Is obesity a risk factor for cirrhosis-related death or hospitalization? A population-based cohort study

BACKGROUND AND AIMS: Our aim was to determine whether increased body mass index (BMI) in the general population is associated with cirrhosis-related death or hospitalization. METHODS: Participants included 11,465 persons aged 25-74 years without evidence of cirrhosis at entry into the study, or during the first 5 years of follow-up, who subsequently were followed-up for a mean of 12.9 years. The BMI was used to categorize participants into normal-weight (BMI < 25 kg/m(2), N = 5752), overweight (BMI 25 to < 30 kg/m(2), N = 3774), and obese categories (BMI >/= 30 kg/m(2), N = 1939). RESULTS: Cirrhosis resulted in death or hospitalization of 89 participants during 150,233 person-years of follow-up (0.59/1000 person-years). Cirrhosis-related deaths or hospitalizations were more common in obese persons (0.81/1000 person-years, adjusted hazard ratio 1.69, 95% confidence interval [CI] 1.0-3.0) and in overweight persons (0.71/1000 person-years, adjusted hazard ratio 1.16, 95% CI 0.7-1.9) compared with normal-weight persons (0.45/1000 person-years). Among persons who did not consume alcohol, there was a strong association between obesity (adjusted hazard ratio 4.1, 95% CI 1.4-11.4) or being overweight (adjusted hazard ratio 1.93, 95% CI 0.7-5.3) and cirrhosis-related death or hospitalization. In contrast, this association was weaker among persons who consumed up to 0.3 alcoholic drinks/day (adjusted hazard ratio 2.48, 95% CI 0.7-8.4 for obesity; adjusted hazard ratio 1.31, 95% CI 0.4-4.2 for overweight) and no association was identified among those who consumed more than 0.3 alcoholic drinks/day. CONCLUSIONS: Obesity appears to be a risk factor for cirrhosis-related death or hospitalization among persons who consume little or no alcohol.     

The association between weight history and physical performance in the Health, Aging and Body Composition study

OBJECTIVE: Although the association between current obesity and physical disability is well known, the cumulative effect of obesity is unknown. Using data from the Health, Aging and Body Composition study, we examined the association between weight history in young and middle adulthood and weight status in late adulthood with physical performance in late adulthood. DESIGN: Longitudinal cohort study.Subjects:White and black men and women aged 70-79 years at study baseline (n=2803). MEASURES: Body mass index (BMI; kg/m(2)) was calculated using recalled height at age 25 and weight at age 25 and 50 and measured height and weight at ages 70-79. Physical performance at ages 70-79 was assessed using a short physical performance battery (SPPB) and a 400-m walk test. RESULTS: In this well-functioning cohort, approximately 24% of men and 8% of women reported being overweight or obese (BMI > or =25 kg/m(2)) at age 25, 51% of men and 37% of women reported being overweight or obese at age 50, and 69% of men and 66% of women were overweight or obese at ages 70-79. Men and women who were obese (BMI > or =30 kg/m(2)) at ages 25, 50 and 70-79 had significantly worse SPPB scores and 400-m walk times than those who were normal weight. Women who were overweight (BMI 25-29.9 kg/m(2)) at ages 25, 50 and 70-79 also had significantly worse physical performance. Furthermore, men and women who had a history of being overweight or obese at ages 25 or 50 had worse physical performance compared to those who were normal weight throughout or who were overweight or obese at ages 70-79 but not in midlife or earlier. CONCLUSIONS: Maintaining a healthy body weight throughout adulthood may play a role in preventing or delaying the onset of physical disability.     

Is the Canadian childhood obesity epidemic related to physical inactivity?

OBJECTIVE: This study examined the relation among children's physical activity, sedentary behaviours, and body mass index (BMI), while controlling for sex, family structure, and socioeconomic status. DESIGN: Epidemiological study examining the relations among physical activity participation, sedentary behaviour (video game use and television (TV)/video watching), and BMI on a nationally representative sample of Canadian children. SUBJECTS: A representative sample of Canadian children aged 7-11 (N=7216) from the 1994 National Longitudinal Survey of Children and Youth was used in the analysis. MEASUREMENTS: Physical activity and sport participation, sedentary behaviour (video game use and TV/video watching), and BMI measured by parental report. RESULTS: Both organized and unorganized sport and physical activity are negatively associated with being overweight (10-24% reduced risk) or obese (23-43% reduced risk), while TV watching and video game use are risk factors for being overweight (17-44% increased risk) or obese (10-61% increased risk). Physical activity and sedentary behaviour partially account for the association of high socioeconomic status and two-parent family structure with the likelihood of being overweight or obese. CONCLUSION: This study provides evidence supporting the link between physical inactivity and obesity of Canadian children.     

Relation between body weight and health-related quality of life among the elderly in Spain

OBJECTIVE: This study examines the relation between body weight and the physical and mental components of health-related quality of life (HRQL) in the population aged 60 y and over in Spain. RESEARCH METHODS AND PROCEDURES: Cross-sectional study covering 3605 subjects, representative of the noninstitutionalised Spanish population aged 60 y and over. Information was collected through home-based personal interview and measurement of blood pressure and anthropometric variables. Logistic regression was used to examine the relation of suboptimal HRQL (score<100) on each SF-36 questionnaire scale with body mass index (BMI) and waist circumference. Separate regression models were constructed for each sex and adjusted for sociodemographic variables, tobacco and alcohol consumption, physical activity, arterial hypertension and diagnosed chronic disease. RESULTS: Mean age of the study population was 70.9 y for men and 72.2 y for women. The percentage of overweight subjects was 48.5% in men and 39.8% in women, and of obese subjects, 31.9 and 41.1% respectively. Men registered a better HRQL than women on most of the SF-36 scales. Compared to normal-weight subjects (BMI: 18.5-24.9 kg/m(2)), frequency of suboptimal physical functioning was higher among obese subjects (BMI>or=30 kg/m(2)), both male (OR: 1.91; 95% CI: 1.22-3.00) and female (OR: 2.58; 95% CI: 1.59-4.19). The aspects of physical functioning most affected were bending, kneeling or stooping, climbing stairs and strenuous effort. Male, though not female, obesity was nonetheless associated with a better HRQL on the SF-36 mental scales. Frequencies of suboptimal scores for overweight persons (BMI: 25-29.9 kg/m(2)) were similar to those for normal-weight subjects on most of the SF-36 scales. Results proved similar for subjects in both the 60-74 and 75-and-over age groups, and also when waist circumference was used as the measure of obesity (>102 cm in men and >88 cm in women). CONCLUSIONS: Obese men and women showed worse physical functioning than normal-weight persons. This occurred irrespective of whether subjects were over or under 74 y of age, or whether obesity was measured by BMI or waist circumference, and was not explained by unhealthy lifestyles or obesity-related chronic disease.     

The relationship of overweight and obesity with subjective health and use of health-care services among Spanish women

OBJECTIVE: To examine the relationship of overweight and obesity with subjective health and use of health-care services among women in Spain. METHODS: Data were drawn from the 1993 Spanish National Health Survey, covering a 13 244-woman sample representative of the non-institutionalised Spanish population aged 16 y and over. Information was collected through home-based interviews. Multiple logistic regression models were used to calculate odds ratios for suboptimal health (fair, poor or very poor) and utilisation of health-care services by women with normal weight (BMI 18.5-24.9 kg/m(2)), overweight (BMI 25.0-29.9 kg/m(2)) and obesity (BMI>or=30 kg/m(2)). Analyses were adjusted for age, education level, occupation, civil status, social support, tobacco use, alcohol consumption, physical activity at work and during leisure time, job status and town of residence. RESULTS: Frequency of suboptimal health was higher in women with overweight (OR 1.7; 95% CI 1.5-1.9) and obesity (OR 2.1; 95% CI 1.8-2.5) than in those with normal weight. Overweight and obese women visited the physician, used hospital emergency services and took medication with greater frequency than did women of normal weight. There was a positive dose-response relationship (P<0.05) of BMI>or=18.5 kg/m(2) with suboptimal health and utilisation of health-care services. These associations were not wholly explained by BMI-related risk factors and chronic diseases, since their statistical significance remained unchanged and their magnitude was only slightly reduced after adjustment for those factors. The association of overweight and obesity with the use of health-care services did not vary with age, educational level or presence of chronic disease. CONCLUSION: Overweight and obese women have worse subjective health and make greater use of health-care services. This finding is an additional argument for implementing weight-control programmes in Spain.     

Impact of obesity on disease-specific health status after percutaneous coronary intervention in coronary disease patients

OBJECTIVE: Several investigators have focused on obesity as a specific risk factor for mortality in patients undergoing bypass surgery, but few have examined it as a risk factor among patients undergoing percutaneous coronary interventions (PCI). In addition, none have evaluated the impact of obesity on post-PCI quality of life or disease-specific health status. This study examined whether obesity is a risk factor for poor quality of life or diminished health status 12-months postprocedure among a large cohort of PCI patients. RESEARCH METHODS AND PROCEDURES: A total of 1631 consecutive PCI patients were enrolled into the study and classified as underweight (BMI <20 kg/m2), normal weight range (BMI >/=20 and <25 kg/m2), overweight (BMI >/=25 and <30 kg/m2), class I obese (BMI >/=30 kg/m2), or class II and III obese (BMI >/=35 kg/m2). The 12-month postprocedure outcomes included need for repeat procedure, survival, quality of life and health status, assessed using the Seattle Angina Questionnaire (SAQ) and the Short Form-12. RESULTS: Obese patients with and without a history of revascularization were significantly younger than overweight, normal weight range, or underweight patients at the time of PCI. However, obese patients demonstrated similar long-term recovery and improved disease-specific health status and quality of life when compared to patients in the normal weight range after PCI. In addition, mortality and risk for repeat procedure was similar to those patients in the normal weight range patients at 12-months postrevascularization. Underweight patients who had no previous history of revascularization reported lower quality of life (F=3.02; P=0.018) and poorer physical functioning (F=2.82; P=0.024) than other BMI groups. CONCLUSION: Obese patients presenting for revascularization were younger when compared to patients in the normal weight range, regardless of previous history of revascularization. However, weight status was not a significant predictor of differences in long-term disease-specific health status, quality of life, repeat procedures, or survival. Underweight patients demonstrated less improvement in quality of life and physical functioning than other BMI groups.     

The health status of obese individuals in Canada

OBJECTIVE: To determine whether there is a clinically relevant difference in the health state utilities of obese and non-obese individuals as measured by the Health Utility Index Mark III. METHODS: Secondary analysis of the population-based, cross-sectional, interviewer-administered National Population Health Survey (NPHS), 1996-1997. A probability sample of house-dwelling Canadians, excluding populations on First Nations Reserves, Canadian Armed Forces Bases, the Yukon and Northwest Territories, and long-term residents of hospitals or residential care facilities. The sub-sample used in this analysis consisted of 38 151 respondents (52.4% male) between the ages of 20 and 64 y, excluding pregnant women. Health Utilities Index-Mark III (HUI3) scores were used to define normal weight (body mass index (BMI) 19-24.9 kg/m(2)), overweight (BMI 25-29.9 kg/m(2)), obese (BMI 30-34.9 kg/m(2)), and morbidly obese (BMI> or =35 kg/m(2)) individuals. HUI3 scores were age- and gender-standardized. RESULTS: The overall prevalence of obesity (BMI> or =30 kg/m(2)) in this Canadian population was 13.3%. The average difference in HUI3 scores between normal weight and morbidly obese respondents was 0.04 (P<0.001). Statistically significant (P<0.05) differences across BMI categories were found in each of the eight component attributes of the HUI3. The attributes with the most substantial difference between normal and obese patients were cognition, mobility and pain. All demonstrated a > or =2-fold increase in the proportion of individuals in poorer classifications of health when normal weight respondents were compared with the morbidly obese. The magnitude of the decrement in utility ratings associated with obesity was comparable with other chronic non-cardiovascular conditions such as migraine or colitis. CONCLUSION: The results indicate that changes in self-rated health status appear to be due to significant changes across several relevant domain attributes. Obesity has a significant impact on both quality of life and health.     

Change in height, weight and body mass index: Longitudinal data from the HUNT Study in Norway

OBJECTIVE: The aim of this study was to analyse changes in body weight and height, and the changes in the prevalence of overweight and obesity. DESIGN: Prospective population based study with 11-year follow-up. SUBJECTS: Norwegian men (n=21565) and women (n=24337) aged 20 years or more who participated in two health surveys, the first in 1984-1986 and the other in 1995-1997. MEASUREMENTS: Height and weight were measured by using standardised procedures at both surveys, and we computed body mass index (BMI) as weight in kilo divided by the squared value of height in meters. RESULTS: Participants who were younger than 50 years at the first survey showed a large increase in body weight, and men and women aged 20-29 years increased their weight with an average of 7.9 kg and 7.3 kg, respectively. Contradictory, participants who were 70 years or older had on average a weight loss. The prevalence of overweight (BMI=25.0-29.9 kg/m(2)) and obesity (BMI>/=30 kg/m(2)) increased between the surveys, especially in the youngest age groups. Overall, the proportion classified as obese increased from 6.7 to 15.5% among men and from 11.0 to 21.0% among women. Some of this increase was due to a reduction in height, which was most pronounced in the oldest age groups. CONCLUSION: During approximately 10 years, body weight increased in all age groups below 70 years, and the prevalence of overweight and obese persons was approximately 20% higher at the second survey compared with the first survey.     

Associations among cardiometabolic risk factor clustering, weight status, and cardiovascular disease in an Appalachian population

It has been suggested that within the traditional body mass index (BMI) categories there is a heterogeneous pattern of cardiometabolic risk factor clustering. The objective of this research was to determine the associations among obesity, cardiometabolic abnormalities, and cardiovascular disease (CVD) in a large population-based study of Appalachian adults. The study comprised a cross-sectional survey of Appalachian adults residing in 6 communities in Ohio and West Virginia, who were aged 18 years and older (n=14,783, 50.9% women). The authors categorized BMI into normal weight (<25kg/m(2) ), overweight (25-29.9kg/m(2) ), and obese (≥30kg/m(2) ). Cardiometabolic abnormalities were defined as the presence of hypertension, elevated triglycerides (≥150mg/dL), decreased high-density lipoprotein cholesterol (<40mg/dL [men], <50mg/dL [women]), elevated fasting glucose (≥100mg/dL)/diabetes, insulin resistance (homeostasis model assessment >5.13), or elevated C-reactive protein (>3mg/L). They found that 25.6% of normal-weight adults displayed clustering of ≥2 cardiometabolic abnormalities; in contrast, 36.8% of overweight/obese adults displayed no clustering. Compared with normal-weight persons without clustering of cardiometabolic abnormalities (referent), the odds ratio of CVD was 1.06 (95% confidence interval [CI], 0.84-1.34) among overweight/obese individuals without cardiometabolic clustering, 2.21 (95% CI, 1.74-2.81) among normal-weight individuals with cardiometabolic clustering, and 2.45 (95% CI, 2.02-2.97) among overweight/obese individuals with cardiometabolic clustering. These results suggest that within the traditional BMI categories, there may be heterogeneity of CVD risk depending on whether there is underlying clustering of cardiometabolic abnormalities.     

Severe elder obesity and 1-year diminished lower extremity physical performance in homebound older adults

OBJECTIVES: To determine whether severe obesity in older people is independently associated with diminished lower extremity physical performance (LEP) in a random sample of homebound older adults that were considered ambulatory. DESIGN: Prospective cohort with 1 year of follow-up (2000-02). SETTING: In-home assessments of homebound older adults in four North Carolina counties. PARTICIPANTS: Random sample of 282 home-delivered meal recipients aged 60 and older who completed both in-home assessments (n = 253) or were nursing home residents (n = 29) at the 1-year follow-up assessment of the Nutrition and Function Study. MEASUREMENTS: Objective measures were selected for baseline and 1-year LEP (timed walking, static and dynamic balance, and chair rise) and baseline body mass index (BMI, based on measured weight and knee height). BMI was categorized as underweight/normal (<25.0 kg/m2), overweight (25.0-29.9 kg/m2), moderately obese (30.0-34.9 kg/m2), and severely obese (> or =35.0 kg/m2). Based on summary scores, overall LEP was categorized as poor, intermediate, or good. Sample characteristics included depressive symptomatology, fear of falling, medical conditions, and medication use. RESULTS: Almost 23% of participants were moderately obese and 15% severely obese. Only severe obesity independently increased the odds (odds ratio 2.9-7.0) for diminished performance at 1 year in individual tests and in overall LEP performance. Severe obesity was independently associated with poor LEP at both assessments or with decline in LEP at 1 year. CONCLUSION: These results highlight the need to distinguish between moderate and severe obesity in older people in terms of relationships with key functional outcomes. The findings identify severe obesity in older people as an important target for future interventions. In particular, this calls for greater understanding of intervention goals, whether to primarily target weight reduction or improvement in physical performance.     

Temporal trends in overweight and obesity in Canada, 1981-1996

OBJECTIVE: To assess changes in the prevalence of overweight and obesity among Canadian children and adults between 1981 and 1996 using recent recommendations for the classification of overweight and obesity. DESIGN: Epidemiological study comparing the prevalence of overweight and obesity from the 1981 Canada Fitness Survey (CFS) to the 1996 National Longitudinal Survey of Children and Youth (NLSCY) and the 1996 National Population Health Survey (NPHS). SUBjECTS: Adults 20-64 y of age and children 7-13 y of age from the CFS, NLSCY and NPHS. MEASUREMENTS: BMI was calculated from directly measured or self-reported body mass and height. For adults 20-64 y of age, overweight and obesity were defined as BMI > or = 25 kg/m2 and BMI > or = 30 kg/m2, respectively. Age- and sex-specific cut-off points for children that correspond to the adulthood categories were used to define overweight and obesity for children 7-13 y of age. RESULTS: The prevalence of overweight increased from 48 to 57% among men and from 30 to 35% among women, while the prevalence of obesity increased from 9 to 14% in men and from 8 to 12% in women. The corresponding increases were from 11 to 33% in boys and from 13 to 27% in girls for overweight and from 2 to 10% in boys and from 2 to 9% in girls for obesity. CONCLUSION: The results indicate dramatic increases in the prevalence of both overweight and obesity in Canada over the last 15 y, and the problem is particularly pronounced among children.     

Trends in overweight and obesity among adults in Canada (1970-1992): evidence from national surveys using measured height and weight

PURPOSE: To examine secular trends in obesity and overweight among Canadian adults between 1970 and 1992. The impact of education level and smoking on weight trends is explored. DATA: Adults aged 20-69 participating in three national health surveys which obtained measured height and weight: the Nutrition Canada Survey conducted between 1970 and 1972 (analysis sample n=5963); the Canada Health Survey of 1978-1979 (analysis sample n=3622); and the Canadian Heart Health Surveys conducted between 1986 and 1992 (analysis sample n=17 699). METHODS: Comparison of percentage overweight (age-standardized body mass index (BMI) 25.0-29.9) and obese (age-standardized BMI > or = 30.0) by sex, education level and smoking status across the three surveys. RESULTS: Among men, the proportion overweight and obese increased steadily from 1970-1972 to 1986-1992. Among women, there was a substantial increase in the proportion overweight and obese between 1970-1972 and 1978-1979, then an increase in proportion obese, but not overweight, between 1978-1979 and 1986-1992. Although the prevalence of obesity increased in all education levels, the sub-groups with the greatest relative increase are men in the primary education category, and women in the secondary and post-secondary between 1970-1972 and 1986-1992. An increase in the prevalence of obesity was greatest among current smokers and, to a lesser extent, among former smokers. CONCLUSION: While excess weight has become an increasing public health problem among Canadian adults, the rate of increase in prevalence of obesity since 1970 varied with sex, education level and smoking status. There is a need for new data on measured heights and weights of Canadian adults and children and youth to update trends.     

Is central obesity associated with cirrhosis-related death or hospitalization? A population-based, cohort study.

BACKGROUND & AIMS: We aimed to determine the interaction between body fat distribution (central versus peripheral) and increased body mass index (BMI) with regards to the risk of cirrhosis-related death or hospitalization. METHODS: Participants included 11,434 persons aged 25-74 years without evidence of cirrhosis at entry into the study or during the first 5 years of follow-up who were subsequently followed for a mean of 12.9 years as part of the first National Health and Nutrition Examination Survey. Participants were categorized into "normal-weight" (BMI < 25 kg/m 2 , N = 5750), "overweight" (BMI 25 to < 30 kg/m 2 , N = 3770), and "obese" (BMI > or = 30 kg/m 2 , N = 1914). The subscapular to triceps skinfold thickness ratio (SFR) was used to categorize body fat distribution into central (SFR > 1, N = 5211) and peripheral (SFR < or = 1, N = 6223). RESULTS: Cirrhosis resulted in death or hospitalization of 88 participants during 149,888 person-years of follow-up (59/100,000 person-years). Among persons with a central body fat distribution, cirrhosis-related deaths or hospitalizations were more common in obese persons (115/100,000 person-years, adjusted hazard ratio 2.2, 95% confidence interval [CI] 1.1-4.6) and in overweight persons (94/100,000 person-years, adjusted hazard ratio 1.5, 95% CI 0.8-3.0) compared to normal-weight persons (59/100,000 person-years). However, among persons with a peripheral fat distribution, there was no association between obesity (adjusted hazard ratio 0.7, 95% CI 0.3-1.6) or overweight (adjusted hazard ratio 0.8, 95% CI 0.2-2.8) and cirrhosis-related death or hospitalization. CONCLUSIONS: The risk of cirrhosis-related death or hospitalization appears to be increased in the presence of cirrhosis, but only among persons with a central fat distribution. The excess risk associated with central obesity might be related to insulin resistance and hepatic steatosis.     

Body mass index in middle age and health-related quality of life in older age: the Chicago heart association detection project in industry study

BACKGROUND: Overweight and obesity are associated with higher morbidity and shorter life expectancy, but the effect of body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) ascertained during middle age on subsequent quality of life among older survivors is unknown. This study evaluates whether BMI in middle age is related to health-related quality of life in older age. METHODS: This prospective cohort of adults from the Chicago Heart Association Detection Project in Industry included 6766 middle-aged men and women, aged 36 to 64 years, without diabetes mellitus or myocardial infarction at baseline (November 7, 1967-January 8, 1973), who completed a 26-year follow-up questionnaire in 1996 when they were 65 years and older. Relationships of baseline BMI (categories: normal weight, overweight, and obese) to mean 26-year follow-up Health Status Questionnaire 12 scores (measuring physical, mental, and social well-being) were assessed. RESULTS: For men and women, BMI had significant inverse-graded associations with all Health Status Questionnaire 12 scores (P<.01 for trend for all). Scores (adjusted for baseline cardiovascular disease risk factors and 1996 age) were highest (best) in normal-weight individuals (BMI, 18.5-<25.0) and decreased significantly (P range,.006-<.001 for trend) with higher BMI, with worst outcomes for obese persons (BMI, >or=30.0). A higher multivariate-adjusted percentage of normal-weight persons reported excellent or very good health compared with overweight and obese persons: for women, 46.8% vs 37.9% and 24.3%; and for men, 53.8% vs 49.1% and 36.5% (P<.001 for trend). CONCLUSIONS: A higher BMI in middle age is associated with a poorer quality of life in older age. Preventive measures may lessen the burden of disease and impaired quality of life associated with excess weight.     

Impact of obesity on quality of life and depression in patients with heart failure

BACKGROUND: The effect of obesity on health related quality of life (HRQOL) and depression in a number of disease states is well documented, but its impact in heart failure (HF) patients remains speculative. We therefore examined the relationship between obesity, HRQOL, and depression in 358 patients with HF. METHODS AND RESULTS: Comparative analyses were conducted to determine if body mass index (BMI) was associated with HRQOL and depression in three groups of patients with HF-normal weight (BMI 18.5-24.9 kg/m2, n = 100), overweight (BMI 25-29.9 kg/m2, n = 141), and obese (BMI > or = 30 kg/m2, n = 117). Obese patients were younger than normal and overweight participants; all other demographic and clinical characteristics were similar. HRQOL and depression scores were significantly higher (worse) for obese patients. Body mass index was significantly correlated with all 3 scales of HRQOL (overall, r2 = .160; physical, r2 = .162; and mental, r2 = .217) as well as with depression (r2 = .166). CONCLUSION: Obese patients with HF are more likely to have poorer HRQOL, physical health, emotional well-being and depressive symptoms. Poorer HRQOL is predictive of worse outcomes in patients with HF; however, given the apparent obesity paradox in HF, further investigation of the impact of obesity in HF is urgently required.     

Impact of body mass index on in-hospital outcomes after percutaneous coronary intervention for ST segment elevation acute myocardial infarction.

BACKGROUND: The impact of body mass index (BMI) on outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) remains unclear. METHODS AND RESULTS: A total of 3,076 patients undergoing PCI for AMI within 48 h after symptom onset were studied. Patients were divided into 4 groups according to baseline BMI: lean (<20 kg/m(2)), normal weight (20.0-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)) and obese (>or=30.0 kg/m(2)). Obese patients were younger and had a higher frequency of diabetes mellitus, hyperlipidemia, hypertension and smoking. Lean patients were older, usually women and had a lower frequency of the aforementioned risk factors. Killip class on admission, renal insufficiency, and final Thrombolysis In Myocardial Infarction (TIMI) flow grade did not differ among the 4 groups. In lean, normal weight, overweight and obese patients, in-hospital mortality was 9.2%, 4.4%, 2.5% and 1.8%, respectively (p<0.01). Multivariate analysis showed that compared with normal weight patients, odds ratios for in-hospital death in lean, overweight and obese patients were 1.92, 0.79 and 0.40, respectively (p=NS). Independent predictors were age, Killip class on admission, renal insufficiency and final TIMI flow grade. CONCLUSION: BMI itself had no impact on in-hospital mortality in patients undergoing primary PCI for AMI. The phenomenon ;obesity paradox' may be explained by the fact that obese patients were younger at presentation.     

Excess weight at time of presentation of myocardial infarction is associated with lower initial mortality risks but higher long-term risks including recurrent re-infarction and cardiac death

OBJECTIVES: To evaluate the influence of elevated body mass index (BMI) on short- and long-term survival following acute myocardial infarction (AMI). BACKGROUND: Recent studies suggest an obesity survival paradox in individuals undergoing percutaneous coronary intervention with better 30-day and 1-year outcomes in obese relative to normal weight patients. We tested a similar obesity paradox hypothesis following acute myocardial infarction. METHODS: Short- and long-term all-cause mortality, and risk of recurrent AMI were evaluated according to BMI status in 894 consecutive survivors of AMI <80 years of age admitted to the Mayo Clinic Coronary Care Unit between January 1, 1988 and April 16, 2001. Normal weight, overweight and obesity were defined as BMI <25, 25-29.9, and >30 kg/m(2), respectively. RESULTS: Overall mortality following hospital discharge was significantly lower in overweight and obese patients and was mostly attributable to lower 6-month mortality (adjusted HR = 0.47, P = 0.01 for BMI >25 kg/m(2)) relative to normal weight patients, while long-term mortality among 6-month survivors was similar in all 3 groups. The risk of recurrent AMI was higher in patients with BMI >25 kg/m(2) (adjusted HR = 2.30, P = 0.01). Overweight and obese patients were significantly more likely to die from cardiac rather than non-cardiac causes (P < 0.01). CONCLUSIONS: Following AMI, overweight and obese individuals although paradoxically protected from short-term death have a long-term mortality risk that is similar to normal weight individuals. Younger age at the time of initial infarction and fewer non-cardiovascular comorbidities presumably explain the short-lived obesity survival paradox following myocardial infarction.     

Early anthropometric measures and reproductive factors as predictors of body mass index and obesity among older women

OBJECTIVE: To examine whether early anthropometric measures and reproductive factors were associated with body mass index (BMI), overweight, and obesity. DESIGN: Cross-sectional, observational study. SUBJECTS: In all, 18 109 healthy women who participated in the Swedish Mammography Cohort aged 49-83 y. MEASUREMENTS: Early anthropometric (birthweight and body shape at age 10 y) and reproductive (age at menarche, age at the birth of the first child, and parity) variables were our predictors and current BMI, overweight (BMI 25-29.99 kg/m(2)), and obesity (BMI > or =30 kg/m(2)) were our outcomes. RESULTS: In multivariate-adjusted polytomous logistic regression analysis, risk of overweight and obesity increased with increasing body shape at age 10 y and decreased with increasing age at menarche and age at first birth (P for trend <0.0001). A U-shaped relation with birthweight was observed. In our tests for effect modification of the relation with overweight/obesity (ow/ob; BMI > or =25 kg/m(2)), we detected significant interactions between body shape at 10 y and age (P<0.0001); body shape at 10 y and physical activity (P<0.0001); age at first birth and smoking (P=0.02); and parity and physical activity (P=0.004). The increased risk of ow/ob among women who reported a larger childhood body shape was reduced as women moved from the lowest to highest quartile of physical activity in adulthood. Likewise, the increasing risk of ow/ob among women with greater parity was reduced with increased physical activity. CONCLUSION: Early anthropometric measures and reproductive factors are significantly associated with BMI, overweight, and obesity among older women. The effects of childhood body weight, age at first birth, and parity may be modified by adult lifestyle choices, as well as age.     

Physical activity in relation to development and maintenance of obesity in men with and without juvenile onset obesity

OBJECTIVE: To examine long-term effects of leisure time physical activity (ltpa) and occupational physical activity (opa) on later obesity, and to examine the effect of body weight on later physical inactivity in men with and without juvenile onset obesity. DESIGN: Population-based longitudinal study of obese and nonobese men, who were identified as draftees of median age of 19 y in 1943-77 and later examined at general health surveys in 1982-84, and in 1991-93. SETTING: Copenhagen and adjacent regions, Denmark. PARTICIPANTS: In all, 1143 juvenile obese men with a BMI > or =31 kg/m2 (corresponding to 35% overweight by an originally used national standard) at draft board examination, and, as a nonobese control group, 1278 men selected as a 0.5% random sample of the approximately 255,600 men examined at the draft board and thus representing the study population. MAIN OUTCOME MEASURES: Obesity, defined as BMI > or =30 kg/m2, and physical inactivity at the last survey. RESULTS: In the cross-sectional analyses, there were strong concurrent inverse associations between ltpa and prevalence of obesity in both groups, whereas there was no relation to opa. In logistic regression analyses of obesity at the last survey, including both ltpa and opa as well as age, BMI at draft board examination, BMI at first follow-up, length of education, smoking and drinking habits, there were no significant effects of ltpa and opa on the risk of development of obesity in the nonobese group or maintenance of obesity in the obese group. Similar analyses of physical inactivity at the last follow-up as outcome showed a significant direct effect of BMI at first follow-up, with a significant trend in the nonobese group, but not in the obese group and no effects on opa. CONCLUSION: There is no long-term influence of physical activity on development and maintenance of obesity in men, whereas greater body weight increases risk of later physical inactivity during leisure time.     

Prevalence and associated factors of overweight and obesity in older rural Chinese

Background:  The elderly obese are at increased risk of mortality and morbidity of many obesity-related chronic diseases, such as hypertension, diabetes and coronary heart disease. This study was designed to investigate the epidemiological features of overweight and obesity in older rural Chinese.
Methods:  A cross-sectional survey was conducted during 2004–2005, which undertook multistage cluster sampling method to select a representative sample in Fuxin county, Liaoning province, China. A total of 6643 elderly persons with age ≥60 years was examined. At baseline, lifestyle and other factors were obtained. Overweight and obesity were defined according to the World Health Organization classification and Chinese criteria, respectively.
Results:  Overall, using World Health Organization criteria, the prevalence of overweight and obesity were 13.8 and 1.7%, respectively. Using Chinese criteria, the corresponding figures were 21.2 and 4.0%, respectively. Multivariate logistic regression showed that women, Mongolian nationality, high levels of education and current drinking status were risk factors for overweight or obese participants. Increasing age, high levels of physical activity and current smoking status were shown as protective factors. A positive association was also observed between body mass index and female sex, Mongolian nationality, education levels and current drinking status. However, there was an inverse association between body mass index and age, physical activity levels and current smoking status.
Conclusion:  Although the prevalence of obesity was low, the prevalence of overweight was relatively high in older rural Chinese, especially in female adults. Unfavourable lifestyles, gender, age, ethnicity, education levels and physical activity were associated with the prevalence of these health conditions.