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Karin A, Jon E, Martin A, Lena B, Martin L, Naveed S, Marcus L, Maria Å, Annika R. Body mass index in adolescence, risk of type 2 diabetes and associated complications: A nationwide cohort study of men. EClinicalMedicine 2022; 46:101356. [PMID: 35330801 PMCID: PMC8938860 DOI: 10.1016/j.eclinm.2022.101356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Obesity is a predominant factor in development of type 2 diabetes but to which extent adolescent obesity influences adult diabetes is unclear. We investigated the association between body mass index (BMI) in young men and subsequent type 2 diabetes and how, in diagnosed diabetes, adolescent BMI relates to glycemic control and diabetes complications. Methods Baseline data from the Swedish Conscript Register for men drafted 1968-2005 was combined with data from the National Diabetes and Patient registries. Diabetes risk was estimated through Cox regression and Kaplan-Meier survival estimates. Relationships between BMI, glycemic control and diabetes complications were assessed through multiple linear and logistic regression. Findings Among 1,647,826 men, 63,957 (3·88%) developed type 2 diabetes over a median follow-up of 29.0 years (IQR[21.0-37.0]). The risk of diabetes within 40 years after conscription was nearly 40% in individuals with adolescent BMI ≥35 kg/m2. Compared to BMI 18·5-<20 kg/m2 (reference), diabetes risk increased in a linear fashion from HR 1·18(95%CI 1·15-1·21) for BMI 20-<22·5 kg/m2 to HR 15·93(95%CI 14·88-17·05) for BMI ≥35 kg/m2, and a difference in age at onset of 11·4 years was seen. Among men who developed diabetes, higher adolescent BMI was associated with higher HbA1c levels and albuminuria rates. Interpretation Rising adolescent BMI was associated with increased risk of type 2 diabetes diagnosed at a younger age, with poorer metabolic control, and a greater prevalence of albuminuria, all suggestive of worse prognosis.
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Affiliation(s)
- Andréasson Karin
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, Gothenburg 41650, Sweden
| | - Edqvist Jon
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, Gothenburg 41650, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adiels Martin
- Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björck Lena
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, Gothenburg 41650, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine Geriatrics and Emergency Medicine, Östra, Gothenburg, Sweden
| | - Lindgren Martin
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, Gothenburg 41650, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Diagnosvägen 11,Östra, Gothenburg 41650, Sweden
| | - Sattar Naveed
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Lind Marcus
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, Gothenburg 41650, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Medicine, NU-Hospital Group, Uddevalla, Sweden
| | - Åberg Maria
- School of Public Health and Community Medicine, Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Regionhälsan, Gothenburg, Sweden
| | - Rosengren Annika
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, Gothenburg 41650, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Diagnosvägen 11,Östra, Gothenburg 41650, Sweden
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Comparison of Weight Loss in Sleeve Gastrectomy Patients With and Without Antrectomy: a Prospective Randomized Study. Obes Surg 2021; 30:446-450. [PMID: 31707570 DOI: 10.1007/s11695-019-04177-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) restricts gastric volume to achieve weight loss. We aimed to compare the efficacy of LSG with and without antrectomy for achieving weight loss. METHODS The prospective randomized study comprised 127 obese patients that underwent either LSG with antrectomy (2 cm to pylorus) (group 1) or LSG without antrectomy (6 cm to pylorus) (group 2), using 36 Fr and 32 Fr bougies, respectively. Patients were examined at 3-, 6-, 12-, and 24-month intervals for body mass index (BMI) measurements. RESULTS Overall, 66 (51%) and 57 (49%) of patients were assigned to groups 1 and 2, respectively. The mean BMI of group 1 patients were 49.5 ± 8.01, 35.8 ± 5.40, 31.3 ± 4.9, 26.7 ± 4.02, and 22.9 ± 4.01 at the baseline, 3rd, 6th, 12th, and 24th month, respectively. The decreases in BMI were statistically significant. The mean BMI of group 2 patients were 46.7 ± 7.06, 39.3 ± 6.04, 32.4 ± 5.01, 26.6 ± 3.76, and 21.6 ± 3.70 at baseline, 3rd, 6th, 12th, and 24th month, respectively. The differences were also statistically significant. When compared with group 2, group 1 patients showed significantly lower BMI values on the 3rd month. Other differences were not statistically significant. CONCLUSION LSG with or without antrectomy is safe and effective for weight loss. Larger studies are required to identify patients likely to benefit from LSG with antrectomy.
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Dikaiou P, Björck L, Adiels M, Lundberg CE, Mandalenakis Z, Manhem K, Rosengren A. Obesity, overweight and risk for cardiovascular disease and mortality in young women. Eur J Prev Cardiol 2020; 28:1351-1359. [PMID: 32122198 DOI: 10.1177/2047487320908983] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/05/2020] [Indexed: 12/15/2022]
Abstract
AIMS The aim of this study was to investigate the relation between body mass index (BMI) in young women, using weight early in pregnancy as a proxy for pre-pregnancy weight, and risk for early cardiovascular disease (CVD) and mortality. METHODS AND RESULTS In this prospective, registry-based study, we used weight data in early pregnancy from women, registered in the Swedish Medical Birth Registry, and who gave birth between 1982 and 2014 (n = 1,495,499; median age 28.3 years). Of the women, 118,212 (7.9%) were obese (BMI ≥ 30 kg/m2) and 29,630 (2.0%) severely obese (BMI ≥ 35 kg/m2). After a follow-up of median 16.3 years, we identified 3295 and 4375 cases of acute myocardial infarction (AMI) and ischemic stroke (IS) corresponding to 13.4 and 17.8 per 100,000 observation years, respectively, occurring at mean ages of 49.8 and 47.3 years. Compared to women with a BMI 20-<22.5 kg/m2, the hazard ratio (HR) of AMI increased with higher BMI from 1.40 (95% confidence interval (CI) 1.27-1.54) among women with BMI 22.5-<25.0 kg/m2 to 4.71 (95% CI 3.88-5.72) among women with severe obesity, with similar findings for IS and CVD death, after adjustment for age, pregnancy year, parity and comorbidities at baseline. Women with BMI 30-<35.0 and ≥35 kg/m2 had increased all-cause mortality with adjusted HR 1.53 (95% CI 1.43-1.63) and 1.83 (95% CI 1.63-2.05), respectively. CONCLUSION A significant increase in the risk for early AMI, IS and CVD death was noticeable in overweight young women, with a marked increase in obese women.
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Affiliation(s)
- Pigi Dikaiou
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital/Sahlgrenska Hospital, Sweden
| | - Lena Björck
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra Hospital, Sweden
| | - Martin Adiels
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Christina E Lundberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra Hospital, Sweden
| | - Karin Manhem
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital/Sahlgrenska Hospital, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra Hospital, Sweden
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Robertson J, Lindgren M, Schaufelberger M, Adiels M, Björck L, Lundberg CE, Sattar N, Rosengren A, Åberg M. Body Mass Index in Young Women and Risk of Cardiomyopathy: A Long-Term Follow-Up Study in Sweden. Circulation 2020; 141:520-529. [PMID: 32065765 PMCID: PMC7017947 DOI: 10.1161/circulationaha.119.044056] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Supplemental Digital Content is available in the text. Incidence rates of cardiomyopathies, which are a common cause of heart failure in young people, have increased during the last decades. An association between body weight in adolescence and future cardiomyopathy among men was recently identified. Whether or not this holds true also for women is unknown. The aim was therefore to determine whether for young women being overweight or obese is associated with a higher risk of developing cardiomyopathy.
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Affiliation(s)
- Josefina Robertson
- School of Public Health and Community Medicine/Primary Health Care (J.R., M.Å.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.L., M.S., L.B., A.R.)
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine (M.L., M.S., M.A., L.B., C.E.L., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.L., M.S., L.B., A.R.)
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine (M.L., M.S., M.A., L.B., C.E.L., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.L., M.S., L.B., A.R.)
| | - Martin Adiels
- Department of Molecular and Clinical Medicine (M.L., M.S., M.A., L.B., C.E.L., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Lena Björck
- Department of Molecular and Clinical Medicine (M.L., M.S., M.A., L.B., C.E.L., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.L., M.S., L.B., A.R.)
| | - Christina E Lundberg
- Department of Molecular and Clinical Medicine (M.L., M.S., M.A., L.B., C.E.L., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (N.S.)
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine (M.L., M.S., M.A., L.B., C.E.L., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.L., M.S., L.B., A.R.)
| | - Maria Åberg
- School of Public Health and Community Medicine/Primary Health Care (J.R., M.Å.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Region Västra Götaland, Regionhälsan, Gothenburg, Sweden (M.Å.)
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Björck L, Lundberg C, Schaufelberger M, Lissner L, Adiels M, Rosengren A. Body mass index in women aged 18 to 45 and subsequent risk of heart failure. Eur J Prev Cardiol 2019; 27:1165-1174. [PMID: 31684761 DOI: 10.1177/2047487319882510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The incidence of heart failure (HF) is decreasing in older ages, but increasing rates have been observed among younger persons in Sweden. Therefore, we investigated the relationship between risk of hospitalization for HF and body mass index (BMI). METHODS This was a prospective registry-based cohort study. We included 1,374,031 women aged 18-45 years (mean age 27.9 years) who gave birth during 1982-2014, and were registered in the Medical Birth Register. Information on hospitalization because of HF was collected through linkage to the National Inpatient Register. RESULTS Compared to women with a BMI of 20-<22.5 kg/m2, women with a BMI of 22.5-<25.0 had a hazard ratio (HR) of 1.24 (95% confidence interval (CI), 1.10-1.39) for HF after adjustment for age, year, parity, baseline disorders, smoking, and education. The HR (95% CI) increased to 1.56 (1.36-1.78), 2.39 (2.05-2.78), 2.82 (2.43-3.28), and 4.51 (3.63-5.61) in women with a BMI of 25-<27.5, 27.5-<30, 30-<35, and ≥35 kg/m2, respectively. The multiple-adjusted HRs (95% CI) associated with risk of HF per one-unit increase in BMI in women with a BMI ≥ 22.5 kg/m2 ranged from 1.01 (0.97-1.06) for HF related to valvular disease to 1.14 (1.12-1.15) for coronary heart disease, diabetes, or hypertension. CONCLUSION Increasing body weight was strongly associated with the risk of early HF in women. Compared with lean women, the risk for HF started to increase at high-normal BMI levels, and was nearly five-fold in women with a BMI ≥ 35 kg/m2.
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Affiliation(s)
- Lena Björck
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
| | - Christina Lundberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
| | - Lauren Lissner
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Adiels
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
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Lissner L, Mehlig K, Rosengren A, Toren K, Åberg M. A Growing Social Divide in Body Mass Index, Strength, and Fitness of Swedish Male Conscripts. J Adolesc Health 2019; 65:232-238. [PMID: 31028008 DOI: 10.1016/j.jadohealth.2019.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/14/2019] [Accepted: 02/26/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of the study was to monitor trends in socioeconomic inequalities in body mass index (BMI), cardiorespiratory fitness (CRF), and muscular strength over several decades in a population of Swedish males aged 18-19 years. METHODS The cohort consists of 1.5 million young men attending military conscript examinations from late 1968 to 2005. Parental education was used as a marker for socioeconomic conditions in the conscripts' families of origin. Changing gradient in BMI, CRF, and muscular strength in sons of parents with higher and lower educational attainment was evaluated during four periods covering 36 years. RESULTS Over the course of the obesity epidemic, BMI remained higher in conscripts with lesser (vs. higher) parental education. Moreover, the absolute difference in obesity prevalence between groups showed a continuous increase, from .6% to 3.9%, indicating growing inequalities. Regarding fitness, lower CRF was consistently associated with less parental education, but with no clear secular trend in the magnitude of the difference. Finally, social differences in muscular strength changed in direction, from lower strength among conscripts with higher parental education in the initial observation period to lower strength associated with lower parental education in the final decade studied. CONCLUSIONS Among Swedish conscripts entering adulthood, social gradients in BMI and obesity widened continuously between 1968 and 2005. An apparent reversal of the earlier gradient in muscular strength in young men may be related to societal trends in occupational and leisure-time physical activity over the observation period. This cohort is being continually monitored through national registries for obesity-related comorbidities in later life.
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Affiliation(s)
- Lauren Lissner
- Department of Public Health and Community Medicine/Epidemiology and Social Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.
| | - Kirsten Mehlig
- Department of Public Health and Community Medicine/Epidemiology and Social Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Cardiovascular and Molecular Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
| | - Kjell Toren
- Department of Public Health and Community Medicine/Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Åberg
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Robertson J, Schaufelberger M, Lindgren M, Adiels M, Schiöler L, Torén K, McMurray J, Sattar N, Åberg M, Rosengren A. Higher Body Mass Index in Adolescence Predicts Cardiomyopathy Risk in Midlife. Circulation 2019; 140:117-125. [PMID: 31132859 PMCID: PMC6635044 DOI: 10.1161/circulationaha.118.039132] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Modifiable lifestyle factors in relation to risk for cardiomyopathy, a common and increasing cause of heart failure in the young, have not been widely studied. We sought to investigate a potential link between obesity, a recognized predictor of early heart failure, in adolescence and being diagnosed with cardiomyopathy in adulthood. Methods: This was a nationwide register-based prospective cohort study of 1 668 893 adolescent men (mean age, 18.3 years; SD, 0.7 years) who enlisted for compulsory military service from 1969 to 2005. At baseline, body mass index (BMI), blood pressure, and medical disorders were registered, along with test results for fitness and muscle strength. Cardiomyopathy diagnoses were identified from the National Hospital Register and Cause of Death Register during an up to 46-year follow-up and divided into categories: dilated, hypertrophic, alcohol/drug-induced, and other. Hazard ratios were calculated with Cox proportional hazards models. Results: During follow-up (median, 27 years; Q1–Q3, 19–35 years), 4477 cases of cardiomyopathy were identified, of which 2631 (59%) were dilated, 673 (15%) were hypertrophic, and 480 (11%) were alcohol/drug-induced. Increasing BMI was strongly associated with elevated risk of cardiomyopathy, especially dilated, starting at levels considered normal (BMI, 22.5–<25 kg/m2; hazard ratio, 1.38 [95% CI, 1.22–1.57]), adjusted for age, year, center, and baseline comorbidities, and with a >8-fold increased risk at BMI ≥35 kg/m2 compared with BMI of 18.5 to <20 kg/m2. For each 1-unit increase in BMI, similarly adjusted hazard ratios were 1.15 (95% CI, 1.14–1.17) for dilated cardiomyopathy, 1.09 (95% CI, 1.06–1.12) for hypertrophic cardiomyopathy, and 1.10 (1.06–1.13) for alcohol/drug-induced cardiomyopathy. Conclusions: Even mildly elevated body weight in late adolescence may contribute to being diagnosed with cardiomyopathy in adulthood. The already marked importance of weight control in youth is further strengthened by these findings, as well as greater evidence for obesity as a potential important cause of adverse cardiac remodeling that is independent of clinically evident ischemic heart disease.
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Affiliation(s)
- Josefina Robertson
- Department of Public Health and Community Medicine/Primary Health Care (J.R., M.A.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.S., M.L., A.R.)
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine (M.S., M.L., M.A., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.S., M.L., A.R.)
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine (M.S., M.L., M.A., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.S., M.L., A.R.)
| | - Martin Adiels
- Department of Public Health and Community Medicine/Primary Health Care (J.R., M.A.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Linus Schiöler
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine (L.S., K.T.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine (L.S., K.T.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - John McMurray
- British Heart Foundation Cardiovascular Research Centre (J.M.), University of Glasgow.,Department of Cardiology, Western Infirmary, Glasgow, UK (J.M.)
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences (N.S.), University of Glasgow
| | - Maria Åberg
- Department of Molecular and Clinical Medicine (M.S., M.L., M.A., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine (M.S., M.L., M.A., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.S., M.L., A.R.)
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Twig G, Reichman B, Afek A, Derazne E, Hamiel U, Furer A, Gershovitz L, Bader T, Cukierman-Yaffe T, Kark JD, Pinhas-Hamiel O. Severe obesity and cardio-metabolic comorbidities: a nationwide study of 2.8 million adolescents. Int J Obes (Lond) 2018; 43:1391-1399. [PMID: 30258119 DOI: 10.1038/s41366-018-0213-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 07/25/2018] [Accepted: 08/29/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Severe obesity is rising among adolescents, but data on the prevalence of metabolic abnormalities among this group are limited. We assessed the secular trend of severe obesity and its association with major cardio-metabolic morbidities. METHODS A total of 2,785,227 Israeli adolescents (aged 17.2 ± 0.5 years) who underwent a pre-recruitment medical examination including routine measurements of weight, height and blood pressure between 1967 and 2015 were included. In all, 230,639 adolescents with abnormally excessive BMI were classified into overweight, classes I, II, and III (severe) obesity. Logistic regression was applied to determine the association between BMI groups and prehypertension, high blood pressure and type 2 diabetes (T2DM). RESULTS There was 45-fold increase in the prevalence of class III obesity during study period. Severe obesity was recorded in 2060 males and 1149 females, in whom nearly 35 and 43% had prehypertension or high blood pressure, respectively. Compared with adolescents with overweight, the odds ratios (ORs) for high blood pressure in classes II and III obesity groups, respectively, were 2.13 (95% CI, 2.04-2.23) and 2.86 (2.60-3.15) in males, and 2.59 (2.43-2.76) and 3.44 (3.04-3.90) in females, whereas the ORs for T2DM were 19.1 (12.3-29.6) and 38.0 (22.6-64.0) in males, and 15.1 (11.4-20.0) and 24.8 (17.2-35.7) in females. Results persisted in extensive sensitivity analyses including a longitudinal follow-up (median: males, 3.4 years; females, 4.9 years). CONCLUSIONS Severe obesity showed a marked secular increase and was associated with significantly higher risk for abnormal blood pressure and T2DM than lower degrees of obesity, in both males and females.
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Affiliation(s)
- Gilad Twig
- Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel. .,Department of Medicine and the Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
| | - Brian Reichman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.,The Women and Children's Health Research Unit, Gertner Institute, Tel Hashomer, Israel
| | - Arnon Afek
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.,Central Management, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Estela Derazne
- Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Uri Hamiel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.,Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Ariel Furer
- Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel
| | - Liron Gershovitz
- Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel
| | - Tarif Bader
- Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel.,Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Tali Cukierman-Yaffe
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.,Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - Jeremy D Kark
- Hebrew University-Hadassah School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
| | - Orit Pinhas-Hamiel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.,Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
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Contaldo F, Santarpia L, Pasanisi F. Are bariatric and metabolic surgeries synonymous? - A nutritional view. Nutr Metab Cardiovasc Dis 2017; 27:1032-1034. [PMID: 28986078 DOI: 10.1016/j.numecd.2017.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 11/23/2022]
Affiliation(s)
- F Contaldo
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Interuniversity Center for Obesity and Eating Disorders (CISRODCA), Federico II University, Naples, Italy
| | - L Santarpia
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Interuniversity Center for Obesity and Eating Disorders (CISRODCA), Federico II University, Naples, Italy.
| | - F Pasanisi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Interuniversity Center for Obesity and Eating Disorders (CISRODCA), Federico II University, Naples, Italy
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Rosengren A, Åberg M, Robertson J, Waern M, Schaufelberger M, Kuhn G, Åberg D, Schiöler L, Torén K. Body weight in adolescence and long-term risk of early heart failure in adulthood among men in Sweden. Eur Heart J 2017; 38:1926-1933. [PMID: 27311731 PMCID: PMC5837553 DOI: 10.1093/eurheartj/ehw221] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/04/2016] [Accepted: 04/29/2016] [Indexed: 01/17/2023] Open
Abstract
AIMS To study the relation between body mass index (BMI) in young men and risk of early hospitalization with heart failure. METHODS AND RESULTS In a prospective cohort study, men from the Swedish Conscript Registry investigated 1968-2005 (n = 1 610 437; mean age, 18.6 years were followed 5-42 years (median, 23.0 years; interquartile range, 15.0-32.0), 5492 first hospitalizations for heart failure occurred (mean age at diagnosis, 46.6 (SD 8.0) years). Compared with men with a body mass index (BMI) of 18.5-20.0 kg/m2, men with a BMI 20.0-22.5 kg/m2 had an hazard ratio (HR) of 1.22 (95% CI, 1.10-1.35), after adjustment for age, year of conscription, comorbidities at baseline, parental education, blood pressure, IQ, muscle strength, and fitness. The risk rose incrementally with increasing BMI such that men with a BMI of 30-35 kg/m2 had an adjusted HR of 6.47 (95% CI, 5.39-7.77) and those with a BMI of ≥35 kg/m2 had an HR of 9.21 (95% CI, 6.57-12.92). The multiple-adjusted risk of heart failure per 1 unit increase in BMI ranged from 1.06 (95% CI, 1.02-1.11) in heart failure associated with valvular disease to 1.20 (95% CI, 1.18-1.22) for cases associated with coronary heart disease, diabetes, or hypertension. CONCLUSION We found a steeply rising risk of early heart failure detectable already at a normal body weight, increasing nearly 10-fold in the highest weight category. Given the current obesity epidemic, heart failure in the young may increase substantially in the future and physicians need to be aware of this.
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Affiliation(s)
- Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Åberg
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Josefina Robertson
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Georg Kuhn
- Centre for Brain Repair and Rehabilitation, Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - David Åberg
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linus Schiöler
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Abstract
OBJECTIVE The prevalence of stroke is expected to increase partly because of prolonged life expectancy in the general population. The objective of this study was to investigate trends in the prevalence of patients hospitalized with ischemic stroke (IS) in Sweden from 1995-2010. METHODS The Swedish inpatient and cause-specific death registries were used to estimate the absolute numbers and prevalence of patients who were hospitalized with and survived an IS from 1995-2010. RESULTS The overall number of IS increased from 129,418 in 1995 to 148,778 in 2010. In 1995, the prevalence of IS was 189 patients per 10,000 population. An increase in overall prevalence was observed until 2000, and then it remained stable, followed by a decline with an annual percentage change of (APC) -0.8% (95% CI -1.0 to 0.6) and with a final prevalence of 199 patients per 10,000 population in 2010. The prevalence of IS in people aged <45 years increased from 6.4 in 1995 to 7.6 patients per 10,000 population in 2010, with an APC of 2.1% (95% CI 0.9 to 3.4) from 1995-1998 and 0.7% (95% CI 0.6-0.9) from 1998-2010. Among those aged 45-54 years, the prevalence rose through the mid to late 1990s, followed by a slight decrease (APC: -0.7%, 95% CI-1.1 to -0.4) until 2006 and then remained stable with a prevalence of 43.8 patients per 10,000 population in 2010. Among ≥85 years, there was a minor decrease (APC: -0.3%, 95% CI -0.5 to -0.1) in overall prevalence after 2002 from 1481 to 1453 patients per 10,000 population in 2010. CONCLUSION The overall prevalence of IS increased until 2000, but then remained stable followed by a slight decline. However, the prevalence of IS in the young increased through the study period. The absolute number of IS survivors has markedly increased, mainly because of demographic changes.
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Persson M, Cnattingius S, Villamor E, Söderling J, Pasternak B, Stephansson O, Neovius M. Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons. BMJ 2017; 357:j2563. [PMID: 28615173 PMCID: PMC5470075 DOI: 10.1136/bmj.j2563] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective To estimate the risks of major congenital malformations in the offspring of mothers who are underweight (body mass index (BMI) <18.5), overweight (BMI 25 to <30), or in obesity classes I (BMI 30 to <35), II (35 to <40), or III (≥40) compared with offspring of normal weight mothers (BMI 18.5 to <25) in early pregnancy.Design Population based cohort study.Setting Nationwide Swedish registries.Participants 1 243 957 liveborn singleton infants from 2001 to 2014 in Sweden. Data on maternal and pregnancy characteristics were obtained by individual record linkages.Exposure Maternal BMI at the first prenatal visit.Main outcome measures Offspring with any major congenital malformation, and subgroups of organ specific malformations diagnosed during the first year of life. Risk ratios were estimated using generalised linear models adjusted for maternal factors, sex of offspring, and birth year.Results A total of 43 550 (3.5%) offspring had any major congenital malformation, and the most common subgroup was for congenital heart defects (n=20 074; 1.6%). Compared with offspring of normal weight mothers (risk of malformations 3.4%), the proportions and adjusted risk ratios of any major congenital malformation among the offspring of mothers with higher BMI were: overweight, 3.5% and 1.05 (95% confidence interval 1.02 to 1.07); obesity class I, 3.8% and 1.12 (1.08 to 1.15), obesity class II, 4.2% and 1.23 (1.17 to 1.30), and obesity class III, 4.7% and 1.37 (1.26 to 1.49). The risks of congenital heart defects, malformations of the nervous system, and limb defects also progressively increased with BMI from overweight to obesity class III. The largest organ specific relative risks related to maternal overweight and increasing obesity were observed for malformations of the nervous system. Malformations of the genital and digestive systems were also increased in offspring of obese mothers.Conclusions Risks of any major congenital malformation and several subgroups of organ specific malformations progressively increased with maternal overweight and increasing severity of obesity. For women who are planning pregnancy, efforts should be encouraged to reduce adiposity in those with a BMI above the normal range.
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Affiliation(s)
- Martina Persson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Department of Diabetes and Endocrinology, Sachsska Children's Hospital, Södersjukhuset, Stockholm, Sweden
| | - Sven Cnattingius
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Eduardo Villamor
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Department of Epidemiology, School of Public Health and Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Jonas Söderling
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Björn Pasternak
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Olof Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Martin Neovius
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
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13
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Chang HC, Yang HC, Chang HY, Yeh CJ, Chen HH, Huang KC, Pan WH. Morbid obesity in Taiwan: Prevalence, trends, associated social demographics, and lifestyle factors. PLoS One 2017; 12:e0169577. [PMID: 28152059 PMCID: PMC5289420 DOI: 10.1371/journal.pone.0169577] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 12/18/2016] [Indexed: 01/01/2023] Open
Abstract
Objective Obesity is one of the most important public health issues worldwide. Moreover, an extreme phenotype, morbid obesity (MO) has insidiously become a global problem. Therefore, we aimed to document the prevalence trend and to unveil the epidemiological characteristics of MO in Taiwan. Methods Nationally representative samples aged 19 years and above from three consecutive waves of Nutrition and Health survey in Taiwan: 1993–1996, 2005–2008, and 2013–2014 (n = 3,071; 1,673; and 1,440; respectively) were analyzed for prevalence trend. And 39 MO (BMI ≥35 kg/m2) cases from the two recent surveys compared with 156 age, gender, and survey-matched normal weight controls (BMI: 18.5–24 kg/m2) for epidemiological characteristics study. The reduced rank regression analysis was used to find dietary pattern associated with MO. Results The prevalence of overweight and obesity together (BMI ≥24 kg/m2) was stabilized in the recent two surveys, but that of MO (0.4%, 0.6%, to 1.4%) and obesity (BMI ≥27 kg/m2) (11.8%, 17.9%, to 22.0%) increased sharply. MO cases tended to have lower levels of education, personal income, and physical activity. Furthermore, their dietary pattern featured with a higher consumption frequency of red meat, processed animal products, and sweets/sweetened beverage, but lower frequencies of fresh fruits, nuts, breakfast cereal, and dairy products. Conclusion This study documents a polarization phenomenon with smaller proportion of overweight people at the center and higher proportions of normal weight and obesity subjects at two extremes. MO was associated with low socioeconomic status and poor dietary pattern. The obesogenic dietary pattern became more prevalent in later time.
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Affiliation(s)
- Heng-Cheng Chang
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Hsin-Chou Yang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Chih-Jung Yeh
- School of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Hsin-Hung Chen
- Department of Nutrition and Health Science, Chang Jung Christian University, Tainan, Taiwan
| | - Kuo-Chin Huang
- Department of Family Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Wen-Harn Pan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- * E-mail:
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Kemaloğlu Öz T, Ünal Dayı Ş, Seyit H, Öz A, Ösken A, Atasoy I, Yıldız U, Özpamuk Karadeniz F, İpek G, Köneş O, Alış H. The effects of weight loss after sleeve gastrectomy on left ventricular systolic function in men versus women. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:492-499. [PMID: 27119820 DOI: 10.1002/jcu.22361] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/21/2016] [Accepted: 03/25/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE To evaluate and compare the effects of weight lost after sleeve gastrectomy on left ventricular (LV) systolic function using both two-dimensional speckle tracking (2D-STE) and three-dimensional echocardiography (3DE) in men versus women. METHODS In 53 obese patients referred for sleeve gastrectomy, 2D-STE and 3DE were performed prior to and 6 months after surgery. RESULTS The study included 53 obese patients (62.3% female; mean age 36.8 ± 10.7 years). Six months after surgery, all patients demonstrated a significant decrease in body mass index, body weight, blood pressure, heart rate, LV end-diastolic dimension, myocardial wall thickness, LV mass, LV mass index, LV mass/height(2.7) , LV end-diastolic volume, LV end-systolic volume, and stroke volume as well as an increase in SV index and ejection fraction. There was no significant difference in measured variables between men and women at baseline or postsurgery, except for baseline LV end-diastolic dimension, and baseline and after surgery LV mass, LV mass index, and LV mass/height(2.7) , which were all significantly higher in men. CONCLUSIONS Sleeve gastrectomy improves LV systolic function and contributes to reverse LV remodeling in both genders. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:492-499, 2016.
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Affiliation(s)
- Tuğba Kemaloğlu Öz
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Turkey.
| | - Şennur Ünal Dayı
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Turkey
| | - Hakan Seyit
- Bakırköy Dr. Sadi konuk Training and Research Hospital, General Surgery Department, Turkey
| | - Ayhan Öz
- Şişli Hamidiye Etfal Training and Research Hospital, General Surgery Department, Turkey
| | - Altuğ Ösken
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Turkey
| | - Işıl Atasoy
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Turkey
| | - Ufuk Yıldız
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Turkey
| | - Fatma Özpamuk Karadeniz
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Turkey
| | - Göktürk İpek
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Turkey
| | - Osman Köneş
- Bakırköy Dr. Sadi konuk Training and Research Hospital, General Surgery Department, Turkey
| | - Halil Alış
- Bakırköy Dr. Sadi konuk Training and Research Hospital, General Surgery Department, Turkey
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Genetic and Environmental Effects on Weight, Height, and BMI Under 18 Years in a Chinese Population-Based Twin Sample. Twin Res Hum Genet 2016; 18:571-80. [PMID: 26379063 DOI: 10.1017/thg.2015.63] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study examined the genetic and environmental effects on variances in weight, height, and body mass index (BMI) under 18 years in a population-based sample from China. We selected 6,644 monozygotic and 5,969 dizygotic twin pairs from the Chinese National Twin Registry (CNTR) aged under 18 years (n = 12,613). Classic twin analyses with sex limitation were used to estimate the genetic and environmental components of weight, height, and BMI in six age groups. Sex-limitation of genetic and shared environmental effects was observed, especially when puberty begins. Heritability for weight, height, and BMI was low at 0-2 years old (less than 20% for both sexes) but increased over time, accounting for half or more of the variance in the 15-17 year age group for boys. For girls, heritabilities for weight, height and BMI was maintained at approximately 30% after puberty. Common environmental effects on all body measures were high for girls (59-87%) and presented a small peak during puberty. Genetics appear to play an increasingly important role in explaining the variation in weight, height, and BMI from early childhood to late adolescence, particularly in boys. Common environmental factors exert their strongest and most independent influence specifically in the pre-adolescent period and more significantly in girls. These findings emphasize the need to target family and social environmental interventions in early childhood years, especially for females. Further studies about puberty-related genes and social environment are needed to clarify the mechanism of sex differences.
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Dreber H, Reynisdottir S, Angelin B, Hemmingsson E. Who is the Treatment-Seeking Young Adult with Severe Obesity: A Comprehensive Characterization with Emphasis on Mental Health. PLoS One 2015; 10:e0145273. [PMID: 26694031 PMCID: PMC4687938 DOI: 10.1371/journal.pone.0145273] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 12/02/2015] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To characterize treatment-seeking young adults (16-25 years) with severe obesity, particularly mental health problems. STUDY DESIGN AND PARTICIPANTS Cross-sectional study of 165 participants (132 women, 33 men) with BMI ≥35 kg/m2 or ≥30 kg/m2 with comorbidities, enrolling in a multidisciplinary obesity treatment program. METHOD Data collection at admission of present and life-time health issues including symptomatology of anxiety, depression (Hospital Anxiety and Depression Scale) and attention-deficit/hyperactivity disorder (Adult ADHD Self-Report scale); self-esteem (Rosenberg Self-Esteem Scale), suicide attempts, health-related quality of life (Short Form-36 Health Survey), psychosocial functioning related to obesity (Obesity-related Problems Scale), cardiorespiratory fitness (Astrand's bicycle ergometer test), somatic and psychiatric co-morbidities, cardiometabolic risk factors, and micronutritional status. We used multiple regression analysis to identify variables independently associated with present anxiety and depressive symptomatology. RESULTS Mean body mass index was 39.2 kg/m2 (SD = 5.2). We found evidence of poor mental health, including present psychiatric diagnoses (29%), symptomatology of anxiety (47%), depression (27%) and attention-deficit/hyperactivity disorder (37%); low self-esteem (42%), attempted suicide (12%), and low quality of life (physical component score = 46, SD = 11.2; mental component score = 36, SD = 13.9, P<0.001 for difference). Variables independently associated with present anxiety symptomatology (R2 = 0.33, P<0.001) included low self-esteem (P<0.001) and pain (P = 0.003), whereas present depressive symptomatology (R2 = 0.38, P<0.001) was independently associated with low self-esteem (P<0.001), low cardiorespiratory fitness (P = 0.009) and obesity-related problems (P = 0.018). The prevalence of type 2 diabetes was 3%, and hypertension 2%. Insulin resistance was present in 82%, lipid abnormality in 62%, and poor cardiorespiratory fitness in 92%. Forty-eight percent had at least one micronutritional deficiency, vitamin D being the most common (35%). CONCLUSION A wide range of health issues, including quite severe mental health problems, was prevalent in treatment-seeking young adults with severe obesity. These are likely to constitute a major treatment challenge, including options relating to bariatric surgery.
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Affiliation(s)
- Helena Dreber
- Obesity Center, Karolinska University Hospital, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Signy Reynisdottir
- Obesity Center, Karolinska University Hospital, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bo Angelin
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hemmingsson
- Obesity Center, Karolinska University Hospital, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Derraik JGB, Ahlsson F, Diderholm B, Lundgren M. Obesity rates in two generations of Swedish women entering pregnancy, and associated obesity risk among adult daughters. Sci Rep 2015; 5:16692. [PMID: 26564817 PMCID: PMC4643250 DOI: 10.1038/srep16692] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 10/19/2015] [Indexed: 12/29/2022] Open
Abstract
We examined changes in obesity rates in two generations of Swedish women entering pregnancy, and assessed the effects of maternal body mass index (BMI) on the risk of overweight or obesity among adult daughters. This study covered an intergenerational retrospective cohort of 26,561 Swedish mothers and their 26,561 first-born daughters. There was a 4-fold increase in obesity rates, which rose from 3.1% among women entering pregnancy in 1982–1988 to 12.3% among their daughters in 2000–2008 (p < 0.0001) when entering pregnancy. The greater the maternal BMI, the greater the odds of overweight and/or obesity among daughters. Underweight mothers had half the odds of having an overweight or obese daughter in comparison to mothers of normal BMI (p < 0.0001). In contrast, the odds ratio of obese mothers having obese daughters was 3.94 (p < 0.0001). This study showed a strong association between maternal obesity and the risk of obesity among their first-born daughters. In addition, we observed a considerable increase in obesity rates across generations in mother-daughter pairs of Swedish women entering pregnancy. Thus, it is important to have preventative strategies in place to halt the worsening intergenerational cycle of obesity.
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Affiliation(s)
- José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Fredrik Ahlsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Barbro Diderholm
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Lundgren
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Prevalence of class-I, class-II and class-III obesity in Australian adults between 1995 and 2011–12. Obes Res Clin Pract 2015; 9:553-62. [DOI: 10.1016/j.orcp.2015.02.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/21/2014] [Accepted: 02/08/2015] [Indexed: 11/19/2022]
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Keating C, Neovius M, Sjöholm K, Peltonen M, Narbro K, Eriksson JK, Sjöström L, Carlsson LMS. Health-care costs over 15 years after bariatric surgery for patients with different baseline glucose status: results from the Swedish Obese Subjects study. Lancet Diabetes Endocrinol 2015; 3:855-65. [PMID: 26386667 PMCID: PMC4880549 DOI: 10.1016/s2213-8587(15)00290-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Bariatric surgery prevents and induces remission of type 2 diabetes in many patients. The effect of preoperative glucose status on long-term health-care costs is unknown. We aimed to assess health-care costs over 15 years for patients with obesity treated conventionally or with bariatric surgery and who had either euglycaemia, prediabetes, or type 2 diabetes before intervention. METHODS The Swedish Obese Subjects (SOS) study is a prospective study of adults who had bariatric surgery and contemporaneously matched controls who were treated conventionally (age 37-60 years; BMI of ≥34 in men and ≥38 in women) recruited from 25 Swedish surgical departments and 480 primary health-care centres. Exclusion criteria were identical for both study groups, and were previous gastric or bariatric surgery, recent malignancy or myocardial infarction, selected psychiatric disorders, and other contraindicating disorders to bariatric surgery. Conventional treatment ranged from no treatment to lifestyle intervention and behaviour modification. In this study, we retrieved prescription drug costs for the patients in the SOS study via questionnaires and the nationwide Swedish Prescribed Drug Register. We retrieved data for inpatient and outpatient visits from the Swedish National Patient Register. We followed up the sample linked to register data for up to 15 years. We adjusted mean differences for baseline characteristics. Analyses were by intention to treat. The SOS study is registered with ClinicalTrials.gov, number NCT01479452. FINDINGS Between Sept 1, 1987, and Jan 31, 2001, 2010 adults who had bariatric surgery and 2037 who were treated conventionally were enrolled into the SOS study. In this study, we followed up 4030 patients (2836 who were euglycaemic; 591 who had prediabetes; 603 who had diabetes). Drug costs did not differ between the surgery and conventional treatment groups in the euglycaemic subgroup (surgery US$10,511 vs conventional treatment $10,680; adjusted mean difference -$225 [95% CI -2080 to 1631]; p=0·812), but were lower in the surgery group in the prediabetes ($10,194 vs $13,186; -$3329 [-5722 to -937]; p=0·007) and diabetes ($14,346 vs $19,511; -$5487 [-7925 to -3049]; p<0·0001) subgroups than in the conventional treatment group. Compared with the conventional treatment group, we noted greater inpatient costs in the surgery group for the euglycaemic ($51,225 vs $25,313; $22,931 [19,001-26,861]; p<0·0001), prediabetes ($58,699 vs $32,861; $27,152 [18,736-35,568]; p<0·0001), and diabetes ($61,569 vs $47,569; 18,697 [9992-27,402]; p<0·0001) subgroups. We noted no differences in outpatient costs. Total health-care costs were higher in the surgery group in the euglycaemic ($71,059 vs $45,542; $22,390 [17,358-27,423]; p<0·0001) and prediabetes ($78,151 vs $54,864; $26,292 [16,738-35,845]; p<0·0001) subgroups than in the conventional treatment group, whereas we detected no difference between treatment groups in patients with diabetes ($88,572 vs $79,967; $9081 [-1419 to 19,581]; p=0·090). INTERPRETATION Total health-care costs were higher for patients with euglycaemia or prediabetes in the surgery group than in the conventional treatment group, but we detected no difference between the surgery and conventional treatment groups for patients with diabetes. Long-term health-care cost results support prioritisation of patients with obesity and type 2 diabetes for bariatric surgery. FUNDING AFA Försäkring and Swedish Scientific Research Council.
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Affiliation(s)
- Catherine Keating
- Deakin Health Economics, Deakin University, and Obesity and Population Health, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Kajsa Sjöholm
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Markku Peltonen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Kristina Narbro
- Regional Health Department, Region Vastra Gotaland, Gothenburg, Sweden
| | - Jonas K Eriksson
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars Sjöström
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena M S Carlsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Chaparro MP, Ivarsson A, Koupil I, Nilsson K, Häggström J, de Luna X, Lindgren U. Regional inequalities in pre-pregnancy overweight and obesity in Sweden, 1992, 2000, and 2010. Scand J Public Health 2015; 43:534-9. [PMID: 25948091 DOI: 10.1177/1403494815579478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2015] [Indexed: 11/16/2022]
Abstract
AIMS To investigate regional differences and time trends in women's overweight and obesity in Sweden. METHODS Using data from the Swedish Medical Birth Register (women aged ⩾18 years, first pregnancy only) and the Total Population Register accessed through the Umeå SIMSAM Lab, age-standardized prevalence of pre-pregnancy overweight/obesity (BMI ⩾ 25 kg/m(2)) and obesity (BMI ⩾ 30 kg/m(2)) were estimated by county for the years 1992, 2000, and 2010. Maps were created using ArcMap v10.2.2 to display regional variations over time and logistic regression analyses were used to assess if the observed trends were significant. RESULTS The prevalence of pre-pregnancy overweight/obesity and obesity increased significantly in all Swedish counties between 1992, and 2010. In 2010, Södermanland and Gotland exhibited the highest age-standardized overweight/obesity (39.7%) and obesity (15.1%) prevalence, respectively. The sharpest increases between 1992 and 2010 were observed in Västerbotten for overweight/obesity (75% increase) and in Gotland for obesity (233% increase). Across the years, Stockholm had the lowest prevalence of overweight/obesity (26.3% in 2010) and obesity (7.3% in 2010) and one of the least steep increases in prevalence of both between 1992 and 2010. CONCLUSIONS Substantial regional differences in pre-pregnancy overweight and obesity prevalence are apparent in Sweden. Further research should elucidate the mechanisms causing these differences.
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Affiliation(s)
- M Pia Chaparro
- Centre for Health Equity Studies (CHESS), Stockholm University & Karolinska Institutet, Stockholm, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Ilona Koupil
- Centre for Health Equity Studies (CHESS), Stockholm University & Karolinska Institutet, Stockholm, Sweden
| | | | - Jenny Häggström
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
| | - Xavier de Luna
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
| | - Urban Lindgren
- Department of Geography and Economic History, Umeå University, Umeå, Sweden
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Johns DJ, Lindroos AK, Jebb SA, Sjöström L, Carlsson LMS, Ambrosini GL. Dietary patterns, cardiometabolic risk factors, and the incidence of cardiovascular disease in severe obesity. Obesity (Silver Spring) 2015; 23:1063-70. [PMID: 25865622 PMCID: PMC6680188 DOI: 10.1002/oby.20920] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 09/16/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The longitudinal associations between a dietary pattern (DP) and cardiometabolic risk factors and cardiovascular disease (CVD) incidence were investigated in a cohort of adults with severe obesity. METHODS The analysis included 2,037 individuals with severe obesity (>34 and >38 kg/m(2) for men and women, respectively) from the Swedish Obese Subjects study repeatedly followed up for 10 years. Reduced rank regression was used to identify a DP characterized by dietary energy density, saturated fat intake, and fiber density. Mixed models examined relationships between repeated measures of DP z-scores and cardiometabolic risk factors. Cox proportional hazards models assessed relationships between DP scores and CVD incidence. RESULTS An energy-dense, high-saturated-fat, and low-fiber DP was derived. A one-unit increase in the DP z-score between follow-ups was associated with an increase in weight [β (SE)] (1.71 ± 0.10 kg), waist circumference (1.49 ± 0.07 cm), BMI (0.60 ± 0.34 kg/m2), serum cholesterol (0.06 ± 0.01 mmol/l), and serum insulin (1.22 ± 0.17 mmol/l; all P < 0.0001), as well as in serum triglycerides (0.05 ± 0.02 mmol/l; P < 0.05), systolic blood pressure (1.05 ± 0.27 mmHg; P < 0.001), and diastolic blood pressure (0.55 ± 0.16 mmHg; P < 0.05). No significant association was observed between repeated measures of the DP z-scores and CVD incidence (HR = 0.96; 95% CI = 0.83-1.12). CONCLUSIONS An energy-dense, high-saturated-fat, and low-fiber DP was longitudinally associated with increases in cardiometabolic risk factors in severe obesity but not with CVD incidence.
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Affiliation(s)
- David J Johns
- Diet and Obesity Research, Medical Research Council, Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
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22
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Trends in consumption of ultra-processed foods and obesity in Sweden between 1960 and 2010. Public Health Nutr 2015; 18:3096-107. [DOI: 10.1017/s1368980015000506] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AbstractObjectiveTo investigate how consumption of ultra-processed foods has changed in Sweden in relation to obesity.DesignNationwide ecological analysis of changes in processed foods along with corresponding changes in obesity. Trends in per capita food consumption during 1960–2010 were investigated using data from the Swedish Board of Agriculture. Food items were classified as group 1 (unprocessed/minimally processed), group 2 (processed culinary ingredients) or group 3 (3·1, processed food products; and 3·2, ultra-processed products). Obesity prevalence data were pooled from the peer-reviewed literature, Statistics Sweden and the WHO Global Health Observatory.SettingNationwide analysis in Sweden, 1960–2010.SubjectsSwedish nationals aged 18 years and older.ResultsDuring the study period consumption of group 1 foods (minimal processing) decreased by 2 %, while consumption of group 2 foods (processed ingredients) decreased by 34 %. Consumption of group 3·1 foods (processed food products) increased by 116 % and group 3·2 foods (ultra-processed products) increased by 142 %. Among ultra-processed products, there were particularly large increases in soda (315 %; 22 v. 92 litres/capita per annum) and snack foods such as crisps and candies (367 %; 7 v. 34 kg/capita per annum). In parallel to these changes in ultra-processed products, rates of adult obesity increased from 5 % in 1980 to over 11 % in 2010.ConclusionsThe consumption of ultra-processed products (i.e. foods with low nutritional value but high energy density) has increased dramatically in Sweden since 1960, which mirrors the increased prevalence of obesity. Future research should clarify the potential causal role of ultra-processed products in weight gain and obesity.
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de Munter JS, Tynelius P, Magnusson C, Rasmussen F. Longitudinal analysis of lifestyle habits in relation to body mass index, onset of overweight and obesity: results from a large population-based cohort in Sweden. Scand J Public Health 2015; 43:236-45. [PMID: 25740615 DOI: 10.1177/1403494815569865] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 11/17/2022]
Abstract
AIMS It is currently unknown whether the prevalence of obesity is increasing or has levelled off in Sweden and other Westernised countries. Given the major importance of lifestyle habits on weight status, we aimed to explore associations of longitudinal changes in lifestyle habits with changes in body mass index (BMI), and the onset of overweight and obesity. METHODS Participants (aged 18-84 years at baseline) were included from the Stockholm Public Health Cohort 2002-2010 (n=23,108). Weight status was from self-reported height and weight. Investigated lifestyle habits were leisure-time physical activity, and fruit, alcohol and smoking habits. We estimated associations of stable, improving or worsening lifestyle habits with longitudinal changes in BMI and onset of overweight or obesity between 2002 and 2010. RESULTS Both men and women increased in weight during the eight years of follow-up. Incidence of obesity was lower in men who increased their leisure-time physical activity (Relative Risk [RR]=0.58, 95% confidence interval 0.42-0.81) than in inactive individuals; the same applied to women (RR=0.37, 0.25-0.54), and similar patterns were identified for overweight and BMI in both genders. Smoking cessation was associated with onset of obesity for men (RR=1.69, 1.15-2.50) and women (RR=1.99, 1.39-2.85). Stable low alcohol intake or decreasing alcohol intake and daily fruit intake was associated with less weight gain, but only in men. CONCLUSIONS Improving physical activity in both men and women, and alcohol habits and fruit intake in men, prevents excess weight gain among adult people in Sweden. Such an improvement might diminish weight gain after smoking cessation.
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Affiliation(s)
- Jeroen S de Munter
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Per Tynelius
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Finn Rasmussen
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Abstract
This review summarizes recent evidence related to the safety, efficacy, and metabolic outcomes of bariatric surgery to guide clinical decision making. Several short term randomized controlled trials have demonstrated the effectiveness of bariatric procedures for inducing weight loss and initial remission of type 2 diabetes. Observational studies have linked bariatric procedures with long term improvements in body weight, type 2 diabetes, survival, cardiovascular events, incident cancer, and quality of life. Perioperative mortality for the average patient is low but varies greatly across subgroups. The incidence of major complications after surgery also varies widely, and emerging data show that some procedures are associated with a greater risk of substance misuse disorders, suicide, and nutritional deficiencies. More research is needed to enable long term outcomes to be compared across various procedures and subpopulations, and to identify those most likely to benefit from surgical intervention. Given uncertainties about the balance between the risks and benefits of bariatric surgery in the long term, the decision to undergo surgery should be based on a high quality shared decision making process.
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Affiliation(s)
- David E Arterburn
- Group Health Research Institute, Group Health Cooperative, Seattle, WA 98101, USA
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25
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Peat G, Bergknut C, Frobell R, Jöud A, Englund M. Population-wide incidence estimates for soft tissue knee injuries presenting to healthcare in southern Sweden: data from the Skåne Healthcare Register. Arthritis Res Ther 2014; 16:R162. [PMID: 25082600 PMCID: PMC4262192 DOI: 10.1186/ar4678] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 07/21/2014] [Indexed: 01/05/2023] Open
Abstract
Introduction Soft tissue knee injury is a well-established and potent risk factor for development of knee osteoarthritis. However, there is a paucity of epidemiological data from the general population. Our aim was to estimate the annual person-level incidence for a wide spectrum of clinically diagnosed soft tissue knee injuries, and their distribution by age, sex, and season. Methods In Sweden, in- and outpatient health care is registered using each individuals’ unique personal identifier including International Classification of Diseases (ICD) 10 diagnostic code(s) as determined by physicians’ clinical examination. For the calendar years 2004–2012, we studied the population in southern Sweden, Skåne region (approx. 1.3 million). We identified residents who had at least one visit to a physician with clinically diagnosed knee ligament, meniscal, or other soft-tissue injury (S80.0, S83 and all subdiagnoses). We then calculated the mean annual incidence over the 9-year period. As a secondary objective, we investigated potential seasonal variation. Results The annual incidence for males and females was 766 (95% CI: 742, 789) and 676 (649, 702) per 100,000 persons/year respectively. For males and females, the peak rate occurred in 15 to 19 year-olds (1698 per 100,000 men and 1464 per 100,000 women, respectively). In women, rates were lowest in the 25 to 34 year-old age range before rising again between the ages of 35 and 49 years. We found substantial seasonal variation, greatest in men, with peaks in March-May and August-October. Conclusions The incidence of clinically diagnosed soft-tissue knee injury peaks in adolescence and emerging adulthood. However, a range of knee injuries continue to occur across the adult lifespan including at ages when osteoarthritis is typically diagnosed and managed. The potential cumulative effect on osteoarthritis progression of these injuries may warrant further investigation. Electronic supplementary material The online version of this article (doi:10.1186/ar4678) contains supplementary material, which is available to authorized users.
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Visscher TLS, Heitmann BL, Rissanen A, Lahti-Koski M, Lissner L. A break in the obesity epidemic? Explained by biases or misinterpretation of the data? Int J Obes (Lond) 2014; 39:189-98. [PMID: 24909829 DOI: 10.1038/ijo.2014.98] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 03/14/2014] [Accepted: 04/01/2014] [Indexed: 12/24/2022]
Abstract
Recent epidemiologic papers are presenting prevalence data suggesting breaks and decreases in obesity rates. However, before concluding that the obesity epidemic is not increasing anymore, the validity of the presented data should be discussed more thoroughly. We had a closer look into the literature presented in recent reviews to address the major potential biases and distortions, and to develop insights about how to interpret the presented suggestions for a potential break in the obesity epidemic. Decreasing participation rates, the use of reported rather than measured data and small sample sizes, or lack of representativeness, did not seem to explain presented breaks in the obesity epidemic. Further, available evidence does not suggest that stabilization of obesity rates is seen in higher socioeconomic groups only, or that urbanization could explain a potential break in the obesity epidemic. However, follow-ups of short duration may, in part, explain the apparent break or decrease in the obesity epidemic. On the other hand, a single focus on body mass index (BMI) ⩾25 or ⩾30 kg m(-)(2) is likely to mask a real increase in the obesity epidemic. And, in both children and adults, trends in waist circumferences were generally suggesting an increase, and were stronger than those reported for trends in BMI. Studies concluding that there is a recent break in the obesity epidemic need to be interpreted with caution. Reported studies presenting a break were mostly of short duration. Further, focusing on trends in waist circumference rather than BMI leads to a less optimistic conclusion: the public health problem of obesity is still increasing.
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Affiliation(s)
- T L S Visscher
- 1] Research Centre for the Prevention of Overweight (Zwolle), Windesheim University of Applied Sciences and VU University, Zwolle, The Netherlands [2] Institute of Health Sciences, VU University, Amsterdam, The Netherlands [3] Prevention and Public Health Taskforce, European Association for the Study of Obesity, London, UK
| | - B L Heitmann
- 1] Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals, The Capital Region, Copenhagen, Denmark [2] National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark [3] The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
| | - A Rissanen
- 1] Prevention and Public Health Taskforce, European Association for the Study of Obesity, London, UK [2] Helsinki University Central Hospital, Helsinki, Finland
| | - M Lahti-Koski
- 1] Prevention and Public Health Taskforce, European Association for the Study of Obesity, London, UK [2] Finnish Heart Association, Helsinki, Finland
| | - L Lissner
- 1] Prevention and Public Health Taskforce, European Association for the Study of Obesity, London, UK [2] Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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Mägi R, Manning S, Yousseif A, Pucci A, Santini F, Karra E, Querci G, Pelosini C, McCarthy MI, Lindgren CM, Batterham RL. Contribution of 32 GWAS-identified common variants to severe obesity in European adults referred for bariatric surgery. PLoS One 2013; 8:e70735. [PMID: 23950990 PMCID: PMC3737377 DOI: 10.1371/journal.pone.0070735] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/27/2013] [Indexed: 12/25/2022] Open
Abstract
The prevalence of severe obesity, defined as body mass index (BMI) ≥ 35.0 kg/m(2), is rising rapidly. Given the disproportionately high health burden and healthcare costs associated with this condition, understanding the underlying aetiology, including predisposing genetic factors, is a biomedical research priority. Previous studies have suggested that severe obesity represents an extreme tail of the population BMI variation, reflecting shared genetic factors operating across the spectrum. Here, we sought to determine whether a panel of 32 known common obesity-susceptibility variants contribute to severe obesity in patients (n = 1,003, mean BMI 48.4 ± 8.1 kg/m(2)) attending bariatric surgery clinics in two European centres. We examined the effects of these 32 common variants on obesity risk and BMI, both as individual markers and in combination as a genetic risk score, in a comparison with normal-weight controls (n = 1,809, BMI 18.0-24.9 kg/m(2)); an approach which, to our knowledge, has not been previously undertaken in the setting of a bariatric clinic. We found strong associations with severe obesity for SNP rs9939609 within the FTO gene (P = 9.3 × 10(-8)) and SNP rs2815752 near the NEGR1 gene (P = 3.6 × 10(-4)), and directionally consistent nominal associations (P<0.05) for 12 other SNPs. The genetic risk score associated with severe obesity (P = 8.3 × 10(-11)) but, within the bariatric cohort, this score did not associate with BMI itself (P = 0.264). Our results show significant effects of individual BMI-associated common variants within a relatively small sample size of bariatric patients. Furthermore, the burden of such low-penetrant risk alleles contributes to severe obesity in this population. Our findings support that severe obesity observed in bariatric patients represents an extreme tail of the population BMI variation. Moreover, future genetic studies focused on bariatric patients may provide valuable insights into the pathogenesis of obesity at a population level.
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Affiliation(s)
- Reedik Mägi
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Sean Manning
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, United Kingdom
- University College London Hospitals/University College London National Institute of Health Research Biomedical Research Centre, London, United Kingdom
- University College London Hospitals Centre for Weight loss, Metabolic and Endocrine Surgery, University College London Hospitals, London, United Kingdom
| | - Ahmed Yousseif
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, United Kingdom
| | - Andrea Pucci
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, United Kingdom
- Obesity Center at the Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Ferruccio Santini
- Obesity Center at the Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Efthimia Karra
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, United Kingdom
| | - Giorgia Querci
- Obesity Center at the Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Caterina Pelosini
- Obesity Center at the Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Mark I. McCarthy
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom
- Oxford National Institute of Health Research Biomedical Research Centre, Churchill Hospital, Oxford, United Kingdom
| | - Cecilia M. Lindgren
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Rachel L. Batterham
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, United Kingdom
- University College London Hospitals/University College London National Institute of Health Research Biomedical Research Centre, London, United Kingdom
- University College London Hospitals Centre for Weight loss, Metabolic and Endocrine Surgery, University College London Hospitals, London, United Kingdom
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Lissner L, Mehlig K, Sjöberg A, Chaplin J, Niklasson A, Albertsson-Wikland K. Secular trends in weight, height and BMI in young Swedes: the 'Grow up Gothenburg' studies. Acta Paediatr 2013; 102:314-7. [PMID: 23163912 DOI: 10.1111/apa.12087] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 11/07/2012] [Indexed: 11/27/2022]
Abstract
AIM This study aims to document secular differences in anthropometry (level and variability of weight, height, BMI) in two cohorts born around 1990 and 1974 and examined as young adults. METHODS Descriptive results are presented for the complete cohorts. The final analysis age-matched the cohorts (mean, 18.8 years) and employed CDC z-scores to compare means and distributions of weight, height and BMI. RESULTS Z-scores for weight, height and BMI were higher in later-born (1990) boys, while in girls weight and height increased over this period without resulting in increased BMI. At the same time, in boys the BMI variances increased, confirming a simultaneous emergence of more overweight and more underweight. In girls, the BMI variance did not increase significantly. Sensitivity analyses, excluding subjects not born in Sweden, confirmed increasing BMI trends in boys. CONCLUSION This study documents that gender differences in the recent childhood obesity epidemic can also be observed in young Swedes as they enter adulthood. Comparing two cohorts of high school students born around 1974 or 1990, less favourable trends in weight status were seen in boys than in girls. Finally, secular increases in height, already observed earlier in the 20th century, continued in these more contemporary cohorts.
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Affiliation(s)
- L Lissner
- Department of Public Health and Community Medicine; Institute of Medicine; Sahlgrenska Academy at University of Gothenburg; Gothenburg; Sweden
| | - K Mehlig
- Department of Public Health and Community Medicine; Institute of Medicine; Sahlgrenska Academy at University of Gothenburg; Gothenburg; Sweden
| | | | - J Chaplin
- Gothenburg Pediatric Growth Research Center (GP-GRC); Department of Pediatrics; Institute of Clinical Sciences; Sahlgrenska Academy at University of Gothenburg; Gothenburg; Sweden
| | - A Niklasson
- Gothenburg Pediatric Growth Research Center (GP-GRC); Department of Pediatrics; Institute of Clinical Sciences; Sahlgrenska Academy at University of Gothenburg; Gothenburg; Sweden
| | - K Albertsson-Wikland
- Gothenburg Pediatric Growth Research Center (GP-GRC); Department of Pediatrics; Institute of Clinical Sciences; Sahlgrenska Academy at University of Gothenburg; Gothenburg; Sweden
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di Pietro M, Fitzgerald RC. Screening and risk stratification for Barrett's esophagus: how to limit the clinical impact of the increasing incidence of esophageal adenocarcinoma. Gastroenterol Clin North Am 2013; 42:155-73. [PMID: 23452636 DOI: 10.1016/j.gtc.2012.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Barrett's esophagus (BE) and gastroesophageal reflux disease are the strongest risk factors for esophageal adenocarcinoma. To reduce the clinical impact of this disease, endoscopic screening to detect BE has been proposed and nonendoscopic diagnostic techniques are under investigation. Because screening would result in new diagnoses of BE and additional costs related to endoscopic surveillance, novel tools for risk stratification are also warranted. Dysplasia is the gold standard for risk stratification. Molecular biomarkers may provide a more objective and reproducible estimation of the individual risk, and further prospective studies are required as a prelude to introducing biomarkers into routine clinical practice.
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Thrift AP, Whiteman DC. The incidence of esophageal adenocarcinoma continues to rise: analysis of period and birth cohort effects on recent trends. Ann Oncol 2012; 23:3155-3162. [PMID: 22847812 DOI: 10.1093/annonc/mds181] [Citation(s) in RCA: 270] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND During the past four decades, the incidence of esophageal adenocarcinoma (EAC) has increased markedly in Western populations. Recent reports have suggested that the rate of increase has slowed or plateaued. PATIENTS AND METHODS Using data from cancer registries in Australia, the United States and Sweden, we examined incidence trends for esophageal and gastric cardia tumors between 1984 and 2008 using joinpoint analyses and age-period-cohort models. RESULTS EAC incidence continues to undergo statistically significant annual increases in Australia and the United States, although the rate of increase has slowed. Among men, incidence increased annually by 2.2% [95% confidence interval (CI) 1.5% to 2.9%] between 1994 and 2008 in Australia and 1.5% (95% CI 0.2% to 2.8%) between 1998 and 2008 in the United States. EAC incidence among men remained unchanged in Sweden between 2001 and 2008 (P = 0.52). EAC incidence among women showed significant linear increases between 1984 and 2008. Age-period-cohort models suggested strong effects for both period and birth cohort on EAC incidence in Australia and the United States, and a strong period effect for Sweden. CONCLUSIONS EAC incidence continues to increase in Australia and the United States. The continued increases, even among more recent birth cohorts, suggest that EAC incidence will continue to rise during coming decades.
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Affiliation(s)
- A P Thrift
- Population Health Department, Queensland Institute of Medical Research, Brisbane, Queensland; School of Population Health, The University of Queensland, Brisbane, Queensland, Australia.
| | - D C Whiteman
- Population Health Department, Queensland Institute of Medical Research, Brisbane, Queensland
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Kark M, Karnehed N. Weight status at age 18 influences marriage prospects. A population-based study of Swedish men. BMC Public Health 2012; 12:833. [PMID: 23020864 PMCID: PMC3505734 DOI: 10.1186/1471-2458-12-833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 09/27/2012] [Indexed: 11/28/2022] Open
Abstract
Background In a longitudinal population-based study of the relationship between body mass index (BMI) in early adulthood and marital status at 40 years of age, obese men were half as likely to be married compared with men of normal weight. Significant associations between obesity and marital status among men in a longitudinal setting are novel findings. Methods The study cohort comprised Swedish men born from 1951 to 1961. Height and weight at age 18 was gathered from the Military Service Conscription Register and information on marital status at 40 years of age was obtained from population registers by record-linkage using the unique personal identification number. The odds ratio (OR) for being married was calculated by polytomous logistic regression analysis adjusting for birth year, intellectual performance, education, country of birth, residential area, socioeconomic position in childhood and adulthood, parental education and muscle strength. Results Our study included 486 599 Swedish men. Young men who were obese (BMI≥30.0) at 18 years of age had an OR of 0.49 (95% CI: 0.46–0.52) for being married at 40 years of age compared to normal weight men (BMI: 18.5–24.9). Underweight men (BMI≤18.5) had an OR of 0.84 (0.82–0.86) and overweight men (BMI: 25.0–29.9) had an OR of 0.83 (0.80–0.85) for being married at 40 years of age. Conclusion Underweight, overweight and obese men were less likely to be married than their normal weight counterparts. Obese men had the lowest likelihood of being married. Stigmatization and discrimination may partly explain these findings, but further research is needed before firm conclusions can be drawn.
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Affiliation(s)
- Malin Kark
- Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institutet, Norrbacka, Stockholm 171 76, Sweden.
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Almgren M, Atkinson R, He J, Hilding A, Hagman E, Wolk A, Thorell A, Marcus C, Näslund E, Östenson CG, Schalling M, Lavebratt C. Adenovirus-36 is associated with obesity in children and adults in Sweden as determined by rapid ELISA. PLoS One 2012; 7:e41652. [PMID: 22848557 PMCID: PMC3407196 DOI: 10.1371/journal.pone.0041652] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 06/25/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Experimental and natural human adenovirus-36 (Adv36) infection of multiple animal species results in obesity through increasing adipogenesis and lipid accumulation in adipocytes. Presence of Adv36 antibodies detected by serum neutralization assay has previously been associated with obesity in children and adults living in the USA, South Korea and Italy, whereas no association with adult obesity was detected in Belgium/The Netherlands nor among USA military personnel. Adv36 infection has also been shown to reduce blood lipid levels, increase glucose uptake by adipose tissue and skeletal muscle biopsies, and to associate with improved glycemic control in non-diabetic individuals. PRINCIPAL FINDINGS Using a novel ELISA, 1946 clinically well-characterized individuals including 424 children and 1522 non-diabetic adults, and 89 anonymous blood donors, residing in central Sweden representing the population in Stockholm area, were studied for the presence of antibodies against Adv36 in serum. The prevalence of Adv36 positivity in lean individuals increased from ∼7% in 1992-1998 to 15-20% in 2002-2009, which paralleled the increase in obesity prevalence. We found that Adv36-positive serology was associated with pediatric obesity and with severe obesity in females compared to lean and overweight/mildly obese individuals, with a 1.5 to 2-fold Adv36 positivity increase in cases. Moreover, Adv36 positivity was less common among females and males on antilipid pharmacological treatment or with high blood triglyceride level. Insulin sensitivity, measured as lower HOMA-IR, showed a higher point estimate in Adv36-positive obese females and males, although it was not statistically significant (p = 0.08). CONCLUSION Using a novel ELISA we show that Adv36 infection is associated with pediatric obesity, severe obesity in adult females and lower risk of high blood lipid levels in non-diabetic Swedish individuals.
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Affiliation(s)
- Malin Almgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Richard Atkinson
- Obetech Obesity Research Center and Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Jia He
- Obetech Obesity Research Center and Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Agneta Hilding
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Emilia Hagman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Alicja Wolk
- Division of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Thorell
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet and Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Claes-Göran Östenson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Martin Schalling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Catharina Lavebratt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
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Lahti-Koski M, Harald K, Saarni SE, Peltonen M, Männistö S. Changes in body mass index and measures of abdominal obesity in Finnish adults between 1992 and 2007, the National FINRISK Study. Clin Obes 2012; 2:57-63. [PMID: 25586048 DOI: 10.1111/j.1758-8111.2012.00035.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED What is already known about this subject • Recent obesity trends across the world in adults are mixed, varying from showing signs of levelling off to a continuously increasing prevalence. • Secular trends in body mass index (BMI) and waist circumference may vary by sex and age. • Relying exclusively on BMI data may lead to underestimate the obesity epidemic. What this study adds • Adverse trends in obesity indicators have continued in Finland in the 2000s. • In older men, BMI remained quite stable and in older women BMI has decreased since 1997. • Steep upward trends in abdominal obesity (waist circumference and waist-to-height ratio, WHtR) have taken place in both men and women and in all age groups, especially during the past 10 years. • The impact of BMI adjustment on trends in abdominal obesity varied by age such that increases in BMI-adjusted waist circumference and WHtR were more prominent in older age groups. SUMMARY Signs that obesity trends will level off at the turn of the 21st century have been reported. In these studies, however, the definition of obesity has been based only on body mass index (BMI). We investigated obesity trends among Finnish adults over recent years by using BMI, waist circumference and waist-to-height ratio as indicators for obesity. Data were derived from the national FINRISK surveys, which are cross-sectional population surveys conducted at 5-year intervals between 1992 and 2007. Altogether, 20 551 randomly selected men and women aged 25-64 years participated in health examinations, where weight, height, and waist and hip circumferences were measured by trained nurses. Mean BMI increased in younger men and women (aged 25-44 years) between 1992 and 2007, whereas in older men, BMI remained quite stable and in older women BMI has decreased since 1997. Nevertheless, mean waist circumference and waist-to-height ratio increased in both men and women over the 15-year period. The upward trends took place in all age groups, especially during the past 10 years. Adverse trends in obesity indicators have continued in Finland in the 2000s. In particular, concerns are related to steep upward trends in abdominal obesity.
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Affiliation(s)
- M Lahti-Koski
- Finnish Heart Association, Helsinki, FinlandNational Institute for Health and Welfare (THL), Helsinki, FinlandDepartment of Psychiatry, Health Center, City of Helsinki, Helsinki, Finland
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Kral JG, Kava RA, Catalano PM, Moore BJ. Severe obesity: the neglected epidemic. Obes Facts 2012; 5:254-69. [PMID: 22647306 DOI: 10.1159/000338566] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 02/12/2012] [Indexed: 12/18/2022] Open
Abstract
Severe obesity (SO) is increasing faster than obesity in adults and in children. Because it is associated with numerous comorbidities, SO accounts for more health care expenditures than any other medical condition. Furthermore, it is associated with poor pregnancy outcomes for mother, fetus, and infant and a high risk of offspring obesity carried into adulthood. Bariatric surgery is the treatment of choice for SO because nonoperative methods fail to provide medically significant durable weight loss and because it is both preventive and therapeutic. The number of operations has sharply increased globally, yet only a small fraction of eligible patients are referred for surgical treatment demonstrating the need for improved access, especially for those disproportionately affected by SO. The risks of surgery mandate careful postoperative long-term multidisciplinary follow-up care. Education is critical for truly informed consent and must continue postoperatively, especially for women with reproductive potential. Even so, surgical treatment of SO remains cost-effective compared to conventional nonoperative treatment, which also requires long-term care. Just as obesity affects all medical disciplines (from allergology and immunology to oncology, urology and women's health), so does postoperative management of bariatric surgery patients. We offer wide-ranging recommendations for policymakers and others to consider in addressing SO.
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Affiliation(s)
- John G Kral
- Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Rokholm B, Silventoinen K, Tynelius P, Gamborg M, Sørensen TIA, Rasmussen F. Increasing genetic variance of body mass index during the Swedish obesity epidemic. PLoS One 2011; 6:e27135. [PMID: 22087252 PMCID: PMC3210134 DOI: 10.1371/journal.pone.0027135] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 10/11/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is no doubt that the dramatic worldwide increase in obesity prevalence is due to changes in environmental factors. However, twin and family studies suggest that genetic differences are responsible for the major part of the variation in adiposity within populations. Recent studies show that the genetic effects on body mass index (BMI) may be stronger when combined with presumed risk factors for obesity. We tested the hypothesis that the genetic variance of BMI has increased during the obesity epidemic. METHODS The data comprised height and weight measurements of 1,474,065 Swedish conscripts at age 18-19 y born between 1951 and 1983. The data were linked to the Swedish Multi-Generation Register and the Swedish Twin Register from which 264,796 full-brother pairs, 1,736 monozygotic (MZ) and 1,961 dizygotic (DZ) twin pairs were identified. The twin pairs were analysed to identify the most parsimonious model for the genetic and environmental contribution to BMI variance. The full-brother pairs were subsequently divided into subgroups by year of birth to investigate trends in the genetic variance of BMI. RESULTS The twin analysis showed that BMI variation could be explained by additive genetic and environmental factors not shared by co-twins. On the basis of the analyses of the full-siblings, the additive genetic variance of BMI increased from 4.3 [95% CI 4.04-4.53] to 7.9 [95% CI 7.28-8.54] within the study period, as did the unique environmental variance, which increased from 1.4 [95% CI 1.32-1.48] to 2.0 [95% CI 1.89-2.22]. The BMI heritability increased from 75% to 78.8%. CONCLUSION The results confirm the hypothesis that the additive genetic variance of BMI has increased strongly during the obesity epidemic. This suggests that the obesogenic environment has enhanced the influence of adiposity related genes.
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Affiliation(s)
- Benjamin Rokholm
- Institute of Preventive Medicine, Copenhagen University Hospital, Centre for Health and Society, Copenhagen, Denmark.
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ORTEGA FRANCISCOB, LABAYEN IDOIA, RUIZ JONATANR, KURVINEN ELVIRA, LOIT HELLEMAI, HARRO JAANUS, VEIDEBAUM TOOMAS, SJÖSTRÖM MICHAEL. Improvements in Fitness Reduce the Risk of Becoming Overweight across Puberty. Med Sci Sports Exerc 2011; 43:1891-7. [PMID: 21407124 DOI: 10.1249/mss.0b013e3182190d71] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Trends in the prevalence of morbid obesity in Australian children and adolescents from 1985 to 2008: what do we know about? Int J Obes (Lond) 2011; 35:1331; author reply 1332-3. [PMID: 21712807 DOI: 10.1038/ijo.2011.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sundström J, Neovius M, Tynelius P, Rasmussen F. Association of blood pressure in late adolescence with subsequent mortality: cohort study of Swedish male conscripts. BMJ 2011; 342:d643. [PMID: 21343202 PMCID: PMC3042737 DOI: 10.1136/bmj.d643] [Citation(s) in RCA: 184] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate the nature and magnitude of relations of systolic and diastolic blood pressures in late adolescence to mortality. DESIGN Nationwide cohort study. SETTING General community in Sweden. PARTICIPANTS Swedish men (n = 1,207,141) who had military conscription examinations between 1969 and 1995 at a mean age of 18.4 years, followed up for a median of 24 (range 0-37) years. MAIN OUTCOME MEASURES Total mortality, cardiovascular mortality, and non-cardiovascular mortality. RESULTS During follow-up, 28,934 (2.4%) men died. The relation of systolic blood pressure to total mortality was U shaped, with the lowest risk at a systolic blood pressure of about 130 mm Hg. This pattern was driven by the relation to non-cardiovascular mortality, whereas the relation to cardiovascular mortality was monotonically increasing (higher risk with higher blood pressure). The relation of diastolic blood pressure to mortality risk was monotonically increasing and stronger than that of systolic blood pressure, in terms of both relative risk and population attributable fraction (deaths that could be avoided if blood pressure was in the optimal range). Relations to cardiovascular and non-cardiovascular mortality were similar, with an apparent risk threshold at a diastolic blood pressure of about 90 mm Hg, below which diastolic blood pressure and mortality were unrelated, and above which risk increased steeply with higher diastolic blood pressures. CONCLUSIONS In adolescent men, the relation of diastolic blood pressure to mortality was more consistent than that of systolic blood pressure. Considering current efforts for earlier detection and prevention of risk, these observations emphasise the risk associated with high diastolic blood pressure in young adulthood.
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Affiliation(s)
- Johan Sundström
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, SE-75185 Uppsala, Sweden.
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Rokholm B, Baker JL, Sørensen TIA. The levelling off of the obesity epidemic since the year 1999--a review of evidence and perspectives. Obes Rev 2010; 11:835-46. [PMID: 20973911 DOI: 10.1111/j.1467-789x.2010.00810.x] [Citation(s) in RCA: 405] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The purpose was to investigate a possible levelling off in the obesity epidemic, by systematically reviewing literature and web-based sources. Eligible studies and data sources were required to have at least two measures of obesity prevalence since 1999. A literature and Internet search resulted in 52 studies from 25 different countries. The findings supported an overall levelling off of the epidemic in children and adolescents from Australia, Europe, Japan and the USA. In adults, stability was found in the USA, while increases were still observed in some European and Asian countries. Some evidence for heterogeneity in the obesity trends across socioeconomic status (SES) groups was found. The levelling off was less evident in the lower-SES groups. No obvious differences between genders were identified. We discussed potential explanations for a levelling off and the utility of investigating obesity trends to identify the driving forces behind the epidemic. It is important to emphasize that the levelling off is not tantamount to calling off the epidemic. Additionally, it is worthwhile to keep in mind that previous stable phases have been followed by further increases in the prevalence of obesity. Therefore, research into the causes, prevention and treatment of obesity should remain a priority.
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Affiliation(s)
- B Rokholm
- Institute of Preventive Medicine, Copenhagen University Hospital, Denmark.
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Neovius K, Neovius M, Kark M, Rasmussen F. Association between obesity status and sick-leave in Swedish men: nationwide cohort study. Eur J Public Health 2010; 22:112-6. [DOI: 10.1093/eurpub/ckq183] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Neovius K, Rasmussen F, Sundström J, Neovius M. Forecast of future premature mortality as a result of trends in obesity and smoking: nationwide cohort simulation study. Eur J Epidemiol 2010; 25:703-9. [DOI: 10.1007/s10654-010-9485-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 06/22/2010] [Indexed: 11/30/2022]
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Hansson LM, Näslund E, Rasmussen F. Perceived discrimination among men and women with normal weight and obesity. A population-based study from Sweden. Scand J Public Health 2010; 38:587-96. [PMID: 20529966 DOI: 10.1177/1403494810372266] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS We examined whether men and women with obesity reported different types of discrimination to a greater extent than those with normal weight, and explored whether these associations were modified by socioeconomic position. METHOD National representative sample of men and women, with normal weight (n = 2,000), moderate obesity (n = 2,461) and severe obesity (n = 557). Participants were identified in a yearly population-based survey (1996-2006) and data on perceived discrimination and potential confounding factors were measured in 2008. Logistic regression models tested whether obesity was associated with perceived lifetime, workplace, healthcare and interpersonal discrimination. RESULTS The overall response rate was 56%. For men, moderate obesity was associated with workplace discrimination, while severely obese women were more likely to report this sort of discrimination than normal weight women. Severely obese individuals were twice as likely to report healthcare discrimination than normal weight individuals. Women, regardless of weight status group, were in turn twice as likely to report healthcare discrimination as men. Women with severe obesity were significantly more likely to report interpersonal discrimination compared with normal weight women. Socioeconomic position modified the association between weight status and healthcare discrimination. Highly educated individuals with moderate and severe obesity were more likely to report healthcare discrimination than their normal weight counterparts, whereas low educated individuals with normal weight, moderate and severe obesity were equally likely to report discrimination. CONCLUSIONS In this large, population-based study, discrimination was more likely to be reported by obese individuals compared with those of normal weight. The associations, however, varied according to gender and socioeconomic position.
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Affiliation(s)
- Lena M Hansson
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
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Cannabis constituents modulate δ9-tetrahydrocannabinol-induced hyperphagia in rats. Psychopharmacology (Berl) 2010; 210:97-106. [PMID: 20349049 DOI: 10.1007/s00213-010-1821-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 02/26/2010] [Indexed: 10/19/2022]
Abstract
RATIONALE The hyperphagic effect of Delta9-tetrahydrocannabinol (Delta9THC) in humans and rodents is well known. However, no studies have investigated the importance of Delta9THC composition and any influence other non-Delta9THC cannabinoids present in Cannabis sativa may have. We therefore compared the effects of purified Delta9THC, synthetic Delta9THC (dronabinol), and Delta9THC botanical drug substance (Delta9THC-BDS), a Delta9THC-rich standardized extract comparable in composition to recreationally used cannabis. METHODS Adult male rats were orally dosed with purified Delta9THC, synthetic Delta9THC, or Delta9THC-BDS, matched for Delta9THC content (0.34-2.68 mg/kg). Prior to dosing, subjects were satiated, and food intake was recorded following Delta9THC administration. Data were then analyzed in terms of hourly intake and meal patterns. RESULTS All three Delta9THC substances tested induced significant hyperphagic effects at doses >or=0.67 mg/kg. These effects included increased intake during hour one, a shorter latency to onset of feeding and a greater duration and consumption in the first meal. However, while some differences in vehicle control intakes were observed, there were significant, albeit subtle, differences in pattern of effects between the purified Delta9THC and Delta9THC-BDS. CONCLUSION All Delta9THC compounds displayed classical Delta9THC effects on feeding, significantly increasing shortterm intake whilst decreasing latency to the first meal. We propose that the subtle adjustment to the meal patterns seen between the purified Delta9THC and Delta9THC-BDS are due to non-Delta9THC cannabinoids present in Delta9THC-BDS. These compounds and other non-cannabinoids have an emerging and diverse pharmacology and can modulate Delta9THC-induced hyperphagia, making them worth further investigation for their therapeutic potential.
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Sex differences among Swedish adolescents in mother–child relationships in the intake of different food groups. Br J Nutr 2010; 103:1205-11. [DOI: 10.1017/s0007114509992972] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The present study has explored mother–child relationships in the intake of different food groups and the sex differences in these relationships. A population-based sample of 471 mother–child pairs from Stockholm completed a dietary questionnaire to assess habitual dietary intake. Girls showed overall stronger correlations with their mothers' diet than boys did. The strongest correlations found, in both girls and boys, were for the intakes of fruit juice and sweet bakery goods (r 0·30–0·37, P < 0·001). There was a wide range in correlation strength between food groups. Milk/yoghurt and desserts showed no mother–child relationship at all. Breakfast cereals was the only food group with a significant sex interaction (P = 0·01; mothers–girls, r 0·30, P < 0·001; mothers–boys, r0·05, NS). There were significant positive correlations between mothers and daughters in the intake of all macronutrients, whereas none between mothers and sons (sex interactions: protein, P = 0·001; fat, P = 0·004; carbohydrates, P = 0·001). Mothers and daughters (r 0·29, P < 0·001), but not mothers and sons, showed significant correlation in total energy intake, (P = 0·001 for sex interaction). There were generally more differences between mothers and children than between boys and girls in the relative intake (percentage of energy) of different food groups. Since teenaged children have a similar intake of especially snack foods as their mothers, it could be meaningful to educate mothers when aiming at improving the diet of teenaged children, both boys and girls.
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Jacobsson JA, Risérus U, Axelsson T, Lannfelt L, Schiöth HB, Fredriksson R. The common FTO variant rs9939609 is not associated with BMI in a longitudinal study on a cohort of Swedish men born 1920-1924. BMC MEDICAL GENETICS 2009; 10:131. [PMID: 20003232 PMCID: PMC2797506 DOI: 10.1186/1471-2350-10-131] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 12/09/2009] [Indexed: 11/12/2022]
Abstract
Background Common FTO (fat mass and obesity associated) gene variants have recently been strongly associated with body mass index and obesity in several large studies. Here we set out to examine the association of the FTO variant rs9939609 with BMI in a 32 year follow up study of men born 1920-1924. Moreover, we analyzed the effect of physical activity on the different genotypes. Methods The FTO rs9936609 was genotyped using an Illumina golden gate assay. BMI was calculated using standard methods and body fat was estimated by measuring skinfold thickness using a Harpenden caliper. Physical activity was assessed using a four question medical questionnaire. Results FTO rs9939609 was genotyped in 1153 elderly Swedish men taking part of a population-based cohort study, the ULSAM cohort. The risk of obesity and differences in BMI according to genotype at the ages of 50, 60, 70, 77 and 82 were investigated. We found no increased risk of obesity and no association with BMI at any age with the FTO rs9939609 variant. We found however interaction between physical activity at the age of 50 years and genotype on BMI levels (p = 0.039) and there was a clear trend towards larger BMI differences between the TT and AA carriers as well as between AT and AA carriers in the less physically active subjects. Conclusion Here we found that the well established obesity risk allele for a common variant in FTO does not associate with increased BMI levels in a Swedish population of adult men which reached adulthood before the appearance of today's obesogenic enviroment. There is an interaction between physical activity and the effect of the FTO genotype on BMI levels suggesting that lack of physical activity is a requirement for an association of FTO gene variants to obesity.
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Affiliation(s)
- Josefin A Jacobsson
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden.
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Abstract
This review identified 36 studies on the relation between obesity status and sick leave. Pooling of effect estimates was not possible due to great heterogeneity between studies regarding definition of sick leave (short-term/long-term), measure of obesity (body mass index/waist circumference/percentage body fat), definition of obesity status (World Health Organization standards/other), study population (sex/age/occupation/country) and exposure and outcome ascertainment (self-reported/objectively assessed). Nevertheless, a clear trend towards greater sick leave among obese compared with normal weight workers could be discerned, especially for spells of longer duration. In studies from the USA, which consistently reported about five times lower number of sick leave days per person-year than European, obese workers had about 1-3 extra days of absence per person-year compared with their normal weight counterparts. In European studies, the corresponding difference was about 10 d. For overweight workers the data were conflicting, indicating either increased or neutral level of sick leave compared with normal weight. Regarding underweight, the studies were very few and concerns regarding direction of causality were greater. Finally, in all four interventional studies identified substantial weight loss in obese subjects resulted in reduced sick leave, at least temporarily. In conclusion, increasing obesity in children and adults is likely to negatively affect future productivity as obesity increases the risk of sick leave, disability pension and death.
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Affiliation(s)
- K Neovius
- Social Medicine, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
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Hemmingsson E, Uddén J, Neovius M. No apparent progress in bioelectrical impedance accuracy: validation against metabolic risk and DXA. Obesity (Silver Spring) 2009; 17:183-7. [PMID: 18997678 DOI: 10.1038/oby.2008.474] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Bioelectrical impedance (BIA) is quick, easy, and safe when quantifying fat and lean tissue. New BIA models (Tanita BC-418 MA, abbreviated BIA(8)) can perform segmental body composition analysis, e.g., estimate %trunkal fatness (%TF). It is not known, however, whether new BIA models can detect metabolic risk factors (MRFs) better than older models (Tanita TBF-300, abbreviated BIA(4)). We therefore tested the correlation between MRF and percentage whole-body fat (%BF) from BIA(4) and BIA(8) and compared these with the correlation between MRF and dual-energy X-ray absorptiometry (DXA, used as gold standard), BMI and waist circumference (WC). The sample consisted of 136 abdominally obese (WC >or= 88 cm), middle-aged (30-60 years) women. MRF included fasting blood glucose and insulin; high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides; high sensitive C-reactive protein, plasminogen activator inhibitor-1 (PAI-1), and fibrinogen; and alanine transaminase (ALT) liver enzyme. We found that similar to DXA, but in contrast to BMI, neither %BF BIA(4) nor %BF BIA(8) correlated with blood lipids or ALT. In the segmental analysis of %TF, BIA(8) only correlated with inflammatory markers, but not insulin, blood lipids, or ALT liver enzyme (in contrast to WC and %TF DXA). %TF DXA was associated with homeostatic model assessment insulin resistance (HOMA-IR) independently of WC (P = 0.03), whereas %TF BIA(8) was not (P = 0.53). Receiver-operating characteristic (ROC) curves confirmed that %TF BIA(8) did not differ from chance in the detection of insulin resistance (P = 0.26). BIA estimates of fatness were, at best, weakly correlated with obesity-related risk factors in abdominally obese women, even the new eight-electrode model. Our data support the continued use of WC and BMI.
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Affiliation(s)
- Erik Hemmingsson
- Department of Medicine (Huddinge), Obesity Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
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Silventoinen K, Magnusson PKE, Tynelius P, Batty GD, Rasmussen F. Association of body size and muscle strength with incidence of coronary heart disease and cerebrovascular diseases: a population-based cohort study of one million Swedish men. Int J Epidemiol 2008; 38:110-8. [DOI: 10.1093/ije/dyn231] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Silventoinen K, Magnusson PKE, Neovius M, Sundström J, Batty GD, Tynelius P, Rasmussen F. Does obesity modify the effect of blood pressure on the risk of cardiovascular disease? A population-based cohort study of more than one million Swedish men. Circulation 2008; 118:1637-42. [PMID: 18824645 DOI: 10.1161/circulationaha.108.772707] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Some studies have suggested that increased blood pressure has a stronger effect on the risk of cardiovascular disease (CVD) in lean persons than in obese persons, although this is not a universal finding. Given the inconsistency of this result, we tested it using a large population-based cohort data set. METHODS AND RESULTS Systolic and diastolic blood pressures (BPs) and body mass index were measured in 1 145 758 Swedish men born between 1951 and 1976 who were in young adulthood (median age 18.2 years). During the register-based follow-up, which lasted until the end of 2006, 65 611 new CVD events took place, including 6799 myocardial infarctions and 8827 strokes. Hazard ratios (HRs) per 1-SD increase in systolic and diastolic BP were computed within established body mass index categories (underweight, normal, overweight, or obese) with Cox proportional hazards models. The strongest associations of diastolic BP with CVD (HR 1.18), myocardial infarction (HR 1.22), and stroke (HR 1.13) were observed in the obese category. For systolic BP, the strongest associations were observed in the obese category with CVD (HR 1.16) and stroke (HR 1.29) but in the overweight category with myocardial infarction (HR 1.19). We observed statistically significant interactions (P<0.0001) with body mass index for diastolic BP in relation to CVD and for systolic BP in relation to CVD and stroke. CONCLUSIONS In contrast to the findings of previous studies, we observed a general increase in the magnitude of the association between blood pressure and subsequent CVD with increasing body mass index. Hypertension should not be regarded as a less serious risk factor in obese than in lean or normal-weight persons.
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Pettersson J, Johansson K, Rössner S, Neovius M. Prevalence of obesity and abdominal obesity in Swedish primary care and occupational health clinics. Obes Facts 2008; 1:251-7. [PMID: 20054186 PMCID: PMC6515889 DOI: 10.1159/000156530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The objective of this study was to describe the prevalence of obesity and abdominal obesity in the Swedish primary and occupational health care setting. PATIENTS AND METHODS Weight, height, and waist circumference (WC) were measured in 1,583 consecutive patients, aged between 18-65 years (46.4 +/- 12.7 years), in 39 primary care and occupational health practices in Sweden, in 2006. The National Cholesterol Education Program (NCEP) WC reference values were used to define abdominal obesity (102 and 88 cm for men and women, respectively). RESULTS The distribution across obesity categories differed significantly between men and women with close to 70 and 55% of men and women, respectively, having a body mass index (BMI) >or= 25. More men than women were overweight (BMI 25-29.9; 45.1 vs. 31.1%) and obese (BMI 30-34.9; 19.8 vs. 12.9%), but less men than women were morbidly obese (4.0 vs. 8.9%; BMI >or= 35). Increasing prevalence with age was seen until age 60 for both overweight and obesity. More women than men were abdominally obese (42.5 vs. 32.7%; p < 0.001). Only 48 and 64% of the abdominally obese women and men, respectively, had a BMI >or= 30. CONCLUSION Compared to national Swedish data, the prevalence of overweight and obesity was higher in primary and occupational health care settings. Both morbid obesity and abdominal obesity were highly prevalent and more common in women, implying that awareness of sex differences may be important or that recommended cut-offs are not comparable across sex. Furthermore, a large fraction of the abdominally obese had a BMI < 30. Both BMI and WC may therefore be important to determine routinely and incorporate into treatment guidelines, in order not to miss patients at risk of obesity-related morbidity.
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Affiliation(s)
- Jan Pettersson
- Obesity Unit, Karolinska Institutet, Karolinska University Hospital (Huddinge), Stockholm, Sweden.
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