Ethnic group differences in obesity in Asian Americans in California, 2013-2014

The Association between Marital Status and Obesity: A Systematic Review and Meta-Analysis

BACKGROUND

Obesity was included in the International Classification of Diseases in 1990 as a chronic disease characterized by the excessive accumulation of body fat and a body mass index (BMI) greater than 30 kg/m2.

AIM

This systematic review was aimed to examine the role of marital status in determining body mass index and the risk of obesity.

METHODS

We performed a systematic literature search using three databases (PubMed (Medline), Embase, and Google Scholar) with the search query.

RESULTS

Of the 105 studies included in the systematic review, 76 studies (72%) reported a greater risk of obesity in married individuals compared to unmarried individuals. A meta-analysis of 24 studies included a total population of 369,499 participants: 257,257 married individuals (40,896 of whom had obesity) and 112,242 comparison subjects (single, divorced, or widowed individuals, 15,084 of whom had obesity). Odds ratios for obesity found a significant pooled odds ratio for obesity in married individuals compared with controls (OR 1.70; 95% CI 1.38-2.10). The socioeconomic environment was not the same throughout the period of studies analyzed. The odds of obesity in married individuals during economic crises was greater than during the period between crises: OR 2.56 (95% CI 2.09-3.13) during crises vs. OR 1.55 (95% CI 1.24-1.95) between crises.

CONCLUSION

The results of this review confirm the importance of considering marital status in determining the risk of obesity.

Secular Trends in Peak Bone Mineral Density: The National Health and Nutrition Examination Survey 1999-2018

Peak bone mineral density (BMD) is one of the most important factors influencing the development of osteoporosis. It was predicted that a 10% increase in peak BMD will delay the onset of osteoporosis by 13 years. However, changes in peak BMD over time are unknown. This study aimed to investigate secular trends in peak BMD among young adults in the United States. Based on the National Health and Nutrition Examination Survey from 1999-2018, 3,975 males aged 19-28 years and 2370 females aged 31-40 years were our target population for estimating peak lumbar spine BMD. BMD was measured by dual-energy X-ray absorptiometry. Generalized linear models adjusted for multiple covariates were used to examine the secular trends in peak BMD in males and females, respectively. Secular trends for peak lumbar spine BMD from 1999-2000 to 2017-2018 were not statistically significant in males or females (all Plinear and Pquadratic > 0.05). Similar results were observed in race/ethnicity subgroups (all Plinear and Pquadratic > 0.05). However, in stratified analyses by obesity category, peak lumbar spine BMD in obese males and females increased from 1999-2000 to 2009-2010 and then decreased until 2017-2018, while peak lumbar spine BMD in non-obese females decreased from 1999-2000 to 2005-2006 and then increased until 2017-2018 (all Pquadratic < 0.05). Peak lumbar spine BMD was greater in obese males and females than in non-obese males and females up to 2009-2010, but not from 2011-2012 onwards. Overall, there were no significant secular trends in peak lumbar spine BMD. However, secular trends differed between obese and non-obese groups.

Racialized and Immigrant Status and the Pursuit of Living Donor Kidney Transplant - a Canadian Cohort Study

Introduction

Both immigrant and racialized status may be associated with the pursuit of living donor kidney transplant (LDKT).

Methods

This study was a secondary analysis of a convenience cross-sectional sample of patients with kidney failure in Toronto, obtained from our "Comprehensive Psychosocial Research Data System" research database. The exposures included racialized, immigrant, and combined immigrant and racialized status (White nonimmigrant, racialized nonimmigrant, White immigrant and racialized immigrant). Outcomes include the following: (i) having spoken about LDKT with others, (ii) having a potential living donor (LD) identified, (iii) having allowed others to share the need for LDKT, (iv) having directly asked a potential donor to be tested, and (v) accept a hypothetical LDKT offer. We assessed the association between exposure and outcomes using univariable, and multivariable binary or multinominal logistic regression (reference: White or White nonimmigrant participants).

Results

Of the 498 participants, 281 (56%) were immigrants; 142 (28%) were African, Caribbean, and Black (ACB); 123 (25%) were Asian; and 233 (47%) were White. Compared to White nonimmigrants, racialized immigrants (relative risk ratio [RRR]: 2.98; 95% confidence interval [CI]: 1.76-5.03) and racialized nonimmigrants (RRR: 2.84; 95% CI: 1.22-6.65) were more likely not to have spoken about LDKT with others (vs. having spoken or planning to do so). Both racialized immigrant (odds ratio [OR]: 4.07; 95% CI: 2.50-6.34), racialized nonimmigrants (OR: 2.68; 95% CI: 1.31-5.51) and White immigrants (OR: 2.68; 95% CI: 1.43-5.05) were more likely not to have a potential LD identified.

Conclusion

Both racialized and immigrant status are associated with less readiness to pursue LDKT. Supporting patients to communicate their need for LDKT may improve equitable access to LDKT.

Uterine cancer among Asian Americans - Disparities & clinical characteristics

OBJECTIVE

To evaluate the patterns and trends of uterine cancer among Asian subgroups living in the U.S.

METHODS

Data were obtained from United States Cancer Statistics (2001-2017), National Cancer Database (2004-2015), and World Population Review (2023). SEER*Stat version 8.3.9.2, Joinpoint regression program 4.9.0.0, and SAS v 9.4 were employed for statistical analysis.

RESULTS

Based on data from 778,891 women in the United States Cancer Statistics database, Asians had a 3.4-fold higher rate of incident uterine cancer compared to White populations (2.14% vs. 0.63%; p < 0.001). Using the National Cancer Database, 7,641 Asian women from six subgroups were analyzed: Filipino, Korean, Indian/Pakistani, Vietnamese, Chinese, and Japanese. Indian and Pakistani women had the greatest increase in the proportion of cancer diagnoses (5.0% to 14.4%; p = 0.0003). Additionally, Indian and Pakistani patients had higher comorbidity scores while Koreans had the lowest (22.7% vs. 10.7%, p < 0.0001). Regarding stage of disease, 25.3% of Filipinos presented with advanced stage disease compared to 19.2% of Indians and Pakistanis (p = 0.0001). Furthermore, Filipinos had the highest proportion of non-endometrioid cancers at 18.4% compared to other subgroups (p = 0.0003). Using the World Population Review, female obesity was highest in Pakistan (8.6%) and the Philippines (7.5%) and lowest in Vietnam (2.6%).

CONCLUSION

Uterine cancer incidence increased at higher rates among Asians compared to White populations. Specifically, Indian and Pakistani uterine cancer patients were more likely to have higher comorbidity rates and Filipino patients had more advanced stage cancer with non-endometrioid histologies than other Asian subgroups. Further research is warranted to better understand these trends.

Underweight status and development of end-stage kidney disease: A nationwide population-based study

BACKGROUND

Underweight status increases the risk of cardiovascular disease and mortality in the general population. However, whether underweight status is associated with an increased risk of developing end-stage kidney disease is unknown.

METHODS

A total of 9 845 420 participants aged ≥20 years who underwent health checkups were identified from the Korean National Health Insurance Service database and analysed. Individuals with underweight (body mass index [BMI] < 18.5 kg/m2 ) and obesity (BMI ≥ 25 kg/m2 ) were categorized according to the World Health Organization recommendations for Asian populations.

RESULTS

During a mean follow-up period of 9.2 ± 1.1 years, 26 406 participants were diagnosed with end-stage kidney disease. After fully adjusting for other potential predictors, the moderate to severe underweight group (<17 kg/m2 ) had a significantly higher risk of end-stage kidney disease than that of the reference (normal) weight group (adjusted hazard ratio, 1.563; 95% confidence interval, 1.337-1.828), and competing risk analysis to address the competing risk of death also showed the similar results (adjusted hazard ratio, 1.228; 95% confidence interval, 1.042-1.448). Compared with that of the reference BMI group (24-25 kg/m2 ), the adjusted hazard ratios for end-stage kidney disease increased as the BMI decreased by 1 kg/m2 . In the sensitivity analysis, sustained underweight status or progression to underweight status over two repeated health checkups, when compared with normal weight status, had a higher hazard ratio for end-stage kidney disease.

CONCLUSIONS

Underweight status is associated with an increased risk of end-stage kidney disease, and this association gradually strengthens as BMI decreases.

Acculturation as a Determinant of Obesity and Related Lifestyle Behaviors in a Multi-Ethnic Asian Population

Limited attention has been given to the role of cultural orientation towards different ethnic groups in multi-ethnic settings without a dominant host culture. We evaluated whether acculturation levels, reflecting cultural orientation towards other ethnic groups, were associated with obesity and related lifestyle behaviors in a cosmopolitan Asian population. We conducted the current study based on data from the Singapore Multi-Ethnic Cohort (N = 10,622) consisting of ethnic Chinese, Malays, and Indians aged 21 to 75 years. Multivariable linear and logistic regression analyses were used to examine associations between the acculturation level (z-score), obesity, and related lifestyle behaviors, including dietary habits and physical activity. A higher acculturation level was directly associated with a higher prevalence of obesity among Chinese, whereas an inverse association was found for ethnic Indians, and no significant association in Malays. In ethnic Malays, greater acculturation was significantly associated with higher dietary quality and less sedentary time. Furthermore, a high acculturation level was significantly associated with higher sugar-sweetened beverage consumption and more leisure-time PA in all ethnic groups. Our findings suggest that greater cultural orientation towards other ethnic groups was associated with convergence in obesity levels. More research is required to understand how acculturation affects obesity-related lifestyle factors in multi-ethnic settings.

Association between thyroid stimulating hormone levels and papillary thyroid cancer risk: A meta-analysis

High thyroid stimulating hormone (TSH) levels may stimulate papillary thyroid cancer (PTC) cell proliferation; however, the relationship between TSH levels and PTC risk remains controversial. We aim to ascertain the association through a meta-analysis. Literature searches were conducted in PubMed, Embase, and Web of Science databases. After literature screening, the methodological quality was assessed using the Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality methods. Cochran's Q and I 2 tests were used to evaluate heterogeneity in the meta-analysis. Egger's test was applied to assess publication bias. A total of 12 eligible studies were included in this meta-analysis; all were of moderate and high methodological quality. The pooled results suggested that increased TSH levels were significantly associated with PTC risk; however, the included studies were significantly heterogeneous. Stratification analysis indicated that the heterogeneity might be from the area or type of control. Although significant publication bias existed among the studies, the trim-and-fill method and sensitivity analysis revealed that the combined results were stable and robust. TSH levels are significantly associated with the PTC risk; however, more high-quality studies in large sample sizes are recommended to verify the extrapolation of these findings.

Measurement of gastric wall thickness after laparoscopic sleeve gastrectomy: obesity comorbidities and gastric wall in Chinese patients with obesity

Leakage of the sleeve remains constant after laparoscopic sleeve gastrectomy (LSG). This complication may be due to a mismatch between the staple height and gastric wall thickness (GWT). Our aim was to measure the GWT in Chinese patients with obesity and investigate the relationship between GWT and gender, body mass index (BMI), body weight, and obesity-related comorbidities. The GWT of 210 resected specimens after LSG was measured using a tissue measuring device, at a compression pressure of 8 g/mm² at three predetermined locations: antrum, midbody, and fundus. Two hundred ten patients (171 female/39 male). The gastric wall was thickest at the antrum followed by the midbody and thinnest at the fundus (3.02 mm, 2.22 mm, and 1.6 mm, respectively). Patients with gastritis and those with reflux esophagitis had thicker GWT at the antrum; male had thicker GWT at the antrum and fundus; patients with body weight > 100 kg, and those with BMI > 40 kg/m² had thicker GWT at the fundus. Linear regression analysis revealed a significant association between GWT with body weight and BMI at the antrum and fundus; Furthermore, hypertension associated with the GWT at the fundus (P < 0.01, P < 0.01, P < 0.02, P < 0.01; and P < 0.04, respectively). This study showed that the anatomical location of the gastric wall is a major predicting factor of GWT. Furthermore, gastritis, reflux esophagitis, male gender, BMI > 40 kg/m², body weight > 100 kg, and hypertension may increase the GWT at the antrum and fundus in Chinese patients with obesity.

Social Determinants of Health, Cardiovascular Risk Factors, and Atherosclerotic Cardiovascular Disease in Individuals of Vietnamese Origin

In 2022, the Vietnamese population in the United States (US) comprises 2.2 million individuals, and Vietnam ranks as the sixth most frequent country of origin among immigrants in the US. The American Heart Association and the National Institutes of Health have called for research to define the burden of cardiovascular risk factors, cardiovascular disease, and their determinants across Asian American subgroups, including Vietnamese Americans. Despite these calls, Vietnamese Americans remain remarkably overlooked in cardiovascular research in the US. Studies in Vietnam, small cross-sectional surveys in the US, and research using US mortality data point to a high prevalence of hypertension and tobacco use among men and a high incidence of gestational diabetes among women. Moreover, Vietnamese Americans have one of the highest rates of cerebrovascular mortality in the country. Adverse social determinants of health-including frequent language barriers, limited health literacy, and low average income-have been suggested as important factors that contribute to cardiovascular risk in this group. In this narrative review, we summarize the existing knowledge in this space, highlight the distinct characteristics of cardiac risk in both Vietnamese and Vietnamese American individuals, discuss upstream determinants, and identify key knowledge gaps. We then outline several proposed interventions and emphasize the need for further studies in this underrepresented population. Our aim is to increase awareness of the significant burden of risk factors and cardiovascular disease shouldered by this large-but thus far overlooked-population in the US, boost research in this space, and help inform tailored, effective preventive interventions.

Obesity and Breast Cancer: Interaction or Interference with the Response to Therapy?

Background: Aromatase inhibitors (AI) are widely used for treating hormone-sensitive breast cancer (BC). Obesity, however, due to aromatase-mediated androgen conversion into estradiol in the peripheral adipose tissue, might impair AI inhibitory capacity. We aimed at identifying a cut-off of body mass index (BMI) with significant prognostic impact, in a cohort of stage I-II BC patients on systemic adjuvant therapy with AI. Methods: we retrospectively evaluated routinely collected baseline parameters. The optimal BMI cut-off affecting disease-free survival (DFS) in AI-treated BC patients was identified through maximally selected rank statistics; non-linear association between BMI and DFS in the AI cohort was assessed by hazard-ratio-smoothed curve analysis using BMI as continuous variable. The impact of the BMI cut-off on survival outcomes was estimated through Kaplan−Meier plots, with log-rank test and hazard ratio estimation comparing patient subgroups. Results: A total of 319 BC patients under adjuvant endocrine therapy and/or adjuvant chemotherapy were included. Curve-fitting analysis showed that for a BMI cut-off >29 in AI-treated BC patients (n = 172), DFS was increasingly deteriorating and that the impact of BMI on 2-year DFS identified a cut-off specific only for the cohort of postmenopausal BC patients under adjuvant therapy with AI. Conclusion: in radically resected hormone-sensitive BC patients undergoing neoadjuvant or adjuvant chemotherapy and treated with AI, obesity represents a risk factor for recurrence, with a significantly reduced 2-year DFS.

Heterogeneity in Obesity Prevalence Among Asian American Adults

BACKGROUND

Obesity increases the risk for metabolic and cardiovascular disease, and this risk occurs at lower body mass index (BMI) thresholds in Asian adults than in White adults. The degree to which obesity prevalence varies across heterogeneous Asian American subgroups is unclear because most obesity estimates combine all Asian Americans into a single group.

OBJECTIVE

To quantify obesity prevalence in Asian American subgroups among U.S. adults using both standard BMI categorizations and categorizations tailored to Asian populations.

DESIGN

Cross-sectional.

SETTING

United States, 2013 to 2020.

PARTICIPANTS

The analytic sample included 2 882 158 adults aged 18 years or older in the U.S. Behavioral Risk Factor Surveillance System surveys (2013 to 2020). Participants self-identified as non-Hispanic White ([NHW] n = 2 547 965); non-Hispanic Black ([NHB] n = 263 136); or non-Hispanic Asian ([NHA] n = 71 057), comprising Asian Indian (n = 13 916), Chinese (n = 11 686), Filipino (n = 11 815), Japanese (n = 12 473), Korean (n = 3634), and Vietnamese (n = 2618) Americans.

MEASUREMENTS

Obesity prevalence adjusted for age and sex calculated using both standard BMI thresholds (≥30 kg/m²) and BMI thresholds modified for Asian adults (≥27.5 kg/m²), based on self-reported height and weight.

RESULTS

Adjusted obesity prevalence (by standard categorization) was 11.7% (95% CI, 11.2% to 12.2%) in NHA, 39.7% (CI, 39.4% to 40.1%) in NHB, and 29.4% (CI, 29.3% to 29.5%) in NHW participants; the prevalence was 16.8% (CI, 15.2% to 18.5%) in Filipino, 15.3% (CI, 13.2% to 17.5%) in Japanese, 11.2% (CI, 10.2% to 12.2%) in Asian Indian, 8.5% (CI, 6.8% to 10.5%) in Korean, 6.5% (CI, 5.5% to 7.5%) in Chinese, and 6.3% (CI, 5.1% to 7.8%) in Vietnamese Americans. The prevalence using modified criteria (BMI ≥27.5 kg/m²) was 22.4% (CI, 21.8% to 23.1%) in NHA participants overall and 28.7% (CI, 26.8% to 30.7%) in Filipino, 26.7% (CI, 24.1% to 29.5%) in Japanese, 22.4% (CI, 21.1% to 23.7%) in Asian Indian, 17.4% (CI, 15.2% to 19.8%) in Korean, 13.6% (CI, 11.7% to 15.9%) in Vietnamese, and 13.2% (CI, 12.0% to 14.5%) in Chinese Americans.

LIMITATION

Body mass index estimates rely on self-reported data.

CONCLUSION

Substantial heterogeneity in obesity prevalence exists among Asian American subgroups in the United States. Future studies and public health efforts should consider this heterogeneity.

PRIMARY FUNDING SOURCE

National Heart, Lung, and Blood Institute.

Race and Ethnicity Differences in Walking and Associations with Neighborhood Perceptions among Older Adults in California

This paper estimates differences in walking and associations of walking with neighborhood perceptions among older adults in California. We analyzed the restricted-use California Health Interview Survey data merged with the American Community Survey data. Walking at least 10 minutes for leisure in the last 7 days and number of minutes walked were regressed on perceived neighborhood social cohesion scale (PNSCS) and neighborhood socioeconomic characteristics. We estimated ordinary least squares regression models. We found that positive neighborhood perceptions were significantly (p< 0.05) associated with walking among older Hispanic and Asian adults. Older Hispanic adults with above median PNSCS report that they walk 6.3 percentage points more than Non-Hispanic White adults. Older adults' perceptions of their neighbors and neighborhoods are positively correlated with walking. Policymakers can consider ways to improve neighborhood perceptions and relationships to help increase walking among minority older adults especially in low SES neighborhoods.