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Wang T, Zhou D, Hong Z. Adipose tissue in older individuals: a contributing factor to sarcopenia. Metabolism 2024; 160:155998. [PMID: 39128607 DOI: 10.1016/j.metabol.2024.155998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 08/05/2024] [Accepted: 08/06/2024] [Indexed: 08/13/2024]
Abstract
Sarcopenia is a geriatric syndrome characterized by a functional decline in muscle. The prevalence of sarcopenia increases with natural aging, becoming a serious health problem among elderly individuals. Therefore, understanding the pathology of sarcopenia is critical for inhibiting age-related alterations and promoting health and longevity in elderly individuals. The development of sarcopenia may be influenced by interactions between visceral and subcutaneous adipose tissue and skeletal muscle, particularly under conditions of chronic low-grade inflammation and metabolic dysfunction. This hypothesis is supported by the following observations: (i) accumulation of senescent cells in both adipose tissue and skeletal muscle with age; (ii) gut dysbiosis, characterized by an imbalance in gut microbial communities as the main trigger for inflammation, sarcopenia, and aged adipose tissue; and (iii) microbial dysbiosis, which could impact the onset or progression of a senescent state. Moreover, adipose tissue acts as an endocrine organ, releasing molecules that participate in intricate communication networks between organs. Our discussion focuses on novel adipokines and their role in regulating adipose tissue and muscle, particularly those influenced by aging and obesity, emphasizing their contributions to disease development. On the basis of these findings, we propose that age-related adipose tissue and sarcopenia are disorders characterized by chronic inflammation and metabolic dysregulation. Finally, we explore new potential therapeutic strategies involving specialized proresolving mediator (SPM) G protein-coupled receptor (GPCR) agonists, non-SPM GPCR agonists, transient receptor potential (TRP) channels, antidiabetic drugs in conjunction with probiotics and prebiotics, and compounds designed to target senescent cells and mitigate their pro-inflammatory activity.
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Affiliation(s)
- Tiantian Wang
- Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Institute of Brain Science and Brain-inspired Technology of West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, Sichuan, China.
| | - Dong Zhou
- Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Institute of Brain Science and Brain-inspired Technology of West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, Sichuan, China
| | - Zhen Hong
- Department of Neurology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Institute of Brain Science and Brain-inspired Technology of West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, Sichuan, China.
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Vecchiato M, Aghi A, Nerini R, Borasio N, Gasperetti A, Quinto G, Battista F, Bettini S, DI Vincenzo A, Ermolao A, Busetto L, Neunhaeuserer D. Comparison of Cardiorespiratory Fitness Prediction Equations and Generation of New Predictive Model for Patients with Obesity. Med Sci Sports Exerc 2024; 56:1732-1739. [PMID: 38768055 DOI: 10.1249/mss.0000000000003463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
PURPOSE Cardiorespiratory fitness (CRF) is a critical marker of overall health and a key predictor of morbidity and mortality, but the existing prediction equations for CRF are primarily derived from general populations and may not be suitable for patients with obesity. METHODS Predicted CRF from different non-exercise prediction equations was compared with measured CRF of patients with obesity who underwent maximal cardiopulmonary exercise testing (CPET). Multiple linear regression was used to develop a population-specific nonexercise CRF prediction model for treadmill exercise including age, sex, weight, height, and physical activity level as determinants. RESULTS Six hundred sixty patients underwent CPET during the study period. Within the entire cohort, R2 values had a range of 0.24 to 0.46. Predicted CRF was statistically different from measured CRF for 19 of the 21 included equations. Only 50% of patients were correctly classified into the measured CRF categories according to predicted CRF. A multiple model for CRF prediction (mL·min -1 ) was generated ( R2 = 0.78) and validated using two cross-validation methods. CONCLUSIONS Most used equations provide inaccurate estimates of CRF in patients with obesity, particularly in cases of severe obesity and low CRF. Therefore, a new prediction equation was developed and validated specifically for patients with obesity, offering a more precise tool for clinical CPET interpretation and risk stratification in this population.
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Affiliation(s)
- Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, ITALY
| | | | - Raffaele Nerini
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, ITALY
| | - Nicola Borasio
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, ITALY
| | - Andrea Gasperetti
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, ITALY
| | - Giulia Quinto
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, ITALY
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, ITALY
| | - Silvia Bettini
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University Hospital of Padova, Padova, ITALY
| | - Angelo DI Vincenzo
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University Hospital of Padova, Padova, ITALY
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, ITALY
| | - Luca Busetto
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University Hospital of Padova, Padova, ITALY
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, ITALY
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Terada T, Pap R, Thomas A, Wei R, Noda T, Visintini S, Reed JL. Effects of muscle strength training combined with aerobic training versus aerobic training alone on cardiovascular disease risk indicators in patients with coronary artery disease: a systematic review and meta-analysis of randomised clinical trials. Br J Sports Med 2024:bjsports-2024-108530. [PMID: 39214675 DOI: 10.1136/bjsports-2024-108530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To compare the effects of aerobic training combined with muscle strength training (hereafter referred to as combined training) to aerobic training alone on cardiovascular disease risk indicators in patients with coronary artery disease (CAD). DESIGN Systematic review with meta-analysis. DATA SOURCES MEDLINE, Embase, CINAHL, SPORTDiscus, Scopus, trial registries and grey literature sources were searched in February 2024. ELIGIBILITY CRITERIA Randomised clinical trials comparing the effects of ≥4 weeks of combined training and aerobic training alone on at least one of the following outcomes: cardiorespiratory fitness (CRF), anthropometric and haemodynamic measures and cardiometabolic blood biomarkers in patients with CAD. RESULTS Of 13 246 studies screened, 23 were included (N=916). Combined training was more effective in increasing CRF (standard mean difference (SMD) 0.26, 95% CI 0.02 to 0.49, p=0.03) and lean body mass (mean difference (MD) 0.78 kg, 95% CI 0.39 kg to 1.17 kg, p<0.001), and reducing per cent body fat (MD -2.2%, 95% CI -3.5% to -0.9%, p=0.001) compared with aerobic training alone. There were no differences in the cardiometabolic biomarkers between the groups. Our subgroup analyses showed that combined training increases CRF more than aerobic training alone when muscle strength training was added to aerobic training without compromising aerobic training volume (SMD 0.36, 95% CI 0.05 to 0.68, p=0.02). CONCLUSION Combined training had greater effects on CRF and body composition than aerobic training alone in patients with CAD. To promote an increase in CRF in patients with CAD, muscle strength training should be added to aerobic training without reducing aerobic exercise volume.
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Affiliation(s)
- Tasuku Terada
- Physiology, Pharmacology and Neuroscience, School of Life Sciences, University of Nottingham, Nottingham, UK
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Robert Pap
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB, Canada
| | - Abby Thomas
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Roger Wei
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Takumi Noda
- Graduate School of Medical Sciences, Department of Rehabilitation Sciences, Kitasato University, Sagamihara, Japan
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Sarah Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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Verma S, Colhoun HM, Dicker D, Hovingh GK, Kahn SE, Kautzky-Willer A, Lingvay I, Plutzky J, Rasmussen S, Rathor N, Hoff ST, Lincoff AM. Semaglutide Effects on Cardiovascular Outcomes in People With Overweight or Obesity (SELECT): Outcomes by Sex. J Am Coll Cardiol 2024:S0735-1097(24)08194-4. [PMID: 39217575 DOI: 10.1016/j.jacc.2024.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Subodh Verma
- St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
| | - Helen M Colhoun
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom
| | - Dror Dicker
- Internal Medicine Department D, Hasharon Hospital-Rabin Medical Center, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Kees Hovingh
- Novo Nordisk A/S, Søborg, Denmark; Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Steven E Kahn
- VA Puget Sound Health Care System and Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Alexandra Kautzky-Willer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Ildiko Lingvay
- Division of Endocrinology, Department of Internal Medicine and Peter O'Donnell Jr School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jorge Plutzky
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - A Michael Lincoff
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Czapla M, Surma S, Kwaśny A, Lewandowski Ł. Association of Body Mass Index with Outcomes in Patients with Heart Failure with Reduced Ejection Fraction (HFrEF). Nutrients 2024; 16:2473. [PMID: 39125352 PMCID: PMC11313842 DOI: 10.3390/nu16152473] [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] [Received: 07/13/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Heart failure (HF) is a major health issue, affecting up to 2% of the adult population worldwide. Given the increasing prevalence of obesity and its association with various cardiovascular diseases, understanding its role in HFrEF outcomes is crucial. This study aimed to investigate the impact of obesity on in-hospital mortality and prolonged hospital stay in patients with heart failure with reduced ejection fraction (HFrEF). We conducted a retrospective analysis of 425 patients admitted to the cardiology unit at the University Clinical Hospital in Wroclaw, Poland, between August 2018 and August 2020. Statistical analyses were performed to evaluate the interactions between BMI, sex, and comorbidities on in-hospital mortality. Significant interactions were found between sex and BMI as well as between BMI and post-stroke status, affecting in-hospital mortality. Specifically, increased BMI was associated with decreased odds of in-hospital mortality in males (OR = 0.72, 95% CI: 0.55-0.94, p < 0.05) but higher odds in females (OR = 1.18, 95% CI: 0.98-1.42, p = 0.08). For patients without a history of stroke, increased BMI reduced mortality odds (HR = 0.78, 95% CI: 0.64-0.95, p < 0.01), whereas the effect was less pronounced in those with a history of stroke (HR = 0.89, 95% CI: 0.76-1.04, p = 0.12). In conclusion, the odds of in-hospital mortality decreased significantly with each 10% increase in BMI for males, whereas for females, a higher BMI was associated with increased odds of death. Additionally, BMI reduced in-hospital mortality odds more in patients without a history of cerebral stroke (CS) compared to those with a history of CS. These findings should be interpreted with caution due to the low number of observed outcomes and potential interactions with BMI and sex.
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Affiliation(s)
- Michał Czapla
- Department of Emergency Medical Service, Wrocław Medical University, 51-616 Wrocław, Poland
- Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, 26006 Logroño, Spain
- Institute of Heart Diseases, University Hospital, 50-566 Wrocław, Poland
| | - Stanisław Surma
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Adrian Kwaśny
- Institute of Dietetics, Academy of Business and Health Science, 90-361 Łódź, Poland;
| | - Łukasz Lewandowski
- Department of Medical Biochemistry, Wrocław Medical University, 50-368 Wrocław, Poland;
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Huang H, Fu B, Long T, Yu Y, Cheng S, Gu M, Cai C, Chen X, Niu H, Hua W. Implication of geriatric nutritional risk index on treatment response and long-term prognosis in patients with cardiac resynchronization therapy. Int J Cardiol 2024; 407:132064. [PMID: 38670460 DOI: 10.1016/j.ijcard.2024.132064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/02/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE Geriatric Nutritional Risk Index (GNRI) is a simple tool for assessing the nutritional status of the aging population. This study aims to explore the clinical implication of GNRI on treatment response and long-term clinical outcomes in heart failure (HF) patients receiving cardiac resynchronization therapy (CRT). METHODS Patients who underwent CRT implantation or upgrade at our hospital were retrospectively included. The association of GNRI and its tertiles with the echocardiographic response, all-cause mortality or heart transplantation, and the first hospitalization due to HF were investigated. RESULTS Totally, 647 patients were enrolled, with a median age of 60 [Interquartile Range (IQR): 52-67] years and mean score of GNRI at 107.9 ± 23.7. Super-response rates increased significantly among the GNRI T1, T2, and T3 groups (25.1%, 29.8% vs. 41.1%, P = 0.002). Patients with higher GNRI were more likely to have better LVEF improvement after multiple adjustments (OR = 1.13, 95% CI: 1.04-1.23, P = 0.010). Higher GNRI was independently associated with a lower risk of all-cause mortality or heart implantation (HR = 0.95, 95% CI: 0.93-0.96, P < 0.001) and HF hospitalization (HR = 0.96, 95% CI: 0.95-0.98, P < 0.001). The inclusion of GNRI enhanced the predictability of all-cause mortality based on traditional model, including sex, New York Heart Association functional class, left bundle branch block, QRS reduction, and N-terminal pro-B-type natriuretic peptide level (C statistics improved from 0.785 to 0.813, P = 0.007). CONCLUSION Higher GNRI was associated with better treatment response and long-term prognosis in HF patients with CRT. Evaluation of nutritional status among CRT population is necessary for individualized choice of potential responders.
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Affiliation(s)
- Hao Huang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bingqi Fu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tianxin Long
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Yu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sijing Cheng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Gu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chi Cai
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuhua Chen
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongxia Niu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Hua
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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7
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An KR, Sandner S, Redfors B, Alexander JH, Alzghari T, Caldonazo T, Cancelli G, Dell'Aquila M, Dimagli A, Gibson CM, Harik L, Heise R, Kulik A, Lamy A, Leith J, Peper J, Perezgrovas-Olaria R, Rossi CS, Ruel M, Soletti GJ, Ten Berg JM, Willemsen LM, Wojdyla DM, Zhao Q, Zhu Y, Verma S, Gaudino MFL. Association between overweight and obesity with coronary artery bypass graft failure: an individual patient data analysis of clinical trials. Eur J Cardiothorac Surg 2024; 65:ezae221. [PMID: 38830050 DOI: 10.1093/ejcts/ezae221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/04/2024] [Accepted: 05/29/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVES The association between obesity and graft failure after coronary artery bypass grafting has not been previously investigated. METHODS We pooled individual patient data from randomized clinical trials with systematic postoperative coronary imaging to evaluate the association between obesity and graft failure at the individual graft and patient levels. Penalized cubic regression splines and mixed-effects multivariable logistic regression models were performed. RESULTS Six trials comprising 3928 patients and 12 048 grafts were included. The median time to imaging was 1.03 (interquartile range 1.00-1.09) years. By body mass index (BMI) category, 800 (20.4%) patients were normal weight (BMI 18.5-24.9), 1668 (42.5%) were overweight (BMI 25-29.9), 983 (25.0%) were obesity class 1 (BMI 30-34.9), 344 (8.8%) were obesity class 2 (BMI 35-39.9) and 116 (2.9%) were obesity class 3 (BMI 40+). As a continuous variable, BMI was associated with reduced graft failure [adjusted odds ratio (aOR) 0.98 (95% confidence interval (CI) 0.97-0.99)] at the individual graft level. Compared to normal weight patients, graft failure at the individual graft level was reduced in overweight [aOR 0.79 (95% CI 0.64-0.96)], obesity class 1 [aOR 0.81 (95% CI 0.64-1.01)] and obesity class 2 [aOR 0.61 (95% CI 0.45-0.83)] patients, but not different compared to obesity class 3 [aOR 0.94 (95% CI 0.62-1.42)] patients. Findings were similar, but did not reach significance, at the patient level. CONCLUSIONS In a pooled individual patient data analysis of randomized clinical trials, BMI and obesity appear to be associated with reduced graft failure at 1 year after coronary artery bypass grafting.
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Affiliation(s)
- Kevin R An
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Björn Redfors
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - John H Alexander
- Department of Medicine and Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Talal Alzghari
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Gianmarco Cancelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Michele Dell'Aquila
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - C Michael Gibson
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Rachel Heise
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Alexander Kulik
- Division of Cardiac Surgery, Boca Raton Regional Hospital and Florida Atlantic Hospital, Boca Raton, FL, USA
| | - Andre Lamy
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jordan Leith
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Joyce Peper
- Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands
| | | | - Camilla S Rossi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Giovanni Jr Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | | | - Laura M Willemsen
- Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Daniel M Wojdyla
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Qiang Zhao
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunpeng Zhu
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
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8
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Yu XR, Du JL, Jiang M, Ren Y, Zhang FL, Kong FL, Li FE. Correlation of TyG-BMI and TyG-WC with severity and short-term outcome in new-onset acute ischemic stroke. Front Endocrinol (Lausanne) 2024; 15:1327903. [PMID: 38846495 PMCID: PMC11153697 DOI: 10.3389/fendo.2024.1327903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
Objectives To research the connection between the indexes of the indexes of triglyceride-glucose (TyG) combined with obesity indices and the initial neurological severity and short-term outcome of new-onset acute ischemic stroke. Methods Data of patients with acute ischemic stroke admitted to the Stroke Ward of the Affiliated Hospital of Beihua University from November 2021 to October 2023, were collected. The two indexes were calculated by combining TyG and obesity indices: TyG-body mass index (TyG-BMI) and TyG-waist circumference (TyG-WC). The National Institute of Health Stroke Scale (NIHSS) was used to assess and group patients with neurological deficits within 24 hours of admission: mild stroke (NIHSS ≤5) and moderate-severe stroke (NIHSS >5). Short-term prognosis was evaluated using the modified Rankin Scale (mRS) at discharge or 14 days after onset of the disease and grouped: good outcome (mRS ≤2) and poor outcome (mRS >2). According to the quartiles of TyG-BMI and TyG-WC, the patients were placed into four groups: Q1, Q2, Q3 and Q4. Multi-factor logistic regression analysis was utilized to evaluate the correlation of TyG-BMI and TyG-WC with the severity and short-term outcome. Results The study included 456 patients. After adjusting for multiple variables, the results showed that compared with the quartile 1, patients in quartile 4 of TyG-BMI had a reduced risk of moderate-severe stroke [Q4: OR: 0.407, 95%CI (0.185-0.894), P = 0.025]; Patients in quartiles 2, 3 and 4 of TyG-BMI had sequentially lower risk of short-term adverse outcomes [Q2: OR: 0.394, 95%CI (0.215-0.722), P = 0.003; Q3: OR: 0.324, 95%CI (0.163-0.642), P = 0.001; Q4: OR: 0.158, 95%CI (0.027-0.349), P <0.001]; Patients in quartiles 3 and 4 of TyG-WC had sequentially lower risk of moderate-severe stroke [Q3: OR: 0.355, 95%CI (0.173-0.728), P = 0.005; Q4: OR: 0.140, 95%CI (0.056-0.351), P <0.001]; Patients in quartiles 3 and 4 of TyG-WC had sequentially lower risk of short-term adverse outcomes [Q3: OR: 0.350, 95%CI (0.175-0.700), P = 0.003; Q4: OR: 0.178, 95%CI (0.071-0.451), P <0.001]. Conclusions TyG-WC and TyG-BMI were correlated with the severity and short-term outcome of new-onset acute ischemic stroke. As TyG-WC and TyG-BMI increased, stroke severity decreased and short-term outcome was better.
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Affiliation(s)
- Xin-Rui Yu
- Postgraduate Department, School of Clinical Medicine, Beihua University, Jilin, China
| | - Jing-Lu Du
- Postgraduate Department, School of Clinical Medicine, Beihua University, Jilin, China
| | - Mei Jiang
- Postgraduate Department, School of Clinical Medicine, Beihua University, Jilin, China
| | - Yuan Ren
- Postgraduate Department, School of Clinical Medicine, Beihua University, Jilin, China
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Fu-Liang Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Fan-Li Kong
- Department of Pathophysiology, School of Basic Medicine, Beihua University, Jilin, China
| | - Feng-E. Li
- Neurology Department, the Affiliated Hospital of Beihua University, Jilin, China
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9
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Alkhalfan F, Bukhari S, Rosenzveig A, Moudgal R, Khan SZ, Ghoweba M, Chaudhury P, Cameron SJ, Tefera L. The Obesity Mortality Paradox in Patients with Pulmonary Embolism: Insights from a Tertiary Care Center. J Clin Med 2024; 13:2375. [PMID: 38673648 PMCID: PMC11051153 DOI: 10.3390/jcm13082375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Background: While obesity is associated with an increased risk of venous thromboembolism (VTE), there is some data to suggest that higher BMI is also associated with decreased all-cause mortality in patients with a pulmonary embolism (PE). Methods: Using PE Response Team (PERT) activation data from a large tertiary hospital between 27 October 2020 and 28 August 2023, we constructed a multivariate Cox proportional hazards model to assess the association between obesity as a dichotomous variable (defined as BMI ≥ 30 vs. BMI 18.5-29.9), BMI as a continuous variable, and 30-day PE-related mortality. Results: A total of 248 patients were included in this analysis (150 with obesity and 98 who were in the normal/overweight category). Obesity was associated with a lower risk of 30-day PE-related mortality (adjusted HR 0.29, p = 0.036, 95% CI 0.09-0.92). A higher BMI was paradoxically associated with a lower risk of PE-related mortality (HR = 0.91 per 1 kg/m2 increase, p = 0.049, 95% CI 0.83-0.999). Conclusions: In our contemporary cohort of patients with a PERT activation, obesity was associated with a lower risk of PE-related mortality.
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Affiliation(s)
- Fahad Alkhalfan
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (F.A.); (S.B.); (A.R.); (R.M.); (S.Z.K.); (M.G.); (P.C.); (S.J.C.)
| | - Syed Bukhari
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (F.A.); (S.B.); (A.R.); (R.M.); (S.Z.K.); (M.G.); (P.C.); (S.J.C.)
| | - Akiva Rosenzveig
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (F.A.); (S.B.); (A.R.); (R.M.); (S.Z.K.); (M.G.); (P.C.); (S.J.C.)
| | - Rohitha Moudgal
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (F.A.); (S.B.); (A.R.); (R.M.); (S.Z.K.); (M.G.); (P.C.); (S.J.C.)
| | - Syed Zamrak Khan
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (F.A.); (S.B.); (A.R.); (R.M.); (S.Z.K.); (M.G.); (P.C.); (S.J.C.)
| | - Mohamed Ghoweba
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (F.A.); (S.B.); (A.R.); (R.M.); (S.Z.K.); (M.G.); (P.C.); (S.J.C.)
| | - Pulkit Chaudhury
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (F.A.); (S.B.); (A.R.); (R.M.); (S.Z.K.); (M.G.); (P.C.); (S.J.C.)
| | - Scott J. Cameron
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (F.A.); (S.B.); (A.R.); (R.M.); (S.Z.K.); (M.G.); (P.C.); (S.J.C.)
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Case Western Reserve University, Cleveland, OH 44120, USA
- Department of Hematology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Leben Tefera
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (F.A.); (S.B.); (A.R.); (R.M.); (S.Z.K.); (M.G.); (P.C.); (S.J.C.)
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10
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Li F, Wang Z, Li S, Liu W, Li Y, Jiang C, Tian Y, Cui W, Zhang X, Zhang J, Xu Y. Association of body fat distribution with all-cause and cardiovascular mortality in US adults: a secondary analysis using NHANES. BMJ Open 2023; 13:e072752. [PMID: 37989359 PMCID: PMC10668279 DOI: 10.1136/bmjopen-2023-072752] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 09/11/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE To investigate the association of fat and lean mass in specific regions with all-cause and cardiovascular-related mortality. DESIGN Population based cohort study. SETTING US National Health and Nutrition Examination Survey (2003-2006 and 2011-2018). PARTICIPANTS 22 652 US adults aged 20 years or older. EXPOSURES Fat and lean mass in specific regions obtained from the whole-body dual-energy X-ray absorptiometry. MAIN OUTCOME MEASURES All-cause and cardiovascular-related mortality. RESULTS During a median of 83 months of follow-up, 1432 deaths were identified. Associations between body composition metrics and mortality risks were evident above specific thresholds. For all-cause mortality, Android fat mass showed elevated HRs above 2.46 kg (HR: 1.17, 95% CI 1.02 to 1.34), while Android lean mass (ALM) had similar trends above 2.75 kg (HR: 1.17, 95% CI 1.03 to 1.33), and Android total mass above 5.75 kg (HR: 1.08, 95% CI 1.01 to 1.16). Conversely, lower HRs were observed below certain thresholds: Gynoid fat mass (GFM) below 3.71 kg (HR: 0.72, 95% CI 0.56 to 0.93), Gynoid lean mass below 6.44 kg (HR: 0.77, 95% CI 0.64 to 0.92), and Gynoid total mass below 11.78 kg (HR: 0.76, 95% CI 0.70 to 0.84). Notably, below 0.722 kg, the HR of visceral adipose tissue mass (VATM) was 1.25 (95% CI 1.04 to 1.48) for all-cause mortality, and above 3.18 kg, the HR of total abdominal fat mass was 2.41 (95% CI 1.15 to 5.05). Cardiovascular-related mortality exhibited associations as well, particularly for Android fat mass (AFM) above 1.78 kg (HR: 1.22, 95% CI 1.01 to 1.47) and below 7.16 kg (HR: 0.50, 95% CI 0.36 to 0.69). HRs varied for Gynoid total mass below and above 10.98 kg (HRs: 0.70, 95% CI 0.54 to 0.93, and 1.12, 95% CI 1.02 to 1.23). Android per cent fat, subcutaneous fat mass (SFM), AFM/GFM, and VATM/SFM were not statistically associated with all-cause mortality. Android per cent fat, Gynoid per cent fat, AFM/GFM, and VATM/SFM were not statistically associated with cardiovascular-related mortality. Conicity index showed that the ALM/GLM had the highest performance for all-cause and cardiovascular-related mortality with AUCs of 0.785, and 0.746, respectively. CONCLUSIONS The relationship between fat or lean mass and all-cause mortality varies by region. Fat mass was positively correlated with cardiovascular mortality, regardless of the region in which they located. ALM/GLM might be a better predictor of all-cause and cardiovascular-related mortality than other body components or body mass index.
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Affiliation(s)
- Fuhai Li
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zhi Wang
- Department of Emergency Medicine, Qingdao Municipal Hospital (Group), Qingdao, Shandong, China
| | - Shaohua Li
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wenheng Liu
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yan Li
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chen Jiang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yulong Tian
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Weining Cui
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xuejuan Zhang
- Department of comprehensive internal medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shangdong, China
| | - Jidong Zhang
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yan Xu
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, Shangdong, China
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11
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Tian M, Yuan J, He P, Yu F, Long C, Zha Y. Lean-to-fat tissue ratio as a risk factor for cognitive impairment in patients undergoing maintenance hemodialysis. J Psychosom Res 2023; 174:111464. [PMID: 37757523 DOI: 10.1016/j.jpsychores.2023.111464] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE The relationship between body mass index (BMI) and cognitive impairment (CI) remains controversial, and no research has been done to explore the effect of lean-to-fat (L/F) tissue ratio on the risk of CI in patients undergoing maintenance hemodialysis (MHD) so far. This study aimed to explore the effect of L/F tissue ratio on the risk of incident CI in patients undergoing MHD. METHODS In this observational cohort study, 3356 patients were recruited and followed up for a median of 2 years. Global cognitive function was measured using Mini-Mental State Examination score. Lean tissue mass (LTM) and fat tissue mass (FTM) were analyzed using body composition monitor based on bioimpedance spectroscopy (BCM-BIS), and L/F tissue ratio was calculated by LTM divided by FTM. Hazard ratios (HRs) for incident CI were determined by Cox regression. RESULTS The median age of the cohort was 55 years, and 68.7% patients were less educated. During the follow-up period, 1249 patients (37.2%) experienced incident CI. Patients with lower L/F tissue ratios had significantly higher risks of CI (HR 1.51, 95% confidence interval 1.24-1.84; p < 0.001) than those with higher L/F tissue ratios. The association between L/F tissue ratio and incident CI persisted in all subgroups stratified by sex, age, education status, especially in older and less educated participants. Both in all our patients and subgroups, BMI and CI occurrence were not independently relevant. CONCLUSION The L/F tissue ratio rather than BMI was an independent risk factor of incident cognitive impairment in patients undergoing MHD.
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Affiliation(s)
- Maolu Tian
- School of Medicine, Guizhou University, Guiyang, China; Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China; NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, China
| | - Jing Yuan
- Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China; NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, China
| | - Pinghong He
- Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Fangfang Yu
- Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Changzhu Long
- Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yan Zha
- Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China; NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, China.
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12
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Kobayashi Y, Long J, Dan S, Johannsen NM, Talamoa R, Raghuram S, Chung S, Kent K, Basina M, Lamendola C, Haddad F, Leonard MB, Church TS, Palaniappan L. Strength training is more effective than aerobic exercise for improving glycaemic control and body composition in people with normal-weight type 2 diabetes: a randomised controlled trial. Diabetologia 2023; 66:1897-1907. [PMID: 37493759 PMCID: PMC10527535 DOI: 10.1007/s00125-023-05958-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/27/2023] [Indexed: 07/27/2023]
Abstract
AIMS/HYPOTHESIS Type 2 diabetes in people in the healthy weight BMI category (<25 kg/m2), herein defined as 'normal-weight type 2 diabetes', is associated with sarcopenia (low muscle mass). Given this unique body composition, the optimal exercise regimen for this population is unknown. METHODS We conducted a parallel-group RCT in individuals with type 2 diabetes (age 18-80 years, HbA1c 47.5-118.56 mmol/mol [6.5-13.0%]) and BMI <25 kg/m2). Participants were recruited in outpatient clinics or through advertisements and randomly assigned to a 9 month exercise programme of strength training alone (ST), aerobic training alone (AER) or both interventions combined (COMB). We used stratified block randomisation with a randomly selected block size. Researchers and caregivers were blinded to participants' treatment group; however, participants themselves were not. Exercise interventions were conducted at community-based fitness centres. The primary outcome was absolute change in HbA1c level within and across the three groups at 3, 6 and 9 months. Secondary outcomes included changes in body composition at 9 months. Per adherence to recommended exercise protocol (PP) analysis included participants who completed at least 50% of the sessions. RESULTS Among 186 individuals (ST, n=63; AER, n=58; COMB, n=65) analysed, the median (IQR) age was 59 (53-66) years, 60% were men and 83% were Asian. The mean (SD) HbA1c level at baseline was 59.6 (13.1) mmol/mol (7.6% [1.2%]). In intention-to-treat analysis, the ST group showed a significant decrease in HbA1c levels (mean [95% CI] -0.44 percentage points [-0.78, -0.12], p=0.002), while no significant change was observed in either the COMB group (-0.35 percentage points, p=0.13) or the AER group (-0.24 percentage points, p=0.10). The ST group had a greater improvement in HbA1c levels than the AER group (p=0.01). Appendicular lean mass relative to fat mass increased only in the ST group (p=0.0008), which was an independent predictor of HbA1c change (beta coefficient -7.16, p=0.01). Similar results were observed in PP analysis. Only one adverse event, in the COMB group, was considered to be possibly associated with the exercise intervention. CONCLUSIONS/INTERPRETATION In normal-weight type 2 diabetes, strength training was superior to aerobic training alone, while no significant difference was observed between strength training and combination training for HbA1c reduction. Increased lean mass relative to decreased fat mass was an independent predictor of reduction in HbA1c level. TRIAL REGISTRATION ClinicalTrials.gov NCT02448498. FUNDING This study was funded by the National Institutes of Health (NIH; R01DK081371).
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Affiliation(s)
- Yukari Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
- Stanford Cardiovascular Institute, Stanford, CA, USA.
| | - Jin Long
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Shozen Dan
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA
| | - Neil M Johannsen
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
- Louisiana State University, Baton Rouge, LA, USA
| | - Ruth Talamoa
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sonia Raghuram
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sukyung Chung
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Kyla Kent
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Marina Basina
- Division of Endocrinology, Gerontology, and Metabolism, Stanford University School of Medicine, Stanford, CA, USA
| | - Cynthia Lamendola
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Mary B Leonard
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Timothy S Church
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
- Louisiana State University, Baton Rouge, LA, USA
- Wondr Health, Dallas, TX, USA
| | - Latha Palaniappan
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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13
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Liu X, Yang C, Dang Y, Chang Z, Li J, Zhao Y, Zhang Y. Risk of Cardiovascular Diseases Among Different Metabolic Obesity Phenotypes: A Prospective Observational Study. Metab Syndr Relat Disord 2023; 21:306-313. [PMID: 37590875 DOI: 10.1089/met.2022.0100] [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: 08/19/2023] Open
Abstract
Objectives: Various diseases are associated with obesity and metabolism. We sought to investigate the risk of cardiovascular disease (CVD) in diverse metabolic obesity phenotypes. Methods and Results: A prospective observational study of 1517 participants ≥25 years of age without CVD at baseline was conducted. Participants were categorized into four groups based on the condition of central obesity and metabolic health status: metabolically healthy normal weight, metabolically healthy obesity (MHO), metabolically unhealthy normal weight, and metabolically unhealthy obese (MUO). A multivariate Cox regression analysis was used to analyze the relationship between different obesity phenotypes and CVD. During 14830.49 person-years of follow-up, there were 244 incident cases of CVD. Of the 1517 participants, 72 (4.75%) and 812 (53.53%) were classified as having MHO and MUO, respectively. MHO and MUO had a tendency toward a higher risk of CVD [adjusted hazard ratios (HRs) = 1.49, 95% confidence interval (CI): 1.11-2.02 and HR = 1.25, 95% CI: 1.00-1.55, respectively] based on the waist circumference criterion. Conclusion: MHO and MUO can increase the risk of CVD.
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Affiliation(s)
- Xiaowei Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Chan Yang
- School of Nursing, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yuanyuan Dang
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zhenqi Chang
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Juan Li
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yi Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, Ningxia, China
| | - Yuhong Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, Ningxia, China
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14
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Chen W, Man S, Hong Y, Kadeerhan G, Chen L, Xu Q, Xiong L, Xu T, Wang B, Huang X. Association between metabolically healthy obesity and kidney stones: results from the 2011-2018 National Health and Nutrition Examination Survey. Front Public Health 2023; 11:1103393. [PMID: 37304121 PMCID: PMC10249726 DOI: 10.3389/fpubh.2023.1103393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction The risk of kidney stones in metabolically healthy obesity (MHO) individuals is largely unexplored. This study using percent body fat (%BF) to categorize obesity, to investigate the association between MHO as well as other metabolic syndrome-obesity combined phenotypes and kidney stones in a national representative population. Materials and methods This cross-sectional study included 4,287 participants in the National Health and Nutrition Examination Survey from 2011 to 2018. Metabolically healthy status was defined as not having any component of metabolic syndrome or insulin resistance. Obesity was identified by %BF, which was measured and assessed by dual-energy x-ray absorptiometry (DXA) scan. Participants were cross-classified by metabolic health and obesity status. The outcome was self-report kidney stones. Multivariable logistic regression model was used to examine the association between MHO and kidney stones. Results A total of 358 participants had kidney stones [weighted prevalence (SE): 8.61% (0.56%)]. The weighted prevalence (SE) of kidney stones in MHN, MHOW, and MHO groups was 3.13% (1.10%), 4.97% (1.36%), and 8.55% (2.09%), respectively. After adjusting for age, sex, race and ethnicity, education level, smoking status, alcohol consumption, physical activity, daily water intake, CKD stage 3-5, and hyperuricemia, MHO individuals (OR: 2.90, 95% CI: 1.18, 7.0) had a significantly higher risk of kidney stones than those with metabolically healthy normal weight. In metabolically healthy participants, a 5% increment in %BF was associated with a significantly higher risk of kidney stones (OR: 1.60, 95% CI: 1.20, 2.14). Furthermore, a nonlinear dose-response relationship between %BF and the kidney stones was observed in metabolically healthy participants (P for non-linearity = 0.046). Conclusion Using %BF to define obesity, MHO phenotype was significantly associated with higher risks of kidney stones, suggesting that obesity can independently contribute to kidney stones in the absence of metabolic abnormalities and insulin resistance. Regarding kidney stones prevention, MHO individuals might still benefit from lifestyle interventions aimed at healthy body composition maintenance.
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Affiliation(s)
- Weinan Chen
- Department of Urology, Peking University People's Hospital, Beijing, China
- Peking University Applied Lithotripsy Institute, Beijing, China
| | - Sailimai Man
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Meinian Institute of Health, Beijing, China
- Peking University Health Science Center Meinian Public Health Institute, Beijing, China
| | - Yang Hong
- Department of Urology, Peking University People's Hospital, Beijing, China
- Peking University Applied Lithotripsy Institute, Beijing, China
| | - Gaohaer Kadeerhan
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Liang Chen
- Department of Urology, Peking University People's Hospital, Beijing, China
- Peking University Applied Lithotripsy Institute, Beijing, China
| | - Qingquan Xu
- Department of Urology, Peking University People's Hospital, Beijing, China
- Peking University Applied Lithotripsy Institute, Beijing, China
| | - Liulin Xiong
- Department of Urology, Peking University People's Hospital, Beijing, China
- Peking University Applied Lithotripsy Institute, Beijing, China
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Bo Wang
- Meinian Institute of Health, Beijing, China
- Peking University Health Science Center Meinian Public Health Institute, Beijing, China
| | - Xiaobo Huang
- Department of Urology, Peking University People's Hospital, Beijing, China
- Peking University Applied Lithotripsy Institute, Beijing, China
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Kawasaki Y, Kitamura E, Kasai T. Impact of Body Composition on Sleep and Its Relationship with Sleep Disorders: Current Insights. Nat Sci Sleep 2023; 15:375-388. [PMID: 37220427 PMCID: PMC10200107 DOI: 10.2147/nss.s340946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 05/04/2023] [Indexed: 05/25/2023] Open
Abstract
Sleep is involved in many physiological processes and is essential for both physical and mental health. Obesity and sleep deprivation due to sleep disorders are major public health issues. Their incidence is increasing, and they have a wide range of adverse health-related consequences, including life-threatening cardiovascular disease. The impact of sleep on obesity and body composition is well-known, and many studies have shown an association between insufficient or excessive sleep duration and obesity, body fat percentage, and weight gain. However, there is growing evidence of the effects of body composition on sleep and sleep disorders (particularly sleep disordered breathing) through anatomical and physiological mechanisms (nocturnal fluid shift, core body temperature, or diet). Although some research has been conducted on the bidirectional effects of sleep-disordered breathing and body composition, the specific effects of obesity and body composition on sleep and the underlying mechanisms that explain these effects remain unclear. Therefore, this review summarizes the findings on the effects of body composition on sleep and draws conclusions and proposals for future research in this field.
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Affiliation(s)
- Yu Kawasaki
- Department of Obstetrics and Gynecology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Eri Kitamura
- Department of Obstetrics and Gynecology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Cardiovascular Management and Remote Monitoring, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Ferrannini G, Pollock C, Natali A, Yavin Y, Mahaffey KW, Ferrannini E. Extremes of both weight gain and weight loss are associated with increased incidence of heart failure and cardiovascular death: evidence from the CANVAS Program and CREDENCE. Cardiovasc Diabetol 2023; 22:100. [PMID: 37120538 PMCID: PMC10149021 DOI: 10.1186/s12933-023-01832-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/12/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Obesity is an independent risk factor for cardiovascular disease (CVD) in patients with type 2 diabetes (T2D). However, it is not known to what extent weight fluctuations might be associated with adverse outcomes. We aimed at assessing the associations between extreme weight changes and cardiovascular outcomes in two large randomised controlled trials of canagliflozin in patients with T2D and high cardiovascular (CV) risk. METHODS In the study populations of the CANVAS Program and CREDENCE trials, weight change was evaluated between randomization and week 52-78, defining subjects in the top 10% of the entire distribution of weight changes as gainers, subjects in the bottom 10% as losers and the remainder as stable. Univariate and multivariate Cox proportional hazards models were used to test the associations between weight changes categories, randomised treatment and covariates with heart failure hospitalisation (hHF) and the composite of hHF and CV death. RESULTS Median weight gain was 4.5 kg in gainers and median weight loss was 8.5 kg in losers. The clinical phenotype of gainers as well as that of losers were similar to that of stable subjects. Weight change within each category was only slightly larger with canagliflozin than placebo. In both trials, gainers and losers had a higher risk of hHF and of hHF/CV death compared with stable at univariate analysis. In CANVAS, this association was still significant by multivariate analysis for hHF/CV death in both gainers and losers vs. stable (hazard ratio - HR 1.61 [95% confidence interval - CI: 1.20-2.16] and 1.53 [95% CI 1.14-2.03] respectively). Results were similar in CREDENCE for gainers vs. stable (adjusted HR for hHF/CV death 1.62 [95% CI 1.19-2.16]) CONCLUSIONS: Extremes of weight gain or loss were independently associated with a higher risk of the composite of hHF and CV death. In patients with T2D and high CV risk, large changes in body weight should be carefully assessed in view of individualised management. TRIALS REGISTRATION CANVAS ClinicalTrials.gov number: NCT01032629. CREDENCE ClinicalTrials.gov number: NCT02065791.
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Affiliation(s)
- Giulia Ferrannini
- Department of Medicine Solna, Karolinska Institutet, Eugeniavägen 27, Solna, S1:02, 171 64, Stockholm, Sweden.
| | - Carol Pollock
- Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Camperdown, Australia
| | - Andrea Natali
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Yshai Yavin
- Janssen Research & Development, LLC, Welsh & McKean Rds, Spring House, PA, USA
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ele Ferrannini
- CNR Institute of Clinical Physiology, Via Savi 12, Pisa, 56126, Italy
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17
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Zhou K, Xiang J, Li GY, Pu XB, Zhang L. Body composition and mortality in a cohort study of Chinese patients with hypertrophic cardiomyopathy. Front Cardiovasc Med 2023; 10:988274. [PMID: 37008327 PMCID: PMC10050713 DOI: 10.3389/fcvm.2023.988274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
ObjectiveTo analyse the characteristics and mortality of hypertrophic cardiomyopathy (HCM) patients with different body compositions.MethodsIn this study, 530 consecutive patients with HCM at West China Hospital were studied from November 2008 to May 2016. An equation based on body mass index (BMI) was used to obtain the Percent body fat (BF) and lean mass index (LMI). Patients were divided into five sex-specific BMI, BF and LMI quintiles.ResultsThe average BMI, BF and LMI were 23.1 ± 3.2 kg/m2, 28.1 ± 7.3% and 16.5 ± 2.2 kg/m2, respectively. Patients with higher BMI or BF were older and had more symptoms and adverse cardiovascular conditions; those with higher LMI were younger and had less coronary artery disease and lower serum NT-proBNP and creatine. BF correlated positively with resting left ventricular (LV) outflow tract gradient, mitral regurgitation (MR) degree and left atrial diameter but was inversely associated with septal wall thickness (SWT), posterior wall thickness (PWT), LV mass, and E/A ratio; LMI was positively correlated with SWT, LV end diastolic volume and LV mass but was negatively associated with MR degree.48 all-cause deaths occurred during a median follow-up of 33.8 months. Reversed J-shape associations of BMI and LMI with mortality were observed. A lower BMI or LMI was significantly associated with high mortality, especially for low-moderate BMI and LMI. No significant difference in mortality was found across BF quintiles.ConclusionsThe associations of BMI, BF and LMI with baseline characteristics and cardiac remodelling are different in HCM patients. In Chinese HCM patients, low BMI and LMI predicted mortality but not BF.
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Affiliation(s)
- Ke Zhou
- Cardiology Department, Affiliated Minda Hospital of Hubei Minzu University, Enshi, China
| | - Jie Xiang
- Cardiac Pacing and Electrophysiological Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Cardiac Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Guo-yong Li
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-bo Pu
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Li Zhang
- Cardiology Department, Affiliated Minda Hospital of Hubei Minzu University, Enshi, China
- Correspondence: Li Zhang
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18
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Horwich T, Srikanthan P, Gaitonde A, Watson K, Allison M, Kronmal R. Association Between Measures of Body Composition and Coronary Calcium: Findings From the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2023; 12:e027708. [PMID: 36752229 PMCID: PMC10111476 DOI: 10.1161/jaha.122.027708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Background Obesity, as measured by body mass index, is widely recognized as a risk factor for the development of cardiovascular disease. However, the role of body composition components such as fat and lean mass is not well studied. Methods and Results A total of 3129 patients who underwent computed tomography scans for quantification of coronary artery calcification and had bioelectrical impedance analysis of body composition (fat mass and fat-free mass) during exam 5 of MESA (Multi-Ethnic Study of Atherosclerosis) were included in this cross-sectional analysis. Multivariable adjusted linear regression analysis was performed to assess the relationship between both fat mass and fat-free mass to prevalent coronary artery calcification, a marker of subclinical coronary artery disease quantified by both the coronary artery calcification (CAC) Agatston score and the spatially weighted calcium score. CAC and spatially weighted calcium score were natural log-transformed for analysis as continuous variables. Fat-free mass, but not fat mass, was independently associated with CAC. There was a 7.6% prevalence risk difference for CAC>0 per 10 kg. Fat-free mass was also significantly associated with natural log of CAC (coefficient=0.272, P<0.001). Both fat-free mass and fat mass were positively associated with natural log of spatially weighted calcium score, with risk difference coefficients of 0.729 and 0.359, respectively (P<0.001). Conclusions In this cross-sectional study, higher lean mass by bioelectrical impedance analysis and, to a lesser extent, higher fat mass by bioelectrical impedance analysis were significantly associated with higher coronary calcium, a marker of subclinical cardiovascular disease. Further exploration of the relationship between components of body composition and the development of cardiovascular disease is warranted.
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Affiliation(s)
- Tamara Horwich
- Division of Cardiology David Geffen School of Medicine at University of California Los Angeles Los Angeles CA
| | - Preethi Srikanthan
- Division of Cardiology David Geffen School of Medicine at University of California Los Angeles Los Angeles CA
| | - Anisha Gaitonde
- Division of Cardiology David Geffen School of Medicine at University of California Los Angeles Los Angeles CA
| | - Karol Watson
- Division of Cardiology David Geffen School of Medicine at University of California Los Angeles Los Angeles CA
| | - Matthew Allison
- Department of Family Medicine and Public Health University of California San Diego La Jolla CA
| | - Richard Kronmal
- Department of Biostatistics University of Washington Seattle WA
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19
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Kirwan R, Newson L, McCullough D, Butler T, Davies IG, Perez de Heredia F. Acceptability of a high-protein Mediterranean-style diet and resistance exercise protocol for cardiac rehabilitation patients: Involving service users in intervention design using a mixed-methods participatory approach. Front Nutr 2023; 10:1043391. [PMID: 36866056 PMCID: PMC9970995 DOI: 10.3389/fnut.2023.1043391] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
Background Current cardiac rehabilitation (CR) practices focus on aerobic-style exercise with minimal nutrition advice. This approach may not be optimal for CR patients with reduced muscle mass and elevated fat mass. Higher protein, Mediterranean-style diets combined with resistance exercise (RE) may improve muscle mass and reduce the risk of future cardiovascular events, although such an approach is yet to be trialed in a CR population. Objective We explored patient perspectives on the proposed design of a feasibility study. Patients reflected on the acceptability of a proposed high-protein Mediterranean-style diet and RE protocol, emphasizing research methodology and the acceptability of the proposed recipes and exercises. Design We applied quantitative and qualitative (mixed methods) approaches. The quantitative approach involved an online questionnaire (n = 40) regarding the proposed study methodology and relevance. A subset of participants (n = 12) received proposed recipe guides and were asked to prepare several dishes and complete an online questionnaire regarding their experience. Another subset (n = 18) received links to videos of the proposed RE and completed a questionnaire regarding their impressions of them. Finally, semi-structured interviews (n = 7) were carried out to explore participants' impressions of the proposed diet and exercise intervention. Results Quantitative data indicated a high level of understanding of the intervention protocol and its importance within the context of this research. There was a high degree of willingness to participate in all aspects of the proposed study (>90%). The trialed recipes were enjoyed and found to be easy to make by a majority of participants (79 and 92.1%, respectively). For the proposed exercises 96.5% of responses agreed they would be willing to perform them and, 75.8% of responses agreed they would enjoy them. Qualitative analysis revealed that participants viewed the research proposal, diet, and exercise protocol in a positive light. The research materials were considered appropriate and well explained. Participants suggested practical recommendations for improving recipe guides and requested more individual-focused exercise recommendations, and more information on the specific health benefits of the diet and exercise protocols. Conclusion The study methodology and the specific dietary intervention and exercise protocol were found to be generally acceptable with some suggested refinements.
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Affiliation(s)
- Richard Kirwan
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, United Kingdom,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom,The Institute for Health Research, Liverpool John Moores University, Liverpool, United Kingdom
| | - Lisa Newson
- The Institute for Health Research, Liverpool John Moores University, Liverpool, United Kingdom,School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Deaglan McCullough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom,Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
| | - Tom Butler
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom,Cardiorespiratory Research Centre, Edge Hill University, Ormskirk, United Kingdom
| | - Ian G. Davies
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom,The Institute for Health Research, Liverpool John Moores University, Liverpool, United Kingdom,*Correspondence: Ian G. Davies,
| | - Fatima Perez de Heredia
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, United Kingdom,The Institute for Health Research, Liverpool John Moores University, Liverpool, United Kingdom
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20
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Orsi E, Solini A, Penno G, Bonora E, Fondelli C, Trevisan R, Vedovato M, Cavalot F, Lamacchia O, Haxhi J, Nicolucci A, Pugliese G. Body mass index versus surrogate measures of central adiposity as independent predictors of mortality in type 2 diabetes. Cardiovasc Diabetol 2022; 21:266. [PMID: 36461034 PMCID: PMC9716975 DOI: 10.1186/s12933-022-01706-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND An "obesity paradox" for mortality has been shown in chronic disorders such as diabetes, and attributed to methodological bias, including the use of body mass index (BMI) for obesity definition. This analysis investigated the independent association of BMI versus surrogate measures of central adiposity with all-cause mortality in individuals with type 2 diabetes. METHODS The Renal Insufficiency And Cardiovascular Events Italian Multicentre Study is a prospective cohort study that enrolled 15,773 patients in 19 Italian centres in 2006-2008. Exposures were BMI and the surrogate measures of central adiposity waist circumference (WC), waist-to-height ratio (WHtR), and A Body Shape Index (ABSI). Vital status was retrieved on 31 October 2015 for 15,656 patients (99.3%), RESULTS: Age- and sex-adjusted hazard ratios and 95% confidence intervals were significantly higher in BMI-based underweight (1.729 [1.193-2.505), P = 0.004), moderately obese (1.214 [1.058-1.392), P = 0.006) and severely obese (1.703 [1.402-2.068), P < 0.0001), lower in overweight (0.842 [0.775-0.915), P < 0.0001) and similar in mildly obese (0.950 [0.864-1.045), P = 0.292), compared to normal-weight individuals. When further adjusting for smoking, physical activity (PA), and comorbidities, risk was lower also in mildly obese versus normal-weight patients. The BMI-mortality relationship did not change after sequentially excluding ever smokers, individuals with comorbidities, and those died within two years from enrollment and when analyzing separately participants below and above the median age. Conversely, a paradox relationship was observed among inactive/moderately inactive, but not moderately/highly active patients. Mortality risk adjusted for age, gender, smoking, PA and comorbidities was significantly higher in the highest tertile of WC (1.279 [1.089-1.501], P = 0.003), WHtR (1.372 [1.165-1.615], P < 0.0001), and ABSI (1.263 [1.067-1.495], P = 0.007) versus the lowest tertile. However, risk was lower in the intermediate versus lowest tertile for WC (0.823 [0.693-0.979], P = 0.028), similar for WHtR, and higher, though not significantly, for ABSI. CONCLUSIONS An "overweight paradox" remained after controlling for age, smoking, and comorbidities, arguing against a collider bias or reverse causation. However, it could be partly explained by confounding from PA level, possibly through its impact on lean mass and cardiorespiratory fitness. No obesity paradox was observed with WHtR and especially ABSI, which predicted mortality risk associated with central adiposity better than WC. Trial registration ClinicalTrials.gov, NCT00715481, 15 July, 2008.
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Affiliation(s)
- Emanuela Orsi
- grid.414818.00000 0004 1757 8749Diabetes Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Solini
- grid.5395.a0000 0004 1757 3729Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Giuseppe Penno
- grid.5395.a0000 0004 1757 3729Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Enzo Bonora
- grid.411475.20000 0004 1756 948XDivision of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | - Cecilia Fondelli
- grid.9024.f0000 0004 1757 4641Diabetes Unit, University of Siena, Siena, Italy
| | - Roberto Trevisan
- grid.460094.f0000 0004 1757 8431Endocrinology and Diabetes Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Monica Vedovato
- grid.5608.b0000 0004 1757 3470Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy
| | - Franco Cavalot
- grid.7605.40000 0001 2336 6580Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Olga Lamacchia
- grid.10796.390000000121049995Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Jonida Haxhi
- grid.7841.aDepartment of Clinical and Molecular Medicine, “La Sapienza” University, Via Di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Antonio Nicolucci
- grid.512242.2Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Giuseppe Pugliese
- grid.7841.aDepartment of Clinical and Molecular Medicine, “La Sapienza” University, Via Di Grottarossa, 1035-1039, 00189 Rome, Italy
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21
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Keller K, Geyer M, Hobohm L, Tamm AR, Kreidel F, Ruf TF, Hell M, Schmitt VH, Bachmann K, Born S, Schulz E, Münzel T, von Bardeleben RS. Survival benefit of overweight patients undergoing MitraClip® procedure in comparison to normal-weight patients. Clin Cardiol 2022; 45:1236-1245. [PMID: 36070481 DOI: 10.1002/clc.23897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/06/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The number of MitraClip® implantations increased significantly in recent years. Data regarding the impact of weight class on survival are sparse. HYPOTHESIS We hypothesized that weight class influences survival of patients treated with MitraClip® implantation. METHODS We investigated in-hospital, 1-year, 3-year, and long-term survival of patients successfully treated with isolated MitraClip® implantation for mitral valve regurgitation (MR) (June 2010-March 2018). Patients were categorized by weight classes, and the impact of weight classes on survival was analyzed. RESULTS Of 617 patients (aged 79.2 years; 47.3% females) treated with MitraClip® implantation (June 2010-March 2018), 12 patients were underweight (2.2%), 220 normal weight (40.1%), 237 overweight (43.2%), and 64 obesity class I (11.7%), 12 class II (2.2%), and 4 class III (0.7%). Preprocedural Logistic EuroScore (21.1 points [IQR 14.0-37.1]; 26.0 [18.5-38.5]; 26.0 [18.4-39.9]; 24.8 [16.8-33.8]; 33.0 [25.9-49.2]; 31.6 [13.1-47.6]; p = .291) was comparable between groups. Weight class had no impact on in-hospital death (0.0%; 4.1%; 1.5%; 0.0%; 7.7%; 0.0%; p = .189), 1-year survival (75.0%; 72.0%; 76.9%; 75.0%; 75.0%; 33.3%; p = .542), and 3-year survival (40.0%; 36.8%; 38.2%; 48.6%; 20.0%; 33.3%; p = .661). Compared to normal weight, underweight (hazard ratio [HR]: 1.35 [95% confidence interval [CI]: 0.65-2.79], p = .419), obesity-class I (HR: 0.93 [95% CI: 0.65-1.34], p = .705), class II (HR: 0.39 [95% CI: 0.12-1.24], p = .112), and class III (HR: 1.28 [95% CI: 0.32-5.21], p = .726) did not affect long-term survival. In contrast, overweight was associated with better survival (HR: 1.32 [95% CI: 1.04-1.68], p = .023). CONCLUSION Overweight affected the long-term survival of patients undergoing MitraClip® implantation beneficially compared to normal weight.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Medical Clinic VII: Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Geyer
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Alexander R Tamm
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Felix Kreidel
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tobias F Ruf
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Michaela Hell
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Volker H Schmitt
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, Mainz, Germany
| | - Kevin Bachmann
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sonja Born
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Eberhard Schulz
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, Mainz, Germany
| | - Ralph S von Bardeleben
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, Mainz, Germany
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22
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Tao WX, Qian GY, Li HD, Su F, Wang Z. Body mass index and outcomes of patients with cardiogenic shock: A systematic review and meta-analysis. World J Clin Cases 2022; 10:10956-10966. [PMID: 36338207 PMCID: PMC9631130 DOI: 10.12998/wjcc.v10.i30.10956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/09/2022] [Accepted: 09/09/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cardiogenic shock continues to be a highly morbid complication that affects around 7%-10% of patients with acute myocardial infarction or heart failure. Similarly, obesity has become a worldwide epidemic.
AIM To analyze the impact of higher body mass index (BMI) on outcomes of patients with cardiogenic shock.
METHODS A systematic and comprehensive search was undertaken on the electronic databases of PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar for all types of studies comparing mortality outcomes of patients with cardiogenic shock based on BMI. All studies defined overweight or obese patients based on the World Health Organization BMI criteria. The data were then extracted and assessed on the basis of the Reference Citation Analysis (https://www.referencecitationanalysis.com/).
RESULTS Five studies were included. On pooled analysis of multivariable-adjusted ratios, we noted a statistically significantly reduced risk of mortality in overweight/ obese vs normal patients (three studies; odds ratio [OR] = 0.92, 95% confidence interval [CI]: 0.85-0.98, I2 = 85%). On meta-analysis, we noted that crude mortality rates did not significantly differ between overweight/obese and normal patients after cardiogenic shock (OR = 0.95, 95%CI: 0.79-1.15, I2 = 99%). The results were not stable on sensitivity analysis and were associated with substantial heterogeneity.
CONCLUSION Current evidence on the association between overweight/obesity and mortality after cardiogenic shock is scarce and conflicting. The obesity paradox might exist in patients with cardiogenic shock but could be confounded by the use of mechanical circulatory support. There is a need for further studies to clarify this relationship.
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Affiliation(s)
- Wen-Xia Tao
- Department of Cardiovascular Medicine, Huzhou Cent Hospital, Affiliated Cent Hospital Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Guo-Ying Qian
- Department of Cardiovascular Medicine, Huzhou Cent Hospital, Affiliated Cent Hospital Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Hong-Dan Li
- Department of Cardiovascular Medicine, Huzhou Cent Hospital, Affiliated Cent Hospital Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Feng Su
- Department of Cardiovascular Medicine, Huzhou Cent Hospital, Affiliated Cent Hospital Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Zhou Wang
- Department of Cardiovascular Medicine, Huzhou Cent Hospital, Affiliated Cent Hospital Huzhou University, Huzhou 313000, Zhejiang Province, China
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23
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Roubille C, Eduin B, Breuker C, Zerkowski L, Letertre S, Mercuzot C, Bigot J, Du Cailar G, Roubille F, Fesler P. Predictive risk factors for death in elderly patients after hospitalization for acute heart failure in an internal medicine unit. Intern Emerg Med 2022; 17:1661-1668. [PMID: 35460014 DOI: 10.1007/s11739-022-02982-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
Abstract
To determine the predictive factors of mortality after hospitalization for acute heart failure (AHF) in an internal medicine department. Retrospective observational analysis conducted on 164 patients hospitalized for AHF in 2016-2017. Demographic, clinical and biological characteristics were assessed during hospitalization. The primary endpoint was the occurrence of all-cause death. Multivariate analysis was performed using the Cox model adjusted for age and renal function. The study population was mostly female (n = 106, 64.6%), elderly (82.9 years ± 10.0), with a preserved LVEF (86%). Mean Charlson comorbidity index was 6.5 ± 2.5. After a median follow-up of 17.5 months (IQR 6-38), 109 patients (65%) had died with a median time to death of 14 months (IQR 3-29). In univariate analysis, patients who died were significantly older, had lower BMI and renal function, and higher CCI and NT-proBNP levels (median of 4944 ng/l [2370-14403] versus 1740 ng/l [1119-3503], p < 0.001). In multivariate analysis, risk factors for death were lower BMI (HR 0.69, CI [0.53-0.90], p = 0.005), lower albuminemia (HR 0.77 [0.63-0.94], p = 0.009), higher ferritinemia (HR 1.38 [1.08-1.76], p = 0.010), higher uricemia (HR 1.28 [1.02-1.59], p = 0.030), higher NT-proBNP (HR 2.46 [1.65-3.67], p < 0.001) and longer hospital stay (HR 1.25 [1.05-1.49] p = 0.013). In elderly multimorbid patients, AHF prognosis appears to be influenced by nutritional criteria, including lower BMI, hypoalbuminemia, and hyperuricemia (independently of renal function). These results underline the importance of nutritional status, especially as therapeutic options are available. This consideration paves the way for further research in this field.
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Affiliation(s)
- Camille Roubille
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex, France.
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier Cedex 5, France.
| | - Benjamin Eduin
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex, France
| | - Cyril Breuker
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier Cedex 5, France
- Clinical Pharmacy Department, CHRU de Montpellier, University of Montpellier, Montpellier, France
| | - Laetitia Zerkowski
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex, France
| | - Simon Letertre
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex, France
| | - Cédric Mercuzot
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex, France
| | | | - Guilhem Du Cailar
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex, France
| | - François Roubille
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier Cedex 5, France
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France
| | - Pierre Fesler
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier Cedex 5, France
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Subramaniapillai S, Suri S, Barth C, Maximov II, Voldsbekk I, van der Meer D, Gurholt TP, Beck D, Draganski B, Andreassen OA, Ebmeier KP, Westlye LT, de Lange AG. Sex- and age-specific associations between cardiometabolic risk and white matter brain age in the UK Biobank cohort. Hum Brain Mapp 2022; 43:3759-3774. [PMID: 35460147 PMCID: PMC9294301 DOI: 10.1002/hbm.25882] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/24/2022] [Accepted: 04/05/2022] [Indexed: 12/13/2022] Open
Abstract
Cardiometabolic risk (CMR) factors are associated with accelerated brain aging and increased risk for sex-dimorphic illnesses such as Alzheimer's disease (AD). Yet, it is unknown how CMRs interact with sex and apolipoprotein E-ϵ4 (APOE4), a known genetic risk factor for AD, to influence brain age across different life stages. Using age prediction based on multi-shell diffusion-weighted imaging data in 21,308 UK Biobank participants, we investigated whether associations between white matter Brain Age Gap (BAG) and body mass index (BMI), waist-to-hip ratio (WHR), body fat percentage (BF%), and APOE4 status varied (i) between males and females, (ii) according to age at menopause in females, and (iii) across different age groups in males and females. We report sex differences in associations between BAG and all three CMRs, with stronger positive associations among males compared to females. Independent of APOE4 status, higher BAG (older brain age relative to chronological age) was associated with greater BMI, WHR, and BF% in males, whereas in females, higher BAG was associated with greater WHR, but not BMI and BF%. These divergent associations were most prominent within the oldest group of females (66-81 years), where greater BF% was linked to lower BAG. Earlier menopause transition was associated with higher BAG, but no interactions were found with CMRs. In conclusion, the findings point to sex- and age-specific associations between CMRs and brain age. Incorporating sex as a factor of interest in studies addressing CMR may promote sex-specific precision medicine, consequently improving health care for both males and females.
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Affiliation(s)
- Sivaniya Subramaniapillai
- LREN, Centre for Research in Neurosciences, Department of Clinical NeurosciencesLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
- Department of Psychology, Faculty of ScienceMcGill UniversityMontrealQuebecCanada
- Department of PsychologyUniversity of OsloOsloNorway
| | - Sana Suri
- Department of PsychiatryUniversity of OxfordOxfordUK
- Wellcome Centre for Integrative NeuroimagingUniversity of OxfordOxfordUK
| | - Claudia Barth
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and AddictionOslo University Hospital and University of OsloOsloNorway
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
| | - Ivan I. Maximov
- Department of PsychologyUniversity of OsloOsloNorway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and AddictionOslo University Hospital and University of OsloOsloNorway
- Department of Health and FunctioningWestern Norway University of Applied SciencesBergenNorway
| | - Irene Voldsbekk
- Department of PsychologyUniversity of OsloOsloNorway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and AddictionOslo University Hospital and University of OsloOsloNorway
| | - Dennis van der Meer
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and AddictionOslo University Hospital and University of OsloOsloNorway
- School of Mental Health and Neuroscience, Faculty of Health Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Tiril P. Gurholt
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and AddictionOslo University Hospital and University of OsloOsloNorway
| | - Dani Beck
- Department of PsychologyUniversity of OsloOsloNorway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and AddictionOslo University Hospital and University of OsloOsloNorway
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
| | - Bogdan Draganski
- LREN, Centre for Research in Neurosciences, Department of Clinical NeurosciencesLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
- Department of NeurologyMax Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
| | - Ole A. Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and AddictionOslo University Hospital and University of OsloOsloNorway
- KG Jebsen Centre for Neurodevelopmental DisordersUniversity of OsloOsloNorway
| | | | - Lars T. Westlye
- Department of PsychologyUniversity of OsloOsloNorway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and AddictionOslo University Hospital and University of OsloOsloNorway
- KG Jebsen Centre for Neurodevelopmental DisordersUniversity of OsloOsloNorway
| | - Ann‐Marie G. de Lange
- LREN, Centre for Research in Neurosciences, Department of Clinical NeurosciencesLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
- Department of PsychologyUniversity of OsloOsloNorway
- Department of PsychiatryUniversity of OxfordOxfordUK
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Xie H, Ruan G, Zhang H, Ge Y, Zhang Q, Lin S, Song M, Zhang X, Liu X, Li X, Zhang K, Yang M, Tang M, Deng L, Gan J, Shi H. Sex differences in the association of triceps skinfold thickness and colorectal cancer mortality. Nutrition 2022; 103-104:111811. [DOI: 10.1016/j.nut.2022.111811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/17/2022] [Accepted: 08/02/2022] [Indexed: 12/03/2022]
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Kanic V, Frank B, Sokolovic I, Glavnik N, Penko M. Fat-Free Mass and Body Fat in Patients with Myocardial Infarction Who Underwent Percutaneous Coronary Intervention. Am J Cardiol 2022; 176:8-14. [PMID: 35618543 DOI: 10.1016/j.amjcard.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 11/01/2022]
Abstract
There are no data on the effects of fat-free mass (FFM) and body fat (BF) on prognosis in patients with myocardial infarction (MI). We investigated the effects of FFM and BF (which were estimated using formulas rather than direct measurements) on 30-day and long-term all-cause mortality in patients with MI who underwent percutaneous coronary intervention. We analyzed data from 6,453 patients with MI. The patients were divided into 2 categories (high/low) according to the fat-free mass index (FFMI) and 2 categories (low/high) according to the BF. The resultant 4 patient groups: HighFFMI-LowBF, HighFFMI-HighBF, LowFFMI-LowBF, and LowFFMI-HighBF, were compared. The lowest crude mortality after 30 days and in the long term was observed in the HighFFMI-LowBF group (3.0%,9.8%, respectively), followed by the HighFFMI-HighBF group (6.6%, 27.0%, respectively), the LowFFMI-LowBF group (10.4%, 36.0%, respectively), and the LowFFMI-HighBF group (14.7%, 56.8%, respectively). The difference was significant (p <0.0001), as was the difference between groups. After adjustment, the FFMI-BF groups independently predicted 30-day mortality (p = 0.003), but the risk was similar in all groups. Compared with the HighFFMI-LowBF group, the long-term mortality risk was similar in the HighFFMI-HighBF group (hazard ratio [HR] 1.11, 95% confidence interval [CI] 0.84 to 1.47, p = 0.47), but the LowFFMI-LowBF and LowFFMI-HighBF patients had a higher risk (HR 1.59, 95% CI 1.20 to 2.11, p = 0.001, HR 1.40, 95% CI 1.03 to 1.91, p = 0.033, respectively). Body composition predicted mortality better than body mass index in patients with MI. Mortality appeared to be inversely related to FFM, with patients with low FFM and low BF having a particularly high mortality risk. The body composition groups also confirmed the obesity paradox.
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Bradley P. Hypothesis: Enhanced glucose availability and insulin resistance enhances an activated immune system and accounts for the obesity paradox. Clin Obes 2022; 12:e12521. [PMID: 35412022 DOI: 10.1111/cob.12521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Many studies have demonstrated an 'obesity paradox' where people with obesity have reduced mortality in the context of acute critical illnesses compared to people of normal weight. In contrast, obesity is associated with reduced life expectancy in the population in general and is associated with an increased risk for type 2 diabetes, cardiovascular disease and other health problems. However, the absence of the metabolic syndrome is associated a lower mortality than when the metabolic syndrome is present regardless of body mass index status and the obesity paradox appears to only occur in association with the metabolic syndrome, but cardiorespiratory fitness modifies these outcomes. Enhanced glucose availability is important when the immune system is activated not only because it has an acute onset, a high consumption of glucose and is substantially an obligate glucose utilizer but also because it has priority over most other tissues and cells for the available glucose. Thus, for vulnerable populations, such as children with severe infections, this increases the risk of hypoglycaemia and death. The obesity paradox may be substantially a consequence of two features associated with obesity. One is endogenous glucose production (EGP). Obesity is associated with an increased capacity for EGP and thus is associated with enhanced glucose availability. Second is insulin resistance that reduces the amount of glucose metabolized by cells that are not obligate glucose utilizers and increases the release of fatty acids and glycerol from adipose stores that are alternative fuels for tissues and cells.
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Chew NW, Kong G, Venisha S, Chin YH, Ng CH, Lin C, Muthiah M, Khoo CM, Chai P, Kong W, Poh KK, Foo R, Yeo TC, Chan MY, Loh PH. Long-term Prognosis of Acute Myocardial Infarction Associated with Metabolic Health and Obesity Status. Endocr Pract 2022; 28:802-810. [PMID: 35654337 DOI: 10.1016/j.eprac.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Emerging evidence supports the favourable cardiovascular health in non-obese subjects with healthy metabolism. However, little is known regarding the prognosis across the range of metabolic phenotypes once cardiovascular disease is established. We examined the prognosis of patients with acute myocardial infarction (AMI) stratified according to metabolic health and obesity status. METHODS This is a retrospective study on consecutive patients with AMI admitted to a tertiary hospital between 2014-2021. Patients were allocated into 4 groups based on metabolic and obesity profile: metabolically healthy obese (MHO), metabolically healthy non-obese (MHNO), metabolically unhealthy obese (MUO) and metabolically unhealthy non-obese (MUNO). Metabolic health was defined in accordance to the BioSHARE-EU Healthy Obese Project. The primary outcome was all-cause mortality. Cox regression analysis examined the independent association between mortality and metabolic phenotypes, adjusting for age, sex, AMI type, chronic kidney disease, smoking status and left ventricular ejection fraction. RESULTS Of 9958 patients, the majority (68.5%) were MUNO, followed by MUO (25.1%), MHNO (5.6%), and MHO (0.8%). MHO had the lowest mortality (7.4%), followed by MHNO (9.7%), MUO (19.2%) and MUNO (22.6%) (p<0.001). Compared to MHNO, MUO (HR 1.737, 95%CI 1.282-2.355, p<0.001) and MUNO (HR 1.482, 95%CI 1.108-1.981, p=0.008) had significantly higher mortality risk, but not MHO (HR 1.390, 95%CI 0.594-3.251, p=0.447), after adjusting for confounders. Kaplan-Meier curves showed favourable survival in the metabolically healthy and obesity groups, with the highest overall survival in the MHO followed by MHNO, MUO and MUNO (p<0.001). CONCLUSION Metabolically healthy and obese AMI patients have favourable prognosis compared to metabolically unhealthy and non-obese patients. It is equally important to prioritize intensive metabolic risk factor management to weight reduction in the early phase after AMI.
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Affiliation(s)
- Nicholas Ws Chew
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore.
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - S Venisha
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chaoxing Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Chin Meng Khoo
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Ping Chai
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - William Kong
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Roger Foo
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Poay Huan Loh
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Gómez-García M, Torrado J, Pereira M, Bia D, Zócalo Y. Fat-Free Mass Index, Visceral Fat Level, and Muscle Mass Percentage Better Explain Deviations From the Expected Value of Aortic Pressure and Structural and Functional Arterial Properties Than Body Fat Indexes. Front Nutr 2022; 9:856198. [PMID: 35571946 PMCID: PMC9099434 DOI: 10.3389/fnut.2022.856198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/21/2022] [Indexed: 12/15/2022] Open
Abstract
Bioelectrical impedance analysis (BIA)-derived indexes [e.g., fat (FMI) and fat-free mass indexes (FFMI), visceral fat level (VFL)] are used to characterize obesity as a cardiovascular risk factor (CRF). The BIA-derived index that better predicts arterial variability is still discussed.
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Affiliation(s)
- Mariana Gómez-García
- Departamento de Educación Física y Salud, Instituto Superior de Educación Física, Universidad de la República, Montevideo, Uruguay
- CUiiDARTE-Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
| | - Juan Torrado
- CUiiDARTE-Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - María Pereira
- Department of Obstetrics and Gynecology, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic Affiliate of Icahn School of Medicine, New York, NY, United States
| | - Daniel Bia
- CUiiDARTE-Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo, Uruguay
| | - Yanina Zócalo
- CUiiDARTE-Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo, Uruguay
- *Correspondence: Yanina Zócalo
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Ge Y, Liu J, Zhang L, Gao Y, Wang B, Wang X, Li J, Zheng X. Association of Lean Body Mass and Fat Mass With 1-Year Mortality Among Patients With Heart Failure. Front Cardiovasc Med 2022; 9:824628. [PMID: 35295256 PMCID: PMC8918916 DOI: 10.3389/fcvm.2022.824628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/07/2022] [Indexed: 01/05/2023] Open
Abstract
BackgroundPrior studies have found an unexplained inverse or U-shaped relationship between body mass index (BMI) and mortality in heart failure (HF) patients. However, little is known about the independent effects of each body component, i.e., lean body mass (LBM) and fat mass (FM), on mortality.MethodsWe used data from the China Patient-centered Evaluative Assessment of Cardiac Events-Prospective Heart Failure Study. LBM and FM were calculated using equations developed from the National Health and Nutrition Examination Survey. LBM and FM index, calculated by dividing LBM or FM in kilograms by the square of height in meters, were used for analysis. We used restricted cubic spline and Cox model to examine the association of LBM and FM index with 1-year all-cause mortality.ResultsAmong 4,305 patients, median (interquartile range) age was 67 (57–76) years, 37.7% were women. During the 1-year follow-up, 691 (16.1%) patients died. After adjustments, LBM index was inversely associated with mortality in a linear way (P-overall association < 0.01; P-non-linearity = 0.52), but no association between FM index and mortality was observed (P-overall association = 0.19). Compared with patients in the 1st quartile of the LBM index, those in the 2nd, 3rd, and 4th quartiles had lower risk of death, with hazard ratio of 0.80 (95% CI 0.66–0.97), 0.65 (95% CI 0.52–0.83), and 0.61 (95% CI 0.45–0.82), respectively. In contrast, this association was not observed between FM index quartiles and mortality.ConclusionHigher LBM, not FM, was associated with lower 1-year mortality among HF patients.
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Affiliation(s)
- Yilan Ge
- National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiamin Liu
- National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lihua Zhang
- National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Gao
- National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Wang
- National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiuling Wang
- National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Li
- National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Jing Li
| | - Xin Zheng
- National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Coronary Artery Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
- *Correspondence: Xin Zheng
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Li P, Li C, Mishra AK, Cai P, Lu X, Sherif AA, Jin L, Wang B. Impact of malnutrition on in-hospital outcomes in takotsubo cardiomyopathy. Nutrition 2022; 93:111495. [PMID: 34735920 DOI: 10.1016/j.nut.2021.111495] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/01/2021] [Accepted: 09/15/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study assesses the effect of malnutrition on the in-hospital outcomes of patients with takotsubo cardiomyopathy (TCM). METHODS We performed a retrospective cohort analysis using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for a primary diagnosis of TCM from the National Inpatient Sample database (2016-2018). A concurrent diagnosis of malnutrition was then identified, and these patients were divided into the malnutrition group and non-malnutrition group. To adjust for underlying risk factors, a multivariable logistic regression model was employed followed by a propensity score matching analysis for the malnutrition and the non-malnutrition group. We then compared the in-hospital outcomes between these two groups. RESULTS Among 4733 patients with a primary diagnosis of TCM, 221 (4.7%) patients with TCM were found to be malnourished. After propensity score matching, patients with TCM with malnutrition were found to have a higher mortality rate (8.3% versus 2.0%, P < 0.001), a higher rate of complications including cardiogenic shock (16.1% versus 7.0%, P < 0.001), ventricular arrhythmia (8.8% versus 3.9%, P = 0.01), acute kidney injury (24.9% versus 10.6%, P < 0.001), and acute respiratory failure (32.7% versus 17.8%, P < 0.001). There was no statistically significant difference in the incidence of cardiac arrest between the two groups. Malnutrition of severe degree was associated with a sevenfold (odds ratio 6.8, 95% confidence interval, 3.2-13.4) increased risk of in-hospital mortality compared with those without malnutrition. CONCLUSION Patients with malnutrition who were admitted with TCM were associated with higher rates of in-hospital mortality and complications compared with those without malnutrition.
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Affiliation(s)
- Pengyang Li
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Chenlin Li
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Ajay Kumar Mishra
- Department of Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, Massachusetts, USA
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Xiaojia Lu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Akil Adrian Sherif
- Department of Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, Massachusetts, USA
| | - Ling Jin
- Department of Medicine, Metrowest Medical Center, Framingham, Massachusetts, USA
| | - Bin Wang
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
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32
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Graham HL, Benton MJ. Comparison of Lean Mass in Women With and Without Heart Disease. J Cardiopulm Rehabil Prev 2022; 42:34-38. [PMID: 34793365 DOI: 10.1097/hcr.0000000000000604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This proof-of-concept study compared lean mass (LM) between women with heart disease (HD) and without HD. METHODS Fifty-six community-dwelling women were pair-matched by age. Heart disease was defined using criteria from the US Behavioral Risk Factor Surveillance System. Body composition was measured using multifrequency bioelectrical impedance analysis. Relative LM was calculated against height (kg/m2) as the lean mass index (LMI). Sarcopenia was defined as an LMI <15.0 kg/m2. Strength was measured with a handgrip dynamometer, arm curl test, and chair stand test. RESULTS Those with HD had significantly less absolute (38.2 ± 0.8 vs 43.5 ± 1.0 kg; P < .001) and relative (15.3 ± 0.3 vs 16.2 ± 0.3 kg/m2, P = .015) LM compared with those without HD. Body mass was significantly greater for those without HD (76.1 ± 2.1 vs 68.4 ± 2.1 kg; P = .013) and there were no differences in fat mass. Upper body strength was significantly less and lower body strength was diminished but not significantly different in those with HD compared to those without HD (handgrip: P = .016; arm curl: P < .001; chair stand: P = .066). CONCLUSIONS In this group of community-dwelling women, those who reported a diagnosis of HD had significantly less LM than those without HD. Although neither group was classified as sarcopenic, women with HD were at greater risk due to lower relative LM. Based on our findings, during cardiac rehabilitation clinicians should counsel women regarding resistance exercise for maintenance of LM in addition to strength.
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Affiliation(s)
- Helen L Graham
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colorado Springs, Colorado Springs
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Zonneveld B, Vu D, Kardys I, van Dalen BM, Snelder SM. Short-term Mortality and Postoperative Complications of Abdominal Aortic Aneurysm Repair in Obese versus Non-obese Patients. J Obes Metab Syndr 2021; 30:377-385. [PMID: 34897071 PMCID: PMC8735824 DOI: 10.7570/jomes21057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/10/2021] [Accepted: 10/08/2021] [Indexed: 11/02/2022] Open
Abstract
Background Obesity is a risk factor not only for abdominal aortic aneurysm (AAA) but also for complications after vascular surgery. This study was to determine the effect of obesity on short-term mortality and post-intervention complications after AAA repair. Methods A systematic review and meta-analysis were performed. A systematic search was performed in PubMed; the articles describing the differences in post-intervention complications after open or endovascular repair of an AAA between obese and non-obese patients were selected. The primary outcome was short-term mortality defined as in-hospital mortality or mortality within 30 days after AAA repair. The secondary outcomes were cardiac complications, pulmonary failure, renal failure, and wound infections. The meta-analysis was performed using OpenMeta. Results Four articles were included in the meta-analysis; these articles included 35,989 patients of which 10,917 (30.3%) were obese. The meta-analysis showed no significant differences for short-term mortality (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.69-1.04). Also, no significant difference was found in pulmonary failure (OR, 1.09; 95% CI, 0.85-1.42). However, obese patients were less likely to suffer from cardiac complications (OR, 0.73; 95% CI, 0.55-0.96). Nevertheless, there was a significantly higher risk of renal failure (OR, 1.16; 95% CI, 1.05-1.30) and wound infections (OR, 1.92; 95% CI, 1.55-2.38) in obese patients. Conclusion Obesity is not a risk factor for short-term mortality after AAA repair compared to non-obesity. Moreover, obese patients suffer less from cardiac complications than non-obese patients.
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Affiliation(s)
- Bo Zonneveld
- Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Duyen Vu
- Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Isabella Kardys
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Bas M van Dalen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Department of Cardiology, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Sanne M Snelder
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Department of Cardiology, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
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34
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Singh P, Covassin N, Marlatt K, Gadde KM, Heymsfield SB. Obesity, Body Composition, and Sex Hormones: Implications for Cardiovascular Risk. Compr Physiol 2021; 12:2949-2993. [PMID: 34964120 PMCID: PMC10068688 DOI: 10.1002/cphy.c210014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Cardiovascular disease (CVD) continues to be the leading cause of death in adults, highlighting the need to develop novel strategies to mitigate cardiovascular risk. The advancing obesity epidemic is now threatening the gains in CVD risk reduction brought about by contemporary pharmaceutical and surgical interventions. There are sex differences in the development and outcomes of CVD; premenopausal women have significantly lower CVD risk than men of the same age, but women lose this advantage as they transition to menopause, an observation suggesting potential role of sex hormones in determining CVD risk. Clear differences in obesity and regional fat distribution among men and women also exist. While men have relatively high fat in the abdominal area, women tend to distribute a larger proportion of their fat in the lower body. Considering that regional body fat distribution is an important CVD risk factor, differences in how men and women store their body fat may partly contribute to sex-based alterations in CVD risk as well. This article presents findings related to the role of obesity and sex hormones in determining CVD risk. Evidence for the role of sex hormones in determining body composition in men and women is also presented. Lastly, the clinical potential for using sex hormones to alter body composition and reduce CVD risk is outlined. © 2022 American Physiological Society. Compr Physiol 12:1-45, 2022.
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Affiliation(s)
- Prachi Singh
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | | | - Kara Marlatt
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - Kishore M Gadde
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
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Luo ZR, Chen XD, Chen LW. Age-dependent differences in the prognostic relevance of body composition-related variables in type A aortic dissection patients. J Cardiothorac Surg 2021; 16:359. [PMID: 34963491 PMCID: PMC8714453 DOI: 10.1186/s13019-021-01742-1] [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: 08/07/2021] [Accepted: 12/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background The current research is allocated to appraise the association between the parameters of body composition and findings in type A aortic dissection (TAAD) cases in diverse age groups. Methods Data from consecutive TAAD patients undergoing implantation of modified triple-branched stent-graft from January 2017 and December 2019 were prospectively collected and analyzed. A regression model of Cox proportional hazard was employed to assess correlations among body composition-related variables (body mass index [BMI], lean body mass [LBM], body surface area [BSA], and LBM index) as well as cumulative mortality. Results Overall, 258 patients (53.9 ± 11.1 years old; 72.9% male) were separated into young (n = 110) and elderly (n = 148) age groups based upon whether they were younger or older than 50 years of age. Of these patients, 247 survivors were included in subsequent analyses over an average 26.8 ± 11.6 month follow-up duration. Multivariate analyses in the elderly group instead of young group indicated that increased BMI (p = 0.042), BMI ≤ 18.5 kg/m2 (p = 0.025), and lower LBM index values (p = 0.019) were significant predictors of increased total all-cause cumulative mortality. BMI was considerably positively correlated with estimated all-cause cumulative mortality in elderly but not young TAAD cases. Conclusion Briefly, these results suggest that BMI and LBM indices are only significant predictors of TAAD patient all-cause mortality in elderly patient cohorts, whereas they do not offer significant prognostic value for younger patients. As such, these age differences must be taken into consideration when conducting stratified risk assessments based upon TAAD patient body composition characteristics. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01742-1.
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Affiliation(s)
- Zeng-Rong Luo
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China
| | - Xiao-Dong Chen
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China. .,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China.
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36
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Zhou B, Sun X, Yu N, Zhao S, Chen K, Hua W, Su Y, Yang J, Liang Z, Xu W, Tang M, Zhang S. Absence of Obesity Paradox in All-Cause Mortality Among Chinese Patients With an Implantable Cardioverter Defibrillator: A Multicenter Cohort Study. Front Cardiovasc Med 2021; 8:730368. [PMID: 34926600 PMCID: PMC8677836 DOI: 10.3389/fcvm.2021.730368] [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: 06/24/2021] [Accepted: 11/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The results of studies on the obesity paradox in all-cause mortality are inconsistent in patients equipped with an implantable cardioverter-defibrillator (ICD). There is a lack of relevant studies on Chinese populations with large sample size. This study aimed to investigate whether the obesity paradox in all-cause mortality is present among the Chinese population with an ICD. Methods: We conducted a retrospective analysis of multicenter data from the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device–implanted Patients (SUMMIT) registry in China. The outcome was all-cause mortality. The Kaplan–Meier curves, Cox proportional hazards models, and smooth curve fitting were used to investigate the association between body mass index (BMI) and all-cause mortality. Results: After inclusion and exclusion criteria, 970 patients with an ICD were enrolled. After a median follow-up of 5 years (interquartile, 4.1–6.0 years), in 213 (22.0%) patients occurred all-cause mortality. According to the Kaplan–Meier curves and multivariate Cox proportional hazards models, BMI had no significant impact on all-cause mortality, whether as a continuous variable or a categorical variable classified by various BMI categorization criteria. The fully adjusted smoothed curve fit showed a linear relationship between BMI and all-cause mortality (p-value of 0.14 for the non-linearity test), with the curve showing no statistically significant association between BMI and all-cause mortality [per 1 kg/m2 increase in BMI, hazard ratio (HR) 0.97, 95% CI 0.93–1.02, p = 0.2644]. Conclusions: The obesity paradox in all-cause mortality was absent in the Chinese patients with an ICD. Prospective studies are needed to further explore this phenomenon.
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Affiliation(s)
- Bin Zhou
- Laboratory of Heart Center, Department of Cardiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Arrhythmia Centre, National Centre for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuerong Sun
- Arrhythmia Centre, National Centre for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Na Yu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuang Zhao
- Arrhythmia Centre, National Centre for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keping Chen
- Arrhythmia Centre, National Centre for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Hua
- Arrhythmia Centre, National Centre for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiefu Yang
- Department of Cardiology, Beijing Hospital, Beijing, China
| | - Zhaoguang Liang
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Xu
- Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing, China
| | - Min Tang
- Arrhythmia Centre, National Centre for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- Arrhythmia Centre, National Centre for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zhou Y, Hou Y, Xiang J, Dai H, Li M, Wang T, Wang S, Lin H, Lu J, Xu Y, Chen Y, Wang W, Bi Y, Xu M, Zhao Z. Associations of body shapes with insulin resistance and cardiometabolic risk in middle-aged and elderly Chinese. Nutr Metab (Lond) 2021; 18:103. [PMID: 34876164 PMCID: PMC8650554 DOI: 10.1186/s12986-021-00629-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/19/2021] [Indexed: 12/25/2022] Open
Abstract
Background We aimed to define refined body shapes by using multiple anthropometric traits that represent fat distribution, and evaluate their associations with risk of insulin resistance (IR) and cardiometabolic disorders in a Chinese population. Methods We performed a cross-sectional analysis in 6570 community-based participants aged ≥ 40 years. Four body circumferences (neck, waist, hip, and thigh) and their ratios were put simultaneously into an open-source Waikato Environment for Knowledge Analysis platform to select the worthiest indicators in determining IR. The ratio of the top 3 fat distribution indicators was used to define the refined body shapes. Results We defined 8 distinct body shapes based on sex-specific combinations of waist-to-hip ratio (WHR), waist-to-thigh ratio (WTR), and waist-to-neck ratio (WNR), which differed in participants’ distribution and risk of IR and related cardiometabolic disorders. In women, as compared to the low WHR-low WTR-low WNR shape, all body shapes were significantly associated with IR and related cardiometabolic disorders; while in men, the low WHR-high WTR-high WNR shape and the higher WHR related shapes were significantly associated with IR and related cardiometabolic disorders. Stratified by WHR, the results were consistent in women; however, no significant associations were detected in men. Conclusions We defined 8 distinct body shapes by taking WHR, WTR, and WNR, simultaneously into account, which differed in association with the risk of IR and related cardiometabolic disorders in women. This study suggests that body shapes defined by multiple anthropometric traits could provide a useful, convenient, and easily available method for identifying cardiometabolic risk. Supplementary Information The online version contains supplementary material available at 10.1186/s12986-021-00629-1.
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Affiliation(s)
- Yulin Zhou
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, 200025, Shanghai, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanan Hou
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, 200025, Shanghai, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiali Xiang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, 200025, Shanghai, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huajie Dai
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, 200025, Shanghai, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mian Li
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, 200025, Shanghai, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiange Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, 200025, Shanghai, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuangyuan Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, 200025, Shanghai, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Lin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, 200025, Shanghai, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jieli Lu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, 200025, Shanghai, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, 200025, Shanghai, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhong Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, 200025, Shanghai, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, 200025, Shanghai, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, 200025, Shanghai, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, 200025, Shanghai, China. .,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, 200025, Shanghai, China. .,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Rozanski A, Gransar H, Hayes SW, Friedman JD, Thomson LEJ, Lavie CJ, Berman DS. Synergistic Assessment of Mortality Risk According to Body Mass Index and Exercise Ability and Capacity in Patients Referred for Radionuclide Stress Testing. Mayo Clin Proc 2021; 96:3001-3011. [PMID: 34311969 DOI: 10.1016/j.mayocp.2021.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/11/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the interrelationship between body mass index (BMI), mode of stress testing (exercise or pharmacological), exercise capacity, and all-cause mortality in patients referred for stress-rest single photon emission computed tomography myocardial perfusion imaging. PATIENTS AND METHODS We evaluated all-cause mortality in 21,638 patients undergoing stress-rest single photon emission computed tomography myocardial perfusion imaging between January 2, 1991, and December 31, 2012. Patients were divided into exercise and pharmacologically tested groups and 9 BMI categories. The median follow-up was 12.8 years (range, 5.0-26.8 years). RESULTS In exercise patients, mortality was increased with both low and high BMI vs patients with a normal referent BMI of 22.5 to 24.9 kg/m2. In pharmacologically tested patients, only low BMI, but not high BMI, was associated with increased mortality vs normal BMI. When exercise and pharmacologically tested groups were compared directly, pharmacologically tested patients manifested a marked increase in mortality risk vs exercise patients within each BMI category, ranging from an approximately 4-fold increase in mortality in those with normal or high BMI to a 12.3-fold increase in those with low BMI values. Similar findings were observed in a cohort of 4804 exercise and 4804 pharmacologically tested patients matched to have similar age and coronary artery disease risk factor profiles. In exercise patients, further risk stratification was achieved when considering both BMI and metabolic equivalent tasks of achieved exercise. CONCLUSION The combined assessment of BMI and exercise ability and capacity provides synergistic and marked risk stratification of future mortality risk in patients referred for radionuclide stress testing, providing considerable insights into the "obesity paradox" that is observed in populations referred for stress testing.
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Affiliation(s)
- Alan Rozanski
- Department of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Imaging and Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Heidi Gransar
- Department of Imaging and Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sean W Hayes
- Department of Imaging and Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - John D Friedman
- Department of Imaging and Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Louise E J Thomson
- Department of Imaging and Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the UQ School of Medicine, New Orleans, LA
| | - Daniel S Berman
- Department of Imaging and Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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Kim BS, Lee Y, Kim HJ, Shin JH, Park JK, Park HC, Lim YH, Shin J. Influence of changes in body fat on clinical outcomes in a general population: a 12-year follow-up report on the Ansan-Ansung cohort in the Korean Genome Environment Study. Ann Med 2021; 53:1646-1658. [PMID: 34533069 PMCID: PMC8451655 DOI: 10.1080/07853890.2021.1976416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The impact of the changes in the obesity status on mortality has not been established; thus, we investigated the long-term influence of body fat (BF) changes on all-cause deaths and cardiovascular outcomes in a general population. METHODS A total of 8374 participants were observed for 12 years. BF was measured at least two times using a bioimpedance method. The causes of death were acquired from the nationwide database. A major adverse cardiovascular event (MACE) was defined as a composite of myocardial infarction, coronary artery disease, stroke, and cardiovascular death. Standard deviations (SDs) were derived using a local regression model corresponding to the time elapsed between the initial and final BF measurements (SDT) and were used to standardize the changes in BF (ΔBF/SDT). RESULTS The incidence rates of all-cause death, cardiovascular death, and MACE were the highest in the participants with ΔBF/SDT <-1 and lowest in the participants with ΔBF/SDT ≥1. Multivariate Cox proportional hazard models adjusted for relevant covariates, including baseline obesity and physical activity, showed that the risks of all-cause deaths (hazard ratio [HR] 0.58; 95% confidence intervals [CI] 0.53-0.64), cardiovascular deaths (HR 0.63; 95% CI 0.51-0.78) and MACEs (HR 0.68; 95% CI 0.62-0.75) decreased as ΔBF/SDT increased. Subgroup analyses showed that existing cardiovascular diseases weakened the associations between higher ΔBF/SDT and better outcomes, while high physical activity and exercise did not impact the associations. CONCLUSION Increasing BF was associated with a lower risk of all-cause death, cardiovascular death, and MACE in the general population.Key messagesIncreasing body fat is associated with a lower risk of all-cause death, cardiovascular death, and major cardiovascular adverse events in a low-risk ageing general population, independently of physical activity, underlying cardiovascular disease burden, changes in muscle mass, and baseline obesity status.Fatness measured at baseline requires adjustment for the changes in fatness during the follow-up to reveal its impact on the clinical outcomes.
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Affiliation(s)
- Byung Sik Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, South Korea
| | - Yonggu Lee
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, South Korea
| | - Hyun-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, South Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, South Korea
| | - Jin-Kyu Park
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, South Korea
| | - Hwan-Cheol Park
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, South Korea
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, South Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, South Korea
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Xiong Y, Wangsheng F, Wang S, Zhou W, Huang X, Bao H, Cheng X. Positive association between body fat percentage and hyperuricemia in patients with hypertension: The China H-type hypertension registry study. Nutr Metab Cardiovasc Dis 2021; 31:3076-3084. [PMID: 34518084 DOI: 10.1016/j.numecd.2021.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/18/2021] [Accepted: 07/04/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS The relationship between the body fat percentage (BFP) and hyperuricemia is still unknown in different gender subjects. The purpose of this study was to determine the magnitude of the association between the BFP and the presence of hyperuricemia in the sex-specific group among hypertensive patients. METHODS AND RESULTS We conducted a cross-sectional study enrolling 14,234 hypertensive participates from the Chinese Hypertension Registry Study. Body fat percentage (BFP) was calculated by simple anthropometric parameters. Hyperuricemia was defined as serum uric acid (SUA) level 420 umol/L in men and 360 umol/L in women. The mean BFP was 24.5% in men and 37.1% in women. Multiple logistic analyses showed that the relationship between BFP with the risk of hyperuricemia in a dose-dependent manner among both men (odds ratio [OR] 1.07, 95% CI 1.06, 1.09) and women (OR 1.08, 95% CI 1.06, 1.09) in the fully adjusted model. Subgroup analyses showed the positive association between BFP and the risk of hyperuricemia was consistent in all stratification subgroups (all P for interaction >0.05). CONCLUSION For patients with hypertension, BFP was positively associated with an increased risk of hyperuricemia among both men and women.
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Affiliation(s)
- Yurong Xiong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China; Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang of Jiangxi, China
| | | | - Shizhi Wang
- The Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, China
| | - Wei Zhou
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China; Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang of Jiangxi, China
| | - Xiao Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China; Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China; Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang of Jiangxi, China
| | - Huihui Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China; Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China; Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang of Jiangxi, China.
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China; Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China; Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang of Jiangxi, China.
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Janis JA, Rifas-Shiman SL, Seshasayee SM, Sagiv S, Calafat AM, Gold DR, Coull BA, Rosen CJ, Oken E, Fleisch AF. Plasma Concentrations of Per- and Polyfluoroalkyl Substances and Body Composition From Mid-Childhood to Early Adolescence. J Clin Endocrinol Metab 2021; 106:e3760-e3770. [PMID: 33740056 PMCID: PMC8372642 DOI: 10.1210/clinem/dgab187] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Indexed: 01/12/2023]
Abstract
CONTEXT Per- and polyfluoroalkyl substances (PFAS) may alter body composition by lowering anabolic hormones and increasing inflammation, but data are limited, particularly in adolescence when body composition is rapidly changing. OBJECTIVE To evaluate associations of PFAS plasma concentrations in childhood with change in body composition through early adolescence. METHODS A total of 537 children in the Boston-area Project Viva cohort participated in this study. We used multivariable linear regression and Bayesian kernel machine regression (BKMR) to examine associations of plasma concentrations of 6 PFAS, quantified by mass spectrometry, in mid-childhood (mean age, 7.9 years; 2007-2010) with change in body composition measured by dual-energy x-ray absorptiometry from mid-childhood to early adolescence (mean age, 13.1 years). RESULTS In single-PFAS linear regression models, children with higher concentrations of perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS), perfluorodecanoate (PFDA), and perfluorohexane sulfonate (PFHxS) had less accrual of lean mass (eg, -0.33 [95% CI: -0.52, -0.13] kg/m2 per doubling of PFOA). Children with higher PFOS and PFHxS had less accrual of total and truncal fat mass (eg, -0.32 [95% CI: -0.54, -0.11] kg/m2 total fat mass per doubling of PFOS), particularly subcutaneous fat mass (eg, -17.26 [95% CI -32.25, -2.27] g/m2 per doubling of PFOS). Children with higher PFDA and perfluorononanoate (PFNA) had greater accrual of visceral fat mass (eg, 0.44 [95% CI: 0.13, 0.75] g/m2 per doubling of PFDA). Results from BKMR mixture models were consistent with linear regression analyses. CONCLUSION Early life exposure to some but not all PFAS may be associated with adverse changes in body composition.
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Affiliation(s)
- Jaclyn A Janis
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Shravanthi M Seshasayee
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA
| | - Sharon Sagiv
- Center for Environmental Research and Children’s Health (CERCH), School of Public Health, University of California, Berkeley, CA, USA
| | | | - Diane R Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Abby F Fleisch
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA
- Pediatric Endocrinology and Diabetes, Maine Medical Center, Portland, ME, USA
- Correspondence: Abby F. Fleisch, MD, MPH, Center for Outcomes Research and Evaluation, 509 Forest Avenue, Suite 200, Portland, ME 04103, USA.
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Abstract
BACKGROUND There is scientific consensus that obesity increases the risk of cardiovascular diseases (CVD), including heart failure (HF). However, in CVD, many studies observed greater survival in overweight or class 1 obesity individuals. This counterintuitive observation was termed "obesity paradox" (OP). OBJECTIVE AND METHODS This article is a narrative overview of the relationship between OP and CVD, particularly HF. The sources used were MEDLINE/PubMed, CINAHL, EMBASE, and Cochrane Library, from 2001 to 31 May 2020, exception for a 1983 work of historical importance. Studies reporting association and prognostic impact of obesity in HF and the impact of body composition on cardiac structure and myocardial function in obesity were also included in this review. In addition, we examined references from the retrieved articles and explored several related websites. Ultimately, we chose 79 relevant documents. Fifty-three were specifically focused on OP and HF. RESULTS In this review, we made a summary of the evidence coming from a series of studies investigating OP. Many of these studies do not take into consideration or underestimate some of the more important morpho-functional variables of patients suffering from HF: among these, body composition and visceral adiposity, sarcopenic obesity, muscle fitness (MF), and cardiorespiratory fitness (CRF). A high body mass index (BMI) represents a risk factor for HF, but it also seems to exert a protective effect under certain circumstances. Fat distribution, lean mass, and cardio fitness could play an essential role in determining the observed differences in the HF population. CONCLUSION BMI does not distinguish between the metabolically healthy and metabolically unhealthy obesity. The obesity impact on morbidity and premature mortality can be underestimated and, therefore, may lead to incorrect clinical courses. LEVEL OF EVIDENCE Level V, Narrative review.
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Impact of Body Composition Indices on Ten-year Mortality After Revascularization of Complex Coronary Artery Disease (From the Syntax Extended Survival Trial). Am J Cardiol 2021; 151:30-38. [PMID: 34049676 DOI: 10.1016/j.amjcard.2021.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 12/22/2022]
Abstract
Numerous studies have demonstrated a paradoxical association between higher baseline body mass index (BMI) and lower long-term mortality risk after coronary revascularization, known as the "obesity paradox", possibly relying on the single use of BMI. The current study is a post-hoc analysis of the SYNTAX Extended Survival (SYNTAXES) trial, which is the extended follow-up of the SYNTAX trial comparing percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) in patients with left-main coronary artery disease (LMCAD) or three-vessel disease (3VD). Patients were stratified according to baseline BMI and/or waist circumference (WC). Out of 1,800 patients, 1,799 (99.9%) and 1,587 (88.2%) had available baseline BMI and WC data, respectively. Of those, 1,327 (73.8%) patients had High BMI (≥25 kg/m2), whereas 705 (44.4%) patients had High WC (>102 cm for men or >88 cm for women). When stratified by both BMI and WC, 10-year mortality risk was significantly higher in patients with Low BMI/Low WC (adjusted hazard ratio [HR]: 1.65; 95% confidence interval [CI]: 1.09 to 2.51), Low BMI/ High WC (adjusted HR: 2.74; 95% CI: 1.12 to 6.69), or High BMI/High WC (adjusted HR: 1.59; 95% CI: 1.11 to 2.27) compared to those with High BMI/Low WC. In conclusion, the "obesity paradox" following coronary revascularization would be driven by low long-term mortality risk of the High BMI/Low WC group. Body composition should be assessed by the combination of BMI and WC in the appropriate evaluation of the long-term risk of obesity in patients with LMCAD or 3VD.
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Kim Y, Han E, Lee JS, Lee HW, Kim BK, Kim MK, Kim HS, Park JY, Kim DY, Ahn SH, Lee BW, Kang ES, Cha BS, Lee YH, Kim SU. Cardiovascular Risk Is Elevated in Lean Subjects with Nonalcoholic Fatty Liver Disease. Gut Liver 2021; 16:290-299. [PMID: 34238770 PMCID: PMC8924809 DOI: 10.5009/gnl210084] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/28/2021] [Accepted: 05/12/2021] [Indexed: 11/05/2022] Open
Abstract
Background/Aims Nonalcoholic fatty liver disease (NAFLD) and obesity are independently associated with an increased risk for atherosclerotic cardiovascular disease (ASCVD), the leading cause of mortality in patients with NAFLD. Many NAFLD patients are lean, but their ASCVD risk compared to obese subjects with NAFLD is unclear. Methods Data from the 2008 to 2011 Korea National Health and Nutrition Examination Surveys database were analyzed (n=4,786). NAFLD was defined as a comprehensive NAFLD score ≥40 or a liver fat score ≥–0.640. ASCVD risk was evaluated using the American College of Cardiology/American Heart Association guidelines. Results The frequency of subjects without NAFLD, with obese NAFLD, and with lean NAFLD was 62.4% (n=2,987), 26.6% (n=1,274), and 11.0% (n=525), respectively. Subjects with lean NAFLD had a significantly higher ASCVD score and prevalence of a high ASCVD risk (mean 15.6±14.0, 51.6%) than those with obese NAFLD and without NAFLD (mean 11.2±11.4, 39.8%; mean 7.9±10.9, 25.5%; all p<0.001). Subjects with lean NAFLD and significant liver fibrosis showed a significantly higher odds ratio for a high risk for ASCVD than those with obese NAFLD with or without significant liver fibrosis (odds ratio, 2.60 vs 1.93; p=0.023). Conclusions Subjects with lean NAFLD had a significantly higher ASCVD score and prevalence of high risk for ASCVD than those with obese NAFLD. Similarly, lean subjects with significant liver fibrosis had a higher probability of ASCVD than obese subjects in the subpopulation with NAFLD.
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Affiliation(s)
- Yuna Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Eugene Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jae Seung Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Kyung Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hye Soon Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Wan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Seok Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Bong-Soo Cha
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Bae J, Ju JW, Lee S, Nam K, Kim TK, Jeon Y, Cho YJ. Association between abdominal fat and mortality in patients undergoing cardiovascular surgery. Ann Thorac Surg 2021; 113:1506-1513. [PMID: 34116000 DOI: 10.1016/j.athoracsur.2021.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/09/2021] [Accepted: 05/14/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Obesity is associated with reduced postoperative mortality in patients undergoing cardiovascular surgery. However, body mass index cannot differentiate abdominal fat composition. This study evaluated the relationships between total abdominal, subcutaneous, and visceral fat composition and postoperative mortality in East Asian patients undergoing cardiovascular surgery. METHODS Adult patients who underwent cardiovascular surgery between October 2004 and December 2016 were retrospectively included. Total, subcutaneous and visceral fat areas were measured from cross-sectional computed tomography images. The relationships between each fat composition and mortality were evaluated. RESULTS A total of 3,661 patients were analyzed, and overall mortality was 19.9% (729 died) during the 4.6 year median follow-up period. The risks of all-cause and cardiac-cause mortality decreased as subcutaneous fat composition increased (adjusted hazard ratio [aHR], 0.997; 95% confidence interval [CI], 0.994-1.000 and aHR, 0.994; 95% CI, 0.989-0.999; P = .02 and = .01, respectively). No association was detected between the total and visceral fat area and mortality. CONCLUSIONS Reduced abdominal subcutaneous fat, but not the total or visceral fat composition was associated with higher all-cause and cardiac-cause mortality after cardiovascular surgery in East Asian patients, consisting mainly of normal or overweight patients.
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Affiliation(s)
- Jinyoung Bae
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae-Woo Ju
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seohee Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Karam Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Tae Kyong Kim
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Yunseok Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Youn Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
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Body composition and mortality in patients undergoing endovascular treatment for peripheral artery disease. Heart Vessels 2021; 36:1830-1840. [PMID: 34097103 PMCID: PMC8556200 DOI: 10.1007/s00380-021-01883-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/28/2021] [Indexed: 11/17/2022]
Abstract
An inverse correlation between body mass index and mortality in patients with peripheral artery disease (PAD) has been reported. However, little information is available regarding the impact of body composition on the clinical outcomes in patients with PAD. This study evaluated the relationships between the lean body mass index (LBMI), body fat % (BF%), and mortality and major amputation rate in patients with PAD. We evaluated 320 patients with PAD after endovascular treatment (EVT) enrolled from August 2015 to July 2016 and divided them into low and high LBMI and BF% groups based on their median values (17.47 kg/m2 and 22.07%, respectively). We assessed 3-year mortality and major amputation for the following patient groups: Low LBMI/Low BF%, Low LBMI/High BF%, High LBMI/Low BF%, and High LBMI/High BF%. During the median 3.1-year follow-up period, 70 (21.9%) patients died and 9 (2.9%) patients experienced major amputation. The survival rate was lower in the Low LBMI than in the High LBMI group, and was not significantly different between the Low and High BF% groups. Survival rates were lowest in the Low LBMI/Low BF% group (57.5%) and highest in the High LBMI/High BF% group (94.4%). There were no significant differences in major amputation rate between the Low LBMI and High LBMI groups, and between the Low BF% and High BF% groups. The Low LBMI and Low BF% groups were associated with an increased risk of mortality after adjustment for age, sex, frailty and conventional risk factors [hazard ratio (HR): 4.02; 95% confidence interval (CI) 2.10–7.70; p < 0.001 and HR: 4.48; 95% CI 1.58–12.68, p = 0.005, respectively], for age, sex, hemodialysis, and prior cerebral cardiovascular disease (HR: 3.63; 95% CI 1.93–6.82; p < 0.001 and HR: 4.03; 95% CI 1.43–11.42, p = 0.009, respectively) and for age, sex, and laboratory date (HR: 3.97; 95% CI 1.88–8.37; p < 0.001 and HR: 3.31; 95% CI 1.15–9.53, p = 0.026, respectively). In conclusion, Low LBMI and Low BF% were associated with poor prognosis in patients undergoing EVT for PAD, and mortality was the lowest in the High LBMI/High BF% group compared with other body composition groups.
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Burns DJ, Rapetto F, Angelini GD, Benedetto U, Caputo M, Ciulli F, Vohra HA. Body mass index and early outcomes following mitral valve surgery for degenerative disease. J Thorac Cardiovasc Surg 2021; 161:1765-1773.e2. [DOI: 10.1016/j.jtcvs.2019.10.193] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 10/02/2019] [Accepted: 10/27/2019] [Indexed: 12/31/2022]
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Lv M, Gao F, Liu B, Pandey P, Feng Y, Wang Y, Zhang Y, Li Z. The Effects of Obesity on Mortality Following Coronary Artery Bypass Graft Surgery: A Retrospective Study from a Single Center in China. Med Sci Monit 2021; 27:e929912. [PMID: 33903583 PMCID: PMC8088123 DOI: 10.12659/msm.929912] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Coronary artery bypass graft (CABG) surgery has become a routine surgical procedure for patients with occlusive coronary artery atherosclerosis. Worldwide, increasing levels of obesity are associated with ischemic heart disease and systemic comorbidities. This retrospective study from a single center in China aimed to investigate the effects of obesity on patient mortality following CABG surgery. Material/Methods Patients undergoing CABG (N=1471) were grouped according to body mass index (BMI) as normal weight (N=596), overweight (N=684), or obese (N=191). Baseline clinical characteristics and outcomes were recorded. Logistic regression analysis was performed for 30-day postoperative mortality. Kaplan-Meier survival curves were plotted, and Cox regression analysis investigated risk and protective factors for long-term mortality, with subgroup analysis for differences between on-pump and off-pump CABG groups. Results The 30-day postoperative mortality was 5.0% in the normal-weight group, 1.3% in the overweight group, and 0% in the obese group. BMI was an independent protective factor for 30-day postoperative mortality (odds ratio=0.748; 95% confidence interval, 0.640–0.874; P<0.001). The 10-year mortality for the groups was 13.2% (normal), 7.8% (overweight), and 12.7% (obese). The >20-year mortality rates for the groups were 33.0% (normal), 41.5% (overweight), and 12.7% (obese). There was no significant correlation between BMI and long-term mortality. Being overweight had a protective effect against long-term mortality in the off-pump CABG subgroup. Conclusions An “obesity paradox” was identified in postoperative outcomes in patients following CABG surgery, with an increased BMI associated with reduced 30-day postoperative mortality. This association was more significant in the off-pump CABG group.
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Affiliation(s)
- Mengwei Lv
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Shanghai East Hospital, Clinical Medical College, Nanjing Medical University, Shanghai, China (mainland)
| | - Fei Gao
- Cardiovascular Department, Huaiyin Hospital of Huai'an City, Huai'an, Jiangsu, China (mainland)
| | - Ban Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Pratik Pandey
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Yipeng Feng
- The First Clinical Medical College of Nanjing Medical University, Shanghai, China (mainland)
| | - Yingwei Wang
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (mainland)
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Zhi Li
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
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Carbone S, Kim Y, Kachur S, Billingsley H, Kenyon J, De Schutter A, Milani RV, Lavie CJ. Peak Oxygen Consumption Achieved at the End of Cardiac Rehabilitation Predicts Long-Term Survival in Patients with Coronary Heart Disease. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 8:361-367. [PMID: 33895797 DOI: 10.1093/ehjqcco/qcab032] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cardiac rehabilitation (CR) improves survival in patients with coronary heart disease (CHD), which is largely mediated by the improvements in cardiorespiratory fitness (CRF) defined as peak oxygen consumption (VO2). Therefore, measuring CRF is essential to predict long-term outcomes in this population. It is unclear, however, whether peak VO2 achieved at the end of CR (END-peak VO2) predicts survival or whether the changes of CRF achieved during CR provide a greater prognostic value. OBJECTIVES To determine whether END-peak VO2 independently predicts long-term survival in patients with CHD undergoing CR. We also aimed at identifying cut-offs for END-peak VO2 that could be used in clinical practice. METHODS Retrospective analysis of 853 patients with CHD referred to CR who completed a maximal cardiopulmonary exercise test. Survival analysis was performed to examine the risk of all-cause mortality (average follow-up years: 6.65) based on peak VO2. The Contal and O'Quigley's method was used to determine the optimal cutoff of END-peak VO2 based on the log-rank statistic. RESULTS END-peak VO2 was inversely associated with mortality risk (hazard ratio [HR]=0.84; 95% CI = 0.78-0.90), independent of changes in peak VO2 adjusted for the baseline peak VO2. The estimated cutoff of end-peak VO2 at ≥ 17.6 mL/kg/min best predicted the survival with high predictive accuracy and patients with END-peak VO2 under the cutoff had a greater risk of mortality (HR = 2.93; 95% CI = 1.81-4.74). CONCLUSIONS In patient with CHD undergoing CR, END-peak VO2 is an independent predictor for long-term survival. Studies utilizing higher intensity CR programs, with and without pharmacologic strategies, to increase peak VO2 to a greater degree in those achieving a suboptimal END-peak VO2, are urgently needed.
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Affiliation(s)
- Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA.,VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Youngdeok Kim
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA
| | - Sergey Kachur
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA
| | - Hayley Billingsley
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA.,VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Jonathan Kenyon
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA
| | - Alban De Schutter
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA
| | - Richard V Milani
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA
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50
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Kim JR, Song P, Joo EY. Sex Differences in Obstructive Sleep Apnea by Bioelectrical Impedance Analysis. J Clin Neurol 2021; 17:283-289. [PMID: 33835750 PMCID: PMC8053553 DOI: 10.3988/jcn.2021.17.2.283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose Obesity is known of one of the risk factors for obstructive sleep apnea (OSA). Although body mass index (BMI) can be an indicator for obesity, it does not represent the actual body composition of fat or muscle. We hypothesized that bioelectrical impedance analysis (BIA) can help analyze the fat and muscle distributions in males and females with OSA. Methods This study screened subjects who visited the Department of Neurology, Samsung Medical Center, Seoul, Korea due to sleep disturbances with symptoms suggestive of OSA from December 2017 to December 2019. All subjects underwent overnight type I polysomnography (PSG) and BIA. Results PSG and BIA were completed in 2,064 OSA patients who had an apnea-hypopnea index (AHI) of ≥5/hour (77.1% males and 22.9% females). The females had remarkably higher fat indicators and lower muscle indicators. The AHI was significant correlated with all BIA parameters in all OSA patients: body fat mass (ρ=0.286, p<0.001), percentage body fat (ρ=0.130, p<0.001), visceral fat area (VFA) (ρ=0.257, p<0.001), muscle mass (ρ=0.275, p<0.001), and skeletal muscle mass (SMM) (ρ=0.270, p<0.001). The correlations in males were similar to those in all patients, where those in females were not. In females with OSA, all of the BIA fat indicators were correlated with AHI, whereas the muscle indicators were not. Adjusting age and BMI when analyzing the SMM/VFA ratio showed a strong correlation in males with OSA (p=0.015) but not in females with OSA (p=0.354). Conclusions This study has revealed that the body composition of fat and muscle has different patterns in OSA patients. The SMM/VFA as measured using BIA is the factor most significantly associated with AHI in males but not in females after adjusting for age and BMI.
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Affiliation(s)
- Jae Rim Kim
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pamela Song
- Department of Neurology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea.
| | - Eun Yeon Joo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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