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    Association of Obesity or Weight Change With Coronary Heart Disease Among Young Adults in South Korea. Choi Seulggie,Kim Kyuwoong,Kim Sung Min,Lee Gyeongsil,Jeong Su-Min,Park Seong Yong,Kim Yeon-Yong,Son Joung Sik,Yun Jae-Moon,Park Sang Min JAMA internal medicine Importance:Previous studies have shown a U- or J-shaped association of body mass index (BMI) or change in BMI with coronary heart disease (CHD) among middle-aged and elderly adults. However, whether a similar association exists among young adults is unclear. Objective:To determine whether an association exists between BMI or BMI change with CHD among young adults. Design, Setting, and Participants:This population-based longitudinal study used data obtained by the Korean National Health Insurance Service from 2002 to 2015. The study population comprised 2 611 450 men and women aged between 20 and 39 years who underwent 2 health examinations, the first between 2002 and 2003 and the second between 2004 and 2005. Exposures:World Health Organization Western Pacific Region guideline BMI categories of underweight, normal weight, overweight, obese grade 1, and obese grade 2 derived during the first health examination and change in BMI calculated during the second health examination. Main Outcomes and Measures:Body mass index (calculated as weight in kilograms divided by height in meters squared). Absolute risks (ARs), adjusted hazard ratios (aHRs), and 95% CIs for acute myocardial infarction or CHD during follow-up from 2006 to 2015. Results:Data from 1 802 408 men with a mean (SD) age of 35.1 (4.8) years and 809 042 women with a mean (SD) age of 32.5 (6.3) years were included. The mean (SD) BMI was 23.2 (3.2) for the total population, 24.0 (3.0) for men, and 21.4 (2.9) for women. Compared with normal weight men, overweight (AR, 1.38%; aHR, 1.18 [95% CI, 1.14-1.22]), obese grade 1 (AR, 1.86%; aHR, 1.45 [95% CI, 1.41-1.50]), and obese grade 2 (AR, 2.69%; aHR, 1.97 [95% CI, 1.86-2.08]) men had an increased risk of CHD (P < .001 for trend). Similarly, compared with normal weight women, overweight (AR, 0.77%; aHR, 1.34 [95% CI, 1.24-1.46]), obese grade 1 (AR, 0.95%; aHR, 1.52 [95% CI, 1.39-1.66]), and obese grade 2 (AR, 1.01%; aHR, 1.64 [95% CI, 1.34-2.01]) women had an increased risk of CHD (P < .001 for trend). Compared with participants who maintained their weight at normal levels, those who became obese had elevated CHD risk among men (0.35% increase in AR; aHR, 1.35 [95% CI, 1.17-1.55]) and women (0.13% increase in AR; aHR, 1.31 [95% CI, 0.95-1.82]). Weight loss to normal levels among obese participants was associated with reduced CHD risk for men (0.58% decrease in AR; aHR, 0.77 [95% CI, 0.64-0.94]) and women (0.57% decrease in AR; aHR, 0.66 [95% CI, 0.45-0.98]). Conclusions and Relevance:Obesity and weight gain were associated with elevated risk of CHD among young adults in this study. Studies that prospectively determine the association between weight change and CHD risk are needed to validate these findings. 10.1001/jamainternmed.2018.2310
    Changes in the Prevalence and Correlates of Weight-Control Behaviors and Weight Perception in Adolescents in the UK, 1986-2015. Solmi Francesca,Sharpe PhD Helen,Gage Suzanne H,Maddock Jane,Lewis Glyn,Patalay Praveetha JAMA pediatrics Importance:In the context of the growing prevalence of childhood obesity, behaviors aimed at weight loss and their psychological burden might be increasing. Objective:To investigate whether the prevalence of weight-control behaviors and weight perception, including their association with depressive symptoms, has changed in the 3 decades between 1986 and 2015. Design, Setting, and Participants:This study used data from repeated cross-sections from successive longitudinal birth cohort studies. These included general population samples of UK adolescents aged 14 to 16 years from 3 ongoing birth cohorts: the British Cohort Study 1970 (children born between April 5 and 11, 1970; data collected in 1986), the Avon Longitudinal Study of Parents and Children (mothers with expected delivery between April 1, 1991, and December 21, 1992; data collected in 2005), and the Millennium Cohort Study (children born between September 1, 2000, and January 11, 2002; data collected in 2015). A total of 22 503 adolescents with data available on at least 1 weight-control or weight-perception variable in midadolescence were included in the study. Data were analyzed from August 1, 2019, to January 15, 2020. Main Outcomes and Measures:Self-reported lifetime dieting and exercise for weight loss, current intentions about weight (doing nothing, lose weight, stay the same, gain weight), and weight perception (underweight, about the right weight, overweight) adjusted for body mass index. The secondary outcome was depressive symptoms. Exposures:The main exposure was time (ie, cohort); secondary exposures were weight-change behaviors and weight perception. Results:The study cohort included 22 503 adolescents (mean [SD] age, 14.8 [0.3] years; 12 061 girls [53.6%]; and 19 942 White individuals [89.9%]). A total of 5878 participants were from the British Cohort Study, 5832 were from the Avon Longitudinal Study of Parents and Children, and 10 793 were from the Millennium Cohort Study. In 2015, 4809 participants (44.4%) had dieted and 6514 (60.5%) had exercised to lose weight compared with 1952 (37.7%) and 344 (6.8%) in 1986. Furthermore, 4539 (42.2%) were trying to lose weight in 2015 compared with 1767 (28.6%) in 2005. Although girls were more likely to report these behaviors in all years, their prevalence increased more in boys over time (lifetime dieting in boys: odds ratio [OR], 1.79; 95% CI, 1.24-2.59; in girls: OR, 1.23; 95% CI, 0.91-1.66; currently trying to lose weight in boys: OR, 2.75; 95% CI, 2.38-3.19; in girls: OR, 1.70; 95% CI, 1.50-1.92). Adolescents also became more likely to overestimate their weight (boys describing themselves as overweight adjusting for body mass index, 2005 vs 1985 OR, 1.60; 95% CI, 1.17-2.19; 2015 vs 1985 OR, 1.36; 95% CI, 1.04-1.80; girls describing themselves as underweight, after adjusting for body mass index, 2015 vs 1986 OR, 0.51; 95% CI, 0.28-0.91). Girls who described themselves as overweight experienced increasingly greater depressive symptoms over time compared to girls who described their weight as about right (mean difference 1986, 0.32; 95% CI, 0.22-0.41; mean difference 2005, 0.33; 95% CI, 0.24-0.42; mean difference 2015, 0.56; 95% CI, 0.49-0.62). Conclusions and Relevance:These findings suggest that the growing focus on obesity prevention might have had unintended consequences related to weight-control behaviors and poor mental health. Public health campaigns addressing obesity should include prevention of disordered eating behaviors and be sensitive to negative impact on mental health. 10.1001/jamapediatrics.2020.4746
    Effect of a lifestyle intervention on weight change in south Asian individuals in the UK at high risk of type 2 diabetes: a family-cluster randomised controlled trial. Bhopal Raj S,Douglas Anne,Wallia Sunita,Forbes John F,Lean Michael E J,Gill Jason M R,McKnight John A,Sattar Naveed,Sheikh Aziz,Wild Sarah H,Tuomilehto Jaakko,Sharma Anu,Bhopal Ruby,Smith Joel B E,Butcher Isabella,Murray Gordon D The lancet. Diabetes & endocrinology BACKGROUND:The susceptibility to type 2 diabetes of people of south Asian descent is established, but there is little trial-based evidence for interventions to tackle this problem. We assessed a weight control and physical activity intervention in south Asian individuals in the UK. METHODS:We did this non-blinded trial in two National Health Service (NHS) regions in Scotland (UK). Between July 1, 2007, and Oct 31, 2009, we recruited men and women of Indian and Pakistani origin, aged 35 years or older, with waist circumference 90 cm or greater in men or 80 cm or greater in women, and with impaired glucose tolerance or impaired fasting glucose determined by oral glucose tolerance test. Families were randomised (using a random number generator program, with permuted blocks of random size, stratified by location [Edinburgh or Glasgow], ethnic group [Indian or Pakistani], and number of participants in the family [one vs more than one]) to intervention or control. Participants in the same family were not randomised separately. The intervention group received 15 visits from a dietitian over 3 years and the control group received four visits in the same period. The primary outcome was weight change at 3 years. Analysis was by modified intention to treat, excluding participants who died or were lost to follow-up. We used linear regression models to provide mean differences in baseline-adjusted weight at 3 years. This trial is registered, number ISRCTN25729565. FINDINGS:Of 1319 people who were screened with an oral glucose tolerance test, 196 (15%) had impaired glucose tolerance or impaired fasting glucose and 171 entered the trial. Participants were in 156 family clusters that were randomised (78 families with 85 participants were allocated to intervention; 78 families with 86 participants were allocated to control). 167 (98%) participants in 152 families completed the trial. Mean weight loss in the intervention group was 1.13 kg (SD 4.12), compared with a mean weight gain of 0.51 kg (3.65) in the control group, an adjusted mean difference of -1.64 kg (95% CI -2.83 to -0.44). INTERPRETATION:Modest, medium-term changes in weight are achievable as a component of lifestyle-change strategies, which might control or prevent adiposity-related diseases. FUNDING:National Prevention Research Initiative, NHS Research and Development; NHS National Services Scotland; NHS Health Scotland. 10.1016/S2213-8587(13)70204-3
    Effect of an Online Weight Management Program Integrated With Population Health Management on Weight Change: A Randomized Clinical Trial. Baer Heather J,Rozenblum Ronen,De La Cruz Barbara A,Orav E John,Wien Matthew,Nolido Nyryan V,Metzler Kristina,McManus Katherine D,Halperin Florencia,Aronne Louis J,Minero Guadalupe,Block Jason P,Bates David W JAMA Importance:Online programs may help with weight loss but have not been widely implemented in routine primary care. Objective:To compare the effectiveness of a combined intervention, including an online weight management program plus population health management, with the online program only and with usual care. Design, Setting, and Participants:Cluster randomized trial with enrollment from July 19, 2016, through August 10, 2017, at 15 primary care practices in the US. Eligible participants had a scheduled primary care visit and were aged 20 to 70 years, had a body mass index between 27 and less than 40, and had a diagnosis of hypertension or type 2 diabetes. Follow-up ended on May 8, 2019. Interventions:Participants in the usual care group (n = 326) were mailed general information about weight management. Participants in the online program only group (n = 216) and the combined intervention group (n = 298) were registered for the online program. The participants in the combined intervention group also received weight-related population health management, which included additional support from nonclinical staff who monitored their progress in the online program and conducted periodic outreach. Main Outcomes and Measures:The primary outcome was weight change at 12 months based on measured weights recorded in the electronic health record. Weight change at 18 months was a secondary outcome. Results:Among the 840 participants who enrolled (mean age, 59.3 years [SD, 8.6 years]; 60% female; 76.8% White), 732 (87.1%) had a recorded weight at 12 months and the missing weights for the remaining participants were imputed. There was a significant difference in weight change at 12 months by group with a mean weight change of -1.2 kg (95% CI, -2.1 to -0.3 kg) in the usual care group, -1.9 kg (95% CI, -2.6 to -1.1 kg) in the online program only group, and -3.1 kg (95% CI, -3.7 to -2.5 kg) in the combined intervention group (P < .001). The difference in weight change between the combined intervention group and the usual care group was -1.9 kg (97.5% CI, -2.9 to -0.9 kg; P < .001) and the difference between the combined intervention group and the online program only group was -1.2 kg (95% CI, -2.2 to -0.3 kg; P = .01). At 18 months, the mean weight change was -1.9 kg (95% CI, -2.8 to -1.0 kg) in the usual care group, -1.1 kg (95% CI, -2.0 to -0.3 kg) in the online program only group, and -2.8 kg (95% CI, -3.5 to -2.0 kg) in the combined intervention group (P < .001). Conclusions and Relevance:Among primary care patients with overweight or obesity and hypertension or type 2 diabetes, combining population health management with an online program resulted in a small but statistically significant greater weight loss at 12 months compared with usual care or the online program only. Further research is needed to understand the generalizability, scalability, and durability of these findings. Trial Registration:ClinicalTrials.gov Identifier: NCT02656693. 10.1001/jama.2020.18977
    Smoking cessation and weight change in relation to cardiovascular disease incidence and mortality in people with type 2 diabetes: a population-based cohort study. Liu Gang,Hu Yang,Zong Geng,Pan An,Manson JoAnn E,Rexrode Kathryn M,Rimm Eric B,Hu Frank B,Sun Qi The lancet. Diabetes & endocrinology BACKGROUND:To reduce their overall substantially increased risk of cardiovascular disease and premature mortality, smoking cessation is especially important for people with diabetes. However, the effect of weight change after quitting smoking on the long-term health consequences of smoking cessation is unclear. We aimed to examine smoking cessation and subsequent weight change in relation to incident cardiovascular disease events and mortality among adults with type 2 diabetes. METHODS:In this population-based cohort study, we analysed data from people with type 2 diabetes from two prospective cohorts in the USA: the Nurses' Health Study (1976-2014) and the Health Professionals Follow-Up Study (1986-2014). We included participants from both cohorts who either had prevalent type 2 diabetes or were diagnosed during the study, and who were either current smokers or never smokers without cardiovascular disease or cancer at diagnosis of diabetes. Information on demographics, newly diagnosed diseases, medical history, and lifestyle factors, including smoking status and weight change, was updated every 2 years through validated questionnaires. We assessed the incidence of cardiovascular disease and all-cause and cause-specific mortality among recent quitters (within 6 years of stopping) and long-term quitters (>6 years) associated with weight change within 6 years of smoking cessation among people with type 2 diabetes. We did a multivariable-adjusted Cox proportional hazard models to estimate hazard ratios (HRs) for the associations of smoking cessation and weight change on the outcomes. FINDINGS:Of 173 229 total cohort participants (121 700 from the Nurses' Health Study and 51 529 from the Health Professionals Follow-Up Study), 10 809 people with type 2 diabetes were included in the incident cardiovascular disease analysis and 9688 were included in the mortality analysis. 2580 incident cases of cardiovascular disease occurred during 153 166 person-years of follow-up, and 3827 deaths occurred during 152 811 person-years of follow-up. Recent quitters (2-6 consecutive years since smoking cessation) without weight gain within the first 6 years of quitting had a significantly lower risk of cardiovascular disease than people who continued to smoke (multivariable-adjusted HR 0·83 [95% CI 0·70-0·99] among all recent quitters, 0·77 [0·62-0·95] among recent quitters without weight gain, 0·99 [0·70-1·41] among recent quitters with weight gain of 0·1-5·0 kg, 0·89 [0·65-1·23] among recent quitters with weight gain of >5·0 kg, and 0·72 [0·61-0·84] among longer-term quitters [>6 consecutive years since smoking cessation]). Weight gain within 6 years after smoking cessation did not attenuate the inverse relation between long-term cessation and all-cause mortality (multivariable-adjusted HR 0·69 [95% CI 0·58-0·82] among long-term quitters without weight gain, 0·57 [0·45-0·71] among long-term quitters with weight gain of 0·1-5·0 kg, and 0·51 [0·42-0·62] among long-term quitters with weight gain of >5·0 kg), with similar results observed for cardiovascular disease and cancer mortality. INTERPRETATION:Smoking cessation without subsequent weight gain is associated with a reduced risk of cardiovascular disease and mortality among smokers with type 2 diabetes. Weight gain after smoking cessation attenuates the reduction in risk of developing cardiovascular disease, but does not attenuate the beneficial effect of smoking cessation with respect to mortality. These findings confirm the overall health benefits of quitting smoking among people with type 2 diabetes, but also emphasise the importance of weight management after smoking cessation to maximise its health benefits. FUNDING:US National Institutes of Health. 10.1016/S2213-8587(19)30413-9
    Smoking Cessation, Weight Change, Type 2 Diabetes, and Mortality. Hu Yang,Zong Geng,Liu Gang,Wang Molin,Rosner Bernard,Pan An,Willett Walter C,Manson JoAnn E,Hu Frank B,Sun Qi The New England journal of medicine BACKGROUND:Whether weight gain after smoking cessation attenuates the health benefits of quitting is unclear. METHODS:In three cohort studies involving men and women in the United States, we identified those who had reported quitting smoking and we prospectively assessed changes in smoking status and body weight. We estimated risks of type 2 diabetes, death from cardiovascular disease, and death from any cause among those who had reported quitting smoking, according to weight changes after smoking cessation. RESULTS:The risk of type 2 diabetes was higher among recent quitters (2 to 6 years since smoking cessation) than among current smokers (hazard ratio, 1.22; 95% confidence interval [CI], 1.12 to 1.32). The risk peaked 5 to 7 years after quitting and then gradually decreased. The temporary increase in the risk of type 2 diabetes was directly proportional to weight gain, and the risk was not increased among quitters without weight gain (P<0.001 for interaction). In contrast, quitters did not have a temporary increase in mortality, regardless of weight change after quitting. As compared with current smokers, the hazard ratios for death from cardiovascular disease were 0.69 (95% CI, 0.54 to 0.88) among recent quitters without weight gain, 0.47 (95% CI, 0.35 to 0.63) among those with weight gain of 0.1 to 5.0 kg, 0.25 (95% CI, 0.15 to 0.42) among those with weight gain of 5.1 to 10.0 kg, 0.33 (95% CI, 0.18 to 0.60) among those with weight gain of more than 10.0 kg, and 0.50 (95% CI, 0.46 to 0.55) among longer-term quitters (>6 years since smoking cessation). Similar associations were observed for death from any cause. CONCLUSIONS:Smoking cessation that was accompanied by substantial weight gain was associated with an increased short-term risk of type 2 diabetes but did not mitigate the benefits of quitting smoking on reducing cardiovascular and all-cause mortality. (Funded by the National Institutes of Health.). 10.1056/NEJMoa1803626
    Weight change across adulthood in relation to all cause and cause specific mortality: prospective cohort study. Chen Chen,Ye Yi,Zhang Yanbo,Pan Xiong-Fei,Pan An BMJ (Clinical research ed.) OBJECTIVE:To investigate the association between weight changes across adulthood and mortality. DESIGN:Prospective cohort study. SETTING:US National Health and Nutrition Examination Survey (NHANES) 1988-94 and 1999-2014. PARTICIPANTS:36 051 people aged 40 years or over with measured body weight and height at baseline and recalled weight at young adulthood (25 years old) and middle adulthood (10 years before baseline). MAIN OUTCOME MEASURES:All cause and cause specific mortality from baseline until 31 December 2015. RESULTS:During a mean follow-up of 12.3 years, 10 500 deaths occurred. Compared with participants who remained at normal weight, those moving from the non-obese to obese category between young and middle adulthood had a 22% (hazard ratio 1.22, 95% confidence interval 1.11 to 1.33) and 49% (1.49, 1.21 to 1.83) higher risk of all cause mortality and heart disease mortality, respectively. Changing from obese to non-obese body mass index over this period was not significantly associated with mortality risk. An obese to non-obese weight change pattern from middle to late adulthood was associated with increased risk of all cause mortality (1.30, 1.16 to 1.45) and heart disease mortality (1.48, 1.14 to 1.92), whereas moving from the non-obese to obese category over this period was not significantly associated with mortality risk. Maintaining obesity across adulthood was consistently associated with increased risk of all cause mortality; the hazard ratio was 1.72 (1.52 to 1.95) from young to middle adulthood, 1.61 (1.41 to 1.84) from young to late adulthood, and 1.20 (1.09 to 1.32) from middle to late adulthood. Maximum overweight had a very modest or null association with mortality across adulthood. No significant associations were found between various weight change patterns and cancer mortality. CONCLUSIONS:Stable obesity across adulthood, weight gain from young to middle adulthood, and weight loss from middle to late adulthood were associated with increased risks of mortality. The findings imply that maintaining normal weight across adulthood, especially preventing weight gain in early adulthood, is important for preventing premature deaths in later life. 10.1136/bmj.l5584
    BMI, Weight Change, and Dementia Risk in Patients With New-Onset Type 2 Diabetes: A Nationwide Cohort Study. Nam Ga Eun,Park Yong Gyu,Han Kyungdo,Kim Mee Kyoung,Koh Eun Sil,Kim Eun Sook,Lee Min-Kyung,Kim Bongsung,Hong Oak-Kee,Kwon Hyuk-Sang Diabetes care OBJECTIVE:This study examined the association between baseline BMI, percentage weight change, and the risk of dementia in patients newly diagnosed with type 2 diabetes. RESEARCH DESIGN AND METHODS:Using the South Korean National Health Insurance Service-National Health Screening Cohort database, we identified 167,876 subjects aged ≥40 years diagnosed with new-onset type 2 diabetes between 2007 and 2012. Their weight changes were monitored for ∼2 years after diagnosis, with follow-up assessments occurring for an average of 3.5 years. The hazard ratios (HRs) and Bonferroni-adjusted 95% CIs of all-cause dementia, Alzheimer disease (AD), and vascular dementia were estimated using multivariable Cox proportional hazards regression models. RESULTS:We identified 2,563 incident dementia cases during follow-up. Baseline BMI among patients with new-onset type 2 diabetes was inversely associated with the risk of all-cause dementia and AD, independent of confounding variables ( for trend <0.001). The percentage weight change during the 2 years after a diagnosis of type 2 diabetes showed significant U-shaped associations with the risk of all-cause dementia development ( < 0.001); the HRs of the disease increased significantly when weight loss or gain was >10% (1.34 [95% CI 1.11-1.63] and 1.38 [1.08-1.76], respectively). Additionally, weight loss >10% was associated with an increased risk of AD (HR 1.26 [95% CI 1.01-1.59]). CONCLUSIONS:A lower baseline BMI was associated with increased risks of all-cause dementia and AD in patients with new-onset type 2 diabetes. Weight loss or weight gain after the diagnosis of diabetes was associated with an increased risk of all-cause dementia. Weight loss was associated with an increased risk of AD. 10.2337/dc18-1667