Joint Associations Of Obesity Research Articles

Abstract 12638: The Independent and Joint Associations of Obesity and Hypertension on Incident Heart Failure: A Pooled Cohort Analysis

Introduction: Obesity and hypertension (HTN) are major risk factors for incident heart failure (HF). Obesity is a major cause of HTN; thus, it is difficult to disentangle the impact of each risk factor on HF incidence. Further, it is not established what factors modify these relationships. Aims: To assess the associations of obesity and HTN as well as their potential synergistic effect on incident HF in large, diverse populations. Methods: We studied participants of 3 major epidemiologic cohorts: Atherosclerosis Risk in Communities Study, Multi-Ethnic Study of Atherosclerosis, and Jackson Heart Study. Participants were stratified into 4 groups: neither obesity nor HTN (reference), only obesity, only HTN, or both obesity and HTN. HTN was defined as ≥140 mmHg systolic or ≥90 mmHg diastolic blood pressure or use of antihypertensive medications. Obesity was defined as body mass index ≥30 Kg/m2. Cox proportional hazards models adjusted for age, sex, race, smoking, alcohol use, diabetes, coronary heart disease, and estimated glomerular filtration rate were used to assess the association of 4 groups with incident HF. Results: 18,351 participants (55.1% women and 31.4% black adults) followed over a mean 14 years were included in our analysis. Participants with only obesity (adjusted HR= 1.60; 95% CI 1.36 to 1.88) and only HTN (aHR 2.1; 95% CI 1.87, 2.37) demonstrated an increased risk of incident HF compared with participants with neither obesity nor HTN after adjustment for covariates. The greatest risk of incident HF was in participants with both obesity and HTN (aHR 2.97; 95% CI 2.63 to 3.36; Figure). HTN did not modify the effects of obesity or vice versa (p=0.193). Conclusions: Obesity and HTN are associated with incident HF and individuals with both have the highest risk of HF. This is an additive effect. These data emphasize the importance of blood pressure control and weight management in the prevention of HF.

Role of Excessive Weight Gain During Gestation in the Risk of ADHD in Offspring of Women With Gestational Diabetes.

Although attention-deficit/hyperactivity disorder (ADHD) has been associated with gestational diabetes mellitus (GDM) and maternal obesity, excessive weight gain (EWG) during pregnancy has scarcely been evaluated. This study aimed to assess the joint effect of maternal weight and EWG on the risk of ADHD in offspring of GDM pregnancies. In this cohort study of singleton births >22 weeks of gestation of women with GDM between 1991 and 2008, gestational weight gain above the National Academy of Medicine (NAM) recommendations was classified into EWG. Cox-regression models estimated the effect of maternal pregestational weight and EWG on the risk of ADHD (identified from medical records), adjusted for pregnancy outcomes and GDM-related variables. Of 1036 children who were included, with a median follow-up of 17.7 years, 135 (13%) were diagnosed with ADHD. ADHD rates according to pregestational maternal weight were 1/14 (7.1%) for underweight, 62/546 (11.4%) for normal weight, 40/281 (14.2%) for overweight, and 32/195 (16.4%) for obesity. Only maternal obesity was independently associated with ADHD (HRadjusted 1.66 [95% CI, 1.07-2.60]), but not maternal overweight or EWG. On evaluating the joint contribution of maternal weight and EWG, maternal obesity with EWG was associated with the highest risk of ADHD (vs normal weight without EWG; HRadjusted 2.13 [95% CI, 1.14-4.01]). Pregestational obesity without EWG was no longer associated (HRadjusted 1.36 [95% CI, 0.78-2.36]). Among GDM pregnancies, pregestational obesity was associated with a higher risk of ADHD in offspring. Nonetheless, when gestational weight gain was taken into account, only the joint association of obesity and EWG remained significant.

Joint Associations of Obesity and Cardiorespiratory Fitness With Coronary Artery Calcium Composition: IS THERE EVIDENCE FOR FAT-BUT-FIT?

The purpose of this study was to examine the individual and joint associations of obesity and cardiorespiratory fitness (CRF) with indices of coronary artery calcification (CAC) in 2090 middle-aged men. Obesity was defined as a body mass index (BMI) ≥25 kg/m2 and a waist circumference (WC) ≥90 cm. Cardiorespiratory fitness was operationally defined as peak oxygen uptake (V˙o2peak) directly measured using gas analysis. Participants were then divided into unfit and fit categories based on age-specific V˙o2peak percentiles. Agatston scores >100 and volume and density scores >75th percentile were defined as indices of CAC, signifying advanced subclinical atherosclerosis. Obese men had increased CAC Agatston, volume, and density scores, while higher CRF was associated with lower Agatston and volume scores after adjusting for potential confounders. In the joint analysis, unfit-obese men had higher CAC Agatston and CAC volume. The fit-obesity category was not associated with CAC Agatston (OR = 0.91: 95% CI, 0.66-1.25, for BMI and OR = 1.21: 95% CI, 0.86-1.70, for WC) and CAC volume (OR = 1.14: 95% CI, 0.85-1.53, for BMI and OR = 1.23: 95% CI, 0.90-1.69, for WC), which were similar to estimates for the fit-normal weight category. These findings demonstrate that while obesity is positively associated with the prevalence of moderate to severe CAC scores, CRF is inversely associated with the prevalence of moderate to severe CAC scores. Additionally, the combination of being fit and obese was not associated with CAC scores, which could potentially reinforce the fat-but-fit paradigm.

Joint Associations of Obesity and Cigarette Smoking With Inflammation and Thrombosis

Joint Associations of Obesity and Cigarette Smoking With Inflammation and Thrombosis

Abstract P257: Obesity and Diabetes are Jointly Associated With Low Fruit and Vegetable Consumption and Low Physical Activity in Adults With Stroke

Introduction: Engaging in unhealthy behaviors (poor diet, insufficient physical activity) increases risk for recurrent stroke, and can be compounded by obesity and diabetes. Although engaging in healthy behaviors is recommended for managing chronic conditions, the joint association of obesity and diabetes with diet and physical activity in stroke survivors is unknown. Purpose: To compare prevalences of low fruit and vegetable consumption (Low_FV, <1 fruit and <1 vegetable daily), low physical activity (Low_PA, <150 minutes of weekly moderate-intensity physical activity), and both Low_FV and Low_PA (Low_FV&PA) in stroke survivors, stratified by obesity-diabetes status (neither condition, obesity only, diabetes only, obesity & diabetes). Methods: Cross-sectional data from 32,876 noninstitutionalized, U.S. stroke survivors aged ≥45 years from the 2015 and 2017 Behavioral Risk Factor Surveillance System were examined. Weighted, age-adjusted prevalence estimates and adjusted odds ratios (AOR, adjusted for age, sex, race, income, education, and marital status) and 95% CIs were calculated. Results: Prevalences and AORs are displayed in the Table. Prevalences of Low_FV and Low_PA exceeded 50% across obesity-diabetes groups. Prevalences were highest in respondents with obesity & diabetes and lowest in respondents with neither condition across outcome variables. Compared to respondents with neither condition, odds for Low_PA were increased for respondents with obesity & diabetes and obesity only; odds for Low_FV&PA were increased only for respondents with obesity & diabetes. Conclusions: Our results indicated a joint effect of obesity and diabetes with Low_PA and Low_FV&PA, placing stroke survivors with both chronic conditions at greatest risk for not engaging in protective health behaviors. Regardless of obesity-diabetes status, Low_FV and Low_PA exceeded 50%. Targeted interventions that modify these unhealthy behaviors should be explored for decreasing recurrent stroke risk among stroke survivors.

Joint Associations of Obesity and NT-proBNP With the Incidence of Atrial Fibrillation in the ARIC Study.

BackgroundCirculating NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) levels, a well‐known indicator of atrial wall stress and remodeling, inversely correlate with body mass index. Both are strongly predictive of atrial fibrillation (AF). Their potential interaction in relation to incident AF, however, has not been explored.Methods and ResultsIn total, 9556 participants of the ARIC (Atherosclerosis Risk in Communities) study who had 2 measurements of NT‐proBNP and no baseline AF or heart failure were followed from 1996 to 1998 through 2016 for the occurrence of incident AF. Participants were categorized as obese (body mass index ≥30) and nonobese (body mass index <30) and by NT‐proBNP levels (using the median of 68.2 pg/mL as the cutoff). Over a median follow‐up of 18.3 years, we identified 1806 incident cases of AF. Analysis using multivariable Cox regression models showed that obese participants with high NT‐proBNP levels at visit 4 had a higher adjusted risk of incident AF (hazard ratio: 3.64; 95% CI, 3.15–4.22) compared with nonobese individuals with low NT‐proBNP levels. The association of obesity with AF risk was not modified by NT‐proBNP levels (P=0.46 for interaction). Increasing BNP among participants from 1990–1992 to 1996–1998 was associated with increased AF risk. After further adjustment for clinical risk factors and medications, results were similar.ConclusionsIndividuals who had both elevated body mass index and NT‐proBNP and were free of clinically recognized heart failure were at higher risk of AF development. Those who experienced an increase in NT‐proBNP levels between visits 2 and 4 were at higher risk of AF.

Independent and joint association of obesity and metabolic syndrome with depression and inflammation.

To investigate the separate and combined associations of obesity and metabolic syndrome (MetS) with depression and the role of inflammation. Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9) and was defined with a cutpoint of ≥10. Obesity was defined as body mass index (BMI) ≥30 kg/m2 from measured height and weight. MetS was defined based on the American Heart Association consensus definition. Participants were divided into four groups: healthy normal weight (MHN), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUN), and metabolic unhealthy obese (MUO). C-Reactive protein was assessed in a subsample. A total of 18,025 subjects were included in the analysis. Participants with MUO had the highest prevalence of depression compared with the MHN group (14.8% vs. 6.8, p < .001). While both obesity and MetS were independently associated with depression, there was a significant interaction between the two (p < .001), indicating that the associations of obesity and MetS with depression were synergistic. After adjusting for baseline characteristics, compared with the MHN group, the MUO group had the highest odds of depression (odds ratio [OR] = 2.30, 95% CI [2.03, 2.61]), followed by MHO group (OR = 1.51, 95% CI [1.30, 1.74]) and the MUN group (OR = 1.39, 95% CI [1.18, 1.64]). The MUO group also showed the highest level of C-reactive protein, and the latter partially mediated the effect between MUO and depressive symptoms (20.5% of the total effect). Both obesity and MetS are associated with depression independent of each other, but when present together, these conditions have a synergistic association with depression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Joint associations of obesity and estimated GFR with clinical outcomes: a population-based cohort study

BackgroundDespite the interrelationships between obesity, eGFR and albuminuria, few large studies examine how obesity modifies the association between these markers of kidney function and adverse clinical outcomes.MethodsWe examined the joint associations between obesity, eGFR and albuminuria on four clinical outcomes (death, end-stage renal disease [ESRD], myocardial infarction [MI], and placement in a long-term care facility) using a population-based cohort with procedures from Alberta. Obesity was defined by body mass index ≥35 kg/m2 as defined by a fee modifier applied to an eligible procedure.ResultsWe studied 1,293,362 participants, of whom 171,650 (13.3%) had documented obesity (BMI ≥ 35 kg/m2 based on claims data) and 1,121,712 (86.7%) did not. The association between eGFR and death was J-shaped for participants with and without documented obesity. After full adjustment, obesity tended to be associated with slightly lower odds of mortality (OR range 0.71–1.02; p for interaction between obesity and eGFR 0.008). For participants with and without obesity, the adjusted odds of ESRD were lowest for participants with eGFR > 90 mL/min*1.73m2 and increased with lower eGFR, with no evidence of an interaction with obesity (p = 0.37). Although albuminuria and obesity were both associated with higher odds of ESRD, the excess risk associated with obesity was substantially attenuated at higher levels of albuminuria (p for interaction 0.0006). The excess risk of MI associated with obesity was observed at eGFR > 60 mL/min*1.73m2 but not at lower eGFR (p for interaction < 0.0001). Participants with obesity had a higher adjusted likelihood of placement in long-term care than those without, and the likelihood of such placement was higher at lower eGFR for those with and without obesity (p for interaction = 0.57).ConclusionsWe found significant interactions between obesity and eGFR and/or albuminuria on the likelihood of adverse outcomes including death and ESRD. Since obesity is common, risk prediction tools for people with CKD might be improved by adding information on BMI or other proxies for body size in addition to eGFR and albuminuria.

Obesity, Dietary inflammation, and Frailty among Older Adults: Evidence from the National Health and Nutrition Examination Survey

Knowledge related to the relationship between obesity and frailty is limited. This study aimed to investigate associations between obesity, dietary inflammation, and frailty among older adults. Study data came from National Health and Nutrition Examination Survey (2007–2014) examinations of adults age ≥60 years (n = 7182). Dietary inflammatory potential was determined using the Dietary Inflammatory Index (DII®) derived from 24-h dietary recall. We analyzed independent and joint associations of obesity and DII with frailty to evaluate interaction. Multivariable logistic regression revealed that both obesity (Odds Ratio [OR] = 2.24, 95% CI: 1.68, 2.99) and moderately pro-inflammatory DII (OR = 1.68, 95% CI: 1.10, 2.58) were independently associated with greater frailty prevalence. A negative multiplicative interaction between obesity and highest pro-inflammatory diet also was found (adjusted odds in non-obese and obese were 2.07 and 2.37, respectively; p = 0.046). Results indicate the importance of considering obesity and dietary inflammatory potential when screening for frailty or developing treatments.

Supplemental Material for Independent and Joint Association of Obesity and Metabolic Syndrome With Depression and Inflammation

Supplemental Material for Independent and Joint Association of Obesity and Metabolic Syndrome With Depression and Inflammation

Joint associations between smoking and obesity as determinants of premature mortality among midlife employees.

Background : Both smoking and obesity increase mortality, however, only few studies have considered premature death. The joint effect of smoking and obesity is less studied. The aim of this study was to examine the joint associations of smoking and obesity with all-cause and cancer mortality among midlife employees. Methods : Baseline mail surveys among employees of the City of Helsinki, Finland, during 2000-2002 include data on smoking (never-, ex-, moderate and heavy), BMI (non-obese, obese), and covariates ( N = 8960, response rate 67%). Data were linked with register data on mortality until 2013. The final sample included 6437 employees. Cox proportional hazard models were used. Finally synergistic interaction effect was examined. Results : Adjusting for age and gender, non-obese heavy smokers had an elevated risk of all-cause mortality (HR 2.98, 95% CI 2.05–4.32). The joint association of obesity and smoking with all-cause mortality was stronger (HR 3.46, 95% CI 1.87–6.40), but there was no synergistic interaction (Synergy Index 0.9). Non-obese heavy smokers had an elevated cancer mortality (HR 2.94, 95% CI 1.79–4.82). The joint association of obesity and smoking with cancer mortality was stronger (HR 4.57, 95% CI 2.14–9.76) suggesting a synergistic interaction (Synergy Index 1.6, NS). Ex-smokers’ risk of death was not elevated irrespective of their weight status. Conclusions : Smoking increases the risk of death, and obesity strengthens this association. Quitting smoking, especially among obese people, may reduce premature mortality.

Joint Association of Obesity and Hypertension with Disability in the Elderly-- A Community-Based Study of Residents in Shanghai, China.

Although both obesity and hypertension are known risk factors for disability, the joint association of obesity and hypertension with risk of disability is unknown. This paper is aim to examine the joint association of obesity and hypertension with risk of disability. Cross-sectional study with 8060 elderly community-dwelling individuals participating in the survey initiated by Shanghai Health and Family Planning Commission from March to September 2013. Obesity was measured using the body mass index (BMI) in World Health Organization (WHO) Asia criteria. Hypertension, based on the doctor's diagnosis, was obtained through face-to-face interview. Disability was measured using the self-reported physical self-maintenance scale (PSMS) and the instrumental activities of daily living (IADL) scale developed by Lawton and Brody. A total of 8.97% of participants reported ADL disability, and 15.18% for IADL disability. After adjusting social demographics and chronic conditions, the risk of ADL disability was progressively greater in obese persons with hypertension (OR=1.40, 95% CI=1.05-1.89), underweight persons without hypertension (OR=2.05, 95% CI=1.29-3.25), and underweight persons with hypertension (OR=2.14, 95% CI=1.36-3.36). For IADL disability, only underweight persons with hypertension were significantly associated (OR=1.65, 95% CI=1.23-2.21). Low or extremely high BMI, independent of its metabolic consequences, is a risk factor for disability among the elderly. Simple hypertension wasn't significantly associated with disability. In addition, having hypertension significantly increased the risk of ADL disability in obese individuals and IADL disability in underweight individuals.

Individual and Joint Associations of Obesity and Physical Activity on the Risk of Heart Failure

Heart failure (HF) has become a major public health problem in both developed and developing countries of the world. The individual and joint associations of physical activity and obesity on the risk of HF have been extensively studied in recent years. The results from prospective studies consistently indicate that regular physical activity reduces the risk of HF, while both general obesity and abdominal obesity increase the risk of HF. Furthermore, research related to the joint association of obesity and physical activity on HF risk indicates that lean and active individuals had the lowest risk of HF. Therefore, preventing HF by maintaining optimal weight and engaging in regular physical activity may reduce the public health burden of HF worldwide.

Joint Association of Obesity and Metabolic Syndrome With Incident Mobility Limitation in Older Men and Women--Results From the Health, Aging, and Body Composition Study

Although both obesity and the metabolic syndrome (MetS) are known risk factors for decline in physical function, the joint association of obesity and metabolic alterations with risk of incident mobility limitation is unknown. Data are from 2,984 women and men aged 70-79 years participating in the Health, Aging, and Body Composition Study without mobility limitation at baseline. Obesity was defined as body mass index greater than or equal to 30 kg/m(2) and the MetS as meeting greater than or equal to 3 of the ATP III criteria. Mobility limitation was defined as any difficulty walking one-quarter mile or climbing 10 steps during two consecutive semiannual assessments for more than 6.5 years. Incidence of mobility limitation was 55% in women and 44% in men. In women, adjusted risk of developing mobility limitation was progressively greater in nonobese participants with the MetS (hazard ratio [HR] = 1.49, 95% confidence interval [CI] = 1.24-1.80), obese participants without the MetS (HR = 1.95, 95% CI = 1.51-2.53), and obese participants with the MetS (HR = 2.16, 95% CI = 1.78-2.63) relative to the nonobese without the MetS. In men, the corresponding adjusted HRs (95% CI) were 1.07 (0.87-1.32), 1.64 (1.19-2.25), and 1.41 (1.12-1.78). Elevated inflammatory markers partly explained the association between obesity, the MetS, and mobility limitation, particularly in nonobese and obese participants with the MetS. Obesity itself, independent of its metabolic consequences, is a risk factor for mobility limitation among obese older adults. In addition, having the MetS increases the risk of functional decline in older nonobese women but not in men.

Adiposity Compared With Physical Inactivity and Risk of Type 2 Diabetes in Women

The relative contribution of adiposity and physical inactivity to the risk of developing type 2 diabetes remains controversial. We prospectively examined the individual and joint association of obesity and physical activity with the development of type 2 diabetes in 68,907 female nurses who had no history of diabetes, cardiovascular disease, or cancer at baseline. Adiposity was measured by BMI and waist circumference. Physical activity was assessed through average hours of moderate or vigorous exercise and computation of an MET score. We documented 4,030 incident cases of type 2 diabetes during 16 years of follow-up (from 1986 to 2002). In a multivariate model including age, smoking, and other diabetes risk factors, risk of type 2 diabetes increased progressively with increasing BMI (P < 0.001) and waist circumference (P < 0.001) and with decreasing physical activity levels (P < 0.001). In joint analyses of BMI and physical activity, using women who had a healthy weight (BMI < 25 kg/m(2)) and were physically active (exercise > or = 21.8 MET h/week) as the reference group, the relative risks of type 2 diabetes were 16.75 (95% CI 13.99-20.04) for women who were obese (BMI > or = 30 kg/m(2)) and inactive (exercise < 2.1 MET h/week), 10.74 (8.74-13.18) for women who were active but obese, and 2.08 (1.66-2.61) for women who were lean but inactive. In combined analyses of waist circumference and physical activity, both variables were significant predictors of type 2 diabetes, but the association for waist circumference was substantially stronger than that for physical inactivity. Obesity and physical inactivity independently contribute to the development of type 2 diabetes; however, the magnitude of risk contributed by obesity is much greater than that imparted by lack of physical activity.