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 Health  Vol.10 No.9 , September 2018
Influence of Underlying Diseases and Age on the Association between Obesity and All-Cause Mortality in Post-Middle Age
Abstract: Background: Studies on the association between obesity and all-cause mortality have found that the degree of obesity is directly proportional to all-cause mortality. In contrast, there have been studies indicating that obese people with underlying diseases have a higher survival rate. We hypothesized that age and underlying diseases lead to such contrasting results. Therefore, we conducted a study to clarify the influence of post-middle age obesity and underlying diseases on all-cause mortality. Methods: This study used data from longitudinal studies in the United States, which conducted follow-up for 19 years on 33,708 participants in different age groups: ≥45, 45 - 64, and ≥65 years. Hazard ratio (HR) was determined using the Cox proportional hazards model to analyze a group consisting of all participants, a group of those with underlying diseases, and a group of those without underlying diseases, considering age, gender, education history, marital status, household income, smoking history, and BMI category as covariates. Results: In the group aged ≥65 without underlying diseases, HR was almost 1 in those with BMI 25 - <30, 30 - <35, and BMI > 35 kg/m2. Further, HR was higher in the 45 - 64 age group without underlying diseases if BMI was >35 kg/m2. However, HR was approximately 1 in the ≥65 age group. Conclusions: The study revealed that among individuals aged ≥65 years without underlying diseases, there was no association between obesity and all-cause mortality. Among individuals without underlying diseases, HR was higher in the 45 - 64 age group with BMI > 35 kg/m2 but was approximately 1 among those aged ≥65 years. Therefore, an interaction based on age was detected. These findings may lead to recommendations regarding the need to modify the advice and education provided to obese individuals in different age groups.
Cite this paper: Yoshimoto, K. , Noda, T. and Imamura, T. (2018) Influence of Underlying Diseases and Age on the Association between Obesity and All-Cause Mortality in Post-Middle Age. Health, 10, 1171-1184. doi: 10.4236/health.2018.109089.
References

[1]   Finucane, M.M., Stevens, G.A., Cowan, M.J., Danaei, G., Lin, J.K., Paciorek, C.J., et al. (2011) National, Regional, and Global Trends in Body-Mass Index since 1980: Systematic Analysis of Health Examination Surveys and Epidemiological Studies with 960 Country-Years and 9.1 Million Participants. Lancet, 377, 557-567.
https://doi.org/10.1016/S0140-6736(10)62037-5

[2]   Ng, M., Fleming, T., Robinson, M., Thomson, B., Graetz, N., Margono, C., et al. (2014) Global, Regional, and National Prevalence of Overweight and Obesity in Children and Adults during 1980-2013: A Systematic Analysis for the Global Burden of Disease Study 2013. Lancet, 384, 766-781.
https://doi.org/10.1016/S0140-6736(14)60460-8

[3]   Seidell, J.C. and Halberstadt, J. (2015) The Global Burden of Obesity and the Challenges of Prevention. Annals of Nutrition & Metabolism, 66, 7-12.
https://doi.org/10.1159/000375143

[4]   NCD Risk Factor Collaboration (2016) Trends in Adult Body-Mass Index in 200 Countries from 1975 to 2014: A Pooled Analysis of 1698 Population-Based Measurement Studies with 19.2 Million Participants. Lancet, 387, 1377-1396.
https://doi.org/10.1016/S0140-6736(16)30054-X

[5]   Tesfaye, F., Nawi, N.G., Van Minh, H., Byass, P., Berhane, Y., Bonita, R., et al. (2007) Association between Body Mass Index and Blood Pressure across Three Populations in Africa and Asia. Journal of Human Hypertension, 21, 28-37.
https://doi.org/10.1038/sj.jhh.1002104

[6]   Guh, D.P., Zhang, W., Bansback, N., Amarsi, Z., Birmingham, C.L. and Anis, A.H. (2009) The Incidence of Co-Morbidities Related to Obesity and Overweight: A Systematic Review and Meta-Analysis. BMC Public Health, 9, 88.
https://doi.org/10.1186/1471-2458-9-88

[7]   Barrios, V., Escobar, C. and Calderon, A. (2010) Clinical Profile and Management of Patients with Hypertension and Chronic Ischemic Heart Disease According to BMI. Obesity, 18, 2017-2022.
https://doi.org/10.1038/oby.2010.12

[8]   Ostchega, Y., Hughes, J.P., Terry, A., Fakhouri, T.H. and Miller, I. (2012) Abdominal Obesity, Body Mass Index, and Hypertension in US Adults: NHANES 2007-2010. American Journal of Hypertension, 25, 1271-1278.

[9]   Lee, S.K., Kim, S.H., Cho, G.Y., Baik, I., Lim, H.E., Park, C.G., et al. (2013) Obesity Phenotype and Incident Hypertension: A Prospective Community-Based Cohort Study. Journal of Hypertension, 31, 145-151.
https://doi.org/10.1097/HJH.0b013e32835a3637

[10]   Lavie, C.J., Alpert, M.A., Arena, R., Mehra, M.R., Milani, R.V. and Ventura, H.O. (2013) Impact of Obesity and the Obesity Paradox on Prevalence and Prognosis in Heart Failure. JACC Heart Fail, 1, 93-102.
https://doi.org/10.1016/j.jchf.2013.01.006

[11]   Kramer, C.K., Zinman, B. and Retnakaran, R. (2013) Are Metabolically Healthy Overweight and Obesity Benign Conditions? A Systematic Review and Meta-Analysis. Annals of Internal Medicine, 159, 758-769.
https://doi.org/10.7326/0003-4819-159-11-201312030-00008

[12]   Lavie, C.J., Sharma, A., Alpert, M.A., De Schutter, A., Lopez-Jimenez, F., Milani, R.V., et al. (2016) Update on Obesity and Obesity Paradox in Heart Failure. Progress in Cardiovascular Diseases, 58, 393-400.
https://doi.org/10.1016/j.pcad.2015.12.003

[13]   Wilson, P.W., D’Agostino, R.B., Sullivan, L., Parise, H. and Kannel, W.B. (2002) Overweight and Obesity as Determinants of Cardiovascular Risk: The Framingham Experience. Archives of Internal Medicine, 162, 1867-1872.
https://doi.org/10.1001/archinte.162.16.1867

[14]   Stevens, J., Cai, J., Pamuk, E.R., Williamson, D.F., Thun, M.J. and Wood, J.L. (1998) The Effect of Age on the Association between Body-Mass Index and Mortality. New England Journal of Medicine, 338, 1-7.
https://doi.org/10.1056/NEJM199801013380101

[15]   Calle, E.E., Thun, M.J., Petrelli, J.M., Rodriguez, C. and Heath Jr., C.W. (1999) Body-Mass Index and Mortality in a Prospective Cohort of U.S. Adults. New England Journal of Medicine, 341, 1097-1105.
https://doi.org/10.1056/NEJM199910073411501

[16]   McTigue, K., Larson, J.C., Valoski, A., Burke, G., Kotchen, J., Lewis, C.E., et al. (2006) Mortality and Cardiac and Vascular Outcomes in Extremely Obese Women. JAMA, 296, 79-86.
https://doi.org/10.1001/jama.296.1.79

[17]   Neovius, M., Sundstrom, J. and Rasmussen, F. (2009) Combined Effects of Overweight and Smoking in Late Adolescence on Subsequent Mortality: Nationwide Cohort Study. BMJ, 338, b496.
https://doi.org/10.1136/bmj.b496

[18]   Whitlock, G., Lewington, S., Sherliker, P., Clarke, R., Emberson, J., Halsey, J., et al. (2009) Body-Mass Index and Cause-Specific Mortality in 900000 Adults: Collaborative Analyses of 57 Prospective Studies. The Lancet (London, England), 373, 1083-1096.
https://doi.org/10.1016/S0140-6736(09)60318-4

[19]   Berrington de Gonzalez, A., Hartge, P., Cerhan, J.R., Flint, A.J., Hannan, L., MacInnis, R.J., et al. (2010) Body-Mass Index and Mortality among 1.46 Million White Adults. The New England Journal of Medicine, 363, 2211-2219.
https://doi.org/10.1056/NEJMoa1000367

[20]   Park, S.Y., Wilkens, L.R., Murphy, S.P., Monroe, K.R., Henderson, B.E. and Kolonel, L.N. (2012) Body Mass Index and Mortality in an Ethnically Diverse Population: The Multiethnic Cohort Study. European Journal of Epidemiology, 27, 489-497.
https://doi.org/10.1007/s10654-012-9695-5

[21]   Orpana, H.M., Berthelot, J.M., Kaplan, M.S., Feeny, D.H., McFarland, B. and Ross, N.A. (2010) BMI and Mortality: Results from a National Longitudinal Study of Canadian Adults. Obesity, 18, 214-218.
https://doi.org/10.1038/oby.2009.191

[22]   Zheng, W., McLerran, D.F., Rolland, B., Zhang, X., Inoue, M., Matsuo, K., et al. (2011) Association between Body-Mass Index and Risk of Death in More than 1 Million Asians. The New England Journal of Medicine, 364, 719-729.
https://doi.org/10.1056/NEJMoa1010679

[23]   Flegal, K.M., Kit, B.K., Orpana, H. and Graubard, B.I. (2013) Association of All-Cause Mortality with Overweight and Obesity Using Standard Body Mass Index Categories: A Systematic Review and Meta-Analysis. JAMA, 309, 71-82.
https://doi.org/10.1001/jama.2012.113905

[24]   Carmienke, S., Freitag, M.H., Pischon, T., Schlattmann, P., Fankhaenel, T., Goebel, H., et al. (2013) General and Abdominal Obesity Parameters and Their Combination in Relation to Mortality: A Systematic Review and Meta-Regression Analysis. European Journal of Clinical Nutrition, 67, 573-585.
https://doi.org/10.1038/ejcn.2013.61

[25]   Patel, A.V., Hildebrand, J.S. and Gapstur, S.M. (2014) Body Mass Index and All-Cause Mortality in a Large Prospective Cohort of White and Black U.S. Adults. PLoS ONE, 9, e109153.
https://doi.org/10.1371/journal.pone.0109153

[26]   Aune, D., Sen, A., Prasad, M., Norat, T., Janszky, I., Tonstad, S., et al. (2016) BMI and All Cause Mortality: Systematic Review and Non-Linear Dose-Response Meta-Analysis of 230 Cohort Studies with 3.74 Million Deaths among 30.3 Million Participants. BMJ, 353, i2156.
https://doi.org/10.1136/bmj.i2156

[27]   Cheng, F.W., Gao, X., Mitchell, D.C., Wood, C., Still, C.D., Rolston, D., et al. (2016) Body Mass Index and All-Cause Mortality among Older Adults. Obesity, 24, 2232-2239.
https://doi.org/10.1002/oby.21612

[28]   Stessman, J., Jacobs, J.M., Ein-Mor, E. and Bursztyn, M. (2009) Normal Body Mass Index Rather than Obesity Predicts Greater Mortality in Elderly People: The Jerusalem Longitudinal Study. Journal of the American Geriatrics Society, 57, 2232-2238.
https://doi.org/10.1111/j.1532-5415.2009.02567.x

[29]   Hamer, M. and Stamatakis, E. (2013) Overweight and Obese Cardiac Patients Have Better Prognosis Despite Reporting Worse Perceived Health and More Conventional Risk Factors. Preventive Medicine, 57, 12-16.
https://doi.org/10.1016/j.ypmed.2013.02.012

[30]   Clark, A.L., Fonarow, G.C. and Horwich, T.B. (2014) Obesity and the Obesity Paradox in Heart Failure. Progress in Cardiovascular Diseases, 56, 409-414.
https://doi.org/10.1016/j.pcad.2013.10.004

[31]   Goyal, A., Nimmakayala, K.R. and Zonszein, J. (2014) Is There a Paradox in Obesity? Cardiology in Review, 22, 163-170.
https://doi.org/10.1097/CRD.0000000000000004

[32]   Gupta, P.P., Fonarow, G.C. and Horwich, T.B. (2015) Obesity and the Obesity Paradox in Heart Failure. Canadian Journal of Cardiology, 31, 195-202.
https://doi.org/10.1016/j.cjca.2014.08.004

[33]   Oga, E.A. and Eseyin, O.R. (2016) The Obesity Paradox and Heart Failure: A Systematic Review of a Decade of Evidence. Journal of Obesity, 2016, Article ID: 9040248.
https://doi.org/10.1155/2016/9040248

[34]   Yang, W., Li, J.P., Zhang, Y., Fan, F.F., Xu, X.P., Wang, B.Y., et al. (2016) Association between Body Mass Index and All-Cause Mortality in Hypertensive Adults: Results from the China Stroke Primary Prevention Trial (CSPPT). Nutrients, 8, E384.
https://doi.org/10.3390/nu8060384

[35]   Hamzeh, N., Ghadimi, F., Farzaneh, R. and Hosseini, S.K. (2017) Obesity, Heart Failure, and Obesity Paradox. The Journal of Tehran University Heart Center, 12, 1-5.

[36]   Chang, V.W., Kenneth, M.L., David, R.W. and Theodore, J.I. (2017) The Obesity Paradox and Incident Cardiovascular Disease: A Population-Based Study. PLoS ONE, 12, e0188636.
https://doi.org/10.1371/journal.pone.0188636

[37]   Janssen, I. (2007) Morbidity and Mortality Risk Associated with an Overweight BMI in Older Men and Women. Obesity, 15, 1827-1840.
https://doi.org/10.1038/oby.2007.217

[38]   Bender, R., Jockel, K.H., Trautner, C., Spraul, M. and Berger, M. (1999) Effect of Age on Excess Mortality in Obesity. JAMA, 281, 1498-1504.
https://doi.org/10.1001/jama.281.16.1498

[39]   Stevens, J., Cai, J., Juhaeri Thun, M.J., Williamson, D.F. and Wood, J.L. (1999) Consequences of the Use of Different Measures of Effect to Determine the Impact of Age on the Association between Obesity and Mortality. American Journal of Epidemiology, 150, 399-407.
https://doi.org/10.1093/oxfordjournals.aje.a010019

[40]   Flegal, K.M., Graubard, B.I., Williamson, D.F. and Cooper, R.S. (2011) Reverse Causation and Illness-Related Weight Loss in Observational Studies of Body Weight and Mortality. American Journal of Epidemiology, 173, 1-9.
https://doi.org/10.1093/aje/kwq341

[41]   World Health Organization (2000) Obesity: Preventing and Managing the Global Epidemic: Report of a WHO Consultation. WHO Technical Report Series No. 894.

[42]   Flegal, K.M., Graubard, B.I., Williamson, D.F. and Gail, M.H. (2007) Impact of Smoking and Preexisting Illness on Estimates of the Fractions of Deaths Associated with Underweight, Overweight, and Obesity in the US Population. American Journal of Epidemiology, 166, 975-982.
https://doi.org/10.1093/aje/kwm152

[43]   Flegal, K.M., Graubard, B.I. and Yi, S.W. (2017) Comparative Effects of the Restriction Method in Two Large Observational Studies of Body Mass Index and Mortality among Adults. European Journal of Clinical Investigation, 47, 415-421.
https://doi.org/10.1111/eci.12756

[44]   Janssen, I. and Mark, A.E. (2007) Elevated Body Mass Index and Mortality Risk in the Elderly. Obesity Reviews, 8, 41-59.
https://doi.org/10.1111/j.1467-789X.2006.00248.x

[45]   Kuk, J.L. and Ardern, C.I. (2009) Influence of Age on the Association between Various Measures of Obesity and All-Cause Mortality. Journal of the American Geriatrics Society, 57, 2077-2084.
https://doi.org/10.1111/j.1532-5415.2009.02486.x

[46]   Ng, T.P., Jin, A., Chow, K.Y., Feng, L., Nyunt, M.S.Z. and Yap, K.B. (2017) Age-Dependent Relationships between Body Mass Index and Mortality: Singapore Longitudinal Ageing Study. PLoS ONE, 12, e0180818.
https://doi.org/10.1371/journal.pone.0180818

[47]   Keith, S.W., Fontaine, K.R., Pajewski, N.M., Mehta, T. and Allison, D.B. (2011) Use of Self-Reported Height and Weight Biases the Body Mass Index-Mortality Association. International Journal of Obesity, 35, 401-408.
https://doi.org/10.1038/ijo.2010.148

[48]   Veronese, N., Li, Y., Manson, J.E., Willett, W.C., Fontana, L. and Hu, F.B. (2016) Combined Associations of Body Weight and Lifestyle Factors with All Cause and Cause Specific Mortality in Men and Women: Prospective Cohort Study. BMJ, 355, i5855.
https://doi.org/10.1136/bmj.i5855

 
 
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