Association between Body Mass Index and Health-Related Quality of Life: The "Obesity Paradox" in 21,218 Adults of the Chinese General Population

Age-appropriate BMI cut-offs for malnutrition among older adults in India

With the increasing prevalence of obesity in India, body mass index (BMI) has garnered importance as a disease predictor. The current World Health Organization (WHO) body mass index (BMI) cut-offs may not accurately portray these health risks in older adults aged 60 years and above. This study aims to define age-appropriate cut-offs for older adults (60-74 years and 75 years and above) and compare the performance of these cut-offs with the WHO BMI cut-offs using cardio-metabolic conditions as outcomes. Using baseline data from the Longitudinal Ageing Study in India (LASI), classification and regression tree (CART) cross-sectional analysis was conducted to obtain age-appropriate BMI cut-offs based on cardio-metabolic conditions as outcomes. Logistic regression models were estimated to compare the association of the two sets of cut-offs with cardio-metabolic outcomes. The area under the receiver operating characteristic curve (AUC), sensitivity and specificity were estimated. Agreement with waist circumference, an alternate measure of adiposity, was conducted. For older adults aged 60-74 years and 75 years and above, the cut-off for underweight reduced from < 18.5 to < 17.4 and < 13.3 respectively. The thresholds for overweight and obese increased for older adults aged 60-74 years old from >  = 25 to > 28.8 and >  = 30 to > 33.7 respectively. For older adults aged 75 years and above, the thresholds decreased for both categories. The largest improvement in AUC was observed in older adults aged 75 years and above. The newly derived cut-offs also demonstrated higher sensitivity and specificity among all age-sex stratifications. There is a need to adopt greater rigidity in defining overweight/obesity among older adults aged 75 years and above, as opposed to older adults aged 60-74 years old among whom the thresholds need to be less conservative. Further stratification in the low risk category could also improve BMI classification among older adults. These age-specific thresholds may act as improved alternatives of the current WHO BMI thresholds and improve classification among older adults in India.

Trends of underweight, overweight, and obesity among older adults in China from 2008 to 2018: a national observational survey

OBJECTIVE

This study aims to investigate the 10-year trends and disparities in underweight, overweight, and obesity among older adults aged 65 years and older in China from 2008 to 2018.

METHODS

We used four waves (2008, 2011, 2014, and 2018) of data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a national community-based cross-sectional survey conducted every 2-3 years. Body weight and height were measured by trained assessors following standardized procedures. BMI was calculated and divided into underweight (< 18.5 kg/m²), normal (18.5-24.9 kg/m²), overweight (25.0-29.9 kg/m²), obese (≥ 30.0 kg/m²) according to WHO reference. Multinomial logistic regression models were used to examine factors related with abnormal BMI groups, after adjusting for potential confounders.

RESULTS

Among 46,543 older adults in China, the prevalence rates of underweight decreased with each survey year from 2008 to 2018, declining from 20.05 to 7.87% (p < 0.001). In contrast, the prevalence rates of overweight and obesity showed an increasing trend (all p < 0.001). Specifically, the prevalence of overweight rose from 12.82% to 2008 to 28.45% in 2018, and the prevalence of obesity increased from 1.62% to 2008 to 4.95% in 2018. In the multinomial logistic regression model, survey year, gender, residence, marital status, economic status, numbers of chronic diseases, smoking status, sleep quality, and functional disability were factors related with obesity.

CONCLUSION

The prevalence rates of overweight and obesity were increasing while the prevalence of underweight and normal weight significantly decreased from 2008 to 2018 among older adults in China, which poses a huge challenge for chronic disease. There is an urgent need for intervention policy planning and early prevention of abnormal body weight for the preparation of an aging society.

Association of body mass index with survival in U.S. cancer survivors: a cross-sectional study of NHANES 1999-2018

Background

Understanding the association between relative mortality with body mass index (BMI) may aid clinicians in making suitable clinical decisions. Our study evaluated the impact of BMI on mortality among cancer survivors.

Methods

We used data from the US National Health and Nutrition Examination Surveys (NHANES) spanning from 1999 to 2018. Relevant mortality data were retrieved up until December 31, 2019. Adjusted Cox models were employed to examine the association of BMI with the risks for total and cause-specific mortality.

Results

Among 4135 cancer survivors, 1486 (35.9%) were obese (21.0% class 1 obesity [BMI 30-< 35 kg/m²], 9.2% class 2 obesity [BMI 35 -< 40 kg/m²], 5.7% class 3 obesity [BMI ≥ 40 kg/m²]), 1475(35.7%) were overweight (BMI 25-< 30 kg/m²). During an average follow-up of 8.9 years (35895 person-years), a total of 1361 deaths were reported (cancer 392; 356 cardiovascular disease [CVD]; 613, non-cancer, non-CVD). In multivariable models, underweight participants (BMI < 18.5 kg/m²) were associated with significantly higher risks of cancer-specific (HR, 3.31; 95% CI, 1.37-8.03, P=0.01) and CVD cause (HR, 3.18; 95% CI, 1.44-7.02, P < 0.001) mortality compared to individuals with normal weight. Being overweight was associated with significantly lower risks of non-cancer, non-CVD cause mortality (HR, 0.66; 95% CI, 0.51-0.87, P < 0.001). Class 1 obesity was associated with significantly reduced risks of all-cause (HR, 0.78; 95% CI, 0.61-0.99, P = 0.04), and non-cancer, non-CVD cause (HR, 0.60; 95% CI, 0.42-0.86, P = 0.01) mortality. A higher risk of CVD-related mortality (HR, 2.35; 95% CI, 1.07-5.18, P = 0.03) was observed in class 3 obesity cases. Lower risks of all-cause mortality were detected in men (overweight, HR, 0.76; 95% CI, 0.59-0.99, P=0.04; class 1 obesity, HR, 0.69; 95% CI, 0.49-0.98, P = 0.04) but not in woman, in never-smokers (class 1 obesity, HR, 0.61; 95% CI, 0.41-0.90, P=0.01) and former smokers (overweight, HR, 0.77; 95% CI, 0.60-0.98, P=0.04) but not in current smokers; in obesity-related cancer (class 2 obesity, HR, 0.49; 95% CI, 0.27-0.89, P=0.01) but not in non-obesity-related cancers.

Conclusions

In the United States, cancer survivors with overweight or moderate obesity (class 1 or class 2 obesity) demonstrated a lower risk of all-cause and noncancer, non-CVD cause mortality.

Depression and health-related quality of life in adolescents and young adults with childhood-onset end-stage kidney disease: a multicenter study in Japan

BACKGROUND

Patient survival and physical outcomes among children with end-stage kidney disease (ESKD) have significantly improved, and recent research has focused on long-term depression symptoms and health-related quality of life (HRQOL). However, no studies have been conducted among adolescents and young adults with childhood-onset ESKD in Japan.

METHODS

This multicenter study included 45 adolescents and young adults aged 16-39 years who developed ESKD at age < 20 years. Depression symptoms were measured using the Beck Depression Inventory (BDI)-II. The Short Form-36 Health Survey (SF-36) was used to assess HRQOL. Factors associated with depression and HRQOL were analyzed.

RESULTS

Depression (BDI-II score ≥ 14) was observed in 13 (29%) patients. Patient's SF-36 physical component summary (PCS) and mental component summary (MCS) scores were comparable with those for the general population. Lower estimated glomerular filtration rate, higher BDI-II scores, and lower body mass index were associated with lower PCS scores. BDI-II scores were negatively correlated with MCS scores. We observed a trend that unemployment was associated with lower MCS scores.

CONCLUSIONS

Depression is frequently observed among adolescents and young adults with childhood-onset ESKD. Regular screening for psychosocial concerns, maintaining stable graft functions, and achieving optimal nutritional status may contribute to improved well-being among these patients.

The impact of BMI on psychological health in oldest old individuals-Are there differences between women and men?

OBJECTIVE

The aim of this study was to determine the association of mental health issues associated with BMI and gender in the oldest old population (secondary data analyses).

METHOD

The data were taken from the second follow-up of a long-term study investigating the impact of the COVID-19 pandemic on health in oldest old individuals (range: 77-96 years). The response rate was 80.0%. Apart from sociodemographic characteristics (age, gender, weight and height); anxiety, depression, somatic complaints and social support were assessed in this survey.

RESULTS

Analyses revealed gender-specific differences, indicating that male participants with excess weight show more complaints compared to their counterparts without excess weight. According to regression results, BMI was associated with somatization, but not depression or anxiety.

CONCLUSION

High BMI contributed to more somatic complaints and men may be affected differently by BMI regarding their mental well-being. Longitudinal results are needed in order to confirm these findings and develop suitable interventions based on individual needs of the oldest old.

Associations between health-related quality of life and measures of adiposity among Filipino adults

OBJECTIVE

Estimate associations between the health-related quality of life (HRQoL) and adiposity in a low-income population.

METHODS

In a cluster random sample of 3796 Filipinos aged 40-70 years in Nueva Ecija province, we measured body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and six dimensions of HRQoL using the 20-item Short Form Health Survey. We stratified by sex and used nonparametric regression to graph mean HRQoL in each dimension by BMI, WC, and WHR. We used ordinary least squares regression to estimate differences in each HRQoL dimension by categories of BMI, WC, and WHR adjusted for sociodemographic characteristics and smoking.

RESULTS

Mean HRQoL was lowest for health perception (Males: 67.5 (SD = 15.9); Females: 66.7 (15.8)) and highest for role functioning (Males: 97.5 (12.9); Females: 97.4 (13.3)). Mean (SD) values of BMI, WC, and WHR were 22.1 (3.6), 84.8 cm (9.5), and 0.9 (0.1), respectively for males, and 23.7 (4.2), 86.5 cm (10.2), and 0.9 (0.1), respectively, for females. There was no evidence that higher BMI was associated with lower HRQoL. Adjusted mean social functioning was 4.92 (p = 0.076) higher for males with high BMI risk (8.6% prevalence) compared with acceptable BMI risk (50.3%). Mean social functioning was 3.61 (p = 0.012) and 5.48 (p = 0.017) lower for females with high WC (44.7%) and WHR (83.1%), respectively, compared with those with low WC (23.8%) and WHR (3.6%). Mean physical functioning was lower by 2.70 (p = 0.204) and 1.07 (p = 0.198) for males and females, respectively, with high compared with low WC. Mean physical functioning was 3.93 (p = 0.037) lower for males with high (7.6%) compared with low (38.8%) WHR. Mean role functioning was 1.09 (p = 0.124) and 2.46 (p = 0.158) lower for males with borderline and high WHR, respectively.

CONCLUSIONS

There is discordance between future adiposity-related health risk and current experience of HRQoL.

Morbid obesity, multiple long-term conditions, and health-related quality of life among Australian adults: Estimates from three waves of a longitudinal household survey

This study aims to investigate the impact of morbid obesity and multiple long-term conditions (MLTCs) on health-related quality of life (HRQoL). Data for this study were sourced from three waves (waves 9, 13 and 17) of the Household, Income and Labour Dynamics in Australia (HILDA) survey. The paper analyses 37,887 person-year observations from 19,387 individuals during the period 2009-2017. The longitudinal random-effects Tobit model was fitted to examine the association between morbid obesity, MLTCs and HRQoL. This study found that morbid obesity and MLTCs were both negatively associated with HRQoL as measured through physical component summary (PCS), mental component summary (MCS), and the short-form six-dimension utility index (SF-6D) of the 36-item Short-Form Health Survey (SF-36). Morbidly obese scored lower points on the PCS (β = -5.05, 95% CI: -5.73, -4.37), MCS (β = -1.03, 95% CI: -1.84, -0.23), and in the SF-6D utility index (β = -0.045, 95% CI: -0.054, -0.036) compared to their healthy weight counterparts. Similar findings were observed for individuals with MLTCs, with lower scores for the PCS (β = -4.79, 95% CI: -5.20, -4.38), MCS (β = -4.95, 95% CI: -5.43, -4.48), and SF-6D utility (β = -0.071, 95% CI: -0.076, -0.066). Additionally, multiplicative interaction between morbid obesity and MLTCs was observed to modestly exacerbated the negative effect of morbid obesity on PCS scores (β = -1.69, 95% CI: -2.74, -0.64). The interaction effect, on the other hand, significantly lessen the unfavourable effect of morbid obesity on the MCS score (β = 1.34, 95% CI: 0.10, 2.58). The findings of this study will be useful for future cost-effectiveness analyses and measuring the burden of diseases since it provides information on the disutility associated with morbid obesity and MLTCs.

Secular Difference in Body Mass Index From 2014 to 2020 in Chinese Older Adults: A Time-Series Cross-Sectional Study

Background

Body 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.

Objective

Evaluating secular difference in BMI in a group of Chinese older adults.

Materials and Methods

We 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 &lt; 18.5 kg/m2), normal weight (18.5 kg/m2 ≤ BMI &lt; 25 kg/m2), overweight (25 kg/m2 ≤ BMI &lt; 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.

Results

From 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%).

Conclusion

Our 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.

Does social capital buffer or exacerbate mental health inequality? Evidence from the China Family Panel Study (CFPS)

Background

Health inequality, including physical and mental health inequality, is an important issue. What role social capital plays in mental health inequality is still ambiguous, especially in developing countries. The aim of this study is to explore the relationship between social capital and mental health inequality in China.

Method

Both family-level and community-/village-level social capitals are included in our analysis. Data is mainly extracted from the China Family Panel Studies in 2018, and lagged term of social capital in CFPS 2016 was used to link with other variables in 2018. Depressive symptoms and subjective well-being are set as indicators of mental health. A series of OLS regression models were conducted to estimate the effects of social capital on mental health and mental health inequality.

Results

Higher levels of social capital and income are related to a lower level of depressive symptoms and a higher level of subjective well-being. The positive coefficient of interaction term of family-level social capital and income level in the urban area indicates that the inhibiting effect of social capital on depressive symptoms is pro-poor. The negative coefficient of interaction term of village-level social capital and income level in the rural area suggests that the promoting effect of social capital on subjective well-being is pro-poor, too.

Conclusion

The results show that severe mental health inequality exists in China; family-level social capital can buffer depressive symptom inequality, and village-level social capital can buffer SWB inequality. Although the amount of social capital of the poor is less than the rich, the poor can better use social capital to improve their mental health. Our study advocates enhancing social participation and communication for the poor to reduce mental health inequality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-022-01642-3.

Health-related Quality of Life Increases After First-time Acute Myocardial Infarction: a Population-based Study

INTRODUCTION

Acute myocardial infarction (AMI) affects patients' health-related quality of life (HRQOL). AMI may decrease HRQOL, thus negatively affecting QOL. However, the improvements in interventional treatment and early rehabilitation after AMI may have a positive effect on HRQOL.

AIM

We evaluated HRQOL in patients after the first AMI treated in a reference cardiology centre in Poland and assessed which clinical variables affect HRQOL after AMI.

MATERIAL AND METHODS

We prospectively evaluated HRQOL in 60 consecutive patients suffering after their first AMI during the index hospitalisation and again after 6 months, using: (i) MacNew, (ii) World Health Organization Quality of Life (WHOQOL) BREF, and (iii) Short Form (SF) 36.

RESULTS

As measured by the MacNew questionnaire, global, social, and physical functioning did not change (p≥0.063), whereas emotional functioning improved 6 months after AMI, compared to index hospitalisation (p=0.002). As measured by WHOQOL BREF, physical health, psychological health, and environmental functioning did not change (p≥0.321), whereas social relationships improved 6 months after AMI (p=0.042). As assessed by SF-36, the global HRQOL improved after AMI (p=0.044). Patients with improved HRQOL in SF-36 often had a higher baseline body mass index (p=0.046), dyslipidaemia (p=0.046), and lower left ventricle ejection fraction (LVEF; p=0.013). LVEF<50% was the only variable associated with improved HRQOL in multivariate analysis (OR 4.463, 95% CI 1.045 - 19.059, p=0.043).

CONCLUSIONS

HRQOL increased 6 months after the first AMI, especially in terms of emotional functioning and social relationships. Patients with LVEF<50% were likely to have improved HRQOL.

Association between healthy lifestyle score changes and quality of life and health-related quality of life: a longitudinal analysis of South Korean panel data

OBJECTIVES

We aimed to determine the influence of changes in the aggregate score of healthy lifestyle factors on health-related quality of life (HRQOL) and overall quality of life (QOL) in the Korean older adult population.

DESIGN

This study used a longitudinal design.

SETTING AND PARTICIPANTS

Data on 9474 participants aged 45 years or older were extracted from the Korean Longitudinal Study on Aging for the period 2006-2016. A composite score of four lifestyle factors (smoking, drinking, physical activity and body mass index) was calculated, and biennial changes in aggregate score were computed.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcomes were HRQOL and QOL.

RESULTS

Generalised estimating equation analysis results showed that those with healthy lifestyle score changes from 'Low-High' (β =-0.987, p=0.002; β =-1.288, p<0.0001), 'High-Low' (β =-1.281, p<0.0001; β =-1.952, p<0.0001) and 'Low-Low' (β =-1.552, p<0.0001; β =-2.398, p<0.0001) groups were more likely to be have lower HRQOL and QOL estimates than those in 'High-High' group. Female gender, older age and depression had a more negative impact on HRQOL, while male gender and younger age had a more negative impact on QOL, especially in the Low-Low group. The relationship between changes in scores and HRQOL and QOL varied across different elements of healthy lifestyle scores. Changes in physical activity, drinking and smoking status were significantly associated with lower HRQOL and QOL.

CONCLUSION

The findings suggest an association between a low healthy lifestyle score and poor quality of life, in both general and health-related aspects. Strategies targeting the Korean ageing demographic to promote a healthier lifestyle should be encouraged.

Stay Slim or Get Fat?: An Examination of the "Jolly Fat" Effect in Chinese Older Adults

Purpose

The association between body mass index (BMI) and health-related quality of life (HRQOL) has not been verified neither in China nor in any other Asian country. This study aimed to examine the association between BMI and HRQOL in the Chinese older adults population.

Methods

A total of 5018 older adults from the China’s Health-Related Quality of Life Survey for Older Adults 2018 was included in this study. The HRQOL was measured by the Chinese version of the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD). Multiple linear regression analysis was used to explore the associations between BMI and HRQOL among the older adults in rural, urban, and total samples.

Results

After adjusting all the confounders, compared with normal weight group, underweight was negatively correlated with the total scores of HRQOL among the older adults in rural (B= −2.310, p < 0.01), urban (B= −1.019, p < 0.001), and total samples (B= −2.351, p < 0.001), whereas overweight was positively associated with the total scores of HRQOL among the older adults in rural samples (B= 0.888, p < 0.05). The results showed that obesity was not associated with the total scores of HRQOL among the older adults in rural (B= −1.214, p > 0.05), urban (B= −0.074, p > 0.05), and total samples (B= −1.461, p > 0.05).

Conclusion

This study suggests that obese Chinese older adults did not show a better quality of life than those of normal weight. But this result does not deny the “jolly fat” hypothesis entirely, as the overweight older adults from rural areas showed better HRQOL. Moreover, underweight older people show a poorer HRQOL. The relationship between BMI and HRQOL in the older adults needs to be differentiated according to different characteristics of the population.

Pharmacoeconomics of obesity in China: a scoping review

Background: With the growing rate of obesity and associated chronic conditions in China, there is a need to assess the health and economic burdens of obesity and examine the effectiveness of pharmaceutical, medical, and comprehensive weight-loss interventions.Areas covered: This article reviewed publications retrieved from PubMed and Google Scholar during 2010-2020 on pharmacoeconomic studies related to overweight and obesity in China. We identified five cost-of-illness studies and four cost-effectiveness analyses of weight-loss interventions, including bariatric surgeries and a comprehensive intervention program.Expert opinion: There is a lack of pharmacoeconomic analyses of obesity in China. Existing studies have often taken the health system perspective without accounting for productivity loss. Cohort studies and studies based on electronic health records or claims data are needed to provide the epidemiologic parameters required for homegrown economic evaluations of the health and economic burdens of obesity in China, as well as the cost-effectiveness of interventions to reduce obesity and its sequela.

Health-related quality of life and related factors among pregnant women

CONTEXT

Quality of life is significant in all stages of life, including within pregnancy. The hormonal, emotional, psychological, and physical factors specific to pregnancy can affect and threaten the quality of life of pregnant mothers.

AIMS

This study sought to investigate the health-related quality of life (HRQoL) and related factors among pregnant women.

SETTINGS AND DESIGN

This cross-sectional study was performed on 300 pregnant women who were in the second and third trimesters of pregnancy without any risk of high-risk pregnancy covered by a community health center in Yazd, Iran, between 2018 and 2019.

SUBJECTS AND METHODS

The required data were collected using demographic questionnaire and HRQoL (SF-12v2) questionnaire.

STATISTICAL ANALYSIS USED

Data were analyzed using SPSS 18 software and ANOVA statistical tests (P < 0.05).

RESULTS

Physical dimension of quality of life of pregnant women had the mean and standard deviation of 43.7 ± 7.3 and that psychological dimension had the mean and standard deviation of 31.5 ± 11.8. Physical dimension of quality of life was significantly correlated with maternal age, gestational age, body mass index before 12 weeks of pregnancy, mother's education and job as well as spouse's level of education (P < 0.05). Furthermore, the psychological dimension of quality of life was significantly correlated with gestational age, mother's education and occupation as well as spouse's level of education (P < 0.05).

CONCLUSIONS

According to the findings, attention to physical and psychological aspects of quality of life of pregnant women and demographic factors affecting it is essential for improving maternal and child health during and after pregnancy.

The COVID-19 Pandemic Lockdowns and Changes in Body Weight among Polish Women. A Cross-Sectional Online Survey PLifeCOVID-19 Study

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.

Health-related quality of life and determinants in North-China urban community residents

BACKGROUND

The objectives of this study were to investigate the HRQoL of residents living in central urban areas (CUA) and developing neighborhoods (DN) areas of North-China and to examine the relationship between health conditions and the physical and mental components of quality of life.

METHODS

A stratified random sample was taken and health survey scoring system questionnaire SF-36 was used to conduct the HRQoL survey among community residents in the two selected districts in 10 cities. A general questionnaire was also administered with questions that collected general information, population demographic characteristics and health behaviours, social relationships and perception of life satisfaction.

RESULTS

Five thousand eight hundred eighty-one questionnaires were returned from 6059 invitations with a effective response rate of 97%. The residents in DN had a higher score of physical function, role limitation due to physical problems and vitality than those living in CUA. The prevalence of several chronic diseases was lower in DN's residents than CUA's residents. Age, presence/absence of chronic diseases, leisure time exercise, regular daily routine, sleep quality, appetite, family and social relationships and life satisfaction were significant determinants of HRQoL.

CONCLUSIONS

Residents living in newly developed neighborhoods in China while keeping some habits and lifestyles of their original rural communities are healthier in terms of chronic diseases and HRQoL. Together with other risk factors chronic diseases are an important determinant on HRQoL. Several healthy habits and behaviors such as having a regular daily routine and exercising during leisure time improved HRQoL in Chinese urban communities. Targeted policies of public health based on these findings can better the health-related quality of life.

Nutritional Determinants of Quality of Life in a Mediterranean Cohort: The SUN Study

Health related quality of life (HRQoL) is a subjective appreciation of how personal characteristics and health influence well-being. This cross-sectional analysis aimed to quantitatively measure the influence of dietary, lifestyle, and demographic factors on HRQoL. A sub-sample of the Seguimiento Universidad de Navarra (SUN) Project, a Mediterranean cohort, was analyzed (n = 15,674). Through self-administered questionnaires the relationship between HRQoL and dietary patterns (Mediterranean-diet (MedDiet) and provegetarian food pattern (FP) assessment), lifestyles (sleeping hours, physical activity) and demographic characteristics were measured. Multivariate linear regression and flexible regression models were used to estimate the pondered effect of personal factors on Short Form-36 (SF-36) scores. Coefficients for MedDiet and provegetarian scores (β-coefficient for global SF-36 score: 0.32 (0.22, 0.42); 0.09 (0.06, 0.12) respectively for every unit increase), physical activity (β: 0.03 (0.02, 0.03) for every metabolic equivalent of task indexes (MET)-h/week) had a positive association to HRQoL. The female sex (β: −3.28 (−3.68, −2.89)), and pre-existing diseases (diabetes, β: −2.27 (−3.48, −1.06), hypertension β: −1.79 (−2.36, −1.22), hypercholesterolemia β: −1.04 (−1.48, −0.59)) account for lower SF-36 scores. Adherence to MedDiet or provegetarian FP, physical activity and sleep are associated with higher HRQoL, whereas the female sex, “other” (versus married status) and the presence of chronic diseases were associated with lower SF-36 scores in this sample.

The prevalence and correlates of burnout among Chinese preschool teachers

BACKGROUND

A series of studies have suggested that teachers are likely to experience professional burnout in various regions around the world. To date, no known research has been conducted to investigate the prevalence and correlates of burnout among preschool teachers in China. This study examined the level of self-reported burnout and correlates of burnout among Chinese preschool teachers.

METHODS

A cross-sectional study was conducted among1795 preschool teachers in Tianjin, China, during August 2018-October 2018. The validated Chinese version of the 15-item Maslach Burnout Inventory was used to assess burnout. A self-administered questionnaire collected the sociodemographic factors. The psychological factors were collected by the Chinese version of the 20-item Center for Epidemiologic Studies Depression Scale (CES-D) and the Perceived Stress Scale-14.

RESULTS

The prevalence of burnout in Chinese preschool teachers was 53.2% (95% CI:51%─56%). Burnout rate was significantly decreased in overweight (P = 0.001, OR = 0.58, 95% CI: 0.42-0.79) and obesity (P = 0.048, OR = 0.75, 95% CI: 0.56-1.00) teachers compared with teachers with normal weight. The type of school (P = 0.007, OR = 1.45, 95% CI: 1.11-1.91), income satisfaction (P = 0.001, OR = 0.67, 95% CI: 0.53-0.86), depression (P < 0.001, OR = 3.08, 95% CI: 2.34-4.05) and perceived stress (P < 0.001, OR = 1.15, 95%CI: 1.13-1.18) were significantly associated with burnout.

CONCLUSIONS

The prevalence of burnout among preschool teachers in Tianjin, China, is high. Burnout was significantly associated with BMI, the type of school, income satisfaction, depression and perceived stress among Chinese preschool teachers.

Gender differences in the association between body mass index and health-related quality of life among adults:a cross-sectional study in Shandong, China

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.

Application of the short form of quality of life instrument version 2 in a large population of Tehran

Background: Quality of life (QoL) is now considered as a key indicator in health studies. Therefore, this study was conducted to evaluate QoL in the general population of Tehran (capital of Iran) using SF-12v2 questionnaire and determine some factors associated with it.

Methods: This was part of a large population-based cross sectional study conducted in Tehran, Iran, in 2011. Participants were selected from all districts of Tehran using multistage cluster random sampling method. Data were collected using the Iranian version of the SF12v2 questionnaire. Linear regression model was used to assess the independent effect of surveyed variables of the study population on their QoL. P< 0.05 was considered statistically significant.

Results: Overall, 30 809 individuals over the age of 20 from 22 urban districts were included in this study and evaluated by SF-12v2 questionnaire. The mean age of the study population was 44.5±15.9, and most of them were female (19 967 (64.8%)). The total mean score of SF-12v2 was 60.4 and the lowest and highest mean scores were observed in GH (46.9±26.5) and MH subscales (64.1±24.7), respectively. It was also observed that District 3 of Tehran had the highest mean score (65.2±18.7) in the total QoL and District 12 had the lowest mean score (56.6±18.7), respectively. The results of multiple linear regression model showed that sex, age, education, household size, presence of chronic disease in family, having insurance, smoking, and marital status were significantly related to most subscales and two summary components of QoL.

Conclusion: The results of this study showed that the surveyed population of Tehran had a relatively moderate QoL, but it changed from district to district. It was also observed that age and education of the study population were important variables in relation to QoL.

Which obesity phenotypes predict poor health-related quality of life in adult men and women? Tehran Lipid and Glucose Study

Purpose

This study aimed to explore the association between different obesity phenotypes and health-related quality of life (HRQoL) among Tehranian men and women.

Methods

The participants of this study were 2880 healthy adults (aged>19 years) who participated in Tehran Lipid and Glucose Study (TLGS). To obtain socio-demographic and HRQoL information, participants were interviewed by trained interviewers and were stratified by body mass index categories and metabolic status. Dysmetabolic status was defined as having either metabolic syndrome or diabetes according to the Joint Interim Statement definition and American Diabetes Association. Poor HRQoL was defined as the first quartile of HRQoL scores and logistic regression analysis was used to compare sex-specific odds ratios.

Results

Mean age of participants was 47.7±15.6 and 47.8±14.2 years in men and women respectively. The most and the least common obesity phenotypes were overweight-normal metabolic status and normal weight-dysmetabolic status, respectively. Only mean scores for physical HRQoL were significantly different among obesity phenotypes in both men and women (p<0.05). In addition, after adjusting for age, marital status, level of education, job status and physical activity, the odds of reporting poor physical HRQoL was significantly higher in men (OR: 1.960, 95% CI: 1.037–3.704; p<0.05) and women (OR: 2.887, 95% CI: 1.674–4.977; p<0.001) with obese-dysmetabolic status, compared to their counterparts with normal weight-normal metabolic status. However, except for overweight-normal metabolic women, who were less likely to report poor mental HRQoL (OR: 0.638, 95% CI: 0.415–0.981; p<0.05), none of the phenotypes were associated with poor mental HRQoL in either gender.

Conclusions

Compared to those with normal weight normal metabolic status, only obese dysmetabolic individuals were more likely to report poor physical HRQoL in both genders.

Acute Intermittent Porphyria in the North of China: The Acute Attack Effect on Quality of Life and Psychological Condition

Background

Acute intermittent porphyria (AIP) is an autosomal recessive disorder with intermittent attacks. Patients with AIP are susceptible to impaired quality of life and psychological distress.

Objectives

To document the clinical features of AIP and its impact on SF-36 and IES scores of AIP patients in China and to explore the variables associated with SF-36 and IES scores.

Methods

A single investigator collated data related to treatments and outcomes in 27 patients with AIP of PUMCH. A cross-sectional questionnaire survey including the SF-36, the IES-R, and demographic questions was conducted in the north of China. Differences in the QoL scale/summary scores and proportions in the QoL dimensions between patients and the general population were analyzed. Independent effects of chronic conditions and demographic variables on the SF-36 and IES-R were analyzed.

Results

AIP patients had considerably lower SF-36 scores than the general population (the PF score and MH were lower than normal, P < 0.05). Working had higher RP than staying at home (P = 0.02); “without acute attack” had higher PF and BP scores and PCS composite score (P = 0.001). The mean IES-R score of AIP was higher than normal (36.7 ± 11.8 points, P < 0.001), “without acute attack” had lower intrusion score than “with acute attack” (P = 0.03).

Conclusion

AIP patients in China had impaired quality of life, especially in terms of physical health. The acute attacks coursed the posttraumatic stress disorder-related symptoms.

Socioeconomic patterns of underweight and its association with self-rated health, cognition and quality of life among older adults in India

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.

Being slightly overweight is associated with a better quality of life in breast cancer survivors

To examine the association between BMI and QOL in breast cancer survivors in China, we conducted a cross-sectional survey and recruited 10708 breast cancer survivors. Survivors self-reported QOL was measured using the EORTC QLQ-C30 and the QLQ-BR23. The impact of BMI on QOL was examined through standard least squares regression. Normal weight and overweight survivors were more likely to have a better QOL than underweight and obese survivors and the results were similar to survivors diagnosed as having chronic diseases. After adjustment for clinical and sociodemographic factors, the QOL increased with increasing BMI in breast cancer survivors ranged from underweight to overweight with no chronic diseases, especially in the scales of emotional function and fatigue. Obese breast cancer survivors reported a significantly worse QOL compared to normal weight and overweight breast cancer survivors. Within breast cancer survivors with one or more chronic diseases, it was more obvious that overweight ones had a significantly better QOL with clear evidence of a dose relationship across underweight to overweight in almost all scales. Unlike obese breast cancer survivors without chronic diseases, the ones with chronic disease(s) had a similar QOL compared to normal weight breast cancer survivors in all scales except in the domain of fatigue.

Determinants of Health Status Three to Six Years After Surgical Treatment of Closed Ankle Fracture and Comparison with the General Population: A Historical Cohort Study

Background:

The purposes of the present study were to identify the determinants of health status 3 to 6 years after open reduction and internal fixation (ORIF) for the treatment of closed ankle fracture and to compare the health status of patients who had undergone this procedure with that in the general population after adjusting for sociodemographic variables, body mass index (BMI), and smoking status.

Methods:

The present study was a historical cohort study combined with a postal survey. In total, 1,149 patients who underwent ORIF for the treatment of closed ankle fractures at 2 hospitals were eligible for chart review; 959 with low-energy fractures were eligible for a postal survey, and 471 (49%) responded to the Short Form Health Survey-36 (SF-36) health status questionnaire and provided data on BMI. Determinants of the physical functioning (PF), physical component summary (PCS), and mental component summary (MCS) scores of the SF-36 were analyzed by means of multivariable linear regression analysis. The health status of patients with an ankle fracture (n = 471) was compared with that in a sample of the general population (n = 5,396) by means of multivariable regression.

Results:

Age, American Society of Anesthesiologists (ASA) class III, and complications following surgery were associated with PF and PCS scores, and a BMI of ≥30 kg/m² and current smoking status was associated with PF and MCS scores. However, the PF, PCS, and MCS scores of patients with ankle fractures did not differ from those of the general population, with unstandardized regression coefficients of 0.25 (95% confidence interval [CI], –1.67 to 2.16; p = 0.80), 0.67 (95% CI, –0.35 to 1.70; p = 0.199), and –0.57 (95% CI, –1.63 to 0.49; p = 0.29), respectively.

Conclusions:

Age, ASA class III, and complications following surgery were associated with PF and PCS scores at 3 to 6 years after surgery for the treatment of closed ankle fractures. However, the health status of patients with ankle fractures did not differ from that in the general population after adjusting for differences in demographic variables, BMI, and smoking status.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Disease activity, resilience and health-related quality of life in Chinese patients with rheumatoid arthritis: a multi-center, cross-sectional study

Background

Positive psychological constructs that can moderate or mediate the negative impact of disease activity on health-related quality of life (HRQOL) in patients with rheumatoid arthritis (RA) have not been explored widely. This study aimed to assess the associations of disease activity, resilience with HRQOL and the moderating and mediating roles of resilience among Chinese RA patients.

Methods

A multi-center, cross-sectional study was conducted in RA inpatients in northeast of China. A total 298 subjects completed the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) and Ego-Resiliency Scale (ERS) to measure HRQOL and resilience. For the SF-36, physical function, physical role limitation, bodily pain and general health perception are gathered into physical component summary (PCS), while vitality, social functioning, emotional role limitation and mental health are gathered into mental component summary (MCS). Disease activity was evaluated by the Disease Activity Score 28-C-reactive protein (DAS28-CRP). Hierarchical regression analysis was applied to examine the associations of disease activity, resilience and the disease activity*resilience interaction with PCS and MCS, respectively. Asymptotic and resampling strategies were utilized to examine the mediating role of resilience.

Results

The mean scores of PCS and MCS were 40.67 and 59.14, respectively. Disease activity was negatively associated with both PCS and MCS, and resilience was only positively associated with MCS. The disease activity*resilience interaction term were significantly associated with MCS (β = 0.144, P = 0.003). The associations between disease activity and MCS were gradually reduced in low (1 SD below the mean, β = −0.369, P < 0.001), mean (β = −0.218, P < 0.001) and high (1 SD above the mean, β = −0.068, P = 0.369) groups of resilience. Resilience acted as a partial mediator in the disease activity-MCS association (effect size was −0.085, BCa 95% CI: −0.159, −0.028).

Conclusions

Disease activity was negatively associated with both physical and mental HRQOL, and resilience was only positively associated with mental HRQOL. Resilience could attenuate and mediate the association between disease activity and mental HRQOL. In addition to controlling disease activity, targeted intervention strategies designed for resilience should be strengthened to improve the HRQOL of this population.

Association between Nine Types of TCM Constitution and Five Chronic Diseases: A Correspondence Analysis Based on a Sample of 2,660 Participants

OBJECTIVE

The purpose of this study was to explore the association of nine types of Traditional Chinese Medicine (TCM) constitution with the five chronic diseases: hypertension, hyperlipidemia, diabetes mellitus, heart disease, and obesity.

METHODS

Chi-squared test was performed to investigate the distribution characteristics of TCM constitutions in the participants with the five chronic diseases in questionnaire. Correspondence analysis was used to explore the correlation between them.

RESULTS

A total of 2,660 participants (1,400 males; 1,260 females) were included in this study. The mean age was 52.54 ± 13.92. Of them, 600 were of gentleness type accounting for 22.56%. Proportions of gentleness type in the chronic diseases (16.00%~23.70%) were less than that in general population (32.14%). The gentleness type and yin-deficiency type were significantly correlated with hypertension and diabetes mellitus, qi-deficiency type was correlated with heart disease, phlegm-dampness type was associated with obesity, and dampness-heat type was correlated with hyperlipidemia.

CONCLUSIONS

The correlations between TCM constitution types and the five chronic diseases were different. This may have a significant implication for TCM practice, and even the people with gentleness type should not be ignored in health management.

Body mass index, waist circumference and waist-hip ratio are associated with depressive symptoms in older Chinese women: results from the Rugao Longevity and Ageing Study (RuLAS)

OBJECTIVE

The objective was to determine whether obesity is associated with depressive symptoms among older Chinese.

METHODS

Data from the cross-sectional Rugao Longevity and Ageing Study were used including anthropometric measurements (body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR)), socio-demographic characteristics, living habits, physical health and cognitive impairment. Depressive symptoms were assessed by the 15-item Geriatric Depression Scale (GDS-15). Chi-square tests and multivariate logistic regression analyses were performed to investigate the association between obesity and depressive symptoms.

RESULTS

Among 1732 elderly Chinese aged 70-84 years, the prevalence of depressive symptoms was 6.7% (5.0%-8.5%) in men and 12.5% (10.4%-14.6%) in women. A negative linear trend was found between depressive symptoms and BMI in women (P_{for trend} < 0.05). Women with BMI ≥ 28.0 kg/m² had lower chances (OR = 0.41 (0.20-0.84), p = 0.01) to have elevated depressive symptoms compared with their normal weight counterparts. Furthermore, consistent trends were observed with lower depression prevalence rates in higher WC and WHR categories in women. However, no such associations were apparent in men.

CONCLUSION

Higher BMI, WC and WHR categories were all associated with a lower risk of depressive symptoms in older women.

Pathways linking obesity to health-related quality of life

PURPOSE

Obesity is a well-recognized risk factor for impaired health-related quality of life (HRQOL). Nevertheless, few studies have investigated the mechanisms underlying the obesity-HRQOL associations. In this study, we explored potential mediators of the associations between obesity and HRQOL.

METHODS

Body mass index (BMI), an indicator of obesity, and HRQOL data were available for the 34,565 individuals 20 years of age and older participating in the cross-sectional Korea National Health and Nutrition Examination Survey 2007-2012. HRQOL was measured by the EuroQol five-dimension descriptive system. Path analysis was performed to assess the contributions of obesity-related diseases and self-rated health (SRH) on the relationships between obesity and HRQOL.

RESULTS

In men, obesity was negatively associated with HRQOL through diabetes mellitus, hypertension, and dyslipidemia and positively associated with HRQOL through SRH. These opposite indirect effects offset one another and produced a non-significant association between obesity and HRQOL in men. However, in women, obesity was directly associated with HRQOL and indirectly associated with HRQOL through diabetes mellitus and SRH. Since these associations were in the same negative direction, the negative obesity-HRQOL association was clearly observed in women.

CONCLUSIONS

Obesity was negatively associated with HRQOL through obesity-related diseases in both genders. However, in men, the positive association between obesity and SRH resulted in a non-significant association of obesity with HRQOL.

Superiority of laparoscopic proximal gastrectomy with hand-sewn esophagogastrostomy over total gastrectomy in improving postoperative body weight loss and quality of life

BACKGROUND

Proximal gastrectomy is not widely performed because the procedure is complicated, particularly under laparoscopy. We developed a simple laparoscopic technique of hand-sewn esophagogastrostomy with an anti-reflux mechanism. This study aimed to evaluate and compare the postoperative body weight loss (BWL) and quality of life (QOL) following laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG) in patients with upper gastric cancer.

METHODS

We retrospectively analyzed patients with stage I upper gastric cancer undergoing LPG or LTG at Kyoto University Hospital between March 2006 and June 2014. The main outcome measures were the % BWL 1 year after gastrectomy, postoperative anastomotic stricture, and reflux esophagitis. Additionally, patient-reported outcomes were evaluated using the Post-Gastrectomy Syndrome Assessment Scale (PGSAS)-45 in patients presenting at the outpatient clinic and exhibiting no recurrence.

RESULTS

A total of 62 patients were included in this study (LTG, n = 42 vs. LPG, n = 20). The % BWL at 12 months in the LPG group was less than that in the LTG group (-16.3 vs. -10.7%). Multivariate analysis revealed that LPG was associated with less BWL (P = 0.003). Anastomotic stricture occurred more frequently in the LPG group than in the LTG group (0 vs. 25%). One patient in each group exhibited grade B severity of reflux esophagitis (based on the Los Angeles classification). In the questionnaire survey, LPG was better than LTG in terms of diarrhea and dissatisfaction with symptoms. In terms of reflux symptoms, patients in the LPG group experienced less acid and bile regurgitation symptoms compared with those in the LTG group.

CONCLUSIONS

LPG with hand-sewn esophagogastrostomy results in less postoperative BWL and better QOL than LTG despite higher rates of anastomotic stricture.

Hypertension Impact on Health-Related Quality of Life: A Cross-Sectional Survey among Middle-Aged Adults in Chongqing, China

Hypertension is a major risk factor of cardiovascular disease in China, and yet little is known about health-related quality of life (HRQOL) and its associations with demographic and social-economic characteristics in middle-aged patients with hypertension. A cross-sectional survey was undertaken in Chongqing, China, using a multistage stratified random sampling methodology. Data was collected on 1,224 eligible adults, aged between 45 and 53 years, including the Medical Outcomes Survey Short Form-36 to measure HRQOL. Hypertension was associated with poor state of physical functioning, role-physical, bodily pain, general health, vitality, and social function (p < 0.05 for all). In multivariable analyses, education level, job conditions, average monthly income, smoking status, sleep quality, perception of relationship with family, childhood breastfeeding history, and body mass index were associated with domains of SF36 among those with hypertension (p < 0.05 for all). Hypertensive respondents with high education, marital status, breastfeeding, higher incomes, good quality of sleep, positive relationship with family, and higher body mass index have better HRQOL in middle-aged people with hypertension. Those unemployed had a better state of general health and had a poorer state of social function. Nonsmokers had a poorer state of bodily pain than smokers. This study provides detailed information of the implications for health care providers to gain a more complete picture of their hypertension patients' health.

Increased calf and plantar muscle fibrotic contents in obese subjects may cause ankle instability

Obesity is strongly associated with musculoskeletal disorders of the lower limb, including ankle instability and resulting gait problems. In the present study, we aimed to examine, using paired comparisons of subjects, whether moderate duration of obesity in patients with mild to moderate elevations of body mass index (BMI), changes the fibrous contents of muscles that support the ankle mortices, namely calf and plantar muscles. We attempted to examine these parameters because this shall provide direct evidence of whether obesity directly impacts myoarchitecture and support of the adjoining joints. MRI image segmentation and pixel correlations by grey level co-occurrence matrix (GLCM) and entropy were used to analyse the changes. The differences in the means between groups (both GLCM and entropy) were significant from control lean populations (P<0.0001, ANOVA) for the parameters examined for both the calf and the plantar muscles. Reduction in weight should thus be a first-line approach in preventing these changes that may significantly affect quality of life due to gait disturbances.

Gender-Related Differential Effects of Obesity on Health-Related Quality of Life via Obesity-Related Comorbidities: A Mediation Analysis of a French Nationwide Survey

BACKGROUND

Negative effects of obesity on health-related quality of life (HRQoL) have been reported, especially in women, but the relative contribution of cardiometabolic and other obesity-related comorbidities to such effects remains unclear. Our objective was to model the association by sex between body mass index and HRQoL and to precisely quantify the indirect effects mediated by obesity-related comorbidities.

METHODS AND RESULTS

Data were drawn from the latest French Decennial Health Survey, a nationwide cross-sectional study conducted in 2003 (21 239 adults aged 25-64 years analyzed). HRQoL was measured by the 36-item short-form health survey questionnaire. A mediation analysis based on the counterfactual framework was performed to quantify the proportion of obesity effects on HRQoL mediated by related comorbidities, including cardiometabolic risk factors (diabetes mellitus, hypertension, dyslipidemia) and diseases (ischemic heart disease, cerebrovascular, and peripheral vascular disease), musculoskeletal disorders, and asthma. After multiple linear regression, inverse associations were found between increasing body mass index category and physically oriented and most mentally oriented 36-item short-form health survey dimensions, with evidence of greater effects in women. Mediation analysis revealed that obesity effects were significantly mediated by several comorbidities, more apparently in men (eg, proportion of obesity class II total effect mediated via cardiometabolic factors: general health 27.0% [men] versus 13.6% [women]; proportion of obesity class II total effect mediated via total count of comorbidities: physical functioning 17.8% [men] versus 7.7% [women] and general health 37.1% [men] versus 20.3% [women]).

CONCLUSIONS

Women have a greater overall impact of obesity on HRQoL, but with proportionally lower effects mediated by cardiometabolic and other obesity-related conditions, suggesting the possible role of other specific psychosocial processes.

Health-related quality of life as measured with the Short-Form 36 (SF-36) questionnaire in patients with recurrent vulvovaginal candidiasis

BACKGROUND

Recurrent vulvovaginal candidiasis (RVVC) has a poor therapeutic outcome and a severe impact on women and their partners, both physically and psychologically. Health-related quality of life (HRQOL) is significantly affected in patients with RVVC; however, little is known about HRQOL in patients with this disease. In this study, we aim to identify the clinical and mycological characteristics of women with RVVC and the effects of RVVC on women's HRQOL.

METHODS

We designed this study as a comparative cross-sectional study. The Short-Form Health Survey (SF-36) was used to measure HRQOL in 102 patients with RVVC and 101 women seeking general health care (controls). RVVC was defined as four or more episodes of proven VVC in the previous 12-month period. VVC was defined as vulvar itching, burning, erythema, vaginal discharge, pseudohyphae or blastoconidia on a wet 10 % potassium hydroxide (KOH)-treated vaginal slide and a positive Candida culture. Group comparisons were conducted with independent samples t test. Correlation analysis was performed on the variables.

RESULTS

The mean age at first diagnosis of the patients with RVVC was 30.96 years (SD 5.38), and the mean age of the controls was 29.75 years (SD 5.83; p > 0.05). The duration of the patients' complaints varied from 6 months to 10 years, with a mean duration of 22.28 (±21.75) months. The most common complaints were increased vaginal discharge (102 cases, 100 %), itching (97 cases, 95.1 %), dyspareunia (65 cases, 63.7 %), burning (79 cases, 77.5 %) and erythema (25 cases, 24.5 %). C. albicans was the predominant Candida species (86 strains, 84.3 %) in the patients, followed by C. glabrata (12 strains, 11.8 %). C. parapsilosis (1 strain, 0.9 %), C. tropicalis (1 strain, 0.9 %), C. krusei (1 strain, 0.9 %) and C. lusitaniae (1 strain, 0.9 %). The mean SF-36 dimension scores for physical function, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health were significantly lower in the patients with RVVC than in the controls (85.20, 61.39, 77.79, 54.95, 53.17, 67.89, 52.48 and 59.17 vs. 90.20, 80.87, 87.08, 67.38, 59.69, 79.86, 68.01 and 65.38). The physical composite and mental composite scores of the patients with RVVC were 63.06 and 64.87, respectively, which were lower than those of the controls (75.01 and 74.87; p < 0.05).

CONCLUSIONS

Nearly all of the patients with RVVC had clinical symptoms. In our sample, RVVC was mainly caused by C. albicans. RVVC has negative effects on women's HRQOL, as indicated by lower physical and mental composite scores among the RVVC group compared with controls.

Associations between Dietary Factors and Self-Reported Physical Health in Chinese Scientific Workers

BACKGROUND

Scientific workers play an important role in the development of science and technology. However, evidence is lacking with regard to the associations between their dietary factors and their health-related quality of life (HRQOL).

METHODS

A cross-sectional survey was conducted among 775 scientific workers from multiple universities and institutes in the Southwest region of China. A self-administered food-frequency questionnaire was used to collect the food consumption information, and the 36-item Short-Form Health Survey was used to assess physical HRQOL. Hierarchical multiple regression analysis was used to identify the factors associated with scientific workers' HRQOL.

RESULTS

Physical HRQOL was negatively associated with age and intake of fresh pork (fat) and animal viscera, whereas consumption of vegetables, fruits, refined cereals and dairy products were positively correlated with physical HRQOL. Participants with daily intake of vegetable oils or mixed oils showed higher physical HRQOL scores than those with intake of animal oils.

CONCLUSIONS

Dietary habits are closely associated with the physical HRQOL of scientific workers. The dietary patterns that had more vegetables and fruits, less fresh pork (fat) and animal viscera, and used vegetable oils during cooking corresponded to higher physical HRQOL scores. These findings are important for planning dietary strategies to improve physical health in scientific workers.