The Concept of Normal Weight Obesity

Individuals with normal body weight by body mass index (BMI) and high body fat percentage show a high degree of metabolic dysregulation. This phenomenon, defined as normal weight obesity, is associated with a significantly higher risk of developing metabolic syndrome, cardiometabolic dysfunction and with higher mortality. Recently, we have also shown that coronary artery disease patients with normal BMI and central obesity have the highest mortality risk as compared to other adiposity patterns. Therefore, it is important to recognize these high-risk groups for better adiposity-based risk stratification. There is a need for an updated definition of obesity based on adiposity, not on body weight.     

Body mass index change in relation to longitudinal systolic blood pressure: An age- and sex-matched and repeated measures study

Background and aimsThe positive association between mean systolic blood pressure (SBP) and body mass index (BMI) diminished or reversed over the past four decades. The primary aim of this study was to evaluate effects of BMI change on longitudinal SBP.Methods and resultsA total of 3638 participants who had annual health examination from 2015 to 2019 were included and matched by age and sex according to BMI levels. BMI and SBP were measured annually and their association were assessed by a linear mixed-effects regression model. The normal weight participants had a sustained weight gain as well as SBP increase during the study period (all P_trend <0.001). The obese participants had a sustained weight loss but SBP did not decrease simultaneously. If BMI change was considered, the obese participants with BMI loss had a significant decrease of SBP during the study period (P_trend = 0.0012). Mixed-effects models showed that weight gain was more influential on longitudinal SBP in the normal weight participants and weight loss was in the obese participants. The obese group with BMI loss had a decrease of SBP by 5.01 mmHg (95% confidence interval: 2.56 mmHg, 7.46 mmHg) compared to their counterparts with BMI maintenance from 2015 to 2019.ConclusionsThe effect of weight change on longitudinal SBP was varied among BMI groups. With the increase of baseline BMI level, the positive effect of weight loss on SBP became greater and the negative effect of weight gain on SBP were attenuated.     

Long-term weight change in adulthood and incident diabetes mellitus: MY Health Up Study

Aim

To investigate whether long-term weight/BMI change in adulthood has a significant impact on the incidence of diabetes, independent of attained weight status.

Methods

A number of 13,700 participants (2962 men and 10,738 women) aged 36 to 55 years were followed for up to 5 years using data from annual health checkups. Incident cases of diabetes were identified from self-reports or single fasting plasma glucose measurements (≥7.0 mmol/l). Weight/BMI change was calculated from participants’ weight/BMI values at age 20 years and weight/BMI values at a given point during follow-up and used as a time-dependent variable in age-stratified multivariate Cox proportional hazards models.

Results

During the 5 year follow-up, 408 participants (137 men and 271 women) developed diabetes. Even after adjusting for BMI during follow-up and other possible confounders, weight/BMI gain since age 20 years was significantly associated with an increased risk of developing diabetes. The hazard ratios were: 2.30 (95% confidence interval (CI): 1.31–4.04) for those who gained 6.0 to <10.0 kg and 3.09 (95% CI: 1.79–5.34) for those who gained ≥10.0 kg [reference: <2.0 kg change]; and 2.61 (95% CI: 1.58–4.31) for those who gained 3.0 to <5.0 kg/m² and 3.70 (95% CI: 2.22–6.16) for those who gained ≥5.0 kg/m² [reference: <1.0 kg/m² change].

Conclusions

The results indicate that long-term weight/BMI gain in adulthood is a significant predictor for the development of diabetes, independent of attained weight status. Because weight gain within the normal weight range could increase the risk of diabetes, non-obese people should also be warned against possible weight gain.     

Body-Shape Perceptions and Body Mass Index of Older African American and European American Women

The prevalence of obesity is higher in African American compared to European American women. Ethnic differences in body-shape perceptions such as greater acceptance of overweight figures, higher levels of body shape satisfaction, or an underestimation of one's body-shape have been suggested as possible contributors. The purpose of this investigation was to compare body-shape perceptions and body mass index of older African American and European American women. Eighty-nine European American and 115 African American women (mean age, 72 years) completed a questionnaire, composed of three parts: general demographic and anthropometric information, and questions regarding body-shape perceptions. The results suggested an underestimation of body-shape in African American women as a possible contributor to obesity. The findings of the present study suggested that in order to enhance the effectiveness of dietary interventions in older African American women, measures to assess the accuracy of self-perceived body-shape should be included.     

Higher Body Fat and Lower Fat-Free Mass in Girls with Premature Adrenarche

Objective:

Idiopathic premature adrenarche (PA) refers to presence of androgenic signs before the age of eight years in girls in the absence of thelarche. In children with PA, increased adrenal androgens lead to changes in body composition and transient growth acceleration. Although the association between PA and some components of the metabolic syndrome is well known, body composition has not been extensively studied in these patients.

Methods:

We examined 47 girls with PA with a median age of 7.39 years and 57 healthy controls with a median age of 7.11 years. For PA group, the inclusion criteria were appearance of pubic/axillary hair before 8 years of age, absence of findings of central puberty and absence of use of any medication. Patients with steroidogenic enzyme defects and virilizing tumors were excluded. Height, body weight, waist and hip circumference were measured. The bioelectrical impedance method was used for body composition analysis.

Results:

In the PA group, both body weight standard deviation score (SDS) and height SDS were significantly higher than in the controls (p<0.001 for both). While total body fat percentage values were significantly higher in the PA group than in the controls (median 22.8% vs. 19.95%, p=0.049), fat-free mass (FFM) and total muscle mass percentages were significantly lower than in the controls (median 76.8% vs. 79.9%, p=0.024 and 72.6% vs. 75.7%, p=0.018, respectively).

Conclusion:

Our findings revealed that girls with PA have higher body weight and height for age values. They also show significant changes in body composition such as an increase in total body fat percentage with a concomitant decrease in the percentages of FFM, muscle mass and total body water.     

Impact of Body Mass Index on Obesity-Related Cancer and Cardiovascular Disease Mortality; The Japan Collaborative Cohort Study

Aim: We aimed to examine the association of obesity-related cancer and cardiovascular disease (CVD) with body mass index (BMI) and the estimated population attributable fraction in lean Asians. Methods: We studied 102,535 participants aged 40–79 years without histories of cancer or CVD at baseline between 1988 and 2009. The cause-specific hazard ratios (csHRs) of BMI categories (＜18.5, 18.5–20.9, 21.0–22.9 [reference], 23.0–24.9, 25.0–27.4, and ≥ 27.5 kg/m²) were estimated for each endpoint. The events considered were mortalities from obesity-related cancer (esophageal, colorectal, liver, pancreatic, kidney, female breast, and endometrial cancer) and those from CVD (coronary heart disease and stroke). Population attributable fractions (PAFs) were calculated for these endpoints. Results: During a 19.2-year median follow-up, 2906 died from obesity-related cancer and 4532 died from CVD. The multivariable-adjusted csHRs (95% confidence interval) of higher BMI categories (25–27.4 and ≥ 27.5 kg/m²) for obesity-related cancer mortality were 0.93 (0.78, 1.10) and 1.18 (0.92, 1.50) in men and 1.25 (1.04, 1.50) and 1.48 (1.19, 1.84) in women, respectively. The corresponding csHRs for CVD mortality were 1.27 (1.10, 1.46) and 1.59 (1.30, 1.95) in men and 1.10 (0.95, 1.28) and 1.44 (1.21, 1.72) in women, respectively. The PAF of a BMI ≥ 25 kg/m² for obesity-related cancer was −0.2% in men and 6.7% in women and that for CVD was 5.0% in men and 4.5% in women. Conclusion: A BMI ≥ 25 kg/m² is associated with an increased risk of obesity-related cancer in women and CVD in both sexes.     

人体脂肪／非脂成分比值与非酒精性脂肪肝关系的横断面研究

我国脂肪肝发病率呈逐年增长趋势且主要与肥胖症而非酒精滥用有关．寻找测量简便的非酒精性脂肪性肝病（NAFLD）预测指标具有重要意义。目的：探讨反映人体脂肪蓄积程度的脂肪／非脂成分比值（FFR）与非酒精性脂肪肝的关系。方法：以1025例上海市公务员为研究对象行横断面研究,调查和检测内容包括人口统计学资料、体质指数（BMI）、腰围（WC）、有无脂肪肝、人体成分分析、空腹血糖（FPG）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）等,以单因素和多因素非条件logistic回归分析FFR与非酒精性脂肪肝的关系。结果：脂肪肝组与非脂肪肝组FFR的中位数和四分位数间距分别为0．39（0．33,0．45）和0．34（0．28,0．40）,组间差异有统计学意义（P〈0．001）。根据FFR的四分位数将研究对象按FFR由低至高分为四组,以FFR最低组为参照,调整性别、年龄、BMI、WC、FPG、TG、HDL-C因素后,各组发生脂肪肝的0R（95％CI）分别为1．37（0．82,2．28）、1．80（1．06,3．07）、2．59（1．44．4．67）．脂肪肝发生风险随FFR的增高呈上升趋势（trendP〈O．001）。结论：FFR增高与非酒精性脂肪肝相关．两者间存在剂量．反应关系．     

The Importance of Local Subcutaneous Fat Thickness in Pilonidal Disease

Purpose This study was designed to investigate the local subcutaneous fat thickness in sacrococcygeal pilonidal disease. Methods Subcutaneous fat thickness was measured by ultrasonography in 125 patients with sacrococcygeal pilonidal disease and 125 age-matched, body mass index-matched and gender-matched controls. Results The sacrococcygeal subcutaneous fat thickness was 14.4 ± 2.9 mm, 18.3 ± 3.1 mm, and 22 ± 2.2 mm, respectively, in normal, overweight, and obese patients with sacrococcygeal pilonidal disease and 9.1 ± 3.1 mm, 11.3 ± 2.6 mm, and 20 ± 1.8 mm, respectively, in normal, overweight, and obese controls. Sacrococcygeal fat was significantly thicker in normal and overweight patients with pilonidal disease compared with controls with same body mass index (P< 0.01). There were no significant differences in fat thickness between obese patients and obese controls (P > 0.05). Conclusions Sacrococcygeal fat thickness, as a local factor, is closely associated with pilonidal disease.     

Physical Activity, Body Mass Index, and Diabetes Risk in Men: A Prospective Study

Objective

Physical activity has been associated with lower diabetes risk, but several prospective studies among women found that activity only slightly attenuated the diabetes risk associated with high body mass index (BMI). We investigated the independent and joint associations between vigorous activity and BMI on diabetes risk in men.

Methods

This was a prospective cohort design within the Physicians' Health Study, using Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident diabetes in 20,757 men without diabetes at baseline. Models were based on self-reported BMI and exercise frequency at baseline, first separately and then with a 6-category joint variable combining World Health Organization BMI category (normal/overweight/obese) with activity status (active/inactive) using weekly vigorous activity as the threshold.

Results

After a median follow-up of 23.1 years, there were 1836 cases of incident diabetes. Compared with active participants with normal BMIs, active but overweight and obese men had multivariable-adjusted HRs of 2.39 (95% CI, 2.11-2.71) and 6.22 (95% CI, 5.12-7.56). Inactive men with normal, overweight, or obese BMIs had multivariable-adjusted HRs of 1.41 (95% CI, 1.19-1.67), 3.14 (95% CI, 2.73-3.62), and 6.57 (95% CI, 5.25-8.21).

Conclusion

Active men with normal and overweight BMIs had lower diabetes hazards than their inactive counterparts, but no difference by weekly activity was seen in obese men. Elevated BMI is a key driver of diabetes risk, with relatively modest attenuation by activity.     

Underweight and obese states both associate with worse disease activity and physical function in patients with established rheumatoid arthritis

Obesity is characterised by low-grade inflammation and could potentially affect disease activity and severity in patients with rheumatoid arthritis (RA). Body mass index (BMI), body fat (BF), erythrocyte sedimentation rate, C-reactive protein, disease activity score 28, physical function (health assessment questionnaire) and presence of erosions and joint surgery were assessed in 294 (female = 219) volunteers with established RA [age 63.3 (56.2–69.6); disease duration 13 (7–20) years]. Smoking status, rheumatoid factor and anti-cyclic citrullinated peptide positivity were also assessed. BMI and BF independently associated with disease characteristics. Compared to normal-weight patients, underweight and obese had higher C-reactive protein (p = 0.046) and physical dysfunction (p = 0.034). BMI or BF did not associate with presence of erosions or joint surgery. In patients with established RA, both very low and very high BMI and BF associate independently with increased disease activity and physical dysfunction; however, this does not seem to associate with presence of erosions or joint surgery. Further longitudinal studies are required to address this apparent dissociation.     

Body Mass Index and Diverticular Disease: A 28-Year Follow-Up Study in Men

Purpose

Diverticular disease increased steadily concomitant with elevated rates of overweight and obesity during the 20th century. Therefore, the objective of this study was to investigate whether overweight and obesity in midlife predict future diverticular disease in men.

Methods

This was a prospective cohort study of a general population of men living in Göteborg, Sweden. A community-based sample of 7,494 men, investigated when aged 47 to 55 years, were followed from baseline in 1970 to 1973 for a maximum of 28 years. Hospitalization with a discharge diagnosis of diverticular disease according to the Swedish hospital discharge register was measured.

Results

Totally, 112 men (1.5 percent) were hospitalized with diverticular disease. A relationship between body mass index and diverticular disease was demonstrated; men with a body mass index between 20 and 22.5 kg/m² had the lowest risk. After adjustment for covariates, the risk increased linearly in men who had a body mass index of 22.5 to 25 (multiple-adjusted hazard ratio, 2.3; 95 percent confidence interval, 0.9–6; 25–27.5 (hazard ratio, 3 (1.2–7.6)), 27.5–30 (hazard ratio 3.2, (1.2–8.6)), and 30 or greater (hazard ratio 4.4, (1.6–12.3)) kg/m² (P for linear trend?=?0.004). Men with a body mass index of ≤20 kg/m² had a nonsignificantly elevated risk (hazard ratio, 3 (0.7–12.5)). Smoking (hazard ratio, 1.6 (1.1–2.3) and diastolic blood pressure (hazard ratio, 1.02 (1.01–1.04) per mmHg) also were independently related to risk of diverticular disease.

Conclusions

In a large community-based sample of middle-aged men, overweight and obesity were strongly linked to future severe diverticular disease leading to hospitalization.

     

Predictors of Body Mass Index in Patients With Moderate to Severe Emphysema

ABSTRACT

People with Chronic Obstructive Pulmonary Disease are at risk for low body weight and the subsequent sequelae of cachexia. The goal of this study was to define the relationship between of degree of emphysema as measured by high resolution chest computerized tomography, body mass index and caloric intake. Subjects from San Diego County were recruited to participate in a multi-center randomized clinical trial to test the Feasibility of Retinoids in the Treatment of Emphysema (FORTE). Forty subjects with Chronic Obstructive Pulmonary Disease, participated in a nutrition substudy and were ex-smokers with FEV₁ between 20%–80% predicted. Body mass index was correlated with the degree of emphysema as measured by high resolution chest tomography (CT), r² = 0.171 p < 0.01 across the full spectrum of disease severity. Dietary intake averaged over four days using 24-hour recalls was inversely correlated with BMI, r² = 0.471, p < 0.001, indicating a higher energy intake in subjects with low BMI. Pulmonary function tests of percent predicated FEV₁ was mildly related to BMI (r² = 0.086, p < 0.06). A regression model was developed to define the relationship of BMI and degree of emphysema and calorie per kilogram body weight, which accounted for 60% of the variability, p < 0.001. Low body weight in the COPD is related to the degree of emphysema, not due to decreased caloric intake. Subjects with low body weight have compensated by increasing their caloric intake and are meeting their nutritional needs.     

动态血压监测探讨体重指数与血压的关系

目的:动态血压监测探讨患者体重指数与血压变化情况。方法:选择门诊和病房住院的患者共691例(其中男性417例,女性274例),年龄范围13~90岁,平均年龄为55岁。所有观察对象测量诊室血压、心率、身高、体重和监测24小时动态血压等指标,按照体重指数分为3组,体重指数<24为正常体重组;24≤体重指数<28为超重组;体重指数≥28为肥胖组。结果:肥胖组患者24小时和白天的平均收缩压/舒张压、夜间平均舒张压以及24小时、白天和夜间心率均高于正常体重组,有显著性差异(P<0.05~0.01)。此外,血压负荷也随着体重指数的增加而增加,有显著性差异(P<0.05~0.01)。结论:体重指数与动态血压和血压负荷有较密切的关系;与正常体重组、超重组比较,肥胖组患者的血压最高、心率最快;动态血压提供的数据信息量大,结论更可靠、准确。     

The Relationship of Body Mass and Fat Distribution With Incident Hypertension : Observations From the Dallas Heart Study

Background

Obesity has been linked to the development of hypertension, but whether total adiposity or site-specific fat accumulation underpins this relationship is unclear.

Objectives

This study sought to determine the relationship between adipose tissue distribution and incident hypertension.

Methods

Normotensive participants enrolled in the Dallas Heart Study were followed for a median of 7 years for the development of hypertension (systolic blood pressure [SBP] ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or initiation of blood pressure medications). Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) was quantified by magnetic resonance imaging and proton-spectroscopic imaging, and lower body fat (LBF) was imaged by dual-energy x-ray absorptiometry. Multivariable relative risk regression was performed to test the association between individual fat depots and incident hypertension, adjusting for age, sex, race/ethnicity, diabetes, smoking, SBP, and body mass index (BMI).

Results

Among 903 participants (median age, 40 years; 57% women; 60% nonwhite; median BMI 27.5 kg/m²), 230 (25%) developed incident hypertension. In multivariable analyses, higher BMI was significantly associated with incident hypertension (relative risk: 1.24; 95% confidence interval: 1.12 to 1.36, per 1-SD increase). However, when VAT, SAT, and LBF were added to the model, only VAT remained independently associated with incident hypertension (relative risk: 1.22; 95% confidence interval: 1.06 to 1.39, per 1-SD increase).

Conclusions

Increased visceral adiposity, but not total or subcutaneous adiposity, was robustly associated with incident hypertension. Additional studies will be needed to elucidate the mechanisms behind this association.     

Minimal Clinically Important Differences in COPD: Body Mass Index and Muscle Strength

Weight loss, muscle wasting, as well as muscle dysfunction are recognized as important problems in COPD, contributing to morbidity and mortality. This paper discusses body weight and muscle function as possible outcome parameters in the management of COPD. The relationship between these outcome measures and COPD-related management goals is discussed. Minimal clinically important differences (MCID) in the approach of patients suffering from COPD for these measures are discussed.     

体重指数与不同亚型高血压的关系

目的探讨中国成年人体重指数(BMI)与不同亚型高血压患病率的关系。方法2000-2001年,对年龄35～74岁的中国成年人群中的代表性抽样样本进行横断面调查,分析了资料完整并且未服用降压药的14124名研究对象的数据。比较男性和女性不同BMI分组的各亚型高血压患病率、比数比(OR值)和归因危险。结果随着BMI水平的增加,男性和女性的收缩压和舒张压均值逐渐增高。男、女性在低体重组、正常体重组、超重组和肥胖组的各亚型高血压患病率和OR值基本上也呈升高趋势。男性超重和肥胖(BMI≥24kg/m2)时患单纯性收缩期高血压(ISH)、单纯性舒张期高血压(IDH)、收缩期和舒张期联合性高血压(SDH)的OR值分别为1.3、2.9和2.4,女性则各为1.6、2.4和2.3(P<0.05)。与非超重者相比,超重和肥胖男性中20%的ISH、65.4%的IDH和57.5%的SDH应归因于BMI≥24kg/m2,而女性相应有37.9%的ISH、59.0%的IDH和55.8%的SDH由超重和肥胖引起。结论体重指数与各亚型高血压的患病危险有显著正相关。减重和控制肥胖对于预防IDH和SDH的发生起重要作用。     

Body Mass Index and Mortality from Nonrheumatic Aortic Valve Disease among Japanese Men and Women

Aim: We aimed to examine the impact of overweight and obesity on mortality from nonrheumatic aortic valve disease. Methods: In the Japan Collaborative Cohort Study, we analyzed data of 98,378 participants aged 40–79 years, with no history of coronary heart disease, stroke, or cancer at baseline (1988–1990) and who completed a lifestyle questionnaire including height and body weight; they were followed for mortality until the end of 2009. The Cox proportional hazards model was used to calculate the multivariable hazard ratios (HRs) with 95% confidence intervals (CIs) of nonrheumatic aortic valve disease mortality according to body mass index (BMI) after adjusting for potential confounding factors. Results: During the median 19.2 years follow-up, 60 deaths from nonrheumatic aortic valve disease were reported. BMI was positively associated with the risk of mortality from nonrheumatic aortic valve disease; the multivariable HRs (95% CIs) were 0.90 (0.40–2.06) for persons with BMI ＜21 kg/m², 1.71 (0.81–3.58) for BMI 23–24.9 kg/m², 1.65 (0.69–3.94) for BMI 25–26.9 kg/m², and 2.83 (1.20–6.65) for BMI ≥ 27 kg/m² (p for trend=0.006), compared with persons with BMI 21–22.9 kg/m². Similar associations were observed between men and women (p for interaction=0.56). Excluding those who died during the first ten years of follow-up or a competing risk analysis with other causes of death as competing risk events did not change the association materially. Conclusions: Overweight and obesity may be independent risk factors for nonrheumatic aortic valve disease mortality in Asian populations.