The age‐related obesity paradigm: results from two large prospective cohort studies
Abstract Background The obesity paradigm has been a health concern globally for many years, its meaning is controversial. In this study, we assess the characteristics and causes of obesity paradigm and detail the mediation of obesity and inflammation on survival. Methods The original cohort included...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-02-01
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| Series: | Journal of Cachexia, Sarcopenia and Muscle |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jcsm.13415 |
| _version_ | 1797335186750308352 |
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| author | Yi‐Zhong Ge Tong Liu Li Deng Qi Zhang Chen‐An Liu Guo‐Tian Ruan Hai‐Lun Xie Meng‐Meng Song Shi‐Qi Lin Qin‐Hua Yao Xian Shen Han‐Ping Shi Investigation on the Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) Group |
| author_facet | Yi‐Zhong Ge Tong Liu Li Deng Qi Zhang Chen‐An Liu Guo‐Tian Ruan Hai‐Lun Xie Meng‐Meng Song Shi‐Qi Lin Qin‐Hua Yao Xian Shen Han‐Ping Shi Investigation on the Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) Group |
| author_sort | Yi‐Zhong Ge |
| collection | DOAJ |
| description | Abstract Background The obesity paradigm has been a health concern globally for many years, its meaning is controversial. In this study, we assess the characteristics and causes of obesity paradigm and detail the mediation of obesity and inflammation on survival. Methods The original cohort included participants from the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, a prospective cohort of a nationally representative sample of adult participants; the oncology validation cohort included patients from the Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) from 2013 to 2021, a prospective cohort of Chinese patients with cancer. Survival analysis was performed using weighted (NHANES) or unweighted (INSCOC) Cox survival analyses. The normal BMI group was used as a reference for all comparisons. Systemic inflammation was defined as neutrophil‐to‐lymphocyte ratio (NLR) > 3. Model‐based causal mediation analysis was used to identify the mediators. Results A total of 52 270 (weighted population: 528506229) participants of the NHANES [mean follow‐up times: 10.2 years; mean age (SD): 47 (19.16) years] were included in the original cohort; and a total of 17 418 patients with cancer of INSCOC [mean follow‐up times: 2.9 years; mean age (SD): 57.37 (11.66) years] were included in the validation cohort. In the subgroups of all the participants, the obesity paradigm was more apparent in older participants and participants with disease [HR (95% CI): age ≥ 65 years, 0.84 (0.76, 0.93); with cancer, 0.84 (0.71, 0.99); with CVD, 0.74 (0.65, 0.85)]. As aged, the protective effect of a high BMI on survival gradually increased and a high BMI showed the effect of a protective factor on older participants [for obese II, HR (95% CI): young adults, 1.91 (1.40, 2.62); middle age, 1.56 (1.28, 1.91); old adults, 0.85 (0.76, 0.96]). The aged‐related obesity paradigm in patients with cancer from the NHANES was verified in the INSCOC cohorts [for obese, HR (95%CI): 0.65 (0.52, 0.81)]. The NLR is an important mediator of the effect of BMI on survival (proportion of mediation = 15.4%). Conclusions The obesity paradigm has a strong correlation with age. Relative to normal weight, obese in young people was association with higher all‐cause mortality, and obese in elderly people was not association with higher mortality. The protection of obesity is association with systemic inflammation. |
| first_indexed | 2024-03-08T08:33:16Z |
| format | Article |
| id | doaj.art-55e2e8ce44904c8f894e15609c5ba84c |
| institution | Directory Open Access Journal |
| issn | 2190-5991 2190-6009 |
| language | English |
| last_indexed | 2024-03-08T08:33:16Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Cachexia, Sarcopenia and Muscle |
| spelling | doaj.art-55e2e8ce44904c8f894e15609c5ba84c2024-02-02T02:28:29ZengWileyJournal of Cachexia, Sarcopenia and Muscle2190-59912190-60092024-02-0115144245210.1002/jcsm.13415The age‐related obesity paradigm: results from two large prospective cohort studiesYi‐Zhong Ge0Tong Liu1Li Deng2Qi Zhang3Chen‐An Liu4Guo‐Tian Ruan5Hai‐Lun Xie6Meng‐Meng Song7Shi‐Qi Lin8Qin‐Hua Yao9Xian Shen10Han‐Ping Shi11Investigation on the Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) GroupDepartment of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University Beijing ChinaDepartment of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University Beijing ChinaDepartment of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University Beijing ChinaDepartment of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University Beijing ChinaDepartment of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University Beijing ChinaDepartment of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University Beijing ChinaDepartment of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University Beijing ChinaDepartment of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University Beijing ChinaDepartment of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University Beijing ChinaDepartment of Integrated Chinese and Western Medicine, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC) Chinese Academy of Sciences Hangzhou ChinaThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou ChinaDepartment of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University Beijing ChinaAbstract Background The obesity paradigm has been a health concern globally for many years, its meaning is controversial. In this study, we assess the characteristics and causes of obesity paradigm and detail the mediation of obesity and inflammation on survival. Methods The original cohort included participants from the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, a prospective cohort of a nationally representative sample of adult participants; the oncology validation cohort included patients from the Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) from 2013 to 2021, a prospective cohort of Chinese patients with cancer. Survival analysis was performed using weighted (NHANES) or unweighted (INSCOC) Cox survival analyses. The normal BMI group was used as a reference for all comparisons. Systemic inflammation was defined as neutrophil‐to‐lymphocyte ratio (NLR) > 3. Model‐based causal mediation analysis was used to identify the mediators. Results A total of 52 270 (weighted population: 528506229) participants of the NHANES [mean follow‐up times: 10.2 years; mean age (SD): 47 (19.16) years] were included in the original cohort; and a total of 17 418 patients with cancer of INSCOC [mean follow‐up times: 2.9 years; mean age (SD): 57.37 (11.66) years] were included in the validation cohort. In the subgroups of all the participants, the obesity paradigm was more apparent in older participants and participants with disease [HR (95% CI): age ≥ 65 years, 0.84 (0.76, 0.93); with cancer, 0.84 (0.71, 0.99); with CVD, 0.74 (0.65, 0.85)]. As aged, the protective effect of a high BMI on survival gradually increased and a high BMI showed the effect of a protective factor on older participants [for obese II, HR (95% CI): young adults, 1.91 (1.40, 2.62); middle age, 1.56 (1.28, 1.91); old adults, 0.85 (0.76, 0.96]). The aged‐related obesity paradigm in patients with cancer from the NHANES was verified in the INSCOC cohorts [for obese, HR (95%CI): 0.65 (0.52, 0.81)]. The NLR is an important mediator of the effect of BMI on survival (proportion of mediation = 15.4%). Conclusions The obesity paradigm has a strong correlation with age. Relative to normal weight, obese in young people was association with higher all‐cause mortality, and obese in elderly people was not association with higher mortality. The protection of obesity is association with systemic inflammation.https://doi.org/10.1002/jcsm.13415AgingCancerInflammationObesity paradigm |
| spellingShingle | Yi‐Zhong Ge Tong Liu Li Deng Qi Zhang Chen‐An Liu Guo‐Tian Ruan Hai‐Lun Xie Meng‐Meng Song Shi‐Qi Lin Qin‐Hua Yao Xian Shen Han‐Ping Shi Investigation on the Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) Group The age‐related obesity paradigm: results from two large prospective cohort studies Journal of Cachexia, Sarcopenia and Muscle Aging Cancer Inflammation Obesity paradigm |
| title | The age‐related obesity paradigm: results from two large prospective cohort studies |
| title_full | The age‐related obesity paradigm: results from two large prospective cohort studies |
| title_fullStr | The age‐related obesity paradigm: results from two large prospective cohort studies |
| title_full_unstemmed | The age‐related obesity paradigm: results from two large prospective cohort studies |
| title_short | The age‐related obesity paradigm: results from two large prospective cohort studies |
| title_sort | age related obesity paradigm results from two large prospective cohort studies |
| topic | Aging Cancer Inflammation Obesity paradigm |
| url | https://doi.org/10.1002/jcsm.13415 |
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