Obesity Progression Between Young Adulthood and Midlife and Incident Diabetes: A Retrospective Cohort Study of U.S. Adults

Transition of visceral adiposity index and risk of cardiovascular disease in middle-aged and older Chinese adults

OBJECTIVE

Visceral obesity and the lifetime risk of cardiovascular disease (CVD) have received increasing attention. However, the relationship between dynamic changes in visceral obesity and CVD has not been studied. We aimed to determine the association of visceral adiposity index (VAI) transition with CVD risk.

METHODS

A total of 5395 participants were recruited in 2011-2012 and followed up until 2018 from the China Health and Retirement Longitudinal Study. The cut-off value of the VAI was obtained by the receiver-operating characteristic curve. Participants were grouped based on VAI change patterns during the follow-up period (2011-2015): the low-low group, low-high group, high-low group, and high-high group. CVD was defined as a medical diagnosis of heart disease and/or stroke. A Cox proportional hazards model was used to evaluate the correlation between VAI transition and CVD.

RESULTS

Over a median follow-up period of 7 years, 969 participants (17.9 %) developed CVD. VAI change patterns were significantly associated with CVD risk after adjustment for demographic characteristics and risk factors. The high-high group (hazard ratio (HR): 1.65, 95 % confidence interval (CI): 1.39-1.97) and the low-high group (HR: 1.29, 95 % CI: 1.04-1.61) were associated with a higher risk of CVD after adjusting for demographic characteristics and traditional risk factors compared to the low-low group, while the effect in the high-low group was not significant.

CONCLUSIONS

VAI transition was significantly associated with the risk of CVD. Monitoring the dynamics of the VAI in public health practice would help prevent CVD.

Weight change and all-cause and cause-specific mortality: A 25-year follow-up study

BACKGROUND

Whether the dynamic weight change is an independent risk factor for mortality remains controversial. This study aimed to examine the association between weight change and risk of all-cause and cause-specific mortality based on the Linxian Nutrition Intervention Trial (NIT) cohort.

METHODS

Body weight of 21,028 healthy residents of Linxian, Henan province, aged 40-69 years was measured two times from 1986 to 1991. Outcome events were prospectively collected up to 2016. Weight maintenance group (weight change <2 kg) or stable normal weight group was treated as the reference. Cox proportional hazard model was performed to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) to estimate the risk of mortality.

RESULTS

A total of 21,028 subjects were included in the final analysis. Compared with the weight maintenance group, subjects with weight loss ≥2 kg had an increased risk of death from all-cause (HR All-cause  = 1.14, 95% CI: 1.09-1.19, P  <0.001), cancer (HR Cancer  = 1.12, 95% CI: 1.03-1.21, P  = 0.009), and heart disease (HR Heart diseases  = 1.21, 95% CI: 1.11-1.31, P  <0.001), whereas subjects with weight gain ≥5 kg had 11% (HR Cancer  = 0.89, 95% CI: 0.79-0.99, P  = 0.033) lower risk of cancer mortality and 23% higher risk of stroke mortality (HR Stroke  = 1.23,95% CI: 1.12-1.34, P  <0.001). For the change of weight status, both going from overweight to normal weight and becoming underweight within 5 years could increase the risk of total death (HR Overweight to normal = 1.18, 95% CI: 1.09-1.27; HR Becoming underweight = 1.35, 95% CI: 1.25-1.46) and cancer death (HR Overweight to normal = 1.20, 95% CI: 1.04-1.39; HR Becoming underweight = 1.44, 95% CI: 1.24-1.67), while stable overweight could increase the risk of total death (HR Stable overweight = 1.11, 95% CI: 1.05-1.17) and death from stroke (HR Stable overweight = 1.44, 95% CI: 1.33-1.56). Interaction effects were observed between age and weight change on cancer mortality, as well as between baseline BMI and weight change on all-cause, heart disease, and stroke mortality (all Pinteraction  <0.01).

CONCLUSIONS

Weight loss was associated with an increased risk of all-cause, cancer, and heart disease mortality, whereas excessive weight gain and stable overweight were associated with a higher risk of stroke mortality. Efforts of weight management should be taken to improve health status.

TRIAL REGISTRATION

https://classic.clinicaltrials.gov/ , NCT00342654.

BMI Trajectories in Late Middle Age, Genetic Risk, and Incident Diabetes in Older Adults: Evidence From a 26-Year Longitudinal Study

This study investigated the association between body mass index (BMI) trajectories in late middle age and incident diabetes in later years. A total of 11,441 participants aged 50-60 years from the Health and Retirement Study with at least 2 self-reported BMI records were included. Individual BMI trajectories representing average BMI changes per year were generated using multilevel modeling. Adjusted risk ratios (ARRs) and 95% confidence intervals (95% CIs) were calculated. Associations between BMI trajectories and diabetes risk in participants with different genetic risks were estimated for 5,720 participants of European ancestry. BMI trajectories were significantly associated with diabetes risk in older age (slowly increasing vs. stable: ARR = 1.31, 95% CI: 1.12, 1.54; rapidly increasing vs. stable: ARR = 1.5, 95% CI: 1.25, 1.79). This association was strongest for normal-initial-BMI participants (slowly increasing: ARR = 1.34, 95% CI: 0.96, 1.88; rapidly increasing: ARR = 2.06, 95% CI: 1.37, 3.11). Participants with a higher genetic liability to diabetes and a rapidly increasing BMI trajectory had the highest risk for diabetes (ARR = 2.15, 95% CI: 1.67, 2.76). These findings confirmed that BMI is the leading risk factor for diabetes and that although the normal BMI group has the lowest incidence rate for diabetes, people with normal BMI are most sensitive to changes in BMI.

Surgical vs nonsurgical treatment for esophageal squamous cell carcinoma in patients older than 70 years: a propensity score matching analysis

PURPOSE

With the rising life expectancy and an aging population, it has become increasingly important to investigate treatments suitable for older adult patients with esophageal cancer. This study investigated whether older adult patients who underwent esophagectomy had better clinical outcomes than those who were nonsurgically treated.

METHODS

We retrospectively analyzed patients with esophageal squamous cell carcinoma (ESCC) who were 70 years or older and underwent esophagectomy, radiotherapy (RT), and/or chemoradiotherapy (CRT) between January 2018 and December 2019. Patients were divided into 2 groups: the surgery group (S group) and the nonsurgery group (NS group). We then compared the clinical outcomes of the 2 groups.

RESULTS

After a median follow-up duration of 36.6 months, the S group showed better overall survival (OS). The 3-year OS was 59% in the S group and 27% in the NS group (hazard ratio [HR], 0.397; 95% CI, 0.278-0.549; P < .0001). In the S group, the median progression-free survival was 38.3 months (95% CI, 30.6-46.1) compared with 12.3 months in the NS group (HR, 0.511; 95% CI, 0.376-0.695; P < .0001). In addition, the number of adverse events in the NS group was higher than that in the S group (P < .001).

CONCLUSION

Overall, patients with ESCC at the age of ≥70 years who underwent esophagectomy had significantly better clinical outcomes than those who underwent nonsurgical treatment with RT and/or CRT.

Patterns of weight change during adulthood and incidence of nephrolithiasis: a population-based study

BACKGROUND

There is some evidence to suggest that there may be a link between body mass index (BMI) and the development of kidney stones, it remains unclear whether weight change was associated with the presence of kidney stone.

AIMS

The objective of this study was to investigate the potential association between changes patterns in weight during adulthood and the incidence of kidney stone.

METHODS

This study included 14472 participants aged 30-75 years, whose BMI was recorded at both baseline and 10 years prior to the survey. We categorized individuals into five weight change patterns: stable healthy, non-obesity to obesity, obesity to non-obesity, stable obesity, and maximum overweight. Odds ratios (OR) and 95% confidence intervals (CI) relating weight change to incident kidney stone were calculated using logistic regression models adjusting for covariates. The non-linear association between absolute weight change was investigated using the restricted cubic spline (RCS) regression. The supposed population attributable fraction (PAF) for the weight change patterns was calculated.

RESULTS

After adjusting for all confounders, participants changing from non-obesity to obesity, obesity to non-obesity, and stable obesity had significantly higher risks of kidney stone than those with healthy weight during adulthood (OR = 1.59, 95% CI:1.18-2.13; OR = 1.78, 95% CI: 1.47-2.16; OR = 1.80, 95% CI: 1.48-2.19, respectively). A U-shaped association was observed, and the risk of kidney stone was lowest in participants with stable healthy BMI. If the population had maintained a healthy BMI, a 28.7% (95% CI: 18.6%-37.5%) lower incidence of kidney stones was observed.

CONCLUSIONS

This study found that changes in weight during adulthood are linked to the risk of developing kidney stones. Maintaining healthy weight during adulthood is important for reducing the risk of developing kidney stones.

Risk assessment of obesity-related noncommunicable diseases through body mass index trajectories in adulthood: NHANES 2007-2018

AIM

To assess the impact of adult body mass index (BMI) trajectories on the risk of obesity-related noncommunicable diseases (NCDs) in the U.S. adults after adjustment for sociodemographic and lifestyle factors.

METHODS

Data were extracted from the National Health and Nutrition Examination Survey conducted from 2007 to 2018, including male and female participants aged 29-59 years. Rao-Scott adjusted chi-square was employed to detect associations between categorical variables in descriptive analyses. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for NCDs and BMI trajectories, adjusted for sociodemographic and lifestyle factors. Kaplan-Meier curves illustrated the cumulative incidence over time.

RESULTS

Analyses were carried out on 15 721 participants and revealing significant differences among BMI trajectories in terms of demographic, lifestyle, and health characteristics. The overall prevalence of NCDs was 28.0% (95%CI:26.6-28.9). The cumulative incidence over time was higher in the high increase, moderate increase, and mixed trajectory groups, with a correspondingly higher cumulative risk (p < 0.001). Non-overweight trajectory was considered reference category in Cox models. The BMI trajectories were independently associated with an increased risk of NCDs, even after adjusting for potential confounders (HR: 1.7; 95%CI: 1.4-1.9 for moderate increase; HR: 3.6; 95%CI: 3.2-4.1 for high increase; and HR: 2.4; 95%CI: 2.1-2.7, for mixed). Furthermore, differences between males and females were also observed.

CONCLUSION

The transition to and persistence of obesity into adulthood increases the risk of NCDs. The implementation of targeted interventions with long-term monitoring of BMI may be beneficial in the prevention of future obesity-related NCDs.

Clinical features of early-onset type 2 diabetes and its association with triglyceride glucose-body mass index: a cross-sectional study

Objective

The incidence of early-onset type 2 diabetes (T2D) has increased significantly, with insulin resistance (IR) and obesity being the main drivers of its onset. This study aims to investigate the clinical characteristics of early-onset T2D and its association with triglyceride glucose body mass index (TyG-BMI), an emerging surrogate of IR.

Methods

A total of 1000 adults newly diagnosed with T2D were enrolled and divided into early-onset T2D (18~40 years, N=500) and late-onset T2D groups (≥40 years, N=500). Independent t and chi-squared tests were used to compare the characteristics of the two groups, and logistic regression analysis, trend tests, restricted cubic spline curves (RCSs), and receiver operating characteristic (ROC) curves were used to identify the relationship between TyG-BMI and early-onset T2D.

Results

Patients with early-onset T2D were more likely to have a higher body mass index (BMI), hemoglobin A1C (HbA1c), fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), serum uric acid (SUA), triglyceride glucose index (TyG), and TyG-BMI (P < 0.05). A higher TyG-BMI was associated with an increased risk of early-onset T2D (P < 0.001). The RCSs showed a nonlinear relationship between TyG-BMI and early-onset T2D, and the slope of the curve increased with an increase in TyG-BMI (P for nonlinearity < 0.001). In the subgroup analysis, additive interactions between TyG-BMI and the risk of early-onset T2D were observed for sex, family history of diabetes, BMI, fatty liver, and hypertension (P < 0.001). ROC curve showed that the area under the curve of TyG-BMI was 0.6781, which was larger than its main components (TyG, BMI, FPG, TG). The best cutoff value was 254.865, the sensitivity was 74.6%, and the specificity was 53.6%.

Conclusion

Patients with early-onset T2D are characterized by severe IR, metabolic disorders, and being overweight/obese and an increase in TyG-BMI is independently associated with an increased risk of early-onset T2D.

Weight changes from early to middle adulthood and cardiometabolic multimorbidity later in life among middle-aged and older adults: a retrospective cohort study from the NHANES 1999-2018

Background

Weight gain in adulthood can influence the development of diabetes and cardiovascular diseases. It is speculated that weight gain is related to cardiometabolic multimorbility (CMM). This study was designed to examine the relationships between weight changes from early to middle adulthood and the risk of CMM.

Methods

Data of the National Health and Nutrition Examination Survey (NHANES) 1999-2018 cycles were analyzed in the present study. Weights at age 25 years and 10 years before recruitment were self-reported and were used to define five weight change patterns including stable normal, maximum overweight, obesity to non-obesity, non-obesity to obesity, and stable obesity patterns. Meanwhile, absolute weight changes were classified into five groups: weight loss≥ 2.5 kg, weight change within 2.5 kg, 2.5 kg≤ weight gain < 10.0 kg, 10.0 kg≤ weight gain < 20.0 kg, and weight gain≥ 20.0 kg. CMM was defined as the coexistence of two or three of diabetes, coronary heart disease (CHD), and stroke.

Results

A total of 25,994 participants were included. Across adulthood, compared to stable normal weight, maximal overweight, obesity to non-obesity, non-obesity to obesity, and stable obesity were consistently associated with increased risks of diabetes, CHD, and CMM. For instance, stable obesity was respectively related to 358.0% (HR: 4.58, 95% CI: 4.57, 4.58), 88.0% (HR: 1.88, 95% CI: 1.88, 1.88), and 292.0% (HR: 3.92, 95% CI: 3.91, 3.92) higher risks of diabetes, CHD, and CMM. Meanwhile, any account of weight loss and gain was linked to higher risks of diabetes, CHD, and CMM than weight change within 2.5 kg. However, participants with maximum overweight had a decreased incidence of stroke (HR: 0.85, 95% CI: 0.85, 0.86), and weight loss ≥ 2.5 kg and weight gain ≥ 2.5 and <20 kg were also related to a lower risk of stroke. J-shaped or U-shaped associations of absolute weight changes with the risks of diabetes, CHD, and CMM were observed.

Conclusions

Maintaining a stable normal weight can benefit more from the prevention of diabetes, CHD, and CMM. Both weight gain and loss across adulthood were accompanied by increased risks of diabetes, CHD, and CMM.

Relationship of weight change patterns from young to middle adulthood with incident rheumatoid arthritis and osteoarthritis: a retrospective cohort study

Background

The relationship between weight change patterns and arthritis onset, specifically rheumatoid arthritis (RA) and osteoarthritis (OA), is unclear. We examined the association between weight changes from young adulthood to midlife and arthritis onset.

Methods

Using data from NHANES 1999-2018, participants with self-reported arthritis were selected. Age at diagnosis determined arthritis onset. Weight change patterns were based on BMI at age 25 and 10 years before the survey. Patterns were categorized as stable non-obese, non-obese to obese, obese to non-obese, and stable obese. Cox regression models and restricted cubic spline (RCS) analysis were employed, calculating hazard ratios (HRs) and 95% confidence intervals (CIs) considering covariates.

Results

Out of 20,859 participants (male 11,017, 52.82%), 4922 developed arthritis over a mean 8.66-year follow-up. Compared to stable non-obese individuals, the HRs for arthritis were 1.55 (95% CI=1.45 to 1.66, P < 0.0001) for non-obese to obese and 1.74 (95% CI=1.56 to 1.95, P < 0.0001) for stable obese. Those gaining 10-20 kg had a HR of 1.33 (95% CI=1.22 to 1.46, P < 0.0001), and gains >20 kg had a HR of 1.56 (95% CI=1.42 to 1.71, P < 0.0001), compared to stable weight (change within 2.5 kg). Identical results observed for OA and RA. RCS showed a nonlinear relationship between weight change and arthritis (all P < 0.01).

Conclusions

Stable obesity and weight gain during adulthood increase arthritis risk. Maintaining a non-obese weight throughout adult years might reduce arthritis risk in later life.

Excessive weight gain onset-age and risk of developing diabetes mellitus: a large, prospective Chinese cohort study

Background

Excessive weight gain and obesity are widely accepted as risk factors for diabetes mellitus, and the age at which obesity onsets may be related to the development of cardiovascular diseases and certain cancers. Here, we aimed to investigate associations between the onset-age of overweight/obesity and risk of developing diabetes mellitus in China.

Methods

42,144 people with the normal weight range and without diabetes at baseline, were enrolled from the Kailuan cohort which began on the 1st June 2006. All participants were followed-up, biennially, until 31st December 2017. During follow-up, 11,220 participants had become overweight/obese. For each case, one normal-weight control was matched according to age ( ± 1 year) and sex. Our final analysis included 10,858 case-control pairs. An age-scaled Cox model was implemented to estimate hazard ratios (HR) with corresponding 95% confidence intervals (CI) for diabetes mellitus incidence across age-groups.

Results

At a median follow-up of 5.46 years, 1,403 cases of diabetes mellitus were identified. After multivariate adjustments, age-scaled Cox modelling suggested that risk gradually attenuated with every 10 year increase in age of onset of overweight/obesity. Diabetes mellitus adjusted HRs (aHRs) for new-onset overweight/obesity at <45years, 45-54 years, and 55-64 years were 1.47 (95%CI, 1.12-1.93), 1.38 (95%CI, 1.13-1.68), 1.32 (95%CI, 1.09-1.59), respectively. However, new-onset of overweight/obesity at ≥65 years did not relate to diabetes mellitus (aHR, 1.20; 95%CI, 0.92-1.57). This trend was not observed in women or the new-onset obesity subgroup but was evident in men and the new overweight onset subgroup.

Conclusion

Participants with early onset of excessive weight gain issues are at considerably higher risk of developing diabetes mellitus compared to those who maintain a normal weight.

Trends in weight change patterns across life course among US adults, 1988-2018: population-based study

BACKGROUND

To examine trends in weight change patterns from young adulthood through midlife to late adulthood and their sex and racial/ethnic disparities among US adults from 1988 to 2018.

METHODS

A total of 48,969 participants from the National Health and Nutrition Examination Survey 1988-1994 and 2001-2018 were included.

RESULTS

The age-adjusted prevalence of stable non-obesity between young adulthood and midlife declined significantly from 84.1% (95 CI, 82.9-85.3%) in 1988-1994 to 68.7% (67.1-70.2%) in 2013-2018, and between midlife and late adulthood from 71.2% (69.2-73.1%) to 52.4% (50.5-54.2%). The magnitude of increase in the prevalence of weight gain from young adulthood to midlife (from 10.8% [9.9-11.6%] in 1988-1994 to 21.2% [20-22.3%] in 2013-2018; P < 0.001 for trend) was greater than that from midlife to late adulthood (from 14.1% [12.9-15.3%] to 17.2% [16.2-18.1%]; P = 0.002 for trend). The magnitude of increase in the prevalence of stable obesity from young adulthood to midlife (from 3.9% [3.1-4.8%] in 1988-1994 to 9.2% [8.2-10.3%] in 2013-2018; P < 0.001 for trend) was smaller than that from midlife to late adulthood (from 11.2% [10.1-12.2%] to 24.8% [23.3-26.3%]; P < 0.001 for trend). The declining trends in the prevalence of stable non-obesity and increasing trends in the prevalence of weight gain and stable obesity from young adulthood through midlife to late adulthood were also observed for all sex and race/ethnicity subgroups. The magnitude of decrease in the prevalence of stable non-obesity, and the magnitude of increase in the prevalence of weight gain from young adulthood through midlife to late adulthood were greater in men than in women (all P for interaction < 0.01). Weight gain patterns for those aged ≥ 65 years were substantially different from the younger age groups.

CONCLUSIONS

More young people born in later years are encountering obesity and accumulate greater obesity exposure across their lives than young people born in earlier years.

Physical Exercise Methods and Their Effects on Glycemic Control and Body Composition in Adults with Type 2 Diabetes Mellitus (T2DM): A Systematic Review

The prevalence of T2DM represents a challenge for health agencies due to its high risk of morbidity and mortality. Physical Activity (PA) is one of the fundamental pillars for the treatment of T2DM, so Physical Exercise (PE) programs have been applied to research their effectiveness. The objective of the study was to analyze the effects of PE methods on glycemic control and body composition of adults with T2DM. A systematic review without meta-analysis was performed, using the PubMed database. Quasi-experimental and pure experimental clinical trials were included, which were available free of charge and were published during 2010-2020. In the results, 589 articles were found and 25 passed the inclusion criteria. These were classified and analyzed according to the methods identified (AE, IE, RE, COM, and others), duration and variable(s) studied. It is concluded that PE is effective for glycemic control and body composition in adults with T2DM using different methods (AE, IE, RE, COM, and others), both in the short and long term. Adequate organization of PE components such as frequency, duration, volume, and intensity, is essential.

Early adulthood weight change, midlife "Life's essential 8" health status and risk of cardiometabolic diseases: a chinese nationwide cohort study

BACKGROUND

The association between weight change during early adulthood and cardiometabolic diseases remains uncertain in Chinese population. Whether the association varies with comprehensive cardiovascular health (CVH) in midlife assessed by "Life's Essential 8" has not been characterized. We aim to examine the associations of early adulthood weight change and midlife "Life's Essential 8" CVH status with cardiometabolic outcomes in a Chinese cohort.

METHODS

The study participants were from the China Cardiometabolic Disease and Cancer Cohort (4 C) Study. This analysis included 72,610 middle-aged and older participants followed for a median of 3.6 years. At baseline, the participants recalled body weight at age 20 and 40 years, and we calculated change in weight and BMI between 20 and 40 years of age. Health behaviors information in "Life's Essential 8" was collected by questionnaire, and health factors were measured in the study center. During follow-up, we ascertained incident cardiovascular events based on medical records, and diagnosed incident diabetes according to the American Diabetes Association 2010 criteria.

RESULTS

72,610 study participants were included with a mean age of 56.0 ± 8.8 years and 29% of them were males. Weight gain of more than 10 kg between 20 and 40 years of age was associated with 22% increased risk of incident cardiovascular events (HR: 1.22; 95%CI: 1.04-1.43) and 38% increased risk of diabetes (HR: 1.38; 95%CI: 1.25-1.53) compared to stable weight. Besides, the association of weight gain more than 10 kg in early adulthood with cardiometabolic risk was even stronger in those with low CVH score in midlife (HR: 2.44; 95%CI: 2.01-2.97 for incident cardiovascular events; HR: 2.20; 95%CI: 1.90-2.55 for incident diabetes) or with few ideal cardiovascular health metrics in midlife.

CONCLUSIONS

Our study indicated that weight gain in early adulthood was associated with significantly increased risk of cardiometabolic diseases. And the association could be stronger in those with poor CVH profiles in midlife. These findings confirmed the significance of weight management during early adulthood and suggested that individuals who experienced substantial weight gain in early life should be encouraged to maintain good CVH status in Chinese population.

Association between weight change and risk of liver fibrosis in adults with type 2 diabetes

Background

Liver fibrosis plays a key role in the progression of non-alcoholic fatty liver disease to cirrhosis. Considering weight change is known to be closely associated with increased risk of liver fibrosis, we aimed to address a gap in evidence regarding the existence of this association in patients with type 2 diabetes (T2D).

Methods

We included data on 622 T2D patients and 1618 non-T2D participants from the 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES). We assessed liver fibrosis by the median values of liver stiffness measurement (LSM). According to the participants' body mass index (BMI) at age 25 (early adulthood), 10 years prior (middle adulthood), and at the 2017-2018 cycle (late adulthood), we categorised weight change patterns into stable non-obese, weight loss, weight gain, and stable obese. We applied logistic regression to association analysis and used population attributable fraction (PAF) to analyses hypothetical prevention regimens.

Results

The prevalence of liver fibrosis was higher in T2D patients (23.04%) than in non-T2D participants (6.70%), while weight change was associated with a greater risk of fibrosis in the former compared to the latter group. Compared with T2D patients in the stable non-obese group, stable obese individuals from 10 years prior to the 2017-2018 cycle had the highest risk of developing liver fibrosis, corresponding to an adjusted odds ratio (aOR) of 3.13 (95% confidence interval = 1.84-5.48). Absolute weight change patterns showed that the risk of liver fibrosis was highest (aOR = 2.94) when T2D patients gained at least 20 kg of weight from 10 years prior to 2017-2018 cycle.

Conclusions

Obesity in middle and late adulthood is associated with an increased risk of T2D complicated with liver fibrosis.

Causal relationship between body mass index, type 2 diabetes and bone mineral density: Mendelian randomization

OBJECTIVE

To reveal the relationship between Body Mass Index(BMI), type 2 diabetes, and bone mineral density(BMD) using a mendelian randomization (MR) approach.

METHODS

GWAS data on BMI, type 2 diabetes, and BMD were selected from the IEU GWAS database at the University of Bristol.Univariable, multivariable, and mediated MR analyses were used to explore the relationship between BMI, type 2 diabetes, and BMD. beta(β) values were given, and three methods, including inverse variance weighting, MR-Egger regression, and weighted median, were used in this analysis.

RESULTS

Univariable mendelian randomization (UVMR) results showed that BMI and type 2 diabetes were positively associated with BMD. However, the association between BMI and BMD was insignificant in the multivariable Mendelian randomization (MVMR) analysis, while that between type 2 diabetes and BMD remained significant. Mediated MR analysis indicated that type 2 diabetes mediated the regulation of BMD by BMI.

CONCLUSION

This study provides evidence supporting a positive causal association between BMI, type 2 diabetes, and BMD. Type 2 diabetes acts as a mediator in the regulation of BMD by BMI, indicating that both BMI and type 2 diabetes exert a protective influence on BMD.

Weight change across adulthood in relation to the risk of depression

Background

Studies examining weight change patterns and depression are scarce and report inconsistent findings. This study-aimed to elucidate the association between weight change patterns and the risk of depression in a large, representative sample of US adults.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 was analyzed. Five weight change groups were categorized: stable normal, weight loss, weight gain, maximum overweight, and stable obesity. Depression was ascertained using the validated Patient Health Questionnaire (PHQ-9) and depression was defined as PHQ score ≥ 10.

Results

A total of 17,556 participants were included. Compared with participants who maintained normal weight, stable obesity participants had increased risks of depression across adulthood from age 25 years to 10 years before the survey (OR = 1.61, 95% CI =1.23 to 2.11), in the 10 years period before the survey (OR = 2.15, 95% CI =1.71 to 2.70), and from age 25 years to survey (OR = 1.88, 95% CI =1.44 to 2.44). Weight gain was associated with an increased risk of depression from age 25 years to 10 years before the survey (OR = 1.71, 95% CI = 1.41 to 2.04), in the 10 years period before the survey (OR = 1.73, 95% CI = 1.35 to 2.21), and for the period from age 25 years to survey (OR = 1.83, 95% CI = 1.49 to 2.24). In the stratified analyses, we found statistically significant interactions with sex.

Conclusion

Our study suggested that stable obesity and weight gain across adulthood were associated with increased risks of depression.

Weigh change across adulthood is related to the presence of NAFLD: results from NHANES III

BACKGROUND

Obesity is a widely recognized driving factor of Non-alcoholic fatty liver disease (NAFLD), it remains unclear whether historical weight status was associated with the presence of NAFLD. The study aimed to explore the relationship between weight change across adulthood and the presence of NAFLD.

METHODS

Data from the National Health and Nutrition Examination Survey III included 6586 participants. Weight change was assessed according to body mass index (BMI) at baseline, at 25 years old, and 10 years before baseline. Obesity was defined as BMI ≥ 30 kg/m². NAFLD was assessed by hepatic ultrasonography.

RESULTS

The prevalence of NAFLD was highest among stable obese participants (48.1%), and the lowest among stable non-obese participants (18.9%). Among non-obese participants, those who get obese in early adulthood had a higher risk for the presence of NAFLD than those who were never obese (odds ratio [OR], 1.82; 95% confidence interval [CI] 1.17-2.92). Among obese participants, those who become obese in middle-late adulthood had a lower risk of NAFLD (OR, 0.79; 95% CI 0.65-0.96) than those with stable obesity. A weight gain of more than 12 kg and 4 kg since early and middle-late adulthood respectively were associated with increased risks of NAFLD.

CONCLUSION

Among current nonobese individuals, those with a history of obesity in their early adulthood had a higher risk of NAFLD than those never obese. Among the currently obese population, those who became obese after mid-adulthood have a significantly lower risk of NAFLD compared with those who were stable obese.

Relationship Between Weight-Change Patterns and Cognitive Function: A Retrospective Study

BACKGROUND

Obesity has been linked to cognitive impairment. However, how changes in body mass index (BMI) over the life course influence cognitive function remains unclear.

OBJECTIVE

The influence of distinct weight-change patterns from young adulthood to midlife and late adulthood on cognitive function in older adults was explored.

METHODS

A total of 5,809 individuals aged≥60 years were included and categorized into four groups on the basis of BMI change patterns. Cognitive function was assessed using four cognition tests in the baseline survey. The relationship between the weight-change patterns and cognition was evaluated using regression models.

RESULTS

In comparison with participants who remained at non-obese, those moving from the non-obese to obese weight-change pattern from young (25 years of age) to middle adulthood showed lower Digit Symbol Substitution Test (DSST) scores (β= -1.28; 95% confidence interval [CI]: -2.24 to -0.32). A non-obese to obese change pattern from age 25 years of age to 10 years before baseline was associated with a higher risk of DSST impairment (odds ratio = 1.40; 95% CI: 1.09 to 1.79). In comparison with participants whose heaviest weight was recorded after 60 years of age, those with the heaviest weight between 18 and 40 years of age had lower DSST scores (β= -1.46; 95% CI: -2.77 to -1.52).

CONCLUSION

Our results suggest that the transition from the non-obese to obese category in early adulthood and appearance of the heaviest weight between 18 and 40 years of age are associated with lower cognitive function in later life.

Weight change across adulthood and accelerated biological aging in middle-aged and older adults

BACKGROUND

Little is known regarding the association between weight change and accelerated aging.

OBJECTIVES

This study aimed to estimate the influence of weight change across adulthood on biological aging acceleration in middle-aged and older adults in the United States.

METHODS

We used data of 5553 adults (40-84 y) from the National Health and Nutrition Examination Survey 1999-2010. Weight change patterns (i.e., stable normal, maximal overweight, obese to nonobese, nonobese to obese, and stable obese) and absolute weight change groups across adulthood (i.e., from young to middle adulthood, young to late adulthood, and middle to late adulthood) were defined. A biological aging measure (i.e., phenotypic age acceleration [PhenoAgeAccel]) at late adulthood was calculated. Survey analysis procedures with the survey weights were performed.

RESULTS

Across adulthood, maximal overweight, nonobese to obese, and stable obesity were consistently associated with higher PhenoAgeAccel. For instance, from young to middle adulthood, compared with participants who had stable normal weight, participants experiencing maximal overweight, moving from the nonobese to obese, and maintaining obesity had 1.71 (standard error [SE], 0.21; P < 0.001), 3.62 (SE, 0.28; P < 0.001), and 6.61 (SE, 0.58; P < 0.001) higher PhenoAgeAccel values, respectively. From young to middle adulthood, relative to absolute weight loss or gain of <2.5 kg, weight loss of ≥2.5 kg was marginally associated with lower PhenoAgeAccel (P = 0.054), whereas an obese to nonobese pattern from middle to late adulthood was associated with higher PhenoAgeAccel (P < 0.001).

CONCLUSIONS

Maximal overweight, nonobese to obese, and stable obesity across adulthood, as well as an obese to nonobese pattern from middle to late adulthood, were associated with accelerated biological aging. In contrast, weight loss from young to middle adulthood was associated with decelerated biological aging. The findings highlight the potential role of weight management across adulthood for aging. Monitoring weight fluctuation may help identify the population at high risk of accelerated aging.

Self-Reported Early and Later Life Weight and the Risk of All-Cause Mortality in Older Adults

OBJECTIVES

The extent to which body weight in early adulthood is associated with late-life mortality risk is unclear. This study aimed to determine the association between body mass index (BMI) in early adulthood (at 18 years of age) and older age (70 years and over), and the risk of mortality in later life.

DESIGN

Secondary analysis of the ASPREE Longitudinal Study of Older Persons (ALSOP).

SETTING, PARTICIPANTS

Data were from 14,853 relatively healthy community-dwelling Australians aged ≥ 70 years when enrolled in the study.

MEASUREMENTS

Self-reported weight at age ≥ 70 years and recalled weight at age 18 years were collected at ALSOP study baseline. Height was measured with a stadiometer and was used for calculation of BMI at both timepoints. BMI at each timepoint was defined as: underweight, normal weight, overweight and obese. Individuals were categorised into one of five 'lifetime' BMI groups: normal weight (BMI between 18.5 and 24.9 at both times), overweight (25.0-29.9 at either or both times), obesity to non-obese (≥30.0 at age 18 and <30.0 ≥ 70 years), non-obese to obesity (<30.0 at age 18 and ≥30.0 at age ≥ 70 years), and early and later life obesity (≥30.0 at both times).

RESULTS

During a median 4.7 years follow-up, 715 deaths occurred. Obesity at 18 years, but not in older age (p=0.44), was significantly associated with the risk of mortality in later life, even after accounting for current health status (HR: 2.35, 95% CI: 1.53-3.58, p<0.001). Compared with participants with normal BMI at both time points, being obese at both time points was associated with increased mortality risk (HR=1.99, 95% CI: 1.04-3.81, p=0.03), and the risk was even greater for individuals who were obese at 18 years but were no longer obese in older age (HR=2.92, 95% CI: 1.65-5.16, p<0.001), in fully adjusted models. Participants who were normal weight at 18 years and were obese in later life, did not have an increased mortality risk (p=0.78).

CONCLUSIONS

Obesity in early adulthood, and obesity in both early and later life, were associated with increased mortality risk in later life. This highlights the importance of preventing obesity in early adulthood and maintaining a normal weight over an adult lifespan.

Mesenchymal Stem Cell Secreted-Extracellular Vesicles are Involved in Chondrocyte Production and Reduce Adipogenesis during Stem Cell Differentiation

Background:

Extracellular vesicles (EVs) are derived from internal cellular compartments, and have potential as a diagnostic and therapeutic tool in degenerative disease associated with aging. Mesenchymal stem cells (MSCs) have become a promising tool for functional EVs production. This study investigated the efficacy of EVs and its effect on differentiation capacity.

Methods:

The characteristics of MSCs were evaluated by flow cytometry and stem cell differentiation analysis, and a production mode of functional EVs was scaled from MSCs. The concentration and size of EVs were quantitated by Nanoparticle Tracking Analysis (NTA). Western blot analysis was used to assess the protein expression of exosome-specific markers. The effects of MSC-derived EVs were assessed by chondrogenic and adipogenic differentiation analyses and histological observation.

Results:

The range of the particle size of adipose-derived stem cells (ADSCs)- and Wharton’s jelly -MSCs-derived EVs were from 130 to 150 nm as measured by NTA, which showed positive expression of exosomal markers. The chondrogenic induction ability was weakened in the absence of EVs in vitro. Interestingly, after EV administration, type II collagen, a major component in the cartilage extracellular matrix, was upregulated compared to the EV-free condition. Moreover, EVs decreased the lipid accumulation rate during adipogenic induction.

Conclusion:

The results indicated that the production model could facilitate production of effective EVs and further demonstrated the role of MSC-derived EVs in cell differentiation. MSC-derived EVs could be successfully used in cell-free therapy to guide chondrogenic differentiation of ADSC for future clinical applications in cartilage regeneration.

Dose-response association between long-term weight loss in young adults and later-life metabolic health

OBJECTIVE

Long-term weight loss (LTWL) has been shown to be associated with lower metabolic risk in young adults with overweight/obesity. However, the dose-response association is uncertain.

METHODS

In a large-scale nationwide screening project in China, the participants aged 35 to 64 years who recalled overweight/obesity at age 25 years and experienced LTWL or maintained stable weight were included. The dose-response association between LTWL from age 25 to screening (35 to 64 years) and the odds of metabolic syndrome at screening were assessed using multivariable adjusted regression models with restricted cubic splines.

RESULTS

A total of 40,150 participants (66.4% women) were included. The increment of LTWL was associated with continuously decreased odds of metabolic syndrome. The odds of metabolic syndrome were 0.64 (0.60 to 0.67), 0.42 (0.40 to 0.45), 0.27 (0.25 to 0.29), and 0.15 (0.13 to 0.17) for those with LTWL of 5% to 9.9%, 10% to 14.9%, 15% to 19.9%, and 20% or greater compared with <5% LTWL, respectively. Moreover, the incremental pattern was observed across all population subgroups.

CONCLUSIONS

An incremental association between LTWL from young adulthood and odds of later-life metabolic syndrome was observed. Our findings highlight the effective ways to achieve LTWL to improve lifetime metabolic health for young adults with overweight/obesity.

Weight Change across Adulthood in Relation to Non-Alcoholic Fatty Liver Disease among Non-Obese Individuals

Background: To investigate the associations of weight change patterns across adulthood with the risk of non-alcoholic fatty liver disease (NAFLD). Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) 2017–2018 cycle, we performed a retrospective cohort study with 2212 non-obese participants aged 36 years old over. Weight change patterns were categorized as “stable non-obese”, “early adulthood weight gain”, “middle and late adulthood weight gain” and “revert to non-obese” according to the body mass index (BMI) at age 25, 10 years prior and at baseline. Vibration-controlled transient elastography (VCTE) was performed to diagnose NAFLD. Modified Poisson regression was used to quantify the associations of weight change patterns with NAFLD. Results: Compared with participants in the “stable non-obese” group, those who gained weight at early or middle and late adulthood had an increased risk of NAFLD, with an adjusted rate ratio (RR) of 2.19 (95% CI 1.64–2.91) and 1.92 (95% CI 1.40–2.62), respectively. The risk of NAFLD in “revert to the non-obese” group showed no significant difference with the stable non-obese group. If the association of weight change and NAFLD was causal, we estimated that 73.09% (95% CI 55.62–82.93%) of incident NAFLD would be prevented if the total population had a normal BMI across adulthood. Conclusions: Weight gain to obese at early or middle and late adulthood was associated with an evaluated risk of NAFLD. A large proportion would have been prevented with effective weight intervention.

Abdominal volume index trajectories and risk of diabetes mellitus: Results from the China Health and Nutrition Survey

AIMS/INTRODUCTION

Abdominal obesity is a risk factor for developing diabetes mellitus, but trajectories of abdominal obesity over time and incident diabetes mellitus have not been considered. We derived trajectories of abdominal volume index (AVI) over 16 years of follow up, and examined the associations between AVI trajectories and risk of diabetes mellitus.

MATERIALS AND METHODS

Data were used from the China Health and Nutrition Survey, and 5,267 participants were enrolled to fit the trajectory of AVI by using latent class growth models. Multivariate logistic regression models explored the relationship between different AVI trajectories and risk of diabetes mellitus. In addition, we examined the slope of the AVI trajectories in relation to age to identify appropriate life course intervention opportunities for the prevention of diabetes mellitus.

RESULTS

Three trajectories were derived reflecting graded categories in the speed and slope of increase in AVI over time: slow, intermediate and fast increase group, respectively. After multivariate adjustment, the odds ratios for diabetes mellitus among those in the intermediate and fast increase groups were 1.81 (95% confidence interval 1.37-2.38, P < 0.001) and 2.80 (95% confidence interval 1.85-4.24, P < 0.001) respectively, relative to the slow increase group. The distribution of AVI slope in the slow increase group showed an inverted "U" shape, whereas the fast increase group presented a "U" shape.

CONCLUSIONS

AVI trajectory is associated with an increased risk of diabetes mellitus. These results provide new insights on the relationship between abdominal adiposity and diabetes mellitus, which in turn can help improve clinical and public health intervention for diabetes mellitus prevention.

Relationship Between Satisfaction With Medical Care, Physical Health, and Emotional Well-Being in Adult Men: Mediating Role of Communication

Background:

Non-communicable diseases and psychiatric pathologies are the health problems that most affect the population in the United States.

Objective:

This study aimed to examine the mediating role of patient-centered communication (PCC) in the relationship between satisfaction with medical care, physical health, and emotional well-being in American men.

Methods:

A cross-sectional - predictive study was carried out. The variables analyzed were satisfaction with medical care, physical health, and emotional well-being. Information from the Health Information National Trends Survey Data (HINTS) was used; HINTS 5, cycle 3 (collected between January and June 2019) and 4 (2020). Data from 3338 men were considered (mean age: M = 55.40, SD = 19.53). Data analyses were carried out using structural equation modeling (SEM) to represent the statistical mediation model with latent and observable variables.

Results:

Analyses showed that the variables were significantly related (P < .01). In the mediation model, there is evidence that satisfaction predicts communication (β = .764, P < .001) and this, in turn, is related to physical health (β = .079, P = .007) and emotional well-being (β = .145, P < .001). In addition, the standardized estimates of the structural multiple mediation model presented acceptable goodness-of-fit indices: χ²/gl = 2.24, CFI = 0.999, TLI = 0.999, RMSEA = 0.019 [90% CI: 0.013-0.022], SRMR = 0.018.

Conclusion:

Patient-centered communication plays a significant dual mediating role in the relationship between satisfaction with medical care, physical health, and emotional well-being, respectively. Therefore, PCC is essential in healthcare for American men.

Consumption of Alcoholic Beverages Associated With Physical Health Status in Adults: Secondary Analysis of the Health Information National Trends Survey Data

INTRODUCTION

Alcohol consumption constitutes one of the main modifiable risk factors that contribute to the increase in the global burden of non-communicable diseases (NCDs). The objective of this study was to determine the effects of the consumption of alcoholic beverages on the state of physical health and its equivalence according to gender.

METHODS

Cross-sectional data from the Health Information National Trends Survey (HINTS) of the National Cancer Institute (NCI) (n = 3865), collected during 2020 were used. Structural equation modeling was applied to assess the fit of the model, which included the prediction of measures of alcohol consumption in physical health and the equivalence of measurements of the proposed structural model in men and women.

RESULTS

The proposed structural model reported adequate goodness-of-fit indices (SBχ²/gl = 3.817, CFI = 0.984, TLI = 0.968, RMSEA [90% CI] = 0.027 [0.016-0.039]; SRMR = 0.016). Frequent alcohol consumption had a negative effect on physical health (b = -0.13, P < .01). Similarly, occasional alcohol consumption negatively predicted elevated BMI and chronic conditions such as, diabetes, hypertension, CVD, and cancer (b = -0.09, P < .01). In addition, drinking patterns of alcoholic beverages affect physical health in equal ways for men and women.

CONCLUSION

The findings highlight that frequent and occasional alcohol consumption significantly affected physical health in a negative way. Future interventions could address ways to encourage the adoption of a healthy lifestyle to reduce the risks of chronic conditions derived from excessive alcohol consumption.

Associations of Body Mass Index and Waist Circumference in Young Adulthood with Later Life Incident Diabetes

CONTEXT

The independent contribution of young adult exposure to overweight and obesity to later-life incident diabetes is not well studied.

OBJECTIVE

To assess the associations of exposures to elevated body mass index (BMI) and waist circumference (WC) in young adulthood (ages 18-39 years) with incident diabetes later in life (≥40 years).

DESIGN

Pooled data from 6 US prospective cohorts (Atherosclerosis Risk in Communities Study, Cardiovascular Risk Development in Young Adults Study, Cardiovascular Health Study, (4) Framingham Heart Study Offspring Cohort, (5) Health, Aging and Body Composition Study, and (6) Multi-Ethnic Study of Atherosclerosis.

SETTING

Population-based cohort studies.

PARTICIPANTS

30 780 participants (56.1% female, 69.8% non-Hispanic white) without a diagnosis of diabetes by age 40.

INTERVENTIONS

We imputed BMI and WC trajectories from age 18 for every participant and estimated time-weighted average exposures to BMI or WC during young adulthood and later life.

MAIN OUTCOME MEASURE(S)

Incident diabetes defined as fasting glucose ≥126 mg/dL, nonfasting glucose ≥200 mg/dL, or use of diabetes medications.

RESULTS

During a 9-year median follow-up, 4323 participants developed incident diabetes. Young adult BMI and WC were associated with later-life incident diabetes after controlling for later-life exposures [hazard ratios (HR) 1.99 for BMI ≥ 30 kg/m2 and 2.13 for WC > 88cm (women)/>102cm (men) compared to normal ranges]. Young adult homeostatic model of insulin resistance mediated 49% and 44% of the association between BMI and WC with later-life incident diabetes. High-density lipoproteins and triglycerides mediated a smaller proportion of these associations.

CONCLUSIONS

Elevated BMI and WC during young adulthood were independently associated with later-life incident diabetes. Insulin resistance may be a key mediator.

Fluctuations in waist circumference increase diabetes risk: a 4-year cohort study in 61,587 older adults

PURPOSE

To evaluate the effect of fluctuations in waist circumference (WC), weight, and body mass index (BMI) on the incidence of diabetes in older adults.

PATIENTS AND METHODS

A prospective cohort of 61,587 older adults (age, 60-96 years) who did not have diabetes at study initiation was examined. Data on weight, BMI, and WC were collected, and participants were followed up until 31 December 2018. The main end point was new-onset diabetes. A Cox regression model was used to estimate the risk of diabetes (hazard ratios [HRs] and confidence intervals [CI]) in these participants.

RESULTS

During a mean follow-up of 3.6 years, being overweight (HR [95% CI] 1.87 [1.62-2.17]), obesity (1.41 [1.26-1.59]), abdominal obesity (1.42 [1.28-1.58]), and obesity plus abdominal obesity at baseline (1.93 [1.66-2.25]) increased the risk of diabetes onset. Compared with older adults who "maintained normal WC", those who "remained abdominally obese" (HR = 1.66), "became abdominally obese" (HR = 1.58), or "achieved normal WC" (HR = 1.36) were at a higher risk of diabetes onset, as well as those with an increase in WC > 3 cm or > 5% compared with the baseline level. Weight gain or loss > 6 kg or weight gain > 5%, increase or decrease in BMI > 2 kg/m², or an increase in BMI > 10% were associated with a higher diabetes risk. The diabetes risk was reduced by 19% in overweight older adults who exercised daily.

CONCLUSION

For older adults, WC, BMI, and healthy weight maintenance reduce the diabetes risk. The findings may provide evidence for developing guidelines of proper weight and WC control for older adults.

Health policy and public health implications of obesity in China

China has experienced many drastic social and economic changes and shifts in people's lifestyles since the 1990s, in parallel with the fast rising prevalence of obesity. About half of adults and a fifth of children have overweight or obesity according to the Chinese criteria, making China the country with the highest number of people with overweight or obesity in the world. Assuming that observed time trends would continue in the future, we projected the prevalence of and the number of people affected by overweight and obesity by 2030, and the associated medical costs. The rising incidence of obesity and number of people affected, as well as the related health and economic consequences, place a huge burden on China's health-care system. China has made many efforts to tackle obesity, including the implementation of relevant national policies and programmes. However, these measures are inadequate for controlling the obesity epidemic. In the past decade, China has attached great importance to public health, and the Healthy China 2030 national strategy initiated in 2016 provides a historical opportunity to establish comprehensive national strategies for tackling obesity. China is well positioned to explore an effective model to overcome the obesity epidemic; however, strong commitment and leadership from central and local governments are needed, as well as active participation of all related society sectors and individual citizens. TRANSLATION: For the Chinese translation of the paper see Supplementary Materials section.

Weight gain from early to middle adulthood increases the risk of incident asthma later in life in the United States: a retrospective cohort study

Background

Data describing the effects of weight change across adulthood on asthma are important for the prevention of asthma. This study aimed to investigate the association between weight change from early to middle adulthood and risk of incident asthma.

Methods

Using data from the National Health and Nutrition Examination Survey (NHANES), we performed a nationally retrospective cohort study of the U.S. general population. A total of 20,771 people aged 40–74 years with recalled weight at young and middle adulthood were included in the cohort. Four weight change groups were categorized: stable non-obesity, non-obesity to obesity, obesity to non-obesity, and stable obesity. Hazard ratios (HRs) and 95% confidence intervals (CIs) relating weight change to incident asthma over 10 years of follow-up were calculated using Cox models adjusting for covariates.

Results

Compared with the stable non-obesity group, the HRs of incident asthma were 1.63 (95% CI = 1.29 to 2.07, P < 0.001) for the non-obesity to obesity group, 1.41 (95% CI = 0.97 to 2.05, P = 0.075) for stable obesity group, and 1.21 (95% CI = 0.41 to 3.62, P = 0.730) for the obesity to non-obesity group. In addition, participants who gained more than 20 kg from young to middle adulthood had a HR of 1.53 (95% CI = 1.15 to 2.03, P = 0.004), compared with those whose weight remained stable (weight change within 2.5 kg).

Conclusions

Weight gain from early to middle adulthood was associated with higher risk of incident asthma as compared to those who maintained normal weight. Thus, maintaining normal weight throughout adulthood might be important for the primary prevention of adult-onset asthma.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12931-021-01735-7.

Long-term prognosis of new adult-onset asthma in obese patients

Background

Obesity has been associated with poor outcomes of asthma in cross-sectional studies, but long-term effect of obesity on asthma remains unknown.

Aims

To study the effects of obesity, found at the time of diagnosis of adult-onset asthma, on 12-year prognosis by focusing on oral corticosteroid (OCS) use and respiratory-related hospital admissions.

Methods

Patients diagnosed with adult-onset asthma (n=203) were divided into three categories based on diagnostic body mass index (BMI) (<25 kg·m⁻², 25–29.9 kg·m⁻², ≥30 kg·m⁻²) and followed for 12 years as part of the Seinäjoki Adult Asthma Study. Self-reported and dispensed OCS were assessed for the 12-year period. Data on hospital admissions were analysed based on medical records.

Results

12 years after diagnosis, 86% of the patients who were obese (BMI ≥30 kg·m⁻²) at diagnosis remained obese. During the follow-up, no difference was found in weight gain between the BMI categories. During the 12-year follow-up, patients obese at diagnosis reported more frequent use of OCS courses (46.9% versus 23.1%, p=0.028), were dispensed OCS more often (81.6% versus 56.9%, p=0.014) and at higher doses (median 1350 (interquartile range 280–3180) mg versus 600 (0–1650) mg prednisolone, p=0.010) compared to normal-weight patients. Furthermore, patients who were obese had more often one or more respiratory-related hospitalisations compared to normal-weight patients (38.8% versus 16.9%, p=0.033). In multivariate logistic regression analyses, obesity predicted OCS use and hospital admissions.

Conclusions

In adult-onset asthma, patients obese at diagnosis mostly remained obese at long-term and had more exacerbations and respiratory-related hospital admissions compared to normal-weight patients during 12-year follow-up. Weight loss should be a priority in their treatment to prevent this outcome.

Obese patients with new adult-onset asthma often remain obese in the long-term and have more exacerbations and respiratory-related hospital admissions during follow-up. High priority should be given to weight loss during treatment to prevent this outcome.https://bit.ly/2G5HtRZ

Incident gout and weight change patterns: a retrospective cohort study of US adults

BACKGROUND

Although the relationship between obesity and incident gout has been clarified, the influence of weight changes during the transition from early adulthood to midlife and the different weight change patterns in specific age ranges on the incidence of gout in later life remain unknown. Therefore, we aimed to investigate the association between weight change patterns across adulthood and incident gout.

METHODS

Using data from the National Health and Nutrition Examination Survey (NHANES), we categorized individuals into four weight change patterns: those who remained obese (stable obese), those who moved from a non-obese body mass index (BMI) to an obese BMI (gaining), those who moved from an obese BMI to a non-obese BMI (losing), and those who remained non-obese (stable non-obese). Incident gout reflected its occurrence over the 10-year follow-up from the recalled midlife weight measure to the time of this survey. Hazard ratios (HRs) and 95% confidence intervals relating weight change patterns to incident gout over the 10-year follow-up period were calculated using Cox models adjusted for covariates. The hypothetical population attributable fraction (PAF) for the weight change patterns was calculated.

RESULTS

Among our sample of adults aged 40-74 years at their midlife weight measure (n = 11,079), 320 developed gout. The highest risk of incident gout was found for participants with the stable obese pattern (HR 1.84; 1.08-3.14) and not for participants who remained stable non-obese during adulthood. Moreover, gaining weight was a significant risk factor for incident gout (HR 1.65; 1.19-2.29). No significant associations were found between losing weight change patterns and the risk of gout during the study period. If participants who gained weight had become non-obese during the 10-year follow-up, an estimated 3.2% (95% CI 0-6.3) of observed gout cases could have been averted. In addition, if the population had maintained a normal BMI, 32.9% (95% CI 18.2-44.9) cases could have been prevented during the 10 years.

CONCLUSIONS

Gaining weight over adulthood was associated with an increased risk of gout. These findings have highlighted that maintaining non-obese weight and weight loss across adulthood is essential for the prevention and treatment of gout in adult life.

Obesity Progression Between Young Adulthood and Midlife and Incident Arthritis: A Retrospective Cohort Study of US Adults

OBJECTIVE

To examine the association between weight change from young adulthood to midlife and the risk of incident arthritis.

METHODS

Using data from the National Health and Nutrition Examination Survey, we categorized participants into weight-change categories based on their recalled weight during young adulthood and midlife. We estimated the association of weight change and developing an arthritis condition over 10 years using adjusted Cox models. Findings were extrapolated to the US population to determine the proportion of incident arthritis cases that could be averted if the entire population maintained a normal body mass index (BMI) in young adulthood and midlife.

RESULTS

Among our sample of adults who were ages 40-69 years at their midlife weight measure (n = 13,669), 3,603 developed an arthritis condition. Compared with adults who maintained a normal-normal BMI, the normal-overweight, normal-obese, overweight-obese, and obese-obese groups had a significantly elevated risk of incident arthritis conditions. The obese-overweight group had a lower risk of incident arthritis conditions compared with the obese-obese group and a comparable risk to the overweight-overweight group. Nearly one-fourth of incident arthritis cases, corresponding to 2.7 million individuals, would have been averted under the hypothetical scenario where all individuals maintained normal weight from young adulthood to midlife.

CONCLUSION

Weight loss from young adulthood to midlife was associated with a substantially reduced risk of developing an arthritis condition. We found no evidence of residual risk from having been heavier earlier in life. Our findings highlight the critical need to expand obesity treatment and prevention to achieve meaningful reductions in the burden of arthritis.

Relationship of Weight Change Patterns From Young to Middle Adulthood With Incident Cardiovascular Diseases

CONTEXT

The effect of weight change patterns on cardiovascular diseases (CVD) remains uncertain.

OBJECTIVE

We aim to examine the relation of weight change patterns and absolute weight change from young adulthood to midlife with incident CVD.

DESIGN

Retrospective cohort study.

SETTING

National Health and Nutrition Examination Survey 1999-2016.

PARTICIPANTS

A total of 20 715 US adults aged 40 through 79 with recalled weight at young adulthood (25 years) and midlife (10 years before baseline).

MAIN OUTCOME MEASURE

CVD status was determined by self-report of a prior diagnosis, and age at diagnosis was used to establish time of CVD onset. CVD events was defined as the first occurrence of a congestive heart failure, coronary heart disease, angina pectoris, heart attack, or stroke.

RESULTS

After 9.76 years of follow-up, compared with participants who remained at normal weight, those in maximum overweight, changing from nonobese to obese, changing from obese to nonobese, maintaining obesity between young and middle adulthood had a 39% (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.19-1.62), 93% (HR, 1.93; 95% CI, 1.64-2.28), 125% (HR, 2.25; 95% CI, 1.29-3.94), and 132% (HR, 2.32; 95% CI, 1.68-3.20) higher risk of CVD, respectively. In addition, compared with weight change within 2.5 kg, weight gain ≥ 10.0 kg was associated with higher risk of CVD.

CONCLUSIONS

Both nonobese to obese, obese to nonobese, and stable obese from young to middle adulthood were associated with increased risks of CVD. The findings emphasize the importance of maintaining normal weight throughout the adulthood for preventing CVD in later life.

Association Between Age at Diagnosis of Type 2 Diabetes and Cardiovascular Diseases: A Nationwide, Population-Based, Cohort Study

OBJECTIVES

Nationwide studies focusing on the impact of early-onset type 2 diabetes and obesity on the development of cardiovascular diseases (CVD) are limited in China. We aimed to investigate the association between age at diagnosis of type 2 diabetes and the risk of CVD, and to further examine the modifying effect of obesity on this association among Chinese adults.

METHODS

This study included 23,961 participants with previously diagnosed diabetes from a large nationwide population-based cohort study across mainland China. With an interviewer-assisted questionnaire, we collected detailed information on CVDs. Logistic regression analysis was used to evaluate the risk of CVDs associated with age at diagnosis of diabetes.

RESULTS

Compared with patients with late-onset diabetes (≥60 years), those with earlier-onset diabetes had increased risks for CVD, with adjusted ORs (95% CIs) of 1.72 (1.36-2.17), 1.52 (1.31-1.75) and 1.33 (1.19-1.48) for patients diagnosed aged <40, 40-49 and 50-59 years, respectively. Each 5-year earlier age at diagnosis of type 2 diabetes was significantly associated with 14% increased risk of CVD (OR, 1.14; 95%CI, 1.11-1.18). This association was more prominent for patients with obesity than those with normal body mass index (BMI). Significant interaction was detected between age at diagnosis and BMI categories on CVD risk (P for interaction=0.0457).

CONCLUSION

Early-onset type 2 diabetes was significantly associated with higher risk of CVD, and this association was more prominent among patients with obesity.

Body Mass Index and Its Change from Adolescence to Adulthood Are Closely Related to the Risk of Adult Metabolic Syndrome in China

AIMS

To investigate the influence of body mass index (BMI) and its change from adolescence to adulthood (ΔBMI) on the risk of metabolic syndrome (MetS) in early adulthood.

METHODS

We selected 931 students from 12 to 16 years of age in Liaoyang City, China. Ninety-three participants from 18 to 22 years of age with complete baseline data were available for follow-up after 5 years. Statistical analysis determined the relationship of MetS at follow-up with baseline BMI (BMI_b), ΔBMI, and follow-up BMI (BMI_f).

RESULTS

ΔBMI was positively correlated with the change of waist circumference (ΔWC), systolic blood pressure (ΔSBP), triglycerides (ΔTG), uric acid, and glycosylated hemoglobin (ΔHbA1c) in follow-up (p < 0.05). For every 1 kg/m² increase in BMI_b, ΔBMI, and BMI_f, the risk of MetS at follow-up increased 1.201-fold, 1.406-fold, and 1.579-fold, respectively. Both BMI_b and ΔBMI were predictive of MetS at follow-up, with prediction thresholds of 23.47 kg/m² and 1.95 kg/m². The participants were divided by the predicted BMI_b and ΔBMI threshold values into four study groups. Interestingly, the group with lower BMI but a higher increase in BMI presented the same metabolic derangements and Mets% of the group with higher BMI but lower Δ BMI.

CONCLUSION

Both BMI of adolescence and ΔBMI were predictive of MetS and cardiovascular risk factors in adulthood. Control of both variables in adolescents would be more effective in decreasing the risk of MetS in young adults than control of BMI alone.

Antioxidant, Antidiabetic, and Anti-obesity Potential of Ipomoea reptans Poir Leaves

Ipomoea reptans Poir or kangkung is a popular leafy vegetable, a favorite to people in Asian countries. However, limited information is available on their bioactivities. In the present study, the antioxidant, antidiabetic, and anti-obesity potential of I. reptans leaves were investigated. Different fractions (ethanol, ethyl acetate, and hexane) of I. reptans leaves were evaluated for their scavenging activity on DPPH radicals, whereas their reducing potential was investigated by cupric reducing antioxidant capacity (CuPRAC), total antioxidant, and reducing power assays. The antidiabetic potential was investigated by their inhibition effect on a-glucosidase. Total phenolic and flavonoid contents of I. reptans leaves were solvent dependent. Ethyl acetate contained the highest phenolic content, followed by ethanol and hexane fractions. However, for flavonoid content, the order was ethanol > ethyl acetate > hexane. All fractions showed DPPH scavenging activity in a concentration-dependent manner, with activities weaker than standards ascorbic acid and BHT, in the order of ethanol > ethyl acetate > hexane. All fractions showed reducing capacity, but only hexane and ethanol fractions of I. reptans leaves showed inhibition on a-glucosidase, with hexane showed more potent inhibition compared to acarbose. The study also found that fractions of I. reptans inhibit lipase and trypsin, enzymes related to lipid metabolism. Findings in this study offer a prospect for I. reptans leaves as a functional food source for antioxidant, antidiabetic, and anti-obesity purposes.

A life-time of hazardous drinking and harm to health among older adults: findings from the Whitehall II prospective cohort study

AIMS

To investigate associations of life-time hazardous and binge drinking with biomarkers of cardiometabolic health, liver function, cardiovascular disease (CVD) and mortality.

DESIGN

Prospective cohort study with median follow-up time to CVD incidence of 4.5 years.

SETTING

London, UK: civil servants within the Whitehall II Study.

PARTICIPANTS

A total of 4820 drinkers aged 59-83 years with biological measurements during the 2011-12 survey.

MEASUREMENTS

Hazardous drinking was defined as having an AUDIT-C score ≥ 5 calculated at each decade of life, forming the following groups: never hazardous drinker, former early (stopping before age 50), former later (stopping after age 50), current hazardous drinker and consistent hazardous drinker (hazardous drinker at each decade of life).

FINDINGS

More than half the sample had been hazardous drinkers at some point during their life-time, comprising former early (< age 50) (19%), former later (≥ age 50) (11%), current (21%) and consistent hazardous drinker (AUDIT-C ≥ 5 across life (5%). After adjusting for covariates, waist circumference was larger with more persistent hazardous drinking (e.g. compared with never hazardous drinkers, former early had increased waist circumference by 1.17 cm [95% confidence interval (CI) = 0.25-2.08]; former later by 1.88 cm (CI = 0.77-2.98); current by 2.44 cm (CI = 1.50-3.34) and consistent hazardous drinker by 3.85 cm (CI = 2.23-5.47). Current hazardous drinkers had higher systolic blood pressure (2.44 mmHg, CI = 1.19-3.68) and fatty liver index scores (4.05 mmHg, CI = 2.92-5.18) than never hazardous drinkers. Current hazardous drinkers [hazard ratio (HR) = 2.75, CI = 1.44-5.22) had an elevated risk of stroke, and former later hazardous drinkers had an elevated risk of non-CVD mortality (HR = 1.93, CI = 1.19-3.14) than never hazardous drinkers. Life-time binge drinking was associated with larger waist circumferences and poorer liver function compared with never binge drinkers.

CONCLUSION

Hazardous drinking may increase cardiometabolic risk factors; this is made worse by persistent hazardous drinking throughout life, particularly in relation to weight gain, suggesting benefits of early intervention.

Intentional weight loss as a predictor of type 2 diabetes occurrence in a general adult population

INTRODUCTION

Observational and intervention studies have verified that weight loss predicts a reduced type 2 diabetes (T2D) risk. At the population level, knowledge on the prediction of self-report intentional weight loss (IWL) on T2D incidence is, however, sparse. We studied the prediction of self-report IWL on T2D incidence during a 15-year follow-up in a general adult population.

RESEARCH DESIGN AND METHODS

The study sample from the representative Finnish Health 2000 Survey comprised 4270 individuals, aged 30-69 years. IWL was determined with questions concerning dieting attempts and weight loss during the year prior to baseline. Incident T2D cases during a 15-year follow-up were drawn from national health registers. The strength of the association between IWL and T2D incidence was estimated with the Cox model.

RESULTS

During the follow-up, 417 incident cases of T2D occurred. IWL predicted an increased risk of T2D incidence (HR 1.44; 95% CI 1.11 to 1.87, p=0.008) in a multivariable model. In interaction analyses comparing individuals with and without IWL, a suggestively elevated risk emerged in men, the younger age group, among less-educated people and in individuals with unfavorable values in several lifestyle factors.

CONCLUSIONS

Self-report IWL may predict an increased risk of T2D in long-term, probably due to self-implemented IWL tending to fail. The initial prevention of weight gain and support for weight maintenance after weight loss deserve greater emphasis in order to prevent T2D.

Association of Weight Loss from Early to Middle Adulthood and Incident Hypertension Risk Later in Life

Background: The effect of obesity in early adulthood and weight loss on incident hypertension in older age has not been well characterized. This study aimed to examine the association of weight loss from young adulthood to midlife with risk of incident hypertension later in life. Methods: We performed a retrospective cohort study using data from the National Health and Nutrition Examination Survey (NHANES). Five weight change groups were categorized: stable normal, weight loss, weight gain, maximum overweight and stable obese. The hazard ratios (HRs) and 95% confidence intervals (CIs) of the association between weight change and risk of hypertension in later life were estimated using Cox regression models. Results: Compared with participants who maintained normal weight, the stable obese, weight gain, maximum overweight and weight loss groups exhibited significantly higher risks of incident hypertension, with HR of 3.28 (95% CI = 2.71 to 3.96), 2.93 (95% CI = 2.62 to 3.28), 1.76 (95% CI = 1.55 to 2.00) and 1.97 (95% CI = 1.17 to 3.31), respectively. We also observed a lower risk among those in the weight loss group (HR = 0.60, 95% CI = 0.35 to 1.02) compared with those who were stable obese. Conclusions: Weight loss from early to middle adulthood was associated with lower risk of incident hypertension as compared to those who stayed obese and higher risk of incident hypertension as compared to those who maintained normal weight. Thus, maintaining normal weight throughout adulthood may be important for the primary prevention of hypertension.

Association of Weight Loss Between Early Adulthood and Midlife With All-Cause Mortality Risk in the US

IMPORTANCE

Describing potential mortality risk reduction associated with weight loss between early adulthood and midlife is important for informing primary and secondary prevention efforts for obesity.

OBJECTIVE

To examine the risk of all-cause mortality among adults who lost weight between early adulthood and midlife compared with adults who were persistently obese over the same period.

DESIGN, SETTING, AND PARTICIPANTS

Combined repeated cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey III (1988-1994) and continuous waves collected in 2-year cycles between 1999 and 2014. The data analysis was conducted from February 10, 2019, to April 20, 2020. Individuals aged 40 to 74 years at the time of survey (baseline) were included in the analyses (n = 24 205).

EXPOSURES

Weight history was assessed by self-reported weight at age 25 years, at 10 years before baseline (midlife: mean age, 44 years; interquartile range, 37-55), and measured weight at baseline. Body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) at each time was categorized as normal (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0). Weight change patterns were assessed from age 25 years (early adulthood) to 10 years before baseline (midlife).

MAIN OUTCOMES AND MEASURES

Incident all-cause mortality using linked data from the National Death Index.

RESULTS

Of the 24 205 participants, 11 617 were women (49.0%) and 11 567 were non-Hispanic White (76.9%). The mean (SD) BMI was 29.0 (6.1) at baseline. During a mean (SD) follow-up of 10.7 (7.2) years, 5846 deaths occurred. Weight loss from obese to overweight was associated with a 54% (hazard ratio, 0.46; 95% CI, 0.27-0.77) reduction in mortality risk compared with individuals with stable obesity between early adulthood and midlife. An estimated 3.2% (95% CI, 1.6%-4.9%) of early deaths could have been avoided if those who maintained an obese BMI instead lost weight to an overweight BMI by midlife. Overall, an estimated 12.4% (95% CI, 8.1%-16.5%) of early deaths may be attributable to having weight in excess of the normal BMI range at any point between early and mid-adulthood.

CONCLUSIONS AND RELEVANCE

In this study, weight loss from obesity to overweight between early adulthood through midlife appeared to be associated with a mortality risk reduction compared with persistent obesity. These findings support the importance of population-based approaches to preventing weight gain across the life course and a need for greater emphasis on treating obesity early in life.

Adolescent Obesity and Early-Onset Type 2 Diabetes

OBJECTIVE

Type 2 diabetes (T2D) is increasingly diagnosed at younger ages. We investigated the association of adolescent obesity with incident T2D at early adulthood.

RESEARCH DESIGN AND METHODS

A nationwide, population-based study evaluated 1,462,362 adolescents (59% men, mean age 17.4 years) during 1996-2016. Data were linked to the Israeli National Diabetes Registry. Weight and height were measured at study entry. Cox proportional models were applied.

RESULTS

During 15,810,751 person-years, 2,177 people (69% men) developed T2D (mean age at diagnosis 27 years). There was an interaction among BMI, sex, and incident T2D (P _interaction = 0.023). In a model adjusted for sociodemographic variables, the hazard ratios for diabetes diagnosis were 1.7 (95% CI 1.4-2.0), 2.8 (2.3-3.5), 5.8 (4.9-6.9), 13.4 (11.5-15.7), and 25.8 (21.0-31.6) among men in the 50th-74th percentile, 75th-84th percentile, overweight, mild obesity, and severe obesity groups, respectively, and 2.2 (1.6-2.9), 3.4 (2.5-4.6), 10.6 (8.3-13.6), 21.1 (16.0-27.8), and 44.7 (32.4-61.5), respectively, in women. An inverse graded relationship was observed between baseline BMI and mean age of T2D diagnosis: 27.8 and 25.9 years among men and women with severe obesity, respectively, and 29.5 and 28.5 years among low-normal BMI (5th-49th percentile; reference), respectively. The projected fractions of adult-onset T2D that were attributed to high BMI (≥85th percentile) at adolescence were 56.9% (53.8-59.9%) and 61.1% (56.8-65.2%) in men and women, respectively.

CONCLUSIONS

Severe obesity significantly increases the risk for incidence of T2D in early adulthood in both sexes. The rise in adolescent severe obesity is likely to increase diabetes incidence in young adults in coming decades.

Cardiovascular morbidity, diabetes and cancer risk among children and adolescents with severe obesity

Severe obesity among children and adolescents is a significant global public health concern. The prevalence has markedly increased over the last decades, becoming common in many countries. Overwhelming rates of obesity among youth have prompted efforts to identify an evidence-based immediate- and long-term cardiometabolic risk factor profile in childhood-onset severe obesity, and to highlight gaps that require further investigation. The PubMed database was systematically searched in accordance with PRISMA guidelines. The search yielded 831 results, of which 60 fulfilled stringent criteria and were summarized in this review. The definition of severe obesity was variable, with only one half the publications using the definition BMI > 120% of the 95th percentile. Point estimates of the prevalence of at least one cardiometabolic risk factor in children with severe obesity reportedly range from 67 to 86%. Cross-sectional studies indicate that children and adolescents with severe obesity are at greater risk than those with mild obesity for type 2 diabetes, hypertension, fatty liver disease and dyslipidemia, already at childhood and adolescence. Robust epidemiological data on the long-term risk and actual point estimates in adulthood are lacking for these diseases as well as for other diseases (coronary heart disease, stroke, chronic kidney disease and cancer). Recent longitudinal studies indicate an increased risk for cardiomyopathy, heart failure, cardiovascular mortality and all-cause mortality in adulthood for adolescents with severe obesity compared to those with mild obesity. Given the alarming increase in the prevalence of severe obesity, the persistence of adiposity from childhood to adulthood and the precarious course of young adults with chronic comorbidities, the economic and clinical services burden on the healthcare system is expected to rise.

Weight change across adulthood in relation to all cause and cause specific mortality: prospective cohort study

OBJECTIVE

To investigate the association between weight changes across adulthood and mortality.

DESIGN

Prospective cohort study.

SETTING

US National Health and Nutrition Examination Survey (NHANES) 1988-94 and 1999-2014.

PARTICIPANTS

36 051 people aged 40 years or over with measured body weight and height at baseline and recalled weight at young adulthood (25 years old) and middle adulthood (10 years before baseline).

MAIN OUTCOME MEASURES

All cause and cause specific mortality from baseline until 31 December 2015.

RESULTS

During a mean follow-up of 12.3 years, 10 500 deaths occurred. Compared with participants who remained at normal weight, those moving from the non-obese to obese category between young and middle adulthood had a 22% (hazard ratio 1.22, 95% confidence interval 1.11 to 1.33) and 49% (1.49, 1.21 to 1.83) higher risk of all cause mortality and heart disease mortality, respectively. Changing from obese to non-obese body mass index over this period was not significantly associated with mortality risk. An obese to non-obese weight change pattern from middle to late adulthood was associated with increased risk of all cause mortality (1.30, 1.16 to 1.45) and heart disease mortality (1.48, 1.14 to 1.92), whereas moving from the non-obese to obese category over this period was not significantly associated with mortality risk. Maintaining obesity across adulthood was consistently associated with increased risk of all cause mortality; the hazard ratio was 1.72 (1.52 to 1.95) from young to middle adulthood, 1.61 (1.41 to 1.84) from young to late adulthood, and 1.20 (1.09 to 1.32) from middle to late adulthood. Maximum overweight had a very modest or null association with mortality across adulthood. No significant associations were found between various weight change patterns and cancer mortality.

CONCLUSIONS

Stable obesity across adulthood, weight gain from young to middle adulthood, and weight loss from middle to late adulthood were associated with increased risks of mortality. The findings imply that maintaining normal weight across adulthood, especially preventing weight gain in early adulthood, is important for preventing premature deaths in later life.

Body mass index and insulin use as identifiers of high-cost patients with type 2 diabetes: A retrospective analysis of electronic health records linked to insurance claims data

AIMS

To study the association of body mass index (BMI) and insulin use with type 2 diabetes-related healthcare expenditures (T2D-HE).

MATERIALS AND METHODS

Retrospective study using de-identified electronic health records linked to insurance claims data. Study included a prevalence-based sample of overweight or obese patients with antihyperglycaemic-treated T2D. Patients had ≥1 A1c measurement in 2014 (last observed = index A1c), ≥1 BMI measurement within ±90 days of index (average BMI = baseline BMI), and continuous enrolment for 180 days before (baseline) through 395 days after index (day 30-395 = follow-up). BMI was categorized as: 25 to 29.9 kg/m² = overweight; 30 to 34.9 kg/m² = obese class I (OCI); 35 to 39.9 kg/m² = OCII; ≥40 kg/m² = OCIII. Multivariable regressions were used to examine one-year follow-up T2D-HE as a function of BMI, insulin use, an interaction term between BMI and insulin use, and patient demographics.

RESULTS

Study included 13 026 patients (mean age = 63.6 years; 48.1% female; 29.5% overweight, 31.6% OCI, 20.3% OCII, 18.6% OCIII; 25.3% insulin users). Baseline insulin use rates monotonically ranged from 19.7% in overweight patients to 33.0% in OCIII patients (P < 0.001). Together, BMI and insulin use were jointly associated with one-year follow-up T2D-HE, which monotonically ranged from $5842 in overweight patients with no insulin to $17 700 OCIII insulin users, P < 0.001. Within each BMI category, insulin users' one-year T2D-HE was at least double that of non-users. Additional analyses of all-cause healthcare expenditures yielded consistent results.

CONCLUSIONS

BMI and insulin use represent simple stratifiers for identifying high-cost patients. OCIII insulin users incurred the greatest annual healthcare expenditures; these patients may be an ideal group for targeted interventions.

Adult weight gain accelerates the onset of breast cancer

PURPOSE

Weight gain in adulthood is a risk factor for breast cancer; however, the impact on age of onset is unknown. The objective of this study was to investigate whether weight gain from early- to mid-adulthood influenced the timing of breast cancer onset.

METHODS

Increase in body mass index (BMI) from lowest adult BMI to BMI at diagnosis and age at which these events occurred were calculated from breast cancer survivors enrolled in a weight loss trial (n = 660). Quartiles (Q) of the average increase in BMI were determined and associations between weight gain and age at disease onset were analyzed using analysis of covariance and spline regression models.

RESULTS

A significant linear trend was observed across the quartiles of BMI change for earlier age at diagnosis [Q1 52.3 (± 0.73), Q2 51.9 (± 0.70), Q3 49.6 (± 0.66), Q4 47.3 (± 0.67), p < 0.0001] after adjusting for potential confounders. In analyses that stratified by tumor subtype and menopausal status, significant linear trends continued to be observed for earlier age at diagnosis across quartiles of BMI for ER ± , PR ± , HER2 + , as well as pre- and postmenopausal status (p-values < 0.001).

CONCLUSIONS

Women who gain excess weight during adulthood are not only at risk for breast cancer, but also may experience earlier onset of disease and reduced cancer-free years.

Association between Alcohol Consumption and Body Mass Index in University Students

Objective: The aim of this study was to determine the correlation between alcohol consumption and body mass index in university students in Eastern Thailand. Methods: Undergraduate students (19-23 years, n = 396) were randomly surveyed via questionnaires, which included general information, alcohol consumption, and unhealthy food consumption. Average daily alcohol consumption was then calculated from grams of ethanol consumed per day. A subject, who has body mass index (BMI) more than 23 kg/m², was defined as excessive weight. Difference between genders of each variable was compared using independent t-test. Mean of each variable between groups was compared using analysis of variance (ANOVA). The correlation between average daily alcohol consumption and BMI, unhealthy consumption and BMI were analyzed by applying Pearson correlation coefficient. Results: 229 university students consumed alcohol (58%). After 229 subjects were divided into three categories, the average daily alcohol consumption of the overweight group was significantly higher than the underweight and normal weight groups in women; meanwhile, unhealthy food consumption frequencies was not different between groups. Average daily alcohol consumption levels for overweight group were 74.17 and 73.45 g/day in men and women, respectively. Furthermore, higher daily alcohol consumption was independently associated with higher BMI (95% confidence interval [CI] R = 0.161: p = 0.015; men R = 0.120: p = 0.236; women R = 0.214: p = 0.015). Conclusion: There was a positive relationship between alcohol consumption and BMI in university students in Eastern Thailand. This study supports that the daily alcohol consumption is a risk factor for excessive weight and gender may contribute to the correlation.

Impacts of skipping breakfast and late dinner on the incidence of being overweight: a 3-year retrospective cohort study of men aged 20-49 years

BACKGROUND

Most studies on the dietary habits and overweight status of men aged 20-49 years have been cross-sectional, with longitudinal studies being scarce. One-quarter of Japanese men aged 20-49 years skip breakfast or have dinner within 2 h of bedtime (late dinner); therefore, the effects of these eating habits on men's increasing body weight need to be determined.

METHODS

We conducted a retrospective cohort study using health check-up data provided from several health insurance societies in Japan. Participants comprised 45 524 men employees aged 20-49 years who were followed up for 3 years. The primary outcome investigated was body mass index (BMI) ≥25 kg m^-2 . We conducted a multivariable logistic regression analysis and calculated the odds ratios for skipping breakfast and late dinner, as well as baseline age, body mass index, smoking status, eating speed, snack-eating status, alcohol drinking frequency, physical activity, sleep habits, and the interaction between skipping breakfast and late dinner.

RESULTS

Of the participants, 17 706 (38.8%) skipped breakfast and 25 987 (57.1%) had a late dinner. At the 3-year follow-up, 5093 (11.2%) had a BMI ≥25 kg m^-2 . The odds ratios of men skipping breakfast and having a late dinner were 1.18 (95% confidence interval = 1.04-1.33) and 0.92 (95% confidence interval = 0.84-1.01), respectively. The interaction between these factors was nonsignificant.

CONCLUSIONS

We suggest that skipping breakfast among men aged 20-49 years was one predictor of being overweight; however, having dinner within 2 h of bedtime was not a predictor.

High-Intensity Interval Training Is Equivalent to Moderate-Intensity Continuous Training for Short- and Medium-Term Outcomes of Glucose Control, Cardiometabolic Risk, and Microvascular Complication Markers in Men With Type 2 Diabetes

We sought to determine the efficacy of 12 weeks high-intensity interval training (HIIT), compared to moderate-intensity continuous training (MICT) on glucose control, cardiometabolic risk and microvascular complication markers in men living with type 2 diabetes (T2D). Both modalities were combined with resistance training (RT). Additionally, the study aimed to determine the medium-term durability of effects. After a 12-week, thrice weekly, training intervention incorporating either MICT+RT (n = 11) or HIIT+RT (n = 12), the study concluded with a 6-month follow-up analysis. The middle-aged study participants were obese, had moderate duration T2D and were taking multiple medications including insulin, statins and beta-blockers. Participants, randomized via the method of minimization, performed MICT (progressing to 26-min at 55% maximum estimated workload [eWLmax]) or HIIT (progressing to two variations in which twelve 1-min bouts at 95% eWLmax interspersed with 1-min recovery bouts, alternated with eight 30-s bouts at 120% eWLmax interspersed with 2:15 min recovery bouts) under supervision at an exercise physiology facility. To account for fixed and random effects within the study sample, mixed-effect models were used to determine the significance of change following the intervention and follow-up phases and to evaluate group^*time interactions. Beyond improvements in aerobic capacity (P < 0.001) for both groups, both training modalities elicited similar group^*time interactions (P > 0.05) while experiencing benefits for glycated hemoglobin (HbA1c; P = 0.01), subcutaneous adiposity (P < 0.001), and heart rate variability (P = 0.02) during the 12-week intervention. Adiposity (P < 0.001) and aerobic capacity (P < 0.001) were significantly maintained in both groups at the 6-month follow-up. In addition, during the intervention, participants in both MICT+RT and HIIT+RT experienced favorable reductions in their medication usage. The study reported the inter-individual variability of change within both groups, the exaggerated acute physiological responses (using exercise termination indicators) that occurred during the interventions as well as the incidence of precautionary respite afforded in such a study sample. To reduce hyperglycaemia, and prevent further deterioration of cardiometabolic risk and microvascular complication markers (in both the short- and medium-term), future strategies that integrate the adoption and maintenance of physical activity as a cornerstone in the treatment of T2M for men should (cognisant of appropriate supervision) include either structured MICT+RT, or HIIT+RT. Clinical Trials Registration Number: ACTRN12617000582358 http://www.anzctr.org.au/default.aspx.