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

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.

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

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa238 ◽

2020 ◽

Vol 113 (1) ◽

pp. 129-141 ◽

Cited By ~ 1

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.

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

Obesity and metabolism ◽

10.14341/omet201343-9 ◽

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.

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The value of blood serotonin for effective weight loss in obese women

Obesity and metabolism ◽

10.14341/omet2015331-35 ◽

2015 ◽

Vol 12 (3) ◽

pp. 31-35

Author(s):

Natal'ya Vadimovna Anikina ◽

Elena Nikolaevna Smirnova

Keyword(s):

Weight Loss ◽

Body Weight ◽

Clinical Laboratory ◽

Normal Weight ◽

Obese Patients ◽

Obese Women ◽

Endothelin 1 ◽

Excessive Accumulation ◽

Made In

Introduction. Obesity is a disorder of energy balance, which leads to excessive accumulation of fat. In recent years, many important discoveries were made in this field, including the discovery of hormones produced by adipose tissue and the identification of many of the central and peripheral pathways of energy balance.Objective. To study the levels of hormones that affect appetite and metabolism in women with obesity baseline and after weight loss while taking sibutramine.Materials and methods. The study included 56 women aged 42,9±9,5 years, with a BMI of 34,6±6,1 kg/m2. All patients underwent clinical, laboratory and instrumental examination. Hormonal study included determination of serotonin, leptin, ghrelin, endothelin-1, adiponectin.Results: In women with obesity we identified hyperleptinemia and increased serotonin levels. The decrease in body weight in patients receiving sibutramine was accompanied by lower levels of serotonin, leptin, ghrelin, endothelin-1, and increase of adiponectin.Conclusions: Obese patients have significantly elevated levels of leptin, serotonin, ghrelin compared to women of normal weight. Sibutramine treatment leads to a decrease in serotonin, leptin, ghrelin and is more effective in women with a BMI less than 36,5 kg/m2.

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The Obesity Paradox in Type 2 Diabetes and Mortality

American Journal of Lifestyle Medicine ◽

10.1177/1559827616650415 ◽

2016 ◽

Vol 12 (3) ◽

pp. 244-251 ◽

Cited By ~ 4

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.

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The Effectiveness of Supportive Psychotherapy in Weight Loss in a Group of Young Overweight and Obese Women

Nutrients ◽

10.3390/nu13020532 ◽

2021 ◽

Vol 13 (2) ◽

pp. 532

Author(s):

Krzysztof Juchacz ◽

Patrycja Kłos ◽

Violetta Dziedziejko ◽

Rafał W. Wójciak

Keyword(s):

Weight Loss ◽

Overweight And Obesity ◽

Obese Women ◽

Supportive Psychotherapy ◽

Diet Plan ◽

Sustained Effect ◽

Group A ◽

The Impact ◽

Loss Effect

Overweight and obesity are among the most widespread health problems worldwide. The primary cause of obesity is an inability to control overeating. Therefore, today, obesity needs to be treated more as an eating disorder, i.e., a mental disorder, and thus, it should be approached as such. Taking the above together, this study aimed to assess the impact of supportive psychotherapy on reducing body weight in young overweight and obese women who attempted slimming therapy and, additionally, the possibility of maintaining the weight-loss effect in the long term. Sixty young women aged 20–30 were randomized into three groups that differed in therapeutic management. With the help of an individually selected diet plan, the highest effectiveness in weight loss was demonstrated in people whose weight reduction was supported by goal-oriented psychotherapy. In this group, a sustained effect of slimming and even further weight loss were observed six months following the discontinuation of the therapy. In conclusion, traditional slimming therapies using an individual diet plan and a dietitian’s care are effective; however, supportive psychotherapeutic work provides more beneficial results and maintains the change from a long-term perspective.

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The association of fitness and body mass index (BMI) on all-cause mortality in cancer survivors: The Henry Ford Exercise Testing Project (The FIT Project).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.7060 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 7060-7060

Author(s):

Catherine Handy Marshall ◽

Paul A McAuley ◽

Hua-Ling Tsai ◽

Zeina Dardari ◽

Mouaz H Al-Mallah ◽

...

Keyword(s):

Prostate Cancer ◽

Body Mass Index ◽

Cancer Patients ◽

Body Mass ◽

Cancer Diagnosis ◽

Exercise Test ◽

Normal Weight ◽

Risk Of Mortality ◽

All Cause Mortality ◽

Henry Ford

7060 Background: The obesity paradox –i.e. inverse associations between body mass index (BMI) and mortality – has been reported in patients with cancer, heart failure, and diabetes. However, the influence of cardiorespiratory fitness (CRF) on this relationship is not well established. This study assesses the association of BMI and CRF with all-cause mortality among cancer patients. Methods: The Henry Ford (HF) FIT Project is a retrospective cohort study of 69,885 consecutive patients who underwent physician-referred exercise stress testing from 1991 through 2009. Cancer diagnosis was identified through linkage to the HF tumor registry. We included patients 40-70 years old, with BMI recorded, at time of exercise test, with a history of cancer > 6 months prior. BMI was categorized as normal (18.5-24.9kg/m2), overweight (25-29.9kg/m2), or obese ( > = 30kg/m2). All-cause mortality was obtained from the National Death Index. Because of a significant interaction between BMI and cancer type, patients with breast or prostate cancer were excluded. Multivariable adjusted Cox proportional hazard models were used to evaluate the association of CRF andBMI with all-cause mortality; adjusted for age at exercise test, sex, diabetes, smoking, cancer stage, and time from cancer diagnosis to exercise test. Results: Included were 676 patients with a mean age of 58 years (SD 7.5), 51% female, 70% White, 25% Black, with a median of 4.8 years from diagnosis to exercise test and median follow up time of 10.3 years. Among patients achieving < 10 METs, those who are overweight and obese had a lower risk of mortality HR 0.47 (95% CI 0.25,0.86) and HR 0.44 (95% CI 0.26, 0.74, respectively), compared to those with normal BMI. Among patients with METs > = 10, those who were overweight had the lowest risk of all-cause mortality (HR 0.23, 95% CI 0.09-0.62) compared to normal weight, while no statistically significant different risk of mortality was observed when comparing those who are obese to normal weight (HR 0.37, 95% CI 0.13-1.06). In an analysis combining BMI and fitness groups (four categories), those with BMI > = 25 and METs > = 10 had the lowest risk of all-cause mortality (Table). Conclusions: In non-breast/non-prostate cancer patients, increased BMI is associated with improved overall survival in those with METs < 10, while a U-shaped relationship between BMI and all-cause mortality exists among those with METs > = 10. [Table: see text]

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Energy Balance, Exercise, and Cancer Risk

10.2310/im.9076 ◽

2018 ◽

Author(s):

Elaine B Trujillo

Keyword(s):

Weight Loss ◽

Body Weight ◽

Cancer Risk ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Body Weight Loss ◽

Normal Weight ◽

Future Research ◽

Excess Body Weight ◽

Healthy Weight

Excess body weight is a risk factor for most cancers. Furthermore, obesity is associated with worsened prognosis after a cancer diagnosis and negatively affects the delivery of systemic therapy, contributes to morbidity of cancer treatment, and may raise the risk of second malignancies and comorbidities. However, an obesity paradox may be occurring in patients with cancer; this paradox has been observed when cancer patients with an elevated body mass index (BMI) have improved survival compared with normal-weight patients, and this has been observed in a variety of cancer patients. The reliance on BMI as a measure of body fatness has limitations in the cancer population; hence, the use of tools that directly measure body fat may be more predictive of cancer risk. Despite public health recommendations for achieving and maintaining a healthy weight for cancer prevention and survivorship, few studies have evaluated the effect of intentional body weight loss on cancer risk, although the evidence is suggestive of a relationship. Future research needs to elucidate if weight loss after a cancer diagnosis decreases the risk of recurrence and mortality, and if so, how much weight loss is needed. This review contains 4 figures, 1 table and 65 references Key words: body weight, cancer, interventions, lifestyle, morbidity, mortality, obesity, prevention, risk, sedentary, survivorship, weight loss

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Potential Adverse Effects of Female and Male Obesity on Fertility: A Narrative Review

International Journal of Endocrinology and Metabolism ◽

10.5812/ijem.101776 ◽

2020 ◽

Vol 18 (3) ◽

Author(s):

Mina Amiri ◽

Fahimeh Ramezani Tehrani

Keyword(s):

Weight Loss ◽

Adverse Effects ◽

Sperm Quality ◽

Educational Interventions ◽

Normal Weight ◽

Overweight And Obesity ◽

Reproductive Age ◽

Miscarriage Rate ◽

First Line Therapy ◽

The Impact

Context: Despite several studies documenting that obesity affects female and male fertility and leads to multiple adverse reproductive outcomes, the mechanisms involved are not elucidated. We aimed to summarize the potential adverse effects of female and male obesity, as well as the impact of weight loss on their fertility status. Evidence Acquisition: This review summarizes papers investigating the potential adverse effects of female and male obesity and the impact of weight-loss interventions on fertility among reproductive age populations. PubMed, Scopus, Web of Science, and Google Scholar databases were searched for retrieving studies published up to November 2019 on obesity/overweight among reproductive age populations. Results: The review of 68 studies revealed that female and male obesity/overweight increases the risk of sub-fecundity and infertility. The destructive effects of female obesity on reproduction are attributed to a variety of ovarian and extra-ovarian factors. In women with overweight or obesity, the time taken to conceive is longer, and they have a decreased fertility rate, increased requirement for gonadotropins, and higher miscarriage rate when compared to those with normal weight. Male obesity may lead to subfertility, mainly because of the disruption of the hypothalamus-pituitary-gonadal (HPG) axis, increased testicular temperature, impairment of the physical and molecular structure of sperm, decreased sperm quality, and erectile dysfunction due to peripheral vascular disease. Most studies recommend lifestyle interventions as first-line therapy in the general population of women and men with obesity and infertility. Conclusions: This study shows the negative effects of female and male overweight and obesity on fertility. Therefore, educational interventions on the adverse effects of obesity and the benefits of weight reduction, such as increasing pregnancy rate, should be considered for couples seeking fertility.

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Maternal early pregnancy obesity and depressive symptoms during and after pregnancy

Psychological Medicine ◽

10.1017/s0033291717003889 ◽

2018 ◽

Vol 48 (14) ◽

pp. 2353-2363 ◽

Cited By ~ 15

Author(s):

Satu M. Kumpulainen ◽

Polina Girchenko ◽

Marius Lahti-Pulkkinen ◽

Rebecca M. Reynolds ◽

Soile Tuovinen ◽

...

Keyword(s):

Depressive Symptoms ◽

Early Pregnancy ◽

Maternal Obesity ◽

Depression Scale ◽

Epidemiological Studies ◽

Normal Weight ◽

Overweight And Obesity ◽

Obese Women ◽

Medical Birth Register ◽

Clinically Significant

AbstractBackgroundPrevious studies have linked maternal obesity with depressive symptoms during and after pregnancy. It remains unknown whether obesity associates with consistently elevated depressive symptoms throughout pregnancy, predicts symptoms postpartum when accounting for antenatal symptoms, and if co-morbid hypertensive and diabetic disorders add to these associations. We addressed these questions in a sample of Finnish women whom we followed during and after pregnancy.MethodsEarly pregnancy body mass index, derived from the Finnish Medical Birth Register and hospital records in 3234 PREDO study participants, was categorized into underweight (<18.5 kg/m2), normal weight (18.5–24.99 kg/m2), overweight (25–29.99 kg/m2), and obese (⩾30 kg/m2) groups. The women completed the Center for Epidemiological Studies Depression Scale biweekly during pregnancy, and at 2.4 (s.d.= 1.2) and/or 28.2 (s.d.= 4.2) weeks after pregnancy.ResultsIn comparison to normal weight women, overweight, and obese women reported higher levels of depressive symptoms and had higher odds of clinically significant depressive symptoms during (23% and 43%, respectively) and after pregnancy (22% and 36%, respectively). Underweight women had 68% higher odds of clinically significant depressive symptoms after pregnancy. Overweight and obesity also predicted higher depressive symptoms after pregnancy in women not reporting clinically relevant symptomatology during pregnancy. Hypertensive and diabetic disorders did not explain or add to these associations.ConclusionsMaternal early pregnancy overweight and obesity and depressive symptoms during and after pregnancy are associated. Mental health promotion should be included as an integral part of lifestyle interventions in early pregnancy obesity and extended to benefit also overweight and underweight women.

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Weight change and the incidence of cardiovascular diseases in adults with normal weight, overweight and obesity without chronic diseases; emulating trials using electronic health records

10.1101/2020.05.14.20102129 ◽

2020 ◽

Author(s):

Michail Katsoulis ◽

Bianca DeStavola ◽

Karla Diaz-Ordaz ◽

Manuel Gomes ◽

Alvina Lai ◽

...

Keyword(s):

Weight Loss ◽

Electronic Health Records ◽

Chronic Diseases ◽

Weight Change ◽

Lower Risk ◽

Weight Maintenance ◽

Normal Weight ◽

Overweight And Obesity ◽

Health Records ◽

Electronic Health

Background: Cross sectional measures of body mass index (BMI) are associated with cardiovascular disease (CVD) incidence, but less is known about whether weight change affects the risk of CVD. Methods: We estimated the effect of 2 year weight change interventions on 7 year risk of CVD, by emulating hypothetical target trials using electronic health records. We identified 138.567 individuals in England between 1998 and 2016, aged 45-69 years old, free of chronic diseases at baseline. We performed pooled logistic regression, using inverse-probability weighting to adjust for baseline and time-varying variables. Each individual was classified into a weight loss, maintenance, or gain group. Findings: In the normal weight, both weight loss and gain were associated with increased risk for CVD [HR vs weight maintenance=1.53 (1.18 to 1.98) and 1.43 (1.19 to 1.71 respectively)]. Among overweight individuals, both weight loss and gain groups, compared to weight maintenance, had a moderately higher risk of CVD [HR=1.20 (0.99 to 1.44) and 1.17 (0.99 to 1.38), respectively]. In the obese, weight loss had a lower risk lower risk of CHD [HR =0.66 (0.49 to 0.89)] and a moderately lower risk of CVD [HR =0.90 (0.72 to 1.13)]. When we assumed that a chronic disease occurred 1-3 years before the recorded date, estimates for weight loss and gain were attenuated among overweight individuals and estimates for weight loss were stronger among individuals with obesity. Interpretation: Among individuals with obesity, the weight loss group had a lower risk of CHD and moderately lower risk of CVD. Weight gain increased the risk of CVD across BMI groups.

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