scholarly journals Challenging the obesity paradox: extreme obesity and COPD mortality in the SUMMIT Trial

2021 ◽  
pp. 00902-2020
Author(s):  
Emily P. Brigham ◽  
Julie A. Anderson ◽  
Robert D. Brook ◽  
Peter M. A. Calverley ◽  
Bartolome R. Celli ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Proportional Hazards ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Class I ◽  
Class Iii ◽  
Obese Class ◽  
Class Iii Obesity ◽  
The Impact ◽  
The Relationship

Populations with COPD demonstrate higher survival in overweight and obese compared with normal weight; the “obesity paradox.” Relationships in less severe COPD are unclear, as is the impact of cardiovascular risk, and few studies include individuals at extremes of obesity.We examined the relationship between body mass index (BMI, defined as underweight: <20 kg·m−2, normal: 20–25 kg·m−2, overweight: 25-<30 kg·m−2, obese class I: 30-<35 kg·m−2, class II: 35-<40 kg·m−2, class III: ≥40 kg·m−2), morbidity, and mortality in the SUMMIT trial population (n=16 485), characterised by moderate COPD and heightened cardiovascular risk with a substantial proportion with class III obesity. The association between BMI category and time to event was modeled via proportional hazards (reference normal weight) adjusted for demographics and cardiorespiratory disease.Consistent with the paradox, underweight individuals demonstrated higher mortality (HR 1.31 (95%CI 1.04–1.64)), with lower mortality among overweight (HR 0.62 (95%CI 0.52–0.73)) and obese class I (HR 0.75 (95%CI 0.62–0.90)). However, mortality increased in obese class III (HR 1.36 (95%CI 1.00–1.86)). Death was primarily attributable to cardiovascular causes.Within a large, multinational cohort with moderate COPD and increased cardiovascular risk, the phenomenon of reduced mortality with obesity did not persist at BMI>40 kg·m−2, suggesting that obesity may not remain protective at the extremes in this population.

Impact of Elevated BMI and Types of Comorbid Conditions on Health-Related Quality of Life in a Nationally Representative US Sample

2021 ◽  
pp. 1-22
Author(s):  
Quang A. Le ◽  
Dimittri Delevry
Keyword(s):  
Chronic Conditions ◽  
Normal Weight ◽  
Class Iii ◽  
Comorbid Conditions ◽  
Class Iii Obesity ◽  
Related Quality ◽  
Health Related ◽  
Nationally Representative ◽  
The Impact

Abstract Objective: Elevated body mass index (BMI) is associated with multiple chronic conditions including diabetes and cardiovascular disease. Patients with overweight or obesity may also suffer from comorbidities not directly related to the pathophysiology of elevated BMI. The current study sought to determine the impact of BMI and different types of chronic conditions on health-related quality of life (HRQoL) outcomes. Design: Six weight categories by BMI were identified: Underweight, Normal weight, Overweight, Class-I obesity, Class-II obesity, and Class-III obesity. Twenty chronic conditions were considered and categorized as elevated BMI-related (concordant) or -unrelated (discordant) conditions. HRQoL outcomes were measured using Short Form-6 Dimensions (SF-6D). Multivariable regression models were performed to examine the impact of type, number of comorbid conditions, and BMI categories on SF-6D scores. Setting: Medical Expenditure Panel Survey (2013-2015). Participants: Nationally representative sample of US population; 18 years or older (n=58,960). Results: Of the sample, 1.7%, 32.9%, 34.0%, and 31.4% were classified as underweight, normal weight, overweight, and obese, respectively. The SF-6D scores were significantly decreased across all obesity classes, with the largest reduction in Class-III obesity (0.033; p < 0.001). Additionally, individuals with obesity having one or more concordant or discordant comorbidities further reduced SF-6D scores between 0.031 and 0.148 (p-values < 0.001) or between 0.080 and 0.212 (p-values < 0.001), respectively. Conclusions: Individuals with obesity had a significant reduction in HRQoL outcomes compared to those with normal BMI. Importantly, discordant comorbidity resulted in greater reduction in HRQoL outcomes compared to concordant comorbidity in subjects with elevated BMI.

scholarly journals The impact of maternal obesity on completion of fetal anomaly screening

2017 ◽  
Vol 45 (9) ◽  
Author(s):  
Kelly-Ann Eastwood ◽  
Ciara Daly ◽  
Alyson Hunter ◽  
David McCance ◽  
Ian Young ◽  
...  
Keyword(s):  
Maternal Obesity ◽  
World Health Organisation ◽  
Normal Weight ◽  
World Health ◽  
Fetal Anomaly ◽  
Class Iii ◽  
Fetal Medicine ◽  
Obese Class ◽  
The World ◽  
The Impact

AbstractObjective:To examine the impact of maternal obesity on completion of fetal anomaly screening.Methods:A retrospective analysis of 500 anomaly scans (19+0–21+6 weeks) was included. Women were categorised according to the World Health Organisation (WHO) body mass index (BMI) classification: normal weight (18.50–24.99 kg/mResults:Image quality deteriorated as BMI increased and was significantly different across the BMI categories (P<0.001). Performance was poorest in imaging of the fetal chest and was significantly different across BMI categories (P<0.001). In obese class III, 33% of four-chamber cardiac views and 38% of outflow tract views were not obtained. In total, 119 women (23.6%) had an incomplete scan. In obese class III, 44.1% of scans were incomplete compared with 10.2% in the normal BMI category (P<0.001). Of 117 women attending for repeat scans, 78.6% were complete, 11.1% were incomplete, 6.8% were advised to re-attend and 3.4% were referred to Fetal Medicine.Conclusion:Maternal obesity has a significant impact on completion of fetal anomaly screening.

scholarly journals Body mass index and cardiovascular outcomes in patients with acute coronary syndrome by diabetes status: the obesity paradox in a Korean national cohort study

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Se-Jun Park ◽  
Kyoung Hwa Ha ◽  
Dae Jung Kim
Keyword(s):  
Body Mass Index ◽  
Acute Coronary Syndrome ◽  
Body Mass ◽  
Obesity Paradox ◽  
Class Ii ◽  
Normal Weight ◽  
Class I ◽  
Coronary Syndrome ◽  
Obese Class ◽  
Diabetes Status

Abstract Background The “obesity paradox” has not been elucidated in the long-term outcomes of acute coronary syndrome (ACS). We investigated the association between obesity and cardiovascular (CV) outcomes in ACS patients with and without diabetes. Methods We identified 6978 patients with ACS aged 40–79 years from the Korean National Health Insurance Service-Health Screening Cohort between 2002 and 2015. Baseline body mass index (BMI) was categorized as underweight (< 18.5 kg/m2), normal weight (18.5–22.9 kg/m2), overweight (23.0–24.9 kg/m2), obese class I (25.0–29.9 kg/m2), and obese class II (≥ 30.0 kg/m2). The primary outcome was major adverse CV events (MACE)—CV death, myocardial infarction (MI), and stroke. The secondary outcomes were the individual components of MACE, hospitalization for heart failure (HHF), and all-cause death. Results After adjustment for confounding variables, compared to normal-weight patients without diabetes (reference group), obese class I patients with and without diabetes had a lower risk of MACE, but only significant in patients without diabetes (with diabetes: hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.78–1.14; without diabetes: HR 0.78, 95% CI 0.62–0.97). Obese class II patient with diabetes had a higher risk of MACE with no statistical significance (HR 1.14, 95% CI 0.82–1.59). Underweight patients with and without diabetes had a higher risk of MACE, but only significant in patients with diabetes (with diabetes: HR 1.79, 95% CI 1.24–2.58; without diabetes: HR 1.23, 95% CI 0.77–1.97). Conclusion In ACS patients, obesity had a protective effect on CV outcomes, especially in patients without diabetes.

Impact of maternal body mass index on the cesarean delivery rate in Germany from 1990 to 2012

2015 ◽  
Vol 43 (4) ◽  
Author(s):  
Ioannis Kyvernitakis ◽  
Christine Köhler ◽  
Stephan Schmidt ◽  
Björn Misselwitz ◽  
Jasmin Großmann ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cesarean Delivery ◽  
Body Mass ◽  
Early Pregnancy ◽  
Normal Weight ◽  
Class I ◽  
Class Iii ◽  
The Past ◽  
Obese Class ◽  
Maternal Bmi

AbstractMaternal obesity is a risk factor for cesarean delivery (CD). The aim of this analysis was to determine the association between early-pregnancy body mass index (BMI) and the rate of CD over the past two decades.We retrospectively analyzed data from the perinatal quality registry of singleton deliveries in the state of Hesse in Germany from 1990 to 2012. We divided the patients into groups according to the WHO criteria for BMI: underweight (<18.5), normal weight (18.5–<25), overweight (25–<30), obese class I (30–<35), obese class II (35–<40), and obese class III (≥40).The analysis included 1,092,311 patients with available data regarding maternal BMI and mode of delivery. The CD rates for underweight (<18.5), normal weight (18.5–<25), overweight (25–<30), obese class I (30–<35), obese class II (35–<40), and obese class III (≥40) women increased from 14.4%, 16.1%, 19.5%, 22.3%, 25%, and 26.9% in the year 1990 to 27.9%, 31.4%, 38.8%, 45.1%, 50.2%, and 55.2% in the year 2012, respectively (P<0.001).Maternal BMI in early pregnancy is linearly associated with the incidence of CD. We found a disproportionate increase of CD in morbidly obese women compared with the CD incidence in the reference BMI population over the past two decades.

scholarly journals On the joint role of non-Hispanic Black race/ethnicity and weight status in predicting postmenopausal weight gain

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247821
Author(s):  
Christopher N. Ford ◽  
Shine Chang ◽  
Alexis C. Wood ◽  
JoAnn E. Manson ◽  
David O. Garcia ◽  
...  
Keyword(s):  
Weight Gain ◽  
Weight Status ◽  
Proportional Hazards ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Class Iii ◽  
Modifying Factors ◽  
Obese Class ◽  
Baseline Weight ◽  
Race Ethnicity

Objectives To determine how baseline weight status contributes to differences in postmenopausal weight gain among non-Hispanic Blacks (NHBs) and non-Hispanic Whites (NHWs). Methods Data were included from 70,750 NHW and NHB postmenopausal women from the Women’s Health Initiative Observational Study (WHI OS). Body Mass Index (BMI) at baseline was used to classify women as having normal weight, overweight, obese class I, obese class II or obese class III. Cox proportional hazards was used to estimate the hazard of a 10% or more increase in weight from baseline. Results In both crude and adjusted models, NHBs were more likely to experience ≥10% weight gain than NHWs within the same category of baseline weight status. Moreover, NHBs who were normal weight at baseline were most likely to experience ≥10% weight gain in both crude and adjusted models. Age-stratified results were consistent with overall findings. In all age categories, NHBs who were normal weight at baseline were most likely to experience ≥10% weight gain. Based on the results of adjusted models, the joint influence of NHB race/ethnicity and weight status on risk of postmenopausal weight gain was both sub-additive and sub-multiplicative. Conclusion NHBs are more likely to experience postmenopausal weight gain than NHWs, and the disparity in risk is most pronounced among those who are normal weight at baseline. To address the disparity in postmenopausal obesity, future studies should focus on identifying and modifying factors that promote weight gain among normal weight NHBs.

THE EFFECT OF OBESITY

2002 ◽  
Vol 35 (1) ◽  
pp. 107-129 ◽  
Author(s):  
RICHARD G. ROGERS ◽  
ROBERT A. HUMMER ◽  
PATRICK M. KRUEGER
Keyword(s):  
Normal Weight ◽  
Class Iii ◽  
Circulatory Disease ◽  
Risk Of Death ◽  
Diabetes Mortality ◽  
Disease Mortality ◽  
Obese Class ◽  
The Relationship ◽  
Age And Sex

This paper explores the relationship between body mass and risk of death among US adults. The National Health Interview Survey–Multiple Cause of Death linked data set is used for the years 1987–1997, and Cox proportional hazard models are employed to estimate the association between obesity, as measured by the body mass index (BMI), and overall, circulatory disease-specific and diabetes-specific mortality. A U-shaped relationship is found between BMI and overall mortality. Compared with normal weight individuals, mortality during the follow-up period is 34% higher among obese class II individuals and 77% higher among obese class III individuals, controlling for age and sex. A J-shaped relationship exists between circulatory disease mortality and obesity, with a slightly higher risk of death for all categories of BMI. The relationship between BMI and diabetes mortality is striking. Compared with normal weight individuals, obese class I individuals are 2·8 times as likely to die, obese class II individuals are 4·7 times as likely to die, and obese class III individuals are 9·0 times as likely to die of diabetes during the follow-up period, controlling for age and sex. These results demonstrate that obesity heightens the risk of overall and circulatory disease mortality, and even more substantially increases the risk of diabetes mortality. These mortality findings, together with the substantial recent increases in obesity, lend urgency to public health programmes aimed at reducing the prevalence and consequences of obesity.

scholarly journals Body mass index and cardiovascular outcomes in patients with acute coronary syndrome by diabetes status: the obesity paradox in a Korean national cohort study

2020 ◽  
Author(s):  
Se-Jun Park ◽  
Kyoung Hwa Ha ◽  
Dae Jung Kim
Keyword(s):  
Body Mass Index ◽  
Acute Coronary Syndrome ◽  
Body Mass ◽  
Obesity Paradox ◽  
Class Ii ◽  
Normal Weight ◽  
Class I ◽  
Coronary Syndrome ◽  
Obese Class ◽  
Diabetes Status

Abstract Background: The “obesity paradox” has not been elucidated in the long-term outcomes of acute coronary syndrome (ACS). We investigated the association between obesity and cardiovascular (CV) outcomes in ACS patients with and without diabetes.Methods: We identified 6,978 patients with ACS aged 40–79 years from the Korean National Health Insurance Service-Health Screening Cohort between 2002 and 2015. Baseline body mass index (BMI) was categorized as underweight (<18.5 kg/m2), normal weight (18.5–22.9 kg/m2), overweight (23.0–24.9 kg/m2), obese class I (25.0–29.9 kg/m2), and obese class II (≥30.0 kg/m2). The primary outcome was major adverse CV events (MACE)—CV death, myocardial infarction (MI), and stroke. The secondary outcomes were the individual components of MACE, hospitalization for heart failure (HHF), and all-cause death. Results: After adjustment for confounding variables, compared to normal-weight patients without diabetes (reference group), obese class I patients with and without diabetes had a lower risk of MACE, but only significant in patients without diabetes (with diabetes: hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.78–1.14; without diabetes: HR 0.78, 95% CI 0.62–0.97). Obese class II patient with diabetes had a higher risk of MACE with no statistical significance (HR 1.14, 95% CI 0.82–1.59). Underweight patients with and without diabetes had a higher risk of MACE, but only significant in patients with diabetes (with diabetes: HR 1.79, 95% CI 1.24–2.58; without diabetes: HR 1.23, 95% CI 0.77–1.97).Conclusion: In ACS patients, obesity had a protective effect on CV outcomes, especially in patients without diabetes.

scholarly journals Markers of adipose tissue hypoxia are elevated in subcutaneous adipose tissue of severely obese patients with obesity hypoventilation syndrome but not in the moderately obese

2021 ◽  
Author(s):  
Marijana Todorčević ◽  
Ari R. Manuel ◽  
Luke Austen ◽  
Zoi Michailidou ◽  
Jonathan M. Hazlehurst ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Hypoxia Inducible Factor ◽  
Class I ◽  
Protein Abundance ◽  
Metabolic Dysfunction ◽  
Class Iii ◽  
Class I Obesity ◽  
Obese Class ◽  
Class Iii Obesity ◽  
Hypoventilation Syndrome

AbstractIt has been suggested that metabolic dysfunction in obesity is at least in part driven by adipose tissue (AT) hypoxia. However, studies on AT hypoxia in humans have shown conflicting data. Therefore we aimed to investigate if markers of AT hypoxia were present in the subcutaneous AT of severly obese individuals (class III obesity) with and without hypoventilation syndrome (OHS) in comparison to moderately obese (class I obesity) and lean controls. To provide a proof-of-concept study, we quantified AT hypoxia by hypoxia inducible factor 1 A (HIF1A) protein abundance in human participants ranging from lean to severly obese (class III obesity). On top of that nightly arterial O2 saturation in individuals with obesity OHS was assessed. Subjects with class III obesity (BMI > 40 kg/m2) and OHS exhibited significantly higher adipose HIF1A protein levels versus those with class I obesity (BMI 30–34.9 kg/m2) and lean controls whereas those with class III obesity without OHS showed an intermediate response. HIF1A gene expression was not well correlated with protein abundance. Although these data demonstrate genuine AT hypoxia in the expected pathophysiological context of OHS, we did not observe a hypoxia signal in lesser degrees of obesity suggesting that adipose dysfunction may not be driven by hypoxia in moderate obesity.

Effects of antiarrhythmic drugs on atrioventricular conduction in patients with preexisting bundle branch block

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Kochav ◽  
R.C Chen ◽  
J.M.D Dizon ◽  
J.A.R Reiffel
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Class I ◽  
Class Iii ◽  
Bundle Branch Block ◽  
Kaplan Meier ◽  
Cox Proportional Hazards Models ◽  
Hazard Ratios ◽  
History Of ◽  
Propensity Score Stratification

Abstract Background Theoretical concern exists regarding AV block (AVB) with class I antiarrhythmics (AADs) when bundle branch block (BBB) is present. Whether this is substantiated in real-world populations is unknown. Purpose To determine the relationship between type of AAD and incidence of AVB in patients with preexisting BBB. Methods We retrospectively studied all patients with BBB who received class I and III AADs between 1997–2019 to compare incidence of AVB. We defined index time as first exposure to either drug class and excluded patients with prior AVB or exposed to both classes. Time-at-risk window ended at first outcome occurrence or when patients were no longer observed in the database. We estimated hazard ratios for incident AVB using Cox proportional hazards models with propensity score stratification, adjusting for over 32,000 covariates from the electronic health record. Kaplan-Meier methods were used to determine treatment effects over time. Results Of 40,120 individuals with BBB, 148 were exposed to a class I AAD and 2401 to a class III AAD. Over nearly 4,200 person-years of follow up, there were 22 and 620 outcome events in the class I and class III cohorts, respectively (Figure). In adjusted analyses, AVB risk was markedly lower in patients exposed to class I AADs compared with class III (HR 0.48 [95% CI 0.30–0.75]). Conclusion Among patients with BBB, exposure to class III AADs was strongly associated with greater risk of incident AVB. This likely reflects differences in natural history of patients receiving class I vs class III AADs rather than adverse class III effects, however, the lack of worse outcomes acutely with class I AADs suggests that they may be safer in BBB than suspected. Funding Acknowledgement Type of funding source: None

Abstract P292: Severe Obesity is Associated with Dramatic Increase in Cardiovascular Disease Risk Factor Prevalence: Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Robert Kaplan ◽  
Larissa M Avilés-Santa ◽  
Christina M Parrinello ◽  
Sheila Castañeda ◽  
Arlene L Hankinson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Class Ii ◽  
Normal Weight ◽  
Class Iii ◽  
C Reactive Protein ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Total N ◽  
Reactive Protein ◽  
Class Iii Obesity

Introduction: Prevalence of severe obesity is increasing, especially among the young Hispanic population. Methods: In the HCHS/SOL cohort of 18-74 year old US Hispanics, we examined gradients across BMI and age in CVD risk factors. Results: Approximately one in five males (total N = 6,547) and one in ten females (total N=9,797) met criteria for class II obesity (BMI 35 - 40 kg/m 2 ) or class III obesity (BMI ≥ 40 kg/m 2 ). The prevalence of hypertension, diabetes, and elevated C-reactive protein rose with each successive class of overweight/obesity. In contrast, the prevalence of elevated levels of total cholesterol, LDL-c and triglycerides increased across normal weight, overweight (BMI 25 - 30 kg/m 2 ), and class I obese (BMI 30 - 35 kg/m 2 ) groups, but did not increase in frequency across class I, class II, and class III obesity groups. The Figure depicts isolines that identify age- specific subgroups of the normal-weight and class II - III obese groups that had the same estimated prevalence of CVD risk factors, with 95 percent confidence intervals. Among young adults with class II or III obesity, the prevalence of hypertension, diabetes, and the combination of three or more CVD risk factors was similar to that among normal-weight individuals (BMI 18.5 - 25 kg/m 2 ) who were 15 to 30 years older. Among young obese individuals, the prevalence of low HDL-c levels and high C-reactive protein levels exceeded that among the oldest adults in the cohort. CVD risk factors had stronger, more consistent gradients across the BMI categories among men than among women. Conclusion: Class II and III obesity, defined as BMI ≥ 35 kg/m 2 , are common in the Hispanic/Latino population. Young adults with these severe forms of obesity have dramatically increased frequency of cardiometabolic risk factors. The age-related accumulation of multiple CVD risk factors, such as is typically seen in normal-weight individuals, is accelerated by 1-2 decades in severly overweight women and by 2-3 decades in severely overweight men.

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