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Reges O, Test T, Dicker D, Karpati T. Association of Waist Circumference and Body Mass Index Deciles Ratio with All-Cause Mortality: Findings from the National Health and Nutrition Examination Survey. Nutrients 2024; 16:961. [PMID: 38612995 PMCID: PMC11013628 DOI: 10.3390/nu16070961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Given the importance and continued interest in finding a simple, accessible, and universal measure which reflects both general and abdominal adiposity, this study tested for an association of the ratio of WC decile to BMI decile (WC-d/BMI-d) with all-cause mortality. Individuals aged 18-79 years who had participated in the National Health and Nutrition Examination Survey (NHANES) during the years 2007 to 2018 were included in the analysis. WC and BMI deciles were defined separately for males and females, while WC-d/BMI-d was calculated for each individual. The association of WC-d/BMI-d with mortality was assessed using logistic models for the total study population, and then again after stratification by sex, ethnicity, morbidity level, and BMI categories. Positive associations between WC-d/BMI-d and mortality were demonstrated for the total study population (adjusted OR = 1.545, 95%CI: 1.369-1.722) and within different sub-groups, including the population with a normal BMI level (adjusted OR = 1.32, 95%CI: 1.13-1.50). WC-d/BMI-d increased with age, with ~40 years representing a critical time point when WC-d surpasses BMI-d, with a sharper incline for males as compared to females. WC-d/BMI-d was significantly associated with all-cause mortality amongst NHANES American adults; thus, measurements of WC and its integration with BMI in this metric should be considered in clinical practice.
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Affiliation(s)
- Orna Reges
- Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel 40700, Israel
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 6209804, Israel
| | - Tsafnat Test
- Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel;
- Clalit Health Services, Southern District, Yerucham 8050315, Israel
| | - Dror Dicker
- Internal Medicine D and Obesity Clinic, Hasharon Hospital, Rabin Medical Center, Petah Tikva 4937211, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - Tomas Karpati
- Department of Digital Technologies in Medicine, Holon Institute of Technology, Holon 5810201, Israel;
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Costa Pereira JPD, da Silva Diniz A, Pinho Ramiro CPS, Cabral PC. Abdominal obesity and hydration status as protective factors against mortality in older adults: A prospective study. Nutrition 2023; 116:112155. [PMID: 37542934 DOI: 10.1016/j.nut.2023.112155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES The aim of this study was to assess the association between different anthropometric and body composition techniques for defining obesity status and to investigate their clinical implications in older hospitalized patients, both during their hospitalization and after discharge. METHODS This prospective study included patients ≥60 y of age. They were followed for 18 mo to assess mortality and hospital length of stay. Anthropometric measurements and body composition were evaluated, including body mass index (BMI), waist circumference, waist-to-height ratio, body fat percentage, total body water percentage, and muscle mass. These measurements are associated with prognosis and survival. RESULTS A higher BMI, excessive body fat, higher total body water percentage, and abdominal obesity were associated with a lower risk for death (P < 0.05). Higher hydration levels were identified as an independent protective factor against mortality. Obesity, defined by body fat percentage, was associated with a shorter hospital stay (P < 0.05). CONCLUSION The present study adds to the growing body of evidence supporting the existence of the obesity paradox in hospitalized older patients. Additionally, our novel finding reveals that higher levels of total body water percentage are associated with decreased odds of mortality. The study emphasizes the importance of considering other anthropometric measurements and body composition in addition to BMI, considering its limitations. These findings have important implications for health care providers when recommending changes in nutritional status for the older adult population.
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Affiliation(s)
| | | | | | - Poliana Coelho Cabral
- Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil
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Oh TK, Song IA. Preoperative Body Mass Index, Waist Circumference, and Mortality After Major Cancer Surgery: A Nationwide Cohort Study in Korea. J Korean Med Sci 2023; 38:e310. [PMID: 37846784 PMCID: PMC10578992 DOI: 10.3346/jkms.2023.38.e310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/13/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Body mass index (BMI) and waist circumference (WC) were used to evaluate nutritional status and obesity. We aimed to examine whether preoperative BMI or WC was associated with mortality after cancer surgery. METHODS This population-based cohort study used data extracted from the National Health Insurance Service database of South Korea. We included adult patients who underwent major cancer surgery with curative intent between January 1, 2016, and December 31, 2020. RESULTS A total of 87,220 patients were included in the final analysis, and 1,374 (1.6%) died within 90 days after cancer surgery. In the multiple logistic regression model, the BMI < 18.5/kg/m² and > 35 kg/m² groups showed 1.98-fold (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.58-2.49; P < 0.001) and 2.60-fold (OR, 2.60; 95% CI, 1.25-5.40; P < 0.001) higher 90-day mortality after cancer surgery than did the BMI 18.5-24.9 kg/m² group. The 25.0-29.9 kg/m² (P = 0.144) and 30.0-34.9 kg/m² (P = 0.105) BMI groups did not show significant differences compared to the BMI 18.5-24.9 kg/m² group. Compared with the normal WC group, the high (P = 0.052) and very high (P = 0.232) WC groups also did not show significant differences in terms of 90-day mortality. CONCLUSIONS Preoperative BMI < 18.5 kg/m² and > 35 kg/m² is associated with an elevated risk of 90-day mortality after major cancer surgery. However, preoperative WC was not significantly associated with 90-day mortality after cancer surgery.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea.
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Cheng YC, Ma WC, Li YH, Wu J, Liang KW, Lee WJ, Liu HC, Sheu WHH, Lee IT. Plasma aryl hydrocarbon receptor associated with epicardial adipose tissue in men: a cross-sectional study. Diabetol Metab Syndr 2023; 15:188. [PMID: 37749614 PMCID: PMC10519097 DOI: 10.1186/s13098-023-01166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Epicardial adipose tissue (EAT) is a type of ectopic fat with endocrine and paracrine functions. Aryl hydrocarbon receptor (AhR) is a ligand-activated transcription factor that responds to environmental stimuli. AhR expression is associated with obesity. In this cross-sectional study, we aimed to determine the relationship between circulating AhR concentrations and EAT. METHODS A total of 30 men with obesity and 23 age-matched men as healthy controls were enrolled. Plasma AhR concentrations were determined at fasting. The EAT thickness was measured on the free wall of the right ventricle from the basal short-axis plane by magnetic resonance imaging. RESULTS The participants with obesity had a higher plasma AhR level than the controls (81.0 ± 24.5 vs. 65.1 ± 16.4 pg/mL, P = 0.010). The plasma AhR level was positively correlated with EAT thickness (correlation coefficient = 0.380, P = 0.005). After adjusting for fasting glucose levels, plasma AhR levels were still significantly associated with EAT thickness (95% CI 0.458‒5.357, P = 0.021) but not with body mass index (P = 0.168). CONCLUSION Plasma AhR concentrations were positively correlated with EAT thickness on the free wall of the right ventricle in men. Further investigations are needed to evaluate the causal effects and underlying mechanisms between AhR and EAT.
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Affiliation(s)
- Yu-Cheng Cheng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, 40227, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan
| | - Wei-Chun Ma
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, 42055, Taiwan
| | - Yu-Hsuan Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan
- Department of Computer Science & Information Engineering, National Taiwan University, Taipei, 10617, Taiwan
| | - Junyi Wu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan
| | - Kae-Woei Liang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, School of Medicine, National Chung Hsing University, Taichung, 402204, Taiwan
| | - Wen-Jane Lee
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Hsiu-Chen Liu
- Department of Nursing, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | | | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan.
- School of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan.
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Seyedhoseinpour A, Barzin M, Mahdavi M, Valizadeh M, Azizi F, Ghareh S, Hosseinpanah F. BMI category-specific waist circumference thresholds based on cardiovascular disease outcomes and all-cause mortality: Tehran lipid and glucose study (TLGS). BMC Public Health 2023; 23:1297. [PMID: 37407928 DOI: 10.1186/s12889-023-16190-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 06/26/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Waist circumference (WC), a representative of abdominal visceral fat, is strongly associated with cardiovascular disease (CVD) and its outcomes. We aimed to define body mass index (BMI)-specific WC thresholds as predictors of CVD and all-cause mortality. METHODS In this prospective cohort study in the context of the Tehran Lipid and Glucose Study (TLGS), a total of 3344 men and 4068 women were followed up for 18 years. Based on BMI, the participants were categorized into three groups: BMI < 25, 25 < BMI < 30, and BMI > 30. In each BMI category, sex-specific WC thresholds were estimated by the maximum value of Youden's index to predict based on incident CVD events and all-cause mortality prediction. RESULTS Overall 667 and 463 CVD events (the incidence rate of 3.1 to 4.5 in men and 1.1 to 2.6 in women per 1,000 person-years within BMI categories) and 438 and 302 mortalities (the incidence rate of 2.1 to 2.7 in men and 1.2 to 1.4 in women per 1,000 person-years within BMI categories) were recorded in men and women, respectively. WC thresholds in the BMI categories of < 25, 25-30, and BMI > 30 kg/m2 with regard to CVD events were 82, 95, and 103 cm in men and 82, 89, and 100 cm in women, and regarding all-cause mortality, the respective values were 88, 95, and 103 cm in men and 83, 90, and 99 cm among women. CONCLUSION BMI-specific WC thresholds observed here can help to better identify individuals at high risk of developing CVDs.
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Affiliation(s)
- Amirhosein Seyedhoseinpour
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Ghareh
- Tehran Branch, Faculty of Medicine, Islamic Azad University, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Song JH, Seo JY, Jin EH, Chung GE, Kim YS, Bae JH, Kim S, Han KD, Yang SY. Association of changes in obesity and abdominal obesity status with early-onset colorectal cancer risk: a nationwide population-based cohort study. Front Med (Lausanne) 2023; 10:1208489. [PMID: 37415766 PMCID: PMC10321412 DOI: 10.3389/fmed.2023.1208489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
Background and aims The incidence of early-onset colorectal cancer (EO-CRC, diagnosed before 50 years of age) has increased in recent decades. The aim of this study was to investigate the association between changes in obesity status and EO-CRC risk. Methods From a nationwide population-based cohort, individuals <50 years old who participated in the national health checkup program in both 2009 and 2011 were included. Obesity was defined as a body mass index ≥25 kg/m2. Abdominal obesity was defined as a waist circumference ≥ 90 cm in men and ≥ 85 cm in women. Participants were classified into 4 groups according to the change in obesity (normal/normal, normal/obese, obese/normal, persistent obese) and abdominal obesity (normal/normal, normal/abdominal obesity, abdominal obesity/normal, persistent abdominal obesity) status. Participants were followed up until 2019 and censored when they became 50 years old. Results Among 3,340,635 participants, 7,492 patients were diagnosed with EO-CRC during 7.1 years of follow-up. The risk of EO-CRC was higher in the persistent obesity and persistent abdominal obesity groups than in the normal/normal groups (hazard ratio (HR) [95% confidence interval (CI)] = 1.09 [1.03-1.16] and 1.18 [1.09-1.29], respectively). Participants with both persistent obesity and abdominal obesity had a higher EO-CRC risk than those in the normal/normal groups for both [HR (95% CI) = 1.19 (1.09-1.30)]. Conclusion Persistent obesity and persistent abdominal obesity before the age of 50 are associated with a slightly increased risk of EO-CRC. Addressing obesity and abdominal obesity in young individuals might be beneficial in reducing the risk of EO-CRC.
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Affiliation(s)
- Ji Hyun Song
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Yeon Seo
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun Hyo Jin
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Goh Eun Chung
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Sun Kim
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Ho Bae
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sunmie Kim
- Department of Obstetrics and Gynecology, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Obstetrics and Gynecology, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Young Yang
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
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Xue X, Li X, Zhao S, Chen K, Hua W, Su YG, Liang Z, Xu W, Zhang S. Sex Differences in the Relationship between Abdominal Obesity and Cardiovascular Death in Elderly Patients with Permanent Pacemakers Implantation: A Retrospective Cohort Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2023; 2023:4383508. [PMID: 36846050 PMCID: PMC9957648 DOI: 10.1155/2023/4383508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 02/19/2023]
Abstract
Objectives This study aims to investigate the association between waist circumference (WC) and cardiovascular death in patients with permanent pacemakers (PPMs). Methods This is a retrospective cohort study that enrolled patients who underwent PPM implantation in Fuwai Hospital from May 2010 to April 2014, according to the BIOTRONIK Home Monitoring database. The WC was treated as sex-specific quartiles, and patients were divided into three groups according to body mass index (BMI): normal (≤22.9 kg/m2), overweight (23-24.9 kg/m2), and obese (≥25 kg/m2). Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals for cardiovascular death according to WC and BMI in patients. Results 492 patients with PPMs implantation were analyzed (mean age: 71.9 ± 10.8 years; 55.1% men (n = 271)). Data showed that after a mean follow-up 67.2 ± 17.5 months, 24 (4.9%) patients had experienced cardiovascular death and 71 (14.4%) were cases of all-cause mortality. Men in the third quartile of WC had an HR of 10.67 (Model 4, 95% CI: 1.00-115.21, p trend = 0.04) for cardiovascular death. However, the association disappeared in female patients (Model 4, HR = 3.99, 95% CI: 0.37-42.87, p trend = 0.25). There was no association between BMI and cardiovascular death or all-cause mortality in both male and female patients. Conclusions Abdominal obesity was associated with an increased risk of cardiovascular death in patients with PPMs, and this relationship was only in male patients.
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Affiliation(s)
- Xiaodi Xue
- Arrhythmia Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyao Li
- Arrhythmia Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuang Zhao
- Arrhythmia Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keping Chen
- Arrhythmia Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Hua
- Arrhythmia Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan-Gang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhaoguang Liang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Xu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shu Zhang
- Arrhythmia Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Xiao X, Yu X, Zhu H, Zhai X, Li S, Ma W, Ouyang M, Liu K, Eshak ES, Cao J. Arm Circumference, Arm-to-Waist Ratio in Relation to Cardiovascular and All-Cause Mortality among Patients with Diabetes Mellitus. Nutrients 2023; 15:nu15040961. [PMID: 36839318 PMCID: PMC9959583 DOI: 10.3390/nu15040961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
Among patients with diabetes mellitus, limited studies have investigated the relationship between anthropometric parameters and cardiovascular disease (CVD), with all-cause mortality. We examined the associations of arm circumference (AC), arm-to-waist ratio (AC/WC), and CVD, with all-cause mortality among patients with diabetes. This is a cohort study of 5497 diabetic individuals aged 20 or over who were recruited in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014. Cox proportional hazards regression models were used to analyze the associations between AC, AC/WC, and CVD, with all-cause mortality. We also conducted stratified analyses and explored the possible non-linear relation by restricted cubic splines. During a median follow-up of 7.2 years, there were 271 and 1093 cases of CVD and all-cause death. The multivariable adjusted hazard ratios (HRs) with 95% confidence intervals (Cis) of CVD mortality in Q2, Q3, and Q4 groups compared with Q1 group were 0.37 (0.22, 0.62), 0.24 (0.12, 0.48), 0.18 (0.07, 0.46) for AC, and 0.18 (0.07, 0.46), 0.34 (0.20, 0.60), 0.28 (0.15, 0.53) for AC/WC. Similar results were observed in the analysis for all-cause mortality risk. AC and AC/WC were both inversely associated with CVD and all-cause mortality among individuals with diabetes. It is important to pay attention to these anthropometric parameters of diabetic patients.
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Affiliation(s)
- Xinyu Xiao
- School of Public Health, Wuhan University, Wuhan 430071, China
| | - Xinyi Yu
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Huiping Zhu
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Xiaobing Zhai
- Center for Artificial Intelligence Driven Drug Discovery, Faculty of Applied Sciences, Macao Polytechnic University, Macau SAR, China
| | - Shiyang Li
- School of Public Health, Wuhan University, Wuhan 430071, China
| | - Wenzhi Ma
- School of Public Health, Wuhan University, Wuhan 430071, China
| | - Meishou Ouyang
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi 565-0871, Osaka, Japan
| | - Keyang Liu
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi 565-0871, Osaka, Japan
| | - Ehab S. Eshak
- Department of Public Health, Faculty of Medicine, Minia University, Minia 61511, Egypt
- Advanced Clinical Epidemiology, Medical data Science Unit, Public Health, Department of Social Medicine, Graduate School of Medicine, 2-2 Yamadaoka, Osaka University, Suita-shi 565-0871, Osaka, Japan
- Public Health, School of Health, Calvin University, Grand Rapids, MI 49546, USA
| | - Jinhong Cao
- School of Management, Hubei University of Traditional Chinese Medicine, Wuhan 430065, China
- Research Center for the Development of Traditional Chinese Medicine, Hubei Province Project of Key Research Institute of Humanities and Social Sciences at Universities, Wuhan 430065, China
- Correspondence:
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Cho SW, Kim JH, Choi HS, Ahn HY, Kim MK, Rhee EJ. Big Data Research in the Field of Endocrine Diseases Using the Korean National Health Information Database. Endocrinol Metab (Seoul) 2023; 38:10-24. [PMID: 36758542 PMCID: PMC10008661 DOI: 10.3803/enm.2023.102] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
The Korean National Health Information Database (NHID) contains big data combining information obtained from the National Health Insurance Service and health examinations. Data are provided in the form of a cohort, and the NHID can be used to conduct longitudinal studies and research on rare diseases. Moreover, data on the cause and date of death are provided by Statistics Korea. Research and publications based on the NHID have increased explosively in the field of endocrine disorders. However, because the data were not collected for research purposes, studies using the NHID have limitations, particularly the need for the operational definition of diseases. In this review, we describe the characteristics of the Korean NHID, operational definitions of endocrine diseases used for research, and an overview of recent studies in endocrinology using the Korean NHID.
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Affiliation(s)
- Sun Wook Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Han Seok Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Eun Jung Rhee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Li S, Wang Y, Ying Y, Gong Q, Lou G, Liu Y, Liu S, Li H. Independent and Joint Associations of BMI and Waist Circumference With the Onset of Type 2 Diabetes Mellitus in Chinese Adults: Prospective Data Linkage Study. JMIR Public Health Surveill 2023; 9:e39459. [PMID: 36630180 PMCID: PMC9878373 DOI: 10.2196/39459] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/19/2022] [Accepted: 11/26/2022] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND General obesity and abdominal obesity, typically measured by BMI and waist circumference (WC), respectively, are associated with an increased risk of type 2 diabetes mellitus (T2DM). However, the magnitude of the association of these two obesity indicators and their joint association with the onset of T2DM remain controversial. OBJECTIVE The aim of this study was to investigate the associations between these two obesity indicators and T2DM among the Chinese population to contribute scientific evidence for appropriate T2DM interventions. METHODS A cohort of 3001 eligible participants was selected from the Ningbo Adult Chronic Disease Surveillance Project running since 2015. Based on BMI, individuals were categorized into groups of underweight or normal, overweight, and obesity. Based on WC, individuals were categorized in groups of normal, precentral obesity, and central obesity. Follow-up was performed by linking data of the baseline data set with the diabetes registry data set and the vital registry data set (both from the Ningbo Municipal Integrated Noncommunicable Disease Collaborative Management System), mainly using the participants' identity numbers. Follow-up was completed when a participant was diagnosed with T2DM. The associations were estimated with multivariate Cox proportional hazard regression. RESULTS In the cohort, 90 of 3001 participants developed T2DM (incidence density: 6.483/1000 person-years) with a median 4.72 years of follow-up. After controlling for age, sex, hypertension, dyslipidemia, smoking status, and family history of diabetes, the multivariate adjusted hazard ratios (HRs) across underweight/normal, overweight, and obesity BMI categories were 1.000, 1.653 (95% CI 1.030-2.654), and 2.375 (95% CI 1.261-4.473), respectively. The multivariate adjusted HRs across the normal, precentral obesity, and central obesity WC categories were 1.000, 1.215 (95% CI 0.689-2.142), and 1.663 (95% CI 1.016-2.723), respectively. Compared with the reference group (normal WC with an underweight/normal BMI), the multivariate adjusted HR for participants with both central obesity according to WC and obesity according to BMI was 2.489 (95% CI 1.284-4.825). CONCLUSIONS Both elevated BMI and WC at baseline increased the risk of T2DM. Compared with WC, BMI as an obesity indicator was more strongly associated with the onset of T2DM.
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Affiliation(s)
- Sixuan Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Yong Wang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Yanyan Ying
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Qinghai Gong
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Ge Lou
- Center for Disease Control and Prevention of Chaoyang District, Beijing, China
| | - Yang Liu
- Shanghai Pudong New Area Center for Disease Control and Prevention, Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Shiwei Liu
- Chinese Center for Disease Control and Prevention, Bejing, China
| | - Hui Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
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Tutor AW, Lavie CJ, Kachur S, Milani RV, Ventura HO. Updates on obesity and the obesity paradox in cardiovascular diseases. Prog Cardiovasc Dis 2022:S0033-0620(22)00134-7. [PMID: 36481212 DOI: 10.1016/j.pcad.2022.11.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 11/26/2022] [Indexed: 12/10/2022]
Abstract
The prevalence of obesity has reached pandemic proportions worldwide and certainly in the United States. Obesity is a well-established independent risk factor for development of many cardiovascular diseases (CVD), including heart failure, coronary heart disease, atrial fibrillation, and hypertension. Therefore, it is logical to expect obesity would have a strong correlation with CVD mortality. However, a substantial body of literature demonstrates a paradox with improved prognosis of overweight and obese patients with established CVD compared to lean patients with the identical CVD. Surprisingly, similar data has also shown that cardiovascular fitness, rather than weight loss alone, influences the relationship between obesity and mortality in those with established CVD. The impact of fitness, exercise, physical activity (PA), and weight loss and their relationship to the obesity paradox are all reviewed here.
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Affiliation(s)
- Austin W Tutor
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA, USA.
| | - Sergey Kachur
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA, USA; Ascension Sacred Heart Regional Heart and Vascular Institute, Pensacola, FL, USA; Department of Medicine, University of Central Florida School of Medicine, Orlando, FL, USA
| | - Richard V Milani
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA, USA
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA, USA
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12
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Peters A, Sprengell M, Kubera B. The principle of 'brain energy on demand' and its predictive power for stress, sleep, stroke, obesity and diabetes. Neurosci Biobehav Rev 2022; 141:104847. [PMID: 36067964 DOI: 10.1016/j.neubiorev.2022.104847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 08/10/2022] [Accepted: 08/26/2022] [Indexed: 12/01/2022]
Abstract
Does the brain actively draw energy from the body when needed? There are different schools of thought regarding energy metabolism. In this study, the various theoretical models are classified into one of two categories: (1) conceptualizations of the brain as being purely passively supplied, which we call 'P-models,' and (2) models understanding the brain as not only passively receiving energy but also actively procuring energy for itself on demand, which we call 'A-models.' One prominent example of such theories making use of an A-model is the selfish-brain theory. The ability to make predictions was compared between the A- and P-models. A-models were able to predict and coherently explain all data examined, which included stress, sleep, caloric restriction, stroke, type-1-diabetes mellitus, obesity, and type-2-diabetes, whereas the predictions of P-models failed in most cases. The strength of the evidence supporting A-models is based on the coherence of accurate predictions across a spectrum of metabolic states. The theory test conducted here speaks to a brain that pulls its energy from the body on-demand.
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Affiliation(s)
- Achim Peters
- Medical Clinic 1, Center of Brain, Behavior and Metabolism, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
| | - Marie Sprengell
- Medical Clinic 1, Center of Brain, Behavior and Metabolism, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Britta Kubera
- Medical Clinic 1, Center of Brain, Behavior and Metabolism, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
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13
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Jung S, Park S. Positive association of unhealthy plant-based diets with the incidence of abdominal obesity in Korea: a comparison of baseline, most recent, and cumulative average diets. Epidemiol Health 2022; 44:e2022063. [PMID: 35940180 PMCID: PMC9754918 DOI: 10.4178/epih.e2022063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/02/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Different approaches for analyzing repeated dietary measurements may yield differences in the magnitude and interpretation of findings. We aimed to compare 3 dietary measurements (baseline, most recent, and cumulative average) in terms of the association between plant-based diet indices (PDIs) and incident abdominal obesity in Korean adults aged 40-69 years. METHODS This study included 6,054 participants (54% women) free of abdominal obesity (defined as waist circumference ≥90 cm for men and ≥85 cm for women) at baseline. As exposures, baseline, most recent, and cumulative average measurements for PDI, healthy-PDI (hPDI), and unhealthy-PDI (uPDI) were created. A Cox proportional-hazard model was used to estimate the hazard ratios (HRs) for abdominal obesity. RESULTS During 45,818 person-years of follow-up (median, 9 years), we identified 1,778 incident cases of abdominal obesity. In the multivariable-adjusted analysis, a higher uPDI was associated with a higher risk of abdominal obesity in both total and stratified analyses. The findings were consistent across all approaches (Q5 vs. Q1: HRbaseline=1.70; 95% confidence interval [CI], 1.46 to 1.98; HRmost recent=1.52; 95% CI, 1.30 to 1.78; HRcumulative average=1.76; 95% CI, 1.51 to 2.06 in the total set). PDI showed no meaningful association with abdominal obesity risk in any analyses. hPDIaverage had a suggestive inverse association with abdominal obesity risk in men, and hPDIbaseline had a positive association with abdominal obesity risk in women. CONCLUSIONS Greater adherence to unhealthy plant-based diets may increase the risk of developing abdominal obesity in Korean adults. The findings were generally consistent across all approaches.
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Affiliation(s)
- Sukyoung Jung
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA,The Korean Institute of Nutrition, Hallym University, Chuncheon, Korea
| | - Sohyun Park
- The Korean Institute of Nutrition, Hallym University, Chuncheon, Korea,Department of Food Science and Nutrition, Hallym University, Chuncheon, Korea,Correspondence: Sohyun Park Department of Food Science and Nutrition, Hallym University, 1 Hallymdaehak-gil, Chuncheon 24252, Korea E-mail:
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14
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Lee SW, Han K, Kwon HS. Weight change and the risk of hip fractures in patients with type 2 diabetes: a nationwide cohort study. Osteoporos Int 2022; 33:1755-1767. [PMID: 35438308 DOI: 10.1007/s00198-022-06398-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/04/2022] [Indexed: 01/18/2023]
Abstract
UNLABELLED Both weight gain and weight loss in type 2 diabetic population were associated with increased risk of hip fracture, while maintaining weight lowered the risk of hip fracture. Regarding the risk of hip fracture, we can propose active monitoring to maintain the weight of type 2 diabetes patients. INTRODUCTION In type 2 diabetes, patients are often asked to control their weight in order to reduce their diabetic morbidity. The American Diabetes Association recommends that diabetic patients conduct high-intensity interventions for regulating diet, physical activity, and behavior to reduce weight, followed by long-term comprehensive weight maintenance programs. Although such weight control attempts are required in diabetic patients, there are few studies on the effect of weight change on hip fracture in this population. We aim to investigate the association between body weight change and the incidence of hip fracture in subjects with type 2 diabetes using large-scale, nationwide cohort data on the Korean population. MATERIALS AND METHODS A total of 1,447,579 subjects (894,204 men and 553,375 women) > 40 years of age, who were diagnosed with type 2 diabetes, were enrolled in this study. Weight change within 2 years was divided into five categories: from weight loss ≥ 10% to weight gain ≥ 10%. The hazard ratios (HRs) and 95% confidence intervals for the incidence of hip fracture were analyzed, compared with the reference of the stable weight group (weight change < 5%). RESULTS Among 5 weight change groups, more than 10% weight loss showed the highest HR (HR, 1.605; 95% CI, 1.493 to 1.725), followed by more than 10% weight gain (HR, 1.457; 95% CI, 1.318 to 1.612). The effect of weight change on hip fracture risk was greater in males than in females, and those under 65 years of age were greater than those over 65 years of age. Baseline BMI did not play a role of weight change affecting the risk of hip fracture. The HR for hip fracture of subjects with regular exercise was lower than those without regular exercise. CONCLUSIONS In the type 2 diabetes population, both weight gain and weight loss were significantly associated with a higher risk of hip fracture, whereas maintaining body weight reduced the risk of hip fracture the most.
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Affiliation(s)
- S-W Lee
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - K Han
- Department of Statistics and Actuarial Science, Soongsil University, 369, Sangdo-ro, Dongjak-gu, 06978, Seoul, Republic of Korea.
| | - H-S Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, Yuksam-ro, Youngdeungpo-gu, 07345, Seoul, Republic of Korea.
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15
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Peters A, Hartwig M, Spiller T. Obesity and Type 2 Diabetes Mellitus Explained by the Free Energy Principle. Front Psychol 2022; 13:931701. [PMID: 35756264 PMCID: PMC9226719 DOI: 10.3389/fpsyg.2022.931701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
According to the free energy principle, all sentient beings strive to minimize surprise or, in other words, an information-theoretical quantity called variational free energy. Consequently, psychosocial “stress” can be redefined as a state of “heightened expected free energy,” that is, a state of “expected surprise” or “uncertainty.” Individuals experiencing stress primarily attempt to reduce uncertainty, or expected free energy, with the help of what is called an uncertainty resolution program (URP). The URP consists of three subroutines: First, an arousal state is induced that increases cerebral information transmission and processing to reduce uncertainty as quickly as possible. Second, these additional computations cost the brain additional energy, which it demands from the body. Third, the program controls which stress reduction measures are learned for future use and which are not. We refer to an episode as “good” stress, when the URP has successfully reduced uncertainty. Failure of the URP to adequately reduce uncertainty results in either stress habituation or prolonged toxic stress. Stress habituation reduces uncertainty by flattening/broadening individual goal beliefs so that outcomes previously considered as untenable become acceptable. Habituated individuals experience so-called “tolerable” stress. Referring to the Selfish Brain theory and the experimental evidence supporting it, we show that habituated people, who lack stress arousals and therefore have decreased average brain energy consumption, tend to develop an obese type 2 diabetes mellitus phenotype. People, for whom habituation is not the free-energy-optimal solution, do not reduce their uncertainty by changing their goal preferences, and are left with nothing but “toxic” stress. Toxic stress leads to recurrent or persistent arousal states and thus increased average brain energy consumption, which in turn promotes the development of a lean type 2 diabetes mellitus phenotype. In conclusion, we anchor the psychosomatic concept of stress in the information-theoretical concept of uncertainty as defined by the free energy principle. In addition, we detail the neurobiological mechanisms underlying uncertainty reduction and illustrate how uncertainty can lead to psychosomatic illness.
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Affiliation(s)
- Achim Peters
- Medical Clinic 1, Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Mattis Hartwig
- German Research Center for Artificial Intelligence (DFKI), Kaiserslautern, Germany.,singularIT GmbH, Leipzig, Germany
| | - Tobias Spiller
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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16
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Population-based study for the comorbidities and associated factors in Ménière's disease. Sci Rep 2022; 12:8266. [PMID: 35585157 PMCID: PMC9117186 DOI: 10.1038/s41598-022-12492-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/06/2022] [Indexed: 11/09/2022] Open
Abstract
To date, no study has reported the objective metabolic laboratory findings worldwide or the comorbidities for Ménière’s disease (MD) using a population-based design in Asian populations. The aim of this study was to investigate the comorbidities and associated factors for MD using the Korean National Health Insurance Service database. This retrospective population-based study was conducted using a data from the National Sample Cohort database from 2009 to 2015. We only enrolled patients whose records showed a prescription for MD medicine and audiometry findings as well as an appropriate diagnostic code. We also included a matched cohort without MD who were enrolled randomly and matched for sex, age, year of diagnosis, income level, and residential area with the MD group with a ratio of 10:1. We evaluated comorbidities including autoimmune, allergic, metabolic diseases and cancer and the health screening data including general characteristics (height, weight, waist circumference, body mass index, and blood pressure), laboratory findings (fasting glucose, cholesterol, triglyceride, high-density lipoproteintryglyceride (HDL) cholesterol, low-density lipoproteintryglyceride cholesterol, hemoglobin, creatinine, aspartate aminotransferase and alanine aminotransferase, and gamma-glutamyltrans- peptidase (rGT)), and general health behaviors (smoking, alcohol, and exercise) of the MD group, and compared these characteristics with those of the MD-free control group. A total of 2,013 and 20,130 participants were included in the MD and MD-free control groups (1,640 and 15,458 for health screening data). We found the increase in incidence of allergic rhinitis and allergic asthma, decrease in systolic blood pressure, HDL cholesterol, and rGT, and less frequent alcohol consumption and less prevalent smoking in the MD group. No significant differences were observed between the groups in the incidence of autoimmune diseases, and cerebro- and cardiovascular disease as well as health screening data and objective laboratory findings. Inconsistence with published studies, the results of this study suggest that the autoimmunity and metabolic disorder, and skeletal growth might not be associated with the onset of MD. Another well-designed study for other races will be needed to the generalization of this study results.
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17
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Bae EH, Lim SY, Yang EM, Oh TR, Choi HS, Kim CS, Ma SK, Kim B, Han KD, Kim SW. Low waist circumference prior to percutaneous coronary intervention predict the risk for end-stage renal disease: a nationwide Korean population based-cohort study. Korean J Intern Med 2022; 37:639-652. [PMID: 35143719 PMCID: PMC9082428 DOI: 10.3904/kjim.2021.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND/AIMS The obesity paradox has been known in end-stage renal disease (ESRD). However, the effect of body mass index (BMI) or waist circumference (WC) prior to percutaneous coronary intervention (PCI) on the development of ESRD is not clear. METHODS Using nationally representative data from the Korean National Health Insurance System, we enrolled 140,164 subjects without ESRD at enrolment who underwent PCI between 2010 and 2015, and were followed-up until 2017. Patients were stratified into five levels based on their baseline BMI and six levels based on their WC with 5-cm increments. BMI and WC were measured at least 2 years prior to PCI. The primary outcome was the development of ESRD. RESULTS During a median follow-up of 5.4 years, 2,082 (1.49%) participants developed ESRD. The underweight group (hazard ratio [HR], 1.331; 95% confidence interval [CI], 0.955 to 1.856) and low WC (< 80/< 75) (HR, 1.589; 95% CI, 1.379 to 1.831) showed the highest ESRD risk and the BMI 25 to 30 group showed the lowest ESRD risk (HR, 0.604; 95% CI, 0542 to 0.673) in all participants after adjusting for all covariates. In the subgroup analysis for diabetes mellitus (DM) duration, WC < 85/80 cm (men/women) increased ESRD risk in only the DM group (DM < 5 years and DM ≥ 5 years) compared to the reference group (85-90/80-85 of WC), but not the normal or impaired fasting glucose group. CONCLUSION Low WC prior to PCI showed an increased ESRD risk in patients with DM undergoing PCI as compared to those without DM.
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Affiliation(s)
- Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Sang Yup Lim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan,
Korea
| | - Eun Mi Yang
- Department of Pediatrics, Chonnam National University Hospital, Gwangju,
Korea
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul,
Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul,
Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
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18
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Song DK, Hong YS, Sung YA, Lee H. Waist circumference and mortality or cardiovascular events in a general Korean population. PLoS One 2022; 17:e0267597. [PMID: 35476723 PMCID: PMC9045645 DOI: 10.1371/journal.pone.0267597] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Obesity is associated with cardiovascular diseases and is a risk factor for all-cause mortality. Until now, the associations between abdominal obesity and mortality or cardiovascular disease (CVD) incidence have not been conclusive. We aimed to evaluate the associations between waist circumference (WC) and mortality or CVD incidence in a general Korean population. Methods We analyzed a total of 204,068 adults older than 40 years of age who had undergone a national health examination at least once from 2009 to 2018 in the Korean National Health Insurance Service Cohort. WC was divided into five categories (< 80, 80–84.9, 85–89.9, 90–94.9, ≥ 95 cm). Hazard ratios for death and CVD incidence were calculated using Cox proportional hazards models. Results In men, WC and overall mortality showed a reverse J-shaped association. In women, the association between WC and overall mortality was not significant. For both men and women, WC was not associated with the risk of cardiovascular mortality. Contrary to the mortality trend, CVD incidence was positively associated with WC in both men and women, and the risk of the CVD incidence was the lowest in subjects with a WC < 80 cm. Conclusions WC exhibited a significant J-shaped association with overall mortality in men, where subjects who had central obesity showed a lower rate of mortality than those in the lowest or highest WC group. The risk of incident CVD showed a positive association with central obesity, where the lowest risk was observed for subjects in the lowest WC group in a general Korean population.
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Affiliation(s)
- Do Kyeong Song
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Sun Hong
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yeon-Ah Sung
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyejin Lee
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
- * E-mail:
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19
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Choi DD, Han K, Park KA, Oh SY. Association of Obesity and Incidence of Third, Fourth, and Sixth Cranial Nerve Palsies. Am J Ophthalmol 2022; 235:258-270. [PMID: 34543662 DOI: 10.1016/j.ajo.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To assess the association between obesity and the development of third, fourth, and sixth cranial nerve palsy (CNP). METHODS We analyzed a cohort of 4,067,842 adults aged between 20 and 90 years who underwent health checkups within the National Health Insurance Service between January 1 and December 31, 2009. The participants were followed until December 31, 2017. Cox proportional hazards regression analysis was used to determine the adjusted hazard ratios (HRs) for CNP. Model 3 (the main analysis model) was adjusted for age, sex, smoking status, alcohol consumption, and physical activity. Model 4 was additionally adjusted for hypertension, dyslipidemia, and diabetes mellitus in the setting of model 3. RESULTS A total of 5,835 individuals were diagnosed with CNP during the follow-up period (7.3 years). General obesity (body mass index [BMI] ≥25 kg/m2) was associated with an increased risk of CNP compared to individuals without general obesity (model 3, HR 1.248, 95% CI 1.184-1.315; model 4, HR 1.162, 95% CI 1.102-1.227). Abdominal obesity (waist circumference [WC] ≥90 cm in men and ≥85 cm in women) also showed an increased HR compared to individuals without abdominal obesity (model 3, 1.239, 95% CI 1.170-1.313; model 4, HR 1.127, 95% CI 1.062-1.196). Compared to the group without either type of obesity, the group with only abdominal obesity (model 3, HR 1.167, 95% CI 1.035-1.317), the group with only general obesity (HR 1.19, 95% CI 1.14-1.24), and the group with both obesity types (HR 1.317, 95% CI 1.236-1.404) showed increased HRs for CNP. CONCLUSION Based on our population-based cohort study, both general and abdominal obesity increased the risk of CNP. Also, the combination of general and abdominal obesity may further increase the risk of CNP.
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Affiliation(s)
- Daye Diana Choi
- From the Department of Ophthalmology, Kim's Eye Hospital, Seoul, Republic of Korea (D.D.C.)
| | - Kyungdo Han
- Department of Statistics, Soongsil University, Seoul, Republic of Korea (K.H.).
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (K.P. and S.Y.O.).
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (K.P. and S.Y.O.).
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20
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Relative Lean Body Mass and Waist Circumference for the Identification of Metabolic Syndrome in the Korean General Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413186. [PMID: 34948793 PMCID: PMC8700886 DOI: 10.3390/ijerph182413186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/26/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
Lean body mass (LBM) comprises organs and muscle, which are the primary determinants of energy expenditure and regulation of glucose and lipid metabolism. Excessive abdominal fat is associated with metabolic abnormality. Little is known about the relationship between metabolic abnormality and LBM and waist circumference (WC), especially in the Asian general population. The aim of this study was to clarify this relationship. We performed a cross-sectional study with 499,648 subjects who received health check-ups at 16 health promotion centers in 13 Korean cities between January 2018 and October 2019. The subjects were categorized into four groups: (a) High (H)-RLBM (relative lean body mass)/Normal (N)-WC, (b) High-RLBM/Abnormal (A)-WC, (c) Low (L)-RLBM/Normal-WC, and (d) Low-RLBM/Abnormal-WC. RLBM was calculated using fat mass data that were estimated via bioelectrical impedance analysis. L-RLBM/A-WC was significantly associated with metabolically unhealthy status (OR: 4.40, 95% CI: 4.326–4.475) compared to H-RLBM/N-WC. L-RLBM/N-WC (OR: 2.170, 95% CI: 2.122–2.218) and H-RLBM/A-WC (OR: 2.713, 95% CI: 2.659–2.769) were also significantly related to metabolic unhealthy status. The cut-offs of RLBM for predicting metabolic syndrome (MetS) were 74.9 in males and 66.4 in females (p < 0.001). L-RLBM and A-WC are associated with metabolic abnormality in the Korean general population. RLBM is an anthropometric index that can be used to predict MetS in primary health care.
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Koo BK, Park SH, Han K, Moon MK. Cardiovascular Outcomes of Obesity According to Menopausal Status: A Nationwide Population-Based Study. Endocrinol Metab (Seoul) 2021; 36:1029-1041. [PMID: 34674503 PMCID: PMC8566123 DOI: 10.3803/enm.2021.1197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/27/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We estimated the effect of obesity on the incidence of cardiovascular disease (CVD) and mortality in women according to menopausal status. METHODS Women aged 40 to 69 years under routine health check-ups provided by the National Health Insurance Service in 2009 were followed up till 2018 (n=2,208,559). RESULTS In premenopausal women, a significant increment of mortality rate was found in underweight and obesity class II (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.31 to 1.67; and HR, 1.25; 95% CI, 1.12 to 1.39) compared to normal body mass index (BMI); overweight and obesity class I did not affect mortality rate. In postmenopausal women, obesity as well as overweight status reduced the risk of mortality compared to normal BMI (HR, 0.86; 95% CI, 0.83 to 0.88; and HR, 0.84; 95% CI, 0.82 to 0.86). By contrast, there was a linear association between CVD and BMI above the normal range irrespective of menopausal status, which was attenuated in diabetic women. CONCLUSION The current study replicated the J-shaped relationship between BMI and mortality, being more prominent in the postmenopausal group. The risk of CVD was linearly increased as BMI was increased above the normal range irrespective of menopausal status.
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Affiliation(s)
- Bo Kyung Koo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Sang-Hyun Park
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Kyungdo Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Department of Biostatistics, Soongsil University, Seoul,
Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul,
Korea
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22
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Joo I, Kwak MS, Park DH, Yoon SH. Fully automated waist circumference measurement on abdominal CT: Comparison with manual measurements and potential value for identifying overweight and obesity as an adjunct output of CT scan. PLoS One 2021; 16:e0254704. [PMID: 34280224 PMCID: PMC8289071 DOI: 10.1371/journal.pone.0254704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/02/2021] [Indexed: 12/29/2022] Open
Abstract
Objective Waist circumference (WC) is a widely accepted anthropometric parameter of central obesity. We investigated a fully automated body segmentation algorithm for measuring WC on abdominal computed tomography (CT) in comparison to manual WC measurements (WC-manual) and evaluated the performance of CT-measured WC for identifying overweight/obesity. Materials and methods This retrospective study included consecutive adults who underwent both abdominal CT scans and manual WC measurements at a health check-up between January 2013 and November 2019. Mid-waist WCs were automatically measured on noncontrast axial CT images using a deep learning-based body segmentation algorithm. The associations between CT-measured WC and WC-manual was assessed by Pearson correlation analysis and their agreement was assessed through Bland-Altman analysis. The performance of these WC measurements for identifying overweight/obesity (i.e., body mass index [BMI] ≥25 kg/m2) was evaluated using receiver operating characteristics (ROC) curve analysis. Results Among 763 subjects whose abdominal CT scans were analyzed using a fully automated body segmentation algorithm, CT-measured WCs were successfully obtained in 757 adults (326 women; mean age, 54.3 years; 64 women and 182 men with overweight/obesity). CT-measured WC was strongly correlated with WC-manual (r = 0.919, p < 0.001), and showed a mean difference of 6.1 cm with limits of agreement between -1.8 cm and 14.0 cm in comparison to WC-manual. For identifying overweight/obesity, CT-measured WC showed excellent performance, with areas under the ROC curve (AUCs) of 0.960 (95% CI, 0.933–0.979) in women and 0.909 (95% CI, 0.878–0.935) in men, which were comparable to WC-manual (AUCs of 0.965 [95% CI, 0.938–0.982] and 0.916 [95% CI, 0.886–0.941]; p = 0.735 and 0.437, respectively). Conclusion CT-measured WC using a fully automated body segmentation algorithm was closely correlated with manually-measured WC. While radiation issue may limit its general use, it can serve as an adjunctive output of abdominal CT scans to identify overweight/obesity.
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Affiliation(s)
- Ijin Joo
- Department of Radiology, Seoul National University Hospital and Seoul National Collage of Medicine, Seoul, Korea
| | - Min-Sun Kwak
- Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Dae Hyun Park
- Department of Research and Development, MEDICALIP Co. Ltd., Seoul, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital and Seoul National Collage of Medicine, Seoul, Korea
- * E-mail:
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Associations of General and Abdominal Obesity with the Risk of Glioma Development. Cancers (Basel) 2021; 13:cancers13122859. [PMID: 34201103 PMCID: PMC8228893 DOI: 10.3390/cancers13122859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/29/2021] [Accepted: 06/03/2021] [Indexed: 12/27/2022] Open
Abstract
Simple Summary While obesity is a well-known risk factor for the development of various types of cancer, conflicting results have been reported concerning the relationship between obesity and the risk of glioma. To date, no studies have evaluated the association between obesity and risk of glioma development in Eastern Asian populations, who usually have greater fat mass and less muscle and are more likely to develop several metabolic diseases than Western populations of the same body mass index (BMI) category. In this nationwide population-based study, we suggest, for the first time, positive associations of general and central obesity with the risk of glioma development. In addition, we demonstrate a stronger association between abdominal obesity and the risk of glioma development than BMI and the risk of glioma development. Abstract The association between obesity and the risk of glioma remains unclear. We sought to evaluate the potential association between general and abdominal obesity and the risk of glioma based on a nationwide population-based cohort study of Koreans. Using data from the Korean National Health Insurance System cohort, 6,833,744 people older than 20 years who underwent regular national health examination in both 2009 and 2011 were followed until the end of 2017. We documented 4771 glioma cases based on an ICD-10 code of C71 during the median follow-up period of 7.30 years. Individuals with a body mass index (BMI) ≥ 25.0 kg/m2 were at significantly higher risk of developing glioma than those with a BMI < 25.0 kg/m2 (HR 1.08 CI 1.02–1.15). Individuals with a waist circumference (WC) ≥ 90 cm (males)/85 cm (females) also had a significantly higher risk of glioma than those with a WC < 90 cm (males)/85 cm (females) (HR 1.16 CI 1.09–1.24). In the group with a BMI ≥ 25.0 kg/m2, individuals with abdominal obesity were at significantly higher risk of developing glioma (HR 1.18 CI 1.09–1.27) than those without abdominal obesity. The role of abdominal obesity in this association was stronger in women than in men. To the best of our knowledge, this is the first demonstration that obese people may be at higher risk of glioma, especially centrally obese people from an Asian population with a BMI ≥ 25.0 kg/m2. Loss of visceral fat in people with abdominal obesity may reduce their risk of developing glioma.
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Apalasamy YD, Awang H, Mansor N, AbRashid N, Kamarulzaman ND, Lih Yoong T. Factors Associated With Obesity and Abdominal Obesity Among Malaysian Older Adults. Asia Pac J Public Health 2021; 33:547-554. [PMID: 34013778 DOI: 10.1177/10105395211014634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obesity is a rising concern globally. This study investigated the prevalence and factors associated with obesity and abdominal obesity (AO) among 5613 Malaysians aged 40 years and older via computer-assisted personal interviewing and anthropometric measurements. Obesity and AO prevalence were 37.8% and 63.1%, respectively. Significant associations were observed between: obesity with higher risk in patients aged between 40 and 49 years, Indians, females, income ≥RM 2000, and health status, and AO with higher risk in patients aged between 50 and 59 years, Indians, females, never married, income ≥RM 2000, and vigorous physical activity. Hence, age, sex, income, and ethnicity are associated with both obesity and AO. Promoting healthy body mass index and waist circumference is essential for healthy ageing.
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Kim CS, Han KD, Choi HS, Bae EH, Ma SK, Kim SW. Association of Body Mass Index and Waist Circumference with All-Cause Mortality in Hemodialysis Patients. J Clin Med 2020; 9:jcm9051289. [PMID: 32365666 PMCID: PMC7288310 DOI: 10.3390/jcm9051289] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022] Open
Abstract
In this study based on a large nationally representative sample of Korean adults, we investigated the potential associations of the body mass index (BMI) and waist circumference (WC) with mortality in patients undergoing hemodialysis. We obtained the data of 18,699 participants >20 years of age who were followed up with for 4 years and for whom BMI and WC information were available, using a nationally representative dataset from the Korean National Health Insurance System. Patients were stratified into five levels by their baseline BMI and into six levels by their WC (5-cm increments). A total of 4975 deaths occurred during a median follow-up period of 48.2 months. Participants with a higher BMI had a lower mortality rate than those with a lower BMI. In a fully adjusted Cox regression analysis, being overweight and obese was associated with a significantly lower relative risk of all-cause mortality relative to the reference group. Conversely, the mortality rate was higher among participants with a high WC than among those with a low WC. Participants with the highest WC had a higher risk of mortality, while those with the lowest WC level had a significantly lower risk of mortality. In conclusion, all-cause mortality was positively associated with WC, a measure of abdominal obesity, and inversely associated with BMI, a measure of body volume, in patients undergoing hemodialysis.
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Affiliation(s)
- Chang Seong Kim
- Departments of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Korea; (C.S.K.); (H.S.C.); (E.H.B.); (S.K.M.)
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Korea;
| | - Hong Sang Choi
- Departments of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Korea; (C.S.K.); (H.S.C.); (E.H.B.); (S.K.M.)
| | - Eun Hui Bae
- Departments of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Korea; (C.S.K.); (H.S.C.); (E.H.B.); (S.K.M.)
| | - Seong Kwon Ma
- Departments of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Korea; (C.S.K.); (H.S.C.); (E.H.B.); (S.K.M.)
| | - Soo Wan Kim
- Departments of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Korea; (C.S.K.); (H.S.C.); (E.H.B.); (S.K.M.)
- Correspondence: ; Tel.: +82-62-220-6271; Fax: +82-62-220-8578
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Relationship between Morbidity and Health Behavior in Chronic Diseases. J Clin Med 2020; 9:jcm9010121. [PMID: 31906521 PMCID: PMC7020052 DOI: 10.3390/jcm9010121] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/25/2019] [Accepted: 12/26/2019] [Indexed: 01/04/2023] Open
Abstract
This study aimed to analyze the demographic characteristics and health behaviors related to chronic diseases and to identify factors that may affect chronic diseases. Data from the Seventh Korea National Health and Nutrition Examination Survey were used, and 3795 adults aged above 40 years were included. The following demographic variables were obtained: sex, age, education, income, type of health insurance, and private insurance. The following health behavior factors were also analyzed: medical checkup, drinking, smoking, exercise, obesity, and hypercholesterolemia. Participants with lower socioeconomic status had a higher risk of developing chronic diseases. Meanwhile, those with private health insurance had a lower risk of developing chronic diseases. In addition, participants who underwent medical checkups and performed exercises had a lower risk, while those with obesity and hypercholesterolemia had a higher risk of developing chronic diseases. It is necessary to manage chronic diseases through comprehensive programs, rather than managing these diseases individually, and through community primary care institutions to improve health behaviors.
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