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Shi Y, Yu C, Zhou W, Wang T, Zhu L, Bao H, Li P, Cheng X. Estimated pulse wave velocity as a predictor of all-cause and cardiovascular mortality in patients with hypertension in China: a prospective cohort study. Front Cardiovasc Med 2024; 11:1365344. [PMID: 38742177 PMCID: PMC11089216 DOI: 10.3389/fcvm.2024.1365344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024] Open
Abstract
Background Whether the estimated pulse wave velocity (ePWV) in Chinese patients with hypertension can serve as an independent predictor of cardiovascular and all-cause mortality remains unknown. Therefore, this study investigated the associations between ePWV and cardiovascular and all-cause mortalities and explored potential effect modifiers influencing these relationships. Finally, we compared the ePWV with the brachial-ankle pulse wave velocity (baPWV) to determine which parameter better predicts mortality. Methods The population of this longitudinal cohort study was selected from the China H-type Hypertension Registry Study. The exposure and outcome variables were ePWV and all-cause and cardiovascular mortalities, respectively. The Cox proportional hazard regression model was applied to assess the associations between ePWV and all-cause and cardiovascular mortalities. The performances of ePWV and baPWV in predicting death were compared using the receiver operating characteristic (ROC) curve area, net reclassification improvement index (NRI), and integrated discrimination improvement index (IDI). Results This prospective study enrolled 14,232 patients with hypertension. Following an average follow-up of 48 months, 806 individuals succumbed to all-cause mortality, with 397 cases specifically attributed to cardiovascular diseases. The Cox proportional regression analysis revealed a significant association between a 1 m/s increase in ePWV and a 37% higher risk of all-cause mortality (hazard ratio [HR]: 1.37, 95% confidence interval [CI]: 1.31-1.43) as well as a 52% higher risk of cardiovascular mortality (HR: 1.52, 95% CI: 1.43-1.62) in the fully adjusted model. The findings for ePWV according to quartile demonstrated hazard ratios for all-cause mortality for Q2 (10.25 < ePWV < 11.32), Q3 (11.32 < ePWV < 12.40), and Q4 (ePWV ≥ 12.40) of 1.50 (HR: 1.50, 95% CI: 1.07-2.10), 2.34 (HR: 2.34, 95% CI: 1.73-3.18), and 4.09 (HR: 4.09, 95% CI: 3.05-5.49), respectively, compared with Q1 (ePWV < 10.25). The risk of cardiovascular death also increased in proportion to the rise in ePWV. The results of the area under the ROC curve, NRI, and IDI all indicated that ePWV outperformed baPWV in predicting mortality. The results of the subgroup analysis demonstrated that body mass index (BMI) and hypoglycemic drug use modified the association between ePWV and mortality. Conclusions The performance of ePWV in predicting all-cause and cardiovascular mortalities was superior to that of baPWV alone. Patients who were overweight or obese with higher ePWV values exhibited a significantly increased risk of all-cause death. The correlation between elevated ePWV and the risk of cardiovascular death was more pronounced in patients who had not received hypoglycemic drugs.
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Affiliation(s)
- Yumeng Shi
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-Center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
| | - Chao Yu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-Center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Wei Zhou
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-Center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Tao Wang
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-Center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Lingjuan Zhu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-Center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Huihui Bao
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-Center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Ping Li
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-Center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-Center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
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Asgari S, Molavizadeh D, Soltani K, Khalili D, Azizi F, Hadaegh F. The impact of obesity on different glucose tolerance status with incident cardiovascular disease and mortality events over 15 years of follow-up: a pooled cohort analysis. Diabetol Metab Syndr 2024; 16:27. [PMID: 38267963 PMCID: PMC10809520 DOI: 10.1186/s13098-023-01253-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/31/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND The effect of obesity in different glucose tolerance statuses i.e. normoglycemia (NGT), pre-diabetes, and type 2 diabetes (T2DM) on cardiovascular disease (CVD) and mortality has been an area of ongoing debate and uncertainty. In the present study, we aimed to examine the impact of being obese, whether general or central separately, in comparison with non-obese in different glucose tolerance statuses on the above outcomes. METHODS The study population included 18,184 participants aged 30-60 years (9927 women) from three longitudinal studies, including Atherosclerosis Risk in Communities, Multi-Ethnic Study of Atherosclerosis, and Tehran Lipid and Glucose Study. Glucose tolerance status was defined as NGT (fasting plasma glucose < 5.55 mmol/L), pre-diabetes (5.55-7.00 mmol/L), and T2DM (≥ 7 mmol/L or taking any medication for diabetes). Moreover, general and central obesity were defined based on body mass index and waist circumference (WC), respectively. Multivariable stratified Cox regression analysis was used to estimate hazard ratios (HRs (95% CI)) for CVD and mortality events. RESULTS During a 16-year follow-up, 2733 CVD events, 1101 CV mortality, and 3678 all-cause mortality events were recorded. We observed that being generally obese in comparison with non-obese increased the risk of CV and all-cause mortality in all glucose tolerance statuses; while considering CVD events, only among individuals with T2DM, the presence of general obesity was associated with marginally significant higher risk [1.19 (0.98-1.43); p-value = 0.07]. Regarding central adiposity, multivariate analysis revealed that elevated WC in NGT participants is associated with incident CVD [1.27(1.12-1.46)] and all-cause mortality [1.13(1.00-1.28)]. Moreover, central adiposity increased the risk of CV mortality in pre-diabetes individuals [1.47 (1.11-1.95)]. CONCLUSION Findings from this pooled prospective cohort studies provide evidence that general obesity shows an unfavorable association with CV and all-cause mortality among the general population irrespective of their glucose tolerance statusThe findings imply that it's important to take into account the requirement and magnitude of weight reduction in people who are obese when offering guidance.
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Affiliation(s)
- Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763, Tehran, Islamic Republic of Iran
| | | | - Kiarash Soltani
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763, Tehran, Islamic Republic of Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763, Tehran, Islamic Republic of Iran.
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Engin A. The Definition and Prevalence of Obesity and Metabolic Syndrome: Correlative Clinical Evaluation Based on Phenotypes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1460:1-25. [PMID: 39287847 DOI: 10.1007/978-3-031-63657-8_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
Increase in the prevalence of obesity has become a major worldwide health problem in adults as well as among children and adolescents. In the last four decades, studies have revealed that the significant increase in the prevalence of obesity has become a pandemic. Obesity is the result of complex interactions between biological, genetic, environmental, and behavioral factors. Indeed, almost all of the children suffering from obesity in early childhood face with being overweight or obese in adolescence. Different phenotypes have different risk factors in the clinical evaluation of obesity. Individuals suffering from metabolically unhealthy obesity (MUO) are at an excess risk of developing cardiovascular diseases (CVDs), several cancer types, and metabolic syndrome (MetS), whereas the metabolically healthy obesity (MHO) phenotype has a high risk of all-cause mortality and cardiometabolic events but not MetS. While most obese individuals have the MUO phenotype, the frequency of the MHO phenotype is at most 10-20%. Over time, approximately three-quarters of obese individuals transform from MHO to MUO. Total adiposity and truncal subcutaneous fat accumulation during adolescence are positively and independently associated with atherosclerosis in adulthood. Obesity, in general, causes a large reduction in life expectancy. However, the mortality rate of morbid obesity is greater among younger than older adults. Insulin resistance (IR) develops with the central accumulation of body fat. MHO patients are insulin-sensitive like healthy normal-weight individuals and have lower visceral fat content and cardiovascular consequences than do the majority of MUO patients. MetS includes clustering of abdominal obesity, dyslipidemia, hyperglycemia, and hypertension. The average incidence of MetS is 3%, with a 1.5-fold increase in the risk of death from all causes in these patients. If lifestyle modifications, dietary habits, and pharmacotherapy do not provide any benefit, then bariatric surgery is recommended to reduce weight and improve comorbid diseases. However, obesity treatment should be continuous in obese patients by monitoring the accompanying diseases and their consequences. In addition to sodium-glucose co-transporter-2 (SGLT2) inhibitors, the long-acting glucagon-like peptide-1 (GLP-1) receptor agonist reduces the mean body weight. However, caloric restriction provides more favorable improvement in body composition than does treatment with the GLP-1 receptor (GLP1R) agonist alone. Combination therapy with orlistat and phentermine are the US Food and Drug Administration (FDA)-approved anti-obesity drugs. Recombinant leptin and synthetic melanocortin-4-receptor agonists are used in rarely occurring, monogenic obesity, which is due to loss of function in the leptin-melanocortin pathway.
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Affiliation(s)
- Atilla Engin
- Faculty of Medicine, Department of General Surgery, Gazi University, Besevler, Ankara, Turkey.
- Mustafa Kemal Mah. 2137. Sok. 8/14, 06520, Cankaya, Ankara, Turkey.
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Yu HJ, Ho M, Liu X, Yang J, Chau PH, Fong DYT. Incidence and temporal trends in type 2 diabetes by weight status: A systematic review and meta-analysis of prospective cohort studies. J Glob Health 2023; 13:04088. [PMID: 37651631 PMCID: PMC10471153 DOI: 10.7189/jogh.13.04088] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Background Diabetes is more prevalent among overweight/obese individuals, but has become a significant public health challenge among normal weight populations. In this meta-analysis, we aimed to estimate diabetes/prediabetes incidence and its temporal trends by weight status. Methods PubMed, Embase, Web of Science, and Cochrane Library were searched until 8 December 2021. Prospective cohort studies reporting diabetes incidence by baseline body mass index (BMI) categories in adults were included. The median year of data collection was used to assess the temporal trends. Subgroup analyses and meta-regression were also performed. Results We included 94 studies involving 3.4 million adults from 22 countries. The pooled diabetes incidence in underweight, normal-weight, and overweight/obese adults was 4.5 (95% confidence interval (CI) = 2.8-7.3), 2.7 (95% CI = 2.2-3.3), and 10.5 (95% CI = 9.3-11.8) per 1000 person-years, respectively. The diabetes incidence in low- and middle-income countries (LMICs) was higher than in high-income countries among normal-weight (5.8 vs 2.0 per 1000 person-years) or overweight/obese (15.9 vs 8.9 per 1000 person-years) adults. European and American regions had a higher diabetes incidence than the non-Western areas, regardless of weight status. Underweight diabetes incidence decreased significantly from 1995-2000 to 2005-2010. Diabetes incidence in normal-weight populations has increased continuously since 1985 by an estimated 36% every five years. In overweight/obese adults, diabetes incidence increased between 1985-1990 and 1995-2000, stabilised between 2000 and 2010, and spiked suddenly after 2010. Conclusions Diabetes incidence and its temporal trends differed by weight status. The continuous upward trend of diabetes incidence among overweight/obese individuals requires urgent attention, particularly in LMICs. Furthermore, diabetes among normal-weight individuals is becoming a significant public health problem. Registration PROSPERO (CRD42020215957).
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Affiliation(s)
- Hong-jie Yu
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Mandy Ho
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Xiangxiang Liu
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Jundi Yang
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Pui Hing Chau
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
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Orsi E, Solini A, Penno G, Bonora E, Fondelli C, Trevisan R, Vedovato M, Cavalot F, Lamacchia O, Haxhi J, Nicolucci A, Pugliese G. Body mass index versus surrogate measures of central adiposity as independent predictors of mortality in type 2 diabetes. Cardiovasc Diabetol 2022; 21:266. [PMID: 36461034 PMCID: PMC9716975 DOI: 10.1186/s12933-022-01706-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND An "obesity paradox" for mortality has been shown in chronic disorders such as diabetes, and attributed to methodological bias, including the use of body mass index (BMI) for obesity definition. This analysis investigated the independent association of BMI versus surrogate measures of central adiposity with all-cause mortality in individuals with type 2 diabetes. METHODS The Renal Insufficiency And Cardiovascular Events Italian Multicentre Study is a prospective cohort study that enrolled 15,773 patients in 19 Italian centres in 2006-2008. Exposures were BMI and the surrogate measures of central adiposity waist circumference (WC), waist-to-height ratio (WHtR), and A Body Shape Index (ABSI). Vital status was retrieved on 31 October 2015 for 15,656 patients (99.3%), RESULTS: Age- and sex-adjusted hazard ratios and 95% confidence intervals were significantly higher in BMI-based underweight (1.729 [1.193-2.505), P = 0.004), moderately obese (1.214 [1.058-1.392), P = 0.006) and severely obese (1.703 [1.402-2.068), P < 0.0001), lower in overweight (0.842 [0.775-0.915), P < 0.0001) and similar in mildly obese (0.950 [0.864-1.045), P = 0.292), compared to normal-weight individuals. When further adjusting for smoking, physical activity (PA), and comorbidities, risk was lower also in mildly obese versus normal-weight patients. The BMI-mortality relationship did not change after sequentially excluding ever smokers, individuals with comorbidities, and those died within two years from enrollment and when analyzing separately participants below and above the median age. Conversely, a paradox relationship was observed among inactive/moderately inactive, but not moderately/highly active patients. Mortality risk adjusted for age, gender, smoking, PA and comorbidities was significantly higher in the highest tertile of WC (1.279 [1.089-1.501], P = 0.003), WHtR (1.372 [1.165-1.615], P < 0.0001), and ABSI (1.263 [1.067-1.495], P = 0.007) versus the lowest tertile. However, risk was lower in the intermediate versus lowest tertile for WC (0.823 [0.693-0.979], P = 0.028), similar for WHtR, and higher, though not significantly, for ABSI. CONCLUSIONS An "overweight paradox" remained after controlling for age, smoking, and comorbidities, arguing against a collider bias or reverse causation. However, it could be partly explained by confounding from PA level, possibly through its impact on lean mass and cardiorespiratory fitness. No obesity paradox was observed with WHtR and especially ABSI, which predicted mortality risk associated with central adiposity better than WC. Trial registration ClinicalTrials.gov, NCT00715481, 15 July, 2008.
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Affiliation(s)
- Emanuela Orsi
- grid.414818.00000 0004 1757 8749Diabetes Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Solini
- grid.5395.a0000 0004 1757 3729Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Giuseppe Penno
- grid.5395.a0000 0004 1757 3729Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Enzo Bonora
- grid.411475.20000 0004 1756 948XDivision of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | - Cecilia Fondelli
- grid.9024.f0000 0004 1757 4641Diabetes Unit, University of Siena, Siena, Italy
| | - Roberto Trevisan
- grid.460094.f0000 0004 1757 8431Endocrinology and Diabetes Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Monica Vedovato
- grid.5608.b0000 0004 1757 3470Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy
| | - Franco Cavalot
- grid.7605.40000 0001 2336 6580Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Olga Lamacchia
- grid.10796.390000000121049995Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Jonida Haxhi
- grid.7841.aDepartment of Clinical and Molecular Medicine, “La Sapienza” University, Via Di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Antonio Nicolucci
- grid.512242.2Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Giuseppe Pugliese
- grid.7841.aDepartment of Clinical and Molecular Medicine, “La Sapienza” University, Via Di Grottarossa, 1035-1039, 00189 Rome, Italy
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Qiao T, Luo T, Pei H, Yimingniyazi B, Aili D, Aimudula A, Zhao H, Zhang H, Dai J, Wang D. Association between abdominal obesity indices and risk of cardiovascular events in Chinese populations with type 2 diabetes: a prospective cohort study. Cardiovasc Diabetol 2022; 21:225. [PMID: 36320060 PMCID: PMC9628026 DOI: 10.1186/s12933-022-01670-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Waist circumference (WC), visceral adiposity index (VAI), lipid accumulation product (LAP), and Chinese visceral adiposity index (CVAI) are considered surrogate indicators of abdominal fat deposition, but the longitudinal association of these indices with cardiovascular (CV) events in adults with type 2 diabetes (T2D) remains unclear. Our study aimed to examine the associations between abdominal obesity indices and incident CV events among people with T2D and to compare their predictive performance in risk assessment. METHODS The present study included 2328 individuals with T2D from the Xinjiang Multi-Ethnic Cohort. Multivariable Cox regression analyses were applied to assess the associations between abdominal obesity indices and CV events. Harrell's concordance statistic (C-statistic), net reclassification improvement (NRI) index, and integrated discrimination improvement (IDI) index were utilized to evaluate the predictive performance of each abdominal obesity index. RESULTS At a median follow-up period of 59 months, 289 participants experienced CV events. After multivariable adjustment, each 1-SD increase in WC, VAI, LAP, and CVAI was associated with a higher risk of CV events in people with T2D, with adjusted hazard ratios (HRs) being 1.57 [95% CI (confidence interval): 1.39-1.78], 1.11 (95% CI 1.06-1.16), 1.46 (95% CI 1.36-1.57), and 1.78 (95% CI 1.57-2.01), respectively. In subgroup analyses, these positive associations appeared to be stronger among participants with body mass index (BMI) < 25 kg/m2 compared to overweight/obese participants. As for the predictive performance, CVAI had the largest C-statistic (0.700, 95% CI 0.672-0.728) compared to VAI, LAP, WC, and BMI (C-statistic: 0.535 to 0.670, all P for comparison < 0.05). When the abdominal obesity index was added to the basic risk model, the CVAI index also showed the greatest incremental risk stratification (C-statistic: 0.751 vs. 0.701, P < 0.001; IDI: 4.3%, P < 0.001; NRI: 26.6%, P < 0.001). CONCLUSIONS This study provided additional evidence that all abdominal obesity indices were associated with the risk of CV events and highlighted that CVAI might be a valuable abdominal obesity indicator for identifying the high risk of CV events in Chinese populations with T2D. These results suggest that proactive assessment of abdominal obesity could be helpful for the effective clinical management of the diabetic population.
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Affiliation(s)
- Tingting Qiao
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017, China
- Department of Clinical Nursing, School of Nursing, Xinjiang Medical University, Urumqi, 830017, China
| | - Tao Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017, China
| | - Hualian Pei
- Department of Nursing, Ningbo First Hospital, Ningbo, 315012, China
| | - Bahegu Yimingniyazi
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017, China
| | - Dilihumaer Aili
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017, China
| | - Aliya Aimudula
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017, China
| | - Hui Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017, China
| | - Huanwen Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017, China
| | - Jianghong Dai
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017, China.
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
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Frundi DS, Kettig E, Popp LL, Hoffman M, Dumartin M, Hughes M, Lamy E, Fru YJW, Bano A, Muka T, Wilhelm M. Physical performance and glycemic control under SGLT-2-inhibitors in patients with type 2 diabetes and established atherosclerotic cardiovascular diseases or high cardiovascular risk (PUSH): Design of a 4-week prospective observational study. Front Cardiovasc Med 2022; 9:907385. [PMID: 35935634 PMCID: PMC9354468 DOI: 10.3389/fcvm.2022.907385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Type 2 diabetes (T2D) is associated with limitation in physical performance. Results from animal studies report enhancement of physical performance in T2D rodents treated with sodium glucose cotransporter 2 inhibitors (SGLT2is). However, in human patients with T2D and established atherosclerotic cardiovascular disease (ASCVD) or high cardiovascular risk, the impact of guideline directed SGLT2i medication on physical performance has not been sufficiently examined. Objectives The main objectives of this study are thus firstly, to assess the changes in physical performance after 4 weeks of exercise therapy in patients with established ASCVD or high cardiovascular risk categorized into three groups according to their glycemic control at baseline. Secondly, to investigate the association of glycemic control at baseline and new guideline directed antidiabetic treatment (inadequate glycemic control and diabetes + new SGLT2i vs. adequate glycemic control and diabetes vs. no diabetes) with change in physical performance. Methods and design This is a 4-week prospective observational study of 450 participants with established ASCVD or high cardiovascular risk with or without T2D and without previous SGLT2i medication undergoing exercise therapy during inpatient rehabilitation in a single center in Switzerland. Upon admission, participants are categorized into 3 groups of 150 participants each according to their glycemic control. Group I consisting of participants with inadequately controlled T2D defined as mean fasting plasma glucose (FPG) of ≥7 mmol/L, who are consequently administered new treatment with an SGLT2i. Group II comprises of participants with adequately controlled T2D with mean FPG of <7 mmol/L requiring no antidiabetic medication change. Group III consists of participants with no diabetes and mean FPG of ≤ 5.5 mmol/L. Primary outcomes are 6-min walk distance and rate of perceived exertion. Secondary outcomes are echocardiographic parameters (left ventricular mass index; global longitudinal strain average; end-diastolic volume), fatigue, muscle, metabolic, and anthropometric measures. Ethics and dissemination This study is conducted in accordance with the Declaration of Helsinki with ethical approval from the Cantonal Ethical Commission of Bern, Switzerland. The results will be published in a peer-reviewed journal. The implementation and reporting will be according to the SPIRIT guidelines. Study protocol registration https://www.clinicaltrials.gov/, identifier: NCT03422263.
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Affiliation(s)
- Devine S. Frundi
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
- Permanence Médicale, Hôpital de Sierre, Sierre, Switzerland
- *Correspondence: Devine S. Frundi
| | - Eva Kettig
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Lena Luise Popp
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Melanie Hoffman
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Marine Dumartin
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Magali Hughes
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Edgar Lamy
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | | | - Arjola Bano
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Center for Preventive Cardiology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Center for Preventive Cardiology, University Hospital Bern and University of Bern, Bern, Switzerland
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8
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Chen R, Safiri S, Behzadifar M, Kong JD, Zguira MS, Bragazzi NL, Zhong W, Zhang W. Health Effects of Metabolic Risks in the United States From 1990 to 2019. Front Public Health 2022; 10:751126. [PMID: 35174121 PMCID: PMC8841675 DOI: 10.3389/fpubh.2022.751126] [Citation(s) in RCA: 4] [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: 07/31/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionMetabolic risks including high body mass index, high fasting plasma glucose, high low-density lipoprotein cholesterol, high systolic blood pressure, kidney dysfunction and low bone mineral density, contribute heavy burden to the US health systems. We aimed to investigate the burden attributable to metabolic risks in the US from 1990 to 2019.MethodsUsing methodology of Global Burden of Disease Study, the deaths and DALYs attributable to metabolic risks were analyzed by age, gender, states, Socio-demographic Index (SDI) and diseases from 1990 to 2019 in the US.ResultsIn 2019, the age-standardized death and DALY rates attributable to metabolic risks were 174.9 and 4738.7 per 100,000 people, accounting for 33.1% and 18.2% of death and DALY rates from all causes in the US, and there was a decrease by −32.5% and −21.2% in age-standardized death and DALY rates since 1990. The burden attributable to metabolic risks increased with age, and was higher in males than females. In addition, the burden varied widely across the states, generally in inverse proportion to the SDI levels, and the heaviest burden was observed in East and West South-Central of the US. Cardiovascular diseases carried heavy burden attributable to metabolic risks.ConclusionThe burden attributable to metabolic risks remained major public health concerns in the US. Prevention of metabolic risks should be a high priority in the US.
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Affiliation(s)
- Ruifang Chen
- Medical Experimental Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Saeid Safiri
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Jude Dzevela Kong
- Department of Mathematics and Statistics, Centre for Disease Modelling, York University, Toronto, ON, Canada
| | - Mohamed Sami Zguira
- Department of Physiology and Lung Function Testing, Faculty of Medicine Ibn-El-Jazzar, University of Sousse, Sousse, Tunisia
| | - Nicola Luigi Bragazzi
- Department of Mathematics and Statistics, Centre for Disease Modelling, York University, Toronto, ON, Canada
| | - Wen Zhong
- Department of General Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Wen Zhong
| | - Weiru Zhang
- Department of General Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Weiru Zhang
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9
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Wang Z, Hazlehurst J, Subramanian A, Tahrani AA, Hanif W, Thomas N, Singh P, Wang J, Sainsbury C, Nirantharakumar K, Crowe FL. Diabetic Foot Risk Classification at the Time of Type 2 Diabetes Diagnosis and Subsequent Risk of Mortality: A Population-Based Cohort Study. Front Endocrinol (Lausanne) 2022; 13:888924. [PMID: 35898465 PMCID: PMC9309507 DOI: 10.3389/fendo.2022.888924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
AIM We aimed to compare the mortality of individuals at low, moderate, and high risk of diabetic foot disease (DFD) in the context of newly diagnosed type 2 diabetes, before developing active diabetic foot problem. METHODS This was a population-based cohort study of adults with newly diagnosed type 2 diabetes utilizing IQVIA Medical Research Data. The outcome was all-cause mortality among individuals with low, moderate, and high risk of DFD, and also in those with no record of foot assessment and those who declined foot examination. RESULTS Of 225,787 individuals with newly diagnosed type 2 diabetes, 34,061 (15.1%) died during the study period from January 1, 2000 to December 31, 2019. Moderate risk and high risk of DFD were associated with increased mortality risk compared to low risk of DFD (adjusted hazard ratio [aHR] 1.50, 95% CI 1.42, 1.58; aHR 2.01, 95% CI 1.84, 2.20, respectively). Individuals who declined foot examination or who had no record also had increased mortality risk of 75% and 25% vs. those at low risk of DFD, respectively (aHR 1.75, 95% CI 1.51, 2.04; aHR 1.25, 95% CI 1.20, 1.30). CONCLUSION Individuals with new-onset type 2 diabetes who had moderate to high risk of DFD were more likely to die compared to those at low risk of DFD. The associations between declined foot examination and absence of foot examinations, and increased risk of mortality further highlight the importance of assessing foot risk as it identifies not only patients at risk of diabetic foot ulceration but also mortality.
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Affiliation(s)
- Zhaonan Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Jonathan Hazlehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Department of Diabetes and Endocrinology, University Hospital Birmingham Foundation Trust, Birmingham, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
| | - Anuradhaa Subramanian
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Abd A. Tahrani
- Department of Diabetes and Endocrinology, University Hospital Birmingham Foundation Trust, Birmingham, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Wasim Hanif
- Department of Diabetes and Endocrinology, University Hospital Birmingham Foundation Trust, Birmingham, United Kingdom
| | - Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Pushpa Singh
- Department of Diabetes and Endocrinology, University Hospital Birmingham Foundation Trust, Birmingham, United Kingdom
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Jingya Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Christopher Sainsbury
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Department of Diabetes, Gartnavel General Hospital, National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Francesca L. Crowe
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Francesca L. Crowe,
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10
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Zoghi G, Shahbazi R, Mahmoodi M, Nejatizadeh A, Kheirandish M. Prevalence of metabolically unhealthy obesity, overweight, and normal weight and the associated risk factors in a southern coastal region, Iran (the PERSIAN cohort study): a cross-sectional study. BMC Public Health 2021; 21:2011. [PMID: 34740348 PMCID: PMC8569952 DOI: 10.1186/s12889-021-12107-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Obesity is a substantial risk factor for cardiovascular and metabolic diseases. Epidemiologic studies have shown that some obese and overweight individuals are metabolically healthy. We aimed to determine the prevalence of metabolically unhealthy obesity (MUO), metabolically unhealthy overweight (MUOW), and metabolically unhealthy normal weight (MUNW) in a southern coastal area of Iran, Bandare-Kong Non-Communicable Diseases (BKNCD) Cohort Study. Methods This population-based study included the participants of BKNCD, as part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN). Metabolic health was defined as not fulfilling the metabolic syndrome (MetS) criteria. Results Among the 3917 participants in this study with the mean age of 48.29 ± 9.39 years, including 1691 (43.2%) males, the age- and sex-standardized prevalence of MUO, MUOW, and MUNW was 13.9, 16.8, and 6.4%, respectively. Binary logistic regression analysis revealed that the adjusted odds of all metabolically unhealthy states were higher in older age groups, except for MUO whose adjusted odds were lower in the 65–70 age group compared to the 55–64 age group. Illiteracy was significantly correlated with MUOW (adjusted OR: 1.43, 95% CI 1.09–1.87, P = 0.010); however, it was not associated with MUO or MUNW. Higher body mass index (BMI) was significantly correlated with MUNW but it was not associated with MUOW or MUO. Higher waist circumference (WC) was also significantly associated with all metabolically unhealthy states. Conclusion The age- and sex-standardized prevalence of MUO, MUOW, and MUNW was 13.9, 16.8, and 6.4%, respectively in the current study. Advanced age and higher WC were significantly correlated with all metabolically unhealthy states, while illiteracy and higher BMI were only associated with MUOW and MUNW, respectively. Metabolic health rather than weight loss should be the focus and objective of public prevention programs.
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Affiliation(s)
- Ghazal Zoghi
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Roghayeh Shahbazi
- Cellular and Molecular Medicine Department, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Masoumeh Mahmoodi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Azim Nejatizadeh
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoumeh Kheirandish
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
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11
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Zhao Y, Qie R, Han M, Huang S, Wu X, Zhang Y, Feng Y, Yang X, Li Y, Wu Y, Liu D, Hu F, Zhang M, Sun L, Hu D. Association of BMI with cardiovascular disease incidence and mortality in patients with type 2 diabetes mellitus: A systematic review and dose-response meta-analysis of cohort studies. Nutr Metab Cardiovasc Dis 2021; 31:1976-1984. [PMID: 33965298 DOI: 10.1016/j.numecd.2021.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/01/2021] [Indexed: 01/11/2023]
Abstract
AIMS The relation of body mass index (BMI) with cardiovascular disease (CVD) and mortality has been extensively investigated in the general population but is less clear in individuals with type 2 diabetes mellitus (T2DM). We performed a meta-analysis of cohort studies to quantitatively evaluate the association of BMI with CVD incidence and mortality in patients with T2DM. DATA SYNTHESIS PubMed and Embase databases were searched for relevant cohort articles published up to June 8, 2020. Restricted cubic splines were used to evaluate the potential linear or non-linear dose-response associations. We identified 17 articles (21 studies) with 1,349,075 participants and 57,725 cases (49,354 CVD incidence and 8371 CVD mortality) in the meta-analysis. We found a linear association between BMI and risk of CVD incidence (Pnon-linearity = 0.182); the pooled RR for CVD incidence was 1.12 (95% CI, 1.04-1.20) with a 5-unit increase in BMI. We found an overall nonlinear relationship between BMI and CVD mortality (Pnon-linearity < 0.001). The lowest risk was at BMI about 28.4 kg/m2, with increased mortality risk for higher BMI values; the RR with a 5-unit increase in BMI was 0.87 (95% CI, 0.79-0.96) and 1.11 (95% CI, 1.04-1.18) for BMI ≤28.4 kg/m2 and BMI >28.4 kg/m2, respectively. CONCLUSIONS In individuals with T2DM, BMI may have a positive linear association with risk of CVD incidence but a nonlinear association with CVD mortality. Our results can provide evidence for weight control and lifestyle intervention for preventing and managing cardiovascular disease in T2DM.
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Affiliation(s)
- Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ranran Qie
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Minghui Han
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shengbing Huang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xiaoyan Wu
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yanyan Zhang
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yifei Feng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xingjin Yang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yang Li
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yuying Wu
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Dechen Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Fulan Hu
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Ming Zhang
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Liang Sun
- Department of Social Medicine and Health Service Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
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12
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Huang HL, Kung CY, Wang SM, Kung PT, Lin YH, Chiu LT, Tsai WC. Effects of Body Mass Index and Pay-for-Performance Program on Risk of Death in Patients with Type 2 Diabetes: A Nationwide Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094648. [PMID: 33925667 PMCID: PMC8125714 DOI: 10.3390/ijerph18094648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022]
Abstract
Background: The diabetes patients enrolled in the pay-for-performance (P4P) program demonstrate reduced risk of death. Body mass index (BMI) is a risk factor of all-cause death. This study investigates the effects of BMI and P4P on the risk of death in type 2 diabetes patients. Methods: This is a retrospective cohort study. The study population includes the 3-wave National Health Interview Survey in Taiwan. A total of 6354 patients with diabetes aged ≥ 20 years were enrolled and followed up until the end of 2014. Results: The highest mortality rate per 1000 person-years was 61.05 in the underweight patients with diabetes. A lower crude death rate was observed in the P4P participants than non-P4P participants. The risk of death was 1.86 times higher in the underweight patients with diabetes than that in the normal weight group (95% CI: 1.37–2.53) and was lower in the P4P participants, as compared to the non-participants (HR: 0.55, 95% CI: 0.44–0.69). The most significant effect of joining the P4P program in reducing death risk was found in the underweight patients with diabetes (HR: 0.11, 95% CI: 0.04–0.38), followed by the obesity group (HR: 0.30, 95% CI: 0.17–0.52). Conclusions: Different effects of joining the P4P program on reducing death risk were observed in the underweight and obesity groups. We strongly recommend that patients with diabetes and without healthy BMIs participate in the P4P program.
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Affiliation(s)
- Hsiu-Ling Huang
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu County 304, Taiwan; (H.-L.H.); (S.-M.W.)
| | - Chuan-Yu Kung
- Department of Nursing, Hengchun Tourism Hospital, Ministry of Health and Welfare, Pingtung County 94641, Taiwan;
| | - Shun-Mu Wang
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu County 304, Taiwan; (H.-L.H.); (S.-M.W.)
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung City 41354, Taiwan;
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung City 40402, Taiwan
| | - Yen-Hsiung Lin
- Department of Pediatrics, Hengchun Tourism Hospital, Ministry of Health and Welfare, Pingtung County 94641, Taiwan;
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan;
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan;
- Correspondence: ; Tel.: +886-422994045; Fax: +886-422993643
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13
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Thong EP, Burden C. The Double Whammy of Obesity and Diabetes on Female Reproductive Health. Semin Reprod Med 2021; 38:333-341. [PMID: 33598908 DOI: 10.1055/s-0041-1723777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The rising global prevalence of obesity and diabetes, especially in youth, confers substantial metabolic consequences and increased mortality in affected individuals. While obesity is strongly tied to the development of insulin resistance and type 2 diabetes, emerging evidence shows that obesity rates are also increasing exponentially in those with type 1 diabetes, contributing to insulin resistance and cardiometabolic sequelae. In addition, both obesity and diabetes can exert adverse effects on female reproductive health independently, with the presence of both conditions likely to exacerbate reproductive dysfunction in this cohort. If the current trends in obesity and diabetes incidence persist, it is likely that more women will be at risk of obesity- and diabetes-related reproductive disorders. This review aims to describe the epidemiology and mechanisms of obesity in women with diabetes, and summarize current literature regarding reproductive disorders in diabetes and weight management strategies in this cohort.
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Affiliation(s)
- Eleanor P Thong
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia.,Department of Diabetes and Vascular Medicine, Monash Health, Melbourne, Australia
| | - Christy Burden
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
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14
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Qi H, Hu C, Wang S, Zhang Y, Du R, Zhang J, Lin L, Wang T, Zhao Z, Li M, Xu Y, Xu M, Bi Y, Wang W, Chen Y, Lu J. Early life famine exposure, adulthood obesity patterns and the risk of nonalcoholic fatty liver disease. Liver Int 2020; 40:2694-2705. [PMID: 32558201 DOI: 10.1111/liv.14572] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/06/2020] [Accepted: 06/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early life exposure to famine and adulthood obesity increased the risk of nonalcoholic fatty liver disease (NAFLD) in adulthood. However, the joint effects on adulthood NAFLD risk are not clear. AIM This study aimed to explore the joint effects of famine exposure and adulthood obesity on NAFLD risk in later life. METHODS We included 7632 subjects aged ≥40 years from a community-dwelling population. Participants were divided into 4 famine exposure groups according to the birth year, including nonexposed (1963-1974), fetal-exposed (1959-1962), childhood-exposed (1949-1958) and adolescent-exposed (1941-1948). General obesity was assessed by body mass index (BMI: overweight ≥24.0 kg/m2 , obesity ≥28.0 kg/m2 ) and abdominal obesity assessed by waist-to-hip ratio (WHR, men/women: moderate ≥0.90/0.85, high ≥0.95/0.90). RESULTS Compared with nonexposed, fetal- and childhood-exposed participants show an increased risk of NAFLD with multivariable-adjusted odds ratio (OR) and 95% confidence interval (CI) of 1.28 (1.02-1.61) and 1.40 (1.04-1.88) respectively. After further adjusting BMI and WHR, the increased risk was observed only in childhood-exposed participants (OR = 1.46, 95% CI = 1.04-2.05). Significant interaction between famine exposure and general obesity on the risk of NAFLD was observed in women (P for interaction = .02). No significant interactions were detected between famine exposure and abdominal obesity (all P for interaction >.05). Compared with normal-BMI and -WHR participants, those with both general and abdominal obesity in adulthood had 20.74 (95% CI: 12.00-35.96), 14.45 (8.76-23.86), 23.02 (16.28-32.57) and 13.04 (8.30-20.48)-fold higher risk in nonexposed, fetal-, childhood- and adolescent-exposed groups respectively. CONCLUSION Coexistence of early life famine exposure and adulthood obesity was associated with a higher risk of NAFLD.
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Affiliation(s)
- Hongyan Qi
- Shanghai National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Chunyan Hu
- Shanghai National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Shuangyuan Wang
- Shanghai National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Yi Zhang
- Shanghai National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Rui Du
- Shanghai National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Jie Zhang
- Shanghai National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China.,Department of endocrine and metabolic diseases, Rui Jin North Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Lin
- Shanghai National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China.,Department of endocrine and metabolic diseases, Rui Jin North Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiange Wang
- Shanghai National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Zhiyun Zhao
- Shanghai National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Mian Li
- Shanghai National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Yu Xu
- Shanghai National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Min Xu
- Shanghai National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Yufang Bi
- Shanghai National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Weiqing Wang
- Shanghai National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Yuhong Chen
- Shanghai National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China.,Department of endocrine and metabolic diseases, Rui Jin North Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jieli Lu
- Shanghai National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
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15
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Yamazaki C, Goto A, Iwasaki M, Sawada N, Oba S, Noda M, Iso H, Koyama H, Tsugane S. Body mass index and mortality among middle-aged Japanese individuals with diagnosed diabetes: The Japan Public Health Center-based prospective study (JPHC study). Diabetes Res Clin Pract 2020; 164:108198. [PMID: 32389744 DOI: 10.1016/j.diabres.2020.108198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 04/03/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
AIM To examine the association between body mass index (BMI) and mortality among middle-aged people with diabetes in Japan. METHODS A total of 3032 men and 1615 women, aged 40-69 years, with diabetes were analyzed. Cox proportional hazards models, adjusted for potential confounding factors, were used to estimate mortality hazard ratios (HRs) across BMI categories at the baseline. RESULTS There were 1761 deaths during a mean follow-up period of 18.5 years. Increased all-cause mortality was observed at both ends of the BMI distribution; compared with the reference BMI category (23.0-24.9 kg/m2), the HRs were 1.25 (95% confidence interval [CI], 0.9997-1.56) in the lowest (14.0-18.9 kg/m2) and 1.36 (95% CI, 1.06-1.74) in the highest (30.0-39.9 kg/m2) categories (P = 0.001). Similar all-cause mortality trends were observed after excluding deaths within 3 years of follow-up, as well as for men and men who had ever smoked. While a similar non-linear pattern was observed for cancer-specific mortality, heart disease-specific mortality was only increased in the highest BMI category (HR, 1.86; 95% CI, 1.06-3.25). CONCLUSION This population-based prospective study demonstrated increased all-cause mortality at both ends of the BMI distribution among Japanese people with diabetes.
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Affiliation(s)
- Chiho Yamazaki
- Department of Public Health, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Atsushi Goto
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan; Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
| | - Motoki Iwasaki
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Norie Sawada
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Shino Oba
- Gunma University Graduate School of Health Sciences, Gunma, Japan
| | - Mitsuhiko Noda
- Department of Diabetes, Metabolism and Endocrinology, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan; Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Koyama
- Department of Public Health, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Shoichiro Tsugane
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
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16
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Dwivedi AK, Dubey P, Cistola DP, Reddy SY. Association Between Obesity and Cardiovascular Outcomes: Updated Evidence from Meta-analysis Studies. Curr Cardiol Rep 2020; 22:25. [DOI: 10.1007/s11886-020-1273-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Qi Y, Zhang X, Seyoum B, Msallaty Z, Mallisho A, Caruso M, Damacharla D, Ma D, Al-janabi W, Tagett R, Alharbi M, Calme G, Mestareehi A, Draghici S, Abou-Samra A, Kowluru A, Yi Z. Kinome Profiling Reveals Abnormal Activity of Kinases in Skeletal Muscle From Adults With Obesity and Insulin Resistance. J Clin Endocrinol Metab 2020; 105:5607358. [PMID: 31652310 PMCID: PMC6991621 DOI: 10.1210/clinem/dgz115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/08/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT Obesity-related insulin resistance (OIR) is one of the main contributors to type 2 diabetes and other metabolic diseases. Protein kinases are implicated in insulin signaling and glucose metabolism. Molecular mechanisms underlying OIR involving global kinase activities remain incompletely understood. OBJECTIVE To investigate abnormal kinase activity associated with OIR in human skeletal muscle. DESIGN Utilization of stable isotopic labeling-based quantitative proteomics combined with affinity-based active enzyme probes to profile in vivo kinase activity in skeletal muscle from lean control (Lean) and OIR participants. PARTICIPANTS A total of 16 nondiabetic adults, 8 Lean and 8 with OIR, underwent hyperinsulinemic-euglycemic clamp with muscle biopsy. RESULTS We identified the first active kinome, comprising 54 active protein kinases, in human skeletal muscle. The activities of 23 kinases were different in OIR muscle compared with Lean muscle (11 hyper- and 12 hypo-active), while their protein abundance was the same between the 2 groups. The activities of multiple kinases involved in adenosine monophosphate-activated protein kinase (AMPK) and p38 signaling were lower in OIR compared with Lean. On the contrary, multiple kinases in the c-Jun N-terminal kinase (JNK) signaling pathway exhibited higher activity in OIR vs Lean. The kinase-substrate-prediction based on experimental data further confirmed a potential downregulation of insulin signaling (eg, inhibited phosphorylation of insulin receptor substrate-1 and AKT1/2). CONCLUSIONS These findings provide a global view of the kinome activity in OIR and Lean muscle, pinpoint novel specific impairment in kinase activities in signaling pathways important for skeletal muscle insulin resistance, and may provide potential drug targets (ie, abnormal kinase activities) to prevent and/or reverse skeletal muscle insulin resistance in humans.
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Affiliation(s)
- Yue Qi
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Xiangmin Zhang
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Berhane Seyoum
- Division of Endocrinology, Wayne State University School of Medicine, Wayne State University, Detroit, MI
| | - Zaher Msallaty
- Division of Endocrinology, Wayne State University School of Medicine, Wayne State University, Detroit, MI
| | - Abdullah Mallisho
- Division of Endocrinology, Wayne State University School of Medicine, Wayne State University, Detroit, MI
| | - Michael Caruso
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Divyasri Damacharla
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Danjun Ma
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Wissam Al-janabi
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Rebecca Tagett
- Department of Computer Science, College of Engineering, Wayne State University, Detroit, MI
| | - Majed Alharbi
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Griffin Calme
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Aktham Mestareehi
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Sorin Draghici
- Department of Computer Science, College of Engineering, Wayne State University, Detroit, MI
| | - Abdul Abou-Samra
- Division of Endocrinology, Wayne State University School of Medicine, Wayne State University, Detroit, MI
- Department of Medicine, Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - Anjaneyulu Kowluru
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
- β-Cell Biochemistry Laboratory, John D. Dingell VA Medical Center, Detroit, MI
| | - Zhengping Yi
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
- Correspondence: Zhengping Yi, PhD, Department of Pharmaceutical Sciences – Room 3146, Eugene Applebaum College of Pharmacy/Health Sciences, Wayne State University, 6135 Woodward Ave., Detroit, MI 48202. E-mail:
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Tate J, Knuiman M, Davis WA, Davis TME, Bruce DG. A comparison of obesity indices in relation to mortality in type 2 diabetes: the Fremantle Diabetes Study. Diabetologia 2020; 63:528-536. [PMID: 31838571 DOI: 10.1007/s00125-019-05057-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS This prospective association study aimed to compare the relationship between each of four obesity indices and mortality risk in people with type 2 diabetes. METHODS The associations of BMI, waist circumference, WHR and A Body Shape Index (ABSI) with all-cause mortality were analysed in 1282 participants of the Fremantle Diabetes Study, followed for up to 20 years after baseline assessment. Models were adjusted for age and other confounders; assessments as continuous measures and by quintile were carried out for men and women separately. Sensitivity analyses were conducted to minimise reverse causality. RESULTS When indices were assessed as continuous variables, there were significant bivariate associations with mortality for: ABSI, which was greater in both men and women who died (p < 0.001); WHR, which was greater in women only (p = 0.033); and BMI, which was lower in women only (p < 0.001). When assessed by quintile, there were significant bivariate associations with mortality for ABSI in men and women (p < 0.001) and BMI in women only (p = 0.002). In Cox models of time to death, adjusted for age, diabetes duration, ethnicity and smoking, ABSI quintiles showed a linear trend for both men (p = 0.003) and women (p = 0.035). Men in the fifth ABSI quintile had an increased mortality risk compared with those in the first quintile (HR [95% CI]: 1.74 [1.24, 2.44]) and women in the fifth ABSI quintile had an increased mortality risk that approached statistical significance (1.42 [0.97, 2.08], p = 0.08). Men in the fifth WHR quintile had an increased mortality risk (1.47 [1.05, 2.06]). There was no association between mortality and BMI or waist circumference in either sex. CONCLUSIONS/INTERPRETATION ABSI was the obesity index most strongly associated with all-cause mortality in Australians with type 2 diabetes. There was no evidence for an obesity paradox with any of the assessed indices. ABSI may be a better index of central obesity than waist circumference, BMI or WHR when assessing mortality risk in type 2 diabetes.
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Affiliation(s)
- Joel Tate
- School of Population and Global Health, University of Western Australia, Nedlands, WA, Australia
| | - Matthew Knuiman
- School of Population and Global Health, University of Western Australia, Nedlands, WA, Australia
| | - Wendy A Davis
- Medical School, Fremantle Hospital, PO Box 480, Fremantle, WA, 6959, Australia
| | - Timothy M E Davis
- Medical School, Fremantle Hospital, PO Box 480, Fremantle, WA, 6959, Australia
| | - David G Bruce
- Medical School, Fremantle Hospital, PO Box 480, Fremantle, WA, 6959, Australia.
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The prevalence and correlates of burnout among Chinese preschool teachers. BMC Public Health 2020; 20:160. [PMID: 32013939 PMCID: PMC6998270 DOI: 10.1186/s12889-020-8287-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/27/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND A series of studies have suggested that teachers are likely to experience professional burnout in various regions around the world. To date, no known research has been conducted to investigate the prevalence and correlates of burnout among preschool teachers in China. This study examined the level of self-reported burnout and correlates of burnout among Chinese preschool teachers. METHODS A cross-sectional study was conducted among1795 preschool teachers in Tianjin, China, during August 2018-October 2018. The validated Chinese version of the 15-item Maslach Burnout Inventory was used to assess burnout. A self-administered questionnaire collected the sociodemographic factors. The psychological factors were collected by the Chinese version of the 20-item Center for Epidemiologic Studies Depression Scale (CES-D) and the Perceived Stress Scale-14. RESULTS The prevalence of burnout in Chinese preschool teachers was 53.2% (95% CI:51%─56%). Burnout rate was significantly decreased in overweight (P = 0.001, OR = 0.58, 95% CI: 0.42-0.79) and obesity (P = 0.048, OR = 0.75, 95% CI: 0.56-1.00) teachers compared with teachers with normal weight. The type of school (P = 0.007, OR = 1.45, 95% CI: 1.11-1.91), income satisfaction (P = 0.001, OR = 0.67, 95% CI: 0.53-0.86), depression (P < 0.001, OR = 3.08, 95% CI: 2.34-4.05) and perceived stress (P < 0.001, OR = 1.15, 95%CI: 1.13-1.18) were significantly associated with burnout. CONCLUSIONS The prevalence of burnout among preschool teachers in Tianjin, China, is high. Burnout was significantly associated with BMI, the type of school, income satisfaction, depression and perceived stress among Chinese preschool teachers.
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Toida T, Sato Y, Ogata S, Wada A, Masakane I, Fujimoto S. Synergic Impact of Body Mass Index, Diabetes, and Age on Long-Term Mortality in Japanese Incident Hemodialysis Patients: A Cohort Study on a Large National Dialysis Registry. J Ren Nutr 2019; 30:333-340. [PMID: 31812321 DOI: 10.1053/j.jrn.2019.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/14/2019] [Accepted: 09/14/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES The relationships among body mass index (BMI), diabetes, age, and all-cause mortality in hemodialysis patients remain unclear. We examined BMI-stratified relationships between diabetes, age, and the risk of long-term mortality in incident hemodialysis patients. METHODS This is a cohort study. Data were obtained from the national dialysis registry in Japan 2007 that included 35,415 incident hemodialysis patients and 6,061 patients aged ≥20 years with BMI data. Patients were divided into 6 categories according to baseline BMI (low: <18.5, normal: 18.5-25, Obesity: ≥25) and the presence or absence of diabetes. The primary outcome was all-cause mortality during a 5-year follow-up. Hazard ratios were estimated using Cox's model for the relationships among diabetes, BMI categories, and all-cause mortality, and adjusted for potential confounders. Patients with a normal BMI and non-diabetic were the reference category. We also examined the effects of age on these relationships. RESULTS A total of 6,061 patients, including 3,239 with diabetes, were enrolled. During the follow-up, 31.0% and 30.7% of all and diabetic patients, respectively, died. Cox's regression analysis showed that low BMI, but not obesity, was independently associated with an increased risk of all-cause death in patients with and without diabetes. When patients were divided into 2 groups-younger and older than 60 years-the risk of mortality in both groups was increased in low BMI with diabetes. CONCLUSIONS Among Japanese incident hemodialysis patients, low BMI increases the risk of all-cause mortality. The markedly high mortality rate in diabetic patients with low BMI regardless of age warrants attention.
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Affiliation(s)
- Tatsunori Toida
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan; Department of Internal Medicine, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan.
| | - Yuji Sato
- Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan
| | - Satoshi Ogata
- Committee of Renal Data Registry, The Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Atsushi Wada
- Committee of Renal Data Registry, The Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Ikuto Masakane
- Committee of Renal Data Registry, The Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan; Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan
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Prognostic Modeling and Prevention of Diabetes Using Machine Learning Technique. Sci Rep 2019; 9:13805. [PMID: 31551457 PMCID: PMC6760163 DOI: 10.1038/s41598-019-49563-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/20/2019] [Indexed: 02/07/2023] Open
Abstract
Stratifying individuals at risk for developing diabetes could enable targeted delivery of interventional programs to those at highest risk, while avoiding the effort and costs of prevention and treatment in those at low risk. The objective of this study was to explore the potential role of a Hidden Markov Model (HMM), a machine learning technique, in validating the performance of the Framingham Diabetes Risk Scoring Model (FDRSM), a well-respected prognostic model. Can HMM predict 8-year risk of developing diabetes in an individual effectively? To our knowledge, no study has attempted use of HMM to validate the performance of FDRSM. We used Electronic Medical Record (EMR) data, of 172,168 primary care patients to derive the 8-year risk of developing diabetes in an individual using HMM. The Area Under Receiver Operating Characteristic Curve (AROC) in our study sample of 911 individuals for whom all risk factors and follow up data were available is 86.9% compared to AROCs of 78.6% and 85% reported in a previously conducted validation study of FDRSM in the same Canadian population and the Framingham study respectively. These results demonstrate that the discrimination capability of our proposed HMM is superior to the validation study conducted using the FDRSM in a Canadian population and in the Framingham population. We conclude that HMM is capable of identifying patients at increased risk of developing diabetes within the next 8-years.
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Pei X, Liu L, Cai Y, Peng Y, Ma C, Jin Y, Ping Z. Body mass index cut-off points for predicting chronic non-communicable disease should differ by gender and age group. Public Health 2019; 175:54-59. [PMID: 31398517 DOI: 10.1016/j.puhe.2019.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/15/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective of this study to determine whether body mass index (BMI) in different genders and age groups need different thresholds when predicting chronic non-communicable diseases (CNCDs). STUDY DESIGN This is a cross-sectional study. METHODS Data were obtained from the China Health and Nutrition Survey conducted in 2009. Sequential sample cluster analysis was used to group age according to BMI. Propensity score matching was used to eliminate the influence of age. Receiver operating characteristic curve based on gender and age group was used to evaluate the cut-off values and efficiency of BMI in each group. RESULTS A total of 8469 individuals were enrolled in this study. Results of sequential sample cluster analyses showed age was divided into three groups: 18-39, 40-59 and 60-99 years. There were significant differences in the distribution of BMI among the three groups for both males and females (P < 0.001). Statistical differences were observed in the distribution of BMI between genders in the 18-39- and 60-99-year-old age groups (P < 0.001). For men, the cut-off values of BMI were ≥25 kg/m2, ≥24 kg/m2 and ≥23 kg/m2 in the 18-39, 40-59 and 60-99 years old groups, respectively; for women, the corresponding cut-off points were ≥25 kg/m2, ≥23 kg/m2 and ≥25 kg/m2 in groups. CONCLUSIONS The thresholds for BMI might be different between gender and age group. In addition, it might not be suitable to determine cut-off values of BMI to predict CNCDs for people aged ≥60 years.
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Affiliation(s)
- X Pei
- College of Public Health, Zhengzhou University, Zhengzhou, China; Henan Provincial People's Hospital and People's Hospital of Zhengzhou University, Henan Eye Institute, Henan Eye Hospital, Zhengzhou, China
| | - L Liu
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Y Cai
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Y Peng
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - C Ma
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Y Jin
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Z Ping
- College of Public Health, Zhengzhou University, Zhengzhou, China.
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Jiménez-Osorio AS, Musalem-Younes C, Cárdenas-Hernández H, Solares-Tlapechco J, Costa-Urrutia P, Medina-Contreras O, Granados J, López-Saucedo C, Estrada-Garcia T, Rodríguez-Arellano ME. Common Polymorphisms Linked to Obesity and Cardiovascular Disease in Europeans and Asians are Associated with Type 2 Diabetes in Mexican Mestizos. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E40. [PMID: 30764545 PMCID: PMC6410269 DOI: 10.3390/medicina55020040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 02/07/2023]
Abstract
Background and objectives: Type 2 diabetes (T2D) is a major problem of public health in Mexico. We investigated the influence of five polymorphisms, previously associated with obesity and cardiovascular disease in Europeans and Asians, on T2D in Mexican Mestizos. Materials and Methods: A total of 1358 subjects from 30 to 85 years old were genotyped for five loci: CXCL12 rs501120; CDNK2A/B rs1333049; HNF-1α rs2259816; FTO rs9939609; and LEP rs7799039. We used logistic regressions to test the effect of each locus on T2D in two case⁻control groups with obesity and without obesity. Also, linear regression models on glucose and glycated hemoglobin (HbA1c) were carried out on the whole sample, adjusted by age, gender, and body mass index. Results: The CXCL12 rs501120 C allele (OR = 1.96, p = 0.02), the FTO rs9939609 A allele (OR = 2.20, p = 0.04) and the LEP rs7799039 A allele (OR = 0.6, p = 0.03) were significantly associated with T2D in obesity case⁻control group. No significant association was found in the non-obesity case⁻control group. The linear regression model showed that CDNK2A/B rs1333049 C allele (β = 0.4, p = 0.03) and FTO rs9939609 A allele (β = 0.5, p = 0.03), were significantly associated with HbA1c, but no association was found among the loci with the glucose levels. Conclusions: Polymorphisms previously linked with obesity and cardiovascular events were also associated with T2D and high levels of HbA1c. Furthermore, we must point at the fact that this is the first report where polymorphisms CXCL12 rs501120 and LEP rs7799039 are associated with T2D in subjects with obesity.
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Affiliation(s)
| | - Claudette Musalem-Younes
- Laboratorio de Medicina Genómica, Hospital Regional Lic. Adolfo López Mateos ISSSTE, Mexico City 01030, Mexico.
| | - Helios Cárdenas-Hernández
- Laboratorio de Medicina Genómica, Hospital Regional Lic. Adolfo López Mateos ISSSTE, Mexico City 01030, Mexico.
| | | | - Paula Costa-Urrutia
- Laboratorio de Medicina Genómica, Hospital Regional Lic. Adolfo López Mateos ISSSTE, Mexico City 01030, Mexico.
| | - Oscar Medina-Contreras
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico.
| | - Julio Granados
- Laboratorio de Medicina Genómica, Hospital Regional Lic. Adolfo López Mateos ISSSTE, Mexico City 01030, Mexico.
- División de Inmunogenética, Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico.
| | - Catalina López-Saucedo
- Department of Molecular Biomedicine, CINVESTAV-IPN, Av. IPN #2508, Col. Zacatenco, Mexico City 07360, Mexico.
| | - Teresa Estrada-Garcia
- Department of Molecular Biomedicine, CINVESTAV-IPN, Av. IPN #2508, Col. Zacatenco, Mexico City 07360, Mexico.
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Qiu S, Cai X, Yang B, Du Z, Cai M, Sun Z, Zügel M, Michael Steinacker J, Schumann U. Association Between Cardiorespiratory Fitness and Risk of Type 2 Diabetes: A Meta-Analysis. Obesity (Silver Spring) 2019; 27:315-324. [PMID: 30604925 DOI: 10.1002/oby.22368] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 10/22/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This meta-analysis aimed to (1) quantify the association of cardiorespiratory fitness (CRF) with type 2 diabetes risk in the general population and statin users and (2) investigate the joint effects of CRF and fatness with type 2 diabetes risk. METHODS Databases were searched for cohort studies reporting the association between CRF and type 2 diabetes risk. Summary hazard ratios (HRs) were obtained using random-effects models. RESULTS Fifteen studies were included. The HRs of type 2 diabetes for every 1-metabolic equivalent increase in CRF were 0.90 (95% CI: 0.86-0.94) for the general population and 0.92 (95% CI: 0.87-0.97) for statin users, and the HRs were linearly shaped (both Pnonlinearity > 0.40). Compared with the nonstatin cohort, there was an increased risk of type 2 diabetes in statin users with the lowest and moderate CRF categories, but this was not present in the highest CRF category. The HR of type 2 diabetes for overweight/obesity-fit category versus normal weight-fit category was larger than that of the normal weight-unfit category versus the normal weight-fit category (Pinteraction = 0.004). CONCLUSIONS There was an inverse and dose-dependent association between CRF and type 2 diabetes risk. High CRF may eliminate the diabetogenic effect from statins, yet decreased body weight index seems superior in preventing type 2 diabetes.
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Affiliation(s)
- Shanhu Qiu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
- Division of Sports and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
| | - Xue Cai
- School of Nursing, Peking University, Beijing, China
| | - Bingquan Yang
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Ziwei Du
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Min Cai
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Martina Zügel
- Division of Sports and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
| | | | - Uwe Schumann
- Division of Sports and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
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Overbeek JA, Heintjes EM, Huisman EL, Tikkanen CK, van Diermen AW, Penning‐van Beest FJ, Herings RM. Clinical effectiveness of liraglutide vs basal insulin in a real-world setting: Evidence of improved glycaemic and weight control in obese people with type 2 diabetes. Diabetes Obes Metab 2018; 20:2093-2102. [PMID: 29726082 PMCID: PMC6099315 DOI: 10.1111/dom.13335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 12/19/2022]
Abstract
AIMS To compare real-world antidiabetic treatment outcomes over 12 months in obese people with type 2 diabetes mellitus (T2DM) who previously received oral antidiabetic therapy and then initiated a first injectable therapy with liraglutide or basal insulin. PATIENTS AND METHODS This was a retrospective, propensity score-matched, longitudinal cohort study using real-world data (January 2010 to December 2015) from the Dutch PHARMO Database Network. Adult obese (body mass index [BMI] ≥35 kg/m2 ) patients with T2DM with ≥2 dispensing dates for liraglutide or basal insulin supported oral therapy (BOT) were selected. The primary endpoint was the change in glycated haemoglobin (HbA1c) from baseline during 12 months of follow-up. The secondary endpoints were the changes in weight, BMI and cardiovascular risk factors from baseline. Clinical data were analysed using descriptive statistics and compared using mixed models for repeated measures. RESULTS Obese patients with T2DM (N = 1157) in each treatment group were matched (liraglutide cohort, n = 544; BOT cohort, n = 613). From 3 months onwards, glycaemic control improved in both cohorts but improved significantly more with liraglutide than with BOT (12 months: -12.2 mmol/mol vs -8.8 mmol/mol; P = .0053). In addition, weight and BMI were significantly lower for treatments with liraglutide vs BOT (12 months: -6.0 kg vs -1.6 kg and - 2.1 kg/m2 vs -0.5 kg/m2 , respectively; P < .0001 for both). No significant differences were seen in changes in cardiovascular risk factors. CONCLUSIONS The results of this real-world study in matched obese patients with T2DM showed that liraglutide was more effective than BOT for HbA1c control and weight/BMI reductions. Patients were more likely to maintain glycaemic control over time after initiating liraglutide than after initiating BOT.
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Affiliation(s)
- Jetty A. Overbeek
- PHARMO Institute for Drug Outcomes ResearchUtrechtthe Netherlands
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research InstituteVU University Medical CentreAmsterdamthe Netherlands
| | | | | | | | | | | | - Ron M.C. Herings
- PHARMO Institute for Drug Outcomes ResearchUtrechtthe Netherlands
- Department of Epidemiology and BiostatisticsVU University Medical CenterAmsterdamthe Netherlands
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Gao F, Wang ZJ, Shen H, Yang SW, Nie B, Zhou YJ. Impact of obesity on mortality in patients with diabetes: Meta-analysis of 20 studies including 250,016 patients. J Diabetes Investig 2018; 9:44-54. [PMID: 28593750 PMCID: PMC5754523 DOI: 10.1111/jdi.12677] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/28/2017] [Accepted: 04/04/2017] [Indexed: 01/03/2023] Open
Abstract
AIMS/INTRODUCTION The impact of body mass index on mortality among patients with diabetes remains controversial. Therefore, we carried out a meta-analysis of pertinent studies. MATERIALS AND METHODS We searched OVID/MEDLINE, EMBASE and Cochrane databases for all reported studies, which investigated the relationship between body mass index and mortality in patients with diabetes. Summary estimates of hazard ratios (HRs) were obtained with a random effects model. Univariate meta-regressions were carried out. RESULTS A total of 20 studies including 250,016 patients with diabetes were identified. The results of the present study showed a significantly reduced risk of all-cause mortality in overweight patients (HR 0.82, 95% CI: 0.74-0.91, P < 0.0001, and I2 = 91.6%) as compared with normal weight patients. The survival benefits of obesity were only observed in the elderly patients (HR 0.69, 95% CI: 0.63-0.75, P < 0.0001, and I2 = 50.4%), but not in the younger patients (HR 1.01, 95% CI: 0.84-1.20, P = 0.96, I2 = 80.1%). Furthermore, the beneficial prognostic impacts on overweight (coefficient = 0.030, P = 0.041) and obesity (coefficient = 0.032, P = 0.010) were attenuated with clinical follow-up duration. CONCLUSIONS The present meta-analysis showed a significantly lower risk of all-cause mortality in overweight patients with diabetes compared with normal weight patients. However, the survival benefits of obesity were only observed among the elderly patients.
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Affiliation(s)
- Fei Gao
- Department of CardiologyAn Zhen HospitalCapital Medical UniversityBeijingChina
| | - Zhi Jian Wang
- Department of CardiologyAn Zhen HospitalCapital Medical UniversityBeijingChina
| | - Hua Shen
- Department of CardiologyAn Zhen HospitalCapital Medical UniversityBeijingChina
| | - Shi Wei Yang
- Department of CardiologyAn Zhen HospitalCapital Medical UniversityBeijingChina
| | - Bin Nie
- Department of CardiologyAn Zhen HospitalCapital Medical UniversityBeijingChina
| | - Yu Jie Zhou
- Department of CardiologyAn Zhen HospitalCapital Medical UniversityBeijingChina
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Engin A. The Definition and Prevalence of Obesity and Metabolic Syndrome. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 960:1-17. [PMID: 28585193 DOI: 10.1007/978-3-319-48382-5_1] [Citation(s) in RCA: 635] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Increase in prevalence of obesity has become a worldwide major health problem in adults, as well as among children and adolescents. Furthermore, total adiposity and truncal subcutaneous fat accumulation during adolescence are positively and independently associated with atherosclerosis at adult ages. Centrally accumulation of body fat is associated with insulin resistance, whereas distribution of body fat in a peripheral pattern is metabolically less important. Obesity is associated with a large decrease in life expectancy. The effect of extreme obesity on mortality is greater among younger than older adults. In this respect, obesity is also associated with increased risk of several cancer types. However, up to 30% of obese patients are metabolically healthy with insulin sensitivity similar to healthy normal weight individuals, lower visceral fat content, and lower intima media thickness of the carotid artery than the majority of metabolically "unhealthy" obese patients.Abdominal obesity is the most frequently observed component of metabolic syndrome. The metabolic syndrome; clustering of abdominal obesity, dyslipidemia, hyperglycemia and hypertension, is a major public health challenge. The average prevalence of metabolic syndrome is 31%, and is associated with a two-fold increase in the risk of coronary heart disease, cerebrovascular disease, and a 1.5-fold increase in the risk of all-cause mortality.
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Affiliation(s)
- Atilla Engin
- Faculty of Medicine, Department of General Surgery, Gazi University, Besevler, Ankara, Turkey. .,, Mustafa Kemal Mah. 2137. Sok. 8/14, 06520, Cankaya, Ankara, Turkey.
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Ikram MA, Brusselle GGO, Murad SD, van Duijn CM, Franco OH, Goedegebure A, Klaver CCW, Nijsten TEC, Peeters RP, Stricker BH, Tiemeier H, Uitterlinden AG, Vernooij MW, Hofman A. The Rotterdam Study: 2018 update on objectives, design and main results. Eur J Epidemiol 2017; 32:807-850. [PMID: 29064009 PMCID: PMC5662692 DOI: 10.1007/s10654-017-0321-4] [Citation(s) in RCA: 338] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/06/2017] [Indexed: 02/07/2023]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1500 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Affiliation(s)
- M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Guy G O Brusselle
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Sarwa Darwish Murad
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Gastro-Enterology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - André Goedegebure
- Department of Otolaryngology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tamar E C Nijsten
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - André G Uitterlinden
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Zaccardi F, Dhalwani NN, Papamargaritis D, Webb DR, Murphy GJ, Davies MJ, Khunti K. Nonlinear association of BMI with all-cause and cardiovascular mortality in type 2 diabetes mellitus: a systematic review and meta-analysis of 414,587 participants in prospective studies. Diabetologia 2017; 60:240-248. [PMID: 27888288 PMCID: PMC6518080 DOI: 10.1007/s00125-016-4162-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/04/2016] [Indexed: 12/12/2022]
Abstract
AIMS/HYPOTHESIS The relationship between BMI and mortality has been extensively investigated in the general population; however, it is less clear in people with type 2 diabetes. We aimed to assess the association of BMI with all-cause and cardiovascular mortality in individuals with type 2 diabetes mellitus. METHODS We searched electronic databases up to 1 March 2016 for prospective studies reporting associations for three or more BMI groups with all-cause and cardiovascular mortality in individuals with type 2 diabetes mellitus. Study-specific associations between BMI and the most-adjusted RR were estimated using restricted cubic splines and a generalised least squares method before pooling study estimates with a multivariate random-effects meta-analysis. RESULTS We included 21 studies including 24 cohorts, 414,587 participants, 61,889 all-cause and 4470 cardiovascular incident deaths; follow-up ranged from 2.7 to 15.9 years. There was a strong nonlinear relationship between BMI and all-cause mortality in both men and women, with the lowest estimated risk from 31-35 kg/m2 and 28-31 kg/m2 (p value for nonlinearity <0.001) respectively. The risk of mortality at higher BMI values increased significantly only in women, whilst lower values were associated with higher mortality in both sexes. Limited data for cardiovascular mortality were available, with a possible inverse linear association with BMI (higher risk for BMI <27 kg/m2). CONCLUSIONS/INTERPRETATION In type 2 diabetes, BMI is nonlinearly associated with all-cause mortality with lowest risk in the overweight group in both men and women. Further research is needed to clarify the relationship with cardiovascular mortality and assess causality and sex differences.
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Affiliation(s)
- Francesco Zaccardi
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Nafeesa N Dhalwani
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.
| | - Dimitris Papamargaritis
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - David R Webb
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Gavin J Murphy
- University of Leicester, Department of Cardiovascular Sciences, Clinical Sciences Wing, Glenfield General Hospital, Leicester, LE3 9QP, UK
| | - Melanie J Davies
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
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Kooijman MN, Kruithof CJ, van Duijn CM, Duijts L, Franco OH, van IJzendoorn MH, de Jongste JC, Klaver CCW, van der Lugt A, Mackenbach JP, Moll HA, Peeters RP, Raat H, Rings EHHM, Rivadeneira F, van der Schroeff MP, Steegers EAP, Tiemeier H, Uitterlinden AG, Verhulst FC, Wolvius E, Felix JF, Jaddoe VWV. The Generation R Study: design and cohort update 2017. Eur J Epidemiol 2017. [PMID: 28070760 DOI: 10.1007/s10654‐016‐0224‐9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Generation R Study is a population-based prospective cohort study from fetal life until adulthood. The study is designed to identify early environmental and genetic causes and causal pathways leading to normal and abnormal growth, development and health from fetal life, childhood and young adulthood. This multidisciplinary study focuses on several health outcomes including behaviour and cognition, body composition, eye development, growth, hearing, heart and vascular development, infectious disease and immunity, oral health and facial growth, respiratory health, allergy and skin disorders of children and their parents. Main exposures of interest include environmental, endocrine, genomic (genetic, epigenetic, microbiome), lifestyle related, nutritional and socio-demographic determinants. In total, 9778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. Response at baseline was 61%, and general follow-up rates until the age of 10 years were around 80%. Data collection in children and their parents includes questionnaires, interviews, detailed physical and ultrasound examinations, behavioural observations, lung function, Magnetic Resonance Imaging and biological sampling. Genome and epigenome wide association screens are available. Eventually, results from the Generation R Study contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.
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Affiliation(s)
- Marjolein N Kooijman
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Claudia J Kruithof
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marinus H van IJzendoorn
- Center for Child and Family Studies, Leiden University, Leiden, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Edmond H H M Rings
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marc P van der Schroeff
- Department of Otolaryngology, Head and Neck Surgery, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eppo Wolvius
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Janine F Felix
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Kooijman MN, Kruithof CJ, van Duijn CM, Duijts L, Franco OH, van IJzendoorn MH, de Jongste JC, Klaver CCW, van der Lugt A, Mackenbach JP, Moll HA, Peeters RP, Raat H, Rings EHHM, Rivadeneira F, van der Schroeff MP, Steegers EAP, Tiemeier H, Uitterlinden AG, Verhulst FC, Wolvius E, Felix JF, Jaddoe VWV. The Generation R Study: design and cohort update 2017. Eur J Epidemiol 2017; 31:1243-1264. [PMID: 28070760 PMCID: PMC5233749 DOI: 10.1007/s10654-016-0224-9] [Citation(s) in RCA: 568] [Impact Index Per Article: 81.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/30/2016] [Indexed: 12/31/2022]
Abstract
The Generation R Study is a population-based prospective cohort study from fetal life until adulthood. The study is designed to identify early environmental and genetic causes and causal pathways leading to normal and abnormal growth, development and health from fetal life, childhood and young adulthood. This multidisciplinary study focuses on several health outcomes including behaviour and cognition, body composition, eye development, growth, hearing, heart and vascular development, infectious disease and immunity, oral health and facial growth, respiratory health, allergy and skin disorders of children and their parents. Main exposures of interest include environmental, endocrine, genomic (genetic, epigenetic, microbiome), lifestyle related, nutritional and socio-demographic determinants. In total, 9778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. Response at baseline was 61%, and general follow-up rates until the age of 10 years were around 80%. Data collection in children and their parents includes questionnaires, interviews, detailed physical and ultrasound examinations, behavioural observations, lung function, Magnetic Resonance Imaging and biological sampling. Genome and epigenome wide association screens are available. Eventually, results from the Generation R Study contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.
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Affiliation(s)
- Marjolein N Kooijman
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Claudia J Kruithof
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marinus H van IJzendoorn
- Center for Child and Family Studies, Leiden University, Leiden, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Edmond H H M Rings
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marc P van der Schroeff
- Department of Otolaryngology, Head and Neck Surgery, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eppo Wolvius
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Janine F Felix
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Kwon Y, Kim HJ, Park S, Park YG, Cho KH. Body Mass Index-Related Mortality in Patients with Type 2 Diabetes and Heterogeneity in Obesity Paradox Studies: A Dose-Response Meta-Analysis. PLoS One 2017; 12:e0168247. [PMID: 28046128 PMCID: PMC5207428 DOI: 10.1371/journal.pone.0168247] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/28/2016] [Indexed: 12/20/2022] Open
Abstract
Objective We conducted a systematic review and meta-analysis of studies to quantify the association between body mass index (BMI) and the risks of all-cause and cardiovascular mortality in patients with type 2 diabetes. Methods We included studies assessing the impact of BMI on all-cause and cardiovascular mortality in patients with type 2 diabetes. Data were combined using a random-effects dose-response model. Results Sixteen cohort studies on all-cause mortality (n = 445,125) and two studies on cardiovascular mortality (n = 92,841) were evaluated in the meta-analysis. A non-linear association was observed between BMI and all-cause mortality among patients with type 2 diabetes. With a BMI nadir of 28–30 kg/m2, the risk of all-cause mortality displayed a U-shaped increase. With a BMI nadir of 29–31 kg/m2, the risk of cardiovascular mortality exhibited a gradual non-linear increase for BMI > 31 kg/m2. Subgroup analyses suggested that study location, diabetes duration, and smoking history may have contributed to heterogeneity among the studies. Conclusions An obesity paradox exists for patients with type 2 diabetes with respect to all-cause and cardiovascular mortality. Study location, diabetes duration, and smoking history might contribute to heterogeneity among obesity paradox studies of patients with type 2 diabetes.
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Affiliation(s)
- Yeongkeun Kwon
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea
| | - Hyun Jung Kim
- Institute for Evidence-based Medicine, The Korean Branch of Australasian Cochrane Center, Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Sungsoo Park
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea
- Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Yong-Gyu Park
- Department of Biostatistics, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Kyung-Hwan Cho
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
- * E-mail:
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Ding C, Chan Z, Magkos F. Lean, but not healthy: the 'metabolically obese, normal-weight' phenotype. Curr Opin Clin Nutr Metab Care 2016; 19:408-417. [PMID: 27552473 DOI: 10.1097/mco.0000000000000317] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Obesity is commonly associated with metabolic dysfunction but there are obese persons who are metabolically healthy. On the opposite side of the coin, there are lean persons who carry multiple cardiometabolic risk factors, typically referred to as metabolically obese, normal-weight (MONW). This has called into question our understanding of obesity and metabolic dysfunction, as an appearance of normal weight may mask significant comorbidities and delay health interventions. RECENT FINDINGS High heterogeneity in MONW prevalence rates has been observed, with estimates ranging from as low as 5% to as high as 45%. Reasons for this include sample size effects, differences in MONW definition, social and demographic factors, as well as assumptions made in establishing normal weight. MONW study participants are often characterized by excess visceral adipose tissue and ectopic fat deposition, adipose tissue inflammation, altered inflammatory and adipokine profiles, reduced skeletal muscle mass and low cardiorespiratory fitness. However, more often than not, groups of MONW study participants have been somewhat 'fatter' than the control groups of metabolically healthy lean study participants, which in itself could be responsible for some of the observed differences. Very limited data are available regarding interventions to improve metabolic function in MONW study participants. SUMMARY There is a need for more research to better understand the characteristics of the MONW phenotype, the cause of metabolic dysfunction in the absence of obesity, and evaluate potential therapies so as to facilitate the establishment of clinical guidelines.
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Affiliation(s)
- Cherlyn Ding
- aClinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR) bDepartment of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Huang K, Liu F, Han X, Huang C, Huang J, Gu D, Yang X. Association of BMI with total mortality and recurrent stroke among stroke patients: A meta-analysis of cohort studies. Atherosclerosis 2016; 253:94-101. [DOI: 10.1016/j.atherosclerosis.2016.08.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 08/11/2016] [Accepted: 08/26/2016] [Indexed: 01/06/2023]
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Guo Y, Zhang T, Wang Z, Yu F, Xu Q, Guo W, Wu C, He J. Body mass index and mortality in chronic obstructive pulmonary disease: A dose-response meta-analysis. Medicine (Baltimore) 2016; 95:e4225. [PMID: 27428228 PMCID: PMC4956822 DOI: 10.1097/md.0000000000004225] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study is to summarize the evidence on the dose-response relationship between body mass index (BMI) and mortality in patients with chronic obstructive pulmonary disease (COPD).We performed a systemic literature search in PubMed, Embase, and Web of Science for relevant studies that were published until June 2015. A random effects meta-analysis was used to estimate the pooled relative risks (RRs) of all-cause mortality in COPD patients with normal weight compared with those who were underweight, overweight, or obese. In addition, a dose-response meta-analysis was conducted to explore the dose-response relationship between BMI and all-cause mortality in COPD patients.A total of 17 observational studies involving 30,182 COPD patients among 285,960 participants were included. Compared with the reference category, the RRs of underweight, overweight, and obese individuals were 1.40 (95% confidence interval (CI), 1.20-1.63), 0.80 (95% CI, 0.67-0.96), and 0.77 (95% CI, 0.62-0.95), respectively. A significant nonlinear relationship between BMI and mortality of COPD patients was found by using a random effects model. COPD patients with BMI of <21.75 kg/m had a higher risk of death. Moreover, an increase in the BMI resulted in a decrease in the risk of death. The risk of death was lowest when BMI was 30 kg/m (RR = 0.69; 95% CI, 0.53-0.89). The BMI was not associated with all-cause mortality when BMI was >32 kg/m.Our findings indicate that overweight is associated with a lower risk of all-cause mortality among patients with COPD whereas underweight is associated with a higher risk of all-cause mortality in these patients. However, there is limited evidence to support the association between obesity and the risk of all-cause mortality in patients with COPD.
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Affiliation(s)
| | | | - Zhiyong Wang
- Department of Information, Changhai Hospital, Second Military Medical University, Shanghai, China
| | | | - Qin Xu
- Department of Health Statistics
| | - Wei Guo
- Department of Health Statistics
| | | | - Jia He
- Department of Health Statistics
- Correspondence: Jia He and Cheng Wu, Department of Health Statistics, Second Military Medical University, Shanghai, China (e-mail: and )
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Zhang M, Zhang H, Wang C, Ren Y, Wang B, Zhang L, Yang X, Zhao Y, Han C, Pang C, Yin L, Xue Y, Zhao J, Hu D. Development and Validation of a Risk-Score Model for Type 2 Diabetes: A Cohort Study of a Rural Adult Chinese Population. PLoS One 2016; 11:e0152054. [PMID: 27070555 PMCID: PMC4829145 DOI: 10.1371/journal.pone.0152054] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 03/08/2016] [Indexed: 11/24/2022] Open
Abstract
Some global models to predict the risk of diabetes may not be applicable to local populations. We aimed to develop and validate a score to predict type 2 diabetes mellitus (T2DM) in a rural adult Chinese population. Data for a cohort of 12,849 participants were randomly divided into derivation (n = 11,564) and validation (n = 1285) datasets. A questionnaire interview and physical and blood biochemical examinations were performed at baseline (July to August 2007 and July to August 2008) and follow-up (July to August 2013 and July to October 2014). A Cox regression model was used to weigh each variable in the derivation dataset. For each significant variable, a score was calculated by multiplying β by 100 and rounding to the nearest integer. Age, body mass index, triglycerides and fasting plasma glucose (scores 3, 12, 24 and 76, respectively) were predictors of incident T2DM. The model accuracy was assessed by the area under the receiver operating characteristic curve (AUC), with optimal cut-off value 936. With the derivation dataset, sensitivity, specificity and AUC of the model were 66.7%, 74.0% and 0.768 (95% CI 0.760–0.776), respectively. With the validation dataset, the performance of the model was superior to the Chinese (simple), FINDRISC, Oman and IDRS models of T2DM risk but equivalent to the Framingham model, which is widely applicable in a variety of populations. Our model for predicting 6-year risk of T2DM could be used in a rural adult Chinese population.
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Affiliation(s)
- Ming Zhang
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
| | - Hongyan Zhang
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Chongjian Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Yongcheng Ren
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Bingyuan Wang
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Lu Zhang
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Xiangyu Yang
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Yang Zhao
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Chengyi Han
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Chao Pang
- Department of Prevention and Health Care, Military Hospital of Henan Province, Zhengzhou, Henan, People’s Republic of China
| | - Lei Yin
- Department of Prevention and Health Care, Military Hospital of Henan Province, Zhengzhou, Henan, People’s Republic of China
| | - Yuan Xue
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Jingzhi Zhao
- Department of Prevention and Health Care, Military Hospital of Henan Province, Zhengzhou, Henan, People’s Republic of China
- * E-mail: (DH); (JZ)
| | - Dongsheng Hu
- Department of Preventive Medicine, Shenzhen University School of Medicine, Shenzhen, Guangdong, People’s Republic of China
- * E-mail: (DH); (JZ)
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Vidakovic AJ, Jaddoe VWV, Gishti O, Felix JF, Williams MA, Hofman A, Demmelmair H, Koletzko B, Tiemeier H, Gaillard R. Body mass index, gestational weight gain and fatty acid concentrations during pregnancy: the Generation R Study. Eur J Epidemiol 2015; 30:1175-85. [PMID: 26666541 PMCID: PMC4684831 DOI: 10.1007/s10654-015-0106-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/27/2015] [Indexed: 12/25/2022]
Abstract
Obesity during pregnancy may be correlated with an adverse nutritional status affecting pregnancy and offspring outcomes. We examined the associations of prepregnancy body mass index and gestational weight gain with plasma fatty acid concentrations in mid-pregnancy. This study was embedded in a population-based prospective cohort study among 5636 women. We obtained prepregnancy body mass index and maximum weight gain during pregnancy by questionnaires. We measured concentrations of saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), n-3 polyunsaturated fatty acid (n-3 PUFA) and n-6 polyunsaturated fatty acid (n-6 PUFA) at a median gestational age of 20.5 (95 % range 17.1–24.9) weeks. We used multivariate linear regression models. As compared to normal weight women, obese women had higher total SFA concentrations [difference: 0.10 standard deviation (SD) (95 % Confidence Interval (CI) 0, 0.19)] and lower total n-3 PUFA concentrations [difference: − 0.11 SD (95 % CI − 0.20, − 0.02)]. As compared to women with sufficient gestational weight gain, those with excessive gestational weight gain had higher SFA concentrations [difference: 0.16 SD (95 % CI 0.08, 0.25)], MUFA concentrations [difference: 0.16 SD (95 % CI 0.08, 0.24)] and n-6 PUFA concentrations [difference: 0.12 SD (95 % CI 0.04, 0.21)]. These results were not materially affected by adjustment for maternal characteristics. Our results suggest that obesity and excessive weight gain during pregnancy are associated with an adverse fatty acids profile. Further studies are needed to assess causality and direction of the observed associations.
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Affiliation(s)
- Aleksandra Jelena Vidakovic
- The Generation R Study Group (Na29-15), Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group (Na29-15), Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Olta Gishti
- The Generation R Study Group (Na29-15), Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Janine F Felix
- The Generation R Study Group (Na29-15), Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Albert Hofman
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hans Demmelmair
- Division of Metabolic Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich Medical Center, Munich, Germany
| | - Berthold Koletzko
- Division of Metabolic Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich Medical Center, Munich, Germany
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Romy Gaillard
- The Generation R Study Group (Na29-15), Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Kuo JF, Hsieh YT, Mao IC, Lin SD, Tu ST, Hsieh MC. The Association Between Body Mass Index and All-Cause Mortality in Patients With Type 2 Diabetes Mellitus: A 5.5-Year Prospective Analysis. Medicine (Baltimore) 2015; 94:e1398. [PMID: 26313785 PMCID: PMC4602915 DOI: 10.1097/md.0000000000001398] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abundances of study in different population have noted that obese cardiovascular disease (CVD) patients have a better prognosis than leaner patients, which refer to the phenomenon of obesity paradox. However, data on the association between body mass index (BMI) and mortality among Asian patients are limited, especially in patients with type 2 diabetes mellitus (T2DM). We investigate the association between BMI and all-cause mortality in Taiwanese patients with T2DM to define the optimal body weight for health.We conducted a longitudinal cohort study of 2161 T2DM patients with a mean follow-up period of 66.7 ± 7.5 months. Using Cox regression models, BMI was related to the risk of all-cause mortality after adjusting all confounding factors.A U-shaped association between BMI and all-cause mortality was observed among all participants. Those with BMIs <22.5 kg/m had a significantly elevated all-cause mortality as compared with those with BMIs 22.5 to 25.0 kg/m, (BMIs 17.5-20.0 kg/m: hazard ratio 1.989, P < 0.001; BMIs 20.0-22.5 kg/m: hazard ratio 1.286, P = 0.02), as did those with BMIs >30.0 kg/m (BMIs 30.0-32.5 kg/m: hazard ratio 1.670, P < 0.001; BMIs 32.5-35.0 kg/m: hazard ratio, 2.632, P < 0.001). This U-shaped association remained when we examined the data by sex, age, smoking, and kidney function.Our study found a U-shaped relationship between all-cause mortality and BMI in Asian patients with T2DM, irrespective of age, sex, smoking, and kidney function. BMI <30 kg/m should be regarded as a potentially important target in the weight management of T2DM.
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Affiliation(s)
- Jeng-Fu Kuo
- From the Department of Internal Medicine, Division of Endocrinology and Metabolism, Changhua Christian Hospital, Changhua (J-FK, I-CM, S-DL, S-TT, M-CH); the Department of Ophthalmology, National Taiwan University Hospital, Taipei (Y-TH); and Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan (M-CH)
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