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Dramé M, Godaert L. The Obesity Paradox and Mortality in Older Adults: A Systematic Review. Nutrients 2023; 15:nu15071780. [PMID: 37049633 PMCID: PMC10096985 DOI: 10.3390/nu15071780] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
“Obesity paradox” describes the counterintuitive finding that aged overweight and obese people with a particular disease may have better outcomes than their normal weight or underweight counterparts. This systematic review was performed to summarize the publications related to the obesity paradox in older adults, to gain an in-depth understanding of this phenomenon. PubMed©, Embase©, and Scopus© were used to perform literature search for all publications up to 20 March 2022. Studies were included if they reported data from older adults on the relation between BMI and mortality. The following article types were excluded from the study: reviews, editorials, correspondence, and case reports and case series. Publication year, study setting, medical condition, study design, sample size, age, and outcome(s) were extracted. This review has been registered with PROSPERO (no. CRD42021289015). Overall, 2226 studies were identified, of which 58 were included in this systematic review. In all, 20 of the 58 studies included in this review did not find any evidence of an obesity paradox. Of these 20 studies, 16 involved patients with no specific medical condition, 1 involved patients with chronic diseases, and 2 involved patients with type 2 diabetes mellitus. Seven out of the nine studies that looked at short-term mortality found evidence of the obesity paradox. Of the 28 studies that examined longer-term mortality, 15 found evidence of the obesity paradox. In the studies that were conducted in people with a particular medical condition (n = 24), the obesity paradox appeared in 18 cases. Our work supports the existence of an obesity paradox, especially when comorbidities or acute medical problems are present. These findings should help guide strategies for nutritional counselling in older populations.
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Affiliation(s)
- Moustapha Dramé
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
- Department of Clinical Research and Innovation, University Hospitals of Martinique, 97261 Fort-de-France, France
| | - Lidvine Godaert
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
- Department of Geriatrics, General Hospital of Valenciennes, 59300 Valenciennes, France
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Undernutrition, overweight and obesity prevalences among community-dwelling elderly in Africa-a systematic review. CLINICAL NUTRITION OPEN SCIENCE 2022. [DOI: 10.1016/j.nutos.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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3
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Affiliation(s)
- Marouane Boukhris
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France.,EpiMaCT, INSERM 1094 & IRD 270, Limoges University, Limoges, France
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Mabiama G, Adiogo D, Preux PM, Desport JC, Fayemendy P, Jésus P. Nutritional status and associated factors among community-dwelling elderly. Clin Nutr ESPEN 2021; 45:220-228. [PMID: 34620321 DOI: 10.1016/j.clnesp.2021.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/30/2021] [Accepted: 08/17/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Although the ageing of the Cameroonian population is a public health issue in the coming years, the nutritional status of the elderly is unknown. The aim of the study was to assess the nutritional status, health status and associated socio-demographic factors among elderly in Cameroon. METHODS A cross-sectional study of 599 elderly (aged ≥ 60) was conducted in urban and rural areas. Several socio-demographic, sanitary, and anthropometric (weight, height, body mass index (BMI), Waist Circumference (WC), Mid-Upper Arm Circumference (MUAC)) data were collected. Nutritional status was defined according to WHO. Multinomial analysis was performed to identify factors associated with nutritional status. The threshold of statistical significance was 5%. RESULTS The population, representative of the elderly, was aged 68.9 ± 7.2 years, with sex ratio M/F = 0.93, weight 68.5 ± 14.7 kg, BMI 24.7 ± 5.3, WC 90.1 ± 12.8 cm and MUAC 28.2 ± 5.0 cm. According to BMI, undernutrition was 19.7%, normal status 37.9%, overweight 24.9%, obesity 17.5%. The concordance for undernutrition between BMI and MUAC was weak (kappa = 0.3). In multinomial analysis, only no medication was negatively associated with undernutrition (OR = 0.3). Obesity was positively associated with the urban environment (OR = 4.8) and inactivity (OR = 2.9) and negatively associated with male gender (OR = 0.4), widowed (OR = 0.2), head of household (OR = 0.4), no income (OR = 0.3), one pathology (OR = 0.4), no medication (OR = 0.2), having normal diastolic pressure (OR = 0.2). CONCLUSIONS Undernutrition and obesity (more frequent in women, and in urban area) affect 37.2% of the elderly. These nutritional disorders are a public health problem that cannot be ignored.
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Affiliation(s)
- Gustave Mabiama
- Inserm U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, 2 Rue Dr Marcland, 87000, Limoges, France; Microbiology, Immunology-Hematology and Morphologic Sciences Laboratory (LMIHSM), Doctoral Training Unit in Health Sciences (UFD-SCS), Doctoral School, Douala University, BP, 2701, Douala, Cameroon.
| | - Dieudonné Adiogo
- Microbiology, Immunology-Hematology and Morphologic Sciences Laboratory (LMIHSM), Doctoral Training Unit in Health Sciences (UFD-SCS), Doctoral School, Douala University, BP, 2701, Douala, Cameroon
| | - Pierre Marie Preux
- Inserm U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, 2 Rue Dr Marcland, 87000, Limoges, France
| | - Jean-Claude Desport
- Inserm U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, 2 Rue Dr Marcland, 87000, Limoges, France; Health Network of the Nouvelle Aquitaine Regional Health Agency Limousin Nutrition (LINUT), Isle, 16 Rue Du Cluzeau, 87170, Isle, France
| | - Philippe Fayemendy
- Inserm U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, 2 Rue Dr Marcland, 87000, Limoges, France; Health Network of the Nouvelle Aquitaine Regional Health Agency Limousin Nutrition (LINUT), Isle, 16 Rue Du Cluzeau, 87170, Isle, France
| | - Pierre Jésus
- Inserm U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, 2 Rue Dr Marcland, 87000, Limoges, France; Health Network of the Nouvelle Aquitaine Regional Health Agency Limousin Nutrition (LINUT), Isle, 16 Rue Du Cluzeau, 87170, Isle, France
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Napolioni V, Scelsi MA, Khan RR, Altmann A, Greicius MD. Recent Consanguinity and Outbred Autozygosity Are Associated With Increased Risk of Late-Onset Alzheimer's Disease. Front Genet 2021; 11:629373. [PMID: 33584820 PMCID: PMC7879576 DOI: 10.3389/fgene.2020.629373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 12/31/2020] [Indexed: 11/13/2022] Open
Abstract
Prior work in late-onset Alzheimer's disease (LOAD) has resulted in discrepant findings as to whether recent consanguinity and outbred autozygosity are associated with LOAD risk. In the current study, we tested the association between consanguinity and outbred autozygosity with LOAD in the largest such analysis to date, in which 20 LOAD GWAS datasets were retrieved through public databases. Our analyses were restricted to eight distinct ethnic groups: African-Caribbean, Ashkenazi-Jewish European, European-Caribbean, French-Canadian, Finnish European, North-Western European, South-Eastern European, and Yoruba African for a total of 21,492 unrelated subjects (11,196 LOAD and 10,296 controls). Recent consanguinity determination was performed using FSuite v1.0.3, according to subjects' ancestral background. The level of autozygosity in the outbred population was assessed by calculating inbreeding estimates based on the proportion (FROH) and the number (NROH) of runs of homozygosity (ROHs). We analyzed all eight ethnic groups using a fixed-effect meta-analysis, which showed a significant association of recent consanguinity with LOAD (N = 21,481; OR = 1.262, P = 3.6 × 10-4), independently of APOE ∗4 (N = 21,468, OR = 1.237, P = 0.002), and years of education (N = 9,257; OR = 1.274, P = 0.020). Autozygosity in the outbred population was also associated with an increased risk of LOAD, both for F ROH (N = 20,237; OR = 1.204, P = 0.030) and N ROH metrics (N = 20,237; OR = 1.019, P = 0.006), independently of APOE ∗4 [(F ROH, N = 20,225; OR = 1.222, P = 0.029) (N ROH, N = 20,225; OR = 1.019, P = 0.007)]. By leveraging the Alzheimer's Disease Sequencing Project (ADSP) whole-exome sequencing (WES) data, we determined that LOAD subjects do not show an enrichment of rare, risk-enhancing minor homozygote variants compared to the control population. A two-stage recessive GWAS using ADSP data from 201 consanguineous subjects in the discovery phase followed by validation in 10,469 subjects led to the identification of RPH3AL p.A303V (rs117190076) as a rare minor homozygote variant increasing the risk of LOAD [discovery: Genotype Relative Risk (GRR) = 46, P = 2.16 × 10-6; validation: GRR = 1.9, P = 8.0 × 10-4]. These results confirm that recent consanguinity and autozygosity in the outbred population increase risk for LOAD. Subsequent work, with increased samples sizes of consanguineous subjects, should accelerate the discovery of non-additive genetic effects in LOAD.
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Affiliation(s)
- Valerio Napolioni
- Genomic and Molecular Epidemiology (GAME) Lab, School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Marzia A. Scelsi
- Computational Biology in Imaging and Genetics (COMBINE) Lab, Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Raiyan R. Khan
- Department of Computer Science, Columbia University, New York, NY, United States
| | - Andre Altmann
- Computational Biology in Imaging and Genetics (COMBINE) Lab, Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Michael D. Greicius
- Functional Imaging in Neuropsychiatric Disorders (FIND) Lab, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
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The obesity paradox: does it exist in the perioperative period? Int Anesthesiol Clin 2020; 58:14-20. [PMID: 32250998 DOI: 10.1097/aia.0000000000000278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Cao Z, Wang R, Cheng Y, Yang H, Li S, Sun L, Xu W, Wang Y. Adherence to a healthy lifestyle counteracts the negative effects of risk factors on all-cause mortality in the oldest-old. Aging (Albany NY) 2019; 11:7605-7619. [PMID: 31525731 PMCID: PMC6781993 DOI: 10.18632/aging.102274] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/05/2019] [Indexed: 12/18/2022]
Abstract
In the study, we examined the extent to which the harmful effects of risk factors on all-cause mortality can be counteracted by healthy lifestyle practices in the oldest-old (80 years of age and older). A total of 17,660 oldest-old from China were followed up for up to 10 years. The data were analyzed using the Cox proportional hazard model with adjustment for potential confounders. We found that having a rural residence, not being married, having lower economic status, physical disability, impaired cognitive function, or comorbidity were all associated with an elevated risk of mortality. Using these factors, we computed a weighted "risk score." Because never smoking, never drinking, doing physical exercise, having an ideal diet, and a normal weight were independently associated with lower mortality, we also combined them to compute a weighted "protection score." Both scores were divided into lowest, middle, and highest groups using their tertiles. In joint effect analyses, participants with the combined highest-risk score and lowest-protection score profile had a nearly threefold higher joint death risk. These analyses show that adherence to a healthy lifestyle counteracts the negative effect of risk factors on all-cause mortality in the oldest-old by more than 20%.
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Affiliation(s)
- Zhi Cao
- School of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Rui Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm SE-17177, Sweden
| | - Yangyang Cheng
- School of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Hongxi Yang
- School of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China.,Department of Biostatistics, School of Public Health, Yale University, New Haven, CT 06520, USA
| | - Shu Li
- School of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Li Sun
- School of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm SE-17177, Sweden
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
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Adebusoye LA, Owolabi MO, Ogunniyi A. Biomarkers, shock index and modified early warning score among older medical hospital inpatients in Nigeria. S Afr Fam Pract (2004) 2019. [DOI: 10.1080/20786190.2018.1554304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- LA Adebusoye
- Chief Tony Anenih Geriatric Centre (CTAGC), University College Hospital, Ibadan, Nigeria
| | - MO Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - A Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Boutin E, Natella PA, Schott AM, Bastuji-Garin S, David JP, Paillaud E, Rolland Y, Canouï-Poitrine F. Interrelations between body mass index, frailty, and clinical adverse events in older community-dwelling women: The EPIDOS cohort study. Clin Nutr 2018; 37:1638-1644. [DOI: 10.1016/j.clnu.2017.07.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/21/2017] [Accepted: 07/29/2017] [Indexed: 12/22/2022]
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10
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Wang S, Ren J. Obesity Paradox in Aging: From Prevalence to Pathophysiology. Prog Cardiovasc Dis 2018; 61:182-189. [PMID: 29990534 DOI: 10.1016/j.pcad.2018.07.011] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/05/2018] [Indexed: 11/25/2022]
Abstract
Recent advances in medical technology and health care have greatly improved the management for chronic diseases and prolonged human lifespan. Unfortunately, increased lifespan and the aging population impose a major challenge on the ever-rising prevalence of chronic diseases, in particular cardiometabolic stress associated with the pandemic obesity in our modern society. Although overweight and obesity are associated with incident cardiovascular diseases (CVD), including heart failure (HF), it paradoxically leads to a more favorable prognosis in patients with chronic HF, a phenomenon commonly defined as "obesity paradox". Numerous population-based and clinical studies have suggested possible explanations such as better metabolic reserve, smoking and disease-associated weight loss for obesity paradox. Recent evidence noticed a shift in obesity paradox with aging. While some studies have reported a more pronounced "obesity paradox" in the older patients, others have seen diminished cardiac benefits with overweight and obesity in the elderly patients with CVD. These findings suggested that a complex relationship among aging, metabolism, and HF severity/chronicity, which may explain the shift in obesity paradox in the elderly. Aging negatively affects body metabolism and cardiac function although its precise impact on obesity paradox remains elusive. To develop new strategies for cardiovascular health in the elderly, it is imperative to understand the precise role for aging on obesity-related CVD.
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Affiliation(s)
- Shuyi Wang
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai 200032, China; Center for Cardiovascular Research and Alternative Medicine, University of Wyoming College of Health Sciences, Laramie, WY 82071, USA
| | - Jun Ren
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai 200032, China; Center for Cardiovascular Research and Alternative Medicine, University of Wyoming College of Health Sciences, Laramie, WY 82071, USA.
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Hu H, Wang J, Han X, Li Y, Wang F, Yuan J, Miao X, Yang H, He M. BMI, Waist Circumference and All-Cause Mortality in a Middle-Aged and Elderly Chinese Population. J Nutr Health Aging 2018; 22:975-981. [PMID: 30272102 DOI: 10.1007/s12603-018-1047-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the association of obesity and all-cause mortality in a sample of middle-aged and elderly population. DESIGN AND SETTING Information of participants was collected in the Dongfeng-Tongji study, a perspective cohort study of Chinese occupational population. The main outcome was risk of death after 8.5 years of follow-up. PARTICIPANTS AND MEASUREMENTS We examined the association of BMI, waist circumference (WC, and waist-height ratio (WHtR) with all-cause mortality in the Dongfeng-Tongji cohort study (n=26,143). Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality. Area under the receiver operating characteristic curves and net reclassification improvement (NRI) were used to calculate the power of prediction models. RESULTS During a mean of 8.5 years of follow-up, 2,246 deaths were identified. There is a U-shaped association of BMI with all-cause mortality in the middle-aged and elderly Chinese population. Compared with individuals with normal BMI, underweight was positively (HR=2.16, 95% CI: 1.73, 2.69) while overweight (HR=0.75, 95% CI: 0.67, 0.84) and obesity (HR=0.67, 95% CI: 0.56, 0.79) were negatively associated with all-cause mortality after adjustment for potential confounders including WC. In contrast, WC (Q5 vs. Q1, HR=1.55, 95% CI: 1.29, 1.86) and WHtR (Q5 vs.Q1, HR=1.69, 95% CI: 1.40, 2.04) were positively associated with mortality after further adjustment for BMI (P trend < 0.001). Addition of both BMI and WC into the all-cause mortality predictive model significantly increased AUC (P =0.0002) and NRI (NRI = 2.57%, P = 0.0007). CONCLUSIONS BMI and WC/WHtR were independently associated with all-cause mortality after mutual adjustment. Combination of BMI and WC/WHtR improved the predictive ability of all-cause mortality risk in the middle-aged and elderly population.
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Affiliation(s)
- H Hu
- Meian He, MD, PhD, Professor, Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei 430030, China. Tel: 86-27-83657914; Fax: 86-27-83657765; E-mail:
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Jésus P, Guerchet M, Pilleron S, Fayemendy P, Maxime Mouanga A, Mbelesso P, Preux PM, Desport JC. Undernutrition and obesity among elderly people living in two cities of developing countries: Prevalence and associated factors in the EDAC study. Clin Nutr ESPEN 2017; 21:40-50. [PMID: 30014868 DOI: 10.1016/j.clnesp.2017.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/24/2017] [Accepted: 05/30/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Nutritional status among elderly people living in Sub-Saharan Africa is poorly studied, even though undernutrition and obesity are known to cause many complications and are risk factors for progression and death in several diseases. The aims of this study were to assess the nutritional status of the elderly in Central Africa and to study the factors associated with nutritional disorders (undernutrition and obesity). METHODS Two cross-sectional population-based studies were carried out in the capitals of Central African Republic (CAR) and Republic of Congo (ROC) between 2008 and 2009. Participants were aged ≥65 years old and underwent nutritional assessment including the following measurements: weight, height, body mass index (BMI), waist circumference (WC). Diet was also investigated. Nutritional status was defined according to the WHO BMI classification (<18.5 = undernutrition; ≥30 = obesity). Multinomial regression analysis was performed in order to identify factors associated with nutritional status. RESULTS 990 elderly people underwent nutritional assessment (482 in CAR and 508 in ROC). Mean BMI was 22.7 ± 4.8 kg/m2. The prevalence of undernutrition was 19.2% and was lower in ROC than in CAR (9.5% vs. 29.5%; p < 0.0001). The prevalence of obesity was 8.8% and was higher in ROC than in CAR (14.6% vs. 2.7%; p < 0.0001). The mean WC was 85.3 ± 28.4 cm. Adjusted on study site, increasing age (OR = 1.6 [95% CI: 1.1-2.3] for 75-84 years, OR = 2.6 [95% CI: 1.4-4.8] for 85+ years), occupation as farmer/breeder (OR = 2.2 [95% CI: 1.1-4.2]), smoking (OR = 1.71 [95% CI: 1.14-2.56]) and low sugar consumption (OR = 1.7 [95% CI: 1.1-2.7]) were positively associated with undernutrition whereas only female sex was positively associated with obesity (OR = 5.0 [95% CI: 2.2-11.0]). CONCLUSIONS The prevalence of undernutrition is high in the elderly population of these countries, in contrast to obesity. Undernutrition and obesity are associated with different socio-economic factors and food consumption. Simple nutritional advice could contribute to improving the nutritional status of elderly people in Central Africa.
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Affiliation(s)
- Pierre Jésus
- INSERM UMR1094, Tropical Neuroepidemiology, School of Medicine of Limoges, Limoges, France; Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, University of Limoges, Limoges, France; Nutrition Unit, Centre for Severe Obesity and Expert Centre for Home Parenteral Nutrition, Dupuytren University Hospital of Limoges, Limoges, France.
| | - Maëlenn Guerchet
- INSERM UMR1094, Tropical Neuroepidemiology, School of Medicine of Limoges, Limoges, France; Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, University of Limoges, Limoges, France; King's College London, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, UK
| | - Sophie Pilleron
- INSERM UMR1094, Tropical Neuroepidemiology, School of Medicine of Limoges, Limoges, France; Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, University of Limoges, Limoges, France
| | - Philippe Fayemendy
- INSERM UMR1094, Tropical Neuroepidemiology, School of Medicine of Limoges, Limoges, France; Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, University of Limoges, Limoges, France; Nutrition Unit, Centre for Severe Obesity and Expert Centre for Home Parenteral Nutrition, Dupuytren University Hospital of Limoges, Limoges, France
| | - Alain Maxime Mouanga
- INSERM UMR1094, Tropical Neuroepidemiology, School of Medicine of Limoges, Limoges, France; Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, University of Limoges, Limoges, France; Psychiatry Department, University Hospital of Brazzaville, Brazzaville, Congo
| | - Pascal Mbelesso
- INSERM UMR1094, Tropical Neuroepidemiology, School of Medicine of Limoges, Limoges, France; Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, University of Limoges, Limoges, France; Neurology Department, Amitié Hospital, Bangui, Central African Republic
| | - Pierre Marie Preux
- INSERM UMR1094, Tropical Neuroepidemiology, School of Medicine of Limoges, Limoges, France; Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, University of Limoges, Limoges, France; Medical Information & Evaluation, Clinical Research and Biostatistics Unit, University Hospital of Limoges, Limoges, France
| | - Jean Claude Desport
- INSERM UMR1094, Tropical Neuroepidemiology, School of Medicine of Limoges, Limoges, France; Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, University of Limoges, Limoges, France; Nutrition Unit, Centre for Severe Obesity and Expert Centre for Home Parenteral Nutrition, Dupuytren University Hospital of Limoges, Limoges, France
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Bentley AR, Rotimi CN. Interethnic Differences in Serum Lipids and Implications for Cardiometabolic Disease Risk in African Ancestry Populations. Glob Heart 2017; 12:141-150. [PMID: 28528248 PMCID: PMC5582986 DOI: 10.1016/j.gheart.2017.01.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/13/2017] [Indexed: 12/12/2022] Open
Abstract
African Americans generally have a healthier lipid profile (lower triglycerides and higher high-density lipoprotein cholesterol concentration) compared with those of other ethnicities. Paradoxically, African Americans do not experience a decreased risk of the cardiometabolic diseases that serum lipids are expected to predict. This review explores this mismatch between biomarker and disease among African ancestry individuals by investigating the presence of interethnic differences in the biological relationships underlying the serum lipids-disease association. This review also discusses the physiologic and genomic factors underlying these interethnic differences. Additionally, because of the importance of serum lipids in assessing disease risk, interethnic differences in serum lipids have implications for identifying African ancestry individuals at risk of cardiometabolic disease. Where possible, data from Africa is included, to further elucidate these ancestral differences in the context of a different environmental background.
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Affiliation(s)
- Amy R Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
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14
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Clark DO, Xu H, Callahan CM, Unverzagt FW. Does Body Mass Index Modify Memory, Reasoning, and Speed of Processing Training Effects in Older Adults. Obesity (Silver Spring) 2016; 24:2319-2326. [PMID: 27804270 PMCID: PMC5554540 DOI: 10.1002/oby.21631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/17/2016] [Accepted: 06/20/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To describe 10-year trajectories of cognitive performance by body mass index (BMI) class and to investigate BMI differences in response to memory, reasoning, and speed of processing training in older adults. METHODS This is a secondary analysis of the multisite, randomized trial Advanced Cognitive Training for Independent and Vital Elderly. There were 701 older adults with normal weight, 1,081 with overweight, and 902 with obesity (mean age 73.6) randomized to memory training, reasoning training, speed of processing training, or no-training control group. Participants completed memory, reasoning, and speed of processing tests. Baseline sociodemographic, health, and chronic disease measures were included as covariates in analyses. RESULTS The 10-year trajectories of memory, reasoning, or speed of processing performance did not differ by BMI status among the participants randomized to the untrained control arm. The training effect on the reasoning and speed of processing outcomes did not differ by BMI status. The training effect on the memory outcome in participants with a BMI indicating obesity, however, was just 38% of that observed in participants with normal-weight BMI. CONCLUSIONS These analyses of data from the largest trial of cognitive training ever conducted suggest that older adults with obesity may be less responsive to memory training.
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Affiliation(s)
- Daniel O Clark
- Indiana University Center for Aging Research, Indianapolis, Indiana, USA.
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA.
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | - Huiping Xu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christopher M Callahan
- Indiana University Center for Aging Research, Indianapolis, Indiana, USA
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Frederick W Unverzagt
- Indiana University Center for Aging Research, Indianapolis, Indiana, USA
- Department of Psychiatry, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S, Romundstad P, Vatten LJ. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ 2016; 353:i2156. [PMID: 27146380 PMCID: PMC4856854 DOI: 10.1136/bmj.i2156] [Citation(s) in RCA: 503] [Impact Index Per Article: 62.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of cohort studies of body mass index (BMI) and the risk of all cause mortality, and to clarify the shape and the nadir of the dose-response curve, and the influence on the results of confounding from smoking, weight loss associated with disease, and preclinical disease. DATA SOURCES PubMed and Embase databases searched up to 23 September 2015. STUDY SELECTION Cohort studies that reported adjusted risk estimates for at least three categories of BMI in relation to all cause mortality. DATA SYNTHESIS Summary relative risks were calculated with random effects models. Non-linear associations were explored with fractional polynomial models. RESULTS 230 cohort studies (207 publications) were included. The analysis of never smokers included 53 cohort studies (44 risk estimates) with >738 144 deaths and >9 976 077 participants. The analysis of all participants included 228 cohort studies (198 risk estimates) with >3 744 722 deaths among 30 233 329 participants. The summary relative risk for a 5 unit increment in BMI was 1.18 (95% confidence interval 1.15 to 1.21; I(2)=95%, n=44) among never smokers, 1.21 (1.18 to 1.25; I(2)=93%, n=25) among healthy never smokers, 1.27 (1.21 to 1.33; I(2)=89%, n=11) among healthy never smokers with exclusion of early follow-up, and 1.05 (1.04 to 1.07; I(2)=97%, n=198) among all participants. There was a J shaped dose-response relation in never smokers (Pnon-linearity <0.001), and the lowest risk was observed at BMI 23-24 in never smokers, 22-23 in healthy never smokers, and 20-22 in studies of never smokers with ≥20 years' follow-up. In contrast there was a U shaped association between BMI and mortality in analyses with a greater potential for bias including all participants, current, former, or ever smokers, and in studies with a short duration of follow-up (<5 years or <10 years), or with moderate study quality scores. CONCLUSION Overweight and obesity is associated with increased risk of all cause mortality and the nadir of the curve was observed at BMI 23-24 among never smokers, 22-23 among healthy never smokers, and 20-22 with longer durations of follow-up. The increased risk of mortality observed in underweight people could at least partly be caused by residual confounding from prediagnostic disease. Lack of exclusion of ever smokers, people with prevalent and preclinical disease, and early follow-up could bias the results towards a more U shaped association.
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Affiliation(s)
- Dagfinn Aune
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway Department of Epidemiology and Biostatistics, Imperial College, London, UK
| | - Abhijit Sen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Manya Prasad
- Department of Community Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, Imperial College, London, UK
| | - Imre Janszky
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Serena Tonstad
- Department of Community Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Pål Romundstad
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars J Vatten
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Clark DO, Unroe KT, Xu H, Keith NR, Callahan CM, Tu W. Sex and Race Differences in the Relationship between Obesity and C-Reactive Protein. Ethn Dis 2016; 26:197-204. [PMID: 27103770 DOI: 10.18865/ed.26.2.197] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
C-reactive protein (CRP) is a risk factor for cardiovascular disease and mortality; it is known to be positively associated with obesity but there is some evidence that this association differs by race or sex. We used nationally representative data of adults aged >50 years to investigate sex and race modifiers of the associations between obesity and CRP in non-Hispanic White males (n=3,517) and females (n=4,658), and non-Hispanic Black males (n=464) and females (n=826). Using multiple linear regression models with the natural logarithm of CRP as the dependent variable, we sequentially included body mass index (BMI), a body shape index (ABSI), and socioeconomic, health and health behavior covariates in the model. The association between BMI and CRP was significantly stronger in females than males. Obese White females had mean CRP values slightly above 3 mg/liter (vs 2 for White males) and Black females had mean CRP values >4 mg/liter (vs 3 for Black males). More than 50% of Black females in the United States have obesity. Continued research into racial and sex differences in the relationship between obesity, inflammation, and health risks may ultimately lead to more personalized weight loss recommendations.
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Affiliation(s)
- Daniel O Clark
- Indiana University Center for Aging Research, Indianapolis, Indiana; Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Kathleen T Unroe
- Indiana University Center for Aging Research, Indianapolis, Indiana
| | - Huiping Xu
- Department of Biostatistics, Indiana University
| | | | | | - Wanzhu Tu
- Department of Biostatistics, Indiana University
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17
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Abstract
PURPOSE OF REVIEW The obesity paradox is a highly controversial concept that may be attributed to methodological limitations related to its identification. One of the primary concerns is the use of BMI to define obesity. This index does not differentiate lean versus adipose tissue compartments (i.e. body composition) confounding health consequences for morbidity and mortality, especially in clinical populations. This review will describe the past year's evidence on the obesity paradox phenomenon, primarily focusing on the role of abnormal body composition phenotypes in explaining the controversies observed in the literature. RECENT FINDINGS In spite of the substantial number of articles investigating the obesity paradox phenomenon, less than 10% used a direct measure of body composition and when included, it was not fully explored (only adipose tissue compartment evaluated). When lean tissue or muscle mass is taken into account, the general finding is that a high BMI has no protective effect in the presence of low muscle mass and that it is the latter that associates with poor prognosis. SUMMARY In view of the body composition variability of patients with identical BMI, it is unreasonable to rely solely on this index to identify obesity. The consequences of a potential insubstantial obesity paradox are mixed messages related to patient-related prognostication.
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Affiliation(s)
- Carla M Prado
- aDepartment of Agricultural, Food and Nutritional Science, University of AB, Edmonton, Alberta, Canada bPost Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil cPennington Biomedical Research Center, Baton Rouge, Los Angeles, USA
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18
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Clark DO, Lane KA, Ambuehl R, Tu W, Liu CJ, Unroe K, Callahan CM. Age Differences in the Association Between Body Mass Index Class and Annualized Medicare Expenditures. J Aging Health 2015; 28:165-79. [PMID: 26112066 DOI: 10.1177/0898264315589574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of the study is to assess the relationship between body mass index (BMI) class and Medicare claims among young-old (65-69), old (70-74), and old-old (75+) adults over a 10-year period. METHOD We assessed costs by BMI class and age group among 9,300 respondents to the 1998 Health and Retirement Study (HRS) with linked 1998-2008 Medicare claims data. BMI was classified as normal (18.5-24.9), overweight (25-29.9), mild obesity (30-34.9), or severe obesity (35 or above). RESULTS Annualized total Medicare claims adjusted for age, gender, ethnicity, education, and smoking history were 109% greater for severely obese young-old adults in comparison with normal weight young-old adults (US$9,751 vs. US$4,663). Total annualized claim differences between the normal weight and severely obese in the old and old-old groups were not statistically significant. DISCUSSION Excess Medicare expenditures related to obesity may be concentrated among severely obese young-old adults. Preventing severe obesity among middle and older aged adults may have large cost implications for society.
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Affiliation(s)
- Daniel O Clark
- Indiana University, Indianapolis, USA Regenstrief Institute, Inc., Indianapolis, IN, USA Indiana University Center for Aging Research, Indianapolis, USA
| | | | | | - Wanzhu Tu
- Indiana University, Indianapolis, USA Regenstrief Institute, Inc., Indianapolis, IN, USA
| | | | - Kathleen Unroe
- Indiana University, Indianapolis, USA Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Christopher M Callahan
- Indiana University, Indianapolis, USA Regenstrief Institute, Inc., Indianapolis, IN, USA
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Suemoto CK, Lebrao ML, Duarte YA, Danaei G. Effects of body mass index, abdominal obesity, and type 2 diabetes on mortality in community-dwelling elderly in Sao Paulo, Brazil: analysis of prospective data from the SABE study. J Gerontol A Biol Sci Med Sci 2015; 70:503-10. [PMID: 25209254 PMCID: PMC6281307 DOI: 10.1093/gerona/glu165] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 08/07/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The majority of studies on the effects of adiposity on mortality in the elderly have been conducted in developed countries with mixed results. We investigated the association between adiposity and mortality in a cohort of community-dwelling elderly in Sao Paulo, Brazil. METHODS Body mass index (BMI), waist circumference, waist-to-hip ratio, and type 2 diabetes were evaluated in 1,882 participants (mean age 71.0 ± 8.3 years old, 61% female). Mortality was confirmed by national vital statistics records during a maximum of 10 years of follow-up. Proportional hazards models were used to estimate hazard ratios (HRs) for mortality after adjusting for sociodemographics and comorbidities. In a subsample of 897 participants, the effects of changes in measures of adiposity on mortality were investigated during a median follow-up of 4.6 years. RESULTS Having type-2 diabetes at baseline was associated with increased mortality (HR = 1.44, 95% CI: 1.17-1.77), with a higher HR among men. When compared with normal weight participants (BMI = 20-<25kg/m(2)), overweight and obesity were not associated with mortality (overweight: HR = 0.84 [0.70, 1.02]; obesity: HR = 0.82 [0.64, 1.06]), whereas participants with low-normal weight (BMI = 18.5<20 kg/m(2)) had increased risk of death (HR = 1.51 [1.08-2.10]). Higher waist circumference and waist-to-hip ratio were not associated with increased mortality. Weight gain was protective against mortality in all BMI categories, except in obese participants, and weight loss increased the risk of death in all BMI categories by 42-63%. CONCLUSIONS In community-dwelling elderly in Sao Paulo, overweight and obesity were not associated with a higher risk of death, and weight gain seemed to reduce mortality, except in the obese.
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Affiliation(s)
- Claudia K Suemoto
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts. Discipline of Geriatrics, University of Sao Paulo Medical School, Brazil.
| | | | - Yeda A Duarte
- Medical Surgical Nursing Department, School of Nursing, University of Sao Paulo, Brazil
| | - Goodarz Danaei
- Department of Global Health and Population and Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
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