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Body weight: Implications for the prevention of coronary heart disease, stroke, and diabetes mellitus in a cohort study of middle aged men
Abstract
To determine the body mass index associated with the lowest morbidity and mortality.
Prospective study of a male cohort.
One general practice in each of 24 British towns.
7735 men aged 40-59 years at screening.
All cause death rate, heart attacks, and stroke (fatal and non-fatal) and development of diabetes, or any of these outcomes (combined end point) over an average follow up of 14.8 years.
There were 1271 deaths from all causes, 974 heart attacks, 290 strokes, and 245 new cases of diabetes mellitus. All cause mortality was increased only in men with a body mass index (kg/m2) < 20 and in men with an index > or = 30. However, risk of cardiovascular death, heart attack, and diabetes increased progressively from an index of < 20 even after age, smoking, social class, alcohol consumption, and physical activity were adjusted for. For the combined end point the lowest risks were seen for an index of 20.0-23.9. In never smokers and former smokers, deaths from any cause rose progressively from an index of 20.0-21.9 and for the combined end point, from 20.0-23.9. Age adjusted levels of a wide range of cardiovascular risk factors rose or fell progressively from an index < 20.
A healthy body mass index in these middle aged British men seems to be about 22.
... no studies were identified which investigated the effects of reducing obesity specifically in patients with peripheral arterial disease. Obesity (defined as a body mass index > 30 kg/m 2 ) has been adversely associated with a number of cardiovascular risk factors (blood pressure, plasma cholesterol, triglycerides, glucose tolerance and thrombogenesis) 23,24 and with an increased risk of mortality. 25 D obese patients with peripheral arterial disease should be treated to reduce their weight. ...
... A number of studies have been conducted to assess whether surveillance improves outcomes for patients. Three randomised controlled trials, [24][25][26] and one poor quality meta-analysis were identified. 27 The metaanalysis included heterogeneous studies (including case series) which used different modes of surveillance and assessed a variety of outcome measures. ...
... 27 The metaanalysis included heterogeneous studies (including case series) which used different modes of surveillance and assessed a variety of outcome measures. The three RcTs investigated the utility of surveillance following infra-inguinal vein graft with one study 24 including follow up of vein and synthetic grafts. The quality of these studies was limited, for example, by small sample sizes, lack of blinding and lack of adherence to the surveillance protocol. ...
In 2005-6 I was surgical senior editor of the SIGN Guidelines. This guideline was withdrawn in 2015. Peripheral arterial disease (PAD) in the legs, sometimes known as peripheral vascular disease, is caused by atheroma (fatty deposits) in the walls of the arteries leading to insufficient blood flow to the muscles and other tissues. Patients with PAD may have symptoms but can also be asymptomatic. The commonest symptom, intermittent claudication, is characterised by leg pain and weakness brought on by walking, with disappearance of the symptoms following rest. Patients diagnosed as having PAD, including those who are asymptomatic, have an increased risk of mortality, myocardial infarction and stroke. Relative risks are two to three times that of age and sex matched groups without PAD.1,2 Management of PAD provides an opportunity for secondary prevention of cardiovascular events. Both lifestyle changes and therapeutic interventions to reduce risk need to be considered. Patients with claudication can have a significantly reduced quality of life due to their restricted mobility. Careful consideration needs to be given to drug and lifestyle management of claudication so that patients can achieve an optimum quality of life within the limitations of their condition. In the primary care setting, the methods of diagnosis and the criteria for referral to a specialist vary between general practitioners, while in secondary care the use of diagnostic investigations and the routine follow up of patients varies between specialists. These differences in clinical practice suggest that, where feasible, guidance is required on the best approach to managing
patients with PAD.
... Physical inactivity and adiposity are associated with an increased risk of type 2 diabetes and cardiovascular disease (1)(2)(3)(4) and constitute a serious public health problem in the UK and globally (5). Evidence suggests that levels of physical activity (PA) are lower among those who are socioeconomically disadvantaged (6), who experience greater economic, access and health related barriers to being physically active (7). ...
... Ogilvie and colleagues found overall levels of PA to be higher among individuals living 2 in social housing compared with owner-occupiers (18). The authors suggest that may 3 capture occupational PA levels which are likely to be higher among those in social housing 4 (18). In contrast, living in private rental accommodation was associated with a greater 5 likelihood of taking up exercise over a 9-year period among men aged 18-49 at baseline, 6 compared with those in local authority accommodation (19). ...
... 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 The associations between neighbourhood perception scales and adiposity and PA outcomes 1 were examined. Each of the neighbourhood quality and crime scores were included in the 2 models as quintiles, to examine the differences in outcomes between the top and bottom 3 quintile. Finally, the effect of adjustment for neighbourhood perception on differences in 4 adiposity and PA between housing sectors was examined. ...
... All participants were confirmed by neurologists to have no disease of the central nervous system and no neurological abnormalities during the study. Referring to the age stages of previous studies [35][36][37], in this study, the young, middle, and old adulthood groups included individuals less than 45, from 45 to 60, and more than 60 years old, respectively. The study protocol (code: 202000104R) was approved by the Institutional Review Board of the Shin Kong Wu Ho-Su Memorial Hospital on 9 April 2020. ...
... In the DK atlas, 34 cerebral subregions (ROIs) are present in each hemisphere. We rearranged the ROIs on the basis of lobes and placed them in the following order: frontal lobe (1-20, odd and even numbers for the left and right hemispheres, respectively), limbic lobe (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), temporal lobe (33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46), parietal lobe (47-58), and occipital lobe (59-68). Fourth, 3D-FD was used to measure the FD value of each parcellated region and lobes for each study group. ...
Normal aging is associated with functional and structural alterations in the human brain. The effects of normal aging and gender on morphological changes in specific regions of the brain are unknown. The fractal dimension (FD) can be a quantitative measure of cerebral folding. In this study, we used 3D-FD analysis with the Desikan–Killiany (DK) atlas to assess subregional morphological changes in adulthood. A total of 258 participants (112 women and 146 men) aged 30–85 years participated in this study. Participants in the middle-age group exhibited a decreased FD in the lateral frontal lobes, which then spread to the temporal and parietal lobes. Men exhibited an earlier and more significant decrease in FD values, mainly in the right frontal and left parietal lobes. Men exhibited more of a decrease in FD values in the subregions on the left than those in the right, whereas women exhibited more of a decrease in the lateral subregions. Older men were at a higher risk of developing mild cognitive impairment (MCI) and exhibited age-related memory decline earlier than women. Our FD analysis using the DK atlas-based prediagnosis may provide a suitable tool for assessing normal aging and neurodegeneration between groups or in individual patients.
... The findings in table 1 show that BMI was increased with age in diabetics. These findings are consistent with other studies (17)(18)(19) . An increase in 1 body mass index unit from 20.0-21.9 ...
... onwards was associated with an approximately 10% increase in the rate of coronary events. Diabetes increased progressively with the increase in BMI (18) . In the present study 35.3 % of male diabetics and 35.5 % of female diabetics were obese. ...
This case-control study includes 356 diabetics and 384 apparently healthy age and sex matched controls who attended Al-Zahrawi Private Hospital Outpatient Department in Mosul during the period from January to December 2004.The aim of the study was to assess the changes in serum lipid profile among type 2 diabetics in relation to body mass index (BMI) and to determine the magnitude and pattern of dyslipidaemia in obese diabetics. Fasting plasma glucose and serum lipid profile were compared in type 2 diabetics and control subjects according to BMI. The collected data were analyzed by chi-square, Z, ANOVA and Duncan tests. Fasting plasma glucose levels were highest in obese diabetics and the frequency of poorly controlled diabetics was increased with increasing BMI. There was a significant and positive association between the BMI and serum triglyceride (TG) (p 0.01), total cholesterol (TC) (p 0.001), LDL-C (P<0.001) and VLDL-C (P<0.01). Serum HDL-C levels were significantly decreased (P<0.01) by increasing BMI. The prevalence of dyslipidaemia was increased with increasing BMI levels in both genders. In conclusion several lipid abnormalities in type 2 diabetics have pointed to the significance of diabetic control, regular lipid profile and control of obesity.
... Manson [46]. In a large prospective study examining the relation between weight and subsequent risk of coronary heart disease, incidence of disease increased progressively with increasing body mass index [49]. After age and lifestyle factors were adjusted, men with BMIs >30 kg/m 2 had twice the risk (RR, 2.09; 95% CI, 1.45 to 3.03) of the normal weight reference group (BMI 20 to 21.9 kg/m 2 ) of developing coronary heart disease. ...
... For example, results from the Behavioral Risk Factor Surveillance System (BRFSS) found prevalence of diabetes increased by approximately 9 percent for every kilogram increase in selfreported body weight; moreover, a significant correlation was found between the prevalence of obesity and diabetes (r = 0.64, P < 0.001) [60]. Studies on both men [49,52,61,62] and women [63][64][65] have found type 2 diabetes development to be associated with weight gain after the age of 18 years. ...
COMPARISON OF SELF-MONITORING TECHNIQUES FOR TRACKING EATING AND EXERCISE BEHAVIORSDiane Lynn Helsel, PhDUniversity of Pittsburgh, 2005Self-monitoring of eating and exercise behaviors has traditionally been done in a detailed manner. Finding ways to simplify this approach would decrease the time involved in the recording process, which may improve long-term adherence to tracking eating and exercise behaviors during weight loss. The purpose of this study was to investigate the effect of two self-monitoring methods for tracking eating and exercise behaviors within the context of a 16 week correspondence-based weight loss intervention. Subjects for this investigation were forty-two overweight adult men and women, ages 21 to 45 with a BMI of 25 to 35 kg/m2. Subjects were randomized to one of two self-monitoring conditions: 1) detailed self-monitoring (DSM) and 2) detailed self-monitoring transitioning to abbreviated self-monitoring (TSM). Participants in both groups recorded eating and exercise behaviors in diaries that were completed daily and returned to investigators each week for review. Participants in the DSM group recorded detailed information about the type, quantity, calories and fat grams of food consumed and type, duration, and rating of perceived exertion (RPE) of exercise. Participants in the transitional (TSM) group self-monitored eating and exercise behaviors using the detailed (DSM) approach during weeks 1-8, but transitioned to an abbreviated diary during weeks 9-16. This diary allowed participants to simplify self-monitoring by using check marks to estimate the quality and quantity of foods eaten, and amount of exercise completed daily. Unlike the DSM group, specific details of eating and exercise were not recorded. A repeated measures design was utilized for this study. The independent variable was type of self-monitoring. The primary dependent variable was completion of eating and exercise diaries; secondary dependent variables were body weight, dietary intake and physical activity. The major finding of this investigation was that both groups were similar with regard to the amount of weight lost, food diary completion scores and changes in eating and exercise behavior. Consequently, this study identified an alternative tracking method (i.e., TSM) that may be less effortful, and provides a similar outcome as detailed self-monitoring.
... The thinnest people show some excess risk compared to those with 'normal' weight and those who are slightly overweight, but then as obesity increases all-causes mortality increases and this is largely due to an increase in cardiovascular mortality [125] . Prospective studies in both men and women have demonstrated that the risk of coronary heart disease already begins to increase at moderate levels of weight gain and overweight [126][127][128][129][130][131] . Overweight is also associated with an increased risk of stroke [130] . ...
... Prospective studies in both men and women have demonstrated that the risk of coronary heart disease already begins to increase at moderate levels of weight gain and overweight [126][127][128][129][130][131] . Overweight is also associated with an increased risk of stroke [130] . ...
... However, CRF, BP, and BMI seems to be interrelated and contribute to the development of CVD. In adults, CRF, PA, and BMI have been associated with CVD, CV mortality and morbidity (Hubert et al., 1983;Paffenbarger et al., 1986;Blair et al., 1989;Manson et al., 1995;Blair et al., 1996;Shaper et al., 1997;Lee et al., 1999). The Aerobic Center Longitudinal Study performed in adults concluded that low physical fitness resulted in a greater risk of mortality than fatness, whereas fitness diminished the impact of fatness on mortality (Blair et al., 1989;Lee et al., 1998). ...
Background: Obesity- and hypertension-related cardiovascular (CV) risk has been shown to originate in childhood. Higher body mass index (BMI) and blood pressure (BP) have been associated with increased large artery stiffness and a lower microvascular arteriolar-to-venular diameter ratio (AVR) in children. This study aimed to investigate the association of cardiorespiratory fitness (CRF) with development of BMI, BP and vascular health during childhood.
Methods: In our prospective cohort study, 1,171 children aged 6–8 years were screened for CRF, BMI, BP, retinal vessel diameters and pulse wave velocity using standardized protocols. Endurance capacity was assessed by 20 m shuttle run test. After 4 years, all parameters were assessed in 664 children using the same protocols.
Results: Children with a higher CRF at baseline developed a significantly lower BMI (β [95% CI] −0.09 [−0.11 to −0.06] kg/m ² , p < 0.001), a lower systolic BP (β [95% CI] −0.09 [−0.15 to −0.03] mmHg, p = 0.004) and a higher AVR (β [95% CI] 0.0004 [0.00004 to 0.0007] units, p = 0.027) after 4 years. The indirect association of CRF with development of retinal arteriolar diameters was mediated by changes in BMI.
Conclusion: Our results identify CRF as a key modulator for the risk trajectories of BMI, BP and microvascular health in children. Obesity-related CV risk has been shown to track into adulthood, and achieving higher CRF levels in children may help counteract the development of CV risk and disease not only in pediatric populations, but may also help reduce the burden of CVD in adulthood.
Registration: http://www.clinicaltrials.gov/ (NCT02853747).
... 90 In British men, CHD incidence increased at BMIs above 22 and an increase of 1 BMI unit was associated with a 10 percent increase in the rate of coronary events. 162 Similar relationships between increasing BMI and CHD risk have been shown in Finnish, Swedish, Japanese, and U.S. populations. 90,163,164 A relationship between obesity and CHD has not always been found. ...
Background:
Obesity is a public health issue worldwide. Conversational agents (CAs), also frequently called chatbots, are computer programs that simulate dialogue between people. Owing to better accessibility, cost-effectiveness, personalization, and compassionate patient-centered treatments, CAs are expected to have the potential to provide sustainable lifestyle counseling for weight management.
Objective:
This systematic review aimed to critically summarize and evaluate clinical studies on the effectiveness and feasibility of CAs with unconstrained natural language input for weight management.
Methods:
PubMed, Embase, the Cochrane Library (CENTRAL), PsycINFO, and ACM Digital Library were searched up to December 2022. Studies were included if CAs were used for weight management and had a capability for unconstrained natural language input. No restrictions were imposed on study design, language, or publication type. The quality of the included studies was assessed using the Cochrane risk-of-bias assessment tool or the Critical Appraisal Skills Programme checklist. The extracted data from the included studies were tabulated and narratively summarized as substantial heterogeneity was expected.
Results:
In total, 8 studies met the eligibility criteria: 3 (38%) randomized controlled trials and 5 (62%) uncontrolled before-and-after studies. The CAs in the included studies were aimed at behavior changes through education, advice on food choices, or counseling via psychological approaches. Of the included studies, only 38% (3/8) reported a substantial weight loss outcome (1.3-2.4 kg decrease at 12-15 weeks of CA use). The overall quality of the included studies was judged as low.
Conclusions:
The findings of this systematic review suggest that CAs with unconstrained natural language input can be used as a feasible interpersonal weight management intervention by promoting engagement in psychiatric intervention-based conversations simulating treatments by health care professionals, but currently there is a paucity of evidence. Well-designed rigorous randomized controlled trials with larger sample sizes, longer treatment duration, and follow-up focusing on CAs' acceptability, efficacy, and safety are warranted.
... This study also has some limitations. First, dietary information 56 was not included in the lifestyle index, although we included body weight control (defined by BMI), which is important for chronic disease prevention 57 . Instead, we included sleep duration, which is associated with diabetes risk 11 but has not been considered in the previous studies 13 . ...
Background
It is well known that healthy lifestyles measured at one time-point are inversely associated with diabetes risk. The impact of transitions in combined lifestyles in real settings remains unknown.
Methods
We identified the trajectory patterns of combined lifestyles over three years using group-based trajectory modeling in 26,647 adults in Japan. We developed two types of indices (not having the unhealthy lifestyle [easy goal] and having healthiest lifestyles [challenging goal]) using five lifestyle factors: smoking, alcohol consumption, exercise, sleep duration, and body weight control. This index was calculated using the yearly total score (0–5; higher score indicated healthier lifestyles). Diabetes was defined by high plasma glucose level, high hemoglobin A1c level, and self-report.
Results
Five trajectory patterns were identified for each index and showed that healthier patterns are associated with a lower risk of type 2 diabetes during 6.6 years of average follow-up. For example, with a challenging-goal, compared with a persistently very unhealthy pattern, the adjusted hazard ratios (95% confidence intervals) were 0.65 (0.59, 0.73), 0.50 (0.39, 0.64), 0.43 (0.38, 0.48), and 0.33 (0.27, 0.41) for “persistently unhealthy”, “improved from unhealthy to moderately healthy”, “persistently moderately healthy”, and “persistently mostly healthy” patterns, respectively.
Conclusion
Our data reinforce the importance of improving and maintaining health-related lifestyles to prevent diabetes.
... The World Health Organization estimated that in 2016 there were more than 340 million children and adolescents aged 5 to 19 1 years worldwide affected by overweight (including obesity) and a further 41 million younger than age 5 years. 1 Overweight is a strong determinant of type 2 diabetes (T2D) risk; this association is apparent for children who are overweight 2 as well as adults. 3,4 Such reported associations have generally been based on childhood body mass index (BMI), a weight-for-height measure, which is widely used in clinical and public health practice. However, BMI has a number of limitations as a marker of body fatness (BF) in children, [5][6][7] particularly its inability as a weight-based measure to discriminate between lean mass (fat-free mass [FFM]) and fat mass (FM), the balance of which can vary markedly in individuals with a given BMI. ...
Importance:
Childhood obesity, defined by cutoffs based on the weight-based marker of body mass index, is associated with adult type 2 diabetes (T2D) risk. Whether childhood fat mass (FM) is the driver of these associations is currently unknown.
Objective:
To quantify and compare height-independent associations between childhood FM and weight with adult T2D risk in a historic Danish cohort.
Design, setting, and participants:
This population-based retrospective cohort study included schoolchildren from The Copenhagen School Health Records Register born between January 1930 and December 1985 with follow-up to adulthood through December 31, 2015. Analyses were based on 269 913 schoolchildren aged 10 years with 21 896 established adult T2D cases and 261 192 children aged 13 years with 21 530 established adult T2D cases for whom childhood height and weight measurements, as well as predicted FM, were available. Statistical analyses were performed between April 2019 to August 2020.
Exposures:
Childhood FM and weight at ages 10 and 13 years.
Main outcomes and measures:
Diagnoses of T2D were established by linkage to national disease registers for adults aged at least 30 years. Sex-specific Cox regression quantified associations, adjusted for childhood height, which were evaluated within 5 birth-cohort groups. Group-specific results were pooled using random-effects meta-analyses accounting for heterogeneity across group-specific associations.
Results:
This cohort study analyzed data from 269 913 children aged 10 years (135 940 boys [50.4%]) with 21 896 established adult T2D cases and 261 192 children aged 13 years (131 025 boys [50.2%]) with 21 530 established adult T2D cases. After adjusting for childhood height, increases in FM and weight (per kilogram) among boys aged 10 years were associated with elevated T2D risks at age 50 years of 12% (hazard ratio [HR], 1.12; 95% CI, 1.10-1.14) and 7% (HR, 1.07; 95% CI, 1.05-1.09), respectively, and among girls aged 10 years of 15% (HR, 1.15; 95% CI, 1.13-1.17) and 10% (HR, 1.10; 95% CI, 1.08-1.11), respectively. Among children aged 13 years, increases in FM and weight (per kilogram) were associated with increased T2D risks at age 50 years of 10% (HR, 1.10; 95% CI, 1.09-1.10) and 6% (HR, 1.06; 95% CI, 1.05-1.07) for boys, respectively, and of 10% (HR, 1.10; 95% CI, 1.10-1.11) and 7% (HR, 1.07; 95% CI, 1.06-1.08), respectively, for girls.
Conclusions and relevance:
This cohort study found that a 1-kg increase in childhood FM was more strongly associated with increased adult T2D risk than a 1-kg increase in weight, independent of childhood height. Information on FM, rather than weight-based measures, focuses on a modifiable component of weight that may be associated with adult T2D risk. These findings support the assessment of childhood FM in adiposity surveillance initiatives in an effort to reduce long-term T2D risk.
... have reported that BMI is a predictor of cardiovascular disease, and that lifestyle changes leading to increased obesity increase the risk of cardiovascular disease 1) . Shaper et al. have reported that BMI is closely associated with increases in the prevalence of diabetes and cardiovascular diseases, and increases in test results for blood pressure, blood sugar, and blood lipids 2) . Furthermore, the American Health Foundation has reported that weight loss reduces the risk factors for cardiovascular disease and diabetes 3) , and it is considered that maintaining appropriate body shape is important for health management. ...
Objectives: Increase in lifestyle-related diseases with high BMI has been shown in numerous epidemiological studies. The present study was a comparative investigation of the effects of changes in BMI over two years on representative lifestyle-related disease onset and normalization.
Subjects: A total of 10,109 subjects (5,766 males and 4,343 females) who underwent annual health check-ups at Tokai University Hospital's Health Screening Center in 2014 and 2016 were included in this study.
Methods: Based on the WHO classification of obesity, and standard weight according to the Japan Society of Obesity, in 2014 the subjects were divided into four groups, by BMI, and in 2016 each group was divided into four groups, by BMI, to make 16 groups in total. The new-onset and normalization rates for hypertension, diabetes and dyslipidemia during this two year period were compared between the groups, with classification by sex.
Results: With both males and females, the hypertension new-onset rate increased with increasing BMI, but the new-onset rate also increased significantly in the groups showing BMI decrease. The diabetes new-onset rate increased with increasing BMI, but females who were slimmer than standard body type also showed increased normalization rate with BMI increase. With both males and females, the dyslipidemia new-onset rate increased with increasing BMI, and the normalization rate increased with decreasing BMI, but these relationships were weak with females.
Conclusion: Changes in BMI are associated with new-onset and normalization rates, especially for dyslipidemia. Although hypertension and diabetes are associated with changes in BMI and new-onset and normalization rates, the involvement of other lifestyle-related factors must also be considered.
... 44 In a prospective study of 7735 males (age range: 40-59 years, mean follow-up: 14.8 years), Shaper et al showed that a BMI of 22 kg/m 2 was associated with the lowest risk of CVD mortality. 45 The Women's Health Australia Project included 13,431 women (age range: from 45 to 49 years) and was designed to assess the relation between BMI and CVD risk. 46 In this study Brown et al demonstrated that a BMI of 19-24 kg/m 2 was the optimal BMI for minimizing CVD risk. ...
Overweight and obesity contribute to the development of cardiovascular disease (CVD) in general and coronary heart disease (CHD) in particular in part by their association with traditional and non-traditional CVD risk factors. Obesity is also considered to be an independent risk factor for CVD. The metabolic syndrome, of which central obesity is an important component, is strongly associated with CVD including CHD. There is abundant epidemiologic evidence of an association between both overweight and obesity and CHD. Evidence from post-mortem studies and studies involving coronary artery imaging is less persuasive. Recent studies suggest the presence of an obesity paradox with respect to mortality in persons with established CHD. Physical activity and preserved cardiorespiratory fitness attenuate the adverse effects of obesity on CVD events. Information concerning the effect of intentional weight loss on CVD outcomes in overweight and obese persons is limited.
... BMI values at the lower and higher ends of the spectrum see an increase in the risk of coronary heart disease and with mortality risk in smokers and non-smokers . All cause mortality was shown to be increased in men with a BMK20 kg.m'^ and a BMI>30 kg.m'1 94 but risk of death by cardiovascular event or diabetes related complications increased progressively from a BMI>20 (Shaper et al, 1997). These gradings are arbitrary and do not take into account the distribution of fat or the fact that lean tissue weighs more than fat and therefore, subjects with pronounced musculature will have an over estimated BMI value whereas, those with an ectomorphic body shapes or elderly subjects who have a low lean mass (reflected by a low BMI) and a high proportion of fat tissue. ...
Adipose tissue occupies a unique role in body physiology by providing a dynamic long term energy store. The purpose of this thesis is to determine whether endocrine signals are secreted from an abdominal subcutaneous adipose tissue bed. In particular, the release of the cytokine-like molecules leptin, IL-6 and TNF-α will be investigated. This triad of molecules are have the potential to alter lipid mechanism at the autocrine/paracrine level in addition to potentially acting as endocrine signals. As no assay for leptin was available at the commencement of this project, the first step was the development of one with sufficient specificity and sensitivity. Due to the high degree of conservation between vertebrate leptin, the production of high affinity antibodies to leptin was anticipated to be problematic. Therefore, different immunisation strategies were investigated to optimise the immune response; variation of host (rabbit/mouse), variation of immunogen (peptides/whole leptin) and variation of immunisation site (subcutaneous/footpad) with varying success. The resulting panel of polyclonal antiserum and monoclonal antibodies were subsequently used in the development of a one-site RIA and two-site ELISA. The former was validated against a commercially available assay and used in a number of clinical studies. The latter was proported to differentiate between bound and free leptin, although the sensitivity of the assay was too low to be used with serum samples. Using the in-house RIA and commercially available high sensitivity assays for cytokines, and their soluble receptors, and a sensitive arterial-venous sampling technique which allows the output of the target organ to be evaluated, release of the target molecules was evaluated. IL-6 and leptin were seen to be released by the adipose tissue studied in the baseline (median arterial IL-6 2.33pg/ml [interquartile range, 1.36-3.77 pg/ml] vs. median venous IL-6 6.06 pg/ml [interquartile range, 3.28-9.43 pg/ml], p<0.001; median arterial leptin 28.45 ng/ml [interquartile range, 9.64-50.64 ng/ml] vs. median venous leptin 35.28 ng/ml [interquartile range, 12.65-61.44 ng/ml], p<0.0001. No net release of TNF-α was observed; median arterial TNF-α 1.79 pg/ml [interquartile range, 1.20-2.26 pg/ml] vs. median venous TNF-α 1.67 pg/ml [interquartile range , 1.33-2.22 pg/ml, p=0.446]. Both leptin and IL-6 were higher in the obese subjects (venous IL-6 vs. % body fat r=0.652, p<0.005; leptin vs. % body fat r=0.890, p<0.0001) and were regulated in a nutritionally independent manner. No net release of IL-6 soluble receptor (IL-6sR) or leptin soluble receptor/binding protein (as determined using a novel semi-quantitative assay) were observed. Significant release of TNF soluble receptor type I was observed (p=0.002) and levels of this correlated with obesity (vs. % body fat r=0.72, p<0.0001). TNF soluble receptor II was also released by this depot, but the levels were not significantly higher than circulating levels. In summary, IL-6 and leptin, but not TNF-α, are released by abdominal subcutaneous adipose tissue. IL-6 and TNF-α are released at levels which are far below those observed in response to pathogenic stimuli. The soluble forms of the IL-6 and leptin receptors are not released by this depot, but both types of TNF soluble receptors are. All these molecules are released at levels which reflect adiposity. Soluble forms of the cellular cytokine receptors have profound effects on the bioactivity of cytokine-like molecules. Therefore, the reciprocal release of the cytokine or the soluble receptor isoforms from the abdominal adipose tissue may constitute a post-secretion regulatory mechanism. Based on these data presented here, the activity of the IL-6 produced by the adipose tissue will be augmented by the presence of the soluble form of the receptor in the circulation. With increasing obesity, levels of IL-6 released from the adipose tissue increase, accompanied by a decrease in the circulating soluble receptor levels - possibly to limit the effects of increasing levels of IL-6. Conversely, the effects of TNF will be negated by the soluble receptor isoforms released at this site. This may work on the membrane bound forms of TNF, or in an autocrine/paracrine fashion. No clear role for the soluble form of the leptin receptor has been determined although it may increase the half-life of leptin by preventing renal clearance. Whether the regulatory mechanisms underlying leptin and IL-6 production are the same as those governing their respective soluble receptor production also remains unknown. A clear link can be established between the products of the adipose tissue and the immune system; IL-6 and TNF-α are potent proinflammatory cytokines and leptin is thought to be an important permissive signal in immunological processes. Other adipose tissue products are also analogous to components of the immune system such as adipsin, acylation stimulating protein (ASP) and adiponectin. This is suggestive of a strong link between energy balance and immune function. The release of these molecules from this depot and their potential to act distally, as well as in an autocrine/paracrine fashion strengthen the argument for an endocrine-like role of adipose tissue.
... All causes of mortality were higher with BMI less than 20 and over 30. 14 In a prospective study we reported that infection, nephropathy, CVA and coma are more important causes of death than CAD. 15 This observation was obviously different from that reported from the mortality profile of diabetic subjects from the West. ...
Objectives:
To compare the level of insulin resistance and β-cell function between lean and overweight/obese Filipino patients with newly diagnosed type 2 diabetes mellitus (T2DM).
Methodology:
This was a cross-sectional analytical study including newly diagnosed T2DM Filipino patients from St. Luke's Medical Center - Quezon City. The patients were classified as either lean or overweight/obese. Age, sex, smoking history, anthropometric measures and blood pressure were obtained. Insulin resistance and β-cell function were determined using the homeostasis model assessment (HOMA). The original model (HOMA1) and the updated model (HOMA2) were used.
Results:
A total of 80 subjects were included. There were 40 subjects in each group. The overweight/obese subjects had significantly higher mean insulin resistance (HOMA1-IR 9.8±11.7, HOMA2-IR 3.0±2.0) compared to the lean group (HOMA1-IR 2.9±1.5, HOMA2-IR 1.3±0.5). This was consistent in both HOMA1 and HOMA2 (p-values=0.001 and <0.001, respectively). The mean β-cell function of the overweight/obese patients was significantly higher than the lean subjects when using HOMA1 (lean=57.8±35.5, overweight/obese=93.6±66.4, p-value=0.003), but not in HOMA2 (lean=57.6±30.5, overweight/obese=74.8±45.7, p-value=0.051). Overweight/obesity increased HOMA1-IR by 4.0 and HOMA1-B by 46.1 (p-values= 0.002 and <0.001, respectively). Through the use of HOMA2, overweight/obesity increased HOMA2-IR by 1.4 and HOMA2-B by 29.1 (p-values<0.001). Being overweight/obese was also associated with significantly higher odds for developing greater insulin resistance (HOMA1-IR adjOR = 5.6, 95%CI= 1.7-19.2, p-value=0.005; HOMA2-IR adjOR=10.9, 95%CI=3.4-34.9, p-value<0.001) and lower odds for a decreased β-cell function (HOMA1-B adjOR = 0.2, 95%CI = 0.05-0.9, p-value=0.033; HOMA2-B adjOR=0.2, 95%CI=0.04-0.9, p-value=0.043) compared to being lean.
Conclusion:
Newly diagnosed overweight/obese T2DM had higher mean insulin resistance and β-cell function compared to lean T2DM. Overweight/obesity was also associated with higher odds of developing insulin resistance and lower odds for a decreased β-cell function compared to being lean. The overweight/obese T2DM group also had worse metabolic profile manifested by higher FPG, HbA1c, SGPT and blood pressures compared to the lean T2DM group.
... After adjusting for other cardiovascular risk factors, BMI was shown to not be a high-level risk factor for stroke [5,6]. Some studies have reported a complete lack of correlation between BMI and stroke [10][11][12]. Several large-scale studies have suggested that abdominal obesity, rather than BMI or general obesity, is more closely related to stroke risk, especially in men [13][14][15]. ...
Obesity is known to increase the risk of stroke. It is unclear whether high absolute fat mass (FM) increases the risk of stroke independently. We studied the correlation between FM and silent brain infarction/white matter change (SI/WMC) using brain computed tomography. We selected subjects from the local government health promotion project. We randomly selected a target population that had never been diagnosed with stroke or dementia. FM was measured by bioelectrical impedance analysis (BIA). We divided the subjects into three groups according to the FM (gender-specific tertiles [GTx]). Seven hundred and twenty-two subjects (321 men) between 50 and 75 years of age were recruited. The overall odds ratio (OR) of SI/WMC was 2.23 (95% confidence interval (CI), 1.34–3.71; p = 0.002) times higher in the 37th to 100th percentiles (GT3) than in the first to 32nd percentiles (GT1). When men and women were separated, the OR of GT3 was 1.35 (CI, 0.62–2.94; p = 0.45) in men and 3.2 (CI, 1.60–6.40; p = 0.001) in women. The findings were not found to be statistically significant after adjusting for the well-known stroke risk factors. When the subjects were divided into a high FM (HFMG, GT3) and low FM group (LFMG, GT1 + GT2), the HFMG showed an increased OR of SI/WMC in women. Similar results were seen after adjusted (overall: OR, 1.38; CI, 0.85–2.25, p = 0.198; men: OR, 0.93; CI, 0.422–2.051; p = 0.86; women: OR, 2.02; CI, 1.06–3.86; p = 0.03). The findings suggest that high FM may be an independent risk factor for ischemic stroke among adults free from stroke and dementia, especially in women.
... High levels of body fatness in childhood have been associated with both overweight and obesity and increased risks of noncommunicable diseases in adulthood-notably type 2 diabetes and cardiovascular diseases. [3][4][5][6][7] Accurate and practical methods for quantifying body fatness in children are essential for effective monitoring, prevention, and management of high body fatness, overweight, and obesity in childhood. 8 9 Body mass index (BMI), the most widely used marker of childhood body fatness in clinical and public health practice, has serious limitations as a marker of body fatness in children. ...
Objectives
To develop and validate a prediction model for fat mass in children aged 4-15 years using routinely available risk factors of height, weight, and demographic information without the need for more complex forms of assessment.
Design
Individual participant data meta-analysis.
Setting
Four population based cross sectional studies and a fifth study for external validation, United Kingdom.
Participants
A pooled derivation dataset (four studies) of 2375 children and an external validation dataset of 176 children with complete data on anthropometric measurements and deuterium dilution assessments of fat mass.
Main outcome measure
Multivariable linear regression analysis, using backwards selection for inclusion of predictor variables and allowing non-linear relations, was used to develop a prediction model for fat-free mass (and subsequently fat mass by subtracting resulting estimates from weight) based on the four studies. Internal validation and then internal-external cross validation were used to examine overfitting and generalisability of the model’s predictive performance within the four development studies; external validation followed using the fifth dataset.
Results
Model derivation was based on a multi-ethnic population of 2375 children (47.8% boys, n=1136) aged 4-15 years. The final model containing predictor variables of height, weight, age, sex, and ethnicity had extremely high predictive ability (optimism adjusted R ² : 94.8%, 95% confidence interval 94.4% to 95.2%) with excellent calibration of observed and predicted values. The internal validation showed minimal overfitting and good model generalisability, with excellent calibration and predictive performance. External validation in 176 children aged 11-12 years showed promising generalisability of the model (R ² : 90.0%, 95% confidence interval 87.2% to 92.8%) with good calibration of observed and predicted fat mass (slope: 1.02, 95% confidence interval 0.97 to 1.07). The mean difference between observed and predicted fat mass was −1.29 kg (95% confidence interval −1.62 to −0.96 kg).
Conclusion
The developed model accurately predicted levels of fat mass in children aged 4-15 years. The prediction model is based on simple anthropometric measures without the need for more complex forms of assessment and could improve the accuracy of assessments for body fatness in children (compared with those provided by body mass index) for effective surveillance, prevention, and management of clinical and public health obesity.
... Physical inactivity and adiposity are associated with an increased risk of type 2 diabetes and cardiovascular disease [1][2][3][4] and constitute a serious public health problem in the UK and globally. 5 Evidence suggests that levels of physical activity (PA) are lower among those who are socioeconomically disadvantaged, 6 who experience greater economic, access and health-related barriers to being physically active. ...
Objectives
The neighbourhood environment is increasingly shown to be an important correlate of health. We assessed associations between housing tenure, neighbourhood perceptions, sociodemographic factors and levels of physical activity (PA) and adiposity among adults seeking housing in East Village (formerly London 2012 Olympic/Paralympic Games Athletes’ Village).
Setting
Cross-sectional analysis of adults seeking social, intermediate and market-rent housing in East Village.
Participants
1278 participants took part in the study (58% female). Complete data on adiposity (body mass index (BMI) and fat mass %) were available for 1240 participants (97%); of these, a subset of 1107 participants (89%) met the inclusion criteria for analyses of accelerometer-based measurements of PA. We examined associations between housing sector sought, neighbourhood perceptions (covariates) and PA and adiposity (dependent variables) adjusted for household clustering, sex, age group, ethnic group and limiting long-standing illness.
Results
Participants seeking social housing had the fewest daily steps (8304, 95% CI 7959 to 8648) and highest BMI (26.0 kg/m², 95% CI 25.5kg/m² to 26.5 kg/m²) compared with those seeking intermediate (daily steps 9417, 95% CI 9106 to 9731; BMI 24.8 kg/m², 95% CI 24.4 kg/m² to 25.2 kg/m²) or market-rent housing (daily steps 9313, 95% CI 8858 to 9768; BMI 24.6 kg/m², 95% CI 24.0 kg/m² to 25.2 kg/m²). Those seeking social housing had lower levels of PA (by 19%–42%) at weekends versus weekdays, compared with other housing groups. Positive perceptions of neighbourhood quality were associated with higher steps and lower BMI, with differences between social and intermediate groups reduced by ~10% following adjustment, equivalent to a reduction of 111 for steps and 0.5 kg/m² for BMI.
Conclusions
The social housing group undertook less PA than other housing sectors, with weekend PA offering the greatest scope for increasing PA and tackling adiposity in this group. Perceptions of neighbourhood quality were associated with PA and adiposity and reduced differences in steps and BMI between housing sectors. Interventions to encourage PA at weekends and improve neighbourhood quality, especially among the most disadvantaged, may provide scope to reduce inequalities in health behaviour.
... 3 Pek çok çalışma bu davranışlar ve kalp-damar hastalıkları ve bu sebeple gerçekleşen ölüm arasında ters yönlü bir ilişki olduğunu göstermiştir. [4][5][6][7][8][9] Sağlıksız davranışların da birçok kronik ve sakatlıkla sonuçlanan hastalığın sebebi olduğu bilinmektedir. 10 Stres, sağlıksız yaşam biçimi davranışları ve düşük sosyo-ekonomik statü bağımsız olarak erken ölüm riskini yükseltmektedir. ...
Amaç: Bu çalışma, Sağlıklı Yaşam Biçimi Davranış ölçeğini kullanmış, cinsiyet, medeni durum, çalışma durumu ve çocuk sahibi olma gibi demografik özelliklerin etkisini raporlamış tezleri meta-analiz yöntemi ile incelemeyi amaçlamıştır. Yöntem: Yükseköğretim Kurulu Ulusal Tez Merkezi Veri Tabanında yapılan tarama sonucunda “sağlıklı yaşam biçimi” anahtar kelimesi ile toplam 112 çalışmaya ulaşılmış ve seçim kriterlerine uyan 46 çalışma araştırma kapsamına alınmıştır. Meta-analizde rastgele etki modeli ve yayın yanlılığının testi için de Egger testinden yararlanılmıştır. Bulgular: Birleştirilmiş meta-analiz sonucuna göre her bir demografik düzeyde SYBD toplam skoru için etki büyüklükleri (-0.138/0.141) önemsiz düzeyde elde edilmiş olup, incelenen forest grafik sonuçlarına göre istatistiksel olarak anlamlı bulunmamıştır. Egger testi sonucuna göre yayın yanlılığı tespit edilmemiştir (p>0.05). Sonuç: Çalışmada cinsiyet, medeni durum, çalışma durumu ve çocuk durumu faktörlerinin sağlıklı yaşam biçimi davranışı üzerinde önemsiz düzeyde etkiye sahip olduğu sonucuna ulaşılmıştır. Moderatör etkilerine göre ayrıştırılmış farklar incelendiğinde ise örnek türü ve örnek yeri açısından anlamlı farklılıklar görülmüştür.
... Ожирение может быть самостоятельным заболеванием либо синдромом, развивающимся при других заболеваниях. Ожирение и ассоциированные с ним метаболические нарушения являются актуальной проблемой современной медицины, поскольку приводят к развитию целого ряда тяжелых заболеваний [6][7][8][9][10]. ...
The presented paper is a third revision of the clinical recommendations for the treatment of morbid obesity in adults. Morbid obesity is a condition with body mass index (BMI) ≥40 kg / m2 or a BMI ≥35 kg / m2 in the presence of serious complications associated with obesity. The recommendations provide data on the prevalence of obesity, its etiology and pathogenesis, as well as on associated complications. The necessary methods for laboratory and instrumental diagnosis of obesity are described in detail. In this revision of the recommendations, the staging of prescribing conservative and surgical methods for the treatment of obesity are determined. For the first time, a group of patients with obesity and type 2 diabetes mellitus is selected, in whom metabolic surgery allows a long-term improvement in the control of glycemia or remission of diabetes mellitus.
... It has been reported that in 2010 overweight and obesity accounted for 3.4 million deaths worldwide (Ng et al., 2014). The risks for heart diseases, stroke, and diabetes increase consistently with the weight gain, and a high body mass index also increases the risks for certain types of cancer (Shaper et al., 1997;, and it has been reported that in 2010 overweight and obesity accounted for 3.4 million deaths worldwide (Ng et al., 2014). ...
Objectives
In this work the current policies and regulatory actions of the government agencies in Brazil for ensuring nutritional quality are discussed.
Material and methods
Information on the efforts of industry, academia and nongovernmental organizations to achieve the proposed goals, the results achieved and the challenges that must still be faced by the different sectors of the Brazilian society are presented and discussed.
Results
The joint action of regulatory agencies, the food production sector, non-governmental entities and academia resulted in the reduction of saturated and trans fats, salt and sugar in foods produced in Brazil.
Limitations
Most of the information related to the food industries in Brazil is made available by ABIA (Brazilian Association of Food Industries) which represents around 60% of the food market in Brazil. Information regarding the rest of the market is limited.
Conclusions
The reduction of saturated and ‘trans’ fats, sodium, and sugar in industrialized foods seems an effective strategy for reducing the intake of these compounds by the Brazilian population. In addition the adequate nutrition labeling and consumer education will allow healthier food choices by the population.
... Risks of CV death were significantly higher for patients with BMI of 24 or higher, except for the group with BMI of 26. Risk of developing heart disease was also significant at BMI of 24 and above, but risk of stroke was not associated with any level of BMI [5]. A meta-analysis of 3 historical cohort studies assessed the association of childhood BMI with the risk of adult CV disease and stroke. ...
... Other studies have confirmed these findings. 13 As for other risk factors, weight reduction has been demonstrated to reduce risk. Thus, a weight loss of more than 9 kg in women has been associated with a 25% decrease in all-cause mortality. ...
There is no single unifying theory to explain the aetiology of obesity but several environmental factors, such as decreased physical activity and increased fat intake may contribute to its development in genetically predisposed individuals. Dietary and pharmacological treatments of morbid obesity have been proven to be unsuccessful. Modern surgical treatments have been shown to be effective in achieving significant weight loss with consequent reduction in morbidity. Despite the fact that surgical treatment of morbid obesity is the only therapeutic form that has stood the test of time, it still remains a crisis-driven form of therapy in the UK. It is probable that a better understanding of the aetiology and physiology of obesity may lead to the development of an effective pharmacological treatment of obesity in the future. However, until then, surgical treatment of morbid obesity should be considered as an effective and efficient way of treatment in selected cases.
... Obesity is defined as having a BMI that is over 30 kg per square meter. Age 40 is also chosen for the construction of the obesity covariates, because middle age obesity has shown strong association with many chronic diseases in later life that cause disability and deaths [48][49][50]. ...
Background:
In the past three decades, the elderly population in the United States experienced increase in life expectancy (LE) and disability-free life expectancy (LE(ND)), but decrease in life expectancy with disability (LE(D)). Smoking and obesity are two major risk factors that had negative impacts on these trends. While smoking prevalence continues to decline in recent decades, obesity prevalence has been growing and is currently at a high level. This study aims to forecast the healthy life expectancy for older adults aged 55 to 85 in the US from 2011 to 2040, in relation to their smoking and obesity history.
Methods:
First, population-level mortality data from the Human Mortality Database (HMD) and individual-level disability data from the US National Health Interview Survey (NHIS) were used to estimate the transition rates between different health states from 1982 to 2010, using a multi-state life table (MSLT) model. Second, the estimated transition rates were fitted and projected up to 2040, using a modified Lee-Carter model that incorporates cohort smoking and obesity history from NHIS.
Results:
Mortality and morbidity for both sexes will continue to decline in the next decades. Relative to 2010, men are expected to have 3.2 years gain in LE(ND) and 0.8 years loss in LE(D). For women, there will be 1.8 years gain in LE(ND) and 0.8 years loss in LE(D). By 2040, men and women are expected to spend respectively 80 % and 75 % of their remaining life expectancy between 55 and 85 disability-free.
Conclusions:
Smoking and obesity have independent negative impacts on both the survival and disability of the US older population in the coming decades, and are responsible for the present and future gender disparity in mortality and morbidity. Overall, the US older population is expected to enjoy sustained health improvements and compression of disability, largely due to decline in smoking.
... These data provide the main source of estimates of hazard size in this analysis and are summarized in the relevant following sections. Some further insight into causality from selected crosssectional and prospective studies is summarized in Figure 8.7, which The relationship between BMI, high blood pressure (systolic pressure ≥160 mmHg) and concentrations of blood lipid in men aged 40-59 years in the United Kingdom Source: Adapted from Shaper et al. (1997). shows a progressive rise in total cholesterol with increasing BMI, from a BMI of 20 kg/m 2 , and a sustained fall in HDL from BMI 20-30 kg/m 2 ). ...
None included but actual publication was :
C218. James WPT, Jackson-Leach R, Ni Mhurchu C, Kalmara E, Shayeghi M, Rigby NJ, Nishida C, Rodgers A. Overweight and obesity (high body mass index). In: (Eds. Ezzati M, Lopez AD, Rodgers A, Murray CJL). Comparative Quantification of Health Risks. Global and Regional Burden of Disease Attributable to Selected Major Risk Factors, Chapter 8, Volume 1. World Health Organization, Geneva, 2004
... Increased adiposity in middle age and later life is an important risk factor for type 2 diabetes and cardiovascular disease, especially coronary heart disease (CHD). [1][2][3][4][5] There has been a worldwide increase in the prevalences of overweight and obesity in recent decades, particularly in higher income countries. [6][7][8] However, overweight and obesity are increasingly affecting younger as well as older people. ...
Objectives Adiposity in middle age is an established risk factor for cardiovascular disease and type 2 diabetes; less is known about the impact of adiposity from early adult life. We examined the effects of high body mass index (BMI) in early and middle adulthood on myocardial infarction (MI), stroke and diabetes risks.
Design A prospective cohort study.
Participants 7735 men with BMI measured in middle age (40–59 years) and BMI ascertained at 21 years from military records or participant recall.
Primary and secondary outcome measures 30-year follow-up data for type 2 diabetes, MI and stroke incidence; Cox proportional hazards models were used to examine the effect of BMI at both ages on these outcomes, adjusted for age and smoking status.
Results Among 4846 (63%) men (with complete data), a 1 kg/m2 higher BMI at 21 years was associated with a 6% (95% CI 4% to 9%) higher type 2 diabetes risk, compared with a 21% (95% CI 18% to 24%) higher diabetes risk for a 1 kg/m2 higher BMI in middle age (hazard ratio (HR) 1.21, 95% CI 1.18 to 1.24). Higher BMI in middle age was associated with a 6% (95% CI 4% to 8%) increase in MI and a 4% (95% CI 1% to 7%) increase in stroke; BMI at 21 years showed no associations with MI or stroke risk.
Conclusions Higher BMI at 21 years of age is associated with later diabetes incidence but not MI or stroke, while higher BMI in middle age is strongly associated with all outcomes. Early obesity prevention may reduce later type 2 diabetes risk, more than MI and stroke.
... experienced the lowest total mortality. 18 In other words, despite distinct dietary and lifestyle patterns and body build between [40][41][42][43] Chinese and Occidental men, both populations show increased risk of death over the same range of low and high BMI. ...
Background The relationship between relative body weight and mortality has been well studied in Western populations and remains controversial. Little is known about the weight-mortality association in less well fed people in developing countries. Methods A cohort of 18 244 Chinese men aged 45-64 years in Shanghai, China enrolled in a prospective study of diet and cancer during January 1986 through September 1989. At recruitment, height and usual body weight were collected through interview. An active, annual follow-up of the cohort was conducted for cancer and death. Proportional hazards regression method was used to examine the relation between body mass index (BMI, weight in kg/height in m 2 ) and overall and cause-specific mortality. Results By 28 February 1995, 1198 deaths (498 from cancer, 422 from cardio- and cerebrovascular disease, and 278 from other causes) had been identified. We found a U-shaped relation between BMI and total mortality among lifelong non-smokers. Compared with non-smokers with BMI 21.0-<23.5, the relative risk (RR) for all cause mortality was 1.73 (95% confidence interval [CI]: 1.23-2.42) for men with BMI <18.5 and 1.48 (95% CI: 1.07-2.03) for men with BMI ≥26 after adjustment for age, level of education, and alcohol drinking. The elevated risk of death in men with BMI ≥26 was largely due to fatal cardio- and cerebro-vascular diseases. There was a nearly twofold excess risk of death from cardio- and cerebro-vascular diseases among lifelong non-smokers with BMI ≥26 compared with non-smokers with BMI 21-<23.5 (95% CI: 1.17-3.22). On the other hand, the increased overall mortality risk in men with BMI <18.5 was primarily due to causes of an infectious origin. Exclusion of the first 4 years of follow-up data did not materially alter the BMI-mortality associations. conclusion Underweight and overweight both are associated with an increased risk of death in middle-aged Chinese men who never smoked cigarettes. The increased total mortality in overweight men is largely due to cardio- and cerebro-vascular diseases while the elevated risk of death in underweight men is attributed primarily to causes of an infectious nature.
This chapter discusses the long‐term prevention of recurrent vascular events among patients with a prior ischemic stroke, transient ischemic attack (TIA), or intracerebral hemorrhage. Patients with stroke and TIA are not only at high risk of recurrent stroke, but also of myocardial infarction, lower limb ischemia, and psychiatric and cognitive impairment due to vascular disease of the brain. The chapter discusses the evidence for using various interventions for people with no prior history of stroke or TIA, and sometimes for those with no history of vascular disease at all. It considers what is known about vascular events and death, both early on and in the long term after intracerebral hemorrhage. Carotid endarterectomy is associated with a wide variety of potential complications other than stroke. There are a large number of case series with very different reported surgical stroke risks for the same reasons as in symptomatic carotid stenosis.
The purpose of this thesis is to study the morphological changes of top athletes and identify structural links between performance and anthropometric characteristics.
This thesis is comprised of various studies that analyze the highest level of performance by morphological aspect and different levels of proof. At first, we show differentiated changes between high level athletes and individuals in the general population (Studies 1 and 2), presupposing that athletes draw benefits from their anthropometric characteristics. Then we highlight the direct links between anthropometric characteristics and performance in track and field athletes and rugby players (studies 2 and 5): rugby teams with heavier forwards and taller backs are more successful than others. In track and field, calculated allometric coefficients show the impact of mass depending on the distance of the race and sex, suggesting a possible anthropometric progression margin for female athletes. The third level of supporting evidence, highlights the existence of couples [optimal morphologies - optimal performance], biometric attractors beneficial in scoring in basketball (Study 3), and BMI optimum with performance intervals in race distance (studies 4, 5 and 6). Mass, height and BMI are relevant indicators used to specify athletes between different events (morphological gradients in track and field following the spectrum of distances, like energy gradients) but also according to their level (inverse gradient between mass and height according to middle and long distances and sprints). These three indicators also reveal morphological differentiation depending on the specific position. Comparing the two, changes in mass and height show asynchronous growth indicative of atypicity. Independent from BMI’s primary function of measuring body size and obesity, it should be refined as a useful indicator of high level performance. Indeed, it reveals trade-offs between power, energy capacity and organization of efficient body structure for high level athletes. In athletic performance, the whole body is in action, and mass, height and BMI take into account the entire athlete who moves. The findings of this thesis will assist in making conclusions and new ways to understand performance and will assist to generate the development of experimental protocols. Physiques are the expression of the performance as well as the organization from which it is realized. The results of this thesis, based on the analysis of consistent databases, provide a new vision on morphological optimizations. For the purpose of performance, it is necessary to know the optimizations established in order to situate athletes in their morphological fields, but also enable them to move towards better anthropometric adaptation specific to their activities.
98. Фитотерапия и липидный обмен при конституционально-экзогенном ожирении у детей школьного возраста / А.А. Гаджиев, В.В. Мугараб-Самеди, И.И. Исаев и др. // Педиатрия. 1993. - № 3. - С. 29 - 32.
Научная библиотека диссертаций и авторефератов disserCat http://www.dissercat.com/content/kliniko-paraklinicheskaya-kharakteristika-nozologicheskikh-form-ozhireniya-u-detei#ixzz4vShCnOIm
General approach to preventing recurrent stroke and other serious vascular eventsPrognosis and prediction of future vascular eventsPharmacological blood pressure reductionPharmacological cholesterol reductionAntiplatelet drugsAnticoagulantsLifestyle modificationDietary supplements: B vitamins and antioxidantsManagement of diabetes mellitus and glucose intoleranceTreatment of specific underlying causesEndarterectomy for symptomatic carotid stenosisEndarterectomy for asymptomatic carotid stenosisCarotid angioplasty and stentingCarotid endarterectomy before, during or after coronary artery surgery?Extra-to-intracranial bypass surgerySurgery and angioplasty for vertebrobasilar ischaemiaOther surgical proceduresPutting secondary prevention into practice
IntroductionWhat to expectAtheroma and large vessel diseaseIntracranial small vessel diseaseEmbolism from the heartRisk factors for ischaemic strokeFrom symptoms, signs and clinical syndrome to causeInvestigationIdentifying the three most common causes of ischaemic stroke and transient ischaemic attack
Obesity contributes to the development of cardiac disease in several ways. It is both an independent risk factor for cardiovascular disease and a facilitative risk factor for coronary artery disease and its complications through its association with a variety of other traditional and nontraditional risk factors. Central obesity is a key component of the metabolic syndrome. There is substantial epidemiologic evidence of an association between overweight and obesity and coronary heart disease. Evidence of an association based on autopsy and coronary angiography is less convincing. An increasing body of evidence supports the existence of an obesity paradox with respect to mortality in patients with coronary heart disease once it is established. Whether purposeful weight loss improves cardiovascular outcomes in overweight or obese patients is uncertain. Obesity is also a risk factor for the development of heart failure and may serve as the sole or predominant cause in individuals who are severely obese. Obesity produces alterations in cardiac hemodynamics and cardiac morphology that may predispose to left ventricular diastolic and less commonly systolic dysfunction. Prolonged exposure to these conditions and the presence of comorbidities such as hypertension, sleep apnea, and obesity hyperventilation predispose to heart failure. Purposeful weight loss is capable of reversing most of the abnormalities of cardiac structure and function associated with obesity. To an even greater extent than with coronary artery disease, an obesity paradox exists with respect to heart failure such that the risk of mortality is lower in overweight and mildly obese persons than in underweight or normal weight individuals.
Objective
Development of these guidelines is mandated by the American Association of Clinical Endocrinologists (AACE) Board of Directors and the American College of Endocrinology (ACE) Board of Trustees and adheres to published AACE protocols for the standardized production of clinical practice guidelines (CPGs).
Methods
Recommendations are based on diligent review of clinical evidence with transparent incorporation of subjective factors.
Results
There are 9 broad clinical questions with 123 recommendation numbers that include 160 specific statements (85 [53.1%] strong [Grade A]; 48 [30.0%] intermediate [Grade B], and 11 [6.9%] weak [Grade C], with 16 [10.0%] based on expert opinion [Grade D]) that build a comprehensive medical care plan for obesity. There were 133 (83.1%) statements based on strong (best evidence level [BEL] 1 = 79 [49.4%]) or intermediate (BEL 2 = 54 [33.7%]) levels of scientific substantiation. There were 34 (23.6%) evidence-based recommendation grades (Grades A-C = 144) that were adjusted based on subjective factors. Among the 1,790 reference citations used in this CPG, 524 (29.3%) were based on strong (evidence level [EL] 1), 605 (33.8%) were based on intermediate (EL 2), and 308 (17.2%) were based on weak (EL 3) scientific studies, with 353 (19.7%) based on reviews and opinions (EL 4).
Conclusion
The final recommendations recognize that obesity is a complex, adiposity-based chronic disease, where management targets both weight-related complications and adiposity to improve overall health and quality of life. The detailed evidence-based recommendations allow for nuanced clinical decision-making that addresses real-world medical care of patients with obesity, including screening, diagnosis, evaluation, selection of therapy, treatment goals, and individualization of care. The goal is to facilitate high-quality care of patients with obesity and provide a rational, scientific approach to management that optimizes health outcomes and safety. (Endocr Pract. 2016;22:Supp3;1-205)
The World Health Organization defines overweight and obesity as an abnormal or excessive fat accumulation that impairs health. However, there are no well established cut-offs to define obesity based on body fat. The NIH, WHO, the American Association of Clinical Endocrinologist, and the American College of Endocrinology define obesity as an excess of total body fat, specifically body fat that is 20–25% of total body weight in men, and 30–35% in women. But there are not enough data supporting these cut-offs as predictors of adverse outcomes. Furthermore, because direct body fat is difficult to measure, more widely available and easier to perform anthropometric measurements are used in clinical practice. Body mass index is the most commonly used and accepted anthropometric measure to define obesity. It is a well known conditional risk factor for the development of several cardiovascular risk factors, such as diabetes mellitus type 2, metabolic syndrome, systemic hypertension, dyslipidemia, obstructive sleep apnea, etc. However, recently scientists have questioned its usefulness as slightly increased body mass index (overweight and mild obesity range) has been related to improved survival and fewer cardiovascular events when compared to subjects with a normal body mass index, a phenomenon known as the “obesity paradox”. Anthropometric measures of obesity that take into consideration body fat distribution, mainly truncal and/or abdominal obesity, such as waist circumference and specially waist-to-hip ratio appear to better predict cardiovascular risk than BMI alone, but this remains to be proven. Interestingly, despite body fat being the gold standard to define obesity, very little is known regarding its impact as a predictor of all-cause and cardiovascular mortality. The following chapter will analyze the different anthropometric measurements including body fat and lean mass and their impact on mortality with a focus on cardiovascular mortality, the leading cause of death worldwide.
Obesity is a complex, multifactorial, chronic disease involving environmental (social and cultural), genetic, physiologic, metabolic, behavioral, and psychological components. It has been increasing at an alarming rate throughout the world over the past two decades to the extent that it is now a pandemic, affecting millions of people globally, and it is the second leading cause of preventable death in the United States. The World Health Organization (WHO) has estimated that more than 300 million people are obese worldwide [1].
The global increase in cardiovascular disease (CVD) during the 20 th century is partially explained by an increasing proportion of older adults in the population, but also by changes in work conditions, transport, diet, and social networks, all of which have a direct impact on risk factors for CVD. Although the mortality rate is falling markedly in some European countries, it is increasing in others and CVD is expected to remain the leading cause of premature death in Europe in the coming decades....
Obesity contributes to the development of cardiac disease in several ways. It is both an independent risk factor for cardiovascular disease and a facilitative risk factor for coronary artery disease and its complications through its association with a variety of other traditional and nontraditional risk factors. Central obesity is a key component of the metabolic syndrome. There is substantial epidemiologic evidence of an association between overweightness and obesity and coronary heart disease. Evidence of an association based on autopsy and coronary angiography is less convincing. An increasing body of evidence supports the existence of an obesity paradox with respect to mortality in patients with coronary heart disease once it is established. Whether purposeful weight loss improves cardiovascular outcomes in overweight or obese patients is uncertain. Obesity is also a risk factor for the development of heart failure and may serve as the sole or predominant cause in individuals who are severely obese. Obesity produces alterations in cardiac hemodynamics and cardiac morphology that may predispose to left ventricular diastolic and less commonly systolic dysfunction. Prolonged exposure to these conditions and the presence of comorbidities such as hypertension, sleep apnea, and obesity hyperventilation predispose to heart failure. Purposeful weight loss is capable of reversing most of the abnormalities of cardiac structure and function associated with obesity. To an even greater extent than with coronary artery disease, an obesity paradox exists with respect to heart failure such that the risk of mortality is lower in overweight and mildly obese persons than in underweight or normal weight individuals.
Background: Obesity and stroke are two major public health problems all over the world, obesity and in particular abdominal obesity plays a major role in the pathogenesis of several metabolic, cardiovascular and cerebrovascular medical disorders. Obesity is one of the most important risk factors of stroke so maintaining healthy body mass index "BMI" and abdominal fat distribution have a role for prevention. The goal of stroke imaging evaluation is to establish early diagnosis thus guiding the appropriate therapy. The aim of this study was to evaluate the relation between obesity and ischemic stroke using Multislice CT techniques (CT brain perfusion, CT angiography and CT abdomen). Methods: This cross-sectional study involved 120 Egyptian persons. Subjects were divided into cases group (n=60) and control group (n=60). CT brain perfusion or CT angiography and abdominal fat distribution were measured by 16 Multislice CT scans. Anthropometric measurements were taken for all subjects. Results: The cerebral blood flow % was correlated to the total abdominal fat, visceral abdominal fat, BMI, waist and hip circumferences and they showed linear inverse proportion relation. Moreover cerebral blood volume% showed the same linear inverse proportion with visceral fat area, BMI and hip circumference only. Conclusion: The study concludes that the cerebral blood flow% is the most important parameter of CT brain perfusion for early detection of brain ischemia; also abdominal visceral fat could be used as a predictor factor for stroke.
Coronary heart disease is the leading cause of death worldwide affecting millions of people in both developed and developing countries. The dual aims of this book are to review the well-established and emerging risk factors in coronary heart disease (CHD) and to apply this knowledge to public health approaches to disease prevention. The book includes authoritative accounts of studies within a single population and international studies, important areas of methodological development, trials to test preventive strategies, and the application of epidemiological and other knowledge to the development of public health policy for the prevention of widespread disease. It is an all-encompassing work containing contributions from the world authorities in the field. The book is divided into four sections. The introduction reviews advances in the understanding of, and the current status, of risk factors for CHD. Section Two looks at recent global trends and emerging patterns of CHD morbidity and mortality in several countries, and includes chapters on work done under the auspices of the World Health Organisation (WHO) on the global burden of disease in relation to smoking and blood pressure. Section Three focuses on advances in understanding the aetiology of CHD with each chapter focused on a particular risk factor. Section Four explores measures of prevention and intervention in terms of public health policy with specific examples from around the world.
The prevalence of obesity has increased dramatically in recent years. Obesity, or excess body fat, is usually operationally defined in terms of body mass index (BMI), calculated by dividing an individual’s weight in kilograms (kg) by the square of height in meters (m). The World Health Organization (WHO) and the U.S. National Institutes of Health (NIH) define overweight as a BMI of 25 to 29.9 kg/m2 and obesity as a BMI of 30 kg/m2 or greater. By this definition, nearly two in three U.S. adults (64.5%) are overweight or obese (1). Although the percentage of adults classified as overweight but not obese has been stable since the 1960s, the prevalence of obesity doubled between 1980 and 2000, rising from 14.5% to 30.5%, and that of severe obesity (i.e., BMI ≥40 kg/m2) more than tripled, increasing from 1.3% to 4.7% during this period (1,2). The proportion of U.S. children and adolescents who are overweight is also increasing. In 2000, the prevalence of overweight among those aged 2 to 5 years, 6 to 11 years, and 12 to 19 years was 10.4%, 15.3%, and 15.5%, respectively, as compared with 7.2%, 11.3%, and 10.5% in 1994 (3). Similar trends are occurring in many developed and developing countries. Worldwide, an estimated 135 million people were obese in 1995; that number is projected to jump to 300 million by 2025 (4).
The concentrations of serum total cholesterol, high density lipoprotein-cholesterol, and triglycerides have been measured in 7735 men aged 40 to 59 years who were drawn from general practices in 24 towns in England, Wales, and Scotland. The distribution of these blood lipids, their interrelations and their association with age, social class, body mass index, cigarette smoking, alcohol intake, and physical activity at work have been examined. Body mass index emerges as the factor most strongly associated with these three blood lipids. Serum total cholesterol increased with increasing body mass index until about 28 kg/m2 but thereafter showed no further rise. The relation between body mass index and high density lipoprotein-cholesterol was negative and linear; that between body mass index and triglycerides was positive and linear. The inverse relation between high density lipoprotein-cholesterol and triglycerides was independent of the fact that both were related to body mass index. Alcohol intake was associated with increased high density lipoprotein-cholesterol concentrations and cigarette smoking with lowered high density lipoprotein concentrations; the association with alcohol appeared to be dominant. No significant trends with age were observed for the three blood lipids. In this population, body mass index is closely associated with the concentration of blood lipids but its effects are probably indirect and mediated by a complex of dietary and other factors.
To determine the risk factors for noninsulin dependent diabetes in a cohort representative of middle aged British men.
Prospective study.
7735 men aged 40-59, drawn from one group practice in each of 24 towns in Britain. Known and probable cases of diabetes at screening (n = 158) were excluded.
Non-insulin dependent diabetes (doctor diagnosed) over a mean follow up period of 12.8 years.
There were 194 new cases of non-insulin dependent diabetes. Body mass index was the dominant risk factor for diabetes, with an age adjusted relative risk (upper fifth to lower fifth) of 11.6; 95% confidence interval 5.4 to 16.8. Men engaged in moderate levels of physical activity had a substantially reduced risk of diabetes, relative to the physically inactive men, after adjustment for age and body mass index (0.4; 0.2 to 0.7), an association which persisted in full multivariate analysis. A nonlinear relation between alcohol intake and diabetes was observed, with the lowest risk among moderate drinkers (16-42 units/week) relative to the baseline group of occasional drinkers (0.6; 0.4 to 1.0). Additional significant predictors of diabetes in multivariate analysis included serum triglyceride concentration, high density lipoprotein cholesterol concentration (inverse association), heart rate, uric acid concentration, and prevalent coronary heart disease.
These findings emphasise the interrelations between risk factors for non-insulin dependent diabetes and coronary heart disease and the potential value of an integrated approach to the prevention of these conditions based on the prevention of obesity and the promotion of physical activity.
To assess the relationship between haematocrit and risk of major ischaemic heart disease events.
Prospective study of a cohort of men followed up for 9.5 years.
General practices in 24 towns in England, Wales, and Scotland (British Regional Heart Study).
Altogether 7735 men aged 40-59 years at screening, who were selected at random from one general practice in each of 24 towns, were studied.
Fatal and nonfatal ischaemic heart disease events.
Risk of major ischaemic heart disease events was significantly increased at haematocrit levels of > or = 46.0%. Men with raised haematocrit (> or = 46.0%) showed a 30% increase in relative risk (RR) of major ischaemic heart disease events (RR = 1.32; 95% confidence intervals (CI) 1.10,1.57, p < 0.01) compared with those with values below 46.0%, even after adjustment for age, social class, smoking, body mass index, physical activity, blood cholesterol, lung function (FEV1), and pre-existing evidence of ischaemic heart disease. Further adjustment for systolic blood pressure reduced the risk slightly (RR = 1.27; 95% CI 1.06,1.51, p = 0.02) but it remained significant. The relationship was seen in men with and without pre-existing evidence of ischaemic heart disease. The study suggests that an increased haematocrit level plays a part in the development of major ischaemic heart disease events.
Earlier studies have not resolved the question of whether elevated circulating insulin levels are independently related to the development of coronary heart disease. Previous studies have not used a specific insulin assay and in all but a minority of studies that have addressed this issue it has not been possible to adjust for possible confounding due to high density lipoprotein (HDL) cholesterol. The authors examined the relation between serum insulin concentration and major coronary disease events (fatal and non-fatal myocardial infarction) in the British Regional Heart Study. The data are based on 5,550 men (aged 40-59 years) in 18 towns whose baseline, non-fasting serum samples were analyzed for insulin using a specific enzyme-linked immunoadsorbent assay (ELISA) method. Known diabetics were excluded. At 11.5 years of follow-up, 521 major coronary disease events had occurred, 261 fatal and 260 non-fatal. A nonlinear relation between serum insulin and coronary disease events was observed with an almost twofold increased relative risk in the 10th decile of the serum insulin distribution (> or = 33.8 mU/liter) relative to the 1st to the 9th deciles combined (age-adjusted relative risk (RR) = 1.9, 95% confidence interval (CI) 1.6-2.4). There was some attenuation of this association on cumulative adjustment for a wide range of biologic and life-style coronary disease risk factors, including HDL cholesterol, though it remained significant in the fully adjusted proportional hazards model (RR = 1.6, 95% CI 1.1-2.3). Similar associations between insulin and coronary disease events were seen in men with and without evidence of coronary disease at screening and in men with baseline serum glucose below the 80th percentile. These data are consistent with the hypothesis that a high level of serum insulin (hyperinsulinemia) is atherogenic, with a threshold effect. However, the markedly nonlinear form of the association and the attenuation in multivariate analysis strongly suggest that elevated insulin levels may only be a marker for common etiologic factors in the development of both coronary disease and non-insulin-dependent diabetes mellitus.
The analysis of censored failure times is considered. It is assumed that on each individual are available values of one or more explanatory variables. The hazard function (age‐specific failure rate) is taken to be a function of the explanatory variables and unknown regression coefficients multiplied by an arbitrary and unknown function of time. A conditional likelihood is obtained, leading to inferences about the unknown regression coefficients. Some generalizations are outlined.
The authors considered whether the difference in body fat distribution between men and women, measured as waist:hip ratio, might explain part of the sex difference in coronary heart disease incidence in prospective population studies of 1,462 women and 792 men. In these studies, conducted in Sweden, men were found to have about four times higher odds for coronary heart disease than women during a 12-year follow-up period (men, 1967 to 1979; women, 1968-1969 to 1980-1981). Controlling for differences in blood pressure, serum cholesterol, smoking, and body mass index only marginally altered the magnitude of the male-female difference. When waist:hip ratio, which predicted coronary heart disease rates in both sexes, was also considered, the sex difference in coronary heart disease risk was significantly reduced and virtually disappeared (odds ratios = 1.0-1.1; nonsignificant). The findings suggest that body fat distribution or a factor highly correlated with waist:hip ratio (genetic, hormonal, or behavioral) may help to explain the sex differences in coronary heart disease.
The aim was to assess the interrelationship between alcohol intake, cigarette smoking, body weight, and blood lipid concentrations.
This was the cross sectional (screening) phase of a prospective study. The main outcome measure was the blood lipids (serum total cholesterol, HDL cholesterol, and triglycerides).
General practices in 24 towns (The British Regional Heart Study).
Subjects were 7735 men aged 40-59 years, selected at random from the age-sex registers of one group practice in each of the 24 towns.
Univariate analysis showed little association between alcohol intake and total cholesterol, a strong positive relation with HDL cholesterol, and a significant increase in triglycerides in heavy drinkers. A strong positive association between alcohol intake and body weight was present in non-smokers but not in moderate/heavy smokers. With the exception of HDL cholesterol, the relationships between alcohol intake and serum lipids were significantly different in smokers and non-smokers, apparently due to the opposing effect of smoking on blood lipids and body weight. Total cholesterol and triglycerides were significantly and positively associated with alcohol intake in non-smokers, the cholesterol association being largely mediated by the influence of alcohol on body weight. In smokers, no such association was seen: current smokers who were heavy drinkers or non-drinkers had the lowest mean cholesterol levels.
The association between alcohol intake and body weight and alcohol intake and blood lipids are strongly conditioned by cigarette smoking. Simple standardisation for smoking in multivariate analyses may obscure the independent relationship with alcohol. These findings are of importance in studies seeking to relate alcohol intake, body weight, or cigarette smoking to blood lipid concentrations, or blood lipid concentration to morbidity or mortality.
To assess the relation between reported physical activity and the risk of heart attacks in middle aged British men.
Prospective study of middle-aged men followed for a period of eight years (The British Regional Heart Study).
One general practice in each of 24 British towns.
7735 men aged 40-59 years at initial examination.
Heart attacks (non-fatal and fatal).
During the follow up period of eight years 488 men suffered at least one major heart attack. A physical activity score used was developed and validated against heart rate and lung function (FEV1) in men without evidence of ischaemic heart disease. Risk of heart attack decreased significantly with increasing physical activity; the groups reporting moderate and moderately vigorous activity experienced less than half the rate seen in inactive men. The benefits of physical activity were seen most consistently in men without preexisting ischaemic heart disease and up to levels of moderately vigorous activity. Vigorously active men had higher rates of heart attack than men with moderate or moderately vigorous activity. The relation between physical activity and the risk of heart attack seemed to be independent of other cardiovascular risk factors. Men with symptomatic ischaemic heart disease showed a reduction in the rate of heart attack at light or moderate levels of physical activity, beyond which the risk of heart attack increased. Men with asymptomatic ischaemic heart disease showed an increasing risk of heart attack with increasing levels of physical activity, but with a progressive decrease in case fatality. Overall, men who engaged in vigorous (sporting) activity of any frequency had significantly lower rates of heart attack than men who reported no sporting activity. However, when all men reporting regular sporting activity at least once a month were excluded from analysis, there remained a strong inverse relation between physical activity and the risk of heart attack in men without pre-existing ischaemic heart disease.
This study suggests that the overall level of physical activity is an important independent protective factor in ischaemic heart disease and that vigorous (sporting) exercise, although beneficial in its own right, is not essential in order to obtain such an effect.
The ideal body weight (kg) of each individual can be calculated by the following formula: ideal body mass index x the height (m)2, since body mass index is expressed by the body weight in kilogram divided by the height squared in meters. We investigated an ideal body mass index with respect to morbidity in 4565 Japanese men and women aged 30-59 years. Ten medical problems served as indices of morbidity: lung disease, heart disease, upper gastrointestinal disease, hypertension, renal disease, liver disease, hyperlipidemia, hyperuricemia, diabetes mellitus and anemia. The value of body mass index associated with the lowest morbidity was 22.2 kg/m2 in men and 21.9 kg/m2 in women, according to the quadratic regression curves relating body mass index to morbidity. From these findings, we propose that the ideal body weight is 22 x height (m)2. Our recommendations apply to the age group studied, namely 30-59 years.
To assess the relation between body mass index and mortality in middle aged British men.
Men who were recruited for the British Regional Heart Study were followed up for a mean of nine years.
General practices in 24 British towns.
7735 Men aged 40-59 years selected from the age-sex registers of one group practice in each of the 24 towns.
Mortality from cardiovascular and non-cardiovascular causes.
660 Of the men died. There was a U-shaped relation between body mass index and total mortality. Very lean men (less than 20 kg/m2) had by far the highest mortality followed by lean men (20-22 kg/m2) and obese men (greater than or equal to 28 kg/m2). The high mortality in lean and very lean men was due largely to non-cardiovascular causes, particularly lung cancer and respiratory disease, which are associated with cigarette smoking. In obese men deaths were more likely to be due to cardiovascular causes. There was a strong inverse association between body weight and cigarette smoking. When the pattern of mortality was examined by age, smoking habits, and pre-existing smoking related disease both very lean men and obese men consistently had an increased mortality. The U-shaped relation was most prominent in men in the oldest age group (55-59). Current smokers had a higher mortality than former smokers at virtually all values of body mass index. An increased mortality in lean men was seen only in current smokers and in men with smoking related disease. Among men who had never smoked, lean men had the lowest total mortality, thereafter mortality increased with increasing body mass index (p less than 0.01).
This study provides strong evidence of the impact of cigarette smoking on body weight and mortality and strongly suggests that the benefits of giving up smoking are far greater than the problems associated with the increase in weight that may occur.
Risk factors for major ischaemic heart disease (acute myocardial infarction or sudden death) have been investigated in a prospective study of 7735 men aged 40-59 years drawn from general practices in 24 British towns. After a mean follow-up of 4.2 years, there have been 202 cases of major ischaemic heart disease. Univariate estimates of the risk of ischaemic heart disease show that serum total cholesterol, HDL-cholesterol and triglyceride concentrations, systolic and diastolic blood pressures, cigarette smoking, and body mass index are all associated with increased risk of ischaemic heart disease. Evidence of ischaemic heart disease at initial examination is also strongly associated with increased risk of subsequent ischaemic heart disease. All these factors were then considered simultaneously using multiple logistic models. Definite myocardial infarction on electrocardiogram and recall of a doctor diagnosis of ischaemic heart disease remained predictive of subsequent major ischaemic heart disease, after allowance for all other risk factors. Serum total cholesterol, blood pressure, and cigarette smoking each remained as highly significant independent risk factors whereas overweight, above average levels of HDL-cholesterol and serum triglyceride were not predictive of risk after allowance for the above factors. Men with and without pre-existing ischaemic heart disease were examined separately in the same way (using multiple logistic models). The strength of association between the principal risk factors and subsequent major ischaemic heart disease was reduced in the men with pre-existing ischaemic heart disease, only age and serum total cholesterol remaining highly significant. Overall the levels of the major risk factors commonly encountered in British men have a marked effect on the risk of ischaemic heart disease. Modification of these risk factors in the general population constitutes an important national priority.
In prospective studies of ischaemic heart disease, data on the incidence of morbidity as well as mortality are critical to the understanding of the natural history of disease. In the Regional Heart Study, 7,735 middle-aged men recruited from general practices in 24 towns in England, Wales and Scotland have been examined, and are being followed for morbidity and mortality for at least five years. This paper explains the methods used and the difficulties encountered in maintaining the flow of information on these subjects and, in particular, discusses the problems of removal and tracing. A network of enquiries, using Family Practitioner Committees, the NHS Central Register and the additional 500 doctors (to date) to whom subjects have transferred, has enabled contact to be maintained. In the first seven towns reviewed at five years from the initial examination, replies have been received from 98 per cent of the original sample still alive and living in Great Britain.
The British Regional Heart Study seeks to define risk factors for cardiovascular disease, to examine their interrelationships, and to explain the geographic variations in cardiovascular disease in Britain. A clinical survey of men aged 40-59 in 24 British towns was carried out and preliminary data from the survey analysed. On a town basis cardiovascular mortality was associated with mean systolic blood pressure and the prevalence of heavy cigarette smoking and heavy alcohol consumption. No such association was seen for body mass index or mean serum total cholesterol or high-density-lipoprotein cholesterol concentration. Cigarette smoking and alcohol intake and, to a less degree, systolic blood pressure were related to the social class (percentage of manual workers) of a town, and these factors may determine to some extent the increased risk of cardiovascular disease in manual workers. Blood pressure in individual subjects was affected predominantly by age, body mass index, and alcohol intake. Body mass index appeared to affect blood pressure to a greater extent than alcohol intake and did so with a consistent and positive linear trend. Nevertheless, the differences between towns in mean blood pressure readings appeared to be more closely associated with variations in the prevalence of heavy drinking than with variations in body mass index. Alcohol intake and body mass index explained only a part of the striking differences between towns in mean blood pressure readings, and some important "town"factors remained unexplained.
A sign next to a finger pulse meter in a Kansas truck stop makes an interesting offer: if your resting pulse rate is less than 60 per minute, you will win a double bacon cheeseburger, home fries, and a bowl of gravy. The often conflicting information about nutrition, fitness, and weight control exemplified by this offer has confused and frustrated many Americans. Calorie intake has been increasing in the past 20 years, because of an increased intake of foods low in fat.1 Cholesterol levels are therefore dropping in the United States,2 but because levels of physical activity have changed little, . . .
The relation between body weight and overall mortality remains controversial despite considerable investigation.
We examined the association between body-mass index (defined as the weight in kilograms divided by the square of the height in meters) and both overall mortality and mortality from specific causes in a cohort of 115,195 U.S. women enrolled in the prospective Nurses' Health Study. These women were 30 to 55 years of age and free of known cardiovascular disease and cancer in 1976. During 16 years of follow-up, we documented 4726 deaths, of which 881 were from cardiovascular disease, 2586 from cancer, and 1259 from other causes.
In analyses adjusted only for age, we observed a J-shaped relation between body-mass index and overall mortality. When women who had never smoked were examined separately, no increase in risk was observed among the leaner women, and a more direct relation between weight and mortality emerged (P for trend < 0.001). In multivariate analyses of women who had never smoked and had recently had stable weight, in which the first four years of follow-up were excluded, the relative risks of death from all causes for increasing categories of body-mass index were as follows: body-mass index < 19.0 (the reference category), relative risk = 1.0; 19.0 to 21.9, relative risk = 1.2; 22.0 to 24.9, relative risk = 1.2; 25.0 to 26.9, relative risk = 1.3; 27.0 to 28.9, relative risk = 1.6; 29.0 to 31.9, relative risk = 2.1; and > or = 32.0, relative risk = 2.2 (P for trend < 0.001). Among women with a body-mass index of 32.0 or higher who had never smoked, the relative risk of death from cardiovascular disease was 4.1 (95 percent confidence interval, 2.1 to 7.7), and that of death from cancer was 2.1 (95 percent confidence interval, 1.4 to 3.2), as compared with the risk among women with a body-mass index below 19.0. A weight gain of 10 kg (22 lb) or more since the age of 18 was associated with increased mortality in middle adulthood.
Body weight and mortality from all causes were directly related among these middle-aged women. Lean women did not have excess mortality. The lowest mortality rate was observed among women who weighed at least 15 percent less than the U.S. average for women of similar age and among those whose weight had been stable since early adulthood.
Although 40% of US women indicate they are currently trying to lose weight, the association between intentional weight loss and longevity is unknown. The authors analyzed prospective data from 43,457 overweight, never-smoking US white women aged 40-64 years who in 1959-1960 completed a questionnaire that included questions on weight change direction, amount, time interval, and intentionality. Vital status was determined in 1972. Proportional hazards regression was used to estimate mortality rate ratios for women who intentionally lost weight compared with women who had no change in weight. Women who died within the first 3 years of follow-up were excluded. Analyses were stratified by preexisting illness and adjusted for age, beginning body mass index, alcohol intake, education, physical activity, and health conditions. In women with obesity-related health conditions (n = 15,069), intentional weight loss of any amount was associated with a 20% reduction in all-cause mortality, primarily due to a 40-50% reduction in mortality from obesity-related cancers; diabetes-associated mortality was also reduced by 30-40% in those who intentionally lost weight. In women with no preexisting illness (n = 28,388), intentional weight loss of > or = 20 lb (> or = 9.1 kg) that occurred within the previous year was associated with about a 25% reduction in all-cause, cardiovascular, and cancer mortality; however, loss of < 20 lb (< 9.1 kg) or loss that occurred over an interval of > or = 1 year was generally associated with small to modest increases in mortality. The association between intentional weight loss and longevity in middle-aged overweight women appears to depend on their health status. Intentional weight loss among women with obesity-related conditions is generally associated with decreased premature mortality, whereas among women with no preexisting illness, the association is equivocal.
To examine the relation between resting heart rate and new major ischaemic heart disease events in middle aged men with and without pre-existing ischaemic heart disease.
Prospective study of a cohort of men with eight years follow up for cardiovascular morbidity and mortality for all men.
General practices in 24 British towns (the British Regional Heart study).
7735 men aged 40-59 years drawn at random from the age-sex registers of one general practice in each town.
Major ischaemic heart disease events such as sudden cardiac death, other deaths attributed to ischaemic heart disease, and non-fatal myocardial infarction.
During the follow up period of eight years, 488 men had a major ischaemic heart disease event (217 fatal and 271 non-fatal). Of these, 117 were classified as sudden cardiac death (death within one hour of the start of symptoms). The relation between heart rate and risk of all major ischaemic heart disease events, ischaemic heart disease deaths, and sudden cardiac death was examined separately in men with and without pre-existing ischaemic heart disease. In men with no evidence of ischaemic heart disease, there was a strong positive association between resting heart rate and age adjusted rates of all major ischaemic heart disease events (fatal and non-fatal), ischaemic heart disease deaths, and sudden cardiac death. This association remained significant even after adjustment for age, systolic blood pressure, blood cholesterol, smoking, social class, heavy drinking, and physical activity, with particularly high risk in those with heart rate > or = 90 beats/min. The increased risk seen in those with increased heart rate was largely due to a significantly increased risk of sudden cardiac death, which was five times higher than in those with heart rate < 60 beats/min. The effect of heart rate on sudden cardiac death was present irrespective of blood pressure or smoking state. In men with pre-existing ischaemic heart disease a positive association was seen between raised heart rate and risk of all major ischaemic heart disease events, ischaemic heart disease death, and sudden cardiac death, but the effect was less noticeable than in men without pre-existing ischaemic heart disease.
In this study of middle aged British men increased heart rate > or = 90 beats/min) is a risk factor for fatal ischaemic heart disease events but particularly for sudden cardiac death. The effect is not dependent on the presence of other established coronary risk factors and is most clearly seen in men free of pre-existing ischaemic heart disease at initial examination.
Over the years ideal or desirable weights have been associated with the lowest mortality and defined in a number of ways. The widely used height-weight tables of the Metropolitan Life Insurance Company, developed in the 1940s, have been supplanted in the last decade by new weight standards based on findings of several population-based studies that compared body weight to mortality. The Quetelet or body mass index (BMI), now used as the de facto criterion for defining a desirable weight index, indicates relative fatness and is only minimally correlated with height. However, the optimal BMI or weight for longevity remains to be defined for a number of methodological reasons. This article reviews the strength of the evidence for increased mortality in adults who are overweight or underweight based on standard BMI ranges and in those who reported a change in body weight. Epidemiological studies show that excess body weight is associated with increased mortality, depending on fat patterning, gender, and age. A similar increase is shown for subjects with body weight below the relative weight range, although here associated life-style factors are greater contributors. Preliminary data suggest that change in body weight may also be associated with increased mortality. Overall, carefully measured weight and height remain the most easily performed and useful determinants of nutritional status and predictors of mortality for the general population.
Because we previously found that weight loss was associated with increased risk for death in all but very overweight men in a cohort of U.S. adults, we undertook a new analysis to determine whether inadequate control for preexisting illness or cigarette smoking contributed to this association.
Cohort study.
The first National Health and Nutrition Examination Survey (NHANES I, 1971 to 1975) collected information on maximum lifetime weight and measured current weight on a probability sample of U.S. adults. The NHANES I Epidemiologic Follow-up Study determined the vital status of participants through 1987.
Men (n = 2453) and women (n = 2739) who were 45 to 74 years old at the time of the NHANES I examination.
The effect of excluding persons who died within the first 5 and first 8 years after baseline was examined to limit the influence of weight loss due to preexisting illness. For women, extension of the exclusionary period weakened the association between weight loss and increased risk for death from noncardiovascular disease. However, excluding death for as much as 8 years after baseline did not affect the strong association between weight loss and increased risk for death from cardiovascular disease among men and women with maximum body mass indexes between 26 and 29 (relative risks of up to 2.1 and 3.6 for men and women, respectively, after excluding deaths in the first 8 years). Results were not substantially altered by limiting the analysis to persons who never smoked.
Preexisting illness may influence the association between weight loss and death principally through deaths from noncardiovascular disease. For some persons, weight loss is associated with an increased risk for death, even after excluding deaths occurring in the first 8 years.
Optimal body weight standards have most often been based on the relationship of relative weight to all cause mortality. This report proposes a strategy based on a more direct measure of adiposity, subscapular skinfolds and cardiovascular disease risk factors, rather than mortality. This approach provides a means for determining standards that are consistent with optimum cardiovascular health without the lengthy follow-up required for mortality studies. The report utilizes data on 2447 non-smoking men and women aged 20-59 years. Seven cardiovascular disease risk factors were significantly related to subscapular skinfold thickness in both sexes in an unfavourable direction. The optimal subscapular skinfolds based on these risk factors for 20-39 year olds were determined to be below 12 mm for men and 15 mm for women. Men and women who had subscapular skinfolds at or below the optimal level had a mean body mass index of 22.6 kg/m2 and 21.1 kg/m2 for men and women, respectively. The probability of being above the optimum adiposity rises rapidly across body mass index levels above 20 kg/m2 and plateaus at above 0.90 in both men and women with body mass index above 24 kg/m2. Thus, screening for above optimal adiposity is necessary only in individuals with body mass index at or below 24 kg/m2.
Both weight gain and weight loss have been associated with increased risk of cardiovascular disease mortality in recent studies from the US. This finding has led to concern and uncertainty about appropriate advice for overweight and obese subjects.
In a prospective study of cardiovascular disease, the relationship between weight change over a 5-year period and subsequent risk of a heart attack during a further 6.5 year follow-up was examined in 7100 middle-aged British men.
Over half of the men remained stable (< 4% change in bodyweight) and served as the reference group; 31% gained weight and 13% lost weight. The 6445 men free from a history of coronary heart disease experienced 318 heart attacks, fatal and non-fatal, during the 6.5 years. Men who gained 4-10% bodyweight had the lowest rate of heart attack, although this was not significantly different from the stable group. The men who lost weight had an increased risk of heart attack, which after adjustment (for age, recall of doctor-diagnosed hypertension and diabetes and other coronary risk factors i.e. serum total cholesterol, blood pressure, social class, initial body mass index (BMI) and lung function (FEV1), and smoking status at screening and 5 years later), was of a similar level of risk to the stable group. The men who gained > 10% bodyweight had a significantly increased risk of a heart attack after the above adjustment (P < 0.05). When the effect of weight change was examined according to initial BMI, those men with a BMI < 25 kg/m2 who lost weight had a marginally increased relative risk of heart attack after full adjustment (P = 0.06), while men who were overweight (BMI 25-27.9 kg/m2) or obese (BMI > or = 28 kg/m2) showed no benefit from weight loss. A small amount of weight gain (4-10%) in the overweight or obese men was associated with decreased risk, whereas considerable weight gain (> 10%) was associated with increased risk, both findings reaching statistical significance in the overweight men (P < 0.05 and P < 0.001 respectively).
Considerable weight gain (> 10%) in middle-aged men is associated with increased risk of a heart attack, but weight loss does not appear to reduce risk even in the overweight or obese.
Body weight is closely related to several known cardiovascular risk factors, but it may also have an independent effect on the risk of coronary heart disease (CHD). In this study, we analyzed the association between body mass index (BMI) and smoking, serum cholesterol, and blood pressure at baseline, as well as how BMI and the other risk factors are related to CHD mortality.
A total of 16 113 men and women aged 30 to 59 years were examined in eastern Finland in either 1972 or 1977. Serum cholesterol and blood pressure had a positive association and smoking had a negative association with BMI. During the 15-year prospective follow-up, mortality from CHD was positively associated with BMI. The BMI-associated risk ratio of CHD mortality, adjusted for age and study year, estimated from the Cox proportional hazards model was 1.04 (per kg/m2) (P < .001) among men. Inclusion of smoking in the model increased the risk ratio for BMI, whereas inclusion of serum cholesterol and blood pressure decreased it. In the model that included age, study year, and all three major cardiovascular risk factors, the BMI-associated risk ratio was 1.03 (P = .027). Among women, the BMI-associated risk ratio of CHD mortality adjusted for age and study year was 1.05 (P = .023) and the multifactorial adjusted risk ratio was 1.03 (P = .151).
Obesity is an independent risk factor for CHD mortality among men and also contributes to the risk of CHD among women. Part of the BMI-associated risk of CHD mortality is mediated through other known cardiovascular risk factors. By preventing overweight, a substantial part of CHD mortality may be prevented.
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18 American Health Foundation Roundtable on healthy weight
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