Thigh circumference and risk of heart disease and premature death: prospective cohort study

Heitmann, Berit Lilienthal; Frederiksen, Peder

doi:10.1136/bmj.b3292

Cited by 162 publications

(141 citation statements)

References 24 publications

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“…38,39 We also did not assess peripheral BF, particularly thigh fat, which may be inversely related to all-cause mortality and may independently enhance cardiometabolic health and may help explain the obesity paradox. [40][41][42] As previously mentioned, our study had a very small number in the group with obese sarcopenia. We also used BF cutpoints of 25% in men and 35% in women, 15,16 and as we have recently discussed, these cutoffs could be in the 20% to 25% range in men and 30% to 38% range in women.…”

Section: Discussionmentioning

confidence: 99%

Body Composition and Coronary Heart Disease Mortality—An Obesity or a Lean Paradox?

Lavie¹,

Schutter²,

Patel³

et al. 2011

Mayo Clinic Proceedings

138

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Body Composition and Heart disease mortalityFor personal use. Mass reproduce only with permission from Mayo Clinic Proceedings a .D espite the well-known adverse affects of obesity on almost all aspects of coronary heart disease (CHD) and CHD risk factors, including hypertension (HTN), plasma lipids, inflammation, glucose abnormalities, insulin resistance, metabolic syndrome and type 2 diabetes mellitus (T2DM), as well as left ventricular hypertrophy (LVH), many studies of cohorts with established cardiovascular (CV) disease, including heart failure (HF), HTN, as well as CHD, have demonstrated an inverse relationship between obesity, generally determined by body mass index (BMI [calculated as the weight in kilograms divided by the height in meters squared]), on subsequent mortality, referred to as the obesity paradox. 1,2 The obesity paradox has also been demonstrated in non-CV studies that included patients with advanced renal disease and the elderly. 3,4 Many large studies of cohorts with CHD have demonstrated this obesity paradox, [5][6][7] which has also been demonstrated in a large meta-analysis by Romero-Corral et al 8 from Mayo Clinic, who analyzed 40 cohort studies totaling more than 250,000 patients with CHD grouped according to BMI.Although BMI is the most frequently used method to assess overweightness/obesity, especially in large epidemiologic studies, this method has been criticized because BMI does not always reflect true body fatness. 1,2,9-14 Some investigators have theorized that at least part of the inconsistent relationship between obesity and major CV disease events, including mortality, may be due to the inaccurate diagnosis of obesity by the BMI assessment and that defining obesity by other methods, including waist circumference, waist/hip ratio, as well as percent body fat (BF) may be more accurate. 2,[9][10][11][12][13] We have recently demonstrated this obesity paradox in a cohort of CHD patients using both BMI and BF determinations. 14 To our knowledge, no prior studies have determined the independent effects of both BMI and BF on mortality in a cohort of CHD patients. Therefore, in the current evaluation, we determined the combined and independent impact of both BMI and BF on mortality in a cohort with stable CHD. PATIENTS AND METHODSWe retrospectively reviewed the case records of 581 consecutive patients with stable CHD who were referred for potential entry into formal cardiac rehabilitation programs between January 1, 2000, and July 31, 2005, and who had baseline anthropometric, lipid, and clinical data, as we have previously described. 14 Patients were divided into low (<25) and high (≥25) BMI. Elevated BF has been defined as greater than 25% in men and greater than 35% in women, 15,16 so patients were also divided into low (≤25% men and ≤35% women) and high BF (>25% men and >35% women Objective: To determine the combined effects of body mass index (BMI) and body fat (BF) on prognosis in coronary heart disease (CHD) to better understand the obesity paradox. Patients and MethOds:We s...

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Section: Discussionmentioning

confidence: 99%

Body Composition and Coronary Heart Disease Mortality—An Obesity or a Lean Paradox?

Lavie¹,

Schutter²,

Patel³

et al. 2011

Mayo Clinic Proceedings

138

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“…Because thigh impingement is one cause of dislocation [14,18], and because we have noted that after bariatric surgery some patients had a decrease in BMI without resolution of thigh impingement, we also measured (Fig. 3) thigh circumference and hip circumference (Table 2), which are parameters [16,20,25] of the body adiposity index (BAI) [3], an alternative measure of body fat. Thigh, waist, and hip circumferences were measured to the nearest 1 cm.…”

Section: Evaluation Of Obesitymentioning

confidence: 99%

Dual-mobility or Constrained Liners Are More Effective Than Preoperative Bariatric Surgery in Prevention of THA Dislocation

Hernigou

Trousselier

Roubineau

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Obesity is associated with an increased risk of dislocation after total hip arthroplasty (THA). However, in patients with obesity, it is not known whether the risk is only in the early postoperative period or whether it persists several years after surgery, and whether having bariatric surgery before undergoing THA and/or receiving a specific device (such as a dual-mobility or constrained acetabular liner) is more effective in terms of decreasing the risk of dislocation. Question/purposes (1) What is the cumulative risk of dislocation in patients with obesity after THA in the absence of a dual-mobility or constrained liner, and is this related to component positioning? (2) Does bariatric surgery before undergoing THA decrease dislocation risk in patients with obesity? (3) Are dual-mobility and constrained liners efficient in preventing dislocation in patients with obesity? Methods At our university-based practice, all surgeons adhered to the following treatment approaches: Before 2000 no dual-mobility implants or constrained liners were used for primary THAs. 2 ) who received standard cups, 85 hips in patients with bariatric surgery before THA using standard cups (with reduction to a BMI \ 30 kg/m 2 ), and 155 hips in patients with obesity who received dual-mobility (when younger than 70 years) or constrained liners (when older than 70 years). All patients received the same implants except for different femoral head diameters (32-mm head with standard cups and 28-mm head with dual-mobility or constrained liners). The patients were followed at routine intervals and were specifically queried about dislocation. All the 670 hips had a minimum followup of 5 years with a mean followup of 14 years (range 5-25 years). At the most recent followup, 101 (15%) hips were lost to followup (respectively, 36 of 215, 34 of 215, five of 85, 24 of 155), which is the same ratio as observed among the underlying populations from which the patients were drawn.Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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“…Incidence rates constitute basic, negative indicators evaluating the state of population health [33][34][35][36][37][38][39][40], so do mortality rates [41][42][43][44][45][46][47][48][49][50][51]. In the analysis of mortality, it is important to analyze premature deaths, as they are meaningful.…”

Section: Discussionmentioning

confidence: 99%

Determinants of premature mortality in a city population: An eight-year observational study concerning subjects aged 18–64

Maniecka-Bryła¹,

Dziankowska-Zaborszczyk²,

Bryła³

et al. 2013

International Journal of Occupational Medicine and Environmental Health

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Background: Premature deaths constitute 31.1% of all deaths in Łódź. Analysis of the causes of premature deaths may be helpful in the evaluation of health risk factors. Moreover, findings of this study may enhance prophylactic measures. Material and Methods: In 2001, 1857 randomly selected citizens, aged 18-64, were included in the Countrywide Integrated Noncommunicable Diseases Intervention (CINDI) Programme. In 2009, a follow-up study was conducted and information on the subjects of the study was collected concerning their health status and if they continued to live in Łódź. The Cox proportional hazards model was used for evaluation of hazard coefficients. We adjusted our calculations for age and sex. The analysis revealed statistically significant associations between the number of premature deaths of the citizens of Łódź and the following variables: a negative self-evaluation of health -HR = 3.096 (95% CI: 1.729-5.543), poor financial situation -HR = 2.811 (95% CI: 1.183-6.672), occurring in the year preceding the study: coronary pain -HR = 2.754 (95% CI: 1.167-6.494), depression -HR = 2.001 (95% CI: 1.222-3.277) and insomnia -HR = 1.660 (95% CI: 1.029-2.678). Our research study also found a negative influence of smoking on the health status -HR = 2.782 (95% CI: 1.581-4.891). Moreover, we conducted survival analyses according to sex and age with Kaplan-Meier curves. Conclusions: The risk factors leading to premature deaths were found to be highly significant but possible to reduce by modifying lifestyle-related health behaviours. The confirmed determinants of premature mortality indicate a need to spread and intensify prophylactic activities in Poland, which is a post-communist country, in particular, in the field of cardiovascular diseases. Attempts to find reasons of deaths in the first decade of the 21st century may lead to a detailed and long-term research which would focus on determining a wide spectrum of factors contributing to the mortality of Łódź citizens. This in turn, may lead to implementation of a multidimensional prophylaxis which would contribute to improving the state of health of the inhabitants of Łódź as well as other cities and industrial populations, where the population of Łódź may act as a representative. THE AIM OF THE STUDYThe study aimed at listing factors which determine premature mortality of the citizens of Łódź, basing on the results of empirical data the sources of which are multidirectional epidemiological studies. Researchers attempt to identify factors influencing the phenomenon of premature deaths.

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Thigh circumference and risk of heart disease and premature death: prospective cohort study

Cited by 162 publications

References 24 publications

Body Composition and Coronary Heart Disease Mortality—An Obesity or a Lean Paradox?

Body Composition and Coronary Heart Disease Mortality—An Obesity or a Lean Paradox?

Dual-mobility or Constrained Liners Are More Effective Than Preoperative Bariatric Surgery in Prevention of THA Dislocation

Determinants of premature mortality in a city population: An eight-year observational study concerning subjects aged 18–64

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