Body-mass index, blood pressure and cause-specific mortality in India: Prospective study of 500 000 adults

Background The associations of cause-specific mortality with body-mass index (BMI) have been studied mainly in higher-income countries. We relate BMI and systolic blood pressure (SBP) to mortality in a South Asian population. Methods In 1998-2001, 500,810 men and women (age≥35) in Chennai city were interviewed, measured, then visited biennially from 2015, recording structured narratives of any deaths before 31.3.2015 for physician coding; in 2013-14, 10,161 participants were re-surveyed. After excluding all with missing data or chronic disease at recruitment or who died within 2 years (leaving 414,746 participants), Cox regressions (standardised for tobacco, alcohol and social factors) relate mortality rate ratios at ages 35-69 (RRs) to SBP, BMI, or BMI given usual SBP. Findings Mean SBP and BMI at recruitment were 127 mmHg (SD15) and 23 kg/m2 (SD4): correlations with re-survey measurements 14 years later were, respectively, 50% and 88%. Low BMI was strongly associated with poverty, tobacco, and alcohol. Of 29,519 deaths at ages 35-69, half were vascular (mainly cardiac). Cardiac and stroke mortality increased steeply with SBP: as in Western populations, 20 mmHg higher usual SBP approximately doubled vascular mortality, as did diabetes. But, although BMI strongly affected SBP (~1 mmHg/kg/m2) and diabetes prevalence, BMI was little related to cardiac or other vascular mortality, with only small excesses even at BMI≥30 kg/m2. After additionally allowing for the usual SBP, BMI was inversely related to cardiac and stroke mortality throughout 15-30 kg/m2; comparing under vs overweight (15-18.5 vs 25-30 kg/m2), cardiac mortality RR was 1.29 (95%CI 1.20-1.38) and stroke mortality RR was 1.47 (1.23-1.75). Interpretation In this South Asian population, BMI was little associated with vascular mortality, even though BMI increases SBP and SBP increases vascular mortality. Hence, there must be importantly adverse effects of some close correlates of below-average BMI, which could be of relevance in all populations.</p

Body-mass index, blood pressure and cause-specific mortality in India: Prospective study of 500 000 adults

Background The associations of cause-specific mortality with body-mass index (BMI) have been studied mainly in higher-income countries. We relate BMI and systolic blood pressure (SBP) to mortality in a South Asian population. Methods In 1998-2001, 500,810 men and women (age≥35) in Chennai city were interviewed, measured, then visited biennially from 2015, recording structured narratives of any deaths before 31.3.2015 for physician coding; in 2013-14, 10,161 participants were re-surveyed. After excluding all with missing data or chronic disease at recruitment or who died within 2 years (leaving 414,746 participants), Cox regressions (standardised for tobacco, alcohol and social factors) relate mortality rate ratios at ages 35-69 (RRs) to SBP, BMI, or BMI given usual SBP. Findings Mean SBP and BMI at recruitment were 127 mmHg (SD15) and 23 kg/m2 (SD4): correlations with re-survey measurements 14 years later were, respectively, 50% and 88%. Low BMI was strongly associated with poverty, tobacco, and alcohol. Of 29,519 deaths at ages 35-69, half were vascular (mainly cardiac). Cardiac and stroke mortality increased steeply with SBP: as in Western populations, 20 mmHg higher usual SBP approximately doubled vascular mortality, as did diabetes. But, although BMI strongly affected SBP (~1 mmHg/kg/m2) and diabetes prevalence, BMI was little related to cardiac or other vascular mortality, with only small excesses even at BMI≥30 kg/m2. After additionally allowing for the usual SBP, BMI was inversely related to cardiac and stroke mortality throughout 15-30 kg/m2; comparing under vs overweight (15-18.5 vs 25-30 kg/m2), cardiac mortality RR was 1.29 (95%CI 1.20-1.38) and stroke mortality RR was 1.47 (1.23-1.75). Interpretation In this South Asian population, BMI was little associated with vascular mortality, even though BMI increases SBP and SBP increases vascular mortality. Hence, there must be importantly adverse effects of some close correlates of below-average BMI, which could be of relevance in all populations.</p

P3230 The association of blood glucose and diabetes with peripheral arterial disease involving different vascular territories: results from 628 246 people who attended vascular screening

Diabetes is an important risk factor for atherosclerotic vascular disease, and previous studies have also shown a positive continuous association between blood glucose concentrations throughout the “normal” reference range and cardiovascular disease. However, diabetes appears to be inversely associated with abdominal aortic aneurysm (AAA). This study reports associations between blood glucose concentration and diabetes with AAA, carotid stenosis and peripheral arterial disease (PAD)

Adiposity in relation to age at menarche and other reproductive factors among 300,000 Chinese women: findings from China Kadoorie Biobank study

Background Adiposity is increasing rapidly in China but little is known about the relevance to it of women’s reproductive factors, which differ intergenerationally and from that in the West. We assess associations of adiposity with life-course reproductive factors in Chinese women. Methods In 2004-8 the nationwide China Kadoorie Biobank recruited 303,000 women aged 30-79 (mean 50) years from 10 diverse regions. Multivariable linear regression was used to examine associations of reproductive factors (e.g. age at menarche/first birth/menopause, parity, breastfeeding, and reproductive years) with measures of general (e.g. body mass index [BMI]) and central (e.g. waist circumference [WC]) adiposity in adulthood. Results Overall, the mean BMI was 23.7 (SD 3.3) kg/m2, mean age at menarche was 15 (2) years, and nearly all had given birth (99%) and breastfed children (98%). Adiposity was associated inversely with age at menarche and at first birth, with 0.19 and 0.05 kg/m2 lower BMI, 0.38 and 0.12 cm lower WC per 1 year delay respectively (p&lt;0.001). Among 128,259 post-menopausal women, adiposity was associated positively with age at menopause and reproductive years, with 0.05 and 0.07 kg/m2 higher BMI and 0.12 and 0.17 cm higher WC per 1 year increase respectively (p&lt;0.001). The proportion with overweight/obesity had similar associations with these reproductive factors. Adiposity had a non-linear positive association with parity, but no association with breastfeeding duration. Conclusion Among Chinese women, earlier age at menarche and at first birth, later age at and longer reproductive years were independently associated with increased adiposity late in life.</p

Fresh fruit consumption and major cardiovascular disease in China.

Background In Western populations, a higher level of fruit consumption has been associated with a lower risk of cardiovascular disease, but little is known about such associations in China, where the consumption level is low and rates of stroke are high. Methods Between 2004 and 2008, we recruited 512,891 adults, 30 to 79 years of age, from 10 diverse localities in China. During 3.2 million person-years of follow-up, 5173 deaths from cardiovascular disease, 2551 incident major coronary events (fatal or nonfatal), 14,579 ischemic strokes, and 3523 intracerebral hemorrhages were recorded among the 451,665 participants who did not have a history of cardiovascular disease or antihypertensive treatments at baseline. Cox regression yielded adjusted hazard ratios relating fresh fruit consumption to disease rates. Results Overall, 18.0% of participants reported consuming fresh fruit daily. As compared with participants who never or rarely consumed fresh fruit (the “nonconsumption” category), those who ate fresh fruit daily had lower systolic blood pressure (by 4.0 mm Hg) and blood glucose levels (by 0.5 mmol per liter [9.0 mg per deciliter]) (P&lt;0.001 for trend for both comparisons). The adjusted hazard ratios for daily consumption versus nonconsumption were 0.60 (95% confidence interval [CI], 0.54 to 0.67) for cardiovascular death, and 0.66 (95% CI, 0.58 to 0.75), 0.75 (95% CI, 0.72 to 0.79), and 0.64 (95% CI, 0.56 to 0.74), respectively, for incident major coronary events, ischemic stroke, and hemorrhagic stroke. There was a strong loglinear dose–response relationship between the incidence of each outcome and the amount of fresh fruit consumed. These associations were similar across the 10 study regions and in subgroups of participants defined by baseline characteristics. Conclusions Among Chinese adults, a higher level of fruit consumption was associated with lower blood pressure and blood glucose levels and, largely independent of these and other dietary and nondietary factors, with significantly lower risks of major cardiovascular diseases. </p

Body mass index and complications following major gastrointestinal surgery: a prospective, international cohort study and meta-analysis.

AIM: Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a meta-analysis of all available prospective data. METHODS: This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien-Dindo Grades III-V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. RESULTS: This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery for malignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49-2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46-0.75, P < 0.001) compared to normal weight patients. CONCLUSIONS: In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease

Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis

Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a metaanalysis of all available prospective data. Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien\u2013Dindo Grades III\u2013V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery formalignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49\u20132.96, P &lt; 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46\u20130.75, P &lt; 0.001) compared to normal weight patients. Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease