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Di Fusco SA, Mocini E, Gulizia MM, Gabrielli D, Grimaldi M, Oliva F, Colivicchi F. ANMCO (Italian Association of Hospital Cardiologists) scientific statement: obesity in adults-an approach for cardiologists. Eat Weight Disord 2024; 29:1. [PMID: 38168872 PMCID: PMC10761446 DOI: 10.1007/s40519-023-01630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Obesity is a complex, chronic disease requiring a multidisciplinary approach to its management. In clinical practice, body mass index and waist-related measurements can be used for obesity screening. The estimated prevalence of obesity among adults worldwide is 12%. With the expected further increase in overall obesity prevalence, clinicians will increasingly be managing patients with obesity. Energy balance is regulated by a complex neurohumoral system that involves the central nervous system and circulating mediators, among which leptin is the most studied. The functioning of these systems is influenced by both genetic and environmental factors. Obesity generally occurs when a genetically predisposed individual lives in an obesogenic environment for a long period. Cardiologists are deeply involved in evaluating patients with obesity. Cardiovascular risk profile is one of the most important items to be quantified to understand the health risk due to obesity and the clinical benefit that a single patient can obtain with weight loss. At the individual level, appropriate patient involvement, the detection of potential obesity causes, and a multidisciplinary approach are tools that can improve clinical outcomes. In the near future, we will probably have new pharmacological tools at our disposal that will facilitate achieving and maintaining weight loss. However, pharmacological treatment alone cannot cure such a complex disease. The aim of this paper is to summarize some key points of this field, such as obesity definition and measurement tools, its epidemiology, the main mechanisms underlying energy homeostasis, health consequences of obesity with a focus on cardiovascular diseases and the obesity paradox.Level of evidence V: report of expert committees.
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Affiliation(s)
- Stefania Angela Di Fusco
- Emergency Department, Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Edoardo Mocini
- Department of Experimental Medicine, Sapienza University, 00161, Rome, Italy.
| | | | - Domenico Gabrielli
- Cardio-Thoracic-Vascular Department, San Camillo-Forlanini Hospital, Rome, Italy
- Heart Care Foundation, Florence, Italy
| | - Massimo Grimaldi
- Department of Cardiology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, 70021, Bari, Italy
| | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, 20162, Milan, Italy
| | - Furio Colivicchi
- Emergency Department, Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
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Latief K, Nurrika D, Tsai MK, Gao W. Body Mass Index Asian populations category and stroke and heart disease in the adult population: a longitudinal study of the Indonesia Family Life Survey (IFLS) 2007 and 2014. BMC Public Health 2023; 23:2221. [PMID: 37950166 PMCID: PMC10636903 DOI: 10.1186/s12889-023-17126-0] [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: 07/12/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND A substantially elevated Body Mass Index (BMI) is one of the largest global modifiable risk factors for stroke and heart diseases. Most studies classify BMI according to the WHO BMI cut-off point in stroke and heart disease studies. However, there is a limited understanding of the association between the BMI cut-off point in the Asian population category and stroke and heart disease. This study aimed to investigate the incidence rate ratio of stroke and heart disease by BMI categories for the Asian population. METHODS A 7-year prospective longitudinal study (2007-2014) was conducted on 6,688 adult Indonesian individuals (≥ 35 years) residing across 13 different provinces in Indonesia during the survey periods. Data on BMI were collected in 2007. Information on stroke and heart disease was obtained in both 2007 and in 2014. A multivariate-adjusted Poisson regression model was used to estimate the incidence rate ratio (IRR) and 95% confidence intervals (CIs) of either stroke or heart disease or both stroke and heart disease by BMI. RESULTS Among the 6,688 eligible participants, 334 (5%) were judged as stroke and heart disease in 2014. The IRR (95% CI) of stroke and heart disease for participants with obesity was 2.57 (1.64-4.04) compared with those within normal weight. This incidence rate ratio was more pronounced among middle-aged adults (< 55 years) rather than the older adults (≥55 years).The IRR of stroke and heart disease among obese middle-aged adults was 4.18 (95% CI 2.10-8.31). CONCLUSIONS An association was observed between obesity and the risk of stroke and heart disease, especially in middle-aged adults. These findings suggest that lowering BMI through the adoption of healthy dietary habits and increasing physical activity, particularly among middle-aged adults with high education, occupational employment, and residence in either urban or rural areas, may be beneficial for preventing stroke and heart disease.
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Affiliation(s)
- Kamaluddin Latief
- Ph.D. Program in Global Health and Health Security, College of Public Health, Taipei Medical University, 250 Wuxing Street, 110, Taipei, Taiwan
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Dieta Nurrika
- Public Health Study Program, Banten School of Health Science, South Tangerang, 15318, Indonesia
- The Ministry of Education, Culture, Research, and Technology, Higher Education Service Institutions (LL-DIKTI) Region IV, Bandung, 40124, Indonesia
| | - Min-Kuang Tsai
- Ph.D. Program in Global Health and Health Security, College of Public Health, Taipei Medical University, 250 Wuxing Street, 110, Taipei, Taiwan
| | - Wayne Gao
- Ph.D. Program in Global Health and Health Security, College of Public Health, Taipei Medical University, 250 Wuxing Street, 110, Taipei, Taiwan.
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Rudnicka AR, Welikala R, Barman S, Foster PJ, Luben R, Hayat S, Khaw KT, Whincup P, Strachan D, Owen CG. Artificial intelligence-enabled retinal vasculometry for prediction of circulatory mortality, myocardial infarction and stroke. Br J Ophthalmol 2022; 106:1722-1729. [PMID: 36195457 PMCID: PMC9685715 DOI: 10.1136/bjo-2022-321842] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/03/2022] [Indexed: 02/02/2023]
Abstract
AIMS We examine whether inclusion of artificial intelligence (AI)-enabled retinal vasculometry (RV) improves existing risk algorithms for incident stroke, myocardial infarction (MI) and circulatory mortality. METHODS AI-enabled retinal vessel image analysis processed images from 88 052 UK Biobank (UKB) participants (aged 40-69 years at image capture) and 7411 European Prospective Investigation into Cancer (EPIC)-Norfolk participants (aged 48-92). Retinal arteriolar and venular width, tortuosity and area were extracted. Prediction models were developed in UKB using multivariable Cox proportional hazards regression for circulatory mortality, incident stroke and MI, and externally validated in EPIC-Norfolk. Model performance was assessed using optimism adjusted calibration, C-statistics and R2 statistics. Performance of Framingham risk scores (FRS) for incident stroke and incident MI, with addition of RV to FRS, were compared with a simpler model based on RV, age, smoking status and medical history (antihypertensive/cholesterol lowering medication, diabetes, prevalent stroke/MI). RESULTS UKB prognostic models were developed on 65 144 participants (mean age 56.8; median follow-up 7.7 years) and validated in 5862 EPIC-Norfolk participants (67.6, 9.1 years, respectively). Prediction models for circulatory mortality in men and women had optimism adjusted C-statistics and R2 statistics between 0.75-0.77 and 0.33-0.44, respectively. For incident stroke and MI, addition of RV to FRS did not improve model performance in either cohort. However, the simpler RV model performed equally or better than FRS. CONCLUSION RV offers an alternative predictive biomarker to traditional risk-scores for vascular health, without the need for blood sampling or blood pressure measurement. Further work is needed to examine RV in population screening to triage individuals at high-risk.
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Affiliation(s)
| | - Roshan Welikala
- Faculty of Science, Engineering and Computing, Kingston University, Kingston-Upon-Thames, UK
| | - Sarah Barman
- Faculty of Science, Engineering and Computing, Kingston University, Kingston-Upon-Thames, UK
| | - Paul J Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, University College London, London, UK
| | - Robert Luben
- MRC Epidemiology Unit, Cambridge University, Cambridge, UK
| | - Shabina Hayat
- Department of Psychiatry, Cambridge Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Kay-Tee Khaw
- MRC Epidemiology Unit, Cambridge University, Cambridge, UK
| | - Peter Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - David Strachan
- Population Health Research Institute, St George's University of London, London, UK
| | - Christopher G Owen
- Population Health Research Institute, St George's University of London, London, UK
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Novel insights into the consequences of obesity: a phenotype-wide Mendelian randomization study. Eur J Hum Genet 2022; 30:540-546. [PMID: 34974530 PMCID: PMC9091238 DOI: 10.1038/s41431-021-00978-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 06/02/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022] Open
Abstract
Obesity is thought to significantly impact the quality of life. In this study, we sought to evaluate the health consequences of obesity on the risk of a broad spectrum of human diseases. The causal effects of exposing to obesity on health outcomes were inferred using Mendelian randomization (MR) analyses using a fixed effects inverse-variance weighted model. The instrumental variables were SNPs associated with obesity as measured by body mass index (BMI) reported by GIANT consortium. The spectrum of outcome consisted of the phenotypes from published GWAS and the UK Biobank. The MR-Egger intercept test was applied to estimate horizontal pleiotropic effects, along with Cochran's Q test to assess heterogeneity among the causal effects of instrumental variables. Our MR results confirmed many putative disease risks due to obesity, such as diabetes, dyslipidemia, sleep disorder, gout, smoking behaviors, arthritis, myocardial infarction, and diabetes-related eye disease. The novel findings indicated that elevated red blood cell count was inferred as a mediator of BMI-induced type 2 diabetes in our bidirectional MR analysis. Intriguingly, the effects that higher BMI could decrease the risk of both skin and prostate cancers, reduce calorie intake, and increase the portion size warrant further studies. Our results shed light on a novel mechanism of the disease-causing roles of obesity.
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Ali A, Alfajjam S, Gasana J. Diabetes Mellitus and Its Risk Factors among Migrant Workers in Kuwait. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073943. [PMID: 35409622 PMCID: PMC8997920 DOI: 10.3390/ijerph19073943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 12/14/2022]
Abstract
The prevalence of diabetes mellitus (DM) is growing enormously worldwide, and actions need to be taken in order to minimize the burden of diabetes mellitus and reduce its complications. Since two-thirds of Kuwait's population are expatriates, the prevalence of and factors associated with diabetes among migrant workers was assessed as it has a significant impact on migrant workers' quality of life, health, and productivity. The data used in this study was for all migrant workers who attended Shuaiba Industrial Medical Center (SIMC) for physical examination in the year 2018. Univariate and multivariate regression were used to assess the relationship between diabetes mellitus and the other independent factors where odds ratios with confidence intervals were delineated. Information for a total of 3477 participants was recorded in the dataset for 2018. Of the total participants, 10.1% had diabetes mellitus. About 49% of the participants were overweight. The largest age group of participants was between 31 and 40 years of age. A small percentage of the participants were diagnosed with hypertension at 11.8%. Additionally, 76.1% of the participants reported themselves as non-smokers. Diabetes was positively associated with age, hypertension, and nationalities. However, no association was found between BMI and smoking tobacco. This is the first study in SIMC to assess DM and its associated risk factor among migrants, since migrant workers are neglected subpopulations that need our focus and attention to achieve justice and fairness. The findings revealed that the prevalence of DM among our study population was considerably lower. However, a healthy lifestyle, including a healthy diet and being physically active, need to be introduced to prevent any further damage.
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Affiliation(s)
- Anwar Ali
- Public Health Department, Ministry of Health, P.O. Box 5, Kuwait City 12009, Kuwait;
| | - Shaikhah Alfajjam
- Occupational Health Department, Ministry of Health, P.O. Box 5, Kuwait City 12009, Kuwait;
| | - Janvier Gasana
- Department of Environmental and Occupational Health, Faculty of Public Health, Kuwait University, P.O. Box 24923, Kuwait City 13110, Kuwait
- Correspondence:
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Fung TT, Li Y, Bromage S, Bhupathiraju SN, Batis C, Fawzi W, Holmes MD, Stampfer M, Hu FB, Deitchler M, Willett WC. Higher Global Diet Quality Score Is Associated with Less 4-Year Weight Gain in US Women. J Nutr 2021; 151:162S-167S. [PMID: 34689192 PMCID: PMC8542092 DOI: 10.1093/jn/nxab170] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/21/2021] [Accepted: 05/05/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND We have developed a simple and globally applicable tool, the Global Diet Quality Score (GDQS), to measure diet quality. OBJECTIVES To test the utility of the GDQS, we examined the associations of the GDQS with weight change and risk of obesity in US women. METHODS Health, lifestyle, and diet information were collected from women (n = 68,336) in the Nurses' Health Study II (aged 27-44 y in 1991) through repeated questionnaires (1991-2015). The GDQS has 25 food groups (maximum = 49 points) and scoring higher points reflects a healthier diet. The association between GDQS change in 4-y intervals and concurrent weight change was computed with linear models adjusted for confounders. RESULTS Mean ± SD weight gain across 4-y periods was 1.68 ± 6.26 kg. A >5-point improvement in GDQS was associated with -1.13 kg (95% CI: -1.19, -0.77 kg) weight gain compared with a score change of <±2 points. For each 5-point increase, weight gain was 0.83 kg less for age <50 y compared with 0.71 kg less for age ≥50 y (P-interaction < 0.05). A >5-point score decrease was associated with 1.13 kg (95% CI: 1.04, 1.22 kg) more weight gain in women aged <50 y and 0.81 kg more (95% CI: 0.63, 0.98 kg) in women aged ≥50 y. Compared with little change in score, obesity RR was 0.77 (95% CI: 0.74, 0.81) for a >5-point increase and 1.32 (95% CI: 1.26, 1.37) for a >5-point decrease. Risk of obesity did not differ by age. Compared with other diet quality scores, the Alternate Healthy Eating Index-2010 had somewhat stronger associations than the GDQS (P < 0.05) but the GDQS had stronger associations than the Minimum Dietary Diversity for Women score (P < 0.05). CONCLUSIONS Improvement of diet quality as measured by the GDQS was associated with less weight gain and risk of obesity in US women. The association was stronger for women aged <50 y. Associations similar in direction and magnitude were observed between the GDQS and obesity across age groups.
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Affiliation(s)
- Teresa T Fung
- Department of Nutrition, Simmons University, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Yanping Li
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Sabri Bromage
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Shilpa N Bhupathiraju
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carolina Batis
- CONACYT—Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Michelle D Holmes
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Meir Stampfer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Megan Deitchler
- Intake—Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Walter C Willett
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Mozafar Saadati H, Mehrabi Y, Sabour S, Mansournia MA, Hashemi Nazari SS. Estimating the effects of body mass index and central obesity on stroke in diabetics and non-diabetics using targeted maximum likelihood estimation: Atherosclerosis Risk in Communities study. Obes Sci Pract 2020; 6:628-637. [PMID: 33354341 PMCID: PMC7746966 DOI: 10.1002/osp4.447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The association of body mass index (BMI) with the risk of cardiovascular disease among diabetic patients is controversial. This study compared the effects of BMI and central obesity on stroke in diabetics and non-diabetics using targeted maximum likelihood estimation. MATERIALS AND METHODS This analysis included 12 725 adults aged 45-75 years, after excluding prevalence cases and participants with missing data, from the Atherosclerosis Risk in Communities study. Obesity was defined with BMI, waist circumference, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body shape index (BSI) and body roundness index (BRI), which categorized all participants as obese and non-obese. Generalized linear models and TMLE (with the tmle package) were used to estimate risk ratio (RR). RESULTS During 27 years of follow-up, 1078 (8.47%) cases of stroke occurred. After adjustment for demographic, behavioural, biologic and central obesity variables, the effect of BMI decreased in both diabetics and non-diabetics. The effect of BMI in diabetics was more attenuated, in full model, (RR: 1.04 [0.90, 1.20]) rather than non-diabetics (RR: 1.11 [1.00, 1.24]). This attenuation was more related to biologic variables in non-diabetics and central obesity in diabetics. With respect to central obesity, BSI (RR [95% CI]: 1.15 [0.96, 1.38]) and WHR (RR [95% CI]: 1.15 [0.87, 1.52]) had strongest and marginally significant effects for diabetics and BSI (RR [95% CI]: 1.10 [1.02, 1.20]) for non-diabetics. CONCLUSIONS Among diabetics, BSI and WHR indices were associated with a higher incidence of stroke. Future studies should consider how central obesity affects higher incidence of stroke among diabetics stratified by sex and age groups.
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Affiliation(s)
- Hossein Mozafar Saadati
- Department of Epidemiology, School of Public Health and safetyShahid Beheshti University of Medical SciencesTehranIran
| | - Yadollah Mehrabi
- Department of Epidemiology, School of Public Health and safetyShahid Beheshti University of Medical SciencesTehranIran
| | - Siamak Sabour
- Department of Epidemiology, School of Public Health and safetyShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Seyed Saeed Hashemi Nazari
- Prevention of Cardiovascular Disease Research Center, Department of Epidemiology, School of Public Health and SafetyShahid Beheshti University of Medical SciencesTehranIran
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Hsu T, Forestell CA. Mindfulness, mood, and food: The mediating role of positive affect. Appetite 2020; 158:105001. [PMID: 33068667 DOI: 10.1016/j.appet.2020.105001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/27/2020] [Accepted: 10/11/2020] [Indexed: 01/07/2023]
Abstract
With rates of overweight and obesity rising worldwide, it is important to examine psychological factors associated with food intake. Previous research has shown that mindfulness may serve as a protective factor against overconsumption of food. Some studies have posited that mindfulness addresses unhealthy eating by promoting the increased awareness of, and decreased responsiveness to, internal emotional cues. The present study investigated the effects of a brief mindfulness induction on positive and negative affect and subsequent energy intake in a sample of undergraduate students (N = 126). After exposure to a negative mood induction, 63 participants were randomly assigned to a brief mindfulness intervention, while the remaining participants listened to a news article. Subsequently all participants were offered healthful and unhealthful snack foods. Although there was not a significant between-group difference in intake, a multiple mediation model indicated that positive affect, but not negative affect, significantly mediated the association between condition and food intake. Relative to controls, those in the experimental condition reported higher positive affect after the mindfulness induction, which in turn reduced their energy intake. Further exploratory analyses indicated that positive affect in the experimental group was associated with reduced consumption of unhealthful food. These findings provide insight into how mindfulness-based interventions may target unhealthy eating behaviors.
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Affiliation(s)
- Ti Hsu
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, U.S.A.
| | - Catherine A Forestell
- Department of Psychological Sciences, William & Mary, P.O. Box 8795, Williamsburg, VA, 23187-8795, USA.
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Age-Related Risk Factors at the First Stroke Event. J Clin Med 2020; 9:jcm9072233. [PMID: 32674391 PMCID: PMC7408897 DOI: 10.3390/jcm9072233] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 01/11/2023] Open
Abstract
(1) Background: Stroke is a multifactorial disease, which can affect individuals at any age. Risk factors (RFs) associated with the first stroke event have been well identified; however, the influence of these RFs on the patient’s age needs to be studied. (2) Objective: This study aimed to examine the effect of modifiable RFs on the age at which a stroke occurs. (3) Methods: A cross-sectional study was conducted on patients admitted consecutively with a first-ever acute stroke at the Burgos University Hospital (Spain). Data on sociodemographic and clinical parameters were collected (high blood pressure (HBP), smoking habit, diabetes mellitus (DM), dyslipemia, abdominal obesity, sedentary lifestyle, alcohol consumption, and cardiovascular diseases). The possible associations between RFs and age were studied using univariate and multivariate regression analyses and a decision tree. (4) Results: A total of 436 patients with a mean age of 75.39 years (standard deviation (SD) ± 12.67) were included. HBP and overweight/obesity were the most prevalent stroke RFs. Being an active smoker (OR 21.48; 95% confidence interval (CI) 8.80–52.41), having a sedentary lifestyle (OR 3.24; 95% CI 1.97–5.31), being an excessive alcohol drinker (OR 2.36; 95% CI 1.45–3.84), or being overweight or obese (OR 1.95; 95% CI 1.14–3.34) increased the risk of having an acute cerebrovascular event in individuals aged 75 years or below. However, a personal history of HBP (OR 0.40; 95% CI 0.24–0.67) was significantly associated with a greater likelihood of having an acute stroke in individuals aged more than 75 years. (5) Conclusions: This study showed that the modifiable RFs strongly influence the first stroke event in patients aged below 75 years, which will be useful in guiding different prevention strategies.
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Leung CW, Wolfson JA, Lahne J, Barry MR, Kasper N, Cohen AJ. Associations between Food Security Status and Diet-Related Outcomes among Students at a Large, Public Midwestern University. J Acad Nutr Diet 2020; 119:1623-1631. [PMID: 31561811 DOI: 10.1016/j.jand.2019.06.251] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/25/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Food insecurity is a growing issue of concern on college campuses. While many studies have focused on predictors of food insecurity, fewer studies have examined how food insecurity affects diet and diet-related outcomes among college students. OBJECTIVE The objective of this study was to examine differences in dietary intake, food and cooking agency, and body mass index (calculated as kg/m2) by food security status in a sample of college students at a large, public midwestern university. DESIGN We conducted a cross-sectional online survey administered from March to June 2018. PARTICIPANTS Students were recruited from a random sample (n=2,000) provided by the university, which included an oversample of minority racial/ethnic students from lower-income households and first-generation students. The response rate was 43% (n=851). After excluding students with missing data, the final sample was 754 enrolled students. MAIN OUTCOME MEASURES Food security status was measured using the US Adult Food Security Survey Module. Dietary intake was assessed using the National Cancer Institute dietary screener questionnaire. Cooking and food agency was measured using the Cooking and Food Provisioning Action Scale, a new validated questionnaire. Body mass index was calculated from self-reported height and weight. STATISTICAL ANALYSIS PERFORMED Differences between food security categories and diet-related outcomes were examined using generalized linear models. Models adjusted for sociodemographic covariates, such as student's age, sex, race/ethnicity, and receipt of financial aid. RESULTS Compared to students with high food security, low food security was associated with lower intake of fruits, and very low food security was associated with higher intakes of total added sugar and added sugar from sugar-sweetened beverages. Marginal and very low food security were positively associated with body mass index. Marginal, low, and very low food security were inversely associated with cooking and food agency. CONCLUSIONS Students with food insecurity experience diet-related challenges that could translate into health disparities over time. More research is needed to understand the longitudinal effects of food insecurity on student health and well being.
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Bendor CD, Bardugo A, Pinhas-Hamiel O, Afek A, Twig G. Cardiovascular morbidity, diabetes and cancer risk among children and adolescents with severe obesity. Cardiovasc Diabetol 2020; 19:79. [PMID: 32534575 PMCID: PMC7293793 DOI: 10.1186/s12933-020-01052-1] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/08/2020] [Indexed: 02/08/2023] Open
Abstract
Severe obesity among children and adolescents is a significant global public health concern. The prevalence has markedly increased over the last decades, becoming common in many countries. Overwhelming rates of obesity among youth have prompted efforts to identify an evidence-based immediate- and long-term cardiometabolic risk factor profile in childhood-onset severe obesity, and to highlight gaps that require further investigation. The PubMed database was systematically searched in accordance with PRISMA guidelines. The search yielded 831 results, of which 60 fulfilled stringent criteria and were summarized in this review. The definition of severe obesity was variable, with only one half the publications using the definition BMI > 120% of the 95th percentile. Point estimates of the prevalence of at least one cardiometabolic risk factor in children with severe obesity reportedly range from 67 to 86%. Cross-sectional studies indicate that children and adolescents with severe obesity are at greater risk than those with mild obesity for type 2 diabetes, hypertension, fatty liver disease and dyslipidemia, already at childhood and adolescence. Robust epidemiological data on the long-term risk and actual point estimates in adulthood are lacking for these diseases as well as for other diseases (coronary heart disease, stroke, chronic kidney disease and cancer). Recent longitudinal studies indicate an increased risk for cardiomyopathy, heart failure, cardiovascular mortality and all-cause mortality in adulthood for adolescents with severe obesity compared to those with mild obesity. Given the alarming increase in the prevalence of severe obesity, the persistence of adiposity from childhood to adulthood and the precarious course of young adults with chronic comorbidities, the economic and clinical services burden on the healthcare system is expected to rise.
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Affiliation(s)
- Cole D Bendor
- Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
- Academy and Research Division, Surgeon General Headquarters, Israel Defense Forces, Medical Corps, Ramat Gan, Israel
| | - Aya Bardugo
- Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
- Academy and Research Division, Surgeon General Headquarters, Israel Defense Forces, Medical Corps, Ramat Gan, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Gilad Twig
- Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel.
- Academy and Research Division, Surgeon General Headquarters, Israel Defense Forces, Medical Corps, Ramat Gan, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
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12
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Cuadrado C, Dunstan J, Silva-Illanes N, Mirelman AJ, Nakamura R, Suhrcke M. Effects of a sugar-sweetened beverage tax on prices and affordability of soft drinks in Chile: A time series analysis. Soc Sci Med 2019; 245:112708. [PMID: 31862547 PMCID: PMC7267770 DOI: 10.1016/j.socscimed.2019.112708] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/19/2019] [Accepted: 11/27/2019] [Indexed: 01/15/2023]
Abstract
Chile is one of several countries that recently implemented a fiscal policy to reduce soft drink (SD) intake and obesity. In 2014 the government increased the existing ad-valorem tax on high-sugar SD by 5% and decreased by 3% the tax on low-sugar SD, based on a 6.25gr/100 ml sugar threshold. This study aims to evaluate the tax modification passed-on to consumers through prices, and to calculate changes in affordability of SDs. We analysed nationally representative consumer price index data of 41 soft drinks within 6 beverage categories between 2009 and 2016. Price change post-tax implementation was estimated for different categories (carbonates, juices, concentrates, waters and energy-sport drinks), using time-series analyses. In addition, changes in affordability were evaluated by estimating the changes in prices relative to wages. The price of carbonates increased by 5.60% (CI 95% 3.18–8.03%) immediately after the tax was implemented. A sustained increase in the prices of concentrates was observed after the implementation. Unexpectedly, a smaller increase was also seen for the price of bottled water – a category that saw no tax change. There were no effects for juices and energy-sports drinks. There was a reduction in affordability for carbonates, concentrates and waters. Overall, the fiscal policy was effective in increasing prices and there are some signs of reduced affordability. Results varied substantially among categories directly affected by the tax policy. While for carbonates the price increase exceeded the tax change (‘over-shifting’), in other categories subject to a tax cut, a price reduction was expected but the opposite occurred. As the effect of the tax on prices differed between categories, the effects of the tax policy on consumption patterns are likely to be mixed. Our findings underline the need to better understand and anticipate price setting behaviour of firms in response to a tax. Chile implemented a tax policy on soft drinks (SD) to promote healthier diets in 2014. It consists in a 5% tax increase on high-sugar SD and 3% reduction on low-sugar SD. Using consumer price index data we estimate policy impact on SD price/affordability. Overall, the policy was effective to increase prices and reduce affordability. Results varied substantially among SD categories, with some counterintuitive effects.
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Affiliation(s)
| | | | | | | | - Ryota Nakamura
- Centre for Health Economics, University of York, UK; Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Japan
| | - Marc Suhrcke
- Centre for Health Economics, University of York, UK; Luxembourg Institute of Socio-economic Research, Luxembourg
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13
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Park SY, Park DJ. Comparison of Foot Structure, Function, Plantar Pressure and Balance Ability According to the Body Mass Index of Young Adults. Osong Public Health Res Perspect 2019; 10:102-107. [PMID: 31065537 PMCID: PMC6481571 DOI: 10.24171/j.phrp.2019.10.2.09] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives This study compared foot arch height, plantar fascia thickness, a range of motion assessments of the ankle joint, strength of the ankle joint, plantar pressure, and balance between obese and normal weight young adults. Methods Fifty-two participants were required for the present study design to achieve 80% power, 0.8 effect size (η2), and an alpha level of 0.05. The participants were categorized to normal weight or obese groups based on BMI (≤ 24 kg/m2 and ≥ 25 kg/m2, respectively). The foot and ankle disability index and Sport survey were completed by the participants before the measurements. Foot arch height was measured using the navicular drop test, and plantar fascia thickness was measured using ultrasound. Plantar pressure and balance tests were also conducted, followed by ankle joint range of motion and strength tests. Results Foot arch height and plantar fascia thickness was significantly higher in the obese group compared with the normal weight group (p < 0.01). There were significant differences in eversion of ankle strength, plantar pressure in the big toe and heel and anterior-posterior balance between normal and obese weight groups (p < 0.05). Conclusion Obese young adults had more abnormalities in the medial longitudinal arch, plantar fascia, and plantar pressure as well as weakened ankle eversion strength and balance problems compared with the normal weight group.
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Affiliation(s)
- Se-Yeon Park
- Department of Physical Therapy, Kaya University, Korea
| | - Du-Jin Park
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Korea
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14
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Stupplebeen DA, Eliason MJ, LeBlanc AJ, Sanchez-Vaznaugh EV. Differential Influence of Weight Status on Chronic Diseases by Reported Sexual Orientation Identity in Men. LGBT Health 2019; 6:126-133. [PMID: 30916609 PMCID: PMC6477578 DOI: 10.1089/lgbt.2018.0167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study examined whether the association between weight status and four chronic diseases (heart disease, hypertension, lifetime asthma, and type 2 diabetes) varied according to sexual orientation identity among adult men, controlling for demographic, socioeconomic, and other factors. METHODS Pooled data from male adult participants (n = 72,214) in the 2003-2012 California Health Interview Survey were used along with logistic regression models to estimate whether the associations between weight status and chronic diseases varied by sexual orientation identity. RESULTS Weight status was positively associated with each of the chronic diseases (hypertension, heart disease, asthma, and diabetes) among both gay and bisexual men and heterosexual men; however, the associations varied significantly by sexual orientation identity. Among gay and bisexual men, the associations were stronger and statistically significant-with the exception of lifetime asthma-particularly for men in the obese classifications, before and after controlling for age, marital status, race/ethnicity, education, income, health insurance status, food security level, smoking, and nativity. CONCLUSIONS Weight status had stronger detrimental associations with chronic disease among gay and bisexual men despite these men having greater socioeconomic advantage and lower body mass index than heterosexual men. Future research should examine mechanisms, including stress related to minority status, which may lead to greater risks for chronic diseases among sexual minority men.
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Affiliation(s)
- David A. Stupplebeen
- Office of Public Health Studies, University of Hawai‘i at Mānoa, Honolulu, Hawai‘i
| | - Michele J. Eliason
- Department of Health Education, College of Health and Social Sciences, San Francisco State University, San Francisco, California
| | - Allen J. LeBlanc
- Department of Sociology, College of Health and Social Sciences, San Francisco State University, San Francisco, California
- Health Equity Institute, College of Health and Social Sciences, San Francisco State University, San Francisco, California
| | - Emma V. Sanchez-Vaznaugh
- Department of Health Education, College of Health and Social Sciences, San Francisco State University, San Francisco, California
- Health Equity Institute, College of Health and Social Sciences, San Francisco State University, San Francisco, California
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15
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Huang H, Long W, Zhao W, Zou L, Song Y, Zuo J, Yang Z. Polymorphism of R353Q (rs6046) in factor VII and the risk of myocardial infarction: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e12566. [PMID: 30278561 PMCID: PMC6181591 DOI: 10.1097/md.0000000000012566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Genetic components substantially contribute to the development of myocardial infarction (MI), and R353Q polymorphism (rs6046) in FVII gene has been suspected to be associated with the risk of MI. METHODS A meta-analysis was conducted on the links between R353Q polymorphism and the susceptibility of MI. A comprehensive literature search was performed on 8 electronic databases. The main effects of the genotypes were estimated using a logistic regression approach. The odds ratios with 95% confidence intervals were calculated using the conventional summary method meta-analysis. The possible sources of heterogeneity among the included studies were explored using meta-regression analysis and subgroup analysis. RESULTS A total of 18 eligible case-control studies, comprising of 4701 cases and 5329 controls, were included. No overall statistical relationship was identified between R353Q and MI by any of the genetic models. The meta-regression demonstrated that the Asian population, body mass index (BMI) category, and diabetes affected the heterogeneity. In addition, subgroup analyses showed that heterogeneities were identified in Asian population and BMI category, which highly agree with the results of meta-regression. CONCLUSIONS The current meta-analysis suggested that R353Q polymorphism was not associated with the MI risk. Asian population, BMI category, and diabetes might be related to the incidence of MI. However, large-scale, case-control studies with rigorous designs are essential to provide accurate evidence.
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Affiliation(s)
- Haoming Huang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine
| | - Wenjie Long
- The First Clinical Medical College, Guangzhou University of Chinese Medicine
| | - Weixuan Zhao
- The First Clinical Medical College, Guangzhou University of Chinese Medicine
| | - Ling Zou
- The First Clinical Medical College, Guangzhou University of Chinese Medicine
| | - Yudi Song
- The First Clinical Medical College, Guangzhou University of Chinese Medicine
| | | | - Zhongqi Yang
- Department of Geriatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
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16
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Zhou YE, Buchowski MS, Akatue RA, Wu J, Liu J, Hargreaves MK. Physical Activity Levels and Cardiometabolic Risks in Obese African American Adults: A Pilot Intervention Study. J Health Care Poor Underserved 2018; 29:1027-1045. [PMID: 30122681 DOI: 10.1353/hpu.2018.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Limited information is available regarding the effects of physical activity on risks of cardiometabolic diseases among obese African American adults. We conducted a church-based 12-week weight control and cardiometabolic risk reduction intervention (n=30, 22 females, 56.7±11.4 years old, BMI 37.4±6.7 kg/m2), after which body weight was slightly reduced (98.3±18.4 and 97.3±19 kg, p=.052); body fat percentage was significantly decreased among males (34.7±8.9 to 28.5±8.4 %; p=.049); and walking steps were increased, but not significantly. Among measured cardiometabolic risk biomarkers, hemoglobin A1c (HbA1c) was decreased significantly (6.8±1.1 to 6.1±1.1%; p=.0004) while time spent in sedentary behaviors was associated with less favorable change in total cholesterol (β=11.49, SE=3.55, p=.003) and tumor necrosis factor (TNF-α, β=0.3, SE=0.13, p=.038). Our study shows that adiposity reduction was feasible through a short-term healthy lifestyle program for obese African American adults, and suggests that reducing sedentary behaviors through light physical activity might lead to a decrease in cardiovascular risks.
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17
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Nazari SSH, Mokhayeri Y, Mansournia MA, Khodakarim S, Soori H. Associations between dietary risk factors and ischemic stroke: a comparison of regression methods using data from the Multi-Ethnic Study of Atherosclerosis. Epidemiol Health 2018; 40:e2018021. [PMID: 29807407 PMCID: PMC6060337 DOI: 10.4178/epih.e2018021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/21/2018] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES We analyzed dietary patterns using reduced rank regression (RRR), and assessed how well the scores extracted by RRR predicted stroke in comparison to the scores produced by partial least squares and principal component regression models. METHODS Dietary data at baseline were used to extract dietary patterns using the 3 methods, along with 4 response variables: body mass index, fibrinogen, interleukin-6, and low-density lipoprotein cholesterol. The analyses were based on 5,468 males and females aged 45-84 years who had no clinical cardiovascular disease, using data from the Multi-Ethnic Study of Atherosclerosis. RESULTS The primary factor derived by RRR was positively associated with stroke incidence in both models. The first model was adjusted for sex and race and the second model was adjusted for the variables in model 1 as well as smoking, physical activity, family and sibling history of stroke, the use of any lipid-lowering medication, the use of any anti-hypertensive medication, hypertension, and history of myocardial infarction (model 1: hazard ratio [HR], 7.49; 95% confidence interval [CI], 1.66 to 33.69; p for trend=0.01; model 2: HR, 6.83; 95% CI, 1.51 to 30.87 for quintile 5 compared with the reference category; p for trend=0.02). CONCLUSIONS Based primarily on RRR, we identified that a dietary pattern high in fats and oils, poultry, non-diet soda, processed meat, tomatoes, legumes, chicken, tuna and egg salad, and fried potatoes and low in dark-yellow and cruciferous vegetables may increase the incidence of ischemic stroke.
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Affiliation(s)
- Seyed Saeed Hashemi Nazari
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yaser Mokhayeri
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Khodakarim
- Department of Epidemiology, School of Paramedical Science, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Soori
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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18
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Feng C, Osgood ND, Dyck RF. Low Birth Weight, Cumulative Obesity Dose, and the Risk of Incident Type 2 Diabetes. J Diabetes Res 2018; 2018:8435762. [PMID: 29541643 PMCID: PMC5818910 DOI: 10.1155/2018/8435762] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Obesity history may provide a better understanding of the contribution of obesity to T2DM risk. METHODS 17,634 participants from the 1958 National Child Development Study were followed from birth to 50 years. Cumulative obesity dose, a measure of obesity history, was calculated by subtracting the upper cut-off of the normal BMI from the actual BMI at each follow-up and summing the areas under the obesity dose curve. Hazard ratios (HRs) for diabetes were calculated using Cox regression analysis. Three separate models compared the predictive ability of cumulative obesity dose on diabetes risk with the time-varying BMI and last BMI. RESULTS In final models, 341 of 15,043 (2.27%) participants developed diabetes; male sex and low birth weight were significant confounding variables. Adjusted HRs were 1.080 (95% CI: 1.071, 1.088) per 10-unit cumulative obesity dose, 1.098 (95% CI: 1.080, 1.117) per unit of the time-varying BMI, and 1.146 (95% CI: 1.084, 1.212) per unit of the last BMI. Cumulative obesity dose provided the best predictive ability for diabetes. CONCLUSIONS Cumulative obesity dose is an improved method for evaluating the impact of obesity history on diabetes risk. The link between low birth weight and T2DM is strengthened by adjusting for cumulative obesity dose.
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Affiliation(s)
- Cindy Feng
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Nathaniel D. Osgood
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Roland F. Dyck
- Department of Medicine, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
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19
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Jamieson A, Finer N. Can we reconcile 'the obesity paradox' with recent cardiovascular outcome trials in diabetes? Clin Obes 2017; 7:255-259. [PMID: 28877557 DOI: 10.1111/cob.12217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/24/2017] [Accepted: 08/04/2017] [Indexed: 01/05/2023]
Affiliation(s)
- A Jamieson
- National Centre for Cardiovascular Prevention and Outcomes, UCL Institute of Cardiovascular Science, London, UK
| | - N Finer
- National Centre for Cardiovascular Prevention and Outcomes, UCL Institute of Cardiovascular Science, London, UK
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20
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Umeh K. Personal care plans and glycaemic control: the role of body mass index and physical activity. ACTA ACUST UNITED AC 2017; 26:543-551. [DOI: 10.12968/bjon.2017.26.10.543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kanayo Umeh
- Senior Lecturer/Chartered Psychologist, School of Natural Sciences and Psychology, Liverpool John Moores University
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21
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Zhou YE, Jackson CD, Oates VJ, Davis GW, Davis C, Takizala ZM, Akatue RA, Williams K, Liu J, Hébert JR, Patel KA, Buchowski MS, Schlundt DG, Hargreaves MK. Refining a Church-Based Lifestyle Intervention Targeting African-American Adults at Risk for Cardiometabolic Diseases: A Pilot Study. ACTA ACUST UNITED AC 2017; 7:96-114. [PMID: 33457107 DOI: 10.4236/ojepi.2017.72009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective The pilot study was intended to test the feasibility of a multiple-component lifestyle intervention targeting African American adults in a weight control and cardiometabolic risk reduction program on diet, activity, and stress, using community-engagement principles. Methods Applying mixed qualitative and quantitative measures, the intervention had a two-part sequential study design consisting of 12 weekly small group sessions that provided individual and group counseling in nutrition, exercise, and mindfulness, while incorporating focus group and interactive techniques to learn about barriers and acceptable practices for this population. The program was implemented at an African-American church in Nashville, Tennessee. Results Thirty-four participants (aged 56.1 ± 11 years, body mass index (BMI) 36.7 ± 6.6 kg/m2) completed the intervention. Lifestyle changes after the 12 weekly sessions showed some positive trends including reduced sodium intake (from 2725.3 ± 326.5 to 2132 ± 330, mg/day, P = 0.008), increased walking steps (from 4392.1 ± 497.2 to 4895.3 ± 497.9, steps/day, not significant), and slightly decreased Perceived Stress Scale (PSS) scores (from 13.7 ± 1.4 to 12.4 ± 1.5, not significant). Body fat % among male participants decreased significantly (from 33.8 ± 2.6 to 28 ± 2.6, %, P = 0.043). Among cardiometabolic risk biomarkers, hemoglobin A1c (HbA1c) decreased significantly (from 6.6 ± 0.2 to 6.1 ± 0.2, %, P < 0.001). The baseline PSS score was positively associated with baseline adiposity levels (e.g., weight, β = 2.4, P = 0.006). Twenty-one participants took part in focus groups during the program to identify barriers to healthy lifestyle changes. Primary barriers reported were price, time for preparing healthy meals, unfamiliarity with mindfulness activities, their health condition, and daily schedule available for physical activities. Conclusions This church-based pilot intervention was proven feasible by showing modest progress in reducing adiposity and decreasing HbA1c levels. The focus group and interactive methods facilitated program direction. Future full-scale studies are warranted to identify key strategies that provide more personalized approaches and supportive environments to sustain a healthy lifestyle among these at risk minorities with limited resources.
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Affiliation(s)
- Yuan E Zhou
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - Cynthia D Jackson
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - Veronica J Oates
- Department of Family and Consumer Sciences, Tennessee State University, Nashville, TN, USA
| | - Gerald W Davis
- Ralph H Boston Wellness Center, Tennessee State University, Nashville, TN, USA
| | | | - Zudi-Mwak Takizala
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - Richmond A Akatue
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - Konya Williams
- Participant and Clinical Interactions Resources, Meharry Medical College, Nashville, TN, USA
| | - Jianguo Liu
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - James R Hébert
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, USA
| | - Kushal A Patel
- Department of Public Health, Tennessee State University, Nashville, USA
| | | | - David G Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
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'Knowing what Matters in diabetes: Healthier below 7': results of the campaign's first 10 years (part 2), participants without known diabetes history. Cardiovasc Endocrinol 2017; 6:48-54. [PMID: 28392974 PMCID: PMC5367513 DOI: 10.1097/xce.0000000000000109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/16/2016] [Indexed: 11/30/2022] Open
Abstract
Type 2 diabetes represents a major problem in many societies. Early detection and, even better, prevention could help to reduce the burden of the disease. Therefore, increased awareness of disorders of glucose metabolism is important. During the campaign ‘Knowing what Matters in diabetes: Healthier below 7’, in the last few years, more than 31 000 shopping mall visitors in Germany were voluntarily checked for their potential diabetes risk.
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Divella R, De Luca R, Abbate I, Naglieri E, Daniele A. Obesity and cancer: the role of adipose tissue and adipo-cytokines-induced chronic inflammation. J Cancer 2016; 7:2346-2359. [PMID: 27994674 PMCID: PMC5166547 DOI: 10.7150/jca.16884] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 09/19/2016] [Indexed: 12/12/2022] Open
Abstract
Adipose tissue in addition to its ability to keep lipids is now recognized as a real organ with both metabolic and endocrine functions. Recent studies demonstrated that in obese animals is established a status of adipocyte hypoxia and in this hypoxic state interaction between adipocytes and stromal vascular cells contribute to tumor development and progression. In several tumors such as breast, colon, liver and prostate, obesity represents a poor predictor of clinical outcomes. Dysfunctional adipose tissue in obesity releases a disturbed profile of adipokines with elevated levels of pro-inflammatory factors and a consequent alteration of key signaling mediators which may be an active local player in establishing the peritumoral environment promoting tumor growth and progression. Therefore, adipose tissue hypoxia might contribute to cancer risk in the obese population. To date the precise mechanisms behind this obesity-cancer link is not yet fully understood. In the light of information provided in this review that aims to identify the key mechanisms underlying the link between obesity and cancer we support that inflammatory state specific of obesity may be important in obesity-cancer link.
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Affiliation(s)
- Rosa Divella
- Clinical Pathology Laboratory, Department of Experimental Oncology. Giovanni Paolo II National Cancer Institute, V.Le Orazio Flacco 65, 70124 -Bari, Italy
| | - Raffaele De Luca
- Department of Surgery Oncology. Giovanni Paolo II National Cancer Institute, V.Le Orazio Flacco 65, 70124 -Bari, Italy
| | - Ines Abbate
- Clinical Pathology Laboratory, Department of Experimental Oncology. Giovanni Paolo II National Cancer Institute, V.Le Orazio Flacco 65, 70124 -Bari, Italy
| | - Emanuele Naglieri
- Department of Medical Oncology, Giovanni Paolo II National Cancer Institute, V.Le Orazio Flacco 65, 70124 -Bari, Italy
| | - Antonella Daniele
- Clinical Pathology Laboratory, Department of Experimental Oncology. Giovanni Paolo II National Cancer Institute, V.Le Orazio Flacco 65, 70124 -Bari, Italy
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Crump C, Sundquist J, Winkleby MA, Sundquist K. Interactive effects of obesity and physical fitness on risk of ischemic heart disease. Int J Obes (Lond) 2016; 41:255-261. [PMID: 27867205 PMCID: PMC5296285 DOI: 10.1038/ijo.2016.209] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 10/24/2016] [Accepted: 10/30/2016] [Indexed: 12/18/2022]
Abstract
Background/Objectives Obesity and low physical fitness are known risk factors for ischemic heart disease (IHD), but their interactive effects are unclear. Elucidation of interactions between these common, modifiable risk factors may help inform more effective preventive strategies. We examined interactive effects of obesity, aerobic fitness, and muscular strength in late adolescence on risk of IHD in adulthood in a large national cohort. Subjects/Methods We conducted a national cohort study of all 1,547,407 military conscripts in Sweden during 1969–1997 (97–98% of all 18-year-old males each year). Aerobic fitness, muscular strength, and body mass index (BMI) measurements were examined in relation to IHD identified from outpatient and inpatient diagnoses through 2012 (maximum age 62 years). Results There were 38,142 men diagnosed with IHD in 39.7 million person-years of follow-up. High BMI or low aerobic fitness (but not muscular strength) was associated with higher risk of IHD, adjusting for family history and socioeconomic factors. The combination of high BMI (overweight/obese vs. normal) and low aerobic fitness (lowest vs. highest tertile) was associated with highest IHD risk (incidence rate ratio, 3.11; 95% CI, 2.91–3.31; P<0.001). These exposures had no additive and a negative multiplicative interaction (i.e., their combined effect was less than the product of their separate effects). Low aerobic fitness was a strong risk factor even among those with normal BMI. Conclusions In this large cohort study, low aerobic fitness or high BMI at age 18 was associated with higher risk of IHD in adulthood, with a negative multiplicative interaction. Low aerobic fitness appeared to account for a similar number of IHD cases among those with normal vs. high BMI (i.e., no additive interaction). These findings suggest that interventions to prevent IHD should begin early in life and include not only weight control but aerobic fitness, even among persons of normal weight.
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Affiliation(s)
- C Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - M A Winkleby
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
| | - K Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Ding C, Chan Z, Magkos F. Lean, but not healthy: the 'metabolically obese, normal-weight' phenotype. Curr Opin Clin Nutr Metab Care 2016; 19:408-417. [PMID: 27552473 DOI: 10.1097/mco.0000000000000317] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Obesity is commonly associated with metabolic dysfunction but there are obese persons who are metabolically healthy. On the opposite side of the coin, there are lean persons who carry multiple cardiometabolic risk factors, typically referred to as metabolically obese, normal-weight (MONW). This has called into question our understanding of obesity and metabolic dysfunction, as an appearance of normal weight may mask significant comorbidities and delay health interventions. RECENT FINDINGS High heterogeneity in MONW prevalence rates has been observed, with estimates ranging from as low as 5% to as high as 45%. Reasons for this include sample size effects, differences in MONW definition, social and demographic factors, as well as assumptions made in establishing normal weight. MONW study participants are often characterized by excess visceral adipose tissue and ectopic fat deposition, adipose tissue inflammation, altered inflammatory and adipokine profiles, reduced skeletal muscle mass and low cardiorespiratory fitness. However, more often than not, groups of MONW study participants have been somewhat 'fatter' than the control groups of metabolically healthy lean study participants, which in itself could be responsible for some of the observed differences. Very limited data are available regarding interventions to improve metabolic function in MONW study participants. SUMMARY There is a need for more research to better understand the characteristics of the MONW phenotype, the cause of metabolic dysfunction in the absence of obesity, and evaluate potential therapies so as to facilitate the establishment of clinical guidelines.
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Affiliation(s)
- Cherlyn Ding
- aClinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR) bDepartment of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Lu WA, Kuo J, Wang YM, Lien TC, Liu YB, Tsai JZ, Kuo CD. Reduced enhancement of high-frequency component in the cross spectrum of ECG and nostril airflow signals in patients with chronic obstructive pulmonary disease. Physiol Rep 2016; 4:4/7/e12763. [PMID: 27053296 PMCID: PMC4831331 DOI: 10.14814/phy2.12763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/19/2016] [Indexed: 11/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic airway disease with increased airway resistance. This study investigated the common characteristics of electrocardiographic (ECG) and nostril airflow signals in COPD patients using cross-spectral analysis. Heart rate variability (HRV) measures and cross-spectral (cs) measures of ECG and nostril airflow were compared in COPD patients and normal subjects, and correlated with their clinical characteristics. We found that cross-spectral analysis can lead to a significant increase in normalized high-frequency power (nHFPcs) and a significant decrease in normalized very low-frequency power (nVLFPcs), normalized low-frequency power (nLFPcs), and low-/high-frequency power ratio (LHRcs) in both normal subjects and COPD patients, as compared with their corresponding HRV measures. Further analysis showed that the percentage increase in nHFP (%nHFP) and the percentage decrease in LHR (%LHR) due to cross-spectral analysis in COPD patients were significantly smaller than those of normal subjects. All cross-spectral measures of ECG and nostril airflow in COPD patients did not significantly correlate with their pulmonary function characteristics. However, the nHFPcs correlated significantly and negatively with body mass index (BMI) in both normal subjects and COPD patients, and the %nHFP correlated significantly and negatively with BMI in COPD patients. We conclude that cross-spectral analysis of ECG and nostril airflow signals could lead to reduced enhancement in the high-frequency component in the cross spectrum of COPD patients. The magnitude of reduced enhancement in the high-frequency component in the cross-spectrum was related to the BMI of the patients. Cross-spectral analysis of ECG and nostril airflow might be used to assess the cardiovascular-related functions of COPD patients.
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Affiliation(s)
- Wan-An Lu
- Laboratory of Biophysics, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Cultural Asset and Reinvention, Fo-Guang University, Yilan, Taiwan
| | - Jane Kuo
- Laboratory of Biophysics, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yan-Min Wang
- Laboratory of Biophysics, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Te-Cheng Lien
- Division of Respiratory Therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Bin Liu
- Medical Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Jang-Zern Tsai
- Department of Electrical Engineering, National Central University, Jung-Li City, Taiwan
| | - Cheng-Deng Kuo
- Laboratory of Biophysics, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan Division of Respiratory Therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Zhao X, Tsujimoto T, Kim B, Katayama Y, Wakaba K, Wang Z, Tanaka K. Effects of increasing physical activity on foot structure and ankle muscle strength in adults with obesity. J Phys Ther Sci 2016; 28:2332-6. [PMID: 27630426 PMCID: PMC5011590 DOI: 10.1589/jpts.28.2332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/14/2016] [Indexed: 02/02/2023] Open
Abstract
[Purpose] The purpose of this study was to examine the effects of increasing physical
activity on foot structure and ankle muscle strength in adults with obesity and to verify
whether the rate of change in foot structure is related to that in ankle muscle strength.
[Subjects and Methods] Twenty-seven adults with obesity completed a 12-week program in
which the intensity of physical activity performed was gradually increased. Physical
activity was monitored using a three-axis accelerometer. Foot structure was assessed using
a three-dimensional foot scanner, while ankle muscle strength was measured using a
dynamometry. [Results] With the increasing physical activity, the participants’ feet
became thinner (the rearfoot width, instep height, and girth decreased) and the arch
became higher (the arch height index increased) and stiffer (the arch stiffness index
increased); the ankle muscle strength also increased after the intervention. Additionally,
the changes in the arch height index and arch stiffness index were not associated with
changes in ankle muscle strength. [Conclusion] Increasing physical activity may be one
possible approach to improve foot structure and function in individuals with obesity.
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Affiliation(s)
- Xiaoguang Zhao
- Doctoral Program in Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | | | - Bokun Kim
- Doctoral Program in Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | | | - Kyousuke Wakaba
- Doctoral Program in Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | - Zhennan Wang
- Doctoral Program in Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | - Kiyoji Tanaka
- Faculty of Health and Sports Sciences, University of Tsukuba, Japan
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