Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality

Abstract Background Selection bias affects Mendelian randomization investigations when selection into the study sample depends on a collider between the genetic variant and confounders of the risk factor–outcome association. However, the relative importance of selection bias for Mendelian randomization compared with other potential biases is unclear. Methods We performed an extensive simulation study to assess the impact of selection bias on a typical Mendelian randomization investigation. We considered inverse probability weighting as a potential method for reducing selection bias. Finally, we investigated whether selection bias may explain a recently reported finding that lipoprotein(a) is not a causal risk factor for cardiovascular mortality in individuals with previous coronary heart disease. Results Selection bias had a severe impact on bias and Type 1 error rates in our simulation study, but only when selection effects were large. For moderate effects of the risk factor on selection, bias was generally small and Type 1 error rate inflation was not considerable. Inverse probability weighting ameliorated bias when the selection model was correctly specified, but increased bias when selection bias was moderate and the model was misspecified. In the example of lipoprotein(a), strong genetic associations and strong confounder effects on selection mean the reported null effect on cardiovascular mortality could plausibly be explained by selection bias. Conclusions Selection bias can adversely affect Mendelian randomization investigations, but its impact is likely to be less than other biases. Selection bias is substantial when the effects of the risk factor and confounders on selection are particularly large.

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Lower insulin sensitivity as an independent risk factor for carotid wall thickening in normotensive, non-diabetic, non-smoking normal weight and obese premenopausal women

International Journal of Obesity ◽

10.1038/sj.ijo.0801239 ◽

2000 ◽

Vol 24 (7) ◽

pp. 825-829 ◽

Cited By ~ 27

Author(s):

G De Pergola ◽

M Ciccone ◽

N Pannacciulli ◽

M Modugno ◽

M Sciaraffia ◽

...

Keyword(s):

Risk Factor ◽

Insulin Sensitivity ◽

Independent Risk Factor ◽

Premenopausal Women ◽

Normal Weight ◽

Wall Thickening ◽

Carotid Wall

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The Concept of Normal Weight Obesity

Progress in Cardiovascular Diseases ◽

10.1016/j.pcad.2013.10.003 ◽

2014 ◽

Vol 56 (4) ◽

pp. 426-433 ◽

Cited By ~ 204

Author(s):

Estefania Oliveros ◽

Virend K. Somers ◽

Ondrej Sochor ◽

Kashish Goel ◽

Francisco Lopez-Jimenez

Keyword(s):

Normal Weight ◽

Normal Weight Obesity

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Lp(a) lipoprotein--an independent risk factor for coronary heart disease after menopause

American Journal of Critical Care ◽

10.4037/ajcc2001.10.1.63 ◽

2001 ◽

Vol 10 (1) ◽

pp. 63-67 ◽

Cited By ~ 11

Author(s):

LG Futterman ◽

L Lemberg

Keyword(s):

Risk Factor ◽

Heart Disease ◽

Lipid Profile ◽

Independent Risk Factor ◽

Treatment Options ◽

Exercise Program ◽

Pressure Control ◽

Normal Weight ◽

Arterial Stenosis ◽

History Of

Lp(a) is an independent risk factor for recurrent atherosclerotic heart disease in men and women after menopause. Excess levels of Lp(a) are seen in both males and females, more common in Africans, African Americans, and Asian populations than in whites. Since the standard lipid profile does not report Lp(a), it has to be ordered separately. Screening for Lp(a) should be considered under the following circumstances: (a) patient or family history of premature atherosclerotic heart disease, (b) familial history of hyperlipidemia, (c) established atherosclerotic heart disease with a normal routine lipid profile, (d) hyperlipidemia refractory to therapy, and (e) history of recurrent arterial stenosis. Treatment options are (a) a new extended-release form of niacin 3 to 4 g daily (although most effective in lowering Lp(a) and in reducing atherosclerotic heart disease mortality rates, its use may be limited because of side effects); (b) estrogen replacement after menopause, (however, concomitant progesterone therapy dilutes the effectiveness of estrogens); (c) lowering LDL with statins (generally effective in atherosclerotic heart disease but has no effect on Lp(a) levels), (d) aspirin and antibiotics (may be effective when C-reactive protein levels are high); and (e) folic acid (reduces homocysteine levels). The general measures that halt the progression of CAD should always be adhered to, namely, maintaining normal weight, a daily exercise program, blood pressure control, a low-cholesterol-forming diet, and daily aspirin.

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Constipation: Is it a risk factor for cholesterol gallstones? Heaton KW, Emmett PM, Symes CL, Braddon FEM. An explanation for gallstones in normal-weight women: slow intestinal transit: Lancet 1993; 341: 8–10

Hepatology ◽

10.1016/0270-9139(93)90032-i ◽

1993 ◽

Vol 18 (2) ◽

pp. 457-458 ◽

Cited By ~ 1

Author(s):

J Watkins

Keyword(s):

Risk Factor ◽

Normal Weight ◽

Intestinal Transit ◽

Cholesterol Gallstones

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P1493CORRELATION BETWEEN END-DIALYSIS OVER-WEIGHT IN INITIAL STAGE OF HEMODIALYSIS AND PROGNOSIS IN INCIDENT HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1493 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Ping Zhang ◽

Ying Wang ◽

Xi Yao ◽

Shaohua Chen ◽

Chunping Xu ◽

...

Keyword(s):

Risk Factor ◽

Cardiovascular Mortality ◽

Multivariate Regression ◽

Independent Risk Factor ◽

Hemodialysis Patients ◽

Maintenance Hemodialysis ◽

Interdialytic Weight Gain ◽

The Relationship

Abstract Background and Aims The volume factor of maintenance hemodialysis patients is closely related to the prognosis. We hypothesized that the excess weight after dialysis (end-dialysis over-weight, edOW) is an important factor of volume impact survival in hemodialysis (HD) patients. The purpose of this study was to analyze the relationship between edOW and long-term prognosis of patients with maintenance hemodialysis. Method This retrospective study observed incident hemodialysis patients who treated in Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University from January 1, 2008 to April 30, 2017, three times a week for at least one year. The end point of follow-up was death, abdominal dialysis, kidney transplantation, transfer or until April 30, 2018. The general data of the patients included age, gender, BMI, primary renal disease, CVD, first hemodialysis access, albumin(Alb), Haemoglobin(Hb), blood pressure, heart rate, ultrafiltration rate(UFR), interdialytic weight gain IDWG, end -dialysis overweight (edOW). Cox multivariate regression was used to analyze the relationship between edow and all-cause mortality and cardiovascular mortality. Results Totally 469 patients male, 64% were enrolled, with an average age of 56.9 ± 17.1 years. During the follow-up period, 102 patients died. The main cause of death was cardiovascular and cerebrovascular events, accounting for 44.7%. The mean value of edow was 0.28 ± 0.02 kg. Kaplan-Meier(Log-rank test) survival analysis showed that the long-term survival rate of the group with edow ≤ 0.28kg was better than that of the group with edow > 0.28kg (P = 0.042), and the cardiovascular mortality of the group with edow > 0.28kg was significantly higher than that of the group with edow ≤ 0.28kg (P = 0.001). Cox multivariate regression analysis showed that edow was an independent risk factor for all-cause death in hemodialysis patients (P = 0.025, AhR = 1.541, 95% CI 1.057-2.249), and also an independent risk factor for CVD death in hemodialysis patients (P = 0.007, AhR = 1.929, 95% CI 1.198-3.107). Conclusion EdOW is an independent risk factor of long-term all-cause and cardiovascular death in hemodialysis patients.

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