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Wang L, Liu X, Du Z, Tian J, Zhang L, Yang L. Cardiometabolic Index and chronic obstructive pulmonary disease: A population-based cross-sectional study. Heart Lung 2024; 68:342-349. [PMID: 39244841 DOI: 10.1016/j.hrtlng.2024.09.002] [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: 04/12/2024] [Revised: 08/27/2024] [Accepted: 09/02/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide and constitutes a global health problem. The cardiometabolic index (CMI) is a new metric that combines abdominal obesity and lipid levels. Studies have shown that the prevalence of lipid metabolism disorders is greater among COPD patients and that the CMI can help reveal the potential role of lipid metabolism in disease progression by assessing the body's metabolic status; however, the association between the CMI and COPD is not known. OBJECTIVE To explore the association between the CMI and the prevalence of COPD. METHODS A cross-sectional study was conducted with 14,340 participants aged ≥ 20 years from the 2007-2018 NHANES databases. To assess the relationship between the CMI and the odds of COPD prevalence, we performed multivariate logistic regression analyses, subgroup analysis interaction tests, smoothed curve fitting, and threshold effect analyses. RESULTS The study included a total of 14,340 participants, 48.49 % male and 51.51 % female, and the average age was 49.75 ± 17.49 years. According to the regression model adjusted for all confounding variables, participants in the highest quartile of the CMI had 22 % greater odds of having COPD than did those in the lowest quartile (OR = 1.22, 95 % CI: 1.03, 1.21, p = 0.010). A nonlinear association was found between the CMI and COPD, with an inflection point of 0.26. The OR (95 % CI) before the inflection point was 1.27 (1.12, 1.44), p = 0.0002. The interaction was statistically significant only in the sex analysis. CONCLUSIONS The level of the CMI and the odds of COPD prevalence were positively correlated in our study. These findings suggest that managing abdominal obesity and lipid levels may help prevent or mitigate COPD, emphasizing the potential value of the CMI as an indicator for early intervention and precision therapy.
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Affiliation(s)
- Lina Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Xiaojun Liu
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Zhongyan Du
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Jiaqi Tian
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Ling Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Lijuan Yang
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, China.
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Nteli M, Nteli D, Moysidis DV, Foka A, Zymaris P, Grantza T, Kazarli O, Vagianos A, Papazoglou AS, Kartas A, Samaras A, Bekiaridou A, Spyridonidis E, Ziakas A, Tzikas A, Giannakoulas G. Prognostic Impact of Body Mass Index in Atrial Fibrillation. J Clin Med 2024; 13:3294. [PMID: 38893005 PMCID: PMC11172694 DOI: 10.3390/jcm13113294] [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: 05/07/2024] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: Contradictory results have been reported regarding the influence of obesity on the prognosis of atrial fibrillation (AF). The present study aimed to explore the potential association of body mass index (BMI) with the clinical outcomes of hospitalized patients with AF. Methods: In this retrospective, post hoc analysis of the MISOAC-AF randomized trial, 1113 AF patients were included and stratified as the following: underweight (BMI < 18 kg/m2), normal weight (BMI 18-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2), and obese (BMI ≥ 30 kg/m2). The primary outcome was all-cause mortality; the secondary composite outcome was any hospitalization related to AF, heart failure (HF), or stroke. Cox regression analysis, survival analysis, and spline curve models were utilized. Results: Of the patients (median age: 76 years (IQR: 13), male: 54.6%), the majority were overweight (41.4%), followed by obese (33%), normal weight (24%), and underweight (1.6%). During a median 31-month follow-up, 436 (39.2%) patients died and 657 (59%) were hospitalized due to AF, HF, or stroke. Underweight, overweight, and obesity groups were significantly associated with an increased risk of all-cause mortality (p-values 0.02, 0.001, and <0.001, respectively), while overweight and obesity were significantly associated with the composite endpoint (p-values 0.01, <0.001, respectively) compared to normal weight. The spline curve analyses yielded that BMIs > 26.3 and > 25 were incrementally associated with all-cause mortality and the composite endpoint, respectively. A J-shaped relationship between BMI and AF prognosis was deduced. Conclusions: In conclusion, in recently hospitalized AF patients, BMI values outside the normal range were independently associated with poorer prognosis; therefore, it is essential that AF patients maintain a normal weight.
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Affiliation(s)
- Maria Nteli
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Despoina Nteli
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Dimitrios V. Moysidis
- 424 General Military Hospital of Thessaloniki, 56429 Thessaloniki, Greece; (D.V.M.); (E.S.)
| | - Anastasia Foka
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Panagiotis Zymaris
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Triantafyllia Grantza
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Olga Kazarli
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Alexis Vagianos
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | | | - Anastasios Kartas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Athanasios Samaras
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Alexandra Bekiaridou
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, USA
| | | | - Antonios Ziakas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Apostolos Tzikas
- Interbalkan European Medical Center, 55535 Thessaloniki, Greece;
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
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Huberts LCE, Li S, Blake V, Jorm L, Yu J, Ooi SY, Gallego B. Predictive analytics for cardiovascular patient readmission and mortality: An explainable approach. Comput Biol Med 2024; 174:108321. [PMID: 38626511 DOI: 10.1016/j.compbiomed.2024.108321] [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: 11/11/2023] [Revised: 02/06/2024] [Accepted: 03/13/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Cardiovascular patients experience high rates of adverse outcomes following discharge from hospital, which may be preventable through early identification and targeted action. This study aimed to investigate the effectiveness and explainability of machine learning algorithms in predicting unplanned readmission and death in cardiovascular patients at 30 days and 180 days from discharge. METHODS Gradient boosting machines were trained and evaluated using data from hospital electronic medical records linked to hospital administrative and mortality data for 39,255 patients admitted to four hospitals in New South Wales, Australia between 2017 and 2021. Sociodemographic variables, admission history, and clinical information were used as potential predictors. The performance was compared to LASSO regression, as well as the HOSPITAL and LACE risk score indices. Important risk factors identified by the gradient-boosting machine model were explored using Shapley values. RESULTS The models performed well, especially for the mortality outcomes. Area under the receiver operating characteristic curve values were 0.70 for readmission and 0.87-0.90 for mortality using the full gradient boosting machine algorithms. Among the top predictors for 30-day and 180-day readmission were increased red cell distribution width, old age (especially above 80 years), high measured troponin and urea levels, not being married or in a relationship, and low albumin levels. For mortality, these included increased red cell distribution width, old age (especially older than 70 years), high measured troponin and urea levels, high neutrophil and monocyte counts, and low eosinophil and lymphocyte counts. The Shapley values gave clear insight into the dynamics of decision-tree-based models. CONCLUSIONS We demonstrated an explainable predictive algorithm to identify cardiovascular patients who are at high risk of readmission or death at discharge from the hospital and identified key risk factors.
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Affiliation(s)
- Leo C E Huberts
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia.
| | - Sihan Li
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Victoria Blake
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia; Eastern Heart Clinic, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Jennifer Yu
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Hospital, South Eastern Sydney Local Health District, NSW, Australia
| | - Sze-Yuan Ooi
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Hospital, South Eastern Sydney Local Health District, NSW, Australia
| | - Blanca Gallego
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
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Engin A. Adipose Tissue Hypoxia in Obesity: Clinical Reappraisal of Hypoxia Hypothesis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1460:329-356. [PMID: 39287857 DOI: 10.1007/978-3-031-63657-8_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
Obese subjects exhibit lower adipose tissue oxygen consumption in accordance with the lower adipose tissue blood flow. Thereby, compared to lean subjects, obese individuals have almost half lower capillary density and more than half lower vascular endothelial growth factor (VEGF). The VEGF expression together with hypoxia-inducible transcription factor-1 alpha (HIF-1α) activity also requires phosphatidylinositol 3-kinase (PI3K) and mammalian target of rapamycin (mTOR)-mediated signaling. Especially HIF-1α is an important signaling molecule for hypoxia to induce the inflammatory responses. Hypoxia contributes to several biological functions, such as angiogenesis, cell proliferation, apoptosis, inflammation, and insulin resistance (IR). Pathogenesis of obesity-related comorbidities is attributed to intermittent hypoxia (IH), which is mostly observed in visceral obesity. Proinflammatory phenotype of the adipose tissue is a crucial link between IH and the development of IR. Inhibition of adaptive unfolded protein response (UPR) in hypoxia increases β cell death. Moreover, deletion of HIF-1α worsens β cell function. Oxidative stress, as well as the release of proinflammatory cytokines/adipokines in obesity, is proportional to the severity of IH. Reactive oxygen species (ROS) generation at mitochondria is responsible for propagation of the hypoxic signal; however, mitochondrial ROS production is required for hypoxic HIF-1α protein stabilization. Alterations in oxygen availability of adipose tissue directly affect the macrophage polarization and are responsible for the dysregulated adipocytokines production in obesity. Hypoxia both inhibits adipocyte differentiation from preadipocytes and macrophage migration from the hypoxic adipose tissue. Upon reaching a hypertrophic threshold beyond the adipocyte fat loading capacity, excess extracellular matrix (ECM) components are deposited, causing fibrosis. HIF-1α initiates the whole pathological process of fibrosis and inflammation in the obese adipose tissue. In addition to stressed adipocytes, hypoxia contributes to immune cell migration and activation which further aggravates adipose tissue fibrosis. Therefore, targeting HIF-1α might be an efficient way to suppress hypoxia-induced pathological changes in the ECM. The fibrosis score of adipose tissue correlates negatively with the body mass index and metabolic parameters. Inducers of browning/beiging adipocytes and adipokines, as well as modulations of matrix remodeling enzyme inhibitors, and associated gene regulators, are potential pharmacological targets for treating obesity.
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Affiliation(s)
- Atilla Engin
- Faculty of Medicine, Department of General Surgery, Gazi University, Besevler, Ankara, Turkey.
- Mustafa Kemal Mah. 2137. Sok. 8/14, 06520, Cankaya, Ankara, Turkey.
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Sakima A, Yamazato M, Kohagura K, Ishida A, Matayoshi T, Tana T, Nakamura Y, Ohya Y. Achievement rate of target blood pressure in patients with hypertension treated by hypertension specialists and non-specialists in a real-world setting. Hypertens Res 2023; 46:2460-2469. [PMID: 37414873 DOI: 10.1038/s41440-023-01362-3] [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: 02/10/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023]
Abstract
Hypertension remains a major global healthcare issue. Considering that most Japanese patients with hypertension are managed by general practitioners, hypertension specialists should be involved in actual clinical practice. We investigated the blood pressure (BP), guidelines recommended for achievement rate of the target BP, and clinical variables of patients with hypertension treated by hypertension specialists and those treated by non-specialists in a real-world setting. Factors associated with the target BP achievement in this population were also investigated. Outpatients with hypertension from 12 medical facilities in Okinawa Prefecture were enrolled (n = 1469 [specialist group, 794; non-specialist group, 675]; mean age, 64.2 years; females, 45.8%). For all patients, BP and rate of the target BP achievement were 129.0 ± 15.5/74.6 ± 10.6 mmHg, and 51.8%, respectively. BP and the rate of target of BP achievement were 128.0 ± 15.1/73.4 ± 10.4 mmHg and 56.7% in the specialist group, and they were 130.1 ± 15.9/76.0 ± 10.8 mmHg and 46.1% in the non-specialist group. The urinary salt excretion and obesity rates were comparable between the specialist and non-specialist groups. Multivariable logistic analyses indicated that hypertension specialists and good medication adherence were positive factors, whereas obesity, chronic kidney disease, diabetes mellitus, and urinary salt excretion were inverse factors associated with target BP achievement in this population. Initiatives for salt reduction, medication adherence, and proper obesity management are crucial to improving BP management in patients with hypertension. Hypertension specialists are expected to play an essential role in them. For all patients, the target blood pressure (BP) achievement rate were 51.8%. Hypertension specialists and good medication adherence were positive factors in achieving target BP; conversely, obesity, diabetes mellitus, chronic kidney disease, and high urinary salt excretion were inverse factors in achieving target BP among patients with hypertension.
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Affiliation(s)
- Atsushi Sakima
- Health Administration Center, University of the Ryukyus, Okinawa, Japan.
| | - Masanobu Yamazato
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kentaro Kohagura
- Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan
| | - Akio Ishida
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tetsutaro Matayoshi
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | | | | | - Yusuke Ohya
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Li SY, Leung JCS, Lu ZH, Kwok TCY. Quantity and Variety of Fruit and Vegetable Intake with Changes in Measures of Adiposity among Community-Dwelling Chinese Older Adults. Nutrients 2023; 15:4096. [PMID: 37836380 PMCID: PMC10574446 DOI: 10.3390/nu15194096] [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: 08/17/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The association between fruit and vegetable intake, considering both quantity and variety, and weight change among older adults remains controversial. We aimed to investigate the association between fruit and vegetable intake, variety, and changes in adiposity measures among community-dwelling Chinese older adults. METHODS A total of 2944 participants aged ≥65 years from Hong Kong communities were included. Fruit and vegetable intake was estimated by a locally validated food frequency questionnaire. Adiposity measures (weight, body mass index (BMI), waist circumference, fat and lean mass) were assessed at baseline and the year four follow-up. Restricted cubic spline and logistic models were performed to estimate the associations between fruit and vegetable intake, variety, and changes in adiposity measures. RESULTS A nonlinear association between vegetable intake and weight change was found, following a J-shape curve. Increased vegetable intake was associated with less increases in weight, BMI, and fat mass among those below median intakes. However, these associations became insignificant at higher intakes (all P-nonlinearity < 0.05). The ORs (95% CIs) for weight gain across the quartiles of vegetable intake were as follows: 1.00 (reference), 0.81 (0.56, 1.17), 0.55 (0.36, 0.83), and 0.88 (0.58, 1.33). Similar patterns were observed in overweight and normal weight participants, but not in those with low body weight. No associations with weight change were found for fruit intake or fruit and vegetable variety. CONCLUSIONS Moderate vegetable intake was associated with less weight gain among community-dwelling Chinese older adults, but not in those with low body weight. No association was observed between fruit intake or variety with weight change.
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Affiliation(s)
- Shu-Yi Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason C. S. Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhi-Hui Lu
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Timothy C. Y. Kwok
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, China
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Ha KH, Kim DJ, Han SJ. Associations of updated cardiovascular health metrics, including sleep health, with incident diabetes and cardiovascular events in older adults with prediabetes: A nationwide population-based cohort study. Diabetes Res Clin Pract 2023; 203:110820. [PMID: 37422164 DOI: 10.1016/j.diabres.2023.110820] [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: 04/25/2023] [Revised: 06/07/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023]
Abstract
AIMS To investigate the association of updated cardiovascular health (CVH) metrics, including sleep health, with the risk of diabetes and major adverse cardiovascular events (MACE) in older adults with prediabetes. METHODS A total of 7,948 older adults with prediabetes aged ≥ 65 years were included in this study. CVH was assessed using seven baseline metrics according to the modified American Heart Association recommendations. RESULTS During a median follow-up time of 11.9 years, 2,405 (30.3%) cases of diabetes and 2,039 (25.6%) MACE were recorded. Compared with the poor composite CVH metrics group, the multivariable-adjusted hazard ratios (HRs) in the intermediate and ideal composite CVH metrics groups were respectively 0.87 (95% confidence intervals [CI] = 0.78-0.96) and 0.72 (95% CI = 0.65-0.79) for diabetes events and 0.99 (95% CI = 0.88-1.11) and 0.88 (95% CI = 0.79-0.97) for MACE. The ideal composite CVH metrics group had a lower risk of diabetes and MACE in older adults aged 65-74 years, but not in those aged ≥ 75 years. CONCLUSIONS Ideal composite CVH metrics in older adults with prediabetes were associated with a lower risk of diabetes and MACE.
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Affiliation(s)
- Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Seung Jin Han
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.
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Wang X, Liang Q, Li Z, Li F. Body Composition and COPD: A New Perspective. Int J Chron Obstruct Pulmon Dis 2023; 18:79-97. [PMID: 36788999 PMCID: PMC9922509 DOI: 10.2147/copd.s394907] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
The proportion of obese or overweight patients in COPD patients is increasing. Although BMI, WC and other easy to measure indicators have been proven to be related to the risk of COPD, they cannot accurately reflect the distribution and changes of body composition, ignoring the body composition (such as fat distribution, muscle content, water content, etc.), the relationship between it and disease risk may be missed. By analyzing the correlation between different body composition indexes and COPD patients, we can provide new research ideas for the prognosis judgment or intervention of COPD disease.
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Affiliation(s)
- Xin Wang
- Department of Integrated Pulmonology, Fourth Clinical Medical College of Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
- Xinjiang National Clinical Research Base of Traditional Chinese Medicine, Urumqi, Xinjiang, People’s Republic of China
| | - Qianqian Liang
- Department of Integrated Pulmonology, Fourth Clinical Medical College of Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
- Xinjiang National Clinical Research Base of Traditional Chinese Medicine, Urumqi, Xinjiang, People’s Republic of China
| | - Zheng Li
- Department of Integrated Pulmonology, Fourth Clinical Medical College of Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
- Xinjiang National Clinical Research Base of Traditional Chinese Medicine, Urumqi, Xinjiang, People’s Republic of China
- Xinjiang Key Laboratory of Respiratory Disease Research, Urumqi, Xinjiang, People’s Republic of China
- Xinjiang Clinical Medical Research Center of Respiratory Obstructive Diseases, Urumqi, Xinjiang, People’s Republic of China
| | - Fengsen Li
- Department of Integrated Pulmonology, Fourth Clinical Medical College of Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
- Xinjiang National Clinical Research Base of Traditional Chinese Medicine, Urumqi, Xinjiang, People’s Republic of China
- Xinjiang Key Laboratory of Respiratory Disease Research, Urumqi, Xinjiang, People’s Republic of China
- Xinjiang Clinical Medical Research Center of Respiratory Obstructive Diseases, Urumqi, Xinjiang, People’s Republic of China
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Lee TW, Chung J, Song K, Kim E. Incidence and predictors of multimorbidity among older adults in Korea: a 10-year cohort study. BMC Geriatr 2022; 22:565. [PMID: 35799103 PMCID: PMC9264523 DOI: 10.1186/s12877-022-03250-w] [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: 01/19/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the rapid growth of the older adult population, multimorbidity has become a global concern for an aging society. Multimorbidity has been associated with poor health outcomes, including low quality of life and a high risk of mortality, resulting in an overload of healthcare systems. However, multimorbidity incidence and its related factors are poorly understood among older adults. This study aimed to determine whether sociodemographic characteristics, lifestyle, and psychosocial factors predict multimorbidity incidence among older adults in Korea. METHODS This longitudinal study used the Korean Longitudinal Study of Aging (KLoSA) dataset from 2008 to 2018. The KLoSA is a panel survey of nationally representative samples aimed at providing data for developing socioeconomic policies for the increasing aging population in Korea. The study sample included 1967 older adults aged 65 years and over who had none or one of the chronic diseases at the baseline in 2008. Multimorbidity incidence was defined as the co-existence of two or more chronic diseases among 12 doctor-diagnosed diseases based on self-reports. Cox's proportional hazards models were used to identify significant predictors of multimorbidity incidence over a 10-year follow-up period. RESULTS Among 1967 respondents (female 54.5%, mean age 72.94), 625 (31.8%) incidents of multimorbidity were reported, contributing to 47.5 incidents per 1000 people after 10 years of follow-up. Low levels of social interaction, obesity, past smoking habits, and current or past drinking habits were identified as significant predictors of multimorbidity incidence among older adults in Korea. CONCLUSIONS This study identified older adults at high risk for multimorbidity incidence. These groups require more attention from health care providers in the course of chronic disease monitoring and management. Specific interventions and health policies to promote social interaction and a healthy lifestyle are essential to delay multimorbidity incidence. This longitudinal approach will contribute to developing preventive strategies to reduce the incidence of multimorbidity among older adults.
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Affiliation(s)
- Tae Wha Lee
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Jane Chung
- School of Nursing, Virginia Commonwealth University, Virginia, USA
| | - Kijun Song
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Eunkyung Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea.
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Ewens B, Kemp V, Towell-Barnard A, Whitehead L. The nursing care of people with class III obesity in an acute care setting: a scoping review. BMC Nurs 2022; 21:33. [PMID: 35090451 PMCID: PMC8796636 DOI: 10.1186/s12912-021-00760-7] [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: 06/16/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with Class III obesity pose unique challenges to health care staff and organisations. Care requirements of this population are unique and require specialised equipment and knowledge to meet these needs, maintain the quality of care, as well as the safety of patients and staff. AIM To synthesise the evidence on the nursing care of Class III obese patients in acute care settings. METHODS A scoping review informed by JBI. CINAHL Plus, Medline, Scopus, Proquest Central, Web of Science and Embase were searched for primary research articles about the nursing management of people classified as Class III obese in acute care. Methodological quality of included studies was assessed; data extracted and synthesised into themes. RESULTS Fourteen studies were included in the review. The synthesis generated three themes: Access to equipment, knowledge and training, patient care, and opportunities to improve care. CONCLUSIONS A paucity of high-quality evidence informs the nursing care of people with Class III obesity in acute care. Access to appropriate equipment dominated the findings of this review. Adequate provision of equipment and education on its use are required. Education to promote engagement with patients, adapting clinical practice and promotion of self-care could improve care and outcomes.
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Affiliation(s)
- Beverley Ewens
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027 Australia
| | - Vivien Kemp
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027 Australia
| | - Amanda Towell-Barnard
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027 Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027 Australia
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11
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van den Berk-Clark C, Pickard J, Davis D, Scherrer JF. The Role of Impulsive Decision Making on Health Behavior Related to Cardiovascular Disease Risk Among Older Adults With Hypertension. J Gerontol Nurs 2021; 47:22-30. [PMID: 34704864 DOI: 10.3928/00989134-20211013-01] [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: 11/20/2022]
Abstract
The purpose of the current study was to investigate whether older adults who are more impulsive also tend to engage in more health behaviors associated with increased risk for cardiovascular disease (CVD). We analyzed data from the Health and Retirement Study. Logistic regression analysis was performed to determine the likelihood of medication adherence, alcohol consumption, and exercise among older adults with hypertension. Adjusted regression results revealed higher impulsive decision making was associated with greater likelihood of obesity (odds ratio [OR] = 2.96, 95% confidence interval [CI] [1.00, 8.92]), lower likelihood of medication adherence (OR = 0.37, 95% CI [0.15, 0.92]), and regular drinking (OR = 0.36, 95% CI [0.15, 0.87]). Higher impulsive decision making was associated with lower likelihood of regular exercise only in unadjusted models. Older adults with hypertension who had higher impulsive decision making engaged in health behaviors associated with increased risk for CVD. Health care providers should consider the range of strategies offered through behavioral economics to improve health in these at-risk populations. [Journal of Gerontological Nursing, 47(11), 22-30.].
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12
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Arigo D, Ainsworth MC, Pasko K, Brown MM, Travers L. Predictors of change in BMI over 10 years among midlife and older adults: Associations with gender, CVD risk status, depressive symptoms, and social support. Soc Sci Med 2021; 279:113995. [PMID: 33993009 PMCID: PMC8393364 DOI: 10.1016/j.socscimed.2021.113995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/10/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
RATIONALE Change in BMI is recognized as a key health indicator among midlife and older adults, though predictors of BMI change in this group have received little attention. OBJECTIVE The aim of this study was to examine relations between hypothesized predictors (i.e., gender, cardiovascular disease [CVD] risk status, depressive symptoms, social support) and BMI change over 10 years, among midlife and older adults. METHODS Participants were adults ages 50-74 at baseline (N = 5,688, 64% women) who completed four assessments over 10 years. Gender, CVD risk status (i.e., diagnosis of hypertension, type 2 diabetes, or both), depressive symptoms, and perceived social support were assessed at baseline, and BMI was calculated from height and weight reports at all assessments. Multilevel models tested for concurrent and prospective relations between predictors and BMI change (effect size estimates as semipartial correlation coefficients, sr), as well as whether observed relations were further moderated by baseline BMI category (underweight, healthy weight, overweight, or obese). RESULTS Baseline BMI was higher among those with (vs. without) CVD risk, higher (vs. lower) depressive symptoms, and lower (vs. higher) social support; all of these relations were moderated by gender (ps < 0.05, srs 0.03-0.32). Moreover, BMI showed significant change over 10 years, and BMI variability during this time was higher among women (vs. men) and those with (vs. without) CVD risk (ps < 0.0001). BMI change also differed by CVD risk status, and this relation was moderated by gender, baseline depressive symptoms, and baseline BMI category (ps < 0.05, srs 0.03-0.08). CONCLUSIONS Although the predictors of interest were not associated with steady BMI decreases (which are associated with long term health risks for older adults), findings reveal unique patterns of change in BMI among subgroups of midlife and older adults, and may allow for early identification of those with noteworthy BMI changes after age 50.
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Affiliation(s)
- Danielle Arigo
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA; Department of Family Medicine, Rowan School of Osteopathic Medicine, One Medical Center Drive, Stratford, NJ, 08084, USA.
| | - M Cole Ainsworth
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA.
| | - Kristen Pasko
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA.
| | - Megan M Brown
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA.
| | - Laura Travers
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA.
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13
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Chen S, Che Q, Zheng Q, Zhang Y, Jia J, Wu Y, Huo Y, Chen D. Relationship Between Different Risk Factor Patterns and Follow-Up Outcomes in Patients With ST-Segment Elevation Myocardial Infarction. Front Cardiovasc Med 2021; 8:633992. [PMID: 34113659 PMCID: PMC8185218 DOI: 10.3389/fcvm.2021.633992] [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: 11/26/2020] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Few studies have been concerned with the combined influences of the presence of multiple risk factors on follow-up outcomes in AMI patients. Our study aimed to identify risk factor patterns that may be associated with 1-year survival in male patients with ST-segment elevation myocardial infarction (STEMI). Methods: Data were from the China STEMI Care Project Phase 2 (CSCAP-2) collected between 2015 and 2018. A total of 15,675 male STEMI patients were enrolled in this study. Risk factor patterns were characterized using latent class analysis (LCA) according to seven risk factors. Associations between risk factor patterns and follow-up outcomes, including the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause death, were investigated by Cox proportional hazard regression analysis. Results: We obtained four risk factor patterns as "young and middle-aged with low levels of multimorbidity," "middle-aged with overweight," "middle-aged and elderly with normal weight," and "elderly with high multimorbidity." Four patterns had significant differences in event-free survival (P < 0.001). As compared with the patients of "young and middle-aged with low levels of multimorbidity" pattern, the risk of incidence of MACCE and all-cause death were increased in patients of "middle-aged with overweight" pattern (All-cause death: HR = 1.70, 95% CI:1.29~2.23; MACCE: HR = 1.49, 95% CI:1.29~1.72), "middle-aged and elderly with normal weight" pattern (All-cause death: HR = 3.04, 95% CI: 2.33~3.98; MACCE: HR = 1.82, 95% CI: 1.56~2.12), and "elderly with high multimorbidity" pattern (All-cause death: HR = 5.78, 95% CI: 4.49~7.42; MACCE: HR = 2.67, 95% CI: 2.31~3.10). Conclusions: By adopting a Latent Class Analysis Approach, STEMI patients can be characterized into four risk factor patterns with significantly different prognosis. The data is useful for the improvement of community health management in each specific subgroup of patients, which indicates a particular risk factor pattern.
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Affiliation(s)
- Si Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Qianzi Che
- Department of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiwen Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jia Jia
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yiqun Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Dafang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Hu J, Xu H, Zhu J, Zhang J, Li J, Chen L, Liu X, Qin G. Association between body mass index and risk of cardiovascular disease-specific mortality among adults with hypertension in Shanghai, China. Aging (Albany NY) 2021; 13:6866-6877. [PMID: 33621195 PMCID: PMC7993713 DOI: 10.18632/aging.202543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/25/2020] [Indexed: 06/12/2023]
Abstract
The aim of our study was to examine the association between body mass index (BMI) and the risk of cardiovascular disease (CVD)-specific mortality among Chinese adults with hypertension by sex. This study included 212,394 adult hypertensive patients aged 20-85 years registered in the records of Minhang District during 2007-2018. Cox proportional hazards regression was performed to evaluate the association between BMI and CVD-specific mortality among Chinese adults with hypertension. There were 14,029 deaths over an average of 8.24 years (range, 0.19-11.96 years). The multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) across BMI categories (< 18.5 kg/m2, 18.5-24.9 kg/m2 [reference group], 25.0-29.9 kg/m2, and ≥ 30 kg/m2) for CVD-specific mortality were 1.37 (1.22-1.53), 1.00 (reference), 0.95 (0.90-1.01), and 1.21 (1.04-1.40) in males, and 1.44 (1.31-1.59), 1.00 (reference), 0.96 (0.91-1.01), and 1.04 (0.92-1.17) in females. A U-shaped relationship was observed between BMI and CVD-specific mortality (overall association P< 0.001; non-linearity P< 0.001). This association was attenuated in old age. This study revealed a U-shaped relationship between BMI and CVD-specific mortality among hypertensive men and women. In older people, overweight and obesity are potential factors that reduce the risk of CVD death.
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Affiliation(s)
- Jing Hu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Huilin Xu
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People’s Republic of China
- Minhang District Branch of School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Jingjing Zhu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Jinling Zhang
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People’s Republic of China
| | - Jun Li
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People’s Republic of China
| | - Linli Chen
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People’s Republic of China
| | - Xiaohua Liu
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People’s Republic of China
- Minhang District Branch of School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People’s Republic of China
- Key Lab of Health Technology Assessment, National Health Commission of the People’s Republic of China, Fudan University, Shanghai, People’s Republic of China
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Abstract
BACKGROUND In association with the rapid lengthening of life expectancy and the ever-rising prevalence of obesity, many studies explored in the elderly the phenomenon usually defined as the obesity paradox. OBJECTIVE AND METHODS This article is a narrative overview of seventy-two papers (1999-2019) that investigated the obesity paradox during the aging process. Twenty-nine documents are examined more in detail. RESULTS The majority of studies suggesting the existence of an obesity paradox have evaluated just BMI as an index of obesity. Some aspects are often not assessed or are underestimated, in particular body composition and visceral adiposity, sarcopenic obesity, and cardio fitness. Many studies support that central fat and relative loss of fat-free mass may become relatively more important than BMI in determining the health risk associated with obesity in older ages. CONCLUSION Inaccurate assessments may lead to a systematic underestimation of the impact of obesity on morbidity and premature mortality and, consequently, to clinical behaviors that are not respectful of the health of elderly patients. Knowledge of the changes in body composition and fat distribution will help to better understand the relationship between obesity, morbidity, and mortality in the elderly. LEVEL OF EVIDENCE Level V, narrative overview.
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Affiliation(s)
- Ottavio Bosello
- Department of Medicine, University of Verona, Verona, Italy.
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16
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Abstract
PURPOSE OF REVIEW The focus of this review is to discuss obesity, physical activity (and physical inactivity/sedentary behavior), cardiovascular disease (CVD), and their often interrelated health implications. The authors summarize the pathophysiological changes associated with obesity, which lead to the development of CVD, recommendations for interventions such as diet, increased physical activity, and weight loss according to current literature and guidelines, and the critical importance of cardiorespiratory fitness (CRF). RECENT FINDINGS Clinical trials continue to demonstrate improved outcomes among overweight or obese individuals who achieve a healthy weight using various methods. Increasing CRF levels appears to demonstrate the largest health improvements, regardless of underlying comorbidities or achieving weight loss. CRF, which is perhaps the single most important predictor of overall health, seems more important than weight loss alone regarding improved CVD outcomes in the obese population. These findings are reproduced in studies involving patients with various forms of CVD and CVD risk factors. The importance of CRF is well established; future endeavors to establish specific CRF targets for various patient cohorts are needed.
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Affiliation(s)
- Andrew Elagizi
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA
| | - Sergey Kachur
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA.
| | - Steven N Blair
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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17
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Sang Y, Wu X, Miao J, Cao M, Ruan L, Zhang C. Determinants of Brachial-Ankle Pulse Wave Velocity and Vascular Aging in Healthy Older Subjects. Med Sci Monit 2020; 26:e923112. [PMID: 32445331 PMCID: PMC7260998 DOI: 10.12659/msm.923112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vascular aging is characterized by increasing arterial stiffness as measured by pulse wave velocity. The present study evaluated the factors influencing vascular aging in Chinese healthy older subjects. MATERIAL AND METHODS Disease- and treatment-free aged (≥60 years) participants were recruited from 2014 to 2019. Cardiometabolic risk factors and brachial-ankle pulse wave velocity (baPWV) were assessed. We defined healthy vascular aging (HVA) as the lowest 10% and early vascular aging (EVA) as the highest 10% of the baPWV distribution, after adjustment for age and blood pressure (BP). We fitted linear and logistic regression models to assess the determinants. RESULTS In all, 794 subjects (mean age 66.5±6.8 years, 71.0% male) were recruited; the 10th and 90th percentiles of baPWV were 1278 cm/s and 1955 cm/s, respectively. Age, BP, heart rate, and triglycerides were all positively associated with baPWV, whereas male subjects and body mass index (BMI) were negatively associated with baPWV. The number of participants diagnosed with either HVA or EVA was 80. Logistic regression models showed that sex, BMI, heart rate, and triglycerides were associated with HVA and EVA after adjustment for age, BP, and other confounding factors. CONCLUSIONS Male, high BMI, low heart rate, and low triglycerides are protective factors for vascular aging in the healthy aged population. Management of BMI, heart rate, triglycerides in a reasonable range may help to alleviate the vascular aging process.
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Affiliation(s)
- Yu Sang
- Department of Geriatrics, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Xiaofen Wu
- Department of Geriatrics, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Jianping Miao
- Department of Geriatrics, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Ming Cao
- Department of Geriatrics, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Lei Ruan
- Department of Geriatrics, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Cuntai Zhang
- Department of Geriatrics, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
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18
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Gaggero A. The effect of type 2 diabetes diagnosis in the elderly. ECONOMICS AND HUMAN BIOLOGY 2020; 37:100830. [PMID: 32114327 DOI: 10.1016/j.ehb.2019.100830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 11/11/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Abstract
In this paper, I use a novel approach based on biomarkers data to examine the effect of type 2 diabetes (T2D) diagnosis on both physical and mental health for a sample of individuals aged 50 and above. In order to retrieve reliable estimates, I exploit the fact that medical guidelines cause a discontinuity in the probability that General Practitioners (GP) diagnose their patients with T2D as a function of exact blood test cut-off in a regression discontinuity design (RDD) approach. Using data from the English Longitudinal Study of Ageing (ELSA), I find compelling evidence that health information, in the form of T2D diagnosis, influences the protection of health into old age. Specifically, after receiving T2D diagnosis, over time, individuals reported a 2.1 lower body mass index (BMI) as well as 5.5 cm lower waist circumference, relative to their counterparts. With respect to self-reported physical health, the results imply that those diagnosed with T2D reported a 0.19 and 0.70 higher score in increased activities of daily living (ADL) and body mobility indexes, respectively. Finally, while I find evidence that T2D-diagnosed patients reported a significant, 0.5 higher, score in the word listening test, I find no evidence that T2D diagnosis impacted self-reported depression levels. I provide a wide variety of evidence on the validity of the results.
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Affiliation(s)
- Alessio Gaggero
- University of Granada, Department of Applied Economics, Cartuja Campus, 18011, Granada, Spain.
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19
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Isiozor NM, Kunutsor SK, Voutilainen A, Kurl S, Kauhanen J, Laukkanen JA. American heart association's cardiovascular health metrics and risk of cardiovascular disease mortality among a middle-aged male Scandinavian population. Ann Med 2019; 51:306-313. [PMID: 31264909 PMCID: PMC7877874 DOI: 10.1080/07853890.2019.1639808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: The burden of cardiovascular disease (CVD) prompted the American Heart Association to develop a cardiovascular health (CVH) metric as a measure to assess the cardiovascular status of the population. We aimed to assess the association between CVH scores and the risk of CVD mortality among a middle-aged Finnish population. Methods: We employed the prospective population-based Kuopio Ischemic Heart Disease cohort study comprising of middle-aged men (42-60 years). CVH scores were computed among 2607 participants at baseline and categorized as optimum (0-4), average (5-9), or inadequate (10-14) CVH. Multivariate cox regression models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CIs) of CVH score for cardiovascular mortality. Results: During a median follow-up period of 25.8 years, 609 CVD mortality cases were recorded. The risk of CVD mortality increased gradually with increasing CVH score across the range 3-14 (p-value for non-linearity =.77). Men with optimum CVH score had HR (95% CI) for CVD mortality of 0.30 (CI 0.21 - 0.42, p < .0001) compared to those with inadequate CVH score after adjustment for conventional cardiovascular risk factors. Conclusions: CVH score was strongly and continuously associated with the risk of CVD mortality among middle-aged Finnish population and this was independent of other conventional risk factors. Key messages Achieving optimum cardiovascular health score reduces the risk of cardiovascular mortality. Adopting the American Heart Association's cardiovascular health metrics is a welcome approach for public health awareness and monitoring of cardiovascular health among Scandinavian population.
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Affiliation(s)
- Nzechukwu M Isiozor
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland , Kuopio , Finland
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol , Bristol , UK.,Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol , Bristol , UK
| | - Ari Voutilainen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland , Kuopio , Finland
| | - Sudhir Kurl
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland , Kuopio , Finland
| | - Jussi Kauhanen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland , Kuopio , Finland
| | - Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyvaskyla , Jyvaskyla , Finland.,Central Finland Health Care District, Department of Internal Medicine , Jyvaskyla , Finland
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20
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Cintra R, Moura FA, Carvalho LSFD, Barreto J, Tambascia M, Pecoits-Filho R, Sposito AC. Inhibition of the sodium-glucose co-transporter 2 in the elderly: clinical and mechanistic insights into safety and efficacy. ACTA ACUST UNITED AC 2019; 65:70-86. [PMID: 30758423 DOI: 10.1590/1806-9282.65.1.70] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/26/2018] [Indexed: 12/16/2022]
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) in the elderly grew sharply over the last decade. Reduced insulin sensitivity and secretory capacity, weight gain, sarcopenia, and elevated adiposity are all common metabolic and body changes in the aging population that favor an increased risk of hypoglycemia, frailty syndrome, falls, and cognitive dysfunction. First line antidiabetic therapy is frequently not safe in older individuals because of its high risk of hypoglycemia and prevalent co-morbid diseases, such as chronic kidney disease, osteoporosis, cardiovascular disease, and obesity. Sodium-glucose cotransporter 2 inhibitor (SGLT2i) is a new class of antidiabetic therapy that inhibits glucose and sodium reabsorption on renal proximal convoluted tubule. Its effect is well demonstrated in various clinical scenarios in the younger population. This review and metanalysis describe particularities of the SGLT2i on the elderly, with mechanistic insights of the potential benefit and remaining challenges about the use of these drugs in this important age group. Further, we will present a meta-analysis of the main effects of SGLT2i reported in post-hoc studies in which the median age of the subgroups analyzed was over 60 years. Despite the absence of specific clinical trials for this population, our findings suggest that SGLT2i therapy on older individuals is effective to lower glucose and maintain its effect on systolic blood pressure and body weight.
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Affiliation(s)
- Riobaldo Cintra
- Laboratory of Atherosclerosis and Vascular Biology, Unicamp, Campinas, SP, Brasil
| | - Filipe A Moura
- Laboratory of Atherosclerosis and Vascular Biology, Unicamp, Campinas, SP, Brasil
| | - Luis Sergio F de Carvalho
- Laboratory of Atherosclerosis and Vascular Biology, Unicamp, Campinas, SP, Brasil.,Cardiology Division, State University of Campinas (Unicamp), Campinas, SP, Brasil
| | - Joaquim Barreto
- Laboratory of Atherosclerosis and Vascular Biology, Unicamp, Campinas, SP, Brasil
| | - Marcos Tambascia
- Endocrinology Division, State University of Campinas (Unicamp), Campinas, SP, Brasil
| | | | - Andrei C Sposito
- Laboratory of Atherosclerosis and Vascular Biology, Unicamp, Campinas, SP, Brasil.,Cardiology Division, State University of Campinas (Unicamp), Campinas, SP, Brasil
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21
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Elagizi A, Kachur S, Lavie CJ, Carbone S, Pandey A, Ortega FB, Milani RV. An Overview and Update on Obesity and the Obesity Paradox in Cardiovascular Diseases. Prog Cardiovasc Dis 2018; 61:142-150. [PMID: 29981771 DOI: 10.1016/j.pcad.2018.07.003] [Citation(s) in RCA: 426] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/01/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Andrew Elagizi
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - Sergey Kachur
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America.
| | - Salvatore Carbone
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Francisco B Ortega
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Richard V Milani
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America
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22
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Lavie CJ, Carbone S, Agarwal MA. An obesity paradox with myocardial infarction in the elderly. Nutrition 2018; 46:122-123. [DOI: 10.1016/j.nut.2017.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/06/2017] [Indexed: 01/21/2023]
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Giezenaar C, van der Burgh Y, Lange K, Hatzinikolas S, Hausken T, Jones KL, Horowitz M, Chapman I, Soenen S. Effects of Substitution, and Adding of Carbohydrate and Fat to Whey-Protein on Energy Intake, Appetite, Gastric Emptying, Glucose, Insulin, Ghrelin, CCK and GLP-1 in Healthy Older Men-A Randomized Controlled Trial. Nutrients 2018; 10:nu10020113. [PMID: 29360778 PMCID: PMC5852689 DOI: 10.3390/nu10020113] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/05/2018] [Accepted: 01/18/2018] [Indexed: 02/07/2023] Open
Abstract
Protein-rich supplements are used widely for the management of malnutrition in the elderly. We reported previously that the suppression of energy intake by whey protein is less in older than younger adults. The aim was to determine the effects of substitution, and adding of carbohydrate and fat to whey protein, on ad libitum energy intake from a buffet meal (180-210 min), gastric emptying (3D-ultrasonography), plasma gut hormone concentrations (0-180 min) and appetite (visual analogue scales), in healthy older men. In a randomized, double-blind order, 13 older men (75 ± 2 years) ingested drinks (~450 mL) containing: (i) 70 g whey protein (280 kcal; 'P280'); (ii) 14 g protein, 28 g carbohydrate, 12.4 g fat (280 kcal; 'M280'); (iii) 70 g protein, 28 g carbohydrate, 12.4 g fat (504 kcal; 'M504'); or (iv) control (~2 kcal). The caloric drinks, compared to a control, did not suppress appetite or energy intake; there was an increase in total energy intake (drink + meal, p < 0.05), which was increased most by the M504-drink. P280- and M504-drink ingestion were associated with slower a gastric-emptying time (n = 9), lower ghrelin, and higher cholecystokinin (CCK) and glucagon-like peptide-1 (GLP-1) than M280 (p < 0.05). Glucose and insulin were increased most by the mixed-macronutrient drinks (p < 0.05). In conclusion, energy intake was not suppressed, compared to a control, and particularly whey protein, affected gastric emptying and gut hormone responses.
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Affiliation(s)
- Caroline Giezenaar
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide, SA 5000, Australia.
| | - Yonta van der Burgh
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide, SA 5000, Australia.
| | - Kylie Lange
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide, SA 5000, Australia.
| | - Seva Hatzinikolas
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide, SA 5000, Australia.
| | - Trygve Hausken
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway.
| | - Karen L Jones
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide, SA 5000, Australia.
| | - Michael Horowitz
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide, SA 5000, Australia.
| | - Ian Chapman
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide, SA 5000, Australia.
| | - Stijn Soenen
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide, SA 5000, Australia.
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Giezenaar C, Luscombe-Marsh ND, Hutchison AT, Standfield S, Feinle-Bisset C, Horowitz M, Chapman I, Soenen S. Dose-Dependent Effects of Randomized Intraduodenal Whey-Protein Loads on Glucose, Gut Hormone, and Amino Acid Concentrations in Healthy Older and Younger Men. Nutrients 2018; 10:nu10010078. [PMID: 29329233 PMCID: PMC5793306 DOI: 10.3390/nu10010078] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/05/2017] [Accepted: 01/09/2018] [Indexed: 02/07/2023] Open
Abstract
Protein-rich supplements are used widely for the prevention and management of malnutrition in older people. We have reported that healthy older, compared to younger, adults have less suppression of energy intake by whey-protein-effects on appetite-related hormones are unknown. The objective was to determine the effects of intraduodenally administered whey-protein on glucose, gut hormone, and amino acid concentrations, and their relation to subsequent ad libitum energy intake at a buffet meal, in healthy older and younger men. Hydrolyzed whey-protein (30 kcal, 90 kcal, and 180 kcal) and a saline control (~0 kcal) were infused intraduodenally for 60 min in 10 younger (19-29 years, 73 ± 2 kg, 22 ± 1 kg/m²) and 10 older (68-81 years, 79 ± 2 kg, 26 ± 1 kg/m²) healthy men in a randomized, double-blind fashion. Plasma insulin, glucagon, gastric inhibitory peptide (GIP), glucagon-like peptide-1 (GLP-1), peptide tyrosine-tyrosine (PYY), and amino acid concentrations, but not blood glucose, increased, while ghrelin decreased during the whey-protein infusions. Plasma GIP concentrations were greater in older than younger men. Energy intake correlated positively with plasma ghrelin and negatively with insulin, glucagon, GIP, GLP-1, PYY, and amino acids concentrations (p < 0.05). In conclusion, intraduodenal whey-protein infusions resulted in increased GIP and comparable ghrelin, insulin, glucagon, GIP, GLP-1, PYY, and amino acid responses in healthy older and younger men, which correlated to subsequent energy intake.
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Affiliation(s)
- Caroline Giezenaar
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide 5000, Australia; (C.G.); (N.D.L.-M.); (A.T.H.); (S.S.); (C.F.-B.); (M.H.); (I.C.)
| | - Natalie D Luscombe-Marsh
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide 5000, Australia; (C.G.); (N.D.L.-M.); (A.T.H.); (S.S.); (C.F.-B.); (M.H.); (I.C.)
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Food and Nutrition, Adelaide 5000, Australia
| | - Amy T Hutchison
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide 5000, Australia; (C.G.); (N.D.L.-M.); (A.T.H.); (S.S.); (C.F.-B.); (M.H.); (I.C.)
| | - Scott Standfield
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide 5000, Australia; (C.G.); (N.D.L.-M.); (A.T.H.); (S.S.); (C.F.-B.); (M.H.); (I.C.)
| | - Christine Feinle-Bisset
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide 5000, Australia; (C.G.); (N.D.L.-M.); (A.T.H.); (S.S.); (C.F.-B.); (M.H.); (I.C.)
| | - Michael Horowitz
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide 5000, Australia; (C.G.); (N.D.L.-M.); (A.T.H.); (S.S.); (C.F.-B.); (M.H.); (I.C.)
| | - Ian Chapman
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide 5000, Australia; (C.G.); (N.D.L.-M.); (A.T.H.); (S.S.); (C.F.-B.); (M.H.); (I.C.)
| | - Stijn Soenen
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide 5000, Australia; (C.G.); (N.D.L.-M.); (A.T.H.); (S.S.); (C.F.-B.); (M.H.); (I.C.)
- Correspondence: ; Tel.: +61-8-8313-3638
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Leskova IV, Mazurina NV, Troshina EA, Ermakov DN, Didenko EA, Adamskaya LV. Social and medical aspects of elderly age: obesity and professional longevity. OBESITY AND METABOLISM 2017. [DOI: 10.14341/omet2017410-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The article raises the problem of the population aging and the expected significant increase in the proportion of the elderly population in Russian in the next 1015 years. Population aging will cause the need to attract additional financial resources for pensions to 1214% of GDP, which is approximately 1.5 1.6 times more than is provided for by the program of the Government of Russia aimed at improving the pension System in the period until 2025. The existing pension system and social security system only partially takes into account the aging process. Mechanisms for adapting the elderly to work have not yet been created, a well-thought-out state policy in this area has yet to be developed. In addition, the aging of the population leads to an increase in the older age groups of the risks of diseases with severe and catastrophic consequences, to prevent and reduce which is the number one task before the social policy of the state for this population group. The costs of medical care and care help are exorbitant in scope for the vast majority of retirees, so the elderly remain virtually defenseless against the risks of old age. It is emphasized that before medicine the task is not simply to increase life expectancy, but to prolong the labor activity of a citizen. The article suggests measures to improve the policy of interaction between state institutions and civil society in overcoming the negative consequences of aging and social adaptation of older persons.
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Giezenaar C, Coudert Z, Baqeri A, Jensen C, Hausken T, Horowitz M, Chapman I, Soenen S. Effects of Timing of Whey Protein Intake on Appetite and Energy Intake in Healthy Older Men. J Am Med Dir Assoc 2017; 18:898.e9-898.e13. [PMID: 28804009 DOI: 10.1016/j.jamda.2017.06.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/26/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Protein-rich supplements are used widely to prevent and manage malnutrition in older adults. We previously showed that 30 g whey protein ingestion, 3 hours before a buffet meal, suppressed energy intake in young, but not in older men. Information about the impact of the timing of ingestion of protein drinks on the suppression of energy intake in older adults is lacking. OBJECTIVE The aim of the study was to determine the effect of the timing of whey protein ingestion on appetite and subsequent ad libitum energy intake in healthy older men. DESIGN In a single blind, randomized design, 16 older men were studied on 5 occasions, on which they consumed a whey protein drink (30 g/120 kcal, 140 mL) 3, 2, 1 hour(s), or immediately before a buffet meal, from which ad libitum energy intake was quantified, and isopalatable noncaloric drinks (∼1 kcal) at the remaining time points. On the control day, noncaloric drinks were ingested at all time points. Perceptions of appetite and gastrointestinal symptoms were determined, by visual analog scales, throughout the study days. RESULTS There was no effect of the timing of protein ingestion on perceptions of appetite and gastrointestinal symptoms (P > .05) or energy intake at the buffet meal (3 hours: 888 ± 49 kcal, 2 hours: 879 ± 56 kcal, 1 hours: 909 ± 47 kcal, 0 hour: 892 ± 51 kcal, control: 930 ± 49 kcal, P = .94). Total energy intake (ie, preload + test meal) was higher on the protein days compared with control (82 ± 24 kcal increase, P = .003). CONCLUSIONS In older men, ingestion of 30 g protein increased total energy intake, irrespective of the time of intake in relation to the meal. These observations support the use of "pure" whey protein drinks to increase overall protein and energy intake in older adults at risk of undernutrition.
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Affiliation(s)
- Caroline Giezenaar
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Zoé Coudert
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Abdul Baqeri
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Caroline Jensen
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Section for Neuroendocrine Gastroenterology, Division of Gastroenterology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Trygve Hausken
- Section for Neuroendocrine Gastroenterology, Division of Gastroenterology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Michael Horowitz
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ian Chapman
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stijn Soenen
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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27
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Forman DE, Santanasto AJ, Boudreau R, Harris T, Kanaya AM, Satterfield S, Simonsick EM, Butler J, Kizer JR, Newman AB. Impact of Incident Heart Failure on Body Composition Over Time in the Health, Aging, and Body Composition Study Population. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.003915. [PMID: 28899988 DOI: 10.1161/circheartfailure.117.003915] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/15/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Prevalence of heart failure (HF) increases significantly with age, coinciding with age-related changes in body composition that are common and consequential. Still, body composition is rarely factored in routine HF care. METHODS AND RESULTS The Health, Aging, and Body Composition study is a prospective cohort study of nondisabled adults. Using yearly dual-energy x-ray absorptiometry, body composition was assessed in the Health, Aging, and Body Composition study over 6 years, comparing those who developed incident HF versus those who did not. Among 2815 Health, Aging, and Body Composition participants (48.5% men; 59.6% whites; mean age, 73.6±2.9 years), 111 developed incident HF over the 6-year study period. At entry into the Health, Aging, and Body Composition study, men and women who later developed HF had higher total body mass when compared with those versus those who did not develop HF (men, 80.9±10 versus 78.6±12.9 kg, P=0.05; women, 72.7±15.0 versus 68.2±14.2 kg, P=0.01, respectively). However, after developing HF, loss of total lean body mass was disproportionate; men with HF lost 654.6 versus 391.4 g/y in non-HF participants, P=0.02. Loss of appendicular lean mass was also greater with HF (-419.9 versus -318.2 g/y; P=0.02), even after accounting for total weight change. Among women with HF, loss of total and appendicular lean mass were also greater than in non-HF participants but not to the extent seen among men. CONCLUSIONS Incident HF in older adults was associated with disproportionate loss of lean mass, particularly among men. Prognostic implications are significant, with key sex-specific inferences on physical function, frailty, disability, and pharmacodynamics that all merit further investigation.
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Affiliation(s)
- Daniel E Forman
- From the Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System (D.E.F.), Department of Epidemiology, Center for Aging and Population Health (A.J.S.), Department of Epidemiology, Graduate School of Public Health (R.B.), and Epidemiology, Medicine, and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA; Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.H.); Division of General Internal Medicine, University of California in San Francisco (A.M.K.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); Intramural Research Program, National Institute on Aging, Baltimore, MD (E.M.S.); Division of Cardiology, Stony Brook University, NY (J.B.); and Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY (J.R.K.).
| | - Adam J Santanasto
- From the Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System (D.E.F.), Department of Epidemiology, Center for Aging and Population Health (A.J.S.), Department of Epidemiology, Graduate School of Public Health (R.B.), and Epidemiology, Medicine, and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA; Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.H.); Division of General Internal Medicine, University of California in San Francisco (A.M.K.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); Intramural Research Program, National Institute on Aging, Baltimore, MD (E.M.S.); Division of Cardiology, Stony Brook University, NY (J.B.); and Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY (J.R.K.)
| | - Robert Boudreau
- From the Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System (D.E.F.), Department of Epidemiology, Center for Aging and Population Health (A.J.S.), Department of Epidemiology, Graduate School of Public Health (R.B.), and Epidemiology, Medicine, and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA; Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.H.); Division of General Internal Medicine, University of California in San Francisco (A.M.K.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); Intramural Research Program, National Institute on Aging, Baltimore, MD (E.M.S.); Division of Cardiology, Stony Brook University, NY (J.B.); and Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY (J.R.K.)
| | - Tamara Harris
- From the Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System (D.E.F.), Department of Epidemiology, Center for Aging and Population Health (A.J.S.), Department of Epidemiology, Graduate School of Public Health (R.B.), and Epidemiology, Medicine, and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA; Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.H.); Division of General Internal Medicine, University of California in San Francisco (A.M.K.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); Intramural Research Program, National Institute on Aging, Baltimore, MD (E.M.S.); Division of Cardiology, Stony Brook University, NY (J.B.); and Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY (J.R.K.)
| | - Alka M Kanaya
- From the Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System (D.E.F.), Department of Epidemiology, Center for Aging and Population Health (A.J.S.), Department of Epidemiology, Graduate School of Public Health (R.B.), and Epidemiology, Medicine, and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA; Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.H.); Division of General Internal Medicine, University of California in San Francisco (A.M.K.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); Intramural Research Program, National Institute on Aging, Baltimore, MD (E.M.S.); Division of Cardiology, Stony Brook University, NY (J.B.); and Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY (J.R.K.)
| | - Suzanne Satterfield
- From the Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System (D.E.F.), Department of Epidemiology, Center for Aging and Population Health (A.J.S.), Department of Epidemiology, Graduate School of Public Health (R.B.), and Epidemiology, Medicine, and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA; Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.H.); Division of General Internal Medicine, University of California in San Francisco (A.M.K.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); Intramural Research Program, National Institute on Aging, Baltimore, MD (E.M.S.); Division of Cardiology, Stony Brook University, NY (J.B.); and Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY (J.R.K.)
| | - Eleanor M Simonsick
- From the Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System (D.E.F.), Department of Epidemiology, Center for Aging and Population Health (A.J.S.), Department of Epidemiology, Graduate School of Public Health (R.B.), and Epidemiology, Medicine, and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA; Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.H.); Division of General Internal Medicine, University of California in San Francisco (A.M.K.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); Intramural Research Program, National Institute on Aging, Baltimore, MD (E.M.S.); Division of Cardiology, Stony Brook University, NY (J.B.); and Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY (J.R.K.)
| | - Javed Butler
- From the Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System (D.E.F.), Department of Epidemiology, Center for Aging and Population Health (A.J.S.), Department of Epidemiology, Graduate School of Public Health (R.B.), and Epidemiology, Medicine, and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA; Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.H.); Division of General Internal Medicine, University of California in San Francisco (A.M.K.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); Intramural Research Program, National Institute on Aging, Baltimore, MD (E.M.S.); Division of Cardiology, Stony Brook University, NY (J.B.); and Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY (J.R.K.)
| | - Jorge R Kizer
- From the Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System (D.E.F.), Department of Epidemiology, Center for Aging and Population Health (A.J.S.), Department of Epidemiology, Graduate School of Public Health (R.B.), and Epidemiology, Medicine, and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA; Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.H.); Division of General Internal Medicine, University of California in San Francisco (A.M.K.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); Intramural Research Program, National Institute on Aging, Baltimore, MD (E.M.S.); Division of Cardiology, Stony Brook University, NY (J.B.); and Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY (J.R.K.)
| | - Anne B Newman
- From the Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System (D.E.F.), Department of Epidemiology, Center for Aging and Population Health (A.J.S.), Department of Epidemiology, Graduate School of Public Health (R.B.), and Epidemiology, Medicine, and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA; Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.H.); Division of General Internal Medicine, University of California in San Francisco (A.M.K.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (S.S.); Intramural Research Program, National Institute on Aging, Baltimore, MD (E.M.S.); Division of Cardiology, Stony Brook University, NY (J.B.); and Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY (J.R.K.)
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Associations between body mass index and mortality or cardiovascular events in a general Korean population. PLoS One 2017; 12:e0185024. [PMID: 28915262 PMCID: PMC5600387 DOI: 10.1371/journal.pone.0185024] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 09/05/2017] [Indexed: 12/15/2022] Open
Abstract
Background/Objectives The relationship between body mass index (BMI) and mortality remains controversial. Furthermore, the association between BMI and cardiovascular events (CVE) is not conclusive and may differ by ethnicity. We aimed to estimate the associations between the BMI and mortality or cardiovascular disease in a general Korean population. Subjects/Methods This study was based on a sample cohort database released by the Korean National Health Insurance Service. We analyzed a total of 415,796 adults older than 30 years of age who had undergone a national health examination at least once from 2002 to 2012. Hazard ratios for death and cardiovascular events were calculated using Cox proportional hazards models. Results For both men and women, BMI and overall mortality showed a U-shaped association, with the lowest mortality rate among those with a BMI of 25–27.4 kg/m2. Compared with them, subjects with a BMI ≥ 30kg/m2, men with a BMI < 25 kg/m2, and women with a BMI < 22.5 kg/m2 showed significantly higher overall mortality. Additionally, men with a BMI < 22.5 kg/m2 and women with a BMI < 20 kg/m2 displayed an increased risk of cardiovascular mortality. Unlike the mortality trend, the CVD events trend showed a linearly positive association. The risk of a CVE was the lowest in men with a BMI ranging from 20 to 22.4 kg/m2 and in women with a BMI < 20 kg/m2. Conclusions The BMI showed a U-shaped association with overall mortality, where slightly obese subjects showed the lowest rate of mortality. The CVE exhibited a linear association with the BMI, where the lowest risk was observed for normal weight subjects in a general Korean population.
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29
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Giezenaar C, Trahair LG, Luscombe-Marsh ND, Hausken T, Standfield S, Jones KL, Lange K, Horowitz M, Chapman I, Soenen S. Effects of randomized whey-protein loads on energy intake, appetite, gastric emptying, and plasma gut-hormone concentrations in older men and women. Am J Clin Nutr 2017; 106:865-877. [PMID: 28747330 DOI: 10.3945/ajcn.117.154377] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 06/27/2017] [Indexed: 02/05/2023] Open
Abstract
Background: Protein- and energy-rich supplements are used widely for the management of malnutrition in the elderly. Information about the effects of protein on energy intake and related gastrointestinal mechanisms and whether these differ between men and women is limited.Objective: We determined the effects of whey protein on energy intake, appetite, gastric emptying, and gut hormones in healthy older men and women.Design: Eight older women and 8 older men [mean ± SEM age: 72 ± 1 y; body mass index (in kg/m2): 25 ± 1] were studied on 3 occasions in which they received protein loads of 30 g (120 kcal) or 70 g (280 kcal) or a flavored water control drink (0 kcal). At regular intervals over 180 min, appetite (visual analog scales), gastric emptying (3-dimensional ultrasonography), and blood glucose and plasma gut-hormone concentrations [insulin, glucagon, ghrelin, cholecystokinin, gastric inhibitory polypeptide (GIP), glucagon-like peptide 1 (GLP-1), and peptide tyrosine tyrosine (PYY)] were measured, and ad libitum energy intake was quantified from a buffet meal (180-210 min; energy intake, appetite, and gastric emptying in the men have been published previously).Results: Energy intake at the buffet meal was ∼80% higher in older men than in older women (P < 0.001). Energy intake was not suppressed by protein compared with the control in men or women (P > 0.05). There was no effect of sex on gastric emptying, appetite, gastrointestinal symptoms, glucose, or gut hormones (P > 0.05). There was a protein load-dependent slowing of gastric emptying, an increase in concentrations of insulin, glucagon, cholecystokinin, GIP, GLP-1, and PYY, and an increase in total energy intake (drink plus meal: 12% increase with 30 g and 32% increase with 70 g; P < 0.001). Energy intake at the buffet meal was inversely related to the stomach volume and area under the curve of hormone concentrations (P < 0.05).Conclusion: In older men and women, whey-protein drinks load-dependently slow gastric emptying and alter gut hormone secretion compared with a control but have no suppressive effect on subsequent ad libitum energy intake. This trial was registered at www.anzctr.org.au as ACTRN12612000941864.
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Affiliation(s)
- Caroline Giezenaar
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Laurence G Trahair
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Natalie D Luscombe-Marsh
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
- The Commonwealth Scientific and Industrial Research Organisation, Animal, Food and Health Sciences, Adelaide, South Australia, Australia; and
| | - Trygve Hausken
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Scott Standfield
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Karen L Jones
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kylie Lange
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Michael Horowitz
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ian Chapman
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Stijn Soenen
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia;
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Lavie CJ, Oktay AA, Milani RV. The obesity paradox and obesity severity in elderly STEMI patients. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2017; 3:166-167. [DOI: 10.1093/ehjqcco/qcx018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Carl J. Lavie
- The John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121-2483, USA
| | - Ahmet Afşin Oktay
- The John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121-2483, USA
| | - Richard V. Milani
- The John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121-2483, USA
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Sandbakk SB, Nauman J, Lavie CJ, Wisløff U, Stensvold D. Combined Association of Cardiorespiratory Fitness and Body Fatness With Cardiometabolic Risk Factors in Older Norwegian Adults: The Generation 100 Study. Mayo Clin Proc Innov Qual Outcomes 2017; 1:67-77. [PMID: 30225403 PMCID: PMC6135019 DOI: 10.1016/j.mayocpiqo.2017.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective To investigate the independent and combined associations of fitness and fatness with cardiometabolic risk factors in older Norwegian women and men. Patients and Methods We conducted a cross-sectional study of 505 women and 417 men aged 70 to 77 years enrolled in the Generation 100 study in Norway. Fitness was assessed as peak oxygen uptake and fatness as high body mass index (BMI; ≥25 kg/m2), waist circumference (WC) of 88 cm or greater for women and 102 cm or greater for men, and percent body fat (%BF) of 35% or greater and 25% or greater for women and men, respectively. High cardiometabolic risk was defined as the presence of 2 or more of the following risk factors: elevated triglyceride level, reduced high-density lipoprotein cholesterol concentration, elevated blood pressure, and elevated fasting glucose level or pharmacological treatment of these conditions. Results Receiver operating characteristic curve analyses identified fitness levels of less than 25.7 and less than 30.7 mL/kg per minute in women and men, respectively, as critical thresholds for having high cardiometabolic risk. Individuals with levels below these thresholds had an adjusted odds ratio of 2.77 (95% CI, 2.09-3.66) for having high cardiometabolic risk, while high BMI, WC, and %BF had odds ratios (95% CIs) of 3.58 (2.69-4.77), 3.06 (2.29-4.10), and 3.26 (2.47-4.30), respectively. In our combined analyses, being lean did not attenuate the cardiometabolic risk associated with low fitness, and combinations of low fitness and/or high BMI, WC, or %BF cumulatively increased cardiometabolic risk. Conclusion Low fitness and indication of fatness were independently and cumulatively associated with poor cardiometabolic health. Our results emphasize the importance of including both physical fitness and body fatness in the assessment of cardiometabolic risk and health promotion efforts in older adults.
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Key Words
- %BF, percent body fat
- AUC, area under the curve
- BMI, body mass index
- BP, blood pressure
- CV, cardiovascular
- CVD, CV disease
- HDL-C, high-density lipoprotein cholesterol
- HTN, hypertension
- HbA1c, glycated hemoglobin
- OR, odds ratio
- PA, physical activity
- ROC, receiver operating characteristic
- T2D, type 2 diabetes
- TG, triglyceride
- VO2peak, peak oxygen uptake
- WC, waist circumference
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Affiliation(s)
- Silvana B. Sandbakk
- K. G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Javaid Nauman
- K. G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Carl J. Lavie
- University of South Carolina, Columbia, SC
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA
| | - Ulrik Wisløff
- K. G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
- Correspondence: Address to Ulrik Wisløff, PhD, K. G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, NTNU, Post Box 8905, Medisinsk Teknisk Forskningssenter, 7491 Trondheim, Norway.
| | - Dorthe Stensvold
- K. G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Obesity in Middle Age Increases Risk of Later Heart Failure in Women—Results From the Prospective Population Study of Women and H70 Studies in Gothenburg, Sweden. J Card Fail 2017; 23:363-369. [DOI: 10.1016/j.cardfail.2016.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 11/30/2016] [Accepted: 12/05/2016] [Indexed: 01/03/2023]
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Abstract
The prevalence of obesity and disability in older adults has significant public health implications. This case review discusses the benefits and risks of weight loss in older adults and outlines treatment options available to Medicare beneficiaries. The importance of preserving lean muscle mass in weight management is emphasized.
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Ben-Yacov L, Ainembabazi P, Stark AH. Is it time to update body mass index standards in the elderly or embrace measurements of body composition? Eur J Clin Nutr 2017; 71:1029-1032. [DOI: 10.1038/ejcn.2017.39] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/13/2017] [Accepted: 02/21/2017] [Indexed: 01/25/2023]
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Klatsky AL, Zhang J, Udaltsova N, Li Y, Tran HN. Body Mass Index and Mortality in a Very Large Cohort: Is It Really Healthier to Be Overweight? Perm J 2017; 21:16-142. [PMID: 28678695 PMCID: PMC5499607 DOI: 10.7812/tpp/16-142] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Controversy persists about optimal body weight. Many experts define "normal" (healthy) body mass index (BMI) as 18.5 to 24.9 kg/m2, 25 to 29.9 kg/m2 as overweight, and 30 kg/m2 or greater as obese. Obesity is subdivided into 30 to 34.9 kg/m2 (Grade 1), 35 to 39.9 kg/m2 (Grade 2), and 40 kg/m2 and above (Grade 3). Studies consistently show higher mortality for underweight and Grade 2 or 3 obesity, but results conflict for the overweight category and Grade 1 obesity. OBJECTIVE To study 30-year risk of death related to baseline BMI. DESIGN Retrospective cohort study in a multiracial population of 273,843 persons using logistic regression with 7 covariates (sex, age, race-ethnicity, education, marital status, smoking, alcohol intake). MAIN OUTCOME MEASURES Mortality risk by baseline BMI. RESULTS With average follow-up exceeding 30 years, there were 103,218 deaths: 41,215 attributed to cardiovascular causes and 62,003 to noncardiovascular causes. Odds ratios (and 95% confidence intervals) for all deaths in BMI categories, with a BMI of 18.5 to 24.9 kg/m2 as the referent, were BMI below 18.5 kg/m2 = 1.1 (1.0-2.0), BMI 25 to 29 kg/m2 = 1.1 (1.1-1.2), BMI 30 to 34 kg/m2 = 1.5 (1.4-1.5), BMI 35 to 39 kg/m2 = 2.1 (1.9-2.3), and BMI 40 kg/m2 or higher = 2.7 (2.4-3.0). Disparities existed regarding age, race/ethnicity, cause of death, and interval to death. CONCLUSION Compared with persons with BMI defined as normal, persons who were underweight, overweight, and obese were at increased risk of death over 30 years.
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Affiliation(s)
- Arthur L Klatsky
- Senior Consultant in Cardiology and an Adjunct Investigator in the Division of Research, Kaiser Permanente Medical Care Program in Oakland, CA.
| | | | | | - Yan Li
- Hematologist and Oncologist at the Oakland Medical Center in CA.
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Abstract
Obesity produces various hemodynamic alterations and changes in cardiac morphology that predispose to ventricular dysfunction and heart failure (HF). Obesity may serve as a risk factor for or the primary cause of HF. Obesity is also associated with impairment of cardiorespiratory fitness. An obesity paradox exists with respect to mortality in those with HF wherein overweight and mildly to moderately obese individuals have a better prognosis than underweight or normal weight persons. Cardiorespiratory fitness is an important determinant of the prognosis in obesity. Many of the alterations in cardiac structure and function as well as the clinical manifestations of HF are reversible with substantial weight loss in moderately to severely obese individuals.
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Ortega FB, Lavie CJ, Blair SN. Obesity and Cardiovascular Disease. Circ Res 2016; 118:1752-70. [DOI: 10.1161/circresaha.115.306883] [Citation(s) in RCA: 578] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/11/2016] [Indexed: 12/20/2022]
Abstract
The prevalence of obesity has increased worldwide over the past few decades. In 2013, the prevalence of obesity exceeded the 50% of the adult population in some countries from Oceania, North Africa, and Middle East. Lower but still alarmingly high prevalence was observed in North America (≈30%) and in Western Europe (≈20%). These figures are of serious concern because of the strong link between obesity and disease. In the present review, we summarize the current evidence on the relationship of obesity with cardiovascular disease (CVD), discussing how both the degree and the duration of obesity affect CVD. Although in the general population, obesity and, especially, severe obesity are consistently and strongly related with higher risk of CVD incidence and mortality, the one-size-fits-all approach should not be used with obesity. There are relevant factors largely affecting the CVD prognosis of obese individuals. In this context, we thoroughly discuss important concepts such as the fat-but-fit paradigm, the metabolically healthy but obese (MHO) phenotype and the obesity paradox in patients with CVD. About the MHO phenotype and its CVD prognosis, available data have provided mixed findings, what could be partially because of the adjustment or not for key confounders such as cardiorespiratory fitness, and to the lack of consensus on the MHO definition. In the present review, we propose a scientifically based harmonized definition of MHO, which will hopefully contribute to more comparable data in the future and a better understanding on the MHO subgroup and its CVD prognosis.
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Affiliation(s)
- Francisco B. Ortega
- From the PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain (F.B.O.); Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden (F.B.O.); Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA (C.J.L.); and
| | - Carl J. Lavie
- From the PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain (F.B.O.); Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden (F.B.O.); Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA (C.J.L.); and
| | - Steven N. Blair
- From the PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain (F.B.O.); Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden (F.B.O.); Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA (C.J.L.); and
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Lavie CJ, De Schutter A, Parto P, Jahangir E, Kokkinos P, Ortega FB, Arena R, Milani RV. Obesity and Prevalence of Cardiovascular Diseases and Prognosis-The Obesity Paradox Updated. Prog Cardiovasc Dis 2016; 58:537-47. [PMID: 26826295 DOI: 10.1016/j.pcad.2016.01.008] [Citation(s) in RCA: 328] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 01/27/2016] [Indexed: 12/18/2022]
Abstract
The prevalence and severity of obesity have increased in the United States and most of the Westernized World over recent decades, reaching worldwide epidemics. Since obesity worsens most of the cardiovascular disease (CVD) risk factors, not surprisingly, most CVDs, including hypertension, coronary heart disease, heart failure, and atrial fibrillation, are all increased in the setting of obesity. However, many studies and meta-analyses have demonstrated an obesity paradox with regards to prognosis in CVD patients, with often the overweight and mildly obese having a better prognosis than do their leaner counterparts with the same CVD. The implication for fitness to markedly alter the relationship between adiposity and prognosis and the potential impact of weight loss, in light of the obesity paradox, are all reviewed.
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Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA, USA.
| | - Alban De Schutter
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA, USA
| | - Parham Parto
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA, USA
| | - Eiman Jahangir
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA, USA
| | - Peter Kokkinos
- Veterans Affairs Medical Center, Cardiology Department, Georgetown University School of Medicine, Washington, DC, USA
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Department of Physical Education and Sports, Faculty of Sports Sciences, University of Granada, Granada, Spain
| | - Ross Arena
- Department of Physical Therapy, Department of Kinesiology and Nutrition, Integrative Physiology Laboratory, College of Applied Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Richard V Milani
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA, USA
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Sharma S, Batsis JA, Coutinho T, Somers VK, Hodge DO, Carter RE, Sochor O, Kragelund C, Kanaya AM, Zeller M, Park JS, Køber L, Torp-Pedersen C, Lopez-Jimenez F. Normal-Weight Central Obesity and Mortality Risk in Older Adults With Coronary Artery Disease. Mayo Clin Proc 2016; 91:343-51. [PMID: 26860580 DOI: 10.1016/j.mayocp.2015.12.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/25/2015] [Accepted: 12/11/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To study the relationship between body mass index (BMI) and central obesity and mortality in elderly patients with coronary artery disease (CAD). PATIENTS AND METHODS We identified 7057 patients 65 years or older from 5 cohort studies assessing mortality risk using either waist circumference (WC) or waist-hip ratio (WHR) in patients with CAD from January 1, 1980, to December 31, 2008. Normal weight, overweight, and obesity were defined using standard BMI cutoffs. High WHR was defined as 0.85 or more for women and 0.90 or more for men. High WC was defined as 88 cm or more for women and 102 cm or more for men. Separate models examined WC or WHR in combination with BMI (6 categories each) as the primary predictor (referent = normal BMI and normal WC or WHR). Cox proportional hazards models investigated the relationship between these obesity categories and mortality. RESULTS Patients' mean age was 73.0±6.0 years (3741 [53%] women). The median censor time was 7.1 years. A normal BMI with central obesity (high WHR or high WC) demonstrated highest mortality risk (hazard ratio [HR], 1.29; 95% CI, 1.14-1.46; HR, 1.29; 95% CI, 1.12-1.50, respectively). High WHR was also predictive of mortality in the overall (HR, 2.14; 95% CI, 1.93-2.38) as well as in the sex-specific cohort. In the overall cohort, high WC was not predictive of mortality (HR, 1.04; 95% CI, 0.97-1.12); however, it predicted higher risk in men (HR, 1.12; 95% CI, 1.01-1.24). CONCLUSION In older adults with CAD, normal-weight central obesity defined using either WHR or WC is associated with high mortality risk, highlighting a need to combine measures in adiposity-related risk assessment.
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Affiliation(s)
- Saurabh Sharma
- Division of Cardiovascular Diseases, Einstein Heart and Vascular Institute, Einstein Medical Center, Philadelphia, PA; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH; Dartmouth Institute for Health Policy & Clinical Practice, Hanover, NH; Centers for Health and Aging and the Health Promotion Research Center at Dartmouth, Dartmouth College, Hanover, NH
| | - Thais Coutinho
- Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada
| | - Virend K Somers
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - David O Hodge
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Rickey E Carter
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Ondrej Sochor
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic
| | | | - Alka M Kanaya
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA
| | - Marianne Zeller
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, University of Bourgogne-Franche-Comté, Dijon, France
| | - Jong-Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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Doshi M, Streja E, Rhee CM, Park J, Ravel VA, Soohoo M, Moradi H, Lau WL, Mehrotra R, Kuttykrishnan S, Kovesdy CP, Kalantar-Zadeh K, Chen JLT. Examining the robustness of the obesity paradox in maintenance hemodialysis patients: a marginal structural model analysis. Nephrol Dial Transplant 2015; 31:1310-9. [PMID: 26590266 DOI: 10.1093/ndt/gfv379] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 10/08/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The inverse association between body mass index (BMI) and mortality observed in patients treated with maintenance hemodialysis (MHD), also known as the obesity paradox, may be a result of residual confounding. Marginal structural model (MSM) analysis, a technique that accounts for time-varying confounders, may be more appropriate to investigate this association. We hypothesize that after applying MSM, the inverse association between BMI and mortality in MHD patients is attenuated. METHODS We examined the associations between BMI and all-cause mortality among 123 624 adult MHD patients treated during 2001-6. We examined baseline and time-varying BMI using Cox proportional hazards models and MSM while considering baseline and time-varying covariates, including demographics, comorbidities and markers of malnutrition and inflammation. RESULTS The patients included 45% women and 32% African Americans with a mean age of 61(SD 15) years. In all models, BMI showed a linear incremental inverse association with mortality. Compared with the reference (BMI 25 to <27.5 kg/m(2)), a BMI of <18 kg/m(2) was associated with a 3.2-fold higher death risk [hazard ratio (HR) 3.17 (95% CI 3.05-3.29)], and mortality risks declined with increasing BMI with the greatest survival advantage of 31% lower risk [HR 0.69 (95% CI 0.64-0.75)] observed with a BMI of 40 to <45 kg/m(2). CONCLUSIONS The linear inverse relationship between BMI and mortality is robust across models including MSM analyses that more completely account for time-varying confounders and biases.
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Affiliation(s)
- Megha Doshi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Jongha Park
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA Division of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Vanessa A Ravel
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Hamid Moradi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, CA, USA
| | - Wei Ling Lau
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Rajnish Mehrotra
- Harborview Medical Center and Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Sooraj Kuttykrishnan
- Harborview Medical Center and Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, CA, USA Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Joline L T Chen
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, CA, USA
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Giezenaar C, Trahair LG, Rigda R, Hutchison AT, Feinle-Bisset C, Luscombe-Marsh ND, Hausken T, Jones KL, Horowitz M, Chapman I, Soenen S. Lesser suppression of energy intake by orally ingested whey protein in healthy older men compared with young controls. Am J Physiol Regul Integr Comp Physiol 2015; 309:R845-54. [PMID: 26290103 PMCID: PMC4666943 DOI: 10.1152/ajpregu.00213.2015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/13/2015] [Indexed: 02/07/2023]
Abstract
Protein-rich supplements are used widely for the management of malnutrition in young and older people. Protein is the most satiating of the macronutrients in young. It is not known how the effects of oral protein ingestion on energy intake, appetite, and gastric emptying are modified by age. The aim of the study was to determine the suppression of energy intake by protein compared with control and underlying gastric-emptying and appetite responses of oral whey protein drinks in eight healthy older men (69-80 yr) compared with eight young male controls (18-34 yr). Subjects were studied on three occasions to determine the effects of protein loads of 30 g/120 kcal and 70 g/280 kcal compared with a flavored water control-drink (0 g whey protein) on energy intake (ad libitum buffet-style meal), and gastric emptying (three-dimensional-ultrasonography) and appetite (0-180 min) in a randomized, double-blind, cross-over design. Energy intake was suppressed by the protein compared with control (P = 0.034). Suppression of energy intake by protein was less in older men (1 ± 5%) than in young controls (15 ± 2%; P = 0.008). Cumulative energy intake (meal+drink) on the protein drink days compared with the control day increased more in older (18 ± 6%) men than young (1 ± 3%) controls (P = 0.008). Gastric emptying of all three drinks was slower in older men (50% gastric-emptying time: 68 ± 5 min) than young controls (36 ± 5 min; P = 0.007). Appetite decreased in young, while it increased in older (P < 0.05). In summary, despite having slower gastric emptying, elderly men exhibited blunted protein-induced suppression of energy intake by whey protein compared with young controls, so that in the elderly men, protein ingestion increased overall energy intake more than in the young men.
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Affiliation(s)
- Caroline Giezenaar
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Laurence G Trahair
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Rachael Rigda
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Amy T Hutchison
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Christine Feinle-Bisset
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Natalie D Luscombe-Marsh
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia; Commonwealth Scientific and Industrial Research Organisation Animal, Food and Health Sciences, Adelaide, Australia; and
| | - Trygve Hausken
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia; Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Karen L Jones
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Michael Horowitz
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Ian Chapman
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Stijn Soenen
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia;
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43
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Douglas BM, Howard EP. Predictors of Self-Management Behaviors in Older Adults with Hypertension. Adv Prev Med 2015; 2015:960263. [PMID: 26347824 PMCID: PMC4549485 DOI: 10.1155/2015/960263] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/22/2015] [Indexed: 01/11/2023] Open
Abstract
The purpose of this study was to develop a prediction model of demographic and sociobehavioral characteristics common among older adults with hypertension (HTN) who engage in self-management behavior. A descriptive, correlational predictive design was used to collect data at 14 faith-based and senior citizen organizations in a major urban northeastern city. Participants ranged in age from 63 to 96 with a mean age of 77 (SD 6.9). A 33-item questionnaire was used to gather data on 15 explanatory and 5 outcome variables. Instruments were the Perceived Stress Scale, the Duke Social Support Index, the stage of change for physical activity scale, and the DASH Food Frequency Questionnaire. Correlation and regression analyses were used to test the hypothesis. Results indicate there is a common set of characteristics such as higher stage of change, reading food labels, and higher self-rated health that can predict the older adult's likelihood to engage in hypertension self-management behavior. The significant correlations found in this preliminary study warrant further study and validation. Findings are clinically relevant as knowledge of demographic and sociobehavioral characteristics associated with engagement in self-management behavior enables health care clinicians to support and encourage older adults to improve management of this common, chronic condition.
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Affiliation(s)
- Brenda M. Douglas
- Northeastern University, 360 Huntington Avenue, 103 Robinson Hall, Boston, MA 02115, USA
| | - Elizabeth P. Howard
- Northeastern University, 360 Huntington Avenue, 103 Robinson Hall, Boston, MA 02115, USA
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44
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Aging, Nutritional Status and Health. Healthcare (Basel) 2015; 3:648-58. [PMID: 27417787 PMCID: PMC4939559 DOI: 10.3390/healthcare3030648] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/07/2015] [Accepted: 07/23/2015] [Indexed: 01/06/2023] Open
Abstract
The older population is increasing worldwide and in many countries older people will outnumber younger people in the near future. This projected growth in the older population has the potential to place significant burdens on healthcare and support services. Meeting the diet and nutrition needs of older people is therefore crucial for the maintenance of health, functional independence and quality of life. While many older adults remain healthy and eat well those in poorer health may experience difficulties in meeting their nutritional needs. Malnutrition, encompassing both under and over nutrition increases health risks in the older population. More recently the increase in obesity, and in turn the incidence of chronic disease in older adults, now justifies weight management interventions in obese older adults. This growing population group is becoming increasingly diverse in their nutritional requirements. Micro-nutrient status may fluctuate and shortfalls in vitamin D, iron and a number of other nutrients are relatively common and can impact on well-being and quality of life. Aging presents a number of challenges for the maintenance of good nutritional health in older adults.
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45
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Abstract
The prevalence of obesity is increasing in the elderly population. The primary goal of obesity therapy in elderly is the improvement of metabolic complications and the prevention of severe functional limitations. Clinical studies could demonstrate that the combination of nutritional intervention and physical exercise is of advantage to improve the functional status. Study evidence about the efficacy and safety of medication for weight reduction in elderly is limited, and the risks of bariatric surgery outweigh the possible benefits. The test battery of the comprehensive geriatric assessment is an important tool to determine body composition, nutritional status as well as functional and cognitive capacities of the elderly patient. These results are of central importance for the treatment plan and goals.
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Affiliation(s)
- Monika Lechleitner
- a Department of Internal Medicine, Hospital Hochzirl, A-6170 Zirl, Austria
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46
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Normandin E, Houston DK, Nicklas BJ. Caloric restriction for treatment of geriatric obesity: Do the benefits outweigh the risks? Curr Nutr Rep 2015; 4:143-155. [PMID: 26213640 PMCID: PMC4509681 DOI: 10.1007/s13668-015-0123-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Most evidence for the health benefits of prescribing caloric restriction (CR) for weight loss is derived from randomized, controlled trials (RCTs) in young/middle-aged adults; there are very few RCTs in older adults in which the isolated effects of CR can be deciphered. The purpose of this review is to summarize the RCT evidence of the benefits (and potential risks) of CR for the treatment of obesity in older adults. We identified only 19 published papers from 10 RCTs ranging from 3 to 18 months that met the criteria of independent effects of a CR component and were conducted in adults with a mean age ≥65 yrs. Overall, the results show a beneficial treatment effect for improving some metabolic, functional and body composition outcomes with few documented risks. However, all outcomes were assessed immediately after treatment cessation. Thus, until additional scientifically rigorous evidence with long-term follow-up is available, the risk-to-benefit ratio of CR for the treatment of obesity in older adults remains unclear.
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Affiliation(s)
- Eve Normandin
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Denise K. Houston
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Barbara J. Nicklas
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Costanzo P, Cleland JG, Pellicori P, Clark AL, Hepburn D, Kilpatrick ES, Perrone-Filardi P, Zhang J, Atkin SL. The obesity paradox in type 2 diabetes mellitus: relationship of body mass index to prognosis: a cohort study. Ann Intern Med 2015; 162:610-8. [PMID: 25938991 DOI: 10.7326/m14-1551] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Whether obesity is associated with a better prognosis in patients with type 2 diabetes mellitus is controversial. OBJECTIVE To investigate the association between body weight and prognosis in a large cohort of patients with type 2 diabetes followed for a prolonged period. DESIGN Prospective cohort. SETTING National Health Service, England. PATIENTS Patients with diabetes. MEASUREMENTS The relationship between body mass index (BMI) and prognosis in patients with type 2 diabetes without known cardiovascular disease at baseline was investigated. Information on all-cause mortality and cardiovascular morbidity (such as the acute coronary syndrome, cerebrovascular accidents, and heart failure) was collected. Cox regression survival analysis, corrected for potential modifiers, including cardiovascular risk factors and comorbid conditions (such as cancer, chronic kidney disease, and lung disease), was done. RESULTS 10,568 patients were followed for a median of 10.6 years (interquartile range, 7.8 to 13.4). Median age was 63 years (interquartile range, 55 to 71), and 54% of patients were men. Overweight or obese patients (BMI >25 kg/m²) had a higher rate of cardiac events (such as the acute coronary syndrome and heart failure) than those of normal weight (BMI, 18.5 to 24.9 kg/m²). However, being overweight (BMI, 25 to 29.9 kg/m²) was associated with a lower mortality risk, whereas obese patients (BMI >30 kg/m²) had a mortality risk similar to that of normal-weight persons. Patients with low body weight had the worst prognosis. LIMITATION Data about cause of death were not available. CONCLUSION In this cohort, patients with type 2 diabetes who were overweight or obese were more likely to be hospitalized for cardiovascular reasons. Being overweight was associated with a lower mortality risk, but being obese was not. PRIMARY FUNDING SOURCE National Institute for Health Research and University of Hull.
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Affiliation(s)
- Pierluigi Costanzo
- From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy
| | - John G.F. Cleland
- From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy
| | - Pierpaolo Pellicori
- From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy
| | - Andrew L. Clark
- From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy
| | - David Hepburn
- From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy
| | - Eric S. Kilpatrick
- From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy
| | - Pasquale Perrone-Filardi
- From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy
| | - Jufen Zhang
- From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy
| | - Stephen L. Atkin
- From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy
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48
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Acosta LD, Carrizo ED, Peláez E, Torres VER. Condiciones de vida, estado nutricional y estado de salud en adultos mayores, Córdoba, Argentina. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2015. [DOI: 10.1590/1809-9823.2015.14058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJETIVO: Describir y comparar el estado nutricional y el estado de salud en dos grupos de adultos mayores de diferentes condiciones de vida, residentes en la ciudad de Córdoba, Argentina. MATERIAL Y MÉTODOS: Estudio transversal, llevado a cabo en dos grupos: adultos mayores concurrentes a Comedores Sociales de la Provincia de Córdoba CSPC; n=308 y adultos mayores afiliados a la obra social universitaria Dirección de Asistencia Social del Personal Universitario DASPU; n=134. Se determinaron parámetros antropométricos: índice de masa corporal IMC, circunferencia de cintura CC e índice cintura cadera ICC. Para la determinación del estado de salud se utilizaron indicadores subjetivos autopercepción de salud, autoinforme de enfermedades crónicas, obtenidos a través de encuesta. Para la corroboración de hipótesis se utilizó Test de X2, cálculo de Odds Ratio OR, y Prueba T. RESULTADOS: En hombres, se observó mayor sobrepeso y obesidad en el grupo DASPU; mientras que en las mujeres no se encontraron mayores diferencias entre ambas instituciones, salvo un promedio menor de IMC en el grupo DASPU. En relación a los indicadores del estado de salud, se observó en ambos sexos, una mejor percepción de la salud en el grupo DASPU, mayor prevalencia de diabetes en hombres del grupo CSPC, hipertensión en mujeres de CSPC y tumor maligno en hombres del grupo DASPU. CONCLUSIONES: Se observa que las condiciones sociales de vida influyen en el estado nutricional y de salud de los adultos mayores, en especial en hombres. Esto implica riesgos diferentes para ambos grupos.
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Affiliation(s)
| | | | - Enrique Peláez
- Universidad Nacional de Córdoba, Argentina; Universidad Nacional de Córdoba, Argentina
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49
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High serum adiponectin concentration and low body mass index are significantly associated with increased all-cause and cardiovascular mortality in an elderly cohort, "adiponectin paradox": the Korean Longitudinal Study on Health and Aging (KLoSHA). Int J Cardiol 2015; 183:91-7. [PMID: 25662058 DOI: 10.1016/j.ijcard.2015.01.057] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 12/02/2014] [Accepted: 01/25/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND The relationship between adiponectin concentration and mortality is unclear. We examined whether serum adiponectin concentration is associated with all-cause and cardiovascular mortality in elderly Asians. METHODS We analyzed the data for community-dwelling adults ≥65 years of age (439 men and 561 women) who were enrolled in the Korean Longitudinal Study on Health and Aging (KLoSHA) cohort in prospective manner. The baseline serum total and high molecular weight adiponectin were measured using an enzyme-linked immunosorbent assay. Using Cox regression, we determined the associations between serum adiponectin concentration and all-cause and cardiovascular mortality after adjusting for well-known cardiovascular risk factors. RESULTS Over a mean follow-up time of 6.2 years, 222 individuals died, and 52 deaths (23.4%) were by cardiovascular disease. After adjusting confounding factors, elevated baseline serum adiponectin concentration was independently associated with all-cause mortality (adjusted hazard ratio [HR] 1.38; 95% confidence interval [CI] 1.17-1.64) and cardiovascular mortality (HR 1.50; 1.06-2.14). We evaluated the effect modification by baseline body mass index (BMI). High serum adiponectin and low BMI were synergistically associated with increased all-cause mortality (HR 6.25; 3.08-12.71) and cardiovascular mortality (HR 13.94; 1.82-106.58). CONCLUSIONS Higher serum adiponectin concentration was associated with increased all-cause and cardiovascular mortality in community-dwelling elderly Asian population. Our data supported the recent theory so called "adiponectin paradox". This relationship was strengthened when combined with low BMI. We suggest that measurement of adiponectin concentration and BMI together could be an additional predictive marker of survival among elderly adults.
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50
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Brown RE, Kuk JL. Consequences of obesity and weight loss: a devil's advocate position. Obes Rev 2015; 16:77-87. [PMID: 25410935 PMCID: PMC4312481 DOI: 10.1111/obr.12232] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/18/2014] [Accepted: 10/03/2014] [Indexed: 12/22/2022]
Abstract
Obesity is associated with multiple negative health consequences and current weight management guidelines recommend all obese persons to lose weight. However, recent evidence suggests that not all obese persons are negatively affected by their weight and that weight loss does not necessarily always improve health. The purpose of this review is not to trivialize the significant health risks associated with obesity, but to discuss subpopulations of obese people who are not adversely affected, or may even benefit from higher adiposity, and in who weight loss per se may not always be the most appropriate recommendation. More specifically, this review will take a devil's advocate position when discussing the consequences of obesity and weight loss for adults with established cardiovascular disease and type 2 diabetes, weight cyclers, metabolically healthy obese adults, youth, older adults and obese individuals who are highly fit.
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Affiliation(s)
- R E Brown
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
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