Adiposity, Inflammation, and Risk for Death in Black and White Men and Women in the United States: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
ABSTRACT It has been proposed that adiposity is a protective response to excess caloric supply, but it is cardiometabolically harmful once adipocytes become inflamed.
The objective of the study was to assess whether elevated C-reactive protein (CRP), a measure of systemic inflammation, can differentiate individuals at higher mortality risk due to excess adiposity.
We conducted an observational study of 16,486 white and 11,168 black men and women in the Reasons for Geographic and Racial Differences in Stroke study, a U.S. national cohort.
The main outcome was all-cause mortality.
The mean age of the cohort was 64 ± 9 yr. Over a 6-yr period, 927 whites and 669 blacks died. The absolute risk of death was highest among underweight whites and blacks (9.2 and 14%, respectively), not the obese (4.7% whites; 4.0% blacks) or severely obese (5.9% whites; and 4.6% blacks). Among those with elevated CRP (≥3 vs. <1 mg/liter), underweight [hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.03-4.21] and normal-weight (HR 2.62, 95% CI 1.87-3.67) whites were at significantly higher mortality risk but not severely obese whites (HR 1.55, 95% CI 0.77-2.96), resulting in a statistical interaction (P = 0.01). Similar results were also seen for blacks, although a higher mortality risk among severely obese blacks with CRP 3 or greater vs. less than 1 mg/liter was also demonstrated (HR 2.58, 95% CI 1.04-6.41). Among whites and black women, higher waist circumference was associated with an increased mortality risk, although this relationship was not modified by CRP levels (P = 0.47 for whites and P = 0.25 for blacks).
Among middle-aged and older adults, the addition of CRP was most informative among underweight and normal-weight individuals, not the obese. This negated our hypothesis that increased levels of CRP would differentiate individuals at higher mortality risk due to excess adiposity.
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ABSTRACT: Our objectives in this article are to provide background and practical applications of the implementation of the new wellness standards developed by the Commission on Accreditation of Rehabilitation Facilities (CARF). The focus of rehabilitation in the stroke population ideally extends beyond maximizing functioning and prevention of further debilitation, by addressing wellness and the opportunity to create a healthy lifestyle. This concept has been recognized by CARF, which has included new wellness standards for stroke rehabilitation. This article provides a framework for implementing these standards and trends related to prevalence, incidence, and prevention of stroke. The Transtheoretical Model of Change, as described by James Prochaska, is discussed in relation to facilitating lifestyle changes in stroke patients in the rehabilitation setting. Additionally, the Six Dimensions of Wellness Model by Dr Bill Hettler is presented as a framework for developing a wellness tool. Finally, we discuss the development, barriers, and implementation of a wellness tool used at Madonna Rehabilitation Hospital to exemplify a tangible strategy to meet the new CARF standards.Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 05/2014; 23(5). DOI:10.1016/j.jstrokecerebrovasdis.2013.09.027 · 1.99 Impact Factor
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ABSTRACT: Convention defines pediatric adiposity by the body mass index z-score (BMIz) referenced to normative growth charts. Waist-to-height ratio (WHtR) does not depend on sex-and-age references. In the HEALTHY Study enrollment sample, we compared BMIz with WHtR for ability to identify adverse cardiometabolic risk. Among 5,482 sixth-grade students from 42 middle schools, we estimated explanatory variations (R (2)) and standardized beta coefficients of BMIz or WHtR for cardiometabolic risk factors: insulin resistance (HOMA-IR), lipids, blood pressures, and glucose. For each risk outcome variable, we prepared adjusted regression models for four subpopulations stratified by sex and high versus lower fatness. For HOMA-IR, R (2) attributed to BMIz or WHtR was 19%-28% among high-fatness and 8%-13% among lower-fatness students. R (2) for lipid variables was 4%-9% among high-fatness and 2%-7% among lower-fatness students. In the lower-fatness subpopulations, the standardized coefficients for total cholesterol/HDL cholesterol and triglycerides tended to be weaker for BMIz (0.13-0.20) than for WHtR (0.17-0.28). Among high-fatness students, BMIz and WHtR correlated with blood pressures for Hispanics and whites, but not black boys (systolic) or girls (systolic and diastolic). In 11-12 year olds, assessments by WHtR can provide cardiometabolic risk estimates similar to conventional BMIz without requiring reference to a normative growth chart.Journal of obesity 01/2014; 2014:421658. DOI:10.1155/2014/421658
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ABSTRACT: Background: Metabolically healthy obesity may confer lower risk of adverse health outcomes compared with abnormal obesity. Diet and race are postulated to influence the phenotype, but their roles and their interrelations on healthy obesity are unclear. Objective: We evaluated food intakes of metabolically healthy obese women in comparison to intakes of their metabolically healthy normal-weight and abnormal obese counterparts. Methods: This was a cross-sectional study in 6964 women of the REGARDS (REasons for Geographic And Racial Differences in Stroke) study. Participants were aged 45–98 y with a BMI (kg/m2) ≥18.5 and free of cardiovascular diseases, diabetes, and cancer. Food intake was collected by using a food-frequency questionnaire. Body mass index (BMI) phenotypes were defined by using metabolic syndrome (MetS) and homeostasis model assessment of insulin resistance (HOMA-IR) criteria. Mean differences in food intakes among BMI phenotypes were compared by using ANCOVA. Results: Approximately one-half of obese women (white: 45%; black: 55%) as defined by MetS criteria and approximately one-quarter of obese women (white: 28%; black: 24%) defined on the basis of HOMA-IR values were metabolically healthy. In age-adjusted analyses, healthy obesity and normal weight as defined by both criteria were associated with lower intakes of sugar-sweetened beverages compared with abnormal obesity among both white and black women (P < 0.05). HOMA-IR–defined healthy obesity and normal weight were also associated with higher fruit and low-fat dairy intakes compared with abnormal obesity in white women (P < 0.05). Results were attenuated and became nonsignificant in multivariable-adjusted models that additionally adjusted for BMI, marital status, residential region, education, annual income, alcohol intake, multivitamin use, cigarette smoking status, physical activity, television viewing, high-sensitivity C-reactive protein, menopausal status, hormone therapy, and food intakes. Conclusions: Healthy obesity was not associated with a healthier diet. Prospective studies on relations of dietary patterns, which may be a better indicator of usual diet, with the phenotype would be beneficial.Journal of Nutrition 01/2014; 144(10):1-9. DOI:10.3945/jn.114.19834 · 4.23 Impact Factor