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Mendez I, Strassle PD, Ponce S, Le R, Stewart AL, Nápoles AM. Age-related differences in the association between financial hardship and weight change during the COVID-19 pandemic. Heliyon 2024; 10:e30917. [PMID: 38779010 PMCID: PMC11108839 DOI: 10.1016/j.heliyon.2024.e30917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Objective To examine the association of financial hardship with weight changes in the US during the COVID-19 pandemic. Methods We used data from the COVID-19's Unequal Racial Burden survey, a nationally representative, cross-sectional, online survey of diverse adults living in the US, 12/2020-2/2021. This study included 1000 Asian, Black, Latino (half Spanish-speaking), and White adults and 500 American Indian or Alaska Native, Native Hawaiian or Pacific Islander, and multiracial adults (5500 total). Age-specific (18-39, 40-59, ≥60) associations between financial hardship domains and weight change were estimated using multinomial logistic regression, adjusted for demographic and health characteristics. Results Financial hardship during the COVID-19 pandemic was prevalent across all age groups (18-39: 76.2 %; 40-59: 75.6 %; ≥60: 50.6 %). Among adults aged 18-39 and ≥ 60 years old, food insecurity was significantly associated with weight loss (18-39: aOR = 1.42, 95 % CI = 1.04, 1.95; ≥60: aOR = 3.67, 95 % CI = 1.50, 8.98). Among all age groups, unmet healthcare expenses was also associated with weight loss (18-39: aOR = 1.31, 95 % CI = 1.01, 1.70; 40-59: aOR = 1.49, 95 % CI = 1.06, 2.08; ≥60: aOR = 1.73, 95 % CI = 1.03, 2.91). Among adults aged 18-39 and ≥ 60 years old, lost income was significantly associated with weight gain (18-39: aOR = 1.36, 95 % CI = 1.09-1.69; ≥60: aOR = 1.46, 95 % CI = 1.04, 2.06), and among adults 40-59 years old, experiencing increased debt was significantly associated with weight gain (aOR = 1.50, 95 % CI = 1.13, 1.99). Conclusions For those aged 18-39 and ≥ 60 years old experiencing financial hardship during the COVID-19 pandemic was associated with both weight loss and weight gain. Less correlation was observed among adults aged 40-59.
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Affiliation(s)
- Izabelle Mendez
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, MD, USA
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Paula D. Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, MD, USA
| | - Stephanie Ponce
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, MD, USA
| | - Randy Le
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, MD, USA
| | - Anita L. Stewart
- University of California San Francisco, Institute for Health & Aging, Center for Aging in Diverse Communities, USA
| | - Anna M. Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, MD, USA
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Mendez I, Strassle PD, Rodriquez EJ, Ponce S, Le R, Green A, Martinez E, Pérez-Stable EJ, Nápoles AM. Racial and ethnic disparities in the association between financial hardship and self-reported weight change during the first year of the pandemic in the U.S. Int J Equity Health 2024; 23:12. [PMID: 38254081 PMCID: PMC10804602 DOI: 10.1186/s12939-023-02093-0] [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: 08/15/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024] Open
Abstract
Studies have shown that financial hardship can impact weight change; however, it is unclear what the economic impact of the COVID-19 pandemic has had on weight change in U.S. adults, or whether racial-ethnic groups were impacted differentially. We estimated the association between financial hardship and self-reported weight change using data from the cross-sectional COVID-19's Unequal Racial Burden (CURB) survey, a nationally representative online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Latino (English- and Spanish-speaking), Native Hawaiian/Pacific Islander, White, and multiracial adults conducted from 12/2020 to 2/2021. Financial hardship was measured over six domains (lost income, debt, unmet general expenses, unmet healthcare expenses, housing insecurity, and food insecurity). The association between each financial hardship domain and self-reported 3-level weight change variable were estimated using multinomial logistic regression, adjusting for sociodemographic and self-reported health. After adjustment, food insecurity was strongly associated with weight loss among American Indian/Alaska Native (aOR = 2.18, 95% CI = 1.05-4.77), Black/African American (aOR = 1.77, 95% CI = 1.02-3.11), and Spanish-speaking Latino adults (aOR = 2.32, 95% CI = 1.01-5.35). Unmet healthcare expenses were also strongly associated with weight loss among Black/African American, English-speaking Latino, Spanish-speaking Latino, and Native Hawaiian/Pacific Islander adults (aORs = 2.00-2.14). Other domains were associated with weight loss and/or weight gain, but associations were not as strong and less consistent across race-ethnicity. In conclusion, food insecurity and unmet healthcare expenses during the pandemic were strongly associated with weight loss among racial-ethnic minority groups. Using multi-dimensional measures of financial hardship provides a comprehensive assessment of the effects of specific financial hardship domains on weight change among diverse racial-ethnic groups.
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Affiliation(s)
- Izabelle Mendez
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA.
| | - Paula D Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland), USA
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Stephanie Ponce
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Randy Le
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Alexis Green
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Emma Martinez
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland), USA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland), USA
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Anna M Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
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Mensinger JL, Cox SA, Henretty JR. Treatment Outcomes and Trajectories of Change in Patients Attributing Their Eating Disorder Onset to Anti-obesity Messaging. Psychosom Med 2021; 83:777-786. [PMID: 34267090 PMCID: PMC8428859 DOI: 10.1097/psy.0000000000000962] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 02/05/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Given the increased prevalence of eating disorders (EDs) among individuals higher on the weight spectrum, we aimed to 1) report the prevalence of ED patients in higher levels of care (residential, partial hospitalization, and intensive outpatient) attributing the onset of their ED to anti-obesity messaging, 2) report the most commonly recollected sources of those messages, and 3) determine if those attributing the onset of their ED to anti-obesity messaging a) enter, b) exit, and c) respond to treatment differently from peers who did not. METHODS This retrospective cohort study used data from 2901 patients receiving ED treatment in higher levels of care at a US-based center between 2015 and 2018. Multilevel models examined differences in ED symptoms and trajectories of change over time. NVivo was used to analyze the patients' comments about sources of messages. RESULTS Eighteen percent attributed their ED onset to anti-obesity messaging, 45% did not, and 37% were unsure. Of those providing comments, the most common sources included the following: educational curriculum/school context (45.9%), media/Internet (24.7%), health care (10.4%), family (9%), and peer bullying (3.7%). At admission, patients attributing their ED onset to anti-obesity messaging had more severe ED symptoms than those who did not (γ = 0.463, standard error [SE] = 0.086, p < .001) and those who were unsure (γ = 0.288, SE = 0.089, p < .001); no differences were evident at discharge (p > .483). During phase 2 of treatment, patients attributing their ED onset to anti-obesity messaging improved faster than those who did not (γ = 0.003, SE = 0.001, p = .008) and those who were unsure (γ = 0.003, SE = 0.001, p = .014). CONCLUSIONS Anti-obesity messaging may put vulnerable individuals at risk for EDs. We recommend increasing weight bias training for school personnel and health care professionals. To reduce health disparities, we also suggest the promotion of weight-neutral health-enhancing self-care practices in media and public health campaigns, legislative policies, and health care overall.
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Suh J, Cho YJ, Kim HJ, Choi SS. Age-Related Difference in Weight Change and All-Cause Mortality in Middle-Aged and Older Korean Populations: Korean Longitudinal Study of Aging. Korean J Fam Med 2021; 42:297-302. [PMID: 34320797 PMCID: PMC8321903 DOI: 10.4082/kjfm.20.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background Obesity is associated with increased mortality as a significant risk factor for chronic diseases, including cardiovascular diseases and cancer. Several people believe that weight gain is harmful, and weight loss helps maintain health. However, some studies have shown that weight loss, particularly among older adults, is more likely to increase the risk of mortality than weight gain. Methods We used data for the cohort of the Korean Longitudinal Study of Aging, which is a nationwide stratified multi-stage sample of adults aged 45 years. The all-cause mortality risk was assessed using the survival status and the number of months of survival calculated from 2006 (baseline year) to 2016. Cox proportional hazard regression were used to study the causal link between weight change and all-cause mortality risk. Results The results showed interactive associations between weight loss and mortality among middle-aged and older adults. The hazard ratio was 1.62 (95% confidence interval [CI], 1.10–2.40) for the participants aged 45–65 years with weight losses greater than 5 kg and 1.56 (95% CI, 1.29–1.89) for those older than 65 years with weight losses greater than 5 kg. The results for the group with weight gain above 5 kg were not significant. Middle-aged and older men showed an increase in all-cause mortality associated with weight loss of more than 5 kg, but only the older women showed significant results. Conclusion This large-scale cohort study in Korea showed a relationship between weight loss and all-cause mortality in middle-aged and older individuals.
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Affiliation(s)
- Jungki Suh
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Yoon Jeong Cho
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hyun Ji Kim
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Seong Soo Choi
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
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Diagnosing undernutrition children and adults: new French criteria. Why, for what and for whom? A joint statement of the French National Authority for Health and French Federation of Nutrition. Br J Nutr 2021; 127:739-751. [PMID: 33958009 DOI: 10.1017/s0007114521001471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective was to establish new diagnostic criteria for undernutrition for the French population, concordant for children aged <18 years and adults aged <70 years, easy to use by health professionals and applicable whatever the situation (in and outpatients). A multi-disciplinary working and a reading group were involved. The procedure was divided into four phases: (1) systematic review and synthesis of the literature; (2) writing of the initial version of the guidelines; (3) reading and (4) finalisation. The literature search included international guidelines, meta-analyses, systematic reviews and randomised control trials from January 2007 to 31 July 2018. A two-step approach was selected: diagnosing undernutrition and then grading its severity. For diagnosis at least one phenotypic criterion associated with at least one aetiologic criterion were required for both children and adults. Phenotypic criteria for children were weight loss, Body Mass Index (BMI) < International Obesity Task Force curve 18·5, weight stagnation, reduction of muscle mass/function; for adults: weight loss, BMI < 18·5 and reduction of muscle mass/function. Aetiological criteria for children and adults were reduction in dietary intake, reduced absorption and hypercatabolism. Phenotypic metrics were used in both children and adults for grading severity (moderate or severe). These new French recommendations integrate the proposals of recent international recommendations combining aetiologic with phenotypic criteria, but for the first time, they are concordant for children and adults. The WHO threshold of 18·5 for BMI was kept as phenotypic criteria because epidemiological data show an increased mortality for that threshold.
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Zheng H, Echave P, Mehta N, Myrskylä M. Life-long body mass index trajectories and mortality in two generations. Ann Epidemiol 2021; 56:18-25. [PMID: 33493649 PMCID: PMC8009819 DOI: 10.1016/j.annepidem.2021.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/04/2021] [Accepted: 01/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify life-long body mass index (BMI) trajectories across two related generations and estimate their associated mortality risks and population attributable deaths. METHODS We use prospective cohort data from the Framingham Heart Study (1948-2011) original (4576 individuals, 3913 deaths) and offspring (3753 individuals, 967 deaths) cohorts and latent trajectory models to model BMI trajectories from age 31 to 80 years. Survival models are used to estimate trajectory-specific mortality risk. RESULTS We define seven BMI trajectories among original cohort and six among offspring cohort. Among original cohort, people who are normal weight at age 31 years and gradually move to overweight status in middle or later adulthood have the lowest mortality risk even compared to those who maintain normal weight throughout adulthood, followed by overweight stable, lower level of normal weight, overweight downward, class I obese upward, and class II/III upward trajectories. Mortality risks associated with obesity trajectories have declined across cohorts, while the prevalence of high-risk trajectories has increased. CONCLUSIONS The mortality impact of weight gain depends on an individual's BMI trajectory. Population attributable deaths associated with unhealthy weight trajectories have grown over generations because the prevalence has increased, offsetting the decline in trajectory-specific mortality risks.
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Affiliation(s)
- Hui Zheng
- Ohio State University, Columbus, OH.
| | | | - Neil Mehta
- University of Texas Medical Branch, Galveston, Texas
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Rostock, Germany
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Cheng YJ, Chen ZG, Wu SH, Mei WY, Yao FJ, Zhang M, Luo DL. Body mass index trajectories during mid to late life and risks of mortality and cardiovascular outcomes: Results from four prospective cohorts. EClinicalMedicine 2021; 33:100790. [PMID: 33778436 PMCID: PMC7985466 DOI: 10.1016/j.eclinm.2021.100790] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Our understanding of the weight-outcome association mainly comes from single-time body mass index (BMI) measurement. However, data on long-term trajectories of within-person changes in BMI on diverse study outcomes are sparse. Therefore, this study is to determine the associations of individual BMI trajectories and cardiovascular outcomes. METHODS The present analysis was based on data from 4 large prospective cohorts and restricted to participants aged ≥45 years with at least two BMI measurements. Hazard ratios (HR) and 95% confidence intervals(95%CI) for each outcome according to different BMI trajectories were calculated in Cox regression models. FINDINGS The final sample comprised 29,311 individuals (mean age 58.31 years, and 77.31% were white), with a median 4 BMI measurements used in this study. During a median follow-up of 21.16 years, there were a total of 10,192 major adverse cardiovascular events (MACE) and 11,589 deaths. A U-shaped relation was seen with all study outcomes. Compared with maintaining stable weight, the multivariate adjusted HR for MACE were 1.53 (95%CI 1.40-1.66), 1.26 (95%CI 1.16-1.37) and 1.08 (95%CI 1.02-1.15) respectively for rapid, moderate and slow weight loss; 1.01 (95%CI 0.95-1.07), 1.13 (95%CI 1.05-1.21) and 1.29 (95%CI 1.20-1.40) respectively for slow, moderate and rapid weight gain. Identical patterns of association were observed for all other outcomes. The development of BMI differed markedly between the outcome-free individuals and those who went on to experience adverse events, generally beginning to diverge 10 years before the occurrence of the events. INTERPRETATION Our findings may signal an underlying high-risk population and inspire future studies on weight management. FUNDING National Natural Science Foundation of China, Guangdong Natural Science Foundation.
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Affiliation(s)
- Yun-Jiu Cheng
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510700, China
- From Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
- Corresponding authors.
| | - Zhen-Guang Chen
- From the Department of Thoracic Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Su-Hua Wu
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510700, China
- From Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Wei-Yi Mei
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510700, China
- From Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Feng-Juan Yao
- From the Department of Medical Ultrasonics, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Zhang
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dong-Ling Luo
- From the Department of Cardiology, the Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen 518033, China
- Corresponding authors.
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Kong JW, Park T, Lee DR, Lee J. Trajectories of Body Mass Index and Their Associations with Mortality among Older Adults in Korea: Analysis of the Korean Longitudinal Study of Aging. Ann Geriatr Med Res 2020; 24:195-203. [PMID: 32829573 PMCID: PMC7533191 DOI: 10.4235/agmr.20.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/11/2020] [Indexed: 01/26/2023] Open
Abstract
Background Weight change is a known risk factor for mortality. Previous Korean studies only considered mortality consequences of weight change between two time points over relatively short periods. This study investigated whether body mass index (BMI) trajectory patterns were associated with all cause-mortality based on continuous BMI observations during a 10-year follow-up period among Korean older adults.
Method This study analyzed data from the 2006–2016 Korean Longitudinal Study of Aging database. The participants included in this study were 3,478 people aged 65 years or older who had no previous cancer history. A trajectory model was developed to classify different homogeneous trajectory subgroups according to BMI, and Cox proportional hazards models were used to investigate the association of BMI trajectory with all-cause mortality.
Result We identified four trajectory groups: obese (OG); overweight (OWG); high normal weight (HNWG); and low normal weight (LNWG). The LNWG and HNWG experienced continuous weight loss during the study period. Trajectories with higher BMI were associated with lower mortality. The adjusted hazard ratios (95% confidence intervals) for all-cause mortality in the LNWG, HNWG, and OWG were 2.40 (1.69–3.40), 1.75 (1.26–2.45), and 1.38 (0.99–1.96), respectively, compared with those in the OG.
Conclusion We found that the lower the BMI of the weight trajectory group, the higher the mortality over 10 years in Korean older adults. This result suggested that baseline obesity status and degree of weight loss during follow-up contributed to mortality in later life.
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Affiliation(s)
- Jong Won Kong
- Department of Family Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
| | - Taegyu Park
- Department of Family Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
| | - Dong Ryul Lee
- Department of Family Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
| | - Jungun Lee
- Department of Family Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
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Javed AA, Aljied R, Allison DJ, Anderson LN, Ma J, Raina P. Body mass index and all-cause mortality in older adults: A scoping review of observational studies. Obes Rev 2020; 21:e13035. [PMID: 32319198 DOI: 10.1111/obr.13035] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/14/2020] [Accepted: 03/24/2020] [Indexed: 12/17/2022]
Abstract
In older age, body composition changes as fat mass increases and redistributes. Therefore, the current body mass index (BMI) classification may not accurately reflect risk in older adults (65+). This study aimed to review the evidence on the association between BMI and all-cause mortality in older adults and specifically, the findings regarding overweight and obese BMI. A systematic search of the OVID MEDLINE and Embase databases was conducted between 2013 and September 2018. Observational studies examining the association between BMI and all-cause mortality within a community-dwelling population aged 65+ were included. Seventy-one articles were included. Studies operationalized BMI categorically (n = 60), continuously (n = 8) or as a numerical change/group transition (n = 7). Reduced risk of mortality was observed for the overweight BMI class compared with the normal BMI class (hazard ratios [HR] ranged 0.41-0.96) and for class 1 or 2 obesity in some studies. Among studies examining BMI change, increases in BMI demonstrated lower mortality risks compared with decreases in BMI (HR: 0.83-0.95). Overweight BMI classification or a higher BMI value may be protective with regard to all-cause mortality, relative to normal BMI, in older adults. These findings demonstrate the potential need for age-specific BMI cut-points in older adults.
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Affiliation(s)
- Ayesha A Javed
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Rumaisa Aljied
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - David J Allison
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada.,Labarge Centre for Mobility in Aging, Hamilton, Canada
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Batsis JA, Petersen CL, Crow RS, Cook SB, Stevens CJ, Seo LM, Brooks E, Mackenzie TA. Weight change and risk of the foundation of National Institute of Health Sarcopenia-defined low lean mass: Data from the National Health and Nutrition examination surveys 1999-2004. Clin Nutr 2020; 39:2463-2470. [PMID: 31727381 PMCID: PMC7196520 DOI: 10.1016/j.clnu.2019.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 09/16/2019] [Accepted: 10/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Self-reported weight change may lead to adverse outcomes. We evaluated weight change with cutpoints of low lean mass (LLM) in older adults. METHODS Of 4984 subjects ≥60 years from NHANES 1999-2004, we applied LLM cutoffs of appendicular lean mass (ALM):body mass index (BMI) males<0.789, females<0.512. Self-reported weight was assessed at time of survey, and questions asked participants their weight one and 10 years earlier, and at age 25. Weight changes were categorized as greater/less/none than 5%. Logistic regression assessed weight change (gain, loss, no change) on LLM, after adjustment. RESULTS Of 4984 participants (56.5% female), mean age and BMI were 71.1 years and 28.2 kg/m2. Mean ALM was 19.7 kg. In those with LLM, 13.5% and 16.3% gained/lost weight in the past year, while 48.9% and 19.4% gained/lost weight in the past decade. Compared to weight at age 25, 85.2 and 6.1% of LLM participants gained and lost ≥5% of their weight, respectively. Weight gain over the past year was associated with a higher risk of LLM (OR 1.35 [0.99,1.87]) compared to weight loss ≥5% over the past year (0.89 [0.70,1.12]). Weight gain (≥5%) over 10-years was associated with a higher risk of LLM (OR 2.03 [1.66, 2.49]) while weight loss (≥5%) was associated with a lower risk (OR 0.98 [0.76,1.28]). Results were robust compared to weight at 25 years (gain OR 2.37 [1.76,3.20]; loss OR 0.95 [0.65,1.39]). CONCLUSION Self-reported weight gain suggests an increased risk of LLM. Future studies need to verify the relationship with physical function.
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Affiliation(s)
- John A Batsis
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States; The Dartmouth Institute for Health Policy, Lebanon, NH, United States.
| | - Curtis L Petersen
- The Dartmouth Institute for Health Policy, Lebanon, NH, United States
| | - Rebecca S Crow
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Summer B Cook
- Department of Kinesiology, University of New Hampshire, Durham, NH, United States
| | | | - Lillian M Seo
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Emma Brooks
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Todd A Mackenzie
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States; The Dartmouth Institute for Health Policy, Lebanon, NH, United States
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11
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Crow RS, Petersen CL, Cook SB, Stevens CJ, Titus AJ, Mackenzie TA, Batsis JA. Reported Weight Change in Older Adults and Presence of Frailty. J Frailty Aging 2020; 9:74-81. [PMID: 32259180 DOI: 10.14283/jfa.2019.44] [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: 12/20/2022]
Abstract
OBJECTIVE A 5% change in weight is a significant predictor for frailty and obesity. We ascertained how self-reported weight change over the lifespan impacts rates of frailty in older adults. METHODS We identified 4,984 subjects ≥60 years with body composition measures from the National Health and Nutrition Examination Survey. An adapted version of Fried's frailty criteria was used as the primary outcome. Self-reported weight was assessed at time current,1 and 10 years earlier and at age 25. Weight changes between each time point were categorized as ≥ 5%, ≤5% or neutral. Logistic regression assessed the impact of weight change on the outcome of frailty. RESULTS Among 4,984 participants, 56.5% were female, mean age was 71.1 years, and mean BMI was 28.2kg/m2. A weight loss of ≥ 5% had a higher association with frailty compared to current weight, age 25 (OR 2.94 [1.72,5.02]), 10 years ago (OR 1.68 [1.05,2.69]), and 1 year ago (OR 1.55 [1.02,2.36]). Weight gain in the last year was associated with increased rate of frailty (1.59 [1.09,2.32]). CONCLUSION There is an association between frailty and reported weight loss over time while only weight gain in the last year has an association with frailty.
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Affiliation(s)
- R S Crow
- Rebecca Crow DO, Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, Telephone: (603) 653-9500, Facsimile: (603) 650-0915, E-mail:
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12
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Hsu MF, Yu SH, Chuang SJ, Kuo TKC, Singal PK, Huang CY, Kao CL, Kuo CH. Can mesenchymal stem cell lysate reverse aging? Aging (Albany NY) 2019; 10:2900-2910. [PMID: 30362957 PMCID: PMC6224235 DOI: 10.18632/aging.101595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/12/2018] [Indexed: 12/16/2022]
Abstract
Recent findings regarding uses of adipose-derived mesenchymal stem cell (MSC)-lysate on weight loss and improved glucose tolerance in mice on a high-fat diet suggest an encouraging possibility of using MSC lysate for an anti-aging intervention in humans. However, weight loss and lipopenia during late life can be as life-threatening as hyperglycemia during early adulthood. For this 3-year lifelong experiment, a total of 92 rats were randomized into the vehicle-injected group (F=22; M=24) and the MSC lysate injected group (F=22, M=24). We examined longevity, spontaneous locomotor activity, and body composition in rats maintained on a normal diet and received an intermittent treatment of human adipose-derived MSC lysate (3 times a week, 11 times a month given every second month), starting at 12 months of age until natural death. In substantiating previous knowledge regarding the effects of long-term MSC lysate treatments on fat loss and insulin resistance, the present findings also highlighted a shortened average lifespan, a longer inactive time, and a greater bone loss with a relative increase of lean mass in MSC lysate rats with respect to controls. Conclusion: Our data suggest that MSC lysate treatments stimulate disparity in tissue development and produce a cachexia-like effect to decrease longevity.
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Affiliation(s)
- Ming-Fen Hsu
- Laboratory of Exercise Biochemistry, University of Taipei, Taipei, Taiwan
| | - Szu-Hsien Yu
- Laboratory of Exercise Biochemistry, University of Taipei, Taipei, Taiwan
| | - Sheng-Ju Chuang
- Laboratory of Exercise Biochemistry, University of Taipei, Taipei, Taiwan.,Université Catholique de Louvain and de Duve Institute, Brussels, Belgium
| | - Tom Kwang-Chun Kuo
- Stem Cell Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Pawan K Singal
- Institute of Cardiovascular Sciences, St Boniface General Hospital Research Centre and Department of Physiology and Pathophysiology, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
| | - Chih-Yang Huang
- Department of Health and Nutrition Biotechnology, Asia University, Taichung, Taiwan.,Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan
| | - Chung-Lan Kao
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | - Chia-Hua Kuo
- Laboratory of Exercise Biochemistry, University of Taipei, Taipei, Taiwan
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Nishimoto M, Tagawa M, Matsui M, Eriguchi M, Samejima KI, Iseki K, Iseki C, Asahi K, Yamagata K, Konta T, Fujimoto S, Narita I, Kasahara M, Shibagaki Y, Moriyama T, Kondo M, Watanabe T, Tsuruya K. A Prediction Model with Lifestyle in Addition to Previously Known Risk Factors Improves Its Predictive Ability for Cardiovascular Death. Sci Rep 2019; 9:12953. [PMID: 31506478 PMCID: PMC6736867 DOI: 10.1038/s41598-019-49003-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/16/2019] [Indexed: 11/17/2022] Open
Abstract
This longitudinal cohort study aimed to create a novel prediction model for cardiovascular death with lifestyle factors. Subjects aged 40–74 years in the Japanese nationwide Specific Health Checkup Database in 2008 were included. Subjects were randomly assigned to the derivation and validation cohorts by a 2:1 ratio. Points for the prediction model were determined using regression coefficients that were derived from the Cox proportional hazards model in the derivation cohort. Models 1 and 2 were developed using known risk factors and known factors with lifestyle factors, respectively. The models were validated by comparing Kaplan-Meier curves between the derivation and validation cohorts, and by calibration plots in the validation cohort. Among 295,297 subjects, data for 120,823 were available. There were 310 cardiovascular deaths during a mean follow-up of 3.6 years. Model 1 included known risk factors. In model 2, weight gain, exercise habit, gait speed, and drinking alcohol were additionally included as protective factors. Kaplan-Meier curves matched better between the derivation and validation cohorts in model 2, and model 2 was better calibrated. In conclusion, our prediction model with lifestyle factors improved the predictive ability for cardiovascular death.
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Affiliation(s)
| | - Miho Tagawa
- Department of Nephrology, Nara Medical University, Nara, Japan
| | - Masaru Matsui
- Department of Nephrology, Nara Medical University, Nara, Japan
| | | | | | - Kunitoshi Iseki
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Chiho Iseki
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Koichi Asahi
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Kunihiro Yamagata
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Tsuneo Konta
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Shouichi Fujimoto
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Ichiei Narita
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Masato Kasahara
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Yugo Shibagaki
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Toshiki Moriyama
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Masahide Kondo
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Tsuyoshi Watanabe
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, Nara, Japan. .,Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan.
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Xing Z, Pei J, Huang J, Peng X, Chen P, Hu X, Gao S. Weight change is associated with increased all-cause mortality and non-cardiac mortality among patients with type 2 diabetes mellitus. Endocrine 2019; 64:82-89. [PMID: 30864142 DOI: 10.1007/s12020-019-01892-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/05/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND It is unclear whether changes in weight affect subsequent adverse events in patients with type 2 diabetes mellitus (T2DM) already at high risk of cardiovascular disease (CVD). METHODS AND RESULTS This is a post hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study data to examine the relationship between changes in weight and adverse events. Patients were divided into groups based on changes in body mass index (BMI): stable weight, gain or loss of BMI ≤1.5 kg/m2; moderate weight gain, BMI gain of 1.5-5 kg/m2; pronounced weight gain, BMI gain >5 kg/m2; moderate weight loss, BMI loss of 1.5-5 kg/m2; and pronounced weight loss, BMI loss >5 kg/m2. The primary endpoint of the present study was all-cause mortality. Secondary endpoints were cardiac death, non-fatal myocardial infarction (MI), and non-cardiac mortality. A total of 9372 T2DM patients with a mean follow-up of 8.08 ± 3.00 years were included for analysis. The average change in weight across the entire study population was 1.80 ± 9.00%, representing ~0.448 ± 2.98 kg/m2. Patients with pronounced weight loss had the highest risk of all-cause mortality (hazard ratio (HR) 2.07, 95% confidence interval (CI): 1.68-2.55), followed by patients with pronounced weight gain (HR 1.23, 95% CI: 1.02-1.56); patients with stable weight had the lowest risk. An asymmetric V-shaped relationship was observed between changes in BMI and all-cause mortality and non-cardiac mortality. Although no statistical significance was observed in terms of cardiac death and non-fatal MI, a flat V-shaped relationship may exist. CONCLUSIONS Weight was stable in most T2DM patients with high risk of CVD. Weight loss and gain is associated with increased all-cause mortality and non-cardiac mortality. Pronounced weight loss and weight gain is associated with a slight increase in cardiac death and non-fatal MI incidence, which does not reach statistical significance.
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Affiliation(s)
- Zhenhua Xing
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Junyu Pei
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Jiabing Huang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Xiaofan Peng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Pengfei Chen
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Xinqun Hu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Shan Gao
- Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
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Observational Evidence for Unintentional Weight Loss in All-Cause Mortality and Major Cardiovascular Events: A Systematic Review and Meta-Analysis. Sci Rep 2018; 8:15447. [PMID: 30337578 PMCID: PMC6194006 DOI: 10.1038/s41598-018-33563-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 09/26/2018] [Indexed: 02/07/2023] Open
Abstract
The obesity paradox has been described in several observational cohorts and meta-analysis. However, evidence of the intentionality of weight loss in all-cause deaths and major cardiovascular events (MACE) in prospective cohorts is unclear. We analysed whether involuntary weight loss is associated with increased cardiovascular events and mortality. In a systematic review, we searched multiple electronic databases for observational studies published up to October 2016. Studies reporting risk estimates for unintentional weight loss compared with stable weight in MACE and mortality were included. Fifteen studies met the selection criteria, with a total of 178,644 participants. For unintentional weight loss, we found adjusted risk ratios (RRs) with confidence intervals (CIs) of 1.38 (95% CI: 1.23, 1.53) and 1.17 (95% CI: 0.98, 1.37) for all-cause mortality and MACE, respectively. Participants with comorbidities, overweight and obese populations, and older adults yielded RRs (95% CI) of 1.49 (1.30, 1.68), 1.11 (1.04, 1.18), and 1.81 (1.59, 2.03), respectively. Unintentional weight loss had a significant impact on all-cause mortality. We found no protective effect of being overweight or obese for unintentional weight loss and MACE.
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Maruyama M, Kamimura K, Hoshiyama A, Hoshiyama K, Hoshiyama M, Hoshiyama Y, Terai S. Effect of Helicobacter pylori eradication on elder cases: Observational study in community-based medicine. World J Clin Cases 2017; 5:412-418. [PMID: 29291198 PMCID: PMC5740184 DOI: 10.12998/wjcc.v5.i12.412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/25/2017] [Accepted: 10/29/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To examine the effect of Helicobacter pylori (H. pylori) eradication therapy on the extra-gastrointestinal factors in elderly patients by a before-after observational study in community medicine.
METHODS Medical records (1 May 2013-31 January 2014) of 130 patients who underwent H. pylori eradication therapy with 2-year after-eradication observation in our institute were reviewed. Data on sex; age; body weight; body mass index (BMI); mean corpuscular volume (MCV); total protein; low-density lipoprotein cholesterol, triglyceride, haemoglobin A1c and haemoglobin levels and gastric hyperplastic polyps (GHPs) at eradication was extracted. Two-year after-eradication change in data was analysed by paired-sample t-test; relationship between GHPs and subclinical iron deficiency anaemia (IDA) improvement was evaluated.
RESULTS The mean patient age (median, interquartile range) at eradication was 69.6 (71.5, 64-77) years. Paired-sample t-tests showed that body weight, BMI and MCV increased by 0.52 kg (P = 0.018), 0.25 kg/m2 (P = 0.006) and 0.83 fL (P < 0.001), respectively. The nonparametric Mann-Whitney test showed no significant difference in the change rate of MCV after eradication between the groups with and without GHPs (P = 0.892).
CONCLUSION H. pylori eradication therapy prevented weight loss and subclinical IDA in elderly individuals. GHPs were not associated with subclinical IDA.
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Affiliation(s)
- Masaki Maruyama
- Department of Gastroenterology, Kashiwazaki General Hospital and Medical Center, Kashiwazaki, Niigata 945-8535, Japan
- Department of Internal Medicine, Kashiwazaki Chuo Hospital, Kashiwazaki, Niigata 945-0055, Japan
| | - Kenya Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Chuo-Ku, Niigata 951-8510, Japan
| | - Ayako Hoshiyama
- Department of Internal Medicine, Kashiwazaki Chuo Hospital, Kashiwazaki, Niigata 945-0055, Japan
| | - Koki Hoshiyama
- Department of Internal Medicine, Kashiwazaki Chuo Hospital, Kashiwazaki, Niigata 945-0055, Japan
| | - Mari Hoshiyama
- Department of Internal Medicine, Kashiwazaki Chuo Hospital, Kashiwazaki, Niigata 945-0055, Japan
| | - Yoshihiro Hoshiyama
- Department of Surgery, Kashiwazaki Chuo Hospital, Kashiwazaki, Niigata 945-0055, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Chuo-Ku, Niigata 951-8510, Japan
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Associations of changes in body mass index with all-cause and cardiovascular mortality in healthy middle-aged adults. PLoS One 2017; 12:e0189180. [PMID: 29216261 PMCID: PMC5720798 DOI: 10.1371/journal.pone.0189180] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 11/21/2017] [Indexed: 12/25/2022] Open
Abstract
Background Conflicting data exist regarding the association of body mass index (BMI) changes with all-cause and cardiovascular (CV) mortality. The current study investigated the association between changes in BMI and all-cause, CV, and non-CV mortality in a large cohort of middle-aged adults. Methods A total of 379,535 adults over 40 years of age without pre-existing CV disease or cancer at baseline were enrolled to undergo a series of at least three health examinations of biennial intervals. Changes in BMI between baseline, midpoint follow-up, and final health examination during mean 9.3 years were defined according to the pattern of BMI change as follows: stable, sustained gain, sustained loss, and fluctuation. The relationship between BMI change category and mortality was assessed by multivariate Cox regression reporting hazard ratio (HR) with 95% confidence interval (95% CI). Results During a mean follow-up of 10.7 years for mortality, 12,378 deaths occurred from all causes, of which 2,114 were CV and 10,264 were non-CV deaths. Sustained BMI gain was associated with the lower risk of all-cause (HR 0.89, 95% CI: 0.83–0.95), CV (HR 0.84, 95% CI 0.72–0.98), and non-CV mortality (HR 0.90, 95% CI 0.84–0.96) compared with stable BMI. Conversely, sustained BMI loss (HR 1.25, 95% CI 1.19–1.32) and fluctuation (HR 1.13, 95% CI 1.08–1.19) displayed a higher risk of all-cause mortality compared with stable BMI, which was mainly attributable to the increase in non-CV mortality. Conclusion Sustained BMI gains were associated with reduced risk of all-cause, CV, and non-CV mortality in middle-aged healthy adults.
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Kim YH, Kim SM, Han KD, Son JW, Lee SS, Oh SW, Lee WY, Yoo SJ. Change in Weight and Body Mass Index Associated With All-Cause Mortality in Korea: A Nationwide Longitudinal Study. J Clin Endocrinol Metab 2017; 102:4041-4050. [PMID: 28938403 DOI: 10.1210/jc.2017-00787] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 08/17/2017] [Indexed: 12/17/2022]
Abstract
CONTEXT Many studies have reported conflicting evidence on the association between weight change and mortality. OBJECTIVE We investigated the association between weight change and subsequent all-cause mortality, using a large-scale, population-based cohort from the National Health Insurance System health checkup data between 2005 and 2015. METHODS A total of 11,524,763 subjects older than age 20 years were included. Weight was measured every 2 years and weight change over 4 years was divided into eight categories, from weight loss ≥15% to weight gain ≥20%, for every 5% of weight change. The hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality were analyzed using multivariable Cox proportional hazard models compared with the stable weight group (weight change <5%) after adjusting for age, sex, smoking, drinking, exercise, diabetes mellitus, hypertension, dyslipidemia, cancer, and income. RESULTS Weight loss was associated with increased mortality rates compared with weight gain; the group with weight loss ≥15% had the highest HR for all-cause mortality (HR, 2.598; 95% CI, 2.537 to 2.659). The HR for all-cause mortality in the ≥20% weight gain group was 1.784 (95% CI, 1.695 to 1.877). Across all body mass index (BMI) categories, weight loss ≥15% was associated with increased mortality rates and the highest mortality rates were found in the BMI ≥30 kg/m2 group (HR, 3.469; 95% CI, 2.236 to 5.381). CONCLUSIONS Weight change over 4 years showed a reverse J-shaped all-cause mortality curve, independent of BMI status. Weight loss was associated with a greater risk of mortality than was weight gain.
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Affiliation(s)
- Yang-Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul 02841, Korea
| | - Seon Mee Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul 02841, Korea
| | - Kyung-do Han
- Department of Medical Statistics, Catholic University College of Medicine, Seoul 06591, Korea
| | - Jang-Won Son
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul 14647, Korea
| | - Seong-Su Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul 14647, Korea
| | - Sang Woo Oh
- Department of Family Medicine, Center for Obesity, Metabolism, and Nutrition, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Korea
| | - Won-Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Soon Jib Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul 14647, Korea
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Xiao Q, Berrigan D, Keadle SK, Matthews CE. Neighborhood Socioeconomic Deprivation and Weight Change in a Large U.S. Cohort. Am J Prev Med 2017; 52:e173-e181. [PMID: 28314557 PMCID: PMC5438759 DOI: 10.1016/j.amepre.2017.01.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 01/03/2017] [Accepted: 01/23/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Both excessive weight gain and weight loss are important risk factors in the older population. Neighborhood environment may play an important role in weight change, but neighborhood effects on weight gain and weight loss have not been studied separately. This study examined the associations between neighborhood socioeconomic deprivation and excessive weight gain and weight loss. METHODS This analysis included 153,690 men and 105,179 women (aged 51-70 years). Baseline addresses were geocoded into geographic coordinates and linked to the 2000 U.S. Census at the Census tract level. Census variables were used to generate a socioeconomic deprivation index by principle component analysis. Excessive weight gain and loss were defined as gaining or losing >10% of baseline (1995-1996) body weight at follow-up (2004-2006). The analysis was performed in 2015. RESULTS More severe neighborhood socioeconomic deprivation was associated with higher risks of both excessive weight gain and weight loss after adjusting for individual indicators of SES, disease conditions, and lifestyle factors (Quintile 5 vs Quintile 1: weight gain, OR=1.36, 95% CI=1.28, 1.45 for men and OR=1.20, 95% CI=1.13, 1.27 for women; weight loss, OR=1.09, 95%% CI=1.02, 1.17 for men and OR=1.23, 95% CI=1.14, 1.32 for women). The findings were fairly consistent across subpopulations with different demographics and lifestyle factors. CONCLUSIONS Neighborhood socioeconomic deprivation predicts higher risk of excessive weight gain and weight loss.
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Affiliation(s)
- Qian Xiao
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa.
| | - David Berrigan
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Sarah K Keadle
- Kinesiology Department, California Polytechnic State University, San Luis Obispo, California
| | - Charles E Matthews
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Li ZB, Wang ML, Dong SY, Sun BR, Miao XY, Fang FS, Dai ZX, Li CL, Tian H. Effects of body mass index and weight change on mortality in older men with impaired glucose regulation. Exp Gerontol 2017; 89:87-92. [DOI: 10.1016/j.exger.2016.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 12/28/2016] [Accepted: 12/30/2016] [Indexed: 11/26/2022]
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Buchanan K, Sheffield J, Tan WH. Predictors of diet failure: A multifactorial cognitive and behavioural model. J Health Psychol 2017; 24:857-869. [PMID: 28810391 DOI: 10.1177/1359105316689605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Obesity is recognised as a multidetermined issue. However, research aimed at addressing diet failure has typically examined factors in isolation. Furthermore, previous research has included limited input from dieters themselves. A qualitative study identified a number of themes contributing to diet failure. This study aimed to test these themes with a larger sample ( n = 426) while also determining their fit within a multifactorial model. The results of this study supported the conceptualisation of diet failure using a multifactorial model while also illustrating correlational pathways to be more complex than currently understood in the literature.
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Cheikh Rouhou M, Karelis A, St-Pierre D, Lamontagne L. Adverse effects of weight loss: Are persistent organic pollutants a potential culprit? DIABETES & METABOLISM 2016; 42:215-23. [DOI: 10.1016/j.diabet.2016.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/09/2016] [Accepted: 05/24/2016] [Indexed: 02/05/2023]
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Thorpe RJ, Ferraro KF. Aging, Obesity, and Mortality: Misplaced Concern About Obese Older People? Res Aging 2016; 26:108-129. [PMID: 22707808 DOI: 10.1177/0164027503258738] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Although there is widespread agreement that obesity (body mass index [BMI] ≥ 30 kg/m(2)) raises health risks, debate has ensued on whether obese older adults are also at greater risk. This study examines the effect of obesity on mortality for younger and older adults to determine whether the risk of obesity is lessened in later life. Data from a 20-year follow-up of a national sample of adults were used to examine the risk of obesity on mortality (N = 6,767). Cox models reveal that obesity raises mortality risk for adults of all ages, but this relationship is nearly twice as strong for persons younger than 50 years of age. Being slightly overweight in later life is associated with lower mortality risk, but obesity raises mortality risk, especially for ischemic heart disease. Obesity in middle age is a grave public health concern, but obesity in later life also merits attention.
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Wilson AR, McAlpine DD. The Effectiveness of Screening for Obesity in Primary Care: Weighing the Evidence. Med Care Res Rev 2016; 63:570-98. [PMID: 16954308 DOI: 10.1177/1077558706290942] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In response to growing alarm about the increase in the prevalence of obesity in the United States, several organizations have recommended that physicians screen their adult patients for this condition and initiate treatment. Screening can be an effective intervention when the condition is grave and prevalent, when an accurate test exists, when effective treatment exists, when the screening program itself does not pose undue risks, and when early detection and treatment improve outcomes. This article critically reviews the evidence supporting these criteria in the case of obesity in adults. It extends previous reviews by assessing the potential impact that uncertainties in the evidence base may have on the effectiveness a screening program. It also examines the feasibility of such a program. We conclude that following the recommendation to screen all adults for obesity is unlikely to improve outcomes.
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Barrera R, Arslan V, Gebrayel N, Melendez J. Body Mass Index as a Predictor of Complications and Length of Hospital Stay after Thoracic Surgery. Nutr Clin Pract 2016. [DOI: 10.1177/088453360001500405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Abstract
The number of older adults living in the USA, 65 years of age and older, has been steadily increasing. Data from the National Health and Nutrition Examination Survey (NHANES), 2007-2010, indicate that more than one-third of older adults, 65 years of age and older, were obese. With the increased rate of obesity in older adults, the purpose of this paper is to present research on different methods to prevent or manage obesity in older adults, namely dietary interventions, physical activity interventions, and a combination of dietary and physical activity interventions. In addition, research on community assistance programs in the prevention of obesity with aging will be discussed. Finally, data on federal programs for older adults will also be presented.
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Affiliation(s)
- Stella Lucia Volpe
- Department of Nutrition Sciences, Drexel University, Room 381, 3rd Floor, Parkway Building, 1601 Cherry Street, Mail Stop 31030, Philadelphia, PA, 19102, USA.
| | - Deeptha Sukumar
- Department of Nutrition Sciences, Drexel University, Room 381, 3rd Floor, Parkway Building, 1601 Cherry Street, Mail Stop 31030, Philadelphia, PA, 19102, USA
| | - Brandy-Joe Milliron
- Department of Nutrition Sciences, Drexel University, Room 381, 3rd Floor, Parkway Building, 1601 Cherry Street, Mail Stop 31030, Philadelphia, PA, 19102, USA
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Tolusso B, Alivernini S, Gigante MR, Ferraccioli G, Gremese E. Biomolecular features of inflammation in obese rheumatoid arthritis patients: management considerations. Expert Rev Clin Immunol 2016; 12:751-62. [PMID: 26950427 DOI: 10.1586/1744666x.2016.1159132] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Adipose tissue is an active organ playing a role not only in metabolism but also in immune and inflammatory processes, releasing several pro-inflammatory mediators. This can explain the possible association between obesity and rheumatoid arthritis (RA) and its role in the progression of the disease. Adipose and synovial tissues share common histological features of local inflammation in terms of activation of target tissues infiltrating cells (i.e. myeloid cells). Among the so-called adipocytokines, PEDF and Chemerin orchestrate the cellular cross-talk between adipose and myeloid cells, being possible biomarkers to monitor the effect of weight loss or the decrease of adipose tissue in patients with RA. Moreover, dietary intervention has been demonstrated to reduce Chemerin as well as IL-6 and MCP-1 expression. Finally, epigenetic regulators such as micro-RNAs (i.e. miR-155) are key regulators of myeloid cells activation in RA and obesity as well as in adipocytes. In this review, we will summarize the biological link between obesity/overweight state and RA focusing on pathophysiological mechanisms, consequences and management considerations.
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Affiliation(s)
- Barbara Tolusso
- a Division of Rheumatology, Institute of Rheumatology , Catholic University of the Sacred Heart , Rome , Italy
| | - Stefano Alivernini
- a Division of Rheumatology, Institute of Rheumatology , Catholic University of the Sacred Heart , Rome , Italy
| | - Maria Rita Gigante
- a Division of Rheumatology, Institute of Rheumatology , Catholic University of the Sacred Heart , Rome , Italy
| | - Gianfranco Ferraccioli
- a Division of Rheumatology, Institute of Rheumatology , Catholic University of the Sacred Heart , Rome , Italy
| | - Elisa Gremese
- a Division of Rheumatology, Institute of Rheumatology , Catholic University of the Sacred Heart , Rome , Italy
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Kim Y, Kim CK, Jung S, Ko SB, Lee SH, Yoon BW. Prognostic importance of weight change on short-term functional outcome in acute ischemic stroke. Int J Stroke 2015; 10 Suppl A100:62-8. [PMID: 26121494 DOI: 10.1111/ijs.12554] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/25/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Controversy exists regarding the question of whether weight change decreases or increases the risk of mortality. AIM The aim of this study was to evaluate the prognostic importance of weight change on short-term outcomes in acute ischemic stroke patients. METHODS A total of 654 patients with acute ischemic stroke were enrolled in this study from March 2010 to May 2013. We assessed the weight change of each participant between admission and discharge from the Department of Neurology. Weight change was defined as change ≥0·05 kg/baseline body mass index unit. We evaluated the short-term outcomes using a modified Rankin Scale at three-months after the onset of a stroke. RESULTS Among the 654 patients, 35·2% were included in the weight-change group. Weight loss occurred in 24·6% of the participants during the hospital stay following the stroke, which lasted an average of nine-days. Compared with the weight-stable group, the pronounced weight-loss group had a higher risk of unfavorable outcomes (odds ratio 2·43; 95% confidence interval 1·12-5·25). CONCLUSIONS Short-term weight loss after stroke appears to be more common than we expected, and our results suggest that it is associated with unfavorable functional outcomes. Therefore, clinical nutrition should be considered as a component of medical treatment and weight loss should be monitored as an indicator of malnutrition.
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Affiliation(s)
- Yerim Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chi Kyung Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seunguk Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Bae Ko
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Hoon Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Byung-Woo Yoon
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
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Abstract
Nutritional epidemiology has recently been criticized on several fronts, including the inability to measure diet accurately, and for its reliance on observational studies to address etiologic questions. In addition, several recent meta-analyses with serious methodologic flaws have arrived at erroneous or misleading conclusions, reigniting controversy over formerly settled debates. All of this has raised questions regarding the ability of nutritional epidemiologic studies to inform policy. These criticisms, to a large degree, stem from a misunderstanding of the methodologic issues of the field and the inappropriate use of the drug trial paradigm in nutrition research. The exposure of interest in nutritional epidemiology is human diet, which is a complex system of interacting components that cumulatively affect health. Consequently, nutritional epidemiology constantly faces a unique set of challenges and continually develops specific methodologies to address these. Misunderstanding these issues can lead to the nonconstructive and sometimes naive criticisms we see today. This article aims to clarify common misunderstandings of nutritional epidemiology, address challenges to the field, and discuss the utility of nutritional science in guiding policy by focusing on 5 broad questions commonly asked of the field.
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Affiliation(s)
- Ambika Satija
- Department of Nutrition and Department of Epidemiology, Harvard School of Public Health, Boston, MA; and
| | | | - Walter C Willett
- Department of Nutrition and Department of Epidemiology, Harvard School of Public Health, Boston, MA; and Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Frank B Hu
- Department of Nutrition and Department of Epidemiology, Harvard School of Public Health, Boston, MA; and Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
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Cheng FW, Gao X, Jensen GL. Weight Change and All-Cause Mortality in Older Adults: A Meta-Analysis. J Nutr Gerontol Geriatr 2015; 34:343-368. [PMID: 26571354 DOI: 10.1080/21551197.2015.1090362] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This meta-analysis of observational cohort studies examined the association between weight change (weight loss, weight gain, and weight fluctuation) and all-cause mortality among older adults. We used Pub Med (MEDLINE), Web of Science, and Cochrane Library to identify prospective studies published in English from inception to November 2014. Seventeen prospective studies met the inclusion criteria and were included in this meta-analysis. Higher all-cause mortality risks were noted with weight change: weight loss (pooled RR, 1.67; 95% CI, 1.51-1.85; p < 0.001 for heterogeneity), weight gain (pooled RR, 1.21; 95% CI, 1.09-1.33; p = 0.03 for heterogeneity), and weight fluctuation (pooled RR, 1.53; 95% CI, 1.36-1.72; p = 0.43 for heterogeneity). Similar results were observed with stricter criteria for sensitivity analyses. None of the study characteristics had statistically significant effects on the pooled RR, except for study quality on weight loss. Weight change is associated with higher mortality risk among community-dwelling adults 60 years and older.
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Affiliation(s)
- Feon W Cheng
- a Department of Nutritional Sciences , The Pennsylvania State University , University Park , Pennsylvania , USA
| | - Xiang Gao
- a Department of Nutritional Sciences , The Pennsylvania State University , University Park , Pennsylvania , USA
| | - Gordon L Jensen
- a Department of Nutritional Sciences , The Pennsylvania State University , University Park , Pennsylvania , USA
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Wing RR. Implications of Look AHEAD for clinical trials and clinical practice. Diabetes Obes Metab 2014; 16:1183-91. [PMID: 24853636 PMCID: PMC4227940 DOI: 10.1111/dom.12318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 12/11/2022]
Abstract
Look AHEAD (Action for Health in Diabetes) was a randomized clinical trial designed to examine the long-term health effects of weight loss in overweight and obese individuals with type 2 diabetes. The primary result was that the incidence of cardiovascular events over a median follow-up of 9.6 years was not reduced in the Intensive Lifestyle Group relative to the control group. This finding is discussed, with emphasis on its implications for design of trials and clinical treatment of obese persons with type 2 diabetes.
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Affiliation(s)
- R R Wing
- Weight Control & Diabetes Research Center, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
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He Y, Lam TH, Jiang B, Li LS, Sun DL, Wu L, Liu M, Yang SS, Wang YY, Tobias DK, Sun Q, Hu FB. Changes in BMI before and during economic development and subsequent risk of cardiovascular disease and total mortality: a 35-year follow-up study in China. Diabetes Care 2014; 37:2540-7. [PMID: 24947786 DOI: 10.2337/dc14-0243] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE It is unclear whether changes in BMI during rapid economic development influence subsequent mortality. RESEARCH DESIGN AND METHODS We analyzed whether BMI in 1976 and 1994 and changes in BMI during 1976-1994 predict cardiovascular disease (CVD) and all-cause mortality in a 35-year follow-up cohort of 1,696 Chinese (1,124 men and 572 women, aged 35-65 years) in Xi'an, China. Participants were categorized as underweight (<18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), and overweight (≥25.0 kg/m(2)). RESULTS During 51,611 person-years of follow-up, we identified 655 deaths from all causes and 234 from CVD. From 1976 to 1994, the prevalence of overweight rose from 9.2 to 27.8%. With each unit increment in 1976 BMI, multivariate hazard ratios (HRs) (95% CI) were 0.78 (0.72-0.84) for CVD and 0.91 (0.87-0.95) for all-cause mortality. In contrast, corresponding HRs were 1.14 (1.08-1.19) and 1.05 (1.01-1.08) in 1994 BMI. The HRs for each unit increment in BMI change from 1976 to 1994 were 1.35 (1.25-1.41) for CVD and 1.09 (1.05-1.13) for all-cause mortality. Compared with participants with stable normal weight in 1976 and 1994, HRs of all-cause mortality for those who had normal weight in 1976 but became overweight in 1994 and for those who were persistently overweight during 1976-1994 were 1.42 (1.12-1.80) and 1.80 (1.04-3.14), respectively. CONCLUSIONS Gaining weight with increased BMI at middle age in Chinese during economic development was associated with elevated risks of all-cause and CVD mortality. Higher BMI measured before economic development was associated with lower mortality risk, whereas BMI measured afterward was associated with increased mortality.
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Affiliation(s)
- Yao He
- Institute of Geriatrics, Chinese PLA General Hospital, Beijing, China State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, Beijing, China Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Beijing, China
| | - Tai Hing Lam
- School of Public Health and Department of Community Medicine, The University of Hong Kong, Hong Kong, China
| | - Bin Jiang
- Department of Chinese Traditional Medicine and Acupuncture, Chinese PLA General Hospital, Beijing, China
| | - Lan Sun Li
- Department of Cardiology, Fourth Military Medical University, Xi'an, China
| | - Dong Ling Sun
- Institute of Geriatrics, Chinese PLA General Hospital, Beijing, China
| | - Lei Wu
- Institute of Geriatrics, Chinese PLA General Hospital, Beijing, China Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Beijing, China
| | - Miao Liu
- Institute of Geriatrics, Chinese PLA General Hospital, Beijing, China Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Beijing, China
| | - Shan Shan Yang
- Institute of Geriatrics, Chinese PLA General Hospital, Beijing, China Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Beijing, China
| | - Yi Yan Wang
- Institute of Geriatrics, Chinese PLA General Hospital, Beijing, China Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Beijing, China
| | - Deirdre K Tobias
- Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA
| | - Qi Sun
- Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA
| | - Frank B Hu
- Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA
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Ellis A, Crowe K, Lawrence J. Obesity-related inflammation: implications for older adults. J Nutr Gerontol Geriatr 2014; 32:263-90. [PMID: 24224937 DOI: 10.1080/21551197.2013.842199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The combination of age-related increases in obesity and inflammation can lead to chronic disease, decreased strength, and physical disability. Lifestyle interventions that include moderate caloric restriction along with aerobic and resistance exercise have shown improvements in metabolic outcomes, strength, and physical function in obese older adults. Although few weight loss studies have addressed diet quality, evidence summarized in this review suggests that encouraging intake of antioxidant-rich fruits and vegetables, high-quality protein, low-glycemic index carbohydrates, and omega-3 fatty acids may further ameliorate obesity-related inflammation. Future controlled trials are indicated to examine the effects of incorporating these foods into multimodal weight loss interventions.
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Affiliation(s)
- Amy Ellis
- a Department of Human Nutrition , University of Alabama , Tuscaloosa , Alabama , USA
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Tobacco use and some characteristics of tobacco users. Preliminary results of "Kardiovize Brno 2030". COR ET VASA 2014. [DOI: 10.1016/j.crvasa.2014.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Adams KF, Leitzmann MF, Ballard-Barbash R, Albanes D, Harris TB, Hollenbeck A, Kipnis V. Body mass and weight change in adults in relation to mortality risk. Am J Epidemiol 2014; 179:135-44. [PMID: 24173550 DOI: 10.1093/aje/kwt254] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Using data from the National Institutes of Health-AARP Diet and Health Study, we evaluated the influence of adulthood weight history on mortality risk. The National Institutes of Health-AARP Diet and Health Study is an observational cohort study of US men and women who were aged 50-71 years at entry in 1995-1996. This analysis focused on 109,947 subjects who had never smoked and were younger than age 70 years. We estimated hazard ratios of total and cause-specific mortality for recalled body mass index (BMI; weight (kg)/height (m)(2)) at ages 18, 35, and 50 years; weight change across 3 adult age intervals; and the effect of first attaining an elevated BMI at 4 successive ages. During 12.5 years' follow-up through 2009, 12,017 deaths occurred. BMI at all ages was positively related to mortality. Weight gain was positively related to mortality, with stronger associations for gain between ages 18 and 35 years and ages 35 and 50 years than between ages 50 and 69 years. Mortality risks were higher in persons who attained or exceeded a BMI of 25.0 at a younger age than in persons who reached that threshold later in adulthood, and risks were lowest in persons who maintained a BMI below 25.0. Heavier initial BMI and weight gain in early to middle adulthood strongly predicted mortality risk in persons aged 50-69 years.
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Haas MC, Bodner EV, Brown CJ, Bryan D, Buys DR, Keita AD, Flagg LA, Goss A, Gower B, Hovater M, Hunter G, Ritchie CS, Roth DL, Wingo BC, Ard J, Locher JL. Calorie restriction in overweight seniors: response of older adults to a dieting study: the CROSSROADS randomized controlled clinical trial. J Nutr Gerontol Geriatr 2014; 33:376-400. [PMID: 25424512 PMCID: PMC4248142 DOI: 10.1080/21551197.2014.965993] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We conducted a study designed to evaluate whether the benefits of intentional weight loss exceed the potential risks in a group of community-dwelling obese older adults who were at increased risk for cardiometabolic disease. The CROSSROADS trial used a prospective randomized controlled design to compare the effects of changes in diet composition alone or combined with weight loss with an exercise only control intervention on body composition and adipose tissue deposition (Specific Aim #1: To compare the effects of changes in diet composition alone or combined with weight loss with an exercise only control intervention on body composition, namely visceral adipose tissue), cardiometabolic disease risk (Specific Aim #2: To compare the effects of a change in diet composition alone or combined with weight loss with an exercise only control intervention on cardiometabolic disease risk), and functional status and quality of life (Specific Aim #3: To compare the effects of a change in diet composition alone or combined with weight loss with an exercise only control intervention on functional status and quality of life). Participants were randomly assigned to one of three groups: Exercise Only (Control) Intervention, Exercise + Diet Quality + Weight Maintenance Intervention, or Exercise + Diet Quality + Weight Loss Intervention. CROSSROADS utilized a lifestyle intervention approach consisting of exercise, dietary, and behavioral components. The development and implementation of the CROSSROADS protocol, including a description of the methodology, detailing specific elements of the lifestyle intervention, assurances of treatment fidelity, and participant retention; outcome measures and adverse event monitoring; as well as unique data management features of the trial results, are presented in this article.
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Affiliation(s)
- Marilyn C Haas
- a Division of Gerontology, Geriatrics, and Palliative Care , University of Alabama at Birmingham , Birmingham , Alabama , USA
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Zheng H, Tumin D, Qian Z. Obesity and mortality risk: new findings from body mass index trajectories. Am J Epidemiol 2013; 178:1591-9. [PMID: 24013201 DOI: 10.1093/aje/kwt179] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Little research has addressed the heterogeneity and mortality risk in body mass index (BMI) trajectories among older populations. Applying latent class trajectory models to 9,538 adults aged 51 to 77 years from the US Health and Retirement Study (1992-2008), we defined 6 latent BMI trajectories: normal weight downward, normal weight upward, overweight stable, overweight obesity, class I obese upward, and class II/III obese upward. Using survival analysis, we found that people in the overweight stable trajectory had the highest survival rate, followed by those in the overweight obesity, normal weight upward, class I obese upward, normal weight downward, and class II/III obese upward trajectories. The results were robust after controlling for baseline demographic and socioeconomic characteristics, smoking status, limitations in activities of daily living, a wide range of chronic illnesses, and self-rated health. Further analysis suggested that BMI trajectories were more predictive of mortality risk than was static BMI status. Using attributable risk analysis, we found that approximately 7.2% of deaths after 51 years of age among the 1931-1941 birth cohort were due to class I and class II/III obese upward trajectories. This suggests that trajectories of increasing obesity past 51 years of age pose a substantive threat to future gains in life expectancy.
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Mohebi R, Bozorgmanesh M, Azizi F, Hadaegh F. Effects of obesity on the impact of short-term changes in anthropometric measurements on coronary heart disease in women. Mayo Clin Proc 2013; 88:487-94. [PMID: 23540294 DOI: 10.1016/j.mayocp.2013.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/13/2012] [Accepted: 01/15/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the impact of short-term changes in body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio on the risk of future coronary heart disease (CHD) among women. PARTICIPANTS AND METHODS The study sample consisted of 2468 women aged 30 years or older without cardiovascular disease at baseline who underwent 2 consecutive examinations, the first between January 31, 1999, and August 21, 2001, and second between October 20, 2001, and September 22, 2005, and were followed up until March 31, 2010. Cox proportional hazard regression was performed to estimate the hazard ratios (HRs) of the anthropometric measures for CHD events. RESULTS During a mean follow-up of 6.6 years, CHD occurred in 127 of the study participants (5.1%). There were significant interactions between a BMI of 30 kg/m(2) or greater and anthropometric changes in prediction of CHD events (all P<.04). Among nonobese individuals, a 1-SD increase in HC changes, independent of WC and BMI changes, was inversely associated with risk of CHD events (HR, 0.60 [95% CI, 0.44-0.83]). Among obese individuals, a 1-SD increase in WC, independent of other changes, increased the risk of CHD. Conversely, a 1-SD increase in BMI decreased the risk of CHD by 35% (HR, 0.65 [95% CI, 0.45-0.94]). CONCLUSION In this study, the impact of changes in anthropometric measures on CHD was modified by obesity at baseline. Among nonobese women, increases in HC could significantly reduce the risk of CHD events. Among obese individuals, although increases in WC were associated with a higher risk of CHD, increases in BMI decreased the risk.
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Affiliation(s)
- Reza Mohebi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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40
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Samadi S, Bozorgmanesh M, Khalili D, Momenan A, Sheikholeslami F, Azizi F, Hadaegh F. Hypertriglyceridemic waist: The point of divergence for prediction of CVD vs. mortality: Tehran Lipid and Glucose Study. Int J Cardiol 2013; 165:260-5. [DOI: 10.1016/j.ijcard.2011.08.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 08/17/2011] [Indexed: 02/02/2023]
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Keith SW, Fontaine KR, Allison DB. Mortality rate and overweight: Overblown or underestimated? A commentary on a recent meta-analysis of the associations of BMI and mortality. Mol Metab 2013; 2:65-8. [PMID: 24199152 DOI: 10.1016/j.molmet.2013.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 03/12/2013] [Indexed: 11/26/2022] Open
Abstract
In this review, we discuss strengths and limitations of a recent rigorous systematic review and meta-analysis of the literature on associations of all-cause mortality with overweight and obesity. A perspective on its meaning and potential implications are provided. To move this field forward, we suggest modeling BMI as a continuous variable, switching to modeling longevity instead of mortality, and generating large publicly available datasets in broad and diverse populations for discerning the extent to which the BMI-mortality relationship differs between groups and over time. Randomized studies of obesity-related interventions that provide assessments of their actual effects on lifespan or mortality would have great value for helping to establish valid clinical and public health recommendations around weight loss and mortality.
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Affiliation(s)
- Scott W Keith
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 1015 Chestnut St., Suite M100, Philadelphia, PA 19107, USA
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Abstract
BACKGROUND There is ongoing debate about whether a decline in body mass represents a true risk factor for dementia, whether it is a phenotypic marker of incipient dementia, or perhaps a marker of another process that increases dementia risk. This study was designed to determine if changes in body mass index (BMI) in later life are associated with hazard of incident dementia over a follow-up period of up to eight years. METHODS Method followed was a prospective cohort study of 4,181 men aged 65-84 years, resident in Perth, Australia. The exposure of interest was change in BMI measured between 1996-1998 and 2001-2004. The outcome was incident dementia, established using the Western Australia Data Linkage System until 2009. We used Cox regression models to establish crude and adjusted hazard of dementia for change in BMI. RESULTS Compared with men with a stable BMI, those with a decrease in BMI >1 kg/m2 had a higher adjusted hazard of dementia (hazard ratio (HR) = 1.89, 95% CI = 1.32-2.70). The cumulative hazard of dementia over follow-up for changes in BMI was greatest for men with a decrease in BMI >1 kg/m2; this trend was apparent for men in all BMI categories (underweight, normal, overweight, obese). A reverse "J-shaped" association between BMI change and incident dementia was observed, with the lowest dementia rate being for men whose BMI remained stable. CONCLUSIONS Men who maintained a stable body mass had the lowest incidence of dementia. Further studies are needed to clarify causality and assess feasibility of interventional studies to preserve body mass in aging men.
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Zajacova A, Ailshire J. Body mass trajectories and mortality among older adults: a joint growth mixture-discrete-time survival analysis. THE GERONTOLOGIST 2013; 54:221-31. [PMID: 23355450 DOI: 10.1093/geront/gns164] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE OF THE STUDY The aim of this study was to investigate heterogeneity in body weight trajectories among older adults and their association with mortality risks. DESIGN AND METHODS Information on body mass index (BMI) and survival come from nine waves of the Health and Retirement Study, a 16-year survey of adults aged 51-61 at baseline (N = 9,703). We used a sex-stratified joint growth mixture-discrete time survival model to characterize BMI trajectory groups and their associated mortality. RESULTS Three distinct classes of BMI trajectories were identified: "stable overweight," "obese gaining," and "obese losing." Relative to the stable overweight class, which comprised about 90% of the sample, the obese gaining class had approximately 50% higher mortality risk; the highest mortality was found in the obese losing category (OR > 2.7, p < .001). The results were similar for men and women. IMPLICATIONS The findings highlight substantial heterogeneity in weight trajectories of older Americans, as well as large survival differentials across the classes. The direction of weight changes appears inextricably linked to the overall BMI level in terms of predicting older adults' longevity. Weight loss is associated with particularly high mortality risk even when the typical BMI change is from obesity to overweight.
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Affiliation(s)
- Anna Zajacova
- Address correspondence to Anna Zajacova, University of Wyoming, Dept. 3293, 1000 E University Ave., Laramie, WY. E-mail:
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Roth J, Qiang X, Marbán SL, Redelt H, Lowell BC. The Obesity Pandemic: Where Have We Been and Where Are We Going? ACTA ACUST UNITED AC 2012; 12 Suppl 2:88S-101S. [PMID: 15601956 DOI: 10.1038/oby.2004.273] [Citation(s) in RCA: 170] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Obesity, a new pandemic, is associated with an increased risk of death, morbidity, and accelerated aging. The multiple therapeutic modalities used to promote weight loss are outlined with caution, especially for patients who are very young or old. Except for very rare single gene defects, the inheritance of obesity is complex and still poorly understood, despite active investigations. Recent advances that have shed light on the pathophysiology of obesity are the recognition that 1) excess fat is deposited in liver, muscle, and pancreatic islets; 2) fat tissue secretes a large number of active signaling molecules including leptin, adiponectin, and resistin, as well as free fatty acids; and 3) activated macrophages colonize the adipose tissue. Other candidates for key roles in the causes and consequences of obesity include 1) metabolic programming, where food acts as a developmental regulator; 2) the constellation of defects known as the "metabolic syndrome;" 3) cortisol overproduction in the adipose tissue; and especially, 4) insulin resistance. The possible etiologies of insulin resistance include cytokine excess, elevated free fatty acids, and hyperinsulinemia itself, as with transgenic overproduction of insulin in mice.
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Affiliation(s)
- Jesse Roth
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
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Villareal DT, Apovian CM, Kushner RF, Klein S. Obesity in Older Adults: Technical Review and Position Statement of the American Society for Nutrition and NAASO, The Obesity Society. ACTA ACUST UNITED AC 2012; 13:1849-63. [PMID: 16339115 DOI: 10.1038/oby.2005.228] [Citation(s) in RCA: 344] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Obesity causes serious medical complications and impairs quality of life. Moreover, in older persons, obesity can exacerbate the age-related decline in physical function and lead to frailty. However, appropriate treatment for obesity in older persons is controversial because of the reduction in relative health risks associated with increasing body mass index and the concern that weight loss could have potential harmful effects in the older population. This joint position statement from the American Society for Nutrition and NAASO, The Obesity Society reviews the clinical issues related to obesity in older persons and provides health professionals with appropriate weight-management guidelines for obese older patients. The current data show that weight-loss therapy improves physical function, quality of life, and the medical complications associated with obesity in older persons. Therefore, weight-loss therapy that minimizes muscle and bone losses is recommended for older persons who are obese and who have functional impairments or medical complications that can benefit from weight loss.
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Affiliation(s)
- Dennis T Villareal
- Division of Geriatrics and Nutritional Sciences, Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO 63110, USA
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Caterson ID, Finer N, Coutinho W, Van Gaal LF, Maggioni AP, Torp-Pedersen C, Sharma AM, Legler UF, Shepherd GM, Rode RA, Perdok RJ, Renz CL, James WPT. Maintained intentional weight loss reduces cardiovascular outcomes: results from the Sibutramine Cardiovascular OUTcomes (SCOUT) trial. Diabetes Obes Metab 2012; 14:523-30. [PMID: 22192338 DOI: 10.1111/j.1463-1326.2011.01554.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The Sibutramine Cardiovascular OUTcomes trial showed that sibutramine produced greater mean weight loss than placebo but increased cardiovascular morbidity but not mortality. The relationship between 12-month weight loss and subsequent cardiovascular outcomes is explored. METHODS Overweight/obese subjects (N = 10 744), ≥55 years with cardiovascular disease and/or type 2 diabetes mellitus, received sibutramine plus weight management during a 6-week Lead-in Period before randomization to continue sibutramine (N = 4906) or to receive placebo (N = 4898). The primary endpoint was the time from randomization to first occurrence of a primary outcome event (non-fatal myocardial infarction, non-fatal stroke, resuscitated cardiac arrest or cardiovascular death). RESULTS For the total population, mean weight change during Lead-in Period (sibutramine) was -2.54 kg. Post-randomization, mean total weight change to Month 12 was -4.18 kg (sibutramine) or -1.87 kg (placebo). Degree of weight loss during Lead-in Period or through Month 12 was associated with a progressive reduction in risk for the total population in primary outcome events and cardiovascular mortality over the 5-year assessment. Although more events occurred in the randomized sibutramine group, on an average, a modest weight loss of approximately 3 kg achieved in the Lead-in Period appeared to offset this increased event rate. Moderate weight loss (3-10 kg) reduced cardiovascular deaths in those with severe, moderate or mild cardiovascular disease. CONCLUSIONS Modest weight loss over short-term (6 weeks) and longer-term (6-12 months) periods is associated with reduction in subsequent cardiovascular mortality for the following 4-5 years even in those with pre-existing cardiovascular disease. While the sibutramine group experienced more primary outcome events than the placebo group, greater weight loss reduced overall risk of these occurring in both groups.
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Affiliation(s)
- I D Caterson
- Boden Institute of Obesity Nutrition, Exercise & Eating Disorders, University of Sydney, NSW, Australia.
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Wadden TA, Webb VL, Moran CH, Bailer BA. Lifestyle modification for obesity: new developments in diet, physical activity, and behavior therapy. Circulation 2012; 125:1157-70. [PMID: 22392863 PMCID: PMC3313649 DOI: 10.1161/circulationaha.111.039453] [Citation(s) in RCA: 360] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Thomas A Wadden
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Abstract
Sarcopenia is a multifactorial age-related condition associated with a sedentary lifestyle and protein intakes during weight loss that are inadequate to maintain muscle mass. Sarcopenic obesity in the elderly is associated with a loss of independence and metabolic complications and represents a major public health challenge in individuals over the age of 65 years. It is likely that age-related losses of muscle mass and coincident increases in fat mass could be reduced through regular resistance exercise combined with adequate protein intake to maintain muscle mass. It has been established that increased protein intake will maintain muscle mass during calorie-restricted diets to a greater extent than usual protein intake. Other strategies, including the use of high-protein meal replacements or supplementation with specific ergogenic or branched-chain amino acids, may be beneficial.
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Affiliation(s)
- Zhaoping Li
- Center for Human Nutrition, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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Wernette CM, White BD, Zizza CA. Signaling proteins that influence energy intake may affect unintentional weight loss in elderly persons. ACTA ACUST UNITED AC 2011; 111:864-73. [PMID: 21616199 DOI: 10.1016/j.jada.2011.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 12/08/2010] [Indexed: 11/25/2022]
Abstract
After age 70 to 75 years, average body weight decreases both in ailing and healthy people because of a loss of appetite that results in reduced energy intake and the loss of body fat and lean muscle tissue. This so-called anorexia of aging predisposes elderly people to continued pathologic weight loss and malnutrition-major causes of morbidity and mortality. Health care professionals must understand the many factors involved in the anorexia of aging to help older adults prevent unintentional weight loss. Psychological, social, and cultural factors are important effectors; however, physiological factors are emphasized here because they are not thoroughly understood and they make it inherently difficult for most people to alter their body weight. Monoamines, steroid hormones (glucocorticoids and mineralocorticoids), endocannabinoids, and proteins all influence body weight. This review is an analysis of proteins from the brain, pancreas, adipose tissue, and gastrointestinal tract that are known to affect energy intake and energy balance, with an attempt to identify those factors that may change with aging. The articles included in this review were obtained by a PubMed database search using the keywords mouse OR rat OR human AND aged OR aging OR older OR elderly AND adult AND anorexia OR "unintentional weight loss," and each of the individual proteins discussed, as well as from the reference lists of those articles. The results reveal that some proteins may be important in the development of unintentional weight loss in elderly persons, whereas others may not have a significant role. However, many of the proteins that could conceivably have a role in unintentional weight loss have not yet been studied with that question in mind. Preventing unintentional weight loss in older adults is an important goal and further research on the role of proteins important for the maintenance of energy balance and the development of unintentional weight loss in elderly persons is warranted.
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Affiliation(s)
- Catherine M Wernette
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL, USA.
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