Associations of obesity and malnutrition with cardiac remodeling and cardiovascular outcomes in Asian adults: A cohort study
Obesity, a known risk factor for cardiovascular disease and heart failure (HF), is associated with adverse cardiac remodeling in the general population. Little is known about how nutritional status modifies the relationship between obesity and outcomes. We aimed to investigate the association of obe...
Gespeichert in:
| Veröffentlicht in: | PLoS medicine 2021-06, Vol.18 (6), p.e1003661 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | |
|---|---|
| container_issue | 6 |
| container_start_page | e1003661 |
| container_title | PLoS medicine |
| container_volume | 18 |
| creator | Chien, Shih-Chieh Chandramouli, Chanchal Lo, Chi-In Lin, Chao-Feng Sung, Kuo-Tzu Huang, Wen-Hung Lai, Yau-Huei Yun, Chun-Ho Su, Cheng-Huang Yeh, Hung-I Hung, Ta-Chuan Hung, Chung-Lieh Lam, Carolyn S. P |
| description | Obesity, a known risk factor for cardiovascular disease and heart failure (HF), is associated with adverse cardiac remodeling in the general population. Little is known about how nutritional status modifies the relationship between obesity and outcomes. We aimed to investigate the association of obesity and nutritional status with clinical characteristics, echocardiographic changes, and clinical outcomes in the general community. We examined 5,300 consecutive asymptomatic Asian participants who were prospectively recruited in a cardiovascular health screening program (mean age 49.6 ± 11.4 years, 64.8% male) between June 2009 to December 2012. Clinical and echocardiographic characteristics were described in participants, stratified by combined subgroups of obesity and nutritional status. Obesity was indexed by body mass index (BMI) (low, [less than or equal to]25 kg/m.sup.2 [lean]; high, >25 kg/m.sup.2 [obese]) (WHO-recommended Asian cutoffs). Nutritional status was defined primarily by serum albumin (SA) concentration (low, |
| doi_str_mv | 10.1371/journal.pmed.1003661 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_plos_</sourceid><recordid>TN_cdi_plos_journals_2552288833</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A667303713</galeid><doaj_id>oai_doaj_org_article_489625865b4f4875b0cc2fa79194e346</doaj_id><sourcerecordid>A667303713</sourcerecordid><originalsourceid>FETCH-LOGICAL-c708t-28dfe1c8f681ac2964848553190cb8141287bc2f6643e474f477a990c37e69533</originalsourceid><addsrcrecordid>eNqVk1uL1DAUx4so7rr6DQQDguDDjEmTJqkPQlm8DCwueHsNaZp2MrTJbJKuDvjhzcxU2cIISh4Szvnlfw7nkmVPEVwizNCrjRu9lf1yO-hmiSDElKJ72TkqSLlAlNH7d95n2aMQNhDmJSzhw-wME0gRJ_w8-1mF4JSR0TgbgGuBq3UwcQekbcAgeztGb_ZO8N3ENVDSN0Yq4PXgGt0b2x3Ag9ndyqDGXnrgxqjcoAMwFlTBSAtkM_YxvAYVUG7tfAQhjs3ucfaglX3QT6b7Ivv67u2Xyw-Lq-v3q8vqaqEY5HGR86bVSPGWciRVXlKSUi8KjEqoao4IyjmrVd5SSrAmjLSEMVkmJ2aalgXGF9mzo-62d0FMhQsiL4o855zjPbE6Eo2TG7H1ZpB-J5w04mBwvhPSR6N6LQgvaV5wWtQpEGdFDVWKLVmJSqIxoUnrzRRtrFNvlLbRy34mOvdYsxaduxU8hwVieRJ4Pgl4dzPqEP-S8kR1MmVlbOuSmBpMUKKilGGYhmRPLU5QnbY6RXZWtyaZZ_zyBJ9OowejTn54OfuQmKh_xE6OIYjV50__wX78d_b625x9cYdda9nHdXD9eBjqOUiOoPIuBK_bP11BUOy36nelxX6rxLRV-BcidhGo</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2552288833</pqid></control><display><type>article</type><title>Associations of obesity and malnutrition with cardiac remodeling and cardiovascular outcomes in Asian adults: A cohort study</title><source>DOAJ Directory of Open Access Journals</source><source>Public Library of Science (PLoS) Journals Open Access</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Chien, Shih-Chieh ; Chandramouli, Chanchal ; Lo, Chi-In ; Lin, Chao-Feng ; Sung, Kuo-Tzu ; Huang, Wen-Hung ; Lai, Yau-Huei ; Yun, Chun-Ho ; Su, Cheng-Huang ; Yeh, Hung-I ; Hung, Ta-Chuan ; Hung, Chung-Lieh ; Lam, Carolyn S. P</creator><contributor>Wu, Jason</contributor><creatorcontrib>Chien, Shih-Chieh ; Chandramouli, Chanchal ; Lo, Chi-In ; Lin, Chao-Feng ; Sung, Kuo-Tzu ; Huang, Wen-Hung ; Lai, Yau-Huei ; Yun, Chun-Ho ; Su, Cheng-Huang ; Yeh, Hung-I ; Hung, Ta-Chuan ; Hung, Chung-Lieh ; Lam, Carolyn S. P ; Wu, Jason</creatorcontrib><description>Obesity, a known risk factor for cardiovascular disease and heart failure (HF), is associated with adverse cardiac remodeling in the general population. Little is known about how nutritional status modifies the relationship between obesity and outcomes. We aimed to investigate the association of obesity and nutritional status with clinical characteristics, echocardiographic changes, and clinical outcomes in the general community. We examined 5,300 consecutive asymptomatic Asian participants who were prospectively recruited in a cardiovascular health screening program (mean age 49.6 ± 11.4 years, 64.8% male) between June 2009 to December 2012. Clinical and echocardiographic characteristics were described in participants, stratified by combined subgroups of obesity and nutritional status. Obesity was indexed by body mass index (BMI) (low, [less than or equal to]25 kg/m.sup.2 [lean]; high, >25 kg/m.sup.2 [obese]) (WHO-recommended Asian cutoffs). Nutritional status was defined primarily by serum albumin (SA) concentration (low, <45 g/L [malnourished]; high, [greater than or equal to]45 g/L [well-nourished]), and secondarily by the prognostic nutritional index (PNI) and Global Leadership Initiative on Malnutrition (GLIM) criteria. Cox proportional hazard models were used to examine a 1-year composite outcome of hospitalization for HF or all-cause mortality while adjusting for age, sex, and other clinical confounders. Our community-based cohort consisted of 2,096 (39.0%) lean-well-nourished (low BMI, high SA), 1,369 (25.8%) obese-well-nourished (high BMI, high SA), 1,154 (21.8%) lean-malnourished (low BMI, low SA), and 681 (12.8%) obese-malnourished (high BMI, low SA) individuals. Obese-malnourished participants were on average older (54.5 ± 11.4 years) and more often women (41%), with a higher mean waist circumference (91.7 ± 8.8 cm), the highest percentage of body fat (32%), and the highest prevalence of hypertension (32%), diabetes (12%), and history of cardiovascular disease (11%), compared to all other subgroups (all p < 0.001). N-terminal pro B-type natriuretic peptide (NT-proBNP) levels were substantially increased in the malnourished (versus well-nourished) groups, to a similar extent in lean (70.7 ± 177.3 versus 36.8 ± 40.4 pg/mL) and obese (73.1 ± 216.8 versus 33.2 ± 40.8 pg/mL) (p < 0.001 in both) participants. The obese-malnourished (high BMI, low SA) group also had greater left ventricular remodeling (left ventricular mass index, 44.2 ± 1.52 versus 33.8 ± 8.28 gm/m.sup.2 ; relative wall thickness 0.39 ± 0.05 versus 0.38 ± 0.06) and worse diastolic function (TDI-e' 7.97 ± 2.16 versus 9.87 ± 2.47 cm/s; E/e' 9.19 ± 3.01 versus 7.36 ± 2.31; left atrial volume index 19.5 ± 7.66 versus 14.9 ± 5.49 mL/m.sup.2) compared to the lean-well-nourished (low BMI, high SA) group, as well as all other subgroups (p < 0.001 for all). Over a median 3.6 years (interquartile range 2.5 to 4.8 years) of follow-up, the obese-malnourished group had the highest multivariable-adjusted risk of the composite outcome (hazard ratio [HR] 2.49, 95% CI 1.43 to 4.34, p = 0.001), followed by the lean-malnourished (HR 1.78, 95% CI 1.04 to 3.04, p = 0.034) and obese-well-nourished (HR 1.41, 95% CI 0.77 to 2.58, p = 0.27) groups (with lean-well-nourished group as reference). Results were similar when indexed by other anthropometric indices (waist circumference and body fat) and other measures of nutritional status (PNI and GLIM criteria). Potential selection bias and residual confounding were the main limitations of the study. In our cohort study among asymptomatic community-based adults in Taiwan, we found that obese individuals with poor nutritional status have the highest comorbidity burden, the most adverse cardiac remodeling, and the least favorable composite outcome.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1003661</identifier><identifier>PMID: 34061848</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Biology and Life Sciences ; Body composition ; Body fat ; Body mass index ; Brain natriuretic peptide ; Cardiovascular disease ; Cardiovascular diseases ; Cholesterol ; Cohort analysis ; Complications and side effects ; Congestive heart failure ; Coronary artery disease ; Diabetes ; Diabetes mellitus ; Ejection fraction ; Heart ; Hospitals ; Hypertension ; Immunoassay ; Laboratories ; Malnutrition ; Medical screening ; Medicine and Health Sciences ; Metabolism ; Normal distribution ; Nutrition research ; Nutritional status ; Obesity ; Population ; Risk factors ; Ventricle ; Weight control ; Womens health</subject><ispartof>PLoS medicine, 2021-06, Vol.18 (6), p.e1003661</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Chien et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Chien et al 2021 Chien et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c708t-28dfe1c8f681ac2964848553190cb8141287bc2f6643e474f477a990c37e69533</citedby><cites>FETCH-LOGICAL-c708t-28dfe1c8f681ac2964848553190cb8141287bc2f6643e474f477a990c37e69533</cites><orcidid>0000-0003-1903-0018 ; 0000-0002-1859-6661 ; 0000-0002-2463-1726 ; 0000-0001-8256-902X ; 0000-0002-6865-855X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205172/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205172/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793</link.rule.ids></links><search><contributor>Wu, Jason</contributor><creatorcontrib>Chien, Shih-Chieh</creatorcontrib><creatorcontrib>Chandramouli, Chanchal</creatorcontrib><creatorcontrib>Lo, Chi-In</creatorcontrib><creatorcontrib>Lin, Chao-Feng</creatorcontrib><creatorcontrib>Sung, Kuo-Tzu</creatorcontrib><creatorcontrib>Huang, Wen-Hung</creatorcontrib><creatorcontrib>Lai, Yau-Huei</creatorcontrib><creatorcontrib>Yun, Chun-Ho</creatorcontrib><creatorcontrib>Su, Cheng-Huang</creatorcontrib><creatorcontrib>Yeh, Hung-I</creatorcontrib><creatorcontrib>Hung, Ta-Chuan</creatorcontrib><creatorcontrib>Hung, Chung-Lieh</creatorcontrib><creatorcontrib>Lam, Carolyn S. P</creatorcontrib><title>Associations of obesity and malnutrition with cardiac remodeling and cardiovascular outcomes in Asian adults: A cohort study</title><title>PLoS medicine</title><description>Obesity, a known risk factor for cardiovascular disease and heart failure (HF), is associated with adverse cardiac remodeling in the general population. Little is known about how nutritional status modifies the relationship between obesity and outcomes. We aimed to investigate the association of obesity and nutritional status with clinical characteristics, echocardiographic changes, and clinical outcomes in the general community. We examined 5,300 consecutive asymptomatic Asian participants who were prospectively recruited in a cardiovascular health screening program (mean age 49.6 ± 11.4 years, 64.8% male) between June 2009 to December 2012. Clinical and echocardiographic characteristics were described in participants, stratified by combined subgroups of obesity and nutritional status. Obesity was indexed by body mass index (BMI) (low, [less than or equal to]25 kg/m.sup.2 [lean]; high, >25 kg/m.sup.2 [obese]) (WHO-recommended Asian cutoffs). Nutritional status was defined primarily by serum albumin (SA) concentration (low, <45 g/L [malnourished]; high, [greater than or equal to]45 g/L [well-nourished]), and secondarily by the prognostic nutritional index (PNI) and Global Leadership Initiative on Malnutrition (GLIM) criteria. Cox proportional hazard models were used to examine a 1-year composite outcome of hospitalization for HF or all-cause mortality while adjusting for age, sex, and other clinical confounders. Our community-based cohort consisted of 2,096 (39.0%) lean-well-nourished (low BMI, high SA), 1,369 (25.8%) obese-well-nourished (high BMI, high SA), 1,154 (21.8%) lean-malnourished (low BMI, low SA), and 681 (12.8%) obese-malnourished (high BMI, low SA) individuals. Obese-malnourished participants were on average older (54.5 ± 11.4 years) and more often women (41%), with a higher mean waist circumference (91.7 ± 8.8 cm), the highest percentage of body fat (32%), and the highest prevalence of hypertension (32%), diabetes (12%), and history of cardiovascular disease (11%), compared to all other subgroups (all p < 0.001). N-terminal pro B-type natriuretic peptide (NT-proBNP) levels were substantially increased in the malnourished (versus well-nourished) groups, to a similar extent in lean (70.7 ± 177.3 versus 36.8 ± 40.4 pg/mL) and obese (73.1 ± 216.8 versus 33.2 ± 40.8 pg/mL) (p < 0.001 in both) participants. The obese-malnourished (high BMI, low SA) group also had greater left ventricular remodeling (left ventricular mass index, 44.2 ± 1.52 versus 33.8 ± 8.28 gm/m.sup.2 ; relative wall thickness 0.39 ± 0.05 versus 0.38 ± 0.06) and worse diastolic function (TDI-e' 7.97 ± 2.16 versus 9.87 ± 2.47 cm/s; E/e' 9.19 ± 3.01 versus 7.36 ± 2.31; left atrial volume index 19.5 ± 7.66 versus 14.9 ± 5.49 mL/m.sup.2) compared to the lean-well-nourished (low BMI, high SA) group, as well as all other subgroups (p < 0.001 for all). Over a median 3.6 years (interquartile range 2.5 to 4.8 years) of follow-up, the obese-malnourished group had the highest multivariable-adjusted risk of the composite outcome (hazard ratio [HR] 2.49, 95% CI 1.43 to 4.34, p = 0.001), followed by the lean-malnourished (HR 1.78, 95% CI 1.04 to 3.04, p = 0.034) and obese-well-nourished (HR 1.41, 95% CI 0.77 to 2.58, p = 0.27) groups (with lean-well-nourished group as reference). Results were similar when indexed by other anthropometric indices (waist circumference and body fat) and other measures of nutritional status (PNI and GLIM criteria). Potential selection bias and residual confounding were the main limitations of the study. In our cohort study among asymptomatic community-based adults in Taiwan, we found that obese individuals with poor nutritional status have the highest comorbidity burden, the most adverse cardiac remodeling, and the least favorable composite outcome.</description><subject>Biology and Life Sciences</subject><subject>Body composition</subject><subject>Body fat</subject><subject>Body mass index</subject><subject>Brain natriuretic peptide</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Cholesterol</subject><subject>Cohort analysis</subject><subject>Complications and side effects</subject><subject>Congestive heart failure</subject><subject>Coronary artery disease</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Ejection fraction</subject><subject>Heart</subject><subject>Hospitals</subject><subject>Hypertension</subject><subject>Immunoassay</subject><subject>Laboratories</subject><subject>Malnutrition</subject><subject>Medical screening</subject><subject>Medicine and Health Sciences</subject><subject>Metabolism</subject><subject>Normal distribution</subject><subject>Nutrition research</subject><subject>Nutritional status</subject><subject>Obesity</subject><subject>Population</subject><subject>Risk factors</subject><subject>Ventricle</subject><subject>Weight control</subject><subject>Womens health</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>DOA</sourceid><recordid>eNqVk1uL1DAUx4so7rr6DQQDguDDjEmTJqkPQlm8DCwueHsNaZp2MrTJbJKuDvjhzcxU2cIISh4Szvnlfw7nkmVPEVwizNCrjRu9lf1yO-hmiSDElKJ72TkqSLlAlNH7d95n2aMQNhDmJSzhw-wME0gRJ_w8-1mF4JSR0TgbgGuBq3UwcQekbcAgeztGb_ZO8N3ENVDSN0Yq4PXgGt0b2x3Ag9ndyqDGXnrgxqjcoAMwFlTBSAtkM_YxvAYVUG7tfAQhjs3ucfaglX3QT6b7Ivv67u2Xyw-Lq-v3q8vqaqEY5HGR86bVSPGWciRVXlKSUi8KjEqoao4IyjmrVd5SSrAmjLSEMVkmJ2aalgXGF9mzo-62d0FMhQsiL4o855zjPbE6Eo2TG7H1ZpB-J5w04mBwvhPSR6N6LQgvaV5wWtQpEGdFDVWKLVmJSqIxoUnrzRRtrFNvlLbRy34mOvdYsxaduxU8hwVieRJ4Pgl4dzPqEP-S8kR1MmVlbOuSmBpMUKKilGGYhmRPLU5QnbY6RXZWtyaZZ_zyBJ9OowejTn54OfuQmKh_xE6OIYjV50__wX78d_b625x9cYdda9nHdXD9eBjqOUiOoPIuBK_bP11BUOy36nelxX6rxLRV-BcidhGo</recordid><startdate>20210601</startdate><enddate>20210601</enddate><creator>Chien, Shih-Chieh</creator><creator>Chandramouli, Chanchal</creator><creator>Lo, Chi-In</creator><creator>Lin, Chao-Feng</creator><creator>Sung, Kuo-Tzu</creator><creator>Huang, Wen-Hung</creator><creator>Lai, Yau-Huei</creator><creator>Yun, Chun-Ho</creator><creator>Su, Cheng-Huang</creator><creator>Yeh, Hung-I</creator><creator>Hung, Ta-Chuan</creator><creator>Hung, Chung-Lieh</creator><creator>Lam, Carolyn S. P</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope><orcidid>https://orcid.org/0000-0003-1903-0018</orcidid><orcidid>https://orcid.org/0000-0002-1859-6661</orcidid><orcidid>https://orcid.org/0000-0002-2463-1726</orcidid><orcidid>https://orcid.org/0000-0001-8256-902X</orcidid><orcidid>https://orcid.org/0000-0002-6865-855X</orcidid></search><sort><creationdate>20210601</creationdate><title>Associations of obesity and malnutrition with cardiac remodeling and cardiovascular outcomes in Asian adults: A cohort study</title><author>Chien, Shih-Chieh ; Chandramouli, Chanchal ; Lo, Chi-In ; Lin, Chao-Feng ; Sung, Kuo-Tzu ; Huang, Wen-Hung ; Lai, Yau-Huei ; Yun, Chun-Ho ; Su, Cheng-Huang ; Yeh, Hung-I ; Hung, Ta-Chuan ; Hung, Chung-Lieh ; Lam, Carolyn S. P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c708t-28dfe1c8f681ac2964848553190cb8141287bc2f6643e474f477a990c37e69533</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Biology and Life Sciences</topic><topic>Body composition</topic><topic>Body fat</topic><topic>Body mass index</topic><topic>Brain natriuretic peptide</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Cholesterol</topic><topic>Cohort analysis</topic><topic>Complications and side effects</topic><topic>Congestive heart failure</topic><topic>Coronary artery disease</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Ejection fraction</topic><topic>Heart</topic><topic>Hospitals</topic><topic>Hypertension</topic><topic>Immunoassay</topic><topic>Laboratories</topic><topic>Malnutrition</topic><topic>Medical screening</topic><topic>Medicine and Health Sciences</topic><topic>Metabolism</topic><topic>Normal distribution</topic><topic>Nutrition research</topic><topic>Nutritional status</topic><topic>Obesity</topic><topic>Population</topic><topic>Risk factors</topic><topic>Ventricle</topic><topic>Weight control</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chien, Shih-Chieh</creatorcontrib><creatorcontrib>Chandramouli, Chanchal</creatorcontrib><creatorcontrib>Lo, Chi-In</creatorcontrib><creatorcontrib>Lin, Chao-Feng</creatorcontrib><creatorcontrib>Sung, Kuo-Tzu</creatorcontrib><creatorcontrib>Huang, Wen-Hung</creatorcontrib><creatorcontrib>Lai, Yau-Huei</creatorcontrib><creatorcontrib>Yun, Chun-Ho</creatorcontrib><creatorcontrib>Su, Cheng-Huang</creatorcontrib><creatorcontrib>Yeh, Hung-I</creatorcontrib><creatorcontrib>Hung, Ta-Chuan</creatorcontrib><creatorcontrib>Hung, Chung-Lieh</creatorcontrib><creatorcontrib>Lam, Carolyn S. P</creatorcontrib><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chien, Shih-Chieh</au><au>Chandramouli, Chanchal</au><au>Lo, Chi-In</au><au>Lin, Chao-Feng</au><au>Sung, Kuo-Tzu</au><au>Huang, Wen-Hung</au><au>Lai, Yau-Huei</au><au>Yun, Chun-Ho</au><au>Su, Cheng-Huang</au><au>Yeh, Hung-I</au><au>Hung, Ta-Chuan</au><au>Hung, Chung-Lieh</au><au>Lam, Carolyn S. P</au><au>Wu, Jason</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Associations of obesity and malnutrition with cardiac remodeling and cardiovascular outcomes in Asian adults: A cohort study</atitle><jtitle>PLoS medicine</jtitle><date>2021-06-01</date><risdate>2021</risdate><volume>18</volume><issue>6</issue><spage>e1003661</spage><pages>e1003661-</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>Obesity, a known risk factor for cardiovascular disease and heart failure (HF), is associated with adverse cardiac remodeling in the general population. Little is known about how nutritional status modifies the relationship between obesity and outcomes. We aimed to investigate the association of obesity and nutritional status with clinical characteristics, echocardiographic changes, and clinical outcomes in the general community. We examined 5,300 consecutive asymptomatic Asian participants who were prospectively recruited in a cardiovascular health screening program (mean age 49.6 ± 11.4 years, 64.8% male) between June 2009 to December 2012. Clinical and echocardiographic characteristics were described in participants, stratified by combined subgroups of obesity and nutritional status. Obesity was indexed by body mass index (BMI) (low, [less than or equal to]25 kg/m.sup.2 [lean]; high, >25 kg/m.sup.2 [obese]) (WHO-recommended Asian cutoffs). Nutritional status was defined primarily by serum albumin (SA) concentration (low, <45 g/L [malnourished]; high, [greater than or equal to]45 g/L [well-nourished]), and secondarily by the prognostic nutritional index (PNI) and Global Leadership Initiative on Malnutrition (GLIM) criteria. Cox proportional hazard models were used to examine a 1-year composite outcome of hospitalization for HF or all-cause mortality while adjusting for age, sex, and other clinical confounders. Our community-based cohort consisted of 2,096 (39.0%) lean-well-nourished (low BMI, high SA), 1,369 (25.8%) obese-well-nourished (high BMI, high SA), 1,154 (21.8%) lean-malnourished (low BMI, low SA), and 681 (12.8%) obese-malnourished (high BMI, low SA) individuals. Obese-malnourished participants were on average older (54.5 ± 11.4 years) and more often women (41%), with a higher mean waist circumference (91.7 ± 8.8 cm), the highest percentage of body fat (32%), and the highest prevalence of hypertension (32%), diabetes (12%), and history of cardiovascular disease (11%), compared to all other subgroups (all p < 0.001). N-terminal pro B-type natriuretic peptide (NT-proBNP) levels were substantially increased in the malnourished (versus well-nourished) groups, to a similar extent in lean (70.7 ± 177.3 versus 36.8 ± 40.4 pg/mL) and obese (73.1 ± 216.8 versus 33.2 ± 40.8 pg/mL) (p < 0.001 in both) participants. The obese-malnourished (high BMI, low SA) group also had greater left ventricular remodeling (left ventricular mass index, 44.2 ± 1.52 versus 33.8 ± 8.28 gm/m.sup.2 ; relative wall thickness 0.39 ± 0.05 versus 0.38 ± 0.06) and worse diastolic function (TDI-e' 7.97 ± 2.16 versus 9.87 ± 2.47 cm/s; E/e' 9.19 ± 3.01 versus 7.36 ± 2.31; left atrial volume index 19.5 ± 7.66 versus 14.9 ± 5.49 mL/m.sup.2) compared to the lean-well-nourished (low BMI, high SA) group, as well as all other subgroups (p < 0.001 for all). Over a median 3.6 years (interquartile range 2.5 to 4.8 years) of follow-up, the obese-malnourished group had the highest multivariable-adjusted risk of the composite outcome (hazard ratio [HR] 2.49, 95% CI 1.43 to 4.34, p = 0.001), followed by the lean-malnourished (HR 1.78, 95% CI 1.04 to 3.04, p = 0.034) and obese-well-nourished (HR 1.41, 95% CI 0.77 to 2.58, p = 0.27) groups (with lean-well-nourished group as reference). Results were similar when indexed by other anthropometric indices (waist circumference and body fat) and other measures of nutritional status (PNI and GLIM criteria). Potential selection bias and residual confounding were the main limitations of the study. In our cohort study among asymptomatic community-based adults in Taiwan, we found that obese individuals with poor nutritional status have the highest comorbidity burden, the most adverse cardiac remodeling, and the least favorable composite outcome.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>34061848</pmid><doi>10.1371/journal.pmed.1003661</doi><orcidid>https://orcid.org/0000-0003-1903-0018</orcidid><orcidid>https://orcid.org/0000-0002-1859-6661</orcidid><orcidid>https://orcid.org/0000-0002-2463-1726</orcidid><orcidid>https://orcid.org/0000-0001-8256-902X</orcidid><orcidid>https://orcid.org/0000-0002-6865-855X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1549-1676 |
| ispartof | PLoS medicine, 2021-06, Vol.18 (6), p.e1003661 |
| issn | 1549-1676 1549-1277 1549-1676 |
| language | eng |
| recordid | cdi_plos_journals_2552288833 |
| source | DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Biology and Life Sciences Body composition Body fat Body mass index Brain natriuretic peptide Cardiovascular disease Cardiovascular diseases Cholesterol Cohort analysis Complications and side effects Congestive heart failure Coronary artery disease Diabetes Diabetes mellitus Ejection fraction Heart Hospitals Hypertension Immunoassay Laboratories Malnutrition Medical screening Medicine and Health Sciences Metabolism Normal distribution Nutrition research Nutritional status Obesity Population Risk factors Ventricle Weight control Womens health |
| title | Associations of obesity and malnutrition with cardiac remodeling and cardiovascular outcomes in Asian adults: A cohort study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-20T02%3A00%3A40IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Associations%20of%20obesity%20and%20malnutrition%20with%20cardiac%20remodeling%20and%20cardiovascular%20outcomes%20in%20Asian%20adults:%20A%20cohort%20study&rft.jtitle=PLoS%20medicine&rft.au=Chien,%20Shih-Chieh&rft.date=2021-06-01&rft.volume=18&rft.issue=6&rft.spage=e1003661&rft.pages=e1003661-&rft.issn=1549-1676&rft.eissn=1549-1676&rft_id=info:doi/10.1371/journal.pmed.1003661&rft_dat=%3Cgale_plos_%3EA667303713%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2552288833&rft_id=info:pmid/34061848&rft_galeid=A667303713&rft_doaj_id=oai_doaj_org_article_489625865b4f4875b0cc2fa79194e346&rfr_iscdi=true |