Optimum BMI?

A place to get your questions answered from McDougall staff dietitian, Jeff Novick, MS, RDN.

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Re: Optimum BMI?

Postby JeffN » Sat Jul 29, 2017 1:34 pm

No surprise


Are body mass index and waist circumference significant predictors of diabetes and prediabetes risk: Results from a population based cohort study.
Haghighatdoost F, Amini M, Feizi A, Iraj B.
World J Diabetes. 2017 Jul 15;8(7):365-373. doi: 10.4239/wjd.v8.i7.365.
PMID: 28751960
http://www.wjgnet.com.ololo.sci-hub.cc/ ... i7/365.htm
Abstract

AIM:
To determine the predictive role of body mass index (BMI) and waist circumference (WC) for diabetes and prediabetes risk in future in total sample as well as in men and women separately.

METHODS:
In a population based cohort study, 1765 with mean ± SD age: 42.32 ± 6.18 healthy participants were followed up from 2003 till 2013 (n = 960). Anthropometric and biochemical measures of participants were evaluated regularly during the follow up period. BMI and WC measures at baseline and diabetes and prediabetes status of participants at 2013 were determined. Multivariable logistic regression analysis was used for determining the risk of diabetes and prediabetes considering important potential confounding variables. Receiver operating characteristic curve analysis was conducted to determine the best cut of values of BMI and WC for diabetes and prediabetes.

RESULTS:
At 2013, among participants who had complete data, 45 and 307 people were diabetic and prediabetic, respectively. In final fully adjusted model, BMI value was a significant predictor of diabetes (RR = 1.39, 95%CI: 1.06-1.82 and AUC = 0.68, 95%CI: 0.59-0.75; P < 0.001) however not a significant risk factor for prediabetes. Also, WC was a significant predictor for diabetes (RR = 1.2, 95%CI: 1.05-1.38 and AUC = 0.67, 95%CI: 0.6-0.75) but not significant risk factor for prediabetes. Similar results were observed in both genders.

CONCLUSION:
General and abdominal obesity are significant risk factors for diabetes in future.

KEYWORDS:
Anthropometric measure; Body mass index; Diabetes; Prediabetes; Waist circumference
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Re: Optimum BMI?

Postby JeffN » Sun Jul 30, 2017 5:47 am

How to solve the obesity epidemic (and it's not better healthcare)
FT
July 2017

https://www.ft.com/content/04208e68-718 ... bd07df1a3c

We now know how to live longer. A third of American premature deaths could be prevented if people exercised more, ate healthily or didn’t smoke, according to the US National Research Council and Institute of Medicine. That’s about 867,000 lives a year. Saving just 10 per cent of them could significantly lengthen US lifespans.

In comparison, the country’s opioid epidemic and the Republican assault on health insurance matter less. Yes, it’s terrible that about 59,000 Americans died last year of drug overdoses.
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Re: Optimum BMI?

Postby JeffN » Tue Aug 15, 2017 5:54 am

Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis
European Heart Journal, ehx448,
https://doi.org/10.1093/eurheartj/ehx448
Published: 14 August 2017

Abstract

Aims
The hypothesis of ‘metabolically healthy obesity’ implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk. We tested this hypothesis in a large pan-European prospective study.

Methods and results
We conducted a case-cohort analysis in the 520 000-person European Prospective Investigation into Cancer and Nutrition study (‘EPIC-CVD’). During a median follow-up of 12.2 years, we recorded 7637 incident coronary heart disease (CHD) cases. Using cut-offs recommended by guidelines, we defined obesity and overweight using body mass index (BMI), and metabolic dysfunction (‘unhealthy’) as ≥ 3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI) within each country using Prentice-weighted Cox proportional hazard regressions, accounting for age, sex, centre, education, smoking, diet, and physical activity. Compared with metabolically healthy normal weight people (reference), HRs were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses.

Conclusion
Irrespective of BMI, metabolically unhealthy individuals had higher CHD risk than their healthy counterparts. Conversely, irrespective of metabolic health, overweight and obese people had higher CHD risk than lean people. These findings challenge the concept of ‘metabolically healthy obesity’, encouraging population-wide strategies to tackle obesity.


Mass media article

People who are 'fat but fit' still face higher risk of heart disease
The Independent
By Ella Pickover
Tuesday 15 August 2017

"Even overweight and obese people who were deemed 'healthy' by their metabolic markers carried a higher risk"

http://www.independent.co.uk/news/uk/ho ... 93746.html
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Re: Optimum BMI?

Postby JeffN » Fri Oct 06, 2017 7:05 am

CDC: 40% of cancers diagnosed in U.S. related to obesity

The rates of 12 obesity-related cancers rose by 7 per cent from 2005 to 2014, which threatens to reverse progress in reducing rates in the United States.

http://www.cbc.ca/news/health/cancer-obesity-1.4326982

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Re: Optimum BMI?

Postby JeffN » Wed Dec 06, 2017 3:45 pm

Nothing new but more confirmation about the supposed J curve of BMI
Jeff

Confounding by ill health in the observed association between BMI and mortality: evidence from the HUNT Study using offspring BMI as an instrument.
Carslake D, Davey Smith G, Gunnell D, Davies N, Nilsen TIL, Romundstad P.
Int J Epidemiol. 2017 Dec 1. doi: 10.1093/ije/dyx246. [Epub ahead of print]
PMID: 29206928
https://academic.oup.com/ije/advance-ar ... 46/4653787
https://watermark.silverchair.com/dyx246.pdf

Abstract

BACKGROUND:
The observational association between mortality and body mass index (BMI) is U-shaped, leading to highly publicized suggestions that moderate overweight is beneficial to health. However, it is unclear whether elevated mortality is caused by low BMI or if the association is confounded, for example by concurrent ill health.

METHODS:
Using HUNT, a Norwegian prospective study, 32 452 mother-offspring and 27 747 father-offspring pairs were followed up to 2009. Conventional hazard ratios for parental mortality per standard deviation of BMI were estimated using Cox regression adjusted for behavioural and socioeconomic factors. To estimate hazard ratios with reduced susceptibility to confounding, particularly from concurrent ill health, the BMI of parents' offspring was used as an instrumental variable for parents' own BMI. The shape of mortality-BMI associations was assessed using cubic splines.

RESULTS:
There were 18 365 parental deaths during follow-up. Conventional associations of mortality from all-causes, cardiovascular disease and cancer with parents' own BMI were substantially nonlinear, with elevated mortality at both extremes and minima at 21-25 kg m-2. Equivalent associations with offspring BMI were positive and there was no evidence of elevated parental mortality at low offspring BMI. The linear instrumental variable hazard ratio for all-cause mortality per standard deviation increase in BMI was 1.18 (95% confidence interval: 1.10, 1.26), compared with 1.05 (1.03, 1.06) in the conventional analysis.

CONCLUSIONS:
Elevated mortality rates at high BMI appear causal, whereas excess mortality at low BMI is likely exaggerated by confounding by factors including concurrent ill health. Conventional studies probably underestimate the adverse population health consequences of overweight.
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Re: Optimum BMI?

Postby JeffN » Sat Dec 09, 2017 10:38 am

Mass Media Article

The 'obesity paradox' is nonsense: Study refutes myth that fatter people have healthier hearts in old age
By Natalie Rahhal For Dailymail.com
PUBLISHED: 14:40 EST, 7 December 2017 | UPDATED: 14:47 EST, 7 December 2017
http://www.dailymail.co.uk/health/artic ... veals.html

* Previous research has suggested that obese people are more likely survive cardiovascular disease in old age
* The so-called 'obesity paradox' hinges on biased study methods, according to new research
* Obesity is known to increase the likelihood of developing cardiovascular disease
* Once the researchers examined pre-diagnosis weights, overweight and obese people with heart diseases were at just as great a risk of death as others



Published Study

The obesity paradox and incident cardiovascular disease: A population-based study
Virginia W. Chang , Kenneth M. Langa, David Weir, Theodore J. Iwashyna
PLOS one
Published: December 7, 2017
https://doi.org/10.1371/journal.pone.0188636

http://journals.plos.org/plosone/articl ... ne.0188636
Abstract

Background
Prior work suggests that obesity may confer a survival advantage among persons with cardiovascular disease (CVD). This obesity “paradox” is frequently studied in the context of prevalent disease, a stage in the disease process when confounding from illness-related weight loss and selective survival are especially problematic. Our objective was to examine the association of obesity with mortality among persons with incident CVD, where biases are potentially reduced, and to compare these findings with those based on prevalent disease.

Methods
We used data from the Health and Retirement Study, an ongoing, nationally representative longitudinal survey of U.S. adults age 50 years and older initiated in 1992 and linked to Medicare claims. Cox proportional hazard models were used to estimate the association between weight status and mortality among persons with specific CVD diagnoses. CVD diagnoses were established by self-reported survey data as well as Medicare claims. Prevalent disease models used concurrent weight status, and incident disease models used pre-diagnosis weight status.

Results
We examined myocardial infarction, congestive heart failure, stroke, and ischemic heart disease. A strong and significant obesity paradox was consistently observed in prevalent disease models (hazard of death 18–36% lower for obese class I relative to normal weight), replicating prior findings. However, in incident disease models of the same conditions in the same dataset, there was no evidence of this survival benefit. Findings from models using survey- vs. claims-based diagnoses were largely consistent.

Conclusion
We observed an obesity paradox in prevalent CVD, replicating prior findings in a population-based sample with longer-term follow-up. In incident CVD, however, we did not find evidence of a survival advantage for obesity. Our findings do not offer support for reevaluating clinical and public health guidelines in pursuit of a potential obesity paradox.
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Re: Optimum BMI?

Postby JeffN » Fri Mar 09, 2018 7:25 am

This is an excellent article on BMI, its history and its value. It also looks at whether the upper end of the BMI range considered "normal" weight, may actually be to high for menopausal women.

Medical News & Perspectives
March 7, 2018
Postmenopausal Women With a “Normal” BMI Might Be Overweight or Even Obese
Rita Rubin, MA
JAMA. Published online March 7, 2018. doi:10.1001/jama.2018.0423

https://jamanetwork.com/journals/jama/f ... le/2674709

"The standard BMI cutoff of 25 for overweight and 30 for obesity might be too high for postmenopausal women because their body composition changes over time. As they age, women tend to lose bone and muscle mass, which are heavier than fat. So even if a 65-year-old woman weighs the same as she did at 25 years of age, fat accounts for a larger share of her weight. And that fat isn’t distributed in her body the way it was at age 25 years. More of it is visceral fat stored in the abdomen, as opposed to subcutaneous fat, and the former is riskier than the latter. Visceral fat has been linked to metabolic dysfunction, including higher total cholesterol and lower-density lipoprotein (“bad cholesterol”) as well as insulin resistance. Banack and her coauthors found that most of the women whose body fat percentage was 35% or more—which meant they were obese and at a greater risk of obesity-related health problems—had a BMI below 30. Broken down by body fat percentage, only 32.4% of women with 35% body fat, 44.6% of women with 38% body fat, and 55.2% of those with 40% body fat had a BMI of 30 or greater in Banack’s study."
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Re: Optimum BMI?

Postby JeffN » Thu May 24, 2018 6:36 pm

From the 2018 AICR report on Diet, Nutrition, Physical Activity, and Cancer: A Global Perspective.

A comprehensive analysis of the global research by independent experts from around the world and covers 17 cancer sites, including colorectal, breast, ovarian and prostate. Findings are based on the data of 51 million people, including 3.5 million cancer cases.

On BodyWeight

http://www.aicr.org/reduce-your-cancer- ... revention/

Keep your weight within the healthy range and avoid weight gain in adult life

Next to not smoking, maintaining a healthy weight is the most important thing you can do to reduce your risk of cancer.Aim to be at the lower end of the healthy Body Mass Index (BMI) range.

Body fat doesn’t just sit there on our waists – it acts like a ‘hormone pump’ releasing insulin, estrogen and other hormones into the bloodstream, which can spur cancer growth.
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Re: Optimum BMI?

Postby JeffN » Tue May 29, 2018 9:05 am

While this was done through bariatric surgery, and not published yet, the impact of weight loss on melanoma was very impressive

Ill keep an eye out for the formal pubslished paper

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Jeff


Study finds that obesity surgery is associated with a massive fall in risk of melanoma skin cancer
23-May-2018
European Association for the Study of Obesity

https://www.eurekalert.org/pub_releases ... 052218.php

New research presented at the European Congress on Obesity in Vienna, Austria (23-26 May), shows that obesity (bariatric) surgery is associated with a 61% fall in the risk of developing malignant melanoma skin cancer, and a 42% drop in the risk of skin cancer in general. The study is by Magdalena Taube and colleagues from University of Gothenburg, Sweden.

Melanoma is a deadly skin cancer, the incidence of which has increased steadily in many countries of the world, especially high-income countries. For example, in the UK, cases have more than doubled since the 1990s, and it is the fifth most common cancer in men and women, with over 15,000 cases each year and more than 2,000 deaths.*

Obesity is an established risk factor for cancer and some studies indicate that intentional weight loss sometimes reduces the risk. However, evidence for a link between obesity, weight loss, and malignant melanoma is limited. In this study, the authors used data from the matched Swedish Obese Subjects (SOS) study - a prospective controlled intervention trial examining bariatric surgery outcomes - to analyse the impact of weight loss on melanoma incidence.

The surgery group consists of 2007 subjects who chose surgical treatment, and the control group consists of 2040 individuals matched for 18 variables (including sex, age, anthropometric measurements, cardiovascular risk factors, psychosocial variables, and personality traits). To analyse malignant melanoma incidence, statistical tests were used to compare time to first melanoma cancer diagnosis between the surgery and control groups. In additional analyses, risk ratios between the surgery and control groups were compared.

The authors found that bariatric surgery markedly reduced the risk of melanoma. Over a median follow-up time of 18 years, they observed a 61% reduced risk of malignant melanoma and a 42% reduced risk of skin cancer in general compared to controls given usual obesity care.

The authors conclude: "In this long?term study, bariatric surgery reduced the risk of malignant melanoma. This finding supports the idea that obesity is a melanoma risk factor, and indicates that weight loss in individuals with obesity can reduce the risk of a deadly form of cancer that has increased steadily in many countries over several decades."
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Re: Optimum BMI?

Postby JeffN » Thu Jun 21, 2018 10:58 am

Body mass index, abdominal fatness, and hypertension incidence: a dose-response meta-analysis of prospective studies
J Hum Hypertens. 2018 May;32(5):321-333.
doi: 10.1038/s41371-018-0046-1.
Epub 2018 Mar 27.
PMID: 29581553

Abstract
Despite the established relationship of obesity to hypertension, the question as to whether there is a linear association between these two morbidities is unanswered. To quantitatively evaluate the relationship between obesity and hypertension, we carried out a dose-response meta-analysis of studies that looked at the relationship of different adiposity measures to hypertension. We searched PubMed, Embase, and Web of Science databases for articles published before 27 June 2017. A random-effects model was used to pool relative risks and 95% confidence intervals. Restricted cubic spline analysis was used to model the relationship. A total of 59 studies were included. Fifty-seven cohort studies with 125,071 incident cases among 830,685 participants were included in the analysis of body mass index and hypertension with the summary relative risk for per 5-unit increment in body mass index of 1.50 (95% confidence interval: 1.40-1.59). We found that the risk of hypertension in the body mass index analysis was greater in populations where the baseline body mass index was <25 kg/m2. The summary relative risk for a 10-cm increase in waist circumference was 1.25 (95% confidence interval: 1.19-1.32) and per 0.1-unit increase in waist-to-hip ratio was 1.27 (95% confidence interval: 1.18-1.37). This meta-analysis suggests that in normal range of obesity indexes, as lean as possible may be the best suggestion to prevent hypertension incidence.
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Re: Optimum BMI?

Postby JeffN » Fri Aug 17, 2018 6:31 am

I guess sometimes more is better

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Article in Press
Long-Term Weight Loss and Metabolic Health in Adults Concerned With Maintaining or Losing Weight: Findings From NHANES
Knell, Gregory et al.
Mayo Clinic Proceedings , Volume 0 , Issue 0 ,
DOI: https://doi.org/10.1016/j.mayocp.2018.04.018
https://www.mayoclinicproceedings.org/a ... 25-6196(18)30323-9/fulltext

Abstract
More than two-thirds of American adults are overweight or obese, with many attempting to lose weight to avoid adverse health outcomes and improve well-being. Achieving long-term weight loss (LTWL) success, defined as reaching at least a 5% to 10% weight loss goal, is challenging, yet important for overall metabolic health. It is currently unclear whether achieving higher thresholds of LTWL is associated with improved health. Therefore, the purpose of this study was to examine the association between LTWL thresholds (5%-9.9%, 10%-14.9%, 15%-19.9%, ≥20%) and metabolic health (metabolic syndrome and metabolic risk z score) among 7670 US adult respondents to the National Health and Nutrition Examination Survey (2007-2014) who were overweight or obese (past or present), were not underweight in the past year, not pregnant, and attempting to lose or maintain weight. A subsample of 3362 participants was used in the analysis of the metabolic risk z score. Multivariable regression models were constructed adjusting for covariates. Results indicate that the lowest and the 2 highest LTWL thresholds were related to lower odds for metabolic syndrome; for example, greater than or equal to 20% LTWL (odds ratio=0.52; 95% CI, 0.23-0.44; P<.001). All LTWL thresholds were significantly associated with the metabolic risk z score, with the largest effect among the 2 highest LTWL thresholds, that is, 15% to 19.9% LTWL (β=−0.45; 95% CI, −0.54 to −0.36; P<.001) and greater than or equal to 20% LTWL (β=−0.35; 95% CI, −0.53 to −0.17; P<.001). In conclusion, although achieving the currently recommended LTWL target was related to improved metabolic health, the 15% LTWL threshold was associated with more favorable outcomes.

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NYTimes Article
Any Weight Loss Can Be Healthful, but More Can Be Much Better
By Nicholas Bakalar
Aug. 15, 2018


"Overweight people who lost 5 to 10 percent of their weight lowered their risk for metabolic syndrome by 22 percent. Those who lost 20 percent cut their risk by over 50 percent."

https://www.nytimes.com/2018/08/15/well ... etter.html
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Re: Optimum BMI?

Postby JeffN » Fri Oct 19, 2018 1:12 pm

This study addresses the question about whether BMI is a good marker of health since there can be many cofounders (body fat, muscle mass, etc). In addition, it also furthers supports a concern I have expressed here often since I put up the recommendation to “aim” for a BMI of 18.5 - 22.5, that lower may not always be better and 18.5 is not the optimal goal.

Just check out the chart.

The results are 100% in line with the 2018 AICR Report on Cancer, and the American Cancer Institute, which recommend, to be as lean as possible within the healthy range for weight.

In Health
Jeff


EDITOR'S CHOICE
The impact of confounding on the associations of different adiposity measures with the incidence of cardiovascular disease: a cohort study of 296 535 adults of white European descent.
European Heart Journal, Volume 39, Issue 17, 1 May 2018, Pages 1514–1520, https://doi.org/10.1093/eurheartj/ehy057
Published: 16 March 2018

https://academic.oup.com/eurheartj/arti ... 14/4937957

Abstract

Aims
The data regarding the associations of body mass index (BMI) with cardiovascular (CVD) risk, especially for those at the low categories of BMI, are conflicting. The aim of our study was to examine the associations of body composition (assessed by five different measures) with incident CVD outcomes in healthy individuals.

Methods and results
A total of 296 535 participants (57.8% women) of white European descent without CVD at baseline from the UK biobank were included. Exposures were five different measures of adiposity. Fatal and non-fatal CVD events were the primary outcome. Low BMI (≤18.5 kg m−2) was associated with higher incidence of CVD and the lowest CVD risk was exhibited at BMI of 22–23 kg m−2 beyond, which the risk of CVD increased. This J-shaped association attenuated substantially in subgroup analyses, when we excluded participants with comorbidities. In contrast, the associations for the remaining adiposity measures were more linear; 1 SD increase in waist circumference was associated with a hazard ratio of 1.16 [95% confidence interval (CI) 1.13–1.19] for women and 1.10 (95% CI 1.08–1.13) for men with similar magnitude of associations for 1 SD increase in waist-to-hip ratio, waist-to-height ratio, and percentage body fat mass.

Conclusion
Increasing adiposity has a detrimental association with CVD health in middle-aged men and women. The association of BMI with CVD appears more susceptible to confounding due to pre-existing comorbidities when compared with other adiposity measures. Any public misconception of a potential ‘protective’ effect of fat on CVD risk should be challenged.

From the article:
In conclusion, increasing adiposity, whether total body and ‘central’ adiposity measures, have generally adverse associations with CVD outcomes in middle-aged men and women. Public health campaigns should emphasize the importance of an individual intentionally maintaining as lean a phenotype as possible to gain maximum CVD benefits. The association of BMI with CVD is more susceptible to bias rather than other adiposity measures and, therefore, health care professionals should challenge any public misconception of some ‘protective’ effect of fat on CVD risk.

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Re: Optimum BMI?

Postby JeffN » Sat May 11, 2019 2:42 pm

Epidemiology and population health
Fate of the metabolically healthy obese—is this term a misnomer?
A study from the Clinical Practice Research Datalink
International Journal of Obesityvolume 43, pages1093–1101 (2019)

https://www.nature.com/articles/s41366-018-0096-z

Abstract

Introduction
The metabolically healthy obese (MHO) phenotype may express typical characteristics on long-term follow-up. Little is known about the initiation of this phenotypes and its future stability.

Aim
The Clinical Practice Research Datalink (CPRD) is a large-scale primary care database. The aim of this study was to assess the stability of, and evaluate the factors associated with a transition into an unhealthy outcome in, a MHO population in the UK.

Methods
The CPRD was interrogated for a diagnosis of ‘obesity’ and cross-referenced with a body mass index (BMI) ≥35 kg/m2; participants were further classified as MH using a clinical diagnostic code or a relative therapeutic code. A hazard cox regression univariate and multivariate analysis evaluated the time to transition for independent variables.

Results
There were 231,399 patients with a recorded BMI of 35 kg/m2 or greater. Incomplete records were eliminated and follow-up limited to 300 months, the cohort was reduced to 180,560 patients. The prevalence of MHO within the obese population from the CPRD was 128,191/180,560 (71%). MHO individuals, who were of male gender (hazard ratio (HR) 1.23 (1.21–1.25), p = < 0.01), older age group (HR 3.93 (3.82–4.04), p = < 0.01), BMI of 50–60 kg/m2 at baseline (HR 1.32(1.26–1.38), p = 0.01), smokers (HR 1.07(1.05–1.09), p = < 0.01) and regionally from North West England (HR 1.15(1.09–1.21), p = < 0.01) were more prone to an unhealthy transition (to develop comorbidities). Overall, of those MH at baseline, 71,485/128,191(55.8%) remained healthy on follow-up, with a mean follow-up of 113.5 (standard deviations (SD) 78.6) months or 9.4 (SD 6.6) years.

Conclusions
From this unique large data set, there is a greater prevalence of MHO individuals in the UK population than in published literature elsewhere. Female gender, younger age group, and lower initial weight and BMI were found to be significant predictors of sustained metabolic health in this cohort. However, there remains a steady progressive transition from a healthy baseline over the years.
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Re: Optimum BMI?

Postby JeffN » Mon Jul 15, 2019 8:11 am

Are you trapped by your genes?

No.

And, those who had a genetic susceptibility to obesity benefited the most by eating healthy

Improving fruit and vegetable intake attenuates the genetic association with long-term weight gain.
Am J Clin Nutr. 2019 Jul 13. pii: nqz136. doi: 10.1093/ajcn/nqz136. [Epub ahead of print]

Abstract

BACKGROUND:
Whether changes in fruit and vegetable intake can modify the effect of genetic susceptibility to obesity on long-term changes in BMI and body weight are uncertain.

OBJECTIVE:
We analyzed the interactions of changes in total and specific fruit and vegetable intake with genetic susceptibility to obesity in relation to changes in BMI and body weight.

METHODS:
We calculated a genetic risk score on the basis of 77 BMI-associated loci to determine the genetic susceptibility to obesity, and examined the interactions of changes in total and specific fruit and vegetable intake with the genetic risk score on changes in BMI and body weight within five 4-y intervals over 20 y of follow-up in 8943 women from the Nurses' Health Study (NHS) and 5308 men from the Health Professionals Follow-Up Study (HPFS).

RESULTS:
In the combined cohorts, repeated 4-y BMI change per 10-risk allele increment was 0.09 kg/m2 among participants with the greatest decrease in total fruit and vegetable intake and -0.02 among those with the greatest increase in intake (P-interaction <0.001; corresponding weight change: 0.20 kg compared with -0.06 kg). The magnitude of decrease in BMI associated with increasing fruit and vegetable intake was more prominent among participants with high genetic risk than those with low risk. Reproducible interactions were observed for fruits and vegetables separately (both P-interaction <0.001). Based on similar nutritional content, the interaction effect was greatest for berries, citrus fruits, and green leafy vegetables, and the interaction pattern persisted regardless of the different fiber content or glycemic load of fruits and vegetables.

CONCLUSIONS:
Genetically associated increased BMI and body weight could be mitigated by increasing fruit and vegetable intake, and the beneficial effect of improving fruit and vegetable intake on weight management was more pronounced in individuals with greater genetic susceptibility to obesity.
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Re: Optimum BMI?

Postby JeffN » Mon Aug 12, 2019 5:40 pm

General and Abdominal Adiposity and Mortality in Mexico City: Prospective Study of 150 000 Adults
Ann Intern Med. [Epub ahead of print 13 August 2019] doi: 10.7326/M18-3502

https://annals.org/aim/article-abstract ... dy-150-000

Abstract

Background:
Some reports suggest that body mass index (BMI) is not strongly associated with mortality in Hispanic populations.

Objective:
To assess the causal relevance of adiposity to mortality in Mexican adults, avoiding reverse causality biases.

Design:
Prospective study.

Setting:
2 Mexico City districts.

Participants:
159 755 adults aged 35 years and older at recruitment, followed for up to 14 years. Participants with a hemoglobin A1c level of 7% or greater, diabetes, or other chronic diseases were excluded.

Measurements:
BMI, waist-to-hip ratio, waist circumference, and cause-specific mortality. Cox regression, adjusted for confounders, yielded mortality hazard ratios (HRs) after at least 5 years of follow-up and before age 75 years.

Results:
Among 115 400 participants aged 35 to <75 years at recruitment, mean BMI was 28.0 kg/m2 (SD, 4.1 kg/m2) in men and 29.6 kg/m2 (SD, 5.1 kg/m2) in women. The association of BMI at recruitment with all-cause mortality was J-shaped, with the minimum at 25 to <27.5 kg/m2. Above 25 kg/m2, each 5-kg/m2 increase in BMI was associated with a 30% increase in all-cause mortality (HR, 1.30 [95% CI, 1.24 to 1.36]). This association was stronger at ages 40 to <60 years (HR, 1.40 [CI, 1.30 to 1.49]) than at ages 60 to <75 years (HR, 1.24 [CI, 1.17 to 1.31]) but was not materially affected by sex, smoking, or other confounders. The associations of mortality with BMI and waist-to-hip ratio were similarly strong, and each was weakened only slightly by adjustment for the other. Waist circumference was strongly related to mortality and remained so even after adjustment for BMI and hip circumference.

Limitations:
Analyses were limited to mortality.

Conclusion:
General, and particularly abdominal, adiposity were strongly associated with mortality in this Mexican population
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