Lean Mass Index: A Better Predictor of Mortality than Body Mass Index in Elderly Asians

OBJECTIVES: To evaluate the correlation between body mass index (BMI), body composition, and all‐cause mortality in an elderly Asian population. DESIGN: A prospective observational cohort study with 3.5‐year follow‐up. SETTING: The Korean Longitudinal Study on Health and Aging Project for elderly residents in Seongnam City, Korea. PARTICIPANTS: Eight hundred seventy‐seven subjects aged 65 and older for whom baseline body composition data was available. MEASUREMENTS: BMI, waist circumference, and body composition of each subject was evaluated. Body composition was examined using bioelectrical impedance analyses of measures, including lean mass (kg), fat mass (kg), and fat proportion (%). In addition, lean mass index (LMI, kg/m²) was calculated by dividing lean mass by the square of height. Participants were divided into three groups: Group 1 (<25th percentile), Group 2 (25–75th percentiles), and Group 3 (≥75th percentile) for BMI, waist circumference, body composition, and LMI. RESULTS: In the fully adjusted Cox proportional hazard model, BMI, waist circumference, and fat composition were not correlated with mortality, but higher lean mass and LMI were considered predictors of lower mortality when comparing Group 3 and Group 1 (in lean mass, relative risk reduction of 84%, 95% confidence interval (CI)=45–96%, P=.004; in LMI, relative risk reduction of 69%, 95% CI=12–89%, P=.03). CONCLUSION: The present study indicates that the recommendation of low BMI as a means of obtaining a survival advantage in the elderly is not supported. Instead, higher lean mass and higher LMI are associated with better survival in the elderly Asian population.     

Association between Asthma and Body Mass Index in Children

Obesity has been reported to be associated with an increase in asthma in children. If there is any association, it could be attributed to an effect of obesity on lung volume and thus airway's obstruction. Data from 2413 children aged 7-12 years in Isfahan were analyzed. The subjects were included in this study if data were available for: height, weight, age, lung volume, and any measure of asthma, including history of diagnosed asthma, wheeze, chronic cough, and medication as obtained by questionnaire. Body mass index (BMI) percentiles, divided into quintiles per year age, were used as a measure of standardized weight.After adjusting for, sex, age, smoking and family history, BMI was a significant risk factor for wheeze ever (p = 0.000) and asthma ever (p = 0.000), diagnosed asthma (P=0.000) and current asthma (p = 0.000). There was no significant correlation between BMI and obstructive spirometry. Increased BMI was significantly associated with an increased airway resistance.Despite the fact that higher BMI is a risk factor for, wheeze ever, wheeze and dyspnea in the last 12 months, and diagnosed asthma, higher BMI is not a risk factor for obstructive pattern in pulmonary function test.     

Obesity-Related Glomerulopathy: Body Mass Index and Proteinuria

Background and objectives: Obesity-related glomerulopathy (ORG) is an increasing cause of end-stage renal disease, but evidence concerning the effects of treatments is rather limited. This study was aimed at exploring the renoprotective effects of weight loss on patients with ORG.Design, setting, participants, & measurements: A total of 63 patients with renal biopsy–proven ORG had food and exercise intervention in the physician-supervised weight loss program and were divided into three groups on the basis of the percentage of weight change from baseline to follow-up: significant weight loss (>3% reduction in body mass index [BMI]), stable weight, or significant weight gain (>3% increase). Metabolic parameters and renal lesions were evaluated regularly for 2 years.Results: After 6 months, 27 patients lost weight by 8.29 ± 4.00%, with a mean decrease in proteinuria of 35.3%, whereas 24 months later, 27 patients achieved a 9.20 ± 3.78% reduction in BMI and a 51.33% reduction in urine protein secretion. The levels of serum triglyceride, serum uric acid, and BP were also decreased. Contrarily, in patients with increased BMI, urine protein was increased by 28.78%. Correlation analysis showed proteinuria was associated with BMI, serum triglyceride, and uric acid, and multivariate regression analysis indicated the changes in BMI were the only predictor of proteinuria (P < 0.01).Conclusions: Weight loss intervention benefited remission of proteinuria in patients with ORG, whose function could not be replaced by conventional pharmacotherapy.Profound lifestyle changes in modern China have resulted in a remarkable increase in the population of obesity (1). Sequelae of obesity include type 2 diabetes, hypertension, cardiovascular diseases, and the progression of renal diseases (2,3). Weight loss, either after bariatric surgery or after lifestyle modification, normalizes blood glucose (4) and decreases BP and plasma lipids (5,6) in obese patients. Similarly, a significant reduction in urinary albumin excretion and glomerular hyperfiltration has been reported in morbidly obese patients with a dramatic decrease of body mass index (BMI) (7,8). Moreover, even a small decrease in BMI is related to the reduction of proteinuria in patients with diabetic nephropathy and other chronic kidney diseases (9–11).Obesity-related glomerulopathy (ORG) has been reported in more and more obese patients without overt diabetes and pre-existing renal diseases (12,13). It is a secondary form of focal and segmental glomerulosclerosis (FSGS) manifested as proteinuria and progressive renal dysfunction (14). The prognosis for patients with ORG were significantly different from those with diabetic nephropathy or with the primary form of FSGS (15). However, the relationship between weight loss and the outcome of ORG has not been clarified until now. Conclusions from the studies of diabetic nephropathy (9) and unidentified chronic kidney diseases (10,11,16) could be different from those of histologic-proven ORG. And evidence from case reports (17,18) concerning the aggressive treatment of ORG with bariatric surgery is unpersuasive because only a small population was involved. In addition, the long-term effects of weight loss in patients with ORG are not studied. So far, no well-designed clinical research studies for histologic-proven ORG are available, especially those concerning the long-term effects of weight loss and lifestyle modification.In this regard, this study was designed to observe the relationship between body weight reduction and the changes in proteinuria in patients with ORG. Patients who were diagnosed with ORG by renal biopsy were included in the physician-supervised weight loss program in our institute and followed up for 2 years. It was the first study demonstrating that the remission of ORG could be achieved in patients with weight loss, but not in patients with increasing body weight.     

体重指数与不同亚型高血压的关系

目的探讨中国成年人体重指数(BMI)与不同亚型高血压患病率的关系。方法2000-2001年,对年龄35～74岁的中国成年人群中的代表性抽样样本进行横断面调查,分析了资料完整并且未服用降压药的14124名研究对象的数据。比较男性和女性不同BMI分组的各亚型高血压患病率、比数比(OR值)和归因危险。结果随着BMI水平的增加,男性和女性的收缩压和舒张压均值逐渐增高。男、女性在低体重组、正常体重组、超重组和肥胖组的各亚型高血压患病率和OR值基本上也呈升高趋势。男性超重和肥胖(BMI≥24kg/m2)时患单纯性收缩期高血压(ISH)、单纯性舒张期高血压(IDH)、收缩期和舒张期联合性高血压(SDH)的OR值分别为1.3、2.9和2.4,女性则各为1.6、2.4和2.3(P<0.05)。与非超重者相比,超重和肥胖男性中20%的ISH、65.4%的IDH和57.5%的SDH应归因于BMI≥24kg/m2,而女性相应有37.9%的ISH、59.0%的IDH和55.8%的SDH由超重和肥胖引起。结论体重指数与各亚型高血压的患病危险有显著正相关。减重和控制肥胖对于预防IDH和SDH的发生起重要作用。     

体重指数与不同亚型高血压的关系

目的探讨中国成年人体重指数(BMI)与不同亚型高血压患病率的关系.方法2000-2001年,对年龄35～74岁的中国成年人群中的代表性抽样样本进行横断面调查,分析了资料完整并且未服用降压药的14 124名研究对象的数据.比较男性和女性不同BMI分组的各亚型高血压患病率、比数比(OR值)和归因危险.结果随着BMI水平的增加,男性和女性的收缩压和舒张压均值逐渐增高.男、女性在低体重组、正常体重组、超重组和肥胖组的各亚型高血压患病率和OR值基本上也呈升高趋势.男性超重和肥胖(BMI≥24kg/m2)时患单纯性收缩期高血压(ISH)、单纯性舒张期高血压(IDH)、收缩期和舒张期联合性高血压(SDH)的OR值分别为1.3、2.9和2.4,女性则各为1.6、2.4和2.3(P＜0.05).与非超重者相比,超重和肥胖男性中20%的ISH、65.4%的IDH和57.5%的SDH应归因于BMI≥24 kg/m2,而女性相应有37.9%的ISH、59.0%的IDH和55.8%的SDH由超重和肥胖引起.结论体重指数与各亚型高血压的患病危险有显著正相关.减重和控制肥胖对于预防IDH和SDH的发生起重要作用.     

Body Mass Index is Inversely Related to Mortality in Elderly Subjects

Purpose To study the long-term effect of being overweight on mortality in very elderly subjects. Methods The medical records of 470 inpatients (226 males) with a mean age of 81.5 ± 7 years and hospitalized in an acute geriatric ward between 1999 and 2000 were reviewed for this study. Body mass index (BMI) at admission day was subdivided into quartiles: <22, 22–25, 25.01–28, and ≥28 kg/m². Patients were followed-up until August 31, 2004. Mortality data were taken from death certificates. Results During a mean follow-up of 3.46 ± 1.87 years (median 4.2 years [range 1.6 to 5.34 years]), 248 patients died. Those who died had lower baseline BMI than those who survived (24.1 ± 4.2 vs 26.3 ± 4.6 kg/m²; p < .0001). The age-adjusted mortality rate decreased from 24 to 9.6 per 100 patient-years from the highest to lowest BMI quartile (p < .001). BMI was associated with all-cause and cause-specific mortality even after controlling for sex. A multivariate Cox proportional hazards model identified that even after controlling for male gender, age, renal failure, and diabetes mellitus, which increased the risk of all-cause mortality, elevated BMI decreased the all-cause mortality risk. Conclusions In very elderly subjects, elevated BMI was associated with reduced mortality risk.     

Computerized data base for evaluation and follow-up of demented outpatients

In the course of evaluating and following more than 600 geriatric outpatients referred to a subspecialty clinic because of cognitive impairment, standardized computer-compatible evaluation and follow-up forms were developed, as well as a computerized data base. The forms cover medical, neurologic, psychiatric, psychometric, and clinical laboratory examinations; they help health professionals to perform thorough, standardized, and efficient examinations focused on those characteristics relevant to dementias. The computerized data base facilitates follow-up and other clinical studies. This article presents both the forms and their translation into query-language terminology.     

Low Body Mass Index Is Associated with Higher Odds of COPD and Lower Lung Function in Low- and Middle-Income Countries

The relationship of body mass index (BMI) with lung function and COPD has been previously described in several high-income settings. However, few studies have examined this relationship in resource-limited settings where being underweight is more common. We evaluated the association between BMI and lung function outcomes across 14 diverse low- and middle-income countries. We included data from 12,396 participants aged 35–95 years and used multivariable regressions to assess the relationship between BMI with either COPD and lung function while adjusting for known risk factors. An inflection point was observed at a BMI of 19.8?kg/m². Participants with BMI < 19.8?kg/m² had a 2.28 greater odds (95% CI 1.83–2.86) of having COPD and had a 0.21 (0.13–0.30) lower FEV₁ and 0.34 (0.27–0.41) lower FEV₁/FVC z-score compared to those with BMI ≥ 19.8?kg/m². The association with lung function remained even after excluding participants with COPD. Individuals with lower BMI were more likely to have COPD and had lower lung function compared to those in higher BMI. The association with lung function remained positive even after excluding participants with COPD, suggesting that being underweight may also play a role in having worse lung function.     

Body Mass Index and Mortality From Aortic Aneurysm and Dissection

Aims: Reports on an association between body mass index and aortic disease, which remains controversial. This study investigated the association between body mass index and mortality from aortic disease.Methods: We conducted the Japan Collaborative Cohort Study, a prospective study of 103,972 Japanese men and women aged 40–79 years. Body mass index was calculated on the basis of self-reported height and weight, and the participants were followed up from 1988–89 through 2009. Sex-specific hazard ratios (95% confidence intervals) of mortality from aortic disease according to quintiles of body mass index were analyzed using the Cox proportional hazards model.Results: During the median 18.8 years of follow-up, we documented 139 deaths due to aortic aneurysm (including 51 thoracic and 74 abdominal aortic aneurysms) and 134 deaths due to aortic dissection. We observed positive associations of body mass index with mortality from aortic aneurysm among men: the multivariable hazard ratios (95% confidence intervals) for highest versus lowest quintiles of body mass index were 4.48 (2.10–9.58), P for trend < 0.0001 for aortic aneurysm; 6.52 (1.33–32.02), P = 0.005 for thoracic aortic aneurysm; 3.81 (1.39–10.49), P = 0.01 for abdominal aortic aneurysm; and 2.71 (1.59–4.62), P = 0.001 for total aortic disease. No association was found for aortic dissection. Among ever-smokers (men ≥ 90%) but not never-smokers (women ≥ 84%), an association between body mass index and aortic disease mortality was observed regardless of sex, which may explain the sex difference (P for sex-interaction = 0.046).Conclusions: We found a positive association between body mass index and mortality from aortic aneurysm among Japanese men and smokers.     

Body Mass Index Trajectories and Healthcare Utilization in Young and Middle-aged Adults

The obesity epidemic is a significant public health issue with adverse impact on health and costs. Applying a life-course perspective to obesity may advance our understanding of the influence of obesity over time on patterns of healthcare utilization in young and middle-aged United States (US) adults.We identified baseline body mass index (BMI) and BMI trajectories, and assessed their association with outpatient visits, emergency department (ED) visits, and hospitalizations in a well-defined population of young and middle-aged US adults.Using the Rochester Epidemiology Project resources, we conducted a retrospective cohort study of adults (N = 23,254) aged 18 to 44 years, with at least 3 BMI measurements, residing in Olmsted County, MN from January 1, 2005 through December 31, 2012.We observed that 27.5% of the population was obese. Four BMI trajectories were identified. Compared to under/normal weight, obese class III adults had higher risk of outpatient visits (adjusted rate ratio [RR], 1.86; 95% confidence intervals [CIs], 1.67–2,08), ED visits (adjusted RR, 3.02; 95% CI, 2.74–3.34), and hospitalizations (adjusted RR, 1.67; 95% CI, 1.59–1.75). BMI trajectory was positively associated with ED visits after adjustment for age, sex, race, and Charlson Comorbidity Index (P < 0.001 for trend).Among young and middle-aged US adults, baseline BMI is positively associated with outpatient visits, ED visits, and hospitalizations, while BMI trajectory is positively associated with ED visits. These findings extend our understanding of the longitudinal influence of obesity on healthcare utilization in early to mid-adulthood.