Does healthy obesity exist?

BBC News | May 2018 | Study casts doubt on ‘healthy obesity’

A new longitudinal study that looked at women’s health in the US over a period of nearly 30 years reports that females who were overweight were more likely to have a stroke or heart attack, even if they had normal blood pressure and cholesterol and no diabetes. The US study followed over 90000 women for around 30 years. 

The study aimed to examine the association between metabolic health and its change over time and cardiovascular disease risk across BMI categories. The scientists found that most of the metabolically healthy women developed either high blood pressure, excess cholesterol or diabetes as they got older, even if they were normal weight. The risk was even higher for women who were overweight and obese.

person-3382248_1920Prof Matthias Schulze, from the German Institute of Human Nutrition Potsdam-Rehbruecke, who led the study said: “Our large cohort study confirms that metabolically healthy obesity is not a harmless condition, and even women who remain free of metabolic diseases for decades face an increased risk of cardiovascular events.” (via BBC News)

Summary

Background

Cardiovascular disease risk among individuals across different categories of BMI might depend on their metabolic health. It remains unclear to what extent metabolic health status changes over time and whether this affects cardiovascular disease risk. In this study, we aimed to examine the association between metabolic health and its change over time and cardiovascular disease risk across BMI categories.

Methods

Between June and December, 1976, 121 701 female nurses were recruited to the Nurses’ Health Study (NHS) of whom 103 298 returned a questionnaire in 1980 used as baseline in this study. After excluding women with a history of cardiovascular disease or cancer, with missing body weight and with underweight. 90 257 women were followed-up from 1980 to 2010 for incident cardiovascular disease. Participants were cross-classified by BMI categories, metabolic health (defined by absence of diabetes, hypertension and hypercholesterolaemia), and change in metabolic health status during follow-up.

Findings

During 2 127  391 person-years of follow-up with a median follow-up of 24 years, we documented 6306 cases of cardiovascular disease including 3304 myocardial infarction cases and 3080 strokes. Cardiovascular disease risk of women with metabolically healthy obesity was increased compared with women with metabolically healthy normal weight (HR 1·39, 95% CI 1·15–1·68), but risk was considerably higher in women with metabolically unhealthy normal weight (2·43, 2·19–2·68), overweight (2·61, 2·36–2·89) and obesity (3·15, 2·83–3·50). The majority of metabolically healthy women converted to unhealthy phenotypes (2555 [84%] of 3027 women with obesity, 22 215 [68%] of 32 882 women with normal-weight after 20 years). Women who maintained metabolically healthy obesity during follow-up were still at a higher cardiovascular disease risk compared with women with stable healthy normal weight (HR 1·57, 1·03–2·38), yet this risk was lower than for initially metabolically healthy women who converted to an unhealthy phenotype (normal-weight 1·90, 1·66–2·17 vs obesity 2·74, 2·30–3·27). Particularly incident diabetes and hypertension increased the risk among women with initial metabolic health.

Interpretation

Even when metabolic health is maintained during long periods of time, obesity remains a risk factor for cardiovascular disease. However, risks are highest for metabolically unhealthy women across all BMI categories. A large proportion of metabolically healthy women converted to an unhealthy phenotype over time across all BMI categories, which is associated with an increased cardiovascular disease risk.

Full reference:

Eckel, Nathalie et al.| Transition from metabolic healthy to unhealthy phenotypes and association with cardiovascular disease risk across BMI categories in 90 257 women (the Nurses’ Health Study): 30 year follow-up from a prospective cohort study | The Lancet Diabetes & Endocrinology| Vol. 0 | 0 | DOI: https://doi.org/10.1016/S2213-8587(18)30137-2

The full article is available to Rotherham NHS staff to request here 

In the media: Study casts doubt on healthy obesity 

Obese are more likely to develop heart issues

Obese individuals are at greater risk of developing atrial fibrillation- a rapid and irregular heart rate which can cause stroke and heart failure among other complications. Scientists from Penn State College of Medicine in the US, found that people who were obese had as much as a 40 per cent increased challenge of developing the condition.

Individuals with obesity had a very similar risk factor towards developing atrial fibrillation as those with hypertension or diabetes.  They were 40 per cent more likely to develop atrial fibrillation, while they are 45 per cent and 51 per cent more likely to develop hypertension or diabetes.

Lead author Dr Andrew Foy said the association could possibly be explained by the stress and strain obesity places on the heart (via Science Daily). 

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Abstract

Prospective cohort studies involving older adults report an association of obesity and new-onset atrial fibrillation and atrial flutter. To assess this relation, we performed a longitudinal cohort study from January 1, 2006 to December 31, 2013, using a national claims database that tracks all inpatient, outpatient, and pharmacy claims data. The primary end point of new-onset atrial fibrillation was compared between obese and nonobese cohorts. We used logistic regression to determine the strength of association between obesity and new-onset atrial fibrillation controlling for age, gender, hypertension, and diabetes.

Overall, 67,278 subjects were included in the cohort, divided evenly between those with and without a diagnosis of obesity. Obese subjects were significantly more likely to have hypertension (29.5% vs 14.6%) and diabetes (12.7% vs 5.2%) at study onset. Over 8 years of follow-up, we recorded a new diagnosis of atrial fibrillation in 1,511 (2.2%) subjects.

Obesity was strongly associated with a new diagnosis of atrial fibrillation after controlling for age, gender, hypertension, and diabetes (odds ratio 1.4, 95% confidence interval 1.3 to 1.6). In conclusion, this information contributes to the growing evidence supporting the causal relation between obesity and atrial fibrillation, and emphasizes the need of addressing obesity as part of our therapeutic strategy to prevent atrial fibrillation.

Full reference: Foy, Andrew J. et al. | 2018|Relation of Obesity to New-Onset Atrial Fibrillation and Atrial Flutter in Adults| American Journal of Cardiology |Vol. 121 |Issue 9 | P. 1072 – 1075 |DOI: https://doi.org/10.1016/j.amjcard.2018.01.019 

Rothterham NHS staff can request the full article here

Risk factors & Alzheimers Disease: Sleep disturbance, depression and anxiety

Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants | Aging & Mental Health

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Objectives: Alzheimer’s disease (AD) dementia is a neurodegenerative condition, which leads to impairments in memory. This study predicted that sleep disturbance, depression, and anxiety increase the hazard of AD, independently and as comorbid conditions.

Methods: Data from the National Alzheimer’s Coordinating Center was used to analyze evaluations of 12,083 cognitively asymptomatic participants. Survival analysis was used to explore the longitudinal effect of depression, sleep disturbance, and anxiety as predictors of AD. The comorbid risk posed by depression in the last two years coupled with sleep disturbance, lifetime depression and sleep disturbance, clinician-verified depression and sleep disturbance, sleep disturbance and anxiety, depression in the last two years and anxiety, lifetime depression and anxiety, and clinician-verified depression and anxiety were also analyzed as predictors of AD through main effects and additive models.

Results: Main effects models demonstrated a strong hazard of AD development for those reporting depression, sleep disturbance, and anxiety as independent symptoms. The additive effect remained significant among comorbid presentations.

Conclusion: Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants. Decreasing the threat posed by psychological symptoms may be one avenue for possibly delaying onset of AD.

Full reference: Shanna L. Burke et al. |  Psychosocial risk factors and Alzheimer’s disease: the associative effect of depression, sleep disturbance, and anxiety  | Aging & Mental Health | Published online: 27th Oct 2017

 

Eating plenty of wholegrains cuts your risk of bowel cancer‏

Wholegrains and bowel cancer – what you need to know | CRUK

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Eating plenty of wholegrains cuts your risk of bowel cancer, according to a new report. And it seems we can reap the benefits without making wild changes to our diets .

The news comes from a report produced by the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR), outlining the latest evidence on how we can reduce our risk of bowel cancer.

It focusses on the effects of diet, weight, physical activity and alcohol on bowel cancer risk. And with bowel cancer being the fourth most common cancer in the UK, finding ways to reduce our risk of the disease are important.

The WCRF studies all the evidence on a potential cause of cancer and decides whether that evidence is strong enough to support recommendations on ways we can reduce our risk.

How the alcohol industry mislead the public about alcohol and cancer

Alcohol consumption increases the risk of several types of cancer, including several common cancers | Drug and Alcohol Review

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As part of their corporate social responsibility activities, the alcohol industry (AI) disseminates information about alcohol and cancer. We examined the information on this which the AI disseminates to the public through its ‘social aspects and public relations organizations’ and related bodies. The aim of the study was to determine its comprehensiveness and accuracy.

Most of the organisations were found to disseminate misrepresentations of the evidence about the association between alcohol and cancer. Three main industry strategies were identified:

  1.  denial/omission: denying, omitting or disputing the evidence that alcohol consumption increases cancer risk.
  2. distortion: mentioning cancer, but misrepresenting the risk.
  3. distraction: focussing discussion away from the independent effects of alcohol on common cancers. Breast cancer and colorectal cancer appeared to be a particular focus for this misrepresentation.

Full reference: Petticrew, M. et al. (2017) How alcohol industry organisations mislead the public about alcohol and cancer. Drug and Alcohol Review. Published online: 7 Septmeber 2017

Alcohol: applying All Our Health

Evidence and guidance to help healthcare professionals reduce alcohol-related harm | Public Health England

Public Health England have updated their evidence and guidance pages to reflect the correct number of adults drinking at levels that pose risk to their health.

Alcohol-related harm is a major health problem. Reducing alcohol-related harm is one of the key indicators in health improvement.

31% of men and 16% of women in England drink alcohol in a way that presents increasing risk or potential harm to their health and wellbeing. This proportion is higher for the 15 to 64 age group.  The Global Burden of Disease Study 2013 revealed that, in England, alcohol misuse is the biggest risk factor for early death, ill health and disability for those aged 15 to 49 years. For all ages it is the fifth most important.

Up to 17 million working days are lost annually through absences caused by drinking; up to 20 million are lost through loss of employment or reduced employment opportunities.

Public Health England’s alcohol learning resources provides online resources and learning for commissioners, planners and practitioners working to reduce alcohol-related harm.

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Image source: http://www.gov.uk

Read more at Public Health England

Sugary beverage intake and preclinical Alzheimer’s

Excess sugar consumption has been linked with Alzheimer’s disease (AD) pathology in animal models | Alzheimers & Dementia

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We examined the cross-sectional association of sugary beverage consumption with neuropsychological (N = 4276) and magnetic resonance imaging (N = 3846) markers of preclinical Alzheimer’s disease and vascular brain injury (VBI) in the community-based Framingham Heart Study. Intake of sugary beverages was estimated using a food frequency questionnaire.

Relative to consuming less than one sugary beverage per day, higher intake of sugary beverages was associated with lower total brain volume (1–2/day, β ± standard error [SE] = −0.55 ± 0.14 mean percent difference, P = .0002; >2/day, β ± SE = −0.68 ± 0.18, P < .0001), and poorer performance on tests of episodic memory (all P < .01). Daily fruit juice intake was associated with lower total brain volume, hippocampal volume, and poorer episodic memory (all P < .05). Sugary beverage intake was not associated with VBI in a consistent manner across outcomes.

Higher intake of sugary beverages was associated cross-sectionally with markers of preclinical AD.

Full reference: Pase, M.P. et a; (2017) Sugary beverage intake and preclinical Alzheimer’s disease in the community. Alzheimers & Dementia. Vol. 13 (Issue 9) pp. 955–964.