BMI and Health Status in the BARI 2D Trial
Background The longitudinal association between obesity, weight variability, and health status outcomes is important for patients with coronary disease and diabetes.
Methods The BARI 2D was a multicenter randomized clinical trial designed to evaluate treatment strategies for patients with both documented stable ischemic heart disease and type 2 diabetes. We examined BARI 2D participants for 4 years to study how body mass index (BMI) was associated with health status outcomes. Health status was evaluated by the Duke Activity Status Index (DASI), RAND Energy/fatigue, Health Distress, and Self-rated Health. Body mass index was measured quarterly throughout follow-up years, and health status was assessed at each annual follow-up visit. Variation in BMI measures was separated into between-person and within-person change in longitudinal analysis.
Results Higher mean BMI during follow-up years (the between-person BMI) was associated with poorer health status outcomes. Decreasing BMI (the within-person BMI change) was associated with better Self-rated health. The relationships between BMI variability and DASI or Energy appeared to be curvilinear and differed by baseline obesity status. Decreasing BMI was associated with better outcomes if patients were obese at baseline but was associated with poorer DASI and Energy outcomes if patients were nonobese at baseline.
Conclusions For patients with stable ischemic heart disease and diabetes, weight gain was associated with poorer health status outcomes, independent of obesity-related comorbidities. Weight reduction is associated with better functional capacity and perceived energy for obese patients but not for nonobese patients at baseline.
Background The prevalence of obesity has risen in recent decades, and more than half of American adults are estimated to be overweight or obese. Obesity increases the risk for both coronary artery disease and type 2 diabetes, as excessive adipose tissue secretes more adipokines, which may lead to systemic inflammation and insulin resistance. Inflammatory factors are associated with greater risk of sarcopenia, bone loss, and anemiaand undermine functional capacity and health status of an individual. Previous studies have shown that being overweight or obese contributes to lower health-related quality of life. However, previous data were primarily cross-sectional and about the longitudinal relationship between obesity and health status remain uncertain.
Apart from obesity, weight fluctuation is also a known risk factor for mortality and adverse cardiovascular events. However, little is known about the relationship between weight variability and health status measures and whether such associations differ by obesity status.
BARI 2D was a multicenter international randomized clinical trial evaluating the treatment strategies for patients with documented stable ischemic heart disease and type 2 diabetes. Baseline results of BARI 2D demonstrated that obesity was inversely associated with desirable health status outcomes, and the relationship was independent of baseline comorbidities and treatment. To investigate the longitudinal relationship between body mass index (BMI) and health status outcomes, we tested the following hypotheses in the present study: (1) higher BMI is associated with lower health status outcomes during follow-up, (2) individual BMI change is associated with change in health status outcomes, and (3) the association between BMI fluctuation and health status differs by baseline obesity status.
Abstract and Introduction
Abstract
Background The longitudinal association between obesity, weight variability, and health status outcomes is important for patients with coronary disease and diabetes.
Methods The BARI 2D was a multicenter randomized clinical trial designed to evaluate treatment strategies for patients with both documented stable ischemic heart disease and type 2 diabetes. We examined BARI 2D participants for 4 years to study how body mass index (BMI) was associated with health status outcomes. Health status was evaluated by the Duke Activity Status Index (DASI), RAND Energy/fatigue, Health Distress, and Self-rated Health. Body mass index was measured quarterly throughout follow-up years, and health status was assessed at each annual follow-up visit. Variation in BMI measures was separated into between-person and within-person change in longitudinal analysis.
Results Higher mean BMI during follow-up years (the between-person BMI) was associated with poorer health status outcomes. Decreasing BMI (the within-person BMI change) was associated with better Self-rated health. The relationships between BMI variability and DASI or Energy appeared to be curvilinear and differed by baseline obesity status. Decreasing BMI was associated with better outcomes if patients were obese at baseline but was associated with poorer DASI and Energy outcomes if patients were nonobese at baseline.
Conclusions For patients with stable ischemic heart disease and diabetes, weight gain was associated with poorer health status outcomes, independent of obesity-related comorbidities. Weight reduction is associated with better functional capacity and perceived energy for obese patients but not for nonobese patients at baseline.
Background The prevalence of obesity has risen in recent decades, and more than half of American adults are estimated to be overweight or obese. Obesity increases the risk for both coronary artery disease and type 2 diabetes, as excessive adipose tissue secretes more adipokines, which may lead to systemic inflammation and insulin resistance. Inflammatory factors are associated with greater risk of sarcopenia, bone loss, and anemiaand undermine functional capacity and health status of an individual. Previous studies have shown that being overweight or obese contributes to lower health-related quality of life. However, previous data were primarily cross-sectional and about the longitudinal relationship between obesity and health status remain uncertain.
Introduction
Apart from obesity, weight fluctuation is also a known risk factor for mortality and adverse cardiovascular events. However, little is known about the relationship between weight variability and health status measures and whether such associations differ by obesity status.
BARI 2D was a multicenter international randomized clinical trial evaluating the treatment strategies for patients with documented stable ischemic heart disease and type 2 diabetes. Baseline results of BARI 2D demonstrated that obesity was inversely associated with desirable health status outcomes, and the relationship was independent of baseline comorbidities and treatment. To investigate the longitudinal relationship between body mass index (BMI) and health status outcomes, we tested the following hypotheses in the present study: (1) higher BMI is associated with lower health status outcomes during follow-up, (2) individual BMI change is associated with change in health status outcomes, and (3) the association between BMI fluctuation and health status differs by baseline obesity status.
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