Rate of Decline in Serum PFOA Concentrations after Granular Activated Carbon Filtration at Two Public Water Systems in Ohio and West Virginia

Background

Drinking water in multiple water districts in the Mid-Ohio Valley has been contaminated with perfluorooctanoic acid (PFOA), which was released by a nearby DuPont chemical plant. Two highly contaminated water districts began granular activated carbon filtration in 2007.

Objectives

To determine the rate of decline in serum PFOA, and its corresponding half-life, during the first year after filtration.

Methods

Up to six blood samples were collected from each of 200 participants from May 2007 until August 2008. The primary source of drinking water varied over time for some participants; our analyses were grouped according to water source at baseline in May–June 2007.

Results

For Lubeck Public Service District customers, the average decrease in serum PFOA concentrations between May–June 2007 and May–August 2008 was 32 ng/mL (26%) for those primarily consuming public water at home (n = 130), and 16 ng/mL (28%) for those primarily consuming bottled water at home (n = 17). For Little Hocking Water Association customers, the average decrease in serum PFOA concentrations between November–December 2007 and May–June 2008 was 39 ng/mL (11%) for consumers of public water (n = 39) and 28 ng/mL (20%) for consumers of bottled water (n = 11). The covariate-adjusted average rate of decrease in serum PFOA concentration after water filtration was 26% per year (95% confidence interval, 25–28% per year).

Conclusions

The observed data are consistent with first-order elimination and a median serum PFOA half-life of 2.3 years. Ongoing follow-up will lead to improved half-life estimation.     

Maternal Diet Quality,Body Mass Index and Resource Use in the Perinatal Period: An Observational Study

The impact of pre-pregnancy obesity and maternal diet quality on the use of healthcare resources during the perinatal period is underexplored. We assessed the effects of body mass index (BMI) and diet quality on the use of healthcare resources, to identify whether maternal diet quality may be effectively targeted to reduce antenatal heath care resource use, independent of women’s BMI. Cross-sectional data and inpatient medical records were gathered from pregnant women attending publicly funded antenatal outpatient clinics in Newcastle, Australia. Dietary intake was self-reported, using the Australian Eating Survey (AES) food frequency questionnaire, and diet quality was quantified from the AES subscale, the Australian Recommended Food Score (ARFS). Mean pre-pregnancy BMI was 28.8 kg/m² (range: 14.7 kg/m²–64 kg/m²). Mean ARFS was 28.8 (SD = 13.1). Higher BMI was associated with increased odds of caesarean delivery; women in obese class II (35.0–39.9 kg/m²) had significantly higher odds of caesarean delivery compared to women of normal weight, (OR = 2.13, 95% CI 1.03 to 4.39; p = 0.04). Using Australian Refined Diagnosis Related Group categories for birth admission, the average cost of the birth admission was $1348 more for women in the obese class II, and $1952 more for women in the obese class III, compared to women in a normal BMI weight class. Higher ARFS was associated with a small statistically significant reduction in maternal length of stay (RR = 1.24, 95% CI 1.00, 1.54; p = 0.05). There was no evidence of an association between ARFS and mode of delivery or “midwifery-in-the-home-visits”.     

Effect of Secular Trend,Age, and Length of Follow-up on Optimum Body Mass Index From 1985 Through 2015 in a Large Austrian Cohort

BackgroundObesity and its health consequences will dominate health care systems in many countries during the next decades. However, the body mass index (BMI) optimum in relation to all-cause mortality is still a matter of debate.Material and MethodsData of the Vorarlberg Health Monitoring & Prevention Program (VHM&PP, 1985–2005) and data provided by the Main Association of Austrian Social Security Institutions (MAASSI, 2005–2015) were analyzed. Information was available on age, sex, smoking status, measured height and weight, and mortality. Generalized additive models were used to model mortality as a function of BMI, calendar time, age, and follow-up.ResultsIn MAASSI (N = 282,216, 46.0% men), men and women were on average 2.7 years older than in VHM&PP (N = 185,361, 46.1% men). Average BMI was slightly higher in men (26.1 vs 25.7 kg/m²) but not in women (24.6 vs 24.7 kg/m²). We found an interactive effect of age and follow-up on the BMI optimum. Over age 35 years in men and 55 years in women, the BMI optimum decreased with length of follow-up. While keeping covariates fixed, BMI optimum increased slightly between 1985 and 2015 in men and women, 24.9 (95% CI, 23.9–25.9) to 26.4 (95% CI, 25.3–27.3), and 22.4 (95% CI, 21.7–23.1) to 23.3 (95% CI, 22.6–24.5) kg/m², respectively.ConclusionAge and length of follow-up have a pronounced effect on the BMI associated with the lowest all-cause mortality. After controlling for age and length of follow-up, the BMI optimum increased slightly over 30 years in this large study sample.Key words: BMI, mortality, age, secular trend, length of follow-up     

The Influence of Obesity on Nutrition and Physical Activity during COVID-19 Pandemic: A Case-Control Study

Obesity is one of the important risk factors for a severe course of COVID-19. Maintaining a healthy body weight through diet and physical activity is a reasonable approach to preventing a SARS-CoV-2 infection or in alleviating its course. The goal of the study was to determine the influence of obesity on nutrition and physical activity during the COVID-19 pandemic. A total of 964 respondents, including 227 individuals with a body mass index (BMI) ≥30 kg/m² were evaluated in this study. In the case of 482 respondents, including 105 individuals (21.8%) with BMI ≥ 30 kg/m², the data were collected during the pandemic period from 1 June to 31 August 2020. The remaining 482 individuals were the “pre-pandemic” group, selected via propensity score matching (PSM) out of the 723 National Health Program study participants whose data was collected in 2017–2019. The evaluated dietary health factors were quantitatively similar in patients with BMI of either <30 kg/m² or ≥30 kg/m² and showed no significant changes during the pandemic. The diets of those who suffered from obesity prior to the pandemic showed the evaluated unhealthy nutritional factors to be less pronounced in comparison with those of individuals with BMI < 30 kg/m². During the pandemic, the BMI ≥ 30 kg/m² group showed a significant increase in the overall calorie intake (by 319 kcal; p = 0.001) and an increased consumption of total carbohydrates 299.3 ± 83.8 vs. 252.0 ± 101.5; p = 0.000), sucrose (51.7 ± 30.0 vs. 71.6 ± 49.9; p = 0.000), plant protein (26.3 ± 12.1 vs. 29.3 ± 8.3; p = 0.040), total fat (73.1 ± 42.6 vs. 84.9 ± 29.6; p = 0.011) and saturated fatty acids (29.5 ± 16.4 vs. 34.3 ± 13.9; p = 0.014) in comparison with the pre-pandemic period. The energy and nutritional value of the diets of BMI < 30 kg/m² individuals did not change between the pre-pandemic and pandemic period. Before the pandemic, the level of leisure physical activity of the BMI ≥ 30 kg/m² group was significantly lower than of those with BMI < 30 kg/m². Such differences were not observed in the levels of physical activity at work or school. The pandemic did not alter the amount of physical activity either during leisure time or at work/school in individuals with BMI ≥ 30 kg/m². However, respondents without obesity exercised significantly less during the pandemic than before. In conclusion, the pandemic altered the diets and levels of physical activity in the Polish population, with dietary changes observed in individuals with BMI ≥ 30 kg/m² and changes in physical activity observed in those with BMI < 30 kg/m².     

Better Adherence to the Mediterranean Diet Could Mitigate the Adverse Consequences of Obesity on Cardiovascular Disease: The SUN Prospective Cohort

Strong observational evidence supports the association between obesity and cardiovascular events. In elderly high-risk subjects, the Mediterranean diet (MedDiet) was reported to counteract the adverse cardiovascular effects of adiposity. Whether this same attenuation is also present in younger subjects is not known. We prospectively examined the association between obesity and cardiovascular clinical events (myocardial infarction, stroke or cardiovascular death) after 10.9 years follow-up in 19,065 middle-aged men and women (average age 38 year) according to their adherence to the MedDiet (<6 points or ≥6 points in the Trichopoulou’s Mediterranean Diet Score). We observed 152 incident cases of cardiovascular disease (CVD). An increased risk of CVD across categories of body mass index (BMI) was apparent if adherence to the MedDiet was low, with multivariable-adjusted hazard ratios (HRs): 1.44 (95% confidence interval: 0.93–2.25) for ≥25 – <30 kg/m² of BMI and 2.00 (1.04–3.83) for ≥30 kg/m² of BMI, compared to a BMI < 25 kg/m². In contrast, these estimates were 0.77 (0.35–1.67) and 1.15 (0.39–3.43) with good adherence to MedDiet. Better adherence to the MedDiet was associated with reduced CVD events (p for trend = 0.029). Our results suggest that the MedDiet could mitigate the harmful cardiovascular effect of overweight/obesity.     

Body Mass Index and Weight Change During Adulthood Are Associated With Increased Mortality From Liver Cancer: The JACC Study

Background

We investigated the association of baseline body mass index (BMI) and weight change since age 20 years with liver cancer mortality among Japanese.

Methods

The data were obtained from the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). A total of 31 018 Japanese men and 41 455 Japanese women aged 40 to 79 years who had no history of cancer were followed from 1988 through 2009.

Results

During a median 19-year follow-up, 527 deaths from liver cancer (338 men, 189 women) were documented. There was no association between baseline BMI and liver cancer mortality among men or men with history of liver disease. Men without history of liver disease had multivariable hazard ratios (HR) of 1.95 (95%CI, 1.07–3.54) for BMI less than 18.5 kg/m² and 1.65 (1.05–2.60) for BMI of 25 kg/m² or higher, as compared with a BMI of 21.0 to 22.9 kg/m². BMI was positively associated with liver cancer mortality among women and women with history of liver disease. Weight change since age 20 years was positively associated with liver cancer mortality among women regardless of history of liver disease. Women with history of liver disease had a multivariable HRs of 1.96 (1.05–3.66) for weight gain of 5.0 to 9.9 kg and 2.31 (1.18–4.49) for weight gain of 10 kg or more, as compared with weight change of −4.9 to 4.9 kg.

Conclusions

Both underweight (BMI <18.5 kg/m²) and overweight (BMI ≥25 kg/m²) among men without history of liver disease, and weight gain after age 20 (weight change ≥5 kg) among women with history of liver disease, were associated with increased mortality from liver cancer.Key words: weight change, body mass index, liver cancer, mortality, prospective study, epidemiology     

Association of Body Mass Index with Ischemic and Hemorrhagic Stroke

Data on the association between body mass index (BMI) and stroke are scarce. We aimed to examine the association between BMI and incident stroke (ischemic or hemorrhagic) and to clarify the relationship between underweight, overweight, and obesity and stroke risk stratified by sex. We analyzed the JMDC Claims Database between January 2005 and April 2020 including 2,740,778 healthy individuals (Median (interquartile) age, 45 (38–53) years; 56.2% men; median (interquartile) BMI, 22.3 (20.2–24.8) kg/m²). None of the participants had a history of cardiovascular disease. Each participant was categorized as underweight (BMI <18.5 kg/m²), normal weight (BMI 18.5–24.9 kg/m²), overweight (BMI 25.0–29.9 kg/m²), or obese (BMI ≥ 30 kg/m²). We investigated the association of BMI with incidence stroke in men and women using the Cox regression model. We used restricted cubic spline (RCS) functions to identify the association of BMI as a continuous parameter with incident stroke. The incidence (95% confidence interval) of total stroke, ischemic stroke, and hemorrhagic stroke was 32.5 (32.0–32.9), 28.1 (27.6–28.5), and 5.5 (5.3–5.7) per 10,000 person-years in men, whereas 25.7 (25.1–26.2), 22.5 (22.0–23.0), and 4.0 (3.8–4.2) per 10,000 person-years in women, respectively. Multivariable Cox regression analysis showed that overweight and obesity were associated with a higher incidence of total and ischemic stroke in both men and women. Underweight, overweight, and obesity were associated with a higher hemorrhagic stroke incidence in men, but not in women. Restricted cubic spline showed that the risk of ischemic stroke increased in a BMI dose-dependent manner in both men and women, whereas there was a U-shaped relationship between BMI and the hemorrhagic stroke risk in men. In conclusion, overweight and obesity were associated with a greater incidence of stroke and ischemic stroke in both men and women. Furthermore, underweight, overweight, and obesity were associated with a higher hemorrhagic stroke risk in men. Our results would help in the risk stratification of future stroke based on BMI.     

Comparison of Abdominal Visceral Adipose Tissue Area Measured by Computed Tomography with That Estimated by Bioelectrical Impedance Analysis Method in Korean Subjects

We evaluated the concordance between visceral fat area (VFA) estimated by bioelectrical impedance analysis (BIA) or computed tomography (CT) in Korean subjects with a wide range in age and body mass index (BMI). In 1006 individuals (mean age 55.2 ± 11.8 (19–87) years, mean BMI 26.0 ± 3.5 (17–46) kg/m², 48.9% men), VFA quantified by CT was compared with VFA using multifrequency BIA machines within 15 days. Concordance rates were compared by age or BMI using correlation analysis, Bland-Altman plots, and intraclass correlation coefficient (ICC). Using BIA data, we established a regression formula to reflect CT-VFA. The mean VFAs by CT and BIA were 131.9 ± 57.3 cm² and 110.5 ± 33.9 cm², respectively (r = 0.605, p < 0.001). The mean difference was 21.4 ± 45.6 cm², tending to increase with BMI. In women with BMI <25 kg/m² or age <50 years, the VFAs by BIA were similar to those by CT (ICC = 0.496 in BMI <25 kg/m² and ICC = 0.638 in age <50 years). However, the difference was greater in men with BMI ≥25 kg/m² or age ≥50 years. Applying our formula, the difference between estimations decreased to 0.2 ± 38.2cm². VFA estimated by BIA correlated well with that by CT, but a more accurate formula is needed to match CT data, particularly in older men or subjects with a high BMI.     

University of Hawai‘i Cancer Center Connection: Bias in Self-reported Anthropometry in Relation to Adiposity and Adulthood Weight Gain among Postmenopausal Caucasian and Japanese American Women

Adiposity is often approximated by body mass index (BMI) in population studies based on self-reported weight and height (kg/m²). However, self-reports tend to underestimate weight and overestimate height, leading to an underestimation of BMI and the prevalence of overweight and obesity. We examined a subgroup of the Multiethnic Cohort Study participants to determine how well self-reported and measured anthropometry correlate with each other, overall and by race/ethnicity, total and abdominal adiposity level, and amount of adulthood weight gain. A cross-sectional sample of 30 Caucasian and 30 Japanese American female cohort participants, between ages 60–65, was selected in such a way the two groups had a similar BMI distribution across the range (18.5–40 kg/m²). Subjects first reported their weight, height, and waist and hip circumferences at home and within several days underwent objective measurements by trained staff and also a whole-body scan of dual energy X-ray absorptiometry (DXA) at a study clinic. The women under-reported their weight by 0.93 kg, waist circumference by 3.95 cm and hip circumference by 0.10 cm and over-reported their height by 0.85 cm. This led to an under-estimation of BMI by 0.67 kg/m² and waist/hip ratio by 0.04. The effect of misreporting (self-report minus measurement) on BMI and waist/hip ratio was significantly greater in higher BMI groups (p-heterogeneity = 0.007 for BMI, 0.0005 for waist/hip ratio), among women with central obesity (waist circumference > 88 cm; p-heterogeneity = 0.006, 0.01) and among women who had gained higher amounts of weight since age 21 (p-heterogeneity = 0.03, 0.01) compared to their counterparts. A similar trend of greater self-report bias was found among women with higher levels of DXA-based total and abdominal adiposity. We did not observe any heterogeneity in these findings by ethnicity. Our results confirm that a small degree of under-reporting exists in self-reported BMI and waist/hip ratio values, and it tends to increase in women with a larger current body size or history of greater weight gain. Studies are underway to investigate this question in greater depth in men and women from five race/ethnic groups.     

Maternal Obesity and Risk of Low Birth Weight,Fetal Growth Restriction,and Macrosomia: Multiple Analyses

The associations between maternal pre-pregnancy obesity and low birth weight (LBW, <2500 g) remain inconclusive. Therefore, birth weight in a Polish prospective cohort of 912 mothers was investigated depending on the pre-pregnancy body mass index (BMI). The whole cohort and the subgroup of gestational weight gain (GWG) in the range of the Institute of Medicine (IOM) recommendations, as well as ‘healthy’ women (who did not develop diabetes or hypertension in this pregnancy) were investigated. Adjusted odds ratios (AOR) of the newborn outcomes (with 95% confidence intervals, CI) for obesity (BMI ≥ 30 kg/m²) vs. normal BMI (18.5−24.9 kg/m²) were calculated using multiple logistic regression. Risk profiles (in the Lowess method) were presented for BMI values (kg/m²) and threshold BMI values were calculated. (1) In the cohort, LBW affected 6.6% of pregnancies, fetal growth restriction (FGR) 2.3%, and macrosomia 10.6%. (2) The adjusted risk of macrosomia was more than three-fold higher for obesity compared to normal BMI in the whole cohort (AOR = 3.21 (1.69−6.1), p < 0.001) and the result was maintained in the subgroups. A 17-fold higher adjusted LBW risk for obesity was found (AOR = 17.42 (1.5−202.6), p = 0.022), but only in the normal GWG subgroup. The FGR risk profile was U-shaped: in the entire cohort, the risk was more than three times higher for obesity (AOR = 3.12 (1.02−9.54), p = 0.045) and underweight (AOR = 3.84 (1.13−13.0), p = 0.031). (3) The risk profiles showed that the highest BMI values were found to be associated with a higher risk of these three newborn outcomes and the threshold BMI was 23.7 kg/m² for macrosomia, 26.2 kg/m² for LBW, and 31.8 kg/m² for FGR. These results confirm the multidirectional effects of obesity on fetal growth (low birth weight, fetal growth restriction, and macrosomia). The results for LBW were heavily masked by the effects of abnormal gestational weight gain.     

Weight Status and Psychological Distress in a Mediterranean Spanish Population: A Symmetric U-Shaped Relationship

Psychological disorders in people with extreme weight (low weight or obesity) should be taken into consideration by health professionals in order to practice an effective treatment to these patients. This study evaluates the association between body mass index (BMI) and psychological distress in 563 inhabitants of Málaga (South of Spain). Participants were classified in four categories of BMI: Underweight (BMI <18.5 Kg/m²), Normal weight (BMI 18.5–24.99 Kg/m²), Overweight (BMI 25.0–29.99 Kg/m²) and Obesity (BMI >30 Kg/m²). Psychological distress was measured with the Spanish version of the Derogatis’ Symptoms Checklist Revised (SCL-90-R). We observed a symmetric U-shaped relationship between weight status and psychological distress in all SCL-90-R dimensions (p for quadratic trend <0.001) for both men and women. Participants with extreme weight showed the worst psychological status, and participants with normal weight exhibited the best. We found no statistically significant differences between underweight and obese participants in 9 of the 10 SCL-90-R dimensions analyzed among men, and in 8 of the 10 dimensions among women. Underweight and obese participants showed no gender differences in psychological distress levels. Psychological treatment of Mediterranean people with extreme weight, should consider underweight and obese patients at the same level of psychological distress.     

Sleep Duration and Weight Gain: Reconsideration by Panel Data Analysis

Background

Inconsistent findings in previous studies of the association between sleep duration and changes in body mass index (BMI) may be attributed to misclassification of sleep duration fluctuations over time and unmeasured confounders such as genetic factors. The aim of the present study was to overcome these failings by using repeated measurements and panel data analysis to examine the sleep-BMI association.

Methods

Panel data were derived by secondary use of the data from mandatory health checkups at a Japanese gas company. Male non-shift workers aged 19–39 years in 2007 were annually followed until 2010 (n = 1687, 6748 records). BMI was objectively measured, and sleep duration was self-reported.

Results

Compared with 7-hour sleepers, panel analysis with the population-averaged model showed a significant increase in BMI among 5-hour (0.11 kg/m², P = 0.001), 6-hour (0.07 kg/m², P = 0.038), and ≥8-hour (0.19 kg/m², P = 0.009) sleepers. On the other hand, after adjustment for unobserved time-invariant confounders using the fixed-effects model, the magnitude of the association was considerably attenuated and no longer significant (5-hour, 0.07 kg/m², P = 0.168; 6-hour, 0.02 kg/m², P = 0.631; ≥8-hour sleepers, 0.06 kg/m², P = 0.460).

Conclusions

The longitudinal association between sleep duration and changes in BMI may be upwardly biased by unobserved time-invariant confounders rather than misclassified sleep duration. The net effect of sleep duration on weight gain may therefore be less than previously believed.Key words: longitudinal studies, sleep, obesity, weight gain, panel analysis     

The Associations of Month of Birth With Body Mass Index,Waist Circumference,and Leg Length: Findings From the China Kadoorie Biobank of 0.5 Million Adults

Background

Season of birth (SoB) has been linked with various health outcomes. This study aimed to examine the associations between month of birth (MoB) and adult measures of leg length (LL), body mass index (BMI), and waist circumference (WC).

Methods

We analysed survey data from 10 geographically diverse areas of China obtained through the China Kadoorie Biobank. Analysis included 487 529 adults with BMI ≥ 18.5 kg/m². A general linear model was used to examine the associations between MoB and adult measures of LL, BMI, and WC, adjusted for survey site, sex, age, education level, smoking habit, alcohol consumption, physical activity level, sedentary leisure time, height (only for WC and LL), and hip circumference (only for LL).

Results

MoB was independently associated with both BMI and WC. Birth months in which participants had higher measures of adiposity were March–July for BMI and March–June for WC. The peak differences were 0.14 kg/m² for BMI and 0.47 cm for WC. The association between MoB and LL depended on survey site. Participants who were born in February–August in four sites (Harbin, Henan, Gansu, and Hunan) had the shortest LL (all P < 0.01). The peak difference in mean LL was 0.21 cm. No statistically significant association between MoB and LL was noted in the other sites (Qingdao, Suzhou, Sichuan, Zhejiang, Liuzhou, and Haikou).

Conclusions

These findings suggest that MoB is associated with variations in adult adiposity measures and LL among Chinese adults. Low exposure to ultraviolet B radiation and subsequent reduced levels of vitamin D during the late second and early third trimesters may be involved in these phenomena.Key words: month of birth, BMI, waist circumference, leg length, vitamin D deficiency     

Human Milk Oligosaccharide Concentrations and Infant Intakes Are Associated with Maternal Overweight and Obesity and Predict Infant Growth

Human milk oligosaccharides (HMOs) are bioactive molecules playing a critical role in infant health. We aimed to quantify the composition of HMOs of women with normal weight (18.5–24.9 kg/m²), overweight (25.0–29.9 kg/m²), or obesity (30.0–60.0 kg/m²) and determine the effect of HMO intake on infant growth. Human milk (HM) samples collected at 2 months (2 M; n = 194) postpartum were analyzed for HMO concentrations via high-performance liquid chromatography. Infant HM intake, anthropometrics and body composition were assessed at 2 M and 6 M postpartum. Linear regressions and linear mixed-effects models were conducted examining the relationships between maternal BMI and HMO composition and HMO intake and infant growth over the first 6 M, respectively. Maternal obesity was associated with lower concentrations of several fucosylated and sialylated HMOs and infants born to women with obesity had lower intakes of these HMOs. Maternal BMI was positively associated with lacto-N-neotetraose, 3-fucosyllactose, 3-sialyllactose and 6-sialyllactose and negatively associated with disialyllacto-N-tetraose, disialyllacto-N-hexaose, fucodisialyllacto-N-hexaose and total acidic HMOs concentrations at 2 M. Infant intakes of 3-fucosyllactose, 3-sialyllactose, 6-sialyllactose, disialyllacto-N-tetraose, disialyllacto-N-hexaose, and total acidic HMOs were positively associated with infant growth over the first 6 M of life. Maternal obesity is associated with changes in HMO concentrations that are associated with infant adiposity.     

Association of Body Mass Index and Mortality in Japanese Diabetic Men and Women Based on Self-Reports: The Japan Collaborative Cohort (JACC) Study

Background

The association between body mass index (BMI) and mortality among Asian diabetic people, especially with respect to the obesity paradox (ie, higher BMI is associated with lower mortality risk), remains unresolved.

Methods

We followed a cohort of 3851 self-reported Japanese diabetics (2115 men and 1736 women) in the Japan Collaborative Cohort Study from 1988–1990 through 2009. Individuals were aged 40 to 79 years and free from a history of cardiovascular disease, cancer, renal disease, or tuberculosis. BMI was grouped into the following four categories: <20.0, 20.0–22.9, 23.0–24.9, and ≥25.0 kg/m².

Results

During 54 707 person-years of follow-up, 1457 deaths from all causes, 445 from cardiovascular disease, 421 from cancer, 43 from renal disease, and 148 from infectious disease were documented. Mortality from all causes, cardiovascular disease, cancer, and renal disease showed L-shaped associations with BMI. Compared to diabetics with BMI of 20.0–22.9 kg/m², those with BMIs of 23.0–24.9 kg/m² and ≥25.0 kg/m² had lower risks of mortality from infectious disease (ie, obesity paradox). The multivariable HRs for mortality from infectious disease were 0.50 (95% confidence interval, 0.31–0.81) and 0.51 (95% confidence interval, 0.32–0.82) among participants with BMIs of 23.0–24.9 kg/m² and ≥25.0 kg/m², respectively. Similar results were observed after stratification by smoking status and age and exclusion of early deaths.

Conclusions

We observed L-shaped associations between BMI and mortality from all causes, cardiovascular disease, cancer, and renal disease, while the association between BMI and mortality from infectious disease manifested the obesity paradox.Key words: diabetes, body mass index, mortality, infection, obesity paradox     

Liver Damage Is Related to the Degree of Being Underweight in Anorexia Nervosa and Improves Rapidly with Weight Gain

Background: The present study investigates the relationship between hypertransaminasemia and malnutrition on the basis of a very large number of patients. We assume that the level of transaminases not only reflects the extent of underlying liver cell damage but also provides information about the metabolic situation under conditions of energy deficiency. Methods: We present an observational study in two different samples. The first sample consists of 3755 patients (mean age 22.7 years, Range 12–73 years; mean BMI 15.4 kg/m², range 8.1–25.7) out of a total of 4212 patients with anorexia nervosa treated in the Roseneck Clinic within five years for whom a complete admission laboratory was available. The second sample was obtained from a special ward for medically at-risk patients with eating disorders. During the period in question, four hundred and ten patients with anorexia nervosa were treated. One hundred and forty-two female patients (mean age 26.4 years, Range 18–63 years; mean BMI 11.5 kg/m², range 8.4–13) had a BMI of thirteen or less and a complete data set was obtained at admission and weekly in the following four weeks after admission. Results: The increase in liver transaminases shows a very high correlation with weight in sample one (N = 3755). The analysis of variance shows highly significant (<0.001) correlations with an F-value of 55 for GOT/AST and 63 for GPT/ALT. Nevertheless, the variance within the groups with the same BMI is quite high. With re-nutrition in sample two, GOT/AST decreased on average from 71 U/L to 26 U/L (MANOVA F 10.7, p < 0.001) and GPT/ALT from 88 to 41 U/L (F = 9.9, p < 0.001) within four weeks. Discussion: Below a BMI of about 13, the nutritional status of the patients becomes so critical that the energy supply of the patient is increasingly dependent on the autophagy of the liver, which can be seen in the very strong increase in transaminases here. Refeeding leads very quickly to the normalisation of the transaminases and, thus, a stabilisation of the metabolism leading also to a decrease in autophagy.     

Effects of Plant-Based Diets on Weight Status in Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Excessive adiposity is a major risk factor for type 2 diabetes (T2D), and dietary patterns are important determinants of weight status. Plant-based dietary patterns (PBDs) are known for their therapeutic effects on T2D. The aim is to systematically review RCTs to investigate the effects of various PBDs compared to regular meat-eating diets (RMDs), in individuals who normally consume a RMD on body weight, BMI, and waist circumference in T2D. RCTs investigating PBDs and body weight, BMI, WC for ≥6 weeks in adults with T2D since 1980 were eligible for inclusion. Seven trials (n = 269) were included in the meta-analysis using random-effects models and expressed as MD (95%Cls). Compared to RMDs, PBDs significantly lowered body weight (−2.35 kg, 95% CI: −3.51, −1.19, p < 0.001), BMI (−0.90 kg/m², 95% CI: −1.42, −0.38, p = 0.001) and WC (−2.41 cm, 95% CI: −3.72, −1.09, p < 0.001). PBDs alone significantly reduced body weight by 5.1% (−4.95 kg, 95% CI: −7.34, −2.55, p < 0.001), BMI by 5.4% (−1.87 kg/m², 95% CI: −2.78, −0.95, p < 0.001) and WC by 4.3%(−4.23, 95% CI: −6.38, −2.07, p < 0.001). Interventions not limiting energy intake led to a significant reduction in body weight (−2.54 kg, 95% CI: −4.16, −0.92, p < 0.005) and BMI (−0.91 kg/m², 95% CI: −1.56, −0.25, p < 0.005). Trials ≥16 weeks had a pronounced reduction in body weight (−2.93 kg, 95% CI: −5.00, −0.87, p = 0.005) and BMI (−1.13 kg/m², 95% CI: −1.89, −0.38, p < 0.005). These findings provide evidence for the implementation of PBDs for better management of central adiposity in individuals with T2D.     

Relationship of Anthropometric Indicators of General and Abdominal Obesity with Hypertension and Their Predictive Performance among Albanians: A Nationwide Cross-Sectional Study

Anthropometric indicators of general and abdominal obesity can predict cardiovascular disease outcomes. Their performance in predicting hypertension (HTN) varies across populations. We aimed to analyze the relationship of body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and conicity index (CI) with HTN, to examine their predictive performance and to determine their optimal cut-offs in a nationally representative sample of Albanians aged 15–59 years (n = 20,635). Logistic regression models were fitted and sex-specific receiver-operating characteristic (ROC) curves were constructed. The indicators were positively associated with HTN. Sex modified the relationships, as associations appeared significantly stronger among females than males in the highest categories of the indicators. The area under ROC curves (AUCs) for BMI were 0.729 (95% confidence interval (CI): 0.720–0.738) among females and 0.648 (95% CI: 0.633–0.663) among males, and AUCs for WHtR were 0.725 (95% CI: 0.716–0.734) among females and 0.637 (95% CI: 0.622–0.652) among males. However, the AUCs for BMI and WHtR did not differ significantly among females (p = 0.279) and males (p = 0.227). BMI outperformed WC and CI in both sexes. The optimal BMI cut-offs were 27.0 kg/m² among females and 25.6 kg/m² among males, and that for WHtR were 0.53 among females and 0.54 among males. BMI and WHtR demonstrated similar discriminatory power, and the identified cut-offs may inform initiatives for structured HTN screening in Albania.     

Time-Restricted Eating Alters Food Intake Patterns,as Prospectively Documented by a Smartphone Application

Time-restricted eating (TRE) can facilitate weight loss, yet its effect on eating patterns remains unknown. Twenty adults with BMI ≥ 25 kg/m² underwent a 12-week randomized trial, examining the effect of an 8-h, time-restricted eating intervention on dietary patterns. Oral intake was documented using a smartphone. Dietary patterns, assessed as frequency of eating occasions (EOs) and types of meals/snacks and beverages, were compared between baseline (T0), early-intervention (T1), and end-intervention (T2). At T1 and T2, both groups had less EOs compared to T0, with greater reduction seen in the TRE group (−28%) than the non-TRE group (−12%) at T2 (p = 0.01 vs. non-TRE). Comparing T1 to T0, the TRE group documented less incomplete meals (−32.5%: p = 0.02), high quality snacks (−23.6%: p = 0.03), and low quality snacks (−36.6%: p = 0.004). Comparing T2 to T0, the TRE group documented less incomplete meals (−33.9%: p = 0.03), high quality snacks (−28.1%: p < 0.001) and low quality snacks (−51.2%: p < 0.001). Caffeinated beverage intake was reduced in the TRE group at T1 (−20.2%) and T2 (−28.8%) vs. T0, but remained unaltered in the non-TRE group. By using a smartphone application to document dietary intake, TRE significantly reduced the number of EOs, snacks, and caffeinated beverages, relative to baseline and relative to the non-TRE.     

Does a 12-Month Transitional Care Model Intervention by Geriatric-Experienced Care Professionals Improve Nutritional Status of Older Patients after Hospital Discharge? A Randomized Controlled Trial

At hospital discharge, many older patients are at health and nutritional risk, indicating a requirement for ongoing care. We aim to evaluate the effects of comprehensive individualized care by geriatric-experienced care professionals, the so-called “pathfinders”, on nutritional status (NS) of older patients after discharge. A total of 244 patients (median age 81.0 years) without major cognitive impairment were randomized to Intervention Group (IG: 123) or Control Group (CG: 121) for a 12-month intervention, with up to 7 home visits and 11 phone calls. The comprehensive individualized care contained nutritional advice, when required. The intervention effect after three (T3m) and 12 (T12m) months on change in MNA-SF (Mini Nutritional Assessment-Short Form) and BMI was evaluated by Univariate General Linear Model (ANOVA), adjusted for age, sex, living situation, and activities of daily living. At baseline, mean MNA-SF did not differ between IG and CG (10.7 ± 2.6 vs. 11.2 ± 2.5, p = 0.148); however, mean BMI was significantly lower in IG compared to CG (27.2 ± 4.7 vs. 28.8 ± 4.8 kg/m², p = 0.012). At T3m, mean change did not differ significantly between the groups, neither in MNA-SF (0.6; 95%CI: −0.1–1.3 vs. 0.4; −0.3–1.1, p = 0.708) nor in BMI (−0.2; −0.6–0.1 vs. 0.0; −0.4–0.4 kg/m², p = 0.290). At T12m, mean change of MNA-SF was significantly higher in IG than in CG (1.4; 0.5–2.3 vs. 0.0; −0.9–0.8; p = 0.012). BMI remained unchanged in IG, whereas it slightly declined in CG (0.0; −0.7–0.6 vs. −0.9; −1.6–−0.2 kg/m², p = 0.034). We observed rather small effects of comprehensive individualized care by pathfinders on NS in older patients 12 months after discharge. For more pronounced effects nutrition expertise might be needed.