Highest Body Mass Index Tertile Research Articles

Trunk-to-leg-volume ratio is not associated with bone density or fracture risk in middle-aged adults: results from the National Health and Nutrition Examination Survey.

Body mass index (BMI) and waist circumference (WC) are commonly used to predict bone health, which is typically assessed via bone mineral density (BMD). Trunk-to-leg-volume ratio (TLVR), a relatively novel measure, predicts cardiometabolic outcomes, but its relationships with BMD and fracture remain unstudied. This study evaluated these anthropometric measures' associations with BMD and fracture in Americans aged 40-60years. Analyses of middle-aged adults from the 2013-2014 to 2017-2018 National Health and Nutrition Examination Survey were conducted. Whole-body, dual-energy X-ray absorptiometry was used to quantify TLVR as well as BMD at the lumbar spine, while a femur-specific scan was used to quantify femoral neck BMD. Fracture history was self-reported. Linear and logistic regression models were constructed with age, diabetes, smoking, race/ethnicity, education, and physical activity as confounding variables. TLVR was generally not associated with BMD, while WC and BMI showed positive associations with femoral neck BMD. Odds of osteopenia/osteoporosis at the femoral neck were ~ 65-80% lower among participants in the highest tertile of BMI and WC versus the lowest (p < 0.001). There were no statistically significant associations between anthropometric predictors and fracture. Women in tertiles 2 or 3 of TLVR (p = 0.097 and 0.079, respectively) did have 2.66 times the odds of wrist fracture than women in tertile 1, but this was not significant. As shown in previous research, BMI and WC show positive associations with femoral BMD. In contrast, the more novel anthropometric marker TLVR shows no association with femoral BMD, and no clear association with fracture.

Associations of adherence to Mediterranean-like diet pattern with incident rosacea: A prospective cohort study of government employees in China.

Despite of growing evidence on gastrointestinal comorbidities of rosacea, there was a lack of literatures regarding the role of diet on rosacea. To investigate the relationship between adherence to a Mediterranean-like diet pattern and the risk of incident rosacea. This was a prospective cohort study of government employees aged >20 years conducted between January 2018 and December 2021 from five cities of Hunan province of China. At baseline, participants completed a food frequency questionnaire and participated in a skin examination. Presence of rosacea was determined by certified dermatologists. Subsequent skin examinations during follow-up were performed every one-year interval since the entry of the study. The Mediterranean diet score (MDS) was generated based on seven food groups (whole grains, red meats, fish, raw vegetables, legumes, fruits and nuts). Binary logistic regression models adjusted for potential confounders were used to estimate risks for incident rosacea. Of the 3,773 participants who completed at least two consecutive skin examinations, 3,496 were eligible for primary analyses. With a total follow-up of 8,668 person-years, we identified 83 incident rosacea cases. After full adjustments for covariates, the MDS was associated a decreased risk of incident rosacea (aOR: 0.84, 95% CI: 0.72, 0.99; P trend = 0.037 for 1-point increment of MDS). In subgroup analyses by body mass index (BMI), this inverse association was consistently observed in the lowest and medium tertiles of BMI (<24.5 kg/m2), but not in the highest tertile of BMI (≥24.5 kg/m2), with a significant interaction effect (P < 0.001). Our results suggested that adherence to a Mediterranean-like diet pattern might reduce the risk of incident rosacea among non-overweight individuals.

Does body size impact muscle recruitment during law enforcement physical control simulator use?

This study examined muscle activation during the ‘push-pull’ component of law enforcement physical abilities testing and assessed activation differences based on sex, height, and body mass index. Fifty participants (40 male) completed the ‘push-pull’ task while surface electromyograms were recorded from ten upper and lower extremity muscles, and six trunk muscles. Muscle activation was amplitude-normalized to maximum voluntary isometric contraction and compared between sexes and tertiles of height and body mass index (BMI). Women had significantly higher activation of anterior deltoid and pectoralis major on the pull, and posterior deltoid and triceps on the push. Significant differences largely remained after controlling for body size in regression analyses. The lowest tertile of height had significantly higher triceps activity on the push. The highest tertile of BMI had significantly higher rectus abdominus and external obliques activity on the pull, and external obliques activation on the push. Practitioner summary: Muscle activation during the ‘push-pull’ component of law enforcement standardised testing was examined, including differences based on sex, height, and BMI. Minimal differences existed between sexes (females had higher deltoid, pectoralis major, triceps activity), height (shorter people had higher triceps activity) and BMI tertiles (larger people had more abdominal activity). Abbreviations: ANOVA: analysis of variance; BMI: body mass index; COPAT: correctional officer's physical abilities test; EMG: electromyogram; IMU: inertial measurement unit; MVIC: maximum voluntary isometric contraction; PARE: physical abilities requirement evaluation; PCS: physical control simulator; POPAT: police officer's physical abilities test; RMS: root mean square

Association of the body mass index with outcomes in elderly patients (≥80 years) undergoing percutaneous coronary intervention

BackgroundThe obesity paradox has been recognized in patients with cardiovascular disease. The association between obesity and outcomes in elderly patients undergoing percutaneous coronary intervention (PCI) has not been investigated, yet. MethodsA total of 990 elderly (≥80 years) patients undergoing PCI at our institution between January 2009 and December 2017 and with available data on body mass index (BMI) were divided according to BMI tertiles (lowest BMI tertile: ≪24.1 kg/m2, middle BMI tertile: 24.1–27.2 kg/m2, and highest BMI tertile: ≫27.2 kg/m2). The primary endpoint was all-cause mortality at a median follow-up of 233 [34–862] days. ResultsAll-cause mortality was 11.2%, 7.6%, and 5.8% in the lowest, the middle, and the highest BMI tertiles (Log Rank p = 0.008). Belonging to the lowest BMI tertile was associated with an increased risk of all-cause mortality (HR 2.14, 95% CI 1.23–3.73, p = 0.007), and associations remained significant after multivariable adjustments (adjusted HR 1.92, 95% CI 1.05–3.52, p = 0.03). While belonging to the lowest BMI tertile was independently associated with an increased all-cause mortality in patients with acute coronary syndromes (HR 2.32, 95% CI 1.24–4.35, p = 0.009; adjusted HR 2.40, 95% CI 1.19–4.84, p = 0.01), relations were not significant in patients with stable coronary artery disease (HR 1.32, 95% CI 0.38–4.56, p = 0.67; adjusted HR 0.80, 95% CI 0.21–3.05, p = 0.75). ConclusionsIn elderly (≥80 years) patients undergoing PCI, belonging to the lowest BMI tertile was associated with an increased mortality, mainly in acute coronary syndromes. Hence, the BMI should be incorporated into the risk stratification of elderly patients with coronary artery disease.

Physical fitness and body fatness are associated with mental health in Korean young adults: a cross sectional study

Background: It has been recognized that body fatness and mental disorders have association, however very limited evidence have proved that physical fitness and mental health have association. Relationship between physical fitness and mental health in young adults has not been fully proved. The purpose of the study was to investigate the association between physical fitness, body fatness, and mental health in young adults.Methods: A total of 149 (97 males and 52 females) college students were included. Physical fitness (sit-ups, push-ups, 1 mile run/walk), and body mass index (BMI) was measured, and psychological questionnaires including life satisfaction, self-efficacy, the beck depression inventory (BDI), and adult self report (ASR) were administered. The levels of physical fitness and BMI were classified into tertile groups and were analyzed.Results: Female participants with the highest tertile of BMI had highest ASR score (p&lt;0.05). Participants with highest level of physical fitness showed higher level of self-efficacy in both males and females (p&lt;0.05). In both male and female, physical fitness was a significant predictor for self-efficacy (Male: β=0.35, p&lt;0.05, Female: β =0.31, p&lt;0.05).Conclusions: In conclusion, physical fitness and body fatness were associated with mental health. Especially, physical fitness, independent of BMI, was proved as significant indicator for mental health in young adults.

Inflammation and insulin resistance according to body composition in European adolescents: the HELENA study.

Inflammation is related to insulin resistance in adults, especially on those individuals with high levels of body composition. The aim of this study is to assess the relationship between a set of inflammatory biomarkers and insulin resistance by levels of body composition in a sample of European adolescents. Nine hundred and sixty-two adolescents (442 boys and 520 girls) from nine European countries met the inclusion criteria of having measurements for the homeostasis model assessment (HOMA) and a set of inflammation-related biomarkers: C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin (IL-6), complement factors C3 and C4 and selected cell adhesion molecules. Body mass index (BMI), fat mass index (FMI) and waist circumference (WC) were categorized using tertiles. To assess the associations stratifying by body composition indexes, ANOVA and linear regression models were performed. Mean biomarkers' concentrations differed across BMI, FMI and WC tertiles (p < 0.05) by sex. In both sexes, insulin, HOMA, CRP, C3 and C4 were significantly different between categories (p < 0.001), always showing the highest mean concentration in the upper category of BMI, FMI and WC. The most consistent finding was an association between insulin resistance and C3 concentrations (p < 0.05), in the adolescents in the highest tertile of BMI, FMI and WC, except in the case of FMI in girls. Inflammatory and glucose metabolism markers differed by tertiles of body composition, being usually higher in the highest tertile. C3 complement factor was associated with insulin resistance in adolescents, especially those with high total and abdominal adiposity.

Body mass index is inversely associated with mortality in patients with acute kidney injury undergoing continuous renal replacement therapy.

BackgroundMany epidemiologic studies have reported on the controversial concept of the obesity paradox. The presence of acute kidney injury (AKI) can accelerate energy-consuming processes, particularly in patients requiring continuous renal replacement therapy (CRRT). Thus, we aimed to investigate whether obesity can provide a survival benefit in this highly catabolic condition.MethodsWe conducted an observational study in 212 patients who had undergone CRRT owing to various causes of AKI between 2010 and 2014. The study end point was defined as death that occurred within 30 days after the initiation of CRRT.ResultsPatients were categorized into three groups according to tertiles of body mass index (BMI). During ≥30 days after the initiation of CRRT, 39 patients (57.4%) in the highest tertile died, as compared with 58 patients (78.4%) in the lowest tertile (P = 0.02). In a multivariable analysis adjusted for cofounding factors, the highest tertile of BMI was significantly associated with a decreased risk of death (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.37–0.87; P = 0.01). This significant association remained unaltered for 60-day (HR, 0.64; 95% CI, 0.43–0.94; P = 0.03) and 90-day mortality (HR, 0.66; 95% CI, 0.44–0.97; P = 0.03).ConclusionThis study showed that a higher BMI confer a survival benefit over a lower BMI in AKI patients undergoing CRRT.

Adverse Anthropometric Profile and Blood Pressure among Young (&amp;#60;40 yrs) Urban Adult Males from Pune, India

High prevalence rates of Non Communicable Diseases (NCDs), particularly hypertension and the precedence in its age at onset in developing countries including India, demands identification of risk factors especially among urban young populations. Working young males from Pune, India (n=254) were measured for weight, height, Body Mass Index (BMI), Waist Circumference (WC) Waist Hip Ratio (WHR), Body Fat (BF), Visceral Fat (VF) and blood pressure; 72.5% were overweight, 48.4 % were obese (BMI≥25) while 68.9% were obese using body fat criterion. Central obesity (WC≥90) was 38.2% and was almost half of overall obesity. BMI was significantly (p&amp;lt;0.001) associated with WC and central obesity increased significantly (p&amp;lt;0.01) as BMI increased from lowest to highest (6% to 76.5%) tertile. Mean SBP was 121.9±10.4 mmHg and mean DBP was 79.9±8.6 mmHg while prevalence of hypertension (HTN) was high (25.6%) especially due to High Diastolic (22.4%) Blood Pressure (HDBP). Overweight and obese subjects had significantly (p&amp;lt;0.001) higher systolic and diastolic blood pressure levels but prevalence of HTN showed significant association only with BMI and VF but not with WC,WHR or BF indicating the importance of body fat distribution. In particular, subjects in the highest tertile of BMI had significantly (p&amp;lt;0.01) higher risk for HTN (OR 3.1, CI:1.5-6.2) and HDBP (OR 3.2, CI:1.5-7.0). This was also true for subjects in highest tertile of VF. Preventing obesity among young adults through modifiable factors associated with BMI and VF is necessary for reducing substantial amount of cardiovascular disease mortality.

Characterization of Myocardial Repolarization Reserve in Adolescent Females With Anorexia Nervosa.

Patients with anorexia nervosa exhibit abnormal myocardial repolarization and are susceptible to sudden cardiac death. Exercise testing is useful in unmasking QT prolongation in disorders associated with abnormal repolarization. We characterized QT adaptation during exercise in anorexia. Sixty-one adolescent female patients with anorexia nervosa and 45 age- and sex-matched healthy volunteers performed symptom-limited cycle ergometry during 12-lead ECG monitoring. Changes in the QT interval during exercise were measured, and QT/RR-interval slopes were determined by using mixed-effects regression modeling. Patients had significantly lower body mass index than controls; however, resting heart rates and QT/QTc intervals were similar at baseline. Patients had shorter exercise times (13.7±4.5 versus 20.6±4.5 minutes; P<0.001) and lower peak heart rates (159±20 versus 184±9 beats/min; P<0.001). The mean QTc intervals were longer at peak exercise in patients (442±29 versus 422±19 ms; P<0.001). During submaximal exertion at comparable heart rates (114±6 versus 115±11 beats/min; P=0.54), the QTc interval had prolonged significantly more in patients than controls (37±28 versus 24±25 ms; P<0.016). The RR/QT slope, best described by a curvilinear relationship, was more gradual in patients than in controls (13.4; 95% confidence interval, 12.8-13.9 versus 15.8; 95% confidence interval, 15.3-16.4 ms QT change per 10% change in RR interval; P<0.001) and steepest in patients within the highest body mass index tertile versus the lowest (13.9; 95% confidence interval, 12.9-14.9 versus 12.3; 95% confidence interval, 11.3-13.3; P=0.026). Despite the absence of manifest QT prolongation, adolescent anorexic females have impaired repolarization reserve in comparison with healthy controls. Further study may identify impaired QT dynamics as a risk factor for arrhythmias in anorexia nervosa.

Associations of Heart Rate With Inflammatory Markers Are Modulated by Gender and Obesity in Older Adults.

Faster resting heart rate (HR), which is associated with inflammation and elevated cortisol levels, is a risk factor for excess cardiovascular morbidity and mortality. Obesity is associated with increased cardiovascular morbidity and mortality, inflammation, and elevated cortisol levels. The aim of the present study was to evaluate the interaction of Body Mass Index (BMI) with inflammation and cortisol in modulating HR in older subjects. We analyzed data of 895 participants aged 65+ enrolled in the "InCHIANTI" study, in sinus rhythm, and not taking beta blockers or digoxin. Linear regression was performed to assess the adjusted association between HR, IL-6, and cortisol levels. The model was also analyzed stratifying for BMI tertiles. Logistic regression was adopted for evaluating the association of HR exceeding the mean value with Il-6 and serum cortisol. According to multivariable linear regression, IL-6 and cortisol levels were associated with HR (B = 1.42, 95% CI = 0.43-2.42; p = .005 and B = .34, 95% CI = 0.17-.51; p < .0001, respectively). The association was significant only among women in the highest BMI tertile (B = 4.16, 95% CI = 1.40-6.91; p = .003 for IL-6 and B = .57, 95% CI = 0.14-1.01; p = .010 for cortisol). Logistic regression confirmed that IL-6 and cortisol levels were associated with HR above the mean value in the highest BMI tertile (OR = 2.13, 95% CI = 1.15-3.97; p = .009 and OR = 1.14, 95% CI = 1.03-1.25; p = .009, respectively). Faster HR is associated with proinflammatory state in elderly patients; this association seems to be limited to women with higher BMI.

Cardiorespiratory fitness, body mass index, and cancer mortality: a cohort study of Japanese men.

BackgroundThe aim of this study is to investigate the independent and joint effects of cardiorespiratory fitness (CRF) and body mass index (BMI) on cancer mortality in a low body mass index population.MethodsWe evaluated CRF and BMI in relation to cancer mortality in 8760 Japanese men. The median BMI was 22.6 kg/m2 (IQR: 21.0-24.3). The mean follow-up period was more than 20 years. Hazard ratios and 95% CI were obtained using a Cox proportional hazards model while adjusting for several confounding factors.ResultsUsing the 2nd tertile of BMI (21.6-23.6 kg/m2) as reference, hazard ratios and 95% CI for the lowest tertile of BMI (18.5-21.5) were 1.26 (0.87–1.81), and 0.92 (0.64–1.34) for the highest tertile (23.7-37.4). Using the lowest tertile of CRF as reference, hazard ratios and 95% CIs for 2nd and highest tertiles of CRF were 0.78 (0.55–1.10) and 0.59 (0.40–0.88). We further calculated hazard ratios according to groups of men cross-tabulated by tertiles of CRF and BMI. Among men in the second tertile of BMI, those belonging to the lowest CRF tertile had a 53% lower risk of cancer mortality compared to those in the lowest CRF tertile (hazard ratio: 0.47, 95% CI: 0.23-0.97). Among those in the highest BMI tertile, the corresponding hazard ratio was 0.54 (0.25-1.17).ConclusionThese results suggest that high CRF is associated with lower cancer mortality in a Japanese population of men with low average BMI.

Interactive effects of dietary fat/carbohydrate ratio and body mass index on iron deficiency anemia among Taiwanese women.

Whether being overweight or obese is associated with increased risk of iron deficiency anemia (IDA) remains controversial. We evaluated the dietary intakes and risk for IDA in relation to body mass index (BMI). One thousand two hundred and seventy-four females aged ≥19 years, enrolled in the third Nutrition and Health Survey in Taiwan (NAHSIT) 2005–2008, were selected. Half of the women were either overweight (24.0%) or obese (25.3%). The overall prevalence of anemia, iron deficiency and IDA among adult women was 19.5%, 8.6% and 6.2%. BMI showed a protective effect on IDA: overweight (odds ratio, OR: 0.365 (0.181–0.736)) and obese (OR: 0.480 (0.259–0.891)) when compared with normal weight. Univariate analysis identified increased IDA risk for overweight/obese women who consumed higher dietary fat but lower carbohydrate (CHO) (OR: 10.119 (1.267–80.79)). No such relationship was found in IDA women with normal weight (OR: 0.375 (0.036–4.022)). Analysis of interaction(s) showed individuals within the highest BMI tertile (T3) had the lowest risk for IDA and the risk increased with increasing tertile groups of fat/CHO ratio; OR 0.381 (0.144–1.008; p = 0.051), 0.370 (0.133–1.026; p = 0.056) and 0.748 (0.314–1.783; p = 0.513); for T1, T2 and T3, respectively. In conclusion, a protective effect of BMI on IDA may be attenuated in women who had increased fat/CHO ratio.

Effect of physical activity on vascular characteristics in young children

Physical activity has long been proposed as an important modifiable cardiovascular risk factor in adults. We assessed whether physical activity already has an effect on childhood vasculature. In the Wheezing-Illnesses-Study-in-Leidsche-Rijn birth cohort, we performed vascular ultrasound to measure carotid intima-media thickness (cIMT) and functional properties (distensibility, elastic modulus) at 5 and 8 years of age. Child typical physical activities were inquired using a questionnaire completed by parents. Linear regression was used with physical activity level, expressed as a standardized value of time-weighted metabolic equivalent (MET) as the independent variable and vascular properties as dependent variables with further confounder adjustment and evaluation for possible body mass index and sex effect modifications. In 595 5-year-old children and in 237 of those who had reached the age of 8 years, we did not find statistically significant associations between total time-weighted MET and each vascular parameter, neither in pooled nor stratified analysis. However, sport activities were associated with thinner cIMT (-3.20 µm/SD, 95% CI -6.34, -0.22, p = 0.04) at 5 years of age; a similar pattern was seen for organized sport. This effect was strongest in children in the highest body mass index tertile (-5.38 µm/SD, 95% CI -10.54, -0.19, p = 0.04). At the age of 8 years, higher sport level tended to be associated with higher vascular distensibility (2.64 × 10(3) kPa/SD, 95% CI -0.18, 5.45, p = 0.07) although this was not statistically significant. Sport activity may have beneficial effects on arteries of young children, particularly those with higher relative body weight.

Association between birth weight and visceral fat in adults

Several studies reported inverse associations between birth weight and central adiposity in adults. However, few studies investigated the contributions of different abdominal fat compartments. We examined associations between birth weight and adult visceral and subcutaneous abdominal fat in the population-based Fenland study. A total of 1092 adults (437 men and 655 women) aged 30-55 y had available data on reported birth weight, standard anthropometric measures, and visceral and subcutaneous abdominal fat estimated by ultrasound. In a subgroup (n = 766), dual-energy X-ray absorptiometry assessment of total abdominal fat was performed. Linear regression models were used to analyze relations between birth weight and the various fat variables adjusted for sex, age, education, smoking, and body mass index (BMI). After adjustment for adult BMI, there was an inverse association between birth weight and total abdominal fat [B (partial regression coefficient expressed as SD/1-kg change in birth weight) = -0.09, P = 0.002] and visceral fat (B = -0.07, P = 0.01) but not between birth weight and subcutaneous abdominal fat (B = -0.01, P = 0.3). Tests for interaction showed that adult BMI modified the association between birth weight and visceral fat (P for interaction = 0.01). In stratified analysis, the association between birth weight and visceral fat was apparent only in individuals with the highest BMI tertile (B = -0.08, P = 0.04). The inverse association between birth weight and adult abdominal fat appeared to be specific to visceral fat. However, associations with birth weight were apparent only after adjustment for adult BMI. Therefore, we suggest that rapid postnatal weight gain, rather than birth weight alone, leads to increased visceral fat.

Body Weight at Birth and at Age Three and Respiratory Illness in Preschool Children

The purpose of this study was to examine the associations of current body weight and body mass index (BMI) at age three and birth weight in developing chronic respiratory illness in childhood and identify possible interaction underlying its mechanism. The study was carried out with 422 children who were enrolled in a hospital-based birth cohort. Birth related anthropometric data were collected at birth. At age 3 years, the presence of respiratory symptoms was evaluated by using the Korean version of core questionnaire for wheezing and asthma from the International Study of Asthma and Allergies in Childhood (ISAAC). Physical examination was carried out to measure the child's weight and height. Children in the lowest birth weight tertile (aOR = 3.97, 95% CI = 0.94-16.68) or highest BMI tertile (aOR = 3.68, 95% CI = 1.24-10.95) at three years of age were at an increased risk of chronic respiratory illness. Children who were initially in the lowest birth weight tertile but now belong in the highest weight tertile had higher risk of chronic respiratory illness compared to those who had remained in the middle tertile (OR=16.35, 95% CI=1.66-160.57). Children with lower birth weight or higher BMI were at an increased risk of chronic respiratory illness. In addition, children who were initially in the lowest birth weight tertile but are now in the highest weight tertile had higher risk of chronic respiratory illness compared to those who remained in the middle tertile.

Physical activity and mammographic breast density in a Mediterranean population: The EPIC Florence longitudinal study

A protective effect of physical activity (PA) on breast cancer (BC) risk has been suggested. Few studies have examined the influence of PA on mammographic breast density (MBD), a strong risk factor for BC. In a prospective study in Florence, Italy, we identified 2,000 healthy women with a mammogram taken 5 years after enrollment. Individual mammograms were retrieved (83%) and MBD assessed according to Wolfe's classification. Detailed information on PA at work and during leisure time, reproductive history, lifestyle and anthropometric measurements at enrollment were available for 1,666 women. Information on hormone replacement therapy (HRT) was also obtained at mammogram. Women with high-MBD (P2 + DY Wolfe's patterns) were compared with women with low-MBD (N1 + P1) by multivariate logistic models. Overall, high-MBD was inversely associated with increasing levels of leisure time PA (p for trend = 0.04) and among peri-/postmenopausal women, also with increasing levels of recreational activities (p for trend = 0.02). An interaction between PA and HRT emerged, with a stronger inverse association of highest level of recreational activity with MBD among HRT nonusers (p for interaction = 0.02). A modifying effect by body mass index (BMI) was evident among 1,025 peri-/postmenopausal women who did not use HRT at the time of mammogram, with a stronger inverse association between recreational PA and MBD in the highest BMI tertile (OR = 0.34; 95% CI 0.20-0.57; p for interaction = 0.03). This large study carried out in Mediterranean women suggests that leisure time PA may play a role in modulating MBD, particularly in overweight/obese peri-/postmenopausal women.

High Body Mass Index and Physical Impairments as Predictors of Walking Limitation 22 Years Later in Adult Finns

Our aim was to study the effects of high body mass index (BMI) and physical impairments in midlife on later life walking limitation. Primarily middle-aged persons (aged 32-72 years) with no walking limitation at baseline (n = 840) were followed-up for 22 years as a part of the Mini-Finland Follow-up Survey. Incident walking limitation (walking speed < 1.2 m/s or difficulty in walking 0.5 km) was predicted by measured BMI, handgrip strength, squatting test, and self-reported running difficulties. Twenty-one percent of the participants developed walking limitation. After adjustment for multiple potential confounders, high BMI, low handgrip strength, impaired squatting, and running difficulties were significant predictors of incident walking limitation. The odds ratio (OR) of walking limitation was 4.55 (95% confidence interval [CI], 1.32-15.74) for squatting difficulties and 2.39 (95% CI, 1.26-4.55) for major running difficulties as compared to participants with no difficulties. The corresponding ORs for handgrip strength and BMI were 0.56 (95% CI, 0.38-0.81) and 1.39 (95% CI, 1.10-1.75) per an increment of 1 standard deviation. For persons in the highest BMI tertile who had two or more physical impairments, the adjusted risk of walking limitation was 4.5 times higher in comparison to normal weight persons with no physical impairments. In primarily middle-aged persons, BMI and simple tests of physical impairment strongly predicted the development of walking limitation 22 years later. In addition, physical impairments coexisting with high BMI predisposed to later life walking limitation more than high BMI alone. Therefore, increasing physical fitness by physical activity and promoting weight loss in middle age may prevent mobility limitation and subsequent disability in old age.

Blood pressure control and factors predicting control in a treatment-compliant male veteran population.

To estimate blood pressure control and identify treatment variables predicting control in treatment-compliant, hypertensive, male veterans. Outpatient clinic of a Veterans Affairs medical center. Retrospective review of computerized patient records over a 12-month period for demographics, comorbidities, patient-specific blood pressure goals, blood pressure history, antihypertensive therapy, and refill history. Two hundred fifty hypertensive men aged 39-90 years whose antihypertensive regimen remained unchanged over 12 months. The proportion of patients with blood pressures below 160/90 mm Hg was 86%; only 34.8% had pressures below 140/90 mm Hg. Blood pressure control was less common with advancing age (42.1%, 33.7%, and 29.4% for patients aged < 60, 60-75, and > 75 yrs, respectively, p = 0.057 for trend). Treatment intensity was highest in obese men, those aged 60-75 years, and those with a history of chronic heart failure or angina, and lowest in men older than 75 years or with a history of stroke. Blood pressure control was independently associated with therapy with beta-blockers (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.5-10.2, p = 0.005), loop diuretics (OR 4.3, 95% CI 1.6-12.1, p = 0.005), angiotensin-converting enzyme inhibitors (OR 3.1, 95% CI 1.2-8.2, p = 0.025), and long-term simvastatin therapy (OR 3.7, 95% CI 1.9-7.4, p = 0.0001), and with a diagnosis of coronary artery disease (OR 3.2, 95% CI 1.35-7.69, p = 0.009). The relationship between simvastatin therapy and blood pressure control persisted after controlling for the higher treatment intensity in patients taking the drug. Factors predicting poor control included a history of stroke (OR for control 0.36, 95% CI 0.19-0.69, p = 0.002), age over 75 years (OR 0.43, 95% CI 0.18-0.98, p = 0.046), highest low-density lipoprotein tertile (OR 0.37, 95% CI 0.17-0.80, p = 0.013), highest body mass index tertile (OR 0.46, 95% CI 0.21-1.00, p = 0.05), and therapy with two or fewer antihypertensives (OR 0.14, 95% CI 0.04-0.61, p = 0.009). In a compliant veteran population, control of blood pressure appeared inadequate but was significantly more likely in those receiving at least three antihypertensive agents. Long-term therapy with simvastatin was independently associated with increased odds of control.

The effect of body mass index on complications from cardiac surgery in the oldest old.

Overweight (body mass index (BMI)>25) and obesity (BMI>30) are associated with adverse outcomes in the general population. In older people, an increased risk of adverse events was observed in leaner and overweight older subjects. We evaluated the association between BMI and cardiac surgery complications in subjects aged 75 and older. Retrospective review of complication rates compiled as part of the New York State Department of Health Adult Cardiac Surgery Report. Academic tertiary care medical center. One thousand four hundred forty-eight subjects aged 75 and older who underwent cardiac surgery in an academic hospital between 1991 and 1999. Subjects were divided into tertiles based on their BMI. Logistic regression was used in multivariate analyses examining the association between tertiles of BMI (<23, 23-26,>26) and complications from cardiac surgery, adjusting for age and gender or using a full model adjusting for history of diabetes mellitus, hypertension, myocardial infarction (MI), congestive heart failure, smoking, chronic obstructive pulmonary disease, peripheral vascular disease, renal disease, surgical priority, age, and gender. Mean age was 79 (range 75-94); 58% of the subjects were male. The incidence of any postoperative complication, respiratory failure, or death was U-shaped, with higher incidence in the first tertile of BMI, followed by the last tertile and then the middle tertile. Subjects in the lowest tertile of BMI in the full model had a higher adjusted risk of stroke (odds ratio (OR) = 1.58, 95% confidence interval (CI) = 0.96-2.59), bleeding (OR = 1.71, 95% CI = 0.79-3.67), respiratory failure (OR = 1.65, 95%CI = 0.95-2.87), cardiovascular complications (stroke, MI, arrhythmia) (OR = 1.59, 95% CI = 0.93-2.73), and all complications (OR = 1.45, 95% CI = 1.05-2.00) than subjects in the middle tertile. The risk of most complications in subjects in the highest tertile of BMI was similar to that of subjects in the middle tertile except for wound infections (OR = 3.51, 95% CI = 0.92-13.33). The risk of death was higher in subjects in the lower tertile of BMI (OR = 1.97, 95% CI = 1.12-3.44) than in subjects in the middle tertile. The association between BMI and adverse cardiac surgical outcomes was stronger in men than women and decreased with advancing age. In the geriatric population, subjects with lower BMI have a higher risk of complications and death from cardiovascular surgery than subjects with higher BMI. An increased BMI does not increase the risk of complications from cardiovascular surgery, with the exception of wound infections.

Dialysis dose and body mass index are strongly associated with survival in hemodialysis patients.

Low dose of hemodialysis (HD) and small body size are independent risk factors for mortality. Recent changes in clinical practice, toward higher HD doses and use of more high-flux dialyzers, suggest the need to redetermine the dose level above which no benefit from higher dose can be observed. Data were analyzed from 45,967 HD patients starting end-stage renal disease (ESRD) therapy during April 1, 1997, through December 31, 1998. Data from Health Care Financing Administration (HCFA) billing records during months 10 to 15 of ESRD were used to classify each patient into one of five categories of HD dose by urea reduction ratio (URR) ranging from <60% to >75%. Cox regression models were used to calculate relative risk (RR) of mortality after adjustment for demographics, body mass index (BMI), and 18 comorbid conditions. Of the three body-size groups, the lowest BMI group had a 42% higher mortality risk than the highest BMI tertile. In each of three body-size groups by BMI, the RR was 17%, 17%, and 19% lower per 5% higher URR category among groups with small, medium, and large BMI, respectively (P < 0.0001 for each group). Patients treated with URR >75% had a substantially lower RR than patients treated with URR 70 to 75% (P < 0.005 each, for medium and small BMI groups). It is concluded that a higher dialysis dose, substantially above the Dialysis Outcomes Quality Initiative guidelines (URR >65%), is a strong predictor of lower patient mortality for patients in all body-size groups. Further reductions in mortality might be possible with increased HD dose.