Association between Class III Obesity (BMI of 40–59 kg/m2) and Mortality: A Pooled Analysis of 20 Prospective Studies

Kitahara, Cari M.; Flint, Alan; González, Amy Berrington de; Bernstein, Leslie; Brotzman, Michelle; MacInnis, Robert J.; Moore, Stephen; Robien, Kim; Rosenberg, Philip S.; Singh, Pramil N.; Weiderpass, Elisabete; Adami, Hans Olov; Anton‐Culver, Hoda; Ballard‐Barbash, Rachel; Buring, Julie E.; Freedman, D. Michal; Fraser, Gary E.; Freeman, Laura E. Beane; Gapstur, Susan M.; Gaziano, J. Michael; Giles, Graham G.; Håkansson, Niclas; Hoppin, Jane A.; Hu, Frank B.; Koenig, Karen L.; Linet, Martha S.; Park, Yikyung; Patel, Alpa V.; Purdue, Mark P.; Schairer, Catherine; Sesso, Howard D.; Visvanathan, Kala; White, Emily; Wolk, Alicja; Zeleniuch‐Jacquotte, Anne; Hartge, Patricia

doi:10.1371/journal.pmed.1001673

Cited by 347 publications

(238 citation statements)

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“…The presence of extreme obesity is rapidly rising in the USA [8,9]. The present study shows that patients with BMI ≥ 40 kg/m 2 do not necessarily have worse outcomes when treated surgically for RCC.…”

Section: Discussionmentioning

confidence: 52%

“…Other studies have reported worse peri-operative outcomes in obese patients [10][11][12], especially when patients have multiple comorbidities [29]. Although severe obesity is associated with medical comorbidities and shortened life-span [8], obesity itself is not independently predictive of worse peri-operative outcomes. Morbidly obese patients without serious comorbidities, therefore, can be expected to have equivalent major peri-operative outcomes compared with other patients with RCC treated surgically.…”

Section: Discussionmentioning

confidence: 92%

“…Interestingly, the authors found no differences in mortality in patients of ideal body weight (BMI 20-24.9 kg/m 2 ) compared with those described as overweight (BMI 25-29.9 kg/m 2 ), or in patients with class 1 obesity (BMI 30-34.9 kg/m 2 ), while mortality rates were higher only in patients with BMI ≥ 35 kg/m 2 [24]. Life expectancy is clearly shortened in morbidly obese patients, with an estimated 6-14 years of life lost for an individual with BMI ≥ 40 kg/m 2 [8]; however, previous studies examining the effects of obesity on patients with RCC have not separately analysed morbidly obese patients [4,6], or contain only a small number of patients with BMI ≥ 40 kg/m 2 . Of 1338 patients with RCC, Waalkes et al [25] reported only 18 patients (1.3%) who had a BMI ≥ 40 kg/m 2 , and Isac et al [20] only identified 28 morbidly obese patients of 250 obese patients treated with robot-assisted partial nephrectomy.…”

Section: Discussionmentioning

confidence: 95%

“…In addition, a large prospective cohort study identified obesity as a risk factor for increased cancer mortality in many types of cancer, including RCC [2]; however, recent studies have suggested that moderate obesity and higher visceral fat percentages in patients with RCC may actually be associated with improved outcomes [3,4] [5][6][7], but few studies have evaluated survival in patients with the most extreme obesity (BMI ≥ 40 kg/m 2 ), despite significant research showing that these patients have the highest prevalence of medical comorbidities and the shortest life expectancies [8].…”

Section: Introductionmentioning

confidence: 99%

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Extreme obesity does not predict poor cancer outcomes after surgery for renal cell cancer

et al. 2015

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ObjectiveTo assess whether extreme obesity (body mass index [BMI] ≥ 40 kg/m 2 ) is associated with peri-operative outcomes, overall survival (OS), cancer-specific survival (CSS), or recurrencefree survival (RFS) after surgical treatment for renal cell carcinoma (RCC). Patients and MethodsAfter institutional review board approval, we used an institutional database to identify patients treated surgically between January 2000 and December 2014 with a pathological diagnosis of RCC. Comprehensive clinical and pathological data were reviewed. Kaplan-Meier analyses were used to estimate OS, RFS and CSS. Univariate and multivariate Cox proportional hazards analysis was used to evaluate associations with OS, CSS and RFS in patients with extreme obesity, among other known predictive variables. ResultsIn all, 100 patients (11.9%) with a BMI ≥ 40 kg/m 2 and 743 patients (88.1%) with a BMI < 40 kg/m 2 who were treated surgically for RCC were identified. Morbid obesity was not associated with an increased risk of blood transfusion (odds ratio [OR] 1, 95% confidence interval [CI] 0.587-1.70; P = 1.0). The median (interquartile range) length of hospital stay (LOS) was 4 (3-6) days. Morbid obesity was not associated with longer LOS (P = 0.26) or 30-day hospital readmission rates (P = 1.0). Major complications (Clavien ≥ 3a) were recorded in 67 patients (7.95%). BMI ≥ 40 kg/m 2 was not a predictor of major complications (OR 0.58, 95% CI 0.227-1.47; P = 0.251) or 90-day mortality (P = 0.4067). BMI ≥ 40 kg/m 2 was not associated with worse OS (P = 0.7), CSS (P = 0.2) or RFS (P = 0.5). BMI ≥ 35 kg/m 2 was also not associated with worse OS, CSS or RFS (P = 0.3, 0.1, 0.5, respectively). The 5-year OS rate was 68.9% for the entire cohort, including 69 and 70% for patients with BMI < 40 kg/ m 2 and BMI ≥ 40 kg/m 2 , respectively (P = 0.69). The 5-year CSS was 79.5% for the entire cohort, including 78.4 and 87.9% (P = 0.16) for patients with BMI < 40 kg/m 2 and BMI ≥ 40 kg/m 2 , respectively. The 5-year RFS rates for BMI < 40 kg/m 2 and BMI ≥ 40 kg/m 2 were 84.1 and 90.6%, respectively (P = 0.48). ConclusionsExtreme obesity is not associated with worse peri-operative or cancer outcomes after surgery for RCC. Surgery should remain a standard treatment option in well selected morbidly obese patients.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Extreme obesity does not predict poor cancer outcomes after surgery for renal cell cancer

et al. 2015

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“…In addition to age, infertility is related to body mass and weight with over 50 % of adults in westernized societies classified as overweight. Three out of every 10 individuals are obese with a body mass index (BMI) greater than or equal to 30 [1][2][3][4][5] with a life expectancy shortened by 14 years [6]. Obesity not only influences fertility status but also impacts on pregnancy outcomes [7,8].…”

Section: Introductionmentioning

confidence: 99%

Androgen receptor (AR) gene CAG trinucleotide repeat length associated with body composition measures in non-syndromic obese, non-obese and Prader-Willi syndrome individuals

Butler

Manzardo

2015

J Assist Reprod Genet

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Purpose Total body mass impacts reproductive health and infertility which has increased in the United States with rising rates of obesity. Overlapping genetic and environmental factors contribute to obesity and infertility including the androgen receptor (AR), a steroid hormone-activated transcription factor that is key in regulating androgen activity and sensitivity to sex hormones, weight and body composition in both males and females. The AR gene which is X-linked contains a polymorphic CAG trinucleotide repeat which varies in length and inversely correlated with gene expression. Methods We examined the AR gene CAG repeat length and measures of weight and body mass index (BMI) in 27 nonsyndromic obese and 33 lean controls and for the first time compared with 28 individuals with Prader-Willi syndrome (PWS), a rare obesity-related genetic disorder with natural sex hormone deficits to examine the effects of AR gene CAG repeat length on androgen-mediated response and obesityrelated factors relevant to human infertility and reproduction.Results Mean CAG repeat length in base pairs (278±7.9) did not significantly differ by subject group (F=2.6, p=0.08) but was strongly positively correlated with height standard deviation (SD) among males (r=0.31, p<0.05), mainly lean and obese, but not PWS (r=0.02, p=0.94). A negative correlation was observed for weight SD among females (r = −0.29, p<0.04) when grouped together. Conclusions The results were consistent with an androgenmediated effect on height and weight negligible in PWS and supporting the role of sex horomones and AR gene interaction in obesity and infertility, both cardinal features of PWS. CAG repeat length of the AR gene is a marker for increased androgen sensitivity with shorter lengths predicting smaller stature in non-PWS adult males possibly due to accelerating fusion of bone growth plates and reducing the growth phase. Increased androgen effects from shorter CAG repeat lengths in non-PWS females could impact pregnancy-related weight gain and pregnancy outcomes.

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Use of Small-Area Estimates to Describe County-Level Geographic Variation in Prevalence of Extreme Obesity Among US Adults

et al. 2020

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IMPORTANCEThe prevalence of extreme obesity continues to increase among adults in the US, yet there is an absence of subnational estimates and geographic description of extreme obesity. This shortcoming prevents a thorough understanding of the geographic distribution of extreme obesity, which in turn limits the ability of public health agencies and policy makers to target areas with a known higher prevalence.OBJECTIVES To use small-area estimation to create county-level estimates of extreme obesity in the US and apply spatial methods to identify clusters of high and low prevalence. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional analysis was conducted using multilevel regression and poststratification with data from the 2012 Behavioral Risk Factor Surveillance System and the US Census Bureau to create prevalence estimates of county-level extreme obesity (body mass index Ն40 [calculated as weight in kilograms divided by height in meters squared]). Data were included on adults (aged Ն18 years) living in the contiguous US. Analysis was performed from June 4 to December 28, 2018. MAIN OUTCOMES AND MEASURES Multilevel logistic regression models estimated the probability of extreme obesity based on individual-level and area-level characteristics. Census counts were multiplied by these probabilities and summed by county to create county-level prevalence estimates. Moran index values were calculated to assess spatial autocorrelation and identify spatial clusters of hot and cold spots. Estimates of moderate obesity were obtained for comparison.RESULTS Overall, the weighted prevalence of extreme obesity was 4.0% (95% CI, 3.9%-4.1%) and the prevalence of moderate obesity was 23.7% (95% CI, 23.4%-23.9%). County-level prevalence of extreme obesity ranged from 1.3% (95% CI, 1.3%-1.3%) to 15.7% (95% CI, 15.3%-16.0%). The Pearson correlation coefficient comparing model-predicted estimates with direct estimates was 0.81 (P < .001). The Moran index I score was 0.35 (P < .001), indicating spatial clustering. Significant clusters of high and low prevalence were identified. Hot spots indicating clustering of high prevalence of extreme obesity in several regions, including the Mississippi Delta region and the Southeast, were identified, as well as clusters of low prevalence in the Rocky Mountain region and the Northeast.CONCLUSIONS AND RELEVANCE Substantial geographic variation was identified in the prevalence of extreme obesity; there was considerable county-level variation even in states generally known as having high or low prevalence of obesity. The results suggest that extreme obesity prevalence demonstrates spatial dependence and clustering and may support the need for substate analysis and benefit of disaggregation of obesity by group. Findings from this study can inform local and national policies seeking to identify populations most at risk from very high body mass index.

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Association between Class III Obesity (BMI of 40–59 kg/m2) and Mortality: A Pooled Analysis of 20 Prospective Studies

Abstract: In a pooled analysis of 20 prospective studies, Cari Kitahara and colleagues find that class III obesity (BMI of 40–59) is associated with excess rates of total mortality, particularly due to heart disease, cancer, and diabetes. Please see later in the article for the Editors' Summary

Cited by 347 publications

References 51 publications

Extreme obesity does not predict poor cancer outcomes after surgery for renal cell cancer

Extreme obesity does not predict poor cancer outcomes after surgery for renal cell cancer

Androgen receptor (AR) gene CAG trinucleotide repeat length associated with body composition measures in non-syndromic obese, non-obese and Prader-Willi syndrome individuals

Use of Small-Area Estimates to Describe County-Level Geographic Variation in Prevalence of Extreme Obesity Among US Adults

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