1
|
Kroll MH, Bi C, Salm AE, Szymanski J, Goldstein DY, Wolgast LR, Rosenblatt G, Fox AS, Kapoor H. Risk Estimation of Severe COVID-19 Based on Initial Biomarker Assessment Across Racial and Ethnic Groups. Arch Pathol Lab Med 2023; 147:1109-1118. [PMID: 37338199 DOI: 10.5858/arpa.2023-0039-sa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 06/21/2023]
Abstract
CONTEXT.— Disease courses in COVID-19 patients vary widely. Prediction of disease severity on initial diagnosis would aid appropriate therapy, but few studies include data from initial diagnosis. OBJECTIVE.— To develop predictive models of COVID-19 severity based on demographic, clinical, and laboratory data collected at initial patient contact after diagnosis of COVID-19. DESIGN.— We studied demographic data and clinical laboratory biomarkers at time of diagnosis, using backward logistic regression modeling to determine severe and mild outcomes. We used deidentified data from 14 147 patients who were diagnosed with COVID-19 by polymerase chain reaction SARS-CoV-2 testing at Montefiore Health System, from March 2020 to September 2021. We generated models predicting severe disease (death or more than 90 hospital days) versus mild disease (alive and fewer than 2 hospital days), starting with 58 variables, by backward stepwise logistic regression. RESULTS.— Of the 14 147 patients, including Whites, Blacks, and Hispanics, 2546 (18%) patients had severe outcomes and 3395 (24%) had mild outcomes. The final number of patients per model varied from 445 to 755 because not all patients had all available variables. Four models (inclusive, receiver operating characteristic, specific, and sensitive) were identified as proficient in predicting patient outcomes. The parameters that remained in all models were age, albumin, diastolic blood pressure, ferritin, lactic dehydrogenase, socioeconomic status, procalcitonin, B-type natriuretic peptide, and platelet count. CONCLUSIONS.— These findings suggest that the biomarkers found within the specific and sensitive models would be most useful to health care providers on their initial severity evaluation of COVID-19.
Collapse
Affiliation(s)
- Martin H Kroll
- From the Department of Medical Operations and Quality (Kroll), Quest Diagnostics, Secaucus, New Jersey
| | - Caixia Bi
- Department of Corporate Medical (Bi), Quest Diagnostics, Secaucus, New Jersey
| | - Ann E Salm
- Department of Infectious Diseases/Immunology (Salm, Kapoor), Quest Diagnostics, Secaucus, New Jersey
| | - James Szymanski
- Department of Pathology, Montefiore Medical Center, Bronx, New York (Szymanski, Goldstein, Wolgast, Fox)
| | - D Yitzchak Goldstein
- Department of Pathology, Montefiore Medical Center, Bronx, New York (Szymanski, Goldstein, Wolgast, Fox)
| | - Lucia R Wolgast
- Department of Pathology, Montefiore Medical Center, Bronx, New York (Szymanski, Goldstein, Wolgast, Fox)
| | - Gregory Rosenblatt
- The Department of Pathology, Albert Einstein College of Medicine, Bronx, New York (Rosenblatt). Kapoor is currently located at HK Healthcare Consultant LLC in Davie, Florida
| | - Amy S Fox
- Department of Pathology, Montefiore Medical Center, Bronx, New York (Szymanski, Goldstein, Wolgast, Fox)
| | - Hema Kapoor
- Department of Infectious Diseases/Immunology (Salm, Kapoor), Quest Diagnostics, Secaucus, New Jersey
| |
Collapse
|
2
|
Wang Y, Liu X, Xue T, Chen Y, Yang Q, Tang Z, Chen L, Zhang L. Body mass index and risk of all-cause mortality among elderly Chinese: An empirical cohort study based on CLHLS data. Prev Med Rep 2023; 35:102308. [PMID: 37455755 PMCID: PMC10339046 DOI: 10.1016/j.pmedr.2023.102308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023] Open
Abstract
The aim of our study was to evaluate the relationship between body mass index (BMI) and all-cause mortality among elderly Chinese. The subjects of our study were a cohort of 13 319 elderly Chinese enrolled between 2008 and 2018. Participants were classified in three groups: underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight and obese (≥25 kg/m2) according to different BMI levels. Cox proportional-hazards regression model was used to analyze the association between BMI grouping and the risk of mortality among the three groups and each corresponding subgroup. The restricted cubic spline regression was performed to investigate the variation tendency of BMI and mortality in different groups and subgroups. We found that the hazard ratios (HRs) of mortality in the underweight and the normal-weight groups were 1.213 and 1.104, respectively, compared with those in the overweight and obesity groups. HR for mortality decreased as BMI increased, although this phenomenon was not observed as not a linear relationship in all participants. Nonetheless, this nonlinear relationship was significant in type 2 diabetes patients. Among subjects with non-type 2 diabetes, the shape of the negative curve, reflecting the HR for BMI and mortality, decreased when BMI increased. Our findings suggest that an obesity paradox exists in non-type 2 diabetes patients, in which BMI has a nonlinear negative relationship with mortality. Conversely, in type 2 diabetes patients there is a U-shaped association. Obesity may thus be protective for all-cause mortality among non-diabetic older populations.
Collapse
Affiliation(s)
- Yun Wang
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Xuekui Liu
- Department of Central Laboratory, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Tongneng Xue
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Yu Chen
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Qianqian Yang
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Zhengwen Tang
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Lianhua Chen
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Liqin Zhang
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| |
Collapse
|
3
|
Taha MB, Javed Z, Nwana N, Acquah I, Satish P, Sharma G, Sabouret P, Cainzos-Achirica M, Nasir K. Body Mass Index and All-Cause and Cardiovascular Mortality in United States Adults With and Without Atherosclerotic Cardiovascular Disease: Findings from the National Health Interview Survey. Popul Health Manag 2023; 26:254-267. [PMID: 37590068 DOI: 10.1089/pop.2022.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
In a nationally representative population-based study of US adults, the authors sought to examine the association between body mass index (BMI) and all-cause and cardiovascular disease (CVD) mortality in a nationally representative sample of adults with and without atherosclerotic cardiovascular disease (ASCVD), and further stratified by age, sex, and race/ethnicity. The study used data from 2006 to 2015 National Health Interview Survey and categorized participants into the following BMI categories: normal weight (20-24.9), overweight (25-29.9), obesity class 1 (30-34.9), obesity class 2 (35-39.9), and obesity class 3 (≥40 kg/m2). Multivariable Cox proportional hazards models were used to assess the risk of all-cause and CVD mortality across successively increasing BMI categories overall, and by sociodemographic subgroups. A total of 210,923 individuals were included in the final analysis. In the population without ASCVD, the risk of all-cause and CVD mortality was lower in overweight and higher in obesity classes 2 and 3, compared with normal weight, with the highest risk observed in the young adult (age 18-39) population. Elderly adults (65 and above) and populations with ASCVD exhibited a BMI-mortality paradox. In addition, Hispanic individuals did not show a relationship between BMI and mortality compared with non-Hispanic White and Black adults. In conclusion, being overweight was associated with decreased risk, whereas obesity class 3 was consistently associated with increased risk of all-cause and CVD mortality in adults without ASCVD, particularly young adults. BMI-mortality paradox was noted in ASCVD, elderly, and non-Hispanic adults.
Collapse
Affiliation(s)
- Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Zulqarnain Javed
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
- Houston Methodist Academic Institute, Houston, Texas, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
| | - Nwabunie Nwana
- Houston Methodist Academic Institute, Houston, Texas, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
| | - Isaac Acquah
- Houston Methodist Academic Institute, Houston, Texas, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
| | - Priyanka Satish
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Garima Sharma
- Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pierre Sabouret
- Department of Cardiology, Heart Institute, Pitié Salpêtrière Hospital (AP-HP), Sorbonne University, Paris, France
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
- Houston Methodist Academic Institute, Houston, Texas, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
- Houston Methodist Academic Institute, Houston, Texas, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
| |
Collapse
|
4
|
Hillary RF, Stevenson AJ, Cox SR, McCartney DL, Harris SE, Seeboth A, Higham J, Sproul D, Taylor AM, Redmond P, Corley J, Pattie A, Hernández MDCV, Muñoz-Maniega S, Bastin ME, Wardlaw JM, Horvath S, Ritchie CW, Spires-Jones TL, McIntosh AM, Evans KL, Deary IJ, Marioni RE. An epigenetic predictor of death captures multi-modal measures of brain health. Mol Psychiatry 2021; 26:3806-3816. [PMID: 31796892 PMCID: PMC8550950 DOI: 10.1038/s41380-019-0616-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/14/2019] [Accepted: 11/20/2019] [Indexed: 11/08/2022]
Abstract
Individuals of the same chronological age exhibit disparate rates of biological ageing. Consequently, a number of methodologies have been proposed to determine biological age and primarily exploit variation at the level of DNA methylation (DNAm). A novel epigenetic clock, termed 'DNAm GrimAge' has outperformed its predecessors in predicting the risk of mortality as well as many age-related morbidities. However, the association between DNAm GrimAge and cognitive or neuroimaging phenotypes remains unknown. We explore these associations in the Lothian Birth Cohort 1936 (n = 709, mean age 73 years). Higher DNAm GrimAge was strongly associated with all-cause mortality over the eighth decade (Hazard Ratio per standard deviation increase in GrimAge: 1.81, P < 2.0 × 10-16). Higher DNAm GrimAge was associated with lower age 11 IQ (β = -0.11), lower age 73 general cognitive ability (β = -0.18), decreased brain volume (β = -0.25) and increased brain white matter hyperintensities (β = 0.17). There was tentative evidence for a longitudinal association between DNAm GrimAge and cognitive decline from age 70 to 79. Sixty-nine of 137 health- and brain-related phenotypes tested were significantly associated with GrimAge. Adjusting all models for childhood intelligence attenuated to non-significance a small number of associations (12/69 associations; 6 of which were cognitive traits), but not the association with general cognitive ability (33.9% attenuation). Higher DNAm GrimAge associates with lower cognitive ability and brain vascular lesions in older age, independently of early-life cognitive ability. This epigenetic predictor of mortality associates with different measures of brain health and may aid in the prediction of age-related cognitive decline.
Collapse
Affiliation(s)
- Robert F Hillary
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Anna J Stevenson
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Simon R Cox
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Daniel L McCartney
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Sarah E Harris
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Anne Seeboth
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Jon Higham
- Medical Research Council Human Genetics Unit, Medical Research Council Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Duncan Sproul
- Medical Research Council Human Genetics Unit, Medical Research Council Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Edinburgh Cancer Research Centre, Medical Research Council Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Adele M Taylor
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Paul Redmond
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Janie Corley
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Alison Pattie
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Maria Del C Valdés Hernández
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Susana Muñoz-Maniega
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mark E Bastin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Craig W Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Tara L Spires-Jones
- UK Dementia Research Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Andrew M McIntosh
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kathryn L Evans
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Riccardo E Marioni
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
5
|
Han BG, Han J, Lee KH. Association of impedance ratio with corrected Geriatric Nutritional Risk Index in older patients with nondialysis chronic kidney disease stage 5. JPEN J Parenter Enteral Nutr 2021; 46:93-103. [PMID: 33586150 DOI: 10.1002/jpen.2089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND The usual calculation of body mass index (BMI) can be misleading in patients with advanced chronic kidney disease (CKD) because their altered fluid balances may not be reflected. We obtained corrected BMI (cBMI) and corrected Geriatric Nutritional Risk Index (cGNRI) values and investigated whether the impedance ratio (IR) of 200/5 kHz, measured using bioimpedance spectroscopy, was associated with cGNRI in older patients with nondialysis CKD stage 5 (CKD5-ND). METHODS Patients over 65 years old (n = 118) were divided into groups by cGNRI tertiles. The differences between the correlations were tested using Steiger's z-test. The IR and cBMI were used as both continuous and categorical variables in the regression analyses to determine the factors that were independently associated with the cGNRI. RESULTS Patients in the third cGNRI tertile had a significantly lower mean IR than those in the other 2 tertiles (P < .001). Across the 3 cGNRI tertile groups, the IR was incrementally lower in the higher cGNRI tertiles (P for trend < .001). The Steiger's z-test showed that the IR had a significantly stronger correlation with cGNRI than cBMI had with cGNRI. In the multivariable linear regression analyses, the IR was independently associated with the cGNRI, after adjusting for various confounders. CONCLUSION The current results revealed that the IR was a more sensitive indicator of nutrition risk than BMI and was independently associated with cGNRI in older patients with CKD5-ND. Our study suggests that the IR is an appropriate tool for nutrition risk screening.
Collapse
Affiliation(s)
- Byoung-Geun Han
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won, Korea
| | - Jihye Han
- Politics and International Relations, London School of Economics and Political Science, London, United Kingdom.,United Nations Development Programme Seoul Policy Center, Seoul, Korea
| | - Kwang Hoon Lee
- Dr. Lee's Medical Clinic and Hemodialysis Center, Wonju, Kang-won, Korea
| |
Collapse
|
6
|
Nicholson E, Allison DJ, Bullock A, Heisz JJ. Examining the obesity paradox: A moderating effect of fitness on adipose endocrine function in older adults. Mech Ageing Dev 2020; 193:111406. [PMID: 33278406 DOI: 10.1016/j.mad.2020.111406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 01/26/2023]
Abstract
Despite evidence linking obesity with increased mortality, older adults with excessive adiposity seem protected, resulting in a so-called obesity paradox. Obesity is characterized by leptin resistance, which contributes to increased risk of all-cause mortality. Therefore, lifestyle factors, such as physical fitness, that lower leptin independent of adiposity may be confounding the obesity paradox. To investigate this, we evaluated whether physical fitness moderated the relationship between leptin and adiposity. We found older adults with higher fitness had lower body mass (r(39) = -0.43, p < 0.01), leptin (r(39) = -0.29, p = 0.03) and inflammation (IL-1β: (r(39) = -0.69, p < 0.01); TNF-α: (r(39) = -0.30, p = 0.03)). Fitness moderated the relationship between leptin and adiposity (F(5, 37) = 3.73, p < 0.01, R2 = 0.33) to reveal the obesity paradox in moderately and high fit individuals (b = 216.24, t(37) = 1.46, p = 0.15; b= -88.10, t(37) = -0.49, p = 0.63) but not in low fit individuals. These results show the link between obesity and mortality may not be dependent on total adiposity, but rather on endocrine function and adipocyte leptin secretion. These results have important implications for older adults struggling to maintain healthy body composition and suggest that fitness may promote overall wellbeing.
Collapse
Affiliation(s)
- E Nicholson
- McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - D J Allison
- McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - A Bullock
- University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada
| | - J J Heisz
- McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada.
| |
Collapse
|
7
|
Emery CF, Finkel D, Gatz M, Dahl Aslan AK. Evidence of Bidirectional Associations Between Depressive Symptoms and Body Mass Among Older Adults. J Gerontol B Psychol Sci Soc Sci 2020; 75:1689-1698. [PMID: 30843043 PMCID: PMC7489100 DOI: 10.1093/geronb/gbz022] [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] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Body fat, measured with body mass index (BMI), and obesity are associated with depressive symptoms. Among younger adults there is stronger evidence of obesity leading to depressive symptoms than of depressive symptoms leading to obesity, but the temporal relationship is unknown among older adults. This study utilized dual-change-score models (DCSMs) to determine the directional relationship between body mass and depressive symptoms among older adults. METHOD Participants (n = 1,743) from the Swedish Twin Registry (baseline age range 50-96 years) completed at least one assessment of BMI (nurse measurement of height and weight) and the Center for Epidemiologic Studies-Depression scale (CESD). More than half the sample completed 3 or more assessments, scheduled at intervals of 2-4 years. DCSMs modeled the relationship of BMI and CESD across age, both independently and as part of bivariate relationships. RESULTS Depressive symptoms contributed to subsequent changes in BMI after age 70, while BMI contributed to subsequent changes in depressive symptoms after age 82. Thus, there is a reciprocal relationship that may change with age. The effect was more pronounced for women. DISCUSSION The association of BMI and depressive symptoms is bidirectional among older adults, and it appears to be affected by both age and sex.
Collapse
Affiliation(s)
| | - Deborah Finkel
- Department of Psychology, Indiana University Southeast, New Albany
- Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden
| | - Margaret Gatz
- Department of Psychology, University of Southern California, Los Angeles
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna K Dahl Aslan
- Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
8
|
Salaffi F, Farah S, Di Carlo M. Frailty syndrome in rheumatoid arthritis and symptomatic osteoarthritis: an emerging concept in rheumatology. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:274-296. [PMID: 32420963 PMCID: PMC7569610 DOI: 10.23750/abm.v91i2.9094] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/11/2020] [Indexed: 12/17/2022]
Abstract
Musculoskeletal conditions such as rheumatoid arthritis (RA) and symptomatic osteoarthritis (OA) were the leading cause of disability in developed countries and disproportionately affects older adults. Frailty is an emerging concept in rheumatology, which represents an important construct to aid in the identification of in- dividuals who are vulnerable to adverse events and less favourable outcomes. The prevalence of frailty among the community-dwelling population increases with age: it ranges from 7% to 10% in those aged over 65 years and to 20-40% among octogenarians. Among patients with RA, the prevalence of frailty is comparable to, or even greater, that of older geriatric cohorts and pre-frailty, a condition including a major health vulnerability between robust and frail, is much more prevalent in RA than in geriatric cohorts. Clinical OA is also associated with frailty and pre-frailty in older adults in European countries. The overall prevalence of clinical OA at any site was 30.4%; frailty was present in 10.2% and pre-frailty in 51.0 %. The diagnosis of frailty is usually clinical and based on specific criteria, which are sometimes inconsistent. Therefore, there is an increasing need to identify and vali- date robust biomarkers for this condition. In the literature, different criteria have been validated to identify frail older subjects, which mainly refer to two conceptual models: the Physical Frailty (PF) phenotype proposed by Fried and the cumulative deficit approach proposed by Rockwood. The purpose of this review was to quantita- tively synthesize published literature on the prevalence of frailty in RA and OA and summarize current evidence on the validity and practicality of the most commonly used screening tools for frailty.
Collapse
Affiliation(s)
| | - Sonia Farah
- Clinica Reumatologica, Ospedale Carlo Urbani di Jesi, Università Politecnica delle Marche, (Ancona), Italy..
| | - Marco Di Carlo
- Clinica Reumatologica, Ospedale Carlo Urbani di Jesi, Università Politecnica delle Marche, (Ancona), Italy..
| |
Collapse
|
9
|
Polinder-Bos HA, Diepen MV, Dekker FW, Hoogeveen EK, Franssen CFM, Gansevoort RT, Gaillard CAJM. Lower body mass index and mortality in older adults starting dialysis. Sci Rep 2018; 8:12858. [PMID: 30150623 PMCID: PMC6110755 DOI: 10.1038/s41598-018-30952-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/06/2018] [Indexed: 01/08/2023] Open
Abstract
Lower body mass index (BMI) has consistently been associated with mortality in elderly in the general and chronic disease populations. Remarkably, in older incident dialysis patients no association of BMI with mortality was found. We performed an in-depth analysis and explored possible time-stratified effects of BMI. 908 incident dialysis patients aged ≥65 years of the NECOSAD study were included, and divided into tertiles by baseline BMI (<23.1 (lower), 23.1–26.0 (reference), ≥26.0 (higher) kg/m2). Because the hazards changed significantly during follow-up, the effect of BMI was modeled for the short-term (<1 year) and longer-term (≥1 year after dialysis initiation). During follow-up (median 3.8 years) 567 deaths occurred. Lower BMI was associated with higher short-term mortality risk (adjusted-HR 1.63 [1.14–2.32] P = 0.007), and lower longer-term mortality risk (adjusted-HR 0.81 [0.63–1.04] P = 0.1). Patients with lower BMI who died during the first year had significantly more comorbidity, and worse self-reported physical functioning compared with those who survived the first year. Thus, lower BMI is associated with increased 1-year mortality, but conditional on surviving the first year, lower BMI yielded a similar or lower mortality risk compared with the reference. Those patients with lower BMI, who had limited comorbidity and better physical functioning, had better survival.
Collapse
Affiliation(s)
- Harmke A Polinder-Bos
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen K Hoogeveen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Nephrology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Casper F M Franssen
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Carlo A J M Gaillard
- Division of Internal Medicine and Dermatology, Department of Nephrology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| |
Collapse
|
10
|
Müller F, Shimazaki Y, Kahabuka F, Schimmel M. Oral health for an ageing population: the importance of a natural dentition in older adults. Int Dent J 2018; 67 Suppl 2:7-13. [PMID: 29023743 DOI: 10.1111/idj.12329] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Despite progress in dentistry, tooth loss in old age is still a reality, even more so in long-term-care residents. However, recent trends indicate that natural teeth are lost later in life. Functional decline and age-related pathologies have to be considered in oral health care for this vulnerable population. Retaining and restoring teeth and oral function in elders is important. Tooth loss significantly impairs masticatory performance, which cannot be fully restored by prosthodontic means. Hence an unconscious change in food intake occurs, often involving malnutrition and withdrawal from common meals. Poor oral appearance and bad breath may further impede social activities. Although a chewing activity may be beneficial for cognitive function, natural teeth can present a considerable risk for fragile elders, in whom aspiration of biofilm can lead to pneumonia and death. The presence of natural teeth is also correlated with higher life expectancy, but socio-economic confounding factors have to be considered. When evaluating oral health in the elderly population, standards and priorities for reporting oral health outcome measures have to be defined. Anatomical indicators such as the number of natural teeth or the presence of prostheses might be one option for reporting. However, functional indicators such as masticatory performance and patient-centred outcome measures may be more relevant. In conclusion, there is an overwhelming body of evidence that maintaining a healthy natural dentition in old age is beneficial from a structural, functional and psycho-social point of view.
Collapse
Affiliation(s)
- Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University of Geneva, University Clinics of Dental Medicine, Geneva, Switzerland
| | - Yoshihiro Shimazaki
- Department of Preventive Dentistry and Dental Public Health, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Febronia Kahabuka
- School of Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Martin Schimmel
- Division of Gerodontology and Removable Prosthodontics, University of Geneva, University Clinics of Dental Medicine, Geneva, Switzerland.,School of Dental Medicine, Division of Gerodontology, University of Bern, Bern, Switzerland
| |
Collapse
|
11
|
Ostrowska J, Szostak-Węgierek D, Jeznach-Steinhagen A. Nutritional status in patients aged over 65 years and its influence on the quantity and type of complications occurring 3, 6 and 12 months after hospitalisation: a clinical prospective study. J Hum Nutr Diet 2018; 32:119-127. [PMID: 30058091 DOI: 10.1111/jhn.12590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Malnutrition in hospitalised patients is associated with frequent complications and increased mortality. The present study aimed to determine the prevalence of abnormal nutritional status in patients aged over 65 years with a diagnosis of cardiovascular diseases and also to determine its relationship with the duration of hospitalisation and the incidence of complications over 3, 6 and 12 months of observation. A comparison was also made of diagnostic performance between the various classifications used to diagnose abnormal nutritional status. METHODS In total, 76 patients aged over 65 years with cardiovascular conditions were involved in the study. Abnormal nutritional status was identified on the basis of Mini-Nutritional Assessment-Short Form (MNA-SF) test results, laboratory tests and European Society for Clinical Nutrition and Metabolism (ESPEN) nutritional status assessment criteria. During 3, 6 and 12 months of observation, data were collected concerning the number of re-hospitalisations and the presence of complications. RESULTS Abnormal nutritional status was reported in 78% of participants. Malnutrition, as diagnosed on the basis of laboratory findings and also on the basis of ESPEN criteria comprising the value of fat free mass index (FFMI), was significantly related to prolonged hospitalisation and an increased complication rate. The results of the MNA-SF test performed at baseline revealed no relationship with the incidence of complications during the first stage of the study. CONCLUSIONS Abnormal nutritional status was a common phenomenon in the group of patients under investigation. The set of criteria for assessing the nutritional status that had the highest association with the duration of hospitalisation and the incidence of complications includes laboratory tests and ESPEN criteria comprising the value of FFMI.
Collapse
Affiliation(s)
- J Ostrowska
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - D Szostak-Węgierek
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - A Jeznach-Steinhagen
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
12
|
Pedersen AB, Gammelager H, Kahlert J, Sørensen HT, Christiansen CF. Impact of body mass index on risk of acute kidney injury and mortality in elderly patients undergoing hip fracture surgery. Osteoporos Int 2017; 28:1087-1097. [PMID: 27866215 DOI: 10.1007/s00198-016-3836-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/07/2016] [Indexed: 12/01/2022]
Abstract
UNLABELLED The literature is limited regarding risk factors for acute kidney injury (AKI) and mortality in hip fracture patients, although AKI is common in these patients. While obese patients were at increased risk of AKI, underweight patients with and without AKI had elevated mortality for up to 1 year after hip fracture surgery, compared with normal-weight patients. INTRODUCTION This study aimed to examine risk of postoperative AKI and subsequent mortality, by body mass index (BMI) level, in hip fracture surgery patients aged 65 and over. METHODS A regional cohort study using medical databases was used. We included all patients who underwent surgery to repair a hip fracture during the years 2005-2011 (n = 13,529) at hospitals in Northern Denmark. We calculated cumulative risk of AKI by BMI level during 5 days postsurgery and subsequent short-term (6-30 days postsurgery) and long-term (31-365 days post-surgery) mortality. We calculated crude and adjusted hazard ratios (aHRs) for AKI and death with 95% confidence intervals (CIs), comparing underweight, overweight, and obese patients with normal-weight patients. RESULTS Risks of AKI within five postoperative days were 11.9, 10.1, 12.5, and 17.9% for normal-weight, underweight, overweight, and obese patients, respectively. Among those who developed AKI, short-term mortality was 14.1% for normal-weight patients compared to 23.1% for underweight (aHR 1.7 (95% CI 1.2-2.4)), 10.7% for overweight (aHR 0.9 (95% CI 0.6-1.1)), and 15.2% for obese (aHR 0.9 (95% CI 0.6-1.4)) patients. Long-term mortality was 24.5% for normal-weight, 43.8% for underweight (aHR 1.6 (95% CI 1.0-2.6)), 20.5% for overweight (aHR 0.8 (95% CI 0.6-1.2)), and 21.4% for obese (aHR 1.1 (95% CI 0.7-1.8) AKI patients. Similar associations between BMI and mortality were observed among patients without postoperative AKI, although the absolute mortality risk estimates by BMI were considerably lower in patients without than in those with AKI. CONCLUSIONS Obese patients were at increased risk of AKI compared with normal-weight patients. Among patients with and without postoperative AKI, overweight and obesity were not associated with mortality. Compared to normal-weight patients, underweight patients had elevated mortality for up to 1 year after hip fracture surgery irrespective of the presence of AKI. The absolute mortality risks were higher in all BMI groups with the presence of AKI.
Collapse
Affiliation(s)
- A B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark.
| | - H Gammelager
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark
| | - J Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark
| | - C F Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark
| |
Collapse
|
13
|
Analysis of the Prevalence and Factors Associated with Nocturia in Adult Korean Men. Sci Rep 2017; 7:41714. [PMID: 28139743 PMCID: PMC5282484 DOI: 10.1038/srep41714] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/23/2016] [Indexed: 12/27/2022] Open
Abstract
This study investigated the prevalence of and factors associated with nocturia in Korean men. A total of 92,626 participants aged between 19 and 103 years from the 2011 Korean Community Health Survey (KCHS) were enrolled. Simple and multiple logistic regression analyses with complex sampling investigated participants’ personal health and socioeconomic and disease factors. The prevalence of nocturia ≥1 time and ≥2 times/night was 41.8% and 17.6%, respectively, and nocturia increased with age (1.44 [1.39–1.50] for each 10-year increase, P < 0.001). Lower income levels (lowest, 1.27 [1.19–1.36]; low-middle, 1.13 [1.07–1.19]; upper-middle, 1.00 [0.95–1.06], P = 0.022) and higher levels of stress (severe, 1.38 [1.23–1.55]; moderate, 1.23 [1.16–1.31]; some, 1.11 [1.05–1.16]) exhibited dose-dependent relationships with nocturia (≥1 time; P < 0.001). Low education level (1.27 [1.20–1.36]), long sleep duration (1.33 [1.18–1.50]), and type of occupation showed significant associations with nocturia (≥1 time; P < 0.001). Underweight (1.19 [1.05–1.34]), hypertension (1.09 [1.03–1.15]), diabetes mellitus (1.32 [1.23–1.41]), hyperlipidaemia (1.28 [1.20–1.35]), and cerebral stroke (1.63 [1.40–1.89]) were significantly related to nocturia (≥1 time; P < 0.001). Married men were less likely to experience nocturia ≥2 times per night (0.72 [0.64–0.82], P < 0.001).
Collapse
|
14
|
Slee A, Birch D, Stokoe D. The relationship between malnutrition risk and clinical outcomes in a cohort of frail older hospital patients. Clin Nutr ESPEN 2016; 15:57-62. [DOI: 10.1016/j.clnesp.2016.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 06/09/2016] [Indexed: 11/29/2022]
|
15
|
Pedersen AB, Cronin Fenton D, Nørgaard M, Kristensen NR, Kuno Møller B, Erikstrup C. Body mass index, risk of allogeneic red blood cell transfusion, and mortality in elderly patients undergoing hip fracture surgery. Osteoporos Int 2016; 27:2765-2775. [PMID: 27099965 DOI: 10.1007/s00198-016-3594-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/06/2016] [Indexed: 02/07/2023]
Abstract
UNLABELLED Despite improvements in preoperative and postoperative treatment, hip fracture surgery may lead to blood transfusion. Little is known about the impact of body mass index on transfusion risk and subsequent mortality. Opposite overweight and obese patients, underweight patients had increased risk of transfusion and death within 1 year of surgery. INTRODUCTION Despite improvements in preoperative and postoperative treatment of hip fracture patients, hip fracture surgery may lead to blood loss. We examined the risk of red blood cell transfusion (as an indirect measure of blood loss) and subsequent mortality by body mass index level in patients aged 65 and over undergoing hip fracture surgery. METHODS This is a population-based cohort study using medical databases. We included all patients who underwent surgery for hip fracture during 2005-2013. We calculated the cumulative risk of red blood cell transfusion within 7 days of surgery treating death as a competing risk and, among transfused patients, short- (8-30 days postsurgery) and long-term mortality (31-365 days postsurgery). RESULTS Among 56,420 patients, 47.7 % received at least one red blood cell transfusion within 7 days of surgery. In patients with normal weight, the risk was 48.8 % compared with 57.0 % in underweight patients (adjusted RR = 1.11; CI 1.08-1.15), 42.1 % in overweight patients (adjusted RR = 0.89; CI 0.86-0.91), and 42.2 % in obese patients (adjusted RR = 0.87; CI 0.84-0.91). Among transfused patients, adjusted HRs for short-term mortality were 1.52 (CI 1.34-1.71), 0.70 (CI 0.61-0.80), and 0.58 (CI 0.43-0.77) for underweight, overweight, and obese patients, respectively, compared with normal-weight patients. The corresponding adjusted HRs for long-term mortality were 1.45 (CI 1.33-1.57), 0.80 (CI 0.74-0.86), and 0.58 (CI 0.50-0.69). Similar association between BMI and mortality was observed also among non-transfused patients. CONCLUSIONS Underweight patients had a higher risk of red blood cell transfusion and death in the first year of surgery than normal-weight patients, even when controlling for age and comorbidity. Opposite findings were seen for overweight and obese patients.
Collapse
Affiliation(s)
- A B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark.
| | - D Cronin Fenton
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark
| | - M Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark
| | - N R Kristensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark
| | - B Kuno Møller
- Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - C Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| |
Collapse
|
16
|
Yamazaki K, Suzuki E, Yorifuji T, Tsuda T, Ohta T, Ishikawa-Takata K, Doi H. Is there an obesity paradox in the Japanese elderly population? A community-based cohort study of 13 280 men and women. Geriatr Gerontol Int 2016; 17:1257-1264. [DOI: 10.1111/ggi.12851] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/08/2016] [Accepted: 05/23/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Kenji Yamazaki
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama University; Okayama Japan
| | - Etsuji Suzuki
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama University; Okayama Japan
| | - Takashi Yorifuji
- Department of Human Ecology, Graduate School of Environmental and Life Science; Okayama University; Okayama Japan
| | - Toshihide Tsuda
- Department of Human Ecology, Graduate School of Environmental and Life Science; Okayama University; Okayama Japan
| | - Toshiki Ohta
- National Hospital for Geriatric Medicine; National Center for Geriatrics and Gerontology; Aichi Japan
- Nagoya Heart Center; Aichi Japan
| | - Kazuko Ishikawa-Takata
- Program of Health Promotion and Exercise; National Institute of Health and Nutrition; Tokyo Japan
- Department of Nutritional Education; National Institutes of Biomedical Innovation, Health and Nutrition; Tokyo Japan
| | - Hiroyuki Doi
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama University; Okayama Japan
| |
Collapse
|
17
|
Flodin L, Laurin A, Lökk J, Cederholm T, Hedström M. Increased 1-year survival and discharge to independent living in overweight hip fracture patients: A prospective study of 843 patients. Acta Orthop 2016; 87:146-51. [PMID: 26986549 PMCID: PMC4812076 DOI: 10.3109/17453674.2015.1125282] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Hip fracture patients usually have low body mass index (BMI), and suffer further postoperative catabolism. How BMI relates to outcome in relatively healthy hip fracture patients is not well investigated. We investigated the association between BMI, survival, and independent living 1 year postoperatively. PATIENTS AND METHODS This prospective multicenter study involved 843 patients with a hip fracture (mean age 82 (SD 7) years, 73% women), without severe cognitive impairment and living independently before admission. We investigated the relationship between BMI and both 1-year mortality and ability to return to independent living. RESULTS Patients with BMI > 26 had a lower mortality rate than those with BMI < 22 and those with BMI 22-26 (6%, 16%, and 18% respectively; p = 0.006). The odds ratio (OR) for 1-year survival in the group with BMI > 26 was 2.6 (95% CI: 1.2-5.5) after adjustment for age, sex, and physical status. Patients with BMI > 26 were also more likely to return to independent living after the hip fracture (OR = 2.6, 95% CI: 1.4-5.0). Patients with BMI < 22 had similar mortality and a similar likelihood of independent living to those with BMI 22-26. INTERPRETATION In this selected group of patients with hip fracture, the overweight and obese patients (BMI > 26) had a higher survival rate at 1 year, and returned to independent living to a higher degree than those of normal (healthy) weight. The obesity paradox and the recommendations for optimal BMI need further consideration in patients with hip fracture.
Collapse
Affiliation(s)
| | | | | | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala
| | | |
Collapse
|
18
|
Negoro H, Sugino Y, Nishizawa K, Soda T, Shimizu Y, Yoshimura K, Ogawa O, Yoshimura K. Underweight body mass index is a risk factor of mortality in outpatients with nocturia in Japan. BMC Res Notes 2015; 8:490. [PMID: 26415511 PMCID: PMC4587784 DOI: 10.1186/s13104-015-1456-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/16/2015] [Indexed: 01/10/2023] Open
Abstract
Background Although nocturia has been reported to increase mortality in elderly individuals, the particular risk factors that are associated with this event are unclear. Therefore, we evaluated risk factors for death in outpatients with nocturia. Methods Between October 2002 and December 2009, 250 consecutive patients with nocturia were enrolled in two general hospitals in Japan. Among them, 193 patients were able to be followed for at least 1 year and up to 9 years (median 4.8 years) if the patients did not die. Mortality rates and risk factors were evaluated in the nocturic outpatients. Results Two- and 5-year survival of the nocturic outpatients was 94.6 % [95 % confidence interval (CI) = 92.2–97.1] and 82.6 % (95 % CI = 75.4–87.8), respectively. Higher Charlson Comorbidity Score, lower body mass index (BMI) and lower Physical Component Summary of Short Form-36 item scores were significantly correlated with mortality (p < 0.0001, p < 0.005 and p < 0.05, respectively) in multivariate analysis. The International Prostate Symptom Score, Pittsburgh Sleep Quality Index, Mental or Role/Social Component Summary of Short Form-36 item scores and Nocturnal Polyuria index were not significantly correlated with mortality. The mortality rate was significantly higher in subjects with an underweight BMI (<18.50) compared with a normal range (18.50–24.99) or overweight (≥25.00) BMI [p < 0.00005, hazard ratio (HR) = 5.84, 95 % CI = 2.03–16.8; p < 0.0005, HR = 5.92, 95 % CI = 1.94–18.0]. Conclusions Additional attention is required for nocturic outpatients with not only a high Charlson Comorbidity Score but also an underweight BMI because of their high mortality. Large prospective studies are warranted to validate this finding and extend more. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1456-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Hiromitsu Negoro
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Yoshio Sugino
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan. .,Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - Koji Nishizawa
- Department of Urology, Kurashiki Central Hospital, Okayama, Japan. .,Department of Urology, Shiga Medical Center for Adults, Shiga, Japan.
| | - Takeshi Soda
- Department of Urology, Kurashiki Central Hospital, Okayama, Japan. .,Department of Urology, Kitano Hospital, Osaka, Japan.
| | - Yosuke Shimizu
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan. .,Department of Urology, West Kobe Medical Center, Kobe, Japan.
| | - Kenichi Yoshimura
- Department of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hospital, Kyoto, Japan. .,Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan.
| | - Osamu Ogawa
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Koji Yoshimura
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan. .,Department of Urology, Shizuoka General Hospital, 4-27-1 Kita Ando, Shizuoka Aoi-ku, Shizuoka, Japan.
| |
Collapse
|
19
|
A comparison of the malnutrition screening tools, MUST, MNA and bioelectrical impedance assessment in frail older hospital patients. Clin Nutr 2015; 34:296-301. [DOI: 10.1016/j.clnu.2014.04.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 01/09/2014] [Accepted: 04/22/2014] [Indexed: 01/11/2023]
|
20
|
Hall MH, Smagula SF, Boudreau RM, Ayonayon HN, Goldman SE, Harris TB, Naydeck BL, Rubin SM, Samuelsson L, Satterfield S, Stone KL, Visser M, Newman AB. Association between sleep duration and mortality is mediated by markers of inflammation and health in older adults: the Health, Aging and Body Composition Study. Sleep 2015; 38:189-95. [PMID: 25348127 DOI: 10.5665/sleep.4394] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 09/21/2014] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Inflammation may represent a common physiological pathway linking both short and long sleep duration to mortality. We evaluated inflammatory markers as mediators of the relationship between sleep duration and mortality in community-dwelling older adults. DESIGN Prospective cohort with longitudinal follow-up for mortality outcomes. SETTING Pittsburgh, Pennsylvania, and Memphis, Tennessee. PARTICIPANTS Participants in the Health, Aging and Body Composition (Health ABC) Study (mean age 73.6 ± 2.9 years at baseline) were sampled and recruited from Medicare listings. MEASUREMENTS AND RESULTS Baseline measures of subjective sleep duration, markers of inflammation (serum interleukin-6, tumor necrosis factor-α, and C-reactive protein) and health status were evaluated as predictors of all-cause mortality (average follow-up = 8.2 ± 2.3 years). Sleep duration was related to mortality, and age-, sex-, and race-adjusted hazard ratios (HR) were highest for those with the shortest (< 6 h HR: 1.30, CI: 1.05-1.61) and longest (> 8 h HR: 1.49, CI: 1.15-1.93) sleep durations. Adjustment for inflammatory markers and health status attenuated the HR for short (< 6 h) sleepers (HR = 1.06, 95% CI = 0.83-1.34). Age-, sex-, and race-adjusted HRs for the > 8-h sleeper group were less strongly attenuated by adjustment for inflammatory markers than by other health factors associated with poor sleep with adjusted HR = 1.23, 95% CI = 0.93-1.63. Inflammatory markers remained significantly associated with mortality. CONCLUSION Inflammatory markers, lifestyle, and health status explained mortality risk associated with short sleep, while the mortality risk associated with long sleep was explained predominantly by lifestyle and health status.
Collapse
Affiliation(s)
- Martica H Hall
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Stephen F Smagula
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Robert M Boudreau
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Hilsa N Ayonayon
- Departments of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Suzanne E Goldman
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Tamara B Harris
- Laboratory of Epidemiology, Demography and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD
| | - Barbara L Naydeck
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Susan M Rubin
- Departments of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Laura Samuelsson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | | | - Katie L Stone
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA
| | - Marjolein Visser
- Institute of Health Sciences, VU University Medical Center and EMGO Institute, VU Medical Center, Amsterdam, the Netherlands
| | - Anne B Newman
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.,Graduate School of Public Health, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
21
|
Kumar A, Karmarkar AM, Tan A, Graham JE, Arcari CM, Ottenbacher KJ, Snih SA. The effect of obesity on incidence of disability and mortality in Mexicans aged 50 years and older. SALUD PUBLICA DE MEXICO 2015; 57 Suppl 1:S31-8. [PMID: 26172232 PMCID: PMC4503366 DOI: 10.21149/spm.v57s1.7587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 10/14/2014] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To examine the effect of obesity on incidence of disability and mortality among non-disabled older Mexicans at baseline. MATERIALS AND METHODS The sample included 8 415 Mexicans aged ≥ 50 years from the Mexican Health and Aging Study (2001 -2012), who reported no limitations in activities of daily living (ADLs) at baseline and have complete data on all covariates. Sociodemographics, smoking status, comorbidities, ADL activities, and body mass index (BMI) were collected. RESULTS The lowest hazard ratio (HR) for disability was at BMI of 25 to < 30 (HR = 0.97;95% confidence interval [CI], 0.85-1.12).The lowest HR for mortality were seen among participants with BMIs 25 to < 30 (HR = 0.85; 95%CI, 075-0.97), 30 to < 35 (HR = 0.86; 95 %CI, 0.72-1.02), and > 35 (HR = 0.92; 95 %CI, 0.70-1.22). CONCLUSION Mexican older adults with a BMI of 25 to < 30 were at less risk for both disability and mortality.
Collapse
Affiliation(s)
- Amit Kumar
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX 77555
| | - Amol M. Karmarkar
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX 77555
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555
| | - Alai Tan
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555
| | - James E. Graham
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX 77555
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555
| | - Christine M. Arcari
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555
| | - Kenneth J. Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX 77555
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555
| | - Soham Al Snih
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX 77555
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555
| |
Collapse
|
22
|
He J, Yu Q, Zhang H, Mahnken JD. The dynamic association of body mass index and all-cause mortality in multiple cohorts and its impacts. Emerg Themes Epidemiol 2014; 11:17. [PMID: 25352909 PMCID: PMC4211318 DOI: 10.1186/1742-7622-11-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 10/02/2014] [Indexed: 11/13/2022] Open
Abstract
Background In the literature, different shapes of associations have been found between body mass index (BMI) and mortality and some of the findings were opposite to each other. The association of BMI and mortality in a single cohort has been found to be dynamic that can lead to different findings under different settings. The identified dynamic features were consistent with the heterogeneity in the literature. It is meaningful to find out whether such dynamic associations exist in other populations. Methods Data of six different cohorts were used for analysis and comparison. The proportional hazards assumptions for BMI in Cox models were tested to identify dynamic associations in each cohort. Time-dependent covariates Cox model was used to model the association of BMI and mortality risk as functions of follow-up time. The Cox model was applied to the pooled data with survival times censored at 5 to 40 years to show the potential impact of the dynamic association on traditional Meta-analysis. Results and discussion Dynamic associations were identified in six models (4 for men and 2 for women), four of which showed the same changing pattern: the elevated mortality risk for low BMI decreased while that for high BMI increased with follow-up time. When the Cox model was applied to the pooled data excluding the largest and also the shortest cohort, low BMI was but high BMI was not associated with high mortality for men with censoring at 5 years but the association for low BMI became weaker and that for high BMI became much stronger when censoring time was at 40 years. The dynamic association indicated that shorter studies tend to obtain inverse associations between BMI and mortality while longer studies tend to obtain J-shaped associations. Conclusions Different or even opposite results about body weight and mortality in the literature may be in part due to the underlying dynamic association of BMI and mortality. The dynamic features need to be taken into consideration in future studies.
Collapse
Affiliation(s)
- Jianghua He
- Department of Biostatistics, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, 66160 Kansas City, KS, USA
| | - Qing Yu
- Department of Biostatistics, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, 66160 Kansas City, KS, USA
| | - Huiquan Zhang
- Sanofi Pasteur Research & Development in China, Beijing, China
| | - Jonathan D Mahnken
- Department of Biostatistics, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, 66160 Kansas City, KS, USA
| |
Collapse
|
23
|
Martín-Ramiro JJ, Álvarez-Martín E, Gil-Prieto R. Discapacidad atribuible al exceso de peso en España. Med Clin (Barc) 2014; 143:150-6. [DOI: 10.1016/j.medcli.2013.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 05/08/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
|
24
|
Müller F. Interventions for edentate elders - what is the evidence? Gerodontology 2014; 31 Suppl 1:44-51. [DOI: 10.1111/ger.12083] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Frauke Müller
- Division of Gerodontology and Removable Prosthodontics; University of Geneva; Geneva Switzerland
- Department of Internal Medicine, Rehabilitation and Geriatrics; University Hospitals Geneva; Geneva Switzerland
| |
Collapse
|
25
|
Abstract
The obese, with disproportionate chronic disease incidence, consume a large share of health care resources and drive up per capita Medicare spending. This study examined the prevalence of obesity and its association with health status, health-related quality of life (HRQOL), function, and outpatient utilization among Medicare Advantage seniors. Results indicate that obese beneficiaries, much more than overweight beneficiaries, have poorer health, functions, and HRQOL than normal weight beneficiaries and have substantially higher outpatient utilization. While weight loss is beneficial to both the overweight and obese, the markedly worse health status and high utilization of obese beneficiaries may merit particular attention.
Collapse
|
26
|
Müller F, Duvernay E, Loup A, Vazquez L, Herrmann FR, Schimmel M. Implant-supported mandibular overdentures in very old adults: a randomized controlled trial. J Dent Res 2013; 92:154S-60S. [PMID: 24158342 DOI: 10.1177/0022034513509630] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was (1) to investigate denture satisfaction following the conversion of existing mandibular complete dentures to implant overdentures (IOD) in very old edentulous patients who depend on help for activities of daily living and (2) to evaluate secondary end points, such as functional, structural, nutritional, and patient-centered aspects. For this randomized clinical trial, 2 interforaminal short implants were placed in the intervention group (n = 16, 85.0 ± 6.19 yrs) to retain mandibular IODs; the control group (n = 18, 84.1 ± 5.55 yrs) received conventional relines. During the first year, no implant was lost; however, 2 patients died. IODs proved more stable, and participants in the intervention group demonstrated significantly higher denture satisfaction as well as an increased oral health-related quality of life compared to the control group. Maximum voluntary bite force improved significantly with IODs, yet the chewing efficiency was not different between groups. Masseter muscle thickness increased with IODs, mainly on the preferred chewing side. Body mass index decreased in both groups, but the decline tended to be smaller in the intervention group; blood markers and the Mini Nutritional Assessment did not confirm this tendency. These results indicate that edentulous patients who depend on help for activities of daily living may benefit from IODs even late in life.
Collapse
Affiliation(s)
- F Müller
- Division of Gerodontology and Removable Prosthodontics, Medical Faculty, Dental School, University of Geneva, Switzerland
| | | | | | | | | | | |
Collapse
|
27
|
Serum total cholesterol: A mortality predictor in elderly hospitalized patients. Clin Nutr 2013; 32:533-7. [DOI: 10.1016/j.clnu.2012.11.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 10/24/2012] [Accepted: 11/07/2012] [Indexed: 11/23/2022]
|
28
|
Bell JJ, Bauer JD, Capra S. The malnutrition screening tool versus objective measures to detect malnutrition in hip fracture. J Hum Nutr Diet 2013; 26:519-26. [PMID: 23889042 DOI: 10.1111/jhn.12040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The Malnutrition Screening Tool (MST) is the most commonly used screening tool in Australia. Poor screening tool sensitivity may lead to an under-diagnosis of malnutrition, with potential patient and economic ramifications. The present study aimed to determine whether the MST or anthropometric parameters adequately detect malnutrition in patients who were admitted to a hip fracture unit. METHODS Data were analysed for a prospective convenience sample (n = 100). MST screening was independently undertaken by nursing staff and a nutrition assistant. Mid upper arm circumference (MUAC) was measured by a trained nutrition assistant. Nutritional risk [MST score ≥ 2, body mass index (BMI) < 22 kg m(-2) , or MUAC < 25 cm] was compared with malnutrition diagnosed by accredited practicing dietitians using International Classification of Diseases version 10-Australian Modification (ICD10-AM) coding criteria. RESULTS Malnutrition prevalence was 37.5% using ICD10-AM criteria. Delirium, dementia or preadmission cognitive impairment was present in 65% of patients. The BMI as a nutrition risk screen was the most valid predictor of malnutrition (sensitivity 75%; specificity 93%; positive predictive value 73%; negative predictive value 84%). Nursing MST screening was the least valid (sensitivity 73%; specificity 55%; positive predictive value 50%; negative predictive value 77%). There was only fair agreement between nursing and nutrition assistant screening using the MST (κ = 0.28). CONCLUSIONS In this population with a high prevalence of delirium and dementia, further investigation is warranted into the performance of nutrition screening tools and anthropometric parameters such as BMI. All tools failed to predict a considerable number of patients with malnutrition. This may result in the under-diagnosis and treatment of malnutrition, leading to case-mix funding losses.
Collapse
Affiliation(s)
- J J Bell
- Department of Nutrition and Dietetics, The Prince Charles Hospital, Queensland Health, Brisbane, Queensland, Australia; Centre for Dietetics Research, School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia
| | | | | |
Collapse
|
29
|
Leibovitz E, Giryes S, Makhline R, Zikri Ditch M, Berlovitz Y, Boaz M. Malnutrition risk in newly hospitalized overweight and obese individuals: Mr NOI. Eur J Clin Nutr 2013; 67:620-4. [PMID: 23549203 DOI: 10.1038/ejcn.2013.45] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Malnutrition risk and its consequences have not been reported in obese and overweight newly hospitalized patients. To estimate malnutrition risk among newly hospitalized overweight or obese patients, and to assess the effect of body mass index (BMI) on duration of hospitalization and risk of in-hospital death among hospitalized adults at increased risk of malnutrition. SUBJECTS/METHODS In this survey, all adults newly admitted to internal medicine and surgical departments at a large tertiary medical center, during the 5-week data acquisition period in 2010, were screened for malnutrition risk using the Nutrition Risk Screen (NRS 2002). Malnutrition risk was compared across body weight categories. In addition, overweight/obese subjects were compared by malnutrition risk category. RESULTS Of the 431 individuals analyzed, 138 were overweight and 105 were obese. Among overweight or obese patients, 23.2% and 24.8%, respectively, were at increased risk for malnutrition. Elevated risk for malnutrition prolonged hospitalization for both overweight and obese patients (from 5.6 ± 7.9 to 10.0 ± 10.3 days (P=0.04) and from 4.8 ± 4.6 to 15.1 ± 25.7 days (P=0.001), respectively). Prolonged hospital stay remained associated with malnutrition risk after controlling for age and BMI. Malnutrition risk significantly increased odds of in-hospital death: odds ratio (OR) 6.4, 95% confidence interval (CI) 1.2-33.2, P=0.03, even after controlling for age and BMI. CONCLUSIONS Increased malnutrition risk is a frequent finding in newly hospitalized overweight/obese adults, prolongs length of hospital stay and increases risk of in-hospital mortality.
Collapse
Affiliation(s)
- E Leibovitz
- Internal Medicine Department 'A', E Wolfson Medical Center, Holon, Israel
| | | | | | | | | | | |
Collapse
|
30
|
Cohen-Mansfield J, Perach R. Is there a reversal in the effect of obesity on mortality in old age? J Aging Res 2011; 2011:765071. [PMID: 21966593 PMCID: PMC3182070 DOI: 10.4061/2011/765071] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 05/05/2011] [Accepted: 06/09/2011] [Indexed: 01/08/2023] Open
Abstract
Studies of obesity and its relationship with mortality risk in older persons have yielded conflicting results. We aimed to examine the age-related associations between obesity and mortality in older persons. Data were drawn from the Cross-Sectional and Longitudinal Aging Study (CALAS), a national survey of a random sample of older Jewish persons in Israel conducted during 1989-1992. Analyses included 1369 self-respondent participants aged 75-94 from the Cross-Sectional and Longitudinal Aging Study (CALAS). Mortality data at 20-year followup were recorded from the Israeli National Population Registry. Obesity was significantly predictive of higher mortality for persons aged 75-84, but from age 85 onwards, obesity had a protective effect on mortality albeit at a nonsignificant level. Being underweight was consistently predictive of mortality. Findings suggest that the common emphasis on avoiding obesity may not apply to those advancing towards old-old age, at least as far as mortality is concerned.
Collapse
Affiliation(s)
- Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, P.O.B. 39040, Ramat Aviv, Tel Aviv 69978, Israel
- Herczeg Institute on Aging, Tel Aviv University, P.O.B. 39040, Ramat Aviv, Tel Aviv 69978, Israel
- George Washington University Medical Center and School of Public Health, Washington, DC 20037, USA
| | - Rotem Perach
- Herczeg Institute on Aging, Tel Aviv University, P.O.B. 39040, Ramat Aviv, Tel Aviv 69978, Israel
| |
Collapse
|
31
|
Lin WY, Tsai SL, Albu JB, Lin CC, Li TC, Pi-Sunyer FX, Sung PK, Huang KC. Body mass index and all-cause mortality in a large Chinese cohort. CMAJ 2011; 183:E329-36. [PMID: 21398246 DOI: 10.1503/cmaj.101303] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Obesity is known to be associated with an increased risk of death, but current definitions of obesity are based on data from white populations. We examined the association between body mass index (BMI) and the risk of death in a large population of adult Chinese people. METHODS We examined the association between body mass index (BMI) and all-cause mortality prospectively among 58,738 men and 65,718 women aged 20 years and older enrolled in 1998-1999 from four national health screening centres in Taiwan. We used Cox proportional hazards regression analyses to estimate the relative risks of all-cause mortality for different BMI categories during a maximum follow-up of 10 years. RESULTS A total of 3947 participants died during the follow-up period. The lowest risk of death was observed among men and women who had a BMI of 24.0-25.9 (mean 24.9). After adjustment for age, smoking status, alcohol intake, betel-nut chewing, level of physical activity, income level and education level, we observed a U-shaped association between BMI and all-cause mortality. Similar U-shaped associations were observed when we analyzed data by age (20-64 or ≥ 65 years), smoking (never, < 10 pack-years or ≥ 10 pack-years) and presence of a pre-existing chronic disease, and after we excluded deaths that occurred in the first three years of follow-up. INTERPRETATION BMI and all-cause mortality had a U-shaped association among adult Chinese people in our study. The lowest risk of death was among adults who had a BMI of 24.0-25.9 (mean 24.9). Our findings do not support the use of a lower cutoff value for overweight and obesity in the adult Chinese population.
Collapse
Affiliation(s)
- Wen-Yuan Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Østbye T, Malhotra R, Chan A. Variation in and Correlates of Body Mass Status of Older Singaporean Men and Women. Asia Pac J Public Health 2011; 25:48-62. [DOI: 10.1177/1010539510393726] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study describes the body mass status of older (≥60 years) Singaporeans, using the international and Asian body mass index (BMI) classifications, assesses sociodemographic correlates of BMI, underweight, obesity, and “high-risk” BMI (≥27.5 kg/m2), and ascertains the relationship between body mass and important health outcomes. Prevalence of underweight, obesity, and high-risk BMI among 4371 older Singaporeans was 6.8%, 7.4%, and 18.6%, respectively. Women (vs men) and Malays and Indians (vs Chinese) were more likely to have obesity or high-risk BMI. Increasing education decreased the odds of obesity and high-risk BMI only among women. Prevalence and odds of various health conditions was similar in corresponding categories of the two BMI classifications. Whereas the prevalence of obesity is lower among elderly in Singapore than in many other countries, the prevalence of high-risk BMI is considerable. It is important to address high-risk BMI among them, with elderly of minority ethnic groups, especially females, being a priority.
Collapse
Affiliation(s)
- Truls Østbye
- Duke–National University of Singapore Graduate Medical School, Singapore
- Duke University Medical Centre, Durham, NC, USA
| | - Rahul Malhotra
- Duke–National University of Singapore Graduate Medical School, Singapore
| | - Angelique Chan
- Duke–National University of Singapore Graduate Medical School, Singapore
- National University of Singapore, Singapore
| |
Collapse
|
33
|
Reis Filho ADD, Coelho CDF, Voltarelli FA, Ferrari Junior J, Ravagnani FCDP, Fett WCR, Fett CA. Associação entre variáveis antropométricas, perfil glicêmico e lipídico em mulheres idosas. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2011. [DOI: 10.1590/s1809-98232011000400007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Estudo transversal com o objetivo de associar variáveis antropométricas, perfil lipídico e glicêmico em 102 idosas de três centros de convivência para idosos do município de Cuiabá-MT, Brasil, com idade entre 60 e 84 anos. MÉTODOS: Avaliaram-se índice de massa corporal, relação cintura/quadril, circunferência abdominal, percentual de gordura, glicemia em jejum, glicemia pós-prandial, hemoglobina glicada, triglicérides, colesterol total, HDL-c e LDL-c. RESULTADOS: Houve associação significativa no grupo 60-69 anos, entre o IMC e glicemia de jejum; relação cintura-quadril e glicemia de jejum e glicemia pós-prandial; circunferência abdominal e glicemia de jejum e glicemia pós-prandial; para o grupo >70 anos, entre o percentual de gordura e colesterol total e a circunferência abdominal e glicemia pós-prandial. Regressão múltipla houve significância somente para o grupos >70anos: IMC e colesterol total; relação cintura-quadril com triglicérides e com colesterol total; circunferência abdominal com glicemia de jejum, com triglicérides, com colesterol total e com LDL-c. CONCLUSÃO: As variáveis antropométricas apresentam fragilidade para associação com a bioquímica sanguínea de idosas. Entretanto, os marcadores de gordura corporal parecem estar associados à piora bioquímica, sendo a circunferência da cintura a que mais se associa especialmente em relação às mais idosas.
Collapse
|
34
|
Lin WY, Albu J, Liu CS, Huang HY, Pi-Sunyer FX, Li CI, Li TC, Lin CC, Huang KC. Larger body mass index and waist circumference are associated with lower mortality in Chinese long-term care facility residents. J Am Geriatr Soc 2010; 58:2092-8. [PMID: 21054289 DOI: 10.1111/j.1532-5415.2010.03148.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the association between body mass index (BMI) and waist circumference (WC) and all-cause mortality of Chinese residents in long-term care facilities in Taiwan. DESIGN Prospective cohort study. SETTING Eight long-term care facilities in Taiwan. PARTICIPANTS Three hundred fifty-four residents aged 60 and older (median 78.4, range 60-101; 156 men, 198 women) were recruited during the study period. MEASUREMENTS Anthropometrics and metabolic parameters were measured at baseline. Mean BMI was 21.7 ± 4.2 kg/m(2) (range 11.6-35.3 kg/m(2) , and mean WC was 82.4 ± 10.9 cm (range 55.0-124.0 cm). Mortality data were from the Department of Health in Taiwan. RESULTS There were 219 deaths during the 5 years of follow-up. After adjusting for age, sex, albumin, Karnofsky performance status scale, hypertension, and diabetes mellitus, subjects in the highest quartile of BMI (27.3 ± 2.8 kg/m(2) ) and WC (96.7 ± 7.4 cm) had a significantly lower mortality rate than did subjects in the lowest quartile (BMI, 16.7 ± 1.7 kg/m(2) ; WC, 69.6 ± 4.2 cm). After further stratification according to central obesity status, the subjects in the two highest BMI quartiles had a lower mortality rate than those in the lowest BMI quartile but only in the central obesity group (≥ 90 cm in men or ≥ 80 cm in women). The adjusted relative risk for all-cause mortality in the highest versus lowest BMI quartile was 0.17 (95% confidence interval = 0.05-0.57). CONCLUSION BMI and WC were negative predictors for all-cause mortality in older Chinese adults living in long-term care facilities. Participants with higher WC and BMI had lower all-cause mortality.
Collapse
Affiliation(s)
- Wen-Yuan Lin
- Department of Family Medicine, China Medical University Hospital, [corrected] Taichung, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Da Silva Coqueiro R, Rodrigues Barbosa A, Ferreti Borgatto A. Nutritional status, health conditions and socio-demographic factors in the elderly of Havana, Cuba: data from SABE survey. J Nutr Health Aging 2010; 14:803-8. [PMID: 21125196 DOI: 10.1007/s12603-010-0126-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the association of nutritional status with sex, age, race/color, education, smoking, physical activity, hypertension, diabetes, and hospitalization in older adults residing in the city of Havana, Cuba. METHODS This was a cross-sectional, population-based household survey. A total of 1,905 persons (1,197 women and 708 men; ≥ 60 years) were examined between 1999 and 2000, selected by probabilistic sampling. Nutritional status was assessed by body mass index (BMI): BMI < 22.0 kg/m2 = underweight; BMI > 27.0 kg/m2 = overweight. Multinomial logistic regression analysis (crude and adjusted) was used. RESULTS The estimation of the prevalence of underweight was 33.0% and that of overweight was 29.6%. The adjusted regression model showed that the probability of underweight was higher in older age groups (OR = 1.63, 70-79 years; OR = 2.05, ≥ 80 years) and among smokers (OR = 1.83). There was negative association between underweight, and hypertension and diabetes. Hypertension (OR = 1.99) was positively associated with overweight. The lower likelihood of overweight was observed among men, smokers, and those aged 80 years and more. CONCLUSION The elderly population of Havana presents a vulnerable nutritional status in view of the prevalence of underweight and overweight. Increasing age, smoking, gender, and hypertension are the factors positively associated with vulnerable nutritional status.
Collapse
Affiliation(s)
- R Da Silva Coqueiro
- Departamento de Saúde, Universidade Estadual do Sudoeste da Bahia, Jequié, BA, Brazil
| | | | | |
Collapse
|
36
|
Abstract
The objective was to examine the effect of BMI on the incidence of various infectious diseases in institutionalised, geriatric subjects. In a retrospective cohort study we analysed medical records of 619 patients aged 75 years and older (mean age 87.6 (sd 6.4) years) who were treated in a geriatric hospital in Vienna, Austria. The total incidence rate of infection in this population was 0.80 per person-year. The most frequent infections were urinary tract infections (0.30 per person-year), followed by infections of the lower respiratory tract (0.19 per person-year), diarrhoea (0.12 per person-year) and other infections (0.20 per person-year). Incidence risk ratios were obtained by a multiplicative Poisson regression model. There was a J-shaped curve in the incidence of infections recorded by BMI with a nadir at 27-28 kg/m2. Compared with the reference group with a BMI of 24-27.9 kg/m2, subjects with a lower BMI had a higher incidence rate of infections. The incidence risk ratios, adjusted for sex, age and chronic diseases, were 1.62 (95 % CI 1.21, 2.17) for those with a BMI of < 20 kg/m2 and 1.84 (95 % CI 1.40, 2.42) for those with a BMI of 20-23.9 kg/m2. However, also patients with a BMI of 28 kg/m2 and above had a higher incidence rate of infections, with an incidence risk ratio of 1.54 (95 % CI 1.07, 2.22). These results show that both underweight and obesity are associated with a higher risk of infections in institutionalised geriatric patients.
Collapse
|
37
|
Oreopoulos A, Kalantar-Zadeh K, Sharma AM, Fonarow GC. The obesity paradox in the elderly: potential mechanisms and clinical implications. Clin Geriatr Med 2010; 25:643-59, viii. [PMID: 19944265 DOI: 10.1016/j.cger.2009.07.005] [Citation(s) in RCA: 229] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The prevalence of overweight and obesity in the elderly has become a growing concern. Recent evidence indicates that in the elderly, obesity is paradoxically associated with a lower, not higher, mortality risk. Although obesity in the general adult population is associated with higher mortality, this relationship is unclear for persons of advanced age and has lead to great controversy regarding the relationship between obesity and mortality in the elderly, the definition of obesity in the elderly, and the need for its treatment in this population. This article examines the evidence on these controversial issues, explores potential explanations for these findings, discusses the clinical implications, and provides recommendations for further research in this area.
Collapse
Affiliation(s)
- Antigone Oreopoulos
- Department of Clinical Epidemiology, School of Public Health, University of Alberta, 2F1.26 Walter C Mackenzie HSC, 8440-112 Street, Edmonton, Alberta, Canada.
| | | | | | | |
Collapse
|
38
|
Kimyagarov S, Klid R, Levenkrohn S, Fleissig Y, Kopel B, Arad M, Adunsky A. Body mass index (BMI), body composition and mortality of nursing home elderly residents. Arch Gerontol Geriatr 2009; 51:227-30. [PMID: 19939476 DOI: 10.1016/j.archger.2009.10.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 10/27/2009] [Accepted: 10/28/2009] [Indexed: 01/07/2023]
Abstract
The body mass index (BMI) is a key marker of nutritional status among older patients, but does not reflect changes in body composition, The aim of the present study was to investigate BMI levels and body composition in a sample of disabled nursing home residents, and to study possible interrelations between BMI, fat-free body mass (FFM), body fat mass (BFM), skeletal muscle mass (SMM) and 1-year mortality rates. FFM and SMM were assessed by 24-h urine creatinine excretion and BFM as the difference between BMI and FFM. We calculated relative risk (RR) and odds ratio (OR) of 1-year mortality, associated with different levels of BMI, FFM index (where index=value/height(2)), SMM index and BFM index in 82 disabled institutionalized elderly patients. One-year mortality rate was 29.3%. Adjusted relative risk of mortality of low BMI patients was 1.45 (95% CI=0.73-2.89; OR=1.73) and 0.63 (95% CI=0.33-1.60; OR=0.72) in high BMI. Risk of mortality was higher in those having low FMM index or SMM index (RR=2.42, 95% CI=0.36-16.18; OR=2.55 and RR=3.22, 95% CI=0.78-13.32; OR=3.67, respectively). It is concluded that low FFM and SMM indexes among disabled nursing home residents are far better predictors than BMI for 1-year mortality estimation.
Collapse
Affiliation(s)
- Simcha Kimyagarov
- The Gilad Geriatric Center, Sheba Medical Center, Tel Hashomer 52621, Israel
| | | | | | | | | | | | | |
Collapse
|
39
|
Weiss A, Boaz M, Beloosesky Y, Kornowski R, Grossman E. Body mass index and risk of all-cause and cardiovascular mortality in hospitalized elderly patients with diabetes mellitus. Diabet Med 2009; 26:253-9. [PMID: 19317820 DOI: 10.1111/j.1464-5491.2009.02672.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIMS Obesity is linked to increased morbidity and mortality risk in both the general population and in patients with diabetes mellitus; however, recent reports suggest that, in hospitalized elderly individuals, the association between body mass index (BMI) and mortality may be inverse. The present study sought to investigate the association between BMI and survival in hospitalized elderly individuals with diabetes mellitus. METHODS The medical records of 470 patients (226 males, mean age of 81.5 +/- 7.0 years) admitted to an acute geriatric ward between 1999 and 2000 were reviewed. Of the 140 patients with diabetes mellitus, 122 had more than 6 months of follow-up and were included in this analysis. Patients were followed up until 31 August 2004. Mortality data were extracted from death certificates. RESULTS During a mean follow-up of 3.7 +/- 1.6 years, 69 (56.6%) subjects died, 31 (25.4%) from cardiovascular causes. Those who died from any cause had lower baseline BMI than those who survived (24.0 +/- 4.0 vs. 27.1 +/- 4.3 kg/m(2); P < 0.0001). Similarly, those who died of cardiovascular causes had lower baseline BMI than those who did not (23.7 +/- 3.6 vs. 25.9 +/- 4.5, P = 0.01). BMI was inversely associated with all-cause [relative risk (RR) 0.89, 95% confidence interval (CI) 0.83-0.96, P = 0.002] and cardiovascular death (RR 0.83, 95% CI 0.74-0.93, P = 0.002) even after controlling for age, sex, smoking, dyslipidaemia and reason for hospital admission. CONCLUSIONS In very elderly subjects with diabetes mellitus, increased BMI was associated with reduced mortality risk.
Collapse
Affiliation(s)
- A Weiss
- Geriatric Ward, Rabin Medical Center, Petah Tikvah, Israel.
| | | | | | | | | |
Collapse
|
40
|
Bales CW, Buhr GT. Body mass trajectory, energy balance, and weight loss as determinants of health and mortality in older adults. Obes Facts 2009; 2:171-8. [PMID: 20054222 PMCID: PMC6516201 DOI: 10.1159/000221008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The relationship between body mass (usually measured as BMI in kg/m(2)) and healthy longevity is a major focus of study in the nutrition and aging field. Over-nutrition now rivals frailty as the major nutritional concern; the number of older adults who are obese has increased dramatically in the past 3 decades. While obesity exacerbates a host of life-threatening, age-related chronic diseases, a somewhat paradoxical finding is that being somewhat overweight in old age appears to be a benefit with regard to longevity. In our recently completed systematic review of randomized controlled weight reduction trials, we found that weight loss interventions in overweight/obese older subjects led to significant benefits for those with osteoarthritis, coronary heart disease, and type 2 diabetes mellitus, while having slightly negative effects on bone mineral density and lean body mass. In contrast to this finding, the preponderance of epidemiological evidence indicates that higher BMIs are associated with increased survival after age 65 years. Because of this contradictory state of the science, there is a critical need for further study of the relationship of weight and weight loss/gain to health in the later years of life.
Collapse
Affiliation(s)
- Connie W Bales
- GRECC, Durham VA Medical Center and Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
| | | |
Collapse
|
41
|
Rohrer JE, Takahashi PY, Adamson SC. Age, Obesity, and Medical Visits in Family Medicine. Popul Health Manag 2008; 11:255-9. [DOI: 10.1089/pop.2008.0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
42
|
Molander L, Lövheim H, Norman T, Nordström P, Gustafson Y. Lower Systolic Blood Pressure Is Associated with Greater Mortality in People Aged 85 and Older. J Am Geriatr Soc 2008; 56:1853-9. [DOI: 10.1111/j.1532-5415.2008.01948.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
43
|
Lang IA, Llewellyn DJ, Alexander K, Melzer D. Obesity, physical function, and mortality in older adults. J Am Geriatr Soc 2008; 56:1474-8. [PMID: 18662211 DOI: 10.1111/j.1532-5415.2008.01813.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To estimate the effects of excess body weight on objective and subjective physical function and mortality risks in noninstitutionalized older adults. DESIGN Population-based cohort study. SETTING The English Longitudinal Study of Ageing (ELSA). PARTICIPANTS Three thousand seven hundred ninety-three participants in the ELSA aged 65 and older followed up for 5 years. MEASUREMENTS Analyses compared the risks of impaired physical function and mortality for subjects who were at the recommended weight (body mass index (BMI)=20.0-24.9) with those who were overweight (BMI=25.0-29.9), obese (BMI=30.0-34.9) or severely obese (BMI>or=35.0). Outcome measures were difficulties with activities of daily living (ADLs), score on the Short Physical Performance Battery, and mortality. RESULTS Participants in higher BMI categories had greater risk of impaired physical function at follow-up but little or no greater risk of mortality. For example, compared with men of recommended weight, obese men (BMI=30.0-34.9) had relative risk ratios of difficulties with ADLs of 1.99 (95% confidence interval (CI)=1.42-2.78), of measured functional impairment of 1.51 (95% CI=1.05-2.16), and of mortality of 0.99 (95% CI=0.60-1.61). Findings were robust when excluding those who lost weight, smoked, or had poor self-rated health. CONCLUSION Excess body weight in people aged 65 and older is associated with greater risk of impaired physical function but not with greater mortality risk. Societies with growing numbers of overweight and obese older people are likely to face increasing burdens of disability-associated health and social care costs.
Collapse
Affiliation(s)
- Iain A Lang
- Epidemiology and Public Health Group, Peninsula Medical School, Exeter, United Kingdom.
| | | | | | | |
Collapse
|