1
|
Lin HC, Hung MJ, Wang CH, Chen TH, Chen WS, Cheng CW. Development and Validation of a Novel Risk Score for All-Cause Mortality Risk Stratification Prior to Permanent Pacemaker Implantation in Octogenarians or Older. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1499. [PMID: 37629789 PMCID: PMC10456785 DOI: 10.3390/medicina59081499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: The demand for permanent pacemaker (PPM) implantation for extremely old patients is increasing. Prior to implanting PPMs, life expectancy evaluation is essential but difficult. We aimed to develop and validate a scoring system for all-cause mortality risk stratification prior to PPM implantation in patients aged ≥80. Materials and Methods: A total of 210 patients aged ≥80 who received PPM implantation were included. Multivariable analysis was performed to assess the effects of different variables on all-cause mortality in a derivation cohort (n = 100). We developed the MELODY score for stratifying all-cause mortality prior to PPM implantation and tested the scoring system in a validation cohort (n = 102). Results: After 4.0 ± 2.7 years of follow-up, 54 patients (54%) had died. The 0.5-, 1- and 2-year all-cause mortality rates were 7%, 10% and 24%, respectively. The MELODY score based on body mass index <21 kg/m2 (HR: 2.21, 95% CI: 1.06-4.61), estimated glomerular filtration rate <30 mL/min/1.73 m2 (3.35, 1.77-6.35), length of hospitalization before PPM implantation >7 days (1.87, 1.02-3.43) and dyspnea as the major presenting symptom (1.90, 1.03-3.50) successfully distinguished patients at high risk of mortality. Patients with MELODY scores ≥3 had a higher risk of mortality compared to those with MELODY scores <3 (8.49, 4.24-17.00). The areas under the receiver operating characteristic curves in predicting 0.5, 1 and 2 years mortality rates were 0.86, 0.81 and 0.74, respectively. The predictive value of the model was confirmed in a validation cohort. Conclusions: The novel scoring system is a simple and effective tool for all-cause mortality risk stratification prior to PPM implantation in patients aged ≥80.
Collapse
Affiliation(s)
- Hsuan-Ching Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
| | - Ming-Jui Hung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
- Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
| | - Chao-Hung Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
- Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
- Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
| | - Wei-Siang Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
| | - Chi-Wen Cheng
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
- Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
| |
Collapse
|
2
|
Nossaman BD. The Eyeball Test. Ochsner J 2023; 23:100-103. [PMID: 37323520 PMCID: PMC10262943 DOI: 10.31486/toj.23.5035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Affiliation(s)
- Bobby D Nossaman
- Department of Anesthesiology and Perioperative Medicine, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA
| |
Collapse
|
3
|
Jiang Y, Zhang X, Xu T, Hong W, Chen Z, Gao X, Xu R. Secular Difference in Body Mass Index From 2014 to 2020 in Chinese Older Adults: A Time-Series Cross-Sectional Study. Front Nutr 2022; 9:923539. [PMID: 35799582 PMCID: PMC9253615 DOI: 10.3389/fnut.2022.923539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/30/2022] [Indexed: 01/04/2023] Open
Abstract
BackgroundBody mass index (BMI) is the most widely used parameter to assess the body weight status. Both the increase of BMI (overweight and obesity) and decrease of BMI (underweight) has been associated with high risk of adverse outcome, such as stroke, disability, and even death. However, recent data on secular differences in BMI in the Chinese aged population are limited. The present study provides robust new evidence about the evolving epidemic of obesity among aged adults in China.ObjectiveEvaluating secular difference in BMI in a group of Chinese older adults.Materials and MethodsWe analyzed 7 continuous survey years (2014–2020), including 50,192 Chinese aged participants (25,505 men and 24,687 women, aged 71.9 ± 6.1 years, age range: 65–99 years). Information on sex, age, height, and body weight, was collected based on medical history. Participants were classified into four groups: underweight (BMI < 18.5 kg/m2), normal weight (18.5 kg/m2 ≤ BMI < 25 kg/m2), overweight (25 kg/m2 ≤ BMI < 30 kg/m2), and obesity (BMI ≥ 30 kg/m2). Linear regressions were used to assess the secular difference in BMI. Sex and age differences were also evaluated by stratified analyses.ResultsFrom 2014 to 2020, age-adjusted mean BMI increased by 0.3 kg/m2 (95% CI: 0.1, 0.5 kg/m2) in men, and 0.5 kg/m2 (95% CI: 0.2, 0.7 kg/m2) in women. Age-standardized prevalence of underweight decreased from 3.0 to 2.3% in men, and from 3.0 to 2.1% in women. Age-standardized prevalence of overweight increased in both men (from 40.1 to 41.7%) and women (from 37.8 to 39.8%), and so as obesity (men: from 4.1 to 6.1%; women: from 5.8 to 8.7%).ConclusionOur results confirmed that BMI gradually increased from 2014 to 2020. The age-adjusted mean BMI increased by 0.3 kg/m2 in older men, and 0.5 kg/m2 in older women. The age- and sex-standardized prevalence of overweight and obesity significantly increased, especially in 70–79-year age group, while the prevalence of underweight decreased. The combination of a balanced-diet and physical exercise is needed to maintain optimal BMI range for the aged population.
Collapse
Affiliation(s)
- Ying Jiang
- Department of Clinical Nutrition, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaomin Zhang
- Department of Clinical Nutrition, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tianwei Xu
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Weiqi Hong
- Caolu Community Health Service Center, Shanghai, China
| | - Zhiqi Chen
- Department of Clinical Nutrition, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiang Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Fudan University, Shanghai, China
| | - Renying Xu
- Department of Clinical Nutrition, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Renying Xu, ; orcid.org/0000-0003-2608-5586
| |
Collapse
|
4
|
Bhardwaj PV, Rastegar V, Meka R, Sawalha K, Brennan M, Stefan MS. The Association Between Body Mass Index, Frailty and Long-Term Clinical Outcomes in Hospitalized Older Adults. Am J Med Sci 2021; 362:268-275. [PMID: 33894183 DOI: 10.1016/j.amjms.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/14/2020] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND While frailty is thought to be a wasting disorder, there is scarce data regarding the association between frailty and body mass index (BMI). The aim of this study was to determine the relationship between BMI, frailty, and mortality among hospitalized older adults. METHODS This is a secondary analysis of a prospective cohort study of patients aged ≥65 years admitted to a tertiary center between 2014 and 2016. Frailty was assessed by Reported Edmonton Frailty Scale (REFS) and categorized as: not frail, vulnerable/mild frail, and moderate/severe frail. BMI (kg/m2) was categorized as: underweight (<18.5), normal (18.5-24.9), overweight (25.0- 29.9), or obese (≥ 30.0). Primary outcome was all-cause one-year mortality. RESULTS Among 769 patients included in the study, 55.4% were frail. There was no statistically significant association between frailty categories and levels of BMI. Frail patients had a higher risk of death than non-frail after adjusting for confounders [HR: 1.98, 95% CI (1.46, 2.70) for mild frail and HR 2.03, 95% CI (1.43, 2.87) for moderate/severe frail]. Compared with normal weight patients, those who were overweight had a survival advantage if they were non-frail [HR 0.55, 95% CI (0.31, 0.96)] or vulnerable/mild frail [HR 0.65, 95% CI (0.43, 0.97)] but not if they were moderate/severe frail. There were no other statistically significant differences in survival by BMI and frailty categories. CONCLUSIONS We did not find a relationship between BMI and frailty among hospitalized older adults. Overweight patients had a survival advantage if they were non-frail or vulnerable. There is need for further longitudinal studies assessing the interaction between frailty and BMI in older adults.
Collapse
Affiliation(s)
- Prarthna V Bhardwaj
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA.
| | - Vida Rastegar
- Institute for Healthcare Delivery and Population Science, Springfield, MA, USA.
| | - Rohini Meka
- Department of Hospital Medicine, Baystate Medical Center, Springfield, MA, USA.
| | - Khalid Sawalha
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA.
| | - Maura Brennan
- Division of Geriatrics, University of Massachusetts Medical School - Baystate, Springfield MA, USA.
| | - Mihaela S Stefan
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA; Institute for Healthcare Delivery and Population Science, Springfield, MA, USA.
| |
Collapse
|
5
|
Garcia GR, Coleman NC, Pond ZA, Pope CA. Shape of BMI-Mortality Risk Associations: Reverse Causality and Heterogeneity in a Representative Cohort of US Adults. Obesity (Silver Spring) 2021; 29:755-766. [PMID: 33629520 DOI: 10.1002/oby.23114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study examines BMI-mortality associations and evaluates strategies intended to limit reverse causality. Heterogeneity in BMI-mortality risk associations across subgroups and causes of death is explored. METHODS A cohort of 654,382 adults from the US National Health Interview Survey was constructed. Associations between unit BMI levels and mortality were estimated using Cox proportional hazards models, including and excluding the first 5 years of follow-up, with and without controls for smoking or preexisting conditions, and including and excluding ever-smokers and individuals with preexisting conditions. Stratified analyses by individual characteristics were performed. RESULTS Addressing reverse causality led to reduced risk of mortality among those with low BMI levels (<18 kg/m2 ). Excluding ever-smokers and individuals with preexisting conditions further led to increased risk among those with high BMI levels (between 33 kg/m2 and >40 kg/m2 ) and lowered the estimated nadir risk from 27 kg/m2 to 23 kg/m2 . After excluding ever-smokers and individuals with preexisting conditions, limiting the analysis to >5 years of follow-up produced no substantive changes. Heterogeneous results were observed across individual characteristics, particularly age and causes of death. CONCLUSIONS The exclusion of smokers and individuals with preexisting conditions alters the BMI-mortality risk association and results in a somewhat lower range of BMI with minimum mortality risk.
Collapse
Affiliation(s)
- George R Garcia
- Department of Economics, Brigham Young University, Provo, Utah, USA
| | - Nathan C Coleman
- Department of Economics, Brigham Young University, Provo, Utah, USA
| | - Zachari A Pond
- Department of Economics, Brigham Young University, Provo, Utah, USA
| | - C Arden Pope
- Department of Economics, Brigham Young University, Provo, Utah, USA
| |
Collapse
|
6
|
Chuangchai W, Pothisiri W. Postural Changes on Heart Rate Variability among Older Population: A Preliminary Study. Curr Gerontol Geriatr Res 2021; 2021:6611479. [PMID: 33727919 PMCID: PMC7937484 DOI: 10.1155/2021/6611479] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/15/2021] [Accepted: 02/20/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE This study aims to investigate an association between body postures and autonomic nervous system (ANS) responses through analysis of short-term heart rate variability (HRV) data obtained through electrocardiography. METHODS Forty older individuals were recruited to form the sample. HRV measurements were taken in three positions-sitting, supine, and standing-and compared. RESULTS Results demonstrated statistically significant differences in the HRV parameters used to examine the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS), specifically in the measurements obtained from the sitting position and the supine position (P < 0.001 for PNS and P = 0.011 for SNS). The differences in these parameters were, however, negligible between the sitting and the standing positions. Moreover, the ANS responses obtained in the sitting position were strongly and positively correlated with those in the standing position (r = 0.854 for PNS and r = 0.794 for SNS). These results suggested that the PNS and SNS parameters obtained while sitting were likely to be affected by orthostatic hypotension in much the same way as those in the standing position, as compared to the supine position. CONCLUSIONS As such, sitting may not be the best position for older individuals in the assessment of their autonomic responses, whereas the supine position is recommended as the baseline posture in the old-age population. These findings are useful for future research in clinical settings that require accuracy in the ANS responses as determined by the HRV measurements.
Collapse
Affiliation(s)
| | - Wiraporn Pothisiri
- College of Population Studies, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
7
|
The COVID-19 Pandemic Lockdowns and Changes in Body Weight among Polish Women. A Cross-Sectional Online Survey PLifeCOVID-19 Study. SUSTAINABILITY 2020. [DOI: 10.3390/su12187768] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There is limited information on the relationships between restrictions linked to COVID-19 and changes in body weight. The aim of the study was to identify the body weight changes and their determinants in the nutritional and socio-demographic context during the COVID-19 pandemic in Polish women. During lockdown in Poland, 34% of women gained weight, while 18% of women reduced weight. As many as 44% of women with obesity before the pandemic increased their body weight, and 74% of women that were underweight reduced their body weight. In a group with weight gain, women increased their body weight by 2.8 kg on average and around 65% of them increased their total food intake. Unhealthy dietary changes and the negative lifestyle changes that comprised of an increase in screen time and a decrease in physical activity were found as key factors associated with weight gain. A higher risk of weight gain was associated with being obese before the pandemic or living in a macroeconomic region >50% of EU-28 GDP, while those younger in age and carrying out remote work had a higher chance of weight loss. Concluding, the specific conditions during lockdown worsened the nutritional status, which may increase the risk of complicatedness and mortality from COVID-19. It seems advisable to create dietary and lifestyle recommendations tailored to the individual needs of women who are underweight or have excessive body weight. More attention should be paid also to environmental impacts. Both, the reduction of excessive body weight and the maintenance of a normal weight should be based on the principle to eat and live sustainably and healthily.
Collapse
|
8
|
Javed AA, Aljied R, Allison DJ, Anderson LN, Ma J, Raina P. Body mass index and all-cause mortality in older adults: A scoping review of observational studies. Obes Rev 2020; 21:e13035. [PMID: 32319198 DOI: 10.1111/obr.13035] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/14/2020] [Accepted: 03/24/2020] [Indexed: 12/17/2022]
Abstract
In older age, body composition changes as fat mass increases and redistributes. Therefore, the current body mass index (BMI) classification may not accurately reflect risk in older adults (65+). This study aimed to review the evidence on the association between BMI and all-cause mortality in older adults and specifically, the findings regarding overweight and obese BMI. A systematic search of the OVID MEDLINE and Embase databases was conducted between 2013 and September 2018. Observational studies examining the association between BMI and all-cause mortality within a community-dwelling population aged 65+ were included. Seventy-one articles were included. Studies operationalized BMI categorically (n = 60), continuously (n = 8) or as a numerical change/group transition (n = 7). Reduced risk of mortality was observed for the overweight BMI class compared with the normal BMI class (hazard ratios [HR] ranged 0.41-0.96) and for class 1 or 2 obesity in some studies. Among studies examining BMI change, increases in BMI demonstrated lower mortality risks compared with decreases in BMI (HR: 0.83-0.95). Overweight BMI classification or a higher BMI value may be protective with regard to all-cause mortality, relative to normal BMI, in older adults. These findings demonstrate the potential need for age-specific BMI cut-points in older adults.
Collapse
Affiliation(s)
- Ayesha A Javed
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Rumaisa Aljied
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - David J Allison
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada.,Labarge Centre for Mobility in Aging, Hamilton, Canada
| |
Collapse
|
9
|
Zhang J, Xu L, Li J, Sun L, Qin W, Ding G, Wang Q, Zhu J, Yu Z, Xie S, Zhou C. Gender differences in the association between body mass index and health-related quality of life among adults:a cross-sectional study in Shandong, China. BMC Public Health 2019; 19:1021. [PMID: 31366336 PMCID: PMC6668122 DOI: 10.1186/s12889-019-7351-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/22/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study aims to assess the association between body mass index (BMI) and health-related quality of life (HRQOL), and to further explore gender differences in BMI-HRQOL association among adults. METHODS We used data from the fifth Health Service Survey of Shandong Province, which was part of China's National Health Service Survey (NHSS), a total of 27,257 adults aged 18 and over were interviewed. The HRQOL was measured using the EuroQOL-5 Dimensions (EQ-5D) instrument. One-way ANOVA and Post hoc tests were used to compare EQ-5D utility values and visual analogue scale (VAS) scores between BMI categories. Tobit regression models were used to identify the association between BMI and HRQOL for male and female separately after controlling for influential confounders, and to assess gender differences on the relationship between BMI and HRQOL. RESULTS The prevalence of underweight in men and women were 3.2 and 5.3%, respectively, while the prevalence of overweight/obesity in men and women were 35.7 and 34.6%, respectively. Men had higher EQ-5D utility values and VAS scores than women. The mean EQ-5D utility value and VAS score was highest in obese men and normal-weight women, respectively. After controlling potential confounders, being underweight was significantly and negatively associated with lower HRQOL among adults. The relationship between obesity and gender was that in women obesity was negatively and significantly associated with HRQOL, whereas in men this association was positive but not statistically significant. Results of gender by BMI interaction in regression model showed that this difference between men and women in this respect was significant. CONCLUSIONS The association between BMI and HRQOL differed by gender and the so-called "obesity-HRQOL paradox" phenomenon was verified in male adults. Gender difference should be considered when implementing targeted weight control programs and appropriate interventions to improve HRQOL.
Collapse
Affiliation(s)
- Jiao Zhang
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
| | - Lingzhong Xu
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
- Collaborative Innovation Center of Social Risks Governance in Health, School of Public health, Fudan University, Shanghai, 200032 China
| | - Jiajia Li
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
- Collaborative Innovation Center of Social Risks Governance in Health, School of Public health, Fudan University, Shanghai, 200032 China
| | - Long Sun
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Collaborative Innovation Center of Social Risks Governance in Health, School of Public health, Fudan University, Shanghai, 200032 China
| | - Wenzhe Qin
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
| | - Gan Ding
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
| | - Qian Wang
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
| | - Jing Zhu
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
| | - Zihang Yu
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
| | - Su Xie
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012 China
| | - Chengchao Zhou
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
- Collaborative Innovation Center of Social Risks Governance in Health, School of Public health, Fudan University, Shanghai, 200032 China
| |
Collapse
|
10
|
Association between body mass index and mortality in the Korean elderly: A nationwide cohort study. PLoS One 2018; 13:e0207508. [PMID: 30444893 PMCID: PMC6239300 DOI: 10.1371/journal.pone.0207508] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/01/2018] [Indexed: 12/14/2022] Open
Abstract
The objective of this study was to investigate the relationship between body mass index (BMI) and mortality in the elderly. This study was a nation-wide population-based retrospective cohort study of the National Health Insurance System-Senior Database (NHIS-SD). In this study, a total of 75,856 subjects were identified and selected from among 251,593 individuals aged ≥ 65 years who underwent health screening at least once between 2009 and 2012 and who had no history of diabetes, cardiovascular disease, stroke, cancer, or chronic obstructive pulmonary disease (COPD). The subjects of this study were followed-up until 2013 to identify the total mortality and the cause-specific mortality of 6 groups divided according to BMI. The hazard ratio (HR) by reference group (23 ≤ BMI < 25 kg/m2) of each group was calculated. A significant increase in the HR with a decreased BMI was observed in the group with a BMI < 23 kg/m2, whereas the HR in the group with a BMI ≥ 25 kg/m2 was not significantly different than that of the reference group (23 ≤ BMI < 25 kg/m2). This pattern was also seen in the subgroup analyses in relation to age, smoking history, alcohol use, exercise level, and socioeconomic status. In this study, we found that a low BMI was a risk factor for death in the elderly and that no significant difference in mortality was seen in the elderly with a BMI of 25 or over. In terms of an optimal BMI in the elderly, it is important to maintain an appropriately healthy range of BMI with the aim of preventing weight loss.
Collapse
|
11
|
Hung CY, Lai CC, Chen PT, Lu CH, Chang PH, Yeh KY, Li SH, Liu KH, Hung YS, Chen JS, Lin YC, Chou WC. Impact of body mass index on long-term survival outcome in Asian populations with solid cancer who underwent curative-intent surgery: A six-year multicenter observational cohort study. J Cancer 2018; 9:3316-3325. [PMID: 30271492 PMCID: PMC6160684 DOI: 10.7150/jca.25729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 07/23/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose: Being elevated body mass index (BMI) has been considered a poor prognostic factor in patients with cancer. However, studies about the impact of elevated BMI on the survival outcome after cancer surgery have conflicting results. This study aimed to evaluate the impact of BMI on long-term postoperative survival outcome in a large cohort of Asian population with solid cancers. Methods: A total of 33,551 patients who underwent curative-intent surgery for solid cancers between January 2007 and December 2012 at four hospitals in Taiwan were included. BMI was analyzed using univariate and multivariate regression analyses to determine its association with survival outcome. Results: With a median follow-up of 43.8 (range, 1-91) months, the rate of all-cause mortality was 21.7% (n=7264 patients), while that of cancer-related mortality was 13.4% (n=4499 patients). BMI was a significant prognostic factor in multivariate analysis for overall survival (OS) and cancer-specific survival (CSS). The adjusted hazard ratio (HR) per kg/m2 was 0.922 (95% confidence interval [CI], 0.916-0.929; P<0.001) and 0.932 (95% CI, 0.924-0.940; P<0.001) for OS and CSS, respectively. Patients with BMI <17 kg/m2 had the highest postoperative mortality risk, with a hazard ratio of 3.8-fold higher for OS and 5.0-fold higher for CSS than those with BMI >35 kg/m2. Conclusions: This study showed that BMI was positively associated with survival outcome in patients with cancer who underwent radical surgery. BMI was an independent prognostic factor and can be used to risk stratify patients in Asians with solid cancers.
Collapse
Affiliation(s)
- Chia-Yen Hung
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyaun, Taiwan.,Division of Hema-Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Cheng-Chou Lai
- Department of Colon and Rectal Surgery Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyaun, Taiwan
| | - Ping-Tsung Chen
- Departments of Medical Oncology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Chang-Hsien Lu
- Departments of Medical Oncology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Pei-Hung Chang
- Department of Medical Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Kun-Yun Yeh
- Department of Medical Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Shau-Hsuan Li
- Department of Medical Oncology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan
| | - Keng-Hao Liu
- Department of Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyaun, Taiwan
| | - Yu-Shin Hung
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyaun, Taiwan
| | - Jen-Shi Chen
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyaun, Taiwan
| | - Yung-Chang Lin
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyaun, Taiwan
| | - Wen-Chi Chou
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyaun, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
12
|
Selvamani Y, Singh P. Socioeconomic patterns of underweight and its association with self-rated health, cognition and quality of life among older adults in India. PLoS One 2018. [PMID: 29513768 PMCID: PMC5841798 DOI: 10.1371/journal.pone.0193979] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Underweight defined as body mass index (BMI) < 18.5 is associated with negative health and quality of life outcomes including mortality. Yet, little is known about the socioeconomic differentials in underweight and its association with health and well-being among older adults in India. This study examined the socioeconomic differentials in underweight among respondents aged ≥50 in India. Consequently, three outcomes of the association of underweight were studied. These are poor self-rated health, cognition and quality of life. METHODS Cross-sectional data on 6,372 older adults derived from the first wave of the WHO's Study on global AGEing and adult health (SAGE), a nationally representative survey conducted in six states of India during 2007-8, were used. Bivariate and multivariate regression analyses were applied to fulfil the objectives. RESULTS The overall prevalence of underweight was 38 percent in the study population. Further, socioeconomic status showed a significant and negative association with underweight. The association of underweight with poor self-rated health (OR = 1.60; p < .001), cognition (β = -0.95; p < .001) and quality of life (β = -1.90; p < .001) were remained statistically significant after adjusting for age, sex, place of residence, marital status, years of schooling, wealth quintile, sleep problems, chronic diseases, low back pain and state/province. CONCLUSION The results indicated significant socioeconomic differentials in underweight and its association with poor self-rated health, cognition and quality of life outcomes. Interventions focussing on underweight older adults are important to enhance the overall wellbeing of the growing older population in India.
Collapse
Affiliation(s)
- Y. Selvamani
- Department of Development Studies, International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, India
- * E-mail:
| | - Pushpendra Singh
- Department of Humanities & Social Sciences, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand, India
| |
Collapse
|
13
|
Yu SY, Kim BS, Won CW, Choi H, Kim S, Kim HW, Kim MJ. Body Mass Index and Mortality according to Gender in a Community-Dwelling Elderly Population: The 3-Year Follow-up Findings from the Living Profiles of Older People Surveys in Korea. Korean J Fam Med 2016; 37:317-322. [PMID: 27900068 PMCID: PMC5122662 DOI: 10.4082/kjfm.2016.37.6.317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/06/2016] [Accepted: 05/24/2016] [Indexed: 01/22/2023] Open
Abstract
Background Body mass index is widely regarded as an important predictor of mortality. The purpose of this study was to investigate the relationship between body mass index and mortality and to compare community-dwelling elderly people in South Korea according to sex. Methods Data were collected from the 2008 and 2011 Living Profiles of Older People Surveys, which comprised 10,613 community-living South Korean men and women aged 65 years or older. The participants were stratified into five groups according to body mass index as defined by the World Health Organization guidelines. The sociodemographic characteristics of participants and mortality rates were compared across the body mass index groups. Results The highest survival rates were observed in men with a body mass index of 25.0–29.9 kg/m2. A similar trend was observed in women, but it was not statistically significant. After adjusting for covariates, this association was also found in men across all BMI index groups, but not in women. Conclusion This study supports previous findings that overweight or mild obesity is associated with the lowest mortality and suggests that the current categories of obesity require revision. Furthermore, the absence of statistically significant findings in the female cohort suggests that body mass index is not a suitable predictor of mortality in women and that an alternative is required.
Collapse
Affiliation(s)
- Seon Yeong Yu
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Byung Sung Kim
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Chang Won Won
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyunrim Choi
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyung Woo Kim
- Department of Statistics, Korea University College of Political Science and Economics, Seoul, Korea
| | - Min Joung Kim
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| |
Collapse
|
14
|
Ota A, Kondo N, Murayama N, Tanabe N, Shobugawa Y, Kondo K. Serum Albumin Levels and Economic Status in Japanese Older Adults. PLoS One 2016; 11:e0155022. [PMID: 27276092 PMCID: PMC4898757 DOI: 10.1371/journal.pone.0155022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/22/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Low serum albumin levels are associated with aging and medical conditions such as cancer, liver dysfunction, inflammation, and malnutrition and might be an independent predictor of long-term mortality in healthy older populations. We tested the hypothesis that economic status is associated with serum albumin levels and explained by nutritional and health status in Japanese older adults. DESIGN We performed a cross-sectional analysis using data from the Japan Gerontological Evaluation study (JAGES). The study participants were 6528 functionally independent residents (3189 men and 3339 women) aged ≥65 years living in four municipalities in Aichi prefecture. We used household income as an indicator of economic status. Multiple linear regression was used to compare serum albumin levels in relation to household income, which was classified as low, middle, and high. Additionally, mediation by nutritional and health-related factors was analyzed in multivariable models. RESULTS With the middle-income group as reference, participants with low incomes had a significantly lower serum albumin level, even after adjustment for sex, age, residential area, education, marital status, and household structure. The estimated mean difference was -0.17 g/L (95% confidence interval, -0.33 to -0.01 g/L). The relation between serum albumin level and low income became statistically insignificant when "body mass index", "consumption of meat or fish", "self-rated health", "presence of medical conditions", "hyperlipidemia", or "respiratory disease "was included in the model. CONCLUSION Serum albumin levels were lower in Japanese older adults with low economic status. The decrease in albumin levels appears to be mediated by nutrition and health-related factors with low household incomes. Future studies are needed to reveal the existence of other pathways.
Collapse
Affiliation(s)
- Asami Ota
- Division of Health and Nutrition, University of Niigata Prefecture, Niigata, Japan
- * E-mail:
| | - Naoki Kondo
- Department of Health and Social Behavior/Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Nobuko Murayama
- Division of Health and Nutrition, University of Niigata Prefecture, Niigata, Japan
| | - Naohito Tanabe
- Division of Health and Nutrition, University of Niigata Prefecture, Niigata, Japan
| | - Yugo Shobugawa
- Division of International Health, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Science, Chiba University, Chiba, Japan
- Center for Well-being and Society, Nihon Fukushi University, Aichi, Japan
- National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan
| | | |
Collapse
|
15
|
Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S, Romundstad P, Vatten LJ. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ 2016; 353:i2156. [PMID: 27146380 PMCID: PMC4856854 DOI: 10.1136/bmj.i2156] [Citation(s) in RCA: 503] [Impact Index Per Article: 62.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of cohort studies of body mass index (BMI) and the risk of all cause mortality, and to clarify the shape and the nadir of the dose-response curve, and the influence on the results of confounding from smoking, weight loss associated with disease, and preclinical disease. DATA SOURCES PubMed and Embase databases searched up to 23 September 2015. STUDY SELECTION Cohort studies that reported adjusted risk estimates for at least three categories of BMI in relation to all cause mortality. DATA SYNTHESIS Summary relative risks were calculated with random effects models. Non-linear associations were explored with fractional polynomial models. RESULTS 230 cohort studies (207 publications) were included. The analysis of never smokers included 53 cohort studies (44 risk estimates) with >738 144 deaths and >9 976 077 participants. The analysis of all participants included 228 cohort studies (198 risk estimates) with >3 744 722 deaths among 30 233 329 participants. The summary relative risk for a 5 unit increment in BMI was 1.18 (95% confidence interval 1.15 to 1.21; I(2)=95%, n=44) among never smokers, 1.21 (1.18 to 1.25; I(2)=93%, n=25) among healthy never smokers, 1.27 (1.21 to 1.33; I(2)=89%, n=11) among healthy never smokers with exclusion of early follow-up, and 1.05 (1.04 to 1.07; I(2)=97%, n=198) among all participants. There was a J shaped dose-response relation in never smokers (Pnon-linearity <0.001), and the lowest risk was observed at BMI 23-24 in never smokers, 22-23 in healthy never smokers, and 20-22 in studies of never smokers with ≥20 years' follow-up. In contrast there was a U shaped association between BMI and mortality in analyses with a greater potential for bias including all participants, current, former, or ever smokers, and in studies with a short duration of follow-up (<5 years or <10 years), or with moderate study quality scores. CONCLUSION Overweight and obesity is associated with increased risk of all cause mortality and the nadir of the curve was observed at BMI 23-24 among never smokers, 22-23 among healthy never smokers, and 20-22 with longer durations of follow-up. The increased risk of mortality observed in underweight people could at least partly be caused by residual confounding from prediagnostic disease. Lack of exclusion of ever smokers, people with prevalent and preclinical disease, and early follow-up could bias the results towards a more U shaped association.
Collapse
Affiliation(s)
- Dagfinn Aune
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway Department of Epidemiology and Biostatistics, Imperial College, London, UK
| | - Abhijit Sen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Manya Prasad
- Department of Community Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, Imperial College, London, UK
| | - Imre Janszky
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Serena Tonstad
- Department of Community Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Pål Romundstad
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars J Vatten
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
16
|
Sugai T, Suzuki Y, Yamazaki M, Shimoda K, Mori T, Ozeki Y, Matsuda H, Sugawara N, Yasui-Furukori N, Minami Y, Okamoto K, Sagae T, Someya T. High prevalence of underweight and undernutrition in Japanese inpatients with schizophrenia: a nationwide survey. BMJ Open 2015; 5:e008720. [PMID: 26656016 PMCID: PMC4679887 DOI: 10.1136/bmjopen-2015-008720] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To clarify the prevalence of underweight and overweight/obesity, and laboratory data for nutritional status in Japanese outpatients and inpatients with schizophrenia. DESIGN Cross-sectional study. SETTING A questionnaire conducted in inpatient and outpatient facilities in Japan. PARTICIPANTS The population of adult patients with schizophrenia in Japan (N=23,116). MAIN OUTCOME MEASURES The prevalence of underweight and undernutrition in Japanese inpatients and outpatients with schizophrenia. RESULTS We conducted a large-scale investigation of the prevalence of underweight and undernutrition in 520 outpatient facilities and 247 inpatient facilities belonging to the Japan Psychiatric Hospitals Association between January 2012 and July 2013. There were 7655 outpatients and 15,461 inpatients with schizophrenia. There was a significant difference in the distribution of three body mass index levels between outpatients and inpatients (p<0.001). The proportion of underweight inpatients with schizophrenia was significantly higher than that among outpatients (p<0.001). Age-specific analysis revealed that the proportion of underweight individuals aged ≥ 40 years was higher in inpatients than in outpatients and in the general Japanese population. The proportion of individuals with hypocholesterolaemia was significantly higher in inpatients with schizophrenia than in outpatients (p<0.001). There was a significant difference in the severity of underweight between outpatients and inpatients with schizophrenia; the proportion of severe underweight in inpatients was twofold higher than in outpatients. CONCLUSIONS The prevalence of underweight and undernutrition in Japanese inpatients with schizophrenia was higher than in outpatients and the general population. Therefore, the physical risk of inpatients should be carefully considered in clinical practice.
Collapse
Affiliation(s)
- Takuro Sugai
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
| | - Yutaro Suzuki
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
| | | | - Kazutaka Shimoda
- Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Takao Mori
- Japan Psychiatric Hospital Association, Tokyo, Japan
| | - Yuji Ozeki
- Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
| | | | - Norio Sugawara
- Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Norio Yasui-Furukori
- Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
| | | | | | - Toyoaki Sagae
- Faculty of Health and Nutrition, Department of Health and Nutrition, Yamagata Prefectural Yonezawa University of Nutrition Sciences, Yonezawa, Japan
| | - Toshiyuki Someya
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
| |
Collapse
|