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Luan B, Tian X, Wang C, Cao M, Liu D. Association between body mass index and mental health among nurses: a cross-sectional study in China. BMC Health Serv Res 2024; 24:506. [PMID: 38654347 DOI: 10.1186/s12913-024-11006-y] [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: 01/31/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE To examine the correlation between body mass index (BMI) and mental well-being in Chinese nurses during the COVID-19 epidemic. METHOD This study was conducted in a tertiary hospital using a cross-sectional design. A total of 2,811 nurses were enlisted at Shengjing Hospital in China during the period from March to April, 2022. Information was gathered through a questionnaire that individuals completed themselves. The mental health of the participants was assessed using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder Assessment-7. Binary logistic regression was used to calculate adjusted odds ratios (ORs) and their corresponding 95% confidence intervals. RESULTS The prevalence of nurses experiencing depression and anxiety was 7.8% (219) and 6.7% (189), respectively. Regarding depression after adjustment, the odds ratios (ORs) for each quartile, compared to the lowest quartile, were as follows: 0.91 (95% confidence interval [CI]: 0.53, 1.56), 2.28 (95% CI: 0.98, 3.77), and 2.32 (95% CI: 1.41, 3.83). The p-value for trend was found to be 0.001. The odds ratios (ORs) for anxiety after adjustment were 2.39 (0.83, 4.36), 4.46 (0.51, 7.93), and 2.81 (1.56, 5.08) when comparing the highest quartiles to the lowest quartile. The p-value for trend was 0.009. CONCLUSION This study found a positive association between BMI and poor mental health among nurses during the COVID-19 pandemic, particularly in those who were overweight or obesity. The findings could assist in developing interventions and help policy-makers establish appropriate strategies to support the mental health of frontline nurses, especially those who are overweight or obesity.
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Affiliation(s)
- Bonan Luan
- Department of Operating Room, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Xueyan Tian
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, P.R. China
| | - Chao Wang
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, P.R. China
| | - Ming Cao
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, P.R. China
| | - Dongmei Liu
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, P.R. China.
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Sun Y, Zhang Y, Liu X, Liu Y, Wu F, Liu X. Association between body mass index and respiratory symptoms in US adults: a national cross-sectional study. Sci Rep 2024; 14:940. [PMID: 38195711 PMCID: PMC10776771 DOI: 10.1038/s41598-024-51637-z] [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: 07/04/2023] [Accepted: 01/08/2024] [Indexed: 01/11/2024] Open
Abstract
The correlation between body mass index (BMI) and the development of cough, shortness of breath, and dyspnea is unclear. Therefore, this study aimed to investigate the association between these parameters. Data from individuals who participated in the National Health and Nutrition Examination Survey between 2003 and 2012 were analyzed. Weighted logistic regression analysis and smoothed curve fitting were used to examine the correlation between BMI and respiratory symptoms. In addition, the relationship between BMI, chronic obstructive pulmonary disease (COPD), and bronchial asthma was examined. Stratified analysis was used to discover inflection points and specific groups. Weighted logistic regression and smoothed curve fitting revealed a U-shaped relationship between BMI and respiratory symptoms. The U-shaped relationship in BMI was also observed in patients with bronchial asthma and COPD. Stratified analysis showed that the correlation between BMI and wheezing and dyspnea was influenced by race. In addition, non-Hispanic black individuals had a higher risk of developing cough than individuals of the other three races [OR 1.040 (1.021, 1.060), p < 0.0001], and they also exhibited an inverted U-shaped relationship between BMI and bronchial asthma. However, the association of BMI with cough, wheezing, dyspnea, COPD, and asthma was not affected by sex. High or low BMI was associated with cough, shortness of breath, and dyspnea, and has been linked to bronchial asthma and COPD. These findings provide new insights into the management of respiratory symptoms and respiratory diseases.
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Affiliation(s)
- Yuefeng Sun
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yueyang Zhang
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiangyang Liu
- School of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yingying Liu
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Fan Wu
- School of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xue Liu
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
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Wiacek M, Natora J, Zubrzycki IZ, Tomasiuk R. Physiological Responses Associated with Nordic-Walking and Walking in Middle-age Women. Int J Sports Med 2023; 44:865-870. [PMID: 37751766 PMCID: PMC10622228 DOI: 10.1055/a-2134-3769] [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: 08/29/2022] [Accepted: 05/31/2023] [Indexed: 09/28/2023]
Abstract
This study aimed to analyze the influence of supervised 12-week walking (W) and Nordic-walking (NW) programs on changes in specific physiological parameters in middle-aged women 55.40±7.87 and 52.58±6.91 years of age, respectively. Body mass, fat tissue percentage, muscle tissue percentage, systolic blood pressure, diastolic blood pressure, resting pulse, and maximum oxygen uptake were measured at the beginning and end of the exercise program. Intra- and intergroup differences in physiological parameters as a function of the preparation period were analyzed using bootstrap analysis. Clinically reliable changes for a specific subject in the W and NW programs were analyzed using the Reliable Change Index (RCI). The results of this study indicate that more distinct differences were observed in the NW group. However, both programs improved the parameters studied. Nevertheless, an analysis of the RCI indicates that the W provides results similar to, if not better than, NW for increasing neuromuscular, cardiovascular, and cardiorespiratory fitness. This study leads us to the conclusion that the W is not less efficient than the NW for middle-aged women.
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Affiliation(s)
- Magdalena Wiacek
- Faculty of Medical and Health Sciences, Kazimierz Pułaski
University of Technology and Humanities in Radom, Radom, Poland
| | - Justyna Natora
- Faculty of Medical and Health Sciences, Kazimierz Pułaski
University of Technology and Humanities in Radom, Radom, Poland
| | - Igor Z Zubrzycki
- Biometry and Mathematics, Botswana University of Agriculture and
Natural Resources, Gaborone, Botswana
| | - Ryszard Tomasiuk
- Faculty of Medical and Health Sciences, Kazimierz Pułaski
University of Technology and Humanities in Radom, Radom, Poland
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4
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He J, Gao L, Mai L. Association between creatinine to body weight ratio and all-cause mortality: a cohort study of NHANES. Ren Fail 2023; 45:2251592. [PMID: 37732400 PMCID: PMC10515683 DOI: 10.1080/0886022x.2023.2251592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/19/2023] [Indexed: 09/22/2023] Open
Abstract
Research on the relationship between the weight-adjusted skeletal muscle mass index and all-cause mortality is rare, and even rarer is the relationship between the creatinine/body weight (Cre/BW) ratio and all-cause mortality. Therefore, this study aimed to investigate the relationship between the Cre/BW ratio and mortality in individuals with normal renal function. This prospective study used data from the National Health and Nutrition Examination Survey (NHANES) database. A Cox hazard model was used to analyze the relationship between the Cre/BW ratio and mortality risk. In total, 45,459 participants were included, of which 49.97% were women, with an average age of 45.68 ± 18.08 years. The incidence of all-cause mortality was 10.9% among these participants during the median (interquartile range) follow-up of 9.6 (5.2, 14.2) years. After adjusting for all covariates, a U-shaped relationship was found between the Cre/BW ratio and all-cause mortality (P for nonlinearity <0.001), with the lowest risk observed at Cre/BW ratios (×100) between 0.821 and 0.987. In the threshold effect analysis, the Cre/BW ratio (×100) had a threshold value of 0.96. When the Cre/BW ratio (×100) was <0.96, all-cause mortality was negatively associated with the Cre/BW ratio (×100) (0.63 (0.41, 0.97)). In contrast, when the Cre/BW ratio (×100) was ≥0.96, the higher Cre/BW ratio was associated with a greater hazard ratio of all-cause mortality (1.67 (1.41, 1.97)). In conclusion, we report a U-shaped relationship between the Cre/BW ratio and all-cause mortality. Controlling the Cre/BW ratio within a certain range may reduce the risk of all-cause mortality.
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Affiliation(s)
- Jiacheng He
- Emergency Department, The Sixth Affiliated Hospital, South China University of Technology, Foshan City, Guangdong, P.R. China
| | - Lijie Gao
- Neurology Department, Medical School, Yan’an University, Yan’an City, Shanxi, P.R. China
| | - Lifeng Mai
- Obstetric Department, The Sixth Affiliated Hospital, South China University of Technology, Foshan City, Guangdong, P.R. China
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The obesity paradox in the stress echo lab: fat is better for hearts with ischemia or coronary microvascular dysfunction. Int J Obes (Lond) 2020; 45:308-315. [PMID: 32830196 DOI: 10.1038/s41366-020-00655-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 07/10/2020] [Accepted: 08/11/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Obesity is an independent risk factor for coronary artery disease (CAD), but once CAD has developed it has been associated with improved survival ("obesity paradox"). AIM To assess how obesity affects prognosis in patients with or without inducible ischemic regional wall motion abnormalities (RWMA) and/or abnormal coronary flow velocity reserve (CFVR) during stress echocardiography (SE). METHODS In an observational retrospective two- center study design, we analyzed 3249 consecutive patients (1907 men; age 66 ± 12 years; body mass index, BMI, 26.9 ± 4.1 kg/m2) with known (n = 1306) or suspected (n = 1943) CAD who underwent dipyridamole SE with simultaneous evaluation of RWMA and CFVR. All-cause death was the outcome end-point. RESULTS 1075 patients were lean (BMI 18.5-24.9 kg/m2), 1523 overweight (BMI 25.0-29.9 kg/m2), and 651 obese (≥30.0 kg/m2). Ischemic test result for RWMA occurred in 28 (3%) lean, 69 (4%) overweight, and 28 (4%) obese patients (p = 0.03). An abnormal CFVR (≤2.0) was found in 281 (26%) lean, 402 (26%) overweight and 170 (26%) obese patients (p = 0.99). During 68 ± 44 months of follow-up, 496 (15%) patients died. At multivariable Cox analysis, BMI ≥ 30 was an independent predictor of reduced mortality in the 878 patients with stress-induced (≥2 segments) RWMA and/or CFVR abnormality (HR 0.58, 95% CI 0.40-0.84; p = 0.003), while showed no effect at univariate analysis in the 2371 patients with no RWMA and normal CFVR (HR 1.04, 95% CI 0.74-1.46; p = 0.84). CONCLUSIONS Obesity exerts a "paradoxical" protective effect in patients with stress-induced ischemia and/ or coronary microvascular dysfunction, and shows a neutral effect in patients with normal CFVR and no stress-induced RWMA.
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6
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The impact of robotic colorectal surgery in obese patients: a systematic review, meta-analysis, and meta-regression. Surg Endosc 2019; 33:3558-3566. [DOI: 10.1007/s00464-019-07000-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 07/19/2019] [Indexed: 12/11/2022]
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Darke S, Duflou J, Kaye S, Farrell M, Lappin J. Body mass index and fatal stroke in young adults: A national study. J Forensic Leg Med 2019; 63:1-6. [PMID: 30822741 DOI: 10.1016/j.jflm.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/22/2019] [Accepted: 02/04/2019] [Indexed: 01/09/2023]
Abstract
Rates of stroke and obesity have increased in recent years. This study aimed to determine the body mass index (BMI) of fatal stroke cases amongst young adults, their clinical characteristics and the association with BMI with risk factors. All cases aged 15-44 years where death was attributed to stroke for whom BMI was available were retrieved from the National Coronial Information System (1/1/2009-31/12/2016). 179 cases were identified: haemorrhagic (165), ischaemic (5), thrombotic (6), mycotic (3), embolic (0). Proportions in each BMI category were: underweight (5.6%), normal weight (37.4%), overweight (27.4%), obese (29.6%). There was a significant linear trend in the proportion of subarachnoid haemorrhages as BMI increased (p < 0.05), and between higher BMI and hypertension (p < 0.001). There were no group differences in cardiomegaly or left ventricular hypertrophy where known causes were other than hypertension, cardiomyopathy, severe coronary artery atherosclerosis, endocarditis or cerebral arteries atherosclerosis. A history of alcoholism (p < 0.01) was less likely with higher BMI. There was no association between BMI and previous stroke, diabetes, vasculitis, gravid/post-partum, tobacco use, psychostimulant use or injecting drug use. Overweight and obese cases were prominent among young fatalities of stroke. Reducing rates of obesity, and associated hypertension, would be expected to reduce the escalating stoke rates among young adults.
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Affiliation(s)
- Shane Darke
- National Drug & Alcohol Research Centre, University of New South Wales, NSW, 2052, Australia.
| | - Johan Duflou
- National Drug & Alcohol Research Centre, University of New South Wales, NSW, 2052, Australia; Sydney Medical School, University of Sydney, NSW, 2006, Australia
| | - Sharlene Kaye
- National Drug & Alcohol Research Centre, University of New South Wales, NSW, 2052, Australia
| | - Michael Farrell
- National Drug & Alcohol Research Centre, University of New South Wales, NSW, 2052, Australia
| | - Julia Lappin
- National Drug & Alcohol Research Centre, University of New South Wales, NSW, 2052, Australia; School of Psychiatry, University of New South Wales, NSW, 2052, Australia
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8
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Nam GE, Park HS. Perspective on Diagnostic Criteria for Obesity and Abdominal Obesity in Korean Adults. J Obes Metab Syndr 2018; 27:134-142. [PMID: 31089555 PMCID: PMC6504202 DOI: 10.7570/jomes.2018.27.3.134] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/10/2018] [Accepted: 08/19/2018] [Indexed: 01/02/2023] Open
Abstract
Excessive body weight is associated with increased health risks in humans. In general, the risk of mortality increases with greater obesity. The 2018 guideline for the management of obesity by the Korean Society for the Study of Obesity proposed the body mass index (BMI) cut-off levels of 25 kg/m2 and 23 kg/m2 as diagnostic criteria for obesity and overweight (pre-obese) in Korean adults, respectively. Abdominal obesity has been defined as waist circumference (WC) ≥90 cm in men and WC ≥85 cm in women. In this review, the validity of these criteria for Korean adults was examined based on the evidence regarding the associations of obesity index with mortality and morbidity. The American Association of Clinical Endocrinologists/American College of Endocrinology algorithm and American Diabetes Association guideline for the medical care of obese and overweight patients support a BMI of 25 kg/m2 and 23 kg/m2, respectively, as the cut-off levels for Asians (and some ethnicities) corresponding to the BMI values of 30 kg/m2 and 25 kg/m2, respectively, for Caucasians. In the future, the optimal cut-off levels for obesity and abdominal obesity may require adjustment as the demographic characteristics of the Korean population change. In addition, development of more valid indicators that better reflect health risks of obesity is needed.
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Affiliation(s)
- Ga Eun Nam
- Department of Family Medicine, Sahmyook Medical Center, Seoul,
Korea
| | - Hye Soon Park
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
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9
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Carslake D, Davey Smith G, Gunnell D, Davies N, Nilsen TIL, Romundstad P. Confounding by ill health in the observed association between BMI and mortality: evidence from the HUNT Study using offspring BMI as an instrument. Int J Epidemiol 2017; 47:760-770. [PMID: 29206928 PMCID: PMC6005033 DOI: 10.1093/ije/dyx246] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/26/2017] [Accepted: 11/01/2017] [Indexed: 11/25/2022] Open
Abstract
Background The observational association between mortality and body mass index (BMI) is U-shaped, leading to highly publicized suggestions that moderate overweight is beneficial to health. However, it is unclear whether elevated mortality is caused by low BMI or if the association is confounded, for example by concurrent ill health. Methods Using HUNT, a Norwegian prospective study, 32 452 mother-offspring and 27 747 father-offspring pairs were followed up to 2009. Conventional hazard ratios for parental mortality per standard deviation of BMI were estimated using Cox regression adjusted for behavioural and socioeconomic factors. To estimate hazard ratios with reduced susceptibility to confounding, particularly from concurrent ill health, the BMI of parents’ offspring was used as an instrumental variable for parents’ own BMI. The shape of mortality-BMI associations was assessed using cubic splines. Results There were 18 365 parental deaths during follow-up. Conventional associations of mortality from all-causes, cardiovascular disease and cancer with parents’ own BMI were substantially nonlinear, with elevated mortality at both extremes and minima at 21–25 kg m−2. Equivalent associations with offspring BMI were positive and there was no evidence of elevated parental mortality at low offspring BMI. The linear instrumental variable hazard ratio for all-cause mortality per standard deviation increase in BMI was 1.18 (95% confidence interval: 1.10, 1.26), compared with 1.05 (1.03, 1.06) in the conventional analysis. Conclusions Elevated mortality rates at high BMI appear causal, whereas excess mortality at low BMI is likely exaggerated by confounding by factors including concurrent ill health. Conventional studies probably underestimate the adverse population health consequences of overweight.
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Affiliation(s)
- David Carslake
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol UK
- Corresponding author. MRC Integrative Epidemiology Unit, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK. E-mail:
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol UK
| | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol UK
| | - Neil Davies
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol UK
| | - Tom I L Nilsen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Romundstad
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
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David CN, Mello RB, Bruscato NM, Moriguchi EH. Overweight and Abdominal Obesity Association with All-Cause and Cardiovascular Mortality in the Elderly Aged 80 and Over: A Cohort Study. J Nutr Health Aging 2017; 21:597-603. [PMID: 28448093 DOI: 10.1007/s12603-016-0812-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the association between overweight and abdominal obesity with all-cause and cardiovascular mortality in the elderly aged 80 and over. DESIGN A prospective cohort study. SETTING A population-based study of community-dwelling very elderly adults in a city in southern Brazil. PARTICIPANTS 236 very elderly adults, number that represents 85% of the population aged 80 and over living in the city in the period (mean age 83.4 ± 3.2). MEASUREMENTS Overweight and abdominal obesity were assessed using recommended cut-off points for body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR). The association between these anthropometric measurements and all-cause and cardiovascular mortality were independently estimated by Cox proportional hazards model. Kaplan-Meier was used to assess survival time. RESULTS Increased WC (>80cm F and >94cm M) and WHtR (>0.53 F and >0.52 M) were associated with lower all-cause mortality, but only WHtR remained associated even after controlling for residual confounding (HR 0.55 CI95% 0.36-0.84; p<0.001). Additionally increased WC was independently associated with lower mortality from cardiovascular diseases (HR 0.57 CI95% 0.34-0.95; p<0.030). BMI and WHR did not show significant independent association with mortality in the main analysis. CONCLUSION Greater abdominal fat accumulation, as estimated by WC and WHtR, presented an association with lower allcause and cardiovascular mortality in the elderly aged 80 and over, but not by BMI and WHR.
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Affiliation(s)
- C N David
- Renato Bandeira de Mello, Hospital de Clínicas de Porto Alegre, 2350, Ramiro Barcelos st., Division of Internal Medicine; room 700, Porto Alegre, Rio Grande do Sul 90035903, Brazil,
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11
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Sun H, Ren X, Chen Z, Li C, Chen S, Wu S, Chen Y, Yang X. Association between body mass index and mortality in a prospective cohort of Chinese adults. Medicine (Baltimore) 2016; 95:e4327. [PMID: 27512844 PMCID: PMC4985299 DOI: 10.1097/md.0000000000004327] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 06/26/2016] [Accepted: 06/29/2016] [Indexed: 02/05/2023] Open
Abstract
Obesity is associated with an increased risk of diabetes mellitus, hypertension, and coronary artery disease; however, the relation between body mass index (BMI) and the risk of all-cause mortality is controversial. We prospectively examined the relationship between BMI and all-cause mortality in 123,384 Chinese men and women who participated in the Kailuan health examination study from 2006 to 2007 and 2008 to 2009. Cases included 6218 deaths (5770 men and 448 women) that occurred during a mean follow-up period of 7.39 years. Relative risk was adjusted for factors such as age, serum lipid levels (ie, triglyceride, high-density lipoprotein, and low-density lipoprotein cholesterol), history of smoking and drinking, and physical activity, as well as a medical history of hypertension, diabetes, myocardial infarction, and stroke. Within the cohort, the lowest risk of all-cause mortality was seen among persons with a BMI of 24 to 28 kg/m in male, and the risk was elevated among persons with BMI levels lower or higher than that range. Moreover, all-cause mortality was greatest in the group with a BMI of <18.5 kg/m. In contrast, in female, a high BMI was associated with increased mortality, and a BMI of <18.5 kg/m was associated with the lowest risk. Further, a U-shaped association was seen between BMI and the risk of death from any cause among men and women, even after adjusting for confounding factors. In conclusion, underweight was associated with a substantially increased risk of all-cause mortality in males. The excess risk of all-cause mortality with a high BMI, however, was seen among females.
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Affiliation(s)
- Hao Sun
- Department of Cardiology, Beijing Chao-yang Hospital, Capital Medical University
| | - Xiaoxia Ren
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing
| | - Zhichao Chen
- Department of Cardiology, The Second Affiliate Hospital of Shantou University Medical College, Guangdong
| | - Chunsheng Li
- Department of Cardiology, The Second Affiliate Hospital of Shantou University Medical College, Guangdong
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China
| | - Youren Chen
- Department of Cardiology, The Second Affiliate Hospital of Shantou University Medical College, Guangdong
| | - Xinchun Yang
- Department of Cardiology, Beijing Chao-yang Hospital, Capital Medical University
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12
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Yu X, Yu H, Fang X. The impact of body mass index on short-term surgical outcomes after laparoscopic hepatectomy, a retrospective study. BMC Anesthesiol 2016; 16:29. [PMID: 27259513 PMCID: PMC4893250 DOI: 10.1186/s12871-016-0194-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 05/28/2016] [Indexed: 02/06/2023] Open
Abstract
Background Surgeons may expect technical difficulties and worse outcomes when performing laparoscopic hepatectomy (LH) on obese patients. The aim of this study is to assess the impact of body mass index (BMI) on short-term surgical outcomes and to verify risk factors of conversion rate and complications of LH. Methods Data were collected from 551 patients who underwent attempted LH between August 1998 and April 2013. Patients were classified into four groups depending on their BMI according to the WHO’s definition of obesity for Asia-Pacific region: underweight <18.5 kg/m2 (Group1); normal 18.5–23.9 kg/m2 (Group2); overweight 24–27.9 kg/m2 (Group3); obese ≥ 28 kg/m2 (Group4) respectively. Short-term surgical outcomes were compared across the BMI categories. Possible risk factors concerned conversion rate and complications were analyzed. Results The overall conversion rate of the 551 patients was 13.07 %. Conversion rate for Group 1, 2, 3, and 4 were 14.3 % (n = 5), 11.2 % (n = 38), 13.0 % (n = 19), and 34.5 % (n = 10) respectively. Patients within the obese group had a much higher conversion rate. The overall complications rate was 11.98 %, where the complication for Group 1, 2, 3, and 4 were 22.9 % (n = 8), 12.7 % (n = 43), 18.2 % (n = 12), and 10.3 % (n = 3) respectively. Patients within the underweight group had a higher complication rate, but it did not reach statistic difference. Obesity and surgical site of left lobe were independent risk factors of conversion. Age, abdominal surgery history, and type of left and right lobe resection were independent risk factors for complications. Conclusions In China, obesity increases risk of conversion rate but it dose not affect surgical complications and other short-outcomes after LH. Electronic supplementary material The online version of this article (doi:10.1186/s12871-016-0194-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xin Yu
- Department of Anaesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hong Yu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiangming Fang
- Department of Anesthesiology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Qing Chun Road 79, Hangzhou, 310003, Zhejiang, China.
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Iwuala SO, Ayankogbe OO, Olatona FA, Olamoyegun MA, OkparaIgwe U, Sabir AA, Fasanmade OA. Obesity among health service providers in Nigeria: danger to long term health worker retention? Pan Afr Med J 2015; 22:1. [PMID: 26600902 PMCID: PMC4643157 DOI: 10.11604/pamj.2015.22.1.5586] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 05/15/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Obesity is a global epidemic. There are rising rates of obesity and its associated disorders, especially in developing countries, including among Health Service Providers (HSPs). Obesity is associated with early retirement, increased morbidity and mortality. Thus, obesity has the potential of reducing long-term retention of HSPs in inadequately staffed health systems of developing countries. This study aimed to determine the magnitude of and factors associated with obesity among HSPs of a tertiary health care facility in Lagos, Nigeria. METHODS A cross sectional study was carried out with a questionnaire, which included the International Physical Activity Questionnaire short form (IPAQ-SF). Obesity was defined as BMI ≥30kg/m2. Statistical significance was set at p < 0.05. RESULTS 300 HSPs were recruited, of which 47.7% were medical doctors and dentists, 43.3% were nurses and other categories of HSPs. The mean age and BMI of the HSPs were 39.3(9.0) years and 27.7(4.6) kg/m2 respectively. Eight two (27.3%) HSPs were obese and 134 (44.7%) were overweight, 149(49.7%) had central obesity. After adjusting for confounding variables using multivariate logistic regression, age > 40 years (OR 3.51, p=0.003), female gender (OR 2.84, p=0.007) and earning a monthly salary of ≤ 200,000 naira relative to 201,000-400,000 naira (OR 2.58, p=0.006) were significantly associated with obesity. CONCLUSION Obesity was prevalent among these Nigerian HSPs. This calls for concern, especially with the implication of loosing health workers to obesity related disorders and early retirement.
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Affiliation(s)
- Sandra Omozehio Iwuala
- Department of Medicine, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | | | - Foluke Adenike Olatona
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Nigeria
| | - Michael Adeyemi Olamoyegun
- Department of Medicine, LAUTECH Teaching Hospital, and College of Health Sciences, LadokeAkintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | | | - Anas Ahmad Sabir
- Department of Medicine, UsmanuDanfodiyo University, Sokoto, Nigeria
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Kivimäki M, Shipley MJ, Bell JA, Brunner EJ, Batty GD, Singh-Manoux A. Underweight as a risk factor for respiratory death in the Whitehall cohort study: exploring reverse causality using a 45-year follow-up. Thorax 2015; 71:84-5. [PMID: 26253581 PMCID: PMC4717419 DOI: 10.1136/thoraxjnl-2015-207449] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 07/14/2015] [Indexed: 11/14/2022]
Abstract
Underweight adults have higher rates of respiratory death than the normal weight but it is unclear whether this association is causal or reflects illness-induced weight loss (reverse causality). Evidence from a 45-year follow-up of underweight participants for respiratory mortality in the Whitehall study (N=18 823; 2139 respiratory deaths) suggests that excess risk among the underweight is attributable to reverse causality. The age-adjusted and smoking-adjusted risk was 1.55-fold (95% CI 1.32 to 1.83) higher among underweight compared with normal weight participants, but attenuated in a stepwise manner to 1.14 (95% CI 0.76 to 1.71) after serial exclusions of deaths during the first 5–35 years of follow-up (Ptrend<0.001).
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Affiliation(s)
- Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Martin J Shipley
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Joshua A Bell
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - G David Batty
- Department of Epidemiology and Public Health, University College London, London, UK Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, UK Centre for Research in Epidemiology and Population Health, INSERM, Villejuif, France
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15
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Jean N, Somers VK, Sochor O, Medina-Inojosa J, Llano EM, Lopez-Jimenez F. Normal-weight obesity: implications for cardiovascular health. Curr Atheroscler Rep 2015; 16:464. [PMID: 25342492 DOI: 10.1007/s11883-014-0464-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We sought to review the epidemiological features and clinical implications of normal-weight obesity. The concept of normal-weight obesity has been recently reported as an important risk factor for cardiovascular disease, metabolic dysregulation, and poor functional outcomes. However, in clinical practice, normal-weight obesity is not commonly recognized. In this review, we examine the clinical significance and important epidemiological outcomes of normal-weight obesity and describe other variants of adiposity and adiposity-related metabolic status. The incorporation of measures of body fat content and distribution in the clinical setting could allow more accurate identification of adiposity-related long-term risk. This could in turn lead to early lifestyle changes and behavioral modifications that are essential to the treatment of obesity.
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Affiliation(s)
- Nathalie Jean
- Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA,
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16
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Dale C, Nüesch E, Prieto-Merino D, Choi M, Amuzu A, Ebrahim S, Casas JP, Davey-Smith G. Why do thin people have elevated all-cause mortality? Evidence on confounding and reverse causality in the association of adiposity and COPD from the British Women's Heart and Health Study. PLoS One 2015; 10:e0115446. [PMID: 25884834 PMCID: PMC4401726 DOI: 10.1371/journal.pone.0115446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 11/24/2014] [Indexed: 11/18/2022] Open
Abstract
Low adiposity has been linked to elevated mortality from several causes including respiratory disease. However, this could arise from confounding or reverse causality. We explore the association between two measures of adiposity (BMI and WHR) with COPD in the British Women's Heart and Health Study including a detailed assessment of the potential for confounding and reverse causality for each adiposity measure. Low BMI was found to be associated with increased COPD risk while low WHR was not (OR = 2.2; 95% CI 1.3-3.1 versus OR = 1.2; 95% CI 0.7-1.6). Potential confounding variables (e.g. smoking) and markers of ill-health (e.g. unintentional weight loss) were found to be higher in low BMI but not in low WHR. Women with low BMI have a detrimental profile across a broad range of health markers compared to women with low WHR, and women with low WHR do not appear to have an elevated COPD risk, lending support to the hypothesis that WHR is a less confounded measure of adiposity than BMI. Low adiposity does not in itself appear to increase the risk of respiratory disease, and the apparent adverse consequences of low BMI may be due to reverse causation and confounding.
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Affiliation(s)
- Caroline Dale
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Eveline Nüesch
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David Prieto-Merino
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Minkyoung Choi
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Antoinette Amuzu
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Shah Ebrahim
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Juan P. Casas
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - George Davey-Smith
- CAiTE centre, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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17
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Wohlfahrt P, Somers VK, Sochor O, Kullo I, Jean N, Lopez-Jimenez F. Influence of body fatness distribution and total lean mass on aortic stiffness in nonobese individuals. Am J Hypertens 2015; 28:401-8. [PMID: 25189869 DOI: 10.1093/ajh/hpu153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Subjects with normal body mass index but high body fat percentage have higher cardiovascular risk than subjects with normal weight and low fat mass. However, the association of fat distribution and lean mass with carotid-femoral pulse wave velocity (cfPWV) among nonobese apparently healthy individuals has never been assessed. METHODS In 136 nonobese volunteers (mean age = 45±9 years; 57% women) without manifest cardiovascular disease, cfPWV was measured by applanation tonometry. Fat and lean mass were measured by dual-energy x-ray absorptiometry. RESULTS In univariate analysis, total fat (r = 0.17; P < 0.01), trunk fat (r = 0.27; P < 0.01), and trunk/total fat ratio (r = 0.32; P < 0.01) were correlated with cfPWV. After adjustment for age and mean arterial pressure, only central fat distribution (trunk/total fat ratio) was significantly associated with cfPWV. In the fully adjustment model, there was a significant interaction between fat distribution and lean mass. When the study sample was grouped by fat distribution and total lean mass medians, subjects with central fat distribution and low lean mass (group 4) had higher log-transformed cfPWV than the noncentral fat/low lean mass group (group 2) (0.89, 95% confidence interval (CI) = 0.86-0.92 vs. 0.85, 95% CI = 0.83-0.87; P < 0.01) or the noncentral fat/high lean mass group (group 1) (0.89, 95% CI = 0.86-0.92 vs. 0.84, 95% CI = 0.81-0.87; P < 0.01) after adjustments. Aortic stiffness increased from group 1 to group 4 (P for linear trend < 0.001). CONCLUSIONS Among normal weight individuals without manifest cardiovascular disease, the combination of central fat distribution and low lean mass is associated with higher cfPWV. These factors are more closely related to cfPWV than total fat mass.
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Affiliation(s)
| | - Virend K Somers
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota USA
| | - Ondrej Sochor
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota USA; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Iftikhar Kullo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota USA
| | - Nathalie Jean
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota USA
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18
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Hong S, Yi SW, Sull JW, Hong JS, Jee SH, Ohrr H. Body mass index and mortality among Korean elderly in rural communities: Kangwha Cohort Study. PLoS One 2015; 10:e0117731. [PMID: 25719567 PMCID: PMC4342154 DOI: 10.1371/journal.pone.0117731] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/03/2014] [Indexed: 11/18/2022] Open
Abstract
Background The relationship between body mass index (BMI) and mortality may differ by ethnicity, but its exact nature remains unclear among Koreans. The study aim was to prospectively examine the association between BMI and mortality in Korean. Methods 6166 residents (2636 men; 3530 women) of rural communities (Kangwha County, Republic of Korea) aged 55 and above were followed up for deaths from 1985–2008. The multivariable-adjusted hazard ratios were calculated using the Cox proportional hazards model. Results During the 23.8 years of follow-up (an average of 12.5 years in men and 15.7 years in women), 2174 men and 2372 women died. Men with BMI of 21.0–27.4 and women with BMI of 20.0–27.4 had a minimal risk for all-cause mortality. A lower BMI as well as a higher BMI increased the hazard ratio of death. For example, multivariable-adjusted hazard ratios associated with BMI below 16, and with BMI of 27.5 and above, were 2.4 (95% CI = 1.6–3.5) and 1.5 (95% CI = 1.1–1.9) respectively, in men, compared to those with BMI of 23.0–24.9. This reverse J-curve association was maintained among never smokers, and among people with no known chronic diseases. Higher BMI increased vascular mortality, while lower BMI increased deaths from vascular diseases, cancers, and, especially, respiratory diseases. Except for cancers, these associations were generally weaker in women than in men. Conclusions A reverse J-curve association between BMI and all-cause mortality may exist. BMI of 21–27.4 (rather than the range suggested by WHO of 18.5–23 for Asians) may be considered a normal range with acceptable risk in Koreans aged 55 and above, and may be used as cut points for interventions. More concern should be given to people with BMI above and below a BMI range with acceptable risk. Further studies are needed to determine ethnicity-specific associations.
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Affiliation(s)
- Seri Hong
- Department of Preventive Medicine, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Sang-Wook Yi
- Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea
- * E-mail:
| | - Jae Woong Sull
- Department of Biomedical Laboratory Science, Eulji University College of Health Science, Sungnam, Republic of Korea
| | - Jae-Seok Hong
- Health Insurance Review & Assessment Service, Seoul, Republic of Korea
| | - Sun Ha Jee
- Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Heechoul Ohrr
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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19
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Rolland Y, Gallini A, Cristini C, Schott AM, Blain H, Beauchet O, Cesari M, Lauwers-Cances V. Body-composition predictors of mortality in women aged ≥ 75 y: data from a large population-based cohort study with a 17-y follow-up. Am J Clin Nutr 2014; 100:1352-60. [PMID: 25332333 DOI: 10.3945/ajcn.114.086728] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The role of body composition as a risk factor for death remains controversial in older persons. OBJECTIVE We determined the role of body-composition variables in mortality in older women. DESIGN Longitudinal analyses were performed in a prospective cohort study of older women. Participants were 4574 community-dwelling women aged ≥ 75 y at the baseline visit (between January 1992 and April 1994). Several body-composition variables were assessed by using anthropometric measures and dual-energy X-ray absorptiometry at the baseline visit. The main outcome was overall mortality. Body-composition variables were body mass index (BMI; in kg/m(2)), hip circumference, waist circumference, waist-to-hip ratio, fat mass/height(2), lean mass/height(2), percentage of fat mass, percentage of lean mass, and the lean mass:fat mass ratio. RESULTS The mean (± SD) age at baseline was 80.2 ± 3.8 y. During the 17.7 y (IQR: 17.2-18.1 y) of follow-up, 2876 women died. U-shaped in crude analyses and reversed J-shaped relations in adjusted analyses between BMI, hip and waist circumferences, fat mass/height(2), and risk of death were shown. Adjusted risk of death was significantly higher in participants with BMI ≤ 24.6 and fat mass/height(2) ≤ 8.2 kg/m(2). There was a negative linear association between fat mass (%) and risk of death: a 10% increase in fat mass was associated with a 12% reduction of mortality risk (adjusted HR: 0.88; 95% CI: 0.84, 0.92; P < 0.001). Linear and statistically significant relations were shown between lean mass/height(2) and risk of death in crude but not adjusted analyses. CONCLUSIONS Risk of mortality was consistently higher in older women with low adiposity. No lean mass indicator was associated with risk of death. Clinicians should be alerted by low adiposity in older women.
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Affiliation(s)
- Yves Rolland
- From the Gerontopôle, Toulouse University Hospital, Toulouse, France (YR and MC); the Institut national de la santé et de la recherche médicale (INSERM) Unité Mixte de Recherche 1027, University of Toulouse III, France (YR, AG, and MC); the Laboratory of Epidemiology and Community Health, Faculty of Medicine, Toulouse, France (CC, AG, and VL-C); the Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University of Lyon, INSERM U1033, Lyon, France (A-MS); the Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University Montpellier 1, Montpellier, France (HB); and the Department of Neuroscience, Division of Geriatric Medicine, Unité Propre de Recherche et d'Enseignement Supérieur-Equipe d'Accueil 4638, Université Nantes Angers Le Mans, Angers University Hospital, Angers, France (OB)
| | - Adeline Gallini
- From the Gerontopôle, Toulouse University Hospital, Toulouse, France (YR and MC); the Institut national de la santé et de la recherche médicale (INSERM) Unité Mixte de Recherche 1027, University of Toulouse III, France (YR, AG, and MC); the Laboratory of Epidemiology and Community Health, Faculty of Medicine, Toulouse, France (CC, AG, and VL-C); the Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University of Lyon, INSERM U1033, Lyon, France (A-MS); the Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University Montpellier 1, Montpellier, France (HB); and the Department of Neuroscience, Division of Geriatric Medicine, Unité Propre de Recherche et d'Enseignement Supérieur-Equipe d'Accueil 4638, Université Nantes Angers Le Mans, Angers University Hospital, Angers, France (OB)
| | - Christelle Cristini
- From the Gerontopôle, Toulouse University Hospital, Toulouse, France (YR and MC); the Institut national de la santé et de la recherche médicale (INSERM) Unité Mixte de Recherche 1027, University of Toulouse III, France (YR, AG, and MC); the Laboratory of Epidemiology and Community Health, Faculty of Medicine, Toulouse, France (CC, AG, and VL-C); the Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University of Lyon, INSERM U1033, Lyon, France (A-MS); the Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University Montpellier 1, Montpellier, France (HB); and the Department of Neuroscience, Division of Geriatric Medicine, Unité Propre de Recherche et d'Enseignement Supérieur-Equipe d'Accueil 4638, Université Nantes Angers Le Mans, Angers University Hospital, Angers, France (OB)
| | - Anne-Marie Schott
- From the Gerontopôle, Toulouse University Hospital, Toulouse, France (YR and MC); the Institut national de la santé et de la recherche médicale (INSERM) Unité Mixte de Recherche 1027, University of Toulouse III, France (YR, AG, and MC); the Laboratory of Epidemiology and Community Health, Faculty of Medicine, Toulouse, France (CC, AG, and VL-C); the Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University of Lyon, INSERM U1033, Lyon, France (A-MS); the Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University Montpellier 1, Montpellier, France (HB); and the Department of Neuroscience, Division of Geriatric Medicine, Unité Propre de Recherche et d'Enseignement Supérieur-Equipe d'Accueil 4638, Université Nantes Angers Le Mans, Angers University Hospital, Angers, France (OB)
| | - Hubert Blain
- From the Gerontopôle, Toulouse University Hospital, Toulouse, France (YR and MC); the Institut national de la santé et de la recherche médicale (INSERM) Unité Mixte de Recherche 1027, University of Toulouse III, France (YR, AG, and MC); the Laboratory of Epidemiology and Community Health, Faculty of Medicine, Toulouse, France (CC, AG, and VL-C); the Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University of Lyon, INSERM U1033, Lyon, France (A-MS); the Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University Montpellier 1, Montpellier, France (HB); and the Department of Neuroscience, Division of Geriatric Medicine, Unité Propre de Recherche et d'Enseignement Supérieur-Equipe d'Accueil 4638, Université Nantes Angers Le Mans, Angers University Hospital, Angers, France (OB)
| | - Olivier Beauchet
- From the Gerontopôle, Toulouse University Hospital, Toulouse, France (YR and MC); the Institut national de la santé et de la recherche médicale (INSERM) Unité Mixte de Recherche 1027, University of Toulouse III, France (YR, AG, and MC); the Laboratory of Epidemiology and Community Health, Faculty of Medicine, Toulouse, France (CC, AG, and VL-C); the Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University of Lyon, INSERM U1033, Lyon, France (A-MS); the Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University Montpellier 1, Montpellier, France (HB); and the Department of Neuroscience, Division of Geriatric Medicine, Unité Propre de Recherche et d'Enseignement Supérieur-Equipe d'Accueil 4638, Université Nantes Angers Le Mans, Angers University Hospital, Angers, France (OB)
| | - Matteo Cesari
- From the Gerontopôle, Toulouse University Hospital, Toulouse, France (YR and MC); the Institut national de la santé et de la recherche médicale (INSERM) Unité Mixte de Recherche 1027, University of Toulouse III, France (YR, AG, and MC); the Laboratory of Epidemiology and Community Health, Faculty of Medicine, Toulouse, France (CC, AG, and VL-C); the Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University of Lyon, INSERM U1033, Lyon, France (A-MS); the Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University Montpellier 1, Montpellier, France (HB); and the Department of Neuroscience, Division of Geriatric Medicine, Unité Propre de Recherche et d'Enseignement Supérieur-Equipe d'Accueil 4638, Université Nantes Angers Le Mans, Angers University Hospital, Angers, France (OB)
| | - Valérie Lauwers-Cances
- From the Gerontopôle, Toulouse University Hospital, Toulouse, France (YR and MC); the Institut national de la santé et de la recherche médicale (INSERM) Unité Mixte de Recherche 1027, University of Toulouse III, France (YR, AG, and MC); the Laboratory of Epidemiology and Community Health, Faculty of Medicine, Toulouse, France (CC, AG, and VL-C); the Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University of Lyon, INSERM U1033, Lyon, France (A-MS); the Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University Montpellier 1, Montpellier, France (HB); and the Department of Neuroscience, Division of Geriatric Medicine, Unité Propre de Recherche et d'Enseignement Supérieur-Equipe d'Accueil 4638, Université Nantes Angers Le Mans, Angers University Hospital, Angers, France (OB)
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Kim JK, Song YR, Kwon YJ, Kim HJ, Kim SG, Ju YS. Increased body fat rather than body weight has harmful effects on 4-year changes of renal function in the general elderly population with a normal or mildly impaired renal function. Clin Interv Aging 2014; 9:1277-86. [PMID: 25120357 PMCID: PMC4128790 DOI: 10.2147/cia.s66714] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background With increasing age, body fat increases and muscle mass reduces. Even people with a normal weight may have a higher percentage of body fat. The aim of this study is to investigate the association between increased body fat and renal function decline (RFD) in the general elderly population with normal or mildly impaired renal function. Method We conducted a prospective study of 615 healthy individuals in the general Korean population aged ≥60 years who participated in two health screening check-ups separated by a 4-year period. Obesity was defined as the highest sex-specific tertiles of the percentage body fat (PBF). The main outcome was changes of estimated glomerular filtration rate (eGFR) during the 4 years. Significant RFD was defined as a decrease of eGFR over the upper quartile (≤−2.1% per year). Results The mean age was 67.2±6.6 years. The median value of the absolute decline in the eGFR and the percent change was −3.0 mL/minute/1.73 m2 and −0.87%/year in men and −3.1 mL/minute/1.73 m2 and −0.89%/year in women, respectively. When stratified by sex-specific PBF tertiles, pronounced differences were observed in both sexes; those at the highest tertile of PBF showed the greatest decline in eGFR. Even after adjustments for traditional risk factors of RFD, PBF was independently associated with eGFR changes (β=−0.181; P<0.001). In addition, the harmful effect of a high PBF was consistently found in subjects with a normal weight, too (β=−0.141; P=0.006). Cases of significant RFD occurred in 181 participants (29.4%), and the risk was higher in obese participants as compared with the nonobese participants. The odd ratios (95% confidence interval) for significant RFD were 2.76 (1.28–7.74) in men and 2.02 (1.06–4.43) in women in a whole population and 3.15 (1.03–18.52) in men and 1.44 (1.01–3.28) in women with a normal weight, respectively. Conclusion Among the elderly population without comorbidities, increased body fat has a harmful effect on RFD, irrespective of body weight.
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Affiliation(s)
- Jwa-Kyung Kim
- Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
| | - Young Rim Song
- Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
| | - Young-Jun Kwon
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
| | - Hyung Jik Kim
- Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
| | - Sung Gyun Kim
- Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
| | - Young-Su Ju
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
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21
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De Lorenzo A, Nardi A, Iacopino L, Domino E, Murdolo G, Gavrila C, Minella D, Scapagnini G, Di Renzo L. A new predictive equation for evaluating women body fat percentage and obesity-related cardiovascular disease risk. J Endocrinol Invest 2014; 37:511-24. [PMID: 24458830 DOI: 10.1007/s40618-013-0048-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 12/17/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obesity represents a global public health problem due to its association with cardiovascular diseases and reduced lifespan. The most widely used classification of obesity is expressed as Body Mass Index (BMI); however, this formula is an imprecise adiposity measurement that ignores several important factors involved. Body Adiposity Index (BAI) was more recently proposed as an indirect evaluation of percentage body fat (PBF). PBF is a direct measure of person's relative body fat and a better predictor of obesity-related risk diseases than BMI and BAI. Since obesity and consequent diseases are considered epidemic, new accurate formulas for epidemiological studies are of interest to the scientific community. Because direct measurement of body composition could be quite expensive, the aims of our work were to analyse the distributions of PBF by Dual X-ray absorptiometry, and the creation of new predictive equation using only anthropometric measures that could be helpful to clinicians to assess easily body fat of female patients. METHODS/RESULTS A sample of 1,031 Caucasian Italian women was recruited and BMI, BAI and PBF were evaluated. With the aim of developing a predictive model of PBF a multivariate regression model was fitted to observed data. CONCLUSIONS The definition of universally recognized PBF by gender and age could have public health implications. In this study, we developed a new predictive PBF equation that does not require the use of medical instruments or skilled measurement techniques and that may be easily applicable to Italian women.
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Affiliation(s)
- A De Lorenzo
- Division of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133, Rome, Italy,
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Scheers T, Philippaerts R, Lefevre J. Objectively-determined intensity- and domain-specific physical activity and sedentary behavior in relation to percent body fat. Clin Nutr 2013; 32:999-1006. [DOI: 10.1016/j.clnu.2013.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 02/07/2013] [Accepted: 03/17/2013] [Indexed: 10/27/2022]
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Lee WJ, Youm Y, Rhee Y, Park YR, Chu SH, Kim HC. Social network characteristics and body mass index in an elderly Korean population. J Prev Med Public Health 2013; 46:336-45. [PMID: 24349655 PMCID: PMC3859855 DOI: 10.3961/jpmph.2013.46.6.336] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 10/17/2013] [Indexed: 11/13/2022] Open
Abstract
Objectives Research has shown that obesity appears to spread through social ties. However, the association between other characteristics of social networks and obesity is unclear. This study aimed to identify the association between social network characteristics and body mass index (BMI, kg/m2) in an elderly Korean population. Methods This cross-sectional study analyzed data from 657 Koreans (273 men, 384 women) aged 60 years or older who participated in the Korean Social Life, Health, and Aging Project. Network size is a count of the number of friends. Density of communication network is the number of connections in the social network reported as a fraction of the total links possible in the personal (ego-centric) network. Average frequency of communication (or meeting) measures how often network members communicate (or meet) each other. The association of each social network measure with BMI was investigated by multiple linear regression analysis. Results After adjusting for potential confounders, the men with lower density (<0.71) and higher network size (4-6) had the higher BMI (β=1.089, p=0.037) compared to the men with higher density (>0.83) and lower size (1-2), but not in the women (p=0.393). The lowest tertile of communication frequency was associated with higher BMI in the women (β=0.885, p=0.049), but not in the men (p=0.140). Conclusions Our study suggests that social network structure (network size and density) and activation (communication frequency and meeting frequency) are associated with obesity among the elderly. There may also be gender differences in this association.
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Affiliation(s)
- Won Joon Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yoosik Youm
- Department of Sociology, Yonsei University College of Social Sciences, Seoul, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yeong-Ran Park
- Division of Silver Industry, Kangnam University, Yongin, Korea
| | - Sang Hui Chu
- Department of Clinical Nursing Science, Yonsei University College of Nursing, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
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Wang Y, Wang Y, Qain Y, Zhang J, Tang X, Sun J, Zhu D. Association of body mass index with cause specific deaths in Chinese elderly hypertensive patients: Minhang community study. PLoS One 2013; 8:e71223. [PMID: 23967168 PMCID: PMC3742783 DOI: 10.1371/journal.pone.0071223] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 06/27/2013] [Indexed: 11/19/2022] Open
Abstract
Background Most studies have suggested that elevated body mass index (BMI) was associated with the risk of death from all cause and from specific causes. However, there was little evidence illustrating the effect of BMI on the mortality in elderly hypertensive patients in Chinese population. Methods The information of 10,957 hypertensive patients at baseline not less than 60 years were from Xinzhuang, a town in Minhang district of Shanghai, was extracted from the Electronic Health Record (EHR) system. All study participants were divided into eight categories of baseline BMI (with cut-points at 18, 20, 22, 24, 26, 28 and 30 kg/m2). Relative hazard ratio of death from all cause, cardiovascular and non-cardiovascular cause by baseline BMI groups were calculated, standardized for sex, age, smoking, drinking, physical activity, systolic blood pressure, history of cardiovascular disorders, serum lipid disturbance, diabetes mellitus and antihypertensive drug treatment. Results During follow up (median: 3.7 years), 561 deaths occurred. Underweight (BMI<18 kg/m2) was associated with significantly increased mortality from all cause mortality (OR: 2.00; 95% CI: 1.43–2.79) and non cardiovascular mortality (OR: 2.76; 95% CI: 1.87–4.07), but not with cardiovascular mortality. For the cause specific analysis, the underweight was associated significantly with neoplasms (OR: 2.15; 95% CI: 1.16–4.00) and respiratory disorders (OR: 3.41; 95% CI: 1.64–7.06). The results for total mortality and specific cause mortality were not influenced by sex, age and smoking status. Conclusion Our study revealed an association between underweight and increased mortality from non-cardiovascular disorders in elderly hypertensive patients in Chinese community. Overweight and obesity were not associated with all cause or cause specific death.
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Affiliation(s)
- Yan Wang
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yajuan Wang
- Xinzhuang Community Health Service Center, Shanghai, China
| | - Yuesheng Qain
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jin Zhang
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaofeng Tang
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Junlei Sun
- Xinzhuang Community Health Service Center, Shanghai, China
- * E-mail: (DZ); (JS)
| | - Dingliang Zhu
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai, China
- * E-mail: (DZ); (JS)
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Muneyuki T, Sugawara H, Suwa K, Oshida H, Saito M, Hori Y, Seta S, Ishida T, Kakei M, Momomura SI, Nakajima K. A community-based cross-sectional and longitudinal study uncovered asymptomatic proteinuria in Japanese adults with low body weight. Kidney Int 2013; 84:1254-61. [PMID: 23783242 DOI: 10.1038/ki.2013.222] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 04/15/2013] [Accepted: 04/25/2013] [Indexed: 11/09/2022]
Abstract
Although proteinuria is highly prevalent in obese individuals, the association between proteinuria and low body weight is equivocal. In this study we determine whether low body weight is more strongly associated with proteinuria compared with normal weight. The association between body mass index (BMI) and proteinuria was examined in a cross-sectional study of 62,582 asymptomatic individuals aged 20-70 years without known kidney diseases recruited, based on the results of medical checkups in 1999. We also examined the incidence of recurrent or nonrecurrent proteinuria in an 8-year longitudinal analysis of 12,493 individuals without proteinuria at baseline. The prevalence of proteinuria showed a J-shaped relationship with BMI. Multivariate regression analysis showed that BMI of 27.0 kg/m(2) and above or 18.9 kg/m(2) and less was significantly associated with proteinuria relative to BMI 21.0-22.9 kg/m(2), even after adjusting for relevant cardiometabolic risk factors. In the longitudinal study, similar J-shaped relationships between the incident rates of proteinuria and baseline BMI groups were observed at post-baseline checkups. Baseline BMI 27.0 kg/m(2) and above was associated with significantly greater risk for recurrent and nonrecurrent proteinuria, whereas BMI 18.9 kg/m(2) and less was only associated with nonrecurrent proteinuria. Thus, obesity and low body weight may be associated with different types of proteinuria independent of cardiometabolic risk factors.
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Affiliation(s)
- Toshitaka Muneyuki
- 1] Division of Clinical Nutrition, Department of Medical Dietetics, Faculty of Pharmaceutical Sciences, Josai University, Sakado, Japan [2] First Department of Comprehensive Medicine, Saitama Medical Center, Jichi Medical University School of Medicine, Saitama, Japan
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Chang JS, Park YH, Ku JH, Kwak C, Kim HH. Predicting factors for death from other causes in patients with localized renal cell carcinoma. Korean J Urol 2012; 53:18-22. [PMID: 22323969 PMCID: PMC3272551 DOI: 10.4111/kju.2012.53.1.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 10/07/2011] [Indexed: 11/23/2022] Open
Abstract
Purpose To identify the predictors of death from other causes in patients with localized renal cell carcinoma (RCC). Materials and Methods We identified 1,101 patients with pathologically confirmed T1 or T2 RCC with a follow-up duration of over 6 months. Survival according to the cause of death was evaluated by using the Kaplan-Meier analysis with log-rank test. Prognostic factors for death from other causes were assessed by multivariate analysis using the Cox proportional hazard regression model. Once the prognostic factors were identified, a risk-group variable was created by counting the number of unfavorable features present for each patient. Results The median follow-up was 62 months, and RCC-related death occurred in 50 patients (4.5%), whereas death from other causes occurred in 47 (4.3%). Patients who died from other causes had a higher American Society of Anesthesiologist (ASA) score (26.1% vs. 10.2%; p=0.044), older age (63.4 years vs. 55.0 years; p<0.001), smaller mass size (5.1 cm vs. 7.9 cm; p<0.001), and lower nuclear grade (p=0.003). In the multivariate Cox regression analysis, older age, higher ASA score, and lower body mass index were independent factors predicting death from other causes in patients with localized RCC. On the basis of the number of risk factors for death from other causes, the 5-year other-cause-specific survival was 98.3% (0 risk factors), 84.7% (1 risk factor), and 67.6% (2 or 3 risk factors), respectively (p<0.001). Conclusions Older age, higher ASA score, and lower body mass index were independent predictors of death from other causes in patients with localized RCC.
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Affiliation(s)
- Jin Suk Chang
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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De Lorenzo A, Bianchi A, Maroni P, Iannarelli A, Di Daniele N, Iacopino L, Di Renzo L. Adiposity rather than BMI determines metabolic risk. Int J Cardiol 2011; 166:111-7. [PMID: 22088224 DOI: 10.1016/j.ijcard.2011.10.006] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 09/07/2011] [Accepted: 10/13/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM There is increasing evidence suggesting that WHO body mass index (BMI) cut-off values are outdated and should not be applied to different population. To overcome misclassifications, direct measurements of percentage body fat (PBF) would be a better tool for preobesity and obesity diagnosis. The aim of this study was to analyze the body composition in a adult population in Centre-South of Italy, by age and gender, and to verify the accordance between BMI and PBF cut-off points for health status classification. METHODS The total subject pool cover a total of 4408 participants adults. A completed screening of anthropometry and body composition by Dual X-ray Absorptiometry, (DXA) was assessed on 3.258 subjects. RESULTS Distributions and quantitative reliable estimates of PBF, total body fat and lean, according to gender and age are provided. The prevalence of "at risk" subjects (preobese and obese) was 69% and 85%, for men and women respectively, according to PBF cut-off points. The agreement of BMI and PBF categories resulted low for the total and male population, even scarce for female population (all P ≤ 0.001). The false negative classification of BMI was stronger for women than men and for younger than older subjects. CONCLUSIONS Screening for adiposity in subjects with a normal BMI could better identify those at higher risk for cardiometabolic disturbances and cardiovascular mortality. The herein used cut-offs points of PBF, by age and gender, may provide a useful reference in clinical settings and public health services, in particular for the Italian Caucasian population.
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Affiliation(s)
- Antonino De Lorenzo
- Department of Neuroscience, Division of Human Nutrition, University of Tor Vergata, Via Montpellier 1, I-00133 Rome, Italy.
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Anthropometric, body composition and health determinants of active ageing: a gender approach. J Biosoc Sci 2011; 43:597-610. [PMID: 21729364 DOI: 10.1017/s0021932011000228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study applied a gender perspective to establish some of the anthropometric, body composition, health and socio-cultural determinants of active ageing. The variable 'active ageing' (presence/absence) was created based on cognitive and disability/illness/physical functioning, subjective health, satisfaction with life and productive activity performed, and used in predictive models to establish its relationship with anthropometric variables, physical health indicators and educational level. The sample consisted of 456 home-living individuals (169 men and 287 women; age range 54-75 years) from Madrid and Toledo in Spain. The women had a higher prevalence of obesity than the men (37.6% vs 29.0%), significantly greater fat accumulation in the abdominal area and worst perceived health (p=0.003). The frequency of active agers is higher in men than in women (38.4% vs 21.9%; p<0.001). Men and women were found to have distinctive ageing patterns. Health factors condition the presence of active ageing in women, while education factors are also relevant in men.
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Hotchkiss JW, Leyland AH. The relationship between body size and mortality in the linked Scottish Health Surveys: cross-sectional surveys with follow-up. Int J Obes (Lond) 2011; 35:838-51. [PMID: 20921963 PMCID: PMC3117149 DOI: 10.1038/ijo.2010.207] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 08/12/2010] [Accepted: 08/14/2010] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the relationship between body mass index (BMI), waist circumference (WC) or waist-hip ratio (WHR) and all-cause mortality or cause-specific mortality. DESIGN Cross-sectional surveys linked to hospital admissions and death records. SUBJECTS In total, 20,117 adults (aged 18-86 years) from a nationally representative sample of the Scottish population. MEASUREMENTS Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause, or cause-specific, mortality. The three anthropometric measurements BMI, WC and WHR were the main variables of interest. The following were adjustment variables: age, gender, smoking status, alcohol consumption, survey year, social class and area of deprivation. RESULTS BMI-defined obesity (≥ 30 kg m(-2)) was not associated with increased risk of mortality (HR = 0.93; 95% confidence interval = 0.80-1.08), whereas the overweight category (25-<30 kg m(-2)) was associated with a decreased risk (0.80; 0.70-0.91). In contrast, the HR for a high WC (men ≥ 102 cm, women ≥ 88 cm) was 1.17 (1.02-1.34) and a high WHR (men ≥ 1, women ≥ 0.85) was 1.34 (1.16-1.55). There was an increased risk of cardiovascular disease (CVD) mortality associated with BMI-defined obesity, a high WC and a high WHR categories; the HR estimates for these were 1.36 (1.05-1.77), 1.41 (1.11-1.79) and 1.44 (1.12-1.85), respectively. A low BMI (<18.5 kg m(-2)) was associated with elevated HR for all-cause mortality (2.66; 1.97-3.60), for chronic respiratory disease mortality (3.17; 1.39-7.21) and for acute respiratory disease mortality (11.68; 5.01-27.21). This pattern was repeated for WC but not for WHR. CONCLUSIONS It might be prudent not to use BMI as the sole measure to summarize body size. The alternatives WC and WHR may more clearly define the health risks associated with excess body fat accumulation. The lack of association between elevated BMI and mortality may reflect the secular decline in CVD mortality.
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Affiliation(s)
- J W Hotchkiss
- MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK.
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Zheng W, McLerran DF, Rolland B, Zhang X, Inoue M, Matsuo K, He J, Gupta PC, Ramadas K, Tsugane S, Irie F, Tamakoshi A, Gao YT, Wang R, Shu XO, Tsuji I, Kuriyama S, Tanaka H, Satoh H, Chen CJ, Yuan JM, Yoo KY, Ahsan H, Pan WH, Gu D, Pednekar MS, Sauvaget C, Sasazuki S, Sairenchi T, Yang G, Xiang YB, Nagai M, Suzuki T, Nishino Y, You SL, Koh WP, Park SK, Chen Y, Shen CY, Thornquist M, Feng Z, Kang D, Boffetta P, Potter JD. Association between body-mass index and risk of death in more than 1 million Asians. N Engl J Med 2011; 364:719-29. [PMID: 21345101 PMCID: PMC4008249 DOI: 10.1056/nejmoa1010679] [Citation(s) in RCA: 664] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Most studies that have evaluated the association between the body-mass index (BMI) and the risks of death from any cause and from specific causes have been conducted in populations of European origin. METHODS We performed pooled analyses to evaluate the association between BMI and the risk of death among more than 1.1 million persons recruited in 19 cohorts in Asia. The analyses included approximately 120,700 deaths that occurred during a mean follow-up period of 9.2 years. Cox regression models were used to adjust for confounding factors. RESULTS In the cohorts of East Asians, including Chinese, Japanese, and Koreans, the lowest risk of death was seen among persons with a BMI (the weight in kilograms divided by the square of the height in meters) in the range of 22.6 to 27.5. The risk was elevated among persons with BMI levels either higher or lower than that range--by a factor of up to 1.5 among those with a BMI of more than 35.0 and by a factor of 2.8 among those with a BMI of 15.0 or less. A similar U-shaped association was seen between BMI and the risks of death from cancer, from cardiovascular diseases, and from other causes. In the cohorts comprising Indians and Bangladeshis, the risks of death from any cause and from causes other than cancer or cardiovascular disease were increased among persons with a BMI of 20.0 or less, as compared with those with a BMI of 22.6 to 25.0, whereas there was no excess risk of either death from any cause or cause-specific death associated with a high BMI. CONCLUSIONS Underweight was associated with a substantially increased risk of death in all Asian populations. The excess risk of death associated with a high BMI, however, was seen among East Asians but not among Indians and Bangladeshis.
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Affiliation(s)
- Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt–Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA.
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Romero-Corral A, Somers VK, Sierra-Johnson J, Korenfeld Y, Boarin S, Korinek J, Jensen MD, Parati G, Lopez-Jimenez F. Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J 2010; 31:737-46. [PMID: 19933515 PMCID: PMC2838679 DOI: 10.1093/eurheartj/ehp487] [Citation(s) in RCA: 393] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 09/01/2009] [Accepted: 09/29/2009] [Indexed: 01/10/2023] Open
Abstract
AIMS We hypothesized that subjects with a normal body mass index (BMI), but high body fat (BF) content [normal weight obesity (NWO)], have a higher prevalence of cardiometabolic dysregulation and are at higher risk for cardiovascular (CV) mortality. METHODS AND RESULTS We analysed 6171 subjects >20 years of age from the Third National Health and Nutrition Examination Survey (NHANES III) and the NHANES III mortality study, whose BMI was within the normal range (18.5-24.9 kg/m(2)), and who underwent a complete evaluation that included body composition assessment, blood measurements, and assessment of CV risk factors. Survival information was available for >99% of the subjects after a median follow-up of 8.8 years. We divided our sample using sex-specific tertiles of BF%. The highest tertile of BF (>23.1% in men and >33.3% in women) was labelled as NWO. When compared with the low BF group, the prevalence of metabolic syndrome in subjects with NWO was four-fold higher (16.6 vs. 4.8%, P < 0.0001). Subjects with NWO also had higher prevalence of dyslipidaemia, hypertension (men), and CV disease (women). After adjustment, women with NWO showed a significant 2.2-fold increased risk for CV mortality (HR = 2.2; 95% CI, 1.03-4.67) in comparison to the low BF group. CONCLUSION Normal weight obesity, defined as the combination of normal BMI and high BF content, is associated with a high prevalence of cardiometabolic dysregulation, metabolic syndrome, and CV risk factors. In women, NWO is independently associated with increased risk for CV mortality.
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Affiliation(s)
| | | | - Justo Sierra-Johnson
- Department of Medicine, Atherosclerosis Research Unit, Karolinska Institute, Sweden
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Diagnostic performance of body mass index to identify obesity as defined by body adiposity: a systematic review and meta-analysis. Int J Obes (Lond) 2010; 34:791-9. [PMID: 20125098 DOI: 10.1038/ijo.2010.5] [Citation(s) in RCA: 706] [Impact Index Per Article: 50.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Davey Smith G, Sterne JAC, Fraser A, Tynelius P, Lawlor DA, Rasmussen F. The association between BMI and mortality using offspring BMI as an indicator of own BMI: large intergenerational mortality study. BMJ 2009; 339:b5043. [PMID: 20028778 PMCID: PMC2797052 DOI: 10.1136/bmj.b5043] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2009] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To obtain valid estimates of the association between body mass index (BMI) and mortality by using offspring BMI as an instrumental variable for own BMI. DESIGN Cohort study based on record linkage, with 50 years of follow-up for mortality. Associations of offspring BMI with all cause and cause specific maternal and paternal mortality were estimated as hazard ratios per standard deviation of offspring BMI. SETTING A large intergenerational prospective population based database covering the general population of Sweden. PARTICIPANTS More than one million Swedish parent-son pairs. RESULTS The final dataset analysed contained information on 1 018 012 mother-son pairs (122 677 maternal deaths) and 1 004 617 father-son pairs (242 126 paternal deaths). For some causes of death, the patterns of associations between offspring BMI and mortality were similar to those seen for own BMI and mortality in previous studies. Parental mortality from diabetes, coronary heart disease, and kidney cancer had the strongest positive associations with offspring BMI (for example, hazard ratio (HR) for coronary heart disease per standard deviation increase in offspring BMI for mothers 1.15, 95% CI 1.14 to 1.17 and for fathers 1.10, 1.09 to 1.11). However, in contrast to the inverse association of own BMI with lung cancer and respiratory disease mortality seen in other studies, there was a positive association between offspring BMI and lung cancer mortality in mothers (1.12, 1.09 to 1.15) and fathers (1.03, 1.02 to 1.05) and between offspring BMI and respiratory mortality in mothers (1.05, 1.02 to 1.08) and fathers (1.02, 1.00 to 1.04). Associations of own BMI and offspring BMI with all cause, cardiovascular disease related, and non-cardiovascular disease related mortality were compared in a subset of father-son pairs (n=72 815). When offspring BMI was used as an instrumental variable for paternal BMI, the causal association between BMI and paternal cardiovascular disease mortality (HR per standard deviation of BMI 1.82, 95% CI 1.17 to 2.83) was stronger than that indicated by the directly observed association between own BMI and cardiovascular disease mortality (1.45, 1.31 to 1.61). CONCLUSIONS Use of offspring BMI as a predictor of own BMI, a technique that avoids problems of reverse causality, suggests that positive associations of BMI with all cause and cardiovascular mortality may be underestimated in conventional observational studies. Use of offspring BMI instead of own BMI in analyses of respiratory disease and lung cancer mortality, for which previous studies have reported consistent and strong inverse associations with own BMI, suggests that such studies have overstated the apparent adverse consequences of lower BMI with respect to these outcomes.
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Affiliation(s)
- George Davey Smith
- Medical Research Council Centre for Causal Analyses in Translational Epidemiology, Department of Social Medicine, University of Bristol, Bristol, BS8 2BN
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