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Kaplan LM, Apovian CM, Ard JD, Allison DB, Aronne LJ, Batterham RL, Busetto L, Dicker D, Horn DB, Kelly AS, Mechanick JI, Purnell JQ, Ramos‐Salas X. Assessing the state of obesity care: Quality, access, guidelines, and standards. Obes Sci Pract 2024; 10:e765. [PMID: 39026558 PMCID: PMC11255038 DOI: 10.1002/osp4.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/18/2024] [Accepted: 05/13/2024] [Indexed: 07/20/2024] Open
Abstract
Background An international panel of obesity medicine experts from multiple professional organizations examined patterns of obesity care and current obesity treatment guidelines to identify areas requiring updating in response to emerging science and clinical evidence. Aims The panel focused on multiple medical health and societal issues influencing effective treatment of obesity and identified several unmet needs in the definition, assessment, and care of obesity. Methods The panel was held in Leesburg, Virginia in September 2019. Results The panelists recommended addressing these unmet needs in obesity medicine through research, education, evaluation of delivery and payment of care, and updating clinical practice guidelines (CPG) to better reflect obesity's pathophysiological basis and heterogeneity, as well as the disease's health, sociocultural, and economic complications; effects on quality of life; need for standards for quantitative comparison of treatment benefits, risks, and costs; and the need to more effectively integrate obesity treatment guidelines into routine clinical practice and to facilitate more direct clinician participation to improve public understanding of obesity as a disease with a pathophysiological basis. The panel also recommended that professional organizations working to improve the care of people with obesity collaborate via a working group to develop an updated, patient-focused, comprehensive CPG establishing standards of care, addressing identified needs, and providing for routine, periodic review and updating. Conclusions Unmet needs in the definition, assessment and treatment of obesity were identified and a blueprint to address these needs developed via a clinical practice guideline that can be utilized worldwide to respond to the increasing prevalence of obesity.
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Affiliation(s)
- Lee M. Kaplan
- Obesity, Metabolism and Nutrition InstituteMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Caroline M. Apovian
- Division of Endocrinology, Diabetes, Nutrition and Weight ManagementNutrition and Weight Management CenterBoston Medical Center and Boston University School of MedicineBostonMassachusettsUSA
| | - Jamy D. Ard
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - David B. Allison
- Department of Epidemiology and BiostatisticsIndiana University School of Public Health‐BloomingtonBloomingtonIndianaUSA
| | - Louis J. Aronne
- Department of MedicineWeill‐Cornell College of MedicineNew YorkNew YorkUSA
| | - Rachel L. Batterham
- Department of MedicineCentre for Obesity ResearchRayne InstituteUniversity College LondonLondonUK
- National Institute for Health and Care ResearchUniversity College London Hospitals Biomedical Research CentreLondonUK
| | - Luca Busetto
- Department of MedicineUniversity of PadovaPadovaItaly
| | - Dror Dicker
- Department of Internal Medicine DHaharon Hospital Rabin Medical CenterSackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Deborah B. Horn
- Center for Obesity Medicine and Metabolic PerformanceUniversity of Texas McGovern Medical SchoolHoustonTexasUSA
| | - Aaron S. Kelly
- Department of Pediatrics and Center for Pediatric Obesity MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Jeffrey I. Mechanick
- Marie‐Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai HeartNew YorkNew YorkUSA
- Metabolic SupportDivision of Endocrinology, Diabetes and Bone DiseaseIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Jonathan Q. Purnell
- Division of Endocrinology, Diabetes, and Clinical NutritionKnight Cardiovascular InstituteOregon Health & Science UniversityPortlandOregonUSA
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Zhang Y, Chen GC, Sotres-Alvarez D, Perreira KM, Daviglus ML, Pirzada A, Gallo LC, Llabre MM, Cai J, Xue X, Isasi CR, Kaplan R, Qi Q. General or Central Obesity and Mortality Among US Hispanic and Latino Adults. JAMA Netw Open 2024; 7:e2351070. [PMID: 38227314 PMCID: PMC10792478 DOI: 10.1001/jamanetworkopen.2023.51070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/01/2023] [Indexed: 01/17/2024] Open
Abstract
Importance The Hispanic and Latino population is the second largest ethnic group in the US, but associations of obesity parameters with mortality in this population remain unclear. Objective To investigate the associations of general and central obesity with mortality among US Hispanic and Latino adults. Design, Setting, and Participants The Hispanic Community Health Study/Study of Latinos is an ongoing, multicenter, population-based cohort study with a multistage probability sampling method performed in Hispanic and Latino adults aged 18 to 74 years with a baseline between January 1, 2008, and December 31, 2011. Active follow-up for this analyses extended from baseline through February 17, 2022. All analyses accounted for complex survey design (ie, stratification and clustering) and sampling weights to generate estimates representing the noninstitutionalized, 18- to 74-year-old Hispanic or Latino populations from selected communities. Exposures Body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), body fat percentage, waist circumference (WC), and waist to hip ratio (WHR). Main Outcome and Measure Deaths were ascertained via death certificates, the National Death Index, and active follow-up. Results Of 15 773 adults (mean [SE] age, 40.9 [0.3] years; 52.8% female), 686 deaths occurred during a median (IQR) follow-up of 10.0 (9.9-10.2) years. When adjusting for sociodemographic, lifestyle, and family history covariates, hazard ratios (HRs) for mortality were 1.55 (95% CI, 1.08-2.22) for a BMI of 35.0 or greater vs 18.5 to 24.9, 1.22 (95% CI, 0.92-1.64) for the highest vs lowest body fat percentage groups (defined according to sex-, age-, and Hispanic or Latino background-specific BMI distribution), 1.35 (95% CI, 0.98-1.85) for WC greater than 102 cm (men) or 88 cm (women) vs 94 cm (men) or 80 cm (women) or less, and 1.91 (95% CI, 1.28-2.86) for WHR of 0.90 (men) or 0.85 (women) or greater vs less than 0.90 (men) or 0.85 (women). Only WHR was associated with mortality with additional adjustment for major comorbidities (HR, 1.75; 95% CI, 1.17-2.62). The association of WHR with mortality was stronger among women compared with men (P = .03 for interaction), and the association between BMI and mortality was stronger among men (P = .02 for interaction). The positive association between severe obesity (BMI ≥ 35.0) and mortality was observed only among adults with WHR of 0.90 (men) or 0.85 (women) or greater but not among those with WHR below 0.90 (men) or 0.85 (women) (P = .005 for interaction) who had greater hip circumference. Conclusions and Relevance In this cohort of US Hispanic and Latino adults, WHR was independently associated with higher all-cause mortality regardless of BMI and prevalent comorbidities. These findings suggest that prioritizing clinical screening and intervention for WHR in this population may be an important public health strategy, with sex-specific strategies potentially being needed.
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Affiliation(s)
- Yanbo Zhang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Guo-Chong Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Krista M. Perreira
- Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | | | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois, Chicago
| | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, California
| | - Maria M. Llabre
- Department of Psychology, University of Miami, Miami, Florida
| | - Jianwen Cai
- Department of Biostatistics, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Carmen R. Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Robert Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
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Sun X, Du T. Trends in weight change patterns across life course among US adults, 1988-2018: population-based study. BMC Public Health 2023; 23:2168. [PMID: 37932673 PMCID: PMC10626664 DOI: 10.1186/s12889-023-17137-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND To examine trends in weight change patterns from young adulthood through midlife to late adulthood and their sex and racial/ethnic disparities among US adults from 1988 to 2018. METHODS A total of 48,969 participants from the National Health and Nutrition Examination Survey 1988-1994 and 2001-2018 were included. RESULTS The age-adjusted prevalence of stable non-obesity between young adulthood and midlife declined significantly from 84.1% (95 CI, 82.9-85.3%) in 1988-1994 to 68.7% (67.1-70.2%) in 2013-2018, and between midlife and late adulthood from 71.2% (69.2-73.1%) to 52.4% (50.5-54.2%). The magnitude of increase in the prevalence of weight gain from young adulthood to midlife (from 10.8% [9.9-11.6%] in 1988-1994 to 21.2% [20-22.3%] in 2013-2018; P < 0.001 for trend) was greater than that from midlife to late adulthood (from 14.1% [12.9-15.3%] to 17.2% [16.2-18.1%]; P = 0.002 for trend). The magnitude of increase in the prevalence of stable obesity from young adulthood to midlife (from 3.9% [3.1-4.8%] in 1988-1994 to 9.2% [8.2-10.3%] in 2013-2018; P < 0.001 for trend) was smaller than that from midlife to late adulthood (from 11.2% [10.1-12.2%] to 24.8% [23.3-26.3%]; P < 0.001 for trend). The declining trends in the prevalence of stable non-obesity and increasing trends in the prevalence of weight gain and stable obesity from young adulthood through midlife to late adulthood were also observed for all sex and race/ethnicity subgroups. The magnitude of decrease in the prevalence of stable non-obesity, and the magnitude of increase in the prevalence of weight gain from young adulthood through midlife to late adulthood were greater in men than in women (all P for interaction < 0.01). Weight gain patterns for those aged ≥ 65 years were substantially different from the younger age groups. CONCLUSIONS More young people born in later years are encountering obesity and accumulate greater obesity exposure across their lives than young people born in earlier years.
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Affiliation(s)
- Xingxing Sun
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tingting Du
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, Hubei, China.
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Pichardo MS, Esserman D, Ferrucci LM, Molina Y, Chlebowski RT, Pan K, Garcia DO, Lane DS, Shadyab AH, Lopez-Pentecost M, Luo J, Kato I, Springfield S, Rosal MC, Bea JW, Cespedes Feliciano EM, Qi L, Nassir R, Snetselaar L, Manson J, Bird C, Irwin ML. Adherence to the American Cancer Society Guidelines on nutrition and physical activity for cancer prevention and obesity-related cancer risk and mortality in Black and Latina Women's Health Initiative participants. Cancer 2022; 128:3630-3640. [PMID: 35996861 DOI: 10.1002/cncr.34428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/29/2022] [Accepted: 07/14/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although adherence to the American Cancer Society (ACS) Guidelines on Nutrition and Physical Activity for Cancer Prevention associates with lower risk of obesity-related cancer (ORC) incidence and mortality, evidence in Black and Latina women is limited. This association was examined in Black and Latina participants in the Women's Health Initiative (WHI). METHODS Semi-Markov multistate model examined the association between ACS guideline adherence and ORC incidence and mortality in the presence of competing events, combined and separately, for 9301 Black and 4221 Latina postmenopausal women. Additionally, ACS guideline adherence was examined in a subset of less common ORCs and potential effect modification by neighborhood socioeconomic status and smoking. RESULTS Over a median of 11.1, 12.5, and 3.7 years of follow-up for incidence, nonconditional mortality, and conditional mortality, respectively, 1191 ORCs (Black/Latina women: 841/269), 1970 all-cause deaths (Black/Latina women: 1576/394), and 341 ORC-related deaths (Black/Latina women: 259/82) were observed. Higher ACS guideline adherence was associated with lower ORC incidence for both Black (cause-specific hazard ratio [CSHR]highvs.low : 0.72; 95% CI, 0.55-0.94) and Latina (CSHRhighvs.low : 0.58, 95% CI, 0.36-0.93) women; but not conditional all-cause mortality (Black hazard ratio [HR]highvs.low : 0.86; 95% CI, 0.53-1.39; Latina HRhighvs.low : 0.81; 95% CI, 0.32-2.06). Higher adherence was associated with lower incidence of less common ORC (Ptrend = .025), but conditional mortality events were limited. Adherence and ORC-specific deaths were not associated and there was no evidence of effect modification. CONCLUSIONS Adherence to the ACS guidelines was associated with lower risk of ORCs and less common ORCs but was not for conditional ORC-related mortality. LAY SUMMARY Evidence on the association between the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention and cancer remains scarce for women of color. Adherence to the guidelines and risk of developing one of 13 obesity-related cancers among Black and Latina women in the Women's Health Initiative was examined. Women who followed the lifestyle guidelines had 28% to 42% lower risk of obesity-related cancer. These findings support public health interventions to reduce growing racial/ethnic disparities in obesity-related cancers.
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Affiliation(s)
- Margaret S Pichardo
- Yale School of Public Health, New Haven, Connecticut, USA.,Howard University College of Medicine, Washington, District of Columbia, USA
| | | | | | - Yamile Molina
- University of Illinois Chicago, Chicago, Illinois, USA
| | - Rowan T Chlebowski
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Kathy Pan
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | | | | | | | | | - Juhua Luo
- Indiana University, Bloomington, Indiana, USA
| | - Ikuko Kato
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | - Milagros C Rosal
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | | | - Lihong Qi
- University of California Davis, Davis, California, USA
| | - Rami Nassir
- Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - JoAnn Manson
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Chloe Bird
- RAND Corporation, Santa Monica, California, USA
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Palomo T, Dreyer P, Muszkat P, Weiler FG, Bonansea TCP, Domingues FC, Vieira JGH, Silva BC, Brandão CMA. Effect of soft tissue noise on trabecular bone score in postmenopausal women with diabetes: A cross sectional study. Bone 2022; 157:116339. [PMID: 35051679 DOI: 10.1016/j.bone.2022.116339] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/29/2021] [Accepted: 01/13/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) is associated with increased fracture risk, despite similar or greater BMD compared to nondiabetics. TBS predicts fracture risk in T2D and nondiabetics. However, increased abdominal thickness, a common feature in T2D, may reduce TBS values. AIM To study the relationship among glycemic status, BMD and TBS, considering abdominal soft tissue thickness (STT) interference. METHODS Cross-sectional analysis of 493 women ≥65 years, with simultaneous DXA scans and HbA1c measures. STT and TBS (iNsight Software, v3.0) were derived from lumbar spine (LS) scans. Subjects were divided according to HbA1c levels: 1 (≥6.5%; n = 116), 2 (5.7-6.4%; n = 217) and 3 (≤5.6%; n = 160). Group 1 was further divided based on HbA1c and/or disease duration: 1a (HbA1c ≥ 7.5%; n = 42), 1b (HbA1c ≥ 6.5% and disease duration ≥5 years; n = 63) and 1c (HbA1c ≥ 7.5% and disease duration ≥5 years; n = 30). FINDINGS For the entire cohort, mean age, TBS, BMI and STT were 71.8 ± 6.0 years, 1.299 ± 0.101, 26.9 ± 4.1 kg/m2, and 21.4 ± 2.9 cm, respectively. LS-BMD was similar among groups. BMD in hip sites and STT were higher in group 1. TBS was lower in patients with higher HbA1c (P = 0.020), with a mean TBS in groups 1, 2, and 3 of 1.280, 1.299 and 1.314, respectively. This difference remained after adjusting for age, LS-BMD and BMI (P = 0.010). After replacing BMI with STT, TBS differences were no longer significant (P = 0.270). The same was observed when subgroups 1a and 1b were compared to group 3. However, for subgroup 1c, TBS remained lower compared to group 3, even after adjusting for age, LS-BMD and STT, with a borderline P-value (1.275 vs. 1.308; P = 0.047). CONCLUSION Higher HbA1c levels were associated with greater BMD in hip sites, higher abdominal STT and lower TBS values. However, after including the STT in the adjustment, TBS differences among groups disappeared, except in women with higher HbA1c levels and longer disease duration.
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Affiliation(s)
- Telma Palomo
- Bone Densitometry Service, Fleury Medicine and Healthcare, São Paulo, Brazil.
| | - Patricia Dreyer
- Bone Densitometry Service, Fleury Medicine and Healthcare, São Paulo, Brazil
| | - Patricia Muszkat
- Bone Densitometry Service, Fleury Medicine and Healthcare, São Paulo, Brazil
| | - Fernanda G Weiler
- Bone Densitometry Service, Fleury Medicine and Healthcare, São Paulo, Brazil
| | - Teresa C P Bonansea
- Bone Densitometry Service, Fleury Medicine and Healthcare, São Paulo, Brazil
| | | | - Jose G H Vieira
- Bone Densitometry Service, Fleury Medicine and Healthcare, São Paulo, Brazil; Department of Medicine, Endocrinology Unit, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Barbara C Silva
- Endocrinology Unit, Santa Casa de Belo Horizonte, Belo Horizonte, Brazil; Endocrinology Unit, Felicio Rocho Hospital, Belo Horizonte, Brazil; Department of Medicine, Centro Universitario de Belo Horizonte (UNI-BH), Belo Horizonte, Brazil
| | - Cynthia M A Brandão
- Bone Densitometry Service, Fleury Medicine and Healthcare, São Paulo, Brazil
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Impact of common cardio-metabolic risk factors on fatal and non-fatal cardiovascular disease in Latin America and the Caribbean: an individual-level pooled analysis of 31 cohort studies. LANCET REGIONAL HEALTH. AMERICAS 2021; 4:None. [PMID: 34957436 PMCID: PMC8669782 DOI: 10.1016/j.lana.2021.100068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/14/2021] [Accepted: 08/24/2021] [Indexed: 12/20/2022]
Abstract
Background Estimates of the burden of cardio-metabolic risk factors in Latin America and the Caribbean (LAC) rely on relative risks (RRs) from non-LAC countries. Whether these RRs apply to LAC remains unknown. Methods We pooled LAC cohorts. We estimated RRs per unit of exposure to body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC) and non-HDL cholesterol on fatal (31 cohorts, n=168,287) and non-fatal (13 cohorts, n=27,554) cardiovascular diseases, adjusting for regression dilution bias. We used these RRs and national data on mean risk factor levels to estimate the number of cardiovascular deaths attributable to non-optimal levels of each risk factor. Results Our RRs for SBP, FPG and TC were like those observed in cohorts conducted in high-income countries; however, for BMI, our RRs were consistently smaller in people below 75 years of age. Across risk factors, we observed smaller RRs among older ages. Non-optimal SBP was responsible for the largest number of attributable cardiovascular deaths ranging from 38 per 100,000 women and 54 men in Peru, to 261 (Dominica, women) and 282 (Guyana, men). For non-HDL cholesterol, the lowest attributable rate was for women in Peru (21) and men in Guatemala (25), and the largest in men (158) and women (142) from Guyana. Interpretation RRs for BMI from studies conducted in high-income countries may overestimate disease burden metrics in LAC; conversely, RRs for SBP, FPG and TC from LAC cohorts are similar to those estimated from cohorts in high-income countries. Funding Wellcome Trust (214185/Z/18/Z).
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7
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Seixas AA, Turner AD, Bubu OM, Jean-Louis G, de Leon MJ, Osorio RS, Glodzik L. Obesity and Race May Explain Differential Burden of White Matter Hyperintensity Load. Clin Interv Aging 2021; 16:1563-1571. [PMID: 34465985 PMCID: PMC8402977 DOI: 10.2147/cia.s316064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/10/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Compared to European Americans, research indicates that African Americans have higher white matter hyperintensity (WMH) load; however, the clinical and biological bases underlying this higher burden are poorly understood. We hypothesize that obesity may explain differences in WMH between African and European Americans. METHODS Participants enrolled in longitudinal brain aging studies (n=292; 61% Female; 92% European American; mean age=69.6±7.7) completed evaluations including medical exams, neuroimaging, and sociodemographic surveys. Overweight/obese status defined as body mass index ≥30 kg/m2, and WMH load, captured by FLAIR images, as sum of deep and periventricular volumes, scored using the Fazekas scale (0-6), WMH≥4 considered high. RESULTS Logistic regression analyses, adjusted for age, sex, hypertension, and smoking history, indicated that age and interaction between race and obesity were significant predictors of WMH, demonstrating that obesity significantly moderated the relationship between race and WMH. Age independently increased the odds of high WMH by 16% (OR=1.16, 95% CI=1.09-1.23, p<0.001). Stratified analysis indicates that older European Americans had increased WMH (OR=1.17, 95% CI=1.09-1.23, p<0.001), while obese African Americans had increased WMH (OR=27.65, 95% CI=1.47-519.13, p<0.05). In a case controlled subgroup matched by age, sex, and education (n=48), African Americans had significantly higher WMH load (27% vs 4%, Χ 2=5.3, p=0.02). CONCLUSION Results denote that age predicted WMH among European Americans, while obesity predicted WMH among African Americans. Matched sample analyses indicate that obesity increases the odds of WMH, though more pronounced in African Americans. These findings suggest that obesity may explain the differential burden of white matter hyperintensity load, signifying public health and clinical importance.
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Grants
- R01 AG013616 NIA NIH HHS
- RF1 AG057570 NIA NIH HHS
- K23 AG068534 NIA NIH HHS
- L30 AG064670 NIA NIH HHS
- R01 HL142066 NHLBI NIH HHS
- R01 AG022374 NIA NIH HHS
- R01 HL111724 NHLBI NIH HHS
- R56 AG058913 NIA NIH HHS
- R01 NS104364 NINDS NIH HHS
- R01 AG067523 NIA NIH HHS
- R25 HL105444 NHLBI NIH HHS
- P30 AG066512 NIA NIH HHS
- K01 HL135452 NHLBI NIH HHS
- R01 HL152453 NHLBI NIH HHS
- R01 MD007716 NIMHD NIH HHS
- R01 AG012101 NIA NIH HHS
- R01 AG056031 NIA NIH HHS
- K07 AG052685 NIA NIH HHS
- the National Institutes of Health: K01HL135452, K07AG052685, R01HL152453, R01MD007716, R01HL142066, R01AG067523, R01AG056031, R01NS104364, MdeL (RF1AG057570, R56 AG058913, R01 AG012101, R01 AG022374, R01 AG013616), R01 HL111724, R01AG05653, R01AG056031, and R25HL105444
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Affiliation(s)
- Azizi A Seixas
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, 10016, USA
- New York University Grossman School of Medicine, Department of Psychiatry, New York, NY, 10016, USA
| | - Arlener D Turner
- New York University Grossman School of Medicine, Department of Psychiatry, New York, NY, 10016, USA
| | - Omonigho Michael Bubu
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, 10016, USA
- New York University Grossman School of Medicine, Department of Psychiatry, New York, NY, 10016, USA
| | - Girardin Jean-Louis
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, 10016, USA
- New York University Grossman School of Medicine, Department of Psychiatry, New York, NY, 10016, USA
| | - Mony J de Leon
- Weill Cornell Medicine, Department of Radiology, New York, NY, 10021, USA
| | - Ricardo S Osorio
- New York University Grossman School of Medicine, Department of Psychiatry, New York, NY, 10016, USA
| | - Lidia Glodzik
- Weill Cornell Medicine, Department of Radiology, New York, NY, 10021, USA
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8
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Nickerson BS. Evaluation of Obesity Cutoff Values in Hispanic Adults: Derivation of New Standards. J Clin Densitom 2021; 24:388-396. [PMID: 33183918 DOI: 10.1016/j.jocd.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
UNLABELLED The diagnostic accuracy of clinical-based body composition methods such as body mass index (BMI), waist circumference (WC), bioimpedance analysis (BIA), and dual energy X-ray absorptiometry (DXA) has yet to be evaluated in Hispanic adults. Moreover, it has also been suggested that previously established obesity cutoff values may need adjusting. PURPOSE The primary aim of this study was to investigate the diagnostic accuracy of BMI, WC, BIA, and DXA for obesity classification in Hispanic adults. The secondary aim was to internally derive obesity cutoff values producing equal sensitivity and specificity for the respective tests. METHODS Hispanic females (n = 101) and males (n = 90) volunteered to participate in this study (18-45 years). Body fat percentage was estimated with BIA, DXA, and a 4-compartment (4C) model. Obesity-defined criteria was employed as follows: (Body fat percentage ≥ 25% and 35% and WC ≥ 102cm and 88cm for males and females, respectively; BMI ≥ 30 kg/m2). A 4C model was used as a criterion to evaluate BMI, WC, DXA, and BIA. RESULTS Sensitivity of DXA and BIA (74.1%-96.9%) was greater than BMI and WC (25.8%-51.9%) when using previously established standards. However, specificity was poor for DXA (<70%), but considered good to excellent for BMI, WC, and BIA (83.1%-96.6%) when using previously established standards. Internally derived cutoff values improved sensitivity for BMI and WC (74.2%-81.5%) and improved specificity for DXA (>80.0%). CONCLUSION The internally derived cutoff values, producing identical sensitivity, and specificity, were developed and shown to improve the diagnostic performance of the body composition methods compared to previously established obesity cutoff standards. Consequently, the internally derived obesity cutoff values are recommended for use by allied health professionals in clinical practice when equal sensitivity and specificity is desired.
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Affiliation(s)
- Brett S Nickerson
- College of Nursing and Health Sciences, Texas A&M International University, Laredo, TX.
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Kwak YE, McMillan R, McDonald EK. Trends in Overweight and Obesity Self-awareness Among Adults With Overweight or Obesity in the United States, 1999 to 2016. Ann Intern Med 2021; 174:721-723. [PMID: 33253038 DOI: 10.7326/m20-3882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ye Eun Kwak
- University of Chicago Medicine, Chicago, Illinois
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10
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Nickerson BS, Esco MR, Fedewa MV, Park KS. Development of a Body Mass Index-based Body Fat Equation: Effect of Handgrip Strength. Med Sci Sports Exerc 2021; 52:2459-2465. [PMID: 33064414 DOI: 10.1249/mss.0000000000002383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Body mass index (BMI)-based body fat equations from Womersley (BMIWOMERSLEY), Jackson (BMIJACKSON), Deurenberg (BMIDEURENBERG), and Gallagher (BMIGALLAGHER) are practical in clinical and field settings. However, research has shown these prediction equations produce large error, which may be due to the inability of BMI to account for differences in fat mass and fat-free mass. Thus, accounting for variations in muscular strength via relative handgrip (RHG) strength could help enhance the accuracy of a BMI-based body fat equation. PURPOSE The purpose of the current study was twofold: 1) to develop a new BMI-based body fat equation that includes the measurement of RHG (BMINICKERSON) and 2) to cross-validate BMINICKERSON, BMIWOMERSLEY, BMIJACKSON, BMIDEURENBERG, and BMIGALLAGHER against a four-compartment criterion. METHODS The development and cross-validation samples consisted of 230 and 110 participants, respectively. Criterion body fat percent was determined with a four-compartment model. RHG was calculated by summing the max of each handgrip strength measurement and dividing by body mass. BMI (kg·m), RHG (kg·kg), age (yr), ethnicity (Hispanic or non-Hispanic White), and sex (male or female) were entered into a stepwise regression to calculate BMINICKERSON. RESULTS BMINICKERSON was calculated as follows: body fat percent = 21.504 - (12.484 × RHG) - (7.998 × sex) + (0.722 × BMI). In the cross-validation sample, BMINICKERSON produced lower constant error (CE) and total error (TE) values (CE = -0.11%, TE = 4.28%) than all other BMI-based body fat equations (CE = 0.89%-1.90%, TE = 5.71%-6.87%). Furthermore, the 95% limits of agreement were lower for BMINICKERSON ± 8.47% than previous BMI-based body fat equations (95% limits of agreement = ±11.14% to 13.33%). CONCLUSION Current study results confirm that previous BMI-based body fat equations produce large error in Hispanics and non-Hispanic Whites but can be improved by accounting for RHG. Allied health professionals are encouraged to use BMINICKERSON in clinical and field settings for adiposity assessments.
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Affiliation(s)
- Brett S Nickerson
- College of Nursing and Health Sciences, Texas A&M International University, Laredo, TX
| | - Michael R Esco
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL
| | - Michael V Fedewa
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL
| | - Kyung-Shin Park
- College of Nursing and Health Sciences, Texas A&M International University, Laredo, TX
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11
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Mechanick JI, Apovian C, Brethauer S, Timothy Garvey W, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring) 2020; 28:O1-O58. [PMID: 32202076 DOI: 10.1002/oby.22719] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. METHODS Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. RESULTS New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). CONCLUSIONS Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.
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Affiliation(s)
- Jeffrey I Mechanick
- Guideline Task Force Chair (AACE); Professor of Medicine, Medical Director, Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart; Director, Metabolic Support Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York; Past President, AACE and ACE
| | - Caroline Apovian
- Guideline Task Force Co-Chair (TOS); Professor of Medicine and Director, Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Stacy Brethauer
- Guideline Task Force Co-Chair (ASMBS); Professor of Surgery, Vice Chair of Surgery, Quality and Patient Safety; Medical Director, Supply Chain Management, Ohio State University, Columbus, Ohio
| | - W Timothy Garvey
- Guideline Task Force Co-Chair (AACE); Butterworth Professor, Department of Nutrition Sciences, GRECC Investigator and Staff Physician, Birmingham VAMC; Director, UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aaron M Joffe
- Guideline Task Force Co-Chair (ASA); Professor of Anesthesiology, Service Chief, Otolaryngology, Oral, Maxillofacial, and Urologic Surgeries, Associate Medical Director, Respiratory Care, University of Washington, Harborview Medical Center, Seattle, Washington
| | - Julie Kim
- Guideline Task Force Co-Chair (ASMBS); Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Robert F Kushner
- Guideline Task Force Co-Chair (TOS); Professor of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard Lindquist
- Guideline Task Force Co-Chair (OMA); Director, Medical Weight Management, Swedish Medical Center; Director, Medical Weight Management, Providence Health Services; Obesity Medicine Consultant, Seattle, Washington
| | - Rachel Pessah-Pollack
- Guideline Task Force Co-Chair (AACE); Clinical Associate Professor of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, New York
| | - Jennifer Seger
- Guideline Task Force Co-Chair (OMA); Adjunct Assistant Professor, Department of Family and Community Medicine, Long School of Medicine, UT Health Science Center, San Antonio, Texas
| | - Richard D Urman
- Guideline Task Force Co-Chair (ASA); Associate Professor of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephanie Adams
- Writer (AACE); AACE Director of Clinical Practice Guidelines Development, Jacksonville, Florida
| | - John B Cleek
- Writer (TOS); Associate Professor, Department of Nutrition Sciences, University of Alabama, Birmingham, Alabama
| | - Riccardo Correa
- Technical Analysis (AACE); Assistant Professor of Medicine and Endocrinology, Diabetes and Metabolism Fellowship Director, University of Arizona College of Medicine, Phoenix, Arizona
| | - M Kathleen Figaro
- Technical Analysis (AACE); Board-certified Endocrinologist, Heartland Endocrine Group, Davenport, Iowa
| | - Karen Flanders
- Writer (ASMBS); Massachusetts General Hospital Weight Center, Boston, Massachusetts
| | - Jayleen Grams
- Writer (AACE); Associate Professor, Department of Surgery, University of Alabama at Birmingham; Staff Surgeon, Birmingham VA Medical Center, Birmingham, Alabama
| | - Daniel L Hurley
- Writer (AACE); Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Shanu Kothari
- Writer (ASMBS); Fellowship Director of MIS/Bariatric Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Michael V Seger
- Writer (OMA); Bariatric Medical Institute of Texas, San Antonio, Texas, Clinical Assistant Professor, University of Texas Health Science Center, Houston, Texas
| | - Christopher D Still
- Writer (TOS); Medical Director, Center for Nutrition and Weight Management Director, Geisinger Obesity Institute; Medical Director, Employee Wellness, Geisinger Health System, Danville, Pennsylvania
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12
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Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis 2019; 16:175-247. [PMID: 31917200 DOI: 10.1016/j.soard.2019.10.025] [Citation(s) in RCA: 235] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The development of these updated clinical practice guidelines (CPG) was commissioned by the American Association of Clinical Endocrinologists, The Obesity Society, the American Society of Metabolic and Bariatric Surgery, the Obesity Medicine Association, and the American Society of Anesthesiologists boards of directors in adherence to the American Association of Clinical Endocrinologists 2017 protocol for standardized production of CPG, algorithms, and checklists. METHODS Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. RESULTS New or updated topics in this CPG include contextualization in an adiposity-based, chronic disease complications-centric model, nuance-based, and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current healthcare arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). CONCLUSIONS Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence-based within the context of a chronic disease. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
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Affiliation(s)
- Jeffrey I Mechanick
- Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, New York; Metabolic Support Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Caroline Apovian
- Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | | | - W Timothy Garvey
- Department of Nutrition Sciences, Birmingham VA Medical Center, Birmingham, Alabama; UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aaron M Joffe
- University of Washington, Harborview Medical Center, Seattle, Washington
| | - Julie Kim
- Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Robert F Kushner
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Rachel Pessah-Pollack
- Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, New York
| | - Jennifer Seger
- Department of Family and Community Medicine, Long School of Medicine, UT Health Science Center, San Antonio, Texas
| | | | - Stephanie Adams
- American Association of Clinical Endocrinologists, Jacksonville, Florida
| | - John B Cleek
- Department of Nutrition Sciences, Birmingham VA Medical Center, Birmingham, Alabama
| | | | | | - Karen Flanders
- Massachusetts General Hospital Weight Center, Boston, Massachusetts
| | - Jayleen Grams
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Birmingham VA Medical Center, Birmingham, Alabama
| | - Daniel L Hurley
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | | | - Michael V Seger
- Bariatric Medical Institute of Texas, San Antonio, Texas, University of Texas Health Science Center, Houston, Texas
| | - Christopher D Still
- Center for Nutrition and Weight Management Director, Geisinger Obesity Institute, Danville, Pennsylvania; Employee Wellness, Geisinger Health System, Danville, Pennsylvania
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13
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Jain RK, Vokes T. The Prediction of Body Composition in African Americans From Spine and Hip Dual-Energy Absorptiometry. J Clin Densitom 2019; 22:444-450. [PMID: 29173816 DOI: 10.1016/j.jocd.2017.10.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 01/06/2023]
Abstract
Body composition, the makeup of the body's fat and lean tissue, is associated with important health outcomes and provides useful clinical information. Although body composition can be measured with total body dual-energy X-ray absorptiometry (DXA), this is rarely performed. As an alternative to total body DXA measurement, methods for estimation of body composition have been developed. These methods use soft tissue measures from spine and hip DXA to predict body composition and include prediction equations previously published by Leslie and proprietary equations within General Electric densitometry software. However, these estimates have not been tested in African Americans (AA), an ethnicity with a different distribution of fat than Caucasians (CA). Therefore, we examined the performance of the existing models in 99 CA and 162 AA subjects over the age of 40 who had total body, spine, and hip DXA measurements. We observed that existing models estimated body composition well in CA but underestimated fat mass and overestimated lean mass in AA. AA subjects were then randomly divided into 2 equal-sized subgroups-the first to develop new prediction equations and the second to independently validate them. We found that body composition can be more accurately estimated using either a new model that we derived in AA subjects using backward stepwise elimination or by adding a fixed offset for AA to the previously published model. Our results demonstrate that body composition estimates from spine and hip DXA require consideration of race/ethnicity.
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Affiliation(s)
- Rajesh K Jain
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago, Illinois.
| | - Tamara Vokes
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago, Illinois
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14
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Segura-Fragoso A, Rodríguez-Padial L, Alonso-Moreno FJ, Villarín-Castro A, Rojas-Martelo GA, Rodríguez-Roca GC, Sánchez-Pérez M. [Anthropometric measurements of general and central obesity and discriminative capacity on cardiovascular risk: RICARTO study]. Semergen 2019; 45:323-332. [PMID: 31105030 DOI: 10.1016/j.semerg.2019.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/05/2019] [Accepted: 02/14/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES Overweight and obese patients have an increased risk of cardiovascular disease and general mortality. It is not clear which obesity index should be used in the clinic. The objective is to compare the relationship between body mass index (BMI), waist circumference (WC), waist-height ratio (WHR), and conicity index (Conicity-I) with 10-year Framingham cardiovascular risk (CVR). MATERIAL AND METHODS Population cross-sectional study in subjects ≥18years, residents in the Toledo (Spain) Health Area. Selection by random sampling. Measurements were made of the BMI, WC, and weight to height ratio with standardised methods. Framingham CVR. Calculation of AUC, and optimal cut-off points. RESULTS The study included 1,309 subjects, with mean age of 48.9±15.8years, and 55% women. The response rate was 36.6%. In women, the index that was best associated with CVR in women was the WC with an AUC=0.85 (95%CI: 0.81-0.88). In men it was the I-Conicity, with an AUC=0.81 (95%CI: 0.77-0.84). Cut points for BMI were similar in women (27.08kg/m2) and men (26.99kg/m2). The WC was lower in women (87.75cm) than in men (94.5cm). The WHR was higher in women (0.59) than in men (0.56). The I-Conicity was slightly lower in women (1.25) than in men (1.28). In women, all the ROC curves were closest to each other. CONCLUSIONS The central obesity indexes (WC and WHR) discriminated better than the BMI the CVR. In women, all the indices had greater AUCs than in men, except for the I-Conicity.
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Affiliation(s)
- A Segura-Fragoso
- Instituto de Ciencias de la Salud, Consejería de Salud y Asuntos Sociales, Junta de Comunidades de Castilla-La Mancha, Talavera de la Reina, Toledo, España.
| | - L Rodríguez-Padial
- Servicio de Cardiología, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | | | - A Villarín-Castro
- Medicina de Familia, Unidad docente multiprofesional de Atención Familiar y Comunitaria, Toledo, España
| | - G A Rojas-Martelo
- Medicina Familiar y Comunitaria, Hospital Ramón y Cajal / Centro de Salud Jazmín, Madrid, España
| | - G C Rodríguez-Roca
- Medicina de Familia, Centro de Salud Puebla de Montalbán, Puebla de Montalbán, Toledo, España
| | - M Sánchez-Pérez
- Enfermería-Investigación del Proyecto RICARTO, Gerencia de Atención Primaria de Toledo, Toledo, España
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15
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Arvanitakis Z, Capuano AW, Bennett DA, Barnes LL. Body Mass Index and Decline in Cognitive Function in Older Black and White Persons. J Gerontol A Biol Sci Med Sci 2019; 73:198-203. [PMID: 28961897 PMCID: PMC5861969 DOI: 10.1093/gerona/glx152] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Indexed: 01/13/2023] Open
Abstract
Background While body mass index (BMI) is higher in black compared to white persons, little is known about BMI and change in cognition in cohorts with a large proportion of blacks. We examine relations of BMI with decline in global cognition and five cognitive domains, in older blacks and whites, and determine whether relations differ by race. Methods Participants were 2,134 persons without baseline dementia (33% black; 75% women; mean age =77.9 [range 53-100] and education = 14.7 years, Mini-Mental State Examination = 28.0), enrolled in one of two longitudinal, community-based cohort studies of aging (Minority Aging Research Study; Rush Memory and Aging Project). Summary scores of global cognition and five domains were based on 19 neuropsychological tests administered annually. Mixed-effects models, controlling for age, sex, education, and race, were used to examine the relation of baseline BMI to change in cognition. Results Baseline BMI = 28.4 units (30.3 in blacks [95% confidence interval (CI): 27.2-27.7]; 27.4 in whites [95% CI: 29.8-30.7]). During a mean annual follow-up of 6 years (SD = 4), lower baseline BMI was related to faster decline in global cognition (p = .002), and semantic memory (p < .001) and episodic memory (p = .004), but not working memory, perceptual speed, or visuospatial ability (all p > .08). The relationship of BMI with change in cognition was not modified by race (all p > .09). Conclusions Late-life lower BMI relates to faster rates of decline in cognition, specifically semantic memory and episodic memory, in both blacks and whites. The effect of BMI on cognition appears to be similar in both racial groups.
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Affiliation(s)
- Zoe Arvanitakis
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Ana W Capuano
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
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16
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Knapik JJ, Sharp MA, Montain SJ. Association between stress fracture incidence and predicted body fat in United States Army Basic Combat Training recruits. BMC Musculoskelet Disord 2018; 19:161. [PMID: 29788936 PMCID: PMC5964907 DOI: 10.1186/s12891-018-2061-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/25/2018] [Indexed: 01/10/2023] Open
Abstract
Background A stress fracture (SF) is a highly debilitating injury commonly experienced in United States Army Basic Combat Training (BCT). Body fat (BF) may be associated with this injury but previous investigations (in athletes) have largely used SF self-reports and lacked sufficient statistical power. This investigation developed an equation to estimate %BF and used that equation to examine the relationship between %BF and SF risk in BCT recruits. Methods Data for the %BF predictive equation involved 349 recruits with BF obtained from dual-energy X-ray absorptiometry. %BF was estimated using body mass index (BMI, weight/height2), age (yr), and sex in the entire population of BCT recruits over an 11-year period (n = 583,651). Medical information was obtained on these recruits to determine SF occurrence. Recruits were separated into deciles of estimated %BF and the risk of SFs determined in each decile. Results The equation was %BF = − 7.53 + 1.43 ● BMI + 0.13 ● age − 14.73 ● sex, with sex either 1 for men or 0 for women (r = 0.88, standard error of estimate = 4.2%BF). Among the men, SF risk increased at the higher and lower %BF deciles: compared to men in the mean %BF decile, the risk of a SF for men in the first (lowest %BF) and tenth (highest %BF) decile were 1.27 (95%confidence interval (95%CI) = 1.17–1.40) and 1.15 (95%CI = 1.05–1.26) times higher, respectively. Among women, SF risk was only elevated in the first %BF decile with risk 1.20 (95%CI = 1.09–1.32) times higher compared to the mean %BF decile. Conclusions Low %BF was associated with higher SF risk in BCT; higher %BF was associated with higher SF risk among men but not women.
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Affiliation(s)
- Joseph J Knapik
- US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA.
| | - Marilyn A Sharp
- US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
| | - Scott J Montain
- US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
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17
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Young DR, Fischer H, Arterburn D, Bessesen D, Cromwell L, Daley MF, Desai J, Ferrara A, Fitzpatrick SL, Horberg MA, Koebnick C, Nau CL, Oshiro C, Waitzfelder B, Yamamoto A. Associations of overweight/obesity and socioeconomic status with hypertension prevalence across racial and ethnic groups. J Clin Hypertens (Greenwich) 2018; 20:532-540. [PMID: 29432662 PMCID: PMC6565383 DOI: 10.1111/jch.13217] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/29/2017] [Accepted: 12/20/2017] [Indexed: 01/29/2023]
Abstract
Racial/ethnic disparities in the prevalence of diagnosed hypertension are persistent but may be partially explained by racial/ethnic differences in weight category and neighborhood socioeconomic status. The authors compared hypertension prevalence rates among 4 060 585 adults with overweight or obesity across 10 healthcare systems by weight category and neighborhood education level in geographically and racially diverse individuals. Data were obtained from electronic health records. Hypertension was defined as at least two outpatient visits or one inpatient hospitalization with a coded diagnosis. Logistic regression, adjusted for age, sex, and site, with two-way interactions between race/ethnicity and weight category or neighborhood education, was used to examine the association between hypertension and race/ethnicity, with whites as the reference. Results documented that odds ratios for hypertension prevalence were greater for blacks, American Indians/Alaskan Natives, Asians, and Native Hawaiians/other Pacific Islanders compared with whites and lower for Hispanics in similar weight categories and neighborhood education levels. Although two-way interactions were statistically significant, the magnitude of the odds of hypertension compared with whites did not substantially vary across weight or neighborhood education. Hypertension odds were almost double relative to whites for blacks and Native Hawaiians/other Pacific Islanders across most weight categories and all neighborhood education levels. Odds of hypertension were about 50% greater for Asians relative to whites across weight categories. Results suggest that other factors might be associated with racial/ethnic disparities in hypertension. More research is needed to understand the many factors that may contribute to variation in diagnosed hypertension across racial/ethnic groups with overweight or obesity.
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Affiliation(s)
- Deborah Rohm Young
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Heidi Fischer
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
| | - Jay Desai
- HealthPartners Institute for Education and Research, Bloomington, MN, USA
| | - Assiamira Ferrara
- Department of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | | | - Corinna Koebnick
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Claudia L Nau
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Caryn Oshiro
- Center for Health Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Beth Waitzfelder
- Center for Health Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Ayae Yamamoto
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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18
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Wu B, Huang J, Fukuo K, Suzuki K, Yoshino G, Kazumi T. Different Associations of Trunk and Lower-Body Fat Mass Distribution with Cardiometabolic Risk Factors between Healthy Middle-Aged Men and Women. Int J Endocrinol 2018; 2018:1289485. [PMID: 29531527 PMCID: PMC5817354 DOI: 10.1155/2018/1289485] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The aim of this study was to assess whether the gender-specific pattern of fat mass (FM) distribution is related to gender differences in cardiometabolic risk factors. 207 healthy middle-aged Japanese were included in the study. We measured FM in the total body, trunk, and lower-body with dual-energy X-ray absorptiometry (DXA). The percentage of trunk FM (TFM) and lower-body FM (LFM) is noted as %TFM and %LFM, respectively. Other measurements included glucose and insulin during oral glucose tolerance test (OGTT), leptin, adiponectin, plasminogen activator inhibitor-1 (PAI-1), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and systemic oxidative stress marker. Arterial properties were indicated by cardio-ankle vascular index (CAVI) and intima-media thickness (IMT) of the common carotid artery. The results showed that %TFM is higher whereas %LFM is lower in men than in women and men have a more atherogenic cardiometabolic profile. In both genders, %TFM (%LFM) is related to an unfavorable (favorable) cardiometabolic profile. In particular, the relation between %LFM and OGTT-derived insulin sensitivity index is stronger in women than in men. These findings suggested that in relatively healthy adults, android and gynoid pattern of FM distribution contributes to gender differences in cardiometabolic risk factors.
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Affiliation(s)
- Bin Wu
- Open Research Center for Studying of Lifestyle-Related Diseases, Mukogawa Women's University, 6-46 Ikebiraki-cho, Nishinomiya, Hyogo 663-8558, Japan
- Department of Endocrinology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Jingshan Huang
- School of Computing, University of South Alabama, Mobile, AL 36688-0002, USA
| | - Keisuke Fukuo
- Open Research Center for Studying of Lifestyle-Related Diseases, Mukogawa Women's University, 6-46 Ikebiraki-cho, Nishinomiya, Hyogo 663-8558, Japan
- Department of Food Sciences and Nutrition, School of Human Environmental Science, Mukogawa Women's University, 6-46 Ikebiraki-cho, Nishinomiya, Hyogo 663-8558, Japan
- Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46 Ikebiraki-cho, Nishinomiya, Hyogo 663-8558, Japan
| | - Kazuhisa Suzuki
- Open Research Center for Studying of Lifestyle-Related Diseases, Mukogawa Women's University, 6-46 Ikebiraki-cho, Nishinomiya, Hyogo 663-8558, Japan
| | - Gen Yoshino
- Department of Diabetes and Endocrinology, Toho University Omori Medical Center, Omori-Ku, Omori-nishi 6-11-1, Tokyo 143-8541, Japan
| | - Tsutomu Kazumi
- Open Research Center for Studying of Lifestyle-Related Diseases, Mukogawa Women's University, 6-46 Ikebiraki-cho, Nishinomiya, Hyogo 663-8558, Japan
- Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46 Ikebiraki-cho, Nishinomiya, Hyogo 663-8558, Japan
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Associations between physical activity and BMI, body fatness, and visceral adiposity in overweight or obese Latino and non-Latino adults. Int J Obes (Lond) 2017; 41:873-877. [PMID: 28220040 PMCID: PMC5461184 DOI: 10.1038/ijo.2017.49] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 02/01/2017] [Accepted: 02/10/2017] [Indexed: 01/11/2023]
Abstract
Background/Objectives Although several studies have reported associations between moderate to vigorous physical activity (MVPA), body fatness, and visceral adipose tissue (VAT), the extent to which associations differ among Latinos and non-Latinos remains unclear. The present study evaluated the associations between body composition and MVPA in Latino and non-Latino adults. Subjects/Methods An exploratory, cross-sectional analysis was conducted using baseline data collected from 298 overweight adults enrolled in a 12-month randomized controlled trial that tested the efficacy of text messaging to improve weight loss. MVPA, body fatness and VAT were assessed by waist-worn accelerometry, DXA, and DXA-derived software (GE CoreScan GE, Madison, WI) respectively. Participants with less than 5 days of accelerometry data or missing DXA data were excluded; 236 participants had complete data. Multivariable linear regression assessed associations between body composition and MVPA per day, defined as time in MVPA, bouts of MVPA (time per bout ≥10 min), non-bouts of MVPA (time per bout <10 min), and meeting the 150-minute MVPA guideline. The modifying influence of ethnicity was modeled with a multiplicative interaction term. Results The interaction between ethnicity and MVPA in predicting percent body fat was significant (p = 0.01, 95% CI [0.58, 4.43]) such that a given increase in MVPA was associated with a greater decline in total body fat in non-Latinos compared to Latinos (adjusted for age, sex and accelerometer wear time). There was no interaction between ethnicity and MVPA in predicting VAT (g) (p = 0.78, 95% CI [−205.74, 273.17]) and BMI (p = 0.18, 95% CI [−0.49, 2.26]). Conclusions An increase in MVPA was associated with a larger decrease in body fat, but neither BMI nor VAT, in non-Latinos compared to Latinos. This suggests that changes in VAT and BMI in response to MVPA may be less influenced by ethnicity than is total body fatness.
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Tian S, Morio B, Denis JB, Mioche L. Age-Related Changes in Segmental Body Composition by Ethnicity and History of Weight Change across the Adult Lifespan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13080821. [PMID: 27529269 PMCID: PMC4997507 DOI: 10.3390/ijerph13080821] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 12/25/2022]
Abstract
This study assessed age-related changes in body composition (specifically in trunk fat and appendicular lean masses), with consideration of body mass index (BMI) at age 20 years (BMI reference age, “BMIref”), ethnicity and lifetime weight change history. A cross-sectional dual-energy X-ray absorptiometry-based dataset was extracted from the U.S. National Health and Nutrition Examination Survey (NHANES) 1999–2004. Only European-American and African-American subjects were used (2705 men, 2527 women). For each gender and ethnicity, 6 analytic cases were considered, based on three BMIref categories (normal, overweight and obese, being 22, 27 and 30 kg/m2, respectively) and two weight contexts (stable weight or weight gain across the lifespan). A nonparametric model was developed to investigate age-related changes in body composition. Then, parametric modelling was developed for assessing BMIref- and ethnicity-specific effects during aging. In the stable weight, both genders’ and ethnicities’ trunk fat (TF) increased gradually; body fat (BF) remained stable until 40 years and increased thereafter; trunk lean (TL) remained stable, but appendicular lean (APL) and body lean (BL) declined from 20 years. In the weight gain context, TF and BF increased at a constant rate, while APL, TL and BL increased until 40–50 years, and then declined slightly. Compared with European-American subjects of both genders, African-American subjects had lower TF and BF masses. Ethnic differences in body composition were quantified and found to remain constant across the lifespan.
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Affiliation(s)
- Simiao Tian
- Department of Scientific Research Project, Affiliated Zhongshan Hospital of Dalian University, 116001 Dalian, China.
| | - Béatrice Morio
- Unité Mixte de Recherche 1397, Laboratoire Carmen, Université Lyon 1, INSERM U1060, INSA de Lyon, Universités Rockefeller et Charles Merieux Lyon-sud, 69000 Lyon, France.
| | - Jean-Baptiste Denis
- Unité de Recherche Mathématiques et Informatique Appliquées, Institut National de Recherche Agronomique, F-78352 Jouy-en-Josas, France.
| | - Laurence Mioche
- Unité de Nutrition Humaine, Unité Mixte de Recherche 1019, Institut National de Recherche Agronomique, F-63000 Clermont-Ferrand, France.
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Looker AC, Sarafrazi Isfahani N, Fan B, Shepherd JA. Trabecular bone scores and lumbar spine bone mineral density of US adults: comparison of relationships with demographic and body size variables. Osteoporos Int 2016; 27:2467-75. [PMID: 26952009 PMCID: PMC7593898 DOI: 10.1007/s00198-016-3550-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/22/2016] [Indexed: 12/12/2022]
Abstract
UNLABELLED This study examines demographic patterns and body size relationships in trabecular bone score and lumbar spine BMD of US adults from NHANES 2005-2008. INTRODUCTION Limited data exist on demographic and body size relationships for trabecular bone score (TBS), a new variable derived from bone texture analysis of lumbar spine dual-energy X-ray absorptiometry (DXA) scans. This study compares demographic patterns and correlations with body size (body mass index (BMI), weight, waist circumference, total body fat, trunk fat, trunk lean) between TBS and lumbar spine bone mineral density (LSBMD) for adults age ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 2005-2008 with BMI in the optimal range for TBS (15-37 kg/m(2)). METHODS LSBMD, TBS, body fat, and lean were obtained by DXA. Weight, height, and waist circumference were measured. BMI was calculated from height and weight. RESULTS Sex differences in TBS varied by age and race/ethnicity (p sex X age interaction and p sex X race/ethnicity interaction < 0.001). In most of the nine demographic subgroups examined, TBS did not differ by sex (four subgroups) or was significantly higher in women (three subgroups). TBS differences by race/ethnicity were inconsistent in men; in women, non-Hispanic whites (NHWs) had higher TBS than non-Hispanic blacks (NHBs) or Mexican Americans (MAs) in all age groups. In contrast, LSBMD was either significantly higher in men (five subgroups) or did not differ by sex (four subgroups). Race/ethnic differences in LSBMD were consistent across age and sex (NHB > NHW > MA). All body size variables were negatively related to TBS but positively related to LSBMD. CONCLUSIONS Demographic patterns and body size relationships differed between TBS and LSBMD.
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Affiliation(s)
- A C Looker
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Hyattsville, MD, 20782, USA.
| | - N Sarafrazi Isfahani
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Hyattsville, MD, 20782, USA
| | - B Fan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - J A Shepherd
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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Abstract
Obesity is an epidemic associated with higher rates of hypertension, diabetes, and cardiovascular diseases. However, significant racial disparities in the prevalence of obesity have been reported. To evaluate racial disparities and trends in the prevalence of obesity and obesity-related diseases. A population-based retrospective cohort study utilized data from the 1985 to 2011 California Behavioral Risk Factor Survey. Trends in obesity prevalence were stratified by age, sex, race/ethnicity, and socioeconomic factors. Multivariate logistic regression models evaluated independent predictors of obesity. The prevalence of obesity in significantly increased from 1985 to 2011 (8.6 vs. 22.8%, p < 0.001). This increase was seen among men and women, and among all race/ethnic, age, and socioeconomic groups. Hypertension and diabetes also increased during this time period (hypertension 20.7-35.9%; diabetes 4.2-11.2%). Obesity prevalence was highest in blacks and Hispanics, and lowest in Asians (blacks 33.3%; Hispanics 28.8%; Asians 9.0%; p < 0.001). Obesity prevalence was associated with lower education level, lower income, and unemployment status. After adjustments for age, sex, co morbidities, and surrogates of socioeconomic status, the increased risk of obesity in blacks and Hispanics persisted (blacks OR 1.51; Hispanics OR 1.18), whereas Asians were less likely to be obese (OR 0.37). While the overall prevalence of obesity increased from 1985 to 2011, significant racial/ethnic disparities in obesity have developed, with the highest prevalence seen in blacks and Hispanics, and the lowest seen in Asians.
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Anthropometrics and Body Composition. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Dinwiddie GY, Zambrana RE, Doamekpor LA, Lopez L. The Impact of Educational Attainment on Observed Race/Ethnic Disparities in Inflammatory Risk in the 2001-2008 National Health and Nutrition Examination Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010042. [PMID: 26703686 PMCID: PMC4730433 DOI: 10.3390/ijerph13010042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 10/08/2015] [Accepted: 10/26/2015] [Indexed: 12/21/2022]
Abstract
Inflammation has shown to be an independent predictor of cardiovascular disease (CVD) and growing evidence suggests Non-Hispanic Blacks (NHBs) and certain Hispanic subgroups have higher inflammation burden compared to Non-Hispanic Whites (NHWs). Socioeconomic status (SES) is a hypothesized pathway that may account for the higher inflammation burden for race/ethnic groups yet little is known about the biological processes by which SES “gets under the skin” to affect health and whether income and education have similar or distinct influences on elevated inflammation levels. The current study examines SES (income and education) associations with multiple levels of C-Reactive Protein (CRP), an important biomarker of inflammation, in a sample of 13,362 NHWs, 7696 NHBs and 4545 Mexican Americans (MAs) in the United States from the 2001 to 2008 National Health and Nutrition Examination Survey. After adjusting for age, sex, and statin use, NHBs and MAs had higher intermediate and high CRP levels compared to NHWs. Income lessened the magnitude of the association for both race/ethnic groups. The greater intermediate and high CRP burden for NHBs and MAs was strongly explained by educational attainment. MAs were more vulnerable to high CRP levels for the lowest (i.e., less than nine years) and post high school (i.e., associates degree) educational levels. After additional adjustment for smoking, heavy drinking, high waist circumference, high blood pressure, diabetes and statin use, the strength of the association between race/ethnicity and inflammation was reduced for NHBs with elevated intermediate (RR = 1.31; p ≤ 0.001) and high CRP levels (RR = 1.14; p ≤ 0.001) compared to NHWs but the effect attenuated for MAs for both intermediate (RR = 0.74; p ≤ 0.001) and high CRP levels (RR = 0.38; p ≤ 0.001). These findings suggest educational attainment is a powerful predictor of elevated CRP levels in race/ethnic populations and challenges studies to move beyond examining income as a better predictor in the SES-inflammation pathway.
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Affiliation(s)
- Gniesha Y Dinwiddie
- African American Studies Department, University of Maryland, College Park, MD 20742, USA.
- Maryland Population Research Center, University of Maryland, College Park, MD 20742, USA.
| | - Ruth E Zambrana
- Women's Studies Department, University of Maryland, College Park, MD 20742, USA.
- Consortium on Race, Gender and Ethnicity, University of Maryland, College Park, MD 20742, USA.
| | | | - Lenny Lopez
- Department of Medicine, University of California, San Francisco, CA 94121, USA.
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Albrecht SS, Gordon-Larsen P, Stern D, Popkin BM. Is waist circumference per body mass index rising differentially across the United States, England, China and Mexico? Eur J Clin Nutr 2015; 69:1306-12. [PMID: 25944180 PMCID: PMC4966607 DOI: 10.1038/ejcn.2015.71] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 01/26/2015] [Accepted: 03/25/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND/OBJECTIVES Little is known about whether waist circumference (WC) has increased disproportionately relative to body mass index (BMI) around the world. SUBJECTS/METHODS Data came from the US National Health and Nutrition Examination Survey (1988-1994 and 2007-2010), Health Survey for England (1992-1993 and 2008-2009); the Mexican Nutrition Survey (1999) and the Mexican National Health and Nutrition Survey (NHNS 2012); and the China Health and Nutrition Survey (1993 and 2011). Country- and sex-stratified (for the United States, also race-/ethnicity-stratified) multivariable linear regressions were used to estimate mean difference in WC over time relative to BMI at specified overweight and obesity cutoff points, adjusting for age and survey year. RESULTS Although mean WC and BMI shifted upward over time in all age-sex subpopulations in all four countries, trends in overweight prevalence were less consistent. However, WC relative to BMI increased at varying magnitudes across all countries and subpopulations, except US Black men. The magnitude of increase was largest for women in the youngest age group (20-29 years), particularly for women in Mexico (+6.6 cm, P<0.0001) and China (+4.6 cm, P<0.0001) (holding BMI constant at 25 kg/m(2)). For men, the increase was primarily evident among Chinese men (+4.8 cm, P<0.0001). CONCLUSIONS WC has increased disproportionately over time relative to overall body mass across the United States, England, Mexico and China, particularly among young women, with the largest increases occurring in the middle-income countries of Mexico and China. These patterns are potentially a cause for concern especially for countries undergoing rapid economic and nutritional transitions.
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Affiliation(s)
- Sandra S. Albrecht
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Penny Gordon-Larsen
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Dalia Stern
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Barry M. Popkin
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Crawford MA, Mendoza-Vasconez AS, Larsen BA. Type II diabetes disparities in diverse women: the potential roles of body composition, diet and physical activity. WOMEN'S HEALTH (LONDON, ENGLAND) 2015; 11:913-27. [PMID: 26648099 PMCID: PMC4864180 DOI: 10.2217/whe.15.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The rates of diabetes in the USA are rapidly increasing, and vary widely across different racial/ethnic groups. This paper explores the potential contribution of body composition, diet and physical activity in explaining diabetes disparities across women of different racial and ethnic backgrounds. For body composition, racial/ethnic groups differ widely by BMI, distribution of body mass and quantity and type of adipose tissue. Dietary patterns that vary across race/ethnicity include consumption of meat, added sugars, high-glycemic carbohydrates and fast food. Additionally, physical activity patterns of interest include aerobic versus muscle-strengthening exercises, and the purpose of physical activity (leisure, occupation, or transportation). Overall, these variables provide a partial picture of the source of these widening disparities, and could help guide future research in addressing and reducing diabetes disparities.
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Affiliation(s)
- Margaret A Crawford
- Department of Family Medicine & Public
Health, University of California, San Diego, CA 92093, USA
| | | | - Britta A Larsen
- Department of Family Medicine & Public
Health, University of California, San Diego, CA 92093, USA
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Bea JW, Thomson CA, Wertheim BC, Nicholas JS, Ernst KC, Hu C, Jackson RD, Cauley JA, Lewis CE, Caan B, Roe DJ, Chen Z. Risk of Mortality According to Body Mass Index and Body Composition Among Postmenopausal Women. Am J Epidemiol 2015; 182:585-96. [PMID: 26350478 DOI: 10.1093/aje/kwv103] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/14/2015] [Indexed: 12/20/2022] Open
Abstract
Obesity, often defined as a body mass index (BMI; weight (kg)/height (m)(2)) of 30 or higher, has been associated with mortality, but age-related body composition changes can be masked by stable BMI. A subset of Women's Health Initiative participants (postmenopausal women aged 50-79 years) enrolled between 1993 and 1998 who had received dual-energy x-ray absorptiometry scans for estimation of total body fat (TBF) and lean body mass (LBM) (n = 10,525) were followed for 13.6 (standard deviation, 4.6) years to test associations between BMI, body composition, and incident mortality. Overall, BMI ≥35 was associated with increased mortality (adjusted hazard ratio (HR) = 1.45, 95% confidence interval (CI): 1.16, 1.82), while TBF and LBM were not. However, an interaction between age and body composition (P < 0.001) necessitated age stratification. Among women aged 50-59 years, higher %TBF increased risk of death (HR = 2.44, 95% CI: 1.38, 4.34) and higher %LBM decreased risk of death (HR = 0.41, 95% CI: 0.23, 0.74), despite broad-ranging BMIs (16.4-69.1). However, the relationships were reversed among women aged 70-79 years (P < 0.05). BMI did not adequately capture mortality risk in this sample of postmenopausal women. Our data suggest the clinical utility of evaluating body composition by age group to more robustly assess mortality risk among postmenopausal women.
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Kreymann KG, DeLegge MH, Luft G, de Heer G. A nutrition strategy for obese ICU patients with special consideration for the reference of protein. Clin Nutr ESPEN 2015; 10:e160-e166. [DOI: 10.1016/j.clnesp.2015.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 05/26/2015] [Accepted: 07/05/2015] [Indexed: 01/10/2023]
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Abstract
The purpose of this ASRM Practice Committee report is to provide clinicians with principles and strategies for the evaluation and treatment of couples with infertility associated with obesity. This revised document replaces the Practice Committee document titled, "Obesity and reproduction: an educational bulletin," last published in 2008 (Fertil Steril 2008;90:S21-9).
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Lambrinoudaki I, Armeni E, Rizos D, Georgiopoulos G, Athanasouli F, Triantafyllou N, Panoulis K, Augoulea A, Creatsa M, Alexandrou A, Alevizaki M, Stamatelopoulos K. Indices of adiposity and thyroid hormones in euthyroid postmenopausal women. Eur J Endocrinol 2015; 173:237-45. [PMID: 26142102 DOI: 10.1530/eje-15-0141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We aimed to evaluate the association between thyroid hormones and indices of obesity in a sample of euthyroid postmenopausal women. DESIGN Cross-sectional study. METHODS Serum levels of TSH, free triiodothyronine (FT3), and free thyroxine (FT4) as well as BMI and waist:hip ratio (WHR) were evaluated in 194 healthy euthyroid postmenopausal women. Ultrasonography was used to assess abdominal fat layers (subcutaneous fat (SF), preperitoneal fat (PF), and SF:PF ratio). Indices of adiposity were defined as high vs low depending on the median value of the assessed parameters. RESULTS After multivariate adjustment for traditional risk factors, lower FT4 levels and a higher FT3:FT4 ratio predicted higher SF mass (FT4, Exp(β)=0.035, P=0.020 and FT3:FT4, Exp(β)=2.374, P=0.018), whereas higher FT3 predicted higher PF mass (Exp(β)=2.815, P=0.032). Women with FT3:FT4 above the highest quartile had a significantly higher SF mass as compared to women in the lowest quartile (1.81 ± 0.62 cm vs 1.54 ± 0.46 cm, P=0.027). BMI had a positive independent association with TSH (Exp(β)=1.829, P=0.018). Finally, FT3 was significantly associated with SF mass among women with higher BMI (FT3, β=0.259, P=0.040) and women with higher WHR (β=0.309, P=0.020) but not among women with lower BMI or WHR values. CONCLUSION Thyroid hormone levels, and in particular FT3, were independently associated with SF and PF in euthyroid postmenopausal women, and this association was mainly evident in women with higher BMIs. On the other hand, among traditional indices of adiposity, only TSH was positively associated with BMI. Larger prospective studies are needed to evaluate the significance of the present findings.
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Affiliation(s)
- Irene Lambrinoudaki
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Eleni Armeni
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Demetrios Rizos
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Georgios Georgiopoulos
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Foteini Athanasouli
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Nikolaos Triantafyllou
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Konstantinos Panoulis
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Areti Augoulea
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Maria Creatsa
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Andreas Alexandrou
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Maria Alevizaki
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
| | - Kimon Stamatelopoulos
- Second Department of Obstetrics and GynecologyHormonal LaboratoryAretaieio Hospital, University of Athens, 76 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of TherapeuticsAlexandra Hospital, University of Athens, 80 Vas. Sofias Avenue, GR-11528 Athens, GreeceDepartment of NeurologyAiginiteion Hospital, University of Athens, 72-74 Vas. Sofias Avenue, GR-11528 Athens, Greece
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Abstract
The obesity epidemic in the USA affects disproportionately women and the ethnic minorities. On the other hand, female sex is traditionally associated with a favorable fat distribution preferentially in the subcutaneous depots of the lower body and with improved endocrine and metabolic function of the adipose tissue. However, these data are derived from predominantly non-Hispanic white populations. This review discusses fat distribution patterns in women of diverse ethnic backgrounds, together with data on the release of adipokines from adipose tissue in these populations. Very little information is available on how the metabolic function of the adipocyte differs depending on ethnicity. Thus, it becomes clear that future clinical and translational research should explicitly discuss and take into account the sex and ethnic background of the populations studied.
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Affiliation(s)
- Kalypso Karastergiou
- Section of Endocrinology, Diabetes & Nutrition, School of Medicine, Boston University, 650 Albany St. EBRC-810, Boston, MA, 02118, USA.
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Psaltis AJ, Overton LJ, Thomas WW, Fox NF, Banks CA, Schlosser RJ. Differences in skull base thickness in patients with spontaneous cerebrospinal fluid leaks. Am J Rhinol Allergy 2015; 28:e73-9. [PMID: 24717891 DOI: 10.2500/ajra.2014.28.4002] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study was designed to determine if differences in overall skull base thickness exist in patients with spontaneous cerebrospinal fluid (SCSF) leaks and to compare our institution's 10-year experience with the endoscopic repair of these leaks to the existing literature. A retrospective cohort study was performed in a tertiary rhinologic practice. METHODS A retrospective study by two blinded independent reviewers compared the skull base thickness on computerized tomography (CT) imaging in our SCSF leak patients to nonleaking controls and patients with traumatic CSF leaks. Surgical outcomes were compared with a pooled analysis of the published literature. RESULTS SCSF leaks were seen most commonly in obese, middle-aged women of African American descent. SCSF leak patients were shown to have thinner skull bases in the region of the ethmoid roof, lateral lamella, and anterior face of the sella (p < 0.05) compared with patients with traumatic leaks and nonleaking controls. No racial difference in skull base thickness was observed when patients were matched according to leak type. The success rate of primary endoscopic intervention in our patients was high at 94% and comparable with the published literature. CONCLUSION Differences in skull base thickness exist in SCSF patients, but whether this predisposes to such leaks or is a consequence of the underlying pathophysiology remains unknown. The endoscopic endonasal approach provides a highly effective means of repairing such leaks with success rates comparable with the endoscopic repair of other leak types. Adjuvant measures including weight reduction, lumbar drain, and acetazolamide use may increase success rates and should be considered in their management.
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Affiliation(s)
- Alkis J Psaltis
- Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Myint PK, Kwok CS, Luben RN, Wareham NJ, Khaw KT. Body fat percentage, body mass index and waist-to-hip ratio as predictors of mortality and cardiovascular disease. Heart 2015; 100:1613-9. [PMID: 24966306 DOI: 10.1136/heartjnl-2014-305816] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To study the utility of body fat percentage in predicting health outcomes when other obesity indices are considered. METHODS We conducted a prospective cohort study to evaluate the independent utility of body fat percentage and other obesity indices in predicting mortality and cardiovascular disease (CVD). RESULTS We prospectively followed 15 062 European Prospective Investigation into Cancer (EPIC)-Norfolk participants who attended a health examination during 1997–2000 for all-cause mortality and incidence of CVD up to end of December 2011 and end of March 2009, respectively. During the follow-up, 2420 died and 4665 had incident CVD. After exclusion of prior stroke, myocardial infarction and cancer and adjusting for potential confounders, body mass index (BMI) and waist-to- hip ratio (WHR), the HR of mortality for men were 0.86 (0.68 to 1.09), 0.81 (0.61 to 1.07) and 0.76 (0.55 to 1.05) and for women were 0.91 (0.70 to 1.17), 0.75 (0.55 to 1.02) and 0.87 (0.61 to 1.23) for second, third and fourth quartile compared with the first (bottom) quartile of body fat percentage. The respective HRs for incident CVD were 0.99 (0.83 to 1.19), 0.85 (0.69 to 1.04) and 0.81 (0.64 to 1.03) for men and 0.98 (0.82 to 1.17), 0.89 (0.73 to 1.10) and 1.02 (0.81 to 1.29) for women. In contrast, higher BMI and WHR were associated with an increased risk of both outcomes and WHR appeared to have the best predictive value among three indices. CONCLUSIONS Once BMI and WHR are taken into account, fat percentage does not add to prediction of mortality or CVD in middle-aged and older-aged adults.
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Affiliation(s)
- Phyo Kyaw Myint
- Division of Applied Health Sciences, School of Medicine & Dentistry, University of Aberdeen, Aberdeen, UK
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Shaikh RA, Siahpush M, Singh GK, Tibbits M. Socioeconomic Status, Smoking, Alcohol use, Physical Activity, and Dietary Behavior as Determinants of Obesity and Body Mass Index in the United States: Findings from the National Health Interview Survey. Int J MCH AIDS 2015; 4:22-34. [PMID: 27622000 PMCID: PMC4948154 DOI: 10.21106/ijma.53] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES The aim of this research was to study the socio-demographic and behavioral determinants of obesity and Body Mass Index (BMI) in the United States, using a nationally representative sample. METHODS We used data from the 2010 US National Health Interview Survey. Analyses were limited to adults 18 years and older (N=23,434). Multivariate regression analyses were conducted to estimate the associations between covariates and obesity and BMI. RESULTS Overall, 28.1% in the sample were obese and the mean BMI was 27.6 kg/m(2). In adjusted models, we found that older age, non-Hispanic Black race, lower education and income levels, Midwestern and Southern region of residence, former smoking, infrequent alcohol use, physical inactivity, consumption of less fruits, vegetables, brown rice and more cheese, fried potato and meat, were associated with obesity. These factors were also associated with higher BMI, along with male gender and higher consumption of meat, fried potatoes and cheese. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS The association of many of the socio-demographic and behavioral factors with obesity and higher BMI found in our study was consistent with previous findings. Persistence of such associations suggest a need for better understanding of the underlying mechanism as well as for evaluation of the current programs and policies targeted at reducing the obesity burden in the United States. In view of the rising global obesity epidemic, especially in the low- and middle-income countries, our findings could help guide development of effective health and social policies and programs aimed at reducing the obesity burden in other parts of the world.
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Affiliation(s)
- Raees A. Shaikh
- Department of Health Promotion, Social and Behavioral Health Sciences, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198-4365, USA
| | - Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health Sciences, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198-4365, USA
| | - Gopal K. Singh
- The Center for Gloabal Health and Health Policy, Global Health and Education projects, Inc., Riverdale, MD 20738, USA
| | - Melissa Tibbits
- Department of Health Promotion, Social and Behavioral Health Sciences, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198-4365, USA
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Ethnic disparities in the association of body mass index with the risk of hypertension and diabetes. J Community Health 2014; 39:437-45. [PMID: 24276618 DOI: 10.1007/s10900-013-9792-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite having lower body mass index (BMI) compared to other ethnic groups, Asians continue to develop significant metabolic diseases such as hypertension and diabetes. To evaluate the disparate association of BMI and risk of hypertension and diabetes in Asians. We retrospectively studied 150,753 adults from the 1985-2011 California Behavioral Risk Factor Survey. Trends in prevalence of obesity, hypertension, and diabetes were stratified by ethnicity. Multivariate logistic regression models evaluated the incremental effect of one unit BMI increase on risk of hypertension and diabetes and the disparate risks of hypertension and diabetes at different BMI thresholds. Asians had the lowest BMI among all groups. However, the impact of increasing BMI on risk of hypertension and diabetes was significantly greater in Asians. For each one unit increase in BMI, Asians were significantly more likely to have hypertension (OR 1.15; 95% CI 1.13-1.18) compared to non-Hispanic whites, blacks, and Hispanics. Similar trends were seen for diabetes (Asians: OR 1.15; 95% CI 1.13-1.18). The risk of hypertension in Asians with BMI ≥ 22 was similar to non-Hispanic whites with BMI ≥ 27 and blacks with BMI ≥ 28. The risk of diabetes in Asians with BMI ≥ 28 was similar to non-Hispanic whites with BMI ≥ 30. Despite lower overall BMI compared to other groups, weight gain in Asians is associated with significantly higher risks of hypertension and diabetes. Compared to other ethnic groups, similar risks of hypertension and diabetes are seen in Asians at much lower BMI.
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Insaf TZ, Shaw BA, Yucel RM, Chasan-Taber L, Strogatz DS. Lifecourse socioeconomic position and 16 year body mass index trajectories: differences by race and sex. Prev Med 2014; 67:17-23. [PMID: 24967954 PMCID: PMC4167219 DOI: 10.1016/j.ypmed.2014.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 05/02/2014] [Accepted: 06/16/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the association between lifecourse socioeconomic position (SEP) and changes in body mass index (BMI), and assess disparities in these associations across racial/ethnic groups. METHODS With longitudinal data from 4 waves of the Americans' Changing Lives Study (1986-2002), we employed mixed-effects modeling to estimate BMI trajectories for 1174 Blacks and 2323 White adults. We also estimated associations between these trajectories and lifecourse SEP variables, including father's education, perceived childhood SEP, own education, income, wealth, and financial security. RESULTS Blacks had higher baseline BMIs, and steeper increases in BMI, compared to Whites. Childhood SEP, as measured by high father's education, was associated with lower baseline BMI among Whites. High education was associated with a lower baseline BMI within both race and sex categories. Income had contrasting effects among men and women. Higher income was associated with higher BMI only among males. Associations between indicators of SEP and BMI trajectories were only found for Whites. CONCLUSIONS Our study demonstrates that lifecourse SEP may influence adult BMI differently within different racial and sex groups.
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Affiliation(s)
- Tabassum Z Insaf
- University at Albany, State University of New York, Albany, NY, United States.
| | - Benjamin A Shaw
- University at Albany, State University of New York, Albany, NY, United States
| | - Recai M Yucel
- University at Albany, State University of New York, Albany, NY, United States
| | | | - David S Strogatz
- University at Albany, State University of New York, Albany, NY, United States; Bassett Research Institute, Cooperstown, NY, United States
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Change in daily energy intake associated with pairwise compositional change in carbohydrate, fat and protein intake among US adults, 1999-2010. Public Health Nutr 2014; 18:1343-52. [PMID: 25203716 DOI: 10.1017/s1368980014001876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess the change in daily energy intake associated with pairwise compositional change in carbohydrate, fat and protein intake among US adults stratified by sex, race/ethnicity and weight status. DESIGN Linear mixture model was performed to estimate the relationship between daily energy intake and macronutrient composition, adjusted for age and alcohol consumption, and accounting for survey design. SETTING Study sample from the National Health and Nutrition Examination Survey, 1999-2010 waves. SUBJECTS A total of 27 589 US adults aged 20 years and older were included in the study. Dietary macronutrient intake was calculated from 24 h dietary recall and BMI from objectively measured weight/height. RESULTS Across all population subgroups, substituting protein or carbohydrate for fat and substituting protein for carbohydrate were associated with decreased daily energy intake, with the largest effect resulting from substituting protein for fat. A 1 % increase in the percentage of energy from protein substituted for a 1 % decrease in the percentage of energy from fat was associated with a decrease in daily energy intake of 268.2 (95 % CI 169.0, 367.4) kJ, 289.5 (95 % CI 215.9, 363.2) kJ and 293.7 (95 % CI 210.0, 377.4) kJ among normal-weight (18.5≤BMI, kg/m2<25.0), overweight (25.0≤BMI, kg/m2<30.0) and obese (BMI≥30.0 kg/m2) men, and 177.4 (95 % CI 130.5, 224.3) kJ, 188.7 (95 % CI 139.3, 238.1) kJ and 204.2 (95 % CI 158.2, 250.2) kJ among normal-weight, overweight and obese women, respectively. The relationship between macronutrient composition and daily energy intake varied substantially across sex, race/ethnicity and weight status. CONCLUSIONS Policies promoting higher daily protein intake at the expense of lower fat intake could be effective in reducing total energy intake among US adults.
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Macias N, Quezada AD, Flores M, Valencia ME, Denova-Gutiérrez E, Quiterio-Trenado M, Gallegos-Carrillo K, Barquera S, Salmerón J. Accuracy of body fat percent and adiposity indicators cut off values to detect metabolic risk factors in a sample of Mexican adults. BMC Public Health 2014; 14:341. [PMID: 24721260 PMCID: PMC4108012 DOI: 10.1186/1471-2458-14-341] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 03/28/2014] [Indexed: 11/15/2022] Open
Abstract
Background Although body fat percent (BF%) may be used for screening metabolic risk factors, its accuracy compared to BMI and waist circumference is unknown in a Mexican population. We compared the classification accuracy of BF%, BMI and WC for the detection of metabolic risk factors in a sample of Mexican adults; optimized cutoffs as well as sensitivity and specificity at commonly used BF% and BMI international cutoffs were estimated. We also estimated conditional BF% means at BMI international cutoffs. Methods We performed a cross-sectional analysis of data on body composition, anthropometry and metabolic risk factors(high glucose, high triglycerides, low HDL cholesterol and hypertension) from 5,100 Mexican men and women. The association between BMI, WC and BF%was evaluated with linear regression models. The BF%, BMI and WC optimal cutoffs for the detection of metabolic risk factors were selected at the point where sensitivity was closest to specificity. Areas under the ROC Curve (AUC) were compared among classifiers using a non-parametric method. Results After adjustment for WC, a 1% increase in BMI was associated with a BF% rise of 0.05 percentage points (p.p.) in men (P < 0.05) and 0.25 p.p. in women (P < 0.001). At BMI = 25.0 predicted BF% was 27.6 ± 0.16 (mean ± SE) in men and 41.2 ± 0.07 in women. Estimated BF% cutoffs for detection of metabolic risk factors were close to 30.0 in men and close to 44.0 in women. In men WC had higher AUC than BF% for the classification of all conditions whereas BMI had higher AUC than BF% for the classification of high triglycerides and hypertension. In womenBMI and WC had higher AUC than BF% for the classification of all metabolic risk factors. Conclusions BMI and WC were more accurate than BF% for classifying the studied metabolic disorders. International BF% cutoffs had very low specificity and thus produced a high rate of false positives in both sexes.
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Affiliation(s)
| | - Amado D Quezada
- Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico.
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Simino J, Shi G, Weder A, Boerwinkle E, Hunt SC, Rao DC. Body mass index modulates blood pressure heritability: the Family Blood Pressure Program. Am J Hypertens 2014; 27:610-9. [PMID: 24029162 PMCID: PMC3958601 DOI: 10.1093/ajh/hpt144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 07/22/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Candidate gene and twin studies suggest that interactions between body mass index (BMI) and genes contribute to the variability of blood pressure (BP). To determine whether there is evidence for gene-BMI interactions, we investigated the modulation of BP heritability by BMI using 4,153 blacks, 1,538 Asians, 4,013 whites, and 2,199 Hispanic Americans from the Family Blood Pressure Program. METHODS To capture the BP heritability dependence on BMI, we employed a generalized variance components model incorporating linear and Gaussian interactions between BMI and the genetic component. Within each race and network subgroup, we used the Akaike information criterion and likelihood ratio test to select the appropriate interaction function for each BP trait (systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP)) and determine interaction significance, respectively. RESULTS BP heritabilities were significantly modified by BMI in the GenNet and SAPPHIRe Networks, which contained the youngest and least-obese participants, respectively. GenNet Whites had unimodal SBP, MAP, and PP heritabilities that peaked between BMI values of 33 and 37kg/m(2). The SBP and MAP heritabilities in GenNet Hispanic Americans, as well as the PP heritability in GenNet blacks, were increasing functions of BMI. The DBP and SBP heritabilities in the SAPPHIRe Chinese and Japanese, respectively, were decreasing functions of BMI. CONCLUSIONS BP heritability differed by BMI in the youngest and least-obese networks, although the shape of this dependence differed by race. Use of nonlinear gene-BMI interactions may enhance BP gene discovery efforts in individuals of European ancestry.
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Affiliation(s)
- Jeannette Simino
- Division of Biostatistics, Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Gang Shi
- Division of Biostatistics, Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Alan Weder
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Eric Boerwinkle
- Human Genetics Center, University of Texas Health Sciences Center, Houston, Texas
| | - Steven C. Hunt
- Cardiovascular Genetics Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Dabeeru C. Rao
- Division of Biostatistics, Washington University in St. Louis, School of Medicine, St. Louis, Missouri
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40
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Does obesity increase early postoperative complications after laparoscopic colorectal surgery? Results from a single center. Surg Endosc 2014; 28:2090-6. [DOI: 10.1007/s00464-014-3440-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
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An R. Prevalence and Trends of Adult Obesity in the US, 1999-2012. ISRN OBESITY 2014; 2014:185132. [PMID: 25002986 PMCID: PMC3913362 DOI: 10.1155/2014/185132] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 12/17/2013] [Indexed: 12/26/2022]
Abstract
Aim. To provide national estimates of obesity among US adults aged 20 years and older in 2011-2012 and track its trends from 1999 to 2012. Methods. Measured weight/height from National Health and Nutrition Examination Survey 1999-2012 waves was used to calculate body mass index (BMI) and prevalence measures. Piecewise logistic regressions were conducted to test the differential trends before and after 2010. Results. In 2011-2012, the age-adjusted prevalence of overweight and obesity combined (BMI ≥ 25) was 71.1% (95% CI: 68.0%-74.2%) among men and 65.5% (61.8%-69.3%) among women, and the prevalence of obesity (BMI ≥ 30) was 33.3% (30.5%-36.2%) among men and 35.8% (32.3%-39.4%) among women. From 1990-2000 to 2009-2010, the prevalence of overweight and obesity combined, obesity, grades 2 and 3 obesity combined (BMI ≥ 35), and grade 3 obesity (BMI ≥ 40) increased by 7.2%, 17.8%, 17.6%, and 33.0%, respectively. Compared to 2009-2010, most gender- and race/ethnicity-specific prevalence measures remained unchanged or slightly decreased in 2011-2012. No significant difference in trends among prevalence measures was found before and after 2010. Conclusions. Concurrent evidence on the leveling off of obesity in the US is thin. Given its high prevalence and profound socioeconomic consequences, close monitoring of the trend is warranted.
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Affiliation(s)
- Ruopeng An
- College of Applied Health Sciences, University of Illinois at Urbana-Champaign, George Huff Hall Room 2013, 1206 South 4th Street, Champaign, IL 61820, USA
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Kemp DE, Sylvia LG, Calabrese JR, Nierenberg AA, Thase ME, Reilly-Harrington NA, Ostacher MJ, Leon AC, Ketter TA, Friedman ES, Bowden CL, Pencina M, Iosifescu DV. General medical burden in bipolar disorder: findings from the LiTMUS comparative effectiveness trial. Acta Psychiatr Scand 2014; 129:24-34. [PMID: 23465084 PMCID: PMC3789858 DOI: 10.1111/acps.12101] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study examined general medical illnesses and their association with clinical features of bipolar disorder. METHOD Data were cross-sectional and derived from the Lithium Treatment - Moderate Dose Use Study (LiTMUS), which randomized symptomatic adults (n = 264 with available medical comorbidity scores) with bipolar disorder to moderate doses of lithium plus optimized treatment (OPT) or to OPT alone. Clinically significant high and low medical comorbidity burden were defined as a Cumulative Illness Rating Scale (CIRS) score ≥4 and <4 respectively. RESULTS The baseline prevalence of significant medical comorbidity was 53% (n = 139). Patients with high medical burden were more likely to present in a major depressive episode (P = .04), meet criteria for obsessive-compulsive disorder (P = .02), and experience a greater number of lifetime mood episodes (P = 0.02). They were also more likely to be prescribed a greater number of psychotropic medications (P = .002). Sixty-nine per cent of the sample was overweight or obese as defined by body mass index (BMI), with African Americans representing the racial group with the highest proportion of stage II obesity (BMI ≥35; 31%, n = 14). CONCLUSION The burden of comorbid medical illnesses was high in this generalizable sample of treatment-seeking patients and appears associated with worsened course of illness and psychotropic medication patterns.
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Affiliation(s)
- David E. Kemp
- Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH USA
| | | | - Joseph R. Calabrese
- Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH USA
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Dinwiddie GY, Zambrana RE, Garza MA. Exploring risk factors in Latino cardiovascular disease: the role of education, nativity, and gender. Am J Public Health 2013; 104:1742-50. [PMID: 24028268 DOI: 10.2105/ajph.2013.301280] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We examined 3 cardiovascular disease risk factors by nativity and gender, evaluating evidence for education and health behaviors in explaining the "Hispanic Health Paradox." METHODS We analyzed 2001-2008 National Health and Nutrition Examination Survey data for adults (n = 6032) to compare hypertension, high waist circumference, and diabetes for US- and foreign-born Mexican men and women. We controlled for age, depression, and health insurance. RESULTS Cardiovascular disease risk factors differed by education, nativity, and gender. Higher education was associated with higher odds of hypertension and high waist circumference for men and women regardless of nativity. As education increased, the odds of diabetes increased for US-born women, showing a gradient for this population. Finally, foreign-born Mexican women with 5 to 19 years in the United States conferred the highest odds of having diabetes, whereas foreign-born men with less than 5 years in the United States had the lowest odds for high waist circumference and presence of diabetes. CONCLUSIONS Results contest assumptions of the Hispanic Health Paradox and suggest new approaches. New research can yield accurate information to ensure the development of appropriate interventions, decreasing health disparities endemic to a subgroup of Latinos.
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Affiliation(s)
- Gniesha Y Dinwiddie
- Gniesha Y. Dinwiddie is with the African American Studies Department and the Maryland Population Research Center, University of Maryland, College Park. Ruth E. Zambrana is with the Department of Women's Studies and the Consortium on Race, Gender and Ethnicity, University of Maryland, College Park. Mary A. Garza is with the Department of Behavioral and Community Health and the Maryland Center for Health Equity, University of Maryland, College Park
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Schwartz R, Kliper E, Stern N, Dotan G, Berliner S, Kesler A. The obesity pattern of idiopathic intracranial hypertension in men. Graefes Arch Clin Exp Ophthalmol 2013; 251:2643-6. [PMID: 23955783 DOI: 10.1007/s00417-013-2420-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/01/2013] [Accepted: 07/03/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a disorder of unknown etiology, predominantly affecting obese women of childbearing age. IIH is uncommon in men, with a reported female-to-male ratio of 8:1. The pathogenesis of IIH is poorly understood. Several mechanisms have been suggested, but no one mechanism has been able to account for all manifestations of the disease. This research aims to characterize the obesity phenotype(s) of men with IIH in order to find potential inducers for this disease. METHODS This is a cross-sectional study based on subjects' medical records. It compared anthropometric parameters between 22 men with IIH, 60 healthy men, and 44 females with IIH. One-way analysis with age and body mass index included as covariates was applied for the assessment of the difference in fat distribution among the three groups. RESULTS No significant differences were observed between the male IIH cohort and healthy males for age, BMI, and waist measurements, whereas hip circumference was significantly larger in the IIH cohort (114 ± 13 vs. 104 ± 16 cm; respectively, p < 0.001). Consequently, waist-to-hip ratio (WHR) was significantly lower in the male IIH cohort (0.88 ± 0.08 vs. 0.95 ± 0.12; p < 0.001). While no significant differences were observed for age and hip measurements between male IIH and female IIH cohorts, waist circumference and waist-to-hip ratio (WHR) were significantly larger in the male cohort (102 ± 19 cm vs. 95 ± 13 cm, p < 0.001; 0.88 ± 0.08 vs. 0.78 ± 0.06, p < 0.001, respectively). All these results maintained after adjustment for age and BMI. CONCLUSIONS This is the first report of body fat distribution patterns in men with IIH. Whereas male IIH have larger central fat deposition than female IIH patients, abdominal fatness is less accentuated in IIH men compared to normal obese men. The later observation is in agreement with similar results regarding female IIH patients. We believe that these findings justify further investigation into the involvement of various fat depots in the pathogenesis of IIH in men and women alike.
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Affiliation(s)
- Roy Schwartz
- Tel Aviv Sourasky Medical Center and The Sackler Faculty of Medicine, University, Tel Aviv, Israel
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Hruschka DJ, Brewis AA. Absolute wealth and world region strongly predict overweight among women (ages 18-49) in 360 populations across 36 developing countries. ECONOMICS AND HUMAN BIOLOGY 2013; 11:337-344. [PMID: 22269776 DOI: 10.1016/j.ehb.2012.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 01/02/2012] [Accepted: 01/02/2012] [Indexed: 05/31/2023]
Abstract
This paper proposes a benchmark for comparing SES gradients across countries, based on gross domestic product apportioned to members of differing wealth categories within countries. Using this approach, we estimate absolute wealth in 360 populations in 36 developing countries and model its relationship with overweight (BMI≥25) among non-pregnant women ages 18-49. A simple model based on absolute wealth alone strongly predicts odds of overweight (R(2)=0.59), a relationship that holds both between countries and between different groups in the same country (10 populations for each of 36 countries). Moreover, world region modifies this relationship, accounting for an additional 22% of variance (R(2)=0.81). This allows us to extract a basic pattern: rising rates of overweight in lower and middle income countries closely track increasing economic resources, and the shape of that gradient differs by region in systematic ways.
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Affiliation(s)
- Daniel J Hruschka
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85287-2402, USA.
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He J, Bhasin S, Binder EF, Yarasheski KE, Castaneda-Sceppa C, Schroeder ET, Roubenoff R, Chou CP, Azen SP, Sattler FR. Cardiometabolic risks during anabolic hormone supplementation in older men. Obesity (Silver Spring) 2013; 21:968-75. [PMID: 23784898 PMCID: PMC3930448 DOI: 10.1002/oby.20081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 09/04/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the cardiometabolic risks of testosterone and growth hormone (GH) replacement therapy to youthful levels during aging. DESIGN AND METHODS A double-masked, partially placebo controlled study in 112 men 65-90 years-old was conducted. Transdermal testosterone (5 g vs. 10 g/day) using a Leydig Cell Clamp and subcutaneous recombinant GH (rhGH) (0 vs. 3 vs. 5 μg/kg/day) were administered for 16-weeks. Measurements included testosterone and IGF-1 levels, body composition by DEXA, and cardiometabolic risk factors (upper body fat, blood pressure, insulin sensitivity, fasting triglycerides, HDL-cholesterol, and serum adiponectin) at baseline and after 16 weeks of treatment. RESULTS Some cardiometabolic factors improved (total and trunk fat, triglycerides, HDL-cholesterol) and others worsened (systolic blood pressure, insulin sensitivity index [QUICKI], adiponectin). Cardiometabolic risk composite scores (CRCSs) improved (-0.69 ± 1.55, P < 0.001). In multivariate analyses, QUICKI, triglycerides, and HDL-cholesterol contributed 33%, 16%, and 14% of the variance in CRCS, respectively. Pathway analyses indicated that changes in fat and lean mass were related to individual cardiometabolic variables and CRCS in a complex manner. Changes in BMI, reflecting composite effects of changes in fat and lean mass, were more robustly associated with cardiometabolic risks than changes in fat mass or LBM individually. CONCLUSIONS Testosterone and rhGH administration was associated with diverse changes in individual cardiometabolic risk factors, but in aggregate appeared not to worsen cardiometabolic risk in healthy older men after 4-months. The long-term effects of these and similar anabolic therapies on cardiovascular events should be investigated in populations with greater functional limitations along with important health disabilities including upper body obesity and other cardiometabolic risks.
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Affiliation(s)
- J He
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
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Optimal scaling of weight and waist circumference to height for maximal association with DXA-measured total body fat mass by sex, age and race/ethnicity. Int J Obes (Lond) 2012. [DOI: 10.1038/ijo.2012.201] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Wells JCK. Ethnic variability in adiposity, thrifty phenotypes and cardiometabolic risk: addressing the full range of ethnicity, including those of mixed ethnicity. Obes Rev 2012; 13 Suppl 2:14-29. [PMID: 23107256 DOI: 10.1111/j.1467-789x.2012.01034.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Ethnic groups vary in cardiometabolic risk, but the underlying mechanisms remain unclear. Several components of body composition variability (fat/lean ratio, fat distribution, lean mass composition and metabolism, and adipose tissue biology) are increasingly linked with cardiometabolic risk and vary substantially across ethnic groups. Constituents of lean mass are proposed to contribute to 'metabolic capacity', a generic trait favouring the maintenance of homeostasis. Adiposity is proposed to contribute to 'metabolic load', which at higher levels challenges metabolic homeostasis, elevating cardiometabolic risk. Ethnic differences in body composition, representing different load-capacity ratios, may therefore contribute to ethnic variability in cardiometabolic risk. Ecological and evolutionary factors potentially contributing to ethnic variability in body composition are explored. In contemporary populations, clinicians encounter an increasing range of ethnicity, along with many individuals of mixed-ethnic ancestry. Increasing understanding of the contribution of body composition to cardiometabolic risk may reduce the need to treat ethnic groups as qualitatively different. A conceptual model is proposed, treating insulin sensitivity and stroke risk as composite functions of body composition variables. Operationalizing this model may potentially improve the ability to assess cardiovascular risk across the full ethnicity spectrum, and to predict cardiometabolic consequences of excess weight gain.
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Affiliation(s)
- J C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, University College London, 30 Guilford St., London, UK.
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Jerrard GA, Liu J, Case RC, Motevalli M, Bolton SG, King KE, Beigel J, Brooks Jackson J. Implications of weight and body mass index for plasma donation and health. ISRN HEMATOLOGY 2012; 2012:937585. [PMID: 23209921 PMCID: PMC3504381 DOI: 10.5402/2012/937585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 10/20/2012] [Indexed: 12/03/2022]
Abstract
This study determined the percentage of potential plasma donors who could donate plasma in the 3 allowable plasma volume limit categories as specified by the Food and Drug Administration (FDA), as well as the association of the body mass index (BMI) of these individuals with age, blood pressure, oral temperature, and pulse. Of 315 plasma donors analyzed, 107 (34.0%) weighed between 110 and 149 lbs (50.0-67.7 kg), 89 (28.2%) weighed between 150 and174 lbs (68.2-79.1 kg), and 119 (37.8%) weighed >175 lbs (79.5 kg), theoretically allowing collection of an additional 101.4 liters (16% more plasma) from both heavier categories based on FDA standards for plasma donor quantities. BMI was positively associated with age, mean arterial pressure (MAP), and pulse (Pearson's r = 0.36, 0.24, and 0.18, resp., P values <0.05), but not with oral temperature. Average BMI for females was higher than for males (+1.8, P = 0.01), and BMI for African Americans was higher than for White and Asian participants (+2.2 and +5.1, resp., Ps <0.05). A significant association was also found in the sex by race interaction with BMI (P = 0.0004). Follow-up analyses suggested a significant difference in BMI by sex among African Americans, higher BMI among African American females than Asian and White males, and higher BMI among White females than African American males (Ps <0.05).
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Affiliation(s)
- Genna A. Jerrard
- Johns Hopkins Hospital, Carnegie 415, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Jing Liu
- Johns Hopkins Hospital, Carnegie 415, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Rosemary C. Case
- Johns Hopkins Hospital, Carnegie 415, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Mahnaz Motevalli
- Johns Hopkins Hospital, Carnegie 415, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Stephen G. Bolton
- Johns Hopkins Hospital, Carnegie 415, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Karen E. King
- Johns Hopkins Hospital, Carnegie 415, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - John Beigel
- Clinical Monitoring Research Program, SAIC-Frederick Inc., Frederick, MD 21702, USA
- National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH) Building 10, 8N234-C 10 Center Dr., MSC 1763, Bethesda, MD 20892-1763, USA
| | - J. Brooks Jackson
- Johns Hopkins Hospital, Carnegie 415, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Wild SH, Byrne CD. Evidence for fetal programming of obesity with a focus on putative mechanisms. Nutr Res Rev 2012; 17:153-62. [PMID: 19079923 DOI: 10.1079/nrr200487] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Obesity is associated with insulin resistance, the metabolic syndrome (a clustering of three or more of increased waist circumference, blood pressure, fasting glucose and fasting plasma triacylglycerol levels and reduced HDL levels), and a marked increase in the risk of type 2 diabetes and CHD. The impact of obesity differs between individuals, particularly between men and women and between ethnic groups. For example, in South Asians, although overall obesity is less prevalent, central obesity and the metabolic syndrome are more prevalent than in Europeans and this pattern is associated with the development of type 2 diabetes and CHD at an earlier age. It is important to examine individual risk factors contributing to obesity because they may have a different impact in population subgroups. Many factors contribute to the aetiology of obesity and there is increasing evidence to suggest that altered early development is one such factor and is associated with abnormal fat accumulation, the metabolic syndrome and type 2 diabetes in later life. The present review presents this evidence and discusses some of the mechanisms that may be involved in the pathogenesis of the programming of obesity.
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Affiliation(s)
- Sarah H Wild
- Public Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
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