Maternal hepatitis B surface antigen status and incidence of pre‐eclampsia

The relationship between chronic hepatitis B virus (HBV) infection with atherosclerosis and cardiovascular disorders remains unclear, and the impact of maternal HBV infection on the development of pregnancy‐induced hypertension (PIH) and pre‐eclampsia (PE) is also controversial. This retrospective cohort study was conducted to examine the relationship between maternal hepatitis B surface antigen (HBsAg) status with PIH and PE in singleton pregnancies that delivered at 24 weeks of gestation and beyond. Among the 86 537 cases in the cohort, 10% were HBsAg positive, and overall 2.0% had PIH, of whom 56.3% developed PE. HBsAg‐positive women had higher weight and body mass index (BMI), but lower incidences of advanced age, nulliparity, PIH (1.6% vs 2.0%, P = 0.007) and PE (0.8% vs 1.1%, P = 0.005). On multiple logistic regression analysis adjusting for the effects of nulliparity, advanced age, high BMI, and underlying renal, cardiac and autoimmune diseases, HBsAg carriage was associated with significantly reduced incidence of PIH (aOR 0.79, 95% CI 0.66–0.95) and PE (aOR 0.71, 95% CI 0.56–0.91). Our results indicate that maternal HBsAg carriage is independently associated with reduced PE. As chronic HBV infection alters the immune response of the individual, our observation could be related to enhanced maternal immunotolerance of the foetus and hence a reduction in the incidence of PE. The implications of our findings on the long‐term health outcome of the infected women, from cardiovascular morbidity to malignancies, warrant further studies.     

Maternal pre‐pregnancy obesity and child neurodevelopmental outcomes: a meta‐analysis

This review examined evidence of the association between maternal pre‐pregnancy overweight/obesity status and child neurodevelopmental outcomes. PubMed and PsycINFO databases were systematically searched for empirical studies published before April 2017 using keywords related to prenatal obesity and children's neurodevelopment. Of 1483 identified papers, 41 were included in the systematic review, and 32 articles representing 36 cohorts were included in the meta‐analysis. Findings indicated that compared with children of normal weight mothers, children whose mothers were overweight or obese prior to pregnancy were at increased risk for compromised neurodevelopmental outcomes (overweight: OR = 1.17, 95% CI [1.11, 1.24], I² = 65.51; obese: OR = 1.51; 95% CI [1.35, 1.69], I² = 79.63). Pre‐pregnancy obesity increased the risk of attention deficit–hyperactivity disorder (OR = 1.62; 95% CI [1.23, 2.14], I² = 70.15), autism spectrum disorder (OR = 1.36; 95% CI [1.08, 1.70], I² = 60.52), developmental delay (OR = 1.58; 95% CI [1.39, 1.79], I² = 75.77) and emotional/behavioural problems (OR = 1.42; 95% CI [1.26, 1.59], I² = 87.74). Given the current obesity prevalence among young adults and women of childbearing age, this association between maternal obesity during pregnancy and atypical child neurodevelopment represents a potentially high public health burden.     

Diabetes mellitus and risk of dementia: A meta‐analysis of prospective observational studies

Aims/Introduction

The aim of the present study was to investigate the association between diabetes and the risk of all type dementia (ATD), Alzheimer's disease (AD) and vascular dementia (VaD).

Materials and Methods

Prospective observational studies describing the incidence of ATD, AD and VaD in patients with diabetes mellitus were extracted from PubMed, EMBASE and other databases up to January 2012. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using the random‐effects model. Subgroup analyses and sensitivity analysis were also carried out.

Results

A total of 28 studies contributed to the analysis. Pooled RR of developing ATD (n = 20) was 1.73 (1.65–1.82, I² = 71.2%), AD (n = 20) was 1.56 (1.41–1.73, I² = 9.8%) and VaD (n = 13) was 2.27 (1.94–2.66, I² = 0%) in patients with diabetes mellitus. Higher and medium quality studies did not show any significant difference for pooled RR for ATD, AD or VaD. Sensitivity analyses showed robustness of pooled RR among ATD, AD and VaD, showing no single study had a major impact on pooled RR.

Conclusions

The results showed a 73% increased risk of ATD, 56% increase of AD and 127% increase of VaD in diabetes patients.     

Association of sarcopenic obesity with the risk of all‐cause mortality: A meta‐analysis of prospective cohort studies

Many prospective studies have investigated the relationship between sarcopenic obesity (SO) and risk of mortality. However, the results have been controversial. The aim of the present study was to evaluate the association between SO and all‐cause mortality in adults by a meta‐analysis of prospective cohort studies. A systematic literature search was carried out through electronic databases up to September 2014. A total of nine articles with 12 prospective cohort studies, including 35 287 participants and 14 306 deaths, were included in the meta‐analysis. Overall, compared with healthy subjects, subjects with SO had a significant increased risk of all‐cause mortality (pooled HR 1.24, 95% CI 1.12–1.37, P < 0.001), with significant heterogeneity among studies (I² = 53.18%, P = 0.0188), but no indication for publication bias (P = 0.7373). Heterogeneity became low and no longer significant in the subgroup analyses by three SO definitions. More importantly, SO, defined by mid‐arm muscle circumference and muscle strength criteria, significantly increased the risk of mortality (HR 1.46, 95% CI 1.23–1.73 and 1.23, 1.09–1.38, respectively). The risk of all‐cause mortality did not appreciably change considering the geography (USA cohorts and non‐USA cohorts) or the duration of follow up (≥10 years and <10 years). However, the risk estimate was only significant in men (HR 1.23, 95% CI 1.08–1.41, P = 0.0017), not in women (HR 1.16, P = 0.1332). The results of the present study show that subjects with SO are associated with a 24% increase risk of all‐cause mortality, compared with those without SO, in particular in men; the significant association was found independent of geographical location and duration of follow up. Geriatr Gerontol Int 2016; 16: 155–166.     

Body mass index in midlife and late‐life as a risk factor for dementia: a meta‐analysis of prospective studies

The relationship between body mass index (BMI) (in midlife and late‐life) and dementia was investigated in meta‐analyses of 16 articles reporting on 15 prospective studies. Follow‐ups ranged from 3.2 to 36.0 years. Meta‐analyses were conducted on samples including 25 624 participants evaluated for Alzheimer's disease (AD), 15 435 participants evaluated for vascular dementia (VaD) and 30 470 followed for any type of dementia (Any Dementia). Low BMI in midlife was associated with 1.96 [95% confidence interval (CI): 1.32, 2.92] times the risk of developing AD. The pooled relative risks for AD, VaD and Any Dementia for overweight BMI in midlife compared with normal BMI were 1.35 (95% CI:1.19, 1.54), 1.33 (95% CI: 1.02, 1.75) and 1.26 (95% CI: 1.10, 1.44), respectively. The pooled relative risks of AD and Any Dementia for obese BMI in midlife compared to normal BMI were 2.04 (95% CI: 1.59, 2.62) and 1.64 (95% CI: 1.34, 2.00), respectively. Continuous BMI in late‐life was not associated with dementia. Small numbers of studies included in pooled analyses reduce generalizability of findings, and emphasize the need for publication of additional findings. We conclude that underweight, overweight and obesity in midlife increase dementia risk. Further research evaluating late‐life BMI and dementia is required.     

Central obesity and risks of pre‐ and postmenopausal breast cancer: a dose–response meta‐analysis of prospective studies

Epidemiologic evidence has shown inconsistent findings regarding the relationships between abdominal fatness, as measured by waist circumferences (WC) or waist‐to‐hip ratio (WHR), and risks of pre‐ and postmenopausal breast cancer (BC). A dose–response meta‐analysis of prospective studies was conducted to address these issues. Potentially eligible studies were identified by searching PubMed and EMBASE databases, and by carefully reviewing the bibliographies of retrieved publications and related reviews. The summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random‐effects model. When the most fully adjusted RRs were combined, both WC (14 studies, RR _{per 10‐cm increase} = 1.06, 95% CI: 1.04–1.09, I² = 29.9%) and WHR (15 studies, RR _{per 0.1‐unit increase} = 1.07, 95% CI: 1.01–1.14, I² = 52.9%) were significantly positively associated with postmenopausal BC, but neither WC (eight studies, RR _{per 10‐cm increase} = 1.05, 95% CI: 0.99–1.10, I² = 0%) nor WHR (11 studies, RR _{per 0.1‐unit increase} = 1.07, 95% CI: 0.95–1.21, I² = 59.7%) were associated with premenopausal BC. The WHR‐postmenopausal BC association lost statistical significance after correcting publication bias (RR _{per 0.1‐unit increase} = 1.06, 95% CI: 0.99–1.13). When considering BMI‐adjusted RRs, WC was associated with both pre‐ (five studies, RR _{per 10‐cm increase} = 1.09, 95% CI: 1.02–1.16, I² = 0%) and postmenopausal BC (seven studies, RR _{per 10‐cm increase} = 1.05, 95% CI: 1.02–1.08, I² = 6.3%), whereas WHR was not associated with either pre‐ (seven studies, RR _{per 0.1‐unit increase} = 1.12, 95% CI: 0.94–1.34, I² = 70.9%) or postmenopausal BC (eight studies, RR _{per 0.1‐unit increase} = 1.05, 95% CI: 0.98–1.13, I² = 57.3%). Among non‐current (former or never) users of hormone replacement therapy, the summary RR _{per 10‐cm increase} of postmenopausal BC associated with WC was 1.08 (95% CI: 1.03–1.05, I² = 69.2%, seven studies; BMI‐adjusted RR = 1.05, 95% CI: 1.02–1.09, I² = 22.8%, four studies). This meta‐analysis indicates that central obesity measured by WC, but not by WHR, is associated with modestly increased risks of both pre‐ and postmenopausal BC independent of general obesity.     

Metabolically healthy obesity and risk of incident type 2 diabetes: a meta‐analysis of prospective cohort studies

The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched Medline (1946–August 2013) and Embase (1947–August 2013) for prospective studies of type 2 diabetes incidence (defined by blood glucose levels or self‐report) among metabolically healthy obese adults (defined by body mass index [BMI] and normal cardiometabolic clustering, insulin profile or risk score) aged ≥18 years at baseline. We supplemented the analysis with an original effect estimate from the English Longitudinal Study of Ageing (ELSA), with metabolically healthy obesity defined as BMI ≥ 30 kg m^?2 and <2 of hypertension, impaired glycaemic control, systemic inflammation, adverse high‐density lipoprotein cholesterol and adverse triglycerides. Estimates from seven published studies and ELSA were pooled using random effects meta‐analyses (1,770 healthy obese participants; 98 type 2 diabetes cases). The pooled adjusted relative risk (RR) for incident type 2 diabetes was 4.03 (95% confidence interval = 2.66–6.09) in healthy obese adults and 8.93 (6.86–11.62) in unhealthy obese compared with healthy normal‐weight adults. Although there was between‐study heterogeneity in the size of effects (I² = 49.8%; P = 0.03), RR for healthy obesity exceeded one in every study, indicating a consistently increased risk across study populations. Metabolically healthy obese adults show a substantially increased risk of developing type 2 diabetes compared with metabolically healthy normal‐weight adults. Prospective evidence does not indicate that healthy obesity is a harmless condition.     

Association of statin use with risk of dementia: A meta‐analysis of prospective cohort studies

Statins are a class of medications that reduce cholesterol by inhibiting 3‐hydroxy‐3‐methylglutaryl‐coenzyme A reductase, which were thought to have a positive impact on dementia. We carried out the present meta‐analysis to investigate whether statins might be associated with a reduction on risk of dementia. We carried out a meta‐analysis of prospective cohort studies to examine the risk of dementia associated with statins. Ovid‐Medline database, PubMed database, Springer Link database and Google Scholar in English search were carried out for relevant studies. Selected studies had to describe an original study defined by strict screening and diagnostic criteria. We included eight prospective cohort studies that reported relative risks with 95% confidence intervals for the association of statins and dementia risk. A random effects model was used to calculate the summary risk estimates. The studies eligible for analysis involved 2851 cases and 57020 participants. The summary relative risk of dementia for the use of statins was 0.62 (95% confidence interval 0.43–0.81), with evidence of heterogeneity (P = 0.001, I² = 70.8%). Findings of the present meta‐analysis show that statin use was associated with a reduced risk of dementia. Geriatr Gerontol Int 2013; 13: 817–824.     

Determinants of pre‐eclampsia among pregnant women attending perinatal care in hospitals of the Omo district,Southern Ethiopia

Pre‐eclampsia is estimated to cause 70 000 maternal death globally every year, with the majority of deaths in low‐ and middle‐income countries. In Ethiopia, pre‐eclampsia causes 16% of direct maternal deaths. Despite the high burden of disease, pre‐eclampsia remains poorly studied in low and middle‐income countries. In this study, we aimed to identify risk factors for pre‐eclampsia in pregnant women attending hospitals in the Omo district of Southern Ethiopia. Data were collected via face‐to‐face interviews. Logistic regression analysis was computed to examine the relationship between the independent variable and pre‐eclampsia. An adjusted odds ratio (AOR) with the corresponding 95% confidence interval (CI) excluding 1 in the multivariable analysis was considered to identify factors associated with pre‐eclampsia at a p‐value of <0.05. A total of 167 cases and 352 controls were included. Factors that were found to have a statistically significant association with pre‐eclampsia were primary relatives who had a history of chronic hypertension (AOR 2.1, 95% CI: 1.06‐4.21), family history of diabetes mellitus (AOR 2.35; 95% CI: 1.07‐5.20), preterm gestation (AOR = 1.56, 95% CI: 1.05‐2.32), and pre‐conception smoking exposure (AOR = 4.16, 95% CI: 1.1‐15.4). The study identified that a family history of chronic illnesses and diabetes mellitus, preterm gestation, and smoking exposure before conception were the risk factors for pre‐eclampsia. Presumably, addressing the identified risk factors may give further insight into where interventions and resources should be focused, as well as having an understanding of the burden of disease.     

Efficacy of weight loss drugs on obesity and cardiovascular risk factors in obese adolescents: a meta‐analysis of randomized controlled trials

Weight loss drugs have been developed to reduce the comorbidities associated with excess weight. We conducted a meta‐analysis of the efficacy of orlistat and sibutramine on weight, body mass index, waist circumference and cardiovascular risk factors in overweight adolescents. MEDLINE and the Cochrane Library were searched for relevant articles using MESH terms and keywords. Studies were included if they had reported quantitative estimates and standard deviations of the association between each weight loss drug and weight, with information on at least one cardiovascular risk factor. A total of eight trials (three orlistat and five sibutramine) with information on 1391 individuals was included in the present analysis. The mean decrease in weight between the intervention and control groups was 5.25 kg (95% confidence interval: 3.03–7.48) after a minimum follow‐up of 6 months. There was evidence of statistical heterogeneity between the studies (I² = 76%) that was no longer apparent after exclusion of trials of orlistat (mean weight decrease = 5.32 kg; I² = 38%). There was little evidence that treatment was associated with adverse effects on cardiovascular risk factors but this requires verification from future large trials with longer study follow‐up.     

Effect of obesity and weight loss on ventricular repolarization: a systematic review and meta‐analysis

We performed a systematic review and meta‐analysis of the effects of obesity ± overweight and weight loss on the corrected QT interval (QTc) and QT or QTc dispersion (indices of ventricular repolarization). Mean difference for both QTc and QT or QTc dispersion with 95% confidence intervals (CIs) was calculated comparing obese ± overweight subjects and normal weight controls and QTc and QT or QTc dispersion before and after weight loss from diet ± exercise or bariatric surgery. A total of 22 studies fulfilled the selection criteria. Compared with normal weight controls, there was a significantly longer QTc in obese ± overweight subjects (mean difference of 21.74 msec, 95% CI: 18.76 to 22.32) and significantly longer QT or QTc dispersion (mean difference of 15.17 msec, 95% CI: 13.59 to 16.74). Weight loss was associated with a significant decrease in QTc (mean difference ?25.77 msec, 95% CI: ?28.33–23.21) and QT or QTc dispersion (mean difference of ?13.46 msec, 95% CI: ?15.60 to ?11.32 in obese ± overweight subjects. Thus, obesity ± overweight is associated with significant prolongation of QTc and QT or QTC dispersion. Weight loss in obese ± overweight subjects produces significant decreases in these variables. © 2016 World Obesity     

Clinical effectiveness of very‐low‐energy diets in the management of weight loss: a systematic review and meta‐analysis of randomized controlled trials

Guidelines suggest that very‐low‐energy diets (VLEDs) should be used to treat obesity only when rapid weight loss is clinically indicated because of concerns about rapid weight regain. Literature databases were searched from inception to November 2014. Randomized trials were included where the intervention included a VLED and the comparator was no intervention or an intervention that could be given in a general medical setting in adults that were overweight. Two reviewers characterized the population, intervention, control groups, outcomes and appraised quality. The primary outcome was weight change at 12 months from baseline. Compared with a behavioural programme alone, VLEDs combined with a behavioural programme achieved ?3.9 kg [95% confidence interval (CI) ?6.7 to ?1.1] at 1 year. The difference at 24 months was ?1.4 kg (95%CI ?2.6 to ?0.2) and at 38–60 months was ?1.3 kg (95%CI ?2.9 to 0.2). Nineteen per cent of the VLED group discontinued treatment prematurely compared with 20% of the comparator groups, relative risk 0.96 (0.56 to 1.66). One serious adverse event, hospitalization with cholecystitis, was reported in the VLED group and none in the comparator group. Very‐low‐energy diets with behavioural programmes achieve greater long‐term weight loss than behavioural programmes alone, appear tolerable and lead to few adverse events suggesting they could be more widely used than current guidelines suggest.