Larger body mass index and waist circumference are associated with lower mortality in Chinese long-term care facility residents

OBJECTIVES: To investigate the association between body mass index (BMI) and waist circumference (WC) and all‐cause mortality of Chinese residents in long‐term care facilities in Taiwan. DESIGN: Prospective cohort study. SETTING: Eight long‐term care facilities in Taiwan. PARTICIPANTS: Three hundred fifty‐four residents aged 60 and older (median 78.4, range 60–101; 156 men, 198 women) were recruited during the study period. MEASUREMENTS: Anthropometrics and metabolic parameters were measured at baseline. Mean BMI was 21.7±4.2 kg/m² (range 11.6–35.3 kg/m², and mean WC was 82.4±10.9 cm (range 55.0–124.0 cm). Mortality data were from the Department of Health in Taiwan. RESULTS: There were 219 deaths during the 5 years of follow‐up. After adjusting for age, sex, albumin, Karnofsky performance status scale, hypertension, and diabetes mellitus, subjects in the highest quartile of BMI (27.3± 2.8 kg/m²) and WC (96.7±7.4 cm) had a significantly lower mortality rate than did subjects in the lowest quartile (BMI, 16.7±1.7 kg/m²; WC, 69.6±4.2 cm). After further stratification according to central obesity status, the subjects in the two highest BMI quartiles had a lower mortality rate than those in the lowest BMI quartile but only in the central obesity group (≥90 cm in men or ≥80 cm in women). The adjusted relative risk for all‐cause mortality in the highest versus lowest BMI quartile was 0.17 (95% confidence interval=0.05–0.57). CONCLUSION: BMI and WC were negative predictors for all‐cause mortality in older Chinese adults living in long‐term care facilities. Participants with higher WC and BMI had lower all‐cause mortality.     

Overweight is an independent risk factor for cardiovascular disease in Chinese populations

In the last decade of the 20th century, cardiovascular disease was the leading cause of death in China, accounting for one‐third of the total deaths. In comparison with western populations, the mean body weight or body mass index (BMI) of the Chinese population was lower, but showed an increasing trend. Whether the variation within lower levels of BMI or waist circumference was associated with other risk factors of cardiovascular disease, and whether they contribute independently to the risk of cardiovascular disease in the Chinese population, was investigated in this study. In keeping with a uniform study design, in each of 14 study populations at different geographical locations and with different characteristics, the incidence rates of stroke, coronary heart disease (CHD) and the causes of death were monitored in ≈100 000 residents from 1991 to 1995 using the MONICA procedure. Risk factors were surveyed in a random cluster sample of 1000 subjects (35–59 years of age) from each population under surveillance using internationally standardized methods and a centralized system to ensure quality control. Among the risk factors, body weight, height, and waist and hip circumferences were measured. Cross‐sectional stratified analyses were used to analyse the relationship of BMI (kg m^?2) or waist circumference to other metabolic risk factors. Ten cohorts among the 14 study populations with 24 734 participants were surveyed from 1982 to 1985 as a baseline for further study and were followed‐up for 9 years taking the events of stroke, CHD and different causes of death as end‐points. Cox regression models were used to explore the association of BMI with the relative risks of stroke, CHD and total death. The survey in 14 random samples with a total number of 19 741 subjects showed that the mean BMI (20.8–25.1) and waist circumference (67.8–86.7 cm) were much lower than those of western populations. There was, however, variation in the anthropometric measurements among populations within China. Thus, rates of overweight varied from 2.7% to 48.1% and obesity from 0% to 9.5% on the basis of the World Health Organization (WHO) classification, but these values were lower than those found in western populations. Data from the 10 cohort samples compared with baseline data in the early 1980s showed that the mean BMIs increased significantly in eight populations during the early 1990s with the differences ranging from 0.5 to 2.5 kg m^?2. Despite the lower level of BMI and the lower rate of overweight, cross‐sectional analyses showed that the prevalence of hypertension, high fasting serum glucose, high serum total cholesterol and low high‐density lipoprotein cholesterol (HDL‐C) and their clustering were all raised with increases in BMI or waist circumference. The prospective cohort study showed that the BMI was one of the independent risk factors for stroke and CHD in Chinese populations. Hence, in a Chinese population characterized by lower levels of BMI and great variability in rates of overweight, variation of BMI was significantly related to the prevalence of other metabolic risk factors and their clustering. Overweight was one of the independent risk factors for stroke and CHD, both at population and individual levels. Given the increasing trends of BMI in the last 10 years, during the period of economic transition there is a need to encourage the population to adopt healthy dietary habits and to increase their physical activity. Health education and health promotion are important for the prevention and non‐pharmacological therapy of cardiovascular disease in China.     

Association of waist circumference,body mass index and conicity index with cardiovascular risk factors in postmenopausal women

Abstract

In menopause, changes in body fat distribution lead to increasing risk of cardiovascular disease and metabolic disorders. The aim of this study was to assess the association of adiposity using the conicity index (CI), body mass index (BMI) and waist circumference (WC) with cardiovascular risk factors (hypertension, diabetes and dyslipidaemia). The sample of this cross-sectional study was collected from June to October 2010 and 165 consecutive menopausal women who had attended the Health and Treatment Centre and Endocrine Research Centre of Firoozgar Hospital in Tehran, Iran were assessed. Age, weight, height, WC, waist–hip ratio (WHR), CI and fat mass were measured. Systolic and diastolic blood pressure (SBP and DBP), fasting blood glucose, insulin, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC) levels were also determined. All statistical analyses were performed by SPSS version 17 (SPSS Inc, Chicago, IL, USA).Results showed that BMI was positively and significantly associated with SBP (r = 0.21; p = 0.009). WC was positively and significantly correlated with SBP (r = 0.26; p = 0.02) and DBP (r = 0.16; p = 0.05). WHR was also significantly and positively associated with SBP (r = 0.29; p = 0.001). Age and WC were associated with CI quartiles at the 0.05 significance level. The correlation of CI quartiles with SBP and weight were at the 0.01 significance level.We showed a significant association of WC with SBP and DBP, and that BMI could be an important determining factor of SBP. For assessing the association between CI and cardiovascular risk factors, future studies with larger sample sizes are recommended.     

Body mass index is inversely related to mortality in older people after adjustment for waist circumference

OBJECTIVES: To examine the individual and combined influence of body mass index (BMI) and waist circumference (WC) on mortality risk in older people. DESIGN: Longitudinal cohort study. SETTING: Cardiovascular Health Study, a longitudinal study of cardiovascular disease and its risk factors in older people. PARTICIPANTS: Five thousand two hundred men and women aged 65 and older. MEASUREMENTS: BMI and WC were measured at baseline. The risks of all-cause mortality associated with BMI and WC were examined using Cox proportional hazards models over 9 years of follow-up. RESULTS: When examined individually, BMI and WC were both negative predictors of mortality, but when BMI and WC were examined simultaneously, BMI was a negative predictor of mortality, whereas WC was a positive predictor of mortality. After controlling for WC, mortality risk decreased 21% for every standard deviation increase in BMI. After controlling for BMI, mortality risk increased 13% for every standard deviation increase in WC. The patterns of associations were consistent by sex, age, and disease status. CONCLUSION: Higher BMI values indicated a lower mortality risk once the risk attributable to WC was accounted for, whereas higher WC values indicate a higher mortality risk once the risk attributable to BMI was accounted for. Both BMI and WC should be measured in the clinical setting, but in older adults higher BMI is associated with lower mortality rates.     

Combined associations of general obesity and central obesity with hypertension stages and phenotypes among children and adolescents in Zhejiang,China

General and central obesity are suggested to be associated with elevated blood pressure (BP), whereas few studies have investigated their combined associations with hypertension in children. This study aimed to assess the associations of combinations of general obesity and central obesity with hypertension in Chinese children, including its stages and phenotypes. A total of 5430 children aged 7–17 years in Zhejiang Province were enrolled. General obesity was evaluated by body mass index (BMI), while central obesity was by waist circumference (WC). Then all children were sorted into three mutually exclusive groups: normal weight with or with no central obesity (NW), abnormal weight with no central obesity (AWNCO), and abnormal weight with central obesity (AWCO). Hypertension was defined as either a systolic or diastolic BP ≥ 95th percentile, and further classified into stage 1 hypertension, stage 2 hypertension, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic diastolic hypertension (SDH). Logistic regression was used. AWNCO and AWCO were associated with stage 1 hypertension (AWNCO, odds ratio [OR] = 1.94, 95% confidence interval [CI]: 1.59-2.37; AWCO, 2.67, 2.20-3.25), stage 2 hypertension (AWNCO, 2.35, 1.33-4.13; AWCO, 4.53, 2.79-7.37), ISH (AWNCO, 2.50, 1.96-3.18; AWCO, 3.95, 3.15-4.95), and SDH (AWNCO, 2.48, 1.75-3.52; AWCO, 2.78, 1.94-3.99). Children with AWCO were more likely to have stage 1 and stage 2 hypertension, as well as ISH and SDH. The combined measurement of general and central obesity is suggested as an appropriate screening tool for hypertension among children and adolescents.     

Dose–response relationship between statin therapy and glycaemia in community‐based patients with type 2 diabetes: the Fremantle Diabetes Study

Although statins may increase glycaemia in type 2 diabetes, available data are from single‐dose intervention trials or studies with no adjustment for concomitant changes in blood glucose‐lowering therapy. To provide real‐life data covering common statin types and doses, glycated haemoglobin (HbA1c) data from patients in the Fremantle Diabetes Study phases I (FDS1) and II (FDS2) and data on stable diabetes treatment before and after statin initiation were analysed. Intensity of statin therapy was categorized as low, moderate or high based on within‐group dose regimens with similar serum LDL cholesterol‐lowering effects. In pooled analyses of 335 eligible patients in FDS1 and FDS2, there was no change in HbA1c in the low‐intensity group (0.04% or 0.4 mmol/mol; n = 159; p = .40), but a mean 0.22% (2.4 mmol/mol) increase in the moderate‐intensity group (n = 185; p = .022) and a larger mean increase of 1.05% (11.5 mmol/mol) increase in the high‐intensity group (n = 11; p = .023). These real‐life data suggest a dose–response relationship between statin treatment intensity and glycaemia that has potential clinical implications.     

Body mass index and risk of all‐cause and cardiovascular mortality in hospitalized elderly patients with diabetes mellitus

Aims Obesity is linked to increased morbidity and mortality risk in both the general population and in patients with diabetes mellitus; however, recent reports suggest that, in hospitalized elderly individuals, the association between body mass index (BMI) and mortality may be inverse. The present study sought to investigate the association between BMI and survival in hospitalized elderly individuals with diabetes mellitus. Methods The medical records of 470 patients (226 males, mean age of 81.5 ± 7.0 years) admitted to an acute geriatric ward between 1999 and 2000 were reviewed. Of the 140 patients with diabetes mellitus, 122 had more than 6 months of follow‐up and were included in this analysis. Patients were followed up until 31 August 2004. Mortality data were extracted from death certificates. Results During a mean follow‐up of 3.7 ± 1.6 years, 69 (56.6%) subjects died, 31 (25.4%) from cardiovascular causes. Those who died from any cause had lower baseline BMI than those who survived (24.0 ± 4.0 vs. 27.1 ± 4.3 kg/m²; P < 0.0001). Similarly, those who died of cardiovascular causes had lower baseline BMI than those who did not (23.7 ± 3.6 vs. 25.9 ± 4.5, P = 0.01). BMI was inversely associated with all‐cause [relative risk (RR) 0.89, 95% confidence interval (CI) 0.83–0.96, P = 0.002] and cardiovascular death (RR 0.83, 95% CI 0.74–0.93, P = 0.002) even after controlling for age, sex, smoking, dyslipidaemia and reason for hospital admission. Conclusions In very elderly subjects with diabetes mellitus, increased BMI was associated with reduced mortality risk.     

不同肥胖指标与社区老年人认知功能关系研究

目的探讨不同肥胖指标(BMI、WC、WHR)与社区老年人认知功能的关系。方法采用分层随机抽样调查方法对上海宝山区大场社区366名65岁及以上居民进行面对面的问卷调查及进行肥胖指标测量,同时采用蒙特利尔认知评估基础量表(MoCA-B)进行认知评估。肥胖相关指标主要包括身体质量指数(BMI)、腰围(WC)和腰臀比(WHR)。结果年龄、教育、BMI及WHR是社区老年人认知的影响因素。大专及以上教育水平(OR=0.177,95%CI0.039~0.809)和高BMI(OR=0.886,95%CI0.807~0.972)是保护因素,年龄(OR=1.087,95%CI1.302~1.145)和WHR(~*10)(OR=2.255,95%CI1.330~3.823)是危险因素。结论WHR是社区老年人认知功能障碍的危险因素。对老年人的认知功能而言,控制腰臀比(WHR)比控制身体质量指数(BMI)更重要。     

2型糖尿病患者伴骨质疏松与血脂的关系

目的探讨2型糖尿病（type 2 diabetes，T2DM）患者骨质疏松（osteoporosis，OP）和血脂的相关性。方法将296例2型糖尿患者按性别分为两组，男106例，女190例。再按其是否合并OP，将上述2组患者再分成2组。比较各组骨密度（BMD）与血脂的相关性。并用二元logist逐步回归方法分析血脂和其他相关因素与OP之间的相关性。结果合并OP的女性T2DM患者甘油三酯（TG）与LI、k、L4的BMD值成正相关（r1=0．302、P1=0．004、r3=0．221、P3=0．039、r4=0．208、P4=0．045），高密度脂蛋白胆固醇（HDL-c）与L1、Neck骨密度成负相关（r1=-0．237、P1：0．026、rN=-0．265、P2=0．013）。未合并OP的女性T2DM患者及男性患者未得到相同的结论，但上述结果在校正年龄和BMI因素后相关关系消失。应用二元logistic回归方法进行分析，只有年龄、性别、体重指数（body mass index，BMI）与OP有关。结论未观察到OP和血脂之间有必然的联系。     

Waist Circumference but Not Body Mass Index Predicts Long‐Term Mortality in Elderly Subjects with Chronic Heart Failure

OBJECTIVES: To examine whether waist circumference (WC) and body‐mass index (BMI) can predict long‐term mortality in elderly subjects with and without chronic heart failure (CHF). DESIGN: Longitudinal evaluation with a 12‐year follow‐up. SETTING: Campania, a region of southern Italy. PARTICIPANTS: One thousand three hundred thirty‐two subjects aged 65 and older selected from the electoral rolls of Campania. MEASUREMENTS: The relationship between WC or BMI and mortality during a 12‐year follow‐up in 125 subjects with and 1,143 subjects without CHF. RESULTS: Mortality increased as WC increased in elderly subjects without CHF (from 47.8% to 56.7%, P=.01), and the increase was even greater in patients with CHF (from 58.1% to 82.0%, P=.01). In contrast, mortality decreased as BMI increased in elderly subjects without CHF (from 53.8% to 46.1%, P0 =.046) but not in those with CHF. According to Cox regression analysis, BMI protected against long‐term mortality in the absence but not in the presence of CHF. In the absence of CHF, WC was associated with a 2% increased risk of long‐term mortality for each 1‐cm greater WC (Hazard Ratio (HR)=1.02, 95% confidence interval (CI)=1.01–1.03; P<.001), versus 5% increased in the presence of CHF (HR=1.06, 95% CI=1.02–1.10; P<.001). CONCLUSION: WC, but not BMI, is predictive of long‐term mortality in elderly individuals with CHF and to a lesser extent in those without CHF.     

湖北地区居民腰围和体质量指数与高血压的相关性研究

目的探讨湖北地区居民腰围及体质量指数(BMI)与高血压之间的相关性。方法采用分层多阶段随机抽样的方法,于2013年1月至2014年1月对湖北地区5个城区及5个乡村年龄15岁居民20 539例进行调查研究。通过体格检查、问卷调查的方式收集调查对象的个人基本情况及腰围等资料。结果男性及女性在高血压发病情况上差异有统计学意义(P0.05)。≥60岁3个不同年龄组(60~69,70~79,80~89岁)研究对象在高血压发病率上随年龄增加而逐渐升高,且差异有统计学意义(P0.05)。高血压组超重、肥胖、腹型肥胖、超重伴腹型肥胖发生率均高于非高血压组。两组人群在超重、肥胖、腹型肥胖、超重伴腹型肥胖发生率上差异有统计学意义(P0.05)。收缩压、年龄、基础代谢、身体脂肪率、内脏脂肪指数、性别均为BMI的危险因素;对于男性,舒张压、基础代谢、身体脂肪率、内脏脂肪指数为中心性肥胖的危险因素,年龄为中心性肥胖的保护因素;对于女性,舒张压、年龄、基础代谢、身体脂肪率、内脏脂肪指数为中心性肥胖的危险因素。结论湖北地区居民超重及肥胖形势严峻,腰围及BMI与高血压关系密切。     

Prediction of cardiovascular and total mortality in Chinese type 2 diabetic patients by the WHO definition for the metabolic syndrome

AIM: The aim of this study is to investigate the prevalence of metabolic syndrome (MES) in type 2 diabetic patients and the predictive values of the World Health Organization (WHO) and National Cholesterol Education Programme (NCEP) definitions and the individual components of the MES on total and cardiovascular mortality. METHODS: A prospective analysis of a consecutive cohort of 5202 Chinese type 2 diabetic patients recruited between July 1994 and April 2001. RESULTS: The prevalence of the MES was 49.2-58.1% depending on the use of various criteria. There were 189 deaths (men: 100 and women: 89) in these 5205 patients during a median (interquartile range) follow-up period of 2.1 (0.3-3.6 years). Of these, 164 (87%) were classified as cardiovascular deaths. Using the NCEP criterion, patients with MES had a death rate similar to those without (3.51 vs. 3.85%). By contrast, based on the WHO criteria, patients with MES had a higher mortality rate than those without (4.3 vs. 2.4%, p = 0.002). Compared to patients with neither NCEP- nor WHO-defined MES, only the group with MES defined by the WHO, but not NCEP, criterion had significantly higher mortality rate (2.6 vs. 6.8%, p < 0.001). Using Cox regression analysis, only age, duration of diabetes and smoking were identified as independent factors for cardiovascular or total death. Among the various components of MES, hypertension, low BMI and albuminuria were the key predictors for these adverse events. CONCLUSIONS: In Chinese type 2 diabetic patients, the WHO criterion has a better discriminative power over the NCEP criterion for predicting death. Among the various components of the MES defined either by WHO or NCEP, hypertension, albuminuria and low BMI were the main predictors of cardiovascular and total mortality.     

Orosomucoid in urine predicts cardiovascular and over-all mortality in patients with Type II diabetes

Aims/hypothesis: Urinary orosomucoid excretion rate is increased in a substantial proportion of patients with Type II (non-insulin-dependent) diabetes mellitus and normal urinary albumin excretion rate. The aim of this study was to determine whether increased urinary orosomucoid excretion rate is predictive of increased mortality in patients with Type II diabetes. Methods: In a cohort study including 430 patients with Type II diabetes, baseline urinary samples were analysed for orosomucoid and albumin. Mean follow-up was 2.4 years. Results: We found that 188 (44 %) patients had normal and 242 (56 %) patients had increased urinary orosomucoid excretion rates. During the study period 41 patients died; out of these 23 patients died of cardiovascular diseases. Odds ratio for all-cause mortality was 2.50 (95 % CI 1.00–6.22) and odds ratio for cardiovascular mortality was 9.81 (1.31–73.6) having increased urinary orosomucoid excretion rate at baseline (odds ratios adjusted for age, sex, duration of diabetes, cardiovascular diseases, weight, medication, HbA_{1 c}, plasma creatinine and urinary albumin excretion rate). Urinary albumin excretion rate was an independent predictor of all-cause mortality when urinary orosomucoid excretion rate was not included in the analysis. Subgroup analysis revealed that 39 % of the patients with normal urinary albumin excretion rate (n = 251) had increased urinary orosomucoid excretion rates and that these patients had a higher cardiovascular mortality (p = 0.007) than patients with normal urinary albumin excretion rate and normal urinary orosomucoid excretion rates. Conclusion/interpretation: We found that urinary orosomucoid excretion rate predicted all-cause and cardiovascular mortality in patients with Type II diabetes independently from other risk factors. [Diabetologia (2002) 45: 115–120] Received: 24 July 2001 and in revised form: 17 September 2001     

Waist circumference, waist-hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults

OBJECTIVES: To compare body mass index (BMI), waist circumference and waist-hip ratio (WHR) as indices of obesity and assess the respective associations with type 2 diabetes, hypertension and dyslipidaemia. DESIGN AND SETTING: A national sample of 11 247 Australians aged > or =25 years was examined in 2000 in a cross-sectional survey. MAIN OUTCOME MEASURES: The examination included a fasting blood sample, standard 2-h 75-g oral glucose tolerance test, blood pressure measurements and questionnaires to assess treatment for dyslipidaemia and hypertension. BMI, waist circumference and WHR were measured to assess overweight and obesity. RESULTS: The prevalence of obesity amongst Australian adults defined by BMI, waist circumference and WHR was 20.8, 30.5 and 15.8% respectively. The unadjusted odds ratio for the fourth vs. first quartile of each obesity measurement showed that WHR had the strongest relationship with type 2 diabetes, dyslipidaemia (women only) and hypertension. Following adjustment for age, however, there was little difference between the three measures of obesity, with the possible exceptions of hypertension in women, where BMI had a stronger association, and dyslipidaemia in women and type 2 diabetes in men, where WHR was marginally superior. CONCLUSIONS: Waist circumference, BMI and WHR identified different proportions of the population, as measured by both prevalence of obesity and cardiovascular disease (CVD) risk factors. Whilst WHR had the strongest correlations with CVD risk factors before adjustment for age, the three obesity measures performed similarly after adjustment for age. Given the difficulty of using age-adjusted associations in the clinical setting, these results suggest that given appropriate cut-off points, WHR is the most useful measure of obesity to use to identify individuals with CVD risk factors.     

Prevalence of obesity, central obesity and the associated factors in urban population aged 20–70 years, in the north of Iran: a population-based study and regression approach

Obesity is an undesirable outcome of changing of lifestyle and behaviours. It is also reversible predisposing factor for the development of several debilitating diseases. This study was aimed to determine the prevalence rate of obesity, overweight, central obesity and their associated factors in the north of Iran. We conducted a population-based cross-sectional study with a sample of 1800 women and 1800 men with respective mean ages of 37.5 +/- 13.0 and 38.5 +/- 14.2 years of urban population aged 20-70 years living in the north of Iran. The demographic and lifestyle data, in particular, age, gender, marital status, marriage age, family history of obesity, educational level, occupation, occupational and leisure time physical activity, duration of exercise per week, parity and the number of children were collected with a designed questionnaire. Diagnosis of obesity and central obesity were confirmed by the WHO standard recommended method by determining of body mass index (BMI) and waist circumference (WC). Logistic regression model was used to estimate the adjusted odds ratio (OR) and its 95% confidence interval. Over half of the study subjects were at educational levels of high school or higher; 79.4% of population was married and 35.3% had a family history of parental obesity. The majority of subjects in particular women had none or low levels of physical activity. The overall prevalence rates of obesity and overweight were 18.8% and 34.8% respectively. The overall prevalence rate of central obesity was 28.3%. The rate of obesity in women was higher than men (P < 0.0001). In both genders, particularly in the women, the rate of obesity was raised by increasing age. There was an inverse relation between the risk of obesity and marriage age, the high level of education (OR = 0.19, P < 0.0001), severe occupational activity (OR = 0.44, P < 0.0001), the level of exercise (in subjects with 3-4 h exercise per week, OR = 0.58, P < 0.001) and leisure time activity. Marriage, history of parental obesity and parity > or =5 were associated with increased risk of obesity (OR = 2.2, P < 0.001 and OR = 2.43, P < 0.0001 and OR = 3.73, P < 0.0001 respectively). The results of this study indicate an increased rate of obesity and overweigh in the north population of Iran. With respect to these findings, low level of activity and education, parity, family history of obesity, marriage at earlier age and ageing are responsible for both obesity and central obesity in the north of Iran. Therefore, a community-based multiple strategies are required to combat with increasing rate of obesity and its subsequent complications such as diabetes, coronary artery disease, hypertension and osteoarthritis.     

Overweight and obesity as protective factors against mortality in nonischemic cardiomyopathy patients with an implantable cardioverter defibrillator

BackgroundPrevious studies have reported inconsistent results on the relationship between body mass index (BMI) and clinical outcomes in implantable cardioverter defibrillator (ICD) patients. Additionally, research on ICD patients with nonischemic cardiomyopathy (NICM) is lacking.HypothesisThis study aimed to investigate the impact of BMI on mortality and ventricular arrhythmias (VAs) in NICM patients with an ICD.MethodsThis study retrospectively analyzed the data from the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device‐implanted patients (SUMMIT) in China. Four hundred and eighty NICM patients with an ICD having BMI data were enrolled. Patients were divided into two groups: underweight and normal range group (BMI < 24 kg/m²), overweight and obese group (BMI≥24 kg/m²). The primary endpoint was all‐cause mortality. The secondary endpoint was the first occurrence of VAs requiring appropriate ICD therapy or shock.ResultsDuring a median follow‐up of 61 (1‐95) months, 70 patients (14.6%) died, 173 patients (36%) experienced VAs requiring appropriate ICD therapy, and 112 patients (23.3%) were treated with ICD shock. Multivariate Cox regression modeling indicated a decreased mortality risk in the overweight and obese group compared with the underweight and normal range group (hazard ratio = 0.44, 95% confidence interval 0.26‐0.77, P = .003). However, the risk of VAs was similar in both groups in univariate and multivariate Cox models.ConclusionsCompared with underweight and normal weight, overweight and obesity are protective against mortality but have only a neutral impact on VAs risk in NICM patients with an ICD.     

Depressive symptom clusters are differentially associated with general and visceral obesity

OBJECTIVES: To examine the relationship between obesity and depressive symptoms taking into account different measures for obesity (body mass index (BMI), waist circumference (WC), and waist‐to‐hip ratio (WHR)) and different depressive symptom clusters. DESIGN: Cross‐sectional population‐based survey. SETTING: Baseline data of the Nijmegen Biomedical Study. PARTICIPANTS: One thousand two hundred eighty‐four persons aged 50 to 70. MEASUREMENTS: Obesity (BMI, WC, and WHR) and depressive symptoms were measured, the latter using the Beck Depression Inventory (BDI). Principal components analysis of the BDI items yielded two factors, one representing a cognitive‐affective symptom cluster and the other a somatic‐affective symptom cluster. Multiple regression analyses corrected for confounders were conducted for each measure of obesity, with separate models testing the BDI sum score and the depression symptom clusters. RESULTS: BMI was significantly associated with BDI sum score (β=0.12, P<.001) and the cognitive‐ (β=0.08, P=.008) and somatic‐affective symptom clusters (β=0.10, P=.001). WC (β=0.11, P<.001) and WHR (β=0.07, P=.004) were specifically associated with the somatic‐affective symptom cluster. CONCLUSION: Visceral obesity, which is more indicative of vascular risk than BMI, is specifically associated with somatic‐affective depressive symptom cluster, which might suggest that these symptoms are primarily due to a (subclinical) somatic condition.