Impact of obesity, overweight and underweight on life expectancy and lifetime medical expenditures: the Ohsaki Cohort Study

The impact of obesity on postoperative outcomes following surgery for colorectal cancer: analysis of the National Inpatient Sample 2015-2019

BACKGROUND

The global burden of obesity has reached epidemic proportions, placing great strain on the North American healthcare system. We designed a retrospective cohort database study comparing postoperative morbidity and healthcare resource utilization between patients living with and without obesity undergoing surgery for colorectal cancer.

METHODS

Adult patients undergoing resection for colorectal cancer were identified from the 2015 to 2019 National Inpatient Sample database. Patients were stratified according to obesity status (i.e., body mass index of 30 kg/m2). Propensity score matching (PSM) with 1:1 nearest-neighbour matching was performed according to demographic, operative, and hospital characteristics. The primary outcome was postoperative morbidity. Secondary outcomes included system-specific postoperative complications, postoperative mortality, length of stay, total admission healthcare cost, and post-discharge disposition. McNemar's and Wilcoxon matched pairs signed rank tests were performed.

RESULTS

After PSM, 7565 non-obese and 7565 obese patients were included. Patients with obesity had a 10% increase in relative risk of overall in-hospital postoperative morbidity (23.1% versus 25.6%, P = 0.0015) and a $4564 increase in hospitalization cost ($70 248 USD versus $74 812 USD, P = 0.0004). Patients with obesity were more likely to require post-operative ICU admission (5.0% versus 8.0%, P < 0.0001) and less likely to be discharged home after their index operation (68.3% versus 64.2%, P = 0.0022).

CONCLUSION

Patients with obesity undergoing surgery for colorectal cancer may be at an increased risk of in-hospital postoperative morbidity. They may also be more likely to have increased hospitalization costs, post-operative ICU admissions, and to not be discharged directly home. Preoperative optimization via weight loss strategies should be further explored.

Body Mass Index and Associated Medical Expenditures in the US Among Privately Insured Individuals Aged 2 to 19 Years in 2018

Importance

Nearly 40% of US youth aged 2 to 19 years do not have a body mass index (BMI) in the healthy weight category. However, there are no recent estimates for BMI-associated expenditures using clinical or claims data.

Objective

To estimate medical expenditures among US youth across all BMI categories along with sex and age groups.

Design, Setting, Participants

This cross-sectional study used IQVIA's ambulatory electronic medical records (AEMR) data set linked with IQVIA's PharMetrics Plus Claims database from January 2018 through December 2018. Analysis was performed from March 25, 2022, through June 20, 2022. It included a convenience sample of a geographically diverse patient population from AEMR and PharMetrics Plus. The study sample included privately insured individuals with a BMI measurement in 2018 and excluded patients with pregnancy-related visits.

Exposure

BMI categories.

Main Outcomes and Measures

Total medical expenditures were estimated using generalized linear model regression with γ distribution and log-link function. For out-of-pocket (OOP) expenditures, a 2-part model was used that included logistic regression to estimate the probability of positive expenditures followed by generalized linear model. Estimates were shown with and without accounting for sex, race and ethnicity, payer type, geographic region, age interacted with sex and BMI categories, and confounding conditions.

Results

The sample included 205 876 individuals aged 2 to 19 years; 104 066 were male (50.5%) and the median age was 12 years. Compared with those with healthy weight, total and OOP expenditures were higher for all other BMI categories. Differences in total expenditures were highest for those with severe obesity ($909; 95% CI, $600-$1218) followed by underweight ($671; 95% CI, $286-$1055) compared with healthy weight. Differences in OOP expenditures were highest for those with severe obesity ($121; 95% CI, $86-$155) followed by underweight ($117; 95% CI, $78-$157) compared with healthy weight. Having underweight was associated with higher total expenditures at ages 2 to 5 years and 6 to 11 years by $679 (95% CI, $228-$1129) and $1166 (95% CI, $632-$1700), respectively; having severe obesity was associated with higher total expenditures at ages 2 to 5 years, 6 to 11 years, and 12 to 17 years by $1035 (95% CI, $208-$1863), $821 (95% CI, $414-$1227), and $1088 (95% CI, $594-$1582), respectively.

Conclusions and Relevance

The study team found medical expenditures to be higher for all BMI categories when compared with those with healthy weight. These findings may indicate potential economic value of interventions or treatments aimed at reducing BMI-associated health risks.

Simple anthropometric measures to predict visceral adipose tissue area in middle-aged Indonesian men

The diagnosing of central obesity requires ethnic-specific cut-offs of waist circumference (WC) and body mass index (BMI). This study aims to develop formulas to predict visceral adipose tissue (VAT) area based on WC and BMI to determine the cut-off points of central obesity in Indonesia. We conducted a cross-sectional study among 32 middle-aged Indonesian men. VAT area was measured using an abdominal CT scan, whereas WC and BMI were assessed through anthropometric measurements. Linear regression analysis was performed to define the formulas to predict VAT area using WC and BMI. Next, the optimal cut-off values of WC and BMI were determined using ROC curve analysis. Strong positive correlations were found between WC and VAT as well as BMI and VAT (r = 0.78; r = 0.67, p <0.001). The formula to predict VAT area from WC was -182.65 + (3.35 × WC), whereas the formula to predict VAT area from BMI was -57.22 + (6.95 × BMI). These formulas predicted WC of 88.5 cm and BMI of 23.9 kg/m2 as the optimal cut-off values for central obesity in middle-aged Indonesian men.

Validation of the most cost-effective nudge to promote workers’ regular self-weighing: a cluster randomized controlled trial

Regular self-weighing is useful in obesity prevention. The impact of nudge-based occupational self-weighing programs in the cluster randomized controlled trial was examined. The primary outcome was regular self-weighing after 6 months, which we used to compute cost-effectiveness. Participants were Japanese local government employees who underwent 1 h workshops after being assigned to one of the three nudge groups. Each group was designed according to the nudges’ Easy, Attractive, Social, Timely framework: quiz group (n = 26, attractive-type nudges), implementation intentions group (n = 25, social-type nudges), and growth mindset group (n = 25, timely type nudges). A reference group (n = 36, no nudges) was also formed. After 6 months, all three interventions were effective for regular self-weighing, with the growth mindset intervention (60.0%) being significantly more effective. The cost-effectiveness of the growth mindset group was 1.7 times and 1.3 times higher than that of the quiz group and the implementation intentions group, respectively. Findings from our study are expected to facilitate the use of nudges for health practitioners and employers, which in turn may promote obesity prevention.

The impact of body mass index on the prognostic performance of the Simplified Acute Physiology Score 3: A prospective cohort study

Objective

To assess the Simplified Acute Physiology Score 3 (SAPS3) prognostic score performance across different body mass index categories.

Methods

A retrospective cohort study in a general ICU in Brazil. A secondary analysis of medical records was performed with clinical and epidemiological data. Patients were stratified according to their body mass index (BMI) category, and a binary logistic regression was then performed to identify factors independently associated with mortality. SAPS3 accuracy was determined using the area under the receiver operating characteristics curve and the Hosmer-Lemeshow test. A modified Kaplan-Meyer plot was employed to evaluate death probability according to BMI. ICU mortality was evaluated as the primary outcome.

Results

A total of 2,179 patients (mean age of 67.9 years and female predominance (53.1%)) were enrolled. SAPS3 was found accurate in all groups except in the underweight (AUC: 0.694 95% CI 0.616–0.773; HL = 0.042). The patients in the underweight group tended to be older, have longer hospital stay, have worse functional status, and have a higher value on prognostic scores. After the adjustments, no statistically significant difference between the BMI groups was noted in relation to mortality, except for the low weight that presented a likelihood of death of 3.50 (95% CI, 1.43–8.58, p = 0.006).

Conclusion

This research showed that SAPS3 had poor accuracy in predicting ICU mortality in underweight patients. This group was shown to be an independent risk factor for worse clinical outcomes.

Behavioral Lifestyles and Survival: A Meta-Analysis

The aim of the study is to determine the association between Behavioral Lifestyles (regular physical activity, healthy diet, sleeping, and weight control) and longevity in the elderly. A search strategy was conducted in the PsycInfo, Medline, PubMed, Web of Science (WoS), and Scopus databases. The primary outcome was mortality/survival. Four variables (mean of participant's age at the baseline of the study, follow-up years of the study, gender, and year of publication) were analyzed to evaluate the role of potential moderators. Ninety-three articles, totaling more than 2,800,000 people, were included in the meta-analysis. We found that the lifestyles analyzed predict greater survival. Specifically, doing regular physical activity, engaging in leisure activities, sleeping 7-8 h a day, and staying outside the BMI ranges considered as underweight or obesity are habits that each separately has a greater probability associated with survival after a period of several years.

Converting health risks into loss of life years - a paradigm shift in clinical risk communication

For facilitating risk communication in clinical management, such a ratio-based measure becomes easier to understand if expressed as a loss of life expectancy. The cohort, consisting of 543,410 adults in Taiwan, was recruited between 1994 and 2008. Health risks included lifestyle, biomarkers, and chronic diseases. A total of 18,747 deaths were identified. The Chiang's life table method was used to estimate a loss of life expectancy. We used Cox regression to calculate hazard ratios (HRs) for health risks. The increased mortality from cardio-metabolic risks such as high cholesterol (HR=1.10), hypertension (HR=1.48) or diabetes (HR=2.02) can be converted into a loss of 1.0, 4.4, and 8.9 years in life expectancy, respectively. The top 20 of the 30 risks were associated with a loss of 4 to 10 years of life expectancy, with 70% of the cohort having at least two such risk factors. Smoking, drinking, and physical inactivity each had 5-7 years loss. Individuals with diabetes or an elevated white count had a loss of 7-10 years, while prolonged sitting, the most prevalent risk factor, had a loss of 2-4 years. Those with diabetes (8.9 years) and proteinuria (9.1 years) present at the same time showed a loss of 16.2 years, a number close to the sum of each risk. Health risks, expressed as life expectancy loss, could facilitate risk communication. The paradigm shift in expressing risk intensity can help set public health priorities scientifically to promote a focus on the most important ones in primary care.

The Trends of Medical Care Expenditure with Adjustment of Lifestyle Habits and Medication; 10-Year Retrospective Follow-Up Study

In Japan, the prevention of lifestyle-related diseases is the most important issue for the optimization of medical expenditure. This study aimed to analyze the impact of lifestyle and medication status on medical expenditure. Health checkup data and medical expenditure records of a retrospective cohort of 1463 people aged between 40 and 65 years old who underwent specific health checks at least three times between 2008 and 2017 were analyzed. Regression analysis was performed with medical expenditure as the dependent variable and age, gender, waist ratio, medication status, and lifestyle habits as independent variables using a Tobit model. Focusing on the factors that increase medical expenditure, the regression coefficients of age, medication status, weight gain of 10 kg or more since the age of 20, and walking more than 1 h per day were 0.048 (95% CI 0.04 to 0.06), 1.020 (95% CI 0.88 to 1.16), 0.210 (95% CI 0.06 to 0.36), and -0.208 (95% CI -0.35 to -0.07), respectively. The estimate of 5-year cumulative medical expenditure showed that those with walking habits without medication had the lowest medical expenditure. The result of this study suggests that walking more than 1 h a day may lower health expenditure in the general population.

Weight as a Risk Factor for Mortality in Critically Ill Patients

OBJECTIVES

To explore the hypothesis that obesity is associated with increased mortality and worse outcomes in children who are critically ill.

METHODS

Secondary analysis of the Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology study, a prospective, multinational observational study. Patients between 3 months and 25 years across Asia, Australia, Europe, and North America were recruited for 3 consecutive months. Patients were divided into 4 groups (underweight, normal weight, overweight, and obese) on the basis of their BMI percentile for age and sex.

RESULTS

A total of 3719 patients were evaluated, of whom 542 (14%) had a primary diagnosis of sepsis. One thousand fifty-nine patients (29%) were underweight, 1649 (44%) were normal weight, 423 (11%) were overweight, and 588 (16%) were obese. The 28-day mortality rate was 3.6% for the overall cohort and 9.1% for the sepsis subcohort and differed significantly by weight status (5.8%, 3.1%, 2.2%, and 1.8% for subjects with underweight, normal weight, overweight, and obesity, respectively, in the overall cohort [P < .001] and 15.4%, 6.6%, 3.6%, and 4.7% in the sepsis subcohort, respectively [P = .003]). In a fully adjusted model, 28-day mortality risk was 1.8-fold higher in the underweight group versus the normal weight group in the overall cohort and 2.9-fold higher in the sepsis subcohort. Patients who were overweight and obese did not demonstrate increased risk in their respective cohorts. Patients who were underweight had a longer ICU length of stay, increased need for mechanical ventilation support, and a higher frequency of fluid overload.

CONCLUSIONS

Patients who are underweight make up a significant proportion of all patients in the PICU, have a higher short-term mortality rate, and have a more complicated ICU course.

Impact of overweight or obesity trajectory on health expenditure in Korea

BACKGROUND

This study aimed to identify the effect of the overweight or obesity (OWOB) trajectory on current health care expenditure in South Korea.

METHODS

Ten years of publicly released data (2002-12) were obtained in 2016 from a retrospective cohort of National Health Insurance System claims. This study included 51,844 adults (aged 30-59 years in 2002) and 21,196 elderly adults (aged ≥ 60 years in 2002).

RESULTS

Compared with adults who maintained normal weight (NW), higher yearly total health expenditures were estimated for adults who lost weight over the 10-year period: by 11.5% (95% confidence interval (CI): 0.18-22.96%) when changing from NW to underweight (UW) and 6.2% (95% CI: 0.47-12.01%) from OWOB to UW/NW. Elderly adults had higher health expenditures when they lost weight by 14.0% (95% CI: 0.37-27.70%) from NW to UW and 6.8% (95% CI: 0.13-13.51%) from OWOB to UW/NW compared with when they maintained NW.

CONCLUSIONS

These findings indicate the importance of early intervention to control OWOB, particularly because people in late adulthood have greater health care needs for reasons other than OWOB.

Differences in prevalence and associated factors of underweight and overweight/obesity according to rural-urban residence strata among women of reproductive age in Bangladesh: evidence from a cross-sectional national survey

OBJECTIVES

This study aimed to investigate the differences in prevalence and factors influencing underweight and overweight/obesity stratified by region of residence among women of reproductive age in Bangladesh.

DESIGN

Secondary analysis of cross-sectional nationwide data.

SETTING

This study used Bangladesh Demographic and Health Survey 2014 data.

PARTICIPANTS

A weighted sample of 16 478 women of reproductive age (15-49 years) were included in the analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

Using the Asian-specific cut-off for body mass index, the primary outcome of this study was categorised as: underweight (<18.5 kg/m2), normal weight (18.5 to <23.0) kg/m2 and overweight/obese (≥23.0 kg/m2) stratified according to rural-urban residence.

RESULTS

More than half of urban women (53%, n=2493) and one-third of rural women (33%, n=3968) were found to be overweight/obese. Around one-fifth of rural women (21%, n=2490) and almost one in eight urban women (12%, n=571) were reported as underweight. In the final multivariable analyses, increasing age, higher educational status and higher order wealth quintile, each had a significant positive association with being overweight/obese and an inverse association with being underweight. Urban unmarried women had lower odds of being overweight/obese compared with their married counterparts. Rural women who used contraceptives had significantly decreased odds (adjusted OR (AOR) 0.8, 95% CI 0.7 to 0.9) of being underweight compared with contraceptive non-users; no such association was noted in urban women. Women from Sylhet division in both urban (AOR 1.7, 95% CI 1.2 to 2.5) and rural regions (AOR 1.5, 95% CI 1.2 to 1.8) had increased odds of being underweight compared with women in Barisal division.

CONCLUSIONS

This study found association of multiple factors with both overweight/obesity and underweight among Bangladeshi women of reproductive age. Public health programmes in Bangladesh aiming to prevent the double burden of malnutrition should focus these factors through comprehensive public awareness and cost-effective operational health interventions.

Impact of pharmacist's intervention on reducing cardiovascular risk in obese patients

Background Obesity is a risk factor for cardiovascular disease, the leading cause of death. Health education, nutritional follow-up, and life style habits modification are key for cardiovascular risk reduction in obese patients. Objective To measure the impact of pharmacist's intervention on cardiovascular risk in obese patients. Setting A Spanish community pharmacy. Method Obese patients (BMI ≥ 30) with (group A, n = 30) and without (group B, n = 14) comorbidities were selected. Variables determined in first visit on-site: anthropometric values (weight, height, waist circumference), blood pressure, glycemic (glucose, HbA1c) and lipid parameters (total cholesterol, HDL-c, LDL-c, triglycerides). The PharmaFit Protocol consisted in a 24-month follow-up focusing (i) monthly on adherence to nutritional guidelines and modification of life style habits, and (ii) bi-monthly on anthropometric variables, blood pressure, and biochemical determinations. Feedback was provided to the primary care physician or specialist. Main ouitcome measure Cardiovascular risk estimated by REGICOR score. Results Anthropometric variables significantly decreased in all groups. Plasma glucose levels were significantly reduced in group A without changes in HbA1c. Lipid parameters significantly improved in group A, whereas HDL-c significantly raised in all groups. REGICOR score was significantly reduced in group A female (13.8 ± 1.6 vs. 5.8 ± 1, p < 0.0001) and male (12.7 ± 1.7 vs. 4.4. ± 0.6, p < 0.005) patients, and in group B female patients (3.5 ± 0.7 vs. 1.9 ± 0.4, p < 0.001). Conclusion Community pharmacist intervention, delivered as a 24-month follow-up and combining health and dietary education, has a highly positive impact on the reduction of cardiovascular risk in obese patients.

Real-World Clinical Effectiveness of Liraglutide 3.0 mg for Weight Management in Canada

OBJECTIVE

Real-world clinical effectiveness of liraglutide 3.0 mg, in combination with diet and exercise, was investigated 4 and 6 months post initiation. Changes in absolute and percent body weight were examined from baseline.

METHODS

A cohort of liraglutide 3.0 mg initiators in 2015 and 2016 was identified from six Canadian weight-management clinics. Post initiation values at 4 and 6 months were compared with baseline values using a paired t test.

RESULTS

The full cohort consisted of 311 participants, with 210 in the ≥ 4-month persistence group and 167 in the ≥ 6-month persistence group. Average baseline BMI was 40.7 kg/m² , and weight was 114.8 kg. There was a significant change in body weight 6 and 4 months after initiation of treatment in persistent subjects (≥ 6-month: -8.0 kg, P < 0.001; ≥ 4-month: -7.0 kg, P < 0.001) and All Subjects, regardless of persistence (-7.3 kg; P < 0.001). Percentage change in body weight from baseline was -7.1% in the ≥ 6-month group and -6.3% in the ≥ 4-month group, and All Subjects lost 6.5% body weight. Of participants in the ≥ 6-month group, 64.10% and 34.5% lost ≥ 5% and > 10% body weight, respectively.

CONCLUSIONS

In a real-world setting, liraglutide 3.0 mg, when combined with diet and exercise, was associated with clinically meaningful weight loss.

Impacts of skipping breakfast and late dinner on the incidence of being overweight: a 3-year retrospective cohort study of men aged 20-49 years

BACKGROUND

Most studies on the dietary habits and overweight status of men aged 20-49 years have been cross-sectional, with longitudinal studies being scarce. One-quarter of Japanese men aged 20-49 years skip breakfast or have dinner within 2 h of bedtime (late dinner); therefore, the effects of these eating habits on men's increasing body weight need to be determined.

METHODS

We conducted a retrospective cohort study using health check-up data provided from several health insurance societies in Japan. Participants comprised 45 524 men employees aged 20-49 years who were followed up for 3 years. The primary outcome investigated was body mass index (BMI) ≥25 kg m^-2 . We conducted a multivariable logistic regression analysis and calculated the odds ratios for skipping breakfast and late dinner, as well as baseline age, body mass index, smoking status, eating speed, snack-eating status, alcohol drinking frequency, physical activity, sleep habits, and the interaction between skipping breakfast and late dinner.

RESULTS

Of the participants, 17 706 (38.8%) skipped breakfast and 25 987 (57.1%) had a late dinner. At the 3-year follow-up, 5093 (11.2%) had a BMI ≥25 kg m^-2 . The odds ratios of men skipping breakfast and having a late dinner were 1.18 (95% confidence interval = 1.04-1.33) and 0.92 (95% confidence interval = 0.84-1.01), respectively. The interaction between these factors was nonsignificant.

CONCLUSIONS

We suggest that skipping breakfast among men aged 20-49 years was one predictor of being overweight; however, having dinner within 2 h of bedtime was not a predictor.

Prevalence of underweight, overweight and obesity and their associated risk factors in Nepalese adults: Data from a Nationwide Survey, 2016

Introduction

Over the past few decades, the total population of Nepal has increased substantially with rapid urbanization, changing lifestyle and disease patterns. There is anecdotal evidence that non-communicable diseases (NCDs) and associated risk factors are becoming key public health challenges. Using nationally representative survey data, we estimated the prevalence of underweight, overweight and obesity among Nepalese adults and explored socio-demographic factors associated with these conditions.

Materials and methods

We used the Nepal Demographic Health Survey 2016 data. Sample selection was based on stratified two-stage cluster sampling in rural areas and three stages in urban areas. Weight and height were measured in all adult women and men. Body mass index (BMI) was calculated using Asian specific BMI cut-points.

Results

A total of 13,542 adults aged 18 years and above (women 58.19%) had their weight and height measured. The mean (±SD) age was 40.63±16.82 years (men 42.75±17.27, women 39.15±16.34); 41.13% had no formal education and 60.97% lived in urban areas. Overall, 17.27% (95% CI: 16.64–17.91) were underweight; 31.16% (95% CI: 30.38–31.94) overweight/obese. The prevalence of both underweight (women 18.30% and men 15.83%, p<0.001) and overweight/obesity (women 32.87% and men 28.77%, p<0.001) was higher among women. The older adults (≥65 years) (aOR: 2.40, 95% CI: 1.92–2.99, p<0.001) and the adults of poorest wealth quintile (aOR: 2.05, 95% CI: 1.62–2.59, p<0.001) were more likely to be underweight. The younger age adults (36–45 years) (aOR: 3.05, 95% CI: 2.61–3.57, p<0.001) and women (aOR: 1.53, 95% CI 1.39–1.68, p<0.001) were more likely to be overweight or obese. Also, all adults were twice likely to overweight/obese (p<0.001). No significant difference was observed for overweight/obesity by ecological regions and place of residence (urban vs. rural).

Conclusion

These findings confirm co-existence of double burden of underweight and overweight/obesity among Nepalese adults. These conditions are associated with increased risk of developing NCDs. Therefore, effective public health intervention approaches emphasizing improved primary health care systems for NCDs prevention and care and using multi-sectoral approach, is essential.

Risk of malnutrition is associated with poor physical function in patients undergoing cardiac rehabilitation following heart failure

AIM

Patients who experience heart failure are prone to malnutrition. The aim of this study was to determine the association between risk of malnutrition and physical function in patients undergoing cardiac rehabilitation following heart failure.

METHODS

A cross-sectional study was performed in consecutive patients hospitalised for cardiac rehabilitation following heart failure. Risk of malnutrition was evaluated using the Mini Nutritional Assessment-Short Form (MNA-SF). Physical function was evaluated using the Barthel index (BI). Univariate and multivariate analyses were used to determine whether nutritional status was associated with BI in these patients.

RESULTS

The present study included 105 patients (mean age of 77.3 years, 56 men and 49 women) for analysis. The median (interquartile range) scores of the MNA-SF and BI were 11 (9-13) and 75 (45-90), respectively. Patients with high risk of malnutrition (MNA-SF score < 7) were significantly older, had a lower body mass index, exhibited lower muscle mass and strength, could walk shorter distances, and had lower BI scores (all P < 0.05). On multivariate analysis, the MNA-SF score was independently associated with BI (β = 0.409, P < 0.001) after adjusting for age, sex, muscle mass and strength, brain natriuretic peptide levels, ejection fraction of the left ventricle, and reason for admission.

CONCLUSIONS

Risk of malnutrition is associated with physical function in patients undergoing cardiac rehabilitation following heart failure. Early detection of malnutrition and commencement of nutritional support may improve functional recovery in these patients.

Impact of obesity on annual medical expenditures and diabetes care in Japanese patients with type 2 diabetes mellitus

AIMS/INTRODUCTION

Diabetes and obesity are important health and economic concerns. We investigated the influence of obesity on diabetes control, the annual medical expenditures and medications in Japanese patients with type 2 diabetes who were relatively lean in comparison with those in Western countries.

MATERIALS AND METHODS

A total of 402 Japanese patients with type 2 diabetes were enrolled and their annual medical expenditures investigated. Obesity was defined as body mass index ≥25 kg/m2 , according to the obesity classifications from the Japan Society for the Study of Obesity.

RESULTS

A total of 165 patients (41.0%) were classified as obese. The obese group was younger, had poor glycemic control and higher frequency of hypertension than the non-obese group. The median total annual medical expenditures for all participants was ¥269,333 (interquartile range ¥169,664-437,437), which was equivalent to approximately $US2,450. The annual medical expenditure was significantly higher in patients with obesity than in non-obese patients (P < 0.001). This difference was mainly attributed to the annual expenditures for medication and hospitalization. In particular, the medication expenditures and the average number of drug classes for hyperglycemia and hypertension were significantly higher in the obese group.

CONCLUSIONS

Japanese patients with type 2 diabetes and obesity had higher annual medical expenditures and a larger number of medications, but their diabetes control care was insufficient in comparison with those without obesity. Further studies are required to assess the effect of reducing bodyweight on diabetes control and costs.

Cross-sectional association between medical expenses and intellectual activity in community-dwelling older adults

Background

Little is known concerning the lifestyle habits and health conditions in community-dwelling elderly who do not get medical care. We investigated the cross-sectional association between medical expenses (ME) and intellectual activity (IA) in community-dwelling older Japanese.

Methods

Self-administered questionnaires were mailed to all residents born between 1945 and 1949 and covered by A City’s medical insurance system (n = 19,354). Independent variables including health behaviors, oral health, social capital, neighborhood environment, and physical and mental functioning were included in the questionnaires. Medical fee receipts were used to evaluate ME for fiscal 2014, and respondents were classified into no, low, medium, and high ME groups. Higher-level functional capacity was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence, which is comprised of three subscales: instrumental activities of daily living, IA, and social role. Poisson regression models were used to examine the association of ME with IA, with the low ME group as reference.

Results

Questionnaires were returned by 12,747 individuals (response rate 65.9%). The no ME group had the lowest response rate, the worst lifestyle behaviors, and the lowest social capital, but no problems with neighborhood environment. Higher-level functional capacity, especially IA, was reduced in both the high ME and no ME groups. After adjustments for age, gender, health insurance, accessibility to public facilities in their residential area, family size, body mass index, and physical and mental functioning, the prevalence ratio (PR) for impaired IA lost its significance in the high ME group (PR 0.97, 95% confidence interval 0.90–1.05), but remained significant in the no ME group (1.19, 1.08–1.31). After additional adjustments for health behaviors (i.e., health checks, smoking, fitness, and dietary variety), the PR of the no ME group was attenuated towards the null (1.08, 0.98–1.20).

Conclusions

Community-dwelling elderly who did not seek medical treatment were indifferent to health surveys and health-promoting behaviors, and undesirable health behaviors were a possible determinant of their impaired IA. Further longitudinal research is needed to confirm the causal associations.

Electronic supplementary material

The online version of this article (10.1186/s12199-017-0672-1) contains supplementary material, which is available to authorized users.

Emerging Molecular Pathways Governing Dietary Regulation of Neural Stem Cells during Aging

Aging alters cellular and molecular processes, including those of stem cells biology. In particular, changes in neural stem cells (NSCs) are linked to cognitive decline associated with aging. Recently, the systemic environment has been shown to alter both NSCs regulation and age-related cognitive decline. Interestingly, a well-documented and naturally occurring way of altering the composition of the systemic environment is through diet and nutrition. Furthermore, it is well established that the presence of specific nutrients as well as the overall increase or reduction of calorie intake can modulate conserved molecular pathways and respectively reduce or increase lifespan. In this review, we examine these pathways in relation to their function on NSCs and cognitive aging. We highlight the importance of the Sirtuin, mTOR and Insulin/Insulin like growth factor-1 pathways as well as the significant role played by epigenetics in the dietary regulation of NSCs and the need for further research to exploit nutrition as a mode of intervention to regulate NSCs aging.

BMI and healthy life expectancy in old and very old women

There is conflicting evidence for the effect of BMI on mortality at older ages, and little information on its effect on healthy life expectancy (HLE). Longitudinal data were from the 1921–1926 cohort of the Australian Longitudinal Study on Women’s Health (n 11 119), over 18 years of follow-up. Self-rated health status was measured at each survey, and BMI was measured at baseline. Multi-state models were fitted to estimate the effect of BMI on total life expectancy (TLE) and HLE. Compared with women of normal weight, overweight women at the age of 75 years had similar TLE but fewer years healthy (−0·79; 95 % CI −1·21, −0·37) and more years unhealthy (0·99; 95 % CI 0·56, 1·42). Obese women at the age of 75 years lived fewer years in total than normal-weight women (−1·09; 95 % CI −1·77, −0·41), and had more unhealthy years (1·46; 95 % CI 0·97, 1·95 years). Underweight women had the lowest TLE and the fewest years of healthy life. Women should aim to enter old age at a normal weight and in good health, as the slight benefit on mortality of being overweight is offset by spending fewer years healthy. All outcomes were better for those who began in good health. The relationship between weight and HLE has important implications for nutrition for older people, particularly maintenance of lean body mass and prevention of obesity. The benefit of weight loss in obese older women remains unclear, but we support the recommendation that weight-loss advice be individualised, as any benefits may not outweigh the risks in healthy obese older adults.

Heart healthy equals prostate healthy and statins, aspirin, and/or metformin (S.A.M.) are the ideal recommendations for prostate cancer prevention

Cardiovascular disease (CVD) has been the number one cause of death in the U.S. for 114 of the last 115 years. Lifestyle factors that promote CVD also appear to increase prostate cancer risk and those that reduce CVD risk also appear to reduce the risk of prostate cancer. The largest randomized trials utilizing dietary supplements or pharmacologic agents for prostate cancer prevention (Selenium and Vitamin E Cancer Prevention Trial [SELECT]) have also shed light on the problems and future solutions in this area. Dietary supplements that have not been found to be CVD protective, such as selenium and Vitamin E have not been found to be prostate protective. In addition, over exposure to specific anti-oxidants in nutritionally replete populations may be encouraging cancer growth. Future trials of dietary supplements to prevent prostate cancer could be problematic because by the time a definitive trial is initiated the participants will no longer be “deficient” in the nutrient being tested, which arguably occurred in the SELECT trial. It is also interesting that statins, aspirin, and/or metformin (S.A.M.) are 3 generic, low-cost, heart healthy agents derived from natural sources with separate mechanism of actions, which all appear to have the best benefit to risk ratio compared to any other agent available for prostate cancer prevention, especially aggressive disease, or as an ancillary agent (s) to conventional cancer treatment. It is time to focus on the forest over the trees and recommend proven CVD protective measures for men concerned about their risk of prostate cancer.

Do thin, overweight and obese children have poorer development than their healthy-weight peers at the start of school? Findings from a South Australian data linkage study

Little is known about the holistic development of children who are not healthy-weight when they start school, despite one fifth of preschool-aged children in high income countries being overweight or obese. Further to this, there is a paucity of research examining low body mass index (BMI) in contemporary high-income populations, although evidence from the developing world demonstrates a range of negative consequences in childhood and beyond. We investigated the development of 4-6 year old children who were thin, healthy-weight, overweight, or obese (as defined by BMI z-scores) across the five domains of the Australian Early Development Census (AEDC): Physical Health and Wellbeing, Social Competence, Emotional Maturity, Language and Cognitive Skills, and Communication Skills and General Knowledge. We used a linked dataset of South Australian routinely collected data, which included the AEDC, school enrollment data, and perinatal records (n = 7533). We found that the risk of developmental vulnerability among children who were thin did not differ from healthy-weight children, after adjusting for a range of perinatal and socio-economic characteristics. On the whole, overweight children also had similar outcomes as their healthy-weight peers, though they may have better Language and Cognitive skills (adjusted Risk Ratio [aRR] = 0.73 [95% CI 0.50-1.05]). Obese children were more likely to be vulnerable on the Physical Health and Wellbeing (2.20 [1.69, 2.87]) and Social Competence (1.31 [0.94, 1.83]) domains, and to be vulnerable on one or more domains (1.45 [1.18, 1.78]). We conclude that children who are obese in the first year of school may already be exhibiting some developmental vulnerabilities (relative to their healthy-weight peers), lending further support for strategies to promote healthy development of preschoolers.

Usability of the Novel Liraglutide 3.0 mg Pen Injector Among Overweight or Obese Adult Patients With or Without Prior Injection Experience

BACKGROUND

Obesity is associated with multiple comorbidities and increased mortality, making it an important target for treatment. However, achieving and maintaining weight loss by diet and physical activity remains challenging, and may often require pharmacotherapy. Liraglutide 3.0 mg has recently been approved for weight management in the United States, Canada, and EU. The current analysis used a summative usability test to assess safety and effectiveness, ease of use, and training requirements for the novel liraglutide 3.0 mg pen injector.

METHODS

Of the 234 participants, half received instructions for use and video-based training and/or opportunity to handle the device. All participants (excluding pharmacists) performed 6 tasks followed by post- task interviews on task difficulty, device ease of use, and any use errors, close calls, and operational difficulties. Tasks included differentiation of correct box and pen injector, medication clarity assessment, normal, dose reversal, and end-of-content injection. Number/type of use errors, close calls, and operational difficulties were evaluated.

RESULTS

All assessed participants interpreted the instructions for use correctly. No potentially serious use errors, and low numbers of nonserious errors, were reported. Overall, participants committed 105 use errors related to handling, with no potential for harm. A total of 25 close calls and 44 operational difficulties were reported without any pattern indicative of a design flaw. Marked differences in the incidence of events were observed for trained versus untrained participants regardless of prior injection experience. Participants rated ease of use as 6.4/7.

CONCLUSIONS

The liraglutide 3.0 mg pen injector is safe and easy to use for liraglutide administration. New device features allow for safe use after brief training.

Dual burden of underweight and overweight among women in Bangladesh: patterns, prevalence, and sociodemographic correlates

The discourse of dual burden caused through underweight and overweight is well-documented globally but this issue and its connection with women's health in Bangladesh is yet to be explored widely. To enrich the current debate, this study, in the context of Bangladesh, examines the patterns, prevalence, and socioeconomic factors influencing the ever-married women of being underweight and overweight over normal weight. Data used in this study have been extracted from the most recent 2011 Bangladesh Demographic and Health Survey. To achieve results connected with the research objectives, both bivariate and multivariate statistical analyses have been employed. In bivariate analysis, we used seven categories of BMI cutoff points for Asian countries as prescribed by World Health Organization (WHO). Multinomial logistic regression model was constructed to investigate the net effect of socioeconomic factors on underweight, pre-overweight, and overweight over normal weight. The results confirm the co-existence of underweight and overweight among women as we found the prevalence of underweight, normal weight, pre-overweight, overweight, and obesity to be 24.1%, 46.7%, 12.8%, 13.5%, and 2.9% respectively. Compared to the richest, the women from the poorest households were significantly (p<0.001) most likely to be underweight (OR=2.75, 95% CI 2.27-3.35) and least likely to be overweight (OR=0.15, 95% CI 0.12-0.19) over normal weight. The urban women, compared to their rural counterparts, were significantly (p<0.001) less likely to be underweight (OR=0.80, 95% CI 0.71-0.91) and more likely to be overweight (OR=1.33, 95% CI 1.18-1.51) than normal weight. The other socioeconomic grades that were most marked to be underweight and overweight are age, women's education, marital status, age at first childbirth, parity, number of children aged ≤ 5 years at the household, and food security. The findings confirm the dual burden of both under- and overweight. Systematic and regular monitoring and surveillance of the social trajectory of nutritional status of women and men in Bangladesh is crucial to develop opposite strategy that addresses the persistent and chronic problem of underweight and the emerging problem of overweight. The dual existence of both types of malnutrition among women in Bangladesh must be taken into consideration so that public health interventions may be adopted through appropriate policy.

Lifestyle risk factors and residual life expectancy at age 40: a German cohort study

BACKGROUND

Cigarette smoking, adiposity, unhealthy diet, heavy alcohol drinking and physical inactivity together are associated with about half of premature deaths in Western populations. The aim of this study was to estimate their individual and combined impacts on residual life expectancy (RLE).

METHODS

Lifestyle and mortality data from the EPIC-Heidelberg cohort, comprising 22,469 German adults ≥40 years and free of diabetes, cardiovascular disease and cancer at recruitment (1994-1998), were analyzed with multivariable Gompertz proportional hazards models to predict lifetime survival probabilities given specific baseline status of lifestyle risk factors. The life table method was then used to estimate the RLEs.

RESULTS

For 40-year-old adults, the most significant loss of RLE was associated with smoking (9.4 [95% confidence interval: 8.3, 10.6] years for male and 7.3 [6.0, 8.9] years for female heavy smokers [>10 cigarettes/day]; 5.3 [3.6, 7.1] years for men and 5.0 [3.2, 6.6] years for women smoking ≤10 cigarettes/day). Other lifestyle risk factors associated with major losses of RLE were low body mass index (BMI <22.5 kg/m(2), 3.5 [1.8, 5.1] years for men; 2.1 [0.5, 3.6] years for women), obesity (BMI ≥30, 3.1 [1.9, 4.4] years for men; 3.2 [1.8, 5.1] years for women), heavy alcohol drinking (>4 drinks/day, 3.1 [1.9, 4.0] years for men), and high processed/red meat consumption (≥120 g/day, 2.4 [1.0, 3.9] years for women). The obesity-associated loss of RLE was stronger in male never smokers, while the loss of RLE associated with low BMI was stronger in current smokers. The loss of RLE associated with low leisure time physical activity was moderate for women (1.1 [0.05, 2.1] years) and negligible for men (0.4 [-0.3, 1.2] years). The combined loss of RLE for heavy smoking, obesity, heavy alcohol drinking and high processed/red meat consumption, versus never smoking, optimal BMI (22.5 to 24.9), no/light alcohol drinking and low processed/red meat consumption, was 17.0 years for men and 13.9 years for women.

CONCLUSIONS

Promoting healthy lifestyles, particularly no cigarette smoking and maintaining healthy body weight, should be the core component of public health approaches to reducing premature deaths in Germany and similar affluent societies.

Physical Activity and Sedentary Behavior Are Independently Associated with Weight in Korean Adolescents

BACKGROUND

This study examines the relationship between physical activity (PA), sedentary behavior (SB) and body weight in Korean adolescents.

METHODS

This study used a nationally representative sample of 72,368 South Korean adolescents, aged 13 to 18 years. The study sample was categorized according to BMI as follows: underweight, body mass index (BMI) <18.5; normal weight, 18.5 ≤ BMI < 23.0; overweight, 23.0 ≤ BMI < 25.0; and obese, 25.0 ≤ BMI. An analysis was then performed to determine if meeting the recommended guidelines for PA frequency (5 times/week ≤) and amount of SB (<2 hours/day) was associated with weight category.

RESULTS

The percentage of normal weight adolescents was 54.3% while the percentages of underweight, overweight, and obese adolescents were 27.4%, 10.2%, and 8.1%, respectively. Significantly fewer underweight and obese adolescents met PA guidelines compared to normal weight adolescents. In addition, underweight, overweight, and obese adolescents had significantly higher SB scores.

CONCLUSION

The present study indicates that in Korean adolescents, physical activity and sedentary behavior are independently associated with weight status. Overweight, obese and underweight Korean adolescents should all be independently monitored for management of health-related behaviors.

J-shapedness: an often missed, often miscalculated relation: the example of weight and mortality

We present three considerations in analysing the association between weight and mortality, as well as other relations that might be non-linear in nature. First, authors must graphically plot their independent and dependent variables in a continuous manner. Second, authors should assess the shape of that relation, and note its shape. If it is non-linear, and specifically, J-shaped or U-shaped, careful consideration should be given to using the 'best' statistical model, of which multivariate fractional polynomial regression is a reasonable choice. Authors should also refrain from truncating their data to avoid dealing with non-linear relations.

Body mass index categories and mortality risk in US adults: the effect of overweight and obesity on advancing death

OBJECTIVES

We examined the association of body mass index with all-cause and cardiovascular disease (CVD)-specific mortality risks among US adults and calculated the rate advancement period by which death is advanced among the exposed groups.

METHODS

We used data from the Third National Health and Nutrition Examination Survey (1988-1994) linked to the National Death Index mortality file with follow-up to 2006 (n = 16 868). We used Cox proportional hazards regression to estimate the rate of dying and rate advancement period for all-cause and CVD-specific mortality for overweight and obese adults relative to their normal-weight counterparts.

RESULTS

Compared with normal-weight adults, obese adults had at least 20% significantly higher rate of dying of all-cause or CVD. These rates advanced death by 3.7 years (grades II and III obesity) for all-cause mortality and between 1.6 (grade I obesity) and 5.0 years (grade III obesity) for CVD-specific mortality. The burden of obesity was greatest among adults aged 45 to 64 years for all-cause and CVD-specific mortality and among women for all-cause mortality.

CONCLUSIONS

These findings highlight the impact of the obesity epidemic on mortality risk and premature deaths among US adults.

Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis

IMPORTANCE

Estimates of the relative mortality risks associated with normal weight, overweight, and obesity may help to inform decision making in the clinical setting.

OBJECTIVE

To perform a systematic review of reported hazard ratios (HRs) of all-cause mortality for overweight and obesity relative to normal weight in the general population.

DATA SOURCES

PubMed and EMBASE electronic databases were searched through September 30, 2012, without language restrictions.

STUDY SELECTION

Articles that reported HRs for all-cause mortality using standard body mass index (BMI) categories from prospective studies of general populations of adults were selected by consensus among multiple reviewers. Studies were excluded that used nonstandard categories or that were limited to adolescents or to those with specific medical conditions or to those undergoing specific procedures. PubMed searches yielded 7034 articles, of which 141 (2.0%) were eligible. An EMBASE search yielded 2 additional articles. After eliminating overlap, 97 studies were retained for analysis, providing a combined sample size of more than 2.88 million individuals and more than 270,000 deaths.

DATA EXTRACTION

Data were extracted by 1 reviewer and then reviewed by 3 independent reviewers. We selected the most complex model available for the full sample and used a variety of sensitivity analyses to address issues of possible overadjustment (adjusted for factors in causal pathway) or underadjustment (not adjusted for at least age, sex, and smoking).

RESULTS

Random-effects summary all-cause mortality HRs for overweight (BMI of 25-<30), obesity (BMI of ≥30), grade 1 obesity (BMI of 30-<35), and grades 2 and 3 obesity (BMI of ≥35) were calculated relative to normal weight (BMI of 18.5-<25). The summary HRs were 0.94 (95% CI, 0.91-0.96) for overweight, 1.18 (95% CI, 1.12-1.25) for obesity (all grades combined), 0.95 (95% CI, 0.88-1.01) for grade 1 obesity, and 1.29 (95% CI, 1.18-1.41) for grades 2 and 3 obesity. These findings persisted when limited to studies with measured weight and height that were considered to be adequately adjusted. The HRs tended to be higher when weight and height were self-reported rather than measured.

CONCLUSIONS AND RELEVANCE

Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.