Generalised and abdominal obesity and risk of diabetes, hypertension and hypertension-diabetes co-morbidity in England.
ABSTRACT To look at trends in generalised (body mass index (BMI) >or=30 kg m(-2)) and abdominal (waist circumference (WC) >102 cm in men, >88 cm in women) obesity among adults between 1993 and 2003, and to evaluate their association with diabetes, hypertension and hypertension-diabetes co-morbidity (HDC) in England.
Analyses of nationally representative cross-sectional population surveys, the Health Survey for England (HSE).
Non-institutionalised men and women aged >or=35 years.
Interviewer-administered questionnaire (sociodemographic information, risk factors, doctor-diagnosed diabetes), measurements of height and weight to calculate BMI. WC and blood pressure measurements were taken by trained nurses.
Generalised obesity increased among men from 15.8% in 1993 to 26.3% in 2003, and among women from 19.3% to 25.8%. Abdominal obesity also increased in both sexes (men: 26.2% in 1993 to 39.0% in 2003; women: 32.4% to 47.0%). In 1994, 1998 and 2003, generalised and abdominal obesity were independently associated with risk of hypertension, diabetes and HDC. The odds of diabetes associated with generalised obesity in 1994, 1998 and 2003 were 1.62, 2.26 and 2.62, respectively, in women and 1.24, 1.82 and 2.10, respectively, in men. Similar differences were observed for hypertension and HDC. Men and women with abdominal obesity also showed a higher risk for diabetes, hypertension and HDC than those with a normal WC.
If current trends in obesity continue then the risk of related morbidities may also increase. This will impact on cardiovascular disease morbidity and mortality, with cost implications for the health service. Therefore there is an urgent need to control the epidemic of obesity.
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ABSTRACT: Advanced age has traditionally been considered a relative contraindication to bariatric surgery due to increased perioperative risk and less weight loss. However, it is now being reconsidered in older patients after encouraging results in recent series and the increasing life expectancy. We compared operative and postoperative outcomes of laparoscopic sleeve gastrectomy in patients over 60 years with outcomes in younger patients. We also, analyzed the effect of bariatric surgery on improvement and resolution of co-morbidities in the older group.Surgery for Obesity and Related Diseases 06/2014; DOI:10.1016/j.soard.2014.05.021 · 4.94 Impact Factor
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ABSTRACT: Life expectancy is increasing, with more elderly people categorized as obese. The objective of this study was to assess the effects of laparoscopic adjustable gastric banding (LAGB) on patients aged ≥70 years. This was a retrospective analysis of patients aged ≥70 years who underwent LAGB at our university hospital between 2003 and 2011. The data included age, weight, body mass index (BMI), and percentage excess weight loss (%EWL) obtained before and after gastric banding. Operative data, length of stay, postoperative complications, and resolution of co-morbid conditions were also analyzed. Fifty-five patients aged ≥70 years (mean 73 years) underwent gastric banding between 2003 and 2012. Mean preoperative weight and BMI were 123 kilograms and 45 kg/m(2), respectively. On average, each patient had 4 co-morbidities preoperatively, with hypertension (n = 49; 86%), dyslipidemia (n = 40; 70%), and sleep apnea (n = 31; 54%) being the most common. Mean operating room (OR) time was 49 minutes, with all patients discharged within 24 hours. There was 1 death at 4 years from myocardial infarction, no intensive care unit admissions, and no 30-day readmissions. Mean %EWL at 1, 2, 3, 4, and 5 years was 36 (±12.7), 40 (±16.4), 42 (±19.2), 41 (±17.1), 50 (±14.9), and 48 (±22.6), respectively. Follow-up rates ranged from 55/55 (100%) at 6 months to 7/9 (78%) of eligible patients at 5 years and 2/2 (100%) at 8 years. Complications included 1 band slip at year 5, 1 band removed for intolerance, and 1 port site hernia. The resolution of hypertension, dyslipidemia, sleep apnea, lower back pain, and non-insulin-dependent diabetes was 27%, 28%, 35%, 31%, and 35%, respectively. LAGB as a primary treatment for obesity in carefully selected patients aged ≥70 can be well tolerated and effective with moderate resolution of co-morbid conditions and few complications.Surgery for Obesity and Related Diseases 07/2013; DOI:10.1016/j.soard.2013.06.022 · 4.94 Impact Factor
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ABSTRACT: Objectives To determine whether the prevalence of CKD in England has changed over time. Design Cross-sectional analysis of nationally representative Health Survey for England (HSE) random samples. Setting England 2003 and 2009/2010. Survey participants 13,896 Adults aged 16+ participating in HSE, adjusted for sampling and non-response, 2009/10 surveys combined. Main outcome measure Change in prevalence of eGFR <60ml/min/1.73m2 (as proxy for stage 3-5 chronic kidney disease [CKD]), from 2003 to 2009/10 based on a single serum creatinine measure using IDMS traceable enzymatic assay in a single laboratory; eGFR derived using MDRD and CKDEPI eGFR formulae. Analysis Multivariate logistic regression modelling to adjust time changes for socio-demographic and clinical factors (body mass index, hypertension, diabetes, lipids). A correction factor was applied to the 2003 HSE serum creatinine to account for a storage effect. Results National prevalence of low eGFR (<60) decreased within each age and gender group for both formulae except males aged 65-74. Prevalence of both obesity and diabetes increased in this period, there was a decrease in hypertension. Adjustment for demographic and clinical factors led to a significant decrease in CKD between the surveyed periods. The fully adjusted odds ratio for eGFR<60ml/min/1.73m2 was 0.75 (0.61-0.92) comparing 2009/10 with 2003 using the MDRD equation, and was similar using the CKDEPI equation 0.73 (0.57-0.93). Conclusion The prevalence of a low eGFR indicative of CKD in England appeared to decrease over this seven year period, despite rising prevalence of obesity and diabetes, two key causes of CKD. Hypertension prevalence declined and blood pressure control improved but this did not appear to explain the fall. Periodic assessment of eGFR and albuminuria in future HSEs is needed to evaluate trends in CKD.BMJ Open 09/2014; DOI:10.1136/bmjopen-2014-005480 · 2.06 Impact Factor