Differential relationship between waist circumference and mortality according to age, sex, and body mass index in Korean with age of 30-90 years; a nationwide health insurance database study

Association of waist circumference and BMI with premature death in young and middle-aged population

Introduction

Premature death is a global health indicator, significantly impacted by obesity, especially in young and middle-aged population. Both body mass index (BMI) and waist circumference (WC) assess obesity, with WC specifically indicating central obesity and showing a stronger relationship with mortality. However, despite known associations between BMI and premature death, as well as the well-recognized correlation between WC and adverse health outcomes, the specific relationship between WC and premature death remains unclear. Therefore, focusing on young and middle-aged individuals, this study aimed to reliably estimate independent and combined associations between WC, BMI and premature death, thereby providing causal evidence to support strategies for obesity management.

Methods

This study involved 49,217 subjects aged 18-50 years in the United States from 1999 to 2018 National Health and Nutrition Examination Survey (NHANES). Independent and combined associations between WC and BMI with premature death across sex and age stratum were examined by Cox regression. Survey weighting and inverse probability weighting (IPW) were further considered to control selection and confounding bias. Robustness assessment has been conducted on both NHANES and China Health and Retirement Longitudinal Study (CHARLS) data.

Results

A linear and positive relationship between WC and all-cause premature death was found in both males and females, with adjusted HRs of 1.019 (95%CI = 1.004-1.034) and 1.065 (95%CI = 1.039-1.091), respectively. Nonlinear relationships were found with respect to BMI and all-cause premature death. For females aged 36-50 with a BMI below 28.6 kg/m2, the risk of premature death decreased as BMI increased, indicated by adjusted HRs of 0.856 (95%CI = 0.790-0.927). Joint analysis showed among people living with obesity, a larger WC increased premature death risk (HR = 1.924, 95%CI = 1.444-2.564).

Discussion

WC and BMI exhibited prominent associations with premature death in young and middle-aged population. Maintaining an appropriate WC and BMI bears significant implications for preventing premature death.

Association of changes in body mass index and waist circumference with cardiovascular risk in non-alcoholic fatty liver disease: A nationwide study

BACKGROUND

We investigated whether changes in body mass index (BMI) and waist circumference (WC) are associated with cardiovascular risk in patients with NAFLD using a nationwide dataset.

METHODS

Using the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) data in Korea, a total of 19,057 subjects who underwent two consecutive medical check-ups (2009-2010 and 2011-2012) and who had a fatty-liver index (FLI) value of ≥ 60 were included in the analysis. Cardiovascular events were defined as the occurrence of stroke or transient ischemic attack, coronary heart disease, and cardiovascular death.

RESULTS

After multivariable adjustment, the risk of cardiovascular events was significantly lower in subjects with decreases in both BMI and WC (HR, 0.83; 95% CI, 0.69-0.99) and those with increased BMI and decreased WC (HR, 0.74; 95% CI, 0.59-0.94) when compared with those who showed increases in both BMI and WC. The effect of cardiovascular risk reduction among the group with increased BMI but decreased WC was particulary pronounced among those who had metabolic syndrome during the second check-up (HR, 0.63; 95% CI 0.43-0.93, p for interaction 0.02).

CONCLUSIONS

Changes in BMI and WC were significantly associated with cardiovascular risk in NAFLD patients. NAFLD patients with increased BMI and decreased WC had the lowest cardiometabolic risk.

Risk Factors of Non-alcoholic Fatty Liver Disease in the Iranian Adult Population: A Systematic Review and Meta-analysis

Context: Non-alcoholic fatty liver disease (NAFLD) is progressing considerably worldwide. Identifying the risk factors of NAFLD is a critical step in preventing its progression. Methods: In November 2022, two independent researchers studied seven databases, including PubMed, ISI/WoS, ProQuest, Scopus, SID, Magiran, and Google Scholar, and reference list of relevant articles, searching studies that assessed NAFLD risk factors in the Iranian adult population. Heterogeneity between studies was assessed by Cochran’s test and its composition using I2 statistics. A random-effects model was used when heterogeneity was observed; otherwise, a fixed-effects model was applied. Egger’s regression test and Trim-and-Fill analysis were used to assess publication bias. Comprehensive Meta-analysis software (version 3) was used for the analyses of the present study. Results: The results of this study showed significant associations between NAFLD with age [n = 15, odds ratio (OR) = 2.12, 95% CI: 1.79 - 2.51], body mass index (n = 46, OR = 5.00, 95% CI: 3.34 - 7.49), waist circumference (n = 20, OR = 6.37, 95% CI: 3.25 - 12.48), waist-to-hip ratio (n = 17, OR = 4.72, 95% CI: 3.93 - 5.66), total cholesterol (n = 39, OR = 1.80, 95% CI: 1.52 - 2.13), high-density lipoprotein (n = 37, OR = 0.53, 95% CI: 0.44 - 0.65), low-density lipoprotein (n = 31, OR = 1.68, 95% CI: 1.38 - 2.05), triglyceride (n = 31, OR = 3.21, 95% CI: 2.67 - 3.87), alanine aminotransferase (n = 26, OR = 4.06, 95% CI: 2.94 - 5.62), aspartate aminotransferase (n = 27, OR = 2.16, 95% CI: 1.50 - 3.12), hypertension (n = 13, OR = 2.53, 95% CI: 2.32 - 2.77), systolic blood pressure (n = 13, OR = 1.83, 95% CI: 1.53 - 2.18), diastolic blood pressure (n = 14, OR = 1.80, 95% CI: 1.48 - 2.20), fasting blood sugar (n = 31,OR = 2.91, 95% CI: 2.11- 4.01), homeostatic model assessment for insulin resistance (n = 5, OR = 1.92, 95% CI: 1.48 - 2.59), diabetes mellitus (n = 15, OR = 3.04, 95% CI: 2.46 - 3.75), metabolic syndrome (n = 10, OR = 3.56, 95% CI: 2.79 - 4.55), and physical activity (n = 11, OR = 0.32, 95% CI: 0.24 - 0.43) (P < 0.05). Conclusions: In conclusion, several factors are significantly associated with NAFLD. However, anthropometric indices had the strongest relationship with NAFLD in the Iranian adult population.

Sex- and age-specific differences in associations of a body shape index with all-cause and cardiovascular death risks among US adults with diabetes

BACKGROUND AND AIMS

Evidence regarding the effect of body shape index (ABSI) on mortality is scarce among individuals with diabetes mellitus (DM). Herein, we explored the relationships between ABSI and all-cause and cardiovascular death risks among US individuals with DM.

METHODS AND RESULTS

A total of 4657 US adults with DM were enrolled from the National Health and Nutrition Examination Survey (NHANES 2003-2014) who had baseline waist circumference, height, and weight data. ABSI was calculated as [Formula: see text] and the survival information of patients was available from recruitment until 2015 utilizing the national death index. We employed Cox proportional hazards models to estimate the association of ABSI with survival. A total of 817 adults with DM died after a median follow-up period of 5.6 years, with an annual all-cause death rate per 1000 person-years of 30.0 [95% CI, 28.0-32.1]. Continuous ABSI z score was positively and significantly associated with all-cause mortality with adjustment for potential confounders (HR = 1.16, 95% CI: 1.06-1.28). ABSI tended to show a higher all-cause and CVD (cardiovascular disease) mortality among men (HR = 1.35, 95% CI: 1.19-1.53 and HR = 1.45, 95% CI: 1.12-1.87, respectively) and patients younger than 60 years (HR = 1.45, 95% CI: 1.16-1.80 and HR = 1.66, 95% CI: 1.09-2.53, respectively). Statistically significant interactions were found between the ABSI and both sex and age for total mortality.

CONCLUSIONS

Among US adults with DM from NHANES, ABSI exhibited a linear and positive relationship with total and CVD mortality risk, especially in men and younger patients.

Optimal body composition indices cutoff values based on all-cause mortality in the elderly

The cutoffs of body composition indices are inconclusive in older populations. This study is designed toward determining the optimal cutoffs of the body composition indices based on the association with all-cause mortality. During 2009 and 2010, a cohort population of 1200 was enrolled in central western Taiwan. Of the 1200 subjects, 428 older subjects (mean age: 72.5 ± 5.4 yrs.; 47.7 % were women) were censored in this study. The waist circumference (WC) and body mass index (BMI) were measured using standard anthropometric methods. A multi-frequency bioelectrical impedance analysis device was utilized to estimate each participant's body composition indices, including percent body fat (PBF) and skeletal muscle mass index (SMMI). All claims records of death from 2009 to 2018 in the National Health Insurance Research Databank were identified. A receiver operating characteristic curve method and the highest Youden index were used to identify the optimal cutoffs. A Cox proportional hazards regression analysis was used to model associations between each of the recommended cutoff values with all-cause mortality. The all-cause mortality rate was 20.09 % after a follow-up period of 5.86 ± 2.39 person-years. The significant indices cutoff value was identified to be WC (86.7 cm) for older women and BMI (23.8 kg/m²) and as WC (77.6 cm), and SMMI (8.7 kg/m²) for older men. The recommended optimal cutoffs of the body composition indices were gender-specific and can be utilized to predict the risk of all-cause mortality.

Long-term waist circumference trajectories and body mass index with all-cause mortality in older Chinese adults: a prospective nationwide cohort study

BACKGROUNDS

Abdominal obesity has been linked to risk of mortality, but whether and how trajectory of waist circumstance (WC) underpins this association remains unclear. The study aimed to identify long-term WC change trajectories and examine their association and joint effect with body mass index (BMI) on mortality among Chinese older adults.

METHODS

This present study included participants 60 years of age or older from China Health and Nutrition Survey (CHNS) from 1991 to 2015. The duration of follow-up was defined as period from the first to latest visit date attended with information on mortality, end of follow-up, or loss to follow-up (censoring). Latent class trajectory analysis (LCTA) was used to assess the changes of WC trajectories overtime. Cox proportional hazard models were used to assess hazard ratios (HRs) and corresponding 95% confidence internal (CIs) for mortality.

RESULTS

A total of 2601 participants with 8700 visits were included, and 562 mortality (21.6%) occurred during a median follow-up of 8.7 years. Using a group-based modeling approach, four distinct trajectories of WC change among Chinese older adults were identified as loss (13.5%), stable (46.8%), moderate gain (31.2%) and substantial gain (8.5%). With WC stable group as reference, the multivariable adjusted HRs for mortality were 1.34(95%CI:1.01-1.78) in loss group, 1.13(0.91-1.41) in moderate gain and 1.54(1.12-2.12) in substantial gain group. Compared with participants with normal BMI at baseline and maintained WC stable, the risk of mortality generally increased for all WC change group in initial overweight/obesity individuals, and the highest risk were observed for WC loss and stable pattern (HR:2.43, 95%CI: 1.41-4.19; HR:1.67 (1.07-2.60)).

CONCLUSIONS

In older Chinese, both long-term WC loss and substantial gain conferred excess risk for mortality. The baseline BMI might modify the effect as overweight individuals had a greater risk imposed by WC loss than those in normal weight. Maintaining stable WC and normal weight might be necessary to reduce the risk of mortality.

High waist circumference is a risk factor for hypertension in normal-weight or overweight individuals with normal metabolic profiles

This study aims to investigate the relationship between waist circumference and hypertension risk in normal‐weight/overweight individuals with normal cardiometabolic profiles. The authors included 7217 normal‐weight and overweight individuals with normal cardiometabolic profiles from the 2001 to 2014 US National Health and Nutrition Examination Survey. The authors summarized demographic characteristics, cardiometabolic profiles, and behavioral factors across waist circumference quartiles. Then, in the logistic regression analysis, the authors observed a positive and significant association between waist circumference (as a continuous variable) and the prevalence of hypertension in all three models (nonadjusted, minimally adjusted, and fully adjusted), with odds ratios (95% confidence intervals) of 1.76 (1.65–1.86), 1.29 (1.20–1.39), and 1.24 (1.09–1.40), respectively. When analyzed as a categorical variable, individuals in the highest waist circumference group had a 1.48‐fold increased risk of hypertension than the lowest group in the fully adjusted model. Moreover, the Cox regression analysis revealed a positive and significant association between waist circumference and all‐cause mortality in individuals with hypertension in the nonadjusted model (HR, 1.27; 95% CI, 1.10–1.47) and the fully adjusted model (HR, 1.59; 95% CI, 1.22–2.06). In conclusions, our results showed that, even in those with normal metabolic profiles, high waist circumference was significantly associated with the increased prevalence of hypertension. And once hypertension has been established, patients with high waist circumference showed elevated all‐cause mortality. Therefore, waist circumference should be routinely measured and controlled regardless of metabolic profiles.

Waist circumference and mortality or cardiovascular events in a general Korean population

Background

Obesity is associated with cardiovascular diseases and is a risk factor for all-cause mortality. Until now, the associations between abdominal obesity and mortality or cardiovascular disease (CVD) incidence have not been conclusive. We aimed to evaluate the associations between waist circumference (WC) and mortality or CVD incidence in a general Korean population.

Methods

We analyzed a total of 204,068 adults older than 40 years of age who had undergone a national health examination at least once from 2009 to 2018 in the Korean National Health Insurance Service Cohort. WC was divided into five categories (< 80, 80–84.9, 85–89.9, 90–94.9, ≥ 95 cm). Hazard ratios for death and CVD incidence were calculated using Cox proportional hazards models.

Results

In men, WC and overall mortality showed a reverse J-shaped association. In women, the association between WC and overall mortality was not significant. For both men and women, WC was not associated with the risk of cardiovascular mortality. Contrary to the mortality trend, CVD incidence was positively associated with WC in both men and women, and the risk of the CVD incidence was the lowest in subjects with a WC < 80 cm.

Conclusions

WC exhibited a significant J-shaped association with overall mortality in men, where subjects who had central obesity showed a lower rate of mortality than those in the lowest or highest WC group. The risk of incident CVD showed a positive association with central obesity, where the lowest risk was observed for subjects in the lowest WC group in a general Korean population.

Comparison between EWGSOP1 and EWGSOP2 criteria and modelling of diagnostic algorithm for sarcopenic obesity in over 70 years old patients

PURPOSE

Sarcopenic obesity (SO) as a new diagnostic entity defined by presence of obesity in combination with sarcopenia represents serious health condition negatively affecting quality of life in old age. Despite the rapidly increasing incidence of SO associated with demographic aging, clear diagnostic criteria for SO have not yet been established. We describe here the applicability of the EWGSOP2 and EWGSOP1 diagnostic criteria in identifying sarcopenia and SO and the development of a refinement algorithm for SO detection.

METHODS

In total 156 subjects were pre-screened, 126 had a complete dataset and were included, 20.6% (n = 26) were men and 79.4% (n = 100) women, mean age 81 ± 6.3 years in tertiary hospital, Prague, Czech Republic. Testing of physical performance (hand-grip test, 400 m walk test, chair stand test, gait speed), anthropometric measures and SARC-F, SPPB and MNA-SF were used to determine physical, functional, and nutritional status, while muscle mass and fat mass were measured by DXA scans to confirm sarcopenia and SO diagnosis.

RESULTS

The prevalence of sarcopenia (BMI adjusted ALM < 0.789 for men, < 0.512 for women) was 26.2% (n = 33), SO in 20.6% (n = 26). 78.8% of all sarcopenic subjects fulfilled the criteria of SO (FM > 27% for men and > 38% for women; waist circumference > 90 cm for men and > 85 cm for women). EWGSOP1 criteria for diagnosing sarcopenia showed better sensitivity of 97.0% than the EWGSOP2 66.7%, while specificity reached 100% for both criteria. According to DXA measurement, EWGSOP1 identified 3.0% cases (1 out of 33) as false negative meanwhile EWGSOP2 identified 33.3% cases as false negative and this difference was statistically significant (McNemar's test, p < 0.001). An algorithm for SO was developed (which uses sex, BMI, height, waist circumference and SPPB) with sensitivity and specificity of 88.5 and 91.0%, respectively.

CONCLUSION

High prevalence of obesity among elderly people and rather low sensitivity of current diagnostic criteria for SO call for ongoing research. Broader international consensus for SO diagnostic criteria, screening and diagnosis algorithm are crucial for early detection of SO in older people in clinical practice so that optimal multi-component therapy can be initiated.

Influence of Obesity on Heart Rate Variability in Nurses with Age and Shift Type as Moderators

Obesity is a risk factor of cardiovascular disease-related mortality and may be associated with changes in the autonomic nerve activity. Nurses working shifts and caring for patients are under great mental and physical pressure, and research has proven that these can negatively affect the body. The objective of this study was to examine the influence of obesity in nurses on their heart rate variability (HRV) and determine whether age or shift type moderates this influence. A questionnaire survey and HRV measurements were conducted on nurses at a hospital in Taiwan during a routine employee health checkup. HRV analysis was conducted using a noninvasive HRV monitor for five minutes. A total of 242 nurses with a mean age of 28.98 ± 6.56 years were enrolled in this study. An overly large waist circumference (WC) had a negative impact on high frequency (HF), low frequency (LF), and standard deviation of normal-to-normal interval (SDNN), while an overly high body mass index (BMI) had a negative impact on very low frequency (VLF) and SDNN. The interaction term “overly large WC × age” had a negative impact on HF (β = −0.21, p = 0.010) and LF (β = −0.18, p = 0.030), whereas the interaction term “overly high BMI×age” had a negative impact on HF (β = −0.27, p = 0.001), LF (β = −0.19, p = 0.023), and VLF (β = −0.17, p = 0.045). The interaction terms “overly large WC × shift type” and “overly high BMI × shift type” did not influence any HRV parameters. As age increased, so did the degree to which the HF and LF of nurses with an overly large WC were lower than normal, and so did the degree to which the HF, LF, and VLF of nurses with an overly high BMI were lower than normal.

The Weight Problem: Overview of the Most Common Concepts for Body Mass and Fat Distribution and Critical Consideration of Their Usefulness for Risk Assessment and Practice

The prevalence of obesity already reached epidemic proportions many years ago and more people may die from this pandemic than from COVID-19. However, the figures depend on which measure of fat mass is used. The determination of the associated health risk also depends on the applied measure. Therefore, we will examine the most common measures for their significance, their contribution to risk assessment and their applicability. The following categories are reported: indices of increased accumulation of body fat; weight indices and mortality; weight indices and risk of disease; normal weight obesity and normal weight abdominal obesity; metabolically healthy obesity; the obesity paradox. It appears that BMI is still the most common measure for determining weight categories, followed by measures of abdominal fat distribution. Newer measures, unlike BMI, take fat distribution into account but often lack validated cut-off values or have limited applicability. Given the high prevalence of obesity and the associated risk of disease and mortality, it is important for a targeted approach to identify risk groups and determine individual risk. Therefore, in addition to BMI, a measure of fat distribution should always be used to ensure that less obvious but risky manifestations such as normal weight obesity are identified.

Relationship between rotating shift work and white blood cell count, white blood cell differential count, obesity, and metabolic syndrome of nurses

This study investigated the relationship between working rotating shifts and white blood cell (WBC) count, WBC differential count (DC), obesity, and metabolic syndrome of nurses. Samples were obtained from a total of 720 nurses who had received health checkups at a large teaching hospital in Taiwan. Among these nurses, 500 worked rotating shifts, and the remaining 220 nurses worked fixed daytime shifts. We used binary logistic regression to identify the risk factors of obesity or metabolic syndrome. The results indicate that nurses working rotating shifts had a significantly higher WBC count than those working fixed daytime shifts. WBC count was an independent factor relating to an overly large waist circumference or overly high body mass index (BMI) of nurses. For every 10³/μL increase in WBC count, the risk of waist circumference exceeding 90 cm and 80 cm respectively in male and female nurses increased by 46%, and for every 10³/μL increase in WBC count, the risk of a BMI 24 kg/m² in nurses increased by 50%. Similarly, WBC count and work type were independent factors influencing the metabolic syndrome of nurses. For every 10³/μL increase in WBC count, the risk of metabolic syndrome occurring in nurses increased by 65%. Nurses working rotating shifts were at a 3.34 times greater risk of having metabolic syndrome than those working fixed daytime shifts. The mean age of our participants was 29.54 years old, and only approximately 4% of the participants had metabolic syndrome. Among these nurses, we found that high WBC was correlated with an overly large waist circumference and overly high BMI. Furthermore, the nurses working rotating shifts may have been at greater risk of metabolic syndrome than those working fixed daytime shifts, and increases in WBC were also associated with the occurrence of metabolic syndrome.

Cardiovascular Outcomes of Obesity According to Menopausal Status: A Nationwide Population-Based Study

BACKGROUND

We estimated the effect of obesity on the incidence of cardiovascular disease (CVD) and mortality in women according to menopausal status.

METHODS

Women aged 40 to 69 years under routine health check-ups provided by the National Health Insurance Service in 2009 were followed up till 2018 (n=2,208,559).

RESULTS

In premenopausal women, a significant increment of mortality rate was found in underweight and obesity class II (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.31 to 1.67; and HR, 1.25; 95% CI, 1.12 to 1.39) compared to normal body mass index (BMI); overweight and obesity class I did not affect mortality rate. In postmenopausal women, obesity as well as overweight status reduced the risk of mortality compared to normal BMI (HR, 0.86; 95% CI, 0.83 to 0.88; and HR, 0.84; 95% CI, 0.82 to 0.86). By contrast, there was a linear association between CVD and BMI above the normal range irrespective of menopausal status, which was attenuated in diabetic women.

CONCLUSION

The current study replicated the J-shaped relationship between BMI and mortality, being more prominent in the postmenopausal group. The risk of CVD was linearly increased as BMI was increased above the normal range irrespective of menopausal status.

Association of central obesity and high body mass index with function and cognition in older adults

OBJECTIVE

To investigate the association of normal BMI with central obesity (CO), high BMI with CO, high BMI without CO, and normal BMI without CO, with function and cognition in older adults.

METHODS

Cross-sectional study involving 754 participants ≥ 65 years. Data collected include demographics, cognition, and physical measurements.

RESULTS

Females had a higher prevalence of high BMI with CO and a lower prevalence of high BMI without CO than males (61.0% vs 44.6% and 4.6% vs 15.0%, respectively). Within gender, CO groups, regardless of BMI, had lower mini-mental state examination (MMSE), handgrip strength (HGS), and longer timed-up-and-go (TUG) scores. Overall, the high BMI without CO group had the highest MMSE scores, HGS, and shortest TUG. Amongst males, HGS was significantly lower in the normal BMI with CO group (B -3.28, 95% CI -6.32 to -0.23, P = 0.04). CO, regardless of normal/high BMI, had significantly longer TUG time (B 2.65, 95% CI 0.45 to 4.84, P = 0.02; B 1.07, 95% CI 0.25 to 1.88, P = 0.01, respectively) than normal BMI without CO group. CO was associated with lower MMSE scores in both genders but significant only in males with normal BMI and CO (B -1.60, 95% CI -3.15 to -0.06, P = 0.04).

CONCLUSION

CO may be a better predictor of obesity and adverse outcomes in older adults. High BMI without CO was associated with better outcomes especially in males but require further validation. Prospective longitudinal studies are needed to ascertain the impact of BMI and/or CO on function, cognition, mortality, and gender differences.

Underweight rather than adiposity is an important predictor of death in rural Chinese adults: a cohort study

BACKGROUND

To assess the associations of body mass index (BMI) with all-cause and cause-specific mortalities among rural Chinese.

METHODS

A prospective study of 28 895 individuals was conducted from 2006 to 2014 in rural Deqing, China. Height and weight were measured. The association of BMI with mortality was assessed by using Cox proportional hazards model and restricted cubic spline regression.

RESULTS

There were a total of 2062 deaths during an average follow-up of 7 years. As compared with those with BMI of 22.0-24.9 kg/m², an increased risk of all-cause mortality was found for both underweight men (BMI <18.5 kg/m²) (adjusted HR (aHR): 1.45, 95% CI: 1.18 to 1.79) and low normal weight men (BMI of 18.5-21.9 kg/m²) (aHR: 1.20, 95% CI: 1.03 to 1.38). A J-shaped association was observed between BMI and all-cause mortality in men. Underweight also had an increased risk of cardiovascular disease and cancer mortalities in men. The association of underweight with all-cause mortality was more pronounced in ever smokers and older men (60+ years). The results remained after excluding participants who were followed up less than 1 year.

CONCLUSION

The present study suggests that underweight is an important predictor of mortality, especially for elderly men in the rural community of China.

Impact of Body Mass Index on the Mortality of Critically Ill Patients Admitted to the Intensive Care Unit: An Observational Study

Background

Obesity is a severe multifactorial disorder that carries high morbidity and mortality.

Objectives

This study aimed to evaluate the possible association between body mass index (BMI) and mortality in patients admitted to intensive care units (ICU).

Methods

In this cross-sectional study, all patients admitted to the ICU were studied. The demographic characteristics, ICU, and hospital length of stay, organ failure, mortality, duration of mechanical ventilation, the occurrence of nosocomial infection, and type of admission were recorded for all patients. Patients were categorized based on their BMI.

Results

In total, 502 patients were studied who 53.2% of them were male. Most of the death (28.6%) were recorded in the obesity class II patients, while the lowest rate (3.9%) was for the normal-weight patients (P value < 0.001). The APACHE II and waist circumference had a statistically significant association with the mortality rate (P value < 0.001). After adjusting for age and gender, a significant association was found between waist circumference and mortality rate (OR = 1.15, 95% CI = 1.03 - 1.29; P value = 0.014), APACHE II score, and mortality rate (OR = 2.79, 95% CI = 1.91 - 4.07, P value < 0.001); but there was no significant association between BMI and mortality rate.

Conclusions

This study demonstrated that BMI is associated with an increased risk of mortality, regardless of age and gender. However, after adjusting for age and gender as confounding factors, BMI didn’t have a significant effect on mortality, while the APACHE II score and waist circumference affected the mortality rate.

Nutritional status related to poor health outcomes in older people: Which is better, obese or lean?

Good nutritional status is crucial for maintaining growth and health in all stages of life. However, the relationship between nutritional status and health and the effect on various health-related outcomes differ, depending on the life stage. Many adverse outcomes in older adults, directly linked to different nutritional status, are not present in middle-aged adults, and their ideal nutritional status may differ. This article will review the optimal nutritional status, mainly evaluated by anthropometric measurements such as body mass index, for older adults from various perspectives. Overall, in older adults low body mass index is at higher risk of health problems such as mortality and difficulties in physical functioning compared with middle-aged adults, reducing the risk of health problems for overweight and (abdominal) obesity. Overweight may be more beneficial than lower level of normal weight in older-old and vulnerable older people. While, with or without obesity, skeletal muscle loss or weakness as well as unintentional weight loss induces health problems in older adults. The impact of metabolic syndrome on the prognosis of older adults is clearly reduced compared with middle-aged adults, requiring a shift in medical attention in older adults from metabolic syndrome to frailty. There are still many unclear points regarding the optimal nutritional status of older people, and further research is needed to support healthy longevity. Geriatr Gerontol Int 2021; 21: 5-13.

Estimated Cardiorespiratory Fitness Attenuates the Impacts of Sarcopenia and Obesity on Non-Alcoholic Fatty Liver in Korean Adults

This population-based, cross-sectional study examined the preventive role of non-exercise-based estimation of cardiorespiratory fitness (eCRF) against the impacts of sarcopenia and obesity on the non-alcoholic fatty liver (NAFL) in Korean adults. Data were obtained from the 2008–2011 Korea National Health and Nutrition Examination Surveys IV and V (n = 14,015 Koreans aged ≥ 18 years, 64% women). eCRF was calculated with the age- and sex-specific algorithms, and classified as lower (lowest 25%), middle (middle 50%) and upper (highest 25%). Individuals were classified as optimal (i.e., the absence of both sarcopenia and obesity), sarcopenia (i.e., the presence of sarcopenia), obesity (i.e., the presence of obesity) or sarcopenic obesity (i.e., the coexistence of sarcopenia and obesity). Limited to the sarcopenia phenotype, the adjusted odds ratio (OR) of NAFL was 2.2 (95% confidence interval, CI, 1.5–3.1) for the lower eCRF, 1.6 (95% CI, 1.3–2.1) for the middle eCRF and 2.1 (95% CI, 1.4–3.1) for the upper eCRF, compared to the optimal phenotype. Limited to the obesity phenotype, the adjusted OR of NAFL was 2.9 (95% CI, 2.0–4.2) for the lower eCRF, 3.5 (95% CI, 2.7–4.6) for the middle eCRF and 1.8 (95% CI, 1.2–2.8) for the upper eCRF, compared to the optimal phenotype. Limited to the sarcopenic obesity phenotype, the adjusted OR of NAFL was 5.9 (95% CI, 4.3–8.2) for the lower eCRF, 4.2 (95% CI, 3.2–5.5) for the middle eCRF and 2.5 (95% CI, 1.5–4.1) for the upper eCRF, compared to the optimal phenotype. The current findings suggest that high eCRF attenuates the individual and synergistic impacts of sarcopenia and obesity on NAFL in Korean adults.

Weight Gain of Service Members After Basic Military Training

INTRODUCTION

Despite weight and fitness requirements, the prevalence of overweight and obesity in the U.S. military approaches that in the general population. The purpose of this study is to assess trends in anthropometric measurements shortly after military enlistment.

METHODS

This longitudinal study evaluated the change in objectively measured body weight and waist circumference in the population of U.S. Air Force members who enlisted in 2012-2013 and graduated from Basic Military Training (n=49,466). Individuals were followed for 4 years or until they left the military, for a mean follow-up of 1,218 (SD=261) days. Data were collected in 2018 and analyzed in 2019.

RESULTS

Among Basic Military Training graduates with available and plausible baseline data (n=46,706), weight increased incrementally by a mean of 1.5-1.8 kg per year and waist circumference by 0.3-1.1 cm per year. Over the 4-year period, total mean weight gain was 6.6 (SD=7.7) kg and waist circumference increase was 3.1 (SD=6.4) cm. Male graduates gained 7.0 (SD=7.7) kg and female graduates gained 4.7 (SD=7.5) kg. Of those who stayed in the military for 4 years, 37.3% transitioned to a higher BMI category (i.e., from normal to overweight/obese or from overweight to obese), whereas 3.9% transitioned to a lower category.

CONCLUSIONS

Future research is needed to understand determinants of unhealthy weight gain and the association between weight gain and physical fitness among young adults embarking on a military career.