New NHLBI clinical guidelines for obesity and overweight: will they promote health?

The Association between Brain-Derived Neurotrophic Factor (BDNF) Protein Level and Body Mass Index

Background and Objectives: Obesity is a major health concern worldwide. Many studies emphasize the important role of brain-derived neurotrophic factor (BDNF) in regulating appetite and body weight. We aimed to investigate the association between BDNF protein serum levels and body mass index (BMI). Materials and Methods: We conducted a cross-sectional study among 108 healthy adult participants divided into six categories depending on their body mass index (BMI). The ages of the participants ranged between 21 to 45 years. The BDNF serum level was measured using the enzyme-linked immunosorbent assay (ELISA) technique. Results: A Kruskal−Wallis test showed a significant difference in BDNF between the different BMI categories, χ2(2) = 24.201, p < 0.001. Our data also showed that BDNF levels were significantly lower in people with obesity classes II and III than those of normal weight (p < 0.05). The Spearman rank correlation test was statistically significant with negative correlations between the BMI and BDNF (r) = −0.478, (p < 0.01). Moreover, we observed a negative dose-dependent relationship pattern between BMI categories and the levels of circulating BDNF protein. Conclusions: In this study, our data support the hypothesis that low serum levels of BDNF are associated with high BMI and obesity in Saudi adults.

Improving Body Mass Index of School-Aged Children Using a Nine-Week Rope Skipping Training Intervention: A One-Group Pre-Test Post-Test Design

Studies examining the effectiveness of rope skipping training to improve the body mass index (BMI) of school children are scarce. Hence, this study examined the effectiveness of nine-week skipping training on the BMI of primary six school-aged children (n = 77). The participants underwent 30 min of skipping training three days per week over a nine-week period. The participants’ BMI was measured at the baseline and during weeks 3, 6 and 9. The results from a one-way ANOVA with repeated measures indicated a statistically significant difference in the BMI for both males [F(3,111) = 9.42, p < 0.001, ηp2 = 0.203] and females [F(3,114) = 7.35, p < 0.001, ηp2 = 0.162], suggesting an improvement in BMI. Post hoc comparisons with a Bonferroni adjustment revealed significant differences in BMI after nine weeks of intervention for males between the pre-test (M = 21.47, SD = 4.94) and the 9-week post-test (M = 20.15, SD = 4.36), and for females between the pre-test (M = 21.56, SD = 5.80) and the 9-week post-test (M = 20.68, SD = 5.32). This study demonstrated that regular participation in vigorous physical activity such as skipping training could promote child health by preventing the likelihood of young children being overweight. This result has implications for the inclusion of skipping training into the school life of school-aged children to help manage their BMI levels.

Análise das diretrizes brasileiras de obesidade: patologização do corpo gordo, abordagem focada na perda de peso e gordofobia

Resumo Atualmente a obesidade é considerada um dos maiores desafios da saúde pública. Ela vem sendo enfrentada a partir do incentivo de mudanças comportamentais individuais, exaltando a perda de peso como forma inquestionável de garantir saúde. Tendo em vista este contexto e a importância das Diretrizes brasileiras de obesidade sobre o campo da obesidade, sua influência sobre a prática profissional, o tipo de tratamento incentivado e o processo decisório em relação aos corpos gordos, foi realizada uma análise deste documento, associada à emergente discussão de como o discurso da saúde justifica e reproduz a gordofobia da sociedade. A análise se deu primeiramente em relação à patologização do corpo gordo e como isto é acompanhado de uma valorização do corpo magro. Em seguida, discute-se a abordagem normativa do peso, que propõe intervenções individuais sempre focadas na perda de peso. Pode-se notar que o discurso presente nas Diretrizes reforça a saúde inerente dos corpos magros, reproduz estereótipos relacionados ao corpo gordo e relaciona diretamente quilos perdidos com melhor nível de saúde.

Framing Obesity

The public debate on obesity will turn on the question of who or what is responsible for causing and curing this emerging epidemic. Previous research suggests that public health problems become amenable to broad policy solutions when those problems can be reframed in systemic terms—specifically, in terms of involuntary risk, universal risk, environmental risk, and knowingly created risk. This article assesses the framing of obesity in news coverage since 1985 to determine whether obesity is being reframed in these terms. The data suggest that a vigorous frame contest is currently under way between arguments emphasizing personal responsibility for health and arguments emphasizing the social environment, including corporate and public policy. The evidence suggests that one of these frame dimensions (environmental risk) has moved decisively toward the systemic pole, while two frame dimensions (involuntary and knowingly created risk) have not moved toward the systemic pole, and the movement of the fourth dimension (risk to everyone) is uncertain.

Aging, Obesity, and Mortality: Misplaced Concern About Obese Older People?

Although there is widespread agreement that obesity (body mass index [BMI] ≥ 30 kg/m(2)) raises health risks, debate has ensued on whether obese older adults are also at greater risk. This study examines the effect of obesity on mortality for younger and older adults to determine whether the risk of obesity is lessened in later life. Data from a 20-year follow-up of a national sample of adults were used to examine the risk of obesity on mortality (N = 6,767). Cox models reveal that obesity raises mortality risk for adults of all ages, but this relationship is nearly twice as strong for persons younger than 50 years of age. Being slightly overweight in later life is associated with lower mortality risk, but obesity raises mortality risk, especially for ischemic heart disease. Obesity in middle age is a grave public health concern, but obesity in later life also merits attention.

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

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.

Affordable care act: comparison of healthcare indicators among different insurance beneficiaries with new coverage eligibility

BACKGROUND

Health coverage in the United States will be increased to nearly universal levels under the Affordable Care Act (ACA). In order to better understand the impact of the type of health insurance and health outcomes, there is a need to examine health disparities and inequalities between the insured and the uninsured based on their eligibility for coverage.

METHODS

The current study used the data from the Medical Expenditure Panel Survey 2012 (MEPS). Selected health characteristics and access to care items were compared in regard to the insurance status: private, public, the uninsured, but likely eligible for Medicaid expansion (EME), and the uninsured, but likely required to purchase health plans through the health insurance exchanges (RPIE).

RESULTS

Analyses showed that 17.2% of US adults ages 27-64 were eligible as EME and 12.9% as RPIE in 2012. Compared to the insured groups, the uninsured who were eligible for coverage reported fewer health problems than those insured privately and publicly. However, they also reported less use of health care, including preventive health service, screenings, and unmet health care needs.

CONCLUSIONS

The ACA aims to increase coverage options and access to treatment and preventive health care services for the majority of the uninsured US population. However, it may not play as significant of a role in improving health among the uninsured, in particular, those eligible for the Medicaid expansion.

Metformin in Amnestic Mild Cognitive Impairment: Results of a Pilot Randomized Placebo Controlled Clinical Trial

Diabetes and hyperinsulinemia may be risk factors for Alzheimer's disease (AD). We conducted a pilot study of metformin, a medication efficacious in treating and preventing diabetes while reducing hyperinsulinemia, among persons with amnestic mild cognitive impairment (aMCI) with the goal of collecting preliminary data on feasibility, safety, and efficacy. Participants were 80 men and women aged 55 to 90 years with aMCI, overweight or obese, without treated diabetes. We randomized participants to metformin 1000 mg twice a day or matching placebo for 12 months. The co-primary clinical outcomes were changes from baseline to 12 months in total recall of the Selective Reminding Test (SRT) and the score of the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog). The secondary outcome was change in relative glucose uptake in the posterior cingulate-precuneus in brain fluorodeoxyglucose positron emission tomography. Change in plasma Aβ42 was an exploratory outcome. The mean age of participants was 65 years. Fifty percent of participants were women. The only baseline variable that was different between the arms was the ADAS-Cog. Metformin could not be tolerated by 7.5% of participants; 15% tolerated 500 mg/day, 35% tolerated 1000 mg/day, 32.5% tolerated 1500 mg/day, and only 10% tolerated the maximum dose. There were no serious adverse events related to metformin. The 7.5% of persons who did not tolerate metformin reported gastrointestinal symptoms. After adjusting for baseline ADAS-cog, changes in total recall of the SRT favored the metformin group (9.7±8.5 versus 5.3±8.5; p = 0.02). Differences for other outcomes were not significant. A larger trial seems warranted to evaluate the efficacy and cognitive safety of metformin in prodromal AD.

Does elevated body mass index (BMI) affect the clinical outcomes of robot-assisted laparoscopic prostatectomy (RALP): a prospective cohort study

OBJECTIVES

With the prevalence of obesity in the United States, a significant proportion of robot-assisted laparoscopic prostatectomy (RALP) candidates have an elevated body mass index (BMI). We determine if this impacts on the clinical outcomes of RALP.

METHODS

218 consecutive patients underwent RALP were identified from a prospectively maintained RALP database recorded and compared for their demographics, clinical outcomes and adverse events in normal weight (BMI <25 kg/m(2)), overweight (BMI ≥25 and <30 kg/m(2)) and obese (BMI ≥30 kg/m(2)) groups.

RESULTS

36 normal weight, 115 overweight and 67 obese patients were identified. There were no significant differences in demographic data among the three groups except for mean BMI (23.1 vs. 27.5 vs. 32.8 kg/m(2), p < 0.001). The median operative time was longer in obese patients compared to both overweight (210 vs. 189 min, p = 0.031) and normal weight (210 vs. 177 min, p = 0.008) patients. There were no significant differences in median estimated blood loss, mean prostate volume, positive surgical margin rate and time to continence without pads. The median urethral catheter duration and hospitalization were similar in all groups. Patients with elevated BMI had a significantly higher median Gleason score (p = 0.046) and incidence of pathologic T3 disease (p = 0.038). The incidence of adverse events was low and there were no significant differences among the three groups (p > 0.05).

CONCLUSIONS

Elevated BMI appears to increase the RALP operative time, but has little impact on other intraoperative parameters, clinical outcomes or patient morbidity. RALP is a safe and effective procedure in patients with elevated BMI.

J-shapedness: an often missed, often miscalculated relation: the example of weight and mortality

We present three considerations in analysing the association between weight and mortality, as well as other relations that might be non-linear in nature. First, authors must graphically plot their independent and dependent variables in a continuous manner. Second, authors should assess the shape of that relation, and note its shape. If it is non-linear, and specifically, J-shaped or U-shaped, careful consideration should be given to using the 'best' statistical model, of which multivariate fractional polynomial regression is a reasonable choice. Authors should also refrain from truncating their data to avoid dealing with non-linear relations.

An Overview of the Complexities in Obesity

A recent survey, even one limited to human studies, found considerable “publication scatter” in that more than 250 different professional journals publish articles on obesity. Over the years, and particularly since the 1970s and 1980s when the so-called obesity epidemic began, there has been an explosion of clinical interest in a field that encompasses general medicine, pediatrics, surgery, psychiatry, and almost every subspecialty. And rightly so, since even by 2008, there were an estimated 1.46 billion adults worldwide who were overweight, and of these, 502 million were in the obese category, all of which translate into major public health consequences. Despite many highly publicized studies, why do we not have a greater understanding about obesity than we do? It is certainly not from a lack of trying. This article presents an overview of the limitations and challenges, that is, complexities, due to discrepant frameworks and diverse conceptualizations of obesity; potential flaws inherent in its clinical studies; and particularly, impediments due to difficulties in the measurement of body composition (and particularly adipose accumulation), food intake, and physical activity, as well as to notoriously inaccurate self-reporting by subjects. As a result, clinicians remain limited in issuing recommendations to their patients.

Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis

IMPORTANCE

Estimates of the relative mortality risks associated with normal weight, overweight, and obesity may help to inform decision making in the clinical setting.

OBJECTIVE

To perform a systematic review of reported hazard ratios (HRs) of all-cause mortality for overweight and obesity relative to normal weight in the general population.

DATA SOURCES

PubMed and EMBASE electronic databases were searched through September 30, 2012, without language restrictions.

STUDY SELECTION

Articles that reported HRs for all-cause mortality using standard body mass index (BMI) categories from prospective studies of general populations of adults were selected by consensus among multiple reviewers. Studies were excluded that used nonstandard categories or that were limited to adolescents or to those with specific medical conditions or to those undergoing specific procedures. PubMed searches yielded 7034 articles, of which 141 (2.0%) were eligible. An EMBASE search yielded 2 additional articles. After eliminating overlap, 97 studies were retained for analysis, providing a combined sample size of more than 2.88 million individuals and more than 270,000 deaths.

DATA EXTRACTION

Data were extracted by 1 reviewer and then reviewed by 3 independent reviewers. We selected the most complex model available for the full sample and used a variety of sensitivity analyses to address issues of possible overadjustment (adjusted for factors in causal pathway) or underadjustment (not adjusted for at least age, sex, and smoking).

RESULTS

Random-effects summary all-cause mortality HRs for overweight (BMI of 25-<30), obesity (BMI of ≥30), grade 1 obesity (BMI of 30-<35), and grades 2 and 3 obesity (BMI of ≥35) were calculated relative to normal weight (BMI of 18.5-<25). The summary HRs were 0.94 (95% CI, 0.91-0.96) for overweight, 1.18 (95% CI, 1.12-1.25) for obesity (all grades combined), 0.95 (95% CI, 0.88-1.01) for grade 1 obesity, and 1.29 (95% CI, 1.18-1.41) for grades 2 and 3 obesity. These findings persisted when limited to studies with measured weight and height that were considered to be adequately adjusted. The HRs tended to be higher when weight and height were self-reported rather than measured.

CONCLUSIONS AND RELEVANCE

Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.

The Relationship between Weight and CVD Risk Factors in a Sample Population from Central Iran (Based on IHHP)

BACKGROUND

Atherosclerosis is one of the leading causes of mortality all around the world. Obesity is an independent risk factor for atherosclerosis and cardiovascular diseases (CVD). In this respect, we decided to examine the effect of the subgroups of weight on cardiovascular risk factors.

METHODS

This cross-sectional study was done in 2006 using the data obtained by the Iranian Healthy Heart Program (IHHP) and based on classification of obesity by the World Health Organization (WHO). In this study, the samples were tested based on the Framingham risk score, Metabolic Measuring Score (MMS) and classification of obesity. Chi-square and ANOVA were used for statistical analysis.

RESULTS

12514 people with a mean age of 38 participated in this study. 6.8% of women and 14% of men had university degrees (higher than diploma). Obesity was seen in women more than men: 56.4% of women and 40% of men had a Body Mass Index of (BMI) ≥ 25 Kg/m2. 13% of the subjects had FBS > 110 and13.9% of them were using hypertensive drugs. In this study, we found that all risk factors, except HDL cholesterol in men, increased with an increase in weight. This finding is also confirmed by the Framingham flowfigure for men and women.

CONCLUSION

One of every two Americans, of any age and sex, has a Body Mass Index of (BMI) ≥ 25 Kg/m2. Obesity associated CVD and other serious diseases. Many studies have been done in different countries to find the relationship between obesity and CVD risk factors. For example, in the U.S.A and Canada they found that emteropiotic parameters, blood presser and lipids increased by age(of both sexes). Moreover, another study done in China, which is a country in Asia like Iran, shows that BMI has an indirect effect on HDL cholesterol, LDL cholesterol and triglyceride. This data is consistent with the results of the current study. However, In China they found that this relationship in men is stronger than women, but our study reveals the opposite.

A systematic review of the literature concerning the relationship between obesity and mortality in the elderly

INTRODUCTION

Obesity is a risk factor for chronic diseases and premature mortality, but the extent of these associations among the elderly is under debate. The aim of this systematic literature review (SR) is to collate and critically assess the available information of the impact of obesity on mortality in the elderly.

METHODS

In PubMed, there are three-hundred twelve papers on the relationship between obesity and mortality among older adults. These papers were analysed on the basis of their abstracts, and sixteen studies were considered suitable for the purpose of the study. It was possible to perform a pooled estimate for aggregated data in three different studies.

CONCLUSION

The results of this SR document that an increased mortality in obese older adults. The limitation of BMI to index obesity and the noted protective action of a moderate increase in BMI on mortality are highlighted. Waist circumference is an indicator of central adiposity and potentially as good a risk factor for mortality as BMI in obese elderly adults.

Does fall history influence residential adjustments?

PURPOSE OF THE STUDY

To determine whether reported falls at baseline are associated with an older adult's decision to make a residential adjustment (RA) and the type of adjustment made in the subsequent 2 years.

DESIGN AND METHODS

Observations (n = 25,036) were from the Health and Retirement Study, a nationally representative sample of community-living older adults, 65 years of age and older. At baseline, fall history (no fall, 1 fall no injury, 2 or more falls no injury, or 1 or more falls with an injury) and factors potentially associated with RA were used to predict the initiation of an RA (i.e., moving, home modifications, increased use of adaptive equipment, family support, or personal care assistance) during the subsequent 2 years.

RESULTS

Compared with those with no history of falls, individuals with a history of falls had higher odds of making any RA. Among those making an RA, individuals with an injurious fall were more likely than those with no history of a fall to start using adaptive equipment or increase their use of personal care assistance.

IMPLICATIONS

The higher initiation of RAs among fallers may indicate proactive steps to prevent future falls and may be influenced by interactions with the health care system. To optimize fall prevention efforts, older adults would benefit from education and interventions addressing optimal use of RAs before falls occur.

Lifelong doubling of mortality in men entering adult life as obese

BACKGROUND

The association between obesity in adults and excess morbidity and mortality is well established, but the impact of being obese in early adulthood on health throughout adult life needs elucidation. We investigated the all-cause mortality until 80 years of age in men starting adult life as obese.

METHODS

Among 362,200 Danish young men, examined for military service between 1943 and 1977, all obese (defined as body mass index (BMI ≥ 31.0 kg m(-2)), and, as controls, a random 1% sample of the remaining population were identified. A total of 1862 obese, corresponding to all men above the 99.5 percentile in this population, and 3476 controls were included, at a median age of 19 years (range: 18-25 years of age). They were followed until 2007 and Cox regression models were used to estimate the mortality in the obese relative to the controls. In addition, two reference groups were used: normal weight men (BMI: 18.5-24.9 kg m(-2)) and the men with the lowest mortality in this cohort (BMI: 22.0-24.9 kg m(-2)).

RESULTS

During the 65 years of follow-up, 1191 men died. At all ages from 18 to 80 years, the mortality in the obese was twice that of the controls (hazard ratio (HR): 2.10; 95% confidence interval (CI): 1.84-2.39). The median survival proportion (0.5) was reached about 8 years earlier in the obese than in either of the reference groups. Relative to the normal weight and men with the lowest mortality HRs of 2.14 (95% CI: 1.86-2.45) and 2.38 (95% CI: 2.00-2.85), respectively, were estimated for the obese. Neither year of birth nor education significantly influenced the excess mortality.

CONCLUSION

Men entering adult life as obese experience a lifelong doubling of mortality, a finding that strongly supports the continued need to avoid beginning adult life as obese.

Variations in BMI and prevalence of health risks in diverse racial and ethnic populations

When examining health risks associated with the BMI, investigators often rely on the customary BMI thresholds of the 1995 World Health Organization report. However, within-interval variations in morbidity and mortality can be substantial, and the thresholds do not necessarily correspond to identifiable risk increases. Comparing the prevalence of hypertension, diabetes, coronary heart disease (CHD), asthma, and arthritis among non-Hispanic whites, blacks, East Asians and Hispanics, we examine differences in the BMI-health-risk relationships for small BMI increments. The analysis is based on 11 years of data of the National Health Interview Survey (NHIS), with a sample size of 337,375 for the combined 1997-2007 Sample Adult. The analysis uses multivariate logistic regression models, employing a nonparametric approach to modeling the BMI-health-risk relationship, while relying on narrowly defined BMI categories. Rising BMI levels are associated with higher levels of chronic disease burdens in four major racial and ethnic groups, even after adjusting for many socio-demographic characteristics and three important health-related behaviors (smoking, physical activity, alcohol consumption). For all population groups, except East Asians, a modestly higher disease risk was noted for persons with a BMI <20 compared with persons with BMI in the range of 20-21. Using five chronic conditions as risk criteria, a categorization of the BMI into normal weight, overweight, or obesity appears arbitrary. Although the prevalence of disease risks differs among racial and ethnic groups regardless of BMI levels, the evidence presented here does not support the notion that the BMI-health-risk profile of East Asians and others warrants race-specific BMI cutoff points.

Associations among body mass index, waist circumference, and health indicators in American Indian and Alaska Native adults

PURPOSE

Little is known about obesity-related health issues among American Indian and Alaska Native (AIAN) populations.

APPROACH

A large cohort of AIAN people was assembled to evaluate factors associated with health.

SETTING

The study was conducted in Alaska and on the Navajo Nation.

PARTICIPANTS

A total of 11,293 AIAN people were included.

METHODS

We present data for body mass index (BMI, kg/m2) and waist circumference (cm) to evaluate obesity-related health factors.

RESULTS

Overall, 32.4% of the population were overweight (BMI 25-29.9 kg/m2), 47.1% were obese (BMI > or = 30 kg/m2), and 21.4% were very obese (BMI, > or = 35 kg/m2). A waist circumference greater than 102 cm for men and greater than 88 cm for women was observed for 41.7% of men and 78.3% of women. Obese people were more likely to perceive their health as fair/poor than nonobese participants (prevalence ratio [PR], 1.91; 95% CI, 1.71-2.14). Participants younger than 30 years were three times more likely to perceive their health as being fair or poor when their BMI results were 35 or greater compared with those whose BMI results were less than 25 kg/m2. A larger BMI was associated with having multiple medical conditions, fewer hours of vigorous activity, and more hours of television watching.

CONCLUSIONS

Given the high rates of obesity in AIAN populations and the association of obesity with other health conditions, it is important to reduce obesity among AIAN people.

Weight change, initial BMI, and mortality among middle- and older-aged adults

BACKGROUND

It is not known how the relationship between weight change and mortality is influenced by initial body mass index (BMI) or the magnitude of weight change.

METHODS

We use the nationally representative Health and Retirement Study (n = 13,104; follow-up 1992-2006) and Cox regression analysis to estimate relative mortality risks for 2-year weight change by initial BMI among 50- to-70-year-old Americans. We defined small weight loss or gain as a change of 1-2.9 BMI units and large weight loss or gain as a change of 3-5 BMI units.

RESULTS

Large and small weight losses were associated with excess mortality for all initial BMI levels below 32 kg/m (eg, hazard ratio [HR] for large weight loss from BMI of 30 = 1.61 [95% confidence interval = 1.31-1.98]; HR for small weight loss from BMI of 30 = 1.19 [1.06-1.28]). Large weight gains were associated with excess mortality only at high BMIs (eg, HR for large weight gain from BMI of 35 = 1.33 [1.00-1.77]). Small weight gains were not associated with excess mortality for any initial BMI level. The weight loss-mortality association was robust to adjustments for health status and to sensitivity analyses considering unobserved confounders.

CONCLUSIONS

Weight loss is associated with excess mortality among normal, overweight, and mildly obese middle- and older-aged adults. The excess risk increases for larger losses and lower initial BMI. These results suggest that the potential benefits of a lower BMI may be offset by the negative effects associated with weight loss. Weight gain may be associated with excess mortality only among obese people with an initial BMI over 35.

Obesity, the endocannabinoid system, and bias arising from pharmaceutical sponsorship

BACKGROUND

Previous research has shown that academic physicians conflicted by funding from the pharmaceutical industry have corrupted evidence based medicine and helped enlarge the market for drugs. Physicians made pharmaceutical-friendly statements, engaged in disease mongering, and signed biased review articles ghost-authored by corporate employees. This paper tested the hypothesis that bias affects review articles regarding rimonabant, an anti-obesity drug that blocks the central cannabinoid receptor.

METHODS/PRINCIPAL FINDINGS

A MEDLINE search was performed for rimonabant review articles, limited to articles authored by USA physicians who served as consultants for the company that manufactures rimonabant. Extracted articles were examined for industry-friendly bias, identified by three methods: analysis with a validated instrument for monitoring bias in continuing medical education (CME); analysis for bias defined as statements that ran contrary to external evidence; and a tally of misrepresentations about the endocannabinoid system. Eight review articles were identified, but only three disclosed authors' financial conflicts of interest, despite easily accessible information to the contrary. The Takhar CME bias instrument demonstrated statistically significant bias in all the review articles. Biased statements that were nearly identical reappeared in the articles, including disease mongering, exaggerating rimonabant's efficacy and safety, lack of criticisms regarding rimonabant clinical trials, and speculations about surrogate markers stated as facts. Distinctive and identical misrepresentations regarding the endocannabinoid system also reappeared in articles by different authors.

CONCLUSIONS

The findings are characteristic of bias that arises from financial conflicts of interest, and suggestive of ghostwriting by a common author. Resolutions for this scenario are proposed.

Weight loss surgery eligibility according to various BMI criteria among adolescents

A BMI cutoff point at the 99th percentile for age and gender or at 40 kg/m(2) has been suggested for more aggressive treatment of adolescent obesity. The main objective of this study was to determine the proportion of adolescents eligible for weight loss surgery (WLS) based on various BMI cutoff points. Data was extracted from the electronic medical record database of an urban pediatric ambulatory care center over 4 years. National data were used to calculate BMI percentiles (Centers for Disease Control and Prevention (CDC), 2000). Eligibility for WLS was based on a BMI percentile criterion (>or=99th percentile) or the adult WLS cutoff point (>or=40 kg/m(2)). The sample consisted of 3,220 adolescents aged 12-17.9 years, of which 53% were female, 55% were of black race, and 17% of Hispanic ethnicity. Overall, 88 (3%) adolescents had a BMI >or=40 kg/m(2) and 236 (7%) had a BMI >or=99th percentile (P < 0.001). All adolescents with BMI >or=40 kg/m(2) had a BMI >or=99th percentile. A total of 159/2,007 (8%) of 12-14.9-year olds had a BMI >or=99th percentile compared with 77/1,213 (6%) 15-17.9-year olds (P = 0.10), whereas 43/2,007 (2%) of 12-14.9-year olds had a BMI >or=40 kg/m(2) compared with 45/1,213 (4%) 15-17.9-year olds (P = 0.003). In summary, a relatively large proportion of adolescents from a diverse urban population would qualify for WLS based on the percentile criterion. Fewer adolescents would be eligible based on the adult WLS criterion, and younger adolescents would be less likely to be eligible for WLS than older adolescents.

Dopamine receptor genetic polymorphisms and body composition in undernourished pastoralists: an exploration of nutrition indices among nomadic and recently settled Ariaal men of northern Kenya

Background

Minor alleles of the human dopamine receptor polymorphisms, DRD2/TaqI A and DRD4/48 bp, are related to decreased functioning and/or numbers of their respective receptors and have been shown to be correlated with body mass, height and food craving. In addition, the 7R minor allele of the DRD4 gene is at a higher frequency in nomadic compared to sedentary populations. Here we examine polymorphisms in the DRD2 and DRD4 genes with respect to body mass index (BMI) and height among men in two populations of Ariaal pastoralists, one recently settled (n = 87) and the other still nomadic (n = 65). The Ariaal live in northern Kenya, are chronically undernourished and are divided socially among age-sets.

Results

Frequencies of the DRD4/7R and DRD2/A1 alleles were 19.4% and 28.2%, respectively and did not differ between the nomadic and settled populations. BMI was higher in those with one or two DRD4/7R alleles in the nomadic population, but lower among the settled. Post-hoc analysis suggests that the DRD4 differences in BMI were due primarily to differences in fat free body mass. Height was unrelated to either DRD2/TaqI A or DRD4/48 bp genotypes.

Conclusion

Our results indicate that the DRD4/7R allele may be more advantageous among nomadic than settled Ariaal men. This result suggests that a selective advantage mediated through behaviour may be responsible for the higher frequency of the 7R alleles in nomadic relative to sedentary populations around the world. In contrast to previous work, we did not find an association between DRD2 genotypes and height. Our results support the idea that human phenotypic expression of genotypes should be rigorously evaluated in diverse environments and genetic backgrounds.

Underweight, overweight and obesity as risk factors for mortality and hospitalization

AIMS

The prevalence of overweight and obesity is increasing in many countries. We aimed to investigate differences in mortality and severe morbidity between underweight people (body mass index (BMI)<18.5), overweight people (BMI 25 to <30), obese people (BMI> or =30), and those with normal weights (BMI 18.5 to <25).

METHODS

Random samples of the Swedish population aged 16-74 years in 1980-81 and 1988-89 were followed for 12 years with regard to all-cause mortality and mortality from circulatory diseases, all inpatient care, and inpatient care for circulatory and musculoskeletal diseases. Relative risks (RRs) for different levels of BMI were adjusted for age, longstanding illness, smoking, and educational level at baseline. In addition, analyses were made with delayed entry until the fourth-year after interview.

RESULTS

Obesity and underweight, but not overweight, was associated with higher all-cause mortality. Among underweight men, the adjusted RR for all-cause mortality was 2.4 (95% confidence interval 1.6-3.6), and among underweight women it was 2.0 (1.5-2.7), but population attributable risks (PARs) were small, at 1.2% and 2.7%, respectively. Overweight was associated with increased risks for inpatient care for circulatory diseases, with PARs being 13.4% among men and 8.1% among women, and musculoskeletal diseases (PARs were 12.7% and 12.9%, respectively). Obese men and women had about 50% higher risks of all-cause mortality than normal-weight people, PARs being 3.2% and 3.8% respectively.

CONCLUSIONS

This study supports the findings of other studies, in that overweight seems to be an exaggerated risk factor for all-cause mortality, but is related to other chronic disease. Underweight and obesity generally implies greater increases of RRs, but avoidance of overweight may have greater effect on the population level with regard to reduced cardiovascular and locomotor disease.

The association between low vision and function

OBJECTIVE

This study considers the relationship between low vision and function, specifically exploring whether vision loss is differentially associated with activities of daily living (ADL) versus instrumental activities of daily living (IADL) disability.

METHODS

Guided by the World Health Organization's International Classification of Functioning, Disability, and Health framework, multinomial logistic regression analyses were performed for IADL and ADL on a sample of 9,115 adults aged 65 years and above from the 1998 Health and Retirement study.

RESULTS

The data supports the fact that ADL and IADL disabilities are associated with vision loss, and there is a differential relationship among functions, with IADLs being more challenging and requiring better visual abilities.

DISCUSSION

The findings provide evidence that ADL and IADLs require different skills and are associated differently depending on numerous variables. As the incidence of people living with vision loss is increasing to epidemic proportions due to an aging population, understanding the relationship between vision and participation in meaningful activities has important implications.

The association of BMI with functional status and self-rated health in US adults

OBJECTIVE

To examine the association of BMI with functional status and self-rated health among US adults and how the association differs by age and sex.

METHODS AND PROCEDURES

All analyses are based on the National Health Interview Survey (NHIS), 1997-2005, a yearly, representative study of the US household population. We pooled all survey years and fitted logistic regression for the two sexes and three age strata (ages 18-44, 45-64, and > or =65).

RESULTS

Our study found that although underweight and severe obesity are consistently associated with increased disability and poorer health status, overweight and moderate obesity show associations that vary considerably by age and sex. For men, the adjusted odds ratios (ORs) for disability and poor/fair self-rated health tended to be lowest among overweight persons, especially for ages > or =45. Among men with moderate obesity, the risk of disability was elevated for ages 18-44 but lower for ages > or =65. For women, the adjusted ORs for disability and poor/fair self-rated health tended to be lowest among normal-weight persons, particularly for ages < or =45. Compared to normal-weight counterparts, overweight women aged > or =65 had a lower risk of disability but a somewhat elevated risk of poor/fair self-rated health.

DISCUSSION

The results suggest that the association of BMI with functional status and self-rated health varies significantly across ages and sexes. The variations in the association of BMI with functional status and self-rated health suggest that a single "ideal body weight category" may not be appropriate for all persons or all health outcomes.

Weight, mortality, years of healthy life, and active life expectancy in older adults

OBJECTIVES

To determine whether weight categories predict subsequent mortality and morbidity in older adults.

DESIGN

Multistate life tables, using data from the Cardiovascular Health Study, a longitudinal population-based cohort of older adults.

SETTING

Data were provided by community-dwelling seniors in four U.S. counties: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Allegheny County, Pennsylvania.

PARTICIPANTS

Five thousand eight hundred eighty-eight adults aged 65 and older at baseline.

MEASUREMENTS

The age- and sex-specific probabilities of transition from one health state to another and from one weight category to another were estimated. From these probabilities, future life expectancy, years of healthy life, active life expectancy, and the number of years spent in each weight and health category after age 65 were estimated.

RESULTS

Women who are healthy and of normal weight at age 65 have a life expectancy of 22.1 years. Of that, they spend, on average, 9.6 years as overweight or obese and 5.3 years in fair or poor health. For both men and women, being underweight at age 65 was associated with worse outcomes than being normal weight, whereas being overweight or obese was rarely associated with worse outcomes than being normal weight and was sometimes associated with significantly better outcomes.

CONCLUSION

Similar to middle-aged populations, older adults are likely to be or to become overweight or obese, but higher weight is not associated with worse health in this age group. Thus, the number of older adults at a "healthy" weight may be much higher than currently believed.

Measures of adiposity and dementia risk in elderly persons

BACKGROUND

Studies relating adiposity to dementia are conflicting. We explored the associations of body mass index (BMI), (calculated as weight in kilograms divided by the square of height in meters) waist circumference, and weight change to dementia, probable Alzheimer disease, and dementia associated with stroke (DAS).

DESIGN

Persons without dementia were followed up for 5 years; 893 persons had BMI data, 907 had waist circumference data, and 709 had a second weight measurement. Dementia was ascertained using standard methods. Cox proportional hazards regression was used for analyses using follow-up as time to event, adjusting for demographics and apolipoprotein E-epsilon4 status.

RESULTS

Compared with persons in the first quartile of BMI, persons in the third quartile had a lower dementia and Alzheimer disease risk and persons in the second quartile had a lower DAS risk. The association between BMI and dementia resembled a U shape in those younger than 76 years, while dementia risk decreased with higher BMI in those 76 years and older. The fourth quartile of waist circumference was related to a higher DAS risk in the whole sample, and to dementia and Alzheimer disease in persons younger than 76 years. Weight loss was related to a higher dementia and DAS risk, and weight gain was related to a higher DAS risk only.

CONCLUSIONS

The prospective association between adiposity and dementia differs depending on the anthropometric measure used, and is modified by age. This may explain previous conflicting reports.

Associations between body composition, anthropometry, and mortality in women aged 65 years and older

OBJECTIVES

We examined the relation between measures of body size and mortality in a predominantly White cohort of 8029 women aged 65 years and older who were participating in the Study of Osteoporotic Fractures.

METHODS

Body composition measures (fat and lean mass and percentage body fat) were calculated by bioelectrical impedance analysis. Anthropometric measures were body mass index (BMI; kg/m2) and waist circumference.

RESULTS

During 8 years of follow-up, there were 945 deaths. Mortality was lowest among women in the middle of the distribution of each body size measure. For BMI, the lowest mortality rates were in the range 24.6 to 29.8 kg/m2. The U-shaped relations were seen throughout the age ranges included in this study and were not attributable to smoking or measures of preexisting illness. Body composition measures were not better predictors of mortality than BMI or waist girth.

CONCLUSIONS

Our results do not support applying the National Institutes of Health categorization of BMI from 25 to 29.9 kg/m2 as overweight in older women, because women with BMIs in this range had the lowest mortality.

The shape of health to come: prospective study of the determinants of 30-year health trajectories in the Alameda County Study

BACKGROUND

Considerable evidence now exists indicating that incidence and progression of disease and disability are associated with socio-economic, behavioural, demographic and psychosocial factors. The emerging life course perspective suggests that these factors might be associated with not just the incidence of disease and death, but also trajectories of health over decades.

METHODS

Prospective study of a representative, population-based cohort studied on four occasions over 30 years. Trajectories of health over this period, combining self-rated health and date of death, were related to behavioural, psychosocial and socio-economic risk factors.

RESULTS

Trajectories of health were associated with behavioural, socioeconomic, and psychosocial risk factors, the strongest predictors being household income and physical activity. Those with an income 1 SD above the mean were approximately 25% more likely to die having previously consistently reported excellent health (Men: relative risk (RR) = 1.27, 95% CI = 1.10-1.46; Women: RR = 1.25, 95% CI = 1.06-1.47), were more likely to remain 'Alive in Excellent Health' (Men: RR = 1.35, 95% CI = 1.21-1.51; Women: RR = 1.30, 95% CI = 1.19-1.43) and were less likely to have shown an 'Unremitting Decline' (Men: RR = 0.72, 95% CI = 0.49-1.05; Women: RR = 0.71, 95% CI = 0.48-1.04). Those with low physical activity were approximately 50% less likely to die having consistently reported excellent health (Men: RR = 0.54, 95% CI = 0.39-0.76; Women: RR = 0.48, 95% CI = 0.33-0.71), and were five-times more likely to show an 'Unremitting Decline' (Men: RR = 5.05, 95% CI = 1.75-14.56; Women: RR = 5.00, 95% CI = 1.48-16.92). They were also less likely to be 'Alive in Excellent Health' (Men: RR = 0.41, 95% CI = 0.29-0.57; Women: RR = 0.44, 95% CI = 0.33-0.57).

CONCLUSIONS

The burden of illness associated with behavioural, socio-economic and psychosocial risk factors extends beyond shortening of life to poorer trajectories of health over decades.

Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old

BACKGROUND

Obesity, defined by a body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters) of 30.0 or more, is associated with an increased risk of death, but the relation between overweight (a BMI of 25.0 to 29.9) and the risk of death has been questioned.

METHODS

We prospectively examined BMI in relation to the risk of death from any cause in 527,265 U.S. men and women in the National Institutes of Health-AARP cohort who were 50 to 71 years old at enrollment in 1995-1996. BMI was calculated from self-reported weight and height. Relative risks and 95 percent confidence intervals were adjusted for age, race or ethnic group, level of education, smoking status, physical activity, and alcohol intake. We also conducted alternative analyses to address potential biases related to preexisting chronic disease and smoking status.

RESULTS

During a maximum follow-up of 10 years through 2005, 61,317 participants (42,173 men and 19,144 women) died. Initial analyses showed an increased risk of death for the highest and lowest categories of BMI among both men and women, in all racial or ethnic groups, and at all ages. When the analysis was restricted to healthy people who had never smoked, the risk of death was associated with both overweight and obesity among men and women. In analyses of BMI during midlife (age of 50 years) among those who had never smoked, the associations became stronger, with the risk of death increasing by 20 to 40 percent among overweight persons and by two to at least three times among obese persons; the risk of death among underweight persons was attenuated.

CONCLUSIONS

Excess body weight during midlife, including overweight, is associated with an increased risk of death.

Impact of perinatal weight change on long-term obesity and obesity-related illnesses

OBJECTIVE

To estimate the impact of perinatal weight change on obesity, weight gain, and development of obesity-related illnesses 15 years after pregnancy.

METHODS

Pregnancy-related factors and weights of 795 women were recorded at first prenatal visit and 6 months postpartum and were available through medical record review at 4, 10, and 15 years. Obesity-related illnesses were recorded 15 years later.

RESULTS

A total of 484 (61%) original cohort members were available for follow-up. Weight gain during pregnancy, weight loss by 6 months postpartum, and baseline body mass index (BMI) were all related to current BMI and weight gain at follow-up. Women who breastfed beyond 12 weeks and participated in postpartum aerobic exercise had lower BMI and weight gain 15 years later. By follow-up, 13% had developed diabetes or prediabetes. Thirty percent had developed heart disease, hypertension, or dyslipidemia. Baseline BMI and weight change over 15 years were significant predictors of both diseases. Smoking status at last follow-up was also a significant predictor of heart disease or pre-heart disease.

CONCLUSION

Excess pregnancy weight gain and failure to lose weight in an appreciable time are indicators of obesity in midlife. Excess weight gain and obesity status are predictors of diabetes and heart disease, although pregnancy-related weight changes alone are not directly related.

Cause-specific mortality in old age in relation to body mass index in middle age and in old age: follow-up of the Whitehall cohort of male civil servants

BACKGROUND

The relevance of body mass index (BMI) to cause-specific mortality in old age is uncertain.

OBJECTIVES

To examine cause-specific 5 year mortality in old age by BMI in old age and middle age (40-69 years).

METHODS

Cox proportional hazards for mortality rates among 4862 former male civil servants in relation to quartiles of BMI measured when screened in 1968-70 and when resurveyed in 1997-98 (median age 76 years).

RESULTS

The association between all-cause mortality after resurvey and BMI in old age was U-shaped with hazard ratios (HRs) of 1.3 (95% CI 1.1-1.5) for the lightest and heaviest categories relative to the middle two. Among 'healthy' men the lightest (<22.7 kg/m2) had greatest all-cause mortality. The heaviest men (>26.6 kg/m2) had increased risk of cardiovascular disease (CVD) mortality in the first two years or for the whole period if never-smokers. Respiratory mortality was inversely associated with BMI in old age [adjusted HR for trend per BMI category increase 0.6 (0.5-0.7)] but cancer mortality lacked a clear pattern. Net gain or loss of 10 kg or more between middle and old age was a strong predictor of all-cause and CVD mortality.

CONCLUSIONS

The shape of the association between BMI in old age and mortality differs by cause of death. Major weight change over time is a warning signal for higher CVD mortality. Having BMI<22.7 kg/m2 in old age is associated with above-average mortality rates even if apparently healthy.

Weight Change, Weight Change Intention, and the Incidence of Mobility Limitation in Well-Functioning Community-Dwelling Older Adults

BACKGROUND

Obesity increases the risk for functional decline in later years, but the functional consequences of weight change in older adults are currently unclear. The aim of this study was to determine whether weight, weight change, and weight change intention are associated with risk for mobility limitation in elderly persons.

METHODS

This study included 2,932 well-functioning black and white men and women aged 70 to 79 years, participating in the Health, Aging and Body Composition (Health ABC) Study, who were followed for 30 months. At baseline, reported weight change of 5 or more pounds during the previous year and weight change intention were assessed. Mobility limitation was defined as reported difficulty or inability to walk one-quarter mile or to climb 10 steps during two consecutive semiannual assessments during a period of 30 months.

RESULTS

Approximately 30% of participants developed mobility limitation. Higher body mass index (BMI) was associated with increased risk for mobility limitation. Unintentional weight loss in the previous year was associated with increased risk for mobility limitation in the extremely obese, which was defined as BMI >or= 35 (hazard ratios [HR], =3.79; 95% confidence interval [CI], 1.84--7.79), and the normal BMI, which was defined as BMI<25 (HR, 2.55; 95% CI, 1.80--3.60). In persons with BMI 25 to 29.9, intentional weight loss (HR, 1.59; 95% CI, 1.12--2.25) and weight fluctuation with any intention (HR, 1.59; 95% CI, 1.10--2.28) increased the risk for mobility limitation. Unintentional weight gain or fluctuation did not confer additional risk for mobility limitation compared with weight stability, regardless of the level of body weight.

CONCLUSION

In this cohort of well-functioning elderly persons, functional consequences of past weight change depended on the type of weight change, intentionality, and current measured body weight.

Association of body weight with condition-specific quality of life in male veterans

PURPOSE

We hypothesized that obese adults with coronary heart disease, obstructive lung disease, or depression would report greater impairments in health-related quality of life owing to their angina, dyspnea, or depressive symptoms as compared with persons with normal body weight.

METHODS

We analyzed cross-sectional data from the Ambulatory Care Quality Improvement Project, a multicenter study of veterans enrolled in general internal medicine clinics. Health-related quality of life was assessed using the Medical Outcomes Study Short Form-36, the Seattle Angina Questionnaire, the Seattle Obstructive Lung Disease Questionnaire, and the Hopkins Symptom Checklist for Depression.

RESULTS

Compared with patients of normal weight (body mass index: 18.5 to 24.9 kg/m2), underweight patients (body mass index <18.5 kg/m2) reported health-related quality-of-life scores that were at least 5% lower (worse) in all 15 quality-of-life domains examined. Patients with class III obesity (body mass index > or =40 kg/m2) reported quality-of-life scores that were at least 5% lower than those of normal weight patients in eight domains. Scores of overweight patients (body mass index: 25 to 29.9 kg/m2) were higher (better) than those of normal weight patients in 11 domains.

CONCLUSION

Body mass index was strongly associated with generic- and condition-specific health-related quality of life. Our results suggest that, when considering health-related quality-of-life outcomes among veterans, the optimal body mass index may be above the "normal" range. Further research should test the validity of the 1998 National Institutes of Health body mass index categories as predictors of health outcomes among veterans.

Overweight and obesity and the burden of disease and disability in elderly men

OBJECTIVE

To examine the prevalence of disease burden and disability associated with overweight and obesity in men aged 60-79 y and to assess whether the current WHO weight guidelines are appropriate in the elderly.

DESIGN

Cross-sectional survey 20 y after enrollment.

SETTING

General practices in 24 British towns.

PARTICIPANTS

In total, 4232 men aged 60-79 y (77% of survivors) with measured weight and height.

MAIN OUTCOME MEASURES

Cardiovascular (CV) risk factors, prevalence of diabetes, cardiovascular disease, cancer, disability and regular medication.

RESULTS

In total, 17% of the men were obese (body mass index (BMI) >/=30 kg/m(2)) and a further 52% were overweight (BMI 25-29.9 kg/m(2)). Prevalence of hypertension, low HDL-cholesterol, high triglycerides and insulin resistance and the prevalence of most disease outcomes increased with increasing degrees of overweight/obesity. Men in the normal weight range (18.5-24.9 kg/m(2)) had the lowest prevalence of ill health. Compared with normal weight men, obese men showed a two-fold risk of major CVD (odds ratio (OR)=1.96, 95% CI 1.44-2.67) and locomotor disability (OR=2.26, 95% CI 1.66, 3.09) and were nearly three times as likely to have diabetes, CV interventions or to be on CV medication. Over 60% of the prevalence of high insulin resistance was attributable to overweight and obesity as was over a third of diabetes and hypertension, a quarter of locomotor disability and a fifth of major CVD.

CONCLUSION

In elderly men, overweight and obesity are associated with a significantly increased burden of disease, in particular CV-related disorders and disability. The current guidelines for overweight and obesity appear to be appropriate in elderly men.

Weight-loss intention in the well-functioning, community-dwelling elderly: associations with diet quality, physical activity, and weight change

BACKGROUND

Many older adults desire to lose weight, yet the proportion with a health-related weight-loss indication, weight-loss strategies, and success is unknown.

OBJECTIVE

We examined the associations of reported intention to lose weight with health-related indications for weight loss, diet quality, physical activity, and weight-loss success in well-functioning older adults.

DESIGN

This prospective, community-based cohort included 2708 elderly persons aged 70-79 y at baseline. We determined indication for weight loss by using the modified National Institutes of Health guidelines, diet quality by using the Healthy Eating Index, and weight-loss intention and physical activity by using questionnaires. Measured weight change over 1 y was assessed.

RESULTS

Twenty-seven percent of participants reported an intention to lose weight, and 67% of those participants had an indication for weight loss. Participants who reported a weight-loss intention were heavier than those who did not, had more depressive symptoms, and were more likely to be dissatisfied with their weight, regardless of weight-loss indication. Participants with an intention to lose weight reported better eating behaviors and a more active lifestyle than did participants without a weight-loss intention, independent of other health conditions. No significant difference in actual weight loss was found between participants intending and not intending to lose weight, regardless of indication for weight loss.

CONCLUSIONS

Despite being associated with healthier behaviors, the intention to lose weight did not predict greater weight loss in this well-functioning elderly cohort. More attention needs to be focused on the necessity and efficacy of specific strategies for weight loss in older adults.

Nocturnal proinflammatory cytokine-associated sleep disturbances in abstinent African American alcoholics

Animal studies reveal that cytokines play a key role in the regulation of sleep. Alcoholic patients show profound alterations of sleep and a defect in the homeostatic recovery of sleep following sleep loss. In this study, we investigated whether nocturnal plasma levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF) were associated with disordered sleep in alcohol dependence by testing the temporal relationships between these inflammatory cytokines and sleep, before and after sleep deprivation. All-night polysomnography and serial blood sampling at 23:00, 03:00, and 06:30 h were conducted across baseline, partial sleep deprivation, and recovery nights in abstinent African American alcoholics (n=16) and matched controls (n=15). Coupled with prolonged sleep latency and increased rapid eye movement sleep, alcoholics showed nocturnal elevations of IL-6 and TNF as compared to controls after adjustment for alcohol consumption and body mass index. Following sleep deprivation, alcoholics showed greater nocturnal levels of IL-6 and greater nocturnal increases of TNF as compared to controls. Pre-sleep IL-6 levels at 23:00 h correlated with prolonged sleep latency after adjustment for potential confounders whereas IL-6 levels at 03:00 h correlated with rapid eye movement sleep in the second half of the night. Taken together, these findings indicate that circulating levels of proinflammatory cytokines may have a negative influence on sleep initiation. These findings have implications for determining why sleep is disordered in alcoholics and may aid in the development of novel treatments to optimize sleep in this population.

The effect of smoking on years of healthy life (YHL) lost among middle-aged and older Americans

OBJECTIVE

To estimate the effects of smoking on quality of life over time, using the Years of Healthy Life (YHL) construct.

DATA SOURCES/STUDY SETTING

The Health and Retirement Study (HRS) survey (N=12,652) of persons 50 to 60 years old and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (N=8,124) of persons > or =70 years old, plus spouses regardless of age, followed from 1992/1993 to 2000.

STUDY DESIGN

Years of healthy life from baseline to death were estimated. Regression models were developed with smoking as the main explanatory variable and with both YHL and years of life remaining as the outcome variables.

PRINCIPAL FINDINGS

Smoking was strongly and consistently related to YHL lost. In HRS, individuals who had quit smoking at least 15 years prior to baseline had a similar number of YHL left as never smokers.

CONCLUSIONS

Efforts to encourage smoking cessation should emphasize the impact of these factors on quality of life.

Health Status among Women with Menstrual Symptoms

PURPOSE

Chronic diseases have been associated with decrements in health status, as measured by the Medical Outcomes Study's Short Form-36 (SF-36). Menstrual symptoms (including irregular menses, menorrhagia, dysmenorrhea and premenstrual symptoms) are common, but little is known about their impact on health status. We sought to determine the prevalence of menstrual symptoms and the degree to which these symptoms affect health status.

METHODS

This was a mailed survey including questions about sociodemographic characteristics, military experiences, current physical symptoms and medical conditions, mental health, health status (SF-36), and life experiences. The participants were a nationally representative, randomly selected sample of women veterans who had made at least one ambulatory visit to a Veterans Affairs facility between July 1, 1994 and June 30, 1995. The main outcome measures were eight domains of the SF-36 health status questionnaire.

RESULTS

Among 3632 respondents (58.4% response rate), 1744 were menstruating women and formed the analytical sample for this study. Among these women (mean age 35.8), 67% reported one or more menstrual symptoms. Women with menstrual symptoms had significantly lower scores for all domains of the SF-36 (p < 0.01), except energy and vitality (p < 0.05), both before and after adjusting for sociodemographic, psychosocial, and comorbidity variables.

CONCLUSIONS

Women veterans who report one or more menstrual symptoms have significantly lower health status compared with those reporting none. Clinicians providing care for women should be attuned to the potential impact of menstrual symptoms on the lives of their patients.

Sexual assault while in the military: violence as a predictor of cardiac risk?

The purpose of this article is to determine whether known cardiac risk factors are more prevalent among women veterans who report having sustained sexual assault while in the military. We surveyed a random sample of 3,632 women veterans using Veterans Administration (VA) ambulatory care nationally. Obesity, smoking, problem alcohol use, sedentary lifestyle, and hysterectomy before age 40 were found to be more common in women reporting a history of sexual assault while in the military than in women without such history. An association between myocardial infarction and prior sexual assault history may be mediated in part by known cardiac risk factors.

Clinical outcomes for low-income adults with hypertension and diabetes

BACKGROUND

Long-term management of hypertension and diabetes, which are more prevalent in minority and socioeconomically disadvantaged populations, presents challenges for healthcare providers in community health centers.

OBJECTIVES

The purpose of the study was twofold: to examine health outcomes for persons with hypertension and diabetes and to compare these outcomes for disparities in patients who were Black, Hispanic, or White.

METHODS

Medical records (N = 280) from an urban community health center that serves predominantly uninsured adults were reviewed for selected clinical outcomes of primary care. Measures included outcomes of hypertension and diabetes control, lifestyle behaviors, preventive care, and patient status. Chi-square tests, t tests, and one-way analysis of covariance were used to analyze racial/ethnic group differences.

RESULTS

Data revealed significant differences in smoking status, influenza immunization, and blood pressure. Racial/ethnic group differences were minimal compared with the overall high prevalence of risk factors such as smoking and obesity. Regular access to primary care did not result in improved clinical outcomes.

CONCLUSION

The findings support the need for more effective interventions that promote healthy lifestyle if health disparities in low-income populations with chronic conditions are to be reduced.

A longitudinal study of the effects of tobacco smoking and other modifiable risk factors on ill health in middle-aged and old Americans: results from the Health and Retirement Study and Asset and Health Dynamics among the Oldest Old survey

BACKGROUND

While the effects of smoking and other modifiable risk factors on mortality and specific diseases are well established, their effects on ill health more generally are less known. Using two national, longitudinal surveys, the objective of this study was to analyze the effect of smoking and other modifiable risk factors on ill health, defined in a multidimensional fashion (i.e., disability, impaired mobility, health care utilization, and self-reported health).

METHODS

The analyses were based on the Health and Retirement Study (HRS) (12,652 persons 50-60 years old surveyed in 1992, 1994, 1996, and 1998) and the Asset and Health Dynamics among the Oldest Old survey (8,124 persons 60-70 years old surveyed in 1993, 1996, and 1998).

RESULTS

Smoking was strongly related to mortality and to ill health, with similar relative effects in the middle-aged and the elderly. There were consistent adverse dose-response relationships between smoking and ill health in the HRS. Persons who had quit smoking at least 15 years prior to the survey were no more likely than never smokers to experience ill health. A dose-response relationship was found between exercise and ill health. For body mass index and alcohol, there were U-shaped relationships with ill health.

CONCLUSIONS

Public health efforts designed to encourage smoking cessation should emphasize improvements in ill health in addition to decreased mortality.

Effects of low body mass index and smoking on all-cause mortality among middle-aged and elderly Japanese

To investigate effects of low body mass index (BMI) and smoking on all-cause mortality among middle-aged and elderly Japanese, we conducted a community-based prospective study. A mail survey was conducted in 1987-1990 in four towns, western Japan. A cohort of 7,301 Japanese men and 8,825 Japanese women was followed up from the date of the mail survey to 1995 in three of the towns and 1998 in the fourth town. We investigated the effect of BMI and smoking on all-cause mortality by using Cox's proportional hazards model. The relationship between BMI and all-cause mortality was a reverse J-shape with minimal mortality in 24 < or = BMI < 26 in men and a U-shape with minimal mortality in 22 < or = BMI < 24 in women, after adjusting for age and smoking. The lowest BMI category (BM < 20) had the highest all-cause mortality in men and also in women. Taking only never-smokers, the highest risk for all-cause mortality was observed in the lowest BMI category for men and for women. This does not seem to be explained by smoking and pre-existing diseases. More attention should be paid to persons with low BMI.

The effect of middle- and old-age body mass index on short-term mortality in older people

OBJECTIVES

To determine the effect of body mass index (BMI) at old age and at age 50 on short-term survival among persons age 65 and older.

DESIGN

Cross-sectional, using the 4,791 respondents to the community interview of the 1994 National Long Term Care Survey (NLTCS).

SETTING

United States of America.

PARTICIPANTS

Persons age 65 and older who lived in community settings as of the 1994 NLTCS interview.

MEASUREMENTS

Short-term mortality was measured from the date of the 1994 NLTCS through year-end 1995. BMI (kg/m2) (at three points: 1994 NLTCS, 1 year before, age 50) and all other variables, including three other modifiable risk factors known to be related to mortality--cigarette smoking, alcohol consumption, and exercise--were based on self-report.

RESULTS

Both the unadjusted and adjusted nadirs of mortality in relation to BMI at old age were found in older persons with a BMI between 30 and 34.9; this was true for males and females in all age groups. The highest mortality rates were found for older persons with very low BMI (<18.5). In contrast, BMI at age 50 was positively related to mortality, with those in the lowest BMI category (<18.5) at age 50 having the lowest mortality. Persons who were obese at age 50 and who were no longer obese at the 1994 NLTCS had lower mortality than persons with stable weight.

CONCLUSIONS

Weight reduction by middle-aged persons who are obese should be reinforced as a public health priority, because there is evidence that long-term weight loss results in better short-term survival. Further study of healthy older survivors to determine why they are not harmed by heavier weight in old age may provide useful insights into successful aging.

Weight change in old age and its association with mortality

OBJECTIVES

Previous studies of weight change and mortality in older adults have relied on self-reported weight loss, have not evaluated weight gain, or have had limited information on health status. Our objective was to determine whether 5% weight gain or loss in 3 years was predictive of mortality in a large sample of older adults.

DESIGN

Longitudinal observational cohort study.

SETTING

Four U.S. communities.

PARTICIPANTS

Four thousand seven hundred fourteen community-dwelling older adults, age 65 and older.

MEASUREMENTS

Weight gain or loss of 5% in a 3-year period was examined in relationship to baseline health status and interim health events. Risk for subsequent mortality was estimated in those with weight loss or weight gain compared with the group whose weight was stable.

RESULTS

Weight changes occurred in 34.6% of women and 27.3% of men, with weight loss being more frequent than gain. Weight loss was associated with older age, black race, higher weight, lower waist circumference, current smoking, stroke, any hospitalization, death of a spouse, activities of daily living disability, lower grip strength, and slower gait speed. Weight loss but not weight gain of 5% or more was associated with an increased risk of mortality that persisted after multivariate adjustment (Hazard ratio (HR) = 1.67, 95% CI = 1.29-2.15) and was similar in those with no serious illness in the period of weight change. Those with weight loss and low baseline weight had the highest crude mortality rate, although the HR for weight loss was similar for all tertiles of baseline weight and for those with or without a special diet, compared with those whose weight was stable.

CONCLUSIONS

This study confirms that even modest decline in body weight is an important and independent marker of risk of mortality in older adults.

Original article underweight, overweight and obesity: relationships with mortality in the 13-year follow-up of the Canada Fitness Survey

The purpose of this study was to determine the risk of all-cause mortality in the Canadian population across the new WHO/NIH BMI categories for the classification of overweight and obesity. The sample includes 10,725 adult participants (20-69 years) in the 1981 Canada Fitness Survey. A total of 593 deaths occurred during 13 years of follow-up. Hazard ratios (HR) for mortality were estimated using Cox proportional hazards models. Compared to normal weight individuals, there is an increased risk of mortality in the underweight category (HR 1.63, 95% CI 0.93-2.85) in addition to increasing levels of risk across the overweight (HR 1.16, 95% CI 0.96-1.39), obese class I (HR 1.25, 95% CI 0.96-1.65) and obese class II and III (HR 2.96, 95% CI 1.39-6.29) categories. Similar patterns were observed in sex-specific analyses. Underweight, overweight and obese Canadians are all at increased risk of mortality compared to those who are normal weight.

Extent and determinants of discrepancy between self-evaluations of weight status and clinical standards

OBJECTIVES

To examine the extent and type of discordance between personal and medical classifications of weight status, and to examine the influence of sociodemographic factors on the misclassification of weight status.

DESIGN/SETTING

The 1991 Health Promotion and Disease Prevention Supplement of the National Health Interview Survey, a nationally representative, cross-sectional survey of the U.S. population.

PARTICIPANTS

Adults 18 years and older (N = 41,676).

MEASUREMENTS AND MAIN RESULTS

Respondents' self-evaluations of weight status were compared to classification of their body mass index (BMI) by medical standards. Twenty-nine percent of respondents incorrectly classified their weight status relative to medical standards, and the nature of this error was variable. While 27.4% of overweight persons judged their weight to be "just about right," of those who did judge themselves to be overweight, 23.9% were in fact normal or underweight according to their BMI. Overall, 16.6% of persons underassessed their weight category, and 12.4% overassessed their weight category. Multivariate analysis revealed that sex, age, race, income, education, and occupation influenced the misclassification of weight status.

CONCLUSIONS

A substantial proportion of Americans deviate from medical standards in their self-evaluations of weight appropriateness, and this lack of correspondence may reflect the normative judgments of various population subgroups. Clinical and public health programs that employ a uniform strategy or approach to the population may not be efficacious.