Association of anthropometric measures with SF-36v2 PCS and MCS in a multi-ethnic Asian population

Purpose

Obesity adversely affects health-related quality of life (HRQoL). Most studies have used body mass index (BMI) to measure obesity. Other measures of obesity, such as waist circumference (WC) or waist-to-hip ratio (WHR), may be better predictors of cardiovascular disease and mortality. We, therefore, examined the associations between other anthropometric measures and HRQoL in a multi-ethnic Asian population.

Methods

In this follow-up study from four previous cross-sectional surveys, HRQoL was measured, at follow-up, using the Short-Form 36 version 2 (SF-36v2) questionnaire. Linear regression was used to assess the relationship between anthropometric measures [BMI, WC, waist residuals (WR) (generated by regressing WC on BMI), WHR, waist-to-height ratio (WHtR) and height (Ht)] and HRQoL. We compared the models’ R ², Akaike’s information criteria (AIC), and Schwarz Bayesian information criteria (BIC) from the different models.

Results

Among 4,981 subjects, 47.6 % were men aged 50.6 ± 12.2 and women aged 49.3 ± 11.6 years. All gender-specific anthropometric measures were significantly correlated with BMI, except WR. After adjusting for known determinants of HRQoL, we found significant associations between BMI, WC and WHtR with SF-36v2 Physical Component Summary (PCS) scores in women but not men. In contrast, after adjusting for known determinants of HRQoL, WR and WHR were significantly associated with SF-36v2 Mental Component Summary (MCS) scores in men, but not women. R², AIC and BIC were similar for all anthropometric measures in the final model.

Conclusions

The associations between measures of central obesity and HRQoL differed between men and women. In women, associations were seen with SF-36v2 PCS, but measures of central obesity did not have significant associations with HRQoL after controlling for BMI. In men, an association between WC and SF-36v2 MCS was statistically significant independent of BMI. These gender differences require further investigation.     

The effect of weight status, lifestyle, and body image perception on health-related quality of life in children: a quantile approach

Purpose

To evaluate the effect of excess weight, lifestyle factors, and body image on HRQoL in a sample of school-aged children.

Methods

Cross-sectional data of 4,338 thirteen-year-old children were collected in 2007 as part of the So.N.I.A project, a nutritional surveillance study in a northern Italian region. A two-stage sampling design was used in order to gain a Health District representative sample of the regional population. HRQoL was assessed using the EQ-5D-Y questionnaire completed by the children at school. The association between weight categories, defined by means of the International Obesity Task Force cut points, physical exercise, and body image perception and HRQoL as measured by the EQ-Visual Analogue Scale was studied by means of a quantile regression analysis.

Results

Of the participants, 891 (20.5 %) and 210 (4.84 %) were overweight and obese, respectively, with 1,922 (44.3 %) children exercising <2 h per week. Results from the quantile regression showed a decreased HRQoL for girls compared with boys, overweight or obese children who do little weekly exercise, and body image dissatisfaction, especially in the lower tail of the VAS distribution.

Conclusions

Excess weight, sedentary behavior, and an unsatisfactory self-perception are associated with reduced HRQoL in this population-based sample. Quantile regression can help to highlight differences in the effects along all of the outcome distribution.     

Health-related quality of life, obesity, and fitness in schoolchildren: the Cuenca study

Purpose

The purpose of this study was to analyze the association of weight status and physical fitness with health-related quality of life (HRQoL) and to examine the independent association of body mass index (BMI), cardiorespiratory fitness (CRF) and musculoskeletal fitness (MF) with HRQoL in schoolchildren.

Methods

Cross-sectional study of 1,158 schoolchildren, 8–11 years, from 20 schools in the Cuenca province, Spain. We measured weight, height, and physical fitness, measured by CRF (20-m shuttle run test) and MF index by summing the age–sex z scores of handgrip strength test/weight + standing broad jump test. Self-reported HRQoL was measured by KIDSCREEN-52 questionnaire.

Results

Normal weight boys scored better in physical well-being, mood and emotions, autonomy, and social support and peers dimensions than overweight/obese boys. The mean in self-perception dimensions was lower in obese girls compared to normal weight or overweight girls. Higher levels of CRF and MF were associated with better physical well-being in both genders. Multiple linear regression models showed that the influence of MF in boys and CRF in girls on HRQoL was greater than that of overweight.

Conclusions

This is one of the first studies that assess the association of CRF and MF with HRQoL while controlling for BMI. CRF and MF are closely related to HRQoL, in particular to physical well-being. Improving fitness could be a strategy of particular interest for improving the HRQoL of schoolchildren.     

Validity of two common asthma-specific quality of life questionnaires: Juniper mini asthma quality of life questionnaire and Sydney asthma quality of life questionnaire

Background

The aim of this study was to evaluate the association between experienced physical violence and health-related quality of life (HRQoL) by comparing self-reported health status for individuals with and without experience of physical violence. Our hypothesis was that individuals exposed to violence would experience worse HRQoL than non-exposed individuals. We tested whether men and women and different age groups experience similar reductions in HRQoL, and the extent to which such differences might be associated with social circumstances and lifestyle conditions. Finally, we explored the HRQoL consequences of exposure to violence in a longer time perspective.

Methods

We used data from self-completed questionnaires in two Danish nationally representative, cross-sectional health interview surveys. Exposure to violence was indicated through specific survey questions (Straus?? conflict tactics scale) enquiring about different types of violence during the last 12?months. Health status of respondents was elicited by the EQ-5D and SF-36 questionnaires. The health status profiles were converted to health score indexes using the Danish algorithm for EQ-5D and the revised Brazier algorithm for SF-6D. Differences in score indexes between the exposed and non-exposed individuals were explored separately for men and women using ordinary least square regression with four age categories as explanatory variables.

Results

In the 2000 and 2005 surveys, respectively, 4.9% and 5.7% of respondents indicated that they had been exposed to physical violence within the last 12?months. Exposure to violence was more prevalent in the younger age groups and more prevalent for men than women. Respondents exposed to violence had lower score indexes on both the EQ-5D and the SF-6D compared with the non-exposed. Respondents who reported exposure to violence in both 2000 and 2005 reported lower HRQoL than individuals who only reported exposure in one of the surveys.

Conclusions

The results of this study provide evidence for an association between exposure to physical violence and reduction in health-related quality of life.     

The impact of weight loss on health-related quality-of-life: implications for cost-effectiveness analyses

Purpose

To assess the impact of weight loss on health-related quality-of-life (HRQL), to describe the factors associated with improvements in HRQL after weight loss, and to assess the relationship between obesity as assessed by body mass index (BMI) and HRQL before and after weight loss.

Methods

We studied 188 obese patients with BMI ≥ 32 kg/m² with one or more comorbidities or ≥35 kg/m². All patients had baseline and follow-up assessments of BMI and HRQL using the EuroQol (EQ-5D) and its visual analog scale (VAS) before and after 6 months of medical weight loss that employed very low-calorie diets, physical activity, and intensive behavioral counseling.

Results

At baseline, age was 50 ± 8 years (mean ± SD), BMI was 40. 0 ± 5.0 kg/m², EQ-5D-derived health utility score was 0.85 ± 0.13, and VAS-reported quality-of-life was 0.67 ± 0.18. At 6-month follow-up, BMI decreased by 7.0 ± 3.2 kg/m², EQ-5D increased by 0.06 [interquartile range (IQR) 0.06–0.17], and VAS increased by 0.14 (IQR 0.04–0.23). In multivariate analyses, improvement in EQ-5D and VAS were associated with lower baseline BMI, greater reduction in BMI at follow-up, fewer baseline comorbidities, and lower baseline HRQL. For any given BMI category, EQ-5D and VAS tended to be higher at follow-up than at baseline.

Conclusion

Measured improvements in HRQL between baseline and follow-up were greater than predicted by the reduction in BMI at follow-up. If investigators use cross-sectional data to estimate changes in HRQL as a function of BMI, they will underestimate the improvement in HRQL associated with weight loss and underestimate the cost-utility of interventions for obesity treatment.     

The relationship between body mass index and health-related quality of life in urban disadvantaged children

Introduction

The study’s aim was to establish, for children living in urban disadvantage, the nature and extent of the relationship between body mass index (BMI) and health-related quality of life (HRQoL), including the role of individual and family factors in influencing this relationship.

Methods

Within the context of a longitudinal design, 255 children aged 7–12 years (50 % male) self-reported their HRQoL (Kidscreen-27) and had their height and weight measured at year one and two. One parent/guardian for each child was also assessed at year one with the OSLO Social Support Scale and Hospital Anxiety and Depression Scale. Regression analysis was also conducted.

Results

BMI was weakly inversely associated with ‘total HRQoL’ (r = ?.15, p < .05), ‘physical well-being’ and ‘autonomy and parent relations’. Significant differences were found between normal weight and obese children on all but the latter dimension. Neither weight group, however, fell below the average European HRQoL range. BMI predicted physical well-being a year later and vice versa, whilst autonomy and parent relations also predicted BMI a year later. In terms of ‘overweight’ children (38 %), those approaching adolescence had poorer physical and school well-being than younger children, and those whose parents had moderate-to-severe levels of depression fared worse on school well-being than children whose parents were not depressed.

Conclusion

The findings suggest that obesity programmes could aim to prevent/reduce obesity and optimise HRQoL in urban disadvantaged preadolescent children whilst also targeting parental mental health difficulties. Future research should examine mediators of the effect of BMI on HRQoL.     

Development of a patient reported outcome scale for fatigue in multiple sclerosis: The Neurological Fatigue Index (NFI-MS)

Background

The impact of Vacuum-assisted breast biopsy (VABB, 11-Gauge) upon Health-related Quality of Life (HRQoL) remains an open field. This study aims to: i) assess short-term (4 days after VABB) responses in terms of HRQoL after VABB, ii) evaluate long-term (18 months after VABB) responses, if any, and iii) examine whether these responses are modified by a variety of possible predictors (anthropometric, sociodemographic, lifestyle habits, breast-related parameters, reproductive history, VABB-related features and complications, seasonality).

Methods

This study included 102 eligible patients undergoing VABB and having benign lesions. A variable number of cores (24-96 cores) has been excised. HRQoL was assessed by EQ-5D and SF-36^® questionnaires: i) in the morning of the VABB procedure day (baseline measurement), ii) four days after VABB (early post-biopsy measurement) and iii) 18 months after VABB (late post-biopsy measurement). Statistical analysis comprised two steps: i. evaluation of differences in EQ-5D/SF-36 dimensions and calculated scores (baseline versus early post-biopsy measurement and baseline versus late post-biopsy measurement) and ii. assessment of predictors through multivariate linear, logistic, ordinal logistic regression, as appropriate.

Results

At baseline patients presented with considerable anxiety (EQ-5D anxiety/depression dimension, EQ-5D TTO/VAS indices, SF-36 Mental Health dimension). At the early post-biopsy measurement women exhibited deterioration in Usual Activities (EQ-5D) and Role Functioning-Physical dimensions. At the late measurement women exhibited pain (EQ-5D pain/discomfort and SF-36 Bodily Pain), deterioration in Physical Functioning (SF-36 PF) and overall SF-36 Physical Component Scale (PCS). Mastalgia, older age and lower income emerged as significant predictors for baseline anxiety, whereas seasonality modified early activities-related responses. Pain seemed idiosyncratic.

Conclusions

The HRQoL profile of patients suggests that VABB exerts effects prior to its performance at a psychological level, immediately after its performance at a functioning-physical level and entails long-term effects associated with pain.     

Measurement bias of the SF-36 Health Survey in older adults with chronic conditions

Purpose

The objectives of this study were to investigate the psychometric properties of the SF-36 in a sample of older adults with chronic conditions and to test whether measurement bias exists based on the levels of comorbidity.

Methods

Participants included were 979 cognitively intact older adults with comorbidities who were interviewed at their homes. We examined the psychometric properties of the SF-36 and conducted confirmatory factor analysis (CFA) to investigate the assumption of measurement invariance by the levels of comorbidity.

Results

Overall data quality was high and scaling assumptions were generally met with few exceptions. Floor and ceiling effects were present for the role-physical and role-emotional subscales. Using CFA, we found that a three-factor measurement model fits the data well. We identified two violations of measurement invariance. Results showed that participants with high comorbidity level place more emphasis on social functioning (SF) and bodily pain (BP) in relation to physical health-related quality of life (HRQoL) than those with low comorbidity level.

Conclusions

Measurement bias was present for the SF and BP components of the SF-36 physical HRQoL measure. Researchers should be cautious when considering the use of SF-36 in clinical studies among older adults with comorbidities.     

Impact of body mass index on the relationship between muscle quality and physical function in older women

Objectives

To investigate the impact of body mass index (BMI) (normal weight, overweight, obese) on the relationship between muscle quality (MQ) and physical function in community-dwelling older women.

Design

Cross-sectional study.

Setting

University research laboratory.

Participants

Community-dwelling older women (n = 94, 73.6 ± 5.4 y) stratified by BMI (normal weight: 20.0–24.9 kg/m²; overweight: 25.0–29.9 kg/m²; obese: ≥ 30.0 kg/m²).

Measurements

Body mass index using height and weight, leg extension power via the Nottingham power rig, body composition using dual-energy X-ray absorptiometry, and physical function (6-minute walk, 8-foot up-and-go, 30-second chair stand). Muscle quality was defined as leg power (watts) normalized for lower-body mineral-free lean mass (kg).

Results

Following adjustments for covariates, muscle quality was significantly higher in women of normal BMI compared to overweight (10.0 ± 0.4 vs 8.7 ± 0.4 watts/kg, p = 0.03). Muscle quality was a significant predictor of performance on the 6-minute walk and 8-foot up-and-go in normal and overweight women (all p < 0.05) and performance on the 30-second chair stand in normal and obese women (both p < 0.05). Body mass index did not significantly impact the association between MQ and physical function (all p > 0.05).

Conclusions

Muscle quality varies by BMI, yet the relationship to physical function is not significantly different across BMI groups. The results imply that interventions that increase MQ in older women may improve physical function, regardless of BMI.     

Evaluation of physical activity and its relationship to health-related quality of life in patients on chronic hemodialysis

Objective

The aim of this study was to investigate the relationship between physical activity and health-related quality of life (HRQOL) in patients on chronic hemodialysis.

Methods

A total of 31 men (69.0 ± 11.1 years) and 17 women (66.9 ± 10.0 years) among 61 male and 30 female patients on chronic hemodialysis at Innoshima General Hospital, Onomichi, Japan, were enrolled in this cross-sectional study. Physical activity was evaluated using tri-axial accelerometers. HRQOL and psychological distress were also evaluated using the EuroQol questionnaire (EQ-5D) and the K6 questionnaire, respectively.

Results

Physical activity evaluated by Σ[metabolic equivalents × h per week (METs·h/w)] was 8.1 ± 6.0 METs·h/w, and EQ-5D score was 0.754 ± 0.177. Among all patients, EQ-5D scores were significantly correlated with physical activity over 4 METs on non-hemodialysis treatment days (r = 0.426, p = 0.003). In women, EQ-5D scores were also correlated with physical activity over 4 METs on hemodialysis treatment days and non-hemodialysis treatment days. By stepwise multiple regression analysis, physical activity over 4 METs on non-hemodialysis treatment days was a determinant factor of EQ-5D even after adjusting for age and K6 scores.

Conclusion

Physical activity over 4 METs on non-hemodialysis treatment days might be associated with EQ-5D in patients on chronic hemodialysis, especially in women.     

Change in maternal body mass index is associated with offspring body mass index: a 21-year prospective study

Purpose

To examine whether changes in maternal overweight and obesity from pre-pregnancy to two decades postpartum predict the body mass index (BMI) of adult offspring.

Methods

We used a subsample of 1997 mother–offspring pairs from the 7,223 original cohorts of women who gave birth in Brisbane, Australia, between 1981 and 1984. Multiple linear regression and multinomial logistic regression were used to examine the relationship between change in maternal BMI from pre-pregnancy to 21-year postpartum, and offspring BMI at 21-year, adjusting for potential confounding factors.

Results

At 21-year postpartum, 31.15 % mothers were overweight and a further 30.80 % were obese. Mothers gained a mean weight of 16.07 kg over the 21 year. We found that the offspring of mothers who became overweight or remained overweight at 21-year postpartum were at greater risk of being overweight and obese at 21 years. In the adjusted model, offspring of mothers who had normal BMI before pregnancy but became overweight by 21-year postpartum were (odds ratio) 1.72 (95 % CI = 1.20, 2.47) times more likely to be overweight. Compared to offspring of mothers who maintained normal weight over two decades, offspring of mothers who remained persistently overweight were (odds ratio) 5.39 (95 % CI = 3.50, 8.30) times more likely to be obese by age 21 year.

Conclusions

The findings of this study suggest that long-term changes in maternal BMI from pre-pregnancy to 21-year postpartum are independently associated with BMI in their young adult offspring.     

Gender,race, BMI,and social support in relation to the health-related quality of life of cancer survivors: a report from the American Cancer Society’s Study of Cancer Survivors II (SCS-II)

Purpose

We examined the main and interactive effects of race, BMI, and social support on physical and mental health-related quality of life (HRQoL) among male and female cancer survivors using the stress and coping theory to inform findings.

Methods

HRQoL issues among 1768 cancer survivors were examined using the American Cancer Society’s cross-sectional Study of Cancer Survivors II. Two-step multiple linear regressions were conducted to assess the physical and mental HRQoL of male and female cancer survivors, respectively.

Results

The average age of participants was 67.36 (SD = 11.51); the majority were female (53.3 %; n = 941) and non-Hispanic White (85.9 %; n = 1517). The average BMI measurement for participants was 28.33 (SD = 5.90), with 41.3 % (n = 729) overweight and 30.3 % (n = 535) obese. Higher BMI was significantly associated with lower physical HRQoL across gender, while social support had significant main effects on physical and mental HRQoL across gender. Race moderated the relationship between social support and physical HRQoL among female cancer survivors and between BMI and mental HRQoL for both genders.

Conclusions

The results of this study contribute a unique gender- and racial-specific perspective to cancer survivorship research. While the buffering hypothesis of the stress and coping theory was not supported, the main effects of BMI and social support on HRQoL were different across gender and race.

     

Impaired parent-reported health-related quality of life of underweight and obese children at elementary school entry

Purpose

Examine the health-related quality of life of 5–6-year-old underweight, overweight and obese children.

Methods

Our cross-sectional study included 3,227 parent–child dyads from the “Be active, eat right” study. Parents completed questionnaires regarding child and parental characteristics. Health-related quality of life of the child was measured using the Child Health Questionnaire Parent Form 28. Children were classified normal weight, overweight, obese, severely obese, and underweight according to the international age and gender BMI cutoff points. Bootstrap analyses were performed for general linear models corrected for potential confounding variables.

Results

Severely obese children (β, ?2.60; 95 % CI, ?4.80 to ?0.57, p < 0.01) and underweight children (β, ?1.11; 95 % CI, ?1.85 to ?0.39, p < 0.01) had lower parent-reported scores on the physical summary scale. On the physical functioning profile scale parents of overweight and severely obese children also reported statistically significant lower scores (p < 0.05 and p < 0.01, respectively).There were no significant differences regarding the psychosocial summary scale scores between the different weight categories.

Conclusion

Underweight and overweight children experience impaired health-related quality of life on the physical functioning domain. Physicians, teachers and parents should be aware of the possible negative impact on health-related quality of life in underweight and overweight 5–6-year-old children.     

Pattern of impact of femoroacetabular impingement upon health-related quality of life: the determinant role of extra-articular factors

Purpose

Despite the interest in surgical treatment of femoroacetabular impingement (FAI), its impact upon health-related quality of life (HRQoL) has not been established. The objectives of this study were twofold: (a) to describe the pattern of impact of FAI on HRQoL and (b) to assess how articular and extra-articular factors influence HRQoL in this group of patients.

Methods

A total of 108 patients [55 females (50.9 %); age 36.0 ± 12.4 years] with intraoperatively confirmed FAI and no evidence of secondary hip osteoarthritis were studied. The pattern of impact on HRQoL was studied using SF-36 V.2? and then contrasted with other medical conditions employing the SF-36 spydergram. The best model explaining the influence of “articular” and “extra-articular” factors over the SF-36 physical and mental component scores (PCS/MCS) was selected using the Akaike information criterion.

Results

The PCS was 53.2 ± 19.2 and MCS was 68.94 ± 17.15. The SF-36 spydergram depicted an impact pattern distinguishable from other conditions. A linear model predicted PCS would increase by 8.9 points in male patients and 3.7 points per point of University of California Los Angeles score (p value <0.01; R2 0.29). For MCS, obesity resulted in a 12.7 point reduction, psychiatric comorbidity reduced it by 11.1; and a combined reduction of 19 points (p value <0.01; R2 0.18). Unexpectedly, the extent of intra-articular disease had no influence on PCS or MCS.

Conclusions

FAI impacts HRQoL with a distinguishable pattern. In our study, the manner in which HRQoL is affected by FAI can be explained only by patients’ characteristics unrelated to the extent of intra-articular disease.

Level of evidence

Prognostic Level IV.     

Validity of the Thai EQ-5D in an occupational population in Thailand

Purpose

To assess the construct validity of the Thai EuroQoL (EQ-5D) among an occupational population in Thailand.

Methods

Data were derived from a large cohort study among employees of the Electricity Generating Authority of Thailand. In 2008 and 2009, 4,850 participants completed the Thai EQ-5D and Short-Form 36 version 2 (SF-36v2). Thai preferences weights were used to convert EQ-5D health states into EQ-5D index scores. Construct validity of the Thai EQ-5D was examined by specifying and testing hypotheses about the relationships between the EQ-5D, SF-36v2, and participants’ demographic and medical characteristics.

Results

Construct validity of the Thai EQ-5D was supported by expected relationships with SF-36v2 scale and summary scores. For example, SF-36v2 scores on the mental health scale were much lower for participants who reported having problems on the EQ-5D anxiety/depression dimension compared to those reporting no problems (mean norm-based SF-36v2 scores: 52.9 vs. 41.8, p < 0.001). Additionally, reporting a problem in a given EQ-5D dimension was generally associated with lower SF-36v2 summary scores. The EQ-5D index score distinguished between groups of participants in the expected manner, on the basis of sex, age, education and self-reported health, thus providing evidence of known-groups validity.

Conclusion

The study demonstrated good construct validity of the Thai EQ-5D in a large occupational population in Thailand.     

Health-related quality of life of children and adolescents with functional disabilities in a northern Swedish county

Purpose

Health-related quality of life (HRQoL) studies in children and adolescents with disabilities tend to report lower self-reported health than in the typical population. However, reports are not always consistent and HRQoL appears to vary depending on diagnosis, cultural setting and clinical context. The aim of this study was to explore HRQoL in children and adolescents with various disabilities in Västerbotten County, Sweden.

Methods

A total of 175 children and adolescents [57 girls, 118 boys; mean age 11.7 years (range 7–17 years)] divided into four different diagnostic groups (intellectual disabilities, autism spectrum disorders, movement disorders and hearing disabilities) participated in the study. The EuroQol Five Dimensions Health Questionnaire, Youth version (EQ-5D-Y) was used as HRQoL measure.

Results

Significant differences in various EQ-5D-Y dimensions between the different diagnostic groups were found, but no differences in overall health status. HRQoL in children and adolescents with hearing disabilities was found similar to the typical child population in Sweden whereas children and adolescents with other diagnoses reported evidently more problems.

Conclusions

Findings suggest that there is an increased risk for children with functional disabilities other than hearing disabilities in northern Sweden to experience difficulties in various health domains and lowered general health.     

Impact of self-reported smoking status on health-related quality of life in Singapore

Aim

To evaluate possible differences in health-related quality of life (HRQoL) according to self-reported smoking status in a multiethnic urban Asian population in Singapore.

Subjects and methods

In this community-based cross-sectional survey of a stratified random sample, interviewers obtained socioeconomic, clinical and HRQoL—Short Form-36, Version 2 (SF-36v2), Health Utilities Index Mark 3 (HUI3) and EuroQoL 5-Dimensions (EQ-5D)—data in English, Chinese or Malay. The association between self-reported smoking status and HRQoL at the overall scale and individual attribute levels stratified by gender were evaluated using regression analyses.

Results

Of 3,006 consenting participants with a mean age of 48 (SD: 16.44) years, 49.9 % males, Chinese: Malay: Indian?=?49.9 %: 25.3 %: 24.8 %, 727 (34.4 %) male and 1,386 (65.6 %) female are never smokers, 208 (86.7 %) male and 32 (13.3 %) female are ex-smokers, 104 (78.8 %) male and 28 (21.2 %) female are occasional smokers, while 460 (88.3 %) male and 61 (11.7 %) female are regular smokers. After adjusting for socioeconomic and clinical variables, male ex-smokers reported lower SF-36v2 MCS (regression coefficient: ?1.60, P?=?0.026) and HUI3 utility scores (regression coefficient: ?0.024, P?=?0.040) compared to never smokers. Female regular smokers reported lower HUI3 utility scores as compared to never smokers (regression coefficient: ?0.056, P?=?0.004).

Conclusion

Compared with never smokers, male ex-smokers and female regular smokers reported poorer HRQoL in this multiethnic Asian study.     

Impact of hypoalphalipoproteinemia on quality of life in Taiwanese women with central obesity

Purpose

To investigate the relationship between health-related quality of life (HRQoL) and different cutoff value of low level of high-density lipoprotein cholesterol (HDL-C) in Taiwanese women with different definition of obesity.

Methods

Prospective observational study in women with central obesity was conducted in Taipei City Hospital. A total of 572 women were screened at our clinic, and 227 of them with a body mass index ≧27 kg/m² defined by the Department of Health in Taiwan and weight circumference ≧80 cm were eligible for the study. We defined two groups as group A-low HDL (HDL-C < 40 mg/dL) and group B-high HDL (HDL-C < 50 mg/dL) according to different definition of hypoalphalipoproteinemia in obese women.

Results

Significantly reduced HRQoL score was noted in group A-low HDL compared to group A-high HDL (HDL-C ≧ 40 mg/dL), but not between group B-low HDL and group B-high HDL (HDL-C ≧ 50 mg/dL). Positively correlation was noted between HDL-C level and physical domain of HRQoL score. HDL-C contributes independently to physical domain of HRQoL score after controlling for other factors. Decreased leptin and adiponectin level were noted in hypoalphalipoproteinemia groups.

Conclusion

Taiwanese obese women with hypoalphalipoproteinemia have adverse impact on HRQoL, especially when the HDL-C level is lower than 40 mg/dL. Both hypoalphalipoproteinemia and hypertension accounted for a great variance to lower scores of physical domain of HRQoL with positively correlation with HDL-C level observed. Decreased leptin and adiponectin were also observed in hypoalphalipoproteinemia group, which implied increased cardiovascular risk. HDL-C level may deem as another indicator for HRQoL in women with central obesity.     

Impact of diagnosis of diabetes on health-related quality of life among high risk individuals: the Diabetes Prevention Program outcomes study

Purpose

The purpose of this study is to assess if diagnosis of type 2 diabetes affected health-related quality of life (HRQoL) among participants in the Diabetes Prevention Program/Diabetes Prevention Program Outcome Study and changes with treatment or diabetes duration.

Methods

3,210 participants with pre-diabetes were randomized to metformin (MET), intensive lifestyle intervention (ILS), or placebo (PLB). HRQoL was assessed using the SF-36 including: (1) 8 SF-36 subscales; (2) the physical component (PCS) and mental component summary (MCS) scores; and (3) the SF-6D. The sample was categorized by diabetes free versus diagnosed. For diagnosed subgroup, mean scores in the diabetes-free period, at 6 months, 2, 4 and 6 years post-diagnosis, were compared.

Results

PCS and SF-6D scores declined in all participants in all treatment arms (P < .001). MCS scores did not change significantly in any treatment arm regardless of diagnosis. ILS participants reported a greater decrease in PCS scores at 6 months post-diagnosis (P < .001) and a more rapid decline immediately post-diagnosis in SF-6D scores (P = .003) than the MET or PLB arms. ILS participants reported a significant decrease in the social functioning subscale at 6 months (P < .001) and two years (P < .001) post-diagnosis.

Conclusions

Participants reported a decline in measures of overall health state (SF-6D) and overall physical HRQoL, whether or not they were diagnosed with diabetes during the study. There was no change in overall mental HRQoL. Participants in the ILS arm with diabetes reported a more significant decline in some HRQoL measures than those in the MET and PLB arms that developed diabetes.