Disability Associated With Obesity,Dynapenia and Dynapenic-Obesity in Chinese Older Adults

ObjectivesWhether the combination of obesity and low muscle strength (dynapenic-obesity) would cause greater impairment of the activities of daily living (ADL)/instrumental activities of daily living (IADL) than obesity alone and low muscle strength alone (dynapenia) remains unclear. The aim of this study was to reveal the possible independent and additive effects of dynapenia and obesity on ADL/IADL disability in an older Chinese population.MethodsA cross-sectional study, including 616 community-dwelling older adults, was conducted in China from 2010 to 2012. Based on the World Health Organization Asian Criteria of Obesity and handgrip strength tertiles, 4 independent groups were identified as follows: nondynapenia/nonobesity, dynapenia alone, obesity alone, and dynapenic-obesity. The Katz Index of Independence in ADL was used to assess ADL disability, whereas 6 IADL items of the Older Americans Resources and Services (OARS) multidimensional functional assessment questionnaire were used to assess IADL disability.ResultsThe prevalence of ADL and IADL disability was 21.1% and 28.9% in the dynapenic-obesity group, 15.5% and 22.6% in the dynapenia alone group, 13.1% and 19.6% in the obesity alone group, and 11.9% and 12.9% in the nondynapenia/nonobesity group, respectively. After adjusting for the covariates, in comparison with the dynapenic-obesity group, the adjusted odds ratios (95% confidence interval) for ADL disability were 0.36 (0.13–0.73) in the nondynapenia/nonobesity group, 0.51 (0.20–0.78) in the dynapenia-alone group, and 0.40 (0.11–0.61) in the obesity-alone group. The corresponding data for IADL disability were 0.55 (0.20–0.93), 0.82 (0.39–0.98), and 0.61 (0.30–0.91), respectively.ConclusionDynapenia, obesity, and dynapenic-obesity were associated with an increased risk of ADL/IADL disability. Dynapenic-obesity was associated with a greater risk of ADL/IADL disability in comparison with dynapenia or obesity alone.     

Disparities in self-reported activities of daily living and instrumental activities of daily living disability among Asian American subgroups in the United States: results from the National Health Interview Survey 2001-2003

BackgroundThe purpose of this study was to compare disability and functional limitations among elderly Asian American subgroups using datasets from the National Health Interview Survey 2001−2003.MethodsThis retrospective cross-sectional study analyzed whether activities of daily living (ADL) and instrumental ADL (IADL) disabilities were different among Asian American subgroups in the United States using data retrieved from the 2001−2003 National Health Interview Survey. For comparing all Asian American subgroups, χ² analysis was applied for the bivariate comparisons.ResultsRates of 7.1% and 12.2% for ADL and IADL disability, respectively, within Asian American group were found. The elder Chinese subgroup accounted for the highest ADL and IADL disability (11.6% and 17.3%, respectively, p < .05). Being female, not married, and older was associated with higher ADL and IADL disability (p < .05).ConclusionsThe findings of the study highlight the intergroup variability among the elder Asian American subpopulations.     

Joint association of obesity and hypertension with disability in the elderly—A community-based study of residents in Shanghai,China

Background

Although both obesity and hypertension are known risk factors for disability, the joint association of obesity and hypertension with risk of disability is unknown. This paper is aim to examine the joint association of obesity and hypertension with risk of disability.

Methods

Cross-sectional study with 8060 elderly community-dwelling individuals participating in the survey initiated by Shanghai Health and Family Planning Commission from March to September 2013. Obesity was measured using the body mass index (BMI) in World Health Organization (WHO) Asia criteria. Hypertension, based on the doctor’s diagnosis, was obtained through face-to-face interview. Disability was measured using the self-reported physical self-maintenance scale (PSMS) and the instrumental activities of daily living (IADL) scale developed by Lawton and Brody.

Results

A total of 8.97% of participants reported ADL disability, and 15.18% for IADL disability. After adjusting social demographics and chronic conditions, the risk of ADL disability was progressively greater in obese persons with hypertension (OR=1.40, 95% CI=1.05-1.89), underweight persons without hypertension (OR=2.05, 95% CI=1.29-3.25), and underweight persons with hypertension (OR=2.14, 95% CI=1.36-3.36). For IADL disability, only underweight persons with hypertension were significantly associated (OR=1.65, 95% CI=1.23-2.21).

Conclusions

Low or extremely high BMI, independent of its metabolic consequences, is a risk factor for disability among the elderly. Simple hypertension wasn’t significantly associated with disability. In addition, having hypertension significantly increased the risk of ADL disability in obese individuals and IADL disability in underweight individuals.

     

Identifying characteristics and outcomes in youth with obesity and developmental disabilities

BackgroundYouth with developmental disability are at increased risk of obesity; literature focusing on the two is rare.ObjectiveTo identify characteristics and outcomes of youth presenting for obesity care having a disability as compared to without.MethodsA medical record review of youth aged 2–18 years initiating obesity care 2013–2015 at a tertiary care obesity management program. Youth were grouped by disability status to identify differences in presenting characteristics and factors associated with a reduction in body mass index (BMI) percent of the 95th BMI percentile (BMIp95) over 12 months. Logistic regression (LR) models examined associations with BMIp95 drop (<5-points versus ≥5-points) for each disability group.ResultsOf 887 subjects, 253 (28.5%) had a disability. At presentation, youth with disability were more often (p < 0.01) male (58.5% versus 47.9%), had birth weight <2500 g (14.1% versus 8.4%), had a father who was not obese (61.6% versus 47.4%), and were on weight influencing medications. Overall, 182 subjects (20.5%) completed 12-month follow-up. At follow-up, the with disability group (n = 63) had mean ?2.3 (SD 10.7) BMIp95 change (p = 0.679); youth having a motor disability less often had ≥5-point BMIp95 drop (odds ratio 0.15, 95% confidence interval 0.04–0.59). At follow-up, the no disability group (n = 119) had mean ?2.9 (SD 8.5) BMIp95 change; youth identified as having initial severe obesity status and not having a parent with diabetes more often had ≥5-point BMIp95 drop.ConclusionYouth with developmental disabilities were as successful in obesity care as those without disabilities. Predictors of success differed between the groups.     

Stroke and activity limitation in Chinese adults 65 Years or older

BackgroundDifferences in activity limitations between stroke survivors and people with other chronic conditions and how their levels of activity limitation vary by sociodemographic characteristics have not been well quantified.ObjectiveTo quantify activity limitations experienced by Chinese older adult stroke survivors and explore stroke effects in specific subgroups.MethodsWe used Chinese Longitudinal Healthy Longevity Survey 2017–2018 data (N = 11,743) to produce population-weighted estimates of activity limitations using the Activities of Daily Living (ADL) and the Instrumental ADL (IADL) scales for older adults (age 65 and older) stroke survivors compared to those with non-stroke chronic conditions and those without chronic conditions. Multinomial logistic regressions were run with outcomes “no activity limitation,” “IADL only limitation,” and “ADL limitation.”ResultsThe weighted marginal prevalence of ADL limitation was higher in the stroke group (14.8%) than in those with non-stroke chronic condition (4.8%) or no chronic conditions (3.6%) (p < 0.01). The corresponding prevalence of IADL limitation for the three groups was 36.0%, 31.4%, and 22.2%, respectively (p < 0.01). Stroke survivors aged ≥ 80 years had a higher prevalence of ADL/IADL limitation than those aged 65–79 years (p < 0.01). Formal education was associated with a lower prevalence of ADL/IADL limitation in each chronic condition group (p < 0.01).ConclusionsPrevalence and severity of activity limitation among Chinese older adult stroke survivors were several times higher than those without chronic conditions and those with non-stroke chronic conditions. Stroke survivors, particularly those aged ≥80 years and those without formal education, might be predisposed to more severe activity limitation and require more support to compensate.     

Prevalence and factors affecting underweight,overweight and obesity using Asian and World Health Organization cutoffs among adults in Nepal: Analysis of the Demographic and Health Survey 2016

ObjectiveThere is a little published data on prevalence and determinants of underweight, overweight and obesity among adults in Nepal. This study analysed the cross-sectional Nepal Demographic and Health Survey (NDHS) 2016 to obtain these using the World Health Organization (WHO) and Asian-specific cutoffs of body mass index (BMI).MethodsThe 2016 NDHS used a multistage cluster-sampling design to obtain data on major health indicators in Nepal. The BMI cutoffs for underweight was <18.5 kg/m². The BMI cutoffs for overweight/obesity as per the Asian and WHO classifications were ≥23, and ≥25 kg/m², respectively. After reporting the prevalence according to sex and background characteristics, multilevel logistic regression was conducted to estimate odds ratios.SubjectsThis analysis included 12,652 adults (5283 males and 7369 females) with a median age of 40 years (interquartile range [IQR]: 28–54).ResultsThe overall median BMI was 21.5 kg/m² (IQR:19.3–24.3). The overall prevalence of underweight was 16.7% (15.1% among males and 17.1% among females). The Asian-specific BMI cutoffs found the prevalence of overweight and obesity as 26.4% (27.4% among males and 25.6% among females) and 11.0% (7.7% among males and 13.3% among females), respectively. The WHO-recommended BMI cutoffs found 18.2% people overweight (16.7% among males and 19.3% among females) and 4.3% (2.5% among males and 5.6% among females) people obese. The prevalence and odds of extreme body weight categories (i.e., underweight, overweight and obesity) varied according to age, sex, education level, household wealth status, place, ecological zone and provinces of residence as per both recommended cutoffs. Overall, higher education level and wealth status were positively associated with overweight/obesity and inversely associated with underweight as per both cutoffs.ConclusionA large proportion Nepalese adults have either underweight, overweight or obesity, and could be at a greater risk of mortality and morbidity due to these extreme body weight categories. It is essential to address the factors or characteristics that are associated with the higher prevalence and likelihood of these extreme body weight categories to reduce the overall burden of underweight and overweight/obesity in Nepal.     

Elevated body mass index increases the risk of cardiovascular events in hypertensive patients accompanied with obstructive sleep apnea: A cohort study

BackgroundEffects of body mass index (BMI) on cardiovascular events are inconsistent. We aimed to investigate the association of BMI with cardiovascular events in hypertensives with obstructive sleep apnea (OSA).MethodsHypertensives with OSA diagnosed with polysomnography between 2011 and 2013 in UROSAH cohort were followed up till Jan 2021. Outcomes were non-fatal cardiovascular events and cardiac death. Cox regression was used to estimate the relationship of continuous and categorical BMI with total and specific outcomes. Sensitivity analyses were performed by excluding those on OSA treatment or underweight patients. Stratified analyses were conducted by parameters including sex and age.Results2239 hypertensives with OSA were included with 405 normal weight (BMI<25 kg/m²), 1164 overweight (25–29.9 kg/m²) and 670 obesity (≥30 kg/m²). 206 non-fatal cardiovascular events and 18 cardiac death were recorded during 6.6 years follow-up. Compared with normal weight group, overweight (HR=1.53, 95%CI: 1.01–2.32, P = 0.047) and obesity groups (1.85, 1.19–2.86, P = 0.006) showed increased risk for cardiovascular events, significant in obesity group and marginal in overweight group in fully-adjusted model. In specific events, obesity showed significantly elevated HR for non-fatal cardiovascular events (1.64, 1.04–2.60, P = 0.035). Continuous BMI showed significantly increased HR for total and specific events in all models. Sensitivity analysis yielded consistent results. In stratification analysis, stronger association between obesity and cardiovascular events was observed in the young (HR=5.97, P interaction=0.030).ConclusionsBMI is in positive association with cardiovascular events in hypertensives with OSA, emphasizing importance of maintaining healthy BMI for prevention of adverse events in this population, on the basis of guideline-recommended treatment.     

Impairments in Individual Autonomous Living Tasks and Time to Self-Care Disability in Middle-Aged and Older Adults

ObjectivesImpairments in specific tasks that are necessary for independent living may identify future self-care limitations, and the use of time-varying covariates can better capture the fluidity in functional capacity trajectories over time. The purpose of this study was to determine the associations between individual instrumental activities of daily living (IADL) impairments and time to activities of daily living (ADL) disability for middle-aged and older adults in the United States.DesignLongitudinal panel.SettingDetailed interviews that included physical, biological, and psychosocial measures were completed in person. The core interview was typically completed over the telephone.ParticipantsA nationally representative sample of 15,336 adults aged at least 50 years from the 2006 wave of the Health and Retirement Study was followed for 8 years.MeasuresAbility to perform IADL and ADL were self-reported at each wave. Separate covariate-adjusted Cox models were used to examine the time-varying associations between individual IADL impairments and time to ADL disability.ResultsThe presence of each IADL impairment was associated with a higher hazard ratio for an ADL disability for the following functions: 2.52 [95% confidence interval (CI) 2.35, 2.70] for grocery shopping, 1.91 (CI 1.77, 2.06) for preparing hot meals, 1.55 (CI 1.37, 1.76) for taking medications, 1.48 (CI 1.36, 1.61) for managing money, 1.41 (CI 1.27, 1.57) for using a telephone, and 1.38 (CI 1.29, 1.48) for using a map.Conclusions/ImplicationsOur findings provide insights into the disabling process by revealing how impairments in each IADL are differentially associated with time to ADL disability. Interventions aiming to retain function during aging should be informed by fluctuations in IADL performance and how specific IADL impairments may exacerbate functional capacity declines more so than others.     

BMI,weight change,and incidence of disability among Korean adults: A nationwide retrospective cohort study

BackgroundLittle is known about the risk of acquired disability diagnosed by a physician in relation to baseline BMI and weight change, particularly in the Asian population.ObjectiveThis study assessed the association of baseline BMI and weight change with incidence of disability.MethodsThis study included 331,900 individuals aged ≥40 years who participated in two health-screening programs since 2002 or 2003 and who were followed up until 2013. This study measured the baseline BMI and weight change for two years and estimated the adjusted hazard ratio (aHR) of the risk of acquired disability diagnosed by a physician using a Cox proportional hazards model.ResultsThis study identified 1758 incident disability cases during an average follow-up period of 10.7 ± 1.3 years from baseline (9.1 ± 1.4 years from the follow-up health screening). Baseline underweight (BMI<18.5 kg/m²) was associated with an increased risk of acquired disability compared with those with normal BMI (aHR, 1.44; 95% confidence interval [CI], 1.14–1.83). The risk of acquired disability was higher in individuals with weight loss of 5–10% (aHR, 1.21; 95% CI, 1.04–1.40), weight loss of ≥10% (aHR, 1.61; 95% CI, 1.27–2.04), weight gain of 5–10% (aHR, 1.30; 95% CI, 1.12–1.52), or weight gain of ≥10% (aHR, 1.35; 95% CI, 1.09–1.75) compared to those with weight change of <5%.ConclusionThis study demonstrated that baseline underweight and weight changes (both loss and gain) are associated with an increased risk of acquired disability.     

Prevalence of disability among adolescents and adults in rural China

BackgroundDisability affects health status and quality of life; however, insufficient research has been done in developing countries using internationally accepted measurements.ObjectiveWe investigated disabilities, sociodemographics, health indicators, and health behaviors using a sample of rural residents in northern China. We reported disability prevalence by age for our study sample and for a sample of rural residents who participated in the 1999-2002 Colorado Disability Survey.MethodsFace-to-face interviews were conducted in 2008, and complete questionnaires were obtained from 2199 individuals 15 years old or older. The definition of disability was conceptually based on the International Classification of Functioning, Disability and Health.ResultsOf those who completed the survey, 154 (7.0%) reported having disabilities. The prevalence was 2.3% for limitations in activities of daily living (ADL) and 3.1% for limitations in instrumental activities of daily living (IADL). Significant differences in the disability prevalence were found across the categories of education, age, and marital status. Among individuals with disabilities, 54.6% rated their health status as poor or very poor compared to 13.4% of people without a disability. A strong association was seen between disability status and injury. A large proportion (79.9%) of persons with disabilities, as well as 82.2% of persons without disabilities, reported paying for their medical expenses out-of-pocket. The age pattern of disabilities (ADL and IADL) was similar to that seen in a rural Colorado population.ConclusionsMany rural Chinese individuals with disabilities report poor general health and may face further limitations in their daily activities and social participation without accessible and affordable health care.     

Associations of perceived stigma,perceived environmental inaccessibility,and self-compassion among people with physical disability in Hong Kong

BackgroundPeople with physical disability are chronically stigmatized. They might internalize ableist attitudes and behaviors that they perceive from others, which can negatively affect social participation and well-being. It is essential to explore potential risk and protective factors associated with stigma perceptions.ObjectiveThe present study proposed and tested the positive associations of perceived environmental inaccessibility and self-coldness with perceived stigma, and the negative associations of self-warmth with perceived stigma, respectively, among people with physical disability in Hong Kong.MethodsA cross-sectional sample of 98 adults with physical disability (42.3% female, mean age = 36.4 years) from 10 nongovernmental organizations in Hong Kong participated in the study. They filled in a self-report questionnaire on perceived stigma, perceived environmental inaccessibility, self-compassion, basic activities of daily living (ADL), instrumental activities of daily living (IADL), and demographics.Main resultsHierarchical multiple regression showed that ADL and IADL alone (Model 1) did not significantly predict perceived stigma. The full model of ADL, IADL, perceived environmental inaccessibility, self-warmth, and self-coldness to predict perceived stigma (Model 2) was significant and explained 53.9% variance in perceived stigma. Perceived environmental inaccessibility and self-coldness were significantly and positively associated with perceived stigma, respectively. Self-warmth was significantly and negatively associated with perceived stigma.ConclusionsThe findings supported the important associations of both external contexts (i.e., as environmental inaccessibility) and internal resources (i.e., as self-compassion) with perceived stigma among people with physical disability. The findings inform future research and three-pronged design approaches to stigma reduction programs for people with physical disability.     

Obesity and symptoms and quality of life indicators of individuals with disabilities

BackgroundHealth risks of obesity are well known, but effects of obesity on health-related quality of life (HRQOL) have not been well-studied in people with physical disabilities.Objective/hypothesisWe examined the association between obesity and HRQOL in people with disabilities relative to the general US population. We hypothesized (a) overall, individuals with disabilities will report worse HRQOL than the general US population and (b) obese individuals with disabilities will report worse HRQOL than non-obese individuals.MethodsIndividuals with muscular dystrophy, multiple sclerosis, post-polio syndrome, and spinal cord injury (N = 1849) completed Patient Reported Outcomes Measurement Information System (PROMIS) measures of fatigue, pain interference, physical and social function, depression, sleep disturbance, and sleep-related impairment. Participants were classified as obese or non-obese based on self-reported weight and height (BMI) and/or waist circumference (WC). PROMIS T-scores were compared to norms and between obesity groups.ResultsMean BMI was 26.4 kg/m² with 23.4% classified as obese. Mean WC was 37.5 inches (males) and 34.0 inches (females); 26.4% reported abdominal obesity. Based on BMI and/or WC, 33.3% (n = 616) were classified obese. Compared to PROMIS norms, obese individuals reported worse HRQOL on all domains (p < 0.0001). Compared to non-obese individuals, obese individuals reported worse functioning on all domains except depression (p < 0.01). Obese individuals with MS and MD reported worse outcomes than non-obese counterparts.ConclusionsObesity in people with physical disabilities is associated with poorer HRQOL. More research is needed to inform clinicians in identifying obese patients and helping them achieve healthy weight, reduce symptom burden, and improve QOL.     

Lifestyle Risk Factors and Utilization of Preventive Services in Disabled Elderly Adults in the Community

Lifestyle risk factor counseling and preventive health services are important to disabled elderly adults to prevent adverse health outcomes. We aimed to examine the prevalence of lifestyle risk factors and utilization of preventive health services in community-dwelling 2,982 adults, aged 60 years or older, with or without disability, in Southeastern Pennsylvania in 2004. The severity of disability was classified as no [independent activities of daily living (ADL) and instrumental activities of daily living (IADL)], some (independent ADL, dependent IADL), and severe limitation (dependent ADL). The prevalence of lifestyle risk factors (cigarette smoking, obesity, binge alcohol use, unhealthy diet, and physical inactivity) and utilization rate of a comprehensive list of preventive health services (risk factor counseling, disease management, vaccination, and cancer screening) were measured, across the disability categories. The prevalence of disability was 14.6% for some limitation and 10.3% for severe limitation. As disability increases, participants with unhealthy diet, physical inactivity, and obesity became more prevalent (8.8, 15.7, and 25.2% for no, some, and severe limitation, respectively) and fewer osteoporosis screenings were performed (51.5, 38.8, and 37.8%). Utilization of other services did not vary significantly across the disability categories, but participants with some or severe limitation were less likely than those without to receive needed health services overall (19.3% or 16.2 vs. 24.2%; P for trend = .047). In conclusion, disabled elderly adults have more undesirable lifestyle risk factors, but are less likely to receive needed health services than nondisabled counterparts. More attention is needed to this vulnerable population.     

Safety and effectiveness data for emergency contraceptive pills among women with obesity: a systematic review

ObjectiveThis study aims to determine whether emergency contraceptive pills (ECPs) are less safe and effective for women with obesity compared with those without obesity.Study designWe searched PubMed for articles through November 2015 regarding the safety and effectiveness of ECPs [ulipristal acetate (UPA), levonorgestrel (LNG) and combined estrogen and progestin] among obese users. We assessed study quality using the United States Preventive Services Task Force evidence grading system.ResultsWe identified four pooled secondary analyses (quality: poor to fair), two of which examined UPA and three examined LNG formulations. Three analyses pooled overlapping data from a total of three primary studies and demonstrated significant associations between obesity and risk of pregnancy after ECP use. One analysis reported a 4-fold increased risk of pregnancy among women with obesity (BMI ≥ 30 kg/m²) compared with women within normal/underweight categories (BMI < 25 kg/m²) after use of LNG ECPs [odds ratio (OR) 4.4; 95% confidence interval (CI) 2.0–9.4]. Further analysis of the same LNG data found that, at an approximate weight of 80 kg, the rate of pregnancy rose above 6%, which is the estimated pregnancy probability without contraception; at weights less than 75 kg, the rate of pregnancy was less than 2%. Two analyses examining UPA suggested an approximate 2-fold increased risk of pregnancy among women with obesity compared with either normal/underweight women or nonobese (BMI < 30 kg/m²) women (OR 2.6; 95% CI 0.9–7.0 and OR 2.1; 95% CI 1.0–4.3, respectively), but CIs were wide. Finally, the fourth secondary analysis pooled data from three separate randomized controlled trials on LNG ECPs and found no increase in pregnancy risk with increasing weight or BMI and found no consistent association between pregnancy and both factors when adjusted for other covariates.ConclusionWhile data are limited and poor to fair quality, findings suggest that women with obesity experience an increased risk of pregnancy after use of LNG ECP compared with those normal/underweight. Women with obesity may also experience an increased risk of pregnancy compared with women without obesity after use of UPA ECP, though differences did not reach statistical significance. Providers should counsel all women at risk for unintended pregnancy, including those with obesity, about the effectiveness of the full range of emergency contraception options in order for them to understand their options, to receive advanced supplies of emergency contraception as needed and to understand how to access an emergency copper intrauterine device if desired.     

Cross-sectional changes in patterns of allostatic load among persons with varying disabilities,NHANES: 2001–2010

BackgroundAllostatic Load (AL) is a measure of physiological stress that correlates with morbidity and mortality.ObjectiveThe purpose of this study was to evaluate patterns of AL among persons with each of eight categories of disability versus persons with no disabilities over the 10-year Healthy People 2010 examination period.MethodsThe study examined measures of AL from the 2001–2010 National Health and Nutrition Examination Survey (NHANES). The independent variable was Disability Status (hearing, vision, memory, physical–mental–emotional, walking up 10 steps, bending or kneeling, lifting or carrying, assistive devices, no disability). Eight laboratory and one social AL dependent variables included blood pressure, body mass index (BMI), HDL cholesterol, number of friends, and neutrophil percentages. Weighted statistical analyses included one-way ANCOVA with age as the covariate and chi-square tests.ResultsAmong respondents, 2.3% had hearing disabilities; 14.0% vision disabilities, 4.6% memory disabilities; 1.5% physical, mental, emotional disabilities; 1.3%, 5.9%, and 3.5% various mobility disabilities; and 5.3% used assistive devices. Persons with disabilities had significantly higher BMI, lower HDL cholesterol, higher C-reactive protein, and higher neutrophil levels than persons without disabilities. Systolic and diastolic blood pressures decreased during the decade, but BMI increased. A range of 36.2–61.0% of persons with non-hearing disabilities exceeded BMI obesity thresholds during 2009, and 13.8–29.9% had fewer than three friends during 2009.ConclusionsThese findings support previous research linking risks for secondary conditions/morbidity and allostatic load while demonstrating associations between disabilities and AL, especially for persons with mobility disabilities.     

Racial differences in gestational weight gain and pregnancy-related hypertension

PurposeThe aim of the study was to examine racial differences in gestational weight gain (GWG) and pregnancy-related hypertension.MethodsLogistic regression models tested racial differences in adequacy of GWG and pregnancy-induced hypertension in all singleton live births from the South Carolina 2004–2006 birth certificates.ResultsCompared with white women, black and Hispanic women had 16%–46% lower odds of gaining weight above the recommendations. However, the odds of inadequate GWG was ∼50% higher in black and Hispanic women with a pregnancy body mass index (BMI) less than 25 kg/m². Furthermore, compared with women with adequate GWG, women with excessive GWG had higher odds of pregnancy-related hypertension (underweight: 2.35, 95% confidence interval [CI; 1.66, 3.32]; normal: 2.05, 95% CI [1.84, 2.27]; overweight: 1.93, 95% CI [1.64, 2.27]; obese: 1.46, 95% CI [1.30, 1.63]). Among women with a BMI less than 25 kg/m², black women had higher odds of pregnancy-related hypertension than white women (underweight: 1.64, 95% CI [1.14, 2.36]; normal weight: 1.28, 95% CI [1.15, 1.42]), whereas among women with a BMI less than 25 kg/m², Hispanic women had 40% lower odds.ConclusionsPrograms are needed to curb excessive GWG in all racial groups and to help some sub-groups ensure adequate GWG. Maternal obesity and GWG are two factors that should be used in combination to reduce racial differences in pregnancy-related hypertension.     

中老年人BMI与日常生活活动能力关联

  目的  探究中国中老年人BMI与工具性日常生活活动能力(instrumental activities of daily living, IADL)之间的关系。  方法  本研究基于中国健康与养老追踪调查(China health and retirement longitudinal study, CHARLS)2011-2015年的随访数据,剔除基线存在IADL失能者,最终纳入研究对象8 955名。采用二分类Logistic线性回归分析模型分析BMI与IADL失能发生风险的关联。  结果  经过4年的随访,2 186名(24.41%)研究对象发生IADL失能,其中男性和女性发生率分别为18.79%和29.89%。低体重、正常体重、超重及肥胖组的IADL失能发生率分别为42.64%、25.13%、19.85%和23.49%。与正常体重组相比,低体重、超重及肥胖组IADL失能发生风险的OR值分别为1.381(95% CI: 1.117~1.707, P=0.003)、0.830(95% CI: 0.727~0.948, P=0.006)和0.985(95% CI: 0.819~1.185, P=0.874)。  结论  与正常体重组相比,中老年人群中低体重与IADL失能的发生呈正向关联,而超重则与IADL失能呈负相关关系,肥胖与IADL失能之间不存在统计学意义。     

Association of Body Mass Index with Ischemic and Hemorrhagic Stroke

Data on the association between body mass index (BMI) and stroke are scarce. We aimed to examine the association between BMI and incident stroke (ischemic or hemorrhagic) and to clarify the relationship between underweight, overweight, and obesity and stroke risk stratified by sex. We analyzed the JMDC Claims Database between January 2005 and April 2020 including 2,740,778 healthy individuals (Median (interquartile) age, 45 (38–53) years; 56.2% men; median (interquartile) BMI, 22.3 (20.2–24.8) kg/m²). None of the participants had a history of cardiovascular disease. Each participant was categorized as underweight (BMI <18.5 kg/m²), normal weight (BMI 18.5–24.9 kg/m²), overweight (BMI 25.0–29.9 kg/m²), or obese (BMI ≥ 30 kg/m²). We investigated the association of BMI with incidence stroke in men and women using the Cox regression model. We used restricted cubic spline (RCS) functions to identify the association of BMI as a continuous parameter with incident stroke. The incidence (95% confidence interval) of total stroke, ischemic stroke, and hemorrhagic stroke was 32.5 (32.0–32.9), 28.1 (27.6–28.5), and 5.5 (5.3–5.7) per 10,000 person-years in men, whereas 25.7 (25.1–26.2), 22.5 (22.0–23.0), and 4.0 (3.8–4.2) per 10,000 person-years in women, respectively. Multivariable Cox regression analysis showed that overweight and obesity were associated with a higher incidence of total and ischemic stroke in both men and women. Underweight, overweight, and obesity were associated with a higher hemorrhagic stroke incidence in men, but not in women. Restricted cubic spline showed that the risk of ischemic stroke increased in a BMI dose-dependent manner in both men and women, whereas there was a U-shaped relationship between BMI and the hemorrhagic stroke risk in men. In conclusion, overweight and obesity were associated with a greater incidence of stroke and ischemic stroke in both men and women. Furthermore, underweight, overweight, and obesity were associated with a higher hemorrhagic stroke risk in men. Our results would help in the risk stratification of future stroke based on BMI.     

Association Between Plasma 25-hydroxyvitamin D Concentrations and Incident Activities of Daily Living Disability: A Longitudinal Community-Based Cohort Study

ObjectivesA few studies of Western populations have found inconsistent results regarding the associations between vitamin D status and physical function. We explored the association between circulating vitamin D status [plasma 25-hydroxyvitamin D, 25(OH)D] and incident activities of daily living (ADL) disability among Chinese older adults.DesignCommunity-based longitudinal cohort study.Setting and ParticipantsA total of 2453 men and women (median age 84.0 years) in 7 Chinese longevity areas were included.MeasuresCox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for incident ADL, with adjustments for potential sociodemographic, and lifestyle confounders and biomarkers. Because there was a statistically significant interaction between plasma 25(OH)D and sex in relation to incident ADL, men and women were analyzed separately.ResultsThe median concentrations of plasma 25(OH)D were 46.6 nmol/L and 36.4 nmol/L for men and women, respectively. Compared with the lowest quartile in the fully adjusted model, the HR for incident ADL disability for the highest quartile was 0.55 (95% CI 0.36–0.85) for women; for men, a null association was indicated (HR_{highest vs lowest} 0.61, 95% CI 0.37–1.00). However, when using the recommended circulating 25(OH)D thresholds by the US Institute of Medicine, those with vitamin D sufficiency (≥50 nmol/L) had better ADL disability prognoses than those with vitamin D deficiency (<30 nmol/L) in both sexes (men HR 0.45, 95% CI 0.28–0.72; women HR 0.58, 95% CI 0.37–0.90).Conclusions and ImplicationsThe relationship between plasma 25(OH)D concentration and incident ADL disability was sex-specific among Chinese older adults. However, participants with recommended vitamin D sufficiency may have better disability prognoses in both sexes, suggesting that the recommended 25(OH)D concentration for bone health may extend to functional outcomes such as ADL disability in Chinese older adults.     

Eating Competence Among Caregivers of Toddlers: Associations With Caregiver and Child Overweight/Obesity

ObjectiveTo examine the association between caregiver eating competence and child overweight/obesity and caregiver obesity.DesignLongitudinal cohort.SettingA large US children's hospital.ParticipantsCaregiver–child dyads (n = 288 with complete data at 2 time points) were sampled in 2017–2019 from those who received care at Nationwide Children's Hospital.Main Outcome Measure(s)Child overweight/obesity at 24 months of age (body mass index [BMI]) z-score >2 per World Health Organization standards and caregiver weight status (underweight/healthy [BMI < 25 kg/m²], overweight [BMI ≥ 25 and < 30 kg/m²], or obese [BMI ≥ 30 kg/m²]).AnalysisLog-binomial models examined the relationship between caregiver eating competence (ecSatter Inventory) at 18 months and child overweight/obesity at 24 months of age. Proportional odds models investigated the relationship between caregivers’ eating competence and weight status.ResultsEating competent caregivers had more than twice the odds (odds ratio, 2.11; 95% confidence interval, 1.30–3.42) of having a lower BMI category and had lower average BMI than noneating competent caregivers. Child overweight/obesity at 24 months did not differ by caregiver eating competence.Conclusions and ImplicationsAlthough child overweight/obesity did not vary by caregiver eating competence, caregiver eating competence was related to their weight status. Longer-term studies are needed to clarify the role of caregiver eating competence as children develop. Promoting caregivers’ eating competence may translate into healthier behaviors and skills for caregivers and their children long term.