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Alsaqaaby MS, Cooney S, le Roux CW, Pournaras DJ. Sex, race, and BMI in clinical trials of medications for obesity over the past three decades: a systematic review. Lancet Diabetes Endocrinol 2024; 12:414-421. [PMID: 38723646 DOI: 10.1016/s2213-8587(24)00098-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 05/25/2024]
Abstract
Medications for obesity have been studied in various populations over the past three decades. We aimed to quantify the baseline demographic characteristics of BMI, sex, age, and race in randomised clinical trials (RCTs) across three decades to establish whether the population studied is representative of the global population affected by the disease. Clinical trials of 12 medications for obesity (ie, orlistat, naltrexone-bupropion, topiramate-phentermine, liraglutide, semaglutide, lorcaserin, sibutramine, rimonabant, taranabant, tirzepatide, retatrutide, and orforglipron) published from Jan 20, 1999, to Nov 12, 2023, were assessed through a systematic review for methodological quality and baseline demographic characteristics. 246 RCTs were included, involving 139 566 participants with or without type 2 diabetes. Most trials over-recruited White, female participants aged 40 years or older with class 1 (30·0-34·9 kg/m2) and class 2 (35·0-39·9 kg/m2) obesity; older participants, those with class 3 (≥40·0 kg/m2) obesity, non-White participants, and male participants were under-recruited. Our systematic review suggests that future trials need to recruit traditionally under-represented populations to allow for accurate measures of efficacy of medications for obesity, enabling more informed decisions by clinicians. It is also hoped that these data will help to refine trial recruitment strategies to ensure that future studies are relevant to the population affected by obesity.
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Affiliation(s)
- Moath S Alsaqaaby
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland; Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sarah Cooney
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland; Diabetes Research Centre, Ulster University, Coleraine, UK
| | - Dimitri J Pournaras
- Department of Bariatric and Metabolic Surgery, North Bristol National Health Service Trust, Bristol, UK.
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Desai A, Hashash JG, Baker G, Farraye FA, Waghray N, Kochhar GS. Effect of Bariatric Surgery on Disease Outcomes in Patients With Inflammatory Bowel Disease: A US-based Propensity Matched Cohort Study. J Clin Gastroenterol 2024; 58:447-453. [PMID: 37390044 DOI: 10.1097/mcg.0000000000001879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/23/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION AND AIM A growing body of evidence suggests a negative impact of obesity on the disease activity of inflammatory bowel disease (IBD). The primary aim of the study was to evaluate disease outcomes of IBD in patients after bariatric surgery (BS). METHODS Patients with IBD and morbid obesity who underwent BS were compared with patients with IBD and morbid obesity without BS in a retrospective, propensity-score matched cohort study using TriNetX, a multi-institutional database. The primary aim was to assess the 2-year risk of a composite of disease-related complications, which included intravenous steroid use or IBD-related surgery. Risk was expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS In all, 482 patients (3.4%) with IBD and morbid obesity underwent BS (mean age 46.9±11.2 y old, mean BMI 42.1±7.72 kg/m 2 , Crohn's disease 60%). After propensity-score matching, the BS cohort had a lower risk (aOR 0.31, 95% CI 0.17-0.56) of a composite of IBD-related complications compared with the control cohort. After propensity-score matching, the BS cohort with sleeve gastrectomy had a decreased risk (aOR 0.45, 95% CI 0.31-0.66) of a composite of IBD-related complications. There was no difference in the risk (aOR 0.77, 95% CI 0.45-1.31) of a composite of IBD-related complications between the BS cohort with Roux-en-Y gastric bypass (RYGB) compared with the control cohort. CONCLUSION Sleeve gastrectomy but not Roux-en-Y gastric bypass is associated with improved disease-specific outcomes in patients with IBD and morbid obesity.
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Affiliation(s)
- Aakash Desai
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Jana G Hashash
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
| | - Gianna Baker
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
| | - Nisheet Waghray
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Gursimran S Kochhar
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA
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Xu S, Ren R, Li W, Liang Y, Ma J, Zheng Y, Zhao W, Ma Y, Zhou T, Zhang Y. The association between obesity indicators and metabolic risk factors in type-2 diabetic patients. Heliyon 2023; 9:e20013. [PMID: 37809456 PMCID: PMC10559737 DOI: 10.1016/j.heliyon.2023.e20013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023] Open
Abstract
Rationale and objectives Obesity, accumulation of adipose tissue, is a global disease that can lead to cardiovascular and metabolic complications. The aim of this study was to investigate the relationship between obesity indicators and metabolic risk factors in type 2 diabetes mellitus (T2DM) patients. Materials and methods A total of 337 T2DM subjects were included in our study. The metabolic risk factors including diabetes duration, fast plasma glucose (FPG), height, weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), estimated average glucose (eAG), glycated hemoglobin (HbA1c), total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c), triglyceride (TG), blood urea nitrogen (BUN), serum creatinine (Scr), free fatty acid (FFA), uric acid (UA), cystatin c (cysc), albumin (Alb), urinary albumin creatinine ratio (UACR) were recorded. The obesity indicators included body surface area (BSA), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), para-perirenal fat thickness (PRFT), total abdominal fat (TAF), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT). The association between obesity indicators and metabolic risk factors was investigated by univariate and multivariate analysis. Results HDL-c was independently associated with WHR and PRFT (β = -0.126 vs. -0.214, both p < 0.05). TG and Scr were both independently associated with PRFT (β = 0.173 vs. 0.218, both p < 0.01, respectively). UA was independently associated with BSA (β = 0.172, p < 0.01) and PRFT (β = 0.151, p < 0.01). cysc, Alb and UACR were independently associated with WC (β = 0.274 vs. 0.204 vs. 0.182, all p < 0.01). Conclusion In T2DM patients, obesity indicators were significantly associated with metabolic risk factors.
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Affiliation(s)
- Sunan Xu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Ruichen Ren
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Wenting Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Yongfeng Liang
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Junqing Ma
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Yongze Zheng
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Wei Zhao
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Yu Ma
- Department of Radiology, Shandong Rongjun General Hospital, Jinan, China
| | - Tao Zhou
- Department of Radiology, Tai'an First People's Hospital, Tai'an, Shandong, China
| | - Yang Zhang
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
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He J, Jia L, Zhang Y, Tian Y, Hao P, Li T, Xiao Y, Peng L, Feng Y, Cheng X, Deng H, Wang P, Chong W, Hai Y, Chen L, You C, Fang F. Obesity Paradox for Postoperative Mortality in Young Chinese Patients Undergoing Craniotomy for Brain Tumor Resection. J Neurosurg Anesthesiol 2023:00008506-990000000-00076. [PMID: 37550895 DOI: 10.1097/ana.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 06/29/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND There is little evidence regarding the association of body mass index (BMI) with postoperative mortality after craniotomy, especially in the Asian population. Our study aimed to explore the association between BMI and postoperative 30-day mortality in Chinese patients undergoing craniotomy for brain tumor resection. METHODS This large retrospective cohort study, Supplemental Digital Content 9, http://links.lww.com/JNA/A634 collected data from 7519 patients who underwent craniotomy for brain tumor resection. On the basis of the World Health Organization obesity criteria for Asians, included patients were categorized as underweight (<18.5 kg/m2), normal weight (18.5 to 22.9 kg/m2), overweight (23to 24.9 kg/m2), obese I (25 to 29.9 kg/m2), and obese II (≥30 kg/m2). We used a multivariable logistic regression model to explore the association between different BMI categories and 30-day postoperative mortality. In addition, we also conducted stratified analyses based on age and sex. RESULTS Overweight (adjusted odds ratio 0.63, 95% CI 0.40-0.99) and obese I (adjusted odds ratio 0.44, 95% CI 0.28-0.72) were associated with decreased 30-day postoperative mortality compared with normal-weight counterparts. Such associations were prominent among younger (age younger than 65 y) patients but not older patients, and there was an interaction between age and overweight versus normal weight on mortality (P for interaction=0.04). CONCLUSIONS We found that among Chinese patients undergoing craniotomy for brain tumors, there was a J-shaped association between BMI and postoperative 30-day mortality, with lowest mortality at 27 kg/m². Moreover, in young patients, overweight and obese I were both associated with decreased risk of 30-day mortality.
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Affiliation(s)
- Jialing He
- Department of Neurosurgery, West China Hospital, Sichuan University
- Department of Neurosurgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong
| | - Lu Jia
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | | | - Yixin Tian
- Department of Neurosurgery, West China Hospital, Sichuan University
| | - Pengfei Hao
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Tiangui Li
- Department of Neurosurgery, Longquan Hospital, Chengdu, Sichuan
| | | | | | | | - Xin Cheng
- Department of Neurosurgery, West China Hospital, Sichuan University
| | | | - Peng Wang
- Affiliated Hospital of Chengdu University
| | | | - Yang Hai
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Lvlin Chen
- Affiliated Hospital of Chengdu University
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University
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Hu W, Han Q, Chu J, Sun N, Li T, Feng Z, He Q, Ma Z, Wang Y, Shen Y. Mechanism of the association between sleep quality and mortality in middle-aged and older adults: A prospective study analysis of the UK Biobank. Arch Gerontol Geriatr 2023; 113:105051. [PMID: 37146482 DOI: 10.1016/j.archger.2023.105051] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Although sleep quality is known to be associated with mortality, how poor sleep quality contributes to an increased risk of mortality is still unknown. We aimed to examine whether lifestyle, psychosocial and biological factors mediate the association. METHODS 205,654 participants from UK Biobank were used for the analysis. The outcome was all-cause, cardiovascular disease (CVD) and cancer mortality by February 2022. Exposure was assessed by a sleep score consisting of five sleep behaviors at baseline. Lifestyle, psychosocial, and biological factors are regarded as potential mediators. Mediation analysis based on Cox proportional hazards models was performed. RESULTS Poor sleep quality was associated with a higher risk of all-cause (Hazard Ratio [HR] = 1.098; 95% CI: 1.058-1.140), CVD (HR = 1.139; 95% CI: 1.045-1.243) and cancer mortality (HR = 1.095; 95% CI: 1.040-1.152). Lifestyle mediators (smoking, physical activity, sedentary, BMI and diet) could explain between 2.6% and 34.0% of the increased risk of all-cause mortality in individuals with poor sleep quality. Self-reported health, frailty, depression, and loneliness were significant psychosocial mediators of this association pathway. About one-fifth of the association can be explained by the biological role of CRP. Similar mediating patterns were observed for CVD and cancer mortality. LIMITATIONS Both exposure and mediators were measured at baseline, so the possibility of reverse causality cannot be ruled out. CONCLUSIONS Poor sleep quality is associated with an increased risk of death through a combination of lifestyle, psychosocial and biological pathways. Adopting healthy lifestyles and staying psychosocial well-being are cost-effective interventions to lower the risk of death.
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Affiliation(s)
- Wei Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China
| | - Qiang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China
| | - Jiadong Chu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China
| | - Na Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China
| | - Tongxing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China
| | - Zhaolong Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China
| | - Qida He
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China
| | - Ze Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China
| | - Yu Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China
| | - Yueping Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China.
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Masters RK. Sources and severity of bias in estimates of the BMI-mortality association. POPULATION STUDIES 2023; 77:35-53. [PMID: 36756765 PMCID: PMC9992219 DOI: 10.1080/00324728.2023.2168035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/13/2022] [Indexed: 02/10/2023]
Abstract
Estimates of mortality differences by body mass index (BMI) are likely biased by: (1) confounding bias from heterogeneity in body shape; (2) positive survival bias in high-BMI samples due to recent weight gain; and (3) negative survival bias in low-BMI samples due to recent weight loss. I investigate these sources of bias in the National Health and Nutrition Examination Survey (NHANES) 1988-94 and 1999-2006 linked to mortality up to 2015 (17,784 cases; 4,468 deaths). I use Cox survival models to estimate BMI differences in all-cause mortality risks among adults aged [45-85) in the United States. I test for age-based differences in BMI-mortality associations and estimate functional forms of the association using nine BMI levels. Estimates of the BMI-mortality association in NHANES data are significantly affected by all three biases, and obesity-mortality associations adjusted for bias are substantively strong at all ages. The mortality consequences of overweight and obesity have likely been underestimated, especially at older ages.
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Affiliation(s)
- Ryan K. Masters
- Department of Sociology, University of Colorado Boulder
- University of Colorado Population Center
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Pacheco M, de Maio Godoi Filho JR, Nunes da Silva Filho J, Pontes Dos Santos J, Dos Santos Farias E. The relation between body mass index and body fat percentage in Brazilian adolescents: assessment of variability, linearity, and categorisation. Ann Hum Biol 2021; 48:437-442. [PMID: 34530666 DOI: 10.1080/03014460.2021.1982002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Reliable but accessible measures to capture body composition are highly important as the world is in an era of obesity-increase. The most used measure, the body mass index (BMI), nevertheless, has been judged as non-reliable to estimate body fat percentage (BF%). The present manuscript assessed the criticisms of BMI as a predictor of BF% and the BMI-based categories of nutritional status. 4164 children/adolescents from 9 to 18 years of age from Porto Velho, Brazil, had their anthropometric and skinfold measures taken. Controlling for socioeconomic status, school (private, public), sex and age, we compared proposed models/variables in the literature relating BMI and BF%. We evaluated the functions and the residual data to understand the variability of BF% estimate per BMI and evaluated three possible categorisations from BMI to predict BF% nutritional status. The function utilising (linear) BMI was the best to predict BF% (R2 = 0.70) with a variability of only 6.49% around the function. Nevertheless, no categorisation of nutritional status was reliable to predict the nutritional status of individuals. BMI is reliable to estimate BF%. Nevertheless, new normative values must be proposed; the original categorisation fails to capture the nutritional status of children/adolescents from this region.
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Affiliation(s)
- Matheus Pacheco
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
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Taramasso L, Bonfanti P, Ricci E, Maggi P, Orofino G, Squillace N, Menzaghi B, Madeddu G, Molteni C, Vichi F, Riguccini E, Saracino A, Santoro C, Guastavigna M, Francisci D, Di Biagio A, De Socio GV. Metabolic syndrome and body weight in people living with HIV infection: analysis of differences observed in three different cohort studies over a decade. HIV Med 2021; 23:70-79. [PMID: 34473897 DOI: 10.1111/hiv.13165] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/25/2021] [Accepted: 08/04/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to assess the incidence of being overweight and metabolic syndrome (MS) among people living with HIV (PHIV) in three different cross-sectional studies conducted over three different periods: 2005, 2011 and 2015. METHODS This was a multi-centre, nationwide study. Data were collected in three studies from the CISAI group - SIMOne, HIV-HY and STOPSHIV - and included a total of 3014 PHIV. Logistic regression [odds ratio (OR), 95% confidence interval (CI)] was used to account for age and gender difference among three groups when comparing MS prevalence and being overweight; potential confounders were accounted for by including them in the regression equation. RESULTS Overall, the mean age was 46.9 ± 10.2 years, and men comprised 73.3% of participants. Comparing 2005, 2011 and 2015, MS was present in 34.5%, 33.0% and 29.3% of PHIV, respectively. Adjusted OR for MS was 0.64 (95% CI: 0.52-0.78) in 2011 and 0.56 (95% CI: 0.46-0.69) in 2015 compared with 2005, while BMI (kg/m2 ) increased from 23.6 in 2005, 24.5 in 2011 and 24.5 in 2015, with a concomitant increase of being overweight from 29.4% to 39.5% to 39.6% (p < 0.0001). CONCLUSIONS In recent years, PHIV have had a significantly improved metabolic profile compared with previously, despite increasing weight and BMI.
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Affiliation(s)
- Lucia Taramasso
- Infectious Diseases Clinic, Policlinico San Martino Hospital-IRCCS, Genoa, Italy
| | - Paolo Bonfanti
- Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Paolo Maggi
- Department of Infectious Disease, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giancarlo Orofino
- Unit of Infectious Diseases, "Divisione A", Amedeo di Savoia Hospital, Torino, Italy
| | - Nicola Squillace
- Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Chiara Molteni
- Infectious Diseases Unit, Ospedale A. Manzoni, Lecco, Italy
| | - Francesca Vichi
- Infectious Diseases Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Italy
| | - Erika Riguccini
- Clinica di Malattie Infettive, Ospedale "Santa Maria della Misericordia" e Università di Perugia, Perugia, Italy
| | | | - Carmen Santoro
- Infectious Disease Clinic, University of Bari, Bari, Italy
| | - Marta Guastavigna
- Unit of Infectious Diseases, "Divisione A", Amedeo di Savoia Hospital, Torino, Italy
| | - Daniela Francisci
- Clinica di Malattie Infettive, Ospedale "Santa Maria della Misericordia" e Università di Perugia, Perugia, Italy
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
| | - Giuseppe Vittorio De Socio
- Clinica di Malattie Infettive, Ospedale "Santa Maria della Misericordia" e Università di Perugia, Perugia, Italy
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Padilha CS, Figueiredo C, Minuzzi LG, Chimin P, Deminice R, Krüger K, Rosa-Neto JC, Lira FS. Immunometabolic responses according to physical fitness status and lifelong exercise during aging: New roads for exercise immunology. Ageing Res Rev 2021; 68:101341. [PMID: 33839332 DOI: 10.1016/j.arr.2021.101341] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023]
Abstract
Molecules such as cytokines, energetic substrates, and hormones found in the immune cell environment, especially lymphocytes and monocytes, are crucial for directing energy metabolism. In turn, changes in energy metabolism occur in a synchronized manner with the activation of certain signaling pathways, thereby this crosstalk is responsible for determining the functionality of immune cells. The immunometabolism field has grown over time and that is becoming increasingly promising in several populations; here we discuss the mechanisms involved in sedentary and physically active middle-aged individuals and master athletes. In this context, this review shows that the physical activity status and lifelong exercise seems to be good strategies for the promotion of metabolic and functional adaptations in T lymphocytes and monocytes, counteracting inflammatory environments caused by expanded adipose tissue and sedentary behavior, as well as delaying the immunosenescence caused by aging.
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Affiliation(s)
- Camila S Padilha
- Exercise and Immunometabolism Research Group, Postgraduation Program in Movement Sciences, Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente, São Paulo, Brazil.
| | - Caique Figueiredo
- Exercise and Immunometabolism Research Group, Postgraduation Program in Movement Sciences, Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente, São Paulo, Brazil
| | - Luciele Guerra Minuzzi
- Exercise and Immunometabolism Research Group, Postgraduation Program in Movement Sciences, Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente, São Paulo, Brazil
| | - Patricia Chimin
- Laboratory of Biochemistry Exercise, Department of Physical Education, Faculty of Physical Education and Sport, State University of Londrina, Londrina, Brazil
| | - Rafael Deminice
- Laboratory of Biochemistry Exercise, Department of Physical Education, Faculty of Physical Education and Sport, State University of Londrina, Londrina, Brazil
| | - Karsten Krüger
- Institute of Sports Science, Department of Exercise Physiology and Sports Therapy, University of Giessen, Giessen, Germany
| | - José Cesar Rosa-Neto
- Immunometabolism Research Group, Department of Cell Biology and Development, Institute of Biomedical Science, University of São Paulo, São Paulo, Brazil
| | - Fabio Santos Lira
- Exercise and Immunometabolism Research Group, Postgraduation Program in Movement Sciences, Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente, São Paulo, Brazil
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Schmalbach I, Schmalbach B, Zenger M, Petrowski K, Beutel M, Hilbert A, Brähler E. Psychometric Properties of the German Version of the Self-Regulation of Eating Behavior Questionnaire. Front Psychol 2021; 12:649867. [PMID: 33776874 PMCID: PMC7994521 DOI: 10.3389/fpsyg.2021.649867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The Self-Regulation of Eating Behavior Questionnaire (SREBQ) is an economical way of assessing an individual's self-regulatory abilities regarding eating behavior. Such scales are needed in the German population; therefore, the purpose of the present study was the translation and validation of a German version of the SREBQ. Method: First, we conducted a pilot study (Study 1; N = 371) after the translation procedure. Second, we assessed the final scale in a representative sample of the German population (Sample 2; N = 2,483) and its underlying factor structure. Further, we tested for measurement invariance and evaluated the SREBQ's associations with related scales to explore convergent and discriminant validity. Finally, we considered differences in SREBQ based on sociodemographic variables and provided derived reference scores (norm values). Results: Factor analysis revealed deficiencies in the original model. Thus, we shortened the scale based on statistical considerations and the adapted version showed improved fit in Confirmatory Factor Analysis and reliability. We also found evidence for partial strict invariance, which means the measure is equivalent for the tested groups of age and gender. Item and scale psychometric properties of the shortened version were satisfactory. In terms of diagnostic validity, it was shown that individuals with higher body mass index (kg/m2) have worse self-regulation of eating behavior than those with lower. Conclusion: In sum, the SREBQ evidenced good validity and reliability and is suitable for application in medical, psychological, and nutritional research.
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Affiliation(s)
- Ileana Schmalbach
- Department of Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Division of Psychological and Social Medicine and Developmental Neurosciences, Research Group Applied Medical Psychology and Medical Sociology, Dresden, Germany
| | - Bjarne Schmalbach
- Department of Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Markus Zenger
- Applied Human Studies, University of Applied Sciences Magdeburg-Stendal, Stendal, Germany.,Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Katja Petrowski
- Department of Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Abteilung für Innere Medizin III, Dresden, Germany
| | - Manfred Beutel
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Elmar Brähler
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.,Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
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11
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Lee H, Park HE, Yoon JW, Choi SY. Clinical Significance of Body Fat Distribution in Coronary Artery Calcification Progression in Korean Population. Diabetes Metab J 2021; 45:219-230. [PMID: 33108855 PMCID: PMC8024146 DOI: 10.4093/dmj.2019.0161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 04/30/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although obesity differs according to ethnicity, it is globally established as a solid risk factor for cardiovascular disease. However, it is not fully understood how obesity parameters affect the progression of coronary artery calcification (CAC) in Korean population. We sought to evaluate the association of obesity-related parameters including visceral adipose tissue (VAT) measurement and CAC progression. METHODS This retrospective observational cohort study investigated 1,015 asymptomatic Korean subjects who underwent serial CAC scoring by computed tomography (CT) with at least 1-year interval and adipose tissue measurement using non-contrast CT at baseline for a routine checkup between 2003 and 2015. CAC progression, the main outcome, was defined as a difference of ≥2.5 between the square roots of the baseline and follow-up CAC scores using Agatston units. RESULTS During follow-up (median 39 months), 37.5% of subjects showed CAC progression of a total population (56.4 years, 80.6% male). Body mass index (BMI) ≥25 kg/m2, increasing waist circumferences (WC), and higher VAT/subcutaneous adipose tissue (SAT) area ratio were independently associated with CAC progression. Particularly, predominance of VAT over SAT at ≥30% showed the strongest prediction for CAC progression (adjusted hazard ratio, 2.20; P<0.001) and remained of prognostic value regardless of BMI or WC status. Further, it provided improved risk stratification of CAC progression beyond known prognosticators. CONCLUSION Predominant VAT area on CT is the strongest predictor of CAC progression regardless of BMI or WC in apparently healthy Korean population. Assessment of body fat distribution may be helpful to identify subjects at higher risk.
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Affiliation(s)
- Heesun Lee
- Division of Cardiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Eun Park
- Division of Cardiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Su-Yeon Choi
- Division of Cardiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Corresponding author: Su-Yeon Choi https://orcid.org/0000-0001-9977-4740 Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 152 Teheran-ro, Gangnam-gu, Seoul 06236, Korea E-mail:
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12
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Shirazi TN, Hastings WJ, Rosinger AY, Ryan CP. Parity predicts biological age acceleration in post-menopausal, but not pre-menopausal, women. Sci Rep 2020; 10:20522. [PMID: 33239686 PMCID: PMC7689483 DOI: 10.1038/s41598-020-77082-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022] Open
Abstract
Understanding factors contributing to variation in ‘biological age’ is essential to understanding variation in susceptibility to disease and functional decline. One factor that could accelerate biological aging in women is reproduction. Pregnancy is characterized by extensive, energetically-costly changes across numerous physiological systems. These ‘costs of reproduction’ may accumulate with each pregnancy, accelerating biological aging. Despite evidence for costs of reproduction using molecular and demographic measures, it is unknown whether parity is linked to commonly-used clinical measures of biological aging. We use data collected between 1999 and 2010 from the National Health and Nutrition Examination Survey (n = 4418) to test whether parity (number of live births) predicted four previously-validated composite measures of biological age and system integrity: Levine Method, homeostatic dysregulation, Klemera–Doubal method biological age, and allostatic load. Parity exhibited a U-shaped relationship with accelerated biological aging when controlling for chronological age, lifestyle, health-related, and demographic factors in post-menopausal, but not pre-menopausal, women, with biological age acceleration being lowest among post-menopausal women reporting between three and four live births. Our findings suggest a link between reproductive function and physiological dysregulation, and allude to possible compensatory mechanisms that buffer the effects of reproductive function on physiological dysregulation during a woman’s reproductive lifespan. Future work should continue to investigate links between parity, menopausal status, and biological age using targeted physiological measures and longitudinal studies.
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Affiliation(s)
- Talia N Shirazi
- Department of Anthropology, Pennsylvania State University, 421 Carpenter Building, University Park, PA, 16802, USA.
| | - Waylon J Hastings
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Asher Y Rosinger
- Department of Anthropology, Pennsylvania State University, 421 Carpenter Building, University Park, PA, 16802, USA.,Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Calen P Ryan
- Department of Anthropology, Northwestern University, Evanston, IL, USA
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13
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Atlantis E, Sahebolamri M, Cheema BS, Williams K. Usefulness of the Edmonton Obesity Staging System for stratifying the presence and severity of weight-related health problems in clinical and community settings: A rapid review of observational studies. Obes Rev 2020; 21:e13120. [PMID: 32812345 DOI: 10.1111/obr.13120] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 12/12/2022]
Abstract
This rapid review aimed to examine the usefulness of the Edmonton Obesity Staging System (EOSS) for stratifying the presence and severity of weight-related health problems in clinical and community settings. We searched PubMed, CINAHL and ProQuest for records from 2009 to May 2020. We considered observational studies in participants with overweight or obesity that investigated the risk of any clinical outcome associated with increasing EOSS. We reviewed and appraised 20 observational studies (cohort = 4, case series = 7, cross-sectional = 9) published between 2011 and 2020. Of 12 studies in clinical populations, the EOSS was most consistently associated with an increased risk of postoperative complications following bariatric surgery, especially for EOSS 3-4, and inversely associated with weight loss, treatment time and resolution of hypertension following bariatric surgery and clinical weight management. Of eight studies in community populations, the EOSS most consistently predicted mortality outcomes, especially for EOSS 3, and was associated with polypharmacy, service use and poorer work outcomes. Studies reported diverse EOSS definitions and outcomes, which slightly weakens the overall evidence base. The EOSS should be routinely used for predicting risks and benefits of surgical and nonsurgical weight management, but it should be applied with caution for population health planning.
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Affiliation(s)
- Evan Atlantis
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia.,School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mehdi Sahebolamri
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia.,Department of Endocrinology (Obesity), Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia
| | - Birinder S Cheema
- School of Health Sciences and the National Institute of Complementary Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Kathryn Williams
- Department of Endocrinology (Obesity), Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia.,Charles Perkins Centre-Nepean, The University of Sydney, Kingswood, New South Wales, Australia
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14
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Atlantis E, Fahey P, Williams K, Edwards S, Samaras K, Dugdale P, Shi Z, Sharma AM. Comparing the predictive ability of the Edmonton Obesity Staging System with the body mass index for use of health services and pharmacotherapies in Australian adults: A nationally representative cross-sectional study. Clin Obes 2020; 10:e12368. [PMID: 32419298 DOI: 10.1111/cob.12368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/19/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022]
Abstract
We assessed the value of the Edmonton Obesity Staging System (EOSS) compared with the body mass index (BMI) for determining associations with use of health services and pharmacotherapies in a nationally representative sample of participants in the 2011-2013 Australian Health Survey. A subsample of participants aged 18 years or over, with at least overweight (BMI ≥ 25 kg/m2 ) or central obesity (waist measurement of ≥102 cm for men; ≥88 cm for women), and who had provided physical measurements (n = 9730) were selected for analysis. For statistical significance of each predictor, we used logistic regression for model comparisons with the BMI and EOSS separately, and adjusted for covariates. For relative explanatory ability, we used the Nagelkerke pseudo R2 , receiver operating characteristic curve, and area under curve statistic. The EOSS was significantly better than the BMI for predicting polypharmacy and most of the health service use variables. Conversely, the BMI was significantly better than the EOSS for predicting having discussed lifestyle changes relevant to weight loss with the primary care physician. Clinicians, health care professionals, consumers, and policy makers should consider the EOSS a more accurate predictor of polypharmacy and health service use than the BMI in adults with overweight or obesity.
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Affiliation(s)
- Evan Atlantis
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Paul Fahey
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Kathryn Williams
- Charles Perkins Centre - Nepean, The University of Sydney, Sydney, New South Wales, Australia
- Department of Endocrinology (Obesity), Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, New South Wales, Australia
| | - Suzanne Edwards
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Katherine Samaras
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Department of Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia
- St Vincent's Clinic School, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Paul Dugdale
- Medical School, Australian National University, Australian Capital Territory, Australia
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Arya M Sharma
- Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, Alberta, Canada
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15
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The health outcomes of inflammation and obesity in patients with heart failure. Heart Lung 2020; 49:896-901. [PMID: 32507469 DOI: 10.1016/j.hrtlng.2020.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Although obesity is a risk factor for cardiovascular disease, higher body mass index is related to longer event-free survival in patients with heart failure (HF). While previous research demonstrated that higher levels of inflammatory mediators were associated with shorter event-free survival, the effect of inflammation on the association between obesity and outcomes of HF have not been considered. HYPOTHESIS Based on the obesity paradox, we hypothesized that patients with higher baseline body mass index (BMI) would experience better event-free survival than those with lower BMI regardless of inflammatory status. METHOD A sample of 415 patients with HF (age 61 ± 11.5 years; 31% female) provided blood to measure soluble tumor necrosis factor receptor1 (sTNFR1), a biomarker of inflammation. Patients were divided into 4 groups based on BMI and a median split of sTNFR1 levels: (1) high BMI ≥ 30 and sTNFR1 > 1804 pg/ml, (2) high BMI ≥ 30 and low sTNFR1 ≤ 1804 pg/ml, and (3) low BMI < 30 and high sTNFR1 > 1804 pg/ml vs. (4) low BMI < 30 and sTNFR1 ≤ 1804 pg/ml. Patients were followed for an average of 365 days to determine the time to first event of either all-cause hospitalization or death. RESULTS There were 177 patients (43%) who experienced either an all-cause hospitalization or death. In a Cox regression, high BMI and high sTNFR1 category predicted time to event (hazard ratio = 1.7, 95% confidence interval = 1.01-2.9) with age, gender, race, left ventricular ejection fraction, New York Heart Association functional class (I/II versus III/IV), log-transformed N-terminal Pro-B-type natriuretic peptide levels, prescribed statin (yes/no), and comorbidity as covariates. CONCLUSION Being in a higher inflammation group was associated with shorter event-free survival regardless of BMI. This study provides evidence that inflammation is an important consideration in the association between obesity and better outcomes in patients with HF.
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16
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Kochhar GS, Desai A, Syed A, Grover A, El Hachem S, Abdul-Baki H, Chintamaneni P, Aoun E, Kanna S, Sandhu DS, Singh S, Shen B, Loftus EV, Dulai PS. Risk of de-novo inflammatory bowel disease among obese patients treated with bariatric surgery or weight loss medications. Aliment Pharmacol Ther 2020; 51:1067-1075. [PMID: 32319111 DOI: 10.1111/apt.15721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/04/2019] [Accepted: 03/22/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND An association between bariatric surgery and development of de-novo inflammatory bowel disease (IBD) has been observed. AIM To evaluate further the association among bariatric surgery, weight loss medications, obesity and new-onset IBD. METHODS Using Explorys, a population-based Health Insurance Portability and Accountability Act compliant database, we estimated the prevalence of de-novo IBD among patients treated with bariatric surgery (Roux-en-Y gastrojejunostomy, laparoscopic sleeve gastrectomy or gastric banding) (n = 60 870) or weight loss medications (orlistat, phentermine/topiramate, lorcaserin, bupropion/naltrexone and liraglutide) (n = 193 790) compared with obese controls (n = 5 021 210), between 1999 and 2018. RESULTS The prevalence of de-novo IBD was lower among obese patients exposed to bariatric surgery (7.72 per 1000 patients) or weight loss medications (7.22 per 1000 patients) compared with patients with persistent obesity not exposed to these interventions (11.66 per 1000 patients, P < 0.0001). The risk reduction for de-novo IBD was consistent across bariatric surgeries and weight loss medications with the exception of orlistat which was not associated with a reduction in risk for de-novo IBD compared with the persistent obese control cohort. CONCLUSION Obese patients undergoing treatment with bariatric surgery or weight loss medications are at a lower risk for developing de-novo IBD compared with persistently obese controls not exposed to these interventions. These data suggest that obesity and ineffective management of obesity are risk factors for de-novo IBD. Further research is needed to confirm these observations and understand potential mechanisms.
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Affiliation(s)
- Gursimran S Kochhar
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
| | - Aakash Desai
- Department of Medicine, MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Aslam Syed
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, USA.,Department of Medicine, MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Abhinav Grover
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
| | - Sandra El Hachem
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
| | - Heitham Abdul-Baki
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
| | - Preethi Chintamaneni
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
| | - Elie Aoun
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
| | - Sowjanya Kanna
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
| | - Dalbir S Sandhu
- Division Gastroenterology & Hepatology, MetroHealth Medical Center, Cleveland, OH, USA
| | - Siddharth Singh
- Division Gastroenterology & Hepatology, University of California, San Diego, CA, USA
| | - Bo Shen
- Center for Inflammatory Bowel Disease, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Edward V Loftus
- Division Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Parambir S Dulai
- Division Gastroenterology & Hepatology, University of California, San Diego, CA, USA
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17
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Murakami JM, Bennett BL, Rand-Giovannetti D, Stefano EC, Latner JD. Enhancing employee wellness: Translating an effective community behavioral weight-loss treatment to the worksite. Nutr Health 2020; 26:215-223. [PMID: 32436453 DOI: 10.1177/0260106020926834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As rates of obesity continue to rise in the USA, there is a need for effective treatments for excess adiposity. Behavioral weight-loss interventions can produce clinically meaningful weight reduction through life-style modifications. However, few studies have evaluated the effectiveness of high-intensity behavioral weight-loss interventions at worksites. AIM The present research investigated the effectiveness of a previously validated behavioral weight-loss intervention in a Hawai'i worksite. METHODS Thirty-six participants were recruited from the employee population of a local employer. Participants received six months of group behavioral weight-loss treatment from trained providers. Anthropomorphic, physiological, psychological, and behavioral assessments were collected pre and post treatment. Select physiological and behavioral assessments were collected every four sessions. RESULTS Sixty-one percent of participants adhered to treatment, and 78% of participants completed treatment. From pre to post treatment, results found that participants achieved clinically significant improvements in weight, body mass index (BMI), and waist circumference, with accompanying physiological, psychological, and behavioral improvements (F(12, 2)=101.379, p=0.010, partial η2=0.998). Analyses revealed that participants also achieved significant changes in weight, BMI, and waist circumference across time points, as well as improvements in specific eating habits. CONCLUSIONS The present study demonstrated the efficacy of a worksite behavioral weight-loss program. The present intervention produced clinically significant weight losses for a large proportion of participants, accompanied by significant improvements in physiological, behavioral, and psychological outcomes. This research is promising for the ongoing implementation of behavioral weight-loss approaches.
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Affiliation(s)
- Jessica M Murakami
- VA Pacific Islands Healthcare System, USA.,Department of Psychology, University of Hawai'i at Mānoa, USA
| | - Brooke L Bennett
- Department of Psychology, University of Hawai'i at Mānoa, USA.,WVU Physicians of Charleston Department of Behavioral Medicine and Psychiatry, Charleston Area Medical Center, USA
| | - Devin Rand-Giovannetti
- Department of Psychology, University of Hawai'i at Mānoa, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, USA
| | - Emily C Stefano
- Department of Psychology, University of Hawai'i at Mānoa, USA.,School of Medicine, Wake Forest University, USA
| | - Janet D Latner
- Department of Psychology, University of Hawai'i at Mānoa, USA
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18
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Jonas K, Waligóra M, Magoń W, Zdrojewski T, Stokwiszewski J, Płazak W, Podolec P, Kopeć G. Prognostic role of traditional cardiovascular risk factors in patients with idiopathic pulmonary arterial hypertension. Arch Med Sci 2019; 15:1397-1406. [PMID: 31749867 PMCID: PMC6855165 DOI: 10.5114/aoms.2018.79242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/08/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Metabolic alterations have been recently associated with onset and progression of idiopathic pulmonary arterial hypertension (IPAH). We aimed to determine the prevalence and prognostic role of cardiovascular risk factors in patients with IPAH. MATERIAL AND METHODS Between February 2009 and January 2015 we recruited consecutive IPAH patients. Clinical assessment included medical history, fasting glucose, lipid profile, N-terminal pro-brain natriuretic peptide concentration, 6-minute walk test distance, WHO functional class and hemodynamic evaluation. Patients' risk was estimated based on the Swedish PAH Register grading system. RESULTS The study group included 61 IPAH patients, and the control group included 2413 Polish residents. When compared to the general population, IPAH patients had lower low-density lipoprotein cholesterol (LDL-C) and a higher triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio. Female patients were characterized by elevated glucose level, higher prevalence of diabetes and lower HDL-C than controls. PAH severity grade correlated positively with age and TG/HDL-C ratio (R = 0.29, p = 0.02) and inversely with LDL-C (R = -0.28, p = 0.03) and HDL-C (R = -0.39, p = 0.02) concentrations. After a follow-up of 48 (23-79) months we recorded 28 deaths in the IPAH group. In the regression analysis lower LDL-C (p = 0.002) and HDL-C (p = 0.0002) levels, and higher TG/HDL-C ratio (p = 0.003) and glucose level (p = 0.003) were associated with all-cause mortality after adjustment for age, sex or PAH severity grade. CONCLUSIONS Patients with IPAH are characterized by an altered profile of lipid and glucose metabolism. Lowered levels of LDL-C and HDL-C and increased TG/HDL-C ratio correlate with disease severity and together with elevated plasma glucose level predict poor survival in IPAH.
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Affiliation(s)
- Kamil Jonas
- Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Marcin Waligóra
- Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Wojciech Magoń
- Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Tomasz Zdrojewski
- Department of Arterial Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
- Department-Centre of Monitoring and Analyses of Population Health, National Institute of Public Health – National Institute of Hygiene, Warsaw, Poland
| | - Jakub Stokwiszewski
- Department-Centre of Monitoring and Analyses of Population Health, National Institute of Public Health – National Institute of Hygiene, Warsaw, Poland
| | - Wojciech Płazak
- Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Grzegorz Kopeć
- Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
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19
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Pattinson AL, Nassar N, da Luz FQ, Hay P, Touyz S, Sainsbury A. The Real Happy Study: Protocol for a Prospective Assessment of the Real-World Effectiveness of the HAPIFED Program-a Healthy APproach to we Ight management and Food in Eating Disorders. Behav Sci (Basel) 2019; 9:bs9070072. [PMID: 31266238 PMCID: PMC6680425 DOI: 10.3390/bs9070072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/12/2019] [Accepted: 06/25/2019] [Indexed: 01/16/2023] Open
Abstract
The prevalence of obesity with comorbid binge eating behaviour is growing at a faster rate than that seen for either obesity or eating disorders as separate conditions. Approximately 6% of the population are affected and they potentially face a lifetime of poor physical and mental health outcomes and an inability to sustain long-term weight loss. Current treatment options are inadequate in that they typically address either obesity or eating disorders exclusively, not the combination of both conditions. By treating one condition without treating the other, relapse is common, and patients are often left disappointed with their lack of weight loss. An integrated approach to treating these individuals is needed to prevent a worsening of the comorbidities associated with excess body weight and eating disorders. A new therapy has recently been developed, named HAPIFED, which addresses both overweight/obesity and comorbid binge eating behaviour with the combination of behavioural weight loss therapy and cognitive behaviour therapy-enhanced (CBT-E). The aim of this paper is to document the protocol for the Real Happy Study, which will evaluate the effectiveness of the HAPIFED program in treating overweight or obesity with comorbid binge-eating behaviour in a real-world setting.
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Affiliation(s)
- Andrea L Pattinson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Felipe Q da Luz
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW 2751, Australia
| | - Stephen Touyz
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006, Australia
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
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20
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DuPont JJ, Kenney RM, Patel AR, Jaffe IZ. Sex differences in mechanisms of arterial stiffness. Br J Pharmacol 2019; 176:4208-4225. [PMID: 30767200 DOI: 10.1111/bph.14624] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/08/2019] [Accepted: 01/21/2019] [Indexed: 12/24/2022] Open
Abstract
Arterial stiffness progressively increases with aging and is an independent predictor of cardiovascular disease (CVD) risk. Evidence supports that there are sex differences in the time course of aging-related arterial stiffness and the associated CVD risk, which increases disproportionately in postmenopausal women. The association between arterial stiffness and mortality is almost twofold higher in women versus men. The differential clinical characteristics of the development of arterial stiffness between men and women indicate the involvement of sex-specific mechanisms. This review summarizes the current literature on sex differences in vascular stiffness induced by aging, obesity, hypertension, and sex-specific risk factors as well as the impact of hormonal status, diet, and exercise on vascular stiffness in males and females. An understanding of the mechanisms driving sex differences in vascular stiffness has the potential to identify novel sex-specific therapies to lessen CVD risk, the leading cause of death in males and females. LINKED ARTICLES: This article is part of a themed section on The Importance of Sex Differences in Pharmacology Research. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.21/issuetoc.
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Affiliation(s)
- Jennifer J DuPont
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Rachel M Kenney
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Ayan R Patel
- Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Iris Z Jaffe
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, United States of America.,Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, United States of America
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21
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Rasool SUA, Ashraf S, Nabi M, Rashid F, Fazili KM, Amin S. Elevated fasting insulin is associated with cardiovascular and metabolic risk in women with polycystic ovary syndrome. Diabetes Metab Syndr 2019; 13:2098-2105. [PMID: 31235143 DOI: 10.1016/j.dsx.2019.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/06/2019] [Indexed: 12/16/2022]
Abstract
AIMS PCOS is associated with various immediate and long term health complications. The aim of this study was to investigate the association of serum fasting insulin concentration with cardiovascular and metabolic risk factors in women with polycystic ovary syndrome. METHODS A total of 349 women, 249 women with polycystic ovary syndrome and 100 age-matched healthy controls, were recruited in this case-control study. Fasting insulin and various other biochemical, hormonal and clinical parameters were measured in all participants. The correlation of insulin with cardiometabolic risk factors was evaluated in PCOS women with normal and high serum insulin concentration. RESULTS Fasting Insulin, BMI, WHR, FAI, LH: FSH, HOMA, QUICKI were significantly higher in PCOS women compared with healthy controls (p < 0.01). Fasting insulin showed a positive correlation with more cardiovascular and metabolic risk factors in PCOS compared to controls. The BMI, BAI, LAP, HOMA IR, QUICKI and FAI were significantly higher (all p < 0.05) in PCOS patients with higher insulin levels than with PCOS women with normal levels. CONCLUSION Fasting insulin is an important determinant in the pathogenesis of obesity and hyperandrogenism in PCOS. It is associated with an increased risk of cardiovascular and metabolic disorders in women with PCOS.
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Affiliation(s)
| | - Sairish Ashraf
- Department of Biochemistry, University of Kashmir, India.
| | - Mudasar Nabi
- Department of Biochemistry, University of Kashmir, India.
| | - Fouzia Rashid
- Clinical Biochemistry, University of Kashmir, India.
| | | | - Shajrul Amin
- Department of Biochemistry, University of Kashmir, India.
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O'Rourke RW. Adipose tissue and the physiologic underpinnings of metabolic disease. Surg Obes Relat Dis 2018; 14:1755-1763. [PMID: 30193906 PMCID: PMC6289667 DOI: 10.1016/j.soard.2018.07.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 07/20/2018] [Accepted: 07/28/2018] [Indexed: 12/22/2022]
Abstract
Adipose tissue dysfunction underlies the pathogenesis of metabolic disease. The metrics used to quantify adiposity and its association with metabolic disease, including body mass index, have limitations with important clinical implications. An understanding of the molecular and cellular mechanisms by which adipose tissue regulates systemic metabolism and contributes to metabolic disease will lead to next-generation adipose tissue-based therapy.
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Affiliation(s)
- Robert W O'Rourke
- Department of Surgery, University of Michigan Medical School, Michigan Medicine, and Ann Arbor Veterans Administration Hospital, Ann Arbor, Michigan.
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Changes in fat mass and fat-free-mass are associated with incident hypertension in four population-based studies from Germany. Int J Cardiol 2018; 274:372-377. [PMID: 30217425 DOI: 10.1016/j.ijcard.2018.09.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/01/2018] [Accepted: 09/07/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND We estimated the association of changes in body weight, waist circumference (WC), fat mass (FM) and fat-free mass (FFM) with changes in blood pressure and incident hypertension using data from four German population-based studies. METHODS We analyzed data from 4467 participants, aged 21 to 82 years not taking antihypertensive medication and not having type 2 diabetes mellitus or a history of myocardial infarction at baseline and follow-up, from four population-based studies conducted in Germany. Body weight, WC, and blood pressure were measured at baseline and follow-up (median follow-up of the single studies 4 to 7 years). FM and FFM were calculated based on height-weight models derived from bioelectrical impedance studies. Hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg. Confounder-adjusted linear and logistic regressions were used to associate changes in anthropometric markers with changes in blood pressure, incident hypertension, and incident normalization of blood pressure. RESULTS In a pooled dataset including all four studies, increments in body weight, WC, FM, and FFM were statistically significantly associated with incident hypertension and changes in systolic and diastolic blood pressure over time. Decreases in body weight, FM, and FFM were significantly associated with incident normalization of blood pressure. CONCLUSIONS Our data suggests that the well-established association between obesity and blood pressure levels might be more related to body composition rather than to total body weight per se. Our findings indicate that gaining or losing FFM has substantial impact on the development or reversion of hypertension.
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Fat mass and obesity-associated gene rs9939609 polymorphism is a potential biomarker of recurrent venous thromboembolism in male but not in female patients. Gene 2018; 647:136-142. [PMID: 29325734 DOI: 10.1016/j.gene.2018.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/03/2018] [Indexed: 11/20/2022]
Abstract
Multiple genetic variations have been identified in FTO (fat mass and obesity-associated) gene. Among them, FTO rs9939609 polymorphism is shown to be associated with the risk of primary venous thromboembolism (VTE). However, its role in recurrent VTE is not known. The aim of our study was to investigate the association between FTO rs9939609 polymorphism and the risk of VTE recurrence in a prospective follow-up study in both male and female patients. FTO rs9939609 polymorphism (T/A) was analyzed in the Malmö thrombophilia study (MATS, followed for ~10 years) by using TaqMan PCR. MATS patients (n = 1050) were followed from the discontinuation of anticoagulant treatment until diagnosis of VTE recurrence or the end of follow-up. A total of 126 patients (12%) had VTE recurrence during follow-up. Cox regression analyses showed that sex modified the potential effect of FTO rs9939609 polymorphism on VTE recurrence. Male patients with the AA genotype for the FTO rs9939609 polymorphism had significantly higher risk of VTE recurrence as compared to the TT or AT genotypes (univariate hazard ratio [HR] = 2.05, 95% confidence interval [CI] = 1.2-3.5, P = 0.009 and adjusted HR = 2.03, 95% CI 1.2-3.6, P = 0.013). There was no association between FTO rs9939609 polymorphism and VTE recurrence in female patients. In conclusion, our results show that FTO rs9939609 polymorphism in recurrent VTE may differ according to gender and FTO polymorphism may predict VTE recurrence in male patients.
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Tellson A, Qin H, Erwin K, Houston S. Efficacy of acute care health care providers in cardiopulmonary resuscitation compressions in normal and obese adult simulation manikins. Proc (Bayl Univ Med Cent) 2018; 30:415-418. [PMID: 28966448 DOI: 10.1080/08998280.2017.11930210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Annually, over 350,000 persons require cardiopulmonary resuscitation (CPR), either in or outside of the hospital. With obesity a rising health issue in the United States, concerns exist regarding the efficacy of quality compressions for CPR in obese patients. The aims of this study were to determine if the compressions for three adult simulation manikins (normal, obese, and morbidly obese) met quality guidelines; to examine any differences in quality of chest compressions performed by health care providers between the three manikins; and to examine the effect of participant characteristics on the quality of chest compressions in obese and morbidly obese manikins. A randomized controlled design was used. Sixty-one health care providers performed chest compressions on the three simulation manikins. Results showed that performance on the normal-sized manikin was significantly better than that on both obese and morbidly obese manikins. Participant characteristics were significantly associated with quality of chest compressions. The effectiveness of compressions in obese and morbidly obese CPR recipients has yet to be determined.
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Affiliation(s)
- Alaina Tellson
- Professional Practice, The Heart Hospital Baylor Plano, Plano, Texas, and The Heart Hospital Baylor Denton, Denton, Texas (Tellson); and the Departments of Quantitative Sciences (Qin) and Nursing Research (Erwin, Houston), Baylor Scott & White Health - North Texas, Dallas, Texas
| | - Huanying Qin
- Professional Practice, The Heart Hospital Baylor Plano, Plano, Texas, and The Heart Hospital Baylor Denton, Denton, Texas (Tellson); and the Departments of Quantitative Sciences (Qin) and Nursing Research (Erwin, Houston), Baylor Scott & White Health - North Texas, Dallas, Texas
| | - Kristin Erwin
- Professional Practice, The Heart Hospital Baylor Plano, Plano, Texas, and The Heart Hospital Baylor Denton, Denton, Texas (Tellson); and the Departments of Quantitative Sciences (Qin) and Nursing Research (Erwin, Houston), Baylor Scott & White Health - North Texas, Dallas, Texas
| | - Susan Houston
- Professional Practice, The Heart Hospital Baylor Plano, Plano, Texas, and The Heart Hospital Baylor Denton, Denton, Texas (Tellson); and the Departments of Quantitative Sciences (Qin) and Nursing Research (Erwin, Houston), Baylor Scott & White Health - North Texas, Dallas, Texas
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Flegal KM, Kit BK, Graubard BI. Bias in Hazard Ratios Arising From Misclassification According to Self-Reported Weight and Height in Observational Studies of Body Mass Index and Mortality. Am J Epidemiol 2018; 187:125-134. [PMID: 29309516 DOI: 10.1093/aje/kwx193] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 02/06/2017] [Indexed: 12/31/2022] Open
Abstract
Misclassification of body mass index (BMI) categories arising from self-reported weight and height can bias hazard ratios in studies of BMI and mortality. We examined the effects on hazard ratios of such misclassification using national US survey data for 1976 through 2010 that had both measured and self-reported weight and height along with mortality follow-up for 48,763 adults and a subset of 17,405 healthy never-smokers. BMI was categorized as <22.5 (low), 22.5-24.9 (referent), 25.0-29.9 (overweight), 30.0-34.9 (class I obesity), and ≥35.0 (class II-III obesity). Misreporting at higher BMI categories tended to bias hazard ratios upwards for those categories, but that effect was augmented, counterbalanced, or even reversed by misreporting in other BMI categories, in particular those that affected the reference category. For example, among healthy male never-smokers, misclassifications affecting the overweight and the reference categories changed the hazard ratio for overweight from 0.85 with measured data to 1.24 with self-reported data. Both the magnitude and direction of bias varied according to the underlying hazard ratios in measured data, showing that findings on bias from one study should not be extrapolated to a study with different underlying hazard ratios. Because of misclassification effects, self-reported weight and height cannot reliably indicate the lowest-risk BMI category.
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Affiliation(s)
- Katherine M Flegal
- Division of Health and Nutrition Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
- Prevention Research Center, School of Medicine, Stanford University, Palo Alto, California
| | - Brian K Kit
- Division of Health and Nutrition Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Barry I Graubard
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Silva G, Ferraresi C, de Almeida RT, Motta ML, Paixão T, Ottone VO, Fonseca IA, Oliveira MX, Rocha-Vieira E, Dias-Peixoto MF, Esteves EA, Coimbra CC, Amorim FT, de Castro Magalhães F. Infrared photobiomodulation (PBM) therapy improves glucose metabolism and intracellular insulin pathway in adipose tissue of high-fat fed mice. Lasers Med Sci 2017; 33:559-571. [PMID: 29247431 DOI: 10.1007/s10103-017-2408-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/29/2017] [Indexed: 12/16/2022]
Abstract
Obesity represents a continuously growing global epidemic and is associated with the development of type 2 diabetes mellitus. The etiology of type 2 diabetes is related to the resistance of insulin-sensitive tissues to its action leading to impaired blood glucose regulation. Photobiomodulation (PBM) therapy might be a non-pharmacological, non-invasive strategy to improve insulin resistance. It has been reported that PBM therapy in combination with physical exercise reduces insulin resistance. Therefore, the aim of this study was to investigate the effects of PBM therapy on insulin resistance in obese mice. Male Swiss albino mice received low-fat control diet (n = 16, LFC) or high-fat diet (n = 18, HFD) for 12 weeks. From 9th to 12th week, the mice received PBM therapy (LASER) or Sham (light off) treatment and were allocated into four groups: LFC Sham (n = 8), LFC PBM (n = 8), HFD Sham (n = 9), and HFD PBM (n = 9). The PBM therapy was applied in five locations: to the left and right quadriceps muscle, upper limbs and center of the abdomen, during 40 s at each point, once a day, 5 days a week, for 4 weeks (780 nm, 250 mW/cm2, 10 J/cm2, 0.4 J per site; 2 J total dose per day). Insulin signaling pathway was evaluated in the epididymal adipose tissue. PBM therapy improved glucose tolerance and phosphorylation of Akt (Ser473) and reversed the HFD-induced reduction of GLUT4 content and phosphorylation of AS160 (Ser588). Also, PBM therapy reversed the increased area of epididymal and mesenteric adipocytes. The results showed that chronic PBM therapy improved parameters related to obesity and insulin resistance in HFD-induced obesity in mice.
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Affiliation(s)
- Gabriela Silva
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Faculdade de Ciências Básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Cleber Ferraresi
- Post-graduation Program in Physical Therapy in Functional Health, Physical Therapy Department, Universidade do Sagrado Coração, São Paulo, Brazil
- Post-Graduation Program in Biomedical Engineering, Universidade Brasil, São Paulo, Brazil
| | - Rodrigo Teixeira de Almeida
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Faculdade de Ciências Básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Mariana Lopes Motta
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Faculdade de Ciências Básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Thiago Paixão
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Faculdade de Ciências Básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Vinicius Oliveira Ottone
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Faculdade de Ciências Básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Ivana Alice Fonseca
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Faculdade de Ciências Básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Murilo Xavier Oliveira
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Physiotherapy Department, Faculdade de Ciências Básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Etel Rocha-Vieira
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Faculdade de Ciências Básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Marco Fabrício Dias-Peixoto
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Faculdade de Ciências Básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Elizabethe Adriana Esteves
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Faculdade de Ciências Básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Cândido Celso Coimbra
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Faculdade de Ciências Básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
- Endocrinology Laboratory, Biological Sciences Institute, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Fabiano Trigueiro Amorim
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Faculdade de Ciências Básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
- University of New Mexico, Albuquerque, NM, USA
| | - Flávio de Castro Magalhães
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Faculdade de Ciências Básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
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Associations of adult genetic risk scores for adiposity with childhood abdominal, liver and pericardial fat assessed by magnetic resonance imaging. Int J Obes (Lond) 2017; 42:897-904. [PMID: 29437161 PMCID: PMC5985956 DOI: 10.1038/ijo.2017.302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/05/2017] [Accepted: 11/19/2017] [Indexed: 02/07/2023]
Abstract
Background Genome-wide association studies (GWAS) identified single nucleotide polymorphisms (SNPs) involved in adult fat distribution. Whether these SNPs also affect abdominal and organ-specific fat accumulation in children is unknown. Methods In a population-based prospective cohort study among 1 995 children (median age: 9.8 years, 95% range 9.4;10.8), We tested the associations of six genetic risk scores based on previously identified SNPs for childhood BMI, adult BMI, liver fat, WHR, pericardial fat mass, visceral- and subcutaneous adipose tissue ratio (VAT/SAT ratio), and four individual SAT and VAT associated SNPs, for association with SAT (N=1 746), VAT (N=1 742), VAT/SAT ratio (N=1 738), liver fat fraction (N=1 950), and pericardial fat mass (N=1 803) measured by Magnetic Resonance Imaging. Results Per additional risk allele in the childhood BMI genetic risk score, SAT increased 0.020 standard deviation scores (SDS), (95% confidence interval (CI) 0.009;0.031, p-value:3.28*10-4) and VAT increased 0.021 SDS, 95% CI:0.009;0.032, p-value:4.68*10-4). The adult BMI risk score was positively associated with SAT (0.022 SDS increase, CI:0.015;0.029, p-value:1.33*10-9), VAT (0.017 SDS increase, CI:0.010;0.025, p-value:7.00*10-6), and negatively with VAT/SAT ratio (-0.012 SDS decrease, CI:-0.019;-0.006, p-value:2.88*10-4). The liver fat risk score was associated with liver fat fraction (0.121 SDS, CI:0.086;0.157, p-value:2.65*10-11). Rs7185735 (SAT), was associated with SAT (0.151 SDS, CI:0.087;0.214, p-value:3.00*10-6) and VAT/SAT ratio (-0.126 SDS, CI:-0.186;-0.065, p-value:4.70*10-5). After stratification by sex the associations of the adult BMI risk score with SAT and VAT and of the liver fat risk score with liver fat fraction remained in both sexes. Associations of the childhood BMI risk score with SAT, and the adult BMI risk score with VAT/SAT ratio were present among boys only, whereas the association of the pericardial fat risk score with pericardial fat was present among girls only. Conclusion Genetic variants associated with BMI, body fat distribution, liver and pericardial fat already affect body fat distribution in childhood.
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The Effects of Synbiotic Supplementation on Carotid Intima-Media Thickness, Biomarkers of Inflammation, and Oxidative Stress in People with Overweight, Diabetes, and Coronary Heart Disease: a Randomized, Double-Blind, Placebo-Controlled Trial. Probiotics Antimicrob Proteins 2017; 11:133-142. [DOI: 10.1007/s12602-017-9343-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Egom EE, Pharithi RB, Shiwani HA, Khan B, Kruzliak P, El-Hiani Y, Maher V. Time to redefine body mass index categories in chronic diseases? Spotlight on obesity paradox. Int J Food Sci Nutr 2017; 69:513-523. [PMID: 29063824 DOI: 10.1080/09637486.2017.1389859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Obesity is a complex condition classically characterised by excessive body fat accumulation and represents one of the most important public health problems worldwide. Although several epidemiological studies have shown that elevated BMI is associated with higher morbidity, and with increased rate of death from all causes and from cardiovascular disease, accumulating evidence suggests that being overweight or obese may be protective (the so-called obesity paradox), at least in chronic diseases. These observations, not only question the validity of the BMI system, but also raise the intriguing question of whether we should redefine what the normal range of BMI is in individuals suffering from a chronic disease. In the present article, we review the available information on the association between elevated BMI and increased morbidity and mortality including obesity-related paradoxes, explore key aspects of the role and limitations of BMI as a measure of increased adiposity and outline potential solutions to address the current controversies regarding the impact of obesity on human health.
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Affiliation(s)
- Emmanuel E Egom
- a Jewish General Hospital and Lady Davis Institute for Medical Research , Montreal , Canada.,b Department of Cardiology , The Adelaide and Meath Hospital Dublin, Incorporating the National Children Hospital , Dublin , Ireland
| | - Rebabonye B Pharithi
- b Department of Cardiology , The Adelaide and Meath Hospital Dublin, Incorporating the National Children Hospital , Dublin , Ireland
| | - Haaris A Shiwani
- c Department of Clinical Medicine, Education Division , Trinity College Dublin, The University of Dublin , Dublin , Ireland
| | - Barkat Khan
- b Department of Cardiology , The Adelaide and Meath Hospital Dublin, Incorporating the National Children Hospital , Dublin , Ireland
| | - Peter Kruzliak
- d International Clinical Research Center , St. Anne's University Hospital and Masaryk University , Brno , Czech Republic
| | - Yassine El-Hiani
- e Department of Physiology and Biophysics , Dalhousie University , Halifax , NS , Canada
| | - Vincent Maher
- b Department of Cardiology , The Adelaide and Meath Hospital Dublin, Incorporating the National Children Hospital , Dublin , Ireland.,c Department of Clinical Medicine, Education Division , Trinity College Dublin, The University of Dublin , Dublin , Ireland
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Association Between Obesity and Wound Infection Following Colorectal Surgery: Systematic Review and Meta-Analysis. J Gastrointest Surg 2017; 21:1700-1712. [PMID: 28785932 DOI: 10.1007/s11605-017-3494-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/30/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this meta-analysis is to comprehensively review and quantify the excess risk of surgical site infections (SSI) in obese patients following colorectal surgery. METHODS A systematic electronic search of the MEDLINE and EMBASE databases identified studies that investigated the association of obesity, defined by body mass index (BMI) with SSI among colorectal surgery patients. RESULTS Twelve studies were included in the final analysis. Patients with BMI ≥30 kg/m2 were at 1.5 times (pooled OR 1.51, 95% CI: 1.39, 1.63, p < 0.001) higher odds of developing SSI after colorectal surgery when compared to BMI <30 kg/m2. Subgroup analysis of the eight studies that investigated only elective procedures showed that the odds of developing SSI when BMI ≥30 kg/m2 is 1.6 times that of those with BMI <30 kg/m2 (pooled OR 1.60; 95% CI 1.34, 1.86; p < 0.001). The odds of having SSI when BMI is 25-29.9 kg/m2 are 1.2 times than those with BMI <25 kg/m2 (pooled OR 1.17; 95% CI 1.07, 1.28; p < 0.001). CONCLUSION Overweight and obese patients carry at least 20% and 50% higher odds of developing SSI after colorectal surgery compared to normal weight patients, respectively.
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Rodriguez Flores M, Aguilar Salinas C, Piché ME, Auclair A, Poirier P. Effect of bariatric surgery on heart failure. Expert Rev Cardiovasc Ther 2017; 15:567-579. [PMID: 28714796 DOI: 10.1080/14779072.2017.1352471] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Obesity increases the risk of heart failure (HF), which continues to be a significant proportion of all cardiovascular diseases and affects increasingly younger populations. The cross-talk between adipose and the heart involves insulin resistance, adipokine signaling and inflammation, with the capacity of adipose tissue to mediate hemodynamic signals, promoting progressive cardiomyopathy. Areas covered: From a therapeutic perspective, there is not yet a single obesity-related pathway that when addressed, can ameliorate cardiomyopathy in obese patients and this is a matter of ongoing research. There is poor evidence of the beneficial long-term effect of small nonsurgical intentional weight loss on HF outcomes, in contrast to the field of HF accompanying severe obesity where observational studies have shown that bariatric surgery is associated with improved cardiac structure/function in severely obese patients with HF and preserved ejection fraction (HFpEF) as well as with improved cardiac structure/function in those with HF and reduced ejection fraction (HFrEF). Few studies report positive outcomes in subjects with obesity and HF, both severe, who underwent bariatric surgery as a rescue treatment, including bridge to heart transplantation. Expert commentary: The fast growing prevalence of obesity will continue to require the development of appropriate interventions directed at controlling or slowing pathways of cardiac damage in these patients, but at present, bariatric surgery should be considered an option to try to decrease morbidity associated with HF in severely obese adults.
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Affiliation(s)
- Marcela Rodriguez Flores
- a Endocrinology Department , Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" , Mexico
| | - Carlos Aguilar Salinas
- a Endocrinology Department , Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" , Mexico
| | - Marie-Eve Piché
- b Cardiology Department , Institut Universitaire de Cardiologie et de Pneumologie de Québec , Québec , Canada.,c Faculty of Medicine , Laval University , Québec , Canada
| | - Audrey Auclair
- b Cardiology Department , Institut Universitaire de Cardiologie et de Pneumologie de Québec , Québec , Canada
| | - Paul Poirier
- b Cardiology Department , Institut Universitaire de Cardiologie et de Pneumologie de Québec , Québec , Canada.,d Faculty of Pharmacy , Laval University , Québec , Canada
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Smith CL, Edwards LJ. A test of separate hypotheses for comparing linear mixed models with non nested fixed effects. COMMUN STAT-THEOR M 2017. [DOI: 10.1080/03610926.2015.1104352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ché L. Smith
- Department of Biostatistics, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Lloyd J. Edwards
- Department of Biostatistics, UNC Chapel Hill, Chapel Hill, NC, USA
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Cabrera-Rode E, Rodríguez J, Álvarez A, Echevarría R, Reyes AD, Cubas-Dueñas I, Turcios-Tristá SE, Díaz-Díaz O. Effects of Obex in Overweight and Obese Subjects With or Without Impaired Fasting Glucose: A Pilot Study. J Diet Suppl 2017; 14:626-639. [PMID: 28384000 DOI: 10.1080/19390211.2017.1304482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Obex is a dietary supplement to help weight loss. The purpose of this study was to evaluate the effect of Obex in overweight/obese participants with or without impaired fasting glucose. This was an open-label pilot study conducted with 40 overweight and obese subjects, 23-60 years old with a body mass index of 25-44 kg/m2 (20 participants with impaired fasting glucose [IFG] and 20 with normal glucose levels). Participants received Obex at a dose of one sachet before the two main meals of each day for 3 months. In addition to anthropometric measures and blood pressure (BP), fasting plasma glucose, lipid profile, insulin, creatinine, and uric acid were determined. Insulin resistance (HOMA-IR) and beta-cell function (HOMA-B) were assessed. Three indirect indices were used to calculate insulin sensitivity. Compared to baseline, Obex significantly reduced body weight, body mass index, waist circumference, waist/hip ratio, and waist/height ratio in both groups of participants (p <.05). In individuals without IFG, Obex improved HDL-c (high-density lipoprotein cholesterol) (p <.0001) and lowered BP (p <.05). After 3 months of Obex, subjects with IFG showed a reduction in fasting glucose concentrations (p <.0001). Compared to baseline, this group also showed improved insulin sensitivity and HDL-c (p <.05). In conclusion, the consumption of Obex contributed to weight reduction, improved glucose tolerance and insulin sensitivity, as well as HDL-c, and appears to be safe in overweight/obese adults with impaired fasting glucose. Obex may be beneficial for weight loss, indicating that further studies are required.
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Affiliation(s)
- Eduardo Cabrera-Rode
- a Department of Immunology , National Institute of Endocrinology , Havana , Cuba
| | - Janet Rodríguez
- a Department of Immunology , National Institute of Endocrinology , Havana , Cuba
| | - Aimee Álvarez
- b Department of Diabetes , National Institute of Endocrinology , Havana , Cuba
| | - Ragmila Echevarría
- c Biochemical Laboratory , National Institute of Endocrinology , Havana , Cuba
| | | | - Ileana Cubas-Dueñas
- a Department of Immunology , National Institute of Endocrinology , Havana , Cuba
| | | | - Oscar Díaz-Díaz
- e Diabetes Care Center , National Institute of Endocrinology , Havana , Cuba
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Butler AA, Girardet C, Mavrikaki M, Trevaskis JL, Macarthur H, Marks DL, Farr SA. A Life without Hunger: The Ups (and Downs) to Modulating Melanocortin-3 Receptor Signaling. Front Neurosci 2017; 11:128. [PMID: 28360832 PMCID: PMC5352694 DOI: 10.3389/fnins.2017.00128] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/01/2017] [Indexed: 11/13/2022] Open
Abstract
Melanocortin neurons conserve body mass in hyper- or hypo-caloric conditions by conveying signals from nutrient sensors into areas of the brain governing appetite and metabolism. In mice, melanocortin-3 receptor (MC3R) deletion alters nutrient partitioning independently of hyperphagia, promoting accumulation of fat over muscle mass. Enhanced rhythms in insulin and insulin-responsive metabolic genes during hypocaloric feeding suggest partial insulin resistance and enhanced lipogenesis. However, exactly where and how MC3Rs affect metabolic control to alter nutrient partitioning is not known. The behavioral phenotypes exhibited by MC3R-deficient mice suggest a contextual role in appetite control. The impact of MC3R-deficiency on feeding behavior when food is freely available is minor. However, homeostatic responses to hypocaloric conditioning involving increased expression of appetite-stimulating (orexigenic) neuropeptides, binge-feeding, food anticipatory activity (FAA), entrainment to nutrient availability and enhanced feeding-related motivational responses are compromised with MC3R-deficiency. Rescuing Mc3r transcription in hypothalamic and limbic neurons improves appetitive responses during hypocaloric conditioning while having minor effects on nutrient partitioning, suggesting orexigenic functions. Rescuing hypothalamic MC3Rs also restores responses of fasting-responsive hypothalamic orexigenic neurons in hypocaloric conditions, suggesting actions that sensitize fasting-responsive neurons to signals from nutrient sensors. MC3R signaling in ventromedial hypothalamic SF1(+ve) neurons improves metabolic control, but does not restore appetitive responses or nutrient partitioning. In summary, desensitization of fasting-responsive orexigenic neurons may underlie attenuated appetitive responses of MC3R-deficient mice in hypocaloric situations. Further studies are needed to identify the specific location(s) of MC3Rs controlling appetitive responses and partitioning of nutrients between fat and lean tissues.
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Affiliation(s)
- Andrew A Butler
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine St. Louis, MO, USA
| | - Clemence Girardet
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine St. Louis, MO, USA
| | - Maria Mavrikaki
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine St. Louis, MO, USA
| | - James L Trevaskis
- In vivo Pharmacology, Cardiovascular and Metabolic Disease, Medimmune Gaithersburg, MD, USA
| | - Heather Macarthur
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine St. Louis, MO, USA
| | - Daniel L Marks
- Papé Family Pediatric Research Institute, Oregon Health and Science University Portland, OR, USA
| | - Susan A Farr
- Department of Internal Medicine, Division of Geriatrics, Saint Louis University School of MedicineSt. Louis, MO, USA; VA Medical CenterSt. Louis, MO, USA
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Oesch L, Tatlisumak T, Arnold M, Sarikaya H. Obesity paradox in stroke - Myth or reality? A systematic review. PLoS One 2017; 12:e0171334. [PMID: 28291782 PMCID: PMC5349441 DOI: 10.1371/journal.pone.0171334] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/18/2017] [Indexed: 12/16/2022] Open
Abstract
Background and purpose Both stroke and obesity show an increasing incidence worldwide. While obesity is an established risk factor for stroke, its influence on outcome in ischemic stroke is less clear. Many studies suggest a better prognosis in obese patients after stroke (“obesity paradox”). This review aims at assessing the clinical outcomes of obese patients after stroke by performing a systematic literature search. Methods The reviewers searched MEDLINE from inception to December 2015. Studies were eligible if they included outcome comparisons in stroke patients with allocation to body weight. Results Twenty-five studies (299’750 patients) were included and none was randomised. Ten of 12 studies (162’921 patients) reported significantly less mortality rates in stroke patients with higher BMI values. Seven of 9 studies (92’718 patients) ascertained a favorable effect of excess body weight on non-fatal outcomes (good clinical outcome, recurrence of vascular events). Six studies (85’042 patients) indicated contradictory results after intravenous thrombolysis (IVT), however. Several methodological limitations were observed in major part of studies (observational study design, inaccuracy of BMI in reflecting obesity, lacking body weight measurement, selection bias, survival bias). Conclusion Most observational data indicate a survival benefit of obese patients after stroke, but a number of methodological concerns exist. No obesity paradox was observed in patients after IVT. There is a need for well-designed randomized controlled trials assessing the effects of weight reduction on stroke risk in obese patients.
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Affiliation(s)
- Lisa Oesch
- Stroke Center, Department of Neurology, Bern University Hospital, Bern, Switzerland
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Marcel Arnold
- Stroke Center, Department of Neurology, Bern University Hospital, Bern, Switzerland
| | - Hakan Sarikaya
- Stroke Center, Department of Neurology, Bern University Hospital, Bern, Switzerland
- * E-mail:
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Visfatin levels are increased in patients with resistant hypertension and are correlated with left ventricular hypertrophy. Blood Press Monit 2017; 22:137-142. [PMID: 28240682 DOI: 10.1097/mbp.0000000000000245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the possible correlation of serum visfatin levels with resistant hypertension (RHT). PATIENTS AND METHODS Patients who had undergone ambulatory blood pressure measurements (ABPM) during the outpatient controls were prospectively recruited. Seventy-one patients with RHT and 94 patients with controlled hypertension (CHT) were included in the study. RHT was defined as 'uncontrolled blood pressure (BP) despite using three antihypertensive agents including a diuretic or need of four or more drugs to control BP'. The demographic properties, medications used, and laboratory parameters including visfatin levels were recorded. RESULTS In the RHT group, left ventricular mass index was significantly higher compared with the CHT group (108.13±26.86 vs. 89.46±24.09 g/m, P<0.01). High-sensitivity C-reactive protein and visfatin levels were significantly higher in the RHT group [4.0 (5.2) vs. 2.3 (3.0) mg/l, P<0.01, and 12.87±4.98 vs. 9.46±4.69 ng/ml, P<0.01, respectively] compared with the CHT group. In the multivariate linear regression model, visfatin level remained as an independent predictor for office systolic BP [B: 2.07, 95% confidence interval (CI): 1.17-2.98, P<0.01]; office diastolic BP (B: 0.71, 95% CI: 0.27-1.16, P<0.01); mean 24-h systolic ABPM (B: 1.46, 95% CI: 0.79-2.13, P<0.01); and mean 24-h diastolic ABPM (B: 0.88, 95% CI: 0.42-1.34, P<0.01) and was also correlated independently with left ventricular mass index (B: 3.13, 95% CI: 2.58-3.99, P<0.01). CONCLUSION In this cohort of RHT patients diagnosed with ABPM, we have found an independent correlation between higher visfatin levels and the presence of RHT and left ventricular hypertrophy.
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Mazimba S, Holland E, Nagarajan V, Mihalek AD, Kennedy JLW, Bilchick KC. Obesity paradox in group 1 pulmonary hypertension: analysis of the NIH-Pulmonary Hypertension registry. Int J Obes (Lond) 2017; 41:1164-1168. [PMID: 28209971 DOI: 10.1038/ijo.2017.45] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/02/2017] [Accepted: 02/09/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The 'obesity paradox' refers to the fact that obese patients have better outcomes than normal weight patients. This has been observed in multiple cardiovascular conditions, but evidence for obesity paradox in pulmonary hypertension (PH) remains sparse. METHODS We categorized 267 patients from the National Institute of Health-PH registry into five groups based on body mass index (BMI): underweight, normal weight, overweight, obese and morbidly obese. Mortality was compared in BMI groups using the χ2 statistic. Five-year probability of death using the PH connection (PHC) risk equation was calculated, and the model was compared with BMI groups using Cox proportional hazards regression and Kaplan-Meier (KM) survival curves. RESULTS Patients had a median age of 39 years (interquartile range 30-50 years), a median BMI of 23.4 kg m-2 (21.0-26.8 kg m-2) and an overall mortality at 5 years of 50.2%. We found a U-shaped relationship between survival and 1-year mortality with the best 1-year survival in overweight patients. KM curves showed the best survival in the overweight, followed by obese and morbidly obese patients, and the worst survival in normal weight and underweight patients (log-rank P=0.0008). In a Cox proportional hazards analysis, increasing BMI was a highly significant predictor of improved survival even after adjustment for the PHC risk equation with a hazard ratio for death of 0.921 per kg m-2 (95% confidence interval: 0.886-0.954) (P<0.0001). CONCLUSION We observed that the best survival was in the overweight patients, making this more of an 'overweight paradox' than an 'obesity paradox'. This has implications for risk stratification and prognosis in group 1 PH patients.
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Affiliation(s)
- S Mazimba
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - E Holland
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - V Nagarajan
- Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - A D Mihalek
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - J L W Kennedy
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - K C Bilchick
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
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Ando T, Yamazaki E, Ogusa E, Ishii Y, Yamamoto W, Motohashi K, Tachibana T, Hagihara M, Matsumoto K, Tanaka M, Hashimoto C, Koharazawa H, Fujimaki K, Taguchi J, Fujita H, Kanamori H, Fujisawa S, Nakajima H. Body mass index is a prognostic factor in adult patients with acute myeloid leukemia. Int J Hematol 2017; 105:623-630. [DOI: 10.1007/s12185-017-2183-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 11/29/2022]
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Effertz T, Engel S, Verheyen F, Linder R. The costs and consequences of obesity in Germany: a new approach from a prevalence and life-cycle perspective. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:1141-1158. [PMID: 26701837 DOI: 10.1007/s10198-015-0751-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 11/20/2015] [Indexed: 06/05/2023]
Abstract
With the steadily growing health burden of obesity in Germany, the measuring and quantification of its costs and relevant economic consequences have become increasingly important. The usual quantifications via previous cost-of-illness approaches mostly have several weaknesses, e.g., applying "indirect methods" by using "population-attributable fractions" to identify parts of costs that can be accrued to obesity, second using highly aggregated data and third often only displaying part of the costs. This article presents a new approach and a new estimation of the cost and consequences of obesity in Germany using claims data from a German health insurance company. A sample of 146,000 individuals was analyzed with both a prevalence and a life-cycle focus on the cost and consequences of obesity. With additional data sets, we calculate the deaths per year due to obesity, the excess costs per year and several intangible consequences usually referred to as "pain and suffering". Our results show that the cost estimations of obesity in Germany so far have been largely underestimated. The annual direct costs of obesity in Germany amount to approximately €29.39 billion and the indirect costs to an additional €33.65 billion. A total of 102,000 subjects die prematurely each year because of obesity, and there is a significant excess of unemployment, long-term nursing care, and pain and suffering due to obesity. From a lifetime perspective, every obese man is equal to an additional burden of €166,911 and each woman of €206,526 for the social security system in Germany. Obesity due to unhealthy eating is thus about to replace tobacco consumption in terms of costs and consequences as the main hazardous lifestyle factor and thus should be more intensively focussed by public health policy.
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Affiliation(s)
- Tobias Effertz
- Institut für Recht der Wirtschaft, Universität Hamburg, Max Brauer Allee 60, 22765, Hamburg, Germany.
| | - Susanne Engel
- WINEG | Wissenschaftliches Institut der TK, für Nutzen und Effizienz im Gesundheitswesen, Bramfelder Straße 140, 22305, Hamburg, Germany
| | - Frank Verheyen
- WINEG | Wissenschaftliches Institut der TK, für Nutzen und Effizienz im Gesundheitswesen, Bramfelder Straße 140, 22305, Hamburg, Germany
| | - Roland Linder
- WINEG | Wissenschaftliches Institut der TK, für Nutzen und Effizienz im Gesundheitswesen, Bramfelder Straße 140, 22305, Hamburg, Germany
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Monnereau C, Vogelezang S, Kruithof CJ, Jaddoe VWV, Felix JF. Associations of genetic risk scores based on adult adiposity pathways with childhood growth and adiposity measures. BMC Genet 2016; 17:120. [PMID: 27538985 PMCID: PMC4991119 DOI: 10.1186/s12863-016-0425-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Results from genome-wide association studies (GWAS) identified many loci and biological pathways that influence adult body mass index (BMI). We aimed to identify if biological pathways related to adult BMI also affect infant growth and childhood adiposity measures. METHODS We used data from a population-based prospective cohort study among 3,975 children with a mean age of 6 years. Genetic risk scores were constructed based on the 97 SNPs associated with adult BMI previously identified with GWAS and on 28 BMI related biological pathways based on subsets of these 97 SNPs. Outcomes were infant peak weight velocity, BMI at adiposity peak and age at adiposity peak, and childhood BMI, total fat mass percentage, android/gynoid fat ratio, and preperitoneal fat area. Analyses were performed using linear regression models. RESULTS A higher overall adult BMI risk score was associated with infant BMI at adiposity peak and childhood BMI, total fat mass, android/gynoid fat ratio, and preperitoneal fat area (all p-values < 0.05). Analyses focused on specific biological pathways showed that the membrane proteins genetic risk score was associated with infant peak weight velocity, and the genetic risk scores related to neuronal developmental processes, hypothalamic processes, cyclicAMP, WNT-signaling, membrane proteins, monogenic obesity and/or energy homeostasis, glucose homeostasis, cell cycle, and muscle biology pathways were associated with childhood adiposity measures (all p-values <0.05). None of the pathways were associated with childhood preperitoneal fat area. CONCLUSIONS A genetic risk score based on 97 SNPs related to adult BMI was associated with peak weight velocity during infancy and general and abdominal fat measurements at the age of 6 years. Risk scores based on genetic variants linked to specific biological pathways, including central nervous system and hypothalamic processes, influence body fat development from early life onwards.
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Affiliation(s)
- Claire Monnereau
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Suzanne Vogelezang
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Claudia J Kruithof
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Janine F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands. .,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
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Koncsos G, Varga ZV, Baranyai T, Boengler K, Rohrbach S, Li L, Schlüter KD, Schreckenberg R, Radovits T, Oláh A, Mátyás C, Lux Á, Al-Khrasani M, Komlódi T, Bukosza N, Máthé D, Deres L, Barteková M, Rajtík T, Adameová A, Szigeti K, Hamar P, Helyes Z, Tretter L, Pacher P, Merkely B, Giricz Z, Schulz R, Ferdinandy P. Diastolic dysfunction in prediabetic male rats: Role of mitochondrial oxidative stress. Am J Physiol Heart Circ Physiol 2016; 311:H927-H943. [PMID: 27521417 DOI: 10.1152/ajpheart.00049.2016] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 07/25/2016] [Indexed: 12/23/2022]
Abstract
Although incidence and prevalence of prediabetes are increasing, little is known about its cardiac effects. Therefore, our aim was to investigate the effect of prediabetes on cardiac function and to characterize parameters and pathways associated with deteriorated cardiac performance. Long-Evans rats were fed with either control or high-fat chow for 21 wk and treated with a single low dose (20 mg/kg) of streptozotocin at week 4 High-fat and streptozotocin treatment induced prediabetes as characterized by slightly elevated fasting blood glucose, impaired glucose and insulin tolerance, increased visceral adipose tissue and plasma leptin levels, as well as sensory neuropathy. In prediabetic animals, a mild diastolic dysfunction was observed, the number of myocardial lipid droplets increased, and left ventricular mass and wall thickness were elevated; however, no molecular sign of fibrosis or cardiac hypertrophy was shown. In prediabetes, production of reactive oxygen species was elevated in subsarcolemmal mitochondria. Expression of mitofusin-2 was increased, while the phosphorylation of phospholamban and expression of Bcl-2/adenovirus E1B 19-kDa protein-interacting protein 3 (BNIP3, a marker of mitophagy) decreased. However, expression of other markers of cardiac auto- and mitophagy, mitochondrial dynamics, inflammation, heat shock proteins, Ca2+/calmodulin-dependent protein kinase II, mammalian target of rapamycin, or apoptotic pathways were unchanged in prediabetes. This is the first comprehensive analysis of cardiac effects of prediabetes indicating that mild diastolic dysfunction and cardiac hypertrophy are multifactorial phenomena that are associated with early changes in mitophagy, cardiac lipid accumulation, and elevated oxidative stress and that prediabetes-induced oxidative stress originates from the subsarcolemmal mitochondria.
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Affiliation(s)
- Gábor Koncsos
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltán V Varga
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary; Laboratory of Cardiovascular Physiology and Tissue Injury, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Tamás Baranyai
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Kerstin Boengler
- Institute of Physiology, Faculty of Medicine, Justus-Liebig University, Giessen, Germany
| | - Susanne Rohrbach
- Institute of Physiology, Faculty of Medicine, Justus-Liebig University, Giessen, Germany
| | - Ling Li
- Institute of Physiology, Faculty of Medicine, Justus-Liebig University, Giessen, Germany
| | - Klaus-Dieter Schlüter
- Institute of Physiology, Faculty of Medicine, Justus-Liebig University, Giessen, Germany
| | - Rolf Schreckenberg
- Institute of Physiology, Faculty of Medicine, Justus-Liebig University, Giessen, Germany
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Attila Oláh
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Csaba Mátyás
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Árpád Lux
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Mahmoud Al-Khrasani
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Tímea Komlódi
- Department of Medical Biochemistry, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Nóra Bukosza
- Institute of Pathophysiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Domokos Máthé
- Department of Biophysics and Radiation Biology, Faculty of Medicine, Semmelweis University, Budapest, Hungary; CROmed Translational Research Centers, Budapest, Hungary
| | - László Deres
- 1st Department of Internal Medicine, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - Monika Barteková
- Institute of Physiology, Faculty of Medicine, Comenius University in Bratislava, Slovakia; Institute for Heart Research, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Tomáš Rajtík
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Slovakia
| | - Adriana Adameová
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Slovakia
| | - Krisztián Szigeti
- Department of Biophysics and Radiation Biology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Hamar
- Institute of Pathophysiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Helyes
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine and Szentágothai Research Centre & MTA-PTE NAP B Chronic Pain Research Group, University of Pécs, Pécs, Hungary; and
| | - László Tretter
- Department of Medical Biochemistry, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Pál Pacher
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary; Laboratory of Cardiovascular Physiology and Tissue Injury, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltán Giricz
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary;
| | - Rainer Schulz
- Institute of Physiology, Faculty of Medicine, Justus-Liebig University, Giessen, Germany
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Guo G, Liu H, Wang L, Shen H, Hu W. The Genome-Wide Influence on Human BMI Depends on Physical Activity, Life Course, and Historical Period. Demography 2016; 52:1651-70. [PMID: 26319003 DOI: 10.1007/s13524-015-0421-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In this analysis, guided by an evolutionary framework, we investigate how the human genome as a whole interacts with historical period, age, and physical activity to influence body mass index (BMI). The genomic influence is estimated by (1) heritability or the proportion of variance in BMI explained by genome-wide genotype data, and (2) the random effects or the best linear unbiased predictors (BLUPs) of genome-wide association studies (GWAS) data on BMI. Data were used from the Framingham Heart Study (FHS) in the United States. The study was initiated in 1948, and the obesity data were collected repeatedly over the subsequent decades. The analyses draw analysis samples from a pool of >8,000 individuals in the FHS. The hypothesis testing based on Pitman test, permutation Pitman test, F test, and permutation F test produces three sets of significant findings. First, the genomic influence on BMI is substantially larger after the mid-1980s than in the few decades before the mid-1980s within each age group of 21-40, 41-50, 51-60, and >60. Second, the genomic influence on BMI weakens as one ages across the life course, or the genomic influence on BMI tends to be more important during reproductive ages than after reproductive ages within each of the two historical periods. Third, within the age group of 21-50 and not in the age group of >50, the genomic influence on BMI among physically active individuals is substantially smaller than the influence on those who are not physically active. In summary, this study provides evidence that the influence of human genome as a whole on obesity depends on historical period, age, and level of physical activity.
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Affiliation(s)
- Guang Guo
- Department of Sociology, University of North Carolina, Chapel Hill, NC, 27599, USA. .,Carolina Population Center, University of North Carolina, Chapel Hill, NC, 27599, USA. .,Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Hexuan Liu
- Department of Sociology, University of North Carolina, Chapel Hill, NC, 27599, USA. .,Carolina Population Center, University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Ling Wang
- Department of Statistics and Operations Research, University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Haipeng Shen
- Department of Statistics and Operations Research, University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Wen Hu
- Department of Sociology, Nankai University, Tianjin, China.
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Jafar TH, Tan NC, Allen JC, Pradhan SS, Goh P, Tavajoh S, Keng FM, Chan J. Management of hypertension and multiple risk factors to enhance cardiovascular health - a feasibility study in Singapore polyclinics. BMC Health Serv Res 2016; 16:229. [PMID: 27391818 PMCID: PMC4938988 DOI: 10.1186/s12913-016-1491-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 06/29/2016] [Indexed: 01/19/2023] Open
Abstract
Background High blood pressure (BP) is a leading contributor to cardiovascular mortality globally. There is scarcity of information on effective health systems interventions to lower BP and reduce cardiovascular risk in Southeast Asian countries. We conducted a pilot exploratory trial on 100 adults aged 40 years or older with uncontrolled hypertension to optimize the design for a structured multi-component intervention in primary care clinics for management of hypertension. Methods Two clinics were involved, each enrolling 50 participants, with one as the intervention clinic and the other as the control (usual care). The intervention comprised the following four components: 1) an algorithm-driven intervention using a fixed-dose combination (FDC) antihypertensive treatment and lipid lowering medication for high risk individuals, 2) subsidized FDC antihypertensive medication; 3) motivational conversation (MC) for high risk individuals; and 4) telephone follow-ups of all individuals. The process outcomes were intervention fidelity measures. The outcomes of change in parameters of interest were healthy lifestyle index (composite score of body mass index, physical activity, dietary habit, dietary quality and smoking), adherence to antihypertensive medications, and systolic and diastolic BP from baseline to follow-up at 3 months. Results Greater than 90 % fidelity was achieved for 3 of the 4 intervention components. Although not designed for conclusive results, the healthy lifestyle score increased by 0.16 (±0.68) with the intervention and decreased by 0.18 (±0.75) with usual care (p = 0.02). Adherence to anti-hypertensive medications at follow-up was 95.3 % in the intervention group compared to 83.8 % for usual care (p = 0.01). Systolic and diastolic BP decreased in both intervention and control groups, although statistical significance between groups was not achieved. Hypertensive individuals rated all intervention components ‘highly favorable’ on a Likert scale. Conclusions Our findings indicate that the proposed, structured multi-component approach for management of hypertension is feasible for implementation in primary care clinics in Singapore, with some changes to the protocol. The observed improvement in the healthy lifestyle index and adherence to anti-hypertensive medications is promising. A large scale, adequately powered trial would be informative to assess intervention effectiveness on BP and cardiovascular risk reduction. Trial registration This trial has been registered at ClinicalTrials.gov. ClinicalTrials.gov number NCT02330224. Registered on 28 December 2014. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1491-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tazeen H Jafar
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore. .,Duke Global Health Institute Durham, Durham, NC, 27710, USA. .,Department of Renal Medicine, Singapore General Hospital, Singapore, 169608, Singapore.
| | - Ngiap C Tan
- SingHealth Polyclinics, Singapore, Singapore
| | - John C Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Shreyasee S Pradhan
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Paul Goh
- SingHealth Polyclinics, Singapore, Singapore
| | - Saeideh Tavajoh
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Fong M Keng
- SingHealth Polyclinics, Singapore, Singapore
| | - Jason Chan
- SingHealth Polyclinics, Singapore, Singapore
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Bi X, Tey SL, Leong C, Quek R, Loo YT, Henry CJ. Correlation of adiposity indices with cardiovascular disease risk factors in healthy adults of Singapore: a cross-sectional study. BMC OBESITY 2016; 3:33. [PMID: 27398222 PMCID: PMC4936162 DOI: 10.1186/s40608-016-0114-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/30/2016] [Indexed: 12/14/2022]
Abstract
Background Obesity has long been highlighted for its association with increased incidence of cardiovascular disease (CVD). Nonetheless, the best adiposity indices to evaluate the CVD risk factors remain contentious and few studies have been performed in Asian populations. In the present study, we compared the association strength of percent body fat (PBF) to indirect anthropometric measures of general adiposity (body mass index (BMI) and body adiposity index (BAI)) and central adiposity (waist circumference (WC), and waist-to-hip ratio (WHR)) for the prediction of CVD risk factors in healthy men and women living in Singapore. Methods A total of 125 individuals (63 men and 62 women) took part in this study. PBF was measured by using three different techniques, including bioelectrical impedance analysis (BIA), BOD POD, and dual-energy X-ray absorptiometry (DEXA). Anthropometric measurements (WC, hip circumference (HC), height, and weight), fasting blood glucose (FBG), fasting serum insulin (FSI), and lipid profiles were determined according to standard protocols. Correlations of anthropometric measurements and PBF with CVD risk factors were compared. Results Irrespective of the measuring techniques, PBF showed strong positive correlations with FSI, HOMA-IR, TC/HDL, TG/HDL, and LDL/HDL in both genders. While PBF was highly correlated with FBG, SBP, and DBP in females, no significant relationships were observed in males. Amongst the five anthropometric measures of adiposity, BAI was the best predictor for CVD risk factors in female participants (r = 0.593 for HOMA-IR, r = 0.542 for TG/HDL, r = 0.474 for SBP, and r = 0.448 for DBP). For males, the combination of WC (r = 0.629 for HOMA-IR, and r = 0.446 for TG/HDL) and WHR (r = 0.352 for SBP, and r = 0.366 for DBP) had the best correlation with CVD risk factors. Conclusion Measurement of PBF does not outperform the simple anthropometric measurements of obesity, i.e. BAI, WC, and WHR, in the prediction of CVD risk factors in healthy Asian adults. While measures of central adiposity (WC and WHR) tend to show stronger associations with CVD risk factors in males, measures of general adiposity (BAI) seems to be the best predictor in females. The gender differences in the association between adiposity indices and CVD risk factors may relate to different body fat distribution in males and females living in Singapore. These results may find further clinical utility to identify patients with CVD risk factors in a more efficient way. Electronic supplementary material The online version of this article (doi:10.1186/s40608-016-0114-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xinyan Bi
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), 30 Medical Drive, Singapore, 117609 Singapore
| | - Siew Ling Tey
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), 30 Medical Drive, Singapore, 117609 Singapore
| | - Claudia Leong
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), 30 Medical Drive, Singapore, 117609 Singapore
| | - Rina Quek
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), 30 Medical Drive, Singapore, 117609 Singapore
| | - Yi Ting Loo
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), 30 Medical Drive, Singapore, 117609 Singapore
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), 30 Medical Drive, Singapore, 117609 Singapore ; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599 Singapore
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46
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Ducrot P, Fassier P, Méjean C, Allès B, Hercberg S, Péneau S. Association between Motives for Dish Choices during Home Meal Preparation and Weight Status in the NutriNet-Santé Study. Nutrients 2016; 8:E413. [PMID: 27399764 PMCID: PMC4963889 DOI: 10.3390/nu8070413] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/21/2016] [Accepted: 06/27/2016] [Indexed: 12/20/2022] Open
Abstract
Although home cooking has been associated with a lower body mass index in a few studies, no data exists on the motives behind food dish choices during home meal preparation and on their association with overweight. This study aimed to evaluate this association in 50,003 participants from the NutriNet-Santé cohort. Dimensions underlying the importance of 27 criteria possibly influencing dish choices were determined using an exploratory factor analysis. The association between dish choice motives and overweight (including obesity) was estimated using logistic regression models adjusted for sociodemographic and lifestyle characteristics. Five dimensions of dishes choice motives emerged: healthy diet (e.g., "nutritional balance of the dish"), constraints (e.g., "my cooking skills"), pleasure (e.g., "originality of the dish"), specific diets (e.g., "my health status"), and organization (e.g., "what I planned to eat"). A negative association was observed between the healthy diet factor and being overweight (OR = 0.65 (95% CI (confidence interval): 0.62-0.67)), whereas a positive association appeared for factors regarding pleasure (OR = 1.14 (95% CI: 1.10-1.19)) and specific diets (OR = 1.19 (95% CI: 1.17-1.22)). No significant associations were observed for constraints and organization. The significant associations between dish choice motives and overweight suggested the interest of focusing on these motives in order to promote healthier food choices during home cooking.
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Affiliation(s)
- Pauline Ducrot
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny F-93017, France.
| | - Philippine Fassier
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny F-93017, France.
| | - Caroline Méjean
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny F-93017, France.
| | - Benjamin Allès
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny F-93017, France.
| | - Serge Hercberg
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny F-93017, France.
- Département de Santé Publique, Hôpital Avicenne, Bobigny Cedex F-93017, France.
| | - Sandrine Péneau
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny F-93017, France.
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Soufer R, Fernandez AB, Meadows J, Collins D, Burg MM. Body Mass Index and Risk for Mental Stress Induced Ischemia in Coronary Artery Disease. Mol Med 2016; 22:286-291. [PMID: 27261777 DOI: 10.2119/molmed.2016.00128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 11/06/2022] Open
Abstract
Acute emotionally reactive mental stress (MS) can provoke prognostically relevant deficits in cardiac function and myocardial perfusion, and chronic inflammation increases risk for this ischemic phenomenon. We have described parasympathetic withdrawal and generation of inflammatory factors in MS. Adiposity is also associated with elevated markers of chronic inflammation. High body mass index (BMI) is frequently used as a surrogate for assessment of excess adiposity, and associated with traditional CAD risk factors, and CAD mortality. BMI is also associated with autonomic dysregulation, adipose tissue derived proinflammatory cytokines, which are also attendant to emotion provoked myocardial ischemia. Thus, we sought to determine if body mass index (BMI) contributes to risk of developing myocardial ischemia provoked by mental stress. We performed a prospective interventional study in a cohort of 161 patients with stable CAD. They completed an assessment of myocardial blood flow with single photon emission computed tomography (SPECT) simultaneously during 2 conditions: laboratory mental stress and at rest. Multivariate logistic regression determined the independent contribution of BMI to the occurrence of mental-stress induced ischemia. Mean age was 65.6 ±9.0 years; 87.0% had a history of hypertension, and 28.6% had diabetes. Mean BMI was 30.4 ± 4.7. Prevalence of mental stress ischemia was 39.8%. BMI was an independent predictor of mental stress ischemia, OR=1.10, 95% CI [1.01-1.18] for one-point increase in BMI and OR=1.53, 95% CI [1.06-2.21] for a 4.7 point increase in BMI (one standard deviation beyond the cohort BMI mean), p=0.025 for all. These data suggest that BMI may serve as an independent risk marker for mental stress ischemia. The factors attendant with greater BMI, which include autonomic dysregulation and inflammation, may represent pathways by which high BMI contribute to this risk and serve as a conceptual construct to replicate these findings in larger CAD populations.
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Affiliation(s)
- Robert Soufer
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
| | - Antonio B Fernandez
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Judith Meadows
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
| | - Dorothea Collins
- VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
| | - Matthew M Burg
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
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Shakiba M, Soori H, Mansournia MA, Nazari SSH, Salimi Y. Adjusting for reverse causation to estimate the effect of obesity on mortality after incident heart failure in the Atherosclerosis Risk in Communities (ARIC) study. Epidemiol Health 2016; 38:e2016025. [PMID: 27283142 PMCID: PMC4974446 DOI: 10.4178/epih.e2016025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/04/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES: The lower mortality rate of obese patients with heart failure (HF) has been partly attributed to reverse causation bias due to weight loss caused by disease. Using data about weight both before and after HF, this study aimed to adjust for reverse causation and examine the association of obesity both before and after HF with mortality. METHODS: Using the Atherosclerosis Risk in Communities (ARIC) study, 308 patients with data available from before and after the incidence of HF were included. Pre-morbid and post-morbid obesity were defined based on body mass index measurements at least three months before and after incident HF. The associations of pre-morbid and post-morbid obesity and weight change with survival after HF were evaluated using a Cox proportional hazard model. RESULTS: Pre-morbid obesity was associated with higher mortality (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.04 to 2.49) but post-morbid obesity was associated with increased survival (HR, 0.57; 95% CI, 0.37 to 0.88). Adjusting for weight change due to disease as a confounder of the obesity-mortality relationship resulted in the absence of any significant associations between post-morbid obesity and mortality. CONCLUSIONS: This study demonstrated that controlling for reverse causality by adjusting for the confounder of weight change may remove or reverse the protective effect of obesity on mortality among patients with incident HF.
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Affiliation(s)
- Maryam Shakiba
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Interventional Cardiovascular Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Soori
- Safety Promotion and Injury Prevention Research Center, 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
| | - Seyed Saeed Hashemi Nazari
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yahya Salimi
- Department of Epidemiology and Biostatistics, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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49
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Audureau E, Pouchot J, Coste J. Gender-Related Differential Effects of Obesity on Health-Related Quality of Life via Obesity-Related Comorbidities: A Mediation Analysis of a French Nationwide Survey. Circ Cardiovasc Qual Outcomes 2016; 9:246-56. [PMID: 27166204 DOI: 10.1161/circoutcomes.115.002127] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 04/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Negative effects of obesity on health-related quality of life (HRQoL) have been reported, especially in women, but the relative contribution of cardiometabolic and other obesity-related comorbidities to such effects remains unclear. Our objective was to model the association by sex between body mass index and HRQoL and to precisely quantify the indirect effects mediated by obesity-related comorbidities. METHODS AND RESULTS Data were drawn from the latest French Decennial Health Survey, a nationwide cross-sectional study conducted in 2003 (21 239 adults aged 25-64 years analyzed). HRQoL was measured by the 36-item short-form health survey questionnaire. A mediation analysis based on the counterfactual framework was performed to quantify the proportion of obesity effects on HRQoL mediated by related comorbidities, including cardiometabolic risk factors (diabetes mellitus, hypertension, dyslipidemia) and diseases (ischemic heart disease, cerebrovascular, and peripheral vascular disease), musculoskeletal disorders, and asthma. After multiple linear regression, inverse associations were found between increasing body mass index category and physically oriented and most mentally oriented 36-item short-form health survey dimensions, with evidence of greater effects in women. Mediation analysis revealed that obesity effects were significantly mediated by several comorbidities, more apparently in men (eg, proportion of obesity class II total effect mediated via cardiometabolic factors: general health 27.0% [men] versus 13.6% [women]; proportion of obesity class II total effect mediated via total count of comorbidities: physical functioning 17.8% [men] versus 7.7% [women] and general health 37.1% [men] versus 20.3% [women]). CONCLUSIONS Women have a greater overall impact of obesity on HRQoL, but with proportionally lower effects mediated by cardiometabolic and other obesity-related conditions, suggesting the possible role of other specific psychosocial processes.
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Affiliation(s)
- Etienne Audureau
- From the Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris, France (E.A., J.C.); Research unit APEMAC, EA 4360, Université Paris-Descartes, Sorbonne Paris Cité, Université de Lorraine, France (E.A., J.P., J.C.); and Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (J.P.).
| | - Jacques Pouchot
- From the Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris, France (E.A., J.C.); Research unit APEMAC, EA 4360, Université Paris-Descartes, Sorbonne Paris Cité, Université de Lorraine, France (E.A., J.P., J.C.); and Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (J.P.)
| | - Joël Coste
- From the Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris, France (E.A., J.C.); Research unit APEMAC, EA 4360, Université Paris-Descartes, Sorbonne Paris Cité, Université de Lorraine, France (E.A., J.P., J.C.); and Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (J.P.)
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50
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Adams TD, Mehta TS, Davidson LE, Hunt SC. All-Cause and Cause-Specific Mortality Associated with Bariatric Surgery: A Review. Curr Atheroscler Rep 2016; 17:74. [PMID: 26496931 DOI: 10.1007/s11883-015-0551-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The question of whether or not nonsurgical intentional or voluntary weight loss results in reduced mortality has been equivocal, with long-term mortality following weight loss being reported as increased, decreased, and not changed. In part, inconsistent results have been attributed to the uncertainty of whether the intentionality of weight loss is accurately reported in large population studies and also that achieving significant and sustained voluntary weight loss in large intervention trials is extremely difficult. Bariatric surgery has generally been free of these conflicts. Patients voluntarily undergo surgery and the resulting weight is typically significant and sustained. These elements, combined with possible non-weight loss-related mechanisms, have resulted in improved comorbidities, which likely contribute to a reduction in long-term mortality. This paper reviews the association between bariatric surgery and long-term mortality. From these studies, the general consensus is that bariatric surgical patients have: 1) significantly reduced long-term all-cause mortality when compared to severely obese non-bariatric surgical control groups; 2) greater mortality when compared to the general population, with the exception of one study; 3) reduced cardiovascular-, stroke-, and cancer-caused mortality when compared to severely obese non-operated controls; and 4) increased risk for externally caused death such as suicide.
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Affiliation(s)
- Ted D Adams
- Division of Cardiovascular Genetics, University of Utah and Intermountain LiVe Well Center, 389 South 900 East, SLC, Salt Lake City, UT, 84102, USA.
| | - Tapan S Mehta
- Department of Physical Therapy, Nutrition Obesity Research Center, University of Alabama at Birmingham, School of Health Professions Building 370, 1705 University Blvd, Birmingham, AL, 35294, USA.
| | - Lance E Davidson
- Department of Exercise Sciences, Brigham Young University, 271 SFH, Provo, UT, 84602, USA.
| | - Steven C Hunt
- Department of Genetic Medicine, Weill Cornell College of Medicine, P.O. Box 24144, Doha, Qatar.
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