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Shadyab AH, Manson JE, Allison MA, Laddu D, Wassertheil-Smoller S, Van Horn L, Wild RA, Banack HR, Tabung FK, Haring B, Sun Y, LeBlanc ES, Wactawski-Wende J, LeBoff MS, Naughton MJ, Luo J, Schnatz PF, Natale G, Ostfeld RJ, LaCroix AZ. Association of Later-Life Weight Changes With Survival to Ages 90, 95, and 100: The Women's Health Initiative. J Gerontol A Biol Sci Med Sci 2023; 78:2264-2273. [PMID: 37642339 PMCID: PMC10692416 DOI: 10.1093/gerona/glad177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Associations of weight changes and intentionality of weight loss with longevity are not well described. METHODS Using longitudinal data from the Women's Health Initiative (N = 54 437; 61-81 years), we examined associations of weight changes and intentionality of weight loss with survival to ages 90, 95, and 100. Weight was measured at baseline, year 3, and year 10, and participants were classified as having weight loss (≥5% decrease from baseline), weight gain (≥5% increase from baseline), or stable weight (<5% change from baseline). Participants reported intentionality of weight loss at year 3. RESULTS A total of 30 647 (56.3%) women survived to ≥90 years. After adjustment for relevant covariates, 3-year weight loss of ≥5% vs stable weight was associated with lower odds of survival to ages 90 (OR, 0.67; 95% CI, 0.64-0.71), 95 (OR, 0.65; 95% CI, 0.60-0.71), and 100 (OR, 0.62; 95% CI, 0.49-0.78). Compared to intentional weight loss, unintentional weight loss was more strongly associated with lower odds of survival to age 90 (OR, 0.83; 95% CI, 0.74-0.94 and OR, 0.49; 95% CI, 0.44-0.55, respectively). Three-year weight gain of ≥5% vs stable weight was not associated with survival to age 90, 95, or 100. The pattern of results was similar among normal weight, overweight, and obese women in body mass index (BMI)-stratified analyses. CONCLUSIONS Weight loss of ≥5% vs stable weight was associated with lower odds of longevity, more strongly for unintentional weight loss than for intentional weight loss. Potential inaccuracy of self-reported intentionality of weight loss and residual confounding were limitations.
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Affiliation(s)
- Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Matthew A Allison
- Department of Family Medicine, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert A Wild
- Division of Reproductive Endocrinology and Infertility, Departments of Obstetrics and Gynecology, and Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Hailey R Banack
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Fred K Tabung
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Bernhard Haring
- Department of Medicine III, Saarland University Hospital, Homburg, Saarland, Germany
- Department of Medicine I, University of Wurzburg, Wurzburg, Germany
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Yangbo Sun
- Department of Preventive Medicine, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Erin S LeBlanc
- Kaiser Permanente, Center for Health Research, Portland, Oregon, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo – SUNY, Buffalo, New York, USA
| | - Meryl S LeBoff
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle J Naughton
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Peter F Schnatz
- Department of Obstetrics/Gynecology and Internal Medicine, Reading Hospital/Tower Health, West Reading, Pennsylvania, USA
| | - Ginny Natale
- Department of Family, Population, and Preventive Medicine, Program in Public Health, Stony Brook University, Stony Brook, New York, USA
| | - Robert J Ostfeld
- Division of Cardiology, Montefiore Health System, Bronx, New York, USA
| | - Andrea Z LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
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Yannakoulia M, Mamalaki E, Poulimenas D. Intentional weight loss and mortality in middle-aged and older adults: A narrative review. Maturitas 2022; 165:100-103. [DOI: 10.1016/j.maturitas.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022]
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Liu Y, Wen X, Gao M, Zhang J, Wei W. Body mass index change in relation to longitudinal systolic blood pressure: An age- and sex-matched and repeated measures study. Nutr Metab Cardiovasc Dis 2022; 32:1886-1893. [PMID: 35738956 DOI: 10.1016/j.numecd.2022.05.015] [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: 02/14/2022] [Revised: 05/11/2022] [Accepted: 05/20/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS The positive association between mean systolic blood pressure (SBP) and body mass index (BMI) diminished or reversed over the past four decades. The primary aim of this study was to evaluate effects of BMI change on longitudinal SBP. METHODS AND RESULTS A total of 3638 participants who had annual health examination from 2015 to 2019 were included and matched by age and sex according to BMI levels. BMI and SBP were measured annually and their association were assessed by a linear mixed-effects regression model. The normal weight participants had a sustained weight gain as well as SBP increase during the study period (all Ptrend <0.001). The obese participants had a sustained weight loss but SBP did not decrease simultaneously. If BMI change was considered, the obese participants with BMI loss had a significant decrease of SBP during the study period (Ptrend = 0.0012). Mixed-effects models showed that weight gain was more influential on longitudinal SBP in the normal weight participants and weight loss was in the obese participants. The obese group with BMI loss had a decrease of SBP by 5.01 mmHg (95% confidence interval: 2.56 mmHg, 7.46 mmHg) compared to their counterparts with BMI maintenance from 2015 to 2019. CONCLUSIONS The effect of weight change on longitudinal SBP was varied among BMI groups. With the increase of baseline BMI level, the positive effect of weight loss on SBP became greater and the negative effect of weight gain on SBP were attenuated.
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Affiliation(s)
- Yanru Liu
- Department of Health Medicine, The 980th Hospital of PLA Joint Logistics Support Forces, Hebei, Shijiazhuang, 050082, China
| | - Xiaohua Wen
- Department of Health Medicine, The 980th Hospital of PLA Joint Logistics Support Forces, Hebei, Shijiazhuang, 050082, China
| | - Mian Gao
- Department of Health Medicine, The 980th Hospital of PLA Joint Logistics Support Forces, Hebei, Shijiazhuang, 050082, China
| | - Jinghuan Zhang
- Department of Health Medicine, The 980th Hospital of PLA Joint Logistics Support Forces, Hebei, Shijiazhuang, 050082, China
| | - Wenzhi Wei
- Department of Health Medicine, The 980th Hospital of PLA Joint Logistics Support Forces, Hebei, Shijiazhuang, 050082, China.
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Prevalence of Malignancy on Contrast-Enhanced Computed Tomography of the Abdomen and Pelvis in Patients With Unexplained, Unintentional Weight Loss. J Comput Assist Tomogr 2021; 45:663-668. [PMID: 34407062 DOI: 10.1097/rct.0000000000001217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the prevalence of malignancy on contrast-enhanced computed tomography (CT) of the abdomen and pelvis in patients with unexplained, unintentional weight loss (UUWL). METHODS This is a retrospective review of 999 adult outpatient contrast-enhanced CT of the abdomen and pelvis for UUWL. Patients were stratified into 2 groups: (1) weight loss only (WLO, n = 222) and (2) UUWL with additional symptoms (UUWL+, n = 777). χ2 test was performed to compare malignancy detection rate in the WLO and UUWL+ groups. RESULTS Prevalence of malignancy was 5.3% (95% confidence interval [CI], 4.2%-7.1%; 55 of 999). Prevalence of malignancy in the WLO group was 2.3% (95% CI, 0.7%-5.2%; 5 of 222), lower than the prevalence of 6.2% (95% CI, 4.6%-8.1%; 48 of 777) in the UUWL+ group (P = 0.02). Prevalence of malignancy was lower in patients younger than 60 years in all patients and in the UUWL+ subgroup (P < 0.01 in both cases). CONCLUSIONS There is low prevalence of malignancy on contrast-enhanced CT of the abdomen and pelvis in patients with UUWL, particularly in younger patients and those without additional symptoms.
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Romero-Ortuno R, Hartley P, Davis J, Knight SP, Rizzo R, Hernández B, Kenny RA, O'Halloran AM. Transitions in frailty phenotype states and components over 8 years: Evidence from The Irish Longitudinal Study on Ageing. Arch Gerontol Geriatr 2021; 95:104401. [PMID: 33819775 DOI: 10.1016/j.archger.2021.104401] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 12/14/2022]
Abstract
AIM Fried's frailty phenotype (FP) is defined by exhaustion (EX), unexplained weight loss (WL), weakness (WK), slowness (SL) and low physical activity (LA). Three or more components define the frail state, and one or two the prefrail. We described longitudinal transitions of FP states and components in The Irish Longitudinal Study on Ageing (TILDA). METHODS We included participants aged ≥50 years with FP information at TILDA wave 1 (2010), who were followed-up over four longitudinal waves (2012, 2014, 2016, 2018). Next-wave transition probabilities were estimated with multi-state Markov models. RESULTS 5683 wave 1 participants were included (2612 men and 3071 women; mean age 63.1 years). Probabilities from non-frail to prefrail, and non-frail to frail were 27% and 2%, respectively. Prefrail had a 32% probability of reversal to non-frail, and a 10% risk of progression to frail. Frail had an 18% probability of reversal to prefrail and 31% risk of death. Probabilities of transitioning from not having to having a component were: 17% for LA, 11% for SL, 9% for EX, 7% for WL and 6% for WK. Probabilities of having a FP component and dying were: 17% for WL, 15% for WK, 14% for SL, 13% for EX, and 10% for LA. Probabilities of having a component and recovering at the next wave were: 59% for WL, 58% for EX, 40% for WK, 35% for LA and 23% for SL. CONCLUSIONS FP states and components are characterized by dynamic longitudinal transitions. Opportunities exist for reducing the probability of adverse transitions.
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Affiliation(s)
- Roman Romero-Ortuno
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland; Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland.
| | - Peter Hartley
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland; Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - James Davis
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
| | - Silvin P Knight
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
| | - Rossella Rizzo
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
| | - Belinda Hernández
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland; Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Aisling M O'Halloran
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
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Yeung SSY, Chan JHY, Chan RSM, Sham A, Ho SC, Woo J. Predictive Value of the GLIM Criteria in Chinese Community-Dwelling and Institutionalized Older Adults Aged 70 Years and Over. J Nutr Health Aging 2021; 25:645-652. [PMID: 33949632 DOI: 10.1007/s12603-021-1610-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The Global Leadership Initiative on Malnutrition (GLIM) has recently published criteria for classifying malnutrition. This study investigated the associations between malnutrition and adverse outcomes, and identified which component(s) of the GLIM criteria is/are risk factor(s) of adverse outcomes in Chinese older adults. DESIGN A prospective cohort study of Chinese older adults in a healthy ageing study. SETTING Participants' place of residence. PARTICIPANTS Community-dwelling and institutionalized Chinese older adults aged ≥70 years living in Hong Kong. MEASUREMENTS Malnutrition at baseline was classified according to selected GLIM criteria. Adverse outcomes including poor self-rated health, functional limitation (Barthel Index), falls, frailty (FRAIL scale), hospitalization and mortality were assessed after a 3-year follow-up. Associations between malnutrition and components of selected GLIM criteria (weight loss, low body mass index (BMI), low muscle mass and disease burden) and each adverse outcome were examined using adjusted binary logistic regression and Cox proportional hazards model. Odds ratio (OR) or hazard ratio (HR) and 95% confidence interval (CI) are presented. RESULTS Data of 1576 community-dwelling (45.5% female, 78.1±6.5 years) and 427 institutionalized (69.6% female, 85.5±6.4 years) older adults were included at baseline. Among community-dwelling older adults, malnutrition was associated with frailty (n=899, OR: 2.44, 95% CI: 1.05-5.70) and mortality (n=1007, HR: 1.37, 95% CI: 1.12-1.66). No association was found for other outcomes. Among institutionalized older adults, malnutrition was not associated with any outcomes. Low BMI and low muscle mass were risk factors of frailty; while weight loss was a risk factor of mortality in community-dwelling older adults. Weight loss and disease burden were risk factors of mortality among institutionalized older adults. CONCLUSION The association between malnutrition and frailty and mortality was observed in community but not in institutional settings. Further studies are required to draw more definitive conclusions on the use of GLIM criteria in institutional settings.
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Affiliation(s)
- S S Y Yeung
- Dr. Suey S.Y. Yeung, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T., Hong Kong. Tel: +852 3505 2190; Fax: +852 26379215;
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Son KY, Kwon H, Park JH, Joh HK, Hwang SE, Cho SH, Han K, Cho B, Park YG. Association between weight change over a period of 4 years and mortality in Korean older adults. Geriatr Gerontol Int 2020; 20:474-481. [PMID: 32196904 DOI: 10.1111/ggi.13908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/06/2020] [Accepted: 02/28/2020] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to evaluate the association between weight change and mortality in Korean older adults. METHODS We collected data pertaining to National Screening Program participants aged ≥65 years from the Korean National Health Insurance Corporation records during 2005-2011. To this data, we included mortality data, such as the date of death, of these patients (up to and including 2017) from Statistics Korea. We defined weight change as a difference in bodyweight measured in the National Screening Program over a period of 4 years. Cox proportional hazards models were used to evaluate the association between weight change and mortality. RESULTS The study population consisted of 1 100 256 participants, and a total of 46 415 deaths were observed during a mean follow-up period of 3.2 ± 0.8 years (maximum 5.0 years). For 3 531 585 person-year follow up, the mortality rate for stable weight was 10.79 per 1000 person-years (PY). Weight loss increased the mortality rate by 68%, whereas weight gain increased the rate by 10% compared with stable weight (weight loss: mortality rate 20.28 per 1000 PY, adjusted hazard ratio 1.68, 95% confidence interval 1.65-1.72; weight gain: mortality rate 12.86 per 1000 PY, adjusted hazard ratio 1.10, 95% confidence interval 1.07-1.13). However, in subgroup analysis, for participants who were underweight at baseline, current cigarette smokers or heavy alcohol drinkers, weight gain did not increase the mortality rate. CONCLUSIONS In Korean older adults, regardless of the risk factors, both weight loss and weight gain increased the mortality rate compared with stable weight. Geriatr Gerontol Int 2020; 20: 474-481.
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Affiliation(s)
- Ki Young Son
- Department of Family Medicine, Asan Medical Center, Seoul, Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Health Promotion Center, Seoul National University Hospital, Seoul, Korea.,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Health Promotion Center, Seoul National University Hospital, Seoul, Korea.,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Kyung Joh
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seo Eun Hwang
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Health Promotion Center, Seoul National University Hospital, Seoul, Korea.,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Su Hwan Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Belong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Health Promotion Center, Seoul National University Hospital, Seoul, Korea.,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Gyu Park
- Department of Biostatistics, The Catholic University of Korea College of Medicine, Seoul, Korea
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Zhang X, Rhoades J, Caan BJ, Cohn DE, Salani R, Noria S, Suarez AA, Paskett ED, Felix AS. Intentional weight loss, weight cycling, and endometrial cancer risk: a systematic review and meta-analysis. Int J Gynecol Cancer 2019; 29:1361-1371. [PMID: 31451560 PMCID: PMC6832748 DOI: 10.1136/ijgc-2019-000728] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Weight cycling, defined as intentional weight loss followed by unintentional weight regain, may attenuate the benefit of intentional weight loss on endometrial cancer risk. We summarized the literature on intentional weight loss, weight cycling after intentional weight loss, bariatric surgery, and endometrial cancer risk. METHODS A systematic search was conducted using MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases published between January 2000 and November 2018. We followed Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) guidelines. We qualitatively summarized studies related to intentional weight loss and weight cycling due to the inconsistent definition, and quantitatively summarized studies when bariatric surgery was the mechanism of intentional weight loss. RESULTS A total of 127 full-text articles were reviewed, and 13 were included (bariatric surgery n=7, self-reported intentional weight loss n=2, self-reported weight cycling n=4). Qualitative synthesis suggested that, compared with stable weight, self-reported intentional weight loss was associated with lower endometrial cancer risk (RR range 0.61-0.96), whereas self-reported weight cycling was associated with higher endometrial cancer risk (OR range 1.07-2.33). The meta-analysis yielded a 59% lower risk of endometrial cancer following bariatric surgery (OR 0.41, 95% CI 0.22 to 0.74). CONCLUSIONS Our findings support the notion that intentional weight loss and maintenance of a stable, healthy weight can lower endometrial cancer risk. Strategies to improve awareness and maintenance of weight loss among women with obesity are needed to reduce endometrial cancer risk.
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Affiliation(s)
- Xiaochen Zhang
- Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Jennifer Rhoades
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Bette J Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - David E Cohn
- Division of Gynecologic Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ritu Salani
- Division of Gynecologic Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sabrena Noria
- Center for Minimally Invasive Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Adrian A Suarez
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Electra D Paskett
- Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Ashley S Felix
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
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Luo J, Hendryx M, Manson JE, Figueiredo JC, LeBlanc ES, Barrington W, Rohan TE, Howard BV, Reding K, Ho GY, Garcia DO, Chlebowski RT. Intentional Weight Loss and Obesity-Related Cancer Risk. JNCI Cancer Spectr 2019; 3:pkz054. [PMID: 31737862 PMCID: PMC6795232 DOI: 10.1093/jncics/pkz054] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/04/2019] [Accepted: 07/27/2019] [Indexed: 12/20/2022] Open
Abstract
Background Epidemiologic studies regarding weight loss and subsequent cancer risk are sparse. The study aim was to evaluate the association between weight change by intentionality and obesity-related cancer incidence in the Women’s Health Initiative Observational Study. Eleven cancers were considered obesity related: breast, ovary, endometrium, colon and rectum, esophagus, kidney, liver, multiple myeloma, pancreas, stomach, and thyroid. Methods Postmenopausal women (n = 58 667) aged 50–79 years had body weight and waist circumference (WC) measured at baseline and year 3. Weight or WC change was categorized as stable (change < ±5%), loss (≥5%), and gain (≥5%). Self-report at year 3 characterized weight loss as intentional or unintentional. During the subsequent 12 years (mean) of follow-up, 6033 incident obesity-related cancers were identified. Relationships were evaluated using multivariable Cox proportional hazards regression models. Results Compared to women with stable weight, women with intentional weight loss had lower obesity-related cancer risk (hazard ratio [HR] = 0.88, 95% confidence interval [CI] = 0.80 to 0.98). A similar result was observed for intentional WC reduction (HR = 0.88, 95% CI = 0.80 to 0.96). Among all cancers, intentional weight loss was most strongly associated with endometrial cancer (HR = 0.61, 95% CI = 0.42 to 0.88). Intentional WC loss was also associated with lower colorectal cancer risk (HR = 0.79, 95% CI = 0.63 to 0.99). Unintentional weight loss or weight gain was not associated with overall obesity-related cancer risk. Conclusion Intentional weight or WC loss in postmenopausal women was associated with lower risk of obesity-related cancer. These findings suggest that postmenopausal women who intentionally lose weight can reduce their obesity-related cancer risk.
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Affiliation(s)
- Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, IU
| | - Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University Bloomington, Bloomington, IU
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jane C Figueiredo
- Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research NW, Portland, OR
| | - Wendy Barrington
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Thomas E Rohan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Barbara V Howard
- MedStar Health Research Institute and Georgetown, Howard Universities Center for Clinical and Translational Sciences, Hyattsville, MD
| | - Kerryn Reding
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA
| | - Gloria Yf Ho
- Department of Occupational Medicine, Epidemiology & Prevention, Feinstein Institute for Medical Research, Northwell Health, and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | - David O Garcia
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
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Cintra R, Moura FA, Carvalho LSFD, Barreto J, Tambascia M, Pecoits-Filho R, Sposito AC. Inhibition of the sodium-glucose co-transporter 2 in the elderly: clinical and mechanistic insights into safety and efficacy. ACTA ACUST UNITED AC 2019; 65:70-86. [PMID: 30758423 DOI: 10.1590/1806-9282.65.1.70] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/26/2018] [Indexed: 12/16/2022]
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) in the elderly grew sharply over the last decade. Reduced insulin sensitivity and secretory capacity, weight gain, sarcopenia, and elevated adiposity are all common metabolic and body changes in the aging population that favor an increased risk of hypoglycemia, frailty syndrome, falls, and cognitive dysfunction. First line antidiabetic therapy is frequently not safe in older individuals because of its high risk of hypoglycemia and prevalent co-morbid diseases, such as chronic kidney disease, osteoporosis, cardiovascular disease, and obesity. Sodium-glucose cotransporter 2 inhibitor (SGLT2i) is a new class of antidiabetic therapy that inhibits glucose and sodium reabsorption on renal proximal convoluted tubule. Its effect is well demonstrated in various clinical scenarios in the younger population. This review and metanalysis describe particularities of the SGLT2i on the elderly, with mechanistic insights of the potential benefit and remaining challenges about the use of these drugs in this important age group. Further, we will present a meta-analysis of the main effects of SGLT2i reported in post-hoc studies in which the median age of the subgroups analyzed was over 60 years. Despite the absence of specific clinical trials for this population, our findings suggest that SGLT2i therapy on older individuals is effective to lower glucose and maintain its effect on systolic blood pressure and body weight.
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Affiliation(s)
- Riobaldo Cintra
- Laboratory of Atherosclerosis and Vascular Biology, Unicamp, Campinas, SP, Brasil
| | - Filipe A Moura
- Laboratory of Atherosclerosis and Vascular Biology, Unicamp, Campinas, SP, Brasil
| | - Luis Sergio F de Carvalho
- Laboratory of Atherosclerosis and Vascular Biology, Unicamp, Campinas, SP, Brasil.,Cardiology Division, State University of Campinas (Unicamp), Campinas, SP, Brasil
| | - Joaquim Barreto
- Laboratory of Atherosclerosis and Vascular Biology, Unicamp, Campinas, SP, Brasil
| | - Marcos Tambascia
- Endocrinology Division, State University of Campinas (Unicamp), Campinas, SP, Brasil
| | | | - Andrei C Sposito
- Laboratory of Atherosclerosis and Vascular Biology, Unicamp, Campinas, SP, Brasil.,Cardiology Division, State University of Campinas (Unicamp), Campinas, SP, Brasil
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11
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Vierboom YC, Preston SH, Stokes A. Patterns of weight change associated with disease diagnosis in a national sample. PLoS One 2018; 13:e0207795. [PMID: 30475881 PMCID: PMC6261267 DOI: 10.1371/journal.pone.0207795] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/06/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The incidence and/or diagnosis of a major disease may activate weight change. Patterns of weight change associated with diagnoses have not been systematically documented. METHODS We use data on adults ages 30+ in the National Health and Nutrition Examination Survey (NHANES) from 1999-2014. Self-reported current weight and weight one year prior are used to estimate percent weight change in the last year. We use self-reported data on arthritis, diabetes, cancer, cardiovascular disease, liver conditions, and respiratory disease diagnoses to compare weight change among individuals never diagnosed with these conditions, individuals diagnosed 0-1 years ago, and individuals diagnosed 2+ years ago. Multinomial logistic regressions adjust for the presence of multiple conditions. RESULTS 17.7% of the adult population experienced weight loss of 5.0% or more in the year prior to survey. Individuals diagnosed with any of the conditions were less likely to maintain their weight than those without a diagnosis. Arthritis, diabetes, cancer, cardiovascular disease, and liver conditions were associated with net weight loss, whereas respiratory diseases were associated with higher probabilities of both losing and gaining weight. Among those losing 10% or more, 56.7% had been diagnosed with one of the conditions. Cancer was associated with the highest probability of unintentional weight loss and diabetes with the highest probability of intentional weight loss. CONCLUSIONS Disease-associated weight changes leave a distinct imprint on patterns of weight change in the population. Individuals losing at least 10% of their weight in the last year have likely been diagnosed with one of the six conditions.
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Affiliation(s)
- Yana C. Vierboom
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Samuel H. Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Andrew Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
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12
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Observational Evidence for Unintentional Weight Loss in All-Cause Mortality and Major Cardiovascular Events: A Systematic Review and Meta-Analysis. Sci Rep 2018; 8:15447. [PMID: 30337578 PMCID: PMC6194006 DOI: 10.1038/s41598-018-33563-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 09/26/2018] [Indexed: 02/07/2023] Open
Abstract
The obesity paradox has been described in several observational cohorts and meta-analysis. However, evidence of the intentionality of weight loss in all-cause deaths and major cardiovascular events (MACE) in prospective cohorts is unclear. We analysed whether involuntary weight loss is associated with increased cardiovascular events and mortality. In a systematic review, we searched multiple electronic databases for observational studies published up to October 2016. Studies reporting risk estimates for unintentional weight loss compared with stable weight in MACE and mortality were included. Fifteen studies met the selection criteria, with a total of 178,644 participants. For unintentional weight loss, we found adjusted risk ratios (RRs) with confidence intervals (CIs) of 1.38 (95% CI: 1.23, 1.53) and 1.17 (95% CI: 0.98, 1.37) for all-cause mortality and MACE, respectively. Participants with comorbidities, overweight and obese populations, and older adults yielded RRs (95% CI) of 1.49 (1.30, 1.68), 1.11 (1.04, 1.18), and 1.81 (1.59, 2.03), respectively. Unintentional weight loss had a significant impact on all-cause mortality. We found no protective effect of being overweight or obese for unintentional weight loss and MACE.
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13
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Chlebowski RT, Luo J, Anderson GL, Barrington W, Reding K, Simon MS, Manson JE, Rohan TE, Wactawski-Wende J, Lane D, Strickler H, Mosaver-Rahmani Y, Freudenheim JL, Saquib N, Stefanick ML. Weight loss and breast cancer incidence in postmenopausal women. Cancer 2018; 125:205-212. [PMID: 30294816 DOI: 10.1002/cncr.31687] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/22/2018] [Accepted: 06/01/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although obesity is an established risk factor for postmenopausal breast cancer, the results of weight loss and breast cancer studies are inconsistent. Therefore, we evaluated associations between weight change and breast cancer risk in postmenopausal women in the Women's Health Initiative Observational Study. METHODS Postmenopausal women (n = 61,335) who had no prior breast cancer and a normal mammogram had body weight and height measured and body mass index (BMI) calculated at baseline and year 3. Weight change at year 3 was categorized as stable (<5%), loss (≥5%), or gain (≥5%) with further assessment of weight loss intentionality by self-report. Multivariable Cox proportional hazard regression models were used to evaluate relationships between weight change and subsequent breast cancer incidence. RESULTS During a mean follow-up of 11.4 years with 3061 incident breast cancers, women with weight loss (n = 8175) had a significantly lower risk of breast cancer compared with women whose weight remained stable (n = 41,139) (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.78-0.98; P = .02) with no interaction by BMI. Adjustment for mammography did not alter findings (HR, 0.88; 95% CI, 0.78-0.99) with no significant difference by weight loss intentionality. Weight gain (≥5%) (n = 12,021) was not associated with breast cancer risk (HR, 1.02; 95% CI, 0.93-1.11) but was associated with higher triple-negative breast cancer incidence (HR, 1.54; 95% CI, 1.16-2.05). CONCLUSIONS Postmenopausal women who lose weight have lower breast cancer risk than those with stable weight. These findings suggest that postmenopausal women who lose weight may reduce their breast cancer risk.
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Affiliation(s)
- Rowan T Chlebowski
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Juhua Luo
- Epidemiology and Biostatistics, Indiana University, Bloomington, Indiana
| | - Garnet L Anderson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Wendy Barrington
- Psychosocial and Community Health, University of Washington, Seattle, Washington
| | - Kerryn Reding
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| | - Michael S Simon
- Clinical Arrangements, Karmanos Cancer Institute, Detroit, Michigan
| | - JoAnn E Manson
- Department of Epidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas E Rohan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, New York
| | - Dorothy Lane
- Department of Epidemiology & Population Health, Stony Brook University School of Medicine, Stony Brook, New York
| | - Howard Strickler
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Yasmin Mosaver-Rahmani
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jo L Freudenheim
- Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, New York
| | - Nazmus Saquib
- Department of Research, Sulaimaon Al Rajhi College School of Medicine, Al Bukayri ah, Saudi Arabia
| | - Marcia L Stefanick
- Department of Medicine, Stanford University School of Medicine, Stanford, California
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14
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The association of weight loss with one-year mortality in hospital patients, stratified by BMI and FFMI subgroups. Clin Nutr 2018; 37:1518-1525. [DOI: 10.1016/j.clnu.2017.08.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/14/2017] [Accepted: 08/22/2017] [Indexed: 01/10/2023]
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15
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LeBlanc ES, Patnode CD, Webber EM, Redmond N, Rushkin M, O'Connor EA. Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2018; 320:1172-1191. [PMID: 30326501 DOI: 10.1001/jama.2018.7777] [Citation(s) in RCA: 275] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Overweight and obesity have been associated with adverse health effects. OBJECTIVE To systematically review evidence on benefits and harms of behavioral and pharmacotherapy weight loss and weight loss maintenance interventions in adults to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed Publisher-Supplied Records, PsycINFO, and the Cochrane Central Register of Controlled Trials for studies published through June 6, 2017; ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials through August 2017; and ongoing surveillance in targeted publications through March 23, 2018. Studies from previous reviews were reevaluated for inclusion. STUDY SELECTION Randomized clinical trials (RCTs) focusing on weight loss or weight loss maintenance in adults. DATA EXTRACTION AND SYNTHESIS Data were abstracted by one reviewer and confirmed by another. Random-effects meta-analyses were conducted for weight loss outcomes in behavior-based interventions. MAIN OUTCOMES AND MEASURES Health outcomes, weight loss or weight loss maintenance, reduction in obesity-related conditions, and adverse events. RESULTS A total of 122 RCTs (N = 62 533) and 2 observational studies (N = 209 993) were identified. Compared with controls, participants in behavior-based interventions had greater mean weight loss at 12 to 18 months (-2.39 kg [95% CI, -2.86 to -1.93]; 67 studies [n = 22065]) and less weight regain (-1.59 kg [95% CI, -2.38 to -0.79]; 8 studies [n = 1408]). Studies of medication-based weight loss and maintenance interventions also reported greater weight loss or less weight regain in intervention compared with placebo groups at 12 to 18 months (range, -0.6 to -5.8 kg; no meta-analysis). Participants with prediabetes in weight loss interventions had a lower risk of developing diabetes compared with controls (relative risk, 0.67 [95% CI, 0.51 to 0.89]). There was no evidence of other benefits, but most health outcomes such as mortality, cardiovascular disease, and cancer were infrequently reported. Small improvements in quality of life in some medication trials were noted but were of unclear clinical significance. There was no evidence of harm such as cardiovascular disease from behavior-based interventions; higher rates of adverse events were associated with higher dropout rates in medication groups than in placebo groups. CONCLUSIONS AND RELEVANCE Behavior-based weight loss interventions with or without weight loss medications were associated with more weight loss and a lower risk of developing diabetes than control conditions. Weight loss medications, but not behavior-based interventions, were associated with higher rates of harms. Long-term weight and health outcomes data, as well as data on important subgroups, were limited.
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Affiliation(s)
- Erin S LeBlanc
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Carrie D Patnode
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Elizabeth M Webber
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan Rushkin
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Elizabeth A O'Connor
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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16
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Sánchez-Rodríguez D, Annweiler C, Ronquillo-Moreno N, Vázquez-Ibar O, Escalada F, Duran X, Muniesa JM, Marco E. Prognostic Value of the ESPEN Consensus and Guidelines for Malnutrition: Prediction of Post-Discharge Clinical Outcomes in Older Inpatients. Nutr Clin Pract 2018; 34:304-312. [DOI: 10.1002/ncp.10088] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 02/20/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Dolores Sánchez-Rodríguez
- Geriatrics Department; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
- Rehabilitation Research Group; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
- School of Medicine; Autònoma University of Barcelona; Barcelona Spain
- School of Medicine; Pompeu Fabra University; Barcelona Spain
| | - Cédric Annweiler
- Department of Neurosciences and Aging; Division of Geriatric Medicine; Angers University Hospital; Angers University Memory Clinic; Research Center on Autonomy and Longevity; UPRES EA 4638; University of Angers; UNAM Angers France
- Robarts Research Institute; Schulich School of Medicine and Dentistry; University of Western Ontario; London Ontario Canada
| | | | - Olga Vázquez-Ibar
- Geriatrics Department; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
- School of Medicine; Pompeu Fabra University; Barcelona Spain
| | - Ferran Escalada
- Rehabilitation Research Group; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
- School of Medicine; Autònoma University of Barcelona; Barcelona Spain
- Physical Medicine and Rehabilitation Department; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
| | - Xavier Duran
- Methodology and Biostatistics Support Unit; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
| | - Josep M. Muniesa
- Rehabilitation Research Group; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
- School of Medicine; Autònoma University of Barcelona; Barcelona Spain
- Physical Medicine and Rehabilitation Department; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
| | - Ester Marco
- Rehabilitation Research Group; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
- School of Medicine; Autònoma University of Barcelona; Barcelona Spain
- Physical Medicine and Rehabilitation Department; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
- International University of Catalunya; Barcelona Spain
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17
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Weight change and 15 year mortality: results from the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) cohort study. Eur J Epidemiol 2017; 33:37-53. [PMID: 29264789 PMCID: PMC5803289 DOI: 10.1007/s10654-017-0343-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 12/09/2017] [Indexed: 11/24/2022]
Abstract
Studies have reported a higher mortality risk associated with weight loss, particularly in middle-aged and older adults, although some of these studies did find that gaining weight was also associated with an increased mortality risk. We examined changes in weight in relation to mortality in a prospective population-based cohort study of men and women, resident in Norfolk, UK. Participants were assessed at baseline (1993–1997) and at a second examination (1998–2000), as part of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) study, and followed up to 2015 for mortality. Participants with a self-reported history of cancer or cardiovascular disease, body mass index < 18.5 kg/m2 or missing data on adjustment variables, at either time-point were excluded, leaving 12,580 participants, aged 39–78 in 1993–1997, eligible for analyses. Cox proportional hazards models were used to determine Hazard Ratios (HRs) for all-cause (2603 deaths), cardiovascular (749 deaths), cancer (981 deaths), respiratory (226 deaths) and other causes of mortality (647 deaths) by categories of weight change. After multivariate adjustment, the HRs (95% CIs) for all-cause mortality for men and women who lost more than 5 kg were 1.85 (1.48–2.31) and 1.64 (1.31–2.05) respectively. Higher hazards were also found for specific causes of mortality and weight loss > 5 kg. Similar associations were observed after excluding deaths in the first 5 years of follow-up. Results for weight gain were inconclusive. We conclude that objectively measured weight loss, but not weight gain, was associated with subsequent higher mortality risk in this population-based study of middle-aged and elderly men and women. However, undiagnosed, pre-existing disease and the inability to account for weight cycling need to be remembered when interpreting these results. Unravelling the causal pathways underlying this association will require more detailed studies, including that of changes in body composition.
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18
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Kawada T. Multifaceted changes and mortality in older adults. Geriatr Gerontol Int 2017; 17:2643. [DOI: 10.1111/ggi.13173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health; Nippon Medical School; Tokyo Japan
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19
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Schaap LA, Quirke T, Wijnhoven HAH, Visser M. Changes in body mass index and mid-upper arm circumference in relation to all-cause mortality in older adults. Clin Nutr 2017; 37:2252-2259. [PMID: 29195733 DOI: 10.1016/j.clnu.2017.11.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND & AIMS The assessment of weight loss as an indicator of poor nutritional status in older persons is currently widely applied to establish risk of mortality. Little is known about the relationship between changes in mid-upper arm circumference (MUAC) and mortality in older individuals. The aim of the present study was to examine the association between 3-year change in MUAC and 20-year mortality in community-dwelling older adults and compare this to the association between body mass index (BMI) change and mortality. METHODS Data on changes in MUAC (cm) and BMI (kg/m2), covariates, and mortality were available for 1307 Dutch older adults (49.7% men) aged 65 years and older in 1995/96 (mean 75.6 years, SD 6.5) from Longitudinal Aging Study Amsterdam (LASA). Anthropometric measurements were performed in 1992/93 with repeated measurements in 1995/96 (baseline), and a mortality follow up until July 2015. BMI and MUAC change were divided into quintiles, with the quintile including zero defined as the reference category. Cox regression analyses were performed to examine the associations of 3-year changes in MUAC and BMI with subsequent 20-year all-cause mortality, adjusted for demographic and health factors. Age, sex and initial measurement of BMI and MUAC (1992/93) were tested for effect modification (P = <0.10). RESULTS Mean baseline BMI was 26.7 kg/m2 (SD 4.2) with a 3-year change of -0.2 (SD 1.5). Mean baseline MUAC was 30.5 cm (SD 3.5) with a 3-year change of -0.8 (SD 1.6). Age, sex, and BMI and MUAC 3 years prior were effect modifiers in the associations between change in anthropometric measurement and mortality. Decrease in MUAC was not associated with mortality in persons with a higher initial MUAC (≥31 cm), while for persons with a lower initial MUAC, a decrease in MUAC of ≤-2.15 was associated with increased mortality risk (HR 1.54; 95% CI: 1.14-2.09), also when further stratified on median age and sex. In stratified analysis of BMI change for median initial BMI (26.5) and additionally stratified for median age and sex, the associations between a BMI decrease of ≤-1.19 and mortality fluctuated, mostly statistically not significant. No associations were found for gain in MUAC or BMI. CONCLUSIONS Given that MUAC loss is more strongly and consistently associated with an increased mortality risk in older individuals with a low initial MUAC compared to BMI loss, this may be a more recommendable measure to use in clinical practice for assessing poor nutritional status, instead of weight loss.
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Affiliation(s)
- Laura A Schaap
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands.
| | - Tara Quirke
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands; Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
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20
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Stenholm S, Solovieva S, Viikari-Juntura E, Aalto V, Kivimäki M, Vahtera J. Change in body mass index during transition to statutory retirement: an occupational cohort study. Int J Behav Nutr Phys Act 2017; 14:85. [PMID: 28651597 PMCID: PMC5485586 DOI: 10.1186/s12966-017-0539-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/14/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Retirement is a major life transition affecting health behaviors. The aim of this study was to examine within-individual changes in body mass index (BMI) during transition from full-time work to statutory retirement by sex and physical work characteristics. METHODS A multiwave cohort study repeated every 4 years and data linkage to records from retirement registers. Participants were 5426 Finnish public-sector employees who retired on a statutory basis in 2000-2011 and who reported their body weight one to three times prior to (w-3, w-2, w-1), and one to three times after (w+1, w+2, w+3) retirement. RESULTS During the 4-year retirement transition (w+1, vs. w-1) men showed decline in BMI, which was most marked among men with sedentary work (-0.18 kg/m2, 95% CI -.30 to -0.05). In contrast, BMI increased during retirement transition in women and was most marked among women with diverse (0.14 kg/m2, 95% CI 0.08 to 0.20) or physically heavy work (0.31 kg/m2, 95% CI 0.16 to 0.45). Physical activity during leisure time or commuting to work, alcohol consumption or smoking did not explain the observed changes during retirement transition. CONCLUSIONS In this study statutory retirement was associated with small changes in BMI. Weight loss was most visible in men retiring from sedentary jobs and weight gain in women retiring from diverse and physically heavy jobs.
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Affiliation(s)
- Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Faculty of Social Sciences (Health Science), University of Tampere, Tampere, Finland
| | | | | | - Ville Aalto
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London Medical School, London, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
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21
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Luo J, Chlebowski RT, Hendryx M, Rohan T, Wactawski-Wende J, Thomson CA, Felix AS, Chen C, Barrington W, Coday M, Stefanick M, LeBlanc E, Margolis KL. Intentional Weight Loss and Endometrial Cancer Risk. J Clin Oncol 2017; 35:1189-1193. [PMID: 28165909 DOI: 10.1200/jco.2016.70.5822] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Purpose Although obesity is an established endometrial cancer risk factor, information about the influence of weight loss on endometrial cancer risk in postmenopausal women is limited. Therefore, we evaluated associations among weight change by intentionality with endometrial cancer in the Women's Health Initiative (WHI) observational study. Patients and Methods Postmenopausal women (N = 36,794) ages 50 to 79 years at WHI enrollment had their body weights measured and body mass indices calculated at baseline and at year 3. Weight change during that period was categorized as follows: stable (change within ± 5%), loss (change ≥ 5%), and gain (change ≥ 5%). Weight loss intentionality was assessed via self-report at year 3; change was characterized as intentional or unintentional. During the subsequent 11.4 years (mean) of follow-up, 566 incident endometrial cancer occurrences were confirmed by medical record review. Multivariable Cox proportional hazards regression models were used to evaluate relationships (hazard ratios [HRs] and 95% CIs) between weight change and endometrial cancer incidence. Results In multivariable analyses, compared with women who had stable weight (± 5%), women with weight loss had a significantly lower endometrial cancer risk (HR, 0.71; 95% CI, 0.54 to 0.95). The association was strongest among obese women with intentional weight loss (HR, 0.44; 95% CI, 0.25 to 0.78). Weight gain (≥ 10 pounds) was associated with a higher endometrial cancer risk than was stable weight, especially among women who had never used hormones. Conclusion Intentional weight loss in postmenopausal women is associated with a lower endometrial cancer risk, especially among women with obesity. These findings should motivate programs for weight loss in obese postmenopausal women.
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Affiliation(s)
- Juhua Luo
- Juhua Luo and Michael Hendryx, Indiana University Bloomington, IN; Rowan T. Chlebowski, University of California, Los Angeles, Medical Center, Torrance; Marcia Stefanick, Stanford University School of Medicine, Stanford, CA; Thomas Rohan, Albert Einstein College of Medicine, Bronx; Jean Wactawski-Wende, University at Buffalo, SUNY, Buffalo, NY; Cynthia A. Thomson, The University of Arizona, Tucson, AZ; Ashley S. Felix, The Ohio State University, Columbus, OH; Chu Chen, Fred Hutchinson Cancer Research Center; Wendy Barrington, University of Washington, Seattle, WA; Mace Coday, University of Tennessee Health Science Center, Memphis, TN; Erin LeBlanc, Kaiser Permanente Center for Health Research, Portland, OR; and Karen L. Margolis, Health Partners Institute, Minneapolis, MN
| | - Rowan T Chlebowski
- Juhua Luo and Michael Hendryx, Indiana University Bloomington, IN; Rowan T. Chlebowski, University of California, Los Angeles, Medical Center, Torrance; Marcia Stefanick, Stanford University School of Medicine, Stanford, CA; Thomas Rohan, Albert Einstein College of Medicine, Bronx; Jean Wactawski-Wende, University at Buffalo, SUNY, Buffalo, NY; Cynthia A. Thomson, The University of Arizona, Tucson, AZ; Ashley S. Felix, The Ohio State University, Columbus, OH; Chu Chen, Fred Hutchinson Cancer Research Center; Wendy Barrington, University of Washington, Seattle, WA; Mace Coday, University of Tennessee Health Science Center, Memphis, TN; Erin LeBlanc, Kaiser Permanente Center for Health Research, Portland, OR; and Karen L. Margolis, Health Partners Institute, Minneapolis, MN
| | - Michael Hendryx
- Juhua Luo and Michael Hendryx, Indiana University Bloomington, IN; Rowan T. Chlebowski, University of California, Los Angeles, Medical Center, Torrance; Marcia Stefanick, Stanford University School of Medicine, Stanford, CA; Thomas Rohan, Albert Einstein College of Medicine, Bronx; Jean Wactawski-Wende, University at Buffalo, SUNY, Buffalo, NY; Cynthia A. Thomson, The University of Arizona, Tucson, AZ; Ashley S. Felix, The Ohio State University, Columbus, OH; Chu Chen, Fred Hutchinson Cancer Research Center; Wendy Barrington, University of Washington, Seattle, WA; Mace Coday, University of Tennessee Health Science Center, Memphis, TN; Erin LeBlanc, Kaiser Permanente Center for Health Research, Portland, OR; and Karen L. Margolis, Health Partners Institute, Minneapolis, MN
| | - Thomas Rohan
- Juhua Luo and Michael Hendryx, Indiana University Bloomington, IN; Rowan T. Chlebowski, University of California, Los Angeles, Medical Center, Torrance; Marcia Stefanick, Stanford University School of Medicine, Stanford, CA; Thomas Rohan, Albert Einstein College of Medicine, Bronx; Jean Wactawski-Wende, University at Buffalo, SUNY, Buffalo, NY; Cynthia A. Thomson, The University of Arizona, Tucson, AZ; Ashley S. Felix, The Ohio State University, Columbus, OH; Chu Chen, Fred Hutchinson Cancer Research Center; Wendy Barrington, University of Washington, Seattle, WA; Mace Coday, University of Tennessee Health Science Center, Memphis, TN; Erin LeBlanc, Kaiser Permanente Center for Health Research, Portland, OR; and Karen L. Margolis, Health Partners Institute, Minneapolis, MN
| | - Jean Wactawski-Wende
- Juhua Luo and Michael Hendryx, Indiana University Bloomington, IN; Rowan T. Chlebowski, University of California, Los Angeles, Medical Center, Torrance; Marcia Stefanick, Stanford University School of Medicine, Stanford, CA; Thomas Rohan, Albert Einstein College of Medicine, Bronx; Jean Wactawski-Wende, University at Buffalo, SUNY, Buffalo, NY; Cynthia A. Thomson, The University of Arizona, Tucson, AZ; Ashley S. Felix, The Ohio State University, Columbus, OH; Chu Chen, Fred Hutchinson Cancer Research Center; Wendy Barrington, University of Washington, Seattle, WA; Mace Coday, University of Tennessee Health Science Center, Memphis, TN; Erin LeBlanc, Kaiser Permanente Center for Health Research, Portland, OR; and Karen L. Margolis, Health Partners Institute, Minneapolis, MN
| | - Cynthia A Thomson
- Juhua Luo and Michael Hendryx, Indiana University Bloomington, IN; Rowan T. Chlebowski, University of California, Los Angeles, Medical Center, Torrance; Marcia Stefanick, Stanford University School of Medicine, Stanford, CA; Thomas Rohan, Albert Einstein College of Medicine, Bronx; Jean Wactawski-Wende, University at Buffalo, SUNY, Buffalo, NY; Cynthia A. Thomson, The University of Arizona, Tucson, AZ; Ashley S. Felix, The Ohio State University, Columbus, OH; Chu Chen, Fred Hutchinson Cancer Research Center; Wendy Barrington, University of Washington, Seattle, WA; Mace Coday, University of Tennessee Health Science Center, Memphis, TN; Erin LeBlanc, Kaiser Permanente Center for Health Research, Portland, OR; and Karen L. Margolis, Health Partners Institute, Minneapolis, MN
| | - Ashley S Felix
- Juhua Luo and Michael Hendryx, Indiana University Bloomington, IN; Rowan T. Chlebowski, University of California, Los Angeles, Medical Center, Torrance; Marcia Stefanick, Stanford University School of Medicine, Stanford, CA; Thomas Rohan, Albert Einstein College of Medicine, Bronx; Jean Wactawski-Wende, University at Buffalo, SUNY, Buffalo, NY; Cynthia A. Thomson, The University of Arizona, Tucson, AZ; Ashley S. Felix, The Ohio State University, Columbus, OH; Chu Chen, Fred Hutchinson Cancer Research Center; Wendy Barrington, University of Washington, Seattle, WA; Mace Coday, University of Tennessee Health Science Center, Memphis, TN; Erin LeBlanc, Kaiser Permanente Center for Health Research, Portland, OR; and Karen L. Margolis, Health Partners Institute, Minneapolis, MN
| | - Chu Chen
- Juhua Luo and Michael Hendryx, Indiana University Bloomington, IN; Rowan T. Chlebowski, University of California, Los Angeles, Medical Center, Torrance; Marcia Stefanick, Stanford University School of Medicine, Stanford, CA; Thomas Rohan, Albert Einstein College of Medicine, Bronx; Jean Wactawski-Wende, University at Buffalo, SUNY, Buffalo, NY; Cynthia A. Thomson, The University of Arizona, Tucson, AZ; Ashley S. Felix, The Ohio State University, Columbus, OH; Chu Chen, Fred Hutchinson Cancer Research Center; Wendy Barrington, University of Washington, Seattle, WA; Mace Coday, University of Tennessee Health Science Center, Memphis, TN; Erin LeBlanc, Kaiser Permanente Center for Health Research, Portland, OR; and Karen L. Margolis, Health Partners Institute, Minneapolis, MN
| | - Wendy Barrington
- Juhua Luo and Michael Hendryx, Indiana University Bloomington, IN; Rowan T. Chlebowski, University of California, Los Angeles, Medical Center, Torrance; Marcia Stefanick, Stanford University School of Medicine, Stanford, CA; Thomas Rohan, Albert Einstein College of Medicine, Bronx; Jean Wactawski-Wende, University at Buffalo, SUNY, Buffalo, NY; Cynthia A. Thomson, The University of Arizona, Tucson, AZ; Ashley S. Felix, The Ohio State University, Columbus, OH; Chu Chen, Fred Hutchinson Cancer Research Center; Wendy Barrington, University of Washington, Seattle, WA; Mace Coday, University of Tennessee Health Science Center, Memphis, TN; Erin LeBlanc, Kaiser Permanente Center for Health Research, Portland, OR; and Karen L. Margolis, Health Partners Institute, Minneapolis, MN
| | - Mace Coday
- Juhua Luo and Michael Hendryx, Indiana University Bloomington, IN; Rowan T. Chlebowski, University of California, Los Angeles, Medical Center, Torrance; Marcia Stefanick, Stanford University School of Medicine, Stanford, CA; Thomas Rohan, Albert Einstein College of Medicine, Bronx; Jean Wactawski-Wende, University at Buffalo, SUNY, Buffalo, NY; Cynthia A. Thomson, The University of Arizona, Tucson, AZ; Ashley S. Felix, The Ohio State University, Columbus, OH; Chu Chen, Fred Hutchinson Cancer Research Center; Wendy Barrington, University of Washington, Seattle, WA; Mace Coday, University of Tennessee Health Science Center, Memphis, TN; Erin LeBlanc, Kaiser Permanente Center for Health Research, Portland, OR; and Karen L. Margolis, Health Partners Institute, Minneapolis, MN
| | - Marcia Stefanick
- Juhua Luo and Michael Hendryx, Indiana University Bloomington, IN; Rowan T. Chlebowski, University of California, Los Angeles, Medical Center, Torrance; Marcia Stefanick, Stanford University School of Medicine, Stanford, CA; Thomas Rohan, Albert Einstein College of Medicine, Bronx; Jean Wactawski-Wende, University at Buffalo, SUNY, Buffalo, NY; Cynthia A. Thomson, The University of Arizona, Tucson, AZ; Ashley S. Felix, The Ohio State University, Columbus, OH; Chu Chen, Fred Hutchinson Cancer Research Center; Wendy Barrington, University of Washington, Seattle, WA; Mace Coday, University of Tennessee Health Science Center, Memphis, TN; Erin LeBlanc, Kaiser Permanente Center for Health Research, Portland, OR; and Karen L. Margolis, Health Partners Institute, Minneapolis, MN
| | - Erin LeBlanc
- Juhua Luo and Michael Hendryx, Indiana University Bloomington, IN; Rowan T. Chlebowski, University of California, Los Angeles, Medical Center, Torrance; Marcia Stefanick, Stanford University School of Medicine, Stanford, CA; Thomas Rohan, Albert Einstein College of Medicine, Bronx; Jean Wactawski-Wende, University at Buffalo, SUNY, Buffalo, NY; Cynthia A. Thomson, The University of Arizona, Tucson, AZ; Ashley S. Felix, The Ohio State University, Columbus, OH; Chu Chen, Fred Hutchinson Cancer Research Center; Wendy Barrington, University of Washington, Seattle, WA; Mace Coday, University of Tennessee Health Science Center, Memphis, TN; Erin LeBlanc, Kaiser Permanente Center for Health Research, Portland, OR; and Karen L. Margolis, Health Partners Institute, Minneapolis, MN
| | - Karen L Margolis
- Juhua Luo and Michael Hendryx, Indiana University Bloomington, IN; Rowan T. Chlebowski, University of California, Los Angeles, Medical Center, Torrance; Marcia Stefanick, Stanford University School of Medicine, Stanford, CA; Thomas Rohan, Albert Einstein College of Medicine, Bronx; Jean Wactawski-Wende, University at Buffalo, SUNY, Buffalo, NY; Cynthia A. Thomson, The University of Arizona, Tucson, AZ; Ashley S. Felix, The Ohio State University, Columbus, OH; Chu Chen, Fred Hutchinson Cancer Research Center; Wendy Barrington, University of Washington, Seattle, WA; Mace Coday, University of Tennessee Health Science Center, Memphis, TN; Erin LeBlanc, Kaiser Permanente Center for Health Research, Portland, OR; and Karen L. Margolis, Health Partners Institute, Minneapolis, MN
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Hoogendijk EO, Deeg DJH, Poppelaars J, van der Horst M, Broese van Groenou MI, Comijs HC, Pasman HRW, van Schoor NM, Suanet B, Thomése F, van Tilburg TG, Visser M, Huisman M. The Longitudinal Aging Study Amsterdam: cohort update 2016 and major findings. Eur J Epidemiol 2016; 31:927-45. [PMID: 27544533 PMCID: PMC5010587 DOI: 10.1007/s10654-016-0192-0] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/13/2016] [Indexed: 12/14/2022]
Abstract
The Longitudinal Aging Study Amsterdam (LASA) is an ongoing longitudinal study of older adults in the Netherlands, which started in 1992. LASA is focused on the determinants, trajectories and consequences of physical, cognitive, emotional and social functioning. The study is based on a nationally representative sample of older adults aged 55 years and over. The findings of the LASA study have been reported in over 450 publications so far (see www.lasa-vu.nl ). In this article we describe the background and the design of the LASA study, and provide an update of the methods. In addition, we provide a summary of the major findings from the period 2011-2015.
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Affiliation(s)
- Emiel O Hoogendijk
- Department of Epidemiology and Biostatistics, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan Poppelaars
- Department of Epidemiology and Biostatistics, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | - Marleen van der Horst
- Department of Epidemiology and Biostatistics, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Hannie C Comijs
- Department of Psychiatry, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Bianca Suanet
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | - Fleur Thomése
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | | | - Marjolein Visser
- Department of Health Sciences, Faculty of Earth and Life Sciences, EMGO + Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of Internal Medicine, Nutrition and Dietetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, VU University, Amsterdam, The Netherlands
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23
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Bouldin ED, Thompson ML, Boyko EJ, Morgenroth DC, Littman AJ. Weight Change Trajectories After Incident Lower-Limb Amputation. Arch Phys Med Rehabil 2016; 97:1-7.e1. [DOI: 10.1016/j.apmr.2015.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/25/2015] [Accepted: 09/26/2015] [Indexed: 01/08/2023]
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Kiesswetter E, Schrader E, Diekmann R, Sieber CC, Volkert D. Varying Associations Between Body Mass Index and Physical and Cognitive Function in Three Samples of Older Adults Living in Different Settings. J Gerontol A Biol Sci Med Sci 2015; 70:1255-61. [PMID: 25910844 DOI: 10.1093/gerona/glv048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 03/25/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The study investigates variations in the associations between body mass index (BMI) and (a) physical and (b) cognitive function across three samples of older adults living in different settings, and moreover determines if the association between BMI and physical function is confounded by cognitive abilities. METHODS One hundred ninety-five patients of a geriatric day hospital, 322 persons receiving home care (HC), and 183 nursing home (NH) residents were examined regarding BMI, cognitive (Mini-Mental State Examination), and physical function (Barthel Index for activities of daily living). Differences in Mini-Mental State Examination and activities of daily living scores between BMI groups (<22, 22-<25, 25-<30, 30-<35, ≥35kg/m(2)) were tested by analysis of covariance considering relevant confounders. RESULTS Activities of daily living and Mini-Mental State Examination impairments increased from the geriatric day hospital over the HC to the NH sample, whereas prevalence rates of obesity and severe obesity (35%, 33%, 25%) decreased. In geriatric day hospital patients cognitive and physical function did not differ between BMI groups. In the HC and NH samples, cognitive abilities were highest in obese and severely obese subjects. Unadjusted mean activities of daily living scores differed between BMI groups in HC receivers (51.6±32.2, 61.8±26.1, 67.5±28.3, 72.0±23.4, 66.2±24.2, p = .002) and NH residents (35.6±28.6, 48.1±25.7, 39.9±28.7, 50.8±24.0, 57.1±28.2, p = .029). In both samples significance was lost after adjustment indicating cognitive function as dominant confounder. CONCLUSIONS In older adults the associations between BMI and physical and cognitive function were dependent on the health and care status corresponding to the setting. In the HC and the NH samples, cognitive status, as measured by the Mini-Mental State Examination, emerged as an important confounder within the association between BMI and physical function.
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Affiliation(s)
- Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
| | - Eva Schrader
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Rebecca Diekmann
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany. Department for Geriatric Medicine, Carl von Ossietzky Universität Oldenburg, Germany
| | - Cornel Christian Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
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25
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Messinger-Rapport BJ, Gammack JK, Little MO, Morley JE. Clinical Update on Nursing Home Medicine: 2014. J Am Med Dir Assoc 2014; 15:786-801. [DOI: 10.1016/j.jamda.2014.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 12/18/2022]
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