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 < 22.5), normal weight (BMI = 22.5–24.9), overweight (BMI = 25–29.9), and obesity (BMI ≥ 30)—and 3 WL categories—<5% (minimal), 5% to <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 < 5% had a lower 60-mo mortality risk than normal-weight women with WL < 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 < 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.

Obesity paradox in older cancer patients for middle and long-term mortality: A prospective multicenter cohort study of 2,071 patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11555-11555
Author(s):  
Claudia Martinez-Tapia ◽  
Thomas Diot ◽  
Nadia Oubaya ◽  
Elena Paillaud ◽  
Johanne Poisson ◽  
...  
Keyword(s):  
Weight Loss ◽  
Cancer Patients ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Cancer Site ◽  
Obese Women ◽  
Risk Of Mortality ◽  
Older Cancer Patients ◽  
Reduced Risk

11555 Background: Overweight and obesity are associated with numerous adverse health outcomes. However, among older adults, substantial literature suggests an improved survival among overweight and obese patients. This phenomenon, referred to as the “obesity paradox” remains controversial. In the context of cancer, the association between overweight/obesity and mortality is complex due to the concomitant weight loss and cachexia. We aim to assess the impact of high Body Mass Index (BMI) on mortality in a large population of older cancer patients. Methods: We studied patients aged ≥70 from the ELCAPA prospective open-cohort (2007-2016; 10 geriatric oncology clinics, Great Paris urban area). Endpoints were 12- and 48-months mortality. A variable combining BMI at cancer diagnosis and weight loss (in the 6 months preceding the diagnosis) was created. BMI categories considered: underweight, (BMI < 22.4kg/m²), normal weight (BMI 22.5-24.9), overweight (BMI 25-29.9), and obese (BMI ≥30); weight loss (WL) categories: < 5%, 5- < 10%, ≥10%. Univariate and multivariate Cox proportional-hazards analysis were conducted in males and females. Results: A total of 2071 patients were included (mean age, 81; female, 48%; metastases, 49%; main localizations: digestive (37%), urinary (26%), breast (16%); underweight (30%), normal weight (23%), overweight (33%), obese (14%)). After adjustment for age, smoking, inpatient status, cancer site, metastasis, performance status and comorbidities, overweight women with < 5% WL were at lower risk of 12- and 48-months mortality compared to normal weight women with < 5% WL (aHR = 0.56; p = 0.043 and 0.65; p = 0.031, respectively). Obese women with < 5% WL had a lower mortality risk only at 48-months (aHR = 0.63; p = 0.036). The obesity paradox was stronger in overweight metastatic women. Overweight or obese women with 5- < 10% or ≥10% WL had no reduced risk of mortality compared to normal weight women. Overweight and obese men had no reduced risk of mortality irrespective of weight loss. Conclusions: By taking into account initial weight loss, we did not found evidence for obesity paradox in older patients with cancer except in the subgroup of women with minimal weight loss. Clinical trial information: NCT02884375.

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.

Obesity is associated with lower mortality risk in elderly diabetic subjects: the Casale Monferrato study

2011 ◽  
Vol 50 (4) ◽  
pp. 563-568 ◽  
Author(s):  
Massimo Perotto ◽  
Francesco Panero ◽  
Gabriella Gruden ◽  
Paolo Fornengo ◽  
Bartolomeo Lorenzati ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Lower Mortality ◽  
Lower Mortality Risk

scholarly journals Obesity Paradox" – another look at the problem of cardiovascular disease

2013 ◽  
Vol 10 (4) ◽  
pp. 3-9
Author(s):  
O V Shpagina ◽  
I Z Bondarenko
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Obesity Paradox ◽  
Developed Countries ◽  
Epidemiologic Studies ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Published Data ◽  
Risk Of Death ◽  
Cardiovascular Prognosis

Major epidemiologic studies over the last century demonstrated that obesity leads to several severe diseases such as diabetes mellitus, hypertension, coronary heart disease, chronic heart failure, cerebrovascular accidents. In developed countries cardiovascular diseases became the main cause of death. In the last 5–6 years some studies showed that people with overweight and obesity of the first degree have a higher life expectancy than people with normal weight. In 2009, the published data showed that the presence of obesity in patients with chronic heart failure does not impair cardiovascular prognosis. Overweight correlates with a decrease in overall mortality by 25%. And in a first degree of obesity the risk of death is reduced by 12%. This phenomenon is called "obesity paradox" and the causes of which are discussed in this review.

Frequency, predictors, and prognosis of ejection fraction improvement in heart failure: an echocardiogram-based registry study

2019 ◽  
Vol 40 (26) ◽  
pp. 2110-2117 ◽  
Author(s):  
Anukul Ghimire ◽  
Nowell Fine ◽  
Justin A Ezekowitz ◽  
Jonathan Howlett ◽  
Erik Youngson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Mortality Risk ◽  
Left Ventricular ◽  
Lower Mortality ◽  
Ventricular Assist ◽  
Reduced Ejection Fraction ◽  
Multivariable Adjustment ◽  
Lower Mortality Risk

Abstract Aims To identify variables predicting ejection fraction (EF) recovery and characterize prognosis of heart failure (HF) patients with EF recovery (HFrecEF). Methods and results Retrospective study of adults referred for ≥2 echocardiograms separated by ≥6 months between 2008 and 2016 at the two largest echocardiography centres in Alberta who also had physician-assigned diagnosis of HF. Of 10 641 patients, 3124 had heart failure reduced ejection fraction (HFrEF) (EF ≤ 40%) at baseline: while mean EF declined from 30.2% on initial echocardiogram to 28.6% on the second echocardiogram in those patients with persistent HFrEF (defined by <10% improvement in EF), it improved from 26.1% to 46.4% in the 1174 patients (37.6%) with HFrecEF (defined by EF absolute improvement ≥10%). On multivariate analysis, female sex [adjusted odds ratio (aOR) 1.66, 95% confidence interval (CI) 1.40–1.96], younger age (aOR per decade 1.16, 95% CI 1.09–1.23), atrial fibrillation (aOR 2.00, 95% CI 1.68–2.38), cancer (aOR 1.52, 95% CI 1.03–2.26), hypertension (aOR 1.38, 95% CI 1.18–1.62), lower baseline ejection fraction (aOR per 1% decrease 1.07 (1.06–1.08), and using hydralazine (aOR 1.69, 95% CI 1.19–2.40) were associated with EF improvements ≥10%. HFrecEF patients demonstrated lower rates per 1000 patient years of mortality (106 vs. 164, adjusted hazard ratio, aHR 0.70 [0.62–0.79]), all-cause hospitalizations (300 vs. 428, aHR 0.87 [0.79–0.95]), all-cause emergency room (ER) visits (569 vs. 799, aHR 0.88 [0.81–0.95]), and cardiac transplantation or left ventricular assist device implantation (2 vs. 10, aHR 0.21 [0.10–0.45]) compared to patients with persistent HFrEF. Females with HFrEF exhibited lower mortality risk (aHR 0.94 [0.88–0.99]) than males after adjusting for age, time between echocardiograms, clinical comorbidities, medications, and whether their EF improved or not during follow-up. Conclusion HFrecEF patients tended to be younger, female, and were more likely to have hypertension, atrial fibrillation, or cancer. HFrecEF patients have a substantially better prognosis compared to those with persistent HFrEF, even after multivariable adjustment, and female patients exhibit lower mortality risk than men within each subgroup (HFrecEF and persistent HFrEF) even after multivariable adjustment.

scholarly journals Healthy eating and lower mortality risk in a large cohort of cardiac patients who received state-of-the-art drug treatment

2015 ◽  
Vol 102 (6) ◽  
pp. 1527-1533 ◽  
Author(s):  
Femke PC Sijtsma ◽  
Sabita S Soedamah-Muthu ◽  
Janette de Goede ◽  
Linda M Oude Griep ◽  
Johanna M Geleijnse ◽  
...  
Keyword(s):  
Drug Treatment ◽  
Healthy Eating ◽  
Mortality Risk ◽  
State Of The Art ◽  
Large Cohort ◽  
Cardiac Patients ◽  
Lower Mortality ◽  
Lower Mortality Risk

Clinical Decision Analysis as a Means of Technology Assessment: The Effectiveness of Intraoperative Cholangiography

1992 ◽  
Vol 8 (1) ◽  
pp. 185-197 ◽  
Author(s):  
Thomas E. Scott ◽  
Itzhak Jacoby
Keyword(s):  
Decision Analysis ◽  
Mortality Risk ◽  
Technology Assessment ◽  
Common Duct ◽  
Cost Effective ◽  
Clinical Decision ◽  
Intraoperative Cholangiography ◽  
Lower Mortality ◽  
Effective Option ◽  
Lower Mortality Risk

AbstractThree strategies for timely detection of common duct stones are examined by decision analysis: the use of intraoperative cholangiography (IOC) in ALL, NONE, or in SOME of the cases that are selected by the estimated probability of a common duct stone. Selective use of IOC is the most cost-effective option and offers a slightly lower mortality risk.

1095 Gastroenterologist Care is Associated With Lower Mortality Risk in Hospitalized Ulcerative Colitis Patients

2012 ◽  
Vol 142 (5) ◽  
pp. S-197 ◽  
Author(s):  
Sanjay K. Murthy ◽  
A. Hillary Steinhart ◽  
Jill M. Tinmouth ◽  
Peter C. Austin ◽  
Geoffrey C. Nguyen
Keyword(s):  
Ulcerative Colitis ◽  
Mortality Risk ◽  
Lower Mortality ◽  
Lower Mortality Risk

scholarly journals Personality Pathways to Mortality: Interleukin-6 Links Conscientiousness to Mortality Risk

2020 ◽  
Author(s):  
Páraic S O'Súilleabháin ◽  
Nick Turiano ◽  
Denis Gerstorf ◽  
Martina Luchetti ◽  
stephen gallagher ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Interleukin 6 ◽  
The United States ◽  
Lower Mortality ◽  
Reactive Protein ◽  
Age Related ◽  
Physiological Pathways ◽  
Adjusted Model ◽  
Lower Mortality Risk

Personality is associated consistently with mortality hazards, but the physiological pathways are not yet clear. Immune system dysregulation may be one such pathway due to its role in age-related morbidity and mortality. In this preregistered study, we tested whether interleukin-6 (IL-6) and C-reactive protein (CRP) mediated the associations between personality traits and mortality hazards. The sample included 957 participants (M ± SD = 58.65 ± 11.51 years; range = 35 – 86 years) from the Midlife in the United States Survey that had 14 years of follow-up. Higher conscientiousness was associated with lower mortality hazards, with each one standard deviation higher conscientiousness associated with a 35% lower mortality risk. IL-6, but not CRP, partially mediated this association, with IL-6 accounting for 18% of this association in the fully adjusted model. While there was initial evidence that the biomarkers mediated both neuroticism and agreeableness and mortality risk, the indirect effects were not significant when controlling for the sociodemographic variables. Taken together, higher conscientiousness may lead to a longer life partially as a result of lower IL-6. This work highlights the importance of biological pathways that link personality to future mortality risk.

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