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Yamamoto Y, Ikeue K, Kanasaki M, Yamakage H, Satoh‐Asahara N, Masuda I, Ishii K. Age-wise examination of the association of obesity based on body mass index and waist circumference with metabolic diseases in comprehensive health checkup participants. Obes Sci Pract 2024; 10:e746. [PMID: 38501152 PMCID: PMC10946448 DOI: 10.1002/osp4.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/14/2024] [Accepted: 03/03/2024] [Indexed: 03/20/2024] Open
Abstract
Aim Body mass index and waist circumference are used for obesity diagnosis and screening of visceral fat; however, their evidence in older adults is insufficient. This study investigated the age-specific association of body mass index and waist circumference with metabolic diseases, assessing their applicability as diagnostic criteria for individuals aged ≥65 years. Methods Analysis included 46,324 individuals aged ≥18 years, categorized into five age groups: 18-44, 45-54, 55-64, 65-74, and ≥75 years. Logistic regression analyses identified associations between obesity and metabolic diseases, stratified by age and sex. Results Men with obesity based on body mass index had a significantly high risk of hypertension, diabetes mellitus, and dyslipidemia across all age groups (all, p < 0.05). Obesity based on waist circumference was significantly positively associated with all metabolic diseases (all, p < 0.05). Women with obesity based on body mass index and waist circumference had a significantly high risk of all metabolic diseases across all age groups (all, p < 0.05), except for diabetes mellitus in individuals aged ≥75 years. Conclusions Participants with obesity based on body mass index and waist circumference exhibited a high risk of hypertension, diabetes mellitus, and dyslipidemia among those aged 18-74 years and men aged ≥75 years. This study contributes to the early prevention and control of metabolic diseases.
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Affiliation(s)
- Yuiko Yamamoto
- Graduate School of Health and Sports ScienceDoshisha UniversityKyotanabeJapan
| | - Kentaro Ikeue
- Graduate School of Health and Sports ScienceDoshisha UniversityKyotanabeJapan
- Department of Endocrinology, Metabolism, and Hypertension ResearchClinical Research InstituteNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | | | - Hajime Yamakage
- Department of Endocrinology, Metabolism, and Hypertension ResearchClinical Research InstituteNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Noriko Satoh‐Asahara
- Department of Endocrinology, Metabolism, and Hypertension ResearchClinical Research InstituteNational Hospital Organization Kyoto Medical CenterKyotoJapan
- Department of Molecular Medicine and MetabolismResearch Institute of Environmental MedicineNagoya UniversityNagoyaJapan
| | - Izuru Masuda
- Department of Endocrinology, Metabolism, and Hypertension ResearchClinical Research InstituteNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Kojiro Ishii
- Faculty of Health and Sports ScienceDoshisha UniversityKyotanabeJapan
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Ikeue K, Kusakabe T, Yamakage H, Ishii K, Satoh-Asahara N. A body shape index is useful for BMI-independently identifying Japanese patients with obesity at high risk of cardiovascular disease. Nutr Metab Cardiovasc Dis 2024; 34:387-394. [PMID: 37949708 DOI: 10.1016/j.numecd.2023.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND AIM Obesity with multiple metabolic syndrome (MetS) components and/or with skeletal muscle loss is at high risk of cardiovascular disease (CVD). This study aimed to clarify the utility of anthropometric indices for identifying patients with overweight/obese at high risk of CVD based on having multiple MetS components and skeletal muscle loss. METHODS & RESULTS This cross-sectional study included 188 overweight/obese (BMI ≥25 kg/m2, Japanese patients; 73 men and 115 women, mean age 55.7 years). First, we performed correlation analysis among seven anthropometric indices, body mass index (BMI), percentage body fat, waist circumference (WC), waist-to-hip ratio (WHpR), waist-to-height ratio (WHtR), a body shape index (ABSI), and body roundness index (BRI). Unlike the others, only ABSI was not correlated with BMI. Then, we conducted receiver operating characteristic analysis to assess the predictive abilities of anthropometric indices for having multiple MetS components. WC, WHpR, WHtR, BRI, and ABSI had significant predictive abilities for having multiple MetS components. Furthermore, multiple regression analysis showed that only ABSI had significantly negative associations with all sarcopenia-evaluated indices (skeletal muscle mass index [SMI], handgrip strength [HGS], and muscle quality [MQ]), irrespective of sex and age. Finally, an analysis of covariance showed that the high ABSI group had significantly lower SMI and HGS than the low ABSI group, irrespective of sex and age. CONCLUSION ABSI was deemed useful for BMI-independently identifying Japanese patients with overweight/obese at high risk of CVD based on having multiple MetS components and skeletal muscle loss. Clinical trials (the unique trial number and the name of the registry) ID: UMIN000042726.
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Affiliation(s)
- Kentaro Ikeue
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto 612-8555, Japan; Graduate School of Health and Sports Science, Doshisha University, 1-3 Tataramiyakodani, Kyotanabe, Kyoto, 610-0394, Japan
| | - Toru Kusakabe
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto 612-8555, Japan.
| | - Hajime Yamakage
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto 612-8555, Japan
| | - Kojiro Ishii
- Faculty of Health and Sports Science, Doshisha University, 1-3 Tataramiyakodani, Kyotanabe, Kyoto, 610-0394, Japan
| | - Noriko Satoh-Asahara
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto 612-8555, Japan
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Kadowaki T, Matsumoto N, Matsuo R, Mitsuhashi T, Sasaki A, Takao S, Yorifuji T. Obesity, overweight, and severe prognosis in COVID-19 patients in Japan. J Infect Chemother 2023; 29:1109-1113. [PMID: 37558090 DOI: 10.1016/j.jiac.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/08/2023] [Accepted: 08/05/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Obesity (i.e., body mass index [BMI] of 30 kg/m2 or more) is one of the risk factors for severe COVID-19, but the findings may not be directly applicable to Asians, who have a different cutoff point for defining obesity. We thus examined the association between obesity/overweight (BMI of 25 kg/m2 or more and less than 30 kg/m2) and the risk of COVID-19 severity. METHODS The study population included COVID-19 patients who had been enrolled in the registry of the Okayama City Public Health Center in Okayama, Japan, between March 2020 and June 2022. We included 27 820 patients who had information on BMI and prognosis, and we conducted Poisson regression analysis with robust error variance to estimate risk ratios (RRs) with 95% confidence intervals (CIs) for severe outcomes. RESULTS Obesity and overweight were associated with the increased risk of severe COVID-19 in all age categories. The RRs (95% CI) for COVID-19 induced respiratory failure compared to the normal weight category were 1.57 (1.31-1.88) for overweight and 2.45 (1.90-3.15) for obesity. CONCLUSIONS Both obesity and overweight were associated with increased risk of severe COVID-19. This study suggests the importance of the overweight category to predict the risk of severe COVID-19 in Asians.
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Affiliation(s)
- Tomoka Kadowaki
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
| | - Naomi Matsumoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Rumi Matsuo
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Ayako Sasaki
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Soshi Takao
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Ha KH, Kim DJ, Han SJ. Associations of updated cardiovascular health metrics, including sleep health, with incident diabetes and cardiovascular events in older adults with prediabetes: A nationwide population-based cohort study. Diabetes Res Clin Pract 2023; 203:110820. [PMID: 37422164 DOI: 10.1016/j.diabres.2023.110820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/07/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023]
Abstract
AIMS To investigate the association of updated cardiovascular health (CVH) metrics, including sleep health, with the risk of diabetes and major adverse cardiovascular events (MACE) in older adults with prediabetes. METHODS A total of 7,948 older adults with prediabetes aged ≥ 65 years were included in this study. CVH was assessed using seven baseline metrics according to the modified American Heart Association recommendations. RESULTS During a median follow-up time of 11.9 years, 2,405 (30.3%) cases of diabetes and 2,039 (25.6%) MACE were recorded. Compared with the poor composite CVH metrics group, the multivariable-adjusted hazard ratios (HRs) in the intermediate and ideal composite CVH metrics groups were respectively 0.87 (95% confidence intervals [CI] = 0.78-0.96) and 0.72 (95% CI = 0.65-0.79) for diabetes events and 0.99 (95% CI = 0.88-1.11) and 0.88 (95% CI = 0.79-0.97) for MACE. The ideal composite CVH metrics group had a lower risk of diabetes and MACE in older adults aged 65-74 years, but not in those aged ≥ 75 years. CONCLUSIONS Ideal composite CVH metrics in older adults with prediabetes were associated with a lower risk of diabetes and MACE.
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Affiliation(s)
- Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Seung Jin Han
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.
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Yamagishi S, Okamura Y, Kang W, Shindate M, Kochi M, Mitsuka Y, Watabe M, Yoshida N, Ikarashi M, Yamazaki S, Aramaki O, Nakayama H, Moriguchi M, Higaki T, Yamashita H. Impact of Sarcopenic Obesity on Severe Postoperative Complications in Patients with Gastric Cancer Undergoing Gastrectomy. Dig Surg 2023; 40:143-152. [PMID: 37527628 DOI: 10.1159/000531797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/15/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Several studies have indicated that sarcopenia affects the short- and long-term outcomes of cancer patients, including those with gastric cancer. In recent years, sarcopenic obesity and its effects have been reported in cancer patients. This study aimed to evaluate the impact of sarcopenic obesity on postoperative complications in patients with gastric cancer undergoing gastrectomy. METHODS This single-center, retrospective study included 155 patients who underwent curative gastrectomy for gastric cancer from January 2015 to July 2021. Sarcopenia was defined by the psoas muscle index (<6.36 cm2/m2 in men and <3.92 cm2/m2 in women), which measures the iliopsoas muscle area at the lumbar L3 level using computed tomography. Obesity was defined by body mass index (≥25). Patients with both sarcopenia and obesity were defined as the sarcopenic obesity group and others as the non-sarcopenic obesity group. Severe postoperative complications were defined as Clavien-Dindo classification grade IIIa or higher. RESULTS Of the 155 patients, 26 (16.8%) had sarcopenic obesity. The incidence of severe postoperative complications was significantly higher in the sarcopenic obesity group (30.8% vs. 10.9%; p = 0.014). Multivariate analysis indicated that sarcopenic obesity was an independent risk factor for severe postoperative complications (odds ratio, 3.950; 95% confidence interval, 1.390-11.200; p = 0.010). CONCLUSION Sarcopenic obesity is an independent risk factor for severe postoperative complications.
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Affiliation(s)
- Shunsuke Yamagishi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan,
| | - Yukiyasu Okamura
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Woodae Kang
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, Ichikawa Hospital, Chiba, Japan
| | - Masataka Shindate
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsugu Kochi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yusuke Mitsuka
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Megumu Watabe
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Nao Yoshida
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masahito Ikarashi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Shintaro Yamazaki
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Osamu Aramaki
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hisashi Nakayama
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masamichi Moriguchi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tokio Higaki
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroharu Yamashita
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
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Yoon SJ, Jung JG, Ahn SK, Kim JS, Hong JH. Non-linear relationship between body mass index and self-rated health in older Korean adults: body image and sex considerations. Epidemiol Health 2023; 45:e2023061. [PMID: 37402412 PMCID: PMC10667579 DOI: 10.4178/epih.e2023061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/05/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the association between body mass index (BMI) and self-rated health (SRH) in older adults aged over 65 years while examining the influence of self-perceived body image (SBI) and sex. METHODS Raw data were obtained from the Korea Community Health Survey, which included BMI measurements of Koreans aged over 65 years (n=59,628). Non-linear relationships between BMI and SRH were analyzed separately for each sex using restricted cubic splines while controlling for SBI and other confounding variables. RESULTS Men showed a reverse J-shaped association, while women showed a J-shaped association between BMI and poor SRH. However, including SBI in the model changed this association for men to an inverted U-shape showing a negative direction, with the highest risk of poor SRH observed in the underweight to overweight range. For women, a nearly linear positive relationship was observed. Regardless of BMI, those who perceived their weight as not "exactly the right weight" had a higher risk of poor SRH than those who perceived their weight as "exactly the right weight" in both men and women. Older men who thought they were much too fat or too thin had similar highest risks of poor SRH, whereas older women who thought they were too thin had the highest risk of poor SRH. CONCLUSIONS The findings of this study emphasize the importance of considering sex and body image perceptions when assessing the relationship between BMI and SRH in older adults, especially in men.
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Affiliation(s)
- Seok-Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jin-Gyu Jung
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Soon-Ki Ahn
- Department of Preventive Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jong-Sung Kim
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jang-Hee Hong
- Clinical Trial Center, Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Korea
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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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Okada A, Yamaguchi S, Jo T, Yokota I, Ono S, Ikeda Kurakawa K, Nangaku M, Yamauchi T, Kadowaki T. Impact of body mass index on in-hospital mortality in older patients hospitalized for bacterial pneumonia with non-dialysis-dependent chronic kidney disease. BMC Geriatr 2022; 22:950. [PMID: 36494609 PMCID: PMC9733221 DOI: 10.1186/s12877-022-03659-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Low body mass index (BMI) in older individuals with decreased kidney function is important because of its association with poor prognosis and frailty. Herein, we aimed to clarify the association between BMI and in-hospital mortality among older patients with non-dialysis-dependent chronic kidney disease (CKD) stratified by kidney function. METHODS Using data from the Medical Vision Database, this multicentre cohort study included people aged ≥ 60 years with an estimated glomerular filtration rate of < 60 ml/min/1.73 m2 but without dialysis dependency, hospitalised for bacterial pneumonia during 2014-2019. We compared the risk of in-hospital death between patients with BMI categories based on the quartiles (low, medium-low, medium-high, and high) setting medium-high BMI as a reference. We further assessed the association with BMI using a cubic spline, setting BMI as a nonlinear continuous variable and a BMI of 22 kg/m2 as a reference. We also evaluated the association between BMI and kidney function using a generalised additive model adjusted for interaction terms between nonlinear continuous BMI and kidney function. RESULTS We obtained data for 3,952 patients, with 350 (8.9%) in-hospital deaths. When compared with medium-high BMI, low BMI was associated with an increased risk of death and longer hospital stay, whereas the other two categories were comparable. Models using a cubic spline showing an association between BMI and in-hospital death showed an L-shaped curve; BMI < 22.0 kg/m2 was associated with an increased risk for mortality, and at a BMI of 18.5 kg/m2, the odds ratio was 1.43 with a 95% confidence interval of 1.26-1.61 when compared with a BMI of 22.0 kg/m2. Analysis of the interactive effects of kidney function using the generalised additive model showed that a protective association of high BMI tapered along with decreased kidney function. CONCLUSIONS This cohort study suggests not only that lower BMI and low kidney function are associated with in-hospital mortality independently but also that the protective effects of high BMI weaken as kidney function decreases via the analysis of the interaction terms. This study highlights the necessity for the prevention of underweight and demonstrates the interaction between BMI and kidney function in older patients with non-dialysis-dependent CKD.
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Affiliation(s)
- Akira Okada
- grid.26999.3d0000 0001 2151 536XDepartment of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoko Yamaguchi
- grid.26999.3d0000 0001 2151 536XDepartment of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- grid.26999.3d0000 0001 2151 536XDepartment of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ,grid.26999.3d0000 0001 2151 536XDepartment of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Isao Yokota
- grid.39158.360000 0001 2173 7691Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido Japan
| | - Sachiko Ono
- grid.26999.3d0000 0001 2151 536XDepartment of Eat-Loss Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kayo Ikeda Kurakawa
- grid.26999.3d0000 0001 2151 536XDepartment of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaomi Nangaku
- grid.26999.3d0000 0001 2151 536XDivision of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- grid.26999.3d0000 0001 2151 536XDepartment of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- grid.26999.3d0000 0001 2151 536XDepartment of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ,grid.26999.3d0000 0001 2151 536XDepartment of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ,grid.410813.f0000 0004 1764 6940Toranomon Hospital, Tokyo, Japan
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Bai Z, Yang J, Wang Z, Cao W, Cao C, Hu Z, Chen R. Association between social capital and self-rated health among community-dwelling older adults. Front Public Health 2022; 10:916485. [PMID: 36159320 PMCID: PMC9493471 DOI: 10.3389/fpubh.2022.916485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/08/2022] [Indexed: 01/22/2023] Open
Abstract
Background It is less known about whether the association of social capital with self-rated health (SRH) varies by the presence of health conditions and how social capital, together with other variables, is linked to self-rated health in later life. Objectives This article aimed to explore the association of social capital with self-rated health and to examine whether the association varies among older people with and without health conditions, with a special focus on how social capital and relevant factors have an effect on self-rated health among community-dwelling older adults. Methods Cross-sectional data were obtained from a survey that commenced from July to September 2017 in Anhui Province. Data on socio-demographic information, social capital (six dimensions), and self-rated health were analyzed. Binary logistic regression and classification and regression tree (CART) models were used to estimate the association. Results Based on the findings, we found that social capital regarding less social support (adjusted odds ratio (AOR) = 1.57, 95% CI: 1.21-2.04), and less reciprocity (AOR = 1.73, 95% CI: 1.29-2.31) were associated with self-rated health among general older adults. Social capital as measured by less social participation (AOR = 1.55, 95% CI: 1.06-2.27), less cohesion (AOR = 0.63, 95% CI: 0.42-0.94), and less reciprocity (AOR =1.77, 95% CI: 1.17-2.68) were linked to self-rated health among older people with health conditions. While social capital regarding less social support (AOR = 2.15, 95% CI: 1.39-3.33) was related to self-rated health among older people without health conditions. We observed the interacting effect of social capital in the CART model, an implication that much focus should be geared toward vulnerable subgroups, especially depressed and lonely older people, as they have low reciprocity and little cohesion. Conclusion This work demonstrates that social capital may be relevant in devising programs and measures to improve self-rated health among community-dwelling older adults with comorbidity.
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Affiliation(s)
- Zhongliang Bai
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, China
| | - Jing Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China,Educational Institute of Behavioral Medicine, Jining Medical University, Jining, China
| | - Zijing Wang
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, China
| | - Wenwen Cao
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, China
| | - Chenglin Cao
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, China
| | - Zhi Hu
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, China,Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China,*Correspondence: Zhi Hu
| | - Ren Chen
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, China,Affiliated Suzhou Hospital of Anhui Medical University, Suzhou, China,Ren Chen
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Inagaki K, Tawada N, Takanashi M, Akahori T. The association between body mass index and all-cause mortality in Japanese patients with incident hemodialysis. PLoS One 2022; 17:e0269849. [PMID: 35749459 PMCID: PMC9231701 DOI: 10.1371/journal.pone.0269849] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 05/28/2022] [Indexed: 11/19/2022] Open
Abstract
Background
A higher body mass index (BMI) has been associated with better survival among chronic kidney disease patients in some reports. However, more research is required to determine the associations between BMI and mortality in incident hemodialysis patients. Therefore, this study aimed to investigate the association between mortality and BMI measured at the first hemodialysis session and 2 weeks after hemodialysis initiation in Japanese patients with incident hemodialysis.
Methods
We retrospectively enrolled 266 adult patients with incident hemodialysis who were treated at our hospital between May 2013 and June 2019. The data on BMI was obtained at the first hemodialysis session and 2 weeks after hemodialysis initiation. Patients were divided into tertiles based on BMI [<18.5 (low), 18.5–23.9 (normal), and ≥24 (high) kg/m2]. The normal group was used as the reference group. The primary outcome was all-cause mortality.
Results
The mean age of patient was 68.9 ± 12.0 years, and the BMI was 23.3 ± 4.24 kg/m2 at the first hemodialysis session. The body mass index was 22.0 ± 3.80 kg/m2 at 2 weeks after hemodialysis initiation. During a mean follow-up of 3.89 ± 2.12 years, 80 (30.1%) deaths occurred. In multivariate analyses, low BMI at the first hemodialysis session was significantly associated with worse all-cause mortality (hazard ratio, 2.39; 95% confidence interval, 1.13–5.03). At 2 weeks after hemodialysis initiation, high BMI was significantly associated with better all-cause mortality (hazard ratio, 0.38; 95% confidence interval, 0.18–0.81).
Conclusion
At 2 weeks after HD initiation, high BMI was associated with lower mortality in Japanese patients with incident hemodialysis.
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Affiliation(s)
- Koji Inagaki
- Department of Nephrology, Chutoen General Medical Center, Shizuoka, Japan
- * E-mail:
| | - Naoto Tawada
- Department of Nephrology, Chutoen General Medical Center, Shizuoka, Japan
| | - Masahiro Takanashi
- Department of Nephrology, Chutoen General Medical Center, Shizuoka, Japan
| | - Toshiyuki Akahori
- Department of Nephrology, Chutoen General Medical Center, Shizuoka, Japan
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11
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Makino K, Lee S, Bae S, Chiba I, Harada K, Katayama O, Shinkai Y, Shimada H. Absolute Cardiovascular Disease Risk Assessed in Old Age Predicts Disability and Mortality: A Retrospective Cohort Study of Community-Dwelling Older Adults. J Am Heart Assoc 2021; 10:e022004. [PMID: 34913358 PMCID: PMC9075253 DOI: 10.1161/jaha.121.022004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Evidence is limited on the predictive validity of absolute cardiovascular disease (CVD) risk, estimated by multivariable assessments in old age, for disability and mortality. We aimed to examine the longitudinal associations of absolute CVD risk assessed using region‐specific risk estimation charts with disability and mortality among community‐dwelling people aged ≥65 years. Methods and Results This retrospective cohort study included 7456 community‐dwelling people aged ≥65 years (mean age, 73.7 years) without CVD and functional decline at baseline. They lived in either Obu City or Midori Ward of Nagoya City, Aichi Prefecture, Japan. We estimated absolute CVD risk using the revised World Health Organization CVD risk estimation charts and stratified risk levels into 3 categories: low (<10%), mid (10% to <20%), and high (≥20%). We followed up the functional disability incidence and all‐cause mortality monthly for 5 years. The prevalence of each CVD risk level based on the laboratory‐based model was as follows: low CVD risk, 1096 (14.7%); mid CVD risk, 5510 (73.9%); and high CVD risk, 850 (11.4%). During follow‐up, the incidence rates of disability and mortality were 33.4 per 1000 and 12.4 per 1000 person‐years, respectively. Cox regression analysis showed that the adjusted hazard ratios (95% CIs) for disability incidence were 1.32 (1.13–1.56) and 1.44 (1.18–1.77) in mid and high CVD risk levels, respectively (reference: low CVD risk level); for mortality incidence, they were 1.53 (1.16–2.01) and 2.02 (1.45–2.80) in mid and high CVD risk levels, respectively (reference: low CVD risk level). Conclusions Absolute CVD risk was associated with both disability and mortality in people aged ≥65 years. Estimated CVD risk levels may be useful surrogate markers for disability and mortality risks even when assessed in old age.
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Affiliation(s)
- Keitaro Makino
- Department of Preventive Gerontology Center for Gerontology and Social Science National Center for Geriatrics and Gerontology Aichi Japan.,Japan Society for the Promotion of Science Chiyoda-ku, Tokyo Japan
| | - Sangyoon Lee
- Department of Preventive Gerontology Center for Gerontology and Social Science National Center for Geriatrics and Gerontology Aichi Japan
| | - Seongryu Bae
- Department of Preventive Gerontology Center for Gerontology and Social Science National Center for Geriatrics and Gerontology Aichi Japan
| | - Ippei Chiba
- Department of Preventive Gerontology Center for Gerontology and Social Science National Center for Geriatrics and Gerontology Aichi Japan
| | - Kenji Harada
- Department of Preventive Gerontology Center for Gerontology and Social Science National Center for Geriatrics and Gerontology Aichi Japan
| | - Osamu Katayama
- Department of Preventive Gerontology Center for Gerontology and Social Science National Center for Geriatrics and Gerontology Aichi Japan
| | - Yohei Shinkai
- Department of Preventive Gerontology Center for Gerontology and Social Science National Center for Geriatrics and Gerontology Aichi Japan
| | - Hiroyuki Shimada
- Center for Gerontology and Social Science National Center for Geriatrics and Gerontology Aichi Japan
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12
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Suzuki R, Sakata N, Fushimi K. Association of body mass index with Clostridioides difficile infection among older patients with pneumonia in Japan. Geriatr Gerontol Int 2021; 22:63-67. [PMID: 34852400 DOI: 10.1111/ggi.14316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 12/12/2022]
Abstract
AIM Obesity is reported to be a risk factor for Clostridioides difficile infection. However, obesity rarely occurs in older Asian patients, and the effects of obesity on health and disease are different in Asian and Western countries. This study aimed to assess the association between body mass index and C. difficile infection risk among older patients with pneumonia in Japan. METHODS This retrospective observational cohort study used data from the nationwide database of acute hospital inpatients' data in Japan between July 2014 and March 2016. All patients aged ≥65 years admitted with a primary diagnosis of pneumonia were enrolled. Risk factors for C. difficile infection were determined by logistic regression analysis, including known risks as covariates. RESULTS Among 221 242 pneumonia patients, 611 developed C. difficile infection. Underweight patients (body mass index <18.5 kg/m2 ) showed higher odds for C. difficile infection (odds ratio 1.38, 95% confidence interval 1.17-1.62, P < 0.001) than normal weight patients (body mass index 18.5-24.9 kg/m2 ), whereas overweight patients (body mass index ≥25 kg/m2 ) showed lower odds (odds ratio 0.63, 95% confidence interval 0.45-0.89, P < 0.01). CONCLUSIONS Body mass index was associated with C. difficile infection in older pneumonia patients in Japan. Underweight was a risk factor, whereas overweight was a protective factor for C. difficile infection. Geriatr Gerontol Int 2021; ••: ••-••.
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Affiliation(s)
- Risa Suzuki
- Department of Health Policy and Informatics, Tokyo medical and Dental University, Tokyo, Japan
| | - Nobuo Sakata
- Department of Health Services Research, Faculty of medicine, University of Tsukuba, Ibaraki, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo medical and Dental University, Tokyo, Japan
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13
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Ryg J, Anru PL, Engberg H, Jorgensen MG, Masud T, Christensen K, Andersen-Ranberg K. Association of Body Mass Index With All-Cause Mortality in Acutely Hospitalized Older Patients. J Am Med Dir Assoc 2021; 23:507-513.e1. [PMID: 34389336 DOI: 10.1016/j.jamda.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/29/2021] [Accepted: 07/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim was to examine the relationship between body mass index (BMI) and mortality in older hospitalized patients taking activities of daily living (ADLs) into account. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Nationwide population-based study of all patients aged ≥65 years admitted to Danish geriatric medical departments during 2005 to 2014 and included in the National Danish Geriatric Database. METHODS Patients were followed until death, emigration, or study termination (December 31, 2015). Primary outcome was all-cause mortality. BMI and ADLs were routinely assessed on admission and linked at an individual level to the Danish national health registers. Kaplan-Meier analysis was used to estimate crude survival according to each BMI subcategory and Cox regression to examine the association with mortality adjusting for age, comorbidity, polypharmacy, ADLs, marital status, prior hospitalizations, and admission year. RESULTS In total, 74,589 patients (63% women) were included aged [mean (SD)] 82.5 (7.5) years with BMI [mean (SD)] of 23.9 (5.1) kg/m2. During follow-up 51,188 died. Follow-up time was 191,972 person-years. Unadjusted and adjusted hazard ratio (HR) for overall, 30-day, and 1-year mortality decreased significantly with increasing BMI. In women, the highest adjusted HR (95% confidence interval) for overall mortality was seen for underweight patients (BMI <16) 1.83 (1.72-1.95) and the lowest for obesity grade II patients (BMI = 35.0-39.9) 0.66 (0.60-0.73) when using normal weight (BMI = 18.5-24.9) as reference. In men, the HR for BMI <16 and BMI = 35.0-39.9 were 1.98 (1.76-2.23) and 0.56 (0.49-0.65), respectively. CONCLUSIONS AND IMPLICATIONS In hospitalized older patients, association between mortality and BMI did not show a U-shaped or J-shaped curve after adjustment of multiple confounders, including ADLs. Instead, mortality was highest in patients with low BMI and decreased with increasing BMI before leveling off in the obese range. Our study highlights the need for a debate and reassessment of what should be the ideal BMI in this vulnerable patient group.
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Affiliation(s)
- Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark; Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Pavithra Laxsen Anru
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Henriette Engberg
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | | | - Tahir Masud
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark; Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Geriatric Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Kaare Christensen
- Danish Ageing Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark; Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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14
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Murayama H, Taguchi A, Spencer MS, Yamaguchi T. Efficacy of a Community Health Worker-Based Intervention in Improving Dietary Habits Among Community-Dwelling Older People: A Controlled, Crossover Trial in Japan. HEALTH EDUCATION & BEHAVIOR 2021; 47:47-56. [PMID: 31933395 DOI: 10.1177/1090198119891975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Community health workers (CHWs), often called "health promotion volunteers" in Japan, are individuals who act as a natural helping resource in the community. Aim. This study tested the efficacy of a CHW-based intervention to improve dietary habits among community-dwelling older people in Japan, using a controlled, crossover design. Method. Seventy-eight people aged 65 to 74 years with poor dietary variety living in four administrative districts in Hikone City (Shiga Prefecture, Japan) were nonrandomly allocated to an immediate-intervened group (IIG; n = 41) or a delayed-intervened group (DIG; n = 37). Participants joined a biweekly, four-session program (120 minutes/session), comprising "CHW drama-style lectures," "group discussion among participants and CHWs," "tasting of dishes," and "take-home practical activities." For the initial 2-month period, the IIG received the intervention and the DIG did not. The groups were crossed over for the subsequent 2-month period. The primary outcome measure was participants' dietary variety score (score range: 0-10). Results. The dietary variety score in the IIG significantly increased in the initial 2-month period compared with the DIG (effect size 1.60 points; 95% confidence interval: 0.75, 2.45). The intervention had a similar effect in the DIG in the subsequent 2-month period. Moreover, an analysis within the IIG showed that the intervention effects persisted for at least 2 months after the intervention. Conclusions. The CHW-based intervention improved dietary habits among older people. Our findings provide evidence that a CHW-based natural helping approach is a possible solution to promote healthy aging in the community.
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15
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Yamazaki K, Suzuki E, Ishihara R, Miyamoto T. Obesity and Remission Rates in Japanese Patients With Rheumatoid Arthritis Requiring Anti-Tumor Necrosis Factor Alpha Therapy. Arch Rheumatol 2021; 35:600-608. [PMID: 33758817 PMCID: PMC7945709 DOI: 10.46497/archrheumatol.2020.7852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/28/2019] [Indexed: 11/04/2022] Open
Abstract
Objectives
This study aims to determine if obesity is a risk factor for a poor response to anti-tumor necrosis factor alpha (anti-TNFα) therapy in Japanese patients with rheumatoid arthritis (RA) using the appropriate body mass index (BMI) cut-off points for Asian populations. Patients and methods
This retrospective cohort study evaluated 382 outpatients with RA (98 males, 284 females; mean age 54.2 years; range, 18 to 84 years) who had received anti-TNFα therapy between May 2009 and July 2017. Patients were classified according to BMI at baseline as follows: <18.5 kg/m2 (underweight), 18.5-23.0 kg/m2 (normal weight), 23.0-27.5 kg/m2 (overweight), and ≥27.5 kg/m2 (obese). The response variable was defined as Simplified Disease Activity Index (SDAI) remission after 12 months. We estimated odds ratios (ORs) and their 95% confidence intervals (CIs) for poor response to the therapy. Results
After 87 patients were excluded, 183 (62.0%) of 295 had reached remission at the 12-month follow-up. Compared with normal-weight patients, the multivariate OR for poor response of obese patients was 2.2 (95% CI: 0.5-9.4). Adjusting for the baseline SDAI score, the corresponding OR was 1.8 (0.4-7.6). Conclusion We found no statistically significant association between obesity and poor response to anti-TNFα therapy in Japanese patients with RA. Because this may partly be due to the limited statistical power of our study, further research is warranted to examine the possible effect modification across countries.
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Affiliation(s)
- Kenji Yamazaki
- Department of Rheumatology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Etsuji Suzuki
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Ryuhei Ishihara
- Department of Rheumatology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Toshiaki Miyamoto
- Department of Rheumatology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
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16
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Obesity paradox in Korean male and female patients with heart failure: A report from the Korean Heart Failure Registry. Int J Cardiol 2020; 325:82-88. [PMID: 33045277 DOI: 10.1016/j.ijcard.2020.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/06/2020] [Accepted: 10/05/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although the survival benefit of obesity has been suggested in patients with heart failure (HF), the impact of sex on obesity paradox is less clear. This study was performed to investigate whether there is a sex difference in the association between body mass index (BMI) and long-term clinical outcomes in patients hospitalized for HF. METHOD A total of 2616 patients hospitalized for HF (Mean age 66 years and 52% males) from the nation-wide registry database were analyzed. Patients were categorized using baseline BMI as normal (18.5 to 22.9 kg/m2), overweight (23 to 27.4 kg/m2) and obese (≥ 27.5 kg/m2). Their all-cause mortality and long-term composite events, including all-cause mortality and HF readmission, were assessed according to the BMI groups. RESULTS During the median follow-up period of 1499 days, there were 662 patients (25.3%) with all-cause mortality and 1071 patients (40.9%) with composite events. Compared to the normal weight group, the overweight (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.51-0.99; P = 0.045) and obese (HR, 0.53; 95% CI, 0.29-0.95; P = 0.032) group showed lower all-cause mortality rates even after adjusting for confounding factors in the male patients. Otherwise, BMI was not associated with composite events in males; it was not associated with all-cause mortality or composite events in females in the multivariable analyses (P > 0.05 for each). CONCLUSIONS Among patients with HF, a greater BMI was associated with low all-cause mortality in males, but not in females. Obesity paradox should be considered in the management of HF patients.
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17
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Javed AA, Aljied R, Allison DJ, Anderson LN, Ma J, Raina P. Body mass index and all-cause mortality in older adults: A scoping review of observational studies. Obes Rev 2020; 21:e13035. [PMID: 32319198 DOI: 10.1111/obr.13035] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/14/2020] [Accepted: 03/24/2020] [Indexed: 12/17/2022]
Abstract
In older age, body composition changes as fat mass increases and redistributes. Therefore, the current body mass index (BMI) classification may not accurately reflect risk in older adults (65+). This study aimed to review the evidence on the association between BMI and all-cause mortality in older adults and specifically, the findings regarding overweight and obese BMI. A systematic search of the OVID MEDLINE and Embase databases was conducted between 2013 and September 2018. Observational studies examining the association between BMI and all-cause mortality within a community-dwelling population aged 65+ were included. Seventy-one articles were included. Studies operationalized BMI categorically (n = 60), continuously (n = 8) or as a numerical change/group transition (n = 7). Reduced risk of mortality was observed for the overweight BMI class compared with the normal BMI class (hazard ratios [HR] ranged 0.41-0.96) and for class 1 or 2 obesity in some studies. Among studies examining BMI change, increases in BMI demonstrated lower mortality risks compared with decreases in BMI (HR: 0.83-0.95). Overweight BMI classification or a higher BMI value may be protective with regard to all-cause mortality, relative to normal BMI, in older adults. These findings demonstrate the potential need for age-specific BMI cut-points in older adults.
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Affiliation(s)
- Ayesha A Javed
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Rumaisa Aljied
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - David J Allison
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada.,Labarge Centre for Mobility in Aging, Hamilton, Canada
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18
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Murayama H, Liang J, Shaw BA, Botoseneanu A, Kobayashi E, Fukaya T, Shinkai S. Age and gender differences in the association between body mass index and all-cause mortality among older Japanese. ETHNICITY & HEALTH 2020; 25:874-887. [PMID: 29726279 DOI: 10.1080/13557858.2018.1469737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
ABSTRACTObjective: Increasing evidence suggests a reverse J-shaped association between body mass index (BMI) and all-cause mortality among the older population. However, findings from non-Western societies including Japan are still sparse. Furthermore, little evidence regarding variation by age and gender in the BMI-mortality relationship in old age exists. This study aimed to examine age and gender variations in the relationship between BMI and all-cause mortality among older Japanese. Design: Data came from a national representative sample of community-dwelling Japanese aged 60 years and older at baseline (n = 4,869). Participants were followed for up to 25 years. We categorized BMI into seven categories: < 18.5, 18.5-19.9, 20.0-21.4, 21.5-22.9, 23.0-24.9, 25.0-26.9, and ≥ 27.0. Cox proportional hazards models were used to assess the relative mortality risk associated with BMI categories. Results: Lower BMI (< 18.5 and 18.5-19.9) was associated with higher mortality, compared to the mid-normal weight category (BMI: 21.5-22.9), after adjusting for covariates. In contrast, high-normal weight (BMI: 23.0-24.9) and overweight (BMI: 25.0-26.9 and ≥ 27.0) were not associated with mortality. Relative to old-old (aged ≥ 75 years), the higher mortality risk associated with lower BMI (< 20) appeared to be more prominent among young-old (aged 60-74 years). A moderately increased mortality risk associated with low BMI (18.5-19.9) was identified among men but not among women. Conclusion: Among older Japanese, low BMI (< 20.0) was associated with higher mortality, while high BMI (≥ 27.0) was not. The increased mortality risk associated with low BMI is more apparent among young-old and men. These age and gender differences need to be considered in assessing healthy body weight in old age.
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Affiliation(s)
| | - Jersey Liang
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Benjamin A Shaw
- Department of Health Policy, Management and Behavior, School of Public Health, State University of New York at Albany, Rensselaer, NY, USA
| | - Anda Botoseneanu
- Department of Health and Human Services and Institute of Gerontology, University of Michigan, Dearborn and Ann Arbor, MI, USA
| | | | - Taro Fukaya
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Shoji Shinkai
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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19
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Liu XC, Liu L, Yu YL, Huang JY, Chen CL, Lo K, Huang YQ, Feng YQ. The Association of Subscapular Skinfold with All-Cause, Cardiovascular and Cerebrovascular Mortality. Risk Manag Healthc Policy 2020; 13:955-963. [PMID: 32801969 PMCID: PMC7407759 DOI: 10.2147/rmhp.s262300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/16/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose Previous studies suggested inconsistent relationship between subscapular skinfold and all-cause, cardiovascular, and cerebrovascular mortality. Therefore, the present study aimed to investigate the associations between subscapular skinfold with all-cause, cardiovascular, and cerebrovascular mortality. Patients and Methods Data were collected from the National Health and Nutrition Examination Survey (NHANES, 1999–2006) with follow-up data through 31 December 2015. Participants were categorized by subscapular skinfold quartiles. The hazard ratios (HRs) and 95% confidence intervals (CIs) were evaluated using the multivariate Cox regression model and subgroup analysis. Kaplan–Meier curves were used to present cause-specific mortalities and used Cox cubic regression splines to examine the association of subscapular skinfold with cause-specific mortalities. Results A total of 16,402 subjects (49.61% male) were involved in our study. After a mean follow-up of 141.73 months, there were 3078 (18.77%), 392 (2.39%), and 128 (0.78%) cases of all-cause, cardiovascular, and cerebrovascular mortality, respectively. Participants in the highest quartile of subscapular skinfold (≥24.80mm) versus the lowest (<13.20mm) had lower risk for all-cause mortality (HR, 0.71; 95% CI, 0.57–0.89; P for trend = 0.007) and cardiovascular mortality (HR, 0.44; 95% CI, 0.23–0.83; P for trend = 0.023) in the fully adjusted model. In the age-stratified analysis, subscapular skinfold was only inversely associated with all-cause and cardiovascular disease mortality in people ≥65 years of age (all P-interaction <0.001). No significant difference was found between subscapular skinfold and cerebrovascular mortality (all P > 0.05). Conclusion Subscapular skinfold showed an inverse association with all-cause and cardiovascular disease mortality in people aged ≥65 years.
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Affiliation(s)
- Xiao-Cong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou 510080, People's Republic of China
| | - Lin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou 510080, People's Republic of China
| | - Yu-Ling Yu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou 510080, People's Republic of China
| | - Jia-Yi Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou 510080, People's Republic of China
| | - Chao-Lei Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou 510080, People's Republic of China
| | - Kenneth Lo
- Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, RI, USA
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou 510080, People's Republic of China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou 510080, People's Republic of China
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20
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Dose-Response Relationships Between Body Composition Indices and All-Cause Mortality in Older Japanese Adults. J Am Med Dir Assoc 2020; 21:726-733.e4. [DOI: 10.1016/j.jamda.2019.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/25/2019] [Accepted: 11/22/2019] [Indexed: 12/19/2022]
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21
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Nishida MM, Okura M, Ogita M, Aoyama T, Tsuboyama T, Arai H. Two-Year Weight Loss but Not Body Mass Index Predicts Mortality and Disability in an Older Japanese Community-Dwelling Population. J Am Med Dir Assoc 2019; 20:1654.e11-1654.e18. [DOI: 10.1016/j.jamda.2019.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 01/04/2023]
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Yang H, Zhao J, Deng X, Tan I, Butlin M, Avolio A, Zuo J. Pulse wave velocity is decreased with obesity in an elderly Chinese population. J Clin Hypertens (Greenwich) 2019; 21:1379-1385. [PMID: 31471955 DOI: 10.1111/jch.13659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/18/2019] [Accepted: 07/26/2019] [Indexed: 01/01/2023]
Abstract
Obesity is generally considered an undesirable risk factor for cardiovascular disease; however, obese subjects with heart failure paradoxically can have better outcomes than their lean counterparts. This study aimed to investigate this characteristic in an elderly Chinese population. Elderly participants (N = 414, age 77 ± 11 years, 211 males) were recruited from a Chinese community-dwelling elderly population. Subjects were divided into 3 groups according to body mass index (BMI ≤ 25, normal; 25-28, overweight; and ≥28, obese). Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV), and the atherosclerosis status was evaluated with the ankle brachial index (ABI). Brachial systolic blood pressure (BSBP) was significantly higher as BMI increased (135 ± 18.4, 138 ± 18.3, 147 ± 17.6 mm Hg; P = .003) adjusted for age, sex, and heart rate. However, baPWV was significantly lower as BMI increased (baPWV 1830 ± 18, 1793 ± 25, 1704 ± 36 cm/s; P = .008) in the three groups, even with additional adjustment for BSBP. BMI showed a significant negative correlation with baPWV (r = -.170, P = .001) after adjusting for confounding factors. Using multiple linear regression, BMI was negatively and independently associated with baPWV (β = -.190, P < .001) especially for age <80 years. Arterial stiffness, as measured by baPWV, is lower in overweight subjects in a Chinese elderly population compared to those with normal body weight. ABI showed no relationship with BMI. These findings suggest that reduced arterial stiffness in the overweight population, independent of confounding factors, may contribute to the explanation of the "obesity paradox."
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Affiliation(s)
- Hui Yang
- Department of Geriatric Medicine, Ruijin Hospital North, Shanghai Jiaotong School of Medicine, Shanghai, China
| | - Jiehui Zhao
- Daning Community Health Service Center, Shanghai, China
| | - Xueqin Deng
- Department of Geriatric Medicine, Ruijin Hospital North, Shanghai Jiaotong School of Medicine, Shanghai, China
| | - Isabella Tan
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Mark Butlin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Junli Zuo
- Department of Geriatric Medicine, Ruijin Hospital North, Shanghai Jiaotong School of Medicine, Shanghai, China.,Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
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Relationship between Individual Social Capital and Cognitive Function among Older Adults by Gender: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122142. [PMID: 31212979 PMCID: PMC6616497 DOI: 10.3390/ijerph16122142] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/06/2019] [Accepted: 06/13/2019] [Indexed: 11/25/2022]
Abstract
As it is not easy to modify lifestyle, it is important to examine the effect of social capital (SC), which does not require behavior modifications, on dementia prevention. This study aimed to clarify gender differences in the relationship between cognitive function and individual SC among people living in a rural area in Japan. We used the Shimane Center for Community-based Healthcare Research and Education (CoHRE) study data from 2011 to conduct a cross-sectional analysis. The analysis included 491 participants, aged 40 years or older, who had undergone medical examinations in two rural towns in Japan. Both cognitive SC and structural SC were measured. Multivariate logistic regression analysis was conducted to estimate the odds ratios (OR) and 95% confidence interval (CI) for cognitive function levels as binary outcomes. We found a significant association between cognitive function and individual cognitive SC in men (OR: 3.11, 95% CI: 1.43–6.78), and found that cognitive function was associated with structural SC in women (OR: 1.89, 95% CI: 1.08–3.31). This study showed that the relationship between cognitive function and individual SC differed by gender. These results suggest that it is important to approach dementia prevention differently in men and women.
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Okuyama K, Abe T, Hamano T, Takeda M, Sundquist K, Sundquist J, Nabika T. Hilly neighborhoods are associated with increased risk of weight gain among older adults in rural Japan: a 3-years follow-up study. Int J Health Geogr 2019; 18:10. [PMID: 31077213 PMCID: PMC6509780 DOI: 10.1186/s12942-019-0174-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/03/2019] [Indexed: 12/27/2022] Open
Abstract
Background Neighborhood environments have been regularly associated with the weight status. Although the evidence is mostly limited to adults residing in western urban settings, the weight status of older adults living in rural areas is also assumed to be significantly affected by their neighborhood environments. This study aimed to identify environmental attributes specific to rural areas that could affect the risk of longitudinal weight gain among older adults (≥ 65 years) in Japan. Methods We examined five environmental attributes, i.e., land slope, public transportation accessibility, residential density, intersection density, and the availability of parks and recreational centers, measured by the geographic information system. Our analysis was based on 714 subjects participated in Shimane Community-based Healthcare Research and Education study in 2012 and 2015. Multinomial logistic regression model was conducted to examine the association between each neighborhood environmental attribute and weight change status (gain, loss and unchanged). Results We observed a significant increase in the risk of weight gain as the steepness of the neighborhood land slope increased. There was no significant association between other environmental attributes and risk of weight gain as well as weight loss among older adults. Conclusion Living in hilly neighborhoods was associated with increased risk of weight gain among rural Japanese older adults. Future research should consider region-specific environmental attributes when investigating their effect on older adults’ weight status.
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Affiliation(s)
- Kenta Okuyama
- Center for Community-based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, 223-8 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan.
| | - Takafumi Abe
- Center for Community-based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, 223-8 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Tsuyoshi Hamano
- Department of Sports Sociology and Health Sciences, Faculty of Sociology, Kyoto Sangyo University, Motoyama, Kamigamo Kita-ku, Kyoto, 603-8555, Japan
| | - Miwako Takeda
- Center for Community-based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, 223-8 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Skåne University Hospital, Lund University, Building 28, Floor 11, Jan Waldenströms Gata 35, 205 02, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Skåne University Hospital, Lund University, Building 28, Floor 11, Jan Waldenströms Gata 35, 205 02, Malmö, Sweden
| | - Toru Nabika
- Department of Functional Pathology, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
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25
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Kamide N, Sakamoto M, Shiba Y, Sato H. Accuracy of body mass index measurements in community-dwelling older Japanese people based on self-reported anthropometric data. Eur Geriatr Med 2019; 10:151-154. [PMID: 32720281 DOI: 10.1007/s41999-018-0138-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/20/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim was to assess the accuracy of body mass index (BMI) measurements in Japanese older people based on self-reported anthropometric data. METHODS The study participants were 420 older people aged 65 years or older who were living independently in their communities. The participants' BMIs were calculated based on height and weight values obtained from self-reported questionnaires and actual measurements. The concordance between self-reported and measured BMI values was then analyzed using intraclass correlation coefficients (ICCs) and 95% limits of agreement (95% LOA) stratified by sex. RESULTS The ICCs were 0.964 in men and 0.970 in women; however, the 95% LOA were relatively broad, ranging from - 1.07 to 1.39 kg/m2 in men and from - 1.52 to 1.46 kg/m2 in women. CONCLUSIONS These findings suggest that BMI assessments in Japanese older people should be based on measured as opposed to self-reported values when investigating changes in BMI over time.
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Affiliation(s)
- Naoto Kamide
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.
- Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.
| | - Miki Sakamoto
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Yoshitaka Shiba
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Haruhiko Sato
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
- Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
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26
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Abe T, Ogura H, Shiraishi A, Kushimoto S, Saitoh D, Fujishima S, Mayumi T, Shiino Y, Nakada TA, Tarui T, Hifumi T, Otomo Y, Okamoto K, Umemura Y, Kotani J, Sakamoto Y, Sasaki J, Shiraishi SI, Takuma K, Tsuruta R, Hagiwara A, Yamakawa K, Masuno T, Takeyama N, Yamashita N, Ikeda H, Ueyama M, Fujimi S, Gando S. Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan: the FORECAST study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:322. [PMID: 30466493 PMCID: PMC6251147 DOI: 10.1186/s13054-018-2186-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/11/2018] [Indexed: 02/08/2023]
Abstract
Background Sepsis is a leading cause of death and long-term disability in developed countries. A comprehensive report on the incidence, clinical characteristics, and evolving management of sepsis is important. Thus, this study aimed to evaluate the characteristics, management, and outcomes of patients with severe sepsis in Japan. Methods This is a cohort study of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma (FORECAST) study, which was a multicenter, prospective cohort study conducted at 59 intensive care units (ICUs) from January 2016 to March 2017. We included adult patients with severe sepsis based on the sepsis-2 criteria. Results In total, 1184 patients (median age 73 years, interquartile range (IQR) 64–81) with severe sepsis were admitted to the ICU during the study period. The most common comorbidity was diabetes mellitus (23%). Moreover, approximately 63% of patients had septic shock. The median Sepsis-related Organ Failure Assessment (SOFA) score was 9 (IQR 6–11). The most common site of infection was the lung (31%). Approximately 54% of the participants had positive blood cultures. The compliance rates for the entire 3-h bundle, measurement of central venous pressure, and assessment of central venous oxygen saturation were 64%, 26%, and 7%, respectively. A multilevel logistic regression model showed that closed ICUs and non-university hospitals were more compliant with the entire 3-h bundle. The in-hospital mortality rate of patients with severe sepsis was 23% (21–26%). Older age, multiple comorbidities, suspected site of infection, and increasing SOFA scores correlated with in-hospital mortality, based on the generalized estimating equation model. The length of hospital stay was 24 (12–46) days. Approximately 37% of the patients were discharged home after recovery. Conclusion Our prospective study showed that sepsis management in Japan was characterized by a high compliance rate for the 3-h bundle and low compliance rate for central venous catheter measurements. The in-hospital mortality rate in Japan was comparable to that of other developed countries. Only one third of the patients were discharged home, considering the aging population with multiple comorbidities in the ICUs in Japan. Trial registration UMIN-CTR, UMIN000019742. Registered on 16 November 2015. Electronic supplementary material The online version of this article (10.1186/s13054-018-2186-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Toshikazu Abe
- Department of General Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan.
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasukazu Shiino
- Department of Acute Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takehiko Tarui
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Kitakyushu, Japan
| | - Yutaka Umemura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Joji Kotani
- Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichiro Sakamoto
- Emergency and Critical Care Medicine, Saga University Hospital, Saga, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shin-Ichiro Shiraishi
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Aizuwakamatsu, Japan
| | - Kiyotsugu Takuma
- Emergency & Critical Care Center, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Ube, Japan
| | - Akiyoshi Hagiwara
- Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Kazuma Yamakawa
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Naoshi Takeyama
- Advanced Critical Care Center, Aichi Medical University Hospital, Nagakute, Japan
| | - Norio Yamashita
- Advanced Emergency Medical Service Center Kurume University Hospital, Kurume, Japan
| | - Hiroto Ikeda
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Masashi Ueyama
- Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, Nagoya, Japan
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Satoshi Gando
- Division of Acute and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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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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28
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He X, Liu C, Chen Y, He J, Dong Y. Overweight Without Central Obesity, Cardiovascular Risk, and All-Cause Mortality. Mayo Clin Proc 2018; 93:709-720. [PMID: 29656788 DOI: 10.1016/j.mayocp.2018.01.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/23/2018] [Accepted: 01/29/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the association of overweight without central obesity with risks of mortality. PATIENTS AND METHODS We included 14,299 participants in the Third National Health and Nutrition Examination Survey (from October 18, 1988, through October 15, 1994). According to their body mass index and waist circumference, participants were categorized into 7 anthropometric groups. Logistic regression models were used to assess the relation of cardiovascular risk factors (hypertension, diabetes, or hypercholesterolemia) and 10-year cardiovascular risk to anthropometric groups. Cox proportional hazards models were used to assess the risk of all-cause mortality, and competing-risks regression models were used for calculating cardiovascular and noncardiovascular mortality. RESULTS Compared with those with normal body mass index and waist circumference, overweight men without central obesity were more likely to have all 3 cardiovascular risk factors and a high cardiovascular risk, whereas women in this anthropometric group were more likely to have hypercholesterolemia. In proportional hazards models, overweight without central obesity was associated with lower all-cause mortality among men in the population with cardiovascular risk factors (hazard ratio, 0.71; 95% CI, 0.56-0.89; P=.004) and the general population (hazard ratio, 0.72; 95% CI, 0.60-0.87; P=.001), whereas results of these comparisons among women were not significant (P>.05). In competing risk analyses, overweight men without central obesity had a lower risk of noncardiovascular mortality, but not cardiovascular mortality. CONCLUSION Although overweight without central obesity was associated with cardiovascular risk factors and a high cardiovascular risk among men, men in this anthropometric group had a lower mortality risk.
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Affiliation(s)
- Xin He
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Chen Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Yili Chen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Jiangui He
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China.
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Kim H, Yoon JL, Lee A, Jung Y, Kim MY, Cho JJ, Ju YS. Prognostic effect of body mass index to mortality in Korean older persons. Geriatr Gerontol Int 2018; 18:538-546. [PMID: 29214747 DOI: 10.1111/ggi.13213] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/05/2017] [Accepted: 10/09/2017] [Indexed: 02/06/2023]
Abstract
AIM Body mass index (BMI) is regarded as a predictor of life expectancy and a determinant of mortality. However, the effect of age on BMI-related mortality remains unclear. The aim of the present study was to examine the prognostic effect of BMI to mortality risk among Korean older persons. METHODS Data were collected from the Korean National Health Insurance Services' Senior Cohort database. This study analyzed the data of 79 341 men and 91 298 women aged ≥65 years who underwent health examinations in the 2007 fiscal year. Individual mortality was identified 5 years after 2008. The participants were stratified into seven groups according to basal BMI. Hazard ratios of death were calculated through Cox proportional hazards model after adjusting for age, sex, smoking status, exercise, alcohol intake and income. RESULTS During the 5-year follow up, 11 651 men and 7 235 women died. In both sexes, a lower BMI had a higher hazard ratio (HR), but the trend of increasing HR at high BMI was not clear. For men, the lowest HR was 0.79 (95% CI 0.71-0.87) at a BMI of 27.5-30.0 kg/m2 . For women, the lowest HR was 0.84 (95% CI 0.78-0.91) at a BMI of 25.0-27.5 kg/m2 . For both sexes, the relative mortality risk was associated with a lower BMI. CONCLUSIONS A high BMI is not associated with increased mortality in older adults aged ≥65 years, whereas a lower BMI is associated with an increased mortality risk in later life in this population. Geriatr Gerontol Int 2018; 18: 538-546.
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Affiliation(s)
- Haksun Kim
- Department of Family Medicine, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jong L Yoon
- Department of Family Medicine, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Department of Family Medicine, Hallym University, College of Medicine, Chuncheon, Korea
| | - Aeyoung Lee
- Department of Family Medicine, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Yujin Jung
- Department of Family Medicine, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Mee Y Kim
- Department of Family Medicine, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Department of Family Medicine, Hallym University, College of Medicine, Chuncheon, Korea
| | - Jung J Cho
- Department of Family Medicine, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Department of Family Medicine, Hallym University, College of Medicine, Chuncheon, Korea
| | - Young S Ju
- Department of Occupational and Environmental Medicine, Hallym University, College of Medicine, Chuncheon, Korea
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Obara-Gołębiowska M, Brycz H, Lipowska M, Lipowski M. The Role of Motivation to Reduce Obesity among Elderly People: Response to Priming Temptation in Obese Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020244. [PMID: 29389858 PMCID: PMC5858313 DOI: 10.3390/ijerph15020244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 01/16/2023]
Abstract
The risk of obesity-related disorders is increased among the elderly, so changing eating habits can be an important element of prevention. The main aim of this article is to consider whether looking at pictures that present either fattening food or healthy food may motivate elderly people to change their nutrition habits. Might priming different kinds of food influence the attractiveness of the food for people in late adulthood undergoing obesity therapy? Based on priming theories, we analysed the effects of the conscious processing of stimuli associated with dietary habits in individuals aged with BMI ≥ 30 kg/m². Our experiments confirmed the influence of a higher-priority goal of "slimming" on the perception and internalization of nutrition-related stimuli. In response to such stimuli, individuals who are actively involved in weight reduction and health-oriented programs use strategies for resisting temptation and to effectively "slim". We present our findings in the context of their theoretical background and practical application.
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Affiliation(s)
- Małgorzata Obara-Gołębiowska
- Department of Psychology of Development and Education, University of Warmia and Mazury, Olsztyn Prawocheńskiego 13, 10-447 Olsztyn, Poland.
| | - Hanna Brycz
- Institute of Psychology, University of Gdansk, Bażyńskiego 4, 80-309 Gdansk, Poland.
| | - Małgorzata Lipowska
- Institute of Psychology, University of Gdansk, Bażyńskiego 4, 80-309 Gdansk, Poland.
| | - Mariusz Lipowski
- Department of Health Psychology, Gdansk University of Physical Education and Sport, Górskiego 1, 80-336 Gdansk, Poland.
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Murayama H, Shaw BA. Heterogeneity in Trajectories of Body Mass Index and Their Associations with Mortality in Old Age: A Literature Review. J Obes Metab Syndr 2017; 26:181-187. [PMID: 31089515 PMCID: PMC6484918 DOI: 10.7570/jomes.2017.26.3.181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 03/23/2017] [Accepted: 04/20/2017] [Indexed: 02/04/2023] Open
Abstract
This article reviewed studies to investigate the association between trajectories of body mass index (BMI) and mortality among older adults. Investigators conducted a systematic search of published peer-reviewed literature in the PubMed database, and three articles that satisfied the inclusion criteria for the review were identified. All of these studies used group-based trajectory models to identify distinct BMI trajectories. Two studies were derived from the U.S. and used data from the Health and Retirement Study, with up to nine repeated observations. Most of the BMI trajectories in older Americans were increasing and fell primarily within the overweight and obese ranges. The other study was from Japan and used nationwide data, with up to seven repeated observations. BMI trajectories identified in the older Japanese were mostly decreasing and fell primarily within the normal weight range. Although the distribution of BMI trajectories was different between the two nations, the findings from these three studies consistently demonstrated that people with stable overweight trajectories had the lowest all-cause mortality rates in both countries. Beyond this, however, these studies suggested that priorities for weight control in old age should likely differ between Western and non-Western countries. Research regarding BMI trajectories and mortality in old age is very limited at present. Evidence from countries other than the U.S. and Japan is warranted in order to validate current findings and guide the development of local clinical and public health strategies for body weight management aimed at improving the health and survival of older adults.
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Affiliation(s)
| | - Benjamin A Shaw
- Department of Health Policy, Management and Behavior, School of Public Health, State University of New York at Albany, NY, USA
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Nishikawa H, Enomoto H, Ishii A, Iwata Y, Miyamoto Y, Ishii N, Yuri Y, Takata R, Hasegawa K, Nakano C, Nishimura T, Yoh K, Aizawa N, Sakai Y, Ikeda N, Takashima T, Iijima H, Nishiguchi S. Prognostic significance of low skeletal muscle mass compared with protein-energy malnutrition in liver cirrhosis. Hepatol Res 2017; 47:1042-1052. [PMID: 27862791 DOI: 10.1111/hepr.12843] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/16/2016] [Accepted: 11/10/2016] [Indexed: 12/24/2022]
Abstract
AIMS To investigate the impact of low skeletal muscle mass (LSMM) on survival as compared with protein-energy malnutrition (PEM) in patients with liver cirrhosis (LC). METHODS A total of 206 individuals with LC were analyzed. We retrospectively examined the impact of LSMM, as defined by psoas muscle mass at the third lumber on computed tomography, on survival as compared with PEM. In terms of comparison of the effects of LSMM and PEM on survival, we used time-dependent receiver operating characteristics (ROC) analysis. RESULTS Our study cohort included 115 men and 91 women with a median age of 67 years. There were 140 patients with Child-Pugh A, 62 with Child-Pugh B, and 4 with Child-Pugh C. A total of 117 patients (56.8%) had LSMM and 52 patients (25.2%) had PEM. The proportion of PEM in patients with LSMM (31.62%, 37/117) was significantly higher than in patients without LSMM (16.85%, 15/89) (P = 0.0229). In the multivariate analysis for the entire cohort, the presence of hepatocellular carcinoma, lower body mass index, presence of LSMM, lower triglyceride value, poorer renal function, and higher des-γ-carboxy prothrombin value were found to be significant adverse predictors linked to overall survival, while presence of PEM tended to be significant. In the time-dependent ROC analysis, all area under the ROCs for survival in LSMM at each time point were higher than those in PEM except for Child-Pugh B patients. CONCLUSION In this comparison of LSMM and PEM on clinical outcomes in LC patients, it was shown that LSMM may have stronger prognostic impact than PEM.
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Affiliation(s)
- Hiroki Nishikawa
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Hirayuki Enomoto
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Akio Ishii
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yoshinori Iwata
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yuho Miyamoto
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Noriko Ishii
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yukihisa Yuri
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Ryo Takata
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Kunihiro Hasegawa
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Chikage Nakano
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Takashi Nishimura
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Kazunori Yoh
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Nobuhiro Aizawa
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yoshiyuki Sakai
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Naoto Ikeda
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Tomoyuki Takashima
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Hiroko Iijima
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Shuhei Nishiguchi
- Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
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