sulfonylurea treatment in those patients should be considered with caution.
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Affiliation(s)
- Nanette C Schloot
- Medical BU Diabetes, Lilly Deutschland GmbH, Bad Homburg, Bad Homburg, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Heinrich Heine University, Düsseldorf, Germany
| | - Axel Haupt
- Medical BU Diabetes, Lilly Deutschland GmbH, Bad Homburg, Bad Homburg, Germany
| | - Morten Schütt
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Klaus Badenhoop
- Department of Internal Medicine I, Division of Endocrinology and Metabolism, Goethe University Hospital, Frankfurt am Main, Germany
| | - Markus Laimer
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
- Division of Endocrinology, Diabetes & Clinical Nutrition, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Claudia Nicolay
- European Statistics, Diabetes (HTA/Medical Affairs), Lilly Deutschland GmbH, Bad Homburg, Bad Homburg, Germany
| | - Matthew Reaney
- eResearchTechnology Limited (ERT), Peterborough, United Kingdom
| | - Katharina Fink
- Institute for Epidemiology and Medical Biometry (ZIBMT), German Center for Diabetes Research (DZD), University Ulm, Ulm, Germany
| | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry (ZIBMT), German Center for Diabetes Research (DZD), University Ulm, Ulm, Germany
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275
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MATLOCH Z, KOTULÁK T, HALUZÍK M. The Role of Epicardial Adipose Tissue in Heart Disease. Physiol Res 2016; 65:23-32. [DOI: 10.33549/physiolres.933036] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Recent studies focused on epicardial fat, formerly relatively neglected component of the heart, have elucidated some of its key roles. It possesses several properties that can distinguish it from other adipose tissue depots. Its unique anatomical location in the heart predisposes the epicardial fat to be an important player in the physiological and biochemical regulation of cardiac homeostasis. Obesity is associated with an increase in epicardial fat mass. Excess of cardiac fat can contribute to greater left ventricular mass and work, diastolic dysfunction and attenuated septal wall thickening. Imbalance in adipokines levels secreted in autocrine or paracrine fashion by epicardial fat can contribute to the activation of the key atherogenic pathways in the setting of metabolic syndrome. Epicardial fat has also been identified as an important source of pro-inflammatory mediators worsening endothelial dysfunction, eventually leading to coronary artery disease. Increased production of pro-inflammatory factors by epicardial fat can also contribute to systemic insulin resistance in patients undergoing cardiac surgery. Here we review the most important roles of epicardial fat with respect to heart disease in the context of other underlying pathologies such as obesity and type 2 diabetes mellitus.
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Affiliation(s)
| | | | - M. HALUZÍK
- Institute of Endocrinology, Prague, Czech Republic
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276
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Mahmoodi BK, Veeger NJ, Middeldorp S, Lijfering WM, Brouwer JLP, ten Berg J, Hamulyák K, Meijer K. Interaction of Hereditary Thrombophilia and Traditional Cardiovascular Risk Factors on the Risk of Arterial Thromboembolism. ACTA ACUST UNITED AC 2016; 9:79-85. [DOI: 10.1161/circgenetics.115.001211] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 12/15/2015] [Indexed: 12/15/2022]
Abstract
Background—
Hereditary thrombophilia is associated with a slightly increased risk of arterial thromboembolism (ATE). Whether hereditary thrombophilia interacts with traditional cardiovascular risk factors on the risk of ATE has yet to be established.
Methods and Results—
A total of 1891 individuals belonging to 4 family cohorts from the Netherlands were included in the analyses. Five hereditary thrombophilic defects, including factor V Leiden, prothrombin G20210A defect, and deficiencies of the natural anticoagulants (ie, antithrombin, protein C, and protein S), were assessed, and data on risk factors and previous ATE were collected. Thrombophilia was associated with elevated risk of ATE (hazard ratio =1.74, 95% confidence interval, 1.18–2.58;
P
=0.005). Overall, the association of thrombophilia with ATE tended to be stronger in the presence of traditional cardiovascular risk factors, especially the synergistic effect of thrombophilia with diabetes mellitus was striking (hazard ratio of thrombophilia–ATE association was 1.41 in nondiabetics versus 8.11 in diabetics). Moreover, the association of thrombophilia with ATE tended to be stronger in females and before the age of 55 years as compared with males and individuals >55 years of age, respectively.
Conclusions—
Thrombophilia is associated with ATE. This association may be stronger in the presence of traditional cardiovascular risk factors in particular in individuals with diabetes mellitus. Future studies on thrombophilia–ATE risk should focus on high-risk populations with high prevalence of traditional cardiovascular risk factors.
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Affiliation(s)
- Bakhtawar K. Mahmoodi
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands (B.K.M., J.t.B.); Division of Hemostasis & Thrombosis, Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., N.J.G.M.V., K.M.); Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (S.M.); Department of Clinical Epidemiology, Leiden University Medical Center, University of Leiden, Leiden, The
| | - Nic J.G.M. Veeger
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands (B.K.M., J.t.B.); Division of Hemostasis & Thrombosis, Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., N.J.G.M.V., K.M.); Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (S.M.); Department of Clinical Epidemiology, Leiden University Medical Center, University of Leiden, Leiden, The
| | - Saskia Middeldorp
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands (B.K.M., J.t.B.); Division of Hemostasis & Thrombosis, Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., N.J.G.M.V., K.M.); Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (S.M.); Department of Clinical Epidemiology, Leiden University Medical Center, University of Leiden, Leiden, The
| | - Willem M. Lijfering
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands (B.K.M., J.t.B.); Division of Hemostasis & Thrombosis, Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., N.J.G.M.V., K.M.); Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (S.M.); Department of Clinical Epidemiology, Leiden University Medical Center, University of Leiden, Leiden, The
| | - Jan-Leendert P. Brouwer
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands (B.K.M., J.t.B.); Division of Hemostasis & Thrombosis, Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., N.J.G.M.V., K.M.); Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (S.M.); Department of Clinical Epidemiology, Leiden University Medical Center, University of Leiden, Leiden, The
| | - Jur ten Berg
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands (B.K.M., J.t.B.); Division of Hemostasis & Thrombosis, Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., N.J.G.M.V., K.M.); Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (S.M.); Department of Clinical Epidemiology, Leiden University Medical Center, University of Leiden, Leiden, The
| | - Karly Hamulyák
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands (B.K.M., J.t.B.); Division of Hemostasis & Thrombosis, Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., N.J.G.M.V., K.M.); Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (S.M.); Department of Clinical Epidemiology, Leiden University Medical Center, University of Leiden, Leiden, The
| | - Karina Meijer
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands (B.K.M., J.t.B.); Division of Hemostasis & Thrombosis, Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., N.J.G.M.V., K.M.); Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (S.M.); Department of Clinical Epidemiology, Leiden University Medical Center, University of Leiden, Leiden, The
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277
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Loenneke JP, Loprinzi PD. Obesity is associated with insulin resistance but not skeletal muscle dysfunction or all-cause mortality. AGE (DORDRECHT, NETHERLANDS) 2016; 38:2. [PMID: 26698153 PMCID: PMC5005886 DOI: 10.1007/s11357-015-9865-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/16/2015] [Indexed: 06/05/2023]
Abstract
Recent work has found that older adults with obesity and systemic inflammation have associated metabolic dysfunction but do not have associated lower lean mass or strength. However, this lean mass estimate may be inflated with obesity, given that 15 % of adipose tissue is composed of fat-free tissue. The primary purpose of this study was to investigate, in a nationally representative sample of adults, whether obese adults with chronic systemic inflammation (unhealthy) have differences in lean mass, muscle strength, and insulin resistance when compared to normal weight individuals without elevated levels of systemic inflammation (healthy). A secondary objective was to determine whether these potential differences were moderated by physical activity and to determine if these groups had a differential risk for all-cause mortality. Our findings suggests that the unhealthy group was associated with higher upper body lean mass (β = 823; 95 % confidence interval (CI) 637-1010; P < 0.001), lower body lean mass (β = 2724; 95 % CI 2291-3158; P < 0.001), and strength (β = 34.6; 95 % CI 13.5-55.7; P = 0.003) compared to the healthy group despite having systemic inflammation and correcting for fat-free adipose tissue. However, the unhealthy group was associated with insulin resistance (odds ratio (OR) = 16.1; 95 % CI 2.7-96.1; P = 0.005) although this finding was attenuated in those physically active (OR = 8.5; 95 % CI 2.43-30.15; P = 0.003). Despite this metabolic dysfunction, there was no difference in all-cause mortality risk between groups (hazard ratio (HR) = 1.16 (95 % CI 0.69-1.96; P = 0.54)) suggesting that higher amounts of lean mass and strength may be protective of premature mortality.
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Affiliation(s)
- Jeremy P Loenneke
- Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
| | - Paul D Loprinzi
- Center for Health Behavior Research, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, University, MS, USA
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278
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Yanala UR, Reidelberger RD, Thompson JS, Shostrom VK, Carlson MA. Effect of proximal versus distal 50% enterectomy on nutritional parameters in rats preconditioned with a high-fat diet or regular chow. Sci Rep 2015; 5:17331. [PMID: 26612764 PMCID: PMC4661515 DOI: 10.1038/srep17331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 10/29/2015] [Indexed: 12/13/2022] Open
Abstract
Obesity may protect against the nutritional consequences of short bowel syndrome. We hypothesized that rats preconditioned with an obesogenic diet would have better outcomes after surgical induction of short bowel syndrome compared to rats on regular chow. Rats were fed a high-fat diet or regular rat chow for six months, and then underwent 50% proximal, 50% distal, or sham enterectomy. Food intake, weight, and body composition were monitored before and for 4 weeks after surgery. The high-fat diet consistently produced obesity (>25% body fat). All procedures induced weight loss, but there was no discernable difference between resection vs. sham resection. Rats on the high-fat diet had a greater post-resection loss of body fat compared to rats on chow (36 vs. 26 g, respectively). There was a nonsignificant trend of less lean mass loss in the former compared to the latter rats (16 vs. 33 g, respectively). Enterectomy moderated serum ghrelin, GIP, PPY, insulin, and leptin. Intestinal adaptation was not different between obese vs. non-obese rats. Rats preconditioned with the high-fat diet may have had better retention of lean body mass after a surgical procedure compared to rats on chow. The effect of 50% enterectomy was less than expected.
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Affiliation(s)
- Ujwal R Yanala
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198.,Department of Surgery, VA-Nebraska Western Iowa Health Care System, Omaha, NE 68105
| | - Roger D Reidelberger
- Department of Surgery, VA-Nebraska Western Iowa Health Care System, Omaha, NE 68105.,Department of Biomedical Sciences, Creighton University, Omaha, NE 68178
| | - Jon S Thompson
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198
| | - Valerie K Shostrom
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE 68198
| | - Mark A Carlson
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198.,Department of Surgery, VA-Nebraska Western Iowa Health Care System, Omaha, NE 68105.,Department of Genetics, Cell Biology, and Anatomy, University of Nebraska Medical Center, Omaha, NE 68198
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279
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Benziger CP, Bernabé-Ortiz A, Gilman RH, Checkley W, Smeeth L, Málaga G, Miranda JJ. Metabolic Abnormalities Are Common among South American Hispanics Subjects with Normal Weight or Excess Body Weight: The CRONICAS Cohort Study. PLoS One 2015; 10:e0138968. [PMID: 26599322 PMCID: PMC4658165 DOI: 10.1371/journal.pone.0138968] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
Objective We aimed to characterize metabolic status by body mass index (BMI) status. Methods The CRONICAS longitudinal study was performed in an age-and-sex stratified random sample of participants aged 35 years or older in four Peruvian settings: Lima (Peru’s capital, costal urban, highly urbanized), urban and rural Puno (both high-altitude), and Tumbes (costal semirural). Data from the baseline study, conducted in 2010, was used. Individuals were classified by BMI as normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30 kg/m2), and as metabolically healthy (0–1 metabolic abnormality) or metabolically unhealthy (≥2 abnormalities). Abnormalities included individual components of the metabolic syndrome, high-sensitivity C-reactive protein, and insulin resistance. Results A total of 3088 (age 55.6±12.6 years, 51.3% females) had all measurements. Of these, 890 (28.8%), 1361 (44.1%) and 837 (27.1%) were normal weight, overweight and obese, respectively. Overall, 19.0% of normal weight in contrast to 54.9% of overweight and 77.7% of obese individuals had ≥3 risk factors (p<0.001). Among normal weight individuals, 43.1% were metabolically unhealthy, and age ≥65 years, female, and highest socioeconomic groups were more likely to have this pattern. In contrast, only 16.4% of overweight and 3.9% of obese individuals were metabolically healthy and, compared to Lima, the rural and urban sites in Puno were more likely to have a metabolically healthier profile. Conclusions Most Peruvians with overweight and obesity have additional risk factors for cardiovascular disease, as well as a majority of those with a healthy weight. Prevention programs aimed at individuals with a normal BMI, and those who are overweight and obese, are urgently needed, such as screening for elevated fasting cholesterol and glucose.
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Affiliation(s)
- Catherine P. Benziger
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Cardiology, University of Washington, Seattle, WA, United States of America
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H. Gilman
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- Asociación Benéfica PRISMA, Lima, Peru
| | - William Checkley
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- Division of Pulmonary and Critical Care, School of Medicine Johns Hopkins University, Baltimore, MD, United States of America
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Germán Málaga
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- * E-mail:
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280
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Bundhun PK, Li N, Chen MH. Does an Obesity Paradox Really Exist After Cardiovascular Intervention?: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies. Medicine (Baltimore) 2015; 94:e1910. [PMID: 26554791 PMCID: PMC4915892 DOI: 10.1097/md.0000000000001910] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Several studies have shown the existence of an obesity paradox after Percutaneous Coronary Intervention (PCI). However, other studies have shown its absence. This study sought to perform a systematic review and meta-analysis of studies comparing the mortality risk between high body mass index patients and normal weight patients after PCI.We have searched PubMed, Embase, and Chinese medical journal for randomized controlled trials (RCTs) and observational studies published between the year 2000 and 2015 by typing the keywords "percutaneous coronary intervention" and "obesity paradox." The main outcome was "all-cause mortality". RevMan 5.3 software was used to calculate the risk ratio (RR) with 95% confidence interval (CI) to express the pooled effect on discontinuous variables.Twenty-two studies have been included in this meta-analysis consisting of a total of 242,377 patients with 73,143 normal weight patients, 103,608 overweight, and 65,626 obese patients. Younger age, higher cardiovascular risk factors and the intensive use of medications have mainly been observed among obese patients followed by overweight and normal weight patients respectively. In-hospital, 12 months and ≥ 1 year (long-term) mortality risks were significantly lower in the overweight and obese groups with (RR: 0.67; 95% CI: 0.63-0.72, P < 0.00001) and (RR: 0.60; 95% CI: 0.56-0.65, P < 0.00001) respectively in the in-hospital follow-up (RR: 0.62; 95% CI: 0.55-0.71 and 0.57; 95% CI: 0.52-0.63, P < 0.00001) at 12 months, and (RR: 0.70; 95% CI: 0.64-0.76; P < 0.00001) and (RR: 0.80; 95% CI: 0.71-0.91, P = 0.0006) respectively for the long-term follow-up after PCI.This "obesity paradox" does exist after PCI. The mortality in overweight and obese patients is really significantly lower compared to the normal weight patients. However, the exact reasons for this phenomenon need further exploration and research in the future.
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Affiliation(s)
- Pravesh Kumar Bundhun
- From the Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P. R. China
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281
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Ayça B, Kafadar D, Avsar M, Avci İİ, Akın F, Okuyan E, Dinckal MH. Lower Muscle Strength and Increased Visceral Fat Associated With No-reflow and High Gensini Score in STEMI. Clin Appl Thromb Hemost 2015; 23:367-373. [DOI: 10.1177/1076029615613159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The impact of fat distribution, muscle mass, and muscle strength on no-reflow and severity of coronary artery disease in patients with ST-segment elevation myocardial infarction (STEMI) remains unclear. Objective: To investigate association between muscle strength and fat and muscle mass and severity of coronary atherosclerosis. Methods: We included 218 patients with STEMI who had undergone primary percutaneous coronary intervention. We evaluated the no-reflow phenomenon in infarct-related artery and calculated Gensini scores from initial angiograms as indicative of coronary atherosclerosis severity. The patients were divided into 2 groups as patients with no-reflow and with thrombolysis in myocardial infarction grade 3 flow and patients with low (<55) Gensini and with high (≥55) Gensini. Patients’ total fat, muscle mass, visceral fat mass, and muscle strength were measured via body composition analyzer and handgrip dynamometer. Results: High Gensini patients had a greater body mass index (BMI) and lower handgrip strength and more visceral fat ( P = .05, P = .017, and P < .001, respectively). The patients with no-reflow had significantly lower handgrip strength and more visceral fat (both, P < .001). In multivariate regression analysis, visceral fat and handgrip strength were associated with high no-reflow rate and high Gensini scores in patients with STEMI ( P = .001, P = .014, P = .022, and P = .010; respectively). Conclusion: Increased visceral fat and lower handgrip strength may be related to increased no-reflow rate and coronary plaque burden in STEMI. Visceral fat and muscle strength may be better prognostic markers than weight, BMI, total fat, and muscle mass in coronary artery disease.
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Affiliation(s)
- Burak Ayça
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Didem Kafadar
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Murat Avsar
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - İ. İlker Avci
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Fatih Akın
- Department of Cardiology, Muğla Sıtkı Koçman University, Medical School, Muğla, Turkey
| | - Ertugrul Okuyan
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - M. Hakan Dinckal
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
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282
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Kim NH, Lee J, Kim TJ, Kim NH, Choi KM, Baik SH, Choi DS, Pop-Busui R, Park Y, Kim SG. Body Mass Index and Mortality in the General Population and in Subjects with Chronic Disease in Korea: A Nationwide Cohort Study (2002-2010). PLoS One 2015; 10:e0139924. [PMID: 26462235 PMCID: PMC4604086 DOI: 10.1371/journal.pone.0139924] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/19/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The association between body mass index (BMI) and mortality is not conclusive, especially in East Asian populations. Furthermore, the association has been neither supported by recent data, nor assessed after controlling for weight changes. METHODS We evaluated the relationship between BMI and all-cause or cause-specific mortality, using prospective cohort data by the National Health Insurance Service in Korea, which consisted of more than one million subjects. A total of 153,484 Korean adults over 30 years of age without pre-existing cardiovascular disease or cancer at baseline were followed-up until 2010 (mean follow-up period = 7.91 ± 0.59 years). Study subjects repeatedly measured body weight 3.99 times, on average. RESULTS During follow-up, 3,937 total deaths occurred; 557 deaths from cardiovascular disease, and 1,224 from cancer. In multiple-adjusted analyses, U-shaped associations were found between BMI and mortality from any cause, cardiovascular disease, and cancer after adjustment for age, sex, smoking status, alcohol consumption, physical activity, socioeconomic status, and weight change. Subjects with a BMI < 23 kg/m2 and ≥ 30 kg/m2 had higher risks of all-cause and cause-specific mortality compared with the reference group (BMI 23-24.9 kg/m2). The lowest risk of all-cause mortality was observed in subjects with a BMI of 25-26.4 kg/m2 (adjusted hazard ratio [HR] 0.86; 95% CI 0.77 to 0.97). In subgroup analyses, including the elderly and those with chronic diseases (diabetes mellitus, hypertension, and chronic kidney disease), subjects with a BMI of 25-29.9 kg/m2 (moderate obesity) had a lower risk of mortality compared with the reference. However, this association has been attenuated in younger individuals, in those with higher socioeconomic status, and those without chronic diseases. CONCLUSION Moderate obesity was associated more strongly with a lower risk of mortality than with normal, underweight, and overweight groups in the general population of South Korea. This obesity paradox was prominent in not only the elderly but also individuals with chronic disease.
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Affiliation(s)
- Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Tae Joon Kim
- Department of Statistics, Korea University, Seoul, Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dong Seop Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Yousung Park
- Department of Statistics, Korea University, Seoul, Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- * E-mail:
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Abstract
As the number of older adults increases rapidly, the national epidemic of obesity is also affecting our aging population. This is particularly concerning given the numerous health risks and increased costs associated with this condition. Weight management is extremely important for older adults given the risks associated with abdominal adiposity, which is a typical fat redistribution during aging, and the prevalence of comorbid conditions in this age group. However, approaches to weight loss must be considered critically given the dangers of sarcopenia (a condition that occurs when muscle mass and quality are lost), the increased risk of hip fracture with weight loss, and the association between reduced mortality and increased BMI in older adults. This overview highlights the challenges and implications of measuring adiposity in older adults and the dangers and benefits of weight loss in this population and provides an overview of the new Medicare Obesity Benefit. In addition, we provide a summary of outcomes from successful weight loss interventions for older adults and discuss implications for advancing clinical practice.
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Affiliation(s)
- Lydia E Gill
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, USA.
- Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Lebanon, NH, 03766, USA.
| | - Stephen J Bartels
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA.
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, USA.
- Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Lebanon, NH, 03766, USA.
| | - John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA.
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, USA.
- Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
- Dartmouth Weight and Wellness Center, Lebanon, NH, USA.
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Lebanon, NH, 03766, USA.
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284
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Smitka K, Marešová D. Adipose Tissue as an Endocrine Organ: An Update on Pro-inflammatory and Anti-inflammatory Microenvironment. Prague Med Rep 2015; 116:87-111. [PMID: 26093665 DOI: 10.14712/23362936.2015.49] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Adipose tissue is recognized as an active endocrine organ that produces a number of endocrine substances referred to as "adipokines" including leptin, adiponectin, adipolin, visfatin, omentin, tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), resistin, pigment epithelium-derived factor (PEDF), and progranulin (PGRN) which play an important role in the food intake regulation and significantly influence insulin sensitivity and in some cases directly affect insulin resistance in skeletal muscle, liver, and adipose tissue. The review summarizes current knowledge about adipose tissue-derived hormones and their influence on energy homeostasis regulation. The possible therapeutic potential of these adipokines in the treatment of insulin resistance, endothelial dysfunction, a pro-inflammatory response, obesity, eating disorders, progression of atherosclerosis, type 1 diabetes, and type 2 diabetes is discussed.
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Affiliation(s)
- Kvido Smitka
- Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Dana Marešová
- Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
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285
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Pareja-Galeano H, Sanchis-Gomar F, Alis R, Morán M, Lucia A. Does midlife obesity really lower dementia risk? Lancet Diabetes Endocrinol 2015; 3:499. [PMID: 26138164 DOI: 10.1016/s2213-8587(15)00214-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Helios Pareja-Galeano
- European University of Madrid, Madrid, 28670, Spain; Research Institute of Hospital 12 de Octubre, Madrid, Spain.
| | | | - Rafael Alis
- School of Medicine and Research Institute Dr Viña Giner, Molecular and Mitochondrial Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain
| | - María Morán
- Research Institute of Hospital 12 de Octubre, Madrid, Spain; CIBER de Enfermedades Raras, U723, Madrid, Spain
| | - Alejandro Lucia
- European University of Madrid, Madrid, 28670, Spain; Research Institute of Hospital 12 de Octubre, Madrid, Spain
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286
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Wang W, Obi JC, Engida S, Carter ER, Yan F, Zhang J. The relationship between excess body weight and the risk of death from unnatural causes. ACCIDENT; ANALYSIS AND PREVENTION 2015; 80:229-235. [PMID: 25931423 DOI: 10.1016/j.aap.2015.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 04/02/2015] [Accepted: 04/19/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The purpose is to exam whether excess body weight is associated with an increased risk of death from unnatural causes, particularly, injury. METHOD We analyzed nationally representative data of 14,453 adults (19 and older) who participated in the third National Health and Nutrition Examination Survey, 1988-1994, and were followed up with vital statuses through December 31, 2006. We used Cox proportional hazard regression to estimate the hazard ratio (HR) of death from all unnatural causes combined and specific ones. Gray's test was performed to assess the equality of cumulative incidence functions between body mass index (BMI) levels. RESULTS A total of 128 unnatural deaths were recorded during an 18-year follow-up with 193,019 person-years accumulated. Compared with healthy weight participants, a person with excess body weight had a low hazard of death from unnatural causes [HR=1.00 (reference), 0.58 (0.39-0.87), and 0.50 (0.30-0.82) for healthy weight, overweight and obese participants, respectively]. Injuries, including motor vehicle accidents and falls, were the major types of unnatural deaths (n=91, 71% of all unnatural deaths), and the risk of death from injuries was linearly and reversely associated with BMI. The HRs of injury were 1.00 (reference), 0.57 (0.36-0.91), and 0.36 (0.19-0.69) for healthy weight, overweight and obese participants, respectively. All these estimates were obtained after adjustment of socio-demographic variables. DISCUSSION Excess body weight appears to be associated with a low risk of death from unnatural causes, particularly, injuries. Additional investigations on the mechanism underlying the relationship between BMI and unnatural deaths are warranted.
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Affiliation(s)
- Wei Wang
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai 200032, China
| | - Jane C Obi
- Department of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA
| | - Selam Engida
- Department of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA
| | - Elizabeth R Carter
- Department of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA
| | - Fei Yan
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai 200032, China
| | - Jian Zhang
- Department of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA.
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287
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Abstract
BACKGROUND Although controversial, most studies examining the relationship of body mass index (BMI) with mortality in diabetes suggest a paradox: the lowest risk category is above normal weight, versus normal weight in nondiabetic persons. One proposed explanation is greater morbidity of diabetes in normal weight persons. If this were so, it would suggest a health care utilization paradox in diabetes, paralleling the mortality paradox, yet no studies have examined this issue. OBJECTIVE To compare the relationship of BMI with health care utilization in diabetic versus nondiabetic persons. DESIGN Population-based cross-sectional study. SUBJECTS Adults in the 2000-2011 Medical Expenditures Panel Surveys (N=120,389). MEASURES Total health care expenditures, hospital utilization (≥1 admission), and emergency department utilization (≥1 visit). BMI (kg/m) categories were: <20 (underweight); 20 to <25 (normal); 25 to <30 (overweight); 30 to <35 (obese); and ≥35 (severely obese). Adjustors were age, sex, race/ethnicity, income, health insurance, education, smoking, co-morbidity, urbanicity, region, and year. RESULTS Among diabetic persons, adjusted mean total health care expenditures were significantly lower in obese versus normal weight persons ($1314, 95% confidence interval [CI], $513-$2115; P=0.001). By contrast, among nondiabetic persons, total expenditures were nonsignificantly higher in obese versus normal weight persons (-$229, 95% CI, -$460 to $2; P=0.052). Findings for hospital and emergency department utilization exhibited similar patterns. CONCLUSIONS Normal weight diabetic persons used substantially more health care than their overweight and obese counterparts, a difference not observed in nondiabetic persons. These differences support the plausibility of a BMI mortality paradox related to greater morbidity of diabetes in normal weight than in heavier persons.
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288
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Bagheri M, Speakman JR, Shabbidar S, Kazemi F, Djafarian K. A dose-response meta-analysis of the impact of body mass index on stroke and all-cause mortality in stroke patients: a paradox within a paradox. Obes Rev 2015; 16:416-23. [PMID: 25753533 DOI: 10.1111/obr.12272] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 02/02/2015] [Indexed: 12/27/2022]
Abstract
The obesity paradox is often attributed to fat acting as a buffer to protect individuals in fragile metabolic states. If this was the case, one would predict that the reverse epidemiology would be apparent across all causes of mortality including that of the particular disease state. We performed a dose-response meta-analysis to assess the impact of body mass index (BMI) on all-cause and stroke-specific mortality among stroke patients. Data from relevant studies were identified by systematically searching PubMed, OVID and Scopus databases and were analysed using a random-effects dose-response model. Eight cohort studies on all-cause mortality (with 20,807 deaths of 95,651 stroke patients) and nine studies of mortality exclusively because of stroke (with 8,087 deaths of 28,6270 patients) were evaluated in the meta-analysis. Non-linear associations of BMI with all-cause mortality (P < 0.0001) and mortality by stroke (P = 0.05) were observed. Among overweight and obese stroke patients, the risk of all-cause mortality increased, while the risk of mortality by stroke declined, with an increase in BMI. Increasing BMI had opposite effects on all-cause mortality and stroke-specific mortality in stroke patients. Further investigations are needed to examine how mortality by stroke is influenced by a more accurate indicator of obesity than BMI.
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Affiliation(s)
- M Bagheri
- Department of Community Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran
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289
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Body mass index and health status in diabetic and non-diabetic individuals. Nutr Diabetes 2015; 5:e152. [PMID: 25915741 PMCID: PMC4423198 DOI: 10.1038/nutd.2015.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/27/2015] [Accepted: 02/22/2015] [Indexed: 01/06/2023] Open
Abstract
Background/Objectives: There is controversy regarding the existence of a body mass index (BMI) mortality paradox in diabetes, whereby the optimal BMI category is higher than it is in non-diabetic persons. To explore possible pathways to a mortality paradox, we examined the relationship of BMI with physical and mental health status in diabetic and non-diabetic persons. Subjects/Methods: We examined adjusted SF-12 Physical and Mental Component Summary (PCS-12 and MCS-12) scores by BMI (kg m−2) category (underweight, <20; normal weight, 20 to <25; overweight, 25 to <30; obese, 30 to <35; severely obese ⩾35) in adult diabetic and non-diabetic respondents to the 2000–2011 United States national Medical Expenditure Panel Surveys (N=119 161). Adjustors were age, sex, race/ethnicity, income, health insurance, education, smoking, comorbidity, urbanicity, geographic region and survey year. Results: In non-diabetic persons the adjusted mean PCS-12 score was highest (that is, most optimal) in the normal-weight category, whereas for diabetic persons the optimal adjusted mean PCS-12 score was in the overweight category (adjusted difference between non-diabetic and diabetic persons in the difference in PCS-12 means for overweight versus normal-weight category=0.8 points, 95% confidence interval; CI 0.1, 1.6; P=0.03). This paradoxical pattern was not evident for the MCS-12, and the adjusted difference between non-diabetic and diabetic persons in the difference in MCS-12 means for overweight versus obese persons was not significant (−0.3 points, 95% CI −0.9, 0.4; P=0.43). The findings were not significantly moderated by smoking status, cancer diagnosis or time period. Conclusions: The optimal BMI category for physical health status (but not mental health status) was higher among diabetic than non-diabetic persons. The findings are consistent with a BMI physical health status paradox in diabetes and, in turn, a mortality paradox.
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290
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Tuso P, Beattie S. Nutrition reconciliation and nutrition prophylaxis: toward total health. Perm J 2015; 19:80-6. [PMID: 25902344 DOI: 10.7812/tpp/14-081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Malnutrition by definition may be an abnormality in either under- or overnutrition. Nutrition reconciliation means that all patients have their nutritional status reconciled on admission to and discharge from the hospital. Nutrition reconciliation is defined as the process of maximizing health by helping align an individual's current diet to the diet prescribed for him or her by the health care team. Nutrition prophylaxis is a proactive intervention to prevent a medical complication.
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Affiliation(s)
- Phillip Tuso
- Nephrologist at the Antelope Valley Medical Center in CA.
| | - Sam Beattie
- Director of Nutritional and Technical Services at PurFoods, LLC in Ankeny, IA.
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291
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Bień B, Bień-Barkowska K, Wojskowicz A, Kasiukiewicz A, Wojszel ZB. Prognostic factors of long-term survival in geriatric inpatients. Should we change the recommendations for the oldest people? J Nutr Health Aging 2015; 19:481-8. [PMID: 25809814 DOI: 10.1007/s12603-014-0570-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Identification of optimal predictors of the 5.5-year survival in former geriatric inpatients.Investigation of the direction and shape of the relationship between mortality risk and its predictors. DESIGN Retrospective survival analysis with the application of the Cox proportional hazards model. SETTING Teaching geriatric unit. PARTICIPANTS 478 inpatients (mean age 77.9; +6.8) discharged from geriatric ward during year 2008, without any exclusion criteria. MEASUREMENTS Comprehensive geriatric assessment of numerous health variables, body mass index (BMI), clinical and biochemical findings, and outcomes of the final diagnosis. Records on the dates of deaths were obtained from the Provincial Office of Population Register. RESULTS During the 5.5-year follow-up 209 (43.7%) patients died. In the multivariate setup, six risk factors with an independent impact on mortality were identified: age (p=0.036), cognitive functioning on the Blessed test (p=0.005), score on instrumental ADL (p<0.0001), score on Charlson comorbidity index (p<0.0001), cholesterol level (p<0.0001), BMI (p<0.0001), and hemoglobin level (p=0.02). The latter two predictors exhibited a significant inverted J-shaped association with mortality, i.e., considerably higher risk of death corresponds to the lower values of these variables in comparison to their higher levels. CONCLUSION Older age, worse IADL and cognitive functioning, and higher comorbidity were recognized as endangering one's long-term survival. On the other hand, moderate obesity (BMI 36), higher cholesterol and the absence of anemia (hemoglobin 13.6 g/dL) are associated with longer survival. Therefore, irrespective of the individualized treatment and physical exercise, nutrient-dense food seems to be a key recommendation to prevent frailty or malnutrition in the oldest and comorbid population.
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Affiliation(s)
- B Bień
- Barbara Bień, Medical University of Bialystok, Department of Geriatrics, Fabryczna 27, Bialystok, 15-471, Poland,
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292
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Lajous M, Banack HR, Kaufman JS, Hernán MA. Should patients with chronic disease be told to gain weight? The obesity paradox and selection bias. Am J Med 2015; 128:334-6. [PMID: 25460531 PMCID: PMC4495879 DOI: 10.1016/j.amjmed.2014.10.043] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 10/27/2014] [Accepted: 10/27/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Martín Lajous
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico; Department of Epidemiology, Harvard School of Public Health, Boston, Mass.
| | - Hailey R Banack
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Miguel A Hernán
- Department of Epidemiology, Harvard School of Public Health, Boston, Mass; Department of Biostatistics, Harvard School of Public Health, Boston, Mass; Harvard-MIT Division of Health Sciences and Technology, Boston, Mass
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293
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Affiliation(s)
- Thilanga Ruwanpathirana
- CCRE Therapeutics; Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - Alice Owen
- CCRE Therapeutics; Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - Christopher M. Reid
- CCRE Therapeutics; Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
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294
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Yuh B, Tate J, Butt AA, Crothers K, Freiberg M, Leaf D, Logeais M, Rimland D, Rodriguez-Barradas MC, Ruser C, Justice AC. Weight change after antiretroviral therapy and mortality. Clin Infect Dis 2015; 60:1852-9. [PMID: 25761868 DOI: 10.1093/cid/civ192] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/04/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Weight gain after antiretroviral therapy (ART) initiation is common, but its implication for mortality is unknown. We evaluated weight change in the first year after ART initiation and its association with subsequent mortality. METHODS Human immunodeficiency virus-infected patients from the Veterans Aging Cohort Study (VACS) who initiated ART between 2000 and 2008, with weight recorded at baseline and 1 year later, were followed another 5 years for mortality. Baseline body mass index (BMI) was classified as underweight (<18.5 kg/m(2)), normal (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)), and obese (≥30 kg/m(2)). We used multivariable Cox models to assess mortality risk with adjustment for disease severity using the VACS Index. RESULTS The sample consisted of 4184 men and 127 women with a mean age of 47.9 ± 10.0 years. After 1 year of ART, median weight change was 5.9 pounds (2.7 kg) (interquartile range, -2.9 to 17.0 pounds, -1.3 to 7.7 kg). Weight gain after ART initiation was associated with lower mortality among underweight and normal-weight patients. A minimum threshold of 10- to 19.9-pound (4.5 to 9.0 kg) weight gain was beneficial for normal-weight patients (hazard ratio, 0.56; 95% confidence interval, .41-.78), but there was no clear benefit to weight gain for overweight/obese patients. Baseline weight, CD4 cell count status, and hemoglobin level were strongly associated with weight gain. Risk for weight gain was higher among those with greater disease severity, regardless of weight at initiation. CONCLUSIONS The survival benefits of weight gain after ART initiation are dependent on starting BMI. Weight gain after ART is associated with lower mortality for those who are not initially overweight.
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Affiliation(s)
- Bianca Yuh
- Yale University School of Medicine, New Haven
| | - Janet Tate
- Yale University School of Medicine, New Haven Veterans Affairs (VA) Connecticut Healthcare System, West Haven
| | - Adeel A Butt
- VA Pittsburgh Healthcare System University of Pittsburgh School of Medicine, Pennsylvania
| | | | - Matthew Freiberg
- VA Pittsburgh Healthcare System University of Pittsburgh School of Medicine, Pennsylvania
| | - David Leaf
- UCLA School of Medicine Greater Los Angeles VA Healthcare System, California
| | - Mary Logeais
- University of Minnesota Medical School, Minneapolis
| | - David Rimland
- Atlanta VA Medical Center Emory University School of Medicine, Atlanta, Georgia
| | | | - Christopher Ruser
- Yale University School of Medicine, New Haven Veterans Affairs (VA) Connecticut Healthcare System, West Haven
| | - Amy C Justice
- Yale University School of Medicine, New Haven Veterans Affairs (VA) Connecticut Healthcare System, West Haven
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295
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An R, Shi Y. Body weight status and onset of functional limitations in U.S. middle-aged and older adults. Disabil Health J 2015; 8:336-44. [PMID: 25863703 DOI: 10.1016/j.dhjo.2015.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/12/2014] [Accepted: 02/18/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND The sweeping obesity epidemic could further increase the incidence of functional limitations in the U.S. rapidly aging population. OBJECTIVE To examine the relationship between body weight status and onset of functional limitations in U.S. middle-aged and older adults. METHODS Study sample came from 1992 to 2010 waves of the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling middle-aged and older adults. Body mass index (BMI) was calculated from self-reported height/weight. Functional limitations were classified into physical mobility limitation (PM), large muscle function limitation (LMF), activities of daily living limitation (ADL), gross motor function limitation (GMF), and fine motor function limitation (FMF). Mixed-effect logistic regressions were performed to estimate the relationship between prior-wave body weight status and current-wave onset of functional limitations, adjusted for individual characteristics and survey design. RESULTS Prior-wave body weight status prospectively predicted onset of functional limitation, and the relationship showed a U-shaped pattern. Compared with their normal weight counterparts, the odds ratios (ORs) in underweight (BMI < 18.5) and obese (BMI ≥ 30) adults were 1.30 (95% confidence interval, 1.05-1.62) and 2.31 (2.11-2.52) for PM, 1.20 (0.96-1.50) and 1.63 (1.49-1.79) for LMF, 2.02 (1.66-2.46) and 1.40 (1.28-1.54) for ADL, 1.96 (1.60-2.39) and 1.77 (1.62-1.93) for GMF, and 1.66 (1.37-2.02) and 1.34 (1.22-1.46) for FMF, respectively. For PM, LMF and GMF, the impact of obesity appeared more pronounced in women, whereas that of underweight more pronounced in men. CONCLUSIONS Proper weight management during aging is crucial in preventing functional limitations in middle-aged and older adults.
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Affiliation(s)
- Ruopeng An
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 1206 S 4th Street, Champaign, IL 61820, USA.
| | - Yuyan Shi
- Division of Health Policy, Department of Family and Preventive Medicine, University of California, San Diego, USA
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296
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Colombo MG, Meisinger C, Amann U, Heier M, von Scheidt W, Kuch B, Peters A, Kirchberger I. Association of obesity and long-term mortality in patients with acute myocardial infarction with and without diabetes mellitus: results from the MONICA/KORA myocardial infarction registry. Cardiovasc Diabetol 2015; 14:24. [PMID: 25885918 PMCID: PMC4396021 DOI: 10.1186/s12933-015-0189-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/04/2015] [Indexed: 02/06/2023] Open
Abstract
Background Paradoxically, beneficial effects of overweight and obesity on survival have been found in patients after cardiovascular events such as acute myocardial infarction (AMI). This obesity paradox has not been analyzed in AMI patients with diabetes even though their cardiovascular morbidity and mortality is increased compared to their counterparts without diabetes. Therefore, the objective of this long-term study was to analyze the association between body mass index (BMI) and all-cause mortality in AMI patients with and without diabetes mellitus. Methods Included in the study were 1190 patients with and 2864 patients without diabetes, aged 28-74 years, recruited from a German population-based AMI registry. Patients were consecutively hospitalized between 1 January 2000 and 31 December 2008 with a first ever AMI and followed up until December 2011. Data collection comprised standardized interviews and chart reviews. To assess the association between BMI and long-term mortality from all causes, Cox proportional hazards models were calculated adjusted for risk factors, co-morbidities, clinical characteristics, in-hospital complications as well as medical and drug treatment. Results AMI patients of normal weight (BMI 18.5-24.9 kg/m2) had the highest long-term mortality rate both in patients with and without diabetes with 50 deaths per 1000 person years and 26 deaths per 1000 person years, respectively. After adjusting for a selection of covariates, a significant, protective effect of overweight and obesity on all-cause mortality was found in AMI patients without diabetes (overweight: hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.58-0.93; p=0.009; obesity: HR 0.64, 95% CI 0.47-0.87; p=0.004). In contrast, an obesity paradox was not found in AMI patients with diabetes. However, stratified analyses showed survival benefits in overweight AMI patients with diabetes who had been prescribed statins prior to AMI (HR 0.51, 95% CI 0.29-0.89, p=0.018) or four evidence-based medications at hospital-discharge (HR 0.52, 95% CI 0.34-0.80, p=0.003). Conclusion In contrast to AMI patients without diabetes, AMI patients with diabetes do not experience a survival benefit from an elevated BMI. To investigate the underlying reasons for these findings, further studies stratifying their samples by diabetes status are needed. Electronic supplementary material The online version of this article (doi:10.1186/s12933-015-0189-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Miriam Giovanna Colombo
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, 86156, Augsburg, Germany. .,Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
| | - Christa Meisinger
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, 86156, Augsburg, Germany. .,Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
| | - Ute Amann
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, 86156, Augsburg, Germany. .,Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
| | - Margit Heier
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, 86156, Augsburg, Germany. .,Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
| | - Wolfgang von Scheidt
- Central Hospital of Augsburg, Department of Internal Medicine I-Cardiology, Stenglinstr. 2, 86156, Augsburg, Germany.
| | - Bernhard Kuch
- Central Hospital of Augsburg, Department of Internal Medicine I-Cardiology, Stenglinstr. 2, 86156, Augsburg, Germany. .,Hospital of Nördlingen, Department of Internal Medicine/Cardiology, Stoffelsberg 4, 86720, Nördlingen, Germany.
| | - Annette Peters
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
| | - Inge Kirchberger
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, 86156, Augsburg, Germany. .,Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
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297
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Shil Hong E, Khang AR, Roh E, Jeong Ku E, An Kim Y, Min Kim K, Hoon Moon J, Hee Choi S, Soo Park K, Woong Kim K, Chul Jang H, Lim S. Counterintuitive relationship between visceral fat and all-cause mortality in an elderly Asian population. Obesity (Silver Spring) 2015; 23:220-7. [PMID: 25294681 DOI: 10.1002/oby.20914] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 09/06/2014] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Abdominal obesity is considered to be a risk factor for mortality. However, recent studies indicate that overweight may be negatively associated with mortality ("obesity paradox"). The relationships between mortality and various obesity markers in an elderly Asian cohort were evaluated. METHODS Subjects of the Korean Longitudinal Study on Health and Aging (KLoSHA) (n = 1000, age ≥65 years) were included. The visceral fat area (VFA) and subcutaneous fat area (SFA) were measured using computed tomography. RESULTS A total of 222 deaths occurred during the 6-year follow-up (median = 5.2 [range 0.1-6.3] years). Body mass index (BMI), VFA, SFA, and total fat mass were negatively associated with all-cause mortality in the univariable analyses (hazard ratio [HR] 0.67 per 1 SD [95% CI 0.57-0.77], 0.66 [0.55-0.79], 0.73 [0.61-0.86], and 0.74 [0.63-0.87], respectively). BMI and VFA were significantly associated with all-cause mortality in the multivariable analyses (HR 0.85 per 1 SD [95% CI 0.73-0.99] and 0.64 [0.47-0.87], respectively). When stratified by quartiles, the HR associated with VFA was the lowest in the third quartile. CONCLUSIONS In this observational study with a short follow-up of elderly Asian people, higher amounts of visceral fat, a marker for central obesity, were associated with decreased all-cause mortality.
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Affiliation(s)
- Eun Shil Hong
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea; Department of Internal Medicine, Konkuk University College of Medicine and Konkuk University Chungju Hospital, Chungju, Korea
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298
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A discursive look at large bodies--implications for discursive approaches in nursing and health research. ANS Adv Nurs Sci 2015; 38:45-54. [PMID: 25635505 DOI: 10.1097/ans.0000000000000060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article illuminates discursive constructions of large bodies in contemporary society and discusses what discursive approaches might add to health care. Today, the World Health Organization describes a current "epidemic of obesity" and classifies large bodies as a medical condition. Texts on the obesity epidemic often draw upon alarming perspectives that involve associations of threat and catastrophe. The concern we see for body size in contemporary discourse is not new. Understandings of body size in Western societies are highly cultural and normative and could be different. The way we approach large bodies affects health care practice as well as subjects' self-perceptions.
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299
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Affiliation(s)
- Eric M Isselbacher
- From the Massachusetts General Hospital Thoracic Aortic Center, Boston, MA; and Harvard Medical School, Boston, MA.
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300
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Cunningham JW, Wiviott SD. Modern obesity pharmacotherapy: weighing cardiovascular risk and benefit. Clin Cardiol 2014; 37:693-9. [PMID: 25223901 PMCID: PMC6649490 DOI: 10.1002/clc.22304] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/27/2014] [Indexed: 12/19/2022] Open
Abstract
Obesity is a major correlate of cardiovascular disease. Weight loss improves cardiovascular risk factors and has the potential to improve outcomes. Two drugs, phentermine plus topiramate and lorcaserin, have recently been approved by the US Food and Drug Administration for the indication of obesity; a third, bupropion plus naltrexone, is under consideration for approval. In clinical trials, these drugs cause weight loss and improve glucose tolerance, lipid profile, and, with the exception of bupropion plus naltrexone, blood pressure. However, their effect on cardiovascular outcomes is unknown. In defining appropriate roles for these drugs in preventive cardiology, it is important to remember the checkered history of drugs for obesity. New weight-loss drugs share the serotonergic and sympathomimetic mechanisms that proved harmful in the cases of Fen-Phen and sibutramine, respectively, albeit with significant differences. Given these risks, randomized cardiovascular outcomes trials are needed to establish the safety, and potential benefit, of these drugs. This review will discuss the history of pharmacotherapy for obesity, existing efficacy and safety data for the novel weight-loss drugs, and issues in the design of postapproval clinical trials.
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Affiliation(s)
- Jonathan W. Cunningham
- TIMI Study Group, Cardiovascular Division, Department of MedicineBrigham and Women's HospitalBostonMassachusetts
| | - Stephen D. Wiviott
- TIMI Study Group, Cardiovascular Division, Department of MedicineBrigham and Women's HospitalBostonMassachusetts
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