Patterns of weight change associated with disease diagnosis in a national sample

The importance of weight stabilization amongst those with overweight or obesity: Results from a large health care system

Data on patterns of weight change among adults with overweight or obesity are minimal. We aimed to examine patterns of weight change and associated hospitalizations in a large health system, and to develop a model to predict 2-year significant weight gain. Data from the Duke University Health System was abstracted from 1/1/13 to 12/31/16 on patients with BMI ≥ 25 kg/m2 in 2014. A regression model was developed to predict patients that would increase their weight by 10% within 2 years. We estimated the association between weight change category and all-cause hospitalization using Cox proportional hazards models. Of the 37,253 patients in our cohort, 59% had stable weight over 2 years, while 24% gained ≥ 5% weight and 17% lost ≥ 5% weight. Our predictive model had reasonable discriminatory capacity to predict which individuals would gain ≥ 10% weight over 2 years (AUC 0.73). Compared with stable weight, the risk of hospitalization was increased by 37% for individuals with > 10% weight loss [adj. HR (95% CI): 1.37 (1.25,1.5)], by 30% for those with > 10% weight gain [adj. HR (95% CI): 1.3 (1.19,1.42)], by 18% for those with 5-10% weight loss [adj. HR (95% CI): 1.18 (1.09,1.28)], and by 10% for those with 5-10% weight gain [adj. HR (95% CI): 1.1 (1.02,1.19)]. In this examination of a large health system, significant weight gain or loss of > 10% was associated with increased all-cause hospitalization over 2 years compared with stable weight. This analysis adds to the increasing observational evidence that weight stability may be a key health driver.

Associations of weight changes with all-cause, cancer and cardiovascular mortality: A prospective cohort study

Objectives

Previous studies suggest that changes in body weight can lead to an increased risk of mortality in the general population, although the results are controversial. The current study sought to investigate this association further using data from the UK Biobank.

Study design

This is a large prospective population-based cohort study. Data were derived from the UK Biobank, with the initial assessments commencing between 2006 and 2010.

Methods

Proportional hazard models were used to assess the association between self-reported weight change and risk of all-cause, cancer and cardiovascular mortality. The effect of gender was also investigated.

Results

Of 433,829 participants with data for self-reported weight change, the mean age was 56 (standard deviation [SD]: 8.1) years and 55% were female. In total, 55% of participants reported no weight change, 28% gained weight, 15% lost weight, 2% did not know and 0.1% preferred not to give an answer. The median follow-up was 7.1 (interquartile range [IQR]: 6.4–7.8) years. Compared with participants with no weight change, those with weight loss had an increased risk of all-cause mortality (adjusted hazard ratio [HR] 1.25, 95% confident interval [CI] 1.18–1.32), cancer death (HR 1.17, 95% CI 1.08–1.27) and cardiovascular death (HR 1.26, 95% CI 1.12–1.43). Similarly, participants reporting weight gain also had an increased risk of all-cause mortality (HR 1.08, 95% CI 1.02–1.13), cancer death (HR 1.14, 95% CI 1.07–1.22) and cardiovascular death (HR 1.27, 95% CI 1.14–1.42). Participants who had a response ‘do not know’ or ‘prefer not to answer’ showed an increased risk of all-cause and cardiovascular mortality, particularly in men.

Conclusions

The results of this study highlight the importance of maintaining a stable weight in middle-aged adults. Further studies are needed to understand the pathophysiology of weight change and its effects on mortality.

Etiologies and 12-month mortality in patients with isolated involuntary weight loss at a rapid diagnostic unit

Background

Numerous studies on involuntary weight loss (IWL) have been published since the 1980s, although most of them have included small samples of patients with specific symptoms. The aim of the present study was to determine the causes, demographic and clinical characteristics and mortality at 12 months in patients attended at a rapid diagnostic unit (RDU) for isolated IWL.

Methods

A single-center retrospective observational study including all patients presenting to the RDU for isolated IWL between 2005 and 2013. The following data were recorded: demographic and clinical variables, results of complementary tests (blood tests, x-rays, computed tomography scan and digestive endoscopy), main diagnosis and vital status at 12 months.

Results

Seven hundred and ninety-one patients met the criteria for IWL. Mean age was 67.9 years (SD 4.7), 50.4% were male and mean weight loss was 8.3 kg (SD 4.7). The cause for IWL was malignant disease in 23.6% of patients, non-malignant organic disease in 44.5%, psychiatric disorder in 29.0% and unknown in 3.2%. Overall mortality at 12 months was 18.6% (95%CI: 16.1–21.6). The mortality rate was highest in the group with malignancy (61.1%; 95%CI: 54.2–68.2).

Conclusions

Almost a quarter of all patients attended at the RDU for IWL were diagnosed with cancer. Mortality at 12 months was higher in this group than in the other three. Malignancy should therefore be ruled out during the first visit for patients attended for IWL.

Association between weight loss since the age of 20 years and the risk of suicide death: A population-based cohort study

BACKGROUND

Past studies have demonstrated that body mass index (BMI) is inversely associated with the risk of suicide death. However, to our knowledge, no study has investigated the association between long-term weight change and the risk of suicide death. The purpose of this study was to investigate the association between weight change from the age of 20 years to middle or older age and the risk of suicide death in a population-based cohort.

METHODS

We analyzed follow-up data for 41,746 participants aged ≥40 years and calculated percent weight change from age 20 years to that at the survey baseline (mean age: 61.2 years). A Cox model was used to estimate the multivariate-adjusted hazard ratios (HRs) for suicide death.

RESULTS

The mean duration of follow up was 6.9 years, and suicide death was documented for 80 persons. Weight loss >5% (WL) was associated with a significantly higher risk of suicide death, with a multivariate-adjusted HR of 1.92 (95% confidence interval: 1.02-3.63). On the other hand, weight gain tended to be associated with a lower risk of suicide death. The significantly higher risk of suicide death observed among those showing WL did not change after excluding participants with a history of disease or psychological distress.

LIMITATIONS

No information was given regarding the reasons for weight change and suicide death.

CONCLUSIONS

The present results suggest that physicians should pay attention to individuals who lose weight from early adulthood because they could be at increased risk for suicide.

Overweight and Risk of Noncommunicable Diseases in Adulthood: An Analysis of NHANES IV 2015-2016

BACKGROUND

Worldwide, overweight is one of the main risk factors for Noncommunicable Diseases (NCDs). In this scenario, Body Mass Index (BMI) is the main tool to assess nutritional status of the adult population.

AIM

To analyze the association between overweight and the risk of developing type 2 diabetes Mellitus (T2DM) and/or high blood pressure (HBP) during adulthood.

SUBJECTS AND METHODS

We used data of subjects aged between 30-64 years old from the United States National Survey of Health and Nutrition Examination (2015-2016). We calculated the risk of developing T2DM and/or HBP in adulthood using a Log-Binomial Regression model. We included sampling weights in our analysis and we adjusted it for confounding factors.

RESULTS

We evaluated a total of 2,666 individuals. Overweight affected around 38% of the sample when they were 25 years old and around 70% during the interview. We found 4 factors (overweight, smoking, sedentary lifestyle, and age) that were positively associated with the development of T2DM and/or HBP. Long-term overweight more than doubles the risk of developing these diseases [RR = 2.44; 95%CI: 1.92-3.09].

CONCLUSION

The incidence of T2DM and/or HBP were positively associated with the overweight in adulthood. These results suggest that the prevention of overweight could decrease NCDs prevalence into adulthood.

Automated data cleaning of paediatric anthropometric data from longitudinal electronic health records: protocol and application to a large patient cohort

‘Big data’ in healthcare encompass measurements collated from multiple sources with various degrees of data quality. These data require quality control assessment to optimise quality for clinical management and for robust large-scale data analysis in healthcare research. Height and weight data represent one of the most abundantly recorded health statistics. The shift to electronic recording of anthropometric measurements in electronic healthcare records, has rapidly inflated the number of measurements. WHO guidelines inform removal of population-based extreme outliers but an absence of tools limits cleaning of longitudinal anthropometric measurements. We developed and optimised a protocol for cleaning paediatric height and weight data that incorporates outlier detection using robust linear regression methodology using a manually curated set of 6,279 patients’ longitudinal measurements. The protocol was then applied to a cohort of 200,000 patient records collected from 60,000 paediatric patients attending a regional teaching hospital in South England. WHO guidelines detected biologically implausible data in <1% of records. Additional error rates of 3% and 0.2% for height and weight respectively were detected using the protocol. Inflated error rates for height measurements were largely due to small but physiologically implausible decreases in height. Lowest error rates were observed when data was measured and digitally recorded by staff routinely required to do so. The protocol successfully automates the parsing of implausible and poor quality height and weight data from a voluminous longitudinal dataset and standardises the quality assessment of data for clinical and research applications.

Obesity and Incident Prescription Opioid Use in the U.S., 2000-2015

INTRODUCTION

Prior studies have identified associations between obesity and numerous conditions that increase risks for chronic pain. However, the impact of obesity on prescription opioid use is not well known. This study investigates the association between obesity and incidence of long-term prescription opioid use.

METHODS

Fifteen panels of the Medical Expenditure Panel Survey from 2000 to 2015 were pooled to generate a sample of civilian non-institutionalized adults aged 30-84 years who were prescription opioid-naïve for approximately 9 months. Incident long-term prescription opioid use was defined as reporting use at 2 of 3 interviews during a 15-month follow-up. BMI was reported at baseline. Analyses were completed in 2019.

RESULTS

Among opioid-naïve adults (n=89,629), obesity was strongly associated with incident long-term prescription opioid use. The association increased at progressively higher BMI values, with 24% elevated odds (95% CI=7%, 44%) in adults with overweight (25-29.9 kg/m²) and 158% increased odds (95% CI=106%, 224%) among adults with Class III obesity (40-49.9 kg/m²). These associations grew with higher-dosage opioids. Of the reasons for opioid use, joint pain, back pain, injury, and muscle/nerve pain contributed the most to the excess use observed among adults with obesity. At the population level, 27.0% of incident long-term prescription opioid use (95% CI=19.0%, 34.8%) was attributable to adults having a BMI above normal weight (25-49.9 kg/m²).

CONCLUSIONS

These findings suggest that obesity has contributed to prescription opioid use in the U.S. Future investments in chronic pain reduction may benefit from increased integration with obesity prevention and treatment.

Associations between nutritional factors and chemotherapy toxicity in older adults with solid tumors

BACKGROUND

Nutritional status can directly affect morbidity and mortality in older adults with cancer. This study evaluated the association between pretreatment body mass index (BMI), albumin level, and unintentional weight loss (UWL) in the prior 6 months and chemotherapy toxicity among older adults with solid tumors.

METHODS

This was a secondary analysis of a prospective, multicenter study involving chemotherapy-treated patients 65 years old or older. Geriatric assessment, BMI, albumin level, and UWL data were collected before treatment. Multivariable logistic regression models evaluated the associations between nutritional factors and the risk of grade 3 or higher (grade 3+) chemotherapy toxicity.

RESULTS

Seven hundred fifty patients with a median age of 72 years (range, 65-94 years) and mostly stage IV disease were enrolled. The median pretreatment BMI and albumin values were 26 kg/m2 (range, 15.1-52.1 kg/m2 ) and 3.9 mg/dL (range, 1.0-5.0 mg/dL), respectively. Nearly 50% of the patients reported UWL, with 17.6% reporting >10% UWL. Multivariable analysis revealed no association between >10% UWL and a risk for grade 3+ chemotherapy toxicity (adjusted odds ratio [AOR], 0.87; P = .58). Multivariable analysis showed a trend toward an association between a BMI ≥ 30 kg/m2 and a decreased risk of grade 3+ chemotherapy toxicity (AOR, 0.65; P = .06), whereas a low albumin level (≤3.6 mg/dL) was associated with a higher risk of grade 3+ chemotherapy toxicity (AOR, 1.50; P = .03). An analysis of the joint effect of BMI and albumin demonstrated the lowest risk of grade 3+ chemotherapy toxicity among patients with high BMIs (≥30 kg/m2 ) and normal albumin levels (AOR, 0.41; P = .008).

CONCLUSIONS

Among older adults with solid tumors, higher BMIs and normal albumin levels are associated with a lower risk of grade 3+ chemotherapy toxicity. Additional research is warranted to define the clinical significance of nutritional markers and to inform future interventions.

Relation of Change of Body Mass Index to Long-Term Mortality After Cardiac Catheterization

Body-mass index (BMI) is a risk marker and therapeutic target in cardiovascular prevention. The effect of changes in BMI on mortality in patients with cardiovascular diseases has not been completely delineated. We aimed to assess the association between percent change in BMI, as measured 3-years after cardiac catheterization, and long-term mortality. Patients who underwent cardiac catheterization (n = 11,220; mean age 63 ± 10 years) were categorized according to BMI groups (normal-weight, 18.50 to 24.99 kg/m²; overweight, 25.00 to 29.99 kg/m²; obesity, ≥30 kg/m²). Follow-up BMI was considered the level measured closest to the timepoint of 3 years post catheterization. Percent change in BMI was calculated and its association with long-term all-cause mortality was investigated. Change in BMI of ±5% was observed in 46% of the patients, a decrease >5% in 15.5%, and an increase of >5% of BMI in 38.5%. Compared with those with the lowest change in BMI (±5%), the adjusted hazard ratios for mortality were 1.45 (95% confidence interval [CI], 1.27 to 1.65), and 1.69 (1.46 to 1.95) in patients with 5% to 10% and >10% decrease in BMI, respectively, and 1.05 (0.94 to 1.17), 1.15 (1.03 to 1.28), and 1.40 (1.19 to 1.64) in patients with 5% to 10%, 10% to 20% and >20% increase in BMI, respectively. The pattern was similar in normal-weight, overweight, and obese subgroups at baseline. However, the magnitude of the association with decrease BMI was more pronounced in normal-weight patients (P-for-interaction 0.031). In conclusion, the association of percent changes in BMI after cardiac catheterization and all-cause mortality had a reversed J-shaped pattern, with both weight loss and weight gain being associated with increased risk. A decrease in BMI was related to higher mortality rates than was an increase in BMI for a comparable degree of percent change.

Health Lifestyles in Late Middle Age

A growing body of work identifies distinct health lifestyles among children, adolescents, and young adults and documents important social correlates. This study contributes to that line of research by identifying the health lifestyles of U.S. adults entering late middle age, assessing structural predictors of membership in different health lifestyles in this understudied age-group, and examining net associations between health lifestyles, chronic conditions, and physical health. The data come from the National Longitudinal Survey of Youth 1979 50+ Health Module. The analysis is based on respondents who answered the 50+ Health Module in 2008, 2010, 2012, or 2014 (N = 7,234). The results confirm similar relationships between health lifestyles and structural factors like class, gender, and race that prior studies observe and also reveal a unique pattern of associations between health lifestyle and health status because of diagnosed conditions that impact health behaviors in adulthood.