Excess deaths associated with obesity: cause and effect

Delaware's 1999-2017 Leading Causes of Death Information Illustrates Its Obesity and Obesity-Related Life-Limiting Disease Burdens

Using commercially available but powerful big data analytics, this non-clinical obesity and underlying causes of death observational study, analyzed the very large US Centers for Disease Control and Prevention's (CDC) State of Obesity records, the CDC WONDER data, and the US census records. Compared to the 1999-to-2017 US obesity rate increase of 29.8%, an uncontrolled increase in Delaware's obesity rate (81.7%) was observed. During the same time period, CDC WONDER death certificate archives disclosed that there was a 60.53% surge in crude Delawarean mortality rate when obesity was listed as a single underlying cause of death. When any mention of obesity was documented on the death certificate, Delaware's 1999-2017 crude mortality rate advanced by 75.69% and its age-adjusted rate rose by 53.18%. Likewise, except for one year, Delaware's African American/Black population experienced higher crude mortality rate averages but however, between the years of 1997 and 2017, its Caucasian/White inhabitants had an enormous 87.34% death rate increase. With additional available CDC mortality data, Delaware males saw substantially larger age-adjusted death rate increases (79.87%) than their female counterparts (28.92%). Diabetes, circulatory system diseases, and neoplasms (cancer), are three common obesity comorbidities. For these three conditions, Delaware's 1999-2017 mortality rate figures mimic the falling national patterns of mortality rate averages, when each disease is listed as the single underlying cause of death, including observations where there are disproportionate numbers of cases that affect the African American/Black race.

1997-2017 Leading Causes of Death Information Due to Diabetes, Neoplasms, and Diseases of the Circulatory System, Issues Cautionary Weight-Related Lesson to the US Population at Large

In the US, cardiovascular disease, cancer, and diabetes are in the top ten leading causes of death categories. The diseases compromise US life-expectancy and account for significant US health-care costs. This observational study investigates the US population's 1997-2017 Centers for Disease Control and Prevention (CDC) WONDER ICD-10 mortality records to extract the prevalence rates for leading causes of death by diabetes, neoplasms (cancers), and diseases of the circulatory system. The variables of race and age are examined for each disease in order to evaluate demographic and age-group risks. To document the public health burden from these three chronic conditions, mortality data from CDC WONDER was analyzed using MS-Excel and Statistical Analysis System (SAS) software. The general trend of deaths by diabetes, neoplasms, and diseases of the circulatory system has been progressively decreasing nationally; however, a significantly higher trend in mortality rates is observed for the Black or African American populations. Furthermore, over the 1997-2017 observational period, the crude mortality rates for the 45-54 (middle-age) and lower age-groups are below national mortality rate averages but are troublingly increasing for diabetes and notably, for the diseases of the circulatory system, the (younger) 25-34 age-group had a crude mortality rate increase of 6.78%.

Diagnosis: a critical social reflection in the genomic era

Abstract Diagnosis is a pivotal tool for the work of medicine as they categorise and classify individual ailments via a generalised schema. However diagnosis is also a profoundly social act, which reflects society, its values and how it makes sense of illness and disease. Considering diagnosis critically, as well as practically, is an important job of the sociologist. This paper reviews how a social model can provide a critical tool for viewing diagnosis in the genomic era. It explores how the formulation of diagnosis, be it via genetic explanations or microbiological ones, are the product of social discovery, negotiation, and consensus.

Obesity, Inflammation, and Periodontal Disease

The prevalence of obesity has increased substantially over the past decades in most industrialized countries. Obesity is a systemic disease that predisposes to a variety of co-morbidities and complications that affect overall health. Cross-sectional studies suggest that obesity is also associated with oral diseases, particularly periodontal disease, and prospective studies suggest that periodontitis may be related to cardiovascular disease. The possible causal relationship between obesity and periodontitis and potential underlying biological mechanisms remain to be established; however, the adipose tissue actively secretes a variety of cytokines and hormones that are involved in inflammatory processes, pointing toward similar pathways involved in the pathophysiology of obesity, periodontitis, and related inflammatory diseases. We provide an overview of the definition and assessment of obesity and of related chronic diseases and complications that may be important in the periodontist’s office. Studies that have examined the association between obesity and periodontitis are reviewed, and adipose-tissue-derived hormones and cytokines that are involved in inflammatory processes and their relationship to periodontitis are discussed. Our aim is to raise the periodontist’s awareness when treating obese individuals.

Mori folium and mori fructus mixture attenuates high-fat diet-induced cognitive deficits in mice

Obesity has become a global health problem, contributing to various diseases including diabetes, hypertension, cancer, and dementia. Increasing evidence suggests that obesity can also cause neuronal damage, long-term memory loss, and cognitive impairment. The leaves and the fruits of Morus alba L., containing active phytochemicals, have been shown to possess antiobesity and hypolipidemic properties. Thus, in the present study, we assessed their effects on cognitive functioning in mice fed a high-fat diet by performing immunohistochemistry, using antibodies against c-Fos, synaptophysin, and postsynaptic density protein 95 and a behavioral test. C57BL/6 mice fed a high-fat diet for 21 weeks exhibited increased body weight, but mice coadministered an optimized Mori Folium and Mori Fructus extract mixture (2 : 1; MFE) for the final 12 weeks exhibited significant body weight loss. Additionally, obese mice exhibited not only reduced neural activity, but also decreased presynaptic and postsynaptic activities, while MFE-treated mice exhibited recovery of these activities. Finally, cognitive deficits induced by the high-fat diet were recovered by cotreatment with MFE in the novel object recognition test. Our findings suggest that the antiobesity effects of MFE resulted in recovery of the cognitive deficits induced by the high-fat diet by regulation of neural and synaptic activities.

The role of gastrointestinal hormones in hepatic lipid metabolism

Hepatocellular accumulation of free fatty acids (FFAs) in the form of triglycerides constitutes the metabolic basis for the development of nonalcoholic fatty liver disease (NAFLD). Recent data demonstrate that excess FFA hepatocyte storage is likely to lead to lipotoxicity and hepatocyte apoptosis. Hence, FFA-mediated hepatocyte injury is a key contributor to the pathogenesis of nonalcoholic steatohepatitis (NASH). Nonalcoholic steatohepatitis, obesity, type 2 diabetes, essential hypertension, and other common medical problems together comprise metabolic syndrome. Evidence suggests that peptide hormones from the L cells of the distal small intestine, which comprise the core of the enteroendocrine system (EES), play two key roles, serving either as incretins, or as mediators of appetite and satiety in the central nervous system. Recent data related to glucagon-like peptide-1 (GLP-1) and other known L-cell hormones have accumulated due to the increasing frequency of bariatric surgery, which increase delivery of bile salts to the hindgut. Bile acids are a key stimulus for the TGR5 receptor of the L cells. Enhanced bile-salt flow and subsequent EES stimulation may be central to elimination of hepatic steatosis following bariatric surgery. Although GLP-1 is a clinically relevant pharmacological analogue that drives pancreatic β-cell insulin output, GLP-1 analogues also have independent benefits via their effects on hepatocellular FFA metabolism. The authors also discuss recent data regarding the role of the major peptides released by the EES, which promote satiety and modulate energy homeostasis and utilization, as well as those that control fat absorption and intestinal permeability. Taken together, elucidating novel functions for EES-related peptides and pharmacologic development of peptide analogues offer potential far-ranging treatment for obesity-related human disease.

Obesity paradox in amputation risk among nonelderly diabetic men

The association between BMI and amputation risk is not currently well known. We used data for a cohort of diabetic patients treated in the US Department of Veterans Affairs Healthcare System in 2003. Men aged <65 years at the end of follow-up were examined for their amputation risk and amputation-free survival during the next 5 years (2004-2008). Compared to overweight individuals (BMI 25-29.9 kg/m(2)), the risks of amputation and treatment failure (amputation or death) were higher for patients with BMI <25 kg/m(2) and were lower for those with BMI ≥30 kg/m(2). Individuals with BMI ≥40 kg/m(2) were only half as likely to experience any (hazard ratios (HR) = 0.49; 95% confidence interval (CI), 0.30-0.80) and major amputations (HR = 0.53; 95% CI, 0.39-0.73) during follow-up as overweight individuals. While the amputation risk continued to decrease for higher BMI, amputation-free survival showed a slight upturn at BMI >40 kg/m(2). The association between obesity and amputation risk in our data shows a pattern consistent with "obesity paradox" observed in many health conditions. More research is needed to better understand pathophysiological mechanisms that may explain the paradoxical association between obesity and lower-extremity amputation (LEA) risk.

Generalised and abdominal adiposity are important risk factors for chronic disease in older people: results from a nationally representative survey

OBJECTIVES

To look at the trends in prevalence of generalised (body mass index (BMI) ≥ 25 kg/m2) and abdominal obesity (waist circumference (WC) >102 cm, men; > 88 cm, women) among older people from 1993 to 2008, prevalence of chronic disease by overweight/obesity and WC categories in England 2005 and evaluate the association of these measures with chronic diseases.

DESIGN

Analyses of nationally representative cross-sectional population surveys, the Health Survey for England (HSE).

PARTICIPANTS

Non-institutionalised men and women aged ≥ 65 years (in HSE 2005, 1512 men and 1747 women).

MEASUREMENTS

Height, weight, waist circumference, blood pressure measurements were taken according to standardised HSE protocols. Information collected on socio-demographic, health behaviour and doctor diagnosed health conditions.

RESULTS

Generalised obesity and abdominal obesity increased among men and women from 1993 to 2008. In 2005, the HSE 2005 focussed on older people. 72% of men and 68% of women aged over 65 were either overweight or obese. Prevalence of raised WC was higher in women (58%) than in men (46%). The prevalence of diabetes and arthritis was higher in people with generalised obesity in both sexes. Men were more likely to have had a joint replacement and had a higher prevalence of stroke if they were overweight only but women were more likely to have had a joint replacement only if they were obese (13%) and had a higher risk of falls with generalised obesity. The pattern was similar for the prevalence of chronic diseases by raised WC. Multivariate analysis showed that generalised and abdominal obesity was independently associated with risk of hypertension, diabetes and arthritis in both men and women. In women only, there was an association between generalised obesity and having a fall in the last year (OR: 1.5), and between abdominal obesity and having a joint replacement (OR: 1.9, p=0.01).

CONCLUSION

Complications of obesity such as diabetes, hypertension and arthritis, are more common in men and women aged over 65 who are overweight or obese, as well as in those with a raised WC. These conditions impact on morbidity, mortality and have cost implications for the health service and are known to improve with weight loss even in old age. Treatment strategies to address these conditions such as weight management and prevention of overweight and obesity are important even in older people. There is a need to ensure that older people are given appropriate advice about keeping physically active and eating sensibly.

Weight loss practices and body weight perceptions among US college students

OBJECTIVE

The authors assessed associations between body weight perception and weight loss strategies.

PARTICIPANTS

They randomly selected male and female college students (N = 38,204).

METHODS

The authors conducted a secondary data analysis of the rates of weight loss strategies and body weight perception among students who completed the National College Health Assessment survey.

RESULTS

Half of respondents (50%) were trying to lose weight, although only 28% of students were overweight or obese. Also, 12% of respondents had inaccurate body weight perception. Women and men with inaccurate body weight perception were significantly more likely to engage in inappropriate weight loss strategies than were those with accurate body weight perception. Of all students attempting to lose weight, 38% used both diet and exercise.

CONCLUSIONS

These data show that college students are interested in weight loss and that body weight perception plays an important role in the desire to lose weight.

Quantitative trait Loci for regional adiposity in mouse lines divergently selected for food intake

OBJECTIVE

Obesity is thought to result from an interaction between genotype and environment. Excessive adiposity is associated with a number of important comorbidities; however, the risk of obesity-related disease varies with the distribution of fat throughout the body. The aim of this study was to map quantitative trait loci (QTLs) associated with regional fat depots in mouse lines divergently selected for food intake corrected for body mass.

RESEARCH METHODS AND PROCEDURES

Using an F2 intercross design (n = 457), the dry mass of regional white (subcutaneous, gonadal, retroperitoneal, and mesenteric) adipose tissue (WAT) and brown adipose tissue (BAT) depots were analyzed to map QTLs.

RESULTS

The total variance explained by the mapped QTL varied between 12% and 39% for BAT and gonadal fat depots, respectively. Using the genome-wide significance threshold, nine QTLs were associated with multiple fat depots. Chromosomes 4 and 19 were associated with WAT and BAT and chromosome 9 with WAT depots. Significant sex x QTL interactions were identified for gonadal fat on chromosomes 9, 16, and 19. The pattern of QTLs identified for the regional deposits showed the most similarity between retroperitoneal and gonadal fat, whereas BAT showed the least similarity to the WAT depots. Analysis of total fat mass explained in excess of 40% of total variance.

DISCUSSION

There was limited concordance between the QTLs mapped in our study and those reported previously. This is likely to reflect the unique nature of the mouse lines used. Results provide an insight into the genetic basis of regional fat distribution.