1
|
Li Y, Ren X, Jiang M, Han L, Zheng X. Association of estimated cardiorespiratory fitness in middle-aged and elderly people with cardiovascular disease: Evidence from the China health and retirement longitudinal study. Nutr Metab Cardiovasc Dis 2024; 34:2257-2265. [PMID: 38866620 DOI: 10.1016/j.numecd.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/11/2024] [Accepted: 04/21/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND AND AIM Cardiovascular diseases (CVD) is a major threat to public health, while cardiorespiratory fitness (CRF) is a key predictor of chronic disease. Given this, the purpose of this study was to investigate the relationship between estimated CRF (eCRF) and CVD in middle-aged and elderly Chinese people. METHODS AND RESULTS The China Health and Retirement Longitudinal Study (CHARLS) with 4761 individuals were included in analysis. Participants were divided into three groups according to eCRF quantile in sex subgroups. Cox proportional hazards regression models were used to explore the correlation of eCRF with CVD (stroke or cardiac events). In total, 4761 participants were included in this cohort study (2500 [52.51%] women). During a 7-year follow-up from 2011 to 2018, 796 CVDs (268 Strokes and 588 cardiac events) were recorded. In multivariable-adjusted analyses, for per 1 SD increase of eCRF, the age-adjusted risk of CVD was reduced by about 18% (HR = 0.82; 95% CI, 0.72-0.93) in men, and was reduced by about 29% (HR = 0.71; 95% CI, 0.62-0.81) in women. Similar associations were also found between eCRF and stroke and cardiac events. Both subgroup and interaction analyses showed that the interaction of age had a statistically significant effect on CVD risk. CONCLUSION ECRF was inversely associated with CVD risk (stroke or cardiac events) in both men and women. Remarkable sex and age differences exist in the effectiveness of increasing eCRF to reduce the risk of CVD. As a potential, efficient and cost-effective risk prediction tool, eCRF deserves further attention and wide application.
Collapse
Affiliation(s)
- Yiqun Li
- Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, 214122, China
| | - Xiao Ren
- Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, 214122, China
| | - Minglan Jiang
- Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, 214122, China
| | - Longyang Han
- Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, 214122, China
| | - Xiaowei Zheng
- Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, 214122, China.
| |
Collapse
|
2
|
Lee P, Hargreaves E, Jiang Y, Calder A, Marsh S, Gray C, Hunt K, Eyles H, Draper N, Heke I, Kara S, Maddison R, Gao L. Long-term cost-effectiveness analysis of rugby fans in training-New Zealand: a body weight reduction programme for males. BMJ Open 2024; 14:e073740. [PMID: 39043600 PMCID: PMC11268026 DOI: 10.1136/bmjopen-2023-073740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVES We sought to extrapolate the long-term costs and clinical impacts attributed to the rugby fans in training-New Zealand (RUFIT-NZ) trial in Aotearoa, New Zealand. DESIGN A modelled cost-effectiveness analysis using efficacy data from RUFIT-NZ was conducted from the Aotearoa New Zealand healthcare perspective. SETTING A Markov cohort model was constructed with a lifetime time horizon. The model simulated events of myocardial infarction (MI), stroke and type 2 diabetes mellitus (T2DM) occurring among a hypothetical cohort of 10 000 individuals receiving either the RUFIT-NZ intervention or no intervention. Efficacy data were based on the RUFIT-NZ trial, and the latest Global Burden of Disease study was used to extrapolate the impact of body weight reduction on clinical outcomes of T2DM, MI or stroke. Cost and utility data were drawn from the RUFIT-NZ trial and published sources. PRIMARY OUTCOME MEASURES The incremental cost-effectiveness ratio (ICER). RESULTS Over a lifetime time horizon, participants in the RUFIT-NZ intervention gained 0.02 (discounted) quality-adjusted life years (QALYs) at an additional cost of NZ$863, relative to no intervention. The estimated ICER was NZ$49 515 per QALY gained (discounted), which is above the arbitrary willingness-to-pay threshold of NZ$45 000 per QALY. Sensitivity analyses supported the robustness of these findings. CONCLUSIONS RUFIT-NZ was associated with a reduction in cardiovascular and endocrine events for overweight and obese males. However, based on conservative assumptions, RUFIT-NZ was unlikely to be cost-effective from a healthcare system perspective. TRIAL REGISTRATION NUMBER ACTRN12619000069156.
Collapse
Affiliation(s)
- Peter Lee
- Deakin Health Economics, School of Social Health and Development, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Elaine Hargreaves
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Yannan Jiang
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Amanda Calder
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Samantha Marsh
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Cindy Gray
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kate Hunt
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Helen Eyles
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Nick Draper
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | | | - Stephen Kara
- Axis Sport Medicine Clinic, Auckland, New Zealand
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Lan Gao
- Deakin Health Economics, School of Social Health and Development, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| |
Collapse
|
3
|
Cruijsen E, Bonekamp NE, Koopal C, Winkels RM, Visseren FLJ, Geleijnse JM. Association of body mass index and waist circumference with long-term mortality risk in 10,370 coronary patients and potential modification by lifestyle and health determinants. PLoS One 2024; 19:e0303329. [PMID: 38820357 PMCID: PMC11142547 DOI: 10.1371/journal.pone.0303329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/23/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND AND AIMS Body adiposity is known to affect mortality risk in patients with coronary artery disease (CAD). We examined associations of body mass index (BMI) and waist circumference (WC) with long term mortality in Dutch CAD patients, and potential and effect modification of these associations by lifestyle and health determinants. METHODS 10,370 CAD patients (mean age ∼65 y; 20% female; >80% on cardiovascular drugs) from the prospective Alpha Omega Cohort and Utrecht Cardiovascular Cohort-Secondary Manifestations of ARTerial disease study were included. Cox models were used to estimate categorical and continuous associations (using restricted cubic splines) of measured BMI and WC with all-cause and cardiovascular mortality risk, adjusting for age, sex, smoking, alcohol, physical activity and educational level. Analyses were repeated in subgroups of lifestyle factors (smoking, physical activity, diet quality), education and health determinants (diabetes, self-rated health). RESULTS During ∼10 years of follow-up (91,947 person-years), 3,553 deaths occurred, including 1,620 from cardiovascular disease. U-shaped relationships were found for BMI and mortality risk, with the lowest risk for overweight patients (BMI ∼27 kg/m2). For obesity (BMI ≥30), the HR for all-cause mortality was 1.31 (95% CI: 1.11, 1.41) in male patients and 1.10 (95% CI: 0.92, 1.30) in female patients, compared to BMI 25-30 kg/m2. WC was also non-linearly associated with mortality, and HRs were 1.18 (95%CI:1.06, 1.30) in males and 1.31 (95%CI:1.05, 1.64) in females for the highest vs. middle category of WC. Results for cardiovascular mortality were mostly in line with the results for all-cause mortality. U-shaped associations were found in most subgroups, associations were moderately modified by physical activity, smoking and educational level. CONCLUSIONS CAD patients with obesity and a large WC were at increased risk of long-term CVD and all-cause mortality, while mildly overweight patients had the lowest risk. These associations were consistent across subgroups of patients with different lifestyles and health status.
Collapse
Affiliation(s)
- Esther Cruijsen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Nadia E. Bonekamp
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Charlotte Koopal
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Renate M. Winkels
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Frank L. J. Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johanna M. Geleijnse
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | | |
Collapse
|
4
|
Keller K, Schmitt VH, Hahad O, Hobohm L. Outcome of Pulmonary Embolism with and without Ischemic Stroke. J Clin Med 2024; 13:2730. [PMID: 38792272 PMCID: PMC11122224 DOI: 10.3390/jcm13102730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/10/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Ischemic stroke is the second, and pulmonary embolism (PE) is the third most common cardiovascular cause of death after myocardial infarction. Data regarding risk factors for ischemic stroke in patients with acute PE are limited. Methods: Patients were selected by screening the German nationwide in-patient sample for PE (ICD-code I26) and were stratified by ischemic stroke (ICD code I63) and compared. Results: The nationwide in-patient sample comprised 346,586 hospitalized PE patients (53.3% females) in Germany from 2011 to 2014; among these, 6704 (1.9%) patients had additionally an ischemic stroke. PE patients with ischemic stroke had a higher in-hospital mortality rate than those without (28.9% vs. 14.5%, p < 0.001). Ischemic stroke was independently associated with in-hospital death (OR 2.424, 95%CI 2.278-2.579, p < 0.001). Deep venous thrombosis and/or thrombophlebitis (DVT) combined with heart septal defect (OR 24.714 [95%CI 20.693-29.517], p < 0.001) as well as atrial fibrillation/flutter (OR 2.060 [95%CI 1.943-2.183], p < 0.001) were independent risk factors for stroke in PE patients. Systemic thrombolysis was associated with a better survival in PE patients with ischemic thrombolysis who underwent cardio-pulmonary resuscitation (CPR, OR 0.55 [95%CI 0.36-0.84], p = 0.006). Conclusions: Ischemic stroke did negatively affect the survival of PE. Combination of DVT and heart septal defect and atrial fibrillation/flutter were strong and independent risk factors for ischemic stroke in PE patients. In PE patients with ischemic stroke, who had to underwent CPR, systemic thrombolysis was associated with improved survival.
Collapse
Affiliation(s)
- Karsten Keller
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (V.H.S.); (O.H.); (L.H.)
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Volker H. Schmitt
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (V.H.S.); (O.H.); (L.H.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Omar Hahad
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (V.H.S.); (O.H.); (L.H.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (V.H.S.); (O.H.); (L.H.)
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| |
Collapse
|
5
|
Hart SM, Keirns BH, Sciarrillo CM, Malin SK, Kurti SP, Emerson SR. Cardiorespiratory fitness and submaximal exercise dynamics in normal-weight obesity and metabolically healthy obesity. Eur J Appl Physiol 2024; 124:1131-1142. [PMID: 37917417 DOI: 10.1007/s00421-023-05344-8] [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: 06/19/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE Cardiorespiratory fitness (CRF) is critical for cardiovascular health. Normal-weight obesity (NWO) and metabolically healthy obesity (MHO) may be at increased risk for cardiovascular disease, but a comparison of CRF and submaximal exercise dynamics against rigorously defined low- and high-risk groups is lacking. METHODS Four groups (N = 40; 10/group) based on body mass index (BMI), body fat %, and metabolic syndrome (MetS) risk factors were recruited: healthy controls (CON; BMI 18.5-24.9 kg/m2, body fat < 25% [M] or < 35% [F], 0-1 risk factors), NWO (BMI 18.5-24.9 kg/m2, body fat ≥ 25% [M] or ≥ 35% [F]), MHO (BMI > 30 kg/m2, body fat ≥ 25% [M] or ≥ 35% [F], 0-1 risk factors), or metabolically unhealthy obesity (MUO; BMI > 30 kg/m2, body fat ≥ 25% [M] or ≥ 35% [F], 2 + risk factors). All participants completed a V ˙ O2peak test on a cycle ergometer. RESULTS V ˙ O2peak was similarly low in NWO (27.0 ± 4.8 mL/kg/min), MHO (25.4 ± 6.7 mL/kg/min) and MUO (24.6 ± 10.0 mL/kg/min) relative to CON (44.2 ± 11.0 mL/kg/min) when normalized to total body mass (p's < 0.01), and adjusting for fat mass or lean mass did not alter these results. This same differential V ˙ O2 pattern was apparent beginning at 25% of the exercise test (PGroup*Time < 0.01). CONCLUSIONS NWO and MHO had similar peak and submaximal CRF to MUO, despite some favorable health traits. Our work adds clarity to the notion that excess adiposity hinders CRF across BMI categories. CLINICALTRIALS gov registration: NCT05008952.
Collapse
Affiliation(s)
- Samantha M Hart
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, 74075, USA
| | - Bryant H Keirns
- Department of Nutrition and Heath Science, Ball State University, Muncie, IN, 47306, USA
| | - Christina M Sciarrillo
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, 74075, USA
| | - Steven K Malin
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
| | - Stephanie P Kurti
- Department of Kinesiology, James Madison University, Harrisonburg, VA, 22807, USA
| | - Sam R Emerson
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, 74075, USA.
- Oklahoma State University, 211 Nancy Randolph Davis, Stillwater, OK, 74078, USA.
| |
Collapse
|
6
|
Becerril-Gaitan A, Ding D, Ironside N, Southerland AM, Worrall BB, Testai FD, Flaherty ML, Elkind MS, Koch S, Sung G, Kittner SJ, Mayson DJ, Gonzales N, McCauley JL, Malkoff M, Hall CE, Frankel MR, James ML, Anderson CD, Aronowski J, Savitz SI, Woo D, Chen CJ. Association Between Body Mass Index and Functional Outcomes in Patients With Intracerebral Hemorrhage. Neurology 2024; 102:e208014. [PMID: 38165334 PMCID: PMC10870743 DOI: 10.1212/wnl.0000000000208014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/13/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence of the so-called "obesity paradox," which refers to the protective effect and survival benefit of obesity in patients with spontaneous intracerebral hemorrhage (ICH), remains controversial. This study aims to determine the association between body mass index (BMI) and functional outcomes in patients with ICH and whether it is modified by race/ethnicity. METHODS Included individuals were derived from the Ethnic/Racial Variations of Intracerebral Hemorrhage study, which prospectively recruited 1,000 non-Hispanic White, 1,000 non-Hispanic Black, and 1,000 Hispanic patients with spontaneous ICH. Only patients with available BMI were included. The primary outcome was 90-day mortality. Secondary outcomes were mortality at discharge, modified Rankin Scale (mRS), Barthel Index, and self-reported health status measures at 90 days. Associations between BMI and ICH outcomes were assessed using univariable and multivariable logistic, ordinal, and linear regression models, as appropriate. Sensitivity analyses after excluding frail patients and by patient race/ethnicity were performed. RESULTS A total of 2,841 patients with ICH were included. The median age was 60 years (interquartile range 51-73). Most patients were overweight (n = 943; 33.2%) or obese (n = 1,032; 36.3%). After adjusting for covariates, 90-day mortality was significantly lower among overweight and obese patients than their normal weight counterparts (adjusted odds ratio [aOR] = 0.71 [0.52-0.98] and aOR = 0.70 [0.50-0.97], respectively). Compared with patients with BMI <25 kg/m2, those with BMI ≥25 kg/m2 had better 90-day mRS (aOR = 0.80 [CI 0.67-0.95]), EuroQoL Group 5-Dimension (EQ-5D) (aβ = 0.05 [0.01-0.08]), and EQ-5D VAS (aβ = 3.80 [0.80-6.98]) scores. These differences persisted after excluding withdrawal of care patients. There was an inverse relationship between BMI and 90-day mortality (aOR = 0.97 [0.96-0.99]). Although non-Hispanic White patients had significantly higher 90-day mortality than non-Hispanic Black and Hispanic (26.6% vs 19.5% vs 18.0%, respectively; p < 0.001), no significant interactions were found between BMI and race/ethnicity. No significant interactions between BMI and age or sex for 90-day mortality were found, whereas for 90-day mRS, there was a significant interaction with age (pinteraction = 0.004). CONCLUSION We demonstrated that a higher BMI is associated with decreased mortality, improved functional outcomes, and better self-reported health status at 90 days, thus supporting the paradoxical role of obesity in patients with ICH. The beneficial effect of high BMI does not seem to be modified by race/ethnicity or sex, whereas age may play a significant role in patient functional outcomes.
Collapse
Affiliation(s)
- Andrea Becerril-Gaitan
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Dale Ding
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Natasha Ironside
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Andrew M Southerland
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Bradford B Worrall
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Fernando D Testai
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Matthew L Flaherty
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Mitchell S Elkind
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Sebastian Koch
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Gene Sung
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Steven J Kittner
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Douglas J Mayson
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Nicole Gonzales
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Jacob L McCauley
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Marc Malkoff
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Christiana E Hall
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Michael R Frankel
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Michael L James
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Christopher D Anderson
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Jaroslaw Aronowski
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Sean I Savitz
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Daniel Woo
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| | - Ching-Jen Chen
- From the Departments of Neurosurgery (A.B.-G., C.-J.C.) and Neurology (J.A., S.I.S.), The University of Texas Health Science Center at Houston; Department of Neurosurgery (D.D.), University of Louisville, KY; Department of Neurosurgery (N.I.); Departments of Neurology and Public Health Sciences (A.M.S., B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology and Rehabilitation (F.D.T.), University of Illinois College of Medicine, Chicago; Department of Neurology (M.L.F., D.W.), University of Cincinnati, OH; Department of Neurology (M.S.E.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Department of Neurology (S.K.) and John P. Hussman Institute for Human Genomics (J.L.M.), University of Miami Miller School of Medicine, FL; Department of Neurology and Neurocritical Care and Stroke (G.S.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (S.J.K.), University of Maryland School of Medicine, Baltimore; Department of Neurology (D.J.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Neurology (N.G.), University of Colorado School of Medicine, Aurora; Departments of Neurology and Neurosurgery (M.M.), University of Tennessee Health Sciences, Memphis; Department of Neurology (C.E.H.), University of Texas Southwestern, Dallas; Department of Neurology (M.R.F.), Emory University, Grady Memorial Hospital, Atlanta, GA; Departments of Anesthesiology and Neurology (M.L.J.), Duke Clinical Research Institute, Duke University, Durham, NC; and Henry and Allison McCane Center for Brain Health and Center for Genomic Medicine (C.D.A.), Massachusetts General Hospital, Massachusetts, Boston
| |
Collapse
|
7
|
Gafni T, Weinstein G, Leonard D, Barlow CE, DeFina LF, Pettee Gabriel K, Berry JD, Shuval K. Independent and joint associations of cardiorespiratory fitness and BMI with dementia risk: the Cooper Center Longitudinal Study. BMJ Open 2023; 13:e075571. [PMID: 38086580 PMCID: PMC10729062 DOI: 10.1136/bmjopen-2023-075571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE This study aimed to examine the association of midlife fitness and body mass index (BMI) with incident dementia later in life. DESIGN AND PARTICIPANTS A cohort study of 6428 individuals (mean age 50.9±7.6 years) from the Cooper Center Longitudinal Study. MEASURES Cardiorespiratory fitness and BMI were assessed twice (1970-1999) during visits to the Cooper Clinic, a preventive medicine clinic in Dallas, Texas. These measures were examined as continuous and categorical variables. As continuous variables, fitness and BMI were examined at baseline (averaged of two examinations) and as absolute change between exams (mean time 2.1±1.8 years). Variables were categorised: unfit versus fit and normal versus overweight/obese. Medicare claims data were used to obtain all-cause dementia incidence (1999-2009). Mean follow-up between midlife examinations and Medicare surveillance was 15.7 ((SD=6.2) years. Multivariable models were used to assess the associations between fitness, BMI and dementia. RESULTS During 40 773 person years of Medicare surveillance, 632 cases of dementia were identified. After controlling for BMI and covariates, each 1-metabolic equivalent increment in fitness was associated with 5% lower (HR 0.95; 95% CI 0.90 to 0.99) dementia risk. In comparison, after controlling for fitness and covariates, each 1 kg/m2 increment in BMI was associated with a 3.0% (HR 1.03; 95% CI 1.00 to 1.07) higher risk for dementia, yet without significance (p=0.051). Similar findings were observed when the exposures were categorised. Changes in fitness and BMI between examinations were not related to dementia. Jointly, participants who were unfit and overweight/obese had the highest (HR 2.28 95% CI 1.57 to 3.32) dementia risk compared with their fit and normal weight counterparts. CONCLUSION Lower midlife fitness is a risk marker for dementia irrespective of weight status. Being unfit coupled with overweight/obese status might increase one's risk for dementia even further.
Collapse
Affiliation(s)
- Tal Gafni
- Department of Epidemiology, University of Haifa, Haifa, Israel
| | - Galit Weinstein
- Department of Epidemiology, University of Haifa, Haifa, Israel
| | - David Leonard
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| | - Carolyn E Barlow
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| | - Laura F DeFina
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabam, USA
| | | | - Kerem Shuval
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| |
Collapse
|
8
|
Haidar A, Horwich T. Obesity, Cardiorespiratory Fitness, and Cardiovascular Disease. Curr Cardiol Rep 2023; 25:1565-1571. [PMID: 37831388 PMCID: PMC10682063 DOI: 10.1007/s11886-023-01975-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE OF REVIEW Obesity, generally defined by body mass index (BMI), is an established risk factor for the development of cardiovascular disease (CVD), while cardiorespiratory fitness (CRF) decreases risk. In chronic CVD, an obesity survival paradox in which higher BMI is associated with improved prognosis has been reported. This paper will examine the effect of obesity on CVD risk, explore obesity as a risk factor in patients with established CVD, and investigate the relationship between CRF, obesity, and CVD. RECENT FINDINGS Through metabolic and hemodynamic changes, obesity increases the risk for CVD and contributes to the development of other cardiovascular risk factors such as diabetes, dyslipidemia, and hypertension. Obesity is associated with metabolic, hormonal, and inflammatory changes that leads to atherosclerosis increasing the risk for coronary artery disease, and myocardial remodeling increasing the risk for heart failure. However, it has also been observed that overweight/obese patients with established CVD have a better prognosis when compared to non-obese individuals termed the obesity paradox. CRF is a vital component of health associated with improved cardiovascular outcomes and furthermore has been shown to markedly attenuate or nullify the relationship between obesity and CVD risk/prognosis. Increasing CRF mitigates CVD risk factors and improves overall prognosis in CVD regardless of obesity status.
Collapse
Affiliation(s)
- Amier Haidar
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tamara Horwich
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| |
Collapse
|
9
|
Jones NR, Ordóñez-Mena JM, Roalfe AK, Taylor KS, Goyder CR, Hobbs FR, Taylor CJ. Body mass index and survival in people with heart failure. Heart 2023; 109:1542-1549. [PMID: 37290898 PMCID: PMC10579501 DOI: 10.1136/heartjnl-2023-322459] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/18/2023] [Indexed: 06/10/2023] Open
Abstract
AIMS In people with heart failure (HF), a high body mass index (BMI) has been linked with better outcomes ('obesity paradox'), but there is limited evidence in community populations across long-term follow-up. We aimed to examine the association between BMI and long-term survival in patients with HF in a large primary care cohort. METHODS We included patients with incident HF aged ≥45 years from the Clinical Practice Research Datalink (2000-2017). We used Kaplan-Meier curves, Cox regression and penalised spline methods to assess the association of pre-diagnostic BMI, based on WHO classification, with all-cause mortality. RESULTS There were 47 531 participants with HF (median age 78.0 years (IQR 70-84), 45.8% female, 79.0% white ethnicity, median BMI 27.1 (IQR 23.9-31.0)) and 25 013 (52.6%) died during follow-up. Compared with healthy weight, people with overweight (HR 0.78, 95% CI 0.75 to 0.81, risk difference (RD) -4.1%), obesity class I (HR 0.76, 95% CI 0.73 to 0.80, RD -4.5%) and class II (HR 0.76, 95% CI 0.71 to 0.81, RD -4.5%) were at decreased risk of death, whereas people with underweight were at increased risk (HR 1.59, 95% CI 1.45 to 1.75, RD 11.2%). In those underweight, this risk was greater among men than women (p value for interaction=0.02). Class III obesity was associated with increased risk of all-cause mortality compared with overweight (HR 1.23, 95% CI 1.17 to 1.29). CONCLUSION The U-shaped relationship between BMI and long-term all-cause mortality suggests a personalised approach to identifying optimal weight may be needed for patients with HF in primary care. Underweight people have the poorest prognosis and should be recognised as high-risk.
Collapse
Affiliation(s)
- Nicholas R Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrea K Roalfe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kathryn S Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clare R Goyder
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
10
|
Cao Z, Bakulski KM, Paulson HL, Wang X. Exposure to Heavy Metals, Obesity, and Stroke Mortality in the United States. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.18.23295722. [PMID: 37790410 PMCID: PMC10543217 DOI: 10.1101/2023.09.18.23295722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
We investigated the associations between blood concentrations of lead and cadmium with stroke mortality, and potential effect modification by obesity. Our study analyzed data from 23,437 individuals aged 40 and above, using the National Health and Nutrition Examination Survey (NHANES 1999-2016) linked to the National Death Index. During a median follow-up period of 8.3 years, 336 stroke-related deaths were reported. After adjusting for potential confounders, we found that higher baseline concentrations of lead and cadmium were significantly associated with increased stroke mortality. Specifically, the hazard ratios (HRs) per doubling of metal concentrations were 1.16 (95% CI: 1.11, 1.20) for lead and 1.31 (95% CI: 1.26, 1.36) for cadmium. Stratified analysis showed that stronger associations were observed among participants who were normal weight or overweight, relative to those who were obese. In conclusion, our study demonstrates that elevated blood concentrations of lead and cadmium are significantly associated with an increased risk of stroke mortality, especially among individuals who are normal weight or overweight.
Collapse
Affiliation(s)
- Ziqin Cao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA, 48109
| | - Kelly M. Bakulski
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA, 48109
- Michigan Alzheimer’s Disease Center, University of Michigan, Ann Arbor, Michigan, USA, 48105
| | - Henry L. Paulson
- Michigan Alzheimer’s Disease Center, University of Michigan, Ann Arbor, Michigan, USA, 48105
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA, 48109
| | - Xin Wang
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA, 48109
| |
Collapse
|
11
|
Ras J, Smith DL, Soteriades ES, Kengne AP, Leach L. Association between Physical Fitness and Cardiovascular Health in Firefighters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5930. [PMID: 37297534 PMCID: PMC10252711 DOI: 10.3390/ijerph20115930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
Firefighters perform strenuous work in dangerous and unpredictable environments requiring optimal physical conditioning. The aim of this study was to investigate the association between physical fitness and cardiovascular health (CVH) in firefighters. This cross-sectional study systematically recruited 309 full-time male and female firefighters between the ages of 20 to 65 years in Cape Town, South Africa. Physical fitness was assessed using absolute (abV̇O2max) and relative oxygen consumption (relVO2max), grip and leg strength, push-ups and sit-ups, sit-and-reach for flexibility and lean body mass (LBM). CVH encompassed age, smoking, blood pressure (BP), blood glucose, lipid profile, body mass index, body fat percentage (BF%), and waist circumference. Linear regressions and logistic regressions were applied. Multivariable analysis indicated that relVO2max was associated with systolic BP (p < 0.001), diastolic BP (p < 0.001), non-fasting blood glucose (p < 0.001), and total cholesterol (p = 0.037). Poor CVH index was negatively associated with relV̇O2max (p < 0.001), leg strength (p = 0.019), and push-ups (p = 0.012). Furthermore, age was inversely associated with V̇O2max (p < 0.001), push-up and sit-up capacity (p < 0.001), and sit-and-reach (p < 0.001). BF% was negatively associated with abV̇O2max (p < 0.001), grip and leg strength (p < 0.001), push-ups (p = 0.008), sit-ups (p < 0.001), and LBM (p < 0.001). Cardiorespiratory fitness, muscular strength, and muscular endurance were significantly associated with a better overall CVH profile.
Collapse
Affiliation(s)
- Jaron Ras
- Department of Sport, Recreation and Exercise Science, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa;
| | - Denise L. Smith
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY 12866, USA;
| | - Elpidoforos S. Soteriades
- Healthcare Management Program, School of Economics and Management, Open University of Cyprus, Nicosia 2220, Cyprus;
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology (EOME), Boston, MA 02115, USA
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa;
| | - Lloyd Leach
- Department of Sport, Recreation and Exercise Science, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa;
| |
Collapse
|
12
|
The Chain-Mediating Effect of Obesity, Depressive Symptoms on the Association between Dietary Quality and Cardiovascular Disease Risk. Nutrients 2023; 15:nu15030629. [PMID: 36771337 PMCID: PMC9919873 DOI: 10.3390/nu15030629] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
In order to explore the relationship between the Healthy Eating Index (HEI-2015) and cardiovascular disease (CVD), and the mediating role of obesity and depressive symptoms, we used the data from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) for further study. A total of 12,644 participants were included in the study. The HEI was derived using NHANES personal food data and USDA Food Pattern Equivalence Database (FPED) dietary data. The risk of cardiovascular disease was determined using the Framingham Heart Study's multifactorial calculation tool. The weighted multiple logistic regression model was used to explore the association between the HEI-2015 and CVD, and the generalized structural equation was used to explore the mediating effects of obesity and depression, respectively and jointly. Higher HEI-2015 scores were associated with a lower risk of CVD compared to lower quartiles. Obesity, depressive symptoms, and their chain effects all played significant mediating roles in the association between the HEI-2015 and CVD, with proportional mediations of 9.03%, 2.23% and 0.25%, respectively. Our results suggest that higher dietary quality is associated with a lower risk of CVD, mediated by obesity, depressive symptoms, and the chain effect of obesity and depressive symptoms.
Collapse
|
13
|
Cardiorespiratory Fitness and Bone Turnover Markers in Adults With Metabolic Syndrome: The Mediator Role of Inflammation. Int J Sport Nutr Exerc Metab 2023; 33:23-29. [PMID: 36270626 DOI: 10.1123/ijsnem.2022-0109] [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: 05/19/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/07/2022]
Abstract
The relationship between inflammatory markers and bone turnover in adults is well known, and a negative association between cardiorespiratory fitness (CRF) and inflammatory markers has also been described. Hence, we tested whether the association between CRF and bone turnover markers is mediated by inflammatory markers in adults with metabolic syndrome. A total of 81 adults (58.5 ± 5.0 years, 62.7% women) were included in the analysis. CRF was measured by the 6-min walking test. Serum interleukin (IL)-1β, IL-6, IL-10, tumor necrosis factor alpha, high-sensitivity c-reactive protein (hsCRP) and vascular endothelial growth factor, collagen type I cross-linked C-telopeptide, procollagen type I N-terminal propeptide (P1NP), and total osteocalcin were assessed using a sensitive ELISA kit. Body composition was assessed by dual-energy X-ray absorptiometry. Partial correlation was used to test the relationship between CRF, inflammatory markers, and bone turnover markers, controlling for sex, lean mass, and fat mass. Boot-strapped mediation procedures were performed, and indirect effects with confidence intervals not including zero were interpreted as statistically significant. CRF was positively correlated with P1NP levels (r = .228, p = .044) and osteocalcin levels (r = .296, p = .009). Furthermore, CRF was positively correlated with IL-1β levels (r = .340, p = .002) and negatively correlated with hsCRP levels (r = -.335, p = .003), whereas IL-1β levels were positively correlated with P1NP levels (r = .245, p = .030), and hsCRP levels were negatively correlated with P1NP levels (r = -.319, p = .004). Finally, the association between CRF and P1NP levels was totally mediated by hsCRP (percentage of mediation = 39.9). Therefore, CRF benefits on bone formation could be dependent on hsCRP concentrations in this population.
Collapse
|
14
|
Keawtep P, Kamnardsiri T, Boripuntakul S, Wichayanrat W, Worakul P, Sungkarat S. Feasibility of Internet-Based Physical-Cognitive Exercise for Health Benefits of Middle-Aged Obese Women. J Prim Care Community Health 2023; 14:21501319231189961. [PMID: 37522590 PMCID: PMC10392207 DOI: 10.1177/21501319231189961] [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: 06/04/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Obesity in middle-aged women markedly increases the risk for non-communicable diseases, neurodegenerative diseases, and physical and cognitive problems. Exercise, particularly combined physical-cognitive exercise, has been demonstrated to have beneficial effects on both physical and cognitive health. However, middle-aged women often face barriers to engaging in exercise, which include time constraints, lack of motivation, and enjoyment. Incorporating an exercise program into a technology-based intervention in the home environment may help overcome these barriers and promote health benefits. Therefore, this study aimed to assess the feasibility of home-based, physical-cognitive internet-based exercise for middle-aged obese women. METHODS A total of 33 middle-aged obese women were enrolled in the study. Participants performed an intervention for 60 min/day, 3 days/week for 3 months. Feasibility outcomes (adherence, adverse events, physical performances, obesity parameters, and enjoyment of the program) were measured. RESULTS Average exercise adherence was 91.67%, and no adverse events were reported in this feasibility study. At the end of the training period, body weight and BMI were significantly decreased compared to baseline. As for physical performances, both cardiorespiratory fitness and lower limb muscle power were significantly improved at post-training when compared to baseline. Furthermore, the participants experienced a high level of exercise enjoyment, and it was maintained over the 3-month training period. CONCLUSION These findings suggest that home-based, internet-based physical-cognitive exercise was safe and feasible for reducing obesity parameters, improving physical function, maintaining enjoyment over the course of training, and facilitating adherence to exercise in middle-aged obese women.
Collapse
|
15
|
Abi-Jaoude JG, Naiem AA, Edwards T, Lukaszewski MA, Obrand DI, Steinmetz OK, Bayne JP, MacKenzie KS, Gill HL, Girsowicz E. A systematic review and meta-analysis of the effect of obesity on patients undergoing lower extremity revascularization. J Vasc Surg 2022:S0741-5214(22)02637-4. [PMID: 36565774 DOI: 10.1016/j.jvs.2022.12.023] [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: 07/22/2022] [Revised: 11/20/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE In the present review, we assessed the effect of obesity on clinical outcomes for patients with peripheral arterial disease who had undergone endovascular or open lower extremity revascularization surgery. METHODS A systematic search strategy of MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library was conducted. The included studies had compared obese and nonobese cohorts with peripheral arterial disease who had undergone endovascular or open lower extremity revascularization. The outcomes included mortality, major adverse cardiovascular events, major adverse limb events, surgical site infections, endovascular access site complications, and perioperative complications. RESULTS Eight studies were included with 171,648 patients. The obese patients (body mass index ≥30 kg/m2) were more likely to be women, to have diabetes, and to have more cardiovascular comorbidities despite being younger. No association was found between obesity and peripheral arterial disease severity. Obesity was associated with an overall 22% decreased mortality risk after lower extremity revascularization (risk ratio [RR], 0.78; 95% confidence interval [CI], 0.71-0.85; P < .001; I2 = 0%; GRADE (grading of recommendations assessment, development, evaluation), very low quality). A subgroup analysis by intervention type showed similar findings (endovascular: RR, 0.79; 95% CI, 0.71-0.87; P < .001; I2 = 0%; open: RR, 0.70; 95% CI, 0.51-0.95; P = .024; I2 = 43%). Obesity was associated with a 14% decreased risk of major adverse cardiovascular events for open surgery only (RR, 0.86; 95% CI, 0.76-0.98; P = .021; I2 = 0%; GRADE, very low quality). Obesity was associated with an increased risk of surgical site infections pooled across intervention types (RR, 1.69; 95% CI, 1.34-2.14; P < .001; I2 = 78%; GRADE, very low quality). No association was found between obesity and major adverse limb events (RR, 1.02; 95% CI, 0.93-1.11; P = .73; I2 = 15%; GRADE, very low quality) or endovascular access site complications (RR, 1.11; 95% CI, 0.76-1.63; P = .58; I2 = 86%; GRADE, very low quality). Pooled perioperative complications did not differ between the obese and nonobese cohorts (RR, 1.04; 95% CI, 0.84-1.28; P = .73; I2 = 92%; GRADE, very low quality). CONCLUSIONS Obesity was associated with reduced mortality risk with both endovascular and open surgery, although a reduction in major adverse cardiovascular events was only observed with open surgery. In addition, obese patients had an increased risk of surgical site infections. Obesity was not associated with major adverse limb events, endovascular access site complications, or perioperative complications. The GRADE quality of evidence was very low. The findings from the present review suggest a survival advantage for obese patients with peripheral arterial disease. Future studies could focus on prospectively investigating the effect of obesity on peripheral arterial disease outcomes. A nuanced evaluation of body mass index as a preoperative risk factor is warranted.
Collapse
Affiliation(s)
- Joanne G Abi-Jaoude
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Ahmed A Naiem
- Division of Vascular Surgery, McGill University, Montreal, QC, Canada
| | - Thomas Edwards
- Northern Ontario School of Medicine, Sudbury, ON, Canada
| | | | - Daniel I Obrand
- Division of Vascular Surgery, McGill University, Montreal, QC, Canada
| | - Oren K Steinmetz
- Division of Vascular Surgery, McGill University, Montreal, QC, Canada
| | - Jason P Bayne
- Division of Vascular Surgery, McGill University, Montreal, QC, Canada
| | - Kent S MacKenzie
- Division of Vascular Surgery, McGill University, Montreal, QC, Canada
| | - Heather L Gill
- Division of Vascular Surgery, McGill University, Montreal, QC, Canada
| | - Elie Girsowicz
- Division of Vascular Surgery, McGill University, Montreal, QC, Canada.
| |
Collapse
|
16
|
Murlasits Z, Kupai K, Kneffel Z. Role of physical activity and cardiorespiratory fitness in metabolically healthy obesity: a narrative review. BMJ Open Sport Exerc Med 2022; 8:e001458. [PMID: 36484059 PMCID: PMC9723844 DOI: 10.1136/bmjsem-2022-001458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 12/11/2022] Open
Abstract
Obesity has been associated with a multitude of metabolic disorders, often clustering with risk factors of cardiovascular disease and type 2 diabetes mellitus, hypertension, dyslipidaemia. Overall, obesity is a worldwide, growing health concern. However, a subgroup of obese individuals with a low burden of metabolic abnormalities have been identified and described as metabolically healthy obese (MHO). Whether the MHO phenotype is protective against obesity-related metabolic disorders in the long-term is presently unclear, and current research examining the potential transition has yielded inconsistent results. In this current narrative review, we aim to provide insights on the role of physical activity (PA) and cardiorespiratory fitness (CRF) in MHO. Lifestyle factors such as PA and CRF may influence the MHO phenotype. Limited studies have characterised energy expenditure and CRF in MHO and metabolically unhealthy obese. However, higher levels of PA, less sedentary behaviour and higher CRF have been observed in MHO individuals. Considering the multiple benefits of PA, it is high time to advocate this lifestyle change beyond its influence on energy balance in a weight loss programme to improve cardiovascular and metabolic risk factors irrespective of body weight and fat mass changes. Improved CRF via increased PA, especially exercise participation, while avoiding weight gain is not only a realistic goal, but should be the primary intervention for MHO populations to prevent the transition to an abnormal metabolic state.
Collapse
Affiliation(s)
- Zsolt Murlasits
- Institute of Sport Science and Physical Education, University of Pécs, Pecs, Hungary
| | - Krisztina Kupai
- Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Kneffel
- Department of Health Sciences and Sport Medicine, Hungarian University of Sports Science, Budapest, Hungary
| |
Collapse
|
17
|
Li YG, Xie PX, Alsheikh-Ali AA, AlMahmeed W, Sulaiman K, Asaad N, Liu SW, Zubaid M, Lip GYH. The "obesity paradox" in patients with atrial fibrillation: Insights from the Gulf SAFE registry. Front Cardiovasc Med 2022; 9:1032633. [PMID: 36531711 PMCID: PMC9748618 DOI: 10.3389/fcvm.2022.1032633] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/17/2022] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND The prognostic impact of obesity on patients with atrial fibrillation (AF) remains under-evaluated and controversial. METHODS Patients with AF from the Gulf Survey of Atrial Fibrillation Events (Gulf SAFE) registry were included, who were recruited from six countries in the Middle East Gulf region and followed for 12 months. A multivariable model was established to investigate the association of obesity with clinical outcomes, including stroke or systemic embolism (SE), bleeding, admission for heart failure (HF) or AF, all-cause mortality, and a composite outcome. Restricted cubic splines were depicted to illustrate the relationship between body mass index (BMI) and outcomes. Sensitivity analysis was also conducted. RESULTS A total of 1,804 patients with AF and recorded BMI entered the final analysis (mean age 56.2 ± 16.1 years, 47.0% female); 559 (31.0%) were obese (BMI over 30 kg/m2). In multivariable analysis, obesity was associated with reduced risks of stroke/systematic embolism [adjusted odds ratio (aOR) 0.40, 95% confidence interval (CI), 0.18-0.89], bleeding [aOR 0.44, 95%CI, 0.26-0.74], HF admission (aOR 0.61, 95%CI, 0.41-0.90) and the composite outcome (aOR 0.65, 95%CI, 0.50-0.84). As a continuous variable, higher BMI was associated with lower risks for stroke/SE, bleeding, HF admission, all-cause mortality, and the composite outcome as demonstrated by the accumulated incidence of events and restricted cubic splines. This "protective effect" of obesity was more prominent in some subgroups of patients. CONCLUSION Among patients with AF, obesity and higher BMI were associated with a more favorable prognosis in the Gulf SAFE registry. The underlying mechanisms for this obesity "paradox" merit further exploration.
Collapse
Affiliation(s)
- Yan-Guang Li
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Peng-Xin Xie
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Alawi A. Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Wael AlMahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | | | - Nidal Asaad
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shu-Wang Liu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Mohammad Zubaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool John Moores University, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
18
|
Macena ML, Hoffman DJ, Clemente AP, Ferriolli E, Pfrimer K, Florêncio TMT, Bueno NB. The relationship between total energy expenditure and physical activity level in women living in an impoverished Brazilian urban area. Am J Hum Biol 2022; 34:e23780. [PMID: 35809076 DOI: 10.1002/ajhb.23780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/09/2022] [Accepted: 06/28/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This study aimed to describe how strong is the relationship between TEE and PAL in women living in an impoverished Brazilian urban area. METHODS Anthropometric, hormonal (insulin, TSH, FT4 , and FT3 ), body composition (deuterium), TEE (doubly labeled water) and PAL (metabolic equivalent task [MET]-7-day triaxial accelerometer, ActivPAL®) data were collected from 55 women (mean age: 31y, mean BMI: 27.4 kg/m2 ). Adjusted-TEE models were calculated incorporating the residuals of anthropometric, hormonal, and body composition variables in the TEE, to assess the relation between MET and adjusted-TEE, through three different analyzes: linear regression, nonlinear regression and change-point regression. RESULTS Most participants (89.1%, n = 49) were classified as low-active. There was no association between crude TEE and MET.h/d (R2 = 0.05; p = 0.09). There was a positive, although weak, linear relationship between adjusted-TEE and MET.h/d (β = 2705.26 kcal; 95% CI: 436.25; 4974.27; adj-R2 = 0.08). A change point of this relationship was identified in the MET.h/d value of 1.53 (SD = 0.02; adj-R2 = 0.13). The association between adjusted-TEE and MET.h/d before the change point (β = 5101.46 kcal; 95%CI: 978.84; 9224.08; adj-R2 = 0.11) was stronger than the association in the full linear model, nevertheless, it was still weak. This association stop existing when it is assessed in individuals after the change point (β = -6609.92 kcal; 95%CI: -16773.24; 3553.40; adj-R2 = 0.08). CONCLUSIONS These results suggest that the relationship between TEE and PAL is weak and it is not completely linear in women living in an impoverished Brazilian urban area.
Collapse
Affiliation(s)
- Mateus L Macena
- Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, Alagoas, Brazil
| | - Daniel J Hoffman
- Department of Nutritional Sciences, Program in International Nutrition, and the New Jersey Institute for Food, Nutrition, and Health, Center for Childhood Nutrition Education and Research, Rutgers University, New Brunswick, New Jersey, USA
| | - Ana Paula Clemente
- Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, Alagoas, Brazil
| | - Eduardo Ferriolli
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil
| | - Karina Pfrimer
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.,Curso de Nutrição, Universidade de Ribeirão Preto, São Paulo, Brazil
| | | | - Nassib B Bueno
- Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, Alagoas, Brazil
| |
Collapse
|
19
|
Giri Ravindran S, Saha D, Iqbal I, Jhaveri S, Avanthika C, Naagendran MS, Bethineedi LD, Santhosh T. The Obesity Paradox in Chronic Heart Disease and Chronic Obstructive Pulmonary Disease. Cureus 2022; 14:e25674. [PMID: 35812616 PMCID: PMC9259072 DOI: 10.7759/cureus.25674] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2022] [Indexed: 11/05/2022] Open
Abstract
Obesity in recent years has become an epidemic. A high body mass index (BMI) is one of today's most crucial population health indicators. BMI does not directly quantify body fat but correlates well with easier body fat measurements. Like smoking, obesity impacts multiple organ systems and is a major modifiable risk factor for countless diseases. Despite this, reports have emerged that obesity positively impacts the prognosis of patients with chronic illnesses such as chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD), a phenomenon known as the Obesity Paradox. This article attempts to explain and summarize this phenomenon. As it stands, two theories explain this paradox. The muscle mass hypothesis states that obese patients are better adapted to tide through acute exacerbations due to increased reserve because of greater muscle mass. The other theory focuses on brown adipose tissue and its anti-inflammatory effects on the body. We performed a literature review on research articles published in English from 1983 to the present in the following databases - PubMed, Elsevier, and Google Scholar. The following search strings and Medical Subject Headings (MeSH) terms were used: "Obesity," "Heart Failure," "COPD," and "Cardio-Respiratory Fitness." In this review, we looked at the obesity paradox in Heart Failure and COPD. We summarized the current literature on the Obesity Paradox and reviewed its relationship with Cardio-Respiratory Fitness.
Collapse
|
20
|
Chew NW, Kong G, Venisha S, Chin YH, Ng CH, Lin C, Muthiah M, Khoo CM, Chai P, Kong W, Poh KK, Foo R, Yeo TC, Chan MY, Loh PH. Long-term Prognosis of Acute Myocardial Infarction Associated with Metabolic Health and Obesity Status. Endocr Pract 2022; 28:802-810. [PMID: 35654337 DOI: 10.1016/j.eprac.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Emerging evidence supports the favourable cardiovascular health in non-obese subjects with healthy metabolism. However, little is known regarding the prognosis across the range of metabolic phenotypes once cardiovascular disease is established. We examined the prognosis of patients with acute myocardial infarction (AMI) stratified according to metabolic health and obesity status. METHODS This is a retrospective study on consecutive patients with AMI admitted to a tertiary hospital between 2014-2021. Patients were allocated into 4 groups based on metabolic and obesity profile: metabolically healthy obese (MHO), metabolically healthy non-obese (MHNO), metabolically unhealthy obese (MUO) and metabolically unhealthy non-obese (MUNO). Metabolic health was defined in accordance to the BioSHARE-EU Healthy Obese Project. The primary outcome was all-cause mortality. Cox regression analysis examined the independent association between mortality and metabolic phenotypes, adjusting for age, sex, AMI type, chronic kidney disease, smoking status and left ventricular ejection fraction. RESULTS Of 9958 patients, the majority (68.5%) were MUNO, followed by MUO (25.1%), MHNO (5.6%), and MHO (0.8%). MHO had the lowest mortality (7.4%), followed by MHNO (9.7%), MUO (19.2%) and MUNO (22.6%) (p<0.001). Compared to MHNO, MUO (HR 1.737, 95%CI 1.282-2.355, p<0.001) and MUNO (HR 1.482, 95%CI 1.108-1.981, p=0.008) had significantly higher mortality risk, but not MHO (HR 1.390, 95%CI 0.594-3.251, p=0.447), after adjusting for confounders. Kaplan-Meier curves showed favourable survival in the metabolically healthy and obesity groups, with the highest overall survival in the MHO followed by MHNO, MUO and MUNO (p<0.001). CONCLUSION Metabolically healthy and obese AMI patients have favourable prognosis compared to metabolically unhealthy and non-obese patients. It is equally important to prioritize intensive metabolic risk factor management to weight reduction in the early phase after AMI.
Collapse
Affiliation(s)
- Nicholas Ws Chew
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore.
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - S Venisha
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chaoxing Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Chin Meng Khoo
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Ping Chai
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - William Kong
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Roger Foo
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Poay Huan Loh
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
21
|
Davis ME, Blake C, Perrotta C, Cunningham C, O'Donoghue G. Impact of training modes on fitness and body composition in women with obesity: A systematic review and meta-analysis. Obesity (Silver Spring) 2022; 30:300-319. [PMID: 35088563 DOI: 10.1002/oby.23305] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study aimed to assess the effectiveness of different exercise modalities and determine the optimal exercise prescription for improving cardiorespiratory fitness, body composition, and metabolic health of women with obesity. METHODS A systematic review of randomized controlled trials (RCTs) published between January 1988 and October 2020 was conducted. The RCTs were screened using the following inclusion criteria: 1) participants: women aged 18 to 65 years with BMI > 30 kg/m2 and without comorbidities; 2) intervention: exercise; 3) comparison: non-intervention control; and 4) outcomes measures: cardiorespiratory fitness (maximal oxygen consumption), body composition (i.e., body weight, percentage body fat), and/or metabolic measures (i.e., blood pressure, cholesterol). RESULTS A total of 20 RCTs with a total of 2,062 participants were included. Although the results showed that any form of exercise was more effective than control, improvements in fitness and body composition were modest. Aerobic exercise (vigorous and moderate intensity) appeared most promising for improving fitness and body weight, whereas low-load resistance training resulted in the largest improvements in body fatness. CONCLUSIONS In women living with obesity, aerobic exercise was consistently effective in improving fitness and body composition. Although both resistance training and combined exercise interventions appear promising, more research is needed to evaluate their efficacy and determine an optimal exercise prescription for this population.
Collapse
Affiliation(s)
- Mary E Davis
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Carla Perrotta
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Gráinne O'Donoghue
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| |
Collapse
|
22
|
Shang X, Li Y, Xu H, Zhang Q, Liu A, Ma G. Speed of Movement, Fatness, and the Change in Cardiometabolic Risk Factors in Children. Int J Sports Med 2021; 43:317-327. [PMID: 34553365 DOI: 10.1055/a-1308-2924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We aimed to examine speed of movement and its interactive association with fatness to changes in cardiometabolic risk factors over one year in children. The analysis included 8345 children aged 6-13 years. Cardiometabolic risk score was computed by summing Z-scores of waist circumference, the average of systolic and diastolic blood pressure, fasting glucose, high-density lipoprotein cholesterol (multiplied by -1), and triglycerides. Both high baseline and improvement in speed of movement were associated with favourable changes in percent body fat, lipids, and cardiometabolic risk score. Percentages of the association between baseline speed of movement and changes in cardiometabolic risk score, triglycerides, and high-density lipoprotein cholesterol explained by baseline BMI were 24.6% (19.6-29.1%), 26.2% (19.7-31.1%), and 12.5% (9.6-15.4%), respectively. The corresponding number for percent body fat was 47.0% (40.4-54.1%), 43.3% (36.7-51.7%), and 29.8% (25.0-34.6%), respectively. Speed of movement mediated the association between fatness and cardiometabolic risk factors. Improved speed of movement was associated with a lower increase in blood pressure in obese children only. Speed of movement is a strong predictor of changes in cardiometabolic risk factors. Fatness and speed of movement are interactively associated with cardiometabolic risk factors. Speed of movement may attenuate the positive association between fatness and blood pressure.
Collapse
Affiliation(s)
- Xianwen Shang
- Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Yanping Li
- Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, United States
| | - Haiquan Xu
- Institute of Food and Nutrition Development, Ministry of Agriculture and Rural Affairs, Beijing, China
| | - Qian Zhang
- Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention National Institute for Nutrition and Health, Beijing, China
| | - Ailing Liu
- Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention National Institute for Nutrition and Health, Beijing, China
| | - Guansheng Ma
- Department of Nutrition and Food Hygiene, Peking University, Beijing, China
| |
Collapse
|
23
|
Castro-Piñero J, Marin-Jimenez N, Fernandez-Santos JR, Martin-Acosta F, Segura-Jimenez V, Izquierdo-Gomez R, Ruiz JR, Cuenca-Garcia M. Criterion-Related Validity of Field-Based Fitness Tests in Adults: A Systematic Review. J Clin Med 2021; 10:jcm10163743. [PMID: 34442050 PMCID: PMC8397016 DOI: 10.3390/jcm10163743] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/23/2021] [Accepted: 08/15/2021] [Indexed: 11/16/2022] Open
Abstract
We comprehensively assessed the criterion-related validity of existing field-based fitness tests used to indicate adult health (19–64 years, with no known pathologies). The medical electronic databases MEDLINE (via PubMed) and Web of Science (all databases) were screened for studies published up to July 2020. Each original study’s methodological quality was classified as high, low and very low, according to the number of participants, the description of the study population, statistical analysis and systematic reviews which were appraised via the AMSTAR rating scale. Three evidence levels were constructed (strong, moderate and limited evidence) according to the number of studies and the consistency of the findings. We identified 101 original studies (50 of high quality) and five systematic reviews examining the criterion-related validity of field-based fitness tests in adults. Strong evidence indicated that the 20 m shuttle run, 1.5-mile, 12 min run/walk, YMCA step, 2 km walk and 6 min walk test are valid for estimating cardiorespiratory fitness; the handgrip strength test is valid for assessing hand maximal isometric strength; and the Biering–Sørensen test to evaluate the endurance strength of hip and back muscles; however, the sit-and reach test, and its different versions, and the toe-to-touch test are not valid for assessing hamstring and lower back flexibility. We found moderate evidence supporting that the 20 m square shuttle run test is a valid test for estimating cardiorespiratory fitness. Other field-based fitness tests presented limited evidence, mainly due to few studies. We developed an evidence-based proposal of the most valid field-based fitness tests in healthy adults aged 19–64 years old.
Collapse
Affiliation(s)
- Jose Castro-Piñero
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui s/n, Puerto Real, 11519 Cádiz, Spain; (J.C.-P.); (J.R.F.-S.); (F.M.-A.); (V.S.-J.); (R.I.-G.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Nuria Marin-Jimenez
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui s/n, Puerto Real, 11519 Cádiz, Spain; (J.C.-P.); (J.R.F.-S.); (F.M.-A.); (V.S.-J.); (R.I.-G.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), 11009 Cádiz, Spain
- Correspondence: ; Tel.: +34-956-016-253
| | - Jorge R. Fernandez-Santos
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui s/n, Puerto Real, 11519 Cádiz, Spain; (J.C.-P.); (J.R.F.-S.); (F.M.-A.); (V.S.-J.); (R.I.-G.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Fatima Martin-Acosta
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui s/n, Puerto Real, 11519 Cádiz, Spain; (J.C.-P.); (J.R.F.-S.); (F.M.-A.); (V.S.-J.); (R.I.-G.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Victor Segura-Jimenez
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui s/n, Puerto Real, 11519 Cádiz, Spain; (J.C.-P.); (J.R.F.-S.); (F.M.-A.); (V.S.-J.); (R.I.-G.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Rocio Izquierdo-Gomez
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui s/n, Puerto Real, 11519 Cádiz, Spain; (J.C.-P.); (J.R.F.-S.); (F.M.-A.); (V.S.-J.); (R.I.-G.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Jonatan R. Ruiz
- PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, School of Sports Science, University of Granada, 18007 Granada, Spain;
| | - Magdalena Cuenca-Garcia
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui s/n, Puerto Real, 11519 Cádiz, Spain; (J.C.-P.); (J.R.F.-S.); (F.M.-A.); (V.S.-J.); (R.I.-G.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), 11009 Cádiz, Spain
| |
Collapse
|
24
|
Ren J, Wu NN, Wang S, Sowers JR, Zhang Y. Obesity cardiomyopathy: evidence, mechanisms, and therapeutic implications. Physiol Rev 2021; 101:1745-1807. [PMID: 33949876 PMCID: PMC8422427 DOI: 10.1152/physrev.00030.2020] [Citation(s) in RCA: 166] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The prevalence of heart failure is on the rise and imposes a major health threat, in part, due to the rapidly increased prevalence of overweight and obesity. To this point, epidemiological, clinical, and experimental evidence supports the existence of a unique disease entity termed “obesity cardiomyopathy,” which develops independent of hypertension, coronary heart disease, and other heart diseases. Our contemporary review evaluates the evidence for this pathological condition, examines putative responsible mechanisms, and discusses therapeutic options for this disorder. Clinical findings have consolidated the presence of left ventricular dysfunction in obesity. Experimental investigations have uncovered pathophysiological changes in myocardial structure and function in genetically predisposed and diet-induced obesity. Indeed, contemporary evidence consolidates a wide array of cellular and molecular mechanisms underlying the etiology of obesity cardiomyopathy including adipose tissue dysfunction, systemic inflammation, metabolic disturbances (insulin resistance, abnormal glucose transport, spillover of free fatty acids, lipotoxicity, and amino acid derangement), altered intracellular especially mitochondrial Ca2+ homeostasis, oxidative stress, autophagy/mitophagy defect, myocardial fibrosis, dampened coronary flow reserve, coronary microvascular disease (microangiopathy), and endothelial impairment. Given the important role of obesity in the increased risk of heart failure, especially that with preserved systolic function and the recent rises in COVID-19-associated cardiovascular mortality, this review should provide compelling evidence for the presence of obesity cardiomyopathy, independent of various comorbid conditions, underlying mechanisms, and offer new insights into potential therapeutic approaches (pharmacological and lifestyle modification) for the clinical management of obesity cardiomyopathy.
Collapse
Affiliation(s)
- Jun Ren
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China.,Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Ne N Wu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China
| | - Shuyi Wang
- School of Medicine, Shanghai University, Shanghai, China.,University of Wyoming College of Health Sciences, Laramie, Wyoming
| | - James R Sowers
- Dalton Cardiovascular Research Center, Diabetes and Cardiovascular Research Center, University of Missouri-Columbia, Columbia, Missouri
| | - Yingmei Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China
| |
Collapse
|
25
|
Xia J, Yu P, Zeng Z, Ma M, Zhang G, Wan D, Gong D, Deng S, Wang J. High Dietary Intervention of Lauric Triglyceride Might be Harmful to Its Improvement of Cholesterol Metabolism in Obese Rats. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2021; 69:4453-4463. [PMID: 33844520 DOI: 10.1021/acs.jafc.1c00745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Hypercholesterolemia is often considered to be a major risk factor for atherosclerosis, and medium-chain fatty acids have been found to reduce the total cholesterol (TC) level and maintain low-density lipoprotein cholesterol (LDL-c) stability. However, we unexpectedly found that the levels of TC and LDL-c were increased in obese rats treated with high-dose lauric triglycerides (LT). The study aimed to investigate the effect and mechanism of LT on cholesterol metabolism in obese rats. Our results showed that LT intervention could reduce cholesterol biosynthesis by downregulating the expression of HMG-CoA reductase in obese rats. LT increased the expression levels of PPARγ1, LXRα, ABCA1, and ABCG8 in the liver. These results indicated that LT could improve the lipid transfer and bile acid efflux. However, LT significantly increased the expression of PCSK 9, resulting in accelerated degradation of LDLR, thus reducing the transport of very LDL (VLDL) and LDL to the liver. Together with the increased expression of NPC1L1 protein, LT impaired the uptake of VLDL/LDL by the liver and increased the reabsorption of sterols, leading to an increase in the levels of TC and LDL-c in obese rats.
Collapse
Affiliation(s)
- Jiaheng Xia
- Jiangxi Province Key Laboratory of Edible and Medicinal Resources Exploitation, School of Resource and Environmental and Chemical Engineering, Nanchang University, Nanchang 330031, China
| | - Ping Yu
- Jiangxi Province Key Laboratory of Edible and Medicinal Resources Exploitation, School of Resource and Environmental and Chemical Engineering, Nanchang University, Nanchang 330031, China
| | - Zheling Zeng
- Jiangxi Province Key Laboratory of Edible and Medicinal Resources Exploitation, School of Resource and Environmental and Chemical Engineering, Nanchang University, Nanchang 330031, China
- State Key Laboratory of Food Science and Technology, Jiangxi Province Key Laboratory of Edible and Medicinal Resources Exploitation, School of Food Science and Technology, Nanchang University, Nanchang 330031, China
| | - Maomao Ma
- State Key Laboratory of Food Science and Technology, Jiangxi Province Key Laboratory of Edible and Medicinal Resources Exploitation, School of Food Science and Technology, Nanchang University, Nanchang 330031, China
| | - Guohua Zhang
- State Key Laboratory of Food Science and Technology, Jiangxi Province Key Laboratory of Edible and Medicinal Resources Exploitation, School of Food Science and Technology, Nanchang University, Nanchang 330031, China
| | - Dongman Wan
- School of Food Science and Technology, Nanchang University, Nanchang 330031, China
| | - Deming Gong
- State Key Laboratory of Food Science and Technology, Jiangxi Province Key Laboratory of Edible and Medicinal Resources Exploitation, New Zealand Institute of Natural Medicine Research, 8 Ha Crescent, Auckland 2104, New Zealand
| | - Shuguang Deng
- Jiangxi Province Key Laboratory of Edible and Medicinal Resources Exploitation, School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona 85284, United States
| | - Jun Wang
- Jiangxi Province Key Laboratory of Edible and Medicinal Resources Exploitation, School of Resource and Environmental and Chemical Engineering, Nanchang University, Nanchang 330031, China
| |
Collapse
|
26
|
Patel KV, Metzinger M, Park B, Allen N, Ayers C, Kawut SM, Sidney S, Goff DC, Jacobs DR, Zaky AF, Carnethon M, Berry JD, Pandey A. Longitudinal Associations of Fitness and Obesity in Young Adulthood With Right Ventricular Function and Pulmonary Artery Systolic Pressure in Middle Age: The CARDIA Study. J Am Heart Assoc 2021; 10:e016968. [PMID: 33775106 PMCID: PMC8174339 DOI: 10.1161/jaha.120.016968] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Low cardiorespiratory fitness (CRF) and obesity are risk factors for heart failure but their associations with right ventricular (RV) systolic function and pulmonary artery systolic pressure (PASP) are not well understood. Methods and Results Participants in the CARDIA (Coronary Artery Risk Development in Young Adults) study who underwent maximal treadmill testing at baseline and had a follow-up echocardiographic examination at year 25 were included. A subset of participants had repeat CRF and body mass index (BMI) assessment at year 20. The associations of baseline and changes in CRF and BMI on follow-up (baseline to year 20) with RV systolic function parameters (tricuspid annular plane systolic excursion, RV Doppler systolic velocity of the lateral tricuspid annulus), and PASP were assessed using multivariable-adjusted linear regression models. The study included 3433 participants. In adjusted analysis, higher baseline BMI but not CRF was significantly associated with higher PASP. Among RV systolic function parameters, higher baseline CRF and BMI were significantly associated with higher tricuspid annular plane systolic excursion and RV systolic velocity of the lateral tricuspid annulus. In the subgroup of participants with follow-up assessment of CRF or BMI at year 20, less decline in CRF was associated with higher RV systolic velocity of the lateral tricuspid annulus and lower PASP, while greater increase in BMI was significantly associated with higher PASP in middle age. Conclusions Higher CRF in young adulthood and less decline in CRF over time are each significantly associated with better RV systolic function. Higher baseline BMI and greater age-related increases in BMI are each significantly associated with higher PASP in middle age. These findings provide insights into possible mechanisms through which low fitness and obesity may contribute toward risk of heart failure.
Collapse
Affiliation(s)
- Kershaw V Patel
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center TX
| | - Mark Metzinger
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Bryan Park
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Norrina Allen
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Colby Ayers
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Steven M Kawut
- Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Stephen Sidney
- Kaiser Permanente Northern California Division of Research Oakland CA
| | - David C Goff
- Kaiser Permanente Northern California Division of Research Oakland CA.,Colorado School of Public Health Aurora CO.,Division of Cardiovascular Sciences NHLBI Bethesda MD
| | - David R Jacobs
- School of Public Health University of Minnesota Minneapolis MN
| | - Ahmed F Zaky
- Department of Anesthesiology and Perioperative Medicine University of Alabama at Birmingham AL
| | - Mercedes Carnethon
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Jarett D Berry
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Ambarish Pandey
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| |
Collapse
|
27
|
Ho CC, Lee PF, Chen HL, Tseng CY, Hsieh XY, Chiu CH. Poor health-related physical fitness performance increases the overweight and obesity risk in older adults from Taiwan. BMC Geriatr 2021; 21:170. [PMID: 33750323 PMCID: PMC7941954 DOI: 10.1186/s12877-021-02112-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/24/2021] [Indexed: 01/12/2023] Open
Abstract
Background The purpose of the present study was to investigate the associations between health-related physical fitness performance and overweight/obesity risk among Taiwanese healthy older adults. Methods A secondary dataset from the nationwide survey was applied in this study. Data from a total of 21,630 respondents aged 65–96 years were collected in this study. Demographic characteristics, life habits, perceived health status, anthropometric assessments, and health-related physical fitness measurements from this dataset were analyzed using the chi-square test, one-way analysis of variance, and logistic regression analysis. Results The results indicated that overweight and obesity significantly associated with health-related physical fitness performance in the Taiwanese older adult population. In particular, the upper extremity muscular endurance scores of older adults with poor activity and physical fitness scores revealed obesity as a critical indicator of health-related physical fitness performance. Conclusions Future studies can use muscle quality or body fat classification to predict obesity in older adults, which could more precisely portray the relationship between obesity and health-related physical fitness performance.
Collapse
Affiliation(s)
- Chien-Chang Ho
- Department of Physical Education, Fu Jen Catholic University, New Taipei City, 242, Taiwan.,Research and Development Center for Physical Education, Health, and Information Technology, Fu Jen Catholic University, New Taipei City, 242, Taiwan
| | - Po-Fu Lee
- Research and Development Center for Physical Education, Health, and Information Technology, Fu Jen Catholic University, New Taipei City, 242, Taiwan.,Office of Physical Education Affairs, Taipei Medical University, Taipei City, 110, Taiwan
| | - Hui-Ling Chen
- Graduate Institute of Educational Leadership and Development, Fu Jen Catholic University, New Taipei City, 242, Taiwan
| | - Ching-Yu Tseng
- Department of Physical Education, Fu Jen Catholic University, New Taipei City, 242, Taiwan.,Research and Development Center for Physical Education, Health, and Information Technology, Fu Jen Catholic University, New Taipei City, 242, Taiwan
| | - Xin-Yu Hsieh
- Department of Physical Education, Fu Jen Catholic University, New Taipei City, 242, Taiwan.,Office of Physical Education Affairs, Taipei Medical University, Taipei City, 110, Taiwan
| | - Chih-Hui Chiu
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung City, Taiwan.
| |
Collapse
|
28
|
Brand C, Gaya ACA, Dias AF, Agostinis-Sobrinho C, Farinha JB, Macedo RCO, Mota J, de Oliveira AR, Gaya AR. The role of adiposity in the relationship between physical fitness with cardiometabolic risk factors, adipocytokines and inflammation in children. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-020-00662-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
29
|
Kerrigan DJ, Brawner CA, Ehrman JK, Keteyian S. Cardiorespiratory Fitness Attenuates the Impact of Risk Factors Associated With COVID-19 Hospitalization. Mayo Clin Proc 2021; 96:822-823. [PMID: 33673935 PMCID: PMC7817471 DOI: 10.1016/j.mayocp.2021.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/06/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | | | | | - Steven Keteyian
- Preventive Cardiology Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI
| |
Collapse
|
30
|
Salier Eriksson J, Ekblom B, Andersson G, Wallin P, Ekblom-Bak E. Scaling VO 2max to body size differences to evaluate associations to CVD incidence and all-cause mortality risk. BMJ Open Sport Exerc Med 2021; 7:e000854. [PMID: 33537151 PMCID: PMC7849897 DOI: 10.1136/bmjsem-2020-000854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 12/16/2022] Open
Abstract
Objective To evaluate and compare ratio and allometric scaling models of maximal oxygen consumption (VO2max) for different body size measurements in relation to cardiovascular disease (CVD) incidence and all-cause mortality. Methods 316 116 individuals participating in occupational health screenings, initially free from CVD, were included. VO2max was estimated using submaximal cycle test. Height, body mass and waist circumference (WC) were assessed, and eight different scaling models (two evaluated in a restricted sample with WC data) were derived. Participants were followed in national registers for first-time CVD event or all-cause mortality from their health screening to first CVD event, death or 31 December 2015. Results Increasing deciles of VO2max showed lower CVD risk and all-cause mortality for all six models in the full sample (p<0.001) as well as with increasing quintiles in the restricted sample (eight models) (p<0.001). For CVD risk and all-cause mortality, significantly weaker associations with increasing deciles for models 1 (L·min−1) and 5 (mL·min−1·height−2) were seen compared with model 2 (mL·min−1·kg−1), (CVD, p<0.00001; p<0.00001: all-cause mortality, p=0.008; p=0.001) and in some subgroups. For CVD, model 6 (mL·min−1·(kg1·height−1)−1) had a stronger association compared with model 2 (p<0.00001) and in some subgroups. In the restricted sample, trends for significantly stronger associations for models including WC compared with model 2 were seen in women for both CVD and all-cause mortality, and those under 50 for CVD. Conclusion In association to CVD and all-cause mortality, only small differences were found between ratio scaling and allometric scaling models where body dimensions were added, with some stronger associations when adding WC in the models.
Collapse
Affiliation(s)
- Jane Salier Eriksson
- Åstrand Laboratory of Work Physiology, Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Björn Ekblom
- Åstrand Laboratory of Work Physiology, Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Gunnar Andersson
- Research Department, HPI Health Profile Institute, Danderyd, Sweden
| | - Peter Wallin
- Research Department, HPI Health Profile Institute, Danderyd, Sweden
| | - Elin Ekblom-Bak
- Åstrand Laboratory of Work Physiology, Swedish School of Sport and Health Sciences, Stockholm, Sweden
| |
Collapse
|
31
|
[Determinants of health in adolescence: cardiorespiratory fitness and body composition]. NUTR HOSP 2021; 38:697-703. [PMID: 33720742 DOI: 10.20960/nh.03507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: cardiorespiratory fitness and body composition are determining indicators of health status during adolescence. The objective of the study was to analyze the relationship of both parameters with indicators of mental and psychosocial health, lifestyle habits, and sociodemographic variables, establishing their predictive factors. Method: a cross-sectional study was conducted with a representative sample of 761 students (14.51 ± 1.63 years old) from 25 educational centers in a northern region of Spain. Body mass index, maximum oxygen uptake, health-related quality of life, self-esteem, hours of nightly sleep, adherence to the Mediterranean diet, physical activity engagement, academic performance, and different sociodemographic factors were analyzed for all participants. Results: the results determined that being a boy, being younger, sleeping fewer hours at night, and presenting a lower academic performance were predictors of suffering from obesity, while being younger and being a migrant were predictors of being overweight. On the other hand, lower physical activity engagement, poorer academic performance, being a migrant, and not practicing extracurricular sports activities were predictive factors of cardiorespiratory fitness in the risk zone. In addition, the environment for performing physical activity and socioeconomic level also showed associations with cardiorespiratory fitness. Conclusions: given the influence of body composition and cardiorespiratory fitness on the physical and psychosocial health of adolescents, promotion strategies are required that take into account the identified predictors, with special attention to promoting healthy lifestyles.
Collapse
|
32
|
Yoo JH, Park SW, Jun JE, Jin SM, Hur KY, Lee MK, Kang M, Kim G, Kim JH. Relationship between low skeletal muscle mass, sarcopenic obesity and left ventricular diastolic dysfunction in Korean adults. Diabetes Metab Res Rev 2021; 37:e3363. [PMID: 32521113 DOI: 10.1002/dmrr.3363] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/29/2020] [Accepted: 06/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Heart failure with preserved ejection fraction is an emerging global health issue attributed to an ageing population. However, the association between low skeletal muscle mass, sarcopenic obesity, and left ventricular diastolic dysfunction remains unclear. In the current study, we aimed to investigate the relationship between low skeletal muscle mass, sarcopenic obesity, and diastolic dysfunction in a large cohort of Korean adults. METHODS We conducted a cross-sectional study of 31 258 subjects who underwent health examinations at Samsung Medical Centre's Health Promotion Centre in Seoul, Republic of Korea. Relative skeletal muscle mass was calculated using the skeletal muscle mass index [SMI (%) = appendicular skeletal muscle mass (kg)/body weight (kg) × 100], which was estimated by bioelectrical impedance analysis. Cardiac structure and function were evaluated by echocardiography. RESULTS Amongst the 31 258 subjects, 3058 (9.78%) were determined to have diastolic dysfunction. The odds ratio (OR) of diastolic dysfunction was 1.56 [95% confidence interval (CI): 1.31-1.85; p for trend <0.001] for the lowest SMI tertile relative to the highest SMI tertile following multivariable adjustment. Furthermore, the risk of diastolic dysfunction was much higher in the sarcopenic obesity (OR: 1.70, 95% CI: 1.44-1.99), followed by in the obesity-only (OR: 1.40, 95% CI: 1.21-1.62), and sarcopenia-only (OR: 1.32, 95% CI: 1.08-1.61) when compared with the nonobese, nonsarcopenic group. These results remained consistent amongst the elderly (age ≥ 65 years). CONCLUSIONS Our findings demonstrate that lower skeletal muscle mass and sarcopenic obesity are strongly associated with diastolic dysfunction in middle-aged and older adults.
Collapse
Affiliation(s)
- Jee Hee Yoo
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Sung Woon Park
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji Eun Jun
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Moon-Kyu Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mira Kang
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Center for Health Promotion, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| |
Collapse
|
33
|
Nicolini C, Fahnestock M, Gibala MJ, Nelson AJ. Understanding the Neurophysiological and Molecular Mechanisms of Exercise-Induced Neuroplasticity in Cortical and Descending Motor Pathways: Where Do We Stand? Neuroscience 2020; 457:259-282. [PMID: 33359477 DOI: 10.1016/j.neuroscience.2020.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023]
Abstract
Exercise is a promising, cost-effective intervention to augment successful aging and neurorehabilitation. Decline of gray and white matter accompanies physiological aging and contributes to motor deficits in older adults. Exercise is believed to reduce atrophy within the motor system and induce neuroplasticity which, in turn, helps preserve motor function during aging and promote re-learning of motor skills, for example after stroke. To fully exploit the benefits of exercise, it is crucial to gain a greater understanding of the neurophysiological and molecular mechanisms underlying exercise-induced brain changes that prime neuroplasticity and thus contribute to postponing, slowing, and ameliorating age- and disease-related impairments in motor function. This knowledge will allow us to develop more effective, personalized exercise protocols that meet individual needs, thereby increasing the utility of exercise strategies in clinical and non-clinical settings. Here, we review findings from studies that investigated neurophysiological and molecular changes associated with acute or long-term exercise in healthy, young adults and in healthy, postmenopausal women.
Collapse
Affiliation(s)
- Chiara Nicolini
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Margaret Fahnestock
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Martin J Gibala
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Aimee J Nelson
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada.
| |
Collapse
|
34
|
Quertier D, Goudard Y, Goin G, Régis-Marigny L, Sockeel P, Dutour A, Pauleau G, De La Villéon B. Overweight and Obesity in the French Army. Mil Med 2020; 187:e99-e105. [PMID: 33331910 DOI: 10.1093/milmed/usaa369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/13/2020] [Accepted: 12/14/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Today, the prevalence of overweight and obesity is, respectively, 49% and 17% among French adults. This research investigates their existence in the French Armed Forces, in terms of the impact on military operative response and military readiness. As no previous studies have evaluated the weight status of the whole French Armed Forces, this work assesses the situation for the first time in France. MATERIAL AND METHODS A prospective cross-sectional study was carried out between September 2016 and April 2017. A single anonymous questionnaire gathered the sociodemographic variables and usual care medical data. The source population was active duty members serving in units reporting to the South-Eastern French Regional Military Health Department. RESULTS Among 1,589 respondents, prevalence of overweight and obesity was, respectively, 38.7% and 10%. Mean waist circumference was 78.2 ± 9.1 cm for women and 89.1 ± 10.5 cm for men. A third of female military and one-fifth of male military had a measure bigger than the standard International Diabetes Federation. Age, sex, weekly fitness activity, and rank were significant independent predictors of body weight excess. Less than 5% of the study population reported a diagnosis of comorbidity: diabetes 2%, high blood pressure 1%, and dyslipidemia 1.5%. CONCLUSIONS As all armies, the French Armed Forces are affected by obesity. Nevertheless, the prevalence of obesity seems lower than in other Western armies. In the French army, as in the general population, obesity is correlated with socioeconomic status and level of education. However, compared to the general French population, there is less obesity and overweight in the French Armed Forces. Moreover, overweight and obese military members have a lower cardiovascular risk than their civilian counterparts. Enlistment standards, military occupational activity, and a mandatory high level of physical fitness could explain these different proportions of overweight and obesity. This raises the question of the protective effect of regular physical activity. Is this a serious way to fight against the growing prevalence of overweight and obesity in Western countries? Indeed, this is a significant public health issue, which also affects the military's quick response force capacity and strategic capabilities. Therefore, the identification of specific demographic characteristics should be considered in developing prevention programs.
Collapse
Affiliation(s)
- Delphine Quertier
- Department of Digestive, Endocrine and Metabolic Surgery, Laveran Hospital, 13013, Marseille (Bouches-du-Rhne), France
| | - Yvain Goudard
- Department of Digestive, Endocrine and Metabolic Surgery, Laveran Hospital, 13013, Marseille (Bouches-du-Rhne), France
| | - Géraldine Goin
- Department of Digestive, Endocrine and Metabolic Surgery, Laveran Hospital, 13013, Marseille (Bouches-du-Rhne), France
| | - Laure Régis-Marigny
- Department of Digestive, Endocrine and Metabolic Surgery, Laveran Hospital, 13013, Marseille (Bouches-du-Rhne), France
| | - Philippe Sockeel
- Department of Digestive, Endocrine and Metabolic Surgery, Laveran Hospital, 13013, Marseille (Bouches-du-Rhne), France
| | - Anne Dutour
- Department of Nutrition and Endocrinology, North Hospital-Chemin des Bourrelly, 13015, Marseille (Bouches-du-Rhne), France
| | - Ghislain Pauleau
- Department of Digestive, Endocrine and Metabolic Surgery, Laveran Hospital, 13013, Marseille (Bouches-du-Rhne), France
| | - Bruno De La Villéon
- Department of Digestive, Endocrine and Metabolic Surgery, Laveran Hospital, 13013, Marseille (Bouches-du-Rhne), France
| |
Collapse
|
35
|
Morgan PT, Smeuninx B, Breen L. Exploring the Impact of Obesity on Skeletal Muscle Function in Older Age. Front Nutr 2020; 7:569904. [PMID: 33335909 PMCID: PMC7736105 DOI: 10.3389/fnut.2020.569904] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/06/2020] [Indexed: 12/16/2022] Open
Abstract
Sarcopenia is of important clinical relevance for loss of independence in older adults. The prevalence of obesity in combination with sarcopenia ("sarcopenic-obesity") is increasing at a rapid rate. However, whilst the development of sarcopenia is understood to be multi-factorial and harmful to health, the role of obesity from a protective and damaging perspective on skeletal muscle in aging, is poorly understood. Specifically, the presence of obesity in older age may be accompanied by a greater volume of skeletal muscle mass in weight-bearing muscles compared with lean older individuals, despite impaired physical function and resistance to anabolic stimuli. Collectively, these findings support a potential paradox in which obesity may protect skeletal muscle mass in older age. One explanation for these paradoxical findings may be that the anabolic response to weight-bearing activity could be greater in obese vs. lean older individuals due to a larger mechanical stimulus, compensating for the heightened muscle anabolic resistance. However, it is likely that there is a complex interplay between muscle, adipose, and external influences in the aging process that are ultimately harmful to health in the long-term. This narrative briefly explores some of the potential mechanisms regulating changes in skeletal muscle mass and function in aging combined with obesity and the interplay with sarcopenia, with a particular focus on muscle morphology and the regulation of muscle proteostasis. In addition, whilst highly complex, we attempt to provide an updated summary for the role of obesity from a protective and damaging perspective on muscle mass and function in older age. We conclude with a brief discussion on treatment of sarcopenia and obesity and a summary of future directions for this research field.
Collapse
Affiliation(s)
- Paul T. Morgan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Benoit Smeuninx
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Cellular & Molecular Metabolism Laboratory, Monash Institute of Pharmacological Sciences, Monash University, Parkville, VIC, Australia
| | - Leigh Breen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
36
|
Lewitt MS, Baker JS. Relationship between abdominal adiposity, cardiovascular fitness, and biomarkers of cardiovascular risk in British adolescents. JOURNAL OF SPORT AND HEALTH SCIENCE 2020; 9:634-644. [PMID: 33308814 PMCID: PMC7749262 DOI: 10.1016/j.jshs.2019.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/18/2018] [Accepted: 10/06/2018] [Indexed: 05/13/2023]
Abstract
BACKGROUND Puberty is a critical time in the development of overweight and obesity. The aim of this study was to examine relationships between measures of adiposity, cardiovascular fitness, and biomarkers of cardiovascular disease risk in adolescents. METHODS In a cross-sectional study design, 129 girls and 95 boys aged 12.9-14.4 years at various stages of puberty were included, along with their mothers (n = 217) and fathers (n = 207). Anthropometric assessments of adiposity were made, along with cardiovascular physical fitness, using the 20-m shuttle run test, and biomarkers associated with cardiovascular risk, including glucose, insulin, triglyceride, fibrinogen, and C-reactive protein (CRP) concentrations. RESULTS Waist-to-height ratio values were similar in boys and girls and correlated positively with diastolic blood pressure, insulin, triglyceride, fibrinogen, and CRP concentrations, and inversely with cardiovascular fitness scores. Skinfold thickness measurements were higher in girls. High-molecular-weight adiponectin concentrations were lower in boys than girls, particularly in late puberty, and CRP levels were higher. Cardiovascular fitness, maternal body mass index (BMI), and paternal BMI contributed independently to the variance in waist measurements in girls and boys. Gender, triceps skinfold thickness, and weight-to-height ratio, but not parental BMI, contributed independently to the variance in cardiovascular fitness. CONCLUSION There is a relationship between measures of adolescent adiposity and parental weight that involves factors other than cardiovascular fitness. Adolescent boys have relatively more abdominal fat than girls and a tendency to have a proinflammatory profile of biomarkers. These observations suggest that family and social environmental interventions are best undertaken earlier in childhood, particularly among boys.
Collapse
Affiliation(s)
- Moira S Lewitt
- School of Health and Life Sciences, University of the West of Scotland, Paisley PA1 2BE, Scotland, UK.
| | - Julien S Baker
- Institute of Clinical Exercise and Health Science, School of Health and Life Sciences, University of the West of Scotland, Lanarkshire G72 0LH, Scotland, UK
| |
Collapse
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
Moon RC, Cunningham SA, Gazmararian J. Impact of Weight Status on the Cardiopulmonary Fitness Outcome of a School-Based Physical Activity Program. THE JOURNAL OF SCHOOL HEALTH 2020; 90:762-770. [PMID: 32794603 PMCID: PMC7856835 DOI: 10.1111/josh.12936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The effectiveness of school-based physical activity interventions for improving cardiopulmonary fitness (CPF) of overweight and obese children is not well established. In this study, we evaluated whether overweight and obese children had similar changes in body mass index (BMI) and CPF as normal weight children after participating in a program for one academic year. METHODS Using purposive sampling at the school level, we selected 16 program and 7 control schools in a large metropolitan area in the Southeast during the 2015-2016 academic year. In these schools, 3396 fourth-graders participated with parental consent. Of these, 2332 (68.7%) participated in BMI measures and 1780 (52.4%) in Progressive Aerobic Cardiovascular Endurance Run (PACER) measures for CPF at two time points. RESULTS Students of all weight statuses pre-program did not show changes in BMI after program implementation. All students showed statistically significant improvements in the PACER test at follow-up, regardless of their participation in the program. However, overweight and obese children showed less improvement in CPF level than their normal weight classmates, regardless of their participation in the program. CONCLUSION Special attention for improving engagements of overweight and obese children may be needed to achieve improvements in their CPF level similar to that of normal weight students.
Collapse
Affiliation(s)
- Rena C. Moon
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, Orlando, FL 32806
| | - Solveig A. Cunningham
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA30322
| | - Julie Gazmararian
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA30322
| |
Collapse
|
39
|
Nesti L, Pugliese NR, Sciuto P, Natali A. Type 2 diabetes and reduced exercise tolerance: a review of the literature through an integrated physiology approach. Cardiovasc Diabetol 2020; 19:134. [PMID: 32891175 PMCID: PMC7487838 DOI: 10.1186/s12933-020-01109-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022] Open
Abstract
The association between type 2 diabetes mellitus (T2DM) and heart failure (HF) is well established. Early in the course of the diabetic disease, some degree of impaired exercise capacity (a powerful marker of health status with prognostic value) can be frequently highlighted in otherwise asymptomatic T2DM subjects. However, the literature is quite heterogeneous, and the underlying pathophysiologic mechanisms are far from clear. Imaging-cardiopulmonary exercise testing (CPET) is a non-invasive, provocative test providing a multi-variable assessment of pulmonary, cardiovascular, muscular, and cellular oxidative systems during exercise, capable of offering unique integrated pathophysiological information. With this review we aimed at defying the cardiorespiratory alterations revealed through imaging-CPET that appear specific of T2DM subjects without overt cardiovascular or pulmonary disease. In synthesis, there is compelling evidence indicating a reduction of peak workload, peak oxygen assumption, oxygen pulse, as well as ventilatory efficiency. On the contrary, evidence remains inconclusive about reduced peripheral oxygen extraction, impaired heart rate adjustment, and lower anaerobic threshold, compared to non-diabetic subjects. Based on the multiparametric evaluation provided by imaging-CPET, a dissection and a hierarchy of the underlying mechanisms can be obtained. Here we propose four possible integrated pathophysiological mechanisms, namely myocardiogenic, myogenic, vasculogenic and neurogenic. While each hypothesis alone can potentially explain the majority of the CPET alterations observed, seemingly different combinations exist in any given subject. Finally, a discussion on the effects -and on the physiological mechanisms-of physical activity and exercise training on oxygen uptake in T2DM subjects is also offered. The understanding of the early alterations in the cardiopulmonary response that are specific of T2DM would allow the early identification of those at a higher risk of developing HF and possibly help to understand the pathophysiological link between T2DM and HF.
Collapse
Affiliation(s)
- Lorenzo Nesti
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy. .,Cardiopulmonary Test Lab, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy.
| | - Nicola Riccardo Pugliese
- Cardiopulmonary Test Lab, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Paolo Sciuto
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy
| | - Andrea Natali
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy
| |
Collapse
|
40
|
Litwin SE, Adams TD, Davidson LE, McKinlay R, Simper SC, Ranson L, Hunt SC. Longitudinal Changes in Cardiac Structure and Function in Severe Obesity: 11-Year Follow-Up in the Utah Obesity Study. J Am Heart Assoc 2020; 9:e014542. [PMID: 32476544 PMCID: PMC7429060 DOI: 10.1161/jaha.119.014542] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Progressive cardiac remodeling and worsening myocardial function over time have been proposed as potential mediators of heart failure in obesity. Methods and Results We serially assessed cardiac structure and function in 254 subjects participating in a longitudinal study of obesity. Demographic, clinical, laboratory, and echocardiographic features were determined at baseline and 2‐, 6‐, and 11‐year follow‐up. We measured body mass index (BMI) exposure as the area under the curve of the BMI at each of the 4 visits. At enrollment, mean age of the subjects was 47 years, 79% were women, mean BMI was 44 kg/m2, 26% had diabetes mellitus, 48% had hypertension, and 53% had hyperlipidemia. Between baseline and 11 years, BMI increased by 1.1 and 0.3 kg/m2 in men and women, respectively. There were modest increases in left ventricular (LV) end‐diastolic volume, LV mass, and left atrial volume, and significant decreases in early/late mitral diastolic flow velocity ratio and E wave deceleration time. However, there were no significant changes in LV ejection fraction or ratio of early mitral diastolic flow velocity/early mitral annular velocity, whereas right ventricular fractional area change increased. Significant predictors of the change in LV mass were male sex, baseline BMI, BMI area under the curve, and change in LV stroke volume, but not smoking, hypertension, or diabetes mellitus. Conclusions In long‐standing, persistent severe obesity, there was evidence of cardiac remodeling over a period of 11 years, but no clear worsening of systolic or diastolic function. Measures of remodeling were most strongly related to BMI. The observed changes might predispose to heart failure with preserved ejection fraction, but are not classic for an evolving dilated cardiomyopathy.
Collapse
Affiliation(s)
- Sheldon E. Litwin
- Department of Internal MedicineMedical University of South CarolinaCharlestonSC
- Ralph H. Johnson Veterans Affairs Medical CenterCharlestonSC
| | - Ted D. Adams
- Division of EpidemiologyUniversity of Utah School of MedicineSalt Lake CityUT
- Intermountain Health CorporationSalt Lake CityUT
| | - Lance E. Davidson
- Division of EpidemiologyUniversity of Utah School of MedicineSalt Lake CityUT
- Department of Exercise SciencesBrigham Young UniversityProvoUT
| | | | | | | | - Steven C. Hunt
- Division of EpidemiologyUniversity of Utah School of MedicineSalt Lake CityUT
- Department of Genetic MedicineWeill Cornell MedicineDohaQatar
| |
Collapse
|
41
|
Taurio J, Järvinen J, Hautaniemi EJ, Eräranta A, Viitala J, Nordhausen K, Kaukinen K, Mustonen J, Pörsti IH. Team-based "Get-a-Grip" lifestyle management programme in the treatment of obesity. Prev Med Rep 2020; 19:101119. [PMID: 32461881 PMCID: PMC7242875 DOI: 10.1016/j.pmedr.2020.101119] [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: 09/19/2019] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/24/2022] Open
Abstract
Team-based one-year lifestyle programme led to mean weight loss of 4.8 kg. Among the participants 44% lost ≥ 5%, while 21% lost ≥ 10% of their initial weight. Beneficial changes were detected in muscle mass, body fat, and visceral fat. Systolic and diastolic blood pressure was reduced significantly.
This study examined weight loss during an extensive 1-year lifestyle programme in primary care in Finland in overweight subjects (n = 134, age 18–69 years; BMI > 30, or BMI > 25 with a comorbidity that would benefit from weight loss) between 2009 and 2013 in a single arm design. The programme included four medical doctor visits, five sessions by a dietitian (advice on diet and on-location shopping behaviour), cooking classes, exercise supervised by personal trainer, and group discussions. A motivational interview method was applied. Of the 134 participants, 92 (69%) completed the 1-year programme. Among the participants 44% lost ≥ 5%, while 21% lost ≥ 10% of their initial body weight. In intention-to-treat-analyses, the mean weight loss during one year was 4.8 kg (p < 0.001). Mean BMI decreased by 1.7 kg/m2 (p < 0.001) and waist circumference by 5.6 cm (p < 0.001). Mean muscle mass increased by 3.3% (p < 0.001), and body fat decreased by 5.0% (p < 0.001). After the programme mean visceral fat content was reduced by 6.4%, systolic blood pressure by 8 mmHg (p < 0.001), and diastolic blood pressure by 6 mmHg (p < 0.001). In conclusion, retention to the team-based lifestyle management programme resulted in moderate but significant weight loss with beneficial changes in body composition, and the trend to lose weight was maintained throughout the year. Trial registration: Clinicaltrials.gov identifier NCT04003259.
Collapse
Affiliation(s)
- Jyrki Taurio
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
| | - Jorma Järvinen
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
| | - Elina J Hautaniemi
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, FI-33014, Finland
| | - Arttu Eräranta
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Finland
| | - Jani Viitala
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Finland
| | - Klaus Nordhausen
- Faculty of Social Sciences, Tampere University, FI-33014, Finland.,Institute of Statistics & Mathematical Methods in Economics, Vienna University of Technology, Wiedner Hauptstr. 7, A-1040 Vienna, Austria
| | - Katri Kaukinen
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, FI-33014, Finland
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, FI-33014, Finland
| | - Ilkka H Pörsti
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, FI-33014, Finland
| |
Collapse
|
42
|
Lechner K, von Schacky C, McKenzie AL, Worm N, Nixdorff U, Lechner B, Kränkel N, Halle M, Krauss RM, Scherr J. Lifestyle factors and high-risk atherosclerosis: Pathways and mechanisms beyond traditional risk factors. Eur J Prev Cardiol 2020; 27:394-406. [PMID: 31408370 PMCID: PMC7065445 DOI: 10.1177/2047487319869400] [Citation(s) in RCA: 172] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/23/2019] [Indexed: 12/21/2022]
Abstract
Despite major efforts to reduce atherosclerotic cardiovascular disease (ASCVD) burden with conventional risk factor control, significant residual risk remains. Recent evidence on non-traditional determinants of cardiometabolic health has advanced our understanding of lifestyle-disease interactions. Chronic exposure to environmental stressors like poor diet quality, sedentarism, ambient air pollution and noise, sleep deprivation and psychosocial stress affect numerous traditional and non-traditional intermediary pathways related to ASCVD. These include body composition, cardiorespiratory fitness, muscle strength and functionality and the intestinal microbiome, which are increasingly recognized as major determinants of cardiovascular health. Evidence points to partially overlapping mechanisms, including effects on inflammatory and nutrient sensing pathways, endocrine signalling, autonomic function and autophagy. Of particular relevance is the potential of low-risk lifestyle factors to impact on plaque vulnerability through altered adipose tissue and skeletal muscle phenotype and secretome. Collectively, low-risk lifestyle factors cause a set of phenotypic adaptations shifting tissue cross-talk from a proinflammatory milieu conducive for high-risk atherosclerosis to an anti-atherogenic milieu. The ketone body ß-hydroxybutyrate, through inhibition of the NLRP-3 inflammasome, is likely to be an intermediary for many of these observed benefits. Adhering to low-risk lifestyle factors adds to the prognostic value of optimal risk factor management, and benefit occurs even when the impact on conventional risk markers is discouragingly minimal or not present. The aims of this review are (a) to discuss novel lifestyle risk factors and their underlying biochemical principles and (b) to provide new perspectives on potentially more feasible recommendations to improve long-term adherence to low-risk lifestyle factors.
Collapse
Affiliation(s)
- Katharina Lechner
- Technical University of Munich, School of Medicine, Department of Prevention, Rehabilitation and Sports Medicine, Germany
| | - Clemens von Schacky
- Preventive Cardiology, Ludwig-Maximilians University, Munich, Germany
- Omegametrix, Martinsried, Germany
| | | | - Nicolai Worm
- German University for Prevention and Health Care Management, Saarbrücken, Germany
| | - Uwe Nixdorff
- European Prevention Centre, Medical Centre Düsseldorf (Grand Arc), Germany
| | - Benjamin Lechner
- Department of Internal Medicine IV, Ludwig-Maximilians University, Munich, Germany
| | - Nicolle Kränkel
- Charité – Universitätsmedizin Berlin, Klinik für Kardiologie, Campus Benjamin Steglitz, Berlin, Germany
| | - Martin Halle
- Technical University of Munich, School of Medicine, Department of Prevention, Rehabilitation and Sports Medicine, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany
| | | | - Johannes Scherr
- Technical University of Munich, School of Medicine, Department of Prevention, Rehabilitation and Sports Medicine, Germany
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Switzerland
| |
Collapse
|
43
|
Liu X, Guo L, Xiao K, Zhu W, Liu M, Wan R, Hong K. The obesity paradox for outcomes in atrial fibrillation: Evidence from an exposure-effect analysis of prospective studies. Obes Rev 2020; 21:e12970. [PMID: 31849187 DOI: 10.1111/obr.12970] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 12/11/2022]
Abstract
The impact of obesity on the prognosis of atrial fibrillation (AF) remains controversial. We conducted an exposure-effect meta-analysis of prospective studies to clarify the relationship between body mass index (BMI) and outcomes in patients with AF. The Cochrane Library, PubMed, and Embase databases were searched through May 1, 2019. Summary relative risks (RRs) were calculated using random-effects models. Nonlinear associations were explored using restricted cubic spline models. Twenty publications involving 161,922 individuals were included. Categorical variable analysis showed that underweight was associated with an increased risk of all-cause mortality (RR: 2.6), cardiovascular death (RR: 2.91), major bleeding (RR: 1.57), stroke or systemic embolism (RR: 1.62), and a composite endpoint (RR: 2.23). In exposure-effect analysis, the risk per 5 BMI increase was reduced for adverse outcomes (RR=0.86, 95% CI: 0.80-0.92 for all-cause death; RR=0.82, 95% CI: 0.71-0.95 for cardiovascular death; RR=0.89, 95% CI: 0.84-0.95 for stroke or systemic embolism; and RR=0.78, 95% CI: 0.67-0.92 for a composite endpoint). There was a significant "U"-shaped exposure-effect relationship with all-cause death, and the nadir of the curve was observed at a BMI of approximately 28. Our results showed that underweight is associated with a worse prognosis, but that overweight and obesity are associated with improved adverse outcomes in patients with AF.
Collapse
Affiliation(s)
- Xiao Liu
- Cardiology Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Linjuan Guo
- Cardiology Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Kaiwen Xiao
- Jiangxi Medical College, Nanchang University, Jiangxi, China
| | - Wengen Zhu
- Cardiology Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Menglu Liu
- Cardiology Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Rong Wan
- Jiangxi Key Laboratory of Molecular Medicine, Jiangxi, China
| | - Kui Hong
- Cardiology Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China.,Jiangxi Key Laboratory of Molecular Medicine, Jiangxi, China
| |
Collapse
|
44
|
Abstract
The obesity paradox, which suggests a survival advantage for the obese in heart failure (HF) has sparked debate in the medical community. Studies demonstrate a survival advantage in obese patients with HF, including those with advanced HF requiring continuous inotropic support for palliation or disease modifying therapy with a left ventricular assist device (LVAD) or heart transplantation (HT). Importantly, the obesity paradox is affected by the level of cardiorespiratory fitness (CRF). It is now recommended that HF patients with body mass index ≥35 kg/m2 achieve at least 5-10% weight loss, in order to improve symptoms and cardiac function, though more robust data are urgently needed. CRF may be the single best predictor of overall health and small improvements in fitness levels may lead to improved outcomes in HF. In addition to implications of obesity in chronic HF, we also discuss management of obese patients with advanced HF and their implications for therapies such as LVAD implantation and HT.
Collapse
|
45
|
Shang X, Li Y, Xu H, Zhang Q, Hu X, Liu A, Du S, Li T, Guo H, Li Y, Xu G, Liu W, Ma J, Ma G. Independent and Interactive Associations of Fitness and Fatness With Changes in Cardiometabolic Risk in Children: A Longitudinal Analysis. Front Endocrinol (Lausanne) 2020; 11:342. [PMID: 32595599 PMCID: PMC7304437 DOI: 10.3389/fendo.2020.00342] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Findings for associations between cardiorespiratory fitness (CRF) and cardiometabolic risk (CMR) factors are inconsistent, and the interactive association between CRF and fatness with CMR factors is unclear in children. Our study aimed to examine whether CRF and fatness are independently and interactively associated with CMR factors. Methods: We included 5,869 children aged 6-13 years in the analysis. Physical examinations, blood tests, and CRF were measured at baseline and 1 year later. Cardiometabolic risk score (CMRS) was computed by summing Z scores of waist circumference (WC), averaged systolic and diastolic blood pressure, glucose, high-density lipoprotein cholesterol (HDL-C, multiplied by -1), and triglycerides. Results: There was a high correlation between fatness and CRF in both boys and girls. High baseline CRF was independently associated with favorable changes in CMRS, BMI, WC, percent body fat (PBF), total cholesterol, LDL-C, and HDL-C (all P < 0.025). Improved CRF was independently associated with favorable changes in CMRS, BMI, WC, PBF, total cholesterol, LDL-C, HDL-C, triglycerides, and fasting glucose (all P < 0.0321). Baseline BMI was positively associated with changes in CMRS, WC, blood pressure, triglycerides, insulin, and HOMA-IR (all P < 0.0462). Low PBF at baseline was associated with favorable changes in CMRS, BMI, WC, blood pressure, HDL-C, triglycerides, insulin, and HOMA-IR (all P < 0.0423). The percentage of the total effect of baseline CRF on changes in CMRS, triglycerides, HDL-C, PBF, and WC mediated by baseline BMI was 66.0, 61.6, 40.3, 20.7, and 9.2%, respectively. Baseline CRF was a significant mediator for the association between baseline BMI and changes in CMRS (mediated by 4.3%), triglycerides (5.1%), and HDL-C (12.0%). An inverse association was found between baseline CRF and CMRS in children with high baseline BMI/PBF only. Improved CRF was associated with decreased BMI and WC in children with low baseline CRF. Conclusions: Fatness and CRF are each independently associated with changes in CMR factors. Fatness is a major mediator for the association between CRF and CMR factors, whereas the association between fatness and CMR factors is also mediated by CRF. The beneficial effect of high CRF on CMR factors was more evident in obese or unfit children.
Collapse
Affiliation(s)
- Xianwen Shang
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Yanping Li
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Haiquan Xu
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
- Institute of Food and Nutrition Development, Ministry of Agriculture and Rural Affairs, Beijing, China
| | - Qian Zhang
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Xiaoqi Hu
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Ailing Liu
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Songming Du
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Tingyu Li
- Department of Pediatrics, Chongqing Children's Hospital, Chongqing, China
| | - Hongwei Guo
- School of Public Health, Fudan University, Shanghai, China
| | - Ying Li
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, China
| | - Guifa Xu
- Department of Public Health, Shandong University, Jinan, China
| | - Weijia Liu
- School Health Department, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Guansheng Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
- *Correspondence: Guansheng Ma
| |
Collapse
|
46
|
Nishida MM, Okura M, Ogita M, Aoyama T, Tsuboyama T, Arai H. Two-Year Weight Loss but Not Body Mass Index Predicts Mortality and Disability in an Older Japanese Community-Dwelling Population. J Am Med Dir Assoc 2019; 20:1654.e11-1654.e18. [DOI: 10.1016/j.jamda.2019.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 01/04/2023]
|
47
|
Lavie CJ, Elagizi A, Ozemek C. Fitness Is More Important than Adiposity in Women. J Womens Health (Larchmt) 2019; 29:279-280. [PMID: 31746667 DOI: 10.1089/jwh.2019.8148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Carl J Lavie
- The John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Andrew Elagizi
- The John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
48
|
Zaccardi F, Franks PW, Dudbridge F, Davies MJ, Khunti K, Yates T. Mortality risk comparing walking pace to handgrip strength and a healthy lifestyle: A UK Biobank study. Eur J Prev Cardiol 2019; 28:704-712. [PMID: 34247229 DOI: 10.1177/2047487319885041] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/07/2019] [Indexed: 12/12/2022]
Abstract
AIMS Brisk walking and a greater muscle strength have been associated with a longer life; whether these associations are influenced by other lifestyle behaviours, however, is less well known. METHODS Information on usual walking pace (self-defined as slow, steady/average, or brisk), dynamometer-assessed handgrip strength, lifestyle behaviours (physical activity, TV viewing, diet, alcohol intake, sleep and smoking) and body mass index was collected at baseline in 450,888 UK Biobank study participants. We estimated 10-year standardised survival for individual and combined lifestyle behaviours and body mass index across levels of walking pace and handgrip strength. RESULTS Over a median follow-up of 7.0 years, 3808 (1.6%) deaths in women and 6783 (3.2%) in men occurred. Brisk walkers had a survival advantage over slow walkers, irrespective of the degree of engagement in other lifestyle behaviours, except for smoking. Estimated 10-year survival was higher in brisk walkers who otherwise engaged in an unhealthy lifestyle compared to slow walkers who engaged in an otherwise healthy lifestyle: 97.1% (95% confidence interval: 96.9-97.3) vs 95.0% (94.6-95.4) in women; 94.8% (94.7-95.0) vs 93.7% (93.3-94.2) in men. Body mass index modified the association between walking pace and survival in men, with the largest survival benefits of brisk walking observed in underweight participants. Compared to walking pace, for handgrip strength there was more overlap in 10-year survival across lifestyle behaviours. CONCLUSION Except for smoking, brisk walkers with an otherwise unhealthy lifestyle have a lower mortality risk than slow walkers with an otherwise healthy lifestyle.
Collapse
Affiliation(s)
| | - Paul W Franks
- Department of Clinical Sciences, Lund University, Sweden.,Umeå University, Sweden
| | | | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, UK.,NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC)-East Midlands, University of Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, UK
| |
Collapse
|
49
|
Grimmer JA, Tanwar V, Youtz DJ, Adelstein JM, Baine SH, Carnes CA, Baer LA, Stanford KI, Wold LE. Exercise does not ameliorate cardiac dysfunction in obese mice exposed to fine particulate matter. Life Sci 2019; 239:116885. [PMID: 31655193 DOI: 10.1016/j.lfs.2019.116885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/31/2019] [Accepted: 09/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Studies have demonstrated that exposure to fine particulate matter (PM2.5) is linked to cardiovascular disease (CVD), which is exacerbated in patients with pre-existing conditions such as obesity. In the present study, we examined cardiac function of obese mice exposed to PM2.5 and determined if mild exercise affected cardiac function. METHODS Obese mice (ob/ob) (leptin deficient, C57BL/6J background) were exposed to either filtered air (FA) or PM2.5 at an average concentration of 32 μg/m3 for 6 h/day, 5 days/week for 9 months. Following exposure, mice were divided into four groups: (1) FA sedentary, (2) FA treadmill exercise, (3) PM2.5 sedentary, and (4) PM2.5 treadmill exercise and all mice were analyzed after 8 weeks of exercise training. RESULTS Echocardiography showed increased left ventricular end systolic (LVESd) and diastolic (LVEDd) diameters in PM2.5 sedentary mice compared to FA sedentary mice. There was increased expression of ICAM1, VCAM and CRP markers in sedentary PM2.5 mice compared to FA mice. Both FA and PM2.5 exercised mice showed decreased posterior wall thickness in systole compared to FA sedentary mice, coupled with altered expression of inflammatory markers following exercise. CONCLUSION Obese mice exposed to PM2.5 for 9 months showed cardiac dysfunction, which was not improved following mild exercise training.
Collapse
Affiliation(s)
- Jacob A Grimmer
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, OH, USA; College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Vineeta Tanwar
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, OH, USA; College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Dane J Youtz
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, OH, USA; College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Jeremy M Adelstein
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, OH, USA; College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Stephen H Baine
- College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Cynthia A Carnes
- College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Lisa A Baer
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Kristin I Stanford
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Loren E Wold
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, OH, USA; College of Nursing, The Ohio State University, Columbus, OH, USA; Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA.
| |
Collapse
|
50
|
Keller K, Hobohm L, Münzel T, Ostad MA, Espinola-Klein C, Lavie CJ, Konstantinides S, Lankeit M. Survival Benefit of Obese Patients With Pulmonary Embolism. Mayo Clin Proc 2019; 94:1960-1973. [PMID: 31585580 DOI: 10.1016/j.mayocp.2019.04.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 03/15/2019] [Accepted: 04/03/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the impact of obesity and underweight on adverse in-hospital outcomes in pulmonary embolism (PE). PATIENTS AND METHODS Patients diagnosed as having PE based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification code I26 in the German nationwide inpatient database were stratified for obesity, underweight, and normal weight/overweight (reference group) and compared regarding adverse in-hospital outcomes. RESULTS From January 1, 2011, through December 31, 2014, 345,831 inpatients (53.3% females) 18 years and older were included in this analysis; 8.6% were obese and 0.5% were underweight. Obese patients were younger (67.0 vs 73.0 years), were more frequently female (60.2% vs 52.7%), had a lower cancer rate (13.6% vs 20.5%), and were more often treated with systemic thrombolysis (6.4% vs 4.3%) and surgical embolectomy (0.3% vs 0.1%) vs the reference group (P<.001 for all). Overall, 51,226 patients (14.8%) died during in-hospital stay. Obese patients had lower mortality (10.9% vs 15.2%; P<.001) vs the reference group and a reduced odds ratio (OR) for in-hospital mortality (OR, 0.74; 95% CI, 0.71-0.77; P<.001) independent of age, sex, comorbidities, and reperfusion therapies. This survival benefit of obese patients was more pronounced in obesity classes I (OR, 0.56; 95% CI, 0.52-0.60; P<.001) and II (OR, 0.63; 95% CI 0.58-0.69; P<.001). Underweight patients had higher prevalence of cancer and higher mortality rates (OR, 1.15; 95% CI, 1.00-1.31; P=.04). CONCLUSION Obesity is associated with decreased in-hospital mortality rates in patients with PE. Although obese patients were more often treated with reperfusion therapies, the survival benefit of obese patients occurred independently of age, sex, comorbidities, and reperfusion treatment.
Collapse
Affiliation(s)
- Karsten Keller
- Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research, Partner Site Rhine Main, Rhine Main, Germany
| | - Mir A Ostad
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Christine Espinola-Klein
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Carl J Lavie
- Department of Cardiovascular Disease, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Democritus University Thrace, Alexandroupolis, Greece
| | - Mareike Lankeit
- Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité-University Medicine, Berlin, Germany; Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| |
Collapse
|