Joint association of body mass index and central obesity with cardiovascular events and all-cause mortality in prediabetic population: A prospective cohort study

ObjectiveTo assess the joint association of body mass index (BMI) and central obesity with cardiovascular events and all-cause mortality in prediabetic population.MethodsAltogether 18,703 participants with prediabetes completed follow-up between June 2006 and December 2015 were included in the analyses. Prediabetes was defined as fasting plasma glucose level 5.6–6.9 mmol/L, and without history of diabetes or currently use of hypoglycemic agents. Participants were classified according to the baseline status of BMI as well as the absence/presence of central obesity. We examined these associations in men and women separately.ResultsThe mean age was 51.5 ± 11.1 years, and 85.6% (N = 16,002) were male. During a median follow up of 9.0 (interquartile range 8.7–9.2) years, 848 and 88 major CV events occurred in men and women, respectively. Besides, 1111 men and 89 women died. Compared with men of BMI 22–23.9 kg/m² and without central obesity, the risk of CV events was increased among men with higher BMI and central obesity (HR 1.32 (95% CI: 1.05–1.67) for BMI 24–27.9 kg/m² and 1.31 (1.03–1.66) for BMI ≥ 28 kg/m², respectively); and the risk of all-cause mortality was the lowest among men of BMI 24–27.9 kg/m² but without central obesity (0.75, 0.61–0.92). We found no such association in women.ConclusionAmong men with prediabetes, both BMI and waist circumference should be included when evaluating the risks of major CV events and mortality. Measurement of adiposity constitutes a simple and cost-effective strategy to identify those at high-risk population in prediabetes.     

中国80岁及以上高龄老人静息心率与全因死亡风险的前瞻性队列研究

目的探讨中国80岁及以上高龄老人静息心率与全因死亡风险的关联。方法采用中国老年健康影响因素跟踪调查(CLHLS)七次(1998、2000、2002、2005、2008、2011和2014年)调查数据。以年龄在80周岁以上的17886名高龄老人为研究对象,通过基线调查收集对象的静息心率次数,并随访研究对象的生存结局和死亡时间。根据研究对象的静息心率次数将其分为6组。采用Cox比例风险模型评估静息心率与死亡风险间的关联,并采用似然比检验分析年龄、性别与静息心率的交互作用。结果17886名研究对象的年龄M(P₂₅,P₇₅)为92(86,100)岁,其中女性10531名(58.9%),共计13598名老年人死亡,死亡密度为195.5/1000人年。多因素Cox比例风险回归模型分析结果显示,与静息心率60~69次/min组相比,静息心率70~79、80~89、90~99、≥100次/min的死亡风险HR(95%CI)值分别为1.06(1.02,1.11),1.09(1.04,1.15),1.23(1.14,1.34),1.25(1.08,1.44)(P值均<0.05)。似然比检验发现,静息心率与年龄存在交互作用(P_交互值=0.011)。结论高龄老人全因死亡的发生风险随静息心率次数的增加而上升,在80~89岁老年人群中相对显著。     

Dipstick proteinuria as a predictor of all-cause and cardiovascular disease mortality in Bangladesh: A prospective cohort study

ObjectiveBaseline, persistent, incident, and remittent dipstick proteinuria have never been tested as predictors of mortality in an undeveloped country. The goal of this study was to determine which of these four types of proteinuria (if any) predict mortality.MethodsBaseline data was collected from 2000 to 2002 in Bangladesh from 11,121 adults. Vital status was ascertained over 11–12 years. Cox models were used to evaluate proteinuria in relation to all-cause and cardiovascular disease (CVD) mortality. CVD mortality was evaluated only in those with baseline proteinuria. Persistent, remittent, and incident proteinuria were determined at the 2-year exam.ResultsBaseline proteinuria of 1 + or greater was significantly associated with all-cause (hazard ratio (HR) 2.87; 95% C.I., 1.71–4.80) and CVD mortality (HR: 3.55; 95% C.I., 1.81–6.95) compared to no proteinuria, adjusted for age, gender, arsenic well water concentration, education, hypertension, BMI, smoking, and diabetes mellitus. Persistent 1 + proteinuria had a stronger risk of death, 3.49 (1.64–7.41)-fold greater, than no proteinuria. Incident 1 + proteinuria had a 1.87 (0.92–3.78)-fold greater mortality over 9–10 years. Remittent proteinuria revealed no increased mortality.ConclusionsBaseline, persistent, and incident dipstick proteinuria were predictors of all-cause mortality with persistent proteinuria having the greatest risk. In developing countries, those with 1 + dipstick proteinuria, particularly if persistent, should be targeted for definitive diagnosis and treatment. The two most common causes of proteinuria to search for are diabetes mellitus and hypertension.     

Weight loss and all-cause mortality: A propensity score matching cohort study

BackgroundWeight loss was supposed to help with decreasing risk of premature mortality. However, results on this topic remain debatable and limited by study design.ObjectiveThe present study aimed to investigate the association between weight loss and all-cause mortality among US adults with overweight or obesity in a national cohort study by using propensity score matching (PSM) analysis.MethodsA total of 5486 pairs of participants were matched in the National Health and Nutrition Examination Survey (NHANES, 2003–2015) after PSM. Hazard ratios (95% confidence intervals) (HRs (95% CIs)) were employed to evaluate the association between weight loss indicated by long-term weight loss (LTWL) and all-cause mortality by using Cox proportional hazards regression models.ResultsDuring a median follow-up of 6.8 years, 674 participants died from all-cause mortality. In each PSM match, compared with participants with LTWL < 5%, the HRs (95% CIs) for participants with LTWL of 5–9.9% (2877 pairs), 10–14.9% (1315 pairs), and ≥ 15% (1294 pairs) were 1.18 (0.83–1.68) (P = 0.366), 1.65 (1.17–2.34) (P = 0.005), and 1.91 (1.21–3.00) (P = 0.006), respectively. The significant increased risk of all-cause mortality for LTWL ≥ 15% remained among male, female, participants aged ≥ 65 years, without weight loss intention, with non-communicable diseases, and without exceeding estimated energy requirement.ConclusionWeight loss especially for being ≥ 15% should be cautious for US adults with overweight or obesity.     

Overweight and obesity in Irish primary schools: retrospective cohort study

BACKGROUND: This retrospective cohort study investigates the feasibility of using established methods and routinely generated data from the statutory primary school health-screening programme to estimate prevalence rates for childhood overweight and obesity in children from a rural area in the Republic of Ireland (ROI). METHOD: Paper-based records in the primary school health service for County Leitrim and parts of County Cavan in north-west of ROI were hand searched to identify children attending senior infant classes during academic year 2001/2002. Electronic calculation of body mass index (BMI) and age at examination was carried out. Application of age- and sex-specific cut-off points from International Obesity Task Force (IOTF) and United Kingdom (UK) standard definitions for childhood overweight and obesity was used to determine age- and sex-specific prevalence rates for childhood overweight and obesity. RESULTS: The eligible cohort was almost completely identified and consisted of 361 children. Weight and height measurements were available on 328 (91%) children aged between 4.22 and 7.92 years. IOTF standard application gave prevalence rates of 25% for obesity and overweight in boys and 26% in girls. With the UK growth standard, this increased to 34% in boys and reduced to 23% in girls. CONCLUSION: It is feasible to generate prevalence rates for childhood overweight and obesity from data routinely obtained through the statutory school health-screening programme in ROI. This study suggests levels of childhood overweight and obesity comparable to other Western societies. Further research on developing a universally accepted standard definition of childhood overweight and obesity is required.     

Neighbourhood environments and mortality in an elderly cohort: results from the cardiovascular health study

BACKGROUND: It has been postulated that neighbourhood conditions are related to the health of the elderly population but longitudinal studies are rare and confounding by individual level variables remains a possibility. METHODS: Data were obtained from the cardiovascular health study, a population based study of adults aged 65 years and older. Census block groups were used as proxies for neighbourhoods. A summary score was used to characterise the neighbourhood socioeconomic environment. Information on personal socioeconomic indicators, cardiovascular disease prevalence, and cardiovascular risk factors was obtained from the baseline examination. Proportional hazards regression and propensity score matching were used to control for individual level variables. RESULTS: Over the eight year follow up there were 1346 deaths among the 5074 participants, of which 43% were attributable to cardiovascular disease. Among white participants, living in the most disadvantaged neighbourhood group was associated with higher rates of cardiovascular death, after adjustment for income, education, and occupation (hazard ratio (HR) 1.5, 95% confidence intervals (CI) 1.2 to 1.9). No neighbourhood differences were observed for non-cardiovascular deaths. Estimates for black participants were 1.3 (95% CI 0.7 to 2.3) for cardiovascular deaths and 1.4 (95% CI 0.8 to 2.4) for non-cardiovascular deaths, but sample size was small. In white participants, associations of neighbourhood characteristics with cardiovascular mortality persisted after adjustment for prevalent baseline disease and cardiovascular risk factors. The use of propensity score matching led to similar results (HR for the lowest compared with the highest neighbourhood score group: 1.6 95% CI 1.1 to 2.5, controlling for personal socioeconomic indicators). CONCLUSION: Neighbourhood disadvantage is related to rates of cardiovascular death in elderly white adults.     

Influenza vaccination and all-cause mortality in community-dwelling elderly in Ontario, Canada, a cohort study

The objective of this study was to evaluate the effectiveness of influenza vaccines in reducing all-cause mortality among community-dwelling elderly. We included 25,922 Ontario residents over age 65 who responded to population health surveys. After full adjustment, influenza vaccination was associated with a statistically significant reduction in all-cause mortality during influenza seasons (hazard ratio (HR) = 0.61; 95% CI 0.47-0.79). Contrary to expectations, statistically significant associations between influenza vaccination and mortality were also observed during periods preceding (HR = 0.55; 95% CI 0.40-0.75) and following (HR = 0.74; 95% CI 0.59-0.94) influenza seasons, indicating the presence of residual confounding. Adjustment for functional status indicators, excluding individuals with high one-year predicted mortality at baseline, and moving the start date of follow-up failed to eliminate the refractory confounding. Since observational studies are prone to bias, future efforts to estimate vaccine effectiveness in the elderly should strive to minimize bias through improved data quality, novel data sources, and/or new analytical techniques.     

Trends of obesity and abdominal obesity in Tehranian adults: a cohort study

Background  

Considering the increasing trend of obesity reported in current data, this study was conducted to examine trends of obesity and abdominal obesity among Tehranian adults during a median follow-up of 6.6 years.     

Overweight and obesity and weight change in middle aged men: impact on cardiovascular disease and diabetes

CONTEXT: The benefit of weight reduction for cardiovascular disease (CVD) outcomes remains uncertain. OBJECTIVE: To examine the effects of baseline body mass index on major CVD outcomes and diabetes over a 20 year follow up, and of weight change in the first five years over the subsequent 15 years. DESIGN AND SETTING: A prospective study of British men followed up for 20 years. PARTICIPANTS: Men aged 40-59 years with no diagnosis of CVD or diabetes (n = 7176) of whom 6798 provided full information on weight change five years later. OUTCOME MEASURES: Major CVD events (fatal and non-fatal myocardial infarction and stroke, angina, "other" CVD deaths) and diabetes. RESULTS: During the 20 year follow up there were 1989 major CVD events and 449 incident cases of diabetes in the 7176 men. Risk of major CVD and diabetes increased significantly with increasing overweight and obesity. During the 15 year follow up, weight gain was associated with increased risk of CVD and diabetes. Weight loss was associated with lower risk of diabetes than the stable group irrespective of initial weight. No significant cardiovascular benefit was seen for weight loss in any men, except possibly in considerably overweight (BMI 27.5-29.9 kg/m(2)) younger middle aged men (RR = 0.42; 95% CI 0.22 to 0.81). CONCLUSION: Long term risk of CVD and diabetes increased significantly with increasing overweight and obesity. Weight loss was associated with significant reduction in risk of diabetes but not CVD, except possibly in considerably overweight younger men. Duration and severity of obesity seem to limit the cardiovascular benefits of weight reduction in older men.     

代谢性肥胖与高血压发病的队列研究

目的  探讨代谢性肥胖与高血压发病的关系,为人群高血压防制提供理论依据。方法  采用前瞻性队列研究设计,于2009年在江苏省宜兴市官林、徐舍2个乡镇采用整群抽样方法纳入4 128名成人进行流行病学基线调查。排除基线2 012名高血压病例,截至2020年7月对2 116名非高血压对象进行高血压发病随访。根据体重和代谢状态将研究对象分为4组：代谢正常体重正常(metabolically healthy and normal weight, MHNW)、代谢正常超重/肥胖(metabolically healthy overweight/obesity, MHO)、代谢异常体重正常(metabolically unhealthy and normal weight, MUNW)、代谢异常超重/肥胖(metabolically unhealthy overweight/obesity, MUO)。采用Cox比例风险回归模型对代谢性肥胖与高血压发病关联进行分析,进一步做分层分析、异质性检验及相加与相乘交互作用分析;排除随访第一年发病的高血压对象、排除偏瘦人群进行敏感性分析。结果  共随访到新发高血压637例,超重肥胖及代谢异常联合相较于体重正常代谢正常的人群归因危险度(population attributable risk, PAR)及PAR%分别为17.4%、57.93%。Cox回归分析结果显示：与MHNW相比,MHO、MUNW、MUO三组的高血压发病风险增加均有统计学意义,调整后的HR(95% CI)值分别为1.29(1.08~1.56)、1.48(1.09~2.01)、1.70(1.37~2.11),并呈风险递增的趋势(均有P < 0.001)。分层分析和异质性检验结果显示：女性MUO的高血压发病风险(调整HR：2.14)高于男性MUO(调整HR：1.22),P_{异质性检验}= 0.017。相乘交互作用分析结果显示：性别与代谢状态之间存在相乘交互作用,调整后的HR(95% CI)值为1.53(1.06~2.22),P=0.024。排除随访第一年高血压发病的对象或排除偏瘦人群进行敏感性分析,关联强度无明显变化。结论  代谢性肥胖增加人群高血压发病风险,尤其在女性人群中风险更高。因此,对超重肥胖及代谢异常相关人群进行主动健康干预预防高血压具有十分重要意义。     

Determinants of hospital mortality in surgical patients aged 80 years and over

OBJECTIVE: To determine prognostic factors associated with mortality in patients aged 80 years and over who were treated at the Department of Surgery within a one-year period. DESIGN: Prospective. METHOD: The following items from the complications register were investigated: degree of mobility prior to the operation and the housing circumstances, presence of comorbidity in the case history (heart disease, lung disease, diabetes mellitus, dementia, urgency of admission and operation (elective, urgent, acute)), and the surgical subspecialism (gastroenterology, traumatology, vascular surgery and general surgery). The number of postoperative complications was also examined. Statistical analyses were performed using the chi 2 test and multiple logistic regression analysis. RESULTS: A total of 179 patients were included: 53 men and 126 women, with an average age of 85 years and 86 years respectively. The overall mortality was 11%: 39% in acutely presented patients and 8% in subacute patients. None of the electively operated patients died. The following factors were significantly associated with mortality: subacute presentation (odds ratio 8.5; 95%-CI: 2.8-27), acute presentation (odds ratio 72; 95%-CI: 8-737), cardiological evaluation without further measures was associated with less mortality (odds ratio 0.13; 95%-CI: 0.02-0.85). CONCLUSION: The risk of mortality increased with the urgency of presentation. A cardiological evaluation in which the patient, without the need for further additional measures, was found to be in an optimal condition was associated with a relatively low risk of mortality.     

The association of personal and neighborhood socioeconomic indicators with subclinical cardiovascular disease in an elderly cohort. The cardiovascular health study

There has been recent interest in determining whether neighborhood characteristics are related to the cardiovascular health of residents. However, there are no data regarding the relationship between neighborhood socioeconomic status (SES) and prevalence of subclinical cardiovascular disease (CVD) in the elderly. We related personal SES (education, income, and occupation type) and neighborhood socioeconomic characteristics (a block-group score summing six variables reflecting neighborhood income and wealth, education, and occupation) to the prevalence of subclinical CVD (asymptomatic peripheral vascular disease or carotid atherosclerosis, electrocardiogram or echocardiogram abnormalities, and/or positive responses to Rose Questionnaire claudication or angina pectoris) among 3545 persons aged 65 and over, without prevalent CVD, in the Cardiovascular Health Study. Sixty percent of participants had at least one indicator of subclinical disease. Compared to those without, those with subclinical disease had significantly lower education, income, and neighborhood scores and were more likely to have blue-collar jobs. After adjustment for age, gender, and race, those in the lowest SES groups had increased prevalence of subclinical disease compared with those in the highest SES groups (OR = 1.50; 95% CI 1.21, 1.86 for income; OR = 1.41; 95% CI 1.18, 1.69 for education; OR = 1.39; 95% CI 1.16, 1.67 for block-group score). Those reporting a blue-collar lifetime occupation had greater prevalence of subclinical disease relative to those reporting a white-collar occupation (OR = 1.29; 95% CI 1.02-1.59). After adjustment for behavioral and biomedical risk factors, all of these associations were reduced. Neighborhood score tended to remain inversely associated with subclinical disease after adjustment for personal socioeconomic indicators but associations were not statistically significant. Personal income and blue-collar occupation remained significantly associated with subclinical disease after simultaneous adjustment for neighborhood score and education. Personal and neighborhood socioeconomic indicators were associated with subclinical disease prevalence in this elderly cohort. These relationships were reduced after controlling for traditional CVD risk factors.     

Impact of health education and screening over all-cause mortality in Japan: evidence from a cohort study during 1984-2002

BACKGROUND: Health education and screening are two components of preventive health services in Japan since 1983. This study investigated their relationships with all-cause mortality as they are studied insufficiently in Hokkaido, Japan. METHODS: This study enrolled 1,532 men and 1,653 women aged 40-97 years from 1,702 randomly selected households of 60 areas during 1984-1985 and followed them until 2002. At baseline survey, staffs of 45 health centers collected sociodemographic, medical, behavioral, and dietary information including health education and screening from study subjects with informed consent. RESULTS: For men, age-adjusted Cox proportional hazard model indicated lower mortality for those who received health education (RR = 0.76, P < 0.01) and screening (RR = 0.83, P < 0.05) than those who did not. Health education showed lower mortality even after adjusting for many variables. Similarly for women, health education (RR = 0.66, P < 0.01) and screening (RR = 0.64, P < 0.001) revealed lower age-adjusted mortality. Almost similar results were found for both services when models were adjusted for many variables and when the deaths including lost to follow-up cases of the first 4 years of baseline survey are excluded. CONCLUSIONS: This study shows protective effects of health education and screening over all-cause mortality for both sexes. However, further studies are needed to confirm the results.