Cardiovascular risk factors in the Federation of Bosnia and Herzegovina

BACKGROUND: Federation of Bosnia and Herzegovina (FBiH) has high cardiovascular disease mortality as other countries in Eastern Europe and situation has even deteriorated in the post war period. Reliable information on risk factor levels and patterns needed in prevention planning and disease management has been lacking. METHODS: A cross sectional population survey was conducted in the FBiH in autumn 2002. A random sample of population, aged 25-64 years, was taken using a three stage stratified sampling methodology. Altogether, 2750 persons participated in the survey (1121 men and 1629 women). The survey was done according to internationally established standards and protocols. RESULTS: The mean systolic blood pressure was 132 mmHg among men and 135 mmHg among women. The mean diastolic blood pressure was 84 mmHg in both genders. Almost 40% of the participants were recognized as hypertensive (blood pressure level over 140/90 mmHg). The prevalence of hypertension among men was 36% and among women 45%. The mean Body Mass Index (BMI) was 26.5 kg/m(2) among males and 27.0 kg/m(2) among females. About 75% of both men and women were overweight (BMI > 25 kg/m(2)) and 16% of men and 20% of women were obese (BMI > 30 kg/m(2)). About 50% of men and 30% of women reported to be daily smokers. CONCLUSIONS: As a whole the non-communicable disease risk factor levels in the FBiH seems to be relatively high. The data can be utilized in health promotion planning and as a baseline for future monitoring activities with possibility of international comparison of results.     

Trimester-specific blood pressure levels in relation to maternal pre-pregnancy body mass index

We evaluated the influence of maternal pre-pregnancy body mass index (BMI), based on reported pre-pregnancy weight and height, on blood pressure (BP) levels during pregnancy by using information from a prospective cohort of 1733 women recruited before 20 weeks' gestation. Maternal antenatal BP values were abstracted from medical records, and we evaluated the mean BP differences according to BMI group in regression models, using generalised estimating equations to account for repeated BP records within each pregnancy. In each trimester, mean systolic BP (SBP) and diastolic BP (DBP) values were positively associated with maternal pre-gestational BMI. This association persisted after adjustment for maternal age, parity, smoking, education, marital status and physical activity. Overweight women (25-29 kg/m(2)) had first-, second- and third-trimester mean SBPs that were 8.1, 7.7 and 8.2 mmHg, respectively, higher than values observed in lean women (<20 kg/m(2)). Mean DBP values were 4.5, 5.4 and 5.6 mmHg higher for each successive trimester in overweight vs. lean women. Obese (>30 kg/m(2)) women consistently had the highest mean SBP and DBP values. Trimester-specific mean SBP values were 10.7-12.0 mmHg higher among obese women vs. lean women. Corresponding trimester-specific mean DBP values were 6.9-7.4 mmHg higher in obese vs. lean women. Similar patterns were observed when trimester-specific average mean arterial pressures were evaluated. Elevated pregnancy BPs associated with maternal pre-gestational BMI are consistent with a large body of literature that documents increased pre-eclampsia risk among overweight and obese women.     

Causes of death in obesity: relevant increase in cardiovascular but not in all-cancer mortality

BACKGROUND AND OBJECTIVE: To assess the relation between body mass index (BMI) and the risk of death from various causes in a prospective cohort study. METHODS: In 6,192 obese patients (BMI > or =25 kg/m(2)) with mean BMI 36.6 kg/m(2) (SD 6.1) and mean age 40.4 years (SD 12.9) who had been referred to the obesity clinic of the Heinrich-Heine-University Düsseldorf, Germany, between 1961 and 1994, there were 1,058 deaths from all causes during a median follow-up time of 14.8 years. We calculated standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) for death from predefined groups of diseases by using Germany as reference population. RESULTS: In both sexes, risk of death from cardiovascular diseases (men: SMR = 2.2, CI 1.9-2.5; women: SMR = 1.6, CI 1.5-1.8), from diabetes (men: SMR = 5.4, CI 3.2-8.7; women: SMR = 3.5, CI 2.6-4.8), and in men from digestive diseases (SMR = 1.6, CI 1.01-2.3) was significantly increased. In contrast to other studies, an association between obesity and all-cancer mortality could not be found. Only in morbidly obese women (BMI > or =40 kg/m(2)), all-cancer mortality was significantly increased (SMR = 1.5, CI 1.1-1.9). CONCLUSION: Obesity is associated with increased risk of death from cardiovascular diseases and diabetes in both sexes, and from diseases of the digestive system in men.     

Prevalence of metabolically healthy obesity and its impacts on incidences of hypertension, diabetes and the metabolic syndrome in Taiwan

Obesity is an epidemic health problem related to morbidity and mortality of metabolic and cardiovascular diseases. However, little is known regarding the development of cardiometabolic diseases in an obese subgroup with a healthy metabolic risk profile. This study examined the prevalence of baseline metabolically healthy obese subjects and its impacts on the incidences of cardiometabolic diseases using a nation-wide population cohort. Metabolically healthy obese were prevalent in 8.2% of the baseline population and 28.5% of the obese subjects. Subjects included were 1,547 men and women (age range, 18-59 years), who were free of components of the metabolic syndrome except waist criteria. During an average 5.4-year follow-up, the cumulative incidences of hypertension, type 2 diabetes and the metabolic syndrome were 7.8%, 1.2% and 5.6%, respectively. The hazard ratios (95% CIs) for the metabolic syndrome incidence were significantly higher at BMI levels of >=23.0 kg/m2 [4.68 (2.22-9.86)] for BMI of 23-24.9 kg/m2; 8.82 (4.01-19.4) for BMI of 25-26.9 kg/m2; and 24.43 (12.33-48.41) for BMI of >=27 kg/m2). The hazard ratios for diabetes or hypertension incidence were significantly higher at BMI levels of >=25.0 kg/m2. Each kg/m2 of BMI gained was associated with an 18% increase in the risk of developing hypertension and a 26% increase in risk for the metabolic syndrome. We conclude that metabolically healthy obese individuals are at higher risk to develop hypertension, type 2 diabetes and the metabolic syndrome than their non-obese counterparts. Our data provide further evidence that opposes the notion of metabolically healthy obese as harmless conditions.     

Modeling the impact of adjustable gastric banding on survival in patients with morbid obesity

OBJECTIVE: Morbid obesity is associated with premature death. Adjustable gastric banding may lead to substantial weight loss in patients with morbid obesity. Little is known about the impact of weight loss on survival after adjustable gastric banding. We therefore developed a mathematical model to estimate life expectancy in patients with a body mass index (BMI) > or =40 kg/m(2) undergoing bariatric surgery. RESEARCH METHODS AND PROCEDURES: We developed a nonhomogeneous Markov chain consisting of five states: the absorbing state ("dead") and the four recurrent states BMI > or =40 kg/m(2), BMI 36 to 39 kg/m(2), BMI 32 to 35 kg/m(2), and BMI 25 to 31 kg/m(2). Scenarios of weight loss and age- and sex-dependent risk of death, as well as BMI-dependent excess mortality were extracted from life tables and published literature. All patients entered the model through the state of BMI > or =40 kg/m(2). RESULTS: In men aged either 18 or 65 years at the time of surgery, who moved from the state BMI > or =40 kg/m(2) to the next lower state of BMI 36 to 39 kg/m(2), life expectancy increased by 3 and 0.7 years, respectively. In women aged either 18 or 65 years at the time of surgery, who moved from the state BMI > or =40 kg/m(2) to the next lower state BMI 36 to 39 kg/m(2), life expectancy increased by 4.5 and 2.6 years, respectively. Weight loss to lower BMI strata resulted in further gains of life expectancy in both men and women. DISCUSSION: Within the limitations of the modeling study, adjustable gastric banding in patients with morbid obesity may substantially increase life expectancy.     

Body mass index and mortality from ischaemic heart disease in a lean population: 10 year prospective study of 220,000 adult men

BACKGROUND: Increased body mass index (BMI) is known to be related to ischaemic heart disease (IHD) in populations where many are overweight (BMI>or=25 kg/m2) or obese (BMI>or=30). Substantial uncertainty remains, however, about the relationship between BMI and IHD in populations with lower BMI levels. METHODS: We examined the data from a population-based, prospective cohort study of 222,000 Chinese men aged 40-79. Relative and absolute risks of death from IHD by baseline BMI were calculated, standardized for age, smoking, and other potential confounding factors. RESULTS: The mean baseline BMI was 21.7 kg/m2, and 1942 IHD deaths were recorded during 10 years of follow-up (6.5% of all such deaths). Among men without prior vascular diseases at baseline, there was a J-shaped association between BMI and IHD mortality. Above 20 kg/m2 there was a positive association of BMI with risk, with each 2 kg/m2 higher in usual BMI associated with 12% (95% CI 6-19%, 2P=0.0001) higher IHD mortality. Below this BMI range, however, the association appeared to be reversed, with risk ratios of 1.00, 1.09, and 1.15, respectively, for men with BMI 20-21.9, 18-19.9, and <18 kg/m2. The excess IHD risk observed at low BMI levels persisted after restricting analysis to never smokers or excluding the first 3 years of follow-up, and became about twice as great after allowing for blood pressure. CONCLUSIONS: Lower BMI is associated with lower IHD risk among people in the so-called normal range of BMI values (20-25 kg/m2), but below that range the association may well be reversed.     

Distribution of blood pressure, body mass index and smoking habits in the urban population of Dar es Salaam, Tanzania, and associations with socioeconomic status

OBJECTIVE: To estimate the distribution of blood pressure (BP), body mass index (BMI), smoking habits and their associations with socioeconomic status (SES) in an urban population in early epidemiological transition. METHODS: Cross-sectional survey of the entire population aged 25-64 years in five branches of Dar es Salaam (Tanzania) through visits to all homes in the study area. Blood pressure was based on the mean of the second and third readings with an automated device. Socioeconomic status was estimated with indicators of education, occupation and wealth. RESULTS: In all 9254 people were examined. Age-adjusted prevalence (%) among men/ women aged 35-64 years was 27.1/30.2 for BP > or = 140/90 mmHg or antihypertensive medication, 13.1/17.7 for BP > or = 160/95 mmHg or antihypertensive medication, 28.0/27.4 for BMI of 25.0-29.9 kg/m(2), 6.9/17.4 for BMI > or = 30 kg/m(2), and 22.0/2.6 for smoking (> or = 1 cigarette per day). Prevalence of categories of drinking frequency and history of diabetes are also reported. After adjustment for covariates, SES was associated inversely with BP and smoking and directly with BMI. Body mass index was associated positively with BP (1.01 and 0.91 mmHg systolic BP per 1 kg/m(2) BMI in men and women, respectively) and inversely with smoking (-1.14 kg/m(2) in male smokers versus non-smokers). Hypertension treatment rates were low, particularly in people of low SES. CONCLUSIONS: High prevalence of several cardiovascular risk factors in the urban population of a low-income country stresses the need for early public health interventions and adaptation of the health care infrastructure to meet the emerging challenge of cardiovascular disease. The direct SES-BMI association may drive increasing BMI and BP while the population becomes more affluent.     

Exercise, body mass index, caloric intake, and cardiovascular mortality

BACKGROUND: The association of physical inactivity and elevated body mass index (BMI) with cardiovascular disease (CVD) risk is well established. The relationship of dietary caloric intake and CVD risk is less certain. METHODS: The epidemiologic follow-up of the First National Health and Nutrition Examination Survey (1971-1992) was examined to determine the relationship of caloric intake, BMI, and physical activity to CVD mortality. Of 14,407 participants, 9790 subjects aged 25 to 74 years met inclusion criteria. The CVD mortality rate was the outcome. RESULTS: During the 17 years of follow-up, there were 3183 deaths, 1531 of which were due to CVD (9.11/1000 person-years). People with relatively less physical activity, lower caloric intake, and who were overweight (BMI 25 to 29.9 kg/m(2)) and obese (BMI > or =30 kg/m(2)) had a less favorable baseline CVD risk profile than did those who were more active and of normal weight and had greater caloric intake. Age- and race/ethnicity-adjusted CVD mortality rates were highest among those with the least physical activity and lowest caloric intake, and who were overweight or obese. Moreover, subjects of normal weight who exercised most were more likely to have high caloric intake and lower CVD mortality (5.9 vs 14.7 per 1000 person-years, p =0.01) than subjects who were obese and exercised least. In Cox regression analysis, controlling for relevant CVD risk factors, least physical activity was independently associated with increased CVD mortality (hazard ratio=1.32, 95% confidence interval [CI]=1.13-1.53); and obesity was associated with increased CVD mortality (hazard ratio=1.24, 95% CI=1.06-1.44). Although highest dietary caloric intake was associated with reduced CVD mortality (hazard ratio=0.83, 95% CI=0.74-0.93), after adjusting for physical activity and BMI, there was no significant association of highest caloric intake with CVD mortality (hazard ratio=0.91, 95% CI=0.81-1.01). CONCLUSIONS: In this large general population sample, lower levels of physical activity and obesity were independently associated with decreased CVD survival. Moreover, when BMI, physical activity, and other relevant characteristics were taken into account, caloric intake was not related to CVD mortality.     

Waist circumference and mortality

The authors examined the association between waist circumference and mortality among 154,776 men and 90,757 women aged 51-72 years at baseline (1996-1997) in the NIH-AARP Diet and Health Study. Additionally, the combined effects of waist circumference and body mass index (BMI; weight (kg)/height (m)(2)) were examined. All-cause mortality was assessed over 9 years of follow-up (1996-2005). After adjustment for BMI and other covariates, a large waist circumference (fifth quintile vs. second) was associated with an approximately 25% increased mortality risk (men: hazard ratio (HR) = 1.22, 95% confidence interval (CI): 1.15, 1.29; women: HR = 1.28, 95% CI: 1.16, 1.41). The waist circumference-mortality association was found in persons with and without prevalent disease, in smokers and nonsmokers, and across different racial/ethnic groups (non-Hispanic Whites, non-Hispanic Blacks, Hispanics, and Asians). Compared with subjects with a combination of normal BMI (18.5-<25) and normal waist circumference, those in the normal-BMI group with a large waist circumference (men: > or =102 cm; women: > or =88 cm) had an approximately 20% higher mortality risk (men: HR = 1.23, 95% CI: 1.08, 1.39; women: HR = 1.22, 95% CI: 1.09, 1.36). The finding that persons with a normal BMI but a large waist circumference had a higher mortality risk in this study suggests that increased waist circumference should be considered a risk factor for mortality, in addition to BMI.     

Eligibility for obesity treatment and risk of mortality in men

OBJECTIVE: To evaluate the risk of all-cause and cardiovascular disease (CVD) mortality associated with each outcome of the NIH obesity treatment algorithm and to examine the effects of cardiorespiratory fitness on the risk of mortality associated with these outcomes. RESEARCH METHODS AND PROCEDURES: The NIH obesity treatment algorithm was applied to 18,666 men (20 to 64 years of age) from the Aerobics Center Longitudinal Study in Dallas, TX, examined between 1979 and 1995. Risk of all-cause and CVD mortality was assessed using Cox proportional hazards regression. RESULTS: A total of 7029 men (37.7%) met the criteria for needing weight loss treatment [overweight (BMI = 25 to 29.9 kg/m2 or WC > 102 cm) with > or =2 CVD risk factors or obese (BMI > or = 30 kg/m2)]. Mortality surveillance through 1996 identified 435 deaths (151 from CVD) during 191,364 man-years of follow-up. Compared with the normal weight reference group, the hazard ratios (95% confidence interval) for death from all causes were 0.63 (0.45 to 0.88), 1.23 (0.98 to 1.54), 1.05 (0.60 to 1.85), and 1.71 (1.64 to 2.31) for men who were overweight with <2 CVD risk factors, overweight with > or = 2 CVD risk factors, obese with <2 CVD risk factors, and obese with > or =2 CVD risk factors, respectively. Corresponding hazard ratios for CVD mortality were 0.72 (0.38 to 1.37), 1.67 (1.12 to 2.50), 1.69 (0.67 to 4.30), and 3.31 (2.07 to 5.30). Including physical fitness as a covariate significantly attenuated all risk estimates. DISCUSSION: The NIH obesity treatment algorithm is useful in identifying men at increased risk of premature mortality; however, including an assessment of fitness would help improve risk stratification among all groups of patients.     

Four-week pedometer-determined activity patterns in normal-weight, overweight and obese adults

OBJECTIVE: To assess pedometer-determined ambulatory activity in normal-weight, overweight and obese UK adults. METHODS: Eighty-six normal-weight (BMI <25 kg/m(2)) (age=34+/-12.1 years), 91 overweight (BMI 25-29.9 kg/m(2)) (age=40.6+/-13.6 years) and 75 obese (BMI >or= 30 kg/m(2)) (age=41.2+/-12.4 years) participants, from the East Midlands, provided 4 weeks of continuous pedometer-determined activity data, during the winter in 2006. Activity levels and patterns were assessed for all three groups. RESULTS: The normal-weight group had a significantly higher mean step count (10247 steps/day) than the overweight (9095 steps/day) and obese (8102 steps/day) participants (p<0.05). No differences in step counts were observed between the overweight and obese groups. A consistent reduction in activity was observed on Sundays in all groups, with this reduction being two-fold greater in the overweight and obese groups (approximately 2000 steps/day) when compared with the normal-weight group (approximately 1000 steps/day). CONCLUSIONS: With the increasing prevalence of obesity in the UK, changes in the activity levels of those at risk are needed. The issuing of pedometers to overweight and obese individuals, with the instruction to increase their ambulatory activity on all days of the week, with particular emphasis on Sunday activity, could be a good starting point in tackling the problem of obesity in the UK.     

The impact of body mass index of 78,612 18-year old Dutch men on 32-year mortality from all causes

In a non-concurrent cohort study, the data from medical examinations of 78,612 Dutch men at the age of 18 were linked to mortality registrations over a follow-up period of 32 years. Body weight and height, blood pressure, resting pulse rate, education, birth order and a health score were recorded. The average Body Mass Index was 20.8 kg/m2. About 5% of the men were very lean (BMI less than 18) and only about 2% had grade I obesity (BMI greater than 25). During 32 years of follow-up 3642 men died. By means of a logistic regression analysis the impact of Body Mass Index (BMI) at the age of 18 on longevity was investigated. Healthy, well-educated men with a BMI of 19 had a higher rate of survival during the entire follow-up period. A negative effect of a high BMI (greater than 25) was only demonstrable after 20 years of follow-up. Men with a BMI under 18 had an increased mortality risk, which was mainly caused by an impaired health status. The results of this study support the hypothesis that moderately obese young men have an increased mortality risk.     

Obesity in South Africa: the South African demographic and health survey

OBJECTIVES: To ascertain the anthropometric profile and determinants of obesity in South Africans who participated in the Demographic and Health Survey in 1998. RESEARCH METHODS AND PROCEDURES: A sample of 13,089 men and women (age, > or =15 years) were randomly selected and then stratified by province and urban and nonurban areas. Height, weight, mid-upper arm circumference, and waist and hip circumference were measured. Body mass index (BMI) was used as an indicator of obesity, and the waist/hip ratio (WHR) was used as an indicator of abdominal obesity. Multivariate regression identified sociodemographic predictors of BMI and waist circumference in the data. RESULTS: Mean BMI values for men and women were 22.9 kg/m(2) and 27.1 kg/m(2), respectively. For men, 29.2% were overweight or obese (> or =25 kg/m(2)) and 9.2% had abdominal obesity (WHR > or =1.0), whereas 56.6% of women were overweight or obese and 42% had abdominal obesity (WHR >0.85). Underweight (BMI <18.5 kg/m(2)) was found in 12.2% of men and 5.6% of women. For men, 19% of the variation of BMI and 34% of the variation in waist circumference could be explained by age, level of education, population group, and area of residence. For women, these variables explained 16% of the variation of BMI and 24% of the variation in waist circumference. Obesity increased with age, and higher levels of obesity were found in urban African women. DISCUSSION: Overnutrition is prevalent among adult South Africans, particularly women. Determinants of overnutrition include age, level of education, ethnicity, and area of residence.     

Dietary zinc intake is inversely associated with systolic blood pressure in young obese women

Zinc may participate in blood pressure regulation and in the pathogenesis of hypertension. The study examined the relationship between zinc status and blood pressure in obese Korean women. Forty obese women (body mass index (BMI) ≥ 25 kg/m²) aged 19-28 years participated in this study. Zinc intake was estimated from one 24 hour recall and 2-day diet records. Serum and urinary zinc concentrations were determined by atomic absorbance spectrophotometry. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using an automatic sphygmometer. Metabolic variables, such as waist circumference, triglyceride, high density lipoprotein (HDL) cholesterol, fasting glucose, and fasting insulin, were also measured. Dietary zinc intake of obese women was averagely 7.5 mg/day. Serum zinc and urinary zinc concentrations were 13.4 µmol/L and 378.7 µg/day, respectively. Averages of SBP and DBP were 119 mmHg and 78 mmHg. Dietary zinc intake was negatively correlated with SBP after adjusting for energy intake (P < 0.05), but serum and urinary zinc concentrations were not found to be correlated with SBP or DBP. Multivariate linear regression analysis showed that dietary zinc intake was inversely associated with SBP in obese women after adjusting for body weight, energy intake and sodium intake (P = 0.0145). The results show that dietary zinc intake may be an independent risk factor of elevated SBP in obese Korean women.     

Anthropometrics and prostate cancer risk

Studies on obesity and prostate cancer risk are inconsistent, perhaps because of differential effects on aggressive and nonaggressive cancers. Participants included 34,754 men residing in Washington State (aged 50-76 years at baseline) in a prospective cohort study who were recruited between 2000 and 2002; 383 developed aggressive (regional/distant stage or Gleason sum 7-10) and 437 developed nonaggressive disease through December 2004. Compared with normal-weight men (body mass index (kg/m(2)) <25), obese men (> or = 30 kg/m(2)) had a reduced risk of nonaggressive disease (hazard ratio = 0.69, 95% confidence interval: 0.52, 0.93; p for trend = 0.01). Overweight men (25-29.9 kg/m(2)) had an increased risk of aggressive disease (hazard ratio = 1.4, 95% confidence interval: 1.1, 1.8), but there was no increased risk for obese men (p for trend = 0.69). Body mass index of >25 at age 18 years was associated with increased risk of aggressive prostate cancer; obesity at ages 30 and 45, but not 18, years was associated with reduced risk of nonaggressive prostate cancer. Height (fourth vs. first quartile) was associated with an increased risk of total prostate cancer (hazard ratio = 1.3, 95% confidence interval: 1.1, 1.6), which did not differ by aggressiveness. There were no associations of prostate cancer with age at which maximum height was reached. Results from this study demonstrate the complexity of prostate cancer epidemiology and the importance of examining risk factors by tumor characteristics.     

Influence of excess fat on cardiac morphology and function: study in uncomplicated obesity

OBJECTIVE: To evaluate whether or not "uncomplicated" obesity (without associated comorbidities) is really associated with cardiac abnormalities. RESEARCH METHODS AND PROCEDURES: We evaluated cardiac parameters in obese subjects with long-term obesity, normal glucose tolerance, normal blood pressure, and regular plasma lipids. We selected 75 obese patients [body mass index (BMI) >30 kg/m(2)], who included 58 women and 17 men (mean age, 33.7 +/- 11.9 years; BMI, 37.8 +/- 5.5 kg/m(2)) with a > or =10-year history of excess fat, and 60 age-matched normal-weight controls, who included 47 women and 13 men (mean age, 32.7 +/- 10.4 years; BMI, 23.1 +/- 1.4 kg/m(2)). Each subject underwent an oral glucose tolerance test to exclude impaired glucose tolerance or diabetes mellitus, bioelectrical impedance analysis to calculate fat mass and fat-free mass, and echocardiography. RESULTS: Obese patients presented diastolic function impairment, hyperkinetic systole, and greater aortic root and left atrium compared with normal subjects. No statistically significant differences between obese subjects and normal subjects were found in indexed left ventricular mass (LVM/body surface area, LVM/height(2.7), and LVM/fat-free mass(kg)), and no changes in left ventricular geometry were observed. No statistically significant differences in cardiac parameters between extreme (BMI > 40 kg/m(2)) and mild obesity (BMI < 35 kg/m(2)) were observed. DISCUSSION: In conclusion, our data showed that obesity, in the absence of glucose intolerance, hypertension, and dyslipidemia, seems to be associated only with an impairment of diastolic function and hyperkinetic systole, and not with left ventricular hypertrophy.     

Obesity, abdominal obesity, and clustering of cardiovascular risk factors in South Korea

The aim of this study was first, to investigate the prevalence of obesity, abdominal obesity, and clustering of cardiovascular (CVD) risk factors, and secondly, to identify the BMI or waist circumference (WC) level at which clustering increases in South Koreans. A population-based, cross-sectional National Health Examination Survey was carried out in 1998. A total of 8,816 subjects (4,029 men and 4,787 women) aged 15-79 y were selected by stratified multistage probability sampling design. The measurements taken of the subjects included: height, weight, waist and hip circumference, blood pressure, fasting glucose, and lipids. The prevalence of BMI > or = 25 kg/m2 was 25.3% for men and 28.3% for women. The prevalence of WC >90 cm in men, and >80 cm in women was 18.5%, and 38.5%, respectively. Clustering of 3 or more CVD risk factors was 22.7% in men ad 21.7% in women. Using <21 kg/m2; as a referent, subjects with BMI of 23 kg/m2; and 27 kg/m2; had an odds ratio of 3.5 and 10.2 in men, and 3.1 and 6.7 in women, respectively for clustering of CVD risk factors. Using <65 cm as a referent, subjects with a WC of > or = 90 cm in men and > or = 85 cm in women had an odds ratio of 13.4, and 13.6, respectively for clustering of CVD risk factors. Considering the significant associations between clustering of CVD risk factors and BMI or WC, the present study suggests that high prevalence of overweight may have important implications for the health care system, even at a lower level of BMI or WC.     

Adapted changes in left ventricular structure and function in severe uncomplicated obesity

OBJECTIVE: A massive amount of fat tissue, as that observed in obese subjects with BMI over 50 kg/m(2), could affect cardiac morphology and performance, but few data on this issue are available. We sought to evaluate cardiac structure and function in uncomplicated severely obese subjects. RESEARCH METHODS AND PROCEDURES: We studied 55 uncomplicated severely obese patients, 40 women, 15 men, mean age 35.5 +/- 10.2 years, BMI 51.2 +/- 8.8 kg/m(2), range 43 to 81 kg/m(2), with a history of fat excess of at least 10 years, and 55 age-matched normal-weight subjects (40 women, 15 men, mean BMI 23.8 +/- 1.2 kg/m(2)) as a control group. Each subject underwent an echocardiogram to evaluate left ventricular (LV) mass and geometry and systolic and diastolic function. RESULTS: Severely obese subjects showed greater LV mass and indexed LV mass than normal-weight subjects (p < 0.01 for all parameters). Nevertheless, LV mass was appropriate for sex, height(2.7), and stroke work in most (77%) uncomplicated severely obese subjects. In addition, no significant difference in LV mass indices and LV mass appropriateness between obese subjects with BMI > or = 50 kg/m(2) and those with BMI < or = 50 kg/m(2) was found. Obese subjects also showed higher ejection fraction and midwall shortening than normal-weight subjects (p = 0.05 and p < 0.01, respectively), suggesting a hyperdynamic systolic function. No significant difference in systolic performance between obese subjects with BMI > or = 50 kg/m(2) and those with BMI < or = 50 kg/m(2) was seen. DISCUSSION: Our data show that uncomplicated severe obesity, despite the massive fat tissue amount, is associated largely with adapted and appropriate changes in cardiac structure and function.     

Impact of overweight and obesity on medical care costs, all-cause mortality, and the risk of cancer in Japan

We conducted three prospective cohort studies that examined the association between body mass index (BMI) and health outcomes in Japan. Our studies found statistically significant relationships between excess body weight and increased medical costs, all-cause mortality, and risk of cancer incidence. There was a U-shaped association between BMI and mean total costs. The estimated excess costs attributable to overweight and obesity was 3.2% of the total costs. This 3.2% is within the range reported in studies in Western countries (0.7%-6.8%). We observed statistically significant elevations in mortality risk in obese (BMI> or = 30.0 kg/m(2)) women and lean (BMI<18.5 kg/m(2)) men and women. Our prospective cohort study found statistically significant relationships between excess weight and increased risk in women of all cancers. The population attributable fraction (PAF) of all incident cancers in this population that were attributable to overweight and obesity were 4.5% in women, which were within the range reported from Western populations, from 3.2% for US women to 8.8% for Spanish women. Our data suggests that excess body weight is a problem not only in Western countries but also in Japan.