The associations between relative and absolute body mass index with mortality rate based on predictions from stigma theory

Background: The social consequences of obesity may influence health and mortality rate (MR), given obesity's status as a highly stigmatized condition. Hence, a high absolute body mass index (BMI) in conjunction with the stigmatization of a high BMI may each independently increase the rate of MR. Objectives: We tested whether relative BMI, defined as ordinal rank within a social reference group jointly defined by age, sex, and race/ethnicity, is associated with MR independent of absolute BMI. Methods: Data were from three nationally representative datasets: the Health and Retirement Study (n = 31,115), the National Health Interview Survey (NHIS, n = 529,362), and the National Health and Nutrition Examination Survey (n = 31,115). Relative BMI kg/m2 deciles were calculated within twenty-four subgroups jointly defined by age (6 levels), sex (2 levels), and race/ethnicity (4 levels). The association between ordinal rank BMI and MR was assessed using Cox survival generalized additive models in each dataset with adjustments for age, race, sex, smoking, educational attainment, and absolute BMI. Results: Absolute BMI had a significant non-monotonic association with MR, such that BMI was positively associated with mortality at BMI levels above approximately 25 kg/m2. Contrary to expectations, results from NHIS indicated that individuals in the first decile of relative BMI had the highest MR whereas relative BMI was not associated with MR in the NHANES and HRS. Conclusion: We hypothesized that the stigmatization of obesity might lead to an increased MR after controlling for absolute BMI. Contrary to expectations, a higher relative BMI was not associated with an increased MR independent of absolute BMI

The validity of US nutritional surveillance: USDA's loss-adjusted food availability data series 1971-2010

The purpose of this study was to examine the validity of the 1971-2010 United States Department of Agriculture’s (USDA’s) loss-adjusted food availability (LAFA) per capita caloric consumption estimates. Estimated total daily energy expenditure (TEE) was calculated for nationally representative samples of US adults, 20-74 years, using the Institute of Medicine’s predictive equations with “low-active” (TEE L-ACT) and “sedentary” (TEE SED) physical activity values. TEE estimates were subtracted from LAFA estimates to create disparity values (kcal/d). A validated mathematical model was applied to calculate expected weight change in reference individuals resulting from the disparity. From 1971-2010, the disparity between LAFA and TEE L-ACT varied by 394 kcal/d—(P < 0.001), from −205 kcal/d (95% CI: −214, −196) to +189 kcal/d (95% CI: 168, 209). The disparity between LAFA and TEE SED varied by 412 kcal/d (P < 0.001), from −84 kcal/d (95% CI: −93, −76) to +328 kcal/d (95% CI: 309, 348). Our model suggests that if LAFA estimates were actually consumed, reference individuals would have lost ~1-4 kg/y from 1971-1980 (an accumulated loss of ~12 to ~36 kg), and gained ~3-7 kg/y from 1988-2010 (an accumulated gain of ~42 to ~98 kg). These estimates differed from the actual measured increments of 10 kg and 9 kg in reference men and women, respectively, over the 39-year period. The USDA LAFA data provided inconsistent, divergent estimates of per capita caloric consumption over its 39-year history. The large, variable misestimation suggests that the USDA LAFA per capita caloric intake estimates lack validity and should not be used to inform public policy

Is Childhood Socioeconomic Status Independently Associated with Adult BMI after Accounting for Adult and Neighborhood Socioeconomic Status?

<div><p>Childhood socioeconomic status (SES) is inversely associated with adult weight in high income countries. Whether the influence of childhood SES on adult weight is best described using a critical period model or an accumulation of risk model is not yet settled. This research tests whether childhood SES is associated with adult BMI and likelihood of obesity independent of adult socioeconomic status and neighborhood characteristics. Data on individual childhood and adult characteristics come from the Health and Retirement Study (N = 13,545). Data on neighborhood characteristics come from the 2000 Decennial Census and American Community Survey (2005–2009). In the fully adjusted models, perceived financial hardship before the age of sixteen and having a father who was unemployed are associated with higher BMI among males and, among females, paternal education remains associated with adult BMI. However, childhood SES is not associated with likelihood of obesity after fully adjusting for adult SES and neighborhood characteristics, suggesting that the direct effects of early childhood SES on BMI are small relative to the other factors associated with obesity in adulthood.</p></div

The Blackwood

<p>Variance Components and Model Fit Statistics, HRS 2006–2008.</p

Hierarchical Linear Model Results for Male BMI, HRS 2006–2008.

<p>Hierarchical Linear Model Results for Male BMI, HRS 2006–2008.</p

Descriptive Statistics of Individual Characteristics, HRS 2006–2008 (N = 13,545).

<p>Descriptive Statistics of Individual Characteristics, HRS 2006–2008 (N = 13,545).</p

Childhood Conditions and Multimorbidity Among Older Adults

Objectives: This research tests whether childhood conditions are associated with trajectories of chronic conditions among older adults. Methods: Using data from the Health and Retirement Study (1992–2008), a series of hierarchical linear models are used to estimate number of chronic conditions at survey midpoint and the rate of increase in chronic conditions across 18 years of data. Results: Results suggest that lower childhood socioeconomic status (SES) and poor childhood health are associated with increased number of chronic conditions; however, childhood SES is no longer associated with chronic conditions after adjustment for adult SES and adult health. Poor childhood health continues to be associated with total number of chronic conditions after adjustment for adult SES and health. Rate of change in chronic conditions was not associated with childhood conditions. Results from a multinomial logistic regression model further indicated that the association between childhood conditions and adult multimorbidity increased at higher levels of multimorbidity. Discussion: This research adds to the evidence that early life conditions have a lasting influence on adult health, and that their influence may be independent of adult health and SES

The inadmissibility of what we eat in America and NHANES dietary data in nutrition and obesity research and the scientific formulation of national dietary guidelines

The Scientific Report of the 2015 Dietary Guidelines Advisory Committee was primarily informed by memory-based dietary assessment methods (M-BMs) (eg, interviews and surveys). The reliance on M-BMs to inform dietary policy continues despite decades of unequivocal evidence that M-BM data bear little relation to actual energy and nutrient consumption. Data from M-BMs are defended as valid and valuable despite no empirical support and no examination of the foundational assumptions regarding the validity of human memory and retrospective recall in dietary assessment. We assert that uncritical faith in the validity and value of M-BMs has wasted substantial resources and constitutes the greatest impediment to scientific progress in obesity and nutrition research. Herein, we present evidence that M-BMs are fundamentally and fatally flawed owing to well-established scientific facts and analytic truths. First, the assumption that human memory can provide accurate or precise reproductions of past ingestive behavior is indisputably false. Second, M-BMs require participants to submit to protocols that mimic procedures known to induce false recall. Third, the subjective (ie, not publicly accessible) mental phenomena (ie, memories) from which M-BM data are derived cannot be independently observed, quantified, or falsified; as such, these data are pseudoscientific and inadmissible in scientific research. Fourth, the failure to objectively measure physical activity in analyses renders inferences regarding diet-health relationships equivocal. Given the overwhelming evidence in support of our position, we conclude that M-BM data cannot be used to inform national dietary guidelines and that the continued funding of M-BMs constitutes an unscientific and major misuse of research resources

Additive effects of obesity and loneliness on C-reactive protein.

Obesity and loneliness are associated with C-reactive protein (CRP), a predictor of cardiovascular disease. It is unknown whether the co-presence of obesity and loneliness is associated with additional risk for clinically elevated CRP. The present study thus examines their independent and combined effects on elevated CRP in older adults. Data come from 10,912 respondents who completed the 2008 and 2010 waves of the Health and Retirement Study. Loneliness was measured using an 11-item Loneliness Scale and body mass index was calculated from technician measured height and weight. Our primary outcome is high sensitivity CRP (hsCRP). Survey-weighted logistic regression models were used to test whether loneliness and BMI category are independent predictors of CRP after adjusting for demographics and other inflammatory-related covariates. In the fully adjusted model for men, obesity (OR = 2.36, p 3.0. Among females, being overweight (OR = 1.75, p 3.0. Among both men and women, results from fully adjusted models indicated that loneliness was not associated with clinically elevated hsCRP (OR = 1.34, p = .0535; OR = 0.97, p = 0.6776, respectively)