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Luah XW, Holst-Hansen T, Lübker C. The association between body mass index and health-related quality of life in the 2017 and 2018 health survey of England data: A cross-sectional observational analysis. Diabetes Obes Metab 2024; 26:2318-2328. [PMID: 38499493 DOI: 10.1111/dom.15546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/20/2024]
Abstract
AIM To provide an updated estimate of the association between body mass index (BMI) and health-related quality of life (HRQoL) among the general population in England and to identify population subgroups with the highest potential utility gains from obesity interventions. MATERIALS AND METHODS The sample included 12 158 adults with valid HRQoL and BMI data from the 2017 and 2018 Health Survey for England. Robust standard error linear regression, controlling for demographic and socioeconomic characteristics, lifestyle behaviours and obesity-related comorbidities, was used for the baseline analysis. Robustness checks assessed the impact of (a) estimator selection; (b) model specifications; (c) statistical outliers at high BMI; (d) potential BMI measurement error; and (e) data pooling. RESULTS The study found a significant association between HRQoL and BMI, which exhibited an inverted U-shaped relationship. The mean HRQoL peaked at 25.7 kg/m2 in men and 22.6 kg/m2 in women and was reduced in the underweight, overweight and obesity BMI ranges. Sensitivity analyses reported similar coefficients, suggesting a robust model specification. CONCLUSIONS Reduced HRQoL beyond optimal BMI underlines the importance of maintaining a normal BMI range for overall health. The rising prevalence of class III obesity is a major public health concern given its disproportionate impact on health, health care utilization and costs. Obesity management is key to preventing the reduction in HRQoL associated with obesity-related comorbidities, and this analysis supports the development of targeted policies and population health initiatives for people with class III obesity.
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Affiliation(s)
- Xiao Wen Luah
- Department of Economics and Related Studies, University of York, York, UK
- Novo Nordisk A/S, Søborg, Denmark
| | | | - Christopher Lübker
- Novo Nordisk A/S, Søborg, Denmark
- Department of Health Sciences, University of York, York, UK
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Ahvenjärvi H, Niiranen M, Simula S, Hämäläinen P, Surcel HM, Remes AM, Ryytty M, Krüger J. Fatigue and health-related quality of life depend on the disability status and clinical course in RRMS. Mult Scler Relat Disord 2023; 77:104861. [PMID: 37442075 DOI: 10.1016/j.msard.2023.104861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/01/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Fatigue is a prominent and disabling symptom of multiple sclerosis (MS), impairing quality of life. The disease course of relapsing remitting MS (RRMS) is individual. OBJECTIVES We aimed to study the effects of demographic and clinical characteristics, as well as lifestyle risk factors on experienced fatigue and health-related quality of life (HRQoL) among RRMS patients, comparing benign and severe disease types. METHODS Altogether 198 Finnish RRMS patients were recruited for this real-life cross-sectional study. Self-reported questionnaires were used to evaluate fatigue and HRQoL by using Fatigue Scale for Motor and Cognitive Functions and 15D health-related quality of life questionnaires. Patients were categorized into subgroups based on the current disability status measured by the Expanded Disability Status Scale (EDSS) cut-off value of 4.5, and by retrospective clinical course divided into benign and aggressive RRMS. RESULTS All in all, 73% of the RRMS patients suffered from fatigue. Lower HRQoL had a strong correlation with more prominent fatigue (r = -0.719). Higher EDSS was associated with more prominent fatigue and lower HRQoL in the whole RRMS cohort. Older age at the disease onset was associated with more prominent fatigue and decreased HRQoL in the groups of aggressive RRMS and EDSS > 4.5. In the groups of EDSS ≤ 4.5 and benign RRMS, a higher number of used disease-modifying treatments (DMTs) was associated with more pronounced fatigue and reduced HRQoL. In addition, higher BMI was associated with lower HRQoL in patients with benign RRMS. Side effects (45 %) and lack of efficacy (26 %) were the most common reasons for discontinuing a DMT. Cessation due to side effects was the only reason that was significantly associated with more prominent fatigue and lower HRQoL. Use of nicotine products, gender, or disease duration were not associated with fatigue or HRQoL. CONCLUSIONS Individuals with severe RRMS and higher EDSS scores are more prone to experience fatigue and lower HRQoL. In addition, fatigue and lower HRQoL are more commonly observed among RRMS patients with older age at disease onset and in those with multiple DMT switches.
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Affiliation(s)
- Henrik Ahvenjärvi
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland
| | - Marja Niiranen
- Neuro Center, Neurology Outpatient Clinic, Kuopio University Hospital, P.O. Box 100, FI-70029 Kuopio, Finland; Institute of Clinical Medicine-Neurology, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Sakari Simula
- Southern Savo Hospital District, Department of Neurology, Porrassalmenkatu 35-37, FI-50100 Mikkeli, Finland
| | - Päivi Hämäläinen
- Masku Neurological Rehabilitation Centre, Vaihemäentie 10, FI-21250 Masku, Finland; Department of Psychology, FI-20014 University of Turku, Finland
| | - Heljä-Marja Surcel
- Faculty of Medicine, University of Oulu, P.O. Box 8000, FI-90014 University of Oulu, Finland; Biobank Borealis of Northern Finland, Northern Ostrobothnia Hospital District, P.O. Box 10, FI-90029 Oulu University Hospital, Finland
| | - Anne M Remes
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Clinical Neurosciences, P.O. Box 4, Yliopistonkatu 3, FI-00014 University of Helsinki, Finland
| | - Mervi Ryytty
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Neurocenter, Neurology, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland
| | - Johanna Krüger
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Neurocenter, Neurology, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland.
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Zou S, Feng G, Li D, Ge P, Wang S, Liu T, Li H, Lai Y, Tan Z, Huang Y, Huang J, Zhang C, Wu Y, Ming WK. Lifestyles and health-related quality of life in Chinese people: a national family study. BMC Public Health 2022; 22:2208. [PMID: 36443710 PMCID: PMC9706972 DOI: 10.1186/s12889-022-14680-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There were few studies that investigated health-related quality of life (HRQoL) of the general population in China, and many of them reported limitations in sampling. OBJECTIVE To investigate the relationship between lifestyles and HRQoL in the Chinese population in both individual and family levels. METHOD Online questionnaires were distributed across China to collect demographic information and participants' HRQoL using EuroQoL 5 Dimension scales. The EuroQoL Group's 5 Dimension scale (EQ-5D) index and EuroQoL Group's visual analog scale (EQ VAS) score were calculated to evaluate the HRQoL. RESULTS A total of 1305 valid questionnaires were included. Higher HRQoL was found in people with intend to lower oil intake, intend to lower salt intake, intend to lower sugar intake, balanced diet, moderate sports every week, a sport hobby and joining a fitness organization (all p<.05). HRQoL was higher among male (female as reference), healthy weight (unhealthy weight as reference) (both p<.05). Negative correlation was found between HRQoL and clinical medical history and drinking history. Small families (1-2 persons, 83.19 ± 20.14) had poorer HRQoL (EQ VAS score) than big families (≥3 persons, 85.00 ± 17.96, p <.05). CONCLUSION In China, people with healthy dietary habits, regular sports habits, healthy weight and male groups tended to have better HRQoL. Clinical medical history and drinking history were negatively related to HRQoL. Small families tend to have poorer HRQoL than big families. The finding implicated influence of the number of family members on people's perception of health and provided scientific evidence for the current policies to encourage birth in China. For a better HRQoL, we suggest people live in big families and take measures to lower salt/sugar/oil intake and exercise regularly in daily life.
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Affiliation(s)
- Shiqian Zou
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 Huangpu W Ave, Tianhe District, Guangzhou, 510632, Guangdong Province, China
| | - Guanrui Feng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 Huangpu W Ave, Tianhe District, Guangzhou, 510632, Guangdong Province, China
| | - Danyang Li
- Medical College of Xi'an Peihua University, Xi'an, China
| | - Pu Ge
- Key Research Base of Philosophy and Social Sciences in Shaanxi Province, Health Culture Research Center of Shaanxi, Xi'an, China
| | - Siyi Wang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 Huangpu W Ave, Tianhe District, Guangzhou, 510632, Guangdong Province, China
| | - Tinlun Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 Huangpu W Ave, Tianhe District, Guangzhou, 510632, Guangdong Province, China
| | - Haijun Li
- School of Pharmacy, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Yongjie Lai
- Key Research Base of Philosophy and Social Sciences in Shaanxi Province, Health Culture Research Center of Shaanxi, Xi'an, China
- School of Pharmaceutical Science, Shandong University, Jinan, Shandong, China
| | - Zijian Tan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 Huangpu W Ave, Tianhe District, Guangzhou, 510632, Guangdong Province, China
| | - Yuling Huang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 Huangpu W Ave, Tianhe District, Guangzhou, 510632, Guangdong Province, China
| | - Jian Huang
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, St Mary's Campus, Imperial College London, Norfolk Place, British, London, UK
| | - Casper Zhang
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Yibo Wu
- Key Research Base of Philosophy and Social Sciences in Shaanxi Province, Health Culture Research Center of Shaanxi, Xi'an, China.
- Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, China.
| | - Wai-Kit Ming
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 Huangpu W Ave, Tianhe District, Guangzhou, 510632, Guangdong Province, China.
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Body Image and Body Mass Index Influence on Psychophysical Well-Being in Bariatric Patients: A Cross-Sectional Study. J Pers Med 2022; 12:jpm12101597. [PMID: 36294736 PMCID: PMC9604850 DOI: 10.3390/jpm12101597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Psychophysical factors may have an impact on the disease of obesity, and it is important to explore which aspects may play an important role on the well-being of obese patients undergoing bariatric surgery. The purpose of this study was to assess the associations of a high body mass index (BMI) and greater dissatisfaction with body image with higher levels of psychopathological aspects, feelings of hopelessness, and psychological and physical health in patients undergoing evaluation for bariatric surgery. Methods: Fifty-nine patients undergoing bariatric surgery filled out the Symptom Checklist-90-Revised, the Body Uneasiness Test, the 12-item Short Form Survey, the Beck Inventory Scale II, and the Beck Hopelessness Scale. Correlations and hierarchical regressions between measures were performed. Results: Dissatisfaction with the perception of one’s own body image was strongly correlated with a worse psychophysiological health. On the contrary, BMI showed no significant correlation with the previous variables. Furthermore, the perception of one’s own body image significantly predicted the state of psychological health. Conclusions: The findings showed a more relevant role of body image compared to the BMI in the association with psychological outcomes, suggesting the importance of considering body image in the assessment and treatment of obese patients requiring bariatric treatment.
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Mejaddam A, Krantz E, Höskuldsdóttir G, Fändriks L, Mossberg K, Eliasson B, Trimpou P, Landin-Wilhelmsen K. Comorbidity and quality of life in obesity-a comparative study with the general population in Gothenburg, Sweden. PLoS One 2022; 17:e0273553. [PMID: 36194568 PMCID: PMC9531784 DOI: 10.1371/journal.pone.0273553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 08/11/2022] [Indexed: 11/14/2022] Open
Abstract
CONTEXT Obesity is considered to have a detrimental impact on health-related quality of life (HRQoL). OBJECTIVE To compare HRQoL in a well-defined group of people with obesity with a population-based control group from the general public. DESIGN Observational cross-sectional cohort study with a reference population. SETTING The Regional Obesity Center at the Department of Medicine at Sahlgrenska University Hospital, Gothenburg, Sweden. PARTICIPANTS People with obesity (n = 1122) eligible for surgical and non-surgical obesity treatment in routine care were included consecutively between 2015 and 2017 into the BASUN study. Men and women from the WHO-MONICA-GOT project were used as a reference population (n = 414). MAIN OUTCOME MEASURES HRQoL was measured with the RAND-36/Short Form-36 questionnaire (SF-36) and a Visual Analogue Scale (VAS) for self-related health (SRH). Prescription drugs for hypertension, diabetes mellitus, depression, and anxiety were taken as a proxy for these conditions. RESULTS People with obesity rated their overall HRQoL lower than the reference population according to the SRH-VAS. Lower scores were reported on physical and social functioning, vitality, general and mental health after adjustment for age and use of prescription drugs (considered a proxy for burden of disease, or comorbidities) using the RAND-36/SF-36 questionnaire. Use of some psychopharmacological agents was more common in patients with obesity. CONCLUSION People with obesity seeking help with weight reduction are more likely to have lower physical and mental self-reported HRQoL than the general population.
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Affiliation(s)
- Ala Mejaddam
- Department of Internal Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- * E-mail:
| | - Emily Krantz
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gudrún Höskuldsdóttir
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- Section for Endocrinology and Diabetology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Fändriks
- Department of Surgery, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Mossberg
- Department of Public Health and Community Medicine Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Eliasson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- Section for Endocrinology and Diabetology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Penelope Trimpou
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- Section for Endocrinology and Diabetology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Landin-Wilhelmsen
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- Section for Endocrinology and Diabetology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Liu X, Chen S, Tan A, Zhou J, Liu W. Stay Slim or Get Fat?: An Examination of the "Jolly Fat" Effect in Chinese Older Adults. Risk Manag Healthc Policy 2021; 14:1271-1279. [PMID: 33790672 PMCID: PMC8005362 DOI: 10.2147/rmhp.s302270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/11/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose The association between body mass index (BMI) and health-related quality of life (HRQOL) has not been verified neither in China nor in any other Asian country. This study aimed to examine the association between BMI and HRQOL in the Chinese older adults population. Methods A total of 5018 older adults from the China’s Health-Related Quality of Life Survey for Older Adults 2018 was included in this study. The HRQOL was measured by the Chinese version of the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD). Multiple linear regression analysis was used to explore the associations between BMI and HRQOL among the older adults in rural, urban, and total samples. Results After adjusting all the confounders, compared with normal weight group, underweight was negatively correlated with the total scores of HRQOL among the older adults in rural (B= −2.310, p < 0.01), urban (B= −1.019, p < 0.001), and total samples (B= −2.351, p < 0.001), whereas overweight was positively associated with the total scores of HRQOL among the older adults in rural samples (B= 0.888, p < 0.05). The results showed that obesity was not associated with the total scores of HRQOL among the older adults in rural (B= −1.214, p > 0.05), urban (B= −0.074, p > 0.05), and total samples (B= −1.461, p > 0.05). Conclusion This study suggests that obese Chinese older adults did not show a better quality of life than those of normal weight. But this result does not deny the “jolly fat” hypothesis entirely, as the overweight older adults from rural areas showed better HRQOL. Moreover, underweight older people show a poorer HRQOL. The relationship between BMI and HRQOL in the older adults needs to be differentiated according to different characteristics of the population.
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Affiliation(s)
- Xiaojun Liu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, Fujian, 350122, People's Republic of China
| | - Shuoni Chen
- Department of Global Health, Wuhan University, Wuhan, Hubei, 430072, People's Republic of China
| | - Anran Tan
- Department of Global Health, Wuhan University, Wuhan, Hubei, 430072, People's Republic of China
| | - Jiayi Zhou
- Department of Global Health, Wuhan University, Wuhan, Hubei, 430072, People's Republic of China
| | - Wenbin Liu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, Fujian, 350122, People's Republic of China
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The prevalence and correlates of burnout among Chinese preschool teachers. BMC Public Health 2020; 20:160. [PMID: 32013939 PMCID: PMC6998270 DOI: 10.1186/s12889-020-8287-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/27/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND A series of studies have suggested that teachers are likely to experience professional burnout in various regions around the world. To date, no known research has been conducted to investigate the prevalence and correlates of burnout among preschool teachers in China. This study examined the level of self-reported burnout and correlates of burnout among Chinese preschool teachers. METHODS A cross-sectional study was conducted among1795 preschool teachers in Tianjin, China, during August 2018-October 2018. The validated Chinese version of the 15-item Maslach Burnout Inventory was used to assess burnout. A self-administered questionnaire collected the sociodemographic factors. The psychological factors were collected by the Chinese version of the 20-item Center for Epidemiologic Studies Depression Scale (CES-D) and the Perceived Stress Scale-14. RESULTS The prevalence of burnout in Chinese preschool teachers was 53.2% (95% CI:51%─56%). Burnout rate was significantly decreased in overweight (P = 0.001, OR = 0.58, 95% CI: 0.42-0.79) and obesity (P = 0.048, OR = 0.75, 95% CI: 0.56-1.00) teachers compared with teachers with normal weight. The type of school (P = 0.007, OR = 1.45, 95% CI: 1.11-1.91), income satisfaction (P = 0.001, OR = 0.67, 95% CI: 0.53-0.86), depression (P < 0.001, OR = 3.08, 95% CI: 2.34-4.05) and perceived stress (P < 0.001, OR = 1.15, 95%CI: 1.13-1.18) were significantly associated with burnout. CONCLUSIONS The prevalence of burnout among preschool teachers in Tianjin, China, is high. Burnout was significantly associated with BMI, the type of school, income satisfaction, depression and perceived stress among Chinese preschool teachers.
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Zhang J, Xu L, Li J, Sun L, Qin W, Ding G, Wang Q, Zhu J, Yu Z, Xie S, Zhou C. Gender differences in the association between body mass index and health-related quality of life among adults:a cross-sectional study in Shandong, China. BMC Public Health 2019; 19:1021. [PMID: 31366336 PMCID: PMC6668122 DOI: 10.1186/s12889-019-7351-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/22/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study aims to assess the association between body mass index (BMI) and health-related quality of life (HRQOL), and to further explore gender differences in BMI-HRQOL association among adults. METHODS We used data from the fifth Health Service Survey of Shandong Province, which was part of China's National Health Service Survey (NHSS), a total of 27,257 adults aged 18 and over were interviewed. The HRQOL was measured using the EuroQOL-5 Dimensions (EQ-5D) instrument. One-way ANOVA and Post hoc tests were used to compare EQ-5D utility values and visual analogue scale (VAS) scores between BMI categories. Tobit regression models were used to identify the association between BMI and HRQOL for male and female separately after controlling for influential confounders, and to assess gender differences on the relationship between BMI and HRQOL. RESULTS The prevalence of underweight in men and women were 3.2 and 5.3%, respectively, while the prevalence of overweight/obesity in men and women were 35.7 and 34.6%, respectively. Men had higher EQ-5D utility values and VAS scores than women. The mean EQ-5D utility value and VAS score was highest in obese men and normal-weight women, respectively. After controlling potential confounders, being underweight was significantly and negatively associated with lower HRQOL among adults. The relationship between obesity and gender was that in women obesity was negatively and significantly associated with HRQOL, whereas in men this association was positive but not statistically significant. Results of gender by BMI interaction in regression model showed that this difference between men and women in this respect was significant. CONCLUSIONS The association between BMI and HRQOL differed by gender and the so-called "obesity-HRQOL paradox" phenomenon was verified in male adults. Gender difference should be considered when implementing targeted weight control programs and appropriate interventions to improve HRQOL.
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Affiliation(s)
- Jiao Zhang
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
| | - Lingzhong Xu
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
- Collaborative Innovation Center of Social Risks Governance in Health, School of Public health, Fudan University, Shanghai, 200032 China
| | - Jiajia Li
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
- Collaborative Innovation Center of Social Risks Governance in Health, School of Public health, Fudan University, Shanghai, 200032 China
| | - Long Sun
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Collaborative Innovation Center of Social Risks Governance in Health, School of Public health, Fudan University, Shanghai, 200032 China
| | - Wenzhe Qin
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
| | - Gan Ding
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
| | - Qian Wang
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
| | - Jing Zhu
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
| | - Zihang Yu
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
| | - Su Xie
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
| | - Chengchao Zhou
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Collaborative Innovation Center of Social Risks Governance in Health, School of Public health, Fudan University, Shanghai, 200032 China
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Apple R, Samuels LR, Fonnesbeck C, Schlundt D, Mulvaney S, Hargreaves M, Crenshaw D, Wallston KA, Heerman WJ. Body mass index and health-related quality of life. Obes Sci Pract 2018; 4:417-426. [PMID: 30338112 PMCID: PMC6180707 DOI: 10.1002/osp4.292] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/21/2018] [Accepted: 06/23/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE There are conflicting data regarding the association between body mass index (BMI) and health-related quality of life (HRQoL), especially among certain population subgroups and for mental and physical health domains. METHODS This study analysed the relationship between BMI and HRQoL (Patient-Reported Outcomes Measurement Information System mental and physical health scales) using ordinary least squares regression. Each model allowed for the possibility of a non-linear relationship between BMI and the outcome, adjusting for age, gender, comorbidities, diet and physical activity. RESULTS A total of 10,133 respondents were predominantly female (71.7%), White (84.1%), median age of 52.1 years (interquartile range 37.2-63.3) and median BMI of 27.9 (interquartile range 24.0-33.2). In adjusted models, BMI was significantly associated with physical and mental HRQoL (p < 0.001). For physical HRQoL, there was a significant interaction with age (p = 0.02). For mental HRQoL, there was a significant interaction with sex (p = 0.0004) but not age (p = 0.7). CONCLUSIONS This study demonstrates a non-linear association of variable clinical relevance between BMI and HRQoL after adjusting for demographic factors and comorbidities. The relationship between BMI and HRQoL is nuanced and impacted by gender and age. These findings challenge the idea of obesity as a main driver of reduced HRQoL, particularly among women and with respect to mental HRQoL.
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Affiliation(s)
- R. Apple
- Department of Internal Medicine and PediatricsVanderbilt University Medical CenterNashvilleTNUSA
| | - L. R. Samuels
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | - C. Fonnesbeck
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | - D. Schlundt
- Department of PsychologyVanderbilt UniversityNashvilleTNUSA
| | - S. Mulvaney
- Department of PediatricsVanderbilt University Medical CenterNashvilleTNUSA
- School of NursingVanderbilt UniversityNashvilleTNUSA
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTNUSA
| | - M. Hargreaves
- Department of Internal MedicineMeharry Medical CollegeNashvilleTNUSA
| | - D. Crenshaw
- Center for Health Services Research, Institute for Medicine and Public HealthVanderbilt UniversityNashvilleTNUSA
| | - K. A. Wallston
- Center for Health Services Research, Institute for Medicine and Public HealthVanderbilt UniversityNashvilleTNUSA
- School of NursingVanderbilt UniversityNashvilleTNUSA
| | - W. J. Heerman
- Department of PediatricsVanderbilt University Medical CenterNashvilleTNUSA
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Rabel M, Meisinger C, Peters A, Holle R, Laxy M. The longitudinal association between change in physical activity, weight, and health-related quality of life: Results from the population-based KORA S4/F4/FF4 cohort study. PLoS One 2017; 12:e0185205. [PMID: 28953956 PMCID: PMC5617179 DOI: 10.1371/journal.pone.0185205] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 09/10/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Longitudinal evidence on the association between physical activity (PA) or weight and health-related quality of life (HRQL) is sparse and studies describe inconclusive results. The aim of this study was to examine longitudinal associations between change in PA and HRQL as between change in weight and HRQL respectively. METHODS Analyses are based on data from the KORA S4 cohort study (1999-2001; n = 4,261, mean age 49.0 ± 13.3 years) and the two follow-up examinations (F4: 2006-2008; FF4: 2013-2014). Information on PA was collected in standardized interviews. Weight was measured objectively. Mental and physical components of HRQL were assessed via the SF-12 questionnaire. First, change in HRQL was regressed on change in PA and weight. Second, hierarchical linear models were fitted, which allowed estimation of between-subject and within-subject effects. Analyses were adjusted for the covariates sex, baseline diseases, and education. RESULTS A change to a physically more active lifestyle is positively associated with physical and mental HRQL. Although weight gain is associated with impairments in physical HRQL, the data show an inverse relationship between weight gain and mental HRQL. The results were consistent for both the change score analyses and the hierarchical linear models. DISCUSSION Our findings stress the importance of interventions on PA/weight. Nonetheless, more research is needed to reveal the causal relationship between PA/weight and HRQL.
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Affiliation(s)
- Matthias Rabel
- Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
- Institute for Medical Information Processing, Biometrics and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München–German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München–German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München–German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München–German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München–German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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11
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Bressington D, Mui J, Tse ML, Gray R, Cheung EFC, Chien WT. Cardiometabolic health, prescribed antipsychotics and health-related quality of life in people with schizophrenia-spectrum disorders: a cross-sectional study. BMC Psychiatry 2016; 16:411. [PMID: 27863522 PMCID: PMC5116189 DOI: 10.1186/s12888-016-1121-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/10/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND People with schizophrenia-spectrum disorders (SSD) often have high levels of obesity and poor cardiometabolic health. Certain types of antipsychotics have been shown to contribute towards weight gain and there is some equivocal evidence that obesity is related to poor health-related quality of life (HRQoL) in people with SSD. It is also still uncertain if antipsychotic polypharmacy/higher doses of antipsychotics are linked with HRQoL and/or increased risk of obesity/Cardiovascular Disease (CVD). Therefore, this study aimed to examine potential relationships between prescribed antipsychotic medication regimens, cardiometabolic health risks and HRQoL in community-based Chinese people with SSD. METHOD This cross-sectional study reports the results of baseline measurements of a random sample of patients in an ongoing controlled trial of physical health intervention for people with severe mental illness. Data from these randomly-selected participants (n = 82) were analysed to calculate 10-year CVD relative-risk (using QRISK®2 score), estimate the prevalence of metabolic syndrome and contextualize patients' prescribed antipsychotics (types, combinations and Daily Defined Dose equivalent). Patients self-reported their HRQoL (SF12v2) and their obesity condition was assessed by waist-circumference and Body Mass Index (BMI). RESULTS Two-thirds of patients had a BMI ≥23 kg/m2, almost half were centrally obese and 29% met the criteria for metabolic syndrome. The individual relative-risk of CVD ranged from 0.62 to 15, and 13% had a moderate-to-high 10-year CVD risk score. Regression models showed that lower physical HRQoL was predicted by higher BMI and lower mental HRQoL. Higher Defined Daily Dose, clozapine, younger age and male gender were found to explain 40% of the variance in CVD relative risk. CONCLUSION The findings indicate that cardiometabolic health risks in people with SSD may be more common than those reported in the general Hong Kong population. The results also provide further support for the need to consider antipsychotic polypharmacy and higher doses of antipsychotics as factors that may contribute towards cardiometabolic risk in Chinese patients with SSD. Clinicians in Hong Kong should consider using routine CVD risk screening, and be aware that younger male patients who are taking clozapine and prescribed higher Defined Daily Dose seem to have the highest relative-risk of CVD. TRIAL REGISTRATION Clinicaltrials.gov NCT02453217 . Prospectively registered on 19th May 2015.
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Affiliation(s)
- Daniel Bressington
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Jolene Mui
- Castle Peak Hospital, Tuen Mun, Hong Kong
| | - Mei Ling Tse
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Richard Gray
- Health Services Research Centre, Hamad Medical Corporation, Doha, Qatar
| | | | - Wai Tong Chien
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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12
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Shishehgar F, Ramezani Tehrani F, Mirmiran P, Hajian S, Baghestani AR. Comparison of the Association of Excess Weight on Health Related Quality of Life of Women with Polycystic Ovary Syndrome: An Age- and BMI-Matched Case Control Study. PLoS One 2016; 11:e0162911. [PMID: 27736861 PMCID: PMC5063389 DOI: 10.1371/journal.pone.0162911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 08/30/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is assumed that obesity adversely affects the health related quality of life (HRQOL) of women with polycystic ovary syndrome (PCOS), not only due to the excess weight, but also due to several other obesity induced metabolic and reproductive consequences. We aimed to compare the effects of excess body weight on the HRQOL between women with PCOS and controls. METHODS This is a case control study of 142 women with PCOS and 140 age- and BMI- matched controls. The Iranian version of short form health survey 36 (SF 36) was used to assess HRQOL. Domains of SF 36 were compared in women with PCOS and controls using multivariate analysis of covariance. The Pearson correlation was used to assess the correlation between body mass index (BMI) and domain scores of SF 36, and the differences between two correlations in cases and controls, using Fisher's Z test. RESULTS Women with PCOS had significantly lower scores for both, the physical and the mental component summary scales, compared to controls. In the cases, a significant negative correlations were observed for BMI with physical function (r = - 0.301, P<0.001), bodily pain (r = - 0.23, P = 0.006), and physical summary score (r = -0.3, P = 0.007). In controls, significant correlation was seen for BMI with bodily pain (r = - 0.3, P<0.001) and physical summary score (r = - 0.27, P = 0.001). The differences between correlations of physical function with BMI in PCOS and controls were statistically significant (Z = -2.41, P = 0.008). CONCLUSION Although the physical aspects of HRQOL are adversely affected by overweight in both PCOS and controls, these impaired effects are greater in women with PCOS.
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Affiliation(s)
- Farnaz Shishehgar
- Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Hajian
- Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Baghestani
- Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Audureau E, Pouchot J, Coste J. Gender-Related Differential Effects of Obesity on Health-Related Quality of Life via Obesity-Related Comorbidities: A Mediation Analysis of a French Nationwide Survey. Circ Cardiovasc Qual Outcomes 2016; 9:246-56. [PMID: 27166204 DOI: 10.1161/circoutcomes.115.002127] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 04/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Negative effects of obesity on health-related quality of life (HRQoL) have been reported, especially in women, but the relative contribution of cardiometabolic and other obesity-related comorbidities to such effects remains unclear. Our objective was to model the association by sex between body mass index and HRQoL and to precisely quantify the indirect effects mediated by obesity-related comorbidities. METHODS AND RESULTS Data were drawn from the latest French Decennial Health Survey, a nationwide cross-sectional study conducted in 2003 (21 239 adults aged 25-64 years analyzed). HRQoL was measured by the 36-item short-form health survey questionnaire. A mediation analysis based on the counterfactual framework was performed to quantify the proportion of obesity effects on HRQoL mediated by related comorbidities, including cardiometabolic risk factors (diabetes mellitus, hypertension, dyslipidemia) and diseases (ischemic heart disease, cerebrovascular, and peripheral vascular disease), musculoskeletal disorders, and asthma. After multiple linear regression, inverse associations were found between increasing body mass index category and physically oriented and most mentally oriented 36-item short-form health survey dimensions, with evidence of greater effects in women. Mediation analysis revealed that obesity effects were significantly mediated by several comorbidities, more apparently in men (eg, proportion of obesity class II total effect mediated via cardiometabolic factors: general health 27.0% [men] versus 13.6% [women]; proportion of obesity class II total effect mediated via total count of comorbidities: physical functioning 17.8% [men] versus 7.7% [women] and general health 37.1% [men] versus 20.3% [women]). CONCLUSIONS Women have a greater overall impact of obesity on HRQoL, but with proportionally lower effects mediated by cardiometabolic and other obesity-related conditions, suggesting the possible role of other specific psychosocial processes.
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Affiliation(s)
- Etienne Audureau
- From the Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris, France (E.A., J.C.); Research unit APEMAC, EA 4360, Université Paris-Descartes, Sorbonne Paris Cité, Université de Lorraine, France (E.A., J.P., J.C.); and Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (J.P.).
| | - Jacques Pouchot
- From the Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris, France (E.A., J.C.); Research unit APEMAC, EA 4360, Université Paris-Descartes, Sorbonne Paris Cité, Université de Lorraine, France (E.A., J.P., J.C.); and Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (J.P.)
| | - Joël Coste
- From the Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris, France (E.A., J.C.); Research unit APEMAC, EA 4360, Université Paris-Descartes, Sorbonne Paris Cité, Université de Lorraine, France (E.A., J.P., J.C.); and Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (J.P.)
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14
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Chang SP, Shih KS, Chi CP, Chang CM, Hwang KL, Chen YH. Association Between Exercise Participation and Quality of Sleep and Life Among University Students in Taiwan. Asia Pac J Public Health 2016; 28:356-67. [DOI: 10.1177/1010539516645160] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This cross-sectional survey study examined exercise, sleep quality, and quality of life (QOL) in 1230 Taiwanese university students. Compared with women, men had higher body mass index (BMI) (22.3 ± 4.1 vs 20.7 ± 3.5 kg/m2), higher exercise frequency (2.6 ± 1.7 vs 2.0 ± 1.4 d/wk), better sleep quality (global Pittsburgh Sleep Quality Index 6.0 ± 2.8 vs 6.5 ± 2.7), better physical QOL (physical component summary 52.7 ± 6.2 vs 51.7 ± 6.6), and higher reporting of good self-perceived health (62.2% vs 43.3%) ( P < .01). However, gender differences were nonsignificant after multivariable adjustment. Exercise frequency, sleep quality, and QOL were significantly intercorrelated. After multivariable adjustment, self-perceived health and satisfaction with exercise participation predicted quality of sleep and QOL ( P < .01). Exercise frequency was positively correlated ( P = .012), and exercise intensity was negatively associated ( P < .001) with physical QOL. In conclusion, those who regularly exercised (at least 1 d/wk or 2.5 h/wk) had better QOL. Students with better self-perceived health or satisfaction with exercise participation also had better quality of sleep and better QOL.
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Affiliation(s)
- Shih-Pei Chang
- Central Taiwan University of Science and Technology, Taichung City, Taiwan
| | - Kuo-Sen Shih
- Central Taiwan University of Science and Technology, Taichung City, Taiwan
| | | | | | - Kai-Lin Hwang
- Chung Shan Medical University, Taichung City, Taiwan
| | - Yu-Hsuan Chen
- Central Taiwan University of Science and Technology, Taichung City, Taiwan
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15
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Xu Y, Zhou Z, Li Y, Yang J, Guo X, Gao J, Yan J, Chen G. Exploring the nonlinear relationship between body mass index and health-related quality of life among adults: a cross-sectional study in Shaanxi Province, China. Health Qual Life Outcomes 2015; 13:153. [PMID: 26395980 PMCID: PMC4580353 DOI: 10.1186/s12955-015-0347-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/12/2015] [Indexed: 11/26/2022] Open
Abstract
Introduction China is a country facing the “double burden” of both obesity and underweight. The objective of this study was to explore the relationship between body mass index (BMI) and health-related quality of life (HRQOL) in adults from Shaanxi Province. Methods The data were derived from the fifth Health Service Survey of Shaanxi Province, which was part of China’s National Health Service Survey (NHSS), conducted in 2013. The HRQOL was assessed using the three-level EQ-5D questionnaire and scored based on a recently developed Chinese-specific tariff. Semiparametric regression models were adopted to explore the non-linear relationship between continuous BMI and overall HRQOL scores. Logistic regression models were further undertaken to assess the relationship between categorized BMI and five dimensions of HRQOL. Results Among the study sample (n = 37,902), 77 % of men and 75 % of women were assigned to normal weight, according to the WHO International classification. There were statistical significant nonlinear relationships between BMI and HRQOL, with optimal HRQOL achieved at a BMI of near 23 kg/m2 for men and 24 kg/m2 for women. Before BMI reached optimal HRQOL, the EQ-5D utility scores were increasing faster among men than the women, whilst after the BMI value reached the optimal utility scores, women showed a faster decline in utility scores than men. With adjustments for socio-demographic, physical activity and co-morbidities, obese respondents were more likely to suffer from physical rather than mental problems. Underweight respondents were significantly more likely to report having any problems in all five dimensions of the EQ-5D, whilst the magnitudes of odds ratios were consistently larger for men than women. Conclusion There was an inverse U-shaped association between continuous BMI and overall HRQOL scores, meaning that both underweight and obesity were associated with lower HRQOL. The relationship between BMI and HRQOL varied between sexes. Underweight respondents had a higher risk of suffering from both physical and mental problems. Interventions aimed to tackle the prevalence of underweight should be put into action in Shaanxi Province.
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Affiliation(s)
- Yongjian Xu
- School of Public Health, Health Science Center, Xi'an Jiaotong University, P.O Box 86, No. 76 West Yanta Road, Xi'an, Shaanxi, 710061, China.
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
| | - Yanli Li
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
| | - Jinjuan Yang
- School of Public Health, Health Science Center, Xi'an Jiaotong University, P.O Box 86, No. 76 West Yanta Road, Xi'an, Shaanxi, 710061, China.
| | - Xiaoyuan Guo
- School of Public Health, Health Science Center, Xi'an Jiaotong University, P.O Box 86, No. 76 West Yanta Road, Xi'an, Shaanxi, 710061, China.
| | - Jianmin Gao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
| | - Ju'e Yan
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
| | - Gang Chen
- School of Medicine, Flinders University, Adelaide, Australia.
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16
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Zhu Y, Wang Q, Pang G, Lin L, Origasa H, Wang Y, Di J, Shi M, Fan C, Shi H. Association between Body Mass Index and Health-Related Quality of Life: The "Obesity Paradox" in 21,218 Adults of the Chinese General Population. PLoS One 2015; 10:e0130613. [PMID: 26087128 PMCID: PMC4472696 DOI: 10.1371/journal.pone.0130613] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 05/21/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There was no consistent recognition of the association between high or low body mass index (BMI) and health related quality of life (HRQL). The aim of this research was to study the association between BMI and HRQL in Chinese adults, and to further explore the stability of that association in the subgroup analysis stratified by status of chronic conditions. METHODS A total of 21,218 adults aged 18 and older were classified as underweight, normal weight, overweight, class I obese, and class II obese based on their BMI. HRQL was measured by the SF-36 Health Survey. The independent impact of each BMI category on HRQL was examined through standard least squares regression by comparing the difference of SF-36 scores and the minimum clinically important differences (MCID), which was defined as 3 points. RESULTS Compared to the normal weight, the class I obese was significantly associated with better HRQL scores in the mental component summary (MCS) (75.1 vs. 73.4, P<0.001). The underweight had the lowest score in both the physical components summary (PCS) (75.4 vs. 77.5, P<0.001) and mental components summary (MCS) (71.8 vs. 73.4, P<0.001). For the MCID, the HRQL score was reduced by more than 3 points in the physical functioning for the class II obese (D=-3.43) and the general health for the underweight (D=-3.71). Stratified analyses showed a similar result in the health subjects and chronic conditions, and it was significant in the chronic conditions. CONCLUSIONS The class I obese showed the best HRQL, especially in the mental domain. The worst HRQL was found in the underweight. The class II obese reduced HRQL in the physical functioning only. "Obesity paradox" was more obvious in the participants with chronic conditions.
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Affiliation(s)
- Yanbo Zhu
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Qi Wang
- School of Preclinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Guoming Pang
- Internal Medicine Department, Kaifeng Hospital of Traditional Chinese Medicine, Kaifeng, Henan, China
| | - Lin Lin
- Department of Quality Management, China-Japan Friendship Hospital, Beijing, China
| | - Hideki Origasa
- Division of Biostatistics and Clinical Epidemiology, School of Medicine, University of Toyama, Toyama, Japan
| | - Yangyang Wang
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Jie Di
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Mai Shi
- Department of Clinical Nutrition, China-Japan Friendship Hospital, Beijing, China
| | - Chunpok Fan
- School of Preclinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Huimei Shi
- School of Management, Beijing University of Chinese Medicine, Beijing, China
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Değirmenci T, Kalkan-Oğuzhanoğlu N, Sözeri-Varma G, Özdel O, Fenkçi S. Psychological Symptoms in Obesity and Related Factors. Noro Psikiyatr Ars 2015; 52:42-46. [PMID: 28360674 DOI: 10.5152/npa.2015.6904] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 06/25/2013] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION This study aimed to investigate the relationship between levels of depression and anxiety symptoms and quality of life, self-esteem in obesity. METHODS Fifty-two subjects whose Body Mass Index (BMI) is 30 kg/m2 and over and 43 control whose BMI is normal were recruited for this study. The socio demographic data form, Hamilton Depression Rating Scale (HAM-D17), Hamilton Anxiety Rating Scale (HAM-A), Quality of Life Scale Short Form (WHOQOL-Brief-TR), Coopersmith Self Esteem Scale (CSES), The Eating Attitudes (EAT), were applied to the participants. RESULTS In this study most of the patients are women, married, postgraduated and live in urban areas. It was determined to scores of HAM-D17, HAM-A and EAT are higher in obese group than control group; WHOQOL-Brief-TR physical field scores was lower in obese group than control group. CSES scores wasn't difference between obese and control group. In obese group, there was HAM-D17 and HAM-A scores a negative correlation between quality of life physical field score, negative correlation between CSES score, positive correlation between EAT scale score. There is no correlation between scores of HAM-D17 and HAM-A and BMI. CONCLUSION Our results suggest that depressive and anxiety levels are high in induvidual with obesity. They have problems in eating attitudes and their quality of life especially physical field is poor. The psychological symptoms have negative effects on the quality of life, self-esteem, and eating attitudes. Our results suggest that psychiatric support to improving positive effects quality of life and self-esteem in individual with obesity.
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Affiliation(s)
| | | | | | - Osman Özdel
- Clinic of Psychiatry, Denizli State Hospital, Denizli, Turkey
| | - Semin Fenkçi
- Clinic of Endocrinology, Surgery, Hospital, Denizli, Turkey
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18
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Maynard S, Keijzers G, Hansen ÅM, Osler M, Molbo D, Bendix L, Møller P, Loft S, Moreno-Villanueva M, Bürkle A, Hvitby CP, Schurman SH, Stevnsner T, Rasmussen LJ, Avlund K, Bohr VA. Associations of subjective vitality with DNA damage, cardiovascular risk factors and physical performance. Acta Physiol (Oxf) 2015; 213:156-70. [PMID: 24703498 DOI: 10.1111/apha.12296] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/09/2013] [Accepted: 03/27/2014] [Indexed: 12/21/2022]
Abstract
AIM To examine associations of DNA damage, cardiovascular risk factors and physical performance with vitality, in middle-aged men. We also sought to elucidate underlying factors of physical performance by comparing physical performance parameters to DNA damage parameters and cardiovascular risk factors. METHODS We studied 2487 participants from the Metropolit cohort of 11 532 men born in 1953 in the Copenhagen Metropolitan area. The vitality level was estimated using the SF-36 vitality scale. Cardiovascular risk factors were determined by body mass index (BMI), and haematological biochemistry tests obtained from non-fasting participants. DNA damage parameters were measured in peripheral blood mononuclear cells (PBMCs) from as many participants as possible from a representative subset of 207 participants. RESULTS Vitality was inversely associated with spontaneous DNA breaks (measured by comet assay) (P = 0.046) and BMI (P = 0.002), and positively associated with all of the physical performance parameters (all P < 0.001). Also, we found several associations between physical performance parameters and cardiovascular risk factors. In addition, the load of short telomeres was inversely associated with maximum jump force (P = 0.018), with lowered significance after exclusion of either arthritis sufferers (P = 0.035) or smokers (P = 0.031). CONCLUSION Here, we show that self-reported vitality is associated with DNA breaks, BMI and objective (measured) physical performance in a cohort of middle-aged men. Several other associations in this study verify clinical observations in medical practice. In addition, the load of short telomeres may be linked to peak performance in certain musculoskeletal activities.
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Affiliation(s)
- S. Maynard
- Center for Healthy Aging; University of Copenhagen; Copenhagen Denmark
- Department of Cellular and Molecular Medicine; University of Copenhagen; Copenhagen Denmark
| | - G. Keijzers
- Center for Healthy Aging; University of Copenhagen; Copenhagen Denmark
- Department of Cellular and Molecular Medicine; University of Copenhagen; Copenhagen Denmark
- Danish Aging Research Center; University of Southern Denmark; Odense Denmark
| | - Å.-M. Hansen
- Department of Public Health; University of Copenhagen; Copenhagen Denmark
- National Research Centre for the Working Environment; Copenhagen Denmark
| | - M. Osler
- Danish Aging Research Center; University of Southern Denmark; Odense Denmark
- Research Centre for prevention and Health; Glostrup University Hospital; Glostrup Denmark
| | - D. Molbo
- Center for Healthy Aging; University of Copenhagen; Copenhagen Denmark
- Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - L. Bendix
- Danish Aging Research Center; University of Southern Denmark; Odense Denmark
- Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - P. Møller
- Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - S. Loft
- Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | | | - A. Bürkle
- Molecular Toxicology Group; University of Konstanz; Konstanz Germany
| | - C. P. Hvitby
- Danish Aging Research Center; University of Southern Denmark; Odense Denmark
- Department of Molecular Biology and Genetics; University of Aarhus; Aarhus Denmark
| | - S. H. Schurman
- Clinical Research Program; National Institute of Environmental Health Sciences; National Institutes of Health; Research Triangle Park NC USA
| | - T. Stevnsner
- Danish Aging Research Center; University of Southern Denmark; Odense Denmark
- Department of Molecular Biology and Genetics; University of Aarhus; Aarhus Denmark
| | - L. J. Rasmussen
- Center for Healthy Aging; University of Copenhagen; Copenhagen Denmark
- Department of Cellular and Molecular Medicine; University of Copenhagen; Copenhagen Denmark
| | - K. Avlund
- Center for Healthy Aging; University of Copenhagen; Copenhagen Denmark
- Danish Aging Research Center; University of Southern Denmark; Odense Denmark
- Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - V. A. Bohr
- Center for Healthy Aging; University of Copenhagen; Copenhagen Denmark
- Laboratory of Molecular Gerontology; National Institute on Aging; National Institutes of Health; Baltimore MD USA
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19
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Liang W, Xie J, Fu H, Wu EQ. The role of health economics and outcomes research in health care reform in China. PHARMACOECONOMICS 2014; 32:231-234. [PMID: 24554475 PMCID: PMC3937542 DOI: 10.1007/s40273-014-0141-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Wannian Liang
- Department of Healthcare Reform, Office of State Council Health Reform Leading Group, National Health and Family Planning Commission of the People’s Republic of China, Beijing, China
| | - Jipan Xie
- Analysis Group, Inc., 111 Huntington Ave, 10th Floor, Boston, MA 02199 USA
| | - Hongpeng Fu
- Department of Medicine Policy, China National Health Development and Research Center, Beijing, China
| | - Eric Q. Wu
- Analysis Group, Inc., 111 Huntington Ave, 10th Floor, Boston, MA 02199 USA
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20
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Milder IEJ, de Hollander EL, Picavet HS, Verschuren WMM, de Groot LCPGM, Bemelmans WJE. Changes in weight and health-related quality of life. The Doetinchem Cohort Study. J Epidemiol Community Health 2014; 68:471-7. [PMID: 24385547 DOI: 10.1136/jech-2013-203127] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The cross-sectional association between obesity and a lower health-related quality of life (HRQL) is clear. However, less is known about the association between changes in weight and HRQL. We examined the association between weight changes and changes in HRQL in a population-based sample of 2005 men and 2130 women aged 26-70 years. METHODS Weight was measured two or three times with 5-year intervals between 1995 and 2009, and was categorised as stable (change ≤2 kg, 40%), weight loss (19%), or weight gain 2.1-4.0 kg, 4.1-6.0 kg, or >6 kg (41%). Changes in HRQL (SF36 questionnaire, including physical and mental scales) per weight change category were compared with a stable weight using generalised estimating equations. RESULTS Weight gain was associated with declines of up to 5 points on five mainly physical scales and holds for different age categories. Especially for women, a dose-response relationship was observed, that is, larger weight gain was associated with larger declines in HRQL. Changes in HRQL for those with weight loss were small, but particularly on the mental scales, changes were in the negative direction compared to a stable weight. CONCLUSIONS Weight gain and weight loss were associated with unfavourable changes in HRQL compared with a stable weight. For weight gain, this was most pronounced on the physical scales and for weight loss, although less consistent, on the mental scales.
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Affiliation(s)
- Ivon E J Milder
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, , Bilthoven, The Netherlands
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21
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de Hollander EL, Picavet HSJ, Milder IE, Verschuren WMM, Bemelmans WJE, de Groot LCPGM. The impact of long-term body mass index patterns on health-related quality of life: the Doetinchem Cohort Study. Am J Epidemiol 2013; 178:804-12. [PMID: 23820786 DOI: 10.1093/aje/kwt053] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Overweight is associated with a reduced health-related quality of life (QOL), but less is known about the impact of long-term body mass index (BMI, calculated as weight (kg)/height (m)(2)) patterns on QOL in adults. In the Dutch Doetinchem Cohort Study (1989-2009) that included 1,677 men and 1,731 women aged 20-66 years, 6 BMI patterns were defined by using 4 measurements over a 15-year period: 1) persistent healthy weight (18.5-24.9, reference pattern); 2) persistent overweight (25.0-29.9); 3) persistent obesity (≥30.0); 4) developing overweight; 5) developing obesity; and 6) switching between BMI categories. For each BMI pattern, adjusted QOL (measured on a 0-100 scale) was estimated at the end of this period. The lowest QOL was observed for persistent obesity of all BMI patterns. It was 5.0 points (P = 0.02) lower for 1 mental dimension in men and 6.2-11.6 points (P < 0.05) lower for 5 (mainly physical) dimensions in women. Developing overweight or obesity scored 1.8-6.3 points (P < 0.05) lower on 2-5 (mainly physical) dimensions. Persistent overweight hardly differed from a persistent healthy weight. In women, switching between BMI categories resulted in a lower QOL on the mental dimensions. Studying long-term BMI patterns over a 15-year period showed that persistent obesity, developing overweight, and developing obesity resulted in a lower QOL-particularly on the physical dimensions-compared with a persistent healthy weight.
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Affiliation(s)
- Ellen L de Hollander
- Centre for Nutrition, Prevention, and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
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22
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Guo X, Zhang Z, Wei Q, Lv H, Wu R, Zhao J. The relationship between obesity and neurocognitive function in Chinese patients with schizophrenia. BMC Psychiatry 2013; 13:109. [PMID: 23570390 PMCID: PMC3627610 DOI: 10.1186/1471-244x-13-109] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 03/27/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Studies have reported that up to 60% of individuals with schizophrenia are overweight or obese. This study explored the relationship between obesity and cognitive performance in Chinese patients with schizophrenia. METHODS Outpatients with schizophrenia aged 18-50 years were recruited from 10 study sites across China. Demographic and clinical information was collected. A neuropsychological battery including tests of attention, processing speed, learning/memory, and executive functioning was used to assess cognitive function, and these 4 individual domains were transformed into a neurocognitive composite z score. In addition, height and weight were measured to calculate body mass index (BMI). Patients were categorized into 4 groups (underweight, normal weight, overweight and obese) based on BMI cutoff values for Asian populations recommended by the World Health Organization. RESULTS A total number of 896 patients were enrolled into the study. Fifty-four percent of participants were overweight or obese. A higher BMI was significantly associated with lower scores on the Wechsler Memory Scale-Revised (WMS-R) Visual Reproduction subscale, the Wechsler Adult Intelligence Scale-Revised (WAIS-R) Digit Symbol subscale, and the composite z score (p's ≤ 0.024). Obese patients with schizophrenia had significantly lower scores than normal weight patients on the Trail Making Test B, the WMS-R Visual Reproduction subscale, the WAIS Digit Symbol subscale, and the composite z score (p's ≤ 0.004). CONCLUSIONS Our study suggests that, in addition to its well established risk for various cardiometabolic conditions, obesity is also associated with decreased cognitive function in Chinese patients with schizophrenia. Future studies should explore if weight loss and management can improve cognitive function in obese patients who suffer from schizophrenia.
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Affiliation(s)
- Xiaofeng Guo
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, No. 139 Renmin Mid Road, Changsha, 410011, China
| | - Zhanchou Zhang
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, No. 139 Renmin Mid Road, Changsha, 410011, China
| | - Qinling Wei
- Department of Psychiatry, 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hailong Lv
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, No. 139 Renmin Mid Road, Changsha, 410011, China
| | - Renrong Wu
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, No. 139 Renmin Mid Road, Changsha, 410011, China
| | - Jingping Zhao
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, No. 139 Renmin Mid Road, Changsha, 410011, China
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23
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Guo X, Zhang Z, Zhai J, Wu R, Liu F, Zhao J. The relationship between obesity and health-related quality of life in Chinese patients with schizophrenia. Int J Psychiatry Clin Pract 2013; 17:16-20. [PMID: 23116241 DOI: 10.3109/13651501.2012.745574] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Studies have reported that up to 60% of individuals with schizophrenia are overweight or obese. This study explored the relationship between obesity and health-related quality of life (HRQoL) in Chinese patients with schizophrenia. METHODS A total of 1,108 patients with schizophrenia aged 18-50 years were recruited from 10 different sites in China. Demographic and medical information were collected; the Mandarin version of Short Form 36 Health Survey questionnaire (SF-36) was used to assess HRQoL; in addition,height and weight were measured to calculate body mass index (BMI). BMI was categorized into underweight, normal weight, overweight and obese using cutoffs for Asian populations recommended by the World Health Organization. RESULTS Fifty-six percent of participants with schizophrenia were overweight or obese. A higher BMI was associated with significantly lower scores in physical functioning, role-physical, and physical component summary (p's ≤ 0.010). Obese patients with schizophrenia had significantly lower scores in 3 domains and physical component summary of the SF-36 compared with normal weight patients (p's ≤ 0.007). CONCLUSION Obesity is associated with decreased HRQoL in Chinese patients with schizophrenia. Our findings suggest that the prevention and management of weight gain and obesity is important in improving HRQoL in patients who suffer from this devastating mental illness.
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Affiliation(s)
- Xiaofeng Guo
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, PR China
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Vathesatogkit P, Sritara P, Kimman M, Hengprasith B, E-Shyong T, Wee HL, Woodward M. Associations of lifestyle factors, disease history and awareness with health-related quality of life in a Thai population. PLoS One 2012. [PMID: 23189172 PMCID: PMC3506606 DOI: 10.1371/journal.pone.0049921] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The impact of the presence and awareness of individual health states on quality of life (HRQoL) is often documented. However, the impacts of different health states have rarely been compared amongst each other, whilst quality of life data from Asia are relatively sparse. We examined and compared the effects of different health states on quality of life in a Thai population. Methods In 2008–2009, 5,915 corporate employees were invited to participate in a survey where HRQoL was measured by the Short Form 36 (SF-36) questionnaire. The adjusted mean SF-36 scores were calculated for each self-reported illness, number of chronic conditions, lifestyle factors and awareness of diabetes and hypertension. The effect sizes (ES) were compared using Cohen's d. Results The response rate was 82% and 4,683 (79.1%) had complete data available for analysis. Physical and Mental Component Summary (PCS and MCS) scores decreased as the number of chronic conditions increased monotonically (p<0.0001). Diabetes and hypertension negatively influenced PCS (mean score differences −0.6 and −1.5, p<0.001 respectively) but not MCS, whereas awareness of diabetes and hypertension negatively influenced MCS (−2.9 and −1.6, p<0.005 respectively) but not PCS. Arthritis had the largest ES on PCS (−0.37), while awareness of diabetes had the largest ES on MCS (−0.36). CVD moderately affected PCS and MCS (ES −0.34 and −0.27 respectively). Obesity had a negative effect on PCS (ES −0.27). Exercise positively affected PCS and MCS (ES +0.08 and +0.21 (p<0.01) respectively). Conclusion Health promotion to reduce the prevalence of chronic diseases is important to improve the quality of life in Asian populations. Physical activity is an important part of such programs. Awareness of diseases may have greater impacts on mental health than having the disease itself. This has implications for the evaluation of the cost-benefit of screening and labeling of individuals with pre-disease states.
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Affiliation(s)
- Prin Vathesatogkit
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
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