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Chu K, Cadar D, Iob E, Frank P. Excess body weight and specific types of depressive symptoms: Is there a mediating role of systemic low-grade inflammation? Brain Behav Immun 2023; 108:233-244. [PMID: 36462595 PMCID: PMC10567582 DOI: 10.1016/j.bbi.2022.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Obesity is associated with an increased risk of depression. Systemic low-grade inflammation, a plausible consequence of obesity, has also been linked to depression. However, the potential mediating effects of systemic low-grade inflammation on the association between excess body weight and specific symptom domains of depression remain uncertain. This study examined whether systemic low-grade inflammation mediated the associations of excess body weight (overweight and obesity) with subsequent overall, cognitive-affective, and somatic depressive symptoms. DESIGN This study used a prospective cohort design. METHODS The final analytical sample included 4,942 adults aged ≥50 years drawn from the English Longitudinal Study of Ageing (ELSA). Body mass index (BMI) and covariates were ascertained at baseline (wave 4, 2008/09). Continuous BMI scores were divided into four categories: 'normal weight' (18.5 ≤ BMI <25 kg/m2); 'overweight' (25 ≤ BMI <30 kg/m2); 'obesity' (BMI ≥30 kg/m2); in addition to 'excess body weight' ('overweight' and 'obesity' combined). Covariates included sociodemographic variables, behavioural factors, and chronic physical conditions. Serum concentrations of CRP were measured at wave 6 (2012/13). Depressive symptoms were assessed at baseline and ten years later (wave 9, 2018/19), using the 8-item Centre for Epidemiological Studies Depression (CES-D) Scale. Two symptom domains were constructed, distinguishing between cognitive-affective (depressed mood, loneliness, sadness, enjoyment in life, and happiness) and somatic (sleep problems, low energy levels, and fatigue) symptoms. Mediation analyses were performed to examine whether CRP statistically mediated the associations between BMI categories and depressive symptoms. RESULTS In multivariable-adjusted analyses, excess body weight was associated with elevated somatic (OR = 1.231, 95% CI: 1.029, 1.473), but not cognitive-affective or overall depressive symptoms at follow-up. Higher CRP was associated with elevated somatic (OR = 1.156, 95% CI: 1.061, 1.259), but not cognitive-affective or overall depressive symptoms. CRP acted as a partial mediator (14.92%) of the association between excess body weight and elevated somatic, but not cognitive-affective, or overall depressive symptoms. CONCLUSION Systemic low-grade inflammation may partially explain the association of excess body weight with somatic depressive symptoms, but not the associations with cognitive-affective or overall depressive symptoms.
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Affiliation(s)
- Keqin Chu
- Department of Behavioural Science and Health, University College London, London, UK.
| | - Dorina Cadar
- Department of Behavioural Science and Health, University College London, London, UK; Brighton and Sussex Medical School, Brighton, East Sussex, UK.
| | - Eleonora Iob
- Social, Genetic & Developmental Psychiatry (SGDP) Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Philipp Frank
- Department of Behavioural Science and Health, University College London, London, UK.
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BONETTI GABRIELE, HERBST KARENL, DONATO KEVIN, DHULI KRISTJANA, KIANI AYSHAKARIM, AQUILANTI BARBARA, VELLUTI VALERIA, MATERA GIUSEPPINA, IACONELLI AMERIGO, BERTELLI MATTEO. Dietary supplements for obesity. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E160-E168. [PMID: 36479472 PMCID: PMC9710396 DOI: 10.15167/2421-4248/jpmh2022.63.2s3.2757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Obesity and associated complications including diabetes, cardiometabolic dysfunction, disability, malignancy and premature mortality are considered epidemic. Research on obesity is therefore of worldwide importance. The development of obesity is a multifactorial phenomenon with contributions from biological, behavioral, genetic and environmental factors. Obesity and its associated issues require various lifestyle modifications and treatment options such medication, exercise, diet, surgery, pharmacological therapy and dietary supplements. Dietary supplements are considered an attractive alternative to traditional therapy due to their low toxicity profile and their accessibility to the general population. Dietary supplements may include one or more dietary ingredients. In this narrative review, we analyze the effects on obesity and obesity-related issues of various natural components. For example, there are a myriad of supplements that have been used as dietary supplements for weight loss such as minerals, vitamins, amino acids, metabolites, herbs, and plant extracts. This narrative review aims to present the benefits and side-effects of several ingredients of dietary supplements for weight loss and treatment of obesity. In particular, the mechanism of action, results of clinical trials, and possible side effects will be presented for the following ingredients: β-Glucans, bitter orange, calcium, vitamin D, chitosan, chromium, cocoa, coleus forskohlii, conjugate linoleic acid, ephedra sinica, fucoxanthin, garcinia cambogia, glucomannan, green coffee, green tea, guar gum, raspberry, hoodia gordonii, irvingia gabonensis, phenylpropylamine, pyruvate, white kidney bean.
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Affiliation(s)
- GABRIELE BONETTI
- MAGI’S LAB, Rovereto (TN), Italy
- Correspondence: Gabriele Bonetti, MAGI’S LAB, Rovereto (TN) 38068, Italy. E-mail:
| | - KAREN L. HERBST
- Total Lipedema Care, Beverly Hills (California) and Tucson (Arizona), USA
| | | | | | | | - BARBARA AQUILANTI
- UOSD Medicina Bariatrica, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - VALERIA VELLUTI
- UOSD Medicina Bariatrica, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - GIUSEPPINA MATERA
- UOSD Medicina Bariatrica, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - AMERIGO IACONELLI
- UOSD Medicina Bariatrica, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - MATTEO BERTELLI
- MAGI’S LAB, Rovereto (TN), Italy
- MAGI EUREGIO, Bolzano, Italy
- MAGISNAT, Peachtree Corners (GA), USA
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Jia H, Lubetkin EI. Association between self-reported body mass index and active life expectancy in a large community-dwelling sample of older U.S. adults. BMC Geriatr 2022; 22:310. [PMID: 35397523 PMCID: PMC8994875 DOI: 10.1186/s12877-022-03021-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 04/01/2022] [Indexed: 11/26/2022] Open
Abstract
Background Obesity may have a protective effect (greater survival) in older adults, a finding known as the “obesity paradox.” This study examined the association between self-reported body mass index (BMI) and active life expectancy (ALE) among older U.S. adults. Methods Using the Medicare Health Outcomes Survey Cohort 15 (2012 baseline, 2014 follow-up), we estimated life expectancy and ALE by participants’ baseline BMI and age using multi-state models. A participant was classified as in an active state if this person reported having no difficulty for any of these six activities of daily living (ADLs). Results Small differences in life expectancy were noted among persons in normal weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25–29.9 kg/m2), and obesity ranges (BMI 30 kg/m2 and higher). However, persons with obesity had a significantly lower ALE. ALE at age 65 was 11.1 (11.0–11.2) years for persons with obesity, 1.2 (1.1–1.3) years less than that for the normal weight and overweight persons (12.3 years for both, 12.2–12.4). Persons with class III obesity had a significantly lower life expectancy and ALE than normal weight persons. Although persons with class I or II obesity had a similar life expectancy as normal weight persons, they have a shorter ALE. Conclusions Although older adults with obesity have a similar life expectancy as normal weight persons, they have a significantly shorter ALE. Given the complex relationship of BMI and ALE, a “one size fits all” approach to weight management is not advisable. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03021-7.
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Amankwaa I, Nelson K, Rook H, Hales C. Association between body mass index, multi-morbidity and activities of daily living among New Zealand nursing home older adults: a retrospective analysis of nationwide InterRAI data. BMC Geriatr 2022; 22:62. [PMID: 35042475 PMCID: PMC8767739 DOI: 10.1186/s12877-021-02696-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background Obesity is a well-established risk factor for multi-morbidity and disability among older adults in the community and acute care settings. However, nursing home residents with body mass index (BMI) below 18.5 kg/m2 and above 25.0 kg/m2 have been understudied. We examined the prevalence of multi-morbidity and disability in activities of daily living (ADL) by BMI category and further investigated the association between BMI, multi-morbidity, and disability of ADL in a large cohort of older adults in nursing homes in New Zealand. Methods A retrospective review of nursing home residents’ data obtained from the New Zealand International Resident Assessment Instrument national dataset from 2015 to 2018. One hundred ninety-eight thousand seven hundred ninety older adults (≥60 years) living in nursing homes were included. BMI was calculated as weight in kilograms (kg) divided by height in meters squared (m2). Multimorbidity was defined as the presence of ≥2 health conditions. The risk of disability was measured by a 4-item ADL self-performance scale. The prevalence ratio (PR) of the association between BMI and multi-morbidity and between BMI and disability in ADL was assessed using Poisson regression with robust variance. Results Of the 198,790 residents, 10.6, 26.6, 11.3 and 5.4% were underweight, overweight, obese, and extremely obese, respectively. 26.4, 31.3 and 21.3% had one, two and three disease conditions, respectively, while 14.3% had four or more conditions. 24.1% could perform only one ADL, and 16.1% could perform none. The prevalence of multi-morbidity increased with increasing BMI, whereas mean disability in ADL decreased with increasing BMI. The risk of multi-morbidity was higher for the overweight (PR, 95%CI: 1.03, 1.02–1.03) and obese (PR, 95% CI: 1.07, 1.06–1.08) compared to normal weight after controlling for age, sex, ethnicity, and region. BMI was inversely associated with mean ADL; β, 95% CI for overweight (− 0.30, − 0.32, − 0.28) and obese − 0.43, − 0.45, − 0.40 compared to normal weight. Conclusion Being underweight was associated with a decline in the performance of ADL in nursing home residents. In contrast, being overweight and obese positively affected functional performance, demonstrating that the obesity paradox plays an important role in this population. The observed associations highlight areas where detection and management of underweight and healthy aging initiatives may be merited.
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Double burden of underweight and overweight among Indian adults: spatial patterns and social determinants. Public Health Nutr 2021; 24:2808-2822. [PMID: 33875031 PMCID: PMC9884774 DOI: 10.1017/s1368980021001634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The current study explores the spatial patterns of underweight and overweight among adult men and women in districts of India and identifies the micro-geographical locations where the risks of underweight and overweight are simultaneously prevalent, after accounting for demographic and socio-economic factors. DESIGN We relied on BMI (weight (kg)/height squared (m2)), a measure of nutritional status among adult individuals, from the 2015-2016 National Family and Health Survey. Underweight was defined as <18·5 kg/m2 and overweight as ≥25·0 kg/m2. SETTING We adopted Bayesian structured additive quantile regression to model the underlying spatial structure in underweight and overweight burden. PARTICIPANTS Men aged 15-54 years (sample size: 108 092) and women aged 15-49 years (sample size: 642 002). RESULTS About 19·7 % of men and 22·9 % of women were underweight, and 19·6 % of men and 20·6 % of women were overweight. Results indicate that malnutrition burden in adults exhibits geographical divides across the country. Districts located in the central, western and eastern regions show higher risks of underweight. There is evidence of substantial spatial clustering of districts with higher risk of overweight in southern and northern India. While finding a little evidence on double burden of malnutrition among population groups, we identified a total of sixty-six double burden districts. CONCLUSIONS The current study demonstrates that the geographical burden of overweight in Indian adults is yet to surpass that of underweight, but the coexistence of double burden of underweight and overweight in selected regions presents a new challenge for improving nutritional status and necessitates specialised policy initiatives.
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Batsis JA, Apolzan JW, Bagley PJ, Blunt HB, Divan V, Gill S, Golden A, Gundamraj S, Heymsfield S, Kahan S, Kopatsis K, Port A, Parks EP, Reilly CA, Rubino D, Saunders KH, Shean R, Tabaza L, Stanley A, Tchang BG, Gundumraj S, Kidambi S. A Systematic Review of Dietary Supplements and Alternative Therapies for Weight Loss. Obesity (Silver Spring) 2021; 29:1102-1113. [PMID: 34159755 PMCID: PMC8231729 DOI: 10.1002/oby.23110] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Dietary supplements and alternative therapies are commercialized as a panacea for obesity/weight gain as a result of the minimal regulatory requirements in demonstrating efficacy. These products may indirectly undermine the value of guideline-driven obesity treatments. Included in this study is a systematic review of the literature of purported dietary supplements and alternative therapies for weight loss. METHODS A systematic review was conducted to evaluate the efficacy of dietary supplements and alternative therapies for weight loss in participants aged ≥18 years. Searches of Medline (PubMed), Cochrane Library, Web of Science, CINAHL, and Embase (Ovid) were conducted. Risk of bias and results were summarized qualitatively. RESULTS Of the 20,504 citations retrieved in the database search, 1,743 full-text articles were reviewed, 315 of which were randomized controlled trials evaluating the efficacy of 14 purported dietary supplements, therapies, or a combination thereof. Risk of bias and sufficiency of data varied widely. Few studies (n = 52 [16.5%]) were classified as low risk and sufficient to support efficacy. Of these, only 16 (31%) noted significant pre/post intergroup differences in weight (range: 0.3-4.93 kg). CONCLUSIONS Dietary supplements and alternative therapies for weight loss have a limited high-quality evidence base of efficacy. Practitioners and patients should be aware of the scientific evidence of claims before recommending use.
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Affiliation(s)
- John A. Batsis
- Division of Geriatric Medicine, School of Medicine, and the Department of Nutrition, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - John W. Apolzan
- Pennington Biomedical Research Center, Louisiana State University Sysytem, Baton Rouge, Louisiana
| | | | | | | | - Sonia Gill
- University of California, Davis School of Medicine, Sacramento, California
| | | | | | - Steven Heymsfield
- Pennington Biomedical Research Center, Louisiana State University Sysytem, Baton Rouge, Louisiana
| | - Scott Kahan
- Director, National Center for Weight and Wellness, George Washington University Milken Institute School of Public Health, Washington, DC
| | | | - Ava Port
- Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD
| | - Elizabeth Prout Parks
- The Children’s Hospital of Philadelphia, Division of Gastroenterology, Hepatology and Nutrition, The Healthy Weight Program, Perelman Medical Center, University of Pennsylvania
| | - Clifford A. Reilly
- The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington VT
| | - Domenica Rubino
- Washington Center for Weight Management and Research, Arlington, VA
| | - Katherine H. Saunders
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York, NY
| | - Ryan Shean
- Dartmouth College, Hanover, New Hampshire
| | - Luai Tabaza
- Albert Einstein Medical Center, Philadelphia, PA
| | - Abishek Stanley
- Pennington Biomedical Research Center, Louisiana State University Sysytem, Baton Rouge, Louisiana
| | - Beverly G. Tchang
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York, NY
| | - Shivani Gundumraj
- AT Still University School of Osteopathic Medicine in Arizona, Mesa, AZ
| | - Srividya Kidambi
- Division of Endocrinology and Molecular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Tavares Milhem Ygnatios N, de Oliveira C, Vaz de Melo Mambrini J, Bof de Andrade F, Lima-Costa MF, Lustosa Torres J. Differences in disability and nutritional status among older Brazilian and English adults: the Brazilian Longitudinal Study of Aging (ELSI-Brazil) and English Longitudinal Study of Aging (ELSA) cohorts. Am J Clin Nutr 2021; 114:422-428. [PMID: 33831943 PMCID: PMC8436132 DOI: 10.1093/ajcn/nqab060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/16/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Brazil and England are 2 countries at different stages in their demographic, epidemiological, and nutritional transitions and with distinct socioeconomic and politic contexts, but with similar universal health systems. We aimed to examine disability and its association with objective anthropometric indicators of nutritional status, including BMI, waist circumference, and waist-to-height ratio, comparing older Brazilian and English adults. METHODS We used cross-sectional data from 2 nationally representative aging studies. For Brazil, we included 9412 participants who participated in the baseline (2015-2016) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil). The English data were from 8024 participants of the wave 6 (2012-2013) of the English Longitudinal Study of Aging (ELSA). Disability was defined as difficulty to perform at least 1 activity of daily living. We used logistic regression models to examine the association between anthropometric indicators and disability, adjusted for sociodemographic and health-related characteristics, considering the interaction term between each anthropometric indicator and country. RESULTS All health-related characteristics were worse in Brazil than England, although the prevalence of disability was similar among Brazilian (17.85%) and English (16.27%) older adults. Fully adjusted models showed statistically significant interaction terms between country and anthropometric indicators. The strength of the associations in Brazil was weaker compared with England. All anthropometric indicators were positively associated with disability: elevated BMI, in Brazil (OR: 1.27; 95% CI: 1.06, 1.51) and in England (OR: 1.80; 95% CI: 1.51, 2.14); elevated waist circumference, in Brazil (OR: 1.21; 95% CI: 1.02, 1.44) and in England (OR: 1.90; 95% CI: 1.51, 2.37); and elevated waist-to-height ratio, in Brazil (OR: 1.20; 95% CI: 0.96, 1.52) and in England (OR: 1.83; 95% CI: 1.37, 2.44). CONCLUSIONS Elevated BMI and waist circumference increased the odds of disability in both populations. However, these associations were stronger in England than in Brazil.
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Affiliation(s)
| | - Cesar de Oliveira
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Benito-Ostolaza JM, Echavarri R, Garcia-Prado A, Oses-Eraso N. Using visual stimuli to promote healthy snack choices among children. Soc Sci Med 2021; 270:113587. [DOI: 10.1016/j.socscimed.2020.113587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/01/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022]
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Kuzuya M. Nutritional status related to poor health outcomes in older people: Which is better, obese or lean? Geriatr Gerontol Int 2020; 21:5-13. [PMID: 33200583 DOI: 10.1111/ggi.14088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/14/2020] [Accepted: 10/29/2020] [Indexed: 12/30/2022]
Abstract
Good nutritional status is crucial for maintaining growth and health in all stages of life. However, the relationship between nutritional status and health and the effect on various health-related outcomes differ, depending on the life stage. Many adverse outcomes in older adults, directly linked to different nutritional status, are not present in middle-aged adults, and their ideal nutritional status may differ. This article will review the optimal nutritional status, mainly evaluated by anthropometric measurements such as body mass index, for older adults from various perspectives. Overall, in older adults low body mass index is at higher risk of health problems such as mortality and difficulties in physical functioning compared with middle-aged adults, reducing the risk of health problems for overweight and (abdominal) obesity. Overweight may be more beneficial than lower level of normal weight in older-old and vulnerable older people. While, with or without obesity, skeletal muscle loss or weakness as well as unintentional weight loss induces health problems in older adults. The impact of metabolic syndrome on the prognosis of older adults is clearly reduced compared with middle-aged adults, requiring a shift in medical attention in older adults from metabolic syndrome to frailty. There are still many unclear points regarding the optimal nutritional status of older people, and further research is needed to support healthy longevity. Geriatr Gerontol Int 2021; 21: 5-13.
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Affiliation(s)
- Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Institutes of Innovation for Future Society, Nagoya University, Nagoya, Japan
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Kim S, Kim M, Han D. Incidence Rates of Disability and Its Associated Factors among Korean Community-Dwelling Older Adults. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1718-1726. [PMID: 33643947 PMCID: PMC7898091 DOI: 10.18502/ijph.v49i9.4091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND We aimed to identify incidence rates of disability and its associated factors among Korean community-dwelling older adults. METHODS The sample included 1,739 Koreans aged over 65 yr from the Korean Longitudinal Study of Aging (2006-2016) who reported no limitations in activities of daily living (ADL) or instrumental activities of daily living (IADL) at baseline (2006) and had complete data for other covariates. ADL, IADL, socio-demographic, lifestyle, and health-condition data were collected and analyzed using multiple logistic regression models. RESULTS The 10-yr incidence rates of ADL and IADL disability in subjects with no disability at baseline were 11.6% and 21.6%, respectively. After adjusting for socio-demographic, lifestyle, and health-condition factors, the incidence of ADL disability was higher in women (odds ratio [OR] =1.418, 95% confidence interval [CI]=1.102-2.613) and increased with age (OR=1.170, 95% CI=1.133-1.208), multi-morbidity (OR=1.194, 95% CI=1.015-1.406), and obesity (OR=1.563, 95% CI=1.057-2.311). It decreased in subjects living alone (OR=0.531, 95% CI=0.328-0.856). The incidence of IADL disability increased with age (OR=1.131, 95% CI=1.102-1.161), multi-morbidity (OR=1.199, 95% CI=1.054-1.365), and cognitive disability (OR=1.422, 95% CI=1.083-1.866) and decreased for subjects living alone (OR=0.484, 95% CI=0.328-0.715) and with overweight (OR=0.725, 95% CI=0.532-0.988). CONCLUSION Incidence rates of disability differed considerably based on socio-demographic, lifestyle, and health-condition factors. These results suggest the importance of identifying factors that can decrease the risk of disability in this group and of prevention efforts in populations with a higher disability risk.
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Affiliation(s)
- Seonho Kim
- Department of Nursing Science, College of Medicine, Chungbuk National University, Cheongju-Si, Republic of Korea
| | - Myoungsuk Kim
- College of Nursing, Kangwon National University, Chuncheon-Si, Republic of Korea
| | - Dallong Han
- Department of Nursing, College of Health & Medical Sciences, Cheongju University, Cheongju-Si, Republic of Korea
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Alexandre TDS, Scholes S, Santos JLF, de Oliveira C. Dynapenic Abdominal Obesity as a Risk Factor for Worse Trajectories of ADL Disability Among Older Adults: The ELSA Cohort Study. J Gerontol A Biol Sci Med Sci 2020; 74:1112-1118. [PMID: 30165562 PMCID: PMC6580691 DOI: 10.1093/gerona/gly182] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Indexed: 01/06/2023] Open
Abstract
Background There is little epidemiological evidence demonstrating that dynapenic abdominal obese individuals have worse trajectories of disability than those with dynapenia and abdominal obesity alone. Our aim was to investigate whether dynapenic abdominal obesity can result in worse trajectories of activities of daily living (ADL) over 8 years of follow-up. Methods We used longitudinal data from 3,723 participants free from ADL disability at baseline from the English Longitudinal Study of Ageing. Using measures of handgrip strength (<26 kg for men; <16 kg for women) and waist circumference (>102 cm for men; >88 cm for women), participants were classified into four groups: nondynapenic/nonabdominal obese (reference group), abdominal obese only, dynapenic only, and dynapenic abdominal obese. We used generalized linear mixed models with ADL as the outcome and the four groups according to dynapenia and abdominal obesity status as the main exposure controlled by sociodemographic, behavioral, and clinical characteristics. Results The estimated change over time in ADL disability was significantly higher for participants with dynapenic abdominal obesity compared with those with neither condition (+0.018, 95% CI: 0.008 to 0.027). Compared with the results of our main analysis (which took into account the combination of dynapenia and abdominal obesity on the rate of change in ADL), the results of our sensitivity analysis—which examined dynapenia and abdominal obesity only as independent conditions—showed an overestimation of the associations of dynapenia only and of abdominal obesity only on the ADL disability trajectories. Conclusions Dynapenic abdominal obesity is an important risk factor for functional decline in older adults.
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Affiliation(s)
- Tiago da Silva Alexandre
- Department of Epidemiology and Public Health, University College London, UK.,Department of Gerontology, Federal University of Sao Carlos
| | - Shaun Scholes
- Department of Epidemiology and Public Health, University College London, UK
| | | | - Cesar de Oliveira
- Department of Epidemiology and Public Health, University College London, UK
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Mulligan AA, Lentjes MAH, Luben RN, Wareham NJ, Khaw KT. Changes in waist circumference and risk of all-cause and CVD mortality: results from the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) cohort study. BMC Cardiovasc Disord 2019; 19:238. [PMID: 31660867 PMCID: PMC6819575 DOI: 10.1186/s12872-019-1223-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/10/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Measures of abdominal adiposity are strongly associated with all-cause mortality and cardiovascular disease (CVD). However, data are limited and conflicting regarding the consequences of changes in body fat distribution. The main aims of this paper are to investigate the association between changes in waist circumference (WC) and all-cause and CVD mortality and to examine these changes in relation to concurrent changes in weight. METHODS The European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) study recruited 25,639 participants between 1993 and 1997, aged 39-79, a number of whom also attended a second examination (1998-2000), and were followed up to 2016 for mortality. Participants were eligible for inclusion if they had WC, weight and height measurements at both time-points; those with a self-reported history of CVD or cancer, body mass index < 18.5 kg/m2 or missing data on covariates were excluded, leaving 12,337 participants for analyses. The median (IQR) follow-up time was 16.4 (15.7, 17.2) years. Hazard Ratios (HRs) for all-cause (2866 deaths) and CVD mortality (822 deaths), by categories of WC change, were determined using Cox proportional hazards analyses. RESULTS After multivariable adjustment, the HRs (95% CIs) for all-cause mortality for men and women with a WC gain (WCG) > 5 cm were 1.51 (1.29-1.75) and 1.25 (1.06-1.46) respectively. For CVD mortality in men and women with a WCG > 5 cm, the HRs were 1.84 (1.39-2.43) and 1.15 (0.85-1.55) respectively. In analyses of concurrent changes in WC and weight, the greatest risk (HRs) (95% CIs) in men occurred with weight loss and WCG: 1.80 (1.13-2.86) for all-cause and 2.22 (1.03-4.82) for CVD mortality. In women, the greatest risk for both all-cause (HR 1.50 (1.16-1.95)) and CVD mortality (HR 1.81 (1.15-2.85)) was observed in those with weight loss and maintenance of WC (WCM). CONCLUSIONS Objectively measured WCG > 5 cm, was associated with subsequent higher total mortality risk and higher CVD mortality risk in men. Interventions focusing on preventing increase in central adiposity rather than lowering weight per se in later life may potentially have greater health benefits.
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Affiliation(s)
- Angela A. Mulligan
- European Prospective Investigation into Cancer and Nutrition, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Worts Causeway, Cambridge, UK
- European Prospective Investigation into Cancer and Nutrition, MRC Epidemiology Unit, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Marleen A. H. Lentjes
- European Prospective Investigation into Cancer and Nutrition, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Worts Causeway, Cambridge, UK
| | - Robert N. Luben
- European Prospective Investigation into Cancer and Nutrition, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Worts Causeway, Cambridge, UK
| | - Nicholas J. Wareham
- European Prospective Investigation into Cancer and Nutrition, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Worts Causeway, Cambridge, UK
- MRC Epidemiology Unit, Cambridge, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Kay-Tee Khaw
- European Prospective Investigation into Cancer and Nutrition, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Worts Causeway, Cambridge, UK
- EPIC, Department of Gerontology, Addenbrooke’s Hospital, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Dose–response relationship between body mass index and risks of all-cause mortality and disability among the elderly: A systematic review and meta-analysis. Clin Nutr 2019; 38:1511-1523. [DOI: 10.1016/j.clnu.2018.07.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/18/2018] [Indexed: 01/01/2023]
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15
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Martinez-Amezcua P, Simonsick EM, Wanigatunga AA, Urbanek JK, Shaffer NC, Ferrucci L, Schrack JA. Association Between Adiposity and Perceived Physical Fatigability in Mid- to Late Life. Obesity (Silver Spring) 2019; 27:1177-1183. [PMID: 31127707 PMCID: PMC6591054 DOI: 10.1002/oby.22500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/19/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to compare and contrast the associations between measures of adiposity and fat distribution and perceived fatigability among well-functioning individuals in mid- to late life. METHODS In 1,054 adults (70.4 ± 12.4 years, 52% female), adiposity was measured as BMI, percent fat (dual-energy x-ray absorptiometry), waist and hip circumferences, and waist to height ratio. In a subset of 383 participants, visceral fat was measured. Perceived fatigability was evaluated after a 5-minute treadmill walk (1.5 mph) using the Borg rating of perceived exertion (range, 6-20). Associations between adiposity measures and perceived fatigability were assessed using regression models adjusting for age, sex, race, smoking, and comorbidities. RESULTS All adiposity measures, except subcutaneous fat, were positively associated with perceived fatigability after adjustment (P < 0.05 for all). Standardized coefficients indicated that BMI, hip circumference, and visceral fat had the strongest associations with fatigability. Associations between BMI and fatigability were present only among those above the threshold for overweight and strongest in those aged ≥ 65 years. Moreover, BMI was associated with fatigability only among participants with higher waist circumference. CONCLUSIONS Measures of adiposity, particularly central adiposity, are strongly associated with fatigability, suggesting that weight management may be an effective target for curbing fatigability and maintaining quality of life with aging.
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Affiliation(s)
- Pablo Martinez-Amezcua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eleanor M. Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland USA
| | - Amal A. Wanigatunga
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jacek K. Urbanek
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Geriatrics & Gerontology, Johns Hopkins School of Medicine, Baltimore Maryland, USA
| | - Nancy Chiles Shaffer
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland USA
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland USA
| | - Jennifer A. Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland USA
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Years of life with and without limitation in physical function and in activities of daily living by body mass index among older adults. Int J Obes (Lond) 2019; 43:2244-2253. [PMID: 31068661 DOI: 10.1038/s41366-019-0370-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 03/19/2019] [Accepted: 03/25/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND While older adults with pre-obesity and Class I obesity have similar or lower mortality risk versus those with normal weight, a heavier body mass index (BMI) may not translate into more healthy life years. Utilizing longitudinal data on 3452 older (≥60 years) Singaporeans, we assessed the association between BMI and years of remaining life overall with and without limitation in physical function and in activities of daily living (ADLs). METHODS Difficulty in any of nine tasks involving upper or lower extremities was considered as limitation in physical function, and health-related difficulty in any basic ADL or instrumental ADL as limitation in ADLs. We utilized multistate life tables, including BMI as a time-varying covariate. RESULTS At age 60, life expectancy (LE) was similar for those with normal weight, pre-obesity and obesity. However, those with obesity, versus normal weight, had 6.3 [95% confidence interval: 3.4-9.2] more years with limitation in physical function and 4.9 [3.4-6.5] less years without limitation in physical function. Those with pre-obesity, versus normal weight, also had 3.7 [1.9-5.3] more years with limitation in physical function. The same pattern across BMI categories was observed for years of life with and without limitation in ADLs. In stratified analyses, similar associations of BMI with years of life with and without limitation in physical function and in ADLs were observed across gender, ethnicity, and educational status. CONCLUSIONS The increasing global prevalence of obesity may result in an increase in years of life with limitation in physical function and in ADLs at older ages. Older adults, their families and healthcare systems should be cognizant of this issue.
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The relationship between body mass index and disability-free survival in elderly Japanese: the Ohsaki Cohort 2006 Study. Int J Obes (Lond) 2019; 43:2254-2263. [PMID: 30940914 DOI: 10.1038/s41366-019-0359-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND The relationship between body mass index (BMI) and disability-free survival (DFS) remains unclear. METHODS We conducted a 10-year prospective cohort study of 12,666 Japanese individuals aged ≥ 65 y. Information on BMI and lifestyle factors was collected via a questionnaire in 2006. Functional disability data were retrieved from the public Long-term Care Insurance database. Subjects were divided into seven groups according to BMI (<19, 19-21, 21-23, 23-25, 25-27, 27-29 and ≥29). Fiftieth percentile differences (PDs) and 95% confidence intervals (CIs) in the DFS period (differences of period until the first 50% of the composite outcome (disability or death) occurred in each of the BMI groups) were calculated using the Laplace regression model. RESULTS There was a U-shaped relationship between BMI and the risk of incident composite outcome, with a BMI nadir of 25-27. Based on BMI 25-27 as a reference, the 50th PDs (95% CIs) (in months) in age at disability or death (median DFS) were -20.8 (-26.4, -15.2) (P < 0.001) months for BMI <19, -13.5 (-18.2, -8.7) (P < 0.001) months for BMI 19-21, -9.8 (-14.2, -5.4) (P < 0.001) months for BMI 21-23, -2.9 (-7.5, 1.7) (P = 0.21) months for BMI 23-25, -2.7 (-8.4, 2.9) (P = 0.34) months for BMI 27-29, and -11.5 (-19.6, -3.5) (P = 0.005) months for BMI ≥ 29. These relationships did not differ by sex. CONCLUSION Older individuals with a BMI of <23 or ≥29 have a significantly shorter DFS period than those with a BMI of 25-27. It is suggested that the optimal BMI range for maximization of disability-free life expectancy in the elderly population is 23-29.
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Meadows R, Bower JK. Associations of anthropometric measures of obesity with physical limitations in older adults. Disabil Rehabil 2018; 42:1101-1106. [PMID: 30574808 DOI: 10.1080/09638288.2018.1516815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Physical limitations are associated loss of independence, lower quality of life, greater healthcare costs, and mortality. Changes in body composition during the aging process contribute to the decline in physical functioning. Body mass index is commonly used to quantify adiposity; however, measurements that better capture abdominal obesity may confer better advantage for risk of physical limitations.Methods: We used data from the 2013-2014 National Health and Nutrition Examination Survey to compare the associations of (1) body mass index, (2) sagittal abdominal diameter, and (3) waist circumference with physical limitations in adults 60-80 years (n = 1258). We used weighted logistic regression models to allow for estimates that are representative of the US population.Results: All three anthropometric measures were significantly associated with physical limitations. Abdominal fat measurements (sagittal abdominal diameter and waist circumference) were more strongly associated with physical limitations in men. However, they were not independently associated with physical limitations after controlling for body mass index. All three measurements did not differ in their ability to distinguish presence of physical limitations.Conclusions: Our data suggest that abdominal fat measurements are not independently associated with physical limitations after accounting for body mass index. Body mass index, waist circumference, and sagittal abdominal diameter are all of equal practical value for identifying older adults at risk for physical limitations.IMPLICATIONS FOR REHABILITATIONOur data suggest that both sagittal abdominal diameter and waist circumference are not independently associated with physical limitations after accounting for body mass index.Strategies to manage overall body weight may be the most effective goal of primary prevention of disability and to support the rehabilitation process.Body mass index, waist circumference, and sagittal abdominal diameter are all of equal practical value for health professionals to identify older adults at higher risk for physical limitations.Practitioners should consider the measures that are most feasible and easiest to obtain in the clinical setting.
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Affiliation(s)
- Rachel Meadows
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Julie K Bower
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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Adair LS, Duazo P, Borja JB. How Overweight and Obesity Relate to the Development of Functional Limitations among Filipino Women. Geriatrics (Basel) 2018; 3. [PMID: 30450359 PMCID: PMC6233880 DOI: 10.3390/geriatrics3040063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
As life expectancy and obesity increase in low and middle-income countries, the relationship of weight status to functional outcomes in older adults in these settings requires attention. We examined how overweight (BMI > 25 kg/m2), obesity (BMI > 30 kg/m2), and high waist circumference (WC > 80 cm) related to grip strength, timed up-and-go, and development of limitations in mobility, activities of daily living (ADL), and instrumental activities of daily living (IADL) among Filipino women. We analyzed data from seven rounds of the Cebu Longitudinal Health and Nutrition Survey (1994, n = 2279 to 2015, n = 1568, age 49–78 years) to examine how women’s reports of functional limitations related to their prior WC, and how their grip strength and timed up-and-go related to concurrently measured overweight and obesity, adjusted for age, socioeconomic status, and urbanicity. High WC was associated with higher odds of subsequent mobility and IADL limitations. Chronic disease morbidity (sum of self-reported arthritis, high blood pressure, heart disease, diabetes, and cancer) fully mediated the association of high WC with ADL and IADL limitations, but not physical/mobility limitations. Longer up-and-go times, and higher grip strength were related to overweight and obesity. Results emphasize the need for obesity prevention to reduce chronic diseases and maintain good functional status as women age.
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Affiliation(s)
- Linda S. Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Correspondence: (L.S.A.); (J.B.B.); Tel.: +1-919-962-6154 (L.S.A.); +63-32-346-0102 (J.B.B.); Fax: +1-919-966-9159 (L.S.A.)
| | - Paulita Duazo
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Nasipit, Talamban, Cebu City 6000, The Philippines;
| | - Judith B. Borja
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Nasipit, Talamban, Cebu City 6000, The Philippines;
- Department of Nutrition and Dietetics, University of San Carlos, Nasipit, Talamban, Cebu City 6000, The Philippines
- Correspondence: (L.S.A.); (J.B.B.); Tel.: +1-919-962-6154 (L.S.A.); +63-32-346-0102 (J.B.B.); Fax: +1-919-966-9159 (L.S.A.)
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20
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Moreno X, Albala C, Lera L, Leyton B, Angel B, Sánchez H. Gender, nutritional status and disability-free life expectancy among older people in Santiago, Chile. PLoS One 2018; 13:e0194074. [PMID: 29590148 PMCID: PMC5874002 DOI: 10.1371/journal.pone.0194074] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 02/23/2018] [Indexed: 12/20/2022] Open
Abstract
Background This study was aimed to estimate life expectancy (LE), disability-free life expectancy (DFLE) and disabled life expectancy (DLE) among older adults from Santiago, Chile, and to determine the existence of differences by gender and by body mass index (BMI) categories in these indicators. Methods A sample of 1216 people aged 60 or more, from the Chilean cohort of the Study of Health, Ageing and Well-Being was recruited in 2000; two follow-up assessments were carried out in a 10-year period. Functional limitation was assessed through self-report of difficulties in activities of daily living, instrumental activities of daily living and mobility. BMI was determined with measured weight and height. Multistate life tables were employed to estimate LE and healthy life expectancy (HLE). Results At 60 years, women could expect to live on average an additional 20.4 years (95% CI 19.0–21.6), and men an additional 16.4 years (95% CI 14.9–17.7). Total LE was longer among women at all ages, but they had a higher proportion of disabled years to be lived compared to men, with a difference of 14% at 60 years, and 10% at 90 years. There were no significant differences in LE, DFLE and DLE between BMI categories. Discussion Despite a longer LE, Chilean older women expect to live a higher proportion of years with disabilities, compared to men. Public health programs should address factors affecting LE of older men, and those associated with disability among older women.
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Affiliation(s)
- Ximena Moreno
- Institute of Nutrition and Food Technology, University of Chile. ElLíbano, Macul, Santiago, Chile
| | - Cecilia Albala
- Institute of Nutrition and Food Technology, University of Chile. ElLíbano, Macul, Santiago, Chile
- * E-mail:
| | - Lydia Lera
- Institute of Nutrition and Food Technology, University of Chile. ElLíbano, Macul, Santiago, Chile
| | - Bárbara Leyton
- Institute of Nutrition and Food Technology, University of Chile. ElLíbano, Macul, Santiago, Chile
| | - Bárbara Angel
- Institute of Nutrition and Food Technology, University of Chile. ElLíbano, Macul, Santiago, Chile
| | - Hugo Sánchez
- Institute of Nutrition and Food Technology, University of Chile. ElLíbano, Macul, Santiago, Chile
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Gómez-Apo E, García-Sierra A, Silva-Pereyra J, Soto-Abraham V, Mondragón-Maya A, Velasco-Vales V, Pescatello LS. A Postmortem Study of Frontal and Temporal Gyri Thickness and Cell Number in Human Obesity. Obesity (Silver Spring) 2018; 26:94-102. [PMID: 29131517 DOI: 10.1002/oby.22036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to compare cortex thickness and neuronal cell density in postmortem brain tissue from people with overweight or obesity and normal weight. METHODS The cortex thickness and neuron density of eight donors with overweight or obesity (mean = 31.6 kg/m2 ; SD = 4.35; n = 8; 6 male) and eight donors with normal weight (mean = 21.8 kg/m2 ; SD = 1.5; n = 8; 5 male) were compared. All participants were Mexican and lived in Mexico City. Randomly selected thickness measures of different cortex areas from the frontal and temporal lobes were analyzed based on high-resolution real-size photographs. A histological analysis of systematic-random fields was used to quantify the number of neurons in postmortem left and right of the first, second, and third gyri of frontal and temporal lobe brain samples. RESULTS No statistical difference was found in cortical thickness between donors with overweight or obesity and individuals with normal weight. A smaller number of neurons was found among the donors with overweight or obesity than the donors with normal weight at different frontal and temporal areas. CONCLUSIONS A lower density of neurons is associated with overweight or obesity. The morphological basis for structural brain changes in obesity requires further investigation.
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Affiliation(s)
- Erick Gómez-Apo
- Neuroscience Project, Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, Mexico City, Mexico
- General Hospital of Mexico, Mexico City, Mexico
| | - Adrián García-Sierra
- Department of Speech, Language and Hearing Sciences, University of Connecticut, Storrs, Connecticut, USA
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Juan Silva-Pereyra
- Neuroscience Project, Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Alejandra Mondragón-Maya
- Neuroscience Project, Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Linda S Pescatello
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
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Trajectories of body mass index among Canadian seniors and associated mortality risk. BMC Public Health 2017; 17:929. [PMID: 29202810 PMCID: PMC5715616 DOI: 10.1186/s12889-017-4917-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 11/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background This study aims to characterize the heterogeneity in BMI trajectories and evaluate how different BMI trajectories predict mortality risk in Canadian seniors. Methods Data came from the Canadian National Population Health Survey (NPHS, 1994–2011) and 1480 individuals aged 65–79 years with at least four BMI records were included in this study. Group-based trajectory model was used to identify distinct subgroups of longitudinal trajectories of BMI measured over 19 years for men and women. Cox proportional hazards models were used to examine the association between BMI trajectories and mortality risks. Results Distinct trajectory patterns were found for men and women: ‘Normal Weight-Down’(N-D), ‘Overweight-Normal weight’ (OV-N), ‘Obese I-Down’ (OB I-D), and ‘Obese II- Down’ (OB II-D) for women; and ‘Normal Weight-Down’ (N-D), ‘Overweight-Normal weight’ (OV-N), ‘Overweight-Stable’ (OV-S), and ‘Obese-Stable’ (OB-S) for men. Comparing with OV-N, men in the OV-S group had the lowest mortality risk followed by the N-D (HR = 1.66) and OB-S (HR = 1.98) groups, after adjusting for covariates. Compared with OV-N, women in the OB II-D group with three or more chronic health conditions had higher mortality risk (HR = 1.61); however, women in OB II-D had lower risk (HR = 0.56) if they had less than three conditions. Conclusion The course of BMI over time in Canadian seniors appears to follow one of four different patterns depending on gender. The findings suggest that men who were overweight at age 65 and lost weight over time had the lowest mortality risk. Interestingly, obese women with decreasing BMI have different mortality risks, depending on their chronic health conditions. The findings provide new insights concerning the associations between BMI and mortality risk.
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The combination of dynapenia and abdominal obesity as a risk factor for worse trajectories of IADL disability among older adults. Clin Nutr 2017; 37:2045-2053. [PMID: 29033231 PMCID: PMC6013360 DOI: 10.1016/j.clnu.2017.09.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/08/2017] [Accepted: 09/25/2017] [Indexed: 12/30/2022]
Abstract
Background/Objectives The concept of dynapenic obesity has been gaining great attention recently. However, there is little epidemiological evidence demonstrating that dynapenic abdominal obese individuals have worse trajectories of disability than those with dynapenia and abdominal obesity alone. Our aim was to investigate whether dynapenia combined with abdominal obesity can result in worse trajectories of instrumental activities of daily living (IADL) among English and Brazilian older adults over eight and ten years of follow-up, respectively. Methods We used longitudinal data from 3374 participants from the English Longitudinal Study of Ageing (ELSA) and 1040 participants from the Brazilian Health, Well-being and Aging Study (SABE) who were free from disability as assessed by IADL at baseline. IADL disability was defined herein as a difficulty to perform the following: preparing meals, managing money, using transportation, shopping, using the telephone, house cleaning, washing clothes, and taking medications according to the Lawton IADL modified scale. The study population in each country was categorized into non-dynapenic/non-abdominal obese (reference group), abdominal obese, dynapenic and dynapenic abdominal obese according to their handgrip strength (<26 kg for men and <16 kg for women) and waist circumference (>102 cm for men and >88 cm for women). We used generalized linear mixed models with IADL as the outcome. Results The estimated change over time in IADL disability was significantly higher for participants with dynapenic abdominal obesity compared to those with neither condition in both cohorts (ELSA: 0.023, 95% CI = 0.012–0.034, p < 0.001; SABE: +0.065, 95% CI = 0.038–0.091, p < 0.001). Abdominal+obesity was also associated with changes over time in IADL disability (ELSA: +0.009, 95% CI = 0.002–0.015, p < 0.05; SABE: +0.021, 95% CI = 0.002–0.041, p < 0.05), which was not observed for dynapenia. Conclusions Abdominal obesity is an important risk factor for IADL decline but participants with dynapenic abdominal obesity had the highest rates of IADL decline over time among English and Brazilian older adults.
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Thom G, Lean M. Is There an Optimal Diet for Weight Management and Metabolic Health? Gastroenterology 2017; 152:1739-1751. [PMID: 28214525 DOI: 10.1053/j.gastro.2017.01.056] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/10/2017] [Accepted: 01/17/2017] [Indexed: 12/24/2022]
Abstract
Individuals can lose body weight and improve health status on a wide range of energy (calorie)-restricted dietary interventions. In this paper, we have reviewed the effectiveness of the most commonly utilized diets, including low-fat, low-carbohydrate, and Mediterranean approaches, in addition to commercial slimming programs, meal replacements, and newly popularized intermittent fasting diets. We also consider the role of artificial sweeteners in weight management. Low-fat diets tend to improve low-density lipoprotein cholesterol the most, while lower-carbohydrate diets may preferentially improve triglycerides and high-density lipoprotein cholesterol. However, differences between diets are marginal. Weight loss improves almost all obesity-related co-morbidities and metabolic markers, regardless of the macronutrient composition of the diet, but individuals do vary in preferences and ability to adhere to different diets. Optimizing adherence is the most important factor for weight loss success, and this is enhanced by regular professional contact and supportive behavioral change programs. Maintaining weight losses in the long term remains the biggest challenge, and is undermined by an "obesogenic" environment and biological adaptations that accompany weight loss.
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Affiliation(s)
- George Thom
- University of Glasgow, Human Nutrition, School of Medicine, Dentistry & Nursing, Glasgow, Scotland, United Kingdom
| | - Mike Lean
- University of Glasgow, Human Nutrition, School of Medicine, Dentistry & Nursing, Glasgow, Scotland, United Kingdom.
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Body mass index as a predictor of healthy and disease-free life expectancy between ages 50 and 75: a multicohort study. Int J Obes (Lond) 2017; 41:769-775. [PMID: 28138135 PMCID: PMC5418561 DOI: 10.1038/ijo.2017.29] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 01/02/2017] [Accepted: 01/20/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND While many studies have shown associations between obesity and increased risk of morbidity and mortality, little comparable information is available on how body mass index (BMI) impacts health expectancy. We examined associations of BMI with healthy and chronic disease-free life expectancy in four European cohort studies. METHODS Data were drawn from repeated waves of cohort studies in England, Finland, France and Sweden. BMI was categorized into four groups from normal weight (18.5-24.9 kg m-2) to obesity class II (⩾35 kg m-2). Health expectancy was estimated with two health indicators: sub-optimal self-rated health and having a chronic disease (cardiovascular disease, cancer, respiratory disease and diabetes). Multistate life table models were used to estimate sex-specific healthy life expectancy and chronic disease-free life expectancy from ages 50 to 75 years for each BMI category. RESULTS The proportion of life spent in good perceived health between ages 50 and 75 progressively decreased with increasing BMI from 81% in normal weight men and women to 53% in men and women with class II obesity which corresponds to an average 7-year difference in absolute terms. The proportion of life between ages 50 and 75 years without chronic diseases decreased from 62 and 65% in normal weight men and women and to 29 and 36% in men and women with class II obesity, respectively. This corresponds to an average 9 more years without chronic diseases in normal weight men and 7 more years in normal weight women between ages 50 and 75 years compared to class II obese men and women. No consistent differences were observed between cohorts. CONCLUSIONS Excess BMI is associated with substantially shorter healthy and chronic disease-free life expectancy, suggesting that tackling obesity would increase years lived in good health in populations.
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Danon-Hersch N, Fustinoni S, Bovet P, Spagnoli J, Santos-Eggimann B. Association between Adiposity and disability in the Lc65+ Cohort. J Nutr Health Aging 2017; 21:799-810. [PMID: 28717810 DOI: 10.1007/s12603-016-0813-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To examine the longitudinal association between body mass index (BMI) and waist circumference (WC) with mortality and incident disability in Lc65+ cohort. DESIGN Population-based cohort of non-institutionalized adults with up to 8.9 years of follow-up. SETTING City of Lausanne, Switzerland. PARTICIPANTS 1,293 individuals aged 65 to 70 at baseline (58% women). MEASUREMENTS BMI, WC and covariates were measured at baseline in 2004-2005. Vital status was obtained up to the 31st December 2013 and difficulty with basic activities of daily living (BADL) was reported in a self-administered questionnaire sent to participants every year. Main outcomes were total mortality and disability, defined as difficulty with BADL for ≥2 years or institutionalization. Cox regression was used with BMI/WC quintiles 2 as the reference. RESULTS 130 persons died over a median follow-up of 8.47 years (crude mortality rate, men: 16.5/1,000 person-years, women: 9.7/1,000 person-years). In Cox regression adjusted for age, sex, education, financial situation, smoking and involuntary weight loss (IWL) at baseline, mortality was significantly associated with neither BMI nor WC, but there were trends towards non-significant J-curves across both BMI and WC quintiles. Disability (231 cases) tended to increase monotonically across both BMI and WC quintiles and was significantly associated with BMI quintile 5 (HR=2.44, 95% CI [1.65-3.63]), and WC quintiles 4 (HR=1.81 [1.15-2.85]) and 5 (HR=2.58, [1.67-4.00]). CONCLUSION Almost half of the study population had a substantially increased HR of disability, as compared to the reference BMI/WC categories. This observation emphasizes the need for life-long strategies aimed at preventing excess weight, muscle loss and functional decline through adequate nutrition and regular physical activity, starting at early age and extending throughout life.
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Affiliation(s)
- N Danon-Hersch
- Nadia Danon-Hersch, Institute of Social and Preventive Medicine (IUMSP), University and University Hospital Center, Biopole 2, Route de la Corniche 10, 1010 Lausanne, Switzerland, Tel : +41 21 314 91 09; Fax: +41 21 314 97 67; ;
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Boden LI, O'Leary PK, Applebaum KM, Tripodis Y. The impact of non-fatal workplace injuries and illnesses on mortality. Am J Ind Med 2016; 59:1061-1069. [PMID: 27427538 DOI: 10.1002/ajim.22632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Little research has examined the relationship between non-fatal workplace injuries and illnesses, and long-term mortality. METHODS We linked non-fatal injury cases reported to the New Mexico workers' compensation system for 1994-2000 with Social Security Administration data on individual earnings and mortality through 2014. We then derived sex-specific Kaplan-Meier curves to show time to death for workers with lost-time injuries (n = 36,377) and comparison workers (n = 70,951). We fit multivariable Cox survival models to estimate the hazard ratio separately for male and female workers with lost-time injuries. RESULTS The estimated hazard ratio for lost-time injuries is 1.24 for women and 1.21 for men. Ninety-five percent confidence intervals were 1.15, 1.35 and 1.15, 1.27, respectively. CONCLUSION Lost-time occupational injuries are associated with a substantially elevated mortality hazard. This implies an important formerly unmeasured cost of these injuries and a further reason to focus on preventing them. Am. J. Ind. Med. 59:1061-1069, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Leslie I. Boden
- Department of Environmental Health; Boston University School of Public Health; Boston Massachusetts
| | - Paul K. O'Leary
- U.S. Social Security Administration; Office of Retirement and Disability Policy; Washington District of Columbia
| | - Katie M. Applebaum
- Department of Environmental and Occupational Health; Milken Institute School of Public Health; George Washington University; Washington District of Columbia
| | - Yorghos Tripodis
- Department of Biostatistics; Boston University School of Public Health; Boston Massachusetts
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Disability, Physical Inactivity, and Impaired Health-Related Quality of Life Are Not Different in Metabolically Healthy vs. Unhealthy Obese Subjects. Nutrients 2016; 8:nu8120759. [PMID: 27897994 PMCID: PMC5188414 DOI: 10.3390/nu8120759] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/06/2016] [Accepted: 11/16/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Obesity represents a major health hazard, affecting morbidity, psychological status, physical functionality, quality of life, and mortality. The aim of the present study was to explore the differences between metabolically healthy (MHO) and metabolically unhealthy (MUO) obese subjects with regard to physical activity, disability, and health-related quality of life (HR-QoL). METHODS All subjects underwent a multidimensional evaluation, encompassing the assessment of body composition, metabolic biomarkers and inflammation, physical activity level (IPAQ questionnaire), disability (TSD-OC test), and HR-QoL (SF-36 questionnaire). MHO and MUO were defined based on the absence or the presence of the metabolic syndrome, respectively. RESULTS 253 subjects were included (54 men and 199 women; age: 51.7 ± 12.8 vs. 50.3 ± 11.7 years, p = 0.46; BMI: 38.1 ± 5.7 vs. 38.9 ± 6.7 kg/m², p = 0.37). No significant difference was observed in body composition. There was no difference between MHO and MUO considering inflammation (hs-CRP: 6517.1 ± 11,409.9 vs. 5294.1 ± 5612.2 g/L; p = 0.37), physical inactivity (IPAQ score below 3000 METs-min/week in 77.6% of MHO vs. 80% of MUO subjects; p = 0.36), obesity-related disability (TSD-OC score > 33%, indicating a high level of obesity-related disability, in 20.2% of MHO vs. 26.5% of MUO subjects; p = 0.28), and the HR-QoL (SF-36 total score: 60 ± 20.8 vs. 62.8 ± 18.2, p = 0.27). DISCUSSION AND CONCLUSION The metabolic comorbidity and the impairment of functional ability and psycho-social functioning may have a different timing in the natural history of obesity. Alterations in the physical activity level and mobility disabilities may precede the onset of metabolic abnormalities. (Trial registration 2369 prot 166/12-registered 23 February 2012; Amendment 223/14-registered 13 February 2014).
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The Association Between Adolescent Obesity and Disability Incidence in Young Adulthood. J Adolesc Health 2016; 59:472-8. [PMID: 27469191 DOI: 10.1016/j.jadohealth.2016.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 04/18/2016] [Accepted: 05/26/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the longitudinal relationship between obesity during adolescence and development of disability during young adulthood. METHODS A cohort of 8,032 individuals aged 11-21 years enrolled in 1994-1995 (Wave I) of the National Longitudinal Study of Adolescent to Adult Health, followed up in 1996 (Wave II) and in 2001-2002 (Wave III). Individuals were divided into four categories based on weight and height of Wave II and Wave III: (1) developing obesity; (2) persistent obesity; (3) no obesity; and (4) obesity reversal. Disability was measured in Wave III using a measure of functional limitations and the Short Form 36 physical functioning scale. Logistic regression was used to predict the probability of disability as a function of weight category. RESULTS Compared with their nonobese peers, adolescents developing obesity (adjusted odds ratio: 1.83 [95% confidence interval: 1.51-2.22]) and with persistent obesity (adjusted odds ratio: 2.09 [95% confidence interval: 1.64-2.67]) had a higher odds of having a functional limitation in Wave III. CONCLUSIONS Developing obesity and persistent obesity during adolescence were significantly associated with increased disability in young adulthood.
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Abstract
OBJECTIVES The present study evaluated the association between energy intake, energy required and mortality in older adults. DESIGN A cohort study with a mean of 10·67 (sd 4·74) years of follow-up. Participants completed a 24 h dietary recall. Energy required per day was computed by BMR. Deaths through 2006 were identified from the National Death Index. A Cox regression was used to estimate the hazard ratios (HR) of quantiles of energy intake and energy required on all-cause and CVD mortality, adjusting for demographics, socio-economic status and co-morbidity. SETTING The National Health and Nutrition Examination Survey (NHANES) III, 1988-1994. SUBJECTS A total of 4846 participants aged 60 years or above were analysed. RESULTS Within the follow-up period, there were a total of 2954 deaths (61·0 %), 51·9 % were caused by CVD. Relative to those in quartile 1 of energy intake, only quartile 4 was associated with all-cause mortality and CVD mortality with HR of 0·86 (95 % CI 0·77, 0·96, P=0·006) and 0·76 (95 % CI 0·65, 0·89, P=0·001), respectively. On the other hand, relative to those in quartile 1 of energy required, all quartiles of participants had a lower risk of all-cause mortality and CVD mortality. The interaction effects between energy intake and energy required with all-cause and CVD mortality were insignificant (P=0·70 and 0·61, respectively). CONCLUSIONS Independent of energy required, higher energy intake was associated with lower HR of both all-cause and CVD mortality in older adults.
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Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S, Romundstad P, Vatten LJ. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ 2016; 353:i2156. [PMID: 27146380 PMCID: PMC4856854 DOI: 10.1136/bmj.i2156] [Citation(s) in RCA: 484] [Impact Index Per Article: 60.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of cohort studies of body mass index (BMI) and the risk of all cause mortality, and to clarify the shape and the nadir of the dose-response curve, and the influence on the results of confounding from smoking, weight loss associated with disease, and preclinical disease. DATA SOURCES PubMed and Embase databases searched up to 23 September 2015. STUDY SELECTION Cohort studies that reported adjusted risk estimates for at least three categories of BMI in relation to all cause mortality. DATA SYNTHESIS Summary relative risks were calculated with random effects models. Non-linear associations were explored with fractional polynomial models. RESULTS 230 cohort studies (207 publications) were included. The analysis of never smokers included 53 cohort studies (44 risk estimates) with >738 144 deaths and >9 976 077 participants. The analysis of all participants included 228 cohort studies (198 risk estimates) with >3 744 722 deaths among 30 233 329 participants. The summary relative risk for a 5 unit increment in BMI was 1.18 (95% confidence interval 1.15 to 1.21; I(2)=95%, n=44) among never smokers, 1.21 (1.18 to 1.25; I(2)=93%, n=25) among healthy never smokers, 1.27 (1.21 to 1.33; I(2)=89%, n=11) among healthy never smokers with exclusion of early follow-up, and 1.05 (1.04 to 1.07; I(2)=97%, n=198) among all participants. There was a J shaped dose-response relation in never smokers (Pnon-linearity <0.001), and the lowest risk was observed at BMI 23-24 in never smokers, 22-23 in healthy never smokers, and 20-22 in studies of never smokers with ≥20 years' follow-up. In contrast there was a U shaped association between BMI and mortality in analyses with a greater potential for bias including all participants, current, former, or ever smokers, and in studies with a short duration of follow-up (<5 years or <10 years), or with moderate study quality scores. CONCLUSION Overweight and obesity is associated with increased risk of all cause mortality and the nadir of the curve was observed at BMI 23-24 among never smokers, 22-23 among healthy never smokers, and 20-22 with longer durations of follow-up. The increased risk of mortality observed in underweight people could at least partly be caused by residual confounding from prediagnostic disease. Lack of exclusion of ever smokers, people with prevalent and preclinical disease, and early follow-up could bias the results towards a more U shaped association.
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Affiliation(s)
- Dagfinn Aune
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway Department of Epidemiology and Biostatistics, Imperial College, London, UK
| | - Abhijit Sen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Manya Prasad
- Department of Community Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, Imperial College, London, UK
| | - Imre Janszky
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Serena Tonstad
- Department of Community Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Pål Romundstad
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars J Vatten
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Jerome GJ, Ko SU, Chiles Shaffer NS, Studenski SA, Ferrucci L, Simonsick EM. Cross-Sectional and Longitudinal Associations Between Adiposity and Walking Endurance in Adults Age 60-79. J Gerontol A Biol Sci Med Sci 2016; 71:1661-1666. [PMID: 26984392 DOI: 10.1093/gerona/glw054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/01/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The impact of excess weight on current and future walking endurance in nondisabled persons is unclear. This study examines the association between obesity and walking endurance among nondisabled persons both in late mid-life and early old age. METHODS Participants in the Baltimore Longitudinal Study of Aging aged 60-79 years (n = 406) who reported no walking limitations, and completed a 400-meter walk "as quickly as possible" without lower-extremity pain, and had a follow-up assessment within 1.7-4.2 years. Adiposity was assessed by weight, body mass index (BMI), BMI category, and percent fat mass by DXA. RESULTS Adjusting for age, sex, race, height, and physical activity, all adiposity measures were cross-sectionally associated with slower 400 meter time in both 60-69 and 70 to 79-year-olds (weight: β = 1.0 and 1.2; BMI: β = 2.8 and 3.6; and percent fat mass: β = 2.0 and 2.0, respectively, all p < .001). With additional adjustment for initial 400-meter performance and follow-up time, in 60- to 69-year-olds, change in 400-meter time (positive β indicates decline) was associated with all adiposity measures (weight: β = 0.4; BMI: β = 1.0; and percent fat mass: β = 0.5; all p ≤ .05) but not in the older group (weight: β = -0.4; BMI: β = -1.2; and percent fat mass: β = -0.2; all p ≥ .17). CONCLUSION Excess weight and adiposity were associated with worse walking endurance in nondisabled persons aged 60-79 years and predicted accelerated decline in endurance in late mid-life adults. Weight management for mobility independence may be best targeted in obese persons approaching traditional retirement age.
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Affiliation(s)
- Gerald J Jerome
- Department of Kinesiology, Towson University, Towson, Maryland.
| | - Seung-Uk Ko
- Department of Mechanical Engineering, Chonnam National University, Gwangju, South Korea
| | | | | | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
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O'Doherty MG, Cairns K, O'Neill V, Lamrock F, Jørgensen T, Brenner H, Schöttker B, Wilsgaard T, Siganos G, Kuulasmaa K, Boffetta P, Trichopoulou A, Kee F. Effect of major lifestyle risk factors, independent and jointly, on life expectancy with and without cardiovascular disease: results from the Consortium on Health and Ageing Network of Cohorts in Europe and the United States (CHANCES). Eur J Epidemiol 2016; 31:455-68. [PMID: 26781655 PMCID: PMC4901087 DOI: 10.1007/s10654-015-0112-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 12/13/2015] [Indexed: 12/26/2022]
Abstract
Seldom have studies taken account of changes in lifestyle habits in the elderly, or investigated their impact on disease-free life expectancy (LE) and LE with cardiovascular disease (CVD). Using data on subjects aged 50+ years from three European cohorts (RCPH, ESTHER and Tromsø), we used multi-state Markov models to calculate the independent and joint effects of smoking, physical activity, obesity and alcohol consumption on LE with and without CVD. Men and women aged 50 years who have a favourable lifestyle (overweight but not obese, light/moderate drinker, non-smoker and participates in vigorous physical activity) lived between 7.4 (in Tromsø men) and 15.7 (in ESTHER women) years longer than those with an unfavourable lifestyle (overweight but not obese, light/moderate drinker, smoker and does not participate in physical activity). The greater part of the extra life years was in terms of “disease-free” years, though a healthy lifestyle was also associated with extra years lived after a CVD event. There are sizeable benefits to LE without CVD and also for survival after CVD onset when people favour a lifestyle characterized by salutary behaviours. Remaining a non-smoker yielded the greatest extra years in overall LE, when compared to the effects of routinely taking physical activity, being overweight but not obese, and drinking in moderation. The majority of the overall LE benefit is in disease free years. Therefore, it is important for policy makers and the public to know that prevention through maintaining a favourable lifestyle is “never too late”.
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Affiliation(s)
- Mark G O'Doherty
- UKCRC Centre of Excellence for Public Health for Northern Ireland, Queens University Belfast, Belfast, BT12 6BA, Northern Ireland, UK.
| | - Karen Cairns
- Centre for Statistical Science and Operational Research (CenSSOR), Queen's University Belfast, Belfast, BT7 1NN, Northern Ireland, UK
| | - Vikki O'Neill
- UKCRC Centre of Excellence for Public Health for Northern Ireland, Queens University Belfast, Belfast, BT12 6BA, Northern Ireland, UK
| | - Felicity Lamrock
- UKCRC Centre of Excellence for Public Health for Northern Ireland, Queens University Belfast, Belfast, BT12 6BA, Northern Ireland, UK.,Centre for Statistical Science and Operational Research (CenSSOR), Queen's University Belfast, Belfast, BT7 1NN, Northern Ireland, UK
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark.,Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Faculty of Medicine, University of Aalborg, Aalborg, Denmark
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Tom Wilsgaard
- Department of Community Medicine, University of Tromsø, 9037, Tromsø, Norway
| | - Galatios Siganos
- Department of Community Medicine, University of Tromsø, 9037, Tromsø, Norway
| | - Kari Kuulasmaa
- Department of Health, National Institute for Health and Welfare (THL), 00271, Helsinki, Finland
| | - Paolo Boffetta
- The Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, NY, 10029, USA.,Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos str., 115 27, Athens, Greece
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos str., 115 27, Athens, Greece.,Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Mikras Asias 75 st, 115 27, Athens, Greece
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health for Northern Ireland, Queens University Belfast, Belfast, BT12 6BA, Northern Ireland, UK
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Pongiglione B, De Stavola BL, Ploubidis GB. A Systematic Literature Review of Studies Analyzing Inequalities in Health Expectancy among the Older Population. PLoS One 2015; 10:e0130747. [PMID: 26115099 PMCID: PMC4482630 DOI: 10.1371/journal.pone.0130747] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/23/2015] [Indexed: 11/21/2022] Open
Abstract
Aim To collect, organize and appraise evidence of socioeconomic and demographic inequalities in health and mortality among the older population using a summary measure of population health: Health Expectancy. Methods A systematic literature review was conducted. Literature published in English before November 2014 was searched via two possible sources: three electronic databases (Web of Science, Medline and Embase), and references in selected articles. The search was developed combining terms referring to outcome, exposure and participants, consisting in health expectancy, socioeconomic and demographic groups, and older population, respectively. Results Of 256 references identified, 90 met the inclusion criteria. Six references were added after searching reference lists of included articles. Thirty-three studies were focused only on gender-based inequalities; the remaining sixty-three considered gender along with other exposures. Findings were organized according to two leading perspectives: the type of inequalities considered and the health indicators chosen to measure health expectancy. Evidence of gender-based differentials and a socioeconomic gradient were found in all studies. A remarkable heterogeneity in the choice of health indicators used to compute health expectancy emerged as well as a non-uniform way of defining same health conditions. Conclusions Health expectancy is a useful and convenient measure to monitor and assess the quality of ageing and compare different groups and populations. This review showed a general agreement of results obtained in different studies with regard to the existence of inequalities associated with several factors, such as gender, education, behaviors, and race. However, the lack of a standardized definition of health expectancy limits its comparability across studies. The need of conceiving health expectancy as a comparable and repeatable measure was highlighted as fundamental to make it an informative instrument for policy makers.
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Affiliation(s)
- Benedetta Pongiglione
- Medical Statistics Department, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Bianca L De Stavola
- Medical Statistics Department, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - George B Ploubidis
- Centre for Longitudinal Studies, Institute of Education, London, United Kingdom
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Hoffmann R, Eikemo TA, Kulhánová I, Kulik MC, Looman C, Menvielle G, Deboosere P, Martikainen P, Regidor E, Mackenbach JP. Obesity and the potential reduction of social inequalities in mortality: evidence from 21 European populations. Eur J Public Health 2015; 25:849-56. [PMID: 26009611 DOI: 10.1093/eurpub/ckv090] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Obesity contributes considerably to the problem of health inequalities in many countries, but quantitative estimates of this contribution and to what extent it is modifiable are scarce. We identify the potential for reducing educational inequalities in all-cause and obesity-related mortality in 21 European populations, by modifying educational differences in obesity and overweight. METHODS Prevalence data and mortality data come from 21 European populations. Mortality rate ratios come from literature reviews. We use the population attributable fraction (PAF) to estimate the impact of scenario-based changes in the social distribution of obesity on educational inequalities in mortality. RESULTS An elimination of differences in obesity between educational groups would decrease relative inequality in all-cause mortality between those with high and low education by up to 12% for men and 42% for women. About half of the relative inequality in mortality could be reduced for some causes of death in several countries, often in southern Europe. Absolute inequalities in all-cause mortality would be reduced by up to 69 (men) and 67 (women) deaths per 100,000 person-years. CONCLUSION The potential reduction of health inequality by an elimination of social inequalities in obesity might be substantial. The reductions differ by country, cause of death and gender, suggesting that the priority given to obesity as an entry-point for tackling health inequalities should differ between countries and gender.
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Affiliation(s)
- Rasmus Hoffmann
- 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Terje A Eikemo
- 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ivana Kulhánová
- 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Margarete C Kulik
- 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Caspar Looman
- 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gwenn Menvielle
- 2 Department of Social Epidemiology, INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France 3 Department of Social Epidemiology, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Patrick Deboosere
- 4 Department of Social Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Pekka Martikainen
- 5 Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Enrique Regidor
- 6 Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
| | - Johan P Mackenbach
- 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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High cardiometabolic risk in healthy Chilean adolescents: associations with anthropometric, biological and lifestyle factors. Public Health Nutr 2015; 19:486-93. [PMID: 25990645 PMCID: PMC4654715 DOI: 10.1017/s1368980015001585] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To analyse the prevalence of cardiovascular risk factors in healthy adolescents of low to middle socio-economic status and to study the influence of anthropometric, biological and lifestyle factors on the risk of metabolic syndrome (MetS). DESIGN Cross-sectional study. BMI, waist circumference, blood pressure, fat and lean mass (by dual-energy X-ray absorptiometry), TAG, HDL-cholesterol, glucose, insulin, homeostatic model assessment-insulin resistance index (HOMA-IR), food intake and physical activity were measured. Cardiovascular risk factors were defined using the International Diabetes Federation criteria and insulin resistance using HOMA-IR ≥2.6. Bivariate and multivariate regressions examined the associations between MetS and anthropometric, biological and lifestyle factors. SETTING Observational cohort study including Chilean adolescents, who were part of a follow-up study beginning in infancy. SUBJECTS Adolescents aged 16-17 years (n 667). RESULTS In the sample, 16.2% had obesity and 9.5% had MetS. Low HDL-cholesterol (69.9%), abdominal obesity (33.3%) and fasting hyperglycaemia (8.7%) were the most prevalent cardiovascular risk factors. In males, obesity (OR=3.7; 95% CI 1.2, 10.8), insulin resistance (OR=3.0; 95% CI 1.1, 8.2), physical inactivity (OR=2.9; 95% CI 1.1, 7.7) and sarcopenia (OR=21.2; 95% CI 4.2, 107.5) significantly increased the risk of MetS. In females, insulin resistance (OR=4.9; 95% CI 1.9, 12.6) and sarcopenia (OR=3.6; 95% CI 1.1, 11.9) were significantly associated with MetS. CONCLUSIONS High prevalences of obesity, abdominal obesity, dyslipidaemia, fasting hyperglycaemia and MetS were found in healthy adolescents. In both sexes, sarcopenia and insulin resistance were important risk factors of MetS. Promotion of active lifestyles at the school level and regulation of the sale of energy-dense foods are needed.
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Artaud F, Singh-Manoux A, Dugravot A, Tavernier B, Tzourio C, Elbaz A. Body mass index trajectories and functional decline in older adults: Three-City Dijon cohort study. Eur J Epidemiol 2015; 31:73-83. [DOI: 10.1007/s10654-015-0027-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 03/27/2015] [Indexed: 10/23/2022]
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Peterson MD, Mahmoudi E. Healthcare utilization associated with obesity and physical disabilities. Am J Prev Med 2015; 48:426-35. [PMID: 25716534 PMCID: PMC4380627 DOI: 10.1016/j.amepre.2014.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/07/2014] [Accepted: 11/12/2014] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Obesity incurs a substantial economic burden to healthcare systems. Little is known about the combined medical costs attributable to obesity among individuals with physical disabilities (PDs). PURPOSE To estimate the annual healthcare utilization and expenditure associated with overweight and obesity among adults with and without PDs. METHODS Weighted multivariate generalized linear models were used to estimate healthcare costs and utilization among adults with and without PDs, across standard BMI categories, using the 2002-2011 Medical Expenditure Panel Survey. The analyses, performed in 2013-2014, included a population representative sample of 215,107 individuals, aged ≥18 years. Overall, 36,349 adults reported moderate or significant PDs. The primary outcomes were total healthcare costs, physician office visits, and hospitalization. RESULTS After adjusting for sociodemographic variables, self-rated mental and physical health, physical activity, and year, adults with PDs incurred more than 1.96 times the adjusted total healthcare costs ($4,298, 95% CI=$3,980, $4,617) than adults without PDs. Obese individuals spent significantly more than those at normal weight ($726, p<0.001). Obese individuals with PDs spent 1.13 times more than normal-weight individuals with PDs ($1,107, p<0.001) and >2.2 times more than normal-weight individuals without PDs ($5,197, p<0.001). PDs plus obesity represents $23.9 billion/year, or roughly 50% of the total costs attributable to obesity in the U.S. CONCLUSIONS Across BMI categories, there was significantly greater healthcare utilization and cost among adults with PDs, independent of age, race, education, and SES. Health policies need to identify behavioral interventions that address both healthy weight achievement/maintenance and functional independence among all adults.
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Affiliation(s)
- Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Elham Mahmoudi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Rappange DR, Brouwer WBF, van Exel J. Rational expectations? An explorative study of subjective survival probabilities and lifestyle across Europe. Health Expect 2015; 19:121-37. [PMID: 25597490 DOI: 10.1111/hex.12335] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Subjective survival probabilities (SSPs) are considered relevant in relation to lifestyle as lifestyle improvements may improve health and lower mortality risk. OBJECTIVE To study individuals' SSP in a population of elderly (i.e. 60 years and older) from 15 European countries. METHODS Data from the second wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used. Individuals were asked about their chances to live up to age [T] or more. These SSPs were related to general characteristics, health and lifestyle. In addition, cross-country comparisons were made. The validity of the probabilistic elicitation format used for collecting SSPs was also addressed. RESULTS The average subjective probability of surviving the next 9-15 years was around 57%. Mean SSPs varied significantly across age, with lower means at higher ages. Cross-country comparisons showed lowest mean in the Czech Republic (42%) and the highest in Denmark (64%). SSPs correlated with socio-demographic, socio-economic and also strongly with (objective) health characteristics except for obesity. Smokers reported significantly lower SSPs compared to non-smokers, but no difference was found between non-smokers and quitters. Excessive alcohol consumers reported significantly higher SSPs than moderate consumers and abstainers, but this only held for female excessive drinkers. Physical inactivity was negatively associated with SSPs, but this relation was attenuated at higher ages. In this context, important cross-country differences were found. CONCLUSIONS Subjective survival probabilities are informative and relevant in relation to lifestyle decisions and can be validly obtained in elder people. The results from this study provide interesting implications for health policy, health communication strategies and future research.
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Affiliation(s)
- David R Rappange
- Department of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Werner B F Brouwer
- Department of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Job van Exel
- Department of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Kumar A, Karmarkar AM, Tan A, Graham JE, Arcari CM, Ottenbacher KJ, Snih SA. The effect of obesity on incidence of disability and mortality in Mexicans aged 50 years and older. SALUD PUBLICA DE MEXICO 2015; 57 Suppl 1:S31-8. [PMID: 26172232 PMCID: PMC4503366 DOI: 10.21149/spm.v57s1.7587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 10/14/2014] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To examine the effect of obesity on incidence of disability and mortality among non-disabled older Mexicans at baseline. MATERIALS AND METHODS The sample included 8 415 Mexicans aged ≥ 50 years from the Mexican Health and Aging Study (2001 -2012), who reported no limitations in activities of daily living (ADLs) at baseline and have complete data on all covariates. Sociodemographics, smoking status, comorbidities, ADL activities, and body mass index (BMI) were collected. RESULTS The lowest hazard ratio (HR) for disability was at BMI of 25 to < 30 (HR = 0.97;95% confidence interval [CI], 0.85-1.12).The lowest HR for mortality were seen among participants with BMIs 25 to < 30 (HR = 0.85; 95%CI, 075-0.97), 30 to < 35 (HR = 0.86; 95 %CI, 0.72-1.02), and > 35 (HR = 0.92; 95 %CI, 0.70-1.22). CONCLUSION Mexican older adults with a BMI of 25 to < 30 were at less risk for both disability and mortality.
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Affiliation(s)
- Amit Kumar
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX 77555
| | - Amol M. Karmarkar
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX 77555
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555
| | - Alai Tan
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555
| | - James E. Graham
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX 77555
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555
| | - Christine M. Arcari
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555
| | - Kenneth J. Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX 77555
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555
| | - Soham Al Snih
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX 77555
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555
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Yang M, Jiang J, Li H, Wu H, Dong B. Association between waist circumference and self-reported disability among Chinese adults aged 90 years and older. Geriatr Gerontol Int 2014; 15:1249-57. [PMID: 25496442 DOI: 10.1111/ggi.12424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 02/05/2023]
Abstract
AIM To investigate the relationship between waist circumference (WC) and activities of daily living (ADL)/instrumental activities of daily living (IADL) disability among nonagenarians and centenarians. METHODS We analyzed data obtained from a cross-sectional study carried out in 870 older Chinese adults aged 90 years and older in Dujiangyan, a town in West China. The participants were divided into four groups according to their sex and WC quartile. The ADL and IADL disabilities were measured using the physical self-maintenance scale and Lawton and Brody's IADL scale, respectively. RESULTS We included 233 men and 505 women in this statistical analysis. The prevalence of ADL or IADL disability was 53.6% in men and 71.3% in women. Participants in the highest WC quartile group (WC ≥83.0 cm for men or WC ≥82.0 cm for women) had higher prevalence of ADL or IADL disability compared with those in the lowest WC quartile group (WC <73.0 cm for men or WC <70.5 cm for women). Adjusting for relevant confounders, the highest quartile group showed significantly increased odds ratios for either ADL (1.7 for men and 2.1 for women) or IADL disability (odds ratios 3.3 for men and 2.0 for women) compared with the lowest quartile group. CONCLUSION Among Chinese older adults aged 90 years and older, both men and women in the highest quartile of WC were at higher risk of ADL or IADL disability compared with those in the lowest quartile of WC. Geriatr Gerontol Int 2015; 15: 1249-1257.
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Affiliation(s)
- Ming Yang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaojiao Jiang
- Department of Rehabilitation, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Li
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Hongmei Wu
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Birong Dong
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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Lisko I, Stenholm S, Raitanen J, Hurme M, Hervonen A, Jylhä M, Tiainen K. Association of Body Mass Index and Waist Circumference With Physical Functioning: The Vitality 90+ Study. J Gerontol A Biol Sci Med Sci 2014; 70:885-91. [PMID: 25394617 DOI: 10.1093/gerona/glu202] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 09/30/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Both obesity and underweight are associated with impaired physical functioning, but related information on the oldest old population is scarce. Our purpose was to examine whether body mass index, waist circumference (WC), and their combination are associated with physical performance and activities of daily living (ADL) disability in 90-year-old women and men. METHODS Data are from the Vitality 90+ Study, which is a population-based study of persons with age ≥90 years living in the area of Tampere, Finland. Altogether 416 women and 153 men, aged 90-91 years, provided data on body mass index, WC, chair stand, and Barthel Index. Comorbidity, physical exercise, smoking history, living residence, and sample year were used as covariates in multinomial logistic and logistic regression models. RESULTS Women in the highest WC tertile had lower physical performance and were more likely unable to perform the chair stand than women in the lowest WC tertile. Women in the highest WC tertile were also more likely to have ADL disability, compared to the lowest WC tertile. In women, overweight and obesity were associated with ADL disability, but not when WC was included in the model. Men with body mass index ≥25 kg/m(2) and WC < sex-specific median were less likely to have ADL disability. Similarly classified women were less likely to have low performance or unable to perform chair stand (marginally significant). CONCLUSIONS High WC in the oldest old women, but not in men, is associated with both poor physical performance and ADL disability.
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Affiliation(s)
- Inna Lisko
- School of Health Sciences, University of Tampere, Finland. Gerontology Research Center, University of Tampere and University of Jyväskylä, Finland. Department of Health Sciences, University of Jyväskylä, Finland.
| | - Sari Stenholm
- School of Health Sciences, University of Tampere, Finland. Gerontology Research Center, University of Tampere and University of Jyväskylä, Finland. Department of Public Health, University of Turku, Finland
| | - Jani Raitanen
- School of Health Sciences, University of Tampere, Finland. Gerontology Research Center, University of Tampere and University of Jyväskylä, Finland. The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Mikko Hurme
- Gerontology Research Center, University of Tampere and University of Jyväskylä, Finland. Department of Microbiology and Immunology, School of Medicine, University of Tampere, Finland. Center of Laboratory Medicine, Tampere University Hospital, Tampere, Finland
| | - Antti Hervonen
- School of Health Sciences, University of Tampere, Finland. Gerontology Research Center, University of Tampere and University of Jyväskylä, Finland
| | - Marja Jylhä
- School of Health Sciences, University of Tampere, Finland. Gerontology Research Center, University of Tampere and University of Jyväskylä, Finland
| | - Kristina Tiainen
- School of Health Sciences, University of Tampere, Finland. Gerontology Research Center, University of Tampere and University of Jyväskylä, Finland
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Hu Y, Bhupathiraju SN, de Koning L, Hu FB. Duration of obesity and overweight and risk of type 2 diabetes among US women. Obesity (Silver Spring) 2014; 22:2267-73. [PMID: 25131512 PMCID: PMC4180760 DOI: 10.1002/oby.20851] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/13/2014] [Accepted: 07/16/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the association between duration of adiposity and risk of type 2 diabetes (T2D) in US women. METHODS Nearly 61,821 participants were prospectively followed from the Nurses' Health Study (1984-2008) and 63,653 participants from Nurses' Health Study II (1991-2011). Participants were considered overweight (BMI 25-30 kg m(-2) ) or obese (BMI ≥ 30 kg m(-2) ) if their BMI was above the cutoffs for two successive assessments. The time-dependent Cox proportional hazard models were used to assess associations between excess weight duration and T2D risk. RESULTS In pooled multivariable analyses of the two cohorts, each two extra years of being overweight was associated with 9% (RR = 1.09, 95% CI 1.08-1.09) increased risk of developing T2D. For each 2-year increment in obesity duration, the risk of T2D was increased by 14% (RR = 1.14, 95% CI 1.14-1.15). Adjustment for current BMI greatly attenuated the association for obesity duration (RR = 1.02, 95% CI 1.01-1.03), although the attenuation was less for overweight duration (RR = 1.04, 95% CI 1.04-1.05). CONCLUSIONS Both overweight and obesity duration were associated with a significantly higher risk of T2D, and these associations were mainly explained by current BMI, especially for obesity duration.
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Affiliation(s)
- Yang Hu
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Lee Y, Kim J, Han ES, Ryu M, Cho Y, Chae S. Frailty and body mass index as predictors of 3-year mortality in older adults living in the community. Gerontology 2014; 60:475-82. [PMID: 24993678 DOI: 10.1159/000362330] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 03/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Frailty and body mass index (BMI) are known to be predictive of late life mortality, but little is known about the combined effects of frailty and BMI on mortality. OBJECTIVE This study investigated the influence of frailty status and BMI category on mortality in older adults. METHODS Data were from the Living Profiles of Older People Survey, a national survey of community-dwelling older people in Korea, with a baseline study of 11,844 Koreans aged 65 years and older in 2008 and a 3-year follow-up for mortality. Frailty was categorized as not frail, prefrail, and frail, based on five indicators (weight loss, exhaustion, physical activity, walking speed, and grip strength). BMI (kg/m(2)) was classified as underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), or obese (≥30.0). A Cox proportional model was used to analyze the association of the combined frailty and BMI categories with all-cause mortality, adjusting for sociodemographics and health-related factors. RESULTS Adjusting for covariates, compared with the normal-weight nonfrail counterpart, the underweight or normal-weight prefrail/frail status demonstrated significantly increased rates of death. The obese frail respondents showed a significantly higher mortality risk (hazard ratio, 3.89; 95% confidence interval, 1.14-13.28). The overweight prefrail/frail group, however, exhibited no significant association with mortality. CONCLUSION Among older people who were of normal weight or underweight, greater frailty was associated with poorer survival. Whereas being overweight tended to be neutral of the influence of frailty on mortality, the obese frail exhibited a significantly elevated rate of death.
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Affiliation(s)
- Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea
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Østbye T, Stroo M, Eisenstein EL, Peterson B, Dement J. Is overweight and class I obesity associated with increased health claims costs? Obesity (Silver Spring) 2014; 22:1179-86. [PMID: 24796000 DOI: 10.1002/oby.20669] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Evaluate the relationship between body mass index (BMI) and health claims costs over the last decade, assess the strength and nature of the relationship between BMI and costs, and identify comorbidities that may drive any increased costs. METHODS Using 2001-2011 claims data for employees participating in annual health appraisals, annual paid claims costs were calculated. One-part negative binomial models were fit to evaluate the relationship between BMI and costs, controlling for age, gender, race/ethnicity, and calendar year period. RESULTS The relationship between increasing BMI and increasing health claims costs is gradual and starts already at a BMI of 19. The nature of the relationship did not change notably over time. The most important obesity-related comorbidities, expressed as percent increase in cost per BMI unit, was cardiovascular disease (males 10.53, 95% CI [6.46, 14.77], females 4.27, 95% CI [1.25, 7.38), while cardiovascular agents (7.23, 95% CI [6.08, 8.39]) were the most important driver of pharmacy costs. CONCLUSION In contrast to recent evidence relating to effects on mortality, we observed a gradual increase in health claims costs starting at the low end of the recommended BMI range.
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Cerhan JR, Moore SC, Jacobs EJ, Kitahara CM, Rosenberg PS, Adami HO, Ebbert JO, English DR, Gapstur SM, Giles GG, Horn-Ross PL, Park Y, Patel AV, Robien K, Weiderpass E, Willett WC, Wolk A, Zeleniuch-Jacquotte A, Hartge P, Bernstein L, Berrington de Gonzalez A. A pooled analysis of waist circumference and mortality in 650,000 adults. Mayo Clin Proc 2014; 89:335-45. [PMID: 24582192 PMCID: PMC4104704 DOI: 10.1016/j.mayocp.2013.11.011] [Citation(s) in RCA: 257] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/14/2013] [Accepted: 11/18/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To assess the independent effect of waist circumference on mortality across the entire body mass index (BMI) range and to estimate the loss in life expectancy related to a higher waist circumference. PATIENTS AND METHODS We pooled data from 11 prospective cohort studies with 650,386 white adults aged 20 to 83 years and enrolled from January 1, 1986, through December 31, 2000. We used proportional hazards regression to estimate hazard ratios (HRs) and 95% CIs for the association of waist circumference with mortality. RESULTS During a median follow-up of 9 years (maximum, 21 years), 78,268 participants died. After accounting for age, study, BMI, smoking status, alcohol consumption, and physical activity, a strong positive linear association of waist circumference with all-cause mortality was observed for men (HR, 1.52 for waist circumferences of ≥110 vs <90 cm; 95% CI, 1.45-1.59; HR, 1.07 per 5-cm increment in waist circumference; 95% CI, 1.06-1.08) and women (HR, 1.80 for waist circumferences of ≥95 vs <70 cm; 95% CI, 1.70-1.89; HR, 1.09 per 5-cm increment in waist circumference; 95% CI, 1.08-1.09). The estimated decrease in life expectancy for highest vs lowest waist circumference was approximately 3 years for men and approximately 5 years for women. The HR per 5-cm increment in waist circumference was similar for both sexes at all BMI levels from 20 to 50 kg/m(2), but it was higher at younger ages, higher for longer follow-up, and lower among male current smokers. The associations were stronger for heart and respiratory disease mortality than for cancer. CONCLUSIONS In white adults, higher waist circumference was positively associated with higher mortality at all levels of BMI from 20 to 50 kg/m(2). Waist circumference should be assessed in combination with BMI, even for those in the normal BMI range, as part of risk assessment for obesity-related premature mortality.
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Affiliation(s)
| | - Steven C Moore
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Eric J Jacobs
- Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | - Cari M Kitahara
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Philip S Rosenberg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Jon O Ebbert
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN
| | - Dallas R English
- Centre for MEGA Epidemiology, The University of Melbourne, Melbourne, Australia
| | - Susan M Gapstur
- Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | | | - Yikyung Park
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Alpa V Patel
- Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | - Kim Robien
- University of Minnesota School of Public Health, Minneapolis, MN
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway; Cancer Register of Norway, Oslo, Norway; Samfundet Folkhälsan, Helsinki, Finland
| | - Walter C Willett
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Alicja Wolk
- Division of Nutritional Epidemiology, The National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Patricia Hartge
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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Incidence, predictive factors, and prognosis for winged scapula in breast cancer patients after axillary dissection. Support Care Cancer 2014; 22:1611-7. [PMID: 24492929 DOI: 10.1007/s00520-014-2125-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Axillary lymph node dissection is part of breast cancer surgery, and winged scapula is a possible sequela. Data regarding its incidence, predictive factors, and patient prognosis remains inconsistent. Ignorance of its diagnosis may lead to undertreatment with physical morbidity. METHODS Breast cancer patients with axillary lymph node dissection were prospectively recruited. Postoperative examinations by the physiotherapy staff were performed. RESULTS One hundred eighty-seven patients were recruited during July-October 2012; 51 patients had a positive diagnosis (27.2 %), with 38 patients (86 %) who recovered completely from the winged scapula, while 6 patients (13 %) still had winged scapula at 6 months after surgery. One hundred thirty patients underwent mastectomy and 100 cases had immediate reconstruction. Age, BMI, previous shoulder joint morbidity, and breast surgery were not associated with winged scapula. Neoadjuvant treatment, mastectomy or conservative surgery, immediate reconstruction, tumor size, and nodal involvement also did not show any correlation. Breast reconstruction with prosthesis, even with serratus muscle dissection, does not increase the incidence of winged scapula. CONCLUSION Winged scapula is not an uncommon incidence after breast cancer surgery. Physiotherapy is related to the complete recovery. The severity or grading of the winged scapula and the recovery time after physiotherapy should be investigated in the future studies.
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Ford DW, Jensen GL, Still C, Wood C, Mitchell DC, Erickson P, Bailey R, Smiciklas-Wright H, Coffman DL, Hartman TJ. The associations between diet quality, Body Mass Index (BMI) and Health and Activity Limitation Index (HALex) in the Geisinger Rural Aging Study (GRAS). J Nutr Health Aging 2014; 18:167-70. [PMID: 24522469 PMCID: PMC4550808 DOI: 10.1007/s12603-014-0016-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the associations between diet quality, body mass index (BMI), and health-related quality of life (HRQOL) as assessed by the health and activity limitation index (HALex) in older adults. DESIGN Multivariate linear regression models were used to analyze associations between Dietary Screening Tool (DST) scores, BMI and HALex score, after controlling for gender, age, education, living situation, smoking, disease burden and self-vs. proxy reporting. SETTING Geisinger Rural Aging Study, Pennsylvania. PARTICIPANTS 5,993 GRAS participants were mailed HRQOL and DST questionnaires with 4,009 (1,722 male, 2,287 female; mean age 81.5 ± 4.4) providing complete data. RESULTS HALex scores were significantly lower for participants with dietary intakes categorized as unhealthy (<60) (0.70, 95% CI 0.69, 0.72, p<0.05) or borderline (60-75) (0.71, 95% CI 0.70, 0.73, p<0.05) compared to those scoring in the healthy range (>75) (0.75, 95% CI 0.73, 0.77) based on DST scores. HALex scores were significantly lower for underweight (0.67, 95% CI 0.63, 0.72, p<0.05), obese class II (0.68, 95% CI 0.66, 0.71, p<0.05) and class III participants (0.62 95% CI 0.57, 0.67, p<0.05) compared to those with BMI 18.5-24.9. CONCLUSIONS Poor diet quality, as assessed by the DST, is associated with lower HRQOL in adults ≥ 74 years of age.
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Affiliation(s)
- D W Ford
- Dara W. Ford, 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania 16802, USA,
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Rillamas-Sun E, LaCroix AZ, Waring ME, Kroenke CH, LaMonte MJ, Vitolins MZ, Seguin R, Bell CL, Gass M, Manini TM, Masaki KH, Wallace RB. Obesity and late-age survival without major disease or disability in older women. JAMA Intern Med 2014; 174:98-106. [PMID: 24217806 PMCID: PMC3963496 DOI: 10.1001/jamainternmed.2013.12051] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE The effect of obesity on late-age survival in women without disease or disability is unknown. OBJECTIVE To investigate whether higher baseline body mass index and waist circumference affect women's survival to 85 years of age without major chronic disease (coronary disease, stroke, cancer, diabetes mellitus, or hip fracture) and mobility disability. DESIGN, SETTING, AND PARTICIPANTS Examination of 36,611 women from the Women's Health Initiative observational study and clinical trial programs who could have reached 85 years or older if they survived to the last outcomes evaluation on September 17, 2012. Recruitment was from 40 US clinical centers from October 1993 through December 1998. Multinomial logistic regression models were used to estimate odds ratios and 95% CIs for the association of baseline body mass index and waist circumference with the outcomes, adjusting for demographic, behavioral, and health characteristics. MAIN OUTCOMES AND MEASURES Mutually exclusive classifications: (1) survived without major chronic disease and without mobility disability (healthy); (2) survived with 1 or more major chronic disease at baseline but without new disease or disability (prevalent diseased); (3) survived and developed 1 or more major chronic disease but not disability during study follow-up (incident diseased); (4) survived and developed mobility disability with or without disease (disabled); and (5) did not survive (died). RESULTS Mean (SD) baseline age was 72.4 (3.0) years (range, 66-81 years). The distribution of women classified as healthy, prevalent diseased, incident diseased, disabled, and died was 19.0%, 14.7%, 23.2%, 18.3%, and 24.8%, respectively. Compared with healthy-weight women, underweight and obese women were more likely to die before 85 years of age. Overweight and obese women had higher risks of incident disease and mobility disability. Disability risks were striking. Relative to healthy-weight women, adjusted odds ratios (95% CIs) of mobility disability were 1.6 (1.5-1.8) for overweight women and 3.2 (2.9-3.6), 6.6 (5.4-8.1), and 6.7 (4.8-9.2) for class I, II, and III obesity, respectively. Waist circumference greater than 88 cm was also associated with higher risk of earlier death, incident disease, and mobility disability. CONCLUSIONS AND RELEVANCE Overall and abdominal obesity were important and potentially modifiable factors associated with dying or developing mobility disability and major chronic disease before 85 years of age in older women.
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Affiliation(s)
- Eileen Rillamas-Sun
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington2Group Health Research Institute, Seattle, Washington
| | - Andrea Z LaCroix
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington2Group Health Research Institute, Seattle, Washington
| | - Molly E Waring
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | | | - Michael J LaMonte
- Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, Buffalo
| | - Mara Z Vitolins
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Rebecca Seguin
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington7Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Christina L Bell
- Department of Geriatric Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - Margery Gass
- The North American Menopause Society, Cleveland, Ohio
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Kamal H Masaki
- Department of Geriatric Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - Robert B Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
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