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Nitecki M, Shapiro G, Orr O, Levitin E, Sharshevsky H, Tzur D, Twig G, Shapira S. Association Between Body Mass Index and Nonspecific Recurrent Low Back Pain in Over 600,000 Healthy Young Adults. Am J Epidemiol 2023; 192:1371-1378. [PMID: 37083852 DOI: 10.1093/aje/kwad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/07/2023] [Accepted: 04/17/2023] [Indexed: 04/22/2023] Open
Abstract
An association between body mass index (BMI; weight (kg)/height (m)2) and low back pain (LBP) has long been debated, but inconsistent measurements of BMI and varying definitions of LBP have produced conflicting findings. We explored this association using measured BMI and physician documentation of recurrent LBP among healthy young adults. Data were extracted from the Israel Defense Forces electronic medical record system. All Israeli citizens with compulsory military service during January 2008-March 2019 were included (n = 705,840). Exclusion criteria were spine deformities, disc pathologies, spinal surgeries, arthropathies, connective tissue diseases, pain syndromes, low bone density disorders, cancers, and psychiatric illnesses. LBP was defined as electronic medical record system documentation of 1) 2 medical visits at least 6 weeks apart with a diagnosis of LBP or "LBP with radiation" or 2) 1 medical visit resulting in referral to an orthopedic surgeon. Logistic regression models were used to explore the association between BMI category and LBP; 619,969 (87.8%) individuals (mean age = 18.9 (standard deviation, 0.97) years; 56.9% male) were included. LBP prevalence was 9.2% (n = 56,918) and higher among males (9.7%) than females (8.5%). Overweight (odds ratio = 1.123, 95% confidence interval: 1.096, 1.151) and obesity (odds ratio = 1.137, 95% confidence interval: 1.096, 1.179) were associated with LBP. The association remained significant after accounting for various sociodemographic factors. Maintaining a healthy BMI may aid in the prevention of LBP in young adults.
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2
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Horesh A, Tsur AM, Bardugo A, Twig G. Adolescent and Childhood Obesity and Excess Morbidity and Mortality in Young Adulthood-a Systematic Review. Curr Obes Rep 2021; 10:301-310. [PMID: 33950400 DOI: 10.1007/s13679-021-00439-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Rates of childhood obesity have been soaring in recent decades. The association between obesity in adulthood and excess morbidity and mortality has been readily established, whereas the association of childhood and adolescent obesity has not. The purpose of this review is to summarize existing data regarding the association of the presence of obesity in childhood/adolescence and early-onset adverse outcomes in adulthood, with specific focus on young adults under the age of 45 years. RECENT FINDINGS Diabetes, cancer, and cardiometabolic outcomes in midlife are closely linked to childhood and adolescent obesity. Childhood and adolescent obesity confer major risks of excess and premature morbidity and mortality, which may be evident before age 30 years in both sexes. The scientific literature is mixed regarding the independent risk of illness, which may be attributed to childhood BMI regardless of adult BMI, and additional data is required to establish causality between the two. Nonetheless, the increasing prevalence of childhood and adolescent obesity may impose an increase of disease burden in midlife, emphasizing the need for effective interventions to be implemented at a young age.
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Affiliation(s)
- Adi Horesh
- The Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Avishai M Tsur
- The Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
- Department of Medicine 'B', Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aya Bardugo
- The Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Gilad Twig
- The Israel Defense Forces Medical Corps, Ramat Gan, Israel.
- Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
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3
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Åberg ND, Adiels M, Lindgren M, Nyberg J, Georg Kuhn H, Robertson J, Schaufelberger M, Sattar N, Åberg M, Rosengren A. Diverging trends for onset of acute myocardial infarction, heart failure, stroke and mortality in young males: role of changes in obesity and fitness. J Intern Med 2021; 290:373-385. [PMID: 33826195 DOI: 10.1111/joim.13285] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/30/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND As opposed to the decreasing overall rates of coronary heart disease (CHD) incidence and overall cardiovascular disease (CVD) mortality, heart failure (HF) and stroke incidence are increasing in young people, potentially due to rising rates of obesity and reduced cardiorespiratory fitness (CRF). OBJECTIVES We investigated trends in early major CVD outcomes in a large cohort of young men. METHODS Successive cohorts of Swedish military conscripts from 1971 to 1995 (N = 1,258,432; mean age, 18.3 years) were followed, using data from the National Inpatient and Cause of Death registries. Cox proportional hazard models were used to analyse changes in 21-year CVD event rates. RESULTS 21-year CVD and all-cause mortality and incidence of acute myocardial infarction (AMI) decreased progressively. Compared with the cohort conscripted in 1971-1975 (reference), the hazard ratios (HRs) for the last 1991-1995 cohort were 0.50 [95% confidence interval (CI) 0.42-0.59] for CVD mortality; 0.57 (95% CI 0.54-0.60) for all-cause mortality; and 0.63 (95% CI 0.53-0.75) for AMI. In contrast, the incidence of ischaemic stroke, intracerebral haemorrhage and HF increased with HRs of 1.43 (95% CI 1.17-1.75), 1.30 (95% CI 1.01-1.68) and 1.84 (95% CI 1.47-2.30), respectively. During the period, rates of obesity increased from 1.04% to 2.61%, whilst CRF scores decreased slightly. Adjustment for these factors influenced these secular trends only moderately. CONCLUSION Secular trends of young-onset CVD events demonstrated a marked shift from AMI and CVD mortality to HF and stroke incidence. Trends were significantly, though moderately, influenced by changing baseline BMI and CRF.
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Affiliation(s)
- N D Åberg
- From the, Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Acute Medicine and Geriatrics (SU/Sahlgrenska), Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Adiels
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Lindgren
- Region Västra Götaland, Sahlgrenska University Hospital, Östra/MGAÖ, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Nyberg
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Neurology Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Georg Kuhn
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Neurology Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute for Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J Robertson
- Region Västra Götaland, Sahlgrenska University Hospital, Östra/MGAÖ, Gothenburg, Sweden.,School of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Schaufelberger
- Region Västra Götaland, Sahlgrenska University Hospital, Östra/MGAÖ, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - N Sattar
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - M Åberg
- School of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Närhälsan, Gothenburg, Sweden
| | - A Rosengren
- Region Västra Götaland, Sahlgrenska University Hospital, Östra/MGAÖ, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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4
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Pool LR, Aguayo L, Brzezinski M, Perak AM, Davis MM, Greenland P, Hou L, Marino BS, Van Horn L, Wakschlag L, Labarthe D, Lloyd-Jones D, Allen NB. Childhood Risk Factors and Adulthood Cardiovascular Disease: A Systematic Review. J Pediatr 2021; 232:118-126.e23. [PMID: 33516680 DOI: 10.1016/j.jpeds.2021.01.053] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To conduct a comprehensive review of the literature on childhood risk factors and their associations with adulthood subclinical and clinical cardiovascular disease (CVD). STUDY DESIGN A systematic search was performed using the MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science databases to identify English-language articles published through June 2018. Articles were included if they were longitudinal studies in community-based populations, the primary exposure occurred during childhood, and the primary outcome was either a measure of subclinical CVD or a clinical CVD event occurring in adulthood. Two independent reviewers screened determined whether eligibility criteria were met. RESULTS There were 210 articles that met the predefined criteria. The greatest number of publications examined associations of clinical risk factors, including childhood adiposity, blood pressure, and cholesterol, with the development of adult CVD. Few studies examined childhood lifestyle factors including diet quality, physical activity, and tobacco exposure. Domains of risk beyond "traditional" cardiovascular risk factors, such as childhood psychosocial adversity, seemed to have strong published associations with the development of CVD. CONCLUSIONS Although the evidence was fairly consistent in direction and magnitude for exposures such as childhood adiposity, hypertension, and hyperlipidemia, significant gaps remain in the understanding of how childhood health and behaviors translate to the risk of adulthood CVD, particularly in lesser studied exposures like glycemic indicators, physical activity, diet quality, very early life course exposure, and population subgroups.
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Affiliation(s)
- Lindsay R Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Liliana Aguayo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Michal Brzezinski
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Amanda M Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew M Davis
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bradley S Marino
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren Wakschlag
- Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Darwin Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Hynynen H, Mutikainen M, Naumenko N, Shakirzyanova A, Tuomainen T, Tavi P. Short high-fat diet interferes with the physiological maturation of the late adolescent mouse heart. Physiol Rep 2020; 8:e14474. [PMID: 32643294 PMCID: PMC7343666 DOI: 10.14814/phy2.14474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/12/2020] [Accepted: 05/04/2020] [Indexed: 11/24/2022] Open
Abstract
Dietary fats are essential for cardiac function. The metabolites of fats known as fatty acids provide most of the energy for cardiac tissue, serve as building blocks for membranes and regulate important signaling cascades. Despite their importance, excess fat intake can cause cardiac dysfunction. The detrimental effects of high-fat diet (HFD) on cardiac health are widely investigated in long-term studies but the short-term effects of fats have not been thoroughly studied. To elucidate the near-term effects of a HFD on the growth and maturation of late adolescent heart we subjected 11-week-old mice to an 8-week long HFD (42% of calories from fat, 42% from carbohydrate, n = 8) or chow diet (12% of calories from fat, 66% from carbohydrate, n = 7) and assessed their effects on the heart in vivo and in vitro. Our results showed that excessive fat feeding interferes with normal maturation of the heart indicated by the lack of increase in dimensions, volume, and stroke volume of the left ventricles of mice on high fat diet that were evident in mice on chow diet. In addition, differences in regional strain during the contraction cycle between mice on HFD and chow diet were seen. These changes were associated with reduced activity of the growth promoting PI3K-Akt1 signaling cascade and moderate changes in glucose metabolism without changes in calcium signaling. This study suggests that even a short period of HFD during late adolescence hinders cardiac maturation and causes physiological changes that may have an impact on the cardiac health in adulthood.
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Affiliation(s)
- Heidi Hynynen
- A.I. Virtanen Institute for Molecular SciencesUniversity of Eastern FinlandKuopioFinland
| | - Maija Mutikainen
- A.I. Virtanen Institute for Molecular SciencesUniversity of Eastern FinlandKuopioFinland
| | - Nikolay Naumenko
- A.I. Virtanen Institute for Molecular SciencesUniversity of Eastern FinlandKuopioFinland
| | | | - Tomi Tuomainen
- A.I. Virtanen Institute for Molecular SciencesUniversity of Eastern FinlandKuopioFinland
| | - Pasi Tavi
- A.I. Virtanen Institute for Molecular SciencesUniversity of Eastern FinlandKuopioFinland
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6
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Glise Sandblad K, Jern S, Åberg M, Robertson J, Torén K, Lindgren M, Adiels M, Hansson PO, Rosengren A. Obesity in adolescent men increases the risk of venous thromboembolism in adult life. J Intern Med 2020; 287:734-745. [PMID: 32338406 DOI: 10.1111/joim.13044] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND As the population of obese and severely obese young adults grows, it is becoming increasingly important to recognize the long-term risks associated with adolescent obesity. OBJECTIVES This study aimed to determine the association between body mass index (BMI) in young men at enlistment for military service and later risk of venous thromboembolism (VTE). METHODS Nationwide register-based prospective cohort study of men enlisting 1969 to 2005, followed through the Swedish National Patient and Cause of Death registries. We identified 1 639 838 men (mean age, 18.3 years) free of prior venous thromboembolism, of whom 29 342 were obese (BMI 30 to <35 kg m-2 ) and 7236 severely obese (BMI ≥ 35 kg m-2 ). The participants were followed until a first registered diagnosis of VTE. RESULTS During a median follow-up of 28 years (interquartile interval, 20 to 36 years), 11 395 cases of deep vein thrombosis and 7270 cases of pulmonary embolism were recorded. Compared with men with a BMI of 18.5 to <20 kg m-2 , men with higher BMI in young adulthood showed an incrementally increasing risk of VTE that was moderately but significantly increased already at normal BMI levels. Adolescent obese men with a BMI of 30 to 35 kg m-2 had an adjusted hazard ratio of 2.93 (95% confidence interval, 2.65 to 3.24) for VTE. Severely obese men with a BMI of ≥35 kg m-2 had a hazard ratio of 4.95 (95% confidence interval, 4.16 to 5.90). CONCLUSIONS Men who were obese or severely obese in young adulthood had a marked increase in risk of VTE.
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Affiliation(s)
- K Glise Sandblad
- From the, Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S Jern
- The Wallenberg Laboratory for Cardiovascular Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Åberg
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Robertson
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - K Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Lindgren
- From the, Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Adiels
- Centre for Applied Biostatistics, Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - P O Hansson
- From the, Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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7
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Rahmani J, Haghighian Roudsari A, Bawadi H, Thompson J, Khalooei Fard R, Clark C, Ryan PM, Ajami M, Rahimi Sakak F, Salehisahlabadi A, Abdulazeem HM, Jamali MR, Mirzay Razaz J. Relationship between body mass index, risk of venous thromboembolism and pulmonary embolism: A systematic review and dose-response meta-analysis of cohort studies among four million participants. Thromb Res 2020; 192:64-72. [PMID: 32454303 DOI: 10.1016/j.thromres.2020.05.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The relationship between body mass index (BMI) and risk of venous thromboembolism (VTE) and pulmonary embolism (PE) is a controversial issue. This dose-response meta-analysis was performed to investigate the association between BMI and risk of VTE and PE incidence based on cohort studies. METHOD A comprehensive systematic search was conducted up to August 2019 in MEDLINE/PubMed, SCOPUS, and Cochrane. DerSimonian and Laird random-effects models were run to estimate combined hazard ratios (HRs) with 95% confidence intervals (CIs). Dose-response analysis was also carried out based on BMI values. RESULTS Eleven articles with 16 arms and 3,910,747 participants were eligible for inclusion in this systematic review and meta-analysis. Pooled results showed a positive association between BMI and risk of VTE in the obese participants compared to participants classified in the normal BMI category (HR: 1.62, 95% CI: 1.29-2.04, I2 = 95%). Furthermore, results showed a significant association between lower BMI (underweight versus normal BMI category) and reduced risk of PE (HR: 0.80, 95% CI: 0.70-0.92, I2 = 9%) and higher risk of PE in obese versus normal BMI participants (HR: 2.24, 95% CI: 1.93-2.60, I2 = 0%). There was a significant linear relationship between BMI and risk of VTE (p < 0.001) and PE (p < 0.001). CONCLUSIONS This systematic review and dose-response meta-analysis with 3,910,747 participants highlights obesity as a significant risk factor related to the incidence of VTE and PE.
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Affiliation(s)
- Jamal Rahmani
- Department of Community Nutrition, Student Research Committee, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezoo Haghighian Roudsari
- Department of Food and Nutrition Policy and Planning, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Hiba Bawadi
- College of Health Sciences, QU-Health, Qatar University, Doha, Qatar
| | - Jacqueline Thompson
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, United Kingdom
| | - Razieh Khalooei Fard
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Cain Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry CV1 5FB, United Kingdom
| | - Paul M Ryan
- School of Medicine, University College Cork, Cork, Ireland
| | - Marjan Ajami
- Department of Food and Nutrition Policy and Planning, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Fatemeh Rahimi Sakak
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ammar Salehisahlabadi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Reza Jamali
- Students' Research Committee, Department of Clinical Nutrition School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jalaledin Mirzay Razaz
- Department of Food and Nutrition Policy and Planning, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Science, Tehran, Iran.
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8
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Robertson J, Lindgren M, Schaufelberger M, Adiels M, Björck L, Lundberg CE, Sattar N, Rosengren A, Åberg M. Body Mass Index in Young Women and Risk of Cardiomyopathy: A Long-Term Follow-Up Study in Sweden. Circulation 2020; 141:520-529. [PMID: 32065765 PMCID: PMC7017947 DOI: 10.1161/circulationaha.119.044056] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Supplemental Digital Content is available in the text. Incidence rates of cardiomyopathies, which are a common cause of heart failure in young people, have increased during the last decades. An association between body weight in adolescence and future cardiomyopathy among men was recently identified. Whether or not this holds true also for women is unknown. The aim was therefore to determine whether for young women being overweight or obese is associated with a higher risk of developing cardiomyopathy.
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Affiliation(s)
- Josefina Robertson
- School of Public Health and Community Medicine/Primary Health Care (J.R., M.Å.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.L., M.S., L.B., A.R.)
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine (M.L., M.S., M.A., L.B., C.E.L., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.L., M.S., L.B., A.R.)
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine (M.L., M.S., M.A., L.B., C.E.L., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.L., M.S., L.B., A.R.)
| | - Martin Adiels
- Department of Molecular and Clinical Medicine (M.L., M.S., M.A., L.B., C.E.L., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Lena Björck
- Department of Molecular and Clinical Medicine (M.L., M.S., M.A., L.B., C.E.L., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.L., M.S., L.B., A.R.)
| | - Christina E Lundberg
- Department of Molecular and Clinical Medicine (M.L., M.S., M.A., L.B., C.E.L., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (N.S.)
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine (M.L., M.S., M.A., L.B., C.E.L., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.L., M.S., L.B., A.R.)
| | - Maria Åberg
- School of Public Health and Community Medicine/Primary Health Care (J.R., M.Å.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Region Västra Götaland, Regionhälsan, Gothenburg, Sweden (M.Å.)
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9
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Kraaijpoel N, Tritschler T, Guillo E, Girard P, Le Gal G. Definitions, adjudication, and reporting of pulmonary embolism-related death in clinical studies: A systematic review. J Thromb Haemost 2019; 17:1590-1607. [PMID: 31301689 DOI: 10.1111/jth.14570] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pulmonary embolism (PE)-related death is a component of the primary outcome in many venous thromboembolism (VTE) studies. The absence of a standardized definition for PE-related death hampers study outcome evaluation and between-study comparisons. OBJECTIVES To summarize definitions for PE-related death used in recent VTE studies and to assess the PE-related death rate. PATIENTS/METHODS A systematic literature search was conducted on 26 April 2018 from 1 January 2014 up to the search date in MEDLINE, Embase, and CENTRAL. Cohort studies and randomized trials in which PE-related death was included in the primary outcome were eligible. Screening of titles, abstracts, and full-text articles, and data extraction were independently performed in duplicate by two authors. Study outcomes included the definition for PE-related death, VTE case-fatality rate, and death due to PE rate. Descriptive statistics were used to analyze the data. RESULTS Of the 6807 identified citations, 83 studies were included of which 27% were randomized trials, 31% were prospective, and 42% retrospective cohort studies. Thirty-five studies (42%) had a central adjudication committee. Thirty-eight (46%) reported a definition for PE-related death of which the most frequently used components were "autopsy-confirmed PE" (50%), "objectively confirmed PE before death" (55%), and "unexplained death" (58%). Median VTE case-fatality rate was 1.8% (interquartile range, 0.0-13). CONCLUSIONS Only half of the included studies reported definitions for PE-related death, which were very heterogeneous. Case-fatality rate of VTE events varied widely across studies. Standardization of the definition and guidance on adjudication and reporting of PE-related death is needed.
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Affiliation(s)
- Noémie Kraaijpoel
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Tobias Tritschler
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Enora Guillo
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Philippe Girard
- Institut du Thorax Curie-Montsouris, Paris, France
- Institut Mutualiste Montsouris, Paris, France
| | - Grégoire Le Gal
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
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10
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Robertson J, Schaufelberger M, Lindgren M, Adiels M, Schiöler L, Torén K, McMurray J, Sattar N, Åberg M, Rosengren A. Higher Body Mass Index in Adolescence Predicts Cardiomyopathy Risk in Midlife. Circulation 2019; 140:117-125. [PMID: 31132859 PMCID: PMC6635044 DOI: 10.1161/circulationaha.118.039132] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Modifiable lifestyle factors in relation to risk for cardiomyopathy, a common and increasing cause of heart failure in the young, have not been widely studied. We sought to investigate a potential link between obesity, a recognized predictor of early heart failure, in adolescence and being diagnosed with cardiomyopathy in adulthood. Methods: This was a nationwide register-based prospective cohort study of 1 668 893 adolescent men (mean age, 18.3 years; SD, 0.7 years) who enlisted for compulsory military service from 1969 to 2005. At baseline, body mass index (BMI), blood pressure, and medical disorders were registered, along with test results for fitness and muscle strength. Cardiomyopathy diagnoses were identified from the National Hospital Register and Cause of Death Register during an up to 46-year follow-up and divided into categories: dilated, hypertrophic, alcohol/drug-induced, and other. Hazard ratios were calculated with Cox proportional hazards models. Results: During follow-up (median, 27 years; Q1–Q3, 19–35 years), 4477 cases of cardiomyopathy were identified, of which 2631 (59%) were dilated, 673 (15%) were hypertrophic, and 480 (11%) were alcohol/drug-induced. Increasing BMI was strongly associated with elevated risk of cardiomyopathy, especially dilated, starting at levels considered normal (BMI, 22.5–<25 kg/m2; hazard ratio, 1.38 [95% CI, 1.22–1.57]), adjusted for age, year, center, and baseline comorbidities, and with a >8-fold increased risk at BMI ≥35 kg/m2 compared with BMI of 18.5 to <20 kg/m2. For each 1-unit increase in BMI, similarly adjusted hazard ratios were 1.15 (95% CI, 1.14–1.17) for dilated cardiomyopathy, 1.09 (95% CI, 1.06–1.12) for hypertrophic cardiomyopathy, and 1.10 (1.06–1.13) for alcohol/drug-induced cardiomyopathy. Conclusions: Even mildly elevated body weight in late adolescence may contribute to being diagnosed with cardiomyopathy in adulthood. The already marked importance of weight control in youth is further strengthened by these findings, as well as greater evidence for obesity as a potential important cause of adverse cardiac remodeling that is independent of clinically evident ischemic heart disease.
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Affiliation(s)
- Josefina Robertson
- Department of Public Health and Community Medicine/Primary Health Care (J.R., M.A.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.S., M.L., A.R.)
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine (M.S., M.L., M.A., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.S., M.L., A.R.)
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine (M.S., M.L., M.A., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.S., M.L., A.R.)
| | - Martin Adiels
- Department of Public Health and Community Medicine/Primary Health Care (J.R., M.A.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Linus Schiöler
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine (L.S., K.T.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine (L.S., K.T.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - John McMurray
- British Heart Foundation Cardiovascular Research Centre (J.M.), University of Glasgow.,Department of Cardiology, Western Infirmary, Glasgow, UK (J.M.)
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences (N.S.), University of Glasgow
| | - Maria Åberg
- Department of Molecular and Clinical Medicine (M.S., M.L., M.A., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine (M.S., M.L., M.A., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.S., M.L., A.R.)
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11
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Twig G, Tirosh A, Derazne E, Haklai Z, Goldberger N, Afek A, Gerstein HC, Kark JD, Cukierman-Yaffe T. Cognitive function in adolescence and the risk for premature diabetes and cardiovascular mortality in adulthood. Cardiovasc Diabetol 2018; 17:154. [PMID: 30518353 PMCID: PMC6280532 DOI: 10.1186/s12933-018-0798-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/28/2018] [Indexed: 12/25/2022] Open
Abstract
Background Epidemiological studies have demonstrated a relationship between cognitive function in youth and the future risk of death. Less is known regarding the relationship with diabetes related death. This study assessed the relationship between cognitive function in late adolescence and the risk for diabetes, cardiovascular- (CVD) and all-cause mortality in adulthood. Methods This retrospective study linked data from 2,277,188 16–19 year olds who had general intelligence tests (GIT) conducted during pre-military recruitment assessment with cause of death as coded by the Israel Central Bureau of Statistics. The associations between cognitive function and cause-specific mortality were assessed using Cox models. Results There were 31,268 deaths that were recorded during 41,916,603 person-years of follow-up, with a median follow-up of 19.2 (IQR 10.7, 29.5) years. 3068, 1443, 514 and 457 deaths were attributed to CVD, CHD, stroke, and diabetes, respectively. Individuals in the lowest GIT vs. highest GIT quintiles in unadjusted models had the highest risk for all-cause mortality (HR 1.84, 95% CI 1.78, 1.91), total CVD (HR 3.32, 95% CI 2.93, 3.75), CHD (HR 3.49 95% CI 2.92, 4.18), stroke (HR 3.96 95% CI 2.85, 5.5) and diabetes-related (HR 6.96 95% CI 4.68, 10.36) mortality. These HRs were attenuated following adjustment for age, sex, birth year, body-mass index, residential socioeconomic status, education and country of origin for all-cause (HR 1.23, 95% CI 1.17, 1.28), CVD (HR 1.76, 95% CI 1.52, 2.04), CHD (HR 1.7 95% CI 1.37, 2.11), stroke (HR 2.03, 95% CI 1.39, 2.98) and diabetes-related (HR 3.14 95% CI 2.00, 4.94) mortality. Results persisted in a sensitivity analyses limited to participants with unimpaired health at baseline and that accounted competing risk. Conclusions This analysis of over 2 million demonstrates a strong relationship between cognitive function at youth and the risk for diabetes, all-cause and CVD-related mortality independent of adolescent obesity. Electronic supplementary material The online version of this article (10.1186/s12933-018-0798-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gilad Twig
- Department of Medicine, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,The Israel Defense Forces Medical Corps, Ramat Gan, Israel. .,The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel. .,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,Department of Military Medicine, Hebrew University, Jerusalem, Israel.
| | - Amir Tirosh
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,The Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Estela Derazne
- The Israel Defense Forces Medical Corps, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Arnon Afek
- Department of Medicine, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hertzel C Gerstein
- Division of Endocrinology & Metabolism, and Population Health Research Institute, McMaster University & Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jeremy D Kark
- Hebrew University-Hadassah School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
| | - Tali Cukierman-Yaffe
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Department of Epidemiology, Sackler School of Medicine, Herczeg institute on Aging, Tel-Aviv university, Tel-Aviv, Israel
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12
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Katz LH, Levi Z, Twig G, Kark JD, Leiba A, Derazne E, Liphshiz I, Keinan-Boker L, Eisenstein S, Afek A. Risk factors associated with gastroenteropancreatic neuroendocrine tumors in a cohort of 2.3 million Israeli adolescents. Int J Cancer 2018; 143:1876-1883. [PMID: 29744856 DOI: 10.1002/ijc.31589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 04/16/2018] [Indexed: 12/27/2022]
Abstract
We investigated whether obesity and sociodemographic factors at adolescence are associated with incident gastroenteropancreatic neuroendocrine tumors (GEP-NET).Our cohort included 2.3 million Israeli adolescents examined at ages 16 to 19 years between 1967 and 2010. The baseline database included sex, country of birth, residential socioeconomic status (SES), body-mass index (BMI) and height. Participants were followed through linkage with the National Cancer Registry up to 2012. We identified 221 cases of GEP-NET (66 pancreatic, 52 gastric, 39 rectal, 27 appendiceal, 23 small bowel and 14 colonic). Immigration from the Former Soviet Union (FSU) was associated with the risk of small bowel and rectal NET's, [Hazard Ratio (HR) 4.79, 95% Confidence Interval (CI) 1.37-16.76 and 3.43, 95% CI 1.20-9.83, respectively].Height >75th percentile and BMI ≥ 85th percentile were associated with increased risk of gastric NET (HR 2.25 95% CI 1.14-4.42 and HR 2.38, 95% CI 1.19-4.75, respectively). Female sex was associated with appendiceal NET (HR 2.30, 95% CI 1.06-4.96) while male gender was associated with an increased risk for NET of the small bowel [HR 4.72 (95% CI 1.10-20.41)].In conclusion, our findings suggest different risk factor associations with the various GEP-NETS: immigrants from the FSU were at increased risk for small bowel and rectal NET; increased height and weight were associated with the risk of gastric NET and females were at increased risk for appendiceal NET. Further focus on the FSU population is indicated in addition to studies verifying the association of BMI and height with gastric NET.
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Affiliation(s)
- Lior H Katz
- The Gastroenterology Department, Sheba Medical Center, Tel-Hashomer, Israel
| | - Zohar Levi
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.,The Gastroenterology Department, Rabin Medical Center, Petach Tikva, Israel
| | - Gilad Twig
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.,The Israel Defense Forces Medical Corps.,The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center.,Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - Jeremy D Kark
- Hebrew University-Hadassah School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
| | - Adi Leiba
- The Israel Defense Forces Medical Corps
| | | | | | | | - Sapir Eisenstein
- Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Arnon Afek
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.,The general manager office, Tel Hashomer, Israel
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13
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Abstract
PURPOSE OF REVIEW Adult obesity and cardiovascular diseases are closely linked. Yet, the relationship of childhood and adolescent obesities with cardiovascular diseases in adulthood requires additional evidence. The goal of the review is to inspect the relationship between childhood- and adolescent-increased body mass index (BMI) and cardiovascular risk factors, fatal and non-fatal cardiovascular diseases in adulthood. RECENT FINDINGS Cardiovascular diseases in adulthood are linked by most of the studies to childhood and adolescent obesities. Studies showed that childhood and adolescent obesities increased the incidence of cardiovascular disease risk factors and were linked to higher risk of cardiovascular morbidity and mortality in adulthood. Childhood and adolescent obesities were also associated, likely with a causal relationship, with an increased likelihood for various cardiovascular morbidities including ischemic heart disease, stroke, but also non-ischemic heart disease-related cardiac pathologies.
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Affiliation(s)
- Adir Sommer
- The Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Gilad Twig
- The Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel.
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel.
- Department of Military Medicine, Hebrew University, Jerusalem, Israel.
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14
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Furer A, Afek A, Orr O, Gershovitz L, Landau Rabbi M, Derazne E, Pinhas-Hamiel O, Fink N, Leiba A, Tirosh A, Kark JD, Twig G. Sex-specific associations between adolescent categories of BMI with cardiovascular and non-cardiovascular mortality in midlife. Cardiovasc Diabetol 2018; 17:80. [PMID: 29871640 PMCID: PMC5989357 DOI: 10.1186/s12933-018-0727-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/28/2018] [Indexed: 02/08/2023] Open
Abstract
Context Most studies linking long-term consequences of adolescent underweight and obesity are limited to men. Objective To assess the sex-specific association of adolescent BMI with cardiovascular- and non-cardiovascular-related mortality in young adulthood and midlife. Setting A nationwide cohort. Participants 927,868 women, 1,366,271 men. Interventions Medical examination data at age 17, including BMI, were linked to the national death registry. Main outcomes Death attributed to cardiovascular (CVD) and non-CVD causes. Results During 17,346,230 women-years and 28,367,431 men-years of follow-up, there were 451 and 3208 CVD deaths, respectively, and 6235 and 22,223 non-CVD deaths, respectively. Compared to low-normal BMI (18.5–22.0 kg/m2), underweight women had a lower adjusted risk for CVD mortality (Cox hazard ratio (HR) = 0.68; 95% CI 0.46–0.98) in contrast to underweight men (HR = 0.99; 0.88–1.13). The latter were at higher risk for non-CVD mortality (HR = 1.04; 1.00–1.09), unlike underweight women (HR = 1.01; 0.93–1.10). Findings, which persisted when the study sample was limited to those with unimpaired health, were accentuated for the obese with ≥ 30 years follow-up. Both sexes exhibited similarly higher risk estimates already in the high-normal BMI range (22.0 ≤ BMI < 25.0 kg/m2) with overall no interaction between sex and BMI (p = 0.62). Adjusted spline models suggested lower BMI values for minimal mortality risk among women (16.8 and 18.2 kg/m2) than men (18.8 and 20.0 kg/m2), for CVD and non-CVD death, respectively. Conclusions Underweight adolescent females have favorable cardiovascular outcomes in adulthood. Otherwise the risk patterns were similar between the sexes. The optimal BMI value for women and men with respect to future CVD outcomes is within or below the currently accepted low-normal BMI range. Electronic supplementary material The online version of this article (10.1186/s12933-018-0727-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ariel Furer
- The Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Arnon Afek
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omri Orr
- The Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Liron Gershovitz
- The Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Moran Landau Rabbi
- The Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Estela Derazne
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Pinhas-Hamiel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Noam Fink
- The Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Adi Leiba
- The Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Tirosh
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat-Gan, Israel.,Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.,The Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeremy D Kark
- Hebrew University-Hadassah School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
| | - Gilad Twig
- The Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel. .,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel. .,The Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Medicine, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
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15
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Twig G, Vivante A, Bader T, Derazne E, Tsur AM, Levi M, Goldberger N, Leiba A, Kark JD. Body Mass Index and Kidney Disease-Related Mortality in Midlife: A Nationwide Cohort of 2.3 Million Adolescents. Obesity (Silver Spring) 2018; 26:776-781. [PMID: 29498231 DOI: 10.1002/oby.22144] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/29/2017] [Accepted: 01/26/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study aimed to evaluate the association of body mass index (BMI) in adolescence with mortality attributed to kidney disease. METHODS In this study, 2,294,139 Jewish Israeli adolescents with measured weight and height at 17 years old during the military fitness assessment were analyzed with a follow-up extending up to 45 years. All kidney-related outcomes, coded by the Central Bureau of Statistics from death notifications as the underlying cause of death, were obtained by linkage. Cox hazards models were applied. RESULTS During 42,297,007 person-years of follow-up (median 18.4 years), 226 deaths related to kidney disease were recorded. There was an increased risk for kidney-related death among adolescents with overweight and obesity with adjusted hazard ratios of 2.7 (95% CI: 1.8-3.9) and 8.4 (5.1-13.8), respectively, with BMI between 18.5 and 22.0 kg/m2 as the reference. A 15% increased risk for kidney-related mortality (1.11-1.19) per unit increment in BMI was observed. Furthermore, a multivariable spline model indicated a minimum risk for kidney-related mortality starting at BMI of 18.6 kg/m2 with significantly increased risk seen above values of 22.8 kg/m2 . The results withstood extensive sensitivity analyses, including stratification of kidney-related death attributed to acute, chronic, and total kidney disease. CONCLUSIONS Adolescent overweight and obesity are risk markers for kidney-related mortality over 4 decades.
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Affiliation(s)
- Gilad Twig
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
- Department of Medicine, Sheba Medical Center, Tel Hashomer, Israel
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Vivante
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics, Sheba Medical Center, Tel Hashomer, Israel
| | - Tarif Bader
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Estela Derazne
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avishai M Tsur
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Moran Levi
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | | | - Adi Leiba
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeremy D Kark
- Hebrew University-Hadassah School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
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