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Sun J, Lin J, Shen W, Ding P, Yang W, Huang L, Chen H. Associations of body mass index, waist circumference and the weight-adjusted waist index with daily living ability impairment in older Chinese people: A cross-sectional study of the Chinese Longitudinal Healthy Longevity Survey. Diabetes Obes Metab 2024. [PMID: 38962934 DOI: 10.1111/dom.15762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/10/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024]
Abstract
AIM To investigate the associations of body mass index (BMI), waist circumference (WC) and the weight-adjusted waist index (WWI) with the impairment of activities of daily living (ADL) in older Chinese people. METHODS A total of 13 260 participants aged 65 years and older from the 2018 Chinese Longitudinal Healthy Longevity Survey were included in this cross-sectional study. BMI, WC and the WWI were calculated from measurements of height, weight and WC. Binary logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). Non-linear correlations were investigated using restricted cubic spline curves. RESULTS In multivariate logistic regression fully adjusted for confounding variables, our analyses revealed significant associations between WC and WWI and ADL impairment, with adjusted ORs (95% CI) of 1.01 (1.00, 1.01) and 1.08 (1.03, 1.12), respectively. Meanwhile, participants with a high WWI had a higher risk of ADL impairment compared with those with a low WWI, with an adjusted OR (95% CI) of 1.12 (1.02, 1.23). Subgroup analyses showed that only the association between WWI and ADL impairment did not differ in any of the different populations. In addition, we found that BMI, WC and WWI were non-linearly associated with ADL impairment. CONCLUSIONS There are significant associations between WC and WWI and ADL impairment in older Chinese people. The findings show the ability of the WWI to serve as a comprehensive and effective indicator of obesity in older Chinese people and emphasize the importance of assessing WWI in screening and preventing ADL impairment in older people.
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Affiliation(s)
- Jie Sun
- Guali Branch of the First People's Hospital of Xiaoshan District, Hangzhou, China
| | - Jie Lin
- Guali Branch of the First People's Hospital of Xiaoshan District, Hangzhou, China
| | - Wenqin Shen
- Guali Branch of the First People's Hospital of Xiaoshan District, Hangzhou, China
| | - Pan Ding
- Department of Medical Record Statistics, Wenzhou People's Hospital, Wenzhou, China
| | - Wenjuan Yang
- Guali Branch of the First People's Hospital of Xiaoshan District, Hangzhou, China
| | - Li Huang
- School of Public Health, Wenzhou Medical University, Wenzhou, China
| | - Huajian Chen
- School of Public Health, Wenzhou Medical University, Wenzhou, China
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Ruscu M, Glavan D, Surugiu R, Doeppner TR, Hermann DM, Gresita A, Capitanescu B, Popa-Wagner A. Pharmacological and stem cell therapy of stroke in animal models: Do they accurately reflect the response of humans? Exp Neurol 2024; 376:114753. [PMID: 38490317 DOI: 10.1016/j.expneurol.2024.114753] [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: 11/19/2023] [Revised: 02/22/2024] [Accepted: 03/10/2024] [Indexed: 03/17/2024]
Abstract
Cerebrovascular diseases are the second leading cause of death worldwide. Despite significant research investment, the only available therapeutic options are mechanical thrombectomy and tissue plasminogen activator thrombolysis. None of the more than a thousand drugs tested on animal models have proven successful in human clinical trials. Several factors contribute to this poor translation of data from stroke-related animal models to human stroke patients. Firstly, our understanding of the molecular and cellular processes involved in recovering from an ischemic stroke is severely limited. Secondly, although the risk of stroke is particularly high among older patients with comorbidities, most drugs are tested on young, healthy animals in controlled laboratory conditions. Furthermore, in animal models, the tracking of post-stroke recovery typically spans only 3 to 28 days, with occasional extensions to 60 days, whereas human stroke recovery is a more extended and complex process. Thirdly, young animal models often exhibit a considerably higher rate of spontaneous recovery compared to humans following a stroke. Fourth, only a very limited number of animals are utilized for each condition, including control groups. Another contributing factor to the much smaller beneficial effects in humans is that positive outcomes from numerous animal studies are more readily accepted than results reported in human trials that do not show a clear benefit to the patient. Useful recommendations for conducting experiments in animal models, with increased chances of translatability to humans, have been issued by both the STEPS investigative team and the STAIR committee. However, largely, due to economic factors, these recommendations are largely ignored. Furthermore, one might attribute the overall failures in predicting and subsequently developing effective acute stroke therapies beyond thrombolysis to potential design deficiencies in clinical trials.
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Affiliation(s)
- Mihai Ruscu
- Department of Neurology, University Hospital Essen, Essen 45147, Germany; Department of Psychiatry, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; Department of Neurology, University of Giessen Medical School, 35392 Giessen, Germany
| | - Daniela Glavan
- Department of Psychiatry, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
| | - Roxana Surugiu
- Department of Psychiatry, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; Department of Neurology, University Medical Center Göttingen, Göttingen 37075, Germany
| | - Thorsten R Doeppner
- Department of Neurology, University Medical Center Göttingen, Göttingen 37075, Germany; Department of Neurology, University of Giessen Medical School, 35392 Giessen, Germany
| | - Dirk M Hermann
- Department of Neurology, University Hospital Essen, Essen 45147, Germany
| | - Andrei Gresita
- Department of Biomedical Sciences, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY 115680-8000, USA
| | - Bogdan Capitanescu
- Department of Psychiatry, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; Department of Biomedical Sciences, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY 115680-8000, USA.
| | - Aurel Popa-Wagner
- Department of Psychiatry, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; Department of Biomedical Sciences, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY 115680-8000, USA.
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Hoffman H, Cote JR, Wood J, Jalal MS, Draytsel DY, Gould GC. The Influence of Body Mass Index on Outcomes in Patients Undergoing Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion: Institutional Experience and Meta-analysis. Neurocrit Care 2024; 40:654-663. [PMID: 37498460 DOI: 10.1007/s12028-023-01801-6] [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: 03/11/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND An obesity paradox, whereby patients with higher body mass index (BMI) experience improved outcomes, has been described for ischemic stroke. It is unclear whether this applies to patients undergoing mechanical thrombectomy (MT) for large vessel occlusion (LVO). METHODS Mechanical thrombectomies for anterior circulation LVO between 2015 and 2021 at a single institution were reviewed. Multivariable logistic regressions were used to determine the association between BMI and favorable functional outcome (90-day modified Rankin Scale 0-2), intracranial hemorrhage, and malignant middle cerebral infarction. A systematic review was performed to identify studies reporting the effect of BMI on outcomes among patients receiving MT for LVO. The data from the systematic review were combined with the institutional data by using a random effects model. RESULTS The institutional cohort comprised 390 patients with a median BMI of 27 kg/m2. Most patients were obese [36.7% (BMI ≥ 30 kg/m2)], followed by overweight [30.5% (BMI ≥ 25 and < 30 kg/m2)], normal [27.9% (BMI ≥ 18.5 and < 25 kg/m2)], and underweight [4.9% (BMI < 18.5 kg/m2)]. As a continuous variable, BMI was not associated with any of the outcomes. When analyzing BMI ordinally, obesity was associated with lower odds of favorable 90-day modified Rankin Scale (odds ratio 0.42, 95% confidence interval 0.20-0.86). The systematic review identified three eligible studies comprising 1,348 patients for a total of 1,738 patients. In the random effects model, there was no association between obesity and favorable outcome (odds ratio 0.89, 95% confidence interval 0.63-1.24). CONCLUSIONS Obesity is not associated with favorable outcomes in patients undergoing MT for LVO.
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Affiliation(s)
- Haydn Hoffman
- Department of Neurosurgery, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA.
| | - John R Cote
- Department of Neurosurgery, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
| | - Jacob Wood
- Department of Neurosurgery, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
| | - Muhammad S Jalal
- Department of Neurosurgery, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
| | - Dan Y Draytsel
- Department of Neurosurgery, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
| | - Grahame C Gould
- Department of Neurosurgery, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
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Barbosa MG, Sganzerla D, Buttelli ACK, Teixeira C. Lower quality of life in obese ICU survivors: a multicenter cohort study. Qual Life Res 2024; 33:361-371. [PMID: 37906347 DOI: 10.1007/s11136-023-03523-w] [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] [Accepted: 09/20/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE To compare health-related quality of life (HRQoL) and functional status between obese, underweight, normal-weight, and overweight patients after three months post-intensive care unit (ICU) discharge. METHODS Multicenter cohort study (10 Brazilian ICUs). 1600 ICU survivors (≥ 72 h in the ICU) were included.The main outcomes were HRQoL and functional status assessed three months after the ICU discharge. The secondary outcomes were mortality, hospital readmission, and ICU readmission during the same period. RESULTS Obese patients (median 50.1; IQR 39.6-59.6) had lower HRQoL in the mental component than normal-weight patients (median 53; IQR 45.6-60.1) (p = 0.033). No differences were found between BMI categories regarding the physical component of HRQoL and the Barthel Index (p = 0.355 and 0.295, respectively). Regarding readmissions, 65.1 and 25.1% of patients were readmitted to the hospital and ICU, but there was no difference between the groups (p = 0.870 and 0.220, respectively). Obese patients died less frequently (11.8%) than underweight (30.9%) and normal-weight (19.3%) patients (p < 0.001). CONCLUSION After three months of post-ICU discharge, obese patients had lower HRQoL in the mental component than normal-weight patients. However, obese patients died less than underweight and normal-weight patients.
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Affiliation(s)
- Mirceli Goulart Barbosa
- Post-Graduation Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Sarmento Leite Street, 245, Porto Alegre, 90050-170, Brazil.
| | - Daniel Sganzerla
- UNIMED, Venancio Aires Street, 1040, Porto Alegre, 90040-191, Brazil
| | | | - Cassiano Teixeira
- Post-Graduation Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Sarmento Leite Street, 245, Porto Alegre, 90050-170, Brazil
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Zhang Y, Jiang X. The relationship between physical activity and stroke in middle-aged and elderly people after controlling demography variables, health status and lifestyle variables. Medicine (Baltimore) 2023; 102:e36646. [PMID: 38115280 PMCID: PMC10727543 DOI: 10.1097/md.0000000000036646] [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: 07/27/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023] Open
Abstract
The increase in the number of stroke patients in China brain has led to the decline in quality of life and the burden of family economic conditions. This study explored the relationship between stroke and physical activity (PA) in middle-aged and elderly Chinese after controlling Demography, health status and lifestyle variables, providing a new basis for the prevention and treatment of stroke in the elderly. The data is from the 2018 China Health and Retirement Longitudinal study. Five thousand seventy people over 50 years old with complete information on PA, stroke, Demography, health status and lifestyle were included in the analysis. SPSS 27.0 software was used to conduct Z test, logistic regression analysis and linear hierarchical regression analysis on the collected data. The results showed that high-level physical exercise was significantly negatively correlated with stroke (P < .05). After adjusting Demographics characteristics (gender, registered residence type, education level, age, widowhood or not), health status characteristics and living habits (arthritis, bad mood, asthma, hyperlipidemia, disability, memory disease, health self-evaluation, hypertension, smoking, depression), There was still statistical significance (P < .05) between PA and stroke. This study concludes that middle-aged and elderly people with high PA have a lower risk of stroke. In the process of preventing and improving stroke symptoms in the elderly, it is important to maintain high PA while also paying attention to health management and a healthy lifestyle.
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Affiliation(s)
- Yaqun Zhang
- School of Sports Medicine, Anshan Normal University, Anshan, China
| | - Xin Jiang
- School of Physical Education, Dalian University, Dalian, China
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Gil-Salcedo A, Dugravot A, Fayosse A, Landré B, Yerramalla MS, Sabia S, Schnitzler A. Role of age and sex in the association between BMI and functional limitations in stroke patients: Cross-sectional analysis in three European and US cohorts. J Stroke Cerebrovasc Dis 2023; 32:107270. [PMID: 37481939 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND A U- or J-shaped association between BMI and different post-stroke outcomes is suggested. Thus, the aim is to evaluate the association between BMI with ADL, IADL and mobility limitations in the ageing post-stroke population at different ages, as well as the differences in this association by sex. METHODS A total of 5,468 participants with stroke and 21,872 without stroke over 50 years of age were assessed for the number of limitations in basic or instrumental activities of daily living (ADL/IADL) as well as mobility tasks. The association between BMI at the interview (continuous time-dependent variable) and the level of limitations was assessed using a linear mixed model stratified by sex and stroke status. RESULTS The association between BMI and ADL/IADL and mobility limitations were found to be significant in both men and women regardless of stroke status (p<0.001 for all). The association differs between those who have suffered a stroke and those who have not (p<0.001 for all). In ADL/IADL limitations, men with stroke showed a transition from an inverted J-shape to a U-shape association with age. In women, the BMI showed a less pronounced association between BMI and ADL/IADL limitations compared to men but with similar trends. A effect of sex was observed in the association between BMI and mobility, with women with and without stroke showing a linear association that differed from the inverted J-shaped or U-shaped association of men. CONCLUSION Our results suggest that BMI is associated with limitations in ADL, IADL and mobility in stroke patients. In addition, this association differs between men and women and is also influenced by age.
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Affiliation(s)
- Andres Gil-Salcedo
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Benjamin Landré
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Manasa S Yerramalla
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Séverine Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Alexis Schnitzler
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France; Université Versailles Saint Quentin en Yvelines, EA 4047 Handi-Resp, Service de neurologie hôpital A. Mignot, Garches, France.
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Fonseca GWPD, von Haehling S. The fatter, the better in old age: the current understanding of a difficult relationship. Curr Opin Clin Nutr Metab Care 2022; 25:1-6. [PMID: 34861670 DOI: 10.1097/mco.0000000000000802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Obesity has shown a protective effect on mortality in older adults, also known as the obesity paradox, but there are still controversies about this relationship. RECENT FINDINGS Recent studies have shown a J or U-shaped relationship between BMI and mortality, wherein an optimal range is described between 22 and 37 kg/m2 depending on the condition. Many mechanisms can explain this protective effect of higher BMI, fat/muscle mass storage, more aggressive treatment in obese individuals, loss of bone mineral content and selection bias. However, BMI must be used with caution due to its limitations to determine body composition and fat distribution. SUMMARY Although BMI is an easy tool to evaluate obesity, its protective effect may be present to certain extend, from normal range to class I obesity (BMI 30-34.9 kg/m2), but then it becomes detrimental. Skeletal muscle mass and muscle function associated with adipose tissue assessment can add valuable information in the risk stratification. Further studies should be performed prospectively, adjust BMI for cofounding variable and consider other elderly subpopulations. To promote healthy ageing, excessive fat mass should be avoided and maintenance or improvement of skeletal muscle mass and muscle function should be stimulated in older adults.
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Affiliation(s)
- Guilherme Wesley Peixoto da Fonseca
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo/SP, Brazil
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG)
- German Centre for Cardiovascular Research (DZHK) Partner Site, Göttingen, Germany
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