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Thacker N, Duncanson K, Eslick GD, Dutt S, O'Loughlin EV, Hoedt EC, Collins CE. Antibiotics, passive smoking, high socioeconomic status and sweetened foods contribute to the risk of paediatric inflammatory bowel disease: A systematic review with meta-analysis. J Pediatr Gastroenterol Nutr 2024. [PMID: 39020449 DOI: 10.1002/jpn3.12303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/27/2024] [Accepted: 06/05/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE Genetic and environmental factors influence pathogenesis and rising incidence of paediatric inflammatory bowel disease (PIBD). The aim was to meta-analyse evidence of diet and environmental factors in PIBD. METHODS A systematic search was conducted to identify diet and environmental factors with comparable risk outcome measures and had been reported in two or more PIBD studies for inclusion in meta-analyses. Those with ≥2 PIBD risk estimates were combined to provide pooled risk estimates. RESULTS Of 4763 studies identified, 36 studies were included. PIBD was associated with higher risk with exposure to ≥/=4 antibiotic courses (includes prescriptions/purchases/courses), passive smoking, not being breastfed, sugary drink intake, being a non-Caucasian child living in a high-income country and infection history (odds ratio [OR] range: 2-3.8). Paediatric Crohn's disease (CD) was associated with higher risk with exposure to antibiotics during early childhood, ≥/=4 antibiotic courses, high socioeconomic status (SES), maternal smoking, history of atopic conditions and infection history (OR range: 1.6-4.4). A history of infection was also associated with higher risk of paediatric ulcerative colitis (UC) (OR: 3.73). Having a higher number of siblings (≥2) was associated with lower risk of paediatric CD (OR: 0.6) and paediatric UC (OR: 0.7). Pet exposure was associated with lower risk of paediatric UC (OR: 0.5). CONCLUSION Several factors associated with PIBD risk were identified that could potentially be used to develop a disease screening tool. Future research is needed to address risk reduction in PIBD.
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Affiliation(s)
- Nisha Thacker
- School of Health Sciences, College of Health Medicine and Wellbeing, The University of Newcastle, Sydney, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Kerith Duncanson
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, The University of Newcastle, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence in Digestive Health, The University of Newcastle, Sydney, New South Wales, Australia
| | - Guy D Eslick
- NHMRC Centre of Research Excellence in Digestive Health, The University of Newcastle, Sydney, New South Wales, Australia
| | - Shoma Dutt
- Department of Gastroenterology, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, New South Wales, Australia
- Children's Hospital at Westmead Clinical School, Sydney Medical Program, University of Sydney, Sydney, New South Wales, Australia
| | - Edward V O'Loughlin
- Department of Gastroenterology, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, New South Wales, Australia
| | - Emily C Hoedt
- NHMRC Centre of Research Excellence in Digestive Health, The University of Newcastle, Sydney, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, College of Health Medicine and Wellbeing, The University of Newcastle, Sydney, New South Wales, Australia
| | - Clare E Collins
- School of Health Sciences, College of Health Medicine and Wellbeing, The University of Newcastle, Sydney, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Mesa-Castrillon CI, Beckenkamp PR, Ferreira M, Simic M, Davis PR, Michell A, Pappas E, Luscombe G, Noronha MD, Ferreira P. Global prevalence of musculoskeletal pain in rural and urban populations. A systematic review with meta-analysis. Musculoskeletal pain in rural and urban populations. Aust J Rural Health 2024. [PMID: 38963186 DOI: 10.1111/ajr.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/10/2024] [Accepted: 06/16/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION To systematically compare the global prevalence of musculoskeletal pain and care-seeking in rural and urban populations. METHODS A systematic review with meta-analysis of observational studies reporting a direct comparison of rural and urban populations was conducted worldwide and included back, knee, hip, shoulder, neck pain and a broad diagnosis of 'musculoskeletal pain'. A search strategy combining terms related to 'prevalence', 'musculoskeletal pain' and 'rural' was used on the following databases: MEDLINE, Embase, CINAHL, Scopus, and rural and remote health from their inception to 1 June 2022. Random-effects meta-analysis was used to pool the data. Results were presented as odds ratios (OR) along with 95% confidence intervals (95% CI). RESULTS A total of 42 studies from 24 countries were included with a total population of 489 439 participants. The quality scores for the included studies, using the modified Newcastle Ottawa Scale tool, showed an average score of 0.78/1, which represents an overall good quality. The pooled analysis showed statistically greater odds of hip (OR = 1.62, 95% CI = 1.23-2.15), shoulder (OR = 1.42, 95% CI = 1.06-1.90) and overall musculoskeletal pain (OR = 1.26, 95% CI = 1.08-1.47) in rural populations compared to urban populations. Although the odds of seeking treatment were higher in rural populations this relationship was not statistically significant (OR = 0.76, 95% CI = 0.55-1.03). CONCLUSION Very low-certainty evidence suggests that musculoskeletal, hip and shoulder pain are more prevalent in rural than urban areas, although neck, back and knee pain, along with care-seeking, showed no significant difference between these populations. Strategies aimed to reduce the burden of musculoskeletal pain should consider the specific needs and limited access to quality evidence-based care for musculoskeletal pain of rural populations.
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Affiliation(s)
- Carlos I Mesa-Castrillon
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Rural Health, Faculty of Medicine and Health, The University of Sydney, Orange Campus, Orange, New South Wales, Australia
| | - Paula R Beckenkamp
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Manuela Ferreira
- School of Health Sciences, Faculty of Medicine and Health, Sydney Musculoskeletal Health, The Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Milena Simic
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Phillip R Davis
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Antonio Michell
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Evangelos Pappas
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
- The University of Wollongong, Wollongong, New South Wales, Australia
| | - Georgina Luscombe
- School of Rural Health, Faculty of Medicine and Health, The University of Sydney, Orange Campus, Orange, New South Wales, Australia
| | - Marcos De Noronha
- Rural Department of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Paulo Ferreira
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
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Moreno-González R, Cruzado JM, Corsonello A, Fabbietti P, Tap L, Mattace-Raso F, Ärnlöv J, Carlsson AC, Guligowska A, Kostka T, Artzi-Medvedik R, Melzer I, Roller-Wirnsberger R, Wirnsberger G, Kob R, Sieber C, Lattanzio F, Formiga F. Kidney function and other associated factors of sarcopenia in community-dwelling older adults: The SCOPE study. Eur J Intern Med 2024; 123:81-93. [PMID: 38103954 DOI: 10.1016/j.ejim.2023.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/08/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023]
Abstract
AIM Sarcopenia is associated with several factors and medical conditions among older adults, though previous research has shown limitations and inconsistencies, especially regarding chronic kidney disease (CKD). We investigated the clinical and laboratory variables associated with sarcopenia and severe sarcopenia in older adults, focusing on kidney function measures. METHODS Data from community-dwelling adults aged ≥75 years participating in the SCOPE multicenter prospective cohort study were assessed cross-sectionally. Comprehensive geriatric assessment was conducted; sociodemographic and lifestyle factors, clinical variables and comorbidities, anthropometric and bioelectrical impedance analysis, blood and urine laboratory variables were collected. EWGSOP2 revised criteria were used to define sarcopenia and its severity. Estimated glomerular filtration rate (eGFR) was calculated using creatinine and non-creatinine-based equations, and CKD stages were defined accordingly. RESULTS 1420 participants were included, prevalence of sarcopenia was 10.6 %, and 6 % had severe sarcopenia. Multivariate logistic regression analysis showed that age [OR =1.14; 95 %CI (1.09-1.19)], body mass index (BMI) [0.83 (0.79-0.88)], disability performing instrumental activities of daily living (IADL) [2.61 (1.69-4.06)], Mini Mental State Examination (MMSE) score <24 [2.75 (1.62-4.67)], osteoporosis [2.39 (1.55-3.67)], and stage 4 CKD defined by CKD-EPIBTP-B2M, a non-creatinine-based eGFR equation [2.88 (1.11-7.49)], were independently associated with sarcopenia; as were specifically with severe sarcopenia, with more pronounced associations. CONCLUSIONS In community-dwelling older adults, sarcopenia is a relevant condition and is associated with severe CKD, older age, IADL, cognitive impairments, osteoporosis and low BMI. These factors should be assessed for proper identification and management of older patients with sarcopenia, and even more so with severe sarcopenia.
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Affiliation(s)
- Rafael Moreno-González
- Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, Systemic Diseases and Ageing Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Maria Cruzado
- Nephrology Department, Hospital Universitari de Bellvitge. Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Andrea Corsonello
- Center for Biostatistic and Applied Geriatric Clinical Epidemiology, Italian National Research Center on Ageing (IRCCS INRCA), Ancona and Cosenza, Italy; Unit of Geriatric Medicine, Italian National Research Center on Ageing (IRCCS INRCA), Cosenza, Italy and Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Paolo Fabbietti
- Center for Biostatistic and Applied Geriatric Clinical Epidemiology, Italian National Research Center on Ageing (IRCCS INRCA), Ancona and Cosenza, Italy
| | - Lisanne Tap
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Francesco Mattace-Raso
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Johan Ärnlöv
- School of Health and Social Studies, Dalarna University, Falun, Sweden; Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Axel C Carlsson
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Agnieszka Guligowska
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Poland
| | - Tomasz Kostka
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Poland
| | - Rada Artzi-Medvedik
- Department of Nursing, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-sheva, Israel
| | - Itshak Melzer
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-sheva, Israel
| | | | | | - Robert Kob
- Department of General Internal Medicine and Geriatrics, Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Regensburg, Germany
| | - Cornel Sieber
- Department of General Internal Medicine and Geriatrics, Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Regensburg, Germany
| | - Fabrizia Lattanzio
- Scientific Direction, Italian National Research Center on Aging (IRCCS INRCA), Ancona, Italy
| | - Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, Systemic Diseases and Ageing Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona. L'Hospitalet de Llobregat, Barcelona, Spain
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Castaldo A, Bassola B, Zanetti ES, Nobili A, Zani M, Magri M, Verardi AA, Ianes A, Lusignani M, Bonetti L. Nursing Home Organization Mealtimes and Staff Attitude Toward Nutritional Care: A Multicenter Observational Study. J Am Med Dir Assoc 2024; 25:898-903. [PMID: 37989497 DOI: 10.1016/j.jamda.2023.10.011] [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: 06/29/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES The aims of this study were to investigate the practices of registered nurses and nurse aides at mealtimes in nursing homes (NHs) and to evaluate the attitudes of health care staff toward the nutritional care of older people. DESIGN This is a multicenter cross-sectional study. SETTING AND PARTICIPANTS The study involved a convenience sample of NH health care staff: physicians, registered nurses, and nurse aides. METHODS Data were collected on characteristics of the dining environment, organizational and nutritional care practices, staff-resident ratio, and staff activities during meals, using 2 questionnaires and staff attitudes were assessed with Staff Attitudes to Nutritional Nursing Care Geriatric Scale (SANN-G). Total score ranges from 18 to 90 points, with the following cutoffs: ≥72, positive attitude; ≤54, negative; and 55-71 points, neutral attitude. RESULTS A total of 1267 workers from 29 NHs in northern Italy participated in the study. The most common nutritional assessment tool used by nurses was the Malnutrition Universal Screening Tool. A median of 4.0 and 4.2 people (family caregivers, volunteers and staff) were present for feeding support, respectively, at lunch and dinner. A median of 2.5 and 2.0 staff members at lunch and at dinner, respectively, fed residents. Overall, 1024 health care workers responded to SANN-G of which 21.9% showed a negative attitude, 57.2% neutral, and 20.9% a positive attitude. Nurse aides (190/714) showed worse attitudes compared with registered nurses (20/204) and physicians (2/36); differences were statistically significant. Overall, the best attitudes were toward "habits," "interventions," and "individualization" of nutritional care. Staff who had received nutritional training (29.2%) had best attitudes. CONCLUSIONS AND IMPLICATIONS The results suggest that NHs should ensure adequate staff-resident ratio during meals, involving trained volunteers and relatives. Moreover, health professionals' knowledge and attitude toward nutritional care should be improved through continuous training.
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Affiliation(s)
- Anna Castaldo
- IRCCS S. Maria Nascente Don Gnocchi Foundation, Milan, Italy; Bachelor in Nursing, University of Milan, Milan, Italy.
| | | | | | | | - Michele Zani
- Fondazione Le Rondini Città di Lumezzane Onlus, Lumezzane (BS), Italy
| | | | | | | | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Loris Bonetti
- Department of Nursing, Nursing Research Competence Center, Ente Ospedaliero Cantonale, Bellinzona, Canton Ticino, Switzerland; Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Manno, Switzerland
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Tanaka Y, Ando T, Tsuchiya K, Mochizuki K. Height and Weight, Not Body Mass Index, Are Closely Associated With Activities of Daily Living in Japanese Older Adults. Asia Pac J Public Health 2024:10105395241247336. [PMID: 38641963 DOI: 10.1177/10105395241247336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Body mass index (BMI) is routinely used to ascertain health status, including activities of daily living (ADLs); however, the associations of ADLs with height and weight in older adults have not been elucidated. Therefore, we cross-sectionally investigated the correlations between ADLs and height, weight, and BMI in 155 participants aged 82 to 103 years and characterized the naïve Bayesian prediction for ADLs. Activities of daily living showed a significant negative correlation with height and weight and a positive correlation with age. In males, a shorter height was associated with an increased risk of falling and disability in phone calling independently, and losing weight was associated with an increased risk of disability in going out. Combining age, weight, and height improved the area under the receiver operating characteristic curve in the prediction of disability in going out and phone calling independently in males. Therefore, height and weight, not BMI, are potential predictors of ADL decline.
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Affiliation(s)
- Yuji Tanaka
- New Industry Creation Hatchery Center, Tohoku University, Sendai, Japan
| | - Takashi Ando
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Kyoichiro Tsuchiya
- Department of Diabetes and Endocrinology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Kazuki Mochizuki
- Laboratory of Food and Nutritional Sciences, Department of Local Produce and Food Sciences, Faculty of Life and Environmental Sciences, University of Yamanashi, Yamanashi, Japan
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Gavriilidou NN, Pihlsgård M, Elmståhl S, Ekström H. Mortality risk relationship using standard categorized BMI or knee-height based BMI - does the overweight/lower mortality paradox hold true? Aging Clin Exp Res 2024; 36:88. [PMID: 38587702 PMCID: PMC11001730 DOI: 10.1007/s40520-024-02742-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/19/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The body mass index (BMI) is prone to misclassification of obesity due to age-related height loss and resulting measurement errors. Knee-height based BMI (KH-BMI) has not been previously studied in relation to mortality risk in older adults. AIM To evaluate the age- and sex-specific mortality risk relationship using classic BMI and knee height predicted BMI (KH-BMI) overweight and obesity in a 15-year follow-up study including older Swedish adults aged 60-93 years. METHODS A 15-year follow-up study among 2,786 individuals aged ≥ 60 years. Height, weight and KH were measured. KH-predicted height was estimated using formulated gender-specific equations. Classic BMI and KH-BMI (kg/m2) were calculated. Mortality data was obtained from the Swedish death registry. Questionnaires were used to collect data on obesity-related lifestyle factors and comorbidities. RESULTS Cox regression revealed that using the classic BMI, when comparing with the normal/underweight reference group, there was a mortality risk among overweight men (HR = 0.67, 0.52-0.87), overweight women (HR = 0.79, 0.65-0.97), and obese men (HR = 0.60, 0.41-0.89) aged ≥ 80 years old. Using the KH-BMI, only overweight men and overweight women aged ≥ 80 years had a lower mortality risk, men (HR = 0.71, 0.55-0.92); women (HR = 0.77, 0.62-0.95) after adjusting for obesity-related lifestyle factors and comorbidities. DISCUSSION There is evidence that obesity is overestimated by the BMI, in comparison with the KH-BMI classification. In terms of mortality risk and after adjusting for height, there remains a paradoxical protective association between overweight and mortality. CONCLUSION Regardless of classic BMI or KH-BMI estimation, overweight men and women aged ≥ 80 years had a lower mortality risk compared to normal/underweight men and women ≥ 80 years.
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Affiliation(s)
| | - Mats Pihlsgård
- Perinatal and Cardiovascular Epidemiology, Lund University Diabetes Centre, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Sölve Elmståhl
- Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Henrik Ekström
- Department of Dental Medicine, Division of Oral Diseases, Karolinska Institutet, Huddinge, Sweden.
- Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Skåne University Hospital, Lund University, Malmö, Sweden.
- Division of Geriatric Medicine, Skåne University Hospital, Lund University, Jan Waldenströms gata 35, Malmö, 205 02, Sweden.
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Putot A, Guyot C, Manckoundia P, Van Wymelbeke-Delannoy V. Association of body mass index with long-term outcomes in older adults hospitalized for COVID-19: an observational study. Sci Rep 2024; 14:7512. [PMID: 38553629 PMCID: PMC10980698 DOI: 10.1038/s41598-024-58388-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/28/2024] [Indexed: 04/02/2024] Open
Abstract
Both underweight and obesity have been associated with poor prognosis in COVID-19. In an older populations of patients hospitalized for SARS-CoV-2 infection, we aimed to evaluate the association between body mass index (BMI) and short and long-term prognosis. Among 434 consecutive patients aged ≥ 70 years and hospitalized for suspected COVID-19 at a university hospital, 219 patients (median age of 83 years, 53% male) testing positive for COVID-19 and for whom BMI was recorded at admission, agreed to participate. Among them, 39 had a BMI < 20 kg/m2, 73 had a BMI between 20 and 24.9 kg/m2 and 107 had a BMI ≥ 25 kg/m2. After adjustment for confounders, BMI < 20 kg/m2 was associated with a higher risk of one-year mortality (hazard ratio (HR) [95% confidence interval]: 1.75 [1.00-3.05], p = 0.048), while BMI ≥ 25 kg/m2 was not (HR: 1.04 [0.64-1.69], p = 0.9). However, BMI was linearly correlated with both in-hospital acute respiratory failure (p = 0.02) and cardiovascular events (p = 0.07). In this cohort of older patients hospitalized for COVID-19, low BMI, rather than high BMI, appears as an independent risk factor for death after COVID-19. The pathophysiological patterns underlying this excess mortality remain to be elucidated.
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Affiliation(s)
- Alain Putot
- Service de Médecine Interne et Maladies Infectieuses, Hôpitaux du Pays du Mont Blanc, Sallanches, France.
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), Université de Bourgogne Franche Comté, Besançon, France.
- Service de Médecine Interne Gériatrie, Pôle Personnes Agées, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France.
| | - Charline Guyot
- Unité de Recherche Nutrition, Pôle Personnes Agées, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France
| | - Patrick Manckoundia
- Service de Médecine Interne Gériatrie, Pôle Personnes Agées, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France
- INSERM U1093 Cognition Action Plasticité, Université de Bourgogne Franche Comté, Besançon, France
| | - Virginie Van Wymelbeke-Delannoy
- Unité de Recherche Nutrition, Pôle Personnes Agées, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France
- Centre des Sciences du Goût et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, 21000, Dijon, France
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Amodio E, Schreiber PW, Faes Hesse M, Wolfensberger A. Adverse Outcomes of Patients with Non-Ventilator-Associated Hospital-Acquired Pneumonia (nvHAP)-A Single Centre Cohort Study. Infect Dis Rep 2024; 16:228-238. [PMID: 38525765 PMCID: PMC10961785 DOI: 10.3390/idr16020018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/01/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Non-ventilator associated hospital-acquired pneumonia (nvHAP) is a common nosocomial infection, but little is known about the outcomes of patients with nvHAP and the risk factors for adverse outcomes. In this retrospective study conducted in a Swiss tertiary care centre, adverse outcomes like in-hospital mortality, intensive care unit (ICU) admission, and mechanical ventilation, both all-cause and nvHAP-associated, were investigated. Of 244 patients with nvHAP, 72 (30%) died, 35 (14%) deaths were attributed to nvHAP. While 36 (15%) patients acquired nvHAP on the ICU, another 173 patients were eligible for ICU-transferral, and 76 (43.9%) needed ICU-admission. Of all patients hospitalized on the ICU 58 (51.8%) needed intubation due to nvHAP. Multivariable logistic regression analysis identified lower body mass index (OR per unit increase: 0.90, 95%CI: 0.82-0.98) and lower haemoglobin on admission (OR per unit in g/l increase: 0.98, 95%CI: 0.97-1.00) as patient specific factors independently associated with nvHAP-associated mortality. Given the frequency of nvHAP adverse outcomes, hospitals should evaluate increasing nvHAP prevention efforts, especially for patients at high risk for nvHAP mortality. To what extent pneumonia prevention interventions do lower nvHAP mortality in these patients is still to be evaluated.
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Affiliation(s)
| | | | | | - Aline Wolfensberger
- Department for Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
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Qureshi AI, Lodhi A, Akhtar IN, Ma X, Kherani D, Kwok CS, Ford DE, Hanley DF, Hassan AE, Nguyen TN, Spiotta AM, Zaidi SF. Mechanical thrombectomy with intra-arterial thrombolysis versus mechanical thrombectomy alone in patients with acute ischemic stroke: A systematic review and meta-analysis. Int J Stroke 2024; 19:16-28. [PMID: 37306490 DOI: 10.1177/17474930231184369] [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] [Indexed: 06/13/2023]
Abstract
BACKGROUND There is conflicting evidence as to whether intra-arterial thrombolysis (IAT) adds benefit in patients with acute stroke who undergo mechanical thrombectomy (MT). METHODS We conducted a systematic review to identify studies that evaluate IAT in patients with acute stroke who undergo MT. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science until February 2023. Statistical pooling with random effects meta-analysis was undertaken to evaluate odds of functional independence, mortality, and near-complete or complete angiographic recanalization with IAT compared to no IAT. RESULTS A total of 18 studies were included (3 matched, 14 unmatched, and 1 randomized). The odds ratio (OR) for functional independence (modified Rankin Scale: 0-2) at 90 days was 1.14 (95% confidence interval (CI): 0.95-1.37, p = 0.17, 16 studies involving 7572 patients) with IAT with moderate between-study heterogeneity (I2 = 38.1%). The OR for functional independence with IAT was 1.28 (95% CI: 0.92-1.78, p = 0.15) in studies that were either matched or randomized and 1.24 (95% CI: 0.97-1.58, p = 0.08) in studies with the highest quality score. IAT was associated with higher odds of near-complete or complete angiographic recanalization (OR: 1.65, 95% CI: 1.03-2.65, p = 0.04) in studies that were either matched or of randomized comparisons. CONCLUSION Although the odds of functional independence appeared to be higher with IAT and MT compared with MT alone, none of the results were statistically significant. A prominent effect of the design and quality of the studies was observed on the association between IAT and functional independence at 90 days.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Abdullah Lodhi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Iqra N Akhtar
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Xiaoyu Ma
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Danish Kherani
- Department of Neurology, Houston Methodist Neurological Institute, Houston, TX, USA
| | - Chun Shing Kwok
- Department of Cardiology, University Hospitals of Birmingham NHS Trust, Birmingham, UK
| | - Daniel E Ford
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel F Hanley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ameer E Hassan
- Department of Neurology, The University of Texas Rio Grande Valley, Harlingen, TX, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston, MA, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Syed F Zaidi
- Department of Neurology, The University of Toledo Medical Center, Toledo, OH, USA
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10
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Eitmann S, Matrai P, Hegyi P, Balasko M, Eross B, Dorogi K, Petervari E. Obesity paradox in older sarcopenic adults - a delay in aging: A systematic review and meta-analysis. Ageing Res Rev 2024; 93:102164. [PMID: 38103840 DOI: 10.1016/j.arr.2023.102164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Abstract
The prognostic significance of obesity in sarcopenic adults is controversial. This systematic review and meta-analysis aimed to investigate the effect of additional obesity on health outcomes in sarcopenia. MEDLINE, EMBASE, Scopus and CENTRAL were systematically searched for studies to compare health outcomes of adults with sarcopenic obesity (SO) to those of sarcopenic non-obese (SNO) adults. We also considered the methods of assessing obesity. Of 15060 records screened, 65 papers were included (100612 participants). Older community-dwelling SO adults had 15% lower mortality risk than the SNO group (hazard ratio, HR: 0.85, 95% confidence interval 0.76, 0.94) even when obesity was assessed by measurement of body composition. Additionally, meta-regression analysis revealed a significant negative linear correlation between the age and the HR of all-cause mortality in SO vs. SNO community-dwelling adults, but not in severely ill patients. Compared with SNO, SO patients presented lower physical performance, higher risk for metabolic syndrome, but similar cognitive function, risk of falls and cardiovascular diseases. Age-related obesity, SO and later fat loss leading to SNO represent consecutive phases of biological aging. Additional obesity could worsen the health state in sarcopenia, but above 65 years SO represents a biologically earlier phase with longer life expectancy than SNO.
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Affiliation(s)
- Szimonetta Eitmann
- Institute for Translational Medicine, Medical School, University of Pecs, 12 Szigeti street, H-7624 Pecs, Hungary
| | - Peter Matrai
- Institute for Translational Medicine, Medical School, University of Pecs, 12 Szigeti street, H-7624 Pecs, Hungary
| | - Peter Hegyi
- Institute for Translational Medicine, Medical School, University of Pecs, 12 Szigeti street, H-7624 Pecs, Hungary; Centre for Translational Medicine, Semmelweis University, 26 Ulloi street, H-1085 Budapest, Hungary; Division of Pancreatic Diseases, Semmelweis University, 23-26 Baross street, H-1085 Budapest, Hungary
| | - Marta Balasko
- Institute for Translational Medicine, Medical School, University of Pecs, 12 Szigeti street, H-7624 Pecs, Hungary
| | - Balint Eross
- Institute for Translational Medicine, Medical School, University of Pecs, 12 Szigeti street, H-7624 Pecs, Hungary; Centre for Translational Medicine, Semmelweis University, 26 Ulloi street, H-1085 Budapest, Hungary; Division of Pancreatic Diseases, Semmelweis University, 23-26 Baross street, H-1085 Budapest, Hungary
| | - Kira Dorogi
- Institute for Translational Medicine, Medical School, University of Pecs, 12 Szigeti street, H-7624 Pecs, Hungary
| | - Erika Petervari
- Institute for Translational Medicine, Medical School, University of Pecs, 12 Szigeti street, H-7624 Pecs, Hungary.
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11
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Lampl S, Cohen Y, Maor Y, Ben-David D. Impact of intensified prevention measures on the rate of hospital-acquired bloodstream infections among mechanically ventilated COVID-19 patients. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e235. [PMID: 38156205 PMCID: PMC10753508 DOI: 10.1017/ash.2023.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 12/30/2023]
Abstract
Background The COVID-19 pandemic was associated with increased rates of hospital-acquired infections. During the early months of the pandemic, we observed high rates of hospital-acquired bloodstream infections (HA-BSIs) among COVID-19 patients, prompting the implementation of intensified prevention measures. Objectives To assess the prevalence of HA-BSI among mechanically ventilated COVID-19 patients, identify risk factors, and evaluate the effect of prevention measures. Methods We conducted a retrospective matched case-control study in adult medical step-up units between March 1, 2020, and March 31, 2021. We matched mechanically ventilated COVID-19 patients with ventilated non-COVID-19 patients based on age group and length of stay before ventilation. In response to the high rates of HA-BSI among COVID-19 patients, a comprehensive infection control intervention was implemented. Results A total of 136 COVID-19 patients were matched with 136 non-COVID-19 patients. No significant differences were observed in pre-hospitalization characteristics. The central venous catheter utilization ratio was higher in COVID-19 patients (83.6%) versus 35.6% in the control group (p < 0.001). During pre-intervention, 35.2% (32/91) of COVID-19 patients developed HA-BSI, compared to 17.8% (13/73) in the control group (p < 0.001). Following the intervention, no significant difference was observed between the groups (17.8% (8/45) versus 15.9% (10 /63), p = 0.79). In a multivariate analysis, HA-BSI was associated with low body mass index (OR 0.9 (95% CI 0.9-1.0), p = 0.015)) and presence of temporary dialysis catheter (OR 2.7 (95% CI 1.0-7.3), p = 0.05)). Conclusions Mechanically ventilated COVID-19 patients were at higher risk for developing HA-BSI compared to non-COVID-19 patients. Intensified prevention measures were associated with decreased rates of HA-BSI.
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Affiliation(s)
| | | | - Yasmin Maor
- Wolfson Medical Center, Holon, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Debby Ben-David
- Wolfson Medical Center, Holon, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Demonceau C, Buckinx F, Reginster JY, Bruyère O. Assessment of risk factors associated with long-term mortality in nursing homes: result from the SENIOR cohort. Aging Clin Exp Res 2023; 35:2997-3005. [PMID: 37917376 DOI: 10.1007/s40520-023-02579-5] [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: 07/11/2023] [Accepted: 09/24/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Previous studies on risk factors for death in nursing homes have focused on short-term observation and limited number risk factors. AIMS This study aims to identify factors predictive of 8-year survival in nursing homes. METHODS The study used the baseline measurements from the SENIOR cohort collected in 2013-2014. Data included clinical assessments (i.e., body composition, nutritional status, physical performance, level of dependence and cognition, frailty phenotype) as well as demographic information, number of medications and medical history. Mortality data were collected annually for 8 years. Univariate analyses were initially performed to assess potential predictive factors, followed by a Cox regression model using stepwise selection. RESULTS Of the 662 participants enrolled in the cohort, 58 (8.8%) were not further assessed due to the withdrawal of 2 nursing homes and 71 (10.7%) had no mortality data available (i.e., relocation, refusal to continue the study). Among the 533 patients included, 111 (20.8%) were still alive in 2022. Median survival time was 4 years (1.93-6.94). Multivariate regression showed that younger age (HR = 1.04 (1.03-1.06)), higher body mass index (HR = 0.96 (0.94-0.98)), higher score on the Mini-Mental State-Examination (HR = 0.97 (0.94-0.99)) and higher score on the Short Physical Performance Battery (HR = 0.93 (0.90-0.97)) were protective factors against mortality. CONCLUSIONS This study highlights that certain modifiable factors related to physical or mental health contribute to increased survival in nursing homes. Because of its ability to improve physical performance and partly cognitive function, promoting physical activity in nursing homes appears to be a public health priority.
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Affiliation(s)
- Céline Demonceau
- WHO Collaborating Center for Epidemiologic Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000, Liège, Belgium.
| | - Fanny Buckinx
- WHO Collaborating Center for Epidemiologic Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000, Liège, Belgium
| | - Jean-Yves Reginster
- WHO Collaborating Center for Epidemiologic Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000, Liège, Belgium
| | - Olivier Bruyère
- WHO Collaborating Center for Epidemiologic Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000, Liège, Belgium
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13
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Hunt B, Zhao H, Cassidy A, Peart S, Olaussen A. Diagnostic Accuracy of Posterior Circulation Stroke by Paramedics: A Systematic Review. PREHOSP EMERG CARE 2023:1-9. [PMID: 37846931 DOI: 10.1080/10903127.2023.2270041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE This systematic review aims to identify the diagnostic accuracy of posterior circulation stroke (PCS) by paramedics and the causes and duration of delay in its recognition. METHODS A systematic search using CINAHL Plus, MEDLINE, Scopus, and PubMed was performed. All databases were searched up to May 25, 2022. Studies were included where patients were adults, assessed by paramedics, and PCS was the primary diagnosis. Bias was assessed using the Newcastle-Ottawa Scale and the Effective Practice and Organization of Care tool. Results have been described by proportions, and both sensitivity calculations and subgroup analysis were performed utilizing MedCalc. RESULTS A total of 797 titles/abstracts and a subsequent 87 full texts were screened, of which 15 were included. There were 5395 patients who were assessed by paramedics and had a confirmed diagnosis of PCS. Among five studies containing both true positive and false negative data, there were 98 (45.8%) true positives. PCS patients lost an average of 27 min (p < 0.001) compared to anterior stroke patients in the prehospital setting. One study revealed that educational intervention, including implementing the finger-to-nose test, increased the sensitivity for diagnosis from 45.8 to 74.1% (p = 0.039) and decreased the time from door to computed tomography from 62 to 41 min (p = 0.037). CONCLUSION There is a substantial lack of evidence regarding the diagnosis of PCS by paramedics. Despite the low quality of evidence available, overall, the sensitivity for paramedic PCS diagnosis appears to be poor. Further investigation is required into paramedics' diagnosis of PCS and the use of educational interventions.Prospective Register of Systematic Reviews Registration Number: CRD42022324675.
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Affiliation(s)
- Brooke Hunt
- Department of Paramedicine, Monash University, Melbourne, Australia
| | - Henry Zhao
- Department of Medicine, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Victorian Stroke Telemedicine, Ambulance Victoria, Melbourne, Australia
| | | | - Sam Peart
- Department of Paramedicine, Monash University, Melbourne, Australia
| | - Alexander Olaussen
- Department of Paramedicine, Monash University, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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14
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Maimaitiyiming M, Yang H, Li H, Xu C, Li S, Zhou L, Zhang X, Wang Y. The association of obesity-related dietary patterns and main food groups derived by reduced-rank regression with cardiovascular diseases incidence and all-cause mortality: findings from 116,711 adults. Eur J Nutr 2023; 62:2605-2619. [PMID: 37219593 DOI: 10.1007/s00394-023-03177-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/15/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE Research about using reduced-rank regression (RRR) to simultaneously study the effects of both individual and combined consumption of foods on cardiovascular diseases (CVD) is scarce. METHODS This study included 116,711 CVD-free participants (a median of 11.8 year follow-up) with 2 or more 24-h online dietary assessments. A total of 210 food items were classified into 45 food groups, and the mean amount of each food group was used in RRR to derive dietary patterns (DPs) explaining the maximum shared variation in obesity-related indicators. The associations of DPs and its main food groups (|factor loading| [Formula: see text] 0.2) with the incident CVD and all-cause mortality were examined by Cox model. In cross-sectional analyses, the associations of DP scores with cardiometabolic risk factors (biomarkers) were examined by linear regression. RESULTS The derived DP was characterized by higher intakes of beer and cider, high-sugar beverages, processed meat, red meat, artificial sweetener, and crisps, chips and savory snacks, and lower intakes of olive oil, high fiber breakfast cereals, tea, and vegetable. Compared to the lowest dietary score quintile, those in the highest were associated with higher risks of total CVD (adjusted-HR: 1.45, 95% CI 1.33-1.57) and all-cause mortality (adjusted-HR 1.31, 95% CI 1.18-1.45). We observed consumption alone of these food groups had a consistent but limited health effect on total CVD and all-cause death incidence. These associations were modified by age and sex. Higher DP scores were related to adverse biomarkers profiles. CONCLUSIONS We developed obesity-related DPs prospectively associated with increased risks of CVD and all-cause mortality.
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Affiliation(s)
| | - Hongxi Yang
- Department of Bioinformatics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Huiping Li
- School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Heping District, Tianjin, 300070, China
| | - Chenjie Xu
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Shu Li
- School of Management, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lihui Zhou
- School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Heping District, Tianjin, 300070, China
| | - Xinyu Zhang
- School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Heping District, Tianjin, 300070, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Heping District, Tianjin, 300070, China.
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15
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Godala M, Gaszyńska E, Walczak K, Małecka-Wojciesko E. Evaluation of Albumin, Transferrin and Transthyretin in Inflammatory Bowel Disease Patients as Disease Activity and Nutritional Status Biomarkers. Nutrients 2023; 15:3479. [PMID: 37571416 PMCID: PMC10421392 DOI: 10.3390/nu15153479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is often accompanied by malnutrition that manifests itself as nutrient deficiencies and body mass loss or deficit. The purpose of this study is to evaluate the utility of albumin, transferrin and transthyretin levels in the assessment of nutritional status and IBD activity. The case-control study included 82 IBD patients. The serum concentrations of albumin, transferrin and transthyretine were determined by a quantitative sandwich enzyme-linked immunosorbent assay (ELISA). Significantly lower median concentrations of albumin were found in the IBD patients vs. controls and in CD patients compared to the UC patients. Significantly higher median transthyretin concentrations were found in the IBD patients compared to the healthy subjects. There were no significant differences in median transferrin concentrations between the IBD patients and the healthy subjects. Significantly higher albumin levels were found in IBD patients in remission compared to patients with moderate and severe exacerbation of IBD symptoms. There were no significant differences in the median transferrin or transthyretin levels in patients with IBD depending on disease activity. No differences were identified in the median transferrin or transthyretin levels in the IBD patients according to nutritional status. The median albumin concentrations in the IBD subjects were significantly higher in patients with normal body fat, normal BMI and normal waist circumferences compared to those with an abnormal nutritional status. The albumin levels reflect both nutritional status and disease activity and therefore cannot be considered a prognostic marker of malnutrition in IBD. As regards the utility of transferrin and transthyretin as markers of activity and nutritional status in IBD patients, further studies are required.
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Affiliation(s)
- Małgorzata Godala
- Department of Nutrition and Epidemiology, Medical University of Lodz, 90-752 Lodz, Poland;
| | - Ewelina Gaszyńska
- Department of Nutrition and Epidemiology, Medical University of Lodz, 90-752 Lodz, Poland;
| | - Konrad Walczak
- Department of Internal Medicine and Nephrodiabetology, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Ewa Małecka-Wojciesko
- Department of Digestive Tract Diseases, Medical University of Lodz, 90-647 Lodz, Poland;
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16
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Jang H, Kim R, Lee JT, Lee DH, Giovannucci EL, Oh H. Overall and abdominal obesity and risks of all-cause and cause-specific mortality in Korean adults: a pooled analysis of three population-based prospective cohorts. Int J Epidemiol 2023; 52:1060-1073. [PMID: 36622207 DOI: 10.1093/ije/dyac242] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/27/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Studies found a J-shaped association between body mass index (BMI) and mortality. However, it is unclear whether the association is driven by biases, particularly confounding by fat-free mass. METHODS We conducted an individual-level pooled analysis of three cohorts of Korean adults (aged ≥ 40 years; n = 153 248). Mortality was followed up through December 2019. Anthropometric data were directly measured at baseline. Fat and fat-free mass were predicted using validated prediction models. Using Cox proportional hazards models, we estimated the associations of BMI and waist circumference (WC) with all-cause and cause-specific mortality. To account for biases, we excluded participants aged ≥ 70 years, deaths that occurred within 5 years of follow-up and ever smokers, and adjusted for fat-free mass index (FFMI). RESULTS During the follow-up of up to 18 years, 6061 deaths were identified. We observed J-shaped association of BMI (nadir at 22-26) and monotonically positive association of WC with all-cause, cardiovascular, and cancer mortality among Korean adults without a history of cancer or cardiovascular disease. In the BMI analysis, excluding ever smokers and adjusting for FFMI attenuated the excess mortality in underweight participants and transformed the J-shaped association into a monotonically positive shape, suggesting an increased mortality at BMI > 22.0. Excluding participants aged ≥ 70 years and deaths that occurred within 5 years of follow-up did not change the results. In the WC analysis, the monotonic positive associations did not change after the control. Similar results were observed among participants with a history of cancer or cardiovascular disease. CONCLUSIONS Our data suggest that both overall and abdominal body fat are associated with increased mortality in Korean adults.
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Affiliation(s)
- Hajin Jang
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - Jong-Tae Lee
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - Dong Hoon Lee
- Department of Nutrition, T.H. Chan Harvard School of Public Health, Boston, MA, USA
| | - Edward L Giovannucci
- Department of Nutrition, T.H. Chan Harvard School of Public Health, Boston, MA, USA
- Department of Epidemiology, T.H. Chan Harvard School of Public Health, Boston, MA, USA
| | - Hannah Oh
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
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17
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Sherigar SS, Gamsa AH, Srinivasan K. Oculomotor deficits in attention deficit hyperactivity disorder: a systematic review and meta-analysis. Eye (Lond) 2023; 37:1975-1981. [PMID: 36280758 PMCID: PMC10333290 DOI: 10.1038/s41433-022-02284-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/23/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022] Open
Abstract
There is equivocal evidence on the presence of oculomotor deficits among children with attention deficit hyperactivity disorder (ADHD), which can be an additional challenge in this population, especially with reading-related tasks. This study aimed to review the deficits in the oculomotor parameters among children with ADHD compared with age-matched controls. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A search of original research articles on various databases was done using key terms, such as "oculomotor deficit," "attention deficit hyperactivity disorder," or related terms. We included case-control studies and excluded studies in which children received medications during the test. Twelve original research studies were considered for this review. Ten studies reported data on various types of saccades, two studies reported data on fixation, and one study reported data on pursuit. Among various oculomotor deficits, the forest-plot analysis of an antisaccade task showed that children with ADHD made more direction errors compared to controls. Although independent studies report that ADHD children have poorer performance compared to control populations during oculomotor tasks, there is a lack of evidence to draw a strong conclusion. Children with ADHD are less precise in performing eye movements and need more time to complete the oculomotor tasks than those without ADHD. The overall results provide minimal evidence regarding the presence of various oculomotor deficits in ADHD.
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Affiliation(s)
- Sharath S Sherigar
- Department of Optometry, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Ashwitha H Gamsa
- Department of Optometry, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Krithica Srinivasan
- Department of Optometry, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
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18
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Bernchou TE, Rasmussen LB, Gaarde P, Færgeman K, Voltelen B, Larsen P. Home-delivered between-meal snacks for fragile older adults – A pilot study. AGING AND HEALTH RESEARCH 2023. [DOI: 10.1016/j.ahr.2023.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
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19
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Bahat G, Ilhan B, Catikkas NM, Tufan A, Ozturk S, Dogan H, Karan MA. Associations between obesity, self-reported weakness and their combinations with mortality in nursing home residents. Acta Clin Belg 2023; 78:112-121. [PMID: 35575752 DOI: 10.1080/17843286.2022.2075180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES There are studies on associations between obesity and mortality in nursing home (NH) residents, but the presence of concomitant muscle weakness has not been examined. We considered that self-reported weakness might be a low muscle strength proxy marker. We aimed to examine associations of obesity alone, self-reported muscle weakness alone, and their combination with mortality in NH residents. METHODS This is a retrospective longitudinal follow-up study. We noted age, sex, nutritional status, functionality, number of chronic diseases, and regular medication. Obesity was assessed by the body fat-percentage method estimated by bioimpedance analysis. Weakness was identified by self-reported muscle weakness. Survival was evaluated with a univariate log-rank test and multivariate Cox regression analyses. RESULTS We included 214 participants. In a median follow-up time of 46 months, mortality occurred in 37.4%. In multivariate analysis adjusted by age, sex, undernutrition, number of chronic diseases, and regular medication, functional scores; 'non-weak non-obese' participants or 'weak alone' participants or 'weak+obese' participants had higher mortality risk when compared with the 'obesity alone' participants [hazard ratio (HR) = 2.6, 95% confidence interval (CI) = 1.2-5.5, p = 0.01; HR = 2.6, 95% CI = 1.2-5.9, p = 0.02; HR = 3.0, 95% CI = 1.2-7.7, p = 0.02]. CONCLUSION This is the first report showing that obesity was associated with lower mortality risk if the weakness was not present in NH residents. However, obesity with concomitant weakness was associated with mortality risk similar to non-weak non-obese or weak alone participants. Our study suggests a simple consideration of weakness that can easily be integrated into everyday practice.
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Affiliation(s)
- Gulistan Bahat
- Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Birkan Ilhan
- Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Nezahat Muge Catikkas
- Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Asli Tufan
- Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Savaş Ozturk
- Department of Internal Medicine, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Hafize Dogan
- Department of General Practitioner, Istanbul Kayisdagi Nursing Home, Istanbul, Turkey
| | - Mehmet Akif Karan
- Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul Medical School, Istanbul, Turkey
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20
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Großschädl F, Schoberer D, Eglseer D, Lohrmann C, Everink I, Gordon AL, Schols JMGA, Bauer S. Obesity and its associated factors in older nursing home residents in three European countries-Secondary data analyses from the "International Prevalence Measurement of Care Quality". Int J Older People Nurs 2023; 18:e12530. [PMID: 36840619 DOI: 10.1111/opn.12530] [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: 09/22/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND The prevalence of obesity has risen in recent decades and reached epidemic proportions worldwide. The proportion of those living with obesity is also increasing in nursing homes. This could impact the nursing care required, equipment and facilities provided, and morbidity in these settings. Limited evidence exists on clinical consequences of obesity in nursing home residents and their care. OBJECTIVE Therefore, the aim was to examine the rate and associated factors of obesity (BMI ≥30; class I (BMI 30.0-34.9 kg/m2 ), class II (BMI 35.0-39.9 kg/m2 ), and class III (BMI >40.0 kg/m2 )) amongst older nursing home residents in European countries. METHODS We analysed data from 21,836 people who reside in nursing homes in Austria, the Netherlands, and the United Kingdom. They participated in the "International Prevalence Measurement of Care Quality", a cross sectional study between 2016 and 2019, where trained nurses interviewed the residents, reviewed care records, and conducted clinical examinations. A tested and standardised questionnaire comprised questions on demographic data, measured BMI, medical diagnosis according to ICD-10, and care dependency. Descriptive and logistic regression analyses were performed. RESULTS Obesity rates were highest in Austria (17.1%) and lowest in the UK (13.0%) (p = .006). Residents with obesity were younger and less likely to be care dependent or living with dementia and had more often diabetes mellitus, endocrine, metabolic, and skin diseases compared to residents without obesity (p < .05). Most obese residents had obesity class I. Therefore, two subgroups were built (class I vs. class II + III). Residents with obesity class II + III were more frequently care dependent for mobility, getting dressed and undressed, and personal hygiene compared to residents with class I (p < .05). CONCLUSIONS This study identified several factors that are associated with obesity amongst older nursing home residents in selected European countries. IMPLICATIONS FOR PRACTICE The division into obesity classes is important for planning targeted care according to the individual needs of nursing home residents.
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Affiliation(s)
| | - Daniela Schoberer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Irma Everink
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Adam L Gordon
- Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Derby, UK.,East Midlands Academic Health Sciences Network Patient Safety Collaborative, Nottingham, UK.,NIHR Applied Research Collaboration - East Midlands (ARC-EM), Nottingham, UK
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Silvia Bauer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
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21
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Pereira DS, da Silva VM, Luz GD, Silva FM, Dalle Molle R. Nutrition risk prevalence and screening tools' validity in pediatric patients: A systematic review. JPEN J Parenter Enteral Nutr 2023; 47:184-206. [PMID: 36336352 DOI: 10.1002/jpen.2462] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/23/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
Nutrition screening (NS) allows health professionals to identify patients at nutritional risk (NR), enabling early nutrition intervention. This study aimed to systematically review the criterion validity of NS tools for hospitalized non-critical care pediatric patients and to estimate the prevalence of NR in this population. This research was performed using PubMed, Embase, and Scopus databases until June 2021. The reviewers extracted the studies' general information, the population characteristics, the NR prevalence, and the NS tools' concurrent and predictive validity data. Quality evaluation was performed using the Newcastle-Ottawa Scale, adapted Newcastle-Ottawa Scale, and Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). The primary studies were qualitatively analyzed, and descriptive statistics were calculated to describe the NR prevalence. Of the total 3944 studies found, 49 met the inclusion criteria. Ten different pediatric NS tools were identified; the most frequently used were Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Pediatric Yorkhill Malnutrition Score (PYMS). The mean NR prevalence was 59.85% (range, 14.6%-96.9%). Among all NS tools analyzed, STRONGkids and PYMS showed the best diagnostic performance. STRONGkids had the most studies of predictive validity showing that the NR predicted a higher hospital length of stay (odds ratio [OR], 1.96-8.02), health complications during hospitalization (OR, 3.4), and the necessity for nutrition intervention (OR, 18.93). Considering the diagnostic accuracy, robust and replicated findings of predictive validity, and studies' quality, STRONGkids performed best in identifying NR in the pediatric population among the tools identified.
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Affiliation(s)
- Danielly S Pereira
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Vitória M da Silva
- Curso de Graduação em Nutrição, Centro Universitário Cesuca, Cachoeirinha, Rio Grande do Sul, Brazil
| | - Gabriela D Luz
- Curso de Graduação em Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Flávia M Silva
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil.,Curso de Graduação em Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Roberta Dalle Molle
- Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
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22
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Domenech-Briz V, Gea-Caballero V, Czapla M, Chover-Sierra E, Juárez-Vela R, Santolalla Arnedo I, Villanueva-Blasco VJ, Sánchez-González JL, Martínez-Sabater A. Importance of nutritional assessment tools in the critically ill patient: A systematic review. Front Nutr 2023; 9:1073782. [PMID: 36793999 PMCID: PMC9923005 DOI: 10.3389/fnut.2022.1073782] [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: 10/24/2022] [Accepted: 12/22/2022] [Indexed: 01/31/2023] Open
Abstract
Background Among the risks of the critically ill patient, one of the aspects to be taken into account is the high probability of occurrence of malnutrition risk (40-50%). This process leads to increased morbimortality and worsening. The use of assessment tools allows the individualization of care. Objective To analyze the different nutritional assessment tools used during the admission of critically ill patients. Methods Systematic review of the scientific literature related to the nutritional assessment of critically ill patients. Between January 2017 and February 2022, articles were rescued from the electronic databases "Pubmed," "Scopus," "CINAHL" and "The Cochrane Library"; which will analyze which instruments are used during nutritional assessment in the ICU, as well as their impact on mortality and comorbidity of patients. Results The systematic review was made up of 14 scientific articles that met the selection criteria, obtained from seven different countries. The instruments described were: mNUTRIC, NRS 2002, NUTRIC, SGA, MUST and the ASPEN and ASPEN criteria. All the included studies demonstrated beneficial effects after nutritional risk assessment. mNUTRIC was the most widely used assessment instrument, with the best predictive validity for mortality and adverse outcomes. Conclusion The use of nutritional assessment tools makes it possible to know the real situation of patients, and by objectifying situations, to allow different interventions to improve the nutritional level of patients. The best effectiveness has been achieved using tools such as mNUTRIC, NRS 2002 and SGA.
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Affiliation(s)
| | - Vicente Gea-Caballero
- Faculty of Health Sciences, Valencian International University, Valencia, Spain,Research Group Community Health and Care, SALCOM, Valencian International University, Valencia, Spain
| | - Michal Czapla
- Department of Emergency Medical Service, Wrocław Medical University, Wrocław, Poland,Nursing Department, Faculty of Health Sciences, University of La Rioja, Research Group GRUPAC, Logroño, Spain
| | - Elena Chover-Sierra
- Facultat d’Infermeria i Podologia, Nursing Department, Nursing Care and Education Research Group (GRIECE), Care Research Group (INCLIVA), Hospital Clínico Universitario de Valencia, Universitat de Valencia, Valencia, Spain
| | - Raúl Juárez-Vela
- Nursing Department, Faculty of Health Sciences, University of La Rioja, Research Group GRUPAC, Logroño, Spain,Center of Biomedical Research – CIBIR, Logroño, Spain
| | - Ivan Santolalla Arnedo
- Nursing Department, Faculty of Health Sciences, University of La Rioja, Research Group GRUPAC, Logroño, Spain,Center of Biomedical Research – CIBIR, Logroño, Spain,*Correspondence: Ivan Santolalla Arnedo,
| | - Víctor J. Villanueva-Blasco
- Faculty of Health Sciences, Valencian International University, Valencia, Spain,Research Group on Health and Psycho-Social Adjustment (GI-SAPS), Valencian International University, Valencia, Spain
| | | | - Antonio Martínez-Sabater
- Facultat d’Infermeria i Podologia, Nursing Department, Nursing Care and Education Research Group (GRIECE), Care Research Group (INCLIVA), Hospital Clínico Universitario de Valencia, Universitat de Valencia, Valencia, Spain
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23
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Optimal body composition indices cutoff values based on all-cause mortality in the elderly. Exp Gerontol 2023; 171:112026. [PMID: 36400117 DOI: 10.1016/j.exger.2022.112026] [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: 09/24/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
The cutoffs of body composition indices are inconclusive in older populations. This study is designed toward determining the optimal cutoffs of the body composition indices based on the association with all-cause mortality. During 2009 and 2010, a cohort population of 1200 was enrolled in central western Taiwan. Of the 1200 subjects, 428 older subjects (mean age: 72.5 ± 5.4 yrs.; 47.7 % were women) were censored in this study. The waist circumference (WC) and body mass index (BMI) were measured using standard anthropometric methods. A multi-frequency bioelectrical impedance analysis device was utilized to estimate each participant's body composition indices, including percent body fat (PBF) and skeletal muscle mass index (SMMI). All claims records of death from 2009 to 2018 in the National Health Insurance Research Databank were identified. A receiver operating characteristic curve method and the highest Youden index were used to identify the optimal cutoffs. A Cox proportional hazards regression analysis was used to model associations between each of the recommended cutoff values with all-cause mortality. The all-cause mortality rate was 20.09 % after a follow-up period of 5.86 ± 2.39 person-years. The significant indices cutoff value was identified to be WC (86.7 cm) for older women and BMI (23.8 kg/m2) and as WC (77.6 cm), and SMMI (8.7 kg/m2) for older men. The recommended optimal cutoffs of the body composition indices were gender-specific and can be utilized to predict the risk of all-cause mortality.
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24
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Bikomeye JC, Balza JS, Kwarteng JL, Beyer AM, Beyer KMM. The impact of greenspace or nature-based interventions on cardiovascular health or cancer-related outcomes: A systematic review of experimental studies. PLoS One 2022; 17:e0276517. [PMID: 36417344 PMCID: PMC9683573 DOI: 10.1371/journal.pone.0276517] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
SIGNIFICANCE Globally, cardiovascular disease (CVD) and cancer are leading causes of morbidity and mortality. While having different etiologies, CVD and cancer are linked by multiple shared risk factors, the presence of which exacerbate adverse outcomes for individuals with either disease. For both pathologies, factors such as poverty, lack of physical activity (PA), poor dietary intake, and climate change increase risk of adverse outcomes. Prior research has shown that greenspaces and other nature-based interventions (NBIs) contribute to improved health outcomes and climate change resilience. OBJECTIVE To summarize evidence on the impact of greenspaces or NBIs on cardiovascular health and/or cancer-related outcomes and identify knowledge gaps to inform future research. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and Peer Review of Electronic Search Strategies (PRESS) guidelines, we searched five databases: Web of Science, Scopus, Medline, PsycINFO and GreenFile. Two blinded reviewers used Rayyan AI and a predefined criteria for article inclusion and exclusion. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale (NOS). This review is registered with PROSPERO, ID # CRD42021231619. RESULTS & DISCUSSION Of 2565 articles retrieved, 31 articles met the inclusion criteria, and overall had a low risk of bias. 26 articles studied cardiovascular related outcomes and 5 studied cancer-related outcomes. Interventions were coded into 4 categories: forest bathing, green exercise, gardening, and nature viewing. Outcomes included blood pressure (BP), cancer-related quality of life (QoL) and (more infrequently) biomarkers of CVD risk. Descriptions of findings are presented as well as visual presentations of trends across the findings using RAW graphs. Overall studies included have a low risk of bias; and alluvial chart trends indicated that NBIs may have beneficial effects on CVD and cancer-related outcomes. CONCLUSIONS & IMPLICATIONS (1) Clinical implication: Healthcare providers should consider the promotion of nature-based programs to improve health outcomes. (2) Policy implication: There is a need for investment in equitable greenspaces to improve health outcomes and build climate resilient neighborhoods. (3) Research or academic implication: Research partnerships with community-based organizations for a comprehensive study of benefits associated with NBIs should be encouraged to reduce health disparities and ensure intergenerational health equity. There is a need for investigation of the mechanisms by which NBIs impact CVD and exploration of the role of CVD biological markers of inflammation among cancer survivors.
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Affiliation(s)
- Jean C. Bikomeye
- Division of Epidemiology & Social Sciences, PhD Program in Public and Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Joanna S. Balza
- Division of Epidemiology & Social Sciences, PhD Program in Public and Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Jamila L. Kwarteng
- Division of Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, United States of America
- MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Andreas M. Beyer
- MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
- Division of Cardiology, Department of Medicine, Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Kirsten M. M. Beyer
- Division of Epidemiology & Social Sciences, PhD Program in Public and Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, United States of America
- MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
- * E-mail:
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25
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Hu J, Chen X, Yang J, Giovannucci E, Lee DH, Luo W, Cheng Q, Gong L, Wang Z, Li Q, Yang S. Association between fat mass and mortality: analysis of Mendelian randomization and lifestyle modification. Metabolism 2022; 136:155307. [PMID: 36058288 DOI: 10.1016/j.metabol.2022.155307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The association between fat mass and mortality has been equivocally shown to be linear, J-shaped, and U-shaped. We aimed to clarify this relationship based on Mendelian randomization (MR) analysis and lifestyle modification. METHODS This prospective analysis included 449,831 participants from UK Biobank. Linear MR analysis was used to estimate the linear relationship between fat mass and mortality. We assessed whole body fat mass by bioimpedance analysis at baseline and categorized subjects into five equal groups based on fat mass index (FMI). The association between FMI and mortality were investigated among whole population and in subgroups stratified by individual lifestyle factors, including diet, physical activity, smoking, alcohol, sleep and psychological health. FINDINGS Linear MR analyses indicated a positive association between genetically predicted fat mass and all-cause mortality (HR 1.10, 95 % CI 1.08-1.12, P < 0.001). The association between FMI and all-cause mortality was manifested as J-shaped (HRs across FMI categories: 1.04, 1.00, 1.07, 1.21, 1.54), which was significantly modified by the number of low-risk lifestyle factors (P for interaction<0.001). When evaluating individual lifestyle factors, we observed a nonlinear relationship between FMI and all-cause mortality among participants who had high-risk lifestyle factors, while a linear relationship was observed among participants who had low-risk lifestyle factors, especially for those with adequate physical activity (HRs across FMI categories: 0.95, 1.00, 1.05, 1.17, 1.44) and who never smoked (0.96, 1.00, 1.03, 1.14, 1.51). INTERPRETATION Genetically determined fat mass is causally and linearly associated with mortality. The J-shape association between anthropometric FMI and mortality is caused by high-risk lifestyle factors.
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Affiliation(s)
- Jinbo Hu
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Departments of Nutrition and Epidemiology, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Boston, MA, USA
| | - Xiangjun Chen
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Edward Giovannucci
- Departments of Nutrition and Epidemiology, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Boston, MA, USA
| | - Dong Hoon Lee
- Departments of Nutrition and Epidemiology, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Boston, MA, USA
| | - Wenjin Luo
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingfeng Cheng
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lilin Gong
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhihong Wang
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qifu Li
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Shumin Yang
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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26
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Shen FC, Chen ME, Wu WT, Kuo IC, Niu SW, Lee JJ, Hung CC, Chang JM, Hwang SJ. Normal weight and waist obesity indicated by increased total body fat associated with all-cause mortality in stage 3–5 chronic kidney disease. Front Nutr 2022; 9:982519. [PMID: 36185692 PMCID: PMC9523665 DOI: 10.3389/fnut.2022.982519] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with chronic kidney disease (CKD) demonstrate a survival benefit with a high body mass index (BMI); this is the obesity paradox. Central obesity has a higher prognostic value than BMI, even in those with normal weight. Whether total body fat percentage (TBF%) provides more information than BMI and waist circumference (WC) remains unknown. We included 3,262 Asian patients with stage 3–5 CKD and divided these patients by TBF% and waist-to-height ratio (WHtR) quartiles (Q1–Q4). TBF% was associated with BMI, WC, nutritional markers, and C-reactive protein. In all patients, BMI but not TBF% or WHtR demonstrated a survival paradox. In patients with BMI <25 kg/m2, but not in those with BMI ≥ 25 kg/m2, TBF% Q4 and WHtR Q4 were associated with all-cause mortality, with hazard ratios [HRs; 95% confidence intervals (CIs)] of 2.35 (1.31–4.22) and 1.38 (1.06–1.80), respectively. The HRs of TBF% Q4 for all-cause mortality were 2.90 (1.50–5.58) in patients with a normal WC and 3.81 (1.93–7.50) in patients with normal weight and normal WC (All P for interaction < 0.05). In conclusion, TBF% can predict all-cause mortality in patients with advanced CKD and a normal weight, normal WC, or both.
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Affiliation(s)
- Feng-Ching Shen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-En Chen
- Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wei-Tsung Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Ching Kuo
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Wen Niu
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-Jung Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Chih Hung
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- *Correspondence: Chi-Chih Hung
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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27
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Woolway GE, Smart SE, Lynham AJ, Lloyd JL, Owen MJ, Jones IR, Walters JTR, Legge SE. Schizophrenia Polygenic Risk and Experiences of Childhood Adversity: A Systematic Review and Meta-analysis. Schizophr Bull 2022; 48:967-980. [PMID: 35674151 PMCID: PMC9434424 DOI: 10.1093/schbul/sbac049] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND HYPOTHESIS Schizophrenia has been robustly associated with multiple genetic and environmental risk factors. Childhood adversity is one of the most widely replicated environmental risk factors for schizophrenia, but it is unclear if schizophrenia genetic risk alleles contribute to this association. STUDY DESIGN In this systematic review and meta-analysis, we assessed the evidence for gene-environment correlation (genes influence likelihood of environmental exposure) between schizophrenia polygenic risk score (PRS) and reported childhood adversity. We also assessed the evidence for a gene-environment interaction (genes influence sensitivity to environmental exposure) in relation to the outcome of schizophrenia and/or psychosis. This study was registered on PROSPERO (CRD42020182812). Following PRISMA guidelines, a search for relevant literature was conducted using Cochrane, MEDLINE, PsycINFO, Web of Science, and Scopus databases until February 2022. All studies that examined the association between schizophrenia PRS and childhood adversity were included. STUDY RESULTS Seventeen of 650 identified studies met the inclusion criteria and were assessed against the Newcastle-Ottawa Scale for quality. The meta-analysis found evidence for gene-environment correlation between schizophrenia PRS and childhood adversity (r = .02; 95% CI = 0.01, 0.03; P = .001), but the effect was small and therefore likely to explain only a small proportion of the association between childhood adversity and psychosis. The 4 studies that investigated a gene-environment interaction between schizophrenia PRS and childhood adversity in increasing risk of psychosis reported inconsistent results. CONCLUSIONS These findings suggest that a gene-environment correlation could explain a small proportion of the relationship between reported childhood adversity and psychosis.
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Affiliation(s)
- Grace E Woolway
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Sophie E Smart
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Amy J Lynham
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Jennifer L Lloyd
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Michael J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Ian R Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Sophie E Legge
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
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28
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Burman M, Hörnsten C, Gustafson Y, Olofsson B, Nordström P. Obesity may increase survival, regardless of nutritional status: a Swedish cohort study in nursing homes. BMC Geriatr 2022; 22:655. [PMID: 35948885 PMCID: PMC9364570 DOI: 10.1186/s12877-022-03356-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/27/2022] [Indexed: 12/01/2022] Open
Abstract
Background To investigate the associations between the body mass index (BMI), Mini Nutritional Assessment–Short Form (MNA-SF) scores, and 2-year mortality. Methods A nationwide cohort study using data from a national quality register of older (age ≥ 65 years) nursing home residents (N = 47,686). Individuals were categorized according to BMI as underweight (< 18.5 kg/m2), normal-weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (class I, 30.0–34.9 kg/m2; class II, 35.0–39.9 kg/m2; class III, ≥ 40.0 kg/m2). Participants’ nutritional status were categorized as good (MNA-SF score 12–14), at risk of malnutrition (MNA-SF score 8–11), or malnutrition (MNA-SF score 0–7). Associations with mortality were analysed using Cox proportional-hazards models. Results At baseline, 16.0% had obesity, and 14.6% were malnourished. During 2 years of follow-up, 23,335 (48.9%) individuals died. Compared with normal-weight individuals, mortality was greater among underweight individuals [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.55–1.69] and lesser among individuals with class I (HR 0.63, 95% CI 0.60–0.66), class II (HR 0.62, 95% CI 0.56–0.68), and class III (HR 0.80, 95% CI 0.69–0.94) obesity. Compared with individuals with good nutritional status, mortality was increased for those with malnutrition (HR 2.98,95% CI 2.87–3.10). Lower mortality among obese individuals was also seen in subgroups defined according to MNA-SF scores. Conclusions Among older nursing home residents, obesity, including severe obesity, was associated with lower 2-year mortality. Higher BMIs were associated with better survival, regardless of nutritional status according to MNA-SF. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03356-1.
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Affiliation(s)
- Maria Burman
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87, Umeå, Sweden.
| | - Carl Hörnsten
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87, Umeå, Sweden
| | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87, Umeå, Sweden
| | | | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87, Umeå, Sweden
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Parkinson M, Thompson J. An exploration of the challenges of providing person-centred care for older care home residents with obesity. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1112-e1122. [PMID: 34268838 DOI: 10.1111/hsc.13519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 05/27/2021] [Accepted: 07/04/2021] [Indexed: 06/13/2023]
Abstract
The aim of this study was to explore care home staff's views on the prevalence of obesity in older people and how well prepared they were for any rise in applications for placements. Thematic analysis was used to analyse focus group interview data collected from seven care homes/33 participants in N.E. England. Findings revealed rises in demand by older people with obesity for care home admittance, consistent with rising prevalence of obesity in this demographic nationally. Findings also highlight implications of rising prevalence of obesity in older people, particularly care home staff's ability to deliver person-centred care (PCC) and the importance of appropriate support/recognition of this as an emergent issue to be addressed at a higher executive level and by health/social care authorities. Ways of ensuring PCC are discussed. Given continuing trends towards rising prevalence of obesity in this population, the findings possess broader translational potential.
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Affiliation(s)
- Mark Parkinson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK
- Fuse, Centre for Translational Research in Public Health-a UK Clinical Research Collaboration Centre for Translational Research in Public Health & NIHR School for Public Health Research (SPHR) Centre of Excellence, Newcastle, UK
| | - Juliana Thompson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK
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Elevated All-Cause Mortality among Overweight Older People: AI Predicts a High Normal Weight Is Optimal. Geriatrics (Basel) 2022; 7:geriatrics7030068. [PMID: 35735773 PMCID: PMC9222635 DOI: 10.3390/geriatrics7030068] [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: 04/17/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
It has been proposed that being overweight may provide an advantage with respect to mortality in older people, although this has not been investigated fully. Therefore, to confirm that and elucidate the underlying mechanism, we investigated mortality in older people using explainable artificial intelligence (AI) with the gradient-boosting algorithm XGboost. Baseline body mass indexes (BMIs) of 5699 people (79.3 ± 3.9 years) were evaluated to determine the relationship with all-cause mortality over eight years. In the unadjusted model, the first negative (protective) BMI range for mortality was 25.9−28.4 kg/m2. However, in the adjusted cross-validation model, this range was 22.7−23.6 kg/m2; the second and third negative BMI ranges were then 25.8−28.2 and 24.6−25.8 kg/m2, respectively. Conversely, the first advancing BMI range was 12.8−18.7 kg/m2, which did not vary across conditions with high feature importance. Actual and predicted mortality rates in participants aged <90 years showed a negative-linear or L-shaped relationship with BMI, whereas predicted mortality rates in men aged ≥90 years showed a blunt U-shaped relationship. In conclusion, AI predicted that being overweight may not be an optimal condition with regard to all-cause mortality in older adults. Instead, it may be that a high normal weight is optimal, though this may vary according to the age and sex.
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Conde WL, Silva IVD, Ferraz FR. Undernutrition and obesity trends in Brazilian adults from 1975 to 2019 and its associated factors. CAD SAUDE PUBLICA 2022; 38Suppl 1:e00149721. [PMID: 35613255 DOI: 10.1590/0102-311xe00149721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 02/04/2022] [Indexed: 12/15/2022] Open
Abstract
Nutritional status has evolved in a dual trend worldwide: underweight has become a minor or local issue while overweight or obesity has risen to play a major role in the global burden of disease. In 2014, Brazil was ranked as the third country with the highest absolute number of obese men. Our aim was to estimate trends of underweight and obesity among Brazilian adults using a comprehensive set of surveys from 1974 to 2019. The data used in the study originate from subjects aged ≥ 18 in six Brazilian national surveys, presented in chronological order: Brazilian National Survey on Household Expenses (ENDEF 1974-1975); Brazilian National Survey on Health and Nutrition (PNSN 1989); Brazilian Household Budget Survey (POF 2002-2003, 2008-2009); and Brazilian National Health Survey (PNS 2013 and 2019). All six surveys were designed to sample household complexes that were representative of the Brazilian population. Body mass index was calculated (kg/m2). The nutritional status of individuals was classified following the standards. We have modeled obesity trend according to income and education strata. The trajectories of underweight and obesity over time in Brazil draw the classical "X" of nutrition transition. From 1975 to 2019 underweight has decreased from 9.1% to 2.5% among men and 12.2% to 3.4% among women. On the other hand, obesity trajectories have scaled up from 3% to 22% among men and from 9% to 30% among women. The increase in obesity rate is directly and negatively proportional to income quintiles. Sociodemographic (income and education) improvement is associated with an increase in obesity. All public policies intending to stop the obesity spread in Brazil have been ineffective or too small to be effective.
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Igbinosa O, Brgdar A, Asemota J, Taha ME, Yi J, Lyonga Ngonge A, Vanaparthy S, Hammonds R, Talbet J, Omire-Mayor D, Ngwa J, Rizwan M, Prafulla M, Opoku I. In-Hospital Outcomes of Coronary Artery Stenting in Patients With ST-Elevation Myocardial Infarction (STEMI) and Metabolic Syndrome: Insights From the National Inpatient Sample. Cureus 2022; 14:e24664. [PMID: 35663720 PMCID: PMC9156345 DOI: 10.7759/cureus.24664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Metabolic syndrome (MetS) has been recognized as a global health problem. Concurrent MetS diagnosis in patients with ST-elevation myocardial infarction (STEMI) is becoming increasingly common. Given the paucity of studies on the impact of MetS on treatment outcomes in STEMI patients, the purpose of this study was to evaluate in-hospital mortality in STEMI patients with a concurrent MetS diagnosis undergoing a stenting procedure to treat their underlying coronary artery disease. Method Patients with or without MetS who underwent coronary stenting following STEMI between 2005 and 2014 were identified from the National Inpatient Sample database. Patients' demographics, comorbidities, and outcomes were compared using a t-test and Pearson's Chi-square test. In addition, 1:1 propensity score matching was performed for age, gender, and race. Results Out of 1,938,097 STEMI patients, 5,817 patients with MetS underwent coronary stenting following STEMI and were matched with 5,817 patients with no Mets. MetS group had significantly higher rates of diabetes, hypertension, hyperlipidemia, chronic kidney disease, and obstructive sleep apnea than the no MetS group but lower rates of heart failure and chronic obstructive pulmonary disease. In-hospital mortality following STEMI was significantly lower in patients with MetS (2.5% vs. 7.1%, p<0.001) and remained significant after adjusting for potential confounders (odds ratio (OR) 0.34, 95% confidence interval (95% CI) 0.28-0.42, p<0.0001). Conclusion Concurrent diagnosis of MetS among patients undergoing coronary stenting is associated with a decreased in-hospital mortality risk. The impact of specific MetS components on the observed reduction in mortality remains unclear and warrants evaluation in future studies.
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Lv Y, Mao C, Gao X, Ji JS, Kraus VB, Yin Z, Yuan J, Chen H, Luo J, Zhou J, Li Z, Duan J, Zhu Q, Zeng Y, Wang W, Wang J, Shi X. The obesity paradox is mostly driven by decreased noncardiovascular disease mortality in the oldest old in China: a 20-year prospective cohort study. NATURE AGING 2022; 2:389-396. [PMID: 37118064 DOI: 10.1038/s43587-022-00201-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 03/07/2022] [Indexed: 04/30/2023]
Abstract
National and international recommendations of healthy body mass index (BMI) are primarily based on evidence in young and middle-aged populations, with an insufficient representation of the oldest old (aged ≥80 years). Here, we report associations between BMI and mortality risk in 27,026 community-dwelling oldest old (mean age, 92.7 ± 7.5 years) in China from 1998 to 2018. Nonlinear curves showed reverse J-shaped associations of BMI with cardiovascular disease (CVD), non-CVD and all-cause mortality, with a monotonic decreased risk up to BMIs in the overweight and mild obesity range and flat hazard ratios thereafter. Compared to normal weight, overweight and obesity were significantly associated with decreased non-CVD and all-cause mortality, but not with CVD mortality. Similar associations were found for waist circumference. Our results lend support to the notion that optimal BMI in the oldest old may be around the overweight or mild obesity range and challenge the application of international and national guidelines on optimal BMI in this age group.
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Affiliation(s)
- Yuebin Lv
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chen Mao
- Division of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiang Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Fudan University, Shanghai, China
| | - John S Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Environmental Sciences and Policy, Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - Virginia Byers Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Zhaoxue Yin
- Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinqiu Yuan
- Division of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Huashuai Chen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jiesi Luo
- Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinhui Zhou
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhihao Li
- Division of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Jun Duan
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qingyang Zhu
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yi Zeng
- Center for the study of Aging and Human Development and the Geriatric Division of School of Medicine, Duke University, Durham, NC, USA
- Center for Study of Healthy Aging and Development Studies, Peking University, Beijing, China
| | - Wentao Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiaonan Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.
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Woo J. What is an optimal BMI after eighty? NATURE AGING 2022; 2:371-372. [PMID: 37118063 DOI: 10.1038/s43587-022-00212-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Perazza LR, Brown-Borg HM, Thompson LV. Physiological Systems in Promoting Frailty. Compr Physiol 2022; 12:3575-3620. [PMID: 35578945 DOI: 10.1002/cphy.c210034] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Frailty is a complex syndrome affecting a growing sector of the global population as medical developments have advanced human mortality rates across the world. Our current understanding of frailty is derived from studies conducted in the laboratory as well as the clinic, which have generated largely phenotypic information. Far fewer studies have uncovered biological underpinnings driving the onset and progression of frailty, but the stage is set to advance the field with preclinical and clinical assessment tools, multiomics approaches together with physiological and biochemical methodologies. In this article, we provide comprehensive coverage of topics regarding frailty assessment, preclinical models, interventions, and challenges as well as clinical frameworks and prevalence. We also identify central biological mechanisms that may be at play including mitochondrial dysfunction, epigenetic alterations, and oxidative stress that in turn, affect metabolism, stress responses, and endocrine and neuromuscular systems. We review the role of metabolic syndrome, insulin resistance and visceral obesity, focusing on glucose homeostasis, adenosine monophosphate-activated protein kinase (AMPK), mammalian target of rapamycin (mTOR), and nicotinamide adenine dinucleotide (NAD+ ) as critical players influencing the age-related loss of health. We further focus on how immunometabolic dysfunction associates with oxidative stress in promoting sarcopenia, a key contributor to slowness, weakness, and fatigue. We explore the biological mechanisms involved in stem cell exhaustion that affect regeneration and may contribute to the frailty-associated decline in resilience and adaptation to stress. Together, an overview of the interplay of aging biology with genetic, lifestyle, and environmental factors that contribute to frailty, as well as potential therapeutic targets to lower risk and slow the progression of ongoing disease is covered. © 2022 American Physiological Society. Compr Physiol 12:1-46, 2022.
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Affiliation(s)
- Laís R Perazza
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Holly M Brown-Borg
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - LaDora V Thompson
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
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Ler P, Li X, Hassing LB, Reynolds CA, Finkel D, Karlsson IK, Dahl Aslan AK. Independent and joint effects of body mass index and metabolic health in mid- and late-life on all-cause mortality: a cohort study from the Swedish Twin Registry with a mean follow-up of 13 Years. BMC Public Health 2022; 22:718. [PMID: 35410261 PMCID: PMC9004188 DOI: 10.1186/s12889-022-13082-3] [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: 10/11/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is robust evidence that in midlife, higher body mass index (BMI) and metabolic syndrome (MetS), which often co-exist, are associated with increased mortality risk. However, late-life findings are inconclusive, and few studies have examined how metabolic health status (MHS) affects the BMI-mortality association in different age categories. We, therefore, aimed to investigate how mid- and late-life BMI and MHS interact to affect the risk of mortality. METHODS This cohort study included 12,467 participants from the Swedish Twin Registry, with height, weight, and MHS measures from 1958-2008 and mortality data linked through 2020. We applied Cox proportional hazard regression with age as a timescale to examine how BMI categories (normal weight, overweight, obesity) and MHS (identification of MetS determined by presence/absence of hypertension, hyperglycemia, low HDL, hypertriglyceridemia), independently and in interaction, are associated with the risk of all-cause mortality. Models were adjusted for sex, education, smoking, and cardiovascular disease. RESULTS The midlife group included 6,252 participants with a mean age of 59.6 years (range = 44.9-65.0) and 44.1% women. The late-life group included 6,215 participants with mean age 73.1 years (65.1-95.3) and 46.6% women. In independent effect models, metabolically unhealthy status in midlife increased mortality risks by 31% [hazard ratio 1.31; 95% confidence interval 1.12-1.53] and in late-life, by 18% (1.18;1.10-1.26) relative to metabolically healthy individuals. Midlife obesity increased the mortality risks by 30% (1.30;1.06-1.60) and late-life obesity by 15% (1.15; 1.04-1.27) relative to normal weight. In joint models, the BMI estimates were attenuated while those of MHS were less affected. Models including BMI-MHS categories revealed that, compared to metabolically healthy normal weight, the metabolically unhealthy obesity group had increased mortality risks by 53% (1.53;1.19-1.96) in midlife, and across all BMI categories in late-life (normal weight 1.12; 1.01-1.25, overweight 1.10;1.01-1.21, obesity 1.31;1.15-1.49). Mortality risk was decreased by 9% (0.91; 0.83-0.99) among those with metabolically healthy overweight in late-life. CONCLUSIONS MHS strongly influenced the BMI-mortality association, such that individuals who were metabolically healthy with overweight or obesity in mid- or late-life did not carry excess risks of mortality. Being metabolically unhealthy had a higher risk of mortality independent of their BMI.
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Affiliation(s)
- Peggy Ler
- Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Xia Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Linda B Hassing
- Department of Psychology and Centre for Ageing and Health, University of Gothenburg, Gothenburg, Sweden
| | - Chandra A Reynolds
- Department of Psychology, University of California - Riverside, Riverside, CA, USA
| | - Deborah Finkel
- Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Psychology, Indiana University Southeast, New Albany, Indiana, USA
| | - Ida K Karlsson
- Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna K Dahl Aslan
- Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Health Sciences, University of Skövde, Skövde, Sweden
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Meister BM, Hong SG, Shin J, Rath M, Sayoc J, Park JY. Healthy versus Unhealthy Adipose Tissue Expansion: the Role of Exercise. J Obes Metab Syndr 2022; 31:37-50. [PMID: 35283364 PMCID: PMC8987461 DOI: 10.7570/jomes21096] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 12/14/2022] Open
Abstract
Although the hallmark of obesity is the expansion of adipose tissue, not all adipose tissue expansion is the same. Expansion of healthy adipose tissue is accompanied by adequate capillary angiogenesis and mitochondria-centered metabolic integrity, whereas expansion of unhealthy adipose tissue is associated with capillary and mitochondrial derangement, resulting in deposition of immune cells (M1-stage macrophages) and excess production of pro-inflammatory cytokines. Accumulation of these dysfunctional adipose tissues has been linked to the development of obesity comorbidities, such as type 2 diabetes, hypertension, dyslipidemia, and cardiovascular disease, which are leading causes of human mortality and morbidity in modern society. Mechanistically, vascular rarefaction and mitochondrial incompetency (for example, low mitochondrial content, fragmented mitochondria, defective mitochondrial respiratory function, and excess production of mitochondrial reactive oxygen species) are frequently observed in adipose tissue of obese patients. Recent studies have demonstrated that exercise is a potent behavioral intervention for preventing and reducing obesity and other metabolic diseases. However, our understanding of potential cellular mechanisms of exercise, which promote healthy adipose tissue expansion, is at the beginning stage. In this review, we hypothesize that exercise can induce unique physiological stimuli that can alter angiogenesis and mitochondrial remodeling in adipose tissues and ultimately promote the development and progression of healthy adipogenesis. We summarize recent reports on how regular exercise can impose differential processes that lead to the formation of either healthy or unhealthy adipose tissue and discuss key knowledge gaps that warrant future research.
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Affiliation(s)
- Benjamin M Meister
- Department of Kinesiology, College of Public Health and Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Soon-Gook Hong
- Department of Kinesiology, College of Public Health and Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Junchul Shin
- Department of Kinesiology, College of Public Health and Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Meghan Rath
- Department of Kinesiology, College of Public Health and Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Jacqueline Sayoc
- Department of Kinesiology, College of Public Health and Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Joon-Young Park
- Department of Kinesiology, College of Public Health and Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
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Bang HJ, Park KN, Youn CS, Kim HJ, Oh SH, Lim JY, Song H, Kim SH, Jeong WJ, Kim HJ. The relationship between body mass index and neurologic outcomes in survivors of out-of-hospital cardiac arrest treated with targeted temperature management. PLoS One 2022; 17:e0265656. [PMID: 35349593 PMCID: PMC8963585 DOI: 10.1371/journal.pone.0265656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background The association of body mass index with outcome in patients treated with targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA) is unclear. The purpose of this study was to examine the effect of body mass index (BMI) on neurological outcomes and mortality in resuscitated patients treated with TTM after OHCA. Methods This multicenter, prospective, observational study was performed with data from 22 hospitals included in the Korean Hypothermia Network KORHN-PRO registry. Comatose adult patients treated with TTM after OHCA between October 2015 and December 2018 were enrolled. The BMI of each patient was calculated and classified according to the criteria of the World Health Organization (WHO). Each group was analyzed in terms of demographic characteristics and associations with six-month neurologic outcomes and mortality after cardiac arrest (CA). Results Of 1,373 patients treated with TTM identified in the registry, 1,315 were included in this study. One hundred two patients were underweight (BMI <18.5 kg/m2), 798 were normal weight (BMI 18.5–24.9 kg/m2), 332 were overweight (BMI 25–29.9 kg/m2), and 73 were obese (BMI ≥ 30 kg/m2). The higher BMI group had younger patients and a greater incidence of diabetes and hypertension. Six-month neurologic outcomes and mortality were not different among the BMI groups (p = 0.111, p = 0.234). Univariate and multivariate analyses showed that BMI classification was not associated with six-month neurologic outcomes or mortality. In the subgroup analysis, the underweight group treated with TTM at 33°C was associated with poor neurologic outcomes six months after CA (OR 2.090, 95% CI 1.010–4.325, p = 0.047), whereas the TTM at 36°C group was not (OR 0.88, 95% CI 0.249–3.112, p = 0.843). Conclusions BMI was not associated with six-month neurologic outcomes or mortality in patients surviving OHCA. However, in the subgroup analysis, underweight patients were associated with poor neurologic outcomes when treated with TTM at 33°C.
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Affiliation(s)
- Hyo Jin Bang
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyu Nam Park
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chun Song Youn
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Han Joon Kim
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sang Hoon Oh
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jee Yong Lim
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hwan Song
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Soo Hyun Kim
- Department of Emergency Medicine, Eunpyeong St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Won Jung Jeong
- Department of Emergency Medicine, St. Vincent’s Hospital, The Catholic University of Korea College of Medicine, Suwon, South Korea
| | - Hyo Joon Kim
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- * E-mail:
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No obesity paradox in patients with community-acquired pneumonia - secondary analysis of a randomized controlled trial. Nutr Diabetes 2022; 12:12. [PMID: 35322019 PMCID: PMC8943130 DOI: 10.1038/s41387-022-00190-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/10/2021] [Accepted: 01/14/2022] [Indexed: 12/04/2022] Open
Abstract
Background Obesity is associated with an increased risk for several chronic conditions and mortality. However, there are data in support of beneficial outcome in acute medical conditions such as community-acquired pneumonia (CAP), termed “obesity paradox”. The aim of this study was to test the association of BMI with clinical outcomes in a large randomized clinical trial of patients hospitalized with CAP. Design and Methods In total, 773 patients hospitalized with CAP were included in this study. Patients were stratified into four groups according to their baseline BMI (underweight <18.5, normal weight 18.5–25, overweight 25–30, and obese >30 kg/m2). The primary endpoint was time to clinical stability (TTCS). Secondary endpoints included 30-day mortality, ICU admission rate, CAP complications, and duration of antibiotic treatment. Results BMI and TTCS had a U-shaped association with shortest TTCS among patients at an overweight BMI of 28 kg/m2. In patients with obesity, there was a trend towards reduced hazards to reach clinical stability when compared to patients with normal weight (HR 0.82; 95%CI, 0.67–1.02; p = 0.07). In underweight BMI group TTCS was prolonged by 1 day (HR 0.63; 95%CI, 0.45–0.89; p = 0.008). There was no difference in mortality or ICU admission rates between BMI groups (p > 0.05). While in the underweight BMI group the total duration of antibiotic treatment was prolonged by 2.5 days (95%CI, 0.88–4.20, p = 0.003), there was no difference in patients with obesity. Conclusions The overweight BMI group had shortest time to clinical stability. While underweight patients face adverse clinical outcomes, there is neither beneficial, nor adverse outcome in patients with obesity hospitalized for CAP. ClinicalTrials.gov (registration no. NCT00973154).
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Brgdar A, Gharbin J, Elawad A, Khalafalla S, Bishaw A, Balogun AF, Taha ME. The Effects of Body Mass Index on In-Hospital Mortality and Outcomes in Patients With Heart Failure: A Nationwide Analysis. Cureus 2022; 14:e22691. [PMID: 35386147 PMCID: PMC8967113 DOI: 10.7759/cureus.22691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/05/2022] Open
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Pereira TG, Lima J, Silva FM. Undernutrition is associated with mortality, exacerbation and poorer quality of life in COPD patients: a systematic review with meta‐analysis of observational studies. JPEN J Parenter Enteral Nutr 2022; 46:977-996. [DOI: 10.1002/jpen.2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/22/2022] [Accepted: 02/10/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Thainá Gattermann Pereira
- Nutrition Science Postgraduation Program of Federal University of Health Science of Porto Alegre Porto Alegre Rio Grande do Sul Brazil
| | - Júlia Lima
- Federal University of Health Science of Porto Alegre Porto Alegre Rio Grande do Sul Brazil
| | - Flávia Moraes Silva
- Nutrition Department and Nutrition Science Postgraduation Program of Federal University of Health Science of Porto Alegre Porto Alegre Rio Grande do Sul Brazil
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Chooi JE, Ravindiran A, Balasubramanian SP. The influence of incidental detection of thyroid nodule on thyroid cancer risk and prognosis-A systematic review. Clin Endocrinol (Oxf) 2022; 96:246-254. [PMID: 34378225 DOI: 10.1111/cen.14575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Clinically inapparent thyroid nodules discovered serendipitously on imaging for nonthyroid indications are termed as thyroid incidentalomas. It is unclear whether these incidentalomas have a lower prevalence of malignancy or slower tumour progression compared to symptomatic nodules. The aims of this systematic review were to determine the impact of incidental detection of thyroid nodules on both the risk of malignancy and on prognosis in patients with thyroid cancer. METHOD PubMed and MEDLINE® on Web of Science databases were searched from inception to March 2020 for English language articles reporting on human studies of thyroid cancer risk and/or prognosis in incidental and nonincidental nodules. RESULTS Eighteen observational studies published between 1998 and 2020 were eligible for analysis; four studies reported on risk, nine on prognosis and five studies reported on both risk and prognosis. When comparing the incidental and nonincidental groups in the risk study, the odds of incidental detection in the cancer and benign groups ranged from 0.16 to 0.5 and 0.06 to 0.38, respectively (odds ratio [OR] = 0.64-2.86) in case-control studies (n = 6); the risk of malignancy for thyroid nodules ranged from 4% to 23.5% in the incidental and 3.8% to 28.7% in the nonincidental groups (relative risk = 0.13-6.27) in the cohort studies (n = 3). A meta-analysis of the eligible case-control studies (n = 3) showed a nonsignificant summated OR of 1.04 (95% confidence interval = 0.63-1.70; p = .88). In the prognosis study, five direct and thirteen indirect markers of prognosis were compared between the incidental and nonincidental groups. A meta-analysis was not possible but incidentally detected thyroid cancer had better progression-free and overall survival. CONCLUSION Current evidence suggests that investigation and management of thyroid nodules should not be influenced by the mode of detection.
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Affiliation(s)
- Je Ern Chooi
- The Medical School, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, UK
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Abiramie Ravindiran
- The Medical School, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Saba P Balasubramanian
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, UK
- Directorate of General Surgery, Sheffield Teaching Hospitals, Sheffield, South Yorkshire, UK
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Hematopoiesis, Inflammation and Aging-The Biological Background and Clinical Impact of Anemia and Increased C-Reactive Protein Levels on Elderly Individuals. J Clin Med 2022; 11:jcm11030706. [PMID: 35160156 PMCID: PMC8836692 DOI: 10.3390/jcm11030706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 01/27/2023] Open
Abstract
Anemia and systemic signs of inflammation are common in elderly individuals and are associated with decreased survival. The common biological context for these two states is then the hallmarks of aging, i.e., genomic instability, telomere shortening, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion and altered intercellular communication. Such aging-associated alterations of hematopoietic stem cells are probably caused by complex mechanisms and depend on both the aging of hematopoietic (stem) cells and on the supporting stromal cells. The function of inflammatory or immunocompetent cells is also altered by aging. The intracellular signaling initiated by soluble proinflammatory mediators (e.g., IL1, IL6 and TNFα) is altered during aging and contributes to the development of both the inhibition of erythropoiesis with anemia as well as to the development of the acute-phase reaction as a systemic sign of inflammation with increased CRP levels. Both anemia and increased CRP levels are associated with decreased overall survival and increased cardiovascular mortality. The handling of elderly patients with inflammation and/or anemia should in our opinion be individualized; all of them should have a limited evaluation with regard to the cause of the abnormalities, but the extent of additional and especially invasive diagnostic evaluation should be based on an overall clinical evaluation and the possible therapeutic consequences.
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Shin IS, Shin JH, Jang DE, Lee J. A Methodological Quality Evaluation of Meta-Analyses on Nursing Home Research: Overview and Suggestions for Future Directions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:505. [PMID: 35010765 PMCID: PMC8744792 DOI: 10.3390/ijerph19010505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 02/04/2023]
Abstract
(1) Background: The nursing home (NH) research field lacks quality reporting about meta-analyses (MAs), and most gradings of MA evidence are biased on analyzing the effectiveness of independent variables in randomized control trials. (2) Objectives: This study aimed to perform a critical methodological review of MAs in the NH research field. (3) Methods: We searched the articles from four databases (PubMed, MEDLINE, CINAHL, and PsycINFO) until 15th January 2021. We reviewed a total of 41 published review articles in the NH research field. (4) Results: The studies primarily fell into the following categories: medicine (17/41), nursing (7/41), and psychiatry or psychology (6/41); 36.6% of the reviewed studies did not use any validated MA guidelines. The lowest correctly reported PRISMA 2000 guideline item was protocol and registration (14.6%), and more than 50% of articles did not report risk of bias. Moreover, 78.0% of studies did not describe missing reports of effect size formula. (5) Discussion: NH researchers must follow appropriate and updated guidelines for their MAs in order to provide validated reviews, as well as consider statistical issues such as the complexity of interventions, proper grouping, and scientific effect-size calculations to improve the quality of their study. Future quality review studies should investigate more diverse studies.
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Affiliation(s)
- In-Soo Shin
- Graduate School of Education, Dongkuk University, Seoul 04620, Korea;
| | - Juh-Hyun Shin
- College of Nursing, Ewha Womans University, Seoul 03760, Korea
| | - Dong-Eun Jang
- School of Nursing, University of Texas at Austin, Austin, TX 78712, USA;
| | - Jiyeon Lee
- College of Nursing, Catholic University of Pusan, Seoul 43241, Korea;
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Milani SA, Lopez DS, Downer B, Samper-Ternent R, Wong R. Effects of diabetes and obesity on cognitive impairment and mortality in older mexicans. Arch Gerontol Geriatr 2022; 99:104581. [PMID: 34837793 PMCID: PMC8810632 DOI: 10.1016/j.archger.2021.104581] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/08/2021] [Accepted: 11/13/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Diabetes is a risk factor for dementia and mortality, while obesity later in life is associated with a reduced risk. Their co-occurrence, diabesity, is common, but its association with dementia and mortality is unclear. METHODS Using data from the Mexican Health and Aging Study, we used multinomial logistic regression to examine the associations of diabetes and body mass index (BMI), and diabesity, in 2012, with cognitive impairment and mortality in 2018, among participants aged ≥60 years with normal cognition at baseline (n = 7,885). RESULTS Diabetes was associated with cognitive impairment, compared to not having diabetes (RRR=1.83, 95% CI=1.48-2.26). BMI was not associated with cognitive impairment. Regarding mortality, diabetes was associated with an increased risk (RRR=2.28, 95% CI=1.98-2.63) and being overweight or having obesity was associated with a reduced risk (RRR=0.74, 95% CI=0.65-0.86; RRR=0.79, 95% CI= 0.66-0.95). When BMI and diabetes were combined, having diabetes only (RRR=2.01, 95% CI=1.40-2.87), being overweight with diabetes (RRR=1.42, 95% CI=1.02-1.97) or having diabesity (RRR=1.50, 95% CI=1.08-2.06) were associated with cognitive impairment, compared to having a normal BMI without diabetes. Diabetes, regardless of BMI, was associated with an increased risk of mortality, while being overweight or having obesity was associated with a reduced risk of mortality. CONCLUSIONS With the increase in the prevalence of obesity and diabetes among Mexicans, it is important to understand how these conditions and their co-occurrence impact cognitive impairment and mortality. Among older Mexicans, diabesity is associated with 6-year mortality and cognitive impairment onset, likely driven by the effect of diabetes.
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Affiliation(s)
- Sadaf Arefi Milani
- Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, University of Texas Medical Branch, USA; Sealy Center on Aging, University of Texas Medical Branch, USA.
| | - David S. Lopez
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch
| | - Brian Downer
- Department of Nutrition, Metabolism and Rehabilitation Sciences
| | - Rafael Samper-Ternent
- Department of Internal Medicine, University of Texas Medical Branch,Sealy Center on Aging, University of Texas Medical Branch
| | - Rebeca Wong
- Sealy Center on Aging, University of Texas Medical Branch,Department of Preventive Medicine and Population Health, University of Texas Medical Branch
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Veronese N, Ferrari G, Barbagallo M. Nutritional Issues of Older People in Primary Care. PRACTICAL ISSUES IN GERIATRICS 2022:59-69. [DOI: 10.1007/978-3-030-78923-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Combined effect of obesity and low physical performance on the incidence of hypertension in Chinese community-dwelling older population. J Hum Hypertens 2021; 35:970-977. [PMID: 33208838 DOI: 10.1038/s41371-020-00442-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/29/2020] [Accepted: 11/01/2020] [Indexed: 02/03/2023]
Abstract
The combination of having a low physical performance and obesity results in a vicious cycle, but the effect of this combination on the incidence of hypertension is still unknown. This article aims to examine the effect of obesity and low physical performance on the incidence of hypertension in older adults. The sample was comprised of 349 Chinese community-dwelling participants (199 women; mean age 66.30 ± 5.78 years) without hypertension at baseline. Obesity was defined as having a body mass index (BMI) greater than or equal to 28 kg/m2. Participants scoring in the top 20% on the Timed Up and Go Test (TUGT) or in the slowest 20% of the 4-m walking test were defined as having a low physical performance. The outcome was new onset hypertension at the 1-year follow-up. We found that 89 (25.5%) of the 349 participants without hypertension at baseline had developed hypertension at their 1-year follow-up. After multivariate adjustments, it was found that the incidence of hypertension was associated with the combination of obesity and having a low physical performance (OR = 7.30, 95% CI = 1.36-39.11), but not solely with obesity (OR = 1.40, 95% CI = 0.68-2.88) or solely with low physical performance (OR = 0.98, 95% CI = 0.29-3.27). Hence, although obesity and low physical performance did not independently affect the incidence of hypertension after one year, the combination of the two can significantly increase the incidence of hypertension in Chinese community-dwelling older adults.
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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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Agnihotri V, Gupta A, Bajpai S, Singhal S, Dey AB, Dey S. Serum Proteomic Approach for Differentiation of Frail and Non-Frail Elderly. ADVANCES IN GERONTOLOGY 2021. [DOI: 10.1134/s2079057021020028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Predictors of incident malnutrition-a nutritionDay analysis in 11,923 nursing home residents. Eur J Clin Nutr 2021; 76:382-388. [PMID: 34239065 PMCID: PMC8907076 DOI: 10.1038/s41430-021-00964-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/30/2021] [Accepted: 06/18/2021] [Indexed: 11/23/2022]
Abstract
Background/Objectives Malnutrition (MN) in nursing home (NH) residents is associated with poor outcome. In order to identify those with a high risk of incident MN, the knowledge of predictors is crucial. Therefore, we investigated predictors of incident MN in older NH-residents. Subjects/Methods NH-residents participating in the nutritionDay-project (nD) between 2007 and 2018, aged ≥65 years, with complete data on nutritional status at nD and after 6 months and without MN at nD. The association of 17 variables (general characteristics (n = 3), function (n = 4), nutrition (n = 1), diseases (n = 5) and medication (n = 4)) with incident MN (weight loss ≥ 10% between nD and follow-up (FU) or BMI (kg/m2) < 20 at FU) was analyzed in univariate generalized estimated equation (GEE) models. Significant (p < 0.1) variables were selected for multivariate GEE-analyses. Effect estimates are presented as odds ratios and their respective 99.5%-confidence intervals. Results Of 11,923 non-malnourished residents, 10.5% developed MN at FU. No intake at lunch (OR 2.79 [1.56–4.98]), a quarter (2.15 [1.56–2.97]) or half of the meal eaten (1.72 [1.40–2.11]) (vs. three-quarter to complete intake), the lowest BMI-quartile (20.0–23.0) (1.86 [1.44–2.40]) (vs. highest (≥29.1)), being between the ages of 85 and 94 years (1.46 [1.05; 2.03]) (vs. the youngest age-group 65–74 years)), severe cognitive impairment (1.38 [1.04; 1.84]) (vs. none) and being immobile (1.28 [1.00–1.62]) (vs. mobile) predicted incident MN in the final model. Conclusion 10.5% of non-malnourished NH-residents develop MN within 6 months. Attention should be paid to high-risk groups, namely residents with poor meal intake, low BMI, severe cognitive impairment, immobility, and older age.
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