scholarly journals Obesity paradox in joint replacement for osteoarthritis — truth or paradox?

GeroScience ◽  
2021 ◽  
Author(s):  
Setor K. Kunutsor ◽  
Michael R. Whitehouse ◽  
Ashley W. Blom
Keyword(s):  
Mortality Risk ◽  
Joint Replacement ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Obese People ◽  
Intentional Weight Loss ◽  
Adverse Health Outcomes ◽  
Increased Risk ◽  
Established Relationship ◽  
Metabolic Reserve

AbstractObesity is associated with an increased risk of cardiovascular disease (CVD) and other adverse health outcomes. In patients with pre-existing heart failure or coronary heart disease, obese individuals have a more favourable prognosis compared to individuals who are of normal weight. This paradoxical relationship between obesity and CVD has been termed the ‘obesity paradox’. This phenomenon has also been observed in patients with other cardiovascular conditions and diseases of the respiratory and renal systems. Taking into consideration the well-established relationship between osteoarthritis (OA) and CVD, emerging evidence shows that overweight and obese individuals undergoing total hip or knee replacement for OA have lower mortality risk compared with normal weight individuals, suggesting an obesity paradox. Factors proposed to explain the obesity paradox include the role of cardiorespiratory fitness (“fat but fit”), the increased amount of lean mass in obese people, additional adipose tissue serving as a metabolic reserve, biases such as reverse causation and confounding by smoking, and the co-existence of older age and specific comorbidities such as CVD. A wealth of evidence suggests that higher levels of fitness are accompanied by prolonged life expectancy across all levels of adiposity and that the increased mortality risk attributed to obesity can be attenuated with increased fitness. For patients about to have joint replacement, improving fitness levels through physical activities or exercises that are attractive and feasible, should be a priority if intentional weight loss is unlikely to be achieved.

Abstract P528: Normal Weight Metabolic Obesity and Risk of Coronary Artery Disease: The Million Veteran Program

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Petra Schubert ◽  
Yuk-lam Ho ◽  
David R Gagnon ◽  
Kelly Cho ◽  
Peter W Wilson ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
The United States ◽  
Normal Weight ◽  
Normal Body Mass Index ◽  
Metabolic Dysfunction ◽  
Obese People ◽  
Increased Risk ◽  
Secondary Analyses ◽  
Artery Disease

Introduction: Obesity and metabolic dysfunction, individually, are known risk factors of stroke, coronary artery disease (CAD), and mortality. However, few studies have examined the long-term risk for CAD among non-obese people with metabolic dysfunction, and no studies have been conducted for Veterans of the United States. Hypothesis: Veterans who are metabolically obese normal weight (MONW) at baseline have an increased risk of developing CAD compared to metabolically healthy normal weight (MHNW) veterans enrolled in the Million Veteran Program (MVP). Methods: We included MVP participants who had a stable normal body mass index (18.5-25kg/m 2 ) five years prior to enrollment. Metabolic obesity was defined as having three or more of the Adult Treatment Panel III criteria [diabetes, hypertension, low HDL-C (≤40 mg/dl for men, ≤50 mg/dl for women), and high triglycerides (≥150 mg/dl)] at enrollment. CAD was defined as non-fatal myocardial infarction, ischemic heart disease or angina pectoris. Participants with prevalent CAD, major cancers and incomplete lifestyle information were excluded. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for CAD incidence. In secondary analyses, we stratified by sex and race to evaluate possible effect modification. Results: Of the 16,764 people identified as normal weight with complete data, 15% were MONW, 84.5% were male, 84.4% were White and the mean age was 63.1 ± 14.2. Over a median follow up of 3.6 (IQR 1.8-5.2) years, there were 847 incident CAD events observed. MONW individuals had a 64% (95% CI: 40 -91%) higher risk of CAD compared to normal weight individuals, controlling for age, race, sex, education, smoking status, physical activity, alcohol use and diet. In secondary analyses, we observed a nominally higher risk among women who were MONW [HR (95% CI): 2.74 (1.30-5.77) for women vs. 1.60 (1.37-1.88) for men], however the interaction of MONW and sex was not statistically significant (interaction p=0.19). Similarly, the interaction of MONW and race was not statistically significant [1.62 (1.37-1.92) for White, 1.55 (0.97-2.48) for Black, and 2.26 (1.03-4.95) for other, interaction p=0.83)]. Conclusions: MONW Veterans had a higher risk of CAD compared to MHNW Veterans. This risk was magnified in female Veterans and attenuated in White and Black Veterans compared to other races (Asian, Pacific Islander, Native American, other). These findings will need to be validated in future studies.

scholarly journals The Obesity Paradox in Type 2 Diabetes and Mortality

2016 ◽  
Vol 12 (3) ◽  
pp. 244-251 ◽  
Author(s):  
Deirdre K. Tobias ◽  
JoAnn E. Manson
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Mortality Risk ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Epidemiological Methods ◽  
Excess Body Weight ◽  
Methodological Considerations

The obesity paradox for survival among individuals with type 2 diabetes has been observed in some but not all studies. Conflicting evidence for the role of overweight and obesity in all-cause mortality may largely be a result of differences in study populations, epidemiological methods, and statistical analysis. For example, analyses among populations with long-term prevalent diabetes and the accrual of other chronic health conditions are more likely to observe that the sickest participants have lower body weights, and therefore, relative to normal weight, overweight and even obesity appear advantageous. Other mortality risk factors, such as smoking, also confound the relationship between body weight and survival, but this behavior varies widely in intensity and duration, making it difficult to assess and effectively adjust for in statistical models. Disentangling the potential sources of bias is imperative in understanding the relevance of excess body weight to mortality in diabetes. In this review, we summarize methodological considerations underlying the observed obesity paradox. Based on the available evidence, we conclude that the obesity paradox is likely an artifact of biases, and once these are accounted for, it is evident that compared with normal body weight, excess body weight is associated with a greater mortality risk.

scholarly journals Obesity Paradox in Short-Term Clinical Outcomes After Percutaneous Coronary Interventions

2021 ◽  
Vol 36 (1) ◽  
pp. 1-8
Author(s):  
Mohammad Khalilur Rahman Siddiqui ◽  
Pradip Kumar Karmakar ◽  
Nur Alam ◽  
Md Mizanur Rahman ◽  
Pranob Karmaker ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Obesity Paradox ◽  
Left Ventricular ◽  
Normal Weight ◽  
Short Term ◽  
Obese People ◽  
Cross Sectional ◽  
Hospital Outcomes ◽  
Group I ◽  
Percutaneous Coronary

Background: The “obesity paradox”, a counterintuitive decrease in morbidity and mortality with increasing body mass index (BMI), has been shown in patients when acute cardiovascular decompensation occurs. However, whether this phenomenon exists in patients undergoing percutaneous coronary intervention (PCI) is not well known. The existence of obesity paradox and its impact on short-term clinical outcomes after PCI have not been thoroughly investigated, especially in Bangladesh. Methods: This cross-sectional observational study was conducted at National Institute of Cardiovascular Diseases, Dhaka, in 100 patients who underwent PCI. They were divided in two groups on the basis of BMI of Asian ethnicity: Group I (BMI < 23 kg/m2) and Group II (BMI <23.0 kg/m2). Short-term in-hospital outcomes after PCI were observed and recorded. Results: Acute left ventricular failure (LVF) was found to be statistically significant between groups (p < 0.01) being higher in Group-I. The difference of mean duration of hospital stay (LOS) after PCI was higher in the same group which was statistically significant (p < 0.01). Diabetes mellitus and dyslipidemia were found to be the independent predictors for developing adverse in hospital outcome (OR= 1.68 and 1.46; 95% CI = 1.25 – 2.24 and 1.16 – 1.83; p = 0.018 and 0.040, respectively). BMI was inversely associated with in-hospital outcomes after PCI (OR = 0.95; 95% CI = 0.91 – 0.98; p = 0.007). Conclusion: The results of the study uphold the phenomenon of the “obesity paradox” following PCI. The underweight and normal weight people are at greater risk to experience short-term in-hospital adverse clinical outcomes than overweight and obese people after PCI. Bangladesh Heart Journal 2021; 36(1): 1-8

scholarly journals Metabolic syndrome identifies normal weight insulin-resistant stroke patients at risk for recurrent vascular disease

2018 ◽  
Vol 14 (6) ◽  
pp. 639-645 ◽  
Author(s):  
Jennifer L Dearborn ◽  
Catherine M Viscoli ◽  
Silvio E Inzucchi ◽  
Lawrence H Young ◽  
Walter N Kernan
Keyword(s):  
Myocardial Infarction ◽  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Diabetic Patients ◽  
Insulin Resistant ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Patients At Risk

Background The obesity paradox refers to the finding in observational studies that patients with obesity have a better prognosis after stroke than normal weight patients. Aim To test the hypothesis that there might be important heterogeneity within the obese stroke population, such that those with metabolic syndrome would be at higher risk for stroke or myocardial infarction and all-cause mortality compared to patients without metabolic syndrome. Methods The Insulin Resistance Intervention after Stroke trial enrolled non-diabetic patients with a recent ischemic stroke or transient ischemic attack and insulin resistance. We examined the association between metabolic syndrome and outcome risk in patients with normal weight at entry (body mass index (BMI) = 18.5–24.9 kg/m2), overweight (BMI = 25–29.9 kg/m2), or obesity (BMI ≥ 30 kg/m2). Analyses were adjusted for demographic features, treatment assignment, smoking, and major comorbid conditions. Results Metabolic syndrome was not associated with greater risk for stroke or myocardial infarction among 1536 patients who were overweight (adjusted hazard ratio (HR), 0.95; 95% confidence interval (CI): 0.69–1.31) or 1626 obese patients (adjusted HR, 1.00; 95% CI: 0.70–1.41). However, among 567 patients with a normal BMI, metabolic syndrome was associated with increased risk for stroke or myocardial infarction (adjusted HR, 2.05; 95% CI: 1.25–3.37), and all-cause mortality (adjusted HR, 1.70; 95% CI: 1.03–2.81) compared to patients without metabolic syndrome. Conclusions The presence of metabolic syndrome identified normal weight patients with insulin resistance but no diabetes who have a higher risk of adverse cardiovascular outcomes, compared with patients without metabolic syndrome.

scholarly journals Underweight and overweight: between Scylla and Charybdis

2009 ◽  
Vol 15 (6) ◽  
pp. 633-639
Author(s):  
O. M. Drapkina ◽  
O. N. Dikur
Keyword(s):  
Insulin Resistance ◽  
Obesity Paradox ◽  
Normal Weight ◽  
The Novel ◽  
Metabolic Disturbances ◽  
Thrifty Phenotype ◽  
Obesity And Diabetes ◽  
Increased Risk ◽  
Clinical Phenomenon ◽  
Mechanisms Of Development

It is well known that overweight as well as underweight is strongly associated with increased risk of development of many disorders, particularly cardiovascular pathology. The paper discloses the most appreciable problems of health associated with obesity and underweight. Pathophysiological mechanisms of development of the basic metabolic disturbances underlying obesity and diabetes mellitus, such as insulin resistance and dyslipoproteinemia, are described. The interaction of hereditary and environmental factors leading to adiposity is discussed in the light of the novel theories of development of adiposity, such as the hypothesis of a thrifty phenotype and "the selfish brain theory". Particular cases of obesity development in the absence of insulin resistance are described. The clinical phenomenon of paradoxical more favorable prognosis in patients with overweight in comparison with patients with normal weight and underweight (the obesity paradox) is discussed.

scholarly journals The obesity paradox for mid- and long-term mortality in older cancer patients: a prospective multicenter cohort study

2020 ◽  
Vol 113 (1) ◽  
pp. 129-141 ◽  
Author(s):  
Claudia Martinez-Tapia ◽  
Thomas Diot ◽  
Nadia Oubaya ◽  
Elena Paillaud ◽  
Johanne Poisson ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Mortality Risk ◽  
Geriatric Oncology ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Lower Mortality ◽  
Obese Women ◽  
Multicenter Cohort Study ◽  
Lower Mortality Risk

ABSTRACT Background Overweight and obesity are associated with adverse health outcomes. However, substantial literature suggests that they are associated with longer survival among older people. This “obesity paradox” remains controversial. In the context of cancer, the association between overweight/obesity and mortality is complicated by concomitant weight loss (WL). Sex differences in the relation between BMI (in kg/m2) and survival have also been observed. Objectives We studied whether a high BMI was associated with better survival, and whether the association differed by sex, in older patients with cancer. Methods We studied patients aged ≥70 y from the ELCAPA (Elderly Cancer Patients) prospective open cohort (2007–2016; 10 geriatric oncology clinics, Greater Paris urban area). The endpoints were 12- and 60-mo mortality. We created a variable combining BMI at cancer diagnosis and WL in the previous 6 mo, and considered 4 BMI categories—underweight (BMI &lt; 22.5), normal weight (BMI = 22.5–24.9), overweight (BMI = 25–29.9), and obesity (BMI ≥ 30)—and 3 WL categories—&lt;5% (minimal), 5% to &lt;10% (moderate), and ≥10% (severe). Univariate and multivariate Cox proportional hazards analyses were conducted in men and women. Results A total of 2071 patients were included (mean age: 81 y; women: 48%; underweight: 30%; normal weight: 23%; overweight: 33%; obesity: 14%; predominant cancer sites: colorectal (18%) and breast (16%); patients with metastases: 49%). By multivariate analysis, obese women with WL &lt; 5% had a lower 60-mo mortality risk than normal-weight women with WL &lt; 5% (adjusted HR: 0.56; 95% CI: 0.37, 0.86; P = 0.012). Overweight/obese women with WL ≥ 5% did not have a lower mortality risk than normal-weight women with WL &lt; 5%. Overweight and obese men did not have a lower mortality risk, irrespective of WL. Conclusions By taking account of prediagnosis WL, only older obese women with cancer with minimal WL had a lower mortality risk than their counterparts with normal weight. This trial was registered at clinicaltrials.gov as NCT02884375.

Abstract MP82: Body Mass Index and Mortality in Chinese Adults with Newly Diagnosed Type 2 Diabetes

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Noel T Mueller ◽  
Andrew O Odegaard ◽  
Woon-Puay Koh ◽  
Myron D Gross ◽  
Jian-Min Yuan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Mass Index ◽  
Body Mass ◽  
Mortality Risk ◽  
Normal Weight ◽  
Chinese Adults ◽  
Risk Of Death ◽  
Increased Risk

In Western populations normal weight adults at the time of incident type 2 diabetes (T2D) diagnosis have been reported to have higher mortality risk than overweight/obese adults. However, little investigation of this topic has occurred in Asian populations who tend to have relatively low body mass index (BMI = kg/m2) yet high rates of T2D. We investigated the association between BMI, reported prior to diagnosis of T2D, and mortality risk among a cohort of Chinese adults with T2D.We used data from the Singapore Chinese Health Study, including Chinese men and women aged 45-74 years of age, free of cancer, heart disease, stroke, and T2D at baseline (1993-1998), and followed for mortality through 2011. A total of 4,288 participants, contributing 57,220 person-years of follow-up, reported physician diagnosed incident T2D at two follow up interviews and reported height and weight at the previous interview, an average of 4.4 years prior to T2D diagnosis. Participants were classified according to WHO Asian-specific definitions as underweight (BMI <18.5), normal weight (18.5-23.49), overweight (23.5-27.49), and obese (≥ 27.5).During an average follow-up of 13.3 years, 470 of the 4,288 participants died: 159 from cardiovascular (CVD) causes and 311 from other causes. After adjustment for demographics, smoking status and alcohol consumption, there were no statistically significant differences in mortality rates across the BMI categories. However, the BMI-mortality association varied markedly by age. Among those who were ≤65 years of age, obesity, compared to normal weight, carried an increased risk of total mortality by 41% (4% to 92%) and of CVD mortality by 56% (-9% to 166%). However, among those >65 years of age we observed no association between BMI and mortality risk. Among Singaporean Chinese adults with type 2 diabetes, being obese prior to diagnosis was associated with increased risk of death in those who were ≤65 years of age, whereas among those >65 years there was no clear association between BMI and risk of mortality.

scholarly journals Patient features and survival of pediatric aplastic anemia in the USA: a large institution experience

2018 ◽  
Vol 41 (2) ◽  
pp. 329-337
Author(s):  
M J Hossain ◽  
S Xie
Keyword(s):  
Health Care ◽  
Platelet Count ◽  
Aplastic Anemia ◽  
Mortality Risk ◽  
Proportional Hazards ◽  
Care Delivery ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Increased Risk ◽  
Male Sex

AbstractBackgroundWe performed the first epidemiologic investigation to examine association of demographics and clinical characteristics at diagnosis, as well as health care expense coverage, with survival of US children with aplastic anemia (AA).MethodsWe obtained electronic medical record data of 1140 children aged 0–19 years diagnosed with AA followed at a pediatric health system between 2004 and 2014. Kaplan–Meier curve and Cox proportional hazards regressions were used.ResultsSelf-pay patients had a mortality risk five times higher than that of those insured by publicly funded insurance (hazards ratio, 95% CI: 6.0, 3.7–9.8). Other features associated with higher mortality risk include pancytopenia (hazards ratio, referent: 4.2, constitutional AA); underweight (2.0, normal-weight); platelet count <50 × 109/l (1.3, ≥50 × 109/l); male sex (1.3, female); and ages at diagnosis 6–11, 11–16 and 16–19 years (1.6, 1.9, 2.3, 1–3 years), respectively.ConclusionsSelf-pay was the strongest prognostic factor for pediatric AA mortality. Older age, pancytopenia, underweight, male sex and lower platelet count were also associated with increased risk of mortality. These findings may be useful for providers, researchers and policymakers to ensure effective health care delivery to this population and to motivate future etiologic research and establishment of a surveillance registry.

Abstract 006: Fitness Status Influences the Paradoxical Association Between BMI and Mortality Risk

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Peter Kokkinos ◽  
Jonathan Myers ◽  
Charles Faselis ◽  
Raya Kheirbek ◽  
Helen Sheriff ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Mortality Risk ◽  
Reference Group ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Entire Cohort ◽  
Hazard Ratios ◽  
Group A ◽  
Low Body Mass Index

Introduction: In some populations, recent evidence supports a higher mortality risk in individuals with relatively low body mass index (BMI), and lower risk in some overweight or obese individuals. However, the role of fitness in this puzzling relationship, termed as the obesity paradox, has not been fully explored. Hypothesis: We assessed the hypothesis that fitness attenuates the BMI-mortality risk paradoxical association. Methods: The association of exercise capacity and mortality risk in 18,228 individuals (mean age: 58±11) was assessed. Three fitness categories were formed based on the 33 rd and 66 th percentiles of exercise capacity (METs) achieved: Low-Fit (≤6 METs; n=6,072); Moderate-Fit: 6.1-8.5 METs; n=6,158); and High-Fit: >8.5 METs; n=5,998). Individuals were also classified based on BMI as Normal-Wt (BMI 18.5-24.9); Over-Wt (BMI: 25-29.9); Moderate-Obese (BMI: 30-34.9) and Obese (BMI ≥35). Results: There were 4,770 deaths (median follow-up 10.1 years). After controlling for age, risk factors and medications, we observed a paradoxical association between BMI categories and mortality risk (p<0.001 for trend). We also observed an inverse and graded association between fitness status and mortality for the entire cohort and within BMI categories, with reductions in risk ranging from approximately 30% to 60% (p<0.001). We then assessed mortality risk based on fitness status within each BMI category, using the Normal-Wt/High-Fit individuals as the reference group. A paradoxical BMI-mortality risk association was evident in all fitness categories. However, in Low-Fit individuals the risk was significantly increased within each BMI category (hazard ratios (HR): 2.26; 1.7; 1.7 and 1.76 for Normal-Weight, Over-Wt; Moderate-Obese and Obese categories, respectively; p<0.001 for all comparisons). However, in Moderate-Fit individuals, a significantly higher risk was observed only in the Normal-Wt category (HR: 1.58; p<0.001). Finally, in High-Fit individuals, mortality risk was significantly lower in Over-Wt (HR: 0.79; p=0.03) and Moderately Obese categories (HR: 0.58; p<0.001). Conclusions: These findings suggest that the paradoxical association between BMI and mortality risk is strongly modulated by fitness status.

scholarly journals AB0871 OSTEOARTHRITIS IN OBESE PATIENTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1741.1-1742
Author(s):  
S. Lapshina ◽  
L. Feiskhanova ◽  
A. Nurmieva ◽  
K. Sadriev
Keyword(s):  
Metabolic Syndrome ◽  
Body Weight ◽  
Normal Weight ◽  
Knee Joints ◽  
Excess Body Weight ◽  
Obese Patients ◽  
Obese People ◽  
X Ray ◽  
The Metabolic Syndrome ◽  
Increased Risk

Background:Obesity is a recognized risk factor for osteoarthritis (OA) of the knee joints, which is associated with increased biomechanical stress. However, the association of OA with metabolic syndrome is more multifaceted, since overweight and obese people have a similar increased risk of OA of the hand joints that do not carry weight, due to systemic factors.Objectives:To identify the features of the course of OA in overweight patients.Methods:52 patients with an established diagnosis of osteoarthritis were examined: women - 84.6%, men - 15.4%, average age - 60.9 ± 8.9 years (32 to 78 years). Clinical examination, calculation of body mass index (BMI), determination of the X-ray stage of OA according to the Kellgren and Lawrence system; ultrasound examination of the knee joints; assessment of the severity of pain according to visual analog scale (VAS); the index WOMAC was used to evaluate pain, stiffness and physical function. We evaluated the quality of life by EQ-5D.Results:The duration of OA was 8.75 [2.58; 26] years. The distribution of patients according to the X-ray stage of OA: I - 9.6%, II - 57.6%, III - 26.9%, IV - 5.9% of patients. The BMI range was from 21 to 43 kg/. A BMI up to 30 kg/ was found in 22 patients: 17.3% - normal weight, 25% - excess body weight. Thirty patients has BMI more than 30 kg/: I degree - 38.4%, II degree - 15.3%, III degree - 4%. Obese patients rated pain according to the VAS scale of 1.3 the score is more intensively than patients with a BMI <30 kg/m2(p <0.001). A detailed examination of each subsequent degree of obesity revealed a tendency to reduce the pain syndrome from 7.52 points at 1 degree of obesity to 5 points at 3 degrees of obesity (p <0.001). With increasing body weight, there was an increase in difficulties in daily activities according to the WOMAC (p <0.05). Reactive knee synovitis was detected in 25 (48%) patients. The incidence of synovitis in patients with a BMI <30 kg / m2is 27%, with a BMI> 30 kg / m2is 68%. Patients with obesity of 1stdegree had synovitis in 65%, 2nddegree - 75%, 3rddegree - 84% of cases (p <0.05). A high correlation between the x-ray stage of OA and BMI (r = 0.74; p <0.001) was revealed. According to the EQ-5D questionnaire, patients with the 1stdegree of obesity (2.31 ± 1.3) were very anxious, but the level of anxiety decreases in patients with 3rddegree of obesity (1.44 ± 0.9) and it’s equal to that in individuals with normal body weight (1.33 ± 0.8).Conclusion:The existence of obesity in patients with OA is associated with an increase in pain, a significant decrease in functional ability, a presence of reactive synovitis of the knee joints, aggravation of the X-ray stage of OA, and the appearance of anxiety and depression. However, with the further progression of obesity, the levels of anxiety for one’s condition decrease.References:[1]Felson DT, Zhang Y, Hannan MT et al. Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham study. Arthritis Rheum. 1997; 40: 728–733.[2]Huffman KM. Osteoarthritis and the metabolic syndrome: more evidence that the etiology of OA is different in men and women. 2012; 20 (7): 603–604.Disclosure of Interests:None declared

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