[Obesity and cardiovascular risk]

Decreasing incidence of coronary heart disease in extreme obesity (BMI≥40)-A single centre experience

AIM

The aim of our comprehensive single centre analysis was to evaluate the incidence of coronary heart disease (CHD) in extremely obese patients.

METHODS AND RESULTS

Between 2005 and 2015 we investigated retrospectively 23,359 patients undergoing cardiac catheterisation in our institution. Patients were divided in six weight classes according to World Health Organization (WHO) criteria [1] (WHO, 2000). Cardiovascular risk factors, comorbidities, CCS stadium [2] (Cox and Naylor, 1992) and NYHA functional class [3] (The Criteria Committee of the New York Heart Association, 1994) were retrieved from electronic patient records. Using multivariable analysis the odds ratio for the target variable CHD with presence of >50% angiographic stenosis was ≥1 with regard to age (OR 1.049, 95% CI 1.045-1.052), male sex (OR 2.507, 95% CI 2.329-2.699), cardiovascular risk factors, atherosclerosis (OR 1.651, 95% CI 1.498-1.820), and presence of angina (OR 4.408, 95% CI 3.892-4.993). NYHA functional class I-IV, absence of angina (OR 0.818, 95% CI 0.729-0.918), and BMI≥40 (OR 0.592, 95% CI 0.494-0.709) resulted in an odds ratio of ≤1. Underweight patients had a higher (5.3%) and overweight (1.2%) and obese patients (class I 0.9% and II 1.1%) a slightly lower all-cause in-hospital mortality compared to extremely obese patients (1.6%).

CONCLUSION

Severely obese patients treated in our hospital surprisingly showed a decreased incidence of CHD (46.1% in normal weight and 38.6% in extremely obese patients) while comorbidities increased CHD as expected. Although CHD burden was lower, obesity and associated comorbidities resulted in higher all-cause-in-hospital mortality.

Body composition indices and predicted cardiovascular disease risk profile among urban dwellers in Malaysia

Objectives. This study aims to compare various body composition indices and their association with a predicted cardiovascular disease (CVD) risk profile in an urban population in Kuala Lumpur, Malaysia. Methods. A cross-sectional survey was conducted in metropolitan Kuala Lumpur, Malaysia, in 2012. Households were selected using a simple random-sampling method, and adult members were invited for medical screening. The Framingham Risk Scoring algorithm was used to predict CVD risk, which was then analyzed in association with body composition measurements, including waist circumference, waist-hip ratio, waist-height ratio, body fat percentage, and body mass index. Results. Altogether, 882 individuals were included in our analyses. Indices that included waist-related measurements had the strongest association with CVD risk in both genders. After adjusting for demographic and socioeconomic variables, waist-related measurements retained the strongest correlations with predicted CVD risk in males. However, body mass index, waist-height ratio, and waist circumference had the strongest correlation with CVD risk in females. Conclusions. The waist-related indicators of abdominal obesity are important components of CVD risk profiles. As waist-related parameters can quickly and easily be measured, they should be routinely obtained in primary care settings and population health screens in order to assess future CVD risk profiles and design appropriate interventions.

Outcomes of renal transplantation in obese recipients

PURPOSE

Although obesity has been shown to paradoxically increase dialysis patient survival, its impact has not been clearly defined on renal transplantation. We assessed outcomes of obesity renal transplant patients by evaluating graft and patient survivals.

PATIENTS AND METHODS

A single-institution, retrospective study was performed on 202 renal transplant recipients from January 2004 to December 2008 excluding two combined kidney and liver transplantations. Recipients were classified based on body mass index (BMI) at the time of transplantation: obese (BMI ≥ 30 kg/m(2)) and nonobese recipients (BMI < 30 kg/m(2)). The comparative analysis included surgical complications, hospital stay, onset of delayed graft function (DGF), acute rejection episodes and graft patient survivals.

RESULTS

Twenty-one renal transplants were performed in obese recipients versus 179 in the control group. Obese patients were older (53.3 ± 11.2 versus 46.4 ± 14.4 years old; P = .035) and more often diabetic (29% ± 0.46 versus 60% ± 0.24, P = .001), but there were no differences among other combidities of high blood pressure, arteriopathy, thrombophilia, and smoking. Obesity did not appear to be a risk factor for urinary or vascular as well as parietal complications, but did tend to augment lymphatic complications (14.3% ± 0.36 versus 4.5% ± 0.21; P = .065). DGF occurred more frequently in obese patients (38% ± 0.50 versus 14% ± 0.34; P = .004) and hospital stays were therefore longer in this group (24.9 ± 23.53 days versus 15.6 ± 13.67 days; P = .008). Graft (hazard ratio [HR] 1.22; 95% confidence interval [CI] [0.25-6.0], P = .63) and patient survivals (HR:0,81; 95% CI [0.12- 5.3], P = .83) were comparable between the groups.

CONCLUSION

Obese patients seeking renal transplantation are usually older and more often diabetic compared with nonobese recipients. The higher rate of lymphatic complications and DGF lead to longer hospital stays among the group with BMI ≥ 30 kg/m(2). However, long-term results showed similar graft and patient survivals as nonobese patients. Consequently, there seemed to be no reason to avoid renal transplantation in obese recipients.

Validity of self-reported weight and height in Austrian adults: sociodemographic determinants and consequences for the classification of BMI categories

Objective

Epidemiological studies have shown that adults tend to underestimate their weight and overestimate their height. This may lead to a misclassification of their BMI in studies based on self-reported data. The aim of the present study was to assess the validity of self-reported weight and height in Austrian adults.

Design

Data on weight, height, health behaviour and sociodemographic characteristics of adults were collected in a standardized procedure via a self-filling questionnaire and a medical examination including measurements of weight and height.

Setting

A publicly accessible out-patient clinic in southern Austria.

Subjects

Austrian residents (n473) aged 18 years and older who attended a health check participated in the study.

Results

The mean difference between reported and measured BMI was not significant in younger adults (<35 years: mean difference −0·21 kg/m2;P< 0·08) but increased significantly with age (≥55 years: mean difference −0·68 kg/m2;P< 0·001). The prevalence of normal weight (BMI = 18·5–24·9 kg/m2) and overweight (BMI = 25·0–29·9 kg/m2) was overestimated based on the self-reported data on BMI, while that for underweight (BMI < 18·5 kg/m2) and obesity (BMI ≥ 30·0 kg/m2) was underestimated (P< 0·001). The self-reported data showed an obesity prevalence of 12·5 %, while measurement showed a prevalence of 15·4 % (P< 0·001).

Conclusions

Our results indicate that prevalence rates of obesity are probably underestimated for Austrian adults when using self-reported weight and height information. The deviations from the measured data clearly increased with age. Analyses based on self-reported data should therefore be adjusted for the age dependency of the validity.

The morbidity and mortality associated with overweight and obesity in adulthood: a systematic review

BACKGROUND

Overweight and obesity are generally thought to elevate morbidity and mortality. New data call this supposed association into question.

METHODS

The Cochrane, Pubmed, and other databases were systematically searched for a combination of relevant terms and subject headings. Meta-analyses and cohort studies based on the German population were evaluated for possible associations between overweight/ obesity and adult morbidity and mortality. Case-control and cross-sectional studies were excluded.

RESULTS

A total of 27 meta-analyses and 15 cohort studies were evaluated. The overall mortality of overweight persons (body mass index [BMI] 25-29.9 kg/m(2)) is no higher than that of persons of normal weight (BMI 18.5-24.9 kg/m(2)), but their mortality from individual diseases is elevated, diminished or unchanged, depending on the particular disease. The overall morbidity is unknown. Both obesity (BMI >30 kg/m(2)) and overweight are associated with increased disease-specific morbidity for some diseases, but decreased or unchanged for others. In general, obesity confers a higher risk than overweight. Morbidity and mortality are markedly influenced by the patient's age, sex, ethnic origin, and social status. The external validity of the comparative predictive performance (c-statistic) of BMI, waist circumference, and ratio of waist to hip circumference cannot be determined from the available analyses.

CONCLUSION

The prevailing notion that overweight increases morbidity and mortality, as compared to so-called normal weight, is in need of further specification. Obesity, however, is indeed associated with an elevated risk for most of the diseases studied.

Viscerally obese women with normal body weight have greater brachial-ankle pulse wave velocity than nonviscerally obese women with excessive body weight

OBJECTIVE

To confirm the association of visceral obesity and brachial-ankle pulse wave velocity (baPWV) and to compare metabolic indices and baPWV between individuals who have normal body weight but are viscerally obese and individuals with excessive body weight who are not viscerally obese.

PATIENTS AND MEASUREMENTS

We recruited a total of 150 women, aged 22 to 67 years. We assessed body composition, measured by computed tomography (CT), and divided the study population into four groups, based on visceral adipose tissue area (normal, normal body weight but viscerally obese, excessive body weight but not viscerally obese, and excessive body weight and viscerally obese). The baPWV was measured, using a volume plethysmographic instrument.

RESULTS

Despite lower levels of total body fat, the women who had a normal body weight but were viscerally obese had a higher plasma triglyceride level and baPWV measurement and greater subcutaneous fat area (SFA) and thigh SFA than the women with excessive body weight who were not viscerally obese. After adjustment for age, mean blood pressure (BP), body mass index (BMI), triglyceride levels, fasting insulin levels, and free fatty acid (FFA) levels, baPWV was independently correlated with abdominal visceral fat area, as measured by CT (P = 0.001).

CONCLUSIONS

Mean baPWV was higher in women with normal body weight who were viscerally obese than in women who had excessive body weight but were not viscerally obese, and abdominal visceral fat was an independent factor for baPWV. These results suggest that early detection and intervention in viscerally obese individuals, even those within a normal BMI range, could be needed to prevent atherosclerosis and cardiovascular disease (CVD).

Psychosoziale Aspekte und Gesundheitsverhalten bei Herzinsuffizienz

Zusammenfassung. Für die steigende Zahl von Patienten mit Herzinsuffizienz stehen verschiedene medizinische Behandlungsansätze zur Verfügung, darunter als letzte Option die Herztransplantation (HTX). Ergänzende psychosoziale und behaviorale Interventionen erscheinen aus verschiedenen Gründen auch für Patienten auf der HTX-Warteliste sinnvoll. Unser Literaturüberblick zeigt, dass bekannte psychosoziale koronare Risikofaktoren wie Depressivität und soziale Isolation auch bei Herzinsuffizienz Morbidität und Mortalität erhöhen. Körperliche Aktivität wirkt sich dagegen günstig auf subjektive und objektive Parameter aus. Diese Faktoren stellen erste Ansatzpunkte für verhaltensorientierte Interventionen dar. Welche Rolle andere koronare Risikofaktoren (z.B. Feindseligkeit, Ärger, Ernährung und Gewichtsreduktion) spielen, ist bislang ungeklärt. Ausblickend werden einige viel versprechende Forschungsansätze skizziert.

Management of overweight and obesity in adults: behavioral intervention for long-term weight loss and maintenance

BACKGROUND

The World Health Organization has identified obesity as a global epidemic. While weight loss is a considerable challenge, long-term maintenance of weight loss is an even greater problem.

AIMS

This review of the assessment and management of overweight and obesity in adults covers factors contributing to overweight and obesity, components of weight-loss management, and interventions and effects of behavioral treatment for long-term weight loss and maintenance.

METHODS

A thorough search of the medical and nursing literature recorded in the MEDLINE database from 1995 to 2003 was conducted by using the keywords "overweight", "obesity", and "behavioral therapy".

RESULTS

Obesity is a complex, multifaceted condition in which excessive body fat places a person at risk of multiple health problems. Excessive body fat results from energy intake that exceeds energy expenditure.

CONCLUSIONS

Increasing evidence suggests that obesity is not simply a problem of will power or self-control but a complex disorder involving appetite regulation and energy metabolism that is associated with a variety of comorbid conditions. Effective strategies of weight loss require management strategies in a combined approach of dietary therapy and physical activity by using behavioral interventions.

Insulin resistance syndrome, body mass index and the risk of ischemic heart disease

BACKGROUND

Many people who are not obese according to standard height and weight criteria may still display features of insulin resistance syndrome and thus be at high risk of ischemic heart disease. We sought to investigate the effect of cumulative features of insulin resistance syndrome on the risk of ischemic heart disease associated with variations in body mass index (BMI) among men who participated in the Quebec Cardiovascular Study.

METHODS

A cohort of 1824 nondiabetic men free of ischemic heart disease was evaluated at the 1985 baseline evaluation and followed for a period of 13 years, during which 284 first ischemic heart disease events were recorded. Relative hazards (RHs) of ischemic heart disease in 3 BMI groups (normal weight, overweight and obese) were estimated using Cox proportional hazards regression.

RESULTS

Although obese men (BMI > or = 30 kg/m2) were the most likely to accumulate features of insulin resistance syndrome, the univariate risk of ischemic heart disease in this group was not significantly increased compared with normal-weight men (BMI < 25 kg/m2) (RH 1.26, 95% confidence interval [CI] 0.88-1.80). However, obese men who accumulated more than 4 features of insulin resistance syndrome were at increased risk of ischemic heart disease (RH 1.81, 95% CI 1.02-3.19) compared with normal-weight men who had fewer than 3 features of the syndrome. Conversely, having more than 4 features of insulin resistance syndrome was associated with a 3-fold increase in the risk of ischemic heart disease among normal-weight men (RH 3.01, 95% CI 1.70-5.32).

INTERPRETATION

Although obesity is an important risk factor for ischemic heart disease, variations in BMI alone poorly reflect the risk of ischemic heart disease associated with features of insulin resistance syndrome.

[Cardiovascular risk factors in overweight and obesity. Changes after a weight loss treatment]

BACKGROUND AND OBJECTIVE

For the treatment of obesity, an adecuate control of associated cardiovascular risk factors (CRF) is fundamental. The objective of this study was to assess the relationship between body mass index (BMI) and CRF, and the effect of a weight loss program on overweight subjects.

PATIENTS AND METHOD

A single-centered cross-sectional prospective study was carried out during 1997-2001 on 1,018 overweight subjects (788 women and 230 men) who were seeking aid to lose weight at an obesity clinic. A program involving a hypocaloric, Mediterranean diet was prescribed plus recommendations for spare-time exercise. Variables measured included weight, height, blood pressure, serum lipids and blood glucose concentrations, measured both at baseline and at the end of the weight loss program.

RESULTS

After adjusting for age, variables showing a significant increase upon higher BMI were: blood pressure, HDL cholesterol (HDL-C) (inverse relationship, only in women), triglycerides and blood glucose. Total cholesterol (CLT), LDL cholesterol (LDL-C) and CLT/HDL-C showed no relationship with BMI. Weight loss had beneficial effects on blood pressure and triglycerides, regardless of the initial values, and on CLT, LDL-C and CLT/HDL-C when the initial levels were increased. No significant changes were found with regard to HDL-C.

CONCLUSIONS

Overweight and obese subjects carry a burden of common coronary risk factors which ncrease upon greater obesity. Weight loss has important beneficial effects with regard to coronary risk factors associated with overweight and obesity, particularly if these factors are previously altered, even when weight loss is < 5% of initial weight.