Abstract
BackgroundThe combined associations of body mass index (BMI) levels and metabolic dysfunction with medical and dental care utilizations is unclear.MethodsA 4-year follow-up study was performed in 16,386 Japanese male employees (mean age 48.2 [standard deviation, 11.0] years) without a history of cardiovascular disease (CVD), cancer, or renal failure. They were classified into eight phenotypes based on four BMI levels (underweight, <18.5; normal weight, 18.5–24.9; overweight, 25.0–29.9; and obese, ≥30.0 kg/m2) and the presence or absence of ≥2 of 4 metabolic abnormalities: high blood pressure, high triglycerides, low high-density-lipoprotein cholesterol, and high blood sugar. Based on their health insurance claims data, we compared medical and dental care days and costs among the eight different BMI/metabolic phenotypes during 2010–2013.ResultsThe combinations of BMI levels and metabolic status were significantly associated with the adjusted mean and median medical outpatient days and costs and the median dental outpatient days and costs. The obese/unhealthy subjects had the highest medical outpatient days and costs, and the underweight/unhealthy subjects had the highest dental outpatient days and costs. The underweight/unhealthy subjects also had the highest medical inpatient days and hospitalization rates of CVD, and had higher medical costs compared with the obese/healthy subjects. The differences in median medical costs between healthy and unhealthy phenotypes were larger year by year across all BMI levels.ConclusionsIdentification of obesity phenotypes using both BMI levels (including the underweight level) and metabolic status may more precisely predict healthcare days and costs compared with either BMI or metabolic status alone.
Highlights
The World Health Organization (WHO) reported that approximately 36 million people die annually from non-communicable diseases, equaling 70% of all deaths in the world in 2008, and the annual number of deaths will increase to 55 million by 2030.1 Cardiovascular disease (CVD) is a leading cause (48% of non-communicable diseases), followed by cancers (21%), respiratory diseases (12%), and diabetes (3.5%).[1]
The frequency of unhealthy metabolic status increased with increasing body mass index (BMI) level (7.5%, 22.5%, 47.6%, and 63.5% for underweight, normal weight, overweight, and obesity, respectively)
Our major findings are as follows: 1) the different combinations of BMI levels and metabolic status were associated with the adjusted mean and median medical outpatient days and costs and median dental outpatient days and costs during the 4-year period; 2) the obese=unhealthy subjects had the highest medical outpatient days and costs, and the underweight=unhealthy subjects had the highest dental outpatient days and costs; 3) the underweight=unhealthy subjects had the highest medical inpatient days and hospitalization rates of all-cause and CVD, and more highly increased medical costs compared with the obese=healthy subjects
Summary
The World Health Organization (WHO) reported that approximately 36 million people die annually from non-communicable diseases, equaling 70% of all deaths in the world in 2008, and the annual number of deaths will increase to 55 million by 2030.1 Cardiovascular disease (CVD) is a leading cause (48% of non-communicable diseases), followed by cancers (21%), respiratory diseases (12%), and diabetes (3.5%).[1]. Obesity is considered to be a fundamental risk factor for metabolic syndrome (MetS); the exact mechanisms underlying the development of MetS have not yet been established, and several institutions have suggested different criteria for MetS In recent years, those who fit non-traditional obesity phenotypes (ie, metabolically unhealthy normal weight, MUNW; and metabolically healthy obesity, MHO) have been increasingly observed.[3] The prevalence of these phenotypes is not low, and their increased risk of diseases and death should not be disregarded.[4,5,6,7,8,9,10,11] These studies suggest that the risk of diabetes, renal disease, CVD, and death could be more precisely assessed using both body mass index (BMI) and metabolic status. The combined associations of body mass index (BMI) levels and metabolic dysfunction with medical and dental care utilizations is unclear
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