Sex differences in the non-linear association between BMI and LDL cholesterol in middle-aged and older adults: findings from two nationally representative surveys in China

Abstract Background The relationship between body mass index (BMI) and low-density lipoprotein cholesterol (LDL-C) has not been clearly elucidated in middle-aged and older adults. This study aimed to evaluate the non-linear dose-response relationship between BMI and LDL-C in males and females. Methods Data was obtained from two nationally representative surveys in China—the China Health and Nutrition Survey (CHNS, 2009) and China Health and Retirement Longitudinal Study (CHARLS, 2011–2012). To evaluate the sex differences in the association between BMI and LDL-C, the generalized additive models with a smooth function for continuous BMI and smooth-factor interaction for sexes with BMI were used. Segmented regressions were fitted to calculate the slopes with different estimated breakpoints among females and males. Results A total of 12,273 participants (47.1% male) aged 45 to 75 years were included. The generalized additive models revealed that a non-linear relationship between BMI and LDL-C level in both sexes after adjustment for age, residence, education levels, marital status, drinking, smoking status, and cohort (CHNS or CHARLS). Slopes of the association between BMI and LDL-C association changed at BMI 20.3 kg/m2 (95% CI: 18.8 to 21.8) in females and 27.1 kg/m2 (95% CI: 25. 8 to 28.4) in males. Below these BMI breakpoints, LDL-C levels increased 1.84 (95% CI: 1.45 to 2.31) in males and 3.49 (95% CI: 1.54 to 5.45) mg/dL per kg/m2 in females. However, LDL-C levels declined − 1.50 (95% CI: − 2.92 to − 0.09) mg/dL per kg/m2 above BMI of 27.1 kg/m2 in males. The non-linear association BMI and LDL-C in males and females was varied by cohort source, age groups, and the number of metabolic syndrome criteria. Conclusions In the Chinese middle aged and older adults, the BMI and LDL-C relationship was inverted U-shaped with a high level of LDL-C at a BMI of 27.1 kg/m2 in males, and an approximately linear association was observed in females.

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Sex Differences in the Nonlinear Association Between BMI and LDL Cholesterol in Middle-Aged and Older Adults: Results from two Nationally Representative Surveys of China

10.21203/rs.3.rs-779196/v1 ◽

2021 ◽

Author(s):

Haibin Li ◽

Jiahui Ma ◽

Deqiang Zheng ◽

Xia Li ◽

Xiuhua Guo ◽

...

Keyword(s):

Metabolic Syndrome ◽

Sex Differences ◽

Generalized Additive Models ◽

Low Density Lipoprotein ◽

Age Groups ◽

Density Lipoprotein ◽

Additive Models ◽

Middle Aged ◽

Nutrition Survey ◽

Nationally Representative

Abstract Background: The association between body mass index (BMI) and low-density lipoprotein cholesterol (LDL-C) in middle-aged and older man and women was understudied. We aimed to explore whether there were sex differences in this relationship in a large sample of Chinese adults.Methods: Participants in the China Health and Retirement Longitudinal Study (CHARLS, 2011-2012) (n=7485) and the China Health and Nutrition Survey (CHNS, 2009) (n=4788) were cross-sectionally investigated. Generalized additive models with a smooth function for BMI and a smooth-factor interaction for BMI with sex were performed and stratified by age and metabolic syndrome. Segment linear splines regressions were fitted to calculate the slopes with the different breakpoints.Results: Among the 12273 participants aged 45 to 75 years, 5780 (47.1%) were males. The nonlinear relationship between BMI and LDL-C was observed in females and males (P interaction <0.001). The slopes of the BMI and LDL-C association changed (P <0.001) at BMI 22.5 kg/m2 in females and 27.5 kg/m2 in males. Below these BMI breakpoints, LDL-C increased 2.14 (95% CI: 1.42 to 2.86) and 1.77 (95% CI: 1.43 to 2.11) mg/dL per kg/m2, respectively. In females, there was a plateau at BMI values of 22.5-27.5 kg/m2, and then gradually increased after a BMI of 27.5 kg/m2. However, LDL-C declined -1.84 (95% CI: -3.01 to -0.66) mg/dL per kg/m2 above BMI of 27.5 kg/m2 in males. The pattern of sex and BMI-LDL-C association was similar in all age groups but modified by the number of metabolic syndrome criteria.Conclusions: The BMI and LDL-C relationship was inverted U-shaped in males and approximately linear in females.

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Decline of depressive symptoms in Europe: differential trends across the lifespan

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-020-01979-6 ◽

2020 ◽

Author(s):

Johannes Beller ◽

Enrique Regidor ◽

Lourdes Lostao ◽

Alexander Miething ◽

Christoph Kröger ◽

...

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Generalized Additive Models ◽

Age Groups ◽

Additive Models ◽

European Countries ◽

Multilevel Regression ◽

Middle Aged ◽

General Decline ◽

Middle Aged Adults

Abstract Purpose We examined changes in the burden of depressive symptoms between 2006 and 2014 in 18 European countries across different age groups. Methods We used population-based data drawn from the European Social Survey (N = 64.683, 54% female, age 14–90 years) covering 18 countries (Austria, Belgium, Denmark, Estonia, Finland, France, Germany, Great Britain, Hungary, Ireland, The Netherlands, Norway, Poland, Portugal, Slovenia, Spain, Sweden, Switzerland) from 2006 to 2014. Depressive symptoms were measured via the CES-D 8. Generalized additive models, multilevel regression, and linear regression analyses were conducted. Results We found a general decline in CES-D 8 scale scores in 2014 as compared with 2006, with only few exceptions in some countries. This decline was most strongly pronounced in older adults, less strongly in middle-aged adults, and least in young adults. Including education, health and income partially explained the decline in older but not younger or middle-aged adults. Conclusions Burden of depressive symptoms decreased in most European countries between 2006 and 2014. However, the decline in depressive symptoms differed across age groups and was most strongly pronounced in older adults and least in younger adults. Future studies should investigate the mechanisms that contribute to these overall and differential changes over time in depressive symptoms.

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Development of subcortical volumes across adolescence in males and females: A multisample study of longitudinal changes

10.1101/171389 ◽

2017 ◽

Author(s):

Megan M. Herting ◽

Cory Johnson ◽

Kathryn L. Mills ◽

Nandita Vijayakumar ◽

Meg Dennison ◽

...

Keyword(s):

Sex Differences ◽

Linear Models ◽

Developmental Trajectories ◽

Generalized Additive Models ◽

Additive Models ◽

Brain Volumes ◽

University Of Pittsburgh ◽

Subcortical Brain ◽

Males And Females ◽

University Of Oslo

AbstractThe developmental patterns of subcortical brain volumes in males and females observed in previous studies have been inconsistent. To help resolve these discrepancies, we examined developmental trajectories using three independent longitudinal samples of participants in the age-span of 8-22 years (total 216 participants and 467 scans). These datasets, including Pittsburgh (PIT; University of Pittsburgh, USA), NeuroCognitive Development (NCD; University of Oslo, Norway), and Orygen Adolescent Development Study (OADS; The University of Melbourne, Australia), span three countries and were analyzed together and in parallel using mixed-effects modeling with both generalized additive models and general linear models. For all regions and across all samples, males were found to have significantly larger volumes as compared to females, and significant sex differences were seen in age trajectories over time. However, direct comparison of sample trajectories and sex differences identified within samples were not consistent. The trajectories for the amygdala, putamen, and nucleus accumbens were most consistent between the three samples. Our results suggest that even after using similar preprocessing and analytic techniques, additional factors, such as image acquisition or sample composition may contribute to some of the discrepancies in sex specific patterns in subcortical brain changes across adolescence, and highlight region-specific variations in congruency of developmental trajectories.

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Sex Difference in Self-Reported Sexual Functioning Among Frail Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.1002 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 313-313

Author(s):

Brianne Olivieri-Mui ◽

Sandra Shi ◽

Ellen McCarthy ◽

Dae Kim

Keyword(s):

Older Adults ◽

Logistic Regression ◽

Sex Differences ◽

Sexual Function ◽

Older Adult ◽

Sexual Functioning ◽

Social Life ◽

Well Being ◽

Adult Males ◽

Males And Females

Abstract Frailty may differentially impact how older adult males and females perceive sexual functioning, an important part of well-being. We assessed the level of frailty (robust, pre-frail, frail) for anyone with data on 11 sexual functioning questions asked in wave 2 of the National Social Life, Health, and Aging Project, 2010-2011 (n=2060). Questions covered five domains: overall sexual function (OSF), sexual function anxiety (SFA), changes in sexual function (CSF), erectile/vaginal dysfunction (EVD), and masturbation. Logistic regression identified sex differences in frailty and reporting worse sexual functioning. Linear regression predicted the number of domains reported as worse. Among males (n=1057), pre-frailty meant higher odds of reporting SFA (OR 1.8 95%CI 1.2-6.6), CSF (OR 1.7 95%CI 1.1-2.7), and EVD (OR 1.5 95%CI 1.0-2.2). Among females (n=1003), there was no difference in reporting by frailty. Females were more likely to report worse OSF (Robust: OR 7.4, 95%CI 4.8-11.4; Pre-frail: OR 6.2, 95%CI 3.9-9.9; Frail: OR 3.4 95%CI 1.7-6.6), but less likely to report SFA (Robust OR .3, 95%CI .2-.5; Pre-frail OR .2, 95%CI .1-.3; Frail OR .2 95%CI .1-.3). Pre-frail and frail females reported fewer domains as worse (Pre-frail coefficient -0.21 SE 0.09, Frail -0.43 SE 0.14). As frailty worsened, males reported more domains as worse (Pre-frail 0.24 SE 0.07, Frail 0.29 SE 0.08). Self-reported sexual functioning differs by sex at all levels of frailty, and reporting by males, but not females, changes with frailty. Providers should be aware that sexual functioning is of importance to both sexes despite varying degrees of frailty.

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The Impact of Work Hours on Depressive Symptoms among Koreans Aged 45 and Over

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18030853 ◽

2021 ◽

Vol 18 (3) ◽

pp. 853

Author(s):

Juyeong Kim ◽

Eun-Cheol Park

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Social Services ◽

Depression Scale ◽

Epidemiological Studies ◽

Work Hours ◽

Middle Aged ◽

Health Studies ◽

Males And Females ◽

The Impact

Background: Given the documented importance of employment for middle-aged and older adults’ mental health, studies of the association between their number of work hours and depressive symptoms are needed. Objectives: To examine the association between the number of work hours and depressive symptoms in Korean aged 45 and over. Methods: We used data from the first wave to fourth wave of the Korea Longitudinal Study of Aging. Using the first wave at baseline, data included 9845 individuals. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression scale. We performed a longitudinal analysis to estimate the prevalence of depressive symptoms by work hours. Results: Both unemployed males and females aged 45–65 years were associated with higher depressive symptoms (β = 0.59, p < 0.001; β = 0.32, p < 0.001). Females working ≥ 69 h were associated with higher depressive symptoms compared to those working 41–68 h (β = 0.25, p = 0.013). Among those both middle-aged and older adults, both males and females unemployed were associated with higher depressive symptoms. Those middle-aged female working ≥69 h were associated with higher depressive symptoms. Conclusions: An increase in depressive symptoms was associated with unemployed males and females working ≥69 h compared to those working 41–68 h. Although this association was found among middle-aged individuals, a decrease in depressive symptoms in both sexes was associated with working 1–40 h. Depressive symptoms should decrease by implementing employment policies and social services to encourage employers to support middle-aged and older adults in the workforce considering their sex and age differences.

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Factors associated with sarcopenia screened by finger-circle test among middle-aged and older adults: a population-based multisite cross-sectional survey in Japan

BMC Public Health ◽

10.1186/s12889-021-10844-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Daiki Watanabe ◽

Tsukasa Yoshida ◽

Takashi Nakagata ◽

Naomi Sawada ◽

Yosuke Yamada ◽

...

Keyword(s):

Older Adults ◽

Smoking Status ◽

Multiple Logistic Regression Analysis ◽

Population Based ◽

Middle Aged ◽

Cross Sectional ◽

Factors Associated ◽

Mail Surveys ◽

Osaka Prefecture ◽

Middle Aged Adults

AbstractBackgroundPrevious epidemiological studies have demonstrated the prevalence and relationship of various factors associated with sarcopenia in older adults; however, few have examined the status of sarcopenia in middle-aged adults. In this study, we aimed to, 1) evaluate the validity of the finger-circle test, which is potentially a useful screening tool for sarcopenia, and 2) determine the prevalence and factors associated with sarcopenia in middle-aged and older adults.MethodsWe conducted face-to-face surveys of 525 adults, who were aged 40–91 years and resided in Settsu City, Osaka Prefecture, Japan to evaluate the validity of finger-circle test. The finger-circle test evaluated calf circumference by referring to an illustration printed on the survey form. The area under the receiver operating characteristic curves (AUROC) was plotted to evaluate the validity of the finger-circle test for screening sarcopenia and compared to that evaluated by skeletal muscle mass index (SMI) measured using bioimpedance. We also conducted multisite population-based cross-sectional anonymous mail surveys of 9337 adults, who were aged 40–97 years and resided in Settsu and Hannan Cities, Osaka Prefecture, Japan. Participants were selected through stratified random sampling by sex and age in the elementary school zones of their respective cities. We performed multiple logistic regression analysis to explore associations between characteristics and prevalence of sarcopenia.ResultsSarcopenia, defined by SMI, was moderately predicted by a finger-circle test response showing that the subject’s calf was smaller than their finger-circle (AUROC: 0.729, < 65 years; 0.653, ≥65 years); such subjects were considered to have sarcopenia. In mail surveys, prevalence of sarcopenia screened by finger-circle test was higher in older subjects (approximately 16%) than in middle-aged subjects (approximately 8–9%). In a multiple regression model, the factors associated with sarcopenia were age, body mass index, smoking status, self-reported health, and number of meals in all the participants.ConclusionsSarcopenia, screened by the finger-circle test, was present not only among older adults but also among middle-aged adults. These results may provide useful indications for developing public health programs, not only for the prevention, but especially for the management of sarcopenia.Trial registrationUMIN000036880, registered prospectively May 29, 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042027

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The Association Between Recent Family Death and Self-Perceptions of Aging Among Middle-Aged and Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.1457 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 450-450

Author(s):

Shu Xu

Keyword(s):

Older Adults ◽

Child Death ◽

Parental Death ◽

Middle Aged ◽

Cross Sectional ◽

Self Perceptions ◽

Perceptions Of Aging ◽

Nationally Representative ◽

And Gender ◽

Family Loss

Abstract The loss of a family member may have a significant influence on one’s aging experience in life. Self-perceptions of aging, which are an individual’s beliefs or evaluation of their experiences of aging, have been described as an important factor for one’s health and daily life. However, there is little research on the association between family death and self-perceptions of aging. This study examines the relationships between recent family death, self-perceptions of aging, and gender of the bereaved among middle-aged and older adults. Using nationally representative data from the Health and Retirement Study (HRS), we conducted cross-sectional analysis on adults age 50 years and older (n=1,839). Self-perceptions of aging were accessed by 8 items derived from the Attitudes Toward Own Aging subscale of the Philadelphia Geriatric Center Morale Scale and the Berlin Aging Study, and we considered recent family death (i.e., parental death, spousal death, sibling death and child death), as well as gender of the bereaved. Multiple linear regression analyses revealed that respondents who experienced recent family death report less positive self-perceptions of aging compared to those who did not experience recent family death (t = 12.40, p < .01). Recent parental death was more negatively related with self-perceptions of aging for bereaved women than for bereaved men (χ2 = 4.28, p < .05). Findings suggest that middle-aged and older adults experiencing recent family loss have less positive self-perceptions of aging, and gender of the bereaved plays an important role in the relationship between parental death and self-perceptions of aging.

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Non-Parametric Generalized Additive Models as a Tool for Evaluating Policy Interventions

Mathematics ◽

10.3390/math9040299 ◽

2021 ◽

Vol 9 (4) ◽

pp. 299

Author(s):

Jaime Pinilla ◽

Miguel Negrín

Keyword(s):

Linear Regression ◽

Regression Models ◽

Linear Trend ◽

Generalized Additive Models ◽

Additive Models ◽

Linear Regression Models ◽

Non Linear ◽

Nonlinear Trends ◽

The Impact ◽

Non Parametric

The interrupted time series analysis is a quasi-experimental design used to evaluate the effectiveness of an intervention. Segmented linear regression models have been the most used models to carry out this analysis. However, they assume a linear trend that may not be appropriate in many situations. In this paper, we show how generalized additive models (GAMs), a non-parametric regression-based method, can be useful to accommodate nonlinear trends. An analysis with simulated data is carried out to assess the performance of both models. Data were simulated from linear and non-linear (quadratic and cubic) functions. The results of this analysis show how GAMs improve on segmented linear regression models when the trend is non-linear, but they also show a good performance when the trend is linear. A real-life application where the impact of the 2012 Spanish cost-sharing reforms on pharmaceutical prescription is also analyzed. Seasonality and an indicator variable for the stockpiling effect are included as explanatory variables. The segmented linear regression model shows good fit of the data. However, the GAM concludes that the hypothesis of linear trend is rejected. The estimated level shift is similar for both models but the cumulative absolute effect on the number of prescriptions is lower in GAM.

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