Association between obesity and unintentional injury in older adults

The association between lower limb fractures and weight gain in adults: a prospective analysis of body mass index trends

PURPOSE

Despite understanding the connection between obesity and fracture risk, there is limited research on the implications of lower limb fractures on subsequent changes in body mass index (BMI). Our study aimed to assess the impact of lower limb fractures on BMI alterations over an 18-month period.

METHODS

A multi-center, prospective cohort study was conducted between January 2021 to June 2023, involving 494 adults with lower limb fractures. Participants were recruited within 2 weeks post-injury and were assessed for demographics, injury details, and weight at seven distinct time points. By 18 months, the primary outcome was the mean weight gain.

RESULTS

The average age of the participants was 39 (± 12.7) with a baseline weight and BMI of 80.4 kg and 27.6, respectively. At the 18-month follow-up, 75% of patients experienced an average weight increase in 4 kg (± 5.39 kg), equating to a BMI rise of 1.39 (± 1.88). Most patients attributed weight changes to their injury, with nearly half expressing distress from their weight change. Only 37% believed that they had resumed their previous activity levels by the final follow-up. Approximately 31% of the patients sought some form of external weight management care in the form of nutritionist advice, training programs, medication and weight management procedures.

CONCLUSIONS

Lower limb fractures significantly affect weight gain over an 18-month period, with substantial psychological and physical consequences. Healthcare providers should anticipate potential weight gain post-fracture and incorporate strategies addressing both physical and mental aspects of rehabilitation to enhance recovery outcomes. Early and even immediate weight bearing may play a pivotal role in mitigating weight changes and returning the patient to their previous level of activity. Further detailed studies focusing on different fractures and postoperative interventions are recommended.

The Critical Role of Oxidative Stress in Sarcopenic Obesity

Sarcopenic obesity (SO) is a combination of obesity and sarcopenia that primarily develops in older people. Patients with SO have high fat mass, low muscle mass, low muscle strength, and low physical function. SO relates to metabolic syndrome and an increased risk of morbimortality. The prevalence of SO varies because of lacking consensus criteria regarding its definition and the methodological difficulty in diagnosing sarcopenia and obesity. SO includes systemic alterations such as insulin resistance, increased proinflammatory cytokines, age-associated hormonal changes, and decreased physical activity at pathophysiological levels. Interestingly, these alterations are influenced by oxidative stress, which is a critical factor in altering muscle function and the generation of metabolic dysfunctions. Thus, oxidative stress in SO alters muscle mass, the signaling pathways that control it, satellite cell functions, and mitochondrial and endoplasmic reticulum activities. Considering this background, our objectives in this review are to describe SO as a highly prevalent condition and look at the role of oxidative stress in SO pathophysiology.

Occupational injury and psychological distress among U.S. workers: The National Health Interview Survey, 2004-2016

INTRODUCTION

Injuries at work may negatively influence mental health due to lost or reduced working hours and financial burden of treatment. Our objective was to investigate, in U.S. workers (a) the prevalence of serious psychological distress (SPD) by injury status (occupational, non-occupational, and no injury) and injury characteristics, and (b) the association between injury status and SPD.

METHODS

Self-reported injuries within the previous three months were collected annually for 225,331 U.S. workers in the National Health Interview Survey (2004-2016). Psychological distress during the past 30 days was assessed using the Kessler 6 (K6) questions with Likert-type scale (0-4, total score range: 0-24). SPD was defined as K6 ≥ 13. Prevalence ratios (PR) from fitted logistic regression models were used to assess relationships between injury and SPD after controlling for covariates.

RESULTS

The prevalence of SPD was 4.74%, 3.58%, and 1.56% in workers reporting occupational injury (OI), non-occupational injury (NOI), and no injury, respectively. Workers with head and neck injury had the highest prevalence of SPD (Prevalence: OI = 7.71%, NOI = 6.17%), followed by workers with scrape/bruise/burn/bite (6.32% for those with OI). Workers reporting OI were two times more likely to have SPD compared to those without injury (PR = 2.19, 95%CI: 1.62-2.96). However, there was no significant difference in SPD between workers with OI and workers with NOI (PR = 0.98, 95%CI: 0.65-1.48).

CONCLUSION

The prevalence of SPD varied by injury status with the highest being among workers reporting OI. We found that the workers reporting OI were significantly more likely to have SPD than those without injury, but not more than those with NOI. Practical Applications: Mental health management programs by employers are necessary for workers who are injured in the workplace.

Calorie Intake and Cognitive Function in the Elderly: Data from the Korean Frailty and Aging Cohort Study (KFACS)

This study aimed to clarify the association between calorie intake and cognitive function in community-dwelling older adults. A cross-sectional analysis was performed on the first-year baseline data of 1559 adults aged 70-84 years using population data from the Korean Frailty and Aging Cohort Study. We included 543 participants who participated in nutritional surveys and accurately responded regarding their daily calorie intake. Daily ingestion was measured using the 24-hour dietary recall method, and neuropsychological tests evaluated cognitive characteristics. Logistic regression models were utilized to calculate odds ratios (ORs) with 95% confidence intervals (CIs). The prevalence rate of cognitive impairment was 8%. Subjects with cognitive impairment mainly showed memory loss. After adjusting the confounding factors, participants who had less than the recommended intake were susceptible to cognitive impairment compared to those who that had the proposed intake (adjusted OR: 7.70, 95% CI: 1.01-58.45). We showed that lesser calorie intake than the recommended intake increases the ORs of cognitive impairment. We suggest that an adequate calorie intake protects against cognitive decline, and further studies are essential to investigate the influence of calorie intake reduction on the elderly before widespread application.

The Relationship Between BMI and Work-Related Musculoskeletal (MSK) Injury Rates is Modified by Job-Associated Level of MSK Injury Risk

OBJECTIVE

The aim of this study was to examine the relationship between body mass index (BMI) and occupational musculoskeletal (MSK) injury rates, and the statistical interaction between BMI and occupational exposure to MSK hazards (measured by level of MSK injury risk based on job category).

METHODS

Using 17 years of data from 38,214 university and health system employees, multivariate Poisson regression modeled the interaction between BMI and MSK injury risk on injury rates.

RESULTS

A significant interaction between BMI and MSK injury risk was observed. Although the effect of BMI was strongest for 'low' MSK injury risk occupations, absolute MSK injury rates for 'mid'/'high' MSK injury risk occupations remained larger.

CONCLUSIONS

To address the occupational MSK injury burden, initiatives focused on optimal measures of workers' BMI are important but should not be prioritized over (or used in lieu of) interventions targeting job-specific MSK injury hazards.

Sex-specific association between obesity and self-reported falls and injuries among community-dwelling Canadians aged 65 years and older

This study investigated the relationship between body mass index (BMI) and falls among community-dwelling elderly. Results indicate that obesity is associated with increased falls and there appears to be a sex-specific difference with obese men at higher risk of falling. Obesity is identified as a risk factor for falls in men.

INTRODUCTION

The prevalence of falls, fall-related injuries, and obesity has increased over the last decade. The objectives of this study were to investigate sex-specific association and dose-response relationship between BMI and falls (and related injuries) among community-dwelling elderly.

METHODS

Our study sample consisted of 15,860 adults aged 65 years or older (6399 men and 9461 women) from the 2008-2009 Canadian Community Health Survey-Healthy Aging (CCHS-HA). Falls, fall-related injuries, and BMI measures were self-reported. For both sex, dose-response curves presenting the relationship between BMI, falls, and fall-related injuries were first examined. Thereafter, multivariate logistic regression analyses were also performed to investigate these relationships after adjustment for potentially confounding variables.

RESULTS

Of women, 21.7 % reported a fall and 16.9 % of men. The dose-response relationship between BMI and prevalence of falls showed that underweight and obese individuals reported falling more than normal and overweight individuals; this being more apparent in men than women. Finally, the dose relationship between BMI and prevalence of fall-related injuries showed that only obese men seem more likely to have sustained a fall-related injury. Results from the multivariate analysis showed that obesity in men was significantly associated with higher odds of falling odds ratio (OR) 1.33 (1.04-1.70) and was not significantly associated with higher odds of fall-related injuries OR 1.10 (0.66-1.84) over a 12-month period compared to normal weight men. For women, obesity was not significantly associated with higher fall prevalence OR 0.99 (0.79-1.25) and fall-related injuries OR 0.71 (0.51-1.00).

CONCLUSION

Obesity is associated with self-reported falls, and there appears to be a sex-specific difference in elderly persons.

Unintentional Injuries among Psychiatric Outpatients with Major Depressive Disorder

Background

No study has investigated the percentages of and factors related to unintentional injuries among psychiatric outpatients with major depressive disorder (MDD). This study aimed to investigate these issues.

Methods

One-hundred and forty-one outpatients with MDD at baseline were enrolled from psychiatric outpatients by systematic sampling, and 119 subjects attended a one-year follow-up. Self-reported unintentional injuries in the past one year were recorded. Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The severity of depression was evaluated by the Hamilton Depression Rating Scale. Other data, including body weight and height, cigarette smoking, headaches, and medications, were collected. Generalized Estimating Equations were used to investigate independent factors related to unintentional injuries.

Results

At baseline and follow-up, 40.4% and 27.7% of subjects had experienced at least one unintentional injury in the past one year, respectively. About half of subjects with unintentional injuries needed medical treatment for injuries and had functional impairment due to injuries. A greater severity of depression, cigarette smoking, a higher body mass index, and an older age were independent risk factors related to unintentional injuries.

Conclusion

Unintentional injuries that increased the medical burden and functional impairment were common among outpatients with MDD and should not be neglected. Treatment of depression, control of body weight, and quitting cigarettes might be helpful to prevent unintentional injuries.

Prevalence of work-site injuries and relationship between obesity and injury among U.S. workers: NHIS 2004-2012

INTRODUCTION

Studies have reported associations between obesity and injury in a single occupation or industry. Our study estimated the prevalence of work-site injuries and investigated the association between obesity and work-site injury in a nationally representative sample of U.S. workers.

METHODS

Self-reported weight, height, and injuries within the previous three months were collected annually for U.S. workers in the National Health Interview Survey (NHIS) from 2004-2012. Participants were categorized as normal weight (BMI: 18.5-24.9kg/m(2)), overweight (BMI: 25.0-29.9), obese I (BMI: 30.0-34.9), and obese II (BMI: 35+). The prevalence of injury and prevalence ratios from fitted logistic regression models was used to assess relationships between obesity and injury after adjusting for covariates. Sampling weights were incorporated using SUDAAN software.

RESULTS

During the 9-year study period from 2004 to 2012, 1120 workers (78 workers per 10,000) experienced a work-related injury during the previous three months. The anatomical sites with the highest prevalence of injury were the back (14.3/10,000±1.2), fingers (11.5±1.3), and knees (7.1±0.8). The most common types of injuries were sprains/strains/twists (41.5% of all injuries), cuts (20.0%), and fractures (11.8%). Compared to normal weight workers, overweight and obese workers were more likely to experience work-site injuries [overweight: PR=1.25 (95% CI=1.04-1.52); obese I: 1.41 (1.14-1.74); obese II: 1.68 (1.32-2.14)]. These injuries were more likely to affect the lower extremities [overweight: PR=1.48, (95% CI=1.03-2.13); obese I: 1.70 (1.13-2.55); obese II: 2.91 (1.91-4.41)] and were more likely to be due to sprains/strains/twists [overweight: PR=1.73 (95% CI=1.29-2.31); obese I: PR=2.24 (1.64-3.06); obese II: PR=2.95 (2.04-4.26)].

CONCLUSIONS

Among NHIS participants, overweight and obese workers were 25% to 68% more likely to experience injuries than normal weight workers.

PRACTICAL APPLICATIONS

Weight reduction policies and management programs may be effectively targeted towards overweight and obese groups to prevent or reduce work-site injuries.

Caloric restriction for treatment of geriatric obesity: Do the benefits outweigh the risks?

Most evidence for the health benefits of prescribing caloric restriction (CR) for weight loss is derived from randomized, controlled trials (RCTs) in young/middle-aged adults; there are very few RCTs in older adults in which the isolated effects of CR can be deciphered. The purpose of this review is to summarize the RCT evidence of the benefits (and potential risks) of CR for the treatment of obesity in older adults. We identified only 19 published papers from 10 RCTs ranging from 3 to 18 months that met the criteria of independent effects of a CR component and were conducted in adults with a mean age ≥65 yrs. Overall, the results show a beneficial treatment effect for improving some metabolic, functional and body composition outcomes with few documented risks. However, all outcomes were assessed immediately after treatment cessation. Thus, until additional scientifically rigorous evidence with long-term follow-up is available, the risk-to-benefit ratio of CR for the treatment of obesity in older adults remains unclear.

Risk factors for falls among seniors: implications of gender

Despite extensive literature on falls among seniors, little is known about gender-specific risk factors. To determine the prevalence of falls by gender and sociodemographic, lifestyle/behavioral, and medical factors, we conducted a cross-sectional study in a nationally representative sample of Canadian adults who were 65 years of age or older (n = 14,881) from the Canadian Community Health Survey-Healthy Aging (2008-2009). Logistic regression models were applied to investigate gender-specific associations between potential risk factors and falls. In men, stroke (odds ratio (OR) = 1.91), nutritional risk (OR = 1.86), post-secondary school degree (OR = 1.68), eye disorder (OR = 1.35), widowed/separated/divorced marital status (OR = 1.28), and arthritis (OR = 1.27) were independently associated with significantly higher odds of falls. In women, significant independent correlates of falls included stroke (OR = 1.53), age of 85 years or older (OR = 1.51), nutritional risk (OR = 1.39), consumption of at least 1 alcoholic drink per week (OR = 1.39), use of 5 or more medications (OR = 1.36), arthritis (OR = 1.36), diabetes (OR = 1.31), and osteoporosis (OR = 1.22). Higher physical activity levels were protective in both genders, and higher household income was protective in women. Gender should be considered when planning fall prevention strategies.

Sarcopenic obesity and endocrinal adaptation with age

In normal aging, changes in the body composition occur that result in a shift toward decreased muscle mass and increased fat mass. The loss of muscle mass that occurs with aging is termed sarcopenia and is an important cause of frailty, disability, and loss of independence in older adults. Age-related changes in the body composition as well as the increased prevalence of obesity determine a combination of excess weight and reduced muscle mass or strength, recently defined as sarcopenic obesity. Weight gain increases total/abdominal fat, which, in turn, elicits inflammation and fatty infiltration in muscle. Sarcopenic obesity appears to be linked with the upregulation of TNF-α, interleukin (IL)-6, leptin, and myostatin and the downregulation of adiponectin and IL-15. Multiple combined exercise and mild caloric restriction markedly attenuate the symptoms of sarcopenic obesity. Intriguingly, the inhibition of myostatin induced by gene manipulation or neutralizing antibody ameliorates sarcopenic obesity via increased skeletal muscle mass and improved glucose homeostasis. In this review, we describe the possible influence of endocrinal changes with age on sarcopenic obesity.

Prevalence of overweight in children with bone fractures: a case control study

BACKGROUND

Children's fractures have been enlisted among orthopaedics complaints of childhood obesity. Unhealthy lifestyle behaviours may contribute to increased risk. This study described the prevalence of overweight/obesity in children and adolescents reporting a recent fracture in relation to gender, dynamic of trauma, and site of fracture.

METHODS

Four-hundred-forty-nine children and adolescents with fracture and 130 fracture-free controls were recruited from a large children's hospital. The interaction between overweight and gender, dynamic of trauma, site of fracture was explored. Sports participation, television viewing, and calcium intake were also investigated.

RESULTS

Overweight/obesity rate was increased in girls with fracture either at the upper or the lower limb (p= 0.004), while it was increased only in boys with fracture at the lower limb (p <0.02). Overweight/obesity rate did not differ between groups with low or moderate trauma. TV viewing ≥ 2 hrs was more frequent in children with fractures than controls (61.5% vs 34.5%, p =0.015) in the overweight/obese group.

CONCLUSIONS

The increased prevalence of overweight/obesity in children with fractures is related to gender and site of fracture. Higher levels of sedentary behaviours characterize overweight children reporting fractures.

Obesity and the elderly

The prevalence of obesity is rising progressively, even among older age groups. By the year 2030 to 2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years or older. The predicted prevalence of obesity in Americans, 60 years and older was 37% in 2010. The predicted prevalence of obesity in Europe in 2015 varies between 20% and 30% dependent on the model used. This means 20.9 million obese 60 years or older people in the United States in 2010 and 32 million obese elders in 2015 in EU. Although cutoff values of body mass index, waist circumference, and percentages of fat mass have not been defined for the elderly, it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a body mass index >30 kg/m(2). Thus, treatment should only be offered to patients who are obese rather than overweight and who have functional impairments, metabolic complications, or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should minimize muscle and bone loss and vigilance as regards the development of sarcopenic obesity--a combination of an unhealthy excess of body fat with a detrimental loss of muscle and fat-free mass including bone--is important. Lifestyle intervention should be the first step and consists of a diet with a 500 kcal energy deficit and an adequate intake of protein of high biological quality, together with calcium and vitamin D, behavioral therapy, and multicomponent exercise. Multicomponent exercise includes flexibility training, balance training, aerobic exercise, and resistance training. The adherence rate in most studies is around 75%. Knowledge of constraints and modulators of physical inactivity should be of help to engage the elderly in physical activity. The role of pharmacotherapy and bariatric surgery in the elderly is largely unknown as in most studies people aged 65 years and older were excluded.

Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline

The prevalence of obesity is rising progressively, even among older age groups. By the year 2030-2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years and older. The predicted prevalence of obesity in Americans, 60 years and older was 37% in 2010. The predicted prevalence of obesity in Europe in 2015 varies between 20 and 30% dependent on the model used. This means 20.9 million obese 60+ people in the USA in 2010 and 32 million obese elders in 2015 in the EU. Although cut-off values of BMI, waist circumference and percentages of fat mass have not been defined for the elderly (nor for the elderly of different ethnicity), it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a BMI above 30 kg/m(2). Thus, treatment should only be offered to patients who are obese rather than overweight and who also have functional impairments, metabolic complications or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should aim to minimize muscle and bone loss but also vigilance as regards the development of sarcopenic obesity - a combination of an unhealthy excess of body fat with a detrimental loss of muscle and fat-free mass including bone - is important in the elderly, who are vulnerable to this outcome. Life-style intervention should be the first step and consists of a diet with a 500 kcal (2.1 MJ) energy deficit and an adequate intake of protein of high biological quality together with calcium and vitamin D, behavioural therapy and multi-component exercise. Multi-component exercise includes flexibility training, balance training, aerobic exercise and resistance training. The adherence rate in most studies is around 75%. Knowledge of constraints and modulators of physical inactivity should be of help to engage the elderly in physical activity. The role of pharmacotherapy and bariatric surgery in the elderly is largely unknown as in most studies people aged 65 years and older have been excluded.

Obesity and its relationship with occupational injury in the canadian workforce

Objectives. To examine associations between obesity and occupational injury. Methods. Participants consisted of a representative sample of 7,678 adult Canadian workers. Participants were placed into normal weight, overweight, and obese categories based on their body mass index. Different injury types, location, and external causes were measured. Logistic regression was used to estimate relationships. Results. By comparison to normal weight workers, obese workers were more likely to report any occupational injuries (odds ratio (OR) 1.40, 95% confidence interval (CI): 0.98-1.99) and serious occupational injuries (1.49, 0.99-2.26). These relationships were more pronounced for sprains and strains (1.80, 1.04-3.11), injuries to the lower limbs (2.14, 1.12-4.11) or torso (2.36, 1.13-4.93), and injuries due to falls (2.10, 0.86-5.10) or overexertion (2.08, 0.96-4.50). Female workers, workers ≥40 years, and workers employed in sedentary occupations were particularly vulnerable. Increased risks were not identified for overweight workers. Conclusions. Obese workers experienced 40-49% higher risks for occupational injury.