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Kadier K, Dilixiati D, Zhang X, Li H, Kuang L, Huang J, Cai X, Ling T, Kong F, Liu X. Rheumatoid arthritis increases the risk of heart failure: results from the cross-sectional study in the US population and mendelian randomization analysis in the European population. Front Immunol 2024; 15:1377432. [PMID: 38863716 PMCID: PMC11165030 DOI: 10.3389/fimmu.2024.1377432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/08/2024] [Indexed: 06/13/2024] Open
Abstract
Objective Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease. Among its various complications, heart failure (HF) has been recognized as the second leading cause of cardiovascular death in RA patients. The objective of this study was to investigate the relationship between RA and HF using epidemiological and genetic approaches. Methods The study included 37,736 participants from the 1999-2020 National Health and Nutrition Examination Survey. Associations between RA and HF in the US population were assessed with weighted multivariate logistic regression analysis. A two-sample Mendelian randomization (MR) analysis was employed to establish the causal relationship between the two variables. The primary analysis method utilized was inverse variance weighting (IVW). Additionally, horizontal pleiotropy and heterogeneity were assessed to account for potential confounding factors. In cases where multiple independent datasets were accessible during MR analysis, we combined the findings through a meta-analytical approach. Results In observational studies, the prevalence of HF in combination with RA reached 7.11% (95%CI 5.83 to 8.39). RA was positively associated with an increased prevalence of HF in the US population [odds ratio (OR):1.93, 95% confidence interval (CI):1.47-2.54, P < 0.0001]. In a MR analysis utilizing a meta-analytical approach to amalgamate the results of the IVW method, we identified a significant causal link between genetically predicted RA and a heightened risk of HF (OR = 1.083, 95% CI: 1.028-1.141; P = 0.003). However, this association was not deemed significant for seronegative RA (SRA) (OR = 1.028, 95% CI: 0.992-1.065; P = 0.126). These findings were consistent across sensitivity analyses and did not indicate any horizontal pleiotropy. Conclusion RA correlates with an elevated prevalence of HF within the US population. Furthermore, genetic evidence derived from European populations underscores a causal link between RA and the risk of HF. However this association was not significant in SRA.
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Affiliation(s)
- Kaisaierjiang Kadier
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Diliyaer Dilixiati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xu Zhang
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Chongqing Reproductive Genetics Institute, Chongqing, China
| | - Huan Li
- Chongqing College of Electronic Engineering, Chongqing, China
| | - Lirong Kuang
- Department of Ophthalmology, Wuhan Wuchang Hospital (Wuchang Hospital Affiliated to Wuhan University of Science and Technology), Wuhan, China
| | - Jian Huang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Department of Diagnostic Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Xintian Cai
- Department of Graduate School, Xinjiang Medical University, Urumqi, China
| | - Tao Ling
- Department of Pharmacy, Suqian First Hospital, Suqian, China
| | - Fanqi Kong
- Department of Cardiology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaozhu Liu
- Department of Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Trends and disparities in osteoarthritis prevalence among US adults, 2005-2018. Sci Rep 2021; 11:21845. [PMID: 34750468 PMCID: PMC8576014 DOI: 10.1038/s41598-021-01339-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/19/2021] [Indexed: 11/14/2022] Open
Abstract
Studies reporting trends and disparities of osteoarthritis (OA) in the United States are limited. We aimed to examine trends and disparities of OA prevalence among US adults, from 2005 to 2018. Continuous National Health and Nutrition Examination Survey (NHANES) data from 2005–2006 to 2017–2018 were analyzed. Age-adjusted and self-reported OA prevalence, stratified by race/ethnicity and socioeconomic status (SES), was calculated separately for men and women. The linear trend and the association between the survey cycles and OA prevalence were assessed. Age-adjusted and self-reported OA prevalence linearly increased in the seven survey cycles (both Plinear trend ≤ 0.0002) in men and women. Non-Hispanic Caucasians (both Plinear trend ≤ 0.0001) in both genders and Non-Hispanic African Americans women (Plinear trend ≤ 0.0001) had significantly increasing linear trends in OA prevalence. In addition, people with lower SES had a lower age-adjusted prevalence of self-reported OA when compared to those with higher SES. The increasing linear trends still existed among both men and women after adjusting for multiple confounders (both Plinear trend ≤ 0.002). There were significant rising trends and disparities in self-reported OA prevalence among US men and women between 2005 and 2018.
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Prevalence Trend and Disparities in Rheumatoid Arthritis among US Adults, 2005-2018. J Clin Med 2021; 10:jcm10153289. [PMID: 34362073 PMCID: PMC8348893 DOI: 10.3390/jcm10153289] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 01/01/2023] Open
Abstract
Rheumatoid arthritis (RA) trends among US adults and disparities in RA patients in recent years have not been well described. We aimed to examine the trend of RA prevalence and disparities among US adults. Data from the National Health and Nutrition Examination Survey (NHANES) of the years 2005–2018 were analyzed to examine the self-reported RA prevalence trend. Age-adjusted RA prevalence stratified by race/ethnicity and socioeconomic status (SES), as well as associated linear trends, were calculated for both genders. The multivariable adjustment was used to evaluate the association between race, SES, and RA. During 2005–2018, there was no significant linear trend in the age-adjusted self-reported RA prevalence among men and women, but significant differences among people from different races, educational levels, and family poverty income ratio (PIR) groups were observed. The RA rate difference was significant for both genders and between Non-Hispanic Caucasians and Non-Hispanic African Americans (both p-value ≤ 0.001). Both men and women with a higher educational level and a higher PIR had a lower age-adjusted RA rate. Age-adjusted RA prevalence fluctuated for both men and women during 2005–2018. Non-Hispanic African Americans and people with low SES had significantly higher age-adjusted RA prevalence and RA risk.
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4
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Thanoo N, Gilbert AL, Trainor S, Semanik PA, Song J, Lee J, Dunlop DD, Chang RW. The Relationship between Polypharmacy and Physical Activity in Those with or at Risk of Knee Osteoarthritis. J Am Geriatr Soc 2020; 68:2015-2020. [PMID: 32441333 DOI: 10.1111/jgs.16501] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Physical activity is associated with improved pain, functional status, and less disability in persons with knee osteoarthritis (KOA). Because polypharmacy is related to several adverse health outcomes in older persons, we hypothesized that it might also be associated with decreased physical activity in those with KOA. This study evaluates the relationship between the number of prescription medications and weekly moderate to vigorous physical activity (MVPA). DESIGN We used hierarchical median quantile regression analysis to examine the cross-sectional association between the number of prescription medications taken in the past 30 days and the median objectively measured MVPA minutes controlling for demographic and clinical variables. SETTING Four Osteoarthritis Initiative (OAI) recruitment centers in Providence, Rhode Island; Columbus, Ohio; Baltimore, Maryland; and Pittsburgh, Pennsylvania. PARTICIPANTS Accelerometer monitoring occurred in 2,127 OAI participants. Of these, 1,889 participants had 4 or more days of valid physical activity monitoring data and complete medication/covariate data. Data were collected at the 48-month OAI follow-up visit (2008-2010). MEASUREMENTS The outcome was weekly minutes of MVPA measured with an accelerometer. Number/type of prescribed medications and covariate data (age, sex, race/ethnicity, body mass index, presence of comorbidities, pain, depressive symptoms, and radiographic KOA severity) were taken from the public OAI database. Polypharmacy was defined as taking five or more prescribed medications. RESULTS The prevalence of polypharmacy in the study population was 28.2%. Each additional prescription medication was related to a decrease of 3.6 minutes (95% confidence interval [CI] = -4.8 to -2.1) in median weekly MVPA minutes. Participants meeting the polypharmacy criterion exhibited a decrease of 12.6 minutes (95% CI = -21.2 to -4.7) in median weekly MVPA minutes compared with those not meeting the criterion. CONCLUSION An increased number of prescription medications and polypharmacy are associated cross-sectionally with decreased MVPA in adults with KOA. Further study is necessary to establish the causal nature of this association.
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Affiliation(s)
- Nivaas Thanoo
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Abigail L Gilbert
- Department of Medicine, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sean Trainor
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pamela A Semanik
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Adult Health and Gerontological Nursing, Rush University College of Nursing, Chicago, Illinois, USA
| | - Jing Song
- Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jungwha Lee
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dorothy D Dunlop
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rowland W Chang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Sadia S, Tariq A, Shaheen S, Malik K, khan F, Ahmad M, Qureshi H, Nayyar BG. Ethnopharmacological profile of anti-arthritic plants of Asia-a systematic review. J Herb Med 2018. [DOI: 10.1016/j.hermed.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
PURPOSE OF REVIEW Physical activity is increasingly recommended for chronic pain. In this review, we briefly survey recent, high-quality meta-analyses on the effects of exercise in human chronic pain populations, followed by a critical discussion of the rodent literature. RECENT FINDINGS Most meta-analytical studies on the effects of exercise in human chronic pain populations describe moderate improvements in various types of chronic pain, despite substantial variability in the outcomes reported in the primary literature. The most consistent findings suggest that while greater adherence to exercise programs produces better outcomes, there is minimal support for the superiority of one type of exercise over another. The rodent literature similarly suggests that while regular exercise reduces hypersensitivity in rodent models of chronic pain, exercise benefits do not appear to relate to either the type of injury or any particular facet of the exercise paradigm. Potential factors underlying these results are discussed, including the putative involvement of stress-induced analgesic effects associated with certain types of exercise paradigms. Exercise research using rodent models of chronic pain would benefit from increased attention to the role of stress in exercise-induced analgesia, as well as the incorporation of more clinically relevant exercise paradigms.
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Affiliation(s)
- Mark Henry Pitcher
- Pain and Integrative Neuroscience Laboratory, National Center for Complementary and Integrative Health, National Institutes of Health, Room 1E-420, 35A Convent Drive, Bethesda, MD, 20892, USA.
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Madva EN, Gomez-Bernal F, Millstein RA, Celano CM, Park ER, Mastromauro CA, Albanese AM, Beale EE, Huffman JC. Magnitude and sources of distress in mid-life adults with chronic medical illness: an exploratory mixed-methods analysis. PSYCHOL HEALTH MED 2018; 23:555-566. [PMID: 28984158 PMCID: PMC6186490 DOI: 10.1080/13548506.2017.1384554] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Most mid-life adults have at least one chronic medical condition (CMC) and are at risk for developing additional CMCs. Stressors specific to this life stage may contribute to CMC development by hindering healthy behaviors. The goal of this study was to compare sources and intensity of distress, as they relate to health behaviors, between mid-life and non-mid-life adults with CMCs. We utilized a mixed-methods approach by analyzing quantitative self-report measures of psychiatric symptoms and psychological well-being, with in-depth, semi-structured qualitative interviews to identify sources of stress in three cohorts of patients with CMCs (heart failure, type 2 diabetes, and coronary artery disease). Between-group differences on self-report measures were compared via independent samples t-tests and relevant themes from interview transcripts were compared via chi-square analysis. We found that mid-life participants (n = 30) reported greater psychological distress (depression/anxiety) than non-mid-life (n = 62) participants (Hospital Anxiety and Depression Scale scores 13.8 [SD 7.3] vs. 10.6 [SD 6.6]; t(90)=2.13; p = .035), and qualitative analysis revealed several specific sources of stress significantly more common (p < .001) in mid-life adults. Interventions targeting the needs of this population could reduce distress, improve health behaviors, and have a major impact on public health.
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Affiliation(s)
- Elizabeth N. Madva
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | - Rachel A. Millstein
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Christopher M. Celano
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Elyse R. Park
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | | | - Eleanor E. Beale
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Jeff C. Huffman
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Duarte N, Rodrigues AM, Branco JDC, Canhão H, Hughes SL, Paúl C. Health and Lifestyles Factors Associated With Osteoarthritis among Older Adults in Portugal. Front Med (Lausanne) 2017; 4:192. [PMID: 29167793 PMCID: PMC5682311 DOI: 10.3389/fmed.2017.00192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/24/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aimed to identify independent associations of sociodemographic, functionality, physical activity, physical and mental health, and osteoarthritis (OA), among older adults. METHODS A sample of 1,645 older adults (50+ years) observed by rheumatologists, from EpiReumaPt, a population-based study was analyzed. A structured interview included sociodemographic data, chronic non-communicable disease, and physical activity. Functional ability was assessed by the Health Assessment Questionnaire Disability Index; depression and anxiety were assessed by Hospital Anxiety and Depression Scale. OA (knee OA and/or hip OA and/or hand OA) was defined after medical evaluation by rheumatologists according to expert opinion combined with the fulfillment of the American College of Rheumatology classification criteria. RESULTS 1,059 participants (64.9%) met the OA classification criteria. Statistically significant differences were found between persons with and without OA in all sociodemographic variables, non-communicable diseases, functional status, physical activity, depression, and anxiety. In the unadjusted logistic regression models, all variables were associated with OA. The final adjusted model explained 32% of the variance. Those who are female with higher age, have more than five comorbidities, and lower levels of function and physical activity were more likely to meet the criteria for a diagnosis of OA. DISCUSSION We have analyzed data from a population-based study and found that a diagnosis of OA was independently associated with age, female gender, higher number of comorbidities, physical disability, and low levels of physical activity. These results reinforce the usefulness of the development of a multidimensional assessment to design and test effective interventions for this population.
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Affiliation(s)
- Natália Duarte
- Research Unit on Ageing, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), University of Porto, Porto, Portugal
| | - Ana Maria Rodrigues
- EpiReumaPt Study Group—Sociedade Portuguesa de Reumatologia, Lisboa, Portugal
- EpiDoc Unit—Unidade de Epidemiologia em Doenças Crónicas (CEDOC, NMS/UNL), Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Jaime Da Cunha Branco
- EpiReumaPt Study Group—Centro de Estudos de Doenças Crónicas (CEDOC) da NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Centro Hospitalar Lisboa Ocidental (CHLO-EPE), Sociedade Portuguesa de Reumatologia, Lisbon, Portugal
| | - Helena Canhão
- EpiReumaPt Study Group—Centro de Estudos de Doenças Crónicas (CEDOC), EpiDoC Unit, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Escola Nacional de Saúde Publica, Universidade Nova de Lisboa, Sociedade Portuguesa de Reumatologia, Serviço de Reumatologia do Hospital de Santa Maria, Centro Hospitalar Lisboa Norte (CHLN-EPE), Lisboa, Portugal
| | - Susan L. Hughes
- Community Health Sciences, School of Public Health, Center for Research on Health and Aging, University of Illinois at Chicago, Chicago, IL, United States
| | - Constança Paúl
- Research Unit on Ageing, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), University of Porto, Porto, Portugal
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Song J, Gilbert AL, Chang RW, Pellegrini CA, Ehrlich-Jones LS, Lee J, Pinto D, Semanik PA, Sharma L, Kwoh CK, Jackson RD, Dunlop DD. Do Inactive Older Adults Who Increase Physical Activity Experience Less Disability: Evidence From the Osteoarthritis Initiative. J Clin Rheumatol 2017; 23:26-32. [PMID: 28002153 PMCID: PMC5180208 DOI: 10.1097/rhu.0000000000000473] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physical inactivity is a leading risk factor for developing disability. Although randomized clinical trials have demonstrated improving physical activity can reduce this risk in older adults with arthritis, these studies did not specifically evaluate inactive adults. OBJECTIVES The aim of this study was to evaluate the relationship of changes in physical activity with disability changes among initially inactive adults with or at high risk of knee osteoarthritis from Osteoarthritis Initiative. METHODS Inactive persons were identified at baseline based on the US Department of Health and Human Services classification (no [zero] 10-minute session of moderate-to-vigorous [MV] activity over 1 week) from objective accelerometer monitoring. Two years later, physical activity change status was classified as follows: (1) met Federal physical activity guidelines (≥150 MV minutes/week acquired in bouts ≥10 minutes), (2) insufficiently increased activity (some but <150 MV bout minutes/week), or (3) remained inactive. Disability at baseline and 2 years was assessed by Late Life Disability Instrument limitation and frequency scores. Multiple regression evaluated the relationship of physical activity change status with baseline-to-2-year changes in disability scores adjusting for socioeconomics, health factors, and baseline disability score. RESULTS Increased physical activity showed a graded relationship with improved disability scores in Late Life Disability Instrument limitation (P < 0.001) and frequency scores (P = 0.027). While increasing MV activity to guideline levels showed the greatest reduction, even insufficiently increased physical activity was related to reduced disability. CONCLUSIONS Findings support advice to increase MV physical activity to reduce disability among inactive adults with or at high risk of knee osteoarthritis, even when guidelines are not met.
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Affiliation(s)
- Jing Song
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Rowland W. Chang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Jungwha Lee
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel Pinto
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Leena Sharma
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - C. Kent Kwoh
- University of Arizona Arthritis Center, Tucson, Arizona
| | | | - Dorothy D. Dunlop
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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10
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Lo T, Parkinson L, Cunich M, Byles J. Discordance between self-reported arthritis and musculoskeletal signs and symptoms in older women. BMC Musculoskelet Disord 2016; 17:494. [PMID: 27905906 PMCID: PMC5133957 DOI: 10.1186/s12891-016-1349-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/23/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Arthritis is a gendered disease where women have a higher prevalence and more disability than men with arthritis of the same age. Health survey data is a major source of information for monitoring of the burden of arthritis. The validity of self-reported arthritis and the determinants of its accuracy among women have not been thoroughly studied. The objectives of this study were to: 1) examine the agreement between self-report diagnosed arthritis and musculoskeletal signs and symptoms in community-living older women; 2) estimate the sensitivity, specificity, and predictive values of self-reported arthritis; and 3) assess the factors associated with the disagreement. METHODS A cross-sectional survey of women was undertaken in 2012-13. The health survey asked women about diagnosed arthritis and musculoskeletal signs and symptoms. Agreement between self-reported arthritis and musculoskeletal signs symptoms was measured by Cohen's kappa. Sensitivity, specificity, and predictive values of self-reported arthritis were estimated using musculoskeletal signs and symptoms as the reference standard. Factors associated with disagreement between self-reported arthritis and the reference standard were examined using multiple logistic regression. RESULTS There were 223 participants self-reported arthritis and 347 did not. A greater number of participants who self-reported arthritis were obese compared to those who did not report arthritis. Those who reported arthritis had worse health, physical functioning, and arthritis symptom measures. Among the 570 participants, 198 had musculoskeletal signs and symptoms suggesting arthritis (the reference standard). Agreement between self-reported arthritis and the reference standard was moderate (kappa = 0.41). Sensitivity, specificity, and positive and negative predictive values of self-reported arthritis in older women were 66.7, 75.5, 59.2, and 81.0% respectively. Regression analysis results indicated that false-positive is associated with better health measured by the Short Form 36 physical summary score, the Health Assessment Questionnaire disability index, or the Western Ontario and McMaster University Osteoarthritis Index total score; whereas false-negative is negatively associated with these variables. CONCLUSION While some women who reported diagnosed arthritis did not have recent musculoskeletal signs or symptoms, others with the signs and symptoms did not report diagnosed arthritis. Researchers should use caution when employing self-reported arthritis as the case-definition in epidemiological studies.
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Affiliation(s)
- Tkt Lo
- Research Centre for Gender, Health and Ageing, HMRI, University of Newcastle, C/- University Drive, Callaghan, NSW, 2308, Australia.
| | - Lynne Parkinson
- Central Queensland University, Rockhampton, QLD, 4701, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Michelle Cunich
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, 2006, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Julie Byles
- Research Centre for Gender, Health and Ageing, HMRI, University of Newcastle, C/- University Drive, Callaghan, NSW, 2308, Australia
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11
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Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: Why and when. Best Pract Res Clin Rheumatol 2015; 29:120-30. [PMID: 26267006 PMCID: PMC4534717 DOI: 10.1016/j.berh.2015.04.022] [Citation(s) in RCA: 259] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chronic pain broadly encompasses both objectively defined conditions and idiopathic conditions that lack physical findings. Despite variance in origin or pathogenesis, these conditions are similarly characterized by chronic pain, poor physical function, mobility limitations, depression, anxiety, and sleep disturbance, and they are treated alone or in combination by pharmacologic and non-pharmacologic approaches, such as physical activity (aerobic conditioning, muscle strengthening, flexibility training, and movement therapies). Physical activity improves general health, disease risk, and progression of chronic illnesses such as cardiovascular disease, type 2 diabetes, and obesity. When applied to chronic pain conditions within appropriate parameters (frequency, duration, and intensity), physical activity significantly improves pain and related symptoms. For chronic pain, strict guidelines for physical activity are lacking, but frequent movement is preferable to sedentary behavior. This gives considerable freedom in prescribing physical activity treatments, which are most successful when tailored individually, progressed slowly, and account for physical limitations, psychosocial needs, and available resources.
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Affiliation(s)
- Kirsten R Ambrose
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Chang RW, Semanik PA, Lee J, Feinglass J, Ehrlich-Jones L, Dunlop DD. Improving physical activity in arthritis clinical trial (IMPAACT): study design, rationale, recruitment, and baseline data. Contemp Clin Trials 2014; 39:224-35. [PMID: 25183043 DOI: 10.1016/j.cct.2014.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/14/2014] [Accepted: 08/16/2014] [Indexed: 11/30/2022]
Abstract
Over 21 million Americans report an arthritis-attributable activity limitation. Knee osteoarthritis (OA) and rheumatoid arthritis (RA) are two of the most common/disabling forms of arthritis. Various forms of physical activity (PA) can improve a variety of health outcomes and reduce health care costs, but the proportion of the US population engaging in the recommended amount of PA is low and even lower among those with arthritis. The Improving Motivation for Physical Activity in Arthritis Clinical Trial (IMPAACT) is a randomized clinical trial that studied the effects of a lifestyle PA promotion intervention on pain and physical function outcomes. The IMPAACT intervention was based on a chronic care/disease management model in which allied health professionals promote patient self-management activities outside of traditional physician office encounters. The program was a motivational interviewing-based, individualized counseling and referral intervention, directed by a comprehensive assessment of individual patient barriers and strengths related to PA performance. The specific aims of IMPAACT were to test the efficacy of the IMPAACT intervention for persons with arthritis (N=185 persons with RA and 155 persons with knee OA) in improving arthritis-specific and generic self-reported pain and Physical Function outcomes, observed measures of function, and objectively measured and self-reported PA levels. Details of the stratified-randomized study design, subject recruitment, and data collection are described. The results from IMPAACT will generate empiric evidence pertaining to increasing PA levels in persons with arthritis and result in widely applicable strategies for health behavior change.
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Affiliation(s)
- Rowland W Chang
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 633 N St. Clair, 18th Floor, Chicago, IL 60611, USA; Rehabilitation Institute of Chicago Arthritis Center, 345 E. Superior, Chicago, IL 60611, USA.
| | - Pamela A Semanik
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 633 N St. Clair, 18th Floor, Chicago, IL 60611, USA; Rehabilitation Institute of Chicago Arthritis Center, 345 E. Superior, Chicago, IL 60611, USA; Rush College of Nursing, 600 S Paulina St, #440, Chicago, IL 60612, USA
| | - Jungwha Lee
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 633 N St. Clair, 18th Floor, Chicago, IL 60611, USA
| | - Joseph Feinglass
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 633 N St. Clair, 18th Floor, Chicago, IL 60611, USA
| | - Linda Ehrlich-Jones
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 633 N St. Clair, 18th Floor, Chicago, IL 60611, USA; Rehabilitation Institute of Chicago Arthritis Center, 345 E. Superior, Chicago, IL 60611, USA
| | - Dorothy D Dunlop
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 633 N St. Clair, 18th Floor, Chicago, IL 60611, USA
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13
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Mo F, Morrison H, Neutel IC. Population attributable risk from obesity to arthritis in the Canadian Population Health Longitudinal Survey 1994-2006. Int J Rheum Dis 2014; 17:628-34. [DOI: 10.1111/1756-185x.12372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Frank Mo
- Social Determinants and Science Integration Directorate; Public Health Agency of Canada; Ottawa Ontario Canada
| | - Howard Morrison
- Social Determinants and Science Integration Directorate; Public Health Agency of Canada; Ottawa Ontario Canada
| | - Ineke C. Neutel
- The R. Samuel McLaughlin Centre; Institute of Population Health; University of Ottawa; Ottawa Ontario Canada
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Abstract
The rising rate of overweight/obesity among the ever-growing ageing population is imposing massive and rapidly changing burdens of ill health. The observation that the BMI value associated with the lowest relative mortality is slightly higher in older than in younger adults, mainly through its reduced impact on coronary heart disease, has often been misinterpreted that obesity is not as harmful in the elderly, who suffer a large range of disabling consequences of obesity. All medical consequences of obesity are multi-factorial and most alleviated by modest, achievable weight loss (5-10 kg) with an evidence-based maintenance strategy. But severe obesity, e.g. BMI >40 may demand greater weight loss e.g. >15 kg to reverse type 2 diabetes. Since relatively reduced physical activity and reduced muscle mass (sarcopenic obesity) are common in the elderly, combining exercise and modest calorie restriction optimally reduces fat mass and preserves muscle mass - age presents no obstacle and reducing polypharmacy is a valuable outcome. The currently licensed drug orlistat has no age-related hazards and is effective in a low fat diet, but the risks from bariatric surgery begin to outweigh benefits above age 60. For the growing numbers of obese elderly with diabetes, the glucagon-like peptide-1 (GLP-1) receptor analogue liraglutide appears a safe way to promote and maintain substantial weight loss. Obesity and sarcopenia should be prevented from younger age and during life-transitions including retiral to improve future health outcomes and quality of life, with a focus on those in "obese families".
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Affiliation(s)
- T S Han
- Department of Diabetes & Endocrinology, St Peter's NHS Foundation Trust, Chertsey, Surrey KT16 0PZ, United Kingdom
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15
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Gremese E, Carletto A, Padovan M, Atzeni F, Raffeiner B, Giardina AR, Favalli EG, Erre GL, Gorla R, Galeazzi M, Foti R, Cantini F, Salvarani C, Olivieri I, Lapadula G, Ferraccioli G. Obesity and reduction of the response rate to anti-tumor necrosis factor α in rheumatoid arthritis: an approach to a personalized medicine. Arthritis Care Res (Hoboken) 2013; 65:94-100. [PMID: 22730143 DOI: 10.1002/acr.21768] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 05/21/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Obesity is a mild, long-lasting inflammatory disease and, as such, could increase the inflammatory burden of rheumatoid arthritis (RA). The study aim was to determine whether obesity represents a risk factor for a poor remission rate in RA patients requiring anti-tumor necrosis factor α (anti-TNFα) therapy for progressive and active disease despite treatment with methotrexate or other disease-modifying antirheumatic drugs. METHODS Patients were identified from 15 outpatient clinics of university hospitals and hospitals in Italy taking part in the Gruppo Italiano di Studio sulle Early Arthritis network. Disease Activity Score in 28 joints (DAS28), body mass index (BMI; categorized as <25, 25-30, and >30 kg/m(2) ), acute-phase reactants, IgM rheumatoid factor, and anti-cyclic citrullinated peptide antibody values were collected. DAS28 remission was defined as a score of <2.6 lasting for at least 3 months. RESULTS Six hundred forty-one outpatients with longstanding RA receiving anti-TNFα blockers (adalimumab, n = 260; etanercept, n = 227; infliximab, n = 154), recruited from 2006-2009 and monitored for at least 12 months, were analyzed. The mean ± SD DAS28 at baseline was 5.6 ± 1.4. A BMI of >30 kg/m(2) was recorded in 66 (10.3%) of 641 RA patients. After 12 months of anti-TNFα treatment, a DAS28 of <2.6 was noted in 15.2% of the obese subjects, in 30.4% of the patients with a BMI of 25-30 kg/m(2) , and in 32.9% of the patients with a BMI of <25 kg/m(2) (P = 0.01). The lowest percentage of remission, which was statistically significant versus adalimumab and etanercept (P = 0.003), was observed with infliximab. CONCLUSION Obesity represents a risk factor for a poor remission rate in patients with longstanding RA treated with anti-TNFα agents. A personalized treatment plan might be a possible solution.
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Affiliation(s)
- Elisa Gremese
- Catholic University of the Sacred Heart, Rome, Italy.
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Lee J, Song J, Hootman JM, Semanik PA, Chang RW, Sharma L, van Horn L, Bathon JM, Eaton CB, Hochberg MC, Jackson R, Kwoh CK, Mysiw WJ, Nevitt M, Dunlop DD. Obesity and other modifiable factors for physical inactivity measured by accelerometer in adults with knee osteoarthritis. Arthritis Care Res (Hoboken) 2013; 65:53-61. [PMID: 22674911 DOI: 10.1002/acr.21754] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 05/25/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the public health impact of obesity and other modifiable risk factors related to physical inactivity in adults with knee osteoarthritis (OA). METHODS The frequency of inactivity as defined by the US Department of Health and Human Services was assessed from objective accelerometer monitoring of 1,089 participants (ages 49-84 years) with radiographic knee OA during the Osteoarthritis Initiative 48-month visit (2008-2010). The relationship between modifiable factors (weight status, dietary fat, fiber, smoking, depressive symptoms, knee function, knee pain, and knee confidence) with inactivity was assessed using odds ratios (ORs) and attributable fractions (AFs), controlling for descriptive factors (age, sex, race, education, lives alone, employment, frequent knee symptoms, and comorbidity). RESULTS Almost half (48.9%) of participants with knee OA were inactive. Being overweight (OR 1.8, 95% confidence interval [95% CI] 1.2-2.5) or obese (OR 3.9, 95% CI 2.6-5.7), having inadequate dietary fiber intake (OR 1.6, 95% CI 1.2-2.2), severe knee dysfunction (OR 1.9, 95% CI 1.3-2.8), and severe pain (OR 1.7, 95% CI 1.1-2.5) were significantly related to inactivity, controlling for descriptive factors. Modifiable factors with significant average AFs were being overweight or obese (AF 23.8%, 95% CI 10.5-38.6%) and inadequate dietary fiber (AF 12.1%, 95% CI 0.1-24.5%), controlling for all factors. CONCLUSION Being obese or overweight, the quality of the diet, severe pain, and severe dysfunction are significantly associated with physical inactivity in adults with knee OA. All components should be considered in designing physical activity interventions that target arthritis populations with low activity levels.
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Affiliation(s)
- Jungwha Lee
- Northwestern University, Chicago, IL 60611, USA.
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17
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Canizares M, Badley EM. Comparison of health-related outcomes for arthritis, chronic joint symptoms, and sporadic joint symptoms: a population-based study. Arthritis Care Res (Hoboken) 2013; 64:1708-14. [PMID: 22674793 DOI: 10.1002/acr.21735] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine predictors and health outcomes for individuals reporting arthritis, chronic joint symptoms (CJS), or sporadic joint symptoms (SJS) compared to those without arthritis or joint symptoms. METHODS Data from the 2008 Canadian Community Health Survey (n = 63,134, ages ≥15 years) were used for the analyses. Respondents not reporting arthritis as a long-term chronic health condition diagnosed by a health professional were asked about joint symptoms, excluding the back and neck, over the past 12 months and whether these symptoms were present on most days in the past month (CJS) or not (SJS). Log Poisson regression was used to estimate prevalence ratios (PRs) for reporting arthritis, CJS, and SJS, and for reporting health outcomes (physical activity, pain that limits activity, activity limitation, poor/fair self-rated health, and poor/fair self-rated mental health) and health service use (visits to primary care physicians, specialists, physiotherapists, and chiropractors, and overnight hospital stays). RESULTS Arthritis was reported by 16.0% of the population, CJS by 10.1%, and SJS by 11.6%. Individuals with arthritis were older than those with CJS or SJS. Women reported arthritis and CJS more often. After adjusting for age, sex, socioeconomic status, lifestyle factors, and comorbidities, PRs of all outcomes were higher for the arthritis and CJS groups than the SJS group, with no significant differences in PRs for the arthritis and CJS groups, except for pain that limits activity. CONCLUSION CJS were reported by 10% of the adult population. Similarities in outcomes to arthritis suggest that CJS have a substantial impact in the population, and that arthritis management advice is likely needed for this group.
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Affiliation(s)
- Mayilee Canizares
- Arthritis Community Research & Evaluation Unit, Toronto Western Research Institute, University Health Network, Ontario, Canada.
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18
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Lee J, Dunlop D, Ehrlich-Jones L, Semanik P, Song J, Manheim L, Chang RW. Public health impact of risk factors for physical inactivity in adults with rheumatoid arthritis. Arthritis Care Res (Hoboken) 2012; 64:488-93. [PMID: 22278986 DOI: 10.1002/acr.21582] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the potential public health impact of modifiable risk factors related to physical inactivity in adults with rheumatoid arthritis (RA). METHODS A cross-sectional study used baseline data from 176 adults with RA enrolled in a randomized controlled trial assessing the effectiveness of an intervention to promote physical activity. Accelerometer data were assessed for inactivity (i.e., no sustained 10-minute periods of moderate to vigorous intensity physical activity during a week's surveillance). The relationships between modifiable risk factors (motivation for physical activity, beliefs related to physical activity, obesity, pain, and mental health) and inactivity were assessed using odds ratios (ORs) and attributable fractions (AFs), controlling for descriptive factors (age, sex, race, education, disease duration, and comorbidity). RESULTS More than 2 in 5 adults (42%) with RA were inactive. Factors most strongly related to inactivity were lack of strong motivation for physical activity (adjusted OR 2.85; 95% confidence interval [95% CI] 1.31, 6.20 and adjusted AF 53.1%; 95% CI 21.7, 74.6) and lack of strong beliefs related to physical activity (OR 2.47; 95% CI 1.10, 5.56 and AF 49.2%; 95% CI 7.0, 76.4). Together, these 2 factors are related to almost 65% excess inactivity in this sample. CONCLUSION These results support the development of interventions that increase motivation for physical activity and that lead to stronger beliefs related to physical activity's benefits, and should be considered in public health initiatives to reduce the prevalence of physical inactivity in adults with RA.
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Affiliation(s)
- Jungwha Lee
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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19
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Bollegala D, Perruccio AV, Badley EM. Combined impact of concomitant arthritis and back problems on health status: Results from a nationally representative health survey. Arthritis Care Res (Hoboken) 2011; 63:1584-91. [DOI: 10.1002/acr.20595] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Badley EM, Canizares M, Mahomed N, Veinot P, Davis AM. Provision of orthopaedic workforce and implications for access to orthopaedic services in Ontario. J Bone Joint Surg Am 2011; 93:863-70. [PMID: 21543676 DOI: 10.2106/jbjs.i.01782] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aging population and increasing obesity rates will increase the prevalence of musculoskeletal conditions. Reports of orthopaedic surgeon shortages raise concerns about the ability of the health-care system to meet current and future demand in orthopaedics. A survey of all orthopaedic surgeons in Ontario, Canada, was carried out in 2006 to (1) update provision estimates of orthopaedic surgeons; (2) examine practice characteristics and perceived barriers to service; and (3) relate geographic availability of surgeons to population utilization of office-based and surgical orthopaedic services. METHODS A two-part questionnaire was sent to all orthopaedic surgeons in Ontario in 2006. Provision data in hours per week and full-time equivalents and practice patterns were analyzed by health region. Population-based data on the use of orthopaedic services were obtained from health service administrative databases. RESULTS There were 396 practicing orthopaedic surgeons in Ontario in 2006, equivalent to 2.43 full-time equivalents per 100,000 population, a finding similar to surveys in 1997 and 2000. Most surgeons were male, with a mean age of forty-nine years, with mainly adult practices; 48% reported having a subspecialty. Provision varied across Ontario, with an average of 112 hours per week of direct clinical time per 100,000 population (50% in the office, 30% in the operating room, 20% working on call). Many surgeons also reported time for administration, teaching, and research. Most respondents reported barriers to timely surgery, notably a lack of resources (operating room time, anesthesia, nursing, and/or bed capacity). Low orthopaedic provision was associated with lower utilization of office-based and surgical services, after controlling for neighborhood income and type of residence (urban or rural). CONCLUSIONS Shortages and geographic variation in the supply of surgeons mean that access to care continues to be a challenge in Ontario. In regions with fewer surgeons, residents are more likely to be deprived of office-based services, potentially affecting access to surgery and to orthopaedic expertise. In light of a potential shortage of surgeons, alternative methods of service provision may be needed to respond to the aging of the baby boomer population and an anticipated growth in the demand for surgery.
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Affiliation(s)
- Elizabeth M Badley
- Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute, Main Pavilion 10-316, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada.
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Khanna D, Maranian P, Palta M, Kaplan RM, Hays RD, Cherepanov D, Fryback DG. Health-related quality of life in adults reporting arthritis: analysis from the National Health Measurement Study. Qual Life Res 2011; 20:1131-40. [PMID: 21298347 PMCID: PMC3156343 DOI: 10.1007/s11136-011-9849-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2011] [Indexed: 01/22/2023]
Abstract
Background Arthritis is the leading cause of disability in the United States. We assess the generic health-related quality-of-life (HRQOL) among a nationally representative sample of US adults with and without self-reported arthritis. Methods The NHMS, a cross-sectional survey of 3,844 adults (35–89 years) administered EuroQol-5D (EQ-5D), Health Utilities Index Mark 2 (HUI2) and 3 (HUI3), SF-36v2™, Quality of Well-being Scale self-administered form (QWB-SA), and the Health and Activities Limitations index (HALex) to each respondent via a telephone interview. Weighted multiple linear regression was used to generate age-gender-arthritis-stratified unadjusted HRQOL means and means adjusted for sociodemographic, socioeconomic covariates and comorbidities by arthritis–age category. Results The estimated population prevalence of self-reported arthritis was 31%. People with arthritis were more likely to be woman, older, of lower socioeconomic status, and had more self-reported comorbidities than were those not reporting arthritis. Adults with arthritis had lower HRQOL on six different indexes compared with adults without arthritis, with overall differences ranging from 0.03 (QWB-SA, age-group 65–74) to 0.17 (HUI3, age-group 35–44; all P-value < .05). Conclusion Arthritis in adults is associated with poorer HRQOL. We provide age-related reference values for six generic HRQOL measures in people with arthritis.
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Affiliation(s)
- Dinesh Khanna
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, 1000 Veteran Avenue, Rm 32-59 Rehabilitation Building, Los Angeles, CA 90095, USA.
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Targeting 5-HT receptors for the treatment of obesity. Curr Opin Pharmacol 2011; 11:52-8. [DOI: 10.1016/j.coph.2011.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 01/24/2011] [Accepted: 01/25/2011] [Indexed: 01/09/2023]
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23
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Abstract
Our population is ageing, and obesity is increasing in the elderly bringing massive and rapidly changing burdens of ill health related to increased body weights and fat as well as the main drivers of poor diet and inactivity. Overweight and obesity, and a static body mass index (BMI) commonly conceal sarcopenia (gain in body fat but loss of muscle mass and functional capacity) in older people, aggravated by inactivity. A systematic computerized literature search using an iterative manipulation process of the keywords: obesity, elderly, weight loss. The following databases were accessed on 20 October 2010: Medline, Cochrane Collaboration, Ovid and Scholar Google. A large number of clinical consequences of overweight and obesity are particularly problematic for elderly individuals, including type 2 diabetes mellitus, arthritis, urinary incontinence and depression. The observation that the BMI value associated with the lowest relative mortality is slightly higher in older than in younger adults has often been misinterpreted that obesity is not as harmful in the elderly. BMI may be a less appropriate index in the elderly. All the medical consequences of obesity are multi-factorial but all are alleviated by modest, achievable weight loss (5-10 kg) with an evidence-based maintenance strategy. Since sarcopenic obesity is common in the elderly, a combination of exercise and modest calorie restriction appears to be the optimal method of reducing fat mass and preserving muscle mass. Reduction in polypharmacy is a valuable target for weight management. Age is not an obstacle to weight management interventions using moderate calorie restriction and exercise, and the currently licensed drug orlistat appears to have no age-related hazards. Overall balance of clinical outcomes has not been evaluated. In older people the risks from bariatric surgery outweigh benefits. Obesity, and specifically sarcopenic obesity, should also be prevented not only from younger age, but also during major life transitions including retirement, to improve better health outcomes and quality of life in later years, with a focus on those in 'obese families', where the main increases in obesity are located. Randomized controlled trials to determine health benefits and risks from long-term weight management in obese elderly are necessary.
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Affiliation(s)
- T S Han
- Department of Diabetes and Endocrinology, Ashford and St Peter’s NHS Trust, Chertsey, Surrey, UK
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